1
|
Park B, Vandal A, Bhat S, Welsh F, Eglinton T, Koea J, Taneja A, Hill AG, Barazanchi AWH, MacCormick AD. Frailty and Long-Term Mortality Following Emergency Laparotomy: A Comparison Between the 11-Item and 5-Item Modified Frailty Indices. J Surg Res 2024; 303:40-49. [PMID: 39298937 DOI: 10.1016/j.jss.2024.07.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Emergency laparotomy (EL) is a high-risk operation which is increasingly performed on an aging patient population. Objective frailty assessment using a validated index has the potential to improve preoperative risk stratification. This study aimed to assess the correlation between frailty and long-term mortality and morbidity outcomes for older EL patients. Secondary aims were to compare the 11-item and shortened five-item modified frailty indices (mFIs) in terms of value and predictive validity. METHODS A prospective multicenter observational study of patients aged ≥55 y undergoing EL was conducted across five hospitals in New Zealand between 2017 and 2022. Frailty was measured using the 11-item and abbreviated five-item mFIs. Multivariable logistic regression was used to determine whether frailty was independently associated with one-year postoperative mortality and other morbidity outcomes. Correlation between the two frailty indices were assessed with the Spearman's correlation coefficient (P). RESULTS Frailty assessments were performed in 861 participants, with the prevalence being 18.7% and 29.8% using the 11-item and five-item mFIs, respectively. Both frailty indices demonstrated similar associations with one-year mortality (two-fold increased risk), major complications, admission to intensive care unit, rehabilitation, and 30-d readmission. The 11-item mFI demonstrated a greater association with early mortality (four-fold increased risk), reoperations, and increased length of stay compared with the five-item frailty index. Spearman P was 0.6 (P < 0.001). CONCLUSIONS Frailty, as identified by the 11-item and five-item mFIs, was associated with one-year mortality and other important morbidity outcomes for older EL patients. These forms of frailty assessment provide important information that may aid in risk assessment and patient-centered decision-making.
Collapse
Affiliation(s)
- Brittany Park
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, New Zealand.
| | - Alain Vandal
- Department of Statistics, The University of Auckland, Auckland, New Zealand
| | - Sameer Bhat
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand
| | - Fraser Welsh
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Waikato Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Tim Eglinton
- Department of Surgery, Christchurch Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Jonathan Koea
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, North Shore Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Ashish Taneja
- Department of Surgery, Auckland City Hospital, Te Whatu Ora, Auckland, New Zealand
| | - Andrew G Hill
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Ahmed W H Barazanchi
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand
| | - Andrew D MacCormick
- Faculty of Medical and Health Sciences, The University of Auckland, Waipapa Taumata Rau, Auckland, New Zealand; Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, New Zealand.
| |
Collapse
|
2
|
Park B, Vandal A, Sulistio E, Bhat S, Welsh F, Eglinton T, Koea J, Taneja A, Hill AG, Barazanchi AWH, MacCormick AD. Association between frailty, long-term mortality and functional outcomes for older adults undergoing emergency laparotomy. World J Surg 2024; 48:1111-1122. [PMID: 38502091 DOI: 10.1002/wjs.12141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/05/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long-term mortality and other important functional outcomes for older EL patients have not been fully explored. METHODS A prospective multicenter study of older EL patients was conducted across four hospital sites in New Zealand from August 2017 to September 2022. The Clinical Frailty Scale (CFS) was used to measure frailty-defined as a CFS of ≥5. Primary outcomes were 30-day and one-year mortality. Secondary outcomes were postoperative morbidity, admission for rehabilitation, and increased care level on discharge. A multivariate logistic regression analysis was conducted, adjusting for age, sex, and ethnicity. RESULTS A total of 629 participants were included. Frailty prevalence was 14.6%. Frail participants demonstrated higher 30-day and 1-year mortality-20.7% and 39.1%. Following adjustment, frailty was directly associated with a significantly increased risk of short- and long-term mortality (30-day aRR 2.6, 95% CI 1.5, 4.3, p = <0.001, 1-year aRR 2.0, 95% CI 1.5, 2.8, p < 0.001). Frailty was correlated with a 2-fold increased risk of admission for rehabilitation and propensity of being discharged to an increased level of care, complications, and readmission within 30 days. CONCLUSION Frailty was associated with increased risk of postoperative mortality up to 1-year and other functional outcomes for older patients undergoing EL. Identification of frailty in older EL patients aids in patient-centered decision-making, which may lead to improvement in outcomes.
