Associations between Ileal Juice Bile Acids and Colorectal Advanced Adenoma.

BACKGROUND: There is an urgent need to identify biomarkers for advanced adenoma, an important precursor of colorectal cancer (CRC). We aimed to determine alterations in ileal juice bile acids associated with colorectal advanced adenoma. METHODS: We quantified a comprehensive panel of primary and secondary bile acids and their conjugates using an ultraperformance liquid chromatography triple-quadrupole mass spectrometric assay in ileal juice collected at colonoscopy from 46 study subjects (i.e., 14 biopsy-confirmed advanced adenomas and 32 controls free of adenoma or cancer). Using analysis of covariance (ANCOVA), we examined the differences in bile acid concentrations by disease status, adjusting for age, sex, body mass index, smoking status and type 2 diabetes. RESULTS: The concentrations of hyodeoxycholic acid (HCA) species in ileal juice of the advanced adenoma patients (geometric mean = 4501.9 nM) were significantly higher than those of controls (geometric mean = 1292.3 nM, p = 0.001). The relative abundance of ursodeoxycholic acid (UDCA) in total bile acids was significantly reduced in cases than controls (0.73% in cases vs. 1.33% in controls; p = 0.046). No significant difference between cases and controls was observed for concentrations of total or specific primary bile acids (i.e., cholic acid (CA), chenodeoxycholic acid (CDCA) and their glycine- and taurine-conjugates) and total and specific major secondary bile acids (i.e., deoxycholic acid and lithocholic acid). CONCLUSIONS: Colorectal advanced adenoma was associated with altered bile acids in ileal juice. The HCA species may promote the development of colorectal advanced adenoma, whereas gut microbiota responsible for the conversion of CDCA to UDCA may protect against it. Our findings have important implications for the use of bile acids as biomarkers in early detection of colorectal cancer.

Association between Sleep Duration and Colorectal Adenomas: Findings from a Case-Control Study in Vietnam.

BACKGROUND: Colorectal cancer is one of the leading cancers worldwide and in Vietnam. Adenomas are important precursors of colorectal cancer. Study on the association between sleep duration and development of colorectal adenoma (CRA) is limited, particularly among Vietnamese population. METHODS: We conducted an individually matched case-control study of 870 CRA cases and 870 controls in a large-scale colorectal screening program involving 103,542 individuals ages ≥40 years old in Hanoi, Vietnam. Sleep duration was categorized in three groups: short: ≤6 hours/day, normal: 7 to 8 hours/day, and long: >8 hours/day. Conditional logistic regression was used to evaluate the association between sleep duration and adenomas risk after controlling for potential confounders. RESULTS: Overall, short-sleep duration was associated with increased risk of having CRA compared with normal duration [OR, 1.48; 95% confidence interval (CI), 1.12-1.97]. This pattern was present in both females (OR, 1.58; 95% CI, 1.14-2.18) and males (OR, 1.45; 95% CI, 1.08-1.93), with advanced adenomas (OR, 1.61; 95% CI, 1.09-2.38) and non-advanced adenomas (OR, 1.66; 95% CI, 1.19-2.32). Furthermore, the association between CRA development and short-sleep duration was more apparent among females who were nondrinker, nonobese, physically active, with proximal or both sided adenomas and with cardiometabolic disorder. Among males, the short-sleep duration was associated with CRA risk among never-smoking, cardiometabolic disorders, and obese. CONCLUSIONS: Short-sleep duration was associated with increased prevalence of both advanced and non-advanced CRAs among Vietnamese population. IMPACT: Findings from this study showed that maintaining an adequate sleep duration may have an important implication for colorectal adenoma prevention and control.

Findings from the first colorectal cancer screening among 103 542 individuals in Vietnam with systematic review of colorectal cancer screening programs in Asia-Pacific region.

