Environmental exposures : an underrecognized contribution to noncommunicable diseases

Previous attempts to determine the degree to which exposure to environmental factors contribute to noncommunicable diseases (NCDs) have been very conservative and have significantly underestimated the actual contribution of the environment for at least two reasons. Firstly, most previous reports have excluded the contribution of lifestyle behavioral risk factors, but these usually involve significant exposure to environmental chemicals that increase risk of disease. Secondly, early life exposure to chemical contaminants is now clearly associated with an elevated risk of several diseases later in life, but these connections are often difficult to discern. This is especially true for asthma and neurodevelopmental conditions, but there is also a major contribution to the development of obesity and chronic diseases. Most cancers are caused by environmental exposures in genetically susceptible individuals. In addition, new information shows significant associations between cardiovascular diseases and diabetes and exposure to environmental chemicals present in air, food, and water. These relationships likely reflect the combination of epigenetic effects and gene induction. Environmental factors contribute significantly more to NCDs than previous reports have suggested. Prevention needs to shift focus from individual responsibility to societal responsibility and an understanding that effective prevention of NCDs ultimately relies on improved environmental management to reduce exposure to modifiable risks.

Global, regional, and national age–sex specifi c all-cause and cause-specifi c mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specific all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specific causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65·3 years (UI 65·0–65·6) in 1990, to 71·5 years (UI 71·0–71·9) in 2013, while the number of deaths increased from 47·5 million (UI 46·8–48·2) to 54·9 million (UI 53·6–56·3) over the same interval. Global progress masked variation by age and sex: for children, average absolute differences between countries decreased but relative differences increased. For women aged 25–39 years and older than 75 years and for men aged 20–49 years and 65 years and older, both absolute and relative differences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10·7%, from 4·3 million deaths in 1990 to 4·8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specific mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade.

Using ICD-10-AM codes to characterise hospital-acquired complications

This paper describes the limitations of using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) to characterise patient harm in hospitals. Limitations were identified during a project to use diagnoses flagged by Victorian coders as hospital-acquired to devise a classification of 144 categories of hospital acquired diagnoses (the Classification of Hospital Acquired Diagnoses or CHADx). CHADx is a comprehensive data monitoring system designed to allow hospitals to monitor their complication rates month-to-month using a standard method. Difficulties in identifying a single event from linear sequences of codes due to the absence of code linkage were the major obstacles to developing the classification. Obstetric and perinatal episodes also presented challenges in distinguishing condition onset, that is, whether conditions were present on admission or arose after formal admission to hospital. Used in the appropriate way, the CHADx allows hospitals to identify areas for future patient safety and quality initiatives. The value of timing information and code linkage should be recognised in the planning stages of any future electronic systems.

Videogames: Dispelling myths and tabloid headlines that videogames are bad

Videogamers are often portrayed as adolescent overweight males eating fast food in their bedroom, and videogames often blamed in the media for violent crime, obesity, social isolation and depression. However videogaming is a mainstream activity. In Australia 65% of the population play videogames (Digital Australia 2014), and humanity as a species play about 3 billion hours of videogames a week. This paper dispels the myths and sensationalised negative tabloid headlines that videogames are bad by presenting the latest research showing that videogames can help fight depression, improve brain function and stimulate creativity; that gamers have higher levels of family closeness and better attachment to school; and that videogames help boys and young men to relax, cope and socialise. Children and adolescents deliberately choose to play videogames in the knowledge that they will feel better as a result, and videogame play allow players to express themselves in ways they may not feel comfortable doing in real life because of their appearance, gender, sexuality, and/or age. The potential benefits of videogames to the individual and to society are yet to be fully realised. However already videogames are helping many gamers to flourish in life.

When coroners care too much: Therapeutic jurisprudence and suicide findings

In common law countries such as England and Australia, violent and otherwise unnatural deaths are investigated by coroners who make findings as to the “manner of death”. This includes determining whether the deceased person intentionally caused their own death. Previous research (Tait and Carpenter 2013a, 2013b, 2014) has suggested that coroners are reluctant to reach such determinations, citing the stigma of suicide and a need for sensitivity to grieving and traumatized families. Based on interviews with both English and Australian coroners, this paper explores whether an ‘ethic of care’ evident in English and Australian coronial suicide determinations, can be understood as an application of the ‘practices and techniques’ of therapeutic jurisprudence. Based on the ways in which coroners position the law as a potential therapeutic agent, we investigate how they understand their role and position as legal actors, and the effects of their decision making in the context of suspected suicides.

There and back again: Is there a need for GLAM education? (GLAM = Galleries, Libraries, Archives and Museums)

Conferences addressing emerging commonalities in the information professions were being held as far back as the early 1980s. At that time, there appeared to be two differing thoughts on the future of the information professions: one that saw the increasing diversification, the other favouring the professions’ convergence. Nearly thirty-five years later, we are still discussing the various advantages and disadvantages that a convergence of the information professions and professionals may bring; yet there has been very little empirical evidence gathered to enable us to move forward in this discussion. This conceptual paper uses existing literature to argue that the convergence of galleries, libraries, archives and museums is not a new concept to these institutions, but that they have been linked – philosophically and intellectually at least - for millennia. The intention of this paper is not to articulate what should be included in a GLAM curriculum, or to identify the skills and knowledge required of an information professional in a converged environment, but rather to demonstrate that this research is needed in order to provide an evidence base from which these may be developed.

