Cultural safety requires the ongoing development of critical consciousness, addressing bias and prejudice, redressing power imbalance, committing to transformative change and ensuring that safe practice is determined by...Cultural safety requires the ongoing development of critical consciousness, addressing bias and prejudice, redressing power imbalance, committing to transformative change and ensuring that safe practice is determined by recipients of care. This paper presents a review and reflection of learnings, looking back over 2 years of implementing the Cultural Safety Training Plan for Vocational Medicine in Aotearoa. Looking forward, recommendations include the development of resources and assessment activities, training of trainers, broadening the scope of cultural safety, strengthening focus on college-level transformation, ensuring stronger communication and resource sharing across the colleges and continuing and expanding current implementation activities.
Artificial intelligence (AI) tools in diabetic retinal screening (DRS) are currently in use overseas within public health systems, with growing evidence of effectiveness. A proof of concept aimed at piloting a model of c...Artificial intelligence (AI) tools in diabetic retinal screening (DRS) are currently in use overseas within public health systems, with growing evidence of effectiveness. A proof of concept aimed at piloting a model of care for AI-integrated DRS to increase access to timely screening for Pacific peoples in Aotearoa New Zealand was undertaken but faced a range of challenges. What appeared to many as a straightforward AI use case proved not to be so in many ways. Challenges arose from issues related to the digital systems, challenges with adjusting models of care, variable clinician readiness and the appropriateness of the AI tools. These challenges are not unique and need to be overcome to realise the benefits of AI across many use cases. Careful planning, adequate resourcing and organisational buy-in and support are all required for any AI implementation projects to succeed and for the benefits to the population and health system to be realised.
AIMS: Bilateral vestibular failure is a rare and disabling condition for which restorative treatment options remain limited. Vestibular implants have emerged as a potential neuroprosthetic intervention. This review summa...AIMS: Bilateral vestibular failure is a rare and disabling condition for which restorative treatment options remain limited. Vestibular implants have emerged as a potential neuroprosthetic intervention. This review summarises current evidence for vestibular implantation and considers relevant clinical, ethical and health system implications, including the New Zealand healthcare context. METHODS: A narrative review of the published literature was conducted using PubMed, Embase and the Cochrane Library from database inception to June 2025. Search terms included "vestibular implant", "vestibular neuroprosthesis" and "bilateral vestibular failure". English-language human studies and relevant preclinical studies were included. Given the limited number of clinical trials and heterogeneity of outcomes, findings were synthesised narratively. RESULTS: Early human studies have demonstrated that vestibular implants can evoke canal-specific vestibulo-ocular reflexes and, in selected patients, modest improvements in dynamic visual acuity and balance. However, functional and quality of life benefits remain inconsistent across small cohorts. Surgical risks, including loss of residual hearing, remain an important consideration. CONCLUSIONS: Vestibular implants offer proof of concept for partial restoration of vestibular function but remain experimental. Further technological development and robust clinical trials are required before routine clinical adoption. Their role within publicly funded systems such as New Zealand's must be considered in the context of cost, access and equity.
AIM: Early-onset colorectal cancer (EOCRC; <50 years) is rising globally, yet the lived experiences of people diagnosed with EOCRC is poorly described. We aimed to carry out a survey to explore patient-reported experienc...AIM: Early-onset colorectal cancer (EOCRC; <50 years) is rising globally, yet the lived experiences of people diagnosed with EOCRC is poorly described. We aimed to carry out a survey to explore patient-reported experiences among people with EOCRC in Aotearoa New Zealand. METHODS: A nationwide, anonymous online survey (August 2024 to January 2025) of people diagnosed with colorectal cancer (CRC) before age 50 years was undertaken. Descriptive analyses report counts/percentages overall and, where relevant, report respondents to each item; ethnicity was summarised using prioritised and total-response approaches. RESULTS: Three hundred and fifty-three people (mean age 41.4 years; 70.5% female) responded to the survey. Half of the people reported ≥6 months from first symptoms to diagnosis and 20% waited more than 12 months for a diagnosis; around 20% of respondents made four or more healthcare visits before referral and 7.1% had a colonoscopy referral initially declined. Initial misdiagnoses were common (112/353; 31.7%) with similar rates between males and females. Among those reporting stage, two-thirds had Stage III-IV. Over half of patients used private care, often via insurance (189/353; 53.5%), yet delays occurred in both insured and uninsured groups. Fertility counselling (29.2%) and sexual side-effect counselling (31.2%) were uncommon, with 23% of respondents reporting persistent sexual dysfunction. Only 12.8% of people received information tailored to younger adults and cultural support was offered to only 7.6% of people. CONCLUSIONS: Younger New Zealanders with CRC reported prolonged diagnostic intervals, frequent initial alternative explanations for symptoms and late-stage disease. Respondents also reported gaps in age-specific information and supportive care.
