RESUMO
BACKGROUND: The CREBRF missense variant (p.Arg457Gln) is paradoxically associated with lower risk of type 2 diabetes, yet higher body mass index (BMI). Here we sought to determine whether this CREBRF variant might be associated with adult height. METHODS: Linear regression was used to analyse the association of the CREBRF minor (A) allele with height in 2286 Maori and Pacific adults living in Aotearoa/New Zealand. A potential type 2 diabetes index event was corrected to account for a bias that may be the cause of paradoxical association between the CREBRF diabetes-protective allele and higher BMI and height. RESULTS: The CREBRF protective allele was associated with increased adult height (ß = 1.25 cm, P = 3.9 × 10-6), with the effect being more pronounced in males. The lower odds of diabetes remained similar when analyses were adjusted for height (OR = 0.67-0.65). We found no evidence of a diabetes index event bias to explain the paradoxical effect of CREBRF with either BMI or height and diabetes. The orthologous CREBRF p.Arg457Gln variant was created in knock-in mice to independently assess the effect of the variant, and length was found to be greater in male mice at 8 weeks of age. CONCLUSION: These data taken together indicate that CREBRF p.Arg457Gln is associated with taller stature in Maori and Pacific adults.
Assuntos
Estatura/genética , Havaiano Nativo ou Outro Ilhéu do Pacífico/genética , Proteínas Supressoras de Tumor/genética , Adulto , Alelos , Animais , Estudos de Coortes , Feminino , Técnicas de Introdução de Genes , Humanos , Masculino , Camundongos , Camundongos Transgênicos , Mutação de Sentido Incorreto/genética , Nova ZelândiaRESUMO
Objectives: Social isolation and loneliness among older people are known to have negative effects on health and wellbeing. Few studies, however, have enabled older people to define these concepts in their own terms. This paper based on research in Aotearoa, New Zealand is the first to comparatively outline the meanings of loneliness and social isolation from the perspective of four ethnically diverse groups of older adults (Maori, Pacific, Asian, and NZ European).Method: We interviewed 44 older people and conducted three focus groups with 32 older people. We used thematic and narrative analyses.Results: Loneliness and social isolation were conceptualized as interconnected concepts described as a 'look and feel', a 'state of mind' and as a 'lack of desired companionship'. Participants conveyed sophisticated understandings of the structural underpinnings of both loneliness and social isolation as multi-dimensional, complex, and situated.Conclusions: Older people describe complex and culturally- nuanced understanding and experience of social isolation and loneliness. More culturally appropriate services, greater mental-health support and more service provision on weekends and evenings are needed.
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Solidão , Isolamento Social , Idoso , Grupos Focais , Humanos , Relações Interpessoais , Nova ZelândiaRESUMO
Befriending services may address loneliness and social isolation amongst older people. However social diversity is rarely reported in investigations of befriending services. The views of non-users are also rarely explored. In this research, we explored older adults' experiences of, and attitudes towards, a befriending service, among service users and non-service users, drawing on interviews and focus groups with 76 older adults, 10 volunteer visitors, and 20 service providers. Participants agreed that the befriending service helped alleviate social isolation and loneliness and that supportive services to foster connection are needed. Barriers to engagement included lack of knowledge, appropriateness of services and feeling undeserving. The befriending service was most successful when a match went beyond a transactional 'professional-client' relationship to resemble genuine friendship, underpinned by mutual interests and norms of reciprocity and reliability. We also identified five clear ideas about what characterizes an ideal supportive service; supported opportunities for getting out, genuine and reciprocal relationships, reliability, visitor characteristics, and connecting people to their culture. Befriending adds to social networks, and enhances connectedness to the community. Loneliness is alleviated when mutually beneficial and genuinely reciprocal relationships develop. However, group interventions or connections to community groups may be more appropriate for some.
