Reduced incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland, Australia

Objective To determine trends in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in Queensland (Australia) between 2005 and 2010 that coincided with changes in state-wide ambulatory diabetic foot-related complication management. Methods All data from cases admitted for the principal reason of diabetes foot-related hospitalisation or amputation in Queensland from 2005–2010 were obtained from the Queensland Hospital Admitted Patient Data Collection dataset. Incidence rates for foot-related hospitalisation (admissions, bed days used) and amputation (total, minor, major) cases amongst persons with diabetes were calculated per 1,000 person-years with diabetes (diabetes population) and per 100,000 person-years (general population). Age-sex standardised incidence and age-sex adjusted Poisson regression models were also calculated for the general population. Results There were 4,443 amputations, 24,917 hospital admissions and 260,085 bed days used for diabetes foot-related complications in Queensland. Incidence per 1,000 person-years with diabetes decreased from 2005 to 2010: 43.0% for hospital admissions (36.6 to 20.9), 40.1% bed days (391 to 234), 40.0% total amputations (6.47 to 3.88), 45.0% major amputations (2.18 to 1.20), 37.5% minor amputations (4.29 to 2.68) (p < 0.01 respectively). Age-sex standardised incidence per 100,000 person-years in the general population also decreased from 2005 to 2010: 23.3% hospital admissions (105.1 to 80.6), 19.5% bed days (1,122 to 903), 19.3% total amputations (18.57 to 14.99), 26.4% major amputations (6.26 to 4.61), 15.7% minor amputations (12.32 to 10.38) (p < 0.01 respectively). The age-sex adjusted incidence rates per calendar year decreased in the general population (rate ratio (95% CI)); hospital admissions 0.949 (0.942–0.956), bed days 0.964 (0.962–0.966), total amputations 0.962 (0.946–0.979), major amputations 0.945 (0.917–0.974), minor amputations 0.970 (0.950–0.991) (p < 0.05 respectively). Conclusions There were significant reductions in the incidence of foot-related hospitalisation and amputation amongst persons with diabetes in the population of Queensland over a recent six-year period.

Statistics as a basis for discrimination in the insurance business

The European Court of Justice has held that as from 21 December 2012 insurers may no longer charge men and women differently on the basis of scientific evidence that is statistically linked to their sex, effectively prohibiting the use of sex as a factor in the calculation of premiums and benefits for the purposes of insurance and related financial services throughout the European Union. This ruling marks a sharp turn away from the traditional view that insurers should be allowed to apply just about any risk assessment criterion, so long as it is sustained by the findings of actuarial science. The naïveté behind the assumption that insurers’ recourse to statistical data and probabilistic analysis, given their scientific nature, would suffice to keep them out of harm’s way was exposed. In this article I look at the flaws of this assumption and question whether this judicial decision, whilst constituting a most welcome landmark in the pursuit of equality between men and women, has nonetheless gone too far by saying too little on the million dollar question of what separates admissible criteria of differentiation from inadmissible forms of discrimination.

On the drivers of inter-annual and decadal rainfall variability in Queensland, Australia

Queensland experiences considerable inter-annual and decadal rainfall variability, which impacts water-resource management, agriculture and infrastructure. To understand the mechanisms by which large-scale atmospheric and coupled air–sea processes drive these variations, empirical orthogonal teleconnection (EOT) analysis is applied to 1900–2010 seasonal Queensland rainfall. Fields from observations and the 20th Century Reanalysis are regressed onto the EOT timeseries to associate the EOTs with large-scale drivers. In winter, spring and summer the leading, state-wide EOTs are highly correlated with the El Nino–Southern Oscillation (ENSO); the Inter-decadal Pacific Oscillation modulates the summer ENSO teleconnection. In autumn, the leading EOT is associated with locally driven, late-season monsoon variations, while ENSO affects only tropical northern Queensland. Examining EOTs beyond the first, southeastern Queensland and the Cape York peninsula emerge as regions of coherent rainfall variability. In the southeast, rainfall anomalies respond to the strength and moisture content of onshore easterlies, controlled by Tasman Sea blocking. The summer EOT associated with onshore flow and blocking has been negative since 1970, consistent with the observed decline in rainfall along the heavily populated coast. The southeastern Queensland EOTs show considerable multi-decadal variability, which is independent of large-scale drivers. Summer rainfall in Cape York is associated with tropical-cyclone activity.

