A new hybrid equilibrium optimized SysFor based geospatial data mining for tropical storm-induced flash flood susceptible mapping.

Flash flood is one of the most dangerous hydrologic and natural phenomena and is considered as the top ranking of such events among various natural disasters due to their fast onset characteristics and the proportion of individual fatalities. Mapping the probability of flash flood events remains challenges because of its complexity and rapid onset of precipitation. Thus, this study aims to propose a state-of-the-art data mining approach based on a hybrid equilibrium optimized SysFor, namely, the HE-SysFor model, for spatial prediction of flash floods. A tropical storm region located in the Northwest areas of Vietnam is selected as a case study. For this purpose, 1866 flash-flooded locations and ten indicators were used. The results show that the proposed HE-SysFor model yielded the highest predictive performance (total accuracy = 93.8%, Kappa index = 0.875, F1-score = 0.939, and AUC = 0.975) and produced the better performance than those of the C4.5 decision tree (C4.5), the radial basis function-based support vector machine (SVM-RBF), the logistic regression (LReg), and deep learning neural network (DeepLNN) models in both the training and the testing phases. Among the ten indicators, elevation, slope, and land cover are the most important. It is concluded that the proposed model provides an alternative tool and may help for effectively monitoring flash floods in tropical areas and robust policies for decision making in mitigating the flash flood impacts.

Machine Learning-Based Gully Erosion Susceptibility Mapping: A Case Study of Eastern India.

Gully erosion is a form of natural disaster and one of the land loss mechanisms causing severe problems worldwide. This study aims to delineate the areas with the most severe gully erosion susceptibility (GES) using the machine learning techniques Random Forest (RF), Gradient Boosted Regression Tree (GBRT), Naïve Bayes Tree (NBT), and Tree Ensemble (TE). The gully inventory map (GIM) consists of 120 gullies. Of the 120 gullies, 84 gullies (70%) were used for training and 36 gullies (30%) were used to validate the models. Fourteen gully conditioning factors (GCFs) were used for GES modeling and the relationships between the GCFs and gully erosion was assessed using the weight-of-evidence (WofE) model. The GES maps were prepared using RF, GBRT, NBT, and TE and were validated using area under the receiver operating characteristic(AUROC) curve, the seed cell area index (SCAI) and five statistical measures including precision (PPV), false discovery rate (FDR), accuracy, mean absolute error (MAE), and root mean squared error (RMSE). Nearly 7% of the basin has high to very high susceptibility for gully erosion. Validation results proved the excellent ability of these models to predict the GES. Of the analyzed models, the RF (AUROC = 0.96, PPV = 1.00, FDR = 0.00, accuracy = 0.87, MAE = 0.11, RMSE = 0.19 for validation dataset) is accurate enough for modeling and better suited for GES modeling than the other models. Therefore, the RF model can be used to model the GES areas not only in this river basin but also in other areas with the same geo-environmental conditions.

Evaluation of Recent Advanced Soft Computing Techniques for Gully Erosion Susceptibility Mapping: A Comparative Study.

Gully erosion is a problem; therefore, it must be predicted using highly accurate predictive models to avoid losses caused by gully development and to guarantee sustainable development. This research investigates the predictive performance of seven multiple-criteria decision-making (MCDM), statistical, and machine learning (ML)-based models and their ensembles for gully erosion susceptibility mapping (GESM). A case study of the Dasjard River watershed, Iran uses a database of 306 gully head cuts and 15 conditioning factors. The database was divided 70:30 to train and verify the models. Their performance was assessed with the area under prediction rate curve (AUPRC), the area under success rate curve (AUSRC), accuracy, and kappa. Results show that slope is key to gully formation. The maximum entropy (ME) ML model has the best performance (AUSRC = 0.947, AUPRC = 0.948, accuracy = 0.849 and kappa = 0.699). The second best is the random forest (RF) model (AUSRC = 0.965, AUPRC = 0.932, accuracy = 0.812 and kappa = 0.624). By contrast, the TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) model was the least effective (AUSRC = 0.871, AUPRC = 0.867, accuracy = 0.758 and kappa = 0.516). RF increased the performance of statistical index (SI) and frequency ratio (FR) statistical models. Furthermore, the combination of a generalized linear model (GLM), and functional data analysis (FDA) improved their performances. The results demonstrate that a combination of geographic information systems (GIS) with remote sensing (RS)-based ML models can successfully map gully erosion susceptibility, particularly in low-income and developing regions. This method can aid the analyses and decisions of natural resources managers and local planners to reduce damages by focusing attention and resources on areas prone to the worst and most damaging gully erosion.

