Estimating the Prevalence of Dementia in New Zealand Using Capture-Recapture Analysis on Routinely Collected Health Data.

OBJECTIVES: Community based dementia prevalence studies are expensive and resource intensive. Aotearoa New Zealand (NZ) has never had a community based dementia prevalence study representing all major ethnic groups. In recent years, dementia prevalence estimates have been derived from routinely collected health data but issues of underdiagnosis and undercoding limit their utility. Capture-recapture techniques can estimate the number of dementia cases missing from health datasets by modelling the ascertained overlaps between linked data sources. METHODS: Three routinely collected national health data sets-interRAI, Public hospital discharges, and Pharmaceuticals-were linked and all prevalent cases of dementia in NZ for the year 1 January 2021-31 December 2021 were identified. Capture-recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of prevalent cases missing from all three datasets. RESULTS: We estimated that almost half (47.8%) of dementia cases are not present in any of the three datasets. Dementia prevalence increased from 3.7% to 7.1% (95% CI 6.9%-7.4%) in the NZ 60+ population and from 4.9% to 9.2% (95% CI 8.9%-9.6%) in the NZ 65+ population when missing cases were included. Estimates of missing cases were significantly higher (p < 0.001) in Maori (49.2%), Pacific peoples (50.6%) and Asian (59.6%) compared to Europeans (46.4%). CONCLUSIONS: This study provides updated estimates of dementia prevalence in NZ and the proportion of undiagnosed dementia in NZ, highlighting the need for better access to dementia assessment and diagnosis.

A new insight for investigating the prenatal and postnatal ossification centers of pelvic and femur bones in white New Zealand rabbits (Oryctolagus cuniculus) using 3D CT, double stain technique, and morphometry.

BACKGROUND: The ossification centers in rabbit limbs are related to fetal age and bone maturation. OBJECTIVE: To address the limited studies on ossification in the hind limbs of New Zealand rabbits, we investigated the prenatal and postnatal development of the pelvic and femur bones. METHODS: Double staining with Alcian Blue and Alizarin Red, computed tomography (CT), and 3D reconstruction were employed to visualize and analyze ossification centers in detail. RESULTS: Using double staining, we observed these patterns: At prenatal days 18 and 21, ossification centers appeared in the ilium. By prenatal days 23 and 25, ossification began in the ischium. On postnatal day 1, ilium ossification centers spread across most of the ilium wings, except for the iliac crest, and new centers appeared in the pubis and cotyloid bones. Most bones had ossified by the third week and one month postnatal, except for the iliac crest and ischial tuberosity. At 1.5 months, both were fully ossified. On day 18 post coitum, an ossification center was visible in the middle of the femur shaft. By day 28 post coitum, ossification extended through the shaft, and postnatally, new ossification spots appeared at the extremities by day one and week one. By the third week, complete ossification of the femur head, lesser trochanter, third trochanter, medial condyle, and lateral condyle was observed. At 1.5 months, the entire proximal extremity was ossified. CONCLUSION: 3D CT provided clear imaging of ossification progression in the pelvic and femur bones. This study enhances our understanding of vertebrate skeletal development.

'A divine right to photograph': E. Graeme Robertson's (1903-1975) historical motion pictures of National Hospital staff in 1933.

In the course of researching and writing the first-ever book length biography of Edward Graeme Robertson's (1903-1975) eventful life and career in Australasian neurology, a rare 1933 cinema film recording of National Hospital staff at Queen Square has recently been rediscovered. Graeme completed his residency in neurology at Queen Square in the early 1930s and maintained close connections with his colleagues in London, thoughtfully recording them at different times using early movie cameras. Two versions of Graeme's 1933 film have been preserved, and there are also other color clips of his colleagues from later in life in the UCL Neurology archives and Robertson family collection. These remarkable films contain images of several historically significant neurologists, including Gordon Morgan Holmes (1876-1965), Samuel Alexander Kinnier Wilson (1878-1937), Derek Denny-Brown (1901-1981), Macdonald Critchley (1900-1997), and several others. We provide a contextual summary of the many clips recorded alongside an in-depth inventory of all the personalities represented in the 1933 film. Selected photographs are used to indicate the contents of these remarkable films.

