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Ashton C.M., H., P., Paterniti, D.A., Collins, T.C., Howard, S.G., O'Malley, K., Petersen, L.A., Sharf, B.F., Suarez-Almazor, M.E., Wray, N.P., Street Jnr, R.L. (2003). Racial and Ethnic Disparities in the Use of Health Sciences. J Gen Intern Med, , 8 pp.
Abstract: African Americans and Latinos use service that require a doctor's order at lower rates than do whites. Racial bias and patient preference contribute to disparities, but their effects appear small. Communication during the medical interaction plays a central role in decision making about subsequent interventions and health behaviours. Research has shown that Doctors have poorer communication with minority patients than with others, but problems in doctor-patient communication have received little attention as a potential cause, a remediable one, of health disparities. We evaluate the evidence that poor communication is a cause of disparities and propose some remedies drawn from the communication sciences.
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Ameratunga, S., N., Alexander, C, S., Smith, G., Lennon, D.R., Norton, R, N. (1999). Trauma-Related Hospitalizations Among Urban Adolescents in New Zealand: Priorities for Prevention. Journal of Adolescent Health, , 9 pp.
Abstract: Purpose: To: (a) determine the magnitude, characteristics,and in-patient costs of injury among hospitalized urban adolescents in New Zealand (NZ); (b) identify regional priorities for injury prevention and investigative research; and (c) compare the study findings with published data from other industrialized countries.
Methods: The 1989–1993 files of the NZ Hospital Discharge Database were accessed to identify and analyze trauma-related admissions of adolescents residing in NZ’s largest metropolitan region.
Results: The estimated 9569 hospitalizations for injury accounted for one-fourth of all adolescent admissions in the region, a mean annual hospitalization rate of 1292/100,000 population and a minimum annual cost of NZ
$5.8 million for in-patient care. Males and indigenous Maori youth had comparatively higher rates of hospitalizations for most major causes of injury. Falls, pedal cyclist injury, cuts, and piercing injuries were leading causes of
hospitalization for trauma in early adolescence. Admission rates for motorcyclist and other motor vehicle occupant trauma and self-inflicted injury increased substantially among older adolescents. Sport and recreational activities comprised at least one-sixth of injury admissions.
Conclusions: The overall rates of injury resulting in hospitalization among Auckland adolescents were comparable to those reported from Australia and France, but higher than those from the United States, Canada, and
Israel. By identifying priority issues and high-risk groups, this study provides a foundation for regional injury control initiatives. It also demonstrates the utility and limitations of E-coded hospital discharge registries in defining the burden of serious nonfatal trauma.
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Yates D.E.T. (1988). Health – A Māori perspective insight and future.2 pp.
Abstract: While addressing to the Māori perspective of health, the Author intends to focus on three periods of time in relation to the arrival of the European in New Zealand:
1. The Pre European period
2. The immediate Post European period
3. The late Post European period (modern day New Zealand)
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Cheung, M. J. (2010). Cellular and Cultural Studies of Human Neurodegenerative Diseases. (286 pp.).
Abstract: The current approaches for developing drugs (e.g. transgenic animal models) have failed to produce effective neuroprotective medicines that translate to patients with neurodegenerative disease. Therefore, new approaches like primary human cultures grown from neurodegenerative disease patient tissues are becoming increasingly important to complement existing methods.
For my doctoral thesis I developed 19 novel primary human brain-derived cell lines from autopsy brain tissue (9 Neurologically Normal, 1 Motor Neuron, 4 Alzheimer‟s, 2 Parkinson‟s and 3 Huntington‟s disease cultures) and evaluated their potential as test systems for identifying new therapies for neurodegenerative disorders. To better understand these cells I determined the optimal substrate, plating strategy and media. To determine whether these cells could be cryopreserved for long-term storage, their viability after freeze/thawing was also studied. As a result of this work we have now developed standard protocols for the initial culture, maintenance, use and storage of primary human brain-derived autopsy cells.
As part of a culturally appropriate methodological approach to science I also developed Tikanga Māori methodologies (customary practices) for working with human brain tissue and primary cells. Additional Mātauranga Māori science case studies (examining a Māori view of the brain, seeking blessing of my iwi to do human tissue research, and developing a Māori bioethical approach to working with Māori Huntington‟s disease whānau and donor families) were undertaken. This was a ground-breaking approach to laboratory practice which may assist Māori and Indigenous peoples to engage in human tissue research and cutting-edge technologies. Growth, morphological and immunocytochemical studies were undertaken to determine the cell types within primary human brain-derived autopsy cultures. CD45-positive microglia were observed in 13 of the cultures. The major cell type with large flat polygonal morphology stained with prolyl-4-hydroxylase, fibronectin, vimentin and -smooth muscle actin suggesting that the polygonal cells could be myofibroblasts. However, prolyl-4-hydroxylase, fibronectin, vimentin and nestin staining along with the polygonal morphology were also consistent with pial cell phenotype, a cell type with stem cell properties that can be differentiated into neurons. To ascertain the similarities between primary human brain-derived cells and what occurs in the human brain with neurodegenerative disease, functional studies were undertaken. There were no significant functional differences between Neurologically Normals and any of the neurologically disease groups as measured with Alamar Blue, Mitotracker Red CMX-H2ROS, ATP luciferase, 5-bromo-2-deoxyuridine (BrdU), Hoechst and lactate dehydrogenase assays. A significant issue was the large within group variation of Neurologically Normals, which significantly correlated to age, and post-mortem delay in all functional measures. Consequently a large number of cases will be needed to observe significant differences. Nevertheless, unhealthy cell cultures whether derived from disease cases or Neurological Normals may be useful to test cytoprotective treatments and such studies may assist the development of novel therapies to combat neurodegeneration.
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Moeke-Maxwell, T., Nikora, L.M. (2017). Wairua Manuake – Flight of the Wairua: Māori end of life preparation. (25 pp.).
Abstract: The introduction sets out to contribute a more nuanced view of older people’s informal care (Chappell & Reid, 2002; Rowland, Hanratty, Pilling, Van den berg, & Grande, 2017) by acknowledging and celebrating the various contributions that Maori whānau (family including immediate and extended kin) make as end of life carers of their own. Whānau care and support is pivotal in the care of ill and dying kaumātua (older men or women) (Moeke-Maxwell, Nikora, & Te Awekotuku, 2013; Wiles, 2011). We ask, what happens during the end of life trajectory that provides the best conditions for Māori whānau to support the transition of the dying kaumātua’s wairua (spirit) at time of death? What factors might challenge this process? Understanding the importance of indigenous peoples’ experiences at the end of life can contribute to a wider incentive to improve health and palliative care, no matter where someone lives or dies.
Māori subscribe to many narratives to explain what occurs in and through the process of dying and death. Whānau carers and other members make a significant contribution to the physical and spiritual wellbeing of ill and dying kaumātua (elderly relative(s)) (Moeke-Maxwell, Nikora, & Te Awekotuku, 2014; Wiles, 2011). They bring to the challenge actions driven by pragmatism, necessity and contemporary health knowledge as well as Māori customary beliefs and practices. In this chapter, we set out to identify, describe and theorise a traditional Māori narrative apparent amongst a range of conversational engagements we had with whānau members who cared for and supported a kaumātua who had a life limiting illness. We begin by briefly considering Māori cosmological beliefs, the Māori afterlife and introduce the concepts of mauri and wairua; we consider the notion of tapu as a guiding framework for whānau care practices and discuss these in relation to manaakitanga, whanaungatanga, karakia and wairuatanga which we define later in this opening section.
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