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Hamilton, New Zealand

Harless W.W.,Waikato District Health Board
Cancer Cell International | Year: 2011

Background: Physiologic wound repair and tissue regeneration are associated with distinct cellular behaviors triggered by tissue damage. Normally quiescent stem cells proliferate to regenerate damaged tissue, while relatively immobile epithelial cells can transform into a motile, tissue invasive phenotype through a partial epithelial-mesenchymal transition. These distinct cellular behaviors may have particular relevance to how cancer cells can be predicted to behave after treatments damaging a tumor.Presentation of the hypothesis: Surgery, chemotherapy, and radiation therapy trigger highly conserved wound healing pathways that: (1) facilitate the phenotypic transformation of surviving cancer cells into a highly mobile, metastatic phenotype through an EMT or epithelial-mesenchymal transition and (2) induce residual cancer stem cell proliferation.Testing the hypothesis: Tissue damage caused by cancer treatments will trigger the release of distinct cytokines with established roles in physiologic wound healing, EMT induction, and stem cell activation. They will be released rapidly after treatment and detectable in the patient's blood. Careful histologic evaluation of cancerous tissue before and after treatment will reveal cellular changes suggestive of EMT induction (down regulation of cytokeratin expression) and cancer stem cell enrichment (stem cell markers upregulated).Implications of the hypothesis: Cancer cells surviving treatment will be more capable of metastasis and resistant to conventional therapies than the pre-treatment population of cancer cells. These changes will develop rapidly after treatment and, in distinct contrast to selection pressures fostering such changes, be triggered by highly conserved wound repair signals released after tissue damage. This pattern of tissue (tumor) repair may be amenable to treatment intervention at the time it is upregulated. © 2011 Harless; licensee BioMed Central Ltd.

Krawitz R.,Waikato District Health Board | Krawitz R.,University of Auckland
Australasian Psychiatry | Year: 2012

Objective: This article is the second in a series of two on the topic. The purpose of the article is to discuss the intervention of self-compassion (and briefly other behavioural interventions) in treating severe chronic self-loathing in people with borderline personality disorder (BPD). The first article focuses on interrupting the self-loathing cycle. Conclusions: Self-compassion has promise as an intervention in the behavioural treatment of severe chronic selfloathing in people with BPD. Due to the challenges faced, it is useful for behavioural clinicians to have a range of flexible treatment approaches embedded into a coherent principled treatment in treating severe chronic selfloathing in people with BPD. © 2013 The Royal Australian and New Zealand College of Psychiatrists.

Liao S.,Waikato District Health Board | Woulfe T.,Waitemata District Health Board | Hyder S.,Waitemata District Health Board | Merriman E.,Waitemata District Health Board | And 3 more authors.
Journal of Thrombosis and Haemostasis | Year: 2014

Background: There are few studies that directly compare the variation in incidence of venous thromboembolism (VTE) according to ethnicity. Objective: The aim of this study was to compare the rates of VTE, deep venous thrombosis (DVT) and pulmonary embolism (PE) among different ethnic groups. Method: The cases diagnosed with VTE, DVT and PE for a period between March 2004 and June 2009 were identified through the hospital-based database system. The 2006 New Zealand Census data were used to calculate the rate of diagnosis. Results: The observed annual incidence of VTE during this period was 81.6 per 100 000 population. The relative risks of VTE when comparing European subjects with Maori, Pacific Island and Asian subjects after age standardization were 1.98 (95% confidence interval [CI], 1.63-2.41), 3.22 (95% CI, 2.60-3.99) and 4.02 (95% CI, 3.34-4.84), respectively. Relative risks of DVT after age standardization when comparing European subjects with Maori, Pacific Island and Asian subjects, were 2.14 (95% CI, 1.72-2.66), 3.20 (95% CI, 2.46-4.17) and 4.75 (95% CI, 3.80-5.94), respectively. Indirect age standardization was used for comparison of the diagnosis of PE. The ratio between the calculated expected number of cases and the actual number of cases was 1.32 (95% CI, 0.89-1.75) for Maori subjects, 2.96 (95% CI, 1.89-4.03) for Pacific Islanders and 3.89 (95% CI, 3.00-4.78) for Asians. Conclusion: Europeans have a significantly higher incidence of VTE compared with Maori, Pacific Island and Asian populations. © 2013 International Society on Thrombosis and Haemostasis.

