Search Results (169)

Background/Objectives: Ethnic inequities in cardiovascular disease and healthcare access are well recognised worldwide, but it is unclear whether these inequities translate into differences in cardiac rehabilitation participation and subsequent clinical outcomes. This study examined ethnic differences in cardiac rehabilitation enrolment, participation, and mortality outcomes within a large multi-ethnic cohort to determine whether the association between rehabilitation exposure and mortality differed across ethnic groups. Methods: This retrospective cohort study included 4940 consecutive patients referred to the Auckland cardiac rehabilitation programme between 2016 and 2023. Baseline characteristics, rehabilitation participation, and all-cause mortality were examined across ethnic groups. Associations with mortality were assessed using multivariable Cox proportional hazards models adjusted for demographic and clinical risk factors. Results: During a median follow-up of 5.6 years, 565 deaths occurred. Cardiac rehabilitation participation differed across ethnic groups (p < 0.001), with lowest participation among Pacific patients (44.3%) and highest participation among Asian patients (58.6%). Among attenders, total session attendance was similar across ethnic groups (p = 0.35). After adjustment, mortality risk was lower among Asian patients (HR 0.58, 95% CI 0.46–0.74, p < 0.001), but did not differ for Māori (HR 1.21, 95% CI 0.86–1.71) or Pacific patients (HR 1.03, 95% CI 0.79–1.36) compared with Europeans. Greater rehabilitation exposure was associated with lower mortality (HR 0.98 per session, 95% CI 0.97–0.99, p = 0.002), and no interaction between ethnicity and rehabilitation exposure was observed. Conclusions: Ethnic differences in cardiac rehabilitation were evident at the level of enrolment, but not in session exposure among attenders or in the association between rehabilitation participation and mortality. This study highlights the importance of distinguishing inequities in access and engagement from the effectiveness of rehabilitation once delivered. Full article

Background/Objectives: Despite the potential use of social media for health promotion and education among Pacific communities, there is a lack of understanding regarding how it is used and how interventions can best utilize it. This scoping review aims to explore how social media is used for health purposes within Pacific communities and the potential benefits, challenges and opportunities. Methods: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews. Databases and grey literature sources were searched for health-related primary research studies that focused on Pacific communities and included social media. Thematic analysis was used to synthesize the included studies and create codes that reflected the text. Results: A total of 37 studies were included, with most mentioning social media as a key finding (35%), while others approached social media as a recruitment strategy (30%), research topic (22%), intervention tool (14%) or recommendation for use in future approaches (11%). The benefits of social media mentioned in health-related studies for Pacific people include access to health information and services and providing a safe and familiar space. Challenges and risks included misinformation, lack of digital literacy, a disconnect with Pacific cultural norms and the negative impacts of prolonged time on social media. Conclusions: Our findings highlight the potential of culturally grounded social media approaches for health promotion among Pacific communities. To support health promotion in the modern world, there are clear opportunities for developing digital literacy, preserving cultural knowledge, identifying trusted voices to disseminate health knowledge and ensuring social media approaches are evaluated for impact and effectiveness. Full article

Recent advances in large language models (LLMs) have enabled new forms of software creation through natural-language interaction. However, many AI-assisted coding tools continue to assume familiarity with development environments, programming workflows, and technical conventions, which may limit accessibility for early-stage learners and communities historically underrepresented in digital participation. This challenge is particularly relevant in Aotearoa New Zealand, where Māori and Pacific peoples remain underrepresented across STEM and technology pathways. This paper introduces TechTahi, a browser-based, syntax-free AI-assisted platform designed to support low-barrier digital creation through natural-language prompts and immediate in-browser previews. The study had two aims: to describe the design rationale and workflow of TechTahi and to explore early learner perceptions following initial use of the platform. An exploratory pilot design was employed. Five participants completed a post-use survey after hands-on interaction with TechTahi. Responses were analysed descriptively, with open-ended feedback reviewed for recurring themes. Findings suggested generally positive perceptions of accessibility and ease of use, particularly the ability to create working applications without prior coding knowledge. Participants also identified opportunities for culturally relevant features, including language support and locally meaningful design elements, alongside areas for improvement such as clearer onboarding guidance and reduced information density. These preliminary findings suggest that syntax-free, culturally responsive AI creation tools may offer promising pathways for widening participation in digital learning. Further research with larger and more diverse samples is needed to evaluate longer-term educational impact. Full article

