Prevalence, detection and drug treatment of hypertension in a rural Australian population : the Greater Green Triangle Risk Factor Study 2004

Background: Hypertension is an important risk factor for cardiovascular disease; however, limited findings are available on its detection and management in rural Australia.

Aim: To assess the prevalence, awareness and treatment of hypertension in a rural South-East Australian population.

Methods: Three cross-sectional surveys in Limestone Coast, Corangamite Shire and Wimmera regions during 2004–2006 using a random population sample (n = 3320, participation rate 49%) aged 25–74 years. Blood pressure was measured by trained nurses. Information on history of hypertension and medication was obtained by questionnaires. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg and/or on antihypertensive drug treatment.

Results: Overall, one-third of participants had hypertension; of these, two-thirds, 54% (95% confidence interval (CI) 47–60) of men and 71% (95% CI 65–77) of women, were aware of their condition. Half of the participants with hypertension were treated and nearly half of these were controlled. Both treatment and control were more common in women (60%, 95% CI 54–67 and 55%, 95% CI 47–64) compared with men (42%, 95% CI 36–49 and 35%, 95% CI 26–44). Monotherapy was used by 55% (95% CI 48–61) of treated hypertensives. Angiotensin-converting enzyme inhibitors were the most frequently used class of antihypertensive drugs in men, whereas angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists and diuretics were all widely used among women.

Conclusion: This study emphasizes suboptimal detection and treatment of hypertension, especially in men, in rural Australia.

Future landscapes in South-eastern Australia : the role of protected areas and biolinks in adaptation to climate change

The extent and rapidity of global climate change is the major novel threatening process to biodiversity in the 21 st century. Globally, numerous studies suggest movement of biota to higher latitudes and altitudes with increasing empirical -evidence emerging. As biota responds to the direct and consequent effects of climate change the potential to profoundly affect natural systems (including the reserve system) of south-eastern Australia is becoming evident. Climate change is projected to accelerate major environmental drivers such as drought, fire and flood regimes. Is the reserve system sufficient for biodiversity conservation under a changing climate? Australia is topographically flat, biologically mega-diverse with high species endemism, and has the driest and most variable climate of any inhabited continent. Whilst the north-south orientation and aftitude gradient of eastern Australia's forests and woodlands provides some resilience to projected climatic change, this has been eroded since European settlement, particularly in the cool-moist Bassian zone of the south-east. Following settlement, massive land-use change for agriculture and forestry caused widespread loss and fragmentation of habitats; becoming geriatric in agricultural landscapes and artificially young in forests. The reserve system persists as an archipelago of ecological islands surrounded by land uses of varying compatibility with conservation and vulnerable to global warming. The capacity for biota to adapt is limited by habitat availability. The extinction risk is exacerbated. Re-examination of earlier analysis of ecological connectivity through biolink zones confirms biolinks as an appropriate risk management response within a broader suite of measures. Areas not currently in the reserve system may be critical to the value and ecological function of biological assets of the reserve system as these assets change. Ecological need and the rise of ecosystem services, combined with changing socio-economic drivers of land-use and social values that supported the expansion of the reserve system, all suggest biolink zones represent a new, necessary and viable multi-functional landscape. This paper explores some of the key ecological elements for restoration within biolink zones (and landscapes at large) particularly through currently agricultural landscapes.

Use and exchange of genetic resources of emerging species for aquaculture and other purposes

From a genetic resources viewpoint, emerging aquaculture species and species groups are examined mainly in terms of food use. In addition, we include species that are becoming increasingly important for biodiversity conservation and related ecotourism aspects. Together with ornamental fish species, we argue that these species are facing increasing vulnerability and warrant attention. Our intention is to raise awareness of the potential for increasing production and revenues from emerging species/species groups with an emphasis on an underlying link to biodiversity conservation and ecosystem preservation, and how this information will inform policy on access to the genetic resources and the sharing of benefits derived from their use. For food purposes, the fastest growing aquaculture sector is mariculture, and within this sector groupers and wrasses are considered to be the most important because they cater to the relatively lucrative live food fish restaurant trade (LFFRT), which is rapidly expanding in selected South-East Asian countries. In the Asian region, ecotourism is an emerging sector and a prominent fish group for this purpose is considered to be mahseer. A number of mahseer species are culturally and commercially important and are often seen as a group of indigenous species that are suitable for aquaculture. This review summarizes much of the limited information related to the patterns of use and exchange of genetic resources on emerging aquatic species/species groups, with particular reference to Asia.

