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Background When COVID-19 emerged, there were well-founded fears that Māori (indigenous peoples of Aotearoa (New Zealand)) would be disproportionately affected, both in terms of morbidity and mortality from COVID-19 itself and through the impact of lock-down measures. A key way in which Kōkiri (a Māori health provider) responded was through the establishment of a pātaka kai (foodbank) that also provided a gateway to assess need and deliver other support services to whānau (in this case, client). Māori values were integral to this approach, with manaakitanga (kindness or providing care for others) at the heart of Kōkiri’s actions. We sought to identify how Kōkiri operated under the mantle of manaakitanga, during Aotearoa’s 2020 nationwide COVID-19 lockdown and to assess the impact of their contributions on Māori whānau. Methods We used qualitative methods underpinned by Māori research methodology. Twenty-six whānau interviews and two focus groups were held, one with eight kaimahi (workers) and the other with seven rangatahi (youth) kaimahi. Data was gathered between June and October 2020 (soon after the 2020 lockdown restrictions were lifted), thematically analysed and interpreted using a Māori worldview. Results Three key themes were identified that aligned to the values framework that forms the practice model that Kōkiri kaimahi work within. Kaitiakitanga, whānau and manaakitanga are also long-standing Māori world values. We identified that kaitiakitanga (protecting) and manaakitanga (with kindness) - with whānau at the centre of all decisions and service delivery - worked as a protective mechanism to provide much needed support within the community Kōkiri serves. Conclusions Māori health providers are well placed to respond effectively in a public-health crisis when resourced appropriately and trusted to deliver. We propose a number of recommendations based on the insights generated from the researchers, kaimahi, and whānau. These are that: Māori be included in pandemic planning and decision-making, Māori-led initiatives and organisations be valued and adequately resourced, and strong communities with strong networks be built during non-crisis times.

Background Screening for and active management of comorbidity soon after cancer diagnosis shows promise in altering cancer treatment and outcomes for comorbid patients. Prior to a large multi-centre study, piloting of the intervention (comprehensive medical assessment) was undertaken to investigate the feasibility of the comorbidity screening tools and proposed outcome measures, and the feasibility, acceptability and potential effect of the intervention. Methods In this pilot intervention study, 72 patients of all ages (36 observation/36 intervention) with newly diagnosed or recently relapsed colorectal adenocarcinoma were enrolled and underwent comorbidity screening and risk stratification. Intervention patients meeting pre-specified comorbidity criteria were referred for intervention, a comprehensive medical assessment carried out by geriatricians. Each intervention was individually tailored but included assessment and management of comorbidity, polypharmacy, mental health particularly depression, functional status and psychosocial issues. Recruitment and referral to intervention were tracked, verbal and written feedback were gathered from staff, and semi-structured telephone interviews were conducted with 13 patients to assess screening tool and intervention feasibility and acceptability. Interviews were transcribed and analysed thematically. Patients were followed for 6–12 months after recruitment to assess feasibility of proposed outcome measures (chemotherapy uptake and completion rates, grade 3–5 treatment toxicity, attendance at hospital emergency clinic, and unplanned hospitalisations) and descriptive data on outcomes collated. Results Of the 29 intervention patients eligible for the intervention, 21 received it with feedback indicating that the intervention was acceptable. Those in the intervention group were less likely to be on 3+ medications, to have been admitted to hospital in previous 12 months, or to have limitations in daily activities. Collection of data to measure proposed outcomes was feasible with 55% (6/11) of intervention patients completing chemotherapy as planned compared to none (of 14) of the control group. No differences were seen in other outcome measures. Overall the study was feasible with modification, but the intervention was difficult to integrate into clinical pathways. C onclusions This study generated valuable results that will be used to guide modification of the study and its approaches prior to progressing to a larger-scale study. Trial registration Retrospective, 26 August 2019, ACTRN12619001192178 .

