Reciprocal relations between cardiovascular disease, employment, financial insecurity, and post cardiac event recovery among Māori men: a case series.

BACKGROUND: Disparities in cardiovascular outcomes between Māori and non-Māori persist despite technological advances in the treatment of cardiovascular disease and improved service provision. Little is known about how social determinants of health, such as income [in]security affect Māori men's access, treatment, and recovery from cardiovascular disease. This paper explores the contexts within which cardiovascular disease is experienced and healthcare becomes embedded. METHODS: This study utilized a case-comparative narrative approach to document and make sense of the patient experiences of four male Māori patients who, in the previous 6 months, had come through cardiac investigation and treatment at Waikato Hospital, a large tertiary cardiac center in New Zealand. Participant accounts were elicited using a culturally patterned narrative approach to case development, informed by Kaupapa Māori Research practices. It involved three repeat 1-3-hour interviews recorded with participants (12 interviews); the first interviews took place 5-16 weeks after surgery/discharge. RESULTS: Each of the four case studies firstly details a serious cardiac event(s) before describing the varying levels of financial worry they experienced. Major financial disruptions to their lives were at the forefront of the concerns of those facing financial insecurity-as opposed to their medical problems. Financial hardship within the context of an unresponsive welfare system impacted the access to care and access to funding contributed to psychological distress for several participants. Economic security and reciprocal relationships between employers and employees facilitated positive treatment experiences and recovery. CONCLUSION: Findings suggest that although multiple factors influence participant experiences and treatment outcomes, financial [in]security, and personal income is a key determinant. The heterogeneity in participant narratives suggests that although general inequities in health may exist for Māori as a population group, these inequities do not appear to be uniform. We postulate diverse mechanisms, by which financial insecurity may adversely affect outcomes from treatment and demonstrate financial security as a significant determinant in allowing patients to respond to and recover from cardiovascular disease more effectively.fals

Improving continence management for people with dementia in the community in Aotearoa, New Zealand: Protocol for a mixed methods study.

BACKGROUND: The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions. METHODS AND ANALYSIS: A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers' study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources.fals

Australasia

Observed changes and impacts Ongoing climate trends have exacerbated many extreme events (very high confidence). The Australian trends include further warming and sea level rise sea level rise (SLR), with more hot days and heatwaves, less snow, more rainfall in the north, less April–October rainfall in the southwest and southeast and more extreme fire weather days in the south and east. The New Zealand trends include further warming and sea level rise (SLR), more hot days and heatwaves, less snow, more rainfall in the south, less rainfall in the north and more extreme fire weather in the east. There have been fewer tropical cyclones and cold days in the region. Extreme events include Australia’s hottest and driest year in 2019 with a record-breaking number of days over 39°C, New Zealand’s hottest year in 2016, three widespread marine heatwaves during 2016–2020, Category 4 Cyclone Debbie in 2017, seven major hailstorms over eastern Australia and two over New Zealand from 2014–2020, three major floods in eastern Australia and three over New Zealand during 2019–2021 and major fires in southern and eastern Australia during 2019–2020

Climate change adaptation through an integrative lens in Aotearoa New Zealand

Climate change is being felt across all human and natural systems in Aotearoa New Zealand and is projected to worsen this decade as impacts compound and cascade through natural system and sectoral dependencies. The effectiveness of adaptation is constrained by how fast greenhouse gas emissions are reduced globally, the pace of change, the frequency and progression of impacts, and the capacity of our natural, societal and political systems to respond. We explore how these systems and sectors interact with existing and projected climate change stressors by categorising climate change impacts (Trends and Events) and consequential thresholds (Thresholds), and by grouping systems and sectors by types (Typologies). This approach has identified commonalities and differences between the typologies which are illustrated with examples. Critical constraints and opportunities for adaptation have been identified to guide sector adaptation decision-making and for ongoing adaptation progress and effectiveness monitoring. Constraints are found across all sectors, and opportunities exist to address them through modelling and projections, monitoring frameworks, decision tools and measures, governance coordination and integration of the Māori worldview of the relationship between humans and nature. However, limits to adaptation exist and will increase over time unless all sectors and all nations urgently reduce their emissions

Climate Change Adaptation Through an Integrative Lens in Aotearoa New Zealand

Climate change is being felt across all human and natural systems in Aotearoa New Zealand and is projected to worsen this decade as impacts compound and cascade through natural system and sectoral dependencies. The effectiveness of adaptation is constrained by how fast greenhouse gas emissions are reduced globally, the pace of change, the frequency and progression of impacts, and the capacity of our natural, societal and political systems to respond. We explore how these systems and sectors interact with existing and projected climate change stressors by categorising climate change impacts (Trends and Events) and consequential thresholds (Thresholds), and by grouping systems and sectors by types (Typologies). This approach has identified commonalities and differences between the typologies which are illustrated with examples. Critical constraints and opportunities for adaptation have been identified to guide sector adaptation decision-making and for ongoing adaptation progress and effectiveness monitoring. Constraints are found across all sectors, and opportunities exist to address them through modelling and projections, monitoring frameworks, decision tools and measures, governance coordination and integration of the Māori worldview of the relationship between humans and nature. However, limits to adaptation exist and will increase over time unless all sectors and all nations urgently reduce their emissions

Changing bodies, spaces, places and politics: Feminist geography at the University of Waikato

'Place matters' in the production of knowledge. This article examines the production of feminist geographical knowledge at a particular place - the Department of Geography, Tourism and Environmental Planning at the University of Waikato. Feminist geography at Waikato represents a nexus of international, national, regional, and local politics. It represents the efforts, personalities, political and personal motivations of particular individuals, at particular times, in a particular space. While international trends are important, they can also mask the unfolding of events in different ways in 'other' places