The role and potential of community based cancer care for Māori in Aotearoa/New Zealand : A thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Wellington, New Zealand

There are unacceptable ethnic differences in cancer survival in Aotearoa/New Zealand and quality of life differs between Māori and non-Māori at all stages of the cancer journey. Overseas studies have recognised that all the priorities for cancer services are affected by actions in primary care – reducing the risk of cancer, early detection and faster access to specialist treatment, improved support for patients living with cancer, and reducing inequalities. Additionally, the importance of strategic policy to direct practical and effective community-based cancer care has also been identified. Māori health provider organisations have been using a ‘Whānau Ora’ approach to provide primary health care services for over twenty years; however their contributions to cancer care have been largely invisible. This qualitative study explores the role and potential of community based cancer care for Māori as a means to addressing three study questions: What helps patients and whānau to access and receive cancer services? What is the role of primary care, which includes Māori health providers and mainstream providers, in facilitating access into and through cancer care services? Does current cancer control policy adequately address Māori needs? Using a case study approach, participants from four areas of cancer care were recruited within a Māori-centred, ethic of care framework, to explore the experiences of those who plan, manage and administer, deliver, and receive cancer care. The main source of data was in-depth semi-structured interviews. The key themes identified from this research are that: whānau hold critical and multiple roles across cancer care; there are gaps in supportive cancer care and information that is appropriate for Māori; ongoing relationships with a primary health care provider assist whānau to navigate their cancer journeys, with Māori health providers in particular, delivering wide ranging cancer care services, and linking patients with mainstream services; engaging successfully with the cancer care system currently requires an individual rather than collective approach; cultural safety education should extend across all cancer care services; communication between cancer care providers is improving and; cancer control policy in Aotearoa has a universal focus which does not adequately address Māori needs. The role of primary care is pivotal in Māori cancer care access, from prevention through to survival, and must be at the forefront of cancer policy. Acknowledgement of the different support and quality of life needs of Māori, including recognition of the interdependence of whānau as a strength, is required. Māori health providers have the potential to play a much greater role in cancer care and support, but sustainable funding models are required if Māori health providers are to continue, and expand on, the wide range of work that they undertake within their communities. The newly implemented Whānau Ora Initiatives may provide a vehicle for provision of sustainable community cancer care services

Client experiences and confidence in nutrition advice delivered by registered exercise professionals

Objectives The aims of this cross-sectional study were to describe the client experiences of registered exercise professionals (REP) in regard to nutrition advice, and to identify factors considered important when selecting a REP. Design A convenience sample of fitness facility-users were recruited. Participants completed a 46 item online questionnaire. Method Frequency distributions were calculated for nutrition advice received from a REP, confidence in the nutrition advice received, and factors considered when selecting a REP. The effect of sex and level of education on participant responses were investigated. Results A total of 455 individuals participated, of which 55.6% had worked with a REP. Participants working with a REP had received nutrition advice on body fat loss (77.4%), muscle gain (78.7%), and clinical nutrition (51.9%). Sex and level of education did not influence confidence in nutrition advice, with 60.7% of participants reporting being ‘very or extremely confident’ in the nutrition advice. Over half of participants (58.3%) prefer to work with a REP who offers nutrition advice. Basic and personal professional conduct were identified as ‘very or extremely important’ by >70% of participants when selecting a REP. Conclusion Clients of REP prefer to work with a REP who provides nutrition advice and are generally confident in this advice. Educating fitness facility-users on the nutrition scope of practice of REP and promoting the role of accredited nutrition professionals should be advocated. Encouraging REP to work collaboratively with nutrition professionals will help ensure clients receive appropriate nutrition care, while better allowing REP to remain within their scope of practice

An experimental study of a virtual reality counselling paradigm using embodied self-dialogue

When faced with a personal problem people typically give better advice to others than to themselves. A previous study showed how it is possible to enact internal dialogue in virtual reality (VR) through participants alternately occupying two different virtual bodies - one representing themselves and the other Sigmund Freud. They could maintain a self-conversation by explaining their problem to the virtual Freud and then from the embodied perspective of Freud see and hear the explanation by their virtual doppelganger, and then give some advice. Alternating between the two bodies they could maintain a self-dialogue, as if between two different people. Here we show that the process of alternating between their own and the Freud body is important for successful psychological outcomes. An experiment was carried out with 58 people, 29 in the body swapping Self-Conversation condition and 29 in a condition where they only spoke to a Scripted Freud character. The results showed that the Self-Conversation method results in a greater perception of change and help compared to the Scripted. We compare this method with the distancing paradigm where participants imagine resolving a problem from a first or third person perspective. We consider the method as a possible strategy for self-counselling

Virtual reality for the rehabilitation and prevention of intimate partner violence – From brain to behavior: A narrative review

Rehabilitation and prevention strategies to reduce intimate partner violence (IPV) have limited effectiveness in terms of improving key risk factors and reducing occurrence. Accumulated experimental evidence demonstrates that virtual embodiment, which results in the illusion of owning a virtual body, has a large impact on people’s emotional, cognitive, and behavioral responses. This narrative review discusses work that has investigated how embodied perspective - taking in virtual reality has been used as a tool to reduce bias, to enhance recognition of the emotional state of another, and to reduce violent behaviors, in particular in the realm of IPV. Some of the potential neurological mechanisms behind these affective and behavioral changes are also discussed. The process of rehabilitation and prevention is complex and not always effective, but the integration of neuroscience-inspired and validated state-of-the-art technology into the rehabilitation process can make a positive contribution

Determinants of hand dermatitis, urticaria and loss of skin barrier function in professional cleaners in New Zealand.

