Etiology and epidemiology of diarrhea in children in Hanoi, Vietnam

SummaryObjectivesThis paper provides a preliminary picture of diarrhea with regards to etiology, clinical symptoms, and some related epidemiologic factors in children less than five years of age living in Hanoi, Vietnam.MethodsThe study population included 587 children with diarrhea and 249 age-matched healthy controls. The identification of pathogens was carried out by the conventional methods in combination with ELISA, immunoseparation, and PCR. The antibiotic susceptibility was determined by MIC following the NCCLS recommendations.ResultsOf those with diarrhea, 40.9% were less than one year old and 71.0% were less than two years old. A potential pathogen was identified in 67.3% of children with diarrhea. They were group A rotavirus, diarrheagenic Escherichia coli, Shigella spp, and enterotoxigenic Bacteroides fragilis, with prevalences of 46.7%, 22.5%, 4.7%, and 7.3%, respectively. No Salmonella spp or Vibrio cholerae were isolated. Rotavirus and diarrheagenic E. coli were predominant in children less than two years of age, while Shigella spp, and enterotoxigenic B. fragilis were mostly seen in the older children. Diarrheagenic E. coli and Shigella spp showed high prevalence of resistance to ampicillin, chloramphenicol, and to trimethoprim/sulfamethoxazole. Children attending the hospitals had fever (43.6%), vomiting (53.8%), and dehydration (82.6%). Watery stool was predominant with a prevalence of 66.4%, followed by mucous stool (21.0%). The mean episodes of stools per day was seven, ranging from two to 23 episodes. Before attending hospitals, 162/587 (27.6%) children had been given antibiotics. Overall, more children got diarrhea in (i) poor families; (ii) families where piped water and a latrine were lacking; (iii) families where mothers washed their hands less often before feeding the children; (iv) families where mothers had a low level of education; (v) families where information on health and sanitation less often reached their households.ConclusionsGroup A rotavirus, diarrheagenic Escherichia coli, Shigella spp, and enterotoxigenic Bacteroides fragilis play an important role in causing diarrhea in children in Hanoi, Vietnam. Epidemiological factors such as lack of fresh water supply, unhygienic septic tank, low family income, lack of health information, and low educational level of parents could contribute to the morbidity of diarrhea in children

Extract and fraction of cashew nut testa ameliorate the hyperglycemic mice induced by Streptozotocin and high-fat diet

Drug strategy is a standard method for treating type 2 diabetes mellitus (T2D), a non-communicable disease with increasing prevalence, which may cause side effects. Therefore, natural compounds with limited adverse effects have come back into vogue for treating T2D. This study aims to evaluate the effects on rehabilitating hyperglycemic mice of cashew nut testa (husk) extract and fraction known as potential bio-substances for improvement in T2D. First, the hyperglycemic mice were induced with a high-fat diet (HFD) for 4 weeks and then were injected with streptozotocin (STZ, dozen for injection was 40 mg/kg/week) for 2 weeks. Next, the confirmed hyperglycemic mice were treated with pioglitazone (HG+PG group), total extract (HG+TE group), and saponin-rich fraction (HG+SRF group) for 3 weeks. Then, the evaluation was based on body mass; blood glucose (BG) level; BG tolerance, lipid profile, pancreatic histology and the expression IRS-1 in the pancreas. The results showed that body mass and BG level significantly increased in hyperglycemic mice. After substance treatment, there was no change in body mass in TE and SRF groups. However, BG level of HG+TE group mice significantly decreased compared to hyperglycemic mice and only BG tolerance of HG+SRF group was improved. Besides, HG+TE and HG+SRF groups modulated the triglyceride, HDL and LDL close to those expressed in normal mice. In addition, histological images of the pancreas revealed the restoration in both HG+TE and HG+SRF groups. Simultaneously, the IRS-1 expression in HG+TE group pancreas was restored to its expression in normal mice. These results demonstrate that the TE and SRF of cashew nut testa could ameliorate BG, lipid profile and pancreatic IRS-1 expression and restore the damaged pancreas and islets in hyperglycemic mice

COMO É QUE OS ESTUDANTES DE MEDICINA E ENFERMAGEM VEEM A TECNOLOGIA DE SAÚDE? UM ESTUDO DE VALIDAÇÃO PSICOMÉTRICA DO QUESTIONÁRIO DE AVALIAÇÃO DE USABILIDADE EM BANGLADESH

