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    Occupational risk factors for ischaemic heart disease : differences among males and females in the Māori and general populations of New Zealand : a thesis with publications presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health (Epidemiology) at Massey University, Wellington, New Zealand
    (Massey University, 2021) Barnes, Lucy
    Occupation is a poorly characterised risk factor for cardiovascular disease, a leading cause of death worldwide, with females and indigenous peoples underrepresented in research. This thesis assessed associations between occupation/occupational exposures and cardiovascular risk factors and ischaemic heart disease (IHD), for males and females of the Māori and general populations of New Zealand. Two previous New Zealand Workforce Surveys (NZWS) in the general (NZWS; n=3003; 2004-2006) and Māori (Māori NZWS; n=2107; 2009-2011) populations were linked to Ministry of Health data in Statistics New Zealand’s Integrated Data Infrastructure. Age-adjusted logistic regression was used to assess associations between occupational groups and cardiovascular risk factors (high blood pressure, high deprivation, high cholesterol, diabetes, smoking and obesity). Cox proportional hazard regression, adjusted for age, deprivation and smoking, was used to assess associations between ever working in an occupational group and incident IHD, over a 7-14 year follow-up period. Associations with occupational exposures were also assessed. Cardiovascular risk factors were disproportionately experienced by blue-collar workers, particularly plant and machine operators and assemblers and elementary workers. In contrast, professionals were less likely to experience risk factors. Similarly, having ever worked as a plant and machine operator and assembler or elementary worker was positively associated with IHD for Māori females. Having ever worked as a technician and associate professional was inversely associated with IHD. Associations were not consistent between Māori and the general population or between males and females, with differences observed for clerks, agriculture and fishery workers and sales and service workers. Occupational exposure to dust, tools that vibrate, smoke or fumes, oils and solvents, and high frequency exposure to repetitive tasks, loud noise, working at high speeds and awkward grip or hand movements, common in blue-collar occupations, was positively associated with IHD. Associations were not consistent across all populations, with no positive associations observed among Māori males. In conclusion, this thesis shows a role of occupation in IHD risk, presenting an opportunity for IHD interventions, particularly for blue-collar occupations. However, findings suggest that occupational risk factors cannot be generalised across all populations and future research and intervention development therefore requires consideration of sex and ethnicity.
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    The effects of the type A behaviour pattern, perceived stress and social structure on depressive symptomatology, alcohol consumption, and smoking behaviours : secondary analysis of an interaction model : a thesis presented in partial fulfilment of requirements for the degree of Master of Arts with endorsement in Clinical Psychology, Massey University
    (Massey University, 1988) Leech, Barry J
    A theoretical interaction model is pre­sented relating perceived stress, the Type A Be­haviour Pattern (assessed by means of the Struc­tured Interview method), and the psychosocial var­iable close friends, with psychological and prob­lematic behavioural outcomes, The model was tested in a secondary analysis of data from a community sample of 524 New Zealand males ages between 30 and 55 years. (Spicer et al, 1981). As an adaption and elaboration of the original study model, stress variables included combined upset/excitement scores, upset alone, undesirable events, life events total, workload, loss upset, and bereavement upset, The latter two stress vari­ables were constructed out of the original data, Outcome variables included depressive symptomatol­ogy, alcohol consumption, and smoking behaviours, Consistent with findings in Spicer et al. (1981), interaction effects show Type As more likely to smoke and consume more alcohol than Type Bs, when under stress. Another significant finding is that number of close friends did not moderate the rela­tionship between the Type A Pattern and health outcomes, The Buffering Effect was therefore re­jected for this group, Overall, evidence showed the benefits of adopting an interaction strategy consequent upon the discovery of no main effect relationship among variables of interest. A notable few interactions were not in the expected direction, including the finding that Type As tended to drink more alcohol the more friends they had. Limitations of the present model focused on the relatively unsatisfactory performance of the workload and friends variables. Future studies of this type might well benefit from the inclusion of a qualitative component for each.
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    Reframing everydayness: a grounded theory study of women's perceptions of the contribution of cardiac rehabilitation to their recovery from a heart attack : a thesis submitted in partial fulfilment of the requirements for the degree of Master of Arts in Nursing at Massey University
    (Massey University, 2003) Day, Wendy K
    Coronary heart disease (CHD) is a serious health issue for women but, in the past, women have been under-represented in research related to this condition. Instead, research using male populations has been used as a basis for the diagnosis and treatment of CHD in women. This has resulted in men and women being treated the same despite the presence of physiological and social differences. To ensure future diagnosis and treatment is based on appropriate research related to women and CHD. Grounded theory was used to explore women's perceptions of the contribution of cardiac rehabilitation to their recovery from a heart attack. The constant comparative method of data analysis was used to develop categories from the data. Overall the experience of suffering a heart attack caused disruption to everyday life and functioning. This included interruption to activities and social roles and shock at having suffered a heart attack. Recovery was characterised by 'reframing' their lives based on the alterations caused by their heart attack experience. The women in this study attempted to return to their everyday roles and responsibilities through the basic social process of "regaining everydayness". Most women did not recognise that they had received phase one cardiac rehabilitation, and although phase two cardiac rehabilitation met some of the education needs of the women in this study, it did not provide the support that all participants required. For some participants social needs were met by attending cardiac rehabilitation sessions. Phase two cardiac rehabilitation attendance was affected by transport, time, family and social issues, such as work commitments. Although some aspects of cardiac rehabilitation were beneficial for most participants, it did not appear to aid recovery for all of them.
