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If your body becomes insulin resistant, then you might face different symptoms of diabetes. If you really want to know what causes diabetes type 2, then you need to have thorough consultation with any expert doctor dealing with the concerned disease. Physical inactivity is also quite important in this case and thus you must consider the same. You also need to change your sleeping habits as bad sleep habits are regarded as one of the greatest causes for the occurrence of this disease.
What are the potential problems of poorly controlled sugar levels in diabetes type 2?Is There A Cure for Diabetes Type 2? AbstractThe 2007 National Pressure Ulcer Advisory Panel pressure ulcer update and the October 2008 facility reimbursement changes by the Centers for Medicare & Medicaid Services for Stage III or IV pressure ulcers add resource burdens to healthcare facilities. Data snapshotIn the March 2010 quarter the unemployment rate for Pacific peoples was 14.4 percent, higher than for all ethnicities.
Inadequate housing affects children more than adults, particularly children in low-income families, in larger families, rental dwellings, and more deprived neighbourhoods (Centre for Housing Research, 2010). Social cohesion means cohesive community relationships with levels of participation in communal activities and public affairs, and a high number of community groups.
A healthy diet is a key determinant of health outcomes and is particularly important for the growth and development of children and young people.Food choices are influenced by affordability as well as personal, family, and cultural preferences. Data snapshotThe National Children’s Nutrition Survey conducted in 2002 found that Pacific children were the least likely to bring their food from home to school, and most likely to buy it from a canteen, shop, or takeaway.Pacific children had a lower mean energy intake than Maori children (but higher than European children), and derived a higher portion of their energy intake from fat. Physical activity is known to protect against obesity and cardiovascular disease, particularly in combination with a healthy diet (National Institute for Health and Clinical Excellence, 2010). Life at Faith City‘Life-changing’ is how participants have described the Life 12 Week Weight Loss Challenge run by Manukau’s Faith City Church.The first Life challenge was held late in 2010. New Zealand has one of the highest obesity rates among OECD countries (Ministry of Social Development, 2009). Smoking is the biggest single cause of preventable morbidity (the non-death impacts of disease) and mortality in OECD countries, including New Zealand, and is well recognised as the leading risk factor for many forms of cancer, respiratory disease, and cardiovascular disease in adults. More Maori and Pacific peoples smoke (45 percent and 31 percent, respectively) compared with the total New Zealand population (20.7 percent) (Ministry of Health, 2008k). Potentially hazardous drinking carries a high risk of damage to physical and mental health; including death and injury due to traffic accidents, drowning, suicide, and violence. Problem gambling can result in a range of negative effects for the gambler, their families, and the wider community. People’s beliefs and practices in relation to health and illness influence the ways they engage in health-promoting behaviours and access health services. Pacific peoples’ beliefs and practices may be different from mainstream understandings about health and illness. Access to timely and effective health care is an important determinant of health outcomes, for both death rates and the impact that chronic conditions have on Pacific peoples. Data snapshotImmunisation provides protection against a range of communicable diseases, and is considered to be one of the most cost-effective public health interventions. For the 12 months to October 2010, 89 percent of Pacific two-year-olds were fully immunised, compared with 87 percent of European two-year-olds. Screening identifies potential health problems at an early stage in people who do not show any symptoms. Breast and cervical cancer screening programmes have been effective in reducing mortality in the general population.
The Primary Health Care Strategy (Ministry of Health, 2001b) established primary health organisations (PHOs) to provide structures for the local delivery of primary health-care services. The benefits of health care are dependent upon the quality of care received as well as accessibility of care.
The average time spent annually with GPs during visits is a key indicator of access and use of primary care.
Secondary care includes services provided by specialists, as well as in-patient and out-patient care in public and private hospitals. Health is strongly influenced by a broad range of cultural, social, economic, and environmental factors.
In some cases, pancreas even stops producing insulin and this is quite a dreadful condition and the doctor confirms that you have developed diabetes. In  this case, glucose directly mixes up with the normal bloodstream rather than getting within body cells and this kind of condition is very much risky and might causes a lot of damages to your body. Increased intake of High-sugar content based foods can be quite riskier and might causes diabetes. You must be physically fit and must leave lethargic habits like watching televisions for hours, sleeping for hours and many more. Sleeping more than nine hours and less than five hours can be the major reasons that might invite the symptoms of diabetes type 2.
