The Health and Wellbeing of Homeless People: Complexities around the Provision of Primary Healthcare in New Zealand

Homelessness is a pressing social issue, and people who are homeless, in particular those who sleep rough, often experience a confluence of physical and mental health issues. Health problems experienced by homeless people can be more severe than those experienced by domiciled people. Such problems can contribute to homelessness, and be exacerbated by homelessness. Previous research has found that for various reasons, primary healthcare services can be inaccessible for homeless populations. More recent research explores the growing availability of accessible, non-threatening health services targeting homeless people, with humanistic approaches to care. This thesis draws on a case study of an NGO clinic providing population-based primary healthcare to homeless and low-income people. The case study is informed by the perspectives of two groups of participants; homeless clinic patients and clinic staff. Ten semi-structured interviews were conducted with homeless clients, and six semi-structured interviews were undertaken with clinic personnel. Social representations theory informs the interpretation, analysis and discussion of the participants' conceptualisations of health and wellbeing, illness and disease, homelessness, health services and the NGO clinic. Social representations from both participant groups (micro perspectives) inform shared social representations (macro perspectives) of the NGO clinic. This determines whether participants conceptualise the clinic as an 'ideal' health service for homeless people. NGO clinic staff responses reveal that clinic staff have a personal and professional ethos to work with people in need and those that may have been stigmatised from society. This shared ethos has shaped the development of the NGO clinic, into its current structure of a holistic, population based primary healthcare for homeless people integrated within a wider social service structure. In this setting, relationships are developed between practitioners and homeless clients to ensure homeless patients healthcare needs are met. Also, practical needs are met as the clinic provides low-cost healthcare to homeless people within the context of an umbrella organisation that provides other much-needed social services. Collaboration is an important component to the efficacy of the NGO clinic, and meeting patient needs. However, clinic staff note that there are many dilemmas in providing healthcare to homeless people, and they can struggle to provide the service according to their vision, due to funding constraints. Nonetheless, NGO clinic personnel are committed to working with their patients, and find their jobs rewarding. The responses from homeless clinic patients brought to mind a military metaphor, which was utilised to anchor the experiences of homeless people in a familiar concept - the military. Each homeless client that was interviewed at the NGO clinic is written about in the form of a health biography, which summarises current health issues, health histories, health related practices and conceptualisations of health. The severity of three major health issues experienced by the participants - addictions, mental health issues and foot problems - are then explored in terms of detailed perspectives from homeless participants, and clinic personnel conceptualisations of those particular health issues. Social networks are discussed as important to homeless people's health and wellbeing, particularly through resource and information sharing. The clinic setting is conceptualised by homeless participants as a caring, welcoming environment; which contrasts with some negative experiences reported by homeless participants in other health service settings. This thesis explores the NGO clinic as a unique model for a health service that meets the various healthcare needs of homeless people. There is a need for more recognition from government organisations and policy makers of the impoverished life situations that many homeless people find themselves in - often without minimum standards of living, which jeopardises their ability to take care of their health. Appropriate health services need to be accessible to homeless people, in order for healthcare needs to be met

Climate-compatible development in New Zealand

Like many countries, New Zealand is grappling with how to reduce greenhouse gas emissions while adapting to climate change. We are working through a Zero Carbon Bill and the implications of transitioning to a low-carbon economy. The country is being told it needs a more co-ordinated and effective way to prepare for climate change impacts, as local government is formulating adaptation and mitigation strategies in an uncertain and, as discussed below, at times confusing legal and policy framework. Potentially helpful is a concept evolving internationally, climatecompatible development. This promotes the idea of explicitly combining strategies and policies for emissions reductions and adaptation initiatives while enabling improvements in human wellbeing. This article explores the usefulness of such a concept for New Zealand

An external evaluation of Phat Pak process and structure: Volume 1: Evaluation report

An evaluation was conducted by the 510 Evaluation Research Group 2007 after receiving a request from the Phat Pak Governance Group (PPGG). The evaluation focused on four areas identified in the Phat Pak service specification plan attached to it’s Ministry of Health contract (Youth participation, Communication Strategies, Decision making Processes and Skills Development). Our intention of evaluating the Phat Pak Programme has been to, through feedback from a range of participants, gauge the extent that the programme objectives (such as those highlighted in the contract are being met. More specifically, the function of the evaluation has been to help identify specific areas that are working well and those areas that need further development. It is our intention that the evaluation will provide both short and long-term direction with added insight towards increasing participation and enhancing health outcomes for youth and the wider community of the Waikato region

An external evaluation of Phat Pak process and structure: Volume 2: Appendices

An evaluation was conducted by the 510 Evaluation Research Group 2007 after receiving a request from the Phat Pak Governance Group (PPGG). The evaluation focused on four areas identified in the Phat Pak service specification plan attached to it’s Ministry of Health contract (Youth participation, Communication Strategies, Decision making Processes and Skills Development)

Transmission and Control of African Horse Sickness in The Netherlands: A Model Analysis