The modernization of healthcare delivery is a reality in various international settings. To ensure efficient and safe use of the diverse forms of healthcare technology available, professionals and students must be receptive to incorporating such tools into their practice. Currently, there is no instrument in Bangladesh to assess healthcare students’ technology acceptance. Objective: To translate, culturally adapt, and validate the Usability Evaluation Questionnaire (UtEQ) among Bangladeshi healthcare students. Method: A cross-sectional study with a methodological approach was conducted in two phases. The first phase involved the translation of the UtEQ questionnaire to Bengali, following the six stages proposed by Beaton et al. In the second phase, the psychometric properties of the questionnaire were evaluated using a non-probability sample of 486 undergraduate healthcare students from three higher education institutions in Bangladesh. Confirmatory factor analysis was performed, and the Cronbach’s alpha coefficient was estimated to find out the internal consistency. Results: Internal consistency was found to be excellent for all scale dimensions, ranging from 0.88 to 0.92, while confirmatory factor analysis showed adequate goodness-of-fit indicators. Conclusion: The UtEQ-B provides a reliable and valid method for healthcare educators and researchers to assess technology acceptance among healthcare students during clinical training in Bangladesh.A modernização da prestação de cuidados de saúde é uma realidade em vários contextos internacionais. Para garantir a utilização eficiente e segura das diversas formas de tecnologia em saúde disponíveis, os profissionais e estudantes devem estar receptivos à incorporação dessas ferramentas na sua prática. Atualmente, não existe em Bangladesh um instrumento para avaliar a aceitação da tecnologia pelos estudantes de saúde. Objetivo: Traduzir, adaptar culturalmente e validar o Questionário de Avaliação da Usabilidade (UtEQ) entre estudantes de saúde de Bangladesh. Método: Foi realizado um estudo transversal com uma abordagem metodológica em duas fases. A primeira fase envolveu a tradução do questionário UtEQ para bengali, seguindo as seis etapas propostas por Beaton et al. Na segunda fase, foram avaliadas as propriedades psicométricas do questionário usando uma amostra não probabilística de 486 estudantes de graduação em saúde de três instituições de ensino superior em Bangladesh. Foi realizada uma análise fatorial confirmatória e estimou-se o coeficiente alfa de Cronbach para verificar a consistência interna. Resultados: Foi encontrada uma consistência interna excelente para todas as dimensões da escala, variando de 0,88 a 0,92, enquanto a análise fatorial confirmatória mostrou indicadores adequados de ajuste. Conclusão: O UtEQ-B fornece um método confiável e válido para educadores e pesquisadores em saúde avaliarem a aceitação da tecnologia entre estudantes de saúde durante o treinamento clínico em Bangladesh

ADAPTAÇÃO CULTURAL E VALIDAÇÃO PSICOMÉTRICA DO QUESTIONÁRIO SELF EFFICIENCY AND PERFORMANCE IN SELF-MANAGEMENT SUPPORT (SEPSS) EM ESTUDANTES DE GRADUAÇÃO EM ENFERMAGEM E MEDICINA DE BANGLADESH

