Wheeze, asthma diagnosis and medication use : a national adult survey in a developing country

Background As relatively little is known about adult wheeze and asthma in developing countries, this study aimed to determine the predictors of wheeze, asthma diagnosis, and current treatment in a national survey of South African adults. Methods A stratified national probability sample of households was drawn and all adults (>14 years) in the selected households were interviewed. Outcomes of interest were recent wheeze, asthma diagnosis, and current use of asthma medication. Predictors of interest were sex, age, household asset index, education, racial group, urban residence, medical insurance, domestic exposure to smoky fuels, occupational exposure, smoking, body mass index, and past tuberculosis. Results A total of 5671 men and 8155 women were studied. Although recent wheeze was reported by 14.4% of men and 17.6% of women and asthma diagnosis by 3.7% of men and 3.8% of women, women were less likely than men to be on current treatment (OR 0.6; 95% confidence interval (CI) 0.5 to 0.8). A history of tuberculosis was an independent predictor of both recent wheeze (OR 3.4; 95% CI 2.5 to 4.7) and asthma diagnosis (OR 2.2; 95% CI 1.5 to 3.2), as was occupational exposure (wheeze: OR 1.8; 95% CI 1.5 to 2.0; asthma diagnosis: OR 1.9; 95% CI 1.4 to 2.4). Smoking was associated with wheeze but not asthma diagnosis. Obesity showed an association with wheeze only in younger women. Both wheeze and asthma diagnosis were more prevalent in those with less education but had no association with the asset index. Independently, having medical insurance was associated with a higher prevalence of diagnosis. Conclusions Some of the findings may be to due to reporting bias and heterogeneity of the categories wheeze and asthma diagnosis, which may overlap with post tuberculous airways obstruction and chronic obstructive pulmonary disease due to smoking and occupational exposures. The results underline the importance of controlling tuberculosis and occupational exposures as well as smoking in reducing chronic respiratory morbidity. Validation of the asthma questionnaire in this setting and research into the pathophysiology of post tuberculous airways obstruction are also needed.

Estimating the burden of disease attributable to four selected environmental risk factors in South Africa

INTRODUCTION: The first South African National Burden of Disease study quantified the underlying causes of premature mortality and morbidity experienced in South Africa in the year 2000. This was followed by a Comparative Risk Assessment to estimate the contributions of 17 selected risk factors to burden of disease in South Africa. This paper describes the health impact of exposure to four selected environmental risk factors: unsafe water, sanitation and hygiene; indoor air pollution from household use of solid fuels; urban outdoor air pollution and lead exposure. METHODS: The study followed World Health Organization comparative risk assessment methodology. Population-attributable fractions were calculated and applied to revised burden of disease estimates (deaths and disability adjusted life years, [DALYs]) from the South African Burden of Disease study to obtain the attributable burden for each selected risk factor. The burden attributable to the joint effect of the four environmental risk factors was also estimated taking into account competing risks and common pathways. Monte Carlo simulation-modeling techniques were used to quantify sampling, uncertainty. RESULTS: Almost 24 000 deaths were attributable to the joint effect of these four environmental risk factors, accounting for 4.6% (95% uncertainty interval 3.8-5.3%) of all deaths in South Africa in 2000. Overall the burden due to these environmental risks was equivalent to 3.7% (95% uncertainty interval 3.4-4.0%) of the total disease burden for South Africa, with unsafe water sanitation and hygiene the main contributor to joint burden. The joint attributable burden was especially high in children under 5 years of age, accounting for 10.8% of total deaths in this age group and 9.7% of burden of disease. CONCLUSION: This study highlights the public health impact of exposure to environmental risks and the significant burden of preventable disease attributable to exposure to these four major environmental risk factors in South Africa. Evidence-based policies and programs must be developed and implemented to address these risk factors at individual, household, and community levels.

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.