Development of an Aotearoa New Zealand adapted Mediterranean dietary pattern and Kai/food basket for the He Rourou Whai Painga randomised controlled trial.

Background: Following a Mediterranean diet (MedDiet) is associated with a lower risk of cardiovascular disease. He Rourou Whai Painga is a dietary intervention trial with behaviour change support that seeks to determine whether a MedDiet pattern can provide equivalent benefits in Aotearoa New Zealand (NZ), a country where cardiovascular disease is a leading cause of death. To do this, the MedDiet needs to be adapted in an acceptable way for NZ, with consideration of the Maori (indigenous) population. Methods: The MedDiet was defined using existing MedDiet scoring tools and adapted to the NZ context using local guidelines. The resulting NZ MedDiet pattern was used to develop a kai/food basket, including products from industry partners, for participants in He Rourou Whai Painga. Criteria set for the kai/food basket included providing up to 75% of energy requirements and falling within the Australia/NZ Acceptable Macronutrient Distribution Range to reduce risk of chronic disease. Maori researchers on the team provided support to ensure Matauranga Maori (Maori knowledge and values) was upheld through this process. Results: The NZ MedDiet pattern criteria was similar to the identified MedDiet scoring tools, with differences in recommendations for dairy, red meat, alcohol and olive oil. The resulting kai/food baskets were estimated to provide on average 73.5% of energy requirements for households, with 36% from fat, 8.6% from saturated fat, 17% protein, and 42% carbohydrate. Forty-two industry partners, including 3 Maori businesses, agreed to provide 22 types of food products towards the total. Conclusion: Small, feasible changes to the MedDiet can be made to align with the NZ guidelines and food environment. However, this eating pattern still differs from what the population, particularly Maori, are currently consuming. Continued partnership with Maori and additional behavioural support is important to facilitate adherence to this dietary pattern within He Rourou Whai Painga.Trial registration: https://www.anzctr.org.au/Default.aspx, identifier ACTRN12622000906752 and https://www.isrctn.com/, identifier ISRCTN89011056.

The physical health and premature mortality of Indigenous Maori following first-episode psychosis diagnosis: A 15-year follow-up study.

BACKGROUND: People experiencing psychosis are at greater risk of physical health conditions and premature mortality. It is likely that Indigenous Maori youth, who experience additional systemic inequities caused by settler-colonisation, face even greater physical health and mortality risks following a diagnosis of first-episode psychosis. OBJECTIVE: Compare Maori and non-Maori for risk of hospitalisation and mortality for up to 15 years following first-episode psychosis diagnosis. METHODS: A cohort (N = 14,122) of young people (16-24 years) with first-episode psychosis diagnosis between 2001 and 2019 were identified. Using crude Kaplan-Meier and adjusted Cox proportional hazards models, Maori (n = 5211) and non-Maori (n = 8911) were compared on hospitalisation and mortality outcomes for up to 15 years. RESULTS: In the 15 years following first-episode psychosis diagnosis, Maori had higher adjusted risk of all-cause mortality (hazard ratio = 1.21, 95% confidence interval = [1.01, 1.45]), hospitalisation with diabetes (hazard ratio = 1.44, 95% confidence interval = [1.15, 1.79]), injury/poisoning (hazard ratio = 1.11, 95% confidence interval = [1.05, 1.16]), general physical health conditions (hazard ratio = 1.07, 95% confidence interval = [1.02, 1.13]) and also appeared to be at greater risk of cardiovascular hospitalisations (hazard ratio = 1.34, 95% confidence interval = [0.97, 1.86]). Kaplan-Meier plots show hospitalisation and mortality inequities emerging approximately 4-7 years following first-episode psychosis diagnosis. CONCLUSIONS: Maori are at greater risk for hospitalisation and premature mortality outcomes following first-episode psychosis. Early screening and intervention, facilitated by culturally safe health service delivery, is needed to target these inequities early.

Rationale and Design of the Australasian Registry of Screening ECGs in National Athletes Project.

