Asunto(s)
Lupus Eritematoso Sistémico , Nativos de Hawái y Otras Islas del Pacífico , Resultado del Embarazo , Humanos , Lupus Eritematoso Sistémico/etnología , Femenino , Embarazo , Resultado del Embarazo/epidemiología , Australia/epidemiología , Nativos de Hawái y Otras Islas del Pacífico/etnología , Factores de Confusión Epidemiológicos , Complicaciones del Embarazo/etnología , Complicaciones del Embarazo/epidemiología , Aborigenas Australianos e Isleños del Estrecho de TorresAsunto(s)
Lupus Eritematoso Sistémico , Nativos de Hawái y Otras Islas del Pacífico , Resultado del Embarazo , Humanos , Femenino , Embarazo , Lupus Eritematoso Sistémico/etnología , Lupus Eritematoso Sistémico/diagnóstico , Lupus Eritematoso Sistémico/epidemiología , Resultado del Embarazo/epidemiología , Australia/epidemiología , Nativos de Hawái y Otras Islas del Pacífico/etnología , Adulto , Complicaciones del Embarazo/etnología , Factores de Confusión Epidemiológicos , Aborigenas Australianos e Isleños del Estrecho de TorresRESUMEN
BACKGROUND: The Australian National Perinatal Data Collection collates all live and stillbirths from States and Territories in Australia. In that database, maternal cigarette smoking is noted twice (smoking <20 weeks gestation; smoking >20 weeks gestation). Cannabis use and other forms of nicotine use, for example vaping and nicotine replacement therapy, are nor reported. The 2021 report shows the rate of smoking for Australian Indigenous mothers was 42% compared with 11% for Australian non-Indigenous mothers. Evidence shows that Indigenous babies exposed to maternal smoking have a higher rate of adverse outcomes compared to non-Indigenous babies exposed to maternal smoking (S1 File). OBJECTIVES: The reasons for the differences in health outcome between Indigenous and non-Indigenous pregnancies exposed to tobacco and nicotine is unknown but will be explored in this project through a number of activities. Firstly, the patterns of parental and household tobacco, nicotine and cannabis use and exposure will be mapped during pregnancy. Secondly, a range of biological samples will be collected to enable the first determination of Australian Indigenous people's nicotine and cannabis metabolism during pregnancy; this assessment will be informed by pharmacogenomic analysis. Thirdly, the pharmacokinetic and pharmacogenomic findings will be considered against maternal, placental, foetal and neonatal outcomes. Lastly, an assessment of population health literacy and risk perception related to tobacco, nicotine and cannabis products peri-pregnancy will be undertaken. METHODS: This is a community-driven, co-designed, prospective, mixed-method observational study with regional Queensland parents expecting an Australian Indigenous baby and their close house-hold contacts during the peri-gestational period. The research utilises a multi-pronged and multi-disciplinary approach to explore interlinked objectives. RESULTS: A sample of 80 mothers expecting an Australian Indigenous baby will be recruited. This sample size will allow estimation of at least 90% sensitivity and specificity for the screening tool which maps the patterns of tobacco and nicotine use and exposure versus urinary cotinine with 95% CI within ±7% of the point estimate. The sample size required for other aspects of the research is less (pharmacokinetic and genomic n = 50, and the placental aspects n = 40), however from all 80 mothers, all samples will be collected. CONCLUSIONS: Results will be reported using the STROBE guidelines for observational studies. FORWARD: We acknowledge the Traditional Custodians, the Butchulla people, of the lands and waters upon which this research is conducted. We acknowledge their continuing connections to country and pay our respects to Elders past, present and emerging. Notation: In this document, the terms Aboriginal and Torres Strait Islander and Indigenous are used interchangeably for Australia's First Nations People. No disrespect is intended, and we acknowledge the rich cultural diversity of the groups of peoples that are the Traditional Custodians of the land with which they identify and with whom they share a connection and ancestry.
