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To examine the associations of excessive internet use with depression, anxiety, and sleep quality among high school students in northern Vietnam, a country experiencing rapid economic growth.A cross-sectional study was conducted in a high school in northern Vietnam from July to September 2019. Symptoms of depression and anxiety were respectively assessed using the Center for Epidemiological Studies Depression Scale and the Vietnamese Anxiety Scale. Sleep quality was measured using the Pittsburgh Sleep Quality Index. Internet use and demographic characteristics were obtained using structured questionnaires. A multiple logistic regression was performed.In total, 678 participants with an average age of 16.1 (standard deviation 0.9) years were included. Nearly one-third of the adolescents (30.7%) exhibited excessive internet use (4 h/day), 19.6% experienced depressive symptoms, 14.5% presented anxiety symptoms, and 58.8% reported poor sleep quality. Compared to non-excessive internet users, excessive internet users (4 h/day) experienced significantly higher levels of depressive symptoms (p = .001), anxiety (p = .008), and poorer sleep quality (p.001). Students who were female and with fair/poor self-rated health experienced higher depression, anxiety, and poor sleep quality (p.05). After adjusting for demographic and health-related factors, students with excessive internet use were 58% more likely to experience poor sleep quality (odds ratio, 1.58, 95% confidence interval [1.06, 2.35]).Excessive internet use in Vietnamese high school students was significantly associated with poor sleep quality, but not with depression or anxiety.

OBJECTIVE The reduction of goal-directed behavior, termed apathy, is a pervasive and debilitating syndrome after traumatic brain injury (TBI). However, understanding of apathy as a multifaceted construct is limited, especially in Southeast Asian nations. This study aimed to investigate the severity, insight, and psychosocial influences of apathy in executive, emotional, and initiation dimensions in Vietnam-a country with high prevalence of TBI. METHOD One hundred and eleven Vietnamese participants (61 individuals with moderate to severe TBI and 50 healthy controls) and their informants completed the self-rated and informant-rated Dimensional Apathy Scale (DAS) for the assessment of executive, emotional, and initiation apathy severity. Insight of apathy was calculated by subtracting DAS self-ratings from informant ratings. Additionally, carers completed measures assessing psychosocial factors of overall family health and overprotective behavior, while participants rated their own self-efficacy. RESULTS Our results showed greater informant-rated apathy for all three dimensions in individuals with TBI relative to controls. However, while people with TBI had greater self-rated initiation apathy, they regarded their executive apathy as lower and their emotional apathy as similar compared with controls. Reduced insight in patients was seen for executive and initiation apathy. Across participants, executive apathy was predicted by family functioning and overprotectiveness, emotional apathy was predicted by family functioning, and initiation apathy was predicted by self-efficacy. CONCLUSIONS These findings support the multidimensional characterizations and socio-cultural considerations of apathy after TBI, which will potentially develop both individual-specific and symptom-specific approaches in clinical practice. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objectives: Tuberculosis (TB) stigma contributes to diagnostic delay, disease concealment, and reduced wellbeing for affected individuals. Despite the availability of several TB stigma scales, most high-TB burden countries do not have a culturally validated version available. This study evaluated the Van Rie TB stigma scale (VTSS) among people with TB in Vietnam. Methods: This study consisted of two phases. In phase 1, the VTSS was culturally and linguistically adapted to the Vietnamese context. In phase 2, people with TB were invited to complete a survey containing the VTSS, a depression scale, and a quality of life scale. The data analysis included confirmatory factor analysis (CFA), exploratory factor analysis (EFA), construct validity, and floor or ceiling effects. Results: In phase 1, items were reworded from the third person to the first person. The TB/HIV co-infection items (items 7 and 11) were the least relevant for people with TB (62% and 73% relevance, respectively). In phase 2, the CFA demonstrated adequate goodness-of-fit indices (GFI = 0.88, CFI = 0.96, RMSEA = 0.058); however several of the item factor loadings were low. The EFA demonstrated good internal consistency (α = 0.85) and revealed one dominant factor. Construct validity was low. Conclusions: The VTSS demonstrated good psychometric properties in Vietnam. Depending on the purpose of the scale, the HIV co-infection items and item 10 could be considered for removal.