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Diversidade Cultural , Relações Interpessoais , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais/métodos , Geriatria/métodos , Humanos , Masculino , Pesquisa Qualitativa , Isolamento Social/psicologiaRESUMO
AIMS/HYPOTHESIS: The A (minor) allele of CREBRF rs373863828 has been associated with increased BMI and reduced risk of type 2 diabetes in the Samoan populations of Samoa and American Samoa. Our aim was to test rs373863828 for associations with BMI and the odds of type 2 diabetes, gout and chronic kidney disease (CKD) in Maori and Pacific (Polynesian) people living in Aotearoa/New Zealand. METHODS: Linear and logistic regression models were used to analyse the association of the A allele of CREBRF rs373863828 with BMI, log-transformed BMI, waist circumference, type 2 diabetes, gout and CKD in 2286 adults. The primary analyses were adjusted for age, sex, the first four genome-wide principal components and (where appropriate) BMI, waist circumference and type 2 diabetes. The primary analysis was conducted in ancestrally defined groups and association effects were combined using meta-analysis. RESULTS: For the A allele of rs373863828, the effect size was 0.038 (95% CI 0.022, 0.055, p = 4.8 × 10-6) for log-transformed BMI, with OR 0.59 (95% CI 0.47, 0.73, p = 1.9 × 10-6) for type 2 diabetes. There was no evidence for an association of genotype with variance in BMI (p = 0.13), and nor was there evidence for associations with serum urate (ß = 0.012 mmol/l, pcorrected = 0.10), gout (OR 1.00, p = 0.98) or CKD (OR 0.91, p = 0.59). CONCLUSIONS/INTERPRETATION: Our results in New Zealand Polynesian adults replicate, with very similar effect sizes, the association of the A allele of rs373863828 with higher BMI but lower odds of type 2 diabetes among Samoan adults living in Samoa and American Samoa.
Assuntos
Índice de Massa Corporal , Diabetes Mellitus Tipo 2/prevenção & controle , Havaiano Nativo ou Outro Ilhéu do Pacífico/genética , Obesidade/genética , Polimorfismo de Nucleotídeo Único , Proteínas Supressoras de Tumor/genética , Adulto , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/genética , Feminino , Frequência do Gene , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Obesidade/diagnóstico , Obesidade/etnologia , Fenótipo , Polinésia/etnologia , Fatores de Proteção , Fatores de RiscoRESUMO
BACKGROUND: The Screen Time Weight-loss Intervention Targeting Children at Home (SWITCH) trial tested a family intervention to reduce screen-based sedentary behaviour in overweight children. The trial found no significant effect of the intervention on children's screen-based sedentary behaviour. To explore these null findings, we conducted a pre-planned process evaluation, focussing on intervention delivery and uptake. METHODS: SWITCH was a randomised controlled trial of a 6-month family intervention to reduce screen time in overweight children aged 9-12 years (n = 251). Community workers met with each child's primary caregiver to deliver the intervention content. Community workers underwent standard training and were monitored once by a member of the research team to assess intervention delivery. The primary caregiver implemented the intervention with their child, and self-reported intervention use at 3 and 6 months. An exploratory analysis determined whether child outcomes at 6 months varied by primary caregiver use of the intervention. RESULTS: Monitoring indicated that community workers delivered all core intervention components to primary caregivers. However, two thirds of primary caregivers reported using any intervention component "sometimes" or less frequently at both time points, suggesting that intervention uptake was poor. Additionally, analyses indicated no effect of primary caregiver intervention use on child outcomes at 6 months, suggesting the intervention itself lacked efficacy. CONCLUSIONS: Poor uptake, and the efficacy of the intervention itself, may have played a role in the null findings of the SWITCH trial on health behaviour and body composition. TRIAL REGISTRATION: The trial was registered in the Australian and New Zealand Clinical Trials Registry (no. ACTRN12611000164998 ); registration date: 10/02/2011.