African horse sickness (AHS) is an equine viral disease that is spread by Culicoides spp. Since the closely related disease bluetongue established itself in The Netherlands in 2006, AHS is considered a potential threat for the Dutch horse population. A vector-host model that incorporates the current knowledge of the infection biology is used to explore the effect of different parameters on whether and how the disease will spread, and to assess the effect of control measures. The time of introduction is an important determinant whether and how the disease will spread, depending on temperature and vector season. Given an introduction in the most favourable and constant circumstances, our results identify the vector-to-host ratio as the most important factor, because of its high variability over the country. Furthermore, a higher temperature accelerates the epidemic, while a higher horse density increases the extent of the epidemic. Due to the short infectious period in horses, the obvious clinical signs and the presence of non-susceptible hosts, AHS is expected to invade and spread less easily than bluetongue. Moreover, detection is presumed to be earlier, which allows control measures to be targeted towards elimination of infection sources. We argue that recommended control measures are euthanasia of infected horses with severe clinical signs and vector control in infected herds, protecting horses from midge bites in neighbouring herds, and (prioritized) vaccination of herds farther away, provided that transport regulations are strictly applied. The largest lack of knowledge is the competence and host preference of the different Culicoides species present in temperate regions

Development of a candidate VP2-based subunit vaccine for African horsesickness virus serotype 5

African horse sickness (AHS) is a lethal disease of horses. The aetiological agent is African horsesickness virus (AHSV) (genus Orbivirus; family: Reoviridae). Immunity to all nine serotypes is needed for full protection. The AHSV virion is composed of seven structural proteins and 10 dsRNA genes. The outer capsid protein, VP2, determines the serotype and elicits protective neutralising antibodies (NAbs). The existing polyvalent attenuated vaccine has some drawbacks. The most important ones are the exclusion of serotypes 5 and 9. Also, vaccinated and naturally infected horses cannot be differentiated. This impedes the international movement of horses. Recombinant su.bunit vaccines should solve both problems. Previously, it was established that baculovirus-expressed AHSV VP2 induces NAbs and partial protection. The main aim of this investigation was to improve the level of protection and develop a prototype VP2-based AHSV -5 vaccine to supplement the current attenuated vaccine and pave the way for developing a VP2-based subunit vaccine that incorporates all nine AHSV serotypes. Preliminary challenge experiments in horses indicated that AHSV -5 rVP2 provides incomplete protection against a lethal AHSV-5 challenge. Probable causes and solutions for this problem had to be sought. Analysis of the baculovirus-expressed AHSV-5 VP2 showed that most (ca. 90 %) is aggregated and that only the soluble part (ca. 10 %) elicits NAbs in guinea pigs and full protection in horses. Preliminary small-scale production studies indicated that solubility of the AHSV-5 rVP2 could be improved considerably by optimising in vitro infection conditions. A significant finding was that the safety and efficacy of soluble AHSV -5 rVP2 is determined by the adjuvant used. Saponin-based adjuvants rendered the best results, albeit with dose-related side effects in horses. Saponin Q was tolerated best. These results for the first time implicated AHSV VP2 in stimulating a protective cell-mediated immunity. Based on these results, it is recommended that a candidate AHSV-5 VP2-based subunit vaccine, consisting of 50 µg rVP2 and 3.0 mg Saponin Q for the primary immunisation followed by a 50 µµg rVP2 and 0.6 mg Saponin Q booster, be formulated for the purpose of field trials. The knowledge generated during this study, combined with the recent cloning of the VP2 genes of all nine AHSV serotypes, provides a route for the development of a complete recombinant vaccine that will offer protection against all nine AHSV serotypes and could well free the restraint on the import and export of horses to and from South Africa.Thesis (PhD (Microbiology))--University of Pretoria, 2005.Biochemistryunrestricte

A critical evaluation of Avery Dulles' different models of the church applied to a contemporary world.

We are living in post-modern time that was preceded by the pre-modern and modern time. All the negative happenings and unfulfilled promises of the modern period gave rise to the post-modern period. This present post-modern period is characterized by a disillusionment with all the harmony, truths and prosperity promised, that didn’t materialize during the modern era. Also the post-modernist challenges the church with its claim on absolute truths. Even so, the missionary task of the church hasn’t changed. However, the church is increasingly under pressure to be relevant and effective in a post-modern world where the church is only one generation away from extinction (Gibbs & Coffey 2001:10-11). From this perspective Averly Dulles’ operational models as presented by different church traditions are evaluated in terms of there effectiveness in our post-modern world. These operational models are researched and explained as an avenue to move people beyond their own limitations and to open conversation between people with different outlooks (Dulles 1987:12). To increase the saving capacity according to God’s salvation plan, a Biblical perspective to missions was added to each of Dulles six models. They include: the visible power structures and functions of the church must recognize the sovereignty of God in saving people; the church as mystical communion must use relationships to reach out to the lost; the church as sacrament must become an event; herald dimension must capture people’s attention; the servant approach must be taken to people’s hurts, needs and interests; disciples must become doers of the word. God’s saving plan works in the post-modern period with the focus on the postmodernist as a person. The post-modernist is drawn away from modern activities and dimensions towards a religion of experience. The model that is introduced is the Pentecostal model where the self-revelation of God is prominent.Prof. JA Du Ran

Evaluation of the Family Start programme: Synthesis of process and impact evaluation findings

This report provides findings from an evaluation of the Family Start programme (‘Family Start’), a voluntary home-visiting programme that supports whānau to improve children’s health, learning and relationships, whānau circumstances, environment and safety