Tuwhera Research Repository

The Tuwhera Research Repository provides sustainable open access and archiving to a broad range of AUT produced research - theses, research outputs and datasets.

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Access status: Open Access ,
Harnessing Routinely Collected Health Data for Global Monitoring of Stroke: Roadmap and Vision For INSPIRE-STROKE
(Karger Publishers, 2025-10-06) Dalli, Lachlan L; Olaiya, Muideen T; Yu, Amy YX; Reeves, Mathew J; Cadilhac, Dominique A; Nedkoff, Lee; Feigin, Valery; Norrving, Bo; Kapral, Moira K; Whiteley, William; Schott, Anne-Marie; Ferrari, Julia; Christensen, Hanne; Mac Grory, Brian; Smith, Eric E; Béjot, Yannick; Vyas, Manav; Mishra, Nishant K; Park, Jong-Moo; Hill, Michael D; Benne-Christensent, Christine; Gall, Seana L; Kilkenny, Monique F; INSPIRE-STROKE collaborators
INTRODUCTION: Sustainable and low-cost data systems for national and global surveillance of stroke are urgently needed to address the growing burden of stroke. Routinely collected health data (including registries and administrative data) are proliferating at a rapid pace, offering promise for systematic and enduring global stroke surveillance. However, several challenges exist in utilising these routinely collected data from across the globe for global stroke surveillance, such as non-standardised definitions and coding, missingness of data, and lack of transparent or reproducible methods. We aim to describe the vision and methods for a new global collaboration to leverage and harmonise population-level health data for global stroke surveillance. METHODS: The International Network for Standardised Population Insights and Real-world Evidence for STROKE (INSPIRE-STROKE) was established in October 2023 and currently includes 39 collaborators from 16 countries. The vision of INSPIRE-STROKE is to develop new methods that will harmonise and combine health databases across the world to facilitate reliable and robust multi-country stroke surveillance. Through this scientific community, we are initially collaborating to 1) summarise existing methods for calculating and reporting measures of post-stroke outcomes using routinely collected health data; 2) develop consensus-based standards for analysing routinely collected health data on post-stroke outcomes; and 3) conduct proof-of-concept studies to align variables/definitions in routinely collected health data and create standardised statistical code to measure post-stroke outcomes (e.g., medication adherence, readmissions, and mortality) according to consensus-based definitions. CONCLUSION: INSPIRE-STROKE will support more reliable investigations into country-level trends in stroke incidence and outcomes, by leveraging routinely collected health data at a global scale. The large and diverse data compiled for INSPIRE-STROKE could facilitate exploration of rare stroke outcomes, particularly among under-represented groups (e.g., pregnant women, children). INSPIRE-STROKE will strengthen health policy and resource planning by providing high-quality evidence to improve access to stroke care and maximise patient outcomes.
Access status: Open Access ,
Proton Pump Inhibitor Co-prescription, Dabigatran Use, and Ischaemic Stroke or Transient Ischaemic Attack in Atrial Fibrillation: A Population-Based Case-Control Study
(Springer, 2026-10-03) Mahawish, Karim M.; Feigin, Valery; White, Harvey; Krishnamurthi, Rita
Background and Objectives: Proton pump inhibitors (PPIs) reduce gastric acidity and lower dabigatran plasma concentrations, raising concern about a clinically relevant drug–drug interaction. We examined whether PPI co-prescription modified the association between dabigatran use and atrial fibrillation (AF)-associated ischaemic stroke (IS) or transient ischaemic attack (TIA). Methods: We conducted a population-based case-control study of adults with AF in Auckland, New Zealand. Cases were patients with adjudicated IS/TIA between September 2020 and August 2021 identified from the fifth Auckland Regional Community Stroke Study, which uses multiple overlapping ascertainment sources and independent clinical adjudication. Controls were patients with AF from the same source population who remained free of IS/TIA during the surveillance period, sampled from the Ministry of Health National Minimum Dataset. Individual-level demographics, comorbidities and medication exposures were obtained from electronic clinical records and dispensing data. Multivariable logistic regression included dabigatran use, PPI use and their interaction term, with adjustment for pre-specified clinical covariates. Results: The analytic sample comprised 300 IS/TIA cases and 1,608 controls. Dabigatran use was associated with lower odds of IS/TIA (adjusted odds ratio [aOR] 0.36 [95%CI 0.24–0.53]). PPI use was associated with higher odds of IS/TIA (aOR 1.55 [95%CI 1.08–2.24]), but this association is likely subject to residual confounding and should not be interpreted as causal. The dabigatran × PPI interaction was not statistically significant (aOR 0.98 [95%CI 0.57–1.69]; p = 0.94). Conclusion: We found no evidence of a large dabigatran-specific interaction with PPI co-prescription. These findings do not support a major clinically important attenuation of dabigatran’s association with lower odds of AF-associated IS/TIA, although modest effect modification cannot be excluded. Generalisability to lower-risk primary-care AF populations and healthcare systems with different patient characteristics may be limited.