Purpose: This study aimed to evaluate the effects of maternal nutritional supplementation (MNS) in conjunction with a breastfeeding support program on birth outcomes and breastfeeding performance. Methods: A total of 228 singleton Vietnamese mothers aged 20–35 years at 26–29 weeks of gestation with pre-pregnancy body mass index (BMI) < 25.0 kg/m2 were randomized to the intervention (n = 114), receiving MNS (252 kcal/day) daily up to 12 weeks postpartum and four breastfeeding education and support sessions or to the control (n = 114), receiving standards of care. Results: The intervention was 2.09 times more likely to exclusively breastfeed over the 12 weeks than the control (95%CI: 1.05–4.13, p = .0358), after controlling for potential confounders. Infant’s breast milk intake was significantly higher in the intervention than the control among mothers with baseline mid-upper arm circumference (MUAC) < 50th (p = .0251). Infants in the intervention had significantly higher birth weight (p = .0312), birth weight-for-age (p = .0141) and birth head circumference-for-age (p = .0487), and higher head circumference-for-age z-score (p = .0183) development over the postnatal period, compared with the control. Conclusions: Use of MNS and breastfeeding support improve birth outcomes and exclusive breastfeeding (EBF) rate in Vietnamese mothers. Additionally, it promotes breast milk production among mothers with lower baseline MUAC.

Human papillomavirus (HPV) infection in men is a serious issue because it is associated with genital warts, anogenital cancers, and HPV transmission to their sex partners. This study aimed to investigate the prevalence and genotypes of HPVs in Vietnamese male patients hospitalized with sexually transmitted infection (STI) symptoms between 2016 and 2020 by using PCR and reverse dot blot hybridization analysis. HPV DNA was detected in 191/941 (20.3%) penile cell samples. The HPV patient's mean age was 30.3 in the range of 16- and 69-year-old. The highest HPV prevalence (84.7%) was found in patients between 20- and 39-year-old. A total of 313 HPV genotypes were identified. Multiple-infection rate was 42.9%. The most common high-risk (HR)-HPV genotypes were HPV-16 (8.0%), HPV-51 (7.7%), HPV-52 (4.8%), HPV-56 (4.2%), and HPV-18 (3.8%). Furthermore, HPV-11 and HPV-6 genotypes were the two most common low-risk (LR)-HPV genotypes with the rate of 36.7% and 21.4%, respectively. Notably, HPV-52 was found circulating in Vietnam for the first time. In conclusion, this study results showed that HPV prevalence in Vietnamese male patients was common and diverse. In addition, regarding public health and cancer prevention, the inclusion of the HPV vaccination into the national vaccination program for both men and women is recommended. This article is protected by copyright. All rights reserved.

Background HIV and other sexually transmitted infections (STIs) have disproportionately affected communities of men who have sex with men (MSM). We describe HIV and STI prevalence and testing patterns among urban Vietnamese MSM. Methods We conducted a cross-sectional community-based study of MSM in Hanoi, Vietnam in 2016. Participants self-reported experiences of social stigma in healthcare settings and previous HIV and STI testing. STI testing included HIV, herpes simplex virus-2 (HSV-2), syphilis, gonorrhea, and chlamydia. Results 205 MSM participated in the study. STI prevalence was HIV (10%), HSV-2 (4%), syphilis (13%), gonorrhea (34%), and chlamydia (19%). More than half (55%) of participants tested positive for at least one STI. Most participants had been previously tested for HIV or another STI (72%), with 24% previously receiving a positive result. Perceived and enacted social stigma in healthcare contexts was negatively associated with previous HIV or STI testing (adjusted prevalence odds ratio (aPOR): 0.22; 95% confidence interval (CI): 0.10–0.48). Discussion High prevalence of STIs was observed among Vietnamese MSM, and perceived and enacted stigma was related to HIV and STI testing. Our findings reaffirm the importance of regular STI screening among this population as well as additional outreach to promote safe HIV and STI healthcare engagement.

