He raruraru whanaketanga roro tō pēpi? Akohia te Holoprosencephaly (HPE)

Kāore e taea te whakapuaki i te hari me te aroha e pā ana ki a tātou ina titiro tātou ki tētahi pēpi hou, āe? Engari i ētahi wā, ka whānau mai ā tātou pēpi ki tēnei ao me ngā raruraru hauora kāore i te tumanakohia. I tēnei rā, ka kōrero tātou mō tētahi hapa whānau he ahua uaua, engari me mōhio tātou.

He aha te Holoprosencephaly (HPE)?

He whakarāpopototanga noa iho, ko te Holoprosencephaly, e mōhiotia ana ko te HPE, he mate whānau e puta ana i te wā e noho tonu ana te pēpi i roto i te kōpū. He hapa whānau tēnei. I roto i tēnei mate, kāore te roro o te tamaiti e wehea tika ana ki ngā taha matau me ngā taha maui i a ia e whanake ana. I mōhio koe e rua ngā wāhanga matua o tō tātou roro, ko te taha matau me te taha maui. E hono ana ēnei taha e rua tetahi ki tetahi, ā, e whakawhitiwhiti kōrero ana mā roto i te paihere o ngā muka io e kiia nei ko te corpus callosum. Waihoki, e wehea ana ia taha ki ētahi atu wāhanga, pērā i te lobe o mua, te lobe parietal, te lobe occipital, me te lobe temporal.

He mea tino nui tēnei wehenga o te roro kia maha ngā wāhanga. Nā te mea ka āwhina tēnei wehenga i te roro ki te tukatuka i te maha o ngā mōhiohio i te wā kotahi, me te mahi i ngā mahi rerekē. Nō reira, pērā i te take o te `(HPE)`, ki te kore tēnei wehenga e puta i te wā e whanake tika ana te roro, ka taea e ia te whakaputa i ētahi raruraru e pā ana ki te tinana me te pūnaha io.

Ko tēnei mate, e kiia nei ko te 'HPE', ka puta wawe tonu i te whanaketanga o te kukune i roto i te kōpū. Ko te tikanga, tera pea i mua i te mōhio kei te hapu koe. He rerekē ngā momo holoprosencephaly, ā, he rerekē te kaha me ngā tohu. Ka rerekē anō hoki te pānga o te mate ki ia tamaiti.

He aha ngā momo matua o te holoprosencephaly (HPE)?

E toru ngā momo matua o te holoprosencephaly (HPE). Me titiro tātou ki ēnei mai i te tino kino ki te iti rawa te kino:

Te Holoprosencephaly Alobar

Koinei te momo tino kino . Ko te mea e tupu ana i konei, kāore te roro o te kōpū e wehea kia rua ngā taha. Nō reira, ka ngaro ngā hanganga kei waenganui i te roro me te mata, ā, ka hanumi ngā kōhao roro. I tua atu i tēnei, ka kitea ngā āhua kino o te mata. I te nuinga o te wā, ka whānau mate ngā pēpi me tēnei momo `(HPE)`, ka mate rānei i muri tata i te whānautanga.

Te Holoprosencephaly Semilobar

I tēnei momo, ka wehea noa te roro o te pēpi kia rua ngā taha . Ka puta tēnei nā te mea e hono ana te taha maui o te roro ki te taha matau i ngā wāhi e kiia nei ko ngā "lobes frontal" me ngā "lobes parietal". Waihoki, ko te rārangi wehewehe i waenganui i te taha matau me te taha maui o te roro, te "fissure interhemispheric", kei muri noa iho o te roro.

Te horoprosencephaly o te roro

I tēnei momo, ka wehea te roro o te kōpū kia rua ngā tuakoi., engari kāore i tino wehea. Ahakoa e rua ngā taha maui (matau me te maui), e honoa ana ngā taha roro i roto i te "frontal cortex". Koinei te momo tino kino o te "(HPE)".

Te momo waenga-waenganui-ā-ira (MIH)

Haunga ēnei momo matua e toru, kei reira anō tētahi momo tuawhā e kiia nei ko te Middle Interhemispheric (MIH). Koinei te wāhi e honoa ai te roro o te kōpū i waenganui.

He aha te rerekētanga i waenga i te hydranencephaly me te holoprosencephaly?