The WIL (Work Integrated Learning) Report : A national scoping study [Australian Learning and Teaching Council (ALTC) Final report]

This report provides an account of the first large-scale scoping study of work integrated learning (WIL) in contemporary Australian higher education. The explicit aim of the project was to identify issues and map a broad and growing picture of WIL across Australia and to identify ways of improving the student learning experience in relation to WIL. The project was undertaken in response to high levels of interest in WIL, which is seen by universities both as a valid pedagogy and as a means to respond to demands by employers for work-ready graduates, and demands by students for employable knowledge and skills. Over a period of eight months of rapid data collection, 35 universities and almost 600 participants contributed to the project. Participants consistently reported the positive benefits of WIL and provided evidence of commitment and innovative practice in relation to enhancing student learning experiences. Participants provided evidence of strong partnerships between stakeholders and highlighted the importance of these relationships in facilitating effective learning outcomes for students. They also identified a range of issues and challenges that face the sector in growing WIL opportunities; these issues and challenges will shape the quality of WIL experiences. While the majority of comments focused on issues involved in ensuring quality placements, it was recognised that placements are just one way to ensure the integration of work with learning. Also, the WIL experience is highly contextualised and impacted by the expectations of students, employers, the professions, the university and government policy.

The arts and Australia's national innovation system 1994 - 2008 arguments, recommendations, challenges

Based on 15 years of arts and innovation literature, this paper explores the central proposition that the arts sector - particularly the performing arts, visual arts and crafts, new media arts and creative writing - should be included in Australian Government innovation policy development and play a significant role in national innovation. After a brief overview of innovation policy and the national innovation systems approach in Australia, we examine the marginal place of the arts in Australia's innovation agenda and various attempts to include them. We identify the principal voices that have argued for arts and innovation development: the humanities, arts and social sciences (HASS) sector, digital content industries, arts education and university research, and new media arts. After three main periods of arts and innovation policy activity from the mid.1990s (when the importance of innovation as a key driver of Australia's prosperity was recognised) to early 2008, a fourth period has opened up as part of the Australian Government's Review of the National Innovation System in 2008.

The whole world shook : shifts in ethnic, national and heroic identities in children's fiction about 9/11

Like many other cataclysmic events September 11, a day now popularly believed to have 'changed the world', has become a topic taken up by children's writers. This thesis, titled The Whole World Shook: Ethnic, National and Heroic Identities in Children's Fiction About 9/11, examines how cultural identities are constructed within fictional texts for young people written about the attacks on the Twin Towers. It identifies three significant identity categories encoded in 9/11 books for children: ethnic identities, national identities, and heroic identities. The thesis argues that the identities formed within the selected children's texts are in flux, privileging performances of identities that are contingent on post-9/11 politics. This study is located within the field of children's literature criticism, which supports the understanding that children's books, like all texts, play a role in the production of identities. Children's literature is highly significant both in its pedagogical intent (to instruct and induct children into cultural practices and beliefs) and in its obscurity (in making the complex simple enough for children, and from sometimes intentionally shying away from difficult things). This literary criticism informed the study that the texts, if they were to be written at all, would be complex, varied and most likely as ambiguous and contradictory as the responses to the attacks on New York themselves. The theoretical framework for this thesis draws on a range of critical theories including literary theory, cultural studies, studies of performativity and postmodernism. This critical framework informs the approach by providing ways for: (i) understanding how political and ideological work is performed in children's literature; (ii) interrogating the constructed nature of cultural identities; (iii) developing a nuanced methodology for carrying out a close textual analysis. The textual analysis examines a representative sample of children's texts about 9/11, including picture books, young adult fiction, and a selection of DC Comics. Each chapter focuses on a different though related identity category. Chapter Four examines the performance of ethnic identities and race politics within a sample of picture books and young adult fiction; Chapter Five analyses the construction of collective, national identities in another set of texts; and Chapter Six does analytic work on a third set of texts, demonstrating the strategic performance of particular kinds of heroic identities. I argue that performances of cultural identities constructed in these texts draw on familiar versions of identities as well as contribute to new ones. These textual constructions can be seen as offering some certainties in increasingly uncertain times. The study finds, in its sample of books a co-mingling of xenophobia and tolerance; a binaried competition between good and evil and global harmony and national insularity; and a lauding of both the commonplace hero and the super-human. Being a recent corpus of texts about 9/11, these texts provide information on the kinds of 'selves' that appear to be privileged in the West since 2001. The thesis concludes that the shifting identities evident in texts that are being produced for children about 9/11 offer implicit and explicit accounts of what constitute good citizenship, loyalty to nation and community, and desirable attributes in a Western post-9/11 context. This thesis makes an original contribution to the field of children's literature by providing a focussed and sustained analysis of how texts for children about 9/11 contribute to formations of identity in these complex times of cultural unease and global unrest.

