Polycyclic aromatic hydrocarbons (PAHs) in mangrove ecosystems: A review.

Polycyclic aromatic hydrocarbons (PAHs) are organic pollutants of increasing concern in the different fields of the environment and human health. There are 16 of them that are recognized as priority pollutants by the US environmental protection agency due to their mutagenic and carcinogenic potentials. Due to their hydrophobicity and stability, they are persistent in the environment and can be transported over long distances. Their toxicological effects on multiple species, including humans, as well as their bioaccumulation in the food web became major topics in organic pollutants research this last decade. In the environment, multiple studies have been conducted on their accumulation in the soil and their degradation processes resulting in numerous review papers. However, the dynamics of PAHs in mangrove ecosystems is not yet completely understood. In this review paper, an exhaustive presentation of what is known about PAHs and their transfer, accumulation, and degradation in mangrove ecosystems is offered. This article brings to light the knowledge already acquired on the subject and the perspective research necessary to fully comprehend PAHs dynamics in mangrove ecosystems.

Resilience of cold-water coral holobionts to thermal stress.

Cold-water corals are threatened by global warming, especially in the Mediterranean Sea where they live close to their upper known thermal limit (i.e. 13°C), yet their response to rising temperatures is not well known. Here, temperature effects on Lophelia pertusa and Madrepora oculata holobionts (i.e. the host and its associated microbiome) were investigated. We found that at warmer seawater temperature (+2°C), L. pertusa showed a modification of its microbiome prior to a change in behaviour, leading to lower energy reserves and skeletal growth, whereas M. oculata was more resilient. At extreme temperature (+4°C), both species quickly lost their specific bacterial signature followed by lower physiological activity prior to death. In addition, our results showing the holobionts' negative response to colder temperatures (-3°C), suggest that Mediterranean corals live close to their thermal optimum. The species-specific response to temperature change highlights that global warming may affect dramatically the main deep-sea reef-builders, which would alter the associated biodiversity and related ecosystem services.

Influences of species and watersheds inputs on trace metal accumulation in mangrove roots.

Mangrove forest is a key ecosystem between land and sea, and provides many services such as trapping sediments and contaminants. These contaminants include trace metals (TM) that can accumulate in mangroves soil and biota. This paper innovates by the comparative study of the effects of the watershed inputs on TM distribution in mangrove soil, on roots bioconcentration factors of two species (Avicennia marina and Rhizophora stylosa), and on Fe plaque formation and immobilization of these TM. Two mangrove forests in New Caledonia were chosen as study sites. One mangrove is located downstream ultramafic rocks and a Ni mine (ultrabasic site), whereas the second mangrove ends a volcano-sedimentary watershed (non-ultrabasic site). TM concentrations (Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Zn) were measured in soil, porewaters, and roots of both species via ICP-OES or Hg analyzer. Analyzed TM were significantly more concentrated in soils at the ultrabasic site with Fe, Cr, and Ni the most abundant. Iron, Mn, and Ni were the most concentrated in the roots with mean values of 9,651, 192, and 133 mg kg-1 respectively. However, the bioconcentration factors (BCF) of Fe (0.16) and Ni (0.11) were low due to a lack of ions in the dissolved phase and potential uptake regulation. The uptake of TM by mangrove trees was influenced by concentrations in soil, but more importantly by their potential bioavailability and the physiological characteristics of each species. TM concentrations and BCF were lower for R. stylosa probably due to less permeable root system. A. marina limits TM absorption through Fe plaque formation on its pneumatophores with a capacity to retain TM up to 94% for Mn. Mean Fe plaque formation is potentially correlated to Fe concentration in soil. Eventually, framboids of pyrite were observed within root tissues in the epidermis of A. marina's pneumatophores.

Ontario's Healthy Babies Healthy Children Screen tool: identifying postpartum families in need of home visiting services in Ottawa, Canada.

INTERVENTION: Across Ontario, the Healthy Babies Healthy Children (HBHC) postpartum screening tool is routinely used to identify families with potential risk of negative development outcomes for children. RESEARCH QUESTION: To identify screening questions associated with subsequent high-risk in-depth assessment (IDA) in order to prioritize services. METHODS: Ottawa families who gave birth (2013-2016) consented to the postpartum HBHC Screen (N = 29,162). Maternal socio-demographics, perinatal indicators, and 36 questions assessing pregnancy/birth, family, parenting, infant development, and health professional observations were analyzed for association with a high-risk IDA using regression analysis. RESULTS: Upon first screen, 51% of families scored two or more risks. Most commonly, labour/delivery complications (27%), previous loss (26%), health professional concerns (22%), and mental illness (17%) were identified. Among IDA completions, 41% were assessed as high risk and this proportion increased when screened with 4+ risks. Characteristics associated with high-risk IDA among families scoring two or three included the following: maternal age ≤ 19 years (aRR = 2.0, 95% CI 1.50-2.80), 20-29 years (1.3, 1.12-1.53), ≥ 35 years (1.2, 1.04-1.45); combination breast and formula feeding on discharge (1.2, 1.03-1.37); < 18 years old at birth of first child (1.7, 1.13-2.43); single parent and no partner involved (1.6, 1.07-2.33); high school incomplete (1.8, 1.45-2.35); newcomer support needed (1.8, 1.43-2.17); financial concerns (1.6, 1.27-2.14); history of mental illness (1.2, 1.01-1.33); and parent disability (1.7, 1.09-2.78). CONCLUSION: While offering the IDA when scoring 2+ risks is a provincial requirement, practices of increasing effort toward contacting families screened with 4+ risks are substantiated. An adapted approach to prioritize families screened with two or three risks is described.

Maternity services for rural and remote Australia: barriers to operationalising national policy.

