Macroalgal cover on coral reefs: Spatial and environmental predictors, and decadal trends in the Great Barrier Reef.

Macroalgae are an important component of coral reef ecosystems. We identified spatial patterns, environmental drivers and long-term trends of total cover of upright fleshy and calcareous coral reef inhabiting macroalgae in the Great Barrier Reef. The spatial study comprised of one-off surveys of 1257 sites (latitude 11-24°S, coastal to offshore, 0-18 m depth), while the temporal trends analysis was based on 26 years of long-term monitoring data from 93 reefs. Environmental predictors were obtained from in situ data and from the coupled hydrodynamic-biochemical model eReefs. Macroalgae dominated the benthos (≥50% cover) on at least one site of 40.4% of surveyed inshore reefs. Spatially, macroalgal cover increased steeply towards the coast, with latitude away from the equator, and towards shallow (≤3 m) depth. Environmental conditions associated with macroalgal dominance were: high tidal range, wave exposure and irradiance, and low aragonite saturation state, Secchi depth, total alkalinity and temperature. Evidence of space competition between macroalgal cover and hard coral cover was restricted to shallow inshore sites. Temporally, macroalgal cover on inshore and mid-shelf reefs showed some fluctuations, but unlike hard corals they showed no systematic trends. Our extensive empirical data may serve to parameterize ecosystem models, and to refine reef condition indices based on macroalgal data for Pacific coral reefs.

Measures of mental health and addictions conditions show a U-shaped relationship with self-rated worker performance.

BACKGROUND: Reports of a meaningful relationship between mental health-related conditions and work productivity measures are relatively common. These, however, are frequently examined for their linearity while ignoring untapped, and potentially rich, non-linear associations. METHODS: Following a serendipitous finding of a curvilinear relationship between workplace presenteeism (lowered productivity while at work) and depression, an investigation was undertaken of the association between worklife prevalence measures of presenteeism (measured by the W.H.O. Health & Work Performance Questionnaire) and lifetime prevalence of twelve psychosocial vulnerabilities, encompassing mental health, mental health-related, and addictive conditions. Linear and quadratic (U-shaped) functions were calculated across the "relative" presenteeism measure (self vs. other workers) for each of the 12 conditions. RESULTS: A visual analysis revealed a U-shaped graphic function in all conditions, and excepting anxiety all were statistically significant. In general, increases beyond the lowest ("poorest") level of self-reported comparative productivity were associated with increases in psychosocial stability, but only as far as deemed equality. Beyond that, increases in self-confidence resulted in a reversal, thus returning to a higher level of vulnerability for the condition in question. A cursory scan of five relevant journals indicated that non-linear analyses were often possible, but rarely carried out. CONCLUSIONS: This has informative value for our conceptualization of overconfidence, and it begs the question of whether an over-reliance on linear measures has caused us to overlook important curvilinear human relationships. The inclusion of analyses of non-linear functions is suggested as a matter of course for future studies.

Implementation of mouth rinsing after use of inhaled corticosteroids in Australia.

BACKGROUND: Clinical guidelines recommend that patients using inhaled corticosteroids should rinse their mouth following inhalation. There is however, a paucity of research regarding patient implementation of this recommendation and the impact it has on the occurrence of adverse effects. OBJECTIVE: The aim of this study was to determine how well patients implement mouth rinsing after using inhaled corticosteroids in practice and their understanding of the rationale, information sources and the impact of mouth rinsing on adverse effects. SETTING: Australians aged 18 years and over with a diagnosis of asthma and/or chronic obstructive pulmonary disease who were currently using an inhaled corticosteroid. METHOD: Participants were recruited via Facebook to complete an online survey. MAIN OUTCOME MEASURE: Implementation of a mouth rinse which aligned to current guideline recommendations. RESULTS: Of 380 eligible responses, 30.5% of patients reported suboptimal mouth rinsing after using inhaled corticosteroids. Receiving advice on mouth rinsing from a healthcare professional increased the likelihood of correct implementation (P < 0.001) and improved patient understanding of the rationale (P = 0.01). Whilst most (90.0%) patients were aware rinsing may reduce oropharyngeal adverse effects, few (5.5%) were aware of its potential to reduce systemic adverse effects. Patients were more likely to report their rinsing procedure had a positive impact if they had experienced oral candidiasis (P < 0.001) or sore mouth/throat (P = 0.01), compared to cough or hoarse voice. CONCLUSION: Almost one-third of patients reported a suboptimal mouth rinsing procedure after using an inhaled corticosteroid. Interventions are required to improve awareness and correct implementation of mouth rinsing.

