title: Ethnic disparities in breast cancer survival in New Zealand: which factors contribute?

authors: Tin Tin, Sandar

subjects: Breast cancer

abstract: Background: New Zealand has major ethnic disparities in breast cancer survival with Maori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. This paper identified underlying factors and assessed their relative contribution to this risk differential. 
Methods: This study involved all women who were diagnosed with primary invasive breast cancer in two health regions, covering about 40% of the national population, between January 2000 and June 2014. Maori and Pacific patients were compared with other ethnic groups in terms of demographics, mode of diagnosis, disease factors and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of excess mortality from breast cancer for Maori and Pacific patients were assessed. 
Results: Of the 13,657 patients who were included in this analysis, 1281 (9.4%) were Maori, and 897 (6.6%) were Pacific women. Compared to other ethnic groups, they were younger, more likely to reside in deprived neighbourhoods and to have co-morbidities, and less likely to be diagnosed through screening and with early stage cancer, to be treated in a private care facility, to receive timely cancer treatment, and to receive breast conserving surgery. They had a higher risk of excess mortality from breast cancer (age and year of diagnosis adjusted hazard ratio: 1.76; 95% CI: 1.51-2.04 for Maori and 1.97; 95% CI: 1.67-2.32 for Pacific women), of which 75% and 99% respectively were explained by baseline differences. The most important contributor was late stage at diagnosis. Other contributors included neighbourhood deprivation, mode of diagnosis, type of health care facility where primary cancer treatment was undertaken and type of loco-regional therapy. 
Conclusions: Late diagnosis, deprivation and differential access to and quality of cancer care services were the key contributors to ethnic disparities in breast cancer survival in New Zealand. Our findings underscore the need for a greater equity focus along the breast cancer care pathway, with an emphasis on improving access to early diagnosis for Maori and Pacific women.

text: Ethnic disparities in breast cancer survival in New Zealand: which factors contribute? Background: New Zealand has major ethnic disparities in breast cancer survival with Maori (indigenous people) and Pacific women (immigrants or descended from immigrants from Pacific Islands) faring much worse than other ethnic groups. This paper identified underlying factors and assessed their relative contribution to this risk differential. 
Methods: This study involved all women who were diagnosed with primary invasive breast cancer in two health regions, covering about 40% of the national population, between January 2000 and June 2014. Maori and Pacific patients were compared with other ethnic groups in terms of demographics, mode of diagnosis, disease factors and treatment factors. Cox regression modelling was performed with stepwise adjustments, and hazards of excess mortality from breast cancer for Maori and Pacific patients were assessed. 
Results: Of the 13,657 patients who were included in this analysis, 1281 (9.4%) were Maori, and 897 (6.6%) were Pacific women. Compared to other ethnic groups, they were younger, more likely to reside in deprived neighbourhoods and to have co-morbidities, and less likely to be diagnosed through screening and with early stage cancer, to be treated in a private care facility, to receive timely cancer treatment, and to receive breast conserving surgery. They had a higher risk of excess mortality from breast cancer (age and year of diagnosis adjusted hazard ratio: 1.76; 95% CI: 1.51-2.04 for Maori and 1.97; 95% CI: 1.67-2.32 for Pacific women), of which 75% and 99% respectively were explained by baseline differences. The most important contributor was late stage at diagnosis. Other contributors included neighbourhood deprivation, mode of diagnosis, type of health care facility where primary cancer treatment was undertaken and type of loco-regional therapy. 
Conclusions: Late diagnosis, deprivation and differential access to and quality of cancer care services were the key contributors to ethnic disparities in breast cancer survival in New Zealand. Our findings underscore the need for a greater equity focus along the breast cancer care pathway, with an emphasis on improving access to early diagnosis for Maori and Pacific women.

year: 2018

title: Kaumātua mana motuhake: Kaumātua managing life-transitions through tuakana-teina/peer-education

authors: Hokowhitu, Brendan

abstract: People face signifi cant transition points as they age, such as loss of independent living, loss of a spouse and changing health conditions. Successfully navigating these transitions depends on being able to manage emotional and socio-economic factors, as well as service systems, while often being reliant on family or whānau. Historically however, kaumātua have faced a dominant society that has failed to realise their full potential as they age. Yet, for Māori, kaumātua are “carriers of culture, anchors for families, models for lifestyle, bridges to the future, guardians of heritage and role models for younger generations.” Kaumātua mana motuhake is invested in upholding kaumātua tino rangatiratanga (independence and autonomy) via high-quality Māori research that will lead to better life outcomes for kaumātua and their whā nau.

