Profiling the novel plant-based meat alternative category: Consumer affective and sensory response in the context of perceived similarity to meat.

Plant-based meat alternatives (PBMAs) are increasingly popular and may contribute towards reduction of negative environmental impacts associated with the meat industry. Inferior sensory characteristics of PBMAs, compared to conventional meat products, remain a barrier for uptake of these products. This study aimed to profile a wide range of PBMAs for perceived similarity to meat, consumer liking, emotional response and sensory experience, and to determine consumer drivers of liking for this product category. Twenty-one PBMAs, spanning a broad range of product types (burger patties, sausages, meatball alternatives, chicken/beef pieces, bacon alternative, turkey roast alternative) and main protein ingredients (extruded plant proteins, tofu, or legumes/vegetables) representative of PBMAs available to Aotearoa New Zealand consumers, were tasted and evaluated by 140 Aotearoa New Zealand residents. Samples ranged widely in their perceived similarity to meat (median value range: 1.0-4.0 on a 5-point-scale) and overall liking ratings (mean ± SD, range: 35.1 ± 1.2--77.7 ± 17.4 on a 100-point hedonic scale). Overall liking ratings were driven mostly by liking for flavour, followed by texture, and less so by appearance. Sensorially, sample differentiation was mostly associated with variation in meat-related flavours and textures, or vegetable-related attributes. Notably meat flavour was the main driver of liking, and a very strong relationship (r = 0.92) was observed between perceived similarity to meat and overall sample liking ratings. Meat-like samples were also associated with positive emotional terms, whereas samples made from wholefoods were associated with negative emotional terms. Textural terms ('gluey/slimy', 'pasty/doughy') associated with wholefood products were also negative drivers for liking, and should be avoided in future PBMA products. In conclusion, the general population maintains a strong preference for PBMAs that are similar to meat, validating ongoing efforts to improve the meat-like properties of new and emerging products. PBMAs made from wholefoods require extensive product development to achieve consumer satisfaction across the category.

Understanding consumer acceptability of verjuice, its potential applications and sensory and chemical drivers of liking.

The wine sector is working to add value, enhance sustainability and reduce waste, yet often creating new products with unknown consumer acceptance. Verjuice, juice made from discarded unripe thinned grapes, is an example. Whilst verjuice has various culinary uses, its versatility in beverages continues to expand. However, its sensory drivers of liking when consumed as a drink, and their potential impact on its application remain unclear. Chemical drivers of sensory characteristics are also unknown representing a critical knowledge gap needed to guide product innovation. This study aimed to provide new knowledge regarding consumer acceptability of verjuice by identifying its sensory drivers of liking as a beverage, evaluating its potential use in different applications and identifying chemical drivers of its sensory characteristics. New Zealand consumers (n = 93) evaluated 13 verjuice samples from different countries. Furthermore, verjuice familiarity and its influence on emotional response was investigated to determine likely future consumer engagement. Sweetness was the most positive driver of liking in verjuice overall, followed by fruity and floral notes, smoothness, and to a lesser extent citrus flavour. Consumers expressed varied preferences for verjuice's sensory profile, with fruity, floral, and honey flavours driving beverage application, whilst winey and green apple notes were more associated with culinary scenarios. Some association between chemical parameters and sensory attributes were evident (e.g. sugars were highly associated with perceived sweetness, fruity, and floral attributes; these attributes also shared proximity with 1-hexanol and cyclohexanol). The general idea of verjuice elicited positive valence emotions, but consumers who were 'not familiar' felt more curious, and those 'familiar' felt happier and more satisfied. Findings highlight the potential to tailor verjuice for specific applications by understanding desired sensory profiles and related chemical parameters. Recognising the interplay between familiarity level and emotional response is crucial for positioning the product in the marketplace and fostering consumer engagement. Marketing initiatives are needed to increase verjuice familiarity and support product innovation, leading to increased product appeal.