Self-Report Measures of Presenteeism Are Not Strongly Correlated With Health Workers' Logged Activity.

OBJECTIVE: Low productivity while at work (presenteeism) has been reported to produce significant cost excesses for organizations and economies. However, many of these reports have been based on estimates drawn from self-report instruments that are not supported by evidence showing their efficacy. Thus, the aim of this study was to assess associations between responses to leading self-report tests of presenteeism and self-recorded on-the-job productivity. METHODS: Health care worker self-ratings of productivity were taken from a questionnaire that contained the key item from each presenteeism instrument. Productivity levels were drawn from employee reported daily work activity logs. RESULTS: Test-based productivity estimates did not show strong associations with daily recordings of work activity. CONCLUSIONS: Associations were too low to recommend any test as a proxy measure for reported productivity. It is suggested that objective measures of work output be explored.

Colchicine in Patients with Chronic Coronary Disease.

BACKGROUND: Evidence from a recent trial has shown that the antiinflammatory effects of colchicine reduce the risk of cardiovascular events in patients with recent myocardial infarction, but evidence of such a risk reduction in patients with chronic coronary disease is limited. METHODS: In a randomized, controlled, double-blind trial, we assigned patients with chronic coronary disease to receive 0.5 mg of colchicine once daily or matching placebo. The primary end point was a composite of cardiovascular death, spontaneous (nonprocedural) myocardial infarction, ischemic stroke, or ischemia-driven coronary revascularization. The key secondary end point was a composite of cardiovascular death, spontaneous myocardial infarction, or ischemic stroke. RESULTS: A total of 5522 patients underwent randomization; 2762 were assigned to the colchicine group and 2760 to the placebo group. The median duration of follow-up was 28.6 months. A primary end-point event occurred in 187 patients (6.8%) in the colchicine group and in 264 patients (9.6%) in the placebo group (incidence, 2.5 vs. 3.6 events per 100 person-years; hazard ratio, 0.69; 95% confidence interval [CI], 0.57 to 0.83; P<0.001). A key secondary end-point event occurred in 115 patients (4.2%) in the colchicine group and in 157 patients (5.7%) in the placebo group (incidence, 1.5 vs. 2.1 events per 100 person-years; hazard ratio, 0.72; 95% CI, 0.57 to 0.92; P = 0.007). The incidence rates of spontaneous myocardial infarction or ischemia-driven coronary revascularization (composite end point), cardiovascular death or spontaneous myocardial infarction (composite end point), ischemia-driven coronary revascularization, and spontaneous myocardial infarction were also significantly lower with colchicine than with placebo. The incidence of death from noncardiovascular causes was higher in the colchicine group than in the placebo group (incidence, 0.7 vs. 0.5 events per 100 person-years; hazard ratio, 1.51; 95% CI, 0.99 to 2.31). CONCLUSIONS: In a randomized trial involving patients with chronic coronary disease, the risk of cardiovascular events was significantly lower among those who received 0.5 mg of colchicine once daily than among those who received placebo. (Funded by the National Health Medical Research Council of Australia and others; LoDoCo2 Australian New Zealand Clinical Trials Registry number, ACTRN12614000093684.).

Development of the coral index, a summary of coral reef resilience as a guide for management.