Asian Americans are the fastest growing and fastest aging U.S. population, and occupy both extremes of socioeconomic and health indices. Using the 2016 NYCgov dataset, multilevel logistic regression analyses were conducted to examine the relationship of poverty, acculturation and neighborhood-level variables with disability for different ethnic groups of Asian older adults (Chinese, South Asian, Filipino, Japanese, Korean and Vietnamese) in New York City. Findings indicated that South Asian older adults had higher odds for disability compared to other ethnic groups. Living in a neighborhood with higher percentages of persons of the same ethnicity was protective for Chinese older adults only. There is an important opportunity for interprofessional collaborations through education, awareness, screening and intervening to enhance systems of care for Asian older adults. Social workers can play a pivotal role in providing key linkages to form interprofessional solutions and shared efforts to address the needs of this understudied and under-resourced population. Future research is needed to better understand how ethnic enclaves are defined, and how they can benefit different ethnic groups of vulnerable Asian older adults.

Rationale: The Southeast Asian tuberculosis burden is high, and it remains unclear if urban indoor air pollution in this setting is exacerbating the epidemic. Objectives: To determine the associations of latent tuberculosis with common urban indoor air pollution sources (secondhand smoke, indoor motorcycle emissions, and cooking) in Southeast Asia. Methods: We enrolled child household contacts of patients with microbiologically confirmed active tuberculosis in Vietnam, from July 2017 to December 2019. We tested children for latent tuberculosis and evaluated air pollution exposures with questionnaires and personal aerosol sampling. We tested hypotheses using generalized estimating equations. Measurements and Main Results: We enrolled 72 patients with tuberculosis (27% with cavitary disease) and 109 of their child household contacts. Latent tuberculosis was diagnosed in 58 (53%) household contacts at baseline visit. Children experienced a 2.56-fold increased odds of latent tuberculosis for each additional household member who smoked (95% confidence interval, 1.27-5.16). Odds were highest among children exposed to indoor smokers and children

This study investigated the overall survival (OS) at 1-year, 3-years, and 5-years after colorectal cancer (CRC) diagnosis and examined the prognostic factors of mortality among patients with CRC in Vietnam's central region.This ambidirectional cohort study included patients newly diagnosed with CRC at a tertiary hospital in Vietnam's central region between 2013 and 2019. Survival duration was calculated from the surgery date or the first day of CRC-specific treatment until the date of death or the study's end date, July 31, 2020. Kaplan-Meier methods and log-rank test were used to estimate and compare the OS between the subgroups, respectively. The Cox proportional-hazards (PH) regression analysis was applied to estimate the magnitude of the effects between prognostic factors and outcome.The median follow-up was 24 months (interquartile range: 13-43 months). The OS rate dropped significantly to 84.7%, 56.19%, and 45.01% at 1-year, 3-years, and 5-years after diagnosis, respectively. The median OS was 48.59 months (39.34 -57.93 months) for the rectum and colon cases. In the multivariate analysis, a higher mortality risk was observed in patients with an advanced-stage CRC (HRadj, 3.04; 95% confidence interval [CI], 1.79-5.18), who were underweight (18.5 kg/m2; HRadj, 1.65; 95%CI, 1.03-2.65), and had elevated preoperative carcinoembryonic antigen (CEA) level (5.0 ng/mL; HRadj, 1.63; 95%CI, 1.03-2.59). Additionally, younger patients (50 years) had a poorer OS than the middle-aged group (60-69 years).Our findings indicate that50% of Vietnamese patients with CRC survive until 5-years after diagnosis. Several individual factors that contribute to the poor OS of patients with CRC, including young age, underweight, and elevated preoperative CEA level, should be evaluated and managed. Early diagnoses through active routine examination of or screening programs for high-risk groups should be prioritized.

