28 results on '"Christin Coomarasamy"'
Search Results
2. Does Bariatric Surgery Improve Faecal Incontinence? A Systematic Review and Meta-analysis
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Don Wilson, Fardowsa Mohamed, Megna Jeram, Melanie Lauti, Andrew D. MacCormick, and Christin Coomarasamy
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Adult ,medicine.medical_specialty ,Roux-en-Y gastric bypass ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Original Contributions ,Pelvic floor disorder ,Urinary incontinence ,Gastric Bypass ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Duodenal switch ,Randomized controlled trial ,Quality of life ,law ,Gastrectomy ,Medicine ,Humans ,Obesity ,Depression (differential diagnoses) ,Bariatric surgery ,Nutrition and Dietetics ,business.industry ,Faecal incontinence ,medicine.disease ,Surgery ,Pelvic organ prolapse ,Obesity, Morbid ,Gastrointestinal health ,030220 oncology & carcinogenesis ,Meta-analysis ,Quality of Life ,030211 gastroenterology & hepatology ,Observational study ,Female ,medicine.symptom ,business ,Biliopancreatic diversion ,Fecal Incontinence - Abstract
Introduction Obesity increases the risk of pelvic floor disorders in individuals with obesity, including faecal incontinence. Faecal incontinence (FI) is a condition with important clinical and psychosocial consequences. Though it is associated with obesity, the effect of bariatric surgery on the prevalence and severity of FI is not well reported. Objective To assess the effect of bariatric surgery on the prevalence and severity of FI in adult patients with obesity. Methods This systematic review was conducted in accordance with the PRISMA statement. Two independent reviewers performed a literature search in MEDLINE, PubMed, Cochrane and Embase from 1 January 1980 to 12 January 2019. We included published English-language randomized control trials and observational studies assessing pre- and post-bariatric surgery prevalence or severity of FI. Random-effects models with DerSimonian and Laird’s variance estimator were used for meta-analysis. Results Thirteen studies were included, eight assessing prevalence (678 patients) and 11 assessing severity of FI (992 patients). There was no significant difference in prevalence post-operatively overall, though it trended towards a reduction [pooled OR=0.55; =0.075]. There was a significant reduction of FI prevalence in women post-bariatric surgery [95% CI 0.22 to 0.94, p=0.034]. There was a statistically significant reduction in FI prevalence following Roux-en-Y gastric bypass and one anastomosis gastric bypass [0.46, 95% CI 0.26 to 0.81; p=0.007]. There was no significant reduction of incontinence episodes post-operatively [pooled mean difference =−0.17, 95% CI −0.90 to 0.56; p=0.65]. Quality of life (QOL) was not significantly improved post-bariatric surgery [mean differences for the following facets of QOL: behaviour −0.35, 95% CI −0.94 to 0.24; depression 0.04, 95% CI −0.12 to 0.2; lifestyle −0.33, 95% CI −0.98 to 0.33; p values of 0.25, 0.61 and 0.33, respectively]. Discussion There was a significant reduction in FI prevalence in women and those who underwent Roux-en-Y or one anastomosis gastric bypass. Our results for FI prevalence overall, FI severity and impact on quality of life were not statistically significant. Larger studies are needed in this under-researched area to determine the true effect of bariatric surgery on FI. Graphical abstract
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- 2021
3. Epidemiology of haemorrhoids and publicly funded excisional haemorrhoidectomies in New Zealand (2007–2016): a population‐based cross‐sectional study
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Weisi Xia, Ahmed W.H. Barazanchi, Tarik Sammour, Andrew G. Hill, Christin Coomarasamy, James Jin, and Andrew D. MacCormick
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Adult ,Hemorrhoidectomy ,medicine.medical_specialty ,education.field_of_study ,business.industry ,Cross-sectional study ,Incidence ,Incidence (epidemiology) ,Population ,Gastroenterology ,Ethnic group ,Population based ,Hemorrhoids ,Cross-Sectional Studies ,Epidemiology ,Public hospital ,medicine ,Humans ,Outpatient clinic ,Female ,education ,business ,New Zealand ,Demography - Abstract
AIM Haemorrhoids are frequently encountered by the general or colorectal surgeon. Although a benign disease, those with symptomatic, advanced grades frequently require excisional haemorrhoidectomy for definitive management. Despite their widespread nature, the epidemiological burden of haemorrhoids and haemorrhoidectomies on populations is not well described. This study seeks to establish the incidence of both haemorrhoids diagnosed and haemorrhoidectomies performed in New Zealand. METHOD This is a population-based cross-sectional study examining the incidence of all patients who were newly diagnosed with haemorrhoids in New Zealand public hospital outpatient clinics and those who received excisional haemorrhoidectomy in New Zealand public hospitals from 2007 to 2016. Data were extracted and linked using the New Zealand National Minimum Dataset and the National Non-Admitted Patient Collection. Variables collected included age group, sex, ethnicity and geographical location. RESULTS A total of 46 095 recorded diagnoses of haemorrhoids were made, with a total of 18 739 haemorrhoidectomies in the 10-year period recorded. The incidence rate of diagnosis increased from 84.6 to 120.5 per 100 000 and the incidence rate of haemorrhoidectomies performed from 30.4 to 51.1 per 100 000, a significantly increased annual incidence. There was a unimodal peak prevalence in the fifth decade of life with women more affected. Europeans formed the largest group affected, with Asians showing the highest rate of increased incidence. CONCLUSION There is an increasing incidence of patients with symptomatic haemorrhoids presenting to the New Zealand public healthcare system, with a preponderance in working age adults, especially women.