Coral reef management is increasingly focused on supporting the resilience of coral communities to increasing and cumulative pressures. The coral index provides a concise summary of coral community resilience that can be efficiently communicated to a range of management and policy stakeholders. We detail the development of the index both as a technical reference for users but also as an example of an approach that could be more generally applied to the reporting of ecosystem resilience. The index is sensitive to acute impacts that are expected when coral communities are exposed to disturbances such as cyclones, bleaching events or crown-of-thorns outbreaks. Importantly, spatial and temporal trends in the index enable the identification of areas and periods of reduced resilience that suggest chronic environmental pressure imposed by runoff. The ability to summarise complex ecological processes into a single index provides an efficient and intuitive tool for the communication of where, when and which pressures are impacting ecosystem resilience.

The Persistence of Opioid Use Following Surgical Admission: An Australian Single-Site Retrospective Cohort Study.

BACKGROUND: Acute pain is common following surgery, with opioids frequently employed in its management. Studies indicate that commencing an opioid during a hospital admission increases the likelihood of long-term use. This study aimed to identify the prevalence of opioid persistence amongst opioid-naïve patients following surgery as well as the indication for use. METHODS: A retrospective review of patients who underwent a surgical procedure at the Royal Hobart Hospital, Tasmania, Australia, between August and September 2016 was undertaken. Patients were linked to the Tasmanian real-time prescription monitoring database to ascertain if they were subsequently dispensed a Schedule 8 opioid (morphine, codeine oxycodone, buprenorphine, hydromorphone, fentanyl, methadone, or tapentadol) and the indication for use. RESULTS: Of the 3275 hospital admissions, 1015 opioid-naïve patients were eligible for inclusion. Schedule 8 opioids were dispensed at or within 2 days of discharge in 41.7% of admissions. Thirty-nine (3.9%) patients received prescribed opioids 2-months post-discharge; 1.8% of the patients were approved by State Health to be prescribed Schedule 8 opioids regularly for a chronic condition at 6 months, and 1.3% received infrequent or one-off prescriptions for Schedule 8 opioids at 6 months. Thirteen (1.3%) patients continued Schedule 8 opioids for at least 6 months following their surgery, with the indication for treatment either related to the surgery or the condition which surgery was sought for. CONCLUSION: This study found that there was a low rate of Schedule 8 opioid persistence following surgery, indicating post-surgical pain is not a significant driver for persistent opioid use.

Shifts in coralline algae, macroalgae, and coral juveniles in the Great Barrier Reef associated with present-day ocean acidification.

Seawater acidification from increasing CO2 is often enhanced in coastal waters due to elevated nutrients and sedimentation. Our understanding of the effects of ocean and coastal acidification on present-day ecosystems is limited. Here we use data from three independent large-scale reef monitoring programs to assess coral reef responses associated with changes in mean aragonite saturation state (Ωar ) in the Great Barrier Reef World Heritage Area (GBR). Spatial declines in mean Ωar are associated with monotonic declines in crustose coralline algae (up to 3.1-fold) and coral juvenile densities (1.3-fold), while non-calcifying macroalgae greatly increase (up to 3.2-fold), additionally to their natural changes across and along the GBR. These three key groups of organisms are important proxies for coral reef health. Our data suggest a tipping point at Ωar 3.5-3.6 for these coral reef health indicators. Suspended sediments acted as an additive stressor. The latter suggests that effective water quality management to reduce suspended sediments might locally and temporarily reduce the pressure from ocean acidification on these organisms.

Validation and implementation of a national survey to assess antimicrobial stewardship awareness, practices and perceptions amongst community pharmacists in Australia.

