Early Pathological Mechanisms in a Mouse Model of Heart Failure with Preserved Ejection Fraction.

Heart failure with preserved ejection fraction (HFpEF) constitutes more than half of all HF cases, yet evidence-based therapies remain lacking due to limited understanding of its underlying pathological mechanisms. Our study aimed to uncover early pathological mechanisms in HFpEF by exposing mice to dietary conditions resembling a Western diet-rich in fats, salt, and low in fiber-alongside excess mineralocorticoids to replicate significant aspects of human HFpEF. Echocardiography was performed at both 3-week and 6-week intervals post-challenge, revealing cardiac alterations as early as 3-weeks. While ejection fraction remained preserved, mice exhibited signs of diastolic dysfunction, reduced stroke volume, and left atrial enlargement. Additionally, changes in pulmonary flow velocities were noted by the 3-week mark, suggesting elevated pulmonary pressure. Extracardiac comorbidities included organ congestion, increased adiposity, impaired glucose tolerance, and hypercholesterolemia. Molecular analyses unveiled evidence of low-grade inflammation, oxidative stress, and impaired NO-cGMP-PKG signaling, contributing to the observed decrease in titin phosphorylation, thereby impacting myocardial stiffness. Additionally, impaired NO signaling might have influenced the alterations observed in coronary flow reserve. Moreover, dysregulation of calcium signaling in cardiomyocytes and reduced SR load were observed. Interestingly, elevated phosphorylation of cMyBP-C was linked to preserved ejection fraction despite reduced SR load. We also observed intestinal atrophy, possibly due to low dietary fiber intake and diminished gut perfusion, potentially contributing to systemic low-grade inflammation. These findings reveal how excess mineralocorticoids-salt-induced hypertension, and dietary factors, like high-fat and low-fiber intake, contribute to cardiac dysfunction and metabolic disturbances, offering insights into early HFpEF pathology in this model.

Anaerobic membrane bioreactors for municipal wastewater: Progress in resource and energy recovery improvement approaches.

Anaerobic membrane bioreactor (AnMBR) offer promise in municipal wastewater treatment, with potential benefits including high-quality effluent, energy recovery, sludge reduction, and mitigating greenhouse gas emissions. However, AnMBR face hurdles like membrane fouling, low energy recovery, etc. In light of net-zero carbon target and circular economy strategy, this work sought to evaluate novel AnMBR configurations, focusing on performance, fouling mitigation, net-energy generation, and nutrients-enhancing integrated configurations, such as forward osmosis (FO), membrane distillation (MD), bioelectrochemical systems (BES), membrane photobioreactor (MPBR), and partial nitrification-anammox (PN/A). In addition, we highlight the essential role of AnMBR in advancing the circular economy and propose ideas for the water-energy-climate nexus. While AnMBR has made significant progress, challenges, such as fouling and cost-effectiveness persist. Overall, the use of novel configurations and energy recovery strategies can further improve the sustainability and efficiency of AnMBR systems, making them a promising technology for future sustainable municipal wastewater treatment.

Observation of super-Nernstian proton-coupled electron transfer and elucidation of nature of charge carriers in a multiredox conjugated polymer.

Nernstian proton-coupled electron transfer (PCET) is a fundamental process central to many physical and biological systems, such as electrocatalysis, enzyme operation, DNA biosynthesis, pH-/bio-sensors, and electrochemical energy storage devices. We report herein the discovery of super-Nernstian PCET behavior with two protons per electron transferred in the electrochemical doping of a redox conjugated polymer, phenazine-substituted ladder poly(benzimidazobenzophenanthroline) (BBL-P), in aqueous electrolyte. We show that the super-Nernstian response originates from existence of multiredox centers that have a gradient of pKa on the conjugated polymer. Our use of various pH-dependent in operando techniques to probe the nature of charge carriers in n-doped BBL-P found that polarons are the charge carriers at low to intermediate levels of doping (0.1-1.0 electron per repeat unit (eru)) whereas at higher doing levels (1.3 eru), polarons, polaron pairs, and bipolarons co-exist, which evolve into strongly coupled polaron pairs at the highest doping levels (>1.5 eru). We show that PCET-assisted n-doping of BBL-P results in very high redox capacity (>1200 F cm-3) in acidic electrolyte. Our results provide important new insights into PCET in organic materials and the nature of charge carriers in n-doped conjugated polymers while having implications for various electrochemical devices.

