title: A path to lotions and potions: Ngāti te Maunga ahi kā use of rongoā for hapū wellbeing

authors: Diamond, Kiri

subjects: rongoā

abstract: The research aimed to determine the challenges and improvements required during the implementation of the rongoā programme. The rongoā programme was based on a papakāinga near a marae, in a semi-rural location with difficult access. Participatory action research and autoethnography methods were used with the ahi kā (local residence) to develop a programme that would fulfil the hapū ora (extended family wellbeing) goals.  The goals of the programme were: for the ahi kā to use rongoā (modalities of health) confidently for their wellbeing; consistently use a Facebook page to learn and share information and to develop a database of the local rongoā rākau (medicinal plant). The ahi kā identified a further question to ask Facebook members to understand what motivated their participation and a survey was conducted. The ahi kā also wanted to understand the local doctor’s view on rongoā and its context on health provision in their area. An interview was conducted and the survey and interview added to the understanding of what the ahi kā could do to improve theirs and the hapū whānau (group extended family) wellbeing.
The findings of the research highlighted the complexities that arise from conducting research in a bicultural space where a common understanding of cultural knowledge is assumed to be homogenous. A shared history with colonisation and religious beliefs brought to the forefront the multiplicity Māori work through to determine a shared hapū identity. Based on an understanding of Māori principle values and tikanga (ways of enacting values), as understood by ahi kā, transformed a programme of learning how to make lotions and potions for the ahi kā, into influencing hapū members to change their attitudes and behaviours to their environment and their wellbeing.
This research highlighted the role that ahi kā hold as keepers of cultural knowledge that is rooted in the papakāinga through ancestral links that informs the identity of a hapū. Learning how to use rongoā provided ahi kā a platform to learn a new skill while helping the hapū heal through connecting with the identity and land of the hapū they belong to.

text: A path to lotions and potions: Ngāti te Maunga ahi kā use of rongoā for hapū wellbeing The research aimed to determine the challenges and improvements required during the implementation of the rongoā programme. The rongoā programme was based on a papakāinga near a marae, in a semi-rural location with difficult access. Participatory action research and autoethnography methods were used with the ahi kā (local residence) to develop a programme that would fulfil the hapū ora (extended family wellbeing) goals.  The goals of the programme were: for the ahi kā to use rongoā (modalities of health) confidently for their wellbeing; consistently use a Facebook page to learn and share information and to develop a database of the local rongoā rākau (medicinal plant). The ahi kā identified a further question to ask Facebook members to understand what motivated their participation and a survey was conducted. The ahi kā also wanted to understand the local doctor’s view on rongoā and its context on health provision in their area. An interview was conducted and the survey and interview added to the understanding of what the ahi kā could do to improve theirs and the hapū whānau (group extended family) wellbeing.
The findings of the research highlighted the complexities that arise from conducting research in a bicultural space where a common understanding of cultural knowledge is assumed to be homogenous. A shared history with colonisation and religious beliefs brought to the forefront the multiplicity Māori work through to determine a shared hapū identity. Based on an understanding of Māori principle values and tikanga (ways of enacting values), as understood by ahi kā, transformed a programme of learning how to make lotions and potions for the ahi kā, into influencing hapū members to change their attitudes and behaviours to their environment and their wellbeing.
This research highlighted the role that ahi kā hold as keepers of cultural knowledge that is rooted in the papakāinga through ancestral links that informs the identity of a hapū. Learning how to use rongoā provided ahi kā a platform to learn a new skill while helping the hapū heal through connecting with the identity and land of the hapū they belong to.

year: 2019

title: Epidemiological evidence that can help to improve timely diagnosis of colorectal cancer in New Zealand.

authors: Hirsz, Malgorzata

subjects: Colorectal cancer

abstract: Incidence 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.

text: Epidemiological evidence that can help to improve timely diagnosis of colorectal cancer in New Zealand. Incidence 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.

year: 2021

title: Migrant remittances, Sustainable Development Goal (SDG) 7 and energy poverty in Sri Lanka

authors: Wijayarathne, Sandamali

subjects: Remittances

abstract: Modern, clean energy is seen as the golden thread that connects economic growth, human development, and environmental sustainability. However, almost 2.4 billion people worldwide still use solid fuels for cooking, exacerbating energy poverty and endangering human health and the environment. Therefore, this thesis investigated the non-price determinants of cooking fuel choice, including the causal relationship between migrant remittances and both cooking fuel choice and energy poverty. Sri Lanka was used as a case study, using more than 78,000 households from four waves of the Household Income and Expenditure survey from 2009 – 2019. Specifically, this thesis includes three empirical studies and one policy paper related to remittances and energy consumption.

