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Wright LK, Jatrana S, Lindsay D. Remote area nurses' experiences of workplace safety in very remote primary health clinics: A qualitative study. J Adv Nurs 2024. [PMID: 38186082 DOI: 10.1111/jan.16028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 11/27/2023] [Accepted: 11/30/2023] [Indexed: 01/09/2024]
Abstract
AIM To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics. DESIGN This qualitative study used online semi-structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management. SETTING The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia. PARTICIPANTS Fifteen Remote Area Nurses participated in the study. RESULTS Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses. CONCLUSION Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge. IMPLICATIONS FOR THE PROFESSION Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements. REPORTING METHOD COREQ reporting guidelines were followed. PIPE STATEMENT A panel of six Remote Area Nurses collaborated in the development of this project.
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Affiliation(s)
- Laura K Wright
- James Cook University, Murtupuni Centre for Rural and Remote Health, Mount Isa, Queensland, Australia
| | - Santosh Jatrana
- James Cook University, Murtupuni Centre for Rural and Remote Health, Mount Isa, Queensland, Australia
- The Australian National University, School of Demography, Canberra, Australian Capital Territory, Australia
- Deakin University, Alfred Deakin Institute for Citizenship and Globalisation, Burwood, Victoria, Australia
| | - David Lindsay
- James Cook University, College of Healthcare Sciences, Townsville, Queensland, Australia
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Semasinghe C, Jatrana S, King TJ. Exploring the associations between the perception of water scarcity and support for alternative potable water sources. PLoS One 2023; 18:e0283245. [PMID: 36930641 PMCID: PMC10022764 DOI: 10.1371/journal.pone.0283245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
This study examines the association between the perception of water scarcity and support for alternative water sources in general, and specifically desalination and recycled water. It also examines the mediating role that perception of climate change has on the aforementioned association. A 46-item survey (n = 588) was conducted in the Geelong region of Australia. Logistic regression was used to determine the independent association between perceived water scarcity and socio-demographic factors, with support for alternative water sources, desalination and recycled water. 82% of respondents supported undefined 'alternative water sources'. However, support for specific alternatives was lower (desalination: 65%; recycled water: 40.3%). Perception of water scarcity was significantly associated with increased odds of support for alternative water sources (OR 1.94, 95% CI: 1.25-3.00) and support for recycled water (OR 2.32, 95% CI: 1.68-3.31). There was no significant relationship between perception of water scarcity and support for desalination (OR 0.959 95% CI: 0.677-1.358). Climate change was found to mediate perceived water scarcity and support for alternative sources (OR 1.360, 95% CI: 0.841-2.198). The mediation of the relationship between perceived water scarcity and support for recycled water by climate change was not strong. These results facilitate enhanced community engagement strategies.
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Affiliation(s)
- Christina Semasinghe
- School of Humanities and Social Sciences, Faculty of Arts and Education, Deakin University, Geelong, Australia
- * E-mail:
| | - Santosh Jatrana
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Australia
- School of Demography, The Australian National University, Canberra, Australia
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, Australia
| | - Tanya J. King
- School of Humanities and Social Sciences, Faculty of Arts and Education, Deakin University, Geelong, Australia
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, Australia
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Jatrana S, Temple J, Wilson T, Payne C. Demography and COVID-19: risks, responses and impacts. J Pop Research 2022; 39:475-478. [PMID: 36159739 PMCID: PMC9483307 DOI: 10.1007/s12546-022-09294-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Jessup B, Hoang H, Podubinski T, Obamiro K, Bourke L, Hellwege B, Jatrana S, Heaney S, Farthing A, Sheepway L, Rasiah R. 'I can't go, I can't afford it': Financial concern amongst health students undertaking rural and remote placements during COVID-19. Aust J Rural Health 2022; 30:238-251. [PMID: 35229400 PMCID: PMC9111257 DOI: 10.1111/ajr.12855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/06/2022] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION As the coronavirus pandemic unfolded during 2020, widespread financial uncertainty emerged amongst university students across the globe. What is not yet clear is how Australian health students were financially impacted during the initial stages of the pandemic and whether this influenced their ability to undertake planned rural or remote placements. OBJECTIVE To examine (a) financial concern amongst health students during COVID-19, (b) the financial implications of changes to planned rural or remote placements and (c) the impact of these factors on students' ability to undertake placements during the pandemic. DESIGN Mixed-methods design involving an online survey (n = 1210) and semi-structured interviews (n = 29). Nursing, medical and allied health students with a planned University Department of Rural Health-facilitated rural or remote placement between February and October 2020 were invited to participate. FINDINGS 54.6% of surveyed students reported financial concern during COVID-19. Financial concern correlated with both changes in financial position and employment, with 36.6% of students reporting a reduction in income and 43.1% of students reporting a reduction in, or cessation of regular employment. Placement changes yielded a range of financial implications. Cancelled placements saved some students travel and accommodation costs, but left others out of pocket if these expenses were prepaid. Placements that went ahead often incurred increased accommodation costs due to limited availability. Financial concern and/or financial implications of placement changes ultimately prevented some students from undertaking their rural or remote placement as planned. DISCUSSION Many nursing, allied health and medical students expressed financial concern during COVID-19, associated with a loss of regular employment and income. Placement changes also presented unforeseen financial burden for students. These factors ultimately prevented some students from undertaking their planned rural or remote placement. CONCLUSION Universities need to consider how best to align financially burdensome placements with the personal circumstances of students during periods of economic uncertainty.
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Affiliation(s)
- Belinda Jessup
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Ha Hoang
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Tegan Podubinski
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Kehinde Obamiro
- Centre for Rural HealthThe University of TasmaniaLauncestonTasmaniaAustralia
| | - Lisa Bourke
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Barbara Hellwege
- Department of Rural HealthThe University of MelbourneSheppartonVictoriaAustralia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote HealthJames Cook UniversityMount IsaQueenslandAustralia
| | - Susan Heaney
- The University of Newcastle Department of Rural HealthThe University of NewcastlePort MacquarieNew South WalesAustralia
| | - Annie Farthing
- Centre for Remote HealthFlinders UniversityAlice SpringsNorthern TerritoryAustralia
| | - Lyndal Sheepway
- La Trobe Rural Health SchoolLa Trobe UniversityWodongaVictoriaAustralia
| | - Rohan Rasiah
- Western Australian Centre for Rural HealthThe University of Western AustraliaKarrathaWestern AustraliaAustralia
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Fatima Y, Hays R, Neilson A, Knight S, Jatrana S. Why patients attend emergency department for primary care type problems: views of healthcare providers working in a remote community. Rural Remote Health 2022; 22:7054. [PMID: 35193360 DOI: 10.22605/rrh7054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Emergency department (ED) utilisation continues to increase, particularly for primary care presentations that do not require high level ED services. The reasons for this are complex, and research has focused on patient perspectives in choosing where to seek care rather than those of ED and general practitioner (GP) providers. This study aimed to address this gap by exploring the views of ED and GP providers regarding ED utilisation for primary care type health conditions in a small, remote Australian city with perhaps unique population demographics and service configuration. METHODS Service providers from the ED and general practice clinics were invited to participate in focus groups and semi-structured interviews exploring their views on ED utilisation for primary-care-type health presentations. The data were analysed using thematic content analysis. RESULTS In total, 24 healthcare providers (five GPs, seven ED practitioners, seven community nurse navigators, four Aboriginal and Torres Strait Islander Health Workers and one Indigenous Liaison Officer) participated in focus groups discussion and interviews. The analysis identified three themes: access and logistic barriers, rational decision-making and self-perceived urgency. While there was some overlap in the healthcare providers' perceptions, there were also strong differences between ED and GP groups. In particular, the ED group believed that GP services are less accessible for urgent appointments, whereas GPs believed that such arrangements were in place. Both groups agreed on the need for clear communication between the ED and general practice. CONCLUSION ED and GP providers demonstrate similarities and differences in understanding patients' reasons for choosing which service to access. The differences may stem from ED providers' focus on offering a rapid resolution of acute presentations and GP providers' focus on offering comprehensive and continuing care. Effective communication between general practice and the ED services and clearer referral pathways may help in reducing ED utilisation for less urgent primary-care-type problems.
