Current Epidemiology and Clinical Features of Cryptococcus Infection in Patients Without Human Immunodeficiency Virus: A Multicenter Study in 46 Hospitals in Australia and New Zealand.

BACKGROUND: Patients without human immunodeficiency virus (HIV) are increasingly recognized as being at risk for cryptococcosis. Knowledge of characteristics of cryptococcosis in these patients remains incomplete. METHODS: We conducted a retrospective study of cryptococcosis in 46 Australian and New Zealand hospitals to compare its frequency in patients with and without HIV and describe its characteristics in patients without HIV. Patients with cryptococcosis between January 2015 and December 2019 were included. RESULTS: Of 475 patients with cryptococcosis, 90% were without HIV (426 of 475) with marked predominance in both Cryptococcus neoformans (88.7%) and Cryptococcus gattii cases (94.3%). Most patients without HIV (60.8%) had a known immunocompromising condition: cancer (n = 91), organ transplantation (n = 81), or other immunocompromising condition (n = 97). Cryptococcosis presented as incidental imaging findings in 16.4% of patients (70 of 426). The serum cryptococcal antigen test was positive in 85.1% of tested patients (319 of 375); high titers independently predicted risk of central nervous system involvement. Lumbar puncture was performed in 167 patients to screen for asymptomatic meningitis, with a positivity rate of 13.2% where meningitis could have been predicted by a high serum cryptococcal antigen titer and/or fungemia in 95% of evaluable cases. One-year all-cause mortality was 20.9% in patients without HIV and 21.7% in patients with HIV (P = .89). CONCLUSIONS: Ninety percent of cryptococcosis cases occurred in patients without HIV (89% and 94% for C. neoformans and C. gattii, respectively). Emerging patient risk groups were evident. A high level of awareness is warranted to diagnose cryptococcosis in patients without HIV.

A randomised controlled trial investigating the effect of improving the cleaning and disinfection of shared medical equipment on healthcare-associated infections: the CLEaning and Enhanced disiNfection (CLEEN) study.

BACKGROUND: Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices. METHODS: The CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention. DISCUSSION: Evidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities. TRIAL REGISTRATION: Australia New Zealand Clinical Trial Registry ACTRN12622001143718.

Complementary medicine use among Australian patients in an acute hospital setting: an exploratory, cross sectional study.

BACKGROUND: The use of Complementary Medicines (CMs) has significantly increased in Australia over the last decade. This study attempts to determine the extent to which complementary and alternative medicines are recorded, ceased or initiated in the acute hospital setting and investigate which health professionals have a role in this process. METHODS: A cross-sectional study of inpatients was conducted at a major tertiary teaching hospital. Patient's medical records were examined to determine the rates of complementary medicine (CM) use and recording on medication charts and discharge prescriptions. Patient progress notes were audited to determine which health professionals were involved with the initiation or cessation of CMs during the inpatient stay. RESULTS: Three hundred and forty-one patients were included for analysis of which 44.3% (n = 151) participants were recorded as utilizing a CM. Patients were admitted on a mean of 2 (±1.4[Sd]; 0-9[range]) CMs and discharged on a mean of 1.7 CMs (±1.3[Sd]; 0-5[range]). 274 individual CMs were recorded on inpatient medication reconciliation forms with multivitamins, magnesium, fish oil and cholecalciferol recorded the most frequently. One hundred and fifty-eight changes to patient CM usage were recorded during the patient hospitalisation. One hundred and seven of these changes (68%) were not accounted for in the patient progress notes. CONCLUSION: Patients use of CM in this hospital setting do not reflect the national estimated usage. On the occasions that CM products are included in patient records, they are subsequently deprescribed following patient examination in hospital. It is currently unclear which health professionals have a role in this deprescribing process.

Mycobacterium abscessus infection following penetrations through wetsuits.

Mycobacterium abscessus is a rapidly growing mycobacterium which is reportedly increasing in prevalence. Infection of the skin and soft tissue with M. abscessus is rare but typically associated with trauma. We present two cases of M. abscessus infection linked by penetration through wetsuits.