Collapse
Affiliation(s)
- Brittany Park
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
| | - Alain Vandal
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
| | - Edrick Sulistio
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
| | - Sameer Bhat
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
| | - Fraser Welsh
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
| | - Tim Eglinton
- Department of Surgery, Christchurch Hospital, Auckland, Aotearoa New Zealand
| | - Jonathan Koea
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
- Department of Surgery, North Shore Hospital, Auckland, Aotearoa New Zealand
| | - Ashish Taneja
- Department of Surgery, Auckland City Hospital, Auckland, Aotearoa New Zealand
| | - Andrew G Hill
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
- Department of Surgery, Middlemore Hospital, Auckland, Aotearoa New Zealand
| | - Ahmed W H Barazanchi
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
- Department of Surgery, Auckland City Hospital, Auckland, Aotearoa New Zealand
| | - Andrew D MacCormick
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, Aotearoa New Zealand
- Department of Surgery, Middlemore Hospital, Auckland, Aotearoa New Zealand
| |
Collapse
|
3
|
Winter-Smith J, Grey C, Paynter J, Harwood M, Selak V. Who are Pacific peoples in terms of ethnicity and country of birth? A cross sectional study of 2,238,039 adults in Aotearoa New Zealand's Integrated Data Infrastructure. DIALOGUES IN HEALTH 2023; 3:100152. [PMID: 38515801 PMCID: PMC10953968 DOI: 10.1016/j.dialog.2023.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/04/2023] [Accepted: 08/24/2023] [Indexed: 03/23/2024]
Abstract
Background The aggregation of Indigenous peoples from Pacific Island nations as 'Pacific peoples' in literature may mask diversity in the health needs of these different groups. The aim of this study was to examine the heterogeneity of Pacific groups according to ethnicity and country of birth. Methods Anonymised individual-level linkage of administrative data identified all NZ residents aged 30-74 years on 31 March 2013 with known ethnicity and country of birth. All participants were described according to ethnicity and country of birth. Pacific participants were also described according to the number of ethnicities they identified. Findings A total of 2,238,039 NZ residents were included, of whom 117,957 (5·0%) were Pacific. Nearly two-thirds of Pacific peoples (65·7%) were born overseas, ranging from 45·3% (Cook Islands Māori) to 82·7% (Fijian) (Māori 2·3%, non-Māori non-Pacific 28·9%). Among NZ-born Pacific peoples, 46·9% (Samoan) to 81·9% (Fijian) were multi-ethnic; the proportion was much lower for overseas-born Pacific peoples (ranging from 3·7% [Tongan] to 23·9% [Tokelauan]). Interpretation There is substantial heterogeneity among Pacific peoples in their country of birth and identification with sole or multiple ethnicities. Assumptions regarding homogeneity in the needs of Pacific peoples are not appropriate and government statistics should therefore disaggregate Pacific peoples whenever possible. Funding Supported by the Health Research Council of New Zealand and a part of Manawataki Fatu Fatu, a programme of research funded by the National Heart Foundation of New Zealand and Healthier Lives - He Oranga Hauora - National Science Challenge of New Zealand.