Asunto(s)
Nativos de Hawái y Otras Islas del Pacífico , Nicotina , Humanos , Embarazo , Femenino , Australia/epidemiología , Adulto , Resultado del Embarazo/epidemiología , Cannabis/efectos adversos , Exposición Materna/efectos adversos , Efectos Tardíos de la Exposición PrenatalRESUMEN
Precision public healthcare has been applied to bring about positive change, narrowing the gap in healthcare inequity for Aboriginal peoples. Three such examples include the Mappa, Lyfe Languages, and Pilbra Faces projects, which were all developed through engagement and codesign with Indigenous Australians and each meet a distinct critical need. The Mappa project offers patients and healthcare providers with the necessary geographical information to navigate and maximally utilize available healthcare services. Lyfe Languages is a community driven translational tool that empowers indigenous languages in healthcare. The Pilbara Faces project aims to create a database of clinical measurements enabling better disease diagnosis and monitoring. These three projects have been integrated into a multi-faceted precision public health program, the Healthy Pilbara Project Initiative, acting synergistically to improve the lives of Aboriginal peoples living in Western Australia.
Asunto(s)
Nativos de Hawái y Otras Islas del Pacífico , Salud Pública , Humanos , Servicios de Salud del Indígena/organización & administración , Australia Occidental , Disparidades en Atención de SaludRESUMEN
INTRODUCTION: Aboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention and Risk Management Program for Aboriginal Australians (DAMPAA) is an Aboriginal Health Practitioner led programme that aims to reduce cognitive decline and functional impairment in older Aboriginal people. METHODS: Design: DAMPAA is a multisite, randomised controlled trial aiming to deliver and evaluate a culturally appropriate risk factor management programme. POPULATION: Community-dwelling Aboriginal people aged 45-90 years. INTERVENTION: Participants will be randomly assigned to either usual care (control) or to a group programme comprising exercise and health education yarning sessions and pharmacist-delivered medication reviews delivered over a 12-month period. PRIMARY OUTCOME: Cognitive function (Kimberley Indigenous Cognitive Assessment (KICA)-Cog score), daily function (KICA-Activities of Daily Living (ADL) score) and quality of life (Good Spirit, Good Life and EQ-5D-5L scores). SECONDARY OUTCOMES: Process evaluation interviews, cardiovascular risk factors, falls and death. Process evaluation will be conducted with qualitative methods. Quantitative outcomes will be analysed with generalised linear mixed models. ETHICS AND DISSEMINATION: The study was approved by the Western Australian Aboriginal Health Ethics Committee and the University of Western Australia Human Research Ethics Committee. Study results will be published in peer-reviewed journals and presented at scientific meetings. We will also develop and disseminate a comprehensive DAMPAA toolkit for health services. The study's findings will guide future prevention strategies and outline a comprehensive process evaluation that may be useful in other Aboriginal health research to contextualise findings.
Asunto(s)
Demencia , Nativos de Hawái y Otras Islas del Pacífico , Humanos , Demencia/prevención & control , Demencia/etnología , Australia , Anciano , Anciano de 80 o más Años , Servicios de Salud del Indígena/organización & administración , Gestión de Riesgos/métodos , Persona de Mediana Edad , Ensayos Clínicos Controlados Aleatorios como Asunto , Calidad de Vida , Femenino , Masculino , Actividades Cotidianas , Factores de Riesgo , Aborigenas Australianos e Isleños del Estrecho de TorresRESUMEN
BACKGROUND: The recent crises of bushfires, floods, and the COVID-19 pandemic on the southeast coast of Australia were unprecedented in their extent and intensity. Few studies have investigated responses to cumulative disasters in First Nations communities, despite acknowledgement that these crises disproportionately impact First Nations people. This study was conducted by Aboriginal and non-Aboriginal researchers in partnership with Waminda, South Coast Women's Health and Wellbeing Aboriginal Corporation, an Aboriginal Community Controlled Health Organisation (ACCHO). It investigated the collective experiences of people affected by cumulative disasters to identify the practices that support healing, and recovery for Aboriginal communities. The study addresses a knowledge gap of how Waminda, designs, manages and delivers responses to address complex health and social issues in the context of cumulative disasters. METHODS: Underpinned