A novel theory speculates how trauma is stored in the brain, the physiology of traumatic reactions and identifies a molecular mechanism that may rapidly erase traumatic memories and reverse their consequences. This theor...A novel theory speculates how trauma is stored in the brain, the physiology of traumatic reactions and identifies a molecular mechanism that may rapidly erase traumatic memories and reverse their consequences. This theory is the basis of Havening Techniques®, used by more than 1,000 certified mental health practitioners worldwide. While trauma therapies such as eye movement desensitisation and reprocessing (EMDR) are well validated by clinical trials, the underlying mechanism of action is unknown. The theory of Havening offers a potential unifying mechanism involving the role of delta brain waves in memory processing, initiated by lateral eye movements (EMDR) or specific forms of touch (Havening). If validated by further clinical trials, Havening Techniques may represent an important advance in mental health care as trauma is a significant but potentially reversable cause of chronic anxiety, depression, post-traumatic stress disorder (PTSD), phobias and addictions. Moreover, the theory includes precise diagnostic criteria for identifying traumatic events and predicting the mental and physical health consequences. Clinical experience suggests that erasing the specific traumatic memories may also lead to sudden relief of stress-induced illness and some cases of chronic pain.
Donald J Trump began his second term as president of the United States (US) in January 2025. Since then, his administration has abandoned the precedents necessary for good government, brushed aside restrictions on execut...Donald J Trump began his second term as president of the United States (US) in January 2025. Since then, his administration has abandoned the precedents necessary for good government, brushed aside restrictions on executive power, sacked tens of thousands of federal workers and undermined healthcare within the US and overseas. I argue the consequences of Trump's actions are so serious they must concern health professionals everywhere, and outline three ways to respond. These are: to actively and effectively support colleagues in the US; to do what we can to sustain health gains worldwide; and to oppose health-damaging Trump-like thinking in Aotearoa New Zealand.
AIM: In New Zealand, ophthalmologists encounter varying degrees of work stress, job satisfaction and burnout. Significant clinical demands, long work hours and high-pressure responsibilities increase the likelihood of bu...AIM: In New Zealand, ophthalmologists encounter varying degrees of work stress, job satisfaction and burnout. Significant clinical demands, long work hours and high-pressure responsibilities increase the likelihood of burnout in this specialty. The present study aims to examine differences in ophthalmologists' work stress, job satisfaction and burnout across public hospital and private practice settings. METHOD: A cross-sectional quantitative study was conducted using a modified Mini Z 2.0 Burnout Survey to assess workplace satisfaction, stress and burnout among 171 New Zealand ophthalmologists. Demographic and practice-related data were also collected. RESULTS: Out of 161 delivered surveys, 84 responses were received (52% response rate). Among respondents, 84.5% had public sector roles and 81% worked in the private sector. Twenty-one percent of public sector ophthalmologists reported a joyous workplace (Mini Z score ≥30) compared with 75% in the private sector. Public sector clinicians reported significantly higher burnout symptoms, stress levels and workplace disorder, as well as poorer workload control and misalignment with leadership, compared with their private sector counterparts. CONCLUSION: The study highlights substantial disparities in job satisfaction and burnout between ophthalmologists working in the public and private sector. Factors such as excessive workload, bureaucratic inefficiencies and limited resource allocation in the public sector contribute to these differences. Adoption of private sector practices, including improved administrative support and autonomy, as well as public-private partnerships, may enhance retention and wellbeing in the public system.
This paper addresses the evidence on the health impacts of climate change in Aotearoa New Zealand with particular attention to who, where and what activities are most vulnerable. Applying the Arksey and O'Malley scoping...This paper addresses the evidence on the health impacts of climate change in Aotearoa New Zealand with particular attention to who, where and what activities are most vulnerable. Applying the Arksey and O'Malley scoping review framework, it consolidates academic and grey literature to identify gaps and future research priorities. The review-conducted from February to October 2024-included 61 papers from 2,265 that were initially screened. The results reveal that temperature and extreme precipitation are the main climate risks associated with health in Aotearoa New Zealand. These are associated with direct and indirect impacts, including heat-related illness and death, enteric diseases, poor mental health, access to safe drinking water/food supplies and access to healthcare. Most regions across Aotearoa New Zealand are susceptible to climate change-induced health risks, with unique pressures for coastal regions, metropolitan areas, rural areas and regions experiencing disproportionate socio-economic inequity. Workers in outdoor manual labour-exposed to heat stress, air pollution and sun damage-are vulnerable to climate change-induced health risks. The review also highlights key demographic characteristics-ethnicity, age, skin colour, occupation, gender, housing, disability and pre-existing health needs, and socio-economic deprivation-that affect vulnerability. In conclusion, the review underscores the importance of responses to climate change-induced health addressing the underlying, intersectional risk factors to protect vulnerable populations.
