Abstract Introduction: Previous research showed that comorbidities that are common in patients with Chronic Obstructive Pulmonary Disease (COPD) are anxiety and depression. Furthermore, stress can be associated with more depressive symptoms. Patients suffering from depression along with an additional medical condition, tend to have more severe symptoms in both depression and their medical illness.   Aim: The aim of this study was to investigate depression, anxiety, and stress among COPD patients, and also to examine if there was a difference in levels of depression, anxiety and stress between genders, and between COPD patients and patients with COPD together with comorbid chronic condition.   Method: This study had a descriptive and cross-sectional design with a quantitative method. The data collection took place at a respiratory ward at Cho Ray Hospital in Ho Chi Minh City, Vietnam. Sixty two COPD patients, both men and women, participated voluntarily by answering a questionnaire. Virginia Henderson´s nursing theory was used as a theoretical framework. Data analysis was conducted through using the statistical program SPSS.   Result: More than half of the COPD patients (88.8%) presented symptoms of depression, 93.5% presented symptoms of anxiety, and 54.8% presented symptoms of stress. There was a statistical significance between genders among COPD patients in anxiety, where all female participants (100%) showed extremely severe levels of anxiety. In levels of extreme severity, both patients with only COPD diagnosis and patients with COPD and comorbid chronic condition presented symptoms in both depression and anxiety, but not in levels of stress.     Conclusion: COPD patients in Ho Chi Minh City presented high levels of depression and anxiety. In addition, levels of stress were present, although not as high as depression and anxiety among this patient group. More information concerning psychological distress needs to be offered by healthcare professionals to COPD patients. Further research in this field is desirable. / Sammanfattning Introduktion: Tidigare forskning visar att depression och ångest är vanligt förekommande bland patienter med Kroniskt Obstruktiv Lungsjukdom (KOL). Stress kan associeras med flera depressiva symtom. Patienter som lider av depression tillsammans med annat mediciniskt tillstånd kan ha en tendens att utveckla svårare symptom i sin depression och sitt medicinska tillstånd.   Syfte: Syftet med denna studie var att undersöka depression, ångest och stress hos patienter med KOL och om skillnader fanns mellan kön. Vidare önskades skillnader undersökas mellan patienter med enbart KOL och patienter med KOL och annat kroniskt tillstånd.     Metod: Studien är en deskriptiv tvärsnittsstudie, med kvantitativ metod. Datainsamling utfördes på en respiratorisk avdelning på Cho Ray sjukhuset i Ho Chi Minh City, Vietnam. Sextio-två KOL-patienter, både män och kvinnor, deltog frivilligt genom att besvara en enkät. Virginia Hendersons omvårdnadsteori användes i detta arbete. Dataanalysen utfördes med hjälp av SPSS programmet.   Resultat: Mer än hälften (88,8 %) av KOL-patienterna visade symtom på depression, 93,5% för ångest, samt 54,8 % visade symtom för stress. Det fanns en statistisk signifikant skillnad mellan könen avseende ångest, där alla kvinnliga deltagare (100 %) visade extremt allvarliga nivåer av ångest. Patienter med enbart KOL-diagnos och patienter med KOL tillsammans med andra kroniska tillstånd uppvisade extremt allvarliga nivåer av både depression och ångest, dock inte av stress.   Slutsats: KOL-patienter i Ho Chi Minh City, Vietnam, uppvisar höga nivåer av depression och ångest. Höga stressnivåer bland deltagare kunde ses, dock inte i lika hög utsträckning som depression och ångest i denna patientgrupp. Mer studier i detta ämne är önskvärt.

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In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

In 1986, Vietnam opened up the country’s economy by launching the Doi Moi (renovation) policy, which made the process of economic liberalisation possible. Accordingly, Ho Chi Minh City, the country’s biggest city, has undergone rapid growth of population, urbanisation and industrialisation. While achieving remarkable economic growth, the city faces considerable urban environmental challenges. The rapid growth of urbanisation and industry has placed increasing pressure on available freshwater resources, through excessive water use and increasing volumes of untreated wastewater. Firstly, the urban water sector has had to meet growing demand for water use for domestic purposes during the dry season. Secondly, groundwater levels have experienced a substantial drawdown in outlying urban districts as a result of over-abstraction. Thirdly, rapidly expanding industrial activities are causing severe demand on water resources. The city’s major supply sources have developed an alarming level of pollutants discharged by industry. The aim of this thesis is to formulate an integrated approach to the sustainable management of water resources in Ho Chi Minh City. In order to achieve this, the research was designed to examine institutional frameworks and arrangements and to explore the perception of water value by water users and stakeholders. The underlying reasons for ineffective management are anchored in fragmented management practices which result from inadequate institutional frameworks and arrangements, inadequate regulations and inappropriate water governance. Weak enforcement of law and insufficient cooperation between government agencies and departments in Ho Chi Minh City and their counterparts in neighbouring provinces also limit management efficacy. The research results show that stakeholders have different perceptions of water resources. Overall, water value has been considered as a social and economic good by both the urban respondents and government officials. However, most urban residents view water as a social good rather than an economic one. Public involvement in the water sector is limited. Most urban dwellers have little understanding and knowledge about the city’s water issues or the available channels to access information on water resources. Many government officials are inadequately trained, poorly qualified, inexperienced and have irrelevant or outdated background knowledge about their field of management. Government respondents did not provide consistent data and information on the water profile because there is no shared common information on water issues in place. Findings from the fieldwork show that decentralisation, privatisation and using rainwater as a potential alternative water source are preferred. Finally, the study proposes a schematic revision of existing management structures and mechanisms between local government agencies. This thesis proposes a model for a water conservation strategy for which the management and use of water resources is aligned with adequate institutional arrangements and effective regulations. Water governance and management of water resources need to work with economic and urbanisation growth. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1331639 / Thesis (Ph.D.) - University of Adelaide, School of Social Sciences, 2008

Participatory Action Research (PAR) was carried out to improve educational practices and environmental sustainability in an International School in Vietnam by undertaking two cycles of PAR to determine how the school community could use paper on a more sustainable basis. The methodology included sorting paper and encouraging the reuse of paper. Practices related to computer printing, report writing and newsletter production were also investigated. Changes in the school community, in terms of accepting responsibility and demonstrating changed attitudes and behaviours, were measured. The school community demonstrated greater awareness, increased responsibility and more action competence. Critical awareness of unsustainable practices increased. Individuals were able to effect change, but it is recommended that such actions should be institutionalised for such changes to be sustainable. Limitations and recommendations emphasise the need for continuing PAR to implement sustainability. / Educational Studies / M. Ed. (Environmental Education)