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\n  \n 2021\n \n \n (1)\n \n \n
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\n \n\n \n \n \n \n \n \n Economic analysis of the ‘Take Charge’ intervention for people following stroke: Results from a randomised trial.\n \n \n \n \n\n\n \n Te Ao, B.; Harwood, M.; Fu, V.; Weatherall, M.; McPherson, K.; Taylor, W. J; McRae, A.; Thomson, T.; Gommans, J.; Green, G.; Ranta, A.; Hanger, C.; Riley, J.; and McNaughton, H.\n\n\n \n\n\n\n Clinical Rehabilitation,026921552110407. August 2021.\n \n\n\n\n
\n\n\n\n \n \n \"EconomicPaper\n  \n \n\n \n \n doi\n  \n \n\n \n link\n  \n \n\n bibtex\n \n\n \n  \n \n abstract \n \n\n \n  \n \n 1 download\n \n \n\n \n \n \n \n \n \n \n\n  \n \n \n\n\n\n
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@article{te_ao_economic_2021,\n\ttitle = {Economic analysis of the ‘{Take} {Charge}’ intervention for people following stroke: {Results} from a randomised trial},\n\tissn = {0269-2155, 1477-0873},\n\tshorttitle = {Economic analysis of the ‘{Take} {Charge}’ intervention for people following stroke},\n\turl = {http://journals.sagepub.com/doi/10.1177/02692155211040727},\n\tdoi = {10.1177/02692155211040727},\n\tabstract = {Objective:\n              To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study.\n            \n            \n              Design:\n              An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment\n            \n            \n              Setting:\n              Community.\n            \n            \n              Participants:\n              Adults ( n = 400) discharged to community, non-institutional living following acute stroke.\n            \n            \n              Interventions:\n              The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions).\n            \n            \n              Measures:\n              The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health.\n            \n            \n              Results:\n              One-year post hospital discharge cost of care was mean (95\\% CI) \\$US4706 (3758–6014) for the Take Charge intervention group and \\$6118 (4350–8005) for control, mean (95\\% CI) difference \\$ −1412 (−3553 to +729). Health utility scores were mean (95\\% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95\\% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was \\$US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of \\$US5000 per QALY, the probability that Take Charge is cost-effective is 99\\%.\n            \n            \n              Conclusion:\n              Take Charge is cost-effective and probably cost saving.},\n\tlanguage = {en},\n\turldate = {2021-09-09},\n\tjournal = {Clinical Rehabilitation},\n\tauthor = {Te Ao, Braden and Harwood, Matire and Fu, Vivian and Weatherall, Mark and McPherson, Kathryn and Taylor, William J and McRae, Anna and Thomson, Tom and Gommans, John and Green, Geoff and Ranta, Annemarei and Hanger, Carl and Riley, Judith and McNaughton, Harry},\n\tmonth = aug,\n\tyear = {2021},\n\tpages = {026921552110407},\n}\n\n
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\n Objective: To undertake an economic analysis of the Take Charge intervention as part of the Taking Charge after Stroke (TaCAS) study. Design: An open, parallel-group, randomised trial comparing active and control interventions with blinded outcome assessment Setting: Community. Participants: Adults ( n = 400) discharged to community, non-institutional living following acute stroke. Interventions: The Take Charge intervention, a strengths based, self-directed rehabilitation intervention, in two doses (one or two sessions), and a control intervention (no Take Charge sessions). Measures: The cost per quality-adjusted life year (QALY) saved for the period between randomisation (always post hospital discharge) and 12 months following acute stroke. QALYs were calculated from the EuroQol-5D-5L. Costs of stroke-related and non-health care were obtained by questionnaire, hospital records and the New Zealand Ministry of Health. Results: One-year post hospital discharge cost of care was mean (95% CI) $US4706 (3758–6014) for the Take Charge intervention group and $6118 (4350–8005) for control, mean (95% CI) difference $ −1412 (−3553 to +729). Health utility scores were mean (95% CI) 0.75 (0.73–0.77) for Take Charge and 0.71 (0.67–0.75) for control, mean (95% CI) difference 0.04 (0.0–0.08). Cost per QALY gained for the Take Charge intervention was $US −35,296 (=£ −25,524, € −30,019). Sensitivity analyses confirm Take Charge is cost-effective, even at a very low willingness-to-pay threshold. With a threshold of $US5000 per QALY, the probability that Take Charge is cost-effective is 99%. Conclusion: Take Charge is cost-effective and probably cost saving.\n
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\n  \n 2020\n \n \n (2)\n \n \n
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\n \n\n \n \n \n \n \n Combination budesonide/formoterol inhaler as sole reliever therapy in Māori and Pacific people with mild and moderate asthma.\n \n \n \n\n\n \n Hardy, J.; Tewhaiti-Smith, J.; Baggott, C.; Fingleton, J.; Semprini, A.; Holliday, M.; Hancox, R. J.; Weatherall, M.; and Harwood, M.\n\n\n \n\n\n\n The New Zealand Medical Journal, 133(1520): 61–72. August 2020.\n \n\n\n\n