OBJECTIVES: Antimicrobial stewardship (AMS) programmes are well established in hospitals, yet such programmes have not been widely implemented in the community. Understanding current practices and perceptions of community pharmacists about AMS may provide insights into the implementation of AMS in community pharmacies. The aims of this study were to validate a questionnaire to measure community pharmacists' perceptions of AMS and to explore barriers and facilitators to their involvement in community-based AMS initiatives. METHODS: A 44-item survey questionnaire comprising sections on demographics, AMS practices and perceptions of community pharmacists, and barriers and facilitators to AMS was hosted online. Community pharmacists were recruited through social media pages of community pharmacist groups across Australia. Cronbach's alpha and exploratory factor analysis were used to measure the reliability and validity of the survey tool, respectively. RESULTS: A total of 330 community pharmacists started the survey, with 255 of them completing at least one question. Pharmacists were more likely to intervene with general practitioners (GPs) (≥80% of the time) for allergies, dosing and drug interactions and were less likely to intervene if they felt the choice of antibiotic was inappropriate (45%). Major barriers limiting pharmacists' participation in AMS were lack of access both to patient data (82.6%) and to a standard guideline to implement AMS programmes (72.1%). Almost all pharmacists (98%) reported that better collaboration with GPs would improve their participation in AMS initiatives. CONCLUSION: Future studies utilising the knowledge gained from this study may provide a framework for AMS in community pharmacy settings.

Does prescribing of immediate release oxycodone by emergency medicine physicians result in persistence of Schedule 8 opioids following discharge?

OBJECTIVES: To identify the prevalence of oxycodone immediate release (IR) prescribed during an ED admission and the persistence of Schedule 8 (S8) opioids following an ED admission. METHODS: A retrospective cross-sectional audit was undertaken reviewing all admission at the ED of the Royal Hobart Hospital, Tasmania, between 1 August and 30 September 2016. The admissions lists for ED were cross matched with the narcotic registers for oxycodone IR (the most commonly supplied S8 in ED) to identify how many patients received IR oxycodone during their ED admissions. Determination of the persistence of opioid use in opioid naïve patients was then undertaken using the Tasmanian real time reporting database of all S8 opioid dispensed in Tasmania (DAPIS). RESULTS: There were 8432 ED admissions for 7065 patients aged over 13 years. IR oxycodone was prescribed during 1049 of these admissions (12.4%). Of the patients who were not taking regularly prescribed S8 opioids prior to their ED admission (n = 853), 48 patients (5.6%) were taking S8 opioids at both 2 and 6 months following their ED admission. Thirty patients (2.8%) were approved for authorities for long-term opioids for non-cancer pain. CONCLUSION: These findings suggest that prescribing of IR oxycodone within ED is lower than previous studies. Additionally, the progression to regular chronic opioid use following an ED admission where IR oxycodone was given was relatively low with 3.0% of opioid naïve patients being approved for indications related to chronic non-cancer pain in the following 6 months.

Updating and validating quality prescribing indicators for use in Australian general practice.

This study aims to update and validate quality prescribing indicators (QPIs) for Australian general practice. The study comprised two phases: (1) developing preliminary potential QPIs based on the 2006 National Prescribing Service (NPS) MedicineWise indicators, published literature, international indicators and guidelines, and through qualitative focus group discussions; and (2) validating the proposed QPIs through a two-round online survey using the Delphi technique. The Delphi panel included four GPs, four pharmacists and two clinical pharmacologists. The Delphi panel rated the potential QPIs for their validity, importance and feasibility using a 1-10 Likert scale. In round one, all proposed QPIs presented as 'prescribing rules' achieved high scores regarding validity, importance and feasibility No rule was eliminated and three new rules were introduced. Rules were reworded into 'prescribing indicators' for round two, which resulted in 35 indicators being accepted and two indicators being eliminated. The final QPIs also include seven drug-drug interactions, which received high scores in round one. In conclusion, 42 QPIs were nominated for use in Australian general practice, based on their validity, importance and feasibility. If implemented, these QPIs have the potential to assist in efforts to improve the quality and safety of medicines management.

Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy.