Collapse
Affiliation(s)
- Julie Winter-Smith
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Corina Grey
- Department of General Practice and Primary Healthcare, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Janine Paynter
- Department of General Practice and Primary Healthcare, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Healthcare, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Vanessa Selak
- Section of Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
4
|
Ghamri N, Brand MKR, Henshall K, MacCormick AD. Accurate completion of tertiary trauma survey for inpatients at a non-trauma centre following significant trauma. Injury 2023; 54:112-118. [PMID: 35985855 DOI: 10.1016/j.injury.2022.07.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION A tertiary trauma survey (TTS) is a structured, comprehensive top-to-toe examination following major trauma [1]. Literature suggests that the ideal time frame for the initial TTS should be completed within 24-hours of a patient's admission and repeated at important moments [2-4]. Evidence suggests that formal TTS reduces the rate of missed injuries by up to 38% [2]. AIMS To determine the rate of TTS being conducted in trauma patients in a tertiary hospital without an admitting trauma service. METHODS We performed a retrospective analysis of adult trauma patients admitted to Middlemore Hospital (MMH) over six months. To be included, patients were either deemed to have a significant mechanism of injury or triggered a trauma call when arriving in the Emergency Department. RESULTS We identified 246 patients who met our criteria for requiring a TTS. 74 (30%) had a TTS completed. Of those completed, 22 (30%) were documented using a standardised form. 35 (47%) were done within the ideal timeframe (24 h); a further 21 (28%) were done within 48 h. House Officers (Junior Medical Officers) conducted the majority (80%), with the remainder being done by final-year medical students (12%), Registrars (Residents) (4%) and Consultants (Attendings) (4%). Of the 74 TTS that were completed, 21 (28%) detected a possible new injury, with 22% leading to further investigations being ordered. 14 (19%) were found to have a previously undetected, clinically significant injury on TTS (defined as 'injuries requiring further clinical intervention'). Most patients (90%) were admitted to either General Surgery or Orthopaedics. Sixty-two (54%) of patients admitted to General Surgery received a TTS; compared to just 11 (10%) admitted under Orthopaedics and 1 of 24 (4%) admitted to other specialities (including Hands, Plastics, Maxillo-Facial, Gynaecology and Medicine). CONCLUSION 30% of patients requiring a TTS received one. 19% of TTS conducted detected clinically significant injuries.
Collapse
Affiliation(s)
- N Ghamri
- Department of Orthopaedics, Middlemore Hospital, Counties Manukau District HEalth Board, Auckland, Aotearoa New Zealand.
| | - M K R Brand
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, Aotearoa New Zealand
| | - K Henshall
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, Aotearoa New Zealand
| | - A D MacCormick
- Department of Surgery, Middlemore Hospital, Counties Manukau District Health Board, Auckland, Aotearoa New Zealand; Department of Surgery, University of Auckland, Auckland, Aotearoa New Zealand
| |
Collapse
|
5
|
Russell J, Grant CC, Morton S, Denny S, Paine (Tūhoe) SJ. Prevalence and predictors of developmental health difficulties within New Zealand preschool-aged children: a latent profile analysis. J R Soc N Z 2022. [DOI: 10.1080/03036758.2022.2083188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Jin Russell
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Developmental Paediatrics, Neuroservices, Starship Children’s Health, Auckland, New Zealand
| | - Cameron C. Grant
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
- Department of Paediatrics: Child & Youth Health, University of Auckland, Auckland, New Zealand
- General Paediatrics, Starship Children’s Health, Auckland, New Zealand
| | - Susan Morton
- Centre for Longitudinal Research – He Ara ki Mua, University of Auckland, Auckland, New Zealand
| | - Simon Denny
- Mater Research, Health Services Research Group, South Brisbane, Australia
| | | |
Collapse
|
6
|
Yao ES, Bullen P, Meissel K, Tiatia J, Fleming T, Clark TC. Effects of Ethnic Classification on Substantive Findings in Adolescent Mental Health Outcomes. J Youth Adolesc 2022; 51:1581-1596. [PMID: 35438431 PMCID: PMC9232462 DOI: 10.1007/s10964-022-01612-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Although most adolescents are healthy, epidemiological studies show that a significant number experience mental health challenges, and that Indigenous and ethnic minority youth tend to have poorer mental health outcomes. However, ethnic classification in adolescence is complex due to increasing multi-ethnic identification, and little is known about how different classification methods affect research conclusions. This study used a nationally representative adolescent sample from Aotearoa New Zealand (N = 8275; ages 12–18; 55% female; 32% multi-ethnic) to investigate the effects that five ethnic classification methods have on substantive findings in three mental health outcomes: overall psychosocial difficulties, deliberate self-harm, and suicide attempts. The results showed that, depending on the classification method used, reported outcomes within the same nominal ethnic group varied by an effect size (d) of up to 0.12, and the reported magnitude of difference between nominal ethnic groups varied by an effect size (d) of up to 0.25. These effects are substantial given that they are solely due to a change in method. The impact that ethnic classification method has on substantive findings highlights the importance of criticality and transparency in research involving ethnicity data.
