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BackgroundStroke systems of care differ between larger urban and smaller rural settings and it is unclear to what extent this may impact on patient outcomes. Ethnicity influences stroke risk factors and care delivery as well as patient outcomes in nonstroke settings. Little is known about the impact of ethnicity on poststroke care, especially in Māori and Pacific populations. ObjectiveOur goal is to describe the protocol for the Reducing Ethnic and Geographic Inequities to Optimise New Zealand Stroke Care (REGIONS Care) study. MethodsThis large, nationwide observational study assesses the impact of rurality and ethnicity on best practice stroke care access and outcomes involving all 28 New Zealand hospitals caring for stroke patients, by capturing every stroke patient admitted to hospital during the 2017-2018 study period. In addition, it explores current access barriers through consumer focus groups and consumer, carer, clinician, manager, and policy-maker surveys. It also assesses the economic impact of care provided at different types of hospitals and to patients of different ethnicities and explores the cost-efficacy of individual interventions and care bundles. Finally, it compares manual data collection to routine health administrative data and explores the feasibility of developing outcome models using only administrative data and the cost-efficacy of using additional manually collected registry data. Regarding sample size estimates, in Part 1, Study A, 2400 participants are needed to identify a 10% difference between up to four geographic subgroups at 90% power with an α value of .05 and 10% to 20% loss to follow-up. In Part 1, Study B, a sample of 7645 participants was expected to include an estimated 850 Māori and 419 Pacific patients and to provide over 90% and over 80% power, respectively. Regarding Part 2, 50% of the patient or carer surveys, 40 provider surveys, and 10 focus groups were needed to achieve saturation of themes. The main outcome is the modified Rankin Scale (mRS) score at 3 months. Secondary outcomes include mRS scores; EQ-5D-3L (5-dimension, 3-level EuroQol questionnaire) scores; stroke recurrence; vascular events; death; readmission at 3, 6, and 12 months; cost of care; and themes around access barriers. ResultsThe study is underway, with national and institutional ethics approvals in place. A total of 2379 patients have been recruited for Part 1, Study A; 6837 patients have been recruited for Part 1, Study B; 10 focus groups have been conducted and 70 surveys have been completed in Part 2. Data collection has essentially been completed, including follow-up assessment; however, primary and secondary analyses, data linkage, data validation, and health economics analysis are still underway. ConclusionsThe methods of this study may provide the basis for future epidemiological studies that will guide care improvements in other countries and populations. International Registered Report Identifier (IRRID)DERR1-10.2196/25374

The world is continuing to experience the COVID-19 pandemic, which has resulted in >767 million reported cases and [approximately equal to] 6.9 million deaths ([approximately equal to] 870 deaths/1 million [...]

Background and Aims: Despite known Indigenous health and socioeconomic disadvantage in countries with a Very High Human Development Index, data on the incidence of stroke in these populations are sparse. With oversight from an Indigenous Advisory Board, we will undertake a systematic review of the incidence of stroke in Indigenous populations of developed countries or regions, with comparisons between Indigenous and non-Indigenous populations of the same region, though not between different Indigenous populations. Methods: Using PubMed, OVID-EMBASE, and Global Health databases, we will examine population-based incidence studies of stroke in Indigenous adult populations of developed countries published 1990-current, without language restriction. Non-peer-reviewed sources, studies including

