Concepts of temporality in the theory of transference

This paper examines the temporal concepts that underlie the theory of transference in psychoanalysis. The paper reviews Freud's rejection of linear temporality as characteristic of unconscious thought in favour of regression, repetition, and deferred action. It then develops concepts drawn from Jacques Lacan's theory of the formation of the ego. Here, the biologically determined helplessness derived from the human prematurity of birth becomes transformed into an ego that anticipates subjective unity. The paper then moves on to the more complex theory of the temporality implied in subject formation, offered in Lacan's later theory of separation. Implications are drawn for the use and understanding of transference in the practice of psychoanalysis via clinical examples. In addition, Lacan's ideas on subject formation are proposed as an extension and clarification of previous psychoanalytic theories of development.

Age-specific norms and determinants of anxiety and depression in 731 women with breast cancer recruited through a population-based cancer registry

The aim of this study was to determine population norms and determinants of anxiety and depression in a population-based sample of 731 women with breast cancer (aged 23–60 years) with the Hospital Anxiety and Depression scale (HADS). The prevalence of ‘probable’ psychological morbidity due to anxiety was 23% and due to depression was 3%. When the women identified as ‘possible’ cases were included, the respective proportions were 45 and 12%. Higher anxiety was present in younger, less educated women not born in Australia. There was no clear pattern of risk factors for depression. These population-based findings highlight the need for clinicians to be aware that age, education and country of birth may identify a particularly vulnerable subgroup. While brief scales such as the HADS are limited in their ability to accurately predict a clinical diagnosis, high scores identify those who may warrant referral for clinical evaluation.

Healthcare identifiers legislation : a whiff of Fourberie

The Healthcare Identifiers Bill 2010 (Cth), which will establish “the national e-health Healthcare Identifiers Service to provide that patients, healthcare providers and provider organisations can be consistently identified”, is in the process of being enacted by the Australian Federal Parliament. The legislation will enable the government to assign to each “healthcare recipient” a 26-digit electronic “Healthcare Identifier”, which will be accessible, with or without the recipient’s consent, to a broad range of health care service providers as well as other entities. The individual Healthcare Identifier file will initially contain such identifying information as, where applicable, the Medicare number and/or the Veterans’ Affairs number; name; address; gender; date of birth; and “the date of birth accuracy indicator”, presumably birth certificate. However, since each “service” provided by a health care provider to a health care recipient will be automatically recorded on each individual’s Healthcare Identifier file, in time these electronic files should contain a full record of such services or contacts. Moreover, the Healthcare Identifiers are considered a “key” to, or a “foundation stone” for, the implementation of the shared electronic health records scheme, because they will enable linkage with and retrieval of each patient’s clinical records throughout the health care service system. However, there has been virtually no discussion about the legal, ethical and social implications of this legislation.

Urban–rural comparison of weight status among women and children living in socioeconomically disadvantaged neighbourhoods

Objective: To compare the weight status of women and children living in socioeconomically disadvantaged rural and urban neighbourhoods in Victoria.

Design, setting and participants: Cross-sectional study of data collected between August 2007 and July 2008 as part of the Resilience for Eating and Activity Despite Inequality (READI) study. Women aged 18–45 years living in 40 rural and 40 urban socioeconomically disadvantaged Victorian areas were surveyed by postal questionnaire. Data from a subset of their children aged 5–12 years were also analysed. Weight and height were self-reported for women and measured for children.

Main outcome measures: Women’s weight status based on body mass index (BMI): underweight; healthy; overweight; or obese Class I, II or III; children’s weight status based on International Obesity Taskforce BMI cut-off points.

Results: Of 11 940 women randomly selected, 4934 (41%) replied to a postal invitation to participate. After exclusions for various reasons, data were available on 3879 women and 636 of their children. Twenty-four per cent of urban and 26% of rural women were classified as overweight; a further 19% of urban and 23% of rural women were classified as obese. Twenty per cent of both urban and rural children were classified as overweight; a further 10% of urban and rural children were classified as obese. In crude analyses, rural women had higher odds of Class I and II obesity (odds ratio [OR], 1.34 and 1.72, respectively) compared with urban women. After adjusting for sociodemographic factors (age, number of children, country of birth, education level, employment status and marital status), there was no difference between urban and rural women in odds of overweight or obesity Class I, II or III. No significant urban–rural difference in odds of overweight/obesity was evident among children.

