Publications by authors named "Pamela Wright"

62 Publications

Maternal health literacy on mother and child health care: A community cluster survey in two southern provinces in Laos.

PLoS One 2021 29;16(3):e0244181. Epub 2021 Mar 29.

Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Vientiane, Lao PDR.

Rational: Increased maternal health literacy (MHL) has contributed considerably to maternal and child health outcomes in many countries. Malnutrition, and low coverage of child vaccination and breastfeeding are major health concerns in Laos, but there is little insight into mothers' literacy on these issues. The aim of this study was to identify the level of MHL of Lao mothers and to explore factors influencing it, in order to provide evidence that can inform policies and planning of health services.

Methods: A cross-sectional survey was conducted using a questionnaire on health literacy (ability to access, understand, appraise and apply health-related information) in relation to care during pregnancy, childbirth, and the postpartum period. We interviewed 384 mothers with children aged under five years; 197 from urban and 187 from rural areas. Descriptive and inferential statistics were applied to analyze the data.

Results: Overall, MHL of Lao mothers was very low in both urban and rural areas; 80% of mothers had either inadequate or problematic MHL, while only 17.4% had sufficient and 3.5% excellent MHL. The MHL scores were significantly higher in urban than in rural areas. One third of mothers found it very difficult to access, understand, appraise and apply information on mother and child (MCH). Health personnel were the main source of MCH information for the mothers. Years of schooling, own income, health status, and number of ANC visits significantly predicted a higher level of MHL (R square = 0.250; adjusted R square = 0.240, P = <0.001).

Conclusions: MHL of Lao mothers was inadequate in both urban and rural areas. Socio-demographics and key practices of the mothers were significantly associated with a better level of MHL. Health education on MHL to mothers in both urban and rural areas needs attention, and could best be done by improving the quality of health providers' provision of information.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244181PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007003PMC
March 2021

Newborn Daily Crying Time Duration.

J Pediatr Nurs 2021 Jan-Feb;56:35-37. Epub 2020 Nov 9.

Department of Neurology, University of California San Francisco (UCSF), USA.

Purpose: Current methods for estimating infant crying time are potentially subject to error as they rely on parents to contemporaneously log and calculate crying time. Our aim was to present the average daily infant crying times from a digital recording device, not dependent on parent-based measurement.

Design And Methods: We conducted a descriptive longitudinal survey of infant crying times. Parents of healthy, term newborns were provided with voice-activated digital recording devices and asked to record infants continuously for randomly selected 24-hour periods during a 4 week time period. We analyzed the daily crying time for infants at different weeks of life.

Results: Of 136 families approached, 28 (20.5%) families were consented with 3 families withdrawing and 5 families submitting incomplete datasets, leaving a total of 20 families with complete datasets. During the first week of life, the mean crying time was about 25 minutes/day, which remained stable for the next few weeks until five weeks of life, when mean crying time increased to almost 40 minutes/day with increasing variance.

Conclusions: In our study sample, infant mean daily crying times based on objective data were much less than estimates in recent studies.

Practice Implications: This study suggests daily crying times measured by digital recorders are less than daily crying times based on parent diaries published in the literature. With the development of new 'apps' to record duration times, it may be clinically inappropriate to compare data based on digital recorders with norms from studies that use parent-reported crying times.
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http://dx.doi.org/10.1016/j.pedn.2020.10.003DOI Listing
April 2021

Balancing Internal and External Validity Using Precis-2 and Re-Aim: Case Exemplars.

West J Nurs Res 2021 Feb 10;43(2):163-171. Epub 2020 Jul 10.

College of Nursing, Advancing Chronic Care through Research and Innovation Center (ACORN Center), University of South Carolina, Columbia, SC, USA.

The National Institutes of Health estimated that $3-$4 billion is spent supporting clinical trials annually, yet an average of 17 years is required for research evidence to be implemented into practice. Study designs that balance external and internal validity, based on the goals of the study and relative to the state of the science, may accelerate knowledge translation. The purpose of this case study was to evaluate two randomized control trials on the effectiveness-efficacy continuum using the PRagmatic Explanatory Continuum Indicator Summary and the Research Effectiveness Adoption Implementation Maintenance model. Findings provided insight into strategies that may lead to more balanced approaches to research design. Incorporating tools such as PRECIS-2 and RE-AIM when designing and implementing research interventions may accelerate knowledge translation to close the gap between scientific knowledge and clinical practice.
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http://dx.doi.org/10.1177/0193945920940308DOI Listing
February 2021

Strengthening human and physical infrastructure of primary healthcare settings to deliver hypertension care in Vietnam: a mixed-methods comparison of two provinces.

Health Policy Plan 2020 Oct;35(8):918-930

Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands.

In Vietnam, the overall prevalence of hypertension (HTN) was 21%, with lower estimates for the prevalence of HTN awareness and treatment. The health systems, like other low- and middle-income countries, were designed to provide acute care for episodic conditions, rather than a chronic condition where patients need long-term care across time and disciplines. This article describes the delivery and organization of HTN care at primary healthcare (PHC) settings in both urban and rural areas at Hue Province of Central Vietnam in comparison with Thai Nguyen province in Northern Vietnam based on the infrastructure capacity and patients' and providers' perspectives and experiences We used mixed-methods design that included in-depth semi-structured interviews with patients and healthcare providers at purposively selected PHC facilities in two districts of each province and a modified version of the service availability and readiness assessment inventory at all PHC facilities. We found that HTN patients in both provinces can access healthcare services to diagnose, treat and control their HTN condition at the PHC level with a focus on district facilities. Health services in Hue have allowed commune health stations (CHSs) to provide routine monitoring and prescription refills for HTN patients while maintaining periodical visits to a higher level of care to monitor the stability of the disease. Such provision of care at CHSs remained restricted in Thai Nguyen. Further improvements are necessary for referral procedures, information system to allow for longitudinal follow-up across levels of care and defining a basic health insurance or benefits package, which meets patients' preferences with a monthly timespan for prescription refills.
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http://dx.doi.org/10.1093/heapol/czaa047DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7553760PMC
October 2020

Why do graduates choose to work in a less attractive specialty? A cross-sectional study on the role of personal values and expectations.

Hum Resour Health 2020 05 4;18(1):32. Epub 2020 May 4.

School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, the Netherlands.

