Vaccine acceptance, determinants, and attitudes toward vaccine among people experiencing homelessness: a systematic review and meta-analysis.

BACKGROUND: COVID-19 has caused millions of deaths globally, with vulnerable populations such as people experiencing homelessness (PEH) at higher risk. This systematic review and meta-analysis aims to identify the prevalence and key factors contributing to vaccine acceptance experienced by PEH. METHODS: The protocol of this study was registered in PROSPERO (CRD42023391659). We included studies that reported relevant information about vaccine acceptance or vaccine hesitant/refusal among PEH. Eight databases were systematically searched in January 2023. Meta-analysis was conducted for the prevalence of vaccine acceptance, vaccine uptake, and factors associated with vaccine acceptance. Attitudes toward vaccines were combined into bar charts. RESULT: A total of 29 papers were included in this systematic review and 19 papers were included for meta-analysis. The pooled prevalence of COVID-19 vaccine acceptance among PEH was 66% (95%CI: 58%-73%). Our meta-regression showed vaccine acceptance was significantly increased over time. Moreover, subgroup meta-analysis showed that PEH were more likely to accept the COVID-19 vaccine after June 2021 (78%, 95%CI: 65%-86%) compared with earlier period (56%, 95%CI: 54%-59%). Subgroup meta-analysis also revealed that women and participants without underlying medical condition (chronic diseases) were significantly less likely to accept the COVID-19 vaccine, compared to men and those with medical conditions, respectively. CONCLUSION: The study emphasizes the need for targeted public health interventions aimed at increasing vaccine acceptance among PEH, especially at the early stage of the pandemic, among females, those without underlying medical conditions, being Black (in Canada and the USA), and young people. These interventions should address the common concerns of vaccine safety, adverse effects, effectiveness, and distrust in health care systems. In addition to offering vaccinations in different areas convenient to them, education programs could be established to increase vaccine acceptance among PEH.

Validity of Machine Learning in Detecting Complicated Appendicitis in a Resource-Limited Setting: Findings from Vietnam.

Background: Complicated appendicitis, a potentially life-threatening condition, is common. However, the diagnosis of this condition is mainly based on physician's experiences and advanced diagnostic equipment. This study built and validated machine learning models to facilitate the detection of complicated appendicitis. Methods: A retrospective cohort study was conducted based on medical charts of all patients undergoing a laparoscopic appendectomy at a city hospital during 2016-2020. The synthetic minority over-sampling technique (SMOTE) was used to adjust for the imbalance. Multiple classification approaches were used to train and validate models including support vector machine (SVM), decision tree (DT), K-nearest neighbor (KNN), logistic regression (LR), artificial neural network (ANN), and gradient boosting (GB). Results: Among 1,950 patients included in the data analysis, there were 483 patients identified as having complicated appendicitis (24.8%). Based on data without SMOTE adjustment for imbalance, the accuracy levels and AUCs were high in all models using different parameters, ranging from 0.687 to 0.815. After adjusting for imbalance data using SMOTE, AUC and accuracy levels in the models using imbalance adjusted data were higher. Of these, the GB had all AUC and accuracy values of approximately 0.8 or more in both adjusted and unadjusted data. Conclusions: Machine learning approaches including SVM, DT, logistic, KNN, ANN, and GB have a high level of validity in classifying patients with complicated appendicitis and patients without complicated appendicitis. Among these, GB had the highest level of validity and should be used or further validated. Our study indicates the beneficial potentials of machine learning techniques in a clinical setting in general and in the diagnosis of complicated appendicitis in particular.

Laparoscopic Hartmann reversal: experiences from a developing country.

PURPOSE: Laparoscopic surgery is considered a promising approach for Hartmann reversal but is also a complicated major surgical procedure. We conducted a retrospective analysis at a city hospital in Vietnam to evaluate the treatment technique and outcomes of laparoscopic Hartmann reversal (LHR). METHODS: A colorectal surgery database in 5 years between 2015 and 2019 (1,175 cases in total) was retrieved to collect 35 consecutive patients undergoing LHR. RESULTS: The patients had a median age of 61 years old. The median operative time was 185 minutes. All the procedures were first attempted laparoscopically with a conversion rate of 20.0% (7 of 35 cases). There was no intraoperative complication. Postoperative mortality and morbidity were 0 and 11.4% (2 medical, 1 deep surgical site infection, and 1 anastomotic leak required reoperation) respectively. The median time to first bowel activity was 2.8 days and median length of hospital stay was 8 days. CONCLUSION: When performed by skilled surgeons, LHR is a feasible and safe operation with acceptable morbidity rate.

Combination of data-driven models and interpolation technique to develop of PM10 map for Hanoi, Vietnam.