A national program to advance dementia research in Vietnam.

BACKGROUND: As Vietnam and other low- and middle-income countries (LMIC) experience a rapid increase in the number of people living with dementia, an acute need exists to strengthen research capacity to inform policy, improve care and support, and develop national dementia plans. We describe the development and early outcomes of an National Institutes of Health (NIH)/National Institute on Aging (NIA)-funded national dementia research capacity building program in Vietnam. METHODS: The research capacity building program commenced in 2019 and has three components: (1) Vietnam Alzheimer's and other dementias research Network (VAN), (2) a mentored pilot grant program, and (3) research training, networking, and dissemination activities. The pilot grant program funds Vietnamese researchers for one to two years to conduct research focusing on Alzheimer's Disease and Alzheimer's Disease Related Dementias (AD/ADRD). Grants are reviewed and scored using NIH criteria, and priority is given to pilot grants with policy relevance and potential for future funding. An international pool of high-income country (e.g., United States, Australia, and United Kingdom) mentors has been engaged and mentors paired with each funded project. Training and networking activities include workshops on AD/ADRD research topics and regular meetings in conjunction with Vietnam's annual national dementia/geriatric conferences. Dissemination is facilitated through targeted outreach and the creation of a national network of institutions. RESULTS: Over four years (2019-2023), we received 62 applications, reviewed 58 applications, and funded 21 projects (4-5 per year). Funded investigators were from diverse disciplines and institutions across Vietnam with projects on a range of topics, including biomarkers, prevention, diagnosis, neuropsychological assessment, family caregiver support, dementia education, and clinical trials. A network of 12 leading academic and research institutions nationwide has been created to facilitate dissemination. Six research training workshops have been organized and included presentations from international speakers. Grantees have published or presented their studies at both national and international levels. The mentoring program has helped grantees to build their research skills and expand their research network. CONCLUSION: This research capacity building program is the first of its kind in Vietnam and may serve as a useful model for other LMIC.

Identifying spatiotemporal trends of SARS-CoV-2 RNA in wastewater: from the perspective of upstream and downstream wastewater-based epidemiology (WBE).

Recently, many efforts have been made to address the rapid spread of newly identified COVID-19 virus variants. Wastewater-based epidemiology (WBE) is considered a potential early warning tool for identifying the rapid spread of this virus. This study investigated the occurrence of SARS-CoV-2 in eight wastewater treatment plants (WWTPs) and their sewerage systems which serve most of the population in Taoyuan City, Taiwan. Across the entire study period, the wastewater viral concentrations were correlated with the number of COVID-19 cases in each WWTP (Spearman's r = 0.23-0.76). In addition, it is confirmed that several treatment technologies could effectively eliminate the virus RNA from WWTP influent (> 90%). On the other hand, further results revealed that an inverse distance weighted (IDW) interpolation and hotspot model combined with the geographic information system (GIS) method could be applied to analyze the spatiotemporal variations of SARS-CoV-2 in wastewater from the sewer system. In addition, socio-economic factors, namely, population density, land use, and income tax were successfully identified as the potential drivers which substantially affected the onset of the COVID-19 outbreak in Taiwan. Finally, the data obtained from this study can provide a powerful tool in public health decision-making not only in response to the current epidemic situation but also to other epidemic issues in the future.

Caregivers of People With Mild Cognitive Impairment and Dementia: Characterizing Social and Psychological Outcomes.