Background: Primary health care (PHC), of which preventive medicine (PM) is a subspecialty, will have to cope with a deficiency of staff in the future, which makes the retention of graduates urgent. This study was conducted in Vietnam, where PM is an undergraduate degree in parallel to medical training. It aims to identify facilitating and hindering factors that impact recruitment and retention of PM graduates in the specialty.

Methods: A cross-sectional study enrolled 167 graduates who qualified as PM doctors from a Vietnamese medical school, between 2012 and 2018. Data were collected via an online questionnaire that asked participants about their motivation and continuation in PM, the major life roles that they were playing, and their satisfaction with their job. Multiple regression analyses were used to identify which life roles and motivational factors were related to the decision to take a PM position and to stay in the specialty, as well as how these factors held for subgroups of graduates (men, women, graduates who studied PM as their first or second study choice).

Results: Half of the PM graduates actually worked in PM, and only one fourth of them expressed the intention to stay in the field. Three years after qualification, many graduates had not yet decided whether to pursue a career in PM. Satisfaction with opportunities for continuous education was rated as highly motivating for graduates to choose and to stay in PM. Responsibility for taking care of parents motivated male graduates to choose PM, while good citizenship and serving the community was associated with the retention of graduates for whom PM was their first choice.

Conclusions: The findings demonstrate the importance of social context and personal factors in developing primary care workforce policy. Providing opportunities for continued education and enhancing the attractiveness of PM as an appropriate specialty to doctors who are more attached to family and the community could be solutions to maintaining the workforce in PM. The implications could be useful for other less popular specialties that also struggle with recruiting and retaining staff.
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http://dx.doi.org/10.1186/s12960-020-00474-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7197171PMC
May 2020

Social construction of biopsychosocial and medical experiences of women with polycystic ovary syndrome.

J Adv Nurs 2020 Jul 17;76(7):1728-1736. Epub 2020 Apr 17.

Advancing Chronic Care through Research and iNnovation Center (ACORN Center), University of South Carolina, Columbia, SC, USA.

Aim: To explore the perceived biopsychosocial and medical experiences of women with polycystic ovary syndrome, as presented in stories written by women on a social support website.

Design: Qualitative descriptive using low inference content analysis, guided by the social construction of illness theoretical framework.

Methods: In July 2018, 95 of 379 website stories were randomly selected. The stories were analysed, ending in September 2018.

Results: Three major themes aligning with framework constructs were identified: Biopsychosocial struggles and management: "I can't even look in the mirror without wanting to cry," Sociocultural navigation: "I feel all alone and no one understands me." and Healthcare encounters: "I don't feel like I'm getting the help I need". These themes revealed that Polycystic ovary syndrome (PCOS) has biological and experiential components, which exist independently of each other and hold social and cultural meanings.

Conclusion: Care for women with PCOS should be multidisciplinary, multidimensional, and multi-level to ameliorate biopsychosocial issues. Provider (physicians, nurse practitioners, physician assistants) education about PCOS is necessary to enhance timely diagnosis and implement individualized treatment strategies. Non-advanced practice nurses are in a unique position to have an impact on patient satisfaction and clinical outcomes by providing and reinforcing patient education, coordinating management processes, counselling via telephone or in-person appointments and facilitating referrals to ancillary providers. Evidence-based and accessible psychosocial supports and interventions will lead to improved self-esteem and effective coping skills, and reduced stigma-related stress. Lastly, policy changes are warranted to address access to care, health insurance inequities and inadequate funding for PCOS-related research.

Impact: Increased awareness of PCOS and its biopsychosocial aspects will aid providers with timely diagnosis and meaningful treatment plans. Women with PCOS will gain acknowledgment, acceptance, and insight towards health care and self-management.
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http://dx.doi.org/10.1111/jan.14371DOI Listing
July 2020

Social construction of biopsychosocial and medical experiences of women with polycystic ovary syndrome.

J Adv Nurs 2020 Jul 17;76(7):1728-1736. Epub 2020 Apr 17.

Advancing Chronic Care through Research and iNnovation Center (ACORN Center), University of South Carolina, Columbia, SC, USA.

Aim: To explore the perceived biopsychosocial and medical experiences of women with polycystic ovary syndrome, as presented in stories written by women on a social support website.

Design: Qualitative descriptive using low inference content analysis, guided by the social construction of illness theoretical framework.

Methods: In July 2018, 95 of 379 website stories were randomly selected. The stories were analysed, ending in September 2018.

Results: Three major themes aligning with framework constructs were identified: Biopsychosocial struggles and management: "I can't even look in the mirror without wanting to cry," Sociocultural navigation: "I feel all alone and no one understands me." and Healthcare encounters: "I don't feel like I'm getting the help I need". These themes revealed that Polycystic ovary syndrome (PCOS) has biological and experiential components, which exist independently of each other and hold social and cultural meanings.

Conclusion: Care for women with PCOS should be multidisciplinary, multidimensional, and multi-level to ameliorate biopsychosocial issues. Provider (physicians, nurse practitioners, physician assistants) education about PCOS is necessary to enhance timely diagnosis and implement individualized treatment strategies. Non-advanced practice nurses are in a unique position to have an impact on patient satisfaction and clinical outcomes by providing and reinforcing patient education, coordinating management processes, counselling via telephone or in-person appointments and facilitating referrals to ancillary providers. Evidence-based and accessible psychosocial supports and interventions will lead to improved self-esteem and effective coping skills, and reduced stigma-related stress. Lastly, policy changes are warranted to address access to care, health insurance inequities and inadequate funding for PCOS-related research.

Impact: Increased awareness of PCOS and its biopsychosocial aspects will aid providers with timely diagnosis and meaningful treatment plans. Women with PCOS will gain acknowledgment, acceptance, and insight towards health care and self-management.
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http://dx.doi.org/10.1111/jan.14371DOI Listing
July 2020

Improvement of Quality of Antenatal Care (ANC) Service Provision at the Public Health Facilities in Lao PDR: Perspective and Experiences of Supply and Demand Sides.

BMC Pregnancy Childbirth 2019 Jul 22;19(1):255. Epub 2019 Jul 22.

Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Samsenthai Street, Pearvath Village, Sisathanark District, Vientiane Capital, Lao PDR, P.O. Box: 7444.