High population growth across developing Pacific countries has increased the share of young people, creating potential for a demographic dividend alongside accelerating digitalisation driven by technology transfer. This study empirically investigates the dynamic relationship between the demographic dividend, digitalisation (ICT access), and economic growth. An endogenous growth framework is employed and extended to incorporate demographic change and information technology adoption, along with education (human capital) and renewable energy use to capture the broader dimensions of sustainable economic growth. The results show that both the demographic dividend and ICT are positively associated with per capita income. Moreover, technology adoption and the demographic dividend exhibit a complementary relationship, implying that improvements in one reinforce the growth effects of the other, while education exerts a positive and statistically significant impact on economic growth. In contrast, renewable energy shows a positive but statistically insignificant effect, suggesting its role is emerging but important for long-term sustainability. In assessing the determinants of digitalisation, the findings indicate that demographic structure and urbanisation contribute positively; however, a substantial share of variation in digitalisation is explained by income levels and mobile phone technology. These results highlight the importance of policies that leverage demographic transition through education and digital technologies, and sustainable energy transitions to accelerate sustainable economic growth and improve welfare outcomes in Pacific developing economies. Full article

There is a significant need for culturally appropriate psychological treatments for chronic pain among American Indian/Alaska Native (AI/AN) peoples. This study used Indigenous community-based participatory research methods with the Portland Area Indian Health Services—Yakama Service Unit (YSU) to gather information needed for developing culturally adapted psychological treatments for AI/AN individuals with chronic pain. This study included remote semi-structured focus groups with 16 AI/AN individuals with chronic pain to identify pain treatment preferences (Aim 1) and priorities for pain treatment outcome domains (Aim 2). Thematic analyses were conducted with Atlas.ti (version 23.2.1). Results indicated a high interest in psychological interventions and concern that referral to psychological treatment meant that pain is “not real.” Pain intensity and pain interference were identified as the most important outcome domains. To measure pain intensity, the 0 to 10 Numerical Rating Scale was most preferred. The findings support the potential utility of culturally adapted psychological treatments for chronic pain for AI/AN individuals and provided information regarding the adaptations that would be most useful. Full article

Pacific peoples in Aotearoa New Zealand (Aotearoa is the Indigenous Te Reo Māori name of New Zealand) experience disproportionately higher rates of anxiety than the general population. However, while informal relational support is strongly utilised, formal or professional help-seeking remains comparatively low. Understanding how Pacific peoples conceptualise anxiety is critical for addressing this disparity. This study provides a snapshot of Pacific peoples’ understandings of anxiety in Aotearoa NZ. A total of 548 Pacific peoples aged 16 to 83 years who resided in Aotearoa NZ completed the Pasifika Mental Health in Aotearoa (PMHA) survey between 2018 and 2019, which included questions about anxiety. Inductive Content Analysis (CA) grounded by Pacific epistemologies was used to categorise open-ended responses, and participants’ response frequencies were analysed. The findings suggest that anxiety was understood as a transient, everyday experience, rather than a prolonged mental health condition. Informal relational support networks were strongly preferred in addressing or managing anxiety, followed by professional support. Perceived causes of anxiety were complex and evenly attributed to experiential, contextual, and health-related risk factors, highlighting the centrality of holism in Pacific worldviews. These findings suggest a nuanced understanding of anxiety that challenges deficit-based assumptions about Pacific peoples’ Mental Health Literacy (MHL), and emphasises the ongoing need for more culturally responsive, community-based, relational, and holistic mental health support. Full article