Avian influenza viruses in New Zealand wild birds, with an emphasis on subtypes H5 and H7: Their distinctive epidemiology and genomic properties.

The rapid spread of highly pathogenic avian influenza (HPAI) A (H5N1) viruses in Southeast Asia in 2004 prompted the New Zealand Ministry for Primary Industries to expand its avian influenza surveillance in wild birds. A total of 18,693 birds were sampled between 2004 and 2020, including migratory shorebirds (in 2004-2009), other coastal species (in 2009-2010), and resident waterfowl (in 2004-2020). No avian influenza viruses (AIVs) were isolated from cloacal or oropharyngeal samples from migratory shorebirds or resident coastal species. Two samples from red knots (Calidris canutus) tested positive by influenza A RT-qPCR, but virus could not be isolated and no further characterization could be undertaken. In contrast, 6179 samples from 15,740 mallards (Anas platyrhynchos) tested positive by influenza A RT-qPCR. Of these, 344 were positive for H5 and 51 for H7. All H5 and H7 viruses detected were of low pathogenicity confirmed by a lack of multiple basic amino acids at the hemagglutinin (HA) cleavage site. Twenty H5 viruses (six different neuraminidase [NA] subtypes) and 10 H7 viruses (two different NA subtypes) were propagated and characterized genetically. From H5- or H7-negative samples that tested positive by influenza A RT-qPCR, 326 AIVs were isolated, representing 41 HA/NA combinations. The most frequently isolated subtypes were H4N6, H3N8, H3N2, and H10N3. Multivariable logistic regression analysis of the relations between the location and year of sampling, and presence of AIV in individual waterfowl showed that the AIV risk at a given location varied from year to year. The H5 and H7 isolates both formed monophyletic HA groups. The H5 viruses were most closely related to North American lineages, whereas the H7 viruses formed a sister cluster relationship with wild bird viruses of the Eurasian and Australian lineages. Bayesian analysis indicates that the H5 and H7 viruses have circulated in resident mallards in New Zealand for some time. Correspondingly, we found limited evidence of influenza viruses in the major migratory bird populations visiting New Zealand. Findings suggest a low probability of introduction of HPAI viruses via long-distance bird migration and a unique epidemiology of AIV in New Zealand.

Cross-Sectional and Longitudinal Association of Clinical and Neurocognitive Factors With Apathy in Patients With Parkinson Disease.

BACKGROUND AND OBJECTIVES: A robust understanding of the natural history of apathy in Parkinson disease (PD) is foundational for developing effective clinical management tools. However, large longitudinal studies are lacking while the literature is inconsistent about even cross-sectional associations. We aimed to determine the longitudinal predictors of apathy development in a large cohort of people with PD and its cross-sectional associations and trajectories over time, using sophisticated Bayesian modeling techniques. METHODS: People with PD followed up in the longitudinal New Zealand Parkinson's progression project were included. Apathy was defined using the neuropsychiatric inventory subscale ≥4, and analyses were also repeated using a less stringent cutoff of ≥1. Both MoCA and comprehensive neuropsychological testing were used as appropriate to the model. Depression was assessed using the hospital anxiety and depression scale. Cross-sectional Bayesian regressions were conducted, and a multistate predictive model was used to identify factors that predict the initial onset of apathy in nonapathetic PD, while also accounting for the competing risk of death. The relationship between apathy presence and mortality was also investigated. RESULTS: Three hundred forty-six people with PD followed up for up to 14 years across a total of 1,392 sessions were included. Apathy occurrence did not vary significantly across the disease course (disease duration odds ratio [OR] = 0.55, [95% CI 0.28-1.12], affecting approximately 11% or 22% of people at any time depending on the NPI cutoff used. Its presence was associated with a significantly higher risk of death after controlling for all other factors (hazard ratio [HR] = 2.92 [1.50-5.66]). Lower cognition, higher depression levels, and greater motor severity predicted apathy development in those without motivational deficits (HR [cognition] = 0.66 [0.48-0.90], HR [depression] = 1.45 [1.04-2.02], HR [motor severity] = 1.37 [1.01-1.86]). Cognition and depression were also associated with apathy cross-sectionally, along with male sex and possibly lower dopaminergic therapy level, but apathy still occurred across the full spectrum of each variable (OR [cognition] = 0.58 [0.44-0.76], OR [depression] = 1.43 [1.04-1.97], OR [female sex] = 0.45 [0.22-0.92], and OR [levodopa equivalent dose] = 0.78 [0.59-1.04]. DISCUSSION: Apathy occurs across the PD time course and is associated with higher mortality. Depressive symptoms and cognitive impairment in particular predict its future development in those with normal motivation.