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@article{hardy_combination_2020,\n\ttitle = {Combination budesonide/formoterol inhaler as sole reliever therapy in {Māori} and {Pacific} people with mild and moderate asthma},\n\tvolume = {133},\n\tissn = {1175-8716},\n\tabstract = {AIM: In the PRACTICAL study, as-needed budesonide/formoterol reduced the rate of severe exacerbations compared with maintenance budesonide plus as-needed terbutaline. In a pre-specified analysis we analysed the efficacy in Māori and Pacific peoples, populations with worse asthma outcomes.\nMETHOD: The PRACTICAL study was a 52-week, open-label, parallel group, randomised controlled trial of 890 adults with mild to moderate asthma, who were randomised to budesonide/formoterol Turbuhaler 200/6mcg one actuation as required or budesonide Turbuhaler 200mcg one actuation twice daily and terbutaline Turbuhaler 250mcg two actuations as required. The primary outcome was rate of severe exacerbations. The analysis strategy was to test an ethnicity-treatment interaction term for each outcome variable.\nRESULTS: Seventy-two participants (8\\%) identified as Māori, 36 participants (4\\%) as Pacific ethnicity. There was no evidence that ethnicity was an effect modifier for severe exacerbations (P interaction 0.70).\nCONCLUSION: The reduction in severe exacerbation risk with budesonide-formoterol reliever compared with maintenance budesonide was similar in Māori and Pacific adults compared with New Zealand European/Other.},\n\tlanguage = {eng},\n\tnumber = {1520},\n\tjournal = {The New Zealand Medical Journal},\n\tauthor = {Hardy, Jo and Tewhaiti-Smith, Jordan and Baggott, Christina and Fingleton, James and Semprini, Alex and Holliday, Mark and Hancox, Robert J. and Weatherall, Mark and Harwood, Matire},\n\tmonth = aug,\n\tyear = {2020},\n\tpmid = {32994594},\n\tkeywords = {Administration, Inhalation, Adult, Anti-Asthmatic Agents, Asthma, Bronchodilator Agents, Budesonide, Budesonide, Formoterol Fumarate Drug Combination, Case-Control Studies, Disease Progression, Drug Therapy, Combination, Ethnic Groups, Female, Humans, Male, Middle Aged, Nebulizers and Vaporizers, New Zealand, Outcome Assessment, Health Care, Terbutaline, Treatment Outcome},\n\tpages = {61--72},\n}\n\n
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\n AIM: In the PRACTICAL study, as-needed budesonide/formoterol reduced the rate of severe exacerbations compared with maintenance budesonide plus as-needed terbutaline. In a pre-specified analysis we analysed the efficacy in Māori and Pacific peoples, populations with worse asthma outcomes. METHOD: The PRACTICAL study was a 52-week, open-label, parallel group, randomised controlled trial of 890 adults with mild to moderate asthma, who were randomised to budesonide/formoterol Turbuhaler 200/6mcg one actuation as required or budesonide Turbuhaler 200mcg one actuation twice daily and terbutaline Turbuhaler 250mcg two actuations as required. The primary outcome was rate of severe exacerbations. The analysis strategy was to test an ethnicity-treatment interaction term for each outcome variable. RESULTS: Seventy-two participants (8%) identified as Māori, 36 participants (4%) as Pacific ethnicity. There was no evidence that ethnicity was an effect modifier for severe exacerbations (P interaction 0.70). CONCLUSION: The reduction in severe exacerbation risk with budesonide-formoterol reliever compared with maintenance budesonide was similar in Māori and Pacific adults compared with New Zealand European/Other.\n
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\n \n\n \n \n \n \n \n \n Patient preferences for asthma management: a qualitative study.\n \n \n \n \n\n\n \n Baggott, C.; Chan, A.; Hurford, S.; Fingleton, J.; Beasley, R.; Harwood, M.; Reddel, H. K; and Levack, W. M. M.\n\n\n \n\n\n\n BMJ Open, 10(8): e037491. August 2020.\n Number: 8\n\n\n\n
\n\n\n\n \n \n \"PatientPaper\n  \n \n\n \n \n doi\n  \n \n\n \n link\n  \n \n\n bibtex\n \n\n \n  \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n  \n \n \n\n\n\n
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@article{baggott_patient_2020,\n\ttitle = {Patient preferences for asthma management: a qualitative study},\n\tvolume = {10},\n\tissn = {2044-6055, 2044-6055},\n\tshorttitle = {Patient preferences for asthma management},\n\turl = {http://bmjopen.bmj.com/lookup/doi/10.1136/bmjopen-2020-037491},\n\tdoi = {10.1136/bmjopen-2020-037491},\n\tabstract = {Objective\n              Preference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients’ attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences.\n            \n            \n              Design\n              A qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups.\n            \n            \n              Setting\n              Three locations within the greater Wellington area in New Zealand.