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Issue

Vol 131 No 1472: 23 March 2018

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Issue Summary

SUMMARY

Ethnic disparities in attendance at New Zealand s chronic pain services

Gwyn N Lewis, Angela Upsdell

The study investigated the ethnicity of people attending our chronic pain services. We found that, overall, Europeans were over-represented but Pasifika and Asian people were under-represented at the services. In addition, non-European populations tended to score worse on clinical assessments undertaken at their first visit. These findings suggest ethnic disparities in attendance at our chronic pain services that should be addressed.

SUMMARY

A review of cervical cancer occurrences in New Zealand 2008 2012

Phil Hider, Kieran Dempster-Rivett, Jonathan Williman, Michelle Dempster-Rivett, Lynn Sadler, Melissa McLeod, Andrew Miller, Peter Sykes

Information about women diagnosed with cervical cancer during 1 January 2008-31 December 2012 was reviewed in order to identify where improvements could be made to the National Cervical Screening Programme. Only 13% of the 644 women aged 25-69 years diagnosed with cervical cancer had undergone regular cervical cancer screening according to New Zealand guidelines. This proportion was lower among Mori and Pacific people and those living in deprived areas. Ongoing efforts are required to improve the uptake of regular cervical screening, particularly for Mori and socio-economically disadvantaged women/wahine. Continuous monitoring of the cervical screening programme using population-linked data, second reviews of screening tests reported as negative and more detailed clinical information from new cancer cases are needed to inform further improvements to cervical cancer prevention in New Zealand.

SUMMARY

Cost implications of avoidable rapid response call activations in older patients

Ashwin Subramaniam, Cameron Green, Mohammad Omair, Aun Chian Yeoh, Lionel Soh, Ravindranath Tiruvoipati

Rapid response calls (RRCs) are designed to appropriately manage clinical deterioration. However, not all RRCs are appropriate due to medical futility or the patient s wishes. Incidence and costs associated with avoidable-RRC (ARRC) remain underexplored. The study aimed to describe the incidence and costs of ARRC activations in older patients. We observed that 10% of RRCs are associated with increased time and financial costs. The costs for investigations, equipment and management was AUD $2,267.01, opportunity costs were AUD $3,861.55, with a grand total cost of AUD $6,128.56.

SUMMARY

Clinical guidelines: what happens when people have multiple conditions?

Elinor Millar, Anthony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

More people are now living with multimorbidity (multiple long-term conditions). Currently clinical treatment guidelines focus on the management of individual conditions, and don t usually consider the impact of combining multiple guidelines for someone with multiple conditions. This may lead to interactions between treatments and often leads to a burdensome treatment regime for patients. Clinical guidelines could be improved to better support clinicians to provide care for people with multimorbidity.

SUMMARY

A fast track clinic improves diagnosis and treatment times for those investigated for lung cancer in Northland District Health Board

Sophie Williams, Peter Davies, Blair Johnson, Stephen Iles

Those with lung cancer can have lots of tests in one day. Where this is done it speeds up diagnosis and treatment, and patients find this helpful. We could improve further by adding in more methods of biopsy such as endoscopic ultra-sound guided biopsy, but this involves investment in equipment and staff.

SUMMARY

Carcinogenicity of glyphosate: why is New Zealand's EPA lost in the weeds?

Jeroen Douwes, Andrea t Mannetje, Dave McLean, Neil Pearce, Alistair Woodward, John D Potter

In 2015, the International Agency for Research on Cancer (IARC) concluded that glyphosate is probably carcinogenic to humans. The New Zealand Environmental Protection Authority (NZEPA) rejected this and commissioned a new report, concluding that glyphosate was unlikely to be genotoxic or carcinogenic to humans. We conclude that the NZEPA process for evaluating the carcinogenicity of glyphosate was flawed and urge that: the NZEPA report be withdrawn; the NZEPA respond to the concerns raised and for a reassessment to be conducted; and clearer process and better understanding of science be used to inform any future review of hazardous substances in New Zealand.

