Tristram Ingham | University of Otago (original) (raw)
Papers by Tristram Ingham
Internal Medicine Journal
Disabilities, Mar 3, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
D37. TOPICS IN GLOBAL HEALTH SERVICES RESEARCH, 2019
Clinical & Experimental Allergy, 2015
Background There is non-experimental evidence that paracetamol (acetaminophen) use may increase t... more Background There is non-experimental evidence that paracetamol (acetaminophen) use may increase the risk of developing asthma. However, numerous methodological issues need to be resolved before undertaking a randomized controlled trial to investigate this hypothesis. Objective To establish the feasibility of a randomized controlled trial of liberal paracetamol as usually given by parents/guardians vs. a comparator (restricted paracetamol in accordance with WHO guidelines, ibuprofen or placebo), and childhood asthma risk. Methods Questionnaires were completed by parents/guardians of infants admitted to Wellington Hospital with bronchiolitis to assess views about comparator treatments. Subsequently, infants of parents/guardians who provided informed consent were randomized to restricted or liberal paracetamol use for 3 months with paracetamol use recorded. Results Of 120 eligible participants, 72 (60%) parents/guardians completed the questionnaire. Ibuprofen, restricted paracetamol and placebo were acceptable to 42 (58%), 29 (40%) and 9 (12%) parents/guardians, respectively. 36 (30%) infants were randomized to restricted or liberal paracetamol. Paracetamol use was greater for the liberal vs. restricted group for reported [Hodges-Lehmann estimator of difference 0.94 mg/kg/day (95% CI 0.2-3.52), P = 0.02] and measured use [Hodges-Lehmann estimator of difference 2.11 mg/kg/day (95% CI 0.9-4.18), P = 0.004]. The median reported and measured use of paracetamol was 2.0-fold and 3.5-fold greater in the liberal vs. restricted group. Conclusions and Clinical Relevance Although separation in paracetamol dosing is likely to be achieved with a liberal vs. restricted paracetamol regime, ibuprofen is the preferred comparator treatment in the proposed RCT of paracetamol use and risk of asthma in childhood.
International Journal of Environmental Research and Public Health
People with lived experience of disability have poorer health and socioeconomic outcomes than peo... more People with lived experience of disability have poorer health and socioeconomic outcomes than people without it. However, within this population, certain social groups are more likely to experience poorer outcomes due to the impacts of multiple intersecting forms of oppression including colonisation, coloniality and racism. This paper describes the multidimensional impacts of inequities for Indigenous tāngata whaikaha Māori (Māori with lived experience of disability). Semi-structured in-depth interviews were conducted with 28 tāngata whaikaha Māori and their whānau (extended family) using a kaupapa Māori Research methodology. An equity framework was used to analyse the data. The results describe: (1) inequitable access to the determinants of health and well-being; (2) inequitable access to and through health and disability care; (3) differential quality of health and disability care received; and (4) Indigenous Māori-driven solutions. These data confirm that tāngata whaikaha Māori i...
Handbook of Disability
Parents and caregivers of children with disabilities often act as representatives, mediators, and... more Parents and caregivers of children with disabilities often act as representatives, mediators, and advocates for their children, partly out of necessity and partly due to the bias of adult-centered agency. This chapter engages with the literature on parent-led activism in South Africa. It also engages with broader activist campaigns which, due to their nature, sometimes subsume the voices of grassroots actors and the parents who tirelessly advocate for their children. The context of the use of advocacy and activist measures and an overview of the literature on parent and caregiver uptake of these is discussed identifying a critical loss of political voice of persons with disabilities post-democratic attainment as well as the need to build stronger child participation fora. The study finds that while the narrative of the social and human rights model approaches to disability dominates in mission statements and objectives of disabled persons’ organizations (DPOs) and nongovernmental organizations, the services offered by some of these organizations have a definite medical slant. A brief synopsis of selected barriers that children with disabilities face, primarily in accessing their socioeconomic rights, including their right to education, health, and freedom from violence, is provided. Litigation brought by parents of children with disabilities is analyzed showing that professionals and organizations acting as curators ad litem and amicus curia, respectively, will likely continue to play an enhanced role in South Africa. Where parents and caregivers of children with disabilities are backed up by DPOs with traction in society, they are more likely to be successful in achieving their advocacy goals. Furthermore, the role of law clinics well versed in disability in representing these children, their parents, and DPOs is crucial. Recommendations for future law reform and activism is provided.
