title: At the end of the Rainbow: Rainbow experiences of palliative care through the lens of a situated case study

authors: Byrne, Kate

subjects: palliative care

abstract: This thesis explores Rainbow experiences of palliative care in Aotearoa New Zealand through the lens of a situated case study and the local policy context for palliative care. Underscoring this thesis is an understanding that the Rainbow community constitute a subgroup of the population which possess specific needs within the palliative care space. A key concept on which this research rests is good death and how palliative care aspires to achieve a good death. This is a novel, exploratory study conducted to address the lack of literature pertaining to Rainbow experiences of palliative care in Aotearoa New Zealand. The theoretical framework for this thesis is grounded in the socio-ecological model of health and the concept of aroha. A case study research design is utilised to give a fine-grained exploration of a single research participant’s experience supporting his partner’s palliative care journey. Semistructured interviews were conducted with the research participant, which provided insights into how palliative care unfolded within the lifeworld of a couple who are members of the Rainbow community. Interview data was analysed with an interpretivist approach. In addition, I conducted analysis of key documents that direct the design and delivery of palliative care in Aotearoa New Zealand. Analysis of the documents was conducted by situating and examining them within the socio-ecological framework. The case study findings include themes of caregiving and the impact of discrimination. Within the theme of caregiving, topics that emerged included transitions in care, dynamic support, and expressions of autonomy. The theme of the impact of discrimination investigated the legacy of the AIDS crisis, the burden of educating people delivering palliative care, and the fear of discrimination. A synthesis of the interview data and document analysis highlights the radical potential of palliative care as a model of care, alongside tensions between aspirations expressed within the palliative care model and lived experience. I also investigate the role of intersectionality in facilitating good death, and the complexities of being openly Rainbow, as key issues within the case study and document analysis. In terms of implications for future research, I argue that fine-grained case study approaches to explore complex, personalised, and deeply contextual experiences such as those included within the study offer novel insights into service delivery. Additionally, this thesis indicates the necessity of further diverse research within the Aotearoa New Zealand context to ensure understandings of Rainbow palliative care experiences are robust.

text: At the end of the Rainbow: Rainbow experiences of palliative care through the lens of a situated case study This thesis explores Rainbow experiences of palliative care in Aotearoa New Zealand through the lens of a situated case study and the local policy context for palliative care. Underscoring this thesis is an understanding that the Rainbow community constitute a subgroup of the population which possess specific needs within the palliative care space. A key concept on which this research rests is good death and how palliative care aspires to achieve a good death. This is a novel, exploratory study conducted to address the lack of literature pertaining to Rainbow experiences of palliative care in Aotearoa New Zealand. The theoretical framework for this thesis is grounded in the socio-ecological model of health and the concept of aroha. A case study research design is utilised to give a fine-grained exploration of a single research participant’s experience supporting his partner’s palliative care journey. Semistructured interviews were conducted with the research participant, which provided insights into how palliative care unfolded within the lifeworld of a couple who are members of the Rainbow community. Interview data was analysed with an interpretivist approach. In addition, I conducted analysis of key documents that direct the design and delivery of palliative care in Aotearoa New Zealand. Analysis of the documents was conducted by situating and examining them within the socio-ecological framework. The case study findings include themes of caregiving and the impact of discrimination. Within the theme of caregiving, topics that emerged included transitions in care, dynamic support, and expressions of autonomy. The theme of the impact of discrimination investigated the legacy of the AIDS crisis, the burden of educating people delivering palliative care, and the fear of discrimination. A synthesis of the interview data and document analysis highlights the radical potential of palliative care as a model of care, alongside tensions between aspirations expressed within the palliative care model and lived experience. I also investigate the role of intersectionality in facilitating good death, and the complexities of being openly Rainbow, as key issues within the case study and document analysis. In terms of implications for future research, I argue that fine-grained case study approaches to explore complex, personalised, and deeply contextual experiences such as those included within the study offer novel insights into service delivery. Additionally, this thesis indicates the necessity of further diverse research within the Aotearoa New Zealand context to ensure understandings of Rainbow palliative care experiences are robust.