Patient-reported use of pancreatic enzyme replacement treatment (PERT) in pancreatic cancer in New Zealand and Australia: a cross-sectional survey study.

PURPOSE: This study investigated pancreatic enzyme replacement therapy (PERT) use in people diagnosed with pancreatic cancer in New Zealand (NZ) and Australia (AU). METHODS: A cross-sectional survey study was conducted using a mixed-media campaign to recruit people with pancreatic cancer and collect information about current PERT use. The questionnaire gathered data on participant demographics, awareness of PERT, prescribing practices and efficacy of enzyme replacement. RESULTS: Over 300 people with pancreatic cancer were recruited, 135 from New Zealand and 199 from Australia. Every region, state and territory was represented except for the West Coast (NZ) and the Northern Territory (AU), the lowest populated areas in both countries. In New Zealand, 60% of participants had heard about PERT, compared to 69.3% in Australia. Dosing regimens were inconsistent in both countries, with 18% and 27% of participants being prescribed PERT considered best practice in New Zealand and Australia, respectively. Before PERT commencement, 70% of participants experienced symptoms of malabsorption, with all symptoms improving after therapy was established. The majority of participants were compliant with their medication. CONCLUSION: PERT use in pancreatic cancer in New Zealand and Australia was highly variable and not compliant with international guidelines in which PERT is recommended as standard therapy. Enzyme replacement is effective for improving the symptoms of malabsorption in patients with pancreatic cancer. Clinician education may be needed to help improve the use of PERT in people with pancreatic cancer.

Ethnic Disparities for Survival and Mortality in New Zealand Patients With Head and Neck Cancer.

