Hancox R, Jones S, Baggott C
… +13 more, Candy S, Corna N, Fingleton J, Hotu S, Hussain S, McRae W, Moore M, Poot B, Reid J, Rhodes S, Travers J, Turner J, Young R
This update revises the Asthma and Respiratory Foundation NZ's Chronic Obstructive Pulmonary Disease (COPD) Guidelines in line with the latest national and international evidence. The aim is to provide simple, practical,...This update revises the Asthma and Respiratory Foundation NZ's Chronic Obstructive Pulmonary Disease (COPD) Guidelines in line with the latest national and international evidence. The aim is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of COPD in clinical practice in an Aotearoa New Zealand context. The intended users are health professionals responsible for delivering acute and chronic COPD care in community and hospital settings, and those responsible for the training of such health professionals.
INTRODUCTION: Human civilisation faces global catastrophic risks such as: nuclear war, bioengineered pandemics, major solar storms and a volcanic winter. For some of these catastrophes, island nations may have relative s...INTRODUCTION: Human civilisation faces global catastrophic risks such as: nuclear war, bioengineered pandemics, major solar storms and a volcanic winter. For some of these catastrophes, island nations may have relative survival potential but any collapse in international trade could also end critical imported goods such as pharmaceuticals. We aimed to explore the latter in New Zealand, a highly trade-dependent island nation. METHODS: We identified the 10 most extensively prescribed pharmaceuticals in New Zealand that can be used for acute treatment (by annual prescription numbers). Based on modern synthesis pathways for these pharmaceuticals in the literature, we identified ingredients and then determined if these ingredients were currently produced in New Zealand. RESULTS: The results suggest that none of these 10 pharmaceuticals could be produced in New Zealand in a trade-ending catastrophe: paracetamol, omeprazole, amoxicillin, ibuprofen, aspirin, metoprolol succinate, salbutamol, prednisone, cetirizine hydrochloride and amlodipine. This is primarily because New Zealand does not refine petrochemicals. For seven of these 10 pharmaceuticals the relevant catalysts or other specific chemical ingredients are also not mined or otherwise produced in New Zealand. There may, however, be some scope for the post-catastrophe scavenging of minerals for producing some catalysts. CONCLUSIONS: This preliminary analysis suggests that none of the 10 most extensively prescribed pharmaceuticals that can be used for acute treatments could be manufactured in New Zealand after a trade-ending global catastrophe. To address this and other domains lacking in resiliency (e.g., liquid fuel supply), planning for building shared resiliency with other neighbouring nations (e.g., Australia) could be considered.
AIM: This study explores the semantic similarities between qualitative research transcripts produced by artificial intelligence (AI) and those transcribed manually, with a particular focus on challenges encountered when...AIM: This study explores the semantic similarities between qualitative research transcripts produced by artificial intelligence (AI) and those transcribed manually, with a particular focus on challenges encountered when working with multicultural participants in health science research who are non-native English speakers. METHOD: The analysis is based on an audio file from one representative participant in a qualitative study involving 20 participants. It compares transcripts generated by a professional audio transcriptionist with those produced by two AI platforms, Otter.ai and Avidnote. RESULTS: Findings reveal that while AI transcription has advantages in speed and cost-effectiveness, it can struggle with speaker differentiation and punctuation accuracy, necessitating manual review. Both platforms faced challenges with cultural terminology and accented speech, but Avidnote showed better performance in word recognition and comprehension. Limitations were primarily in the transcription of te reo Māori. CONCLUSION: The study highlights the critical role of culturally competent researchers in reviewing transcripts to ensure accuracy and clarity. These findings contribute to a deeper understanding of the benefits and limitations of AI transcription tools in qualitative health research, especially when working with linguistically and culturally diverse populations.
