The principal scientific journal for the profession in New Zealand

Vol 135 No 1565: 2 December 2022

Doctor owned investigation and treatment facilities: a conflict of interest or a pragmatic way forward?

Editorial
Open Access

Doctor owned investigation and treatment facilities: a conflict of interest or a pragmatic way forward?

The New Zealand health system is implementing a significant reform agenda amidst continued pressure related to the COVID-19 pandemic. A feature of the response, as the system continues to work through the reform agenda, has been the use of capacity and capability across both public and private components of the sector.

Article
Open Access

An assessment of burnout in New Zealand orthopaedic resident medical officers

It is well documented that burnout and fatigue are common in the medical profession. Most of the available literature is based on assessment of the senior workforce, focussing primarily on consultants.

Article
Open Access

A health sector response to the commercial determinants of health

The large losses and inequities in health and wellbeing due to harmful commodities such as tobacco, alcohol, unhealthy food and beverages, and gambling products are well-established.

Viewpoint
Open Access

Beyond muddy waters: Three Waters reforms required to future-proof water service delivery and protect public health in Aotearoa New Zealand

In 2016, drinking water contaminated with animal faeces made much of an entire town sick (~8,000 people), with 58 hospitalisations and four deaths, costing an estimated NZ$21million. The outbreak was an outcome of systemic flaws in Aotearoa New Zealand’s regulatory system for drinking water, which were highlighted in the ensuing Government Inquiry.

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ARTICLE
Vol 135 No 1566: 2 December 2022

A health sector response to the commercial determinants of health

Sarah Sharpe, Karen McIlhone, Summer Hawke, Shanthi Ameratunga

The large losses and inequities in health and wellbeing due to harmful commodities such as tobacco, alcohol, unhealthy food and beverages, and gambling products are well-established.

ARTICLE
Vol 135 No 1566: 2 December 2022

A survey of adult respiratory and sleep services in Aotearoa New Zealand: inequities in the provision of adult respiratory and sleep services

Roland Meyer, Paul Dawkins, James Fingleton, Brett Shand, Elaine Yap

Standards for respiratory and sleep services in New Zealand were recognised and published on the Ministry of Health (MoH) website in 2004, where they have remained unchanged.

ARTICLE
Vol 135 No 1566: 2 December 2022

Community specialist palliative care services in New Zealand: a survey of Aotearoa hospices

Salina Iupati, Rod MacLeod, James Stanley, Cheryl Davies, Richard Egan

With Aotearoa New Zealand’s ageing population, demand for palliative care is projected to increase substantially in the next 20 years, whilst equitable access to palliative care services is emphasised in the Ministry of Health’s Palliative Care Action Plan.

ARTICLE
Vol 135 No 1566: 2 December 2022

Presenting characteristics, length of stay and oxygen use among COVID-19 cases at a single tertiary hospital in Auckland, New Zealand, using retrospective medical recorded data | OPEN ACESS

Nicole Hotchkiss, Georgia Van Zantvoort, Christin Coomarasamy, Eunicia Tan, Andrew Brainard

In the August 2021 Delta outbreak, the use of diagnostic and predictive models for COVID-19 for clinical and resource management were undeveloped. Efficient diagnosis and clinical predictors of disease severity were needed.

ARTICLE
Vol 135 No 1566: 2 December 2022

An assessment of burnout in New Zealand orthopaedic resident medical officers

Tanushk Luke Brito Martyn, Earle Savage, Simon Bruce Murdoch MacLean

It is well documented that burnout and fatigue are common in the medical profession. Most of the available literature is based on assessment of the senior workforce, focussing primarily on consultants.

ARTICLE
Vol 135 No 1565: 11 November 2022

Medication dispensing among Māori and non-Māori screened for preschool ADHD

Tania Cargo, Kiani Stevenson, Nicholas Bowden, Barry Milne, Sarah Hetrick, Stephanie D’Souza

Children with a diagnosis of ADHD are significantly more likely to experience adverse outcomes, including anti-social behaviour and drug use, criminal convictions, mental health difficulties, poorer physical health and negative academic and occupational outcomes. It is important to identify children with symptoms indicative of ADHD to facilitate early identification and treatment and to mitigate the risk of poorer long-term outcomes.