year: 2024

title: Biological flora of New Zealand 13. Pittosporum cornifolium, tāwhiri karo, cornel-leaved pittosporum

authors: Clarkson, Fiona Marie

subjects: biological flora

abstract: A comprehensive review of the morphology, anatomy, taxonomy, chemistry and ecology of the endemic New Zealand facultative shrub epiphyte Pittosporum cornifolium (Pittosporaceae) is presented. Strong habitat specificity restricts this species to lowland forest and coastal habitats, which are widely yet discontinuously distributed north of latitude 42°15′S. Pittosporum cornifolium is typically associated with old growth forest systems and low nutrient substrates, with low mean daily temperatures in the coldest month (<0.6 °C) and high mean October vapour pressure deficits (>0.5 kPa) apparently restricting its distribution. Significant morphological variability is evident in leaves and flowers, especially with respect to plants from the Poor Knights Islands. Genetic analyses of five mainland populations and individuals representing Poor Knights Islands populations revealed relatively low genetic diversity at the population level which is likely to be the result of geographic isolation. Molecular phylogenetic studies suggest a New Caledonian origin for the species with close affinities to both P. pimeleoides subspecies. Several lines of evidence suggest recognition of the Poor Knights Islands entity as a new taxon. However, analysis of additional morphological, reproductive and molecular data across the full geographic range will be required to confirm current inferences. Although populations have declined, P. cornifolium is not currently threatened, however, it should be considered for reintroduction to sites in districts where its range has been severely reduced.

text: Biological flora of New Zealand 13. Pittosporum cornifolium, tāwhiri karo, cornel-leaved pittosporum A comprehensive review of the morphology, anatomy, taxonomy, chemistry and ecology of the endemic New Zealand facultative shrub epiphyte Pittosporum cornifolium (Pittosporaceae) is presented. Strong habitat specificity restricts this species to lowland forest and coastal habitats, which are widely yet discontinuously distributed north of latitude 42°15′S. Pittosporum cornifolium is typically associated with old growth forest systems and low nutrient substrates, with low mean daily temperatures in the coldest month (<0.6 °C) and high mean October vapour pressure deficits (>0.5 kPa) apparently restricting its distribution. Significant morphological variability is evident in leaves and flowers, especially with respect to plants from the Poor Knights Islands. Genetic analyses of five mainland populations and individuals representing Poor Knights Islands populations revealed relatively low genetic diversity at the population level which is likely to be the result of geographic isolation. Molecular phylogenetic studies suggest a New Caledonian origin for the species with close affinities to both P. pimeleoides subspecies. Several lines of evidence suggest recognition of the Poor Knights Islands entity as a new taxon. However, analysis of additional morphological, reproductive and molecular data across the full geographic range will be required to confirm current inferences. Although populations have declined, P. cornifolium is not currently threatened, however, it should be considered for reintroduction to sites in districts where its range has been severely reduced.

year: 2012

title: The physical health and premature mortality of Indigenous Māori following first-episode psychosis diagnosis: A 15-year follow-up study

authors: Monk, Nathan

subjects: First-episode psychosis, New Zealand, Māori, indigenous health, health equity, physical health, cardiometabolic health, premature mortality, cohort study

abstract: Background:
People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis.
Objective:
Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis.
Methods:
A cohort (N = 14,122) of young people (16–24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan–Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years.
Results:
In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan–Meier plots show hospitalisation and mortality inequities emerging approximately 4–7 years following first-episode psychosis diagnosis.
Conclusions:
Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.

text: The physical health and premature mortality of Indigenous Māori following first-episode psychosis diagnosis: A 15-year follow-up study Background:
People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Māori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis.
Objective:
Compare Māori and non-Māori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis.
Methods:
A cohort (N = 14,122) of young people (16–24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan–Meier and adjusted Cox proportional hazards models, Māori (n = 5211) and non-Māori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years.
Results:
In the 15 years following first-episode psychosis diagnosis, Māori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan–Meier plots show hospitalisation and mortality inequities emerging approximately 4–7 years following first-episode psychosis diagnosis.
Conclusions:
Māori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.

year: 2024