AIM: This study investigates the relationship between disability and food insecurity in Aotearoa New Zealand, exploring how different types and complexities of disabilities relate to food security status. METHOD: Adult d...AIM: This study investigates the relationship between disability and food insecurity in Aotearoa New Zealand, exploring how different types and complexities of disabilities relate to food security status. METHOD: Adult data from the 2019/2020 New Zealand Health Survey were analysed, with the Washington Group Short Set questions collecting information on six disability domains (visual, hearing, walking, memory/concentration, washing/dressing and communication), and a New Zealand-specific eight-item questionnaire assessing food security status. Exploratory data analysis and modified Poisson regression models were employed. RESULTS: Our analysis revealed that 27.4% of disabled people experience food insecurity compared with 11.6% of non-disabled people. Disability was significantly associated with food insecurity, and the risk of experiencing food insecurity increased with the complexity of disability, with individuals having multiple disabilities facing substantially higher risk. Pacific and Māori people with disabilities experienced disproportionately higher rates of food insecurity (57% and 35% respectively). CONCLUSION: Disability is associated with food insecurity in New Zealand, emphasising the need for targeted interventions and policies that consider disability type, complexity and intersecting identities when addressing food security challenges.
AIM: We aimed to examine clinical characteristics associated with ischaemic stroke (IS) or transient ischaemic attack (TIA) among non-anticoagulated patients with atrial fibrillation (AF). METHODS: We conducted a case-co...AIM: We aimed to examine clinical characteristics associated with ischaemic stroke (IS) or transient ischaemic attack (TIA) among non-anticoagulated patients with atrial fibrillation (AF). METHODS: We conducted a case-control study restricted to adults with non-valvular AF who were not treated with oral anticoagulation. Incident IS/TIA cases were identified from the Auckland Regional Community Stroke (ARCOS) V study (1 September 2020-31 August 2021). Controls were patients hospitalised with AF prior to 1 September 2020 who remained IS/TIA-free through follow-up and were identified from the National Minimum Dataset. Demographics, comorbidities, body mass index and AF phenotype were ascertained from clinical records. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs), with stabilised inverse probability weighting (IPW) performed as a sensitivity analysis. RESULTS: Among 593 non-anticoagulated AF patients, 121 experienced IS/TIA. Cases were older, more often female, and had a higher comorbidity burden. Persistent/permanent AF was strongly associated with IS/TIA compared with paroxysmal AF (aOR 5.32 [95% confidence interval (CI) 3.20-8.82]), with partial attenuation after IPW (aOR 4.41 [95% CI 2.72-7.12]). Female sex was also associated with higher odds of IS/TIA (aOR 1.78 [95% CI 1.08-2.94]), and this association remained after IPW. CONCLUSION: Among non-anticoagulated patients with AF, IS/TIA risk is concentrated within identifiable high-risk phenotypes, highlighting missed opportunities for stroke prevention in routine clinical practice.
