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Issue

Vol 135 No 1553: 14 April 2022

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Issue Summary

Editorial

SUMMARY

Leadership and governance—what is needed to deliver Aotearoa New Zealand health reforms

Iwona Stolarek, Karina McHardy, Lloyd McCann, Andrew Simpson, Grant Howard, John Robson

Aotearoa New Zealand has embarked on a once in a generation reform of its health system. Healthcare delivery is complex. There are no simple off-the-shelf solutions for many of the challenges that are faced. Addressing complex challenges requires a different skill set and approach in the design and evaluation of solutions. As clinicians step into system leadership and governance, we must ensure they have the appropriate skill sets and support them in these roles.

SUMMARY

Rate of recurrence of toxoplasmosis retinochoroiditis at a tertiary eye centre in Auckland

Himanshu Wadhwa, Joanne L Sims, Rachael L Niederer

Toxoplasmosis infection of the retina and choroid can self-resolve but tend to cause additive damage to the retina with each acute flare. Our retrospective study looked at 126 eyes from 115 patients, and found that over a 6.1 year median follow-up period, 73 recurrences occurred in 36 patients. Recurrence occurred in 15% in the first year, and the risk of recurrence was increased 2x for every previously documented recurrence.

Article

SUMMARY

Patient-reported quality of life and eligibility for cataract surgery: assessing the relationship between ethnicity and ‘Impact on Life’ questionnaire scores in New Zealand

Nancy Wang, Lyn Hunt, James McKelvie

The ‘Impact on Life’ (IoL) questionnaire is a patient reported quality-of-life assessment tool currently used to prioritise for public-funded cataract surgery in New Zealand. Our study aimed to assess the association between ethnicity and IoL questionnaire responses using Ministry of Health data for patients being prioritised for cataract surgery between November 2014 and March 2019 in New Zealand. The results show that Māori and Pacific people presented at a younger age with more advanced cataracts and worse visual acuity than other ethnic groups at the time of prioritisation. However, the IoL score did not reflect this ethnic disparity in any meaningful way, after controlling for other potential factors. While this could be due to a real lack of disparity in quality of life amongst different ethnic groups, it could also be due to the IoL questionnaire being an unsuitable tool for assessing these differences.

Article

SUMMARY

Caregiver survey of preschool children with obesity referred to Whānau Pakari—a multidisciplinary healthy lifestyle intervention programme

Tami L Cave, José G B Derraik, Esther J Willing, Paul L Hofman, Yvonne C Anderson

This paper aims to examine the perceptions of caregivers of preschool children related to the acceptability of weight screening at New Zealand’s B4 School Check (B4SC), and the accessibility and acceptability of the Whānau Pakari healthy lifestyle programme for preschool children identified with weight issues.

Article

SUMMARY

The prevalence of glaucoma among 45-year-old New Zealanders

Aqeeda Singh, Jesse Gale, Kirsten Cheyne, Antony Ambler, Richie Poulton, Graham Wilson

This study aimed to estimate the prevalence of glaucoma in New Zealand using various data including spectral domain optical coherence tomography (OCT) in a population-based birth cohort of 45-year-olds. The prevalence was found to be between 0.2% and 1.4%, consistent with other population-based studies in the same age group. This is one of the first population-based studies to include OCT in the diagnosis of glaucoma, and it highlights the sensitivity of OCT and the potential for misinterpretation and over-investigation especially if used for screening in the community.

Article

SUMMARY

CPAP for paediatric patients in Aotearoa New Zealand: audit of a developing service at Capital and Coast DHB 2005–2020

Dawn Elder, Sophie Gandhi, Angela Campbell

Snoring in children and young people can indicate the presence of significant Obstructive Sleep Apnoea (OSA). This is being increasingly recognised with more patients being referred for assessment and treatment. Many of these children have obesity as their main risk factor for OSA. Untreated OSA can have longterm effects on both heart function and learning in affected children and adolescents. There is currently limited availability of assessment and treatment services for OSA in the paediatric and adolescent age range.