Tērā pea ka pōhēhē koe i ēnei ingoa e rua. He whānautanga hapa te Hydranencephaly me te holoprosencephaly e pā ana ki te roro o te pēpi, engari he rerekētanga kei waenganui i a rāua.

Ko te hydranencephaly te ngaronga o tētahi wāhanga o te roro o tō pēpi. He mate tino onge tēnei e kiia nei ko te hydrocephalus (upoko wai). Ko ngā pēpi e pāngia ana e tēnei mate he upoko nui ake.

Heoi, ko te Holoprosencephaly te wā kāore te roro e wehe tika ana ki ngā taha matau me ngā taha maui i te wā e whānau ana. E mārama ana koe ki taua rerekētanga?

Ko wai ka pāngia e tēnei mate? ​​He pēhea te noa o tōna pānga?

Ko te Holoprosencephaly (HPE) he mate e pā ana ki ngā kukune e tipu ana i roto i te kōpū. I te nuinga o te wā ka puta i te wiki tuarua me te tuatoru o te whanaketanga o te kukune. Ko te tikanga o tēnei, i mua i te mōhio kei te hapu koe.

E ai ki ngā whakatau tata a ngā kairangahau, tata ki te 1 i roto i te 250 ngā kukune ka pāngia e te holoprosencephaly i te wā tōmua o te kukune (te wiki tuarua me te tuatoru o te hāputanga). Heoi, ko te nuinga o ēnei hāputanga ka mutu ki te materoto, ki te whānautanga mate rānei.

Nō reira, he mate onge te holoprosencephaly i roto i ngā whānautanga ora, e pā ana ki te 1 i roto i te 16,000 whānautanga ora.

He aha ngā tohu o te holoprosencephaly (HPE)?

Nā te mea he rerekē ngā momo holoprosencephaly (HPE), ka rerekē te kaha me ngā tohu. Ko te tikanga he rerekē ēnei tohu i waenga i te tamaiti me te tamaiti.

Ngā tohu noa

Ko ngā tohu noa e pā ana ki te HPE ko:

• Ngā whakaroa whanaketanga.
• Hauātanga hinengaro.
• Te mate haurangi me ngā hopuhopu.
• He iti te māhunga (microcephaly).
• He nui te māhunga (macrocephaly).
• Te nui rawa o te wai e kohia ana i roto i te roro (hydrocephalus).
• Ngā āhuatanga rerekē o te kanohi .
• Ngā rerekētanga o ngā niho (hei tauira, kotahi te kaitapahi niho o waenganui).
• Ngutu ngatata me/ranei te waha whati.
• He uaua ki te whakahaere i te pāmahana o te tinana, te tere o te manawa, me te manawa.
• Te uaua ki te kai.

Ngā Āhuatanga o Alobar HPE

Koinei te momo tino kino, nō reira he kaha ake ngā tohu:

• Kotahi te kanohi (cyclopia), he tata rawa ngā kanohi tetahi ki tetahi (ethmocephaly), kāore rānei he kanohi (anophthalmia).
• He iti rawa ngā karu (microphthalmia) me te ihu rite ki te ngongo (proboscis).
• He ihu papatahi me ngā kanohi piri (ngā ngutu mārō o te taha o te ngutu), he ngutu mārō rānei kei waenganui o te ngutu (ngutu mārō waenga), kei ngā taha e rua rānei (ngutu mārō rua).

Ngā Āhuatanga o Semilobar HPE

• Ngā kanohi e tū tata ana (te hypotelorism orbital), ngā karu iti rawa (microphthalmia), te kanohi kotahi, neke atu rānei (anophthalmia).
• Te whakawhāiti i te piriti me te pito o te ihu.
• Kotahi te pongaponga o te ihu.
• Ngutu mawhatu waenga, ngutu mawhatu rua rānei.
• Te waha whati.

Ngā Āhuatanga o Lobar HPE

Koinei te momo tino kino, engari ka kitea pea ēnei tohu:

• Ngutu mārua rua.
• Te tirohanga tata o ngā kanohi.
• Ihu papatahi, ihu totohu rānei.

Ka taea hoki tēnei āhuatanga, e kiia nei ko te holoprosencephaly, te puta hei wāhanga o ētahi mate ira rerekē. He tohu me ngā tohu motuhake tō ia o ēnei mate.

He aha te take o te holoprosencephaly (HPE)?

