What explains the association between socioeconomic status and depression among Vietnamese adults?

Background Depression is a major public health problem worldwide and is currently ranked second to heart disease for years lost due to disability. For many decades, international research has found that depressive symptoms occur more frequently among low socioeconomic (SES) individuals than their more-advantaged peers. However, the reasons as to why those of low socioeconomic groups suffer more depressive symptoms are not well understood. Studies investigating the prevalence of depression and its association with SES emanate largely from developed countries, with little research among developing countries. In particular, there is a serious dearth of research on depression and no investigation of its association with SES in Vietnam. The aims of the research presented in this Thesis are to: estimate the prevalence of depressive symptoms among Vietnamese adults, examine the nature and extent of the association between SES and depression and to elucidate causal pathways linking SES to depressive symptoms Methods The research was conducted between September 2008 and November 2009 in Hue city in central Vietnam and used a combination of qualitative (in-depth interviews) and quantitative (survey) data collection methods. The qualitative study contributed to the development of the theoretical model and to the refinement of culturally-appropriate data collection instruments for the quantitative study. The main survey comprised a cross-sectional population–based survey with randomised cluster sampling. A sample of 1976 respondents aged between 25-55 years from ten randomly-selected residential zones (quarters) of Hue city completed the questionnaire (response rate 95.5%). Measures SES was classified using three indicators: education, occupation and income. The Center for Epidemiologic Studies-Depression (CES-D) scale was used to measure depressive symptoms (range0-51, mean=11.0, SD=8.5). Three cut-off points for the CES-D scores were applied: ‘at risk for clinical depression’ (16 or above), ‘depressive symptoms’ (above 21) and ‘depression’ (above 25). Six psychosocial indicators: life time trauma, chronic stress, recent life events, social support, self esteem, and mastery were hypothesized to mediate the association between SES and depressive symptoms. Analyses The prevalence of depressive symptoms were analysed using bivariate analyses. The multivariable analytic phase comprised of ordinary least squares regression, in accordance with Baron and Kenny’s three-step framework for mediation modeling. All analyses were adjusted for a range of confounders, including age, marital status, smoking, drinking and chronic diseases and the mediation models were stratified by gender. Results Among these Vietnamese adults, 24.3% were at or above the cut-off for being ‘at risk for clinical depression’, 11.9% were classified as having depressive symptoms and 6.8% were categorised as having depression. SES was inversely related to depressive symptoms: the least educated those with low occupational status or with the lowest incomes reported more depressive symptoms. Socioeconomicallydisadvantaged individuals were more likely to report experiencing stress (life time trauma, chronic stress or recent life events), perceived less social support and reported fewer personal resources (self esteem and mastery) than their moreadvantaged counterparts. These psychosocial resources were all significantly associated with depressive symptoms independent of SES. Each psychosocial factor showed a significant mediating effect on the association between SES and depressive symptoms. This was found for all measures of SES, and for males and females. In particular, personal resources (mastery, self esteem) and chronic stress accounted for a substantial proportion of the variation in depressive symptoms between socioeconomic groups. Social support and recent life events contributed modestly to socioeconomic differences in depressive symptoms, whereas lifetime trauma contributed the least to these inequalities. Conclusion This is the first known study in Vietnam or any developing country to systematically examine the extent to which psychosocial factors mediate the relationship between SES and depression. The study contributes new evidence regarding the burden of depression in Vietnam. The findings have practical relevance for advocacy, for mental health promotion and health-care services, and point to the need for programs that focus on building a sense of personal mastery and self esteem. More broadly, the work presented in this Thesis contributes to the international scientific literature on the social determinants of depression.

Unlocking risk allocation and equitable conversion : reform of the passing of risk in the sale of land

The principles relating to the passing of risk under a contract for the sale of real property would seem to have been long settled. The rule under the general law is that the risk of loss of the subject matter under a contract for the sale of real property passes to the buyer upon the creation of a valid and binding contract. This article considers the origin of that rule, how it developed with the growth of equity, and advances the view that it is anomalous in a modern context of property dealings. In doing so, the article adverts to the variety of statutory mechanisms used to subvert the rule, few of which are of practical value. It concludes that the rule is outmoded in many respects and suggests a number of reforms which might be implemented nationally to bring consistency and simplicity to the issue of damage or destruction of improvements which are the subject of a land contract.

