NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: This study aims to investigate the perceptions of Māori, Pacific, and non-Māori/Pacific breast cancer patients' treatment experience in Wellington, Aotearoa New Zealand. It will also explore the support they received throughout their treatment journey and the information provided to them over the course of their care.

Method: Qualitative semi-structured focus groups were carried out including breast cancer patients who had completed treatment within the past 2 years. Participants were recruited through breast cancer clinics. Data were analysed using reflexive thematic analysis.

Results: Participants reported a need for more tailored information from health professionals. Many participants reported barriers accessing services and follow-up appointments. Additionally, many participants, especially Māori and Pacific participants, emphasised the importance of ongoing support from healthcare professionals and their personal networks.

Conclusion: The findings highlight the need for improving patient-centred communication, recognising the important role of patient support systems and providing more tailored information and resources throughout breast cancer treatment. Addressing these factors could improve different patient groups' experiences and outcomes by fostering a more informed and supported treatment journey.

Aim: Cardiovascular disease (CVD) inequities in Aotearoa New Zealand disproportionately affect Māori and Pacific peoples, who experience higher risk factors, hospitalisations and mortality than NZ Europeans. These disparities stem from the historical and contemporary effects of colonisation, including institutional racism, impacting access to healthcare and socio-economic resources. Despite guidelines for earlier CVD risk assessments (CVDRA), gaps in identification and management persist.

Method: The Manawataki Fatu Fatu (MFF) for Māori and Pacific Hearts in Unison for Achieving Cardiovascular Care in Equity Studies (ACCESS) is a Māori and Pacific-led research programme examining CVD inequities in Aotearoa New Zealand. This study presents phase three, focussing on qualitative co-design hui (meetings) across Aotearoa New Zealand to gather insights from Māori and Pacific patients, whānau (family/supports) and kaimahi (healthcare workers) engaged with CVD services spanning primary to secondary care.

Results: A total of 105 participants attended four regional hui focussed on the heart healthcare experiences of Māori and Pacific peoples in Aotearoa New Zealand. Template analysis revealed four key themes for achieving equitable healthcare: the importance of the whānau/community, the need for providers to engage with patients at their level, the persistent barriers faced and a strong commitment to protecting Māori and Pacific communities and kaimahi.

Conclusion: This study is a comprehensive qualitative investigation into heart healthcare for Māori and Pacific peoples in Aotearoa New Zealand. The findings reiterate that care must align with the realities of Māori and Pacific peoples and that interventions must address long-standing systemic barriers to care.

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: 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: 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.