Professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries: Systematic review.

OBJECTIVES: This systematic review aimed to review the safety and effectiveness of professionally applied fluorides for preventing and arresting dental caries in low- and middle-income countries (LMICs). METHODS: Randomized controlled trials conducted in LMICs, in which professionally applied fluorides were compared with placebo/no treatment/health education only or usual care with a minimum one-year follow-up period, were included. Any topically applied fluoride agents such as sodium fluoride (NaF), acidulated phosphate fluoride, silver diamine fluoride (SDF), and nano silver fluoride (NSF) were included. Five databases (PubMed, Embase, Scopus, Web of Science, and Cochrane Library) were searched in May 2022. Meta-analysis was conducted using a random effect model. RESULTS: This review included 33 studies for qualitative synthesis, encompassing 16,375 children aged between 1.5 and 14 years. Nevertheless, the meta-analysis focused on only 17 studies, involving 4067 children. Fourteen papers assessed potential adverse events, none of which was reported as major adverse events. SDF and NSF were identified as effective in arresting caries on primary teeth (p < 0.05) compared with a placebo or no treatment. Fluoride varnish and gel were identified as effective in reducing new caries development on primary teeth (p < 0.05) but not on permanent teeth (p > 0.05). The certainty of the generated evidence obtained is low. CONCLUSION: The review provides valuable insights into the use of professionally applied fluorides in LMICs and contributes to recommendations for their use. However, the limited rigorous evidence suggests the need for further research to strengthen these findings and draw more robust conclusions.

Esophageal Mucosal Admittance: A New Technique to Diagnose Gastroesophageal Reflux Disease - Is It Feasible?

Purpose: Esophageal mucosal admittance (MA) is a promising diagnostic method for gastroesophageal reflux disease (GERD). We conducted a study to describe the esophageal MA in patients with reflux symptoms and determine its diagnostic accuracy. Patients and Methods: We recruited 92 patients with ambulatory pH-impedance monitoring, upper gastrointestinal endoscopy, and MA measured by the tissue conductance meter. MA was measured during endoscopy at 5cm (distal esophagus) and 15cm above the Z line (middle esophagus), repeated at least five times at each position, and median MA was obtained. Afterwards, two biopsies were taken 5cm above the Z line for histopathological evaluation using the Esohisto criteria. Patients were classified as GERD or non-GERD according to the 2018 Lyon consensus. Results: The mean age was 43.2 years, and 42 patients were males. The most common symptoms were regurgitation (75.0%), belching (65.2%), and heartburn (46.7%). Twenty-three (32.3%) were diagnosed with GERD using the Lyon consensus, and 24 (26.1%) had esophagitis on histopathology. The median MA at the distal and middle esophagus was moderately correlated. The median MA at both positions was higher in the GERD group but only statistically significant in the middle esophagus. MA was not associated with pH-impedance parameters and esophagitis on histopathology. The diagnostic model developed using the logistic regression did not have good accuracy. Conclusion: MA was not different between GERD and non-GERD patients.

Trends in, projections of, and inequalities in non-communicable disease management indicators in Vietnam 2010-2030 and progress toward universal health coverage: A Bayesian analysis at national and sub-national levels.

Background: Movement towards Universal Health Coverage (UHC) can improve health services, risk factor management, and inequality in non-communicable diseases (NCD); conversely, prioritizing and monitoring NCD management can support pathways to UHC in resource-limited settings. We aimed to estimate trends in NCD management indicators in Vietnam from 2010, and projections to 2030 at national and sub-national levels; compute the probability of reaching UHC targets; and measure inequalities in NCD management indicators at demographic, geographic, and socio-economic levels. Methods: We included data of 37,595 households from four nationally representative surveys from 2010. We selected and estimated the coverage of NCD health service and risk management indicators nationally and by six sub-national groups. Using Bayesian models, we provided trends and projections and calculated the probability of reaching UHC targets of 80% coverage by 2030. We estimated multiple inequality indices including the relative index of inequality, slope index of inequality, and concentration index of inequality, and provided an assessment of improvement in inequalities over the study period. Findings: Nationally, all indicators showed a low probability of achieving 2030 targets except sufficient use of fruit and vegetables (SUFV) and non-use of tobacco (NUT). We observed declining trends in national coverage of non-harmful use of alcohol (NHUA), sufficient physical activity (SPA), non-overweight (NOW), and treatment of diabetes (TOD). Except for SPA, no indicator showed the likelihood of achieving 2030 targets at any regional level. Our model suggested a non-achievement of 2030 targets for all indicators in any wealth quintile and educational level, except for SUFV and NUT. There were diversities in tendency and magnitude of inequalities with widening gaps between genders (SPA, TOD), ethnic groups (SUFV), urban-rural areas (TOH), wealth quintiles, and educational levels (TOD, NUT, NHUA). Interpretation: Our study suggested slow progress in NCD management at the national level and among key sub-populations in Vietnam, together with existing and increasing inequalities between genders, ethnicities, geographic areas, and socioeconomic groups. We emphasised the necessity of continuously improving the healthcare system and facilities, distributing resources between geographic areas, and simultaneously integrating economic, education, and gender intervention and programs. Funding: None.

