An investigation of non-prescription medicine supply in community pharmacies in Hanoi, Vietnam

Supplying safe, appropriate and effective non-prescription medicines for customers in community pharmacies is a key role of pharmacists and pharmacy assistants in every country. However, in low and middle-income countries, including Vietnam, the quality of professional services from pharmacies is limited, unclear and has often been questioned. There is limited research about the real situation surrounding non-prescription medicine supply in community pharmacies in Vietnam. The factors that influence the supply of non-prescription medicines to customers and to what extent the service provision could be improved for the benefit of pharmacy customers needs to be explored. This study aimed to investigate non-prescription medicines supply in community pharmacies in Hanoi, Vietnam in order to provide scientific evidence about the situation. A mixed method approach was used in this study to provide valuable insights into what occurs during pharmacy staff-customer transactions. Following ethical approval, fieldwork observations were undertaken in five community pharmacies over a five week period from March to May 2011, this was followed by 22 semi-structured interviews with eight pharmacists and 14 pharmacy assistants who had been observed. The interviews enabled participants to express their perceptions and experiences regarding the supply of non-prescription medicines to customers in community pharmacies. Survey research, using a structured questionnaire, was conducted with 505 pharmacy customers who were asked to evaluate the pharmacy service that they had just received. Results from the three sources were triangulated and validated by comparing, contrasting, complementing and confirming in order to provide a better understanding of non-prescription medicines supply and make recommendations for improving the service provision in community pharmacies in Vietnam. The findings from this study indicate that factors influencing the supply of non-prescription medicines in community pharmacies include attitudes of pharmacy staff, their medical and pharmaceutical knowledge and their communication skills. The influence of the pharmacy settings, customer factors such as customers’ complex and diverse demands, the irrational use of medicines, using medicines following the suggestions of others, and tough customers were all factors that impacted on staff-customer transactions. Being conveniently located, the pharmacy offering reasonably priced medicines and being a large pharmacy with a good reputation were also considered important impacting on customer selection of community pharmacy. The results of this research show that there are limitations in pharmacy service provision and there is a discrepancy between pharmacy staff perceptions and actual practice in terms of attitudes. Poor performance, in many situations, did not come from a lack of knowledge; rather it appeared to result from the negative attitudes of pharmacy staff. Such negative attitudes of pharmacy staff are likely to be related to their focus on just short-term profit rather than focusing on a balance between short-term and long-term benefits for both customers and pharmacies. Positive attitudes, taking greater responsibility, customer loyalty and long-term benefits were ignored. Poor performance of pharmacy staff, to some extent, was also affected by their education and training. Some educational organisations have commercialised their training activities and paid too much attention to the quantity of graduated students rather than the quality of their education and training. This study has important implications for the improvement of the responsible supply of non-prescription medicines in community pharmacies in Vietnam including the identified needs for attitude interventions and training. New subjects should be added to the pharmacy students’ curricula and training should be developed for pharmacy assistants in areas such as communication skills, customer psychology, selling skills and patient safety. For pharmacists and pharmacy assistants, gaining treatment experience from customers’ feedback and keeping up to date with new information should be a continuous activity. Close co-operation between health authorities, policy makers and researchers needs to be developed in conducting further research and implementing appropriate policies, in order to improve the service provision in community pharmacies in Vietnam

An investigation of non-prescription medicine supply in community pharmacies in Hanoi, Vietnam

