Vol 134 No 1541: 3 September 2021

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Issue Summary

Article

SUMMARY

The carbon footprint of cataract surgery in Wellington

Matthew Latta, Caroline Shaw, Jesse Gale

The health sector contributes around 5% of New Zealand greenhouse gas emissions and must be part of the de-carbonisation of the economy .Cataract surgery is our most common operation, with around 30,000 operations each year. We estimated the carbon footprint of cataract operations in Wellington at two public and two private hospitals and found an average of 152 kgCO2e from each operation. Procurement was the biggest contributor to the footprint, so efforts to reduce the emissions from cataract surgery should focus on reducing consumption of disposable materials.

Article

SUMMARY

Paediatric exploratory ingestion presentations to Christchurch Hospital emergency department during 2019

Aditya Raina, Brennan Carne, Roshit Bothara, Andrew McCombie, Paul Gee, Laura Joyce

111 children under 7 years of age presented to Christchurch Hospital emergency department during 2019 after having ingested medications or other potential toxins (paediatric exploratory ingestions (PEIs)). This accounted for 1.2% of all paediatric presentations. This is a reduction compared to 1999. 2 year olds were most likely to present with PEIs., while children of Asian and Pacific ethnicities were less likely to present with PEIs. Paracetamol most the most commonly ingested substance. There has been a worrying increase in ingestions of dangerous drugs such as morphine.

Article

SUMMARY

Mapping prevalence and patterns of use of, and expenditure on, traditional, complementary and alternative medicine in New Zealand: a scoping review of qualitative and quantitative studies

E Lyn Lee, Jeff Harrison, Joanne Barnes

Traditional, complementary and alternative medicine (TCAM) is a broad term used to describe the health products, preparations, practitioners and practices that have a long history of use in traditional medicine systems and/or those that are not typically part of dominant “conventional medicine” systems. TCAM is used by people of all ages, ethnicities and with various health conditions in New Zealand. Available studies in New Zealand exploring TCAM use are mostly small and localised (eg, use of TCAM by patients attending one hospital in Auckland). There are limited national data on TCAM use; the most recent study on dietary supplement use was a nutritional survey done in 2008/9. Given TCAM’s popularity as a healthcare choice, reliable, current national data on TCAM use are needed in New Zealand.

Clinical Correspondence

SUMMARY

Balloon aortic valvuloplasty for severe aortic stenosis: single-centre contemporary patterns and experience

Ammar Alsamarrai, Tom Kai Ming Wang

Aortic stenosis is narrowing of the main valve of the heart, and it is the most common valve problem in the developed world. The best treatment for this condition is to replace it with an artificial heart valve. Because this is major operation, it is not suitable in people who have generally poor health. One alternative is to put a small balloon through the valve and inflate it open. Our study demonstrates that this procedure is generally safe and is effective in the short-term.

Article

SUMMARY

The wellbeing and health needs of a cohort of transgender young people accessing specialist medical gender-affirming healthcare in Auckland

Jeannie Oliphant, Daniel Barnett, Jaimie Veale, Simon Denny, Bridget Farrant

High levels of distress are experienced by young transgender people in Aotearoa New Zealand. This speaks to an urgent need to upskill primary care on the health needs for young transgender people and provide clear referral pathways to access specialist gender-affirming healthcare services. Urgent access to mental health support that is competent to meet the needs of young transgender people is needed.

Article

SUMMARY

Vitamin D deficiency, supplementation and testing: have we got it right in New Zealand?

Mark J Bolland, Alison Avenell, Andrew Grey

We tracked rates of vitamin D prescriptions in New Zealand between 2003 and 2019, finding that they increased 14-fold to more than 1 million prescriptions/year in 2019. Even though vitamin D tablets are cheap (less than 50c/tablet), the medication costs alone for vitamin D in 2019 were more than $1 million. To find out whether the increasing amount of vitamin D supplementation had actually prevented consequences of vitamin D deficiency, we tracked the annual numbers of hospital admissions in New Zealand for the consequences of vitamin D deficiency (rickets and osteomalacia). Despite the dramatic increase in prescriptions for vitamin D, the number of hospital admissions for rickets, osteomalacia, and unspecified vitamin D deficiency remained small and stable, between 10 and 20 cases/year. Lastly, we assessed vitamin D measurements in Auckland in two time periods, 2002 and 2003 and 2009 and 2019, finding that vitamin D results increased between the two periods, partly as a result of increasing vitamin D prescriptions, but importantly, most tests in the later time period simply identified individuals with normal levels. Collectively, these results suggest that guidance and practice around vitamin D in New Zealand should change, because the costs of increasing vitamin D supplementation and poorly targeted testing could be better spent on different approaches to prevent osteomalacia and rickets

Article

SUMMARY

Does the National Immunisation Register stack up? Quantifying accuracy when compared to parent-held health record books

Hannah Chisholm, Janine Paynter, Esther Willing, Nikki Turner, Anna S Howe

The National Immunisation Register (NIR) is an important tool for the provision of clinical services, national immunisation programme evaluation and immunisation research in New Zealand. This study aimed to examine, describe and quantify the extent of discrepancy in the NIR compared to Well Child Tamariki Ora parent-held health record books (Health Books). Overall, NIR performance was high, with NIR performance higher for National Immunisation Schedule (NIS) vaccines compared with non-NIS vaccines.

Article

SUMMARY

Publicly reported health performance measures 2010–2020

Colin F Thompson

New Zealand DHBs are required by legislation to publish performance measures as part of their accountability to the public. Measures represent many areas of DHB operations in prevention, community care, hospital care and rehabilitation but cannot cover every situation. This study has shown how in one DHB their usefulness has been further limited by a lack of continuity, uncertain accuracy, questionable effectiveness or clinical relevance and by few being clearly associated with outcomes most important to patients. Performance measurements can be important tools for increasing healthcare productivity, but they also need to be evaluated for their potential to cause a range of unintended consequences or even harm.

Editorial