Polycystic ovary syndrome (PCOS) is the most common female endocrine disorder, with many women initially presenting during adolescence. Diagnosis during this period is particularly challenging, yet many emphasize the importance of an early diagnosis given the long-term metabolic and reproductive health consequences associated with the syndrome. The objective of this study was to review the current literature to determine whether the diagnostic label 'PCOS' is necessary to effectively manage adolescent girls presenting with features of the syndrome. A literature search was conducted (PubMed, Medline, Informit Health and the Cochrane Database of Systematic Reviews) identifying papers addressing the diagnosis and management of PCOS during adolescence. Articles were selected based on date of publication, relevance of material and the quality of evidence presented. A total of 427 papers were screened, with 40 of these selected from the initial search. A subsequent 154 were included from manual review of reference lists from key papers identified in the initial search. Current guidelines recommend treating the individual manifestations of PCOS. In doing so, there is good evidence identifying that this approach adequately targets the underlying metabolic and reproductive changes associated with the syndrome. This suggests that providing a diagnostic label of PCOS is not actually necessary to effectively manage adolescent girls with features of this syndrome.
For adolescents with chronic illness, their perception of illness severity is an important indicator of psychosocial well-being. Physicians do not accurately infer their patients' perception of illness severity.
This article considers implications of the recent Love decision in the High Court for the debate about Indigenous constitutional recognition and a First Nations constitutional voice. Conceptually, it considers how the differing judgments reconcile the sui generis position of Indigenous peoples under Australian law with the theoretical ideal of equality—concepts which are in tension both in the judicial reasoning and in constitutional recognition debates. It also discusses the judgments’ limited findings on Indigenous sovereignty, demonstrating the extent to which this is predominantly a political question that cannot be adequately resolved by courts. Surviving First Nations sovereignty can best be recognised and peacefully reconciled with Australian state sovereignty through constitutional reform authorised by Parliament and the people. The article then discusses political ramifications. It argues that allegations of judicial activism enlivened by this case, rather than demonstrating the risks of a First Nations voice, in fact illustrate the foresight of the proposal: a First Nations voice was specifically designed to be non-justiciable and therefore intended to address such concerns. Similarly, objections that this case introduced a new, race-based distinction into the Constitution are misplaced. Such race-based distinctions already exist in the Constitution’s text and operation. The article then briefly offers high-level policy suggestions address two practical issues arising from Love. With respect to the three-part test of Indigenous identity, it suggests a First Nations voice should avoid the unjustly onerous burdens of proof that are perpetuated in some of the reasoning in Love. It also proposes policy incentives to encourage Indigenous non-citizens resident in Australia to seek Australian citizenship, helping to prevent threats of deportation that faced Love and Thoms.
Indigenous peoples in Chile have suffered dispossession and discrimination by colonizing forces, like many Indigenous peoples globally, and did not have a fair say in the development of successive constitutions establishing new political systems on their land. In the October 2020 referendum, Chileans voted to create a new constitution. This presents an opportunity for Indigenous peoples to create a fairer power relationship with the Chilean state. For the first time, the constitutional convention includes a specific quota for 17 Indigenous representatives. This will enable Indigenous peoples to contribute to the constitutional design process. This report presents comparative examples of self-determinative institutional mechanisms that empower Indigenous peoples to be heard by and influence decision making in state institutions. The focus of the paper is on options for institutional structures that enable Indigenous representation, participation and consultation with respect to Indigenous peoples’ own affairs.
This article analyses and explores the Uluru Statement from the Heart’s call for a constitutionally guaranteed First Nations voice in their affairs, as constitutional reform intended to address the ongoing problem of Indigenous constitutional vulnerability and powerlessness. It contends that a First Nations voice is a suitable solution: it coheres and aligns with Australian constitutional culture and design which recognises, represents and gives voice to the preexisting political communities, or constitutional constituencies. The article evaluates, compares and attempts to refine drafting options to give effect to a First Nations constitutional voice, by reference to principles of constitutional suitability, responsiveness to concerns about parliamentary supremacy and legal uncertainty, and assessment of political viability. The article concludes that the proposal for a constitutionally enshrined First Nations voice strikes the right conceptual balance between pragmatism and ambition, for viable yet worthwhile constitutional change. With appropriate constitutional drafting and legislative design, such a proposal offers a ‘modest yet profound’ way of meaningfully addressing Indigenous constitutional vulnerability, by empowering the First Nations with a voice in their affairs.
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