Zealand Experience Research Articles

Per-oral endoscopic myotomy: a multi-centre New Zealand experience.

Per-oral endoscopic myotomy (POEM) is an established treatment for achalasia. We aim to review outcomes of all POEM cases performed in New Zealand for achalasia. A retrospective review of all POEM procedures performed in the five hospitals offering POEM between November 2015 and December 2022 was undertaken. The primary outcome was clinical success, defined as Eckardt score ≤3. Secondary outcomes included procedural complications. One hundred and sixty-six index and four redo POEM procedures were performed by seven clinicians. Ninety-six (58%) were male and mean age was 49.6 years (standard deviation [SD] 19.2 years). Eighty-three (50%) had a previous achalasia intervention. Median length of hospital stay was 1 day (interquartile range [IQR] 1-2 days). Median pre-POEM Eckardt score was 8 (IQR 6-9) and improved to 0 (IQR 0-2) at 6 months (p<0.001). Technical success was achieved in 164 (99%). Clinical success was achieved in 124 (93%) at 6 months and sustained to 12 months in 37/42 (88%) of these patients with follow-up data. Clinical success was achieved in 92% who underwent any prior intervention. There were five reported complications: tunnel leak (three), significant pain (one) and pneumothorax (one). One tunnel leak required thoracotomy for empyema debridement, all other complications were managed conservatively. Forty-seven (31%) reported symptomatic reflux after POEM. This first review of all POEM procedures performed in New Zealand for achalasia demonstrates high 6-month clinical success and safety for the management of achalasia.

Burp tax: Regulation and revenue potential in Indonesia

The increasingly urgent phenomenon of climate change requires concrete actions from various sectors, including the livestock sector which is a significant contributor to greenhouse gas emissions, particularly methane. This study explores the potential of implementing Burp Tax in Indonesia as a regulatory mechanism to reduce methane emissions from beef and dairy cattle farms. By referring to New Zealand's experience as a Burp Tax pioneer, this study analyzes the policy scheme that includes tax subjects, tax objects, tariffs, and fair and efficient collection mechanisms. In addition, this study identifies various obstacles that may be faced in the implementation of Burp Tax in Indonesia and provides recommendations to support the national commitment in achieving the Zero Emission target in 2045/2060. The research used qualitative methods with literature study data collection techniques. The research concludes that there is great potential for the imposition of Burp Tax, so that in addition to being a form of effort to reduce methane emissions from beef and dairy cattle farms, Burp Tax can also increase the portion of state revenue from the taxation sector. The specific tariff scheme is IDR30/KgCH4 with tax subjects in the beef and dairy cattle farming sector, including individuals with 30 cows and business entities. However, it is important to note that the imposition of Burp Tax may have an economic impact on livestock business actors and affect the price of meat and milk commodities. Therefore, further studies are needed regarding the potential and impact of Burp Tax implications in Indonesia. The results of this study are expected to make a significant contribution to the development of sustainable taxation policies that are responsive to the challenges of climate change.

Navigating the long journey of heart failure-experiences of Māori and Pacific peoples.

Māori and Pacific peoples in Aotearoa New Zealand experience significant inequities in heart failure rates, treatment and outcomes compared to NZ Europeans. We aimed to understand the experiences of Māori and Pacific people living with heart failure as they navigated care across primary and secondary settings. This research involved a secondary analysis of data collected in a wider qualitative study investigating evidence-practice gaps of cardiovascular care experienced by Māori and Pacific people. From the wider pool of semi-structured interviews, we identified 24 people (seven Māori and 17 Pacific peoples, 23 from the North Island) living with heart failure, and applied template and framework analysis to explore their distinct experiences. Two major themes identified related to participants: 1) Condition-need for more support to understand and self-manage their heart failure condition, and 2) Journey-desire to feel well-connected to the health system in their heart failure journey. Addressing heart failure inequities for Māori and Pacific peoples requires that providers engage in clear and meaningful communication to support patient self-management. Strengthening pathways for Māori and Pacific patients and whānau (families) between primary and secondary services is required to reduce their likelihood of becoming disconnected from care.

