Behavior problems reduce academic outcomes among primary students: A moderated mediation of parental burnout and parents' self-compassion.

The present study examines the mediating role of parental burnout in the relationship between students' behavior problems and academic outcomes and whether this mediating process is moderated by parents' self-compassion (PSC). This study was designed according to a cross-sectional study model, and includes 821 Vietnamese primary students (Mage = 9.98, SD = 0.889) completing behavior problems questionnaires. The parents completed parental burnout and the PSC questionnaires. The school office reported academic outcomes. Main findings include: (1) Student's behavior problems have a direct negative influence on academic outcomes; (2) the mediating role of parental burnout was significant; (3) the moderating role of PSC was also significant. This study suggests that students' behavior problems increase parental burnout, reducing academic outcomes. Next, higher self-compassion protected parents from the negative effect of children's behavior problems. The results of this study are meaningful for developing interventions, which help improve parents' mental health and children's positive outcomes.

Tuberculous otitis media in Vietnam: Clinical features and diagnostic difficulties.

OBJECTIVES: The purpose of this article is to draw the attention of otorhinolaryngologists to tuberculous otitis media in the light of two cases illustrating the diagnostic difficulties of this rare form of extrapulmonary tuberculosis, which often presents as subacute otomastoiditis or apparently benign chronic otitis media. It is characterized by symptoms such as atonic tympanic membrane perforation with granulation tissue, absence of any history of otitis media, facial paralysis or severe otosclerosis, and failure to respond to the usual treatments. CASE REPORTS: The first case was a 24-year-old man referred for right chronic otitis media present for 18 months despite topical treatment and tympanoplasty. The second case was a 21-year-old woman referred for right facial paralysis present for 8 days in a context of chronic otitis media, also treated medically for two years and by two tympanoplasties without success. CONCLUSION: The diagnosis of tuberculous otitis media is not based on histopathological examination, but bacteriological identification of Mycobacterium tuberculosis on an otorrhoea fluid sample collected according to the technique described here. A rigorous clinical approach should ensure early diagnosis and initiation of treatment to prevent complications and severe sequelae.

Systematic review: association of polycystic ovary syndrome with metabolic syndrome and non-alcoholic fatty liver disease.

BACKGROUND: Polycystic ovary syndrome (PCOS) is a common disorder for women of child-bearing age and is associated with metabolic syndrome (MS). AIM: To assess the literature for associations between polycystic ovary syndrome and non-alcoholic fatty liver disease (NAFLD). METHODS: We performed a systematic review using PubMed-search for peer-reviewed articles related to polycystic ovary syndrome and NAFLD. Articles were summarised and grouped according to different sections defining interactions of polycystic ovary syndrome with metabolic syndrome and non-alcoholic fatty liver disease as well as risk factors, pathogenic pathways and treatment options. RESULTS: Obesity is a common factor involved in both polycystic ovary syndrome and non-alcoholic fatty liver disease. Obesity causes non-alcoholic fatty liver disease and aggravates hirsutism and menstrual disorders in polycystic ovary syndrome. Insulin resistance, a hallmark of metabolic syndrome is observed in 50-80% of women with polycystic ovary syndrome and patients with non-alcoholic fatty liver disease. Recent findings suggest that women with polycystic ovary syndrome may be at risk for developing non-alcoholic fatty liver disease and conversely, non-alcoholic fatty liver disease may be a risk for polycystic ovary syndrome. Based on the association of polycystic ovary syndrome and other metabolic abnormalities, such as insulin resistance, hyperandrogenism, obesity and non-alcoholic fatty liver disease, the candidate genes have been speculated for polycystic ovary syndrome. Closer scrutiny of these genes placed most of their proteins at the crossroads of three highly inter-related conditions: metabolic syndrome, obesity and non-alcoholic fatty liver disease. In most studies, the prevalence of both polycystic ovary syndrome and non-alcoholic fatty liver disease rises proportionally to the degree of insulin resistance and increases in the mass of adipose tissue. CONCLUSIONS: Non-alcoholic fatty liver disease is considered as the hepatic manifestation of metabolic syndrome. Similarly, it seems appropriate to consider polycystic ovary syndrome as the ovarian manifestation of metabolic syndrome. Both these conditions can co-exist and may respond to similar therapeutic strategies.