Context Brown Buttabean Motivation (BBM) is a grassroot Pacific-led organisation aiming to reduce obesity amongst Pasifika (Pacific people in Aotearoa New Zealand) and Indigenous Maori, helping them choose a healthy and active life-style for themselves, their children and their wider family. BBM offers a holistic approach to weight loss, recognising that mental health, family and cultural factors all play essential and critical roles in nutrition and physical activity patterns. Objective To understand how participants experience and engage with BBM. Study Design & Analysis Qualitative study conducted by our co-design research team within a broader BBM research project. Initial inductive thematic approach followed by theoretical deductive analysis of coded data guided by Pacific Fonofale and Maori Te Whare Tapa Wha health models. In this meetinghouse metaphor, the floor is family, roof is culture, house-posts are physical, mental, spiritual and sociodemographic health and well-being, surrounded by environment, time and context. Setting South Auckland, New Zealand 2021 Population Studied BBM participants Instrument Semi-structured interviews Outcome Measures Narrative data Results 22 interviewees (50% female) aged 24-60 years of mixed Pacific and Maori ethnicities. Majority self-reported weight loss (between three and 135kg) since starting BBM. Two researchers independently coded data with adjudication (kappa=0.61) Participants identified the interactive holistic nature of health and wellbeing from BBM. As well as physical, mental and spiritual benefits, BBM helped many reconnect with both their family and their culture. BBM is seen as a new way of life. Participants 'immediately belong to BBM family' regardless of culture or size, 'with no judgements' and adopt the BBM motto 'no excuses'. Conclusions Many weight loss studies provide programmes to improve physical exercise and nutrition, but seldom address sustainability and other core factors such as mental health and motivation. BBM is a community-embedded Maori and Pasifika-led intervention, with no reliance on researchers nor external authorities for its ongoing implementation. It addresses factors impacting participants' lives and social determinants of health, including vaccination drives, food parcels and adapting to the COVID-19 pandemic and lockdowns. Our three-year longitudinal cohort study assessing sustained weight loss is ongoing., Presenters Felicity Goodyear-Smith, MD, MBChB, Faasisila Savila, PhD, Matire Harwood, PhD, MBChB, Warwick Bagg, MD, MBChB, FRACP, Paea Leakehe, Dave Letele, Boyd Swinburn, FRACP, FNZCPHM, MBChB, Anele [...]

Acute rheumatic fever (ARF) is a preventable multisystem inflammatory disease that develops in ARF and RHD remain major causes of illness and death (5). In 2015, global prevalence of RHD [...]

Background. Cardiovascular disease is a major health issue for Māori that requires timely and effective first-response care. Māori report culturally unsafe experiences in health care, resulting in poor health outcomes. Research in the pre-hospital context is lacking. This study aimed to explore experiences of cultural (un)safety for Māori and their whānau who received acute pre-hospital cardiovascular care from paramedics. Methods. Utilising a qualitative descriptive methodology and Kaupapa Māori Research (KMR), in-depth semi-structured interviews were undertaken with 10 Māori patients and/or whānau, and a general inductive approach was used for analysis. Results. Three key themes were identified: (1) interpersonal workforce skills, (2) access and service factors and (3) active protection of Māori. Participants described paramedics' clinical knowledge and interpersonal skills, including appropriate communication and ability to connect. Barriers to accessing ambulance services included limited personal and community resources and workforce issues. The impact of heart health on communities and desire for better preventative care highlighted the role of ambulance services in heart health. Conclusion. Māori experience culturally unsafe pre-hospital care. Systemic and structural barriers were found to be harmful despite there being fewer reports of interpersonal discrimination than in previous research. Efforts to address workforce representation, resource disparities and cultural safety education (focussing on communication, partnership and connection) are warranted to improve experiences and outcomes for Māori. [ABSTRACT FROM AUTHOR]

Te Poka Pū is a Kaupapa Māori national surgical interest group that supports Māori doctors and medical students in Aotearoa who are interested in surgery. The group was formed to address the shortage of Māori surgeons and is committed to revitalizing te reo Māori and tikanga Māori as part of improving Māori health equity in surgery. Te Poka Pū conducts research, provides mentorship, and creates opportunities to strengthen relationships between Māori communities and surgeons. They have established an online support network and delivered webinars to connect Māori surgeons and academics. The group aims to conduct rigorous Kaupapa Māori research and develop solutions that prioritize the needs of Māori communities. [Extracted from the article]

