Donald J Trump began his second term as president of the United States (US) in January 2025. Since then, his administration has abandoned the precedents necessary for good government, brushed aside restrictions on executive power, sacked tens of thousands of federal workers and undermined healthcare within the US and overseas. I argue the consequences of Trump's actions are so serious they must concern health professionals everywhere, and outline three ways to respond. These are: to actively and effectively support colleagues in the US; to do what we can to sustain health gains worldwide; and to oppose health-damaging Trump-like thinking in Aotearoa New Zealand.
{"title":"How should New Zealand health professionals respond to Trump 2.0?","authors":"Alistair Woodward","doi":"10.26635/6965.7037","DOIUrl":"https://doi.org/10.26635/6965.7037","url":null,"abstract":"<p><p>Donald J Trump began his second term as president of the United States (US) in January 2025. Since then, his administration has abandoned the precedents necessary for good government, brushed aside restrictions on executive power, sacked tens of thousands of federal workers and undermined healthcare within the US and overseas. I argue the consequences of Trump's actions are so serious they must concern health professionals everywhere, and outline three ways to respond. These are: to actively and effectively support colleagues in the US; to do what we can to sustain health gains worldwide; and to oppose health-damaging Trump-like thinking in Aotearoa New Zealand.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1623","pages":"88-94"},"PeriodicalIF":1.3,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145259597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Drug use (including tobacco, alcohol and illicit drugs) is a leading cause of premature death, health loss and health inequities in Aotearoa New Zealand. Effective prevention and early intervention have potential to reduce drug-related human suffering across the lifecourse, thus decreasing pressure on health and social services.
Methods: To inform policy and practice, we investigated drug harm indicators among secondary students in Aotearoa and identified sub-populations at greatest need. We used Youth19 survey data (N=7,721) to investigate five indicators related to e-cigarette, tobacco, alcohol or cannabis use: prevalence of 1) past month use, 2) heavy use, 3) worry about use, 4) desire to cut down or stop, and 5) reported difficulty accessing cessation help.
Results: We found many adolescents, particularly those who used tobacco, were worried about their own drug use and wanted to cut down, yet getting appropriate help was not always easy. Need was not evenly spread; Māori, Pacific and LGBTQ+ youth, those aged under 16 years and those living in small towns, rural areas and the most socio-economically deprived communities had higher needs on many indicators.
Conclusion: Greater investment in drug harm prevention and early intervention may be warranted, with a focus on under-served populations.
{"title":"Drug harm prevention needs among adolescents in Aotearoa New Zealand: findings from the Youth19 Survey.","authors":"Grace Sullivan, Jane Zhang, Luisa Silailai, Karen Wright, Emily Cooney, Michaela Pettie, Jude Ball","doi":"10.26635/6965.7062","DOIUrl":"https://doi.org/10.26635/6965.7062","url":null,"abstract":"<p><strong>Background: </strong>Drug use (including tobacco, alcohol and illicit drugs) is a leading cause of premature death, health loss and health inequities in Aotearoa New Zealand. Effective prevention and early intervention have potential to reduce drug-related human suffering across the lifecourse, thus decreasing pressure on health and social services.</p><p><strong>Methods: </strong>To inform policy and practice, we investigated drug harm indicators among secondary students in Aotearoa and identified sub-populations at greatest need. We used Youth19 survey data (N=7,721) to investigate five indicators related to e-cigarette, tobacco, alcohol or cannabis use: prevalence of 1) past month use, 2) heavy use, 3) worry about use, 4) desire to cut down or stop, and 5) reported difficulty accessing cessation help.</p><p><strong>Results: </strong>We found many adolescents, particularly those who used tobacco, were worried about their own drug use and wanted to cut down, yet getting appropriate help was not always easy. Need was not evenly spread; Māori, Pacific and LGBTQ+ youth, those aged under 16 years and those living in small towns, rural areas and the most socio-economically deprived communities had higher needs on many indicators.</p><p><strong>Conclusion: </strong>Greater investment in drug harm prevention and early intervention may be warranted, with a focus on under-served populations.