Melbourne School of Population and Global Health - Research Publications
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ItemSexual identity or religious freedom: could conversion therapy ever be morally permissible in limited urgent situations?(SPRINGER HEIDELBERG, 2021-07)Conversion therapy refers to a range of unscientific, discredited and harmful heterosexist practices that attempt to re-align an individual's sexual orientation, usually from non-heterosexual to heterosexual. In Australia, the state of Victoria recently joined Queensland and the Australian Capital Territory in criminalising conversion therapy. Although many other jurisdictions have also introduced legislation banning conversion therapy, it persists in over 60 countries. Children are particularly vulnerable to the harmful effects of conversion therapy, which can include coercion, rejection, isolation and blame. However, if new biotechnologies create safe and effective conversion therapies, the question posed here is whether it would ever be morally permissible to use them. In addressing this question, we need to closely examine the individual's circumstances and the prevailing social context in which conversion therapy is employed. I argue that, even in a sexually unjust world, conversion therapy may be morally permissible if it were the only safe and effective means of relieving intense anguish and dysphoria for the individual. The person providing the conversion therapy must be qualified, sufficiently independent from any religious organisation and must provide conversion therapy in a way that is positively affirming of the individual and their existing sexuality.
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ItemHearing Parents' Voices: Parental Refusal of Cochlear Implants and the Zone of Parental Discretion(SPRINGER, 2022-03)It has been forty years since the first multi-channel cochlear implant was used in Australia. While heralded in the hearing world as one of the greatest inventions in modern medicine, not everyone reflects on this achievement with enthusiasm. For many people in the Deaf community, they see the cochlear implant as a tool that reinforces a social construct that pathologizes deafness and removes Deaf identity. In this paper, I set out the main arguments for and against cochlear implantation. While I conclude that, on balance, cochlear implants improve the well-being and broaden the open futures of deaf children, this does not justify mandating implants in circumstances where parents refuse them because this may compound unintended harms when society interferes in the parent-child relationship. For this reason, I argue that parental refusal of cochlear implantation falls within Gillam's concept of the zone of parental discretion.
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ItemIdentifying the Patterns of Family Contact for Children in Care(ROUTLEDGE JOURNALS, TAYLOR & FRANCIS LTD, 2022-01-02)Contact between children in care and family members is complex and often emotionally difficult for all concerned. In the context of a wider Australian cross-jurisdictional intervention trial, focusing on contact between children in long-term care and their parents, a snapshot survey of 901 children in Victorian foster care and kinship care placements was undertaken. The aim was to determine which children had seen parents, siblings or extended family members within a 12-month period, and how practitioners explained lack of contact between children and their parents. The study found that most children had had contact with parents or other family members, though children in long-term care were less likely to have seen their parents than those where reunification was still a possibility. Practitioners’ views on why parental contact had not occurred for 18% of the sample illustrate the complexity of the issues involved in contact. IMPLICATIONS To support children’s best interests, professionals should be clear about the purpose of family contact and provide support appropriate to that purpose. With children in long-term care less likely to see their parents, professionals have a role in helping these parents adjust to a new role. Developing strategies to maintain meaningful connections between children in long-term care and their parents may be more effective for children’s best interests than the current emphasis on actual visits.
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ItemDecision-making of municipal urban forest managers through the lens of governance(ELSEVIER SCI LTD, 2020-02)Awareness of the benefits of urban trees has led many cities to develop ambitious targets to increase tree numbers and canopy cover. Policy instruments that guide the planning of cities recognize the need for new governance arrangements to implement this agenda. Urban forests are greatly influenced by the decisions of municipal managers, but there is currently no clear understanding of how municipal managers find support to implement their decisions via new governance arrangements. To fill this knowledge gap, we collected empirical data through interviews with 23 urban forest municipal managers in 12 local governments in Greater Melbourne and regional Victoria, Australia, and analysed these data using qualitative interpretative methods through a governance lens. The goal of this was to understand the issues and challenges, stakeholders, resources, processes, and rules behind the decision-making of municipal managers. Municipal managers said that urban densification and expansion were making it difficult for them to implement their strategies to increase tree numbers and canopy cover. The coordination of stakeholders was more important for managers to find support to implement their decisions than having a bigger budget. The views of the public or wider community and a municipal government culture of risk aversion were also making it difficult for municipal managers to implement their strategies. Decision-making priorities and processes were not the same across urban centres. Lack of space to grow trees in new developments, excessive tree removal, and public consultation, were ideas more frequently raised in inner urban centres, while urban expansion, increased active use of greenspaces, and lack of data/information about tree assets were concerns for outer and regional centres. Nonetheless, inter-departmental coordination was a common theme shared among all cities. Strengthening coordination processes is an important way for local governments to overcome these barriers and effectively implement their urban forest strategies.