Fuzzy-metaheuristic ensembles for spatial assessment of forest fire susceptibility.

Forests are important dynamic systems which are widely affected by fire worldwide. Due to the complexity and non-linearity of the forest fire problem, employing hybrid evolutionary algorithms is a logical task to achieve a reliable approximation of this environmental threat. Three fuzzy-metaheuristic ensembles, based on adaptive neuro-fuzzy inference systems (ANFIS) incorporated with genetic algorithm (GA), particle swarm optimization (PSO), and differential evolution (DE) evolutionary algorithms are used to produce the forest fire susceptibility map (FFSM) of a fire-prone region in Iran. A sensitivity analysis is also executed to evaluate the effectiveness of the proposed ensembles in terms of time and complexity. The results revealed that all models produce FFSMs with acceptable accuracy. However, the superiority of the GA-ANFIS was shown in both recognizing the pattern (AUROCtrain = 0.912 and Error = 0.1277) and predicting unseen fire events (AUROCtest = 0.850 and Error = 0.1638). The optimized structures of the proposed GA-ANFIS and PSO-ANFIS ensembles could be good alternatives to traditional forest fire predictive models, and their FFSMs can be promisingly used for future planning and decision making in the proposed area.

Spatial Landslide Susceptibility Assessment Based on Novel Neural-Metaheuristic Geographic Information System Based Ensembles.

Regular optimization techniques have been widely used in landslide-related problems. This paper outlines two novel optimizations of artificial neural network (ANN) using grey wolf optimization (GWO) and biogeography-based optimization (BBO) metaheuristic algorithms in the Ardabil province, Iran. To this end, these algorithms are synthesized with a multi-layer perceptron (MLP) neural network for optimizing its computational parameters. The used spatial database consists of fourteen landslide conditioning factors, namely elevation, slope aspect, land use, plan curvature, profile curvature, soil type, distance to river, distance to road, distance to fault, rainfall, slope degree, stream power index (SPI), topographic wetness index (TWI) and lithology. 70% of the identified landslides are randomly selected to train the proposed models and the remaining 30% is used to evaluate the accuracy of them. Also, the frequency ratio theory is used to analyze the spatial interaction between the landslide and conditioning factors. Obtained values of area under the receiver operating characteristic curve, as well as mean square error and mean absolute error showed that both GWO and BBO hybrid algorithms could efficiently improve the learning capability of the MLP. Besides, the BBO-based ensemble surpasses other implemented models.

Slope Stability Monitoring Using Novel Remote Sensing Based Fuzzy Logic.

By the assist of remotely sensed data, this study examines the viability of slope stability monitoring using two novel conventional models. The proposed models are considered to be the combination of neuro-fuzzy (NF) system along with invasive weed optimization (IWO) and elephant herding optimization (EHO) evolutionary techniques. Considering the conditioning factors of land use, lithology, soil type, rainfall, distance to the road, distance to the river, slope degree, elevation, slope aspect, profile curvature, plan curvature, stream power index (SPI), and topographic wetness index (TWI), it is aimed to achieve a reliable approximation of landslide occurrence likelihood for unseen environmental conditions. To this end, after training the proposed EHO-NF and IWO-NF ensembles using training landslide events, their generalization power is evaluated by receiving operating characteristic curves. The results demonstrated around 75% accuracy of prediction for both models; however, the IWO-NF achieved a better understanding of landslide distribution pattern. Due to the successful performance of the implemented models, they could be promising alternatives to mathematical and analytical approaches being used for discerning the relationship between the slope failure and environmental parameters.

Prediction of Pullout Behavior of Belled Piles through Various Machine Learning Modelling Techniques.

