NEW ZEALAND MEDICAL JOURNAL最新文献

Aims: To describe urinary incontinence prevalence for New Zealand women.

Methods: The New Zealand Health Survey Adult Sexual and Reproductive Health module 2014/2015 was used to estimate urinary incontinence prevalence. Associations between urinary incontinence and age, body mass index (BMI), parity and ethnicity were estimated by logistic regression adjusted for sampling weights.

Results: There were 2,472/5,685 (43.5%) of women aged between and 16 and 74 who responded to the urinary incontinence question and reported at least some incontinence. The sample survey weight-adjusted prevalence (95% confidence interval) was 41.7% (40.0-43.4). An increased prevalence of incontinence was seen with older age, increased BMI and greater parity. The association between BMI and parity was complex, with the lower prevalence with lower BMI attenuated with increasing parity. After adjustment for these variables there was no association with incontinence prevalence for Māori versus non-Māori or European versus non-European.

Conclusions: Urinary incontinence is highly prevalent in New Zealand women. There was no association with ethnicity after adjusting for older age, increased BMI and parity. The prevalence identified in the New Zealand Health Survey is higher than that reported in older surveys based on the electoral roll.

Aims: To characterise diabetes-related lower extremity amputations (DRLEA) and prior contact with specialist podiatrists in Northern New Zealand.

Methods: Using administrative data, DRLEA ≥35 years were identified for the Northern Region (July 2013 to June 2016). For those domiciled in Metro Auckland (July 2015 to June 2016), additional clinical data described amputation cause, diabetes-related comorbidities and podiatry contact.

Results: There were 862 DRLEA for 488 people, including 25% (n=214) major amputations. Age-standardised amputation rates were three times higher for males than females (41.1 vs 13.6 per 100,000 population [95% confidence interval (CI): 37.3-44.9 vs 11.6-15.6 per 100,000] respectively). Amputation rates varied by ethnicity, being 2.8 and 1.5 times higher respectively for Māori and Pacific people than non-Māori, non-Pacific people. Mortality was high at 1-, 3- and 6-months post-admission (7.9%, 12.4 % and 18.3% respectively). There was high prevalence of peripheral vascular disease (78.8%), neuropathy (75.6%), retinopathy (73.6%) and nephropathy (58%). In the 3 months prior to first DRLEA admission, 65% were not seen by specialist podiatry.

Conclusions: Our study confirms higher DRLEA admission rates for Māori and males. We identified elevated rates among Pacific populations and observed suboptimal utilisation of specialist podiatry services.

The use of screen-based digital technologies (such as computers and digital devices) is increasing for children and adolescents, worldwide. Digital technologies offer benefits, including educational opportunities, social connection and access to health information. Digital fluency has been recognised as an essential skill for future prosperity. However, along with these opportunities, digital technologies also present a risk of harm to young people. This issue may be particularly important for young New Zealanders, who have among the highest rates of screen use in the world. Our recently published review examined the impacts of digital technologies on the health and wellbeing of children and adolescents. Key findings revealed some positive impacts from moderate use of digital technologies; however, frequent and extended use of screen-based digital tools were associated with negative impacts on child and adolescent health in some areas, such as eye health, noise-induced hearing loss and pain syndromes. Conversely, in areas such as mental health, wellbeing and cognition, quality of screen media content and additional factors such as age may be more important than duration of use. These challenges gave us the impetus to develop pragmatic recommendations for the use of digital technologies in schools, kura kaupapa and early childhood education. Recommendations include interventions to lower risk across different ages and stages of development. Supporting young people to mitigate risk and develop safer screen behaviours will allow them to gain essential digital skills and access opportunities that will enable them to thrive.

Aims: Anti-NMDAR encephalitis is an increasingly recognised autoimmune disorder, with evolving diagnostic criteria. This study aims to analyse the prevalence and diagnostic patterns of anti-NMDAR encephalitis in a New Zealand hospital setting.