It has been found in the medical researches that most of the fellows who are developing this disease after the age of 40. If you found this useful, please don’t forget to share with your friends and followers at Facebook, Twitter and Google+ etc.
The ultimate goal of these updates and changes is to decrease the overall rate of hospital-acquired pressure ulcers. The quality of housing and household crowding are closely related to the risk of developing ARF, meningococcal disease, respiratory disease, and other infectious diseases.Due to their low income, many Pacific families live in less affluent communities. Healthier food options are often more expensive than those with high concentrations of fat and sugar, and those that are nutritionally limited. Thirty-three mostly Pacific women completed the three-month course, which is designed for those who are very overweight and are keen to eat more healthily and be more active.Life involves training four times a week, sessions with a nutritionist and three weekend retreats to help address the psychological reasons behind obesity and unhealthy lifestyles. Obesity is associated with many adult health conditions such as cardiovascular disease, type 2 diabetes, cancer, and psychological and social problems (Ministry of Health, 2008e). Exposure to cigarette smoke (during a mother’s pregnancy and in childhood) is recognised as a major risk factor for sudden unexplained death in infancy syndrome and respiratory illness (Ministry of Health, 2005).Smoking is an important contributor to inequalities in life expectancy between ethnic groups. Alcohol problems are also associated with high-risk sexual behaviour and consequent problems.Fewer Pacific peoples drink alcohol than the general population. Pacific peoples’ understandings tend to be characterised by a holistic perspective, where healthy and strong families are the basis for the well-being of individuals and communities. Suicide, for example, can be seen as the “ultimate rejection of one’s family” and a bereaved family can experience a “sense of failure to adequately care for and support the individual who is ill” (Beautrais et al, 2005). In 2006, just over 90 percent of New Zealand infants were enrolled with Plunket, which provides clinical assessment, health promotion and parent education services. Screening improves health outcomes by offering effective interventions before diseases become advanced. An increase in the uptake of cervical screening and the introduction of the HPV vaccination programme in 2008 (which has reported high coverage among Pacific girls (Minister of Pacific Island Affairs, 2010) should contribute to lower incidence of, and deaths from, cervical cancer in the future. The levels of coverage are below the target of 70 percent of all eligible women, but there has been a sustained increase in coverage for Pacific women. Each PHO has an enrolled population, and is responsible for providing services to this population.In October 2007, nearly 100 percent of Pacific peoples were enrolled with a PHO6. The quality of health care is in part determined by interpersonal care; the interaction between health-care professionals and health-care users or their caregivers. The National Primary Medical Care Survey found that Pacific, Maori, and Asian people spent significantly less time with GPs, after controlling for a range of other variables. Secondary care services are normally accessed by referral from primary care or hospital emergency departments. In general, people with fewer socio-economic resources tend to have poorer health outcomes due to a combination of reduced material resources, greater exposure to health risks and behaviours, greater psychosocial stress, and reduced access to health services.Many Pacific peoples have not experienced success in the education system, and therefore tend to have lower incomes and live in communities with the fewest economic resources. The estimate of the socio -economic contribution is based on analysis undertaken in relation to the impact of socio-economic inequality on the difference between the Maori and the European or other ethnic group in the NZ Census-Mortality Study.
That is, they were physically active for at least 30 minutes a day, for at least five days in the previous week.
The survey uses AUDIT, which is a ten-item questionnaire covering alcohol consumption, abnormal drinking behaviour, and alcohol-related problems.
This data is from the Enriched CBF Register produced by HealthPac at the Ministry of Health.
Low-grade and mild inflation which is being distributed to your body due to fat deposition is the main cause for diabetes. Therefore, diabetic patients are having restrictions in having high-calorie diets, refined beverages and foods and many more. Keep your body active by doing healthy exercises so that unwanted fat deposition especially at the abdomen area can be prevented.
Since genes are automatically transferred from one generation to another therefore you do not have hands in the same and thus you need to take more care and must lead a restricted life. This is because after this age, the immunity power decreases as a result of which the pancreas function is automatically affected.
