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Issue

Vol 136 No 1573: 14 April 2023

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Issue Summary

Editorial

SUMMARY

Superheated storms: climate drivers, health effects and responses

Rhys Jones, Alex Macmillan, Alistair Woodward

The recent floods and storms affecting Aotearoa are a sign of worsening extreme weather events, which bring devastating health impacts. These health impacts particularly affect communities who already face disadvantage such as Māori, Pasifika, disabled people, low-income households and those living in poor quality housing. Climate pollution makes these weather events more frequent and severe, and our land use patterns make us more susceptible to their impacts. Every action to recover and adapt must also be an action to prevent further devastating events. This means tackling the root causes of climate change, with a focus on Indigenous knowledges and relationships with the environment.

Article

SUMMARY

Gaps in measles immunisation coverage for pre-school children in Aotearoa New Zealand: a cross-sectional study

Nienke N Hagedoorn, Andrew Anglemyer, Tony Walls

Measles is a disease caused by a virus that can easily spread from person to person. Children under the age of five who have not received a vaccine are at a high risk of getting very sick or even dying from measles. Since the borders in New Zealand have fully opened and the number of measles cases around the world has increased, the chances of measles being imported into New Zealand have also gone up. We found that fewer children are getting vaccinated against measles—in fact, the coverage for the first measles, mumps, rubella (MMR1) vaccine has dropped from 95.1% for those born in 2017 to 88.9% for those born in 2020. This means that there are not enough children under the age of five who are protected against measles to stop a potential measles outbreak.

Article

SUMMARY

Outcomes and access to angiography following non-ST-segment elevation acute coronary syndromes in patients who present to rural or urban hospitals: ANZACS-QI 72

Rory Miller, Garry Nixon, Robin M Turner, Tim Stokes, Rawiri Keenan, Corina Grey, Yannan Jiang, Andrew Kerr

This study shows that for patients that present to rural hospitals or hospitals without routine access to advanced cardiology interventions with heart attacks, they are less likely to have angiography (an invasive testy to determine whether the arteries that supply the heart are blocked or narrowed) compared to urban hospitals where this was readily available. However, there was no significant difference in the chances of dying between the three groups of hospitals (rural hospitals, smaller urban hospitals or urban hospitals with advanced cardiology intervention) either at 30-days after the heart attack. There was a small increase in the chances of dying after 2-years for patients that presented to rural hospitals, the reasons for this are unclear and not able to be answered by this study.

Article

SUMMARY

Exploring the current and future osteoarthritis health service delivery needs in Aotearoa New Zealand

Daniel W O’Brien, Sam Norman, Rebecca Grainger, Richard Ellis, Ben Hudson, Ivana Nakarada-Kordic, J Haxby Abbott

In 2021 the OA Basecamp Symposium was launched in Auckland to bring together clinicians from all disciplines, health delivery organisations, consumers and researchers interested in OA management in Aotearoa New Zealand. The symposium included a co-design workshop to capture views about current and future OA health service delivery. The results highlighted several promising current healthcare delivery initiatives. Health literacy and obesity prevention policies featured in the thematic analysis suggest a lifespan or systemwide approach is needed. Data highlighted a need for reformed systems that enhances hauora/wellbeing, promotes physical activity, and facilitates interprofessional service delivery and collaboration across care settings.

Article

SUMMARY

Skin-to-deltoid-muscle distance at three recommended sites for intramuscular vaccination in a population with obesity: an observational study

Marjan Doppen, Melissa Black, Irene Braithwaite, Jonathan Bong, Allie Eathorne, Louis Kirton, Stacey Kung, Michaela Walton, Thomas Hills, Mark Weatherall, Richard Beasley, Ciléin Kearns

Guidance on how to choose the site of injection for vaccines given into the deltoid (shoulder) muscle differs internationally. The site of injection affects the distance from the skin to the muscle. Many people with obesity should be vaccinated with a longer needle to ensure the vaccine is injected into the deltoid muscle.

