Genomic discrimination in New Zealand health and life insurance. AGenDA: Against Genomic Discrimination in Aotearoa

Nil.

Molecular Profiling of Endometrial Cancer: An Exploratory Study in Aotearoa, New Zealand

BACKGROUND

Aotearoa, New Zealand, has one of the fastest-rising rates of endometrial cancer (EC) worldwide, increasing particularly in younger Māori and Pasifika women. There is a move towards using molecular profiling to direct treatment for each EC subtype.

AIM

This study aimed to explore the molecular profiling of primary EC tissue in Aotearoa.

METHODS

We used the PORTEC guidelines for the molecular subtyping of 90 patients' samples into four categories: POLE-mutated, p53 abnormal, mismatch repair deficient (MMRd) and no specific molecular profile (NSMP). The CTNNB1 mutation and L1CAM expression were also included in the analysis. POLE and CTNNB1 mutations were analysed using targeted next-generation sequencing (NGS). Novel mutations were assessed using VarSome. MMRd, L1CAM and p53 abnormalities were analysed using immunohistochemistry.

RESULTS

In total, 15 samples were MMRd, 9 were p53 abnormal, 8 were POLE-mutated and the rest (56) were NSMP. Eleven samples had exon 3 CTNNB1 mutations and eleven novel POLE mutations were described.

CONCLUSION

Surrogate markers for POLE mutations should be investigated. The validation of POLE variants and CTNNB1 mutations as part of an Aotearoa-based molecular panel is warranted.

Exploring access to vasectomy services: a case study of funding in Counties Manukau

INTRODUCTION Although vasectomy rates in New Zealand have been reported as among the highest worldwide, there is limited information about who is receiving these services and how they are being accessed. This information is needed to develop equitable access to vasectomy services. AIM To describe the ethnicity and socioeconomic status of men accessing District Health Board-funded and self-funded vasectomies in Counties Manukau. METHODS A retrospective cohort analysis of provider data linked to ethnicity and area deprivation as an indicator of socioeconomic status. RESULTS Of 332 vasectomies, 66% were for New Zealand European men. Socioeconomic status was not associated with the number of procedures for New Zealand European men, but of the Māori and Pacific men who underwent vasectomies, most lived in the greatest areas of deprivation; 58% (18/31) and 50% (12/24), respectively. When vasectomies were funded, the number of procedures doubled for men from areas of high deprivation. The number of procedures was low for men of other ethnicities. DISCUSSION Our findings indicate differential access to vasectomies by ethnicity and socioeconomic status. Funding vasectomies may provide community benefits in terms of improving equity in access and alleviating a financial burden for many families living in areas of high deprivation.

Views of the obstetric profession on non-invasive prenatal testing in Aotearoa New Zealand: A national survey

BACKGROUND

Non-invasive prenatal testing (NIPT) has been available in Aotearoa New Zealand (NZ) for approximately four years. It is likely to be introduced into the publicly funded prenatal screening service.

AIM

To explore obstetrician use and views of NIPT, with consideration to its implementation into screening services for Down syndrome and other conditions.

METHODS

An anonymous online survey combining Likert scales and free text was designed to assess current practice, knowledge, ethical considerations, counselling and views toward public funding of NIPT. The survey was distributed through the New Zealand members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (n = 418) and responses collected over a two-month period in 2016.

RESULTS

There were 134/418 (32.1%) respondents. Current knowledge influenced decisions to offer NIPT (70.3%, 85/121). Confidence in offering NIPT was: 'not at all' (0.8%, 1/128); 'a little' (7.03%, 9/128), 'somewhat' (16.4%, 21/128), 'quite' (40.6%, 52/128) and 'very' (35.2%, 45/128). A total of 83.5% (101/121) stated NIPT should be publicly funded and NIPT capability developed within NZ (89.1%, 106/119). More information and support on the provision of NIPT was called for.

CONCLUSION

There was strong support for public funding of NIPT, and for NIPT capability to be developed in NZ. The call for more training, education and support needs to be actioned in order to facilitate the introduction of NIPT into screening services.

In situ Biofilm Formation by Multi-species Oral Bacteria Under Flowing and Anaerobic Conditions

An understanding of biofilm behavior of periodontopathic bacteria is key to the development of effective oral therapies. We hypothesized that interspecies bacterial aggregates play an important role in anaerobic biofilm establishment and proliferation, and contribute to the survivability of the biofilm against therapeutic agents. The system developed in this study assessed a multi-species ( Streptococcus gordonii, Actinobacillus actinomycetemcomitans, and Fusobacterium nucleatum) biofilm formation under anaerobic and flowing conditions with the use of an in situ image analysis system. The biofilm was comprised of a base film of non-aggregated cells and complex interspecies aggregates that formed in the planktonic phase which rapidly colonized the surface, reaching 58 ± 9% and 65 ± 11.8% coverage by 5 and 24 hrs, respectively. Upon SDS (0.1%) treatment of a 24-hour biofilm, substantial detachment (55 ± 14%, P < 0.05) of the aggregates was observed, while the base film bacteria remained attached but non-viable. Rapid re-establishment of the biofilm occurred via attachment of viable planktonic aggregates.

