NEW ZEALAND MEDICAL JOURNAL最新文献

Aims: We described long-term trends in obesity using preschool data from New Zealand and compared rates pre- and post-COVID by key demographic variables.

Methods: Growth data from the B4 School Check (B4SC) information system for the period 1 July 2012 to 30 June 2022 were used to calculate obesity rates. The date 25 March 2020 was the threshold used to compare the rates between pre- and post-COVID periods. Obesity rate ratios for these two periods were calculated for each demographic sub-group.

Results: The overall obesity rate increased by 1.8% after COVID-19. Males had higher obesity rates and a greater absolute increase (2%) in the post-COVID period. The greatest absolute increase in obesity was among Pacific peoples (4.3%), followed by Māori (2.2%). Children in most deprived areas and those in the Auckland Region had greater absolute increases of 3% and 2.5% respectively, post-COVID.

Conclusion: The COVID-19 lockdown has had an immediate impact on obesity rates among 4-year-old children, especially for the Pacific population, those living in high deprivation areas and regions with longer periods of lockdown (Auckland). There are implications for public health policy and practice to support children in adopting a healthy lifestyle, especially during pandemics.

Aim: This feasibility study was undertaken to implement and assess a Rongoā Māori (traditional Māori healing)/Western medicine collaboration model in a general surgical outpatient setting.

Methods: Six patients were recruited and consulted with both a Rongoā Māori practitioner and a Western trained surgeon three times in 6 months. Appointments were an average of 45 minutes duration, patient whānau (family) were welcome and kai (food) was provided as a culturally appropriate custom. Qualitative interviews were conducted with patients, whānau and practitioners after the final appointment with practitioners. The data were thematically analysed and reviewed by the team researchers.

Results: Seven themes were identified from the successful collaboration: benefits of Rongoā/medical collaboration to participants; the high value of healer/doctor relationships with participants; participants' experiences of healer/doctor collaboration; healer/doctor perceptions of the Rongoā/medical collaboration process; paying attention to the ecosystem of each participant; unanimous support for Rongoā/medical collaboration to be implemented in the health system; suggestions for Rongoā/medical collaboration improvement.

Conclusions: Many challenges remain, but collaboration between Rongoā Māori healing and Western health professionals in public hospitals is not only possible, but also meets the need for patient-centred care.

Aim: To quantify and characterise patients with coexistent septic arthritis (SA) and crystal arthritis (CA) (SACA) in an emergency department (ED) setting.

Methods: A single-centre, retrospective, 10-year observational study was conducted at a major referral centre. Patients with a positive joint aspirate for CA or SA carried out in ED, were included. The Newman criteria were utilised to define SA.

Results: Of the 567 patients included in the final analysis, 427 had CA and 140 had a final diagnosis of SA. Twenty-three point six percent of patients diagnosed with SA had concomitant CA, while 7.2% of patients diagnosed with CA had concomitant SA. The greatest predisposing factors for SACA were previous history of gout, rheumatoid arthritis, being immunocompromised or having joint metalware. Synovial fluid (SF) white cell count (WCC) showed excellent predictive capability for joint infection with the area under the receiver operating characteristic curves (AUROCs) of 0.81 and 0.87 for SA and SACA respectively. The receiver operating characteristic curves (ROCs) reported a SF WCC cutoff of 32,000/mm3 allowed for 100% sensitivity and approximately 50% specificity.

Conclusions: SACA remains a small but important sub-group of patients at risk of misdiagnosis of CA alone. SF WCC of 32,000/mm3 may be a better cutoff than the traditionally accepted 50,000/mm3, possibly warranting inpatient admission for investigation and management of presumed SA.

Aims: To compare sodium valproate dispensing in women of childbearing age diagnosed with borderline personality disorder in 2014 and 2019 to discover if prescribing practices in Aotearoa New Zealand have changed in response to international recommendations.

Methods: National dispensing data from the Pharmaceutical Collection were linked with diagnostic data from PRIMHD (the national mental health and addiction database) to identify people diagnosed with borderline personality disorder in Aotearoa New Zealand who were dispensed psychotropic medication. Dispensing of sodium valproate for women of childbearing age was compared between 2014 and 2019. Rates of dispensing were compared between ethnicities.

Results: In 2014, 10% of women of childbearing age diagnosed with borderline personality disorder were dispensed sodium valproate. This reduced to 6% of women in 2019 (p<0.001). In 2014, there was substantial ethnic disparity with 18.1% of Māori women and 15.8% of Pacific women dispensed sodium valproate compared with 7.4% of New Zealand Europeans. This disparity reduced in 2019, with 6.4% of Māori women and 12.5% of Pacific women dispensed sodium valproate compared with 5.6% of New Zealand Europeans.

Conclusions: These findings suggest that international recommendations and guidelines have been effective in changing clinical practice and reducing ethnic inequities. Given the significant risk to offspring exposed to sodium valproate, we echo warnings against off-label prescribing of sodium valproate in borderline personality disorder.