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Affiliation(s)
- Yaqoot Fatima
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia; and Institute for Social Science Research, University of Queensland, Brisbane, Queensland, Australia
| | - Richard Hays
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Anne Neilson
- Darling Downs Hospital and Health Service, Kingaroy, Queensland, Australia
| | - Sabina Knight
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Santosh Jatrana
- Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
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Hoang H, Jessup B, Obamiro K, Bourke L, Hellwege B, Podubinski T, Heaney S, Sheepway L, Farthing A, Rasiah R, Fitzroy R, Jatrana S, Argus G, Knight S. Impact of COVID-19 on rural and remote student placements in Australia: A national study. Aust J Rural Health 2022; 30:197-207. [PMID: 35103353 DOI: 10.1111/ajr.12836] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/04/2021] [Accepted: 12/12/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate students' perceptions of the impact of coronavirus SARS-CoV-2 on rural and remote placements facilitated by 16 University Departments of Rural Health in Australia in 2020. DESIGN A mixed-method design comprising an online survey and semi-structured interviews. SETTING Australia. PARTICIPANTS Allied health, nursing and medical students with a planned University Departments of Rural Health-facilitated rural or remote placement between February and October 2020. INTERVENTION A planned rural or remote placement in 2020 facilitated by a University Departments of Rural Health, regardless of placement outcome. MAIN OUTCOME MEASURES Questionnaire included placement outcome (completed or not), discipline of study (nursing, allied health, medicine), and Likert measures of impact to placement (including supervision, placement tasks, location, accommodation, client contact and student learning) and placement experience (overall, support, supervision, university support). Semi-structured interviews asked about placement planning, outcome, decisions, experience and student perceptions. RESULTS While coronavirus SARS-CoV-2 reportedly impacted on the majority of planned placements, most students (80%) were able to complete their University Departments of Rural Health-facilitated placement in some form and were satisfied with their placement experience. Common placement changes included changes to tasks, setting, supervisors and location. Allied health students were significantly more likely to indicate that their placement had been impacted and also felt more supported by supervisors and universities than nursing students. Interview participants expressed concerns regarding the potential impact of cancelled and adapted placements on graduation and future employment. CONCLUSIONS The coronavirus SARS-CoV-2 pandemic was reported to impact the majority of University Departments of Rural Health-facilitated rural and remote placements in 2020. Fortunately, most students were able to continue to undertake a rural or remote placement in some form and were largely satisfied with their placement experience. Students were concerned about their lack of clinical learning and graduating on time with adequate clinical competence.
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Affiliation(s)
- Ha Hoang
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Belinda Jessup
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, The University of Tasmania, Launceston, TAS, Australia
| | - Lisa Bourke
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Barbara Hellwege
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Tegan Podubinski
- Department of Rural Health, The University of Melbourne, Shepparton, Vic., Australia
| | - Susan Heaney
- School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle Department of Rural Health, Port Macquarie, NSW, Australia
| | - Lyndal Sheepway
- La Trobe Rural Health School, La Trobe University, Wodonga, Vic., Australia
| | - Annie Farthing
- Centre for Remote Health, Flinders University, Alice Springs, NT, Australia
| | - Rohan Rasiah
- Western Australian Centre for Rural Health, The University of Western Australia, Karratha, WA, Australia
| | - Robyn Fitzroy
- Centre for Rural Health, University of Sydney, Lismore, NSW, Australia
| | - Santosh Jatrana
- JCU Murtupini Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Geoff Argus
- Southern Queensland Rural Health, Cranley, QLD, Australia
| | - Sabina Knight
- JCU Murtupini Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
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Wright LK, Jatrana S, Lindsay D. Workforce safety in the remote health sector of Australia: a scoping review. BMJ Open 2021; 11:e051345. [PMID: 34452968 PMCID: PMC8404439 DOI: 10.1136/bmjopen-2021-051345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To scope the evidence surrounding workplace health and safety risks for the remote health workforce in Australia and to collate the recommendations to address those risks. DESIGN A five-stage scoping review framework refined by Cooper et al was used for this review. Informit Health Collection, Ovid Emcare, Medline, Web of Science Core Collection, ProQuest and the grey literature were searched in October 2020 using a combination of key words derived from the eligibility criteria. No date restriction was placed on the search. Title and abstract screening, full-text review and data extraction were performed by three reviewers. Data were analysed by the lead author using qualitative thematic analysis. ELIGIBILITY CRITERIA Articles were eligible for inclusion if they were published research or industry reports, focused on safety for the remote health workforce in Australia, identified hazards/safety risks or recommendations to reduce risk, and were written in English. RESULTS The search yielded 312 articles, of which 18 met the inclusion criteria. A wide range of hazards/safety risks and recommendations were identified within the literature, which related to safety culture, isolation, safe environment, and education and training. Some recommendations, such as the use of a risk management approach, good post-incident support, safer clinics and accommodation, and improved access to education and training, had been discussed in the literature for over a decade, with a high level of agreement regarding their importance. Two articles briefly evaluated the impact of some recommendations. CONCLUSION While many recommendations have been developed to improve the safety of the remote health workforce in Australia, there is little evidence of their implementation and evaluation. As many remote health professionals report ongoing or worsening workplace safety issues, there is an urgent need for the implementation and evaluation of the workforce safety strategies recommended in the literature and required by legislation.
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Affiliation(s)
- Laura Kimberly Wright
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - Santosh Jatrana
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - David Lindsay
- College of Healthcare Sciences, James Cook University, Townsville, Queensland, Australia
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Atlas A, Muru-Lanning M, Moyes S, Kerse N, Jatrana S. Cell phone and technology use by octogenarians. J Prim Health Care 2021; 12:35-40. [PMID: 32223848 DOI: 10.1071/hc19042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 02/13/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Many countries, including New Zealand, have an aging population and new technologies such as cell phones may be useful for older people. AIM To examine cell phone and technology use by octogenarians. METHODS Te Puawaitanga O Nga Tapuwae Kia Ora Tonu- Life and Living in Advanced Age: A Cohort Study In New Zealand (LILACs NZ) cohort study data of Māori (aged 80-90 years, 11-year age band) and non-Māori (aged 85 years, 1-year age band) followed for 3 years was used to describe the prevalence among study participants of the use of the internet, cell phones and watching pay-per-view television. Association of these activities with living arrangement, congestive heart failure, chronic obstructive respiratory disease and participants' cognition were examined. RESULTS Technology use was relatively low among study octogenarians. Fewer Māori used cell phones and the internet (16% and 6%) than non-Māori (30% and 19%). Māori participants supported only by a pension were less likely to use cell phones than Māori with more income. More men watched pay-per-view television (e.g. SKY) than women. Living alone and having chronic lung disease were associated with not watching pay-per-view television. Participants who used the internet had higher cognition scores than others. Non-Māori women were less likely to watch pay-per-view television and non-Māori on a pension only were less likely to watch pay-per-view television than people on a higher income. Participants who lived alone were less likely to watch pay-per-view. CONCLUSION Relatively low use of technology may limit potential for health technology innovation for people of advanced age. Socioeconomic and ethnic disparities will amplify this.
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Affiliation(s)
- Astrid Atlas
- University of Auckland School of Population Health, General Practice and Primary Health Care, Auckland, New Zealand; and Corresponding author.
| | | | - Simon Moyes
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Ngaire Kerse
- The University of Auckland, School of Population Health, Auckland, New Zealand
| | - Santosh Jatrana
- Swinburne University of Technology, Centre for Social Impact, Auckland, New Zealand
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Fatima Y, Hays R, Knight S, Neilson A, Fleming R, Panaretto K, Jatrana S, Skinner I. Drivers of general practice-type presentations to the emergency department in a remote outback community. Aust J Rural Health 2021; 29:391-398. [PMID: 34051017 DOI: 10.1111/ajr.12706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To estimate the number of general practice-appropriate attendances in a remote emergency department and explore the reasons for patients' choice of service. DESIGN A four-step case study approach was adopted, focusing on hospital emergency department (ED) attendances that were potentially manageable in general practice. SETTING A large, remote community with substantial populations of Indigenous peoples and fly-in, fly-out mining industry workers. The ED is experiencing rapid growth in demand for services for lower urgency. PARTICIPANTS Patients attending the emergency department with lower urgency problems. INTERVENTIONS ED attendance data for 2016 were reviewed to identify lower urgency presentations. Patient records for 400 randomly selected presentations were subject to deeper analysis. A prospective survey was conducted over 6 months of 369 ED patients with lower urgency presentations. MAIN OUTCOME MEASURES The proportion of patients attending the ED with GP-appropriate problems and influences on their decisions to attend the ED. RESULTS About 48% of all attendances met the agreed definition of GP-appropriate problems. About half of presentations were during the normal work hours and about half of patients stated that GP services were unavailable. Younger age, lack of information about local GP services, and perceptions of convenience contributed significantly to seeking ED care. CONCLUSION Increasing the availability of GP services alone is unlikely to be sufficient to change service utilisation. Strategies should include raising community awareness of how and when to utilise the appropriate service, understanding different models of care, and the need to register with a general practice.
