NEW ZEALAND MEDICAL JOURNAL最新文献

{"title":"Proton pump inhibitors in cirrhosis: a retrospective five-year analysis of increased risks of hepatic decompensation and infections.","authors":"Abhimati Ravikulan, Natalie Russell, Christin Coomarasamy, Ashok Raj","doi":"10.26635/6965.6838","DOIUrl":"https://doi.org/10.26635/6965.6838","url":null,"abstract":"<p><strong>Aim: </strong>Proton pump inhibitors (PPIs) are widely used in cirrhotic patients, often without a clear indication. Evidence links PPI use to adverse outcomes such as hepatic encephalopathy and spontaneous bacterial peritonitis. This study analyses outcomes associated with PPI use in cirrhosis over 5 years at a New Zealand tertiary centre.</p><p><strong>Methods: </strong>This retrospective study included all patients diagnosed with liver cirrhosis at Counties Manukau Health in 2014. Patients were divided into two groups: those taking PPIs and those not taking PPIs. Demographic data, relevant blood tests and cumulative PPI doses were recorded. Outcomes such as mortality, liver-related events (hepatic encephalopathy, spontaneous bacterial peritonitis, variceal bleeding and ascites) and infections were monitored over 5 years. Logistic regression analyses calculated odds ratios (ORs) for the association of PPI usage with outcomes, adjusting for age, comorbidities, medications, aetiology of cirrhosis and liver disease severity.</p><p><strong>Results: </strong>Of 392 patients, 304 (77%) received PPIs and 88 (23%) did not. Only 31% had a clear indication for PPI use. PPI users had higher comorbidity and liver disease severity. Adjusted analysis showed no significant difference in all-cause mortality (29.9% vs 19.3%, p=0.67) or liver-related mortality (35.2% vs 17.6%, p=0.37). However, there were higher liver-related events (30.9% vs 10%, OR 2.9, p=0.046) and all-cause infections (30.9% vs 11.2%, OR 2.4, p=0.024).</p><p><strong>Conclusion: </strong>PPI use in cirrhosis is linked to hepatic decompensation and higher infection risk. Judicious PPI use with clear indications is essential.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"70-80"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The common good: reviving our social contract to improve healthcare.","authors":"Philip Bagshaw, John D Potter, Andrew Hornblow, Susan Bagshaw, Christopher Frampton, Robert Campbell, Ganesh R Ahirao, William J Rosenberg, Gilbert O Barbezat, John McCall, Brian Cox, Matthew Roskruge, Frank Kueppers","doi":"10.26635/6965.6920","DOIUrl":"https://doi.org/10.26635/6965.6920","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"9-13"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144022429","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of pre-operative cardiorespiratory fitness on functional and subjective outcomes following total hip and knee arthroplasty: a single centre, observational study.","authors":"Brendon H Roxburgh, Holly A Campbell, James D Cotter, Ulla Reymann, Michael Ja Williams, David P Gwynne-Jones, Kate N Thomas","doi":"10.26635/6965.6855","DOIUrl":"https://doi.org/10.26635/6965.6855","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to assess the effect of pre-operative cardiorespiratory fitness (peak VO2) on physical and subjective recovery from total hip or knee arthroplasty. A secondary aim was to assess the relationship between daily step count or estimated peak VO2 via the Duke Activity Status Index (DASI) questionnaire, on post-operative recovery.</p><p><strong>Methods: </strong>In this secondary analysis of a prior randomised controlled trial, 51 patients (69 [8] y; 25 female; peak VO2: 20.1 [7.8] mL/min/kg) scheduled for total hip (n=23) or knee (n=28) arthroplasty underwent pre-operative assessment (cardiopulmonary exercise testing, physical function tests [30-second sit to stand, timed up and go, knee range of motion]), accelerometry and subjective questionnaire (DASI). Post-operative assessments included length of hospital stay, the Surgical Recovery Scale (SRS) and repeated functional assessments.</p><p><strong>Results: </strong>A low pre-operative peak VO2 (i.e., <15mL/min/kg) was associated with five fewer sit-to-stand reps (95% CI [confidence interval]: 3 to 7; p=0.002), 3,500 fewer daily steps (95% CI: 1,053 to 5,867; p=0.006) and poorer subjective surgical recovery at 7-days (-12 arbitrary units [AU], 95% CI: -3 to -22, p=0.014) and 6-weeks post-operative (-13 AU, 95% CI: -5 to -21; p=0.003). Estimated pre-operative peak VO2 using the DASI questionnaire was moderately correlated with post-operative daily step count (r=0.51, p <0.001); post-operative daily step count increased by 500 steps for every 1mL/min/kg increase in estimated peak VO2.