Access status: Open Access ,
Effects of Edible Insect Enrichment of Meat-Based and Meat Analogue Products on the Nutritional Composition, Techno-Functional Properties, and Acceptability to Consumers: A Systematic Review
(MDPI AG, 2026-07-01) Amoah, Isaac; Lombardo, Mauro; Diako, Charles; Adjei-Boamah, Comfort; Adu Sarpong, Vanessa; Rush, Elaine
BACKGROUND: Meat-based and meat analogue products are commonly consumed foods for protein nourishment across the globe. These food products are promising carrier media that can be targeted for the delivery of edible insect products as a strategy to overcome food neophobia. This systematic review aimed to evaluate the effect of edible insect enrichment on the nutritional, physicochemical, techno-functional, and acceptability of meat-based and meat analogue products for consumers. METHODS: A systematic search for relevant articles was conducted on the databases PubMed, ScienceDirect, and Scopus on 5 November 2025. A total of 25 papers were included. RESULTS: Edible insects and larvae from mealworms, crickets, grasshoppers, silkworm pupae, and superworms were commonly used to enrich meat-based and meat analogue products. Commonly reported meat products were sausages from pork and beef, pork patties, meat emulsion, and frankfurters. Soya flour was commonly used for meat analogue formulation. CONCLUSIONS: Acceptable edible insect incorporation is matrix-dependent, with conventional meat products generally tolerating low substitution levels (≈2.5-10%) before sensory and structural quality declines, whereas meat analogue systems can accommodate substantially higher inclusion (≈10-40% and, in some cases, up to ~60%). However, heterogeneity in formulations and sensory evaluation methods restricts direct comparison across studies.
Access status: Open Access ,
Targeting Bakery Products for Dysphagia, Sarcopenia and Protein Malnutrition Management in Older Adults: A Systematic Review
(Springer Science and Business Media LLC, 2026-07-06) Amoah, Isaac; Adu Sarpong, Vanessa; Adjei-Boamah, Comfort; Tawiah, Phyllis; Lombardo, Mauro; Rush, Elaine
Bakery products including bread, cookies, biscuits and cake are commonly consumed staples across the life course. They can therefore be targeted for enrichment with protein-rich ingredients which may enhance their textural properties and address age-related nutritional challenges such as dysphagia, sarcopenia, and protein malnutrition in older adults. This systematic review aimed to highlight current advances in the use of bakery products formulated with protein and texture-modulating ingredients as potential vehicles to deliver protein and address age-related nutritional challenges in older adults. A systematic search for relevant articles was conducted on the databases PubMed, Scopus, ScienceDirect and Cochrane Library up to October 01, 2025. Fourteen papers (n = 14) investigated the ease of chew and swallow in older adults. The most frequently reported vehicle was bread (n = 9). Commonly used ingredients for enrichment of the bakery products included soy protein isolate, whey protein isolate, soybean soluble polysaccharide, drum-dried pumpkin flour, inulin, sacha inchi seed cake and chicken protein powder. Most enriching ingredients were good sources of protein. Incorporation into the bakery products resulted in reduction of hardness and improved the subjective ease of chew and swallow. Enriching bread with protein-rich ingredients resulted in a significant increase in the protein intake of older adults. Recipe reformulation, through controlled inclusion of protein isolates, hydrocolloids, vegetable flours, or dietary fibers, can enhance the nutritional value, improve the textural properties and ingestion of bakery products and could address protein malnutrition in older adults. Future studies should explore the use of other underutilized protein-rich ingredients for bakery product reformulation.
Access status: Open Access ,
The Upside of Mess: Conceptualising (Dis)order as a Dynamic Family Resource
(Elsevier, 2026-10-16) Abarashi, Jamal; Edirisingha, Prabash; Errmann, Amy
This study examines how domestic (dis)order emerges as shifting states shaped by everyday socio-material interactions. Drawing on assemblage theory and photo-elicitation interviews with 22 households, we show how (dis)order develops through dynamic relations among family members, objects, spaces, and temporal rhythms. We identify three assemblage capacities—transient, functional, and conducive—that shape how disorder materialises and is understood, along with three corresponding management strategies: restoring, tolerating, and concealing. Beyond the home, these capacities extend assemblage theory by providing a transferable framework for theorising how assemblages generate distinct emergent states across consumer and marketplace contexts. Reconceptualising (dis)order as an emergent assemblage property rather than an individual shortcoming, the study reveals conditions under which mess serves as a productive resource supporting household flow, functional efficiency, and relational harmony. The study also offers practical implications for flexible storage design, functional mess zone identification, and organisation solutions that support family wellbeing.