Evidence-based geriatric knowledge among healthcare providers in Vietnam: adaptation, validation, and pilot of the knowledge about older patients quiz.

BACKGROUND: Vietnam's aging population is growing rapidly, but its health workforce's capacity to provide quality geriatric care is not clearly understood. We aimed to provide a cross-culturally relevant and validated instrument to assess evidence-based geriatric knowledge among healthcare providers in Vietnam. METHODS: We translated the Knowledge about Older Patients Quiz from English to Vietnamese using cross-cultural adaptation methods. We validated the translated version by evaluating its relevance to the Vietnamese context, as well as its semantic and technical equivalence. We fielded the translated instrument on a pilot sample of healthcare providers in Hanoi, Vietnam. RESULTS: The Vietnamese Knowledge about Older Patients Quiz (VKOP-Q) had excellent content validity (S-CVI/Ave) and translation equivalence (TS-CVI/Ave) of 0.94 and 0.92, respectively. The average VKOP-Q score was 54.2% (95% CI: 52.5-55.8) and ranged from 33.3 to 73.3% among 110 healthcare providers in the pilot study. Healthcare providers in the pilot study had low scores on questions related to the physiopathology of geriatric conditions, communication techniques with sensory impaired older adults, and differentiating age related changes from abnormal changes or symptoms. CONCLUSIONS: The VKOP-Q is a validated instrument to assess geriatric knowledge among healthcare providers in Vietnam. The level of geriatric knowledge among healthcare providers in the pilot study was unsatisfactory, which supports the need for further assessment of geriatric knowledge among a nationally representative sample of healthcare providers.

Patient-centered care and geriatric knowledge translation among healthcare providers in Vietnam: translation and validation of the patient-centered care measure.

BACKGROUND: People are living longer, and the majority of aging people reside in low- and middle-income countries (LMICs). However, inappropriate healthcare contributes to health disparities between populations of aging people and leads to care dependency and social isolation. Tools to assess and evaluate the effectiveness of quality improvement interventions for geriatric care in LMICs are limited. The aim of this study was to provide a validated and culturally relevant instrument to assess patient-centered care in Vietnam, where the population of aging people is growing rapidly. METHODS: The Patient-Centered Care (PCC) measure was translated from English to Vietnamese using forward-backward method. The PCC measure grouped activities into sub-domains of holistic, collaborative, and responsive care. A bilingual expert panel rated the cross-cultural relevance and translation equivalence of the instrument. We calculated Content Validity Indexing (CVI) scores at both the item (I-CVI) and scale (S-CVI/Ave) levels to evaluate the relevance of the Vietnamese PCC (VPCC) measure to geriatric care in the Vietnamese context. We piloted the translated instrument VPCC measure with 112 healthcare providers in Hanoi, Vietnam. Multiple logistic regression models were specified to test the a priori null hypothesis that geriatric knowledge is not different among healthcare providers with perception of high implementation compared with low implementation of PCC measures. RESULTS: On the item level, all 20 questions had excellent validity ratings. The VPCC had excellent content validity (S-CVI/Ave of 0.96) and translation equivalence (TS- CVI/Ave of 0.94). In the pilot study, the highest-rated PCC elements were the holistic provision of information and collaborative care, while the lowest-rated elements were the holistic attendance to patients' needs and responsive care. Attention to the psychosocial needs of aging people and poor coordination of care within and beyond the health system were the lowest-rated PCC activities. After controlling for healthcare provider characteristics, the odds of the perception of high implementation of collaborative care were increased by 21% for each increase in geriatric knowledge score. We fail to reject the null hypotheses for holistic care, responsive care and PCC. CONCLUSION: The VPCC is a validated instrument that may be utilized to systemically evaluate the practice of patient-centered geriatric care in Vietnam.

Bovine extracellular vesicles contaminate human extracellular vesicles produced in cell culture conditioned medium when 'exosome-depleted serum' is utilised.

