Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies

A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22kg/m2 to 25kg/m2 in different Asian populations; for high risk it varies from 26kg/m2 to 31kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.

Moving beyond 'rates, roads and rubbish' : how do local governments make choices about healthy public policy to prevent obesity?

While the causes of obesity are well known traditional education and treatment strategies do not appear to be making an impact. One solution as part of a broader complimentary set of strategies may be regulatory intervention at local government level to create environments for healthy nutrition and increased physical activity. Semi structured interviews were conducted with representatives of local government in Australia. Factors most likely to facilitate policy change were those supported by external funding, developed from an evidence base and sensitive to community and market forces. Barriers to change included a perceived or real lack of power to make change and the complexity of the legislative framework. The development of a systematic evidence base to provide clear feedback on the size and scope of the obesity epidemic at a local level, coupled with cost benefit analysis for any potential regulatory intervention, are crucial to developing a regulatory environment which creates the physical and social environment required to prevent obesity.

Prison rape : is it okay to make jokes about rape in prison?

The trivialisation of sexual violence through what passes as humour is much less common than it once was. Jokes about rape are not innocent, are not harmless fun, are not unconnected to the horrible crime they make light of. Their gradual marginalisation represents social change of real importance. But there is one last refuge of the rape joke in mainstream popular culture, and its continued presence reflects a shameful blind spot in our society. It is a joke which conceals a horrible and damaging reality which is somehow both a taboo topic and a truth universally acknowledged.

A picture that circulated widely on Facebook and other social media last year captures the horror in the humour. It is a picture of a man’s back, decorated with a huge image of an alluring, naked woman, with the man’s buttocks marked to look like breasts. The caption: This man had what he thought was the best tattoo in the world . . . until he went to prison. How can a gag about a man being anally raped while in prison be widely popular, seen as funny, a giggle to share? Were the prospective victim a child or a woman, or were the rape in almost any other setting, the reaction would surely be revulsion and anger. Jail rape, though, somehow remains funny.

‘We should change ourselves, but we can’t’: accounts of food and eating practices amongst British Pakistanis and Indians with type 2 diabetes

Objective(s). To look at food and eating practices from the perspectives of Pakistanis and Indians with type 2 diabetes, their perceptions of the barriers and facilitators to dietary change, and the social and cultural factors informing their accounts.

Method. Qualitative, interview study involving 23 Pakistanis and nine Indians with type 2 diabetes. Respondents were interviewed in their first language (Punjabi or English) by a bilingual researcher. Data collection and analysis took place concurrently with issues identified in early interviews being used to inform areas of investigation in later ones.

Results. Despite considerable diversity in the dietary advice received, respondents offered similar accounts of their food and eating practices following diagnosis. Most had continued to consume South Asian foods, especially in the evenings, despite their perceived concerns that these foods could be 'dangerous' and detrimental to their diabetes control. Respondents described such foods as 'strength-giving', and highlighted a cultural expectation to participate in acts of commensality with family/community members. Male respondents often reported limited input into food preparation. Many respondents attempted to balance the perceived risks of eating South Asian foodstuffs against those of alienating themselves from their culture and community by eating such foods in smaller amounts. This strategy could lead to a lack of satiation and is not recommended in current dietary guidelines.

Conclusions. Perceptions that South Asian foodstuffs necessarily comprise 'risky' options need to be tackled amongst patients and possibly their healthcare providers. To enable Indians and Pakistanis to manage their diabetes and identity simultaneously, guidelines should promote changes which work with their current food practices and preferences; specifically through lower fat recipes for commonly consumed dishes. Information and advice should be targeted at those responsible for food preparation, not just the person with diabetes. Community initiatives, emphasising the importance of healthy eating, are also needed.

6 things I know about Geminoid F, or what I think about when I think about android theatre

On Friday evening I saw one of the finest theatre performances from an actor. Her subtle movements, her natural cadence, her ability to portray her character in a way that demonstrated diligent devotion, careful analysis and measured construction, was simply awe-inspiring. Which actor gave this fine performance? It was an android.

The Digital Divide: Differences in Computer Use between Home and School in Low Socio-economic Households

This article examines information and communication technologies(ICTs) practices in the home and school settings of four disadvantaged families. It reports the findings of a year-long study that investigated the nexus between computer-mediated literacy practices at home and at school and whether this inter-connectivity could make a difference in school success. The findings indicate that there was disjunction between home and school use. The ``digital divide'' exists for the families of this study, not in terms of access but in the gap between ICT practices at home and school. Schools in this study did not integrate ICT skills learned and demonstratedin the home environment into ICT practices at school. The study concludes that constructing pedagogical connections between home and school ICT practices may begin to bridge the ``digital divide''.

