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South eastern Australia is a global warming hotspot, and is also home to ~70% of Australia's population and one of Australia's largest fisheries—the South East Scalefish and Shark Fishery. This fishery spans shelf to deep waters, subtropical to temperate waters, employs many gears, and interacts with over 100 species. Despite following best practice fisheries management principles, including taking an ecosystem perspective to overall fisheries interactions, management interventions have failed to arrest or recover the decline of some focal species. Using an Atlantis ecosystem model developed for the fishery over the past 20 years, this paper presents simulations that suggest climate change may be a major contributor to the trajectories seen for a number of species—such as jackass morwong (Nemadactylus macropterus), blue warehou (Seriolella brama), and gemfish (Rexea solandri). This kind of climate influence poses many challenges for fisheries management into the future, raising questions about what to do when climate change undermines or overrides fisheries management actions and objectives. [ABSTRACT FROM AUTHOR]

Background: Answering clinical questions arising from patient care can improve that care and offers an opportunity for adult learning. It is also a vital component in practising evidence-based medicine. GPs' sources of in-consultation information can be human or non-human (either hard copy or electronic).Objectives: To establish the prevalence and associations of GP trainees' in-consultation information-seeking, and to establish the prevalence of use of different sources of information (human, hard copy and electronic) and the associations of choosing particular sources.Methods: A cross-sectional analysis of data (2010-13) from an ongoing cohort study of Australian GP trainees' consultations. Once each 6-month training term, trainees record detailed data of 60 consecutive consultations. The primary outcome was whether the trainee sought in-consultation information for a problem/diagnosis. Secondary outcomes were whether information-seeking was from a human (GP, other specialist or other health professional) or from a non-human source (electronic or hard copy), and whether a non-human source was electronic or hard copy.Results: Six hundred forty-five trainees (response rate 94.3%) contributed data for 84,723 consultations including 131,583 problems/diagnoses. In-consultation information was sought for 15.4% (95% confidence interval=15.3-15.6) of problems/diagnoses. Sources were: GP in 6.9% of problems/diagnoses, other specialists 0.9%, other health professionals 0.6%, electronic sources 6.5% and hard-copy sources 1.5%. Associations of information-seeking included younger patient age, trainee full-time status and earlier training stage, longer consultation duration, referring the patient, organizing follow-up and generating learning goals. Associations of choosing human information sources (over non-human sources) were similar, but also included the trainee's training organization. Associations of electronic rather than hard-copy information-seeking included the trainee being younger, the training organization and information-seeking for management rather than diagnosis.Conclusion: Trainee information-seeking is mainly from GP colleagues and electronic sources. Human information-sources are preferentially sought for more complex problems, even by these early-career GPs who have trained in the 'internet era'. [ABSTRACT FROM AUTHOR]

Focal Ratio Degradation (FRD) in optical fibres can result in light loss. In astronomical instrumentation, FRD must be controlled because light levels are low. A new Integral Field Spectrograph (IFS) instrument called Hector, was recently completed and was installed on the Anglo-Australian Telescope (AAT) in Australia in 2021 December. The integral field units (IFUs) for Hector made with hexagonally packed multi-mode fibres are called hexabundles. In this paper, we introduce a cone-beam measurement method to measure FRD at optical wavelengths. We present the FRD and throughput performance of the hexabundles for Hector and show that the process for making hexabundles introduced no additional significant FRD beyond that of the bare fibre. [ABSTRACT FROM AUTHOR]

We describe a case of a 12-year-old female with a past history of autism spectrum disorder who presented to the emergency department of a rural hospital in Australia after ingesting two nickel-metal hydride (NiMH) batteries at home. Hitherto, no literature has described any gastrointestinal complications related to NiMH battery ingestion. This paper aims to provide insight into the management of NiMH battery ingestion and to increase the awareness of the need for prompt management to prevent further damage to the gastrointestinal tract. [ABSTRACT FROM AUTHOR]

Using length frequency distribution data (LFD) is cost-effective for estimating somatic growth in fish or invertebrates as length data are relatively easy to obtain. The recently developed R packages TropFishR and fishboot extend classic ELEFAN (Electronic LEngth Frequency ANalysis) programs and include more powerful optimization procedures and a bootstrap method for estimating uncertainties. Yet, the fundamental functions require users to provide search conditions (e.g. upper and lower limits for each parameter, length-class size, number of length-classes for the calculation of moving average), which can significantly affect the results. In this paper, we compare the ELEFAN approach with a Bayesian approach in analysing LFD, employing both standard and seasonal von Bertalanffy growth functions. We apply both approaches to a commercially valuable but poorly studied red endeavour prawn (Metapenaeus ensis) harvested in Australia's Northern Prawn Fishery. Sensitivity tests on ELEFAN confirm that any change in search settings would affect the results. Simulation studies on Bayesian growth models show that Linf and K can be accurately obtained even with modal progression of only one year-class and using non-informative priors. However, age information, including the theoretical age at length zero (t0), is difficult to estimate and requires LFD from multiple age classes and informative priors. The Bayesian models yield mean parameters of: Linf = 36.56 mm (carapace length), K = 2.74 yr–1, and t0 = -0.02 yr for the males, and Linf = 51.81 mm, K = 1.94 yr–1, and t0 = -0.02 yr for the females. Seasonal oscillation models fit the LFD better, but the improvement is small and the estimated season-related parameters have large variances. [ABSTRACT FROM AUTHOR]