The main goal of this study is to estimate the pullout forces by developing various modelling technique like feedforward neural network (FFNN), radial basis functions neural networks (RBNN), general regression neural network (GRNN) and adaptive neuro-fuzzy inference system (ANFIS). A hybrid learning algorithm, including a back-propagation and least square estimation, is utilized to train ANFIS in MATLAB (software). Accordingly, 432 samples have been applied, through which 300 samples have been considered as training dataset with 132 ones for testing dataset. All results have been analyzed by ANFIS, in which the reliability has been confirmed through the comparing of the results. Consequently, regarding FFNN, RBNN, GRNN, and ANFIS, statistical indexes of coefficient of determination (R2), variance account for (VAF) and root mean square error (RMSE) in the values of (0.957, 0.968, 0.939, 0.902, 0.998), (95.677, 96.814, 93.884, 90.131, 97.442) and (2.176, 1.608, 3.001, 4.39, 0.058) have been achieved for training datasets and the values of (0.951, 0.913, 0.729, 0.685 and 0.995), (95.04, 91.13, 72.745, 66.228, 96.247) and (2.433, 4.032, 8.005, 10.188 and 1.252) are for testing datasets indicating a satisfied reliability of ANFIS in estimating of pullout behavior of belled piles.

A Novel Swarm Intelligence-Harris Hawks Optimization for Spatial Assessment of Landslide Susceptibility.

In this research, the novel metaheuristic algorithm Harris hawks optimization (HHO) is applied to landslide susceptibility analysis in Western Iran. To this end, the HHO is synthesized with an artificial neural network (ANN) to optimize its performance. A spatial database comprising 208 historical landslides, as well as 14 landslide conditioning factors-elevation, slope aspect, plan curvature, profile curvature, soil type, lithology, distance to the river, distance to the road, distance to the fault, land cover, slope degree, stream power index (SPI), topographic wetness index (TWI), and rainfall-is prepared to develop the ANN and HHO-ANN predictive tools. Mean square error and mean absolute error criteria are defined to measure the performance error of the models, and area under the receiving operating characteristic curve (AUROC) is used to evaluate the accuracy of the generated susceptibility maps. The findings showed that the HHO algorithm effectively improved the performance of ANN in both recognizing (AUROCANN = 0.731 and AUROCHHO-ANN = 0.777) and predicting (AUROCANN = 0.720 and AUROCHHO-ANN = 0.773) the landslide pattern.

A Review of Remote Sensing Approaches for Monitoring Blue Carbon Ecosystems: Mangroves, Seagrassesand Salt Marshes during 2010⁻2018.

Blue carbon (BC) ecosystems are an important coastal resource, as they provide a range of goods and services to the environment. They play a vital role in the global carbon cycle by reducing greenhouse gas emissions and mitigating the impacts of climate change. However, there has been a large reduction in the global BC ecosystems due to their conversion to agriculture and aquaculture, overexploitation, and removal for human settlements. Effectively monitoring BC ecosystems at large scales remains a challenge owing to practical difficulties in monitoring and the time-consuming field measurement approaches used. As a result, sensible policies and actions for the sustainability and conservation of BC ecosystems can be hard to implement. In this context, remote sensing provides a useful tool for mapping and monitoring BC ecosystems faster and at larger scales. Numerous studies have been carried out on various sensors based on optical imagery, synthetic aperture radar (SAR), light detection and ranging (LiDAR), aerial photographs (APs), and multispectral data. Remote sensing-based approaches have been proven effective for mapping and monitoring BC ecosystems by a large number of studies. However, to the best of our knowledge, this is the first comprehensive review on the applications of remote sensing techniques for mapping and monitoring BC ecosystems. The main goal of this review is to provide an overview and summary of the key studies undertaken from 2010 onwards on remote sensing applications for mapping and monitoring BC ecosystems. Our review showed that optical imagery, such as multispectral and hyper-spectral data, is the most common for mapping BC ecosystems, while the Landsat time-series are the most widely-used data for monitoring their changes on larger scales. We investigate the limitations of current studies and suggest several key aspects for future applications of remote sensing combined with state-of-the-art machine learning techniques for mapping coastal vegetation and monitoring their extents and changes.

A Novel Ensemble Artificial Intelligence Approach for Gully Erosion Mapping in a Semi-Arid Watershed (Iran).