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- 2020
4. Impact of severe obesity on long-term success and complications of the retropubic midurethral sling
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Nicola Dykes, Lynsey Hayward, and Christin Coomarasamy
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medicine.medical_specialty ,030219 obstetrics & reproductive medicine ,Sling (implant) ,business.industry ,Genitourinary system ,Urology ,030232 urology & nephrology ,Obstetrics and Gynecology ,Severe obesity ,medicine.disease ,Obesity ,Urinary Urge Incontinence ,03 medical and health sciences ,Distress ,0302 clinical medicine ,Matched cohort ,Internal medicine ,Medicine ,business ,Complication - Abstract
With conflicting evidence in the literature, we hypothesised that the long-term subjective outcomes of the retropubic midurethral sling (MUS) are the same in the severely obese and non-obese populations. A retrospective matched cohort study was performed on women with a BMI ≥ 35 and
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- 2020
5. Ethnic Disparities in Access to Publicly Funded Bariatric Surgery in South Auckland, New Zealand
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Matire Harwood, Andrew G. Hill, Christin Coomarasamy, Jamie-Lee Rahiri, and Andrew D. MacCormick
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medicine.medical_specialty ,Native Hawaiian or Other Pacific Islander ,Endocrinology, Diabetes and Metabolism ,Ethnic group ,Bariatric Surgery ,030209 endocrinology & metabolism ,Logistic regression ,Indigenous ,03 medical and health sciences ,0302 clinical medicine ,Ethnicity ,Humans ,Medicine ,Receipt ,Nutrition and Dietetics ,business.industry ,Odds ratio ,medicine.disease ,Comorbidity ,Obesity ,Confidence interval ,Obesity, Morbid ,Surgery ,030211 gastroenterology & hepatology ,business ,New Zealand - Abstract
In New Zealand (NZ), Indigenous Māori and Pacific peoples experience a higher burden of obesity and obesity-related disease. Counties Manukau Health (CMH) provides the largest public bariatric service in NZ housing a higher proportion (64%) of non-European groups (Asian, Pacific and Māori). This study investigated whether ethnic disparities in the receipt of bariatric surgery exist within one of the most ethnically diverse populations in NZ. All patients accepted on to the CMH bariatric programme between 1 January 2011 and 31 December 2017 were identified through hospitalisation records. Logistic regression modelling with multivariate adjustment was utilised to assess the likelihood (odds ratio) of receipt of bariatric surgery by ethnicity. A total of 2519 referrals were received, of which 1051 proceeded to surgery. The proportion of patients referred who eventually underwent bariatric surgery was significantly higher for Other Europeans (68%) and NZ Europeans (63%) compared to Asian (42%), Māori (41%) and Pacific peoples (28%, p
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- 2020
6. Prospective community programme versus parent-driven care to prevent respiratory morbidity in children following hospitalisation with severe bronchiolitis or pneumonia
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Florina Chan Mow, Mirjana Jaksic, Henare Mason, Karen Hoare, Julie Anne Higham, Teuila Percival, Adrian Trenholme, Harley Aish, Aileen Elborough, C McBride, Alison Vogel, Joanna Stewart, William Leung, Russell Metcalfe, Christin Coomarasamy, Lyndsay Le Comte, Shirley Lawrence, Catherine A. Byrnes, and Christine G. McIntosh
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Pulmonary and Respiratory Medicine ,Male ,Parents ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Risk Assessment ,Severity of Illness Index ,respiratory infection ,paediatric lung disaese ,pneumonia ,bronchiectasis ,Lower respiratory tract infection ,Severity of illness ,Outcome Assessment, Health Care ,medicine ,Pneumonia, Bacterial ,Humans ,Single-Blind Method ,Community Health Services ,Prospective Studies ,Bronchiectasis ,business.industry ,Respiratory disease ,Respiratory infection ,Infant ,medicine.disease ,Prognosis ,Anti-Bacterial Agents ,Hospitalization ,Pneumonia ,Caregivers ,Bronchiolitis ,Relative risk ,Female ,business ,Follow-Up Studies ,New Zealand - Abstract
BackgroundHospitalisation with severe lower respiratory tract infection (LRTI) in early childhood is associated with ongoing respiratory symptoms and possible later development of bronchiectasis. We aimed to reduce this intermediate respiratory morbidity with a community intervention programme at time of discharge.MethodsThis randomised, controlled, single-blind trial enrolled children aged Findings400 children (203 intervention, 197 control) were enrolled in 2011–2012; mean age 6.9 months, 230 boys, 87% Maori/Pasifika ethnicity and 83% from the most deprived quintile. Final assessment of 321/400 (80.3%) showed no differences in presence of wet cough (33.9% intervention, 36.5% controls, relative risk (RR) 0.93, 95% CI 0.69 to 1.25), abnormal examination (21.7% intervention, 23.9% controls, RR 0.92, 95% CI 0.61 to 1.38) or Brasfield score ≤22 (32.4% intervention, 37.9% control, RR 0.85, 95% CI 0.63 to 1.17). Twelve (all intervention) were diagnosed with bronchiectasis within this timeframe.InterpretationWe have identified children at high risk of ongoing respiratory disease following hospital admission with severe LRTI in whom this intervention programme did not change outcomes over 2 years.Trial registration numberACTRN12610001095055.
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- 2020
7. Early adolescent physical activity, sleep and symptoms of depression at 16 years of age
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Christin Coomarasamy, Edwin A. Mitchell, Karen E. Waldie, Rebecca F. Slykerman, John M. D. Thompson, Clare R Wall, and Rinki Murphy
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Pediatrics ,medicine.medical_specialty ,Longitudinal study ,Adolescent ,Population ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,030225 pediatrics ,Epidemiology ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Child ,Prospective cohort study ,education ,Exercise ,Depression (differential diagnoses) ,education.field_of_study ,Depression ,business.industry ,Infant, Newborn ,General Medicine ,medicine.disease ,Pediatrics, Perinatology and Child Health ,Cohort ,Small for gestational age ,Gestation ,Sleep ,business - Abstract
Aim To examine early adolescent physical activity and risk of later depressive symptoms at age 16 years in a prospective cohort study. Methods Participants were children and parents enrolled at birth of the child. Approximately half the children enrolled in the Auckland Birthweight Collaborative Study were small for gestational age at birth (SGA ≤10th percentile for sex and gestation) and half were appropriate for gestational age (AGA >10th percentile). Maternal demographic data were collected at birth, and children were followed through to age 16 years. Depression at 16 was assessed using the Center for Epidemiological Studies Depression Scale for Children. Accelerometer measures of physical activity and sleep were measured at 11 years of age. Results Moderate to severe depression was present in 15.6% of the 467 16-year-olds. Objectively measured physical activity and sleep at 11 years were not significantly associated with depressive symptoms at 16 years of age. Conclusion Prospectively collected objective measures of physical activity levels and sleep were not predictive of depressive symptoms later in adolescence in a healthy community cohort. While interventions to promote increased physical activity and sleep in adolescents who are depressed may be effective, physical activity and sleep in the general population of adolescents does not protect against future depression.
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- 2020
8. Exposure to antibiotics in the first 24 months of life and neurocognitive outcomes at 11 years of age
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Rebecca F. Slykerman, Janice Kang, Julian Crane, Kristin Wickens, Thorsten Stanley, Christine Barthow, John M. D. Thompson, Christin Coomarasamy, and Ed A. Mitchell
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Pharmacology ,Pediatrics ,medicine.medical_specialty ,medicine.drug_class ,business.industry ,Antibiotics ,Breastfeeding ,Cognition ,Impulsivity ,medicine.disease ,Antibiotic resistance ,medicine ,Anxiety ,Attention deficit hyperactivity disorder ,medicine.symptom ,business ,Neurocognitive - Abstract
Antibiotics are commonly prescribed for infants. In addition to increasing concern about antibiotic resistance, there is a concern about the potential negative impact of antibiotics on the gut microbiota and health and development outcomes. The aim of this study was to investigate the association between early life antibiotic exposure and later neurocognitive outcomes. Participants were infants born to mothers enrolled in the probiotics study. The initial study was designed to evaluate the effect of two different probiotics on allergy outcomes in childhood. Antibiotic exposure was based on parent report and categorised according to the following timing of the first exposure: 0–6 months, 6–12 months, 12–24 months or not at all. At 11 years of age, children’s neurocognitive outcomes were assessed using psychologist-administered, parent-report and self-report measures. The relationship between the timing of antibiotic exposure and neurocognitive outcomes was examined using regression models. Of the 474 participants initially enrolled, 342 (72%) children had a neurocognitive assessment at 11 years of age. After adjustment for mode of delivery, probiotic treatment group assignment, income and breastfeeding, children who had received antibiotics in the first 6 months of life had significantly lower overall cognitive and verbal comprehension abilities, increased risk of problems with metacognition, executive function, impulsivity, hyperactivity, attention-deficit hyperactivity disorder, anxiety and emotional problems. These results provide further evidence that early exposure to antibiotics may be associated with detrimental neurodevelopmental outcomes.