In an aging society, healthcare professionals and students face increasing demands to actively involve patients in the decision-making process regarding their health conditions and lifestyles. Self-management support is considered a best practice that aligns with the patient-centered care paradigm in Bangladesh. However, there is currently no instrument available to assess healthcare professionals’ competencies in this field, particularly during their early education and training period. The aim of this study was to translate the Self Efficiency and Performance in Self-management Support (SEPSS) instrument into Bangla and validate its psychometric properties in a sample of undergraduate healthcare students in Bangladeshi higher education institutions. A cross-sectional study was conducted to assess the reliability, validity, and cultural appropriateness of the Bangla version of SEPSS-36 among 486 nursing and medical students. Confirmatory factor analysis was carried out using the chi-square model fit index (CMIN), comparative fit index (CFI), and Root Mean Square Error of Approximation (RMSEA) as fit indices. The internal consistency was estimated by the Cronbach alpha coefficient. The results indicate that the CMIN (2.658) and RMSEA (.058) values suggest that the sample data and hypothetical model are an acceptable fit in the analysis, with satisfactory CFI values (.895). The reliability for all SEPSS dimensions was acceptable. The Bangla version of the SEPSS questionnaire is a valid and reliable instrument that can assist healthcare educators and researchers in determining students’ competencies within this domain.Numa sociedade envelhecida, os profissionais de saúde e os estudantes enfrentam exigências cada vez maiores para envolver ativamente os pacientes no processo de tomada de decisão em relação às suas condições de saúde e estilos de vida. O apoio à autogestão é considerado uma prática recomendada que está alinhada com o paradigma de cuidados centrados no paciente em Bangladesh. No entanto, atualmente não existe um instrumento disponível para avaliar as competências dos profissionais de saúde nesse campo, especialmente durante o período inicial de educação e formação. O objetivo deste estudo foi traduzir o instrumento Self Efficiency and Performance in Self-management Support (SEPSS) para o bengali e validar as suas propriedades psicométricas numa amostra de estudantes de saúde de graduação em instituições de ensino superior de Bangladesh. Foi realizado um estudo transversal para avaliar a confiabilidade, validade e adequação cultural da versão em bengali do SEPSS-36 entre 486 estudantes de enfermagem e medicina. A análise fatorial confirmatória foi conduzida utilizando o índice de ajustamento do modelo qui-quadrado (CMIN), o índice de ajustamento comparativo (CFI) e o erro quadrado médio de aproximação (RMSEA) como índices de ajustamento. A consistência interna foi estimada pelo coeficiente alfa de Cronbach. Os resultados indicam que os valores de CMIN (2,658) e RMSEA (0,058) sugerem que os dados da amostra e o modelo hipotético têm um ajustamento aceitável na análise, com valores de CFI satisfatórios (0,895). A confiabilidade de todas as dimensões do SEPSS foi aceitável. A versão em bengali do questionário SEPSS é um instrumento válido e fiável que pode ajudar os educadores e investigadores em saúde a determinar as competências dos estudantes nesta área

EFETIVIDADE DA INTERVENÇÃO EDUCACIONAL DIGICARE NA MELHORIA DAS HABILIDADES DE COACHING CLÍNICO DE ESTUDANTES DE ENFERMAGEM E MEDICINA NO VIETNAME E BANGLADESH: UM PRÉ- E PÓS-ESTUDO EXPLORATÓRIO

Coaching has become an important approach to support self-management of patients with non-communicable diseases (NCDs) in healthcare education. Studies conducted in European countries have emphasized the significance of formal coaching training in enhancing the competencies of healthcare students. However, in Southeast Asia, where NCDs pose a serious public health concern, there is a lack of such training opportunities. To address this issue, an exploratory pre and post study was conducted to evaluate the effectiveness of the DigiCare educational intervention in improving clinical coaching skills. Nursing and medical students from six universities in Vietnam and Bangladesh were invited to participate. The intervention included both theoretical and practical classes with interactive methods and home assignments, with a total duration of over 10 contact hours. Pre- and post-intervention assessments were conducted using the Self-Efficacy and Performance in Self-management Support instrument, which was translated and culturally adapted to both countries. Statistical analysis showed a significant improvement in students’ overall competence scores from before (M = 2.6, SD = .67) to after the intervention (M = 3.05, SD = .55), with a medium effect size (p < .001; d = .73). The DigiCare educational intervention appears to be a low-cost and meaningful addition to the curriculum of both nursing and medical universities across countries, with potential benefits in the development of students’ clinical coaching competencies.O coaching tornou-se uma abordagem importante para apoiar a autogestão de pacientes com doenças não transmissíveis (DNTs) na educação em saúde. Estudos realizados em países europeus têm enfatizado a importância do treinamento formal em coaching para aprimorar as competências dos estudantes de saúde. No entanto, no Sudeste Asiático, onde as DNTs representam uma séria preocupação de saúde pública, há uma falta de oportunidades de treinamento nesse sentido. Para abordar essa questão, foi conduzido um pré- e pós-estudo exploratório para avaliar a eficácia da intervenção educacional DigiCare na melhoria das habilidades de coaching clínico. Estudantes de enfermagem e medicina de seis universidades no Vietname e em Bangladesh foram convidados a participar. A intervenção incluiu aulas teóricas e práticas com métodos interativos e tarefas domiciliares, totalizando mais de 10 horas de contato. Avaliações pré e pós-intervenção foram conduzidas utilizando o instrumento de Autoeficácia e Desempenho no Suporte à Autogestão, que foi traduzido e adaptado culturalmente para ambos os países. Análises estatísticas mostraram uma melhoria significativa nas pontuações gerais de competência dos estudantes, de antes (M = 2,6, DP = 0,67) para depois da intervenção (M = 3,05, DP = 0,55), com um efeito médio (p < 0,001; d = 0,73). A intervenção educacional DigiCare parece ser uma adição de baixo custo e significativa para o currículo de universidades de enfermagem e medicina em diferentes países, com benefícios potenciais no desenvolvimento das competências clínicas de coaching dos estudantes

