NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: To determine if high normal early pregnancy HbA1c (35-40mmol/mol), in the absence of diabetes, was associated with increased risk of adverse perinatal outcomes compared to normal HbA1c (<35mmol/mol).

Method: A retrospective chart review was carried out on all singleton births in the Wellington region from 1 July 2019 to 31 December 2019. Exclusion criteria were participants domiciled outside the Wellington region, HbA1c ≥50mmol/mol, pre-existing diabetes, gestational diabetes in current pregnancy, no HbA1c performed <20 weeks or the first HbA1c was taken at ≥20 weeks. Baseline characteristics, HbA1c and pregnancy outcomes were obtained. The primary outcome was birth weight and was analysed using multiple linear regression.

Results: There were 1,067 participants in the normal HbA1c (nHbA1c) group and 186 in the high normal HbA1c (hnHbA1c) group. There was no difference in birth weight between hnHbA1c and nHbA1c. hnHbA1c had significantly lower odds of post-partum haemorrhage and composite maternal adverse outcomes compared to nHbA1c (OR 0.52, 95% CI 0.35-0.76) and (OR 0.64, 95% CI 0.46-0.89).

Conclusion: High normal HbA1c was not associated with increased risk of adverse perinatal outcomes in pregnant people who did not develop gestational diabetes.

Aim: Acute alcohol use (AAU) can increase suicide risk. It is unknown if this effect differs by population sub-group in New Zealand, and what characteristics are associated with alcohol being coded as contributory to death, when AAU is identified. This study aimed to answer: 1) are the characteristics associated with suicide involving AAU different between females and males, and 2) among suicides that involved AAU, what factors are associated with alcohol being coded as a contributory factor?

Method: Secondary analysis was conducted of suicide data from 2007-2020, from the National Coronial Information System. Binomial regression models for females and males were used to estimate sex-specific differences in risk of suicide involving AAU. Poisson regression modelling was used to estimate the relative risk of alcohol being coded as contributory where AAU was identified.

Results: Suicide was more likely to involve AAU among Māori females (adjusted risk ratio [ARR] 1.35, 95% confidence interval [CI] 1.08-1.68) and Pacific females (ARR 1.75, 95% CI 1.22-2.51), compared to European females. Compared to males who were employed, all other employment statuses had significantly lower risk of suicide that involved AAU. Those who died by hanging (ARR 0.75, 95% CI 0.62-0.92) or firearms (ARR 0.55, 95% CI 0.38-0.90) were less likely to have alcohol coded as contributory, compared to those who died by poisoning.

Conclusion: Targeted public health interventions designed by and for specific demographic groups (particularly Māori and Pacific females) are needed, alongside universal interventions that address social and structural determinants. Data systems and coding must accurately reflect the association between AAU and suicide in New Zealand.

Aim: To evaluate the implementation of the New Zealand Medicinal Cannabis Scheme (MCS), including how products, prices, prescribing and patient access have evolved since 2020.

Method: Analysis of administrative data obtained via Official Information Act (OIA) requests and publicly available information on products and prices.

Results: Six emerging trends were identified: 1) quarterly supply of medicinal cannabis products has increased fourteenfold since the implementation of the Scheme in 2020, 2) most products are now THC-dominant rather than CBD, 3) most products are in the form of dried cannabis flower rather than oral liquids/oils, 4) prices of products have declined to be comparable to the illegal market, 5) specialised private cannabis clinics have expanded patient access, and 6) inequities persist due to expense, and disproportionately affect Māori and those on lower incomes.

Conclusions: The New Zealand MCS successfully established a domestic medicinal cannabis production sector, reduced prices and expanded the range of products to provide alternatives to illegal supply. It has also inadvertently created the conditions for the emergence of specialised cannabis clinics that have enhanced access. However, the increasing supply of THC-dominant and flower products, and the privatisation of prescribing via cannabis clinics, may have unintended negative consequences.

Aims: To estimate the cost-impact if faricimab were approved for the treatment of neovascular age-related macular degeneration (nAMD) in New Zealand.

Methods: A retrospective, single-centre cost-analysis study. Data on intravitreal agent and injection intervals were obtained and statistically compared. Cost estimates were based on internal facility and publicly available data. The current costs of care were compared to two scenarios: one where all eyes receive faricimab, and another where eyes receiving aflibercept switch to faricimab.

Results: A total of 352 eyes from 292 patients were analysed. Present values locally over 10 years were estimated at -$6,776,340 for the first scenario and $5,015,922 for the second, releasing 252 and 176 hours of clinical time per year, respectively. Nationally, the savings extrapolated to -$187,925,737 and $139,104,706, respectively. The analysis indicates significant direct cost savings for the health sector and potential reductions in patient harm due to fewer injections.

Conclusions: The approval of faricimab for the treatment of nAMD could result in substantial direct cost savings for the health sector. Additional benefits include reducing patient harm and improving ophthalmic health inequalities for Māori and Pacific peoples. Further research in diverse patient populations across multiple centres is needed to estimate the magnitude of cost savings more accurately. This study highlights the potential of faricimab to alleviate the treatment burden and provide a more sustainable healthcare option for nAMD in New Zealand, especially in cases of recalcitrant nAMD, if used in a tailored and patient-specific manner alongside the existing armamentarium of treatments.

Aims: The TMGH-Global COVID-19 Collaborative was a multinational, multicentre, cross-sectional survey assessing the awareness and preparedness of healthcare workers (HCWs) during the first wave of the pandemic across 57 countries. Here, we report the results from Aotearoa New Zealand.

Methods: This cross-sectional survey was conducted at Christchurch Hospital between February and May 2020. Data were collected from a convenience sample of HCWs and analysed using descriptive and multivariate regression to determine awareness (out of 40) and preparedness (out of 15) scores and influencing factors.

Results: Of the 158 participants (response rate 20.8%), most were women (73%) and doctors (58%) with a median age of 38 years (interquartile range [IQR] 29-49). The median awareness and preparedness scores were 33.6 (IQR 31.1-35.1) and 8 (IQR 6-8), respectively. Mainstream media was the primary source of information on COVID-19 among HCWs. The awareness score was significantly affected by gender and profession, whereas the preparedness score was influenced by age, profession, clinical experience duration and COVID-19 training.

Conclusions: Although frontline HCWs had high awareness levels, preparedness was low. Variables influenced awareness and preparedness differently. These findings identified gaps in pandemic readiness and factors that can be leveraged to enhance future pandemic preparedness and response in New Zealand.

The Code of Health and Disability Services Consumers' Rights (the Code)1 and the Health and Disability Commissioner Act (the Act)2 are up for review. The Code currently applies to clinical care, teaching and research. When it was introduced, there were no national mechanisms to govern research, but since then the National Ethics Advisory Committee (NEAC) has developed detailed guidelines and established a network of ethics committees at various institutional levels. As currently written, the Code prohibits research on a patient who lacks capacity unless it is in their "best interests." This precludes some important research. The NEAC guidelines are more nuanced and measured, designed to balance the risks to the patient with the benefits to the community. We argue that the Code and the Act should be amended to allow decisions about research proposals on people who lack capacity to be made by an ethics committee set up by NEAC.