OBJECTIVE: Little is known about caregiving across the spectrum of cognitive impairment [mild cognitive impairment (MCI) to dementia] and how early life and sociocultural factors affect caregiver health. In this study, we characterized differences between caregivers of those with MCI versus those with dementia. METHODS: A total of 158 caregivers were enrolled in this cross-sectional study, most of whom were dementia caregivers (65%). Caregivers completed questionnaires on depressive symptoms, self-rated health (SRH), perceived burden and stress, as well as psychosocial and demographic measures. RESULTS: Caregivers of those with MCI reported fewer depressive symptoms and lower stress and burden compared with dementia caregivers. In adjusted analyses caregivers with greater stress reported more depressive symptoms. For SRH, at lower stress levels, having a sibling die before age 18 (ie, early life adversity) was associated with poorer SRH; at higher stress levels, having early life adversity was associated with better SRH. At lower burden levels, more live births were associated with worse SRH; at higher burden levels, more live births were associated with better SRH. CONCLUSIONS: Early life factors are relevant for caregivers of those with cognitive impairment and targeted prevention and early intervention may be helpful in alleviating caregiver burden and stress.

Mapping racial and ethnic healthcare disparities for persons living with dementia: A scoping review.

INTRODUCTION: We set out to map evidence of disparities in Alzheimer's disease and Alzheimer's disease related dementias healthcare, including issues of access, quality, and outcomes for racial/ethnic minoritized persons living with dementia (PLWD) and family caregivers. METHODS: We conducted a scoping review of the literature published from 2000 to 2022 in PubMed, PsycINFO, and CINAHL. The inclusion criteria were: (1) focused on PLWD and/or family caregivers, (2) examined disparities or differences in healthcare, (3) were conducted in the United States, (4) compared two or more racial/ethnic groups, and (5) reported quantitative or qualitative findings. RESULTS: Key findings include accumulating evidence that minoritized populations are less likely to receive an accurate and timely diagnosis, be prescribed anti-dementia medications, and use hospice care, and more likely to have a higher risk of hospitalization and receive more aggressive life-sustaining treatment at the end-of-life. DISCUSSION: Future studies need to examine underlying processes and develop interventions to reduce disparities while also being more broadly inclusive of diverse populations.

Chain Length Dependence of Electron Transport in an n-Type Conjugated Polymer with a Rigid-Rod Chain Topology.

Most currently known n-type conjugated polymers have a semiflexible chain topology, and their charge carrier mobilities are known to peak at modest chain lengths of below 40-60 repeat units. Herein, we show that the field-effect electron mobility of a model n-type conjugated polymer that has a rigid-rod chain topology grows continuously without saturation, even at a chain length exceeding 250 repeat units. We found the mechanism underlying the novel chain length-dependent electron transport to originate from the reduced structural disorder and energetic disorder with the increasing degree of polymerization inherent to the rigid-rod chain topology. Furthermore, we demonstrate a unique chain length-dependent decay of threshold voltage, which is rationalized by decreased trap densities and trap depths with respect to the degree of polymerization. Our findings provide new insights into the role of polymer chain topology in electron transport and demonstrate the promise of rigid-rod chain architectures for the design of future high-mobility conjugated polymers.

Care needs assessment of older adults with dementia in a semi-rural district in Vietnam: A community-based cross-sectional study.

BACKGROUND: The increasing needs of people living with dementia (PLWD) in Vietnam present an enormous public health challenge. Vietnam is an understudied country, and little is known regarding the overall unmet needs of caregivers or the demographic risk factors associated with unmet caregiving needs. This study aimed to determine the burden of unmet care needs of community-dwelling PLWD and identify sociodemographic risks associated with unmet care needs. METHODS: A cross-sectional study in a rural area facing urbanisation in Hanoi, Vietnam recruited PWLD-caregiver dyads with multistage sampling. We utilised the Camberwell Assessment of Need for the Elderly (CANE) instrument to evaluate care needs across four domains. Caregivers rated PLWD needs, with higher scores indicating greater unmet needs. The Mann-Whitney test was employed for comparing two groups, while the Kruskal-Wallis test was used for comparisons involving more than two groups in the analysis, and a P-value of less than 0.05 was considered statistically significant. RESULTS: Among 90 PLWD participating in the study, the overall mean care needs score was 11.6 ± 4.3, with only 16.2% of PLWD having their care needs met. Environmental and physical needs were more frequently met than psychological or social needs. Only 48.0% and 43.9% of environmental and physical needs were met respectively, and a meagre 20.9% and 23.6% for psychological and social needs. Unmet care needs were more frequent for PWLD who were female, single or divorced, had lower monthly household income, or who were in more advanced stages of dementia, as indicated by Clinical Dementia Rating scores ≥1. CONCLUSIONS: Unmet needs for PWLD are common. Increased caregiver education, resources, and services in Vietnam are urgently required to improve the quality of life for this population.

