Postnatal depression in Central Vietnam

Postnatal depression (PND) is a significant global health issue, which not only impacts maternal wellbeing, but also infant development and family structures. Mental health disorders represent approximately 14% of global burden of disease and disability, including low and middle-income countries (LMIC), and PND has direct relevance to the Millennium Development Goals of reducing child mortality, improving maternal health, and creating global partnerships (United Nations, 2012; Guiseppe, Becker & Farmer, 2011). Emerging evidence suggests that PND in LMIC is similar to, or higher than in high-income countries (HIC), however, less than 10% of LMIC have prevalence data available (Fisher, Cabral de Mello, & Izutsu 2009; Lund et al., 2011). Whilst a small number of studies on maternal mental disorders have been published in Vietnam, only one specifically focuses on PND in a hospital-based sample. Also, community based mental health studies and information on mental health in rural areas of Vietnam is still scarce. The purpose of this study was to determine the prevalence of PND, and its associated social determinants in postnatal women in Thua Thien Hue Province, Central Vietnam. In order to identify social determinants relevant to the Central Vietnamese context, two qualitative studies and one community survey were undertaken. Associations between maternal mental health and infant health outcomes were also explored. The study was comprised of three phases. Firstly, iterative, qualitative interviews with Vietnamese health professionals (n = 17) and postpartum women (n = 15) were conducted and analysed using Kleinman's theory of explanatory models to identify narratives surrounding PND in the Vietnamese context (Kleinman, 1978). Secondly, a participatory concept mapping exercise was undertaken with two groups of health professionals (n = 12) to explore perceived risk and protective factors for postnatal mental health. Qualitative phases of the research elucidated narratives surrounding maternal mental health in the Vietnamese context such as son preference, use of traditional medicines, and the popularity of confinement practices such as having one to three months of complete rest. The qualitative research also revealed the construct of depression was not widely recognised. Rather, postpartum changes in mood were conceptualised as a loss of 'vital strength' following childbirth or 'disappointment'. Most women managed postpartum changes in mood within the family although some sought help from traditional medicine practitioners or biomedical doctors. Thirdly, a cross-sectional study of twelve randomly selected communes (six urban, six rural) in Thua Thien Hue Province was then conducted. Overall, 465 women with infants between 4 weeks and six months old participated, and 431 questionnaires were analysed. Women from urban (n = 216) and rural (n = 215) areas participated. All eligible women completed a structured interview about their health, basic demographics, and social circumstances. Maternal depression was measured using the Edinburgh Postnatal Depression Scale (EPDS) as a continuous variable. Multivariate generalised linear regression was conducted using PASW Statistics version 18.0 (2009). When using the conventional EPDS threshold for probable depression (EPDS score ~ 13) 18.1% (n = 78) of women were depressed (Gibson, McKenzie-McHarg, Shakespeare, Price & Gray, 2009). Interestingly, 20.4% of urban women (n = 44) had EPDS scores~ 13, which was a higher proportion than rural women, where 15.8% (n = 34) had EPDS scores ~ 13, although this difference was not statistically significant: t(429) = -0.689, p = 0.491. Whilst qualitative narratives identified infant gender and family composition, and traditional confinement practices as relevant to postnatal mood, these were not statistically significant in multivariate analysis. Rather, poverty, food security, being frightened of your husband or family members, experiences of intimate partner violence and breastfeeding difficulties had strong statistical associations. PND was also associated with having an infant with diarrhoea in the past two weeks, but not infant malnutrition or acute respiratory infections. This study is the first to explore maternal mental health in Central Vietnam, and provides further evidence that PND is a universally experienced phenomenon. The independent social risk factors of depressive symptoms identified such as poverty, food insecurity, experiences of violence and powerlessness, and relationship adversity points to women in a context of social suffering which is relevant throughout the world (Kleinman, Das & Lock, 1997). The culturally specific risk factors explored such as infant gender were not statistically significant when included in a multivariable model. However, they feature prominently in qualitative narratives surrounding PND in Vietnam, both in this study and previous literature. It appears that whilst infant gender may not be associated with PND per se, the reactions of close relatives to the gender of the baby can adversely affect maternal wellbeing. This study used a community based participatory research approach (CBPR) (Israel.2005). This approach encourages the knowledge produced to be used for public health interventions and workforce training in the community in which the research was conducted, and such work has commenced. These results suggest that packages of interventions for LMIC devised to address maternal mental health and infant wellbeing could be applied in Central Vietnam. Such interventions could include training lay workers to follow up postpartum women, and incorporating mental health screening and referral into primary maternal and child health care (Pate! et al., 2011; Rahman, Malik, Sikander & Roberts, 2008). Addressing the underlying social determinants of PND through poverty reduction and violence elimination programs is also recommended.