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- 2019
9. Laparoscopic Ventral Hernia Repair in South Auckland, New Zealand—A Retrospective Review
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Andrew G. Hill, L Poole, Christin Coomarasamy, Jamie-Lee Rahiri, and Garth Poole
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Adult ,Male ,medicine.medical_specialty ,Native Hawaiian or Other Pacific Islander ,Ethnic group ,Strengthening the reporting of observational studies in epidemiology ,White People ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Recurrence ,medicine ,Humans ,Healthcare Disparities ,Laparoscopy ,Herniorrhaphy ,Aged ,Retrospective Studies ,Retrospective review ,medicine.diagnostic_test ,Ventral hernia repair ,business.industry ,General surgery ,Confounding ,Health Status Disparities ,Length of Stay ,Middle Aged ,Hernia, Ventral ,Analgesics, Opioid ,Treatment Outcome ,030220 oncology & carcinogenesis ,Cohort ,Linear Models ,Female ,030211 gastroenterology & hepatology ,Surgery ,Complication ,business ,Follow-Up Studies ,New Zealand - Abstract
Background Ethnic disparities in surgical care and outcomes have been previously reported in studies for other surgical procedures. In addition, it has been reported that ethnic differences in postoperative analgesia exist. We aimed to determine ethnic disparities in postoperative outcomes, total opioid analgesia use, and complication rates of all patients who underwent a laparoscopic ventral hernia repair (LVHR) at our institution over a 3-y period. Methods A retrospective review of all patients who underwent an LVHR at Counties Manukau Health from January 1, 2013, to December 31, 2015, was performed in line with the Strengthening the Reporting of Observational Studies in Epidemiology statement. Results A total of 267 ventral hernias were repaired in 254 patients at Counties Manukau Health over the study period, of which most were primary umbilical ventral hernias. The majority of patients in our cohort were New Zealand European and male. Major complications, as per the Clavien-Dindo classification grade 3 and above, were observed in six patients with no deaths (2.4%). There were no statistically significant ethnic disparities in length of stay, receipt of opioid analgesia, and rates of complication observed after linear regression modeling after adjustment for confounding factors. Conclusions Our study showed that the majority of patients who had a ventral hernia repaired at our institution were mostly New Zealand European and male. Although significant ethnic disparities in patient characteristics were observed, these were not associated with ethnic disparities in postoperative outcomes after an LVHR.
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- 2019
10. The epidemiology of mycosis fungoides in New Zealand
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Fen-Lan Cherry Chang, Paul Jarrett, and Christin Coomarasamy
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Adult ,Male ,medicine.medical_specialty ,Mycosis fungoides ,Native Hawaiian or Other Pacific Islander ,business.industry ,MEDLINE ,Dermatology ,Middle Aged ,medicine.disease ,White People ,Mycosis Fungoides ,Epidemiology ,medicine ,Humans ,Female ,business ,Aged ,New Zealand ,Retrospective Studies - Published
- 2021
11. Pregnancy outcomes in women with booking HbA1c ≤ 40 mmol/mol compared with 41-49 mmol/mol in South Auckland, New Zealand
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Lesley M. E. McCowan, Charlotte Oyston, Sharron Arrol, Christin Coomarasamy, Karaponi Okesene-Gafa, and Yuxin Lim
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medicine.medical_specialty ,endocrine system diseases ,Population ,030209 endocrinology & metabolism ,Prenatal care ,Logistic regression ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Diabetes mellitus ,medicine ,Birth Weight ,Humans ,education ,Glycated Hemoglobin ,education.field_of_study ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Infant, Newborn ,Pregnancy Outcome ,nutritional and metabolic diseases ,Obstetrics and Gynecology ,General Medicine ,Odds ratio ,medicine.disease ,Diabetes, Gestational ,Hemoglobin A ,Gestation ,Female ,business ,New Zealand - Abstract
There are few data on pregnancy outcomes in women with pre-diabetes (HbA1c 41-49 mmol/mmol) at pregnancy booking. We aimed to (i) identify the proportion of women in Counties Manukau Health (CMH), South Auckland, New Zealand (NZ), with pre-diabetes at booking and (ii) compare outcomes between women with normal HbA1c and pre-diabetes.Using data from a multi-ethnic population of 10,869 singleton pregnancies, booked at20 weeks from January 2017 to December 2018 in CMH, we compared outcomes between those with normal HbA1c (≤40 mmol/mol) and those with pre-diabetes (HbA1c 41-49 mmol/mol). The primary outcomes were gestational diabetes mellitus (GDM) by NZ criteria and large for gestational age (LGA) defined as birthweight90th customised centile. Logistic regression determined the contribution of HbA1c 41-49 mmol/mol to the development of GDM.Among 10,869 participants, 193 (1.78%) had an HbA1c 41-49 mmol/mol at20 weeks' gestation. Those with HbA1c 41-49 mmol/mol were 11 times more likely to develop GDM (59.6 vs 7.9%; adjusted odds ratio (aOR) 11.16 (7.59, 16.41)) and were more likely to have an LGA baby (47 (24.4%) vs 1436 (13.5%) aOR 1.63 (1.10, 2.41)) versus those with normal HbA1c. They also had significantly higher rates of pre-eclampsia, caesarean sections, preterm births and perinatal deaths.Nearly two-thirds of women with a booking HbA1c of 41-49 mmol/mmol developed GDM as well as multiple other perinatal complications compared to women with HbA1c ≤40. Trials to evaluate the impact of treatment in early pregnancy on the risk of late-pregnancy complications are required.