Background: Achieving people-centred health care systems requires new and innovative strategies to capture information about whether, and to what degree, health care is successful in improving health from the perspective of the patient. Patient-reported outcome measures (PROMs) and Patient-reported experience measures (PREMs) can bring some of these new insights, and are increasingly used in research, clinical care, and policymaking.Methods: This paper reflects the ongoing discussions and findings of the OECD PaRIS Working Group on Patient-reported Indicators for Mental Health Care.Results: The OECD has been measuring quality of care for mental health conditions over the last 14 years through the Health Care Quality and Outcomes (HCQO) program; nonetheless, information on how persons with mental health problems value the services they receive, and impact of the services, remains limited. As of 2018, a survey from the OECD showed that only five of the twelve countries surveyed (Australia, Israel, Netherlands, Sweden, United Kingdom) reported PROMs and PREMs collection on a regular basis in mental health settings. The paper details some of the challenges specific to the collection and use of PROMs and PREMs in mental health care, and examples from countries which have implemented comprehensive programmes to gather information about PROMs and PREMs for individuals receiving mental health services.Conclusions: Given the health and economic impact of mental ill-health across all OECD countries, there is significant value to being able to assess the quality and outcomes of care in this area using internationally-comparable measures. Continued international harmonisation of PROMs and PREMs for mental health through international coordination is a key way to facilitate the sharing of national experiences, promote the use of PROMs and PREMs, and create meaningful indicators for national and international benchmarking. [ABSTRACT FROM AUTHOR]

Background: Achieving people-centred health care systems requires new and innovative strategies to capture information about whether, and to what degree, health care is successful in improving health from the perspective of the patient. Patient-reported outcome measures (PROMs) and Patient-reported experience measures (PREMs) can bring some of these new insights, and are increasingly used in research, clinical care, and policymaking.Methods: This paper reflects the ongoing discussions and findings of the OECD PaRIS Working Group on Patient-reported Indicators for Mental Health Care.Results: The OECD has been measuring quality of care for mental health conditions over the last 14 years through the Health Care Quality and Outcomes (HCQO) program; nonetheless, information on how persons with mental health problems value the services they receive, and impact of the services, remains limited. As of 2018, a survey from the OECD showed that only five of the twelve countries surveyed (Australia, Israel, Netherlands, Sweden, United Kingdom) reported PROMs and PREMs collection on a regular basis in mental health settings. The paper details some of the challenges specific to the collection and use of PROMs and PREMs in mental health care, and examples from countries which have implemented comprehensive programmes to gather information about PROMs and PREMs for individuals receiving mental health services.Conclusions: Given the health and economic impact of mental ill-health across all OECD countries, there is significant value to being able to assess the quality and outcomes of care in this area using internationally-comparable measures. Continued international harmonisation of PROMs and PREMs for mental health through international coordination is a key way to facilitate the sharing of national experiences, promote the use of PROMs and PREMs, and create meaningful indicators for national and international benchmarking. [ABSTRACT FROM AUTHOR]

Methods for calculating health indicators profoundly influence understanding of and action on population health and inequities. Age-standardization can be useful and is commonly applied to account for differences in age structures when comparing health indicators across groups. Age-standardized rates have well-acknowledged limitations, including that they are relative indices for comparison, and not accurate measures of actual rates where the age structures of groups diverge. This paper explores these limitations, and demonstrates alternative approaches through a case study quantifying mortality rates within the Aboriginal and Torres Strait Islander (Indigenous) population of Australia and inequities compared with the non-Indigenous population, over 2001-16. Applying the Australian Standard Population, the Aboriginal and Torres Strait Islander age-standardized mortality rate was more than double the crude mortality rate in 2001 and 2016, inflated through high weighting of older age groups. Despite divergent population age structures, age-standardized mortality rates remain a key policy metric for measuring progress in reducing Indigenous-non-Indigenous inequities in Australia. Focusing on outcomes age-standardized to the total population can obscure inequities, and denies Aboriginal and Torres Strait Islander peoples and communities valid, actionable information about their health and well-being. Age-specific statistics convey the true magnitude of health risks and highlight high-risk subgroups. When requiring standardization, standardizing to a population-specific standard (here, an Indigenous standard) generates metrics centred around and reflective of reality for the population of focus, supporting communities' self-determination to identify priorities and informing resource allocation and service delivery. The principles outlined here apply across populations, including Indigenous and other populations internationally. [ABSTRACT FROM AUTHOR]

