22 research outputs found
Te tuangi (the clam): A metaphor for teaching, learning and the key competencies
This article explores the shift from āessential skillsā to ākey competenciesā in the school curriculum. Drawing on information gathered from teacher interviews and observations at a New Zealand primary school, this article suggests that culture and context strongly shape and influence the interpretation of key competencies. The authors develop a metaphorāte tuangiāto theorise the relationship between a learner (akonga) and a teacher (kaiako) in a cultural and social context
Organisational transformations in the New Zealand retirement village sector: A critical-rhetorical and -discursive analysis of promotion, community, and resident participation.
This thesis examines quotcustomer-focusedquot communication and resident participation within the retirement village sector which is one part of the increasingly quotmarketisedquot aged-care services in New Zealand. In this respect the sector is no different from other domains of consumer life where marketing-oriented organisations aim to find out what their customers want and give it to them. This research examines communication related to customer-focused organisational activities and residents' enactment of participation within retirement village organisation (RVO) settings with respect to these processes of marketisation.
Taking a critical-interpretive perspective, the thesis undertakes a collective case study involving two major New Zealand RVOs. Both organisations were defined as quotretirement villagesquot within the meaning of the Retirement Villages Act 2003, established in the 1990s, and offered quotretirement livingquot independent housing and apartments across a range of locations. A significant part of the study also examined publicly available promotional material from six RVOs operating multiple sites in various New Zealand locations.
This thesis explores retirement villages as co-productions between the corporate entities that develop and market villages and the residents who live in them. The thesis also explores RVO rhetoric about quotretirement living for active 55 plusquot, RVO enactment of customer focused communication and activities, and residents responses to and expectations of both. It is argued that this co-production has implications for residents' participation, their roles and relationships with employees, as well as for organisational communication processes and structures.
The rhetorical and critical discourse analysis reveals the complexity of what quotparticipationquot means for the residents. Through a close examination of these meanings, the thesis extends current understandings of relationships between quotcustomersquot and quotcustomer-focusedquot
organisations and highlights the role of older people in Western Society as co-producers of the very product they purchase: the retirement village. It also raises practical and theoretical issues for organisational communication. At the practical level it highlights how communication messages, structures and processes within RVOs experience tensions in meeting the needs of both internal, current, and long-term customers, and external, potential, and future customers. The thesis offers insights into issues of individual action and freedom within the frame of market-driven and avowedly quotcustomer-focusedquot organisations and consequently suggests a reconsideration of participation in organisations in which customers are also quotinsidersquot
KaumÄtua mana motuhake: KaumÄtua managing life-transitions through tuakana-teina/peer-education
People face signifi cant transition points as they age, such as loss of independent living, loss of a spouse and changing health conditions. Successfully navigating these transitions depends on being able to manage emotional and socio-economic factors, as well as service systems, while often being reliant on family or whÄnau. Historically however, kaumÄtua have faced a dominant society that has failed to realise their full potential as they age. Yet, for MÄori, kaumÄtua are ācarriers of culture, anchors for families, models for lifestyle, bridges to the future, guardians of heritage and role models for younger generations.ā KaumÄtua mana motuhake is invested in upholding kaumÄtua tino rangatiratanga (independence and autonomy) via high-quality MÄori research that will lead to better life outcomes for kaumÄtua and their whÄ nau
Enhancing well-being and social connectedness for Maori elders through a peer education (Tuakana-Teina) programme: A cross-sectional baseline study
Background: MÄori kaumÄtua (elders) face stark health and social inequities compared to non-MÄori New Zealanders. The tuakana-teina (older sibling-younger sibling) peer education programme is a strengths-based approach to enhance well-being and social connectedness. The purpose of this study is to present the baseline data from this programme and identify correlates of well-being outcomes.
Method: Participants included 128 kaumÄtua who completed a self-report survey about health-related quality of life, spirituality, social connection and loneliness, life satisfaction, cultural identity and connection, elder abuse, health service utilisation and demographics.
Findings: Multiple regression models illustrated the following correlates of outcomes: (a) self-rated health: needing more help with daily tasks (Ī² = ā0.36) and housing problems (Ī² = ā0.17); (b) health-related quality of life: needing more help with daily tasks (Ī² = ā0.31), housing problems (Ī² = ā0.21), and perceived autonomy (Ī² = 0.19); (c) spiritual well-being: understanding of tikanga (cultural protocols) (Ī² = 0.32) and perceived autonomy (Ī² = 0.23); (d) life satisfaction: social support (Ī² = 0.23), sense of purpose (Ī² = 0.23), cultural identity (Ī² = 0.24), trouble paying bills (Ī² = ā0.16), and housing problems (Ī² = ā0.16); (e) loneliness: elder abuse (Ī² = 0.27), social support (Ī² = ā0.21), and missing pleasure of being with whÄnau (extended family) (Ī² = 0.19).
Conclusions: Key correlates for outcomes centred on social support, housing problems, cultural connection and perceived autonomy. These correlates are largely addressed through the programme where tuakana/peer educators provide support and links to social and health services to teina/peer recipients in need. This study illustrates needs and challenges for kaumÄtua, whilst the larger programme represents a strengths-based and culturally-centred approach to address health issues related to ageing in an Indigenous population
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Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.
Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (nā=ā143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (nā=ā152), or no hydrocortisone (nā=ā108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (nā=ā137), shock-dependent (nā=ā146), and no (nā=ā101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707
Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950ā2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021
Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020ā21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62Ā·8% [95% UI 60Ā·5ā65Ā·1] decline), and increased during the COVID-19 pandemic period (2020ā21; 5Ā·1% [0Ā·9ā9Ā·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4Ā·66 million (3Ā·98ā5Ā·50) global deaths in children younger than 5 years in 2021 compared with 5Ā·21 million (4Ā·50ā6Ā·01) in 2019. An estimated 131 million (126ā137) people died globally from all causes in 2020 and 2021 combined, of which 15Ā·9 million (14Ā·7ā17Ā·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22Ā·7 years (20Ā·8ā24Ā·8), from 49Ā·0 years (46Ā·7ā51Ā·3) to 71Ā·7 years (70Ā·9ā72Ā·5). Global life expectancy at birth declined by 1Ā·6 years (1Ā·0ā2Ā·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15Ā·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7Ā·89 billion (7Ā·67ā8Ā·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39Ā·5% [28Ā·4ā52Ā·7]) and south Asia (26Ā·3% [9Ā·0ā44Ā·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92Ā·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic