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10 headshots of men and women

The Health Research Council has awarded seven Otago projects a total of $12.2 million in funding.

Lung cancer is the greatest single cancer contributor to the life expectancy gap between Māori and non-Māori. University of Otago researchers are hoping to change that.

Since 2018, they have been working on joint research projects with Health New Zealand | Te Whatu Ora. Collectively called Te Oranga Pūkahukahu, the projects are focused on providing information to inform the development of an effective, equitable lung cancer screening pathway that could be introduced in Aotearoa New Zealand.

Te Oranga Pūkahukahu has just received a $5 million funding boost from the Health Research Council.

It is one of seven programme and project grants, worth a total of $12.2 million, that have been announced for Otago in the latest HRC Projects and Programmes funding rounds.

Study lead Professor Sue Crengle (Kāi Tahu, Kāti Māmoe, Waitaha), Co-Director of Otago’s Ngāi Tahu Māori Health Research Unit, says the team is “super-excited” to receive the funding.

“We are all really committed to this research and really want to design a lung cancer screening programme that works for those that most need it.

“Lung cancer is the leading cause of death for Māori women in Aotearoa New Zealand and the second leading cause of death for Māori and non-Māori men. Screening enables the disease to be diagnosed at an early stage, reducing lung cancer deaths by 20 to 26 per cent,” she says.

This funding will, among other things, enable researchers to investigate using a biomarker to improve lung cancer risk prediction, and the use of artificial intelligence (AI) in screening.

“We only offer lung cancer screening to people considered to be at high risk of developing lung cancer, but predicting this risk relies heavily on people’s recall of their personal tobacco use over their lifetime.

“The biomarker we are looking at is known to be an accurate marker for tobacco exposure – both personal tobacco use and second hand smoke exposure – and is associated with cardiovascular disease outcomes. We are looking to see if it improves the accuracy of risk prediction for use in lung cancer screening,” Professor Crengle says.

The AI project will seek views of community members and health professionals on using the technology to read scans, alongside a human radiologist. Māori and European CT scans will also be compared to see if there are any differences in lung tissue which may bias AI models.

Health NZ has a longstanding collaborative relationship through Te Oranga Pūkahukahu, and is continuing to support this next phase of the research programme. The programme includes undertaking a second round of scans for participants in earlier trials, and undertaking screening in a rural setting in the Manawatū with support of the local Iwi Māori Partnership Board.

Director of Health Equity at Health New Zealand Dr Karen Bartholomew says this programme grant is designed to directly inform planning for a national lung cancer screening programme.

“The work draws on high profile national and international expertise, and puts New Zealand at the forefront of screening innovation focused on equitable outcomes.”

Otago’s Deputy Vice-Chancellor (Research and Enterprise) Professor Richard Blaikie says it is fantastic to see such critical research being funded.

“Otago has world-leading researchers, carrying out work which benefits New Zealanders across their life course – this programme and all the other grants announced are testament to that.

“I am also pleased to see exceptionally talented emerging researchers receiving recognition for their work, alongside established research leaders – I look forward to following all of them with interest,” Professor Blaikie says.

five headshots of men and women

Top row, on the left, is Dr Jerram Bateman and Dr Rebbecca Lilley. Bottom row, from left, is Dr Rosemary Brown, Dr Ken Taiapa and Dr Christina McKercher.

Projects grant recipients:

Returning to productive life and work: an investigation of the impacts of cancer

Dr Jerram Bateman, Department of Preventive & Social Medicine (Dunedin School of Medicine)

36 months, $1,193,292

This research aims to investigate how cancer impacts the productivity of survivors, and identify ways to better support survivors in their return to work and other productive activities. The study will be conducted in three phases, over three years, and will use a mixed-methods approach. The first phase will focus on establishing relationships with relevant stakeholders, while the second phase will examine the current situation for cancer survivors returning to work and productive activities, including investigating gaps in supportive care provision, the economic impact of cancer, and the experience of employers, unions, and insurers. The third and final phase will use the findings from the first two phases to develop a strategy for disseminating the research and improving the support available to cancer survivors. The study will take a Māori-centred approach and use the Meihana Model to ensure a holistic understanding of the issues facing cancer survivors in New Zealand.

Exploring the mental health impacts of climate change on kai sovereignty

Dr Ken Taiapa, Department of Preventive & Social Medicine (Dunedin School of Medicine) and Dr Christina McKerchar, Department of Population Health (UoO Christchurch) 

36 months, $1,199,912

Global climate change will undermine public health initiatives and outcomes at population levels and the ability to grow and gather food is a critical dimension of this challenge. Weather instability, rising temperatures, ocean acidification, extreme droughts, and floods have and will continue to apply pressure on humanity’s ability to survive on planet earth (Willett et al., 2019). Internationally, climate and eco-anxiety, the distress caused by ecological crises, is increasingly recognised as a key driver of mental and emotional distress (Hickman et al., 2021) especially for Indigenous groups among whom impacts on mental health are direct, indirect and cumulative. Immediate effects change environments and lifeways toward unsustainability, exacerbating existing vulnerabilities with losses related to food insecurity, culture, place and socio-economic disadvantages (Vecchio et al., 2022). This research will explore the intersection between climate change, food security/sovereignty, and mental health along State Highway 35 in the Eastern Bay of Plenty/Te Tairāwhiti regions.

