Polities and poetics: a ‘place’ for reconciliation

The thesis analysed the ways in which Australian literature written between 1990 - 2010 has informed concepts of Indigenous and non-Indigenous reconciliation. There is a ‘place’ for reconciliation in postcolonial Australia, and literature is one such ‘place’, with its ability to construct, incorporate and promote postcolonial race relations through reimaginings of history, place, bodies and the sacred.

Supporting healthy communities through sports and recreation programs

There is some evidence, in the form of critical descriptions of programs and systematic reviews, on the benefits to Aboriginal and Torres Strait Islander communities from participation in sport and recreational programs. These include some improvements in school retention, attitudes towards learning, social and cognitive skills, physical and mental health and wellbeing; increased social inclusion and cohesion; increased validation of and connection to culture; and crime reduction.Although the effects of sports and recreation programs can be powerful and transformative, these effects tend to be indirect. For example, using these programs to reduce juvenile antisocial behaviour largely work through diversion, providing alternative safe opportunities to risk taking, maintenance of social status, as wellas opportunities to build healthy relationships with Elders and links with culture.Although Indigenous Australians have lower rates of participation in sport than non-Indigenous people, surveys suggest that around one-third of Indigenous people participate in some sporting activity (ABS 2010). That makes sports a potentially powerful vehicle for encouraging Indigenous communities to look at challenging personal and community issues.Within Indigenous communities, a strong component of sport and recreation is the link with traditional culture. Cultural activities such as hunting are generally more accepted as a form of sport and recreation than traditional dance. Therefore sport and recreation are integral in understanding ‘culture’ within Indigenous communities, as well as highlighting the culture within which sport and recreation operate.

Community music-making in regional Australia: creating, improvising and performing at a festival

Community arts in Australia, as in many other countries, continue to permeate society, illuminating the past and shaping the future. This article situates itself as an aspect of community music through creative music-making within a larger research project that started at Deakin University (DU) (Melbourne, Australia) in 2011 called ‘Flows and Catchments’. Through the lens of creative arts and music-making, I argue that community partnerships between local communities and tertiary institutions are a fertile ground to celebrate arts practice where the cultural and artistic life of the community is promoted, fostering respect and understanding between indigenous and non-indigenous peoples. In 2012, I presented a music workshop at the 8th Annual Lake Bolac Eel Festival (LBEF) in Western Victoria. Using the African term Masakhane, which means ‘let us build together’, I provide a snapshot of my experience through journaling and anecdotal feedback as I reflect in and on the teaching and learning episode of the volcanic composition. The community partnership between DU (academics in an urban space) and the LBEF (local community in a regional place) provided an opportunity for people of all ages to engage, explore and experience music-making collectively in a social context. As a tertiary music educator, I propose more pathways being established with regional communities in order to deepen the knowledge and understanding of them; schools, communities, artists, academics and tertiary students can form cultural synergies in place-based settings like those of festivals.

Web-based alcohol intervention for Māori university students: double-blind, multi-site randomized controlled trial

AIMS: Like many indigenous peoples, New Zealand Māori bear a heavy burden of alcohol-related harm relative to their non-indigenous compatriots, and disparities are greatest among young adults. We tested the effectiveness of web-based alcohol screening and brief intervention (e-SBI) for reducing hazardous drinking among Māori university students. DESIGN: Parallel, double-blind, multi-site, randomized controlled trial. SETTING: Seven of New Zealand's eight universities. PARTICIPANTS: In April 2010, we sent e-mail invitations to all 6697 17-24-year-old Māori students to complete a brief web questionnaire including the Alcohol Use Disorders Identification Test (AUDIT)-C, a screening tool for hazardous and harmful drinking. Those screening positive were computer randomized to: <10 minutes of web-based alcohol assessment and personalized feedback (intervention) or screening alone (control). MEASUREMENTS: We conducted a fully automated 5-month follow-up assessment with observers and participants blinded to study hypotheses, design and intervention delivery. Pre-determined primary outcomes were: (i) frequency of drinking, (ii) amount consumed per typical drinking occasion, (iii) overall volume of alcohol consumed and (iv) academic problems. FINDINGS: Of the participants, 1789 were hazardous or harmful drinkers (AUDIT-C ≥ 4) and were randomized: 850 to control, 939 to intervention. Follow-up assessments were completed by 682 controls (80%) and 733 intervention group members (78%). Relative to controls, participants receiving intervention drank less often [RR = 0.89; 95% confidence interval (CI): 0.82-0.97], less per drinking occasion (RR = 0.92; 95% CI: 0.84-1.00), less overall (RR = 0.78; 95% CI: 0.69-0.89) and had fewer academic problems (RR = 0.81; 95% CI: 0.69-0.95). CONCLUSIONS: Web-based screening and brief intervention reduced hazardous and harmful drinking among non-help-seeking Māori students in a large-scale pragmatic trial. The study has wider implications for behavioural intervention in the important but neglected area of indigenous health.

