Prevalence of QoI resistance and mtDNA diversity in the Irish Zymoseptoria tritici population

peer-reviewedThe emergence and spread of Quinone outside Inhibitor (QoI) fungicide resistance in the Irish Zymoseptoria tritici population in the early 2000s had immediate impacts on the efficacy of the entire group of fungicides for the control of septoria tritici blotch. As a result, a dramatic reduction in the quantities applied to winter wheat occurred in the following seasons. Even in the absence of these fungicides, the frequency of the resistance allele, G143A in the pathogens mtDNA has remained exceptionally high (>97%), and as such, it can be anticipated that continued poor efficacy of current QoI fungicides will be observed. Amongst the isolates with G143A, differences in sensitivity to the QoI pyraclostrobin were observed in vitro. The addition of the alternative oxidase (AOX) inhibitor salicylhydroxamic acid increased sensitivity in these isolates, suggesting some continued impairment of respiration by the QoI fungicides, albeit weak. Interestingly, amongst those tested, the strains from a site with a high frequency of inserts in the MFS1 transporter gene known to enhance QoI efflux did not exhibit this increase in sensitivity. A total of 19 mtDNA haplotypes were detected amongst the 2017 strain collection. Phylogenetic analysis confirmed the suggestion of a common ancestry of all the haplotypes, even though three of the haplotypes contained at least one sensitive strain

‘Closing the gap’: how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women

The reproductive health outcomes for Aboriginal and Torres Strait Islander mothers and infants are significantly poorer than they are for other Australians; they worsen with increasing remoteness where the provision of services becomes more challenging. Australia has committed to 'Overcoming Indigenous Disadvantage' and 'Closing the Gap' in health outcomes. Fifty-five per cent of Aboriginal and Torres Strait Islander birthing women live in outer regional and remote areas and suffer some of the worst health outcomes in the country. Not all of these women are receiving care from a skilled provider, antenatally, in birth or postnatally while the role of midwives in reducing maternal and newborn mortality and morbidity is under-utilised. The practice of relocating women for birth does not address their cultural needs or self-identified risks and is contributing to these outcomes. An evidence based approach for the provision of maternity services in these areas is required. Australian maternal mortality data collection, analysis and reporting is currently insufficient to measure progress yet it should be used as an indicator for 'Closing the Gap' in Australia. A more intensive, coordinated strategy to improve maternal infant health in rural and remote Australia must be adopted. Care needs to address social, emotional and cultural health needs, and be as close to home as possible. The role of midwives can be enabled to provide comprehensive, quality care within a collaborative team that includes women, community and medical colleagues. Service provision should be reorganised to match activity to need through the provision of caseload midwives and midwifery group practices across the country. Funding to embed student midwives and support Aboriginal and Torres Strait Islander women in this role must be realised. An evidence base must be developed to inform the provision of services in these areas; this could be through the testing of the Rural Birth Index in Australia. The provision of primary birthing services in remote areas, as has occurred in some Inuit and New Zealand settings, should be established. 'Birthing on Country' that incorporates local knowledge, on-site midwifery training and a research and evaluation framework, must be supported

How optimal caseload midwifery can modify predictors for preterm birth in young women: integrated findings from a mixed methods study

Objective to identify possible mechanisms by which caseload midwifery reduces preterm birth for young childbearing women. Design a mixed methods triangulation, convergence design was used to answer the research question ‘How does the way maternity care is provided affect the health and well-being of young women and their babies?’ The project generated quantitative and qualitative findings which were collected and analysed concurrently then separately analysed and published. The research design enabled integration of the quantitative and qualitative findings for further interpretation through a critical pragmatic lens. Setting a tertiary maternity hospital in Australia providing care to approximately 500 pregnant young women (aged 21 years or less) each year. Three distinct models of care were offered: caseload midwifery, young women's clinic, and standard 'fragmented' care. Participants a cohort study included data from 1971 young women and babies during 2008–2012. An ethnographic study included analysis of focus group interviews with four caseload midwives in the young women's midwifery group practice; as well as ten pregnant and postnatal young women receiving caseload midwifery care. Findings integrated analysis of the quantitative and qualitative findings suggested particular features in the model of care which facilitated young women turning up for antenatal care (at an earlier gestation and more frequently) and buying in to the process (disclosing risks, engaging in self-care activities and accepting referrals for assistance). We conceptualised that Optimal Caseload Midwifery promotes Synergistic Health Engagement between midwife and the young woman. Key conclusions optimal Caseload Midwifery (which includes midwives with specific personal attributes and philosophical commitments, along with appropriate institutional infrastructure and support) facilitates midwives and young clients to develop trusting relationships and engage in maternity care. Health engagement can modify predictors for preterm birth that are common amongst pregnant adolescents by promoting earlier maternity booking, sufficient antenatal care, greater emotional resilience, ideal gestational weight gain, less smoking/drug use, and fewer untreated genito-urinary infections. Implications for practice the institutional infrastructure and managerial support for caseload midwifery should value and prioritise the philosophical commitments and personal attributes required to optimise the model. Furthermore the location of visits, between appointment access to primary midwife, and back-up system should be organised to optimise the midwife-woman relationship in order to promote the young woman's engagement with maternity care

