Dunedin Public Hospital

Conceived as a publicly-funded means of providing affordable, secure homes, social housing has historically been integral to growth-driven economies. With the gradual retrenchment of welfare policies, the sector continues facing mounting tensions between market imperatives and its social mission—challenges further compounded by the climate crisis. Degrowth proposes an emancipation from a growth-oriented system to reconcile socio-ecological goals; however, the compatibility of a degrowth agenda with that of social housing providers is underexplored. We investigated social housing providers' perceptions of the interventions needed to address the system structures that undermine social housing management and provision—such as declining housing quality, demolition, disinvestment in physical and social infrastructure, and lack of tenant representation—and explored their potential to catalyse the transformational change envisioned by degrowth. In a workshop with representatives of four London-based housing associations, we used participatory system dynamics (SD) to identify systemic interventions, and discuss their feasibility, impact, and implementation barriers. We then bridged systems thinking and degrowth frameworks to explore the kinds of transformation these interventions may enact, and their synergies with approaches to creating degrowth-oriented value. Approaches such as ‘Equalising inequalities’ and ‘Shrinking, slowing, and extending resource cycles’ were more frequently linked to interventions at shallower leverage points in the system. Conversely, most interventions associated with ‘Democratic, purpose-driven, and transparent governance’ and ‘Overcoming economic growth dynamics’ targeted the deepest type of leverage points in the system. Our findings demonstrate the value of SD in helping stakeholders formulate interventions addressing symptoms and root causes of systemic issues arising from growth-oriented structures, offering guidance for future research and practice. • System dynamics workshops elicited interventions in the English social housing system. • The interventions identified by participants align with approaches to create degrowth-oriented value. • These approaches exhibit different potential to catalyse the transformational change envisioned by degrowth. • Systems thinking and degrowth frameworks can support a combination of interventions at deep and shallow leverage points.

Most children with intussusception are successfully treated with radiologic enema reduction. Our recent nationwide study revealed significant variation in enema reduction success and the requirement of secondary operative intervention. This may be due to variation in the management of intussusception. As such, radiologic enema management patterns across Aotearoa New Zealand (AoNZ) were investigated. A snapshot survey of all AoNZ radiologists who had managed paediatric intussusception in the preceding 5 years was performed. Survey answers were collected anonymously via REDCap between April 1, 2023, and July 1, 2023. Network sampling was used to attain respondent saturation. Responses were recorded from 24 of the 26 radiologists who had recently managed paediatric intussusception. An institutional management guideline was available in 88% of cases. Pneumatic reduction via Foley catheter under fluoroscopic guidance was used preferentially by 23 clinicians (96%). Respondents described a wide range of catheter retention strategies and reduction hardware. There was significant variation in reported initial (0-120 mmHg) and peak (100-130 mmHg) reduction pneumatic pressures. If partially successful, respondents attempted further reduction after 0-5 min with a maximum of 3-8 attempts per sitting. Most clinicians confirmed reduction with small bowel insufflation (92%), but seven utilised post-reduction ultrasound (29%). Almost all AoNZ centres relied on pneumatic reduction under fluoroscopic guidance and rarely utilised hydrostatic or ultrasound-guided reduction. Reduction hardware and catheter retention strategies were diverse. There was inter-centre variation in pneumatic pressure limits, reduction timing, and periprocedural care. Intussusception care could benefit from a multidisciplinary, standardised, national approach.

