Epidemiological transition to mortality and refracture following an initial fracture

This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4; 95% CI, 1.79–3.21), advancing age (HR 1.67; 1.53–1.83), and lower femoral neck BMD (HR 1.16; 1.01–1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions

A Risk Assessment Tool for Predicting Fragility Fractures and Mortality in the Elderly

Existing fracture risk assessment tools are not designed to predict fracture-associated consequences, possibly contributing to the current undermanagement of fragility fractures worldwide. We aimed to develop a risk assessment tool for predicting the conceptual risk of fragility fractures and its consequences. The study involved 8965 people aged >= 60 years from the Dubbo Osteoporosis Epidemiology Study and the Canadian Multicentre Osteoporosis Study. Incident fracture was identified from X-ray reports and questionnaires, and death was ascertained though contact with a family member or obituary review. We used a multistate model to quantify the effects of the predictors on the transition risks to an initial and subsequent incident fracture and mortality, accounting for their complex interrelationships, confounding effects, and death as a competing risk. There were 2364 initial fractures, 755 subsequent fractures, and 3300 deaths during a median follow-up of 13 years (interquartile range [IQR] 7-15). The prediction model included sex, age, bone mineral density, history of falls within 12 previous months, prior fracture after the age of 50 years, cardiovascular diseases, diabetes mellitus, chronic pulmonary diseases, hypertension, and cancer. The model accurately predicted fragility fractures up to 11 years of follow-up and post-fracture mortality up to 9 years, ranging from 7 years after hip fractures to 15 years after non-hip fractures. For example, a 70-year-old woman with aT-score of -1.5 and without other risk factors would have 10% chance of sustaining a fracture and an 8% risk of dying in 5 years. However, after an initial fracture, her risk of sustaining another fracture or dying doubles to 33%, ranging from 26% after a distal to 42% post hip fracture. A robust statistical technique was used to develop a prediction model for individualization of progression to fracture and its consequences, facilitating informed decision making about risk and thus treatment for individuals with different risk profiles. (c) 2020 American Society for Bone and Mineral Research

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

Extra classes and learning outcomes of eight-year-old children in Vietnam

Although primary school enrolment in Vietnam is high (91 per cent), most primary school students receive little more than half the annual teaching time defined by international norms. The Vietnamese school year is very short by international standards, covering only 33 weeks. In addition, only around 20 per cent of children in Vietnam receive a full-day of schooling, 5 or 6 hours according to international standards. Extra classes, outside of the normal school system, have proliferated in all regions of Vietnam. These classes fall into two categories. Legal classes, organised by schools themselves, include those provided for low-score performers or for outstandingly talented children. Illegal classes are taught by teachers who deliberately reduce the duration and content of their school-based classes to encourage students to take private tuition. The Vietnamese government is committed to providing full shifts of primary education by 2015 and has banned extra classes provided outside the normal school system. Nonetheless, the availability of and enrolment in illegal extra classes continue to increase. Young Lives research examined the extent and effects of extra classes for eight-year-old children in Vietnam. It tested for association between extra classes and numeracy, reading and writing skills. The paper presents statistical data on the amount of time and money spent on extra classes. The authors argue that such classes should be restricted because of the financial pressure that they place on poor households –without improving the attainment of children who take them

SỬ DỤNG PHƯƠNG PHÁP ĐO PHỔ THỰC NGHIỆM XÁC ĐỊNH SỰ PHÂN BỐ HÀM LƯỢNG VẬT CHẤT LƠ LỬNG TỪ ẢNH VỆ TINH LANDSAT 7 TẠI KHU VỰC VEN BIỂN THÀNH PHỐ HẢI PHÒNG

