Cultural factors influencing the uptake of pulmonary rehabilitation by Maori in New Zealand: A grounded theory investigation.

There is little research on experiences of rehabilitation among indigenous people in colonised countries (370 million people worldwide).1 This New Zealand (NZ) study examined the influence of cultural factors on uptake of pulmonary rehabilitation (PR) – an intervention known to improve function and quality of life in people with chronic obstructive pulmonary disease (COPD).2,

Whakawhanaungatanga: culturally-meaningful connections as a pathway to better health for Maori with chronic obstructive pulmonary disease - a qualitative study

Background: Pulmonary rehabilitation is known to improve function and quality of life for people with chronic obstructive pulmonary disease (COPD). However, little research has been conducted on the influence of culture on experiences of pulmonary rehabilitation. This study examined factors influencing uptake of pulmonary rehabilitation by Māori with COPD in New Zealand. Method: Grounded theory nested within kaupapa Māori methodology. Transcripts were analyzed from interviews and focus groups with 15 Māori and ten New Zealand non-Māori invited to attend pulmonary rehabilitation for COPD. Māori participants had either attended a mainstream hospital-based program, a community-based program designed “by Māori , for Māori ”, or had experienced both. Results: Several factors influencing uptake of pulmonary rehabilitation were common to all participants regardless of ethnicity: 1) participants’ past experiences (eg, of exercise; of health care systems), 2) attitudes and expectations, 3) access issues (eg, time, transport, and conflicting responsibilities), and 4) initial program experiences. These factors were moderated by the involvement of family and peers, interactions with health professionals, the way information on programs was presented, and by new illness events. For Māori, however, several additional factors were also identified relating to cultural experiences of pulmonary rehabilitation. In particular, Māori participants placed high value on whakawhanaungatanga: the making of culturally meaningful connections with others. Culturally appropriate communication and relationship building was deemed so important by some Māori participants that when it was absent, they felt strongly discouraged to attend pulmonary rehabilitation. Only the more holistic services offered a program in which they felt culturally safe and to which they were willing to return for ongoing rehabilitation. Conclusion: Lack of attention to cultural factors in the delivery of pulmonary rehabilitation may be a barrier to its uptake by indigenous, minority ethnic groups, such as New Zealand Māori . Indigenous-led or culturally responsive health care interventions for COPD may provide a solution to this issue

Social and technical readiness for a telehealth assessment service for adults with complex wheelchair and seating needs: a national survey of stakeholders

Wheelchairs can significantly improve quality of life for those who need them, yet access to physiotherapists or occupational therapists specialising in wheelchair and seating assessment can be difficult, especially for Mäori. This paper reports on a national online survey that was undertaken as phase 1 of a mixed methods study of key stakeholders of the perceived social and technical requirements of a telehealth wheelchair assessment service for people with complex mobility needs. Key stakeholders included wheelchair users and their families, specialist and non-specialist assessors, technicians, and service managers. Responses (n = 114) indicated perceived shortcomings with current in-person assessment. Telehealth assessment was anticipated to improve service quality, particularly the timeliness of services (52/92, 57%) and prioritisation of the urgency of assessment (71/92, 77%). Preferences were for use of existing software rather than bespoke systems. Training in conducting assessment via telehealth was considered essential by most assessors (29/41, 71%). Internet connectivity was in place for most wheelchair users (43/47, 92%) but was inadequate for 29% (14/49) of assessors (pre-COVID-19). Mäori wheelchair users largely had infrastructure in place for telehealth assessment (10/11, 91%) and held positive expectations of it. Telehealth wheelchair and seating assessment is anticipated to improve the quality of care for wheelchair users with complex needs. Upgraded technical capability of public health services and robust training in conducting assessment via telehealth will be critical to successful uptake of this service. Specific needs for Mäori wheelchair users warrant further investigation

Additional file 3: of Living with osteoarthritis is a balancing act: an exploration of patients’ beliefs about knee pain

Participant data supporting Theme 2 – Living with osteoarthritis. Additional data to support theme 2. (PDF 485 kb

Additional file 2: of Living with osteoarthritis is a balancing act: an exploration of patients’ beliefs about knee pain

Participant data supporting Theme 1 – Knowledge: Certainty and Uncertainty. Additional data to support theme 1. (PDF 490 kb

Additional file 2: of BetaMe: impact of a comprehensive digital health programme on HbA1c and weight at 12 months for people with diabetes and pre-diabetes: study protocol for a randomised controlled trial

Health literacy modules. (DOCX 14 kb

Additional file 3: of BetaMe: impact of a comprehensive digital health programme on HbA1c and weight at 12 months for people with diabetes and pre-diabetes: study protocol for a randomised controlled trial

