A Pacific approach to investigating Pacific tertiary students’ understandings of sexual and reproductive well-being

CD Young,[[1]] M Taumoepeau,[[2]] JE Girling,[[1]] BE Hohmann-Marriott,[[3]] RJ Bird[[1]]

[[1]]Department of Anatomy, [[2]]Department of Psychology, [[3]]Schools of Sociology, Gender Studies and Criminology, University of Otago, Dunedin

The Pacific peoples are the fastest growing population in Aotearoa New Zealand. Historically sexuality education has fallen short of incorporating Pacific cultural perspectives and worldviews. Contemporary efforts to recognise the uniqueness of Pacific Aotearoa has brought rise to strategic frameworks, such as the Pasifika Education Plan and Tapasā Cultural Competencies Framework. These strategies fail to address the shame and discomfort Pacific communities feel around these health topics.

With a Pacific approach, we investigated Pacific students’ understandings of sexual and reproductive well-being. Students at the University of Otago in 2020 who identified as Pacific Islanders were invited to participate. This research employed an exploratory mixed method approach directed by the Kakala research model and talanoa (discussion) methodology. Cultural advisory groups supported the development of an online survey using REDCap software. Talanoa interviews enriched the findings of the survey and were thematically coded and analyzed through Nvivo software.

Participants (n = 82) ranged in age (mean = 22.85 yrs), genders (4), disciplines (4) and ethnic groups (20). Some participants displayed broad and holistic understandings of general health and well-being, acknowledging the complex factors contributing to an individual’s state of being. Some participants struggled to differentiate the distinct topics of sexual and reproductive well-being. Participants expressed the primary origins of their knowledge to be from peers and family/community members. Participants stated that formal sexuality education often had detrimental effects to their understandings of well-being.

Contemporary perceptions of contraception, venereal diseases and sexual identity clash with traditional cultural perceptions of these topics. Through a strengths-based lens, this data informs changes required for current teaching practices to be culturally responsible. These recommendations are presented in an effort to form culturally effective policies within the Department of Anatomy at the University of Otago; a university within the Pacific region.

Funded by the School of Biomedical Sciences.

Using fluorescence-activated cell sorting to characterise drug-tolerant A375 melanoma populations

K Elgar, C J Drummond, G Reid

Department of Pathology, Otago School of Medical Sciences, University of Otago, Dunedin

Cancer drug resistance was long believed to arise from pre-existing mutations that allow rare tumour cells to survive. Increasing evidence suggests a non-genetic component provides reversible advantages to a small, rare subpopulation of tolerant cells. Examining tolerant cell populations for markers of cellular plasticity could tell us whether these survival mechanisms already exist within tolerant cells or whether they can be induced using targeted therapies.

This project aimed to characterise vemurafenib-tolerant subpopulations in the A375 melanoma cell line. Using fluorescence-activated cell sorting we divided cells into groups based on expression of rare markers—AXL, CD36, NGFR and MART-1—selected to represent the four different cell populations observed in drug-tolerant melanoma. These markers are highly expressed on the cell surface making them ideal targets for cell sorting. Differences were analysed in untreated cells and drug-tolerant cells surviving vemurafenib treatment. Pluripotency factors were analysed using real-time PCR.

Both NGFR (64.3%) and AXL (91.6%) had substantial numbers of positive cells in the untreated population. NGFR+ cells increased with treatment to 96.0% while AXL decreased (19.6%). MART-1 remained unchanged with treatment (4.49% in untreated populations and 3.14% in treated populations) while CD36+ cells were low in untreated populations (2.74%) and increased dramatically with treatment to 48.4%. Further experiments are required to confirm these preliminary data. Analysis of pluripotency markers showed that relative to the untreated control, levels of OCT3/4 and NANOG increased by 25-fold (P < 0.0001) and 50-fold (P < 0.05), respectively.

Our FACS results identified clear differences in treated and untreated populations for three out of the four markers used. We also found distinct differences in how subpopulations change with treatment. This suggests that while the tolerant cells display a baseline level of pre-existing plasticity, external cues such as vemurafenib can induce additional expression of key markers that facilitate survival.