\n            \n            \n              Participants\n              \n                Twenty-seven adults with self-reported doctor’s diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta\n                2\n                -agonist, who had used any inhaled asthma medication within the last month.\n              \n            \n            \n              Results\n              Four key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management.\n            \n            \n              Conclusions\n              This study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective.\n            \n            \n              Trial registration number\n              Australian New Zealand Clinical Trials Registry (ACTRN12619000601134).},\n\tlanguage = {en},\n\tnumber = {8},\n\turldate = {2020-09-03},\n\tjournal = {BMJ Open},\n\tauthor = {Baggott, Christina and Chan, Amy and Hurford, Sally and Fingleton, James and Beasley, Richard and Harwood, Matire and Reddel, Helen K and Levack, William Mark Magnus},\n\tmonth = aug,\n\tyear = {2020},\n\tnote = {Number: 8},\n\tpages = {e037491},\n}\n\n
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\n Objective Preference for asthma management and the use of medications is motivated by the interplay between lived experiences of asthma and patients’ attitudes towards medications. Many previous studies have focused on individual aspects of asthma management, such as the use of preventer and reliever inhalers. The aim of this qualitative study was to explore the preferences of patients with mild-moderate asthma for asthma management as a whole and factors that influenced these preferences. Design A qualitative study employing qualitative descriptive analysis situated within a constructionist epistemology to analyse transcribed audio recordings from focus groups. Setting Three locations within the greater Wellington area in New Zealand. Participants Twenty-seven adults with self-reported doctor’s diagnosis of asthma, taking short-acting beta-agonists alone or inhaled corticosteroids with or without long-acting beta 2 -agonist, who had used any inhaled asthma medication within the last month. Results Four key areas described preferences for asthma management. Preferences for self-management: participants wanted to be in control of their asthma and developed personal strategies to achieve this. Preferences for the specific medications or treatment regimen: participants preferred regimens that were convenient and reliably relieved symptoms. Preferences for inhaler devices: devices that had dose counters and were easy to use and portable were important. Preferences for asthma services: participants wanted easier access to their inhalers and to be empowered by their healthcare providers. Participant preferences within each of these four areas were influenced by the impact asthma had on their life, their health beliefs, emotional consequences of asthma and perceived barriers to asthma management. Conclusions This study illustrates the interaction of the lived experience of asthma, factors specific to the individual, and factors relating to asthma treatments in shaping patient preferences for asthma management. This aids our understanding of preferences for asthma management from the patient perspective. Trial registration number Australian New Zealand Clinical Trials Registry (ACTRN12619000601134).\n
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\n  \n 2014\n \n \n (1)\n \n \n
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\n \n\n \n \n \n \n \n Combination budesonide/formoterol inhaler as maintenance and reliver therapy in Maori with asthma.\n \n \n \n\n\n \n Pilcher, J.; Patel, M.; Smith, A.; Davies, C.; Pritchard, A.; Travers, J.; Black, P.; Weatherall, M.; Beasley, R.; and Harwood, M.\n\n\n \n\n\n\n Respirology, 19. 2014.\n \n\n\n\n
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@article{pilcher_combination_2014,\n\ttitle = {Combination budesonide/formoterol inhaler as maintenance and reliver therapy in {Maori} with asthma},\n\tvolume = {19},\n\tdoi = {10.1111/resp.12319},\n\tjournal = {Respirology},\n\tauthor = {Pilcher, Janine and Patel, Mitesh and Smith, Ann and Davies, Cheryl and Pritchard, Alison and Travers, Justin and Black, Peter and Weatherall, Mark and Beasley, Richard and Harwood, Matire},\n\tyear = {2014},\n}\n
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\n  \n 2013\n \n \n (1)\n \n \n
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\n \n\n \n \n \n \n \n SINGLE BUDESONIDE/FORMOTEROL INHALER AS MAINTENANCE AND RELIEVER THERAPY IS BENEFICIAL IN MAORI ASTHMA.\n \n \n \n\n\n \n Pilcher, J; Patel, M; Smith, A; Davies, C.; Harwood, M.; Weatherall, M.; and Beasley, R.\n\n\n \n\n\n\n Respirology, 18: 44. 2013.\n \n\n\n\n
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@article{pilcher_single_2013,\n\ttitle = {{SINGLE} {BUDESONIDE}/{FORMOTEROL} {INHALER} {AS} {MAINTENANCE} {AND} {RELIEVER} {THERAPY} {IS} {BENEFICIAL} {IN} {MAORI} {ASTHMA}},\n\tvolume = {18},\n\tjournal = {Respirology},\n\tauthor = {Pilcher, J and Patel, M and Smith, A and Davies, Cheryl and Harwood, Matire and Weatherall, Mark and Beasley, Richard},\n\tyear = {2013},\n\tpages = {44},\n}\n\n