In 2007, nearly 13% of all pressure ulcers reported through PA-PSRS were categorized as Stage III or IV; more than 26% of the total reports did not include any pressure ulcer staging information.
For example, the proportion of Pacific households (with at least one Pacific adult) spending more than 30 percent of their income on housing was 33 percent in 2009, reflecting a steady increase from 23 percent in 2004 (Ministry of Social Development, 2010, p69).Students attending schools in communities with fewer economic resources tend to experience less education success than those in more affluent communities (Ministry of Social Development, 2009, p138). The prevalence of factors associated with lower levels of well-being, such as widespread smoking, obesity, hazardous drinking, and non-casino gaming machines, is greater in these communities. Societies with diminished social cohesion have higher mortality rates and worse social outcomes than those with high levels of social cohesion (Stansfeld, 2006).Most Pacific communities have strong social connections, often centred on church and community activities.
Affordability of food is a significant issue for Pacific households, who were the least likely to report that they could always eat properly. The training sessions include gym workouts, weights, running, boxing, aquarobics, and hill running. Obesity is primarily caused by poor nutrition and sedentary lifestyles (Ministry of Health, 2008e). Pacific peoples who drink alcohol are more likely to be New Zealand-born and young (Alcohol Advisory Council of New Zealand, 2009).
Similarly, 7.6 percent of the Pacific population reported experiencing problems as the result of someone else’s gambling, double the number of adults in the total population who reported being affected by someone else’s gambling.
Suicide prevention, support, and other interventions must therefore be tailored to work with and within existing beliefs and attitudes.Similarly, culturally-based attitudes towards sex mean that Pacific youth often have reduced access to information regarding sexual health. It includes the provision of health education and prevention services, coordination and treatment of less serious illnesses, and referral to secondary care.Other than emergency departments, primary care services are the first step into the health system.
Pacific infants (87.2 percent) were less likely than European, but more likely than Maori infants to be enrolled (Craig et al, 2007, p121). Effective screening is dependent on well-structured and organised processes and the monitoring of indicators of process quality.


One of the providers, BreastScreen South, has reached the 70 percent target for both Maori women and Pacific women (National Screening Unit, nd, a). For the overall population, the target coverage is 75 percent (Massey University, Centre for Public Health Research, 2008). Craig et al (2007) reported that Pacific children and young people had higher enrolment rates compared with non-Pacific people. Underlying good interpersonal skill are communication skills, the building of trust, understanding and empathy, the discussion and explanation of the patients’ symptoms, and involvement in decisions regarding management or treatment of a patient’s condition (Campbell, Roland, & Buetow, 2000). Overall, Pacific patients spent an average of 18.8 minutes less time annually with GPs than European patients. Despite this, Pacific peoples are actively involved in their communities and have strong social and cultural resources with strong family ties, church affiliation, and community support. The level of blood sugar increases as a result of overweight conditions and on the other hand insulation-resistance condition occurs. The admission diagnosis and documentation of Stage III or IV pressure ulcers are essential to overall pressure ulcer identification, care, and ultimately, reduction. Pacific students tend to have poorer education outcomes than other students from the same communities. An individual’s identity and well-being are traditionally dependent on family heritage, connections, roles, and responsibilities. They were also more likely (at nearly 50 percent) than Maori and Europeans to report sometimes running out of food due to lack of money (Ministry of Health, 2003). Social interaction is one of the factors that promote participation in physical activity (De Bourdeauhuiji, 1998), which in turn encourages social cohesion and social well-being.Pacific children have relatively high levels of incidental physical activity (such as walking to school), although they participate less than other groups in organised leisure and sport. Day one of the challenge requires participants to push four-wheel drive vehicles around a carpark.Faith City project manager Essendon Tuitupou says women in last year’s challenge called it “life-changing”. Smoking accounted for 37 percent of this loss for men and 13 percent of the loss for women (Ministry of Health, 2001a). However, the Youth 2007 Survey found that twice as many Pacific students are regular smokers compared with European students.Living in a house with a smoker influences children and young people to take up smoking, and contributes to respiratory and other childhood illnesses.