Supplying safe, appropriate and effective non-prescription medicines for customers in community pharmacies is a key role of pharmacists and pharmacy assistants in every country. However, in low and middle-income countries, including Vietnam, the quality of professional services from pharmacies is limited, unclear and has often been questioned. There is limited research about the real situation surrounding non-prescription medicine supply in community pharmacies in Vietnam. The factors that influence the supply of non-prescription medicines to customers and to what extent the service provision could be improved for the benefit of pharmacy customers needs to be explored. This study aimed to investigate non-prescription medicines supply in community pharmacies in Hanoi, Vietnam in order to provide scientific evidence about the situation. A mixed method approach was used in this study to provide valuable insights into what occurs during pharmacy staff-customer transactions. Following ethical approval, fieldwork observations were undertaken in five community pharmacies over a five week period from March to May 2011, this was followed by 22 semi-structured interviews with eight pharmacists and 14 pharmacy assistants who had been observed. The interviews enabled participants to express their perceptions and experiences regarding the supply of non-prescription medicines to customers in community pharmacies. Survey research, using a structured questionnaire, was conducted with 505 pharmacy customers who were asked to evaluate the pharmacy service that they had just received. Results from the three sources were triangulated and validated by comparing, contrasting, complementing and confirming in order to provide a better understanding of non-prescription medicines supply and make recommendations for improving the service provision in community pharmacies in Vietnam. The findings from this study indicate that factors influencing the supply of non-prescription medicines in community pharmacies include attitudes of pharmacy staff, their medical and pharmaceutical knowledge and their communication skills. The influence of the pharmacy settings, customer factors such as customers’ complex and diverse demands, the irrational use of medicines, using medicines following the suggestions of others, and tough customers were all factors that impacted on staff-customer transactions. Being conveniently located, the pharmacy offering reasonably priced medicines and being a large pharmacy with a good reputation were also considered important impacting on customer selection of community pharmacy. The results of this research show that there are limitations in pharmacy service provision and there is a discrepancy between pharmacy staff perceptions and actual practice in terms of attitudes. Poor performance, in many situations, did not come from a lack of knowledge; rather it appeared to result from the negative attitudes of pharmacy staff. Such negative attitudes of pharmacy staff are likely to be related to their focus on just short-term profit rather than focusing on a balance between short-term and long-term benefits for both customers and pharmacies. Positive attitudes, taking greater responsibility, customer loyalty and long-term benefits were ignored. Poor performance of pharmacy staff, to some extent, was also affected by their education and training. Some educational organisations have commercialised their training activities and paid too much attention to the quantity of graduated students rather than the quality of their education and training. This study has important implications for the improvement of the responsible supply of non-prescription medicines in community pharmacies in Vietnam including the identified needs for attitude interventions and training. New subjects should be added to the pharmacy students’ curricula and training should be developed for pharmacy assistants in areas such as communication skills, customer psychology, selling skills and patient safety. For pharmacists and pharmacy assistants, gaining treatment experience from customers’ feedback and keeping up to date with new information should be a continuous activity. Close co-operation between health authorities, policy makers and researchers needs to be developed in conducting further research and implementing appropriate policies, in order to improve the service provision in community pharmacies in Vietnam

PREPARATION AND FTIR STUDIES OF PMMA/PVC POLYMER BLENDS, PVC-g-PMMA GRAFT COPOLYMERS AND EVALUATING GRAFT CONTENT

This study presents the qualitative and quantitative analyses of Fourier Transform Infrared (FTIR) spectra of poly(methyl methacrylate)/poly(vinyl chloride) blends (PMMA/PVC), as well as PVC-g-PMMA graft copolymers. Graft copolymerizations of methyl mathacrylate (MMA) onto PVC macromolecules were carried out mixture of cyclohexanone/N,N-dimethylformamide as solvents, dibenzoyl peroxide as initiator and nitrogen medium. FTIR spectra of PMMA/PVC blends showed that there were molecular interactions between C=O groups of PMMA and C-Cl groups of PVC. Assignments of infrared absorption bands for specific groups of PMMA/PVC blends have been contributed. Using regression method, linear calibration curve between PMMA mole content and peak areas of C=O groups in FTIR spectra of the blends has been found when C=O peak areas were multiplied by an appropriate factor. PMMA grafted content and total PMMA formed content in PVC-g-PMMA graft copolymers have been evaluated. The results showed that grafted PMMA content was increased since PVC was initiatly dechlorinated by NaOH solution. The grafted PMMA content and total formed PMMA content were 5.05 wt.% and 11.25 wt.% respectively when MMA monomers were grafted onto neat PVC and modified PVC molecules

Experimental investigation of friction behavior in pre-sliding regime for pneumatic cylinder