Background Appropriate antibiotic prescribing improves patient outcomes and mitigates antimicrobial resistance. As the majority of antibiotics are used in the community, rational prescribing in this setting is of paramount importance. Objectives We aimed to (1) evaluate the concordance of community antibiotic prescribing with guidelines for three common infection types among patients who presented to hospital, and (2) identify relationships between guideline concordance and patient-related factors. Methods Medical records were evaluated from the Royal Hobart Hospital (Tasmania, Australia) for patients presenting with respiratory tract, urinary tract or skin and soft tissue infections within a 12-month period. Prior-to-hospital antibiotic therapy was assessed for concordance with prescribing guidelines based on presenting diagnosis. Concordance was assessed against first-line recommendations in the Australian Therapeutic Guidelines - Antibiotic, based on drug choice, dose, frequency and patient factors. Descriptive statistics were performed to address Objective 1. Multivariate logistic regressions were conducted to address Objective 2 with the following independent variables: infection type, age, allergies, diabetes status, gender and residential setting. Results A total of 285 patient records were eligible for data analysis; 28.8% (n = 82) were fully guideline concordant. The most common reason for non-concordance was inappropriate drug choice (n = 143, 50.2%). Patients with the following characteristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI 0.1-0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98-1.00, P = .04). Conclusions Almost three-quarters of patients received community-initiated antibiotic therapy that was not fully guideline concordant. Antimicrobial stewardship interventions are urgently needed to improve guideline concordance for community-initiated antibiotic therapy.

Spatial resilience of the Great Barrier Reef under cumulative disturbance impacts.

In the face of increasing cumulative effects from human and natural disturbances, sustaining coral reefs will require a deeper understanding of the drivers of coral resilience in space and time. Here we develop a high-resolution, spatially explicit model of coral dynamics on Australia's Great Barrier Reef (GBR). Our model accounts for biological, ecological and environmental processes, as well as spatial variation in water quality and the cumulative effects of coral diseases, bleaching, outbreaks of crown-of-thorns starfish (Acanthaster cf. solaris), and tropical cyclones. Our projections reconstruct coral cover trajectories between 1996 and 2017 over a total reef area of 14,780 km2 , predicting a mean annual coral loss of -0.67%/year mostly due to the impact of cyclones, followed by starfish outbreaks and coral bleaching. Coral growth rate was the highest for outer shelf coral communities characterized by digitate and tabulate Acropora spp. and exposed to low seasonal variations in salinity and sea surface temperature, and the lowest for inner-shelf communities exposed to reduced water quality. We show that coral resilience (defined as the net effect of resistance and recovery following disturbance) was negatively related to the frequency of river plume conditions, and to reef accessibility to a lesser extent. Surprisingly, reef resilience was substantially lower within no-take marine protected areas, however this difference was mostly driven by the effect of water quality. Our model provides a new validated, spatially explicit platform for identifying the reefs that face the greatest risk of biodiversity loss, and those that have the highest chances to persist under increasing disturbance regimes.

High spatio-temporal variability in Acroporidae settlement to inshore reefs of the Great Barrier Reef.

Recovery of coral reefs after disturbance relies heavily on replenishment through successful larval settlement and their subsequent survival. As part of an integrated study to determine the potential effects of water quality changes on the resilience of inshore coral communities, scleractinian coral settlement was monitored between 2006 and 2012 at 12 reefs within the inshore Great Barrier Reef. Settlement patterns were only analysed for the family Acroporidae, which represented the majority (84%) of settled larvae. Settlement of Acroporidae to terracotta tiles averaged 0.11 cm-2, representing 34 ± 31.01 (mean ± SD) spat per tile, indicating an abundant supply of competent larvae to the study reefs. Settlement was highly variable among reefs and between years. Differences in settlement among locations partly corresponded to the local cover of adult Acroporidae, while substantial reductions in Acroporidae cover caused by tropical cyclones and floods resulted in a clear reduction in settlement. Much of the observed variability remained unexplained, although likely included variability in both connectivity to, and the fecundity of, adult Acroporidae. The responsiveness of settlement patterns to the decline in Acroporidae cover across all four regions indicates the importance of supply and connectivity, and the vulnerability towards region-wide disturbance. High spatial and temporal variability, in addition to the resource-intensive nature of sampling with settlement tiles, highlights the logistical difficulty of determining coral settlement over large spatial and temporal scales.

