Behavioural factors affecting physical health of the New Zealand Maori

Facial Fractures in Indigenous and Non-indigenous Populations of South Australia

INTRODUCTION

Maxillofacial trauma in indigenous populations is complex with sociocultural factors, access to health care, and poorer general health issues that impact outcomes. Assaults and road traffic accidents are disproportionately experienced by indigenous persons compared with non-indigenous.

METHODS

A retrospective review was conducted from January 2012 to January 2017 at the Women and Children's Hospital and Royal Adelaide Hospital, Adelaide. All maxillofacial fractures that attended or were referred to the unit were included in this study. The primary objective was to analyze epidemiological trends of facial fractures and clinical outcomes in the South Australian indigenous and non-indigenous populations.

RESULTS

Maxillofacial fractures in indigenous persons were less than in non-indigenous (31.2 versus 38.2 y, P < 0.001) with 3.8 odds of a facial fracture. Assault was 2.9 times more likely to result in a facial fracture, falls 40.9% less likely, and sports 29.4% less likely compared with non-indigenous ( P < 0.001). Alcohol-related facial fractures had significantly higher rates [odds ratio (OR = 3.8)] compared with non-indigenous. Indigenous from most disadvantaged areas and very remote areas also had significantly higher odds of a facial fracture. Indigenous persons had higher operative rates (OR = 2.8), postoperative complications (OR = 3.1), and a 3.7-day mean difference for the length of stay (6.6 versus 2.9 d, P < 0.001).

CONCLUSIONS

Indigenous people are more likely to experience facial fractures from assault resulting in mandibular fractures, whereas non-indigenous people are likely to have sport or fall-related midface fractures. Young indigenous women from outer regional and very remote areas have greater odds of facial fractures caused by assault and alcohol with higher operative rates, postoperative complications, and extended length of stay.

Cultural efficacy predicts body satisfaction for Māori

This paper examines the relationship between body mass index (BMI), self-esteem and self-reported confidence and capability in expressing oneself culturally as Māori (cultural efficacy) for 5,470 Māori who participated in Te Rangahau o Te Tuakiri Māori me Ngā Waiaro ā-Pūtea | The Māori Identity and Financial Attitudes Study (MIFAS) in 2017. Adjusting for demographics, self-reported health, education and socio-economic status, we found that a higher BMI was associated with lower body satisfaction and self-esteem. However, higher scores on cultural efficacy were associated with higher levels of body satisfaction and self-esteem for respondents. Furthermore, the negative association between BMI and both body satisfaction and self-esteem was weaker for those with higher cultural efficacy. This held for BMI scores of 25, 30, and 35+. While our data suggest higher cultural efficacy may directly or interactively shield Māori from developing lowered self-esteem typically associated with higher BMI in Western populations, further research, using more comprehensive measures of body satisfaction should explore the extent to which Māori may find the Western "thin ideal" personally desirable for their own bodies.

The Perception of Environmental Risks among Ethnically Diverse Groups

Social science theories and empirical data on perceptions of environmental risk have focused almost exclusively on factors related to frequently occurring disagreements between the lay population and technical experts. Discussions of variability within the nonexpert population itself are uncommon, even though theories of risk and culture, as well as empirical evidence, suggest that significant differences in judgments may occur within a diverse population such as that in the United States. Perceptions of risk are influenced, in part, by characteristic ways in which situations of uncertainty are framed and interpreted. Because culturally based attitudes and values can influence general orientation toward risk and uncertainty, it is reasonable to expect that factors differentiating individuals on the basis of shared experiences, values, and beliefs relevant to risk evaluation will be associated with nonequivalent perceptions in many situations. One such variable, ethnicity, is examined for its association with variability in perceptions of environmental risk. The authors review available evidence indicating when ethnic differences in risk perceptions have been observed, and consider three hypotheses that could explain why ethnicity would be predictive of dissimilarities in judgments for many environmental risks. Possible explanations for an ethnicity effect include differences in prior experiences with or exposure to various hazards, dissimilar general beliefs about risk and uncertainty, and differences on various qualitative dimensions that influence nonexpert assessments of risk.