Extracellular vesicles (EVs) are important intercellular communication messengers. Half of the published studies in the field are in vitro cell culture based in which bovine serum in various concentrations and forms is used to facilitate the production of extracellular vesicles. 'Exosome depleted serum' is the type of bovine serum most widely used in the production of human EVs. Herein, we demonstrate that, despite the initial caution raised in 2014 about the persistence of bovine EVs, 'exosome depleted serum' was still used in 46% of publications on human or rodent EVs between 2015 and 2019. Using nanoparticle tracking analysis combined with detergent lysis of vesicles as well as bovine CD9 ELISA, we show that there were approximately 5.33 x 107/mL of bovine EVs remaining in the 'exosome depleted serum'. Importantly, the 'exosome depleted serum' was relatively enriched in small EVs by approximately 2.7-fold relative to the large EVs compared to that in the original serum. Specifically, the percentage of small EVs in total vesicles had increased from the original 48% in the serum before ultracentrifugation to 92% in the 'exosome depleted serum'. Furthermore, the pervasive bovine EVs carried over by the 'exosome depleted serum', even when the lowest concentration (0.5%) was used in cell culture, resulted in a significant contamination of human EVs in cell culture conditioned medium. Our findings indicate that the use 'exosome depleted serum' in cell culture-based studies may introduce artefacts into research examining the function of human and rodent EVs, in particular those involving EV miRNA. Thus, we appeal to the researchers in the EV field to seriously reconsider the practice of using 'exosome depleted serum' in the production of human and other mammalian EVs in vitro.

Role of aptamer technology in extracellular vesicle biology and therapeutic applications.

Extracellular vesicles (EVs) are cell-derived nanosized membrane-bound vesicles that are important intercellular signalling regulators in local cell-to-cell and distant cell-to-tissue communication. Their inherent capacity to transverse cell membranes and transfer complex bioactive cargo reflective of their cell source, as well as their ability to be modified through various engineering and modification strategies, have attracted significant therapeutic interest. Molecular bioengineering strategies are providing a new frontier for EV-based therapy, including novel mRNA vaccines, antigen cross-presentation and immunotherapy, organ delivery and repair, and cancer immune surveillance and targeted therapeutics. The revolution of EVs, their diversity as biocarriers and their potential to contribute to intercellular communication, is well understood and appreciated but is ultimately dependent on the development of methods and techniques for their isolation, characterization and enhanced targeting. As single-stranded oligonucleotides, aptamers, also known as chemical antibodies, offer significant biological, chemical, economic, and therapeutic advantages in terms of their size, selectivity, versatility, and multifunctional programming. Their integration into the field of EVs has been contributing to the development of isolation, detection, and analysis pipelines associated with bioengineering strategies for nano-meets-molecular biology, thus translating their use for therapeutic and diagnostic utility.

The role of the size of affinity ligands in the detection and characterization of extracellular vesicles.

Surface proteins on the membrane of nano-sized extracellular vesicles (EVs) not only play crucial roles in cell-to-cell communication, but also are specific binding targets for EV detection, isolation and tracking. The low abundance of protein biomarkers on EV surface, the formation of clusters and the complex EV surface network impose significant challenges to the study of EVs. Employing bulky sized affinity ligands, such as antibodies, in the detection and characterization of these vesicles often result in reduced sensitivity of detection or poor quantification of proteins on the EV surface. By virtue of their small size and high specificity, Affibody molecules emerge as a potential alternative to their monoclonal antibody counterparts as robust affinity ligands in EV research. In this study, we present a theoretical framework on the superiority of anti-HER2 Affibodies over anti-HER2 antibodies in labeling and detecting HER2-positive EVs, followed by the demonstration of the advantages of HER2 Affibodies in accessing EV surface and the detection of EVs through multiple types of approaches including fluorescence intensity, colorimetry, and fluorescence polarization. HER2 Affibodies outperformed by 10-fold over three HER2 antibody clones in accessing HER2-positive EVs derived from different human cancer cell lines. Furthermore, HRP-Affibody molecules could detect EVs from cancer cells spiked into human serum with at least a 2-fold higher sensitivity compared with that of their antibody counterparts. In addition, in fluorescence polarization assays in which no separation of free from bound ligand is required, FITC-labeled HER2 Affibodies could sensitively detect HER2-positive EVs with a clinically relevant limit of detection, whilst HER2 antibodies failed to detect EVs in the same conditions. With the demonstrated superiority in accessing and detecting surface targets over bulky-sized antibodies in EVs, Affibodies may become the next-generation of affinity ligands in the precise characterization and quantification of molecular architecture on the surface of EVs.