Collapse
Affiliation(s)
- Esther S Yao
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand.
| | - Pat Bullen
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Kane Meissel
- Faculty of Education and Social Work, The University of Auckland, Auckland, New Zealand
| | - Jemaima Tiatia
- School of Māori Studies and Pacific Studies, The University of Auckland, Auckland, New Zealand
| | - Theresa Fleming
- School of Health, Victoria University of Wellington, Wellington, New Zealand
| | - Terryann C Clark
- School of Nursing, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Yao ES, Meissel K, Bullen P, Clark TC, Atatoa Carr P, Tiatia-Seath J, Peiris-John R, Morton SMB. Demographic discrepancies between administrative-prioritisation and self-prioritisation of multiple ethnic identifications. SOCIAL SCIENCE RESEARCH 2022; 103:102648. [PMID: 35183304 DOI: 10.1016/j.ssresearch.2021.102648] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/22/2021] [Accepted: 09/19/2021] [Indexed: 06/14/2023]
Abstract
Ethnic classification is an inherently subjective process, especially when multiple ethnic identifications are involved. There are two methods commonly used to classify multiple ethnicities into single categories: administrative-prioritisation (assignment via a predetermined hierarchy) and self-prioritisation (where individuals select their "main" ethnicity). Currently, little is known about whether the demographic composition of outputted ethnic groups differs by prioritisation method. This study utilised large-scale data of multi-ethnic children (N = 1,860), adolescents (N = 2,413), and adults (N = 1,056) from Aotearoa New Zealand to examine individual and contextual demographic characteristics associated with discrepancies between administratively-prioritised and self-prioritised ethnicity. Results showed that discrepancy rates, which exceeded 50%, were systematically associated with neighbourhood ethnic composition and socioeconomic deprivation, but largely not associated with gender, age, and birthplace. The contextual nature of self-prioritisation highlights the importance of researchers' choice of ethnic classification method. Implications are discussed in the context of increasing multi-ethnic prevalence.
Collapse
Affiliation(s)
- Esther S Yao
- Faculty of Education and Social Work, The University of Auckland, New Zealand.
| | - Kane Meissel
- Faculty of Education and Social Work, The University of Auckland, New Zealand
| | - Pat Bullen
- Faculty of Education and Social Work, The University of Auckland, New Zealand
| | | | - Polly Atatoa Carr
- National Institute of Demographic and Economic Analysis, The University of Waikato, New Zealand
| | - Jemaima Tiatia-Seath
- School of Māori Studies and Pacific Studies, The University of Auckland, New Zealand
| | | | - Susan M B Morton
- Centre for Longitudinal Research, The University of Auckland, New Zealand
| |
Collapse
|
8
|
Classifying multiple ethnic identifications: Methodological effects on child, adolescent, and adult ethnic distributions. DEMOGRAPHIC RESEARCH 2021. [DOI: 10.4054/demres.2021.44.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
9
|
Abstract
OBJECTIVES (1) To establish the likelihood of dying within 12 months for a cohort of hospital inpatients in New Zealand (NZ) on a fixed census date; (2) to identify associations between likelihood of death and key sociodemographic, diagnostic and service-related factors and (3) to compare results with, and extend findings of, a Scottish study undertaken for the same time period and census date. National databases of hospitalisations and death registrations were used, linked by unique health identifier. PARTICIPANTS 6074 patients stayed overnight in NZ hospitals on the census date (10 April 2013), 40.8% of whom were aged ≥65 years; 54.4% were women; 69.1% of patients were NZ European; 15.3% were Maori; 7.6% were Pacific; 6.1% were Asian and 1.9% were 'other'. SETTING All NZ hospitals. RESULTS 14.5% patients (n=878) had died within 12 months: 1.6% by 7 days; 4.5% by 30 days; 8.0% by 3 months and 10.9% by 6 months. In logistic regression models, the strongest predictors of death within 12 months were: age ≥80 years (OR=5.52(95% CI 4.31 to 7.07)); a history of cancer (OR=4.20(3.53 to 4.98)); being Māori (OR=1.62(1.25 to 2.10)) and being admitted to a medical specialty, compared with a surgical specialty (OR=3.16(2.66 to 3.76)). CONCLUSION While hospitals are an important site of end of life care in NZ, their role is less significant than in Scotland, where 30% of an inpatient cohort recruited using similar methods and undertaken on the same census date had died within 12 months. One reason for this finding may be the extended role of residential long-term care facilities in end of life care provision in NZ.
