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R. Lawrenson

University of Waikato, School of Health, Faculty Member

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Professor of Population Health University of Waikato

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The University of New South Wales

Leipzig University (Universität Leipzig)

Meera Mary Sunny

Indian Institute of Technology Gandhinagar

Washington and Lee University

Queen's University Belfast

Cedars-Sinai Medical Center

Michele Di Giorgio

Università degli Studi di Bari

French Institute of Pondicherry

Dr. K. Manikandan

University Of calicut

Evangelia Demerouti

Eindhoven University of Technology

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Papers by R. Lawrenson

EP04.01-023 Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry (ANZLCR)

Journal of Thoracic Oncology

Hā Ora: Reflecting on a Kaupapa Māori Community-Engaged Co-design Approach to Lung Cancer Research

International Journal of Indigenous Health, 2021

Co-designed research is gaining prominence within the health care space. Community engagement is ... more Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand. This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori. The team worked with four rural Māori communities, with whom we aimed to co-design local interventions that would promote earlier diagnosis of lung cancer. This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budge...

Mortality from venous thromboembolism among young women in Europe: no evidence for any effect of third generation oral contraceptives

Journal of Epidemiology & Community Health, 1997

Study objective-To investigate whether there has been an increase of venous thromboembolism (VTE)... more Study objective-To investigate whether there has been an increase of venous thromboembolism (VTE) mortality in European countries, concurrent with the replacement of second generation by third generation combined oral contraceptives (COCs). Such an increase has been predicted, and reportedly detected, because published studies have detected an increased incidence of VTE associated with third generation rather than second generation COC use. Design-Data were collected on population and annual VTE mortality in women 15-34 and 35-49 years old, and on second and third generation COC sales, from 1981 to 1994 in 13 European countries. Data from the seven most populous countries were analysed by linear regression of annual VTE mortality, in the 15-34 and 15-49 age groups, with respect to calculated total and third generation COC use rates, and the regression coefficients used to estimate mortality differences between second generation users and non-users and between third and second generation users, respectively. Main results-The estimated mortality

Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations

Journal of Epidemiology & Community Health, 2001

Background and objective: The optimum management of localised prostate cancer is unclear, with no... more Background and objective: The optimum management of localised prostate cancer is unclear, with no evidence from randomised controlled trials comparing the treatment options: surgery, radiotherapy or monitoring ('watchful waiting'). We have used routine data to examine patterns of utilisation of one of these treatments, radical prostatectomy, in NHS hospitals. Methods: Numbers of radical prostatectomies performed in English NHS hospitals were obtained from the Hospital Episode Statistics database for 1991-1997. Directly age-standardised operation rates were calculated for NHS regions and ward deprivation quintiles. The relative risk of admission for radical prostatectomy was calculated by ward deprivation quintile. Findings: There was a 14-fold increase in surgery, and a five-fold increase in the number of Trusts undertaking surgery, over the study period. By 1997 under half of all operations occurred in Trusts where surgeons operated more than once a month. Rates of surgery were greatest in the South East and Northern and Yorkshire NHS regions. In NHS regions outside London risk of surgery in an NHS hospital was significantly greater for men living in aZuent areas (RR=1.6, 95% confidence interval 1.3 to 1.9, P TREND <0.001), in London this trend was reversed (RR=0.2, 95% confidence interval 0.1 to 0.6, P TREND <0.001). Interpretation: In the absence of evidence of eVectiveness, use of radical prostatectomy has increased dramatically in England in recent years. This increase in surgery, and local variations in its development, probably reflects a combination of access to PSA testing, particularly through the private sector, and urologists' preferences. By 1997 most operations were still being performed in 'low-volume' hospitals, which may have implications for quality of care and subsequent outcome. Rational development of care for men with early prostate cancer should be informed ideally by a randomised trial of treatment options, or, at a minimum, by the routine collection of outcome data.

Emergency contraception in the community [letter]

Journal of Family Planning and Reproductive Health Care, 2001

These authors suggest that some emergency contraception users may access multiple sources and tha... more These authors suggest that some emergency contraception users may access multiple sources and that this will result in GP records underestimating the figure for repeat use. They also postulate that first-time emergency contraception users may go to a general practitioner (GP) and then next time they require treatment they may shy away from the GP and go to a family planning clinic. The latest survey data show that the majority of women 68% use a GP as their source of supply of hormonal emergency contraception. 3 Alternative sources used are family planning clinics (32%) and accident and emergency departments (3%). (excerpt)

Primary care units in A&E departments in North Thames in the 1990s: initial experience and future implications

BACKGROUND In 1992, the Tomlinson Report recommended a shift from secondary to primary care, incl... more BACKGROUND In 1992, the Tomlinson Report recommended a shift from secondary to primary care, including specific primary care provision in accident and emergency (A&E) departments. Availability of short-term so-called Tomlinson moneys allowed a number of experimental services. A study of the experience of A&E-based staff is reported to assist general practitioners (GPs) and purchasers and identify areas for further research. AIMS To find the number and scope of primary care facilities in A&E services in North Thames; to find factors encouraging or inhibiting the setting-up of a successful service; to examine the views of a range of A&E staff including GPs, consultants, and nurses; and to suggest directions for more specific research. METHOD A postal questionnaire was sent to all North Thames A&E departments, and an interview study of staff in one unit was arranged, leading to a questionnaire study of all GPs employed in North Thames primary care services in A&E. This was followed by ...