Sociodemographic Variation in Consumption Patterns of Sustainable and Nutritious Seafood in Australia.

National dietary guidelines (DGs) consistently recommend consuming seafood for health benefits, however, the sustainability of increasing seafood consumption is often challenged. Seafood products vary in environmental performance as well as health benefits, yet there is no information integrating the health and ecological impacts of different seafood choices. The first step in optimising improved health and environmental outcomes is to examine more closely the types of seafood being consumed at population and individual levels, to develop the means to increase the intake of seafood that is optimal for human health and the environment. The purpose of this analysis was to better understand the specific types and amounts of seafood consumed by the Australian population, and by socioeconomic subgroups within the population, to determine the relative nutritional content and sustainability of seafood consumed by these groups. Secondary analysis of the Australian Health Survey (AHS) (2011-2013), which reached 32,000 people (25,000 households) was undertaken. The majority of respondents (83%) did not consume any seafood on the day of the survey. Results indicated the proportion of seafood consumers was lowest among adults who were unemployed, had the least education and were the most socio-economically disadvantaged. Crustaceans and farmed fish with low omega 3-content, such as basa and tilapia, were identified as the least nutritious and least sustainable seafood categories. These two categories constituted a substantial amount of total seafood intake for the lowest socio-economic consumers, and over 50% for unemployed consumers. In contrast, consumers in the highest socio-demographic group consumed mainly high trophic level fish (moderate nutrition and sustainability) and farmed fish with high omega-3 content (high nutrition, moderate sustainability). Fewer than 1% of adults or children reported eating seafood identified as both more nutritious and less resource intensive, such as small pelagics or molluscs. Opportunities exist to increase seafood intakes to improve health outcomes by varying current seafood consumption patterns to maximise nutritional outcomes and minimise environmental impacts. Initiatives to promote the health and environmental benefits of seafood should be promoted at the population level, with targeted interventions for specific groups, and should encourage consumption of highly nutritious low resource intensive types of seafood.

Australian pharmacists' knowledge of the efficacy and safety of complementary medicines.

Global usage and expenditure on complementary medicines is increasing. Over 50% of consumers purchase these products from pharmacies and expect pharmacists to provide them with appropriate information regarding efficacy and safety of these products. Internationally, pharmacists have identified their lack of detailed knowledge of the efficacy and safety of these products as a barrier to recommending these products. Currently, little is known about the actual knowledge Australian pharmacists have of these products. This research seeks to determine Australian pharmacists' knowledge of the efficacy and safety of complementary medicines. An online survey was validated and distributed by three professional pharmacy bodies in Australia and online social media to survey Australian pharmacists' knowledge of a selection of complementary medicines that are defined as having therapeutic benefits as per the Australian Therapeutic Guidelines. In total, 535 complete surveys were returned and included in the final analysis. Surveys were predominantly completed by community pharmacists. The mean knowledge score obtained was 62%. There were no statistically significantly different results from pharmacists with a nutritional qualification. Australian pharmacists appear to have a basic knowledge of complementary medicines with a defined clinical effect. Specialised and targeted education focussing on relevant and efficacious complementary medicines with strong clinical evidence base is required.

Microbial counts in hands with and without nail varnish after surgical skin preparation: a randomized control trial.

Nail varnish is commonly removed from fingernails prior to surgical procedures. We report the results of a randomized controlled trial comparing the microbial counts in hands with and without nail varnish applied, following surgical skin preparation. Forty-three patients were randomized; three patients were lost to follow-up. Each patient had one hand painted with nail varnish and had both hands tested 1 week later. There was no significant difference in terms of positive microbial growth between the nail plates or hyponichia with or without nail varnish applied. Our results demonstrate that the presence of nail varnish does not have an effect on the microbial counts of hands following surgical skin preparation. LEVEL OF EVIDENCE: I.

Consuming sustainable seafood: guidelines, recommendations and realities.

