He Pikinga Waiora Implementation Framework

The Framework has indigenous self-determination at its core. All four elements have conceptual fit with Kaupapa Māori aspirations and all have demonstrated evidence of positive implementation outcomes. A coding scheme derived from the Framework was applied to 13 studies of diabetes prevention in indigenous communities in Australia, Canada, New Zealand, and the United States. Cross-tabulations demonstrated that cultural centeredness (p=.008) and community engagement (p=.009) explained differences in diabetes outcomes and community engagement (p=.098) explained difference in blood pressure outcomes. The Framework is intended as a planning tool to guide the successful development and implementation of interventions. Funders can use the Framework to assess the likely effectiveness of proposed interventions. Community organizations can use the Framework to work with researchers or policy makers to strengthen each of the four elements

2016 He Pikinga Waiora external funding MBIE National Science Challenge Healthier Lives

Background: About 40% of all health burden in New Zealand is due to cancer, cardiovascular disease, and type 2 diabetes/obesity. Outcomes for Māori (indigenous people) are significantly worse than non-Maori; these inequities mirror those found in indigenous communities elsewhere. Evidence-based interventions with established efficacy may not be effective in indigenous communities without addressing specific implementation challenges. We present an implementation framework

Improving patient experience and outcomes following serious injury

This study highlights perceived issues in the patient care pathway in the transition from inpatient to community-based care, especially communication and discharge information delivered by surgical clinical teams. Comprehensive inpatient care and clinical handover to primary care (rather than discharge planning processes) by dedicated clinical trauma services may provide more holistic models for surgical services to improve their influence on the transition of trauma patients into the community, assisted by organisation changes and support to enable effective service delivery. This is the first qualitative study to investigate the experience of Waikato Hospital (non-major) trauma patients and their families/whanau as they transition from inpatient surgical services to community-based care. The findings will inform system changes to support improved health, vocational and social outcomes for injured patients

AN ANALYSIS OF THE 2009-10 STATE AND TERRITORY HEALTH BUDGETS

This analysis of the 2009-10 State and Territory Health Budgets has been prepared by assessing the budget commitments, as we found them in the publicly available budget papers and related information, against the partnership commitments agreed through the COAG process. Given the dramatically different ways in which governments present their budgets, and different levels of detail, this has not been an easy task. However we would argue that if the COAG partnerships to drive forward health care reform nationally are to be effective, efficient and publicly accountable, then the ability to make this sort of analysis annually is essential

BUDGET 2009-10: A HEALTHY MID YEAR ECONOMIC AND FISCAL OUTLOOK?

The purpose of the MYEFO report is to provide updated information to allow the assessment of the Government’s fiscal performance against the fiscal strategy set out in the current Budget Papers. The Treasurer must publicly release and table a Mid-year Economic and Fiscal Outlook (MYEFO) report by the end of January in each year, or within 6 months after the last budget, whichever is later. Typically, the MYEFO is released in November each year. This year it was released on November 2. Over the past 12 months the global economic conditions have seriously impacted the fiscal outlook so this year the MYEFO was anxiously anticipated

Scorecard on Government Health Commitments

While the Rudd Government has delivered on quite a few of its pre-election commitments, obesity and dental health are two of the stand-out issues yet to be addressed in any depth. Australia is one of the most overweight countries and both childhood and adult obesity are on the rise. Let’s not forget the range of worrying co-morbidities associated with overweight and obesity, including diabetes and heart disease, and the social, economic and health costs of these largely preventable conditions. Dental disease also worsens these chronic conditions and the National Health and Hospitals Reform Commission (NHHRC), in its interim report ‘A healthier future for all Australians’, estimates that there were 50,000 avoidable hospital admissions arising from preventable dental conditions in 2004–05. There has been some progress in tackling these issues. In late 2007 the Minister for Health, the Hon Nicola Roxon MP, attended a summit aimed at tackling childhood obesity in Australia, and outlined the new government’s commitment to making obesity prevention a National Health Priority Area. In addition, obesity was identified as a key issue at the ‘2020 Summit’. On dental health, while the NHHRC supports the principle that dentistry should be included in Medicare, the Government has failed to gain the support needed in the Senate to pass legislation for the Commonwealth Dental Plan. Last month, the Standing Committee on Health and Ageing tabled its report on the inquiry into obesity in Australia, ‘Weighing it up: Obesity in Australia.’ It focuses on future implications for Australia’s health system and complements the National Preventative Health Taskforce process. In addition to the recently released NHHRC report ‘A healthier future for all Australians’, a number of other major reports are expected to be released in coming weeks, including those of the National Primary Health Care Strategy External Reference Group and the Preventative Health Taskforce. The Government’s response to these reports will have a significant impact on how prevention issues will be tackled and how health care services will be delivered. The reports might also provide the impetus for the Australian Government to deliver on further important election commitments to combat obesity and the poor oral health status of many Australians. Real health care reform will require a concerted, long-term and well-resourced commitment to both obesity prevention and treatment and better and more affordable dental health care