Appendiceal diverticulitis is known as a rare pathology and its etiology remains largely unknown. We describe a case of a 41-year-old woman with a past history of inflammatory bowel disease (IBD) who was admitted to the Emergency Department at a rural hospital in Australia with right iliac fossa pain (RIF) and later was found to have acute appendiceal diverticulitis on histopathologic studies. Thus far, no literature has described IBD as one of the possible contributing factors of appendiceal diverticulitis. This paper aims to shed light on the possible causative relation between appendiceal diverticulitis and IBD. [ABSTRACT FROM AUTHOR]

With this paper, we initiate the Supplement on Deepening our Understanding of Quality in Australia (DUQuA). DUQuA is an at-scale, cross-sectional research programme examining the quality activities in 32 large hospitals across Australia. It is based on, with suitable modifications and extensions, the Deepening our Understanding of Quality improvement in Europe (DUQuE) research programme, also published as a Supplement in this Journal, in 2014. First, we briefly discuss key data about Australia, the health of its population and its health system. Then, to provide context for the work, we discuss previous activities on the quality of care and improvement leading up to the DUQuA studies. Next, we present a selection of key interventional studies and policy and institutional initiatives to date. Finally, we conclude by outlining, in brief, the aims and scope of the articles that follow in the Supplement. This first article acts as a framing vehicle for the DUQuA studies as a whole. Aggregated, the series of papers collectively attempts an answer to the questions: what is the relationship between quality strategies, both hospital-wide and at department level? and what are the relationships between the way care is organised, and the actual quality of care as delivered? Papers in the Supplement deal with a multiplicity of issues including: how the DUQuA investigators made progress over time, what the results mean in context, the scales designed or modified along the way for measuring the quality of care, methodological considerations and provision of lessons learnt for the benefit of future researchers. [ABSTRACT FROM AUTHOR]

Study Question: What is the likelihood of having a child within 4 years for men and women with strong short-term reproductive intentions, and how is it affected by age?Summary Answer: For women, the likelihood of realising reproductive intentions decreased steeply from age 35: the effect of age was weak and not significant for men.What Is Known Already: Men and women are postponing childbearing until later ages. For women, this trend is associated with a higher risk that childbearing plans will not be realised due to increased levels of infertility and pregnancy complications.Study Design, Size, Duration: This study analyses two waves of the nationally representative Household, Income and Labour Dynamics in Australia (HILDA) survey. The analytical sample interviewed in 2011 included 447 men aged 18-45 and 528 women aged 18-41. These respondents expressed a strong intention to have a child in the next 3 years. We followed them up in 2015 to track whether their reproductive intention was achieved or revised.Participants/materials, Settings, Methods: Multinomial logistic regression is used to account for the three possible outcomes: (i) having a child, (ii) not having a child but still intending to have one in the future and (iii) not having a child and no longer intending to have one. We analyse how age, parity, partnership status, education, perceived ability to conceive, self-rated health, BMI and smoking status are related to realising or changing reproductive intentions.Main Results and the Role Of Chance: Almost two-thirds of men and women realised their strong short-term fertility plans within 4 years. There was a steep age-related decline in realising reproductive intentions for women in their mid- and late-30s, whereas men maintained a relatively high probability of having the child they intended until age 45. Women aged 38-41 who planned to have a child were the most likely to change their plan within 4 years. The probability of realising reproductive intention was highest for married and highly educated men and women and for those with one child.Limitations, Reasons For Caution: Our study cannot separate biological, social and cultural reasons for not realising reproductive intentions. Men and women adjust their intentions in response to their actual circumstances, but also in line with their perceived ability to have a child or under the influence of broader social norms on reproductive age.Wider Implications Of the Findings: Our results give a new perspective on the ability of men and women to realise their reproductive plans in the context of childbearing postponement. They confirm the inequality in the individual consequences of delayed reproduction between men and women. They inform medical practitioners and counsellors about the complex biological, social and normative barriers to reproduction among women at higher childbearing ages.Study Funding/competing Interest(s): This research was partly supported by a Research School of Social Sciences Visiting Fellowship at the Australian National University and an Australian Research Council Discovery Project (DP150104248). Éva Beaujouan's work was partly funded by the Austrian Science Fund (FWF) project 'Later Fertility in Europe' (Grant agreement no. P31171-G29). This paper uses unit record data from the HILDA Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services (DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research (Melbourne Institute). The findings and views reported in this paper, however, are those of the authors and should not be attributed to either DSS or the Melbourne Institute. The authors have no conflicts of interest. [ABSTRACT FROM AUTHOR]