This study assessed the risk of dermatitis, urticaria and loss of skin barrier function in 425 cleaners and 281 reference workers (retail workers and bus drivers). Symptoms, atopy and skin barrier function were assessed by questionnaire, skin prick tests, and measurement of transepidermal water loss. Cleaners had an increased risk of current (past 3 months) hand/arm dermatitis (14.8% vs. 10.0%; OR = 1.9, p < 0.05) and urticaria (11% vs. 5.3%; OR = 2.4, p < 0.05) and were more likely to have dermatitis as adults (17.6% vs. 11.4%; OR = 1.8, p < 0.05). The risk of atopy was not increased, but associations with symptoms were more pronounced in atopics. Transepidermal water loss was significantly higher in cleaners. Wet-work was a significant risk factor for dermatitis and hand washing and drying significantly reduced the risk of urticaria. In conclusion, cleaners have an increased risk of hand/arm dermatitis, urticaria and loss of skin barrier function

The efficiency of C-4 substituents in activating the -lactam scaffold towards serine proteases and hydroxide ion

The presence of a leaving group at C-4 of monobactams is usually considered to be a requirement for mechanism-based inhibition of human leukocyte elastase by these acylating agents. We report that second-order rate constants for the alkaline hydrolysis and elastase inactivation by N-carbamoyl monobactams are independent of the pKa of the leaving group at C-4. Indeed, the effect exerted by these substituents is purely inductive: electron-withdrawing substituents at C-4 of N-carbamoyl-3,3-diethylmonobactams increase the rate of alkaline hydrolysis and elastase inactivation, with Hammett rho-I values of 3.4 and 2.5, respectively, which indicate the development of a negative charge in the transition-states. The difference in magnitude between these rho-I values is consistent with an earlier transition-state for the enzymatic reaction when compared with that for the chemical process. These results suggest that rate limiting step in elastase inactivation is the formation of the tetrahedral intermediate, and that beta-lactam ring-opening is not concerted with the departure of a leaving group from C-4. Monobactam sulfones emerged as potent elastase inhibitors even when the ethyl groups at C-3, required for interaction with the primary recognition site, are absent. For one such compound, a 1:1 enzyme-inhibitor complex involving porcine pancreatic elastase has been examined by X-ray crystallography and shown to result from serine acylation and sulfinate departure from the β-lactam C-4

A História da Alimentação: balizas historiográficas

Os M. pretenderam traçar um quadro da História da Alimentação, não como um novo ramo epistemológico da disciplina, mas como um campo em desenvolvimento de práticas e atividades especializadas, incluindo pesquisa, formação, publicações, associações, encontros acadêmicos, etc. Um breve relato das condições em que tal campo se assentou faz-se preceder de um panorama dos estudos de alimentação e temas correia tos, em geral, segundo cinco abardagens Ia biológica, a econômica, a social, a cultural e a filosófica!, assim como da identificação das contribuições mais relevantes da Antropologia, Arqueologia, Sociologia e Geografia. A fim de comentar a multiforme e volumosa bibliografia histórica, foi ela organizada segundo critérios morfológicos. A seguir, alguns tópicos importantes mereceram tratamento à parte: a fome, o alimento e o domínio religioso, as descobertas européias e a difusão mundial de alimentos, gosto e gastronomia. O artigo se encerra com um rápido balanço crítico da historiografia brasileira sobre o tema

Are exercise professionals fit to provide nutrition advice? An evaluation of general nutrition knowledge

Objectives Registered exercise professionals (REP) are trained to provide structured exercise recommendations and general nutrition advice to healthy clients. However REP provide specific nutrition advice beyond their scope of practice, including diet-disease advice. The present study aims to investigate the level of general nutrition knowledge of REP, and compare this to a sample of community members (CTM), and university trained dietitians (DN). Design Age-matched REP, CTM and DN were recruited to complete the previously validated revised-general nutrition knowledge questionnaire. Methods Total nutrition knowledge score and section scores were compared between REP, CTM and DN. The impact of sex, age, level of education, and years’ experience on nutrition knowledge was investigated. Results A total of 554 participants completed the questionnaire (REP, n = 161; CTM, n = 357; DN, n = 36). The DN group performed significantly better overall (DN, 91.2 ± 4.6; REP, 78.4 ± 9.6; CTM, 75.4 ± 11.3) and for knowledge of dietary guidelines (DN, 82.3 ± 20.7; REP, 80.5 ± 15.5; CTM, 80.0 ± 14.1), nutrient content of foods (DN, 92.6 ± 4.4; REP, 80.9 ± 9.9; CTM, 75.7 ± 12.0), and diet-disease relationships (DN, 91.4 ± 9.7; REP, 65.4 ± 18.0; CTM, 68.6 ± 11.1) compared to the REP and CTM groups (p < 0.001). Sex, education and age were all significant predictors of total nutrition knowledge (p < 0.0005). Conclusions Total nutrition knowledge and knowledge of diet-disease relationships is limited in REP. Encouraging REP to work collaboratively with a multidisciplinary team, including DN, will assist in providing optimal client care in achieving health and body composition related goals