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"14-31"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The problem with ten-year private healthcare contracts.","authors":"Phil Bagshaw, John D Potter, Sue Bagshaw","doi":"10.26635/6965.7171","DOIUrl":"https://doi.org/10.26635/6965.7171","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"119-120"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087859","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Unicuspid aortic valve with ascending aortic aneurysm: a rare cause of heart failure in a middle-aged male.","authors":"Mona Alsomali","doi":"10.26635/6965.7125","DOIUrl":"https://doi.org/10.26635/6965.7125","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"113-115"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p><strong>Background: </strong>Copying results to a patient's primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates uncertainty around the continuity of patient care. We aimed to survey primary care, with a focus on general practitioners (GPs), regarding their medico-legal awareness, preferences regarding receiving copied results, views on when transfer of care should happen, work-life balance, career pathway and the administrative burden (non-patient-facing clinical time) within their total clinical work hours.</p><p><strong>Methods: </strong>This was an anonymous, cross-sectional survey for clinically active primary care clinicians (GPs, urgent care physicians, nurse practitioners [NPs]) in the Northern region of Aotearoa New Zealand. The survey link was open from August to October 2023 and distributed via email, promoted during webinars and shared on social media.</p><p><strong>Results: </strong>A total of 470 eligible responses were collected: 428 GPs, 15 urgent care physicians, 18 NPs and 9 doctors that identify as "other primary care". Across the professions, 34% were unaware of the medico-legal responsibilities of being copied into results they did not initiate. With the exception of NPs, most primary care clinicians prefer to not be copied to radiology, histology, microbiology, haematology and biochemistry results they did not order. Four out of five participants agreed that any results copied to primary care should involve prior discussion and acceptance by a relevant clinician. Although GPs and NPs reported poorer work-life balance, lower job satisfaction and higher rates of burnout compared with the other primary care professions, all professions have seen reductions in their patient-facing hours in the past 5 years, with increased administrative burden identified as a major contributing factor. Indeed, 47.7% of the GPs surveyed stated their intent to leave primary care within the next 5 years. The median proportion of non-patient-facing clinical hours as part of total clinical hours was 31% for GPs, 17% for urgent care physicians, and 31% for both NPs and other primary care professionals. Among GPs, a higher proportion of non-patient-facing clinical work was associated with older age, female gender, other non-European ethnicity, holding vocational registration in general practice, more years of general practice experience, having a personal list of enrolled patients and working in a non-Very Low Cost Access practice. However, medico-legal awareness of copied results was not associated with an increased proportion of non-patient-facing clinical work.</p><p><strong>Conclusion: </strong>A gap in medico-legal knowledge related to test result responsibility exists within the primary care workforce. While this deficit was not linked to increased time spent on non-patient-facing clinical work, the majority of clinician
{"title":"Transfer of care and inbox management in primary care: a survey on medico-legal responsibility awareness and administrative burden in Aotearoa New Zealand.","authors":"Albert Wu","doi":"10.26635/6965.6952","DOIUrl":"https://doi.org/10.26635/6965.6952","url":null,"abstract":"<p><strong>Background: </strong>Copying results to a patient's primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates uncertainty around the continuity of patient care. We aimed to survey primary care, with a focus on general practitioners (GPs), regarding their medico-legal awareness, preferences regarding receiving copied results, views on when transfer of care should happen, work-life balance, career pathway and the administrative burden (non-patient-facing clinical time) within their total clinical work hours.</p><p><strong>Methods: </strong>This was an anonymous, cross-sectional survey for clinically active primary care clinicians (GPs, urgent care physicians, nurse practitioners [NPs]) in the Northern region of Aotearoa New Zealand. The survey link was open from August to October 2023 and distributed via email, promoted during webinars and shared on social media.