Research Involvement and Engagement, 2022
Introduction Current best practice recommends group-based pain management programmes for long-ter... more Introduction Current best practice recommends group-based pain management programmes for long-term improvements in persistent pain-related disability. However, there are barriers for people to access in-person delivered pain management programmes in Aotearoa. Aims To develop a co-designed, culturally responsive, online group-based pain management programme (iSelf-help) for people with persistent pain. Methods A modified participatory action research (PAR) framework was used to co-design contents and cultural-appropriateness of iSelf-help. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended an in-person delivered group pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR group and a Nominal Group Technique was used to rank order the preferred features of content delivery. In parallel, to ensure cul...
Energy Policy, 2019
Abstract The aim of this paper is to examine the effect of receiving a voucher for electricity on... more Abstract The aim of this paper is to examine the effect of receiving a voucher for electricity on the electricity use of a household. The Warm Homes for Elder New Zealanders Study was a randomised controlled trial which gave participants aged over 55 with chronic obstructive pulmonary disease a voucher providing NZ$500 credit to their electricity account for one winter. Electricity use increased over the winter the participant received the voucher. Participants with lower initial electricity use increased their consumption by about 10%, those with medium- or high-initial use by 2–3%. However, most participants did not use the entire value of the voucher on additional electricity. The study involved only a small informational component: this consisted of a brochure sent to the participants to encourage them to increase their energy use. This was designed to mimic the effects of a possible widespread rollout of this programme. The policy implication of this analysis is that a winter energy voucher accompanied by minimal education was effective at increasing winter energy use among a vulnerable sub-population with a health condition that merited additional heating in winter.
Thorax, 2019
IntroductionA gap exists in the literature regarding dose–response associations of objectively as... more IntroductionA gap exists in the literature regarding dose–response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.MethodsA prospective, unmatched case–control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011–2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp–mould subscale. The main outcome was case–control status. Adjusted ORs (aORs) of the association of housing quality measures with case–control st...
Child: Care, Health and Development, 2019
BACKGROUND Around 10% of young people suffer from chronic health conditions and their healthcare ... more BACKGROUND Around 10% of young people suffer from chronic health conditions and their healthcare needs are different from those of children or adults. Most research about young people’s chronic illness focuses on specific conditions, younger children’s experience and on the perspectives of parents. This study explored the experiences of young people with two very different chronic conditions (asthma and cancer) and their perception of the New Zealand health system's response to their needs. METHODS This was a collaborative research process where eight young co-researchers who had asthma or cancer were employed to work alongside the research team to develop protocols, interview peers and assist with analysis. The challenges of this process are described in the article. Twenty-one young people between ages 15 and 27 from two urban areas of New Zealand participated in semi-structured open-ended interviews about their healthcare experiences. Sixteen participants are female and five male. Eleven of the participants had finished cancer treatment (with an average of 3.6 years since diagnosis) and ten had asthma. Purposeful sampling meant that 80% of the participants with asthma identified as Māori and the other participants identified with a range of other ethnic groups. Data was thematically coded and co-researchers were consulted to derive the ultimate findings. RESULTS Chronic illness disrupted the trajectory of young people’s lives and had significant effects on their relationships. The New Zealand health system generally did not respond well to the needs of these young people but many encountered extraordinary individuals who supported them effectively. The experiences of some indigenous participants indicates that health professionals require effective cultural competence training. CONCLUSIONS This study provides insights into how young people with very different conditions experience the health system. Young people should be consulted and actively included in decision-making about making health systems responsive to their diverse needs.