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Affiliation(s)
- Yaqoot Fatima
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia.,Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia
| | - Richard Hays
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Sabina Knight
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Anne Neilson
- Darling Downs Hospital and Health Service, Kingaroy, QLD, Australia
| | - Rhonda Fleming
- Western Queensland Primary Health Network, Mount Isa, QLD, Australia
| | - Kathryn Panaretto
- Gidgee Healing, Mount Isa, QLD, Australia.,University of Queensland, Brisbane, QLD, Australia
| | - Santosh Jatrana
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
| | - Isabelle Skinner
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD, Australia
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Jatrana S, Hasan MM, Mamun AA, Fatima Y. Global Variation in Hand Hygiene Practices Among Adolescents: The Role of Family and School-Level Factors. Int J Environ Res Public Health 2021; 18:ijerph18094984. [PMID: 34067142 PMCID: PMC8125682 DOI: 10.3390/ijerph18094984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 01/26/2023]
Abstract
While appropriate hand hygiene practices (HHP) are protective against infections, the paucity of evidence on global estimates and determinants of HHP in adolescents limits effective design and planning of intervention to improve HHP in young people. We examined the prevalence and correlates of HHP in adolescents. We used nationally representative data from the Global School-based Student Health Survey (2003–2017) from 92 countries. HHP were categorized as “appropriate”, “inappropriate” and “lacking” based on the information about “hand washing before eating”, “hand washing after using the toilet”, and “hand washing with soap”. Multinomial logistic regression analyses were used to assess the role of socio-demographic, health, lifestyle, school, and family-related variables in HHP. Among 354,422 adolescents (13–17 years), only 30.3% were found to practice appropriate hand hygiene. Multivariable models suggest that sedentary behavior (adjusted relative risk ratio (ARRR) 1.41, 95% CI 1.31–1.51)), and bullying victimization (ARRR 1.20, 95% CI 1.10–1.30) promoted inappropriate HHP. In contrast, parental supervision (ARRR 0.55, 95% CI 0.50–0.59) and parental bonding (ARRR 0.81, 95% CI 0.75–0.87) were protective against inappropriate HHP. From a policy perspective, hand hygiene promotion policies and programs should focus on both school (bullying, exercise) and family-level factors (parental supervision and parental bonding) factors.
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Affiliation(s)
- Santosh Jatrana
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD 4825, Australia;
- School of Demography, The Australian National University, Canberra, ACT 2601, Australia
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Melbourne, VIC 3220, Australia
- Department of Public Health, University of Otago, Wellington 6021, New Zealand
| | - Md. Mehedi Hasan
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD 4068, Australia; (M.M.H.); (A.A.M.)
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD 4068, Australia
| | - Abdullah A. Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD 4068, Australia; (M.M.H.); (A.A.M.)
- The Australian Research Council Centre of Excellence for Children and Families over the Life Course (The Life Course Centre), The University of Queensland, Indooroopilly, QLD 4068, Australia
| | - Yaqoot Fatima
- Centre for Rural and Remote Health, James Cook University, Mount Isa, QLD 4825, Australia;
- Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD 4068, Australia; (M.M.H.); (A.A.M.)
- Correspondence:
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Yiengprugsawan V, Jatrana S, Banwell C, Welsh J. Functional limitations and life satisfaction dynamics among Asian-born migrants and Australian-born participants in the HILDA study. Australas J Ageing 2019; 38:284-289. [PMID: 31165565 DOI: 10.1111/ajag.12678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 05/02/2019] [Accepted: 05/05/2019] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate functional limitations and life satisfaction among Asian-born migrants and Australian-born participants in the Household, Income and Labour Dynamics in Australia (HILDA) study. METHODS Information on 10 167 Australian-born participants and 650 Asian-born migrants from Waves 6 to 16 (2006-2016) of HILDA was analysed using multivariate linear regressions, adjusting for baseline covariates. RESULTS Middle-aged and older Asian-born migrants had a lower decline in functional limitations compared to the Australian-born participants (-1.74 vs -4.47 during the 5-year period and -5.66 vs -8.50 during the 10-year period). Decline in life satisfaction scores was relatively stable among older Australian-born participants, but there was a steeper decline among Asian-born migrants in the 5-year period. Notably, relative change was not statistically significant for both outcomes. CONCLUSION This study reveals that middle-aged and older Asian-born migrants had less decline in physical health but not in life satisfaction. Monitoring health and well-being of migrants as they age could help to minimise health disparities in Australia.
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Affiliation(s)
- Vasoontara Yiengprugsawan
- Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, The Australian National University, Canberra, ACT, Australia.,Australian Research Council Centre of Excellence in Population Ageing Research, Kensington, NSW, Australia
| | - Santosh Jatrana
- Faculty of Arts and Education, Deakin University, Geelong, Victoria, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
| | - Jennifer Welsh
- National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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Joshi S, Jatrana S, Paradies Y. Tobacco smoking between immigrants and non-immigrants in Australia: A longitudinal investigation of the effect of nativity, duration of residence and age at arrival. Health Promot J Austr 2017; 29:282-292. [PMID: 30511489 DOI: 10.1002/hpja.19] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Accepted: 10/16/2017] [Indexed: 11/07/2022] Open
Abstract
ISSUE ADDRESSED Earlier research evidence suggests that there is a difference and over time change in the prevalence of tobacco smoking between immigrants and native-born population. This study investigates the differences in smoking among immigrants from English speaking (ESC) and non-English speaking (NESC) countries relative to native-born (NB) Australians, and how those differences change with duration of residence (DoR) and age at arrival (AA). METHODS Information on 12 634 individuals from the first twelve waves (2001-2012) of Household, Income and Labour Dynamics in Australia (HILDA) longitudinal survey was analysed using multilevel group-mean-centred mixed logistic regression models. Smoking status as an outcome was dichotomized as current vs non-current smokers. RESULTS After adjusting for covariates, relative to native-born respondents, there was no difference in the odds of smoking for English speaking countries immigrants, while immigrants from non-English speaking countries had lower odds of smoking. The smoking prevalence of immigrants from non-English speaking countries converged towards the native-born after 20 years of residence in Australia. The association between duration of residence and smoking was modified by age at arrival, with immigrants (combined ESC and NESC) who arrived as children or adolescents and had lived 20 years or longer were significantly more likely to smoke than native-born Australians. CONCLUSION The results suggest that the initially lower smoking prevalence among non-English speaking countries immigrants converges with that of native-born Australians after twenty years of residence, and immigrants (combined ESC and NESC) who arrived as children or adolescents more than 20 years ago were more likely to be smokers. SO WHAT?: Current health promotion and anti-smoking programs should ensure that immigrants from non-English speaking background have access to education and information about the hazards of tobacco consumptions and are aware of the available smoking cessation services. Efforts to prevent smoking uptake among NESC immigrants and those who arrive as children or adolescents and live longer than 20 years is especially important for tobacco control interventions.
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Affiliation(s)
- Suresh Joshi
- School of Humanities and Social Sciences, Faculty of Arts and Education, Deakin University, Geelong, VIC, Australia
| | - Santosh Jatrana
- Centre for Social Impact Swinburne, Swinburne University of Technology, Hawthorn, Australia
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, VIC, Australia
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Connolly MJ, Kerse N, Wilkinson T, Menzies O, Rolleston A, Chong YH, Broad JB, Moyes SA, Jatrana S, Teh R. Testosterone in advance age: a New Zealand longitudinal cohort study: Life and Living in Advanced Age (Te Puāwaitanga o Ngā Tapuwae Kia Ora Tonu). BMJ Open 2017; 7:e016572. [PMID: 29133315 PMCID: PMC5695316 DOI: 10.1136/bmjopen-2017-016572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Serum testosterone (T) levels in men decline with age. Low T levels are associated with sarcopenia and frailty in men aged >80 years. T levels have not previously been directly associated with disability in older men. We explored associations between T levels, frailty and disability in a cohort of octogenarian men. SETTING Data from all men from Life and Living in Advanced Age Cohort Study in New Zealand, a longitudinal cohort study in community-dwelling older adults. PARTICIPANTS Community-dwelling (>80 years) adult men excluding those receiving T treatment or with prostatic carcinoma. OUTCOMES MEASURES Associations between baseline total testosterone (TT) and calculated free testosterone (fT), frailty (Fried scale) and disability (Nottingham Extended Activities of Daily Living scale (NEADL)) (baseline and 24 months) were examined using multivariate regression and Wald's χ2 techniques. Subjects with the lowest quartile of baseline TT and fT values were compared with those in the upper three quartiles. RESULTS Participants: 243 men, mean (SD) age 83.7 (2.0) years. Mean (SD) TT=17.6 (6.8) nmol/L and fT=225.3 (85.4) pmol/L. On multivariate analyses, lower TT levels were associated with frailty: β=0.41, p=0.017, coefficient of determination (R2)=0.10 and disability (NEADL) (β=-1.27, p=0.017, R2=0.11), low haemoglobin (β=-7.38, p=0.0016, R2=0.05), high fasting glucose (β=0.38, p=0.038, R2=0.04) and high C reactive protein (CRP) (β=3.57, p=0.01, R2=0.06). Low fT levels were associated with frailty (β=0.39, p=0.024, R2=0.09) but not baseline NEADL (β=-1.29, p=0.09, R2=0.09). Low fT was associated with low haemoglobin (β=-7.83, p=0.0008, R2=0.05) and high CRP (β=2.86, p=0.04, R2=0.05). Relationships between baseline TT and fT, and 24-month outcomes of disability and frailty were not significant. CONCLUSIONS In men over 80 years, we confirm an association between T levels and baseline frailty scores. The new finding of association between T levels and disability is potentially relevant to debates on T supplementation in older men, though, as associations were not present at 24 months, further work is needed.
