Atlantoaxial dislocation due to Os odontoideum in down syndrome: Literature review and case reports.

INTRODUCTION AND IMPORTANCE: Os odontoideum is a rare condition commonly associated with atlantoaxial instability (AAI) and leading to atlantoaxial dislocation. The incidence of Os odontoideum is higher in patients with Down syndrome. Similar to odontoid fractures, atlantoaxial dislocation in patients with Os odontoideum can result in neurological deficits, disability, and even mortality. CASE PRESENTATION: We present two cases of Os odontoideum accompanied by Down syndrome. Both patients were hospitalized due to progressive tetraparesis after falls several months prior. Upon examination, the patients exhibited myelopathy and were unable to walk or stand. MRI revealed spinal stenosis at the C1-C2 level due to atlantoaxial dislocation. C1-C2 fixation using Harms' technique was performed in both cases. One case experienced a complication involving instrument failure, necessitating revision surgery. CLINICAL DISCUSSION: Due to the characteristics of transverse ligament laxity, low muscle tone, excessive joint flexibility, and cognitive impairment, children with both Down syndrome and Os odontoideum are at a high risk of disability and even mortality from spinal cord injury. Most authors recommend surgical management when patients exhibit atlantoaxial instability. Additional factors such as low bone density, cognitive impairment, and a high head-to-body ratio may increase the risk of surgical instrument failure and nonunion postoperatively in patients with Down syndrome. CONCLUSION: Os odontoideum is a cause of AAI in patients with DS. Indication of surgery in the presence of AAI helps to resolve neurological injury and prevent further deterioration. The use of a cervical collar is considered to prevent instrument failure postoperatively.

1 Year-follow-up of transforaminal surgical approach in the management of migrated disc herniation: a cross-sectional study.

Transforaminal percutaneous endoscopic lumbar discectomy (TPELD) recently confirms its superiority compared to typical open discectomy in the treatment of very high-grade migrated disk herniation. In Vietnam, this technique has been applied in recent years; however; lack of reports and evidence. Objectives: In this study, the authors would like to share their surgical experience and report the initial results in their center, after successfully performing TPELD for very high-grade migrated disk herniation in 40 patients. Patients and methods: Forty patients, who underwent TPELD to remove the nucleus of very high-grade migrated disk herniation, were enrolled in this study. The study was carried out from April 2019 to April 2021. Preoperative and postoperative MRI were compared to demonstrate the removed disk. Postoperative visual analog score, oswestry disability index, and modified Macnab criteria were obtained after 1 month, 6 months, and 1 year and were compared. Results: There were no major complications related directly to this technique. Seven patients were operated at L3-4, 28 patients at L4-5, and 5 patients at l5-S1. Mean visual analog score for leg pain improved from 7.36±0.64 preoperatively to 1.22±1.16 at 6 months postoperatively and 1.34±1.47 at 1 year postoperatively (P<0.01). The mean preoperative oswestry disability index improved from 67.1±8.79 preoperatively to 12.1±13.48 at 1 year postoperatively (P<0.01). Excellent or good global outcomes were obtained in 95%. Conclusions: TPELD is a minimally invasive treatment with effective and safe results of very high-grade migrated disk herniation. Improvement of several pain scores can be observed in the 12-month follow-up after surgery.

A cross-sectional study of MIS TLIF in treatment of spondylolisthesis: initial good results from 92 Vietnamese patients.