Early years national curriculum documents : revisiting inclusive education

Early years education encompasses early childhood education and care (ECEC) and the early years of school across the age range birth to eight years. The introduction of two national curriculum documents for early years education – the Early Years Learning Framework (Department of Education, Employment and Workplace Relations DEEWR, 2009) for ECEC programs and the Australian Curriculum (Australian Curriculum, Assessment and Reporting Authority ACARA, 2011a) – indicates a trend towards national coherence, yet highlights a gap between notions of inclusion in the ECEC and school sectors of early years education. These gaps have the potential to impact negatively on school transition experiences through reductions in continuity of pedagogy and partnerships with families. Australian definitions of inclusion have moved beyond integration (i.e., mainstream classroom placement with support services and accommodations to address disability or lack of English), to encompass curricular and pedagogic differentiation catering for the participation rights and sense of belonging of children with a diverse range of abilities and backgrounds. This paper considers improved curriculum alignment and pedagogic continuity through enactment of elements relevant to inclusion.

Development of a climate assessment tool for hybrid air conditioner

Australian climate is highly suitable for using outdoor air for free building cooling. In order to evaluate the suitability of hybrid cooler for specific applications, a pre-design climate assessment tool is developed and presented in this paper. In addition to the consideration of the local climate, comfort zone proposed by ASHRAE handbook and specific design of building and operation of hybrid cooler, possible influence from environmental factors (e.g. air humidity and air velocity), as well as personal factors (e.g. activity level and clothing insulation) on occupant’s thermal comfort are also considered in this tool. It is demonstrated that with the input of climatic data for a particular location and the associated design data for a specific application, the developed climate assessment tool is able to not only sort outdoor air conditions into the different process regions but also project them onto the psychrometric chart. It can also be used to estimate the hours for an individual operational mode under various climate conditions and summarize them in a table “Results”.

The influence of internal load density on the energy and thermal performance of air-conditioned office buildings in the face of global warming

Internal heat sources may not only consume energy directly through their operation (e.g. lighting), but also contribute to building cooling or heating loads, which indirectly change building cooling and heating energy. Through the use of building simulation technique, this paper investigates the influence of building internal load densities on the energy and thermal performance of air conditioned office buildings in Australia. Case studies for air conditioned office buildings in major Australian capital cities are presented. It is found that with a decrease of internal load density in lighting and/or plug load, both the building cooling load and total energy use can be significantly reduced. Their effect on overheating hour reduction would be dependent on the local climate. In particular, it is found that if the building total internal load density is reduced from the base case of “medium” to “extra–low, the building total energy use under the future 2070 high scenario can be reduced by up to 89 to 120 kWh/m² per annum and the overheating problem could be completely avoided. It is suggested that the reduction in building internal load densities could be adopted as one of adaptation strategies for buildings in face of the future global warming.

Challenges in field monitoring of energy performance of air conditioners

Experimental work could be conducted in either laboratory or at field site. Generally, the laboratory experiments are carried out in an artificial setting and with a highly controlled environment. By contrast, the field experiments often take place in a natural setting, subject to the influences of many uncontrolled factors. Therefore, it is necessary to carefully assess the possible limitations and appropriateness of an experiment before embarking on it. In this paper, a case study of field monitoring of the energy performance of air conditioners is presented. Significant challenges facing the experimental work are described. Lessons learnt from this case study are also discussed. In particular, it was found that on-going analysis of the monitoring data and the correction of abnormal issues are two of the keys for a successful field test program. It was also shown that the installation of monitoring systems could have a significant impact on the accuracy of the data being collected. Before monitoring system was set up to collect monitoring data, it is recommended that an initial analysis of sample monitored data should be conducted to make sure that the monitoring data can achieve the expected precision. In the case where inevitable inherent errors were induced from the installation of field monitoring systems, appropriate remediation may need to be developed and implemented for the improved accuracy of the estimation of results. On-going analysis of monitoring data and correction of any abnormal issues would be the key to a successful field test program.