Development of Blueberry-Derived Extracellular Nanovesicles for Immunomodulatory Therapy.

Over the past decade, there has been a significant expansion in the development of plant-derived extracellular nanovesicles (EVs) as an effective drug delivery system for precision therapy. However, the lack of effective methods for the isolation and characterization of plant EVs hampers progress in the field. To solve a challenge related to systemic separation and characterization in the plant-derived EV field, herein, we report the development of a simple 3D inner filter-based method that allows the extraction of apoplastic fluid (AF) from blueberry, facilitating EV isolation as well as effective downstream applications. Class I chitinase (PR-3) was found in blueberry-derived EVs (BENVs). As Class I chitinase is expressed in a wide range of plants, it could serve as a universal marker for plant-derived EVs. Significantly, the BENVs exhibit not only higher drug loading capacity than that reported for other EVs but also possess the ability to modulate the release of the proinflammatory cytokine IL-8 and total glutathione in response to oxidative stress. Therefore, the BENV is a promising edible multifunctional nano-bio-platform for future immunomodulatory therapies.

Exploring barriers to, and enablers of, evidence-informed hip fracture care in five low- middle-income countries: China, India, Thailand, the Philippines and Vietnam.

Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle-Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence-informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence-informed care of patients with fragility fractures, are applicable to these settings. This study utilized semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from 11 hospitals in 5 countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility and utilization of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high-quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high-quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care.

Seatbelt and child restraint use among vehicle occupants in Ho Chi Minh City: an observational study in Vietnam.

This paper presents the trend of seatbelt use, disaggregated by vehicle occupants, in Ho Chi Minh City between 2016 and 2018. We conducted statistical analyses to identify the determinants of seatbelt use, including the effect of a new fine imposed against seatbelt law violation in the rear seats that became effective in January 2018. Seatbelt use was observed in at least half of all vehicle occupants, and drivers were more likely to use seatbelts than passengers. Only 4.4% of children younger than 5-years and 2.5% of 5 to12-year-olds used a child restraint system. Seatbelt use increased among all occupants after the imposed fine, especially among rear-seat passengers. Imposing new or increasing fixed penalties, with enforcement and public education, may increase seatbelt use to prevent road traffic injuries.

Helmet use among motorcycle riders in Ho Chi Minh City, Vietnam: results of a five-year repeated cross-sectional study.

OBJECTIVE: In Vietnam, motorcycle riders comprise about three-quarters of road traffic fatalities, the most common cause of which is head injuries that can be prevented by wearing a helmet. This study aims to assess helmet-wearing behaviors in Ho Chi Minh City, the largest city in Vietnam. METHODS: Eight rounds of observational studies were conducted in six randomly selected locations between July 2015 and April 2019. Given the multinomial nature of the outcome measure (not wearing a helmet; wearing a substandard helmet; wearing an unstrapped standard helmet; wearing a strapped standard helmet), a multinomial model was developed to estimate the level and trend of helmet use and identify the related individual and environmental factors. FINDINGS: A total of 479,892 motorcycle riders were observed, over 90 % of whom were wearing helmets (range over the eight rounds: 92.5 %-96.0 %). However, the prevalence of correct helmet use (defined as wearing a strapped standard helmet) gradually declined from 80.8 % in round 1-55.6 % in round 8. Results from a multinomial model showed the probability of wearing a strapped standard helmet had declined by 22.4 percentage points from round 3 to round 8 while holding other factors constant (95 % CI: 21.8-23.0). The prevalence of correct use is 11.3 percentage points higher for adults than for children (95 % CI: 10.5-12.1). During the same period, unstrapped standard helmet use increased by 24.5 percentage points (95 % CI: 24.1-24.9); substandard helmet use declined but remained high. CONCLUSION: The upward trend of incorrect helmet wearing behaviors and wearing substandard helmets sends a rallying call for multisectoral interventions.