Background Delays in diagnosis and treatment from first noticeable breast cancer symptoms are associated with poor outcomes. Understanding the reasons and barriers for patients’ delay in seeking medical care is critical to mitigating the problem. Methods In‐person surveys were conducted among 462 women, aged 18–79, with incident breast cancer cases, recruited from two cancer hospitals in North Vietnam. Delay, defined as the time interval between symptom recognition to the diagnosis and initiation of treatment equal to or exceeding 3 months, was categorized as follows: no delay (, A case cohort study found that delay in diagnosis and treatment of breast cancer is common among Vietnamese women and is affected by financial and physical barriers, psychological barriers, and lack of proper knowledge. Proper policy needs to be developed accordingly to address this public health issue.

Highlights • HPV infection in men having sex with men (MSM) was studied in two cities of Vietnam • Prevalence of any HPV and HPV16/18 among MSM was 32.3% and 11.0%, respectively • High-risk HPV infections in MSM were associated with risky sexual behaviours • A targeted HPV vaccination strategy would be beneficial for MSM in Vietnam, Objectives Men who have sex with men (MSM) are at risk of human papillomavirus (HPV)-related cancers, while published data are scarce. This study determined HPV prevalence and risk factors in MSM in Vietnam to inform HPV prevention strategies in this key population. Methods A cross-sectional study of 799 MSM aged 16-50 years was conducted in Vietnam in 2017-2018. Information was collected on risk behaviours, and knowledge of HPV and anal cancer; rectal swabs were taken to detect anal HPV infection. An in-house polymerase chain reaction and Genoflow HPV array test kit were used for HPV detection and genotyping. Results The median age of the study participants was 25 years (range 18-52). Overall prevalence of any HPV and HPV16/18 infection was 32.3% and 11.0%, respectively. A higher prevalence of high-risk HPV infection to all 14 types tested was found in Ho Chi Minh City (30.9%) than in Hanoi (18.4%). High-risk HPV infection was associated with inconsistent condom use and history of engaging in sex under the influence of drugs (adjusted odds ratio (aOR), 2.27; 95% CI, 1.48-10.67), as well as having multiple sexual partners (aOR, 1.01; 95% CI, 1.00–1.02). Conclusions High-risk anal HPV infections in Vietnamese MSM were significantly associated with risky sexual behaviours. A targeted HPV vaccination strategy would have substantial benefit for MSM in Vietnam.

U.S. Vietnamese have high cervical cancer incidence and low human papillomavirus (HPV) vaccine initiation. Using the P3 model, we explored practice-, provider-, and patient-level determinants of U.S. Vietnamese parents’ HPV vaccine decision-making for their adolescents. We conducted a cross-sectional, online survey (04/2020–12/2020) with U.S. Vietnamese parents who had ≥ 1 adolescent ages 9–18. We assessed HPV vaccination outcomes (initiation, willingness to initiate, completion) and provider recommendation. Modified Poisson regressions were used to identify practice-, provider- and patient-level correlates of outcomes. The sample (n = 408) was 44 years old on average; 83% were female and 85% had a Bachelor’s degree. Around half of adolescents were female (51%) and 13–18 year old (54%). Only 41 and 23% of parents had initiated and completed the HPV vaccine series for their child, respectively. Initiation was associated with receiving provider recommendation (either low- or high-quality), while willingness to initiate was associated with receiving high-quality recommendation. Both initiation and willingness to initiate was negatively associated with parental perception that their child was too young for a “sexually transmitted infection (STI)-preventing vaccine.” Provider recommendation was associated with higher parental U.S. acculturation and the child being older and female. Provider-facing interventions should promote high-quality, age-based, gender-neutral HPV vaccine recommendation. These and population- and individual-facing interventions should recognize the need for additional parental education, particularly related to misconceptions regarding STI prevention. Supplementary Information The online version contains supplementary material available at 10.1007/s10865-021-00265-3.

