NEW ZEALAND MEDICAL JOURNAL最新文献

Colonoscopy is a cornerstone of colorectal cancer screening with a low incidence of complications such as bleeding and perforation. Infectious complications such as liver abscesses are exceedingly rare. We report a case of a 72-year-old Sri Lankan man with a background of diabetes mellitus and diverticulosis who developed a pyogenic liver abscess (PLA) following an uncomplicated colonoscopy performed as part of the New Zealand bowel screening programme. The abscess was caused by Klebsiella pneumoniae, a pathogen commonly associated with such infections. He was successfully treated with broad-spectrum antibiotics and ultrasound-guided drainage. This case raises the possibility of a rare association between colonoscopies and pyogenic liver abscesses, even in non-invasive procedures, particularly in high-risk patients, though direct causality cannot be established. We reviewed potential mechanisms and relevant literature in this case report.

Background: Meaningful community engagement is essential when designing health services and initiatives. Te Wāhi Tiaki Tātou was established as the Porirua locality under the Pae Ora Act 2022 to support place-based approaches to hauora. Our community engagement takes the form of "reimagining sessions":, facilitated hui that elevate lived experience as a powerful and essential form of evidence in health service design.

Methods: Reimagining sessions blend principles from participatory action research (PAR) and service design, grounded in Te Tiriti o Waitangi. From PAR, they draw on honouring lived experience as expertise. Service design contributes sequencing and holistic thinking principles. Shared principles across both PAR and service design are community-centred approaches, where whānau are positioned as co-creators (from service design) or co-researchers (from PAR), and power sharing with the community to create space for true community-led decision making. Whānau and providers are invited separately to map their experiences of current health services and envision an ideal future state. Sessions are guided by relational engagement and reflexive practice.

Results: Reimagining sessions are more than a consultation mechanism, and serve to share power and elevate community voice. Outputs are synthesised into action-oriented reports validated by participants. Our learnings highlight the importance of trusted relationships, culturally safe environments and emotional anchoring to support aspirational thinking.

Conclusion: Reimagining sessions demonstrate that whānau-led change is possible when communities are treated as experts in their own lives. They reflect a shift from consultation to collaboration, from systems-centred to whānau-centred and from generic services to community-informed services.

Background: This study examines national trends in thoracic spine injury (TSI)-related claims in New Zealand over an 11-year period (2013-2023), with a focus on incidence patterns by sex, age group, injury type and ethnicity.

Methods: A descriptive longitudinal study design was used to analyse 11 years' (2013-2023) data from the Accident Compensation Corporation (ACC). TSIs were grouped into fractures/dislocations, soft tissue injuries and pain syndromes. Incidence rates per 100,000 population were calculated using Stats NZ Tatauranga Aotearoa denominators. Trends were explored using descriptive analyses, population pyramids and heatmaps and modelled using Poisson and negative binomial regression to estimate annual percent change (APC). Forecasts to 2033 were generated using time-series models.

Results: Between 2013 and 2023 there were 1,003,713 new TSI claims. From 2013 to 2023, the incidence of TSI increased from 1,749 to 1,901 per 100,000 (z=-10.49, p<0.001). Our findings demonstrate that females had more claims than males. Modelled APCs were +0.32% (95% CI: -0.29% to +0.94%) for males and +0.25% (95% CI: -1.22% to +1.74%) for females, both non-significant. Fractures (APC: +1.24% [95% CI: +0.13 to +2.35, p=0.028]) accounted for only 1.8% of claims (n=18,334) compared to soft tissue injuries (n=981,796). However, the APC was non-significant for soft tissue injuries. The highest burden occurred in the 30-54 age groups. In terms of ethnicity, European and Asian groups had higher TSI rates than Māori and Pacific peoples.

Conclusion: TSIs have increased modestly over the past decade. The burden varies by sex, age and ethnicity. These findings support targeted prevention with implications for workforce health and equity-focused policy planning.

Background: Children of Pacific ethnicity living in Aotearoa New Zealand have the second highest incidence of bone and joint infections (BJI) globally. This paper reports illness characteristics and outcomes for Pacific children diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) from the Auckland Region over a 5-year period. It also reports features associated with severe and complex disease.

Methods: Cases included all children aged ≤15 years hospitalised for AHO or SA in the Auckland Region, 1 January 2018-31 September 2023. Prioritised ethnicity was identified from hospital records. Direct medical hospitalisation costs, treatment type and outcomes were described up to 1 year following discharge. Complex illness was defined as recurrence/chronic infection, readmission, intensive care admission, complication following treatment or >1 surgical procedure.