BACKGROUND: Colorectal cancer is a leading cancer incidence and cause of death worldwide and in Vietnam. Although screening is considered an effective measure to prevent and control colorectal cancer, there is no such effort in Vietnam. METHODS: Between 01 January 2018 and 31 October 2019, a population-based colorectal cancer screening program was conducted in Hanoi, Vietnam. A health advocacy campaign and follow-up phone calls were used to enroll residents aged ≥40 years old to complete an immunochemical-fecal occult blood testing. Positive immunochemical-fecal occult blood testing was followed by a colonoscopy. We also conducted a systematic review of the colorectal cancer screening programs in the Asia-Pacific region that used similar approach by searching Ovid Medline and PubMed databases. RESULTS: During study period, 103 542 individuals among 672 742 eligible residents attended the screening of whom 81.5% participants finished immunochemical-fecal occult blood testing test and the positive rate was 6.1%. The coverage rate for immunochemical-fecal occult blood testing test was 11.9%. Among 2278 individuals who underwent colonoscopy, 3.5% were histologically diagnosed with cancer, 17.8% with advanced adenomas, and 23.1% with non-advanced adenomas. Males had significantly higher detection rate of advanced adenomas, cancer or ≥ two polyps/tumor than females (P < 0.0001). The systematic review showed that in two-step modality (i.e. immunochemical-fecal occult blood testing/fecal immunochemical test and colonoscopy), the test positive was from 4.1 to 10.6%. Once colonoscopy was performed subsequently, the rate of cancer among positive participants was from 1.7 to 16.4% and that of advanced adenomas was from 7.1 to 23.1%. CONCLUSION: We showed that the two-step modality is a promising strategy for colorectal cancer screening in Vietnam that might apply to similar settings with limited resources.

Association between body mass index and colorectal adenomas: Findings from a case-control study in Vietnam.

Colorectal cancer is a leading cancer worldwide and in Vietnam. Adenomas (adenomatous polyps) is an important precursor of colorectal cancer. There is currently no study to determine the modifiable risk factors for colorectal adenomas, including body mass index (BMI) in Vietnam. We conducted an individually matched case-control study of 1149 colorectal adenomas and 1145 controls in a large-scale colorectal screening program involving 103 542 individuals aged 40-75 years old in Hanoi, Vietnam. Conditional logistic regression was used to evaluate the association between BMI and colorectal adenomas prevalence, after controlling for potential confounders. Overall, comparing to normal weight (ie, 18.5-22.9 kg/m2 ), underweight (ie, BMI < 18.5) was associated with a non-statistically significant increased prevalence of colorectal adenomas (odd ratio [OR] = 1.29 and 95% confident interval [CI]: 0.88-1.87). This association became significant among male (OR = 1.98, 95% CI: 1.20-3.27), male who were ever smokers (OR = 2.59, 95% CI: 1.33-5.03), nonregular exercise (OR = 2.44, 95% CI: 1.26-4.73) and individuals with cardiometabolic disorders (OR = 3.46, 95% CI: 1.19-10.00). The association between underweight and colorectal adenomas did not vary by smoking status, drinking status, family history of cancer, adenomas types or cardiometabolic disorders. No association was observed among obese individuals (BMI ≥ 25). In the population with low prevalence of obesity, we found that the association between BMI and colorectal adenomas followed a reversed J-shape that underweight was associated with increased prevalence. Further studies are, therefore, warranted to replicate our results and to investigate the biologic mechanism the effect of underweight on colorectal adenomas prevalence.

Changes in and challenges for intentional injury in Vietnam: evidence from 2 national adolescent health surveys, 2004 and 2009.

OBJECTIVE: To describe the current situation of intentional injury among Vietnamese youth as well as risk and protective factors. METHOD: The Sample of Survey Assessment of Vietnamese Youth 2009 (SAVY2) involving 10,044 youth aged 14 to 25 in 2009 was used and compared with SAVY1 in this study. The data were analyzed using bivariate and multivariate statistical techniques. RESULTS: Of the sample in 2009, 3% of the young people reported that they had been injured by a family member. The proportion who were intentionally injured by others outside their home was 7.6%. Youth who were most likely to hurt others included urban males, those who had ever been drunk, those who had been intentionally injured by others, and those who had weak family connectedness. Having suicidal thoughts (both sexes) is related to alcohol consumption. CONCLUSIONS: The rate of violent behaviors was low, but several risk and protective factors were found and confirmed.