AIM: This study aimed to estimate rates and factors associated with eating disorder risk in transgender youth, and to explore the association between this risk and unmet need for gender-affirming hormone therapy (GAHT)....AIM: This study aimed to estimate rates and factors associated with eating disorder risk in transgender youth, and to explore the association between this risk and unmet need for gender-affirming hormone therapy (GAHT). METHODS: In a national cross-sectional survey of participants aged 14-24 years, the five-item Sick, Control, One stone, Fat, Food (SCOFF) instrument was used to assess eating disorder risk. GAHT demand was self-reported. Modified Poisson regressions were employed to assess risk. RESULTS: Overall, 1,401 participants were eligible, of whom 1,010 (72.1%) had valid SCOFF scores. Of these, 398 (38.4%) participants met the threshold for eating disorder risk. In adjusted analyses, those aged 14-18 years had an increased prevalence ratio (PR) of eating disorder risk compared with their counterparts aged 19-24 years (PR: 1.26; 95% confidence interval: 1.06-1.50). GAHT demand was reported by 645 participants, with 277 (42.9%) having unmet need. No statistical evidence was found relating unmet GAHT need with eating disorder risk (p=0.29). CONCLUSION: Nearly two in five transgender youth are at eating disorder risk, and unmet GAHT need rates appear higher. While it is recognised that eating disorders are a global health concern, they have not received the priority they deserve. In the calls for urgent action, transgender youth deserve particular attention.
AIMS: To describe Health New Zealand - Te Whatu Ora rheumatology services across Aotearoa New Zealand using the Arthritis New Zealand/New Zealand Rheumatology Association-endorsed rheumatology service standards. METHODS:...AIMS: To describe Health New Zealand - Te Whatu Ora rheumatology services across Aotearoa New Zealand using the Arthritis New Zealand/New Zealand Rheumatology Association-endorsed rheumatology service standards. METHODS: Descriptive study with data collection by survey from clinical service leads from all 16 Health New Zealand - Te Whatu Ora rheumatology services. RESULTS: Response rate was 100%. No services met all the service standards. Staffing of rheumatologists approached the standards in only three services, and nursing staffing was well below the standards in all services, with two services not employing any nurses. Where nurses were employed, nursing services standards were largely met. Five services did not provide inpatient consultations. Almost all services had access to conventional imaging modalities, but less than half of services provided point-of-care ultrasounds or had access to fluorodeoxyglucose-positron emission tomography (FDG-PET). Most services were able to make referrals to physiotherapy, occupational therapy and hand therapy. Ability of services to meet care standards for the care of rheumatoid arthritis (RA) was variable. Between 2023 and 2025, two services had a substantive increase in rheumatologist staffing and two had a substantive increase in nursing staffing. CONCLUSION: This first national-level description of all Health New Zealand - Te Whatu Ora rheumatology services found considerable heterogeneity, and generally services did not meet all services standards.
AIM: We aimed to describe the experience of strengthening leadership at a hospital to improve patient outcomes and staff satisfaction and wellbeing. METHOD: Following a review of the Hutt Hospital Emergency Department, s...AIM: We aimed to describe the experience of strengthening leadership at a hospital to improve patient outcomes and staff satisfaction and wellbeing. METHOD: Following a review of the Hutt Hospital Emergency Department, several actions were taken to strengthen the capacity, culture and leadership of the department. In addition, an organisation-wide values and culture exercise was undertaken. Senior clinical and non-clinical leaders were provided with interprofessional leadership training to foster shared understanding, strengthen relationships and promote practical application of learned skills. RESULTS: Subsequent external reviews of the emergency department documented a significant change in its culture and functioning; these changes have endured, and it is now a preferred place to train and work. Wider organisational leadership training was an essential part of creating a culture that valued staff and their wellbeing, and delivering better outcomes for patients. Involving local health system leaders, e.g., from primary care, provided significant additional value. CONCLUSIONS: Healthcare organisations and the health system are complex and present a myriad of leadership challenges. Healthcare leaders need and deserve specific training and strong support to lead effectively. A focus on this is essential if New Zealand is to successfully address health system challenges, both old and emerging.