Supported by a scholarship from the Otago Medical School.

The Public Health Unit role in managing COVID-19: a Nelson Marlborough DHB Public Health Unit case study

PR Sutherland, KC Morgaine, S Derrett

Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin

The emergence of COVID-19 as a global pandemic in 2020 provided immense challenges to Public Health Units (PHUs) across New Zealand. PHUs were tasked with identifying COVID-19 cases, tracing their contacts, and managing quarantine and isolation for those with COVID-19. This qualitative case study aimed to investigate the delivery of public health services in the high intensity COVID-19 pandemic situation in the Nelson Marlborough District Health Board (NMDHB) to identify good practice and areas for possible future improvement.

Data were collected through semi-structured interviews (N=13 key informants) and from NMDHB documents; analysed according to Donabedian’s Quality of Care framework. Key informants were purposively sampled for their roles in managing COVID-19 within the NMDHB. During the interviews, participants were asked to describe their experiences and perceptions of the COVID-19 response. Interviews were recorded and transcribed. Interview and documentary data were analysed thematically by the first author and reviewed jointly by the research team for confirmation.

Participants identified consistency with the PHU’s Operational Plan and the national Coordinated Incident Management System, formal training sessions, preparedness to work remotely, frequent external communication and cultural adaptation of the case investigation template as strengths of the response to COVID-19. Limitations arose from the need to train colleagues shifting into pandemic management roles while remaining responsible for their own work, and unclear or inconsistent internal communication channels.

Increased training and clear channels of internal communication were identified as two priority areas for improvement within the NMDHB PHU. Focusing on these areas is recommended to increase future preparedness and efficiency of PHUs responding to COVID-19 and future pandemics.

Supported by the Otago Medical School Summer Research Scholarship.

Accuracy and clinical impact of point-of-care cardiac ultrasound in the emergency department: a retrospective cohort study

H Aziz Shamri, S Beck, G Whalley

Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin

There is a lack of evidence regarding how point-of-care ultrasound (POCUS) is used in patient management in New Zealand emergency departments (EDs). This study aimed to assess the diagnostic performance and utilisation of cardiac POCUS in the Dunedin ED.

We analysed 211 cardiac POCUS scans performed in Dunedin ED between October 2019 and May 2020 after excluding single view cardiac examinations performed as part of FAST (Focused Assessment with Sonography for Trauma), patients under 16 years of age, missing identifier and demographic data. Pericardial effusion, left ventricular systolic dysfunction (LVSD), right ventricular systolic dysfunction (RVSD) and right ventricular (RV) dilation were investigated. An expert echocardiographer and ED ultrasound expert independently reviewed the scans. Cohen’s Kappa analysis demonstrated almost perfect agreement for pericardial effusion (κ = 0.88), substantial agreement for LVSD (κ = 0.76) and moderate agreement for RVSD (κ = 0.58) and RV dilation (κ = 0.53).

One-third of the scans were undocumented (33.2%). The scans were mostly suboptimal (ie, only basic interpretation is possible) or poor quality (ie meaningful interpretation was not permittable) for the five cardiac views parasternal long axis (PLAX), parasternal short axis (PSAX), apical four chamber (A4C), subcostal (SC) and inferior vena cava (IVC). Sensitivity for pericardial effusion was low compared to expert echocardiographer (66.7%, 95% CI 22.2–95.7) and ED ultrasound expert reviews (83.3%, 95% CI 35.9–99.6). Specificity for pericardial effusion was high compared to expert echocardiographer (86.7%, 95% CI 76.8–93.4) and ED ultrasound expert reviews (88.2%, 95% CI 79.8–93.9). A similar trend was observed for LVSD, RVSD and RV dilation. Common technical errors identified were off-axis structures, artifacts and inappropriate depth.

A formalised credentialed training pathway is recommended to ensure clinicians are capable of using POCUS accurately and reporting all findings in accordance with the Australasian College of Emergency Medicine guidelines.