Corporate, risk, mining camps and knowledge/power

Australia is currently in the midst of a major resources boom. However the benefits from the boom are unevenly distributed, with state governments collecting billions in royalties, and mining companies billions in profits. The costs are borne mostly at a local level by regional communities on the frontier of the mining boom, surrounded by thousands of men housed in work camps. The escalating reliance on non–resident workers housed in camps carries significant risks for individual workers, host communities and the provision of human services and infrastructure. These include rising rates of fatigue–related death and injuries, rising levels of alcohol–fuelled violence, illegally erected and unregulated work camps, soaring housing costs and other costs of living, and stretched basic infrastructure undermining the sustainability of these towns. But these costs have generally escaped industry, government and academic scrutiny. This chapter directs a critical gaze at the hopelessly compromised industry–funded research vital to legitimating the resource sector’s self–serving knowledge claims that it is committed to social sustainability and corporate responsibility. The chapter divides into two parts. The first argues that post–industrial mining regimes mask and privatise these harms and risks, shifting them on to workers, families and communities. The second part links the privatisation of these risks with the political economy of privatised knowledge embedded in the approvals process for major resource sector projects.

Bicycling injuries and perceived risk

Introduction Government promotion of active transport has renewed interest in cycling safety. Research has shown that bicyclists are up to 20 times more likely to be involved in serious injury crashes than drivers. On-road cycling injuries are under-reported in police data, and many non-serious injuries are not recorded in any official database. This study aims to explore the relationships between rider characteristics and environmental factors that influence per kilometre risk of bicycle-related crash and non-crash injuries. Method A survey of 2,532 Queensland adults who had ridden at least once in the past year was conducted from October 2009 to March 2010, with most responses received online (99.3%). Riders were asked where they rode (footpath, bike path, road etc.), average travel speed, purpose of riding, type of bike ridden, how far and how often they rode in. Measures of rider experience, skill, safety perceptions, safety behaviours, crash involvement and demographic characteristics were also collected. RESULTS Increasing exposure and having more expensive bicycles were shown to reduce the risk per km of crash and non-crash injury rates, and to reduce perceived risk. Never wearing bright coloured clothing related to increased crash risk, use of fluorescent and reflective clothing had no effect on crash risk. Riding in low-speed environments, never using a front light, and riding in low-speed environments were associated with reduced non-crash injury risk. Perceived risk was influenced by exposure, use of conspicuity aids and helmets, riding for utilitarian reasons, and group-riding behaviours. DISCUSSION Perceived risk does not appear to influence injury rates and injury rates do not appear to influence the perceived risk of cycling. Riders who perceive cycling to be risky tend not to be commuters, do not engage in group riding and always wear helmets. Not all measures of conspicuity were associated with risk, with rear lights found to have no relationship to injury. The risks of experiencing a crash or non-crash injury were similar, therefore injury prevention strategies should expand their scope to include other factors such as the importance of bicycle set-up.

Evaluation of the skills for preventing injury in youth program : impact on health risk behaviors, injury and school connectedness