Community engagement in general practice: a qualitative study

Journal of Primary Health Care

BACKGROUNDCommunity engagement is believed to be an important component of quality primary health... more BACKGROUNDCommunity engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODSWe conducted 20 distinct interviews with 31 key informants from general practice and the wider community. The interviews were semi-structured around key relevant topics and were analysed thematically. RESULTSKey themes identified from the interview transcripts included an understanding of ‘community’, examples of community engagement and the perceived benefits and barriers to community-engaged general practice. We particularly explored aspects of community engagement with Māori. CONCLUSIONSGeneral practices in the study do not think in terms of communities, and they do not have a systematic framework for engagement. Although local champions have generated some great initiatives, most practices seemed to lack a conceptual framework for e...

Abstract P4-21-28: Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer

Cancer Research

Introduction HER2 status has been routinely ascertained for stage I-III breast cancer since late ... more Introduction HER2 status has been routinely ascertained for stage I-III breast cancer since late 2005. Trastuzumab was first funded in New Zealand for use in HER2+ breast cancer in July 2007. This observational study aims to compare the difference in outcome between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did not. Differences in presentation, treatment and outcomes between Māori and NZ European were studied. Methods The combined Waikato and Auckland Breast Cancer Registries have clinical details of 12377 women diagnosed with breast cancer between June 2000 and May 2013. 9506 women with breast cancer were tested for HER2 receptor status. Proportion of women with HER2+ (FISH amplified or IHC 3+), stage I-III breast cancer were examined by age, ethnicity and stage. Differences in use of trastuzumab for women with stage I-III breast cancer with a tumour size equal or larger than 1 cm and aged less than 75 years were assessed by ethnicity and year of diagnosis. Patients who had inflammatory breast cancer or developed metastatic disease or local recurrence within 3 months after diagnosis were excluded. Kaplan-Meier method and Cox proportional hazards model were used to examine the breast cancer-specific survival between women treated with trastuzumab and chemotherapy and those treated with chemotherapy without trastuzumab. Results 1454 patients with early invasive breast cancer were HER2+. The proportion of cases with HER2+, stage I-III breast cancer increased with stage (stage I-III: 11.5%-26.9%), but decreased with age ( Conclusions Trastuzumab improved the breast cancer-specific survival of women with HER2+ stage I-III breast cancer. Māori women were more likely to have HER2+ cancer and less likely to be treated with trastuzumab. Rates of treatment with trastuzumab and the adjusted survival between Māori women and NZ European women were not significantly different. Citation Format: Lawrenson R, Lao C, Harvey V, Campbell I, Brown C, Seneviratne S, Edwards M, Scott N, Elwood M, Sarfati D, Kuper-Hommel M. Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-28.

Risk factors associated with mortality from breast cancer in Waikato, New Zealand: a case-control study

Public health, Jan 6, 2015

The aim of this study is to identify key characteristics associated with mortality from breast ca... more The aim of this study is to identify key characteristics associated with mortality from breast cancer among women with newly diagnosed breast cancer in New Zealand (NZ). Case-control study. All primary breast cancers diagnosed between 01/01/2002 and 31/12/2010 in Waikato, NZ, were identified from the Waikato Breast Cancer Register. A total of 258 breast cancer deaths were identified from 1767 invasive cancers diagnosed over this period. Breast cancer deaths (n = 246) were compared with an age and year of diagnosis matched control group (n = 652) who were alive at the time of the death of the corresponding case and subsequently did not die from breast cancer. Diagnosis through symptomatic presentation, advanced stage, higher grade, absent hormone receptors (i.e. oestrogen and progesterone) and HER-2 amplification were associated with significantly higher risks of breast cancer mortality in bivariate analysis. Tumour stage, grade and hormone receptor status remained significant in the...