Importance: It is essential to identify inequitable cancer care for ethnic minority groups, which may allow policy change associated with improved survival and decreased mortality and morbidity. Objective: To investigate ethnic disparities in survival and mortality among New Zealand (NZ) patients with head and neck cancer (HNC) and the association of other variables, including socioeconomic status, tumor stage, and age at diagnosis, with survival rates. Design, Setting, and Participants: This retrospective cohort study was conducted among NZ patients diagnosed with specific HNCs from 2010 to 2020. Anonymized data were obtained from the NZ Cancer Registry, including patients diagnosed from International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes C00-C14 and C30-C32. Data were analyzed from July 2020 through January 2024. Main Outcomes and Measures: Censored Kaplan-Meier estimates were used to analyze survival distribution. Cox regression models were used to estimate the association of age, tumor stage at diagnosis, and socioeconomic status with survival rates. Age-standardized mortality rates were assessed. Results: Among 6593 patients with HNCs (4590 males [69.6%]; 4187 patients aged 51-75 years [63.5%]), there were 706 Maori individuals (10.7%) and 5887 individuals with other ethnicity (89.3%), including 4327 NZ European individuals (65.6%; defined as New Zealanders of European descent). Maori individuals had a decreased survival proportion at all years after diagnosis compared with individuals with other ethnicity (eg, 66.1% [95% CI, 62.6%% to 69.8%] vs 71.2% [95% CI, 70.0% to 72.4%] at 2 years). At 1 year after diagnosis, Maori individuals did not have a significantly increased mortality rate compared with 5795 individuals with other ethnicity with data (193 deaths [27.3%] vs 1400 deaths [24.2%]; P = .06), but the rate was significantly increased at 5 years after diagnosis (277 deaths [39.3%] vs 2034 deaths [35.1%]; P = .03); there was greater disparity compared with NZ European individuals (1 year: 969 deaths [22.4%]; P = .003; 5 years: 1441 deaths [33.3%]; P = .002). There were persistent age-adjusted mortality rate disparities: 40.1% (95% CI, -25.9% to 71.2%) for Maori individuals and 18.8% (95% CI, -15.4% to 24.4%) for individuals with other ethnicity. Maori individuals were diagnosed at a mean age of 58.0 years (95% CI, 57.1-59.1 years) vs 64.3 years. (95% CI, 64.0-64.7 years) for individuals with other ethnicity, or 5 to 7 years younger, and died at mean age of 63.5 years (95% CI, 62.0-64.9 years) compared with 72.3 years (95% CI, 71.8-72.9 years) for individuals with other ethnicity, or 7 to 10 years earlier. Maori individuals presented with proportionally more advanced disease (only localized disease, 102 patients [14.5%; 95% CI, 12.0%-17.4%] vs 1413 patients [24.0%; 95% CI, 22.9%-25.1%]; P < .001) and showed an increase in regional lymph nodes (276 patients [39.1%; 95% CI, 35.5%-42.9%] vs 1796 patients [30.5%; 95% CI, 29.3%-31.8%]; P < .001) at diagnosis compared with individuals with other ethnicity. Socioeconomic status was not associated with survival. Conclusions and Relevance: This study found that Maori individuals experienced worse survival outcomes and greater mortality rates from HNC in NZ and presented with more advanced disease at a younger age. These findings suggest the need for further research to alleviate these disparities, highlight the importance of research into minority populations with HNC globally, and may encourage equity research for all cancers.

Conversion practices in Aotearoa New Zealand: Developing a holistic response to spiritual abuse.

Research arising from conversion practices, also known as conversion therapy and sexual orientation and gender identity change efforts, has generally been underpinned by an emancipatory discourse that has evolved to counter harmful practices by evidencing associated harms and estimating prevalence. Little attention, however, has focused on what is required to support survivors, inclusive of those currently or those having previously experienced conversion efforts. Within a context of Aotearoa New Zealand having recently criminalised conversion practices, this study adopted an in-depth qualitative research design, informed by a dual adherence to life history and an empowerment methodology. Twenty-three religious conversion practice survivors, who had experienced religious conversion practices across a range of Christian identified faith settings, were interviewed. Participants had a median age of 34 and the majority identified as New Zealand European, cisgender, and gay. Participant narratives were discursively analysed. Three primary discourses were identified that inform the needed development of interventions and supports: 1) pervasive framing of conversion practices as harm, rather than spiritual abuse, has minimised the impacts of conversion practices. Rather, conceptualising conversion as spiritual abuse positions conversion practices as requiring urgent intervention and ongoing support, inclusive of the development of policy and operational responses; 2) the coercive nature of spiritual abuse needs to be appreciated in terms of spiritual, social, and structural entrapment; 3) the metaphor of a pipeline was enlisted to encapsulate the need for a multidimensional array of interventions to ensure those entrapped within spiritual abuse have a "pipeline to safety". Holistic survivor-centric conversion-related responses to spiritual abuse are required. These need to be informed by an understanding of entrapment and the associated need for holistic responses, inclusive of extraction pathways and support for those entrenched within abusive religious settings, support immediately after leaving abusive environments, and support throughout the survivors' healing journeys.

Changes in admission rates to an Aotearoa New Zealand hospital general medical service during COVID-19 lockdowns.