Background/Objectives: Assessment of disease-specific knowledge levels among children with coeliac disease (CD) is essential to support self-management of their condition. A suitable knowledge assessment tool has not yet been identified that is appropriate for children. The aim of this study was to develop and validate a tool for this purpose. Materials and Methods: Using content synthesis of available literature, a CD knowledge assessment tool (CD-Know) was developed to include items shown to be relevant to the management of CD for children. CD-Know went through development stages of expert review, two rounds of pilot/validation testing, and item response analysis. CD-Know scores were compared between participant groups using a univariate linear model. Results: CD-Know was developed using content synthesis and review by international CD experts. CD-Know was initially piloted among adults/children with CD (n = 12) and underwent the first validation study (n = 330 participants) among adults/children with CD, cohabitants, healthcare professionals (HCPs), and groups without CD. Based on item response analysis the tool was modified. The phases of the pilot (n = 7) and validation studies were repeated among refined groups (n = 230). The final 15-item CD-Know demonstrated an appropriate hierarchy of knowledge between testing groups. Children with CD scored lower than cohabitants of someone with CD (mean difference (MD) -3.0, SD 0.4, p < 0.001) and HCPs (MD -1.7, p = 0.009), at a similar level to adults without CD (MD 0.6, p = 0.88), and higher than children without CD (MD 5.8, p < 0.001). The CD-Know score of children with CD was positively associated with their adherence level to a gluten-free diet (R 0.30, p = 0.017). Test-retest reliability had a good intraclass correlation coefficient (R 0.73, p = 0.003). Internal consistency was good (Cronbach's alpha 0.71). Conclusions: CD-Know is a validated tool to assess disease-related knowledge in children diagnosed with CD. Its potential applications include identifying areas for knowledge enhancement within the population and assessment of CD interventions.

BackgroundEnhanced recovery after surgery (ERAS) significantly improves outcomes for colorectal surgery, but in publicly funded health services with resource constraints, some targets can be difficult to fully implement. eHealth interventions are increasingly used in surgery to improve outcomes. In 2020, we developed eHealth content to optimise prehabilitation, the delivery of an ERAS program, and postoperative care in a tertiary New Zealand hospital. Our objective was to summarise the clinical outcomes of implementing a patient-orientated eHealth intervention for patients undergoing elective colorectal surgery for neoplasia.MethodsWe conducted a retrospective analysis of clinical outcomes with propensity score matching for patients undergoing elective colorectal resection for neoplastic disease between January 2020 and May 2024. Those using eHealth were compared to patients receiving standard care. Demographic and clinical data were extracted from the Otago Clinical Audit (OCA) database and from the eHealth platform. Complications, length of hospital stay (LOS), and readmission were compared using intention-to-treat (ITT) and per-protocol (PP) analyses.ResultsWe identified 333 patients; 102 using eHealth and 231 receiving standard care. For matched ITT analysis, 102 patients from the standard care group were included. The eHealth group had a significantly shorter LOS [median of 5 vs. 6 days; relative risk (RR) =0.79; 95% confidence interval (CI): 0.71, 0.88; P<0.001] and fewer total complications [27 vs. 51; odds ratio (OR) =0.60; 95% CI: 0.30, 1.22; P=0.03]. Readmissions were not significantly different between groups. The eHealth platform was well-liked, with 72% of interactions rated as “very helpful”.ConclusionsPatient support through eHealth, with a focus on prehabilitation as well as postoperative recovery, can be used to effectively supplement ERAS pathways and improve clinical outcomes.

[This corrects the article DOI: 10.1007/s13205-025-04363-w.].

To investigate the genetic diversity in OXA-48-producing Escherichia coli ST131 in a New Zealand community outbreak, and to characterize the mobile genetic elements carrying blaOXA-48, with emphasis on the gene's global dissemination. Forty outbreak isolates underwent short-read sequencing; 36 also underwent long-read sequencing. Bayesian phylogenetics reconstructed the emergence and spread of the outbreak. A pangenome graph of 543 Col156 plasmids and 806 global blaOXA-48-positive contigs were analyzed to assess structural diversity, mobility, and global distribution. The outbreak clone likely emerged circa 2017, following a single introduction into New Zealand after acquiring blaOXA-48 on a 7872 bp Col156 plasmid. It shares ancestry (circa 2009) with Southeast Asian E. coli ST131 genomes. Long-read sequencing and pangenome graph analyses identified a single IS1-mediated transposition of blaOXA-48 into a Col156 plasmid backbone, observed across species and continents. Globally, blaOXA-48 is present in diverse plasmid contexts and insertion sequence arrangements and is widely distributed among Enterobacterales. This is the first high-resolution genomic reconstruction of a community-associated blaOXA-48 outbreak, identifying a compact Col156 plasmid as a key vector driving carbapenem resistance. Our findings demonstrate the value of complete genome assemblies and pangenome graph analyses in resolving the structural and evolutionary dynamics of antimicrobial resistance.