BACKGROUND: Cardiac screening of elite athletes is widely recommended by Australasian sporting federations, but data are not structured to be shared. Data are lacking from underrepresented groups to inform ECG interpretation guidelines. The ARENA (Australasian Registry of Screening ECGs in National Athletes) project is a retrospective and prospective, multicenter, longitudinal, observational registry of athlete cardiac screening results and outcomes. The aim is to create a repository to improve our understanding of the diagnoses and outcomes of screening. METHODS: Participating sports that conduct cardiac screening of athletes will contribute data. This includes an initial collection (retrospective data, waiver of consent) and future prospective data (opt-out consent). Data include sex, age, sport/event, screening date, ECG findings, cardiac test results, follow-up details, sport participation status, cardiac diagnoses, and major cardiovascular outcomes defined as sudden cardiac arrest/death, cardiac syncope or implanted cardioverter defibrillator shock, cardiac hospitalization, and arrhythmias requiring intervention. Comparisons will be made between diagnoses, outcomes, and ECG features and analyzed by sport and sex. The ARENA project was developed in collaboration with sporting bodies, team physicians, and players association representatives and endorsed by the Australasian College of Sport & Exercise Physicians and Sports Medicine Australia. CONCLUSIONS: The ARENA project will provide a long-term international data repository to improve our understanding of ECG interpretation, cardiac screening and diagnoses, and the prevalence of cardiovascular outcomes in screened athletes. A unique aim is to address evidence gaps in underrepresented athlete groups, specifically female athletes and Indigenous populations. Results will inform screening policies and guidelines.

Roles and Responsibilities of the Global Specialist Digital Health Workforce: Analysis of Global Census Data.

Background: The Global Specialist Digital Health Workforce Census is the largest workforce survey of the specialist roles that support the development, use, management, and governance of health data, health information, health knowledge, and health technology. Objective: This paper aims to present an analysis of the roles and functions reported by respondents in the 2023 census. Methods: The 2023 census was deployed using Qualtrics and was open from July 1 to August 13, 2023. A broad definition was provided to guide respondents about who is in the specialist digital health workforce. Anyone who self-identifies as being part of this workforce could undertake the survey. The data was analyzed using descriptive statistical analysis and thematic analysis of the functions respondents reported in their roles. Results: A total of 1103 respondents completed the census, with data reported about their demographic information and their roles. The majority of respondents lived in Australia (n=870, 78.9%) or New Zealand (n=130, 11.8%), with most (n=620, 56.3%) aged 35-54 years and identifying as female (n=720, 65.3%). The top four occupational specialties were health informatics (n=179, 20.2%), health information management (n=175, 19.8%), health information technology (n=128, 14.4%), and health librarianship (n=104, 11.7%). Nearly all (n=797, 90%) participants identified as a manager or professional. Less than half (430/1019, 42.2%) had a formal qualification in a specialist digital health area, and only one-quarter (244/938, 26%) held a credential in a digital health area. While two-thirds (502/763, 65.7%) reported undertaking professional development in the last year, most were self-directed activities, such as seeking information or consuming online content. Work undertaken by specialist digital health workers could be classified as either leadership, functional, occupational, or technological. Conclusions: Future specialist digital health workforce capability frameworks should include the aspects of leadership, function, occupation, and technology. This largely unqualified workforce is undertaking little formal professional development to upskill them to continue to support the safe delivery and management of health and care through the use of digital data and technology.

Standard of care and outcomes for Maori patients with neck of femur fractures - an Australia & New Zealand Hip Fracture Registry (ANZHFR) study.