This paper reviews application of the Daily Egg Production Method (DEPM) to sardine (Sardinops sagax) off southern Australia between 1995 and 2019. Coefficients of variation (CVs) of estimates of spawning biomass (SB) were reduced from 23–59% to 8–12% by: (i) estimating mean daily egg production (P 0), spawning fraction (S), and sex ratio (R) from all historical data rather than annually; and (ii) combining batch fecundity (F) and female weight (W) into a single parameter, relative fecundity (F ′ =  F ^ / W). Total daily egg production was estimated most precisely from annual estimates of spawning area (A) and estimates of P 0 obtained from historical data. Both S and R were estimated most precisely from historical data. Estimating W and F from historical data did not increase precision. F ′ had lower CVs than both W and F , and was stable across years and a wide range of W. Findings demonstrate that A can be converted into a precise estimates of SB using estimates of P 0, S , R , and F ′ obtained from historical data. However, the possibility that DEPM parameters may change in the future cannot be discounted. Future monitoring should include annual estimation of P 0 and periodic (e.g. 3–5 years) re-estimation of adult parameters. [ABSTRACT FROM AUTHOR]

Objectives The purpose of this paper is to investigate the utilisation of general practice Medicare Benefit Schedule (MBS) services aligned to Comprehensive Geriatric Assessment (CGA) within 6 months of an aged care eligibility assessment and its effects on mortality and transition to permanent residential aged care (PRAC). Design Retrospective cohort study from the Historical Cohort of the Registry of Senior Australians. Setting Community. Participants In total, 69,171 Individuals (aged 75+) receiving home care packages (HCPs) between 2011 and 2015. Outcome measures Mortality and transition to PRAC. Results The claims for a management plan with team care arrangement (TCA) within 3 months of the health assessment (i.e. CGA) was present in 5% and associated with 14% lower mortality (adjusted hazard ratio [aHR], 95%CI = 0.86, 0.80–0.93) compared to no claims, lower than that seen with partial CGA which was either health assessment claims only 7.0% (aHR, 95%CI = 0.93, 0.89–0.97) or management plan coupled with TCA claims only 9.0% (aHR, 95%CI = 0.91, 0.89–0.97). This pattern was seen in those frailer but not in those where the frailty index score was <0.21. Claims for management plans coupled with TCAs alone were associated with a 10% lower transition to PRAC (asHR, 95%CI = 0.90, 0.85–0.96) in those with FI score < 0.21 while this estimate was not significant in individuals with FI score ≥ 0.21. Conclusion It appears the conduct of a combination of interventions considered to be components of the CGA by GPs was associated with a lower risk of mortality that no claims or partial conduct of CGA. [ABSTRACT FROM AUTHOR]

Ascochyta lentis causes ascochyta blight in lentil (Lens culinaris Medik.) and yield loss can be as high as 50%. With careful agronomic management practices, fungicide use, and advances in breeding resistant lentil varieties, disease severity and impact to farmers have been largely controlled. However, evidence from major lentil producing countries, Canada and Australia, suggests that A. lentis isolates can change their virulence profile and level of aggressiveness over time and under different selection pressures. In this paper, we describe the first genome assembly for A. lentis for the Australian isolate Al4, through the integration of data from Illumina and PacBio SMRT sequencing. The Al4 reference genome assembly is almost 42 Mb in size and encodes 11,638 predicted genes. The Al4 genome comprises 21 full-length and gapless chromosomal contigs and two partial chromosome contigs each with one telomere. We predicted 31 secondary metabolite clusters, and 38 putative protein effectors, many of which were classified as having an unknown function. Comparison of A. lentis genome features with the recently published reference assembly for closely related A. rabiei show that genome synteny between these species is highly conserved. However, there are several translocations and inversions of genome sequence. The location of secondary metabolite clusters near transposable element and repeat-rich genomic regions was common for A. lentis as has been reported for other fungal plant pathogens [ABSTRACT FROM AUTHOR]