</p><p><strong>Results: </strong>A total of 470 eligible responses were collected: 428 GPs, 15 urgent care physicians, 18 NPs and 9 doctors that identify as \"other primary care\". Across the professions, 34% were unaware of the medico-legal responsibilities of being copied into results they did not initiate. With the exception of NPs, most primary care clinicians prefer to not be copied to radiology, histology, microbiology, haematology and biochemistry results they did not order. Four out of five participants agreed that any results copied to primary care should involve prior discussion and acceptance by a relevant clinician. Although GPs and NPs reported poorer work-life balance, lower job satisfaction and higher rates of burnout compared with the other primary care professions, all professions have seen reductions in their patient-facing hours in the past 5 years, with increased administrative burden identified as a major contributing factor. Indeed, 47.7% of the GPs surveyed stated their intent to leave primary care within the next 5 years. The median proportion of non-patient-facing clinical hours as part of total clinical hours was 31% for GPs, 17% for urgent care physicians, and 31% for both NPs and other primary care professionals. Among GPs, a higher proportion of non-patient-facing clinical work was associated with older age, female gender, other non-European ethnicity, holding vocational registration in general practice, more years of general practice experience, having a personal list of enrolled patients and working in a non-Very Low Cost Access practice. However, medico-legal awareness of copied results was not associated with an increased proportion of non-patient-facing clinical work.</p><p><strong>Conclusion: </strong>A gap in medico-legal knowledge related to test result responsibility exists within the primary care workforce. While this deficit was not linked to increased time spent on non-patient-facing clinical work, the majority of clinician","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"32-55"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanna Katovich, Vidit Singh, Eugene Michael, James McKelvie
Aim: To evaluate the impact of the COVID-19 pandemic on New Zealand ophthalmology surgical training, focusing on surgical volume, case-mix, trainee involvement and gender disparities.
Methods: Analysis of logbook data for New Zealand based trainees of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) from 1 January 2017 to 31 December 2022 was conducted comparing trainee-involved and trainee-performed case volumes between pre-pandemic (2017-2019) and pandemic (2020-2022) years, normalised by full-time equivalents (FTE).
Results: Analysis of 41,370 trainee-involved surgeries revealed that while the total number of trainee-involved procedures remained stable during the pandemic, trainee-performed surgeries decreased significantly by 11.8%. This was driven by a significant gender disparity (p=0.045), with a 24.9% decline for female trainees, concentrated among those in urban centres, while male trainee numbers remained stable (+0.74%). Provincial trainees performed twice as many surgeries as urban counterparts. A significant case-mix shift also occurred, with greater glaucoma (+27.6%) and fewer oculoplastic (-20.8%) surgeries.
Conclusion: The pandemic was associated with a significant gender disparity in surgical training, driven by a reduction in procedures performed by female trainees predominantly in urban centres. The findings underscore the need to ensure equitable access to surgical training.
{"title":"Gender disparity and the impact of COVID-19 on surgical training in New Zealand ophthalmology.","authors":"Hanna Katovich, Vidit Singh, Eugene Michael, James McKelvie","doi":"10.26635/6965.7003","DOIUrl":"https://doi.org/10.26635/6965.7003","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the impact of the COVID-19 pandemic on New Zealand ophthalmology surgical training, focusing on surgical volume, case-mix, trainee involvement and gender disparities.</p><p><strong>Methods: </strong>Analysis of logbook data for New Zealand based trainees of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) from 1 January 2017 to 31 December 2022 was conducted comparing trainee-involved and trainee-performed case volumes between pre-pandemic (2017-2019) and pandemic (2020-2022) years, normalised by full-time equivalents (FTE).</p><p><strong>Results: </strong>Analysis of 41,370 trainee-involved surgeries revealed that while the total number of trainee-involved procedures remained stable during the pandemic, trainee-performed surgeries decreased significantly by 11.8%. This was driven by a significant gender disparity (p=0.045), with a 24.9% decline for female trainees, concentrated among those in urban centres, while male trainee numbers remained stable (+0.74%). Provincial trainees performed twice as many surgeries as urban counterparts. A significant case-mix shift also occurred, with greater glaucoma (+27.6%) and fewer oculoplastic (-20.8%) surgeries.</p><p><strong>Conclusion: </strong>The pandemic was associated with a significant gender disparity in surgical training, driven by a reduction in procedures performed by female trainees predominantly in urban centres. The findings underscore the need to ensure equitable access to surgical training.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"56-65"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS) is an innovative tool designed to support equitable service delivery within specialist healthcare services. A multidisciplinary team reviewed the health system structure and developed the HMET-SHS in the form of a Periodic Service Review (PSR) for measuring and monitoring Hauora Māori outcomes in specialist health services. The HMET-SHS promises to reshape specialist healthcare services and champion equitable healthcare improvements for all New Zealanders.