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Affiliation(s)
- Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Tim Wilkinson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Oliver Menzies
- Geriatric Medicine, Auckland District Health Board, Auckland, New Zealand
| | - Anna Rolleston
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Yih Harng Chong
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Simon A Moyes
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Centre for Social Impact, Faculty of Business and Law, Swinburne University of Technology, Melbourne, Australia
- University of Otago, Wellington, New Zealand
| | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
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Jatrana S, Richardson K, Pasupuleti SSR. Investigating the Dynamics of Migration and Health in Australia: A Longitudinal Study. Eur J Popul 2017; 34:519-565. [PMID: 30976253 DOI: 10.1007/s10680-017-9439-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 07/10/2017] [Indexed: 11/29/2022]
Abstract
There have been few longitudinal studies investigating the immigrant health and changes in their health with longer residency in the host country. Additionally, the pathways and mechanisms by which transition of health over time occurs are poorly understood, limiting the ability to implement policies that will result in improved health for all, including immigrants. We assessed differences in health outcomes among foreign-born people from English speaking countries and non-English speaking countries relative to native-born Australians over a 10-year period using a large representative longitudinal dataset. We also explored English language proficiency, socio-economic factors and health behaviour factors as possible mechanisms through which health outcomes change over time post-migration. Conventional multilevel mixed and hybrid regression models were used to evaluate health outcomes in 9558 native-born and 3067 foreign-born people from the Household, Income and Labour Dynamics in Australia survey. There were clear differences in physical health, mental health and self-assessed health between foreign-born subgroups in comparison with native-born Australians. Foreign-born people from English speaking countries typically had a health advantage relative to native-born people, and foreign-born people from non-English speaking countries had a health disadvantage with respect to native-born people for all health outcomes. There was no evidence that these differences changed by duration of residence except for self-assessed health amongst foreign-born people from non-English speaking countries when duration of residence exceeded 20 years. English language proficiency mediated the relationship between duration of residence and health for foreign-born people from non-English speaking countries.
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Affiliation(s)
- Santosh Jatrana
- 1Centre for Social Impact Swinburne, Faculty of Business and Law, Swinburne University of Technology, PO Box 218, Mail 23, Cnr John and Wakefield Streets, Hawthorn, VIC 3122 Australia
| | - Ken Richardson
- 2Department of Public Health, School of Medicine and Health Sciences Wellington, University of Otago, PO Box 7343, Wellington, New Zealand
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Hayman KJ, Kerse N, Dyall L, Kepa M, Teh R, Wham C, Clair VWS, Wiles J, Keeling S, Connolly MJ, Wilkinson TJ, Moyes S, Broad JB, Jatrana S. Erratum to: Life and living in advanced age: a cohort study in New Zealand -Te Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: study protocol. BMC Geriatr 2017. [PMID: 28629315 PMCID: PMC5477101 DOI: 10.1186/s12877-017-0517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Affiliation(s)
- Karen J Hayman
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand.
| | - Ngaire Kerse
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand
| | - Lorna Dyall
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand
| | - Carol Wham
- Institute of Food, Nutrition and Human Health, Massey University, Auckland, New Zealand
| | - Valerie Wright-St Clair
- School of Rehabilitation & Occupation Studies, Auckland University of Technology, Auckland, New Zealand
| | - Janine Wiles
- Department of Community Health, University of Auckland, Auckland, New Zealand
| | - Sally Keeling
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Martin J Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Tim J Wilkinson
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, Auckland, 92109, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University, Sydney, Australia
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Wright-St Clair VA, Rapson A, Kepa M, Connolly M, Keeling S, Rolleston A, Teh R, Broad JB, Dyall L, Jatrana S, Wiles J, Pillai A, Garrett N, Kerse N. Ethnic and Gender Differences in Preferred Activities among Māori and non-Māori of Advanced age in New Zealand. J Cross Cult Gerontol 2017; 32:433-446. [PMID: 28597090 DOI: 10.1007/s10823-017-9324-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study explored active aging for older Māori and non-Māori by examining their self-nominated important everyday activities. The project formed part of the first wave of a longitudinal cohort study of aging well in New Zealand. Māori aged 80 to 90 and non-Māori aged 85 were recruited. Of the 937 participants enrolled, 649 answered an open question about their three most important activities. Responses were coded under the World Health Organization's International Classification of Functioning, Disability and Health (ICF), Activities and Participation domains. Data were analyzed by ethnicity and gender for first in importance, and all important activities. Activity preferences for Māori featured gardening, reading, walking, cleaning the home, organized religious activities, sports, extended family relationships, and watching television. Gendered differences were evident with walking and fitness being of primary importance for Māori men, and gardening for Māori women. Somewhat similar, activity preferences for non-Māori featured gardening, reading, and sports. Again, gendered differences showed for non-Māori, with sports being of first importance to men, and reading to women. Factor analysis was used to examine the latent structural fit with the ICF and whether it differed for Māori and non-Māori. For Māori, leisure and household activities, spiritual activities and interpersonal interactions, and communicating with others and doing domestic activities were revealed as underlying structure; compared to self-care, sleep and singing, leisure and work, and domestic activities and learning for non-Māori. These findings reveal fundamental ethnic divergences in preferences for active aging with implications for enabling participation, support provision and community design.
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Affiliation(s)
- Valerie A Wright-St Clair
- School of Clinical Sciences, Auckland University of Technology, Private Bag 92006, Auckland, 1142, New Zealand.
| | - Angela Rapson
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Martin Connolly
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Sally Keeling
- Department of Medicine, The Princess Margaret Hospital, University of Otago Christchurch, Christchurch, New Zealand
| | - Anna Rolleston
- Te Kupenga Hauora Māori, General Practice & Primary Care, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Lorna Dyall
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Centre for Social Impact-Swinburne, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Janine Wiles
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Avinesh Pillai
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Nick Garrett
- Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
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Kerse N, Teh R, Moyes SA, Dyall L, Wiles JL, Kēpa M, Wham C, Hayman K, Connolly M, Wilkinson T, Wright St Clair V, Keeling S, Broad J, Jatrana S, Lumley T. Socioeconomic correlates of quality of life for non-Māori in advanced age: Te Puāwaitanga o Nga Tapuwae Kia ora Tonu. Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). N Z Med J 2016; 129:18-32. [PMID: 27607082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To establish socioeconomic and cultural profiles and correlates of quality of life (QoL) in non-Māori of advanced age. METHOD A cross sectional analysis of the baseline data of a cohort study of 516 non-Māori aged 85 years living in the Bay of Plenty and Rotorua areas of New Zealand. Socioeconomic and cultural characteristics were established by face-to-face interviews in 2010. Health-related QoL (HRQoL) was assessed with the SF-12. RESULTS Of the 516 non-Māori participants enrolled in the study, 89% identified as New Zealand European, 10% other European, 1% were of Pacific, Asian or Middle Eastern ethnicity; 20% were born overseas and half of these identified as 'New Zealand European.' More men were married (59%) and more women lived alone (63%). While 89% owned their own home, 30% received only the New Zealand Superannuation as income and 22% reported that they had 'just enough to get along on'. More than 85% reported that they had sufficient practical and emotional support; 11% and 6% reported unmet need for practical and emotional support respectively. Multivariate analyses showed that those with unmet needs for practical and emotional support had lower mental HR QoL (p<0.005). Reporting that family were important to wellbeing was associated with higher mental HR QoL (p=0.038). Those that did not need practical help (p=0.047) and those that reported feeling comfortable with their money situation (0.0191) had higher physical HRQoL. High functional status was strongly associated with both high mental and high physical HR QoL (p<0.001). CONCLUSION Among our sample of non-Māori people of advanced age, those with unmet support needs reported low HRQoL. Functional status was most strongly associated with mental and physical HRQoL.
