ISSN 1178-6191

Maori Health Review

Making Education Easy Issue 37-2012

Maori Health Review
Maori Health Review

Pre-hospital delay in acute coronary syndromes: PREDICT CVD-18

Authors: Garofalo D et al

Summary: This study assessed components and determinants of pre-hospital delay in patients with acute coronary syndromes (ACS) admitted to Middlemore Hospital Coronary Care Unit between January 2009 and July 2010. Pre-hospital delay was defined as the time from onset of worst symptom(s) to defibrillator availability: either ambulance arrival at the scene or time of hospital arrival (non-ambulance patients). For 805 patients the median delay from symptom onset to defibrillator availability was 174 minutes; the delay to defibrillator availability was >3 hours for 50% of the cohort. The median delay was an hour longer for patients from areas of greatest deprivation compared with those from less deprived areas (208 vs 149 min; p=0.015) and 7 hours longer for non-ambulance vs ambulance patients (553 vs 130 min; p<0.001). Māori, Pacific, Indian and those from areas of higher deprivation were less likely to travel to hospital by ambulance. Of ST-elevation myocardial infarction patients eligible for reperfusion, over two-thirds of the total delay between symptom onset and reperfusion occurred pre-hospital.

Comment: Interventions to address the delays in time to ambulance care for Māori are essential, given the 7-hour difference between nonambulance and ambulance patients. However, an examination of reasons for delayed access to an ambulance is required first. Too often clinicians tell me it is because Māori delay seeking care – however I’d like to know if this is true (or are people put off calling?) and if so what can be done about it.

Reference: N Z Med J. 2012;125(1348):12-22.


An examination of Māori tamariki (child) and taiohi (adolescent) traumatic brain injury within a global cultural context

Authors: Elder H

Summary: This paper describes the size and shape of Māori tamariki (child) and taiohi (adolescent) traumatic brain injury (TBI) and reviews the wider international literature related to cultural factors and TBI. Scant research focuses on children and young people at highest risk of TBI. There is evidence of Māori tamariki and taiohi being significantly over-represented in TBI populations, with poorer outcomes including higher mortality rates. According to international research, ‘minority’ culture is a risk factor for certain causes of injury and a differential rehabilitation service response.

Comment: As the author suggests, given the high incidence and prevalence of TBI in tamariki and tai tamariki Māori, and poor outcomes including mental health issues, reduced educational achievement and incarceration, all health providers should consider a context of TBI in these settings. Application of tikanga Māori may be useful. However, I’d also like to see equity in clinical care, including diagnosis and management of TBI.

Reference: Australas Psychiatry. 2012;20(1):20-3.


Self-reported oral health, dental self-care and dental service use among New Zealand secondary school students: findings from the Youth 07 study

Authors: Areai DM et al

Summary: Data from the cross-sectional Youth 07: National Survey of the Health and Wellbeing of New Zealand Secondary School Students were explored to describe secondary school students’ use of dental services and determine the nature and extent of any inequities by deprivation status and ethnicity. The researchers also examined students’ toothbrushing practices and self-reported dental pain experience, past restorative treatment and tooth loss. The survey involved a representative sample of 9,098 secondary school students aged 13–17 years from 96 secondary schools across New Zealand. Seventy-two per cent of participants reported a dental visit in the previous 12 months; those who were more likely to have done so included females, those who brushed at least twice daily, and those who had been kept awake at night by dental pain. Those who were less likely included those identifying with Māori, Pacific or Asian ethnicity (and those in the ‘Other’ ethnic category) relative to European students, and those residing in medium- or high-deprivation areas relative to those in low-deprivation areas. One in seven participants reported having lost a tooth due to oral disease. Having had a tooth filled was reported by almost three-quarters of the sample, and having been kept awake by dental pain at night was reported by just over one in five. Almost two-thirds reported brushing their teeth twice or more in the previous 24 hours, and a small minority had not brushed at all.

Comment: Highlights the importance of having accessible dental service for Māori, Pacific and Asian students; and for those living in high-deprivation areas.

Reference: N Z Dent J. 2011;107(4):121-6.


The pervasive effects of racism: experiences of racial discrimination in New Zealand over time and associations with multiple health domains

Authors: Harris R et al

Summary: This study investigated the prevalence of self-reported experience of racial discrimination in New Zealand by ethnicity, changes over time and associations with multiple health measures, using data from the 2002/03 (n=12,500) and 2006/07 (n=12,488) New Zealand Health Surveys, nationally representative population-based surveys of adults (≥15 years). Reported experience of racial discrimination was measured in both surveys and covered 5 items: experience of an ethnically motivated physical or verbal attack; and unfair treatment because of ethnicity by a health professional, in work, or when gaining housing. Reported experience of racial discrimination increased between 2002/03 (28.1% ever) and 2006/07 (35.0% ever) among Asian peoples but remained largely unchanged for other ethnic groupings (Māori 29.5%, Pacific 23.0%, European 13.5%). Experience of racial discrimination was associated with all negative health measures except excess body fat. Where there were significant associations, a dose-response relationship was also evident.

Comment: A major strength of this paper is that it builds on previous work. In doing so it not only confirms the impact racism has on health; but highlights the fact that research on this topic is both valid and robust.

Reference: Soc Sci Med. 2012;74(3):408-15.


Maori Health Review

Propranolol reduces implicit negative racial bias

Authors: Terbeck S et al

Summary: This study examined the role of noradrenergic mechanisms in the generation of implicit racial attitudes and involved 36 healthy volunteers of White ethnic origin, who were randomised to receive a single oral 40 mg dose of the β-adrenoceptor antagonist, propranolol (n=18) or a placebo (n=18). Participants completed an explicit measure of prejudice and the racial implicit association test, 1–2 h after propranolol administration. Relative to placebo, propranolol significantly lowered heart rate and abolished implicit racial bias, without affecting the measure of explicit racial prejudice. Propranolol did not affect subjective mood.

Comment: I have had a few requests for the paper following reports about the study’s findings in local newspapers. Interestingly, treatment effects were most evident for ‘unconscious’ racism. However, as the authors suggest, biological research aiming to make people morally better is fraught with issues. Careful consideration to ethical issues is necessary.

Reference: Psychopharmacology (Berl). 2012 Feb 28. [Epub ahead of print]


Increasing incidence of serious infectious diseases and inequalities in New Zealand: a national epidemiological study

Authors: Baker MG et al

Summary: These researchers developed and applied a systematic method in order to monitor all hospital admissions for infectious and non-infectious diseases in New Zealand from 1989 to 2008. They investigated trends in incidence and distribution by ethnic group and socioeconomic status. Infectious diseases were the largest contributor to hospital admissions of any cause, increasing from 20.5% of acute admissions in 1989-93 to 26.6% in 2004-08. Ethnic and social inequalities were noted for infectious disease risk. In 2004-08, the age-standardised rate ratio was 2.15 for Māori (Indigenous New Zealanders) and 2.35 for Pacific peoples compared with the European and Other groups. The ratio was 2.81 for the most socioeconomically deprived quintile compared with the least deprived quintile. These inequalities have increased substantially in the past 20 years, particularly for Māori and Pacific peoples in the most deprived quintile.

Comment: An example of the need to continue collecting and analyzing valid, reliable, comparable data for trends, levels and inequalities in order to monitor progress and plan services. More importantly, the findings underscore the fact that social effects are the biggest contributor to these health inequities in New Zealand.

Reference: Lancet. 2012 Feb 17. [Epub ahead of print]