Overall, those aged 35–44 years had the highest prevalence of problem gambling (Ministry of Health, 2008a). Parents are less available to provide advice, as it is considered culturally inappropriate for children to discuss sexual health with their parents. They are crucially important in identifying serious illnesses that are then managed in conjunction with secondary and tertiary services.
The results demonstrate that effective means are available to engage with Pacific peoples and deliver care services. BreastScreen South used a communications campaign where Maori and Pacific women were the priority audience, as it was apparent they were groups who were less familiar with the service (National Screening Unit, nd, b). From 2011, the coverage target will be 80 percent (National Screening Unit nd, e).Since 2007, National Cervical Screening Programme communications campaigns have been particularly focused on encouraging more Maori and Pacific women to have regular smears (National Screening Unit nd, c).
Fifteen percent of Pacific peoples were enrolled with a Pacific PHO and the remainder with a mainstream PHO (Ministry of Health, 2010c). Improvements in the annual consultation rate coincide with the implementation of the Primary Health Care Strategy (Ministry of Health, 2001b) and the reduction in fees to access primary care.To access services, people must first be aware that the services are available and that they are needed. Only 21.2 percent of Pacific adults compared with 31 percent of non-Pacific adults used medical specialists in the previous 12 months. These community ties provide protection from some of the worst consequences of illness, and health services can be promoted to Pacific peoples through community organisations.Lower incomes mean that many of the conditions or factors that support good health, such as good nutrition and quality housing, are less accessible. From this low base about 85 percent of Pacific peoples are sending remittances overseas (Money Pacific, 2010). Risk reduction strategies include pressure ulcer protocol development, implementation, consistent documentation, and communication systems that extend along the entire continuum of care. This is a result of a combination of factors, including lower levels of participation in early childhood education and teaching and learning practices throughout schooling that are less effective for Pacific students(Statistics NZ and Ministry of Pacific Island Affairs, 2010).Poor education reduces peoples’ employment opportunities.
This reduces access to employment or education opportunities, community activities, and health care.
Having a strong sense of belonging seems to reduce the likelihood that an individual will consider or attempt suicide (Beautrais et al, 2005).In the 2006 Census, 83 percent of Pacific peoples stated they had at least one religion, compared with 61 percent of New Zealand overall. The 2002 National Children’s Nutrition Survey found that Pacific children were more likely than European children to be the most active, and the least likely to be the least active. In 2006, 48.1 percent of Pacific children under the age of 15 years lived in a household with a smoker (Craig et al, 2007, p165).
Primary care services have historically been centred around GP and practice nurse services, but more recently these have been expanded to involve multi-disciplinary teams and a broader range of services.
It was considered that this may reflect the difficulties of working through caregivers during the consultation, or generational or cultural differences (Davis et al, 2005). These findings are concerning given the documented high health needs of Pacific peoples, particularly the prevalence of chronic health conditions.Cultural competence is the ability of individuals and systems to understand and appreciate the differences and similarities within and among groups. Pacific peoples were even less likely to visit medical specialists when the specialist was located at a private facility. Pacific peoples experience greater exposure to risk factors such as smoking, alcohol, and poor nutrition, with Pacific youth being particularly at risk.
4 percent).For the 12-month period to October 2010, 89 percent of Pacific 2-year-olds were fully immunised, compared with 87 percent of European 2-year-olds. The 2006 Census of Population and Dwellings showed that 35 percent of Pacific peoples had no qualifications, compared with 25 percent of all New Zealanders. Improvements in health can be achieved by improving educational performance and other social and economic circumstances. Pacific students express the importance of spiritual beliefs (57 percent) much more frequently than European students (20 percent) (Helu et al, 2009).
The biggest thrill for me is when those ladies go away and continue with physical activity themselves.”Members of the group forged strong friendships and have continued to train together. Interestingly, the rate of parents ‘smoking at home’ was much lower than overall parental smoking rates, indicating that approximately half of Pacific families with smokers do not support smoking inside the house.Youth smoking rates are a key predictor of adult smoking behaviour, as taking up smoking early increases the risk of smoking-related diseases.