ARTICLE
Vol 135 No 1565: 11 November 2022

Feasibility and acceptability of telehealth and contactless delivery of human papillomavirus (HPV) self-testing for cervical screening with Māori and Pacific women in a COVID-19 outbreak in Aotearoa New Zealand

Karen Bartholomew, Jane Grant, Anna Maxwell, Collette Bromhead, Fiona Gillett, Rajneeta Saraf, Kate Moodabe, Susan M Sherman, Georgina McPherson, Deralie Flower, Jyoti Kathuria, Sue Crengle, Richard Massey, Nina Scott, Pania Coote

Nearly 200 cases of cervical cancer are reported annually in Aotearoa New Zealand, with incidence and mortality rates in Māori and Pacific women more than two folds higher than in NZ European women.

ARTICLE
Vol 135 No 1565: 11 November 2022

Socio-economic deprivation and healthcare service use of young people with type 1 and type 2 diabetes

Sasini M. Wijayaratna, Arier Lee, Emmanuel Jo, Hyun Young Park, Tim Cundy, Warwick Bagg

In Aotearoa New Zealand, which has experienced marked increases in inequality, early onset T2D disproportionately affects the Indigenous Māori population, Pacific people (Pasifika), and those of South Asian descent.

ARTICLE
Vol 135 No 1565: 11 November 2022

Asian New Zealanders’ experiences of racism during the COVID-19 pandemic and its association with life satisfaction | OPEN ACCESSS

Rebekah Jaung, Lynne Soon-Chean Park, Joohyun J Park, David Mayeda, Changzoo Song

Based on an online survey method, this paper aims to depict the experiences of racism among members of Asian communities in Aotearoa before and after the start of the pandemic, and explain the association between their racism experiences and life satisfaction.

ARTICLE
Vol 135 No 1565: 11 November 2022

Ethnicity data audit in a secondary care gastroenterology service

Jennifer Randle, Stephen Inns, Ricci Harris, Melissa McLeod

Accurate ethnicity data are important because they are used to quantify health inequities, including monitoring trends in disease rates and healthcare delivery. In relation to Māori health equity, high-quality ethnicity data in health are also an obligation under Te Tiriti.

EDITORIAL
Vol 135 No 1566: 2 December 2022

Doctor owned investigation and treatment facilities: a conflict of interest or a pragmatic way forward?

Peter Robertson

The New Zealand health system is implementing a significant reform agenda amidst continued pressure related to the COVID-19 pandemic. A feature of the response, as the system continues to work through the reform agenda, has been the use of capacity and capability across both public and private components of the sector.

EDITORIAL
Vol 135 No 1565: 11 November 2022

The long road to good care

Jason K Gurney

This travel issue impacts our Indigenous Māori population to a much greater extent than it impacts our non-Māori population. Around 25% of Māori live in rural areas, compared to 20% of NZ Europeans, 7% Pasifika and 5% Asian—and nearly a third (32%) of those who live in the most remote areas of Aotearoa are Māori.

EDITORIAL
Vol 135 No 1564: 28 October 2022

Suicide amongst doctors

Roger Mulder, Frank Frizelle

Burnout has been documented to affect 45% in a consultant survey in one New Zealand hospital prior to the COVID-19 pandemic, and this is likely to have increased with the present frustrating work environment.

EDITORIAL
Vol 135 No 1563: 7 October 2022

Early-onset colorectal cancer: Never too young

Oliver Waddell, Jacqui Keenan, Frank Frizelle

Colorectal cancer (CRC) is the second most common cancer in Aotearoa New Zealand, second only behind prostate cancer in men and breast cancer in woman. It is the second highest cause of cancer death behind lung cancer, with approximately the same death rate as prostate and breast cancer combined.

EDITORIAL
Vol 135 No 1562: 23 September 2022

Regional vs Metropolitan. Bigger is not always better

Chris Wakeman, Rachael Lauchlan, Ros Pochin

Trauma team activation is used throughout the world to gather the multi-disciplinary teams to meet trauma patients in emergency department (ED) trauma bays, with the aim of providing the best possible treatment for the unwell trauma patient. Trauma teams have been shown to reduce the time to resuscitation, time to computed tomography (CT), time to discharge from the ED and, most importantly, time to transfer to the operating theatre.

EDITORIAL
Vol 135 No 1561: 2 September 2022

Does the smokefree generation proposal go far enough?

Janet Hoek, Andrew Waa, Richard Edwards

The Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Bill currently progressing through Parliament will establish a smokefree generation (SFG) by ending the sale of smoked tobacco products to people born on or after 1 January 2009.

EDITORIAL
Vol 135 No 1561: 2 September 2022

The present healthcare crises and the delusion of looking for an answer to this in the restructuring of the health system

Frank Frizelle

The New Zealand primary and secondary health sectors are struggling to provide an adequate service and meet demand.