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- 2021
12. Big data and dementia in New Zealand
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Rosie Whittington, Adrian Martinez-Ruiz, Christin Coomarasamy, Claudia Rivera Rodriguez, Rita Krishnamurthi, Gary Cheung, Sarah Cullum, Ngaire Kerse, and Susan Yates
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Gerontology ,History ,Epidemiology ,business.industry ,Health Policy ,Big data ,medicine.disease ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,medicine ,Dementia ,Neurology (clinical) ,Geriatrics and Gerontology ,business - Published
- 2020
13. Predictors of care home placement in people diagnosed with dementia in a New Zealand memory service
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Susan Yates, Christin Coomarasamy, Gary Cheung, Sarah Cullum, Rosie Whittington, and Chris Varghese
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Gerontology ,Service (business) ,medicine.medical_specialty ,Home placement ,Epidemiology ,business.industry ,Health Policy ,medicine.disease ,Prevalence incidence ,Psychiatry and Mental health ,Cellular and Molecular Neuroscience ,Developmental Neuroscience ,medicine ,Dementia ,Neurology (clinical) ,Geriatrics and Gerontology ,business - Published
- 2020
14. A retrospective, case‐controlled study of patients with inflammatory skin disease who have Staphylococcus aureus bacteraemia
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Harriet Bell, David Holland, Paul Jarrett, Juhee Roh, Shaochen Liu, and Christin Coomarasamy
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medicine.medical_specialty ,business.industry ,Internal medicine ,Inflammatory skin disease ,Case-control study ,Medicine ,Staphylococcus aureus bacteraemia ,Dermatology ,business - Published
- 2020
15. Exposure to Toenail Heavy Metals and Child Behavior Problems in Nine-Year-Old Children: A Cross-Sectional Study
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Shamshad Karatela, Christin Coomarasamy, Janis Paterson, and Neil I. Ward
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Male ,Longitudinal study ,Cross-sectional study ,Health, Toxicology and Mutagenesis ,lcsh:Medicine ,Pacific Islands ,Article ,Pregnancy ,Risk Factors ,Metals, Heavy ,Environmental health ,Humans ,Medicine ,Longitudinal Studies ,Child ,Child Behavior Checklist ,heavy metals ,Socioeconomic status ,Problem Behavior ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,Environmental Exposure ,medicine.disease ,Obesity ,behavior problems ,Cross-Sectional Studies ,Nails ,Cohort ,Marital status ,Female ,Observational study ,nail biomarker ,business ,Environmental Monitoring ,New Zealand - Abstract
Behavioral problems are multifactorial and includes perinatal, maternal, family, parenting, socio-economic and personal risk factors, but less is known about the association of postnatal heavy metals on children&rsquo, s behavioral problems in Pacific Island children. Methods: A cohort of eligible nine-year-old children within a Pacific Island Families longitudinal study were recruited for a cross-sectional study. Child behavior problems were assessed using the child behavior checklist. Heavy metals (including Ni, Cu, Pb, Al, Cr and Cd) were determined in toenails, after acid digestion and analyzed using inductively coupled plasma mass spectrometry. Other factors such as lifestyle (smoking in pregnancy), health outcomes (obesity, health status), demographics (gender, ethnicity, parents&rsquo, marital status) and socioeconomic status (household income levels) were also collected. The statistical analysis included t-tests for independent sample and Mann&ndash, Whitney U-test, and chi-square or Fisher&rsquo, s exact tests of independence for comparisons of the proportions. Regression models tested the hypothesized risk factors for behavior outcomes. Results: This observational study enrolled 278 eligible Pacific Island children living in Auckland, New Zealand. The prevalence of behavioral problems in the clinical range was high (22%) but there was no significant association between heavy metals in toenails and adverse behavioral outcomes. Conclusion: Regular monitoring and assessments of children for environmental risk factors, as well as social and lifestyle factors for behavior problems, continues. Alternative indicators of exposure to heavy metal should be evaluated.
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- 2020
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16. Effect of early probiotic supplementation on childhood cognition, behaviour and mood a randomised, placebo-controlled trial
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Ed A. Mitchell, Julian Crane, Christin Coomarasamy, N Van Zyl, Rinki Murphy, Kristin Wickens, Rebecca F. Slykerman, Janice Kang, Christine Barthow, Gordon Purdie, and Thorsten Stanley
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0301 basic medicine ,Pediatrics ,medicine.medical_specialty ,Intelligence ,Placebo-controlled study ,Breastfeeding ,Child Behavior ,Placebo ,Executive Function ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Double-Blind Method ,Pregnancy ,Humans ,Medicine ,Child ,biology ,business.industry ,Probiotics ,Infant ,General Medicine ,biology.organism_classification ,Bifidobacterium animalis ,Clinical trial ,Affect ,030104 developmental biology ,Mood ,Prenatal Exposure Delayed Effects ,Pediatrics, Perinatology and Child Health ,Anxiety ,Female ,medicine.symptom ,business ,Neurocognitive ,030217 neurology & neurosurgery - Abstract
Aim To determine whether probiotic supplementation in early life improves neurocognitive outcomes assessed at 11 years of age. Methods A total of 474 children who were born March 2004-Aug 2005 participated in a two-centre randomised placebo-controlled trial of infants at risk of developing allergic disease. Pregnant women were randomised to take Lactobacillus rhamnosus strain HN001, Bifidobacterium animalis subsp. lactis strain HN019 or placebo daily from 35 weeks gestation until six months if breastfeeding, and their infants the same treatment from birth to two years. Intelligence, executive function, attention, depression and anxiety were assessed when the children were 11 years of age. Results A total of 342 (72.2%) children were assessed (HN001 n = 109, HN019 n = 118 and placebo n = 115). Overall, there were no significant differences in the neurocognitive outcomes between the treatment groups. Conclusion HN001 and HN019 given in early life were not associated with neurocognitive outcomes at 11 years of age in this study. However, we cannot exclude that other probiotics may have a beneficial effect. Further clinical trials are indicated.
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- 2018
17. The epidemiology of subcutaneous panniculitis‐like alpha‐beta T‐cell lymphoma in New Zealand
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Christin Coomarasamy, Paul Jarrett, and Yena Kim
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Adult ,Male ,medicine.medical_specialty ,Panniculitis ,Skin Neoplasms ,Adolescent ,Dermatology ,Young Adult ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Subcutaneous Tissue ,0302 clinical medicine ,Epidemiology ,medicine ,Humans ,T-cell lymphoma ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Lymphoma, T-Cell, Cutaneous ,Lymphoma ,030220 oncology & carcinogenesis ,Relative risk ,Population study ,Female ,business ,New Zealand ,Rare disease - Abstract
Background/objectives Subcutaneous panniculitis-like alpha-beta T-cell lymphoma is a rare disease, which comprises less than 1% of all non-Hodgkin lymphoma. The epidemiology of this disorder has not been established in New Zealand, particularly the ethnic variation. Methods A retrospective study was conducted from 2005 to 2017 in South Auckland, New Zealand. Patients with histopathologically confirmed subcutaneous panniculitis-like alpha-beta T-cell lymphoma, according to the WHO-EORTC classification, were included. Cases were identified from multiple data sources to ensure the study population was completely surveyed. Census data were used as the denominator. Results Ten cases were identified. Five were men and five women. The median age at diagnosis was of 38.5 years (range 17-73 years). Nine were Māori/Pacific, and one was European. The ethnic relative risk of subcutaneous panniculitis-like alpha-beta T-cell lymphoma in Māori/Pacific versus European was 11.1 (95% Cl 1.83-246.1, P = 0.005). Conclusion Māori and Pacific have a higher relative risk of subcutaneous panniculitis-like alpha-beta T-cell lymphoma compared to non-Māori/Pacific.