Overall, Pacific adults experienced greater levels of harmful consequences subsequent to drinking and those who drank reported greater alcohol consumption (Huakau et al, 2005).According to the results of a 2003 Alcohol Advisory Council (ALAC) survey that looked at youth access to alcohol, Pacific young people are more likely to be non-drinkers compared with other ethnicities. Pacific young people are less likely to access sexual health services as they are concerned that others may find out (Ministry of Health, 2008i).
Programmes with a strong community-support focus, including provision of transport to attend appointments, have also had a positive effect on cervical screening participation rates.Cost is recognised as a continued barrier and the Ministry of Health supports subsidised cervical screening for groups where the uptake of screening services is lower (H Lewis, personal communication, October 2010). Similarly, medical insurance, which can allow more timely access to health care, is held by half as many Pacific (19 percent) as non-Pacific adults (38.
Exposure to these risk factors contributes to a greater incidence of chronic diseases (such as diabetes, stroke, and ischaemic heart disease) among Pacific peoples. When a facility reports a pressure ulcer event through PA-PSRS, the two additional staging options appear in the event detail questions. The unemployment rate is higher for Pacific peoples (14.4 percent in the March 2010 quarter) than for any other ethnic group (Statistics NZ, 2010).
This has been discussed in Education and Pacific peoples in New Zealand (Statistics NZ and Ministry of Pacific Island Affairs, 2010) and will be explored in a future report on economic development. Voluntary work underpins a wide range of groups and organisations whose activities contribute to social well-being. The survey found that about two-thirds of Pacific young people (compared with just under half of young people overall) are non-drinkers (McMillen, Kalafatelis & De Bonnaire, 2004). Appropriate sexual and reproductive health information needs to be made available by alternative means.The relatively low success rate of smoking cessation programmes among Pacific peoples may be related to the belief, held by a relatively large number of Pacific smokers (24. Cultural competence training of professionals improves patient satisfaction and the number of patients continuing with agreed medical care plans. 6 percent) (Ministry of Health, 2008a).‘Did-not-attend’ rates for out-patient appointments appear to be consistently higher among Pacific peoples.
Alcohol consumption is associated with a greater risk of injury through accidents and violence.
These stages include Suspected Deep Tissue Injury (SDTI) and Unstageable (see Table 1 for definitions of these and other stages). Since the March 2008 quarter, the rise in Pacific unemployment has been greater than the total rise in unemployment.
The General Social Survey 2008 showed that 42 percent of Pacific peoples had done voluntary work in the previous four weeks, significantly more than the mainly European ethnic group (Ministry of Social Development, 2010).The General Social Survey showed that 85 percent of Pacific peoples had at least weekly face to face contact with friends compared to 79 percent of the total population. This may be because Pacific children have higher rates of incidental activity, but lower rates of participation in organised leisure and sport, which is what SPARC measured.Research findings about adult levels of activity are mixed. However, among young people who do drink, Pacific youth consumed, on average, 6.9 standard drinks. Those Pacific people who used face-to-face counselling services were experiencing more severe harm5 than those from other ethnic groups (Francis Group, 2009). Pacific primary care providers deliver integrated services that include health promotion, primary care, secondary care, and social services. 4 percent), followed by lack of time, lack of availability of a suitable appointment, and not wanting to make a fuss.
It impacts on the ability of an individual to communicate with health professionals, to discern what good advice is, and to translate this into action. The New Zealand Health Practitioners Competence Assurance Act 2004 requires professional bodies to ensure that set levels of cultural competence are met by practitioners (Tiatia, 2008). Addressing these risk factors will improve Pacific peoples’ health outcomes.People’s beliefs and practices in relation to health and illness influence their behaviour and how they access health services. Pacific peoples are over-represented in non-skilled and lower-skilled occupations (Ministry of Pacific Island Affairs, 2010). The Youth 2007 Survey found that 17 percent of Pacific youth had helped others in their community in the last 12 months, (Helu et al, 2009) compared with 14 percent of youth overall (Adolescent Health Research Group, 2008). The New Zealand Health Survey (Ministry of Health, nd, f) found that only about half of New Zealand’s total population, and slightly fewer Pacific peoples (46.1 percent), were sufficiently active to gain any health benefits3. Fonua Mo’ui grants are designed to improve Pacific peoples’ health by supporting initiatives that promote healthy eating and physical activity. Since 1999, the number of smokers in the total New Zealand population has been trending down for all groups including Pacific boys and girls (Paynter, 2010).