BACKGROUND: This study aimed to compare the demographic differences between Maori and NZ Europeans with neck of femur fracture (NOF), identify any differences in management, surgical and post-op care and outcomes. METHODS: All cases in New Zealand between 2018 and 2020 were collected from the Australia & New Zealand Hip Fracture Registry (ANZHFR). Basic demographics, management factors, and surgical factors were collected. Key outcomes at 120 days post-fracture included walking status, residential status and survival. Univariate analysis was performed to compare differences in demographics, and management factors between ethnicities. Multivariable analysis was conducted on key outcome comparisons and management differences. RESULTS: Data from 9432 patients were analyzed. 305 patients were Maori (3.2%). Age-standardized incidence between Maori and NZ European were similar (103 (95% CI 91-115) vs. 95 (95% CI 92-99)/100 000/year). Maori had a longer time to theatre (38.7 vs. 34.5 h, P = 0.01). The only difference between Maori and NZ European in the key outcomes was private residential status (67% vs. 62% P < 0.01). There was no difference in survival (87% vs. 87% P = 0.68) and decrease in walking status (0.43 vs. 0.41 P = 0.99). Following multivariable analysis, Maori ethnicity was an independent risk factor for time to theatre >48 hours after adjustment for other factors (OR 1.44 (95% CI 1.07, 1.93), P = 0.016). DISCUSSION: Although Maori were a small percentage of patients with NOFs, there was similar age-standardized incidence compared to NZ Europeans. While there were no differences in key outcomes, identifying reasons for longer time to theatre for Maori patients is required.

Risk Assessment of Displaced Sediment by an Extreme Event Cyclone in a Peri-Urban Zone Using Bioassays and Analytical Chemistry.

Hawke's Bay in New Zealand was impacted by Cyclone Gabrielle in 2023, experiencing intense weather conditions and rainfall. Rivers and streams surged beyond their banks, displacing large amounts of sediment. The sewage treatment plant and industries in the Waitangi catchment, south of the city of Napier, were heavily impacted, making them potential sources of contaminants. The aim of this study was to investigate the risk of displaced sediments deposited south of Napier City, using bioassays and chemical analysis methods. Sediment samples were collected across a gradient between the coastline and the Waitangi Stream. The toxicity of chemically extracted or elutriate samples was assessed by Microtox®, mussel embryo-larval development, and aryl hydrocarbon and constitutive androstane receptor yeast two-hybrid assays. Targeted chemical analysis and automated identification and quantification system (AIQS-GC) methods were used to identify contaminants. The elutriates showed low toxicity and the yeast assays showed levels of activity like those previously reported. Chemical methods confirmed historical contamination by DDT and its metabolites DDE and DDD, as well as by plant sterols. Overall, the toxicity and chemicals detected are what would be expected from a typical agricultural soil. The risk posed by the displaced sediment in the Waitangi catchment can be considered low. Combining chemical and bioanalytical methods was an effective approach to investigate the potential risks of post-disaster contamination.

Population-Level Impacts of Alcohol Use on Mental and Physical Health Outcomes.

This study explores patterns of alcohol drinking within a representative New Zealand sample (2887 participants (1464 female, 1423 male)). Alcohol use and drinking patterns across the population are described. Multivariable logistic regressions document associations between alcohol use and drinking patterns and the likelihood of experiencing different health outcomes. Alcohol use, early drinking initiation, frequent drinking, and heavy episodic drinking (HED) are prevalent in New Zealand and vary in relation to gender, age, and socioeconomic characteristics. Those who reported alcohol-related problems were more likely to report poor mental health (AOR: 2.21; 95% CI: 1.42-3.46) and disability (AOR: 1.79, 95% CI: 1.06-3.00), and less likely to experience positive mental health (AOR: 0.28, 95% CI: 0.18-0.42). Those who reported HED were also less likely to experience good general health (AOR: 0.61, 95% CI: 0.47-0.81) and positive mental health (AOR: 0.67, 95% CI: 0.53-0.84). Younger age cohorts were more likely to engage in early drinking, and those who initiated regular drinking before age 18 were more likely to report HED and alcohol-related problems. Findings indicate that problem drinking and HED are not only associated with poor physical health, but also reduce the likelihood of individuals experiencing positive mental health. This provides information to enable public health practitioners to target alcohol prevention strategies at the entire population of drinkers.

'I never see anyone like myself represented in discussions about endometriosis': priorities of LGBTQIA + endometriosis patients in New Zealand.