Background Physical activity has been implicated as a risk factor in the development of testicular cancer (TC), but the relationship remains controversial. This systematic review pooled available evidence regarding this association. Methods Using Boolean search terms and following PRISMA guidelines, we examined the risk of TC across three categories of exposure: intensity (i.e. comparison of risk between those previously exposed to high, moderate and low levels of physical activity); dose-response (i.e. whether risk of TC increases or decreases with increasing exposure to physical activity); and the role of timing of physical activity (i.e. during early childhood or adolescence). Results Thirteen studies (11 case-control studies, 2 cohort studies) were included in the review. While some studies have reported a strong protective effect of high levels of physical activity on risk of TC, others have reported either no relationship or a weak direct association; and while a dose-response relationship has been identified across several studies, this relationship has been observed in both directions. Similarly conflicting results exist in terms of individual types of activity and the lifecourse timing of the physical activity. Reasons for this inconsistency may include the absence of any association, heterogeneous assessment of physical activity, misclassification bias and difference in sample sizes. Conclusions On balance, there is presently no strong evidence of an association between physical activity and risk of subsequent TC. This review highlights key areas for future investigation that may clarify any association between physical activity and risk of testicular cancer.

Background Māori in New Zealand have markedly higher incidence and poorer survival from stomach cancer than non-Māori. We investigated the presentation, management and survival of stomach cancer in a cohort of newly diagnosed Māori and non-Māori patients. Methods A clinical notes review of all Māori from the North Island diagnosed between 2006 and 2008, and a random equivalent sample of non-Māori, was conducted (final cohort n  = 335). Patient characteristics, tumour characteristics, receipt and timing of treatment and cancer-specific survival were compared. Results Compared to non-Māori, Māori patients had a younger average age at diagnosis, higher prevalence of congestive heart failure and renal disease, and were more likely to be diagnosed with distal disease (43 % Māori, 26 % non-Māori, p  = 0.004). Stage and grade distributions were similar between ethnic groups. Two-thirds (66 %) of stage I–III patients had definitive surgery, with similar rates for Māori (71 %) and non-Māori (68 %). Māori were less likely to have surgery performed by a specialist upper gastrointestinal surgeon (38 % Māori, 79 % non-Māori, p  < 0.01) and less likely to be treated in a main centre (44 % Māori, 87 % non-Māori, p  < 0.01). After adjusting for age, sex, stage, tumour site and comorbidity, Māori had nonsignificant 27 % poorer survival (hazard ratio 1.27, 95 % CI 0.96–1.68). Conclusions There was evidence of differential presentation and access to specialised surgical services, as well as differential survival, for Māori stomach cancer patients compared to non-Māori. These findings support the development of the national stomach cancer treatment standards and highlight the need for an equity focus within these guidelines.

Background Long-term conditions (LTCs) are the biggest contributor to health loss in New Zealand. The economic cost and burden on the health system is substantial and growing. Self-management strategies offer a potential way to reduce the pressure on health services. This study evaluates a comprehensive self-management programme (the BetaMe programme) delivered by mobile and web-based technologies for people with Type 2 diabetes (T2DM) and pre-diabetes. The primary aim of this study is to evaluate the effectiveness of the BetaMe programme versus usual care among primary care populations in improving the control of T2DM and pre-diabetes, as measured by change in HbA1c and weight over 12 months. Methods Participants will be recruited through two primary healthcare organisations and a Māori healthcare provider in New Zealand ( n = 430). Eligible participants will be 18 to 75 years old, with T2DM or pre-diabetes, with an HbA1c of 41–70 mmol/mol up to 2 years prior to study commencement. Eligible participants who consent to participate will be individually randomised to the control arm (usual care) or intervention arm (usual care and BetaMe). The programme consists of a 16-week core followed by a maintenance period of 36 weeks. It incorporates (1) individualised health coaching, (2) goal setting and tracking, (3) peer support in an online forum and (4) educational resources and behaviour-change tools. The primary outcome measures are change in HbA1c and weight at 12 months. Secondary outcomes are changes in waist circumference, blood pressure, patient activation and diabetes-specific behaviours. All outcomes will be assessed at 4 and 12 months for the total study population and for Māori and Pacific participants specifically. All primary analyses will be based on intention-to-treat. Primary analysis will use linear mixed models comparing mean outcome levels adjusted for initial baseline characteristics at 12 months. Discussion This is a randomised controlled trial of a comprehensive self-management intervention for people with diabetes and pre-diabetes. If effective, this programme would allow healthcare providers to deliver an intervention that is person-centred and supports the self-care of people with T2DM, pre-diabetes and potentially other LTCs. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000549325 . Registered on 19 April 2017.