Results: Of 563 cases of acute BJI, 152 were children identifying as Pacific ethnicity. Compared with NZ European children with BJI, Pacific children had more eczema (34% vs 19%, p=0.002), multifocal sepsis (30% vs 10%, p=<0.05) and surgical intervention (61% vs 47%, p=0.01) with lengthier hospitalisations (14 days vs 9 days, p=0.001). Most Pacific children experienced complex illness (66%). Complex illness was associated with cultures positive for Staphylococcus aureus and eczema diagnosis. In regression analysis, complex illness was less likely for children with a previous throat swab positive for group A Streptococcus (GAS).

Conclusion: Pacific children with BJI experience more severe illness compared with NZ European children with BJI. Eczema is common among Pacific children with BJI. Proactive eczema management may represent suitable focus for disease prevention. Prior GAS throat swab appears associated with reduced rates of complex illness.

Young-onset (<50 years) colorectal cancer (YOCRC) has been increasing in Aotearoa New Zealand since the birth cohort born around the mid-1950s. Possible responses include education and public health measures, none of which are likely to make a major impact in the foreseeable future. Many YOCRCs are presenting at late stages with predominantly distal cancers. Our current National Bowel Screening Programme (NBSP), screening people 60-75 years, was introduced with inadequate resources; as a result, some colonoscopy services have been moved from symptomatic cases to screening, resulting in diagnostic delays and poorer outcomes. Extending screening to 40 or 45 years will markedly increase the need for follow-up colonoscopies and stretch services beyond breaking point. Sigmoidoscopy is associated with a substantial and sustained reduction in risk of distal colorectal cancer incidence and mortality. As there are too few endoscopists for the existing workload, increasing the nurse endoscopist workforce is a rational step. Initial training would focus on flexible sigmoidoscopy (FS) and concentrate on symptomatic patients <50 years. Steadily increasing nurse endoscopist numbers will contribute to management of the rising incidence of YOCRC. Without disrupting the NBSP or putting much extra strain on need for follow-up colonoscopies, nurse-led FS clinical services can expand to anyone with relevant symptoms and, as a longer-term goal, eventually become part of an expanded screening programme that could include one-off FS at age 50. If we are agreed that this is essential, training and service must be adequately funded and accompanied by a public advocacy campaign to ensure sufficient resources.

This review explores COVID-19 (coronavirus disease of 2019) from the perspective of Darwinian natural selection and consequent evolution of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). COVID-19 has caused unprecedented societal and economic turmoil. The human host population has responded with widespread vaccination, therapeutic monoclonal antibodies, convalescent plasma and antiviral drugs. SARS-CoV-2 has demonstrated remarkable resilience and has been able to quickly adapt to its rapidly changing habitat. SARS-CoV-2 has generated new antibody and vaccine evasive mutations in its genome, while simultaneously optimising its infectivity by improving its affinity to the ACE2 receptor and host proteases. Molecular analysis of SARS-CoV-2 has demonstrated natural selection of advantageous mutations in both individual patients with chronic COVID-19 infection and at a host population level, leading to extinction of less fit strains. COVID-19 is living proof of Darwinian evolution, which is occurring in observable time rather than over millions of years. Viewing COVID-19 from an evolutionary perspective will help mitigate the current and future pandemics. The aim of this article is to illustrate these concepts, using examples from the human host peer-reviewed literature.

Aims: To describe Health New Zealand - Te Whatu Ora rheumatology services across Aotearoa New Zealand using the Arthritis New Zealand/New Zealand Rheumatology Association-endorsed rheumatology service standards.

Methods: Descriptive study with data collection by survey from clinical service leads from all 16 Health New Zealand - Te Whatu Ora rheumatology services.

Results: Response rate was 100%. No services met all the service standards. Staffing of rheumatologists approached the standards in only three services, and nursing staffing was well below the standards in all services, with two services not employing any nurses. Where nurses were employed, nursing services standards were largely met. Five services did not provide inpatient consultations. Almost all services had access to conventional imaging modalities, but less than half of services provided point-of-care ultrasounds or had access to fluorodeoxyglucose-positron emission tomography (FDG-PET). Most services were able to make referrals to physiotherapy, occupational therapy and hand therapy. Ability of services to meet care standards for the care of rheumatoid arthritis (RA) was variable. Between 2023 and 2025, two services had a substantive increase in rheumatologist staffing and two had a substantive increase in nursing staffing.

Conclusion: This first national-level description of all Health New Zealand - Te Whatu Ora rheumatology services found considerable heterogeneity, and generally services did not meet all services standards.