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The Health of Pacific Peoples in New Zealand

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The Health of Pacific Peoples in New Zealand THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association CONTENTS This Issue in the Journal 4 A summary of the original articles featured in this issue Editorials 7 Direct-to-consumer genetic testing: letting the genie out of the bottle? Dee Mangin, Ben Hudson, Les Toop 11 The health of Pacific peoples in New Zealand Jim Reid Original Articles 14 General practitioner attitudes to direct-to-consumer genetic testing in New Zealand Sanyogita Ram, Bruce Russell, Mary Gubb, Rebekah Taylor, Cassandra Butler, Imran Khan, Andrew Shelling 27 A Pacific population’s access to and use of health services in Dunedin Faafetai Sopoaga, Lianne Parkin, Andrew Gray 37 Improved stroke care processes and outcomes following the institution of an acute stroke unit at a New Zealand district general hospital Nicholas G Burgess, Ritva Vyas, Jennifer Hudson, Olivia Browne, Y C Lee, Sisira Jayathissa, Tom Thomson 47 Young ischaemic stroke in South Auckland: a hospital-based study Teddy Y Wu, Ajay Kumar, Edward H Wong 57 An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with M āori and Pacific people following stroke Matire Harwood, Mark Weatherall, Api Talemaitoga, P Alan Barber, John Gommans, William Taylor, Kathryn McPherson, Harry McNaughton 68 Health-enhancing physical activity programme (HEPAP) for transient ischaemic attack and non-disabling stroke: recruitment and compliance James Faulkner, Danielle Lambrick, Brandon Woolley, Lee Stoner, Lai-kin Wong, Gerard McGonigal 77 Carotid endarterectomy in octogenarians Shaw-Hua Kueh, Vicki Livingstone, Ian A Thomson NZMJ 26 October 2012, Vol 125 No 1364; ISSN 1175 8716 Page 1 of 147 URL: http://journal.nzma.org.nz/journal/125-1364/5392/ ©NZMA 83 Investigating the pathways in primary practice leading to the diagnosis of central hypothyroidism Veronique Gibbons, Ross Lawrenson, Phillipa Sleigh, Tania Yarndley, John V Conaglen Viewpoint 91 Smoking cessation is a prolonged journey rather than a single trip K Marie Ditchburn, Brent Caldwell, Julian Crane Clinical Correspondence 98 New Zealand’s first two-pair kidney transplant chain Karina Voitov, Ian Dittmer, Jo Burton, Carl Muthu 102 Thigh pain—an unusual presentation of ruptured appendicitis John English, Jean-Claude Theis 107 Tarantula hair keratitis Simran Singh Mangat, Bill Newman 111 Medical image. Another stroke with chest infection? Philip M C Choi, Danielle H J Oh Letters 114 Synthetic cannabinoid use in New Zealand: a recent rebound Leo J Schep, Robin J Slaughter, Wayne A Temple, Bruce S Lambie, Paul Gee, Martin Watts, Chip Gresham 117 Admission to Medicine at the University of Auckland Brigid Loughnan 119 Multiple nutrient insufficiencies—hypovitaminosis D and C in young adult New Zealand males Anitra C Carr, Margreet C M Vissers, John Lewis, Peter Elder 121 Cholesterol levels have negligible correlations with cardiovascular incidents Reginald Marsh 123 Take it from me Roger M Ridley-Smith 100 Years Ago in the NZMJ 124 Presidential Address: ‘A State service will eventually evolve’ Proceedings 125 Proceedings of the 213th Scientific Meeting of the Otago Medical School Research Society, Wednesday 26 September 2012 NZMJ 26 October 2012, Vol 125 No 1364; ISSN 1175 8716 Page 2 of 147 URL: http://journal.nzma.org.nz/journal/125-1364/5392/ ©NZMA 130 Proceedings of the Waikato Clinical School Biannual Research Seminar, September 2012 Methuselah 137 Selected excerpts from Methuselah Medicolegal 139 Professional Misconduct (Med10/151P) Obituaries 143 Major David Eilenberg 146 Raj Kumar Gupta NZMJ 26 October 2012, Vol 125 No 1364; ISSN 1175 8716 Page 3 of 147 URL: http://journal.nzma.org.nz/journal/125-1364/5392/ ©NZMA THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association This Issue in the Journal General practitioner attitudes to direct-to-consumer genetic testing in New Zealand Sanyogita Ram, Bruce Russell, Mary Gubb, Rebekah Taylor, Cassandra Butler, Imran Khan, Andrew Shelling The aim of the study was to explore the attitudes of general practitioners (GPs) towards Direct to Consumer (DTC) Genetic Testing and elicit their perceptions of the risks and benefits associated with DTC genetic testing. Misunderstanding of results and inadequate provision of information were perceived to be the greatest risks associated. Clinical validity of tests and counselling were thought to be the most important aspects to be regulated. Respondents considered convenience to be the greatest benefit for the individual requesting DTC genetic testing. The involvement of health professionals in the DTC genetic testing process will aid patients in making informed health decisions, and ensure increased benefit from recent advances