THE NEW ZEALAND MEDICAL JOURNAL Vol 119 No 1235 ISSN 1175 8716 CONTENTS This Issue in the Journal A summary of the original articles featured in this issue Editorial Diabetes epidemiology in New Zealand—does the whole picture differ from the sum of its parts? Juliet Berkeley, Helen Lunt Original Articles First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in M āori and Pacific Islanders Adrian Scott, Robyn Toomath, David Bouchier, Raymond Bruce, Nic Crook, David Carroll, Rick Cutfield, Paul Dixon, John Doran, Peter Dunn, Cheri Hotu, Maunt Khant, Maureen Lonsdale, Helen Lunt, Esko Wiltshire, Denise Wu Ethnic differences in Type 2 diabetes care and outcomes in Auckland: a multiethnic community in New Zealand Tom Robinson, David Simmons, David Scott, Eileen Howard, Karen Pickering, Rick Cutfield, John Baker, Ashwin Patel, John Wellingham, Sara Morton Health status of New Zealand European, Maori, and Pacific patients with diabetes at 242 New Zealand general practices Andrew Tomlin, Murray Tilyard, Alexander Dawson, Susan Dovey The Dunedin Multidisciplinary Health and Development Study: are its findings consistent with the overall New Zealand population? Richie Poulton, Robert Hancox, Barry Milne, Joanne Baxter, Kate Scott, Noela Wilson Metabolic equivalent (MET) intensities of culturally-specific physical activities performed by New Zealanders Karen Moy, Robert Scragg, Grant McLean, Harriette Carr Do snacks of exercise lower blood pressure? A randomised crossover trial Raina Elley, Emma Bagrie, Bruce Arroll Dietary patterns of New Zealand European preschool children Reremoana Theodore, John Thompson, Clare Wall, David Becroft, Elizabeth Robinson, Phillipa Clark, Jan Pryor, Chris Wild, Ed Mitchell NZMJ 2 June 2006, Vol 119 No 1235 Page 1 of 145 URL: http://www.nzma.org.nz/journal/119-1235/2022/ © NZMA Review Article Epidemiology of diabetes in New Zealand: revisit to a changing landscape Grace Joshy, David Simmons Case Reports Extramedullary plasmacytoma of the thyroid Sheng-Fong Kuo, Hung-Yu Chang, Chuen Hsueh, Jen-Der Lin Cutaneous paraneoplastic syndrome (acrokeratosis paraneoplastica) preceding squamous cell carcinoma of the glottic larynx Gorkem Aksu, Ahmet Karadeniz Special Series PHARMAC and Herceptin for early-stage breast cancer in New Zealand: Herceptin or deception? Martin Rosevear 100 Years Ago in the NZMJ Odds and ends of a year’s surgery. A case of appedicitis with general suppurative peritonitis. (Sudden death on eleventh day.) Medical Image Stalk failure Sarah Mathai, Krishna Sudeep, Mathew John Methuselah Selected excerpts from Methuselah Letters New Zealand guidelines for early management of meningococcal disease— time for revision? Amanda Kvalsvig, Michael Baker Response to McNaughton and colleagues regarding their article—Interferon beta, PHARMAC, and political directives: in the best interests of people with multiple sclerosis? Nola Rawson Metastatic thyroid carcinoma: a case from Australia Shane Anderson, Clive O’Connor Neurotoxic reaction to citalopram John Thwaites, Christopher Hutchinson, Christopher Collins NZMJ 2 June 2006, Vol 119 No 1235 Page 2 of 145 URL: http://www.nzma.org.nz/journal/119-1235/2022/ © NZMA Expected versus demonstrated skills of postgraduate year 1 (PGY1) doctors in New Zealand John Thwaites, Dale Sheehan Alcohol advertising in New Zealand Harold Coop Obituary Sir John Staveley Book Reviews How to pass. The insider’s guide to the RACP examination (Ingrid Naden, Zoe Raos) John Young, John Fink The good writing guide (Margaret McLaren) Brennan Edwardes NZMJ 2 June 2006, Vol 119 No 1235 Page 3 of 145 URL: http://www.nzma.org.nz/journal/119-1235/2022/ © NZMA THE NEW ZEALAND MEDICAL JOURNAL Vol 119 No 1235 ISSN 1175 8716 This Issue in the Journal First national audit of the outcomes of care in young people with diabetes in New Zealand: high prevalence of nephropathy in M āori and Pacific Islanders A Scott, R Toomath, D Bouchier, R Bruce, N Crook, D Carroll, R Cutfield, P Dixon, J Doran, P Dunn, C Hotu, M Khant, M Lonsdale, H Lunt, E Wiltshire, D Wu Diabetes is known to cause long-term complications which can be reduced by maintaining good control of blood glucose levels. In this study, the largest survey of diabetes care amongst children and young adults across New Zealand, data on 1282 people from 9 hospitals were pooled and analysed. Overall blood glucose control (measured using HbA1c) was poor but some centres achieved better levels than others. These findings are similar to those reported in this age group, by other countries such as the UK. Complications such as eye and kidney problems (retinopathy and nephropathy) were common particularly after more than 10 years of diabetes. M āori and Pacific Islanders were more likely to have evidence of kidney damage than New Zealand Europeans. Ethnic differences in Type 2 diabetes care and outcomes in Auckland: a multiethnic community in New Zealand T Robinson, D Simmons, D Scott, E Howard, K Pickering, R Cutfield, J Baker, A Patel, J Wellingham, S Morton Māori and Pacific people with Type 2 diabetes are more likely to have bad