Background: The maternal mortality rate in Lao PDR (Laos) is still the highest in Southeast Asia, at 197 per 100,000 live births. Antenatal care (ANC) could contribute to maternal and child mortality reduction. The quality of ANC service remains inadequate and little information is available on the quality of health education and counseling services of health providers in Laos. This study aims to gain insight into the perceptions of stakeholders on both supply and demand sides of public ANC services in Laos and evidence for recommendations to improve the quality of ANC services.

Methods: Semi-structured interviews were conducted with 50 participants from different stakeholder groups; on the demand side, couples with a currently pregnant woman and mothers with children under one year of age and a family member; and on the supply side, health providers, managers, policy makers of the Ministry of Health, and development partners. The interviews were voice recorded and transcribed verbatim for analysis by open and thematic coding, using the MAXQDA software program.

Results: All respondents reported that the number of pregnant women who visit ANC services has increased. However, an analysis of the supply side identified issues related to the quality of ANC that need to be improved in the areas of facilities, human resources, privacy and confidentiality, providers' behavior, attitudes, and ineffective communication skills when it comes to providing health education and counseling to pregnant women and their family members. The analysis of the demand side mainly emphasized the issues of providers' behavior, attitude, communication and unequal treatment, and the lack of privacy. Both sides also suggested solutions to the problems, such as training, effective materials, rewarding good role models, and building a feedback system.

Conclusion: The number of public ANC services has increased, but both supply and demand sides experienced challenges with the quality of ANC. All respondents proposed possible solutions to improve quality of ANC service in public health facilities in Laos.
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http://dx.doi.org/10.1186/s12884-019-2345-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647136PMC
July 2019

Do health care providers give sufficient information and good counseling during ante-natal care in Lao PDR?: an observational study.

BMC Health Serv Res 2019 Jul 4;19(1):449. Epub 2019 Jul 4.

Institute of Research and Education Development, University of Health Sciences, Ministry of Health, Samsenthai Street, Pearvath Village, Sisathanark District, P.O. Box: 7444, Vientiane Capital, Lao PDR.

Background: It is increasingly recognized that improving the quality of maternal health care delivery is of utmost importance in many countries. In Laos, the quality of antenatal care (ANC) service remains inadequate, but it has never been assessed thoroughly. This study aims to determine the ANC quality at the urban and rural public health facilities in Laos and provides suggestions to improve health education and counseling in addition to other routine care in public ANC services.

Methods: This health-facility based, cross-sectional observation study included both health providers (n = 77) and pregnant women (n = 421) from purposively selected health facilities (n = 16). Information on the mothers' current pregnancies, previous visits and their last children was collected. The time spent for each ANC session as well as ANC services provided were recorded. Descriptive and inferential statistics were applied to analyze the data.

Results: Overall performance of ANC services by health care providers was poor in both urban and rural areas. Insufficient provision of information on danger signs during pregnancy, nutrition, breast feeding and iron supplements was revealed. Generally the communication skills, behavior and attitude of health providers were very poor. Less than a quarter of pregnant women were treated with kindness and respect. Only 4% of the observed ANC session took privacy into consideration. Less than 10% of available information materials were used during each ANC session. None of the health providers in both rural and urban areas performed specific counseling. Overall mean (SD) time-spent for each ANC session was 16.21 (4.28) minutes. A positive correlation was identified between the length of working experience of health providers and their physical performance scores (adjusted R square = 0.017).

Conclusions: The overall performance of ANC services by health care providers was inadequate in both urban and rural areas. Insufficient provision of health education and poor communication skills of health care providers were revealed. Existing IEC materials were scarcely used. Taking action to improve the quality of ANC services by training and providing specific guidelines, creating dedicated rooms, and providing sufficient and effective materials for counseling are all greatly needed in public health facilities in Laos.
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http://dx.doi.org/10.1186/s12913-019-4258-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6611023PMC
July 2019

Access to hypertension care and services in primary health-care settings in Vietnam: a systematic narrative review of existing literature.

Glob Health Action 2019 ;12(1):1610253

a Athena Institute for Research on Innovation and Communication in Health and Life Sciences , Faculty of Sciences, Vrije Universiteit Amsterdam , Amsterdam , The Netherlands.

: Health care in Vietnam is challenged by a high burden of hypertension (HTN). Since 2000, several interventions were implemented to manage HTN; it is not clear what is the status of patient access to HTN care. : This article aims to perform a systematic narrative review of the available evidence on access to HTN care and services in primary health-care settings in Vietnam. : Search engines were used to identify relevant records of scientific and grey literature. Data from selected articles were analysed using standardised spreadsheets and MaxQDA and following a framework synthesis methodology. : There has been increasing interest in research and policy concerning the burden of HTN in Vietnam, covering many aspects of access to treatment at the primary health-care level. Vietnam's National HTN Programme is managed as a vertical programme and its services integrated into the network of primary health-care facilities across the public sector in selected provinces. The Programme financed population-wide screening campaigns for the early detection of HTN among people above 40 years of age. There was no information on the acceptability of HTN health services, especially regarding the interaction between patients and health professionals. In general, articles reported good availability of medication, but problems in accessing them included: fragmentation and lack of consistency in prescribing medication between different levels and short timespans for dispensing medication at primary health-care facilities. There was limited information related to the cost and economic impact of HTN treatment. Treatment adherence among hypertensive patients based on four studies did not exceed 70%. : Although the Vietnamese health-care system has taken steps to accommodate some of the needs of HTN patients, it is crucial to scale-up interventions that allow for regular, systematic, and integrated care, especially at the lowest levels of care.
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http://dx.doi.org/10.1080/16549716.2019.1610253DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534204PMC
August 2019

Working in preventive medicine or not? Flawed perceptions decrease chance of retaining students for the profession.

Hum Resour Health 2019 05 15;17(1):31. Epub 2019 May 15.

Faculty of Health, Medicine and Life Sciences, School of Health Professions Education (SHE), Maastricht University, P.O. Box 616, 6200, MD, Maastricht, the Netherlands.

Background: Recruiting and retaining students in preventive medical (PM) specialties has never been easy; one main challenge is how to select appropriate students with proper motivation. Understanding how students perceive PM practice differently from practicing doctors is necessary to guide students, especially for those for whom PM is only a substitute for medicine as their first study preference, properly during their study and, later, the practice of PM.

Methods: One thousand three hundred eighty-six PM students in four Vietnamese medical schools and 101 PM doctors filled out a questionnaire about the relevance of 44 characteristics of working in PM. ANOVAs were conducted to define the relationship between students' interest, year of study, willingness to work in PM, and the degree to which students had realistic perceptions of PM practice, compared to doctors' perceptions.