Assuntos
Família , Comportamentos Relacionados com a Saúde , Obesidade Infantil/prevenção & controle , Televisão , Jogos de Vídeo , Composição Corporal , Criança , Serviços de Saúde da Criança , Feminino , Humanos , Masculino , Nova Zelândia , Educação de Pacientes como Assunto , Avaliação de Processos em Cuidados de Saúde , Resultado do TratamentoRESUMO
BACKGROUND: Non-communicable diseases (NCD) are the leading cause of premature death and disability in the Pacific. In 2011, Pacific Forum Leaders declared "a human, social and economic crisis" due to the significant and growing burden of NCDs in the region. In 2013, Pacific Health Ministers' commitment to 'whole of government' strategy prompted calls for the development of a robust, sustainable, collaborative NCD monitoring and accountability system to track, review and propose remedial action to ensure progress towards the NCD goals and targets. The purpose of this paper is to describe a regional, collaborative framework for coordination, innovation and application of NCD monitoring activities at scale, and to show how they can strengthen accountability for action on NCDs in the Pacific. A key component is the Dashboard for NCD Action which aims to strengthen mutual accountability by demonstrating national and regional progress towards agreed NCD policies and actions. DISCUSSION: The framework for the Pacific Monitoring Alliance for NCD Action (MANA) draws together core country-level components of NCD monitoring data (mortality, morbidity, risk factors, health system responses, environments, and policies) and identifies key cross-cutting issues for strengthening national and regional monitoring systems. These include: capacity building; a regional knowledge exchange hub; innovations (monitoring childhood obesity and food environments); and a robust regional accountability system. The MANA framework is governed by the Heads of Health and operationalised by a multi-agency technical Coordination Team. Alliance membership is voluntary and non-conditional, and aims to support the 22 Pacific Island countries and territories to improve the quality of NCD monitoring data across the region. In establishing a common vision for NCD monitoring, the framework combines data collected under the WHO Global Framework for NCDs with a set of action-orientated indicators captured in a NCD Dashboard for Action. Viewing NCD monitoring as a multi-component system and providing a robust, transparent mutual accountability mechanism helps align agendas, roles and responsibilities of countries and support organisations. The dashboard provides a succinct communication tool for reporting progress on implementation of agreed policies and actions and its flexible methodology can be easily expanded, or adapted for other regions.
Assuntos
Doença Crônica/epidemiologia , Vigilância em Saúde Pública/métodos , Fortalecimento Institucional , Humanos , Mortalidade Prematura/tendências , Ilhas do Pacífico/epidemiologia , Fatores de Risco , Responsabilidade SocialRESUMO
BACKGROUND: Screen-based activities, such as watching television (TV), playing video games, and using computers, are common sedentary behaviors among young people and have been linked with increased energy intake and overweight. Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child, small sample sizes, and short follow-up periods. The SWITCH (Screen-Time Weight-loss Intervention Targeting Children at Home) study aimed to determine the effect of a home-based, family-delivered intervention to reduce screen-based sedentary behaviour on body composition, sedentary behaviour, physical activity, and diet over 24 weeks in overweight and obese children. METHODS: A two-arm, parallel, randomized controlled trial was conducted. Children and their primary caregiver living in Auckland, New Zealand were recruited via schools, community centres, and word of mouth. The intervention, delivered over 20 weeks, consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content, which focused on training and educating them to use a wide range of strategies designed to reduce their child's screen time. Families were given Time Machine TV monitoring devices to assist with allocating screen time, activity packages to promote alternative activities, online support via a website, and monthly newsletters. Control participants were given the intervention material on completion of follow-up. The primary outcome was change in children's BMI z-score from baseline to 24 weeks. RESULTS: Children (n = 251) aged 9-12 years and their primary caregiver were randomized to receive the SWITCH intervention (n = 127) or no intervention (controls; n = 124). There was no significant difference in change of zBMI between the intervention and control groups, although a favorable trend was observed (-0.016; 95% CI: -0.084, 0.051; p = 0.64). There were also no significant differences on secondary outcomes, except for a trend towards increased children's moderate intensity physical activity in the intervention group (24.3 min/d; 95% CI: -0.94, 49.51; p = 0.06). CONCLUSIONS: A home-based, family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9-12 years. TRIAL REGISTRATION: Australian New Zealand Clinical Trials RegistryWebsite: http://www.anzctr.org.au TRIAL REGISTRATION NUMBER: ACTRN12611000164998.