Renal Failure in Patients with Neurogenic Lower Urinary Tract Dysfunction

Neuroepidemiology, 2001

People with multiple sclerosis, paraplegia and neural tube defects typically have neurogenic lowe... more People with multiple sclerosis, paraplegia and neural tube defects typically have neurogenic lower urinary tract dysfunction (NLUTD). This encompasses detrusor hyperreflexia with or without detrusor sphincter dyssynergia and hypo- or acontractility. Their effects undermine safe, effective and controlled storage and voiding of urine and predispose to reflux nephropathy. Therefore, patients in these diagnostic groups with NLUTD would be expected to have increased risk of renal failure. The aim of this study was to quantify this risk using the General Practice Research Database (GPRD). All patients registered in the database between 1994 and 1997 and aged 10-69 were included in the study. The prevalence and incidence of renal failure and renal replacement therapy in the general population was ascertained, as was the prevalence of multiple sclerosis, paraplegia and neural tube defects. The prevalence of renal failure in each of the special populations was then compared with the prevalence in the unaffected general population. The age-standardised prevalence of renal failure in the GPRD population aged 10-69 years was 14 per 10,000. The rate ratio of renal failure compared with the general population in each of the years 1994-1997 for neural tube defects ranged between males (M) 6.8-9.0 and females (F) 9.2-11.5, for paraplegia M 4.1-9.0, F 4.0-7.0, and for multiple sclerosis M 0.4-1.3, F 0.5-2.2. As expected, people with paraplegia or neural tube defects were found to have a substantially increased risk of renal failure compared with the general population. We could not demonstrate an increased risk of renal failure in people with multiple sclerosis. We believe this finding requires further study, but may reflect a problem in the recognition of renal failure in this group of patients. We recommend that all three patient groups should be regularly screened so that renal impairment may be detected prior to the development of renal failure.

Use of the combined oral contraceptive pill by under 16s

Journal of Family Planning and Reproductive Health Care, 2001

The General Practice Research Database was used to examine prescribing of the combined oral contr... more The General Practice Research Database was used to examine prescribing of the combined oral contraceptive pill for females aged under 16 in England and Wales in 1997. From these data, calculations were made to estimate prevalence for these countries; family planning clinic return data were combined with the general practice estimates to give an overall figure of 4.2 per 100. This extent of use is low considering the amount of sexual activity now occurring. A weak effect of population density on prescribing was found, with higher rates in the more rural areas.

A UK general practice database study of prevalence and mortality of people with neural tube defects

Clinical Rehabilitation, 2000

Objective: To investigate the prevalence of neural tube defects (NTDs) in the UK and to compare t... more Objective: To investigate the prevalence of neural tube defects (NTDs) in the UK and to compare the mortality rate with that of the general population. Methods: A cross-sectional study. The General Practice Research Database (GPRD) contains the prescribing and diagnostic records since 1990 of over 4 million people from throughout the UK. All patients aged 10–69 and registered on the database in the years 1994–1997 were included in the study. Patients with a diagnosis of NTD were identified from the database and prevalence and standardized mortality ratios in each year were calculated. Results: The size of the GPRD reduced during the study period – there were 2 116 452 patients aged 10–69 years on the database in 1994, of whom 1751 had a prior record of NTD. In 1997 there were 998 368 patients, of whom 842 had an NTD. The age standardized prevalence between 1994 and 1997 for NTDs ranged between 7.8 and 8.4 per 10 000 for males and 9.0 and 9.4 per 10 000 for females aged 10–69 years. ...

The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared

Journal of Affective Disorders, 2000

Background: Antidepressants are commonly prescribed by general practitioners as treatment for dep... more Background: Antidepressants are commonly prescribed by general practitioners as treatment for depression. Controversy exists as to the effectiveness in everyday use of the older tricyclic antidepressants (TCAs) when compared to the newer selective serotonin reuptake inhibitors (SSRIs). Aim: To investigate the patterns of current prescribing of antidepressants for the treatment of depression and compare TCAs with the newer SSRIs. Method: The study population was patients attending 151 computerised general practices from throughout the United Kingdom between 1991 and 1996. Patients with new prescriptions for antidepressants and a diagnosis of depression were identified. Age and gender distributions, prescribed doses and drop-out rates were investigated. Results: During the study period 9.8% of patients received a prescription for an antidepressant, there was a 40% increase in the prescribing rate of TCAs and a 460% increase in SSRI prescribing. TCAs were initially prescribed in sub-therapeutic doses. More than 50% of patients ceased taking their antidepressants within 6 weeks of starting treatment. Fluoxetine and paroxetine were more likely to be prescribed for a therapeutic period than were other antidepressants. Conclusions: General practitioners should prescribe a therapeutic dose of antidepressant for a recognised therapeutic period to ensure that patients with depression receive the most effective treatment.

The prevalence of diabetic foot disease in the Waikato region

Diabetes Research and Clinical Practice

The aim of this study was to establish the prevalence of diabetic foot disease in the Waikato reg... more The aim of this study was to establish the prevalence of diabetic foot disease in the Waikato region. Diabetic foot disease is a well-recognised and serious complication of diabetes. The prevalence is unknown in the New Zealand population. Understanding both the prevalence and severity of foot disease in the diabetes population is necessary in helping to predict the need for podiatry services in people with diabetes. It is also important to be able to target those at most risk for regular monitoring. 3850 people with diabetes who attended the Waikato Regional Diabetes Service mobile retinal photo screening service over a six month period in 2014 were invited to participate. Of this group, 2192 people consented to a foot screen including testing for sensation and pedal pulses. A digital image was taken of the dorsal and plantar aspect of each foot for review by a registered Podiatrist. The foot screen was performed at the same appointment as the retinal photo screen. Thirteen percent of the study sample were identified as having a high risk foot including active foot complications. Sixty five percent were categorised as low risk and a further 22% at moderate risk of diabetic foot disease. Factors that were identified to be significant included age, type of diabetes, duration of diabetes, and smoking. These all placed people more at risk of diabetic foot disease. Surprisingly, ethnicity was not identified as a significant factor. However, those who attended rural based clinics were more likely to be at high risk. All the findings were consistent with international research. This study has highlighted the need for more podiatry services to address diabetic foot disease. Foot screening is easy to perform and should be included in future planning to meet the ever growing need of New Zealanders with diabetes.

