Influence of physicochemical parameters on PPCP occurrences in the wetlands

There have been many global studies on the occurrence and distribution of pharmaceuticals and personal care products (PPCPs) in the aquatic resources, but reports on the effects of physicochemical properties of water on their concentrations are very scarce. The amounts and removal of these contaminants in various environmental media are dependent on these physicochemical properties, which include pH, temperature, electrical conductivity, salinity, turbidity, and dissolved oxygen. Here, we reviewed the influence of these properties on determination of PPCPs. Reports showed that increase in turbidity, electrical conductivity, and salinity gives increase in concentrations of PPCPs. Also, neutral pH gives higher PPCP concentrations, while decrease in temperature and dissolved oxygen gives low concentration of PPCPs. Nevertheless, it is quite challenging to ascertain the influence of water quality parameters on the PPCP concentration, as other factors like climate change, type of water, source of pollution, persistence, and dilution factor may have great influence on the concentration of PPCPs. Therefore, routine monitoring is suggested as most water quality parameters vary because of effects of climate change.

Nursing Students' Perspectives and Readiness to Transition to E-Learning During COVID-19 in the UAE: A Cross-Sectional Study

INTRODUCTION

The 2020 COVID-19 crisis affected all sectors, including education. This study explored the experiences and challenges faced by tertiary students in the United Arab Emirates when they were suddenly required to transition from traditional classroom learning to E-learning following the outbreak of COVID-19.

METHODS

This cross-sectional study used mixed methods to collect and analyse qualitative and quantitative data. The participants were Nursing students involved in clinical training.

RESULTS

Most students (87%) reported inexperience with studying via E-learning. Challenges encountered included the lack of privacy, Internet connection issues, problems with the teaching platform and communication difficulties. Some students also reported that instructors were slow at responding to their needs. The lack of robust internet coverage was a major overarching issue that affected communication, students' engagement, preparedness for E-learning, and other challenges.

DISCUSSION

This study is significant because it highlights the challenges experienced by Nursing Students during the rapid transition from traditional education to e-learning. It enables the faculty to understand and support students during the time of crisis. Communication with students needs to be streamlined for successful E-learning. Authorities should provide more essential infrastructure such as reliable and stable Internet connectivity to strengthen the E-learning approach.

Prevalence of Generalised Anxiety Disorders Among Clinical Training Students at the University of Sharjah

Introduction

This study aimed to determine the prevalence of anxiety among clinical training students. Despite the existence of interventions that address anxieties, lack of data on the size of the problem, especially in the Middle East where mental health stigmatized, means that outcomesmay not be maximized.

Materials and Methods

Our study was cross-sectional survey of the University of Sharjah (UOS), the United Arab Emirates students undergoing clinical training in health sciences. The participants were selected from all the three UOS campuses: medical and science colleges; women's colleges; and men's colleges. A sample of 219 clinical training students were randomly sent an electronic link to participate on an online survey. The study received ethical approval from the UOS Research Ethics Committee number is REC-20-03-04-02-S.

Results

The mean score for state anxiety was 47.24±1.31 and the mean score for trait anxiety was 46.82±1.21. These scores indicated a high level of anxiety among students undertaking clinical training. Overall, 63% of the sample were classified as having high state anxiety, and 62% had high trait anxiety.

Conclusion

This study shows clinical training students experience high levels of state and trait anxiety. It is necessary to address this issue to improve the conditions and circumstances for students entering clinical training. It may also be necessary to implement strategies to enable students with anxiety to perform well in clinical training.