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Affiliation(s)
- Ngaire Kerse
- Professor and Head, School of Population Health, Tāmaki, University of Auckland
| | - Ruth Teh
- enior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tāmaki, University of Auckland
| | - Simon A Moyes
- Statistician, Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland
| | - Lorna Dyall
- Senior Lecturer, Department of General Practice and Primary Health Care, School of Population Health, Tāmaki, University of Auckland
| | - Janine L Wiles
- Senior Lecturer, Social and Community Health, School of Population Health, Tāmaki Campus, University of Auckland
| | - Mere Kēpa
- Honorary Senior Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tāmaki Campus, University of Auckland
| | - Carol Wham
- Senior Lecturer, Institute of Food, Nutrition and Human Health, Massey University, Auckland
| | - Karen Hayman
- Research Fellow, Department of General Practice and Primary Health Care, School of Population Health, Tāmaki Campus, University of Auckland
| | - Martin Connolly
- Freemasons' Professor of Geriatric Medicine, Freemason's Department of Geriatric Medicine, University of Auckland and Waitemata District Health Board
| | - Tim Wilkinson
- Professor of Medicine, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Valerie Wright St Clair
- Associate Professor, School of Occupational Science and Therapy, and Co-Director Active Ageing Research Group Auckland University of Technology, New Zealand
| | - Sally Keeling
- Senior Lecturer, Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Broad
- Senior Research Fellow, Freemason's Department of Geriatric Medicine, North Shore, University of Auckland
| | - Santosh Jatrana
- Associate Professor, Alfred Deakin Institute for Citizenship & Globalisation, Deakin University Waterfront Campus, Geelong, Victoria, Australia. Honorary Senior Research Fellow, University of Otago, Wellington
| | - Thomas Lumley
- Professor of Biostatistics, Department of Statistics, University of Auckland
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Abstract
This study examines the health experiences of migrant female workers in the construction industry in North India by addressing the following four broad categories of issues: what do these women think about their health in general? Where do these women go for treatment when they are ill? What are their perceptions about the utilization of trained medical personnel or hospitals for childbirth? Does migration improve women's health and their utilization of health facilities and if yes, does duration of stay in an urban area matter? Based on focus group discussions (FGDs), the results suggest that while the health status of these women have improved after migration, they have not started using modern health facilities either for childbirth or general illnesses. The study recommends that in order to understand the impact of migration on migrant women working in the informal sector, we need to address the broader social environment within which their health behavior occurs. We also need to look at the geographical dimension of exposure to urban lifestyles and ideas besides exposure over time (i.e., whether longer or shorter duration of stay in urban areas) and age (i.e., whether they migrated at younger ages or older ages).
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Toyota M, Jatrana S, Yeoh BS. Introduction: Migrants' Vulnerability and Health Risks in Asia. Asian and Pacific Migration Journal 2016. [DOI: 10.1177/011719680401300101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Jatrana S, Richardson K, Norris P, Crampton P. Is cost-related non-collection of prescriptions associated with a reduction in health? Findings from a large-scale longitudinal study of New Zealand adults. BMJ Open 2015; 5:e007781. [PMID: 26553826 PMCID: PMC4654342 DOI: 10.1136/bmjopen-2015-007781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 08/04/2015] [Accepted: 09/17/2015] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate whether cost-related non-collection of prescription medication is associated with a decline in health. SETTINGS New Zealand Survey of Family, Income and Employment (SoFIE)-Health. PARTICIPANTS Data from 17 363 participants with at least two observations in three waves (2004-2005, 2006-2007, 2008-2009) of a panel study were analysed using fixed effects regression modelling. PRIMARY OUTCOME MEASURES Self-rated health (SRH), physical health (PCS) and mental health scores (MCS) were the health measures used in this study. RESULTS After adjusting for time-varying confounders, non-collection of prescription items was associated with a 0.11 (95% CI 0.07 to 0.15) unit worsening in SRH, a 1.00 (95% CI 0.61 to 1.40) unit decline in PCS and a 1.69 (95% CI 1.19 to 2.18) unit decline in MCS. The interaction of the main exposure with gender was significant for SRH and MCS. Non-collection of prescription items was associated with a decline in SRH of 0.18 (95% CI 0.11 to 0.25) units for males and 0.08 (95% CI 0.03 to 0.13) units for females, and a decrease in MCS of 2.55 (95% CI 1.67 to 3.42) and 1.29 (95% CI 0.70 to 1.89) units for males and females, respectively. The interaction of the main exposure with age was significant for SRH. For respondents aged 15-24 and 25-64 years, non-collection of prescription items was associated with a decline in SRH of 0.12 (95% CI 0.03 to 0.21) and 0.12 (95% CI 0.07 to 0.17) units, respectively, but for respondents aged 65 years and over, non-collection of prescription items had no significant effect on SRH. CONCLUSION Our results show that those who do not collect prescription medications because of cost have an increased risk of a subsequent decline in health.
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Affiliation(s)
- Santosh Jatrana
- Alfred Deakin Institute for Citizenship & Globalisation, Deakin University Waterfront Campus, Geelong, Victoria, Australia
| | - Ken Richardson
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
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Connolly M, Kerse N, Moyes S, Wilkinson T, Rolleston R, Chong Y, Menzies O, Broad J, Jatrana S, Teh R. 75SERUM TESTOSTERONE LEVELS RELATE TO BOTH FRAILTY AND ADL IN OCTOGENARIAN MALES: LILACS STUDY, NEW ZEALAND. Age Ageing 2015. [DOI: 10.1093/ageing/afv115.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wham C, Baggett F, Teh R, Moyes S, Kēpa M, Connolly M, Jatrana S, Kerse N. Dietary protein intake may reduce hospitalisation due to infection in Māori of advanced age: LiLACS NZ. Aust N Z J Public Health 2015; 39:390-5. [DOI: 10.1111/1753-6405.12406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 01/01/2015] [Accepted: 02/01/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Carol Wham
- School of Food and Nutrition; Massey University; New Zealand
| | - Fiona Baggett
- School of Food and Nutrition; Massey University; New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
| | - Mere Kēpa
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
| | - Martin Connolly
- Freemason's Department of Geriatric Medicine; North Shore, University of Auckland; New Zealand
| | - Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University; Victoria
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care; University of Auckland; New Zealand
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Kerse N, Teh R, Moyes SA, Broad J, Rolleston A, Gott M, Kepa M, Wham C, Hayman K, Jatrana S, Adamson A, Lumley T. Cohort Profile: Te Puawaitanga o Nga Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Int J Epidemiol 2015; 44:1823-32. [DOI: 10.1093/ije/dyv103] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jatrana S. Transition in JPR leadership: a note from the new Editor-in-Chief. J Pop Research 2015. [DOI: 10.1007/s12546-015-9142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Jatrana S, Richardson K, Blakely T, Dayal S. Does mortality vary between Asian subgroups in New Zealand: an application of hierarchical Bayesian modelling. PLoS One 2014; 9:e105141. [PMID: 25140523 PMCID: PMC4139320 DOI: 10.1371/journal.pone.0105141] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/08/2014] [Indexed: 12/28/2022] Open
Abstract
The aim of this paper was to see whether all-cause and cause-specific mortality rates vary between Asian ethnic subgroups, and whether overseas born Asian subgroup mortality rate ratios varied by nativity and duration of residence. We used hierarchical Bayesian methods to allow for sparse data in the analysis of linked census-mortality data for 25-75 year old New Zealanders. We found directly standardised posterior all-cause and cardiovascular mortality rates were highest for the Indian ethnic group, significantly so when compared with those of Chinese ethnicity. In contrast, cancer mortality rates were lowest for ethnic Indians. Asian overseas born subgroups have about 70% of the mortality rate of their New Zealand born Asian counterparts, a result that showed little variation by Asian subgroup or cause of death. Within the overseas born population, all-cause mortality rates for migrants living 0-9 years in New Zealand were about 60% of the mortality rate of those living more than 25 years in New Zealand regardless of ethnicity. The corresponding figure for cardiovascular mortality rates was 50%. However, while Chinese cancer mortality rates increased with duration of residence, Indian and Other Asian cancer mortality rates did not. Future research on the mechanisms of worsening of health with increased time spent in the host country is required to improve the understanding of the process, and would assist the policy-makers and health planners.
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Affiliation(s)
- Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University Waterfront Campus, Geelong, Victoria, Australia
| | - Ken Richardson
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand
| | - Tony Blakely
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand
| | - Saira Dayal
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Newtown, Wellington, New Zealand
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Jatrana S, Richardson K, Crampton P. Is change in global self-rated health associated with change in affiliation with a primary care provider? Findings from a longitudinal study from New Zealand. Prev Med 2014; 64:32-6. [PMID: 24680875 DOI: 10.1016/j.ypmed.2014.03.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 02/19/2014] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
AIMS To investigate the association of self-rated health and affiliation with a primary care provider (PCP) in New Zealand. METHODS We used data from a New Zealand panel study of 22,000 adults. The main exposure was self-rated health, and the main outcome measure was affiliation with a PCP. Fixed effects conditional logistic models were used to control for observed time-varying and unobserved time-invariant confounding. RESULTS In any given wave, the odds of being affiliated with a PCP were higher for those in good and fair/poor health relative to those in excellent health. While affiliation for Europeans increased as reported health declined, the odds of being affiliated were lower for Māori respondents reporting very good or good health relative to those in excellent health. No significant differences in the association by age or gender were observed. CONCLUSIONS Our data support the hypothesis that those in poorer health are more likely to be affiliated with a PCP. Variations in affiliation for Māori could arise for several reasons, including differences in care-seeking behaviour and perceived need of care. It may also mean that the message about the benefits of primary health care is not getting through equally to all population groups.
