Maori Health Review

Making Education Easy Issue 12 – 2008

Maori Health Review
Maori Health Review

Burden of stroke in Mäori and Pacific peoples of New Zealand

Authors: Feigin VL et al

Summary: This report is an overview of published population-based stroke incidence studies and other relevant research in the multi-ethnic New Zealand population, with a particular emphasis on Mäori and Pacific populations. The researchers highlight the fact that the stroke epidemiology data are skewed unfavourably towards Mäori and Pacific people and they call upon health providers to introduce effective measures and delivery systems with urgency, in order to reverse this trend and improve Mäori and Pacific people’s health.

Comment: Ethnic disparities are well recognised for stroke rates, outcomes and care. This is true both internationally, as shown by the paper published in an international stroke journal, and in NZ. Stroke is common: 800 Mäori are admitted to hospital each year with stroke and 140 per year die from stroke. As part of the Cardiovascular Chapter in the latest ‘Hauora: Mäori Standards of Health’ book, the Stroke section not only provides up to date statistics but describes steps along the stroke care pathway where disparities occur and how they can be eliminated. This Chapter can be accessed at: hauora_chapter08_web.pdf

Reference: Int J Stroke. 2007;2:208-10


Delayed time to defibrillation after inhospital cardiac arrest

Authors: Chan PS et al

Summary: These researchers examined data from 6,789 patients who had cardiac arrest due to ventricular fibrillation or pulseless ventricular tachycardia at 369 hospitals participating in the National Registry of Cardiopulmonary Resuscitation, to determine the prevalence of delayed defibrillation (>2 minutes) in the US and its effect on survival. The overall median time to defibrillation was 1 minute; delayed defibrillation occurred in 2,045 patients (30.1%). Multivariate logistic regression analysis identified the following characteristics as being associated with delayed defibrillation; Black race, noncardiac admitting diagnosis, and occurrence of cardiac arrest at a hospital with <250 beds, in an unmonitored hospital unit, and during after-hours periods (5 p.m. to 8 a.m. or weekends). After adjusting for differences in patient and hospital characteristics, significantly fewer patients survived to hospital discharge when defibrillation was delayed than when it was not (22.2% vs 39.3%). In addition, a graded association was seen between increasing time to defibrillation and lower rates of survival to hospital discharge for each minute of delay (p for trend <0.001).

Comment: Although we don’t know the exact number of in-hospital cardiac arrests, US authors suggest that it is double that of out-of-hospital arrests. Survival after cardiac arrest due to an arrhythmia requires prompt defibrillation (electric shock). This study set a time limit of 2 minutes (many studies use 3 minutes). Defibrillation after 2 minutes was associated with poor outcome even after co-existing conditions (such as underlying heart or kidney disease) were taken into account. Importantly, African American patients were more likely to have delayed treatment, confirming unequal treatment by ethnicity. The other take home message for me is that physicians spending time worrying about improving out-of-hospital care should perhaps refocus their attention on improving outcomes for hospitalised patients.

Reference: N Engl J Med. 2008;358:9-17


Insulin sensitivity and intramyocellular lipid concentrations in young Mäori men

Authors: Stannard SR et al

Summary: In European Caucasian men, insulin sensitivity is negatively associated with intramyocellular lipid (IMCL) content, which may provide an early marker of diabetes risk. This study aimed to determine whether vastus lateralis IMCL content contributes to insulin sensitivity in 21 healthy Mäori men (mean age 28 years), all of whom had normal fasting blood glucose at baseline. According to multiple regression analysis incorporating the homeostasis model assessment of insulin resistance (HOMA-IR) as the dependent variable, increased body fatness and decreased aerobic capacity (per kg lean body mass) were significant predictors of insulin sensitivity as estimated by HOMAIR, and elevated vastus lateralis IMCL concentrations failed to predict insulin sensitivity.

Comment: To be honest, I’m not sure that this study will be particularly relevant to most providers. However, it does show that there are Mäori health researchers undertaking lab-based studies at research institutions which many of us may not hear about.

Reference: Diabet Med. 2007;24:1205-12


Recommendations for teaching about racial and ethnic disparities in health and health care

Authors: Smith WR et al

Summary: This study reports recommendations developed by the US Society of General Internal Medicine Health Disparities Task Force, following a review and consensus process of health curricula. These recommendations specify that a curricula address 3 areas of racial and ethnic health disparities and focus on specific learning objectives:1) examining and understanding attitudes, such as mistrust, subconscious bias, and stereotyping, which practitioners and patients may bring to clinical encounters; 2) gaining knowledge of the existence and magnitude of health disparities, including the multifactorial causes of health disparities and the many solutions required to diminish or eliminate them; and 3) acquiring the skills to effectively communicate and negotiate across cultures, languages, and literacy levels, including the use of key tools to improve communication

Comment: A timely paper from a dedicated Task Force utilising robust methods (literature review and consensus) to provide clear directions for teaching facilities. The drive for developing similar curriculum on disparities in NZ must start at medical schools. However, education must continue for clinicians also and perhaps similar guidelines should be developed for and adopted by respective colleges or at the DHB level.

Reference: Ann Intern Med. 2007;147:654-65


Maori Health Review