From 'White Australia' to 'part of Asia': recent shifts in Australian immigration policy towards the region.

PIP: This article examines migration policy in Australia with reference to the "White Australia" policy prior to 1975 and the multicultural policy thereafter. Mass immigration has not caused major social tensions. Mass tourism has been welcomed. Australian attitudes have changed from fear of massive numbers of Asians and mass poverty and ignorance to multiculturalism. Suspicious attitudes toward Asians, however, are still present among a minority of Australians. The most influential arguments against Asians are the concerns about employment of new arrivals and the environmental impact of an increasing population. Although there are many cultural differences, Australia is linked to Singapore, Malaysia, and the Philippines in that all have a history of British or American influence. Educated Indians and Sri Lankans are linked to Australians by their common language and Christian religion. The integration of Asians in the business and financial community holds the potential for economic gain over the years. The author finds that the Australian relationship to Asia is more acceptable in public arenas than the comparable changing relationship between Britain and Europe. The roots of a Whites-only policy extend back to 1901, when the Commonwealth Immigration Restriction Act was ratified. The exclusion of non-European immigrants was not specified in the law. The mechanism for exclusion was included in the law. Undesirable immigrants could be excluded. Under mass migration programs after 1947 the population of non-English speaking Europeans increased. By 1973 government shifted from an assimilationist approach to a multicultural approach due to pressure from the Department of Foreign Affairs. Numerous historical events occurring during 1942-80 drew Australia out of its isolationist position in the world. At present about 25% of the total population are of non-British origin. Over 900,000 would have been excluded under the old migration policy. In 1991, 665,315 persons were born in Asia, of which the largest numbers came from Mainland China, Malaysia, and the Philippines. Asian immigrants are either refugees from Viet Nam, Cambodia, and Laos or voluntary Asian immigrants.^ieng

Intensive education improves knowledge, compliance, and foot problems in type 2 diabetes.

Despite the established role of foot care education in diabetes management, reports evaluating such interventions are rare. The effectiveness of an intensive foot care intervention programme and a conventional one were therefore compared in Type 2 diabetes. The intensive group showed significantly greater improvements than the conventional group in foot care knowledge (p less than 0.001), compliance with the recommended foot care routine (p = 0.012), and compliance with the initial advice to consult a podiatrist (other than the project podiatrist) for further treatment (p = 0.008). At the first follow-up visit the intensive group also showed a significantly greater reduction in the number of foot problems requiring treatment than the conventional group.

Impact of intensive educational approach to dietary change in NIDDM.

The aim of this study was to compare the effects of an intensive educational approach incorporating longer time, greater simplicity, repetition, and cognitive motivational techniques with a conventional one in subjects with established non-insulin-dependent diabetes mellitus (NIDDM) whose weight, glycemic control, and diet were not optimal. Subjects were randomly allocated to intensive or conventional education. Of 350 subjects, 70 met the study criteria, which included established NIDDM (greater than or equal to 3 mo), suboptimal recent glycemic control, dietary fat intake greater than or equal to 35% of total energy intake, and body mass index greater than or equal to 25 kg/m2. The intensive approach was associated with significantly greater improvements in dietary compliance, dietary intake (complex carbohydrate, [P = 0.013], legumes [P less than 0.0001], fiber [P less than 0.0001], total fat [P less than 0.004], saturated fat [P less than 0.004]), and total cholesterol level (P = 0.007). The transient improvement in glycemic control was similar in both groups. An intensive education program can improve dietary compliance in established NIDDM subjects more than a conventional one. These recommended dietary improvements achieve better improvement in total cholesterol but do not necessarily improve glycemic control.

Supplementary iodine fails to reverse hypothyroidism in adolescents and adults with endemic cretinism.