The first study found that household income, household wealth, household head’s characteristics (age, marital status and education), education of spouse, household characteristics (household size and number of children under 5), housing characteristics (number of bedrooms, drinking water source, and housing material), and residential sector (urban vs rural) were significant for selecting clean fuel for cooking, using multinomial logistic analysis. Moreover, the Advanced sustainability analysis showed a strong synergy between SDG 7 (clean energy), SDG 6 (Clean water), and SDG 4 (quality education).

The second study investigated the relationship between migrant remittances and cooking fuel choice by taking household wealth as a mediating variable. Using the propensity score matching method the study found that migrants used about 5.7% more clean fuels for cooking than non-migrant households. Furthermore, the control function approach found that a 1% increase in remittances increased clean cooking fuel use by 0.034 units, and instrumental variable (IV) mediation analysis indicated that household wealth significantly mediated this relationship.

The third study further explored the link between migrant remittances and energy poverty, using income inequality as the mediating variable. Two-Stage-Least-Squares (2SLS) regression results showed that a 10% increase in remittances decreased energy poverty by 0.042 units, while IV mediation analysis indicated that income inequality significantly mediated this relationship.

The final study examined the causes and economic implications of Sri Lanka's current energy crisis, its effect on energy poverty and the attainment of SDG 7. Specifically, the findings of the second and third studies were used to forecast the impact of a decline in migrant remittances of 40% due to the crisis on clean cooking fuel use and energy poverty. A 40% drop in remittances could reduce clean cooking fuel consumption by 0.16 units and increase energy poverty by 0.0016 units. The study concluded that Sri Lanka should encourage migrant remittances to enhance the use of clean cooking fuels and minimize energy poverty in light of the current energy crisis.

text: Migrant remittances, Sustainable Development Goal (SDG) 7 and energy poverty in Sri Lanka Modern, clean energy is seen as the golden thread that connects economic growth, human development, and environmental sustainability. However, almost 2.4 billion people worldwide still use solid fuels for cooking, exacerbating energy poverty and endangering human health and the environment. Therefore, this thesis investigated the non-price determinants of cooking fuel choice, including the causal relationship between migrant remittances and both cooking fuel choice and energy poverty. Sri Lanka was used as a case study, using more than 78,000 households from four waves of the Household Income and Expenditure survey from 2009 – 2019. Specifically, this thesis includes three empirical studies and one policy paper related to remittances and energy consumption.

The first study found that household income, household wealth, household head’s characteristics (age, marital status and education), education of spouse, household characteristics (household size and number of children under 5), housing characteristics (number of bedrooms, drinking water source, and housing material), and residential sector (urban vs rural) were significant for selecting clean fuel for cooking, using multinomial logistic analysis. Moreover, the Advanced sustainability analysis showed a strong synergy between SDG 7 (clean energy), SDG 6 (Clean water), and SDG 4 (quality education).

The second study investigated the relationship between migrant remittances and cooking fuel choice by taking household wealth as a mediating variable. Using the propensity score matching method the study found that migrants used about 5.7% more clean fuels for cooking than non-migrant households. Furthermore, the control function approach found that a 1% increase in remittances increased clean cooking fuel use by 0.034 units, and instrumental variable (IV) mediation analysis indicated that household wealth significantly mediated this relationship.

The third study further explored the link between migrant remittances and energy poverty, using income inequality as the mediating variable. Two-Stage-Least-Squares (2SLS) regression results showed that a 10% increase in remittances decreased energy poverty by 0.042 units, while IV mediation analysis indicated that income inequality significantly mediated this relationship.

The final study examined the causes and economic implications of Sri Lanka's current energy crisis, its effect on energy poverty and the attainment of SDG 7. Specifically, the findings of the second and third studies were used to forecast the impact of a decline in migrant remittances of 40% due to the crisis on clean cooking fuel use and energy poverty. A 40% drop in remittances could reduce clean cooking fuel consumption by 0.16 units and increase energy poverty by 0.0016 units. The study concluded that Sri Lanka should encourage migrant remittances to enhance the use of clean cooking fuels and minimize energy poverty in light of the current energy crisis.

year: 2024-04-16