by practice theory this study employed Indigenous-informed, narrative inquiry. Culturally-appropriate, multiple interpretive methods were used to collect data including: observations; yarns with Aboriginal community members, yarns with Waminda practitioners, management and board members; interviews-to-the-double, visual images and documentation. The data were collated and analysed using the phases of reflexive thematic analysis. RESULTS: The paper articulates a suite of culturally safe and place-based practices that enhance social, emotional and spiritual well-being following cumulative disasters. These practice bundles include: adopting a Country-centred conception of local communities; being community-led; viewing care as a collective, relational, sociomaterial accomplishment and having fluid boundaries. These practice bundles 'hang together' through organising practices including the Waminda Model of Care, staff wellbeing framework and emergency management plan which orient action and manage risks. The paper demonstrates the need for disaster responses to be community-led and culturally situated. ACCHOs are shown to play a crucial role, and their local responses to immediate community needs are grounded in contextual knowledge and use existing resources rather than relying on mainstream system-wide interventions. CONCLUSIONS: The paper suggests crafting responses that focus on assisting communities (re)gain their sense of belonging, hope for the future, control over their lives and their capacities to care for and to be cared for by Country, are key to both enhancing healing, health and well-being and harnessing the strengths of communities.
Asunto(s)
COVID-19 , Servicios de Salud del Indígena , Nativos de Hawái y Otras Islas del Pacífico , Humanos , Nativos de Hawái y Otras Islas del Pacífico/psicología , Femenino , COVID-19/epidemiología , Servicios de Salud del Indígena/organización & administración , Australia , Desastres , Masculino , SARS-CoV-2 , AdultoRESUMEN
A form of food retail regulation called the Stores Licensing Scheme was introduced by the Australian Government in 2007-2022 to ensure food security in remote Indigenous communities of the Northern Territory. We examined evaluations of this Scheme implemented under the Northern Territory National Emergency Response and Stronger Futures Northern Territory Acts. Grey literature search identified nine primary source evaluations. Reported outcomes were extracted and thematic analysis utilised to determine barriers and enablers. Outcomes included improved availability and quality of groceries, financial structures, and retail practices, albeit not consistently reported. Governance and food cost were perceived barriers. Future policy aimed to improve food security through community stores should consider food cost subsidy, measures to incentivise all stores to improve standards, and improved governance arrangements enabling self-determination for Aboriginal and Torres Strait Islander Store Directors.
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Nativos de Hawái y Otras Islas del Pacífico , Northern Territory , Humanos , Concesión de Licencias , Comercio , Población Rural , Abastecimiento de Alimentos , Seguridad AlimentariaRESUMEN
Rapa Nui (also known as Easter Island) is one of the most isolated inhabited places in the world. It has captured the imagination of many owing to its archaeological record, which includes iconic megalithic statues called moai1. Two prominent contentions have arisen from the extensive study of Rapa Nui. First, the history of the Rapanui has been presented as a warning tale of resource overexploitation that would have culminated in a major population collapse-the 'ecocide' theory2-4. Second, the possibility of trans-Pacific voyages to the Americas pre-dating European contact is still debated5-7. Here, to address these questions, we reconstructed the genomic history of the Rapanui on the basis of 15 ancient Rapanui individuals that we radiocarbon dated (1670-1950 CE) and whole-genome sequenced (0.4-25.6×). We find that these individuals are Polynesian in origin and most closely related to present-day Rapanui, a finding that will contribute to repatriation efforts. Through effective population size reconstructions and extensive population genetics simulations, we reject a scenario involving a severe population bottleneck during the 1600s, as proposed by the ecocide theory. Furthermore, the ancient and present-day Rapanui carry similar proportions of Native American admixture (about 10%). Using a Bayesian approach integrating genetic and radiocarbon dates, we estimate that this admixture event occurred about 1250-1430 CE.