Introduction. In Aotearoa New Zealand (NZ), there is inequity in rates of neural tube defects (NTDs). Among Maaori, NTD occur in 4.58/10 000 live births, and for Pacific peoples, it is 4.09/10 000 live births; this is compared to 2.81/10 000 live births for non-Maaori, non-Pacific peoples. Aim. To describe self-reported pre-pregnancy folic acid supplementation and to determine the association between pregnancy intendedness, ethnicity, parity, maternal age, care provider and pre-pregnancy folic acid supplementation. Methods. Secondary analysis of postpartum survey data collected at Te Whatu Ora Te Toka Tumai and Counties Manukau birthing facilities in 2020 was conducted. Descriptive analyses explored pregnancy intendedness and self-reported folic acid use by demographic variables. Multivariable logistic regression explored independent associations between demographic variables and folic acid use among intended pregnancies. Results. In total, 398 participants completed the survey. The response rate was (140/149) 94% at Counties Manukau and (258/315) 82% at Te Toka Tumai. Pre-pregnancy supplementation was reported by 182 of 398 participants (46%). Use was higher among those who intended their pregnancy (151/262, 58%) compared to those who were 'pregnancy ambivalent' (9/33, 27%) or did not intend to become pregnant (22/103, 21%). Factors independently associated with supplementation among intended pregnancies included: 'Other ethnicity' (European, Middle Eastern, Latin American, African) compared to Maaori (aOR 5.3 (95% CI 1.3, 21.8)), age =30 years compared to <30 years (aOR 2.1 (1.0, 4.1)), and private obstetrician compared to midwifery care (aOR 4.2 (1.6, 10.9)). Discussion. Low rates of pre-pregnancy folic acid supplementation exist in Auckland with significant ethnic disparity. Mandatory fortification of non-organic wheat is important, but supplementation is still recommended to maximally reduce risk. [ABSTRACT FROM AUTHOR]

This article provides a summary of available data on Māori ocular health, highlighting significant disparities between Māori and non‐Māori populations. Māori are more likely to develop diabetes, sight‐threatening retinopathy and keratoconus, and present for cataract surgery earlier with more advanced disease. Limited data exists for macular degeneration and glaucoma, but there is some suggestion that Māori may have lower prevalence rates. The article emphasises the urgent need for robust national data on Māori ocular health to enable targeted interventions and funding allocation. Achieving equity for Māori in all aspects of health, including ocular health, requires concerted efforts from all stakeholders. [ABSTRACT FROM AUTHOR]