Results: Overall, compared to doctors' perceptions, students overestimated the importance of most of the investigated PM practice's characteristics. Moreover, students' perception related to their preference and willing to pursue a career in PM after graduation. In particular, students for whom PM was their first choice had more realistic perceptions of community practice than those who chose PM as their second choice. And, second-choice students had more realistic perceptions than first-choice students in their final years of study, but expected higher work stress in PM practice. Students who were willing to pursue a career in PM rated the importance of community practice higher than those who were not. We also found that students' perception changed during training as senior students had more realistic perceptions of clinical aspects and working stress than junior students, even though they overemphasized the importance of the community aspects of PM practice.

Conclusions: To increase the number of students actually entering the PM field after graduation, the flawed perceptions of students about the real working environment of PM doctors should be addressed through vocation-oriented activities in the curriculum targeted on groups of students who are most likely to have unrealistic perceptions. Our findings also have implications for other less attractive primary health care specialties that experience problems with recruiting and retaining students.
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http://dx.doi.org/10.1186/s12960-019-0368-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521520PMC
May 2019

How have researchers defined and used the concept of 'continuity of care' for chronic conditions in the context of resource-constrained settings? A scoping review of existing literature and a proposed conceptual framework.

Health Res Policy Syst 2019 Mar 7;17(1):27. Epub 2019 Mar 7.

Guelph International Health Consulting, Amsterdam, The Netherlands.

Background: Within the context of the growing burden of non-communicable diseases (NCDs) globally, there is limited evidence on how researchers have explored the response to chronic health needs in the context of health policy and systems in low- and middle-income countries. Continuity of care (CoC) is one concept that represents several elements of a long-term model of care. This scoping review aims to map and describe the state of knowledge regarding how researchers in resource-constrained settings have defined and used the concept of CoC for chronic conditions in primary healthcare.

Methods: This scoping review adopted the modified framework for interpretive scoping literature reviews. A systematic literature search in PubMed was performed, followed by a study selection process and data extraction, analysis and synthesis. Extracted data regarding the context of using CoC and the definition of CoC were analysed inductively to identify similar patterns; based on this, articles were divided into groups. MaxQDA was then used to re-code each article with themes according to the CoC definition to perform a cross-case synthesis under each identified group.

Results: A total of 55 peer-reviewed articles, comprising reviews or commentaries and qualitative or quantitative studies, were included. The number of articles has increased over the years. Five groups were identified as those (1) reflecting a change across stages or systems of care, (2) mentioning continuity or lack of continuity without a detailed definition, (3) researching CoC in HIV/AIDS programmes and its scaling up to support management of NCDs, (4) researching CoC in NCD management, and (5) measuring CoC with validated questionnaires.

Conclusion: Research or policy documents need to provide an explicit definition of CoC when this terminology is used. A framework for CoC is suggested, acknowledging three components for CoC (i.e. longitudinal care, the nature of the patient-provider relationship and coordinated care) while considering relevant contextual factors, particularly access and quality.
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http://dx.doi.org/10.1186/s12961-019-0426-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407241PMC
March 2019

Prevalence of Hypertension in Vietnam: A Systematic Review and Meta-Analysis.

Asia Pac J Public Health 2019 03 24;31(2):101-112. Epub 2019 Jan 24.

1 Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Studies on the prevalence of hypertension in Vietnam have reported various estimates. There is no up-to-date assessment of the evidence on the magnitude of hypertension in Vietnam. Search engines for scientific and gray literature were used to identify relevant records for eligibility screening and quality assessment. Data from selected articles were extracted using standardized spreadsheets. Statistical analysis included estimating pooled prevalence and odds ratio, heterogeneity evaluation, meta-regression, and subgroup analysis, in addition to sensitivity analysis and publication bias evaluation. The pooled prevalence of measured hypertension in Vietnam was 21.1% (95% confidence interval = 18.5-23.7) based on 10 studies, and 18.4% (95% confidence interval = 15.2-21.8) based on 3 national surveys. Lower pooled prevalence was estimated for hypertension awareness (9.3%) and hypertension treatment (4.7%). The pooled prevalence of measured hypertension is significantly higher among men. The pooled prevalence of measured hypertension and hypertension awareness and treatment were significantly lower in rural settings. There is a need to strengthen efforts for primary and secondary prevention and disease management to reduce morbidity and mortality, especially in rural residence settings.
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http://dx.doi.org/10.1177/1010539518824810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463272PMC
March 2019

Preventive medicine as a first- or second-choice course: a cross-sectional survey into students' motivational differences and implications for information provision.

BMC Res Notes 2017 Aug 10;10(1):383. Epub 2017 Aug 10.

School of Health Professions Education (SHE), Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.

Background: Challenges in recruiting and retaining medical staff in preventive medical specialties have recently been the subject of numerous studies. To improve selection procedures, it is important to understand the career preferences and incentives of students in preventive medicine (PM), who initially marked the program as either their first choice or second choice. 1386 PM students in four Vietnamese medical schools participated in a survey using a structured, written questionnaire. Students were asked about their reasons for entering medical school and studying PM, their perceptions of PM during the academic course, and their expected career path following graduation.

Results: First-choice PM students (group 1) more often had siblings working as a preventive doctor, while second-choice PM students' siblings (group 2) were more often medical students or clinical doctors. Group 1 had gathered more information about PM by consulting their high-school teachers and the national career guide. They were mainly drawn to the PM program by the newness of the profession, the prospect of a high-income job, its low entry criteria and low study burden compared to general medicine, their desire to uphold their family tradition, and to fulfill their family's wish of having a doctor in the family. Group 2 chose to study PM because they wanted to pursue their dream of becoming a doctor. Compared to the first group, their perception of PM more frequently changed during the later years of the curriculum and they more frequently envisioned becoming a clinical doctor following graduation.

Conclusions: Interest in and motivation for PM may be cultivated among prospective or current students by improving information provision, diffusing knowledge, and otherwise acquainting students better with the PM specialty before and during the program.
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http://dx.doi.org/10.1186/s13104-017-2706-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553608PMC
August 2017

U.S. Veteran Health Care Utilization Increases after Caregivers' Use of National Caregiver Telephone Support Line.