health outcomes than other New Zealanders with diabetes. This study asks whether some of these differences may be due to differences in general practice care. The care provided to nearly 6000 people with Type 2 diabetes was studied. We found that although GPs were providing equally intensive care to M āori and Pacific people they were not achieving the same outcomes of care (for example smokefree, blood pressure control, blood sugar control) Health status of New Zealand European, M āori, and Pacific patients with diabetes in 242 New Zealand general practices A Tomlin, M Tilyard, A Dawson, S Dovey In this paper, we compare indicators of health between New Zealand European as well as M āori and Pacific people presenting with diabetes at general practices in the South Island of New Zealand. Practices and patients were participating in the Government’s Get Checked programme providing free annual diabetes health checks. Ethnic inequalities were noted in seven of nine health status measures; M āori and Pacific people were more likely to be at risk for diabetes complications. NZMJ 2 June 2006, Vol 119 No 1235 Page 4 of 145 URL: http://www.nzma.org.nz/journal/119-1235/2011/ © NZMA The Dunedin Multidisciplinary Health and Development Study: are its findings consistent with the overall New Zealand population? R Poulton, R Hancox, B Milne, J Baxter, K Scott, N Wilson The health of 26-year-old participants in the long-running Dunedin Multidisciplinary Health and Development Study was found to be very similar to people of the same age in the nationally representative New Zealand Health and National Nutrition Surveys. This suggests that the findings from regional cohort studies such as the Dunedin Study are likely to be relevant to people in other parts of New Zealand. It also suggests that the health of the Dunedin Study members has not been changed by repeated assessments throughout their lives. These findings have important implications for the design of the proposed national Longitudinal Study of New Zealand Children and Families. Metabolic equivalent (MET) intensities of culturally-specific physical activities performed by New Zealanders K Moy, R Scragg, G McLean, H Carr This study’s aim was to collect objective information on physical activities typically performed by New Zealanders, including M āori and Pacific cultural activities. Information about the type of activities performed, and the physical effort or ‘intensity’ associated with executing such activities, were collected from 186 adults. Data were converted to metabolic equivalents (METs) to classify activities as light, moderate, or vigorous intensity, and compiled to create a New Zealand-specific compendium of physical activities. This culturally-specific information can be incorporated into physical activity and health-related questionnaires to improve the quality of information collected from respondents in both clinical and public health settings. Do snacks of exercise lower blood pressure? A randomised crossover trial R Elley, E Bagrie, B Arroll We know that regular exercise, such as brisk walking for 30–40 minutes per day, can help lower blood pressure, particularly in those with hypertension. However, with busy lives, people can not always set aside 30–40 minutes per day to achieve this. Completing the required amount in ‘snacks of walking’ spread throughout the day would make it easier for some people to gain the benefit of exercise. Previously, there was little evidence that 10-minute snacks of exercise could achieve blood pressure reductions as effectively as continuous walking. This study found that 4 ×10-minute snacks of walking are as effective as 40 minutes continuous walking per day at reducing blood pressure, when compared with doing no exercise. This reinforces the message that walking can help control hypertension and can be achieved in 10-minute snacks throughout the day. NZMJ 2 June 2006, Vol 119 No 1235 Page 5 of 145 URL: http://www.nzma.org.nz/journal/119-1235/2011/ © NZMA Dietary patterns of New Zealand European preschool children R Theodore, J Thompson, C Wall, D Becroft, E Robinson, P Clark, J Pryor, C Wild, E Mitchell Little is known about what preschool New Zealand children eat. The aims of this study were to describe the dietary patterns of New Zealand (NZ) European preschool children and to compare these with NZ Ministry of Health (MOH) food and nutrition guidelines. Food frequency information was collected on 549 New Zealand European children aged 3.5 years. Notable proportions of children were not eating fruit (27%), vegetables (52%), and bread and cereal (93%) at levels recommended by the MOH. NZMJ 2 June 2006, Vol 119 No 1235 Page 6 of 145 URL: http://www.nzma.org.nz/journal/119-1235/2011/ © NZMA THE NEW ZEALAND MEDICAL JOURNAL Vol 119 No 1235 ISSN 1175 8716 Diabetes epidemiology in New Zealand—does the whole picture differ from the sum of its parts? Juliet Berkeley, Helen Lunt At a time when most chronic diseases are showing a slowing of growth in prevalence and/or incidence, the diabetes epidemic in New Zealand continues unabated.