Renal transplantation from living related donors: a single center experience in Viet Nam.

INTRODUCTION: End-stage renal disease is a major public health problem in Viet Nam. A cooperative project between the University of Liège, Belgium, and the University of Medicine Pham Ngoc Thach, Ho Chi Minh City, Viet Nam, has permitted the establishment of an autonomous program of renal transplantation from living-related donors at the Peoples' Hospital No 115. The aim of this paper was to report the primary results of the project and to draw conclusions for the future. PATIENTS AND METHODS: From January 2004 to July 2008, we performed 33 living-related renal transplantations. Mean ages of donors and recipients were 31.8 ± 9.5 and 41.6 ± 13.5 years, respectively. Laparoscopic nephrectomy was performed in 6 donors. The immunosuppressive regimen consisted of three drugs associated with induction therapy using anti-interleukin-2 receptor monoclonal antibody. RESULTS: The 33 donors are in good health at follow-up. Four developed major intra- or postoperative hemorrhage necessitating transfusion, with a surgical re-exploration in 1 donor. Wound infection occurred in 2 donors. Posttransplant recipient and graft survivals at 1 versus 3 years were 82% and 73% versus 82% and 65%, respectively. Eight recipients presented 13 biopsy-proven acute rejection episodes that were reversible in 7, but 1 patient lost his graft due to an irreversible rejection. Two recipients developed cancer. CONCLUSIONS: These initial results have encouraged us to continue the program of renal transplantation from living-related donors. However, they also pointed out the need to develop other donor sources.

Diabetes alters protein expression of hyperpolarization-activated cyclic nucleotide-gated channel subunits in rat nodose ganglion cells.

Vagal afferent neurons, serving as the primary afferent limb of the parasympathetic reflex, could be involved in diabetic autonomic neuropathy. Hyperpolarization-activated cyclic nucleotide-gated (HCN) channels are expressed in the vagal afferent neurons and play an important role in determining cell membrane excitation. In the present study, the protein expression and the electrophysiological characteristics of HCN channels were investigated in nodose ganglion (NG) afferent neurons (A-fiber and C-fiber neurons) from sham and streptozotocin (STZ)-induced diabetic rats. In the sham NG, HCN1, HCN3, and HCN4 were expressed in the A-fiber neurons; and HCN2, HCN3, and HCN4 were expressed in the C-fiber neurons. Compared to the sham NG neurons, diabetes induced the expression of HCN2 in the A-fiber neurons besides overexpression of HCN1 and HCN3; and enhanced the expression of HCN2 and HCN3 in C-fiber neurons. In addition, whole-cell patch-clamp data revealed diabetes also increased HCN currents in A-fiber and C-fiber neurons. However, we found that diabetes did not alter the total nodose afferent neuron number and the ratio of A-fiber/C-fiber neurons. These results indicate that diabetes induces the overexpression of HCN channels and the electrophysiological changes of HCN currents in the A- and C-fiber nodose neurons, which might contribute to the diabetes-induced alteration of cell excitability in the vagal afferent neurons.

Does a novel prefilled injection device make postpartum oxytocin easier to administer? Results from midwives in Vietnam.

OBJECTIVE: to assess the acceptability of the Uniject prefilled injection device for delivery of oxytocin in the third stage of labour, and the effect of the device on overall willingness to perform active management of the third stage of labour (AMTSL). DESIGN: descriptive study that used baseline and post-intervention questionnaires. SETTING: three districts in northern Vietnam. The study population consisted of 52 midwives from two districts where AMTSL was already practiced, and 35 midwives from a district where AMTSL was introduced as part of the study. MEASUREMENTS AND FINDINGS: the majority of midwives reported that the Uniject device was easier to use and preferable compared with ampoules and standard syringes. They found the training materials easy to understand. KEY CONCLUSIONS: the use of a prefilled injection device overcame many of the barriers cited by midwives with regard to the use of oxytocin in ampoules, such as trying to break ampoules and fill syringes in a hurry. This device enabled midwives to deliver the correct dose of oxytocin in the third stage of labour in a safe and timely way, while attending to the other needs of the mother and her newborn baby. IMPLICATIONS FOR PRACTICE: use of a prefilled injection device for oxytocin may increase the acceptability and practice of AMTSL in primary level facilities, thus reducing maternal mortality due to postpartum haemorrhage.