Evaluation of early-generation tropical maize testcrosses for grain-yield potential and weevil (Sitophilus zeamais Motschulsky) resistance

Smallholder maize farmers in Africa experience pre- and post-harvest production stresses either individually or in combination at different stages of the crop cycle. The maize weevil is among the major post-harvest storage pests. A strategy to address this problem is to develop and promote high yielding maize germplasm with resistance to multiple stresses. A study was conducted to: 1) assess yield and agronomic performance of testcross hybrids developed from early generation lines; and 2) assess the response of the testcross hybrids to infestation with Sitophilus zeamais. Fifty-eight drought-tolerant testcross hybrids were evaluated for agronomic performance and weevil resistance at four environments in Uganda in 2016. Hybrid G39 (L2/T2) had the best grain yield performance; it significantly out-performed the best check by 11.4% in all environments. Hybrid grain from field trials was subjected to Sitophilus zeamais infestation in a choice and no choice test under laboratory conditions. Hybrids G56 (L49/T2) and G58 (L51/T2) had the least weevil damage and were rated as resistant to Sitophilus zeamais. The numbers of damaged kernels, number of exit holes and ear aspect were positively correlated with the grain weight loss. The results suggest possibilities for simultaneous selection for high grain yield and storage insect pest resistance among drought-tolerant genotypes. Use of high-yielding and resistant maize hybrids to storage insect pest should be promoted for increased maize production and managing post-harvest losses due to the maize weevil in smallholder farming communities in Africa.

Factors Influencing Genomic Prediction Accuracies of Tropical Maize Resistance to Fall Armyworm and Weevils

Genomic selection (GS) can accelerate variety improvement when training set (TS) size and its relationship with the breeding set (BS) are optimized for prediction accuracies (PAs) of genomic prediction (GP) models. Sixteen GP algorithms were run on phenotypic best linear unbiased predictors (BLUPs) and estimators (BLUEs) of resistance to both fall armyworm (FAW) and maize weevil (MW) in a tropical maize panel. For MW resistance, 37% of the panel was the TS, and the BS was the remainder, whilst for FAW, random-based training sets (RBTS) and pedigree-based training sets (PBTSs) were designed. PAs achieved with BLUPs varied from 0.66 to 0.82 for MW-resistance traits, and for FAW resistance, 0.694 to 0.714 for RBTS of 37%, and 0.843 to 0.844 for RBTS of 85%, and these were at least two-fold those from BLUEs. For PBTS, FAW resistance PAs were generally higher than those for RBTS, except for one dataset. GP models generally showed similar PAs across individual traits whilst the TS designation was determinant, since a positive correlation (R = 0.92***) between TS size and PAs was observed for RBTS, and for the PBTS, it was negative (R = 0.44**). This study pioneered the use of GS for maize resistance to insect pests in sub-Saharan Africa.

An atoxigenic L-strain of Aspergillus flavus (Eurotiales: Trichocomaceae) is pathogenic to the coffee twig borer, Xylosandrus compactus (Coleoptera: Curculionidea: Scolytinae)

This study isolated and evaluated virulence of fungal entomopathogens of Xylosandrus compactus - an important pest of Robusta coffee in Sub-Saharan Africa. A survey was conducted in five farming systems in Uganda to isolate entomopathogens associated with X. compactus. Four fungal isolates were screened for virulence against X. compactus in the laboratory at 1 × 10⁷ conidia ml^-1 where an atoxigenic L-strain of A. flavus killed 70%-100% of all stages of X. compactus compared with other unidentified isolates which caused 20%-70% mortalities. The time taken by A. flavus to kill 50% of X. compactus eggs, larvae, pupae and adults in the laboratory was 2-3 days; whereas the other unidentified fungal isolates took 4-7 days. The concentrations of A. flavus that killed 50% of different stages of X. compactus were 5 × 10⁵ , 12 × 10⁵ , 17 × 10⁵ and 30 × 10⁵ conidia ml^-1 for larvae, eggs, pupae and adults respectively. A formulation of A. flavus in oil caused higher mortalities of X. compactus larvae, pupae and adults in the field (71%-79%) than its formulation in water (33%-47%). The atoxigenic strain of A. flavus could therefore be developed into a safe biopesticide against X. compactus.