From health crisis to balance: Evaluation of a national Falls Prevention Pathway

Dr Rebbecca Lilley, Department of Preventive & Social Medicine (Dunedin School of Medicine)

36 months, $1,199,894

As our population ages rapidly, falls in community dwelling older persons, already highly prevalent, are expected to dramatically increase demand on New Zealand’s Emergency Medical Services (EMS). While non-transported fall-related calls can limit EMS resources available to respond to higher need cases, it can also present an opportunity for EMS referral pathways to preventive programmes, such as evidence-based Strength and Balance classes known to reduce the likelihood of falls in the community. This cohort study will evaluate the clinical and cost efficacy of a pilot EMS referred Falls

Prevention Pathway (FPP) with a uncertain future funding status. The evaluation will consider aspects of access, efficacy, acceptability and equity of the FPP for all vulnerable groups. Findings will influence future investments in EMS referred FFP and improvements in a new model of service delivery.

Protecting Mum: hormone-driven neural plasticity to regulate mood and behaviour

Dr Rosemary Brown, Department of Physiology (School of Biomedical Sciences)

36 months, $1,199,922

Healthy growth and development of new-born infants requires significant investment in caregiving by mothers. However, transition into motherhood is difficult for many women with maternal mood disorders affecting 14 per cent of new mothers in Aotearoa New Zealand. We have previously reported that action of the hormone prolactin in the brain is critical for caregiving behaviour following birth. We have also found increased activity of prolactin in the medial amygdala, a brain region key in regulating mood and emotion. We hypothesise that prolactin action in the medial amygdala is required for postpartum maternal behaviour. Here we will examine how prolactin acts in the medial amygdala to alter activity of critical neurons to bring about appropriate changes in the behaviour of mothers. We will also test whether maternal behaviour can be restored in an animal model of postpartum mood disorder through targeted activation of prolactin-sensitive neurons in the medial amygdala.

Five headshots of men and women

Top row, on the left, is Dr Karyn Maclennan and Dr Megan Leask. Bottom row, from left, is Associate Professor Andrew Waa, Lani Teddy and Professor Sue Crengle.

Te Hao Hou: Rangatahi Maori experiences and perceptions of smoking and vaping

Associate Professor Andrew Waa and Lani Teddy, Department of Public Health (UoO Wellington), and Dr Karyn Maclennan, Ngāi Tahu Māori Health Research Unit, 36 months, $1,199,950

There is rising concern about burgeoning vaping rates among rangatahi, in particular rangatahi Māori. To date Government policies have tended to reflect the needs of people who smoke but have done little to address risk of rangatahi taking up vapes. This reflects a Western biomedical perspective on harm and overlooks more holistic perspectives advocated by Māori, often by rangatahi Māori themselves. This project will apply a mixed methods approach that creates a platform for rangatahi Māori voices, repeatedly surveys form year cohorts of secondary school aged rangatahi, and conducts in-depth interviews with rangatahi Maori over a three-year period.

Translational 'omics of the hidden genome for equitable precision medicine

Dr Megan Leask, Department of Physiology (School of Biomedical Sciences)

36 months, $1,199,988

Cardiometabolic diseases (e.g., type 2 diabetes, chronic kidney disease and gout) are increasing in prevalence worldwide at an alarming rate. A precision medicine approach to tackling metabolic disease, informed by an individual’s genetics, promises to save lives, improve quality of life and lower medical costs. However, for Māori and Pacific people there is a critical need to expand the development of genetic resources and analyses, and build genetics capabilities in Aotearoa if these groups are to receive equal medical care in the future. In this study, we aim to reduce the precision medicine gap for Māori and Pacific people by applying large data techniques to genetic data from Māori and Pacific individuals, and identify unique genetics that can be targeted in the treatment and prevention of metabolic diseases.

Programmes grant recipients:

Te Oranga Pūkahukahu: Future directions for lung cancer screening in Aotearoa

Professor Sue Crengle, Ngāi Tahu Māori Health Research Unit

54 months, $4,999,898

Lung cancer is the second leading cause of death for non-Māori and for Māori men. It is the leading cause of death for Māori women. Lung cancer screening using a low dose CT scan reduces lung cancer deaths by 20-26 per cent. The proposed programme will add to an existing research programme (Te Oranga Pūkahukahu) that has the goal of designing a lung cancer screening programme that is equitable, effective, and acceptable especially for Māori who experience significant inequities in lung cancer mortality. The proposed projects will provide new information about improving lung cancer risk prediction using a biomarker, second rounds of CT scans, the role that Māori providers can play in lung cancer screening and the use of artificial intelligence (AI) in lung cancer screening. The information obtained from the programme will be used to design and implement a national lung cancer screening programme.

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