Seneviratne S.,University of Auckland | Campbell I.,University of Auckland | Scott N.,Waikato District Health Board | Coles C.,Breast Care and Screening Services | Lawrenson R.,University of Auckland
Ethnicity and Health | Year: 2015

Objectives. To identify differences in delay for surgical treatment of breast cancer between ethnic groups and to evaluate the role of health system, sociodemographic and tumour factors in ethnic inequities in breast cancer treatment. Methods. A retrospective analysis of prospectively collected data from the Waikato Breast Cancer Register for cancers diagnosed in the Waikato region in New Zealand (NZ) from 1 January 2005 to 31 December 2010. Results. Approximately 95% (1449 out of 1514) of women with breast cancer diagnosed in the Waikato over the study period were included. Of women undergoing primary surgery (n = 1264), 59.6% and 98.2% underwent surgery within 31 and 90 days of diagnosis, respectively. Compared with NZ European women (mean 30.4 days), significantly longer delays for surgical treatment were observed among Ma¯ori (mean = 37.1 days, p = 0.005) and Pacific women (mean = 42.8 days, p = 0.005). Ma¯ori women were more likely to experience delays longer than 31 (p = 0.048) and 90 days (p = 0.286) compared with NZ European women. Factors predicting delays longer than 31 and 90 days in the multivariable model included public sector treatment (OR 5.93, 8.14), DCIS (OR 1.53, 3.17), mastectomy (OR 1.75, 6.60), higher comorbidity score (OR 2.02, 1.02) and earlier year of diagnosis (OR 1.21, 1.03). Inequities in delay between Ma¯ori and NZ European women were greatest for women under 50 years and those older than 70 years. Conclusion. This study shows that significant inequities in timely access to surgical treatment for breast cancer exist in NZ, with Ma¯ori and Pacific women having to wait longer to access treatment than NZ European women. Overall, a high proportion of women did not receive surgical treatment for breast cancer within the guideline limit of 31 days. Urgent steps are needed to reduce ethnic inequities in timely access to breast cancer treatment, and to shorten treatment delays in the public sector for all women. © 2014 Taylor & Francis.

Phadnis J.,Waikato District Health Board | Phillips P.,Waikato Hospital | Willoughby R.,Waikato Hospital
Journal of Pediatric Orthopaedics | Year: 2012

BACKGROUND: Slipped capital femoral epiphysis (SCFE) has been shown to have considerable racial variation. Children of Polynesian, and especially Maori, ethnicity are thought to have the highest worldwide incidence. Despite this, very little published literature exists to corroborate this. The aim of this study was to describe the characteristics of SCFE in the largest series of Maori children ever published. METHODS: Case notes and radiographs were used to analyze the demographic and slip characteristics of all SCFE admissions over a 10-year period. Comparisons of these characteristics were made between Maori and New Zealand European (NZE) children and census data were used to provide incidences and racial frequencies for the two groups. RESULTS: A total of 130 Maori children and 44 NZE children had a new diagnosis of SCFE during the study period. For the "at-risk" age group (5 to 14 y), incidence in Maori children (81/100,000) was significantly higher than NZEs (11.3/100,000) (P≤0.001). Maori had a more even distribution of SCFE between males and females (P=0.04), with a lower age at presentation (P=0.002) and a higher incidence of bilateral SCFE (P=0.05). Female children also had a younger age at presentation (P=0.001) and higher incidence of future contralateral SCFE (P=0.02). CONCLUSIONS: This is the first published study primarily looking at the epidemiologic characteristics of SCFE in Maori children. It would appear that Maori children have the highest reported worldwide frequency of SCFE and present at a younger age with a greater rate of bilateral SCFE than their counterparts. LEVEL OF EVIDENCE: Prognostic Level III. Copyright © 2012 by Lippincott Williams & Wilkins.

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