Minimally invasive transforaminal lumbar interbody fusion has proven effectiveness in treating spondylolisthesis, but there were few reports applying the technique from scarce resourcing developing countries. In this study, the authors report the results and share our experience of minimally invasive spinal transforaminal lumbar interbody fusion in spondylolisthesis treatment in Vietnamese patients. Materials and methods: In this study, the authors enroled 92 patients diagnosed with single-level, grade I or grade II lumbar spondylolisthesis from January 2019 to October 2022. Results: The median age in our study was 47.79±12.61 (range 15-75), the male/female ratio was 1/2.3. The mean disease duration was 28.57 months. Conventional X-ray images showed that there were 74 patients (80.43%) with spondylolisthesis grade I, 18 patients (19.57%) with grade II. Spondylolisthesis occured mainly in L4-L5 with 53 patients (57.61%). The isthmic sign was recorded in 16 patients (31.4%). The mean blood loss was 149.46 ml. Patients walked on average of 3.22 days after surgery. VAS score reduced significantly in both back and leg. Spinal function improved significantly with a preoperative Owestry Disability Index of 48.18% decrease to 15.18% 12 months after surgery. The surgical results were good and excellent at 95.00% after 12 months of surgery according to Macnab scale. The fusion rate reached 97.50%. Conclusions: The results of this Macnab's classification study show that minimally invasive spinal transforaminal lumbar interbody fusion is an effective treatment for spondylolisthesis with less pain, less blood loss after surgery, and high fusion rate.

Efficacy of a Mobile Phone-Based Intervention on Health Behaviors and HIV/AIDS Treatment Management: Randomized Controlled Trial.

BACKGROUND: Antiretroviral therapy (ART) is considered the most important intervention for HIV-positive patients; thus, encouraging the use of and adherence to ART are vital to HIV treatment outcomes. Advances in web and mobile technologies hold potential in supporting HIV treatment management. OBJECTIVE: The aim of this study was to evaluate the feasibility and efficacy of a theory-based mobile health (mHealth) intervention on health behaviors and HIV treatment adherence among patients with HIV/AIDS in Vietnam. METHODS: We performed a randomized controlled trial on 425 HIV patients in two of the largest HIV clinics in Hanoi, Vietnam. Both the intervention group (238 patients) and the control group (187 patients) received regular consultations with doctors and then participated in 1-month and 3-month follow-up visits. Patients in the intervention group received a theory-driven smartphone app to facilitate medication adherence and self-efficacy in HIV patients. Measurements were developed based on the Health Belief Model, which included the visual analog scale of ART Adherence, HIV Treatment Adherence Self-Efficacy Scale, and HIV Symptom Management Self-Efficacy Scale. We also included the 9-item Patient Health Questionnaire (PHQ-9) to assess patients' mental health throughout treatment. RESULTS: In the intervention group, the adherence score increased significantly (ß=1.07, 95% CI .24-1.90) after 1 month, whereas the HIV adherence self-efficacy was significantly higher after 3 months (ß=2.17, 95% CI 2.07-2.27) compared to the control group. There was a positive but low level of change in risk behaviors such as drinking, smoking, and drug use. Factors related to positive change in adherence were being employed and having stable mental well-being (lower PHQ-9 scores). Factors associated with self-efficacy in treatment adherence and symptom management were gender, occupation, younger age, and having no other underlying conditions. A longer duration of ART increased treatment adherence but decreased self-efficacy in symptom management. CONCLUSIONS: Our study demonstrated that the mHealth app could improve the overall ART adherence self-efficacy of patients. Further studies with larger sample sizes and longer follow-up periods are needed to support our findings. TRIAL REGISTRATION: Thai Clinical Trials Registry TCTR20220928003; https://www.thaiclinicaltrials.org/show/TCTR20220928003.

Women's holistic self-care behaviors during pregnancy and associations with psychological well-being: implications for maternal care facilities.

BACKGROUND: Self-care behaviors during pregnancy significantly impacts mother and children's health. This study aimed to explore the self-care behaviors and the associations of these behaviors with the psychological well-being of women during pregnancy, as well as the mediating effects of different social support with these associations. METHODS: A cross-sectional data of 562 pregnant women at Hanoi Obstetrics & Gynecology Hospital and Ca Mau Obstetrics & Pediatrics in Vietnam were analyzed. Questions about self-care behaviors, pregnancy characteristics, social support, and psychological well-being were asked. Multivariate regression models were performed. Structural Equation Modeling (SEM) was employed to test the mediating effects of different social support with the association between self-care behaviors and psychological well-being. FINDINGS: Only 13% of pregnant women often or always did physical exercise at least three times a week, and 40% consumed enough fiber and five servings of vegetables a day. Only 78.7% always avoided alcohol drinking, and 53.9% of pregnant women avoided being exposed to second-hand smoking and 71,7% avoided using traditional medicine without physicians' prescriptions. Around 66% of pregnant women always or often had prenatal care checkups as scheduled. Information sources, social support and childbirth expectation were major drivers for self-care practices. SEM model showed that social support mediated the relationship between maternal health behaviors and mental well-being. CONCLUSION: This study highlighted the remarkable gaps in self-care practices among our pregnant women, which were significantly associated with their mental well-being. Social support-oriented consultancy and interventions should be warranted for improving behaviors and the mental well-being of pregnant women in Vietnam.

