"I'm not getting paid to give you a TED talk on how my trans body works". Experiences of hysterectomy gender affirming surgery: A qualitative study.

OBJECTIVE: To explore the experiences of care surrounding hysterectomy as part of gender affirming surgery. METHODS: An in-depth reflexive thematic analysis from accounts by 10 out of 12 people was undertaken. Experiences were then mapped to the surgery journey as a template for developing system responsiveness. RESULTS: No one person's experience of the procedure was affirmed across the entire surgery journey. Transgender health literacy was central to inclusive practice as it mediated bodily autonomy being upheld. The physical care environment influenced the experience, for example, the waiting room was marginalizing (intimidating), with a gendered clinic name and toilets. Some participants took a female support person/partner so that "people looking would assume that I was there supporting her, not the other way around." Communication misalignments were evident around information provided/understood about fertility and ovarian preservation. Participants were also placed in the position of both receiving care and providing education: "I also shouldn't have to be going in there for treatment, and then being expected to educate the medical professional that's meant to be helping me… I'm not getting paid to give you a TED talk on how my trans body works." The experiences mapped across the surgery journey highlighted multiple levels of service provision development needed to foster inclusive practice, for example, from workforce education to healthcare policy. CONCLUSION: Healthcare for transgender people can be unsafe and inequitable. Increasing transgender health responsiveness across the surgery journey will facilitate better alignments in communication and uphold bodily autonomy, leading to safer and inclusive practice.

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 Maori 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.

What are women saying about noninvasive prenatal testing? An analysis of online pregnancy discussion forums.

OBJECTIVE: The aim of this study was to explore what women are saying about noninvasive prenatal testing (NIPT) in online discussion forums. METHODS: Inductive thematic analysis of content from 13 open-access discussion forums written in English from 11 popular maternity websites from four different countries (the United Kingdom, United States, New Zealand, and Australia) between 2013 to 2017 (n = 127 women). RESULTS: The forums were a space where women were provided with emotional support and advice in making their decision about NIPT as screening option. Justifications were made for paying for NIPT with terminology echoing commercial advertising "price was high … well worth the peace of mind." Paying for NIPT was referred to as a shopping exercise to find the "best deal." Women in the United States often talked about having to choose between NIPT and a scan because their insurance "won't pay for both." Commercial influence on maternity care providers' preference for different brands of NIPT was evident: "my doctor only uses [brand]. He said it's the best one on the market." CONCLUSION: Our findings highlight women's need for experiential information in prenatal screening counselling and how NIPT commercialization influences both routinized perspectives, and access, which may affect informed choice and best evidence screening practice.

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.

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 Maori 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.

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: Maori 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 Maori and non-Maori 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 Maori and 127 non-Maori) 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 Maori 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 Maori women (44%; 95% CI 25-65) than non-Maori 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. Maori 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.

Plaques from different individuals yield different microbiota responses to oral-antiseptic treatment.

Dental caries is a polymicrobial disease and complicated to treat. Understanding the microbiota responses to treatment from different individuals is a key factor in developing effective treatments. The aim of this study was to investigate the 24-h posttreatment effect of two oral antiseptics (chlorhexidine and Listerine) on species composition of microplate plaque biofilms that had been initiated from the saliva of five different donors and grown in both 0.15% and 0.5% sucrose. Plaque composition was analyzed using checkerboard DNA : DNA hybridization analysis, which comprised of a panel of 40 species associated with oral health and disease. The supernatant pH of the plaques grown in 0.15% sucrose ranged from 4.3 to 6 and in 0.5% sucrose, it ranged from 3.8 to 4. Plaque biomass was largely unaffected by either antiseptic. Each donor had a different salivary microbial profile, differentiating according to the prevalence of either caries or periodontal/anaerobic pathogens. Despite similar plaque microbiota compositions being elicited through the sucrose growth conditions, microbiota responses to chlorhexidine and Listerine differentiated according to the donor. These findings indicate that efficacious caries treatments would depend on the responses of an individual's microbiota, which may differ from person to person.

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.