Health Soc Work 2017 May;42(2):e111-e119

Kern Center for the Science of Healthcare Delivery, and Division of Health Care Policy and Research, Mayo Clinic, 200 1st Avenue SW, Rochester, MN 55905. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Care Management and Social Work Services, Veterans Health Administration, Washington, DC. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems. Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care Systems, and University of Minnesota, Minneapolis.

The U.S. Department of Veterans Affairs (VA) established the national Caregiver Support Line (CSL) in February 2011. The CSL is operated by licensed master's degree social workers who provide caregivers of veterans with information about caregiver benefits and services, counseling, and referrals to a caregiver support coordinator at the nearest VA medical center. The authors compared differences in veteran health care utilization patterns in the six months before and after a caregiver call to the CSL, hypothesizing that veterans with caregivers using the CSL had improved access to health care services and improved access increased utilization of health care. A pre- and posttest design was used. CSL calls that resulted in referrals to VA health care services or to local VA caregiver support coordinators were included in the sample. Data were extracted from the CSL database and matched to veteran care utilization data using veteran medical record data. Veteran inpatient stays for general medicine, hospice, respite, and long-term care significantly increased after the CSL call, but other inpatient stays (surgery, neurology) did not. Outpatient services for home health, respite, and mental health all significantly increased. Caregivers' use of the national CSL may help facilitate access for veterans to needed care services.
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http://dx.doi.org/10.1093/hsw/hlx016DOI Listing
May 2017

Adherence to hypertension medication: Quantitative and qualitative investigations in a rural Northern Vietnamese community.

PLoS One 2017 1;12(2):e0171203. Epub 2017 Feb 1.

Department of Pharmacy, Unit of PharmacoTherapy, -Epidemiology & -Economics (PTE2), University of Groningen, Groningen, the Netherlands.

Objectives: The purposes of this study were to assess the adherence to medication of hypertensive patients visiting community health stations in a rural area in Vietnam, to examine the relationship between levels of adherence and cardiovascular risk among hypertensive patients and to further understand factors influencing adherence.

Methods: This study is part of a prospective one-year study conducted on hypertension management in a population aged 35 to 64 years. Data on age, sex, blood pressure and blood test results were collected at baseline. Cardiovascular risk was based on the Cardiovascular Risk Prediction Model for populations in Asia. To calculate medication adherence, the number of days the drug was taken was divided by the number of days since the first day of the prescription. A threshold of 80% was applied to differentiate between adherence and non-adherence. In-depth interviews were conducted among 18 subjects, including subjects classified as adherent and as non-adherent.

Results: Among 315 patients analyzed, 49.8% of the patients were adherent. Qualitative investigation revealed discrepancies in classification of adherence and non-adherence based on quantitative analysis and interviews. No significant difference in medication compliance between two cardiovascular disease risk groups (<10% vs. >10% risk) was found, also not after controlling for age, sex, and ethnicity (adjusted odds ratio at 1.068; 95% CI: 0.614 to 1.857). The odds of medication adherence in females was 1.531 times higher than in males but the difference was not statistically significant (95% CI: 0.957 to 2.448). Each one-year increase in age resulted in patients being 1.036 times more likely to be compliant (95% CI: 1.002 to 1.072). Awareness of complications related to hypertension was given as the main reason for adherence to therapy.

Conclusions: Medication adherence rate was relatively low among hypertensive subjects. The data suggest that rather than risk profile, the factor of age should be considered for guiding the choice on who to target for improving medication adherence.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0171203PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5287477PMC
August 2017

Cost-Effectiveness Analysis of Screening for and Managing Identified Hypertension for Cardiovascular Disease Prevention in Vietnam.

PLoS One 2016 18;11(5):e0155699. Epub 2016 May 18.

University of Groningen, Department of Pharmacy, Unit of PharmacoEpidemiology & PharmacoEconomics, Groningen, the Netherlands.

Objective: To inform development of guidelines for hypertension management in Vietnam, we evaluated the cost-effectiveness of different strategies on screening for hypertension in preventing cardiovascular disease (CVD).

Methods: A decision tree was combined with a Markov model to measure incremental cost-effectiveness of different approaches to hypertension screening. Values used as input parameters for the model were taken from different sources. Various screening intervals (one-off, annually, biannually) and starting ages to screen (35, 45 or 55 years) and coverage of treatment were analysed. We ran both a ten-year and a lifetime horizon. Input parameters for the models were extracted from local and regional data. Probabilistic sensitivity analysis was used to evaluate parameter uncertainty. A threshold of three times GDP per capita was applied.

Results: Cost per quality adjusted life year (QALY) gained varied in different screening scenarios. In a ten-year horizon, the cost-effectiveness of screening for hypertension ranged from cost saving to Int$ 758,695 per QALY gained. For screening of men starting at 55 years, all screening scenarios gave a high probability of being cost-effective. For screening of females starting at 55 years, the probability of favourable cost-effectiveness was 90% with one-off screening. In a lifetime horizon, cost per QALY gained was lower than the threshold of Int$ 15,883 in all screening scenarios among males. Similar results were found in females when starting screening at 55 years. Starting screening in females at 45 years had a high probability of being cost-effective if screening biannually was combined with increasing coverage of treatment by 20% or even if sole biannual screening was considered.

Conclusion: From a health economic perspective, integrating screening for hypertension into routine medical examination and related coverage by health insurance could be recommended. Screening for hypertension has a high probability of being cost-effective in preventing CVD. An adequate screening strategy can best be selected based on age, sex and screening interval.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0155699PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871542PMC
July 2017

Isolation and Identification of Conventional Dendritic Cell Subsets from the Intestine of Mice and Men.

Methods Mol Biol 2016 ;1423:101-18

Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Veterinary, Medical and Life Sciences, University of Glasgow, Scotland, UK.

The identification of conventional dendritic cells (cDCs) in the intestinal mucosa has been hampered by the difficulties associated with isolating cells from the intestine and by the fact that overlapping markers have made it complicated to discriminate them accurately from other intestinal mononuclear phagocytes such as macrophages (MFs). Here we detail the protocols we have developed to isolate live leukocytes from both murine and human small and large intestines and describe reliable strategies which can be used to identify bona fide cDCs in such preparations.
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http://dx.doi.org/10.1007/978-1-4939-3606-9_7DOI Listing
December 2017

Utilities of Patients with Hypertension in Northern Vietnam.

PLoS One 2015 27;10(10):e0139560. Epub 2015 Oct 27.