Pacific smokers are also most likely to believe that smokers should be able to quit without the assistance of a programme (Ministry of Health, 2009a). They aim to provide services that incorporate Pacific cultural care and language components to ensure the services are more appropriate for, and responsive to, Pacific peoples. Pacific peoples were significantly more likely than non-Pacific people to cite cost as a reason for an unmet GP need.


Those with limited health literacy have worse health status than those with adequate health literacy. This applies to both nurses (Nursing Council of New Zealand, nd) and doctors (Medical Council of New Zealand, 2006).
The higher rate among Pacific peoples may reflect the barriers Pacific peoples face in accessing services, including getting time off work, transport difficulties, cultural beliefs, and a lack of cultural responsiveness (Ministry of Health, 2008f).Surgical admissions (which tend to be elective rather than emergency) are lower for Pacific peoples. For example, attitudes to sexual health act as a barrier to Pacific peoples accessing sexual health services and protecting their sexual health. PA-PSRS Definitions - Skin Integrity Stages   An SDTI indicates a localized discolored area of intact skin or a blood-filled blister. Evidence from previous recessions also suggests that unskilled workers are hit hardest in times of recession, when unemployment rates for unskilled workers increase more than those for skilled workers (Department of Labour, 2009).Figure 1 shows that approximately half of all Pacific children and young people live in a crowded house, a higher proportion than other ethnic groups. Pacific peoples were the most sedentary group (undertaking less than 30 minutes of physical activity in the previous week) – 19. The Youth 2007 Survey found that Pacific students regularly smoked at twice the rate of European students, and that rates were highest among Samoan and Cook Island students (Helu et al, 2009).The 2006 Census showed that there are sub-group differences within the Pacific population.
The proportion of Pacific young people (32 percent) who reported ‘binge drinking’ at least once in the previous four weeks was slightly lower than European young people (Helu et al, 2009).Drinking alcohol at an early age is associated with greater adverse health outcomes (Odgers et al, 2008).
These findings show that beliefs regarding the nature of nicotine addiction and cessation options need to be changed in order to increase the number of Pacific people who give up smoking. Access to care has been improved through lowering fees, providing local facilities, and giving nurses a greater role in primary care. Cost is also a factor in the collection of prescribed medications (Jatrana, Crampton, & Norris, 2010). Older people, those with more limited education, lower socio-economic groups, and those whose primary language is not local tend to have more limited levels of health literacy (Adams et al, 2009). Access to coronary artery bypass grafts (CABG) operations, angioplasties, and major joint-replacement operations has improved (Ministry of Health, 2006b).
Lack of knowledge of tobacco addiction and smoking cessation interventions may prevent Pacific peoples accessing cessation services and traditional respect for authority may prevent Pacific peoples demanding the best care within the health system. A child growing up in an over-crowded house will be more susceptible to communicable diseases (Hawker, 2005) and over-crowding can have a detrimental effect on successful learning. It is estimated that three-quarters of Pacific peoples in New Zealand send money to family members in the Pacific region (Money Pacific, 2010).As well as building resilient and supportive communities, social connections also provide useful foundations for community health interventions.
4 percent – and were 40 percent more likely to be sedentary than the total New Zealand population. Drinking socially at an early age can cause increased short-term harm such as motor vehicle injuries and deaths, suicide, as well as longer-term harm from alcohol dependence, abuse, and related medical conditions (Alcohol Advisory Council of New Zealand, 2002). Nicotine replacement therapies are considered ineffective by a large number of Pacific peoples, and a relatively low proportion of Pacific peoples in south Auckland made claims for subsidised nicotine replacement therapies.