HIV-related risk behaviors among the general population: a survey using Audio Computer-Assisted Self-Interview in 3 cities in Vietnam.

This study used a confidential survey method-namely, Audio Computer-Assisted Self-Interview (ACASI)-to gather data about HIV-related risk knowledge/behaviors among the general population in Vietnam. The study sample included 1371 people aged 15 to 49 years in 3 cities-Hanoi, Da nang, and Can Tho. Results indicated that 7% of participants had ever had nonconsensual sex, and 3.6% of them had ever had a one-night stand. The percentage of male participants reported to ever have sex with sex workers was 9.6% and to ever inject drugs was 4.3%. The proportion of respondents who had ever tested for HIV was 17.6%. The risk factors and attitudes reported in the survey indicate the importance of analyzing risk behaviors related to HIV infection among the general population. Young people, especially men in more urbanized settings, are engaging in risky behaviors and may act as a "bridge" for the transmission of HIV from high-risk groups to the general population in Vietnam.

Peer and community influences on the acceptance of premarital sex among Vietnamese adolescents.

AIM: Adolescents in Vietnam have a low level of sexual activity, but this may increase with urbanisation and economic development. The aim of this analysis is to understand trends in correlates of permissive attitudes towards premarital sex among Vietnamese adolescents using an ecological framework. METHODS: Data from the Survey Assessment of Vietnamese Youth from 2003 (n = 7584) and 2009 (n = 10,044) were analysed using multivariable logistic regressions to examine associations between permissive attitudes towards premarital sex and demographic and contextual factors among adolescents aged 14 to 25. RESULTS: Correlates of having permissive attitudes towards premarital sex in both 2003 and 2009 included being male, older age, living in an urban area, living in the North, having ever used the Internet and perceiving that people in the community were having premarital sex. Variables that were significant in 2009 but not in 2003 included socio-economic status and belonging to an ethnic minority. Statistically significant changes in associations between 2003 and 2009 were observed for age, socio-economic status and belonging to an ethnic minority. CONCLUSIONS: The association of permissive attitudes with community norms and certain socio-demographic variables in conjunction with overarching economic development and urbanisation suggests that premarital sex will likely become increasingly common among Vietnamese adolescents. These trends should be further assessed as adolescent sexual activity becomes more common and adolescent friendly health services should be developed to provide appropriate and acceptable sexual and reproductive health care to young people.

Road traffic injury among young people in Vietnam: evidence from two rounds of national adolescent health surveys, 2004-2009.

BACKGROUND: Based on previous data, road traffic injury (RTI) was a leading cause of non-fatal injury in all-age groups in Vietnam, and among the top causes of injury in children and adolescents. Specific analysis on RTIs in young people, however, has yet to be fully investigated. Using the results of two surveys in 2004 and 2009, the present study aims to describe the current situation of non-fatal, unintentional RTIs among Vietnamese youths. In addition, it explores RTI-related risk and protective factors. METHODS: This study utilized the nationally representative Survey Assessment of Vietnamese Youth 2009 (SAVY2) of 10,044 youths aged 14 to 25 from all 63 provinces in Vietnam. The indicators were compared with data from SAVY1 in 2004 of 7,584 youths. Bivariate and multivariable statistical techniques were applied. RESULTS: Overall, 75% of youths used a motorcycle in SAVY2 compared with 54.2% in SAVY1. Of the SAVY2 sample, the proportion that had experienced an RTI was 10.6% vs. 14.1% in SAVY1. While the proportion of RTIs for both sexes decreased, the decline was greater for males (11.9% vs. 17.8% in SAVY1) than in females (9.2% vs. 10.4%). The proportion of rural youths aged 22-25 who experienced an RTI increased slightly in the 5 years between the two study intervals. The percentage of youths reporting frequent helmet use increased significantly from 26.2% in SAVY1 to 73.6% in SAVY2. Factors related to the likelihood of ever having experienced an RTI included: older age, male, ever being drunk, and ever riding motorcycles after drinking. CONCLUSION: While improvements in RTIs appear to have occurred between 2004 and 2009, more attention should be paid, particularly, in maintenance and supervision of law enforcement to helmet use and drunk driving.