</p><p><strong>Conclusion: </strong>Pre-operative peak VO2 was associated with physical and subjective recovery following total hip or knee arthroplasty. Daily step count and estimated peak VO2 via the DASI questionnaire had similar moderate associations with post-operative functional outcomes as directly measured pre-operative peak VO2 and may be acceptable alternatives to predict recovery following hip or knee arthroplasty.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"19-41"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144024484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Asian health trends in New Zealand from 2002 to 2021, and the case for dedicated research funding.","authors":"Robert Scragg, Zhenqiang Wu, Sally F Wong","doi":"10.26635/6965.6834","DOIUrl":"https://doi.org/10.26635/6965.6834","url":null,"abstract":"<p><p>The proportion of the Aotearoa New Zealand population with Asian ancestry is growing, from 17% in the 2023 census to an expected 26% by 2043. Thus, the health of the Asian community in New Zealand is increasing in importance. We have recently completed a major report on the health status of Asian people living in New Zealand since 2002 using data from the New Zealand Health Survey. While there have been some improvements, levels of most risk factors-such as fruit and vegetable intake, physical activity, alcohol intake and obesity-have worsened or not improved over the last 20 years. These have resulted in elevated risk of cardiometabolic disease, particularly among South Asians, at levels similar to those for Māori and Pacific. We have reviewed the funding of Asian health research by the Health Research Council of New Zealand since 2010 by searching the lay summaries of grants. We have found a mismatch between the number of funded grants and the size of the Asian population in New Zealand (respectively, 2.3% and 17% in 2023). The Health Research Council needs to ring-fence funding for Asian researchers so that Asian researchers have increased resources to research the major health issues that are adversely affecting their communities.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"110-122"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scurvy in the modern era: a case of vitamin C deficiency with unexplained bruising and anaemia.","authors":"Akram Shmendi","doi":"10.26635/6965.6824","DOIUrl":"https://doi.org/10.26635/6965.6824","url":null,"abstract":"","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"123-125"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Applying Indigenous identity definitions in official health statistics: a case study using linked cancer registry data on stomach cancer.","authors":"Nicole Satherley, Brandon de Graaf, Gabrielle Davie, Sheree Gibb, Andrea Teng, Andrew Sporle","doi":"10.26635/6965.6844","DOIUrl":"https://doi.org/10.26635/6965.6844","url":null,"abstract":"<p><strong>Aim: </strong>Ethnicity and descent are two different officially recognised identity definitions for the Indigenous Māori population of New Zealand. Official health statistics are usually reported by Māori ethnicity but not descent, as health collections such as the New Zealand Cancer Registry (NZCR) do not record Māori descent information. We explored the potential of linked administrative data to describe health outcomes by Māori descent using gastric (stomach) cancer as an example.</p><p><strong>Methods: </strong>The Integrated Data Infrastructure (IDI) was used to source information on Māori descent from the 2013 and 2018 censuses as well as birth and death records linked to the NZCR for gastric cancer registrations for the years 1995-2021 (N=10,575).</p><p><strong>Results: </strong>Māori descent information could be sourced for 81.8% of gastric cancer registrations. Descent information was available for 65.2% of gastric cancer registrations in death records, 39.5% in the 2013 or 2018 census, 6.1% from a child's birth record and ≤0.3% from personal birth records. Of the registrations for whom Māori descent information could be obtained, 18.6% were identified as being of Māori descent vs 17.3% identified as Māori by ethnicity. Missing Māori descent data was lower (around 5%) in more recent gastric cancer registrations (2012 onwards).</p><p><strong>Conclusion: </strong>Based on our case study, classifying cancer registrations by Māori descent for health outcome reporting, in addition to Māori ethnicity, may be feasible for recent years of data. Use of death records for Māori descent information should be carefully considered, as this may introduce bias to analyses such as survival analysis.