Article

SUMMARY

Patient factors associated with appointment non-attendance at an ophthalmology department in Aotearoa New Zealand

Jackie Low, William J Cunningham, Rachael L Niederer, Helen V Danesh-Meyer

Non-attendance to appointments are a common problem for all medical specialist clinics including ophthalmology services, with widespread implications to the patients and the health system. This study aimed to explore and identify patient demographic variables associated with appointment non-attendance in a large public ophthalmology clinic in Auckland, New Zealand. It was observed that ethnicity, age and deprivation score are associated with non-attendance, with Māori and Pasifika ethnic groups, younger patients and patients with a higher New Zealand Deprivation Index score (an area-based measure of socioeconomic status) significantly impacted by higher rates of non-attendance. These results suggest that there are critical barriers to accessing eye care that disproportionately affect these at-risk population groups. This study therefore identifies a greater need for our health workforce and health system to further improve on providing better patient care, and develop targeted interventions addressing access barriers for our Māori, Pasifika, young and socially disadvantaged patients.

Article

SUMMARY

A critical Tiriti analysis of Te Pae Tata: the Interim New Zealand Health Plan

Ngaire Rae, Heather Came, Leah Bain, Alana McCambridge

The newly reformed health system has stated aims to reflect a Te Tiriti partnership and embed equity. A core marker in measuring progress towards these aims is Te Pae Tata: the Interim New Zealand Health Plan. This paper analysed the Plan from a critical Te Tiriti lens and found good engagement with ōritetanga (equity) and fair to poor engagement on other criteria. A Te Tiriti compliant plan (and health system) will require the Crown to recognise that Māori never ceded sovereignty and treaty principles are not equivalent to the authoritative Māori text.

Article

SUMMARY

Investigating attitudes and insights into the global warming impact of inhalers

Matthew J Woodall, John Ma, Kate Emett, Amelia PE Hamblin, Katie Knowles, Tom Hyunwoo Lee, Wilson Mitchell, Wennarator Irae Ofoia, Letoe Renee Topeto, John D Dockerty, Robert J Hancox

Most clinicians and patients are willing to consider changing the type of inhaler they use to protect the environment. The propellants in currently available pressurised respiratory inhalers are potent greenhouse gases, and make up a substantial part of the carbon footprint of health services in New Zealand and many countries. Alternative types of inhaler are available that don’t use propellants and have a much lower global warming effect, but these are used less often, despite being equally effective for most people. We asked prescribers and patients whether they would be willing to consider the environmental impact of inhalers when deciding which ones to use. Although everyone agreed that it was most important to have an inhaler that is effective and easy to use, most patients and clinicians were willing to consider the environment in their inhaler choice.

Viewpoint

SUMMARY

A further look into obtaining informed consent for medical students

Ekta Bagga, Edmund Leung

This paper investigates the understanding of obtaining informed consent for involvement of medical students and adherence to ethical guidelines. The population we investigated were medical students and senior doctors at Taranaki hospital. Based on our results we have complied some recommendations to improve the currently sub-optimal consenting process.

Clinical Correspondence

SUMMARY

Acute visual change as first symptom of B-cell prolymphocytic leukaemia

Luke Hawley, Oscar Eaton, Louis S Han

A case report discussing the unique presentation of a young patient with isolated visual obscuration leading to the diagnosis of a rare and aggressive neoplastic blood disease in the form of B-cell prolymphocytic leukaemia.

Research Letter

SUMMARY

Biomarkers in the early prediction of rescue therapy in acute severe colitis—a single-centre retrospective study

Kevin YY Chen, Sota Kamiya, Sarah Yap, Hamish Neave, Russell S Walmsley, Cameron Schauer, Nathan SS Atkinson

A study at North Shore Hospital on severe inflammation of the large bowel from inflammatory bowel disease has demonstrated that blood tests done on admission are significantly correlated with treatment outcomes. Stool testing is also known to be of increasing promise in this area but unfortunately sample numbers were too low to demonstrate any significant results.

Research Letter

SUMMARY

Limited sequence magnetic resonance imaging appears reasonable for the evaluation of stroke-like symptoms

Rachel E Matthews, Karim M Mahawish

While magnetic resonance imaging (MRI) has revolutionised patient care, this resource is limited and under high demand. This study showed that a more focused MRI scan to help diagnosis in patients with stroke-like symptoms, was associated in less time spent in the scanner and patient outcomes were no different at discharge or at six months follow-up. This study is important as it highlights a potential way for healthcare services to increase the efficiency of MRI usage, with potential for decreasing associated costs, and making MRI less daunting for patients due to less time spent in the scanner. This study supports a global trend towards more selective MRI sequence use, however was limited by a small study size and therefore more data is desirable to support widespread adoption.

Editorial