Maori children with disabilities : an analysis from a cultural perspective

This thesis explores a cultural perspective through the life stories told by the mothers of five Maori children who have a disability and relate with their tribal affiliations. The emphasis is on how culture, health, education and community support services have enabled Maori and disabilities to be addressed through a cultural perspective. From semi-structured interviews being carried out, the outcome recognises the importance of a strong whanau support system from the onset of the child's disability while adjustments were being put into place. Communication, trust, respect and personal power were important features within Maori culture that needed to be set in place between Maori and the services they were accessing to be more transparent in order to get the best care for their child who has a disability

A European intensive seminar to learn both spatial quality and the cooperation process

Town planning is closely linked with the national geographic and institutional context. Europeanization and globalisation are influencing planning but also planning education. The paper discusses how six universities from six different countries go into partnership to take into account this trend and elaborate a common pedagogic module through an intensive programme. The intensive programme achieves these objectives of the Europeanization of planning but also some specific ones which each university would not be able to achieve separately. The process of the intensive program itself pushes students to increase the quality of their proposals. It obliges students to work on unprecedented cases and to collaborat

Moving beyond the front line: a 20-year retrospective cohort study of career trajectories from the Indigenous Health Program at the University of Queensland

This report examines critical success factors for enabling Aboriginal and Torres Strait Islander leadership across the health system as demonstrated by alumni of the University of Queensland (UQ) Indigenous Health Program (IHP) (1994–2005) who today work in various leadership roles throughout the country.\ua0It determines the enablers of professional success of these health leaders in various facets of the health system and investigates the impact of active participation in the community of Aboriginal and Torres Strait Islander health professionals over the course of a career. Through this analysis, the report further theorises the confluence of community, subjectivity, self-determination and health

Feasibility of introducing a comprehensive package of antenatal care services in rural public clinics in South Africa

The Maternal, Child and Women’s Health Unit, in collaboration with the Population Council’s FRONTIERS in Reproductive Health (FRONTIERS) program, the Reproductive Health Research Unit of the University of Witwatersrand, and the Department of Medical Microbiology and Infectious Diseases of the Nelson Mandela School of Medicine, University of Natal, developed and then pilot-tested this revised model in KwaZulu-Natal, South Africa. The project’s objective was to develop and test an improved and integrated antenatal care program for public-sector clinics that would increase the range and quality of services received by pregnant women and improve their reproductive health behavior and status. Various problems, such as trainer and staff turnover, were encountered during and immediately after introduction that influenced the clinics’ capacity to implement and sustain the reorganized services. This implies that efforts to scale-up or replicate this model must consider such resource issues, and that other support systems, such as staff supervision and educational materials, also need attention. It is possible to conclude, however, that interventions such as this, that rely heavily on training staff in new ways of organizing and providing services, must develop and use training and supervisory strategies or systems that are explicitly designed to incorporate relatively rapid rates of staff turnover. This study also highlights the importance of paying attention to health systems when introducing revised or new services, especially HIV-related services

Ten-year mortality, disease progression, and treatment-related side effects in men with localised prostate cancer from the ProtecT randomised controlled trial according to treatment received

Background The ProtecT trial reported intention-to-treat analysis of men with localised prostate cancer randomly allocated to active monitoring (AM), radical prostatectomy, and external beam radiotherapy. Objective To report outcomes according to treatment received in men in randomised and treatment choice cohorts. Design, setting, and participants This study focuses on secondary care. Men with clinically localised prostate cancer at one of nine UK centres were invited to participate in the treatment trial comparing AM, radical prostatectomy, and radiotherapy. Intervention Two cohorts included 1643 men who agreed to be randomised and 997 who declined randomisation and chose treatment. Outcome measurements and statistical analysis Analysis was carried out to assess mortality, metastasis and progression and health-related quality of life impacts on urinary, bowel, and sexual function using patient-reported outcome measures. Analysis was based on comparisons between groups defined by treatment received for both randomised and treatment choice cohorts in turn, with pooled estimates of intervention effect obtained using meta-analysis. Differences were estimated with adjustment for known prognostic factors using propensity scores. Results and limitations According to treatment received, more men receiving AM died of PCa (AM 1.85%, surgery 0.67%, radiotherapy 0.73%), whilst this difference remained consistent with chance in the randomised cohort (p = 0.08); stronger evidence was found in the exploratory analyses (randomised plus choice cohort) when AM was compared with the combined radical treatment group (p = 0.003). There was also strong evidence that metastasis (AM 5.6%, surgery 2.4%, radiotherapy 2.7%) and disease progression (AM 20.35%, surgery 5.87%, radiotherapy 6.62%) were more common in the AM group. Compared with AM, there were higher risks of sexual dysfunction (95% at 6 mo) and urinary incontinence (55% at 6 mo) after surgery, and of sexual dysfunction (88% at 6 mo) and bowel dysfunction (5% at 6 mo) after radiotherapy. The key limitations are the potential for bias when comparing groups defined by treatment received and changes in the protocol for AM during the lengthy follow-up required in trials of screen-detected PCa. Conclusions Analyses according to treatment received showed increased rates of disease-related events and lower rates of patient-reported harms in men managed by AM compared with men managed by radical treatment, and stronger evidence of greater PCa mortality in the AM group. Patient summary More than 95 out of every 100 men with low or intermediate risk localised prostate cancer do not die of prostate cancer within 10 yr, irrespective of whether treatment is by means of monitoring, surgery, or radiotherapy. Side effects on sexual and bladder function are better after active monitoring, but the risks of spreading of prostate cancer are more common

Functional and quality of life outcomes of localised prostate cancer treatments (prostate testing for cancer and treatment [ProtecT] study)

Objective To investigate the functional and quality of life (QoL) outcomes of treatments for localised prostate cancer and inform treatment decision-making. Patients and Methods Men aged 50–69 years diagnosed with localised prostate cancer by prostate-specific antigen testing and biopsies at nine UK centres in the Prostate Testing for Cancer and Treatment (ProtecT) trial were randomised to, or chose one of, three treatments. Of 2565 participants, 1135 men received active monitoring (AM), 750 a radical prostatectomy (RP), 603 external-beam radiotherapy (EBRT) with concurrent androgen-deprivation therapy (ADT) and 77 low-dose-rate brachytherapy (BT, not a randomised treatment). Patient-reported outcome measures (PROMs) completed annually for 6 years were analysed by initial treatment and censored for subsequent treatments. Mixed effects models were adjusted for baseline characteristics using propensity scores. Results Treatment-received analyses revealed different impacts of treatments over 6 years. Men remaining on AM experienced gradual declines in sexual and urinary function with age (e.g., increases in erectile dysfunction from 35% of men at baseline to 53% at 6 years and nocturia similarly from 20% to 38%). Radical treatment impacts were immediate and continued over 6 years. After RP, 95% of men reported erectile dysfunction persisting for 85% at 6 years, and after EBRT this was reported by 69% and 74%, respectively (P < 0.001 compared with AM). After RP, 36% of men reported urinary leakage requiring at least 1 pad/day, persisting for 20% at 6 years, compared with no change in men receiving EBRT or AM (P < 0.001). Worse bowel function and bother (e.g., bloody stools 6% at 6 years and faecal incontinence 10%) was experienced by men after EBRT than after RP or AM (P < 0.001) with lesser effects after BT. No treatment affected mental or physical QoL. Conclusion Treatment decision-making for localised prostate cancer can be informed by these 6-year functional and QoL outcomes