COMO É QUE OS ESTUDANTES DE ENFERMAGEM PERCEBEM A TECNOLOGIA EM SAÚDE? UM ESTUDO DE VALIDAÇÃO PSICOMÉTRICA DO USABILITY EVALUATION QUESTIONNAIRE NO VIETNAME

The rapid advancement of technology has transformed the role of nurses and nursing students in patient care, making it an integral component of healthcare delivery. The use of innovative technologies has become commonplace in healthcare settings, creating a high-tech environment that can enhance nursing care quality and patient experience. It is essential for nursing staff and students to be receptive to incorporating such tools into their practice to ensure safe and efficient use of various forms of healthcare technology. Objective: Given the absence of an existing tool in Vietnam to evaluate healthcare students’ technology acceptance, the aim of our research was to culturally adapt, translate, and validate the Usability Evaluation Questionnaire (UtEQ) among nursing students in Vietnam. Method: We conducted a methodological and cross-sectional study in two phases: translation of the UtEQ to Vietnamese (UtEQ-V) following six stages proposed by Beaton and collaborators, and assessment of its psychometric properties in a non-probability sample of 295 Vietnamese nursing students. Results: The UtEQ-V’s reliability was found to be above 0.8 for all factors (.88–.95), while confirmatory factor analysis showed adequate goodness-of-fit indicators. Conclusion: The UtEQ-V is a reliable and valid instrument that can support nursing educators and researchers to assess students’ technology acceptance during their clinical training.O rápido avanço da tecnologia transformou o papel das enfermeiras e dos estudantes de enfermagem nos cuidados aos pacientes, tornando-o um componente integral da prestação de cuidados de saúde. O uso de tecnologias inovadoras tornou-se comum nos contextos de saúde, criando um ambiente de alta tecnologia que pode melhorar a qualidade dos cuidados de enfermagem e a experiência do paciente. É essencial que a equipa de enfermagem e os estudantes estejam recetivos à incorporação de tais ferramentas na sua prática, a fim de garantir o uso seguro e eficiente de várias formas de tecnologia de saúde. Objetivo: Dada a inexistência de uma ferramenta existente no Vietname para avaliar a aceitação da tecnologia por parte dos estudantes de saúde, o objetivo da nossa investigação foi adaptar culturalmente, traduzir e validar o Questionário de Avaliação da Usabilidade (UtEQ) entre estudantes de enfermagem no Vietname. Método: Realizámos um estudo metodológico e transversal em duas fases: tradução do UtEQ para vietnamita (UtEQ-V) seguindo as seis etapas propostas por Beaton e colaboradores e avaliação das suas propriedades psicométricas numa amostra não probabilística de 295 estudantes de enfermagem vietnamitas. Resultados: A fiabilidade do UtEQ-V revelou-se superior a 0,8 para todos os fatores (.88–.95), enquanto a análise fatorial confirmatória apresentou indicadores adequados de ajustamento. Conclusão: O UtEQ-V é um instrumento fiável e válido que pode apoiar os educadores e os investigadores de enfermagem na avaliação da aceitação da tecnologia pelos estudantes durante o seu treino clínico

SIMULATION AS A TEACHING METHOD FOR NURSING EDUCATION IN HEALTHCARE-ASSOCIATED INFECTION PREVENTION AND CONTROL IN ASIAN COUNTRIES: A QUALITATIVE STUDY

BACKGROUND: Applying simulation for nursing education, especially in healthcare-associated infection prevention and control (HAI-PC) in developing countries has limited evidence. The study was conducted to explore educators’ perceptions of simulation as a teaching method for nursing education in HAI-PC in two Vietnamese and two Cambodian universities. METHODS: An exploratory qualitative design was applied. A focus group of 37 educators from four universities was conducted for data collection. Inductive and deductive qualitative content analysis was applied in analysing the data. RESULTS: The core category was constructed to reflect educators’ perception of scenario-based simulation (SBS) as a teaching method for nursing education in HAI prevention and control. This main category included three subcategories: (i) enhancing nursing competence; (ii) preparing students for simulation; and [1] promoting simulation pedagogy competence. CONCLUSIONS: The findings identified the importance and benefits of applying simulation as a teaching method in nursing education. Additionally, it emphasized the necessity of enhancing knowledge associated with HAIs and providing additional training on simulation for educators to improve the quality of conducting simulations

