Knowledge, Attitudes and Practices on Reproductive Health Among Abortion Adolescents in Vietnam.

Background: Adolescent pregnancy is a global issue. The majority of these adolescents experience unintended pregnancy ending in abortion. Knowledge gaps and misconceptions about reproductive health are the main reasons for unintended pregnancy among adolescents. Objective: This study aims to identify knowledge, attitudes, practices, and related factors of reproductive health among adolescent post-abortion or those seeking abortion at Hanoi Obstetrics and Gynecology Hospital (HOGH), a tertiary hospital in Vietnam. Methods: Ours was a descriptive cross-sectional study of 103 adolescents who sought induced abortions between January 1, 2022 and June 30, 2023. Participants were interviewed directly via questionnaires to collect information. Results: The mean age of participants was 16.3 years. 64.1% of the population did not have general knowledge regarding reproductive health, 42.7% of subjects displayed incorrect attitudes regarding reproductive health. As a result, lack of knowledge and incorrect attitudes led to unsafe sex. The percentage of adolescents practicing unsafe sex is incredibly high (90.3%) thus causing unintended pregnancies. Education levels and family economic status were the main factors linked to knowledge, attitudes, and practices (KAP) regarding reproductive health. Conclusion: Most adolescents seeking abortion had poor KAP regarding reproductive health. Their KAP of reproductive health were linked to levels of education and family economic status. The findings emphasize the need to provide reproductive health care information and services for adolescents, and the need for appropriate attention from both family and society to the target group. We believe this will result in the improvement of their health and the avoidance of unfortunate consequences.

Rifampicin resistant Mycobacterium tuberculosis in Vietnam, 2020-2022.

Objective: We conducted a descriptive analysis of multi-drug resistant tuberculosis (MDR-TB) in Vietnam's two largest cities, Hanoi and Ho Chi Minh city. Methods: All patients with rifampicin resistant tuberculosis were recruited from Hanoi and surrounding provinces between 2020 and 2022. Additional patients were recruited from Ho Chi Minh city over the same time period. Demographic data were recorded from all patients, and samples collected, cultured, whole genome sequenced and analysed for drug resistance mutations. Genomic susceptibility predictions were made on the basis of the World Health Organization's catalogue of mutations in Mycobacterium tuberculosis associated with drug resistance, version 2. Comparisons were made against phenotypic drug susceptibility test results where these were available. Multivariable logistic regression was used to assess risk factors for previous episodes of tuberculosis. Results: 233/265 sequenced isolates were of sufficient quality for analysis, 146 (63 %) from Ho Chi Minh City and 87 (37 %) from Hanoi. 198 (85 %) were lineage 2, 20 (9 %) were lineage 4, and 15 (6 %) were lineage 1. 17/211 (8 %) for whom HIV status was known were infected, and 109/214 (51 %) patients had had a previous episode of tuberculosis. The main risk factor for a previous episode was HIV infection (odds ratio 5.1 (95 % confidence interval 1.3-20.0); p = 0.021). Sensitivity for predicting first-line drug resistance from whole genome sequencing data was over 90 %, with the exception of pyrazinamide (85 %). For moxifloxacin and amikacin it was 50 % or less. Among rifampicin-resistant isolates, prevalence of resistance to each non-first-line drug was < 20 %. Conclusions: Drug resistance among most MDR-TB strains in Vietnam's two largest cities is confined largely to first-line drugs. Living with HIV is the main risk factor among patients with MDR-TB for having had a previous episode of tuberculosis.

Histopathological features in the clinical specimens with tuberculosis diagnosis by BACTEC MGIT 960 culture.

Diagnosis of extrapulmonary tuberculosis remains challenging in lower-middle income countries with high burden of tuberculosis (TB). This study aims to describe the histological characteristics in biopsy samples from patients with confirmed TB. This is a retrospective study of clinical biopsy specimens with positive liquid medium culture for Mycobacterium tuberculosis and histopathological examination in the National Lung Hospital in Vietnam. Among 1045 biopsy specimens with mycobacteria culture, the overall rate of growth of Mycobacteria tuberculosis in culture was 20.7% (216/1045). The positivity rates of MIGT culture among surgical biopsy specimens were 75% in bone specimen, followed by vertebral specimens (51.3%), and joint specimens (26.4%). For specimens obtained by the fine needle aspiration, the positivity rates of MIGT culture were 26.3% in lymph node and 25.3% in pleural specimen. Among specimens with culture confirmation of TB, the most common histopathoglogical suggestive finding of TB was the presence of epithelioid cell (83.3%), Langhans giant cells (75.9%), and caseous necrosis (75.5%). The high proportion of histological features suggestive of TB among the TB culture confirmed biopsy samples support for further evaluation of histological examination and its combination with other recommended rapid molecular assays in specimens with suspicion of TB.

Ferromagnetic Order at Room Temperature in Monolayer WSe2 Semiconductor via Vanadium Dopant.