Audio computer-assisted self interview compared to traditional interview in an HIV-related behavioral survey in Vietnam.

INTRODUCTION: Globally, population surveys on HIV/AIDS and other sensitive topics have been using audio computer-assisted self interview for many years. This interview technique, however, is still new to Vietnam and little is known about its application and impact in general population surveys. One plausible hypothesis is that residents of Vietnam interviewed using this technique may provide a higher response rate and be more willing to reveal their true behaviors than if interviewed with traditional methods. OBJECTIVE: This study aims to compare audio computer-assisted self interview with traditional face-to-face personal interview and self-administered interview with regard to rates of refusal and affirmative responses to questions on sensitive topics related to HIV/AIDS. METHODS: In June 2010, a randomized study was conducted in three cities (Ha Noi, Da Nan and Can Tho), using a sample of 4049 residents aged 15 to 49 years. Respondents were randomly assigned to one of three interviewing methods: audio computer-assisted self interview, personal face-to-face interview, and self-administered paper interview. Instead of providing answers directly to interviewer questions as with traditional methods, audio computer-assisted self-interview respondents read the questions displayed on a laptop screen, while listening to the questions through audio headphones, then entered responses using a laptop keyboard. A MySQL database was used for data management and SPSS statistical package version 18 used for data analysis with bivariate and multivariate statistical techniques. Rates of high risk behaviors and mean values of continuous variables were compared for the three data collection methods. RESULTS: Audio computer-assisted self interview showed advantages over comparison techniques, achieving lower refusal rates and reporting higher prevalence of some sensitive and risk behaviors (perhaps indication of more truthful answers). Premarital sex was reported by 20.4% in the audio computer-assisted self-interview survey group, versus 11.4% in the face-to-face group and 11.1% in the self-administered paper questionnaire group. The pattern was consistent for both male and female respondents and in both urban and rural settings. Men in the audio computer-assisted self-interview group also reported higher levels of high-risk sexual behavior--such as sex with sex workers and a higher average number of sexual partners--than did women in the same group. Importantly, item refusal rates on sensitive topics tended to be lower with audio computer-assisted self interview than with the other two methods. CONCLUSIONS: Combined with existing data from other countries and previous studies in Vietnam, these findings suggest that researchers should consider using audio computer-assisted self interview for future studies of sensitive and stigmatized topics, especially for men.

Intentional injury in young people in Vietnam: prevalence and social correlates.

INTRODUCTION: Violent acts in young people constitute one of the most serious forms of violence in any society. Violence by young people in schools, on the streets, and in their families has been documented in many studies worldwide. Homicide and non-fatal assaults involving young people have been reported as a great global burden of premature death, injury and disability. Adolescents and young people are both the main victims and perpetrators of such violence. In Vietnam, an emerging pattern of health problems in adolescents related to intentional injury and violence is drawing increasingly more attention from government and the public. OBJECTIVE: Describe the situation of intentional injury among Vietnamese youth, including risk and protective factors, in order to suggest policy implications. METHODS: The 2003 Survey Assessment of Vietnamese Youth was used as a data source, providing a nationally representative sample of 7584 youth aged 14-25 years, resident in 42 of the country's 61 provinces. This sample was drawn from the 45,000 households in the 2002 Vietnam Living Standards Survey, with a multi-staged and stratified design, using the probability-proportional-to-size method to maintain representativity. Data were analyzed using bivariate and multivariate statistical techniques. RESULTS: Of the sample of young people, 2.2% reported injury resulting from violent behavior by a family member and 8.0% by non-family members, the latter demonstrating a significantly higher rate among males than females (13.6% vs. 2.4%). Characteristics of youth most likely to hurt others included: male sex, inebriation at some point, victims of intentional injury, group riot participants and carriers of weapons. Youth who had been members of mass social organizations or clubs in the community were half as likely to hurt other people as those who were unaffiliated with such groups. Females were almost four times more likely than males to attempt suicide. Other risk factors for suicide attempts were past inebriation (OR 2.7, 95% CI 1.3-5.4), ever having been a victim of intentional injury by a family member (OR 3.3, 95% CI 1.1-11.5) or ever having had feelings of hopelessness (OR 6.5, 95% CI 3.3-13.6). CONCLUSIONS: Prevalence of violence and self-harm among Vietnamese youth is comparatively less than in Western and other Asian countries. Risk and protective factors appear similar to those found in most populations. In particular, this study indicated a possible protective effect of membership in social groups. National policy for injury prevention should include strategies to reduce violence and self-harm within this population group.