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Affiliation(s)
- Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University Waterfront Campus, Geelong, Victoria 3220, Australia.
| | - Ken Richardson
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand
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Joshi S, Jatrana S, Paradies Y, Priest N. Differences in health behaviours between immigrant and non-immigrant groups: a protocol for a systematic review. Syst Rev 2014; 3:61. [PMID: 24915754 PMCID: PMC4062644 DOI: 10.1186/2046-4053-3-61] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 05/22/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health behaviours are important determinants of health and adoption of unhealthy behaviour is considered as one of the mechanisms through which immigrants' health changes over time in the host country. The change in health behaviours over time can contribute either to improving or worsening the overall health status of immigrants. Despite being the important mediators for the change in overall health status and chronic health conditions, no previous review (either general or systematic) has examined differences in key health behaviours simultaneously between immigrants and non-immigrants. This study aims to provide a systematic overview of the current global literature on differences in key health behaviours (that is, tobacco smoking, physical activity and alcohol drinking) between immigrant and non-immigrant groups. METHODS/DESIGN Empirical studies in English language reporting quantitative data simultaneously on both immigrant and non-immigrant groups will be considered for this systematic review. Electronic scientific searches will be conducted on seven databases to identify relevant studies of interests: MEDLINE, CINAHL, PsycINFO, EMBASE, Global Health, SocINDEX and ProQuest. In addition, Google/Google Scholar will be used to find the relevant studies and personal contact with experts will also be undertaken. Titles, abstracts and keywords of studies identified in the search strategies will be screened for inclusion criteria. The authors will select the studies following the PRISMA guidelines. The quality of included studies will be appraised using the Critical Appraisal Skills Programme (CASP) checklists. A descriptive summary statistics of included studies will describe the study designs, socio-demographic characteristics, and the exposure (immigrant and non-immigrant groups) and outcome (key health behaviours) measures. P-values and confidence intervals (CIs) for the associations between exposure and key health behaviours will also be reported. DISCUSSION This systematic review will facilitate a better understanding of differences in key health behaviours between immigrant and non-immigrant counterparts. It will provide a rigorous and reliable research base for future research and advance information on key health behaviours for a range of immigrant groups compared to non-immigrants in the high-migrant-receiving countries. SYSTEMATIC REVIEW REGISTRATION This systematic review protocol has been registered with PROSPERO (registration number: CRD42014008688).
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Affiliation(s)
- Suresh Joshi
- Alfred Deakin Research Institute (ADRI), Faculty of Arts and Education, Deakin University, Geelong Waterfront Campus, Locked Bag 2000, 3220 Geelong, VIC, Australia.
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Dyall L, Kepa M, Teh R, Mules R, Moyes SA, Wham C, Hayman K, Connolly M, Wilkinson T, Keeling S, Loughlin H, Jatrana S, Kerse N. Cultural and social factors and quality of life of Maori in advanced age. Te puawaitanga o nga tapuwae kia ora tonu - Life and living in advanced age: a cohort study in New Zealand (LiLACS NZ). N Z Med J 2014; 127:62-79. [PMID: 24816957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM To establish 1) the socioeconomic and cultural profile and 2) correlates of quality of life (QOL) of Maori in advanced age. METHOD A cross sectional survey of a population based cohort of Maori aged 80-90 years, participants in LiLACS NZ, in the Rotorua and Bay of Plenty region of New Zealand. Socioeconomic and cultural engagement characteristics were established by personal interview and QOL was assessed by the SF-12. RESULTS In total 421 (56%) participated and 267 (63%) completed the comprehensive interview. Maori lived with high deprivation areas and had received a poor education in the public system. Home ownership was high (81%), 64% had more than 3 children still living and social support was present for practical tasks and emotional support in 82%. A need for more practical help was reported by 21%. Fifty-two percent of the participants used te reo Maori me nga tikanga (Maori language and culture) daily. One in five had experienced discrimination and one in five reported colonisation affecting their life today. Greater frequency of visits to marae/sacred gathering places was associated with higher physical health-related QOL. Unmet need for practical help was associated with lower physical health-related QOL. Lower mental health-related QOL was associated with having experienced discrimination. CONCLUSION Greater language and cultural engagement is associated with higher QOL for older Maori and unmet social needs and discrimination are associated with lower QOL.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Ngaire Kerse
- School of Population Health, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Richardson K, Jatrana S, Tobias M, Blakely T. Migration and Pacific mortality: estimating migration effects on Pacific mortality rates using Bayesian models. Demography 2014; 50:2053-73. [PMID: 23904393 DOI: 10.1007/s13524-013-0234-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pacific people living in New Zealand have higher mortality rates than New Zealand residents of European/Other ethnicity. The aim of this paper is to see whether Pacific mortality rates vary by natality and duration of residence. We used linked census-mortality information for 25- to 74-year-olds in the 2001 census followed for up to three years. Hierarchical Bayesian modeling provided a means of handling sparse data. Posterior mortality rates were directly age-standardized. We found little evidence of mortality differences between the overseas-born and the New Zealand-born for all-cause, cancer, and cardiovascular disease (CVD) mortality. However, we found evidence for lower all-cause (and possibly cancer and CVD) mortality rates for Pacific migrants resident in New Zealand for less than 25 years relative to those resident for more than 25 years. This result may arise from a combination of processes operating over time, including health selection effects from variations in New Zealand's immigration policy, the location of Pacific migrants within the social, political, and cultural environment of the host community, and health impacts of the host culture. We could not determine the relative importance of these processes, but identifying the (modifiable) drivers of the inferred long-term decline in health of the overseas-born Pacific population relative to more-recent Pacific migrants is important to Pacific communities and from a national health and policy perspective.
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Affiliation(s)
- Ken Richardson
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, PO Box 7343, Wellington, New Zealand,
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Teh R, Doughty R, Connolly M, Broad J, Pillai A, Wilkinson T, Edlin R, Jatrana S, Dyall L, Kerse N. Agreement between self-reports and medical records of cardiovascular disease in octogenarians. J Clin Epidemiol 2013; 66:1135-43. [PMID: 23860185 DOI: 10.1016/j.jclinepi.2013.05.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 04/24/2013] [Accepted: 05/02/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Self-reported health and disease status is a common method used in epidemiologic studies and surveys involving younger populations, but its reliability in octogenarians is unknown. The objective of the present study was to examine the level of agreement between self-reports and medical records on specific cardiovascular diagnoses. STUDY DESIGN AND SETTING The Life and Living to Advanced Age: a Cohort Study in New Zealand recruited 937 octogenarians in New Zealand. Standardized questionnaires were administered to determine sociodemographic status and medical history. Diagnoses of myocardial infarction (MI), stroke, congestive heart failure (CHF), and hypertension were compared between self-reports and two combined sources of medical records. RESULTS There were moderate levels of agreement between self-reports and medical records for MI, stroke, and hypertension (κ = 0.43-0.45) and low levels for CHF (κ = 0.19). The proportion of discordance for MI, stroke, CHF, and hypertension was 16%, 12%, 22%, and 27%, respectively. Adjusting for socioeconomic-demographic status and cognitive function, the number of comorbidities is highly associated with agreement between self-reports and medical records (P < 0.01). Gender, socioeconomic status, and cognitive function were also related to agreement between self-reports and medical records, but the strength of association was ethnic specific. CONCLUSION Self-reported information on specific cardiovascular conditions has only modest reliability in octogenarians and is associated with number of comorbidities.