Friction always presents in pneumatic cylinders and causes difficulties in controlling position and velocity of pneumatic systems. In order to improve the control performance of the pneumatic systems, it is necessary to fully understand behavior of friction in the pneumatic cylinders. So far, dynamic friction behavior of pneumatic cylinders has been investigated but mainly focused on the friction behavior in sliding regime. In pre-sliding regime, friction behavior has not been investigated. In this paper, experimental investigations of friction behavior of a pneumatic cylinder in pre-sliding regime are made. The friction force is calculated from the equation of motion of the piston using the measured values of pressures in the two cylinder chambers and the piston displacement. The pressures are controlled by using two proportional pressure control valve. The friction force versus piston displacement characteristics are measured and analysed under various operating conditions of the applied force and the pressures. Experimental results show that: i) the piston motion in pre-sliding regime exhibits a nonlinear spring behavior; ii) hysteretic behavior with nonlocal memory is verified; iii) the pressures have influence only on the size of the hysteretic loop. These experimental results can be applied to develop a friction model for pneumatic cylinders

Intergenerational effects of violence on women's perinatal wellbeing and infant health outcomes: evidence from a birth cohort study in Central Vietnam.

BACKGROUND: Girls exposed to violence have a high risk of being victimized as adults and are more likely than non-abused women to have children who are treated violently. This intergenerational transmission may be especially serious when women suffer violence during pregnancy and early motherhood, as it impairs maternal wellbeing and infant health and development. This study examined the intergenerational effects of being exposed to childhood maltreatment (CM) and prenatal intimate partner violence (p-IPV) on perinatal mental distress and birth outcomes in central Vietnam. METHODS: A birth cohort study in Hue City, Vietnam was conducted with 150 women in the third trimester of pregnancy (Wave 1) and 3 months after childbirth (Wave 2). Using multivariable logistic regression models, augmented inverse-probability-weighted estimators and structural equation modelling (SEM), we analyzed a theoretical model by evaluating adjusted risk differences and pathways between CM, p-IPV and subsequent perinatal adversity and indicators of infant health problems. RESULTS: One in two pregnant women experienced at least one form of CM (55.03%) and one in ten pregnant women experienced both CM and p-IPV (10.67%). Mothers who experienced p-IPV or witnessed IPV as a child were approximately twice as likely to experience poor mental health during pregnancy [ARR 1.94, 95% CI (1.20-3.15)]. Infants had a two-fold higher risk of adverse birth outcomes (low birth weight, preterm birth, admission to neonatal intensive care) [ARR 2.45 95% CI (1.42, 4.25)] if their mothers experienced any form of p-IPV, with greater risk if their mothers were exposed to both CM and p-IPV [ARR 3.45 95% CI (1.40, 8.53)]. Notably, significant pathways to p-IPV were found via adverse childhood experience (ACE) events (β = 0.13), neighborhood disorder (β = 0.14) and partner support (β = - 1.3). CONCLUSION: These results emphasize the detrimental and prolonged nature of the effect of violence during childhood and pregnancy. Exposure to childhood maltreatment and violence during pregnancy increases the risk of maternal mental health difficulties and adverse birth outcomes. Antenatal care systems need to be responsive to women's previous experiences of violence and maternal mental health. The significant protective role of partner support and social support should also be considered when designing tailored interventions to address violence during pregnancy

Risk factors of dengue fever in an urban area in Vietnam: a case-control study

BackgroundDengue is a mosquito-borne flavivirus present in many metropolitan cities of tropical countries.MethodsDuring and after the dengue season (September 2018 to January 2019), we conducted a case-control study in order to determine the risk factors for dengue fever in Hanoi city, Vietnam. 98 dengue patients and 99 patients with other acute infections, such as Hepatitis B virus infection, were recruited at Department of Infectious Disease of Bach Mai national hospital in Hanoi. Patients were interviewed using a structured questionnaire covering demographic, housing, environmental factors and knowledge, attitude, and practice on dengue prevention and control. Univariate analysis and multivariable logistic regression were used to determine the risk factors of dengue status.ResultsThe mean score of knowledge items and practice items was only 7.9 out of total 19 points and 3.9 out of total 17 points, respectively. While the mean score of attitude items was 4.8 out of total 6 points. Multivariable logistic regression indicated that older patients had lesser risk of getting dengue infection as compared to younger adults aged 16-30, and patients living in peri-urban districts were less likely to suffer of dengue fever than patients living in central urban districts (OR=0.31; 95% CI 0.13-0.75). This study could not find any association with occupation, water storage habit, knowledge, attitude, or practice on dengue prevention.ConclusionsAll patients had a relatively low level of knowledge and practice on dengue prevention and control. However, the attitude of the participants was good. We found that age group and living district were the risk factors correlated with the dengue status. Communication programs on raising dengue awareness should be repeated all year round and target particular groups of adolescents, younger adults, landlords and migrants from other provinces to improve their knowledge and encourage them to implement preventive measures against dengue fever