Use of Non-Cancer Medications in New Zealand Women at the Diagnosis of Primary Invasive Breast Cancer: Prevalence, Associated Factors and Effects on Survival

International Journal of Environmental Research and Public Health

Background: Assessing the use of multiple medications in cancer patients is crucial as such use m... more Background: Assessing the use of multiple medications in cancer patients is crucial as such use may affect cancer outcomes. This study reports the prevalence of non-cancer medication use at breast cancer diagnosis, its associated factors, and its effect on survival. Methods: We identified all women diagnosed with primary invasive breast cancer between 1 January 2007 and 31 December 2016, from four population-based breast cancer registries, in Auckland, Waikato, Wellington, and Christchurch, New Zealand. Through linkage to the pharmaceutical records, we obtained information on non-cancer medications that were dispensed for a minimum of 90 days’ supply between one year before cancer diagnosis and first cancer treatment. We performed ordered logistic regressions to identify associated factors and Cox regressions to investigate its effect on patient survival. Results: Of 14,485 patients, 52% were dispensed at least one drug (mean—1.3 drugs; maximum—13 drugs), with a higher prevalence ob...

Geographical isolation and uptake of adjuvant chemotherapy for stage III colon cancer: Results from the New Zealand PIPER Cohort study

Journal of Clinical Oncology

Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry

The New Zealand medical journal, Jan 27, 2018

This study aims to report the characteristics of newly diagnosed lung cancer cases, and to examin... more This study aims to report the characteristics of newly diagnosed lung cancer cases, and to examine the data accuracy of registrations in the New Zealand Cancer Registry (NZCR) in 2011-2015. The accuracy and completeness of lung cancer registrations in the NZCR was explored using the Midland Lung Cancer Register (MLCR, including Lakes, Waikato, Tairawhiti and Bay of Plenty District Health Boards) and clinical records. A combined Midland Lung Cancer Dataset was created based on the NZCR and the MLCR. The characteristics of lung cancer cases was described and compared between Māori and non-Māori patients. The subgroup differences were examined by Chi-Square tests. The odds ratio of having small cell lung cancer compared to non-small cell lung cancer between Māori patients and non-Māori patients was estimated using the logistic regression model. The combined Midland Lung Cancer Dataset included 2,057 verified lung cancer registrations, including 656 (31.9%) Māori patients and 1,401 (68....

Effect of multimorbidity on health service utilisation and health care experiences

Journal of Primary Health Care

INTRODUCTION Multimorbidity, the co-existence of two or more long-term conditions, is associated ... more INTRODUCTION Multimorbidity, the co-existence of two or more long-term conditions, is associated with poor quality of life, high health care costs and contributes to ethnic health inequality in New Zealand (NZ). Health care delivery remains largely focused on management of single diseases, creating major challenges for patients and clinicians. AIM To understand the experiences of people with multimorbidity in the NZ health care system. METHODS A questionnaire was sent to 758 people with multimorbidity from two primary health care organisations (PHOs). Outcomes were compared to general population estimates from the NZ Health Survey. RESULTS Participants (n = 234, 31% response rate) reported that their general practitioners (GPs) respected their opinions, involved them in decision-making and knew their medical history well. The main barriers to effective care were short GP appointments, availability and affordability of primary and secondary health care, and poor communication between...

Response to Dr Caleb Armstrong: proposed Waikato medical school

The New Zealand medical journal, Nov 10, 2017

Development and validation of a new predictive model for breast cancer survival in New Zealand and comparison to the Nottingham prognostic index

BMC cancer, Jan 17, 2018

The only available predictive models for the outcome of breast cancer patients in New Zealand (NZ... more The only available predictive models for the outcome of breast cancer patients in New Zealand (NZ) are based on data in other countries. We aimed to develop and validate a predictive model using NZ data for this population, and compare its performance to a widely used overseas model, the Nottingham Prognostic Index (NPI). We developed a model to predict 10-year breast cancer-specific survival, using data collected prospectively in the largest population-based regional breast cancer registry in NZ (Auckland, 9182 patients), and assessed its performance in this data set (internal validation) and in an independent NZ population-based series of 2625 patients in Waikato (external validation). The data included all women with primary invasive breast cancer diagnosed from 1 June 2000 to 30 June 2014, with follow up to death or Dec 31, 2014. We used multivariate Cox proportional hazards regression to assess predictors and to calculate predicted 10-year breast cancer mortality, and therefore...