Post-kyphoplasty secondary vertebral compression fractures in Vietnamese patients: A single-center prospective cross-sectional study.

Background: Despite its well-known effectiveness in vertebral compression fractures (VCFs), kyphoplasty could also bring the risk of developing subsequent VCFs post-augmentation, especially at adjacent vertebrae, which has been rarely reported in Asian countries. Methods: In this cross-sectional study, we performed cement augmentation on 69 vertebrae in 65 patients at the Spine Surgery Department, Viet Duc University Hospital, from June 2019 to November 2020. Cement augmentation was performed on 69 vertebrae in 65 patients. They then were followed and assessed for subsequent VCFs every 3, 6, 9 months after surgery. Results: 69 vertebrae in 65 patients were treated by kyphoplasty, 2 patients had 2 vertebrae treated and only one patient had 3 vertebrae injected. The average age recorded was 72 ± 8 years old. The average amount of cement injected was 5.4 ± 1.4 ml per vertebrae. At the end of the study, 63 patients did not develop subsequent VCFs. Two patients (3.07%) had new VCFs post-augmentation within the first two-month period post-injection. Age, gender, history of steroid injection and number of vertebrae treated with kyphoplasty showed no significant difference between the two groups. Conclusions: Kyphoplasty is an effective pain-reliving treatment for patients with osteoporotic VCFs and would pose no threats to subsequent VCFs. For patients developing abnormal acute pain within the period of two months, further examinations and MRI scan should be performed to detect subsequent VCFs in time.

Depressive Symptoms, Suicidal Ideation, and Mental Health Service Use of Industrial Workers: Evidence from Vietnam.

Background: Depressive symptoms and suicidal ideation substantially reduce industrial workers' productivity and performance. This study was performed to examine the prevalence of depressive symptoms and suicidal ideation and identify associated factors among industrial workers in different provinces of Vietnam. Materials and Methods: We performed a cross-sectional study in industrial zones of four provinces of Vietnam. The Patient Health Questionnaire (PHQ-9) was employed to screen depressive symptoms and suicidal ideation. Multivariate logistic regression was performed to determine factors related to depressive symptoms and suicidal ideation. Results: Of 1200 industrial workers, 30.5% and 33.6% industrial workers had positive depressive symptoms and suicidal ideation in the last two weeks, respectively. There were 38.3% ever using mental health services in the last 12 months. High school education (OR = 0.64, 95% CI = 0.44-0.95); living in dormitory (OR = 3.07, 95% CI = 1.51-6.24), living with siblings (OR = 2.98; 95% CI = 1.32-6.75), having two children or more (OR = 1.45, 95% CI = 1.03-2.03), high years of experience (OR = 0.94; 95% CI = 0.89-0.98), suffering from burnout, alcohol use disorder (OR = 2.38; 95% CI = 1.72-3.28), and smoking status (OR = 0.38, 95% CI = 0.23-0.61) were associated with positive depressive symptoms. Living with children, working in mechanical/metallurgy/electronics factories, completely exhausted and often thinking of quitting, and alcohol use disorder were positively related to suicidal ideation. Conclusions: This study found a high prevalence of depressive symptoms and suicidal ideation among industrial workers in Vietnam. Regular screening and detecting high-risk groups, along with interventions to reduce health risk behaviors, burnout and on-site medical service quality improvement, are recommended to alleviate the burden of depression in industrial workers.

Factors Associated with Sleep Disorders among Methadone-Maintained Drug Users in Vietnam.

