Preliminary assessment of using mobile point-of-care human papillomavirus (HPV) testing with the option of immediate colposcopy in a rural area in a high-income country: a case study.

AIM: Cervical cancer is now preventable with human papillomavirus (HPV) vaccination and HPV screening. However, structural health system barriers in rural areas can inhibit screening access. Inequitable access for rural Maori is exacerbated by social determinants and racism. Pro-equity tools, such as self-taken swabs point of care (POC) testing, now exist. This study aimed to investigate whether POC HPV testing and immediate offer of colposcopy by a mobile colposcopy service is possible at a rural community event. METHODS: This case study was a collaboration between a research centre, a women's health bus, a molecular diagnostics company, a Maori health provider and a community charity, and took place prior to the new cervical screening programme introduction at a 2-day community event-a shearathon. Eligible participants were offered a self-taken swab for HPV, which was analysed by POC testing. If high-risk HPV was detected, they were offered an immediate colposcopy. The Maori-centred qualitative component explored women's experiences of the process. RESULTS: Fourteen women undertook a self-test for HPV. High-risk HPV was detected in six women and all were offered immediate colposcopy. Six women were interviewed. All were supportive of the service. Culturally safe staff taking time to put women at ease contributed to acceptability and positive experiences. CONCLUSION: This case study shows that provision of POC HPV testing and colposcopy at a rural community event setting is possible through cross-sector collaboration. This service was acceptable to rural transient workers who face barriers to healthcare in a high-income country.

What does abortion law reform mean for primary care practitioners in New Zealand?

New Zealand achieved a major sexual reproductive health and rights milestone when abortion ceased to be a crime. Introduction of the Abortion Legislation Act 2020 has significantly changed the way abortion care can be provided in New Zealand, with the potential to improve access, reduce inequities and transform the abortion experience for those people who choose to end their pregnancy. The primary care sector stands to be a key player in the provision of first-trimester abortion care. However, with issues relating to funding, training and access to medications yet to be resolved, the health sector is not yet ready to provide best-practice abortion care within the new legislative framework.

Student use of common online resources in a multi-campus medical school.

This article was migrated. The article was marked as recommended. Background: Multi-campus medical schools can differ in medical curriculum delivery due to location specific factors, creating different learning contexts. Common online learning may reduce perceived inequities. Using a shared curriculum structure, we developed two learning resource components (topic-based learning objects and multiple-choice question banks) in Obstetrics and Gynaecology for students in our 3-campus medical school. Objective: We evaluated common learning resource use across different learning contexts. We hypothesised that students with fewer structured learning hours would make greater use of topic-based learning resources due to their perceived utility value. We also explored an alternative hypothesis; that resources more closely linked to assessment (MCQ banks) would encourage a strategic approach to learning and would be used most highly at all campuses. Methods: We assessed student opinion of the value of the resources through a cross-campus online survey, and quantified usage of the resources by analysing learning management system logs. Comparisons of response and usage patterns for the two resource components were conducted to identify if context influenced usage. Results: Survey results (RR = 70%) showed that students across campuses rated the resources as valuable. Usage logs partially supported our hypothesis that learning object usage would be highest at the campus (Campus 3) with the lowest structured learning hours in both the proportion of users (p <0.006) and frequency of access for 16 of the 26 topics (p<0.05). However, the reverse was found to be true for the question bank, with lowest usage of question banks at Campus 3 (p< 0.001). Conclusions: We interpret the results as evidence of difference in the perceived utility value of the learning resources across campuses. Clear differences in usage patterns provide evidence that different learning contexts can influence online resource use, and these contexts should be considered when evaluating the effectiveness of online learning resources.

Development and application of a LC-MS/MS assay for simultaneous analysis of 25-hydroxyvitamin-D and 3-epi-25-hydroxyvitamin-D metabolites in canine serum.