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\n  \n 2012\n \n \n (2)\n \n \n
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\n \n\n \n \n \n \n \n \n Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life – a randomized controlled trial.\n \n \n \n \n\n\n \n Harwood, M.; Weatherall, M.; Talemaitoga, A.; Barber, P A.; Gommans, J.; Taylor, W.; McPherson, K.; and McNaughton, H.\n\n\n \n\n\n\n Clinical Rehabilitation, 26(6): 493–501. June 2012.\n \n\n\n\n
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@article{harwood_taking_2012,\n\ttitle = {Taking charge after stroke: promoting self-directed rehabilitation to improve quality of life – a randomized controlled trial},\n\tvolume = {26},\n\tissn = {0269-2155, 1477-0873},\n\tshorttitle = {Taking charge after stroke},\n\turl = {http://journals.sagepub.com/doi/10.1177/0269215511426017},\n\tdoi = {10.1177/0269215511426017},\n\tabstract = {Objective: Few community interventions following stroke enhance activity, participation or quality of life. We tested two novel community interventions designed to promote self-directed rehabilitation following stroke.\n            Design: This was a randomized, controlled parallel group 2×2 trial.\n            Setting: Community.\n            Participants: Maori and Pacific New Zealanders, {\\textgreater}15 years old, randomized within three months of a new stroke.\n            Interventions: A DVD of four inspirational stories by Maori and Pacific people with stroke and a ‘Take Charge Session’ – a single structured risk factor and activities of daily living assessment, designed to facilitate self-directed rehabilitation.\n            Main measures: Primary outcomes were Health-related Quality of Life (Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form 36 (SF-36)) 12 months from randomization. Secondary outcomes were Barthel Index, Frenchay Activities Index, Carer Strain Index and modified Rankin score.\n            Results: One hundred and seventy-two people were randomized with 139 (80.8\\%) followed up at 12 months post randomization. The effect of the Take Charge Session on SF-36 PCS at 12 months was 6.0 (95\\% confidence interval (CI) 2.0 to 10.0) and of the DVD was 0.9 (95\\% CI −3.1 to 4.9). Participants allocated to the Take Charge Session were less likely to have a modified Rankin score of {\\textgreater}2 (odds ratio (OR) 0.42, 95\\% CI 0.2 to 0.89) and their carers had lower (better) Carer Strain Index scores (−1.5, 95\\% CI −2.8 to −0.1).\n            Conclusion: A simple, low-cost intervention in the community phase of stroke recovery aiming to promote self-directed rehabilitation improved outcomes.},\n\tlanguage = {en},\n\tnumber = {6},\n\turldate = {2021-09-09},\n\tjournal = {Clinical Rehabilitation},\n\tauthor = {Harwood, Matire and Weatherall, Mark and Talemaitoga, Api and Barber, P Alan and Gommans, John and Taylor, William and McPherson, Kathryn and McNaughton, Harry},\n\tmonth = jun,\n\tyear = {2012},\n\tpages = {493--501},\n}\n\n
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\n Objective: Few community interventions following stroke enhance activity, participation or quality of life. We tested two novel community interventions designed to promote self-directed rehabilitation following stroke. Design: This was a randomized, controlled parallel group 2×2 trial. Setting: Community. Participants: Maori and Pacific New Zealanders, \\textgreater15 years old, randomized within three months of a new stroke. Interventions: A DVD of four inspirational stories by Maori and Pacific people with stroke and a ‘Take Charge Session’ – a single structured risk factor and activities of daily living assessment, designed to facilitate self-directed rehabilitation. Main measures: Primary outcomes were Health-related Quality of Life (Physical Component Summary (PCS) and Mental Component Summary (MCS) scores of the Short Form 36 (SF-36)) 12 months from randomization. Secondary outcomes were Barthel Index, Frenchay Activities Index, Carer Strain Index and modified Rankin score. Results: One hundred and seventy-two people were randomized with 139 (80.8%) followed up at 12 months post randomization. The effect of the Take Charge Session on SF-36 PCS at 12 months was 6.0 (95% confidence interval (CI) 2.0 to 10.0) and of the DVD was 0.9 (95% CI −3.1 to 4.9). Participants allocated to the Take Charge Session were less likely to have a modified Rankin score of \\textgreater2 (odds ratio (OR) 0.42, 95% CI 0.2 to 0.89) and their carers had lower (better) Carer Strain Index scores (−1.5, 95% CI −2.8 to −0.1). Conclusion: A simple, low-cost intervention in the community phase of stroke recovery aiming to promote self-directed rehabilitation improved outcomes.\n
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\n \n\n \n \n \n \n \n An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with Maori and Pacific people following stroke.\n \n \n \n\n\n \n Harwood, M.; Weatherall, M.; Talemaitoga, A.; Barber, P. A.; Gommans, J.; Taylor, W.; McPherson, K.; and McNaughton, H.\n\n\n \n\n\n\n The New Zealand Medical Journal, 125(1364): 57–67. October 2012.\n Number: 1364\n\n\n\n
