NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: The 2006 New Zealand national multiple sclerosis (MS) prevalence study (NZMSPS) provided invaluable information about the prevalence of MS in Aotearoa and characteristics of people with this debilitating condition. This study aimed to update the NZMSPS by identifying people with MS using linked administrative health records.

Methods: Cases of MS were identified from hospitalisation, pharmaceutical dispensing, needs assessments for older adults and disability support records between January 1988 and June 2022. MS prevalence was estimated, and characteristics described and compared by sub-groups.

Results: A total of 7,890 people (73% female) with MS were identified across the study period. The estimated crude national prevalence of MS in 2022 was 96.6 per 100,000 (72.4 in 2006). MS prevalence exhibited a strong latitudinal gradient. Estimated age-adjusted prevalence was highest for Europeans (124.7 per 100,000), followed by Middle Eastern/Latin American/African (MELAA) (85.5), Māori (41.8), Asian (16.8) and Pacific peoples (11.1) ethnic groups.

Conclusion: Characteristics of MS cases were broadly similar to previous research, excepting a greater estimated prevalence among Māori, and a lower relative estimated prevalence for Auckland than surrounding regions. Linked administrative health data can be used to identify people with MS in Aotearoa, providing a mechanism for further research.

Aim: To evaluate the regulation of unapproved medicines and its impact on paramedic practice in out-of-hospital settings by comparing regulatory frameworks in New Zealand, the United Kingdom (UK) and Australia. The objective was to propose actionable policy recommendations to improve New Zealand's current regulatory approach.

Methods: A comparative analysis was conducted using theoretical frameworks including regulatory theory, public health law, institutionalism, comparative policy analysis and health crisis management. A technical comparison was also undertaken. Data were collected from legislative texts, policy documents and secondary sources. The analysis focussed on prescribing and administration authority, administrative requirements, flexibility in emergency situations and the impact on patient care.

Results: Section 29 of the New Zealand Medicines Act 1981 imposes comprehensive reporting requirements and restricts unapproved medicine use to registered medical practitioners, hindering timely interventions by paramedics. The administrative burden and lack of flexibility in emergency situations compromise patient care. In contrast, the UK's Human Medicines Regulations 2012 and Australia's Therapeutic Goods Act 1989 provide structured and adaptable pathways. The Therapeutic Products Act 2023 in New Zealand proposed reforms but is currently in the process of being repealed.

Conclusion: New Zealand's framework of Section 29 is ill-suited for pre-hospital emergency care, creating ethical and practical dilemmas for paramedics. Comparative insights reveal that more flexible legal frameworks in the UK and Australia better support paramedics' ability to provide timely care. Ethical considerations emphasise the need to balance regulatory oversight with patient care imperatives. Legislative reforms in New Zealand are urgently needed to enable the lawful administration of unapproved medicines by paramedics, reduce administrative burdens and align its framework with international best practices.

Aim: The aim was to determine whether changes made to the Southern Cochlear Implant Programme (SCIP) following a previous audit in 20141 have affected referral patterns, and to identify ongoing areas of potential need that may inform future service provision and organisational policy. The primary objective was to assess whether changes in referral patterns (specifically distance to referral centre, ethnicity) occurred following interventions in SCIP service provision. The secondary objective was to evaluate the distribution of socio-economic deprivation for referrals to SCIP.

Methods: A retrospective review of all adult patients referred for consideration of cochlear implantation to the SCIP was conducted between 1 December 2014 and 1 December 2022. Distances to nearest SCIP referral centre were calculated based on patients' regions of domicile. This was modelled with linear regression to assess the relationship between incidence of referrals and distance to nearest SCIP centre. Along with demographic data, this was compared to the 2014 audit and baseline New Zealand population demographics from the 2018 New Zealand Census.

Results: In total, 793 individual patient referrals were identified and included. An improvement in referrals relative to distance to SCIP centre was demonstrated, along with a more even distribution of referrals across socio-economic groups. Assessment of ethnicity data was limited by the amount of unrecorded data.