A mixed-method analysis of New Zealand's smart meter rollout experience

A mixed-method analysis of New Zealand's smart meter rollout experience

Supporting Digital Health Integration in a National Curriculum: The New Zealand Experience.

The World Health Organisation considers that digital health can play a vital role in strengthening health systems, including increasing equity in access to health services; however, to realise the benefits of digital health this subject needs to be included in nursing education. In New Zealand the recent establishment of the centralised Te Pūkenga Institute of Skills and Technology allows for the creation of a common unified curriculum for entry to nursing programmes among the community-based tertiary education providers. Expertise to advise on the digital health component of the curriculum was sought from the New Zealand nursing and midwifery informatics group and this group's contribution is reported here. Delays in implementing the new curriculum means that by the end of 2023 no students had yet graduated, and evaluating their success, combined with research into the students' preparedness for working in a digital health environment is recommended.

Next day cochlear implant switch-on: the New Zealand experience

ABSTRACT The objective of this study was to review the practice of next-day cochlear implant activation, or switch-on, after surgery for adult cochlear recipients in northern New Zealand. A retrospective observational study compared next-day and three-week post-surgical outcomes related to early complications, electrode impedance values, speech perception outcomes and the number of patient appointments and speech processor MAPs to the point of stabilisation. Over a five-year period, 167 consecutively implanted recipients were included in this review. Results indicate that less time from surgery to switch-on had no impact on the incidence of wound or fitting complications, and resulted in lower initial impedance measures, fewer hours of follow-up visits and fewer MAPs during the subsequent nine months. Speech perception outcomes did not differ between the early and later switch-on groups. General satisfaction with next-day switch-on practices has resulted in consistent use of this protocol with high patient and clinician satisfaction and improved clinical efficiencies.

"This was never about a virus": Perceptions of Vaccination Hazards and Pandemic Risk in #Covid19NZ Tweets.

In this paper, we draw on qualitative methods from the medical humanities and quantitative approaches from corpus linguistics to assess the different mappings of pandemic risks by Twitter (X) users employing the #Covid19nz hashtag. We look specifically at their responses to government measures around vaccines between August and November 2021. Risk, we reveal, was a major discursive thread in tweets during this period, but within our tweets, it was the vaccine rather than the virus around which hazard perception and response were grouped. We find that the discursive stance of those opposed to the vaccine evoked entangled medical and political hazards, untrustworthy experts, obscure information, restrictions on sovereignty, threats to children, and uncertain future dangers, all of which positioned them within what Ulrich Beck termed the world risk society. We also found that these narratives of risk manifested in specific Twitter styles, which employed a consistently larger number of hashtags. The lack of conjunctions between the hashtags, we argue, encouraged a disordered reading of doubt and precaution, as the hashtags presented triggering phrases whose interconnections were hinted at rather than specified. By contrast, those who tweeted in support of government measures were rhetorically led by solutions rather than risks, with one exception: their perception of those who were vaccine opposed. We use scholarship on risk and precautionary logic to map out the contrasting positions in tweets addressing Aotearoa New Zealand's pandemic experience during the closing months of 2021.

Durable ventricular assist devices for patients with advanced heart failure: the New Zealand experience.

The prevalence of heart failure in New Zealand is increasing. A small number of select patients with predicted poor short-term survival are candidates for advanced heart failure therapies such as transplantation and durable mechanical circulatory support (MCS). The aim of our study was to introduce left ventricular assist devices (LVADs) to the wider clinicians and highlight their role in managing patients with advanced heart failure in New Zealand. A retrospective audit of all ventricular assist device (VAD) recipients from January 2005 to December 2022 was conducted. Data were collated using electronic medical and paper records. The primary outcome was survival to transplantation or successful explant of VAD. Thirty-nine patients received VADs; 32 were male and seven female. Mean age was 45 years (range 10-64 years). Most recipients were NZ European (25), six were Māori, four were Pacific peoples and four were of other ethnicities. The majority of LVADs were implanted for those with dilated cardiomyopathy (67%). At the time of data collection, 24 (62%) had survived to heart transplantation, seven (18%) died while on VAD support, five from right ventricular failure and two from strokes, one patient had their VAD explanted due to recovery and seven (18%) VAD recipients continue on support awaiting transplant. This audit has provided an opportunity to inform New Zealand clinicians of our durable MCS programme and the expanding role of VAD support in patients with advanced heart failure. The programme will need to continue to audit and report its practice in order to provide equitable allocation of this very limited resource to a growing population in need.