I te nuinga o te wā, ka wehea te roro o te kōpū kia rua ngā taha i te tīmatanga o te whanaketanga. Ka puta te Holoprosencephaly (HPE) ina kore e wehea tika te taha o mua o te roro, te prosencephalon, ki ngā taha matau me ngā taha maui. Arā, hei utu mō te taha maui me te taha matau o mua o te roro e tino wehea ana, he hononga rerekē kei waenganui i ngā taha e rua.

Ina koa, ka puta te holoprosencephaly i:

• Ka puta ngā whakarerekētanga ira i roto i te iti rawa 14 ngā ira rerekē .
• Ngā rerekētanga o te ira tangata .
• Ētahi mate ira .

Heoi, i roto i te nuinga o ngā wā, kāore e taea e ngā tākuta te kimi i te tino take.

Ngā whakarerekētanga ira

Ko te whakarerekētanga ira he panoni i te raupapa o tō DNA. Mā tēnei raupapa o te DNA ka hoatu ki ō pūtau ngā mōhiohio e hiahiatia ana e rātou hei mahi i ā rātou mahi. Nō reira, ki te kore e oti, e pakaru rānei tētahi wāhanga o te raupapa o te DNA, tera pea ka pāngia koe e ngā tohu o tētahi mate ira.

Ka taea e te pēpi te whiwhi i tētahi whakarerekētanga ira mai i tētahi, i ngā mātua e rua rānei, i runga i te āhua o te tukunga iho o te whakarerekētanga ira. Heoi anō, ka puta noa mai ētahi whakarerekētanga ira, arā, kāore he hītori o tētahi o te whānau mō te whakarerekētanga ira.

Kua honoa e ngā kaipūtaiao ngā whakarerekētanga ira o ngā ira e whai ake nei ki te mate (HPE):

• `SHH`
• `ONO3`
• `TGIF1`
• `ZIC2`
• `PTCH1`
• `FOXH1`
• `NODAL`
• `CDON`
• `FGF8`
• `GLI2`

Nā ēnei whakarerekētanga ira ka kore e mahi tika ngā ira me ngā pūmua e whakaputaina ana e rātou. Koinei te mea e pā ana ki te whanaketanga o te roro o te kukune, ā, ka puta ai te holoprosencephaly.

Ngā rerekētanga o te ira tangata

E 46 ngā ira ira kei roto i ō tātou pūtau katoa, e 23 ngā takirua. Kei roto i ēnei ira te DNA. He māmā noa iho, kei roto i ēnei ngā tohutohu mō te tipu me te mahi a ō tātou tinana. Kotahi te huinga ira ira ka riro mai i a tātou mai i tō tātou whaea, kotahi te huinga mai i tō tātou pāpā.

Tata ki te kotahi hautoru o ngā pēpi i whānau mai me te holoprosencephaly he rerekētanga ira. Ko te rerekētanga ira e pā ana ki te HPE ko te noho mai o ngā tārua e toru o te ira 13, e mōhiotia ana ko te trisomy 13. Ka taea hoki e te Trisomy 18 (e toru ngā tārua o te ira 18) me te triploidy (te noho mai o ngā ira 69 i roto i te pūtau hei utu mō te 46 noa) te whakararu i te HPE.

Ngā mate ira

I ētahi wā, ka puta te holoprosencephaly hei wāhanga o ētahi mate ira ka puta ai ētahi atu raruraru hauora i tua atu i te HPE.

Ko ētahi o ngā mate ira e pā ana ki te HPE ko:

• `(Te mate Hartsfield)`
• `(Te mate Kallman tuarua)`
• `(Te mate Steinfeld)`
• `(Te mate Smith-Lemli-Opitz)`
• `(Te mate Stromme)`

Me pēhea te tautuhi i te holoprosencephaly (HPE)?

He maha ngā wā ka taea e ngā tākuta te tātaritanga i te holoprosencephaly (HPE), inā koa ngā take kino rawa atu, i mua i te whānautanga o te pēpi, mā te whakamahi i te matawai ultrasound i mua i te whānautanga. Ka taea hoki te tātaritanga i te mate i mua i te whānautanga mā te matawai MRI (Magnetic Resonance Imaging) fetal.

