The Australian burden of disease study : measuring the loss of health from diseases, injuries and risk factors

This is an overview of the first burden of disease and injury studies carried out in Australia. Methods developed for the World Bank and World Health Organization Global Burden of Disease Study were adapted and applied to Australian population health data. Depression was found to be the top- ranking cause of non-fatal disease burden in Australia, causing 8% of the total years lost due to disability in 1996. Mental disorders overall were responsible for nearly 30% of the non-fatal disease burden. The leading causes of total disease burden (disability-adjusted life years [DALYs]) were ischaemic heart disease and stroke, together causing nearly 18% of the total disease burden. Depression was the fourth leading cause of disease burden, accounting for 3.7% of the total burden. Of the 10 major risk factors to which the disease burden can be attributed, tobacco smoking causes an estimated 10% of the total disease burden in Australia, followed by physical inactivity (7%).

A collaborative group method of inclusive research

Funding bodies in Australia and the United Kingdom require research on issues that affect the lives of people with intellectual disability to be inclusive. Debate continues about the nature and benefits of inclusive research, which has become an umbrella term encompassing a broad spectrum of approaches.

Conceptualizing inclusive research with people with intellectual disability

The inclusion of people with intellectual disability in research is a common requirement of research funding. Little conceptual clarity is available to guide the conduct of inclusive research or judge its fidelity, there is minimal evidence of its impact, and questions remain about its feasibility and rigour.

Inclusion in political and public life: the experiences of people with intellectual disability on government disability advisory bodies in Australia

BACKGROUND: Civil and political participation lies at the core of citizenship. Increasingly, people with intellectual disability are members of disability advisory bodies. This study investigated the political orientations of advisory body members with intellectual disability, their participatory experiences, and the types of support they received. METHOD: The 9 people with intellectual disability who in 2005 were members of disability advisory bodies at a state, national, and Victorian local government level were interviewed, together with 12 other members or secretariat staff of these bodies. Observations were also conducted of advisory body meetings. RESULTS: The political perspective of members with intellectual disability varied, but all had a background in self-advocacy. They found the work hard but rewarding and encountered both practical and intangible obstacles to participation. Members received varying types of practical support, but a supportive collegial milieu was characteristic among members who felt most confident about their participation. CONCLUSIONS: The milieu, structures, and processes of advisory bodies must all be adjusted to accommodate people with intellectual disability if they are to participate meaningfully.

Ethical issues and lessons in the voices of Pacific children project

Knowledge of the needs and experiences of children with disability living in Vanuatu and Papua New Guinea (PNG) is limited and that which does exist, does not focus on data collected directly from children themselves. This project aims to establish a method of data collection to determine the self-reported needs and priorities of children living with disability in Vanuatu and PNG. The project involves a multi-staged capacity building approach between two Disabled People’s Organisations (DPOs): PNG Assembly of Disabled Persons (PNGADP) and the Disability Promotion and Advocacy Association Vanuatu (DPA); and Save the Children and Deakin University. The research is funded by an Australian Development Research Award and is being undertaken between 2013 and 2015. The research will collect data from up to 50 children with disability aged between 5 and 18 years in each country.

Increasing body weight and risk of limitations in activities of daily living: a systematic review and meta-analysis

This study examined the relationship between normal weight, overweight and obesity class I and II+, and the risk of disability, which is defined as impairment in activities of daily living (ADL). Systematic searching of the literature identified eight cross-sectional studies and four longitudinal studies that were comparable for meta-analysis. An additional four cross-sectional studies and one longitudinal study were included for qualitative review. Results from the meta-analysis of cross-sectional studies revealed a graded increase in the risk of ADL limitations from overweight (1.04, 95% confidence interval [CI] 1.00-1.08), class I obesity (1.16, 95% CI 1.11-1.21) and class II+ obesity (1.76, 95% CI 1.28-2.41), relative to normal weight. Meta-analyses of longitudinal studies revealed a similar graded relationship; however, the magnitude of this relationship was slightly greater for all body mass index categories. Qualitative analysis of studies that met the inclusion criteria but were not compatible for meta-analysis supported the pooled results. No studies identified met all of the pre-defined quality criteria, and subgroup analysis was inhibited due to insufficient comparable studies. We conclude that increasing body weight increases the risk of disability in a graded manner, but also emphasize the need for additional studies using contemporary longitudinal cohorts with large numbers of obese class III individuals, a range of ages and with measured height and weight, and incident ADL questions.

The relation between non-occupational physical activity and years lived with and without disability

OBJECTIVES: The effects of non-occupational physical activity were assessed on the number of years lived with and without disability between age 50 and 80 years. METHODS: Using the GLOBE study and the Longitudinal Study of Aging, multi-state life tables were constructed yielding the number of years with and without disability between age 50 and 80 years. To obtain life tables by level of physical activity (low, moderate, high), hazard ratios were derived for different physical activity levels per transition (non-disabled to disabled, non-disabled to death, disabled to non-disabled, disabled to death) adjusted for age, sex and confounders. RESULTS: Moderate, compared to low non-occupational physical activity reduced incidence of disability (HR 0.66, 95% CI 0.51 to 0.86), increased recovery (HR 1.95, 95% CI 1.32 to 2.87), and represents a gain of disability-free years and a loss of years with disability (male 3.1 and 1.2; female 4.0 and 2.8 years). Performing high levels of non-occupational physical activity further reduced incidence, and showed a higher gain in disability-free years (male 4.1; female 4.7), but a similar reduction in years with disability. CONCLUSION: Among 50-80-year-olds promoting physical activity is a fundamental factor to achieve healthy ageing.

