Translating 'proportionate universal healthcare' into meaningful system design to optimize equity in child and family services.

AIM: To conduct a child and family health nursing service redesign to improve pathways of access, response and outcomes for all families with children aged 0-5 years. DESIGN: The study was conducted as an iterative, mixed-method study of the process and impact of the service redesign, informed by a participatory action research paradigm and the NSW Agency for Clinical Innovation process for developing a model of care. METHODS: Diagnostic, solution design, implementation and sustainability phases were undertaken. Quantitative analyses were undertaken of administrative data, and child and family health nurse and client surveys. Qualitative analyses were undertaken of design workshops. RESULTS: The administrative data demonstrated that prior to the redesign service provision was the same for all clients regardless of levels of risk. The design solution, developed through a series of diagnostic and visioning workshops, included multiple new client response pathways. Implementation included development of tools and training. Sustainability of the redistribution of resources to the new pathways was assessed though an evaluation demonstrating a positive impact for families with adversity, with no deleterious effects for families receiving a universal response, and improvements in the emotional labour undertaken by nurses. Despite this, nurse burnout increased post-redesign. CONCLUSION: The shift from equal services (everyone receives the same) to equitable proportionate universal provision in response to need can be achieved and has positive impacts for nurses and families. IMPACT: This study shows the value of undertaking a systematic and participatory approach to service redesign. A proportionate universalism approach can ensure that early childhood nursing services are available to all in relation to needs. REPORTING METHOD: The Revised Standards for Quality Improvement Reporting Excellence (SQUIRE 2.0) check-list was used to guide reporting. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

The Impact of Positive and Adverse Experiences in Adolescence on Health and Wellbeing Outcomes in Early Adulthood.

This study evaluated the associations between positive and adverse experiences and environments in adolescence and health, education and employment outcomes in early adulthood. Data were extracted from the Longitudinal Studies of Australian Youth cohort that commenced in 2003. The items were conceptually mapped to Positive and Adverse Youth Experiences and environments (PYEs and AYEs) at 15, 16 and 17 years old and outcomes at 25 years old. The associations between PYEs, AYEs and general health, mental health, education and employment were examined, including testing whether PYEs mitigated the association between AYEs and outcomes. A higher number of AYEs was associated with poorer health, education, and employment outcomes. Conversely, a higher number of PYEs was correlated with positive outcomes. The participants with higher PYEs had significantly greater odds of better general and mental health outcomes, even after accounting for AYEs. This relationship was not observed for employment or education outcomes. Adolescence and the transition to adulthood are critical developmental stages. Reducing adverse experiences and environments and increasing positive ones during adolescence could enhance adult wellbeing.

Genetic analysis of the capsular biosynthetic locus from all 90 pneumococcal serotypes.

Several major invasive bacterial pathogens are encapsulated. Expression of a polysaccharide capsule is essential for survival in the blood, and thus for virulence, but also is a target for host antibodies and the basis for effective vaccines. Encapsulated species typically exhibit antigenic variation and express one of a number of immunochemically distinct capsular polysaccharides that define serotypes. We provide the sequences of the capsular biosynthetic genes of all 90 serotypes of Streptococcus pneumoniae and relate these to the known polysaccharide structures and patterns of immunological reactivity of typing sera, thereby providing the most complete understanding of the genetics and origins of bacterial polysaccharide diversity, laying the foundations for molecular serotyping. This is the first time, to our knowledge, that a complete repertoire of capsular biosynthetic genes has been available, enabling a holistic analysis of a bacterial polysaccharide biosynthesis system. Remarkably, the total size of alternative coding DNA at this one locus exceeds 1.8 Mbp, almost equivalent to the entire S. pneumoniae chromosomal complement.

Molecular markers with potential to replace phage typing for Salmonella enterica serovar typhimurium.

Using Amplified Fragment Length Polymorphism (AFLP) analysis of isolates from 23 phage types, we isolated 11 molecular markers that are potentially useful for molecular typing of Salmonella enterica serovar typhimurium. We tested these and 11 previously studied markers for their ability to discriminate among isolates and for correlation of their distribution with phage types. The Simpson's index of discriminatory power for the molecular markers is 0.96. One hundred and twenty one isolates from 33 phage types tested were divided into 51 types which are further grouped into 24 patterns. Eight patterns can unambiguously identify 8 phage types and a further 12 correlated with phage type distribution, showing the usefulness of these markers for molecular phage typing.

Molecular evolutionary relationships of enteroinvasive Escherichia coli and Shigella spp.

Enteroinvasive Escherichia coli (EIEC), a distinctive pathogenic form of E. coli causing dysentery, is similar in many properties to bacteria placed in the four species of Shigella. Shigella has been separated as a genus but in fact comprises several clones of E. coli. The evolutionary relationships of 32 EIEC strains of 12 serotypes have been determined by sequencing of four housekeeping genes and two plasmid genes which were used previously to determine the relationships of Shigella strains. The EIEC strains were grouped in four clusters with one outlier strain, indicating independent derivation of EIEC several times. Three of the four clusters contain more than one O antigen type. One EIEC strain (an O112ac:H- strain) was found in Shigella cluster 3 but is not identical to the Shigella cluster 3 D2 and B15 strains with the same O antigen. Two forms of the virulence plasmid pINV have been identified in Shigella strains by using the sequences of ipgD and mxiA genes, and all but two of our EIEC strains have pINV A. The EIEC strains were grouped in two subclusters with a very low level of variation, generally not intermingled with Shigella pINV A strains. The EIEC clusters based on housekeeping genes were reflected in the plasmid gene sequences, with some exceptions. Two strains were found in the pINV B form by using the ipgD sequence, with one strain having an mxiA sequence similar to the divergent sequence of D1. Clearly, EIEC and Shigella spp. form a pathovar of E. coli.