Patterns of coronary heart disease mortality over the 20th century in England and Wales : possible plateaus in the rate of decline

Background
Coronary heart disease (CHD) rates in England and Wales between 1950 and 2005 were high and reasonably steady until the mid 1970s, when they began to fall. Recent work suggests that the rate of change in some groups has begun to decrease and may be starting to plateau or even reverse.

Methods
Data for all deaths between 1931 and 2005 in England and Wales were grouped by year, sex, age at death and contemporaneous ICD code for CHD as cause of death. CHD mortality rates by calendar year and birth cohort were produced for both sexes and rates of change were examined.

Results
The pattern of increased burden of CHD mortality within older age groups has only recently emerged in men, whereas it has been established in women for far longer. CHD mortality rates among younger people showed little variation by birth cohort. For younger women (49 and under), the rate of change in CHD mortality has reversed in the last 20 years, indicating a future plateau and possible reversal of previous improvement in CHD mortality rates. Among younger men the rate of change in CHD mortality has been consistent for the past 15 years indicating that rates in this group have continued to fall steadily.

Conclusion
Although CHD mortality rates continue to drop in older age groups the actual burden of coronary heart disease is increasing due to the ageing of the population. The rate of improvement in CHD mortality appears to be beginning to decline and may even be reversing among younger women.

Coronary heart disease trends in England and Wales from 1984 to 2004 : concealed levelling of mortality rates among young adults

Background: Trends in cardiovascular risk factors among UK adults present a complex picture. Ominous increases in obesity and diabetes among young adults raise concerns about subsequent coronary heart disease (CHD) mortality rates in this group.

Objective: To examine recent trends in age-specific mortality rates from CHD, particularly those among younger adults.

Methods and results: Mortality data from 1984 to 2004 were used to calculate age-specific mortality rates for British adults aged 35+ years, and joinpoint regression was used to assess changes in trends. Overall, the age-adjusted mortality rate decreased by 54.7% in men and by 48.3% in women. However, among men aged 35–44 years, CHD mortality rates in 2002 increased for the first time in over two decades. Furthermore, the recent declines in CHD mortality rates seem to be slowing in both men and women aged 45–54. Among older adults, however, mortality rates continued to decrease steadily throughout the period.

Conclusions: The flattening mortality rates for CHD among younger adults may represent a sentinel event. Deteriorations in medical management of CHD appear implausible. Thus, unfavourable trends in risk factors for CHD, specifically obesity and diabetes, provide the most likely explanation for the observed trends.

Has the ban on smoking in New South Wales restaurants worked? A comparison of restaurants in Sydney and Melbourne

Objective: To evaluate compliance with a legislative ban on smoking inside restaurants by comparing smoking in Sydney restaurants (where it is legally banned) with smoking in Melbourne restaurants (not subject to a legal ban).

Design and participants: Unobtrusive observational study of restaurant patrons, and interviews with restaurant staff, carried out by 159 volunteers.

Setting: 78 Sydney restaurants with smoke-free indoor environments (as required by legislation) and 81 Melbourne restaurants not subject to legislation preventing smoking. The study took place from 20-31 October 2000.

Intervention: Legislation to ban smoking in indoor areas of restaurants was introduced in New South Wales in September 2000 (about six weeks before our study).

Outcomes: Observed incidents of smoking inside restaurants; staff attitudes to the ban; customer satisfaction as indicated by comments to staff; staff perceptions of restaurant patronage.

Results: No restaurant patrons were seen smoking in 78 Sydney restaurants during 156 hours of observation of 2646 diners, compared with 176 smokers among 3014 Melbourne diners over 154 hours of observation. Thirty-one per cent (24/78) of Sydney restaurants had experienced smokers attempting to smoke indoors after the legislation was introduced; 6% (5/78) reported instances of smokers refusing to stop smoking when asked; 79% (62/78) of restaurants had received favourable comments from patrons about the smoke-free law; 81% (63/78) of restaurant staff interviewed either supported or strongly supported the law. Since introduction of the legislation, 76% of restaurants reported normal trade, 14% increased trade, and 9% reduced trade.

Conclusions: Smoke-free restaurants do not require "smoking police" to enforce bans, present few ongoing difficulties for staff, attract many more favourable than unfavourable comments from patrons, and do not adversely affect trade.

From the hustings to harbour views : electoral institutions in New South Wales 1856-2006

'Easy to enrol, easy to vote' was the slogan devised by the New South Wales electoral office in the 1980s. How did this system evolve from a British based model to a distinctively Australian one?

150 years of democracy? The case of New South Wales

New South Wales has a rich history of parliamentary democracy. As the oldest of the Australian States, it has provided a microcosm of the evolution of modern British-style democracy from the ‘hustings’ of the early colonial to the harbour views of the contemporary politicians’ offices. New South Wales’ political history is also rich with experimentation. The early introduction of the secret ballot, payment for members, the abolition of plural voting, and adult suffrage are well known. Although it needs to be recognized that it followed slightly behind that ‘ Paradise of Dissent’ South Australia on all those features.