In this study, we introduced a novel hybrid artificial intelligence approach of rotation forest (RF) as a Meta/ensemble classifier based on alternating decision tree (ADTree) as a base classifier called RF-ADTree in order to spatially predict gully erosion at Klocheh watershed of Kurdistan province, Iran. A total of 915 gully erosion locations along with 22 gully conditioning factors were used to construct a database. Some soft computing benchmark models (SCBM) including the ADTree, the Support Vector Machine by two kernel functions such as Polynomial and Radial Base Function (SVM-Polynomial and SVM-RBF), the Logistic Regression (LR), and the Naïve Bayes Multinomial Updatable (NBMU) models were used for comparison of the designed model. Results indicated that 19 conditioning factors were effective among which distance to river, geomorphology, land use, hydrological group, lithology and slope angle were the most remarkable factors for gully modeling process. Additionally, results of modeling concluded the RF-ADTree ensemble model could significantly improve (area under the curve (AUC) = 0.906) the prediction accuracy of the ADTree model (AUC = 0.882). The new proposed model had also the highest performance (AUC = 0.913) in comparison to the SVM-Polynomial model (AUC = 0.879), the SVM-RBF model (AUC = 0.867), the LR model (AUC = 0.75), the ADTree model (AUC = 0.861) and the NBMU model (AUC = 0.811).

Spatial pattern analysis and prediction of forest fire using new machine learning approach of Multivariate Adaptive Regression Splines and Differential Flower Pollination optimization: A case study at Lao Cai province (Viet Nam).

Understanding spatial patterns of forest fire is of key important for fire danger management and ecological implication. This aim of this study was to propose a new machine learning methodology for analyzing and predicting spatial patterns of forest fire danger with a case study of tropical forest fire at Lao Cai province (Vietnam). For this purpose, a Geographical Information System (GIS) database for the study area was established, including ten influencing factors (slope, aspect, elevation, land use, distance to road, normalized difference vegetation index, rainfall, temperature, wind speed, and humidity) and 257 fire locations. The relevance level of these factors with the forest fire was analyzed and assessed using the Mutual Information algorithm. Then, a new hybrid artificial intelligence model named as MARS-DFP, which was Multivariate Adaptive Regression Splines (MARS) optimized by Differential Flower Pollination (DFP), was proposed and used construct forest fire model for generating spatial patterns of forest fire. MARS is employed to build the forest fire model for generalizing a classification boundary that distinguishes fire and non-fire areas, whereas DFP, a metaheuristic approach, was utilized to optimize the model. Finally, global prediction performance of the model was assessed using Area Under the curve (AUC), Classification Accuracy Rate (CAR), Wilcoxon signed-rank test, and various statistical indices. The result demonstrated that the predictive performance of the MARS-DFP model was high (AUC = 0.91 and CAR = 86.57%) and better to those of other benchmark methods, Backpropagation Artificial Neural Network, Adaptive neuro fuzzy inference system, Radial Basis Function Neural Network. This fact confirms that the newly constructed MARS-DFP model is a promising alternative for spatial prediction of forest fire susceptibility.

Genetic and firefly metaheuristic algorithms for an optimized neuro-fuzzy prediction modeling of wildfire probability.

In the terrestrial ecosystems, perennial challenges of increased frequency and intensity of wildfires are exacerbated by climate change and unplanned human activities. Development of robust management and suppression plans requires accurate estimates of future burn probabilities. This study describes the development and validation of two hybrid intelligence predictive models that rely on an adaptive neuro-fuzzy inference system (ANFIS) and two metaheuristic optimization algorithms, i.e., genetic algorithm (GA) and firefly algorithm (FA), for the spatially explicit prediction of wildfire probabilities. A suite of ten explanatory variables (altitude, slope, aspect, land use, rainfall, soil order, temperature, wind effect, and distance to roads and human settlements) was investigated and a spatial database constructed using 32 fire events from the Zagros ecoregion (Iran). The frequency ratio model was used to assign weights to each class of variables that depended on the strength of the spatial association between each class and the probability of wildfire occurrence. The weights were then used for training the ANFIS-GA and ANFIS-FA hybrid models. The models were validated using the ROC-AUC method that indicated that the ANFIS-GA model performed better (AUCsuccessrate = 0.92; AUCpredictionrate = 0.91) than the ANFIS-FA model (AUCsuccessrate = 0.89; AUCpredictionrate = 0.88). The efficiency of these models was compared to a single ANFIS model and statistical analyses of paired comparisons revealed that the two meta-optimized predictive models significantly improved wildfire prediction accuracy compared to the single ANFIS model (AUCsuccessrate = 0.82; AUCpredictionrate = 0.78). We concluded that such predictive models may become valuable toolkits to effectively guide fire management plans and on-the-ground decisions on firefighting strategies.