Changes to airborne pollen counts across Europe

A progressive global increase in the burden of allergic diseases has affected the industrialized world over the last half century and has been reported in the literature. The clinical evidence reveals a general increase in both incidence and prevalence of respiratory diseases, such as allergic rhinitis (common hay fever) and asthma. Such phenomena may be related not only to air pollution and changes in lifestyle, but also to an actual increase in airborne quantities of allergenic pollen. Experimental enhancements of carbon dioxide (CO) have demonstrated changes in pollen amount and allergenicity, but this has rarely been shown in the wider environment. The present analysis of a continental-scale pollen data set reveals an increasing trend in the yearly amount of airborne pollen for many taxa in Europe, which is more pronounced in urban than semi-rural/rural areas. Climate change may contribute to these changes, however increased temperatures do not appear to be a major influencing factor. Instead, we suggest the anthropogenic rise of atmospheric CO levels may be influential.

Impact of rain on daily bus ridership : a Brisbane case study

Weather is one of the most significant elements affecting transit ridership on a daily basis. Until now, there has been limited focus in the literature investigating this issue. Adverse weather conditions impact travellers in choosing travel mode and route, travel schedule, and trip making itself. This paper explores the relationship between adverse weather and transit ridership by analysing the correlation between daily bus ridership and daily precipitation for a three-year period from 2010 to 2012. It is observed from the analysis that wet weather has varying impacts on daily bus ridership. Overall, rainfall negatively affects the daily bus ridership in this region. Morning peak-hours and weekend ridership were found more sensitive to rain than entire day’s ridership and weekdays. The study also found a negative correlation between the morning-peak precipitation level and the daily bus ridership, which suggests that a small amount of morning peak-hours rain reduces a significant amount bus ridership for the whole day. The analysis also confirms that summer rain has the most significant effect on ridership compared with the other three seasons. The study findings will contribute to enhancing the fundamental understanding of traveller behaviours, particularly mode choice behaviour under adverse weather conditions.

The efficiency of corpus-based distributional models for literature-based discovery on large data sets

This paper evaluates the efficiency of a number of popular corpus-based distributional models in performing discovery on very large document sets, including online collections. Literature-based discovery is the process of identifying previously unknown connections from text, often published literature, that could lead to the development of new techniques or technologies. Literature-based discovery has attracted growing research interest ever since Swanson's serendipitous discovery of the therapeutic effects of fish oil on Raynaud's disease in 1986. The successful application of distributional models in automating the identification of indirect associations underpinning literature-based discovery has been heavily demonstrated in the medical domain. However, we wish to investigate the computational complexity of distributional models for literature-based discovery on much larger document collections, as they may provide computationally tractable solutions to tasks including, predicting future disruptive innovations. In this paper we perform a computational complexity analysis on four successful corpus-based distributional models to evaluate their fit for such tasks. Our results indicate that corpus-based distributional models that store their representations in fixed dimensions provide superior efficiency on literature-based discovery tasks.

