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From 2015 onwards, the number of vancomycin-resistant Enterococcus faecium (VREfm) isolates increased in Tasmania. Previously, we examined the transmission of VREfm at the Royal Hobart Hospital (RHH). In this study, we performed a state-wide analysis of VREfm from Tasmania’s four public acute hospitals. Whole-genome analysis was performed on 331 isolates collected from screening and clinical specimens of VREfm. In silico multi-locus sequence typing (MLST) was used to determine the relative abundance of broad sequence types (ST) across the state. Core genome MLST (cgMLST) was then applied to identify potential clades within the ST groupings followed by single-nucleotide polymorphic (SNP) analysis. This work revealed that differences in VREfm profiles are evident between the state’s two largest hospitals with the dominant vanA types being ST80 at the RHH and ST1421 at Launceston General Hospital (LGH). A higher number of VREfm cases were recorded at LGH (n = 54 clinical, n = 122 colonization) compared to the RHH (n = 14 clinical, n = 67 colonization) during the same time period, 2014–2016. Eleven of the clinical isolates from LGH were vanA and belonged to ST1421 (n = 8), ST1489 (n = 1), ST233 (n = 1), and ST80 (n = 1) whereas none of the clinical isolates from the RHH were vanA. For the recently described ST1421, cgMLST established the presence of individual clusters within this sequence type that were common to more than one hospital and that included isolates with a low amount of SNP variance (≤16 SNPs). A spatio-temporal analysis revealed that VREfm vanA ST1421 was first detected at the RHH in 2014 and an isolate belonging to the same cgMLST cluster was later collected at LGH in 2016. Inclusion of isolates from two smaller hospitals, the North West Regional Hospital (NRH) and the Mersey Community Hospital (MCH) found that ST1421 was present in both of these institutions in 2017. These findings illustrate the spread of a recently described sequence type of VREfm, ST1421, to multiple hospitals in an Australian state within a relatively short time span.

In 2015, a marked increase in vancomycin-resistant Enterococcus faecium (VREfm) isolation was detected at the Royal Hobart Hospital, Australia. The primary objective of this work was to examine the dynamics of VREfm transmission using whole genome data mapped to public health surveillance information. Screening and clinical isolates of VREfm from patients were typed for the specific vancomycin-resistance locus present. Of total isolates collected from 2014–2016 (n = 222), 15.3% and 84.7% harboured either the vanA or the vanB vancomycin-resistance locus, respectively. Whole-genome sequencing of 80 isolates was performed in conjunction with single-nucleotide polymorphic (SNP) analysis and in silico multi-locus sequence typing (MLST). Among the isolates sequenced, 5 phylogenetic clades were identified. The largest vanB clade belonged to MLST sequence type ST796 and contained clinical isolates from VREfm infections that clustered closely with isolates from colonised patients. Correlation of VREfm genotypes with spatio-temporal patient movements detected potential points of transmission within the hospital. ST80 emerged as the major vanA sequence type for which the most likely index case of a patient cluster was ascertained from SNP analyses. This work has identified the dominant clones associated with increased VREfm prevalence in a healthcare setting, and their likely direction of transmission.

There have been efforts worldwide to reduce the incidence of hospital-onset Staphylococcus aureus bacteremia (SAB). This longitudinal study demonstrates a nationwide reduction in both methicillin-resistant and methicillin-susceptible SAB in Australia. Background. Staphylococcus aureus bacteremia (SAB) is a serious cause of morbidity and mortality. This longitudinal study describes significant reductions in hospital-onset SAB (HO-SAB) in Australian hospitals over the past 12 years. Methods. An observational cohort study design was used. Prospective surveillance of HO-SAB in 132 hospitals in Australia was undertaken. Aggregated data from all patients who acquired HO-SAB was collected (defined as 1 or more blood cultures positive for S. aureus taken from a patient who had been admitted to hospital for >48 hours). The primary outcome was the incidence of HO-SAB, including both methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) S. aureus strains. Results. A total of 2733 HO-SAB cases were identified over the study period, giving an aggregate incidence of 0.90 per 10 000 patient-days (PDs) (95% confidence interval [CI], .86–.93). There was a 63% decrease in the annual incidence, from 1.72 per 10 000 PDs in 2002 (95% CI, 1.50–1.97) to 0.64 per 10 000 PDs (95% CI, .53–.76) in 2013. The mean reduction per year was 9.4% (95% CI, −8.1% to −10.7%). Significant reductions in both HO-MRSA (from 0.77 to 0.18 per 10 000 PDs) and HO-MSSA (from 1.71 to 0.64 per 10 000 PDs) bacteremia were observed. Conclusions. There was a major and significant reduction in incidence of HO-SAB caused by both MRSA and MSSA in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time. It suggests that national and local efforts to reduce the burden of healthcare-associated infections have been very successful.