Is the Birthing Unit Design Spatial Evaluation Tool valid for diverse groups?

© 2018 Australian College of Midwives Background: Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care. Aim: To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds. Methods: Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively. Results: Item-level content validity was achieved on 37 items for birth unit midwives (n = 10); 35 items for Aboriginal or Torres Strait Islander women (n = 6); 33 items for women who had anticipated a vaginal birth after a caesarean (n = 6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n = 20). Survey-level content validity was not demonstrated in any group. Conclusion: Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors

Recovering a lost baseline: missing kelp forests from a metropolitan coast

© 2008 AuthorThere is concern about historical and continuing loss of canopy-forming algae across the world’s temperate coastline. In South Australia, the sparse cover of canopy-forming algae on the Adelaide metropolitan coast has been of public concern with continuous years of anecdotal evidence culminating in 2 competing views. One view considers that current patterns existed before the onset of urbanisation, whereas the alternate view is that they developed after urbanisation. We tested hypotheses to distinguish between these 2 models, each centred on the reconstruction of historical covers of canopies on the metropolitan coast. Historically, the metropolitan sites were indistinguishable from contemporary populations of reference sites across 70 km (i.e. Gulf St. Vincent), and could also represent a random subset of exposed coastal sites across 2100 km of the greater biogeographic province. Thus there was nothing ‘special’ about the metropolitan sites historically, but today they stand out because they have sparser covers of canopies compared to equivalent locations and times in the gulf and the greater province. This is evidence of wholesale loss of canopy-forming algae (up to 70%) on parts of the Adelaide metropolitan coast since major urbanisation. These findings not only set a research agenda based on the magnitude of loss, but they also bring into question the logic that smaller metropolitan populations of humans create impacts that are trivial relative to that of larger metropolitan centres. Instead, we highlight a need to recognise the ecological context that makes some coastal systems more vulnerable or resistant to increasing human-domination of the world’s coastlines. We discuss challenges to this kind of research that receive little ecological discussion, particularly better leadership and administration, recognising that the systems we study out-live the life spans of individual research groups and operate on spatial scales that exceed the capacity of single research providers.Sean D. Connell, Bayden D. Russell, David J. Turner, Scoresby A. Shepherd, Timothy Kildea, David Miller, Laura Airoldi, Anthony Cheshir

The quality of health services provided to remote dwelling aboriginal infants in the top end of northern Australia following health system changes: A qualitative analysis

© 2017 The Author(s). Background: In Australia the health outcomes of remote dwelling Aboriginal infants are comparable to infants in developing countries. This research investigates service quality, from the clinicians' perspective and as observed and recorded by the researcher, in two large Aboriginal communities in the Top End of northern Australia following health system changes. Methods: Data were collected from semi-structured interviews with 25 clinicians providing or managing child health services in the two study sites. Thirty hours of participant observation was undertaken in the 'baby-rooms' at the two remote health centres between June and December 2012. The interview and observational data, as well as field notes were integrated and analysed thematically to explore clinicians' perspectives of service delivery to infants in the remote health centres. Results: A range of factors affecting the quality of care, mostly identified before health system changes were instigated, persisted. These factors included ineffective service delivery, inadequate staffing and culturally unsafe practices. The six themes identified in the data: 'very adhoc', 'swallowed by acute', 'going under', 'a flux', 'a huge barrier' and 'them and us' illustrate how these factors continue, and when combined portray a 'very chaotic system'. Conclusion: Service providers perceived service provision and quality to be inadequate, despite health system changes. Further work is urgently needed to improve the quality, cultural responsiveness and effectiveness of services to this population

Improving interagency service integration of the Australian Nurse Family Partnership Program for First Nations women and babies: a qualitative study.