The efficacy of supplemental iodine in correcting hypothyroidism in adults and older children with endemic myxedematous cretinism is not known. To investigate this issue we administered im iodized oil (1.5 mL) to 28 hypothyroid endemic cretins (TSH, greater than 5 mIU/L) from western China, aged 14-52 yr (mean = 29 SD = 11 yr). Clinical examination, intelligence testing (Hiskey Nebraska Test of Learning Aptitude and the Griffiths Mental Development Scales), and thyroid function tests were performed before and 6 months after iodine supplementation. We found that signs of thyroid hormone deficiency, dwarfism, and delayed sexual maturity persisted after iodine supplementation. Further, mental disability and other clinical features of neurological damage were not altered by treatment. The mean serum concentration of total T4 before treatment was 75 nmol/L (SD = 40) and fell after iodized oil administration to 56 nmol/L (SD = 29; P less than 0.001). Mean serum levels of TSH before and after iodine showed a paradoxical fall [85 mIU/L (SD = 102) and 46 mIU/L (SD = 46), respectively]. Serum TSH levels decreased into the normal range (less than 5 mIU/L) in only 1 of 28 patients (4%). We conclude that iodine supplementation does not reverse thyroid hormone deficiency or its sequelae in adolescents and adults with endemic myxedematous cretinism. Iodized oil in this age group of patients with endemic cretinism does not appear to be beneficial and should be used with caution.

Sexual desire, general arousability, and sexual dysfunction.

To determine the interrelationships among neuroticism, general arousability, sexual desire, and sexual dysfunction in women, two studies were conducted. The first found a significant positive correlation between general arousability and neuroticism. The second found a curvilinear relationship between general arousability and sexual dysfunction, and a negative correlation between levels of sexual desire and sexual dysfunction. Implications for therapy with sexually dysfunctional women are discussed.

Intercorrelations among general arousability, emerging and current sexual desire, and severity of sexual dysfunction in women.

Intercorrelations among general trait arousability, emerging sexual desire, current sexual desire, lack of sexual desire perceived as a problem, and sexual dysfunction were assessed in 65 women currently involved in marital or de facto heterosexual relationships. The Stimulus Screening Test was used to measure general arousability and the Assessment of Sexual Function and Dysfunction Questionnaire was used to measure emerging sexual desire, current sexual desire lack of sexual desire, and sexual dysfunction. Analysis showed that arousability was positively associated with current levels of sexual desire which was negatively associated with sexual dysfunction. There was a curvilinear relationship between arousability and sexual dysfunction, with women experiencing both high and low levels of arousability being more likely to score higher on measures of sexual dysfunction than those experiencing medium levels of arousal. The possible implications of these results are discussed.

Iodine deficiency impairs intellectual and neuromotor development in apparently-normal persons. A study of rural inhabitants of north-central China.

Intelligence was measured by means of the Hiskey-Nebraska Test of Learning Aptitude or the Griffiths Mental Development Scales in a sample of 369 patients from iodine-deficient rural villages (Baihuyao), iodine-sufficient rural villages (Huanglo) and urban populations to test for the damaging effects of iodine deficiency on the development of the nervous system in the presumed healthy section of a community. In urban school-children who were aged seven to 14 years (n = 78), a normal range of measured intelligence was found (mean +/- SD intelligence-quotient score, 107.0 +/- 18.3). By comparison, intelligence-quotient scores were lower in all rural cohorts (a rural suppression effect) but the distribution of intelligence-quotient scores showed a further shift to the left in the iodine-deficient township. In Baihuyaon villagers who were aged 30-35 years (n = 50), who were born during the period of severe iodine deficiency, 72% of villagers had an intelligence-quotient score of less than 70 compared with 41% (P less than 0.05) of villagers who were aged 28-35 years from Huanglo, a rural iodine-sufficient control group (n = 49). Although measured intelligence was higher in Baihuyaon children whose mothers had received iodized salt - 44% of seven- to 14-year-old children had intelligence-quotient scores of less than 70 (n = 141)--it remained significantly depressed compared with rural (n = 51) and urban (n = 78) control subjects (18% and 4%, respectively). These findings were consistent with other parameters (that is, the persistently-high rate of goitre), which indicated that the salt-iodization programme was inadequate. In the iodine-deficient village, lower intelligence-quotient scores showed a relationship with the detection by audiometry of nerve deafness and with the presence of abnormal neurological signs. The latter included spasticity and pyramidal signs which were of a similar pattern to the neurological deficits that have been demonstrated in overt neurological cretins. We conclude that iodine deficiency imposes a further suppressive effect on the intellectual performance of rural inhabitants, and results in a shift of the entire population distribution of cognitive skills to a lower level.