Sleep quality among heroin-dependent patients receiving methadone maintenance treatment (MMT) is not fully investigated in Vietnam. This study explored the prevalence of poor sleep quality in methadone-maintained patients and associated factors. This cross-sectional included 395 MMT patients at three clinics in Nam Dinh province, Vietnam. The Pittsburgh Sleep Quality Index (PSQI) was employed to measure patients' sleep quality. Sociodemographic, clinical, behavioral, psychological, and social support characteristics were collected. Multivariate Logistic and Generalized Linear Regression models were applied to identify associated factors. Among 395 patients, 26.6% had poor sleep quality according to the PSQI scale. People having jobs were less likely to have poor sleep quality and lower PSQI scores compared to unemployed patients. Those having spouses had lower PSQI scores than single patients. High depression, anxiety, and stress scores were associated with poor sleep quality and high PSQI scores. A longer duration of MMT increased the likelihood of experiencing poor sleep quality. Patients smoking tobacco daily or concurrently using drugs had lower PSQI scores than those that did not. This study highlights a moderate prevalence of poor sleep quality among Vietnamese MMT patients. Regular evaluation, appropriate psychological management, and social support, as well as the provision of employment opportunities, potentially improve the sleep quality of methadone-maintained patients.

Knowledge and Attitude Toward Geriatric Palliative Care among Health Professionals in Vietnam.

This study assessed the knowledge and attitude toward palliative care for the elderly among health professionals in a tertiary geriatric hospital in Vietnam and explored their determinants. Cross-sectional data were obtained on 161 geriatric health professionals at the National Geriatric Hospital. Modified-Palliative Care Knowledge Test and Frommelt Attitudes Toward Care of the Dying instruments were used to measure knowledge and attitude toward geriatric palliative care. As a result, 40.5% physicians and 74.2% nurses showed insufficient knowledge about geriatric palliative care (p < 0.05). The lowest score was for dyspnea, following by gastrointestinal and pain problems. No significant difference was found regarding the attitude between physicians and nurses (p > 0.05). Health professional category, age, and years of experience were found to be associated with knowledge about palliative care. Meanwhile, only knowledge score had correlations with total attitude score (Coef. = 0.2; 95%CI = 0.1-0.3), attitude toward patients (Coef. = 0.1; 95%CI = 0.0-0.1) and toward patients' family (Coef. = 0.1; 95%CI = 0.0-0.1). This study highlights a significant knowledge gap and preferable attitude toward palliative care for the elderly among physicians and nurses in the geriatric hospital. Intensive training about geriatric palliative care, focusing on pain, dyspnea and gastrointestinal issue management, should be performed to ensure the quality of palliative care services, especially in nurses.

Factors Associated with Improved HIV/AIDS Treatment Outcomes: Comparing two Major ART Service Delivery Models in Vietnam.

A mixed design approach was performed to assess the CD4 count levels over time and their associated factors among 362 HIV patients on ART from clinics with HIV testing and counseling (ART-HTC) services and those with general healthcare (ART-GH) services. Longitudinal CD4 count data were retrospectively collected from medical records. Sociodemographic, clinical, alcohol use and smoking characteristics were obtained via face-to-face interviews. Multivariate mixed effect linear regression was utilized to determine the association. We found that HIV patients at ART-GH clinics were more likely to achieve higher CD4 counts over time compared to patients at ART-HTC clinics. Additionally, having an increase in CD4 counts was found to be associated with having longer duration of ART and higher baseline CD4 levels. Cigarette smoking and hazardous alcohol use, however, were not associated with CD4 count improvement. Our findings suggest that combining HTC and GH services might provide a synergistic benefit in ART treatment outcomes through an improved access to comprehensive HIV healthcare services for HIV patients on therapy.

Catastrophic health expenditure of Vietnamese patients with gallstone diseases - a case for health insurance policy revaluation.