Australia and East Timor : elitism, pragmatism and the national interest

For over two decades the issue of East Timor's right to self-determination has been a ‘prickly’ issue in Australian foreign policy. The invasion by Indonesian forces in 1975 was expected, as Australian policy-makers had been well informed of the events leading up to the punitive action being taken. Indeed, prior discussions involving the future of the territory were held between the Australian Prime Minister and the Indonesian President in 1974. In response to the events unfolding in the territory the Australian Labor Government at the time was presented with two policy options for dealing with the issue. The Department of Defence recommended the recognition of an independent East Timor; whereas the Department of Foreign Affairs proposed that Australia disengage itself as far as possible from the issue. The decision had ramifications for future policy considerations especially with changes in government. With the Department of Foreign Affairs option being the prevailing policy what were the essential ingredients that give explanation for the government's choice? It is important to note the existence of the continuity and cyclical nature of attitudes by Labor governments toward Indonesia before and after the invasion. To do so requires an analysis of the influence ‘Doc’ Evatt had in shaping any possible Labor tradition in foreign policy articulation. The support given by Evatt for the decolonisation of the Netherlands East Indies (Indonesia) gave rise to the development of a special relationship-so defined. Evidence of the effect Evatt had on future Labor governments may be found in the opinions of Gough Whitlam. In 1975 when he was Prime Minister, Whitlam felt the East Timor issue was merely the finalisation of Indonesia's decolonisation honouring Evatt's long held anti-colonialist tradition existing in the Australian Labor Party. The early predisposition toward Indonesia's cohesiveness surfaced again in the Hawke and Keating Labor governments of later years. It did not vary a great deal with changes in government The on-going commitment to preserving and strengthening the bilateral relationship meant Indonesia's territorial integrity became the focus of the Australian political elites’ regional foreign policy determinations. The actions taken by policy-makers served to promote the desire for a stable region ahead of independence claims of the East Timorese. From a realist perspective, the security dilemma for Australian policy-makers was how to best promote regional order and stability in the South East Asian region. The desire for regional cohesiveness and stability continues to drive Australian political elites to promote policies that gives a priority to the territorial integrity of regional states. Indonesia, in spite of its diversity, was only ever thought of as a cohesive unitary state and changes to its construct have rarely been countenanced. Australia's political elite justifications for this stance vacillate between strategic and economic considerations, ideological (anti-colonialism) to one of being a pragmatic response to international politics. The political elite argues the projection of power into the region is in Australia’s national interest. The policies from one government to the next necessarily see the national interest as being an apparent fixed feature of foreign policy. The persistent fear of invasion from the north traditionally motivated Australia's political elite to adopt a strategic realist policy that sought to ‘shore up’ the stability, strength and unity of Indonesia. The national interest was deemed to be at risk if support for East Timorese independence was given. The national interest though can involve more than just the security issue, and the political elite when dealing with East Timor assumed that they were acting in the common good. Questions that need to be addressed include determining what is the national interest in this context? What is the effect of a government invoking the national interest in debates over issues in foreign policy? And, who should participate in the debate? In an effort to answer these questions an analysis of how the ex-foreign affairs mandarin Richard Woolcott defines the national interest becomes crucial. Clearly, conflict in East Timor did have implications for the national interest. The invasion of East Timor by Indonesia had the potential to damage the relationship, but equally communist successes in 1975 in Indo-China raised Australia's regional security concerns. During the Cold War, the linking of communism to nationalism was driving the decision-making processes of the Australian policy-makers striving to come to grips with the strategic realities of a changing region. Because of this, did the constraints of world politics dominated by Cold War realities combined with domestic political disruption have anything to do with Australia's response? Certainly, Australia itself was experiencing a constitutional crisis in late 1975. The Senate had blocked supply and the Labor Government did not have the funds to govern. The Governor-General by dismissing the Labor Government finally resolved the impasse. What were the reactions of the two men charged with the responsibility of forming the caretaker government toward Indonesia's military action? And, could the crisis have prevented the Australian government from making a different response to the invasion? Importantly, and in terms of economic security, did the knowledge of oil and gas deposits thought to exist in the Timor Sea influence Australia's foreign policy? The search for oil and gas requires a stable political environment in which to operate. Therefore for exploration to continue in the Timor Sea Australia must have had a preferred political option and thoughts of with whom they preferred to negotiate. What was the extent of each government's cooperation and intervention in the oil and gas industry and could any involvement have influenced the Australian political elites’ attitude toward the prospect of an independent East Timor? Australia's subsequent de jure recognition that East Timor was part of Indonesia paved the way for the Timor Gap (Zone of Cooperation) Treaty signing in 1989. The signing underpinned Australia's acceptance of Indonesian sovereignty over East Timor. The outcome of the analysis of the issues that shaped Australia's foreign policy toward East Timor showed that the political elite became locked into an integration model, which was defended by successive governments. Moreover, they formed an almost reflexive defence of Indonesia both at the domestic and international level.