Supported by Division of Health Sciences Summer Research Scholarship, University of Otago.

Te taha hinengaro ki Waitaki: mental distress and wellbeing service provision in the Waitaki District

HJ Coulter,[[1]] JM Ross,[[1]] S Nada-Raja[[2]]

[[1]]Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin. [[2]]Centre for Pacific Health, Va’a o Tautai, Health Sciences Division, University of Otago, Dunedin

A community approach to researching services is important in understanding mental health in small population centres. This study aimed to assess the availability of mental health and wellness services in the Waitaki District, assess the impact of COVID-19 locally and assess interest in a form of training for non-professional staff. Extensive consultation with relevant stakeholders, conducted prior to fieldwork, allowed the team to incorporate an element of co-design into the study protocol.

A purposive sample of 28 mental health service providers was interviewed between November 2020 and January 2021 using a semi-structured schedule. Interviews were recorded, transcribed, and analysed using a General Inductive approach. Analysis was conducted by the first author and reviewed by the research team.

Results showed that participants identified benefits in a close-knit community and in existing well-organised networks of providers, which were generally effective in providing opportunities for sharing developments in services. Most of the providers expressed frustration at over-stretched secondary care services and primary health counselling, and suggested increased funding. Specific services for several groups, including Māori, the large Pasifika communities, children and youth, and more remotely located people, were identified as insufficient. The COVID-19 pandemic has led to both increases and decreases in demand for different services during varying Alert Levels.

This project provides the Waitaki community with a snapshot of their services as they are seen by local providers and the team is offering to speak to local groups, as well as planning further mental health research based in this community, given the relationships we have now developed locally. This research can also be used to add to growing knowledge about the way Aotearoa’s smaller communities care for their members.

Supported by an Otago Medical School Summer Research Scholarship.

Cannabis and small airway function in mid-adult life

HS Tan,[[1]] RJ Hancox,[[1]] HM McAnally,[[1]] J Dummer[[2]]

[[1]]Department of Preventive and Social Medicine, [[2]]Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin

Cannabis is one of the most widely used recreational drugs world-wide. Despite the high prevalence of cannabis use, we do not understand the potential impact it has on respiratory health. Previous studies have shown that cannabis smoking affects the lungs, although the effects appear to be different to tobacco. The long-term effects of cannabis smoking on small airways remain unclear. This study aimed to investigate the effects of cannabis smoking on small airway function in an adult population at age 45 years.

We determined the association between how much cannabis participants have smoked in joint-years and their small airway function measured by impulse oscillometry (IOS) parameters at 45 years in the Dunedin Multidisciplinary Health and Development Study (a cohort of 1037 individuals born in 1972/1973). Three individuals with IOS values more than 5 SDs from the mean were excluded. The IOS parameters R5,R20,R5-R20 capture airway resistance while AX,X5 and Fres reflect lung reactance. The parameters R5,R20,R5-R20,AX and Fres were transformed using natural logarithms to achieve parametric distributions. Analyses for IOS measures were performed using multiple linear regression models that adjusted for tobacco pack-years, BMI, and height.

The findings indicate that cannabis smoking was significantly associated with pre-bronchodilator R5-R20, R5, X5, AX and Fres but was not associated with R20. This suggests that cannabis smoking is associated with small airway dysfunction at 45.

Cannabis smoking is associated with changes in small airway function at age 45 and the findings indicate that peripheral airway function needs to be considered when assessing the impact of cannabis exposure on pulmonary physiology.

Supported by a Summer studentship funded by the Department of Preventive & Social Medicine, Dunedin School of Medicine.

Estrogen deprivation prolongs the sexual refractory period and dampens the Coolidge effect in male rats

JM Mainwaring, E Wibowo

Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin.