Dissemination policy. (DOCX 18 kb

Predictors of hospitalization in patients with rheumatic disease and COVID-19 in Ireland: data from the COVID-19 global rheumatology alliance registry

Objectives Given the limited data regarding the risk of hospitalization in patients with rheumatic disease and coronavirus disease 2019 (COVID-19) in Ireland, we used the COVID-19 Global Rheumatology Alliance (GRA) registry data to study outcomes and their predictors. The primary objective was to explore potential predictors of hospitalization. Methods We examined data on patients and their disease-related characteristics entered in the COVID-19 GRA provider registry from Ireland (from 24 March 2020 to 31 August 2020). Multivariable logistic regression was used to assess the association of demographic and clinical characteristics with hospitalization. Results Of 105 patients, 47 (45.6%) were hospitalized and 10 (9.5%) died. Multivariable logistic regression analysis showed that age [odds ratio (OR) = 1.06, 95% CI 1.01, 1.10], number of co-morbidities (OR = 1.93, 95% CI 1.11, 3.35) and glucocorticoid use (OR = 15.01, 95% CI 1.77, 127.16) were significantly associated with hospitalization. A diagnosis of inflammatory arthritis was associated with lower odds of hospitalization (OR = 0.09, 95% CI 0.02, 0.32). Conclusion Increasing age, co-morbidity burden and glucocorticoid use were associated with hospitalization, whereas a diagnosis of inflammatory arthritis was associated with lower odds of hospitalization

Outcomes of COVID-19 in people with rheumatic and musculoskeletal disease in Ireland over the first 2 years of the pandemic

Background: Poor COVID-19 outcomes occur with higher frequency in people with rheumatic and musculoskeletal diseases (RMD). Better understanding of the factors involved is crucial to informing patients and clinicians regarding risk mitigation. Aim: To describe COVID-19 outcomes for people with RMD in Ireland over the first 2 years of the pandemic. Methods: Data entered into the C19-GRA provider registry from Ireland between 24th March 2020 and 31st March 2022 were analysed. Differences in the likelihood of hospitalisation and mortality according to demographic and clinical variables were investigated. Results: Of 237 cases included, 59.9% were female, 95 (41.3%) were hospitalised, and 22 (9.3%) died. Hospitalisation was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular and pulmonary disease, and cancer. Hospitalisation was less frequent in people with inflammatory arthritis and conventional synthetic or biologic disease-modifying antirheumatic drug use. Hospitalisation had a U-shaped relationship with disease activity, being more common in both high disease activity and remission. Mortality was more common with increasing age, gout, smoking, long-term glucocorticoid use, comorbidities, and specific comorbidities of cardiovascular disease, pulmonary disease, and obesity. Inflammatory arthritis was less frequent in those who died. Conclusion: Hospitalisation or death were more frequently experienced by RMD patients with increasing age, certain comorbidities including potentially modifiable ones, and certain medications and diagnoses amongst other factors. These are important 'indicators' that can help risk-stratify and inform the management of RMD patients.</p

Temporal trends in COVID-19 outcomes in people with rheumatic diseases in Ireland: data from the COVID-19 global rheumatology alliance registry

Objectives: Although evidence is accumulating globally, data on outcomes in rheumatic disease and COVID-19 in Ireland are limited. We used data from the COVID-19 Global Rheumatology Alliance (C19-GRA) to describe time-varying COVID-19 outcomes for people with rheumatic disease in Ireland.Methods: Data entered into the C19-GRA provider registry from Ireland between 24th March 2020 and 9th July 2021 were analysed. Differences in the likelihood of hospitalisation and mortality according to demographic and clinical variables were investigated using Chi-squared test or Fisher's exact test, as appropriate. Trends in odds of hospitalisation and mortality over time were investigated using logistic regression with the time period as a categorical variable.Results: Of 212 cases included, 59.4% were female and median age was 58.0 years (range 13-96). Of the 212 cases, 92 (43%) were hospitalized and 22 (10.4%) died. Increasing age, a diagnosis of gout, ever smoking, glucocorticoid use, having comorbidities, and specific comorbidities of cancer, cardiovascular, and pulmonary disease were more common in those hospitalised. A diagnosis of inflammatory arthritis, csDMARD and/or b/tsDMARD use were less frequent in those hospitalised. Increasing age, a diagnosis of gout, ever smoking, having comorbidities and specific comorbidities of obesity, cardiovascular and pulmonary disease were more common in those who died. Odds of hospitalisation or mortality did not change over time.Conclusion: No temporal trend was observed in either COVID-19 related hospitalisation or mortality outcomes for people with rheumatic disease in Ireland.</div