Challenges and Lessons Learned in the Development of a Participatory Learning and Action Intervention to Tackle Antibiotic Resistance: Experiences From Northern Vietnam

Antibiotic use in the community for humans and animals is high in Vietnam, driven by easy access to over-the counter medicines and poor understanding of the role of antibiotics. This has contributed to antibiotic resistance levels that are amongst the highest in the world. To address this problem, we developed a participatory learning and action (PLA) intervention. Here we describe challenges and lessons learned while developing and testing this intervention in preparation for a large-scale One Health trial in northern Vietnam. We tested the PLA approach using community-led photography, and then reflected on how this approach worked in practice. We reviewed and discussed implementation documentation and developed and refined themes. Five main themes were identified related to challenges and lessons learned: understanding the local context, stakeholder relationship development, participant recruitment, building trust and motivation, and engagement with the topic of antibiotics and antimicrobial resistance (AMR). Partnerships with national and local authorities provided an important foundation for building relationships with communities, and enhanced visibility and credibility of activities. Partnership development required managing relationships, clarifying roles, and accommodating different management styles. When recruiting participants, we had to balance preferences for top-down and bottom-up approaches. Building trust and motivation took time and was challenged by limited study team presence in the community. Open discussions around expectations and appropriate incentives were re-visited throughout the process. Financial incentives provided initial motivation to participate, while less tangible benefits like collective knowledge, social connections, desire to help the community, and new skills, sustained longer-term motivation. Lack of awareness and perceived importance of the problem of AMR, affected initial motivation. Developing mutual understanding through use of common and simplified language helped when discussing the complexities of this topic. A sense of ownership emerged as the study progressed and participants understood more about AMR, how it related to their own concerns, and incorporated their own ideas into activities. PLA can be a powerful way of stimulating community action and bringing people together to tackle a common problem. Understanding the nuances of local power structures, and allowing time for stakeholder relationship development and consensus-building are important considerations when designing engagement projects

Implementation of point-of-care testing of C-reactive protein concentrations to improve antibiotic targeting in respiratory illness in Vietnamese primary care: a pragmatic cluster-randomised controlled trial

Background In previous trials, point-of-care testing of C-reactive protein (CRP) concentrations safely reduced antibiotic use in non-severe acute respiratory infections in primary care. However, these trials were done in a research-oriented context with close support from research staff, which could have influenced prescribing practices. To better inform the potential for scaling up point-of-care testing of CRP in respiratory infections, we aimed to do a pragmatic trial of the intervention in a routine care setting. Methods We did a pragmatic, cluster-randomised controlled trial at 48 commune health centres in Viet Nam between June 1, 2020, and May 12, 2021. Eligible centres served populations of more than 3000 people, handled 10–40 respiratory infections per week, had licensed prescribers on site, and maintained electronic patient databases. Centres were randomly allocated (1:1) to provide point-of-care CRP testing plus routine care or routine care only. Randomisation was stratified by district and by baseline prescription level (ie, the proportion of patients with suspected acute respiratory infections to whom antibiotics were prescribed in 2019). Eligible patients were aged 1–65 years and visiting the commune health centre for a suspected acute respiratory infection with at least one focal sign or symptom and symptoms lasting less than 7 days. The primary endpoint was the proportion of patients prescribed an antibiotic at first attendance in the intention-to-treat population. The per-protocol analysis included only people who underwent CRP testing. Secondary safety outcomes included time to resolution of symptoms and frequency of hospitalisation. This trial is registered with ClinicalTrials.gov, NCT03855215. Findings 48 commune health centres were enrolled and randomly assigned, 24 to the intervention group (n=18 621 patients) and 24 to the control group (n=21 235). 17 345 (93·1%) patients in the intervention group were prescribed antibiotics, compared with 20 860 (98·2%) in the control group (adjusted relative risk 0·83 [95% CI 0·66–0·93]). Only 2606 (14%) of 18 621 patients in the intervention group underwent CRP testing and were included in the per-protocol analysis. When analyses were restricted to this population, larger reductions in prescribing were noted in the intervention group compared with the control group (adjusted relative risk 0·64 [95% CI 0·60–0·70]). Time to resolution of symptoms (hazard ratio 0·70 [95% CI 0·39–1·27]) and frequency of hospitalisation (nine in the intervention group vs 17 in the control group; adjusted relative risk 0·52 [95% CI 0·23–1·17]) did not differ between groups. Interpretation Use of point-of-care CRP testing efficaciously reduced prescription of antibiotics in patients with non-severe acute respiratory infections in primary health care in Viet Nam without compromising patient recovery. The low uptake of CRP testing suggests that barriers to implementation and compliance need to be addressed before scale-up of the intervention. Funding Australian Government, UK Government, and the Foundation for Innovative New Diagnostics