Aims This paper analyses the content of news media messages on drinking during pregnancy in Australia over an 18-year period to understand whether and how the nature of messages communicated to women has changed over time. Methods Factiva was used to search Australian newspapers from 2000 to 2017, resulting in a sample of 1394 articles from the 18 major national and state-based newspapers. Content analysis of articles was undertaken, and Poisson regression analysis was used to assess changes over time. Results The largest number of articles on drinking during pregnancy was published in 2007. Themes that significantly increased over time included Harms to the Child (from 0.97% in 2008 to 29.69% in 2015) and Prevention Initiatives (from 0% in 2005 to 12.50% in 2017). Articles endorsing women not consuming alcohol during pregnancy significantly increased over time (from 20.69% in 2001 to 53.78% in 2013), matched by a decreasing trend in the proportion of articles presenting mixed advice (from 15.93% in 2009 to 0% in 2017). The largest number of articles adopted no position in relation to women's consumption. Conclusions A stronger abstinence message during pregnancy has been communicated through Australian newspaper media over time. The mixed messaging and large number of articles not endorsing a position on consumption may reflect the inconclusiveness of the evidence on harms from low to moderate levels of alcohol consumption during pregnancy. Opportunities remain for researchers to work with public health advocates to disseminate balanced messages based on evidence-based research. [ABSTRACT FROM AUTHOR]

Background The hospital intensive care unit (ICU) environment encompasses sick patients who present for care in health crisis. Healthcare in this setting is complex, often involving the co-ordination of multiple professional teams, all under significant time pressures. The sequelae for staff interacting in this dynamic and often volatile setting are variable, depending upon their coping skillset and their familiarity with the stressors. Aims The primary aim of this study was to describe and in doing so, normalize the behavioural responses expressed by ICU doctors (Intensivists) in response to stressful workplace events. The secondary aim was to identify those responses that contributed to resilience. Methods A prospective qualitative study of senior Intensivists using a semi-scripted iterative interview. Data were transcribed and thematically analysed with verbatim quotations selected to support coding choices. Results Nineteen experienced Intensivists from three sites in Australia and Israel participated. Clinicians described conscious, physiological and professional responses to stressors, including sense-making and taking time to process information with appropriate support. Two of the most important mitigation processes revealed were the use of reflective learning and preventative practice changes to prevent future errors. These were overlaid with the importance of disclosure and transparency in clinical work. Conclusions Repeated exposure to stressful events potentiates burnout, wherein staff no longer experience satisfaction and enjoyment in what they do. This paper presents the behavioural responses that experienced Intensivists described in relation to stressful events in the ICU, including steps taken to mitigate the effects of these events on their personal well-being. [ABSTRACT FROM AUTHOR]

While research in social and affective neuroscience has a long history, it is only in the last few decades that it has been truly established as an independent field of investigation. In the Australian region, despite having an even shorter history, this field of research is experiencing a dramatic rise. In this review, we present recent findings from a survey conducted on behalf of the Australasian Society for Social and Affective Neuroscience (AS4SAN) and from an analysis of the field to highlight contributions and strengths from our region (with a focus on Australia). Our results demonstrate that researchers in this field draw on a broad range of techniques, with the most common being behavioural experiments and neuropsychological assessment, as well as structural and functional magnetic resonance imaging. The Australian region has a particular strength in clinically driven research, evidenced by the types of populations under investigation, top cited papers from the region, and funding sources. We propose that the Australian region has potential to contribute to cross-cultural research and facilitating data sharing, and that improved links with international leaders will continue to strengthen this burgeoning field. [ABSTRACT FROM AUTHOR]

The majority of people living with Alzheimer disease (AD) and related dementias are women. Longer life expectancy is one factor thought to contribute to this observation, but possible sex-specific biological mechanisms have received considerable attention from the research community. In the current issue of the Journal , Buckley et al. (Am J Epidemiol. 2019;188(7):1213–1223) use death certificate information on all deaths occurring among adults aged ≥60 years in Australia between 2006 and 2014 to evaluate sex/gender differences in rates of death with dementia (all types), AD dementia, and vascular dementia listed on the death certificate. The paper by Buckley et al. highlights several important methodological challenges for research examining sex/gender differences in risk of AD and related dementias, including challenges in measurement, survival bias and competing risks, and selection bias arising from sample selection. The current evidence on possible sex-specific biological risk factors for AD is intriguing, but there are numerous alternative explanations for differences in AD dementia and AD biomarkers between women and men. Triangulation of evidence from study designs with different strengths and weaknesses and transdisciplinary collaboration will be vital to generating conclusive evidence about sex/gender differences in risk of AD and related dementias. [ABSTRACT FROM AUTHOR]