Ahakoa ka taea e ēnei whakamātautau whakaahua i mua i te whānautanga te kite i te HPE, he maha ngā wā ka kitea te HPE i muri i te whānautanga o te pēpi , ina tīmata te puta o ngā rerekētanga o te kanohi, o ngā raruraru pūnaha io rānei. Kātahi ka mahia ngā whakamātautau whakaahua o te upoko hei whakaū i te tautuhi.

Kāore pea e taea te tautuhi i ngā pēpi e pāngia ana e te momo holoprosencephaly tino ngawari tae noa ki te tau te pakeke. I roto i ēnei āhuatanga, ko ngā whakaroa whanaketanga he tohu pea kei te raru pea te pūnaha io. Kātahi ka whakahau ngā tākuta i ngā whakamātautau whakaahua roro.

Ngā whakamātautau tātaritanga

Ka whakamahia e ngā tākuta ngā whakamātautau whakaahua e whai ake nei hei tātaritanga i te holoprosencephaly i muri i te whānautanga o te pēpi:

• Te Ultrasound o te Upoko: Ko te Ultrasound (e kiia ana ko te sonography) he whakamātautau whakaahua kore mamae, kāore e pokanoa e whakamahi ana i ngā ngaru oro auau teitei hei whakaputa whakaahua ora, ataata rānei o ngā kiko pēnei i ngā whekau o roto, ngā uaua toto rānei.
• Matawai roro mā te whakaahua aukume (MRI):He whakamātautau kore mamae anō hoki te matawai MRI. Ka taea e ia te whakaatu i ngā whakaahua tino mārama o ngā hanganga me ngā kiko o te roro o tāu tamaiti. Ka whakamahia e te MRI he aukume nui, he ngaru reo irirangi, me te rorohiko. Kāore e whakamahia he hihi-X (irahiko).
• Matawai rorohiko (CT) o te upoko: He whakamātautau te matawai CT e whakamahi ana i ngā hihi-X me te rorohiko hei hanga i ngā whakaahua toru-ahu (3D) o te wāhanga tinana e tirotirohia ana (i tēnei wā, ko te upoko me te roro o tāu tamaiti).

Mena ka taea, ka whakahaerehia e ngā tākuta ngā rangahau DNA, tae atu ki te tātari ira tangata, ngā whakamātautau cytogenetic me ngā whakamātautau ngota ngota, hei whakatau i te tino pūtake o te HPE.

Mena ka kitea he raruraru ira, he raruraru ira rānei e pā ana ki te holoprosencephaly i roto i ngā whakamātautau ira, ka tūtohu pea tō tākuta kia rapu koe i te tohutohu ira mena kei te whakaaro koe ki te whānau i tētahi atu tamaiti.

He aha ngā maimoatanga mō te holoprosencephaly (HPE)?

Heoi, kāore anō kia kitea he rongoā, he rongoā nui rānei mō te mate holoprosencephaly (HPE) i tēnei wā. Engari, ka rongoāhia ia tamaiti e ngā tākuta ki te HPE i runga i ō rātou tohumate. Ko te tikanga he rerekē ngā kōwhiringa maimoatanga i ia tamaiti, i ia tamaiti.

Tērā pea ka hiahiatia he mahi tahi a tētahi rōpū tohunga rerekē mō tēnei maimoatanga, tae atu ki:

• Ngā Tākuta Tamariki
• Ngā tohunga roro
• Ngā tohunga endocrine
• Ngā taote pokanga kirihou
• Ngā kaiwhakaora mahi me ngā kaiwhakaora tinana
• Rōpū tiaki mamae
• Rōpū tiaki matatini

Ka taea te whakauru atu i ngā tāngata pēnei.

Ngā maimoatanga noa

Anei ētahi o ngā maimoatanga e whakamahia whānuitia ana mō te HPE:

• Ngā rongoā ārai-ohorere hei ārai, hei whakaiti, hei whakahaere rānei i ngā hopukanga.
• Mena he hydrocephalus tō tāu tamaiti, ka taea te rongoā mā te ventriculoperitoneal (VP) shunt.
• Ka taea e ngā rongoā me te whakaora tinana me te whakaora mahi te āwhina i ngā mate nekehanga pērā i te pakari o te uaua (spasticity) me ngā nekehanga koretake (dystonia).
• Pokanga hanga kirihou mō te ngutu ngatata me te waha whati, me ētahi atu āhuatanga kanohi rānei.
• Ngā rongoā hei rongoā i ngā koretake o te taurite o ngā homoni i roto i te repe pituitary.
• Te mahi i ngā mahi hei whakapai ake i te kai a ngā tamariki he uaua ki te whāngai. Hei tauira, te whāngai mā te ngongo ki roto i te puku (ngoipu gastrostomy - ngongo-G).