AIM: To better understand the reasons for reduced hospital admissions to a hospital general medicine service during COVID-19 lockdowns. METHODS: A statistical model for admission rates to the General Medicine Service at Wellington Hospital, Aotearoa New Zealand, since 2015 was constructed. This model was used to estimate changes in admission rates for transmissible and non-transmissible diagnoses during and following COVID-19 lockdowns for total admissions and various sub-groups. RESULTS: For the 2020 lockdown (n=734 admissions), the overall rate ratio of admissions was 0.71 compared to the pre-lockdown rate. Non-transmissible diagnoses, which constitute 87% of admissions, had an admission rate ratio of 0.77. Transmissible diagnoses, constituting 13% of admissions, had an admission rate ratio of 0.44. Reductions in admissions did not exacerbate existing ethnic disparities in access to health services. The lag in recovery of admission rates was more pronounced for transmissible than non-transmissible diagnoses. The 2021 lockdown (n=105 admissions) followed this pattern, but was of shorter duration with small numbers, and therefore measures were frequently not statistically significant. CONCLUSIONS: The biggest relative reduction in hospital admission was due to a reduction in transmissible illness admissions, likely due to COVID-related public health measures. However, the biggest reduction in absolute terms was in non-transmissible illnesses, where hospital avoidance may be associated with increased morbidity or mortality.

Dispensing of attention-deficit hyperactivity disorder medications for adults in Aotearoa New Zealand.

AIM: To report dispensing trends for attention-deficit hyperactivity disorder (ADHD) in Aotearoa New Zealand, focussing on adults in order to highlight increasing demand for ADHD treatment by adults and to prompt discussion. METHOD: Demographic and dispensing data for ADHD were obtained from the Pharmaceutical Collection between the years 2006 and 2022. This was stratified according to child (<18 years) and adult (≥18 years) populations. Population dispensing rates for methylphenidate and atomoxetine were calculated. Key findings are reported to reveal demographic and dispensing trends for medication treated ADHD in Aotearoa New Zealand. RESULTS: More males are dispensed ADHD medication than females, although this is less evident for adults (54.8% male). Maori adults are dispensed ADHD medication at a lower rate (10.1%) than Maori children (22.9%). There was a 10-fold increase in dispensing of ADHD medication for adults compared to a three-fold increase for children over the study period. New dispensing for adults doubled between 2011 and 2022. CONCLUSION: Medication treatment for adult ADHD is increasing in Aotearoa New Zealand and includes treatment for persisting childhood ADHD and new diagnoses made in adulthood. Despite increases, dispensing rates for ADHD remain lower than prevalence estimates, suggesting a significant treatment gap. Addressing the treatment gap for ADHD may reduce negative effects of ADHD, but wider social influences should also be considered.

Health impacts of war: case studies of New Zealand veterans of the First World War.

AIM: Armed conflict remains a tragic feature of the modern world and so it is necessary to continue to study its health impacts. Even the study of historical conflicts is relevant given that certain health impacts are common to most wars e.g., post-traumatic stress disorder (PTSD). METHODS: This study built on a previous quantitative analysis of a randomly selected group of 200 New Zealand veterans from the First World War (WWI). From this sample we selected 10 cases that illustrated particular themes around morbidity impacts. RESULTS: The theme of severity of impacts was illustrated with a case who was severely wounded and died from suicide when back in New Zealand, and another case with severe PTSD. The theme of the high frequency of non-fatal conditions was revealed with cases illustrating new diagnoses (a case with n=8 diagnoses), hospitalisations for new conditions (n=6), non-fatal injury events (n=3) and for sexually transmitted infections (n=3). The theme of chronic debility as a consequence of various conditions was illustrated with cases who had suffered from being gassed or having gastroenteritis, malaria or pandemic influenza. CONCLUSION: These 10 selected cases reiterate how severe and extensive the morbidity burden for military personnel in WWI could be. Also illustrated is how the morbidity could contribute to adverse impacts on some of their lives after returning to New Zealand.

Navigating challenges: insights into chronic kidney disease care in South Auckland.

The burden of chronic kidney disease is increasing throughout New Zealand, resulting in growing strain on patients, families and the healthcare system. The population of South Auckland is the most diverse in New Zealand and it is particularly vulnerable to the effects of chronic kidney disease due its demography and its many communities that endure significant hardships. This article explores the prevailing challenges identified by renal physicians and nurse specialists over 35 years of caring for patients with chronic kidney disease in South Auckland.