Assuntos
Ingestão de Energia , Comportamento Alimentar , Promoção da Saúde/métodos , Comportamento Sedentário , Redução de Peso , Composição Corporal , Índice de Massa Corporal , Criança , Computadores , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Atividade Motora , Nova Zelândia , Obesidade/terapia , Sobrepeso/terapia , Televisão , Resultado do Tratamento , Jogos de Vídeo , Circunferência da CinturaRESUMO
AIM: Little is known about the extent to which families in Aotearoa New Zealand are affected by long-term health conditions (HCs). This study aimed to explore the rates of nine selected HCs among New Zealand family members within the same household. METHOD: Linked population and administrative health data were obtained for families living in the same household according to the 2013 New Zealand Census (N=1,043,172). Health data (2008-2013) were used to ascertain whether people in these families (N=3,137,517) received treatment or services for nine selected HCs: cancer, chronic obstructive pulmonary disease, heart disease, diabetes, dementia, gout, stroke, traumatic brain injury (TBI), or mental health/behaviour conditions (MHBCs). RESULTS: Over 60% of families included at least one person with a HC, and this rate was higher among multi-generation families (73.9%). The most common HCs were MHBCs (39.4% of families), diabetes (16.0%) and TBI (13.9%). At the highest level of socio-economic deprivation, 57.6% of children aged under 18 years lived with a family member who had a HC. CONCLUSION: Three in five New Zealand household families included someone with at least one of nine selected HCs, with differences in the proportion affected according to family composition, socio-economic status and an individual's ethnicity. This suggests that there are a substantial number of people at risk of the poor outcomes associated with the experience of HCs within their family.
Assuntos
Censos , Humanos , Nova Zelândia/epidemiologia , Estudos Transversais , Masculino , Feminino , Adulto , Criança , Adolescente , Doença Crônica/epidemiologia , Pessoa de Meia-Idade , Pré-Escolar , Idoso , Adulto Jovem , Lactente , Características da Família , Diabetes Mellitus/epidemiologia , Fatores SocioeconômicosRESUMO
PURPOSE: Despite having the highest medical needs by population for weight loss treatment, Pacific patients in Aotearoa New Zealand face substantial levels of attrition in publicly funded weight loss surgery programs. In collaboration with the Auckland City Hospital bariatric surgery team, a Pacific-led preoperative weight loss surgery program was co-designed, delivered, and evaluated between 2020 and 2023. MATERIALS AND METHODS: This was a single-arm, prospective co-designed evaluation study that took place at Auckland City Hospital in Aotearoa New Zealand. Participants were Pacific patients (n = 14) referred to the weight loss surgery program. Survey and video diaries were analyzed to determine if the program had the potential to increase Pacific patient retention through the preoperative stage of weight loss surgery, increase surgery completion rates, and improve the quality of treatment experiences. RESULTS: Nine out of 14 participants attended all preoperative sessions. Six participants subsequently underwent weight loss surgery. Program components that had positive impacts on patient success and satisfaction were accessibility, information quality, having Pacific role models, cultural safety, and the group support system. The patients found the program to be culturally anchored and there was support for the implementation of the program going forward. CONCLUSION: This study demonstrated how a culturally anchored intervention can increase patient retention for those patients who may not respond to mainstream treatment. Adjusting existing preoperative weight loss surgery programs to integrate Pacific-led models of healthcare has the potential to increase Pacific patient resiliency to follow through with surgery.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Humanos , Obesidade Mórbida/cirurgia , Estudos Prospectivos , Atenção à Saúde , Poder PsicológicoRESUMO
AIMS: To assess whether diabetes treatment satisfaction differs by ethnicity among participants with insufficient glycaemic control of type 2 diabetes mellitus in a clinical trial involving additional oral diabetes medications. Patient satisfaction is used as an indicator of healthcare quality. However, data on patients' diabetes treatment satisfaction in the context of insufficient glycaemic control is limited. METHODS: Individuals with type 2 diabetes and an HbA1c of 58-110mmol/mol (7.5-12.5%) were recruited across Aotearoa New Zealand to participate in an 8-month randomised crossover study of vildagliptin and pioglitazone as add-on therapy to metformin and/or sulfonylurea. Participants completed the Diabetes Treatment Satisfaction Questionnaire (DTSQ) at baseline pre-randomisation. Treatment satisfaction scores were compared between ethnic groups and other characteristics using the analysis of variance and linear regression. Perceived hyper- and hypoglycaemia were summarised separately. RESULTS: Between February 2019 and March 2020, 346 participants (41% women, 32% Pacific peoples, 23% Maori, 26% European) completed the DTSQ. Mean (SD) age was 57.5 (10.9) years, diabetes duration was 9 (6.3) years and HbA1c was 75 (12)mmol/mol (9.0[3.2]%). At study entry, 40% were receiving monotherapy for diabetes. Treatment satisfaction was rated highly, with a score of 29(6) (interquartile range 25-33). Pacific peoples and older people reported greater treatment satisfaction than other groups (p<0.001). CONCLUSIONS: Diabetes treatment satisfaction was high, particularly among Pacific peoples, despite suboptimal glycaemic control and insufficient glucose-lowering therapy.