It is important to understand how consumers (person with stroke/family member/carer) and health workers perceive stroke care services. Consumers and health workers from across New Zealand were surveyed on perceptions of stroke care, access barriers, and views on service centralisation. Quantitative data were summarised using descriptive statistics whilst thematic analysis was used for free-text answers. Of 149 consumers and 79 health workers invited to complete a survey, 53 consumers (36.5%) and 41 health workers (51.8%) responded. Overall, 40/46 (87%) consumers rated stroke care as 'good/excellent' compared to 24/41 (58.6%) health workers. Approximately 72% of consumers preferred to transfer to a specialised hospital. We identified three major themes related to perceptions of stroke care: 1) 'variability in care by stage of treatment'; 2) 'impact of communication by health workers on care experience'; and 3) 'inadequate post-acute services for younger patients'. Four access barrier themes were identified: 1) 'geographic inequities'; 2) 'knowing what is available'; 3) 'knowledge about stroke and available services'; and 4) 'healthcare system factors'. Perceptions of stroke care differed between consumers and health workers, highlighting the importance of involving both in service co-design. Improving communication, post-hospital follow-up, and geographic equity are key areas for improvement. Provision of detailed information on stroke recovery and available services in the community is recommended. Improvements in the delivery of post-hospital stroke care are required to optimise stroke care, with options including routine phone follow up appointments and wider development of early supported discharge services. Stroke rehabilitation services should continue to be delivered 'close to home' to allow community integration. Telehealth is a likely enabler to allow specialist urban clinicians to support non-urban clinicians, as well as increasing the availability and access of community rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Ethnic differences in post-stroke outcomes have been largely attributed to biological and socioeconomic characteristics resulting in differential risk factor profiles and stroke subtypes, but evidence is mixed. Aims: This study assessed ethnic differences in stroke outcome and service access in New Zealand (NZ) and explored underlying causes in addition to traditional risk factors. Methods: This national cohort study used routinely collected health and social data to compare post-stroke outcomes between NZ Europeans, Māori, Pacific Peoples, and Asians, adjusting for differences in baseline characteristics, socioeconomic deprivation, and stroke characteristics. First and principal stroke public hospital admissions during November 2017 to October 2018 were included (N = 6879). Post-stroke unfavorable outcome was defined as being dead, changing residence, or becoming unemployed. Results: In total, 5394 NZ Europeans, 762 Māori, 369 Pacific Peoples, and 354 Asians experienced a stroke during the study period. Median age was 65 years for Māori and Pacific Peoples, and 71 and 79 years for Asians and NZ Europeans, respectively. Compared with NZ Europeans, Māori were more likely to have an unfavorable outcome at all three time-points (odds ratio (OR) = 1.6 (95% confidence interval (CI) = 1.3–1.9); 1.4 (1.2–1.7); 1.4 (1.2–1.7), respectively). Māori had increased odds of death at all time-points (1.7 (1.3–2.1); 1.5 (1.2–1.9); 1.7 (1.3–2.1)), change in residence at 3 and 6 months (1.6 (1.3–2.1); 1.3 (1.1–1.7)), and unemployment at 6 and 12 months (1.5 (1.1–2.1); 1.5 (1.1–2.1)). There was evidence of differences in post-stroke secondary prevention medication by ethnicity. Conclusion: We found ethnic disparities in care and outcomes following stroke which were independent of traditional risk factors, suggesting they may be attributable to stroke service delivery rather than patient factors. [ABSTRACT FROM AUTHOR]

The article discusses the evolving understanding of rehabilitation, emphasizing the need for a broader perspective that includes psychology, sociology, and other behavioral sciences. It challenges the biomedical approach and advocates for the biopsychosocial model of wellness. It recommends for a reevaluation of rehabilitation dogma and a shift towards a person-centered approach.

Objective: To assess diabetes eye service use in New Zealand among people aged ≥15 years by estimating service attendance, biennial screening rate, and disparities in the use of screening and treatment services. Methods: We obtained Ministry of Health data from the National Non-Admitted Patient Collection on diabetes eye service events between 1 July 2006 and 31 December 2019 and sociodemographic and mortality data from the Virtual Diabetes Register and linked these using a unique patient identifier (encrypted National Health Index). We 1) summarized attendance at retinal screening and ophthalmology services, 2) calculated biennial and triennial screening rate, 3) summarized treatment with laser and anti-VEGF and used log-binomial regression to examine associations of all of these with age group, ethnicity, and area-level deprivation. Results: In total, 245,844 people aged ≥15 years had at least one diabetes eye service appointment attended or scheduled; half of these (n = 125,821, 51.2%) attended only retinal screening, one-sixth attended only ophthalmology (n = 35,883, 14.6%) and one-third attended both (n = 78,300, 31.8%). The biennial retinal screening rate was 62.1%, with large regional variation (73.9% in Southern District to 29.2% in West Coast). Compared with NZ Europeans, Māori were approximately twice as likely to never receive diabetes eye care or to access ophthalmology when referred from retinal screening, 9% relatively less likely to receive biennial screening and received the fewest anti-VEGF injections when treatment was commenced. Disparities in service access were also present for Pacific Peoples compared to NZ Europeans, younger and older age groups compared to those aged 50–59 years and those living in areas with higher deprivation. Conclusions: Access to diabetes eye care is suboptimal, with substantial disparity between age groups, ethnicity groups, area level deprivation quintile and across districts. Efforts to improve access to and quality of diabetes eye care services must include strengthening data collection and monitoring. [ABSTRACT FROM AUTHOR]

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]