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@article{harwood_assessment_2012,\n\ttitle = {An assessment of the {Hua} {Oranga} outcome instrument and comparison to other outcome measures in an intervention study with {Maori} and {Pacific} people following stroke},\n\tvolume = {125},\n\tissn = {1175-8716},\n\tabstract = {AIM: Health outcomes research for Maori has been hampered by the lack of adequately validated instruments that directly address outcomes of importance to Maori, framed by a Maori perspective of health. Hua Oranga is an outcome instrument developed for Maori with mental illness that uses a holistic view of Maori health to determine improvements in physical, mental, spiritual and family domains of health. Basic psychometric work for Hua Oranga is lacking. We sought to explore the psychometric properties of the instrument and compare its responsiveness alongside other, more established tools in an intervention study involving Maori and Pacific people following acute stroke.\nMETHODS: Randomised 2x2 controlled trial of Maori and Pacific people following acute stroke with two interventions aimed at facilitating self-directed rehabilitation, and with follow-up at 12 months after randomisation. Primary outcome measures were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form 36 (SF36) at 12 months. Hua Oranga was used as a secondary outcome measure for participants at 12 months and for carers and whanau (extended family). Psychometric properties of Hua Oranga were explored using plots and correlation coefficients, principal factors analysis and scree plots.\nRESULTS: 172 participants were randomised, of whom 139 (80.8\\%) completed follow-up. Of these, 135 (97\\%) completed the Hua Oranga and 117 (84.2\\%) completed the PCS and MCS of the SF36. Eighty-nine carers completed the Hua Oranga. Total Hua Oranga scores and PCS improved significantly for one intervention group but not the other. Total Hua Oranga scores for carers improved significantly for both interventions. Total Hua Oranga score correlated moderately with the PCS (correlation coefficient 0.55, p{\\textless}0.001). Factor analysis suggested that Hua Oranga measures two and not four factors; one 'physical-mental' and one 'spiritual-family'.\nCONCLUSION: The Hua Oranga instrument, developed for Maori people with mental illness, showed good responsiveness and adequate psychometric properties in Maori and Pacific people after stroke. Its simplicity, relative brevity, minimal cost and adequate psychometric properties should favour its use in future studies with both Maori and Pacific people. Suggestions are made for refinements to the measure. These should be tested in a new population before Hua Oranga is recommended for general use in a clinical setting.},\n\tlanguage = {eng},\n\tnumber = {1364},\n\tjournal = {The New Zealand Medical Journal},\n\tauthor = {Harwood, Matire and Weatherall, Mark and Talemaitoga, Api and Barber, P. Alan and Gommans, John and Taylor, William and McPherson, Kathryn and McNaughton, Harry},\n\tmonth = oct,\n\tyear = {2012},\n\tpmid = {23242398},\n\tnote = {Number: 1364},\n\tkeywords = {Adult, Age Factors, Aged, Caregivers, Continuity of Patient Care, Female, Humans, Male, Middle Aged, New Zealand, Oceanic Ancestry Group, Outcome Assessment, Health Care, Patient Satisfaction, Physical Therapy Modalities, Prognosis, Psychometrics, Quality of Life, Risk Assessment, Severity of Illness Index, Sex Factors, Stroke, Stroke Rehabilitation, Treatment Outcome},\n\tpages = {57--67},\n}\n\n
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\n AIM: Health outcomes research for Maori has been hampered by the lack of adequately validated instruments that directly address outcomes of importance to Maori, framed by a Maori perspective of health. Hua Oranga is an outcome instrument developed for Maori with mental illness that uses a holistic view of Maori health to determine improvements in physical, mental, spiritual and family domains of health. Basic psychometric work for Hua Oranga is lacking. We sought to explore the psychometric properties of the instrument and compare its responsiveness alongside other, more established tools in an intervention study involving Maori and Pacific people following acute stroke. METHODS: Randomised 2x2 controlled trial of Maori and Pacific people following acute stroke with two interventions aimed at facilitating self-directed rehabilitation, and with follow-up at 12 months after randomisation. Primary outcome measures were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form 36 (SF36) at 12 months. Hua Oranga was used as a secondary outcome measure for participants at 12 months and for carers and whanau (extended family). Psychometric properties of Hua Oranga were explored using plots and correlation coefficients, principal factors analysis and scree plots. RESULTS: 172 participants were randomised, of whom 139 (80.8%) completed follow-up. Of these, 135 (97%) completed the Hua Oranga and 117 (84.2%) completed the PCS and MCS of the SF36. Eighty-nine carers