NEW ZEALAND MEDICAL JOURNAL最新文献

Aims: This study aimed to evaluate the effectiveness of COVID-19 vaccines in preventing COVID-19 outcomes when the Omicron variant was predominant in Aotearoa New Zealand.

Methods: We conducted a retrospective cohort study using routinely available data (8 December 2020-28 February 2023). We evaluated the vaccine effectiveness (VE) of COVID-19 vaccines using the Cox proportional-hazards model, adjusting for covariates.

Results: The VE against COVID-19 hospitalisation (VEH) for the second booster dose compared to no vaccination was found to be 81.8% (95% confidence interval [95% CI]: 73.6-87.5) after 1 month post-vaccination. After 4 months, VEH was 72.2% (95% CI: 58.5-81.4), and after 6 months VEH was 49.0% (95% CI: 7.9-71.8). Similarly, VEH decreased after the first booster dose (1-month VEH=81.6% [95% CI: 75.6-86.1]; 2 months VEH=74.7% [95% CI: 68.2-79.9]; and 6 months VEH=57.4% [95% CI: 45.8-66.6]). VE against COVID-19 death (VED) was 92.9% (95% CI: 82.1-97.2) 2 months after the first booster vaccination, with VED being sustained until months 5 and 6 (VED=87.2%; 95% CI: 67.4-94.9). The VE after the second dose of the vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (VEI) (real-time polymerase chain reaction [RT-PCR]) was sustained at 5 months post-vaccination (40.6%; 95% CI: 25.6-52.5).

Conclusion: We provide a comprehensive quantification of both VE and VE waning. These findings can guide policymakers to help evaluate the COVID-19 vaccination programme and minimise the effect of future COVID-19 in Aotearoa New Zealand.

Aim: To examine the impact of integrated employment support and mental health treatment (Individual Placement and Support, or "IPS") on Aotearoa New Zealand participants' employment, income, health, education and justice outcomes.

Method: De-identified linked data from the Stats NZ Integrated Data Infrastructure and propensity score matching were used to estimate effects.

Results: In total, 1,659 IPS participants were matched to 1,503 non-participants. Compared with matched non-participants, matched participants were 1.6 times more likely to be in employment at 12 months. Over 3 years, matched IPS participants had more earnings, more time in employment, greater total income and were more likely to gain qualifications. They also had more face-to-face contacts with mental health teams, mental health-related inpatient stays and mental health service crisis contacts than matched non-participants. Effects for Māori were similar in direction and scale to the overall results.

Conclusion: Our results show that people with mental health conditions or problematic substance use who receive employment support made available together with mental health and addiction treatment have more employment, gains in qualifications and more independent income when compared to similar people who do not receive this support. More research is needed to understand differences in engagement with mental health services and effects on participants' health and wellbeing.

Introduction: Endoscopic submucosal dissection (ESD) is a specialised endoscopic technique in the treatment of large pre-cancerous and early cancerous gastrointestinal lesions that avoids the need for surgical resections. The objective of this study was to assess the feasibility, efficacy and safety of learning ESD in an untutored approach in a prevalence-based setting within New Zealand.

Methods: Over a 4-year period, 80 ESD procedures were performed at a single tertiary centre within New Zealand. We retrospectively reviewed basic demographics of the patients, along with successful en bloc resection rates, dissection speeds, histological diagnoses (including margin assessments) and complications.

Results: We captured 80 procedures. Within this database we achieved an en bloc resection of 88.7% (71 out of 80 cases) and an R0 resection of 72.5% (58 out of 80 cases). The international benchmark for dissection speed of 9cm2/h was achieved within the first block of 20 cases and was maintained throughout. There was a perforation rate of 6.25% (five patients), with one patient (1.25%) requiring emergency surgery for a rectal perforation.

Conclusions: Our study shows it is feasible and safe to learn ESD within a low-volume tertiary centre within New Zealand via a prevalence-based approached. The majority of patients were able to have en bloc resection and a R0 resection. Our intent is that this data be used to help design a more formalised training process for learning ESD within a New Zealand setting.

Aim: In New Zealand, colorectal cancer (CRC) is the second highest cause of cancer death. We sought to characterise a unique population, the individuals who attempt to engage one or multiple times with screening yet fail to ever obtain successful screening.

Methods: This is a cross-sectional descriptive analysis on data from the New Zealand National Bowel Screening Programme 2012 to 2022.

Results: Over 7,000 individuals (1.26% of all participants) have attempted but failed to be successfully screened in the national bowel screening programme. Males compared with females (OR 1.11, 95% CI 1.06-1.17), Asian (OR 1.65, 95% CI 1.55-1.77), Māori (OR 2.07, 95% CI 1.92-2.24) or Pacific peoples (OR 2.30, 95% CI 2.09-2.52) compared with Europeans had greater odds to attempt but fail to be screened. Māori New Zealand Index of Deprivation (NZDep) quintile five (most deprived) had 4.12 (95% CI 3.64-4.67, plt;0.0001) the odds to attempt but fail to be screened compared with European deprivation quintile one participants (least deprived).

Conclusions: There are important variations in the failure to successfully receive CRC screening by gender, age, ethnicity, deprivation level and screening year. We suggest drop-off location checking services for all participants are required.