VIEWPOINT
Vol 135 No 1566: 2 December 2022

Beyond muddy waters: Three Waters reforms required to future-proof water service delivery and protect public health in Aotearoa New Zealand

Tim Chambers, Professor Nick Wilson, Professor Simon Hales, Marnie Prickett, Edward Ellison, Professor Michael G Baker

In 2016, drinking water contaminated with animal faeces made much of an entire town sick (~8,000 people), with 58 hospitalisations and four deaths, costing an estimated NZ$21million. The outbreak was an outcome of systemic flaws in Aotearoa New Zealand’s regulatory system for drinking water, which were highlighted in the ensuing Government Inquiry.

VIEWPOINT
Vol 135 No 1565: 11 November 2022

Understanding disparities in post-operative mortality for Indigenous patients

Jason K Gurney, Melissa McLeod, Courtney Thomas, Doug Campbell, Elizabeth Dennett, Sarah Jackson, Dick Ongley, Juliet Rumball-Smith, James Stanley, Diana Sarfati, Jonathan Koea

In 2014, a Lancet commission was launched to investigate the state of global surgery. Stating that “surgery is an indivisible, indispensable part of health care”, the Commission re-confirmed the importance of safe, affordable and equitable surgical care for all, and highlighted the rights of under-served populations not currently being met.

VIEWPOINT
Vol 135 No 1564: 28 October 2022

Radiology and Te Whatu Ora – Health New Zealand in 2022. Why we should all care

Anthony James Doyle

Demand for radiology in the public system continues to increase and, in recent years, has exceeded both population growth and the ability of the existing services to cope with that demand.

VIEWPOINT
Vol 135 No 1563: 7 October 2022

Identification of clinically relevant cohorts of people with heart failure from electronic health data in Aotearoa: potential, pitfalls and a plan | OPEN ACCESS

Heart failure (HF) is a complex clinical syndrome caused by underlying abnormalities of cardiac structure and/or function that reduces the ability of the heart to fill with blood and/or eject adequate blood volume to meet the needs of the body.

VIEWPOINT
Vol 135 No 1562: 23 September 2022

Responding to the tāngata whai ora voice: an Aotearoa New Zealand quality improvement solution

Amanda Luckman, Paul Clements, Thomas White, Angela Jury, Jennifer Lai, Mark Smith

To truly recognise and hear the voices of people who experience mental health challenges and substance use issues (tāngata whai ora – people seeking wellness) it is imperative to act on information about people’s service experiences.

VIEWPOINT
Vol 135 No 1561: 2 September 2022

Pākehā/Palangi positionality: disentangling power and paralysis | OPEN ACCESS

Andi Crawford, Fiona Langridge

This paper explores our viewpoint based on experiences as Pākehā/Palangi health practitioners and researchers working in Māori and Pasifika communities. In reflecting on our practice, we noted there was limited literature that explored and critiqued Pākehā/Palangi perspectives in health and health research environments.

VIEWPOINT
Vol 135 No 1560: 19 August 2022

The 2021 Global Health Security (GHS) Index: Aotearoa New Zealand’s improving capacity to manage biological threats must now be consolidated

Matt Boyd, Michael G Baker, Cassidy Nelson, Nick Wilson

The Global Health Security (GHS) Index was first published in 2019 by the Nuclear Threat Initiative (NTI), Johns Hopkins Centre for Health Security, and the Economist Intelligence Unit. It is a comprehensive, criteria-based assessment of health security capabilities across 195 States Parties to the International Health Regulations. The metric encompasses six categories relevant to health security and biological threats: Prevent, Detect, Respond, Health, Norms, and Risk.

LETTER
Vol 135 No 1566: 2 December 2022

Medical students and informed consent—response to “Consent for Teaching”

Sarah C Rennie, Lynley Anderson, Alan F Merry, Suzanne Pitama, Papaarangi Reid, Jeanne Snelling, Simon Walker, Tim Wilkinson, Warwick Bagg

We disagree with Dr Gray’s proposal that the consensus statement is flawed. Gray argues the consensus statement is couched in ethical terms that prioritise patient autonomy, which is inconsistent with the approach of balancing the quadruple aim of quality medical practice.

LETTER
Vol 135 No 1566: 2 December 2022

Novel use of technology

Gaenor Bell, Brad Peckler, Christine Coulter

I am a Trainee Intern (TI) doing a rotation in General Practice (GP) where unfortunately my GP supervisor came down with COVID-19. As she was not unwell with it, we decided that we would still see patients and her nurse and I would act as a surrogate.