INTRODUCTION: In Australia, many small birthing units have closed in recent years, correlating with adverse outcomes including a rise in the number of babies born before arrival to hospital. Concurrently, a raft of national policy and planning documents promote continued provision of rural and remote maternity services, articulating a strategic intent for services to provide responsive, woman-centred care as close as possible to a woman's home. The aims of this paper are to contribute to an explanation of why this strategic intent is not realised, and to investigate the utility of an evidence based planning tool (the Toolkit) to assist with planning services to realise this intent. METHODS: Interviews, focus groups and a group information session were conducted involving 141 participants in four Australian jurisdictions. Field notes and reports were thematically analysed. RESULTS: We identified barriers that helped explain the gap between strategic intent and services on the ground. These were absence of informed leadership; lack of knowledge of contemporary models of care and inadequate clinical governance; poor workforce planning and use of resources; fallacious perceptions of risk; and a dearth of community consultation. In this context, the implementation of policy is problematic without tools or guidance. CONCLUSIONS: Barriers to operationalising strategic intent in planning maternity services may be alleviated by using evidence based planning tools such as the Toolkit.

Primary Maternity Units in rural and remote Australia: Results of a national survey.

BACKGROUND: Primary Maternity Units (PMUs) offer less expensive and potentially more sustainable maternity care, with comparable or better perinatal outcomes for normal pregnancy and birth than higherlevel units. However, little is known about how these maternity services operate in rural and remote Australia, in regards to location, models of care, service structure, support mechanisms or sustainability. This study aimed to confirm and describe how they operate. DESIGN: a descriptive, cross-sectional study was undertaken, utilising a 35-item survey to explore current provision of maternity care in rural and remote PMUs across Australia. Data were subjected to simple descriptive statistics and thematic analysis for free text answers. SETTING AND PARTICIPANTS: Only 17 PMUs were identified in rural and remote areas of Australia. All 17 completed the survey. RESULTS: the PMUs were, on average, 56km or 49minutes from their referral service and provided care to an average of 59 birthing women per year. Periodic closures or downgrading of services was common. Low-risk eligibility criteria were universally used, but with some variability. Medically-led care was the most widely available model of care. In most PMUs midwives worked shift work involving both nursing and midwifery duties, with minimal uptake of recent midwifery workforce innovations. Perceived enablers of, and threats to, sustainability were reported. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: a small number of PMUs operate in rural Australia, and none in remote areas. Continuing overreliance on local medical support, and under-utilisation of the midwifery workforce constrain the restoration of maternity services to rural and remote Australia.

Local birthing services for rural women: Adaptation of a rural New South Wales maternity service.

OBJECTIVE: To describe the outcomes of a public hospital maternity unit in rural New South Wales (NSW) following the adaptation of the service from an obstetrician and general practitioner-obstetrician (GPO)-led birthing service to a low-risk midwifery group practice (MGP) model of care with a planned caesarean section service (PCS). DESIGN: A retrospective descriptive study using quantitative methodology. SETTING: Maternity unit in a small public hospital in rural New South Wales, Australia. PARTICIPANTS: Data were extracted from the ward-based birth register for 1172 births at the service between July 2007 and June 2012. MAIN OUTCOME MEASURES: Birth numbers, maternal characteristics, labour, birthing and neonatal outcomes. RESULTS: There were 750 births over 29 months in GPO and 277 and 145 births over 31 months in MGP and PCS, respectively, totalling 422 births following the change in model of care. The GPO had 553 (73.7%) vaginal births and 197 (26.3%) caesarean section (CS) births (139 planned and 58 unplanned). There were almost universal normal vaginal births in MGP (>99% or 276). For normal vaginal births, more women in MGP had no analgesia (45.3% versus 25.1%) or non-invasive analgesia (47.9% versus 38.6%) and episiotomy was less common in MGP than GPO (1.9% versus 3.4%). Neonatal outcomes were similar for both groups with no difference between Apgar scores at 5 min, neonatal resuscitations or transfer to high-level special care nurseries. CONCLUSION: This study demonstrates how a rural maternity service maintained quality care outcomes for low-risk women following the adaptation from a GPO to an MGP service.

Reconceptualising risk: Perceptions of risk in rural and remote maternity service planning.

OBJECTIVE: to explore perceptions and examples of risk related to pregnancy and childbirth in rural and remote Australia and how these influence the planning of maternity services. DESIGN: data collection in this qualitative component of a mixed methods study included 88 semi-structured individual and group interviews (n=102), three focus groups (n=22) and one group information session (n=17). Researchers identified two categories of risk for exploration: health services risk (including clinical and corporate risks) and social risk (including cultural, emotional and financial risks). Data were aggregated and thematically analysed to identify perceptions and examples of risk related to each category. SETTING: fieldwork was conducted in four jurisdictions at nine sites in rural (n=3) and remote (n=6) Australia. PARTICIPANTS: 117 health service employees and 24 consumers. MEASUREMENTS AND FINDINGS: examples and perceptions relating to each category of risk were identified from the data. Most medical practitioners and health service managers perceived clinical risks related to rural birthing services without access to caesarean section. Consumer participants were more likely to emphasise social risks arising from a lack of local birthing services. KEY CONCLUSIONS: our analysis demonstrated that the closure of services adds social risk, which exacerbates clinical risk. Analysis also highlighted that perceptions of clinical risk are privileged over social risk in decisions about rural and remote maternity service planning. IMPLICATIONS FOR PRACTICE: a comprehensive analysis of risk that identifies how social and other forms of risk contribute to adverse clinical outcomes would benefit rural and remote people and their health services. Formal risk analyses should consider the risks associated with failure to provide birthing services in rural and remote communities as well as the risks of maintaining services.