SUMMARY

Health consequences of transport patterns in New Zealand s largest cities

Caroline Shaw, Edward Randal, Michael Keall, Alistair Woodward

This study aimed to look at sustainable transport systems in New Zealand s six largest cities and quantify the health consequences of the current transport situation. We estimated the health impacts and carbon emission changes if Auckland, Tauranga, Hamilton, Christchurch and Dunedin had the same walking, cycling and public transport levels as Wellington currently does. All cities would have health benefits, for example in Auckland s case there would be 57 fewer premature deaths each year, in Tauranga 50 fewer. The health gain would be as a result of increased physical activity, reduced air pollution and reduced overall injury (despite slightly increased cyclist and pedestrian injury) due to fewer cars on the roads. Carbon emissions from light vehicles would be between 7 to 32% lower (depending on the city) if the other big cities in New Zealand had the same transport patterns as Wellington currently does. Local (and central) Government needs better transport policies that take into account health and carbon impacts.

SUMMARY

Childhood predictors of adult adiposity: findings from a longitudinal study

Geraldine FH McLeod, David M Fergusson, L John Horwood, Joseph M Boden, Frances A Carter

This paper uses data gathered as part of the Christchurch Health and Development Study, a longitudinal study of a cohort of 1,265 children born in Christchurch in 1977, to examine childhood factors associated with later risks of overweight and obesity in adulthood. At ages 30 and 35 years, approximately one-third of the cohort were overweight and one-fifth were obese. Childhood predictors of overweight and obesity spanned an array of factors reflecting social and family background, biological endowment, cognitive ability and childhood adversity. Potential implications of these findings for programmes aiming to reduce the prevalence of overweight and obesity are discussed.

ALL ARTICLES
SUMMARY

Climate change: allergens and allergic diseases

Ethnic disparities in attendance at New Zealand s chronic pain services

Gwyn N Lewis, Angela Upsdell

A review of cervical cancer occurrences in New Zealand 2008 2012

Phil Hider, Kieran Dempster-Rivett, Jonathan Williman, Michelle Dempster-Rivett, Lynn Sadler, Melissa McLeod, Andrew Miller, Peter Sykes

Cost implications of avoidable rapid response call activations in older patients

Ashwin Subramaniam, Cameron Green, Mohammad Omair, Aun Chian Yeoh, Lionel Soh, Ravindranath Tiruvoipati

Multimorbidity and clinical guidelines: problem or opportunity?

Tim Stokes

Clinical guidelines: what happens when people have multiple conditions?

Elinor Millar, Anthony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

Performance of risk scores at predicting post-operative atrial fibrillation after coronary artery bypass grafting

Tom Kai Ming Wang

Some Biological Aspects of Warfare

Ingested bread clip as an unexpected diagnostic tool

Sharon Jay, Michael Russell, Yee Lau, Joel Dunn, Ross Roberts

A fast track clinic improves diagnosis and treatment times for those investigated for lung cancer in Northland District Health Board

Sophie Williams, Peter Davies, Blair Johnson, Stephen Iles

E-cigarettes: NRT or new commercial addictive agents?

Philip Pattemore

Carcinogenicity of glyphosate: why is New Zealand's EPA lost in the weeds?

Jeroen Douwes, Andrea t Mannetje, Dave McLean, Neil Pearce, Alistair Woodward, John D Potter

Health consequences of transport patterns in New Zealand s largest cities

Caroline Shaw, Edward Randal, Michael Keall, Alistair Woodward

Childhood predictors of adult adiposity: findings from a longitudinal study

Geraldine FH McLeod, David M Fergusson, L John Horwood, Joseph M Boden, Frances A Carter

SUMMARY

Ethnic disparities in attendance at New Zealand s chronic pain services

Gwyn N Lewis, Angela Upsdell

The study investigated the ethnicity of people attending our chronic pain services. We found that, overall, Europeans were over-represented but Pasifika and Asian people were under-represented at the services. In addition, non-European populations tended to score worse on clinical assessments undertaken at their first visit. These findings suggest ethnic disparities in attendance at our chronic pain services that should be addressed.

SUMMARY

A review of cervical cancer occurrences in New Zealand 2008 2012

Phil Hider, Kieran Dempster-Rivett, Jonathan Williman, Michelle Dempster-Rivett, Lynn Sadler, Melissa McLeod, Andrew Miller, Peter Sykes

Information about women diagnosed with cervical cancer during 1 January 2008-31 December 2012 was reviewed in order to identify where improvements could be made to the National Cervical Screening Programme. Only 13% of the 644 women aged 25-69 years diagnosed with cervical cancer had undergone regular cervical cancer screening according to New Zealand guidelines. This proportion was lower among Mori and Pacific people and those living in deprived areas. Ongoing efforts are required to improve the uptake of regular cervical screening, particularly for Mori and socio-economically disadvantaged women/wahine. Continuous monitoring of the cervical screening programme using population-linked data, second reviews of screening tests reported as negative and more detailed clinical information from new cancer cases are needed to inform further improvements to cervical cancer prevention in New Zealand.