A thorough analysis of the effect of surfactant/s on the solubility and pharmacokinetics of (S)-zaltoprofen.

Until now, there are no publications about the preformulation studies on (S)-zaltoprofen ((S)-ZPF). Hence, we first investigated the solubility of (S)-ZPF, screened solubilizers and performed the pharmacokinetic study of (S)-ZPF in the presence of the solubilizers. The measurement of the solubility of (S)-ZPF in 26 different solvents was carried out, including d-alpha tocopheryl polyethylene glycol 1000 succinate (TPGS), 2-hydroxypropyl-ß-cyclodextrin (HPCD), and mixtures of individual solvent. The plasma concentration of (S)-ZPF and the amount of (S)-ZPF retained in stomach were determined after oral (35.0 mg/kg) and intravenous (5.0 mg/kg) administration. The solubility of (S)-ZPF showed an increase of 484-fold in TPGS compared to its aqueous solubility. There was a significant increase of AUC0-24   h for pure (S)-ZPF in the TPGS group (813.59 ±â€¯64.17 µg⋅h/ml) in comparison with AUC0-24   h in the HPCD group (595.57  ±â€¯71.76 µg⋅h/ml) and water group (465.57 ±â€¯90.89 µg⋅h/ml). In addition, the Tmax of (S)-ZPF in the TPGS group was 2 h, much faster than that in the HPCD or water groups (5.50 or 5.67 h, respectively). This suggested that TPGS played a significant role in the increase of solubility and bioavailability of (S)-ZPF.

Immediate-released pelletized solid dispersion containing fenofibrate: Formulation, in vitro characterization, and bioequivalence studies in experimental beagle dogs.

There have been many strategies to increase solubility, dissolution rates, and oral bioavailability of fenofibrate such as micronization, nanonization, solid dispersion, and emulsion so far. To our knowledge, only first three technologies have been applied in producing marketed products, and no combination of solid dispersion and pellet has been found even in laboratory-based reports. Therefore, the aim of this study was to develop novel solid dispersion-based pellets via an one-step process directly from fenofibrate powder using layering method. Developed fenofibrate pellets were in vitro characterized on size distribution, dissolution rates, sensory evaluation and stability. In addition, the transformation from crystalline fenofibrate to amorphous fenofibrate, and intermolecular interactions of fenofibrate in solid dispersion were confirmed using physico-chemical methods. The dissolution rate of pellets containing fenofibrate was significantly higher than that of the reference, Lipanthyl® 160 mg tablets at early stage, satisfying the criteria in USP 38. The pellets, then, were packed in hard capsules for bioequivalence studies in experimental beagle dogs using a validated HPLC assay. Final findings of the present study should be beneficial for further development of new fenofibrate formulations containing solid dispersion-based pellets which were bioequivalent to Lipanthyl® 160 mg tablets.

Sex Ratio at Birth in Vietnam: Results From Data in CHILILAB HDSS, 2004 to 2013.

This study aimed to explore the association of demographic and socioeconomic characteristics and imbalanced sex ratio at birth (SRB) in Chi Linh district, Hai Duong. The data were collected from a longitudinal study using a community-based periodic, referred as Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) during 2004 to 2013. A total of 7568 children were analyzed. Results showed that SRB in Chi Linh dramatically increased to the imbalanced sex ratio (114.6 boys to 100 girls) by 2013. SRB was associated with birth order and sex of preceding siblings. SRB was extremely high among families without any sons (136/100). SRB was highest among families having third or more children (175/100). Imbalanced SRB was more likely to occur among women working in small business/homemakers and others, women who attained high education level, and women in wealthy households. We suggested further efforts to tackle imbalanced SRB in periurban areas in Vietnam.

Patterns of Mortality in the Elderly in Chi Linh, Hai Duong, Vietnam, Period 2004-2012.

