Occupational class differences in suicide: evidence of changes over time and during the global financial crisis in Australia

BACKGROUND: Previous research showed an increase in Australian suicide rates during the Global Financial Crisis (GFC). There has been no research investigating whether suicide rates by occupational class changed during the GFC. The aim of this study was to investigate whether the GFC-associated increase in suicide rates in employed Australians may have masked changes by occupational class.

METHODS: Negative binomial regression models were used to investigate Rate Ratios (RRs) in suicide by occupational class. Years of the GFC (2007, 2008, 2009) were compared to the baseline years 2001-2006.

RESULTS: There were widening disparities between a number of the lower class occupations and the highest class occupations during the years 2007, 2008, and 2009 for males, but less evidence of differences for females.

CONCLUSIONS: Occupational disparities in suicide rates widened over the GFC period. There is a need for programs to be responsive to economic downturns, and to prioritise the occupational groups most affected.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013

Background: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Methods: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian metaregression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. Findings: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. Interpretation: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

Suicide among male road and rail drivers in Australia: A retrospective mortality study

Objectives: This paper aims to describe the epidemiology of suicide among males employed in driving occupations (road and rail) compared to other male occupations in Australia. Methods: Suicide cases among road and rail drivers were extracted from a national dataset of occupationally coded suicide cases for the period 2001 to 2010. Suicide rates per 100 000 were calculated and standardised using the Australian standard population (2001). Incidence rate ratios (IRR) with 95% confidence intervals were calculated using Mantell Haenszel rates and compared to all employed suicide cases. Results: The majority of suicides in this occupational category occurred in truck drivers, followed by road and rail drivers. 98% of these suicides were among males; hence only males were included in further analyses. The age-standardised rate of male suicide among Road and Rail drivers over the period 2001 to 2010 was 22.6 per 100 000 (95% CI 19.2 to 25.9). The IRR of suicide in this occupational group compared to other male occupations was 1.42 (95% CI 1.26 to1.60). Conclusions: Suicide among Road and Rail drivers is higher than in the other male occupations. Suicide prevention initiatives addressing these risk factors, while also providing access to treatment for those at risk, are clearly needed.

Yield, growth and mortality rate of the Thai river sprat, Clupeichthys aesarnensis, in Sirinthorn Reservoir, Thailand

The Thai river sprat, Clupeichthys aesarnensis Wongratana, is a clupeid with a short life span, and supports artisanal fisheries in a number of reservoirs in the Mekong Basin. The growth parameters, mortality rates and the status of the Thai river sprat in Sirinthorn Reservoir (28 800 ha), NE Thailand (15°N; 105°E), are presented. The fishery is based on lured lift-nets, operated 7–14 days in the new moon period, September to April each year. It was shown that the von Bertalanffy growth function (VBGF) model was L_t (mm) = 78.43[1 − exp{−0.211[t − (−0.7996)]}] and its growth conformed to an isometric pattern. Natural mortality rate (month−¹) was 0.13 month−¹. Total mortality rates ranged from 0.69 to 1.53 month−¹ depending on the weather and the fishing season. Recruitment was continuous throughout the year but peaked in June and July. The yield per recruit model indicated that the exploitation rate of this fishery is probably too high.

Building health promoting work settings : identifying the relationship between work characteristics and occupational stress in Australia

Occupational stress is a serious threat to the health of individual workers, their families and the community at large. The settings approach to health promotion offers valuable opportunities for developing comprehensive strategies to prevent and reduce job stress. However, there is evidence that many workplace health promotion programs adopt traditional, lifestyle-oriented strategies when dealing with occupational stress, and ignore the impact that the setting itself has on the health of employees. The aim of the present study was to address two of the barriers to adopting the settings approach; namely the lack of information on how psycho-social work characteristics can influence health, and not having the confidence or knowledge to identify or address organizational-level issues. A comprehensive occupational stress audit involving qualitative and quantitative research methods was undertaken in a small- to medium-sized public sector organization in Australia. The results revealed that the work characteristics ‘social support’ and ‘job control’ accounted for large proportions of explained variance in job satisfaction and psychological health. In addition to these generic variables, several job-specific stressors were found to be predictive of the strain experienced by employees. When coupled with the results of other studies, these findings suggest that work characteristics (particularly control and support) offer valuable avenues for creating work settings that can protect and enhance employee health. The implications of the methods used to develop and complete the stress audit are also discussed.