AIM: This study examines the relative prevalence of pre-existing comorbidities and their relationship with key in-hospital complications across all injury severities of a trauma patient cohort in New Zealand. METHODS: A...AIM: This study examines the relative prevalence of pre-existing comorbidities and their relationship with key in-hospital complications across all injury severities of a trauma patient cohort in New Zealand. METHODS: A retrospective review of data from the Te Manawa Taki (TMT) trauma registry linked to the National Minimum Dataset in New Zealand was conducted. The linked data include patients of all injury severities over 10 years, from 1 January 2014 to 31 December 2023, and pre-existing comorbidities and complications associated with admission events across facilities. Comorbidities and complications were defined using the Australia and New Zealand Trauma Registry classification. RESULTS: Between 2014 and 2023, 13% of trauma admissions in the TMT Region involved patients with pre-existing comorbidities, with a mean Charlson Comorbidity Index (CCI) of 4.7 (SD=2.4). Incidence rate ratios (IRRs) show that patients of non-Māori ethnicities (1.4), females (1.8) and those aged 65 and over (4.8) are more likely (p<0.001) to have a comorbidity. Diabetes is the most common pre-existing comorbidity, followed by chronic pulmonary diseases and cerebrovascular diseases. Findings demonstrate that individuals aged 65 and over with comorbidities face a 2.2 times higher risk of in-hospital complications (p<0.001). Regression analysis indicates that having multiple comorbidities, reflected by higher CCI scores, increases the likelihood of complications in trauma patients (F[428]=0.22, p<0.001). CONCLUSION: From a clinical and systems perspective, these findings suggest that early incorporation of comorbidity assessment in trauma pathways is essential and should be applied across the full spectrum of injury severities.
AIM: We aimed to determine the incidence of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) in the Waitaha Canterbury Region, and to describe the clinical characteristics, time to relapse, rate of...AIM: We aimed to determine the incidence of anti-neutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV) in the Waitaha Canterbury Region, and to describe the clinical characteristics, time to relapse, rate of remission and survival. METHODS: Incident cases of AAV diagnosed between 1 January 2016 and 31 December 2020 were identified. Electronic medical records were reviewed from the date of diagnosis until 31 December 2021, last clinical encounter or death. Incidence was calculated and survival was estimated through Kaplan-Meier plots. RESULTS: Forty-six cases of AAV were identified, giving an incidence of 1.70 cases per 100,000 per annum over the 5 years (95% confidence interval 1.25-2.27). There was no change in incidence over time. The mean (standard deviation) age at diagnosis for any type of AAV was 66.8 (13.3) years. Remission was achieved in 38/46 (82.6%) patients by 3 months and 35/38 (92.1%) by 18 months. There were 11 deaths (23.4%), with three occurring within the first 12 months of diagnosis. CONCLUSION: Despite the limited availability of rituximab, survival at 5 years is similar to international studies. There has been no clear change in incidence of AAV over time.
AIM: Acute rheumatic fever (ARF) rates declined in Aotearoa New Zealand during the COVID-19 pandemic (2020-2022). This study aimed to explore the impact of COVID-19 public health measures on ARF hospitalisations and ethn...AIM: Acute rheumatic fever (ARF) rates declined in Aotearoa New Zealand during the COVID-19 pandemic (2020-2022). This study aimed to explore the impact of COVID-19 public health measures on ARF hospitalisations and ethnic inequities for Māori and Pacific peoples. METHODS: We conducted a descriptive Kaupapa Māori epidemiological study using hospital discharge data to calculate frequencies, rates and rate ratios for initial ARF hospitalisations (<35 years), 2000-2022. Multivariable Poisson regression models evaluated the impact of COVID-19 public health measures on ARF incidence. RESULTS: A temporal association between ARF hospitalisation and COVID-19 elimination-suppression strategies was identified (adjusted rate ratios [aRR] 0.47, 95% confidence interval [CI] 0.33-0.69, p<0.001). The association differed between 2020 and 2021 with the addition of any lockdown. Crude rates trend downwards for Pacific peoples from 2020 to 2022 and were low in 2022 for both Māori and Pacific peoples. In 2022, ethnic inequities were large for Māori (aRR 45) and Pacific peoples (aRR 77) compared with non-Māori, non-Pacific peoples. CONCLUSIONS: Persistently high rates of ARF in Māori and Pacific peoples are not inevitable. Interpreting hospitalisation trends and health inequities during the period of COVID-19 public health measures requires understanding of how racism and coloniality shape the distribution of risk and protective factors. Structural transformation is required to achieve health equity.
