Development of an Artificial Intelligence-Based Breast Cancer Detection Model by Combining Mammograms and Medical Health Records.

BACKGROUND: Artificial intelligence (AI)-based computational models that analyze breast cancer have been developed for decades. The present study was implemented to investigate the accuracy and efficiency of combined mammography images and clinical records for breast cancer detection using machine learning and deep learning classifiers. METHODS: This study was verified using 731 images from 357 women who underwent at least one mammogram and had clinical records for at least six months before mammography. The model was trained on mammograms and clinical variables to discriminate benign and malignant lesions. Multiple pre-trained deep CNN models to detect cancer in mammograms, including X-ception, VGG16, ResNet-v2, ResNet50, and CNN3 were employed. Machine learning models were constructed using k-nearest neighbor (KNN), support vector machine (SVM), random forest (RF), Artificial Neural Network (ANN), and gradient boosting machine (GBM) in the clinical dataset. RESULTS: The detection performance obtained an accuracy of 84.5% with a specificity of 78.1% at a sensitivity of 89.7% and an AUC of 0.88. When trained on mammography image data alone, the result achieved a slightly lower score than the combined model (accuracy, 72.5% vs. 84.5%, respectively). CONCLUSIONS: A breast cancer-detection model combining machine learning and deep learning models was performed in this study with a satisfactory result, and this model has potential clinical applications.

Disparities in Gynecological Healthcare Service Utilization Among Ethnic Minority Women in Vietnam.

The study aimed to investigate differences in the prevalence of gynecological healthcare service utilization in 12 ethnic minority groups and associated socio-demographic correlates with gynecological healthcare service utilization in Vietnam. Based on the national survey on healthcare utilization among 6912 people in 12 ethnic minorities, 900 women aged 21-49 years were included in the final analysis. Prevalence of gynecological healthcare service utilization in 12 ethnic minority groups was measured, based on the question "Have you ever used any gynecological healthcare services?" Socio-demographic characteristics including region, ethnicity, age, marital status, literacy level, education level, languages spoken, occupation, religion, household economy status, using contraception, and distance to the nearest healthcare facility were examined. The association between gynecological healthcare service utilization and socio-demographic characteristics was assessed by using logistic regression. The results showed that the prevalence of gynecological healthcare service utilization was 62.0% (95% CI: 58.7-65.2%), which ranged from 36.5 (Mnong) to 87.7% (Bru Van Kieu). Bru Van Kieu women had significantly higher odds of gynecological healthcare service utilization (OR = 9.42, 95% CI = 3.71-23.91), compared to those in Khmer ethnicity. Besides, Ba Na, Cham Ninh Thuan, and Dao women also had significantly higher odds of gynecological healthcare service utilization (Ba Na: OR = 5.73, 95% CI = 2.15-15.26; Cham Ninh Thuan: OR = 4.24, 95% CI = 1.79-10.06; Dao: OR = 3.43, 95% CI = 1.49-7.90), compared to those in Khmer ethnicity. Getting married, being older, being not poor, and using contraception had significantly higher odds of using gynecological healthcare services. Health education specialists and healthcare workers should be aware of these issues so that they can provide appropriate gynecological healthcare services and ensure high coverage of routine gynecological exams in ethnic minority women in reproductive age.

Tobacco and electronic cigarette smoking among in-school adolescents in Vietnam between 2013 and 2019: prevalence and associated factors.

BACKGROUND: Smoking among adolescents in schools is a major global public health concern. There is limited evidence regarding prevalence and associated factors in Vietnam. OBJECTIVE: To compare the prevalence of smoking and associated factors among in-school adolescents aged 13-17 years in Vietnam between 2013 and 2019. METHODS: Data were collected from two rounds of the national representative Vietnam Global School-based Student Health Survey (GSHS) conducted in 2013 (n = 3,331) and 2019 (n = 7,690). Logistic regression was used to identify the factors associated with tobacco and electronic cigarette smoking among in-school adolescents. RESULTS: There was a significant reduction in the prevalence of current smoking (water pipes and cigarettes) from 5.4% (95% CI: 4.0-7.2) in 2013 to 2.8% (95% CI: 2.2-3.6) in 2019. In 2019, 2.6% of the in-school adolescents reported having used electronic cigarette products 30 days prior to the survey. Factors associated with a significantly higher likelihood of current smoking status included gender, loneliness, suicidal ideation, sexual activity, truancy, and alcohol consumption. Similar patterns were observed for e-cigarettes. CONCLUSION: Smoking among in-school adolescents in Vietnam decreased between 2013 and 2019. Follow-up studies are needed to further investigate causal factors so that future policies and communication programmes can be more effectively targeted to reduce smoking in adolescents.

