Vol 132 No 1504: 25 October 2019

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SUMMARY

The motivations behind science denial

Alan McLintic

Cultural cognition is where we view information through the lens of our worldview. Worldview is a term for our deeply engrained values and beliefs that give us our sense of self, group identity and how we want society to be.

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Wintertime Vitamin D status and its related risk factors among children living in Auckland, New Zealand

Maryam Delshad, Kathryn L Beck, Cathryn A Conlon, Owen Mugridge, Marlena C Kruger, Berit P Jensen, Jing Ma, Pamela R von Hurst

This study showed that approximately one-third of our population had vitamin D less than recommendations. Poor vitamin D status during childhood can affect long-term health, so opportunities to intervene during childhood should be pursued. A strong consideration should be given to the high-risk children for whom supplementation may be considered especially in wintertime.

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The cost of diabetes-related hospital care to the Southern District Health Board in 2016/17

Kirsten J Coppell, Shaun J Drabble, Janine A Cochrane, Rosemary A Stamm, Trudy A Sullivan

We estimated the cost of diabetes hospital admissions to Dunedin Hospital and Southland Hospital for the year 2016/17. There were 6,994 separate diabetes-related hospital admissions costing a total of NZ$41M. Where diabetes was coded as the main reason for hospitalisation the cost was NZ$2.2M, compared with NZ$8M if diabetes was coded as the main underlying reason for hospitalisation. A high proportion of the costs were attributed to cardiovascular disease, eye disease and diseases of the musculoskeletal system, many of which were related to diabetes. Hospital costs are likely to increase as the number of people diagnosed with diabetes increase unless interventions that target preventable diabetes-related admissions and programmes to prevent diabetes are prioritised.

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On personal responsibility in medicine

Helen Ker

It's commonly said that doctors treat patients only to send them back into the environments that made them sick. Encouraging patients to make behavioural changes despite these environmental in-fluences is very difficult, and is hindered by our narrow working construct of personal responsibility, largely based on the Western construct of self-contained individualism. Through recognising alterna-tive notions of self and responsibility, while advocating to improve the social determinants of health, we can better enable patients to enjoy greater health.

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A cost-effectiveness analysis of the Prediabetes Intervention Package (PIP) in primary care: a New Zealand pilot programme

Deborah Connor, Kirsten Coppell, Andrew Gray, Trudy Sullivan

A prediabetes programme delivered by primary care nurses called the Prediabetes Intervention Package (PIP) was piloted in Hawke s Bay in New Zealand. The costs and benefits of PIP were com-pared with standard care. We found that the intervention is likely to be a cost-effective weight loss strategy for preventing or delaying progression to type 2 diabetes in people with prediabetes.

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An open-label feasibility study of repetitive transcranial magnetic stimulation (rTMS) for treatment-resistant depression in the New Zealand healthcare context

Kate EM Godfrey, Suresh D Muthukumaraswamy, Cathy M Stinear, Nicholas R Hoeh

A significant number of people in New Zealand struggle with clinical depression. People with clinical depression have difficulties with employment, maintaining healthy relationships, and have an in-creased risk of suicide. Many people with clinical depression do not respond to treatments with multi-ple trials of medications and talk therapy. Treatment with repetitive transcranial magnetic stimulation (rTMS) is established as a helpful and safe treatment which is widely available internationally. Addi-tionally, rTMS can be safely used in combination with other types of treatment. However, currently the majority of the New Zealand population has almost no realistic way to access rTMS treatment. This study demonstrates that treatment with rTMS can be helpful and safely provided to many people in New Zealand struggling with clinical depression.

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New Zealand needs a comprehensive interpreting service

Ben Gray

Abdelfattah Qasem was one of the people killed in the Christchurch Mosque shootings. He worked as an interpreter. In response to the shootings there has been considerable commitment expressed to make New Zealand a more inclusive society. Current provision of interpreting services is woefully inadequate and it is common for people with limited English proficiency to receive inferior care. Establishing a fully funded national interpreting service would be a fitting way to mark Abdelfattah Qasem s passing and a tangible way to improve the integration of minority communities into New Zealand.

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The burden of alcohol-related presentations to a busy urban New Zealand hospital emergency department

Georgina Svensen, Bridget Kool, Sarah Buller

This study analysed electronic patient records for adult alcohol-related presentations (ARPs) to a major New Zealand emergency department (ED) for a 12-month period (November 2017 to October 2018). Among 73,381 presentations, 7% were alcohol-related, the majority were male (65%) and aged 20-39 (52%). ARPs were more frequent at night, during the weekends, public holidays and over the summer months. Sixteen percent of injury-related presentations were alcohol-related. ARPs commonly arrived at the ED via emergency services and had a longer length of stay than non-ARPs. Continued public health efforts are required to implement preventative strategies for alcohol-related harm in the ED and society as a whole.

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Differing protocols of managing adult diabetic ketoacidosis outside of the intensive care unit make no difference to the rate of resolution of hyperglycaemia and acidosis

Geoffrey Braatvedt, Alfred Kwan, Will Dransfield, Catherine McNamara, Cameron Schauer, Steven Miller, Manish Khanolkar

This study has shown that different protocols of insulin infusion in people with type 1 diabetes admitted to hospital with ketoacidosis made no difference to the rate of resolution of the metabolic abnormalities, nor length of hospital stay.

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Gender and the surgical profession

Angela D McGregor

Gender imbalance exists in the surgical profession, meaning there are more barriers for women to overcome when pursuing a career in surgery compared to men. The gender imbalance is rooted in our stereotypical expectations of men and women and is perpetuated by extensions of these expecta-tions. It is important for the surgical profession to address this gender imbalance so that the character-istics, values and experiences women bring to surgery can be combined with those of men. That way we can appreciate our differences, learn from and build on each other s strengths, and work together for improved patient care.

Editorial