511 research outputs found
Ya got ta know when ta hold āem: Maori women and gambling
Gambling among Maori women is under-researched. In this study, I interviewed thirty Maori
women to investigate how they got involved in gambling, what maintained their gambling and
what they thought might help to moderate their gambling. I found that the whanau was central
to understanding these issues. As children, my participants were exposed to gambling within
their whanau. As adults, whanau and other social support relationships were an integral part of
their gambling, which most commonly occurred in the context of card schools and housie. A
sense of reciprocity was important in both forms of gambling. Card schools were reported to be
close-knit groups within which the money circulated, giving all a chance to win. By playing
housie, the women felt that they were contributing to the welfare of their marae. Through the
social bonds of gambling and the acquisition of skills, gambling contributed to these womenās
sense of identity. On the other hand, financial and relationship difficulties were identified as
negative consequences of gambling. The women felt there was a need for Maori-focused
services for problem gambling
MÄori Women and Gambling: Every Day is a War Day!
This study was concerned with the health implications of new forms of gambling such as casinos, pokie machines and internet gambling for MÄori women and their families in Auckland and the Bay of Plenty region of Aotearoa (New Zealand). It set out to discover what culturally appropriate services were available and the extent to which MÄori women gamblers were utilising them. The literature documenting MÄori perceptions of gambling shows that MÄori women gamblers and their partner/whÄnau members and gambling service providers have been little studied previously.
These goals translated into the following specific aims: 1) to study how MÄori women problem gamblers, their partner or whÄnau members and key informants perceived gambling, what it meant to them and why they did it; 2) to investigate the consequences of gambling for MÄori women, whÄnau and service providers in dealing with the effects of gambling; 3) to report on how these three groups dealt with the effects of gambling; and 4) to discover what helped to bring about positive changes for the three groups.
All of the aims were achieved.
A MÄori approach (Kaupapa MÄori), combined with a naturalistic approach to data collection, was adopted. Qualitative methods are most appropriate to use when working with some MÄori, as there is a growing realisation that research with MÄori needs to be interactive. A MÄori research procedure modelled on the ritual ceremony of encounter (PÅwhiri) provided an appropriate structure for the development and presentation of the research process. The major focus was on the qualitative data obtained from semi-structured interviews in two locations - Rotorua and Auckland. The interviews were conducted with twenty MÄori women gamblers, sixteen whÄnau members including partners and ten interviews with staff involved in services that provided help for problem gamblers. The three interview schedules were based on a number of broad themes and open-ended questions to obtain meaningful descriptive data. The interviews were audio recorded and used to produce transcripts that were then sent back to the participants for feedback. Qualitative data analysis was conducted on the returned documents.
The findings from this study revealed major impacts of the women's socio-economic, familial and societal circumstances on gambling behaviour and its effects, which are areas of concern for mental health professionals and researchers. The mythical MÄori canoes on which MÄori voyaged from their place of origin (Hawaiiki) to Aotearoa, the Waka, provided an appropriate metaphor to present the interrelationship between the pull and push factors toward gambling, and its implications for society. This is illustrated as a spinning waka, Te Waka HÅ«rihuri. On the other hand, Te Waka MÄia (courageous) demonstrates the relationships between the variables that help MÄori women gamblers to cope and helpful strategies found to assist them to modify or stop their gambling behaviour. It is recommended that the government limit the proliferation of gaming venues and continue to encourage development of emerging MÄori services. Moreover, a coordinated approach is essential, as MÄori women gamblers, partners and whÄnau members need to heal together for positive outcomes for MÄori health development in Aotearoa.
The main implication of this study is that a wide range of further research into MÄori and gambling is required. Recommendations on ways in which the current delivery of services in Rotorua and Auckland could be improved are:
That the Ministry of Health purchase services that establish support groups for MÄori people with problem gambling and their whÄnau, and
That non-MÄori provider services and organisations support the development of emerging MÄori services.