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Estudos Cross-Over , Diabetes Mellitus Tipo 2 , Hipoglicemiantes , Satisfação do Paciente , Humanos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/etnologia , Feminino , Nova Zelândia , Masculino , Pessoa de Meia-Idade , Hipoglicemiantes/uso terapêutico , Idoso , Hemoglobinas Glicadas/análise , Hemoglobinas Glicadas/metabolismo , Metformina/uso terapêutico , Pioglitazona/uso terapêutico , Compostos de Sulfonilureia/uso terapêutico , Quimioterapia Combinada , Inquéritos e Questionários , Etnicidade/estatística & dados numéricosAssuntos
Havaiano Nativo ou Outro Ilhéu do Pacífico , Peso Corporal , Criança , Pré-Escolar , Humanos , PrevalênciaRESUMO
Aims: Monogenic diabetes accounts for 1-2% of diabetes cases yet is often misdiagnosed as type 2 diabetes. The aim of this study was to examine in Maori and Pacific adults clinically diagnosed with type 2 diabetes within 40 years of age, (a) the prevalence of monogenic diabetes in this population (b) the prevalence of beta-cell autoantibodies and (c) the pre-test probability of monogenic diabetes. Methods: Targeted sequencing data of 38 known monogenic diabetes genes was analyzed in 199 Maori and Pacific peoples with BMI of 37.9 ± 8.6 kg/m2 who had been diagnosed with type 2 diabetes between 3 and 40 years of age. A triple-screen combined autoantibody assay was used to test for GAD, IA-2, and ZnT8. MODY probability calculator score was generated in those with sufficient clinical information (55/199). Results: No genetic variants curated as likely pathogenic or pathogenic were found. One individual (1/199) tested positive for GAD/IA-2/ZnT8 antibodies. The pre-test probability of monogenic diabetes was calculated in 55 individuals with 17/55 (31%) scoring above the 20% threshold considered for diagnostic testing referral. Discussion: Our findings suggest that monogenic diabetes is rare in Maori and Pacific people with clinical age, and the MODY probability calculator likely overestimates the likelihood of a monogenic cause for diabetes in this population.
Assuntos
Diabetes Mellitus Tipo 2 , Adulto , Humanos , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/genética , Povo Maori , Nova Zelândia/epidemiologia , Testes GenéticosRESUMO
Introduction Chronic disease such as cancer, cardiovascular, diabetes, mental health and obesity have debilitating effects on sufferers with impacts seen increasingly at a younger age. A whole-of-family approach to life-course research is essential to inform health and wellbeing policies and programmes that make a difference for children, youth, adults, and later in life. Aim The aim is to present the research protocol about a study to understand the impact of chronic conditions on families, with an emphasis on outcomes that have life-long benefits, and co-develop a sustainable and culturally centred life-course programme for overall health and wellbeing. Methods The qualitative study will assess the family, household and community strengths that allow people in the Tokelau community to thrive despite the challenges of living in households with chronic disease. A total of 200 participants will be involved in family group and stakeholder focus group interviews, digital storytelling and community-based participatory action workshops, and the implementation and evaluation of action plans. The study will be augmented by Pacific research models, and the New Zealand Health Research Council Pacific guidelines. Results Research findings will have implications for policy and primary health-care delivery, and the potential to upscale and construct life-enhancing pathways across the life-course. Discussion Understanding Tokelauan families' health status, exposure to health hazards, access to health services and medicines, and the strengths of the family unit and community that allows them to thrive despite the challenges of living with chronic conditions, can help to inform policy and practice, and achieve better health outcomes for them.
