Issue

Vol 133 No 1513: 24 April 2020

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Issue Summary

Viewpoint

SUMMARY

The case for New Zealand to have its own COVID-19 vaccine programme

James E Ussher, Graham Le Gros, Miguel E Quiñones-Mateu, Shivali A Gulab, Melissa Yiannoutsos

Top scientists are calling for a national COVID-19 vaccine programme to ensure New Zealand is best placed to access an effective vaccine at the earliest opportunity. While there are multiple vaccines being developed overseas, there is concern about the ability of manufacturers to scale up vaccine production to meet unprecedented global demand. A national COVID-19 vaccine programme is urged to build New Zealand-specific capability which can contribute to the worldwide vaccine development effort, secure early access to a COVID-19 vaccine to prevent SARS-CoV-2 infections in New Zealand and Pacific nations, and grow capability to respond to future pandemics.

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SUMMARY

Why BMI should still be on the table

Lisa Daniels, Wayne S Cutfield, Rachael W Taylor, Barry J Taylor

Body mass index (BMI) is a calculation used to estimate body fatness and is used worldwide to define overweight and obesity. While its use during the before school check (a free health and development check for all New Zealand four-year-olds) has recently come into question it is currently the only appropriate field tool for assessing overweight and obesity. In this viewpoint article, we discuss the evidence in support of the measurement of BMI for population health monitoring as well as for screening a child’s weight status.

Article

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The characteristics and outcomes of patients with colorectal cancer in New Zealand, analysed by Cancer Network

Tania Blackmore, Chunhuan Lao, Lynne Chepulis, Blaithin Page, Ross Lawrenson

Bowel cancer in New Zealand is common and we have relatively poor survival compared with other countries. We have shown that for younger patients the outcomes from bowel cancer in New Zealand are not affected by where you live—but there are regional variations for older patients with better outcomes for those living in the Northern and Southern Regional Cancer Networks. However, the greatest survival disparity continues to be found for Māori and Pacifica patients.

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SUMMARY

The post-lockdown period should be used to acquire effective therapies for future resurgence in SARS-Cov-2 infections

Kurt L Krause, Richard Furneaux, Paul Benjes, Margaret Brimble, Tony Davidson, William Denny, Lawrence Harris, Simon Hinkley, Peter Tyler, James E Ussher, Vernon Ward

COVID-19 will be with us through the remainder of 2020 and almost certainly beyond. New Zealand needs a viable strategy to protect its populace until a vaccine is developed and in wide use. Until that time, it makes sense to protect the population by putting in place treatments that will be safe and effective, such as the use of convalescent sera and the use of direct-acting anti-virals. These treatments should be sourced externally or made locally, but steps in this direction must now begin as the lockdown ends. New Zealand has the scientists, the facilities and the will to make this happen, but the support of the government and the population will be needed if this plan is to succeed.

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SUMMARY

Changes to management of a non-pandemic illness during the COVID-19 pandemic: case study of invasive management of acute coronary syndrome

Sean Coffey, Anouska Moynagh, Belinda Green, John Edmond, Gerard T Wilkins, Brendan Arnold, James Pemberton, Ben Wilkins, Michael JA Williams

Non-COVID-19 conditions will continue to be an issue during the COVID-19 pandemic. Usual treatment approaches need to be modified as the standard risk/benefit assessment is likely significantly changed during the pandemic. The main considerations relate to the risk of COVID-19 to patients and healthcare workers, population spread and potential resource constraints. With these considerations in mind, as a case study, we discuss in this paper how these changes affect management of patients with heart attacks in hospitals without on-site interventional cardiology (stenting) services.

Article

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Is there a role for Rongoā Māori in public hospitals? The results of a hospital staff survey

Jonathan Koea, Glennis Mark

A significant number of staff at Waitemata District health Board had a knowledge of Rongoā Māori and just over a third of the total responders to a staff survey supported its availability within the hospital system. A larger feasibility study is now underway consulting with healers, hospital staff and patient participants to ascertain the culturally appropriate and medically robust practices necessary for researching Rongoā Māori/medicine collaboration within the health system.

Article

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The prevalence of refractive error and visual impairment among New Zealand children in a community with significant socioeconomic disadvantage: is current preschool vision screening effective?