We present a method for measuring the dispersion of higher mode surface wave phase velocities from a single seismogram using a hierarchical transdimensional Bayesian approach. The 1-D shear velocity profiles down to 800 km depth between sources and seismic stations are regarded as the controlling parameters to tune the phase velocities of fundamental and higher modes. The misfits between synthetics and real waveforms indicate whether the phase velocities are recovered well from the data. We use Monte Carlo Markov chains to approximate the posterior distribution of each model parameters and assess the uncertainties from these probability density functions. These techniques can test models of varying dimensions while being parsimonious, thereby letting the data themselves control the complexity of the solution. Another advantage is that the algorithm can decide how much data noise is needed in order to explain the data without overfitting them. The data noise can be treated as an unknown and different noise levels can be applied to the different time windows considered. The posterior noise distributions can then be used as an indicator of the quality of the waveform fit within each frequency–time window. We considered phase velocities between 50 and 200 s for each mode and performed a reliability analysis to determine which modes and periods are reliably constrained. In this paper, we first present the method and demonstrate its feasibility with synthetic tests, which show that the technique is robust. We then illustrate it with applications to real data. We applied the method to two paths sampling Australia using earthquakes at regional distances and obtained results that agree well with previous studies. The new method can be used in regional and global tomographic studies to obtain phase velocity maps and 3-D models of seismic velocities and anisotropy at depths that are not well resolved by fundamental mode surface waves or body waves. [ABSTRACT FROM AUTHOR]

In the absence of quantitative relationships, a cross-gradient function can be used to correlate unknown physical properties in a joint inversion of geophysical data sets. It introduces a structural correlation between properties. A commonly used, inexact approach adds a weighted cross-gradient term as a penalty to the cost function being minimized during inversion. This weighting factor needs to be tuned to balance the regularization and cross-gradient terms. In this paper we propose nonlinear weighting for the cross-gradient function which addresses the very different magnitudes of the cross-gradient and regularization terms. This approach also couples the weighting factors for the regularization and correlation terms reducing the number of tuning parameters. The approach is investigated for a synthetic case. Results are also shown for the 3-D joint inversion of high-resolution magnetic and gravity anomaly data from Southern Queensland in Australia with over 30 million cells. [ABSTRACT FROM AUTHOR]

Aims This paper examines: (a) change over time (2001–2013) in recently reducing or ceasing drinking in the Australian population and (b) the reasons given for reducing or ceasing drinking in the most recent survey (2013); stratified by sex and age group. Short summary Rates of reducing and ceasing drinking increased between 2001 and 2013 in Australia. Young people were more likely to modify drinking due to lifestyle and enjoyment reasons; older groups were more likely to report health reasons. These trends contribute to the broader context of declining alcohol consumption in Australia. Methods Data are from five waves of the National Drug Strategy Household Survey (N = 119,397). Logistic regression models with interaction terms were used to identify a shift in sex or age over time in predicting reduction or cessation of drinking and to predict motivations for reducing or ceasing drinking by sex and age. Results Reports of recently reducing the quantity or frequency of drinking increased from 2001 to 2007 and remained stable between 2007 and 2013. There was a steady increase in the number of Australians reporting recently ceasing drinking from 2001 to 2013, with a significant effect for age (younger groups more likely than older groups to cease drinking in the past two waves). Reasons for reducing or ceasing drinking varied by age, with older people more likely to report health reasons and younger people more likely to report lifestyle reasons or enjoyment. Conclusion Increases over time in reports of reduction or cessation of drinking due to health, lifestyle, social and enjoyment reasons suggest that the social position of alcohol in Australia may be shifting, particularly among young people. [ABSTRACT FROM AUTHOR]

Objectives: This paper explores, from the patients' perspective, the likely impact of the Australian after-hours house-call (AHHC) medical services on emergency department (ED) presentations. This has become imperative given the significant cost difference between patient presentations to either the AHHC or ED and their practical implications for health care funding.Design, setting and participants: A cross-sectional, self-reported survey of all 10 838 patients in Australia known to have patronized AHHC services over the last week of January 2016.Main outcome measure: The study used a validated, self-completion questionnaire, dispatched through a mixture of online and postal methods.Results: A total of 1228 questionnaires were returned, of which 1211 included all relevant sections of the survey (11.2% response rate). Four hundred and eighty-six patients (40.1%) indicated that they would have gone to the ED on the same day or night of their illness had the AHHC not been available, with the elderly (≥65) and children (<16) accounting for nearly two-thirds of these (64.6%). Following their AHHC consultations, 103 (8.5%) patients eventually attended the ED, meaning that the service prevented 383 patients from attending the ED, a decrease of 78.8%. Stratification based on location showed that this impact was seen across all states and territories in Australia where AHHC services exist, ranging from a reduction of 73.9% in Western Australia to 85.0% in Tasmania. Similarly, the impact cuts across all patient demographics, including age ranges, gender and social divides.Conclusions: Based on our respondents' reports, AHHC services appear to be associated with a reduction in ED visits in Australia, with the impact cutting across all regions and patient demographics. [ABSTRACT FROM AUTHOR]