Nuclear FAK in endothelium: An intrinsic inhibitor of NF-κB activation in atherosclerosis.

BACKGROUND AND AIMS: Hyperlipidemia leads to the accumulation of oxidized low-density lipoprotein (oxLDL) within the vessel wall where it causes chronic inflammation in endothelial cells (ECs) and drives atherosclerotic lesions. Although focal adhesion kinase (FAK) is critical in proinflammatory NF-κB activation in ECs, it is unknown if hyperlipidemia alters FAK-mediated NF-κB activity in vivo to affect atherosclerosis progression. METHODS: We investigated changes in EC FAK and NF-κB activation using Apoe-/- mice fed a western diet (WD). Both pharmacological FAK inhibition and EC-specific FAK inhibited mouse models were utilized. FAK and NF-κB localization and activity were also analyzed in human atherosclerotic samples. RESULTS: ECs of hyperlipidemic mice clearly showed much higher levels of FAK activation in the cytoplasm, which was associated with increased NF-κB activation compared to normal diet (ND) group. On the contrary, FAK is mostly localized in the nucleus and inactive in ECs under healthy conditions with a low NF-κB activity. Both pharmacological and EC-specific genetic FAK inhibition in WD fed Apoe-/- mice exhibited a significant decrease in FAK activity and cytoplasmic localization, NF-κB activation, macrophage recruitment, and atherosclerotic lesions compared to the vehicle or FAK wild-type groups. Analyses of human atherosclerotic specimens revealed a positive correlation between increased active cytoplasmic FAK within ECs and NF-κB activation in the lesions. CONCLUSIONS: Hyperlipidemic conditions activate NF-κB pathway by increasing EC FAK activity and cytoplasmic localization in mice and human atherosclerotic samples. As FAK inhibition can efficiently reduce vascular inflammation and atherosclerotic lesions in mice by reversing EC FAK localization and NF-κB activation, these findings support a potential use for FAK inhibitors in treating atherosclerosis.

Characterization of reciprocation membrane bioreactor on treatment performance, energy consumption and membrane fouling.

Two reciprocating membranes (rMBR) with two frequencies of 0.46 Hz (rMBR-0.46) and 0.3 Hz (rMBR-0.3) were operated to compare the treatment performance and gross energy consumption with a conventional MBR. The average organic removal rates of MBR, rMBR-0.46 and rMBR-0.3 were maintained 295 ± 51; 823 ± 296; and 397 ± 129 mgCOD/gVSS.d, respectively. Nitrogen removal was enhanced in rMBR phases compared to conventional MBR phase due to anoxic membrane chamber. Further, fouling rate was found to be highest of 16.5 mbar/day (at conventional MBR phase), which was and much decreased to1.0 mbar/day (at rMBR-0.46 phase) and then 0.2 mbar/day (rMBR-0.3 phase). The reciprocation membrane also showed energy potential by saving 10.6% electricity for each treated cubic meter of wastewater compared to the conventional MBR.

Current application of seaweed waste for composting and biochar: A review.

To address the origins of ocean acidification, seaweed aquaculture is emerging as a key biosequestration strategy. Nevertheless, seaweed biomass is involved in developing food and animal feed, whereas seaweed waste from commercial hydrocolloid extraction is dumped in landfills, which together limit the carbon cycle and carbon sequestration. This work sought to evaluate the production, properties, and applications of seaweed compost and biochar to strengthen the "carbon sink" implications of aquaculture sectors. Due to their unique characteristics, the production of seaweed-derived biochar and compost, as well as their existing applications, are distinct when compared to terrestrial biomass. This paper outlines the benefits of composting and biochar production as well as proposes ideas and perspectives to overcome technical shortcomings. If properly synchronized, progression in the aquaculture sector, composting, and biochar production, potentially promote various Sustainable Development Goals.