Context matters : Violence against women and reporting to police in rural, suburban and urban areas

Despite plentiful efforts to identify perpetrator, victim, and incident characteristics correlated with reporting violence against women to police, few studies have addressed the contexts that shape such reporting. Even fewer have examined variations in these contexts across geographic areas. Drawing upon National Crime Victimization Survey data from 1992 through 2009, this paper uses conjunctive analysis of case configurations to identify and investigate the dominant situational contexts of reporting of violence against women to police across rural, suburban, and urban areas. Our findings show that context matters and the importance of incident, perpetrator, and victim characteristics vary across geographic areas.

Vote with your feet : hyperlocal polling for urban screens

Vote with Your Feet is a hyperlocal polling tool for urban screens that lets users express their opinion on current affairs. Similar to vox populi interviews on TV, it is meant to reflect the mindset of the community and its diversity. It shows one Yes/No question at a time and lets the user vote by stepping with their foot on one of two physical buttons. By not only displaying the local but also national results (taken from newspaper polls or TV news), it creates a sense of place and can spark offline conversations as well as making people think about their own opinion. As a tangible media installation that bridges physical and digital urban layers, the project empowers citizens and facilitates a bottom-up approach in terms of stimulating opinions and decision making (rather than broadcasting or automating). In a second iteration of the design, we want to encourage users to submit their own questions.

First flush behaviour in urban residential catchments

The current state of knowledge in relation to first flush does not provide a clear understanding of the role of rainfall and catchment characteristics in influencing this phenomenon. This is attributed to the inconsistent findings from research studies due to the unsatisfactory selection of first flush indicators and how first flush is defined. The research study discussed in this thesis provides the outcomes of a comprehensive analysis on the influence of rainfall and catchment characteristics on first flush behaviour in residential catchments. Two sets of first flush indicators are introduced in this study. These indicators were selected such that they are representative in explaining in a systematic manner the characteristics associated with first flush. Stormwater samples and rainfall-runoff data were collected and recorded from stormwater monitoring stations established at three urban catchments at Coomera Waters, Gold Coast, Australia. In addition, historical data were also used to support the data analysis. Three water quality parameters were analysed, namely, total suspended solids (TSS), total phosphorus (TP) and total nitrogen (TN). The data analyses were primarily undertaken using multi criteria decision making methods, PROMETHEE and GAIA. Based on the data obtained, the pollutant load distribution curve (LV) was determined for the individual rainfall events and pollutant types. Accordingly, two sets of first flush indicators were derived from the curve, namely, cumulative load wash-off for every 10% of runoff volume interval (interval first flush indicators or LV) from the beginning of the event and the actual pollutant load wash-off during a 10% increment in runoff volume (section first flush indicators or P). First flush behaviour showed significant variation with pollutant types. TSS and TP showed consistent first flush behaviour. However, the dissolved fraction of TN showed significant differences to TSS and TP first flush while particulate TN showed similarities. Wash-off of TSS, TP and particulate TN during the first 10% of the runoff volume showed no influence from corresponding rainfall intensity. This was attributed to the wash-off of weakly adhered solids on the catchment surface referred to as "short term pollutants" or "weakly adhered solids" load. However, wash-off after 10% of the runoff volume showed dependency on the rainfall intensity. This is attributed to the wash-off of strongly adhered solids being exposed when the weakly adhered solids diminish. The wash-off process was also found to depend on rainfall depth at the end part of the event as the strongly adhered solids are loosened due to impact of rainfall in the earlier part of the event. Events with high intensity rainfall bursts after 70% of the runoff volume did not demonstrate first flush behaviour. This suggests that rainfall pattern plays a critical role in the occurrence of first flush. Rainfall intensity (with respect to the rest of the event) that produces 10% to 20% runoff volume play an important role in defining the magnitude of the first flush. Events can demonstrate high magnitude first flush when the rainfall intensity occurring between 10% and 20% of the runoff volume is comparatively high while low rainfall intensities during this period produces low magnitude first flush. For events with first flush, the phenomenon is clearly visible up to 40% of the runoff volume. This contradicts the common definition that first flush only exists, if for example, 80% of the pollutant mass is transported in the first 30% of runoff volume. First flush behaviour for TN is different compared to TSS and TP. Apart from rainfall characteristics, the composition and the availability of TN on the catchment also play an important role in first flush. The analysis confirmed that events with low rainfall intensity can produce high magnitude first flush for the dissolved fraction of TN, while high rainfall intensity produce low dissolved TN first flush. This is attributed to the source limiting behaviour of dissolved TN wash-off where there is high wash-off during the initial part of a rainfall event irrespective of the intensity. However, for particulate TN, the influence of rainfall intensity on first flush characteristics is similar to TSS and TP. The data analysis also confirmed that first flush can occur as high magnitude first flush, low magnitude first flush or non existence of first flush. Investigation of the influence of catchment characteristics on first flush found that the key factors that influence the phenomenon are the location of the pollutant source, spatial distribution of the pervious and impervious surfaces in the catchment, drainage network layout and slope of the catchment. This confirms that first flush phenomenon cannot be evaluated based on a single or a limited set of parameters as a number of catchment characteristics should be taken into account. Catchments where the pollutant source is located close to the outlet, a high fraction of road surfaces, short travel time to the outlet, with steep slopes can produce high wash-off load during the first 50% of the runoff volume. Rainfall characteristics have a comparatively dominant impact on the wash-off process compared to the catchment characteristics. In addition, the pollutant characteristics also should be taken into account in designing stormwater treatment systems due to different wash-off behaviour. Analysis outcomes confirmed that there is a high TSS load during the first 20% of the runoff volume followed by TN which can extend up to 30% of the runoff volume. In contrast, high TP load can exist during the initial and at the end part of a rainfall event. This is related to the composition of TP available for the wash-off.