The Impact of the COVID-19 Pandemic on Mediation and New Zealand's Dispute Resolution System

The COVID-19 pandemic has transformed mediation practice in New Zealand's institutional, government-led mediation regimes. The introduction of lockdowns, social distancing and personal protective equipment created a "new normal" for the delivery of consensual third-party dispute resolution in this area. Many of the changes introduced during the pandemic remain despite the removal of restrictions in 2022. This article explores New Zealand's online alternative dispute resolution (ADR) capacity on the eve of the pandemic. This limited capacity was severely tested during the first lockdown in 2020, highlighting barriers and challenges but also opportunities. However, it was the second major lockdown beginning in August 2021 that cemented many of the changes. In addition to exploring the New Zealand experience, this article provides specific case studies, such as employment mediation, and make some comparisons with apposite overseas jurisdictions. ADR, and mediation in particular, is at a crossroads. A choice must now be made whether to return to a primarily in-person model or continue to emphasise online delivery.

Enhancing midwives' occupational well-being: Lessons from New Zealand's COVID-19 experience.

The World Health Organization posits that adequate maternity health is possible if midwives are supported, respected, protected, motivated, and equipped to work safely and optimally within interdisciplinary health care teams. Based on qualitative survey data, we argue that the COVID-19 pandemic amplified job demands and resources, professional invisibility, and gender norms to negatively impact midwives' well-being. We aim to develop a refined understanding of the antecedents of well-being in midwifery to equip policymakers, administrators, and professional associations with the knowledge to enhance midwives' well-being postpandemic. Drawing on the Job Demands-Resources model, we thematically analyzed qualitative survey data ( N = 215) from New Zealand midwives to reveal how job demands, resources, and structural factors impacted midwives' well-being. We identified fear of contracting and spreading COVID-19, financial and legal imperatives (job demands), work-related hypervigilance, sense of professional duty, practical and social support, and appreciation and recognition (job resources) as key antecedents of midwives' well-being. These job demands and resources were influenced by professional invisibility and gender norms. Policy and practice solutions must address job demands, resources, and structural factors to meaningfully enhance midwives' well-being postpandemic. We recommend that policymakers, administrators, and professional associations monitor for signs of overcommitment and perfectionistic strivings and then take appropriate remedial action. We also suggest that midwives receive equitable pay, sick leave, and other related benefits.

EXPERIENCES OF PACIFIC PATIENTS SEEKING ARTHROPLASTY IN NEW ZEALAND

Pacific people in New Zealand experience significant disparity in health outcomes. There is little known about the burden of arthritis within this community or difficulties accessing specialist orthopaedic care. This qualitative study evaluated the experiences of Pacific patients who underwent hip or knee arthroplasty with a goal to identify barriers to accessing arthroplasty for this community.We interviewed Pacific patients within the Bay of Plenty region who had received either elective hip or knee arthroplasty between 2013 and 2022. Interviews were centred on perceptions of arthritis severity, duration of symptoms, primary care and specialist interactions. Patients were encouraged to offer feedback on ways to improve this experience.We identified 6087 publicly funded primary joints performed in Tauranga hospital and 58 patients were of Pacific ethnicity. After exclusion criteria was applied, we successfully interviewed 20 patients eligible for our study. Pacific patients represented 2.9% of the of the BOP catchment but only received 0.43% of the publicly funded joints. Most reported reluctance to seek help from primary care until symptoms were present for at least a year. Most commonly cited reasons for not seeking help were fear of hospital services and lack of awareness in the community about osteoarthritis.We identified a lack of community awareness of osteoarthritis and arthroplasty among Pacific. This may result in delayed presentation to primary care and decreased utilisation of publicly funded joint surgery. It is reassuring that most patients of Pacific ethnicity who receive primary hip or knee arthroplasty report a positive experience. Public health initiatives together with positive feedback from Pacific patients who have undergone surgery will help to increase awareness of arthroplasty as an option to restore function and relieve pain.