Awareness about Breast Cancer and Breast Self-Examination among Female Students at the University of Sharjah: A Cross-Sectional Study

Background:

Breast cancer is a leading cause of mortality among women in the United Arab Emirates (UAE). Many young women in the UAE have poor knowledge about breast cancer screening, including risk factors and warning signs/symptoms. We investigated awareness about breast cancer and breast self-examination (BSE) as a screening tool among female students at the University of Sharjah, UAE.

Methods:

This study used a cross sectional survey design. Participants were 241 undergraduate female students (aged ≥18 years) from three University of Sharjah campuses. Data were collected from March to April 2017 using a self-administered questionnaire. The questionnaire covered: sociodemographic characteristics; knowledge about breast cancer, risk factors, and warning signs/symptoms; and knowledge and practice of BSE. Data were analyzed using descriptive statistics and Pearson’s chi-square tests.

Results:

About 38.6% of participants were from the Medical campus, 37.3% were from the Women’s campus, and 24% were from the Fine Arts and Design campus. Most (99%) participants had heard of breast cancer. About 50% were knowledgeable about the risk factors, but only 38% were knowledgeable about warning signs/symptoms. The most commonly identified risk factors were family and personal histories of breast cancer, and the most commonly identified warning sign/symptom was breast lump. There was a significant association between knowledge about risk factors and campus type. Participants from the Medical campus were more knowledgeable about risk factors than participants from the other two campuses. Overall, 68.5% of participants had heard of BSE, but few participants actually performed BSE. Reasons for not performing BSE included “forgetting” and “not knowing how.”

Conclusions:

Although most participants were aware of breast cancer, knowledge about risk factors and warning signs/symptoms was relatively poor. Knowledge about performing BSE was particularly low. This highlights the importance of increasing awareness about breast cancer and BSE among young women in the UAE.

Cassava whitefly, Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) in East African farming landscapes: a review of the factors determining abundance

Bemisia tabaci (Gennadius) (Hemiptera: Aleyrodidae) is a pest species complex that causes widespread damage to cassava, a staple food crop for millions of households in East Africa. Species in the complex cause direct feeding damage to cassava and are the vectors of multiple plant viruses. Whilst significant work has gone into developing virus-resistant cassava cultivars, there has been little research effort aimed at understanding the ecology of these insect vectors. Here we assess critically the knowledge base relating to factors that may lead to high population densities of sub-Saharan African (SSA) B. tabaci species in cassava production landscapes of East Africa. We focus first on empirical studies that have examined biotic or abiotic factors that may lead to high populations. We then identify knowledge gaps that need to be filled to deliver sustainable management solutions. We found that whilst many hypotheses have been put forward to explain the increases in abundance witnessed since the early 1990s, there are little published data and these tend to have been collected in a piecemeal manner. The most critical knowledge gaps identified were: (i) understanding how cassava cultivars and alternative host plants impact population dynamics and natural enemies; (ii) the impact of natural enemies in terms of reducing the frequency of outbreaks and (iii) the use and management of insecticides to delay the development of resistance. In addition, there are several fundamental methodologies that need to be developed and deployed in East Africa to address some of the more challenging knowledge gaps.

Grain-yield stability among tropical maize hybrids derived from doubled-haploid inbred lines under random drought stress and optimum moisture conditions

Drought is a devastating environmental stress in agriculture and hence a common target of plant breeding. A review of breeding progress on drought tolerance shows that, to a certain extent, selection for high yield in stress-free conditions indirectly improves yield in water-limiting conditions. The objectives of this study were to (i) assess the genotype × environment (GE) interaction for grain yield (GY) and other agronomic traits for maize (Zea mays L.) across East African agro-ecologies; and (ii) evaluate agronomic performance and stability in Uganda and Tanzania under optimum and random drought conditions. Data were recorded for major agronomic traits. Genotype main effect plus GE (GGE) biplot analysis was used to assess the stability of varieties within various environments and across environments. Combined analysis of variance across optimum moisture and random drought environments indicated that locations, mean-squares for genotypes and GE were significant for most measured traits. The best hybrids, CKDHH1097 and CKDHH1090, gave GY advantages of 23% and 43%, respectively, over the commercial hybrid varieties under both optimum-moisture and random-drought conditions. Across environments, genotypic variance was less than the GE variance for GY. The hybrids derived from doubled-haploid inbred lines produced higher GY and possessed acceptable agronomic traits compared with the commercial hybrids. Hybrid CKDHH1098 ranked second-best under optimum-moisture and drought-stress environments and was the most stable with broad adaptation to both environments. Use of the best doubled-haploids lines in testcross hybrids make-up, well targeted to the production environments, could boost maize production among farmers in East Africa.

