Waikato District Health Board

Hamilton, New Zealand

Waikato District Health Board

Hamilton, New Zealand

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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.

Van Zeist-Jongman A.,Waikato District Health Board
Australasian Psychiatry | Year: 2015

Objective: The aim of this study was to investigate how early career psychiatrists in 2014 valued the leadership skill education in their training to become psychiatrists. Method: All psychiatrists who gained Fellowship since 2009 after training in New Zealand or Australia were invited to take part in a survey. Results: Respondents considered themselves not adequately prepared for the leadership, management and administrative tasks and roles they have as psychiatrists, with preparedness for management tasks scoring the lowest. They valued as most useful to have opportunity to practice with a leadership role, to be able to observe 'leaders at work', to have a supervisor with special interests and skills in leadership and management and to have a formal teaching program on leadership and management. They advised teaching to be given throughout the entire 5 years of the training program by experienced leaders. Conclusions: Leadership skills training in the education of psychiatrists should contain both practical experience with leadership and management roles and formal teaching sessions on leadership and management skills development. Suggestions for improvement of the leadership and management skills education in the training of psychiatrists have been formulated.

Haughey A.,Waikato District Health Board | Coalter G.,Waikato District Health Board | Mugabe K.,Waikato District Health Board
Australasian Physical and Engineering Sciences in Medicine | Year: 2011

The study aimed to assess the suitability of linear array metal oxide semiconductor field effect transistor detectors (MOSFETs) as in vivo dosimeters to measure rectal dose in high dose rate brachytherapy treatments. The MOSFET arrays were calibrated with an Ir192 source and phantom measurements were performed to check agreement with the treatment planning system. The angular dependence, linearity and constancy of the detectors were evaluated. For in vivo measurements two sites were investigated, transperineal needle implants for prostate cancer and Fletcher suites for cervical cancer. The MOSFETs were inserted into the patients' rectum in theatre inside a modified flatus tube. The patients were then CT scanned for treatment planning. Measured rectal doses during treatment were compared with point dose measurements predicted by the TPS. The MOSFETs were found to require individual calibration factors. The calibration was found to drift by approximately 1% ±0.8 per 500 mV accumulated and varies with distance from source due to energy dependence. In vivo results for prostate patients found only 33% of measured doses agreed with the TPS within ±10%. For cervix cases 42% of measured doses agreed with the TPS within ±10%, however of those not agreeing variations of up to 70% were observed. One of the most limiting factors in this study was found to be the inability to prevent the MOSFET moving internally between the time of CT and treatment. Due to the many uncertainties associated with MOSFETs including calibration drift, angular dependence and the inability to know their exact position at the time of treatment, we consider them to be unsuitable for in vivo dosimetry in rectum for HDR brachytherapy. © Australasian College of Physical Scientists and Engineers in Medicine 2011.

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.

Menkes D.B.,Waikato Clinical School | Lancaster K.,Waikato District Health Board | Grant M.,Waikato District Health Board | Marsh R.W.,Waikato Clinical School | And 2 more authors.
BMC Psychiatry | Year: 2012

Background: Vitamin D deficiency is widespread in New Zealand, confers multiple health risks, and may be particularly common among people with psychiatric illness. We studied vitamin D status in an unselected sample of adult psychiatric inpatients in Hamilton (latitude 37.5 S) during late winter.Methods: We recruited 102 consenting subjects and measured 25-hydroxy vitamin D3 levels in venous blood using a competitive electrochemiluminescence immunoassay. In addition to descriptive statistics, we used one-sample t-tests to determine the extent to which ethnic and diagnostic subgroups fell below the vitamin D deficiency threshold of 50 nM.Results: 75 subjects (74%) had vitamin D levels <50 nM and thus had at least mild deficiency, while 19 (19%) were severely deficient with levels <25 nM. Rates of deficiency were comparable for men and women; only the former showed a correlation of vitamin D levels with age (r = 0.45, p < 0.01). Maori participants constituted half the sample (n = 51) and were more likely to be deficient than their European counterparts (p = 0.04). Vitamin D also varied by diagnosis, with schizophrenia associated with markedly lower levels than mania and depression (p < 0.001).Conclusions: Vitamin D deficiency is prevalent in the psychiatric inpatient setting in New Zealand and may be relevant to poor physical health outcomes, notably among Maori and those with schizophrenia. These findings support proposals to provide vitamin D supplementation, particularly during the winter months. © 2012 Menkes et al.;licensee BioMed Central Ltd.

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.

Yuan J.,The New Zealand Institute for Plant and Food Research Ltd | Dunn P.,Waikato District Health Board | Martinus R.D.,University of Waikato
Cell Stress and Chaperones | Year: 2011

There is increasing evidence that mitochondrial dysfunction and oxidative stress may be integral to the pathogenesis of type 2 diabetes mellitus. Heat shock protein (Hsp60) is a mitochondrial stress protein known to be induced under conditions of mitochondrial impairment. Although this intracellular protein is normally found in the mitochondrion, several studies have shown that this protein is also present in systemic circulation. In this study, we report the presence of elevated levels of Hsp60 in both saliva and serum of type 2 diabetic patients compared to non-diabetic controls. Hsp60 was detectable in the saliva of 10% of control and 93% of type 2 diabetic patients. Levels detected were in the range of 3-7 ng/ml in control and 3-75 ng/ml in type 2 diabetic patients. Serum Hsp60 levels in the range of 3-88 ng/ml were detected in 33% of control subjects, and levels in the range of 28-1,043 ng/ml were detected in 100% of type 2 diabetic patients. This is the first reporting of the presence of mitochondrial stress protein in salivary secretions. The serum Hsp60 levels were 16-fold higher compared to those in saliva, and there was a good positive correlation between salivary and serum Hsp60 levels (r=0.55). While the exact mechanisms responsible for the secretion of Hsp60 into biological fluids such as saliva and blood are not yet known. The presence of this molecular marker of mitochondrial stress in saliva offers a non-invasive route to further investigate the biological functions of extracellular Hsp60 in type 2 diabetes mellitus and other conditions. © Cell Stress Society International 2011.

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.

Fullerton M.,Waikato District Health Board | Gibbons V.,University of Auckland
New Zealand Medical Journal | Year: 2011

Aim The aim of this study was to quantify the extent of needlestick underreporting, to examine factors which may contribute to underreporting, and to optimise the relevant risk management strategy. Method An 11-item structured postal questionnaire was adapted from an existing CDC design. Results The survey results showed that 9% of respondents had experienced at least one needlestick injury in the past year, and three practitioners had five or more injuries in the same period. The overall underreporting rate for needlestick injuries was 33%, which is consistent with internationally-reported figures. More than one in six respondent doctors (17.8%) had sustained one or more needlestick injuries in the past year, compared with nurses (7.6%) or midwives (6.7%). Conclusion The survey identified the level of underreporting and the factors that influence needlestick reporting. This has resulted in a series of recommendations that will help our DHB to formulate an appropriate strategy to manage needlestick incidence and impact. © NZMA.

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