The meaning of professional excellence for private practitioners in occupational therapy

OT AUSTRALIA's Accredited Occupational Therapist Program is promoted using the message 'Assuring professional excellence'. It is widely assumed that professional excellence is understood. Yet, this concept encompasses complex themes, including competence and clinical reasoning. In this paper, the meaning of professional excellence is examined by investigating the perspectives of private practitioners. Private practitioners were chosen as they represent the diversity of the occupational therapy field, and may pre-empt trends within broader practice. Sixteen key informants were interviewed to obtain their perspectives on professional excellence. Common themes that arose from the findings include the significance of experience in practice, and the importance of understanding one's limitations in knowledge and expertise. Findings are discussed in relation to OT AUSTRALIA's aim to assure standards of practice.

Some care, little responsibility? Promoting directors'and managers' legal accountability for Occupational Health and Safety in the workplace

Health and safety at work remains a serious and under-recognised problem in Australia. This paper argues for the importance of increasing the individual responsibility and accountability of senior managers and directors of corporations for the development and maintenance of occupational health and safety (OHS) standards in the workplace. In order to do so, the paper first sets out the range of statutory and general law duties and liabilities to which directors and senior managers are subject, considers to what extent these obligations have relevance in the OHS area and argues for the extension of these duties and liabilities in some circumstances. The paper then goes on to argue for a better legislative model for the legal responsibility of managers and officers, supported by the increased prosecution of individuals in appropriate circumstances, as well as acknowledging the benefits of a broader range of non-legal strategies to improve board level commitment to OHS that will influence corporate compliance overall.

Not quite a brave new world: Victoria's occupational health and safety Act 2004

This article provides a concise overview ofthe Victoria's new Occupational Health and Safety Act 2004 ("OHSA 2004"). After outlining the Maxwell Report on which much ofthe OHSA 2004 is based, the article examines the principal legislative provisions of the Act, especially those that differ from the Occupational Health and Safety Act 1985 (Vic) ("1985 Act"). Analysis of the legislation evaluates some positive developments, as well as suggests amendments. Although the OHSA 2004 contains numerous alterations in its scheme as compared to the 1985 Act, these changes are unlikely to usher in a brave new world of occupational health and safety regulation in Victoria

Food insecurity, malnutrition and mortality in Maewo and Ambae islands, Vanuatu

Context: This paper reports on findings from the ex-post evaluation of the Maewo Capacity Building project in Maewo Island, Vanuatu, which was funded by World Vision Australia.
Objectives: To examine the extent to which the infrastructure and systems left behind by the project contributed to the improvement of household food security and health and nutritional outcomes in Maewo Island, using Ambae Island as a comparator.
Setting: Two-stage cluster survey conducted from 6 to 20 July 2004, which included anthropometric measures and 4.5-year retrospective mortality data collection.
Participants: A total of 406 households in Maewo comprising 1623 people and 411 households in Ambae comprising 1799 people.
Main outcome measures: Household food insecurity, crude mortality rate (CMR), under-five mortality rate (U5MR) and malnutrition prevalence among children.
Results: The prevalence of food insecurity without hunger was estimated at 15.3%
(95% confidence interval (CI): 12.1, 19.2%) in Maewo versus 38.2% (95% CI: 33.6, 43.0%) in Ambae, while food insecurity with hunger in children did not vary by location. After controlling for the child’s age and gender, children in Maewo had higher weight-for-age and height-for-age Z-scores than children of the same age in Ambae. The CMR was lower in Maewo (CMR ¼ 0.47/10 000 per day, 95% CI: 0.39, 0.55) than in Ambae (CMR ¼ 0.59/10 000 per day, 95% CI: 0.51, 0.67) but no difference existed in U5MR. The major causes of death were similar in both locations, with frequently reported causes being malaria, acute respiratory infection and
diarrhoeal disease.
Conclusions: Project initiatives in Maewo Island have reduced the risks of mortality and malnutrition. Using a cross-sectional ‘external control group’ design, this paper demonstrates that it is possible to draw conclusions about project effectiveness where baseline data are incomplete or absent. Shifting from donor-driven evaluations to impact evaluations has greater learning value for the organisation, and greater value when reporting back to the beneficiaries about project impact and transformational
development in their community. Public health nutritionists working in the field are well versed in the collection and interpretation of anthropometric data for evaluation of nutritional interventions such as emergency feeding programmes. These same skills can be used to conduct impact evaluations, even some time after project completion, and elucidate lessons to be learned and shared. These skills can also be applied more widely to projects which impact on the longer-term nutritional status of
communities and their food security.

