School of Clinical Sciences

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https://hdl.handle.net/10292/1241
The School of Clinical Sciences plays an important role in specialist teaching and research conducted by its academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand, especially in the fields of Midwifery, Nursing, Occupational Therapy, Oral Health, Paramedicine, Physiotherapy, Podiatry.

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    Health Effects of Transport Noise
    (Taylor and Francis Group, 2023-04-26) Welch, D; Shepherd, D; Dirks, KN; Reddy, R
    The relationship between transport noise and health outcomes is complex, in part because of the large number of factors involved as well as the range of health impacts, both direct and indirect. To enable the reader to come to grips with the complexity, we have divided the health outcomes into groups: those that are more directly linked to transport noise exposure and those that are more indirectly linked. Four health outcomes, namely annoyance, cognitive disruption, sleep problems, and noise-induced hearing loss, can be directly attributable to transport noise exposure. Less direct outcomes are stress, mental health, metabolic health, cardiovascular health, and overall health-related quality of life. Stress may occur as a direct response to noise, or may occur in response to the aforementioned direct effects. The stress response is a survival mechanism in the short term, but in the long term, stress may lead to systemic health conditions, namely metabolic and cardiovascular outcomes, and to mental health conditions. Finally, a global health outcome that incorporates all of the more direct outcomes is health-related quality of life. Other exposures associated with transport noise that may explain parts of the health outcomes need to be acknowledged, including exposure to social inequities, air pollution, and vibration. These may all be more likely to be experienced by people who are exposed to transport noise in the community and may thus influence the outcomes. Finally, transport noise appears to have more impact on health in those who are noise sensitive, thus noise sensitivity is a key moderator of all the effects observed.
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    A Smartphone App Effectively Facilitates Mothers’ Mind-Mindedness: A Randomized Controlled Trial
    (Wiley, 2023-11-15) Larkin, Fionnuala; Oostenbroek, Janine; Lee, Yujin; Hayward, Emily; Fernandez, Amy; Wang, Ying; Mitchell, Alex; Li, Lydia Y; Meins, Elizabeth
    The efficacy of a smartphone app intervention (BabyMind©) in facilitating mind‐mindedness was investigated in a randomized controlled trial, assigning mothers and their 6‐month‐olds (N = 152; 72 girls, 146 White) to intervention or active control conditions. Mothers who had received the BabyMind© app intervention scored higher for appropriate (d = .61, 95% CI .28, .94) and lower for non‐attuned (d = −.55, 95% CI −.92, −.18) mind‐related comments at follow‐up (age 12 months), compared with their control group counterparts. Adjusting for missing data did not alter this pattern of findings. Mothers' baseline parental reflective functioning did not moderate these relations. Results are discussed in terms of the benefits of early intervention and exploring the efficacy of the app in more diverse populations.
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    Stigmatising and Racialising COVID-19: Asian People’s Experience in New Zealand
    (Springer Science and Business Media LLC, 2022-11-11) Liu, LS; Jia, X; Zhu, A; Ran, GJ; Siegert, R; French, N; Johnston, D
    The Asian community — the second largest non-European ethnic community in New Zealand — plays an important role in combatting the COVID-19 pandemic, evidenced by their active advocation for border control and mass masking. Despite the long history of racial discrimination against the Asian population, the Asian community has experienced certain degrees of racial discrimination associated with the stigmatisation as the cause of the COVID-19 outbreak in New Zealand. Based on data from a quantitative online survey with 402 valid responses within the Asian communities across New Zealand and the in-depth interviews with 19 Asian people in Auckland, New Zealand, this paper will illustrate Asian people’s experience of racial discrimination and stigmatisation during the pandemic in the country. The survey shows that since the outbreak of COVID-19, under a quarter of the participants reported experiencing discrimination, and a third reported knowing an immediate contact who had experienced discrimination. However, when looking beyond their immediate social circle, an even higher proportion reported noticing racism and stigmatisation through the traditional or social media due to COVID-19. Major variations of the degree of racial discrimination experienced are determined by three demographic variables: ethnicity, age, and region. The in-depth interviews largely echoed the survey findings and highlighted a strong correlation between the perceived racial discrimination among the local Asian community and the stigmatisation associated with COVID-19. These findings are important for improving the way we manage future pandemics and other disasters within the context of the UN Sendai Framework for Disaster Risk Reduction.
