Have the health services reoriented at all?

Recently, I had an opportunity to observe the workings of the health care system from the inside. I was admitted to a mixed surgical ward in an Australian public hospital with a mysterious ailment. My personal health required acute promotion.

My participant observation research demonstrated that the calls for action in the Ottawa Charter are still urgent. The Charter, twenty three years ago, stated

The responsibility for health promotion in health services is shared among individuals, community groups, health professionals, health service institutions and governments. They must work together towards a health care system which contributes to the pursuit of health.

The role of the health sector must move increasingly in a health promotion direction, beyond its responsibility for providing clinical and curative services. Health services need to embrace an expanded mandate which is sensitive and respects cultural needs. This mandate should support the needs of individuals and communities for a healthier life, and open channels between the health sector and broader social, political, economic and physical environmental components.

Reorienting health services also requires stronger attention to health research as well as changes in professional education and training. This must lead to a change of attitude and organization of health services which refocuses on the total needs of the individual as a whole person.

Jack of all trades, master of some ...or none? Training teachers in Integrated Arts

This article reports on the integration of music with other ‘Arts’ in teacher training at a South African university where a challenge tertiary educators face is how to successfully integrate music within the Arts and Culture learning area of the school education system. The article firstly provides a brief background to the South African educational context. Secondly, it outlines current practices in the in the implementation of the integrated arts curriculum in schools and teacher training. Thirdly, it discusses pertinent issues and challenges in relation to team teaching, integration and curriculum change in teacher training. Given the constraints and opportunities that universities currently experience, this article investigates and reports on the issue of whether students should be trained as Jack of all trades and master of some…or none or Master of one trade and Jack of some with regard to integrating the Arts.

All that is dark can become white: the rules of the game in Bend it Like Beckham

The “light” and uplifting film, Bend it Like Beckham (2002), is deconstructed to expose its passive ideologies that equate physical darkness with regressive cultural and social outlooks and practices. While Bend it Like Beckham constructs itself as a modern fairy tale of a girl achieving her dream of athletic opportunity and success (with a nice side-dish of romance), the film’s privileging of whiteness is both a cultural and a gendered norm that must be desired and achieved before that dream may come true.

The all for Australia league in New South Wales : a study in political entrepreneurship and hegemony

In 1931, the All for Australia League and other 'citizens movements' mounted a major challenge to the established conservative parties. Traditional views of the League saw it as a reflection of economic group interests, whether of the business establishment or dissident capitalists such as manufactures. More recent scholarship has stressed middle-class concerns with 'sound finance' as the inspiration of the League. This paper instead situates the League in the historical context of centre party projects in New South Wales, and of progressivism, in particular industrial psychology. The economic crisis and the rightward shift of the nationalists enabled a group of political entrepreneurs to transform the League from a front group for business into a populist movement. However, the shift of mainstream conservatism back to the political centre fatally undercut the League's support base.

Risk of cardiovascular and all-cause mortality in individuals with diabetes mellitus, impaired fasting glucose, and impaired glucose tolerance. The Australian Diabetes, Obesity and Lifestyle Study (AusDiab)

Background--Diabetes mellitus increases the risk of cardiovascular disease (CVD) and all-cause mortality. The relationship between milder elevations of blood glucose and mortality is less clear. This study investigated whether impaired fasting glucose and impaired glucose tolerance, as well as diabetes mellitus, increase the risk of all-cause and CVD mortality.

Methods and Results--In 1999 to 2000, glucose tolerance status was determined in 10 428 participants of the Australian Diabetes, Obesity, and Lifestyle Study (AusDiab). After a median follow-up of 5.2 years, 298 deaths occurred (88 CVD deaths). Compared with those with normal glucose tolerance, the adjusted all-cause mortality hazard ratios (HRs) and 95% confidence intervals (CIs) for known diabetes mellitus and newly diagnosed diabetes mellitus were 2.3 (1.6 to 3.2) and 1.3 (0.9 to 2.0), respectively. The risk of death was also increased in those with impaired fasting glucose (HR 1.6, 95% CI 1.0 to 2.4) and impaired glucose tolerance (HR 1.5, 95% CI 1.1 to 2.0). Sixty-five percent of all those who died of CVD had known diabetes mellitus, newly diagnosed diabetes mellitus, impaired fasting glucose, or impaired glucose tolerance at baseline. Known diabetes mellitus (HR 2.6, 95% CI 1.4 to 4.7) and impaired fasting glucose (HR 2.5, 95% CI 1.2 to 5.1) were independent predictors for CVD mortality after adjustment for age, sex, and other traditional CVD risk factors, but impaired glucose tolerance was not (HR 1.2, 95% CI 0.7 to 2.2).

Conclusions--This study emphasizes the strong association between abnormal glucose metabolism and mortality, and it suggests that this condition contributes to a large number of CVD deaths in the general population. CVD prevention may be warranted in people with all categories of abnormal glucose metabolism.

HOMA insulin sensitivity index and the risk of all-cause mortality and cardiovascular disease events in the general population : the Australian diabetes, obesity and lifestyle study (AusDiab) study

Aims/hypothesis We assessed whether the relationships between insulin sensitivity and all-cause mortality as well as fatal or non-fatal cardiovascular disease (CVD) events are independent of elevated blood glucose, high blood pressure, dyslipidaemia and body composition in individuals without diagnosed diabetes.
Methods Between 1999 and 2000, baseline fasting insulin, glucose and lipids, 2 h plasma glucose, HbA1c, anthropometrics, blood pressure, medication use, smoking and history of CVD were collected from 8,533 adults aged >35 years from the population-based Australian Diabetes, Obesity and Lifestyle study. Insulin sensitivity was estimated by HOMA of insulin sensitivity (HOMA-%S). Deaths and fatal or non-fatal CVD events were ascertained through linkage to the National Death Index and medical records adjudication.
Results After a median of 5.0 years there were 277 deaths and 225 CVD events. HOMA-%S was not associated with all-cause mortality. Compared with the most insulin-sensitive quintile, the combined fatal or non-fatal CVD HR (95% CI) for quintiles of decreasing HOMA-%S were 1.1 (0.6–1.9), 1.4 (0.9–2.3), 1.6 (1.0–2.5) and 2.0 (1.3–3.1), adjusting for age and sex. Smoking, CVD history, hypertension, lipid-lowering medication, total cholesterol and waist-to-hip ratio moderately attenuated this relationship. However, the association was rendered non-significant by adding HDL. Fasting plasma glucose, but not HOMA-%S significantly improved the prediction of CVD, beyond that seen with other risk factors.
Conclusions/interpretation In this cohort, HOMA-%S showed no association with all-cause mortality and only a modest association with CVD events, largely explained by its association with HDL. Fasting plasma glucose was a better predictor of CVD than HOMA-%S.

Is theism capable of accounting for any natural evil at all?

Received wisdom has it that a plausible explanation or theodicy for Gods permission of at least some instances of natural evil is not beyond the reach of the theist. In this paper I challenge this assumption, arguing instead that theism fails to account for any instance, kind, quantity, or distribution of natural evil found in the world. My case will be structured around a specific but not idiosyncratic conception of natural evil as well as an examination of three prominent theodicies for natural evil. In contrast, however, to much contemporary discussion, my assessment of these theodicies will be grounded in the prior conviction that a successful theodicy for moral evil is available.