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- 2019
18. A randomized, double-blind, placebo-controlled trial of the effect of monthly vitamin D supplementation in mild psoriasis
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Paul Jarrett, Christin Coomarasamy, Carlos A. Camargo, and Robert Scragg
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Male ,0301 basic medicine ,Vitamin ,medicine.medical_specialty ,Placebo-controlled study ,Dermatology ,Placebo ,Severity of Illness Index ,law.invention ,030207 dermatology & venereal diseases ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Psoriasis Area and Severity Index ,Internal medicine ,Psoriasis ,medicine ,Vitamin D and neurology ,Humans ,Aged ,Cholecalciferol ,Aged, 80 and over ,business.industry ,Interleukin-17 ,Dermatology Life Quality Index ,Middle Aged ,Placebo Effect ,medicine.disease ,Treatment Outcome ,030104 developmental biology ,chemistry ,Dietary Supplements ,Physical therapy ,Female ,business - Abstract
Purpose: To investigate the clinical effect of vitamin D3 supplementation on psoriasis from a community-dwelling population.Materials and methods: Participants with psoriasis in a large randomized controlled trial examining the effect of vitamin D3 supplementation (100,000 IU monthly) in adults aged 50–84 years were invited to participate in a psoriasis sub-study over 12 months. The primary outcome was the Psoriasis Area and Severity Index (PASI) and secondary outcomes were Physicians Global Assessment (PGA), Dermatology Life Quality Index (DLQI), and Psoriasis Disability Index (PDI). Trial identification number ACTRN12611000402943.Results: Twenty-three were allocated to vitamin D and 42 to placebo. There was no significant difference at baseline between the two groups. Mean (SD) baseline 25-hydroxyvitamin D was 65.7 (25.7) nmol/L. There were no significant differences (p > .05) between the groups in all of the psoriasis outcome measures. Mean scores [95% CI] at 12 months for the Placebo versus Vi...
- Published
- 2017
19. Household Smoking Status and Heavy Metal Concentrations in Toenails of Children
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Christin Coomarasamy, Neil I. Ward, Shamshad Karatela, and Janis Paterson
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Male ,Longitudinal study ,Health, Toxicology and Mutagenesis ,toenail biomarker ,chemistry.chemical_element ,lcsh:Medicine ,Health outcomes ,Pacific Islands ,Article ,Environmental health ,Metals, Heavy ,Medicine ,Humans ,Limited evidence ,Longitudinal Studies ,Child ,Cadmium ,business.industry ,lcsh:R ,Public Health, Environmental and Occupational Health ,Toes ,Secondhand smoking ,chemistry ,Nails ,child health ,Marital status ,Household income ,neurotoxins ,Smoking status ,Female ,Tobacco Smoke Pollution ,Second hand smoking ,business ,Biomarkers ,Environmental Monitoring ,New Zealand - Abstract
There is limited evidence on the distribution of heavy metals and its association with secondhand smoking (SHS) within Pacific Island children living in New Zealand. Certain heavy metals such as cadmium (Cd), lead (Pb), and aluminum (Al) bioaccumulates in the body and can deteriorate health in both children and adults. Others, such as chromium (Cr) and nickel (Ni) in trace amounts are necessary but become toxic at high levels. Exposure routes of these elements include food, water, and air. The purpose of this study was to identify the distribution of toxic metal concentrations and its possible correlation with SHS within the Pacific Island children. A sub-sample of children within Pacific Island families longitudinal study, at the nine-year phase, who were living in the New Zealand city of Auckland were invited to participate, (n = 278). Toenails were used as a biomarker to determine Cr, Pb, Cd, Cu, Ni, and Al concentration using inductively coupled plasma mass spectrometry. Reliable and validated questionnaires were used for demographics, lifestyle, and health outcome variables. Significant differences between household smoking status and ethnicity, as well as parents&rsquo, marital status, were observed (p <, 0.05). There was no statistical difference in heavy metal concentrations in smoking versus non-smoking households. However, Cr, Pb, Cd, Cu, and Ni concentrations were all higher than the required optimal health value in both groups. A high concentration of heavy metals was observed in these children that exceeded the value required for optimal health, although no significant difference in heavy metals with regards to secondhand smoking was observed. SHS was associated with children&rsquo, s ethnicity and parental marital status, but not with household income levels or maternal education.
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- 2019
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20. Impact of Using a 3D Visual Metaphor Serious Game to Teach History-Taking Content to Medical Students: Longitudinal Mixed Methods Pilot Study
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Mataroria Lyndon, Frederick Sundram, Hussain Alyami, Marcus A. Henning, Mohammed Alawami, Mohsen Alyami, Andrew G. Hill, and Christin Coomarasamy
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retention ,020205 medical informatics ,Objective structured clinical examination ,Teaching method ,education ,Biomedical Engineering ,Physical Therapy, Sports Therapy and Rehabilitation ,Physical examination ,02 engineering and technology ,metaphor ,memory ,0202 electrical engineering, electronic engineering, information engineering ,medicine ,Medical history ,instructional technology ,Self-efficacy ,Medical education ,Original Paper ,learning ,medicine.diagnostic_test ,business.industry ,05 social sciences ,Rehabilitation ,050301 education ,Usability ,Cognition ,video games ,Computer Science Applications ,Psychiatry and Mental health ,business ,Psychology ,0503 education ,Cognitive load ,clinical competence - Abstract
Background History taking is a key component of clinical practice; however, this skill is often poorly performed by students and doctors. Objective The study aimed to determine whether Metaphoria, a 3D serious game (SG), is superior to another electronic medium (PDF text file) in learning the history-taking content of a single organ system (cardiac). Methods In 2015, a longitudinal mixed methods (quantitative and qualitative) pilot study was conducted over multiple sampling time points (10 weeks) on a group of undergraduate medical students at The University of Auckland Medical School, New Zealand. Assessors involved in the study were blinded to group allocation. From an initial sample of 83, a total of 46 medical students were recruited. Participants were assigned to either a PDF group (n=19) or a game group (n=27). In total, 1 participant left the PDF group after allocation was revealed and was excluded. A total of 24 students in the game group and 14 students in the PDF group completed follow-up 7 weeks later. Using an iterative design process for over a year, with input from a variety of clinical disciplines, a cardiac history-taking game and PDF file were designed and informed by Cognitive Load Theory. Each group completed its intervention in 40 min. A total of 3 levels of Kirkpatrick training evaluation model were examined using validated questionnaires: affective (perception and satisfaction), cognitive (knowledge gains and cognitive load), and behavioral attitudes (Objective Structured Clinical Exam) as well as qualitative assessment. A priori hypotheses were formulated before data collection. Results Compared with baseline, both groups showed significant improvement in knowledge and self-efficacy longitudinally (P Conclusions Students favored learning through utilization of an SG with regard to cardiac history taking. This may be relevant to other areas of medicine, and this highlights the importance of innovative methods of teaching the next generation of medical students.