Health service utilisation amongst urban Aboriginal and Torres Strait Islander children aged younger than 5 years registered with a primary health-care service in South-East Queensland

AIM

The majority of Australia's Aboriginal and/or Torres Strait Islander children live in urban areas; however, little is known about their health service use. We aimed to describe health service utilisation amongst a cohort of urban Aboriginal and/or Torres Strait Islander children aged <5 years.

METHODS

We analysed health service utilisation data collected in an ongoing prospective cohort study of children aged <5 years registered with an Aboriginal-owned and operated primary health-care service. Enrolled children were followed monthly for 12 months, with data on health service utilisation collected at baseline and at each monthly follow-up. Health service utilisation rates, overall and by service provider and reason for presentation, were calculated and reported as incidence rates per 100 child-months with the corresponding 95% confidence intervals (CIs).

RESULTS

Between February 2013 and November 2015, 180 children were enrolled, and 1541 child-months of observation were available for analysis. The overall incidence of health service utilisation was 52.5 per 100 child-months (95% CI 48.7-56.5); 81% of encounters were with general practitioners. Presentation rates were the highest for acute respiratory illnesses (30.7/100 child-months, 95% CI 27.8-33.9).

CONCLUSIONS

In this community, acute respiratory illnesses are predominant causes of health service utilisation in young children. The health-care utilisation profile of these children presents important opportunities for health promotion and intervention.

Maize Combined Insect Resistance Genomic Regions and Their Co-localization With Cell Wall Constituents Revealed by Tissue-Specific QTL Meta-Analyses

Combinatorial insect attacks on maize leaves, stems, and kernels cause significant yield losses and mycotoxin contaminations. Several small effect quantitative trait loci (QTL) control maize resistance to stem borers and storage pests and are correlated with secondary metabolites. However, efficient use of QTL in molecular breeding requires a synthesis of the available resistance information. In this study, separate meta-analyses of QTL of maize response to stem borers and storage pests feeding on leaves, stems, and kernels along with maize cell wall constituents discovered in these tissues generated 24 leaf (LIR), 42 stem (SIR), and 20 kernel (KIR) insect resistance meta-QTL (MQTL) of a diverse genetic and geographical background. Most of these MQTL involved resistance to several insect species, therefore, generating a significant interest for multiple-insect resistance breeding. Some of the LIR MQTL such as LIR4, 17, and 22 involve resistance to European corn borer, sugarcane borer, and southwestern corn borer. Eleven out of the 42 SIR MQTL related to resistance to European corn borer and Mediterranean corn borer. There KIR MQTL, KIR3, 15, and 16 combined resistance to kernel damage by the maize weevil and the Mediterranean corn borer and could be used in breeding to reduce insect-related post-harvest grain yield loss and field to storage mycotoxin contamination. This meta-analysis corroborates the significant role played by cell wall constituents in maize resistance to insect since the majority of the MQTL contain QTL for members of the hydroxycinnamates group such as p-coumaric acid, ferulic acid, and other diferulates and derivates, and fiber components such as acid detergent fiber, neutral detergent fiber, and lignin. Stem insect resistance MQTL display several co-localization between fiber and hydroxycinnamate components corroborating the hypothesis of cross-linking between these components that provide mechanical resistance to insect attacks. Our results highlight the existence of combined-insect resistance genomic regions in maize and set the basis of multiple-pests resistance breeding.