Severe Symptoms of Mental Disorders Among Students Majoring in Foreign Languages in Vietnam: A Cross-Sectional Study.

Mental health disorders among university students have been a serious issue in many countries and can negatively affect academic performance and all aspects of daily living, relationships, and physical health. In this study, we aim to estimate the prevalence of severe symptoms of mental disorders and examine associated factors among students majoring in foreign languages in Vietnam. We used the Depression, Anxiety, and Stress Scales (DASS-21) to detect severe symptoms of mental disorders in 1,788 students, including severe symptoms of depression, anxiety, and stress. The Financial-Study-Family-Friend (FSFF) scale was utilized to assess how much students worried about finance, academic, and social support from family and friends. Multiple logistic regressions were carried out to evaluate the relationship between severe symptoms of mental disorders and FSFF factors. The prevalence of severe levels of depression, anxiety, and stress were 21.1, 35.0, and 16.3%, respectively. While varying somewhat due to students' demographic characteristics, all four aspects of the FSFF scale were related to the severe symptoms of mental disorders of students. Concerns about study had the largest effects (ORs ranging from 2.84 to 3.72) while difficulty in finance had the smallest effects (ORs ranging from 1.23 to 1.37) on students' depression, anxiety, and stress. The prevalence of severe symptoms of mental disorders in students was high in our study. Teachers and universities should focus more attention on students' mental health. Social support from family and friends also plays a crucial role in the mental health of students.

Perceptions and Use of Electronic Cigarettes Among Young Adults in Vietnam 2020.

Electronic cigarette use among adolescents has increased in the past decade. Little is known about the perception and use of e-cigarettes in Vietnam, especially among young people. This study examines the perceptions and use of electronic cigarettes among young adults in Vietnam. The study uses data from a survey of adult tobacco consumption among adults at the provincial level in 2020, which was funded and managed by the Vietnam Tobacco Control Fund-Ministry of Health. Data were collected from 34 provinces and cities throughout Vietnam and managed using REDCap software. The survey engaged 80,166 participants, of which 9478 were young adults aged 15-24 were selected and reported in this paper. The results show that, at the time of the survey, 2.4% of young Vietnamese adults were smoking e-cigarettes. Many survey participants cited more than one reason for smoking e-cigarettes. These reasons included preferring the taste of e-cigarettes (64.0%), disliking the odour of other cigarettes (46.2%), following the example of family members (44.9%), and believing e-cigarettes threatened fewer health risks (39.1%). Almost half of the e-cigarette users wanted to quit (48%). E-cigarette use was associated with males living in urban areas who are aware of the Law on Prevention and Control of Tobacco Harms. The findings of this study provide evidential data that support public health policies aimed at reducing and ceasing e-cigarette use among young people.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019.

BACKGROUND: Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. METHODS: We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. FINDINGS: The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 - 0·93; females: OR = 0·69, 95% HDI: 0·47 - 0·98). INTERPRETATION: Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. FUNDING: The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Respiratory complications after surgery in Vietnam: National estimates of the economic burden.