The degradation of air quality is the most concerned issue of our society due to its harmful impacts on human health, especially in cities with rapid urbanization and population growth like Hanoi, the capital of Vietnam. This study aims at developing a new approach that combines data-driven models and interpolation technique to develop the PM10 concentration maps from meteorological factors for the central area of Hanoi. Data-driven models that relate the PM10 concentration with the meteorological factors at the air quality monitoring stations in the study area were developed using the Multiple Linear Regression (MLR) and Artificial Neural Network (ANN) algorithms. Models' performance comparison showed that ANN models yielded better goodness-of-fit indices than MLR models at all stations in the study area with average coefficient of correlation (r) and Nash-Sutcliffe Efficiency Index (NSE) of 0.51 and 0.34 for the former, and 0.7 and 0.49 for the latter. These indices indicates that the ANN-based data-driven models outperformed the MLR-based models. Thus, the ANN-based models and the Inverse Distance Weighting (IDW) interpolation technique were then combined for mapping the monthly PM10 concentration with a spatial resolution of 1 km from global meteorological data. With this combination, the PM10 concentration maps account for both local PM10 concentration and impacts of spatio-temporal variations of meteorological factors on the PM10 concentration. This study provides a promising method to predict the PM concentration with a high spatio-temporal resolution from meteorological data.

Emergency surgery for obstructed colorectal cancer in Vietnam.

BACKGROUND: The benefit of one-stage surgery in emergency surgery for obstructing colorectal cancer (oCRC) by colorectal surgeons has increased during the last century but little is known about the outcomes of this technique conducted by general surgeons in developing countries. This retrospective study was to evaluate the outcomes of emergency surgery for oCRC in a general surgery unit. METHODS: A retrospective review of data from 1175 patients who underwent colorectal surgery between January 2013 and January 2018 was performed. Among these, a total of 186 patients with oCRC who underwent surgery within 24 h of hospital admission were analyzed. For patients with resectable right-sided oCRC, one-stage surgery was performed. For left-sided oCRC, primary anastomosis was mainly attempted; otherwise, a stoma was formed. The rates of primary resection, PRa, stoma, mortality, and morbidity were evaluated. RESULTS: Among 186 patients, oCRC involving the right colon, left colon, and rectum were found in 33.3%, 59.1% and 7.5% respectively. Primary resection and anastomosis were performed in 100%, 44.7%, and 0% of patients with oCRC in the right colon, left colon, and rectum respectively. The complication incidence based on Clavien-Dindo grade III or higher was 16.1% and the mortality rate was 7.5%. The median length of hospital stay was 8.5 days, ranging from 2 to 70 days. CONCLUSION: General surgeons with colorectal surgery experience can still manage oCRC effectively. Primary resection and anastomosis for left-sided oCRC is safe in selective patients. The emergency surgery for oCRC could be benefit with the participation of colorectal surgeons.

A randomised, double-blind, phase 3 study comparing the efficacy and safety of ceftazidime/avibactam plus metronidazole versus meropenem for complicated intra-abdominal infections in hospitalised adults in Asia.

Ceftazidime/avibactam comprises the broad-spectrum cephalosporin ceftazidime and the non-ß-lactam ß-lactamase inhibitor avibactam. This phase 3, randomised, double-blind study (NCT01726023) assessed the efficacy and safety of ceftazidime/avibactam plus metronidazole compared with meropenem in patients with complicated intra-abdominal infection (cIAI) in Asian countries. Subjects aged 18-90 years and hospitalised with cIAI requiring surgical intervention were randomised 1:1 to receive every 8 h either: ceftazidime/avibactam (2000/500 mg, 2-h infusion) followed by metronidazole (500 mg, 60-min infusion); or meropenem (1000 mg, 30-min infusion). Non-inferiority of ceftazidime/avibactam plus metronidazole to meropenem was concluded if the lower limit of the 95% confidence interval (CI) for the between-group difference in clinical cure rate was greater than -12.5% at the test-of-cure (TOC) visit (28-35 days after randomisation) in the clinically evaluable (CE) population. Safety was also evaluated. Of 441 subjects randomised, 432 received at least one dose of study medication (ceftazidime/avibactam plus metronidazole, n = 215; meropenem, n = 217). In the CE population at the TOC visit, non-inferiority of ceftazidime/avibactam plus metronidazole to meropenem was demonstrated, with clinical cure reported for 93.8% (166/177) and 94.0% (173/184) of subjects, respectively (between-group difference, -0.2, 95% CI -5.53 to 4.97). The clinical cure rate with ceftazidime/avibactam plus metronidazole was comparable in subjects with ceftazidime-non-susceptible and ceftazidime-susceptible isolates (95.7% vs. 92.1%, respectively). Adverse events were similar between the study groups. Ceftazidime/avibactam plus metronidazole was non-inferior to meropenem in the treatment of cIAIs in Asian populations and was effective against ceftazidime-non-susceptible pathogens. No new safety concerns were identified.