completed the Hua Oranga. Total Hua Oranga scores and PCS improved significantly for one intervention group but not the other. Total Hua Oranga scores for carers improved significantly for both interventions. Total Hua Oranga score correlated moderately with the PCS (correlation coefficient 0.55, p\\textless0.001). Factor analysis suggested that Hua Oranga measures two and not four factors; one 'physical-mental' and one 'spiritual-family'. CONCLUSION: The Hua Oranga instrument, developed for Maori people with mental illness, showed good responsiveness and adequate psychometric properties in Maori and Pacific people after stroke. Its simplicity, relative brevity, minimal cost and adequate psychometric properties should favour its use in future studies with both Maori and Pacific people. Suggestions are made for refinements to the measure. These should be tested in a new population before Hua Oranga is recommended for general use in a clinical setting.\n
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\n  \n 2011\n \n \n (1)\n \n \n
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\n \n\n \n \n \n \n \n Ethnicity and functional outcome after stroke.\n \n \n \n\n\n \n McNaughton, H.; Feigin, V.; Kerse, N.; Barber, P A.; Weatherall, M.; Bennett, D.; Carter, K.; Hackett, M.; and Anderson, C.\n\n\n \n\n\n\n Stroke, 42(4): 960–964. 2011.\n Number: 4 Publisher: Am Heart Assoc\n\n\n\n
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@article{mcnaughton_ethnicity_2011,\n\ttitle = {Ethnicity and functional outcome after stroke},\n\tvolume = {42},\n\tissn = {0039-2499},\n\tnumber = {4},\n\tjournal = {Stroke},\n\tauthor = {McNaughton, Harry and Feigin, Valery and Kerse, Ngaire and Barber, P Alan and Weatherall, Mark and Bennett, Derrick and Carter, Kristie and Hackett, Maree and Anderson, Craig},\n\tyear = {2011},\n\tnote = {Number: 4\nPublisher: Am Heart Assoc},\n\tpages = {960--964},\n}\n\n
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\n  \n 2005\n \n \n (2)\n \n \n
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\n \n\n \n \n \n \n \n Lung cancer in Maori: a neglected priority.\n \n \n \n\n\n \n Harwood, M.; Aldington, S.; and Beasley, R.\n\n\n \n\n\n\n The New Zealand Medical Journal, 118(1213): U1410. April 2005.\n Number: 1213\n\n\n\n
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@article{harwood_lung_2005,\n\ttitle = {Lung cancer in {Maori}: a neglected priority},\n\tvolume = {118},\n\tissn = {1175-8716},\n\tshorttitle = {Lung cancer in {Maori}},\n\tlanguage = {eng},\n\tnumber = {1213},\n\tjournal = {The New Zealand Medical Journal},\n\tauthor = {Harwood, Matire and Aldington, Sarah and Beasley, Richard},\n\tmonth = apr,\n\tyear = {2005},\n\tpmid = {15843839},\n\tnote = {Number: 1213},\n\tkeywords = {Ethnic Groups, Humans, Lung Neoplasms, New Zealand, Oceanic Ancestry Group, Smoking Cessation, Socioeconomic Factors},\n\tpages = {U1410},\n}\n\n
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\n \n\n \n \n \n \n \n \n Efficacy of bupropion in the indigenous Maori population in New Zealand.\n \n \n \n \n\n\n \n Holt, S\n\n\n \n\n\n\n Thorax, 60(2): 120–123. February 2005.\n Number: 2\n\n\n\n
\n\n\n\n \n \n \"EfficacyPaper\n  \n \n\n \n \n doi\n  \n \n\n \n link\n  \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n  \n \n \n\n\n\n
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@article{holt_efficacy_2005,\n\ttitle = {Efficacy of bupropion in the indigenous {Maori} population in {New} {Zealand}},\n\tvolume = {60},\n\tissn = {0040-6376},\n\turl = {http://thorax.bmj.com/cgi/doi/10.1136/thx.2004.030239},\n\tdoi = {10.1136/thx.2004.030239},\n\tlanguage = {en},\n\tnumber = {2},\n\turldate = {2020-07-13},\n\tjournal = {Thorax},\n\tauthor = {Holt, S},\n\tmonth = feb,\n\tyear = {2005},\n\tnote = {Number: 2},\n\tpages = {120--123},\n}\n\n
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\n  \n 2000\n \n \n (2)\n \n \n
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\n \n\n \n \n \n \n \n Asthma morbidity 6 yrs after an effective asthma self-management programme in a Maori community.\n \n \n \n\n\n \n D'Souza, W. J.; Slater, T.; Fox, C.; Fox, B.; Te Karu, H.; Gemmell, T.; Ratima, M. M.; Pearce, N. E.; and Beasley, R. B.\n\n\n \n\n\n\n The European Respiratory Journal, 15(3): 464–469. March 2000.\n Number: 3\n\n\n\n
\n\n\n\n \n\n \n \n doi\n  \n \n\n \n link\n  \n \n\n bibtex\n \n\n \n  \n \n abstract \n \n\n \n\n \n \n \n \n \n \n \n\n  \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n\n\n\n
