1,720,991 research outputs found
Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives
Get PDFObesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context.
The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future.
This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice.
The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management.
This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Epidemiological evidence that can help to improve timely diagnosis of colorectal cancer in New Zealand.
Get PDFIncidence rates of colorectal cancer (CRC) in New Zealand (NZ) are among the highest in the world. The long-term survival rates in NZ are poor, which has partially been attributed to late diagnosis. Considering that CRC is a curable disease if diagnosed early, conducting research targeted at the improvement of early diagnosis is therefore important. This thesis provides statistical models for the calculation of CRC incidence rates in the entire NZ population and population strata defined by age, gender, ethnicity and diabetes status, and a model for CRC risk in individual patients referred to the secondary care. The models presented here could assist health professionals in the selection of patients for further investigation to facilitate earlier diagnosis. The empirical part consists of three independent observational studies, briefly described below.
Sub-study 1. The objectives were, first, to describe trends in CRC incidence in the NZ population and, second, to investigate whether there are any strata defined by gender and ethnicity with especially increased incidence rates of CRC. To address these objectives, I analysed data from the New Zealand Cancer Registry (years 1994–2018) using an age- period-cohort (APC) model. The overall CRC incidence rates in NZ decreased between 1994 and 2018 by an average of 1.31% per year. However, the decrease was observed only in patients 50 years and older. In those 30-<50 years old, the incidence rates increased between 1994 and 2018 regardless of gender and ethnicity. The increase was similar for proximal, distal and rectal cancers. The APC analyses revealed very strong cohort effects that could explain nearly the entire trends in CRC incidence, pointing out generations born in the 1970s and 80s being affected by the increased incidence rates, rather than individuals 30-<50 years old. The cohort effects were different in Ma ̄ori and non-Ma ̄ori populations. In non-Ma ̄ori born between approximately 1939 and 1955, incidence rates decreased sharply. By contrast, those Ma ̄ori generations have not benefitted from the sharp decrease in rates. However, CRC incidence increased substantially in both M ̄aori and non-M ̄aori groups born in the 1970s and 80s.
Sub-study 2. The objective was to estimate the IRR for CRC in patients with diabetes compared to those without diabetes, with relation to diabetes duration and use of insulin for diabetes control. Registration in the Virtual Diabetes Register (VDR) in the years 2014–2018 was used as a marker of a diabetes diagnosis. Tables with counts of the entire NZ population stratified by age, gender, and ethnicity were obtained from Statistics NZ. In total, data from 310,710 patients with diabetes, corresponding to 1,277,284 person- years and 2512 incident CRC cases were analysed using a Poisson regression model. Diabetes was associated with an overall increased CRC incidence of 13% compared to non-diabetes [IRR=1.13 (95% CI: 1.08, 1.18)]. The IRR was especially high in the first three months after diabetes diagnosis [IRR=2.55 (95% CI 2.02, 3.21)], likely due to detection bias. The association was equally strong in males and females. However, in the analysis by ethnicity, the incidence of CRC was increased only in non-Ma ̄ori patients and restricted only to those younger than 75 years.
Sub-study 3. The objective was to develop a predictive model for CRC risk in individual patients referred to secondary care. To develop such a model, I extracted information from free text included in e-referrals from GPs’ to the Gastroenterology and General Surgery departments in the Waikato Hospital from 2015-2018, including: symptoms; test results; and family history of CRC. The reference test was a full colonoscopy with visualisation of the cecum. Data from 3015 patients, 20-<90 years old were analysed using a logistic regression model. The final model included the following predictors associated with increased CRC risk: anaemia, rectal bleeding, palpable mass in abdomen or rectum, weight loss, age and gender, and a decreased CRC risk: family history of CRC, abdominal pain, and inflammatory bowel disease. The model discriminates patients with low CRC risk well. According to the final cross-validated model, around 20% of patients from our cohort had performed colonoscopy despite a very low CRC risk (less than 1.5%).
In conclusion, the APC analysis revealed an alarming pattern. According to the fitted APC model, the combination of increasing age and cohort effect in generations born in the 1970s and 80s will bring a wave of CRC diagnoses in the near future when the young generations with high CRC incidence rates will replace the old generations with low CRC incidence. The results from this study could therefore help policy-makers to plan the needs for gastroenterology services.
Secondly, CRC incidence rates in diabetes have been found to be slightly increased com- pared to non-diabetes but only in non-Ma ̄ori individuals younger than 75 years.
Third, the results suggest that males underutilise health services. As shown in sub- study 3, males underwent fewer colonoscopies than females, despite having a higher risk of CRC. The higher detection bias in males than in females (sub-study 2) could also suggest underuse of health services by males, but the difference was not statistically significant.
Finally, based on the fitted models for CRC incidence in sub-studies 1 and 2, population- wide CRC screening for Ma ̄ori and patients with diabetes, based on the incidence, instead of age alone, would be proposed to start at age 57.5 years if the screening in the general population starts at age 60 years
Evaluating the effectiveness of an education group intervention on the psychological wellbeing of breast cancer patients
Get PDFBreast cancer (BC) is a significant health problem for New Zealand (NZ) women, with approximately 3,300 women diagnosed every year. Psychosocial distress is commonly associated with a BC diagnosis; 20-50% of women with BC will suffer from psychological distress within the first year after diagnosis. Distress is associated with less adherence to treatment; exacerbated preexisting psychological and psychiatric conditions; slower recovery from surgery and other treatment; and poor Quality of Life (QOL) and well-being. To treat distress, the Cancer Society of New Zealand, a local organisation that helps cancer patients, delivers a psychoeducational intervention called the Living Well (LW) programme. This programme deals with emotions, relaxation, perceptions, coping, self-care, and informs patients about their cancer, treatment and what to expect. Very little research has been done in NZ to assess the effectiveness of such programmes. To evaluate the effectiveness of the LW programme for individual BC patients, a repeated measures design was used to investigate the effect of the programme as measured by the Hospital Anxiety and Depression Scale (HADS), a screening tool commonly used to identify anxiety and depression in BC patients.
Stage I-II BC patients referred to the Cancer Society and enrolled in the LW programme were recruited for the study. HADS scores were collected and analysed weekly using a repeated measures design prior to, during and after the intervention (LW programme).
Analysis shows that the participants reacted similarly to the LW programme, as demonstrated by their HADS scores. Across all phases of the study (baseline, intervention and post-intervention) mean depression scores were lower than anxiety scores. During baseline mean anxiety scores were slightly higher, on average, than the intervention and post-intervention phases.
While no consistent systematic effect on well-being from attending the LW programme was found, psychosocial distress in the breast cancer patients recruited for the study was evident. Therefore, there is value and benefit to provide interventions, to aid women by providing information so that they are better informed, can develop improved coping strategies, and develop new avenues for social support
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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