text: Kaumātua mana motuhake: Kaumātua managing life-transitions through tuakana-teina/peer-education People face signifi cant transition points as they age, such as loss of independent living, loss of a spouse and changing health conditions. Successfully navigating these transitions depends on being able to manage emotional and socio-economic factors, as well as service systems, while often being reliant on family or whānau. Historically however, kaumātua have faced a dominant society that has failed to realise their full potential as they age. Yet, for Māori, kaumātua are “carriers of culture, anchors for families, models for lifestyle, bridges to the future, guardians of heritage and role models for younger generations.” Kaumātua mana motuhake is invested in upholding kaumātua tino rangatiratanga (independence and autonomy) via high-quality Māori research that will lead to better life outcomes for kaumātua and their whā nau.

year: 2017

title: New Zealand’s Regulation of Internet Child Pornography

authors: Ball, Tawhana

abstract: The Internet has revolutionised the exchange of all forms of information, including that of an issue of great concern: child pornography. The consumption of child pornography is not a legislative or punitive problem. It is a law enforcement issue exacerbated by the main medium of supply, the Internet. The problem of the regulation of child pornography on the Internet has no universal answer. The solution to this concern will require a modulated response which will enable law enforcement agencies to adequately counter every aspect of the issue. This thesis examines New Zealand’s classification system and the primary statutory authority which prohibits the proliferation of child pornography, the Films, Videos, and Publications Classification Act 1993. 

Drawing on institutional, private and law enforcement narratives, this thesis investigates New Zealand’s current legal responses to the consumption of child pornography by way of the Internet. The intention of this investigation is to ascertain whether institutional responses could be improved and to make recommendations to assist law enforcement agencies to respond more effectively to this concern. Empirical data has been gathered from law enforcement personnel through qualitative research and has provided a privileged insight into the complexities of child pornography investigations. This qualitative empirical research confirmed that New Zealand’s child pornography legislation must be continually critiqued to ensure that it is keeping pace with technology. New Zealand’s institutional responses also need to be constantly evaluated to guarantee that the capacity of law enforcement agencies to respond to the problem of child pornography keeps pace with the main medium of supply, the Internet. Moreover, this thesis contends that all forms of child pornography should be outlawed because of its potential to cause harm to children and society. Although, the recommendations of this thesis do not constitute the definitive answer to the issue of child pornography on the Internet, each individual aspect of the recommendations constitutes a critical component of an overall response to this concern.

text: New Zealand’s Regulation of Internet Child Pornography The Internet has revolutionised the exchange of all forms of information, including that of an issue of great concern: child pornography. The consumption of child pornography is not a legislative or punitive problem. It is a law enforcement issue exacerbated by the main medium of supply, the Internet. The problem of the regulation of child pornography on the Internet has no universal answer. The solution to this concern will require a modulated response which will enable law enforcement agencies to adequately counter every aspect of the issue. This thesis examines New Zealand’s classification system and the primary statutory authority which prohibits the proliferation of child pornography, the Films, Videos, and Publications Classification Act 1993. 

Drawing on institutional, private and law enforcement narratives, this thesis investigates New Zealand’s current legal responses to the consumption of child pornography by way of the Internet. The intention of this investigation is to ascertain whether institutional responses could be improved and to make recommendations to assist law enforcement agencies to respond more effectively to this concern. Empirical data has been gathered from law enforcement personnel through qualitative research and has provided a privileged insight into the complexities of child pornography investigations. This qualitative empirical research confirmed that New Zealand’s child pornography legislation must be continually critiqued to ensure that it is keeping pace with technology. New Zealand’s institutional responses also need to be constantly evaluated to guarantee that the capacity of law enforcement agencies to respond to the problem of child pornography keeps pace with the main medium of supply, the Internet. Moreover, this thesis contends that all forms of child pornography should be outlawed because of its potential to cause harm to children and society. Although, the recommendations of this thesis do not constitute the definitive answer to the issue of child pornography on the Internet, each individual aspect of the recommendations constitutes a critical component of an overall response to this concern.

year: 2017