EP04.01-023 Development of an Australia and New Zealand Lung Cancer Clinical Quality Registry (ANZLCR)

Journal of Thoracic Oncology

Hā Ora: Reflecting on a Kaupapa Māori Community-Engaged Co-design Approach to Lung Cancer Research

International Journal of Indigenous Health, 2021

Co-designed research is gaining prominence within the health care space. Community engagement is ... more Co-designed research is gaining prominence within the health care space. Community engagement is a key premise of co-design and is also particularly vital when carrying out kaupapa Māori research. Kaupapa Māori describes a “by Māori, for Māori” approach to research in Aotearoa/New Zealand. This article discusses the research process of Hā Ora: a co-design project underpinned by a kaupapa Māori approach. The objective was to explore the barriers to early presentation and diagnosis of lung cancer, barriers identified by Māori. The team worked with four rural Māori communities, with whom we aimed to co-design local interventions that would promote earlier diagnosis of lung cancer. This article highlights and unpacks the complexities of carrying out community- engaged co-design with Māori who live in rural communities. In particular, we draw attention to the importance of flexibility and adaptability in the research process. We highlight issues pertaining to timelines and budge...

Mortality from venous thromboembolism among young women in Europe: no evidence for any effect of third generation oral contraceptives

Journal of Epidemiology & Community Health, 1997

Study objective-To investigate whether there has been an increase of venous thromboembolism (VTE)... more Study objective-To investigate whether there has been an increase of venous thromboembolism (VTE) mortality in European countries, concurrent with the replacement of second generation by third generation combined oral contraceptives (COCs). Such an increase has been predicted, and reportedly detected, because published studies have detected an increased incidence of VTE associated with third generation rather than second generation COC use. Design-Data were collected on population and annual VTE mortality in women 15-34 and 35-49 years old, and on second and third generation COC sales, from 1981 to 1994 in 13 European countries. Data from the seven most populous countries were analysed by linear regression of annual VTE mortality, in the 15-34 and 15-49 age groups, with respect to calculated total and third generation COC use rates, and the regression coefficients used to estimate mortality differences between second generation users and non-users and between third and second generation users, respectively. Main results-The estimated mortality

Society for Social Medicine and the International Epidemiological Association European Group. Abstracts of oral presentations

Journal of Epidemiology & Community Health, 2001

Background and objective: The optimum management of localised prostate cancer is unclear, with no... more Background and objective: The optimum management of localised prostate cancer is unclear, with no evidence from randomised controlled trials comparing the treatment options: surgery, radiotherapy or monitoring ('watchful waiting'). We have used routine data to examine patterns of utilisation of one of these treatments, radical prostatectomy, in NHS hospitals. Methods: Numbers of radical prostatectomies performed in English NHS hospitals were obtained from the Hospital Episode Statistics database for 1991-1997. Directly age-standardised operation rates were calculated for NHS regions and ward deprivation quintiles. The relative risk of admission for radical prostatectomy was calculated by ward deprivation quintile. Findings: There was a 14-fold increase in surgery, and a five-fold increase in the number of Trusts undertaking surgery, over the study period. By 1997 under half of all operations occurred in Trusts where surgeons operated more than once a month. Rates of surgery were greatest in the South East and Northern and Yorkshire NHS regions. In NHS regions outside London risk of surgery in an NHS hospital was significantly greater for men living in aZuent areas (RR=1.6, 95% confidence interval 1.3 to 1.9, P TREND <0.001), in London this trend was reversed (RR=0.2, 95% confidence interval 0.1 to 0.6, P TREND <0.001). Interpretation: In the absence of evidence of eVectiveness, use of radical prostatectomy has increased dramatically in England in recent years. This increase in surgery, and local variations in its development, probably reflects a combination of access to PSA testing, particularly through the private sector, and urologists' preferences. By 1997 most operations were still being performed in 'low-volume' hospitals, which may have implications for quality of care and subsequent outcome. Rational development of care for men with early prostate cancer should be informed ideally by a randomised trial of treatment options, or, at a minimum, by the routine collection of outcome data.

Emergency contraception in the community [letter]

Journal of Family Planning and Reproductive Health Care, 2001

These authors suggest that some emergency contraception users may access multiple sources and tha... more These authors suggest that some emergency contraception users may access multiple sources and that this will result in GP records underestimating the figure for repeat use. They also postulate that first-time emergency contraception users may go to a general practitioner (GP) and then next time they require treatment they may shy away from the GP and go to a family planning clinic. The latest survey data show that the majority of women 68% use a GP as their source of supply of hormonal emergency contraception. 3 Alternative sources used are family planning clinics (32%) and accident and emergency departments (3%). (excerpt)

Primary care units in A&E departments in North Thames in the 1990s: initial experience and future implications

BACKGROUND In 1992, the Tomlinson Report recommended a shift from secondary to primary care, incl... more BACKGROUND In 1992, the Tomlinson Report recommended a shift from secondary to primary care, including specific primary care provision in accident and emergency (A&E) departments. Availability of short-term so-called Tomlinson moneys allowed a number of experimental services. A study of the experience of A&E-based staff is reported to assist general practitioners (GPs) and purchasers and identify areas for further research. AIMS To find the number and scope of primary care facilities in A&E services in North Thames; to find factors encouraging or inhibiting the setting-up of a successful service; to examine the views of a range of A&E staff including GPs, consultants, and nurses; and to suggest directions for more specific research. METHOD A postal questionnaire was sent to all North Thames A&E departments, and an interview study of staff in one unit was arranged, leading to a questionnaire study of all GPs employed in North Thames primary care services in A&E. This was followed by ...