Access to Secondary Mental Health Services in a Cohort of New Zealand Mothers

To explore access to secondary mental health services for New Zealand women during pregnancy and for up to 1 year post-delivery. A retrospective cohort analysis of public hospital maternity data linked to mental health collections. 27 in 1000 pregnancies were associated with access to secondary mental health services (736/27,153). Independent of ethnicity, young age (<20 years) was associated with access (RR1.84; 95 %CI 1.42-2.38; P < .0001). Smoking (1.48; 1.24-1.78; P < .0001), alcohol (1.3; 0.97-1.71; P < .0001) and substance use (3.57; 2.61-4.88; P < .0001) during pregnancy were independent risk factors associated with access. Antenatal period provides an opportunity for navigating to services to ensure timely access to secondary mental health services.

Uterine cancer: exploring access to services in the public health system

BACKGROUND

Māori are the indigenous peoples of New Zealand and experience higher rates of uterine cancer and poorer survival rates. Postmenopausal bleeding (PMB) is the most common presenting symptom for uterine cancer. Prompt investigation is essential with 28 days being viewed as an appropriate time from first medical contact (FMC) to first specialist appointment (FSA).

AIMS

To compare access to services for the investigation of PMB between Māori and non-Māori women.

MATERIALS AND METHODS

The time interval between FMC to FSA was obtained from medical records for women presenting to gynaecology clinics for PMB. Dates of first bleeding symptoms, knowledge and access issues were collected in a nurse-administered questionnaire.

RESULTS

A total of 154 women (n = 27 Māori and 127 non-Māori) participated in the study. 23% of women had their FSA from FMC within 28 days and 67% waited more than six weeks. The 75th percentile was approximately two weeks longer for Māori women. 25% (n = 37) of women were not aware that they needed to see a doctor about PMB, and this was significantly more common for Māori women (44%; 95% CI 25-65) than non-Māori women (20%; 95% CI 13-28; P = 0.011).

CONCLUSIONS

The majority of women were not seen for FSA within 28 days of their FMC. Māori women were more likely to experience lengthy delays and to report that they did not know they should see a doctor about PMB. Further investigation into reasons for delays and initiatives to improve access to services and health information appears warranted.

Smoking, chronic periodontitis and smoking cessation support: reviewing the role of dental professionals

Smoking is one of the main modifiable risk factors for chronic periodontitis. Smokers tend to have poorer periodontal health and a poor response to periodontal treatment, showing approximately half as much improvement following surgical or non-surgical therapy. In light of the current health target ("Better help for smokers to quit"), the purpose of this article is to review the role of dental professionals in providing smoking cessation support, and to review the literature associated with the aetiology of chronic periodontitis, specifically on the impact that smoking cessation has on periodontal health and treatment outcomes. The current New Zealand Smoking Cessation Guidelines state that "all people who smoke, regardless of whether they express a desire to want to stop or not, should be advised to stop smoking." Although there are only limited data from long-term clinical studies to demonstrate the benefit of smoking cessation for periodontal treatment outcomes, the evidence does indicate that smoking cessation improves periodontal health. Smoking cessation support provided by dental professionals could therefore be pivotal in improving periodontal health and the outcome of periodontal treatment.

Treatment of Streptococcus mutans biofilms with a nonthermal atmospheric plasma

AIMS

A nonthermal atmospheric plasma, designed for biomedical applications, was tested for its antimicrobial activity against biofilm cultures of a key cariogenic bacterium Streptococcus mutans.

METHODS AND RESULTS

The Strep. mutans biofilms were grown with and without 0.15% sucrose. A chlorhexidine digluconate rinse (0.2%) was used as a positive antimicrobial reference. The presence of sucrose and the frequency of plasma application during growth were shown to have a significant effect on the response to treatment and antibacterial activity.

CONCLUSIONS

A single plasma treatment for 1 min on biofilms cultured without sucrose caused no re-growth within the observation period. However, with either single or repeated plasma treatments of 1 min, on biofilms cultured with 0.15% sucrose, growth was only reduced.

SIGNIFICANCE AND IMPACT OF THE STUDY

In summary, there may be a role for nonthermal plasma therapies in dental procedures. Sucrose and associated growth conditions may be a factor in the survival of oral biofilms after treatment.