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Affiliation(s)
- Ruth Teh
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
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Hayman KJ, Kerse N, Dyall L, Kepa M, Teh R, Wham C, Clair VWS, Wiles J, Keeling S, Connolly MJ, Wilkinson TJ, Moyes S, Broad JB, Jatrana S. Life and living in advanced age: a cohort study in New Zealand--e Puāwaitanga o Nga Tapuwae Kia Ora Tonu, LiLACS NZ: study protocol. BMC Geriatr 2012; 12:33. [PMID: 22747503 PMCID: PMC3502153 DOI: 10.1186/1471-2318-12-33] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 06/29/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of people of advanced age (85 years and older) is increasing and health systems may be challenged by increasing health-related needs. Recent overseas evidence suggests relatively high levels of wellbeing in this group, however little is known about people of advanced age, particularly the indigenous Māori, in Aotearoa, New Zealand. This paper outlines the methods of the study Life and Living in Advanced Age: A Cohort Study in New Zealand. The study aimed to establish predictors of successful advanced ageing and understand the relative importance of health, frailty, cultural, social & economic factors to successful ageing for Māori and non-Māori in New Zealand. METHODS/DESIGN A total population cohort study of those of advanced age. Two cohorts of equal size, Māori aged 80-90 and non-Māori aged 85, oversampling to enable sufficient power, were enrolled. A defined geographic region, living in the Bay of Plenty and Lakes District Health Board areas of New Zealand, defined the sampling frame. Rūnanga (Māori tribal organisations) and Primary Health Organisations were subcontracted to recruit on behalf of the University. Measures--a comprehensive interview schedule was piloted and administered by a trained interviewer using standardised techniques. Socio-demographic and personal history included tribal affiliation for Māori and participation in cultural practices; physical and psychological health status used standardised validated research tools; health behaviours included smoking, alcohol use and nutrition risk; and environmental data included local amenities, type of housing and neighbourhood. Social network structures and social support exchanges are recorded. Measures of physical function; gait speed, leg strength and balance, were completed. Everyday interests and activities, views on ageing and financial interests complete the interview. A physical assessment by a trained nurse included electrocardiograph, blood pressure, hearing and vision, anthropometric measures, respiratory function testing and blood samples. DISCUSSION A longitudinal study of people of advanced age is underway in New Zealand. The health status of a population based sample of older people will be established and predictors of successful ageing determined.
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Affiliation(s)
- Karen J Hayman
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Lorna Dyall
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Mere Kepa
- Te Kupenga Hauora, Department of Māori Studies, University of Auckland, Auckland, New Zealand
| | - Ruth Teh
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Carol Wham
- Institute of Food, Nutrition and Human Health, Massey University, Auckland, New Zealand
| | - Valerie Wright-St Clair
- School of Rehabilitation & Occupation Studies, Auckland University of Technology, Auckland, New Zealand
| | - Janine Wiles
- Department of Community Health, University of Auckland, Auckland, New Zealand
| | - Sally Keeling
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Martin J Connolly
- Freemasons’ Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Tim J Wilkinson
- Dept of Medicine, University of Otago, Christchurch, New Zealand
| | - Simon Moyes
- Department of General Practice and Primary Healthcare, University of Auckland, Private Bay, 92109, Auckland, New Zealand
| | - Joanna B Broad
- Freemasons’ Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University, Sydney, Australia
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Jatrana S, Crampton P. Gender differences in financial barriers to primary health care in New Zealand. J Prim Health Care 2012; 4:113-122. [PMID: 22675695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Gender differences in health status and use of health care services have been established in the developed world with less attention paid to gender differences in financial barriers to primary care. Such barriers represent potentially avoidable mortality and morbidity. AIM To examine gender differences in financial barriers to New Zealand primary health care. METHODS Data from SoFIE-health, an add-on to Statistics New Zealand-led Survey of Family, Income and Employment (SoFIE), analysed using logistic regression, controlling for demographic, socioeconomic, health behaviour and health variables. Access to primary health care includes general practitioner and dental care and prescription drugs. RESULTS Odds of deferring seeing their doctor(s), dentist and buying a prescription respectively at least once during preceding 12 months, because they could not afford the cost of a visit or prescription, were greater for women compared to men (Odds Ratio (OR) 1.82, 95% CI: 1.67-1.99; OR 2.05, 95% CI: 1.78-2.34; and OR 1.58, 95% CI: 1.47-1.71; respectively). Adjusting for demographic, socioeconomic, health behaviour and health status attenuated OR to 1.45 (1.31-1.61) for deferring medical visit, 1.47 (1.26-1.71) buying prescription, and 1.35 (1.24-1.46) for deferring dental visit, although confidence intervals still excluded the null. DISCUSSION Gender significantly associated with reporting cost barriers to primary health care, regardless of individual deprivation or income levels, suggesting that primary health care policies targeting gender-specific factors are warranted. Policy measures to reduce co-payments may improve access to care for both women and men, and may have positive health implications.
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Affiliation(s)
- Santosh Jatrana
- Alfred Deakin Research Institute, Deakin University, Geelong Geelong, Victoria 3220, Australia.
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Jatrana S, Crampton P, Richardson K, Norris P. Increasing prescription part charges will increase health inequalities in New Zealand. N Z Med J 2012; 125:78-80. [PMID: 22722220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Abstract
INTRODUCTION: Gender differences in health status and use of health care services have been established in the developed world with less attention paid to gender differences in financial barriers to primary care. Such barriers represent potentially avoidable mortality and morbidity. AIM: To examine gender differences in financial barriers to New Zealand primary health care. METHODS: Data from SoFIE-health, an add-on to Statistics New Zealandled Survey of Family, Income and Employment (SoFIE), analysed using logistic regression, controlling for demographic, socioeconomic, health behaviour and health variables. Access to primary health care includes general practitioner and dental care and prescription drugs. RESULTS: Odds of deferring seeing their doctor(s), dentist and buying a prescription respectively at least once during preceding 12 months, because they could not afford the cost of a visit or prescription, were greater for women compared to men (Odds Ratio (OR) 1.82, 95% CI: 1.671.99; OR 2.05, 95% CI: 1.782.34; and OR 1.58, 95% CI: 1.471.71; respectively). Adjusting for demographic, socioeconomic, health behaviour and health status attenuated OR to 1.45 (1.311.61) for deferring medical visit, 1.47 (1.261.71) buying prescription, and 1.35 (1.241.46) for deferring dental visit, although confidence intervals still excluded the null. DISCUSSION: Gender significantly associated with reporting cost barriers to primary health care, regardless of individual deprivation or income levels, suggesting that primary health care policies targeting gender-specific factors are warranted. Policy measures to reduce co-payments may improve access to care for both women and men, and may have positive health implications. KEYWORDS: Gender; primary health care; access barriers; New Zealand
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Jatrana S, Carter K, McKenzie S, Wilson N. Binge drinking is patterned by demographic and socioeconomic position in New Zealand: largest national survey to date. N Z Med J 2011; 124:110-115. [PMID: 22072182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Jatrana S, Crampton P, Richardson K. Continuity of care with general practitioners in New Zealand: results from SoFIE-Primary Care. N Z Med J 2011; 124:16-25. [PMID: 21475356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Continuity of care has been defined as seeing the same health care provider over time, and has been shown to be associated with positive health outcomes, high quality care, high patient satisfaction with care and with lowering health care costs. While the benefits of continuity of care with a primary care provider are well documented, relatively little is known about those patients who receive or do not receive continuity of care. Using data from SoFIE-health, which is an add-on to the Statistics New Zealand-led Survey of Family, Income and Employment, this paper aims to construct a summary measure of continuity of care and to contribute to an enhanced understanding of the prevalence of continuity of care in New Zealand. We used the Primary Care Assessment Tools (PCAT) to create a mean score of continuity of care. We found continuity of care is high in New Zealand. Overall, our data provide some support for the hypothesis that people with high health needs have higher mean continuity of care scores (e.g. the elderly, Pacific and Asian ethnic groups, those in the low income tertile, and those with one or more chronic conditions). The authors propose that continued incentives to develop and sustain affiliation with a primary care provider and continuity of care are important for maintaining the quality and cost-effectiveness of primary health care.
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Affiliation(s)
- Santosh Jatrana
- Department of Public Health, University of Otago, Wellington, PO Box 7343, Wellington, New Zealand.
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Hajat A, Blakely T, Dayal S, Jatrana S. Do New Zealand's immigrants have a mortality advantage? Evidence from the New Zealand Census-Mortality Study. Ethn Health 2010; 15:531-547. [PMID: 20672201 DOI: 10.1080/13557858.2010.496479] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine all-cause mortality differentials among New Zealand's (NZ) immigrant population. Unlike other studies that use the total non-migrant population as the reference group, we use NZ-born populations of the same ethnic group for comparison purposes. Our study intends to answer two questions: first, do immigrants have a mortality advantage relative to their NZ-born counterparts of the same ethnicity? Second, does an immigrant mortality advantage, if one exists, decline as duration of residence increases? DESIGN Data from the New Zealand Census-Mortality Study from 1996-1999 and 2001-2004 were used. The main variable of interest, years of residence in NZ, was classified as living in NZ for less than 5, 5-9, 10-19, 20-34, 35 or more years, and born in NZ. Three main ethnic groups were examined, such as Asian, Pacific, and European/Other. Mortality rates for subgroups within these broad ethnic groups were not calculated. Negative binomial models controlled for socioeconomic and demographic factors to assess the independent effect of duration of residence on mortality. RESULTS European/Other and Asian immigrants have a mortality advantage relative to their NZ-born counterparts, which declines as length of residence increases. Within strata of duration of residence, there are few differences between European/Other and Asian mortality. Pacific immigrants showed no statistically significant mortality advantage relative to the NZ-born Pacific people, and had higher mortality rates than Europeans/Others or Asians regardless of duration in NZ. CONCLUSION Findings from our study are consistent with international literature. Both the healthy migrant effect and acculturation may be responsible for the protective mortality effect among Asians and Europeans/Others that erodes over time. However, our results for the Pacific population suggest some migrant groups come to the host country with a health disadvantage and with no apparent healthy migrant effect.