The impact of a rural emergency department rotation on applicant ranking of a US emergency medicine residency program.

INTRODUCTION: Few US emergency medicine (EM) residency programs have been located in rural states due to program requirements for emergency department (ED) patient volume. Recent revision to the program requirements now permits 'educationally justifiable exceptions' to the patient population requirement, 'such as clinical sites in a rural setting', and some EM residency programs now plan to offer rural ED clinical experiences as a required curricular component. The impact of a required rural EM rotation on the ranking decisions of applicants is important to residency programs seeking to attract the most desirable applicants. OBJECTIVE: To assess the impact of a required rural ED rotation on applicant ranking of an EM residency program in the US National Resident Matching Program (NMRP). METHODS: All applicants to the study's EM residency program completing the interview portion of the application process received a mailed and emailed survey following the release of the 2004 NMRP results. The survey included questions addressing the rural/non-rural classification of the location of the applicants' childhood home, medical school, and anticipated future practice. RESULTS: Of 46 eligible subjects, 32 (69.6%) completed the survey. Of subjects with a rural childhood, 73.3% reported a positive impact on rank order (95% CI 50.9-95.7%) and 26.7% reported no impact (CI 4.3-49.1%); 81.3% of subjects with non-rural backgrounds reported no impact (CI 62.2-100%), 12.5% higher rank (CI 0-28.7%), and 6.3% lower (CI 0-18.2%). If planning a future practice in a rural community, 83.3% reported positive impact (CI 62.2-100%) and 16.7% no impact (CI 0-37.8%); 78.9% of subjects anticipating future practice in non-rural communities reported no impact (CI 60.6-97.3%), 15.8% higher rank (CI 0-32.2%), and 5.3% lower (CI 0-15.4). Of the subjects attending medical school in rural states, 52.2% reported a positive impact (CI 31.8-72.6%) and 47.8% no impact (CI 27.4-68.2%), while 75% of graduates of medical schools in non-rural states reported no impact (CI 32.6-100%) and 25% (CI 0-67.4%) a negative impact. CONCLUSION: The presence of a rural ED rotation did not adversely impact EM residency applicants' ranking of the program.

Reducing postpartum hemorrhage in Vietnam: assessing the effectiveness of active management of third-stage labor.

AIM: The study was undertaken to meet the need of the Ministry of Health to have local evidence on the effectiveness of active management of third-stage labor (AMTSL) in reducing the incidence of postpartum hemorrhage (PPH) > or = 500 mL and the need for PPH treatment. METHODS: Using a quasi-experimental design, AMTSL was introduced for all births attended by government midwives (at home, community, and district levels) in one district while standard practice without AMTSL was continued in three neighboring districts (with a 1:2 ratio of participants). Oxytocin (10 IU) was administered either by standard disposable syringe and needle or by a prefilled, single-use injection device. Postpartum blood loss was estimated using standard containers; other outcome measures included the duration of third stage, the need for additional treatments, and final maternal condition. A total of 3607 women participated (1236 in the intervention district and 2371 in the comparison districts). Multivariate logistic regression was used to control for age, parity, place of delivery, and first-stage oxytocin augmentation. RESULTS: AMTSL was associated with reduced risks for prolonged third stage beyond 30 min (odds ratio [OR] = 0.20, 95%; confidence interval [CI]: 0.11, 0.35), supplemental oxytocin (OR = 0.68, 95% CI: 0.49, 0.94), and bimanual compression (OR = 0.63, 95%; CI: 0.41, 0.98). When cases with first-stage oxytocin augmentation were excluded, AMTSL was associated with a 34% reduction in PPH incidence (OR = 0.66, 95%; CI: 0.45, 0.98). CONCLUSION: This study supports the value of AMTSL in reducing the incidence of PPH, shortening the third stage of labor, and reducing the need for additional treatments.