Equally fascinating is the role of the Labour Party, whose campaigning on behalf of adult suffrage and payment for Members is fairly well known. Less known, but of great interest, were its activities on behalf of electoral reform, political accountability and easier enrolment and voting, particularly for ‘ itinerants’ at a time when its political base was in the rural workforce. New South Wales Labour was significant for its decision to stand alone, in contrast with its Victorian and New Zealand counterparts, which threw in their lot with the Progressives.

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.

Radical conservative experiment in New South Wales education

This study, written from the perspective of a parent activist, articulates the 'battle of ideas' or struggle 'around the truth' of public education in New South Wales since the conservative Greiner government came to power in 1988 and instituted the 'new right' agenda. Political control is theorised in the light of debates about hegemony, power, ideology and truth. Documents what happened in 'consultations' about educational reform between the Ministers and their appointees on on the one hand, and the public education lobby, on the other.

Teaching music in New South Wales primary schools : 1920-1956

This thesis concerns the place of music in New South Wales schools from 1920 to 1956. The initial chapters explore issues related to the investigation and the methodology that has guided the research. To provide a foundation for the thesis as a whole, the investigation’s British antecedents are considered and the relevant literature is reviewed. Six broad themes are used as the organisational framework for this thesis: the major events that shaped schooling, the syllabus and recommended music resources, the rationales for the inclusion of music in schools, the place of school music broadcasts, music teaching practice in schools, and the provision of teacher training. Each theme forms the basis of one chapter, with the exception of one extensive theme which is discussed in two adjoining chapters.

This investigation concluded that from 1920 to 1956, the Department of Education’s fundamental aim for schooling was to develop the state’s children into good citizens. Music was valued for its ability to contribute to this aim.

During this period, the Department engaged in a policy of music transmissionism. Specifically, the Department sought to transmit the music values, knowledge and skills that it held in high regard to teachers who in turn were expected to transmit them to their students. The dominant culture and values that were transmitted were those of Britain and the British Empire—that is, music was used to transmit Britishness to children.

The investigation also concluded that during this period there was an expansion of music curriculum and pedagogy in New South Wales. However, in a oneway traffic of ideas between Britain and Australia, it was British music education practices that continued to influence the methods used in New South Wales schools.

In addition, this investigation concluded that there were past periods when New South Wales schools were very musical places—specifically, at the turn of the twentieth century, during the Second World War and during the immediate post-war years. The successes achieved in music during these times required the interplay of six factors: a Department of Education that valued music for the contribution it made to the development of children as good citizens; a Department of Education that provided strong leadership for music by employing a conscientious, inspirational music educator or educators whose sole responsibility was to champion and supervise music across the state; a Departmental expectation that music would be taught by generalist teachers who themselves had developed music expertise during their pre-service preparation or through professional development opportunities offered to them; the existence of a reward system to encourage teachers to increase their music discipline knowledge and skills; a music syllabus that was developmental and hence built on prior music knowledge and skills; and teachers who were able to deliver quality music programs to their students because they themselves were one element in a cycle of respect for music.

Illusions of consensus : New South Wales stakeholders' constructions of the identity of history

This article analyses the relationships between the perspectives of stakeholders involved in the development of the 1998 New South Wales Stages 4–5 history syllabus. It examined four key issues that emerged in the debates about history education during the review and found that stakeholders' views diverged significantly on three of these issues. While loose coalitions formed around particular issues, stakeholders provided different rationales for their positions, and coalitions re-formed on other debates. The analysis highlights the divergence between stakeholders and between the Commonwealth and state governments and stakeholders on the desirable content and goals of history education. The findings indicate that consultation might not produce consensus, and that even the appearance of consensus can be grounded in substantively and philosophically different premises. In practical terms, the findings suggest that if the purpose of consultation as a method of curriculum development is to produce a syllabus that reflects the diverse perspectives held by stakeholders, then the syllabus structure needs to make provision for content options as well as common core areas of study.

Prescription medication hoarding and borrowing or sharing behaviours in older residents in the Illawarra, New South Wales, Australia

Aim: To examine prescription medication hoarding and borrowing or sharing (PMHBS) behaviours in older people, particularly which medications are subject to these behaviours and the circumstances that enable these behaviours.

Methods: A mixed methods triangulation design, using consecutive qualitative (focus groups) and quantitative (survey) methodologies in a convenience sample of people older than 65 years, living independently in the Illawarra region (New South Wales).

Results: Focus group participants (n= 28) acknowledged PMHBS behaviours were widespread; however, very few survey respondents (n= 226) admitted to engaging in these behaviours. Main findings in the study were enablers for these behaviours: the prescription medication is considered the same as that prescribed previously; and self-medicating for pain relief.

Conclusions: The prevalence of PMHBS behaviours in this study was low, although it was acknowledged such behaviours occurred in the wider community. Sharing strong pain medication and the same prescription medication appeared to be acceptable in this population.

A menace to this realm : the new guard and the New South Wales police, 1931-32

In 1931 and 1932, New South Wales faced civic collapse. During the last months of the Lang government, the semi-fascist New Guard became a serious threat to the state. This article examines the challenge posed by the New Guard to the New South Wales police, and the strategies used by the police to suppress the group. Superintendent W.J. MacKay, the colourful and Machiavellian future commissioner, effectively and ruthlessly exercised police power against the New Guard. This article disputes the dominant historical interpretation of this period, which sees the police as collaborators with a reactionary secret army, the ‘Old Guard’.