Article

SUMMARY

Telephone triage does not improve attendance rates in a paediatric audiology outpatient service

Michelle A Pokorny, Renee A Hislop, Elizabeth A L Holt

Hearing healthcare services are important for children who have a significant hearing loss or ear disease but nonattendance at appointments is a significant issue in many outpatient services for children. This study took place during the COVID-19 lockdown to see if a telephone consultation with an audiologist would improve attendance rates after services started again. Attendance was found to be associated with ethnicity and wait times. Telephone consultation did not improve attendance rates overall nor for any specific ethnicity subgroups.

Viewpoint

SUMMARY

Improving the provision of cataract surgery in New Zealand demands disruptive change | OPEN ACCESS

Samuel Burridge, Jonathan Wood, Jesse Gale, Albie Covello, James McKelvie, Graham Wilson

Cataract surgery is a very cost-effective treatment, but the number of surgeries performed in New Zealand ranks poorly compared with other high-income countries. We present several evidence-based strategies with overlapping benefits in access, equity, efficiency, and sustainability. Key strategies include that Health New Zealand mandate a national prioritisation threshold for surgical access, that PHARMAC leverage cheaper access to surgical supplies using nationally agreed equipment standards, establishing high-throughput cataract units, offering same-day bilateral cataract surgery when appropriate, and rationalising post-operative care.

Clinical Correspondence

SUMMARY

An audit of dog-related injury notification practices in a New Zealand public hospital

Natasha Duncan-Sutherland, Calum Cunningham, Susannah Cooper, Sylvia Boys

Injury caused by dogs is an ongoing public health concern in New Zealand, with serious injuries occurring in both children and adults. Notification of dog-related injuries or other incidents involving dog aggression provides an opportunity for secondary prevention to avoid further incidents with the dog occurring. Health professionals frequently treat these serious injuries, however it was unknown how often these events were being notified to animal management or other services. This study found a very low rate (1.5%) of notification of dog bite and other dog-related injuries that was documented by health professionals.

Clinical Correspondence

SUMMARY

Solar maculopathy and dissociative symptoms: a case report on a patient on buprenorphine opioid replacement therapy

James Redmayne, Lewis Lam

This is a case report of a patient who experienced damage to their eyes from staring at the sun while daydreaming. The patient was taking buprenorphine, a medication used in opioid replacement therapy that has been demonstrated to increase “dissociative symptoms”. Dissociative symptoms are interruptions of normal awareness that range from daydreaming to out-of-body experiences. It is possible that this medication contributed to the patient’s eye damage, and we recommended people who are at risk of dissociative symptoms are counselled to wear eye protection when exposed to the sun.

Article

SUMMARY

The priorities for future clinical trials and large cohort studies addressing health and healthcare for mothers and babies in Aotearoa New Zealand

Katie M Groom, Clara Mossinger, Jody Lawrence, Jane E Harding, Karaponi Okesene-Gafa, Matire Harwood, Frances Benge, Jessica Steele, Caroline A Crowther

Clinical trials and cohort studies are ways to test (research) health interventions including treatments, tests and health systems, in people and populations in real life situations to see if they work and work safely. Research prioritisation is the process of deciding which is the most important research to do. We have designed and used an equity driven framework to prioritise which clinical trials and cohort studies in mothers and babies’ health should be done and supported in Aotearoa New Zealand in the future. A large number of people including pregnant women and their whanau, healthcare providers and researchers contributed to this project. The framework can be used across all areas of health research.

Article

SUMMARY

Persisting variance in middle ear ventilation tube insertion in Auckland children: why ethnic disparity continues

Julia Y Seo, Randall P Morton, Catherine Gerard, Lesley Salkeld, Suzanne C Purdy

Ventilation tubes (VTs) or grommets are a common surgical treatment for recurrent middle ear disease in pre-school children (0–4-year-olds), however the rates of procedures do not appear to align with disease burden. Māori and Pacific children generally experience a greater burden of ear disease, but have lower rates of VT insertions compared to European children of the same age group. The differences in ethnicity are more pronounced in Counties Manukau DHB, compared to Auckland DHB and the national average. These persisting ethnic and regional inequities in treatment rates highlight ongoing socioeconomic and cultural barriers in accessing surgical services for Māori and Pacific populations, as well as the gaps in our current screening services for middle ear disease in children.

Editorial