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"81-90"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016932","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anticoagulation management and poor clinical outcomes in tamariki and rangatahi with rheumatic heart disease following mechanical valve replacement surgery in Counties Manukau.","authors":"Prathyusha Tangirala, Bridget Farrant, Rachel Webb","doi":"10.26635/6965.6736","DOIUrl":"https://doi.org/10.26635/6965.6736","url":null,"abstract":"<p><strong>Aim: </strong>Rheumatic heart disease (RHD) causes significant cardiovascular morbidity and mortality, with persisting inequitably high rates in Māori and Pacific tamariki and rangatahi. Mechanical valve replacement surgery is required for people with severe RHD and requires lifetime anticoagulation. Contemporary data regarding anticoagulation management and outcomes for tamariki and rangatahi following mechanical valve replacement surgery for RHD are lacking. We aimed to describe patient characteristics, anticoagulation management practices and complications in a cohort of tamariki and rangatahi ≤25 years of age.</p><p><strong>Methods: </strong>A retrospective observational study of patients aged ≤25 years with RHD and mechanical valves, living in Counties Manukau, South Auckland, 2016-2021, was conducted.</p><p><strong>Results: </strong>A total of 53 patients were identified. The median age at time of first mechanical valve surgery was 15 years (range 4-23 years). Nineteen percent of the cohort were Māori and 81% were Pacific peoples. The median duration of anticoagulation was 4 years (range 0.5-18 years). The most common method of monitoring was via the community laboratory service and general practitioner. There were 38 individuals who had ≥1 anticoagulation-related hospitalisation. There were 80 anticoagulation-related hospitalisations: 52% were due to a subtherapeutic international normalised ratio (INR) without clinical complication; 15% had a supratherapeutic INR without clinical complication; 14% haemorrhage; 9% stroke; 6% other thromboembolic events; and 4% prosthetic valve thrombosis. Five deaths occurred between 2016 and 2021.</p><p><strong>Conclusion: </strong>The majority of the cohort had serious anticoagulation-related hospitalisation events, and 10% died. Urgent efforts are required to improve services for anticoagulation monitoring and management and clinical outcomes in young adults following mechanical valve surgery for RHD.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"53-60"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144054570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancers potentially attributable to excess body weight in Aotearoa New Zealand from 2019 to 2023.","authors":"Michael Walsh, Jennifer Brenton-Peters, Olivia Perelini, Karen Bartholomew","doi":"10.26635/6965.6871","DOIUrl":"https://doi.org/10.26635/6965.6871","url":null,"abstract":"<p><strong>Aim: </strong>This study quantifies the incidence of cancers attributable to excess body weight (EBW) in Aotearoa New Zealand adults aged 30+ from 2019 to 2023 and assesses public health implications.</p><p><strong>Methods: </strong>Relative risk estimates from an existing review and EBW prevalence from the New Zealand Health Survey were used to calculate population attributable fractions (PAFs) for 12 cancer types. PAFs were applied to Cancer Registry data to estimate EBW-attributable cases. Confidence intervals were calculated using bootstrap techniques. Two scenarios explored the potential impact of reducing EBW prevalence.</p><p><strong>Results: </strong>An estimated 6,962 cancers (5.1% of all cases) were potentially attributable to EBW, averaging 1,390 cases annually. The impact was greater for females (PAF 6.3%) than males (PAF 4.1%). Among Māori, 6.9% of cancers (221 per year) were attributed to EBW, while Pacific peoples had a higher PAF of 11.8% (145 cases per year). PAFs were highest for Pacific females (16.1%, 110 per year). Modelling suggests halving EBW prevalence could potentially prevent 600 cases annually.</p><p><strong>Conclusion: </strong>EBW contributes to a large number of cancers in New Zealand, compounding health inequities, particularly for Māori and Pacific peoples. These inequities highlight the urgent need for multisectoral, collaborative interventions that address the complex, inequitable drivers of EBW. Public health must strengthen its pro-equity, anti-stigmatising approach to prevention, management and treatment. However, sustained reductions in EBW-related cancers will ultimately depend on preventing EBW rather than relying on treatment-based interventions.