- Published
- 2019
21. Predictors of mortality in Māori, Pacific Island, and European patients diagnosed with dementia at a New Zealand Memory Service
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Gary Cheung, Sarah Cullum, Laura Hadfield, Susan Yates, Madeline Christie, Bonnie Liu, Chris Varghese, Brian Yeom, Rosie Whittington, Aakash Rajay, Kerry Appleton, and Christin Coomarasamy
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Male ,medicine.medical_specialty ,Native Hawaiian or Other Pacific Islander ,medicine.medical_treatment ,Ethnic group ,Comorbidity ,Pacific Islands ,White People ,03 medical and health sciences ,0302 clinical medicine ,Epidemiology ,Medicine ,Dementia ,Humans ,Date of birth ,Mortality ,Antipsychotic ,030214 geriatrics ,business.industry ,Cognition ,Middle Aged ,medicine.disease ,Psychiatry and Mental health ,Pacific islanders ,Female ,Cholinesterase Inhibitors ,Geriatrics and Gerontology ,business ,Demography ,Antipsychotic Agents ,New Zealand - Abstract
Background As the economic impact of dementia on health and social care increases, governments require disease-specific epidemiological data that will help inform spending and policy decisions. The aim of this study is to examine predictors of mortality in dementia in consecutive referrals to a New Zealand (NZ) memory service that includes Māori, Pacific Islander, and NZ European patients. Methods Date of birth, sex, ethnicity, living situation, cognitive function, dementia subtype, dementia severity, physical comorbidity, and medication data were collected from electronic health records. The resulting data set was linked to administrative data on mortality and last hospital contact dates to allow time-dependent survival analyses. Results The risk of death in people with dementia was increased by age (adjusted HR per year 1.08, 95%CI:1.05-1.12) and lower cognitive score at baseline (adjusted HR for severe impairment:2.54, 95% CI:1.25-5.16), and was reduced by cholinesterase inhibitors (adjusted HR:0.54, 95% CI:0.34-0.88). Compared to NZ Europeans (HR:1.19, 95% CI:0.63-2.25), antipsychotics increased the risk of death three-fold in Māori (adjusted HR:3.62, 95% CI:0.79-16.7) and Pacific Islanders (adjusted HR:2.54, 95%CI:1.10-5.85). Conclusions Further research is required to elucidate the mechanisms underlying the survival rates in Māori and Pacific Islanders living with dementia in NZ,and their increased risk of death if antipsychotics are used.
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- 2019
22. When mental illness and cancer collide: An investigation of the predictors of outcomes for cancer patients with a history of mental health problems
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Marie J Young, Nathan S. Consedine, Christin Coomarasamy, Lisa M. Reynolds, Daisy Huang, and Amy Hemmington
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Adult ,Male ,Mental Health Services ,medicine.medical_specialty ,Treatment outcome ,Population ,Experimental and Cognitive Psychology ,Comorbidity ,Psychotropic medication ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Neoplasms ,medicine ,Humans ,030212 general & internal medicine ,Psychiatry ,education ,education.field_of_study ,business.industry ,Mental Disorders ,Cancer ,Middle Aged ,medicine.disease ,Mental illness ,Advanced cancer ,Mental health ,Hospitalization ,Psychiatry and Mental health ,Mental Health ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Female ,business - Abstract
Objective People with a serious mental health condition are no more likely to receive a diagnosis of cancer than the general population but fare more poorly in terms of outcomes. The current study investigated whether a background of mental health problems (measured by contact with mental health services and psychotropic medication) predicted treatment outcomes over and above demographic and medical confounds for cancer patients at Counties Manukau Health. Methods The sample consisted of 1652 patients diagnosed with cancer in the period 1 January 2016 to 31 December 2016. The sample was split into three groups: non-mental health, moderate mental health, and serious mental health. Results Patients in the serious and moderate mental health groups were more likely to have physical comorbidities. Those in the serious mental health group were also marginally more likely to have advanced cancer at diagnosis. There were no differences between groups in terms of treatment delays, but patients in the serious mental health group were more likely to be hospitalised and die in the 12 months following diagnosis. Whilst differences in mortality may be explained by greater clinical complexity (being older, having other physical comorbidities) and later stage at presentation, mental health history was independently associated with hospitalisations. Conclusions Cancer patients with a history of more serious mental health issues fare more poorly than those with moderate mental health issues or no such history. The clinical complexity of working with these patients, indexed by mental and physical comorbidities, may be a factor contributing to this disparity.
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- 2019
23. Epidemiology, Management, and Outcomes of Large and Small Native Joint Septic Arthritis in Adults
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Stephen McBride, Edbert Wong, Katie Ross, Norman Quek, Zanazir Alexander, David Holland, Tim Askelund, Christopher Hopkins, Jessica Mowbray, William Caughey, Veronica Playle, Dinshaw Mistry, Robert J. Orec, Ahsan Siddiqui, Christopher Luey, and Christin Coomarasamy
- Subjects
0301 basic medicine ,Microbiology (medical) ,Adult ,Male ,medicine.medical_specialty ,Staphylococcus aureus ,medicine.drug_class ,medicine.medical_treatment ,030106 microbiology ,Antibiotics ,Prosthesis ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Epidemiology ,medicine ,Humans ,030212 general & internal medicine ,Socioeconomic status ,Aged ,Retrospective Studies ,Arthritis, Infectious ,business.industry ,Incidence (epidemiology) ,Retrospective cohort study ,Staphylococcal Infections ,medicine.disease ,Comorbidity ,Anti-Bacterial Agents ,Infectious Diseases ,Septic arthritis ,business ,New Zealand - Abstract
BackgroundNative joint septic arthritis (NJSA) is poorly studied. We describe the epidemiology, treatment, and outcomes of large joint NJSA (LNJSA) and small joint NJSA (SNJSA) in adults at Middlemore Hospital, Auckland, New Zealand.MethodsThis was a coding-based retrospective study of patients ≥16 years old admitted between 2009 and 2014. Prosthetic joint infections were excluded.ResultsFive hundred forty-three NJSA episodes were included (302 LNJSA, 250 SNJSA). Only 40% had positive synovial fluid culture. Compared to SNJSA, LNJSA has higher incidence (13 vs 8/100 000 person-years [PY]), occurs in older, more comorbid patients, and is associated with greater rates of treatment failure (23% vs 12%) and mortality, despite longer antibiotic treatment. Total incidence is higher than previously reported (21/100 000 PY), with marked interethnic variation. Incidence rises with age (LNJSA only) and socioeconomic deprivation (LNJSA and SNJSA). Tobacco smokers and males are overrepresented. The most commonly involved joints were knee (21%) and hand interphalangeal (20%). Staphylococcus aureus was the most common pathogen (53%). Mean antibiotic duration was 25 days for SNJSA and 40 days for LNJSA, and the mean number of surgical procedures was 1.5 and 1.6, respectively. Treatment failure was independently associated with LNJSA, age, intra-articular nonarthroplasty prosthesis, and number of surgical procedures.ConclusionsThis is the largest contemporary series of adult NJSA. SNJSA has better outcomes than LNJSA and may be able to be safely treated with shorter antimicrobial courses. Incidence is high, with significant ethnic and socioeconomic variation. Microbiological NJSA case ascertainment underestimates case numbers as it frequently excludes SNJSA.