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    Ethnic Differences of the Care Pathway Following an Out-of-Hospital Cardiac Event: A Systematic Review
    (Elsevier, 2023-10-27) Newport, Rochelle; Grey, Corina; Dicker, Bridget; Ameratunga, Shanthi; Harwood, Matire
    AIM: This systematic review aimed to determine to what extent and why the care pathways for acute cardiac events in the community might differ for minoritised ethnic populations compared to non-minoritised populations. It also sought to identify the barriers and enablers that could influence variations in access to care for minoritised populations. METHODS: A multi-database search was conducted for articles published between 1 January 2000 and 1 January 2023. A combination of MeSH terms and keywords was used. Inclusion criteria for papers were published in English, adult population, the primary health condition was an acute cardiac event, and the primary outcomes were disaggregated by ethnicity or race. A narrative review of extracted data was performed, and findings were reported according to the PRISMA 2020 guidelines. RESULTS: Of the 3552 articles identified using the search strategy, 40 were deemed eligible for the review. Studies identified a range of variables in the care pathway that differed by ethnicity or race. These could be grouped as time to care, transportation, event related-variables, EMS interactions and symptoms. A meta-analysis was not performed due to heterogeneity across the studies. CONCLUSION: The extent and reasons for differences in cardiac care pathways are considerable. There are several remediable barriers and enablers that require attention to achieve equitable access to care for minoritised populations.
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    The Incidence, Impact and Risk Factors for Moderate to Severe Persistent Pain After Breast Cancer Surgery a Prospective Cohort Study
    (Oxford University Press (OUP), 2023-05-15) Chiang, Daniel LC; Rice, David A; Helsby, Nuala A; Somogyi, Andrew A; Kluger, Michal T
    Background: Few Australasian studies have evaluated persistent pain after breast cancer surgery. Objective: To evaluate the incidence, impact, and risk factors of moderate to severe persistent pain after breast cancer surgery in a New Zealand cohort. Design: Prospective cohort study Methods: Consented patients were reviewed at 3 timepoints (preoperative, 2 weeks and 6 months postoperative). Pain incidence and interference, psychological distress and upper limb disability were assessed perioperatively. Clinical, demographic, psychological, cancer treatment-related variables, quantitative sensory testing, and patient genotype (COMT, OPRM1, GCH1, ESR1, and KCNJ6) were assessed as risk factors using multiple logistic regression. Results: Of the 173 patients recruited, 140 completed the 6-month follow-up. Overall, 15.0% (n = 21, 95% CI: 9.5% - 22.0%) of patients reported moderate to severe persistent pain after breast cancer surgery with 42.9% (n = 9, 95% CI: 21.9% - 66.0%) reporting likely neuropathic pain. Pain interference, upper limb dysfunction and psychological distress were significantly higher in patients with moderate to severe pain (P <. 004). Moderate to severe preoperative pain (OR= 3.60, 95% CI: 1.13-11.44, P =. 03), COMT rs6269 GA genotype (OR = 5.03, 95% CI: 1.49 - 17.04, P =. 009) and psychological distress at postoperative day 14 (OR= 1.08, 95% CI: 1.02 - 1.16, P =. 02) were identified as risk factors. Total intravenous anesthesia (OR= 0.31, 95% CI: 0.10 - 0.99, P =. 048) was identified as protective. Conclusion: The incidence of moderate to severe persistent pain after breast cancer surgery is high with associated pain interference, physical disability, and psychological distress. Important modifiable risk factors were identified to reduce this important condition.
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