Conclusions: The higher prevalence of obesity in rural women compared with urban women was largely explained by individual-level sociodemographic factors, such as age, number of children, country of birth, education level, employment status and marital status. This suggests that higher obesity levels among women in rural areas may be attributable to the sociodemographic composition of these areas.

Lower levels of physical activity in childhood associated with adult depression

Emerging evidence indicates that early life exposures influence adult health outcomes and there is cause to hypothesise a role for physical activity (PA) in childhood as a protective factor in adult depression. This study aimed to investigate the association between self-reported levels of PA in childhood and self-reported depressive illness. Lifetime depression and levels of physical activity (low/high) in childhood (<15 yr) were ascertained by self-report in 2152 adults (20–97 yr) participating in an ongoing epidemiological study in south-eastern Australia. Data were collected between 2000 and 2006. In this sample, 141 women (18.9%) and 169 men (12.0%) reported ever having a depressive episode. Low PA in childhood was associated with an increased risk of reporting depression in adulthood (OR = 1.70, 95%CI = 1.32–2.17, p < 0.001). Adjustment for age, gender and adult PA attenuated the relationship somewhat (OR = 1.35, 95%CI = 1.01–1.78, p = 0.04), however further adjustment for SES or country of birth did not affect this relationship. In this community-based study, lower levels of self-reported PA in childhood were associated with a 35% increase in odds for self-reported depression in adulthood. These results are consistent with the hypothesis that lower levels of PA in childhood may be a risk factor for adult depression.

Low and high birth weight as risk factors for obesity among 4 to 5 year old Australian children : does gender matter?

Studies testing whether birth weight and childhood obesity differ by gender are lacking. We aimed to describe the relationship between birth weight and childhood overweight/obesity and investigate the influence that gender has on this relationship among 4 to 5-year-old children. We performed a secondary analysis of an Australian nationally representative cross-sectional study in 4 to 5-year-old children. The main outcome measure was child overweight and obesity. We found that low birth weight (LBW) was associated with lower risk of overweight/obesity among girls at 4–5 years before (OR 0.50, 95%CI 0.32, 0.77) and after adjusting for socio-demographic factors (OR 0.51 95%CI 0.33, 0.80) and ethnicity (OR 0.52, 95%CI 0.33, 0.81) but was not associated with child overweight/obesity among boys before or after adjustment. High birth weight (HBW) was associated with a higher risk of overweight/obesity among both girls (adjusted OR: 1.76, 95%CI 1.12, 2.78) and boys (adjusted OR: 2.42 95% CI 2.06, 2.86). Conclusion: There are gender differences in the association of birth weight with child overweight/obesity. HBW was associated with a higher risk of child overweight/obesity in boys and girls before and after adjustment for socio-demographic factors. However, LBW was associated with a lower risk of child overweight/obesity in girls but not in boys. These gender differences need to be considered when planning interventions to reduce child overweight/obesity.

Determinants of permanent first incisor eruption in grazing Australian Angora goats

Objective: To investigate the effects of live weight, sex and other factors on deciduous (first incisor) loss and permanent first incisor development in Angora goats. Design: Goats were part of a pen study on the effects of energy intake in Angora does during pregnancy and lactation on kid growth and development. The design was three levels of nutrition in mid-pregnancy × two levels of postnatal nutrition in 17 randomised blocks. Methods: Conception times were calculated by using artificial insemination, with ultrasound examination 43 days after insemination. Does were fed different amounts of a formulated diet in their pens. After weaning, goats were grazed in sex groups. Deciduous first incisor loss and permanent first incisor development were recorded at 11 time points from 14 to 20 months of age. Results: For each sex, the time for visible eruption and full development of permanent first incisor declined linearly with increased live weight by 5.9 and 5.4 days/kg live weight, respectively. The time to reach similar development stages for first permanent incisors eruption was 3 months longer for the lightest animals compared with the heaviest animals. Date of birth, birth weight, doe age, growth rates, mid-pregnancy and postnatal nutrition, parity, day of weaning and weaning weight had no detectable effect. Conclusions: The results explain much of the substantial range in reported first permanent incisor eruption dates for small ruminants and have application in ageing of goats, marketing of kids for meat, in the selection of animals for breeding flocks and in educational material.

Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Background While the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.

Methods Adults (n=38 355) aged 40–69 years living in Melbourne, Australia were recruited in 1990–1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports.

Results CVD mortality was higher for those with primary education only, compared with those who had completed tertiary education, with an HR of 1.66 (95% CI 1.10 to 2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared with the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78 to 1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups.

Conclusions Most of the excess CVD mortality in lower socio-economic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socio-economic groups.

Contribution of stretch to the change of activation properties of muscle fibers in the diaphragm at the transition from fetal to neonatal life

The transition from fetal to postnatal life involves clearance of liquid from the lung and airways, and rapid formation of a functional residual capacity. Despite the importance of the diaphragm in this process, the impact of birth on the mechanical and functional activity of its muscle fibers is not known. This study determined the contractile characteristics of individual “skinned” diaphragm fibers from 70 days (0.47) gestation to after birth in sheep. Based on differential sensitivity to the divalent ions calcium (Ca²⁺) and strontium (Sr²⁺), all fibers in the fetal diaphragm were classified as “fast,” whereas fibers from the adult sheep diaphragm exhibited a “hybrid” phenotype where both “fast” and “slow” characteristics were present within each single fiber. Transition to the hybrid phenotype occurred at birth, was evident after only 40 min of spontaneous breathing, and could be induced by simple mechanical stretch of diaphragm fibers from near-term fetuses (∼147 days gestation). Both physical stretch of isolated fibers, and mechanical ventilation of the fetal diaphragm in situ, significantly increased sensitivity to Ca²⁺ and Sr²⁺, maximum force generating capacity, and decreased passive tension in near-term and preterm fetuses; however, only fibers from near-term fetuses showed a complete transition to a “hybrid” activation profile. These findings suggest that stretch associated with the transition from a liquid to air-filled lung at birth induces physical changes of proteins determining the activation and elastic properties of the diaphragm. These changes may allow the diaphragm to meet the increased mechanical demands of breathing immediately after birth.

The allometric relationship between clean mohair growth and the fleece-free liveweight of Angora goats is affected by liveweight change

Clean fleece weight (CFWt) is affected by liveweight and change in liveweight in Merino sheep, Angora and cashmere goats. However, how these relationships progress as animals age has not been elucidated. Measurements were made over 12 shearing periods on a population of Angora goats representing the current range and diversity of genetic origins including South African, Texan and interbred admixtures of these and Australian sources. Records of breed, sire, dam, date of birth, dam age, birthweight, birth parity, weaning weight, liveweight, fleece growth and fleece quality were taken for does and castrated males (wethers) (n = 267 animals). Fleece-free liveweights (FFLwt) were determined for each goat at shearing time by subtracting the greasy fleece weight from the liveweight recorded immediately before shearing. The average of the FFLwt at the start of the period and the FFLWt at the end of the period was calculated (AvFFLwt). Liveweight change (LwtCh) was the change in FFLwt over the period between shearings. A restricted maximum likelihood model was developed for CFWt, after log10 transformation, which allowed the observations of the same animal at different ages to be correlated in an unstructured manner. A simple way of describing the results is: CFWt = κ (AvFFLwt)β, where κ is a parameter that can vary in a systematic way with shearing age, shearing treatment and LwtCh; and β is an allometric coefficient that only varies with LwtCh. CFWt was proportional to FFLwt0.67 but only when liveweight was lost at the rate of 5–10 kg during a shearing interval of 6 months. The allometric coefficient declined to 0.3 as LwtCh increased from 10 kg loss to 20 kg gain during a shearing interval. A consequence is that, within an age group of Angora goats, the largest animals will be the least efficient in converting improved nutrition to mohair.