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ItemNo Preview AvailableNeospora caninum is not an important contributor to poor reproductive performance of primiparous ewes from southern Australia: evidence from a cross-sectional study(Springer, 2021-10-02)Neospora caninum has been implicated as a sporadic cause of abortion and perinatal deaths in sheep flocks globally. However, its significance as a reproductive pathogen for sheep in Australia remains unknown. The aims of this study were to (i) determine the seroprevalence of N. caninum in Australian breeding ewes and (ii) examine if natural exposure to N. caninum is associated with poor reproductive performance of primiparous ewes in southern Australia. Thirty flocks of primiparous ewes (aged 1–2 years old at lambing) from 28 farms in three states (Western Australia, South Australia and Victoria) were monitored between mating and lamb marking. Blood samples were also collected from multiparous mature ewes (aged 3 years or older) at each farm. Seroprevalence for anti-N. caninum IgG using indirect ELISA was determined for a subset of primiparous ewes that were predominantly determined to be pregnant and subsequently failed to rear a lamb (n = 1279) and randomly selected mature multiparous ewes with unknown reproductive status (n = 558). Neopsora caninum apparent seroprevalence was 0.16% (95% confidence interval 0.03%, 0.5%) in primiparous ewes, with seropositivity identified in two ewes from farms located in South Australia and Victoria. There was no evidence of seropositivity in mature ewes with apparent seroprevalence 0% (0%, 0.45%). These findings suggest that N. caninum infection was not widespread in primiparous ewes or mature multiparous ewes on these farms, and exposure to N. caninum infection was unlikely to explain abortion and perinatal mortalities observed for primiparous ewes.
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ItemNo Preview AvailableThe role of animal welfare in improving the future of farming(CSIRO Publishing, 2022)Context: Animal production plays a critical role in many global challenges around sustainability, including climate change and resilience, One Health and food security. With this role comes pressures on livestock welfare. Aims: This paper demonstrates key contributions animal welfare makes to global sustainability challenges. Methods: This paper highlights ‘win–win’ improvements for both animal welfare and other aspects of sustainability by using the following four case studies: tail docking Australian sheep, agroforestry systems in Ethiopia, the Australian dairy-beef industry, and strategic feeding of goats in Pakistan. Key results: These case studies show how animal welfare can be improved alongside livelihoods. However, even in these win–win situations, the adoption of improved practices is not guaranteed. Conclusions: Long-term, sustained change in animal welfare can simultaneously make in roads to other challenges around sustainability. To do this, we must have a broader understanding of the system in which the animals are raised, so that barriers to change can be identified. Implications: Lessons from these case studies can be applied to other production contexts and challenges, highlighting the universal value of understanding and addressing animal welfare.
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ItemCharacteristics and outcomes of children receiving intensive care therapy within 12 hours following a medical emergency team event(AUSTRALASIAN MED PUBL CO LTD, 2021-09)Objectives: To describe characteristics and outcomes of children requiring intensive care therapy (ICT) within 12 hours following a medical emergency team (MET) event. Design: Retrospective cohort study. Setting: Quaternary paediatric hospital. Patients: Children experiencing a MET event. Measurements and main results: Between July 2017 and March 2019, 890 MET events occurred in 566 patients over 631 admissions. Admission to intensive care followed 183/890 (21%) MET events. 76/183 (42%) patients required ICT, defined as positive pressure ventilation or vasoactive support in intensive care, within 12 hours. Older children had a lower risk of requiring ICT than infants aged < 1 year (age 1-5 years [risk difference, -6.4%; 95% CI, -11% to -1.6%; P = 0.01] v age > 5 years [risk difference, -8.0%; 95% CI, -12% to -3.8%; P < 0.001]), while experiencing a critical event increased this risk (risk difference, 16%; 95% CI, 3.3-29%; P = 0.01). The duration of respiratory support and intensive care length of stay was approximately double in patients requiring ICT (ratio of geometric means, 2.0 [95% CI, 1.4-3.0] v 2.1 [95% CI, 1.5-2.8]; P < 0.001) and the intensive care mortality increased (risk difference, 9.6%; 95% CI, 2.4-17%; P = 0.01). Heart rate, oxygen saturation and respiratory rate were the most commonly measured vital signs in the 6 hours before the MET event. Conclusions: Approximately one-fifth of MET events resulted in intensive care admission and nearly half of these required ICT within 12 hours. This group had greater duration of respiratory support, intensive care and hospital length of stay, and higher mortality. Age < 1 year and a critical event increased the risk of ICT.