Roles of microalgae-based biofertilizer in sustainability of green agriculture and food-water-energy security nexus.

For years, agrochemical fertilizers have been used in agriculture for crop production. However, intensive utilization of chemical fertilizers is not an ecological and environmental choice since they are destroying soil health and causing an emerging threat to agricultural production on a global scale. Under the circumstances of the increasing utilization of chemical fertilizers, cultivating microalgae to produce biofertilizers would be a wise solution since desired environmental targets will be obtained including (1) replacing chemical fertilizer while improving crop yields and soil health; (2) reducing the harvest of non-renewable elements from limited natural resources for chemical fertilizers production, and (3) mitigating negative influences of climate change through CO2 capture through microalgae cultivation. Recent improvements in microalgae-derived-biofertilizer-applied agriculture will be summarized in this review article. At last, the recent challenges of applying biofertilizers will be discussed as well as the perspective regarding the concept of circular bio-economy and sustainable development goals (SDGs).

Hydration of a Side-Chain-Free n-Type Semiconducting Ladder Polymer Driven by Electrochemical Doping.

We study the organic electrochemical transistor (OECT) performance of the ladder polymer poly(benzimidazobenzophenanthroline) (BBL) in an attempt to better understand how an apparently hydrophobic side-chain-free polymer is able to operate as an OECT with favorable redox kinetics in an aqueous environment. We examine two BBLs of different molecular masses from different sources. Regardless of molecular mass, both BBLs show significant film swelling during the initial reduction step. By combining electrochemical quartz crystal microbalance gravimetry, in-operando atomic force microscopy, and both ex-situ and in-operando grazing incidence wide-angle X-ray scattering (GIWAXS), we provide a detailed structural picture of the electrochemical charge injection process in BBL in the absence of any hydrophilic side-chains. Compared with ex-situ measurements, in-operando GIWAXS shows both more swelling upon electrochemical doping than has previously been recognized and less contraction upon dedoping. The data show that BBL films undergo an irreversible hydration driven by the initial electrochemical doping cycle with significant water retention and lamellar expansion that persists across subsequent oxidation/reduction cycles. This swelling creates a hydrophilic environment that facilitates the subsequent fast hydrated ion transport in the absence of the hydrophilic side-chains used in many other polymer systems. Due to its rigid ladder backbone and absence of hydrophilic side-chains, the primary BBL water uptake does not significantly degrade the crystalline order, and the original dehydrated, unswelled state can be recovered after drying. The combination of doping induced hydrophilicity and robust crystalline order leads to efficient ionic transport and good stability.

Neighborhood segregation and cognitive change: Multi-Ethnic Study of Atherosclerosis.

INTRODUCTION: We investigated associations between neighborhood racial/ethnic segregation and cognitive change. METHODS: We used data (n = 1712) from the Multi-Ethnic Study of Atherosclerosis. Racial/ethnic segregation was assessed using Getis-Ord (Gi*) z-scores based on American Community Survey Census tract data (higher Gi* = greater spatial clustering of participant's race/ethnicity). Global cognition and processing speed were assessed twice, 6 years apart. Adjusted multilevel linear regression tested associations between Gi* z-scores and cognition. Effect modification by race/ethnicity, income, education, neighborhood socioeconomic status, and neighborhood social support was tested. RESULTS: Participants were on average 67 years old; 43% were White, 11% Chinese, 29% African American/Black, 17% Hispanic; 40% had high neighborhood segregation (Gi* > 1.96). African American/Black participants with greater neighborhood segregation had greater processing speed decline in stratified analyses, but no interactions were significant. DISCUSSION: Segregation was associated with greater processing speed declines among African American/Black participants. Additional follow-ups and comprehensive cognitive batteries may further elucidate these findings. HIGHLIGHTS: A study of neighborhood racial/ethnic segregation and change in cognition. Study was based on a racially and geographically diverse, population-based cohort of older adults. Racial/ethnic segregation (clustering) was measured by the Getis-ord (Gi*) statistic. We saw faster processing speed decline among Black individuals in segregated neighborhoods.