PURPOSE: Despite gallstone diseases (GSDs) being a major public health concern with both acute and chronic episodes, none of the studies in Vietnam has been conducted to investigate the household expenditure for the GSD treatment. The objective of this study was to estimate the costs of managing GSD and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among Vietnamese patients. MATERIALS AND METHODS: A cross-sectional study was conducted from June 2016 to March 2017 in the Department of Hepatobiliary and Pancreatic Surgery, Viet Duc Hospital in Hanoi, Vietnam. A total of 206 patients were enrolled. Demographic and socioeconomic data, household income, and direct and indirect medical costs of patients seeking treatment for GSD were collected through face-to-face interview. Multivariate logistic regression was used to explore factors associated with CHE. RESULTS: The prevalence of CHE in patients suffering from GSD was 35%. The percentage of patients who were covered by health insurance and at risk for CHE was 41.2%, significantly higher than that of those noninsured (15.8%). Proportions of patients with and without health insurance who sought outpatient treatment were 30.6% and 81.6%, respectively. Patients who were divorced or widowed and had intrahepatic gallstones were significantly more likely to experience CHE. Those who were outpatients, were women, had history of pharmacological treatment to parasitic infection, and belong to middle and highest monthly household income quantile were significantly less likely to experience CHE. CONCLUSION: The findings suggested that efforts to re-evaluate health insurance reimbursement capacity, especially for acute diseases and taking into account the varying preferences of people with different disease severity, should be conducted by health authority. Further studies concerning CHE of GSD in the context of ongoing health policy reform should consider utilizing WHO-recommended measures like the fairness in financial contribution index, as well as taking into consideration the behavioral aspects of health care spending.

Understanding Risk Behaviors of Vietnamese Adults with Chronic Hepatitis B in an Urban Setting.

Cigarette smoking and alcohol consumption can be considered as risk factors that increase the progression of chronic liver disease. Meanwhile, unprotected sex is one of the main causes of hepatitis B infection. This study aimed to explore drinking, smoking, and risky sexual behaviors among people with chronic hepatitis B virus (HBV) in a Vietnamese urban setting, as well as investigating potential associated factors. A cross-sectional study was performed in October 2018 in Viet-Tiep Hospital, Hai Phong, Vietnam. A total of 298 patients who had been diagnosed with chronic hepatitis B reported their smoking status, alcohol use, and sexual risk behavior in the last 12 months. A multivariate logistic regression model was used to identify the associated factors. It was identified that 82.5% of participants never used alcohol. The Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) positive result among male patients was 7.4% (0% in female patients). In addition, 14.5% of participants were current smokers and the mean number of cigarettes per day was 7.4 (SD = 3.4). It was found that 35.4% of male patients had sex with two or more sex partners. Furthermore, 66.7% and 74.1% of participants used condoms when having sex with casual partners/one-night stands and sex workers, respectively. There was a positive correlation between monthly drinking and currently smoking. White-collar workers were less likely to have multiple sex partners within the last 12 months. Our study highlights the need for integrating counseling sessions and educational programs with treatment services.

Which eHealth interventions are most effective for smoking cessation? A systematic review.

PURPOSE: To synthesize evidence of the effects and potential effect modifiers of different electronic health (eHealth) interventions to help people quit smoking. METHODS: Four databases (MEDLINE, PsycINFO, Embase, and The Cochrane Library) were searched in March 2017 using terms that included "smoking cessation", "eHealth/mHealth" and "electronic technology" to find relevant studies. Meta-analysis and meta-regression analyses were performed using Mantel-Haenszel test for fixed-effect risk ratio (RR) and restricted maximum-likelihood technique, respectively. Protocol Registration Number: CRD42017072560. RESULTS: The review included 108 studies and 110,372 participants. Compared to nonactive control groups (eg, usual care), smoking cessation interventions using web-based and mobile health (mHealth) platform resulted in significantly greater smoking abstinence, RR 2.03 (95% CI 1.7-2.03), and RR 1.71 (95% CI 1.35-2.16), respectively. Similarly, smoking cessation trials using tailored text messages (RR 1.80, 95% CI 1.54-2.10) and web-based information and conjunctive nicotine replacement therapy (RR 1.29, 95% CI 1.17-1.43) may also increase cessation. In contrast, little or no benefit for smoking abstinence was found for computer-assisted interventions (RR 1.31, 95% CI 1.11-1.53). The magnitude of effect sizes from mHealth smoking cessation interventions was likely to be greater if the trial was conducted in the USA or Europe and when the intervention included individually tailored text messages. In contrast, high frequency of texts (daily) was less effective than weekly texts. CONCLUSIONS: There was consistent evidence that web-based and mHealth smoking cessation interventions may increase abstinence moderately. Methodologic quality of trials and the intervention characteristics (tailored vs untailored) are critical effect modifiers among eHealth smoking cessation interventions, especially for web-based and text messaging trials. Future smoking cessation intervention should take advantages of web-based and mHealth engagement to improve prolonged abstinence.