Prolactin-induced proteins and dependence on protein synthesis for β-casein expression in mouse mammary cells

The regulation of milk protein gene expression in mammary epithelial cells occurs in response to multiple hormonal signals, plus cell-matrix and cell-cell interactions. A number of signalling molecules have been implicated in this process, but the exact molecular mechanisms regulating milk protein gene expression remain to be established. The project described in this thesis focuses on investigating the de novo synthesis of proteins in response to prolactin in mammary epithelial cells, to determine the role of de novo synthesis in lactogenic signalling, and to identify proteins which are induced by prolactin that could act as mediators of lactogenic signals. Two main approaches were taken: (1) The results of proteome analyses using two-dimensional electrophoresis revealed a number of prolactin-responsive proteins in cells from the mouse mammary epithelial cell line, COMMA-D, and also lactation-associated proteins in freshly isolated mouse mammary epithelial cells. Two prolactin-induced and lactation-associated proteins, p77 and p63, were identified as glucose regulated protein 78 (grp78) and protein disulphide isomerase (PDI), and assessed as potential regulators of lactation. These proteins are reticuloplasmins and probably function in mammary epithelial cells in the processing of milk proteins for secretion. The results of this investigation have shown that grp78 and PDI were not rapidly induced in response to prolactin, thus it is unlikely that these proteins are involved in mediating lactogenic signals in response to prolactin. (2) The requirement for de novo protein synthesis for maximal prolactin-stimulated β-casein gene expression was evaluated in COMMA-D cells using the protein synthesis inhibitors cycloheximide (CHX) and anisomycin. It appears that protein synthesis is required at the level of transcription for maximal induction and maintenance of β-casein gene expression (over the first 8 h of prolactin treatment). Furthermore, this effect was shown to be very rapid and independent of the lactogenic hormones, insulin and hydrocortisone, and the extracellular matrix. To determine the molecular basis for the effect of CHX on β-casein mRNA levels, STAT5 protein levels and DNA-binding activity were analysed in COMMA-D cells cultured in the presence or absence of prolactin and/or CHX. The results of Western analyses showed that STAT5 protein levels were not significantly altered in the presence or absence of (prolactin and/ or) CHX. A DNA probe, denoted STAT5(30), derived from the rat β-casein promoter sequence (-104 to -75), which contains a high affinity STAT5 consensus sequence was used for EMSA. CHX treatment stimulated the induction of a DNA-binding activity of distinct mobility to STAT5. This protein-DNA complex was shown to contain the p50 subunit of NF-κB. Detailed analysis revealed that CHX-stimulated NF-κB bound to a putative κB half-site on the STAT5(30) probe (GGAATT), which overlaps the high-affinity STAT5 DNA-binding site (TTCTTGGAA). Therefore, the effect of CHX appears to be mediated by inhibition of IκB synthesis, leading to the activation of NF-κB. Since the κB site overlaps the STAT5 binding site, it is possible that NF-κB competes for binding to the β-casein promoter and sterically hinders STAT5 binding and transactivation of β-casein transcription. It is conceivable that competition between NF-κB and STAT5 is functionally significant if NF-κB is activated in response to physiological signals in the mammary gland. This remains to be demonstrated

Identifying strategic opportunities for Māori community organisations to respond to pre-diabetes: Building a platform for integrated care to deliver change that matters to communities.