Injury is the leading cause of death among young people, and involvement in health risk behaviors, such as alcohol use and transport-related risks, is related to increased risk for injury. Effective health promotion programs for adolescents focus on multiple levels, including relationships with peers and parents, student knowledge, behavior and attitudes, and school-level factors such as school connectedness. This study describes the pilot evaluation of a comprehensive, multi-level injury prevention program for 13-14 year old adolescents, targeting change in injury associated with transport and alcohol risks. The program, called Skills for Preventing Injury in Youth (SPIY), incorporates two primary elements: an 8-week, teacher delivered attitude and behavior change curriculum with peer protection and first aid messages; and professional development for program teachers focusing on strategies to increase students’ connectedness to school. Five Australian high schools were recruited for the pilot evaluation research, with three being assigned to receive intervention components and two assigned as curriculum-as-usual controls. In the intervention schools, 118 Year 8 students participated in surveys at baseline, with 105 completing surveys at follow up, six months following the intervention. In the control schools, 196 Year 8 students completed surveys at baseline and 207 at follow up. Survey measures included self-reported injury, risk taking behavior and school connectedness. Results showed that students in the control schools were significantly more likely to report riding bikes without helmets, riding with dangerous drivers, having driven cars on the road, and using alcohol six months after the program, while the intervention group showed no such increase in these behaviors. Additionally, students in the control schools were significantly more likely to report having had pedestrian-related injuries at follow up than they were at the baseline measurement, while intervention school students showed no change. There was also a trend observed in terms of a decrease in bicycle related injuries among intervention school students, compared with a slight increasing trend in bicycle injuries among control students. Overall, scores on the school connectedness scale decreased significantly from baseline to follow up for both intervention and control students, however measurement limitations may have impacted on results relating to students’ connectedness. Overall, the SPIY program has shown promising results in regards to prevention of students’ health risk behavior and injuries. Evidence suggests that the curriculum component was important; however there was limited evidence to suggest that teacher training in school connectedness strategies contributed to these promising results. While school connectedness may be an important factor to target in risk and injury prevention programs, programs may need to incorporate whole-of-school strategies or target a broader range of teachers than were selected for the current research.

Current research in risk-aware business process management : overview, comparison, and gap analysis

The management of risks in business processes has been a subject of active research in the past few years. Many benefits can potentially be obtained by integrating the two traditionally-separated fields of risk management and business process management, including the ability to minimize risks in business processes (by design) and to mitigate risks at run time. In the past few years, an increasing amount of research aimed at delivering such an integrated system has been proposed. However, these research efforts vary in terms of their scope, goals, and functionality. Through systematic collection and evaluation of relevant literature, this paper compares and classifies current approaches in the area of risk-aware business process management in order to identify and explain relevant research gaps. The process through which relevant literature is collected, filtered, and evaluated is also detailed.

Modelling port water collision risk using traffic conflicts

Navigational collisions are one of the major safety concerns for many seaports. Despite the extent of work recently done on collision risk analysis in port waters, little is known about the influencing factors of the risk. This paper develops a technique for modeling collision risks in port waterways in order to examine the associations between the risks and the geometric, traffic, and regulatory control characteristics of waterways. A binomial logistic model, which accounts for the correlations in the risks of a particular fairway at different time periods, is derived from traffic conflicts and calibrated for the Singapore port fairways. Estimation results show that the fairways attached to shoreline, traffic intersection and international fairway attribute higher risks, whereas those attached to confined water and local fairway possess lower risks. Higher risks are also found in the fairways featuring higher degree of bend, lower depth of water, higher numbers of cardinal and isolated danger marks, higher density of moving ships and lower operating speed. The risks are also found to be higher for night-time conditions.

Adolescent involvement in anti-social and delinquent behaviours : predicting future injury risk

The purpose of this study was to challenge the broadly based focus of injury prevention strategies towards concern with the needs of young adolescents who engage in multiple anti-social and delinquent behaviours. Five hundred and forty 13-14 year olds reported on injuries and truancy, violence, illegal road behaviours, drug, and alcohol use. Engagement in these behaviours was found to contribute to the likelihood of an injury. Those engaging in the most anti-social and delinquent behaviours were around five times more likely to report medically-treated injuries in the past three months. Their likelihood of future injury was 1.8 times more likely when they were followed up three months later. The engagement in multiple delinquent and illegal behaviours thus significantly increased the likelihood of injury and identifies a particularly vulnerable group. The findings also suggest that reaching these young people represents a key target for change strategies in injury prevention programs.

Students as advisors in an intervention program for at-risk students : The QUT experience

A managed team of discipline-experienced and trained later year students are used as Student Success Advisors (SSAs) in the Student Success Program, an intervention program that manages student engagement by identifying and supporting first year students at-risk of disengaging from learning. This report focuses on the recruitment and training of SSAs and the day-to-day challenges they and their managers face. The Nuts & Bolts session provides participants with opportunities to discuss the applicability to their institutional contexts of the recruitment and training processes and the “solutions” to the challenges used at QUT.