Glonacalling doctorates?: The international and global connectedness of Australian PhD graduates

Simon Marginson and Gary Rhoades coined the term ‘glonacal’ the express the interconnectedness of global, national and local social relations, especially in terms educational systems and experiences. This paper presents some selected data from a recent ARC Discovery Project entitled Research capacity-building: the development of the Australian PhD programs in national and emerging global contexts. Some of selected data show the extent Australian PhD theses have addressed topics in South and East Asia as an illustration of how research capacity-building may be created in/for Australia through topics which address problems or ideas located in other (in this case East and South Asia) national and local contexts. Other data relate to the international movements of—particularly astronomy and chemistry—PhD graduates out of Australia, some of whom return to Australia. The paper discusses these movements in terms of PhD culture being ‘glonacal’ in nature from its programs and postdoctoral relations.

Healthy minds for country youth : help-seeking for depression among rural adolescents

Objective: To assess depression recognition, barriers to accessing help from health professionals and potential sources of help for depression among rural adolescents.

Design: Cross-sectional survey.

Setting: Two rural secondary schools in south-east South Australia.

Participants: Seventy-four secondary school students aged 14 to 16 years.

Main outcome measure(s): Depression recognition was measured using a depression vignette. Helpfulness of professionals, barriers to seeking help and help-seeking behaviours for depression were assessed by self-report questionnaire.

Results: Depression was identified in the vignette by 73% (n = 54) of participants. Participants indicated that it would be more helpful for the vignette character to see other health professionals (98.6%, 95% CI, 92.0–100.0%) than a doctor (82.4%, 72.1–89.6%). Barriers to seeking help from doctors and other health professionals were categorised into logistical and personal barriers. Participants agreed more strongly to personal (mean = 2.86) than logistical barriers (mean = 2.67, P < 0.05) for seeing a doctor. Boys and girls responded differently overall, and to personal barriers to seeing an other health professional. Sources of help were divided into three categories: formal, informal and external. Informal sources of help (mean = 4.02) were identified as more helpful than both formal (mean = 3.66) and external sources (mean = 3.72, P < 0.001). Gender differences were observed within and between the three sources of help categories.

Conclusions: Recognising symptoms of depression was demonstrated in this study. Helpfulness of professionals, barriers to seeking help and potential sources of help for depression were identified. More work is required for improving depression literacy and providing effective interventions specifically for rural adolescents.

Ways in which 'community' benefits frail older women's well-being : '... we are much happier when we feel we belong'

Aim: This paper aims to explore frail older women’s lived experiences of ‘community’ and which aspects of ‘community’ they perceive as beneficial to their well-being.

Method: This qualitative project used a mixed methodological approach which integrated aspects of descriptive phenomenology and grounded theory. Ten frail, older women residing in South East Melbourne, Australia participated in in-depth interviews.

Results: This research obtained a rich and detailed account of the aspects of ‘community’ identified by participants as enhancing their well-being. These included: social contact, community dynamics, feelings of support and positive orientation.

Conclusion: This paper has increased our understanding of the factors supporting well-being of frail older women. Service providers should actively consider how they can strengthen these factors to improve social connectedness for frail older women by the use of volunteers, developing social networks and increasing availability and quality of community-based activities.