Faster than the speed of white (noise): potential pressure points in research partnerships and processes

White noise occurs in the thinking, decision making and communication of dominant Settler cultures. It inhibits clear reception of messages, somewhat like the indistinct, fuzzy static of an un-tuned radio. As much a systemic issue as an individual one, it results from assumed privilege and lack of knowledge of worldviews other than the dominant. Until white noise is acknowledged, development of partnerships between Indigenous and non-Indigenous groups is likely to be limited by having to continually start at a point of inequality where nonIndigenous gaps in knowledge and understanding remain unrecognised. This paper/workshop considers challenges encountered while researching experiences of Aboriginal education in Western Australian prisons. Each pressure point occurred where the dominant world view prevailed without question. Discussion will focus on the specific pressure points of ethics approval, project development, informed consent and application of outcomes and findings. The paper asks the questions ‘Who decides what stories are created at these pressure points? What informs those stories?’ As individuals, we might not be able to crash through the white noise barrier but we can chip away and be transparent about its existence with the goal of eventually moving faster than the speed of white (noise).

Socio-cultural disparities in GDM burden differ by maternal age at first delivery

Aims : Several socio-cultural and biomedical risk factors for gestational diabetes mellitus (GDM) are modifiable. However, few studies globally have examined socio-cultural associations. To eliminate confounding of increased risk of diabetes in subsequent pregnancies, elucidating socio-cultural associations requires examination only of first pregnancies.

Methods : Data for all women who delivered their first child in Victoria, Australia between 1999 and 2008 were extracted from the Victorian Perinatal Data Collection. Crude and adjusted GDM rates were calculated. Multivariate logistic regression was used to examine odds of GDM within and between socio-cultural groups.

Results : From 1999 to 2008, 269,682 women delivered their first child in Victoria. GDM complicated 11,763 (4.4%) pregnancies and burden increased with maternal age, from 2.1% among women aged below 25 years at delivery to 7.0% among those aged 35 years or more. Among younger women, GDM rates were relatively stable across socioeconomic levels. Amongst older women GDM rates were highest in those living in most deprived areas, with a strong social gradient. Asian-born mothers had highest GDM rates. All migrant groups except women born in North-West Europe had higher odds of GDM than Australian-born non-Indigenous women. In all ethnic groups, these differences were not pronounced among younger mothers, but became increasingly apparent amongst older women.

Conclusions : Socio-cultural disparities in GDM burden differ by maternal age at first delivery. Socio-cultural gradients were not evident among younger women. Health and social programs should seek to reduce the risk amongst all older women to that of the least deprived older mothers.

Welcome to country: acknowledgement, belonging and white anti-racism

 The Welcome to Country (WTC) ceremony and its twin, the Acknowledgement of Traditional Owners, have become prominent anti-racist rituals in the post-settler society of Australia. These rituals are rich in meaning. They are simultaneously emblems of colonisation and dispossession; of recognition and reconciliation; and a periodic focus of political posturing. This article analyses the multiple meanings of WTC ceremonies. In particular, I explore the politics of belonging elicited by WTC and Acknowledgement rituals. Drawing on ethnography of non-Indigenous people who work in Indigenous affairs, I argue that widespread enjoyment of these rituals among White anti-racists is explained because they paradoxically experience belonging through a sense of not belonging.