The relationship between chronic disease self-efficacy and nutritional status, functional ability and quality of life in older adults at risk of hospital readmission

Background and significance: Older adults with chronic diseases are at increasing risk of hospital admission and readmission. Approximately 75% of adults have at least one chronic condition, and the odds of developing a chronic condition increases with age. Chronic diseases consume about 70% of the total Australian health expenditure, and about 59% of hospital events for chronic conditions are potentially preventable. These figures have brought to light the importance of the management of chronic disease among the growing older population. Many studies have endeavoured to develop effective chronic disease management programs by applying social cognitive theory. However, limited studies have focused on chronic disease self-management in older adults at high risk of hospital readmission. Moreover, although the majority of studies have covered wide and valuable outcome measures, there is scant evidence on examining the fundamental health outcomes such as nutritional status, functional status and health-related quality of life. Aim: The aim of this research was to test social cognitive theory in relation to self-efficacy in managing chronic disease and three health outcomes, namely nutritional status, functional status, and health-related quality of life, in older adults at high risk of hospital readmission. Methods: A cross-sectional study design was employed for this research. Three studies were undertaken. Study One examined the nutritional status and validation of a nutritional screening tool; Study Two explored the relationships between participants. characteristics, self-efficacy beliefs, and health outcomes based on the study.s hypothesized model; Study Three tested a theoretical model based on social cognitive theory, which examines potential mechanisms of the mediation effects of social support and self-efficacy beliefs. One hundred and fifty-seven patients aged 65 years and older with a medical admission and at least one risk factor for readmission were recruited. Data were collected from medical records on demographics, medical history, and from self-report questionnaires. The nutrition data were collected by two registered nurses. For Study One, a contingency table and the kappa statistic was used to determine the validity of the Malnutrition Screening Tool. In Study Two, standard multiple regression, hierarchical multiple regression and logistic regression were undertaken to determine the significant influential predictors for the three health outcome measures. For Study Three, a structural equation modelling approach was taken to test the hypothesized self-efficacy model. Results: The findings of Study One suggested that a high prevalence of malnutrition continues to be a concern in older adults as the prevalence of malnutrition was 20.6% according to the Subjective Global Assessment. Additionally, the findings confirmed that the Malnutrition Screening Tool is a valid nutritional screening tool for hospitalized older adults at risk of readmission when compared to the Subjective Global Assessment with high sensitivity (94%), and specificity (89%) and substantial agreement between these two methods (k = .74, p < .001; 95% CI .62-.86). Analysis data for Study Two found that depressive symptoms and perceived social support were the two strongest influential factors for self-efficacy in managing chronic disease in a hierarchical multiple regression. Results of multivariable regression models suggested advancing age, depressive symptoms and less tangible support were three important predictors for malnutrition. In terms of functional status, a standard regression model found that social support was the strongest predictor for the Instrumental Activities of Daily Living, followed by self-efficacy in managing chronic disease. The results of standard multiple regression revealed that the number of hospital readmission risk factors adversely affected the physical component score, while depressive symptoms and self-efficacy beliefs were two significant predictors for the mental component score. In Study Three, the results of the structural equation modelling found that self-efficacy partially mediated the effect of health characteristics and depression on health-related quality of life. The health characteristics had strong direct effects on functional status and body mass index. The results also indicated that social support partially mediated the relationship between health characteristics and functional status. With regard to the joint effects of social support and self-efficacy, social support fully mediated the effect of health characteristics on self-efficacy, and self-efficacy partially mediated the effect of social support on functional status and health-related quality of life. The results also demonstrated that the models fitted the data well with relative high variance explained by the models, implying the hypothesized constructs under discussion were highly relevant, and hence the application for social cognitive theory in this context was supported. Conclusion: This thesis highlights the applicability of social cognitive theory on chronic disease self-management in older adults at risk of hospital readmission. Further studies are recommended to validate and continue to extend the development of social cognitive theory on chronic disease self-management in older adults to improve their nutritional and functional status, and health-related quality of life.

