The age of ‘depoliticisation’ and ‘dejuridification’ and its ‘logic of assembling’: an essay against the instrumentalist use of comparative law’s geopolitics

While comparative law has become a key discipline, its instrumentalist use has turned out to be a powerful weapon: it is the ‘pen’ by which the identity of and differences in law’s geopolitics are continually written and rewritten. Given its attractive functionalist essence, comparative law is gaining increasing international credit as a way of developing newer theories of sovereignty and governance in a framework in which law is conceived of less as a set of rules and more as a symbolic vestimentum of global soft power. The present contribution critically investigates the relationship between distortive views of comparative law’s geopolitics and the intimate essence of the doctrine aimed at creating the ‘aspatial’, unbounded, illimitable (and hence intangible) liberal global order whose governance appears to transcend the idea and form(s) of law through which the ‘politicization’ and ‘juridification’ of modernity have been achieved in the last century. In doing so, it also addresses why such an alliance has made it easier to ‘discover’ and ‘sell’ the smooth and rectilinear land of the figuratively unspoken and unwritten as the terra incognita that lies over what is created by the constructivist political intervention(s) of the modern nation-state

The Counterweight Programme: prevalence of CVD risk factors by body mass index and impact of a 10% weight change

Objectives

To examine relationships between body mass index (BMI), prevalence of physician-recorded cardiovascular disease (CVD) risk factors in primary care, and changes in risk with 10% weight change.

Methods

The Counterweight Project conducted a baseline cross-sectional survey of medical records of 6150 obese (BMI ≥ 30 kg/m2), 1150 age- and sex-matched overweight (BMI 25 to <30 kg/m2), and 1150 age- and sex-matched normal weight (BMI 18.5 to <25 kg/m2) controls, in primary care. Data were collected for the previous 18 months to examine BMI and disease prevalence, and then modelled to show the potential effect of 10% weight loss or gain on risk.

Results

Obese patients develop more CVD risk factors than normal weight controls. BMI ≥ 40 kg/m2 exhibits increased prevalence of type 2 diabetes mellitus (DM), odds ratio (OR) men: 6.16 (p < 0.001); women: 7.82 (p < 0.001) and hypertension OR men: 5.51 (p < 0.001); women: 4.16 (p < 0.001). Dyslipidaemia peaked around BMI 35 to <37.5 kg/m2, OR men: 3.26 (p < 0.001); women 3.76 (p < 0.001) and CVD at BMI 37.5 to <40 kg/m2 in men, OR 4.48 (p < 0.001) and BMI ≥ 40 kg/m2 in women, OR 3.98 (p < 0.001).

A 10% weight loss from the sample mean of 32.5 kg/m2 reduced the OR for type 2 DM by 30% and CVD by 20%, while 10% weight gain increased type 2 DM risk by more than 35% and CVD by 20%.

Conclusion

Obesity plays a fundamental role in CVD risk, which is reduced with weight loss. Weight management intervention strategies should be a public health priority to reduce the burden of disease in the population.

An efficacy trial of brief lifestyle intervention delivered by generalist community nurses (CN SNAP trial)

Background
Lifestyle risk factors, in particular smoking, nutrition, alcohol consumption and physical inactivity (SNAP) are the main behavioural risk factors for chronic disease. Primary health care (PHC) has been shown to be an effective setting to address lifestyle risk factors at the individual level. However much of the focus of research to date has been in general practice. Relatively little attention has been paid to the role of nurses working in the PHC setting. Community health nurses are well placed to provide lifestyle intervention as they often see clients in their own homes over an extended period of time, providing the opportunity to offer intervention and enhance motivation through repeated contacts. The overall aim of this study is to evaluate the impact of a brief lifestyle intervention delivered by community nurses in routine practice on changes in clients' SNAP risk factors.

Methods/Design
The trial uses a quasi-experimental design involving four generalist community nursing services in NSW Australia. Services have been randomly allocated to an 'early intervention' group or 'late intervention' (comparison) group. 'Early intervention' sites are provided with training and support for nurses in identifying and offering brief lifestyle intervention for clients during routine consultations. 'Late intervention site' provide usual care and will be offered the study intervention following the final data collection point. A total of 720 generalist community nursing clients will be recruited at the time of referral from participating sites. Data collection consists of 1) telephone surveys with clients at baseline, three months and six months to examine change in SNAP risk factors and readiness to change 2) nurse survey at baseline, six and 12 months to examine changes in nurse confidence, attitudes and practices in the assessment and management of SNAP risk factors 3) semi-structured interviews/focus with nurses, managers and clients in 'early intervention' sites to explore the feasibility, acceptability and sustainability of the intervention.

Discussion
The study will provide evidence about the effectiveness and feasibility of brief lifestyle interventions delivered by generalist community nurses as part of routine practice. This will inform future community nursing practice and PHC policy.

Client experience of brief lifestyle intervention by community nurses

Lifestyle modification interventions in primary health care settings are an important means of addressing lifestyle risk factors. An essential factor for the success of lifestyle advice is the client’s acceptance. Lifestyle interventions offered in general practice are well accepted by clients. However, little is known about how lifestyle interventions are accepted if offered by community nurses in the client’s home. This study investigates the experience and perspectives of clients who were offered brief lifestyle interventions from community nurses, based on the 5As model. Semi-structured interviews were conducted with 20 clients who had received brief lifestyle interventions from community nurses as part of a larger intervention trial. All clients perceived the provision of lifestyle interventions to be an appropriate part of the community nurses’ role. The advice and support offered was useful only to some, depending on personal preferences, experiences, perceived lifestyle risk and self-rated health. Offering brief lifestyle interventions did not affect the rapport between client and nurse and this puts community nurses in an ideal place to address lifestyle issues that can sometimes be sensitive. However, client-centredness must be emphasised to improve clients’ uptake of lifestyle advice and support.

Victoria's new homicide laws: provocative reforms or more stories of women 'asking for it'

The controversial partial defence of provocation has now been abolished in three Australian jurisdictions, including Victoria. Recent developments in Victorian case law would appear to suggest a continuation of ‘excuses’ for male anger and violence towards women that position the woman victim as to blame for her own death. This article considers that the 2005 abolition of provocation was only in part designed to redress the problem of victim-blame. The decision was accompanied by other key changes introduced into the Crimes Act 1958 (Vic) to make it easier for women who kill in the context of family violence to successfully claim self-defence and ‘excessive self-defence’ (defensive homicide). Drawing on recent developments in Victorian case law since the 2005 amendments, this article argues that the claim that provocation’s victim-blaming narratives are being mobilised in the guise of other defences merits closer analysis. It also argues that provocation’s critics must continue to expose the gendered (and raced) assumptions underlying the other defences to homicide, such as self-defence including manslaughter and the new offence of defensive homicide. Otherwise there is a risk that provocation’s victim-blaming narratives could end up rewritten in such a way that support an argument for a reduction in culpability in cases where there is a history of violence against the woman victim, which is likely to result in claims that little has changed.