Vol 136 No 1568: 20 January 2023

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Issue Summary

Editorial

SUMMARY

Public health interventions: the elephant in the room of the health system crisis

Caroline Shaw, Christine Cleghorn

COVID-19 has increased people’s need for healthcare in New Zealand for multiple reasons. Many of these reasons are likely to be enduring. The healthcare system was already struggling before COVID-19 and is now in a very bad position, as are the health systems in most other developed counties. Alongside measures to increase the health workforce we should be looking at putting in place public health interventions that reduce the number of people needing to go to hospital. There are a range of interventions that can improve health in quite a short time period; policy-makers should consider these as a core part of our response to the current health system crisis.

Article

SUMMARY

The economic cost of Indigenous child health inequities in Aotearoa New Zealand—an updated analysis for 2003–2014

Sarah-Jane Paine, Chao Li, Karen Wright, Ricci Harris, Belinda Loring, Papaarangi Reid

This study calculated the costs or savings that arise from Māori children having different rates of avoidable death, hospitalisation and use of healthcare services than non-Māori children. It found that health inequities for Māori children actually save the Government health system money, yet are very expensive for society as a whole, especially Māori whānau. In addition to being a social justice and Indigenous rights concern, health inequities are costing New Zealand money.

Article

SUMMARY

The impact of pain on function after spinal cord injury

Jae Hong Ryu, Hannah Joyce, Christin Coomarasamy, Jessica Ozumba, Victoriya Semikina, Suresh Subramanian

Pain is a common complication for spinal cord injury patients that can affect them for a long time. From our study, we found that almost three-quarters of patients had pain by time of discharge from spinal cord injury rehabilitation units. However, most of these patients reported that they were satisfied with the management they received for their pain, and this did not severely affect their activities of daily living, mood, or sleep. Future focus will be to improve support for patients who do have pain that severely affects their day-to-day living and to also see if the effects of pain change over a long period of time.

Article

SUMMARY

Time for another review: following implementation of a new service model for Auckland Sexual Health service there has been an increase in referrals, case complexity and clinical workload but regional inequities in access remain

Sunita Azariah

A review of the Auckland sexual health regional service in 2014 did not respond appropriately to staff concerns and resulted in the unnecessary redundancy of two sexual health specialists. Auckland has disproportionate numbers of people considered to be sexual health priority populations including young people, men who have sex with men and people of Māori and Pacific ethnicities and therefore requires an appropriately resourced specialist sexual health service. There are continuing inequities in access to the sexual health service by people living in the Counties Manukau Region and this needs to be urgently addressed, particularly because syphilis is increasingly affecting women of child-bearing age in this region. There has been a rapidly increasing demand for gender affirming health care in recent years, however the sexual health service was never adequately resourced for this purpose and is currently struggling to meet the needs of this community.

Article

SUMMARY

A national audit of performance standards for blood cultures in Aotearoa New Zealand: opportunities for improvement

Juliet Elvy, Michael Addidle, Hanna-Sofia Andersson, Vivian Black, Dragana Drinković, Julia Howard, Michael O’Connor, Susan Taylor, Arthur J Morris

Blood cultures are performed for patients with suspected bloodstream infection to determine if any pathogens can be grown from the blood. Blood cultures can help identify the cause of the infection and ensure the best antibiotics are used for treatment. However, they need to be performed carefully to improve the chance of culturing the pathogen and reduce contamination. This audit looked at how well different regions were performing blood cultures by using laboratory data. The results demonstrated that there was variation in the performance of blood cultures across different regions.

Article

SUMMARY

HIV in women in Aotearoa New Zealand: 25 years of surveillance data

Ashleigh de Gouw, Susan McAllister, Jane Bruning, Judith Mukakayange, Jerram Bateman, Patricia Priest

From information received through routine reporting data over the past 25 years (1996 to 2020), a total of 634 women have been diagnosed with HIV in New Zealand, 180 of whom were reported to have acquired HIV in New Zealand. After a peak in 2006, the number of women diagnosed each year has remained steady at around 20 per year over the past 10 years. Amongst women who acquired HIV in New Zealand, almost half were diagnosed late—meaning they had been living with the virus for several years and not been tested for HIV. Early diagnosis is essential for successful treatment and reducing infectivity to sexual partners.

Article

SUMMARY

An investigation into the digitalisation of New Zealand general practice services during COVID-19 | OPEN ACCESS

Nargis Mashal, Sussie C Morrish

Our paper summarises six key points in Enablers and Barriers of technological innovation adoption in GP medical centres in time of Covid-19 pandemic. These include enablers: 1) The availability of existing technology and devices within the GP medical centres; 2) The ease of use of the current technology to facilitate digitalisation combined with cost effectiveness and secure communication; and 3) Forced Information Communication Technology (ICT) adoption caused by Covid-19 induced business disruption, and social and physical distancing restrictions (a necessity-based enabler). These also include barriers: 4) The perception of risk and potential impact/utility of health interventions delivered via digital vs face to face means amongst primary care teams and patients; 5) Individual resistance to change amongst medical teams and patients; 6) Lack of knowledge and prior training in Information Technology (IT) systems for effective telehealth delivery amongst GPs and administrative staff.

Clinical Correspondence

SUMMARY

Stroke thrombolysis in a patient on dabigatran in the extended time window

Stewart Shiu, Bobae Lee, Karim M Mahawish

More recent imaging modalities are being used increasingly to identify patients who have salvageable brain after a stroke who could benefit from treatment. Previously, patients on blood thinning medication were excluded from treatment with clot busting medication due to the fear of causing major bleeding. Here, we present a patient who had an ischaemic stroke while on anticoagulants. This case illustrates a patient who benefitted from clot busting treatment after reversing the effects of the anticoagulant.

Viewpoint

SUMMARY

Sleep-in to stay well: addressing school start times for the health and wellbeing of teens in Aotearoa

Charmaine Barber, Sarah Hetrick, Liza Edmonds, Rachael W Taylor, Mohamed Alansari, Leigh Signal, Jillian Haszard, Jacinta Oldehaver, Barbara Galland and members of the School Start Time Study Advisory Group

Many teens in Aotearoa New Zealand do not get enough sleep, exacerbated by school start times that force them to wake earlier than they are programmed to. Adolescent’s natural sleep-wake biology shifts at puberty to favour later bedtimes, meaning they naturally need to wake later in the morning, and it does not change again until approximately age 21. In this opinion piece, we argue that a later school start time (no earlier than 9:45 am) every day for senior secondary school students (years 12 and 13) is an attractive, non-stigmatising approach to address adolescent sleep issues, and is backed up by considerable published research on the issue from both here and overseas. Increased sleep also has the potential to favourably impact multiple areas of adolescents' health and wellbeing, as well as school success. However, the authors are acutely aware that later school start times for senior students would impact many people and organisations in a variety of ways, and therefore they also need to hear the opinions of many key stakeholders as to what might help or hinder schools considering shifting to later starts. Short surveys for parents of New Zealand high school-aged teens and New Zealand principals and teachers of high schools, can be accessed on our “Child and Teen Sleep Research Group” Facebook page. Additionally there is a longer survey for New Zealand High School teens (aged 16 and over) that asks for their opinion on later starts, and also asks about their current school start times, and own sleep and wellbeing.

Editorial