Ka mahia ēnei mea katoa hei whakarato i te kounga pai rawa atu o te oranga mō te tamaiti.

Ka taea te ārai i te holoprosencephaly (HPE)?

Engari, ka puta te holoprosencephaly (HPE)He maha ngā āhuatanga kāore e taea te ārai. Nā te mea he maha ngā wā ka puta mai i ngā raruraru ira tuku iho "huna". Mena kei te whakaaro koe kia whānau he tamaiti, he mea pai kia kōrero koe ki tō tākuta mō ngā whakamātautau ira kia mārama ai koe ki te tūponotanga o tāu tamaiti ki te pāngia e tētahi āhuatanga ira, ki tētahi whakarerekētanga ira tuku iho rānei, pērā i te HPE.

Heoi anō, kua tautuhia e ngā kaipūtaiao ētahi āhuatanga mōrearea ka piki ake te tūponotanga ka pāngia te tamaiti e te holoprosencephaly. Ko ētahi o ēnei:

• Te mate huka: Mena he mate huka momo 1, momo 2 rānei tōu i mua i tō hapūtanga, tera pea ka nui ake tō tūponotanga ki te whānau tamariki me te HPE. Kaua tēnei e whakapoauau ki te mate huka hapūtanga, e puta ana i te wā e hapū ana.
• Te korenga o te waikawa folic (folate): He mea nui te folic, te momo tūturu o te huaora B9, mō te whanaketanga hauora o te kukune, inā koa te roro me te taurakira. Mā te korenga o te folic i mua atu me te wā e hapu ana ka piki ake te mōrearea o te whānautanga o tētahi pēpi me te HPE.
• Te pānga ki ngā teratogens: Ko ngā teratogens he matū, he āhuatanga rānei e whakararuraru ana i te whanaketanga o te kukune, ā, ka puta he hapa whānau. Mā te pānga ki ngā teratogens, pērā i te etanoru (waipiro), te waikawa retinoic, me ngā mycotoxins (ngā paitini pokepokea ai) mai i te kai, ka piki ake pea te mōrearea o te whānautanga o tētahi pēpi me te holoprosencephaly.

Nō reira, he mea tino nui te whai i te oranga hauora, te kai i te kai taurite, me te whai i ngā tohutohu hauora i te wā e hapu ana, me mua atu hoki i te hapūtanga.

He aha te matapae mō te holoprosencephaly (HPE)?

He rerekē te tirohanga, te matapae rānei, mō te holoprosencephaly (HPE) i runga i te kaha o te mate me te take motuhake.

Ko te tirohanga whānui mō te HPE ngawari ki te kino he kino. He tokoiti noa iho ngā tamariki e ora ana ki te pakeketanga me te HPE ngawari ki te kino. Ko ngā tamariki e ora ana ki te pakeketanga me te HPE ngawari ki te kino, engari he maha tonu ngā wā ka ora rātou me ngā raruraru hauora e pā ana ki te HPE.

He maha ngā tamariki e pāngia ana e te holoprosencephaly e hiahia ana ki ngā rongoā me ngā maimoatanga o ia rā hei ārai i ngā haurangi me te rongoā i ētahi atu raruraru.

Te roanga o te oranga

Ko te roanga o te oranga o te tangata e pāngia ana e te holoprosencephaly (HPE) e whakawhirinaki ana ki te momo HPE e pāngia ana e rātou me te tino take o te mate.

Ko ngā pēpi me te Alobar HPE (te momo tino kino) ka mate i te whānautanga mate, i muri tata mai i te whānautanga, i roto rānei i ngā marama tuatahi e ono o te oranga.

Neke atu i te 50% o ngā tamariki he HPE semilobar, lobar rānei, ā, kāore he mate okana kē atu, ka ora mō te iti rawa 12 marama.

Ko ngā tamariki e pāngia ana e te HPE ngawari ka ora tonu rātou tae noa ki te pakeketanga.

