Maori Health Review

Making Education Easy Issue 50 – 2014

Maori Health Review
Maori Health Review

Outcome following heart transplantation in New Zealand Māori

Authors: Stewart FR et al.

Summary: These researchers performed a retrospective analysis of all New Zealand heart transplant recipients over a 25-year period (from December 1987 to December 2012) to compare access to and outcomes following heart transplantation between Māori and non-Māori. Of 253 patients transplanted, 176 (69%) were European, 47 Māori (19%) and 30 (12%) of other ethnicities. Demographics were similar between Māori and non-Māori for median age (both 46 years), gender (17% vs 21% female), time on waiting list (90 vs 76 days) and diagnosis (dilated cardiomyopathy: 62% vs 58%). Māori were heavier (median 81 vs 71 kg; p<0.0001) and more were blood group A (58% vs 39%). Five-year survival was similar (79% vs 78%) but 10-year survival was significantly reduced in Māori (54% vs 67%; p=0.02).

Comment: An interesting review of heart transplant demography and outcomes by ethnicity.

Reference: Heart Lung Circ 2014;23(4):353-6


Maintenance of statin use over 3 years following acute coronary syndromes: a national data linkage study (ANZACS-QI-2)

Authors: Grey C et al.

Summary: This study linked national hospitalisation, mortality and pharmaceutical dispensing data for 11,348 patients aged 35–84 years discharged from a public hospital with an acute coronary syndrome in New Zealand in 2007. Patients were followed for 3 years, to describe patterns of statin use and predictors of poor maintenance. Within 90 days of discharge, 83% had received a statin. The proportions of patients who were adequately maintained on a statin (MPR ≥80%) were 69% in year 1 of follow-up, 67% in year 2 and 66% in year 3. Patients taking statins prior to admission and those who underwent a coronary procedure were 20–50% more likely to have a MPR ≥80% over 3 years than others. Patients aged 35–45 years and those of Māori or Pacific ethnicity were 13–25% less likely to have a MPR ≥80% than those aged 55–64 years and Europeans.

Comment: Given the “marked ethnic inequalities in cardiovascular health in New Zealand, it is vital that every effort is made to increase the use of effective preventive treatments in Māori and Pacific peoples”.

Reference: Heart 2014;100(10):770-4


Ukaipō niho: the place of nurturing for oral health

Authors: Broughton JR et al.

Summary: This paper reports on oral health-related characteristics, beliefs and behaviours among 222 pregnant Māori women participating in a randomised controlled trial of an intervention to prevent early childhood caries among Māori children. The women were randomly allocated to Intervention or Delayed groups. There were no systematic differences between these groups at baseline, other than those in the Delayed group being slightly older, on average. Around 37.0% were expecting their first child. Most reported good health; 43.6% were current smokers, and 26.4% had never smoked. Current use of alcohol was reported by 8.2%. Almost all were dentate, and 57.7% described their oral health as fair or poor. Toothache in the previous year was reported by 1 in 6 respondents; 33.8% reported being uncomfortable about the appearance of their teeth, and 27.7% reported difficulty in eating. Use of dental services was relatively low and symptom-related; 78.9% needed to see a dentist. Overall, most of the sample believed that it was important to avoid sweet foods, visit dentists and to brush the teeth, while about half thought that using fluoride toothpaste and using floss were important. Drinking fluoridated water was considered to be important by 38.2% of the women. There was evidence of oral health-related fatalism: 74.2% believed that most people usually get dental problems; 58.6% believed that most people will need extractions at some stage and that most children eventually get dental caries.

Comment: Some interesting results, particularly the acceptance by most that dental problems, particularly in children, are inevitable.

Reference: N Z Dent J 2014;110(1):18-23


Maori Health Review

Protecting children from taking up smoking: parents’ views on what would help

Authors: Marck K et al.

Summary: Responses are described from 1806 parents of children in low-income areas of Auckland, New Zealand, who participated in a community-, school- and familybased smoking-initiation questionnaire that explored their thinking around what factors could help protect their children from smoking initiation. The majority of respondents (80%) were either Pacific Island or Māori mothers and 25% were current smokers. Five main categories of suggested strategies for preventing smoking initiation were identified: building children’s knowledge of smoking risks; denormalising smoking; reducing access to tobacco; building children’s resilience; and health promotion activities. The most common suggestion was to educate children about smoking.

Comment: Another project looking in detail at what parents think would work best for children. As the authors say, the next step is to engage whānau along a creative pathway, to generate new and useful strategies that work.

Reference: Health Promot J Austr 2014;25(1):59-64


The effect of active video games by ethnicity, sex and fitness: subgroup analysis from a randomised controlled trial

Authors: Foley L et al.

Summary: The Electronic Games to Aid Motivation to Exercise (eGAME) study was a randomised controlled trial to evaluate the effect of active video games on body composition, physical activity and cardiovascular fitness in overweight and obese children in New Zealand. The study recruited 322 children aged 10–14 years who regularly used traditional sedentary video games and randomly allocated them to a 24-week active video games intervention (n=160) or control (n=162). At 24 weeks, statistically significant overall treatment effects were observed favouring the intervention group for body mass index, body mass index z-score and percentage body fat. Regression analyses revealed that the interaction operated consistently across important subgroups (by ethnicity, sex, and cardiovascular fitness).

Comment: My son would love this article! Liked that the authors have been ‘up front’ with the limitations in analysis (did not recruit as many Māori and Pacific children as had hoped, more males than females) and that it adds to the sparse evidence on this topic.

Reference: Int J Behav Nutr Phys Act 2014;11(1):46


Enacting kaitiakitanga: challenges and complexities in the governance and ownership of rongoā research information

Authors: Boulton A et al.

Summary: This paper acknowledges the lack of consistent guidelines for researchers and research teams in New Zealand regarding the governance and ownership of research data collected from Māori individuals or collectives. The article discusses challenges encountered by one research team as it negotiated data ownership and governance of rongoā Māori (tradiational Māori healing). The paper describes ways in which traditional knowledge may be protected in a modern intellectual property law context and how to adequately support those, often community-based organisations, who work at the interface between Indigenous knowledge and the Western world.

Comment: A timely article given the work underway in various areas to organise data (including information, genetic material, tissue) into ‘banks’ such as biobanks. The authors don’t provide the answers, but have set out the questions we need to ask.

Reference: Int Indigenous Policy J 2014;5(2):1-18