Impact of Education and Network for Avian Influenza H5N1 in Human: Knowledge, Clinical Practice, and Motivation on Medical Providers in Vietnam

BACKGROUND: Knowledge, clinical practice, and professional motivation of medical providers relating to H5N1 infection have an important influence on care for H5N1 patients who require early diagnosis and early medical intervention. METHODS/PRINCIPAL FINDINGS: Novel educational programs including training and workshops for medical providers relating to H5N1 infection in Vietnam were originally created and implemented in 18 provincial hospitals in northern Vietnam between 2008 and 2010. A self-administered, structured questionnaire survey was conducted in 8 provincial hospitals where both educational training and workshops were previously provided. A total of 326 medical providers, including physicians, nurses, and laboratory technicians who attended or did not attend original programs were enrolled in the survey. Knowledge, clinical attitudes and practice (KAP), including motivation surrounding caring for H5N1 patients, were evaluated. The study indicated a high level of knowledge and motivation in all professional groups, with especially high levels in laboratory technicians. Conferences and educational programs were evaluated to be the main scientific information resources for physicians, along with information from colleagues. The chest radiographs and the initiation of antiviral treatment in the absence of RT-PCR result were identified as gaps in education. Factors possibly influencing professional motivation for caring for H5N1 patients included healthcare profession, the hospital where the respondents worked, age group, attendance at original educational programs and at educational programs which were conducted by international health-related organizations. CONCLUSIONS: Educational programs provide high knowledge and motivation for medical providers in Vietnam caring for H5N1 patients. Additional educational programs related to chest radiographs and an initiation of treatment in the absence of RT-PCR are needed. Networking is also necessary for sharing updated scientific information and practical experiences. These enhanced KAPs by educational programs and integrated systems among hospitals should result in appropriate care for H5N1 patients and may reduce morbidity and mortality

The association between high ambient temperature and risk of hospitalization: a time-series study in eight ecological regions in Vietnam

Viet Nam is among the countries most threatened by and vulnerable to climate change and extreme weather events. However, research on the temperature-morbidity relationship at the national scale has been scarce. This study aimed to assess the impact of high temperatures on the risk of hospital admissions for all causes and heat-sensitive diseases across eight ecological regions in Vietnam. The study utilized a longitudinal dataset that included hospitalization and meteorological data from eight provinces representing eight regions in Vietnam. A time series analysis was applied using the generalized linear and distributed lag models with a quasi-Poisson family to examine the temperature-hospitalization association in each province. A random-effects meta-analysis was used to calculate the pooled estimate of risk for the national scale. The country-level pooled effects (%, [95% CI]) indicated that a 1 °C increase above the threshold temperature (19 °C) increased the hospitalization risk for all causes and infectious diseases by 0.8% [0.4%–1.2%] and 2.4% [1.02%–1.03%], respectively at lag 0–3 d. The effects of heat on respiratory diseases and mental health disorders were not significant. At the regional level, the association varied across eight regions, of which the Northern parts tended to have a higher risk than the Southern. This is among very few national-scale studies assessing hospitalization risk associated with high temperatures across eight ecological regions of Vietnam. These findings would be useful for developing evidence-based heat-health action plans

A Multidisciplinary approach to treat massive recurrent hematochezia from a jejunal Dieulafoy lesion: A case report

Jejunal Dieulafoy lesion (DL) is an exceedingly rare, life-threatening cause of gastrointestinal bleeding. Due to its rarity, intermittent bleeding symptoms that often necessitate prompt clinical intervention, variability in detection and treatment methods, and the risk of rebleeding, this condition frequently presents a diagnostic and therapeutic conundrum. We report a case of severe, intermittent, recurrent hematochezia due to a jejunal DL that was difficult to localize. In this case, the metallic coils used as a radiopaque marker allowed surgeons to accurately identify the bleeding site during intraoperative enteroscopy and successfully manage the lesion with minimally invasive laparoscopic surgery

Impacts of Perinatal Dioxin Exposure on Motor Coordination and Higher Cognitive Development in Vietnamese Preschool Children: A Five-Year Follow-Up

<div><p>Dioxin concentrations remain elevated in the environment and in humans residing near former US Air Force bases in South Vietnam. Our previous epidemiological studies showed adverse effects of dioxin exposure on neurodevelopment for the first 3 years of life. Subsequently, we extended the follow-up period and investigated the influence of perinatal dioxin exposure on neurodevelopment, including motor coordination and higher cognitive ability, in preschool children. Presently, we investigated 176 children in a hot spot of dioxin contamination who were followed up from birth until 5 years old. Perinatal dioxin exposure levels were estimated by measuring dioxin levels in maternal breast milk. Dioxin toxicity was evaluated using two indices; toxic equivalent (TEQ)-polychlorinated dibenzo-p-dioxins/furans (PCDDs/Fs) and concentration of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD). Coordinated movements, including manual dexterity, aiming and catching, and balance, were assessed using the Movement Assessment Battery for Children, Second Edition (Movement ABC-2). Cognitive ability was assessed using the nonverbal index (NVI) of the Kaufman Assessment Battery for Children, Second Edition (KABC-II). In boys, total test and balance scores of Movement ABC-2 were significantly lower in the high TEQ- PCDDs/Fs group compared with the moderate and low exposure groups. NVI scores and the pattern reasoning subscale of the KABC-II indicating planning ability were also significantly lower in the high TCDD exposure group compared with the low exposure group of boys. However, in girls, no significant differences in Movement ABC-2 and KABC-II scores were found among the different TEQ-PCDDs/Fs and TCDD exposure groups. Furthermore, in high risk cases, five boys and one girl highly exposed to TEQ-PCDDs/Fs and TCDD had double the risk for difficulties in both neurodevelopmental skills. These results suggest differential impacts of TEQ-PCDDs/Fs and TCDD exposure on motor coordination and higher cognitive ability, respectively. Moreover, high TEQ-PCDDs/Fs exposure combined with high TCDD exposure may increase autistic traits combined with developmental coordination disorder.</p></div

Comparisons of adjusted KABC-II scores between high and low TCDD exposure groups in 5-year-olds.

<p>Comparisons of adjusted KABC-II scores between high and low TCDD exposure groups in 5-year-olds.</p

Comparisons of adjusted Movement ABC-2 scores among the three TEQ-PCDDs/Fs exposure groups.

<p>Comparisons of adjusted Movement ABC-2 scores among the three TEQ-PCDDs/Fs exposure groups.</p

Children at risk for having difficulties in motor coordination and/or cognitive ability.

<p>Children at risk for having difficulties in motor coordination and/or cognitive ability.</p

Respondents' background.

<p>*The original educational programs which were previously conducted by study investigators.</p>†<p>Educational programs which were conducted by government or health department of province.</p>‡<p>Educational programs which were conducted my international heal-related organization such as the World Health Organization and Center for Disease Control and Prevention.</p

Information resource relating to H5N1 infection on each professional.

<p>Information resource relating to H5N1 infection on each professional.</p

Professional motivation relating to care H5N1 patients.

<p>*Others includes pharmacists and hospital administrators.</p