OBJECTIVE: This paper examines the trends of mortality in the elderly people in Chi Linh during period 2004-2012 and identifies a number of factors related to mortality in the elderly. DESIGN: The longitudinal study method is used. The analyzed data is extracted from database of theDemographic-Epidemiologic Surveillance System (DESS) of Chililab. The data is collected from 7 communes/town of Chi Linh district, Hai Duong province during 2004-2012 with all elderly people. Descriptive statistical analysis and survival analysis using Kaplan Meier survival estimates and Cox regression models were used. The indirect standardization was used to compare between the mortality rate of the elderly in Chi Linh and the rates of those in some reference groups. RESULTS: Mortality rate in elderly tend to decrease over the period 2004-2012. In all the time, mortality rate in elderly men is higher than that in the elderly women. Specific mortality rates by age groups have increased in both males and females. The increase Age specific mortality rates in males is higher than females. Indirect standardized mortality data for the elderly in 2009 in Chi Linh, Vietnam, Canada, the United States of America (USA) showed that elderly mortality rate in Chililab in 2009 was lower than that in elderly of Vietnam (standardized mortality ratio-SMR of elderly in Chililab is only by 75% in comparison with elderly of Vietnam), and also lower than that in elderly people in the US, and Canada. Cox regression analysis (multivariate models) show that with every 1 year older, the risk of death in elderly men increased by 9% and 12% increase in elderly female, for both men and women general risk increased by 10% (p < 0.05). Elderly with higher education levels, elderly with better family economic conditions; elderly living with wife/husband have lower mortality risk than the other counterparts. CONCLUSIONS: The research results suggest some recommendations: Strengthening health care programs for elderly people with low education levels, poor economic conditions, and celibacy groups (the vulnerable groups).

Tadalafil-loaded nanostructured lipid carriers using permeation enhancers.

Tadalafil is a phosphodiesterase-5 inhibitor indicated for the treatment of erectile dysfunction. In this study, we prepared and evaluated transdermal nanostructured lipid carriers (NLC) to improve the skin permeability of tadalafil. Tadalafil-loaded NLC dispersions were prepared using glyceryl monostearate as a solid lipid, oleic acid as a liquid lipid, and Tween 80 as a surfactant. We characterized the dispersions according to particle size, polydispersity index, zeta potential, encapsulation efficiency, and transmission electron microscopy. In vitro skin permeation studies were carried out using Franz diffusion cells, and cytotoxicity was examined using HaCaT keratinocyte cell lines. Tadalafil skin permeability increased for all tadalafil-loaded NLC formulations. The tadalafil-loaded NLC dispersion with ethanol and limonene as skin permeation enhancers exhibited the highest flux (∼4.8-fold) compared to that observed with tadalafil solution alone. Furthermore, a tadalafil-loaded NLC gel with selected permeation enhancers showed tolerance against toxicity in HaCaT cells. These results suggest that the NLC formulations with ethanol and limonene as skin permeation enhancers could be a promising dermal delivery carrier for tadalafil.

The Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS).

The Chi Linh Health and Demographic Surveillance System (CHILILAB HDSS) is the only health and demographic surveillance system (HDSS) in an urbanizing area of the Chi Linh district of Hai Duong, a northern province of Vietnam. It is one of the few field laboratories in the world that links operational research and health interventions with field training. The CHILILAB HDSS provides longitudinal data on demographic and health indicators for the community of Chi Linh. In 2012, when the CHILILAB HDSS included 57,561 people from 17 993 households in 3 towns and 4 communes, it used structured questionnaires to collect information on population changes (birth, death, migration, marriage, and pregnancy) in the community. As of December 2012, 5 rounds of a baseline survey and 17 periodic update surveys or re-enumeration surveys had been conducted. In addition, several specialized public-health research projects, focused particularly on adolescent health, have been implemented by the CHILILAB HDSS. The information that the CHILILAB HDSS has gathered provides a picture of the health status of the population and socio-economic situation in Chi Linh district. The contact person for data sharing is the director of the CHILILAB (E-mail: thb@hsph.edu.vn).