ObjectivesTo identify patterns of age disparities in cancer survival, using colon and lung cancer as exemplars.DesignSystematic review of the literature.Data sourcesWe searched Embase, MEDLINE, Scopus and Web of Science through 18 December 2020.Eligibility criteriaWe retained all original articles published in English including patients with colon or lung cancer. Eligible studies were required to be population-based, report survival across several age groups (of which at least one was over the age of 65) and at least one other characteristic (eg, sex, treatment).Data extraction and synthesisTwo independent reviewers extracted data and assessed the quality of included studies against selected evaluation domains from the QUIPS tool, and items concerning statistical reporting. We evaluated age disparities using the absolute difference in survival or mortality rates between the middle-aged group and the oldest age group, or by describing survival curves.ResultsOut of 3047 references, we retained 59 studies (20 for colon, 34 for lung and 5 for both sites). Regardless of the cancer site, the included studies were highly heterogeneous and often of poor quality. The magnitude of age disparities in survival varied greatly by sex, ethnicity, socioeconomic status, stage at diagnosis, cancer site, and morphology, the number of nodes examined and treatment strategy. Although results were inconsistent for most characteristics, we consistently observed greater age disparities for women with lung cancer compared with men. Also, age disparities increased with more advanced stages for colon cancer and decreased with more advanced stages for lung cancer.ConclusionsAlthough age is one of the most important prognostic factors in cancer survival, age disparities in colon and lung cancer survival have so far been understudied in population-based research. Further studies are needed to better understand age disparities in colon and lung cancer survival.PROSPERO registration numberCRD42020151402.

Key Points Cryptorchidism (undescended testes) is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer The key factors associated with the occurrence of cryptorchidism remain elusive Few factors are supported by consistent evidence of an association with cryptorchidism despite a considerable body of aetiological research For factors for which evidence seems unequivocal, the measured factor is likely to be a surrogate for the true causal factor The relative importance of each risk factor could vary considerably between mother–son pairs depending on an array of genetic, maternal, placental and fetal factors, which could vary between regions Undescended testis — known as cryptorchidism — is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer. The key factors that contribute to the occurrence of cryptorchidism remain elusive and a broad range of putative risk factors have been evaluated, but their plausibility is still in question. Undescended testis — known as cryptorchidism — is one of the most common congenital abnormalities observed in boys, and is one of the few known risk factors for testicular cancer. The key factors that contribute to the occurrence of cryptorchidism remain elusive. Testicular descent is thought to occur during two hormonally-controlled phases in fetal development — between 8–15 weeks (the first phase of decent) and 25–35 weeks gestation (the second phase of descent); the failure of a testis to descend permanently is probably caused by disruptions to one or both of these phases, but the causes and mechanisms of such disruptions are still unclear. A broad range of putative risk factors have been evaluated in relation to the development of cryptorchidism but their plausibility is still in question. Consistent evidence of an association with cryptorchidism exists for only a few factors, and in those cases in which evidence seems unequivocal the factor is likely to be a surrogate for the true causal exposure. The relative importance of each risk factor could vary considerably between mother–son pairs depending on an array of genetic, maternal, placental and fetal factors — all of which could vary between regions. Thus, the role of causative factors in aetiology of cryptorchidism requires further research.