Acute drivers influence recent inshore Great Barrier Reef dynamics.

Understanding the dynamics of habitat-forming organisms is fundamental to managing natural ecosystems. Most studies of coral reef dynamics have focused on clear-water systems though corals inhabit many turbid regions. Here, we illustrate the key drivers of an inshore coral reef ecosystem using 10 years of biological, environmental, and disturbance data. Tropical cyclones, crown-of-thorns starfish, and coral bleaching are recognized as the major drivers of coral loss at mid- and offshore reefs along the Great Barrier Reef (GBR). In comparison, little is known about what drives temporal trends at inshore reefs closer to major anthropogenic stress. We assessed coral cover dynamics using state-space models within six major inshore GBR catchments. An overall decline was detected in nearly half (46%) of the 15 reefs at two depths (30 sites), while the rest exhibited fluctuating (23%), static (17%), or positive (13%) trends. Inshore reefs responded similarly to their offshore counterparts, where contemporary trends were predominantly influenced by acute disturbance events. Storms emerged as the major driver affecting the inshore GBR, with the effects of other drivers such as disease, juvenile coral density, and macroalgal and turf per cent cover varying from one catchment to another. Flooding was also associated with negative trends in live coral cover in two southern catchments, but the mechanism remains unclear as it is not reflected in available metrics of water quality and may act through indirect pathways.

Perceptions and current practices of community pharmacists regarding antimicrobial stewardship in Tasmania.

Background Despite increasing interest in antimicrobial stewardship (AMS), little is known about the related practices and perceptions of community pharmacists. Objective To develop and validate a questionnaire to measure the current practices of, and barriers to community pharmacists' participation in AMS. Setting Community pharmacists in Tasmania, Australia. Method A questionnaire to explore AMS knowledge, current practices and perceptions of community pharmacists was developed. It was designed after rigorous literature review, expert opinion, and feedback from a group of community pharmacists. A convenience sample of 140 Tasmanian community pharmacists was used for this study. Cronbach's alpha and exploratory factor analysis (EFA) were used for reliability and validity. The questionnaire was hosted online, a link to which was sent by invitation e-mails, fax and post to community pharmacists in Tasmania, Australia. Main outcome measure Current AMS practices, perceived importance, barriers and facilitators of AMS. Results Eighty-five pharmacists responded to the survey yielding a response rate of 61%. EFA identified one factor solution for each of three perceptions scales and showed acceptable reliability. The Cronbach's alpha of perceived importance-understanding was 0.699, perceived importance-motivating was 0.734, perceived support from GPs was 0.890, operational barriers was 0.585, general facilitators was 0.615. Most pharmacists reported that they counselled patients on adverse effects (86%), drug interactions (94%), and allergies (96%). In contrast, less than half (43%) intervened with prescribers regarding antibiotic selection. Lack of training, lack of access to patients' records, limited interactions with general practitioners and absence of a reimbursement model were major barriers limiting community pharmacists' participation in AMS. Conclusion The questionnaire was of acceptable reliability and validity; a larger study will further contribute in its reliability and validity. Future studies utilising the questionnaire at national and international level may provide further insights into the determinants of community pharmacist's involvement in AMS.

Agreement among the Productivity Components of Eight Presenteeism Tests in a Sample of Health Care Workers.