Diluted magnetic semiconductors including Mn-doped GaAs are attractive for gate-controlled spintronics but Curie transition at room temperature with long-range ferromagnetic order is still debatable to date. Here, the room-temperature ferromagnetic domains with long-range order in semiconducting V-doped WSe2 monolayer synthesized by chemical vapor deposition are reported. Ferromagnetic order is manifested using magnetic force microscopy up to 360 K, while retaining high on/off current ratio of ≈105 at 0.1% V-doping concentration. The V-substitution to W sites keeps a V-V separation distance of 5 nm without V-V aggregation, scrutinized by high-resolution scanning transmission electron microscopy. More importantly, the ferromagnetic order is clearly modulated by applying a back-gate bias. The findings open new opportunities for using 2D transition metal dichalcogenides for future spintronics.

Analysis of the 56-kDa type specific antigen gene of Orientia tsutsugamushi from northern Vietnam.

Scrub typhus has been documented since 1932 in Vietnam, however, the disease burden of scrub typhus remains poorly understood in the country. We conducted this study to describe the phylogenetic analysis of the 56-kDa type-specific antigen (TSA) gene of Orientia tsutsugamushi associated with PCR positive cases of scrub typhus. Of 116 positive samples, 65 type-specific antigen gene sequences were obtained and classified into 3 genogroups: Karp, Kato and Gilliam. The Karp genogroup was the most frequently detected phylogenetic cluster in the study with 30 samples (46%), followed by Kato and Gilliam with 20 (31%) and 15 (23%), respectively. All sequences showed 94-100% nucleotide similarity to reference sequences collected in the central part of Vietnam in 2017. Patients infected with Karp genogroup were more likely to have significant thrombocytopenia than the other genogroups. These results suggest that any scrub typhus vaccine considered for use in Vietnam should provide protection against each of these 3 genogroups.

Feasibility and safety of extended-release naltrexone treatment of opioid and alcohol use disorder in HIV clinics: a pilot/feasibility randomized trial.

BACKGROUND AND AIMS: HIV-infected people with substance use disorders are least likely to benefit from advances in HIV treatment. Integration of extended-release naltrexone (XR-NTX) into HIV clinics may increase engagement in the HIV care continuum by decreasing substance use. We aimed to compare (1) XR-NTX treatment initiation, (2) retention and (3) safety of XR-NTX versus treatment as usual (TAU) for treating opioid use disorder (OUD) and/or alcohol use disorder (AUD) in HIV clinics. DESIGN: Non-blinded randomized trial of XR-NTX versus pharmacotherapy TAU. SETTING: HIV primary care clinics in Vancouver, BC, Canada and Chicago, IL, USA. PARTICIPANTS: Fifty-one HIV-infected patients seeking treatment for OUD (n = 16), AUD (n = 27) or both OUD and AUD (n = 8). MEASUREMENTS: Primary outcomes were XR-NTX initiation (receipt of first injection within 4 weeks of randomization) and retention at 16 weeks. Secondary outcomes generated point estimates for change in substance use, HIV viral suppression [HIV RNA polymerase chain reaction (pcr) < 200 copies/ml] and safety. FINDINGS: Two-thirds (68%) of participants assigned to XR-NTX initiated treatment, and 88% of these were retained on XR-NTX at 16 weeks. In comparison, 96% of TAU participants initiated treatment, but only 50% were retained on medication at 16 weeks. Mean days of opioid use in past 30 days decreased from 17.3 to 4.1 for TAU and from 20.3 to 7.7 for XR-NTX. Mean heavy drinking days decreased from 15.6 to 5.7 for TAU and 12.5 to 2.8 for XR-NTX. Among those with OUD, HIV suppression improved from 67 to 80% for XR-NTX and 58 to 75% for TAU. XR-NTX was well tolerated, with no precipitated withdrawals and one serious injection-site reaction. CONCLUSIONS: Extended-release naltrexone (XR-NTX) is feasible and safe for treatment of opioid use disorder and alcohol use disorder in HIV clinics. Treatment initiation appears to be lower and retention greater for XR-NTX compared with treatment as usual (clinicaltrials.gov NCT01908062).

[Demand for and supply of health care: general practice in the miners' fund]. / La demande et l'offre des soins: la médecine générale dans le régime minier.

In France, the miners and their families are registered to a special sickness insurance fund. The fund has salaried GPs who are paid on a capitation basis, whereas more than 80 percent of the French population are insured to the "régime général" and are served by private practitioners paid on a fee-for-service basis. During seven weeks, the demand for care in the Miners' Fund was surveyed to assess its volume and variations according to the characteristics (age and sex) of the patients. As expected, the demand for care is higher as concerns the young children and the elderly. These variations have a specific pattern for each type of provided care (office visits, home visits, drug prescriptions, prescriptions of auxiliary care, prescriptions of diagnostic procedures...). Moreover, the demand for care varies according to the characteristics of GPs, age of patients being controlled. For instance, the referral ratio to specialists or hospitals varies according to age of GPs, to their having or not several offices, to their practising or not additional activities (MCH, visit to nursing homes...). It is noteworthy that in the French Miners' Fund, patients have little freedom to choose their GPs and GPs have no freedom to choose their patients, as in the "régime général".