Being explicit about aspects of mathematics pedagogy

It is conventional wisdom that contextualising mathematics tasks can make them more meaningful for students, and that open-ended questions create opportunities for student engagement. Yet concerns are emerging that strategies such as these may exacerbate the disadvantage of some. We report data from a project that seeks to address such concerns by encouraging teachers to be explicit about aspects of their pedagogy. Men teachers were explicit about aspects of the pedagogy, the students responded in the direction intended.

Capital works procurement policies in Australia : implications for understanding and meeting client needs

This paper undertakes a case study of procurement through a comparative analysis of the capital works procurement policies of the Commonwealth, State, and Territory Governments in Australia. Capital works procurement policies provide the mechanism by which governments manage procurement processes, and frame how individual government agencies, as clients, participate in those processes. The paper proposes a typology of capital works procurement approaches, together with implications of how these different policies play out for clients. A tentative proposition is advanced that policy approaches to capital works procurement either explicitly or implicitly, make assumptions about the organisational capability of clients to plan and deliver capital works projects, including their ability to understand and articulate their own building needs. Additionally, the paper concludes that innovation has occurred at a policy level in capital works procurement. Recommendations for further research are suggested.

“I call it the blame and shame disease”: a qualitative study about perceptions of social stigma surrounding type 2 diabetes

Abstract
Objectives While health-related stigma has been the subject of considerable research in other conditions (obesity and HIV/AIDS), it has not received substantial attention in diabetes. The aim of the current study was to explore the social experiences of Australian adults living with type 2 diabetes mellitus (T2DM), with a particular focus on the perception and experience of diabetes-related stigma.

Design A qualitative study using semistructured interviews, which were audio recorded, transcribed and subject to thematic analysis.

Setting This study was conducted in non-clinical settings in metropolitan and regional areas in the Australian state of Victoria. Participants were recruited primarily through the state consumer organisation representing people with diabetes.

Participants All adults aged ≥18 years with T2DM living in Victoria were eligible to take part. Twenty-five adults with T2DM participated (12 women; median age 61 years; median diabetes duration 5 years).

Results A total of 21 (84%) participants indicated that they believed T2DM was stigmatised, or reported evidence of stigmatisation. Specific themes about the experience of stigma were feeling blamed by others for causing their own condition, being subject to negative stereotyping, being discriminated against or having restricted opportunities in life. Other themes focused on sources of stigma, which included the media, healthcare professionals, friends, family and colleagues. Themes relating to the consequences of this stigma were also evident, including participants’ unwillingness to disclose their condition to others and psychological distress. Participants believed that people with type 1 diabetes do not experience similar stigmatisation.

Conclusions Our study found evidence of people with T2DM experiencing and perceiving diabetes-related social stigma. Further research is needed to explore ways to measure and minimise diabetes-related stigma at the individual and societal levels, and also to explore perceptions and experiences of stigma in people with type 1 diabetes

Quantitative studies of student self-assessment in higher education: a critical analysis of findings

Student self-assessment occurs when learners make judgements about aspects of their own performance. This paper focuses on one aspect of quantitative self-assessments: the comparison of student-generated marks with those generated by teachers. Studies including such comparisons in the context of higher education courses are reviewed and the following questions are addressed: (i) do students tend to over- or under-rate themselves vis-á-vis teachers?, (ii) do students of different abilities have the same tendencies?, (iii) do students in different kinds or levels of course tend to under- or over-rate themselves?, (iv) do students improve their ability to rate themselves over time or with practice?, (v) are the same tendencies evident when self-marks are used for formal assessment purposes?, and (vi) are there gender differences in self-rating? The paper also discusses methodological issues in studies of this type and makes recommendations concerning the analysis and presentation of information.