AIMS: The primary objective of this study was to explore type 2 diabetes (T2D) awareness, knowledge, attitudes and risk factors among youth in Auckland. METHODS: We undertook convenience sampling of participants aged 16-...AIMS: The primary objective of this study was to explore type 2 diabetes (T2D) awareness, knowledge, attitudes and risk factors among youth in Auckland. METHODS: We undertook convenience sampling of participants aged 16-25 years of Pacific and Māori descent recruited from South, Central and East Auckland through multiple community outreach events organised by the Tongan Health Society from 25 May to 31 July 2024. An additional three participants aged 26-31 years were assessed opportunistically to enhance our study power. Data were collected through a structured survey, an HbA1c point-of-care test, body composition assessments (using the TANITA RD-545 InnerScan PRO body composition scale) and height measurements. RESULTS: In a sample of 138 participants (aged 16-31 years; 58% female; 62% Tongan, 18% Samoan and 3% Māori), 51.9% were classified as obese, and one new case of diabetes was identified. Approximately 60.1% of participants reported awareness of T2D. Of these, 40% were made aware primarily through familial sources. High consumption of sugary drinks was common. Non-dietary risk factors included a first-degree family history of T2D (36%), smoking (39%) and alcohol consumption (45%). Most participants reportedly engaged in regular physical activity (41% males and 59% females). Participants suggested a multifaceted, youth-focussed care model, primarily lifestyle management for T2D prevention and management. CONCLUSIONS: A significant proportion of young people aged 16-31 years were identified as obese and had a higher proportion of dietary and non-dietary risks for T2D. The results underscore the necessity for tailored prevention strategies, mainly aimed at Pacific and Māori youth, to mitigate the risk of future T2D development.
AIM: Endoscopic submucosal dissection (ESD) has become a well-established treatment option for premalignant and early malignant lesions of the gastrointestinal tract. This study aimed to evaluate the recurrence rate foll...AIM: Endoscopic submucosal dissection (ESD) has become a well-established treatment option for premalignant and early malignant lesions of the gastrointestinal tract. This study aimed to evaluate the recurrence rate following ESD in a single tertiary centre cohort of patients. METHODS: All consecutive patients who received ESD treatment for premalignant or early malignant lesions by a single endoscopist (AS) at Middlemore Hospital from 11 February 2019 to 6 October 2023 were included in this retrospective cohort study. The primary outcome was recurrence rate of premalignant and early malignant lesions of the gastrointestinal tract following ESD. Recurrence was defined as confirmed neoplasm on histopathology on first follow-up surveillance endoscopy. The target recurrence rate was less than or equal to 5%. Secondary outcome was recurrence stratified by location of the lesion, lesion size, en bloc resection status, R0 resection status and histopathological type of lesion. RESULTS: A total of 119 ESD procedures were completed during the study time frame, with 91 having a surveillance endoscopy with a median time of 231 days. Twenty-eight cases did not have surveillance endoscopy completed. Three (3.3%) had recurrence of disease, of which two were oesophageal squamous cell carcinoma and one was rectal sessile serrated adenoma. We were unable to ascertain any statistically significant associations with regard to our secondary outcome variables. CONCLUSION: This study supports the efficacy of ESD in our centre as a curative treatment modality for premalignant and early malignant gastrointestinal lesions, demonstrating a recurrence rate within the acceptable international benchmark.
Colonoscopy is a cornerstone of colorectal cancer screening with a low incidence of complications such as bleeding and perforation. Infectious complications such as liver abscesses are exceedingly rare. We report a case...Colonoscopy is a cornerstone of colorectal cancer screening with a low incidence of complications such as bleeding and perforation. Infectious complications such as liver abscesses are exceedingly rare. We report a case of a 72-year-old Sri Lankan man with a background of diabetes mellitus and diverticulosis who developed a pyogenic liver abscess (PLA) following an uncomplicated colonoscopy performed as part of the New Zealand bowel screening programme. The abscess was caused by Klebsiella pneumoniae, a pathogen commonly associated with such infections. He was successfully treated with broad-spectrum antibiotics and ultrasound-guided drainage. This case raises the possibility of a rare association between colonoscopies and pyogenic liver abscesses, even in non-invasive procedures, particularly in high-risk patients, though direct causality cannot be established. We reviewed potential mechanisms and relevant literature in this case report.