Gas exchange and lung mechanics during percutaneous transtracheal ventilation in an unparalyzed canine model.

OBJECTIVE: To compare the efficacy of percutaneous transtracheal ventilation (PTV) in the unparalyzed state with that in the paralyzed state using a sedated nonobstructed canine model. METHODS: Eight mongrel dogs (16.8-32 kg) were anesthetized, instrumented, and placed in a volume plethysmograph. Anesthesia was achieved with pentobarbital sodium (up to 30 mg/kg). The spontaneous respiratory drive was kept intact. PTV was performed using a 13-ga transtracheal catheter and compressed air at 45 psi at an I:E ratio of 1:3 (15 breaths/min). Each dog was sequentially ventilated in both the paralyzed and unparalyzed states. The paralyzed/unparalyzed sequence was alternated among the animals to avoid sequence bias. Paralysis was achieved with succinylcholine (0.1 mg/kg bolus and 0.01 mg/kg/min drip). Reversal of paralysis was achieved by discontinuing the succinylcholine infusion. Key variables, including arterial blood gas, tidal volume, and pulmonary mechanics, were measured and compared for the paralyzed and unparalyzed states. RESULTS: Gas exchanges and lung mechanics were similar between the unparalyzed and paralyzed states. There was no significant difference in mean pH, pCO2, pO2, tidal volume, or peak inspiratory transpulmonary pressure. There was also no significant difference in pulmonary resistance or pulmonary compliance. CONCLUSION: In a sedated nonobstructed canine model, PTV is as efficacious in the unparalyzed state as it is in the paralyzed state. The lung mechanics are also similar in the 2 states. These data suggest that it may be unnecessary to induce paralysis when using PTV for emergency ventilation in the heavily sedated state.

Response to dopamine vs norepinephrine in tricyclic antidepressant-induced hypotension.

OBJECTIVE: To compare the efficacy of dopamine (DA) with that of norepinephrine (NE) in the treatment of refractory hypotension caused by tricyclic antidepressants (TCAs). METHODS: A retrospective analysis was used to compare blood pressure responses in concurrent case series of patients treated with vasopressors for TCA-associated hypotension. The patients were adults (aged > or = 16 years) treated at 2 urban teaching hospitals from 1983 to 1994. All patients were diagnosed as having TCA ingestion (positive serum toxicologic assay), were hypotensive [systolic blood pressures (SBPs) < or = 90 mm Hg], and required vasopressor therapy. The patients were grouped by initial vasopressor treatment (i.e., NE vs DA). RESULTS: There were 26 hypotensive adult patients who met study criteria. All 26 patients remained hypotensive after initial treatment of their TCA-associated hypotension with crystalloid infusion and alkalinization. The NE and DA groups were similar in age, sex, and proportion of patients with single and co-drug ingestion. The NE group, however, had a significantly lower average SBP at study entry (56 vs 74 mm Hg, p = 0.04). Nine of 15 (60%) patients responded to DA (5-10 micrograms/kg/min) and 11/11 (100%) patients responded to NE (5-53 micrograms/min). The difference in response rates was statistically significant (p = 0.02). Six patients in whom DA (max rate 10-50 micrograms/min/kg) failed to raise the SBP subsequently responded to NE (max rate 5-74 micrograms/ min) when this drug was later used. One patient receiving NE (12 micrograms/min) developed ventricular ectopy, successfully treated with lidocaine. There were no ischemic complications from either NE or DA. Patients who failed DA therapy tended to be older (39 vs 30 years, p = 0.08), to be more hypotensive at study entry (64 vs 81 mm Hg, p = 0.008), and to remain hypotensive even at higher doses of DA (24 vs 7 micrograms/min/kg, p = 0.002). CONCLUSION: While this was not a prospective randomized study, NE appears advantageous over DA as the first-line vasopressor agent for those patients who require vasopressor support in the setting of TCA-induced hypotension that is refractory to IV fluid and serum alkalinization.