Methods: Data from Waikato Hospital's lab database, encompassing anti-NMDAR antibody requests between August 2013 and July 2023, were examined. Cases were categorised based on age, gender and diagnostic outcomes.

Results: In all requests, 288/318 (91%) were processed and 10/288 (3.5%) anti-NMDAR antibodies were positive. Positive cases were equally frequent by sex, with an average age of 29.4 years. Only 6/10 were diagnosed with anti-NMDAR encephalitis, while others received alternative diagnoses. Māori ethnicity was overrepresented. This study indicates a low prevalence of anti-NMDAR encephalitis in the Waikato region, with adult predominance. Ethnic disparities were observed. The need for refining testing criteria to optimise cost-effectiveness is discussed.

Conclusion: Anti-NMDAR encephalitis is relatively rare in Waikato Hospital, New Zealand, with diagnostic challenges related to testing criteria and ethnic diversity. Further research and consideration of testing protocols are warranted.

Aim: We investigated if continuous glucose monitoring (CGM) in children with type 1 diabetes (T1D) within 12 months of being diagnosed modifies the development of glycaemic outcome inequity on the basis of either ethnicity or socio-economic status (SES).

Method: De-identified clinical and SES data from the KIWIDIAB data network were collected 12 months after diagnosis in children under 15 years diagnosed with T1D between 1 October 2020 and 1 October 2021.

Results: There were 206 children with new onset T1D: CGM use was 56.7% for Māori and 77.2% for Europeans. Mean (SD) HbA1c was 62.4 (14.2) mmol/mol at 12 months post diagnosis, but Māori were 9.4mmol/mol higher compared to Europeans (p<0.001). For those without CGM, Māori had an HbA1c 10.8 (95% CI 2.3 to 19.4, p=0.013) mmol/mol higher than Europeans, whereas there was no evidence of a difference between Māori and Europeans using CGM (62.1 [9.3] mmol/mol vs 58.5 [12.4] mmol/mol p=0.53 respectively). Comparing quintiles of SES, HbA1c was 10.8 (95% CI 4.7 to 16.9, p<0.001) mmol/mol higher in the lowest quintile of SES compared to the highest.

Conclusion: These observational data suggest CGM use ameliorates the ethnic disparity in HbA1c at 12 months in new onset T1D.

The modern treatment of inflammatory bowel disease (IBD) has evolved significantly in recent years. This includes development of new pharmacologic therapies and their implementation in clinical practice. Moderate-to-severe IBD represents a group of patients at risk of poorer outcomes, and mounting evidence suggests biologic and small molecule medications, collectively termed advanced therapies, are the most effective tools clinicians possess. Even with biologic treatment, many patients do not respond or lose response over time. Until recently, most randomised trials demonstrating efficacy and safety of biologics have been placebo-controlled with a lack of head-to-head studies. Therefore, selecting the right medication for the appropriate clinical scenario can be difficult. In addition, there is evidence of differing clinical success when positioning biologic treatments in different sequences. This is important, as one-third of patients treated with biologics will require a switch to a second agent by 12 months, and a further 20% will require a third agent. Over the years, there have been widespread calls in Aotearoa New Zealand for increasing biologic treatment options. Ustekinumab and vedolizumab received public funding for the treatment of moderate-to-severe IBD in 2023, and this has presented long-awaited opportunities for patients, but also new challenges for clinicians in regard to treatment selection. The purpose of this document is to provide guidance to clinicians on biologic selection, sequencing and optimisation for IBD. These recommendations are specific to the domestic prescribing climate, supported by the best available evidence and endorsed by the New Zealand Society of Gastroenterology IBD Working Group.

Aim: To examine the approaches that are being used in New Zealand when conducting decision-making capacity (DMC) assessments among the healthcare professionals that commonly conduct DMC assessments and those that are involved in, but do not conduct, the assessments.

Method: An online quantitative survey was conducted, lasting 10 minutes, including a mix of closed- and open-ended questions. The survey garnered responses from a total of n=78 participants.