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Atenção à Saúde , Havaiano Nativo ou Outro Ilhéu do Pacífico , Adolescente , Adulto , Criança , Doença Crônica , Grupos Focais , Humanos , Pesquisa QualitativaRESUMO
Introduction Participation in the health-care system is a key component of healthy ageing strategies. The number of Pacific people aged ≥65 years in Aotearoa New Zealand will increase significantly over the next decade. Addressing the considerable health inequities and unmet need for care Pacific Island people experience when compared to other ethnicities in Aotearoa New Zealand should be a priority. Aim To identify barriers to older Pacific people's participation in the health-care system in Aotearoa New Zealand. Methods A participatory action research design was utilised. In total, 104 Pacific co-researchers contributed to focus groups using Talanoa , a traditional method of conversational dialogue deeply rooted in Pacific Island culture. Data were collected in Pacific Island languages from storytelling and conversations shared within the focus groups. Data were translated into English and analysed using a collaborative approach. Results Three main themes captured older Pacific peoples' barriers to participation in the health-care system: accessing health care; relationships with health-care providers; and understanding the health-care system. Discussion Older Pacific people have the capacity to influence locally driven programmes to be more responsive to their needs and aspirations. Improving older Pacific peoples' participation in health care will require a commitment to partnership and inter-sectoral collaboration identified in recent ageing strategies. The findings will inform local communities, and policy and practice aimed at improving the health and wellbeing of Pacific peoples who are ageing in Aotearoa New Zealand.
Assuntos
Etnicidade , Havaiano Nativo ou Outro Ilhéu do Pacífico , Aceitação pelo Paciente de Cuidados de Saúde , Humanos , Atenção à Saúde , Nova ZelândiaRESUMO
BACKGROUND: Approximately one third of New Zealand children and young people are overweight or obese. A similar proportion (33%) do not meet recommendations for physical activity, and 70% do not meet recommendations for screen time. Increased time being sedentary is positively associated with being overweight. There are few family-based interventions aimed at reducing sedentary behavior in children. The aim of this trial is to determine the effects of a 24 week home-based, family oriented intervention to reduce sedentary screen time on children's body composition, sedentary behavior, physical activity, and diet. METHODS/DESIGN: The study design is a pragmatic two-arm parallel randomized controlled trial. Two hundred and seventy overweight children aged 9-12 years and primary caregivers are being recruited. Participants are randomized to intervention (family-based screen time intervention) or control (no change). At the end of the study, the control group is offered the intervention content. Data collection is undertaken at baseline and 24 weeks. The primary trial outcome is child body mass index (BMI) and standardized body mass index (zBMI). Secondary outcomes are change from baseline to 24 weeks in child percentage body fat; waist circumference; self-reported average daily time spent in physical and sedentary activities; dietary intake; and enjoyment of physical activity and sedentary behavior. Secondary outcomes for the primary caregiver include change in BMI and self-reported physical activity. DISCUSSION: This study provides an excellent example of a theory-based, pragmatic, community-based trial targeting sedentary behavior in overweight children. The study has been specifically designed to allow for estimation of the consistency of effects on body composition for Maori (indigenous), Pacific and non-Maori/non-Pacific ethnic groups. If effective, this intervention is imminently scalable and could be integrated within existing weight management programs. TRIAL REGISTRATION: ACTRN12611000164998.
Assuntos
Computadores/estatística & dados numéricos , Comportamento Sedentário , Televisão/estatística & dados numéricos , Programas de Redução de Peso , Criança , Feminino , Humanos , Masculino , Atividade Motora , Nova ZelândiaRESUMO
Minority ethnic patient groups typically have the highest bariatric surgery preoperative attrition rates and lowest surgery utilisation worldwide. Eligible patients of Pacific Island ethnicity (Pacific patients) in New Zealand (NZ) follow this wider trend. OBJECTIVES: The present study explored structural barriers contributing to Pacific patients' disproportionately high preoperative attrition rates from publicly-funded bariatric surgery in Auckland, NZ. SETTING: Publicly-funded bariatric surgery programmes based in the wider Auckland area, NZ. DESIGN: Semi-structured interviews with health sector professionals (n=21) were conducted.Data were analysed using an inductive thematic approach. RESULTS: Two primary themes were identified: (1) Confidence negotiating the medical system, which included Emotional safety in clinical settings and Relating to non-Pacific health professionals and (2) Appropriate support to achieve preoperative goals, which included Cultural considerations, Practical support and Relating health information. Clinical environments and an under-representation of Pacific staff were considered to be barriers to developing emotional safety, trust and acceptance of the surgery process with patients and their families. Additionally, economic deprivation and lower health literacy impacted preoperative goals. CONCLUSIONS: Health professionals' accounts indicated that Pacific patients face substantial levels of disconnection in bariatric surgery programmes. Increasing representation of Pacific ethnicity by employing more Pacific health professionals in bariatric teams and finding novel solutions to implement preoperative programme components have the potential to reduce this disconnect. Addressing cultural competency of staff, increasing consultancy times and working in community settings may enable staff to better support Pacific patients and their families. Programme structures could be more accommodating to practical barriers of attending appointments, managing patients' preoperative health goals and improving patients' health literacy. Given that Pacific populations, and other patients from minority ethnic backgrounds living globally, also face high rates of obesity and barriers accessing bariatric surgery, our findings are likely to have broader applicability.