Hypovitaminosis D and hypervitaminosis D are well recognised disorders in dogs. Hypovitaminosis D can occur following consumption of a diet inadequately supplemented with vitamin D or as a sequelae of severe intestinal disease. Hypervitaminosis D may occur as a result of consuming proprietary dog foods over-supplemented with vitamin D or through ingestion of vitamin D containing medicinal products or rodenticides. Consequently, there is a clear need to establish a methodology that can accurately quantify vitamin D metabolites across a broad dynamic range in dogs. The existence of C3-epimers of vitamin D metabolites has yet to be elucidated in dogs, yet are known to interfere with the analysis of vitamin D and have unknown biological activity in other species. Here, we describe the development and validation of a sensitive, specific and robust analytical liquid chromatography tandem mass spectrometry (LC-MS/MS) assay capable of separating and accurately measuring 25-hydroxyvitamin-D2/3 (25(OH)D2/3) and 3-epi-25-hydroxyvitamin-D2/3 (3-epi-25(OH)D2/3). We describe a simplified workflow utilising supported liquid extraction (SLE) without derivatization that provides good linearity (mean r > 0.996) and accuracy across a broad dynamic range of 4-500 nmol/L for D3 metabolites and 7.8-500 nmol/L for D2 metabolites. Upon application of this assay to 117 canine serum samples, 25(OH)D3 was detectable in all samples with a median concentration of 82.1 nmol/L (inter-quartile range (IQR) 59.7-101.8 nmol/L). 3-epi-25(OH)D3 could be detected in 87.2 % of the study population, with a median concentration of 5.2 nmol/L (2.4-8.1 nmol/L). However, 3-epi-25(OH)D3 was quantified below the LLOQ in 40.2 % of these samples. 3-epi-25(OH)D3 contributed on average 6.3 % to 25(OH)D3 status (contribution ranges from 0 to 23.8%) and a positive correlation was detected between 25(OH)D3 and 3-epi-25(OH)D3 concentrations. Free 25(OH)D was also measured using an immunoassay with a median concentration of 15.2 pmol/L (12.5-23.2 pmol/L), and this metabolite was also positively correlated to both 3-epi-25(OH)D3 and 25(OH)D3 concentrations. D2 metabolites were not detected in canine serum as expected. Vitamin D metabolite concentrations were variable between individuals, and research into the causes of this variation should include factors such as breed, age, sex and neuter status to determine the impact of genetic and hormonal factors. Given the clinical importance of vitamin D in dogs, and the immense potential for utilising this species as a model for human disease, further elucidation of the vitamin D pathway in this species would provide immense clinical and research benefit.

A survey of the views and practices of abortion of the New Zealand Fellows and trainees of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

BACKGROUND: Abortion is a common procedure in New Zealand (NZ). Currently, it is only legal when two certifying consultants agree that the person seeking an abortion meets the statutory grounds outlined in Section 187A of the NZ Crimes Act (1961). The Crimes Act also states that one-half of certifying consultants must be practising obstetricians/gynaecologists. However, with abortion law reform on the political agenda, the way that abortion services are provided in NZ may change. AIM: This survey of NZ Fellows and trainees evaluates their attitudes toward training requirements for abortion, abortion care provision, and conscientious objection. MATERIALS AND METHODS: A pre-validated questionnaire was sent electronically to all NZ trainees and Fellows. Quantitative data were analysed using descriptive statistics and qualitative data analysed using generalised inductive thematic analysis. RESULTS: Most respondents (95.9%) believe that abortion should be available and 46.8% of respondents either provide abortion, or counsel women about their options and refer. The majority of respondents (73%) support abortion training in FRANZCOG and 68.5% support training in DRANZCOG. Qualitative data reflect a range of views on abortion, the role of conscientious objection in abortion care, and gestational limits. CONCLUSION: This study identifies overall support for abortion provision in NZ and abortion training. However, there is a range of views and practices of abortion among RANZCOG trainees and Fellows that reflects the complexity of the abortion debate.

Role of Pseudomonas aeruginosa PhoP-phoQ in resistance to antimicrobial cationic peptides and aminoglycosides.

Resistance to the polycationic antibiotic polymyxin B and expression of the outer-membrane protein OprH in the opportunistic pathogen Pseudomonas aeruginosa both involve the PhoP-PhoQ two-component regulatory system. The genes for this system form an operon with oprH, oprH-phoP-phoQ, that responds to Mg(2+) starvation and PhoP levels. In this study, the Mg(2+)-regulated promoter for this operon was mapped upstream of oprH by primer-extension experiments. An oprH::xylE-Gm(R) mutant H855 was constructed and measurement of the catechol 2,3-dioxygenase activity expressed from this transcriptional fusion provided evidence for a second, weak promoter for phoP-phoQ. Wild-type P. aeruginosa PAO1 strain H103 was found to exhibit Mg(2+)-regulated resistance to the alpha-helical antimicrobial cationic peptide CP28 in addition to its previously characterized resistance to polymyxin B. Resistance to this peptide was unchanged in the OprH-null mutant H855 and a PhoP-null mutant H851. In contrast, PhoQ-null mutant H854 demonstrated constitutive CP28 resistance. Northern blot analysis revealed constitutive expression of phoP in this strain, implicating PhoP-PhoQ in the resistance of P. aeruginosa to cationic peptides. Furthermore, all three null-mutant strains demonstrated increased resistance to the aminoglycoside antibiotics streptomycin, kanamycin and amikacin. Two additional mutant strains, H895 and H896, were constructed that carried unmarked deletions in oprH and were found to exhibit aminoglycoside susceptibility equivalent to that of the wild-type. This result provided definitive evidence that OprH is not involved in P. aeruginosa aminoglycoside resistance and that the changes in resistance in strain H855 and a previously reported oprH mutant were due to polar effects on phoP-phoQ rather than loss of OprH expression. A role for PhoP-PhoQ in resistance to aminoglycosides is envisaged that is distinct from that in resistance to cationic peptides and polymyxin B.