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

Primary airway epithelial cells from asthmatics, but not subjects with COPD, generate elevated extracellular uric acid levels.

<p>(<b>A</b>) Cell culture supernatant analysis of uric acid levels in un-stimulated primary human airway epithelial cells from healthy age-matched control subjects and asthmatics following 24h of culture. (<b>B</b>) Cell culture supernatant analysis of uric acid levels in un-stimulated primary human airway epithelial cells from healthy age-matched control subjects and those with COPD following 24h of culture. Data represent mean +/- SD, n = 5–8. Significance is represented by *p<0.05 relative to healthy controls.</p

Extracellular uric acid levels from human airway epithelial cells can be attenuated with the XDH inhibitor, allopurinol, and the ABCC4 inhibitor, MK-571.

<p><b>(A)</b> Allopurinol (500 μM) and MK-571 (20 μM) treatment for 24h attenuated un-stimulated production of uric acid from HBEC-6KT, a human airway epithelial cell line derived from a healthy individual. <b>(B)</b> <i>XDH</i> and <b>(C)</b> <i>ABCC4</i> gene expression in HBEC-6KT cells. Data represent mean +/- SD, n = 3. Significance is represented by * = p<0.05 relative to control.</p

TNF-α and IFN-γ elevate extracellular uric acid levels and XDH gene expression in human airway epithelial cells.

<p><b>(A)</b> HBEC-6KT human airway epithelial cells were treated with TNF-α (20ng/ml) and IFN-γ (1000U/ml) for 24h followed by analysis of cell culture supernatant for uric acid levels in the presence or absence of allopurinol (500 μM) <b>(B)</b> <i>XDH</i> gene expression following TNF-α (20ng/ml) and IFN-γ (1000U/ml) treatment for 24h. Data represent mean +/- SD, n = 3. Significance is represented by * = p<0.05 relative to DMSO/control, % = p<0.05 relative to DMSO/ TNF-α+IFN-γ</p

Exposure to HDM but not cigarette smoke induces uric acid production <i>in vivo</i> in mouse lungs and <i>in vitro</i> in human airway epithelial cells.

<p>(<b>A</b>) BAL analysis of uric acid levels in mice 24h following exposure to air or cigarette smoke (n = 10). (<b>B</b>) BAL analysis of uric acid levels in mice 24h following exposure to PBS or HDM (n = 10). (<b>C</b>) HBEC-6KT human airway epithelial cell culture supernatant analysis of uric acid levels 24h following exposure to control (media alone) or cigarette smoke (4% cigarette smoke extract conditioned media) (n = 6). (<b>D</b>) HBEC-6KT human airway epithelial cell culture supernatant analysis of uric acid levels 24h following exposure to control (PBS) or HDM (50 μg/ml) (n = 6). Data represent mean +/- SD. Significance is represented by * = p<0.05 relative to control.</p

Clinical subject characteristics.

<p>Clinical subject characteristics.</p

Extracellular uric acid levels in cultured human airway epithelial cells are not augmented by diverse chemical exposures.

<p>Treatment of HBEC-6KT human airway epithelial cells with ferric ammonium sulfate (50 μM), cycloheximide (0.01 μg/ml), H₂O₂ (100 μM), and dexamethasone (10 μg/ml) for 24h did not induce elevations in extracellular uric acid levels in contrast to the positive control of HDM (50 μg/ml). Data represent mean +/- SD, n = 3. Significance is represented by * = p<0.05 relative to control.</p