Laparoscopic distal pancreactectomy, does lesion size matter? Richardson, John; Di Fabio, Francesco; Shamali, Aawad ...
Pancreatology : official journal of the International Association of Pancreatology (IAP) ... et al.,
June 2014, Volume:
14, Issue:
3
Journal Article
To investigate ethnic, socioeconomic, and urban/rural differences in stage at diagnosis and cervical cancer survival in New Zealand.
The study involved 1594 cervical cancer cases registered during ...1994-2005. Cox regression was used to estimate adjusted cervical cancer mortality hazard ratios (HRs).
Māori and Pacific women had higher death rates than Other (predominantly European) women, with age and year of diagnosis adjusted HRs of 2.15 (95% CI 1.68-2.75) and 1.98 (95% CI 1.25-3.13), respectively, whereas Asian women had a lower (nonstatistically significant) risk (0.81, 95% CI 0.47-1.42). Adjustment for stage reduced the HR in Māori to 1.62 (95% CI 1.25-2.09), but there was little change for Pacific or Asian women. These patterns varied over time: for cases diagnosed during 1994-1997, the HR for Māori women was 2.34 (95% CI 1.68-3.27), which reduced to 1.83 (95% CI 1.29-2.60) when adjusted for stage; for cases diagnosed during 2002-2005, the corresponding estimates were 1.54 (95% CI 0.75-3.13) and 0.90 (95% CI 0.43-1.89). Socioeconomic status and urban/rural residence had only marginal effects.
There were major ethnic differences in cervical cancer survival in New Zealand that were only partly explained by stage at diagnosis. These patterns varied over time, with postdiagnostic factors playing an important role in the high Māori mortality rates in the 1990s, but in more recent years, the excess mortality in Māori women appeared to be almost entirely due to stage at diagnosis, indicating that ethnic differences in access to and uptake of screening and treatment of premalignant lesions may have been playing a major role.
Epidemiology is struggling increasingly with problems with correlated exposures and small relative risks. As a consequence, some scholars have strongly emphasized molecular epidemiology, whereas ...others have argued for the importance of the population context and the reintegration of epidemiology into public health. Environmental epidemiology has several unique features that make these debates especially pertinent to it. The very large number of environmental exposures require prioritization, and the relative risks are usually very low. Furthermore, many environmental exposures can be addressed only by comparing populations rather than individuals, and the disruption of both local and global ecosystems requires us to develop new methods of study design. The population context is also very important to consider in risk management decisions because of the involuntary nature of most environmental exposures and the diversity of possible outcomes, both health- and nonhealth-related. Studies at the individual or molecular level tend to focus the research hypotheses and subsequent interventions at that level, even when research and interventions at other levels may be more appropriate. Thus, only by starting from the population and ecosystem levels can we ensure that these are given appropriate consideration. Although better research is needed at all levels, it is crucially important to choose the most appropriate level, or levels, of research for a particular problem. Only by conducting research at all these levels and by developing further methods to combine evidence from these different levels can we hope to address the challenges facing environmental epidemiology today.
Objective To investigate differences in breast cancer prognostic factors between ethnic and socioeconomic groups in New Zealand. Methods We analyzed all 21,586 breast cancer cases on the New Zealand ...Cancer Registry (July 1994-June 2004). Māori, Pacific, and non-Māori/non-Pacific women were categorized according to ethnicity on the Registry. Deprivation was analyzed as quintiles of the New Zealand Deprivation Index 2001, an area-based measure of socioeconomic position. Logistic regression was used to estimate age-adjusted odds ratios (OR) (95% confidence intervals (CI)). Results Māori and Pacific women were more likely to have non-local stage, less well differentiated cancer, larger tumors and positive human epidermal growth factor receptor-type 2 (HER-2) status than non-Māori/non-Pacific women. Māori were less likely and Pacific women more likely than non-Māori/non-Pacific women to have negative oestrogen (ER) and progesterone receptor (PR) status. Adjusting for deprivation did not materially alter the results. Women living in more deprived areas had a higher risk of non-local stage and larger tumors. These associations were only partially explained by ethnicity. There was no relationship between tumor grade, ER, PR or HER-2 status and deprivation. Conclusions Our results confirm that Māori, Pacific and low socioeconomic women present with poor prognosis breast tumors.