Asunto(s)
Indio Americano o Nativo de Alaska , ADN Antiguo , Pueblo Europeo , Genética de Población , Genoma Humano , Migración Humana , Nativos de Hawái y Otras Islas del Pacífico , Femenino , Humanos , Masculino , Indio Americano o Nativo de Alaska/genética , Indio Americano o Nativo de Alaska/historia , Américas/etnología , Teorema de Bayes , ADN Antiguo/análisis , Europa (Continente)/etnología , Pueblo Europeo/genética , Pueblo Europeo/historia , Genoma Humano/genética , Historia del Siglo XVII , Historia del Siglo XVIII , Historia del Siglo XIX , Historia del Siglo XX , Historia Antigua , Historia Medieval , Migración Humana/historia , Nativos de Hawái y Otras Islas del Pacífico/genética , Nativos de Hawái y Otras Islas del Pacífico/historia , Filogenia , Polinesia/etnología , Densidad de Población , Datación Radiométrica , Secuenciación Completa del GenomaRESUMEN
BACKGROUND: The care of wounds is an ongoing issue for Indigenous people worldwide, yet culturally safe Indigenous wound care training programs for rural and remote Australian Aboriginal Health Workers are largely unavailable. The higher prevalence of chronic disease, lower socioeconomic status and poorer access to services experienced by Aboriginal and Torres Strait Islanders compared to non-Indigenous people, leads to a greater incidence of chronic wounds in Aboriginal and Torres Strait Islander people. Identifying the barriers and enablers for delivering wound care will establish areas of need for facilitating the development of a specific wound care program for Aboriginal Health Workers and Aboriginal Health Practitioners. This paper reports the first phase of a larger project directly aligned to the Indigenous Australians' Health Program's objective of supporting the delivery and access to high quality, culturally appropriate health care and services to Aboriginal and Torres Strait Islander Australians. This study aimed to examine experiences of Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses for managing chronic wounds within rural and remote Aboriginal Medical Services in Queensland, Australia. METHODS: Yarning facilitated by two Aboriginal researchers among Aboriginal Health Workers, Aboriginal Health Practitioners, and nurses currently employed within four Aboriginal Medical Services located in rural and remote areas of Queensland, Australia. RESULTS: Two themes were developed through rigorous data analysis of yarning information and responses: participants' experiences of managing wounds and barriers and enablers to effective wound care. CONCLUSIONS: This study contributes an insight into the experiences of Aboriginal Health Workers on the current barriers and enablers to timely treatment of chronic wounds. Results from this study indicate a significant barrier to obtaining timely and effective wound care in regional and remote settings is access to an appropriately skilled, culturally competent, and resourced health work force. A lack of education and professional development for Aboriginal Health Workers can compromise their ability to maximise patient outcomes and delay wound healing. Findings have informed the development of an evidence based, culturally competent open access chronic wound care education program for Aboriginal Health Workers.
Asunto(s)
Servicios de Salud del Indígena , Nativos de Hawái y Otras Islas del Pacífico , Servicios de Salud Rural , Heridas y Lesiones , Humanos , Queensland , Heridas y Lesiones/terapia , Heridas y Lesiones/etnología , Servicios de Salud del Indígena/organización & administración , Servicios de Salud Rural/organización & administración , Femenino , Masculino , Población Rural , Personal de Salud/educación , Mejoramiento de la Calidad , AdultoRESUMEN
AIM: To examine the impact of integrated employment support and mental health treatment (Individual Placement and Support, or "IPS") on Aotearoa New Zealand participants' employment, income, health, education and justice outcomes. METHOD: De-identified linked data from the Stats NZ Integrated Data Infrastructure and propensity score matching were used to estimate effects. RESULTS: In total, 1,659 IPS participants were matched to 1,503 non-participants. Compared with matched non-participants, matched participants were 1.6 times more likely to be in employment at 12 months. Over 3 years, matched IPS participants had more earnings, more time in employment, greater total income and were more likely to gain qualifications. They also had more face-to-face contacts with mental health teams, mental health-related inpatient stays and mental health service crisis contacts than matched non-participants. Effects for Maori were similar in direction and scale to the overall results. CONCLUSION: Our results show that people with mental health conditions or problematic substance use who receive employment support made available together with mental health and addiction treatment have more employment, gains in qualifications and more independent income when compared to similar people who do not receive this support. More research is needed to understand differences in engagement with mental health services and effects on participants' health and wellbeing.