Department of Pharmacy, Unit of PharmacoEpidemiology&PharmacoEconomics (PE2), University of Groningen, Antonius Deusinglaan 1, 9713AV, Groningen, The Netherlands; Institute for Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen (UMCG), Groningen, The Netherlands.

Objectives: The study aims to inform potential cost-effectiveness analysis of hypertension management in Vietnam by providing utilities and predictors of utilities in patients with hypertension.

Methods: Hypertensive patients up to 80 years old visiting the hospital were invited to participate in a survey using Quality Metric's Short-form 36v2TM translated into Vietnamese. Health-state utilities were estimated by applying a previously published algorithm.

Results: The mean utility of the 691 patients interviewed was 0.73. Controlling for age, sex, blood pressure (BP) stage, and history of stroke, the utilities in older patients were lower than those in younger ones, and statistically significantly different between the extremes of youngest and oldest groups (p = 0.03). Utility in males was higher than in females (p = 0.002). As expected, patients with a history of stroke appeared to exhibit lower utilities than patients without such history, but the difference was not statistically significant (p = 0.73). Patients with more than three comorbidities did have lower utilities than patients without comorbidity (p = 0.01).

Conclusions: Health-state utilities found among hypertensive patients in Vietnam were similar to those found in other international studies. It is suggested that lower of health-state utilities exist among those patients who were older, female or had more than three comorbidities in comparison with respective reference groups. However, further research for confirmation is required. The data from this study provide a potential reference on health-state utilities of hypertensive patients in Vietnam as an input for future cost-effectiveness analysis of interventions. Also, it may serve as a reference for other similar populations, especially in the context of similar environments in low income countries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0139560PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4623979PMC
June 2016

Challenges in detection and treatment of multidrug resistant tuberculosis patients in Vietnam.

BMC Public Health 2015 Sep 29;15:980. Epub 2015 Sep 29.

Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Oxford, United Kingdom.

Background: Vietnam is ranked 14(th) among 27 countries with high burden of multidrug-resistant tuberculosis (MDR-TB). In 2009, the Vietnamese government issued a policy on MDR-TB called Programmatic Management of Drug-resistant Tuberculosis (PMDT) to enhance and scale up diagnosis and treatment services for MDR-TB. Here we assess the PMDT performance in 2013 to determine the challenges to the successful identification and enrollment for treatment of MDR-TB in Vietnam.

Methods: In 35 provinces implementing PMDT, we quantified the number of MDR-TB presumptive patients tested for MDR-TB by Xpert MTB/RIF and the number of MDR-TB patients started on second-line treatment. In addition, existing reports and documents related to MDR-TB policies and guidelines in Vietnam were reviewed, supplemented with focus group discussions and in-depth interviews with MDR-TB key staff members.

Results: 5,668 (31.2 %) of estimated 18,165 MDR-TB presumptive cases were tested by Xpert MTB/RIF and second-line treatment was provided to 948 out of 5100 (18.7 %) of MDR-TB patients. Those tested for MDR-TB were 340/3224 (10.5 %) of TB-HIV co-infected patients and 290/2214 (13.1 %) of patients who remained sputum smear-positive after 2 and 3 months of category I TB regimen. Qualitative findings revealed the following challenges to detection and enrollment of MDR-TB in Vietnam: insufficient TB screening capacity at district hospitals where TB units were not available and poor communication and implementation of policy changes. Instructions for policy changes were not always received, and training was inconsistent between training courses. The private sector did not adequately report MDR-TB cases to the NTP.

Conclusions: The proportion of MDR-TB patients diagnosed and enrolled for second-line treatment is less than 20 % of the estimated total. The low enrollment is largely due to the fact that many patients at risk are missed for MDR-TB screening. In order to detect more MDR-TB cases, Vietnam should intensify case finding of MDR-TB by a comprehensive strategy to screen for MDR-TB among new cases rather than targeting previously treated cases, in particular those with HIV co-infection and contacts of MDR-TB patients, and should engage the private sector in PMDT.
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http://dx.doi.org/10.1186/s12889-015-2338-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587724PMC
September 2015

Ankylosing spondylitis patients display altered dendritic cell and T cell populations that implicate pathogenic roles for the IL-23 cytokine axis and intestinal inflammation.

Rheumatology (Oxford) 2016 Jan 28;55(1):120-32. Epub 2015 Aug 28.

Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow and

Objective: AS is a systemic inflammatory disease of the SpA family. Polymorphisms at loci including HLA-B27, IL-23R and ERAP-1 directly implicate immune mechanisms in AS pathogenesis. Previously, in an SpA model, we identified HLA-B27-mediated effects on dendritic cells that promoted disease-associated Th17 cells. Here we extend these studies to AS patients using deep immunophenotyping of candidate pathogenic cell populations. The aim of our study was to functionally characterize the immune populations mediating AS pathology.

Methods: Using 11-parameter flow cytometry, we characterized the phenotype and functions of lymphocyte and myeloid cells from peripheral blood, and the synovial phenotype of AS patients and age-matched healthy controls.

Results: Significantly fewer circulating CD1c-expressing dendritic cells were observed in AS patients, offset by an increase in CD14(-) CD16(+) mononuclear cells. Ex vivo functional analysis revealed that this latter population induced CCR6 expression and promoted secretion of IL-1β and IL-6 when co-cultured with naive CD4(+) T cells. Additionally, systemic inflammation in AS patients significantly correlated with increased proportions of activated CCR9(+) CD4(+) T cells.

Conclusion: CD14(-) CD16(+) mononuclear cells may contribute to AS by promoting Th17 responses, and antigen-presenting cells of mucosal origin are likely to contribute to systemic inflammation in AS.
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http://dx.doi.org/10.1093/rheumatology/kev245DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676904PMC
January 2016

Implementing a skillslab training program in a developing country.

Educ Health (Abingdon) 2014 Sep-Dec;27(3):243-8

Medical Education Center, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang St, District 5, Ho Chi Minh City, Vietnam, Vietnam.

Background: Eight skills laboratories (skillslabs) were established by consensus of Vietnamese medical universities, with international support. A national list of basic skills needed for medical practice and suitable for skillslab training was developed; models, medical and teaching equipment were supplied; learning material was developed and core staff and teachers were trained. This study was designed to assess how closely eight schools in Vietnam came to implementing all recommended skills on list developed by educators of that country, and identify the facilitating factors and barriers to skillslab use within the country's largest school.