Multi-hazards vulnerability assessment of southern coasts of Iran.

Coastal vulnerability assessment has become one of the most important tools for decision making and providing effective managerial solutions to reduce adverse socio-economic impacts of multiple environmental hazards on coupled social-ecological systems of coastal areas. The aim of this study was to assess the vulnerability of the northern coasts of the Persian Gulf (PG) and the Gulf of Oman (GO) in the Hormozgan province of Iran. Nine variables of vulnerability that included the rate of coastline change, relative sea level rise, coastal slope, mean tidal range, coastal geomorphology, significant wave height (SWH), extreme storm surge, population density, and fishing intensity were weighted, mapped, and combined into the Coastal vulnerability index (CVI). Experts viewed sea level rise, shoreline change and extreme storm surge as most important for imparting vulnerabilities on the northern coasts of PG and GO. Socio-economic variables (i.e., population density and fishery intensity) were considered least important. Of the total length of the provincial shoreline, 27% were classified into the very low vulnerability class, 31% into the low, 17.4% into the moderate, 15.4% into the high, and 9.2% into the very high vulnerability class. About 1295 km (58%) of shorelines were classified into the low and very low vulnerability classes (CVI value ≤ 8.32) and mainly consisted of shorelines on the western coast along the PG. In contrast, 553 km (24.6%) of shorelines were classified into the high and very high vulnerability classes (CVI values > 13.39) and were located along the central coasts (especially in the Qeshm Island and Strait of Hormuz) and on the east coasts of the GO. At least a quarter of all shorelines in the province have high and very high vulnerability to environmental hazards that are the harbingers of climate change.

A Novel Hybrid Swarm Optimized Multilayer Neural Network for Spatial Prediction of Flash Floods in Tropical Areas Using Sentinel-1 SAR Imagery and Geospatial Data.

Flash floods are widely recognized as one of the most devastating natural hazards in the world, therefore prediction of flash flood-prone areas is crucial for public safety and emergency management. This research proposes a new methodology for spatial prediction of flash floods based on Sentinel-1 SAR imagery and a new hybrid machine learning technique. The SAR imagery is used to detect flash flood inundation areas, whereas the new machine learning technique, which is a hybrid of the firefly algorithm (FA), Levenberg⁻Marquardt (LM) backpropagation, and an artificial neural network (named as FA-LM-ANN), was used to construct the prediction model. The Bac Ha Bao Yen (BHBY) area in the northwestern region of Vietnam was used as a case study. Accordingly, a Geographical Information System (GIS) database was constructed using 12 input variables (elevation, slope, aspect, curvature, topographic wetness index, stream power index, toposhade, stream density, rainfall, normalized difference vegetation index, soil type, and lithology) and subsequently the output of flood inundation areas was mapped. Using the database and FA-LM-ANN, the flash flood model was trained and verified. The model performance was validated via various performance metrics including the classification accuracy rate, the area under the curve, precision, and recall. Then, the flash flood model that produced the highest performance was compared with benchmarks, indicating that the combination of FA and LM backpropagation is proven to be very effective and the proposed FA-LM-ANN is a new and useful tool for predicting flash flood susceptibility.

Land Subsidence Susceptibility Mapping in South Korea Using Machine Learning Algorithms.

In this study, land subsidence susceptibility was assessed for a study area in South Korea by using four machine learning models including Bayesian Logistic Regression (BLR), Support Vector Machine (SVM), Logistic Model Tree (LMT) and Alternate Decision Tree (ADTree). Eight conditioning factors were distinguished as the most important affecting factors on land subsidence of Jeong-am area, including slope angle, distance to drift, drift density, geology, distance to lineament, lineament density, land use and rock-mass rating (RMR) were applied to modelling. About 24 previously occurred land subsidence were surveyed and used as training dataset (70% of data) and validation dataset (30% of data) in the modelling process. Each studied model generated a land subsidence susceptibility map (LSSM). The maps were verified using several appropriate tools including statistical indices, the area under the receiver operating characteristic (AUROC) and success rate (SR) and prediction rate (PR) curves. The results of this study indicated that the BLR model produced LSSM with higher acceptable accuracy and reliability compared to the other applied models, even though the other models also had reasonable results.

