Papaarangi Reid

Socioeconomic deprivation and fatal unintentional domestic fire incidents in New Zealand 1993-1998

A cross-sectional study was undertaken in Aotearoa New Zealand to investigate the relationship between socioeconomic deprivation and risk of an unintentional fatal domestic fire incident. Addresses of unintentional fatal domestic fire incidents were geocoded to small area (census meshblock) level and analysed with the New Zealand index of socioeconomic deprivation. Fatal unintentional domestic fire incidents occurred disproportionately in dwellings in the most socioeconomically deprived meshblocks. Annual rates of fatal unintentional fire incidents per 100,000 households in the most deprived decile were significantly higher than rates in the least deprived decile (RR 5.6, 95%CI 1.9-16). Strategies to prevent fire related deaths must overcome barriers to household fire safety in population groups experiencing increased risk, including the socioeconomically deprived, seniors, and ethnic minorities. Specific intervention strategies relevant to risks associated with socioeconomic deprivation include improving quality and affordability of housing; increasing prevalence of installed and functioning smoke detectors; and regulation of specific characteristics of cigarettes to reduce risk of ignition from abandoned heat sources. Substantial progress awaits reduction of the underlying socioeconomic determinants of disadvantage.

Sleep, sleepiness and motor vehicle accidents: a national survey

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Prevalence and consequences of insomnia in New Zealand: disparities between Maori and non-Maori

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Selection and validation of quality indicators for the Shorter Stays in Emergency Departments National Research Project

Objective: Despite the spread of time targets for ED lengths of stay around the world, there have been few studies exploring the effects of such policies on quality of ED care. The Shorter Stays in Emergency Departments (SSED) National Research Project seeks to address this. The purpose of this paper was to describe how the indicators for the SSED study in New Zealand were selected and validated.

Implementing performance improvement in New Zealand emergency departments: the six hour time target policy national research project protocol

BackgroundIn May 2009, the New Zealand government announced a new policy aimed at improving the quality of Emergency Department care and whole hospital performance. Governments have increasingly looked to time targets as a mechanism for improving hospital performance and from a whole system perspective, using the Emergency Department waiting time as a performance measure has the potential to see improvements in the wider health system. However, the imposition of targets may have significant adverse consequences. There is little empirical work examining how the performance of the wider hospital system is affected by such a target. This project aims to answer the following questions: How has the introduction of the target affected broader hospital performance over time, and what accounts for these changes? Which initiatives and strategies have been successful in moving hospitals towards the target without compromising the quality of other care processes and patient outcomes? Is there a difference in outcomes between different ethnic and age groups? Which initiatives and strategies have the greatest potential to be transferred across organisational contexts?Methods/designThe study design is mixed methods; combining qualitative research into the behaviour and practices of specific case study hospitals with quantitative data on clinical outcomes and process measures of performance over the period 2006-2012. All research activity is guided by a Kaupapa Māori Research methodological approach. A dynamic systems model of acute patient flows was created to frame the study. Consequences of the target (positive and negative) will be explored by integrating analyses and insights gained from the quantitative and qualitative streams of the study.DiscussionAt the time of submission of this protocol, the project has been underway for 12 months. This time was necessary to finalise both the case study sites and the secondary outcomes through key stakeholder consultation. We believe that this is an appropriate juncture to publish the protocol, now that the sites and final outcomes to be measured have been determined.

Access and Society as Determinants of Ischaemic Heart Disease in Indigenous Populations

BACKGROUND Ischaemic Heart Disease (IHD) is a leading cause of death in New Zealand and the burden falls disproportionately on Māori, the indigenous population of Aotearoa New Zealand. METHODS Data for Māori:non-Māori disparities in risk factors, hospitalisation, procedure receipt and mortality for IHD are analysed. Age-adjusted rates of IHD mortality (2000-2004) and publicly funded hospitalisations and procedures (2003-2005) for Māori and non-Māori are reported and compared. RESULTS Significant inequalities between Māori and non-Māori in IHD risk factors, hospitalisations, mortality and the receipt of related procedures exist. IHD hospitalisation rates for Māori are 1.4 times that of non-Māori, however mortality rates are more than twice that of non-Māori. In recent years Māori revascularisation rates have increased (as have non-Māori rates) but are still considerably less than might be expected given the much higher mortality rates. CONCLUSION Despite high need, Māori receive relatively low access to appropriate care for IHD. The role of society, policy, and the clinician are three key factors to be considered in reducing inequalities for IHD between Māori and non-Māori.

The cost of child health inequalities in Aotearoa New Zealand: a preliminary scoping study

BackgroundHealth inequalities have been extensively documented, internationally and in New Zealand. The cost of reducing health inequities is often perceived as high; however, recent international studies suggest the cost of “doing nothing” is itself significant. This study aimed to develop a preliminary estimate of the economic cost of health inequities between Māori (indigenous) and non-Māori children in New Zealand.MethodsStandard quantitative epidemiological methods and “cost of illness” methodology were employed, within a Kaupapa Māori theoretical framework. Data were obtained from national data collections held by the New Zealand Health Information Service and other health sector agencies.ResultsPreliminary estimates suggest child health inequities between Māori and non-Māori in New Zealand are cost-saving to the health sector. However the societal costs are significant. A conservative “base case” scenario estimate is over

Prevalence of abnormal sleep duration and excessive daytime sleepiness in pregnancy and the role of socio-demographic factors: comparing pregnant women with women in the general population.

NZ62 million per year, while alternative costing methods yield larger costs of nearly

Indigenous Health Workforce Development: challenges and successes of the Vision 20:20 programme

NZ200 million per annum. The total cost estimate is highly sensitive to the costing method used and Value of Statistical Life applied, as the cost of potentially avoidable deaths of Māori children is the major contributor to this estimate.ConclusionsThis preliminary study suggests that health sector spending is skewed towards non-Māori children despite evidence of greater Māori need. Persistent child health inequities result in significant societal economic costs. Eliminating child health inequities, particularly in primary care access, could result in significant economic benefits for New Zealand. However, there are conceptual, ethical and methodological challenges in estimating the economic cost of child health inequities. Re-thinking of traditional economic frameworks and development of more appropriate methodologies is required.

What helps and hinders indigenous student success in higher education health programmes: a qualitative study using the Critical Incident Technique

OBJECTIVES To compare the prevalence of self-reported abnormal sleep duration and excessive daytime sleepiness in pregnancy among Māori (indigenous New Zealanders) and non-Māori women versus the general population, and to examine the influence of socio-demographic factors. METHODS Self-reported total sleep time (TST) in 24-hrs, Epworth Sleepiness Scale scores and socio-demographic information were obtained from nullipara and multipara women aged 20-46 yrs at 35-37 weeks pregnant (358 Māori and 717 non-Māori), and women in the general population (381 Māori and 577 non-Māori). RESULTS After controlling for ethnicity, age, socio-economic status, and employment status, pregnant women average 30 min less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to be short sleepers (≤6 h) and 1.9 times more likely to be long sleepers (>9 h). In addition, pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Pregnant women >30 years of age experienced greater age-related declines in TST. Identifying as Māori, being unemployed, and working at night increased the likelihood of reporting abnormal sleep duration across all women population in this study. EDS also more likely occurred among Māori women and women who worked at night. CONCLUSIONS Pregnancy increases the prevalence of abnormal sleep duration and EDS, which are also higher among Māori than non-Māori women and those who do night work. Health professionals responsible for the care of pregnant women need to be well-educated about the importance of sleep and discuss sleep issues with the women they care for.