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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 ? 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.

Although seafood is considered to be an important part of a healthy and balanced diet, many Australians still do not consume the recommended amounts for good health. Fish is an excellent source of protein, omega-3 fatty acids and other nutrients, and studies have shown that seafood-rich diets can have a lower impact on the environment than diets high in other animal proteins. Concerns about health and sustainability have led to an increased interest in understanding consumers' attitudes toward seafood. This review aims to assess the current knowledge on drivers and barriers to seafood consumption in the Australian context. Systematic search strategies were used to identify relevant peer-reviewed journal articles from three electronic databases (SCOPUS, Web of Science and Science Direct) and grey literature reports from targeted government and industry websites. Accepted studies investigated drivers and/or barriers to seafood consumption in Australia through qualitative, quantitative, or mixed method designs. Initial searches identified 504 publications from which fourteen met the criteria for the review process. The reviewed studies revealed that influences on seafood consumption in Australia are similar to those identified in other developed countries. The leading drivers of seafood consumption are health, taste, and convenience, while the main barriers are price, availability, concerns about quality, and a lack of confidence in selecting and preparing seafood. Some possible intervention strategies targeted toward these factors are explored in the discussion. Future research should focus on designing and implementing specific interventions so that their effectiveness in increasing seafood consumption in Australia can be assessed.

The risk factors for and clinical features of bloodstream infection with uncommon Candida spp. (species other than C. albicans, C. glabrata, C. parapsilosis, C. tropicals and C. krusei) are incompletely defined. To identify clinical variables associated with these species that might guide management, 57 cases of candidaemia resulting from uncommon Candida spp. were analysed in comparison with 517 episodes of Candida albicans candidaemia (2001-2004). Infection with uncommon Candida spp. (5.3% of candidaemia cases), as compared with C. albicans candidaemia, was significantly more likely to be outpatient-acquired than inpatient-acquired (15 of 57 vs. 65 of 517 episodes, p0.01). Prior exposure to fluconazole was uncommon (n =1). Candida dubliniensis was the commonest species (n =22, 39%), followed by Candida guilliermondii (n = 11, 19%) and Candida lusitaniae (n = 7, 12%). C. dubliniensis candidaemia was independently associated with recent intravenous drug use (p0.01) and chronic liver disease (p0.03), and infection with species other than C. dubliniensis was independently associated with age <65 years (p0.02), male sex (p0.03) and human immunodeficiency virus infection (p0.05). Presence of sepsis at diagnosis and crude 30-day mortality rates were similar for C. dubliniensis-related, non- C. dubliniensis-related and C. albicans-related candidaemia. Haematological malignancy was the commonest predisposing factor in C. guilliermondii (n = 3, 27%) and C. lusitaniae (n = 3, 43%) candidaemia. The 30-day mortality rate of C. lusitaniae candidaemia was higher than the overall death rate for all uncommon Candida spp. (42.9% vs. 25%, not significant). All isolates were susceptible to amphotericin.B, voriconazole, posaconazole, and caspofungin; five strains (9%) had fluconazole MIC values of 16-32 mg/L. Candidaemia due to uncommon Candida spp. is emerging among hospital outpatients; certain clinical variables may assist in recognition of this entity. © 2009 The Authors Journal c

Australia-wide population-based surveillance for scedosporiosis identified 180 cases, with 118 (65.6%) cases of colonization and 62 (34.4%) cases of infection. Predisposing factors for isolation of Scedosporium spp. included chronic lung disease in 37.8% and malignancy in 21.7% of cases. Predictors of invasive disease (n = 62) included haematological stem cell transplantation (n = 7), leukaemia (n = 16) and diabetes mellitus (n = 8). Of 183 phenotypically-speciated isolates, 75 (41%) were Scedosporium prolificans (risk factors: haematologic cancer (n = 17), neutropaenia (n = 14)) and 108 (59%) had Scedosporium apiospermum/Pseudallescheria boydii phenotype [risk factor: diabetes (n = 15)]. Scedosporium prolificans (p 0.01) and leukaemia (p 0.03) independently predicted death. Epidemiological and antifungal susceptibility profiles of Scedosporium aurantiacum (prevalence >=15.8%) and S. apiospermum were similar. No patient with S aurantiacum infection (n = 6) died. This is the first description of clinical features associated with S. aurantiacum. © 2009 The Authors Journal compilation © 2009 European Society of Clinical Microbiology and Infectious Diseases.

Population-based surveillance for candidemia in Australia from 2001 to 2004 identified 1,095 cases. Annual overall and hospital-specific incidences were 1.81/100,000 and 0.21/1,000 separations (completed admissions), respectively. Predisposing factors included malignancy (32.1%), indwelling vascular catheters (72.6%), use of antimicrobial agents (77%), and surgery (37.1%). Of 919 episodes, 81.5% were inpatient healthcare associated (IHCA), 11.6% were outpatient healthcare associated (OHCA), and 6.9% were community acquired (CA). Concomitant illnesses and risk factors were similar in IHCA and OHCA candidemia. IHCA candidemia was associated with sepsis at diagnosis (p<0.001), death <=30 days after infection (p<0.001), and prolonged hospital admission (p<0.001). Non-Candida albicans species (52.7%) caused 60.5% of cases acquired outside hospitals and 49.9% of IHCA candidemia (p = 0.02). The 30-day death rate was 27.7% in those >=65 years of age. Adult critical care stay, sepsis syndrome, and corticosteroid therapy were associated with the greatest risk for death. Systematic epidemiologic studies that use standardized definitions for IHCA, OHCA, and CA candidemia are indicated.

One hundred clinical isolates from a prospective nationwide study of scedosporiosis in Australia (2003-2005) and 46 additional isolates were genotyped by internal transcribed spacer-restriction fragment length polymorphism (ITS-RFLP) analysis, ITS sequencing, and M13 PCR fingerprinting. ITS-RFLP and PCR fingerprinting identified 3 distinct genetic groups. The first group corresponded to Scedosporium prolificans (n = 83), and the other 2 comprised isolates previously identified as S. apiospermum: one of these corresponded to S. apiospermum (n = 33) and the other to the newly described species S. aurantiacum (n = 30). Intraspecies variation was highest for S. apiospermum (58%), followed by S. prolificans (45%) and S. aurantiacum (28%) as determined by PCR fingerprinting. ITS sequence variation of 2.2% was observed among S. apiospermum isolates. No correlation was found between genotype of strains and their geographic origin, body site from which they were cultured, or colonization versus invasive disease. Twelve S. prolificans isolates from 2 suspected case clusters were examined by amplified fragment length polymorphism analysis. No specific clusters were confirmed.