The government's response to an online petition calling for fair pay for nurses is disgusting (news, 16 November). Ministers should come to a trust unexpectedly - without the trust suddenly having enough staff just for the visit. Only then will they appreciate how nurses try to manage a ward with patients all with differing diagnoses, helped only by agency and bank staff who may not know the hospital, let alone the ward.

BACKGROUND: Childhood abuse is a major global and public health problem associated with a myriad of adverse outcomes across the life course. Suicide is one of the leading causes of mortality during the perinatal period. However, few studies have assessed the relationship between experiences of childhood abuse and suicidal ideation in pregnancy. OBJECTIVE: We sought to examine the association between exposure to childhood abuse and suicidal ideation among pregnant women. STUDY DESIGN: A cross-sectional study was conducted among 2964 pregnant women attending prenatal clinics in Lima, Peru. Childhood abuse was assessed using the Childhood Physical and Sexual Abuse Questionnaire. Depression and suicidal ideation were assessed using the Patient Health Questionnaire-9 scale. Logistic regression procedures were performed to estimate adjusted odds ratios and 95% confidence intervals adjusted for potential confounders. RESULTS: Overall, the prevalence of childhood abuse in this cohort was 71.8% and antepartum suicidal ideation was 15.8%. The prevalence of antepartum suicidal ideation was higher among women who reported experiencing any childhood abuse compared to those reporting none (89.3% vs 10.7%, P

Objective To describe the current epidemiology of Clostridium difficile infection (CDI) in Tasmania Design, setting and participants Tasmania undertakes continuous surveillance for CDI at all public hospitals. Data on cases of CDI between 2006 and 2010 were examined. All positive tests occurring within 8 weeks of a previous case, and cases occurring in children less than 2 years old were excluded, consistent with national definitions. Only cases identified at public hospitals were included in the analysis Main outcome measures The rate of CDI in Tasmanian hospitals over the study period and the ability to demonstrate the effect of variances in surveillance definitions. Results A total of 357 cases of CDI were reported over the study period – a rate of 3.08 per 10 000 patient care days (95%CI 2.90–3.27) or 0.94 per 1000 patient separations (95%CI 0.91–0.98) for hospital-identified cases of CDI. Yearly rates for the period 2006 to 2010 were 2.3, 3.2, 2.8 and 3.9 per 10 000 patient care days, respectively. The overall trend was an increase in cases over the study period. The CDI rate from 2009–10 was significantly higher than that from 2008–09. Of the total cases reported,64% were healthcare-associated, healthcare-facility onset (HCAHFO), equating to a rate of 2.1 per 10 000 patient care days over the 4-year period. Conclusion The Tasmanian rate of HCA HFO is increasing, and appears to be greater than that reported by other Australian states, but is less than many northern hemisphere regions, where hypervirulent strains of C. difficile are causing increasing morbidity and mortality. It is difficult to compare reported rates of CDI nationally and internationally owing to inconsistencies in study duration, denominator selection, testing effort and testing methodology. This study demonstrates the need for national standards for CDI testing and reporting.

Catheter-associated urinary tract infections (CAUTIs) occur frequently in healthcare settings. The insertion and maintenance of indwelling urinary catheters is a routine element of healthcare. In order to prevent CAUTI, it is important that healthcare professionals providing catheter care understand the indications for catheter use and the correct procedure for insertion and maintenance of catheters. This paper reviews and summarises three recent key publications on the prevention of CAUTIs and proposes the use of a care bundle and checklist for catheter indications, insertion and maintenance, and quality improvement.

The American Dental Education Association's Admissions Committee Workshop (ADEA ACW) was designed to challenge dental school administrators and admissions committee members to review their current admissions practices and to explore ways to attract a more diverse student body. Presented at the invitation of dental schools, this half-day interactive workshop provides opportunities for a dental school's administrators, staff, and admissions committee members to learn about the value of diversity in the educational environment and how to implement holistic admissions practices that take into consideration the experiences, attributes, and metrics of candidates for admission. This report explores the rationale for the development of the ADEA ACW, discusses lessons learned from presentation of the workshop at more than twenty-seven U.S. dental schools, and tracks enrollment trends of underrepresented minority students in dental schools where the workshop has been presented.