AIM: To provide a balanced account of psilocybin treatment of depression for expectations to be appropriately set. METHOD: Review and discussion of key psilocybin efficacy studies. Reporting of side effects and risk of h...AIM: To provide a balanced account of psilocybin treatment of depression for expectations to be appropriately set. METHOD: Review and discussion of key psilocybin efficacy studies. Reporting of side effects and risk of harm with psychedelic treatments. Comparisons and contrasts with ketamine studies of treatment-resistant depression (TRD). RESULT: Early psilocybin studies offer promise but expectation bias and functional unblinding are factors in the treatment response. Psilocybin is generally well tolerated but side effects are often not systematically reported, and some recipients may experience harm. The ketamine research has similar methodological considerations, but the weight of positive evidence is stronger for a treatment-resistant group. CONCLUSION: The evidence for psilocybin treatment of depression is insufficient to press for wider availability and use.
The Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS) is an innovative tool designed to support equitable service delivery within specialist healthcare services. A multidisciplinary team reviewed...The Hauora Māori Equity Toolkit for Specialist Healthcare Services (HMET-SHS) is an innovative tool designed to support equitable service delivery within specialist healthcare services. A multidisciplinary team reviewed the health system structure and developed the HMET-SHS in the form of a Periodic Service Review (PSR) for measuring and monitoring Hauora Māori outcomes in specialist health services. The HMET-SHS promises to reshape specialist healthcare services and champion equitable healthcare improvements for all New Zealanders.
AIM: The aims of this study are to describe the current status of the heart failure nursing workforce in Aotearoa New Zealand, identify key challenges and provide recommendations. METHOD: In March 2023, a survey coordina...AIM: The aims of this study are to describe the current status of the heart failure nursing workforce in Aotearoa New Zealand, identify key challenges and provide recommendations. METHOD: In March 2023, a survey coordinated by the Cardiac Society of Australia and New Zealand and the New Zealand Regional Heart Failure Working Group was distributed to all district health boards in Aotearoa New Zealand. The survey collected data on heart failure nursing resources, including full-time equivalent (FTE) per population, clinical versus non-clinical time, scope of practice, nurse-led services, and performance measures. RESULTS: A total of 23 hospital responded, yielding a 100% response rate and revealing varied resource allocation across district health boards. While FTE rates have generally increased, nearly half of the boards reported less than one FTE per 100,000 population, with only three reaching the recommended two FTE per 100,000 as endorsed by the British Society for Heart Failure. CONCLUSION: This foundational survey highlights the current status of the heart failure nursing workforce in Aotearoa New Zealand. It suggests that increasing the number of specialised nursing staff, particularly nurse practitioners (NP), to meet international standards would improve access to timely, effective and equitable treatment for all heart failure patients. Increasing NP FTE across hospital and community settings is likely to enhance healthcare and social outcomes, especially in under-served regions. Further research focussing on ethnicity, geographic distribution and workforce participation is recommended to guide targeted workforce development.
AIM: To evaluate the impact of the COVID-19 pandemic on New Zealand ophthalmology surgical training, focusing on surgical volume, case-mix, trainee involvement and gender disparities. METHODS: Analysis of logbook data fo...AIM: To evaluate the impact of the COVID-19 pandemic on New Zealand ophthalmology surgical training, focusing on surgical volume, case-mix, trainee involvement and gender disparities. METHODS: Analysis of logbook data for New Zealand based trainees of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) from 1 January 2017 to 31 December 2022 was conducted comparing trainee-involved and trainee-performed case volumes between pre-pandemic (2017-2019) and pandemic (2020-2022) years, normalised by full-time equivalents (FTE). RESULTS: Analysis of 41,370 trainee-involved surgeries revealed that while the total number of trainee-involved procedures remained stable during the pandemic, trainee-performed surgeries decreased significantly by 11.8%. This was driven by a significant gender disparity (p=0.045), with a 24.9% decline for female trainees, concentrated among those in urban centres, while male trainee numbers remained stable (+0.74%). Provincial trainees performed twice as many surgeries as urban counterparts. A significant case-mix shift also occurred, with greater glaucoma (+27.6%) and fewer oculoplastic (-20.8%) surgeries. CONCLUSION: The pandemic was associated with a significant gender disparity in surgical training, driven by a reduction in procedures performed by female trainees predominantly in urban centres. The findings underscore the need to ensure equitable access to surgical training.
