Not all roads lead to Rome - a review of quality of life measurement in diabetes

Aims Quality of life (QoL) is recognized widely as an important health outcome in diabetes, where the burden of selfmanagement places great demands on the individual. However, the concept of QoL remains ambiguous and poorly defined. The aim of our review is to clarify the measurement of QoL in terms of conceptualization, terminology and psychometric properties, to review the instruments that have been used most frequently to assess QoL in diabetes research and make recommendations for how to select measures appropriately.

Methods A systematic literature search was conducted to identify the ten measures most frequently used to assess QoL in diabetes research (including clinical trials) from 1995 to March 2008.

Results Six thousand and eight-five abstracts were identified and screened for instrument names. Of the ten instruments most frequently used to assess ‘QoL’, only three actually do so [i.e. the generic World Health Organization Quality of Life (WHOQOL) and the diabetes-specific Diabetes Quality of Life (DQOL) and Audit of Diabetes-Dependent Quality of Life (ADDQoL)]. Seven instruments more accurately measure health status [Short-Form 36 (SF-36), EuroQoL 5-Dimension (EQ-5D)], treatment satisfaction [Diabetes Treatment Satisfaction Questionnaire (DTSQ)] and psychological well-being [Beck Depression Inventory (BDI), Hospital Anxiety and Depression Scale (HADS), Well-Being Questionnaire (W-BQ), Problem Areas in Diabetes (PAID)].

Conclusions No single measure can suit every purpose or application but, when measures are selected inappropriately and data misinterpreted, any conclusions drawn are fundamentally flawed. If we value QoL as a therapeutic goal, we must ensure that the instruments we use are both valid and reliable. QoL assessment has the proven potential to identify ways in which treatments can be tailored to reduce the burden of diabetes. With careful consideration, appropriate measures can be selected and truly robust assessments undertaken successfully.

Identifying depression and anxiety disorders in people presenting for substance use treatment

Objective: To identify the type and proportion of depressive and related mental health disorders in a group of individuals seeking outpatient treatment at an alcohol and other drug (AOD) service.
Design, setting and participants: A cross-sectional study using diagnostic interviews with 95 participants (56 men, 39 women) seeking treatment from an AOD service.
Main outcome measures: Mental health and substance disorders were measured using the Composite International Diagnostic Interview, Posttraumatic Stress Disorder Checklist, Beck Depression Inventory, and State–Trait Anxiety Inventory (Trait Version).
Results: This was a complex group with addiction, mental health and physical health conditions; 76% had a depressive disorder and 71% had an anxiety disorder. Most were diagnosed with at least two mental health disorders and 25% were diagnosed with four or more different disorders. Alcohol and cannabis use were the most commonly diagnosed AOD disorders. Further, those diagnosed with a drug use disorder reported significantly higher levels of depression compared with those with an alcohol-only disorder. Finally, 60% of the sample reported chronic health conditions, with over one third taking medication for a physical condition on a regular basis.
Conclusions: Primary care providers such as general practitioners are likely to be increasingly called on to assess, treat and/or coordinate care of patients with AOD disorders. We show that this group will likely present to their GP with more than one MJA 2011; 195: S60–S63 mental health disorder in addition to acute and chronic physical health conditions.

The future of diversity and difference : can the national curriculum for English be hospitable?

This chapter explores the context of constructing the Australian Curriculum: English and how it represents and responds to the diversity of students. It starts with the brief genealogy of neoliberal standards-based reforms as a way of managing differences. In doing so, the chapter situates the national agenda of curriculum reforms in the semiotic order of ‘risk societies’ (Beck, 1992) through which various risks are both manufactured and managed. The semiotic order of managing educational risks through reforms is presented as a discursive force-field that both creates ‘moral panics’ and provides solutions, thereby appealing to the broader public and securing its consent. This discussion prepares the ground for the reading of texts produced in the lead-up to the actual release of the national curriculum for English and statements about diversity in these documents as well as in the curriculum itself. The chapter then goes on to explore what might be possible in the process of the curriculum implementation, by drawing on ideas of hospitality, responsibility and dialogism. In conclusion, this essay argues that no national curriculum can be successfully implemented unless it is sensitive to the textual and cultural practices of other groups and unless it wins their political consent. Equally, no national curriculum can be ethically implemented unless it recognises and responds to difference and unless it creates a possibility of transcending the logic of the Same.