Heeding the outcome of this research should help improve New Zealand's existing health policy and capacity for MÄori women's health development. It should also enrich our understanding of the adaptation patterns of MÄori whÄnau member/s, and thus should have implications, not only for MÄori health policies, but also relevance for the wider field of international cross-comparative research on indigenous gambling and mental health issues. Limitations of this study included a small, localised sample that means the findings can only tentatively be generalised to the wider population of MÄori women gamblers. Nonetheless, information gained from the study contributes to understanding of the adaptation patterns of MÄori women gamblers, their whÄnau member/s, and those who are trying to help them. It is hoped that the study will make it at least a little less true that every day is a war day for MÄori women and their whÄnau trying to deal with the problem of gambling
Reducing Barriers to Accessing Administrative Data on SARS-CoV-2 Vaccination for Research
Public trust in scientific research, especially research regarding vaccines, has proven fragile during the COVID-19 pandemic. To counter abundant misinformation about SARS-CoV-2 vaccines, rigorous, ongoing evaluations of vaccine safety and effectiveness by independent Canadian researchers are important. However, researchers\u27 efforts to conduct timely, national studies of vaccine effectiveness have been hindered by barriers to data sharing that have made it difficult to integrate patients\u27 vaccination status into SARS-CoV-2 clinical and epidemiological studies. Here, McRae et al discuss how a risk-averse data-sharing culture has led to missed opportunities to conduct robust, timely, pan-Canadian SARS-CoV-2 clinical and vaccine effectiveness studies, and outline mechanisms for data sharing that can and should be undertaken
Assessing health-related quality of life (HRQoL) in survivors of out-of-hospital cardiac arrest : A systematic review of patient-reported outcome measures
Aim: High quality evidence of out-of-hospital cardiac arrest (OHCA) survivors' health-related quality of life (HRQoL) can measure the long-term impact of CA. The aim of this study was to critically appraise the evidence of psychometric quality and acceptability of measures used in the assessment of HRQoL in cardiac arrest survivors. Methods: Systematic literature searches (2004-2017) and named author searches to identify articles pertaining to the measurement of HRQoL. Data on study quality, measurement and practical properties were extracted and assessed against international standards. Results: From 356 reviewed abstracts, 69 articles were assessed in full. 25 provided evidence for 10 measures of HRQoL: one condition-specific; three generic profile measures; two generic index; and four utility measures. Although limited, evidence for measurement validity was strongest for the HUI3 and SF-36. However, evidence for reliability, content validity, responsiveness and interpretability and acceptability was generally limited or not available in the CA population for all measures. Conclusions: This review has demonstrated that a measure of quality of life specific to OHCA survivors is not available. Limited evidence of validity exists for one utility measure - the HUI3 - and a generic profile - the SF-36. Robust evidence of the quality and acceptability of HRQoL measures in OHCA was limited or not available. Future collaborative research must seek to urgently establish the relevance and acceptability of these measures to OHCA survivors, to establish robust evidence of essential measurement and practical properties over the short and long-term, and to inform future HRQoL assessment in the OHCA population. (C) 2017 Elsevier B.V. All rights reserved.Peer reviewe
Expanding Paramedicine in the Community (EPIC): study protocol for a randomized controlled trial.
BackgroundThe incidence of chronic diseases, including diabetes mellitus (DM), heart failure (HF) and chronic obstructive pulmonary disease (COPD) is on the rise. The existing health care system must evolve to meet the growing needs of patients with these chronic diseases and reduce the strain on both acute care and hospital-based health care resources. Paramedics are an allied health care resource consisting of highly-trained practitioners who are comfortable working independently and in collaboration with other resources in the out-of-hospital setting. Expanding the paramedic's scope of practice to include community-based care may decrease the utilization of acute care and hospital-based health care resources by patients with chronic disease.Methods/designThis will be a pragmatic, randomized controlled trial comparing a community paramedic intervention to standard of care for patients with one of three chronic diseases. The objective of the trial is to determine whether community paramedics conducting regular home visits, including health assessments and evidence-based treatments, in partnership with primary care physicians and other community based resources, will decrease the rate of hospitalization and emergency department use for patients with DM, HF and COPD. The primary outcome measure will be the rate of hospitalization at one year. Secondary outcomes will include measures of health system utilization, overall health status, and cost-effectiveness of the intervention over the same time period. Outcome measures will be assessed using both Poisson regression and negative binomial regression analyses to assess the primary outcome.DiscussionThe results of this study will be used to inform decisions around the implementation of community paramedic programs. If successful in preventing hospitalizations, it has the ability to be scaled up to other regions, both nationally and internationally. The methods described in this paper will serve as a basis for future work related to this study.Trial registrationClinicalTrials.gov: NCT02034045. Date: 9 January 2014