Novel GIS Based Machine Learning Algorithms for Shallow Landslide Susceptibility Mapping.

The main objective of this research was to introduce a novel machine learning algorithm of alternating decision tree (ADTree) based on the multiboost (MB), bagging (BA), rotation forest (RF) and random subspace (RS) ensemble algorithms under two scenarios of different sample sizes and raster resolutions for spatial prediction of shallow landslides around Bijar City, Kurdistan Province, Iran. The evaluation of modeling process was checked by some statistical measures and area under the receiver operating characteristic curve (AUROC). Results show that, for combination of sample sizes of 60%/40% and 70%/30% with a raster resolution of 10 m, the RS model, while, for 80%/20% and 90%/10% with a raster resolution of 20 m, the MB model obtained a high goodness-of-fit and prediction accuracy. The RS-ADTree and MB-ADTree ensemble models outperformed the ADTree model in two scenarios. Overall, MB-ADTree in sample size of 80%/20% with a resolution of 20 m (area under the curve (AUC) = 0.942) and sample size of 60%/40% with a resolution of 10 m (AUC = 0.845) had the highest and lowest prediction accuracy, respectively. The findings confirm that the newly proposed models are very promising alternative tools to assist planners and decision makers in the task of managing landslide prone areas.

Detection of post-exercise stunning by early gated SPECT myocardial perfusion imaging: results from the IAEA multi-center study.

BACKGROUND: Transient post-ischemic LV dysfunction due to myocardial stunning in patients with coronary artery disease can be missed by conventional gated SPECT (GSPECT) acquisitions. The aim of this IAEA-sponsored multi-center study was to determine whether early post-exercise imaging is more likely to detect stunning than conventional without adversely affecting image quality or perfusion information. METHODS AND RESULTS: Patients undergoing exercise/rest GSPECT were enrolled in this international multicenter study. Post-exercise studies were acquired at 15 ± 5 minutes after radiotracer injection (Stress-1) and repeated at 60 ± 15 minutes (Stress-2). Rest studies (R) were acquired at 60 minutes post injection. A core laboratory quantitatively assessed perfusion pattern and LV blinded to the acquisition time. Ischemia was defined as summed stress score (SDS) ≥4, and stunning was defined as the difference between rest and post-stress LVEF (Δ-LVEF). In the 229 patients enrolled into the study, both image quality and perfusion information were similar between Stress-1 and Stress-2. Post-stress LVEF was associated with both ischemia and time of acquisition, with a significant correlation between SDS and Δ-LVEF, which was stronger at Stress-1 than Stress-2 in the ischemic compared to the non-ischemic population (r = 0.23 vs 0.08, P = 0.10). CONCLUSIONS: Early post-exercise imaging is feasible, and can potentially improve the detection of post-ischemic stunning without compromising image quality and perfusion data.

Informal caregiving among people supporting a person with type 2 diabetes in rural communities of Northern Vietnam: A cross-sectional study of caregiver burdens.

OBJECTIVE: The prevalence of type 2 diabetes mellitus (T2DM) in Vietnam has doubled from 3% to 6% over the last decades, with potential consequences for persons with diabetes and their caregivers. This study aimed to assess caregiver burdens and factors associated with caregiver burden. METHOD: A cross-sectional study was conducted in 2019, using data from 1,241 informal caregivers (ICGs). Caregiver burden was scored from 0-32 using 8 questions from the Zarit Burden Interview (ZBI). Quantile regression analysis was used to identify factors associated with caregiver burden. RESULTS: The median score of the ZBI was 7.0 (Q1-Q3: 2.0-10.0), indicating that the burden among caregiver of persons with T2DM is not high. Quantile regression showed that the higher the monthly income, the lower the burden among caregivers (50% quantile and 75% quantile of burden: -0.004). Lower educational level (25%Q: 4.0, 50%Q; 3.0, 75%Q: 2.16), being a farmer (25%Q: 2.0) and providing care to other people besides the person with T2DM (25%Q: 2.0, 50%Q; 2.54, 75%Q: 1.66) were associated with higher burden on caregivers. CONCLUSION: The study found that caregivers facing additional life stressors, such as low income or other caregiving responsibilities, reported higher levels of burden. These findings could inform the development of interventions targeted at supporting informal caregivers in rural areas in low- and middle-income countries.