Multifaith movements in ultramodernity

Ultramodernity (Willaime 2006), following on from modernity, has been characterised as an era of fear, risk and uncertainty and paradoxically as a time of great hope and global interdependence (Baumann 2006; Beck 2006; Obama 2006). Following the events of September 11, 2001, the Bali and London bombings, a climate of fear has inspired a plethora of policies that have eroded civil liberties, jeopardising trust in state systems and thereby inadvertently elevating the risk of further violence, particularly in so-called Western societies. Conversely, ultramodern scholars, including Jürgen Habermass and Ulrich Beck, have advocated cosmopolitan solutions to more effectively and cooperatively counter global risks. These optimistic scenarios, while reaching populist proportions, have also received their fare share of criticism (Brassett 2008). Indeed, when we look toward the current state of the United Nations it is difficult not to lose hope. Where is the proof that Immanuel Kant’s cosmopolitan condition is coming into being in the global arena beyond these sociological theories? I argue that the rise of multifaith movements in ultramodernity provides this much needed evidence.

Social support and clinical depression in China

Introduction It has been recognised for many years that in Western contexts social support is associated with depression. However, relatively few studies have investigated this association in non-Western countries, and few, if any, in a clinical population. The present study aimed to establish how the perceived quality of social support provided by their spouse, their family and their friends to people in China who have a clinical diagnosis of depression is associated with aspects of their illness.

Methods The sample comprised 50 males and 50 females ranging in age from 19 to 62 years. All participants had a clinical diagnosis of depression. They completed the Beck Depression Inventory and a scale assessing perceived social support.

Results Contrary to predictions and previous research findings, no significant association was found between perceived quality of social support and level of depression, length of depression, and number of episodes of depression.

Discussion A variety of cultural factors may be associated with the quality of social support provided to patients with depression. Further research is required to investigate if these findings generalise across other non-Western populations, and also, to explore other factors that may influence the onset and continuation of depression among people in China.

Somatization, but not depression, is characterized by disorders in the tryptophan catabolite (TRYCAT) pathway, indicating increased indoleamine 2,3-dioxygenase and lowered kynurenine aminotransferase activity

BACKGROUND: Reduced plasma tryptophan occurs in depression and somatization. Induction of indoleamine 2,3-dioxygenase (IDO) with consequent synthesis of tryptophan catabolites (TRYCATs) and lowered tryptophan are associated with the onset of depression in the puerperium and during interferon-alpha treatment. Depression is accompanied by lowered kynurenic acid, a neuroprotectant, or increased kynurenine, a neurotoxic TRYCAT.

AIMS AND METHODS: To examine plasma tryptophan; kynurenine; kynurenic acid; the kynurenine / tryptophan (KY/TRP) ratio, indicating IDO activity; and the kynurenine / kynurenic acid (KY/KA) ratio, indicating kynurenine aminotransferase (KAT) activity, in somatization; depression; somatization + depression; and controls. Illness severity is measured by the Somatic Symptom Index (SSI), the Screening for Somatoform Symptoms (SOMS), and the Beck Depression Inventory (BDI).

RESULTS: Tryptophan is significantly lower in patients than in controls and lower in somatization than in depression. KY/TRP is significantly increased in somatization. Kynurenic acid is significantly lower in patients than in controls, and lower in somatization than in depression. KY/KA is significantly higher in somatization and somatization + depression than in depression and controls. There are significant correlations between the severity of somatization, but not depression, and KY/TRP and KY/KA (positive) and tryptophan (negative). Kynurenine and kynurenic acid are significantly correlated in controls, somatization + depression, and depression, but not in somatization.

CONCLUSIONS: Somatization is characterized by increased IDO activity and disorders in KAT activity and an increased neurotoxic potential. The TRYCAT pathway may play a role in the pathophysiology of somatizing and “psychosomatic” symptoms through effects on pain, gut motility, the autonomic nervous system, peripheral NMDA receptors, etc. Even more, biological disorders, such as aberrations in the TRYCAT pathway, which are considered to be a hallmark for depression, are in fact attributable to somatization rather than to depression per se. Future research in depression on the TRYCAT pathway should always control for the possible effects of somatization.

The reflexive museum : opening the door to behind the scenes

In this paper I argue for a shift in conceptualising exhibitions: from products to be presented to processes to be revealed. I will explore how museum theory and practice are inextricably intertwined and can be brought into fruitful dialogue within an exhibition setting. By revealing the processes leading to the definition of categories and the interpretation of identities, and by giving ‘faces’ to decisions made, the ‘reflexive museum’ can become an embodiment of democracy, which does not silence controversies but gives diversity public voices. The ‘reflexive museum’ as I envisage it, by referring to Beck and Bonss’ ‘reflexive modernity’ (2001) is not only self-aware, but confronts, critiques, questions and ultimately transforms itself and invites the visitor to democratically participate in this process.