Fuel consumption and gas emissions of an automatic transmission vehicle following simple eco-driving instructions on urban roads

Following eco-driving instructions can reduce fuel consumption between 5 to 20% on urban roads with manual cars. The majority of Australian cars have an automatic transmission gear-box. It is therefore of interest to verify whether current eco-driving instructions are e cient for such vehicles. In this pilot study, participants (N=13) drove an instrumented vehicle (Toyota Camry 2007) with an automatic transmission. Fuel consumption of the participants was compared before and after they received simple eco-driving instructions. Participants drove the same vehicle on the same urban route under similar tra c conditions. We found that participants drove at similar speeds during their baseline and eco-friendly drives, and reduced the level of their accelerations and decelerations during eco-driving. Fuel consumption decreased for the complete drive by 7%, but not on the motorway and inclined sections of the study. Gas emissions were estimated with the VT-micro model, and emissions of the studied pollutants (CO2, CO, NOX and HC) were reduced, but no di erence was observed for CO2 on the motorway and inclined sections. The di erence for the complete lap is 3% for CO2. We have found evidence showing that simple eco-driving instructions are e cient in the case of automatic transmission in an urban environment, but towards the lowest values of the spectrum of fuel consumption reduction from the di erent eco-driving studies.

Environmental sustainability of urban road transport : an integrated analysis for life cycle emission impact

Despite of significant contributions of urban road transport to global economy and society, it is one of the largest sources of local and global emission impact. In order to address the environmental concerns of urban road transport it is imperative to achieve a holistic understanding of contributory factors causing emissions which requires a complete look onto its whole life cycle. Previous studies were mainly based on segmental views which mostly studied environmental impacts of individual transport modes and very few considered impacts other than operational phase. This study develops an integrated life cycle inventory model for urban road transport emissions from a holistic modal perspective. Singapore case was used to demonstrate the model. Results show that total life cycle greenhouse gas emission from Singapore’s road transport sector is 7.8 million tons per year. The total amount of criteria air pollutants are also estimated in this study.