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- 2018
24. Epidemiology and survival of Merkel cell carcinoma in New Zealand: A population-based study between 2000 and 2015 with international comparison
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Phillip Chao, Christin Coomarasamy, Young Suk Lee, and Jon A. Mathy
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Skin Neoplasms ,Adolescent ,Population ,Dermatology ,030207 dermatology & venereal diseases ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Age Distribution ,Internal medicine ,Medicine ,Humans ,Registries ,Neoplasm Metastasis ,Sex Distribution ,education ,Child ,Survival rate ,Aged ,Retrospective Studies ,Aged, 80 and over ,education.field_of_study ,integumentary system ,business.industry ,Merkel cell carcinoma ,Proportional hazards model ,Incidence (epidemiology) ,Infant, Newborn ,Infant ,Middle Aged ,medicine.disease ,United States ,Cancer registry ,Carcinoma, Merkel Cell ,Survival Rate ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Child, Preschool ,Female ,Skin cancer ,business ,Merkel cell ,New Zealand - Abstract
Background/objectives Merkel cell carcinoma is an aggressive neuroendocrine skin cancer. Australian studies report high incidence and poor survival rates compared internationally. While New Zealand has a comparable UV index and racial composition to Australia, survival outcomes are currently unknown. The role of Merkel cell polyoma virus in oncogenesis of Merkel cell carcinoma is an active area of research. We describe the incidence and survival of Merkel cell carcinoma in New Zealand with correlation to demographic and clinical factors including regional polyoma virus prevalence. Methods Retrospective study of population-based data from the New Zealand Cancer Registry. Incidence rates were directly standardised to the US standard 2000 population. Survival was investigated using Kaplan-Meier and multivariable Cox regression models. Results Six hundred and one cases were diagnosed in New Zealand between 2000 and 2015. The overall incidence rate was 0.96/100 000 population. Merkel cell carcinoma is more common in males, elderly and on sun-exposed areas. Eighteen percent of patients were diagnosed with distant metastasis at time of presentation. The overall 5-year survival rate and relative 5-year survival rate were 31% and 45%, respectively. Mortality was 1.9 and 2.5 times higher for stage III and IV disease, respectively, relative to stage I/II disease. Patients over age 80 had twice the mortality compared to those aged 60-69. Conclusions New Zealand has a high incidence of Merkel cell carcinoma and poor survival outcomes when compared internationally. We have the highest proportion of distant metastatic disease at time of diagnosis. Further research into the role of nonpolyoma-related Merkel cell carcinoma is warranted to improve Merkel cell carcinoma outcomes in New Zealand and abroad.
- Published
- 2018
25. Healthy Lungs Study: A Randomised Controlled Trial of a Community Intervention Programme Versus Usual Care to Prevent Chronic Respiratory Symptoms in Children Following Severe Bronchiolitis or Pneumonia
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Alison Vogel, Joanna Stewart, Shirley Lawrence, C McBride, Adrian Trenholme, Harley Aish, Russell Metcalfe, Christin Coomarasamy, Lyndsay Le Comte, Mirjana Jaksic, Dianna Lennon, Christine G. McIntosh, Henare Mason, Teuila Percival, Aileen Elborough, Karen Hoare, Florina Chan Mow, Julie-Ann Higham, Catherine A. Byrnes, and William Leung
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Pediatrics ,medicine.medical_specialty ,education.field_of_study ,Bronchiectasis ,business.industry ,Population ,medicine.disease ,law.invention ,Clinical trial ,Randomized controlled trial ,Informed consent ,Bronchiolitis ,law ,Intervention (counseling) ,Health care ,medicine ,business ,education - Abstract
Background: Bronchiectasis prevalence has increased, especially in indigenous children. One evolutionary pathway follows hospitalisation with severe lower respiratory tract infection (LRTI) in early childhood. We aimed to reduce the intermediate respiratory morbidity with an intervention programme introduced at discharge. Methods: This randomised, controlled, single-blind trial enrolled children aged
- Published
- 2018
26. Stillbirth is associated with perceived alterations in fetal activity - findings from an international case control study
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Louise M. O'Brien, Tomasina Stacey, Jayne Budd, Edwin A. Mitchell, Jane Warland, Christin Coomarasamy, Alexander E. P. Heazell, Heazell, Alexander EP, Warland, Jane, Stacey, Tomasina, Coomarasamy, Christin, Budd, Jayne, Mitchell, Edwin A, and O'Brien, Louise M
- Subjects
Adult ,medicine.medical_specialty ,Internationality ,Reproductive medicine ,Gestational Age ,Logistic regression ,lcsh:Gynecology and obstetrics ,03 medical and health sciences ,0302 clinical medicine ,Fetal movement ,Pregnancy ,Risk Factors ,Maternal perception ,Surveys and Questionnaires ,Obstetrics and Gynaecology ,Odds Ratio ,medicine ,Humans ,030212 general & internal medicine ,lcsh:RG1-991 ,Reduced fetal movement ,030219 obstetrics & reproductive medicine ,Obstetrics ,business.industry ,Case-control study ,Obstetrics & Gynecology ,Obstetrics and Gynecology ,Prenatal Care ,Odds ratio ,Stillbirth ,medicine.disease ,Exaggerated fetal movement ,Confidence interval ,Logistic Models ,Case-Control Studies ,Gestation ,Female ,Perception ,Pregnant Women ,business ,Research Article - Abstract
Background Stillbirth after 28 weeks gestation affects between 1.3–8.8 per 1000 births in high-income countries. The majority of stillbirths in this setting occur in women without established risk factors. Identification of risk factors which could be identified and managed in pregnancy is a priority in stillbirth prevention research. This study aimed to evaluate women’s experiences of fetal movements and how these relate to stillbirth. Methods An international internet-based case–control study of women who had a stillbirth ≥28 weeks’ gestation within 30 days prior to completing the survey (n = 153) and women with an ongoing pregnancy or a live born child (n = 480). The online questionnaire was developed with parent stakeholder organizations using a mixture of categorical and open–ended responses and Likert scales. Univariate and multiple logistic regression was used to determine crude (unadjusted) and adjusted odds ratios (aOR) with 95% confidence intervals (CI). Summative content analysis was used to analyse free text responses. Results Women whose pregnancy ended in stillbirth were less likely to check fetal movements (aOR 0.54, 95% CI 0.35–0.83) and were less likely to be told to do so by a health professional (aOR 0.55, 95% CI 0.36–0.86). Pregnancies ending in stillbirth were more frequently associated with significant abnormalities in fetal movements in the preceding two weeks; this included a significant reduction in fetal activity (aOR 14.1, 95% CI 7.27–27.45) or sudden single episode of excessive fetal activity (aOR 4.30, 95% CI 2.25–8.24). Cases described their perception of changes in fetal activity differently to healthy controls e.g. vigorous activity was described as “frantic”, “wild” or “crazy” compared to “powerful” or “strong”. Conclusions Alterations in fetal activity are associated with increased risk of stillbirth. Pregnant women should be educated about awareness of fetal activity and reporting abnormal activity to health professionals. Electronic supplementary material The online version of this article (10.1186/s12884-017-1555-6) contains supplementary material, which is available to authorized users.