Pacific providers have shown better results for the management of patients with long-term conditions than other providers (Ministry of Health, 2010c). The Adult Literacy and Life Skills Survey 2006 showed that, overall, the literacy of Pacific peoples was lower than other ethnic groups (Statistics NZ and Ministry of Pacific Island Affairs, 2010). Ambulatory-sensitive hospitalisations (ASH) are admissions that are potentially avoidable through primary care interventions. While the number of admissions for coronary operations is low compared with the need experienced by Pacific peoples (Tukuitonga & Bindman, 2002), the inequalities in angioplasty operations are narrowing. An SDTI may be difficult to detect in patients with dark skin tones, so accurate assessment skills are critical. Projects that “create and reinforce strong social connections across Pacific communities” (Tait, 2008) provide useful foundations for effective public health action. SPARC’s 2008 Active NZ Survey used the same criteria as the New Zealand Health Survey, and had similar findings. Tokelauans are the most likely to be regular smokers, followed by Cook Islanders (38 percent), Niueans (33 percent), Tongans (29 percent), and Samoans (28 percent). Among young people, Cook Islanders are the heaviest drinkers with the most harmful drinking patterns, while Samoan men and women, and Tongan women are the least likely to drink (Ministry of Health, 2008i). Although more Pacific people are likely to smoke, 60 percent fewer Pacific people used nicotine replacement therapies compared with Europeans (Thornley, Jackson, Mcrobbie, Sinclair, & Smith, 2010).
This may be due to a combination of factors, including poor communication of services by providers and difficulties managing the required application processes.
Pacific peoples experience other factors that contribute to limited health literacy, such as lower socio-economic status and language difficulties. Between 1999 and 2005, there was a larger growth in the number of Pacific peoples receiving angioplasties than in the number of non-Maori, non-Pacific peoples receiving angioplasties (Ministry of Health, 2006b). For example, the success of initiatives such as the MeNZB and HPV vaccination campaigns in Pacific communities has been attributed to these strengths (F Tupu, personal communication, 2009; CBG Health Research Ltd, 2006). An ALAC study also found that Pacific young people, born and raised in New Zealand, consumed alcohol more frequently, pointing to the influence of acculturation factors (Alcohol Advisory Council of New Zealand, 2009).
A Counties Manukau study of Pacific and Maori parents showed that these groups had a low awareness of other available cessation options (Glover & Cowie, 2010). For example, in education, difficulty with application processes was one of the main reasons identified for poor access to supplementary support (particularly when language is a barrier) (Clark et al, 2007; Rivers, 2005). The incidence of ischaemic heart disease among Pacific peoples suggests that this group would have a greater need for angioplasties. Smoking is particularly common for young Samoans and Cook Islanders, older men, Pacific-born men – particularly Tongan men, and younger New Zealand-born women, particularly Tokelauan and Cook Island women.Traditionally, Pacific men were more likely to be smokers than Pacific women. This clearly indicates that these groups of smokers need to be better informed.The traditional respect for authority figures in Pacific communities can make it more difficult for Pacific people to question their health professionals and demand more effective services (Statistics NZ and Ministry of Pacific Island Affairs, 2010). If Stage III or IV pressure ulcers are not present upon admission but appear at the time of discharge, associated patient care will not be reimbursed.
This can lead to Pacific peoples being disempowered in the health system, not receiving services as needed, and therefore experiencing poorer outcomes. However, rates did decline for Pacific children aged 0-4 years (Ministry of Health, 2008c).There is some evidence that the delivery of effective health care to Pacific peoples is improving. Patients may be admitted from home or other facilities with existing pressure ulcers, and hospitals are faced with the challenge of identifying, staging, and carefully documenting such conditions upon admission. Between 2001 and 2007, the proportion of people with diabetes receiving an annual check through the Get Checked Programme has increased, including for Pacific peoples, who have higher coverage than other ethnic groups.
Physicians or any qualified healthcare practitioners documenting the patient’s admitting diagnosis must indicate the presence and clinical data of pressure ulcer upon admission, so documented detailed and accurate admission skin assessments are essential to avoid any question as to when an ulcer occured.2,6   In 2007, nearly 13% of all pressure ulcers reported through PA-PSRS were categorized as Stage III or IV (see Table 2).
Prescription of statin medication also increased markedly for all ethnic groups, including Pacific peoples (Ministry of Health, 2008b).