Cochrane Database of Systematic Reviews, 2018
Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic... more Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: a qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers.
Pediatric pulmonology, Jan 6, 2017
To investigate the relationship between hair nicotine levels at 15 months of age and prior parent... more To investigate the relationship between hair nicotine levels at 15 months of age and prior parent-reported smoking exposure, and the risk of wheezing and current asthma from 15 months to 6 years of age. We measured hair nicotine levels at 15 months of age in 376 of 535 infants enrolled in a prospective birth cohort in Christchurch, New Zealand. We obtained detailed information from parents about smoking exposure during pregnancy and in the home at 3 and 15 months of age. Data for demographics, wheezing, and asthma were obtained from yearly questionnaires up to age 6 years. We assessed hair nicotine levels in relation to reported smoke exposure in pregnancy and up to age 15 months, and the association between high levels of hair nicotine and annual reports of current wheeze and current asthma using multiple logistic regression. Hair nicotine increased with numbers of smokers and daily cigarettes smoked at home, and was also strongly associated with smoking in pregnancy. High level of...
The New Zealand medical journal, 2017
The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is... more The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of asthma in children and adolescents in New Zealand, with the aim of improving outcomes and reducing inequities. The intended users are health professionals responsible for delivering asthma care in the community and hospital emergency department settings, and those responsible for the training of such health professionals.
Respirology, 2017
New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal pu... more New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries. A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting β2 -agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use (P &amp;amp;amp;amp;amp;lt; 0.0001). Adherence was higher with ICS/LABA than ICS-alone (P &amp;amp;amp;amp;amp;lt; 0.0001), and higher in NZ than in AU (P &amp;amp;amp;amp;amp;lt; 0.0001). ACT scores were similar (P = 0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non-urgent asthma reviews (56.6% vs 50.4%; P = 0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P = 0.75). This comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS-containing medications. The greater use of ICS-alone in NZ relative to ICS/LABA does not appear to have compromised population-level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings.
International journal of chronic obstructive pulmonary disease, 2016
Pulmonary rehabilitation is known to improve function and quality of life for people with chronic... more 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. 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. 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,...
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
This article presents a case study of the use of the Official Information Act 1982 (OIA), for res... more This article presents a case study of the use of the Official Information Act 1982 (OIA), for research commissioned by the Waitangi Tribunal in 2018 into disability-related issues for Mäori. The responses of Crown organisations to OIA requests examined in this research highlight both issues with inconsistent application of the OIA, and limited access to information held and made available by Crown agencies for Mäori with lived experience of disability.1 The statutory time frame for responses to OIA requests was rarely met. Organisations also resisted providing information, while crucial information for ensuring equity for Mäori with lived experience of disability was often not able to be released because it was not collected at all. The impact of these limitations is discussed, particularly pertaining to core government roles of performance monitoring and ensuring accountability. In addition to querying who benefits from, and is privileged by, the OIA and its application, questions ...
Internal Medicine Journal
Disabilities, Mar 3, 2022
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
D37. TOPICS IN GLOBAL HEALTH SERVICES RESEARCH, 2019
Clinical & Experimental Allergy, 2015
Background There is non-experimental evidence that paracetamol (acetaminophen) use may increase t... more Background There is non-experimental evidence that paracetamol (acetaminophen) use may increase the risk of developing asthma. However, numerous methodological issues need to be resolved before undertaking a randomized controlled trial to investigate this hypothesis. Objective To establish the feasibility of a randomized controlled trial of liberal paracetamol as usually given by parents/guardians vs. a comparator (restricted paracetamol in accordance with WHO guidelines, ibuprofen or placebo), and childhood asthma risk. Methods Questionnaires were completed by parents/guardians of infants admitted to Wellington Hospital with bronchiolitis to assess views about comparator treatments. Subsequently, infants of parents/guardians who provided informed consent were randomized to restricted or liberal paracetamol use for 3 months with paracetamol use recorded. Results Of 120 eligible participants, 72 (60%) parents/guardians completed the questionnaire. Ibuprofen, restricted paracetamol and placebo were acceptable to 42 (58%), 29 (40%) and 9 (12%) parents/guardians, respectively. 36 (30%) infants were randomized to restricted or liberal paracetamol. Paracetamol use was greater for the liberal vs. restricted group for reported [Hodges-Lehmann estimator of difference 0.94 mg/kg/day (95% CI 0.2-3.52), P = 0.02] and measured use [Hodges-Lehmann estimator of difference 2.11 mg/kg/day (95% CI 0.9-4.18), P = 0.004]. The median reported and measured use of paracetamol was 2.0-fold and 3.5-fold greater in the liberal vs. restricted group. Conclusions and Clinical Relevance Although separation in paracetamol dosing is likely to be achieved with a liberal vs. restricted paracetamol regime, ibuprofen is the preferred comparator treatment in the proposed RCT of paracetamol use and risk of asthma in childhood.