Growing friends by growing and sharing garden produce

Most urban agriculture literature focus on addressing access to healthy and affordable food and environmental issues via managing the urban farming chain which consists of production, processing, marketing, distribution and consumption. This paper focuses on a less acknowledged and documented aspect of individual urban farming: growing and sharing garden produce for recreation, well-being and friend making. This paper summarizes the experience of individual backyard farming and sharing as a way to interact with nature and people and explores ways to improve this experience, especially with the assistance of Information Communication Technology.

Urban consolidation : reality or fantasy

Urban consolidation has been a policy objective of many local and state governments in Australia for the past decade. Densification of city centres and other identified activity centres is a sensible solution to a plethora of policy objectives including: growth management, housing affordability, housing choice and infrastructure utilisation etc whilst preserving the fabric of existing neighbourhoods. However despite the plethora of supportive policies and ripe redevelopment sites, urban sprawl continues to permeate city fringes and affordable urban densification in the post GFC environment slips into the “too hard” basket. This article discusses current issues facing the development industry, highlighting factors contributing to the disequilibrium between demand and supply in the medium to high density residential markets.

Food and Brisbane households : dietary, social and health consequences of food insecurity

Background & Aims: Access to sufficient amounts of safe and culturally-acceptable foods is a fundamental human right. Food security exists when all people, at all times, have physical, social, and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life. Food insecurity therefore occurs when the availability or access to sufficient amounts of nutritionally-adequate, culturally-appropriate and safe foods, or, the ability to acquire such foods in socially-acceptable ways, is limited. Food insecurity may result in significant adverse effects for the individual and these outcomes may vary between adults and children. Among adults, food insecurity may be associated with overweight or obesity, poorer self-rated general health, depression, increased health-care utilisation and dietary intakes less consistent with national recommendations. Among children, food insecurity may result in poorer self or parent-reported general health, behavioural problems, lower levels of academic achievement and poor social outcomes. The majority of research investigating the potential correlates of food insecurity has been undertaken in the United States (US), where regular national screening for food insecurity is undertaken using a comprehensive multi-item measurement. In Australia, screening for food insecurity takes place on a three yearly basis via the use of a crude, single-item included in the National Health Survey (NHS). This measure has been shown to underestimate the prevalence of food insecurity by 5%. From 1995 – 2004, the prevalence of food insecurity among the Australian population remained stable at 5%. Due to the perceived low prevalence of this issue, screening for food insecurity was not undertaken in the most recent NHS. Furthermore, there are few Australian studies investigating the potential determinants of food insecurity and none investigating potential outcomes among adults and children. This study aimed to examine these issues by a) investigating the prevalence of food insecurity among households residing in disadvantaged urban areas and comparing prevalence rates estimated by the more comprehensive 18-item and 6-item United States Department of Agriculture (USDA) Food Security Survey Module (FSSM) to those estimated by the current single-item measure used for surveillance in Australia and b) investigating the potential determinants and outcomes of food insecurity, Methods: A comprehensive literature review was undertaken to investigate the potential determinants and consequences of food insecurity among developed countries. This was followed by a cross-sectional study in which 1000 households from the most disadvantaged 5% of Brisbane areas were sampled and data collected via mail-based survey (final response rate = 53%, n = 505). Data were collected for food security status, sociodemographic characteristics (household income, education, age, gender, employment status, housing tenure and living arrangements), fruit and vegetable intakes, meat and take-away consumption, presence of depressive symptoms, presence of chronic disease and body mass index (BMI) among adults. Among children, data pertaining to BMI, parent-reported general health, days away from school and activities and behavioural problems were collected. Rasch analysis was used to investigate the psychometric properties of the 18-, 10- and 6-item adaptations of the USDA-FSSM, and McNemar's test was used to investigate the difference in the prevalence of food insecurity as measured by these three adaptations compared to the current single-item measure used in Australia. Chi square and logistic regression were used to investigate the differences in dietary and health outcomes among adults and health and behavioural outcomes among children. Results were adjusted for equivalised household income and, where necessary, for indigenous status, education and family type. Results: Overall, 25% of households in these urbanised-disadvantaged areas reported experiencing food insecurity; this increased to 34% when only households with children were analysed. The current reliance on a single-item measure to screen for food insecurity may underestimate the true burden among the Australian population, as this measure was shown to significantly underestimate the prevalence of food insecurity by five percentage points. Internationally, major potential determinants of food insecurity included poverty and indicators of poverty, such as low-income, unemployment and lower levels of education. Ethnicity, age, transportation and cooking and financial skills were also found to be potential determinants of food insecurity. Among Australian adults in disadvantaged urban areas, food insecurity was associated with a three-fold increase in experiencing poorer self-rated general health and a two-to-five-fold increase in the risk of depression. Furthermore, adults from food insecure households were twoto- three times more likely to have seen a general practitioner and/or been admitted to hospital within the previous six months, compared to their food secure counterparts. Weight status and intakes of fruits, vegetables and meat were not associated with food insecurity. Among Australian households with children, those in the lowest tertile were over 16 times more likely to experience food insecurity compared to those in the highest tertile for income. After adjustment for equivalised household income, children from food insecure households were three times more likely to have missed days away from school or other activities. Furthermore, children from food insecure households displayed a two-fold increase in atypical emotions and behavioural difficulties. Conclusions: Food insecurity is an important public health issue and may contribute to the burden on the health care system through its associations with depression and increased health care utilisation among adults and behavioural and emotional problems among children. Current efforts to monitor food insecurity in Australia do not occur frequently and use a tool that may underestimate the prevalence of food insecurity. Efforts should be made to improve the regularity of screening for food insecurity via the use of a more accurate screening measure. Most of the current strategies that aim to alleviate food insecurity do not sufficiently address the issue of insufficient financial resources for acquiring food; a factor which is an important determinant of food insecurity. Programs to address this issue should be developed in collaboration with groups at higher risk of developing food insecurity and should incorporate strategies to address the issue of low income as a barrier to food acquisition.