Identifying strategic opportunities for Māori community organisations to respond to pre-diabetes: Building a platform for integrated care to deliver change that matters to communities Authors: Angela Beaton , Carey Manuel, Jade Tapsell, John Oetzel, Maui Hudson, Nina Scott, Moana Rarere Abstract Background: Inequities between Māori and non-Māori are the most consistent and compelling health inequities in New Zealand. Māori are three times as likely as non-Māori to have type II diabetes and are more likely to develop complications. Despite a strong international evidence base for health interventions that improve health outcomes, there has been little progress made in the way of reducing health inequities in New Zealand. He Pikinga Waiora (HPW) is a core project within the Healthier Lives National Science Challenge research programme within New Zealand, which aims to integrate community-based participatory research, kaupapa Māori, systems thinking and implementation science to promote transformational improvements in health service delivery, with a focus on pre-diabetes. Aims: In partnership with a Māori Development Organisation (MDO), this research aims to identify strategic opportunities to respond to pre-diabetes for the benefit of Māori. Methods: Key relationships, partnerships, contracts, funding streams, services and organisational strengths and barriers were identified and analysed utilising case study methodology. A range of data sources were triangulated (Yin, 2003) including open-ended semi-structured interviews, observation, documents (vision, mission, values and strategic plan), archival records (contracts and funding reporting information), organisation structure charts and other sources that provide a clearer understanding or corroborate other data. These data will be compared with a pre-diabetes/diabetes systems map to identify opportunities for action. Results: Case study data will be presented within the context of a wider systems map for the organisation to identify strategic opportunities that may be considered and applied by MDOs to provide a more effective, integrated response to pre-diabetes. A thematic analysis identified the following domains: Inter-sectoral integration between health and social services, Leveraging organisational strengths and data to inform funding decisions and shift organisation-level performance, Managing barriers and constraints, and mitigating business risks, to improve patient, whānau and health professional journeys in navigating the system and accessing services, and Enhancing connections with wider public health services, promoting wellness and preventing other long term conditions and complications. Conclusion: While most integrated care efforts represent a partnership, predominantly led by health services, further exploration of other strategies and models is needed to integrate community-based participatory research, kaupapa Māori, systems thinking and implementation science for improved outcomes. Lessons learned and suggestions for further research: In many political agendas, integrated care remains synonymous with IT integration and other structural initiatives without paying adequate attention to the outcomes of integration - the patient, whānau and community experience being key. It is important that these aspects are also addressed in ongoing/future research. Keywords: indigenous, pre-diabetes, community-based participatory research, systems thinking, implementation science How to Cite: Beaton A, Manuel C, Tapsell J, Oetzel J, Hudson M, Scott N, et al.. Identifying strategic opportunities for Māori community organisations to respond to pre-diabetes: Building a platform for integrated care to deliver change that matters to communities. International Journal of Integrated Care. 2017;17(5):A166. DOI: http://doi.org/10.5334/ijic.3474 Published on 17 Oct 2017

Perceptions of economic hardship and implications for illness management: a survey of general practitioners in western Sydney

The present study aimed to understand the options available to general practitioners (GPs) practising in Western Sydney to help patients experiencing economic hardship to manage their illnesses and the implications of these findings for policy

Specialist palliative care: Current and future service challenges

Introduction/Background: Those working in palliative care face several current challenges, including: to reach beyond cancer and the physical to other dimensions of care; to start much earlier than at terminal stages of illness; to extend from specialist services to generalists; and to support primary carers. Research Question: How well does the Calvary Health Care Bethlehem (CHCB) model of specialist palliative care tackle these challenges? Methodology: We conducted a mixed‐method, multi‐perspective study in which thirty palliative care patients and their nominated carers and health care professionals (HCPs) were interviewed over a six month period. HCPs also participated in focus groups. Results were analysed using a thematic content analysis framework. HCP accounts of the CHCB service were used to construct a narrative description of the CHCB model of specialist palliative care. Policy Implications: Recent policy reports from the National Health and Hospitals Reform Commission and the Productivity Commission’s draft report Caring for Older Australians advocated greater use of coordination and teamwork in palliative care. This study helps define what this might mean in practice