Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

Background--Diabetes mellitus increases the risk of cardiovascular disease (CVD) and all-cause mortality. The relationship between milder elevations of blood glucose and mortality is less clear. This study investigated whether impaired fasting glucose and impaired glucose tolerance, as well as diabetes mellitus, increase the risk of all-cause and CVD mortality.

Methods and Results--In 1999 to 2000, glucose tolerance status was determined in 10 428 participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). After a median follow-up of 5.2 years, 298 deaths occurred (88 CVD deaths). Compared with those with normal glucose tolerance, the adjusted all-cause mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for known diabetes mellitus and newly diagnosed diabetes mellitus were 2.3 (1.6 to 3.2) and 1.3 (0.9 to 2.0), respectively. The risk of death was also increased in those with impaired fasting glucose (HR 1.6, 95% CI 1.0 to 2.4) and impaired glucose tolerance (HR 1.5, 95% CI 1.1 to 2.0). Sixty-five percent of all those who died of CVD had known diabetes mellitus, newly diagnosed diabetes mellitus, impaired fasting glucose, or impaired glucose tolerance at baseline. Known diabetes mellitus (HR 2.6, 95% CI 1.4 to 4.7) and impaired fasting glucose (HR 2.5, 95% CI 1.2 to 5.1) were independent predictors for CVD mortality after adjustment for age, sex, and other traditional CVD risk factors, but impaired glucose tolerance was not (HR 1.2, 95% CI 0.7 to 2.2).

Conclusions--This study emphasizes the strong association between abnormal glucose metabolism and mortality, and it suggests that this condition contributes to a large number of CVD deaths in the general population. CVD prevention may be warranted in people with all categories of abnormal glucose metabolism.

Greening Australian workplaces : workers and the environment

Workers have in the past have been seen as a hindrance to environmental reform. This has been primarily because of the fear of job loss. The job versus the environment dichotomy that has placed workers and trade unions against environmentalists is unhelpful and believed by many as outdated. Internationally, trade unions have worked together with the United Nations and other international bodies to ensure that the rights of workers have not been ignored in the climate change debate. Significantly workers are now seen as part of the answer. Workers are not a hindrance to environmental reform. Rather they are an important part of finding solutions to climate change and wider environmental sustainability measures in our community. The United Nations Environmental Programme report titled ‘Labour and the Environment; A Natural Synergy’ examines how workers and their representative trade unions can make a significant contribution towards promoting action on climate change and wider environmental sustainability measures in the workplace. The report outlines three broad recommendations which countries can implement to foster a growing ‘synergy’ between the interests of labour and protection of the environment. The advantage of the report is that it discusses the recommendations in the context of existing laws and general regulatory structures common to many countries including Australia. The first two recommendations draw upon labour laws whilst the third is in the area of company law. The first recommendation is the use of enterprise bargaining to incorporate clauses which protect and promote the environment in enterprise agreements commonly called ‘green friendly’ clauses. The second recommendation is the use of occupational health and safety laws as a vehicle for the promotion of environmental standards in the workplace. The third recommendation is the active engagement of corporate social responsibility principles by companies. This article discusses the recommendations in the context of Australian law.

Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian diabetes, obesity and lifestyle study (AusDiab)

OBJECTIVE--We examined the associations of objectively measured sedentary time and physical activity with continuous indexes of metabolic risk in Australian adults without known diabetes.

RESEARCH DESIGN AND METHODS--An accelerometer was used to derive the percentage of monitoring time spent sedentary and in light-intensity and moderate-to-vigorous-intensity activity, as well as mean activity intensity, in 169 Australian Diabetes, Obesity and Lifestyle Study (AusDiab) participants (mean age 53.4 years). Associations with waist circumference, triglycerides, HDL cholesterol, resting blood pressure, fasting plasma glucose, and a clustered metabolic risk score were examined.

RESULTS--Independent of time spent in moderate-to-vigorous-intensity activity, there were significant associations of sedentary time, light-intensity time, and mean activity intensity with waist circumference and clustered metabolic risk. Independent of waist circumference, moderate-to-vigorous-intensity activity time was significantly beneficially associated with triglycerides.

CONCLUSIONS--These findings highlight the importance of decreasing sedentary time, as well as increasing time spent in physical activity, for metabolic health.

