title: A population-based study of traumatic brain injury incidence and mechanisms in New Zealand: 2021–2022 compared with 2010–2011

authors: Jones, Kelly

subjects: Traumatic brain injury

abstract: Background: Monitoring traumatic brain injury (TBI) incidence and epidemiological patterns is important for evidence-based strategic planning, policy, prevention, and resource allocation. We revisited population-based estimates and examined patterns of TBI incidence (all ages, severities) in 2021–2022 compared with 2010–2011 in New Zealand (NZ). Methods: Examining an urban (Hamilton) and rural (Waikato District) region in NZ (May 2021–April 2022, unintentionally following the start of the COVID-19 pandemic), we calculated crude annual age-, sex-, ethnic-, urban/rural area- and mechanism-specific TBI incidence per 100,000 person-years with 95% Confidence Intervals (CI). Poisson regression was used to derive adjusted Risk Ratios (aRRs) to compare age-standardised rates between sex, ethnicity, and area groups. Direct standardisation was used to age-standardise rates to the world population. We calculated Incidence Rate Ratios (IRRs) with 95% CI to compare 2021–2022 with 2010–2011 age-standardised rates. Findings: Total TBI incidence per 100,000 person-years was 852 cases (95% CI 816–890), including 791 cases (756–828) of mild TBI, and 61 cases (52–72) of moderate to severe TBI. TBI affected males more than females (IRR 1.31, 95% CI 1.29–1.33), and urban more than rural residents (IRR 1.57, 1.43–1.73). Most TBI (61%) occurred in people aged 15–64 years and were due to falls (48%). European and Asian peoples had lower risk of TBI than Māori (aRRs 0.68, 0.31 respectively). Compared to 2010–2011, total TBI incidence and rates among Māori were stable; TBI incidence was greater among females, urban residents, and adults aged ≥34 years; and TBI due to falls significantly increased (IRR 1.20, 95% CI 1.03–1.40). Interpretation: Noting increased risks for underestimation due to COVID-19, findings suggest overall TBI incidence rate in NZ was similar in 2021–2022 to 2010–2011, while highlighting changes in TBI distribution. Age-, sex-, area-, ethnic-, and mechanism-specific distributions should be considered when revisiting prevention strategies to reduce TBI incidence. Funding: Health Research Council of New Zealand of NZ.

text: A population-based study of traumatic brain injury incidence and mechanisms in New Zealand: 2021–2022 compared with 2010–2011 Background: Monitoring traumatic brain injury (TBI) incidence and epidemiological patterns is important for evidence-based strategic planning, policy, prevention, and resource allocation. We revisited population-based estimates and examined patterns of TBI incidence (all ages, severities) in 2021–2022 compared with 2010–2011 in New Zealand (NZ). Methods: Examining an urban (Hamilton) and rural (Waikato District) region in NZ (May 2021–April 2022, unintentionally following the start of the COVID-19 pandemic), we calculated crude annual age-, sex-, ethnic-, urban/rural area- and mechanism-specific TBI incidence per 100,000 person-years with 95% Confidence Intervals (CI). Poisson regression was used to derive adjusted Risk Ratios (aRRs) to compare age-standardised rates between sex, ethnicity, and area groups. Direct standardisation was used to age-standardise rates to the world population. We calculated Incidence Rate Ratios (IRRs) with 95% CI to compare 2021–2022 with 2010–2011 age-standardised rates. Findings: Total TBI incidence per 100,000 person-years was 852 cases (95% CI 816–890), including 791 cases (756–828) of mild TBI, and 61 cases (52–72) of moderate to severe TBI. TBI affected males more than females (IRR 1.31, 95% CI 1.29–1.33), and urban more than rural residents (IRR 1.57, 1.43–1.73). Most TBI (61%) occurred in people aged 15–64 years and were due to falls (48%). European and Asian peoples had lower risk of TBI than Māori (aRRs 0.68, 0.31 respectively). Compared to 2010–2011, total TBI incidence and rates among Māori were stable; TBI incidence was greater among females, urban residents, and adults aged ≥34 years; and TBI due to falls significantly increased (IRR 1.20, 95% CI 1.03–1.40). Interpretation: Noting increased risks for underestimation due to COVID-19, findings suggest overall TBI incidence rate in NZ was similar in 2021–2022 to 2010–2011, while highlighting changes in TBI distribution. Age-, sex-, area-, ethnic-, and mechanism-specific distributions should be considered when revisiting prevention strategies to reduce TBI incidence. Funding: Health Research Council of New Zealand of NZ.

year: 2026

title: Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives

authors: Norman, Kimberley

subjects: Obesity

abstract: Obesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context.
The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future.
This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice.
The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management.
This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted.