Assuntos
Cirurgia Bariátrica/estatística & dados numéricos , Letramento em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Relações Profissional-Paciente , Adulto , Cirurgia Bariátrica/psicologia , Feminino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Grupos Minoritários/psicologia , Nova Zelândia , Obesidade/cirurgia , Pesquisa Qualitativa , Tempo para o Tratamento/estatística & dados numéricosRESUMO
BACKGROUND: Bariatric surgery results in substantial medical and economic benefits; however, independent studies typically report high patient preoperative attrition rates. Studies have identified individual characteristics and sociodemographic variables of those who complete the surgery compared to those who do not. The aim of the present protocol is to outline a systematic review focussed on identifying the sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who were enrolled in bariatric surgery programmes. METHODS/DESIGN: The databases Scopus, CINAHL, PsycINFO, Web of Science, and MEDLINE will be searched for retrospective, prospective, and cross-sectional observational studies that have identified any sociodemographic, medical, cultural, psychological, and patient-led factors affecting preoperative attrition in clients who are enrolled in a bariatric surgery programme. English-language articles published between 1997 to 2020, inclusive of adults 18 years or older, will be included in the review. This protocol has been registered in PROSPERO, registration number; CRD42017068557. DISCUSSION: Presently, there are studies and reviews investigating population-based utilisation and access to bariatric surgery; however, there is a need to review the reasons behind preoperative bariatric surgery patient attrition once selected for bariatric surgery. The results of the review will highlight potential systematic disparities in patient attrition, where gaps in knowledge remain for further investigation, and suggest areas where countermeasures may be focussed for decreasing attrition rates. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017068557.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Período Pré-Operatório , Humanos , Motivação , Cooperação do Paciente , Fatores Socioeconômicos , Revisões Sistemáticas como AssuntoRESUMO
Precision medicine seeks to draw on data from both individuals and populations across disparate domains to influence and support diagnosis, management and prevention in healthcare at the level of the individual patient and their family/whanau. Central to this initiative is incorporating the effects of the inherent variation that lies within genomes and can influence health outcomes. Identifying and interpreting such variation requires an accurate, valid and representative dataset to firstly define what variants are present and then assess the potential relevance for the health of a person, their family/whanau and the wider community to which they belong. Globally the variation embedded within genomes differs enormously and has been shaped by the size, constitution, historical origins and evolutionary history of their source populations. Maori, and more broadly Pacific peoples, differ substantially in terms of genomic variation compared to the more closely studied European and Asian populations. In the absence of accurate genomic information from Maori and Pacific populations, the precise interpretation of genomic data and the success and benefits of genomic medicine will be disproportionately less for those Maori and Pacific peoples. In this viewpoint article we, as a group of healthcare professionals, researchers and scientists, present a case for assembling genomic resources that catalogue the characteristics of the genomes of New Zealanders, with an emphasis on peoples of Maori and Polynesian ancestry, as a healthcare imperative. In proposing the creation of these resources, we note that their governance and management must be led by iwi and Maori and Pacific representatives. Assembling a genomic resource must be informed by cultural concepts and values most especially understanding that, at a physical and spiritual level, whakapapa is embodied within the DNA of a person. Therefore DNA and genomic data that connects to whakapapa (genealogy) is considered a taonga (something precious and significant), and its storage, utilisation and interpretation is a culturally significant activity. Furthermore, such resources are not proposed to primarily enable comparisons between those with Maori and broader Pacific ancestries and other Aotearoa peoples but to place an understanding of the genetic contributors to their health outcomes in a valid context. Ongoing oversight and governance of such taonga by Maori and Pacific representatives will maximise hauora (health) while also minimising the risk of misuse of this information.