{"title":"Introducing the Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS).","authors":"Maira Patu, Melissa Kerdemelidis, Nadia Summers, Nathan J Monk, Amber Philpott, Angela Beard, Janet Geddes, Scott Babington, Stephen Mark, Suzanne Pitama","doi":"10.26635/6965.6942","DOIUrl":"https://doi.org/10.26635/6965.6942","url":null,"abstract":"<p><p>The Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS) is an innovative tool designed to support equitable service delivery within specialist healthcare services. A multidisciplinary team reviewed the health system structure and developed the HMET-SHS in the form of a Periodic Service Review (PSR) for measuring and monitoring Hauora Māori outcomes in specialist health services. The HMET-SHS promises to reshape specialist healthcare services and champion equitable healthcare improvements for all New Zealanders.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"80-93"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Spontaneous closure and later recurrence of a macular hole requiring vitrectomy.","authors":"QuanLe Li, Francesc March de Ribot","doi":"10.26635/6965.6958","DOIUrl":"https://doi.org/10.26635/6965.6958","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"104-107"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087810","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Time to make CPR and first aid training compulsory in New Zealand schools.","authors":"Clive Solomon","doi":"10.26635/6965.7166","DOIUrl":"https://doi.org/10.26635/6965.7166","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"116-118"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim: To provide a balanced account of psilocybin treatment of depression for expectations to be appropriately set.
Method: Review and discussion of key psilocybin efficacy studies. Reporting of side effects and risk of harm with psychedelic treatments. Comparisons and contrasts with ketamine studies of treatment-resistant depression (TRD).
Result: Early psilocybin studies offer promise but expectation bias and functional unblinding are factors in the treatment response. Psilocybin is generally well tolerated but side effects are often not systematically reported, and some recipients may experience harm. The ketamine research has similar methodological considerations, but the weight of positive evidence is stronger for a treatment-resistant group.
Conclusion: The evidence for psilocybin treatment of depression is insufficient to press for wider availability and use.
{"title":"Reappraisal of the hype and hope offered by psilocybin treatment of depression.","authors":"Ben Beaglehole, Jenni Manuel","doi":"10.26635/6965.7138","DOIUrl":"https://doi.org/10.26635/6965.7138","url":null,"abstract":"<p><strong>Aim: </strong>To provide a balanced account of psilocybin treatment of depression for expectations to be appropriately set.</p><p><strong>Method: </strong>Review and discussion of key psilocybin efficacy studies. Reporting of side effects and risk of harm with psychedelic treatments. Comparisons and contrasts with ketamine studies of treatment-resistant depression (TRD).</p><p><strong>Result: </strong>Early psilocybin studies offer promise but expectation bias and functional unblinding are factors in the treatment response. Psilocybin is generally well tolerated but side effects are often not systematically reported, and some recipients may experience harm. The ketamine research has similar methodological considerations, but the weight of positive evidence is stronger for a treatment-resistant group.</p><p><strong>Conclusion: </strong>The evidence for psilocybin treatment of depression is insufficient to press for wider availability and use.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1622","pages":"94-97"},"PeriodicalIF":1.3,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145087833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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