- Published
- 2017
27. The effectiveness of the levonorgestrel intrauterine system in obese women with heavy menstrual bleeding
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Christin Coomarasamy, Alec Ekeroma, Valentina Shaw, and Alain C. Vandal
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Adult ,medicine.medical_specialty ,Visual Analog Scale ,medicine.medical_treatment ,Levonorgestrel ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Surveys and Questionnaires ,medicine ,Contraceptive Agents, Female ,Humans ,030212 general & internal medicine ,Obesity ,Prospective Studies ,Prospective cohort study ,Menorrhagia ,Gynecology ,030219 obstetrics & reproductive medicine ,Hysterectomy ,business.industry ,Obstetrics ,Intrauterine Devices, Medicated ,Obstetrics and Gynecology ,General Medicine ,Middle Aged ,medicine.disease ,Family planning ,Quality of Life ,Female ,business ,Body mass index ,Developed country ,medicine.drug - Abstract
INTRODUCTION: To evaluate the effectiveness of the levonorgestrel intrauterine system (LNG-IUS) in obese women with heavy menstrual bleeding in Counties Manukau Auckland area New Zealand. METHODS: Prospective observational study in a tertiary teaching hospital. Twenty women with heavy menstrual bleeding (HMB) who agreed to treatment with the LNG-IUS and had a body mass index (BMI) of >30 kg/m2 were recruited between May and December 2014. The women completed two validated tools (Menstrual Impact Questionnaire and the Pictorial Bleeding Assessment Chart) at recruitment 6 and 12 months follow-up. Demographic medical and laboratory variables were obtained from the relevant CMH databases. Data on side effects and satisfaction were obtained from the women at 12 months. RESULTS: The median age (range) and BMI of the 20 women were 40.5 years (27-52 years) and 40.6 kg/m2 (30-68) respectively. Three LNG-IUS were removed due to infection and pain and these women were subsequently booked for a hysterectomy. The reduction in menstrual loss was estimated at 19.7% per month (95% CI (12.5% 26.2%); P < 0.001) which translates to 73.2% per period of 6 months (95% CI (55.3% 83.9%)) and 92.8% per period of 12 months (95% CI (80.0% 97.4%)). The six items in the quality of life measure improved significantly in 14 women but only 12 women were satisfied with the treatment. CONCLUSION: The LNG-IUS was an effective treatment for 67% of obese women with heavy menstrual bleeding over a 12-month period as assessed by the reduction in menstrual bleeding and the improvement in the quality of life measures. (c) 2016 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
- Published
- 2016
28. Primary prophylaxis with granulocyte colony-stimulating factor (GCSF) reduces the incidence of febrile neutropenia in patients with non-Hodgkin lymphoma (NHL) receiving CHOP chemotherapy treatment without adversely affecting their quality of life: cost-benefit and quality of life analysis
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Samar Issa, Hilary Blacklock, Christin Coomarasamy, Sophie Lee, Angela Knox, and Irene S. L. Zeng
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Oncology ,Adult ,Male ,medicine.medical_specialty ,Vincristine ,Neutropenia ,Cyclophosphamide ,Fever ,Filgrastim ,medicine.medical_treatment ,Cost-Benefit Analysis ,CHOP ,Polyethylene Glycols ,Cohort Studies ,Young Adult ,immune system diseases ,Prednisone ,hemic and lymphatic diseases ,Internal medicine ,Surveys and Questionnaires ,Antineoplastic Combined Chemotherapy Protocols ,Granulocyte Colony-Stimulating Factor ,Medicine ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,Chemotherapy ,business.industry ,Incidence ,Lymphoma, Non-Hodgkin ,Middle Aged ,medicine.disease ,Recombinant Proteins ,Granulocyte colony-stimulating factor ,Surgery ,Doxorubicin ,Quality of Life ,Female ,business ,Febrile neutropenia ,medicine.drug - Abstract
Treatment of non-Hodgkin lymphoma (NHL) with cyclophosphamide, vincristine, doxorubicin and prednisone (CHOP) is known to be associated with a significant risk of febrile neutropenia (FN) of up to 50% [Osby et al. 2003 Blood 101(10): 3840-3848; Lyman and Delgado 2003 Cancer 98(11): 2402-2409]. This study sought to examine the impact of primary granulocyte colony-stimulating factor (GCSF) prophylaxis on the incidence of FN, quality of life and overall cost.In this retrospective cohort study, a group of 65 consecutive patients who received CHOP chemotherapy for NHL between December 2006 and October 2009 was studied. Patients either received filgrastim (300 mcg, average of seven doses), pegylated filgrastim (6 mg, single dose), or no GCSF prophylaxis. In addition, 19 patients were asked to complete Functional Assessment of Cancer Therapy: General quality-of-life questionnaires.Overall, patients who received primary GCSF prophylaxis had significantly fewer FN compared to those who did not (5 vs. 60%, p0.0001; numbers needed to treat of 1.8; 95% confidence interval, 1.6-2.9). Cost-benefit analysis showed that the GCSF prophylaxis was associated with only a small increase in direct financial cost ($238 NZD [US$189] more to give primary GCSF prophylaxis per patient vs. no prophylaxis). The quality of life assessment showed that the patients' quality of life scores were similar to the published data from the validation study population (466 patients with mixed cancers) for Functional Assessment of Cancer Therapy.Our study shows that primary GCSF prophylaxis is effective in preventing FN in patients receiving CHOP chemotherapy for NHL without adversely affecting their quality of life, and is cost effective.
- Published
- 2012
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