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@article{dsouza_asthma_2000,\n\ttitle = {Asthma morbidity 6 yrs after an effective asthma self-management programme in a {Maori} community},\n\tvolume = {15},\n\tissn = {0903-1936},\n\tdoi = {10.1034/j.1399-3003.2000.15.07.x},\n\tabstract = {A 6-month Maori community-based asthma self-management programme, involving a "credit card" asthma self-management plan, has previously been shown to be an effective and acceptable system for reducing asthma morbidity. The effectiveness of the asthma self-management programme and participants' self-management behaviour was assessed 6 yrs after the formal end of the programme. Participants were surveyed at the time of enrollment, and 1, 2, and 6 yrs after completing the programme. In each survey, participants were questioned on markers of asthma morbidity and use of medical services during the previous 12 months. Self-management behaviour was assessed using a questionnaire at 2 years and 6 yrs. Of the 69 original participants, 47 (68\\%) were surveyed after 6 yrs. They generally had reduced severe asthma morbidity and emergency use of health services from baseline. In particular, the proportion who had an emergency visit to a general practitioner had decreased from 41\\% to 18\\% (p=0.02). However, the percentage of nights woken due to asthma had returned to preintervention levels, and the proportion of participants taking prescribed regular inhaled steroid had decreased from 91\\% to 53\\% (p{\\textless}0.001). Compared with 2 yrs after completion of the asthma programme, self-management behaviour had also deteriorated, with 29\\% versus 73\\% (p{\\textless}0.001) using their peak flow meter daily when their asthma was "getting bad" and 41\\% versus 86\\% (p{\\textless}0.001) using the "credit card" plan to increase the amount of inhaled steroids in the last year. Although the programme participants were still experiencing reduced morbidity from their asthma 6 yrs after the end of the self-management programme, the benefits were less than those observed at 2 yrs. These findings suggest that under-recognition and under-treatment of asthma with appropriate amounts of inhaled steroids is a major factor contributing to asthma morbidity in this indigenous rural community. To obtain enduring benefits from a self-management system of care continued reinforcement of self-management skills seems to be an essential component of any follow-up.},\n\tlanguage = {eng},\n\tnumber = {3},\n\tjournal = {The European Respiratory Journal},\n\tauthor = {D'Souza, W. J. and Slater, T. and Fox, C. and Fox, B. and Te Karu, H. and Gemmell, T. and Ratima, M. M. and Pearce, N. E. and Beasley, R. B.},\n\tmonth = mar,\n\tyear = {2000},\n\tpmid = {10759438},\n\tnote = {Number: 3},\n\tkeywords = {Adult, Asthma, Female, Follow-Up Studies, Humans, Male, New Zealand, Patient Participation, Program Evaluation, Time Factors},\n\tpages = {464--469},\n}\n\n
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\n A 6-month Maori community-based asthma self-management programme, involving a \"credit card\" asthma self-management plan, has previously been shown to be an effective and acceptable system for reducing asthma morbidity. The effectiveness of the asthma self-management programme and participants' self-management behaviour was assessed 6 yrs after the formal end of the programme. Participants were surveyed at the time of enrollment, and 1, 2, and 6 yrs after completing the programme. In each survey, participants were questioned on markers of asthma morbidity and use of medical services during the previous 12 months. Self-management behaviour was assessed using a questionnaire at 2 years and 6 yrs. Of the 69 original participants, 47 (68%) were surveyed after 6 yrs. They generally had reduced severe asthma morbidity and emergency use of health services from baseline. In particular, the proportion who had an emergency visit to a general practitioner had decreased from 41% to 18% (p=0.02). However, the percentage of nights woken due to asthma had returned to preintervention levels, and the proportion of participants taking prescribed regular inhaled steroid had decreased from 91% to 53% (p\\textless0.001). Compared with 2 yrs after completion of the asthma programme, self-management behaviour had also deteriorated, with 29% versus 73% (p\\textless0.001) using their peak flow meter daily when their asthma was \"getting bad\" and 41% versus 86% (p\\textless0.001) using the \"credit card\" plan to increase the amount of inhaled steroids in the last year. Although the programme participants were still experiencing reduced morbidity from their asthma 6 yrs after the end of the self-management programme, the benefits were less than those observed at 2 yrs. These findings suggest that under-recognition and under-treatment of asthma with appropriate amounts of inhaled steroids is a major factor contributing to asthma morbidity in this indigenous rural community. To obtain enduring benefits from a self-management system of care continued reinforcement of self-management skills seems to be an essential component of any follow-up.\n
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\n \n\n \n \n \n \n \n \n Asthma morbidity 6 yrs after an effective asthma self-management programme in a Maori community.\n \n \n \n \n\n\n \n D'souza, W.; Slater, T; Fox, C; Fox, B; Te Karu, H; Gemmell, T; Ratima, M.; Pearce, N.; and Beasley, R.\n\n\n \n\n\n\n European Respiratory Journal, 15(3): 464–469. March 2000.\n Number: 3\n\n\n\n
\n\n\n\n \n \n \"AsthmaPaper\n  \n \n\n \n \n doi\n  \n \n\n \n link\n  \n \n\n bibtex\n \n\n \n\n \n\n \n \n \n \n \n \n \n\n  \n \n \n\n\n\n