SUMMARY

Cost implications of avoidable rapid response call activations in older patients

Ashwin Subramaniam, Cameron Green, Mohammad Omair, Aun Chian Yeoh, Lionel Soh, Ravindranath Tiruvoipati

Rapid response calls (RRCs) are designed to appropriately manage clinical deterioration. However, not all RRCs are appropriate due to medical futility or the patient s wishes. Incidence and costs associated with avoidable-RRC (ARRC) remain underexplored. The study aimed to describe the incidence and costs of ARRC activations in older patients. We observed that 10% of RRCs are associated with increased time and financial costs. The costs for investigations, equipment and management was AUD $2,267.01, opportunity costs were AUD $3,861.55, with a grand total cost of AUD $6,128.56.

SUMMARY

Clinical guidelines: what happens when people have multiple conditions?

Elinor Millar, Anthony Dowell, Ross Lawrenson, Dee Mangin, Diana Sarfati

More people are now living with multimorbidity (multiple long-term conditions). Currently clinical treatment guidelines focus on the management of individual conditions, and don t usually consider the impact of combining multiple guidelines for someone with multiple conditions. This may lead to interactions between treatments and often leads to a burdensome treatment regime for patients. Clinical guidelines could be improved to better support clinicians to provide care for people with multimorbidity.

SUMMARY

A fast track clinic improves diagnosis and treatment times for those investigated for lung cancer in Northland District Health Board

Sophie Williams, Peter Davies, Blair Johnson, Stephen Iles

Those with lung cancer can have lots of tests in one day. Where this is done it speeds up diagnosis and treatment, and patients find this helpful. We could improve further by adding in more methods of biopsy such as endoscopic ultra-sound guided biopsy, but this involves investment in equipment and staff.

SUMMARY

Carcinogenicity of glyphosate: why is New Zealand's EPA lost in the weeds?

Jeroen Douwes, Andrea t Mannetje, Dave McLean, Neil Pearce, Alistair Woodward, John D Potter

In 2015, the International Agency for Research on Cancer (IARC) concluded that glyphosate is probably carcinogenic to humans. The New Zealand Environmental Protection Authority (NZEPA) rejected this and commissioned a new report, concluding that glyphosate was unlikely to be genotoxic or carcinogenic to humans. We conclude that the NZEPA process for evaluating the carcinogenicity of glyphosate was flawed and urge that: the NZEPA report be withdrawn; the NZEPA respond to the concerns raised and for a reassessment to be conducted; and clearer process and better understanding of science be used to inform any future review of hazardous substances in New Zealand.

SUMMARY

Health consequences of transport patterns in New Zealand s largest cities

Caroline Shaw, Edward Randal, Michael Keall, Alistair Woodward

This study aimed to look at sustainable transport systems in New Zealand s six largest cities and quantify the health consequences of the current transport situation. We estimated the health impacts and carbon emission changes if Auckland, Tauranga, Hamilton, Christchurch and Dunedin had the same walking, cycling and public transport levels as Wellington currently does. All cities would have health benefits, for example in Auckland s case there would be 57 fewer premature deaths each year, in Tauranga 50 fewer. The health gain would be as a result of increased physical activity, reduced air pollution and reduced overall injury (despite slightly increased cyclist and pedestrian injury) due to fewer cars on the roads. Carbon emissions from light vehicles would be between 7 to 32% lower (depending on the city) if the other big cities in New Zealand had the same transport patterns as Wellington currently does. Local (and central) Government needs better transport policies that take into account health and carbon impacts.

SUMMARY

Childhood predictors of adult adiposity: findings from a longitudinal study

Geraldine FH McLeod, David M Fergusson, L John Horwood, Joseph M Boden, Frances A Carter

This paper uses data gathered as part of the Christchurch Health and Development Study, a longitudinal study of a cohort of 1,265 children born in Christchurch in 1977, to examine childhood factors associated with later risks of overweight and obesity in adulthood. At ages 30 and 35 years, approximately one-third of the cohort were overweight and one-fifth were obese. Childhood predictors of overweight and obesity spanned an array of factors reflecting social and family background, biological endowment, cognitive ability and childhood adversity. Potential implications of these findings for programmes aiming to reduce the prevalence of overweight and obesity are discussed.

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