Assuntos
Genômica , Disparidades em Assistência à Saúde/etnologia , Medicina de Precisão , Genética Médica , Humanos , Havaiano Nativo ou Outro Ilhéu do Pacífico/genética , Nova Zelândia/etnologiaRESUMO
INTRODUCTION: Hearing impairment (HI) affects an estimated 538 million people worldwide, with 80% of these living in developing countries. Untreated HI in childhood may lead to developmental delay and in adults results in social isolation, inability to find or maintain employment, and dependency. Early intervention and support programmes can significantly reduce the negative effects of HI. AIM: To estimate HI prevalence and identify available hearing services in some Pacific countries - Cook Islands, Fiji, Niue, Samoa, Tokelau, Tonga. METHODS: Data were collected through literature review and correspondence with service providers. Prevalence estimates were based on census data and previously published regional estimates. RESULTS: Estimates indicate 20-23% of the population may have at least a mild HI, with up to 11% having a moderate impairment or worse. Estimated incidence of chronic otitis media in Pacific Island nations is 3-5 times greater than other Australasian countries in children under 10 years old. Permanent HI from otitis media is substantially more likely in children and adults in Pacific Island nations. Several organisations and individuals provide some limited hearing services in a few Pacific Island nations, but the majority of people with HI are largely underserved. DISCUSSION: Although accurate information on HI prevalence is lacking, prevalence estimates of HI and ear disease suggest they are significant health conditions in Pacific Island nations. There is relatively little support for people with HI or ear disease in the Pacific region. An investment in initiatives to both identify and support people with hearing loss in the Pacific is necessary.
Assuntos
Perda Auditiva/etnologia , Otite Média/etnologia , Adolescente , Adulto , Idade de Início , Idoso , Envelhecimento , Teorema de Bayes , Criança , Pré-Escolar , Doença Crônica , Feminino , Predisposição Genética para Doença , Acessibilidade aos Serviços de Saúde , Perda Auditiva/terapia , Perda Auditiva Provocada por Ruído/etnologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Ilhas do Pacífico/epidemiologia , Educação de Pacientes como Assunto , Prevalência , Índice de Gravidade de Doença , Adulto JovemRESUMO
INTRODUCTION: Obesity and low levels of physical activity are increasing among Pacific and Maori adolescents in New Zealand. AIM: To assess the feasibility of an after-school exercise and lifestyle programme to improve cardiorespiratory fitness, health and usual activity in less-active Pacific and Maori adolescents over six weeks. METHODS: Eighteen less-active secondary school students participated. The six-week programme included 3 x 1.5 hour exercise and healthy lifestyle sessions per week. Outcomes included estimated cardiorespiratory fitness (VO2max), insulin resistance (Homeostasis Model Assessment), physical activity, glycated haemoglobin (HbA1c), fasting plasma glucose, blood pressure, waist circumference and fasting lipids, measured at baseline and six weeks. Programme attendance and qualitative comments were also recorded. Student's t-tests were used. RESULTS: Of the 18 students enrolled, 16 (89%) completed six-week follow-up, 14 (78%) were female, 13 (72%) were Pacific ethnicity and 5 (28%) were Maori . At baseline, mean age was 16.3 (standard deviation [SD] 1.0) years, body mass index (BMI) 35.2 (SD 6.7) kg/m2, VO2max 31.5 (SD 4.3) mL/kg/min, systolic blood pressure 125.0 (SD 12.9) mm Hg, HbA1c 39.9 (SD 3.8) mmol/mol, fasting serum insulin 28.3 (SD 27.8) µU/mL. At follow-up, improvements had occurred in VO2max (3.2 mL/kg/min; p=0.02), systolic blood pressure (-10.6 mm Hg; p=0.003), HbA1c (-1.1 mmol/mol; p=0.03) and weekly vigorous (4 hours, p=0.002) and moderate (2 hours, p=0.006) physical activity, although waist circumference increased (p=0.005). Programme attendance was over 50%. Comments were mostly positive. DISCUSSION: The after-school exercise and lifestyle programme and study methods were feasible. Such programmes have the potential to improve health outcomes for Pacific and Maori adolescents.