Evidence-based practice and rural nursing : A literature review

This literature review is an exploration of issues related to evidence-based practice and rural nursing. Given the contribution that nursing research can make to improved client care in rural areas, it is important that nurses’ awareness and understanding of evidence-based practice be enhanced, and that strategies for fostering the development of clinically relevant programs of nursing research be identified for rural health services. The review highlights the deficiencies in the current metropolitan-based approaches to evidence-based practice that may disadvantage rural clients and nursing practitioners, because they do not accommodate the inherent differences in rural and metropolitan healthcare cultures. It emphasises the need to seek approaches to research-based practice that arise from the specific needs of the rural setting.

Respiratory illness during winter : a cohort study of urban children from temperate Australia

Objective: To examine the epidemiology and burden of respiratory illness during winter in urban children from temperate Australia. Methods: We conducted a cohort study of healthy Melbourne children, aged from 12 to 71 months. Parents kept a daily respiratory symptom diary and recorded resource use when an influenza-like illness (ILI) occurred. Results: One-hundred and eighteen children had 137 ILI episodes over 12 weeks for a rate of 0.53 ILI episodes per child-month (95% CI 0.44-0.61). Risk factors for ILI included younger age, fewer people residing in the household, structured exposure to other children outside the home, and a higher household income. Episodes had a mean duration of 10.4 days with 64 visits to a general practitioner (46.7 GP visits per 100 episodes), 27 antibiotic courses prescribed (19.7 antibiotic courses per 100 episodes), and three overnight hospitalizations (2.2 admissions per 100 episodes). Parents reported an average of 11.7 h excess time spent caring for a child per episode. Conclusions: Respiratory illnesses are a common and largely neglected cause of illness in Australian children. Pathogen-specific data are required to better assess the likely impact of available and developing vaccines and other treatment options.