The "25×25" strategy to tackle the global challenge of non-communicable diseases takes a traditional approach, concentrating on a few diseases and their immediate risk factors.
We propose elements of ...a comprehensive strategy to address NCDs that takes account of the evolving social, economic, environmental and health care contexts, while developing mechanisms to respond effectively to local patterns of disease. Principles that underpin the comprehensive strategy include: (a) a balance between measures that address health at the individual and population level; (b) the need to identify evidence-based feasible and effective approaches tailored to low and middle income countries rather than exporting questionable strategies developed in high income countries; (c) developing primary health care as a universal framework to support prevention and treatment; (d) ensuring the ability to respond in real time to the complex adaptive behaviours of the global food, tobacco, alcohol and transport industries; (e) integrating evidence-based, cost-effective, and affordable approaches within the post-2015 sustainable development agenda; (f) determination of a set of priorities based on the NCD burden within each country, taking account of what it can afford, including the level of available development assistance; and (g) change from a universal "one-size fits all" approach of relatively simple prevention oriented approaches to more comprehensive multi-sectoral and development-oriented approaches which address both health systems and the determinants of NCD risk factors.
The 25×25 is approach is absolutely necessary but insufficient to tackle the the NCD disease burden of mortality and morbidity. A more comprehensive approach is recommended.
Vigorous pharmacological interventions have a clear role in the management of existing diabetes. Nevertheless, in some Pacific countries a large proportion of resources is spent on identifying people ...with diabetes and on a variety of non-standardised drug treatment regimens.
To address the hypotheses that electrical workers are exposed to higher magnetic fields and are at higher risk of leukemia than nonelectrical workers, we performed a registry-based case-control study ...among men aged 20-64 years with known occupation who were diagnosed with cancer in Los Angeles County between 1972 and 1990. Controls were men with cancers other than those of the central nervous system or leukemia. Magnetic field measurements on workers in each electrical occupation and in a random sample of occupations presumed to be nonelectrical were used to estimate magnetic field exposures for each occupation. Among men in electrical occupations, 121 leukemias were diagnosed. With the exception of electrical engineers, magnetic field exposures were higher among workers in electrical occupations than in nonelectrical occupations. A weakly positive trend in leukemia risk across average occupational magnetic field exposure was observed (odds ratio OR per 10 milligauss increase in average magnetic field = 1.2, 95% confidence interval CI 1.0-1.5). A slightly stronger association was observed for chronic myloid leukemia, although only 28 cases occurred among electrical workers (OR 10 milligauss increase = 1.6, 95% CI = 1.2-2.0). The results were not materially altered by adjustment for exposure to several agents known or suspected to cause leukemia. Although not conclusive, these results are consistent with findings from studies based on job title alone that electrical workers may be at slightly increased risk of leukemia.
Industrialising societies are said to have undergone various epidemiological transition stages, in which the transition from stage two to stage three involves a change from receding pandemics to ...lifestyle diseases.1 The dynamics of this transition, which took thousands of years in Western countries, have been unprecedented and greatly compacted in time in most indigenous populations.
To estimate occupational mortality rates in New Zealand males for the period 2001-2005.
Occupation information noted in the free text of death records of males aged 15-64 years during 2001-2005 was ...classified to the New Zealand Standard Classification of Occupation 1999 and age and deprivation standardised mortality rates and ratios were calculated for the major ICD10-AM categories of disease and different occupational groups.
A total of 12,713 male deaths were included in the study. There were marked differences in mortality between occupations. Plant and machine operators and assemblers and agriculture and fishery workers had the overall highest rates. The former had the highest rates for ischemic heart disease, other diseases of the circulatory system, diseases of the respiratory system, and endocrine, nutritional and metabolic diseases, while the latter had the highest rate for external causes.
The last published study investigating occupational disease mortality in New Zealand is now over 20 years old and currently no regular monitoring of occupation-related mortality is occurring in New Zealand. This paper shows that there continues to be marked differences in mortality between occupations in New Zealand and that many of these differences persist following adjustment for socioeconomic deprivation.
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