Collapse
Affiliation(s)
- Merryn Gott
- The School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Joanna Broad
- Freemasons Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Xian Zhang
- Freemasons Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
| | - Lene Jarlbaek
- Department of Clinical Research, The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Glasgow, UK
| |
Collapse
|
10
|
Valles SA. The challenges of choosing and explaining a phenomenon in epidemiological research on the "Hispanic Paradox". THEORETICAL MEDICINE AND BIOETHICS 2016; 37:129-148. [PMID: 26754488 DOI: 10.1007/s11017-015-9349-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
According to public health data, the US Hispanic population is far healthier than would be expected for a population with low socioeconomic status. Ever since Kyriakos Markides and Jeannine Coreil highlighted this in a seminal 1986 article, public health researchers have sought to explain the so-called "Hispanic paradox." Several candidate explanations have been offered over the years, but the debate goes on. This article offers a philosophical analysis that clarifies how two sets of obstacles make it particularly difficult to explain the Hispanic paradox. First, different research projects define the Hispanic paradox phenomenon in substantially different ways. Moreover, using Bas van Fraassen's pragmatic theory of explanation and Sean Valles's extension of it with the concept of "phenomenon choice," it also becomes clear that there are also multiple ways of explaining each individual definition of the phenomenon. A second set of philosophical and methodological challenges arises during any attempt to study "Hispanic" phenomena, with one key challenge being that the "Hispanic" panethnic concept was intentionally made vague as it was developed and popularized during the 1960s-1970s. After comparing this case with similar cases in the philosophical literature, the article concludes with observations on what makes this problem unique, particularly its ethical features.
Collapse
Affiliation(s)
- Sean A Valles
- Lyman Briggs College and Department of Philosophy, Michigan State University, Holmes Hall, 919 E. Shaw Lane, Room E35, East Lansing, MI, 48825, USA.
| |
Collapse
|
11
|
Rata E, Zubaran C. Ethnic Classification in the New Zealand Health Care System. THE JOURNAL OF MEDICINE AND PHILOSOPHY 2016; 41:192-209. [DOI: 10.1093/jmp/jhv065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
12
|
Campbell M, Apparicio P, Day P. Geographic analysis of infant mortality in New Zealand, 1995-2008: an ethnicity perspective. Aust N Z J Public Health 2014; 38:221-6. [PMID: 24890479 DOI: 10.1111/1753-6405.12222] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 07/01/2013] [Accepted: 01/01/2014] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To detect spatial clusters of high infant mortality rates in New Zealand for Māori and non-Māori populations and verify if these clusters are stable over a certain time period (1995-2008) and similar between the two populations. METHOD We applied the Kulldorff's spatial scan statistics on data collected by New Zealand Ministry of Health (1995 to 2008) at the territorial local authorities (TLA) level. Kappa coefficient was used to assess the concordance between clusters obtained for Māori and non-Māori populations. T-test analyses were conducted to identify associations between spatial clusters and two predictors (population density and deprivation score). RESULTS There are some significant spatial clusters of infant mortality in New Zealand for both Māori and Non-Māori. The concordance of the cluster locations between the two populations is strong (kappa=0.77). Unsurprisingly, infant mortality clusters for both Māori and Non-Māori are associated with the deprivation score. The population density predictor is only significantly and positively associated with clusters obtained for the non-Māori population. After controlling for deprivation the presence of spatial clusters is all but eliminated. CONCLUSIONS Infant mortality patterns are geographically similar for both Māori and Non-Māori. However, there are differences geographically between the two populations after accounting for deprivation. IMPLICATIONS Health services that can affect infant mortality should be aware of the geographical differences across NZ. Deprivation is an important factor in explaining infant mortality rates and policies that ameliorate its effects should be pursued, as it is the major determinant of the geographical pattern of infant mortality in NZ.