Limited information is available regarding the experiences and perspectives of LGBTQIA + patients internationally, and no literature exists for New Zealand. Twenty-eight LGBTQIA + endometriosis patients took part in asynchronous, online text-based discussions about their experiences navigating endometriosis diagnosis and management in Aotearoa New Zealand. Their qualitative responses were coded in an iterative thematic manner. The mean delay to diagnosis of this cohort was 10.2 ± 5.6 years from symptom onset, longer than previously reported delays in Aotearoa New Zealand. Participants shared a strong discomfort with the predominant focus of endometriosis management strategies on penetrative sex and pregnancy, and the sense they were dismissed if prioritising these functions was not their priority. Several potential improvements to current treatment and care for LGBTQIA + endometriosis patients were generally agreed upon by the cohort, including research to better understand a practice approach for managing the symptoms of transmasculine patients; expanding the management strategies for patients who are not prioritising fertility and penetrative sex; improving awareness of LGBTQIA + people and experiences amongst medical practitioners to reduce homophobia, transphobia, misogyny, misgendering and mistreatment in care; and the development of gender-neutral spaces for the support of patients who feel uncomfortable in cisgender women-centric endometriosis spaces.

An outbreak of ischaemic teat necrosis in a dairy herd in Taranaki, New Zealand.

CASE HISTORY: In spring 2021, on a seasonally calving, pastorally based, Taranaki dairy farm, 12 first-calving heifers (≤ 30 days post-calving) developed similar dry, red to black, crusting lesions on the medial aspect of the teat udder junction extending down the medial teat. Some cows had multiple teats affected. Treatment was initially unrewarding and did not slow the progression of the disease. Overall, 8/12 cows recovered, and 4/12 cows were culled, with three of the cows culled after a teat sloughed and the fourth after surgical amputation of a teat. Outbreaks of the same condition, on the same farm but affecting fewer animals, occurred in spring 2022 (n = 6) and spring 2023 (n = 3). CLINICAL FINDINGS: An initial scab-like or crusting lesion progressed to resemble a thick eschar consisting of very dry and hard dead tissue. The unaffected areas of the teat felt normal but immediately under the dead tissue, there was a warm, firmer area consistent with an inflammatory reaction. Removing the scab led to profuse bleeding, with no visible bed of granulation underneath the scab. There was no leaking of milk in those cows that lost a teat, and no smell to the lesions themselves. Serology and virology ruled out the involvement of bovine alphaherpesvirus (BoHV-2) bovine gammaherpesvirus (BoHV-4), orthopoxviruses (cowpox) and parapoxviruses (pseudocowpox). Histopathology of an affected and surgically amputated teat showed multifocal erosion and ulceration of the epidermis, covered by a thick serocellular crust. In areas of ulceration, there were numerous neutrophils, and the dermis was expanded by granulation tissue with variable numbers of neutrophils, eosinophils, and lymphocytes around small blood vessels. DIAGNOSIS: Based on the similarity of the history, presentation, and histopathological changes to those described for a novel disease reported in the UK, a diagnosis of ischaemic teat necrosis (ITN) was made. CLINICAL RELEVANCE: If ITN is an emerging condition in New Zealand and becomes as prevalent as it has in the UK, clinicians will be confronted with a significant new welfare problem in dairy cows. Anecdotally, there have been reports of other ITN outbreaks in New Zealand, and the Ministry for Primary Industries would be interested in collating reports from other New Zealand veterinarians.

Achieving gender equity in academic psychiatry - barriers to involvement and solutions for success.

OBJECTIVE: Women face considerable barriers in pursuing careers in academic psychiatry. METHODS: A group of Australian and New Zealand academic women psychiatrists convened in September 2022 to identify and propose solutions to increase opportunities for women in academic psychiatry. RESULTS: Limiting factors were identified in pathways to academia including financial support, engagement and coordination between academia and clinical services, and flexible working conditions. Gender biases and the risk of burnout were additional and fundamental barriers. Potential solutions include offering advanced training certificates to enable trainees to commence a PhD and Fellowship contemporaneously; improved financial support; expanding opportunities for research involvement; establishing mentoring opportunities and communities of practice; and strategies to enhance safety at work and redress gender bias and imbalance in academia. CONCLUSIONS: Support for women in research careers will decrease gender disparity in academic psychiatry and may decrease problematic gender bias in research. Fellows and trainees, the RANZCP, universities, research institutes, governments, industry and health services should collaborate to develop and implement policies supporting changes in working conditions and training. Facilitating the entry and retention of women to careers in academic psychiatry requires mentoring and development of a community of practice to provide and enable support, role modelling, and inspiration.