OBJECTIVE: Encouraging people to eat more seafood can offer a direct, cost-effective way of improving overall health outcomes. However, dietary recommendations to increase seafood consumption have been criticised following concern over the capacity of the seafood industry to meet increased demand, while maintaining sustainable fish stocks. The current research sought to investigate Australian accredited practising dietitians' (APD) and public health nutritionists' (PHN) views on seafood sustainability and their dietary recommendations, to identify ways to better align nutrition and sustainability goals. DESIGN: A self-administered online questionnaire exploring seafood consumption advice, perceptions of seafood sustainability and information sources of APD and PHN. Qualitative and quantitative data were collected via open and closed questions. Quantitative data were analysed with χ 2 tests and reported using descriptive statistics. Content analysis was used for qualitative data. SETTING: Australia. SUBJECTS: APD and PHN were targeted to participate; the sample includes respondents from urban and regional areas throughout Australia. RESULTS: Results indicate confusion around the concept of seafood sustainability and where to obtain information, which may limit health professionals' ability to recommend the best types of seafood to maximise health and sustainability outcomes. Respondents demonstrated limited understanding of seafood sustainability, with 7·5 % (n 6/80) satisfied with their level of understanding. CONCLUSIONS: Nutrition and sustainability goals can be better aligned by increasing awareness on seafood that is healthy and sustainable. For health professionals to confidently make recommendations, or identify trade-offs, more evidence-based information needs to be made accessible through forums such as dietetic organisations, industry groups and nutrition programmes.

A moveable feast: Exploring barriers and enablers to food citizenship.

Despite the ability of the globalised food system to deliver varied and plentiful food supplies to most in the developed world it also disconnects consumers from where, how and by whom food is grown, which discourages food citizenship. This paper uses an ecological framework to examine the individual, social, physical and macro-level environments that can positively or negatively influence peoples' engagement with food citizenship. This research used narrative inquiry methodology and purposive sampling to gather stories through focus group conversations. Fifty-two people voluntarily attended focus groups comprised of food procurers from one of five sources: community gardens, Community Supported Agriculture (CSA), farmers' markets, fresh food markets or supermarkets. A narrative was constructed for each of these groups of food procurers; their commonalities and particularities were illuminated through a final interpretive narrative. The findings showed that the community gardeners exhibited a range of personal characteristics that prioritised engagement with local food systems. The physical setting of the community garden enabled the gardeners to make connections to the earth and the people within their social networks. The CSA and farmers' market groups were cognisant of the implications of their food choices and usually proved to be food citizens, as they selected seasonal, local and ethically produced food from their farmer(s). The fresh food market shoppers were ambivalent towards organic and seasonal food and the market setting did not connect them directly to the provenance of their food. The supermarket shoppers' disconnection from those who grew their food and where it was grown disempowered them from making sustainable food choices. Adjustments to the macro-level food environment are needed to enable people to have a greater commitment to food citizenship.

A moveable feast: Contemporary relational food cultures emerging from local food networks.

Although the globalised food system delivers unparalleled food variety and quantity to most in the developed world it also disconnects consumers from where, how and by whom food is grown. This change in the food system has resulted in an acceptance of an anonymous and homogeneous food supply, which has contributed to over-consumption and the rise in diet-related diseases. 'Nutritionism' responds to this issue by maintaining that a 'healthy diet' can be achieved by consuming the correct balance of energy and nutrients, but with limited success. Yet, some food cultures can moderate the effects of the environmental drivers of increasing global obesity rates. This paper draws on this premise and presents an alternative eco-dietetic response, exploring people's meaning-making of food and food culture through local food networks. This research used narrative inquiry methodology and purposive sampling to gather stories through focus group conversations. Twenty people attended focus groups comprised of food procurers from one of three local food networks in the Canberra region: community gardens, a modified Community Supported Agriculture (CSA) and farmers' markets. The findings showed that those using local food networks enjoyed a 'contemporary relational food culture' that highlighted the importance of people, place and time, in their visceral experiences of food. The community gardeners made meaning of food through their connections to the earth and to others. The farmers' market and CSA food procurers valued the seasonal, local and ethical food produced by their beloved farmer(s). This paper provides qualitative evidence that local food networks enable people to enjoy multi-dimensional relationships to food. Further research is required to examine whether experiencing a contemporary relational food culture can lead to improved health outcomes for people and the planet.