Rebound or resignation: developing a predictive model of return to subjective wellbeing set-point

Though subjective wellbeing (SWB) is generally stable and consistent over time, it can fall below its set-point in response to adverse life events. However, deviations from set-point levels are usually only temporary, as homeostatic processes operate to return SWB to its normal state. Given that income and close interpersonal relationships have been proposed as powerful external resources that are coincident with higher SWB, access to these resources may be an important predictor of whether or not a person is likely to recover their SWB following a departure from their set-point. Under the guiding framework of SWB Homeostasis Theory, this study considers whether access to a higher income and a committed partner can predict whether people who score lower than normal for SWB at baseline will return to normal set-point levels of SWB (rebound) or remain below the normal range (resigned) at follow-up. Participants were 733 people (53.3 % female) from the Australian Unity Longitudinal Wellbeing Study who ranged in age from 20 to 92 years (M = 59.65 years; SD = 13.15). Logistic regression analyses revealed that participants’ demographic characteristics were poor predictors of whether they rebounded or resigned. Consistent with homeostasis theory, the extent of departure from the proposed normal SWB set-point at baseline was significantly associated with rebound or resignation at time 2. These findings have implications for the way that SWB measures can be used in professional practice to identify people who are particularly vulnerable to depression and to guide the provision of appropriate and effective therapeutic interventions.

Lab-on-a-chip or chip-in-a-lab: challenges of commercialization lost in translation

Lab-on-a-chip technology has been long envisaged to have tremendous commercial potential, owing to the ability of such devices to encapsulate a full range of laboratory processes in a single instrument and operate in a portable manner, rapidly and at low cost. Devices are believed to have potential in fields ranging across medical diagnostics, environmental sampling and a range of consumer products, however, to date very few devices have attained commercial success. This review examines the challenges relating to the commercialization of lab-on-a-chip technology from fundamental research to mass manufacturing and aims to provide insight to both academics and product development specialists the perceived hindrances to commercialization and a strategy by which future work could be translated into commercial success.

Providing culturally appropriate mental health first aid to an Aboriginal or Torres Strait Islander adolescent: development of expert consensus guidelines

BACKGROUND: It is estimated that the prevalence of mental illness is higher in Aboriginal and Torres Strait Islander adolescents compared to non-Aboriginal adolescents. Despite this, only a small proportion of Aboriginal youth have contact with mental health services, possibly due to factors such as remoteness, language barriers, affordability and cultural sensitivity issues. This research aimed to develop culturally appropriate guidelines for anyone who is providing first aid to an Australian Aboriginal or Torres Strait Islander adolescent who is experiencing a mental health crisis or developing a mental illness.

METHODS: A panel of Australian Aboriginal people who are experts in Aboriginal youth mental health, participated in a Delphi study investigating how members of the public can be culturally appropriate when helping an Aboriginal or Torres Strait Islander adolescent with mental health problems. The panel varied in size across the three sequential rounds, from 37-41 participants. Panellists were presented with statements about cultural considerations and communication strategies via online questionnaires and were encouraged to suggest additional content. All statements endorsed as either Essential or Important by ≥ 90% of panel members were written into a guideline document. To assess the panel members' satisfaction with the research method, participants were invited to provide their feedback after the final survey.

RESULTS: From a total of 304 statements shown to the panel of experts, 194 statements were endorsed. The methodology was found to be useful and appropriate by the panellists.

CONCLUSION: Aboriginal and Torres Strait Islander Youth mental health experts were able to reach consensus about what the appropriate communication strategies for providing mental health first aid to an Aboriginal and Torres Strait Islander adolescent. These outcomes will help ensure that the community provides the best possible support to Aboriginal adolescents who are developing mental illnesses or are in a mental health crisis.

Using fractal geometry to make rapid field measurements of riverbed topography at ecologically useful spatial scales

A method is described for making rapid in situ field measurements of riverbed topography over spatial scales of ≅1–10 m. This method uses rolling balls to make quick, accurate measurements of river-bed roughness at several spatial scales. Random sampling and replication generate multiple estimates of the fractal dimension (d) that can be used to test for significant differences in the complexity of riverbed architecture between habitat types and spatial scales.

Outdoor education and bush adventure therapy: A social-ecological approach to health and wellbeing.

Together, outdoor education and bush adventure therapy can be seen to constitute a population-wide health intervention strategy. Whether in educational or therapeutic settings, the intentional use of contact with nature, small groups, and adventure provides a unique approach in the promotion of health and wellbeing for the general population, and for individuals with identified health vulnerabilities. This paper explicitly emphasises human and social health, however, an integral assumption is that a healthy and sustainable environment is dependent on healthy human relationships with nature. We invite outdoor educators and bush adventure therapy practitioners to examine the proposition that healthy interactions with nature can create a unique stream of socio-ecological interventions. A spectrum of outdoor adventure programs is provided, allowing outdoor educators and bush adventure therapy practitioners to locate their work according to program context and aims, and participant aims and needs.