Ecosystem-based management (EBM) is now widely accepted as the best means of managing the complex interactions in marine systems. However, progress towards implementing and operationalizing it has been slow. We take a pragmatic approach to EBM. Our simple definition is balancing human activities and environmental stewardship in a multiple-use context. In this paper, we present case studies on the development and implementation of EBM in Australia. The case studies (Australia's Ocean Policy, the Great Barrier Reef, New South Wales (NSW) marine estate, Gladstone Harbour, and South Australia and Spencer Gulf) span different spatial scales, from national to regional to local. They also cover different levels of governance or legislated mandate. We identify the key learnings, necessary components and future needs to support better implementation. These include requirements for clearly identified needs and objectives, stakeholder ownership, well defined governance frameworks, and scientific tools to deal with conflicts and trade-offs. Without all these components, multi-sector management will be difficult and there will be a tendency to maintain a focus on single sectors. While the need to manage individual sectors remains important and is often challenging, this alone will not necessarily ensure sustainable management of marine systems confronted by increasing cumulative impacts. [ABSTRACT FROM AUTHOR]

Objective: this paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period. Methods: the study comprised a retrospective cohort study of residents dwelling in accredited nursing homes in Australia whose deaths were reported to the Coroners between 1 July 2000 and 30 June 2013 and was attributed to physical restraint. Results: five deaths in nursing home residents due to physical restraint were reported in Australia over a 13-year period. The median age of residents was 83 years; all residents had impaired mobility and had restraints applied for falls prevention. Neck compression and entrapment by the restraints was the mechanism of harm in all cases, resulting in restraint asphyxia and mechanical asphyxia, respectively. Conclusions: this national study confirms that the use of physical restraint does cause fatalities, although rare. Further research is still needed to identify which alternatives strategies to restraint are most effective, and to examine the reporting system for physical restraint-related deaths. [ABSTRACT FROM AUTHOR]

Objective. Chronic pain is experienced by one in five Australians and is estimated to be the nation's third most costly health problem. In 2013, a chronic pain treatment outcomes registry was established, with the goals of evaluating treatment of chronic pain in multidisciplinary centers, establishing a benchmarking system to drive quality improvement and providing answers to important questions regarding types of treatment ("dose," intensity, and response) and which treatment is appropriate for different patients. This paper describes the development and the first-phase implementation of the registry. Methods.A minimum data set of primarily patient-rated measures was developed for use within pain management services. Governance structures and protocols for data collection were established, and software and resources created, to support pain management services. Results. Data collection commenced in 21 centers in Australia and is being implemented in over 20 others across Australia and New Zealand within the first two years. Feedback in the initial phase has already resulted in improvements to the software and reports, as well as minor changes to the data set. Centers have submitted high-quality data describing the demographic and clinical characteristics of patients referred to specialist pain services. Conclusions. The electronic Persistent Pain Outcomes Collaboration has been established for Australasia and is strongly supported by specialist societies and consumer groups. The next phase will increase the proportion of follow-up data in order to realize the registry's goals of evaluation, benchmarking, and research to improve outcomes and services for patients experiencing persistent pain. [ABSTRACT FROM AUTHOR]

Incorporating social and economic relationships, together with ecological sustainability objectives into models to provide management advice creates a number of challenges, particularly when this advice requires complex trade-offs between objectives. This is further complicated by differences in quality and quantity of data across fisheries, and difficulties in quantifying some measures, particularly around social objectives and outcomes. Internationally, a wide variety of approaches have been used, some as part of the formal management strategy evaluation process, and others more exploratory. In this paper, we outline the general challenges around incorporating multiple objectives into models for management advice under different levels of data availability. We present three case Australian study fisheries where different approaches have been used to include social, economic and ecological considerations, reflecting the differences in data types and availability. We focus on Australian fisheries as the sewere among the first in the world to embrace a management objective of maximizing net economic returns as the primary objective of fisheries management, and, more recently, social objectives have increasingly been promoted in fisheries management. Quantifying the latter has created challenges for the development of fisheries models, requiring innovate ways to link the different components. [ABSTRACT FROM AUTHOR]

Background: There has been little research on the economic status of those with multiple health conditions, particularly on the relationship between multiple health conditions and wealth. This paper will assess the difference in the value and type of wealth assets held by Australians who have multiple chronic health conditions. Methods: Using Health & WealthMOD, a microsimulation model of the 45-64-year-old Australian population in 2009, a counterfactual analysis was undertaken. The actual proportion of people with different numbers of chronic health conditions with any wealth, and the value of this wealth was estimated. This was compared with the counterfactual values had the individuals had no chronic health conditions. Results: There was no change in the proportion of people with one health condition who actually had any wealth, compared to the counterfactual proportion had they had no chronic health conditions. Ninety-four percent of those with four or more health conditions had some accumulated wealth; however, under the counterfactual, 100% would have had some accumulated wealth. There was little change in the value of non-income-producing assets under the counterfactual, regardless of number of health conditions. Those with four or more chronic health conditions had a mean value of $17 000 in income-producing assets; under the counterfactual, the average would have been $78 000. Conclusion: This study has highlighted the variation in the value of wealth according to number of chronic health conditions, and hence the importance of considering multiple morbidities when discussing the relationship between health and wealth. [ABSTRACT FROM AUTHOR]