text: Obesity Management in Rural New Zealand General Practice from Healthcare Professional and Client Perspectives Obesity is a health issue which currently affects over 34% of New Zealand (NZ) adults. Obesity, if left unchecked, leads to further physical and psychosocial health complications and an overall poor quality of life. People living in rural communities, high deprivation areas, as well as Indigenous Māori and Pacific Island populations in NZ, experience significant obesity health inequities and have a high-risk of developing obesity. General practice clinicians are positioned to be ‘best suited’ to deliver effective obesity healthcare in their practice, however, despite weight management intervention options being available through general practice, the obesity rates have continued to rise in the last 30 years. This suggests that there are potentially barriers to achieving a healthy weight in this context.
The aim of this research thesis is to understand the experiences with, and barriers to, effective obesity management in general practice from clinician and client perspectives to identify areas of improvement in the future.
This research thesis examines obesity healthcare in NZ general practice using a sequential explanatory mixed method research design in three parts. Firstly, a literature review study was conducted as a baseline point to identify the efficacy of any weight management interventions that are available in general practice. Secondly, a quantitative exploratory survey was conducted with Waikato region general practitioners (GP’s). Lastly, interviews with rural clinicians (GPs, nurses, and Indigenous Māori health professionals) and clients (patients engaging with rural general practice) were then conducted to understand the more in-depth perspectives of any barriers experienced with delivering, or engaging with, obesity management in general practice.
The experiences of both clinicians and clients were found to be complex and nuanced, with each participant having a unique experience with obesity management. Concepts such as effective yet inaccessible weight management interventions, interventions not suitable for sociocultural health needs, conflicting nutritional guidelines, lack of rural general practice systemic support, the unique and time consuming nature of obesity ‘treatment’, complications with the role of a clinician in obesity management, stigma or power imbalances in the general practice context, social determinants of health, the obesogenic environment, privatised weight management programmes and the individualised nature of sociocultural norms were found to be significant to effective obesity management.
This research thesis identified that the positioning of general practitioners as ‘best suited’ for delivering effective obesity healthcare in their practice was questionable. Potentially, the clinician role is better suited as a supportive one to an obesity health specialist who can meet the more holistic needs of a client when it comes to weight management. The current health model generates difficulties for clinicians to deliver comprehensive healthcare for such a complex and individualised health issue. Future research should look to develop weight management options that are suitable for rural and indigenous health needs to improve quality of life for clients and reduce health inequities. In addition, wider critical reflection on the current obesity healthcare model and the feasibility of a more specialist service outside general practice is warranted.

year: 2024

title: Solving the structure of the mycobacterial chromosome condensing protein Lsr2 in complex with DNA

authors: Summers, Emma Louise

abstract: Lsr2 is a DNA binding protein that is highly conserved in mycobacteria and related actinomycetes and it is thought to be essential in Mycobacterium tuberculosis. Previous studies have shown that Lsr2 is involved in down-regulating a range of genes involved in cell wall synthesis and metabolic functions and it is proposed that it does this by organisation of bacterial chromatin. We solved the structure of the N-terminal dimerisation domain of Lsr2 using crystallographic ab initio approaches1 whereas the C-terminal DNA binding domain structure was solved by others using NMR2. Electron microscopy shows that Lsr2 organises DNA into large helical structures involving several strands1. Whilst DNA binding by individual domains has been modelled based on the NMR structure, the exact mechanism of DNA binding and chromosome organisation by the entire protein is unknown. Lsr2 contains a long flexible loop between the two domains which may lead to the protein having a large range of movement, allowing it to bind DNA in a dynamic way. The Lsr2 dimer is also capable of forming linear oligomers through the interaction of overlapping N terminal residues and evidence of this has been shown in our crystal structure and using TEM1. We wish to solve the structure of Lsr2 bound to DNA. For the purposes of crystallisation of Lsr2 we have engineered the removal of important N-terminal residues involved in oligomersiation to prevent this process occurring in solution. The truncated form of Lsr2 provides a sub-population of purified Lsr2 that is DNA-free and we have utilised this population for binding specific dsDNA oligonucleotides for crystallisation. To date, we have determined the optimal length of DNA required and have refined the exact combination of nucleotides for ideal protein binding. We have progressed through the crystallisation of Lsr2 bound to a range of oligonucleotides. One oligonucleotide has yielded the most success to date with crystals that have diffracted to 2.7 Å resolution. Attempts to solve the structure using molecular replacement have thus far been unsuccessful. Our current focus is to reproduce crystals for improving resolution and for heavy atom soaking to assist with solving the structure.

text: Solving the structure of the mycobacterial chromosome condensing protein Lsr2 in complex with DNA Lsr2 is a DNA binding protein that is highly conserved in mycobacteria and related actinomycetes and it is thought to be essential in Mycobacterium tuberculosis. Previous studies have shown that Lsr2 is involved in down-regulating a range of genes involved in cell wall synthesis and metabolic functions and it is proposed that it does this by organisation of bacterial chromatin. We solved the structure of the N-terminal dimerisation domain of Lsr2 using crystallographic ab initio approaches1 whereas the C-terminal DNA binding domain structure was solved by others using NMR2. Electron microscopy shows that Lsr2 organises DNA into large helical structures involving several strands1. Whilst DNA binding by individual domains has been modelled based on the NMR structure, the exact mechanism of DNA binding and chromosome organisation by the entire protein is unknown. Lsr2 contains a long flexible loop between the two domains which may lead to the protein having a large range of movement, allowing it to bind DNA in a dynamic way. The Lsr2 dimer is also capable of forming linear oligomers through the interaction of overlapping N terminal residues and evidence of this has been shown in our crystal structure and using TEM1. We wish to solve the structure of Lsr2 bound to DNA. For the purposes of crystallisation of Lsr2 we have engineered the removal of important N-terminal residues involved in oligomersiation to prevent this process occurring in solution. The truncated form of Lsr2 provides a sub-population of purified Lsr2 that is DNA-free and we have utilised this population for binding specific dsDNA oligonucleotides for crystallisation. To date, we have determined the optimal length of DNA required and have refined the exact combination of nucleotides for ideal protein binding. We have progressed through the crystallisation of Lsr2 bound to a range of oligonucleotides. One oligonucleotide has yielded the most success to date with crystals that have diffracted to 2.7 Å resolution. Attempts to solve the structure using molecular replacement have thus far been unsuccessful. Our current focus is to reproduce crystals for improving resolution and for heavy atom soaking to assist with solving the structure.

year: 2018