Collapse
|
13
|
Aragona M, Rovetta E, Pucci D, Spoto J, Villa AM. Somatization in a primary care service for immigrants. ETHNICITY & HEALTH 2012; 17:477-491. [PMID: 22352805 DOI: 10.1080/13557858.2012.661406] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIM To study somatization in a large sample of immigrants attending a first visit to a primary care service. Differences in somatization among four large immigrant groups (Europeans, Asians, South Americans, and Africans) and 16 subgroups based on nationality were assessed. DESIGN A total of 3105 patients were asked to participate in the study, of whom 3051 completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or higher on the BSI-21 were considered to be somatizers. A multiple logistic regression analysis adjusting for intervening variables tested the relative risk of somatization in and among the groups. RESULTS Among the 3051 patients who completed the BSI-21, 782 (25.6%) were somatizers. Somatizers were significantly more prevalent among South Americans (30.1%). After adjusting for covariates, Asians and Europeans, but not Africans, showed a significantly lower risk of somatization compared to South Americans. Among national subgroups, somatization occurred more frequently in Peruvians (32.9%). Compared to Peruvians, migrants from Eastern Europe, Morocco, the Philippines, Sri Lanka, and El Salvador demonstrated a significantly lower risk of somatization. CONCLUSIONS Approximately one-fourth of socially disadvantaged immigrants who accessed primary care services used somatization to express their distress. However, the likelihood of somatization varied widely among the different groups, and was significantly higher in South Americans and in some African groups, and lower in some Asian groups.
Collapse
|
14
|
Cameron VA, Faatoese AF, Gillies MW, Robertson PJ, Huria TM, Doughty RN, Whalley GA, Richards MA, Troughton RW, Tikao-Mason KN, Wells EJ, Sheerin IG, Pitama SG. A cohort study comparing cardiovascular risk factors in rural Maori, urban Maori and non-Maori communities in New Zealand. BMJ Open 2012; 2:bmjopen-2011-000799. [PMID: 22685219 PMCID: PMC3378934 DOI: 10.1136/bmjopen-2011-000799] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To understand health disparities in cardiovascular disease (CVD) in the indigenous Māori of New Zealand, diagnosed and undiagnosed CVD risk factors were compared in rural Māori in an area remote from health services with urban Māori and non-Māori in a city well served with health services. DESIGN Prospective cohort study. SETTING Hauora Manawa is a cohort study of diagnosed and previously undiagnosed CVD, diabetes and risk factors, based on random selection from electoral rolls of the rural Wairoa District and Christchurch City, New Zealand. PARTICIPANTS Screening clinics were attended by 252 rural Māori, 243 urban Māori and 256 urban non-Māori, aged 20-64 years. MAIN OUTCOME MEASURES The study documented personal and family medical history, blood pressure, anthropometrics, fasting lipids, insulin, glucose, HbA1c and urate to identify risk factors in common and those that differ among the three communities. RESULTS Mean age (SD) was 45.7 (11.5) versus 42.6 (11.2) versus 43.6 (11.5) years in rural Māori, urban Māori and non-Māori, respectively. Age-adjusted rates of diagnosed cardiac disease were not significantly different across the cohorts (7.5% vs 5.8% vs 2.8%, p=0.073). However, rural Māori had significantly higher levels of type-2 diabetes (10.7% vs 3.7% vs 2.4%, p<0.001), diagnosed hypertension (25.0% vs 14.9% vs 10.7%, p<0.001), treated dyslipidaemia (15.7% vs 7.1% vs 2.8%, p<0.001), current smoking (42.8% vs 30.5% vs 15.2%, p<0.001) and age-adjusted body mass index (30.7 (7.3) vs 29.1 (6.4) vs 26.1 (4.5) kg/m(2), p<0.001). Similarly high rates of previously undocumented elevated blood pressure (22.2% vs 23.5% vs 17.6%, p=0.235) and high cholesterol (42.1% vs 54.3% vs 42.2%, p=0.008) were observed across all cohorts. CONCLUSIONS Supporting integrated rural healthcare to provide screening and management of CVD risk factors would reduce health disparities in this indigenous population.
