NEW ZEALAND MEDICAL JOURNAL最新文献

Co-design in quality improvement projects is well-established as an effective way of creating more consumer-centred, whānau-centred care, and to shape solutions that work for consumers as well as services. However, in practice, consumers of health services, families and whānau are often consulted after key decisions about project design are made. This can result in tokenism, missed opportunities for improvement and breached obligations to the Māori right to autonomy, self-determination and control of their own destiny as expressed in Article 2 of Te Tiriti o Waitangi. "Front-loaded" co-design was used in selection of project areas and project design in Te Tāhū Hauora - New Zealand Health Quality & Safety Commission's mental health quality improvement work and has been critical to success. With broad sector consultation, one area mental health consumers agreed was a priority for improvement was elimination of seclusion in mental health services, particularly for Māori who experienced significant health inequity in this area. This aim was considered unachievable by many in the sector at the time. However, the zero seclusion project has successfully contributed to reductions in rates of seclusion of all ethnicities, and continues to do so. "Front-loaded" co-design with Māori and consumer guidance is critical to this success. Furthermore, true co-design also ensures the mana motuhake and tino rangatiratanga (self-determination and control over one's own destiny) of Māori, and of all peoples who use our health services.

Aim: To explore the impact of COVID-19 protection measures on children's respiratory health in Aotearoa New Zealand.

Method: Annual hospitalisation rates (2017/2018 to 2022/2023) for specific respiratory illnesses in children under age 15 years were calculated. Comparisons were made across time and age/sex/ethnicity groups.

Results: Hospitalisation rates for respiratory illnesses were lower for all children in the years when COVID-19 protection measures were strictly enforced, followed by an increase in rates in subsequent years. There was an excess of hospitalisations for tamariki Māori and for Pacific children compared with non-Māori, non-Pacific children. Inequities in influenza that were present before the pandemic re-emerged rapidly following the relaxation of COVID-19 protection measures.

Conclusion: Reducing the burden of respiratory illness in children is a key challenge for health delivery in Aotearoa New Zealand. The re-appearance of inequities across outcomes and age groups following the relaxation or removal of COVID-19 protection measures indicates the need for an effective strategy that embeds learnings from our pandemic response.

Aim: To assess the hepatitis C virus (HCV) seroprevalence data for defined regions in New Zealand.

Methods: Email or mobile phone text invitations were sent out to adults enrolled with three participating general practices in different parts of New Zealand. Patients who provided informed consent were instructed to self-present for HCV blood tests. Patients with positive HCV antibodies had reflex testing of HCV antigen and ribonucleic acid (RNA) viral load.

Results: In total, 26,247 invitations were issued. Of these, 1,368 (5.2%) people gave informed consent and 1,021 patients (3.9%) had HCV blood tests. Ten out of 1,021 (0.98%; 95% confidence interval [CI] 0.51-1.82%) tested positive for HCV antibodies, of whom two (0.2%; 95% CI <0.01-0.76%) had positive antigen and elevated RNA viral load. The proportion of NZ Māori and Pacific people was low, at 3.8% and 0.4%, respectively. Volunteers with a high deprivation index were under-represented (3% from New Zealand Index of Deprivation deciles 9 and 10).

Conclusions: The HCV viraemia prevalence in this general practice-based screening programme is 0.2%, which is lower than previous estimates. This may have implications for appropriate resource allocations and the determination of the best strategies to find new HCV infections. Participation rates of people with high deprivation indexes or who were NZ Māori and Pacific people were low, suggesting that a tailored screening approach is needed.

Aim: To estimate the current prevalence of dysphagia in the Aotearoa New Zealand population and to project its prevalence to 2073.

Methods: The current prevalence of dysphagia in Aotearoa New Zealand is computed from the prevalences of the aetiologies of dysphagia combined with the rates at which the aetiologies result in dysphagia. Projected dysphagia rates use autoregressive integrated moving average forecasting techniques combined with population projections from Statistics New Zealand and estimates of current and past prevalence rates of dysphagia.

Results: The prevalence of dysphagia in Aotearoa New Zealand is estimated to have been approximately 1.78% in 2020, with the biggest aetiological contributors being stroke, Alzheimer's disease and other dementias, and gastroesophageal reflux disease. These three causes made up 81.5% of all estimated dysphagia cases in 2019. The prevalence rate of dysphagia in Aotearoa New Zealand is projected to rise to 2.54%, reflecting the ageing population.

Conclusion: An increased prevalence of dysphagia will result in an increased healthcare burden, both from resources spent on treating dysphagia and complications stemming from undiagnosed and thus untreated dysphagia. Estimating the full extent of this increased burden is hampered by the absence of systematic, extensive and reliable records available relating to cases of dysphagia in Aotearoa New Zealand.

The terms cardiopulmonary resuscitation (CPR) and resuscitation have been used non-specifically and interchangeably. To provide clarity and transparency to clinicians and patients when facilitating conversations about what treatments are warranted and wanted if clinical deterioration occurs in the hospital, CPR must be reframed as its original, official definition in New Zealand: chest compressions and rescue breaths. Key messages: CPR has become shorthand for resuscitation, with the terms used interchangeably. Resuscitation measures to preserve life and organ function are far broader than CPR. Separation of CPR from other resuscitative measures will result in better clinician-patient conversations and more precise treatment decisions tailored to preventing deterioration and, thus, cardiac arrest.In-hospital progressive deterioration leading to natural dying is different from sudden cardiac arrest.

Background: Over the past decade there has been a rapid emergence of a new dermatophyte species Trichophyton indotineae (T. indotineae) in the Indian subcontinent, with associated global spread. It is noted for extensive recalcitrant infections and high rates of terbinafine resistance that are changing treatment paradigms for tinea infection.

Aim: To report on the epidemiology of dermatophyte infections from the National Mycology Reference Laboratory at Auckland City Hospital and the arrival of T. indotineae in New Zealand.

Methods: This was a retrospective review of laboratory data from January 2017 to August 2024. Antifungal susceptibility was performed by disc testing. Species identification was performed by phenotypic methods and for a limited number of isolates by DNA sequence analysis.

Results: There were 961 dermatophytes identified. Trichophyton rubrum was the most common species, accounting for 72% of all isolates. There were 85 (9%) confirmed or probable T. indotineae identified from 63 individuals. These included both Auckland isolates and isolates referred from laboratories around the country. Of the 49 T. indotineae isolates that had antifungal susceptibility testing performed, only 30 (61%) were susceptible to terbinafine, while 45 (92%) were susceptible to itraconazole.

Conclusions: Terbinafine resistant T. indotineae has arrived in New Zealand. To assist appropriate management, practitioners encountering extensive tinea infection, particularly if failing terbinafine treatment, should request culture, asking for full dermatophyte identification and susceptibility testing. Itraconazole is the recommended treatment for T. indotineae, and up to 12 weeks duration may be required.

Gun control is a pressing issue in Aotearoa New Zealand that has garnered the attention of policymakers and the general public. Given the physical and social harms that guns potentiate, healthcare workers in Aotearoa New Zealand have a critical role in analysing and advocating for evidence-based legislation to ensure low levels of gun-related harm.We reviewed the historical and contemporary circumstances that have created the societal and legislative landscape of gun culture in Aotearoa New Zealand. The current Coalition Government is undertaking a review of the Arms Act, which could lead to weakening of current gun legislation.We, as healthcare providers, advocate for an evidence-based approach in relation to gun laws in Aotearoa New Zealand. Ongoing monitoring, evaluation and adaptation of gun control regulation is essential to ensure effectiveness and responsiveness to evolving challenges.