BACKGROUND: Presenteeism (reduced productivity at work) is thought to be responsible for large economic costs. Nevertheless, much of the research supporting this is based on self-report questionnaires that have not been adequately evaluated. OBJECTIVES: To examine the level of agreement among leading tests of presenteeism and to determine the inter-relationship of the two productivity subcategories, amount and quality, within the context of construct validity and method variance. METHODS: Just under 500 health care workers from an urban health area were asked to complete a questionnaire containing the productivity items from eight presenteeism instruments. The analysis included an examination of test intercorrelations, separately for amount and quality, supplemented by principal-component analyses to determine whether either construct could be described by a single factor. A multitest, multiconstruct analysis was performed on the four tests that assessed both amount and quality to test for the relative contributions of construct and method variance. RESULTS: A total of 137 questionnaires were completed. Agreement among tests was positive, but modest. Pearson r ranges were 0 to 0.64 (mean = 0.32) for Amount and 0.03 to 0.38 (mean = 0.25) for Quality. Further analysis suggested that agreement was influenced more by method variance than by the productivity constructs the tests were designed to measure. CONCLUSIONS: The results suggest that presenteeism tests do not accurately assess work performance. Given their importance in the determination of policy-relevant conclusions, attention needs to be given to test improvement in the context of criterion validity assessment.

Gender similarities in somatic depression and in DSM depression secondary symptom profiles within the context of severity and bereavement.

BACKGROUND: Most population studies report higher rates of depression among women than men, and some researchers have observed gender differences in depression symptoms overall, or in sub-groupings (e.g. somatic depression). However, gender symptom differences have been inconsistent, prompting this investigation of gender differences in secondary DSM symptom profiles in the context of bereavement status, age, and depression severity. METHODS: Individuals with symptoms of core depression (flat affect or anhedonia) were selected from a large survey of adults in the Alberta, Canada workforce. Analyses involved the comparison of gender profiles across the seven DSM-IV secondary depressive symptoms plus a MANOVA of sex, bereavement, and age, with secondary symptoms comprising the dependent variable. RESULTS: Gender profiles were very similar, irrespective of depression severity or bereavement. Secondary symptoms were marginally more common among women and more frequent among bereaved young adults, but there was no evidence for a gender-related somatic factor. LIMITATIONS: First, data were gathered only for persons in the workforce and thus may not be generalizable to, for example, stay-at-home parents or those with employment issues. Second, the focus here is restricted to DSM symptoms, leaving risk factors, social roles, and brain functioning for separate investigation. Third, inferences were drawn from associations between groups of persons, rather than between individuals, requiring caution when speculating about individual attributes. CONCLUSIONS: Gender differences in depression represent a difference in amount, not kind, suggesting that the range of depressive experiences is similar for men and women. There was no gender difference ascribable to somatic depression.

Barriers to Optimal Pain Management in Aged Care Facilities: An Australian Qualitative Study.

Up to 80% of residents in aged care facilities (ACFs) experience pain, which is often suboptimally managed. The purpose of this study was to characterize pain management in ACFs and identify the barriers to optimal pain management. This exploratory descriptive qualitative study used semistructured interviews in five Southern Tasmania, Australian ACFs. Interviewees included 23 staff members (18 nurses and 5 facility managers) and were conducted from September to November 2015. Interviews included questions about how pain was measured or assessed, what happened if pain was identified, barriers to pain management, and potential ways to overcome these barriers. Interviewees noted that there were no formal requirements regarding pain assessment at the ACFs reviewed; however, pain was often informally assessed. Staff noted the importance of adequate pain management for the residents' quality of life and employed both nonpharmacologic and pharmacologic techniques to reduce pain when identified. The barriers to optimal pain management included difficulty identifying and assessing pain, residents' resistance to reporting pain and/or taking medications, and communication barriers between the nursing staff and GPs. Staff interviewed were dedicated to managing residents' pain effectively; however, actions in a number of areas could improve resident outcomes. These include a more consistent approach to documenting pain in residents' progress notes and improving nurse-GP communications to ensure that new or escalating pain is identified and expedient changes can be made to the resident's management. Additionally, resident, family, nurse, and carer education, conducted within the facilities on a regular basis, could help improve the pain management of residents.