From estrangement to a sense of place …

Maggie MacKellar in her book Core of my Heart, my Country writes 'What is sense of place? Why is relationship with place so fundamental to our identity as individuals and as communities?' MacKellar rightly acknowledges that 'A sense of place is a complex connection between land and self. Place is both inside and outside; it takes us beyond ourselves, yet allows us to make sense of ourselves. Attachments to place are born into us, but they are also formed through movement, through labour, through words.' My mother Maria Radzimirski-Herzog considered herself truly Swiss and thoroughly Australian. Through one migrant's story this paper explores something of the complex intertwining of place, memory and identity. It grapples with the notion of belonging to one's country of birth and one's adopted country via a rich understanding of place. In Maria's case, place becomes inextricably bound with who she became as a person. In the early 1940s, Maria explored Switzerland on bike and on foot during war-time restrictions on cars and she came to know it intimately. She photographed the land and the mountains; she documented her journeys. Spirn writes perceptively that 'Significance does not depend on human perception or imagination alone.' For Maria significance was, to use Spirn's words, 'there to be discovered, inherent and ascribed, shaped by what senses perceive, what instinct and experience read as significant, what minds know'. For Maria, Landscape was not 'mere scenery'. The ability to see, to listen, to be present in place, stood her in good stead in her adopted country, Australia. Maria called place into being for her children: through her lived experiences, her memories, her story telling, through language, traditions and history, Maria shared her Swiss identity with her children. But imperceptibly she also taught them how to understand her new homeland Australia, their birth country. How did Maria become Australian? Was that her creative response to exile from Switzerland? How did she come to feel at home in both countries, to understand both places? How did they seep into her and she into them? Through my own research on place I have discovered that assessing 'sense of place' is not an exact science but a creative analysis of the attributes of a place. The methodology I have adopted to explore the complex interrelationships between place, memory and identity allows recovery and reclamation, rediscovery, juxtaposing the subjective and the objective, the co-presence of different evidence. This paper draws on place research, on personal papers, letters and photographs, and the author's own experiences and memories. Through story and narrative it interweaves autobiography and biography with theoretical scholarship, to illuminate one migrant's journey from estrangement to a sense of place in her adopted country, Australia.

The relationship between the incidence of medullated fibres in mohair and live weight over the lifetime of Angora goats

The presence of even a small amount of medullated fibre, in otherwise high quality mohair, may have a pronounced adverse effect on its value and end-use potential. However, there is considerable confusion about the effects, if any, of environmental variables and management upon the incidence of medullated fibres in mohair. This study examined how the incidence of medullated fibres (Med, % by number) is related to the fleece-free live weight (FFLwt) of Angora goats of different genetic origins over their lifetime, and how the relationship varies with other lifetime factors. Measurements were made over 11 shearing periods of 6 months, on a population of Angora goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Records of breed, sire, dam, date of birth, dam age, birth weight, birth parity, weaning weight, live weight, fleece growth and fleece quality were taken for castrated males (wethers) (n = 94 animals). A restricted maximum likelihood (REML) model was developed for log10(Med + 1), which allowed the observations of the same animal at different ages to be correlated in an unstructured manner. Med varied between 0.1% and 4.3%. The median average FFLwt during a shearing interval increased from 15 kg at 1 year old to 59 kg at 6 years old. Generally, within each shearing interval, Med increased with increasing average FFLwt. However, the size and shape of the relationship differed greatly between shearing ages. For example, at 3.5 years of age Med increased from about 1.1% at an average FFLwt of 26 kg to 2.6% at 50 kg, whilst at 5.0 years of age Med only changed from 1.4% at 32 kg to 1.6% at 56 kg. Goats with mixed genetic parentage showed an increase in Med at some shearings, particularly at younger ages. Variation in animal nutrition, as measured by live weight change during shearing periods, did not affect Med. The results supplement our earlier findings that mohair mean fibre diameter and clean mohair fleece weight, but not staple length, are greater in larger Angora goats. Live weight needs to be taken into account in genetic evaluation of the incidence of medullated fibres. We conclude that any advantage in handling fewer but larger Angora goats rather than more but smaller goats will come at the detriment of producing lower quality mohair, both in terms of increased Med and mean fibre diameter.