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    Living with acute coronary syndrome and prediabetes : an interpretive description of complex illness : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Nursing at Massey University, Wellington, New Zealand
    (Massey University, 2013) Van Wissen, Kim
    The purpose of this research is to reveal the experience and interpretation people have of cardiovascular disease (CVD) and prediabetes as complex illness. CVD and diabetes are both increasing in prevalence in New Zealand and globally. Prediabetes is known to be precursory to type 2 diabetes; CVD and prediabetes are fast becoming an established comorbidity. As the prevalence of complex illness soars, the experience and interpretation people have of their condition requires deeper appreciation by nurses as members of a practice discipline. This doctoral research draws attention to the experiences as interpreted by participants and subsequently by the researcher, using interpretive description informed by Gadamer and Merleau-Ponty. Thirty three participants with CVD and prediabetes were recruited into this study. Open ended interviews were undertaken in hospital before discharge and then approximately 9 months later in the community. Interviews were transcribed, data managed by NVivo 9 software, data analysed using thematic analysis, and a thematic framework was developed to organise themes. The overarching theme is in/conspicuous detail indicating the visible and the invisible elements of complex illness. The two major themes, invisible disequilibrium and dialogue as caring, foreground further subthemes and embedded subthemes. The major theme invisible disequilibrium describes the experience of illness and is supported by three subthemes: losing equilibrium, becoming embattled and making sense of evolving illness. The second major theme dialogue as caring interprets the experiences participants had and is supported by subthemes: restorative dialogue, caring and constructing illness. Major findings indicate that complex illness is heterogeneous and participants were continually working with and making sense of the conspicuous and less conspicuous detail of ‘the whole’. Further findings include the proclivity of risk (choice) as a function of participants’ lifestyle such as diet type, activity levels, understanding of medications, plus how this risk may in the longer term cause disease and illness. A third major finding is that participants focussed on self-care as part of their construction of illness. This research provided insights into the experiences of people with CVD and prediabetes. It also showed that complex illness is the occurrence of an intricate meshing of personal circumstances, signs and symptoms that requires attending to needs as identified by the patient. This continues the debate concerning how illness affects the lives of individuals, potentially influencing future service planning.
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    Progression to diabetes : 5 year follow-up of the Northland Diabetes Screening and Cardiovascular risk assessment pilot : a thesis presented to fulfil requirements for the degree of Master of Public Health at Massey University, Wellington, New Zealand
    (Massey University, 2014) White, Bronwyn Kaye
    Aim: The primary aim was to determine the effect the Northland Diabetes Screening and Cardiovascular risk assessment pilot had on the progression from a normal glucose test (NGT) at baseline to diabetes. Method: Patients from a single practice (Maori = 1509, Non-Maori = 619) who were invited onto the pilot with NGT at baseline were retrospectively followed up for 7 years. Results for Pilot (PG) (Maori = 336, Non-Maori 255) and Non-Pilot (NPG) groups (Maori = 537, Non-Maori = 204) were compared on progression to diabetes, impaired glucose tolerance (IGT), all-cause mortality. Results for Maori: There were 10 incidence cases of diabetes, 20 IGT and 18 deaths from any-cause during a median duration of follow-up of 6.4 years in the PG compared with 22 incidence cases of diabetes, 23 IGT and 30 deaths from any-cause in the NPG followed for a median duration of 4.3 years. Participation in the pilot was associated with a statistically significant protective effect on progression to diabetes (Age-adjusted rate ratio 0.44(95% CI 0.2156, 0.912) and all-cause mortality (Age-adjusted rate ratio 0.49 (95% CI 0.2771, 0.8626). Results for Non-Maori: There were 12 incidence cases of diabetes, 13 IGT diagnoses and 19 deaths from any-cause during a median duration of follow-up of 6.2 years in the PG compared with 9/204 diabetes incidence cases, 11 IGT and 13 deaths from any-cause in the NPG followed for a median duration of 4.7 years. There was no statistically significant association with participation in the pilot on progression to diabetes, IGT or all-cause mortality. Conclusion: The protective effect for Maori patients in the pilot on progression to diabetes was either because they had inherently lower risk than the non-pilot group or potentially because their baseline results were interpreted in the context of their CVD risk. The effectiveness of CVDRA programmes on reducing incidence diabetes should be formally assessed. Research focusing on risk reduction for Maori aged 35-49 years is recommended.