NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: We aimed to examine the experiences of Pacific nurses in Aotearoa New Zealand who provide informal language assistance to Pacific patients with limited English proficiency (LEP).

Methods: A cross-sectional online survey was distributed to 229 alumni of the Aniva Leadership Programme. The survey included quantitative and qualitative questions about interpreting experiences. Descriptive statistics and logistic regression were used for quantitative analysis; framework analysis was applied to free-text responses.

Results: The response rate was 69% (n=159). Of respondents, 80% spoke a Pacific language and 85% of these had been asked to interpret in clinical settings, most commonly by patients, families and colleagues. While 75% felt confident interpreting, many reported difficulties with technical terminology. Nurses observed improved patient trust, understanding and engagement when using Pacific languages. However, interpreting often conflicted with core duties, raised ethical concerns and was not formally recognised or supported.

Conclusion: Pacific nurses routinely provide informal interpreting, significantly enhancing patient care. Yet this work is uncompensated, untrained and exposes nurses to professional risks. Health systems must reduce reliance on informal interpreting by investing in professional services, offering interpreter training for bilingual staff and formally recognising the cultural and linguistic labour of Pacific nurses to support equitable care.

Breast density influences both breast cancer risk and the sensitivity of mammographic screening. Several countries routinely notify women of their breast density in community-based screening programmes and provide guidance directly or through general practitioners. In contrast, BreastScreen Aotearoa (BSA) does not currently notify breast density to women, resulting in limited awareness and raising concerns relating to equitable care, patient autonomy in decision making, trust in health professionals and uncertainty regarding clinical pathways. Although the recent Health New Zealand - Te Whatu Ora technical review provides a comprehensive evidence summary and identifies areas for further investigation, policy progression has not occurred as anticipated. An implementation timeline, governance responsibility, communication planning and culturally responsive approach have not yet been specified. Although emerging evidence suggests that artificial intelligence may offer more consistent and reproducible breast density assessment than radiologists, planning for its integration has not been outlined. Research from the comparable settings suggests that misunderstanding, rather than notification itself, drives anxiety. This highlights the importance of communication design, health literacy considerations and primary care readiness. Ethical considerations around transparency and informed decision making remain relevant for screening equity. Addressing the implementation barriers is now crucial, and a coordinated and equity-driven approach is required to inform future policy on breast density notification.

Background: Traditional knowledge takes a more holistic view of the interconnectedness between nature and human health compared to modern healthcare systems. This review synthesises literature on the nexus between traditional knowledge, the environment and health, with the goal of an environmentally sustainable healthcare system.

Methods: We searched Web of Science, Scopus, Medline and Embase for peer-reviewed publications using keywords related to the natural environment or planetary health, Indigenous/traditional knowledge, and healthcare. Themes were developed by thematic synthesis in an eight-step process.

Results: We identified 22 reports across 21 studies; 15 were published in the last 10 years. Six initial themes were identified and subsequently collapsed into two overarching themes: "holistic wellbeing" and "epistemological pluralism". The first theme highlights the need for healthcare to adopt a holistic concept of health centred on nature. The second theme emphasises the importance of embracing diverse epistemologies to achieve optimal health outcomes. Together, these themes suggest that healthcare systems should be guided by a more inclusive, environmentally focussed understanding of health rather than by a predominantly technical paradigm.

Conclusions: Literature on the relationship between traditional knowledge, planetary health and healthcare is both limited and recent. The review suggests that healthcare systems should incorporate respect for nature, diverse cultures and local contexts.

Aim: We aimed to describe nurse practitioner (NP) workforce characteristics, clinical practice and enablers and barriers in Aotearoa New Zealand.

Methods: Five cross-sectional, self-reported online surveys were distributed biannually in collaboration with Nurse Practitioners New Zealand. Eligible participants were registered Aotearoa New Zealand NPs. Quantitative items covered demographics, practice activities and work environment; qualitative items captured priorities for change. Data were cleaned and reclassified to ensure comparability across survey rounds, and descriptive statistics were used to report findings. Ethics approval: Te Herenga Waka-Victoria University of Wellington, Human Ethics Committee, 2024/HE000107.