Rapid fabrication of MgO@g-C3N4 heterojunctions for photocatalytic nitric oxide removal.

Nitric oxide (NO) is an air pollutant impacting the environment, human health, and other biotas. Among the technologies to treat NO pollution, photocatalytic oxidation under visible light is considered an effective means. This study describes photocatalytic oxidation to degrade NO under visible light with the support of a photocatalyst. MgO@g-C3N4 heterojunction photocatalysts were synthesized by one-step pyrolysis of MgO and urea at 550 °C for two hours. The photocatalytic NO removal efficiency of the MgO@g-C3N4 heterojunctions was significantly improved and reached a maximum value of 75.4% under visible light irradiation. Differential reflectance spectroscopy (DRS) was used to determine the optical properties and bandgap energies of the material. The bandgap of the material decreases with increasing amounts of MgO. The photoluminescence spectra indicate that the recombination of electron-hole pairs is hindered by doping MgO onto g-C3N4. Also, NO conversion, DeNOx index, apparent quantum efficiency, trapping tests, and electron spin resonance measurements were carried out to understand the photocatalytic mechanism of the materials. The high reusability of the MgO@g-C3N4 heterojunction was shown by a five-cycle recycling test. This study provides a simple way to synthesize photocatalytic heterojunction materials with high reusability and the potential of heterojunction photocatalysts in the field of environmental remediation.

COVID-19 impacts, opportunities and challenges for wildlife farms in Binh Duong and Ba Ria Vung Tau, Vietnam.

The wildlife trade is a major cause of species loss and can trigger disease transmission. While the COVID-19 pandemic sparked public interest in eliminating the wildlife trade, a better understanding is needed of the economic repercussions of COVID-19 on those who rely on wildlife farming for their livelihoods. Using the case studies of Ba Ria Vung Tau and Binh Duong provinces in Vietnam - a country seen as Asia's wildlife trade hotspot - this paper explores COVID-19's impacts on wildlife farms and their owners. Understanding these impacts is important, both in order to design appropriate interventions to support local people in mitigating COVID-19's impacts as well as to inform effective policymaking around wildlife conservation in Vietnam. In this study, we adopted mixed research methods (including a literature and policy review, stakeholder consultation with government agencies and NGOs engaged in designing and monitoring wildlife conservation policies, a wildlife farming household survey, and research validation workshop) to understand the status of Vietnamese wildlife farms, as well as the impacts of COVID-19, and any opportunities and challenges for wildlife conservation and management in Vietnam. Our paper shows that, across the two studied provinces, numbers of wildlife farms and farmed wildlife animals have both declined since the pandemic, with declining market demand and wildlife farm owners experiencing difficulties accessing markets due to travel restrictions. Although this affected wildlife-related income, this represented less than 30 % of families' overall income on average, and thus households were able to maintain their livelihoods through other sources. Most wildlife is raised as an additional food source for farming families and plays an important role in the diets of surveyed households. Findings also highlighted that most surveyed households' post-pandemic recovery strategies involved expanding their wildlife farms in scope and scale; these households perceived a stable domestic market and high prices for wildlife products in future. Our study found several opportunities for sustainable wildlife farming practices, including greater political commitment, an increasing number of wildlife conservation policies, and stronger law enforcement mechanisms. Challenges remain, however; including an unclear and inconsistent policy framework, the presence of an illegal market, and wildlife farm owners' limited knowledge and understanding of wildlife policies. Our paper also shows a lack of comprehensive data and understanding around actual wildlife transactions during the pandemic, leading to challenges in confirming whether COVID-19 had any real impact on wildlife trade. Further research is required to address this knowledge gap.

An overview of deploying membrane bioreactors in saline wastewater treatment from perspectives of microbial and treatment performance.

