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The New Zealand Medical Journal

 Journal of the New Zealand Medical Association, 20-January-2012, Vol 125 No 1348

This Issue in the Journal
Pre-hospital delay in acute coronary syndromes: PREDICT CVD-18
Daniel Garofalo, Corina Grey, Mildred Lee, Daniel Exeter, Andrew J Kerr
In people admitted to Middlemore Hospital with heart attacks and unstable angina we studied the time delay between developing chest pain and coming under potentially life-saving paramedic care. Over a half of people had a delay in the community of over 3 hours. Those from more deprived areas were delayed more than an hour compared with those from less deprived areas. Māori, Pacific, Indian and those from areas of higher deprivation were less likely to travel to hospital by ambulance. Community intervention targeted at more disadvantaged communities and higher risk ethnic groups should be considered as part of an overall strategy to reduce disparity and improve cardiac outcomes.
Uptake of pulmonary rehabilitation in New Zealand by people with chronic obstructive pulmonary disease in 2009
William M M Levack, Mark Weatherall, Julie C Reeve, Christina Mans, Antonia Mauro
Pulmonary rehabilitation is a health intervention for people with respiratory disease that typically involves an 8–16 week programme of group exercise and education. Pulmonary rehabilitation is one of the few health interventions that has been demonstrated to improve physical function and quality of life in people with chronic obstructive pulmonary disease (COPD)—a disorder affecting approximately120,000 to 320,000 New Zealanders. This survey investigated the total uptake of pulmonary rehabilitation in New Zealand by people with COPD in 2009, and found that currently approximately only 1% of the total population of people who could potentially benefit from pulmonary rehabilitation were participating in it in one year. Given the cost-effectiveness of pulmonary rehabilitation for improving health outcomes for people with COPD, there is a need for far greater investment of healthcare resources in pulmonary rehabilitation and a need for the development of strategies to improve its uptake.
Hazardous patterns of alcohol use are relatively common in smokers: ITC Project (New Zealand)
Nick Wilson, Deepa Weerasekera, Christopher W Kahler, Ron Borland, Richard Edwards
In this study we aimed to describe patterns of alcohol use in a nationally-representative sample of 1376 New Zealand smokers. We found that a third (33.1%) of these smokers had a drinking pattern that was considered hazardous (i.e., AUDIT scores >=8). These figures were much higher than for non-smokers in the NZ Health Survey (at 13.1%). Furthermore, we found that hazardous drinking patterns were significantly more common among: younger smokers, male smokers, and Māori smokers (and in some analyses for smokers with financial stress and for moderate individual-level deprivation). Given the international evidence that hazardous drinking may impede quitting, policy makers could consider the potential benefits of improved alcohol control as part of the national strategy to curtail the tobacco epidemic and achieve the government’s “Smokefree Nation 2025” goal. Such an approach could also reduce this country’s high levels of alcohol-related harm and reduce gender and ethnic health inequalities.
Diagnosis of disorders of intermediary metabolism in New Zealand before and after expanded newborn screening: 2004–2009
Callum Wilson, Nicola J Kerruish, Bridget Wilcken, Esko Wiltshire, Kathy Bendikson, Dianne Webster
Inborn errors of metabolism refer to a group of rare genetic chemical disorders. Children with these conditions often present with serious symptoms such as coma. However because these symptoms are usually due to other more common conditions clinicians may not investigate the patient for an underlying metabolic disorder. This is unfortunate as treatment, if commenced very early dramatically improves the outcome. This paper reports the findings of a nationwide 3-year surveillance study that shows that these disorders have been under diagnosed in recent years in New Zealand. A small number of children are likely to have died yearly as a result. The recent introduction of expanded newborn screening, a process whereby key chemicals are measured in the neonatal Guthrie card blood test prior to the child becoming sick , will hopefully improve this situation. The paper further discusses this new form of screening, its advantages and limitations.
New Zealanders’ knowledge of palliative care and hospice services
Rod D MacLeod, Rachel Thompson, John W Fisher, Kris Mayo, Nathan Newman, Donna M Wilson
This project surveyed over 1000 New Zealanders’ views about palliative care and local hospice services. There was a reasonably good understanding of the concept of palliative care. However, people could not always identify local hospices, with younger people and males more unaware of accessible hospice services. Better education about what hospices do is needed.
Ocular trauma epidemiology: 10-year retrospective study
Archana Pandita, Michael Merriman
This paper gives an insight regarding the eye trauma within New Zealand, illustrates common causes and effects from it. Appropriate safety and precautionary measures can be taken to prevent much eye trauma from happening, reducing visual loss and impact on the community from it.
Aspiration pneumonia and challenges following the Samoa Tsunami in 2009
Tamara Ah Leong-Nowell, Foloto Leavai, Lucilla Ah Ching, Limbo Fiu, Rosemary Wyber, Mitzi Nisbet, David Jones, Tim Blackmore, Tupu Ioane-Cleverley
The medical problems of the tsunami that hit Samoa in 2009 was caused by the pressure of tsunami waves forcing dirty seawater contaminated with all sorts of foreign objects (blunt or sharp), germs, sand and mud to penetrate the skin through to deep tissue and organs such as the lungs causing aspiration pneumonia or “tsunami lung” and can cause blood stream infection, that can kill unless aggressively treated in a timely manner.
This paper reports the challenge of treating tsunami lung victims in a developing country like Samoa, with all the expected problems of limited resources for diagnosis, treatment and monitoring. The challenge was that little is known about how best to treat tsunami lungs, as randomised trials upon which best practice is based are not appropriate or ethical to be carried out in such disaster situations. Despite numerous tsunami disasters, there is no database of tsunami shared-experiences to learn from, particularly for doctors working in undeveloped countries with resources and internet access. Local doctors generally have the best understanding of the local health situation as well as their resource constraints are fundamental for the initial and on-going tsunami response efforts. The management approach taken during the Samoa situation was driven by necessity, locally available resources and the application of basic clinic practice with suggestions from overseas experts.
The outcomes of the Samoa tsunami patients admitted with aspiration pneumonia were very good, only one patient died and all were discharged with no complications on follow-up.
     
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