Field and Service Robotics: Results of the 9th International Conference

The Field and Service Robotics (FSR) conference is a single track conference with a specific focus on field and service applications of robotics technology. The goal of FSR is to report and encourage the development of field and service robotics. These are non-factory robots, typically mobile, that must operate in complex and dynamic environments. Typical field robotics applications include mining, agriculture, building and construction, forestry, cargo handling and so on. Field robots may operate on the ground (of Earth or planets), under the ground, underwater, in the air or in space. Service robots are those that work closely with humans, importantly the elderly and sick, to help them with their lives. The first FSR conference was held in Canberra, Australia, in 1997. Since then the meeting has been held every 2 years in Asia, America, Europe and Australia. It has been held in Canberra, Australia (1997), Pittsburgh, USA (1999), Helsinki, Finland (2001), Mount Fuji, Japan (2003), Port Douglas, Australia (2005), Chamonix, France (2007), Cambridge, USA (2009), Sendai, Japan (2012) and most recently in Brisbane, Australia (2013). This year we had 54 submissions of which 36 were selected for oral presentation. The organisers would like to thank the international committee for their invaluable contribution in the review process ensuring the overall quality of contributions. The organising committee would also like to thank Ben Upcroft, Felipe Gonzalez and Aaron McFadyen for helping with the organisation and proceedings. and proceedings. The conference was sponsored by the Australian Robotics and Automation Association (ARAA), CSIRO, Queensland University of Technology (QUT), Defence Science and Technology Organisation Australia (DSTO) and the Rio Tinto Centre for Mine Automation, University of Sydney.

Diagnostic markers and uses therefor

The present invention relates generally to methods for diagnosing and treating infectious diseases and other conditions related thereto. More particularly, the present invention relates to methods for determining the presence of organisms of the Chlamydiaceae family in a subject, including species of Chlamydia, and to methods for determining the stage of an infection caused by such organisms. The present invention also relates to kits for use with the diagnostic methods. The methods and kits of the present invention are particularly useful in relation to human and non-human, i.e. veterinary subjects. The present invention further relates to methods for identifying proteins or nucleic acid sequences associated with chlamydial infection in a subject. Such proteins or nucleic acid sequences are not only useful in relation to the diagnostic methods of the invention but are also useful in the development of methods and agents for preventing and/or treating chlamydial infection in a subject, such as but not limited to, immunotherapeutic methods and agents.

Emerging issues for road construction and maintenance – A futuristic view

In the coming decades the design, construction and maintenance of roads will face a range of new issues and as such will require a number of new approaches. In particular, road authorities will be required to consider and respond to a range of issues related to climate change, and associated extreme weather events, such as the extensive flooding in January 2011 in Queensland, Australia Figure 1). Coupled with diminishing access to road construction supplies (such as aggregate), water scarcity, and the potential for increases in oil and electricity prices, this range of challenges bear little resemblance to those previously faced. In Australia, state and federal authorities face further pressures given the variety of needs resulting from the country's geographical and population diversity, expansive road networks, road freight requirements and relatively small population base.

NAPLAN, MySchool and accountability: Teacher perceptions of the effects of testing

This paper explores Rizvi and Lingard’s (2010) idea of the “local vernacular” of the global education policy trend of using high-stakes testing to increase accountability and transparency, and by extension quality, within schools and education systems in Australia. In the first part of the paper a brief context of the policy trajectory of National Assessment Program – Literacy and Numeracy (NAPLAN) is given in Australia. In the second part, empirical evidence drawn from a survey of teachers in Western Australia (WA) and South Australia (SA) is used to explore teacher perceptions of the impacts a high-stakes testing regime is having on student learning, relationships with parents and pedagogy in specific sites. After the 2007 Australian Federal election, one of Labor’s policy objectives was to deliver an “Education Revolution” designed to improve both the equity and excellence in the Australian school system1 (Rudd & Gillard, 2008). This reform agenda aims to “deliver real changes” through: “raising the quality of teaching in our schools” and “improving transparency and accountability of schools and school systems” (Rudd & Gillard, 2008, p. 5). Central to this linking of accountability, the transparency of schools and school systems and raising teaching quality was the creation of a regime of testing (NAPLAN) that would generate data about the attainment of basic literacy and numeracy skills by students in Australian schools.

If you don’t know, you can’t help: A practical guide for alcohol and other drug screening in psychological services

Alcohol is implicated in over 60 diseases and injuries and accounted for 6.2 per cent of all male deaths globally in 2004 (WHO, 2011). Alcohol and other drug (AOD) abuse causes significant individual, family and social harms at all age levels and across all socioeconomic groups. These may result from intoxication (e.g., overdose, vulnerability to physical injury/trauma or death, consequences of impulsive behaviour, aggression and driving under the influence) and longer-term consequences (e.g., alcohol or drug-related brain injury, cardiovascular and liver diseases, blood borne viruses e.g., Chikritzhs et al., 2003, Roxburgh et al., 2013). Mental health problems may be triggered or exacerbated, and family breakdown, poor self-esteem, legal issues and lack of community engagement may also be evident. Despite the prevalence of substance use disorders and evident consequences for the individual, family and wider community, it would seem that health professionals, including psychologists, are reluctant to ask about substance use.