Management of chronic kidney disease for Maori in Aotearoa New Zealand: a summary of clinical practice guidelines.

AIMS: The kaupapa of the Caring for Australians and New Zealanders with Kidney Impairment (CARI) Clinical practice guidelines for management of chronic kidney disease for Maori in Aotearoa New Zealand is to provide whanau-centred and evidence-based recommendations to healthcare systems, healthcare providers and healthcare workers. The guidelines include screening, identification, management and system-level responses to chronic kidney disease (CKD) to deliver best practice care to Maori affected by CKD across community, primary and secondary services. METHODS: The guidelines are funded by the Ministry of Health - Manatu Hauora and are written by a panel of Maori and non-Maori clinicians and literacy experts across Aotearoa New Zealand from Kaupapa Maori organisations, general practice and nephrology units using standardised methods. The guidelines methodology included consultation with whanau Maori with lived experience of CKD and primary and secondary care practitioners. Additional guideline development would be required to inform management of CKD for non-Maori in Aotearoa New Zealand. RESULTS: The guidelines provide recommendations about equity, governance and accountability, cultural safety, case management, information systems, social determinants of equity and wellbeing and screening. CONCLUSIONS: Recommendations to health services for Maori with CKD are based on giving effect to Te Tiriti o Waitangi and best practice care to prevent CKD, delaying its progression, treating kidney failure through timely transplantation, delivering in community and providing high-quality symptom management.

Drivers of access to cardiovascular health care for rural Indigenous Peoples: a scoping review.

INTRODUCTION: Māori (the Indigenous Peoples of Aotearoa New Zealand) are disproportionately represented in cardiovascular disease (CVD) prevalence, morbidity and mortality rates, and are less likely to receive evidence-based CVD health care. Rural Māori experience additional barriers to treatment access, poorer health outcomes and a greater burden of CVD risk factors compared to Non-Māori and Māori living in urban areas. Importantly, these inequities are similarly experienced by Indigenous Peoples in other nations impacted by colonisation. Given the scarcity of available literature, a systematic scoping review was conducted on literature exploring barriers and facilitators in accessing CVD health care for rural Māori and other Indigenous Peoples in nations impacted by colonisation. METHODS: The review was underpinned by Kaupapa Māori Research methodology and was conducted utilising Arksey and O'Malley's (2005) methodological framework. A database search of MEDLINE (OVID), PubMed, Embase, SCOPUS, CINAHL Plus, Australia/New Zealand Reference Centre and NZResearch.org was used to explore empirical research literature. A grey literature search was also conducted. Literature based in any healthcare setting providing care to adults for CVD was included. Rural or remote Indigenous Peoples from New Zealand, Australia, Canada, and the US were included. Literature was included if it addressed cardiovascular conditions and reported barriers and facilitators to healthcare access in any care setting. RESULTS: A total of 363 articles were identified from the database search. An additional 19 reports were identified in the grey literature search. Following screening, 16 articles were included from the database search and 5 articles from the grey literature search. The literature was summarised using the Te Tiriti o Waitangi (Treaty of Waitangi) Framework principles: tino rangatiratanga (self-determination), partnership, active protection, equity and options. Themes elucidated from the literature were described as key drivers of CVD healthcare access for rural Indigenous Peoples. Key driver themes included input from rural Indigenous Peoples on healthcare service design and delivery, adequate resourcing and support of indigenous and rural healthcare services, addressing systemic racism and historical trauma, providing culturally appropriate health care, rural Indigenous Peoples' access to family and wellbeing support, rural Indigenous Peoples' differential access to the wider social determinants of health, effective interservice linkages and communication, and equity-driven and congruent data systems. CONCLUSION: The findings are consistent with other literature exploring access to health care for rural Indigenous Peoples. This review offers a novel approach to summarising literature by situating the themes within the context of equity and rights for Indigenous Peoples. This review also highlighted the need for further research in this area to be conducted in the context of Aotearoa New Zealand.