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ItemThink Big: A multinational collaboration to promote children's role as coresearchers in participatory research(Wiley, 2022-06)The field of participatory research with children developed largely thanks to shared learning between different cultures, places, and disciplines. However, grand narratives and power relationships in academia inherited from colonialism and imperialism can threaten to obstruct the transformative value of this approach. In this article, we present the case of Think Big, a multinational collaboration for participatory research with children that involved adult and child coresearchers from Australia, Chile, Colombia, and the United Kingdom. Our aim was to explore how this project helped build solidarities between adult researchers from different countries and disciplines. We applied a methodology of diffraction to explore the processes and outcomes of this collaboration and presented our insights using the metaphor of a tree to explain the roots (knowledges and frameworks), trunk (ongoing collaboration and communication between the teams from different countries), branches (local projects), and fruits (research outcomes) of our work. Based on our experience, we proposed that multinational collaborations for participatory research offer important opportunities for adult researchers to collaborate with children to generate more democratic knowledge about their lives and to generate more egalitarian relationships between adult researchers from different places and backgrounds. However, it is important to anticipate that multinational collaborations are more likely to be affected by social and political upheavals, and language barriers must be overcome to decentralize academia. Also, the organizations involved in these collaborations need to develop strategies that facilitate funding, ethics clearance, and international research agreements.
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ItemNo Preview AvailableThe impact of built and social environmental characteristics on incidence and estimated risk of dementia(Wiley, 2021-12)Background Dementia is a public health priority1 and the current study designed to investigate associations between built and social environmental characteristics and dementia incidence, and the estimated future risk of dementia. Further we investigated spatial variations in dementia risk and dementia incidence to identify unmet areas for policy intervention. Method We used 25,511 patients (aged 65 years and older) records in Adelaide between 2011‐2015. In addition to dementia incidence, we calculated a dementia risk score based on risk and protective factors for patients not diagnosed with dementia. The following built and social environment exposures were estimated for each statistical area level 1 (SA1)2: social fragmentation, nitrogen dioxide (NO2), public open spaces, walkability, socio‐economic status and the length of main roads. We performed multilevel regression analyses to allow for the hierarchical nature of the data and applied spatial cluster analysis to identify areas with high and low risk of dementia. Result We found that a one standard deviation (SD) increase in NO2 and walkability score was associated with 10% higher odds of any versus no dementia (95% confidence interval (CI): 1%, 21% for NO2 and 0%, 22% for walkability score). For estimated future risk of dementia, a 1‐SD increase in social fragmentation (mobility component) and NO2 was associated with a 1% increase in dementia risk (95% CI: 0, 1%). 1‐SD increases in public open space and socioeconomic status were associated with 3% (95% CI: 0.95, 0.98) and 1% decreases (95% CI: 0.98, 0.99) in dementia risk, respectively. There was spatial heterogeneity in the pattern of dementia incidence and dementia risk. Conclusion Associations of neighbourhood NO2 level, walkability, public open space and social fragmentation with dementia incidence and estimated future risk of dementia were statistically significant, indicating the potential to reduce the risk through changes in built and social environments. Mapping the estimated future risk of dementia and diagnosed cases of dementia offers a novel approach to identifying areas of unmet need. 1. Towards a dementia plan: a WHO guide. Geneva: WHO; 2018. 2. Australian Statistical Geography Standard (ASGS): Volume 1 ‐ Main Structure and Greater Capital City Statistical Areas, 2016.
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ItemNo Preview AvailableExtracellular vesicular lipids as biomarkers for the diagnosis of Alzheimer’s disease(Wiley, 2021-12-31)An increasing number of studies have revealed that dysregulated lipid homeostasis is associated with the pathological processes that lead to Alzheimer’s disease (AD). If changes in key lipid species could be detected in the periphery, it would advance our understanding of the disease and facilitate biomarker discovery. Global lipidomic profiling of sera/blood however has proved challenging with limited disease or tissue specificity. Small extracellular vesicles (EV) in the central nervous system, can pass the blood-brain barrier and enter the periphery, carrying a subset of lipids that could reflect lipid homeostasis in brain. This makes EVs uniquely suited for peripheral biomarker exploration.