EXPERIENCES OF THE NURSING STUDENT IN LEARNING HAI PREVENTION AND CONTROL IN ASIAN COUNTRIES THROUGH THE USE OF SCENARIO-BASED SIMULATION: AN EXPLORATIVE QUALITATIVE STUDY

BACKGROUND: Healthcare-associated infections (HAIs) have posed a major threat to both patients and to the safety healthcare personnel worldwide. According to the World Health Organization, 10% of hospitalized patients are affected by HAIs worldwide. OBJECTIVE: The objective of this study was to explore the experiences of nursing students in learning HAIs prevention and control by the application of the scenario-based simulation pedagogy now in use in two Vietnamese and two Cambodian universities. METHODS: A qualitative study was conducted among 160 nursing students from 2 Cambodian universities and 2 Vietnamese universities, and by using the purposive-sampling method. The data were collected through a focus group discussion and analyzed by the Graneheim and Lundman method (Graneheim & Lundman, 2004). RESULTS: Two themes and six categories were generated. 1) First theme: factors for enhancing student learning on the prevention and control of HAIs by use of scenario-based simulation; and 2) Second theme: factors hindering students learning on HAI prevention and control by use of scenario-based simulation. CONCLUSION: The findings showed that SBS is an effective learning method for nursing students that can be applied to enhance the quality of nursing education in the Asian countries as SBS not only improves the clinical skills, but also the soft skills of nursing students. However, the effective outcomes and impacts can only be achieved in the context with the appropriate learning materials and equipment, simulation facilities and the instructors with pedagogical skills

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke

Politique monétaire dans le contexte de l'économie vietnamienne

Cette thèse propose quatre contributions à l'étude de la politique monétaire dans le contexte de l'économie vietnamienne, depuis 1995-1996 jusqu’à maintenant.Le premier chapitre donne aperçu de l'économie vietnamienne et sa politique monétaire. Il s’agit d’un chapitre qui problématise les questions traitées économétriquement dans le reste de la thèse.Chapitre 2 montrent qu'il y a une relation à long terme entre le taux de change du marché noir et ses variables monétaires. Le taux de change officiel, l’écart de la masse monétaire et de taux d'intérêt intérieur ont des effets positifs significatifs sur le taux de change du marché noir tandis que la production intérieure réelle et le taux d'intérêt à l'étranger ont un impact négatif significatif sur cet indice. Chapitre 3 fournissent de fortes preuves relatives à la relation à long terme entre taux de change et ses fondamentaux monétaires relatifs. Bien que les signes des taux d'intérêt estimés soient ambigu, les coefficients estimés de la monnaie et du rendement sont compatibles avec toutes les variantes traditionnelles du modèle monétaire de la détermination du taux de change. Finalement, nous constatons que le pass-through du taux de change sur l'inflation est fort et rapide, et que le taux de change a un effet positif significatif sur l'inflation. La masse monétaire joue un rôle important dans la détermination de l'inflation alors que le taux d'intérêt ne semble pas avoir un impact significatif sur l'inflation. En outre, le prix du pétrole l’influence considérablement. Un choc de taux d’intérêts des États-Unis joue un rôle insignifiant dans l’explication de la variabilité des variables macroéconomiques domestiques.This dissertation proposes four contributions to the study of monetary policy in the context of Vietnamese economy from 1995-96 onwards. The first chapter provides an overview of Vietnamese economy and its monetary policy. It provides some issues that are resolved econometrically in the rest of the thesis.The second chapter investigates the black market exchange rate determination. We find that there is a long-run relationship between black market exchange rate and its relative monetary variables. Official exchange rate, money supply differential and domestic interest rate have significant positive effects on black market exchange rate while domestic real output and foreign interest rate have meaningful negative impact on black market exchange rate.The third chapter examines how well versions of monetary models explain the VND/U.S dollar exchange rate. Estimates provide strong evidences of long-run relationship between exchange rate and its relative monetary fundamentals. Although the signs of estimated interest rates are mixed, estimated coefficients of money and output are consistent with any traditional variant of monetary model of exchange rate determination. Eventually, we find that the exchange rate pass-through to inflation is high and rapid, and exchange rate has a significant positive effect of exchange rate on inflation. Estimates also reveal that money supply plays a significant role in shaping inflation while interest rate does not seem to have a meaningful impact on inflation. In addition, oil price also has significant impact on inflation. U.S interest rate shock plays an insignificant role in explaining the variability of domestic macro variables