Asunto(s)
Empleos Subvencionados , Trastornos Mentales , Humanos , Nueva Zelanda , Femenino , Masculino , Adulto , Trastornos Mentales/terapia , Trastornos Mentales/epidemiología , Empleo/estadística & datos numéricos , Servicios de Salud Mental/estadística & datos numéricos , Renta , Persona de Mediana Edad , Estado de Salud , Adulto Joven , Nativos de Hawái y Otras Islas del Pacífico , Trastornos Relacionados con Sustancias/terapia , Trastornos Relacionados con Sustancias/epidemiologíaRESUMEN
AIMS: Ethnicity is an important variable, and in Aotearoa New Zealand it is used to monitor population health needs, health services outcomes and to allocate resources. However, there is a history of undercounting Maori. The aim of this study was to compare national and primary care ethnicity data to self-reported ethnicity from a Kaupapa Maori research cohort in the Waikato region. METHODS: Through individual record linkage, prospective self-reported ethnicity, collected using New Zealand Census and Ministry of Health - Manatu Hauora ethnicity protocol as a "gold standard", was compared to ethnicity in secondary and primary healthcare datasets. Logistic regression analyses were used to determine if demographic variables such as age, ethnicity and deprivation are associated with inaccuracies in ethnicity recording. RESULTS: Maori were undercounted in secondary NHI (32.5%) and primary care (31.3%) datasets compared to self-reported (34.6%). Between 9.5-11% of individuals had a different ethnicity recorded in health datasets than self-reported. Multiple ethnicities were less often recorded (secondary NHI [5.3%] and primary care [5.8%]) compared to self-reported (8.7%). Maori ethnicity (p=0.039) and multiple ethnicity (p<0.001) were associated with lower ethnicity data accuracy. CONCLUSION: Routine health datasets fail to adequately collect ethnicity, particularly for those with multiple ethnicities. Inaccuracies disproportionately affect Maori and urgent efforts are needed to improve compliance with ethnicity data standards at all levels of the health system.
Asunto(s)
Etnicidad , Nativos de Hawái y Otras Islas del Pacífico , Atención Primaria de Salud , Autoinforme , Humanos , Nueva Zelanda , Atención Primaria de Salud/estadística & datos numéricos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Adolescente , Etnicidad/estadística & datos numéricos , Adulto Joven , Atención Secundaria de Salud/estadística & datos numéricos , Anciano , Niño , Preescolar , Exactitud de los Datos , LactanteRESUMEN
This article makes a case for Maori organisations to investigate developing hospitals in addition to hauora primary care services. Our programme of research on kaumatua hauora has involved ten noho wananga in Te Tai Tokerau, Waikato and Tauranga Moana. During our wananga and associated kanohi-ki-kanohi interviews, we heard from older Maori who experienced hospital stays as detrimental to their wellbeing. At a whakahoki korero with Waikato kaumatua, we were requested to investigate the rationale for a Maori hospital, a wish that has historical roots in Princess Te Puea Herangi's efforts to create a small hospital at Turangawaewae Marae. Her project was stymied by the health authorities of the time. Our observations are backed up by other research demonstrating adverse outcomes for Maori at New Zealand's public hospitals. A small international literature offers some pointers for success in developing hospitals for Indigenous populations. While there are many aspects that would need thorough investigation in a development process (e.g., tikanga, scope, sites, architecture, development finance, cost structures, staffing, clientele and accessibility), we argue that hospitals developed by and for Maori are a long-held dream that could well be enacted in today's health service environment.
