Reducing early preterm birth for 25 cents a day

Editorial. No abstract available

Teenage parents

Teenage pregnancy is considered to be one of the most important adolescent health problems in Western society. It is associated with a high economic cost involving both direct monetary expenditure for public assistance for welfare and child health care as well as negative societal outcomes in terms of child abuse, neglect and poverty (Quinlivan, 2004). Australia now has one of the highest adolescent fertility rates in the world. Teenage mothers may experience a number of adverse outcomes associated with teenage pregnancy including failure to complete schooling, inability to find a job, and increased risk of poor health (Quinlivan, 2004; Social Exclusion Unit, 1999). There is now considerable evidence that many teenagers idealise pregnancy and parenthood and regard it with high expectations. A significant proportion of adolescent pregnancies result as a consequence of positive, idealised attitudes to pregnancy, parenthood and personal change rather than by accident or negative attitudes to contraception (Condon et al., 2001)

Small interface changes have dramatic impacts: How mandatory fields in electronic medical records increased pertussis vaccination rates in Australian obstetric patients

Introduction: Electronic health records have been widely introduced into clinical practice. The aim of this study was to determine whether a small interface change could improve compliance with a key quality indicator, namely antenatal pertussis vaccination. Methods: Audits were performed between 1–31 July 2015 and 1–31 July 2017 of all deliveries at the Centenary Hospital for Women and Children to determine compliance with antenatal pertussis vaccination. The single difference between time points was changing the interface so the antenatal pertussis vaccination field became compulsory. Results: 275 and 299 women delivered in the audit periods. Vaccination rates almost doubled (52.7% vs 91.4%, p\u3c0.0001). Conclusion: Small interface changes increase compliance. Interface change could be considered for key quality outcomes in patient care

Implementation of the International Association of Diabetes and Pregnancy Study Groups criteria: Not always a cause for concern

Background: Controversy surrounds the decision to adopt the International Association of Diabetes and Pregnancy Study Groups (IADPSG) criteria for the diagnosis of gestational diabetes mellitus (GDM) as fears that disease prevalence rates will soar have been raised. Aims: To investigate the prevalence of pregnancy complicated with GDM before and after the introduction of the IADPSG 2010 diagnostic criteria. Materials and Methods: A prospective audit of all women who delivered from July 1, 2010, to June 30, 2014, in a predefined geographic region within the North Metropolitan Health Service of Western Australia. Women were diagnosed with GDM according to Australian Diabetes in Pregnancy Society (ADIPS 1991) criteria until December 31, 2011, and by the IADPSG 2010 criteria after this date. Incidence of GDM and predefined pregnancy outcomes were audited. Results: Of 10,296 women, antenatal oral glucose tolerance test (OGTT) results and follow-up data were obtained for 10,103 women (98%), of whom 349 (3.5%) were diagnosed with GDM. The rate of GDM utilising ADIPS criteria was 3.4% and the rate of utilising IADPSG criteria was 3.5% ( = 0.92). Conclusion: IADPSG diagnostic criteria did not significantly increase the incidence of GDM in this low prevalence region

Survey of Australian father\u27s attitudes towards infant vaccination: Findings from the Australian Father\u27s Study

Objective: To investigate the attitudes of expectant Australian fathers towards vaccination, and to identify factors which may influence these attitudes. Methods: A cross-sectional survey study of 407 Australian men with expectant partners, mean age 30.4 (SD 6.7). Self reported attitude, level of knowledge and information resources accessed regarding pregnancy related issues. Participant demographics collected included: Age, number of children, relationship status, level of education, employment information and smoking status. Results: Majority (89%) of participants had a positive attitude towards infant vaccination, 9% felt neutral and 2% had negative attitudes. Positive attitudes towards vaccination were associated with lower self-reported knowledge of pregnancy issues but a higher likelihood of discussing pregnancy issues with health care providers rather than sourcing information from the internet (both p\u3c0.001). Conclusion: A majority of Australian expectant fathers have a positive attitude towards infant vaccination. Fathers with negative attitudes to vaccination self-reported higher levels of knowledge. They were more likely to obtain information from the Internet instead of healthcare staff. Implication for public health: Including fathers in health discussion with knowledgeable health care providers may result in increased vaccine uptake

New techniques to characterise the vaginal microbiome in pregnancy

Understanding of the vaginal microbiome in health and disease is essential to screen, detect and manage complications in pregnancy. One of the major complications of pregnancy is preterm birth, which is the leading world-wide cause of death and disability in children under five years of age. The aetiology of preterm birth is multifactorial, but a causal link has been established with infection. Despite the importance of understanding the vaginal microbiome in pregnancy in order to evaluate strategies to prevent and manage PTB, currently used culture based techniques provide limited information as not all pathogens are able to be cultured. The implementation of culture-independent high-throughput techniques and bioinformatics tools are advancing our understanding of the vaginal microbiome. New methods employing 16S rRNA and metagenomics analyses make possible a more comprehensive description of the bacteria of the human microbiome. Several studies on the vaginal microbiota of pregnant women have identified a large number of taxa. Studies also suggest reduced diversity of the microbiota in pregnancy compared to non-pregnant women, with a relative enrichment of the overall abundance of Lactobacillus species, and significant differences in the diversity of Lactobacillus spp. A number of advantages and disadvantages of these techniques are discussed briefly. The potential clinical importance of the new techniques is illustrated through recent reports where traditional culture-based techniques failed to identify pathogens in high risk complicated pregnancies whose presence subsequently was established using culture-independent, high-throughput analyses

Reforming local government: Must it always be democracy versus efficiency?

The financial crisis from 2008 has had a profound impact on Irish local government. Councils were faced with a disastrous combination of factors - declining funding from central government, difficulties in collecting commercial rates as businesses struggled, and a drastic fall in revenue from development levies. Staffing levels in the local government sector were reduced by over 20 per cent, significantly more than the losses suffered by central government ministries and departments. Yet the financial crisis also offered an opportunity for reform and a fundamental reappraisal of subnational government in Ireland. A reform strategy produced in 2012 paved the way for the Local Government Reform Act, 2014. As a result of this legislation, the number of local authorities was reduced from 114 to 31 with the complete abolition of all town councils. The number of council seats also fell from 1,627 to 949. Using Scharpf’s dimensions of democratic legitimacy, this article assesses whether the focus of the 2014 reforms was on output legitimacy (efficiency and effectiveness) as opposed to input legitimacy (citizen integration and participation)

Reconsidering directly elected mayors in Ireland: Experiences from the United Kingdom and America

As part of the proposed modernisation of Irish local government a directly elected mayor with executive powers will be introduced in Dublin in 2011. It is then anticipated that the system of elected mayors will be extended to the whole country. However, it is not known what impact this new form of executive leadership will have on the prevailing system whereby city and county managers are dominant. Drawing from experiences in the United Kingdom and the United States, this paper suggests that Ireland needs a clear, unambiguous mayoral model. As a political leader with executive powers it is imperative that the mayor’s relationships with both the council and the city/county manager are tightly defined