Results: Of the 1,004 valid responses (52-74% of the workforce per survey), most respondents were practicing clinically (>94%). By 2022, prescribing was near-universal (98%), with most ordering laboratory (92%) and radiology (70%) investigations. Employment was concentrated in district health boards/Health New Zealand - Te Whatu Ora, with increasing representation in primary health organisations, private practice, non-governmental organisations and self-employment. Respondents reported barriers to practicing at full-scope of practice, limited succession planning and challenges to workforce sustainability.

Conclusion: NPs are an established part of Aotearoa New Zealand's health workforce. However, persistent structural barriers, limited succession planning and variable support for full-scope practice continue to constrain their contribution. Strengthening integration and sustainable policy support are essential to realise the full potential of the NP role.

Aim: The inflammatory bowel disease severity index (IBD-DSI) aims to describe inflammatory bowel disease (IBD) severity over the duration of disease. We aimed to correlate the IBD-DSI with a patient-completed disease severity score (PCDSS). We also aimed to investigate whether individual factors such as psychological measures or clinical characteristics moderate this correlation.

Methods: This multicentre trial involved gastroenterologists completing the IBD-DSI and Harvey-Bradshaw Index or Simple Clinical Colitis Activity Index for each participant while patients completed a self-reported IBD severity score and psychological questionnaires. The excess severity score (ESS) was calculated by subtracting the IBD-DSI from the PCDSS.

Results: One hundred and sixty-four patients with IBD participated (98.2% response rate; average age 41.2 years; 105 [62.9%] female; 100 [59.9%] Crohn's disease) and 164 IBD-DSI were completed. The IBD-DSI and PCDSS were positively correlated (r=0.44, r2=0.19, p<0.001) although the mean ESS was 29.0 (23.2). The relationship between the scales is reflected in the equation: PCDSS=39.53+0.59*IBD-DSI. There were larger discrepancies at the lower end of IBD-DSI. After controlling for IBD-DSI, previous colectomy (p=0.03), any IBD or bowel-related surgery (p=0.01) and ulcerative colitis extent of disease (p=0.049) were associated with ESS while 5-aminosalicylic acid use (p=0.01) was negatively associated with ESS.

Conclusions: IBD-DSI and PCDSS are significantly positively associated with each other and with larger discrepancies at the lower end of the IBD-DSI. Possible contributing factors to the discrepancy are floor effects, regression to the mean and patients putting different implicit weights on particular factors than the IBD-DSI does.

Aim: We aimed to describe demographics and rates of diagnoses of blood-borne viruses and other sexually transmitted infections (STBBI) in sex workers attending an outreach clinic in Auckland.

Methods: Sex workers attending an outreach clinic in Auckland from 31 December 2018 to 31 December 2020 were eligible for inclusion. Gonorrhoea and chlamydia rates in sex workers were compared to rates in two comparator groups: attendees to general sexual health clinics and a population-based sample.

Results: Three hundred and fifty-six sex workers were eligible for inclusion. The majority were cisgender-gender females (93.5%, n=333). Test positive rates for chlamydia (5.1%) and gonorrhoea (3.9%) in cisgender-female sex workers were lower than for females attending general sexual health clinics. Chlamydia and gonorrhoea rates were higher in transgender-female sex workers than in cisgender-female sex workers, but the numbers were small (n=14). Of the 159 sex worker participants tested for hepatitis C antibody, 25 were antibody positive (15.7%).

Conclusions: Cisgender-female sex workers had lower rates of diagnosis of chlamydia and gonorrhoea than females attending general sexual health clinics. STBBI testing in sex workers should routinely include assessment and testing for hepatitis C. The data indicate that sex workers should continue to be a priority population in the STBBI strategy.