International Journal of Environmental Research and Public Health
People with lived experience of disability have poorer health and socioeconomic outcomes than peo... more People with lived experience of disability have poorer health and socioeconomic outcomes than people without it. However, within this population, certain social groups are more likely to experience poorer outcomes due to the impacts of multiple intersecting forms of oppression including colonisation, coloniality and racism. This paper describes the multidimensional impacts of inequities for Indigenous tāngata whaikaha Māori (Māori with lived experience of disability). Semi-structured in-depth interviews were conducted with 28 tāngata whaikaha Māori and their whānau (extended family) using a kaupapa Māori Research methodology. An equity framework was used to analyse the data. The results describe: (1) inequitable access to the determinants of health and well-being; (2) inequitable access to and through health and disability care; (3) differential quality of health and disability care received; and (4) Indigenous Māori-driven solutions. These data confirm that tāngata whaikaha Māori i...
Handbook of Disability
Parents and caregivers of children with disabilities often act as representatives, mediators, and... more Parents and caregivers of children with disabilities often act as representatives, mediators, and advocates for their children, partly out of necessity and partly due to the bias of adult-centered agency. This chapter engages with the literature on parent-led activism in South Africa. It also engages with broader activist campaigns which, due to their nature, sometimes subsume the voices of grassroots actors and the parents who tirelessly advocate for their children. The context of the use of advocacy and activist measures and an overview of the literature on parent and caregiver uptake of these is discussed identifying a critical loss of political voice of persons with disabilities post-democratic attainment as well as the need to build stronger child participation fora. The study finds that while the narrative of the social and human rights model approaches to disability dominates in mission statements and objectives of disabled persons’ organizations (DPOs) and nongovernmental organizations, the services offered by some of these organizations have a definite medical slant. A brief synopsis of selected barriers that children with disabilities face, primarily in accessing their socioeconomic rights, including their right to education, health, and freedom from violence, is provided. Litigation brought by parents of children with disabilities is analyzed showing that professionals and organizations acting as curators ad litem and amicus curia, respectively, will likely continue to play an enhanced role in South Africa. Where parents and caregivers of children with disabilities are backed up by DPOs with traction in society, they are more likely to be successful in achieving their advocacy goals. Furthermore, the role of law clinics well versed in disability in representing these children, their parents, and DPOs is crucial. Recommendations for future law reform and activism is provided.
Research Involvement and Engagement, 2022
Introduction Current best practice recommends group-based pain management programmes for long-ter... more Introduction Current best practice recommends group-based pain management programmes for long-term improvements in persistent pain-related disability. However, there are barriers for people to access in-person delivered pain management programmes in Aotearoa. Aims To develop a co-designed, culturally responsive, online group-based pain management programme (iSelf-help) for people with persistent pain. Methods A modified participatory action research (PAR) framework was used to co-design contents and cultural-appropriateness of iSelf-help. The PAR team included: (1) seven end-users living with persistent pain, who had previously attended an in-person delivered group pain management programme, (2) two pain management clinicians, (3) two health researchers, (4) two digital health experts, and (5) a health literacy expert. Five meetings were held with the PAR group and a Nominal Group Technique was used to rank order the preferred features of content delivery. In parallel, to ensure cul...