An analysis of risk factors for child suicide in three centres from 2008 to 2017.

As a part of a study of suicide in children aged 17 years and under in three centers-Hennepin County in the United States (US), Auckland in New Zealand (NZ), and South Australia in Australia (AUS) from 2008 to 2017 it was decided to characterize potential risk factors and to determine whether these differed by jurisdiction. Reviewed data included a history of psychiatric illness, symptoms prior to suicide, events preceding suicide, previous suicidal ideation or suicide attempts, and communication of suicidal intent. The most common events preceding suicide were arguments with family/friends and relationship issues; in addition depression with or without expressed suicidal ideation, self-harming behavior, sadness, distress, drug/substance abuse, and anorexia were documented. Suicidal intent was on occasion communicated via technological means. In 79.5% of cases in South Australia decedents had a previously diagnosed psychiatric illness, with 62% in Hennepin County. This compared to a much lower proportion of cases in Auckland (23.8%). Whether this reflects more limited access to psychiatric services or a reluctance to seek support and therapy in Auckland is unclear. It does, however, demonstrate that risk factors for child suicide are not uniform among communities and so extrapolation of data from one area to another may not be appropriate. Disturbingly parents/carers were not aware of the decedent's suicidal intent in 84-87.2% of cases.

Gastrointestinal stromal tumours: incidence, recurrence and mortality. A decade of patients from a New Zealand tertiary surgical centre.

BACKGROUND: Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract. The New Zealand (NZ) population incidence has not previously been documented nor has the potential effect of ethnicity been reviewed. We furthermore wanted to assess the difference between those undergoing a wedge resection versus a more extensive operation which we hypothesised would correlate with recurrence and mortality. METHODS: All patients (n = 103) with a GIST diagnosed and treated at Te Whatu Ora Waitemata (Auckland, New Zealand) between 2012 and 2021 are presented. Patient demographics, method of GIST detection, management approach, index surgery, histological features, use of adjuvant and neoadjuvant imatinib, follow-up, recurrence and mortality rates were analysed. RESULTS: This paper reports the largest NZ GIST cohort to date and estimates an incidence of 17 cases per million per year. Eighty-four patients underwent surgical resection, 58 received a wedge resection and 17 received a more extensive operation. Five-year disease-free survival rates were 100% in the low/very low risk, 90% in the intermediate and 59% in the high risk groups as determined by the modified NIH criteria. Our overall 5-year GIST-specific survival rate was 83%; it was 91% in those who underwent a wedge resection and 60% in the extensive operation group. There is evidence that Maori have higher rates of GIST recurrence compared to non-Maori and are more likely to require an extensive surgical resection.

Public awareness and knowledge about speech-language pathology and communication impairments in Aotearoa New Zealand.

PURPOSE: This survey-based study explored public awareness of the speech-language pathology profession in Aotearoa New Zealand. The study also aimed to understand participants' knowledge and experiences of individuals with speech, language, and communication impairments. METHOD: An online survey was designed and distributed via the Qualtrics survey platform. The survey included three sections, which focused on participant demographics, awareness about speech-language pathology, and knowledge and experiences of communication impairments. RESULT: The responses from 800 fully completed surveys were analysed. A majority of participants indicated that they had never heard or read anything about speech-language pathology and had never met a speech-language pathologist. The participants' responses reflected low or moderate levels of understanding about the roles of speech-language pathologists and their scope of practice. CONCLUSION: Findings indicated low levels of awareness among the general public about speech-language pathology and individuals with communication impairments. These findings were consistent with similar international research conducted over the past 4 decades. Further research is needed to support the development of initiatives designed to increase awareness of the speech-language pathology profession and the needs of individuals with communication impairments.

Intersectional perspectives of parents of transgender children in Aotearoa (New Zealand).