Background/Objectives: Ethnic disparities in type 2 diabetes (T2D) outcomes remain a significant public health challenge in Aotearoa New Zealand (NZ), but are not accurately reported in large datasets. This cross-sectional study used linked regional health records to examine ethnic inequities in glycaemic control and achievement of clinical targets among adults with T2D in the Waikato and Auckland regions. Methods: A cross-sectional analysis was conducted on 57,734 adults aged 18–75 years with confirmed T2D enrolled in four Primary Healthcare Organisations. Clinical and sociodemographic data from February 2021 to December 2023 were linked via National Health Index numbers. Key outcomes included the percentage of patients at target for HbA1c, blood pressure, lipid profiles, renal and liver function tests. Logistic regression assessed associations between ethnicity, socioeconomic deprivation, and clinical target attainment. Results: The mean age was 56.5 ± 12.4 years, and 86.8% of the cohort were overweight or obese. Overall, only 46.3% achieved the HbA1c target (<53 mmol/mol) in their most recent test, with Māori (OR 1.35) and Pacific (OR 1.84) ethnicities, higher deprivation, obesity, and younger age independently associated with elevated HbA1c. Hypertension affected two-thirds of participants (71.9% above target), notably Asians and Pacific peoples. Māori and Pacific peoples had over twice the odds of renal impairment and were 2.5 times more likely to have elevated albumin-to-creatinine ratios. Abnormal liver function test decreased with age (OR ≤ 0.65), though Asians had over twice the odds of elevated ALT and AST compared to Europeans. Conclusions: Significant ethnic inequities exist in glycaemic and clinical target attainment among people with T2D in NZ. These findings highlight critical gaps in diabetes management and underscore the urgent need for targeted, equity-focused interventions addressing both socioeconomic and ethnic disparities to improve outcomes and reduce health inequities. Full article

US-affiliated Island nations and territories are home to diverse populations, including substantial Indigenous communities who have extensive exposure to marine and geoscience content, with some of their knowledge sustained through heritage practices. Despite this demographic presence, Indigenous peoples of the Pacific remain notably underrepresented in STEM fields, particularly in the geosciences and marine sciences. Beyond an equity gap in participation, this underrepresentation reflects broader issues of epistemic and representational justice, raising questions about whose knowledge is validated and whose voices are legitimized in scientific spaces. This study examines how Pacific university bridge programs support Indigenous islander participation in authentic STEM research, with particular focus on climate adaptation, environmental change, and marine science contexts. Through qualitative interviews with Micronesian participants in the SEAS (Supporting Emerging Aquatic Scientists) Islands Alliance, we analyzed STEM identity development as students navigated cultural and scientific identities. Findings emphasize the critical importance of sustained, mentored engagement in real-world scientific inquiry that meaningfully connects to ongoing research agendas and community well-being, rather than simulated classroom exercises. The study offers insights into the multifaceted influences affecting student participation and pathways through STEM. Full article

Multiple sclerosis (MS) affects approximately 2.9 million people in the world, exerting a significant economic and societal burden. The disease is increasingly identified among populations considered as uncommonly affected. MS is reported in all regions of the World Health Organization (WHO) member states in Africa, the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific, affecting all ethnicities while exhibiting substantially variable prevalences. Countries with high MS prevalence and some with moderate frequencies generally have economically better structured healthcare systems. Nevertheless, health disparities in these countries are accentuated by suboptimal accessibility of care for their minorities, immigrants and other underserved populations. Social Determinants of Health (SDOH) might have an impact on morbidity and higher rates of disability. Large segments of the world population (i.e., African, Latin American, people from the Middle East and Southeast Asia) do not have access to adequate MS diagnostic procedures, compounded by reduced availability of neurologists. Healthcare disparities exist practically in every country of the world. Active wars and a large number of refugees resulting from conflict augments the challenges to healthcare systems. These global factors constitute obstacles to the adequate management of MS. A collective international path is required to facilitate access to highly effective, albeit onerous treatments, some already approved and being utilized, i.e., monoclonal antibodies and B-lymphocyte depletory agents, and others foreseen in the future as advanced therapeutic molecules continue to develop. Full article