in genetic information. A Pacific population’s access to and use of health services in Dunedin Faafetai Sopoaga, Lianne Parkin, Andrew Gray There are Pacific people who do not have a regular GP/health service. It was surprising that many students were in this category, as there are heavily subsidised services for tertiary students. Pacific organisations can work together with primary care providers to encourage access to services. A ‘walk in’ health service provides for the needs of those whose GPs are not able to see them at short notice. Improved stroke care processes and outcomes following the institution of an acute stroke unit at a New Zealand district general hospital Nicholas G Burgess, Ritva Vyas, Jennifer Hudson, Olivia Browne, YC Lee, Sisira Jayathissa, Tom Thomson A Stroke Unit is another way of saying: highly organised care for Stroke. It is proven to reduce mortality and dependency after stroke. In this paper we describe how we re- organise care for Stroke in our DHB showing marked improvements in process of care ( number of patients who got aspirin within 48hours, number of patients who got a swallow test, reduction in delay in transfer to the rehabilitation ward) and some reduction in complications such as urinary infections. We show a trend towards a reduction in length of stay and reduction in mortality. Other similar size hospitals in Australasia could reorganise their services similarly without great expense and achieve substantial benefit for their patients NZMJ 26 October 2012, Vol 125 No 1364; ISSN 1175 8716 Page 4 of 147 http://journal.nzma.org.nz/journal/125-1364/5393/ ©NZMA Young ischaemic stroke in South Auckland: a hospital-based study Teddy Y Wu, Ajay Kumar, Edward H Wong We performed an audit looking at the risk factors and outcome of young strokes patients (age 15-45 years) admitted to Middlemore Hospital between June 2004 and December 2009. We found a relatively high proportion of patients to have hypertension (42.7%), high cholesterol (45.8%), obesity (36.6%) and were current tobacco smokers (42.7%) at the time of the stroke. There is an over representation of Pacific Island (41.2%) and Maori (30.5%) in this group of patients studied. We believe further research into ethnic appropriate healthy initiative is required. An assessment of the Hua Oranga outcome instrument and comparison to other outcome measures in an intervention study with M āori and Pacific people following stroke Matire Harwood, Mark Weatherall, Api Talemaitoga, P Alan Barber, John Gommans, William Taylor, Kathryn McPherson, Harry McNaughton The Hua Oranga instrument, developed for Maori people with mental illness, showed good responsiveness and adequate psychometric properties in Maori and Pacific people after stroke. Its simplicity, relative brevity, minimal cost and adequate psychometric properties should favour its use in future studies with both Maori and Pacific people. Suggestions are made for refinements to the measure. These should be tested in a new population before Hua Oranga is recommended for general use in a clinical setting. Health-enhancing physical activity programme (HEPAP) for transient ischaemic attack and non-disabling stroke: recruitment and compliance James Faulkner, Danielle Lambrick, Brandon Woolley, Lee Stoner, Lai-kin Wong, Gerard McGonigal Sixty individuals who experienced a transient ischaemic attack (TIA; mini stroke) were successfully recruited and retained into a research trial. Participants were typically of European descent and lived within 20km of the study site. Distance to travel was largely reported as the primary reason for non-participation. A different approach is required to study interventions in M āori, Pacific Islanders, Asian and Indian populations. If the exercise intervention improves vascular risk factors and reduces recurrent vascular events, it could be applied to a large number of people who suffer a TIA or non-disabling stroke. NZMJ 26 October 2012, Vol 125 No 1364; ISSN 1175 8716 Page 5 of 147 http://journal.nzma.org.nz/journal/125-1364/5393/ ©NZMA Carotid endarterectomy in octogenarians Shaw-Hua Kueh, Vicki Livingstone, Ian A Thomson Corrective surgery for carotid artery narrowing (carotid endarterectomy) to prevent stroke has previously been thought to be associated with increased perioperative complication rate amongst patients older than 80 years old (octogenarians). In our retrospective study over 9 year period, older age did not appear to be associated with significantly increased overall perioperative complication at 14% compared to 17% amongst younger patients. Investigating the pathways in primary practice leading to the diagnosis of central hypothyroidism Veronique Gibbons, Ross Lawrenson, Phillipa Sleigh, Tania Yarndley, John V Conaglen Clinical diagnosis of central hypothyroidism
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