Usefulness of the construct of social network to explain mental health service utilization by the maori population in new zealand

This article briefly reviews the literature on the relationship between social network and mental health, and presents a theoretical framework outlining the role social networks may play in explaining the differential mental health service utilization rates between Maori and European people of New Zealand. By buffering individuals from the ill effects of stressful events, social networks may have a protective effect on people's mental health. In addition, social networks influence the way people with mental illnesses use mental health services. An inverse relationship between the size of an individual's social network and the rate of utilization of in-patient services has been reported. Despite having a larger and presumably more supportive social networks, Maori are over-represented in mental health service utilization statistics. Using the Maori example, we demonstrate that ethnic differences exist in the structure of social networks and the provision of social support to their members. Such differences may be based on the degree of emphasis placed on kinship or on individualism by cultures and on the receptivity or prejudice of the host community. We examine the sources of stress on Maori social networks that may adversely affect the network's ability to support its members experiencing mental illnesses. Caution must be exercised in using service utilization rates as measures of the mental health needs of different ethnic groups because of problems with help seeking and the detection of mental health issues in different ethnic groups.

Psychiatrists' recommendations for improving bicultural training and Maori mental health services: a New Zealand survey

OBJECTIVE

In the context of Maori being over-represented as clients, and underrepresented as professionals in New Zealand's mental health system, this study ascertained the beliefs of New Zealand's psychiatrists about issues pertaining to Maori mental health. The overriding objective was to gather recommendations as to how to improve bicultural training and mental health services for Maori.

METHOD

A questionnaire involving closed and open-ended questions was sent to 335 New Zealand psychiatrists.

RESULTS

Of the 247 psychiatrists (74%) responding, 40% believed their training had prepared them to work effectively with Maori. Recommendations for improving training focused on the need for greater understanding of Maori perspectives of well-being. Recommendations for improving mental health services for Maori highlighted the need for more Maori professionals and for Maori-run services. No psychiatrists thought that pakeha clinicians should not work with Maori clients, but the majority (70%) recognised the need to consult with Maori staff when doing so. Twenty-eight psychiatrists (11.3%), all male, New Zealand born, and with 10 or more years clinical experience, believed that Maori were biologically or genetically more predisposed than others to mental illness. Several respondents offered other racist comments.

CONCLUSIONS

The high response rate and the many positive recommendations suggest a high level of constructive interest in these issues among psychiatrists. Comparisons with a simultaneous survey of psychologists are made. It is hoped that the recommendations might inform those responsible for training programs and for providing or purchasing mental health services.

Comparative clinical and physiological features of Maori, Pacific Islanders and Europeans with sleep related breathing disorders

Recent studies have suggested that there is a familial association of sleep apnoea syndrome and that this is not entirely explained by inheritance of known risk factors. Maori (M) and Pacific Islanders (PI) have many of the body habitus features associated with sleep apnoea and therefore might be expected to exhibit more severe disease than Europeans (E).

OBJECTIVE

To compare the clinical and physiological characteristics of the different ethnic groups and to determine if race was an independent predictor of severity of sleep apnoea.

METHODOLOGY

A prospective evaluation of patients attending the Sleep Disordered Breathing Clinic which serves the whole of Auckland (population 1.1 million), New Zealand was conducted for the period July 1994 to August 1995. The evaluation included history including a 26 question questionnaire, Epworth sleepiness score, examination, and where indicated, full polysomnography.

RESULTS

A total of 233 patients (154 E, 48 M and 33 PI), underwent full polysomnography. Forty-one (85%) of the M and 31 (94%) of PI had obstructive or mixed sleep apnoea compared with only 74 (49%) of the E (P < 0.0001; chi 2). There were few racial differences in the responses to the sleep questionnaire. M and PI were shown to have much greater neck and waist circumference and body mass indices. Severity parameters (apnoea-hypopnoea index, wake and minimum oxygen saturation, and apnoea duration) were greater for both M and PI compared with E (P < 0.001; Mann-Whitney U-test). Stepwise regression identified neck size, body mass index and age as independent predictors of severity.

CONCLUSION

When other factors were controlled for, race was not an important independent predictor of severity of sleep apnoea.

The second fatal impact: cigarette smoking, chronic disease, and the epidemiological transition in Oceania

The island countries of Oceania are now experiencing the epidemiological transition which has shifted patterns of morbidity and mortality from primarily infectious to mainly noncommunicable diseases. Prominent among these are many ailments known to be linked to or caused by tobacco smoking--especially to smoking of flue-cured, commercially made cigarettes. Cigarette manufacture by major tobacco transnational corporations began in the Pacific during the mid-1950s and production has grown rapidly since then. Cigarettes have been marketed aggressively, with a result that they have increasingly replaced the smoking of home-grown and twist tobacco. The history of tobacco production and marketing is sketched, and the literature on chronic diseases related to smoking is summarized for the Pacific region. The rise of anti-smoking movements in Oceania is then discussed, with particular attention to the PNG case during the 1980s.