BackgroundThe Australian Nurse Family Partnership Program (ANFPP) is an evidence-based, home visiting program that offers health education, guidance, social and emotional support to first-time mothers having Aboriginal and/or Torres Strait Islander (First Nations) babies. The community-controlled sector identified the need for specialised support for first time mothers due to the inequalities in birthing and early childhood outcomes between First Nations' and other babies in Australia. The program is based on the United States' Nurse Family Partnership program which has improved long-term health outcomes and life trajectories for mothers and children. International implementation of the Nurse Family Partnership program has identified interagency service integration as key to program recruitment, retention, and efficacy. How the ANFPP integrates with other services in an Australian urban setting and how to improve this is not yet known. Our research explores the barriers and enablers to interagency service integration for the Australian Nurse Family Partnership Program ANFPP in an urban setting.MethodsA qualitative study using individual and group interviews. Purposive and snowball sampling was used to recruit clients, staff (internal and external to the program), Elders and family members. Interviews were conducted using a culturally appropriate 'yarning' method with clients, families and Elders and semi-structured interview guide for staff. Interviews were audio-recorded and transcribed prior to reflexive thematic analysis.ResultsSeventy-six participants were interviewed: 26 clients, 47 staff and 3 Elders/family members. Three themes were identified as barriers and three as enablers. Barriers: 1) confusion around program scope, 2) duplication of care, and 3) tensions over 'ownership' of clients. Enablers (existing and potential): 1) knowledge and promotion of the program; 2) cultural safety; and 3) case coordination, co-location and partnership forums.ConclusionEffective service integration is essential to maximise access and acceptability of the ANFPP; we provide practical recommendations to improve service integration in this context

A note on the impact of CYP51 alterations and their combination in the wheat pathogen Zymoseptoria tritici on sensitivity to the azole fungicides epoxiconazole and metconazole

Septoria tritici blotch caused by the fungal pathogen Zymoseptoria tritici is the most economically damaging disease of winter wheat in Ireland. As azoles have been intensively used, Z. tritici has developed different means of resisting their toxic effects with multiple alterations now reported in individual strains. Using previously characterised Irish collections of Z. tritici, the relationships between these different alterations have been examined using conditional inference trees and random forest. The results from this study highlight the importance of specific alterations I381V and S524T, with both contributing most to the reductions in epoxiconazole (EPZ) and metconazole (MTZ) sensitivity. As the azole class of fungicides is an extensive and diverse group, it is possible these alterations do not impact other azoles in a similar manner. Further analysis of these and contemporary collections to additional azoles, including mefentrifluconazole, which continues to provide good field control of Z. tritici, is warranted

Developing a Core Competency Model and Educational Framework for Primary Maternity Services: A national consensus approach

Background: An appropriately educated and competent workforce is crucial to an effective health care system. The National Health Workforce Taskforce (now Health Workforce Australia) and the Maternity Services Inter-Jurisdictional Committee funded a project to develop Core Competencies and Educational Framework for Primary Maternity Services in Australia. These competencies recognise the interdisciplinary nature of maternity care in Australia where care is provided by general practitioners, obstetricians and midwives as well as other professionals. Participants: Key stakeholders from professional organisations and providers of services related to maternity care and consumers of services. Methods: A national consensus approach was undertaken using consultation processes with a Steering Committee, a wider Reference Group and public consultation. Findings: A national Core Competencies and Educational Framework for Primary Maternity Services in Australia was developed through an iterative process with a range of key stakeholders. There are a number of strategies that may assist in the integration of these into primary maternity service provider professional groups' education and practice. Conclusions: The Core Competencies and Educational Framework are based on an interprofessional approach to learning and primary maternity service practice. They have sought to value professional expertise and stimulate awareness and respect for the roles of all primary maternity service providers. The competencies and framework described in this paper are now a critical component of Australian maternity services as they are included in actions in the newly released National Maternity Services Plan and thus have relevance for all providers of Australian maternity services. © 2011 Australian College of Midwives

Access and outcomes of general practitioner obstetrician (rural generalist)-supported birthing units in Queensland

Funding Information Queensland Rural Generalist PathwayPeer reviewedPublisher PD