Event that never happened : the history and politics of decentralisation in Victoria and New South Wales 1885-1985

The thesis is an account of movements and policies for decentralisation of population and economic activity away from metropolitan to non-metropolitan areas in Victoria and N.S.W. in the period 1885-1985. It examines the pull from the country and the push from the capitals for decentralisation. Ballarat (Victoria) and Bathurst (N.S.W.) are used as case studies. Introductory chapters describe the historic pattern of population distribution in the two Colonies/States and discuss theories about the spatial distribution of population and industry. Chapters recounting and discussing the history and politics of decentralisation in Victoria and N.S.W. are organised in three periods: 1885-1940; 1940-1965; 1965-1985. A more decentralised distribution of population in Victoria and N.S.W. was almost always widely accepted as being in the public interest. Decentralisation rose and fell recurrently on the issue attention cycle. The pull from the country was fragmented and locally self-interested. The push from the capitals occurred only when life or its quality was perceived as threatened because of factors related to city size. Governments in both States introduced micro policies ostensibly to counter formidable centralising forces. In the 1970s there was an abortive attempt to implement a selective decentralisation policy in N.S.W. The thesis argues that decentralisation did not happen because: (1) there was not a consistent set of values and goals underlying the pull and push; (2) there was never a sustained, unified constituency for decentralisation, even in the country; (3) the power to influence, subvert or obstruct decentralisation policies was too widely diffused; (4) insufficient account was taken in decentralisation policymaking of the underlying economic, social and political dynamics.

Career in writing : Judah Waten and the cultural politics of a literary career

This thesis examines the literary career of Judah Waten (1911-1985) in order to focus on a series of issues in Australian cultural history and theory. The concept of the career is theorised as a means of bringing together the textual and institutional dimensions of writing and being a writer in a specific cultural economy. The guiding question of the argument which re-emerges in different ways in each chapter is: in what ways was it possible to write and to be a writer in a given time and place? Waten's career as a Russian-born, Jewish, Australian nationalist, communist and realist writer across the middle years of this century is, for the purposes of the argument, at once usefully exemplary and usefully marginal in relation to the literary establishment. His texts provide the central focus for individual chapters; at the same time each chapter considers a specific historical moment and a specific set of issues for Australian cultural history, and is to this extent self-contained. Recent work in narrative theory, literary sociology and Australian literary and cultural studies is brought together to revise accepted readings of Waten's texts and career, and to address significant absences or problems in Australian cultural history. The sequence of issues shaping Waten's career in writing is argued in terms of the following conjunctions of theoretical and historical categories: proletarianism, modernity and theories of the avant-garde; the "e;migrant"e; writer and minority literatures; realism, political purpose and narrative self-situation; communism, nationalism and literary practice in the cold war; utopianism and the "e;literary witness"e; narrative of the Soviet Union; assimilationism, multicultural theory and the "e;non-Anglo-Celtic"e; writer; theories of autobiographical writing, and autobiography in Waten's career. The purpose of the thesis is not to discover a single key to Waten's writing across the oeuvre but rather to plot the specific occasions of this writing in the context of the structure of a career and the cultural institutions within which it was formed.

Poetry and silence : "a sequence of disappearances"

[No Abstract]

An exploration of motives for attending Australian ecotourism locations and their influence on future intentions

This paper sought to explore the push [internal] motivations of eco-tourists and the influence of these motivational drives on their future ecotourism intentions. Findings from this exploratory study identified five key internal motivations, namely, 'self-esteem', 'relaxation', 'social interaction', 'self-fulfilment' and 'thrill and excitement'. Further analysis identified that 'self-esteem', elaxation' and 'self-fulfilment' motives were significantly related to ecotourist's intention to volunteer as well as their intention to donate money to an eco-tourism destination. Additionally, 'self-fulfilment' and 'thrill and excitement' motives were identified as impacting upon eco-tourists’ future attendance intentions. Consequently, findings from this research provide eco-tourism operators with insight into eco-tourist motivations to inform product and brand development and promotional activities and assist in the ongoing development effective eco-tourist retention strategies.

Analytical relationship between family history and genetic and environmental risks, with application to female breast cancer

It is well established in genetic epidemiology that family history is an important indicator of familial aggregation of disease in a family. A strong genetic risk factor or an environmental risk factor with high familial correlation can result in a strong family history. In this paper, family history refers to the number of first-degree relatives affected with the disease. Cui and Hopper (Journal of Epidemiology and Biostatistics 2001; 6: 331-342) proposed an analytical relationship between family history and relevant genetic parameters. In this paper we expand the relationship to both genetic and environmental risk factors. We established a closed-form formula for family history as a function of genetic and environmental parameters which include genetic and environmental relative risks, genotype frequency, prevalence and familial correlation of the environmental risk factor. The relationship is illustrated by an example of female breast cancer in Australia. For genetic and environmental relative risks less than 10, most of the female breast cancer cases occur between the age of 40 and 60 years. A higher genetic or environmental relative risk will move the peak of the distribution to a younger age. A more common disease allele or more prevalent environmental risk factor will move the peak to an older age. For a proband with breast cancer, it is most likely (with probability ge80%) that none of her first-degree relatives is affected with the disease. To enable the probability of having a positive family history to reach 50%, the environmental relative risks must be extremely as high as 100, the familial correlation as high as 0.8 and the prevalence as low as 0.1. For genetic risk alone, even the relative risk is as high as 100, the probability of having a positive family history can only reach about 30%. This suggests that the environmental risk factor seems to play a more important role in determining a strong family history than the genetic risk factor.