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Nativos de Hawái y Otras Islas del Pacífico , Nueva Zelanda , Humanos , Servicios de Salud del Indígena/organización & administración , Pueblo MaoríRESUMEN
BACKGROUND: There is a lack of literature concerning dermatological conditions affecting patients of Pacific ethnicity. AIM: To investigate dermatological conditions in patients of Pacific ethnicity referred to dermatology from 2016 to 2022. METHODS: Single-centre study of electronic referrals to dermatology from January 2016 to May 2022. RESULTS: Pacific ethnicity was recorded for 1.7% of 30,769 referrals to dermatology, under-representing census data for the local population (5.4%). Dermatological diagnoses were eczema in 36% of patients, benign skin lesions in 11% and skin infection in 8.3%. CONCLUSION: Eczema was the most common reason for referral to dermatology in patients of Pacific ethnicity in the Waikato Region.
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Eccema , Nativos de Hawái y Otras Islas del Pacífico , Derivación y Consulta , Humanos , Nueva Zelanda/epidemiología , Eccema/epidemiología , Derivación y Consulta/estadística & datos numéricos , Femenino , Masculino , Adulto , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Persona de Mediana Edad , Adolescente , Niño , Adulto Joven , Anciano , Preescolar , Lactante , Dermatología/estadística & datos numéricos , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/etnologíaRESUMEN
Pacific Island Countries (PICs) have exceptionally high rates of obesity and non-communicable diseases. The causes are complex but one prominent factor is the notable shift from traditional plant and seafood diets to diets high in unhealthy processed foods. Literature is sparse on the motives behind food choice decisions of Pacific Islanders. The widely used Food Choice Questionnaire (FCQ) (Steptoe et al., 1995) is a multi-dimensional tool capturing nine potential food choice motives. This study used a hybrid thematic analysis. Fourteen in-depth semi-structured interviews with urban indigenous Fijian mothers were conducted to (1) explore how the nine FCQ motives impact food choice (2) to examine conceptual equivalence of the nine FCQ motives and (3) to identify additional food choice motives, not captured in the FCQ. Mothers identified seven of the nine FCQ motives (i.e., health, mood, convenience, sensory appeal, weight control and familiarity) and three new food choice motives (i.e., food that is filling, religious dietary restrictions and food quality) as important determinants of food choice. Moreover, while choosing foods that promote health and well-being was identified as an important food choice motive, mothers also identified four other motives, that they considered important, which lead to over-eating and unhealthy eating. Food choice is a complex, layered decision, driven by multiple considerations, some more important than others. These findings can inform diet-related interventions and policy within this community. Adapting the FCQ for broader PIC use through further qualitative exploration in PICs, and validating the adapted FCQ with larger samples will enhance its utility in measuring food choice motives in PICs.
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Conducta de Elección , Preferencias Alimentarias , Motivación , Población Urbana , Humanos , Fiji , Preferencias Alimentarias/psicología , Femenino , Adulto , Encuestas y Cuestionarios , Madres/psicología , Investigación Cualitativa , Dieta/psicología , Nativos de Hawái y Otras Islas del Pacífico/psicología , Adulto Joven , Persona de Mediana EdadRESUMEN
Health promotion programs and strategies have the potential to support people to live healthier lives. Dementia, a collective name for brain disorders that impact thinking and memory, affects over 55 million people worldwide. Currently, there is no cure for dementia, so prevention is critical. Health promotion has the potential to reduce dementia by targeting the twelve potentially modifiable risk factors. A project currently being undertaken by the research team aims to strengthen the quality of clinical care and health services that specifically address dementia risk for Australian Aboriginal and Torres Strait Islander peoples. One of the intended strategies supporting the project's aim is the need for appropriate and safe health promotion programs and resources that support dementia risk reduction. Consequently, the aim of this scoping review is to identify and determine the quality and appropriateness of existing health promotion programs and resources aimed at dementia risk reduction developed or modified for Indigenous populations of Canada, the USA, Aotearoa New Zealand, and Australia that could be incorporated into the broader project. The Joanna Briggs Institute method for scoping reviews will be used to identify programs and resources focussed on dementia risk reduction for Indigenous peoples. Searches will be limited to the English language and literature published since January 2010. Databases to be searched include: CINAHL, Medline, PsychInfo, PubMed, Scopus and Google. Data that answers the research questions will be extracted from the literature and recorded on a data charting form. A combination of quantitative and qualitative methods will be used to analyse the findings of the scoping review. Dissemination of the findings through continuing community engagement, conference presentations and publications will be led by Aboriginal and Torres Strait Islander members of the research team.
