NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: We aimed to examine barriers and enablers to mental health support for transgender and gender-diverse individuals in rural Aotearoa New Zealand, drawing on research conducted in the Whanganui Region.

Method: Findings were drawn from a qualitative study involving interviews with transgender and gender-diverse participants in Whanganui, where mental health concerns consistently arose despite not being the study's primary focus.

Results: Participants reported high levels of psychological distress, shaped by intersecting factors such as gender dysphoria, neurodivergence, financial hardship and social isolation. Major barriers to accessing support included a lack of affirming and knowledgeable mental health providers, limited service availability and experiences of discrimination-both systemic and interpersonal. Some participants described additional difficulty related to provider biases or the ineligibility of publicly funded therapy for gender-related issues. At the same time, protective factors included access to gender-affirming care, culturally safe counselling and peer or community-based support. For neurodivergent participants, inflexible service design and diagnostic barriers further impacted mental health access.

Conclusion: Strengthening culturally safe, affirming and accessible mental health services is essential for improving outcomes for transgender and gender-diverse communities in rural Aotearoa. Strategies such as increasing provider training, supporting community-led initiatives, expanding telehealth and creating clearer care pathways may help address persistent inequities.

Aim: The B4 School Check includes hearing screening of four-year-old children in Aotearoa New Zealand. This study describes the prevalence and distribution of hearing loss, likely due to otitis media with effusion (OME), to determine if there is inequity in access to screening and primary healthcare, and to inform programme design and delivery.

Method: Hearing data over a five-year period were linked with demographic data and interrogated using regression analyses for differences in disease burden, access to screening and to primary healthcare.

Results: Māori and Pacific children and those living with higher deprivation were less likely to be screened. When screened these children had higher rates of disease, were less likely to be referred immediately and had poorer access to primary healthcare to enable appropriate management.

Conclusion: The current delivery of hearing screening is inequitable, missing those that need it most and exacerbating an uneven distribution of disease burden. A redeveloped programme to enable identification and screening of all eligible children, differential delivery according to need and a more holistic provision of care is required. This includes support for speech and language concerns, ear health promotion and linkage with primary care and healthy housing programmes.

Aim: We investigated Māori and Pacific adults with type 2 diabetes (T2D) to determine the prevalence of latent autoimmune diabetes in adults (LADA), assess the type 1 diabetes (T1D) genetic risk score (GRS) distribution in those with and without autoantibodies and investigate differences in clinical diabetes characteristics based on autoantibody presence or a high T1D GRS.

Method: A total of 2,538 Māori and Pacific participants from the Genetics of Gout, Diabetes, and Kidney Disease study in Aotearoa New Zealand were included (830 with T2D, 1,708 without). LADA was defined as age of diabetes onset >30 years, presence of autoantibodies and no insulin treatment within the first 6 months. Clinical characteristics were extracted from medical records. T1D-associated autoantibodies (glutamic acid decarboxylase, islet antigen 2, zinc transporter 8) were measured from stored blood samples from 293 participants (262 T2D, 31 without). A T1D GRS consisting of 30 single-nucleotide polymorphisms was calculated for all participants.

Results: Autoantibodies were detected in 8.8% (23/262) of individuals with T2D, with 5.3% (14/262) meeting the criteria for LADA. No significant difference in T1D GRS or clinical characteristics was observed between T2D cases with and without autoantibodies. Autoantibodies were also detected in 3.2% (1/31) of participants without diabetes.

Conclusion: LADA is present in a subset of Māori and Pacific individuals with T2D. Autoantibody presence was not associated with differences in T1D GRS or clinical features. Further research is needed to assess whether C-peptide monitoring could guide treatment decisions in those with LADA.

Aim: No previous research has assessed the epidemiology or treatment of narcolepsy in New Zealand. This study aimed to estimate its national incidence and prevalence and examine demographic trends in the prescribing of narcolepsy-related medications.

Method: From 2021 to 2023, diagnostic data from all centres conducting multiple sleep latency tests (MSLTs) were analysed to estimate incidence and prevalence. Concurrently, data on all special authority (SA) approvals for narcolepsy medications were obtained from Pharmac and analysed by medication type, region, age, gender and ethnicity.

Results: Among 342 MSLTs, 57 cases of narcolepsy were identified, giving an incidence of 0.36 per 100,000 person-years and a prevalence of 21.9 per 100,000 people. Over the same period, 223 new and 762 total SA applications were approved. The average number of new approvals (74.3 per year) was 3.9 times higher than the number of new diagnoses (19 per year). Demographic variations were observed in the SA data. Generally, methylphenidate hydrochloride was prescribed more than modafinil.

Conclusions: This is the first national estimate of the incidence and prevalence of narcolepsy in New Zealand. The mismatch between diagnosis and treatment data likely reflects limited diagnostic access, multiple medication use, the existence of imported cases with established diagnoses and the treatment of idiopathic hypersomnolence (IH) under the guise of narcolepsy. Policy and funding changes are needed to improve care access and reporting accuracy.

Aim: This study aims to investigate the cancer incidence and mortality among patients with systemic lupus erythematosus (SLE) in New Zealand.

Methods: SLE patients were linked to the New Zealand Cancer Registry to identify cancer cases. The cancer incidence rate and cancer mortality rate among SLE patients in 2010-2021 were age-standardised to the general population. The estimations were stratified by cancer site, sex, ethnicity and age group.

Results: Among 2,656 SLE patients, 240 new cancer cases were identified, including 187 women and 53 men. Haematologic cancers accounted for 20% of cancer cases identified. The relative risk of cancer incidence for SLE patients compared to the general population was 1.48 (95% confidence interval [CI] 1.28-1.71) for women and 2.08 (95% CI 1.59-2.73) for men. The relative risk of cancer death for SLE patients compared to the general population was 1.75 (95% CI 1.40-2.19) for women and 2.27 (95% CI 1.49-3.44) for men. Younger patients had greater relative risks of cancer incidence and cancer mortality than older patients.

Conclusions: Patients with SLE in New Zealand experience a higher cancer burden compared to the general population, with greater disparity among younger patients and male patients. Haematologic cancers were especially prevalent among SLE patients.

Aims: To discuss the regulatory scope of Medicines Act 1981 related to point-of-care testing (POCT) in vitro diagnostic (IVD) devices, the implications of the now repealed Therapeutic Products Act 2023 and the regulatory requirements which will be needed in the proposed Medical Products Bill.

Methods: This review includes the relevant sections on regulation of IVD devices under the Medicines Act 1981, the role of Medsafe, the relevant sections of the Therapeutic Products Act 2023, the cabinet papers on the proposed Medical Products Bill and published literature on regulation for POCT devices in New Zealand and overseas.

Results: IVD devices are not regulated under the Medicines Act 1981. Faulty devices have been supplied to health services and direct to the public. New Zealand is currently behind international regulatory standards. Cabinet papers and the proposed Medical Products Bill state that IVD devices should be regulated and subject to a risk classification system.

Conclusion: A comprehensive regulatory framework for POCT IVD devices is required to ensure the supply of high-quality devices to health services and consumers. The proposed Medical Products Bill must include a regulatory framework for POCT IVD devices in the interests of patient safety. Implemented wisely, the advantages of regulation outweigh disadvantages.

This update revises the Asthma and Respiratory Foundation NZ's Chronic Obstructive Pulmonary Disease (COPD) Guidelines in line with the latest national and international evidence. The aim is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of COPD in clinical practice in an Aotearoa New Zealand context. The intended users are health professionals responsible for delivering acute and chronic COPD care in community and hospital settings, and those responsible for the training of such health professionals.