BACKGROUND: Copying results to a patient's primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates...BACKGROUND: Copying results to a patient's primary care provider confers a medico-legal responsibility to take action, which can complicate transfer of care. This practice contributes to administrative burden and creates uncertainty around the continuity of patient care. We aimed to survey primary care, with a focus on general practitioners (GPs), regarding their medico-legal awareness, preferences regarding receiving copied results, views on when transfer of care should happen, work-life balance, career pathway and the administrative burden (non-patient-facing clinical time) within their total clinical work hours. METHODS: This was an anonymous, cross-sectional survey for clinically active primary care clinicians (GPs, urgent care physicians, nurse practitioners [NPs]) in the Northern region of Aotearoa New Zealand. The survey link was open from August to October 2023 and distributed via email, promoted during webinars and shared on social media. RESULTS: A total of 470 eligible responses were collected: 428 GPs, 15 urgent care physicians, 18 NPs and 9 doctors that identify as "other primary care". Across the professions, 34% were unaware of the medico-legal responsibilities of being copied into results they did not initiate. With the exception of NPs, most primary care clinicians prefer to not be copied to radiology, histology, microbiology, haematology and biochemistry results they did not order. Four out of five participants agreed that any results copied to primary care should involve prior discussion and acceptance by a relevant clinician. Although GPs and NPs reported poorer work-life balance, lower job satisfaction and higher rates of burnout compared with the other primary care professions, all professions have seen reductions in their patient-facing hours in the past 5 years, with increased administrative burden identified as a major contributing factor. Indeed, 47.7% of the GPs surveyed stated their intent to leave primary care within the next 5 years. The median proportion of non-patient-facing clinical hours as part of total clinical hours was 31% for GPs, 17% for urgent care physicians, and 31% for both NPs and other primary care professionals. Among GPs, a higher proportion of non-patient-facing clinical work was associated with older age, female gender, other non-European ethnicity, holding vocational registration in general practice, more years of general practice experience, having a personal list of enrolled patients and working in a non-Very Low Cost Access practice. However, medico-legal awareness of copied results was not associated with an increased proportion of non-patient-facing clinical work. CONCLUSION: A gap in medico-legal knowledge related to test result responsibility exists within the primary care workforce. While this deficit was not linked to increased time spent on non-patient-facing clinical work, the majority of clinicians expressed a preference to not be routinely copied into test results unless a closed loop communication process with the ordering clinician is established. Improving the viability of primary care as a profession and patient care productivity will require coordinated efforts between primary care providers and Health New Zealand - Te Whatu Ora to reform current practices and uphold the principles of "Transfer of Care and Test Results Responsibility".
BACKGROUND: Drug use (including tobacco, alcohol and illicit drugs) is a leading cause of premature death, health loss and health inequities in Aotearoa New Zealand. Effective prevention and early intervention have poten...BACKGROUND: Drug use (including tobacco, alcohol and illicit drugs) is a leading cause of premature death, health loss and health inequities in Aotearoa New Zealand. Effective prevention and early intervention have potential to reduce drug-related human suffering across the lifecourse, thus decreasing pressure on health and social services. METHODS: To inform policy and practice, we investigated drug harm indicators among secondary students in Aotearoa and identified sub-populations at greatest need. We used Youth19 survey data (N=7,721) to investigate five indicators related to e-cigarette, tobacco, alcohol or cannabis use: prevalence of 1) past month use, 2) heavy use, 3) worry about use, 4) desire to cut down or stop, and 5) reported difficulty accessing cessation help. RESULTS: We found many adolescents, particularly those who used tobacco, were worried about their own drug use and wanted to cut down, yet getting appropriate help was not always easy. Need was not evenly spread; Māori, Pacific and LGBTQ+ youth, those aged under 16 years and those living in small towns, rural areas and the most socio-economically deprived communities had higher needs on many indicators. CONCLUSION: Greater investment in drug harm prevention and early intervention may be warranted, with a focus on under-served populations.