Estrogen is involved in normal male sexual function. Here, we explored estrogen’s role on both the sexual refractory period (ie, the time when males cannot be sexually aroused after an ejaculation) and the Coolidge effect (ie, a shortening of the refractory period when a novel sexual partner is introduced after ejaculation) in male rats. This research may be relevant to estrogen-deprived men such as those with natural cause (due to genetic or hormonal conditions) or due to various treatments (eg, cancer treatment).

Sexually experienced adult male rats were assigned to a daily treatment of either saline (7 rats, control group) or a drug that blocks estrogen production (fadrozole dissolved in saline, 1mg/kg/day, 8 rats, estrogen-deprived group). After 29 days, they were mated with a female until sexual satiety (no longer showing ejaculation) was reached, and then a novel female replaced the first.

With the first female, the refractory period after the first ejaculation was longer in the estrogen-deprived group (median = 688.74 (interquartile range = 497.53) s) than in the control group (262.52 (25.87) s) (U = 6.00, P < .05). However, the time to reach sexual satiety was shorter in the estrogen-deprived (892.33 ± 647.71 s) rats compared to a control (3480.13 ± 670.10 s, t(11) = 7.047, P < .001). Coincidentally, the total number of ejaculations was fewer in the estrogen-deprived (1.25 ± 1.04) group than the control group (5.71± 1.60, t(13) = 6.495, P < .001).

Following introduction of the second female, the Coolidge effect occurred in both groups at the same rate. However, the proportion of rats displaying ejaculation with the novel female was higher in the control group (71.4%) than the estrogen-deprived group (12.5%) (χ[[2]](1) = 5.402, P < .05).

Overall, estrogen contributes to the regulation of the refractory period and to a lesser extent, the Coolidge effect. Our findings provide further evidence on the role of estrogen in male sexual refractory period, and that estrogen supplementation may potentially help maintain sexual activity in hormone-deprived males.

The Summer Studentship was supported by the Elspeth Gold Men’s Health Fund.

Effects of Seneca Valley virus with clinically available chemotherapeutic drugs on 3D tumour-like cell cultures of BT549 triple negative breast cancer cells

E Watanabe, L Burga

Department of Medicine, Department of Microbiology and Immunology, University of Otago, Dunedin

Triple negative breast cancer (TNBC) makes up approximately 15%–20% of all breast cancers. There is currently no targeted therapy against TNBC. Oncolytic virotherapy, the use of viruses to eliminate cancer cells, is a promising strategy for targeted cancer therapy. Seneca Valley virus (SVV), a novel oncolytic virus, shows high affinity for tumours and no affinity for healthy tissue. The cellular receptor responsible for this affinity is anthrax toxin receptor 1 (ANTXR1) also known as tumour endothelial marker 8 (TEM8). TEM8 is present in over 60% of human solid cancers including TNBC and absent in healthy tissue. Clinical trials of SVV as a monotherapy have proven the safety of the treatment but yielded inconclusive results of therapeutic efficacy.

This study explored combination therapies of SVV and three clinically approved drugs (Filgotinib, RAD001, and SAHA) on tumour-like 3D cell cultures (tumourspheres) of a TNBC cell line (BT549) that showed resistance to SVV in 2D attached culture. BT549 tumourspheres were grown and treated with SVV only and combinations of SVV with one of Filgotinib, RAD001, and SAHA. After five days, cell viability was measured using an ATP bioluminescence assay.

There was significant reduction in cell viability across all condition groups (SVV only, drug only and SVV-drug combinations) when compared to the control. A reduction in cell viability of 62.6% (±7.2%) was observed in the SVV only treated group. The most potent combination therapy was SVV with Filgotinib which yielded a reduction in cell viability of 74.9% (±1.6%).

The susceptibility of BT549 tumourspheres to SVV suggested by the data provides strong grounds for progression into testing of SVV on tumours in animal models. The efficacy of SVV-drug combination therapies showed promise but requires further investigation to distinguish whether the effects were a product of mechanistic SVV-drug symbiosis or simple cumulative effects of concurrent SVV and drug treatment.

Supported by a scholarship from the Department of Microbiology and Immunology, Otago University, Dunedin.