Young-onset (<50 years) colorectal cancer (YOCRC) has been increasing in Aotearoa New Zealand since the birth cohort born around the mid-1950s. Possible responses include education and public health measures, none of whi...Young-onset (<50 years) colorectal cancer (YOCRC) has been increasing in Aotearoa New Zealand since the birth cohort born around the mid-1950s. Possible responses include education and public health measures, none of which are likely to make a major impact in the foreseeable future. Many YOCRCs are presenting at late stages with predominantly distal cancers. Our current National Bowel Screening Programme (NBSP), screening people 60-75 years, was introduced with inadequate resources; as a result, some colonoscopy services have been moved from symptomatic cases to screening, resulting in diagnostic delays and poorer outcomes. Extending screening to 40 or 45 years will markedly increase the need for follow-up colonoscopies and stretch services beyond breaking point. Sigmoidoscopy is associated with a substantial and sustained reduction in risk of distal colorectal cancer incidence and mortality. As there are too few endoscopists for the existing workload, increasing the nurse endoscopist workforce is a rational step. Initial training would focus on flexible sigmoidoscopy (FS) and concentrate on symptomatic patients <50 years. Steadily increasing nurse endoscopist numbers will contribute to management of the rising incidence of YOCRC. Without disrupting the NBSP or putting much extra strain on need for follow-up colonoscopies, nurse-led FS clinical services can expand to anyone with relevant symptoms and, as a longer-term goal, eventually become part of an expanded screening programme that could include one-off FS at age 50. If we are agreed that this is essential, training and service must be adequately funded and accompanied by a public advocacy campaign to ensure sufficient resources.
This review explores COVID-19 (coronavirus disease of 2019) from the perspective of Darwinian natural selection and consequent evolution of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). COVID-19 has cause...This review explores COVID-19 (coronavirus disease of 2019) from the perspective of Darwinian natural selection and consequent evolution of SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2). COVID-19 has caused unprecedented societal and economic turmoil. The human host population has responded with widespread vaccination, therapeutic monoclonal antibodies, convalescent plasma and antiviral drugs. SARS-CoV-2 has demonstrated remarkable resilience and has been able to quickly adapt to its rapidly changing habitat. SARS-CoV-2 has generated new antibody and vaccine evasive mutations in its genome, while simultaneously optimising its infectivity by improving its affinity to the ACE2 receptor and host proteases. Molecular analysis of SARS-CoV-2 has demonstrated natural selection of advantageous mutations in both individual patients with chronic COVID-19 infection and at a host population level, leading to extinction of less fit strains. COVID-19 is living proof of Darwinian evolution, which is occurring in observable time rather than over millions of years. Viewing COVID-19 from an evolutionary perspective will help mitigate the current and future pandemics. The aim of this article is to illustrate these concepts, using examples from the human host peer-reviewed literature.
BACKGROUND: This study examines national trends in thoracic spine injury (TSI)-related claims in New Zealand over an 11-year period (2013-2023), with a focus on incidence patterns by sex, age group, injury type and ethni...BACKGROUND: This study examines national trends in thoracic spine injury (TSI)-related claims in New Zealand over an 11-year period (2013-2023), with a focus on incidence patterns by sex, age group, injury type and ethnicity. METHODS: A descriptive longitudinal study design was used to analyse 11 years' (2013-2023) data from the Accident Compensation Corporation (ACC). TSIs were grouped into fractures/dislocations, soft tissue injuries and pain syndromes. Incidence rates per 100,000 population were calculated using Stats NZ Tatauranga Aotearoa denominators. Trends were explored using descriptive analyses, population pyramids and heatmaps and modelled using Poisson and negative binomial regression to estimate annual percent change (APC). Forecasts to 2033 were generated using time-series models. RESULTS: Between 2013 and 2023 there were 1,003,713 new TSI claims. From 2013 to 2023, the incidence of TSI increased from 1,749 to 1,901 per 100,000 (z=-10.49, p<0.001). Our findings demonstrate that females had more claims than males. Modelled APCs were +0.32% (95% CI: -0.29% to +0.94%) for males and +0.25% (95% CI: -1.22% to +1.74%) for females, both non-significant. Fractures (APC: +1.24% [95% CI: +0.13 to +2.35, p=0.028]) accounted for only 1.8% of claims (n=18,334) compared to soft tissue injuries (n=981,796). However, the APC was non-significant for soft tissue injuries. The highest burden occurred in the 30-54 age groups. In terms of ethnicity, European and Asian groups had higher TSI rates than Māori and Pacific peoples. CONCLUSION: TSIs have increased modestly over the past decade. The burden varies by sex, age and ethnicity. These findings support targeted prevention with implications for workforce health and equity-focused policy planning.
