ChlVPP combination chemotherapy for Hodgkin's disease: long-term results.

Two hundred and eighty-four patients with advanced Hodgkin's disease (HD) (stage II with poor prognostic features and stage III/IV) have been treated with the ChlVPP combination chemotherapy regimen (chlorambucil, vinblastine, procarbazine and prednisolone) in a single-centre unselected series. Median follow up is 92 months. Fifty-five patients had previously received radiotherapy but none had received previous chemotherapy. Eighty-five per cent of previously untreated patients and 91% of previously irradiated patients entered complete remission (CR); 71% and 68% of these respectively remain in CR at 10 years and 65% and 64% of each group respectively are alive at 10 years. On univariate analysis, age, stage, site of visceral disease and lymphocyte count predicted survival and on multivariate analysis age, absence of symptoms, absence of lung, liver or bone marrow disease and achieving a CR remained important predictors of survival. Acute toxicity was mild. The 10 year actuarial risk of acute leukaemia was 2.7%. This study adds further support to the view that chlorambucil is as effective and less toxic than mustine in combination chemotherapy for HD. We suggest that MOPP chemotherapy is no longer routinely indicated for HD

"It's like a sinking ship and you've got a cup to try and save it" : a thematic account of health professionals and parents thoughts and experiences of childhood obesity in Aotearoa/New Zealand : a thesis presented in partial fulfilment of the requirements of the degree of Master of Science in Psychology (Endorsement in Health Psychology) at Massey University, Wellington, New Zealand

The prevalence of childhood obesity is growing at a serious rate globally, and the World Health Organisation states that it is one of the most serious public health challenges of the 21st century. Childhood obesity is now a well-recognised problem in Aotearoa/New Zealand. New Zealand has the third highest rates of childhood obesity among 40 OECD countries, with 1 in 3 children in New Zealand above what is considered a healthy weight range. Consequently, New Zealand’s government have made tackling the high rates of childhood obesity a top public health priority by introducing multi-disciplinary weight management programmes across the country. However to date, little is known about how the implementation of childhood weight management programmes is going in practice. Programme evaluations are important to guide programme development and to make sure health interventions are working to their fullest potential for all New Zealanders. The current study explored key stakeholders (health professionals and parent’s) views and experiences of childhood obesity management in a New Zealand context. Health professionals’ personal experiences and perceptions were explored, around their management of childhood obesity and the perceived barriers to engaging families in intervention programmes for childhood weight management. Additionally, families’ reasons and rationales for declining a referral to a multi-disciplinary weight service were a key focus. A secondary aim of the current research was to produce pragmatic suggestions for the MidCentral District Health Board, to facilitate the implementation of childhood obesity prevention and management initiatives. A qualitative approach to inquiry was employed for an in-depth exploration of health professionals’ and parents’ thoughts and experiences. A purposive sampling method was used to recruit participants. Four focus groups were held, comprising 33 health professionals; additionally, face-to-face interviews were conducted with five mothers of pre-school aged children who had been identified as being above the healthy weight range and who declined a referral to a multi-disciplinary childhood weight management service. The interviews were focussed on mothers’ thoughts and perceptions of childhood obesity programmes. All transcripts were analysed using an explorative, inductive and data driven approach to thematic analysis. The interviews and focus groups with key stakeholders generated insights into the difficulties and challenges perceived by health professionals and parents at the individual, organisational and social level, in relation to implementing childhood obesity management. Health professional’s accounts reflected awareness of the broader contextual factors (e.g., availability and accessibility of healthy foods, family culture, and health literacy) and social and emotional factors (e.g., parental knowledge, social norms, family pressures) that could affect family adoption of healthy lifestyle behaviours. The mother’s accounts were largely focussed on the social factors affecting their ability to live a healthy lifestyle and the importance of feeling understood by health professionals. The findings from this study identify opportunities for assisting families and health professionals in the management of childhood obesity

Mothers, meal kits and morals : creating good eaters, being a good mother and reimagining the good daughter in Aotearoa : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Social Anthropology at Massey University, Manawatū, New Zealand

The use of meal kits in family foodwork is an increasing phenomenon in Aotearoa and not since supermarketisation has there been such a significant change to the food provisioning system. As a popular food procurement option, meal kits inevitably interact with the enduring entanglement of mothers and family foodwork. I use this significant change in how families are fed to explore the everyday work done by mothers as they navigate the moral meanings of being a good mother and a good daughter. Drawing on extensive autoethnographic practice, coupled with participant observation and co-constructed interviews with five other mothers, I use thematic analysis that positions the everyday experiences of women as integral to understanding the moral work done by mothers when using meal kits to feed their families. This research asks the previously unexplored question of how morally informed ideas of goodness affect the way mothers incorporate meal kits into their everyday foodwork. The importance of the intersubjective identities of mother and daughter, the need to provide competent care to children, and the contradictions present in what being a good mother means, in the context of women’s own lives and wider Western society, are highlighted in my research. I argue that the intersection of the new phenomenon of meal kits with the perennially intertwined morass of motherhood, morals and foodwork is a space where the continuation of gendered foodwork, the resistance to and reproduction of good mothering ideology and the transmission of moral practices across generations is found

High dose melphalan, BCNU and etoposide with autologous bone marrow transplantation for Hodgkin's disease.

Thirty-eight patients with previously treated Hodgkin's disease were given high dose combination chemotherapy using melphalan and BCNU and autologous bone marrow transplantation. In 25 patients etoposide was added in conventional dosage. During the course of the study the dose of melphalan was increased from 80 to 140 mg m-2 and the dose of BCNU from 300 to 600 mg m-2. The response rate was 76% with 53% complete remission. Forty-five per cent of the patients are free of disease at 4-20 months follow-up. There were eight (26%) treatment-related deaths due to lung damage (seven cases) and irreversible cardiac failure (one case). Fatal lung damage occurred only in patients receiving 600 mg m-2 of BCNU with high dose melphalan. The dose of BCNU given with high dose melphalan should not exceed 500 mg m-2. This treatment is effective against relapsed Hodgkin's disease but must be used cautiously. The best time for its use remains to be determined