Tree contributions to climate change adaptation through reduced cattle heat stress and benefits to milk and beef production.

Cattle heat stress causes billions of dollars' worth of losses to meat and milk production globally, and is projected to become more severe in the future due to climate change. Tree establishment in pastoral livestock systems holds potential to reduce cattle heat stress and thus provide nature-based adaptation. We developed a general model for the impact of trees on cattle heat stress, which can project milk and meat production under future climate scenarios at varying spatial scales. The model incorporates the key microclimate mechanisms influenced by trees, including shade, air temperature, humidity, and wind speed. We conducted sensitivity analyses to demonstrate the relative influence of different mechanisms through which trees can impact cattle heat stress, and how tree impacts are influenced by climatic context globally. Trees hold the greatest potential to reduce cattle heat stress in higher latitudes and altitudes, with minor benefits in the lowland tropics. We projected the future contributions of current trees in mitigating climate change impacts on the dairy and beef herds of Aotearoa-New Zealand (A-NZ) in 2070-2080. Trees were simulated to contribute to A-NZ milk yields by over 491 million liters (lower CI = 112 million liters, upper CI = 850 million liters), and meat yields by over 8316 tonnes (lower CI = 2431 tonnes, upper CI = 13,668 tonnes) annually. The total economic contribution of existing trees in mitigating future cattle heat stress was valued at $US 244 million (lower CI = $US 58 million, upper CI = $US 419 million). Our findings demonstrate the importance of existing trees in pastoral landscapes and suggest that strategic tree establishment can be a valuable adaptation option for reducing cattle heat stress under climate change. Tree establishment in the next few years is critical to provide adaptation capacity and economic benefit in future decades.

Female RNA concussion (FeRNAC) study: assessing hormone profiles and salivary RNA in females with concussion by emergency departments in New Zealand: a study protocol.

BACKGROUND: Females of reproductive age with concussion report a greater number of symptoms that can be more severe and continue for longer than age matched males. Underlying mechanisms for sex differences are not well understood. Short non-coding Ribonucleic Acids (sncRNAs) are candidate salivary biomarkers for concussion and have been studied primarily in male athletes. Female sex hormones influence expression of these biomarkers, and it remains unclear whether a similar pattern of sncRNA expression would be observed in females following concussion. This study aims to evaluate recovery time, the ratio of salivary sncRNAs and symptom severity across different hormone profiles in females presenting to emergency departments (ED) with concussion and, to investigate the presence of low energy availability (LEA) as a potential modifier of concussion symptoms. METHODS: This prospective cohort study recruits participants from New Zealand EDs who are biologically female, of reproductive age (16-50 years) and with a confirmed diagnosis of concussion from an ED healthcare professional. Participants are excluded by ED healthcare professionals from study recruitment as part of initial routine assessment if they have a pre-diagnosed psychiatric condition, neurological condition (i.e., epilepsy, cerebral palsy) or more than three previously diagnosed concussions. Participants provide a saliva sample for measurement of sncRNA's, and online survey responses relating to hormone profile and symptom recovery at 7-day intervals after injury until they report a full return to work/study. The study is being performed in accordance with ethical standards of the Declaration of Helsinki with ethics approval obtained from the Health and Disability Ethics Committee (HDEC #2021 EXP 11655), Auckland University of Technology Ethics Committee (AUTEC #22/110) and locality consent through Wellington hospital research office. DISCUSSION: If saliva samples confirm presence of sncRNAs in females with concussion, it will provide evidence of the potential of saliva sampling as an objective tool to aid in diagnosis of, and confirmation of recovery from, concussion. Findings will determine whether expression of sncRNAs is influenced by steroid hormones in females and may outline the need for sex specific application and interpretation of sncRNAs as a clinical and/or research tool. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) registration number ACTRN12623001129673.