AIM: The aim of this study was to quantify interrupted care (delayed care and complete loss to follow-up) across the diabetes eye care pathway among people aged ≥15 years in Auckland, New Zealand, and assess disparities...AIM: The aim of this study was to quantify interrupted care (delayed care and complete loss to follow-up) across the diabetes eye care pathway among people aged ≥15 years in Auckland, New Zealand, and assess disparities by age, sex, ethnicity, deprivation and diabetes duration. METHOD: We analysed data from people engaged with diabetes retinal screening in Auckland between 1 January 2008 and 31 December 2019. Follow-up continued from first appointment until death or study end. Delayed care and complete loss to follow-up were assessed at retinal screening, when referred from screening to ophthalmology with referrable diabetic retinopathy (R3 or worse), and at ophthalmology review. RESULTS: Almost one-third of people experienced delays in retinal screening care beyond 24 months (n=4,471/14,708; 30.4%) and one-fifth were completely lost to follow-up (n=2,970/14,708; 20.2%). Similar proportions were observed for a delay beyond 6 months when referred from retinal screening to ophthalmology with referrable retinopathy (n=648/1,909; 33.9%) and a delay beyond 12 months between ophthalmology review (n=366/1,136; 32.2%) or complete loss to follow-up from these two stages (n=433/1,909; 22.7% and n=188/1,136; 16.5% respectively). Younger adults were more likely to experience complete loss to follow-up from retinal screening and ophthalmology review compared to people aged 50-59 years; compared to NZ Europeans, all other ethnicity groups were more likely to be lost to follow-up from retinal screening, with Māori and Pacific peoples experiencing the greatest disparity. CONCLUSION: Loss to follow-up and delayed care were common across all stages of the diabetes care pathway assessed, with disparities by age and ethnicity.
Primary healthcare data can be used to conduct cost-effective research that improves understanding of population health and disease, leading to more effective prevention, earlier diagnosis, better-informed health models...Primary healthcare data can be used to conduct cost-effective research that improves understanding of population health and disease, leading to more effective prevention, earlier diagnosis, better-informed health models and improved health equity. However, Aotearoa New Zealand lacks a national primary healthcare data collection and has no national infrastructure to integrate and interrogate routinely collected primary healthcare data. This paper describes new technical approaches used internationally to improve researcher access to healthcare data and considers how this may be applied in the New Zealand context using Māori data governance and ethical data stewardship principles. Data access may be improved through platform-level, algorithm-level and data-level approaches. Māori data governance and ethical data stewardship principles can be applied to these new technical approaches. A governance model requires strict management, administration and oversight. An open-access model could provide easier access for researchers to develop and test models on synthetic data within a trusted research environment. Improving primary healthcare data access for research in New Zealand requires partnership that upholds Māori data governance principles and ethical research standards. Debate of the advantages and disadvantages of these technical approaches and stewardship models including patients and the public is welcomed.
AIMS: Life expectancy in Aotearoa New Zealand has increased over recent decades, but these increases have not been distributed equally across population groups. Examining how changes in cause-specific mortality have cont...AIMS: Life expectancy in Aotearoa New Zealand has increased over recent decades, but these increases have not been distributed equally across population groups. Examining how changes in cause-specific mortality have contributed to changes in life expectancy can improve understanding of evolving mortality patterns and persistent inequities. This study quantified the contribution of major causes of death to changes in life expectancy over approximately two decades. METHODS: Mortality data from the New Zealand Mortality Collection and population estimates from Statistics New Zealand were used to calculate life expectancy at birth for Māori, Pacific, Asian, and European and Other populations for the periods 2001-2003 and 2020-2022. Changes in life expectancy were decomposed by age and cause of death using the Arriaga method. Deaths were grouped into major disease categories and selected individual causes to estimate their contribution to the change in life expectancy. RESULTS: Life expectancy increased for all ethnic groups, with the largest absolute increases observed among Māori. Improvements were driven primarily by reductions in mortality at adult and older ages. Across all ethnic and sex groups, declines in cardiovascular disease and cancer mortality accounted for more than half of the total change in life expectancy. Reductions in mortality from diabetes and smoking-related conditions also contributed to increases among Māori and Pacific peoples. Despite these improvements, substantial ethnic inequities in life expectancy remain. CONCLUSION: Increases in life expectancy in Aotearoa New Zealand between 2001-2003 and 2020-2022 were driven largely by reductions in mortality from major non-communicable diseases, primarily cardiovascular disease and cancer. Māori experienced some narrowing of the life expectancy gap relative to European and Other populations, whereas the gap for Pacific peoples remained largely unchanged. Despite overall improvement, substantial inequities persist. Further increases are likely to depend on strengthening primary prevention, particularly reductions in smoking and cardiovascular risk factors, alongside improved participation in screening and early detection programmes, including the potential role of lung cancer screening, and ensuring equitable access across care pathways.