Hand-held spectrometer has been used in experimental research to build the deciphering keys of satellite images. However, it is difficult to measure the spectral reflectance in practice due to the continuous variation of solar radiation energy. This leads to the error in the analysis. This paper develops an experimental procedure to measure the spectral reflectance indoor to establish the correlation function between the spectral reflectance and the suspended matter concentration in seawater in Hai Phong coastal zone. This procedure eliminates the errors caused by the continuous variation of solar energy. The results reveal that the suspended matter concentration and the ratio NIR/GREEN have a direct proportion correlation with the following function: NTU = 3197 × (NIR/Green) – 511.37 with the correlation coefficient r = 0.979. The result from the Landsat 7 image taken on October 5, 2009, showed that the suspended matter content ranges from 244 NTU to 981 NTU, and spreads with decreasing concentration from the delta to the sea.Hiện nay, máy đo phổ cầm tay được sử dụng nhiều trong các nghiên cứu thực nghiệm để xây dựng các bộ mẫu chìa khóa giải đoán ảnh viễn thám. Tuy nhiên, đo phổ phản xạ trong thực tế gặp rất nhiều khó khăn. Một trong những khó khăn đó là sự thay đổi liên tục của năng lượng bức xạ mặt trời dẫn đến sai số trong các kết quả phân tích. Nghiên cứu này xác lập quy trình thực nghiệm đo phổ phản xạ trong phòng để tính toán hàm tương quan giữa giá trị phổ phản xạ và hàm lượng vật chất lơ lửng của nước biển ở khu vực ven biển thành phố Hải Phòng. Quy trình này loại bỏ được những sai số do sự thay đổi liên tục của năng lượng mặt trời. Kết quả nghiên cứu đã xác định được hàm lượng vật chất lơ lửng (NTU – Nephelometric Turbidity Unit) và tỉ số kênh NIR/Green (cận hồng ngoại/xanh lục) có tương quan tỉ lệ thuận với nhau theo hàm NTU = 3197 × (NIR/Green) – 511,37 với hệ tố tương quan r = 0,979. Áp dụng tính toán cho ảnh Landsat 7 chụp ngày 05/10/2009 thì hàm lượng vật chất lơ lửng của nước khu vực này có giá trị dao động từ 244 đến 981 NTU, phân bố giảm dần từ các của sông ra phía biển

Maternal social capital and child health in Vietnam.

In Vietnam there is growing concern about the potential social impact of rapid economic changes. The extent and type of social connectedness within communities, or social capital, may be changing. Studies from other developing countries have demonstrated that social capital is often independently associated with various indicators of well-being, including such aspects of human capital as health and education. Social capital can be thought of as the ‘value’ of social relationships, reflecting the quality and quantity of relationships in a given population, most commonly those within a community. Most research acknowledges that high levels of social capital can be associated with exclusion of outsiders, restrictions on individual freedoms and reinforcement of harmful norms. This paper offers the first quantitative examination of maternal social capital and its effects upon child health in Vietnam. It shows that high levels of maternal social capital may positively affect child health by enabling mothers to access more services and more assets, such as jobs, money, and goods. It may also improve maternal physical and/or mental health. While previous research in developed and developing countries has demonstrated positive associations between adult social capital and adult indicators of well-being, the association between maternal social capital and child health has not been previously examined

Young Lives Preliminary Country Report: Vietnam

This report presents a brief literature review of childhood poverty in Vietnam, reviews national policies affecting childhood poverty, identifies key audiences for the Young Lives study, describes research results and draws provisional conclusions from the first round of data collection from Young Lives in Vietnam. Vietnam is one of the few countries to have seen a significant drop in poverty over the past decade. According to the World Bank, the total poverty rate fell from 57 per cent in 1992-93 to 37 per cent in 1997-98. Despite this achievement, there is growing concern about inequality and the vulnerability of poor children. There are no official data on the numbers of children working, but various NGO reports have shown that many work in very hazardous and difficult conditions. Laws to protect children and prevent exploitation of their labour are poorly enforced. Vietnam has high rates of school enrolment, but disparities exist for children in poorer, rural regions. Other problems include low completion rates, low quality of teaching, and fewer years of schooling compared with regional competitors. While 95 per cent of children have been immunised, fewer children in poorer quintiles have been fully immunised. Infant mortality rates are improving, but the gap between poor and non-poor households has widened and is more severe in poorer provinces. Malnutrition has declined considerably, but is still very prevalent, with rates varying from 28 per cent in relatively prosperous south-eastern Vietnam to 58 per cent in the central highlands. Over the past two decades policymakers in Vietnam have focused on economic growth, poverty reduction, and industrialisation. Social sector reforms have been undertaken, and programmes such as the Hunger Eradication and Poverty Reduction Programme have targeted the most disadvantaged groups. Young Lives data contributes to the formulation of policy and programmes that are more favourable to poor children in Vietnam. From the preliminary findings detailed in this report, the authors make a number of provisional conclusions and outline their implications for policy relating to questions of rural poverty, health, child nutrition, gender inequality, education, income diversification, and access to basic services