Results: Bedside cognitive tests were found to be the most commonly reported tool used to assess DMC among those conducting and those contributing to DMC assessments. Nearly a third (31.9%) of participants conducting DMC assessments used a structured clinical interview as one of their most common approaches while 27.5% of this same group reported not being aware of this approach. It was reported by both those conducting and those contributing to DMC assessments that the current standards lack quality and consistency, with partial capacity being poorly understood and identified, and supported decision making often being overlooked for substitute decision making.

Conclusions: Current approaches to DMC assessment lack standardisation and consistency, with assessment approaches being widely varied. This article serves as a call for the development of and adherence to nationally recognised standards for DMC assessments.

Aim: There are no data on the performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the staging and diagnosis of lung cancer in New Zealand. We aimed to assess the performance of EBUS-TBNA for lung cancer staging and diagnosis at our institution before and after the commencement of regular performance monitoring with comparison to published EBUS quality indicators.

Methods: The performance of EBUS-TBNA in the staging and diagnosis of lung cancer was assessed in two phases. Phase 1 consisted of a retrospective review of all lung cancer EBUS performed over a 2-year period. Published quality indicators were determined from the literature with relevant indicators being extracted and used to determine EBUS performance. Local reporting and education were undertaken and prospective data collection was commenced. Phase 2 consisted of prospective assessment of all lung cancer EBUS over the subsequent year. Performance of EBUS was then compared between phases 1 and 2 in order to determine the effect of performance monitoring and identify areas for service improvement.

Results: A total of 115 staging EBUS and 117 diagnostic EBUS were performed during the study period. Staging EBUS demonstrated good performance across phases 1 and 2 with high sensitivity and negative predictive values (NPV) for the detection of N2/3 disease, meeting published quality standards. During phase 2 there was evidence of a transition towards more guideline-concordant practice evidenced by more detailed nodal sampling during staging EBUS; however, this did not affect overall sensitivity or NPV. Diagnostic EBUS resulted in high rates of pathological confirmation meeting published quality standards across both phases. Pathway times were similar between phases 1 and 2, with reporting of molecular profiling being the predominant factor in delayed pathway times.

Conclusion: Monitoring and reporting of local performance allows critical assessment of practice and can identify areas for quality improvement. This review demonstrated good overall performance but prompted a move towards more guideline-concordant practice with increased mediastinal nodal sampling during staging procedures. Consideration should be given to the adoption of routine EBUS performance monitoring within local and/or regional networks, which could be incorporated alongside the newly proposed Lung Cancer Clinical Quality Registry.

Aims: The prevalence of heart failure in New Zealand is increasing. A small number of select patients with predicted poor short-term survival are candidates for advanced heart failure therapies such as transplantation and durable mechanical circulatory support (MCS). The aim of our study was to introduce left ventricular assist devices (LVADs) to the wider clinicians and highlight their role in managing patients with advanced heart failure in New Zealand.

Method: A retrospective audit of all ventricular assist device (VAD) recipients from January 2005 to December 2022 was conducted. Data were collated using electronic medical and paper records. The primary outcome was survival to transplantation or successful explant of VAD.

Results: Thirty-nine patients received VADs; 32 were male and seven female. Mean age was 45 years (range 10-64 years). Most recipients were NZ European (25), six were Māori, four were Pacific peoples and four were of other ethnicities. The majority of LVADs were implanted for those with dilated cardiomyopathy (67%). At the time of data collection, 24 (62%) had survived to heart transplantation, seven (18%) died while on VAD support, five from right ventricular failure and two from strokes, one patient had their VAD explanted due to recovery and seven (18%) VAD recipients continue on support awaiting transplant.

Conclusion: This audit has provided an opportunity to inform New Zealand clinicians of our durable MCS programme and the expanding role of VAD support in patients with advanced heart failure. The programme will need to continue to audit and report its practice in order to provide equitable allocation of this very limited resource to a growing population in need.