Community engagement in general practice: a qualitative study

Journal of Primary Health Care

BACKGROUNDCommunity engagement is believed to be an important component of quality primary health... more BACKGROUNDCommunity engagement is believed to be an important component of quality primary health care. We aimed to capture specific examples of community engagement by general practices, and to understand the barriers that prevent engagement. METHODSWe conducted 20 distinct interviews with 31 key informants from general practice and the wider community. The interviews were semi-structured around key relevant topics and were analysed thematically. RESULTSKey themes identified from the interview transcripts included an understanding of ‘community’, examples of community engagement and the perceived benefits and barriers to community-engaged general practice. We particularly explored aspects of community engagement with Māori. CONCLUSIONSGeneral practices in the study do not think in terms of communities, and they do not have a systematic framework for engagement. Although local champions have generated some great initiatives, most practices seemed to lack a conceptual framework for e...

Abstract P4-21-28: Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer

Cancer Research

Introduction HER2 status has been routinely ascertained for stage I-III breast cancer since late ... more Introduction HER2 status has been routinely ascertained for stage I-III breast cancer since late 2005. Trastuzumab was first funded in New Zealand for use in HER2+ breast cancer in July 2007. This observational study aims to compare the difference in outcome between women with HER2+ stage I-III breast cancer who received trastuzumab as adjuvant therapy versus those who did not. Differences in presentation, treatment and outcomes between Māori and NZ European were studied. Methods The combined Waikato and Auckland Breast Cancer Registries have clinical details of 12377 women diagnosed with breast cancer between June 2000 and May 2013. 9506 women with breast cancer were tested for HER2 receptor status. Proportion of women with HER2+ (FISH amplified or IHC 3+), stage I-III breast cancer were examined by age, ethnicity and stage. Differences in use of trastuzumab for women with stage I-III breast cancer with a tumour size equal or larger than 1 cm and aged less than 75 years were assessed by ethnicity and year of diagnosis. Patients who had inflammatory breast cancer or developed metastatic disease or local recurrence within 3 months after diagnosis were excluded. Kaplan-Meier method and Cox proportional hazards model were used to examine the breast cancer-specific survival between women treated with trastuzumab and chemotherapy and those treated with chemotherapy without trastuzumab. Results 1454 patients with early invasive breast cancer were HER2+. The proportion of cases with HER2+, stage I-III breast cancer increased with stage (stage I-III: 11.5%-26.9%), but decreased with age ( Conclusions Trastuzumab improved the breast cancer-specific survival of women with HER2+ stage I-III breast cancer. Māori women were more likely to have HER2+ cancer and less likely to be treated with trastuzumab. Rates of treatment with trastuzumab and the adjusted survival between Māori women and NZ European women were not significantly different. Citation Format: Lawrenson R, Lao C, Harvey V, Campbell I, Brown C, Seneviratne S, Edwards M, Scott N, Elwood M, Sarfati D, Kuper-Hommel M. Trastuzumab improves outcomes of New Zealand women with HER2+ stage I-III breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-28.

Risk factors associated with mortality from breast cancer in Waikato, New Zealand: a case-control study

Public health, Jan 6, 2015

The aim of this study is to identify key characteristics associated with mortality from breast ca... more The aim of this study is to identify key characteristics associated with mortality from breast cancer among women with newly diagnosed breast cancer in New Zealand (NZ). Case-control study. All primary breast cancers diagnosed between 01/01/2002 and 31/12/2010 in Waikato, NZ, were identified from the Waikato Breast Cancer Register. A total of 258 breast cancer deaths were identified from 1767 invasive cancers diagnosed over this period. Breast cancer deaths (n = 246) were compared with an age and year of diagnosis matched control group (n = 652) who were alive at the time of the death of the corresponding case and subsequently did not die from breast cancer. Diagnosis through symptomatic presentation, advanced stage, higher grade, absent hormone receptors (i.e. oestrogen and progesterone) and HER-2 amplification were associated with significantly higher risks of breast cancer mortality in bivariate analysis. Tumour stage, grade and hormone receptor status remained significant in the...