Energy Policy, 2019
Abstract The aim of this paper is to examine the effect of receiving a voucher for electricity on... more Abstract The aim of this paper is to examine the effect of receiving a voucher for electricity on the electricity use of a household. The Warm Homes for Elder New Zealanders Study was a randomised controlled trial which gave participants aged over 55 with chronic obstructive pulmonary disease a voucher providing NZ$500 credit to their electricity account for one winter. Electricity use increased over the winter the participant received the voucher. Participants with lower initial electricity use increased their consumption by about 10%, those with medium- or high-initial use by 2–3%. However, most participants did not use the entire value of the voucher on additional electricity. The study involved only a small informational component: this consisted of a brochure sent to the participants to encourage them to increase their energy use. This was designed to mimic the effects of a possible widespread rollout of this programme. The policy implication of this analysis is that a winter energy voucher accompanied by minimal education was effective at increasing winter energy use among a vulnerable sub-population with a health condition that merited additional heating in winter.
Thorax, 2019
IntroductionA gap exists in the literature regarding dose–response associations of objectively as... more IntroductionA gap exists in the literature regarding dose–response associations of objectively assessed housing quality measures, particularly dampness and mould, with hospitalisation for acute respiratory infection (ARI) among children.MethodsA prospective, unmatched case–control study was conducted in two paediatric wards and five general practice clinics in Wellington, New Zealand, over winter/spring 2011–2013. Children aged <2 years who were hospitalised for ARI (cases), and either seen in general practice with ARI not requiring admission or for routine immunisation (controls) were included in the study. Objective housing quality was assessed by independent building assessors, with the assessors blinded to outcome status, using the Respiratory Hazard Index (RHI), a 13-item scale of household quality factors, including an 8-item damp–mould subscale. The main outcome was case–control status. Adjusted ORs (aORs) of the association of housing quality measures with case–control st...
Child: Care, Health and Development, 2019
BACKGROUND Around 10% of young people suffer from chronic health conditions and their healthcare ... more BACKGROUND Around 10% of young people suffer from chronic health conditions and their healthcare needs are different from those of children or adults. Most research about young people’s chronic illness focuses on specific conditions, younger children’s experience and on the perspectives of parents. This study explored the experiences of young people with two very different chronic conditions (asthma and cancer) and their perception of the New Zealand health system's response to their needs. METHODS This was a collaborative research process where eight young co-researchers who had asthma or cancer were employed to work alongside the research team to develop protocols, interview peers and assist with analysis. The challenges of this process are described in the article. Twenty-one young people between ages 15 and 27 from two urban areas of New Zealand participated in semi-structured open-ended interviews about their healthcare experiences. Sixteen participants are female and five male. Eleven of the participants had finished cancer treatment (with an average of 3.6 years since diagnosis) and ten had asthma. Purposeful sampling meant that 80% of the participants with asthma identified as Māori and the other participants identified with a range of other ethnic groups. Data was thematically coded and co-researchers were consulted to derive the ultimate findings. RESULTS Chronic illness disrupted the trajectory of young people’s lives and had significant effects on their relationships. The New Zealand health system generally did not respond well to the needs of these young people but many encountered extraordinary individuals who supported them effectively. The experiences of some indigenous participants indicates that health professionals require effective cultural competence training. CONCLUSIONS This study provides insights into how young people with very different conditions experience the health system. Young people should be consulted and actively included in decision-making about making health systems responsive to their diverse needs.
Cochrane Database of Systematic Reviews, 2018
Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic... more Factors influencing referral to and uptake and attendance of pulmonary rehabilitation for chronic obstructive pulmonary disease: a qualitative evidence synthesis of the experiences of service users, their families, and healthcare providers.