Caries-related plaque microcosm biofilms developed in microplates

In vivo dental plaque biofilms consist of complex communities of oral bacteria that are a challenge to replicate in vitro. The aim of this investigation was to establish human dental plaque microcosms in microplates to reflect conditions that are relevant to dental caries. Microcosm plaque biofilms were initiated from the saliva of two different donors, grown for up to 10 days in 24-welled microplates on Thermanox coverslips in various types of artificial saliva with and without sucrose, which were replaced daily. Microbiota composition of 40 species associated with oral health and dental caries was monitored in the plaques using Checkerboard DNA-DNA hybridization analysis. pH was measured as an indicator of cariogenic potential. The composition of the saliva inocula was different, and yielded plaque microcosms with different composition and growth responses to sucrose. Artificial saliva type and presence of sucrose, and the resulting growth and pH conditions, modified the growth of individual species and hence the ecological profile of the microplate plaques during development. Complex population shifts were observed during development, and older plaques comprised predominantly facultative anaerobic species. Sucrose supplementation limited the decline of Streptococci over time but did not increase the abundance of mutans Streptococci. Sucrose at 0.15% increased levels of caries-associated species including Lactobacillus fermentum, Lactobacillus acidophilus and Actinomyces gerensceriae; these were further increased with sucrose at 0.5%, in addition to Actinomyces israelii, Rothia dentocariosa and Capnocytophaga gingivalis. The microplate plaques demonstrated complex community dynamics that appeared to reflect the maturation of natural plaques, and sucrose induced a cariogenic plaque composition and pH.

A fluorescence assay to determine the viable biomass of microcosm dental plaque biofilms

Dental plaque bacteria form complex and robust cell aggregates which cannot be counted accurately using epifluorescence microscopy. This causes a significant problem for quantifying their viability. The aim of the investigation was to develop a fluorescence assay to quantify the viable biomass of dental plaque biofilms. Using an artificial mouth system, microcosm plaques were grown under a range of fluoride and mineralizing conditions, and were treated with the oral antiseptics chlorhexidine (CHX) and Listerine. Plaques were harvested, made into suspension and stained in microtitre plates with a di-chromatic fluorescent stain (Live/Dead BacLight). The percentage of viable biomass was calculated from the regression data generated from a viability standard. The standard was constructed using different proportions of viable (green fluorescence) and non-viable (red fluorescence) plaque bacteria, and growth conditions for optimizing green fluorescence were investigated. The results from the assay showed that fluoride at 1000 and 3000 ppm promoted plaque viability by at least 15%, from approximately 45 to 60%, and at 5000 ppm to approximately 87% (P<0.05). Plaques treated with Listerine and CHX from d 0 yielded insufficient biomass to be tested for viability, however 14 d post-treatment, viability was comparable to untreated plaques (approximately 55%, P>0.05). Treatment with Listerine and CHX from d 3 reduced biomass but not viability. Development of this assay enabled viability of plaque bacteria which cannot be resolved with epifluorescence microscopy to be evaluated. It offers a rapid alternative to epifluorescence microscopy and could be applied to nonoral bacteria.

Antimicrobial effects of essential oils in combination with chlorhexidine digluconate

The aim of the present study was to compare antimicrobial effects of essential oils alone and in combination with chlorhexidine digluconate against planktonic and biofilm cultures of Streptococcus mutans and Lactobacillus plantarum. The essential oils included cinnamon, tea-tree (Melaleuca alternifola), manuka (Leptospermum scoparium), Leptospermum morrisonii, arnica, eucalyptus, grapefruit, the essential oil mouthrinse Cool Mint Listerine and two of its components, menthol and thymol. Cinnamon exhibited the greatest antimicrobial potency (1.25-2.5 mg/ml). Manuka, L. morrisonii, tea-tree oils, and thymol also showed antimicrobial potency but to a lesser extent. The combination effect of the essential oil-chlorhexidine was greater against biofilm cultures of both S. mutans and L. plantarum than against planktonic cultures. The amount of chlorhexidine required to achieve an equivalent growth inhibition against the biofilm cultures was reduced 4-10-fold in combination with cinnamon, manuka, L. morrisonii, thymol, and Listerine. We conclude that there may be a role for essential oils in the development of novel anticaries treatments.

Biofilm growth of Lactobacillus species is promoted by Actinomyces species and Streptococcus mutans

The ability of oral bacteria to integrate within a biofilm is pivotal to their survival. A dependence on the amount of biofilm growth by noncoaggregating Lactobacillus rhamnosus and Lactobacillus plantarum on coculture with Actinomyces naeslundii, Actinomyces gerencseriae, Streptococcus mutans and Veillonella parvula was investigated using an artificial-mouth culture system. Biofilm formation by the lactobacilli in mono-culture was poor. In coculture with Actinomyces species the amount of L. rhamnosus increased 7-20 times and L. plantarum 4-7 times compared to its mono-culture biofilm. S. mutans also promoted substantial biofilm growth of lactobacilli but V. parvula had no effect. We conclude that these Actinomyces species promoted growth of key Lactobacillus species in a biofilm, as did S. mutans to a smaller extent, and that the ability of individual bacteria to form mono-culture biofilms is not necessarily an indicator of their survival and pathogenic potential in a complex multispecies biofilm community.