First, I sketch out recent academic musings on museological approaches. Then I present some examples of exhibitions in Germany in which these theories have been put into practice. I conclude by arguing for a symbiotic relationship between museum theory and practice, enabling the museum to realise its unique potential as a dynamic ‘playground’ located between scholarly thinking and the public.

Humanising contact zones : the stories and faces of cross-cultural dialogue

We live in a radically ‘cosmopolitanised’ world, facing a plethora of mostly unwanted or unforeseen cross-cultural encounters as side effects of global trade and global threats (Beck, 2006). The potentially positive role of both cultural tourism and museums in this context has been widely recognised and theorised. But what does cross-cultural dialogue mean for the person experiencing it, and how is it negotiated within time and space? Drawing on a long-term narrative study of global visitors to the Museum of New Zealand Te Papa Tongarewa (Te Papa), I explore cross-cultural meanings empirically through a hermeneutic interpretation embedded in Beck’s ‘cosmopolitan critical theory’. The evidence presented in this research suggests that the individual is the point of departure from which cross-cultural dialogue is humanised by giving it ‘faces’ and stories. I argue that the impact of any travel experience is best understood via the meanings tourists make and negotiate in the long-term.

Characterization of the improvement in depressive symptoms following Bariatric surgery

Background : The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss. Given the potential similarity in obesity-related and depressive symptoms, it is uncertain whether all components of depression would improve equally with weight loss.

Method : The study included obese patients who had undergone laparoscopic adjustable gastric banding (LAGB) surgery and had completed BDIs at baseline and 1 year after surgery. Two groups of patients were included, a general background group (N = 191, mean age = 41 ± 9, mean BMI = 43 ± 8) and a group identified as experiencing elevated depressive symptoms based on BDI scores ≥23 (EDS group; (N = 67, mean age = 40 ± 9, mean BMI = 45 ± 7).

Results : Overall, BDI scores fell for both groups, background group at baseline 17 ± 9–8 ± 7 at 1 year and for the EDS group at baseline 30 ± 5–14 ± 10 at 1 year. Patient scores on the negative self-attitude subscale were significantly greater than the two other subscales and showed the greatest improvement 1 year following LAGB. Preexisting antidepressant therapy had little or no association on the BDI scores or on its change following weight loss.

Conclusion : High rates of depression are continually reported in obesity, as is a remarkable decrease in depressive symptoms following weight loss. Negative attitudes towards one’s self appears to be driving elevated BDI scores rather than the overlap in physical symptoms between obesity and depression.

Raised CRP levels in obese patients : symptoms of depression have an independent positive association

Background: Depression and obesity, the two common ailments of modern society, are associated with increased risk of coronary artery disease and raised C-reactive protein (CRP) levels. Are the effects of depression and obesity related or do they influence CRP levels independently?

Objective: In 493 consecutive patients presenting for obesity surgery, we explored the relationship between symptoms of depression and raised CRP levels after controlling for confounding factors.

Methods and Procedures: Depression was measured using the Beck Depression Inventory (BDI). Confounding variables were age, gender, BMI, waist and hip measures, smoking and alcohol habits, medications, biochemical measures of the metabolic syndrome, and indirect measures of insulin resistance. General linear regression sought variables independently associated with CRP levels.

Results: These patients had a BMI range from 31 to 91 kg/m2, participants age ranged from 14 to 71 years, and 76% were women. The median CRP concentration was 7.7 mg/l (interquartile range: 3.9–14), 40% had an abnormally raised concentration (>10 mg/l). The mean BDI score was 17.0 ± 9.0, indicating symptoms of moderate depression. We found five independent factors associated with raised CRP levels. In order of strength of association, these were: higher BMI (β = 0.36, P < 0.001), female gender (β = −0.19, P < 0.001), estrogen therapy (β = 0.18, P < 0.001), higher BDI score (β = 0.11, P = 0.01), and insulin resistance index (β = 0.11, P = 0.01), and with a combined R 2 = 0.24, (P < 0.001). Discussion: In obese patients, symptoms of depression were associated with raised CRP levels after controlling for confounding variables. Obese women on estrogen therapy are at risk of high CRP levels.

Identity on the edge: The impact of risk, compliance and performativity on VET practitioner identity.

 German Sociologist, Ulrich Beck’s seminal political analysis of risk, Risk Society: Towards a New Modernity, in 1992 posited the concept of ‘risk’ that has become privatised, objectified and a matter for individual concern. This study examines how the management of ‘risk’ is achieved through individual scrutiny, audit and review and the impact these practices have on changing VET practitioner identity. Preliminary PhD interviews with VET practitioners, using grounded theory methodology, identified the symbiotic nature of risk management and generation within the current diverse and challenging VET environment. Resistance or acquiescence to compliance practices and the performative VET environment have significant implications for VET practitioners’ identity construction.