Business Plan for a Vietnamese Restaurant & Coffee Shop in Helsinki

The objective of the thesis was to invent a practical business plan for setting up a combination of a Vietnamese Restaurant and Coffee Shop which is located in the capital city of Finland – Helsinki and in a very central area of the Antilla Shopping Mall. The main purpose of this study is to determine whether a very unique Vietnamese restaurant is viable to function without any coordination with other Asian cuisines such as Chinese, Thai, etc… This thesis also clarifies the constructive opportunities of creating a unique Vietnamese restaurant and coffee shop brand with the featured cuisine and beverage culture; especially this will bring more information and advantages to not only the author but also persons or investors interested in a very beautiful Asian culture. During the thesis, the detailed financial condition and budget were completed. The theoretical background for constructing the business plan was based on a number of books about what are key elements in writing a business plan and what other theories should be used to implement the research. Business plan is needed for many reasons: to be a guideline for the business, support the internationalization and to manage the financial budget of the business. Moreover, the management methods for staff, customers and the service are very important also. From the author’s view and experience, the main key factors why the customers choose the restaurant and what marketing strategies or customer service campaign make the restaurant successful. As in this study is used a project-based method, the resources used in the the-sis are literature, internet sources related to the topic and the author’s own ex-perience. As a learning process, the study is beneficial to the author. The thesis shows a basic model of writing a business plan and this is limited to a specific industry in a specific area so anyone who uses this thesis as a reference for making a business plan must take targeted industry into consideration

Community Participatory Interventions to Improve Farmer Knowledge and Practices of Household Biogas Unit Operation in Ha Nam Province, Vietnam

Context: The use of biogas systems to treat livestock waste is a common practice in Vietnam. However, farmers' knowledge and practices of the safe and appropriate use of household biogas units (HBUs) are still limited and could negatively impact human, animal, and environmental health. Objective: To assess the effectiveness of an intervention to improve knowledge and practices of biogas operation among farmers in 2 communes of Ha Nam Province, Vietnam. Design: A community-based intervention approach. Setting: This study was conducted from 2015 to 2016 in 2 communes of Ha Nam Province, Vietnam. Participants: Only farmers with HBUs (N = 399) participated in this research. Farmers were assigned to either an intervention group or a control group at a ratio of 1:2. Intervention: Two intervention steps were implemented over a 6-month period as follows: (i) the core farmer group trained in 6 steps of HBU safe handling practice; and (ii) the core farmer group conducted peer-to-peer communication with its neighbors in the commune using the provided material. Main Outcome Measure(s): Farmers' knowledge and practices in biogas operation were assessed by a structured questionnaire. The questionnaire was administered before (baseline) and after the intervention (follow-up) to both the control and intervention groups. Results: There was a significant difference in the knowledge and practices of biogas operation between the 2 groups, in which farmers in the intervention group demonstrated better understanding of the related topic than the control group (P < .05, t test). A linear regression model indicated that baseline and follow-up scores in both knowledge and practices of the intervention group were higher than those of the control group. After the intervention, the mean difference score in knowledge and practices between the intervention and control groups was 5.0 and 2.0 points, respectively (P < .01). Conclusion: A community-based intervention approach could be applied to improve knowledge and practices among farmers in using biogas systems. However, further studies should be conducted to assess the sustainability and effectiveness of this model

Investigating the traditional medicine shoulder pain (Jian Tong) characteristics in patients with ischaemic stroke in the early rehabilitation phase