Effectiveness of a cough management algorithm at the transitional phase from acute to chronic cough in Australian children aged <15 years: protocol for a randomised controlled trial

INTRODUCTION

Acute respiratory infections (ARIs) are leading causes of hospitalisation in Australian children and, if recurrent, are associated with increased risk of chronic pulmonary disorders later in life. Chronic (>4 weeks) cough in children following ARI is associated with decreased quality-of-life scores and increased health and societal economic costs. We will determine whether a validated evidence-based cough algorithm, initiated when chronic cough is first diagnosed after presentation with ARI, improves clinical outcomes in children compared with usual care.

METHODS AND ANALYSIS

A multicentre, parallel group, open-label, randomised controlled trial, nested within a prospective cohort study in Southeast Queensland, Australia, is underway. 750 children aged <15 years will be enrolled and followed weekly for 8 weeks after presenting with an ARI with cough. 214 children from this cohort with persistent cough at day 28 will be randomised to either early initiation of a cough management algorithm or usual care (107 per group). Randomisation is stratified by reason for presentation, site and total cough duration at day 28 (<6 and ≥6 weeks). Demographic details, risk factors, clinical histories, examination findings, cost-of-illness data, an anterior nasal swab and parent and child exhaled carbon monoxide levels (when age appropriate) are collected at enrolment. Weekly contacts will collect cough status and cost-of-illness data. Additional nasal swabs are collected at days 28 and 56. The primary outcome is time-to-cough resolution. Secondary outcomes include direct and indirect costs of illness and the predictors of chronic cough postpresentation.

ETHICS AND DISSEMINATION

The Children's Health Queensland (HREC/15/QRCH/15) and the Queensland University of Technology University (1500000132) Research Ethics Committees have approved the study. The study will inform best-practice management of cough in children.

TRIAL REGISTRATION NUMBER

ACTRN12615000132549.

Towards best practice in acute stroke care in Ghana: a survey of hospital services

Background

Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice.

Methods

A multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards.

Results

Availability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care.

Conclusion

This study confirms previous reports of limited and variable provision of evidence based stroke services and the low priority for stroke care in resource poor settings. Health policy initiatives to enhance uptake of evidence-based acute stroke services is required to reduce stroke-related mortality and morbidity in countries such as Ghana.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2061-2) contains supplementary material, which is available to authorized users.

The Incidence and Short-term Outcomes of Acute Respiratory Illness with Cough in Children from a Socioeconomically Disadvantaged Urban Community in Australia: A Community-Based Prospective Cohort Study

BACKGROUND

Acute respiratory illnesses with cough (ARIwC) are predominant causes of morbidity in Australian Indigenous children; however, data on disease burden in urban communities are scarce. This study aimed to determine the incidence of ARIwC, the predictors of recurrent (≥4 episodes) ARIwC, and development of chronic cough following an ARIwC in urban, predominantly Indigenous, children aged <5 years from northern Brisbane, Australia.

METHODS

Prospective cohort study of children aged <5 years registered with a primary healthcare center. ARIwC episodes and outcomes were collected for 12 months. Recurrent ARIwC was defined as ≥4 episodes in 12 months. Chronic cough was defined as cough lasting >4 weeks. Children who developed chronic cough were reviewed by a pediatric pulmonologist. Incidence densities per child-month of observation were calculated and predictors of recurrent ARIwC and chronic cough were evaluated in logistic regression models.