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Affiliation(s)
- Anjum Hajat
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI 48109-2029, USA.
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Abstract
OBJECTIVES This paper aims to examine ethnic differences in financial barriers to access to prescription medication in New Zealand. METHODS Data from SoFIE-Health (wave 3), which is an add-on to the Statistics New Zealand-led longitudinal Survey of Family, Income and Employment (SoFIE) (N=18 320), were analysed using logistic regression, adjusting for demographic, socioeconomic, health behaviour and health variables. Financial barriers to access to prescription items were measured by the following question: 'In the past 12 months, have there been any times when a doctor gave you a prescription, but you didn't collect one or more of these items because you could not afford the cost?'. RESULTS The odds of deferring buying a prescription at least once during the preceding 12 months because they could not afford the cost of the prescription were greater for Māori and Pacific people than for NZ Europeans (OR 2.98, 95% CI 2.56 to 3.47 vs OR 3.52, 95% CI 2.85 to 4.35). Adjusting for potential confounders attenuated the ORs to 1.31 (95% CI 1.08 to 1.58) for Māori people and to 2.17 (95% CI 1.68 to 2.81) for Pacific people. Deferring buying medications because of cost was also associated with increased odds of poor self-reported health status, high/very high psychological stress and the presence of two or more comorbid conditions. CONCLUSION Ethnicity plays a critical role in facilitating or impeding access to primary health care. This suggests that policy measures to further reduce financial barriers to buying medication may improve access to care for everyone including Māori and Pacific people and may have positive health implications.
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Affiliation(s)
- Santosh Jatrana
- School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
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Jatrana S, Crampton P. Primary health care in New Zealand: Who has access? Health Policy 2009; 93:1-10. [DOI: 10.1016/j.healthpol.2009.05.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 04/22/2009] [Accepted: 05/06/2009] [Indexed: 11/30/2022]
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Jatrana S, Crampton P, Filoche S. The case for integrating oral health into primary health care. N Z Med J 2009; 122:43-52. [PMID: 19829391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Severe disparities in oral health and inequities in access to oral health care exist globally. In New Zealand, the cost of oral health services is high. Physician services and medicines are heavily subsidised by the government -- however, in contrast, private financing, either as out-of-pocket payments or as private insurance, dominates dental care. Consequently, the use of services is often prompted by symptoms, and services are mostly oriented towards relief of pain. The high cost of dental care with insufficient emphasis on primary prevention of oral diseases, poses a considerable challenge for providing equitable access to health care as laid down by the Alma-Ata Declaration on Primary Health Care (PHC). While improving oral health is one of the health objectives of the New Zealand Health Strategy, providing accessible and affordable oral health services does not feature prominently in the current Primary Health Care Strategy. This paper discusses current knowledge regarding oral health in relation to general health and health care strategies and frameworks, in order to highlight that oral health care is an important component of primary health care. The authors also propose that oral health care should be integrated into primary health care in New Zealand. This could be achieved by placing oral health within the broader framework of PHC as encapsulated by the Alma-Ata Declaration and the New Zealand Primary Health Care Strategy.
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Affiliation(s)
- Santosh Jatrana
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand.
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Abstract
INTRODUCTION: This paper aims to examine gender differences in general practice utilisation in New Zealand. METHODS: The data for this research came from 10 506 visit records gathered from 246 general practitioners (GPs) who took part in the National Primary Medical Care Survey (NatMedCa), a nationally representative, multistage, probability sample survey of GPs and patient visits conducted in 2001/2002. The number of visits to a general practice in the last 12 months among those patients who visited the GP at least once during the past 12 months was used as the outcome variable. Poisson regression was used for analysis. RESULTS: Women were more likely than men to visit a GP over the last 12 months (IRR=1.13; 95% CI: 1.03–1.24). We also found significant female excess in utilisation of GP services even after excluding gynaecological and obstetric conditions and across all age groups. Asian were 39% less likely than European women to visit a GP (IRR=0.61; 95% CI: 0.43–0.85); a result that was not reflected in men’s utilisation of GP services. In addition, we found that women visiting GPs were 39% more likely to have reported ‘life-threatening’ problems as compared to ‘self-limiting’ problems (IRR=1.39; 95% CI: 1.00–1.94). CONCLUSION: Our results do not support the body of literature that suggests that women’s excess in service use can largely be attributed to gynaecological and obstetrical conditions or that the female excess in visits is focussed in the childbearing years. Ethnicity and the severity of a problem contributed significantly to explaining women’s, but not men’s, utilisation of GPs. KEYWORDS: Gender differences; health services utilisation; New Zealand
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Gross R, McNeill R, Davis P, Lay-Yee R, Jatrana S, Crampton P. The association of gender concordance and primary care physicians' perceptions of their patients. Women Health 2008; 48:123-44. [PMID: 19042213 DOI: 10.1080/03630240802313464] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this article, we examined the effect of gender concordance on physicians' perception of their patients and of their medical condition, analyzing a data set of 8,258 visit questionnaires from the New Zealand National Primary Care Medical Care Survey conducted in 2001 2002. Multivariate analysis indicated that the concordant female patient/female physician dyad had a positive independent association with physicians' reporting high rapport and a negative independent association with reporting uncertainty about the diagnosis. The discordant female patient/male physician dyad had a positive independent association with physicians' perceptions of uncertainty of diagnosis and hidden agenda, and a negative independent association with rating the patient's condition of high severity. The findings suggest a need to raise male physicians' awareness to possible biases when treating female patients. The findings also suggest the need to empower female patients to take an active partnership role to improve their communication with male physicians.
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Affiliation(s)
- Revital Gross
- School of Social Work, Bar Ilan University, Jerusalem, Israel.
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Abstract
This paper examines the effects of socioeconomic characteristics on older adult health and investigates whether these socioeconomic effects carry through from the young-old to the oldest-old ages among Singaporean adults. Previous research shows little consensus over whether the impact of socioeconomic factors on health diminish with age. The variation in these results may be due to different definitions of socio-economic status, or the use of different health indicators. We use a comprehensive set of socioeconomic indicators (income, education level, homeownership, asset possession, and perceived income adequacy) to predict three health outcomes; poor self-assessed health, the presence of chronic illness, and functional disability. We find that while socioeconomic differentials in health status exist, the associations are not as consistent, nor as strong, as those reported for Western settings. Health inequalities related with socioeconomic status decline slightly but do not disappear with old age in Singapore.
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Affiliation(s)
- Santosh Jatrana
- Department of Public Health, Wellington School of Medicine and Health Sciences, University of Otago, Wellington South, New Zealand.
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Crampton P, Jatrana S, Lay-Yee R, Davis P. Exposure to primary medical care in New Zealand: number and duration of general practitioner visits. N Z Med J 2007; 120:U2582. [PMID: 17589550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
AIMS To estimate (among different population groups and different practice types) average duration of visit to a general practitioner, average number of visits, and average population exposure to primary medical care in New Zealand. METHODS Observational study using a representative survey of visits to general practitioners in New Zealand. Average exposure to primary medical care for a particular class of patient (e.g. by age group) was calculated as the average of the product of number of visits over the past 12 months and duration of visit for the current visit. Comparisons were made across different demographic groups of patients and different practice types. RESULTS Annual exposure to primary medical care was highest amongst the elderly (65+ years), followed by adults (18-64 years). Adjusting for age, gender, NZDep2001, rural/urban, and organisation type, average annual exposure to primary medical care was higher in the European ethnic group than in the Maori, Pacific, and Asian ethnic groups. Exposure to primary medical care did not differ significantly across NZDep2001 quintiles after controlling for other co-variates. CONCLUSIONS Annual exposure to primary medical care is both a direct measure of utilisation of primary medical care and also an indicator of access. Primary medical care exposure measurement can be used to monitor equity of service provision across different population groups: groups with high identified health care needs should have relatively high exposure to primary medical care. The most obvious breach of this principle is for Maori and Pacific users of primary medical care and for those living in deprived areas. Similarly, the low overall exposure to primary medical care for the Asian ethnic group is concerning and warrants further exploration.
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Affiliation(s)
- Peter Crampton
- Department of Public Health, University of Otago, Wellington, Wellington.
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