Journal of the New Zealand Medical Association Vol 133 | No 1517 | 26 June 2020 Mass masking: an alternative to a second lockdown in Aotearoa Asthma and Respiratory Foundation NZ Adolescent and Adult Asthma Guidelines 2020: a quick reference guide Medical considerations for supporting elite athletes during the post-peak phase of the New Zealand COVID-19 pandemic: a New Zealand sporting code consensus Te Hā o Whānau: A culturally E-cigarettes, vaping and Is snacking the new eating responsive framework of a Smokefree Aotearoa: norm for New Zealand children? maternity care where to next? An urgent call for research Publication Information published by the New Zealand Medical Association NZMJ Editor NZMA Chair Professor Frank Frizelle Dr Kate Baddock NZMJ Production Editor NZMA Communications Manager Rory Stewart Diana Wolken Other enquiries to: NZMA To contribute to the NZMJ, fi rst read: PO Box 156 www.nzma.org.nz/journal/contribute The Terrace Wellington 6140 © NZMA 2020 Phone: (04) 472 4741 To subscribe to the NZMJ, email [email protected] Subscription to the New Zealand Medical Journal is free and automatic to NZMA members. Private subscription is available to institutions, to people who are not medical practitioners, and to medical practitioners who live outside New Zealand. Subscription rates are below. All access to the NZMJ is by login and password, but IP access is available to some subscribers. 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Please email [email protected] for more information. Individual articles are available for purchase by emailing [email protected] NZMJ 26 June 2020, Vol 133 No 1517 ISSN 1175-8716 © NZMA 2 www.nzma.org.nz/journal CONTENTS EDITORIALS 66 8 Te Hā o Whānau: A culturally Mass masking: an alternative to a responsive framework of second lockdown in Aotearoa maternity care Amanda Kvalsvig, Nick Wilson, Kendall Stevenson, Sara Filoche, Ling Chan, Sophie Febery, Sally Roberts, Fiona Cram, Beverley Lawton Bryan Betty, Michael G Baker GUIDELINES 14 E-cigarettes, vaping and a 73 Asthma and Respiratory Smokefree Aotearoa: where Foundation NZ Adolescent and to next? Adult Asthma Guidelines 2020: a Richard Edwards, Janet Hoek, Andrew Waa quick reference guide Richard Beasley, Lutz Beckert, ARTICLES James Fingleton, Robert J Hancox, Matire Harwood, Miriam Hurst, 18 Stuart Jones, Susan Jones, Ciléin Social consequences of assisted Kearns, David McNamara, Betty Poot, dying: a case study Jim Reid Rhona Winnington, Roderick MacLeod VIEWPOINTS 24 Demographics of New Zealand 100 women with vulval lichen Human lungs are created to sclerosus: is specialist care breathe clean air: the questionable equitable? quanti cation of vaping safety Harriet S Cheng, Coco Kerckho s, “95% less harmful” Nicky Perkins, Lois Eva Kelly S Burrowes, Lutz Beckert, Stuart Jones 32 Performance of CVD risk 107 equations for older patients Medical considerations for assessed in general practice: a supporting elite athletes during cohort study the post-peak phase of the Sue Wells, Romana Pylypchuk, New Zealand COVID-19 pandemic: Suneela Mehta, Andrew Kerr, a New Zealand sporting code Vanessa Selak, Katrina Poppe, consensus Corina Grey, Rod Jackson Bruce Hamilton, Lynley Anderson, Nat Anglem, Stuart Armstrong, 56 Simon Baker, Sarah Beable, Surveillance for dysplasia in Peter Burt, Lynne Coleman, patients with in ammatory bowel Rob Doughty, Tony Edwards, Dan Exeter, disease: an updated national Mark Fulcher, Stephen Kara, survey of colonoscopic practice in John Mayhew, Sam Mayhew, Chris New Zealand Milne, Tamara Glyn Mullaney, Brendan O’Neill, Hamish Osborne, Andrew McCombie, Melinda Parnell, Jake Pearson, Christopher Wakeman, Karen Rasmussen, Judikje Sche er, Timothy Eglinton, Richard Gearry Martin Swan, Mark Thomas, David Gerrard NZMJ 26 June 2020, Vol 133 No 1517 ISSN 1175-8716 © NZMA 3 www.nzma.org.nz/journal CONTENTS CLINICAL CORRESPONDENCE 131 117 Is snacking the new eating norm for Ocular complications from primary New Zealand children? An urgent varicella infection call for research Aaron Yap, Joanne L Sims, Christy O’Toole, Ryan Gage, Rachael L Niederer Christina McKerchar, Viliami Puloka, Rachael McLean, Louise Signal 123 Simultaneous ischaemic and 133 haemorrhagic strokes in a Can we teach psychiatry in medical hypertensive man: a manifestation school in a better way? of cerebral small vessel disease Nicholas R Wilson Karim M Mahawish, Almond Leung 100 YEARS AGO 126 135 An unexpected case of Gonorrhoea: Some Notes on disseminated tuberculosis from the Evil Results of its Abortive tumour necrosis factor inhibition Treatment in the A.I.F. Danny Con, Andrew Gador-Whyte, By FRANK