Analyses of stiffened plates resting on the viscoelastic foundation subjected to a moving vehicle by a cell-based smoothed triangular plate element

Recently, a cell-based smoothed discrete shear gap method (CS-FEM-DSG3) based on the firstorder shear deformation theory (FSDT) was proposed for static and free vibration analyses of Mindlin plates. The CS-FEM-DSG3 uses three-node triangular elements that can be easily generated automatically for arbitrary complicated geometric domains. This paper further extends the CS-FEMDSG3 for static, free vibration, and dynamic response of the stiffened plate resting on viscoelastic foundation subjected to a moving vehicle. The viscoelastic foundation is modeled by discrete springs and dampers whereas the stiffened plate can be considered as the combination between the Mindlin plate and the Timoshenko beam elements. The moving vehicle is transformed into one concentrated load at its central point. Some numerical examples are investigated and numerical results show that the CS-FEMDSG3 overcomes shear-locking phenomena and has a fast convergence. The results also illustrate the good agreement of the CS-FEM-DSG3 for static and free vibration analyses of un-stiffened plate compared with the previous published methods. In addition, the numerical results for dynamic analysis of stiffened plates by the CS-FEM-DSG3 also show the expected property in which the deflection of the stiffened plate is much smaller than those of the un-stiffened plate

Practice skills and compliance of private pharmacies with regulations on the prescription drug: A multi-method study in Vietnam

Professional practice of pharmacists plays a crucial role in the reinforcement of drug retailers’ services to achieve optimal health care provision to customers. To evaluate the professional skills and compliance of retail pharmacy staff with selling prescription drugs by surveying patients’ knowledge of drugs and role-playing the customer buying antibiotics without a prescription. A cross-sectional study was conducted with two kinds of surveys at 480 drug retail establishments using the cluster sample technique among 12 provinces/cities in Vietnam. Clients were interviewed to assess their knowledge about drugs. Moreover, the method of acting as a client was used in two common scenarios in order to evaluate the implementation of professional regulations and professional practice skills of drug sellers: a child acute respiratory infection (ARI) case and an amoxicillin case without a prescription. The data were presented as frequency and percentage. The basic tests were used to compare the ratios and means between the two groups. The total number of interviewed customers was 2389 while the figure for role-playing was 960 cases. When customers buy medications with a prescription, 100% of those were fully aware of the dosage of the drugs they purchased, which was higher than the scenario of buying without a prescription (93.1%). In role-play scenarios, the rate of drug sellers asking patients to explore information was higher in the ARI children case than in the amoxicillin case. Besides, 100% of customers were consulted on treatment in both cases, and the rate of advising was at a low rate in both scenarios 3.8% in the amoxicillin case compared to 15.4% in the ARI case. Drug sellers did not respond well to requirements in professional practice and were influenced by economic concerns in business

INO80 function is required for mouse mammary gland development, but mutation alone may be insufficient for breast cancer

The aberrant function of ATP-dependent chromatin remodeler INO80 has been implicated in multiple types of cancers by altering chromatin architecture and gene expression; however, the underlying mechanism of the functional involvement of INO80 mutation in cancer etiology, especially in breast cancer, remains unclear. In the present study, we have performed a weighted gene co-expression network analysis (WCGNA) to investigate links between INO80 expression and breast cancer sub-classification and progression. Our analysis revealed that INO80 repression is associated with differential responsiveness of estrogen receptors (ERs) depending upon breast cancer subtype, ER networks, and increased risk of breast carcinogenesis. To determine whether INO80 loss induces breast tumors, a conditional INO80-knockout (INO80 cKO) mouse model was generated using the Cre-loxP system. Phenotypic characterization revealed that INO80 cKO led to reduced branching and length of the mammary ducts at all stages. However, the INO80 cKO mouse model had unaltered lumen morphology and failed to spontaneously induce tumorigenesis in mammary gland tissue. Therefore, our study suggests that the aberrant function of INO80 is potentially associated with breast cancer by modulating gene expression. INO80 mutation alone is insufficient for breast tumorigenesis