Conflicts of law and the mutual recognition of same-sex unions in the EU

My thesis uses legal arguments to demonstrate a requirement for recognition of same-sex marriages and registered partnerships between EU Member States. I draw on the US experience, where arguments for recognition of marriages void in some states previously arose in relation to interracial marriages. I show how there the issue of recognition today depends on conflicts of law and its interface with US constitutional freedoms against discrimination. I introduce the themes of the importance of domicile, the role of the public policy exception, vested rights, and relevant US constitutional freedoms. Recognition in the EU also depends on managing the tension between private international law and freedoms guaranteed by higher norms, in this case the EU Treaties and the European Convention on Human Rights. I set out the inconsistencies between various private international law systems and the problems this creates. Other difficulties are caused by the use of nationality as a connecting factor to determine personal capacity, and the overuse of the public policy exception. I argue that EU Law can constrain the use of conflicts law or public policy by any Member State where these are used to deny effect to same-sex unions validly formed elsewhere. I address the fact that family law falls only partly within Union competence, that existing EU Directives have had limited success at achieving full equality and that powers to implement new measures have not been used to their full potential. However, Treaty provisions outlawing discrimination on grounds of nationality can be interpreted so as to require recognition in many cases. Treaty citizenship rights can also be interpreted favourably to mandate recognition, once private international law is itself recognised as an obstacle to free movement. Finally, evolving interpretations of the European Convention on Human Rights may also support claims for cross-border recognition of existing relationships.

Twisting the knife: discrimination in the law

Of the many different variations that can occur in human sexual formation, transsexualism no doubt remains the least understood by the wider Australian community. As a consequence, the process of attaining human rights to legal status, privacy, dignity and freedom from discrimination for those who experience this unusual condition has been a slow and sometimes frustrating one. The article seeks to introduce the reader to some of the more recent developments in the international jurisprudence of transsexualism and the underlying medical evidence that has supported them. It also offers criticism of the belated attempt by the State of Victoria,  with the Births, Deaths & Marriages Registration (Amendment) Act 2004, to establish certain statutory rights in this regard. While the legislation was enacted with the stated and very laudable purpose of providing for the  correction of birth records on the Register of Births of those people with transsexualism who have altered their phenotypic sex by hormonal  medication and surgery, the article argues it has also served to remove other equally important rights already won and proposes that a final remedy will only be found, as on previous occasions, in the courts.

Allegations of unlawful discrimination in education: parents taking their fight for Auslan to the courts

This paper examines the use of the Disability Discrimination Act (Commonwealth of Australia, 1992) by parents seeking access for their deaf children to native sign language in the classroom. It reviews a number of cases in which Australian parents have claimed indirect discrimination by educational authorities over their children's lack of access to instruction through Australian Sign Language (Auslan) and discusses the outcomes of such litigation. The policies endorsed by deafness organizations are contrasted with those of state educational authorities. The author discusses the limitations of a complaints-based system to address systemic discrimination and suggests the need for legislation to protect the linguistic rights of deaf children.

Urban area disadvantage and physical activity: a multilevel study in Melbourne, Australia

Objective: To estimate variation between small areas in the levels of walking, cycling, jogging, and swimming and overall physical activity and the importance of area level socioeconomic disadvantage in predicting physical activity participation.