Variation in mohair staple length over the lifetime of Angora goats

Previous work has shown that, within an Angora goat flock, clean fleece weight is proportional to fleece-free liveweight (FFLwt)2/3 and for goats of the same age and cohort, the mean mohair fibre diameter is proportional to FFLwt1/3. This indicates that fibre length might not be related to the size of animals. This study examines how mohair staple length (SL) is related to FFLwt of Angora goats of different genetic origins over their lifetime and how the relationship varies with other lifetime factors. Measurements were made over 11 shearing periods on a population of Angora goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Records of breed, sire, dam, date of birth, dam age, birthweight, birth parity, weaning weight, liveweight, fleece growth and fleece quality were taken for castrated males (wethers) (n = 94 animals). FFLwt were determined for each goat at shearing time by subtracting the greasy fleece weight from the liveweight recorded immediately before shearing. The average of the FFLwt at the start of the period and the FFLWt at the end of the period was calculated. Liveweight change (LwtCh) was the change in FFLwt over the period between shearings. A restricted maximum likelihood model was developed for SL, which allowed the observations of the same animal at different ages to be correlated in an unstructured manner. Average SL differed from ~12.0 to ~14.5 cm, depending on age. There were no consistent effects of season. At any age, an increase of 10 kg LwtCh between animals results in about a 0.34 (s.e. = 0.087) cm increase in SL. There was no evidence of an effect of FFLwt on SL. The results confirm our hypothesis that within a single age cohort of Angora goats, there is very little, if any, relationship between the liveweight and SL of individual animals. This implies that the biological determinants of size of fibres related to cross-sectional area are substantially different to the size determinants of fibre length.

The relationship of the incidence of medullated fibres to the dimensional properties of mohair over the lifetime of Angora goats

In a range of animals, increasing mean fibre diameter (MFD) of fibre is associated with an increasing incidence of medullated fibres (Med). It would thus be expected that Med in mohair fleeces, from animals in a flock, would be related to the MFD of those fleeces. MFD of mohair is not the only dimensional attribute of fibres. Med in mohair is phenotypically and genetically related to the size of animals. This study examined how Med is related to dimensional properties of mohair over the lifetime of Angora goats and how the relationship varies with other lifetime factors. The relationship found is then examined to determine the extent that the relationship can be explained by variations in animal size of the goats. Measurements were made over 11 shearing periods on a population of Angora goats representing the current range and diversity of genetic origins in Australia, including South African, Texan and interbred admixtures of these and Australian sources. Records of breed, sire, dam, date of birth, dam age, birth weight, birth parity, weaning weight, live weight, fleece growth and fleece attributes were taken for castrated males (wethers). Animals’ fleece-free live weight (FFLwt, kg) were determined for each goat at shearing time by subtracting the greasy fleece weight from the live weight recorded immediately prior to shearing. The average of the FFLwt at the start of the period and the FFLwt at the end of the period was calculated. Two restricted maximum likelihood (REML) models were developed to relate Med to MFD, staple length (SL) and other lifetime factors. One model allowed FFLwt in the model and the other excluded FFLwt. With the exception of the 1.5 years shearing, Med strongly increased with increasing MFD whether or not adjustments were made for FFLwt measurements. In particular Med increased by 2.0% for each 1 μm increase in MFD, with no adjustment for FFLwt measurements, and increased by 1.5% for each 1 μm increase in MFD, with adjustment for FFLwt measurements. Within each shearing interval increasing average FFLwt was associated with increasing incidence of Med in a similar way to that which has been previously reported without including MFD in the model. There was no evidence that SL needed to be included in the models for Med. Mohair grown by the goats of Mixed genetic background grew mohair which had a higher incidence of Med at ages 2 and 2.5 years and the trend was apparent in other shearing periods. We can conclude that there is both a large response of Med to live weight and a large response to MFD, and that these responses are largely functionally separate. While the response to MFD is in accord with earlier work, there is an unrelated and unreported physiological mechanism that favours the production of Med in larger Angora goats. Clearly, larger Angora goats are biologically different compared with smaller animals from the same flock, in ways that are not purely related to the allometrics of size.

Midwifery work and the making of narrative

This paper draws on a study of birth support conducted across three Melbourne maternity units. Midwife informants were asked to participate in semistructured interviews with two researchers and describe the activity and role of lay birth support people. In the course of the study, the activity of the midwives themselves became a research focus. The study found that one of the key tasks midwives described was assisting birthing women to develop and negotiate satisfactory birth narratives that could encompass the intense and sometimes difficult experience of birth. Midwife informants offered strategies for the development of such narratives as part of their professional and personal labour in the birth room.