Methods: Data were collected from reports from the eight skillslabs. Students and trainers from the largest university were surveyed for their perceptions of the quality of training on eight selected skills. Results of students' skill assessments were gathered, and focus group discussions with trainers were conducted. SPSS 16 was used to analyze the quantitative data and cluster analysis was used to test for differences.

Results: Only one medical school was able to train all 56 basic skills proposed by consensus among the eight Vietnamese medical universities. Deeper exploration within the largest school revealed that its skillslab training was successful for most skills, according to students' postprogram skills assessment and to students' and trainers' perceptions. However, through focus group discussions we learned that the quantity of training aids was perceived to be insufficient; some models/manikins were inappropriate for training; more consideration was needed in framing the expected requirements of students within each skill; too little time was allocated for the training of one of the eight skills investigated; and further curriculum development is needed to better integrate the skills training program into the broader curriculum.

Discussion: The fact that one medical school could teach all skills recommended for skillslab training demonstrates that all Vietnamese schools may be similarly able to teach the basic skills of the national consensus list. But as of now, it remains challenging for most schools in this developing country to fully implement a national skillslab training program.
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http://dx.doi.org/10.4103/1357-6283.152181DOI Listing
November 2015

The VA Caregiver Support Line: A Gateway of Support for Caregivers of Veterans.

J Gerontol Soc Work 2015 11;58(4):386-98. Epub 2015 Mar 11.

a VA Caregiver Support Line , Canandaigua , New York , USA.

In passing the Caregivers and Veterans Omnibus Health Services Act of 2010, Congress created a legislative mandate for the Veterans Administration (VA) to strengthen its program of support services for caregivers of veterans. As part of this expansion, the VA implemented a nationwide toll-free telephone Caregiver Support Line (CSL). The CSL is a single point of entry system to link caregivers to national and local services to support care of a veteran. This article describes the CSL and its role in supporting aging veterans and their caregivers, discusses social workers' contributions to its development and implementation, and reports utilization data.
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http://dx.doi.org/10.1080/01634372.2015.1019168DOI Listing
October 2016

Cancer-related fatigue: results from patient experience surveys undertaken in a UK regional cancer centre.

Support Care Cancer 2015 Jul 23;23(7):2089-95. Epub 2014 Dec 23.

Lynda Jackson Macmillan Centre, Mount Vernon Cancer Centre, Northwood, Middlesex, HA6 2RN, UK,

Purpose: Cancer-related fatigue (CRF) is a common but under reported symptom significantly impacting on cancer patients' quality of life. The purpose of these surveys was to drive improvements in the provision of support of patients with CRF.

Method: Two surveys were conducted to determine the incidence and impact of cancer-related fatigue (CRF) amongst patients attending a Cancer Centre (CC) for radiotherapy and/or systemic anti-cancer therapy.

Results: Survey 1: retrospective examination of 68 patients' clinical notes. Survey 2: a questionnaire distributed prospectively to 148 patients whilst attending for treatment. Survey 1 identified 29 patients' notes recording the patient experiencing fatigue, but only two were given any advice to manage symptoms. In survey 2, the majority of patients (86%) were advised about the risk of CRF before treatment, but only 67% were assessed and advised about CRF during treatment. Physical fatigue (57%) was more common than emotional (37%) or cognitive fatigue (29%).

Conclusions: Many patients are not being given advice to manage their CRF symptoms. Reasons for this include a lack of awareness regarding the occurrence of CRF and its impact and a misunderstanding by Health Care Professionals (HCPs) about the advice patients should be given. Recommendations include the continued need to improve education of HCPs to ensure patients receive the appropriate advice they need to manage their CRF.
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http://dx.doi.org/10.1007/s00520-014-2565-9DOI Listing
July 2015

Perceptions of climate change and its impact on human health: an integrated quantitative and qualitative approach.

Glob Health Action 2014 8;7:23025. Epub 2014 Dec 8.

The Medical Committee Netherlands - Vietnam, Hanoi, Vietnam.

Background: The World Health Organization emphasized that climate change is a significant and emerging threat to public health, especially in lower income populations and tropical/subtropical countries. However, people in Asia and Africa were the least likely to perceive global warming as a threat. In Vietnam, little research has been conducted concerning the perceptions of effects of climate change on human health.

Objective: The aim of this study was to explore the perceptions on climate change and its impact on human health among people in Hanoi.

Design: We applied a combined quantitative and qualitative approach to study perceptions on climate change among people in Hanoi. A total of 1,444 people were recruited, including 754 people living in non-slum areas and 690 people living in slum areas of Hanoi. A structured questionnaire was used to collect quantitative data on their perceptions. In a parallel qualitative study, two focus group discussions and 12 in-depth interviews (IDs) were carried out involving 24 people from both slum and non-slum areas.

Results: The majority of the respondents in the study had heard about climate change and its impact on human health (79.3 and 70.1% in non-slum and slum areas, respectively). About one third of the respondents reported that members of their family had experienced illness in the recent summer and winter compared to the same seasons 5 years ago. The most common symptoms reported during hot weather were headaches, fatigue, and dizziness; hypertension and other cardiovascular diseases were also reported. During cold weather, people reported experiencing cough, fever, and influenza, as well as pneumonia and emerging infectious diseases such as dengue and Japanese encephalitis.

Conclusions: The observed high level of awareness on the links between climate change and human health may help to increase the success of the National Prevention Program on Climate Change. Moreover, understanding the concerns of the people may help policy makers to develop and implement effective and sustainable adaptation measures for Hanoi City as well as for Vietnam as a whole.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265644PMC
http://dx.doi.org/10.3402/gha.v7.23025DOI Listing
April 2015

Climatic-driven seasonality of emerging dengue fever in Hanoi, Vietnam.

BMC Public Health 2014 Oct 16;14:1078. Epub 2014 Oct 16.

Biostatistics and Medical Informatics Department, Institute of Training for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.

Background: Dengue fever (DF) has been emerging in Hanoi over the last decade. Both DF epidemiology and climate in Hanoi are strongly seasonal. This study aims at characterizing the seasonality of DF in Hanoi and its links to climatic variables as DF incidence increases from year to year.

Methods: Clinical suspected cases of DF from the 14 central districts of Hanoi were obtained from the Ministry of Health over a 8-year period (2002-2009). Wavelet decompositions were used to characterize the main periodic cycles of DF and climatic variables as well as the mean phase angles of these cycles. Cross-wavelet spectra between DF and each climatic variables were also computed. DF reproductive ratio was calculated from Soper's formula and smoothed to highlight both its long-term trend and seasonality.