Methods: All census collector districts (CCDs) in the 20 innermost local government areas in metropolitan Melbourne, Australia, were identified and ranked by the percentage of low income households (<$400/week) living in the CCD. Fifty CCDs were randomly selected from the least, middle, and most disadvantaged septiles of the ranked CCDs and 2349 residents (58.7% participation rate) participated in a cross sectional postal survey about physical activity. Multilevel logistic regression (adjusted for extrabinomial variation) was used to estimate area level variation in walking, cycling, jogging, and swimming and in overall physical activity participation, and the importance of area level socioeconomic disadvantage in predicting physical activity participation.

Results: There were significant variations between CCDs in all activities and in overall physical participation in age and sex adjusted models; however, after adjustment for individual SES (income, occupation, education) and area level socioeconomic disadvantage, significant differences remained only for walking (p = 0.004), cycling (p = 0.003), and swimming (p = 0.024). Living in the most socioeconomically disadvantaged areas was associated with a decreased likelihood of jogging and of having overall physical activity levels that were sufficiently active for health; these effects remained after adjustment for individual socioeconomic status (sufficiently active: OR 0.70, 95% CI 0.55 to 0.90 and jogging: OR = 0.69, 95% CI 0.51 to 0.94).

Conclusion: These research findings support the need to focus on improving local environments to increase physical activity participation.

Abbreviations: SES, socioeconomic status; CCD, census collector district

Cultural racism, language prejudice and discrimination in hospital contexts : an Australian study

This article explores the idea that racial and ethnic disparities in healthcare may be expressive of unacknowledged practices of cultural racism. In conducting this exploration, the researchers identify, describe and discuss the practice of language prejudice and discrimination by health service providers, discovered serendipitously in the context of a broader study exploring cultural safety and cultural competency in an Australian healthcare context. The original study involved individual and focus groups interviews with 145 participants recruited from over 17 different organisational and domestic home sites. Participants included health service managers, ethnic liaison officers, qualified health interpreters, cultural trainers/educators, ethnic welfare organisation staff, registered nurses, allied health professionals, and healthcare consumers. Participants self-identified as being from over 27 different ethnocultural and language backgrounds.

Analysis of the data revealed that English language proficiency, like skin colour, was used as a social marker to classify, categorise, and negatively evaluate people of non-English speaking backgrounds (NESB) in the contexts studied. Negative evaluations, in turn, were used to justify the exclusion of NESB people from healthcare relationships and resources. Further data analysis revealed that underpinning the negative attitudes and behaviours in hospital domains concerning people who spoke accented English or who did not speak English proficiently were a dislike of difference, fear of difference, intolerance of difference, fear of competition for scarce healthcare resources, repressed hostility toward difference, and ignorance.

Highlighting the implications of language prejudice for the safety and quality care of NESB people, the researchers call for further internationally comparative research and debate on the subject.

Cholinesterase response in native birds exposed to fenitrothion during locust control operations in Eastern Australia

Huge aggregations of flightless locust nymphs pose a serious threat to agriculture when they reach plague proportions but provide a very visible and nutritious resource for native birds. Locust outbreaks occur in spring and summer months in semiarid regions of Australia. Fenitrothion, an organophosphate pesticide, is sprayed aerially to control locust plagues. To evaluate fenitrothion exposure in birds attending locust outbreaks, we measured total plasma cholinesterase (ChE), butrylcholinesterase (BChE), and acetylcholinesterase (AChE) activities in four avian species captured pre- and postfenitrothion application and ChE reactivation in birds caught postspray only. Eleven of 21 plasma samples from four species had ChE activity below the diagnostic threshold (two standard deviations below the mean ChE activity of prespray samples). Granivorous zebra finches (Taeniopygia guttata) and insectivorous white-winged trillers (Lalage sueurii) had significantly lower mean plasma total ChE, BChE, and AChE activity postspray, while other insectivores, white-browed (Artamus superciliosus) and masked woodswallows (Artamus personatus), did not. Cholinesterase was reactivated in 19 of the 73 plasma samples and in one of three brain samples. We conclude that native bird species are exposed to fenitrothion during locust control operations. This exposure could have detrimental impacts, as both locust outbreaks and avian reproductive events are stimulated by heavy summer rainfall, leading to co-occurrence of locust control and avian breeding activities.

