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Examines factors associated with post-traumatic stress (PTS) among both currently serving and retired NZ military personnel. Determines the prevalence of PTS (symptomology and presumptive clinical cases) and identifies protective and risk factors most strongly associated with PTS. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Background Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper reports on data from the longitudinal Prospective Outcomes of Injury Study – 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term. Methods Follow-up telephone interviews were conducted with 305 POIS-10 Māori participants, who were injured and recruited 12-years earlier, experiencing a range of injury types and severities. Free text responses about trouble accessing injury-related health services were thematically analysed. Results Sixty-one participants (20%) reported trouble accessing injury-related health services and provided free text responses. Three related themes describing participants’ experiences were connected by the overarching concept that participants were engaging with a system that was not operating in a way it was intended to work: 1) Competing responsibilities and commitments encapsulates practical barriers to accessing services, such as a lack of time and having to prioritise other responsibilities such as work or whānau (family); 2) D isrupted mana refers to the feelings of personal disempowerment through, for example, receiving limited support, care or information tailored to participants’ circumstances and is a consequence of patients contending with the practical barriers to accessing services; and 3) Systemic abdication highlights systemic barriers including conflicting information regarding diagnoses and treatment plans, and healthcare provider distrust of participants. Conclusions Twelve years post-injury, a considerable proportion of Māori reported experiencing barriers to accessing healthcare services. To restore a sense of manaakitanga and improve Māori access to healthcare, Māori-specific supports are required and systemic barriers must be addressed and removed.

Examines if differences exist between injured Māori and non-Māori in accessing and receiving support from the Accident Compensation Corporation (ACC) for treatment and rehabilitation of subsequent injuries. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Examines opportunities for subsequent injury prevention from the perspectives of people who have recently experienced subsequent injury events (>2 injury events) in the previous 12 months. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

Purpose To examine the life satisfaction outcomes after spinal cord injury (SCI) and to identify the factors associated with life satisfaction at 18 months and 10 years post-SCI in New Zealand (NZ). Methods Adults (16–64 years) were recruited between 2007 and 2009 from NZ’s two spinal units following first admission for SCI. Interviews at 6 months, 18 months, and 10 years post-SCI examined demographic, physical, psychosocial, economic, and environmental characteristics. Multivariable regression models were used to identify predictors of life satisfaction at each timepoint. Results Overall, 118 people participated at 6 months, 103 at 18 months, and 63 at 10 years post-SCI. Pre-SCI, 90% of participants were satisfied with life, 67% were satisfied at 18 months, and 78% at 10 years. At 18 months post-SCI, participants who reported: never or sometimes using a wheelchair, no problems with self-care, no problems with anxiety or depression, no/lesser disability, or fewer secondary health conditions (SHCs) at 6 months post-SCI were more likely to be satisfied ( p  < 0.05), compared to those without these characteristics. Participants who experienced considerable disability at 6 months post-SCI were 22% less likely to be satisfied 10 years post-SCI compared to those experiencing no/lesser disability ( p  = 0.028). Conclusions A higher proportion of participants were satisfied at both 18 months and 10 years post-SCI than not satisfied. To improve the likelihood of satisfaction with life, increased focus on reducing disability and providing supports for those using wheelchairs, experiencing anxiety/depression or problems with self-care, and effects of SHCs are promising for future potential interventions.

ObjectivesDespite significant international interest in the economic impacts of health inequities, few studies have quantified the costs associated with unfair and preventable ethnic/racial health inequities. This Indigenous-led study is the first to investigate health inequities between Māori and non-Māori adults in New Zealand (NZ) and estimate the economic costs associated with these differences.DesignRetrospective cohort analysis. Quantitative epidemiological methods and ‘cost-of-illness’ (COI) methodology were employed, within a Kaupapa Māori theoretical framework.SettingData for 2003–2014 were obtained from national data collections held by NZ government agencies, including hospitalisations, mortality, outpatient and primary care consultations, laboratory and pharmaceutical usage and accident claims.ParticipantsAll adults in NZ aged 15 years and above who had engagement with the health system between 2003 and 2014 (deidentified).Primary and secondary outcome measuresRates of ‘potentially avoidable’ hospitalisations and mortality as well as ‘excess or underutilisation’ of healthcare were calculated, as the difference between actual rates for Māori and the rate expected if Māori had the same rates as non-Māori. These differences were then quantified using COI methodology to estimate the financial cost of ethnic inequities.ResultsIn this conservative estimate, health inequities between Māori and non-Māori adults cost NZ$863.3 million per year. Direct costs of NZ$39.9 million per year included costs from ambulatory sensitive hospitalisations and outpatient care, with cost savings from underutilisation of primary care. Indirect costs of NZ$823.4 million per year came from years of life lost and lost wages.ConclusionsIndigenous adult health inequities in NZ create significant direct and indirect costs. The ‘cost of doing nothing’ is predominantly borne by Indigenous communities and society. The net cost of adult health inequities to the government conceals substantial savings to the government from underutilisation of primary care and accident/injury care.