Attitudes toward nonsmoking policies and tobacco tax increases: a cross-sectional study among Vietnamese adults.

Following the 2009 update of the 2005 Framework Convention on Tobacco Control, Vietnam issued a new policy to ban smoking at workplaces and public places. This cross-sectional survey explored public attitudes toward this new regulation and provides evidence to inform future laws. Using stratified cluster sampling, 10 383 Vietnamese people older than 15 years were drawn from 11 142 selected households. Policies mandating "no smoking at workplaces" were supported by 88.7% of Vietnamese adults, whereas "no smoking in public places" and "increasing the tobacco tax" received less support. Educational level, knowledge of health effects, access to information on quitting and smoking health risks, smoking status, ethnicity, and region had significant associations with positive attitudes toward all 3 tobacco control policies. Adults belonging to the non-Kinh ethnic group, those who do not live in the Red river delta, people with lower educational levels, and current smokers should be targeted in tobacco control communication programs.

Social contexts of risk behaviors for HIV among male, unskilled, unregistered laborers in urban Vietnam.

In Vietnam there has been relatively little success in controlling the HIV epidemic, in part because the subpopulations most exposed to the virus are often difficult to engage in prevention research and programs. In this qualitative study we explored social contexts shaping HIV risk behaviors among Vietnamese men involved in unskilled, unregistered, and low-income labor in urban settings. Based on self-disclosed behaviors, it is clear that these men were at high risk of sexually transmitted infection (STI). Evidence emerged from the interview data highlighting equivalent influences of individual psychological factors, social integration, social barriers, and accessibility regarding drug use and sexual risk behavior. Psychological influences such as tedium, distress, fatalism and revenge, and the strong effects of collective decision making and fear of social isolation appeared important for these men living on the economic and social margins of this rapidly urbanizing society. The study findings suggest directions for research and culturally appropriate HIV preventive education and services for these men.

Smoking among Vietnamese health professionals: knowledge, beliefs, attitudes, and health care practice.

The study aimed to investigate smoking patterns and compare knowledge, beliefs, and attitudes, as well as explore predictors of smoking status among Vietnamese health professionals. A global survey questionnaire on tobacco use among health professionals by the World Health Organization and the Centers for Disease Control and Prevention was adapted for data collection. Data from 2151 health workers from the 3 largest hospitals--each of which is located in South, Central, and North Vietnam, respectively--were collected using quantitative methods. Both descriptive and inferential statistics were used in the data analysis. Smoking prevalence among Vietnamese health professionals is 13.4%, dominant among male health professionals compared with female counterparts (35.6% vs 1.8%), and significantly varies by regions. Physicians and dentists display a greater smoking proportion than nurses (23.0%, 10.5%, and 7.7%, respectively). The findings highlight the importance of improving and promoting beliefs of health professionals about being role models for their patients by not smoking. Special attention should be given to the following slogan: "Health professionals should act as nonsmoking role models for their patients and the public." This message should be incorporated into cigarette restriction regulations and policies at hospitals and recognized as one of the effective measures in cigarette control in the hospital context.

Smoking among Vietnamese medical students: prevalence, costs, and predictors.

This cross-sectional study investigated smoking patterns and predictors among Vietnamese medical students. In total, 4720 medical students from 3 universities, each located in South, Central, and North Vietnam, were interviewed using an adapted Global Youth Tobacco Survey Questionnaire. Ideas on smoking behavior and tobacco control derived from group discussions with students and from unstructured interviews with student managers and university directors. Overall, the current smoking rate was 25.0% and dominant in men at 43.7%. Most started smoking when just entering university (18 +/- 3.3 years). Male students from the central region had the highest smoking rate (35.1%), whereas their northern counterparts had the greatest smoking magnitude: age of smoking initiation (18.6 +/- 3.5), number of cigarettes per day (4.4 +/- 4.5), number of smoking days per month (16.5 +/- 11.6), and proportion of smoking cost among total expenses per month (10.9% +/- 11.9%). Smoking tended to increase across academic years, being highest in years 5 to 6 (35.0%). In contrast, the practice of ever quitting and the intention of quitting tended to decline from years 1-2 to years 5-6 (from 82.2% to 71.5%, P < .05, and from 70.8% to 51.5%, P < .001, respectively). Positive attitudes toward smoking (odds ratio = 1.4, P < .05), negative beliefs on hazards of smoking (odds ratio = 1.7), and daily exposure to family smokers (odds ratio = 2.0, P < .05) and to social smokers (odds ratio = 4.5, P < .05) were main predictors of smoking. Qualitative results suggest that nonsmoking university regulations played a critical role in tobacco control among medical students. Nonsmoking regulations and penalties for students who smoke need to be formulated at medical universities. The message that medical students must make a nonsmoking role model for community should be systematically promoted.