RESULTS

Between February 2013 and November 2015, 200 children were enrolled; median age of 18.1 months, range (0.7-59.7 months) and 90% identified as Indigenous. A total of 1,722 child-months of observation were analyzed (mean/child = 8.58, 95% CI 8.18-9.0). The incidence of ARIwC was 24.8/100 child-months at risk (95% CI 22.3-27.5). Twenty-one children (10.5%) experienced recurrent ARIwC. Chronic cough was identified in 70/272 (25.7%) episodes of ARIwC. Predictors of recurrent ARIwC were presence of eczema, mold in the house, parent/carer employment status, and having an Aboriginal and Torres Strait Islander mother/non-Aboriginal and Torres Strait Islander father (compared to both parents being Aboriginal and Torres Strait Islander). Predictors of chronic cough included being aged <12 months, eczema, childcare attendance, previous history of cough of >4 weeks duration, having an Aboriginal and Torres Strait Islander mother/non-Aboriginal and Torres Strait Islander father (compared to both parents being Aboriginal and Torres Strait Islander), and a low income. Of those with chronic cough reviewed by a pediatric pulmonologist, a significant underlying disorder was found in 14 children (obstructive sleep apnea = 1, bronchiectasis = 2, pneumonia = 2, asthma = 3, tracheomalacia = 6).

DISCUSSION

This community of predominantly Aboriginal and Torres Strait Islander and socially disadvantaged children bear a considerable burden of ARIwC. One in 10 children will experience more than three episodes over a 12-month period and 1 in five children will develop chronic cough post ARIwC, some with a serious underlying disorder. Further larger studies that include a broader population base are needed.

The effect of payment and incentives on motivation and focus of community health workers: five case studies from low- and middle-income countries

INTRODUCTION

Community health workers (CHWs) have been proposed as a means for bridging gaps in healthcare delivery in rural communities. Recent CHW programmes have been shown to improve child and neonatal health outcomes, and it is increasingly being suggested that paid CHWs become an integral part of health systems. Remuneration of CHWs can potentially effect their motivation and focus. Broadly, programmes follow a social, monetary or mixed market approach to remuneration. Conscious understanding of the differences, and of what each has to offer, is important in selecting the most appropriate approach according to the context.

CASE DESCRIPTIONS

The objective of this review is to identify and examine different remuneration models of CHWs that have been utilized in large-scale sustained programmes to gain insight into the effect that remuneration has on the motivation and focus of CHWs. A MEDLINE search using Ovid SP was undertaken and data collected from secondary sources about CHW programmes in Iran, Ethiopia, India, Bangladesh and Nepal. Five main approaches were identified: part-time volunteer CHWs without regular financial incentives, volunteers that sell health-related merchandise, volunteers with financial incentives, paid full-time CHWs and a mixed model of paid and volunteer CHWs.

DISCUSSION AND EVALUATION

Both volunteer and remunerated CHWs are potentially effective and can bring something to the health arena that the other may not. For example, well-trained, supervised volunteers and full-time CHWs who receive regular payment, or a combination of both, are more likely to engage the community in grass-roots health-related empowerment. Programmes that utilize minimal economic incentives to part-time CHWs tend to limit their focus, with financially incentivized activities becoming central. They can, however, improve outcomes in well-circumscribed areas. In order to maintain benefits from different approaches, there is a need to distinguish between CHWs that are trained and remunerated to be a part of an existing health system and those who, with little training, take on roles and are motivated by a range of contextual factors. Governments and planners can benefit from understanding the programme that can best be supported in their communities, thereby maximizing motivation and effectiveness.

The use of common bean (Phaseolus vulgaris) traditional varieties and their mixtures with commercial varieties to manage bean fly (Ophiomyia spp.) infestations in Uganda