[Geographic inequity revisited: medical staffing of the French territory (1964-1994)]. / Les inégalités géographiques revisitées: la médicalisation du territoire (1964-1994).

In 1964, a study evidenced the lack of geographic mobility among French doctors: young graduates are reluctant to take an installation far away from the city of their medical school. Since a law in 1971 entrusted the government with fixing the numerous clausus of each medical school--all medical schools are state-run in France--this paved the way for correcting inequalities in medical staffing by a differenciated student intake according to regions. A study conducted in 1974 quantified this action region by region. Two decades later, one can observe that such an action was not undertaken extensively. However, in relative terms, there was some reduction of geographic inequity in medical staffing. As a matter of fact, the steady growth of French medical workforce and change in all the health system have modified drastically the perceived topic.

Projection of supply and requirement of health manpower with particular reference to primary health care manpower.

PIP: Usual methods of projection of supply and requirement of manpower in the primary health care (PHC) field are critically reviewed. Methods commonly used to project health manpower supply are explained. Trend observation and extrapolation, which are involved in most methods, are described. Usual methods of projection of health manpower requirements are reviewed. The following approaches are described in detail: 1) health manpower/population ratio method; 2) service targets approach; 3) health needs approach; 4) economic effective demand approach. It is noted that all methods of rquirement projection express an ethical basis. Shortcomings of the above projection methods are generally discussed, and a case study of irrelevant projection of health manpower requirements is given. The fundamental irrelevance in separating supply and demand in the projection process is discussed, with a case study of the interrelationship between supply and demand of health manpower used to illustrate the point. Inadequacies of the usual projection methods for PHC manpower discussed include ignorance of differences between health professionals and PHC workers and availability of facilities and drugs. Concluding remarks stress the need for projections to reflect the team approach of PHC and to be country specific.^ieng

Statistical analysis of the world health manpower situation circa 1975.

PIP: The study objective was to provide a clear and comprehensive picture of the personnel situation in the main health professions circa 1975. By personnel situation is meant the number of practitioners of those professions and their numerical relationship to the population. The data are derived from the survey on health personnel which the World Health Organization conducts each year since 1957 among its Member countries and their associated territories by means of a questionnaire which lists the various health professions accompanied by a broad definition of each. The most recent version of this questionniare dates from 1974. The study was confined to 14 professions or groups of professions: medicine and nursing; dentistry; diagnostic technicians; and others (pharmacists/chemists and sanitarians). A single indicator was used throughout the study, which is the ratio of manpower population or, more succinctly, density. Manpower density is calculated/100,000 inhabitants. When the developed countries were compared with those of the 3rd world, the density/100,000 inhabitants for all the 14 professions together averaged 1021 in the rich countries and 98 in the poor countries. Thus on the world scale it can be reported that in 1975, proportionately to population, health personnel resources were 10 times smaller in the 3rd world than in the developed nations. For the same population size, there were in the developed countries 7 times as many physicians, 6 times as many pharmacists, 13 times as many nurses and midwives, and up to 43 times as many medical assistants. The disparity in favor of the rich countries was 8:1 for dentists, 10:1 for dental operating auxiliaries, and 14:1 for technicians. As regards diagnostic and research technicians, the rich countries as a whole had 10 times as many radiological technicians and 22 times as many laboratory technicians as the 3rd world. To every 100 physicians in the developed world there 283 auxiliaries, medical assistants, midwives, auxiliary midwives, nurses, auxiliary nurses and multi-purpose health auxiliaries. The ratio was 191 auxiliaries/100 physicians in the 3rd world. In the developed countries the density of their health manpower has been increasing very rapidly for a decade. The growth is particularly vigorous in the case of physicians, midwives, nurses, and diagnostic and research technicians. In the countries of the 3rd world there has also been some increase in the density of physicians and of midwives and nurses but it is less pronounced.^ieng

Women in the health professions.

There is a very great diversity at international level with regard to the percentage of women in each of the three professions considered. As time goes on, however, this diversity appears to be slowly diminishing, partly as a result of an overall rise in the rates. Apart from a few cases, of which the most striking is that of physicians in the USSR, the proportion of women in the health professions increased, sometimes considerably, during the 1960s. In most cases, this growth was dependent on the following processes: --after the age of 50, the number of women at times declined less quickly than that of men, perhaps as a result of excess male mortality, --after the age of 35 and up to the age 50, the number of women in some cases declined less quickly than that of men, in particular as a result of a return to the profession by mothers once their children had grown up, --under the age of 35, the number of women in almost all cases increased much more rapidly than the number of men. The first two of these three processes were only of secondary importance, and in some cases, indeed, of no importance. The third was the one with the most pronounced effect on overall growth in the degree to which women were represented in the three professions considered by the study. This degree did not seem at any given time, to be linked to the proportion of members of the profession in the population (as expressed by the ratio of members of the profession to the population) nor to the proportion of women in gainful occupation (expressed as the female activity rate) nor to the national level of economic development (expressed as the national per capita income). It did, on the other hand, appear to be directly affected by each country's own policy decisions and academic traditions.