A deliberative approach to Northeast Asia's contested history

The failure to reconcile views of the past and to address historical injustice has damaged inter-state relations in Northeast Asia. Joint committees, dialogues and the participation of civil society have been used to address historical issues, but scholars in the disciplines of international relations and area studies have largely ignored these dialogues and deliberative forums. At the same time, there is an emergent theoretical literature on how deliberative democracy can address ethnic conflicts and historical injustice. There is a serious disconnect or distance between the theoretical literature on the resolution of conflicts via deliberation on the one hand, and empirical studies of deliberative approach in East Asia on the other. This article aims to address this shortcoming in the study of the politics of historical dispute in Northeast Asia by proposing a deliberative approach to history disputes and highlighting the achievements, limits and dynamics of deliberation. Through mapping and comparative testing, we confirm that deliberation offers some potential for a departure from nationalist mentalities and a shift towards a consciousness of regional history in Northeast Asia. Our empirical test of the utility of the deliberative approach suggests that a new model for addressing regional disputes may be emerging.

Patterns and perceptions of physical activity and sedentary time in male transport drivers working in regional Australia

 Abstract

Objective: To objectively measure physical activity (PA) patterns and sedentary time, and explore perceptions of workplace PA opportunities in regional male transport workers.

Methods: A multi-method study involving 28 drivers (52.4±9.69years) working at a bus company in South-East Queensland, Australia. PA was measured using accelerometers (n=23) to determine the proportion of time spent in sedentary (<150 cpm), light (151–2,689 cpm) and moderate+ (≥2,690 cpm) intensity categories. Paired sample t-tests were used to evaluate differences between categories on a workday/off-workday (n=16), and during work/non-work time (n=15). Interviews were conducted with 28 drivers and six managers to explore perceptions and ideas relating to workplace PA opportunities.

Results: Sedentary time was significantly higher on off-work (64% of wear time) than work (52%) days (p<0.05), while the opposite was the case for light intensity time (off-workday=33%; workday=44%; p<0.05). On workdays, sedentary time was significantly lower when employees were working (44%) than when not working (60%; p<0.05). No significant differences were found for time spent in moderate+ PA. Driver perceptions indicated that PA opportunities (walking club and corporate gym membership) were being adopted by some drivers. However, at this depot, perceived health issues and organisational barriers (shift work and irregular driving routines), tended to preclude some drivers from engaging with these opportunities.

Conclusions: Findings contest the notion that a sedentary occupation such as driving necessitates an inactive work environment.

Implications: This research informs ongoing intervention efforts to target inactive drivers who are struggling to take advantage of existing workplace-related PA opportunities.

Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

BACKGROUND: The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. METHODS: We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. FINDINGS: 292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland. INTERPRETATION: Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa. FUNDING: Bill & Melinda Gates Foundation.

Challenges within the annual cycle of long-distance migratory waders along the East Asian-Australasian flyway

 The thesis focuses on the conservation of migratory shorebirds, particularly in this part of the world. Loss of habitats is one of the greatest threats and prioritizing the conservation of these habitats is of great importance to the future of these species.

Holocene record of Tuggerah Lake estuary development on the Australian east coast: sedimentary responses to sea-level fluctuations and climate variability

We investigated the Holocene palaeo-environmental record of the Tuggerah Lake barrier estuary on the south-east coast of Australia to determine the influence of local, regional and global environmental changes on estuary development. Using multi-proxy approaches, we identified significant down-core variation in sediment cores relating to sea-level rise and regional climate change. Following erosion of the antecedent land surface during the post-glacial marine transgression, sediment began to accumulate at the more seaward location at ~8500. years before present, some 1500. years prior to barrier emplacement and ~4000. years earlier than at the landward site. The delay in sediment accumulation at the landward site was a consequence of exposure to wave action prior to barrier emplacement, and due to high river flows of the mid-Holocene post-barrier emplacement. As a consequence of the mid-Holocene reduction in river flows, coupled with a moderate decline in sea-level, the lake experienced major changes in conditions at ~4000. years before present. The entrance channel connecting the lake with the ocean became periodically constricted, producing cyclic alternation between intervals of fluvial- and marine-dominated conditions. Overall, this study provides a detailed, multi-proxy investigation of the physical evolution of Tuggerah Lake with causative environmental processes that have influenced development of the estuary.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.