Short term reoffending by child victim sex offenders in New Zealand : a comparison of those with and without extended supervision

Sexual offenders with child victims in New Zealand who are considered at high risk for reoffending are subject to an Extended Supervision Order. This allows for a period of supervision of up to ten years following release to the community. The present study examined 89 offenders given Extended Supervision Orders over the 33 month period since the legislation was enacted. All types of reoffending resulting in criminal convictions by this group were included. A matched sample of sexual offenders with child victims released prior to this legislation and a sample of offenders judged to be lower risk were compared to those under extended supervision. Offenders under extended supervision reoffended faster and at a higher rate for both sexual and general offences than those deemed lower risk, but at a lower rate than pre-extended supervision high risk offenders. The relationship between specialist treatment programme attendance and completion, actuarial risk level, and recidivism in the extended supervision sample were also investigated. These variables were found not to be significant predictors of sexual recidivism.

Integrating farm production and natural resource management in Tasmania, Australia

This paper reports on the social learning from a project aimed to increase the knowledge and capacity of a group of farmers in Tasmania, Australia, to reduce the impacts of intensive agriculture on soil health and waterways, and to optimise the efficient use of on-farm inputs. The plan-do-check-review cycle adopted in this project required the farmers to assess current management practices, identify where to make changes, implement changes and monitor for improvements. The success of the project was due to careful attention to social processes as well as technical input. The combination of group activities with individual mentoring and one-to-one advice was key to the success of this project in enabling farmers to undertake on-farm action.

There is value in social learning that included developing relationships, using one-to-one contact and group workshops together with expert input when working with farmers to tackle some difficult and complex interrelated natural resource management and production issues. Sufficient time must be allowed for the process of facilitating good practice in natural resource management, particularly when addressing systemic environmental impacts. Practical operational recommendations are presented on communication, feedback, focus of activities and meeting content, as these will be useful to other project officers and facilitators working with farmer groups.

Breeding ecology and bias in offspring sex ratio in little grassbirds (Megalurus gramineus)

Little grassbirds (Megalurus gramineus) are small, sexually monomorphic passerines that live in reed beds, lignum swamps and salt marshes in southern Australia. The breeding biology and patterns of sex allocation of the little grassbird were investigated over a single breeding season. Our observations of this species in the Edithvale Wetland Reserve revealed a highly male-biased population sex ratio, with some breeding territories containing several additional males. Nevertheless, there was little compelling evidence that little grassbirds breed cooperatively. The growth rates of male and female nestlings were similar and, as predicted by theory, there was no overall primary sex ratio bias. However, the primary sex ratio was female-biased early in the breeding season and became increasingly male-biased later in the breeding season.

Improving the effectiveness of the Sex Discrimination Act: recommendations from the 2008 Senate Inquiry

One way to characterise the Rudd Government’s first year in office would be by the flurry of inquiries and reports that it commissioned. Three related to gender equality. The Productivity Commission conducted an inquiry into a national paid maternity, paternity and parental leave scheme and the House of Representatives Standing Committee on Employment and Workplace Relations conducted an inquiry into pay equity. This article is concerned with a third inquiry — the Senate Standing Committee on Legal and Constitutional Affairs (the committee) inquiry into the effectiveness of the Sex Discrimination Act 1984 (Cth) (SDA) in eliminating discrimination and promoting gender equality. These inquiries were not the Rudd Government’s only activities in relation to sex discrimination and gender equality. It also enacted legislation which removed discrimination against same sex couples from 68 Commonwealth laws and announced its intention to accede to the Optional Protocol to the International Convention on the Elimination of All Forms of Discrimination against Women.