Conclusion: Publicly funded cochlear implantation is currently a limited resource in New Zealand. Findings from this audit help assess both current and past service provisions, providing insights to guide future service developments. Interventions targeted at improving access to SCIP for those more geographically isolated from the service appear to be effective. These interventions, along with ongoing collection, audit and reporting of demographic data including ethnicity, should continue and help inform future service planning.

In this viewpoint we consider brief case studies of four former Aotearoa New Zealand prime ministers whose poor health impaired their decision making. Two of them died in office-Michael Joseph Savage (leader for 1935-1940) and Norman Kirk (1972-1974)-while a third, Joseph Ward (1928-1930), died shortly after his resignation from his position. The fourth, Robert Muldoon (1975-1984), drank heavily at critical times during his prime ministership. We suggest that further New Zealand research on health-impaired leaders is justified, and discuss possible system improvements that can help to recognise when leaders become incapable or even need, if possible, to be removed from any position of authority.

Aim: To estimate the burden of yersiniosis and sequelae in New Zealand, expressed as disability-adjusted life years (DALYs).

Methods: Information on the incidence of yersiniosis was taken from the New Zealand notifiable disease database (EpiSurv). Information on the duration and subsequent sequelae (reactive arthritis, erythema nodosum) were obtained from a New Zealand case-control study. Transition factors (e.g., proportion of cases for which a specimen is requested, proportion of cases providing a specimen) were taken from the New Zealand Acute Gastrointestinal Illness (AGI) Study. Disability weights used to calculate DALYs were those from the 2013 Global Burden of Disease Study.

Results: For 2022, the burden of yersiniosis in New Zealand was estimated to be 119 (95% credible interval 41.5-243) DALYs. Most of the burden (110/119 DALYs) was due to primary gastroenteritis. Rates of reactive arthritis and erythema nodosum were similar to those observed in overseas studies.

Conclusion: The burden of disease due to yersiniosis is predominantly due to the long duration of the gastrointestinal disease, with relatively minor contributions from sequelae.

Aim: The aim of this study is to understand patterns and experiences of smoking and electronic cigarette use, as well as related attitudes and behaviours among adults in Aotearoa New Zealand who smoke or recently stopped smoking.

Methods: We analysed data from the Evidence for Achieving Smokefree Aotearoa Equitably/International Tobacco Control New Zealand Survey (N=1,230), conducted between November 2020 and February 2021.

Results: Among people who smoked, 77.5% (95% confidence interval [CI] 74.0-80.8%) reported regretting having started smoking, 73.6% (95% CI 69.5-77.4) intended to quit, 87.3% (95% CI 84.1-89.9) reported being addicted to smoking and 86.3% (95% CI 83.3-88.8) had tried to quit smoking in the past. Among people who smoked, 24.8% (95% CI 21.3-28.6) used electronic cigarettes (ECs) daily and 4.6% (95% CI 3.3-6.6) used heated tobacco products (HTPs) daily. Among people who had recently stopped smoking, 33.4% (95% CI 25.6-42.2) used ECs daily and less than 1% used HTPs daily.

Conclusion: High levels of regret for starting smoking, addiction and intent to quit smoking highlight the importance of implementing effective and equitable smokefree measures to prevent people from starting to smoke and to support people to stop smoking.

Using data extracted from the New Zealand Health Survey (NZHS), the purpose of this study was to compare lesbian, gay and bisexual people and heterosexual people on engagement with general practitioner (GP) and nursing services and patient experiences of GP services. Quantitative data spanning four waves of NZHS from the years 2017/2018 to 2020/2021 were used to undertake a comparative analysis of lesbian females, bisexual females, gay males, bisexual males and heterosexual males and females. Statistically significant differences were observed in the percentage of GP and nurse utilisation across sexual identity groups. Our analysis showed that both bisexual females and gay/bisexual males were significantly more likely to report poorer levels of trust in GPs and experience poorer explanation of doctors and health conditions. The findings of this study indicate that lesbian, gay and bisexual people have a poorer experience of GP services than do their heterosexual counterparts. These findings indicate the need for GPs and nurses to better understand the ways in which the health needs of lesbian, gay and bisexual people differ from those of heterosexuals to facilitate the provision of culturally appropriate care.