MACKY, M.B., B.S. (Melb.). Robert MacGinley LETTERS 129 Health advice for counselling: would parvovirus infection in puppies affect children and women? Kam Lun Hon, Karen Ka Yan Leung NZMJ 26 June 2020, Vol 133 No 1517 ISSN 1175-8716 © NZMA 4 www.nzma.org.nz/journal SUMMARIES Social consequences of assisted dying: a case study Rhona Winnington, Roderick MacLeod This paper discusses the potential effects of assisted dying (AD) legislation beyond the relief of individual suffering. AD is when an individual chooses that they wish to die and either self-medicate to end their life under clinical supervision, or clinicians administer the medi- cation for them. This paper focuses on potential family/whānau and community consequences should we introduce such legislation into New Zealand culture, highlighting that family members whose loved one has had an assisted death are feeling obligated to also consider dying in this way as their health fails. Furthermore, we highlight that even when AD is a legal option, all those involved in the assisted death remain secretive about what has occurred due to a fear of being judged by others. Finally, we offer insight into a concerning potential side- effect of AD legislation; that is that when individuals are exposed to someone considering an assisted death, they too will also consider using this legislation. This participant describes the effect of AD legislation as being infectious. Demographics of New Zealand women with vulval lichen sclerosus: is specialist care equitable? Harriet S Cheng, Coco Kerckho s, Nicky Perkins, Lois Eva Vulval lichen sclerosus is an autoimmune skin condition which can cause infl ammation, scarring and increased risk of cancer in genital skin. Around 1% of women are affected. This study examined cases of lichen sclerosus seen by dermatology, gynaecology and sexual health at Auckland District Health Board. We found most women seen were of New Zealand European ethnicity and compared with Census data for our region, European women were over-represented. Māori, Pacifi c and Asian women were under-represented. Causes for this inequitable ethnic representation may include sociocultural beliefs, variations in access to care or ethnic differences in the prevalence of lichen sclerosus. Further study is required to deepen our understanding and allow work to reduce inequity. Performance of CVD risk equations for older patients assessed in general practice: a cohort study Sue Wells, Romana Pylypchuk, Suneela Mehta, Andrew Kerr, Vanessa Selak, Katrina Poppe, Corina Grey, Rod Jackson Cardiovascular disease (CVD) is the leading cause of preventable health loss for older people, many of whom are still engaged in the workforce and physically active. The current Ministry of Health CVD guidelines recommend that GPs consider doing a routine heart check using New Zealand CVD risk equations for healthy people over 75 years and discuss the same management options as for people under 75 years of age. However, risk assessment and management is more complex for older age groups as health status varies greatly. The risk of other long-term conditions increases with age and this in turn is associated with complicated medication regimens. As a fi rst step, we investigated how well current CVD risk equations (developed for people 30–74 years) performed for over 40,000 older people for whom GPs considered suitable for routine preventive CVD risk assessment. We found current CVD risk equations underestimated fi ve-year CVD hospitalisations or deaths for women from 75 years and men from 80 years. NZMJ 26 June 2020, Vol 133 No 1517 ISSN 1175-8716 © NZMA 5 www.nzma.org.nz/journal SUMMARIES Surveillance for dysplasia in patients with in ammatory bowel disease: an updated national survey of colonoscopic practice in New Zealand Tamara Glyn Mullaney, Andrew McCombie, Christopher Wakeman, Timothy Eglinton, Richard Gearry Infl ammatory bowel disease patients are at a higher risk of developing colorectal cancer and so undergo surveillance endoscopy to identify the changes (dysplasia) at an early stage. In the past, it has been diffi cult to see all these changes (and sometimes even cancers), so we have tended to treat these patients (even with early changes) by removing their large bowel. Current techniques are more accurate at identifying the changes and this survey suggests New Zealand endoscopists are using them appropriately, however we are possibly still recom- mending removal of the large bowel more often than is necessary. Perhaps some of these patients will be able to be managed with the advanced techniques safely and avoid the need to their remove their bowel at this stage.