Renal Failure in Patients with Neurogenic Lower Urinary Tract Dysfunction

Neuroepidemiology, 2001

People with multiple sclerosis, paraplegia and neural tube defects typically have neurogenic lowe... more People with multiple sclerosis, paraplegia and neural tube defects typically have neurogenic lower urinary tract dysfunction (NLUTD). This encompasses detrusor hyperreflexia with or without detrusor sphincter dyssynergia and hypo- or acontractility. Their effects undermine safe, effective and controlled storage and voiding of urine and predispose to reflux nephropathy. Therefore, patients in these diagnostic groups with NLUTD would be expected to have increased risk of renal failure. The aim of this study was to quantify this risk using the General Practice Research Database (GPRD). All patients registered in the database between 1994 and 1997 and aged 10-69 were included in the study. The prevalence and incidence of renal failure and renal replacement therapy in the general population was ascertained, as was the prevalence of multiple sclerosis, paraplegia and neural tube defects. The prevalence of renal failure in each of the special populations was then compared with the prevalence in the unaffected general population. The age-standardised prevalence of renal failure in the GPRD population aged 10-69 years was 14 per 10,000. The rate ratio of renal failure compared with the general population in each of the years 1994-1997 for neural tube defects ranged between males (M) 6.8-9.0 and females (F) 9.2-11.5, for paraplegia M 4.1-9.0, F 4.0-7.0, and for multiple sclerosis M 0.4-1.3, F 0.5-2.2. As expected, people with paraplegia or neural tube defects were found to have a substantially increased risk of renal failure compared with the general population. We could not demonstrate an increased risk of renal failure in people with multiple sclerosis. We believe this finding requires further study, but may reflect a problem in the recognition of renal failure in this group of patients. We recommend that all three patient groups should be regularly screened so that renal impairment may be detected prior to the development of renal failure.

Use of the combined oral contraceptive pill by under 16s

Journal of Family Planning and Reproductive Health Care, 2001

The General Practice Research Database was used to examine prescribing of the combined oral contr... more The General Practice Research Database was used to examine prescribing of the combined oral contraceptive pill for females aged under 16 in England and Wales in 1997. From these data, calculations were made to estimate prevalence for these countries; family planning clinic return data were combined with the general practice estimates to give an overall figure of 4.2 per 100. This extent of use is low considering the amount of sexual activity now occurring. A weak effect of population density on prescribing was found, with higher rates in the more rural areas.

A UK general practice database study of prevalence and mortality of people with neural tube defects

Clinical Rehabilitation, 2000

Objective: To investigate the prevalence of neural tube defects (NTDs) in the UK and to compare t... more Objective: To investigate the prevalence of neural tube defects (NTDs) in the UK and to compare the mortality rate with that of the general population. Methods: A cross-sectional study. The General Practice Research Database (GPRD) contains the prescribing and diagnostic records since 1990 of over 4 million people from throughout the UK. All patients aged 10–69 and registered on the database in the years 1994–1997 were included in the study. Patients with a diagnosis of NTD were identified from the database and prevalence and standardized mortality ratios in each year were calculated. Results: The size of the GPRD reduced during the study period – there were 2 116 452 patients aged 10–69 years on the database in 1994, of whom 1751 had a prior record of NTD. In 1997 there were 998 368 patients, of whom 842 had an NTD. The age standardized prevalence between 1994 and 1997 for NTDs ranged between 7.8 and 8.4 per 10 000 for males and 9.0 and 9.4 per 10 000 for females aged 10–69 years. ...

The treatment of depression in UK general practice: selective serotonin reuptake inhibitors and tricyclic antidepressants compared

Journal of Affective Disorders, 2000

Background: Antidepressants are commonly prescribed by general practitioners as treatment for dep... more Background: Antidepressants are commonly prescribed by general practitioners as treatment for depression. Controversy exists as to the effectiveness in everyday use of the older tricyclic antidepressants (TCAs) when compared to the newer selective serotonin reuptake inhibitors (SSRIs). Aim: To investigate the patterns of current prescribing of antidepressants for the treatment of depression and compare TCAs with the newer SSRIs. Method: The study population was patients attending 151 computerised general practices from throughout the United Kingdom between 1991 and 1996. Patients with new prescriptions for antidepressants and a diagnosis of depression were identified. Age and gender distributions, prescribed doses and drop-out rates were investigated. Results: During the study period 9.8% of patients received a prescription for an antidepressant, there was a 40% increase in the prescribing rate of TCAs and a 460% increase in SSRI prescribing. TCAs were initially prescribed in sub-therapeutic doses. More than 50% of patients ceased taking their antidepressants within 6 weeks of starting treatment. Fluoxetine and paroxetine were more likely to be prescribed for a therapeutic period than were other antidepressants. Conclusions: General practitioners should prescribe a therapeutic dose of antidepressant for a recognised therapeutic period to ensure that patients with depression receive the most effective treatment.

The prevalence of diabetic foot disease in the Waikato region

Diabetes Research and Clinical Practice

The aim of this study was to establish the prevalence of diabetic foot disease in the Waikato reg... more The aim of this study was to establish the prevalence of diabetic foot disease in the Waikato region. Diabetic foot disease is a well-recognised and serious complication of diabetes. The prevalence is unknown in the New Zealand population. Understanding both the prevalence and severity of foot disease in the diabetes population is necessary in helping to predict the need for podiatry services in people with diabetes. It is also important to be able to target those at most risk for regular monitoring. 3850 people with diabetes who attended the Waikato Regional Diabetes Service mobile retinal photo screening service over a six month period in 2014 were invited to participate. Of this group, 2192 people consented to a foot screen including testing for sensation and pedal pulses. A digital image was taken of the dorsal and plantar aspect of each foot for review by a registered Podiatrist. The foot screen was performed at the same appointment as the retinal photo screen. Thirteen percent of the study sample were identified as having a high risk foot including active foot complications. Sixty five percent were categorised as low risk and a further 22% at moderate risk of diabetic foot disease. Factors that were identified to be significant included age, type of diabetes, duration of diabetes, and smoking. These all placed people more at risk of diabetic foot disease. Surprisingly, ethnicity was not identified as a significant factor. However, those who attended rural based clinics were more likely to be at high risk. All the findings were consistent with international research. This study has highlighted the need for more podiatry services to address diabetic foot disease. Foot screening is easy to perform and should be included in future planning to meet the ever growing need of New Zealanders with diabetes.