Drawing on the interconnection of workforce diversity and oral health access, the American Dental Education Association (ADEA) is leading a novel approach to improve student body diversity in U.S. dental schools through an admissions committee development program. With funding provided by the Pipeline, Profession, and Practice: Community-Based Dental Education program and the Robert Wood Johnson Foundation, ten dental directors/deans of admissions from a cross-section of U.S. dental schools were selected through a competitive application process to participate in a Train-the-Trainers Admissions Committee Workshop. After completing intensive training that was built on legally sound admissions practices, these new trainers copresented ADEA Admissions Committee Workshops in two-member teams at six U.S. dental schools. This report summarizes the evaluation of both the train-the-trainers workshop and six workshops held in summer 2009. Also summarized are post-workshop outcomes relative to structural diversity at the participating schools.

Despite the growth in literature on the merits of treatment, opinion remains divided about the lack of relevant evaluative research on the effectiveness of psychological treatments for sexual offenders. This study reports a systematic review of randomised control trials reporting the effectiveness of sexual offender treatment programmes. Electronic and hand searches were carried out for randomised control trials published between 1998 and 2003. Searches revealed nine randomised control trials (RCTs) and these contained data on the treatment of over 500 men, 231 of whom have been followed up for 10 years. Analysis of the nine trials showed that cognitive behavioural therapy (CBT) in groups reduced re-offence at one year compared with standard care (n = 155) but increased re-arrest at 10 years. The implications of these findings and the subsequent use of randomised control trials in clinical policy and research are discussed.

This paper reports the method and results of a systematic review of the international literature on psychological interventions with adult sexual offenders and those showing abusive sexual behaviours. It provides the results of quasi-experimental and qualitative research in this area and is linked to our previous paper in this volume (a meta-analysis of randomised control trials). The research shows that 21 studies which used quasi-experimental methodologies met the criteria for inclusion. Of these, seven studies found significant effects and 10 revealed no significant effects. As with the review of the experimental literature, there is little consensus on the capabilities of interventions from varying theoretical backgrounds in altering offenders' behaviour or attitudes. In the review of the qualitative literature, the research team identified four studies which met the Cochrane guidelines for inclusion. Valuable findings from the studies include crucial contextual information on the barriers to and facilitation of effective treatment. Three process evaluations were found; in two of these data were analysed using grounded theory, and one exploratory study was found which used thematic content analysis. However, no large process evaluations of interventions were found of sophistication or complexity, suggesting a paucity of sound qualitative research in the area. The paper concludes by suggesting the implications of this for policy-makers and practitioners working with this group of offenders.

Background In recent year, national bodies have been actively addressing the increasing concern on the spread of healthcare-associated infections (HAIs). The current study measures the knowledge, intentions and beliefs of third-year Australian nursing students on key infection prevention and control (IPC) concepts. Methods A cross-sectional study of final-year undergraduate nursing students from Schools of Nursing at six Australian universities was undertaken. Students were asked to participate in an anonymous survey. The survey explored knowledge of standard precautions and transmission based precautions. In addition intentions and beliefs towards IPC were explored. Results 349 students from six universities completed the study. 59.8% (95% CI 58.8–60.8%) of questions were answered correctly. Significantly more standard precaution questions were correctly answered than transmission-based precaution questions (p

Speech-language pathologists and social workers at the three Aphasia Centres in Ontario, Canada, work in partnership with aphasic adults and their families to increase communicative access to participation in various aspects of social and community life. The delivery of optimal service in this context requires an expansion of the traditional role played by speech-language pathologists in the field of aphasia. Illustrative ideas, activities, and programs developed by the three centers are described with emphasis on the benefits of a professional partnership between the professions of speech-language pathology and social work.

Drawing on the interconnection of workforce diversity and oral health access, the American Dental Education Association (ADEA) is leading a novel approach to improve student body diversity in U.S. dental schools through an admissions committee development program. With funding provided by the Pipeline, Profession, and Practice: Community-Based Dental Education program and the Robert Wood Johnson Foundation, ten dental directors/deans of admissions from a cross-section of U.S. dental schools were selected through a competitive application process to participate in a Train-the-Trainers Admissions Committee Workshop. After completing intensive training that was built on legally sound admissions practices, these new trainers copresented ADEA Admissions Committee Workshops in two-member teams at six U.S. dental schools. This report summarizes the evaluation of both the train-the-trainers workshop and six workshops held in summer 2009. Also summarized are post-workshop outcomes relative to structural diversity at the participating schools.

