Vol 132 No 1507: 13 December 2019

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Issue Summary

Viewpoint

SUMMARY

Resisting ethnic inequities in advanced breast cancer: a call to action

Irene Kereama-Royal, Sara Jones, Elisa Lavelle Wijohn, Claire Doole, Elisabeth Burgess, Heather Came

In this paper we argue that while New Zealand’s overall survival rates are low compared with other OECD countries, ethnic inequity, due to institutional racism, results in Māori survival rates being less than half of non-Māori for advanced breast cancer. Multiple, modifiable sites of inequity exist including inadequate screening and risk assessment, a lack of support for Māori within the system and in navigating the system, lack of effective treatments due to underfunding of modern medications, and treatment delays or inaccessibility. These inequities continue despite significant advocacy from patients with advanced breast cancer and their allies. We call on policy makers and health providers to uphold their Tiriti o Waitangi obligations and addressing these systemic issues through adopting co-design with Māori in decision making, policy making, sector design, implementation and evaluation of all aspects of the breast cancer continuum.

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SUMMARY

Age is not just a number—synopsis of the 5th New Zealand Influenza Symposium 2019

Mary Nowlan, Diana Murfitt, Nikki Turner

This paper is a summary of the 5th New Zealand Influenza Symposium run by the Immunisation Advisory Centre in collaboration with the Ministry of Health. National and international presenters discussed improving the uptake of the influenza vaccine in New Zealand, and the severity and consequences of influenza, particularly for the elderly and those with chronic health issues. Highlighted were the benefits of influenza vaccination and how it can reduce declines in cognitive and physical health that can lead to loss of independence for older people.

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“Beasts”—New Zealand’s utility vehicles: their climate change emissions and macho marketing

John Horrocks, Nick Wilson

Vehicle emissions are an important contributor to the growth of greenhouse gas emissions in New Zealand. In our analysis for this article we report that 8 out of 10 of the highest-selling new light vehicles in 2018 were sports utility vehicles (SUVs) or diesel-powered utes, with the latter standing out as the heaviest emitters of carbon dioxide, as well as posing health hazards through their emissions of fine particulates and nitrogen oxides. Furthermore, we show how these vehicles are often marked as macho symbols of toughness and dominance, often through comparisons with savage predators. The current popularity of these vehicles may create resistance to some of the substantive regulatory steps which will be needed if New Zealand is to meet its international climate change commitments.

Article

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No attributable effects of PRP on greater trochanteric pain syndrome

Grant Thompson, John F Pearson

Greater trochanteric pain syndrome (GTPS) (commonly referred to as ‘trochanteric bursitis’) is a common, chronic and debilitating painful condition of the outer hip, particularly (but not exclusively) in middle-aged females. Traditionally GTPS has been treated with exercise and steroid injections. Platelet rich plasma (PRP) injections utilise blood taken from the patient and concentrated via centrifuge to obtain a higher platelet concentration. Platelets contain growth factors that are thought to assist in healing. The study involved participants with chronic lateral hip pain randomly ascribed to having PRP or control (saline) injections with both groups prescribed eccentric exercise. Both groups showed reduction in pain and there was no statistical difference between the treatment (PRP) or control (saline) groups.

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Long-term opioid medication use before and after joint replacement surgery in New Zealand

Ross Wilson, Yana Pryymachenko, Richard Audas, J Haxby Abbott, on behalf of the Consortium Against the overuse of Opiates in Surgery

Total joint replacement surgery for severe hip or knee osteoarthritis is expected to greatly alleviate patients’ joint pain; after recovery from surgery, the need for strong painkillers such as opioid medications (eg, codeine, morphine) should therefore be reduced. In this study, we used comprehensive data from the New Zealand public healthcare system to investigate the use of opioid medications before and after joint replacement surgery and whether long-term use after surgery was associated with opioid use before surgery or for short-term pain management immediately after surgery. We found that opioid use was reduced after surgery, but that a substantial minority of patients remained long-term opioid users for several years after their surgery. These patients were much more likely to have been prescribed opioids regularly during the year before their surgery or to facilitate post-surgery recovery. We suggest that avoiding unnecessary opioid prescribing for patients awaiting surgery and choosing non-opioid options for post-surgery pain management could help to reduce the number of patients relying on opioids long-term after surgery.

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2019 Richard Robinson Award Recipient for Best Clinical Manuscript and Medical Writing: Childhood predictors of adult adiposity: findings from a longitudinal study | OPEN ACCESS

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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Barriers to the prescription of LARCs in general practice in New Zealand—a qualitative research study

Orna McGinn, Helen JJ Fulcher, Bruce Arroll, Lesley McCowan

New Zealand has a high rate of unplanned pregnancy and a low rate of use of the most effective forms of contraception, LARCs (long acting reversible contraception), such as the IUD or coil, and the contraceptive implant. This paper looked at the barriers which prevent general practitioners from offering these effective methods of contraception to their patients. The main barriers are the lack of access to training—New Zealand does not currently have an accredited scheme for training healthcare practitioners to insert or remove LARCs. Secondly, very little funding is available in primary care for contraception and so costs are passed on to patients, which are unaffordable in many cases. Thirdly, the Mirena IUS, one of the most effective forms of contraception, has been available in New Zealand since 1997 but until 1 November 2019 (after the paper was submitted) it was not funded for contraceptive use. To improve uptake of LARC, comprehensive training and funding for primary care should be considered.

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A survey of the New Zealand rheumatology workforce

Andrew A Harrison, Nicola Tugnet, William J Taylor

Rheumatologists are specialist doctors who treat inflammatory diseases of the joints (arthritis), blood vessels and other organs. This study shows that there are not enough rheumatologists in New Zealand to meet the needs of the people and the ageing population, and that some parts of the country are better off than others. More and more woman are becoming rheumatologists. Public rheumatology clinics now decline referrals that were previously accepted, and which rheumatologists still see in their private practices. There has been no real improvement in public staffing levels since the last survey in 2011.

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One hundred years ago in 1919: New Zealand’s birth reduction shock associated with an influenza pandemic

Nick Wilson, Nikki Turner, Michael G Baker

While there is international evidence for the impact of the 1918 influenza pandemic on reducing birth rates, such an impact has not been studied for New Zealand. In this study we found that in 1919 there were 3,756 fewer non-Māori and 239 fewer Māori births than the pre-pandemic year of 1917, with these representing reductions in birth rates per 1,000 population of 16.6% and 19.8% respectively. We estimated the likely major driver of the natality deficit in 1919 was embryonic and fetal loss due to influenza infection in pregnancy (ie, increased miscarriages). Pandemic planning needs to consider ways to prevent such future burdens. There is also a need to improve on the current low level of routine influenza vaccination in pregnancy so as to minimise fetal loss from seasonal influenza infection.

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Impact of the national public ‘FAST’ campaigns

Craig Gordon, Rebecca Bell, Annemarei Ranta

Stroke is the second most common cause of death and adult disability in New Zealand and globally. Stroke symptoms can often be reversed if people with stroke present urgently to hospital, but this depends on early recognition of stroke symptoms and an awareness that it is important to call 111 immediately. The F-A-S-T message has been used to highlight stroke symptoms (‘FACE-ARM-SPEECH’ and the importance of ‘TIME’ and to ‘TAKE action’). The Ministry of Health has funded several national stroke F-A-S-T public campaigns in an effort to change the behaviour of New Zealanders experiencing or witnessing a stroke to improve rapid access to urgent stroke treatments. Our study found that the New Zealand stroke public campaigns were associated with a rise in stroke symptom recognition, time critical awareness, ambulance stroke notifications and acute stroke treatment rates.

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