This may be due to the fact that smoking was traditionally a male activity in the Pacific Islands. In a study of people with both type 1 and type 2 diabetes in Counties Manukau, access to tests and appropriate medication was consistent across ethnic groups (Smith et al, 2010).
This percentage has remained unchanged from the June 2004 to December 2005 reports data discussed in the September 2006 issue of the Patient Safety Advisory.7  Clearly defined pressure ulcer reporting criteria includes pressure ulcer assessment, documentation, and precise ulcer staging.
It appears Pacific women born in New Zealand have been influenced by local smoking behaviour. A study of patients with type 2 diabetes in south and west Auckland showed Pacific peoples, who visited a regular GP, had a higher average number of consultations, equivalent frequency of testing, but worse glucose control.
They were less likely to be on a statin, despite higher serum lipids compared with the total population (Robinson et al, 2006).Overall, Pacific peoples receive less effective care. Access to care and the quality of care is improving but outcomes are not equivalent to other ethnic groups. The reasons for this are complicated, and seem to include a combination of late presentation, receiving appropriate medication and treatment less often, and less effective ongoing management.
2007 Pressure Ulcer Reports with  Stages Submitted through PA-PSRSThe number of PA-PSRS pressure ulcer reports that lack staging information, coupled with the new SDTI and Unstageable stages and the cost to treat these pressure ulcers add resource burdens to healthcare facilities. This is influenced by the cultural attitudes and expectations of both Pacific peoples and those in the health system, and by levels of financial resources. Facilities are obliged to provide education to all clinicians conducting skin assessments as to the pressure ulcer stages and documentation requirements. Improved cultural competence of services will improve the quality of consultations and services, promote improved health-care delivery, and improve health outcomes. Physicians must be involved in the prevention of pressure ulcers and in the documentation of skin assessments upon patient admission so that pressure ulcers that are present on admission are not mistaken for hospital-acquired pressure ulcers.8Facilities may consider the development of a multi-disciplinary pressure ulcer prevention taskforce composed of wound ostomy and continence nurses, physicians, nurses, dietitians, physical therapists, and any departments involved with pressure ulcer prevention such as patient transport.
High-risk patients may include those who are bedridden or those who have comorbid conditions such as poor circulation, poor nutrition, incontinence, obesity, and dry skin. Use a standard reassessment tool to reassess daily a patient’s pressure ulcer risk, as condition changes indicate, and with transfers to the next level of care. Perform daily skin inspections, including skin temperature, turgor, color, moisture, and integrity status. Pay close attention to bony prominences, particularly the sacrum and heels, as these are the most common adult pressure ulcer locations. Use lift devices or heel-protector devices to assist in turning, repositioning, lifting, or transferring patients to prevent friction or shearing forces, which may contribute to skin integrity issues. Evaluate the facility’s support surfaces such as mattresses (including those in the operating room suites), pillows, and chair cushions to ensure that pressure-relieving surfaces are used. Establish and maintain par-levels for skin care devices and products in each patient care area to ensure that resources are available to healthcare providers to deliver consistent pressure ulcer prevention.3,6,11MonitorAssess and monitor patient’s calorie intake, and notify the prescriber or dietitian if the patient has an unintentional weight loss, as this and poor nutrition often contribute to pressure ulcer risk.
A comprehensive nutritional assessment addressing risk factors, protein intake, hydration, caloric needs, vitamins, and minerals is essential to pressure ulcer prevention. Vitamin or dietary supplementation may be indicated for nutritionally compromised patients.6,10,11ProtectProtect patient’s skin from excessive moisture and dryness due to incontinence, perspiration, or wound drainage. Only use products that wick moisture away from the body.6,10 Educate Provide pressure ulcer prevention education about assessments, protocols, documentation, and communication systems to all levels of healthcare providers. Provide prompt communication of modifications or additions to skin protocols or products to all healthcare providers.6,10NotesBlack J, Baharestani MM, Cuddigan J, et al.
CMS improves patient safety for Medicare and Medicaid by addressing never events [fact sheet online]. Previous medical history includes a cerebrovascular accident and hypertension.Which factors may lead to hospital-acquired pressure ulcer formation for this patient?



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