The American Dental Education Association's Admissions Committee Workshop (ADEA ACW) was designed to challenge dental school administrators and admissions committee members to review their current admissions practices and to explore ways to attract a more diverse student body. Presented at the invitation of dental schools, this half-day interactive workshop provides opportunities for a dental school's administrators, staff, and admissions committee members to learn about the value of diversity in the educational environment and how to implement holistic admissions practices that take into consideration the experiences, attributes, and metrics of candidates for admission. This report explores the rationale for the development of the ADEA ACW, discusses lessons learned from presentation of the workshop at more than twenty-seven U.S. dental schools, and tracks enrollment trends of underrepresented minority students in dental schools where the workshop has been presented.

To the Editor—We thank Worth and colleagues [1] for reflecting on some important points related to our recent study where we reported a 63% reduction in hospital-onset (HO) Staphylococcus aureus bacteremia (SAB) in Australia [2]. We agree that the HO-SAB definition used in our study is not the national definition currently used for healthcare-associated (HCA) SAB surveillance in Australian hospitals. We commented on this in the discussion. Authors of our study have previously made similar comments to those made by Worth and colleagues [3–8]. For the purposes of benchmarking Australia internationally, we believe a HO-SAB definition is a robust and accurate approach to identify any real reduction in SAB—the aim of the paper. Capturing all HCA-SAB cases requires much more additional work by infection control professionals and infectious diseases physicians at a local level. In addition, collecting such additional surveillance requires validation [9, 10], potentially lacking in parts of Australia. However, there are 2 important reasons why we used only a HO-SAB definition in our study. First, we wanted to report data over a long time frame, 12 years of data. The HCA-SAB definition was not agreed upon by Health Ministers until 2008 in Australia, meaning previous longitudinal prospective data were not collected consistently. Retrospective analysis would have been very difficult and likely subject to bias. Second, the HO-SAB definition allows for international comparisons, whereas the HCA-SAB definition does not. Without using a HO-SAB definition, we would not have been able to undertake the comparisons outlined in our discussion. We fully support the use of HCA-SAB surveillance definition and hope that many other countries move to such a definition for the reasons described by Worth and colleagues. We believe that when data are presented, HO-SAB should be presented as a subset of the total HCA-SAB numbers where possible. Comparisons can then be made with studies that have not used the more inclusive definition. The conclusions in our study are consistent with the definitional approach we used. We never stated or implied that we tried to measure and report all cases of HCA-SAB. We acknowledge the point made by Worth and colleagues regarding data analysis and model adjustment for heterogeneity and multistate frailty. We are not convinced that this extra complexity in analysis is needed to demonstrate the points made. Regardless, under the agreements with those providing data for our study, only aggregated hospital data were to be analyzed and published, so the proposed analysis was not possible. What our data showed was a major and significant reduction in incidence of HO-SAB over a 12-year period caused by both methicillin-resistant and methicillin-sensitive S. aureus in Australian hospitals since 2002. This reduction coincided with a range of infection prevention and control activities implemented during this time [2]. It suggests that national and local efforts to reduce the burden have been very successful. As we commented, there are many potential reasons for the reductions in HO-SAB observed in our study, and Worth and colleagues are correct in acknowledging the important role that surveillance and multiple interventions play [11, 12].

Drugs, crime and public health: the political economy of drug policy, by Alex Stevens, London, Routledge, 2011, 202 pp., ISBN 10: 0-415-49104-5/13: 978-0-415-49101-4 As suggested by its title, this...

The paper attempts to reconcile the conflicting concerns about information as a public resource and information as an economic commodity within an information society. The free and uncompensated distribution of information can be rationalized within the context of an agricultural or manufacturing society as a means for furthering the economic interests of the group; however, an information society requires a global economy which is interdependent, for information societies cannot survive without outside support for basic goods and needs. Such a society requires a legal system which recognizes the value of the contribution of those who engage in the creative process. The paper discusses various property rights in information, including rights of access, rights of confidentiality, and rights of reply. The paper also discusses jurisdictional questions concerning the structure of information transport systems, as well as the applicability of the GATT to telecommunications services and information pro...

The United States and Japan lead the world in information technology. Yet they occupy opposite ends of the spectrum with respect to planning for the development of the information infrastructure—the central nervous system of a democratic society. While the Japanese expend great resources on centralized planning and monitoring the impact of the information society, United States officials are engaged in a mammoth deregulation exercise intended to dismantle government involvement in the competitive marketplace. While this policy may be appropriate for a period of technological innovation, it may be less efficacious in the period of consolidation, merger, and acquisition which usually follows.