The discharged saline wastewater has severely influenced the aquatic environment as the treatment performance of many wastewater treatment techniques is limited. In addition, the sources of saline wastewater are also plentiful from agricultural and various industrial fields such as food processing, tannery, pharmaceutical, etc. Although high salinity levels negatively impact the performance of both physicochemical and biological processes, membrane bioreactor (MBR) processes are considered as a potential technology to treat saline wastewater under different salinity levels depending on the adaption of the microbial community. Therefore, this study aims to systematically review the application of MBR widely used in the saline wastewater treatment from the perspectives of microbial structure and treatment efficiencies. At last, the concept of carbon dioxide capture and storage will be proposed for the MBR-treating saline wastewater technologies and considered toward the circular economy with the target of zero emission.

Resources for Enhancing Alzheimer's Caregiver Health in Vietnam (REACH VN): Exploratory Analyses of Outcomes of a Cluster Randomized Controlled Trial to Test the Feasibility and Preliminary Efficacy of a Family Dementia Caregiver Intervention in Vietnam.

OBJECTIVE: Few support services and caregiving interventions exist to support family caregivers in low- and middle-income countries (LMIC). This paper presents exploratory analyses of outcomes of Resources for Enhancing Alzheimer's Caregiver Health in Vietnam (REACH VN). METHODS: A cluster randomized controlled trial (RCT) was conducted in Soc Son, a semi-rural area in Hanoi. Nine clusters with 60 caregivers were randomized to either an enhanced control group or REACH VN, an in-home, multicomponent, family caregiver support intervention delivered over two to three months. Outcomes were assessed at baseline and three months. RESULTS: Caregivers in the intervention group experienced a significantly greater reduction in frustration levels compared to those in the control group. There were differences in other outcomes (e.g., care recipient problem behaviors and associated caregiver bother) favoring the intervention condition that did not reach statistical significance. CONCLUSION: We found additional evidence that REACH VN is a promising intervention to improve family caregiver outcomes in Vietnam.

Resources for Enhancing Alzheimer's Caregiver Health in Vietnam (REACH VN): study protocol for a cluster randomized controlled trial to test the efficacy of a family dementia caregiver intervention in Vietnam.

BACKGROUND: Alzheimer's disease and related dementias (AD/ADRD) are a public health challenge for Vietnam because of its rapidly aging population. However, very few community-based programs exist to support people living with AD/ADRD and their family caregivers. Resources for Enhancing Alzheimer's Caregiver Health in Vietnam (REACH VN) is a culturally adapted family caregiver intervention shown in a pilot study to be feasible and promising in terms of preliminary efficacy. We describe the protocol for a larger cluster randomized controlled trial (RCT) to test the efficacy of REACH VN among family caregivers of people living with dementia in a semi-rural area outside of Hanoi, Vietnam. METHODS: Thirty-two clusters with approximately 350 caregivers will be randomized to either REACH VN intervention or enhanced usual care. REACH VN is a multicomponent intervention delivered in-home or by phone over the course of 2 to 3 months. To be eligible, family caregivers need to be ≥18 years old, be the person who provides the most day-to-day care for people living with dementia, and have a score ≥ 6 on the Zarit Burden Interview-4. The primary outcomes are caregiver burden (Zarit Burden Interview-12) and psychological distress (Patient Health Questionnaire-4). Secondary outcomes include caregiver somatic symptoms (Patient Health Questionnaire-15) and perceived stress (Perceived Stress Scale-10). These outcomes will be assessed at baseline, 3 months, and 6 months. Exploratory analyses to examine potential mediators of primary outcomes are also planned. DISCUSSION: To our knowledge, this is the first large-scale study to test the efficacy of a community-based family dementia caregiver intervention in Vietnam. Results from this study will help inform efforts to widely deliver the REACH VN intervention or similar community-based family dementia caregiver support programs in Vietnam and other low- and middle-income countries (LMIC). TRIAL REGISTRATION: ClinicalTrials.gov NCT04542317 . Registered on 9 September 2020.