NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: Patient barriers to accessing hospice and palliative care (PC) have been well studied. Important, yet less investigated, is how cancer patients whose hospice referrals were not accepted are being cared for. This article aims to understand the referral process from PC providers' perspectives and the implications of the current palliative system for patients, families and health professionals.

Methods: We conducted interviews with 28 healthcare professionals via Zoom. Participants worked in specialist and primary PC settings, such as hospices and aged residential care, and were based in seven Aotearoa New Zealand regions. We thematically analysed the interview transcripts.

Results: We identified four themes: the state of the PC system; communication issues; unmet needs and inequities; and managing care within the current system.

Conclusion: The limited funding for PC and other health services is resulting in a decrease in PC services. The specialist-primary model of end-of-life supportive care in New Zealand is undermined by under-funding. The implications for cancer patients, their families/whānau and their healthcare professionals are moves towards a more biomedical model of PC, a reduction in training and unsustainable workarounds to manage care within the under-resourced system. Considering the ageing population, urgent action is needed.

This article makes the case for taking a model-based management approach, specifically using the Viable System Model (VSM), to embed learning and adaptation into the New Zealand health system so it can function as a learning health system. We draw on a case study of a specialist clinical service where the VSM was used to guide semi-structured interviews and workshops with clinicians and managers and to guide analysis of the findings. The VSM analysis revealed a lack of clarity of organisational functioning, and of the systems, processes and integrated IT infrastructure necessary to support the fundamental requirements of a learning health system. We conclude that model-based management, specifically using the VSM, has significant potential for embedding the requirements for a learning health system into core functioning, including identifying technology infrastructure requirements. In addition, the VSM holds promise for improving clinical engagement and enhancing the health system's ability to achieve financial sustainability, high performance, distributed decision making and efficiency.

Background and aim: Dysmenorrhea affects the majority of young women worldwide, but geographical and cultural differences can influence the reporting, impact and management of symptoms. Aotearoa New Zealand is a culturally diverse country, with a high proportion of Māori and Pacific peoples. The aim of this scoping review was to assess the current literature on the prevalence, impact and management strategies for dysmenorrhea in Aotearoa New Zealand.

Method: The Joanna Briggs Institute (JBI) scoping review methodology was used to systematically map the evidence of prevalence, severity and symptoms, impact and management strategies for dysmenorrhea in Aotearoa New Zealand. Eight electronic databases were searched in August 2024.

Results: Ten studies met the inclusion criteria. Our findings show that the current data for the prevalence, impact and management strategies for dysmenorrhea in Aotearoa New Zealand are both limited and outdated.

Conclusion: The results from this scoping review highlight the need for updated data on dysmenorrhea in Aotearoa New Zealand, with particular focus on Māori and Pacific peoples, and geographical diversity.

Aim: There are limited data on the prevalence of calcific aortic valve disease (CAVD) in Māori and known inequities in outcomes after aortic valve intervention. Our study aimed to investigate the prevalence of CAVD in Māori.

Methods: Data from initial clinically indicated echocardiograms performed between 2010 to 2018 in patients aged ≥18 years were linked to nationally collected outcome data. Ethnicity was defined using protocols from the Ministry of Health.

Results: Of the 23,635 patients, 1,312 (5.6%) identified as Māori, and 22,323 (94.4%) as European. Prevalence of aortic stenosis was 5.3% in Māori and 9.9% in Europeans. Age-specific prevalence did not differ between the two groups. Māori with CAVD were more than twice as likely to have advanced cardiac impairment (right ventricular dysfunction) than Europeans (10.1% vs 4.6, p<0.001).

Conclusions: Age-specific CAVD rates did not differ between Māori and Europeans, though Māori had a higher proportion of advanced cardiac impairment, which is likely unrelated to CAVD. Differences in population structure likely explain the difference in overall prevalence of CAVD. The improving life expectancy in Māori may lead to increasing incidence of CAVD, thus strategies to improve detection and medical management of CAVD should begin as soon as possible.

The hypothesis that lunar cycles influence human behaviour, particularly incidents recorded by police or coroners, has been a topic of public and media interest around the world for decades. While connections between lunar cycles and numerous cultural practices are well-documented, claims that lunar cycles influence crime or suicide statistics have not been consistently supported. There have been recent media claims that suicide rates in New Zealand follow a lunar cycle, correlating with the Māori Maramataka lunar calendar. Building on prior research, this study scrutinises the postulated association between lunar phases and suicide rates, for general and Māori populations. Utilising 2 decades (2000-2022) of data from the National Coronial Information System (NCIS) and the New Zealand Ministry of Health - Manatū Hauora, the study employs Poisson regression models and cosine curve analyses. Results reveal no significant correlation between lunar phases and suicide rates for the overall population or the Māori sub-group. The absence of a lunar effect persists across univariate and multivariate analyses, incorporating annual, seasonal and day-of-the-week variations. Contrary to claims linking lunar phases to Māori suicide rates, this study provides a robust analysis of comprehensive suicide data. While acknowledging potential limitations, such as the diversity among Maramataka systems and unaccounted external factors, this study emphasises the need for evidence-based practices in mental health interventions. Further research is warranted to explore potential lunar influences on less severe mental health indicators and to substantiate claims supporting traditional Māori Maramataka-based treatments.