Results: Temperature, rainfall, and vapor pressure show strong seasonality. DF and relative humidity show both strong seasonality and a sub-annual periodicity. DF reproductive ratio is increasing through time and displays two clear peaks per year, reflecting the sub-annual periodicity of DF incidence. Temperature, rainfall and vapor pressure lead DF incidence by a lag of 8-10 weeks, constant through time. Relative humidity leads DF by a constant lag of 18 weeks for the annual cycle and a lag decreasing from 14 to 5 weeks for the sub-annual cycle.

Conclusion: Results are interpreted in terms of mosquito population dynamics and immunological interactions between the different dengue serotypes in the human compartment. Given its important population size, its strong seasonality and its dengue emergence, Hanoi offers an ideal natural experiment to test hypotheses on dengue serotypes interactions, knowledge of prime importance for vaccine development.
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http://dx.doi.org/10.1186/1471-2458-14-1078DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287517PMC
October 2014

Burden of care for persons with disabilities in Vietnam.

Health Soc Care Community 2014 Nov 25;22(6):660-71. Epub 2014 Sep 25.

Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.

Vietnam has more than 6 million persons with disabilities (PWD), or 7.8% of the population. To provide better services for them, it is important to investigate the care they currently receive, and to obtain evidence on the health outcomes from that care. This study aimed to estimate the quality of life and functional status of a group of PWD in Vietnam and the cost of care they receive. This was an analytical study exploring the time and cost of informal care, the cost of illness (prevalence-based, patient perspective), quality of life using EuroQoL and functional status using the Barthel Index. The sample was selected from urban and rural areas of Quang Tri province in Central Vietnam, using systematic random sampling. Data were collected by face-to-face interviews, and in a 1-month diary recorded during July-August 2010 for summer and in December 2010 for winter. The costs are presented in 2010 USD values. The data were analysed by descriptive, univariate and multivariate statistics to summarise and explore the relationships among dependent and independent variables. The study sample included 210 PWD, with an average age of 38 years and duration of disability on average 26 years. The health-related quality of life measured in terms of the health utility score (0 = death, 1 = full health) was on average 0.44 and 0.39 in summer and winter respectively. The total cost of illness per year per case was USD 971 (83% of gross domestic product per capita); explanatory variables were the age of the PWD, receiving community-based rehabilitation, receiving government support and the severity of the disability. This illustrates the importance of services and support for reduction of the economic burden on the family. In conclusion, the results of this study provide information on the burden caused by disabilities in rural and urban households in Vietnam.
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http://dx.doi.org/10.1111/hsc.12147DOI Listing
November 2014

Models to Predict the Burden of Cardiovascular Disease Risk in a Rural Mountainous Region of Vietnam.

Value Health Reg Issues 2014 May 10;3:87-93. Epub 2014 May 10.

Unit of PharmacoEpidemiology & PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.

Objective: To compare and identify the most appropriate model to predict cardiovascular disease (CVD) in a rural area in Northern Vietnam, using data on hypertension from the communities.

Methods: A cross-sectional survey was conducted including all residents in selected communities, aged 34 to 65 years, during April to August 2012 in Thai Nguyen province. Data on age, sex, smoking status, blood pressure, and blood tests (glucose, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol) were collected to identify the prevalence of high blood pressure and to use as input variables for the models. We compared three models, Asian, Chinese Multiple-provincial Cohort Study (CMCS), and Framingham, to estimate cardiovascular risk in the coming years in this context and compare these models and outcomes.

Results: The prevalence of high blood pressure in these communities was lower than reported nationally (12.3%). CVD risk differed greatly depending on the model applied: approximately 21% of the subjects according to the CMCS and Asian models, but 37% using the Framingham model, had more than 10% risk for CVD. In the group without current CVD, these numbers decreased to 9% using the CMCS and Asian models but increased to 28% according to the Framingham model. There were no significant differences between the Asian and CMCS models, but differences were highly significant when comparing Asian versus Framingham or CMCS versus Framingham model.

Conclusions: The Asian and CMCS models provided similar results in predicting CVD risk in the Vietnamese population in Thai Nguyen. The Framingham model provided vastly different results. The suggestion may be that for the specific Vietnamese setting, the Asian and CMCS models provide most valid and reliable results; however, this has to be investigated in further analyses using real-life data for potential confirmation.
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http://dx.doi.org/10.1016/j.vhri.2014.03.003DOI Listing
May 2014

The relationships between the use of self-regulated learning strategies and depression among medical students: an accelerated prospective cohort study.

Psychol Health Med 2015 14;20(1):59-70. Epub 2014 Mar 14.

a Public Health Program , Graduate School, Khon Kaen University , Khon Kaen , Thailand.

We conducted this study to determine the relationships between the use of self-regulated learning strategies (SRL) and depression scores among medical students. An accelerated prospective cohort study among 623 students at a public medical university in Vietnam was carried out during the academic year 2012-2013. The Depression, Anxiety and Stress Scales (21 items) was used to measure depression scores as the primary research outcome, and to measure anxiety and stress scores as the confounding variables. Fourteen SRL subscales including intrinsic/extrinsic goal orientation, task value, self-efficacy for learning, control of learning beliefs, rehearsal, elaboration, organization, critical thinking, meta-cognitive strategies, time and study environment, effort regulation, peer learning, and help seeking were measured using the Motivated Strategies for Learning Questionnaire. Data were collected at two points in time (once each semester). There were 744 responses at the first time (95.88%) and 623 at time two (drop-out rate of 16.26%). The generalized estimating equation was applied to identify any relationships between the use of each SRL subscale and depression scores at time 2, adjusting for the effects of depression at time 1, anxiety, stress, within cluster correlation, and potential demographic covariates. Separate multivariate GEE analysis indicated that all SRL subscales were significantly negatively associated with depression scores, except for extrinsic goal orientation and peer learning. Whereas full multivariate GEE analysis revealed that self-efficacyT1, help-seekingT1, time and study environmentT2 were found to be significantly negatively associated with depressionT2, adjusting for the effects of depressionT1, anxiety, stress, and demographic covariates. The results should be used to provide appropriate support for medical students to reduce depression.
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http://dx.doi.org/10.1080/13548506.2014.894640DOI Listing
July 2015