Pediatric pulmonology, Jan 6, 2017
To investigate the relationship between hair nicotine levels at 15 months of age and prior parent... more To investigate the relationship between hair nicotine levels at 15 months of age and prior parent-reported smoking exposure, and the risk of wheezing and current asthma from 15 months to 6 years of age. We measured hair nicotine levels at 15 months of age in 376 of 535 infants enrolled in a prospective birth cohort in Christchurch, New Zealand. We obtained detailed information from parents about smoking exposure during pregnancy and in the home at 3 and 15 months of age. Data for demographics, wheezing, and asthma were obtained from yearly questionnaires up to age 6 years. We assessed hair nicotine levels in relation to reported smoke exposure in pregnancy and up to age 15 months, and the association between high levels of hair nicotine and annual reports of current wheeze and current asthma using multiple logistic regression. Hair nicotine increased with numbers of smokers and daily cigarettes smoked at home, and was also strongly associated with smoking in pregnancy. High level of...
The New Zealand medical journal, 2017
The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is... more The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of asthma in children and adolescents in New Zealand, with the aim of improving outcomes and reducing inequities. The intended users are health professionals responsible for delivering asthma care in the community and hospital emergency department settings, and those responsible for the training of such health professionals.
Respirology, 2017
New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal pu... more New Zealand (NZ) and Australia (AU) have similarly high asthma prevalence; both have universal public health systems, but different criteria for subsidized medicines. We explored differences in asthma management and asthma-related outcomes between these countries. A web-based survey was administered in AU (2012) and NZ (2013) to individuals aged ≥16 years with current asthma, drawn randomly from web-based panels, stratified by national population proportions. Symptom control was assessed with the Asthma Control Test (ACT). Healthcare utilization was assessed from reported urgent doctor/hospital visits in the previous year. NZ (n = 537) and Australian (n = 2686) participants had similar age and gender distribution. More NZ than Australian participants used inhaled corticosteroid (ICS)-containing medication (68.8% vs 60.9%; P = 0.006) but ICS/long-acting β2 -agonist (LABA) constituted 44.4% of NZ and 81.5% of Australian total ICS use (P &amp;amp;amp;amp;amp;lt; 0.0001). Adherence was higher with ICS/LABA than ICS-alone (P &amp;amp;amp;amp;amp;lt; 0.0001), and higher in NZ than in AU (P &amp;amp;amp;amp;amp;lt; 0.0001). ACT scores were similar (P = 0.41), with symptoms well controlled in 58.6% and 54.4% participants, respectively. More NZ participants reported non-urgent asthma reviews (56.6% vs 50.4%; P = 0.009). Similar proportions had urgent asthma visits (27.9% and 28.6%, respectively, P = 0.75). This comparison, which included the first nationally representative data for asthma control in NZ, showed that poorly controlled asthma is common in both NZ and AU, despite subsidized ICS-containing medications. The greater use of ICS-alone in NZ relative to ICS/LABA does not appear to have compromised population-level asthma outcomes, perhaps due to better adherence in NZ. Different ICS/LABA subsidy criteria and different patient copayments may also have contributed to these findings.
International journal of chronic obstructive pulmonary disease, 2016
Pulmonary rehabilitation is known to improve function and quality of life for people with chronic... more 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. 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. 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,...
This is an Open Access article distributed under the terms of the Creative Commons Attribution Li... more This is an Open Access article distributed under the terms of the Creative Commons Attribution License
This article presents a case study of the use of the Official Information Act 1982 (OIA), for res... more This article presents a case study of the use of the Official Information Act 1982 (OIA), for research commissioned by the Waitangi Tribunal in 2018 into disability-related issues for Mäori. The responses of Crown organisations to OIA requests examined in this research highlight both issues with inconsistent application of the OIA, and limited access to information held and made available by Crown agencies for Mäori with lived experience of disability.1 The statutory time frame for responses to OIA requests was rarely met. Organisations also resisted providing information, while crucial information for ensuring equity for Mäori with lived experience of disability was often not able to be released because it was not collected at all. The impact of these limitations is discussed, particularly pertaining to core government roles of performance monitoring and ensuring accountability. In addition to querying who benefits from, and is privileged by, the OIA and its application, questions ...