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Demencia , Promoción de la Salud , Humanos , Demencia/prevención & control , Demencia/epidemiología , Demencia/etnología , Australia/epidemiología , Canadá/epidemiología , Estados Unidos/epidemiología , Promoción de la Salud/métodos , Nueva Zelanda/epidemiología , Conducta de Reducción del Riesgo , Nativos de Hawái y Otras Islas del PacíficoRESUMEN
BACKGROUND: Higher odds of survival have been reported in European infants compared to Indigenous Maori and Pasifika infants with critical congenital heart disease in New Zealand. We therefore aimed to understand how to mitigate this disparity by investigating the parent and healthcare professional experiences' of critical congenital heart disease healthcare in New Zealand. METHODS: A prospective qualitative study utilising semi-structured interviews was conducted on a cohort of purposefully sampled parents and health professionals with experience of critical congenital heart disease healthcare in New Zealand. Parents were recruited after a fetal critical congenital heart disease diagnosis and offered two interviews at least three months apart, whilst multidisciplinary fetal and cardiosurgical health professionals were interviewed once. Interviews were recorded and transcribed verbatim before coding, categorization and qualitative analysis. RESULTS: During 2022 and 2023, 45 people participated in 57 interviews (25 parents: 19 mothers, 6 fathers; Indigenous Maori, n = 5; Pasifika, n = 6; Asian, n = 4; European, n = 10; and 20 healthcare professionals: European n = 17). The three lessons learned from participants were: (1) Minoritized groups experience disparate healthcare quality; (2) healthcare systems are under-resourced to provide equitable support for the differential needs of grieving parents; and (3) healthcare systems could engage minoritized families more optimally in shared decision-making. CONCLUSIONS: According to the experiences of parents and healthcare professionals, persisting inequities in CCHD healthcare quality occur by ethnic group, with the New Zealand healthcare system privileging European families. The concepts from this study could be translated by healthcare leaders, policymakers, and professionals into evidence-based healthcare system improvements to enhance experiences for non-European families more broadly.
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Equidad en Salud , Personal de Salud , Cardiopatías Congénitas , Padres , Investigación Cualitativa , Humanos , Nueva Zelanda , Cardiopatías Congénitas/terapia , Femenino , Masculino , Padres/psicología , Estudios Prospectivos , Personal de Salud/psicología , Adulto , Entrevistas como Asunto , Nativos de Hawái y Otras Islas del Pacífico/psicología , Recién Nacido , Disparidades en Atención de Salud/etnologíaRESUMEN
BACKGROUND: Dietary acculturation is the process by which diet and dietary practises from the environment of origin are retained or changed and/or those prevalent in a new environment are adopted. Despite rapid population growth the U.S., knowledge gaps exist on characterising dietary acculturation among Asian American, Native Hawaiian, and Pacific Islander communities (AANHPI). This study characterise dietary patterns in a sample representative of AANHPI on key demographic characteristics. METHODS: Data were from a 2013-2014 population-based case-control study in the San Francisco Bay Area, U.S. Survey items were adapted from dietary acculturation scales developed for AANHPI populations. Validated measures assessed social capital, social standing, discrimination and immigration experiences. A principal components factor analysis was conducted to characterise dietary patterns of acculturation. RESULTS: Three dietary patterns were identified: "Asian," "Western," and a distinct "Multicultural" factor. Respondents reporting a high-Asian diet tended to also report smaller social networks, higher levels of stress, and, among those born outside of the U.S., an educational standing that was better before immigration. Respondents reporting a high-Western diet tended to also report the highest level of discrimination. Those reporting a high-Multicultural diet tended to report higher neighbourhood collective efficacy. CONCLUSIONS: The finding of a distinct "Multicultural" factor beyond the typical "Asian" and "Western" factors may reflect the multidirectional relationships between culture, diet, and dietary behavior, in which origin and destination cultures interact in complex ways and where foods from multiple ethnicities intermix.