Background: Suicide is higher among economically inactive and unemployed persons than employed persons. This paper investigates differences in this relationship by sex and age over the period 2001 to 2010 in Australia. It also examines changes in suicide among employed, unemployed and economically inactive persons during the recession of 2007–09.Method: Suicide data from the National Coroners Information System were utilised for this retrospective study. Negative binomial and Poisson regression was used to estimate the association between suicide and employment status and to investigate differences in suicide rates over the period of the recession (2007–09) compared with the year before the recession (2006).Results: Results suggest that during 2001–10 economically inactive/unemployed males had a suicide rate ratio (RR) of 4.62 [95% confidence interval (CI) 4.10, 5.19; P < 0.001] compared with employed males (RR = 1.00), whereas economically inactive/unemployed females had a suicide RR of 8.44 compared with employed females (95% CI 7.38, 9.67; P < 0.001). There was an increase in suicide among both employed (7% rise in 2007, P = 0.003) and economically inactive/unemployed males during the GFC (22% in 2008, P < 0.001). Suicide also increased among economically inactive/unemployed females (12% in 2007, P = 0.03; 19% in 2008, P = 0.001) but not among employed females.Conclusions: These results suggest the need for adequate policy and social welfare responses to ameliorate the effects of the economic recession on the working age population. Particularly, these should target unemployed and economically inactive men and women in Australia, who may be at higher risk of suicide than previously thought. [ABSTRACT FROM AUTHOR]

Background The positive cross-sectional association between health and SES often strengthens at younger ages before peaking at middle ages and then weakening at older ages. Selective mortality is a possible reason for the weakening relationship at older ages but current evidence for this is limited. Methods This paper uncovers the changing nature of the inter-dependence between SES and health over the lifecycle by further developing and applying longitudinal inequality decomposition techniques which account for mortality. We examine changes in SES-related health inequality for rolling age cohorts by gender for Australia (using the Household, Income and Labour Dynamics in Australia (HILDA) survey) and the United Kingdom (using the Understanding Society survey). Results We find for young men in both countries that the simultaneous co-movement in both health and income plays the major role in increasing health inequalities. At middle ages the poor start to lose health more quickly than the rich but at older ages selective mortality plays the major role with the poor more likely to die than the rich which also has an indirect effect of making morbidity losses seem less concentrated among the poor. Conclusions Selective mortality plays a major role in weakening the relationship between SES and health at older ages. Past studies have missed identifying the full effect of selective mortality. Key messages SES-related health inequalities accumulate throughout the lifecycle, even in older ages. [ABSTRACT FROM AUTHOR]

Focus of Presentation Rheumatic fever (RF) and rheumatic heart disease (RHD) are endemic among Indigenous Australians. End RHD in Australia: Study of Epidemiology (ERASE) aimed to characterize contemporary RF/RHD epidemiology. Using multi-jurisdictional linked data from several administrative sources, we undertook sub-studies covering diverse epidemiological questions, requiring substantial methods development. Mixed methods further identified barriers/facilitators to inform system redesign. Our multi-disciplinary collaboration supported diverse initiatives to contribute to policy at government, service and community/stakeholder levels. We show how findings from ERASE were applied/translated to address the impact of RF/RHD in Australia. Findings Academic: >15 papers and commentaries/editorials provided the backbone to translational outputs and methods sharing. PhD students have ongoing projects using ERASE datasets. Advocacy: ERASE epidemiological and economic information supported the Endgame Strategy (roadmap for eliminating RHD in Australia by 2031) presented to government. Health professionals: ERASE data contributed to Australian RF/RHD guidelines. Slides of results/interpretation are publically-available on the RHDAustralia website. Student lectures integrate biomedical and culturally-informed perspectives. Indigenous stakeholder engagement: involves (1)presentations to peak Indigenous-controlled organisations (2)co-designed resources (booklets/slides) for capacity-building of RHDAustralia's national Champions4Change network (3)research workshops to promote two-way learning and health literacy/numeracy. Challenges remain regarding strengths-based approaches when reporting high disparities. Conclusions/Implications Strong translational commitment and national multi-disciplinary networks of Indigenous and non-Indigenous collaborators ensured ERASE generated multiple outputs that continue to inform training, practice, policy and community health literacy. Key messages Build translation and broad collaboration into study from the start. [ABSTRACT FROM AUTHOR]