BackgroundThe ‘Prospective Outcomes of Injury Study–10 years on’ (POIS-10) aims to contribute to improving long-term disability, health and well-being outcomes for injured New Zealanders. This brief report describes recruitment, characteristics and key outcomes to 12 years post-injury.MethodsBetween 2007 and 2009, the study recruited 2856 people, including 566 Māori, from New Zealand’s Accident Compensation Corporation’s entitlement claims register. People experienced a range of injury types, causes and settings; 25% had been hospitalised for their injury. POIS-10 data were primarily collected via interviewer-administered structured questionnaires.ResultsOf the original participants, 2068 (92%) were eligible for follow-up in POIS-10. Of these, 1543 (75%) people participated between March 2020 and July 2021, including 240 Māori. Half of the participants (n=757; 50%) reported ongoing problems attributed to their injury 12 years earlier. Most reported difficulties with items assessing disability (WHO Disability Assessment Schedule II). For health-related quality of life (HRQoL), measured using the EQ-5D-5L, the prevalence of problems was higher 12 years post-injury compared with 12 months post-injury for four of five dimensions. Importantly, the prevalence of problems did not reduce to pre-injury levels for any HRQoL dimension.DiscussionPOIS-10 highlights the importance of early post-injury interventions to improve health, disability and well-being outcomes of injured New Zealanders.

ObjectiveTo identify and describe (1) which health-related quality of life (HRQoL) measures have been used with Indigenous children/youth (aged 8–17 years) within the Pacific Rim; and (2) studies that refer to Indigenous health concepts in the use of child/youth HRQoL measures.DesignA scoping review.Data sourcesOvid (Medline), PubMed, Scopus, Web of Science and CINAHL were searched up until 25 June 2020.Eligibility criteriaEligible papers were identified by two independent reviewers. Eligible papers were written in English, published between January 1990 and June 2020 and included an HRQoL measure used in research with Indigenous child/youth populations (aged between 8 and 17 years) in the Pacific Rim region.Data extraction and synthesisData extracted included study characteristics (year, country, Indigenous population, Indigenous sample size, age group), HRQoL measure characteristics (generic or condition-specific measure, child or adult measure, who completed the measure(s), dimensions, items and response scale of measure) and consideration of Indigenous concepts (created for Indigenous population, modified for Indigenous population, validated for Indigenous population, reliability in Indigenous populations, Indigenous involvement, reference to Indigenous theories/models/frameworks).ResultsAfter removing duplicates, 1393 paper titles and abstracts were screened, and 543 had full-text review for eligibility. Of these, 40 full-text papers were eligible, reporting on 32 unique studies. Twenty-nine HRQoL measures were used across eight countries. Thirty-three papers did not acknowledge Indigenous concepts of health, and only two measures were specifically created for use with Indigenous populations.ConclusionsThere is a paucity of research investigating HRQoL measures used with Indigenous children/youth and a lack of involvement of Indigenous peoples in the development and use of HRQoL measures. We strongly recommend explicit consideration of Indigenous concepts when developing, validating, assessing and using HRQoL measures with Indigenous populations.

IntroductionIndigenous people, including Māori in New Zealand, face many inequities in health and the determinants of health. Historically, the analysis and reporting of Indigenous health in the literature has usually taken a western medical view, often with a descriptive and deficit-oriented approach—ignoring the holistic nature of Indigenous health. This project takes a nondeficit approach and is interested in the factors that support the health and well-being of Indigenous people, including Māori. Flourishing is a recent and increasingly used term within the well-being literature; however, concepts, theories and determinants related to Indigenous flourishing are largely unknown. This scoping review aims to identify, describe and synthesise the nature and extent of the current empirical literature related to concepts, theories and determinants of Indigenous flourishing, in health and well-being contexts.Methods and analysisScoping review methods and guidelines included in the framework developed by Arksey and O’Malley, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews, will be followed for best practice and reporting of this scoping review. The literature for this review will be identified by searching the following databases: Medline (OVID), EMBASE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, MAI journal, the Cochrane Library and Google Scholar. The research team has formulated a systematic search strategy, which will be restricted to articles published between January 1970 and May 2020 and published in the English language. Two reviewers will independently screen eligible studies for final study selection. A third reviewer will resolve any discrepancies that arise. Data from included studies will be extracted and included in thematic analysis, using a tool developed iteratively by the research team.Ethics and disseminationEthical approval was not required for this review. Dissemination of results will include publication in peer-reviewed journal articles, presentation of results at conferences and interactive discussions with a project expert advisory group. This scoping review also informs a larger project, examining the long-term health and flourishing of Māori, the Indigenous people of New Zealand and their whānau (families).

To investigate post‐injury disability prevalence and identify pre‐injury and injury‐related predictors 24 months post‐injury among Māori Prospective Outcomes of Injury Study participants. Participants were recruited from New Zealand's no‐fault injury insurer. Pre‐injury and injury‐related characteristic information was obtained from participants at three and 24 months post‐injury. The World Health Organization Disability Assessment Schedule was used to measure disability. Multivariable models were developed to estimate relative risks of post‐injury disability. Of 2,856 participants, 566 were Māori. Analyses were restricted to 374 Māori with pre‐injury and 24‐month post‐injury disability data available. Pre‐injury, 9% reported disability compared to 19% 24 months post‐injury. Strong predictors of increased risk of disability 24 months post‐injury were having ≥2 chronic conditions pre‐injury and having trouble accessing healthcare services after injury. Hospitalisation for injury and having inadequate pre‐injury household income were other predictors. Māori experience considerable disability 24 months post‐injury. Pre‐injury socio‐demographic, health and psychosocial, and injury‐related characteristics independently predict post‐injury disability and provide focus for future research and interventions to improve Māori post‐injury outcomes. Despite having had access to services, injured Māori experienced considerable long‐term disability. Pre‐injury and injury‐related factors predict long‐term disability and should be the focus to reduce the post‐injury disability burden for Māori.