Vision impairment and differential access to eye health services in Aotearoa New Zealand: a scoping review

IntroductionIn Aotearoa New Zealand, Māori and Pacific People experience worse health outcomes compared with other New Zealanders. No population-based eye health survey has been conducted, and eye health services do...

Surgical Management of Ebstein Anomaly: The Australia and New Zealand Experience.

Ebstein anomaly is a rare congenital anomaly of the tricuspid valve which presents challenges to cardiac surgeons due to the spectrum of the disease and the technical difficulty of valve repair. The natural history of the anomaly differs between patients presenting in the neonatal period to those presenting in adulthood. A retrospective review of all patients >15 years of age with Ebstein anomaly, undergoing surgery on the tricuspid valve at 6 centers across Australia and New Zealand was performed. Patients from 1985 to 2019 were included in the study. A total of 125 patients were included in the study, 76 patients (60%) undergoing tricuspid valve repair, of which 23 patients underwent a Cone repair and 49 (40%) had a tricuspid valve replacement. The mean follow-up was 7.9 ± 7.3 years. Postoperatively, early mortality was 3 patients (2%) and 10-year survival was 91.5%. A postoperative pacemaker was required in 24 patients (19%). Reoperation was required in 21 patients (17%). There was no statistically significant difference in survival or reoperation between patients who underwent repair or replacement of the tricuspid valve; however, with a small number of patients in long-term follow-up. Older children and adult patients undergoing surgery for Ebstein anomaly in Australia and New Zealand experience good medium-term postoperative survival. Repair of the valve is achieved in a significant proportion of patients with increasing use and success with the Cone repair technique.

Legal nature of the environmental ombudsman institution: the New Zealand experience

Legal nature of the environmental ombudsman institution: the New Zealand experience

Designing a Powerful General Anti-Avoidance Rule: Reflections on the New Zealand Experience

Designing a Powerful General Anti-Avoidance Rule: Reflections on the New Zealand Experience

Expediency assessment of the experience used in the New Zealand creative economy strategic development

The creative economy creates significant economic value through the production and replication of commercial goods as well as the creative services export. New industries and commercial structures are formed, tourism is stimulated, favorable investment climate and technology transfer is organized through the creative economy brands creation. The purpose of this article is to identify successful experiences in the creative economy strategic development in New Zealand, as the New Zealand experience has been poorly studied in academic discourse. Although the creative industry in New Zealand is vital economic sector, there are also number of problems that need to be solved to support its further growth and development. Therefore, the creative economy of New Zealand has been defined as the research object, the research subject is the strategic development experience. The methodology of the research is the general theory of strategy and the methodology of strategizing, developed by Professor V.L. Kvint. The methods of research were analysis, synthesis, comparison, generalization, strategic benchmarking as well as OTSW-analysis. New Zealand has implemented a number of strategies and initiatives aimed at supporting the creative industry and promoting innovation in the country. The strategic initiatives implemented to support the industry have helped unlock its economic growth potential. The successful development of the film industry allowed the serious national brands creation. The article conducted a strategic analysis of New Zealand’s creative economy and identified strategic opportunities – these include the development of industries that were not supported at the state level. The author also analyzed the best practices of workforce strategy in the creative economy of New Zealand. The scientific and practical significance of obtained lies in the possible implementation to adjust the national state policy in the field of heritage and culture support, as well as the technological entrepreneurship innovative ecosystem formation. The experience gained as a result of the study of the New Zealand creative economy strategic development can be applied to differentiate promising areas for further creative economy strategic development of the Russian Federation, taking into account the labor resources optimal use.