The bean fly (Ophiomyia spp.) is considered the most economically damaging field insect pest of common beans in Uganda. Despite the use of existing pest management approaches, reported damage has remained high. Forty-eight traditional and improved common bean varieties currently grown in farmers' fields were evaluated for resistance against bean fly. Data on bean fly incidence, severity and root damage from bean stem maggot were collected. Generalized linear mixed model (GLMM) revealed significant resistance to bean fly in the Ugandan traditional varieties. A popular resistant traditional variety and a popular susceptible commercial variety were selected from the 48 varieties and evaluated in pure and mixed stands. The incidence of bean fly infestation on both varieties in mixtures with different arrangements (systematic random versus rows), and different proportions within each of the two arrangements, was measured and analysed using GLMMs. The proportion of resistant varieties in a mixture and the arrangement type significantly decreased bean fly damage compared to pure stands, with the highest decrease in damage registered in the systematic random mixture with at least 50 % of resistant variety. The highest reduction in root damage, obvious 21 days after planting, was found in systematic random mixtures with at least 50 % of the resistant variety. Small holder farmers in East Africa and elsewhere in the world have local preferences for growing bean varieties in genetic mixtures. These mixtures can be enhanced by the use of resistant varieties in the mixtures to reduce bean fly damage on susceptible popular varieties.

The respiratory health of urban indigenous children aged less than 5 years: study protocol for a prospective cohort study

BACKGROUND

Despite the burden of acute respiratory illnesses (ARI) among Aboriginal and Torres Strait Islander children being a substantial cause of childhood morbidity and associated costs to families, communities and the health system, data on disease burden in urban children are lacking. Consequently evidence-based decision-making, data management guidelines, health resourcing for primary health care services and prevention strategies are lacking. This study aims to comprehensively describe the epidemiology, impact and outcomes of ARI in urban Aboriginal and Torres Strait Islander children (hereafter referred to as Indigenous) in the greater Brisbane area.

METHODS/DESIGN

An ongoing prospective cohort study of Indigenous children aged less than five years registered with a primary health care service in Northern Brisbane, Queensland, Australia. Children are recruited at time of presentation to the service for any reason. Demographic, epidemiological, risk factor, microbiological, economic and clinical data are collected at enrolment. Enrolled children are followed for 12 months during which time ARI events, changes in child characteristics over time and monthly nasal swabs are collected. Children who develop an ARI with cough as a symptom during the study period are more intensely followed-up for 28 (±3) days including weekly nasal swabs and parent completed cough diary cards. Children with persistent cough at day 28 post-ARI are reviewed by a paediatrician.

DISCUSSION

Our study will be one of the first to comprehensively evaluate the natural history, epidemiology, aetiology, economic impact and outcomes of ARIs in this population. The results will inform studies for the development of evidence-based guidelines to improve the early detection, prevention and management of chronic cough and setting of priorities in children during and after ARI.

TRIAL REGISTRATION

Australia New Zealand Clinical Trial Registry Registration Number: 12614001214628 . Registered 18 November 2014.

How much does intellectual disability really cost? First estimates for Australia

BACKGROUND

Given the paucity of relevant data, this study estimates the cost of intellectual disability (ID) to families and the government in Australia.

METHOD

Family costs were collected via the Client Service Receipt Inventory, recording information relating to service use and personal expense as a consequence of ID. Government expenditure on the provision of support and services was estimated using top-down costing.

RESULTS

A total of 109 parents participated. The cost of ID in Australia is high, especially for families. Total economic costs of ID are close to $14,720 billion annually. Opportunity cost of lost time provided 85% of family expense. A comparison of family expense and social welfare benefits received suggests that families suffer considerable loss. This may impact on families' physical and emotional wellbeing.

CONCLUSIONS

Monitoring of changes in expenditure is required. Policies should ensure that money devoted to ID is allocated in a rational, equitable, and cost-effective manner.

Linking acute care to a strategy for improving Aboriginal health

In this paper we consider the extent to which strategies to improve access to acute care services have been integrated with national strategies to improve Aboriginal health outcomes. To do this we review the primary and secondary sources and provide an overview of current national strategy in Aboriginal health and identify where policy and strategic issues relevant to acute care have been developed. In particular we consider the extent to which national policy processes have focussed on the interface between the primary and acute sectors. It is our contention that nationally integrated strategies to improve access to the acute care sector require the development of an Aboriginal health focus in hospital based quality assurance processes and a comprehensive engagement with Aboriginal issues across the acute care sector.