Variation Overtime among Patients of the Six Methadone Maintenance Treatment Clinics in Thai Nguyen from 2011 to 2015.

BACKGROUND: Methadone Maintenance Treatment (MMT) program's success depends on the likelihood of reducing drop-out rate and keeping patients remaining in the program. There have been neither comprehensive studies about variation among patients who have been experiencing MMT for long period nor prediction of MMT period in which the risk of drop-out would be the highest in Thai Nguyen, a northern mountainous province where the MMT was established in 2011. OBJECTIVES: To analyze variation of the MMT population through indicators of drop-out and death, re-enrolment, and retention rate in the six Thai Nguyen MMT clinics. METHODS: A retrospective study by reviewing daily treatment notebooks of the six MMT clinics in Thai Nguyen to identify events of drop-out, death, reenrolment among 2,567 patients registered from 12 May 2011 to 6 September 2015. RESULTS: Cumulative hazard of drop-out over period from the first to the fourth year of MMT treatment has an increasing trend at 0.15; 0.31; 0.46; and 0.61, respectively. The cumulative probability of re-enrolment among 740 patients who have already quit the MMT program and then returned slightly increased from 0.07 to 0.16 between the first years and the fourth year in which the highest returning rate occurred within the first 2 years after drop-out. The cumulative retention rate decreased annually and stayed at 71.7% after 4 years of running the MMT. CONCLUSIONS: MMT patients and their families should be informed and consulted about the highest risk period of drop-out and also about period when drop-out patients are most likely to reenter the MMT. Counseling adherence for patients should be conducted not only at the beginning but also during the ongoing MMT and play an extremely important role in reducing drop-out of the program while special counseling should also be reenforced for the re-enrolment patients of MMT.

Customers' Perceptions of Compliance with a Tobacco Control Law in Restaurants in Hanoi, Vietnam: A Cross-Sectional Study.

The Tobacco Harm Prevention Law has been promulgated in 2012 in Vietnam, prohibiting smoking in public places such as restaurants except for designated smoking areas. However, currently, evidence about Vietnamese customers’ and restaurants’ compliance with the Law is constrained. This study aimed to explore customers’ perceptions; attitudes and practices towards the compliance with tobacco control regulations in the restaurants in Hanoi, Vietnam. A cross-sectional study was performed in October 2015 with 1746 customers in 176 communes in Hanoi, Vietnam. Data about customers’ perceptions on how restaurants comply with the smoking control law and whether customers smoking actively or experienced SHS in restaurants in the last 30 days were collected. Multivariable mixed effects logistic regression model was used to determine the factors related to smoking in the restaurant. Most customers were aware of the law on Tobacco Harm Prevention (79%; n = 1320) and regulations that prohibited smoking in restaurants (78.4%; n = 1137). While 75.8% (n = 1285) of customers perceived that they did not see or rarely saw no-smoking signs, 17.7% (n = 481) of customers reported that they frequently saw direct marketing of tobacco in visited restaurants. About one-fourth of customers witnessed that the staff reminded customers not to smoke inside restaurants (28.8%; n = 313), and 65% (n = 1135) sometimes or always were exposed to secondhand smoke in their visited restaurants. People who were female (OR = 0.02, 95% CI = 0.01⁻0.05) were less likely to report their smoking in the restaurant than their counterparts. Those having higher age (OR = 1.03; 95% CI = 1.01⁻1.06), high school education (OR = 2.14, 95% CI = 1.07⁻4.26), being office workers (OR = 3.24, 95% CI = 1.33⁻7.92) or unemployed (OR = 4.45; 95% CI = 1.09⁻18.15) had a higher likelihood of reporting to be restaurant smokers than those having lower high education or students, respectively. This study highlighted a low level of perceived compliance with the smoke-free law in Vietnamese restaurants. Improving the monitoring systems for the enforcement of the smoking law in restaurants should be prioritized; restaurant owners should implement 100% smoke-free environments as following the best practice towards the tobacco control law along with educational campaigns to promote the awareness of restaurant owners and customers about the tobacco control law.