Haematological (‘blood’) cancers are a diverse group of non-solid cancers with varying incidence, mortality and survival. While there is some evidence that Māori experience disparities in blood cancer outcomes relative to New Zealand’s majority European population, there is a need for a comprehensive overview of the current state of evidence in this context. Blood cancer registrations were derived from the NZ Cancer Registry for the 2007–2019 period (combined blood cancers: 2653 Māori, 20,458 Europeans), and linked to Mortality records. We calculated age-sex-standardised incidence and mortality rates, and conducted cancer-specific survival analysis, for four main categories of blood cancers (leukaemia, Hodgkin lymphoma, non-Hodgkin lymphoma and myeloma) as well as for sub-types of leukaemia non-Hodgkin lymphoma. We found that Māori are more likely to be diagnosed with (incidence) and to die from (mortality) both leukaemia and myeloma, and similarly likely to be diagnosed or die from Hodgkin and non-Hodgkin lymphoma, compared to Europeans. Māori had demonstrably poorer cancer-specific survival outcomes across most blood cancer types (age-sex-adjusted hazard ratios [HRs], Māori vs European: leukaemia 1.77, 95 % CI 1.57–2.00; Hodgkin lymphoma 1.18, 95 % CI 0.65–2.16; non-Hodgkin lymphoma 1.71, 95 % CI 1.50–1.95; myeloma 1.40, 95 % CI 1.19–1.64). Blood cancers are a common cancer type for Māori, and we found evidence of disparities in incidence, mortality and survival compared to Europeans. Further research is required to further pinpoint exactly where interventions should be aimed to reduce blood cancer incidence and address survival disparities for Māori. •Blood cancers are among the most commonly diagnosed cancers among Māori in New Zealand.•Māori are more likely to be diagnosed with (incidence) and to die from (mortality) leukaemia and myeloma.•Māori had demonstrably poorer survival outcomes across blood cancer types, including sub-types.•Research is needed to help pinpoint interventions that will reduce incidence and address survival disparities for Māori.

Blood cancers are some of the more common cancers and causes of cancer death among Māori in Aotearoa New Zealand. Leukaemia is the fifth most frequently diagnosed cancer among Māori and the ninth most common cause of Māori cancer death, while non-Hodgkin lymphoma is the eighth most commonly diagnosed and the tenth most common cause of death. Māori have poorer cancer-specific survival for all forms of blood cancer. Overall, the causes of blood cancers are not fully understood, and the proportion of blood cancers that may be attributable to known modifiable risk factors is modest compared to solid tumours. However, there are some risk factors known to influence tumour development. Improving survival for Māori and closing gaps in survival between Māori and non-Māori will require improvements in access to early detection and best-practice treatment for Māori with these cancers. In this viewpoint, we summarise the key actions we may take to reduce blood cancers for Māori, improve survival outcomes and reduce disparities.

Aims/hypothesisThe aim of this RCT was to evaluate the effectiveness of a digital health programme (BetaMe/Melon) vs usual care in improving the control of type 2 diabetes and prediabetes in a primary care population.MethodsWe conducted a randomised parallel-group two-arm single-blinded superiority trial in the primary care setting in two regions of New Zealand. Eligible participants were identified through Primary Health Organisations and participating practices. Eligibility criteria were as follows: age 18–75 years, HbA1c 41–70 mmol/mol (5.9–8.6%), not taking insulin, and daily access to the internet. BetaMe/Melon is a 12 month mobile-device and web-based programme with four components: health coaching; evidence-based resources; peer support; and goal tracking. Participants were randomised into the intervention or control arm (1:1 allocation) based upon baseline HbA1c (prediabetes or diabetes range), stratified by practice and ethnicity. Research nurses and the study biostatistician were blind to study arm. Primary outcomes of the study were changes in HbA1c and weight at 12 months, using an intention-to-treat analysis.ResultsFour hundred and twenty-nine individuals were recruited between 20 June 2017 and 11 May 2018 (n = 215 intervention arm, n = 214 control arm), most of whom were included in analyses of co-primary outcomes (n = 210/215, 97.7% and n = 213/214, 99.5%). HbA1c levels at 12 months did not differ between study arms: mean difference was −0.9 mmol/mol (95% CI −2.9, 1.1) (−0.1% [95% CI −0.3, 0.1]) for the diabetes group and was 0.0 mmol/mol (95% CI −0.9, 0.9) (0.0% [95% CI −0.1, 0.1]) for the prediabetes group. Weight reduced slightly at 12 months for participants in both study arms, with no difference between arms (mean difference −0.4 kg [95% CI −1.3, 0.5]).Conclusions/interpretationThis study did not demonstrate clinical effectiveness for this particular programme. Given their high costs, technology-assisted self-management programmes need to be individually assessed for their effectiveness in improving clinical outcomes for people with diabetes.Trial registrationwww.anzctr.org.au ACTRN12617000549325 (universal trial number U1111–1189-9094)FundingThis study was funded by the Health Research Council of New Zealand, the Ministry of Health New Zealand and the Healthier Lives National Science Challenge.