NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: Diverse ethnic representation in clinical trials is critical to ensuring research priorities align with patient need and uphold commitments to health equity. In Aotearoa New Zealand, this is crucial given the persistent health inequities faced by Māori despite obligations of the government to Te Tiriti o Waitangi/the Treaty of Waitangi. We report the findings of a systematic review of ethnic representation, with a focus on Māori and Pacific peoples, in randomised controlled trials (RCTs) undertaken in New Zealand between 2010 and 2020.

Methods: A search was undertaken for RCTs undertaken in New Zealand between 2010 and 2020, registered in the Australia New Zealand Clinical Trials Registry (ANZCTR) and published in a peer-reviewed journal. Ethnicity data were categorised to Stats NZ Tatauranga Aotearoa (Stats NZ) level one or two codes. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline was followed. The primary outcome was the proportion of each Stats NZ level one ethnicity code, for all participants recruited to RCTs conducted in New Zealand which reported ethnicity.

Results: One thousand and forty trials were identified, 342 met the inclusion criteria, of which 103 reported no ethnicity data. For 295,254 participants across all 239 included studies, 6.1% of participants were European, 2.9% Māori, 1.4% Pacific peoples, 7.5% Asian, 2.5% Middle Eastern/Latin American/African (MELAA) and 9.0% Other ethnicity, with 70.6% Residual (unable to be categorised).

Conclusion: Ethnicity reporting in New Zealand-based clinical trials is inadequate and not standardised. Mandatory ethnicity reporting per Stats NZ codes to the New Zealand Health and Disability Ethics Committees, ANZCTR and peer-reviewed journals, should be considered mandatory for RCTs undertaken in New Zealand.

Introduction: Dysphagia frequently occurs in movement disorders, leading to malnutrition and aspiration. Percutaneous endoscopic gastrostomy (PEG) provides nutrition directly into the stomach, bypassing the dysfunctional swallow. However, PEG insertion is a complex decision, both clinically and ethically. Although PEG outcomes are reported in other neurological disorders, there is limited research in atypical parkinsonian syndromes such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). Insertion rates remain variable, reflecting a paucity of research and lack of consistent guidelines. Basic mortality and morbidity data would help inform practice. To our knowledge, this is the first international study of PEG insertion and its impact on survival and aspiration pneumonia in atypical parkinsonian syndromes.

Method: This was an international retrospective study of 72 patients with MSA, PSP or CBD. Survival was recorded from reported onset of dysphagia to death. Secondary outcomes included hospital admission rate for aspiration pneumonia.

Results: Median survival was 17.4 months (95% confidence interval [CI] 14.0-24.9) in non-PEG patients versus 48.8 months (95% CI 44.8 to not reached) in PEG patients, hazard ratio (HR) 0.38 (95% CI 0.18-0.81; p=0.013). PEG was not associated with reduced risk of aspiration pneumonia; 0.76 versus 0.68 admissions per patient-year, incidence rate ratio (IRR) 1.41 (95% CI 0.74-2.68; p=0.297).

Conclusion: PEG insertion may improve survival in atypical parkinsonian syndromes, though we found no evidence of reduced aspiration risk. Given the rarity of these conditions, international registries may help to determine the safety and efficacy of PEG use.

Community-led action is essential for building a more effective and equitable health system. Yet Aotearoa New Zealand's history of top-down structural reforms has undermined progress toward "healthy futures for all". We draw on complexity science and system-change principles to explain why genuine devolution and community engagement are not just ideological preferences but practical necessities in a complex health system. Community agency and locally tailored innovation can drive emergent, system-wide improvements, but only if central structures enable and sustain these relationships. A key step is reframing our mental model of the health system from a linear machine to a complex adaptive system. We discuss how the turbulence of current policy changes fits into long-running patterns and why a clearer conceptualisation of complexity can guide policymakers toward tangible actions that reorient the system towards patients and communities. Finally, we outline some essential ingredients for how New Zealand can transition from rhetoric and good intentions to the effective implementation of an equitable, community-centred health system.

Aim: While less common than adult blindness, childhood blindness has a significant burden in terms of the total number of "blind years". We aim to determine if there is scope for improved strategies in the prevention of childhood blindness in Aotearoa New Zealand.

Method: We conducted a review of New Zealand childhood blindness data.

Results: In New Zealand, there is a paucity of data on childhood blindness. However, significant scope remains for prevention through optimising maternal health, neonatal care, increasing uptake of immunisations and attendance at vision screening programmes, as well as the earliest possible detection of myopia and keratoconus.

Conclusion: Ophthalmologists and the Royal Australian and New Zealand College of Ophthalmologists must continue to actively collaborate with obstetricians, paediatricians, general practitioners, optometrists, national screening units, vaccination programmes, epidemiologists and Health New Zealand - Te Whatu Ora to promote primary prevention strategies and improve visual outcomes for our tamariki.