Rebecca Findlay, Joanna Black, Nicola Anstice, Alison Burge, Alison Leversha

The current preschool vision screening was effective in detecting amblyopia (lazy eye) but poor at detecting refractive error (need for glasses) in a study of mainly Māori and Pacific children living in socioeconomic disadvantage. The current vision screening programme is likely to be increasing inequities. More than half of children with refractive error passed the screening. Ten percent of children did not receive screening and a further 11% were identified for rescreening, which was not completed prior to starting school. Urgent attention is required to review the B4SC vision screening protocol to improve equity by ensuring that all children receive appropriate vision screening and eyecare.

Article

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Variation in volumes and characteristics of trauma patients admitted to a level one trauma centre during national level 4 lockdown for COVID-19 in New Zealand

Grant Christey, Janet Amey, Alaina Campbell, Alastair Smith

Despite the significant reduction in admissions during level 4 lockdown, hospitals should continue to provide full services until resource limitations are unavoidable. Immediate messaging is recommended to reduce rates of injury on the farm and at home, specifically falls prevention. Ongoing attention of road users to road safety is essential to reduce the incidence of preventable major injury. These immediate measures can potentially reduce unnecessary pressure on hospital beds and resources during the pandemic.

Article

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Ability of the Maze Navigation Test, Montreal Cognitive Assessment, and Trail Making Tests A & B to predict on-road driving performance in current drivers diagnosed with dementia

Etuini Ma’u, Gary Cheung

While drivers diagnosed with a dementia are twice as likely to be involved in a motor vehicle accident compared to cognitively intact older adults, the majority of drivers diagnosed with a mild dementia will still pass an on-road driving assessment. With specialist driving assessments being expensive and no longer publicly funded, this study aimed to evaluate the ability of three quick to administer cognitive tests to predict driving performance in individuals with dementia on a specialist on-road driving assessment. This study provides clinicians with a quickly administered maze navigation test (MNT) and an interpretation of the commonly used MoCA cognitive screening test that can help inform the need for a specialist driving assessment.

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SUMMARY

Towards elimination of tuberculosis in New Zealand

Ayesha J Verrall, Philip C Hill, Dougal Thorburn, Michael Maze, Lavinia Perumal, Kate Grimwade, Craig N Thornley, Josh Freeman, Mitzi Nisbet, Timothy K Blackmore

Tuberculosis is still an important disease in New Zealand. We could eliminate TB by improved screening and preventive treatment for people from overseas, and address the legacy of TB from colonial times that continues to impact Māori. Improved preventive, treatment and laboratory services are important to achieving this goal.

Article

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Trends in prescription medicine use by older people in New Zealand 2010– 2015: a national population-based study

Andrew M Tomlin, David J Woods, James J Reid, Murray W Tilyard

This study has shown that in older people the use of most types of medicines is increasing and that people aged 85 years and older tend to use the most medicines. In particular, we found that use of strong painkillers and psychoactive medicines (those used for depression, other psychiatric disorders and sleep problems) were used frequently in older people and often in combination, which can lead to increased adverse events such as falls. Investigating the trends and patterns of medicines used in older people identifies opportunities to provide education on safe and appropriate medicines and reduce potential harm associated with medicines in this age group.

Article

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The New Zealand oral and maxillofacial surgeon workforce in 2017–18: characteristics, practice and prospects

John B Bridgman, Graham Fulton, Simon M-Y Lou, W Murray Thomson, Alastair N Goss

We surveyed all of New Zealand’s oral and maxillofacial surgeons (OMS) to update findings from a similar survey done in 2001. The findings highlight a number of problems—some long-standing, others emerging—in our OMS system. Because more surgeons are now working exclusively in private, there is greater stress on those who are working in the public hospital system, especially with more facial trauma and cancer cases to be treated. More resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.We surveyed all of New Zealand’s oral and maxillofacial surgeons (OMS) to update findings from a similar survey done in 2001. The findings highlight a number of problems—some long-standing, others emerging—in our OMS system. Because more surgeons are now working exclusively in private, there is greater stress on those who are working in the public hospital system, especially with more facial trauma and cancer cases to be treated. More resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.

Article

SUMMARY

Ocular syphilis in Pacific peoples—are we making misdiagnoses secondary to yaws?

Hannah Gill, Helen V Danesh-Meyer, Joanne L Sims, Mitzi Nisbet, Rachael L Niederer

This paper was an audit assessing the demographic and clinical features of patients with ocular disease consistent with syphilis and positive treponemal serology in Auckland. It wanted to compare patients who lived in a Pacific nation before 1960 with all other patients, as they may have returned a positive treponemal serology due to prior yaws infection, rather than syphilis. The results demonstrated that the presentation of older, Pacific Peoples was different to others in the study, and that alternative causes for ocular inflammation should be considered as differentials.

Editorial