The importance of stories in understanding people's relationship to food: narrative inquiry methodology has much to offer the public health nutrition researcher and practitioner.

OBJECTIVE: Despite the usefulness of quantitative research, qualitative research methodologies are equally needed to allow researchers to better understand the important social and environmental factors affecting food choice and eating habits. The present paper contributes insights from narrative inquiry, a well-established qualitative methodology, to a food-related doctoral research study. The connections between food shoppers and the producer, family, friends and others in the food system, between eaters and the earth, and how these connections affect people's meaning-making of food and pathways to food citizenship, were explored in the research. DESIGN: The research used narrative inquiry methodology and focus groups for data collection. SETTING: Five different food-ways in the Canberra region of Australia were selected for the present research; that is, community gardens, community-supported agriculture, farmers' markets, fresh food markets and supermarkets. SUBJECTS: Fifty-two people voluntarily attended eight focus groups with four to nine participants in each. RESULTS: From a practical perspective, the present paper offers a guide to the way in which narrative inquiry has been applied to one research project. The paper describes the application of narrative inquiry methodology, revealing the important place of narratives in generating new knowledge. The paper further outlines how phased narrative analysis can lead to a defensible and rigorous interpretive framework grounded in the data generated from people's stories and meaning-making. CONCLUSIONS: We argue that individual, social and system change will not be possible without further rigorous qualitative studies to inform and complement the empirical basis of public health nutrition practice.

Transbronchial lung biopsy (TBLB) in diagnosing pulmonary alveolar proteinosis (PAP): forgotten role in Australia?

Transbronchial lung biopsy (TBLB) is uncommonly performed in non-malignant conditions because of its low sensitivity and small tissue samples. It is not routinely performed in Australia to investigate idiopathic pulmonary fibrosis, although it can be a useful adjunct in obtaining tissue diagnosis in selected conditions in interstitial lung disease (ILD). A 52-year-old non-smoker received a living unrelated renal transplant in January 2014 but developed insidious onset of dyspnea on exertion 1 year later. Computed tomography of the thorax showed bilateral persistent ground glass opacifications with a characteristic crazy paving pattern, although P neumocystis jirovecii pneumonia was more concerning. He was treated as P neumocystis jirovecii pneumonia but his initial bronchoscopy failed to confirm either diagnoses. He then went on to TBLB that showed the presence of periodic acid-Schiff staining material. We conclude that TBLB is a useful adjunct to obtain histological diagnosis of ILD in carefully selected patients with appropriate radiological indications.

What is the real cost of our food? Implications for the environment, society and public health nutrition.

The current, globalised food system supplies 'cheap' food to a large proportion of the world's population, but with significant social, environmental and health costs that are poorly understood. The present paper examines the nature and extent of these costs for both rural and urban communities, by illustrating the financial pressures on food producers and manufacturers to produce cheap food, the disconnection people experience with how and where their food is produced, and the rise in obesity levels that plague the globe. The paper then proposes that community food systems may play an important role in mitigating the adverse environmental, economic and social effects of the dominant food system, by the use of more sustainable food production methods, the development of local economies and enabling closer connections between farmers and consumers. There are many opportunities for public health nutritionists to contribute to the local food system literature to ascertain whether these systems improve inequities, provide better access to healthy food and help stem the tide of rising global obesity levels. Public health nutritionists can play a key role in supporting people to become food citizens and to advocate for democratic and sustainable food systems.

Failure of commercial ligase chain reaction to detect Mycobacterium tuberculosis DNA in sputum samples from a patient with smear-positive pulmonary tuberculosis due to a deletion of the target region.

We report on a strain of Mycobacterium tuberculosis with a deletion in the protein antigen B gene overlapping the probe binding sites for the Abbott Diagnostics LCx M. tuberculosis (LCx-MTB) probe assay. A false-negative result with the LCx-MTB assay delayed a laboratory diagnosis of tuberculosis.