Collapse
Affiliation(s)
- Vicky A Cameron
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | | | - Matea W Gillies
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Paul J Robertson
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Tania M Huria
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Rob N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Faculty of Social and Health Sciences, Unitec, Auckland, New Zealand
| | - Mark A Richards
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Richard W Troughton
- Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - Karen N Tikao-Mason
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Elisabeth J Wells
- Department of Public Health, University of Otago, Christchurch, New Zealand
| | - Ian G Sheerin
- Department of Public Health, University of Otago, Christchurch, New Zealand
| | - Suzanne G Pitama
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| |
Collapse
|
15
|
Bhopal RS, Bansal N, Fischbacher CM, Brown H, Capewell S. Ethnic variations in the incidence and mortality of stroke in the Scottish Health and Ethnicity Linkage Study of 4.65 million people. Eur J Prev Cardiol 2011; 19:1503-8. [DOI: 10.1177/1741826711423217] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- RS Bhopal
- University of Edinburgh, Edinburgh, UK
| | - N Bansal
- University of Edinburgh, Edinburgh, UK
| | - CM Fischbacher
- University of Edinburgh, Edinburgh, UK
- NHS Scotland National Services, Edinburgh, UK
| | - H Brown
- University of Edinburgh, Edinburgh, UK
| | | | | |
Collapse
|
16
|
Pitama S, Wells JE, Faatoese A, Tikao-Mason K, Robertson P, Huria T, Gillies T, Doughty R, Whalley G, Troughton R, Sheerin I, Richards M, Cameron VA. A Kaupapa Māori approach to a community cohort study of heart disease in New Zealand. Aust N Z J Public Health 2011; 35:249-55. [DOI: 10.1111/j.1753-6405.2011.00702.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
17
|
Callister P, Galtry J, Didham R. The risks and benefits of sun exposure: should skin colour or ethnicity be the main variable for communicating health promotion messages in New Zealand? ETHNICITY & HEALTH 2011; 16:57-71. [PMID: 21213156 DOI: 10.1080/13557858.2010.527925] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Using New Zealand as a case study, to determine whether ethnicity is appropriate for communicating sun exposure health promotion messages. DESIGN This study reviews recent literature on minimising skin cancer risk and achieving sufficient serum vitamin D levels. It draws on a variety of scientific literature, reports and media statements to determine appropriate sun exposure messages for minimising skin cancer risk and achieving sufficient vitamin D status among the New Zealand population, which is diverse with regards to both ethnicity and skin colour. RESULT(S) Due to a unique combination of factors, New Zealand and Australia lead the world in melanoma incidence. Devising ways of minimising skin cancer risk and achieving optimal vitamin D blood levels among the New Zealand population provide major challenges for researchers and health promoters. These challenges include the many unknowns and uncertainties about vitamin D, such as determining what constitutes an optimal level as well as its association with specific diseases. There is strong evidence that skin cancer, including melanoma, is caused by excess harmful sun exposure with skin colour having long been established as a risk factor. More recently, there has been significant focus in New Zealand on the potential beneficial aspects of sun exposure, mainly in assisting vitamin D synthesis, especially for Maori and Pacific people. But research also shows that Maori and Pacific people are increasingly at risk of developing melanoma. In New Zealand, where there is a high rate of ethnic intermarriage and ethnicity is culturally constructed, there is likely to have been a weakening of the relationship between ethnicity and skin colour. Skin colour information is required to understand both the risks and benefits of sun exposure. In the immediate future, ethnicity appears likely to remain an important reference point for assessing the risks and benefits of sun exposure in New Zealand. However, we contend that while ethnic-based channels may be useful for communicating appropriate sun exposure messages, there are dangers in such advice based on membership of particular ethnic group(s). Rather skin colour, along with other key variables, such as season and time of day, should be the core considerations for assessing and discussing risk. In the longer term, direct measures of skin type are needed when assessing the risks and benefits of sun exposure, including the potential protective effects against various illnesses. CONCLUSION While ethnic-based dissemination channels may be useful for communicating about the risks and benefits of sun exposure in New Zealand, discussion of risk factors should focus on skin colour.