Background/Objectives: The global epidemic of type 2 diabetes (T2D) is a critical public health issue, particularly in New Zealand, where prevalence rates are high, especially among Māori and Pacific people. Recent research indicates that dietary interventions, particularly carbohydrate reduction, can lead to the remission or reversal of T2D. However, little is known about how such approaches perform when implemented in routine New Zealand primary care, particularly within high-risk and underserved populations. This study aimed to evaluate changes in HbA1c, diabetes status, and cardiometabolic outcomes among adults with prediabetes and T2D engaged in such a model of care. Methods: This study reports findings from a retrospective, observational, real-world, multi-site clinical audit (service evaluation) of a holistic model of care implemented in three primary care practices in New Zealand. The model of care is characterised by a three-pronged approach: whole food, carbohydrate reduction; a health-coach, behaviour-change-based delivery approach; and community- or peer-based initiatives. Audit data from 106 patients with prediabetes (PD) and T2D were analysed (median follow-up 19 months; IQR 6–32) to assess changes in glycosylated haemoglobin (HbA1c) levels, diabetes status, and cardiometabolic outcomes. Results: We observed an overall reduction in HbA1c (median change −3 mmol/mol (IQR: −7 to 3), p = 0.004), with 32% of patients with T2D at baseline achieving reversal and 44% of those with PD attaining normoglycaemia at final follow-up. Weight loss was associated with greater HbA1c reduction (0.56 mmol/mol decrease per kg lost) and additional improvements seen in lowered alanine aminotransferase (ALT). HDL cholesterol showed a small decline (r = 0.31), and triglycerides and blood pressure showed no significant change, indicating that these measures remained broadly stable over the evaluation period. Conclusions: Given the retrospective and uncontrolled audit design, findings should be interpreted with appropriate caution. However, the consistent improvements observed across multiple practices suggest that carbohydrate-reduction strategies within holistic models of care can meaningfully improve diabetes outcomes in real-world primary care settings. Future research should evaluate longer-term sustainability, implementation fidelity, and the applicability of this model at scale, particularly for Māori and Pacific communities. Full article

Bangladesh’s electricity use is growing rapidly, but it has limited fossil fuel reserves. This disadvantage makes it harder for the country to provide people in densely populated cities with access to reliable energy. Solar photovoltaic (PV) electricity could solve these problems by making the grid less dependent on fossil fuels, cutting carbon emissions, and encouraging businesses and institutions to switch to cleaner energy sources. This study designs and simulates a 27 kWp grid-connected solar photovoltaic (PV) system for the University of Asia Pacific (UAP) in Dhaka, Bangladesh. The system has 80 SunPower SPR-MAX2-340 modules and one Sunways STT-30KTL-P inverter. It is expected to generate 36,412 kWh of electricity every year with a performance ratio (PR) of 82.42%. The economic analysis indicates that the system is financially profitable, with a levelized cost of energy (LCOE) of 0.0613 USD/kWh and a payback period of 5 years. The environmental assessment also states that the system will reduce emissions by 503.0 tCO₂ over its lifetime. The results indicate that solar PV systems in cities in Bangladesh could be a long-term solution for meeting energy needs. The overall results show that grid-connected solar PV systems can be a viable, long-term solution for meeting Bangladesh’s urban energy needs. Full article

Background: Healthcare burnout is pervasive, necessitating more efforts to reduce it. Objective: To evaluate the effectiveness of well-being leadership training in reducing healthcare burnout. Design: The Clinician Wellness Council (CWC) leadership training consisted of 15 months of educational and small group sessions (September 2023–November 2024) with pre–post-training burnout survey comparison. Setting: Primary and specialty departments across a Pacific Northwest community-based hospital system. Participants comprised 22 clinicians from primary and specialty departments. Participants identified an intervention group where they would focus their leadership efforts. Those groups contained 549 clinicians, and 5439 non-intervention clinicians were controls. Intervention: Well-being leadership training. Measures: The Maslach Burnout Inventory (MBI) and the turnover intent questions before and after training. Results: Of the 22 CWC participants, 15 (68%) completed the surveys before and after training. Burnout reduction was seen (47% to 13%; p = 0.0253), primarily driven by decreased emotional exhaustion (EE). Among 549 intervention group clinicians, 173 completed both surveys compared to 359 of 5439 clinicians in the control group. Intervention practitioners (N = 173) showed reductions in EE items (e.g., feeling burnout, working too hard, working with people is stressful) and turnover intent. Multivariable regression analyses showed that EE reductions were associated with co-workers’ intent to leave. Limitations: We obtained pre- and post-training MBI measures on a subset of the intervention group co-workers rather than a majority. Conclusions: Participation in a well-being leadership training program consisting of education, coaching, and community building reduced burnout, increased confidence to improve their workplace, and their leadership decreased co-worker EE and turnover intent. This training creates a blueprint for reducing burnout in clinician leaders and co-workers. Primary Funding Source: A PPMC foundation grant sponsored 10 local participants. Central division funding came from system and local funds. Participants received $1000/month training reimbursement. Full article