Premarital sex and condom use among never married youth in Vietnam.

UNLABELLED: Premarital sex and unprotected sexual intercourse are issues of growing concern in Vietnam. The present study aims to explore the factors associated with the onset and delay of premarital sex among youth in Vietnam. METHODS: A cross-sectional in-home survey was undertaken in a suburb of Hanoi, Vietnam among a sample of 2,394 never married youth ages 15 to 24 years in the end of 2003. RESULTS: Cox regression analyses showed that youth who had ever experienced sexual abuse were 35 times more likely to report having had premarital sex. Connectedness to mother likewise was associated with a decreased likelihood of having sex before marriage. A medium level of school connectedness was also a factor associated with the delay of premarital sex (OR = 0.27). Peer social deviance, on the other hand, increased the likelihood by at least 2.6 times. Separate models for each sex confirmed: the protective effect of mother connectedness among females; the negative effect of peer social deviance among males; and the predominant risk of past sexual abuse in both sexes for premarital sex. When factors associated with condom use among sexually active never married youth were explored, males were found more likely to use condom at first sexual intercourse. CONCLUSIONS: These results reaffirm a growing body of literature from around the world that has shown connectedness to a parent to be associated with delay of premarital sex, while peer social deviance and exposure of previous sexual abuse have been both associated with early sexual debut.

Child health status and maternal and child care in Quangtri Province, Vietnam.

Save the Children's CS-18 Project implemented from 2003 to 2008 aimed to improve child health and nutritional status people in Quangtri Province through the increased use of life-saving health interventions, both behaviors and services. This baseline survey, conducted at the start of the project to provide data to evaluate the effectiveness of the intervention upon its completion. A household survey was conducted of four hundred mothers of children under 2 years of age. Logistic regression was used to determine the relationship between maternal care behaviours and child health, controlling for confounding variables. In-depth interviews with 27 mothers and 4 focus group discussions with 38 mothers were also conducted. The rate of childhood malnutrition was 40.5%. The percentage of mothers that gave birth at home was 56.5%, and only 35.4% of these used a clean home delivery kit. Health staff only attended approximately 17.7% deliveries. Few mothers and newborns (23.8%) were checked after delivery. About half the mothers 54% did not feed their child colostrum, and most mothers (81.6%) stopped breastfeeding before 18 months. 58.8% of the children were sick within a month of birth. Child malnutrition was associated with child sex, age, birth weight, ethnicity, and socio-economic status (P < .001). Low rates of safe delivery and child care practices and high rates of infant illness indicate a need for improved service provision and education. Health facilities should be staffed continuously, promote village health workers in villages. Health staff should carry out a health communication campaign about maternal and child health. Family members, especially husbands, should be encouraged to take care of recent mothers during pregnancy and delivery.

Alumni survey of Masters of Public Health (MPH) training at the Hanoi School of Public Health.