Aim: In February 2024, the Aotearoa New Zealand Government repealed legislation to mandate very low nicotine cigarettes (VLNCs), greatly reduce the number of tobacco retailers and disallow sale of tobacco products to people born after 2008 (smokefree generation). We investigated acceptability and likely impacts of these measures among people who smoke or who recently (≤2 years) quit smoking.

Method: We analysed data from 1,230 participants from Wave 3 (conducted in late 2020 and early 2021) and 615 participants from Wave 3.5 (conducted in June/July 2021) of the New Zealand arm of the International Tobacco Control (ITC) Policy Evaluation Project. Data were weighted to represent the national population of people who smoke and who recently quit smoking.

Results: Support (excluding "Don't know" responses) was 82.7% (95% confidence interval 77.9, 86.6) for a smokefree generation, 75.0% (95% CI 71.4, 78.3) for mandated VLNCs and 35.2% (95% CI 31.7, 38.9) for retailer reduction. Support was mostly similar by ethnicity, gender, age and evidence of financial hardship, but was higher among people who had recently quit smoking. Around half of the participants who smoked anticipated quitting completely, switching to vaping or cutting down the amount they smoke if mandated VLNCs or substantial retailer reductions were introduced. If VLNCs were mandated, 19% of people who smoked stated they would carry on smoking like they do now and find a way to get the cigarettes or tobacco they want to smoke.

Conclusion: Support for and anticipated actions in response to the smokefree legislation measures call into question the Government's decision to repeal them.

Background: The prevalence of diabetes has been increasing in Aotearoa New Zealand by approximately 7% per year, and is three times higher among Māori and Pacific peoples than in Europeans. The depth of the diabetes epidemic, and the expansive breadth of services required for its management, elevate the need for high-quality evidence on the projected future burden of this complex disease.

Methods: In this manuscript we have projected the prevalence of diabetes (type 1 and type 2 combined) out to 2040-2044 using age-period-cohort modelling. National-level data from central government on diabetes prevalence (Virtual Diabetes Register) were used to describe recent diabetes prevalence trends (2006-2019) by age group, calendar period and birth cohort, with these trends used to project diabetes prevalence out from 2020 to 2044.

Results: Aotearoa New Zealand will experience a significant increase in the absolute volume of prevalent diabetes, rising by nearly 90% to more than 500,000 by 2044. The age-standardised prevalence of diabetes will increase from around 3.9% of the population (268,248) to 5.0% overall (502,358). The prevalence and volume of diabetes diagnoses will increase most drastically for Pacific peoples, most notably Pacific females for whom diabetes prevalence is projected to increase to 17% of the population by 2044.

Conclusions: The increases in the future burden of diabetes mellitus projected here will heighten pressure on health services. Immediate action is required to reduce new cases of diabetes and other obesity-related illnesses. Fiscal policies to prevent these diseases, coupled with population-level interventions to more effectively manage and control diabetes, are effective tools for reducing disease burden.

Aim: Electronic cigarette use (vaping) has increased rapidly among adolescents globally. Most electronic cigarettes (e-cigarettes) contain nicotine, which is addictive and can cause behaviour problems and mood dysregulation. We sought to assess whether an educational intervention increased knowledge about vaping-related health risks and desire to quit among high school students. We assessed whether the effects differed between in-person or online intervention.

Method: The analysis included 332 students from four high schools in Ōtautahi Christchurch. Students were randomly assigned to an in-person or online group and completed pre- and post-intervention questionnaires. Risk factors for smoking and vaping were assessed with logistic regression. Schools' socio-economic status was imputed from their Equity Index rank. Intervention effects were assessed with and without demographic covariates using mixed-effect linear regression.

Results: Students attending schools in lower socio-economic areas and those with Māori ethnicity were at greater risk of smoking and vaping. Risk of smoking increased with year level; however, risk of vaping did not. There was significant improvement in responses to 3 out of 10 knowledge questions, and there was no evidence that post-intervention scores were affected by participant characteristics. The in-person group showed higher percentage improvements than the online group. Expressed desire to quit vaping increased from 61.7% to 68.8%; however, there was significantly greater desire to quit vaping in students from years 9 and 10 than years 11 and 12 (P=0.043).

Conclusion: Our educational intervention improved the knowledge of high school students on vaping-related health risks and increased expressed desire to quit vaping.