To describe the Aotearoa New Zealand (NZ) neurology workforce, estimate neurology capacity, trends over time and future projections to assist with health sector planning. 2024 neurology workforce demographics, capacity and productivity were derived from multiple overlapping data sources including a nationwide individual neurologist and public hospital neurology unit head surveys, Health NZ and Royal Australasian College of Physicians data, and annual survey data from the Australian and New Zealand Association of Neurologists. Neurological service demand was assessed using epidemiological data, prior reported demand models and considered local practice patterns. Comparisons were made to our 2014 NZ report, Australian and international data. Projections were made modelling several scenarios. In 2024, there were 83 individual neurologists in NZ providing 67.3 full-time equivalents (FTEs) including 52.6 public adult, 8.3 paediatric and 6.4 private neurology FTE. The public sector FTE compared with 36 FTE in 2014. The combined adult headcount equates to 1 neurologist per 74 604 people (1.34/100 000) compared with Australia where there is 1 neurologist per 41 000 people (2.77/100 000) and 1 in 14 000 (7.1/100 000) in other high-income countries around the globe. A recent Australian workforce model estimated a minimum demand of 1 neurologist per 28 000 based on updated neurological disease and best-practice management requirements. If current training, recruitment, retention and practice patterns persist, projections indicate there will be a gradual worsening in the NZ neurology workforce over time. The NZ neurology workforce has increased over the past 10 years, but NZ ranks well below other high-income countries globally, and demand continues to significantly exceed supply. This remains true, even after adjusting for NZ practice patterns which favour generalist over subspecialist care. If current trends continue, the gap is expected to widen rather than narrow over the next 12 years.

Kiwis have high conservation needs and populations are often closely monitored. Mark‐recapture approaches provide useful information, but it is difficult to implement with these species. We developed a method using trail cameras that, with development, could identify individuals in the wild and may allow for a mark‐recapture approach. We measured kiwi bills with high accuracy, in ideal conditions (daylight, stationary, taxidermied kiwi), using a home‐modified stereo camera. Under these conditions, the level of accuracy obtained was within the required inter‐observer error (&lt;1.5%) for hand measurement of live birds. Measuring a live kiwi bill at night in field conditions imposed additional challenges. Background composition was key in correctly identifying the bill tip. Camera orientation changes (e.g., a higher, angled‐down placement) may potentially mitigate at least one source of error (the correct identification of the bill tip). We were able to synchronise videos, but synchronising photos would allow for higher‐quality images, providing greater accuracy in identifying features for measurements. Given ongoing improvements in trail camera technology, there is great potential to use stereo cameras for the measurement of kiwi bills to determine age class and eventually individual identification.

ABSTRACTMarine megafauna are important components of marine ecosystems and are of major significance to Indigenous communities, including Māori. Despite being recognised as a biodiversity hotspot for megafauna, most locations in Aotearoa New Zealand (NZ) do not have adequate information for the management of anthropogenic impacts on these taxa. Due to long‐standing relationships with Māori, there is a wealth of mātauranga Māori (Māori knowledge) on megafauna that may help fill key gaps. This study, Tere Tohorā Karanga Tāngata, aims to address information gaps on marine megafauna within Te Ākau/Bream Bay, on the north‐east of NZ's North Island. We utilise a wānanga (shared learning) approach alongside conventional visual and acoustic surveys to synthesise an accurate baseline of species occurrence, distribution, habitat use and site fidelity. Māori knowledge in a variety of forms was gathered and simultaneously integrated into the survey design across seven vessel‐based field surveys. We calculate seasonal sighting rates and use species distribution models (SDM) to determine the distribution of commonly occurring species and use photo‐identification to investigate site fidelity of marine mammals. Both knowledge systems confirmed the importance of Te Ākau/Bream Bay for marine megafauna, reporting high diversity and abundance of marine mammal (8 species) and seabird species (24 species) and high sighting rates of threatened taxa. While most species were encountered year‐round, sighting rates and predictions from SDMs highlight seasonal variability in the occurrence and distribution of most species. Māori knowledge aligned closely with results from conventional scientific approaches in confirming the most common species (common dolphin, Bryde's whale), seasonal habitat preferences, and, importantly, provided historical information on species that have been extirpated from the study area. Combined, the two knowledge systems have generated a robust baseline on marine megafauna that can be used to guide the management of these important species and showcase the advantages of utilising dual‐knowledge systems for characterising marine biodiversity.