Amyotrophic lateral sclerosis (ALS), the most common form of motor neurone disease (MND), is a neurodegenerative condition with typically short life expectancy. Riluzole, the only survival prolonging medication funded in Aotearoa New Zealand, has high uptake in other developed countries.

Aims: To quantify riluzole use in New Zealand, identify factors associated with its use and explore reasons for non-use.

Methods: In 2025, people in New Zealand diagnosed with MND were invited to self-complete questionnaires. Data were collected via Qualtrics, exported to Excel and analysed using descriptive and inferential statistics. Respondents with progressive muscular atrophy or primary lateral sclerosis diagnoses were excluded from this analysis.

Results: Of 115 respondents, 55 (48%) were currently taking riluzole, 14 (12%) had taken it previously and 42 (36%) had never taken it. Common reasons for non-use included riluzole not being offered and concerns about lack of effectiveness and/or side effects. Uptake was lower with bulbar onset than limb onset (p<0.05).

Conclusions: People with ALS in New Zealand have low uptake of riluzole, despite its survival benefits. Prescribers and people with ALS need up-to-date information about riluzole's benefit-risk profile to increase uptake and confidence in prescription and use. Liquid riluzole is needed in New Zealand to aid uptake.

Aims: Despite dramatic declines in coronary heart disease (CHD) incidence in Aotearoa New Zealand over more than 50 years, the burden of CHD is still inequitable, particularly for Māori and Pacific peoples. We studied recent trends in first hospitalisations for acute coronary syndromes (ACS) by ethnicity.

Methods: All first ACS hospitalisations (2005-2019) were identified from national administrative datasets. Population denominators were constructed using multiple linked national data sources. Trends in rates of incident ACS and incidence rate ratios (IRRs) were analysed for younger (20-59 years) and older (60-84 years) patients.

Results: The ACS cohort (n=69,161) comprised 74.7% European, 14.2% Māori, 6.1% Pacific peoples, 2.8% Indian and 2.2% non-Indian Asian peoples. For younger patients, annual ACS incidence initially decreased in all ethnic groups but plateaued between 2013 and 2015 for Māori, non-Indian Asians and Europeans; the decline was minimal for Pacific peoples across the time period. In older patients ACS incidence initially fell for all groups, but plateaued for Māori from 2015, and slowed after 2014 for Europeans. IRRs, compared with Europeans, increased between 2005 and 2019 for younger Māori (IRR 1.5 to 2.25, p=0.017) and Pacific peoples (IRR 1.25 to 1.5, p<0.001), and for older Māori (IRR 1.35 to 1.6, p=0.006) and Pacific peoples (IRR 1.0 to 1.6, p<0.001).

Conclusion: Rates of decline in ACS incidence have stalled or slowed for most younger ethnic groups, and for older Māori and Europeans. The differential rate of change between ethnic groups has resulted in increasing inequity for Māori and Pacific peoples across the age range.

Women with an abdominal aortic aneurysm (AAA) in Aotearoa New Zealand experience inequity at every stage of diagnosis and management. We currently treat women too late in their disease course, where increased age, comorbidities, larger AAA diameter, preventable ruptures, loss of eligibility for simple endovascular repair (EVAR) and clinical "turn down for surgery" rates all add to higher AAA mortality. There is scope for great improvements in cardiovascular risk reduction for people living with a small AAA and for considering the inclusion of women in proposals for an AAA screening programme.

Aim: To quantify the current state of the cardiology specialist workforce in Health New Zealand - Te Whatu Ora.

Methods: The Cardiac Society of Australia and New Zealand sent a survey to all Health New Zealand - Te Whatu Ora cardiology departments in 2024, requesting information on specialist cardiac staff. Population information was obtained from Health New Zealand - Te Whatu Ora. International comparisons were obtained by website search.

Results: Of 154 Health New Zealand - Te Whatu Ora-employed cardiologists, 119 (77%) were male, and 113 (73%) received cardiology training in New Zealand. Over half were aged >50, 35% >55, including 18% >60 years. Time in current position was 12±9 years and the vacancy rate was 14%. The current ratio of persons per cardiologist is 35,000. In the five districts with the highest proportion of Māori and Pacific peoples, this ratio exceeds the national average: Tairāwhiti 54,000; Counties Manukau 38,000; Lakes 61,000; Northland 52,000; Hawke's Bay 47,000. For cities with cardiac surgery the ratio is 32,000 and without is 46,000. International ratios include: United States of America (USA) 15,000; Canada 25,000; United Kingdom (UK) 40,000 and Australia 25,000 persons per cardiologist.

Conclusions: Health New Zealand - Te Whatu Ora has an experienced but ageing cardiologist workforce, with many vacancies. Districts with higher Māori/Pacific populations have fewer cardiologists per capita than the national average of 1:35,000, which is similar to the UK, but less than the USA, Australia and Canada.