Prehospital resuscitation with hypertonic saline-dextran modulates inflammatory, coagulation and endothelial activation marker profiles in severe traumatic brain injured patients
<p>Abstract</p> <p>Background</p> <p>Traumatic brain injury (TBI) initiates interrelated inflammatory and coagulation cascades characterized by wide-spread cellular activation, induction of leukocyte and endothelial cell adhesion molecules and release of soluble pro/antiinflammatory cytokines and thrombotic mediators. Resuscitative care is focused on optimizing cerebral perfusion and reducing secondary injury processes. Hypertonic saline is an effective osmotherapeutic agent for the treatment of intracranial hypertension and has immunomodulatory properties that may confer neuroprotection. This study examined the impact of hypertonic fluids on inflammatory/coagulation cascades in isolated head injury.</p> <p>Methods</p> <p>Using a prospective, randomized controlled trial we investigated the impact of prehospital resuscitation of severe TBI (GCS < 8) patients using 7.5% hypertonic saline in combination with 6% dextran-70 (HSD) <it>vs </it>0.9% normal saline (NS), on selected cellular and soluble inflammatory/coagulation markers. Serial blood samples were drawn from 65 patients (30 HSD, 35 NS) at the time of hospital admission and at 12, 24, and 48-h post-resuscitation. Flow cytometry was used to analyze leukocyte cell-surface adhesion (CD62L, CD11b) and degranulation (CD63, CD66b) molecules. Circulating concentrations of soluble (s)L- and sE-selectins (sL-, sE-selectins), vascular and intercellular adhesion molecules (sVCAM-1, sICAM-1), pro/antiinflammatory cytokines [tumor necrosis factor (TNF)-Ī± and interleukin (IL-10)], tissue factor (sTF), thrombomodulin (sTM) and D-dimers (D-D) were assessed by enzyme immunoassay. Twenty-five healthy subjects were studied as a control group.</p> <p>Results</p> <p>TBI provoked marked alterations in a majority of the inflammatory/coagulation markers assessed in all patients. Relative to control, NS patients showed up to a 2-fold higher surface expression of CD62L, CD11b and CD66b on polymorphonuclear neutrophils (PMNs) and monocytes that persisted for 48-h. HSD blunted the expression of these cell-surface activation/adhesion molecules at all time-points to levels approaching control values. Admission concentrations of endothelial-derived sVCAM-1 and sE-selectin were generally reduced in HSD patients. Circulating sL-selectin levels were significantly elevated at 12 and 48, but not 24 h post-resuscitation with HSD. TNF-Ī± and IL-10 levels were elevated above control throughout the study period in all patients, but were reduced in HSD patients. Plasma sTF and D-D levels were also significantly lower in HSD patients, whereas sTM levels remained at control levels.</p> <p>Conclusions</p> <p>These findings support an important modulatory role of HSD resuscitation in attenuating the upregulation of leukocyte/endothelial cell proinflammatory/prothrombotic mediators, which may help ameliorate secondary brain injury after TBI.</p> <p>Trial registration</p> <p>NCT00878631.</p
Genome-wide association study of dental caries in the Hispanic Communities Health Study/Study of Latinos (HCHS/SOL)
Dental caries is the most common chronic disease worldwide, and exhibits profound disparities in the USA with racial and ethnic minorities experiencing disproportionate disease burden. Though heritable, the specific genes influencing risk of dental caries remain largely unknown. Therefore, we performed genome-wide association scans (GWASs) for dental caries in a population-based cohort of 12 000 Hispanic/Latino participants aged 18ā74 years from the HCHS/SOL. Intra-oral examinations were used to generate two common indices of dental caries experience which were tested for association with 27.7 M genotyped or imputed single-nucleotide polymorphisms separately in the six ancestry groups. A mixed-models approach was used, which adjusted for age, sex, recruitment site, five principal components of ancestry and additional features of the sampling design. Meta-analyses were used to combine GWAS results across ancestry groups. Heritability estimates ranged from 20ā53% in the six ancestry groups. The most significant association observed via meta-analysis for both phenotypes was in the region of the NAMPT gene (rs190395159; P-value = 6 Ć 10ā10), which is involved in many biological processes including periodontal healing. Another significant association was observed for rs72626594 (P-value = 3 Ć 10ā8) downstream of BMP7, a tooth development gene. Other associations were observed in genes lacking known or plausible roles in dental caries. In conclusion, this was the largest GWAS of dental caries, to date and was the first to target Hispanic/Latino populations. Understanding the factors influencing dental caries susceptibility may lead to improvements in prediction, prevention and disease management, which may ultimately reduce the disparities in oral health across racial, ethnic and socioeconomic strata
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