Prevalence of cervical infection with HPV type 16 and 18 in Vietnam: implications for vaccine campaign.

BACKGROUND: The Expanded Program on Immunization currently considers offering Human Papilomavirus vaccine on a routine basis in Vietnam. However, as the current available vaccine can prevent only two types HPV 16 and 18, before implementing a large-scale vaccine campaign we need information about the prevalence of infection with only HPV 16 and 18 in Viet Nam. This study was done in 5 large cities in Vietnam to estimate the prevalence of HPV 16 and/or 18 infections and to explore the distribution of other high risk types of HPV among married women in these provinces. METHODS: The study employed a cross-sectional design with multistage sampling. The sample size included 4500 married women in two rounds (aged ranged from 18-69 years old, median age: 40 year old). Participant were randomly selected, interviewed and given gynaecological examinations. HPV infection status (by real-time PCR kit using TaqMan probe) and HPV genotyping test (by Reverse dot blot) were done for all participants. RESULTS: The prevalence of cervical infection with HPV type 16 and/or 18 among married women in this study ranged from 3.1% to 7.4%. Many positive HPV cases (ranged from 24.5% to 56.8%) were infected with other type of high risk HPV which can lead to cervical cancer and cannot prevented by currently available vaccines. In addition to HPV 16 and/or 18, most common types of high risk HPV were types 58, 52, 35 and 45. Awareness about HPV and HPV vaccines was still low in the study samples. DISCUSSION: While it is relevant to implement an HPV vaccine campaign in Viet Nam, it is important to note that one can be infected with multiple types of HPV. Vaccination does not protected against all type of high risk HPV types. Future vaccine campaigns should openly disclose this information to women receiving vaccines. CONCLUSION: High prevalence of infection with HPV high risk types was observed in this study. As HPV infection has a high correlation with cervical cancer, this study emphasizes the need for both primary prevention of cervical cancer with HPV vaccines as well as secondary prevention with screening.

Polypharmacy among people living with type 2 diabetes mellitus in rural communes in Vietnam.

OBJECTIVES: People with diabetes are at high risk of polypharmacy owing to complex treatment of diabetes and comorbidities. Polypharmacy is associated with increased risk of adverse reactions and decreased compliance. Therefore, the objectives of this study were to assess polypharmacy in people with type 2 diabetes (T2D) and associated diabetes-related factors in rural areas in Vietnam. METHOD: People with T2D (n = 806) who had received treatment for diabetes at a district hospital were invited to participate in a questionnaire-based cross-sectional survey. Polypharmacy was defined as ≥5 types of medicine and assessed as a) prescription medicine and non-prescription/over the counter (OTC) medicine and b) prescription medicine and non-prescription/OTC, herbal and traditional medicine, and dietary supplement. Multiple logistic regression was used to investigate the association between polypharmacy and diabetes specific factors: duration, comorbidities and diabetes-related distress. RESULTS: Of the people with T2D, 7.8% had a medicine use corresponding to polypharmacy (prescription medicine and non-prescription/OTC), and 40.8% when herbal and traditional medicine, and dietary supplement were included. Mean number of medicine intake (all types of medicines and supplements) were 3.8±1.5. The odd ratios (ORs) of polypharmacy (medicine and supplements) increased with diabetes duration (<1-5 years OR = 1.66; 95%CI: 1.09-2.53 and >5 years OR = 1.74; 95%CI: 1.14-2.64 as compared to ≤1-year duration of diabetes), number of comorbidities (1-2 comorbidities: OR = 2.0; 95%CI: 1.18-3.42; ≥3 comorbidities: OR = 2.63;95%CI: 1.50-4.61 as compared to no comorbidities), and suffering from diabetes-related distress (OR = 1.49; 95%CI: 1.11-2.01) as compared to those without distress. CONCLUSIONS: In rural northern Vietnam, persons with longer duration of T2D, higher number of comorbidities and diabetes-related stress have higher odds of having a medicine use corresponding to polypharmacy. A high proportion of people with T2D supplement their prescription, non-prescription/OTC medicine with herbal and traditional medicine and dietary supplements.