title: Discordance in perceptions of barriers to diabetes care between patients and primary care and secondary care

authors: Simmons, David

subjects: DAWN

abstract: OBJECTIVE—We sought to compare perceived barriers to diabetes care between people with diabetes and different health professional groups. 
RESEARCH DESIGN AND METHODS—This was a cross-sectional, postal, open-questionnaire survey conducted in the Waikato district, New Zealand. A total of 3,890 individuals with diabetes participated, as well as 436 primary and secondary health professionals. 
RESULTS—Barriers were reported in 69.7% of patients. Psychological barriers were most important (55.5%), followed by systems barriers (25.7%), and then knowledge as least important (15.3%). Psychological barriers were ranked first among general practitioners (91.0%), but systems barriers were ranked first by other health professionals (38.8–100%). General practitioner and patient barrier group rankings were similar (rT = 0.976, P < 0.05). Of specific barriers among individuals with diabetes, strictness of treatment regimen was the most frequently reported (42.3 vs. 0.1–16.8%) (P < 0.001) and 2.5 (95% CI 2.4–2.7)- to 3.4 (3.2–3.7)-fold more than the 2nd through 4th ranked barriers. Motivation was the most common specific barrier reported by general practitioners (86%), practice nurses (31.5%), and the diabetes team (85.7%). Practice and hospital nurse/dietitian rankings were most comparable with patients (rT = 0.457 and 0.466, respectively, both P < 0.05). A major area of patient–health professional discordance was the influence of other health problems, which was ranked 2nd among patients but 10th–18th among health professionals. 
CONCLUSIONS—The most important barriers to diabetes care perceived by patients are psychological and particularly relate to the strictness of the regimen. Discordance between patients and different health professionals exists in the perception of the importance of different barriers to diabetes care.

text: Discordance in perceptions of barriers to diabetes care between patients and primary care and secondary care OBJECTIVE—We sought to compare perceived barriers to diabetes care between people with diabetes and different health professional groups. 
RESEARCH DESIGN AND METHODS—This was a cross-sectional, postal, open-questionnaire survey conducted in the Waikato district, New Zealand. A total of 3,890 individuals with diabetes participated, as well as 436 primary and secondary health professionals. 
RESULTS—Barriers were reported in 69.7% of patients. Psychological barriers were most important (55.5%), followed by systems barriers (25.7%), and then knowledge as least important (15.3%). Psychological barriers were ranked first among general practitioners (91.0%), but systems barriers were ranked first by other health professionals (38.8–100%). General practitioner and patient barrier group rankings were similar (rT = 0.976, P < 0.05). Of specific barriers among individuals with diabetes, strictness of treatment regimen was the most frequently reported (42.3 vs. 0.1–16.8%) (P < 0.001) and 2.5 (95% CI 2.4–2.7)- to 3.4 (3.2–3.7)-fold more than the 2nd through 4th ranked barriers. Motivation was the most common specific barrier reported by general practitioners (86%), practice nurses (31.5%), and the diabetes team (85.7%). Practice and hospital nurse/dietitian rankings were most comparable with patients (rT = 0.457 and 0.466, respectively, both P < 0.05). A major area of patient–health professional discordance was the influence of other health problems, which was ranked 2nd among patients but 10th–18th among health professionals. 
CONCLUSIONS—The most important barriers to diabetes care perceived by patients are psychological and particularly relate to the strictness of the regimen. Discordance between patients and different health professionals exists in the perception of the importance of different barriers to diabetes care.

year: 2007

title: Valuing trout angling benefits of water quality improvements while accounting for unobserved lake characteristics: An application to the Rotorua Lakes

authors: Mkwara, Lena

subjects: Trout angling

abstract: Trout angling is one of the most popular water-based recreational activities in the Rotorua Lakes. Despite the high demand for trout angling and other recreational purposes, water quality in some of these lakes has been declining over the past decades and initiatives to try to restore the lakes are underway. To compliment these efforts, this study uses the travel cost random utility models to explore how changes in water quality would impact upon angler’s choice of fishing destinations. The welfare impacts due to water quality changes and possible lake closures are also explored. These findings highlight the importance of discrete choice random utility models as a policy decision making tool for recreational-based natural resource managers in New Zealand. Additionally, this study represents one of the unique cases in travel cost random utility applications that accounts fully for unobserved site effects

text: Valuing trout angling benefits of water quality improvements while accounting for unobserved lake characteristics: An application to the Rotorua Lakes Trout angling is one of the most popular water-based recreational activities in the Rotorua Lakes. Despite the high demand for trout angling and other recreational purposes, water quality in some of these lakes has been declining over the past decades and initiatives to try to restore the lakes are underway. To compliment these efforts, this study uses the travel cost random utility models to explore how changes in water quality would impact upon angler’s choice of fishing destinations. The welfare impacts due to water quality changes and possible lake closures are also explored. These findings highlight the importance of discrete choice random utility models as a policy decision making tool for recreational-based natural resource managers in New Zealand. Additionally, this study represents one of the unique cases in travel cost random utility applications that accounts fully for unobserved site effects

year: 2011

title: Who owns native nature? Discourses of rights to land, culture, and knowledge in New Zealand

authors: Goldsmith, Michael

subjects: indigenous cultures

abstract: Michael Brown famously asked ‘Who owns native culture?’ This paper revisits that question by analyzing what happens to culture when the culturally defined boundary between it and nature becomes salient in the context of disputes between indigenous and settler populations. My case study is the dispute between the New Zealand government and Maori tribal groupings concerning ownership of the foreshore and seabed. Having been granted the right to test their claims in court in 2003, Maori groups were enraged when the government legislated the right out of existence in 2004. Though the reasons for doing so were clearly political, contrasting cultural assumptions appeared to set Maori and Pakeha (New Zealanders of European origin) at odds. While couching ownership of part of nature as an IPR issue may seem counter-intuitive, I argue that as soon as a property claim destabilizes the nature/culture boundary, IPR discourse becomes pertinent.

text: Who owns native nature? Discourses of rights to land, culture, and knowledge in New Zealand Michael Brown famously asked ‘Who owns native culture?’ This paper revisits that question by analyzing what happens to culture when the culturally defined boundary between it and nature becomes salient in the context of disputes between indigenous and settler populations. My case study is the dispute between the New Zealand government and Maori tribal groupings concerning ownership of the foreshore and seabed. Having been granted the right to test their claims in court in 2003, Maori groups were enraged when the government legislated the right out of existence in 2004. Though the reasons for doing so were clearly political, contrasting cultural assumptions appeared to set Maori and Pakeha (New Zealanders of European origin) at odds. While couching ownership of part of nature as an IPR issue may seem counter-intuitive, I argue that as soon as a property claim destabilizes the nature/culture boundary, IPR discourse becomes pertinent.

year: 2009