Cancer incidence, mortality and survival for Pacific Peoples in Aotearoa New Zealand.

Pacific Peoples comprise over 16 culturally diverse ethnic groups and experience a disproportionate burden of preventable cancers, attributable to infectious diseases and obesity. This study aims to provide updated evidence on cancer incidence, mortality and survival rates among Pacific Peoples in Aotearoa New Zealand. The study extracted incident cases of cancer diagnosed between 2007-2019 from the New Zealand Cancer Registry (NZCR) and linked them to the national Mortality Collection to determine individuals who died of cancer over the study period. The study also compared cancer survival rates between Pacific and European peoples in Aotearoa New Zealand. The most commonly diagnosed cancers and the most common causes of cancer death among Pacific Peoples were identified, and key findings were summarised. The European population was utilised as the comparator group for the analyses. The study employed a total ethnicity approach, wherein anyone with a record of Pacific ethnicity was classified as Total Pacific, regardless of other ethnicities. The age- and sex-standardised incidence and mortality rates were calculated, and 1-, 3- and 5-year survival rates determined. We used Cox proportional-hazards models to compare survival outcomes between Pacific and European peoples. The study results revealed that Pacific Peoples in Aotearoa New Zealand experience higher cancer incidence and a lower survival rate for several cancers, including lung, liver and stomach cancers, when compared to the European population. This study underscores the need for intervention to reduce the burden of cancer among Pacific Peoples and improve cancer outcomes. This study's findings can inform planning and delivery of interventions to achieve equitable outcomes across the cancer continuum for Pacific Peoples in Aotearoa New Zealand.

Pacific high school students’ experiences of sexual and reproductive health education in Aotearoa New Zealand

ABSTRACT Young people of Pacific heritage living in Aotearoa New Zealand experience poor sexual and reproductive health outcomes. Current understandings of Pacific youth sexual and reproductive experiences are limited and efforts to deliver culturally appropriate sexuality education are made difficult by lack of resources and cultural sensitivities and taboos. This study aimed to understand Pacific youth experiences of sexuality education within the school setting to ascertain culturally responsive approaches to sexuality education for Pacific youth. The study used the Pacific talanoa methodology to conduct group discussions with young people aged 16–18 years old. A total of six group discussions were carried out over a three-month period. Data were analysed using thematic analysis. The study found a lack of information provided at school. Discussion of abstinence, sex before marriage and asking questions at home was aligned to Pacific values of family, taboo, and gender. Perspectives on trust, privacy and confidentiality within the school setting were important to young people, many of whom were not familiar with being able to speak freely about sexual health topics. Pornography and social media were easily accessible to youth and influenced their ability to explore and understand sexual and reproductive health issues and needs.

First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences

First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences

Recognising plural valuation of nature when shaping conservation policies: A New Zealand perspective

Plural valuation of nature seeks to overcome a lack of attention by conservationists to the multiple values people assign to nature. Proponents claim plural valuation makes conservation socially and ecologically more effective. This study analyses conservation laws and uses a survey of New Zealand conservation professionals to investigate the potential of plural valuation for conservation. Document analysis revealed a plurality of values and multiple co-existing framings of nature in New Zealand’s conservation laws. Also, relational values of nature, embedded in the uniqueness of New Zealand’s native fauna and flora, are important to most surveyed conservation professionals and complement instrumental reasons to value nature. However, answers showed various positions on human-nature relationships that correspond to divergent perceptions of the place of introduced species and humans in nature. The New Zealand experience illustrates how multiple values of nature could influence conservation decision-making and management in different ways. Therefore, investigators of plural valuation of nature will need to elicit the divergent underlying understandings of what nature means for individual actors. Failing to do so may lead to an underestimation of the variety of visions of conservation values assigned to nature can sustain, hamper cooperation between conservation stakeholders, frustrate the potential of plural valuation of nature and hence, lead to less effective conservation.