Mortality, malnutrition and the humanitarian response to the food crises in Lesotho

Background: At the height of the food crisis in southern Africa, the Government of Lesotho declared a state of famine and emergency in April 2002 and launched a Famine Relief Appeal for over $137 million. World Vision, in partnership with the World Food Program, became involved in December 2002 providing food aid to affected communities.
Objective: to document mortality rates, causes of death, malnutrition prevalence, and the proportion of lost pregnancies after almost three years of humanitarian response to the food crisis in Lesotho and to propose a way forward.
Design: A two-stage, 30 cluster household survey was undertaken in three districts from the 16th to the 26th of May 2005, with a sample size of 3610 people.
Results: The crude mortality rate (CMR) of 0.8/10,000/day (95%CI: 0.7-0.9). The reported CMR was significantly lower than the CMR emergency threshold (<1/10,000/day). Using 2000 as a pre-drought baseline, 38528 excess deaths occurred between 2000 and 2005. The under-five mortality rate (U5MR) of 3.2 deaths/10,000/day (95%CI: 2.8-3.6/10,000/day) was 4 times the reported CMR and 1.4 times higher the U5MR emergency threshold for sub-Saharan Africa (2.3/10,000/day). CMR was lower among food aid beneficiaries (0.68; 95%CI: 0.57-0.79) than non-beneficiaries (1.42; 95%CI: 1.13-1.70). This was also true for U5MR (2.94; 95%CI: 2.39-3.50 versus 6.44; 95%CI: 5.21-7.68). The prevalence of wasting increased from 5.4% to 12% while that of stunting declined from 45.4% to 36.2% between 2000 and 2005, but the nutritional status did not vary by beneficiary status.
Conclusion: Despite the alarming U5MR, findings suggest that the food aid program ensured survival mainly among adults. The situation could have been catastrophic in the absence of humanitarian assistance.

Professional competence for private practitioners in occupational therapy

The aim of the present study was to investigate the meaning of professional competence for occupational therapy private practitioners and their experience of the barriers to professional competence. Semi-structured interviews with 16 key informants from private practice in Victoria elicited diverse opinions and experiences. However, the difficulty of assessing competence, and the lack of standards that identify competent practice for occupational therapy were major themes in the findings. The role of theory in competent practice was evident in discussion but it was not clearly articulated by many participants. Experiences of professional socialisation varied yet participants perceived input from peers as contributing to assuring competence. Major barriers to professional competence were identified as professional isolation, time and finances. The present study highlights the complexity of current attempts to assess professional competence for practising occupational therapists including the implementation of an accreditation program by The Australian Association of Occupational Therapists Inc. (OT AUSTRALIA), the peak body representing occupational therapists.

Death, mortality and religious diversity

Developed in partnership between the Immigration Museum and Deakin University, this exhibition examines how eight different groups in Victoria deal with death. It includes representatives of Moslem, Hindu, Christian (Catholic, Anglican, Greek Orthodox), Jewish, Buddhist faiths and those with no religion.