Concurrent drug use among methadone maintenance patients in mountainous areas in northern Vietnam.

OBJECTIVES: With the rise in methadone maintenance therapy (MMT) for drug users in Vietnam, there has been growing interest in understanding if and how often MMT patients engage in concurrent illicit drug use while on methadone therapy in various settings. This study examined factors associated with concurrent opioid use among patients on MMT in a mountainous area in Vietnam. SETTING: One urban and one rural MMT clinics in Tuyen Quang province. PARTICIPANTS: Survey participants consisted of patients who were taking MMT at the selected study sites. A convenience sampling approach was used to recruit the participants. PRIMARY AND SECONDARY OUTCOME MEASURES: Participants were asked a series of questions about their socioeconomic status, current alcohol and tobacco use, health problems (measured by the EuroQol-Five Dimension-Five Level instrument), psychological distress (measured by Kessler score), and factors associated with current and/or previous drug use. Regression models were used to determine factors associated with concurrent drug use among MMT patients. RESULTS: Among the 241 male MMT patients included in the study, 13.4% reported concurrent opioid use. On average, the longer patients had been enrolled in MMT, the less likely they were to concurrently use drugs. Conversely, patients with higher levels of psychological distress were more likely to engage in concurrent drug use while on MMT. CONCLUSION: Longer duration of MMT was significantly correlated with reduced illicit drug use among participants. Higher levels of psychological distress were associated with increased use of illicit drugs among MMT patients. Regardless of distance, long-term MMT is still effective and should be expanded in mountainous areas.

Correlated Factors with Quitting Attempts Among Male Smokers in Vietnam: A QUITLINE-Based Survey.

Despite its decreasing prevalence, cigarette smoking remains the second leading cause of preventable death worldwide. In Vietnam, despite recent smoking cessation efforts, the prevalence of tobacco consumption remains high, particularly among males. In this study, we aim to evaluate the self-efficacy in quitting smoking (i.e., quitting confidence), intention to quit, and identifying associated factors among both rural and urban Vietnamese male populations. A cross-sectional study was conducted on 321 patients (52.7% urban and 47.4% rural inhabitants) who utilized QUITLINE services of Bach Mai Hospital (Hanoi, Vietnam). Socio-economic status, smoking history, cigarette usage data, and intent to quit were assessed. Baseline data were correlated with quitting confidence, to identify significant associated factors. The majority (75.9%) of participants were in the planning phase of cessation, yet 90.8% lacked complete confidence in their quitting ability. Older age, fewer cigarettes per day and previous quitting attempts were associated with quitting confidence (p < 0.05) and plans to quit (p < 0.05). Older smokers and previous quitters were more confident in their ability to quit in the near future and more likely to have made plans to quit. Future smoking cessation efforts should focus on improving self-efficacy, particularly among younger and newer smokers.

Factors associated with nicotine dependence during methadone maintenance treatment: findings from a multisite survey in Vietnam.