Background and aims Vietnam implemented numerous measures to reduce the transmission of COVID-19 among school students, including study-at-home/self-quarantine. During the study-at-home period, adolescents may engage in more video gaming than usual, potentially contributing to gaming disorder. However, the regionally-representative prevalence of gaming disorder and its association with parenting practice and discipline practice have not been described. We assessed the prevalence of gaming disorder among Vietnamese adolescents during the initial 6 months of the COVID-19 pandemic and the associations between gaming disorder and parenting practice and discipline practice. Methods We conducted a school-based, self-administered cross-sectional survey of 2,084 students in Hanoi, Vietnam (response rate = 97.1%). The survey included standardized instruments translated from English to Vietnamese. We performed multilevel logistic regressions to assess the associations between parenting practice, discipline practice, and gaming disorder. Results The prevalence of gaming disorder among the respondents was 11.6%. Healthy parent-child relationship was protective against gaming disorder (Adj OR = 0.36; 95% CI = 0.21, 0.62). Non-supervision, non-discipline, violent discipline were positively associated with gaming disorder. Discussion and Conclusions We found associations between gaming disorder and parent-child relationship, parental supervision, and parental discipline. Future interventional studies should consider assessing the effect of fostering healthy parent-child relationships and appropriate discipline on the occurrence or prognosis of gaming disorders.

Background COVID-19 vaccines have been speedily developed and deployed. The more vaccine doses are delivered to users, the more common adverse events following immunization (AEFI) are reported. This study aimed to identify factors affecting AEFI in Vietnamese people receiving the COVID-19 vaccine AZD1222 developed by AstraZeneca and Oxford University. Methods In July 2021, an online cross-sectional survey was conducted among Vietnamese who have been vaccinated with COVID-19 vaccines. The questionnaire collected demographic characteristics, medical history, types of injected vaccines, common AEFI, and post-vaccination activities from respondents. The effects of host-related factors on AEFI including 24 specific symptoms were also explored. Results After screening, 1028 participants who were Vietnamese, over 18 years old and received at least one dose of AZD1222, were included in the study. Only 40/1028 (3.9%) participants reported not having any AEFI, whereas 25/1028 (2.4%) reported to have severe symptoms. The most common AEFI were moderate fever (69.4%), muscle aches (68.6%), followed by fatigue/ sleepiness (62.5%), body aches (59.4%), headache (58.5%), pain at injection site (58.3%) and chills (45.7%). Data analysis showed that females complained about AEFI particularly gastrointestinal symptoms more frequently than males. Age of participants and number of doses were also important factors affecting AEFI as the increase of age or number of vaccine doses was associated with the decrease of self-reported AEFI frequency. Conclusions This study provides a detailed assessment of risk factors associated with AEFI in Vietnamese people vaccinated with AZD1222. It seems that gender, age and vaccine doses are important factors affecting AEFI.

BackgroundSchool violence and injury are major public health problems worldwide; however, current information on these issues in Vietnam is lacking. We aim to investigate the prevalence of violence and non-fatal injury and associated factors among Vietnamese adolescents aged 13-17 years old.MethodsWe used data from the 2019 Vietnam Global School-based Student Health Survey (GSHS), which is a nationally representative survey developed by the World Health Organization to monitor behavioral risk factors among school-aged students. The Vietnam GSHS 2019 was conducted in 20 provinces and cities, with a sample size of 7,690 male and female students aged 13-17 years old.ResultsWe found the prevalence of violence and non-fatal injury was 14.5% and 21.4%, respectively. Common risk factors for both violence and non-fatal injuries included cigarette smoking, alcohol use, mental health problems, and living with neither parent; violence was also a risk factor for non-fatal injuries. Student older age was associated with lower odds of school violence. Parents played an important role in preventing violence among female students and non-fatal injuries in both genders.ConclusionsFuture policies should consider individual factors as well as adolescent-parent bonding, to mitigate the burden of violence and injury among in-school adolescents in Vietnam.