BACKGROUND: Estimating the cost of postoperative respiratory complications is crucial in developing appropriate strategies to mitigate the global and national economic burden. However, systematic analysis of the economic burden in low- and middle-income countries is lacking. METHODS: We used the nationwide database of the Vietnam Social Insurance agency and extracted data from January 2017 to September 2018. The data contain 1 241 893 surgical patients undergoing one of seven types of surgery. Propensity score matching method was used to match cases with and without complications. We used generalized gamma regressions to estimate the direct medical costs; logistic regressions to evaluate the impact of postoperative respiratory complications on re-hospitalization and outpatient visits. FINDINGS: Postoperative respiratory complications increased the odds of re-hospitalization and outpatient visits by 3·49 times (95% CI: 3·35-3·64) and 1·39 times (95% CI: 1·34-1·45) among surgical patients, respectively. The mean incremental cost associated with postoperative respiratory complications occurring within 30 days of the index admission was 1053·3 USD (95% CI: 940·7-1165·8) per procedure, which was equivalent to 41% of the GDP per capita of Vietnam in 2018. We estimated the national annual incremental cost due to respiratory complications occurring within 30 days after surgery was 13·87 million USD. Pneumonia contributed the greatest part of the annual cost burden of postoperative respiratory complications. INTERPRETATION: The economic burden of postoperative respiratory complications is substantial at both individual and national levels. Postoperative respiratory complications also increase the odds of re-hospitalization and outpatient visits and increase the length of hospital stay among surgical patients. FUNDING: The authors did not receive any funds for conducting this study.

Addressing Unintentional Exclusion of Vulnerable and Mobile Households in Traditional Surveys in Kathmandu, Dhaka, and Hanoi: a Mixed-Methods Feasibility Study.

The methods used in low- and middle-income countries' (LMICs) household surveys have not changed in four decades; however, LMIC societies have changed substantially and now face unprecedented rates of urbanization and urbanization of poverty. This mismatch may result in unintentional exclusion of vulnerable and mobile urban populations. We compare three survey method innovations with standard survey methods in Kathmandu, Dhaka, and Hanoi and summarize feasibility of our innovative methods in terms of time, cost, skill requirements, and experiences. We used descriptive statistics and regression techniques to compare respondent characteristics in samples drawn with innovative versus standard survey designs and household definitions, adjusting for sample probability weights and clustering. Feasibility of innovative methods was evaluated using a thematic framework analysis of focus group discussions with survey field staff, and via survey planner budgets. We found that a common household definition excluded single adults (46.9%) and migrant-headed households (6.7%), as well as non-married (8.5%), unemployed (10.5%), disabled (9.3%), and studying adults (14.3%). Further, standard two-stage sampling resulted in fewer single adult and non-family households than an innovative area-microcensus design; however, two-stage sampling resulted in more tent and shack dwellers. Our survey innovations provided good value for money, and field staff experiences were neutral or positive. Staff recommended streamlining field tools and pairing technical and survey content experts during fieldwork. This evidence of exclusion of vulnerable and mobile urban populations in LMIC household surveys is deeply concerning and underscores the need to modernize survey methods and practices.

The Utilization of Maternal Healthcare Services Among Ethnic Minority Populations in Vietnam.

BACKGROUND: Previous studies have observed lower utilization of maternal healthcare services by ethnic minority groups in Vietnam compared with the majority Kinh community. This study sought to assess the utilization of maternal healthcare service-associated factors within 12 ethnic minority groups. METHOD: The cross-sectional study enrolled 996 women from 12 ethnic minority groups in Vietnam in 2019. Women had pregnancy outcomes in the last 5 years. The two variables for maternal healthcare utilization were [1] a minimum of four antenatal contacts and [2] health facility-based delivery. We examined the association of individual characteristics of maternal healthcare services using multilevel modeling. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS: This nationally representative study found that 34.1% of women from ethnic minority backgrounds had four or more antenatal contacts during pregnancy, ranging from 8.3% in Mong community to 80.2% in Cham An Giang. Most of the women (94.4%) delivered at health facilities. Factors independently correlated with having fewer than four antenatal contacts included being illiterate, early marriage, unemployment, religious affiliation, household economy, and distance to the nearest health facility. Factors significantly associated with home delivery were living in the most disadvantaged areas and having fewer than four antenatal contacts. CONCLUSION: Substantial inequity exists in antenatal coverage both within ethnic minority groups and between socio-economic groups. The low coverage of having at least four antenatal contacts and its' correlates with facility-based delivery suggests that the government should focus efforts on increasing the number of antenatal contacts for ethnic minority women.

Self-reported non-communicable diseases and associated socio-demographic status among ethnic minority populations in Vietnam, 2019.