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@article{dsouza_asthma_2000-1,\n\ttitle = {Asthma morbidity 6 yrs after an effective asthma self-management programme in a {Maori} community},\n\tvolume = {15},\n\tissn = {0903-1936, 1399-3003},\n\turl = {http://erj.ersjournals.com/content/15/3/464},\n\tdoi = {10.1034/j.1399-3003.2000.15.07.x},\n\tlanguage = {en},\n\tnumber = {3},\n\turldate = {2020-07-13},\n\tjournal = {European Respiratory Journal},\n\tauthor = {D'souza, W.j and Slater, T and Fox, C and Fox, B and Te Karu, H and Gemmell, T and Ratima, M.m and Pearce, N.e and Beasley, R.b},\n\tmonth = mar,\n\tyear = {2000},\n\tnote = {Number: 3},\n\tpages = {464--469},\n}\n\n
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\n  \n 1993\n \n \n (1)\n \n \n
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\n \n\n \n \n \n \n \n Trial of an asthma action plan in the Maori community of the Wairarapa.\n \n \n \n\n\n \n Beasley, R.; D'Souza, W.; Te Karu, H.; Fox, C.; Harper, M.; Robson, B.; Howden-Chapman, P.; Crane, J.; Burgess, C.; and Woodman, K.\n\n\n \n\n\n\n The New Zealand Medical Journal, 106(961): 336–338. August 1993.\n Number: 961\n\n\n\n
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@article{beasley_trial_1993,\n\ttitle = {Trial of an asthma action plan in the {Maori} community of the {Wairarapa}},\n\tvolume = {106},\n\tissn = {0028-8446},\n\tabstract = {AIMS: An asthma action plan has been tested in a study conducted by Wairarapa Maori community health workers and the Wellington asthma research group. There were several distinctive features of the project, including the programme of marae-based asthma clinics, and the partnership between the researchers and the Maori community groups. This paper describes the process by which the study was conducted since this experience may be relevant to future Maori health research projects.\nMETHODS: The programme was launched with a series of hui at marae in the Wairarapa, and marae-based clinics were set up. These were followed up by further support from the Maori community health workers who helped people to keep diaries to monitor their asthma, and generally maintained contact. The severity of asthma in the participants was compared for a two-month period before the action plan was introduced, and for a four-month period after the plan was introduced.\nRESULTS: There was a high participation rate, with 91\\% (63/69) of participants finishing the programme, 75\\% of whom adequately completed their daily asthma diaries. Asthma control improved significantly in the participants. They commented positively on the programme, and particularly on the marae-based clinics.\nCONCLUSIONS: The study was successful in terms of participation in the marae-based clinics, acceptance and use of the plan, and improvement in asthma control of the participants. The findings indicate what can be achieved when researchers and Maori community groups work in partnership.},\n\tlanguage = {eng},\n\tnumber = {961},\n\tjournal = {The New Zealand Medical Journal},\n\tauthor = {Beasley, R. and D'Souza, W. and Te Karu, H. and Fox, C. and Harper, M. and Robson, B. and Howden-Chapman, P. and Crane, J. and Burgess, C. and Woodman, K.},\n\tmonth = aug,\n\tyear = {1993},\n\tpmid = {8341475},\n\tnote = {Number: 961},\n\tkeywords = {Asthma, Community Health Workers, European Continental Ancestry Group, Humans, New Zealand, Oceanic Ancestry Group, Patient Acceptance of Health Care, Patient Education as Topic, Program Evaluation},\n\tpages = {336--338},\n}\n\n
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\n AIMS: An asthma action plan has been tested in a study conducted by Wairarapa Maori community health workers and the Wellington asthma research group. There were several distinctive features of the project, including the programme of marae-based asthma clinics, and the partnership between the researchers and the Maori community groups. This paper describes the process by which the study was conducted since this experience may be relevant to future Maori health research projects. METHODS: The programme was launched with a series of hui at marae in the Wairarapa, and marae-based clinics were set up. These were followed up by further support from the Maori community health workers who helped people to keep diaries to monitor their asthma, and generally maintained contact. The severity of asthma in the participants was compared for a two-month period before the action plan was introduced, and for a four-month period after the plan was introduced. RESULTS: There was a high participation rate, with 91% (63/69) of participants finishing the programme, 75% of whom adequately completed their daily asthma diaries. Asthma control improved significantly in the participants. They commented positively on the programme, and particularly on the marae-based clinics. CONCLUSIONS: The study was successful in terms of participation in the marae-based clinics, acceptance and use of the plan, and improvement in asthma control of the participants. The findings indicate what can be achieved when researchers and Maori community groups work in partnership.\n
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