Fatores de risco para morte em pacientes diabéticos e não diabéticos em tratamento hemodialítico

A mortalidade dos pacientes diabéticos, quando iniciam tratamento hemodialítico, ainda é muito elevada, significativamente maior do que a dos pacientes não diabéticos. As doenças cardíacas são a principal causa de morte nestes pacientes. O diabetes, por si só, está associado a uma alta prevalência de hipertensão, doença cardiovascular e insuficiência cardíaca, resultando em morbi-mortalidade significativas. Tradicionalmente, a mortalidade tem sido associada à cardiopatia isquêmica. A mortalidade cardiovascular, entretanto, não está relacionada apenas à isquemia, mas também à insuficiência cardíaca e à morte súbita. O objetivo deste estudo foi analisar o papel da doença cardiovascular como fator prognóstico para a morte de pacientes diabéticos e não diabéticos, que iniciam hemodiálise, levando em consideração outros fatores. Este foi um estudo prospectivo de uma coorte de 40 pacientes diabéticos e 28 não diabéticos, que iniciaram programa de hemodiálise, de agosto de 1996 a junho de 1999, em 5 hospitais de Porto Alegre, Brasil. O tempo total de acompanhamento foi de 4,25 anos. A avaliação inicial, realizada entre o 20 e o 30 mês de hemodiálise, incluiu: um questionário com características demográficas, história do diabetes e suas complicações, história de hipertensão e acidente vascular cerebral; o exame físico incluindo avaliação nutricional e exame oftalmológico; e avaliação laboratorial com medidas de parâmetros nutricionais, bioquímicos, hormonais, perfil lipídico, e controle metabólico do diabetes, além da avaliação da adequação da diálise. Para a avaliação cardiovascular foram utilizados: questionário Rose, ECG em repouso, cintilografia em repouso e sob dipiridamol, e ecocardiograma bi-dimensional e com Doppler. A mortalidade foi analisada ao final dos 51 meses, e as causas de morte, definidas pelos registros médicos, atestados de óbito ou informações do médico assistente ou familiar. Na análise estatística, foram empregados o teste t de Student, o qui-quadrado (χ2) ou teste exato de Fisher. Para a análise da sobrevida, o método de Kaplan-Meier foi utilizado, e, para identificar os principais fatores associados à mortalidade, construiu-se um modelo de regressão múltipla de Cox. O nÍvel de significância adotado foi de 5%. Ao final do estudo, os pacientes diabéticos tiveram um índice de mortalidade significativamente mais elevado do que os pacientes sem diabetes (47,5% vs. 7,1%; P=0,0013, log rank test). Na análise de Cox, o padrão pseudonormal ou restritivo de disfunção diastólica esteve associado a um risco de 3,2 (IC 95%:1,2-8,8; P=0,02), e a presença de diabetes, a um risco de 4,7 (IC 95%:1,03-21,4; P=0,04) para a morte. Concluiu-se que a disfunção diastólica do ventrículo esquerdo foi o principal preditor de mortalidade nesta coorte de pacientes que estão iniciando tratamento hemodialítico.

Nhembo'e : enquanto o encanto permanece! : processos e práticas de escolarização nas aldeias Guarani

A escola nas aldeias Guarani do Rio Grande do Sul é um acontecimento recente. Algumas TEKOÁ decidiram não abrigá-la em seu meio, considerando que a educação tradicional, assentada na cosmologia Guarani, é suficiente para o seu viver e, portanto, prescindem dos saberes escolares. Outras, evidenciando a necessidade de saberes que se relacionam à escola – como a escrita, a leitura, a Língua Portuguesa e o sistema monetário, entre outros –, a solicitam e a acolhem, iniciando processos e práticas de escolarização que afirmam o desejo de se apropriar de instrumentos que permitam um diálogo mais eqüitativo com a sociedade não indígena. Num movimento de interlocução com os gestores das políticas públicas, tensionam a Secretaria de Estado da Educação para criar condições de implementar a Escola Específica e Diferenciada nas aldeias. No entanto, experimentam a ambigüidade de uma aproximação e de um afastamento, de um querer e um não querer a escola em suas aldeias, pois intuem as mudanças que poderá desencadear no modo de vida tradicional. Para compreender os processos de implementação da escola do povo Guarani, e os significados que atribuem à educação escolar, dirigi o olhar e aprofundei o estudo em três aldeias do Rio Grande do Sul: TEKOÁ JATAÍTY (Cantagalo, município de Viamão), TEKOÁ ANHETENGUÁ (Lomba do Pinheiro, Porto Alegre) e TEKOÁ IGUA´PORÃ (Pacheca, município de Camaquã). Os movimentos de aproximação com a cosmologia Guarani e com o universo das aldeias, constituído através de um estar-junto sensível, e o com-viver com a totalidade cosmológica de cada lugar pesquisado possibilitou a elaboração de um contorno antropológico etnográfico que busca dizer dos Guarani desde si. A perspectiva teórica, assentada principalmente na aproximação da Educação com uma Antropologia Filosófica latino-americana, possibilitou a compreensão do pensamento indígena e da ambigüidade do “ser” europeu e do “estar” americano, presente nas aldeias e fora delas também. A pesquisa mostra que há nos preceitos educacionais da cosmologia Guarani um admirável mundo a ser desvendado, em que os significados de cada gesto, de cada ação mostram a integridade de um povo que sobrevive e se recria e a escola na aldeia poderá se inserir nesse universo e dialogar com todos os princípios que compõem a educação tradicional e a cosmologia Guarani.