OBJECTIVES: Smoking is associated with adverse health outcomes among drug users, including those in treatment. To date, however, there has been little evidence about smoking patterns among people receiving opioid-dependence treatment in developing countries. We examined self-reported nicotine dependence and associated factors in a large sample of opioid-dependent patients receiving methadone maintenance treatment (MMT) in northern Vietnam. SETTING: Five clinics in Hanoi (urban area) and Nam Dinh (rural area). PARTICIPANTS: Patients receiving MMT in the settings during the study period. PRIMARY AND SECONDARY OUTCOME MEASURES: We collected data about smoking patterns, levels of nicotine dependence and other covariates such as socioeconomic status, health status, alcohol use and drug use. The Fagerström test was used to measure nicotine dependence (FTND). Logistic regression and Tobit regression were employed to examine relationships between the smoking rate, nicotine dependence and potentially associated variables. RESULTS: Among 1016 drug users undergoing MMT (98.7% male), 87.2% were current smokers. The mean FTND score was 4.5 (SD 2.4). Longer duration of MMT (OR 0.98, 95% CI 0.96 to 0.99) and being HIV-positive (OR 0.46, 95% CI 0.24 to 0.88) were associated with lower likelihood of smoking. Being employed, older age at first drug injection and having long duration of MMT were inversely related with FTND scores. Higher age and continuing drug and alcohol use were significantly associated with higher FTND scores. CONCLUSION: Smoking prevalence is high among methadone maintenance drug users. Enhanced smoking cessation support should be integrated into MMT programmes in order to reduce risk factors for cigarette smoking and improve the health and well-being of people recovering from opiate dependence.

The importance of assessing out-of-pocket payments when the financing of antiretroviral therapy is transitioned to domestic funding: findings from Vietnam.

OBJECTIVE: To assess out-of-pocket payments and catastrophic health expenditures among antiretroviral therapy (ART) patients in Vietnam, and to model catastrophic payments under different copayment scenarios when the primary financing of ART changes to social health insurance. METHODS: Cross-sectional facility-based survey of 843 patients at 42 health facilities representative of 87% of ART patients in 2015. RESULTS: Because of donor and government funding, no payments were made for antiretroviral drugs. Other health expenditures were about $66 per person per year (95% CI: $30-$102), of which $15 ($7-$22) were directly for HIV-related health services, largely laboratory tests. These payments resulted in a 4.9% (95% CI: 3.1-6.8%) catastrophic payment rate and 2.5% (95% CI: 0.9-4.1%) catastrophic payment rate for HIV-related health services. About 32% of respondents reported, they were eligible for SHI without copayments. If patients had to pay 20% of costs of ART under social health insurance, the catastrophic payment rate would increase to 8% (95% CI: 5.5-10.0%), and if patients without health insurance had to pay the full costs of ART, the catastrophic payment rate among all patients would be 24% (95% CI: 21.1-27.4%). CONCLUSIONS: Health and catastrophic expenditures were substantially lower than in previous studies, although different methods may explain some of the discrepancy. The 20% copayments required by social health insurance would present a financial burden to an additional 0.6% to 5.1% of ART patients. Ensuring access to health insurance for all ART patients will prevent an even higher level of financial hardship.

A study on the influence of internet addiction and online interpersonal influences on health-related quality of life in young Vietnamese.

BACKGROUND: Internet addiction (IA) is a common problem found in young Asians. This study aimed to study the influence of IA and online activities on health-related quality of life (HRQOL) in young Vietnamese. This study also compared the frequencies of anxiety, depression and other addiction of young Vietnamese with and without IA. METHODS: This study recruited 566 young Vietnamese (56.7% female, 43.3% male) ranging from 15 to 25 years of age via the respondent-driven sampling technique. Chi-squared, t-test and analysis of variance were used to compare young Vietnamese with and without IA. Regression analyses were used to examine the association between internet usage characteristics and HRQOL. RESULTS: Results from this cross-sectional study showed that 21.2% of participants suffered from IA. Online relationship demonstrated significantly higher influences on behaviors and lifestyles in participants with IA than those without IA. Participants with IA were more likely to have problems with self-care, difficulty in performing daily routine, suffer from pain and discomfort, anxiety and depression. Contrary to previous studies, we found that there were no differences in gender, sociodemographic, the number of participants with cigarette smoking, water-pipe smoking and alcohol dependence between the IA and non-IA groups. IA was significantly associated with poor HRQOL in young Vietnamese. CONCLUSION: IA is a common problem among young Vietnamese and the prevalence of IA is the highest as compared to other Asian countries. Our findings suggest that gender may not play a key role in IA. This can be an emerging trend when both genders have equal access to the internet. By studying the impact of IA on HRQOL, healthcare professionals can design effective intervention to alleviate the negative consequences of IA in Vietnam.