Mena he mate pāwera tō taku pēpi (HPE), he aha ngā mea ka tumanakohia e au?

He mea tino nui tēnei. Kia maumahara kāore e rua ngā tamariki e pāngia ana e te holoprosencephaly (HPE) i te ara kotahi. Kāore he huarahi hei mōhio me pēhea te pānga o tō tamaiti. Ko te mea pai rawa atu ka taea e koe te mahi hei whakarite mō te heke mai ko te kōrero ki ngā tohunga e rangahau ana, e rongoā ana hoki i te holoprosencephaly. Ka taea e rātou te hoatu atu i ētahi atu kōrero mō tēnei.

Me pēhea taku tiaki i taku pēpi me te holoprosencephaly (HPE)?

Hei āwhina i te tiaki i tāu tamaiti me te holoprosencephaly (HPE), whai i ēnei tohutohu a ā rātou tākuta:

• Hoatu ngā rongoā kua tohua kia rite ki ngā tohutohu.
• Tirohia mō ngā aromatawai whanaketanga me ngā maimoatanga.
• Me whakarite kia tae atu koe ki ngā haerenga hauora katoa e whai ake nei.

Ka pā mai pea ngā raruraru hinengaro, pūnaha io, me/ranei ngā raruraru nekeneke i te holoprosencephaly. He maha ngā tamariki whai HPE he raruraru whanaketanga ā rātou, ā, me āwhina pea rātou ki ngā mahi o ia rā puta noa i ō rātou oranga.

Ka taea e te tīma hauora o tāu tamaiti te whakautu i ō pātai me te tautoko i a koe. Ka taea hoki e rātou te tohutohu i a koe ki ngā rōpū tautoko i tō rohe, i te ipurangi rānei. Kia maumahara kāore koe i te mokemoke.

Āhea ahau me toro atu ki te tākuta o taku tamaiti?

Mena kua tāpaetia tāu tamaiti ki te mate holoprosencephaly (HPE), me toro atu ia ki tā rātou tīma hauora i ia wā, kia mōhio ai kei te whai hua tā rātou maimoatanga, kia aromatawai hoki i tōna ahunga whakamua whanaketanga.

He uaua ki te whakatau kei te pāngia tō pēpi e te holoprosencephaly. Engari kia mōhio koe ehara i te mea ko koe anake. He maha ngā rauemi e wātea ana hei āwhina i a koe me tō whānau. He mea nui kia kōrero koe ki tētahi tākuta e mōhio ana ki tēnei mate. Mā tēnei koe e āwhina ki te ako atu mō te pānga o tō pēpi me pēhea te whakarite mōna.

Hei whakamutunga, ngā mea hei maumahara (Karere hei tango ki te kāinga)

He hapa whānau uaua te Holoprosencephaly (HPE) e puta ana ina kore e wehea tika te roro o te pēpi kia rua ngā taha i roto i te kōpū.

• He rerekē ngā momo me ngā taumata o te kaha , nō reira he rerekē ngā tohu i ia tamaiti, i ia tamaiti.
• He maha ngā wā ka uru mai ngā take ira me ngā rerekētanga o te ira tangata , engari i ētahi wā kāore e taea te kimi i te pūtake.
• Ahakoa ka taea te kite i mua i te whānautanga mā te whakamahi i te ultrasound, te MRI rānei, he maha ngā wā ka kitea i muri i te whānautanga.
• Kāore he rongoā motuhake , engari he maha ngā maimoatanga hei whakahaere i ngā tohu me te tautoko i te tamaiti.
• Ka rerekē te āhua o te mate i runga i te kaha o te mate. I ngā mate ngawari, ka ora pea ngā tamariki tae noa ki te pakeketanga.
• Mena kei te hapu koe, kei te whakaaro rānei kia hapu, kia tūpato ki ngā mea pēnei i te whakahaere i tō mate huka me te tango waikawa folic.
• Kāore koe i te mokemoke i tēnei āhuatanga. Ka taea e koe te tiki āwhina mai i ngā tākuta, i ngā kaiwhakatakoto whakaaro, me ngā rōpū tautoko. He mea tino nui ngā mōhiohio me te tautoko tika.

` Holoprosencephaly, HPE, mate roro, whānautanga hapa, whanaketanga o te kukune, mate ira, rerekētanga o te ira tangata, hauora hāputanga, hauora tamaiti