Contribuição ao estudo da reação á tricofitina nas dermatofitoses

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação da cinemática do complexo tóracoabdominal durante repouso e endurance muscular respiratória em obesos

Background: Obesity may affect the respiratory system, causing changes in respiratory function and in the pulmonary volumes and flows. Objectives: To evaluate the influence of obesity in the movement of thoracoabdominal complex at rest and during maximal voluntary ventilation (MVV), and the contribution between the different compartments of this complex and the volume changes of chest wall between obese and non-obese patients. Materials and Methods: We studied 16 patients divided into two groups: the obese group (n = 8) and group non-obese (n = 8). The two groups were homogeneous in terms of spirometric characteristics (FVC mean: 4.97 ± 0.6 L - 92.91 ± 10.17% predicted, and 4.52 ± 0.6 L - 93.59 ± 8.05%), age 25.6 ± 5.0 and 26.8 ± 4.9 years, in non-obese and obese respectively. BMI was 24.93 ± 3.0 and 39.18 ± 4.3 kg/m2 in the groups investigated. All subjects performed breathing calm and slow and maneuver MVV, during registration for optoelectronic plethysmography. Statistical analysis: we used the unpaired t test and Mann-Whitney. Results: Obese individuals had a lower percentage contribution of the rib cage abdominal (RCa) during breathing at rest and VVM. The variation of end expiratory (EELV) and end inspiratory (EILV) lung volumes were lower in obese subjects. It has been found asynchrony and higher distortion between compartments of thoracoabdominal complex in obese subjects when compared to non-obese. Conclusions: Central obesity impairs the ventilation lung, reducing to adaptation efforts and increasing the ventilatory work

Influência do sistema de fornecimento de oxigênio na qualidade de vida de pacientes com hipoxemia crônica

OBJETIVO: Avaliar a qualidade de vida relacionada à saúde de pacientes com doença obstrutiva crônica das vias aéreas recebendo oxigenoterapia domiciliar prolongada (ODP) por meio de cilindros de oxigênio e comparar estes resultados com os obtidos após seis meses de modificação do sistema de fornecimento para concentradores de oxigênio. MÉTODOS: Um total de 45 pacientes, 24 com hipoxemia crônica e 21 sem evidências de hipoxemia, foram avaliados. Os pacientes com hipoxemia crônica estavam recebendo ODP regularmente durante pelo menos os últimos seis meses e foram avaliados no momento basal, em uso de cilindro, e após seis meses de transição para concentradores. Os pacientes não hipoxêmicos foram avaliados no mesmo intervalo de tempo que os pacientes hipoxêmicos. Para avaliar a qualidade de vida foi utilizada a versão validada para língua portuguesa (Brasil) do Questionário Respiratório Saint George (Saint George's Respiratory Questionnaire - SGRQ). RESULTADOS: No momento inicial, os pacientes hipoxêmicos apresentaram maior comprometimento da qualidade de vida, avaliada pelo escore total e pelos escores dos domínios sintomas e impacto do SGRQ, que os pacientes não hipoxêmicos. Após seis meses, houve melhora significativa da qualidade de vida dos pacientes hipoxêmicos e, neste momento, não foi encontrada diferença entre os pacientes com e sem hipoxemia. CONCLUSÃO: Nossos achados mostraram que os pacientes com doença obstrutiva crônica das vias aéreas e hipoxemia crônica apresentam prejuízo da qualidade de vida, que essa qualidade de vida pode ser melhorada com o uso regular de ODP e que o sistema de fornecimento de oxigênio tem influência nessa melhora.