Collapse
Affiliation(s)
- Paul Callister
- Institute of Policy Studies, Victoria University, Wellington, New Zealand.
| | | | | |
Collapse
|
18
|
Cormack D, Sarfati D, Harris R, Robson B, Shaw C, Blakely T. Re: ‘An overview of cancer and beliefs about the disease in Indigenous people of Australia, Canada, New Zealand and the US’ Aust NZ J Public Health. 2009; 33: 109-18. Aust N Z J Public Health 2010; 34:90-1; author reply 91-2. [DOI: 10.1111/j.1753-6405.2010.00481.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
|
19
|
Melanoma in Maori, Asian, and Pacific Peoples in New Zealand. Cancer Epidemiol Biomarkers Prev 2009; 18:1706-13. [DOI: 10.1158/1055-9965.epi-08-0682] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
20
|
Massey KA, Magee LA, Dale S, Claydon J, Morris TJ, von Dadelszen P, Liston RM, Ansermino JM. A current landscape of provincial perinatal data collection in Canada. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:236-246. [PMID: 19416570 DOI: 10.1016/s1701-2163(16)34122-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Canadian Perinatal Network (CPN) was launched in 2005 as a national perinatal database project designed to identify best practices in maternity care. The inaugural project of CPN is focused on interventions that optimize maternal and perinatal outcomes in women with threatened preterm birth at 22+0 to 28+6 weeks' gestation. OBJECTIVE To examine existing data collection by perinatal health programs (PHPs) to inform decisions about shared data collection and CPN database construction. METHODS We reviewed the database manuals and websites of all Canadian PHPs and compiled a list of data fields and their definitions. We compared these fields and definitions with those of CPN and the Canadian Minimal Dataset, proposed as a common dataset by the Canadian Perinatal Programs Coalition of Canadian PHPs. RESULTS PHPs collect information on 2/3 of deliveries in Canada. PHPs consistently collect information on maternal demographics (including both maternal and neonatal personal identifiers), past obstetrical history, maternal lifestyle, aspects of labour and delivery, and basic neonatal outcomes. However, most PHPs collect insufficient data to enable identification of obstetric (and neonatal) practices associated with improved maternal and perinatal outcomes. In addition, there is between-PHP variability in defining many data fields. CONCLUSION Construction of a separate CPN database was needed although harmonization of data field definitions with those of the proposed Canadian Minimal Dataset was done to plan for future shared data collection. This convergence should be the goal of researchers and clinicians alike as we construct a common language for electronic health records.
Collapse
Affiliation(s)
- Kiran A Massey
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, University of British Columbia, Vancouver BC; BC Women's Hospital and Health Centre, Vancouver BC
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, University of British Columbia, Vancouver BC; BC Women's Hospital and Health Centre, Vancouver BC; Department of Population and Public Health, University of British Columbia, Vancouver BC; British Columbia Perinatal Health Program, Vancouver BC; Department of Medicine, University of British Columbia, Vancouver BC
| | - Sheryll Dale
- British Columbia Perinatal Health Program, Vancouver BC
| | - Jennifer Claydon
- Department of Paediatrics, University of British Columbia, Vancouver BC; Canadian Perinatal Surgery Network, Vancouver BC
| | - Tara J Morris
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, University of British Columbia, Vancouver BC; BC Women's Hospital and Health Centre, Vancouver BC
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Centre for Advanced Health Research and Evaluation, University of British Columbia, Vancouver BC; BC Women's Hospital and Health Centre, Vancouver BC; Department of Population and Public Health, University of British Columbia, Vancouver BC; British Columbia Perinatal Health Program, Vancouver BC
| | - Robert M Liston
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; BC Women's Hospital and Health Centre, Vancouver BC; Department of Population and Public Health, University of British Columbia, Vancouver BC
| | - J Mark Ansermino
- Centre for Advanced Health Research and Evaluation, University of British Columbia, Vancouver BC; Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Vancouver BC
| | | |
Collapse
|