Introduction: Emergency departments (EDs) at public hospitals in Vietnam typically face problems with overcrowding, as well as being populated by a wide variety of illnesses, resulting in increasing dissatisfaction from patients. To alleviate these problems, we used the increasingly popular value-stream mapping (VSM) and lean strategy approaches to (1) evaluate the current patient flow in EDs; (2) identify and eliminate the non-valued-added components; and (3) modify the existing process in order to improve waiting times. Methods: Data from a total of 742 patients who presented at the ED of 108 Military Central Hospital in Hanoi, Vietnam, were collected. A VSM was developed where improvement possibilities were identified and attempts to eliminate non-value-added activities were made. A range of issues that were considered as a resource waste were highlighted, which led to a re-design process focusing on prioritizing blood tests and ultrasound procedures. On the administrative side, various measures were considered, including streamlining communication with medical departments, using QR codes for healthcare insurance payments, and efficient management of X-ray and CT scan online results. Results: By implementing a lean approach, the following reductions in delay and waiting time were incurred: (1) pre-operative test results (for patients requiring medical procedures/operations) by 33.3% (from 134.4 to 89.4 min); (2) vascular interventions by 10.4% (from 54.6 to 48.9 min); and (3) admission to other hospital departments by 49.5% (from 118.3 to 59.8 min). Additionally, prior to the implementation of the lean strategy approach, only 22.9% of patients or their proxies (family members or friends), who responded to the survey expressed satisfaction with the ED services. This percentage increased to 76.5% following the curtailment of non-value-added activities. Through statistical inferential test analyses, it can be confidently concluded that applying lean strategy and tools can improve patient flow in public/ general hospital EDs and achieve better staff coordination within the various clinical and administrative hospital departments. To the authors' knowledge, such analysis in a Vietnamese hospital's ED context has not been previously undertaken.

Native Hawaiian and Pacific Islander populations have been disproportionately affected by COVID-19 (1-3). Native Hawaiian, Pacific Islander, and Asian populations vary in language; cultural practices; and social, economic, and environmental experiences,† which can affect health outcomes (4).§ However, data from these populations are often aggregated in analyses. Although data aggregation is often used as an approach to increase sample size and statistical power when analyzing data from smaller population groups, it can limit the understanding of disparities among diverse Native Hawaiian, Pacific Islander, and Asian subpopulations¶ (4-7). To assess disparities in COVID-19 outcomes among Native Hawaiian, Pacific Islander, and Asian populations, a disaggregated, descriptive analysis, informed by recommendations from these communities,** was performed using race data from 21,005 COVID-19 cases and 449 COVID-19-associated deaths reported to the Hawaii State Department of Health (HDOH) during March 1, 2020-February 28, 2021.†† In Hawaii, COVID-19 incidence and mortality rates per 100,000 population were 1,477 and 32, respectively during this period. In analyses with race categories that were not mutually exclusive, including persons of one race alone or in combination with one or more races, Pacific Islander persons, who account for 5% of Hawaii's population, represented 22% of COVID-19 cases and deaths (COVID-19 incidence of 7,070 and mortality rate of 150). Native Hawaiian persons experienced an incidence of 1,181 and a mortality rate of 15. Among subcategories of Asian populations, the highest incidences were experienced by Filipino persons (1,247) and Vietnamese persons (1,200). Disaggregating Native Hawaiian, Pacific Islander, and Asian race data can aid in identifying racial disparities among specific subpopulations and highlights the importance of partnering with communities to develop culturally responsive outreach teams§§ and tailored public health interventions and vaccination campaigns to more effectively address health disparities.