LETTER
Vol 135 No 1563: 7 October 2022

Azithromycin versus doxycycline: management of female urogenital and rectal Chlamydia trachomatis infections

Elissa M McDonald, Rachel T Woodcock, Felix S F Ram

Chlamydia trachomatis infection is the most common sexually transmitted infection (STI) internationally, with the greatest burden of disease in young sexually active adults, and it is associated with pelvic inflammatory disease, chronic pelvic pain, infertility and pregnancy complications.

LETTER
Vol 135 No 1563: 7 October 2022

Cardiac Computed Tomography to exclude left atrial appendage thrombus in atrial arrhythmias prior to electrical cardioversion during the COVID-19 pandemic

Jeffrey Sebastian, Tina Thomas, Francis Wu, Su Yin Tang, Budresh Joshi, Niels van Pelt, Ruvin Gabriel, Tim Sutton, Mansi Turaga, Jen-Li Looi

Our group had recently showed that an early rhythm control strategy, with either early inpatient transoesophageal echocardiogram (TOE)-guided direct current cardioversion (DCCV) or ablation in patients hospitalised with AF or AFL and decompensated heart failure with reduced ejection fraction, had a low rate of all-cause mortality and rehospitalisation for heart failure at one year.

LETTER
Vol 135 No 1562: 23 September 2022

Is PHARMAC’s decision-making fair, cost-effective and clinically effective? Observations from the real world

We identified other aspects of PHARMAC’s interactions with clinicians, and its clinical advisors, that led us to conclude that the outcomes of PHARMAC’s decision-making is not clinically efficient, cost-effective or fair.

LETTER
Vol 135 No 1562: 23 September 2022

Global food security, self-sufficiency and the cost of bread to Aotearoa

Elaine Rush, Heather Came, Gayle Souter-Brown, Geoff Kira

Agriculture is the main driver of food and nutrition security, yet few governments and trade agreements have cohesive policies that link national food guidelines based on evidence for prevention of disease and promotion of health and immunity to agricultural and economic policies.

LETTER
Vol 135 No 1560: 19 August 2022

Just because you can…does not mean you should: an examination of efficacy and potential harms from non-prescribed supplements taken by members of the Christchurch Health and Development Study at age 40

Geraldine FH McLeod, Anna Fenton, Bryony Manning, Andrea Insch, Joseph M Boden

The development and sale of non-prescribed dietary supplements is a growing industry. According to Euromonitor (2020) the value of global retail sales of non-prescribed supplements increased by 105% between 2007 and 2021. New Zealand’s market grew by 72% during the same period from NZ$194.8 million to NZ$335.5 million. Global demand for supplements such as vitamins C and D, minerals and herbal supplements increased as the COVID-19 pandemic has worsened despite, in most cases, no scientific evidence that their consumption can directly combat SARS CoV-2.

BOOK REVIEW
Vol 135 No 1550: 25 February 2022

This pākehā life: an unsettled memoir

Kaaren Mathias

This pākehā life: an unsettled memoir is a candid memoir by Alison Jones, who currently is a Professor in the Faculty of Education and Social Work at the University of Auckland in the school of Māori and Indigenous Education, Te Puna Wānanga.

BOOK REVIEW
Vol 134 No 1532: 26 March 2021

Perfection: The life and times of Sir William Manchester

Saxon Connor

I recently spent a weekend in Martinborough and as many people do spent some time browsing the local bookshop.

BOOK REVIEW
Vol 133 No 1527: 18 December 2020

From Southland to Surgery: A Journey around Values

Richard Acland

Professor John Morton has not only written an intriguing catalogue of the Christchurch surgical scene in the latter part of the 20th century, but has also provided a well-considered philosophy for medical care.

BOOK REVIEW
Vol 133 No 1521: 4 September 2020

My Life in Public Health

Frank Frizelle

In the time of Covid, some of the superheroes of the health sector are the public health physicians. This book outlines the active and varied personal and professional life of one New Zealand public health physician.

BOOK REVIEW
Vol 132 No 1489: 1 February 2019

Mind That Child; A Medical Memoir

Frank Frizelle

This a book that recounts the experience of the Auckland Starship’s paediatrician Dr Simon Rowley over his professional lifetime.

BOOK REVIEW
Vol 132 No 1488: 18 January 2019

The Art of Recovery: six personal journeys

Frank Frizelle

As an editor you receive books for review, which are sent to suitable people following an email agreement to review.

BOOK REVIEW
Vol 132 No 1488: 18 January 2019

Fat Off; the Right Way A clever and sustainable eating guide for weight loss and healthy living

Frank Frizelle

Paul Anderson is a New Zealander who trained in general surgery and works part-time in Australia and part-time in New Zealand.

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