Introduction: Ischaemic stroke often leaves serious sequelae affecting patients' daily activities and quality of life, especially shoulder pain. Shoulder pain after stroke often occurs in the first 3 months with an occurrence rate of 25–72% due to the strong natural neurological mechanism during the time, interferes with the recovery of motor function, increases hospital stay, is associated with depression, and limits mobility as well as inhibits treatment results. In Vietnam, Traditional Medicine (TM) has played an essential role in treating and rehabilitating shoulder pain after stroke for quite a long time. Studies on the pathology of shoulder pain (Jian Tong) after stroke in TM in Vietnam are still inadequate. Therefore, this study evaluated the severity and characteristics of post-stroke Jian Tong in patients with ischaemic stroke. Methods: The study was conducted from January 1, 2023–May 1, 2023. The study consisted of two phases: Phase 1: Searching TM documents and selecting the characteristics that appear in the documents as components for the questionnaire of phase 2. Phase 2: Conduct a cross-sectional study to investigate the characteristics of Jian Tong in 65 patients after ischaemic stroke in the early rehabilitation phase. Results: In phase 1, the study encoded 17 features of Jian Tong from 10 literary documents. In phase 2, we surveyed over 65 patients, and the result was that shoulder pain aggravated by exertion had the highest rate, whereas shoulder pain alleviated by cold and distended shoulder had the fewest. Pain level measured by Number Rating Scale (NRS) points and gender was significantly related to the characteristics of TM shoulder pain – Jian Tong (p < 0.05). Conclusion: The study demonstrated the pain level and the characteristics of Jian Tong in patients with ischaemic stroke in the early rehabilitation phase to contribute to the process of personalized diagnosing and treating Jian Tong after stroke for each patient, especially based on the theoretical basis and reasoning methods of Traditional Medicine

Magnetically tunable organic semiconductors with superparamagnetic nanoparticles

International audienc

SALAD: Syringe-based Arduino-operated Low-cost Antibody Dispenser

Lateral Flow Assays (LFA) have been one of the most widely adopted technologies in clinical diagnosis over recent years, especially during the COVID-19 pandemic, due to their feasibility, compactness, and rapid readout. However, the precise dispensing of antibodies–a key part of the fabrication process–requires costly line dispenser equipment, which poses a challenge to researchers with limited budgets. This study aims to resolve this key issue by introducing a Syringe-based Arduino-operated Low-cost Antibody Dispenser (SALAD). By utilizing a microneedle, stepper motor-driven syringe pump, and conveyor belt, SALAD can form micro-droplets to create an even band of antibodies. Our evaluation results showed comparable performance between SALAD and a commercialized model – Claremont ALFRD, with SALAD exceeding in affordability and feasibility. SALAD yielded an even signal, uniform bandwidth, and low background noise, yet optimization in the conveyor belt should be considered to enhance stability. With a low manufacturing cost ($200.61) compared to the commercialized models, our model is expected to provide an affordable approach for LFA researchers

Infection control and tuberculosis among health care workers in Viet Nam, 2009-2013: a cross-sectional survey

Abstract Background Data on tuberculosis (TB) among health care workers (HCW) and TB infection control (TBIC) indicators are rarely available at national level. We assessed multi-year trends in notification data of TB among HCW and explored possible associations with TBIC indicators. Methods Notified TB incidence among HCW and 3 other TBIC indicators were collected annually from all 64 provincial and 3 national TB facilities in Vietnam. Time trends in TB notification between 2009 and 2013 were assessed using linear regression analysis. Multivariate regression models were applied to assess associations between the facility-specific 5-year notification rate and TBIC indicators. Results Forty-seven (70 %) of 67 facilities contributed data annually over five years; 15 reported at least one HCW with TB in 2009 compared to six in 2013. The TB notification rate dropped from 593 to 197 per 100,000 HCW (ptrend = 0.02). Among 104 TB cases reported, 30 were employed at TB wards, 24 at other clinical wards, ten in the microbiology laboratory, six at the MDR-TB ward, and 34 in other positions. The proportion of facilities with a TBIC plan and focal person remained relatively stable between 70 % and 84 %. The proportion of facilities providing personal protective equipment (PPE) to their staff increased over time. Facilities with a TBIC focal person were 7.6 times more likely to report any TB cases than facilities without a focal person. Conclusions The TB notification rates among HCW seemed to decrease over time. Availability of PPE increased over the same period. Appointing a TBIC focal person was associated with reporting of TB cases among HCW. It remains unclear whether TBIC measures helped in reduction of the TB notification rates in HCW