Bloods, Crips and Southern Cross Soldiers: we are all gangbangers now!

This paper presents findings from the author's PhD thesis exploring violent youth subcultures in Australia. It addresses whether growing uncertainties around issues of cultural identity and belonging in an era of risk has produced more defensive models of DIY youth culture at a local scale. Theoretically, the author examines whether globalisation has unsettled normative youth subject positions associated with the nation-state, problematising conventional logics of youth cultural formation (i.e. which view questions of race and racism through a white/black, mainstream/subculture binary). As Beck (1992;1999) argues, the de-bounding influence of globalisation has led to an ambivalent set of relations where forms of youth identity have become freed from the nation-state and class based forms of community and must be self-organised. In particular, he argues that this has produced cosmopolitan subjects and social movements as well as ‘counter-modern’ subjects and cultures. This paper applies Beck’s theories alongside theories focused on global/local influences on youth culture to an ethnographic study of two violent youth subcultures in Australia, these being the white ‘patriotic’ youth formation which emerged in the Cronulla riots and youth gang formations in Melbourne’s western suburbs. In doing so the author examines the extent to which violent youth subcultures in Australia can be regarded as strategic responses intended to restore forms of collective cultural belonging at a local scale vis a vis ‘the global’ and its destabilizing influences.

Locating cosmopolitanism within academic mobility

Intensified academic mobility is an enticing platform for examining the emerging manifestations of cosmopolitanism in expanding intercultural encounters. Cosmopolitanism calls for a dialogue between cultures and for reciprocal appropriation and internalisation of cultures within one’s own culture. This paper endeavours to locate empirical evidence on evolving cosmopolitanism in everyday intercultural interactions and academic experiences. It is guided by the methodological applications of cosmopolitanism and the way cosmopolitanism is redefining the sociological frame of reference. This paper presents discussion and empirical testing of three defining features of cosmopolitanism according to Beck (2002): globality, plurality and civility. Mirroring these guiding principles, this research attempted to identify and analyse cosmopolitan values and dispositions in everyday intercultural encounters, discourses, situations and experiences. This paper presented an argument that cosmopolitan values and dispositions tend to create mutually beneficial conditions for intercultural inclusion and academic mobility provides a fertile ground for their current and future exploration. 

Effects of bone-specific physical activity, gender and maturity on tibial cross-sectional bone material distribution; a cross-sectional pQCT comparison of children and young adults aged 5-29 years

Growth is the opportune time to modify bone accrual. While bone adaptation is known to be dependent on local loading and consequent deformations (strain) of bone, little is known about the effects of sex, and bone-specific physical activity on location-specific cross-sectional bone geometry during growth. To provide more insight we examined bone traits at different locations around tibial cross sections, and along the tibia between individuals who vary in terms of physical activity exposure, sex, and pubertal status. Data from 304 individuals aged 5-29 years (172 male, 132 female) were examined. Peripheral quantitative computed tomography (pQCT) was applied at 4%, 14%, 38%, and 66% of tibial length. Maturity was established by estimating age at peak height velocity (APHV). Loading history was quantified with the bone-specific physical activity questionnaire (BPAQ). Comparisons, adjusted for height, weight and age were made between sex, maturity, and BPAQ tertile groups. Few to no differences were observed between sexes or BPAQ tertiles prior to APHV, whereas marked sexual dimorphism and differences between BPAQ tertiles were observed after APHV. Cross-sectional location-specific differences between BPAQ tertiles were not evident prior to APHV, whereas clear location-specificity was observed after APHV. In conclusion, the skeletal benefits of physical activity are location-specific in the tibia. The present results indicate that the peri- or post-pubertal period is likely a more favourable window of opportunity for enhancing cross-sectional bone geometry than pre puberty. Increased loading during the peri-pubertal period may enhance the bone of both sexes.

The politics of boganism and public relations in contemporary Australia

What is meant by the term ‘bogan’ and how does its popular usage distinguish a new public occupying a particular class position and social presence in Australian society. Examining a number of media texts, this paper explores the bogan phenomenon and asks if it normatively repositions Marxist ideas of class within the contemporary construct of lifestyle politics and classless capitalism (Beck). Challenging the idea the term is politically benign, the paper argues that the rise ‘boganism’ and its stigmatic associations has implications for public relations. In particular, it argues successful framing techniques designate a group of people occupying social risk positions and that are dis-empowered by eco-discourses and targeted for social control. These marginalised publics lack the sociocultural resources required for participation in the public sphere and as such are malleable and highly receptive to intrinsic and extrinsic forms of public relations.