NEW ZEALAND MEDICAL JOURNAL最新文献

Background: Children of Pacific ethnicity living in Aotearoa New Zealand have the second highest incidence of bone and joint infections (BJI) globally. This paper reports illness characteristics and outcomes for Pacific children diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) from the Auckland Region over a 5-year period. It also reports features associated with severe and complex disease.

Methods: Cases included all children aged ≤15 years hospitalised for AHO or SA in the Auckland Region, 1 January 2018-31 September 2023. Prioritised ethnicity was identified from hospital records. Direct medical hospitalisation costs, treatment type and outcomes were described up to 1 year following discharge. Complex illness was defined as recurrence/chronic infection, readmission, intensive care admission, complication following treatment or >1 surgical procedure.

Results: Of 563 cases of acute BJI, 152 were children identifying as Pacific ethnicity. Compared with NZ European children with BJI, Pacific children had more eczema (34% vs 19%, p=0.002), multifocal sepsis (30% vs 10%, p=<0.05) and surgical intervention (61% vs 47%, p=0.01) with lengthier hospitalisations (14 days vs 9 days, p=0.001). Most Pacific children experienced complex illness (66%). Complex illness was associated with cultures positive for Staphylococcus aureus and eczema diagnosis. In regression analysis, complex illness was less likely for children with a previous throat swab positive for group A Streptococcus (GAS).

Conclusion: Pacific children with BJI experience more severe illness compared with NZ European children with BJI. Eczema is common among Pacific children with BJI. Proactive eczema management may represent suitable focus for disease prevention. Prior GAS throat swab appears associated with reduced rates of complex illness.

This review explores COVID-19 (coronavirus disease of 2019) from the perspective of Darwinian natural selection and consequent evolution of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). COVID-19 has caused unprecedented societal and economic turmoil. The human host population has responded with widespread vaccination, therapeutic monoclonal antibodies, convalescent plasma and antiviral drugs. SARS-CoV-2 has demonstrated remarkable resilience and has been able to quickly adapt to its rapidly changing habitat. SARS-CoV-2 has generated new antibody and vaccine evasive mutations in its genome, while simultaneously optimising its infectivity by improving its affinity to the ACE2 receptor and host proteases. Molecular analysis of SARS-CoV-2 has demonstrated natural selection of advantageous mutations in both individual patients with chronic COVID-19 infection and at a host population level, leading to extinction of less fit strains. COVID-19 is living proof of Darwinian evolution, which is occurring in observable time rather than over millions of years. Viewing COVID-19 from an evolutionary perspective will help mitigate the current and future pandemics. The aim of this article is to illustrate these concepts, using examples from the human host peer-reviewed literature.

This paper addresses the evidence on the health impacts of climate change in Aotearoa New Zealand with particular attention to who, where and what activities are most vulnerable. Applying the Arksey and O'Malley scoping review framework, it consolidates academic and grey literature to identify gaps and future research priorities. The review-conducted from February to October 2024-included 61 papers from 2,265 that were initially screened. The results reveal that temperature and extreme precipitation are the main climate risks associated with health in Aotearoa New Zealand. These are associated with direct and indirect impacts, including heat-related illness and death, enteric diseases, poor mental health, access to safe drinking water/food supplies and access to healthcare. Most regions across Aotearoa New Zealand are susceptible to climate change-induced health risks, with unique pressures for coastal regions, metropolitan areas, rural areas and regions experiencing disproportionate socio-economic inequity. Workers in outdoor manual labour-exposed to heat stress, air pollution and sun damage-are vulnerable to climate change-induced health risks. The review also highlights key demographic characteristics-ethnicity, age, skin colour, occupation, gender, housing, disability and pre-existing health needs, and socio-economic deprivation-that affect vulnerability. In conclusion, the review underscores the importance of responses to climate change-induced health addressing the underlying, intersectional risk factors to protect vulnerable populations.

Aim: This study aimed to estimate rates and factors associated with eating disorder risk in transgender youth, and to explore the association between this risk and unmet need for gender-affirming hormone therapy (GAHT).

Methods: In a national cross-sectional survey of participants aged 14-24 years, the five-item Sick, Control, One stone, Fat, Food (SCOFF) instrument was used to assess eating disorder risk. GAHT demand was self-reported. Modified Poisson regressions were employed to assess risk.

Results: Overall, 1,401 participants were eligible, of whom 1,010 (72.1%) had valid SCOFF scores. Of these, 398 (38.4%) participants met the threshold for eating disorder risk. In adjusted analyses, those aged 14-18 years had an increased prevalence ratio (PR) of eating disorder risk compared with their counterparts aged 19-24 years (PR: 1.26; 95% confidence interval: 1.06-1.50). GAHT demand was reported by 645 participants, with 277 (42.9%) having unmet need. No statistical evidence was found relating unmet GAHT need with eating disorder risk (p=0.29).

Conclusion: Nearly two in five transgender youth are at eating disorder risk, and unmet GAHT need rates appear higher. While it is recognised that eating disorders are a global health concern, they have not received the priority they deserve. In the calls for urgent action, transgender youth deserve particular attention.

Aims: To describe Health New Zealand - Te Whatu Ora rheumatology services across Aotearoa New Zealand using the Arthritis New Zealand/New Zealand Rheumatology Association-endorsed rheumatology service standards.

Methods: Descriptive study with data collection by survey from clinical service leads from all 16 Health New Zealand - Te Whatu Ora rheumatology services.

Results: Response rate was 100%. No services met all the service standards. Staffing of rheumatologists approached the standards in only three services, and nursing staffing was well below the standards in all services, with two services not employing any nurses. Where nurses were employed, nursing services standards were largely met. Five services did not provide inpatient consultations. Almost all services had access to conventional imaging modalities, but less than half of services provided point-of-care ultrasounds or had access to fluorodeoxyglucose-positron emission tomography (FDG-PET). Most services were able to make referrals to physiotherapy, occupational therapy and hand therapy. Ability of services to meet care standards for the care of rheumatoid arthritis (RA) was variable. Between 2023 and 2025, two services had a substantive increase in rheumatologist staffing and two had a substantive increase in nursing staffing.

Conclusion: This first national-level description of all Health New Zealand - Te Whatu Ora rheumatology services found considerable heterogeneity, and generally services did not meet all services standards.

A novel theory speculates how trauma is stored in the brain, the physiology of traumatic reactions and identifies a molecular mechanism that may rapidly erase traumatic memories and reverse their consequences. This theory is the basis of Havening Techniques®, used by more than 1,000 certified mental health practitioners worldwide. While trauma therapies such as eye movement desensitisation and reprocessing (EMDR) are well validated by clinical trials, the underlying mechanism of action is unknown. The theory of Havening offers a potential unifying mechanism involving the role of delta brain waves in memory processing, initiated by lateral eye movements (EMDR) or specific forms of touch (Havening). If validated by further clinical trials, Havening Techniques may represent an important advance in mental health care as trauma is a significant but potentially reversable cause of chronic anxiety, depression, post-traumatic stress disorder (PTSD), phobias and addictions. Moreover, the theory includes precise diagnostic criteria for identifying traumatic events and predicting the mental and physical health consequences. Clinical experience suggests that erasing the specific traumatic memories may also lead to sudden relief of stress-induced illness and some cases of chronic pain.