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    Reciprocal relations between cardiovascular disease, employment, financial insecurity, and post cardiac event recovery among Māori men: a case series.
    (BioMed Central Ltd, part of Springer Nature, 2023-11-12) Lisipeki S; Masters-Awatere B; Hodgetts D; Liew TV
    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.
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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.
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    The influence of medication use on adopting healthy lifestyle behaviours, and health-related quality of life for older adults with heart trouble : a thesis presented in partial fulfilment of the requirements for the degree of Master of Science in Health Psychology at Massey University, Palmerston North, New Zealand
    (Massey University, 2013) Ramjee, Zanisha Mukesh
    Currently, cardiovascular disease is a leading cause of death in New Zealand. The combination of non-modifiable and modifiable risk factors contributes to the disease. Medication can be used to treat modifiable risk factors to slow down the progression of cardiovascular disease. In conjunction with medication, modifiable lifestyle changes such as physical activity, non-smoking, and diet can further discourage the progression of cardiovascular disease. This exploratory study aimed to investigate if medication use influences adopting healthy lifestyle changes, and if health-related quality of life is affected. Using secondary data from the Health, Work, and Retirement Longitudinal study, a total of 406 participants with heart trouble were identified. This sample comprised of males and females aged between 49-72 years old, who completed a questionnaire about their health, work and retirement. The results of the study showed that physical activity was associated with a better quality of life and that medication use did not significantly moderate this relationship. However, significant main effects between medication use and physical activity were observed. The number of days being active decreased as the number of prescribed medications increased. Main effects between non-smoking and medication, and non-smoking and quality of life were non-significant. Cumulatively, there are mixed results of this study compared to some the literature. Due to the nature of the data used, several limitations were identified. Nevertheless, this exploratory study was useful to shed light on the idea that medication use can perhaps influence healthy lifestyle behaviours for older adults, and thus this should be explored further to ensure effective treatment plans for patients with cardiovascular disease.
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    Green kiwifruit: effects on plasma lipids and APOE interactions
    (28/05/2012) Gammon CS; Kruger R; Minihane AM; Conlon CA; von Hurst PR; Stonehouse W
    Background Diet is a crucial element in the reduction of risk of cardiovascular disease (CVD). Furthermore, response to dietary change may be influenced by genotype. Kiwifruit are a good source of several dietary components shown to improve dyslipidaemia and lower CVD incidence such as soluble fibre and some vitamins and phytochemicals. Objective To investigate the effect of consuming two green kiwifruit daily in conjunction with a healthy diet on plasma lipids and examine response according to apolipoprotein E (APOE) genotype in hypercholesterolaemic men. Design Eighty-five hypercholesterolaemic men (low-density lipoprotein cholesterol (LDL-C) >3.0 mmol/L and triglycerides (TG) <3 mmol/L) completed an eight week randomised controlled cross-over study, after undergoing a four week healthy diet phase. The study consisted of two 4-week treatment sequences of 2 green kiwifruit/day plus healthy diet (intervention) or healthy diet alone (control). Fasting blood samples were taken at baseline, 4 and 8 weeks for the measurement of plasma lipids (total cholesterol (TC), LDL-C, TG, high-density lipoprotein cholesterol (HDL-C)), serum apolipoproteins A1 and B (apoA1 and apoB). Outcomes After the kiwifruit intervention plasma HDL-C concentrations were significantly higher (mean difference 0.04 [95% CI: 0.01, 0.07] mmol/L [P=0.004]) and the TC/HDL ratio was significantly lower (0.15 [-0.24, -0.05] mmol/L [P=0.002]), compared to control. In carriers of APOE4 allele TG concentrations were significantly lower (0.18 [-0.34, -0.02] mmol/L [P=0.03]) after the kiwifruit intervention compared to control. There were no significant differences between the two treatments for plasma TC, TG, LDL-C and serum apoA1 or apoB. Conclusion The small but significant increase in HDL-C and decrease in TC/HDL ratio and TG (in APOE4 carriers) suggests that the regular inclusion of green kiwifruit as part of a healthy diet may be beneficial in improving the lipid profiles of men with high cholesterol. Source of Funding: ZESPRI® International Trial No: ACTRN12610000213044
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    Quality of life impact of cardiovascular and affective conditions among older residents from urban and rural communities.
    (14/08/2013) Allen J; Inder KJ; Harris ML; Lewin TJ; Attia JR; Kelly BJ
    BACKGROUND: The demographic, health and contextual factors associated with quality of life impairment are investigated in older persons from New South Wales, Australia. We examine the impact of cardiovascular and affective conditions on impairment and the potential moderating influence of comorbidity and remoteness. METHODS: Data from persons aged 55 and over were drawn from two community cohorts sampling from across urban to very remote areas. Hierarchical linear regressions were used to assess: 1) the impact of cardiovascular and affective conditions on physical and psychological quality of life impairment; and 2) any influence of remoteness on these effects (N = 4364). Remoteness was geocoded to participants at the postal code level. Secondary data sources were used to examine the social capital and health service accessibility correlates of remoteness. RESULTS: Physical impairment was consistently associated with increased age, male gender, lower education, being unmarried, retirement, stroke, heart attack/angina, depression/anxiety, diabetes, hypertension, current obesity and low social support. Psychological impairment was consistently associated with lower age, being unmarried, stroke, heart attack/angina, depression/anxiety and low social support. Remoteness tended to be associated with lower psychological impairment, largely reflecting overall urban versus rural differences. The impacts of cardiovascular and affective conditions on quality of life were not influenced by remoteness. Social capital increased and health service accessibility decreased with remoteness, though no differences between outer-regional and remote/very remote areas were observed. Trends suggested that social capital was associated with lower psychological impairment and that the influence of cardiovascular conditions and social capital on psychological impairment was greater for persons with a history of affective conditions. The beneficial impact of social capital in reducing psychological impairment was more marked for those experiencing financial difficulty. CONCLUSIONS: Cardiovascular and affective conditions are key determinants of physical and psychological impairment. Persons affected by physical-psychological comorbidity experience greater psychological impairment. Social capital is associated with community remoteness and may ameliorate the psychological impairment associated with affective disorders and financial difficulties. The use of classifications of remoteness that are sensitive to social and health service accessibility determinants of health may better inform future investigations into the impact of context on quality of life outcomes.