Determinação de haplótipos do gene βs em portadores de anemia falcifome

Haplotypes linked to the βS gene represent patterns of DNA polymorphisms along chromosome 11 of individuals bearing the βS gene. Analysis of haplotypes, in addition to serving as an important source for anthropological studies about the ethnic origin of a population, contributes to a better understanding of the variations in clinical severity of sickle cell anemia. The aim of the present study was to determine βS gene haplotypes in a group of patients with sickle cell anemia treated at the Dalton Barbosa Cunha Hematology Center (Hemonorte) in Natal, Brazil and the Oncology and Hematology Center in Mossoró, Brazil. Blood samples were obtained from 53 non-related patients (27 males and 26 females), aged between 3 months and 61 years (mean age: 16.9 ± 12.1 years). Laboratory analyses consisted of the following: erythrogram, reticulocyte count, hemoglobin electrophoresis at alkaline pH, measurement of hemoglobin A2 and Fetal hemoglobin, solubility test and molecular analysis to determine βS gene haplotypes. DNA samples were extracted by illustra blood genomicPrep Mini Spin kit and βS gene haplotypes were determined by PCR-RFLP, using Xmn I, Hind III, Hinc II and Hinf I restriction enzymes for analysis of six polymorphic restriction sites in the beta cluster. Of 106 βS chromosomes studied, 75.5% were Central African Republic (CAR) haplotype, 11.3% Benin (BEN) and 6.6% Cameroon (CAM). The atypical haplotypes had a frequency of 6.6%. More than half the patients (58.5%) were identified as CAR/CAR genotype carriers, 16.9% heterozygous CAR/BEN, 13.2% CAR/CAM and 1.9% BEN/BEN. Patients with atypical haplotype in one or two chromosomes accounted for 9.5% (CAR/Atp, BEN/Atp and Atp/Atp). The genotype groups showed no statistically significant difference (p < 0.05) in their laboratory parameters. This is the first study related to βS haplotypes conducted in state of Rio Grande do Norte and the higher frequency of Cameroon halotype found, compared to other Brazilian states, suggests the existence of a peculiarity of African origin

A ultra-sonografia do pâncreas é eficaz em diagnosticar o diabete melito tipo 1 e tipo 2?

Este trabalho foi realizado para verificar se a ultra-sonografia do pâncreas oferece dados auxiliares na classificação de diabéticos adultos dos tipos 1 e 2. O tamanho e a ecogenicidade do pâncreas foram determinados pela ultra-sonografia em 81 diabéticos, sendo 20 do tipo 1 e 61 do tipo 2 (53 obesos e oito não-obesos). Os pacientes tipo 2 obesos diferiram dos demais por apresentarem área total e diâmetro ântero-posterior do corpo do pâncreas significativamente maiores. Quanto à ecogenicidade pancreática, esta estava aumentada com maior freqüência nos diabéticos tipo 2 obesos que nos diabéticos tipo 1. Consideramos, assim, que a ultra-sonografia do pâncreas constitui metodologia auxiliar na classificação de diabéticos entre os tipo 1 e 2, sendo menos eficaz quando os últimos não são obesos.

O tabagismo como fator de risco para as doenças periodontais: aspectos microbiológicos

O fumo é considerado importante fator predisponente para muitas doenças, incluindo-se as periodontopatias. Desde que as doenças periodontais representam a inter-relação entre os fatores de virulência da microbiota subgengival sobre um hospedeiro susceptível, foi objetivo avaliar a freqüência de isolamento de três periodontopatógenos em indivíduos sadios e pacientes com doença periodontal, fumantes ou não, com níveis variados de higiene bucal; verificar a relação entre o número de microrganismos produtores de sulfeto de hidrogênio na placa subgengival de fumantes e não fumantes e sua condição clínica. Foram examinados 189 pacientes e indivíduos sadios, dos quais 60 foram selecionados para análise microbiológica. O índice de placa foi registrado de acordo com o índice de O'Leary e os espécimes de placa subgengival coletados e processados de acordo com SLOTS35 (1982). A identificação dos isolados foi obtida pelas suas características morfocelulares, morfocoloniais e bioquímico-fisiológicas. Verificou-se que a freqüência de isolamento dos bastonetes anaeróbios produtores de pigmento negro, Fusobacterium nucleatum e bactérias produtoras de sulfeto de hidrogênio foi similar entre fumantes e não fumantes, sendo mais elevada nos pacientes com doença periodontal. Já Actinobacillus actinomycetemcomitans foi isolado mais freqüentemente em sadios fumantes do que sadios não fumantes.