An Australian experience of managing pressure ulcers in persons with SCI

Pressure ulcers are a difficult and complex problem, frequently resulting in poor patient outcomes ,and significantly increased cost of care. This project evolved from a desire to improve the management and subsequent outcomes for persons with spinal cord injury (SCI) who experience pressure ulcers acquired in the community. The vast body of work related to pressure ulcers has focused on risk assessment and prevention. However, there has been little interest in the management of prevailing pressure ulcers. Using a retrospective case history audit and interviews with patients and health care workers from an Australian spinal services unit, current practices associated with the care of pressure ulcers are described. A number of issues are identified that relate to funding, diet, attitudes, consistency of care, and low levels of staff interest in pressure ulcer management. This work provides baseline data from which current management practices can be reviewed, revised, and empirically evaluated.

Individual differences in children's suggestibility : a comparison between intellectually disabled and mainstream samples

This study examined whether age, gender, intelligence, communication ability and shyness predict intellectually disabled children’s susceptibility to an interviewer’s misleading suggestions. Further, the study examined whether the relative influence of these factors differs between intellectually disabled and mainstream samples. Participants included 75 children with mild and borderline intellectual disabilities (aged 77–158 months) and 83 mainstream children (aged 68–152 months). All children were individually administered the Yield and Shift subscales of the Gudjonsson Suggestibility Scale (Form 2) as well as standardised measures of IQ, shyness and communication ability. For the intellectually disabled children, multiple regression analyses revealed that age, IQ and communication inversely predicted Yield suggestibility, however, none of the factors predicted Shift suggestibility. For the mainstream children, age made a significant independent contribution to both Yield and Shift suggestibility, while IQ was a significant predictor of Shift suggestibility. When comparing the relative impact of these factors across the samples, age had a significantly greater impact on mainstream (compared with intellectually disabled) children’s Shift suggestibility, while IQ had a significantly greater influence on intellectually disabled (compared with mainstream) children’s Yield scores. These findings highlight the limited generalisability of previous findings involving mainstream children’s suggestibility to intellectually disabled samples.

RE Kevin and the right of transsexual persons to marry in Australia

This article considers the decision of the Family Court of Australia in Re Kevin (Validity of Marriage of a Transsexual) [2001] FamCA 1074, which was upheld by the Full Court of the Family Court of Australia in February 2003. Re Kevin was the first case in Australia to deal directly with the question of whether a transsexual person could marry under Australian law. In the past, Australia had adhered to the judgement of Ormrod J in Corbett v Corbett [1971] P. 83, which set the benchmark for what is ‘male’ and what is ‘female’ under the common law. Prior to Re Kevin the question of what is a man and what is a woman for the purposes of marriage in Australia mirrored the strict biological test established in Corbett. In other words, the Australian courts relied upon biological factors, as espoused by Ormrod J, when determining a person's true sex. In Re Kevin, Chisholm J examined in detail what it is to be a man or woman, but unlike Ormrod J considered ‘brain sex’ to have a significant impact on a person's view of their own innate sexual identity. The Full Court of the Family Court agreed with the powerful and well-reasoned judgement of Chisholm J at first instance.

Mood and self-esteem of persons with multiple sclerosis following an exacerbation

ObjectiveThis study was designed to determine the impact of an exacerbation in the symptoms of multiple sclerosis (MS) on the mood and self-esteem of persons with MS over an 18-month period.MethodsParticipants were 243 (80 males and 163 females) persons with MS and 184 (56 males and 128 female) persons from the general population. Information was obtained about coping styles, mood, and self-esteem among all respondents at Time 1, Time 2 (6 months later), and Time 3 (18 months later).ResultsThe results demonstrated that both groups of persons with MS experienced poorer mood levels than the general population, with the exacerbation group showing the highest levels of anxiety and confusion. Coping strategies did not predict mood in either of the MS groups.ConclusionThe findings of this study demonstrate that persons with MS experience significant problems with their mood states. However, respondents need to be tracked over a longer period to further explore the role of coping strategies in the adjustment of persons with MS

Conceptualization, measurement, and application of quality of life for persons with intellectual disabilities: report of an international panel of experts

In this article a number of issues involving the concept of quality of life as applied to persons with intellectual disabilities are summarized, and a number of agreed-upon principles regarding its conceptualization, measurement, and application are presented. We realize that the concepts and models presented in this article will vary potentially from country to country, and even from area to area within countries. The cross-cultural understanding of the concept of quality of life is in its infancy, and we hope that the discourses resulting from the material presented in this article will facilitate both cross-cultural understanding and collaborative work. The article reflects current thought about the conceptualization, measurement, and application of this increasingly important and widely used concept in the field of intellectual disabilities and sets the stage for its continuing development.