AIM: Previous research suggested that Māori patients have a lower incidence of pulmonary embolism (PE) compared to Europeans.5-7 The aim of this study was to re-examine this in the Bay of Plenty (BOP) region of Aotearoa...AIM: Previous research suggested that Māori patients have a lower incidence of pulmonary embolism (PE) compared to Europeans.5-7 The aim of this study was to re-examine this in the Bay of Plenty (BOP) region of Aotearoa New Zealand. METHOD: This retrospective study analysed all computed tomography pulmonary angiography (CTPA) scans completed from 1 February 2024 to 31 July 2024. Age-standardised rates for CTPA and PE in Māori were calculated using indirect standardisation to the European population. RESULTS: Of the scans completed, 719 CTPA scans met inclusion criteria. When age standardised, Māori received more CTPAs than Europeans, with an incidence ratio of 1.50 (95% CI [confidence interval] 1.34 to 1.68, p <0.0001). The age-standardised incidence of PE for Māori was 82.0 (95% CI 69.6 to 108) per 100,000 person years, and for Europeans was 87.0 (95% CI 65.1 to 102) per 100,000 person years, with an incidence ratio of 1.06 (95% CI 0.77 to 1.46, p=0.70). CONCLUSION: This study demonstrates no ethnic difference in the age-adjusted incidence of PE. These findings suggest that ethnicity should not be used in isolation for clinical decision making. Higher rates of CTPA in Māori suggest an equitable approach to CTPA scan requesting.
BACKGROUND: Children of Pacific ethnicity living in Aotearoa New Zealand have the second highest incidence of bone and joint infections (BJI) globally. This paper reports illness characteristics and outcomes for Pacific...BACKGROUND: Children of Pacific ethnicity living in Aotearoa New Zealand have the second highest incidence of bone and joint infections (BJI) globally. This paper reports illness characteristics and outcomes for Pacific children diagnosed with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) from the Auckland Region over a 5-year period. It also reports features associated with severe and complex disease. METHODS: Cases included all children aged ≤15 years hospitalised for AHO or SA in the Auckland Region, 1 January 2018-31 September 2023. Prioritised ethnicity was identified from hospital records. Direct medical hospitalisation costs, treatment type and outcomes were described up to 1 year following discharge. Complex illness was defined as recurrence/chronic infection, readmission, intensive care admission, complication following treatment or >1 surgical procedure. RESULTS: Of 563 cases of acute BJI, 152 were children identifying as Pacific ethnicity. Compared with NZ European children with BJI, Pacific children had more eczema (34% vs 19%, p=0.002), multifocal sepsis (30% vs 10%, p=<0.05) and surgical intervention (61% vs 47%, p=0.01) with lengthier hospitalisations (14 days vs 9 days, p=0.001). Most Pacific children experienced complex illness (66%). Complex illness was associated with cultures positive for Staphylococcus aureus and eczema diagnosis. In regression analysis, complex illness was less likely for children with a previous throat swab positive for group A Streptococcus (GAS). CONCLUSION: Pacific children with BJI experience more severe illness compared with NZ European children with BJI. Eczema is common among Pacific children with BJI. Proactive eczema management may represent suitable focus for disease prevention. Prior GAS throat swab appears associated with reduced rates of complex illness.
BACKGROUND: Meaningful community engagement is essential when designing health services and initiatives. Te Wāhi Tiaki Tātou was established as the Porirua locality under the Pae Ora Act 2022 to support place-based appro...BACKGROUND: Meaningful community engagement is essential when designing health services and initiatives. Te Wāhi Tiaki Tātou was established as the Porirua locality under the Pae Ora Act 2022 to support place-based approaches to hauora. Our community engagement takes the form of "reimagining sessions":, facilitated hui that elevate lived experience as a powerful and essential form of evidence in health service design. METHODS: Reimagining sessions blend principles from participatory action research (PAR) and service design, grounded in Te Tiriti o Waitangi. From PAR, they draw on honouring lived experience as expertise. Service design contributes sequencing and holistic thinking principles. Shared principles across both PAR and service design are community-centred approaches, where whānau are positioned as co-creators (from service design) or co-researchers (from PAR), and power sharing with the community to create space for true community-led decision making. Whānau and providers are invited separately to map their experiences of current health services and envision an ideal future state. Sessions are guided by relational engagement and reflexive practice. RESULTS: Reimagining sessions are more than a consultation mechanism, and serve to share power and elevate community voice. Outputs are synthesised into action-oriented reports validated by participants. Our learnings highlight the importance of trusted relationships, culturally safe environments and emotional anchoring to support aspirational thinking. CONCLUSION: Reimagining sessions demonstrate that whānau-led change is possible when communities are treated as experts in their own lives. They reflect a shift from consultation to collaboration, from systems-centred to whānau-centred and from generic services to community-informed services.