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"91-109"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034764","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delay to diagnosis in childhood bone and joint infection.","authors":"Sarah Hunter, Elsie Brown, Haemish Crawford, Vanessa Selak, Cameron Grant","doi":"10.26635/6965.6720","DOIUrl":"https://doi.org/10.26635/6965.6720","url":null,"abstract":"<p><strong>Aim: </strong>To determine the proportion of delayed diagnosis among cases of acute childhood bone and joint infection (BJI) and examine the impact of delayed diagnosis on illness trajectory.</p><p><strong>Methods: </strong>A retrospective review was undertaken of patients <16 years with acute haematogenous osteomyelitis (AHO) or septic arthritis (SA) treated in the Auckland region from 2018-2023. Electronic case information was used to identify any alternative diagnosis given prior to identification of BJI (delayed disease recognition). Cases were grouped into the following subtypes: multifocal sepsis or shock, \"isolated\" AHO or SA, or contiguous local infection such as pyomyositis and subperiosteal abscess. Primary outcomes included length of stay (LOS) and hospitalisation cost.</p><p><strong>Results: </strong>A total of 563 cases of childhood BJI were identified, of whom 512 had clearly documented presenting complaint. A high proportion received an alternative initial diagnosis (43%). Alternatively diagnosed children were more likely to have attended primary or urgent care (82% vs 38%, p=0.00001) and have a recent viral illness (46% vs 34%, p=0.008). Receiving alternative diagnosis was associated with greater delay to treatment (7.8 vs 4 days, p=<0.00001). Contiguous local infection was more likely in children with >1 week of symptoms (34% vs 17%, p=0.002). Contiguous infection required more surgical intervention, longer LOS and higher hospitalisation cost when compared to isolated AHO.</p><p><strong>Conclusion: </strong>Delayed recognition of childhood AHO and SA is common and is associated with delayed treatment. Symptoms present for >1 week are associated with contiguous infection, which, compared with isolated AHO, requires more surgery with increased hospitalisation costs.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"42-52"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144056748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electric scooter-related orthopaedic injuries in Wellington.","authors":"Wing Yung Agnes Chu, Michael T Lee, Ilia Elkinson","doi":"10.26635/6965.6812","DOIUrl":"https://doi.org/10.26635/6965.6812","url":null,"abstract":"<p><strong>Aim: </strong>Commercially operated electric scooters (e-scooters) were introduced to Wellington City in June 2019. This study aims to compare e-scooter-related orthopaedic injuries presenting to Wellington Hospital from June 2017 to June 2021, with data from other regions of New Zealand.</p><p><strong>Methods: </strong>The Wellington Hospital Accident Compensation Corporation Department provided a list of e-scooter-related claims presenting to Wellington Hospital over the 48-month period. A retrospective review was performed. Data were collected for patient demographics, circumstances of injury, management and follow-up. A single investigator reviewed all relevant imaging.</p><p><strong>Results: </strong>Between June 2017 and 2019, there were 14 e-scooter-related presentations with a total of two orthopaedic fractures in a single patient. Over the 2 years following June 2019, there were 295 e-scooter-related presentations. One hundred and seventeen patients sustained a total of 145 orthopaedic fractures. Twenty-nine percent of orthopaedic fractures required operative management. Intoxicated riders had a higher rate of open long bone fractures (p=0.003).</p><p><strong>Conclusion: </strong>Orthopaedic injuries are common with e-scooter use. Higher rates of orthopaedic fractures in Wellington City require operative management compared with Auckland. The establishment of regulations and education around use of personal protective equipment, use while intoxicated and speed limits would also be beneficial.</p>","PeriodicalId":48086,"journal":{"name":"NEW ZEALAND MEDICAL JOURNAL","volume":"138 1614","pages":"61-69"},"PeriodicalIF":1.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143988272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}