The aim of this study was to report the prevalence of self-reported non-communicable diseases among ethnic minority populations in Vietnam and related factors. A total of 5033 individuals aged 15 years and older who belonged to ethnic minority populations from 12 provinces in Vietnam completed a household survey. The overall prevalence of self-reported non-communicable diseases was 12.4% (95% CI: 11.5%-13.4%). Cardiovascular diseases were the most prevalent, followed by diabetes. Ethnicity was shown to have an independently significant correlation to having any non-communicable diseases. Older people, near-poor and non-poor people had significantly higher odds of having non-communicable diseases as compared to younger and poor people.

Relationship between family functioning and health-related quality of life among methadone maintenance patients: a Bayesian approach.

PURPOSE: To examine the relationship of family functioning on health-related quality of life (HRQoL) among methadone maintenance patients using the Bayesian approach. METHODS: A cross-sectional study was conducted on 182 patients at Go Vap Methadone Clinic, Ho Chi Minh City, Vietnam. Family functioning and HRQoL were measured by the APGAR scale and World Health Organization Quality of Life short-form instrument (WHOQoL-BREF), respectively. Directed Acyclic Graphs were used to present the conceptual framework and to identify a set of confounders of the relationship between family functioning and HRQoL. Bayesian multivariable linear regressions were fitted with four different priors to determine the effect size of the relationship of interest. RESULTS: The mean score of APGAR was 6.0 (SD = 3.3), and the mean scores of HRQoL were from 47.1 (SD = 17.6) in the social relationships dimension to 69.0 (SD = 10.3) in the environment dimension. Patients with a higher score of family functioning were likely to have a higher score of HRQoL, with coefficients and 95% highest density interval (HDI) greater than 0 in all priors. Family functioning had the most substantial impact on the psychological health dimension, with 99.9% to 100% and 44.6% to 83.7% of posterior distribution greater than 1 and 2, in different priors, respectively. CONCLUSION: Family functioning is intimately associated with HRQoL. Treatment plans for patients undergoing methadone maintenance treatment should aim to involve the families appropriately and effectively to maximize the benefits for patients and improve their overall well-being.

Access to Improved Water Sources and Sanitation in Minority Ethnic People in Vietnam and Some Sociodemographic Associations: A 2019 National Survey.

BACKGROUND: Achieving access to clean water and basic sanitation remains as major challenges in Vietnam, especially for vulnerable groups such as minority people, despite all the progress made by the Millennium Development Goal number 7.C. OBJECTIVES: The study aimed to describe the access to improved water sources and sanitation of the ethnic minority people in Vietnam based on a national survey and to identify associated factors. METHODS: A cross-sectional study was conducted in 2019 with a sample size of 1385 ethnic minority households in 12 provinces in Vietnam. Multivariate logistic regression modeling was performed to examine the probability of having access to improved water sources and sanitation and sociodemographic status at a significance level of P < .05. RESULTS: The access to improved water sources and sanitation was unequal among the ethnic minority people in Vietnam, with the lowest access rate in the northern midland and mountainous and Central Highland areas and the highest access rate in the Mekong Delta region. Some sociodemographic variables that were likely to increase the ethnic minority people's access to improved water sources and/or sanitation included older age, female household heads, household heads with high educational levels, religious households, and households in not poor status. CONCLUSION AND RECOMMENDATIONS: The study suggested more emphasis on religion for improving the ethnic minority's access to improved water sources and sanitation. Besides, persons of poor and near-poor status and with low educational levels should be of focus in future water and sanitation intervention programs.

HIV Prevalence and Factors Related to HIV Infection Among Transgender Women in Vietnam: A Respondent Driven Sampling Approach.

Transgender women are at higher risk of HIV infection, however, there is a lack of information about HIV infection and related factors among transgender women in Vietnam. From February 2018 to June 2018, 456 transgender women were recruited in the study using Respondent-Driven Sampling technique. Participants completed the computer-based questionnaire and were tested for HIV serostatus. Multivariable logistic regression was used to identify factors related to HIV infection. The prevalence of HIV infection was 77 (16.5%), of which 19 (24.7%) were not aware of their HIV-positive status prior to the study. Factors associated with HIV infection included popper use (aOR 2.01, p = 0.044) and having regular male partner(s) (aOR 0.42, p = 0.006). More efforts are needed to reduce the high prevalence of HIV infection, such as expanding the reach of HIV screening and prevention programs to the transgender women population, particularly for substance users.