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Aculturación , Asiático , Dieta , Nativos de Hawái y Otras Islas del Pacífico , Humanos , San Francisco , Femenino , Adulto , Asiático/estadística & datos numéricos , Asiático/psicología , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , Nativos de Hawái y Otras Islas del Pacífico/psicología , Dieta/etnología , Dieta/estadística & datos numéricos , Estudios de Casos y Controles , Diversidad Cultural , Adulto Joven , Anciano , Pueblos Isleños del PacíficoRESUMEN
Little is known about the impacts of living in diaspora from the Hawaiian Islands on Native Hawaiian health. To address this, the authors conducted an exploratory analysis using cross-sectional data from the 2021 Native American COVID-19 Alliance Needs Assessment. A total of 1418 participants identified as Native Hawaiian (alone or in any combination), of which 1222 reported residency in the continental US and 196 in Hawai'i. Residency status in the continental US vs Hawai'i was evaluated as a predictor of survey outcomes using likelihood ratio tests on linear and logistic regression models for linear and binary outcomes, respectively. Results showed that NH residency in the continental US was significantly associated with increased odds of reporting fair or poor self-rated health; increased odds for screening positive for anxiety, depression, and suicidality; and increased odds of health insurance loss (P's < .05). Residency in the continent was also associated with lower odds of reporting a diagnosed chronic health condition (P < .05). Residency in the continental US had no observed effect on the odds that participants engaged cultural activities or cultural coping strategies. These results support the role of place of residency as an important Native Hawaiian health predictor during and beyond the COVID-19 pandemic.
Asunto(s)
COVID-19 , Nativos de Hawái y Otras Islas del Pacífico , Humanos , COVID-19/psicología , COVID-19/epidemiología , COVID-19/etnología , Hawaii/epidemiología , Femenino , Masculino , Estudios Transversales , Adulto , Persona de Mediana Edad , Nativos de Hawái y Otras Islas del Pacífico/psicología , Nativos de Hawái y Otras Islas del Pacífico/estadística & datos numéricos , SARS-CoV-2 , Anciano , Pandemias , Estado de SaludRESUMEN
BACKGROUND: In Victoria, Australia, children with Pacific Islander ('Pacific') ethnicities are overrepresented in acute rheumatic fever (ARF) and rheumatic heart disease (RHD). In June 2023, ARF and RHD became notifiable in Victoria. To inform public health and clinical practice, we described young Pacific patients' and their caregivers' understandings and experiences of ARF/RHD, and identified possible ways to improve the delivery of clinical care. METHODS: We established a project reference group including local Pacific people to guide this research. Pacific patients who attended an ARF/RHD clinic at The Royal Children's Hospital, Melbourne, were invited to participate, as were their caregivers. A Samoan researcher conducted qualitative 'talanoa' (conversational) interviews with patients and caregivers. A second researcher conducted semi-structured interviews with treating clinicians and other stakeholders. Interview transcripts underwent thematic analysis guided by the Tuilaepa Youth Mentoring Services Pacific Youth Wellbeing Framework. RESULTS: We interviewed 27 participants. This included nine patients and nine caregivers, all of whom were Samoan. These 18 participants expressed a desire to learn more about ARF/RHD and connect with other affected people. While some shared their experiences of having well-liked and trusted healthcare providers, patients often struggled to have two-way clinical conversations. The need to support clinicians working with high-risk populations to improve their awareness of ARF was identified. Receiving treatment on time was a top priority for affected families, despite injection pain, inconvenience and financial costs. The need to support continuity of care for young adult patients was raised by participants. CONCLUSIONS: Pacific people living with ARF/RHD and their families require additional support to receive high quality management in Victoria. Introducing a patient register and a specialist RHD nurse would enhance access to treatment, as would removing cost barriers, improving clinical awareness of ARF/RHD and creating Victoria-specific patient resources.