This paper contains an overview of the human colonisation of Australasia and Oceania over the last 65,000 years, and highlights the resultant diversity of settlement types, place and cultural landscape formations, and architectural solutions, but simultaneously gives attention to the long-term retention of particular traditions throughout the study region. The time, geographic and multi-cultural scales are thus vast, implying this is a study in the category of ‘deep history’. However, the author has drawn from his editing of the regional volume of ‘Australasia and Oceania,’ for the 2nd edition of the Encyclopaedia of Vernacular Architecture of the World, or EVAW 2, containing some 200 contributions on this region. Two migratory events are explored. The first is that of Aboriginal people into Australia some 65,000 years ago. The second is the Austronesian migrations into the Pacific Ocean from 5000 to 1500 BP. Despite millennia of cultural, environmental, climatic, economic and warfare disruptions, a series of continuities of tradition are identified and analysed in a limited manner due to the brevity of the paper. However, the paper provides a significant contribution in making such a broad-scale holistic overview of the pattern languages of building traditions that link communities in Oceania and Australasia arising from past migrations and drawing on multi-disciplinary sources. Full article

Background/Objectives: Rheumatic fever is preventable and can be treated successfully; however, a lack of understanding of the disease and barriers to timely healthcare can impact outcomes. Pacific people in Aotearoa New Zealand experience inequitable burdens, and a Pacific community group and health professional network are working together to co-design education initiatives. This descriptive, mixed-methods study aimed to (1) explore Pacific people’s awareness and understanding of rheumatic fever, (2) describe where Pacific people access health information. Methods: An online survey co-developed with Pacific community members was run from December 2024 to February 2025. Questions related to sore throats, rheumatic fever, medication adherence, long-term outcomes and where Pacific people access health information. Quantitative data was analyzed descriptively using SPSS version 28 and open-ended qualitative responses were analyzed using an inductive content analysis approach. Results: A total of 400 Pacific respondents were included: 34% were aged 16–24 years and 66% were female. Based on the analysis, 71% of Pacific participants knew that a sore throat should always be checked by a health professional and 65.3% had heard of rheumatic fever. Fever and sore throats were commonly identified as symptoms of rheumatic fever, with joint pain, body aches and chest pain mentioned less. Barriers to health services such as cost, long waiting times and cultural factors were discussed as reasons why many Pacific people often utilize social media and online forums for health information. Conclusions: This study highlights gaps in rheumatic fever knowledge and thus opportunities for health education initiatives for Pacific communities, potentially utilizing social media and online platforms. Full article

Hepatitis B virus (HBV) infection is a global health concern with an estimated 254 million people with chronic HBV infection. The utilization of immunosuppressive therapies (ISTs) is increasing and expanding continuously with new agents being implemented across multiple medical disciplines. The occurrence of HBV reactivation (HBVr) during or after IST varies from 15% to 50% in HBsAg-positive individuals and can be higher than 75% after stem cell transplantation. HBVr is gaining increasing significance in contemporary clinical practice. The American Gastroenterological Association (AGA) in 2025, the European Association for the Study of the Liver (EASL) in 2025, and the Asian Pacific Association for the Study of the Liver (APASL) in 2021, published their most recent clinical guidelines as major societies in the area, which enables us to better predict and manage HBVr. This narrative review focuses on comparing these three current guidelines, highlighting key similarities and differences to provide valuable guidance for practitioners navigating the complex, sometimes conflicting recommendations, thereby aiding clinicians in their decision-making. The risk of HBVr during IST has been stratified into three categories in all three guidelines: high (>10%), moderate (1–10%), and low (<1%). The effectiveness of prophylaxis scales with baseline risk for HBV reactivation. Prophylaxis is clearly cost-effective for high-risk patients, potentially beneficial for those at moderate risk, and generally may not be justified for low-risk individuals. Entecavir (ETV), tenofovir disoproxil fumarate (TDF), and tenofovir alafenamide (TAF) are all highly effective in preventing HBV reactivation during immunosuppression and all are considered to be economically viable options for HBVr high risk patients. When selecting among these agents, safety considerations—particularly renal and bone toxicity—and insurance coverage remain the primary factors directing clinical decision-making. Full article