Introduction: This article explores the intersectional perspectives of parents of transgender children in Aotearoa (New Zealand). The substantial body of research on parent experiences in this area has largely focused on parents who are white North American middle-class cisgender women. We seek to extend this research by taking an intersectional approach and examining the perspectives of a group of participants of different genders, sexual orientations, and cultural backgrounds. Methods: We asked 20 participants in Aotearoa who self-identified as gender-affirming parents to draw their experience of parenting a transgender child and discuss this with us in interview. Results: The research resulted in rich visual and verbal depictions of gender-affirming parenting, drawing from the intersectional perspectives of Maori, Pakeha, Pacific, Asian, queer, straight, female, male and non-binary parents. Using visual and verbal discourse analysis, we explore how the participants constructed their experience from their uniquely situated perspectives, both specific and multilayered. Conclusion: We argue that the parents' perspectives reveal both challenges and strengths, reflecting the burdens of intersectional oppression, while also fostering the parents' capacity for engaging in discursive resistance to advance their children's interests.

Dairy farmer, engagement and understanding of One Health and antimicrobial resistance - a pilot survey from the lower north island of Aotearoa New Zealand.

BACKGROUND: Reducing antimicrobial resistance (AMR) requires a multidisciplinary One Health approach, which necessitates buy-in from all stakeholders. In Aotearoa New Zealand, where the dairy industry is one of the largest users of antimicrobials, there are ongoing efforts to optimise antimicrobial usage (AMU) to minimise the development of AMR. These include regulations around the veterinary authorisation of the use of antibiotics by farmers without the need for a specific prescription ("the RVM process") and programmes such as the New Zealand Veterinary Association's antibiotic 'Traffic Light System'. The goal of this pilot survey was to develop and trial a questionnaire to determine how much Aotearoa dairy farmers understand about One Health, AMR, the RVM process and how their actions regarding AMU affect the wider environment. METHODS: A 55-question semi-structured questionnaire was piloted on 15 dairy farms in the Lower North Island of Aotearoa New Zealand via an in-person semi-structured interview between September and November 2021. RESULTS: None of the interviewed farmers could define the term One Health. However, the majority found the RVM process to be of use on their farm, although admitted they generally felt frustration regarding AMR, seeing it as a blockage to productivity, and lacked awareness regarding how their actions were related to its development. Of the farmers interviewed over half had not heard of the traffic light system, and of those who had, one admitted they refused to adhere to it. CONCLUSIONS: This survey's novel findings have highlighted that there are notable gaps within dairy farmer understanding of AMU, AMR and One Health as well as highlighting that veterinarians could do more to keep their clients informed of their important role within One Health. There is still a lot more work to do with regards to vets, farmers and industry representatives working together to embrace One Health. Simple solutions would be to encourage farmers returning unused drugs to their veterinarians for correct disposal and to actively engage farmers further regarding AMU and AMR, so that these end-product users do not feel disconnected from the process.

Histological diversity in hyperkeratotic flexural erythema-Beyond granular parakeratosis?

The term 'hyperkeratotic flexural erythema' (HFE) has been used synonymously with granular parakeratosis (GP), to describe a scaly, typically intertriginous rash associated with contact factors such as benzalkonium chloride. However, clinical HFE can occur without the classical GP histological pattern. We reviewed skin biopsies from 10 patients with clinically diagnosed HFE. A progression of histopathological features is suggested. The absence of histological GP should not exclude the clinical diagnosis of HFE when there is a high index of suspicion.

Making the most of what we have: What does the future hold for Emergency Department data?

Over 10 million ED visits occur each year across Australia and Aotearoa New Zealand. Outside basic administrative data focused on time-based targets, there is minimal information about clinical performance, quality of care, patient outcomes, or equity in emergency care. The lack of a timely, accurate or clinically useful data collection represents a missed opportunity to improve the care we deliver each day. The present paper outlines a proposal for a National Acute Care Secure Health Data Environment, including design, possible applications, and the steps taken to date by the Australasian College for Emergency Medicine ED Epidemiology Network in collaboration with the College of Emergency Nursing Australasia. Optimal use of the existing information collected routinely during clinical care of emergency patients has the potential to enable data-driven quality improvement and research, leading to better care and better outcomes for millions of patients and families each year.