Use of Non-Cancer Medications in New Zealand Women at the Diagnosis of Primary Invasive Breast Cancer: Prevalence, Associated Factors and Effects on Survival

International Journal of Environmental Research and Public Health

Background: Assessing the use of multiple medications in cancer patients is crucial as such use m... more Background: Assessing the use of multiple medications in cancer patients is crucial as such use may affect cancer outcomes. This study reports the prevalence of non-cancer medication use at breast cancer diagnosis, its associated factors, and its effect on survival. Methods: We identified all women diagnosed with primary invasive breast cancer between 1 January 2007 and 31 December 2016, from four population-based breast cancer registries, in Auckland, Waikato, Wellington, and Christchurch, New Zealand. Through linkage to the pharmaceutical records, we obtained information on non-cancer medications that were dispensed for a minimum of 90 days’ supply between one year before cancer diagnosis and first cancer treatment. We performed ordered logistic regressions to identify associated factors and Cox regressions to investigate its effect on patient survival. Results: Of 14,485 patients, 52% were dispensed at least one drug (mean—1.3 drugs; maximum—13 drugs), with a higher prevalence ob...

Geographical isolation and uptake of adjuvant chemotherapy for stage III colon cancer: Results from the New Zealand PIPER Cohort study

Journal of Clinical Oncology

Characteristics of lung cancers and accuracy and completeness of registration in the New Zealand Cancer Registry

The New Zealand medical journal, Jan 27, 2018

This study aims to report the characteristics of newly diagnosed lung cancer cases, and to examin... more This study aims to report the characteristics of newly diagnosed lung cancer cases, and to examine the data accuracy of registrations in the New Zealand Cancer Registry (NZCR) in 2011-2015. The accuracy and completeness of lung cancer registrations in the NZCR was explored using the Midland Lung Cancer Register (MLCR, including Lakes, Waikato, Tairawhiti and Bay of Plenty District Health Boards) and clinical records. A combined Midland Lung Cancer Dataset was created based on the NZCR and the MLCR. The characteristics of lung cancer cases was described and compared between Māori and non-Māori patients. The subgroup differences were examined by Chi-Square tests. The odds ratio of having small cell lung cancer compared to non-small cell lung cancer between Māori patients and non-Māori patients was estimated using the logistic regression model. The combined Midland Lung Cancer Dataset included 2,057 verified lung cancer registrations, including 656 (31.9%) Māori patients and 1,401 (68....

Effect of multimorbidity on health service utilisation and health care experiences

Journal of Primary Health Care

INTRODUCTION Multimorbidity, the co-existence of two or more long-term conditions, is associated ... more INTRODUCTION Multimorbidity, the co-existence of two or more long-term conditions, is associated with poor quality of life, high health care costs and contributes to ethnic health inequality in New Zealand (NZ). Health care delivery remains largely focused on management of single diseases, creating major challenges for patients and clinicians. AIM To understand the experiences of people with multimorbidity in the NZ health care system. METHODS A questionnaire was sent to 758 people with multimorbidity from two primary health care organisations (PHOs). Outcomes were compared to general population estimates from the NZ Health Survey. RESULTS Participants (n = 234, 31% response rate) reported that their general practitioners (GPs) respected their opinions, involved them in decision-making and knew their medical history well. The main barriers to effective care were short GP appointments, availability and affordability of primary and secondary health care, and poor communication between...

Response to Dr Caleb Armstrong: proposed Waikato medical school

The New Zealand medical journal, Nov 10, 2017

Development and validation of a new predictive model for breast cancer survival in New Zealand and comparison to the Nottingham prognostic index

BMC cancer, Jan 17, 2018

The only available predictive models for the outcome of breast cancer patients in New Zealand (NZ... more The only available predictive models for the outcome of breast cancer patients in New Zealand (NZ) are based on data in other countries. We aimed to develop and validate a predictive model using NZ data for this population, and compare its performance to a widely used overseas model, the Nottingham Prognostic Index (NPI). We developed a model to predict 10-year breast cancer-specific survival, using data collected prospectively in the largest population-based regional breast cancer registry in NZ (Auckland, 9182 patients), and assessed its performance in this data set (internal validation) and in an independent NZ population-based series of 2625 patients in Waikato (external validation). The data included all women with primary invasive breast cancer diagnosed from 1 June 2000 to 30 June 2014, with follow up to death or Dec 31, 2014. We used multivariate Cox proportional hazards regression to assess predictors and to calculate predicted 10-year breast cancer mortality, and therefore...