A comparative study of neurological and myxedematous endemic cretinism in western China.

Endemic cretinism occurs in areas of severe iodine deficiency and is manifested by two major clinical patterns, myxedematous and neurological. The relationship between these types and the factors responsible for the clinical variability are not clear. We examined 69 endemic cretins, aged 4-52 yr, categorized clinically at the beginning of the study into the three traditional types of endemic cretins, myxedematous (n = 25), neurological (n = 15), and the mixed form (n = 29), from a previously unreported endemia in Qinghai Province, China. These patients underwent detailed endocrine and neurological examination, including intelligence assessment using the Hiskey-Nebraska Test of Learning Aptitude or the Griffiths Mental Development Scales, audiometry (in a subset of 37 patients); thyroid function testing and thyroid ultrasonography; and radiology of the skull, hand, and hip. We found that categorization of the cretins into the conventional types did not reflect the pathophysiology of the condition, since an identical pattern and intensity of neurological, intellectual, and audiometric deficits were common to and equally present in all three types of endemic cretins regardless of their thyroid function. Gait disorder (in 99%) and pyramidal signs such as patellar hyper-reflexia (in 91%) were the most common neurological abnormalities. There was no difference in mean intelligence test scores among the three groups [overall mean intelligence score (Hiskey or Griffiths tests), 28.8 +/- 12.8 (SD)]. The differing clinical manifestations of cretinism could be explained by the length and severity of thyroid hormone deficiency. Myxedematous cretins were severely thyroid hormone deficient, and as a result sexually immature, dwarfed, and had retarded skeletal maturity. They had clinical and sonographic thyroid atrophy, rather than goiter. Although neurological cretins were euthyroid, linear growth arrest lines (demonstrated radiologically) in the long bones of these cretins suggested previous hypothyroidism. Furthermore, all cretins were growth retarded when compared with peers of similar age and race. Our data therefore suggest that the different clinical types of endemic cretinism are in fact the same disorder phenotypically modified by the length and severity of postnatal hypothyroidism. The neurological manifestations are interpreted as reflecting the effects of maternal and fetal hypothyroxinemia, secondary to severe iodine deficiency, on the developing nervous system.

Body shape perception and its disturbance in anorexia nervosa.

The perception of body shape was studied in 15 female patients with anorexia nervosa and 15 age matched controls. A lens was used which could be manipulated to cause a horizontal distortion of an image projected onto a video monitor. The patients showed a greater tendency to over- and under-estimate their present body shape than did the controls. Further, the patients' desired body shape was significantly thinner than that of controls, as was their estimation of what constitutes a normal body shape. These findings are discussed in relation to the literature and it is suggested that they may have important implications for treatment.

Change in unconscious concern with body image following treatment for obesity.

The Secord Homonym Test was used to elicit unconscious concerns about the body in one normal and two obese samples. The first sample of nonobese subjects was used to gather baseline data and also to examine the discriminant validity of the test as a measure of unconscious rather than conscious body concern. In a second sample of obese subjects a significantly greater concern with the body was observed. A third sample of obese subjects was tested before and after weight reduction counseling. Initial measures showed them to have similar levels of concern to the second sample; however, following treatment the levels matched those of the nonobese subjects.

Body percept change in obese females after weight reduction therapy.

Video-image representations of body size were measured on a television monitor that was modified to give a display continuum that ranged from 50% under- to 50% over-estimation of objective size. Sixty-eight females who were undergoing weight reduction counseling were measured before and after treatment. All Ss judged themselves to be significantly more obese than they actually were, with a tendency for errors to be greatest among the more obese Ss. After therapy, more realistic estimates of their physiques ensued. A drop-out rate of 23% was recorded; the drop-outs saw themselves as significantly more obese than those who graduated from the program.