A risk simulation framework for information infrastructure protection

Information communication and technology (ICT) systems are almost ubiquitous in the modern world. It is hard to identify any industry, or for that matter any part of society, that is not in some way dependent on these systems and their continued secure operation. Therefore the security of information infrastructures, both on an organisational and societal level, is of critical importance. Information security risk assessment is an essential part of ensuring that these systems are appropriately protected and positioned to deal with a rapidly changing threat environment. The complexity of these systems and their inter-dependencies however, introduces a similar complexity to the information security risk assessment task. This complexity suggests that information security risk assessment cannot, optimally, be undertaken manually. Information security risk assessment for individual components of the information infrastructure can be aided by the use of a software tool, a type of simulation, which concentrates on modelling failure rather than normal operational simulation. Avoiding the modelling of the operational system will once again reduce the level of complexity of the assessment task. The use of such a tool provides the opportunity to reuse information in many different ways by developing a repository of relevant information to aid in both risk assessment and management and governance and compliance activities. Widespread use of such a tool allows the opportunity for the risk models developed for individual information infrastructure components to be connected in order to develop a model of information security exposures across the entire information infrastructure. In this thesis conceptual and practical aspects of risk and its underlying epistemology are analysed to produce a model suitable for application to information security risk assessment. Based on this work prototype software has been developed to explore these concepts for information security risk assessment. Initial work has been carried out to investigate the use of this software for information security compliance and governance activities. Finally, an initial concept for extending the use of this approach across an information infrastructure is presented.

Theoretical perspectives on motorcycle training: reducing risk taking

Little past empirical support has been found for the efficacy of motorcycle rider training as a road safety countermeasure. However, it has been argued that rider training should focus more particularly on the psychosocial factors that influence risk taking behaviour in addition to the traditional practice of developing vehicle-handling skills. This paper examines how rider training to reduce risk taking could be guided by appropriate theories. Two fundamental perspectives are examined: firstly training can be considered in terms of behaviour change, and secondly in terms of adult learning. Whilst behaviour change theories assume some pre-existing level of dysfunctional behaviour, an adult learning perspective does not necessarily carry this assumption. This distinction in perspectives conceptually aligns with the notions of intervention and prevention (respectively), with possible implications for specific target groups for pre-licence and post-licence training. The application of the Theory of Reasoned Action (Ajzen & Fishbein, 1975, 1980) and Transformative Learning Theory (Mezirow, 1997) to a pre-licence rider training program in Queensland, Australia is discussed.

Measuring the effect of motorcycle rider training on psychosocial influences for risk taking

Aim: Whilst motorcycle rider training is commonly incorporated into licensing programs in many developed nations, little empirical support has been found in previous research to prescribe it as an effective road safety countermeasure. It has been posited that the lack of effect of motorcycle rider training on crash reduction may, in part, be due to the predominant focus on skills-based training with little attention devoted to addressing attitudes and motives that influence subsequent risky riding. However, little past research has actually endeavoured to measure attitudinal and motivational factors as a function of rider training. Accordingly, this study was undertaken to assess the effect of a commercial motorcycle rider training program on psychosocial factors that have been shown to influence risk taking by motorcyclists. Method: Four hundred and thirty-eight motorcycle riders attending a competency-based licence training course in Brisbane, Australia, voluntarily participated in the study. A self-report questionnaire adapted from the Rider Risk Assessment Measure (RRAM) was administered to participants at the commencement of training, then again at the conclusion of training. Participants were informed of the independent nature of the research and that their responses would in no way effect their chance of obtaining a licence. To minimise potential demand characteristics, participants were instructed to seal completed questionnaires in envelopes and place them in a sealed box accessible only by the research team (i.e. not able to be viewed by instructors). Results: Significant reductions in the propensity for thrill seeking and intentions to engage in risky riding in the next 12 months were found at the end of training. In addition, a significant increase in attitudes to safety was found. Conclusions: These findings indicate that rider training may have a positive short-term influence on riders’ propensity for risk taking. However, such findings must be interpreted with caution in regard to the subsequent safety of riders as these factors may be subject to further influence once riders are licensed and actively engage with peers during on-road riding. This highlights a challenge for road safety education / training programs in regard to the adoption of safety practices and the need for behavioural follow-up over time to ascertain long-term effects. This study was the initial phase of an ongoing program of research into rider training and risk taking framed around Theory of Planned Behaviour concepts. A subsequent 12 month follow-up of the study participants has been undertaken with data analysis pending.