BACKGROUND: 1) To elicit the opinions of the Public Health alumni of the MPH program; 2) To assess the applicability of the knowledge and skills acquired; 3) To identify the frequency of the public health competencies that the alumni performed. METHODS: We requested 187 graduates to complete a self-administered questionnaire and conducted in-depth interviews with 8 alumni as well as a focus group discussion with 14 alumni. RESULTS: In total 79.1% (148) of the MPH graduates completed and returned the questionnaire. Most alumni (91%) agreed that the MPH curriculum corresponded with the working requirements of public health professionals; and nearly all were satisfied with what they have learnt (96%). Most respondents said that the MPH program enabled them to develop relevant professional skills (95%) and that they were satisfied with the curriculum (90%). Notably fewer respondents (73%) felt that the MPH program structure was balanced and well designed. Most alumni (64.3%) were satisfied with Hanoi School of Public Health (HSPH) full-time lecturers; but even more (83%) were satisfied with visiting lecturers. The most commonly selected of the 34 pre-identified public health competencies were: applying computer skills (66.4%), planning and managing health programs (47.9%), communicating with the community and/or mobilizing the community to participate in health care (43.2%). Overall, the MPH alumni felt that HSPH emphasized research methods at the expense of some management and operational competencies. The most important challenges at work identified by the alumni were insufficient skills in: data analysis, decision making, inter-sectoral cooperation development, English language and training. CONCLUSION: The training program should be reviewed and revised to meet the needs of its graduates who enter diverse situations and positions. English language skills were identified as top priority for further emphasis. The training program should comply with a more advanced accreditation system and standards.

A pilot of audio computer-assisted self-interview for youth reproductive health research in Vietnam.

PURPOSE: Several recent adolescent health studies in Vietnam have shown low levels of premarital sex among youth compared to neighboring countries and other regions of the world. One possible explanation for these findings is that adolescents in Vietnam are less willing to reveal their true behaviors. This study aims to assess the level of reporting of sensitive behaviors/events using three methods of survey data collection: face-to-face interviewer-administered (IA), paper-and-pencil self-administered (SA) and AudioComputerAssisted Self Interview (ACASI). METHODS: A randomized experiment was undertaken in Gialam, a suburb of Hanoi, among a sample of 2,394 youth ages 15 to 24 years. Respondents were randomly assigned to one of three interviewing methods, with females and males evaluated separately. RESULTS: ACASI showed certain advantages with regard to respondent attitudes and perceptions of sensitive topics. ACAI also revealed higher prevalence rates for sensitive and stigmatized behaviors. Among those in the pencil and paper survey group it is estimated that 12.9% of unmarried males and 3.4% of unmarried females have had premarital sex. The rate found by using ACASI is higher at 17.1% in males (95% CI: 13.5-21.4) and 4.5% in females (95% CI: 2.7-7.3). Using ACASI, unmarried males also reported higher levels of risky sexual relations. For example, 7.8% confirmed visiting sex workers compared with only 1.2% in SA group and 3.9% in IA group. Additionally, ACASI respondents reported having had more sex partners by age group, gender and marital status. CONCLUSIONS: When coupled with the emerging data from around the world, the present findings suggest that researchers should consider using ACASI for future studies dealing with sensitive and stigmatized topics.

Reassessing the level of unintended pregnancy and its correlates in Vietnam.

Despite rapidly increasing contraceptive use and rapidly declining fertility, unintended pregnancy and induced abortion remain common in Vietnam. This study reassesses the level of unintended pregnancy in Vietnam and its correlates, drawing on retrospective calendar data gathered for the Vietnam Demographic and Health Survey II. Data from 13,540 "segments" of outcomes and contraceptive practice were analyzed. Based on the calendar data, 40 percent of pregnancies during the 1994-97 period are estimated to have been unintended, a proportion 48 percent higher than the prevailing estimate calculated from the reported intendedness of live births. When concealment of pregnancies ending in induced abortions is taken into account, the unintended pregnancy rate in Vietnam is likely to approach levels found only in developing countries. Unintended pregnancy was found to be associated with age, early marriage, spousal age difference, number of living sons, past unintended pregnancy, geographic region, contraceptive use prior to pregnancy, and the family planning supply environment. The findings suggest that broadening the method mix at the community level, targeting high-risk and underserved groups, and expanding postabortion counseling and services are likely to have a dramatic impact on the unintended pregnancy rate in Vietnam.