Background Evidence regarding the outcomes of percutaneous coronary intervention (PCI) in low-and-middle incomes countries remains limited. Objectives To report the outcomes post PCI at discharge, 30 days and 12 months in Vietnam and identify the key factors associated with adverse outcomes at 12 months. Methods We used data from a single centre prospective cohort in Vietnam. Data regarding demographics, clinical presentation, procedural information, and outcomes of patients were collected and analysed. Primary outcomes were mortality and major adverse cardiac and cerebrovascular events. Results In total, 926 patients were included. Poor outcomes were relatively low in those undergoing PCI. Predictors of mortality and major adverse cardiac and cerebrovascular events at 12 months post-PCI included being older than 75, being male, having acute myocardial infarction, left ventricular ejection fraction ≤ 40%, prior cerebral vascular disease and having an unsuccessful PCI. Conclusions Adverse outcomes of patients undergoing PCI in Vietnam are relatively low in comparison with those reported in other countries across the Asia Pacific region. Identification of factors associated with poor outcomes is beneficial for improving the quality of cardiac care and developing the prediction model of outcomes post-PCI in Vietnam.

Cancer carries stigma, taboos, and shame including, for diverse communities, who can have difficulty understanding and communicating about family health history genetic cancer screening (GCS). The Oregon Health Authority ScreenWise Program reached out to our academic-community research team to explore Asians and Micronesian Islanders (MI) perceptions on public health education outreach on GCS due to having previously only worked with the Latinx community. The purpose of the qualitative description pilot study was to elicit perceptions, beliefs, experiences, and recommendations from Asian and MI community leaders and community members regarding family health history GCS outreach in communities. Twenty Asians (Chinese and Vietnamese) and Micronesian Islanders (Chuukese and Marshallese) were recruited from the US Pacific Northwest. Nineteen participants are immigrants with an average 21.4 and 18.5 years having lived in the USA, respectively. Individual in-depth interviews were conducted using a semi-structured, open-ended interview guide and analyzed using conventional content analysis. Three main transcultural themes were identified: (1) degree of knowing and understanding cancer screening versus family health history GCS, (2) needing culturally relevant outreach messaging on family health history GCS, and (3) communication and decision-making regarding discussing with family and health care providers about cancer screening and GCS. Culturally relevant messaging rather than generic messaging is needed for inclusive outreach. Healthcare providers are encouraged to assess a client's family health history routinely because Asian and MI clients may not understand the information requested, may be hesitant to offer, or unable to provide information about their personal or family history of cancer.

The aim of this study was to examine how perceived racial discrimination is associated with mental distress among diverse Asian Americans and to explore the potential moderators in the relationship. Based on the 2015 Asian American Quality of Life (AAQoL) survey (n = 2609), direct influences were tested of the contextual (demographic, health-related, and immigration-related) variables and perceived racial discrimination on mental distress, as well as their interactions. About 30% of the sample reported perceived racial discrimination, and 44% fell into the category of having mental distress. Perceived racial discrimination was associated with 1.90 times higher odds of mental distress and had significant interactions with age, education, and ethnicity. The association of mental distress with perceived racial discrimination was higher among those who were 60 or older, less educated, and Vietnamese than among their respective counterparts. Findings can guide strategic and targeted interventions for high-risk groups.

Although Medicare is a vital source of health insurance coverage for older Americans, little is known about Medicare enrollment among older Asians. This study aimed to examine heterogeneity in Medicare enrollment across the six largest subgroups of Asian Americans (Chinese, Japanese, Filipino, Indian, Korean, and Vietnamese), in relation to their citizenship status and labor force participation. Data from the American Community Survey Public Use Microdata Sample (2014–2018) were analyzed for older foreign-born Asians aged 65 or older (N = 83,378). A two-level multilevel logistic regression model (states > individuals) was used to model the probabilities of Medicare enrollment, accounting for state-level residential clustering by Asian subgroup and, thus, for nonindependence among respondents from the same state. The results indicated a substantial amount of heterogeneity in Medicare enrollment across the six Asian subgroups. Although the overall Medicare enrollment rate was low (90.2%), the rates varied from 85.5% among Indians to 93.8% among Koreans and Japanese. Naturalized citizens and those not in the labor force were associated with greater probabilities of Medicare enrollment. However, the relative differences in the Medicare enrollment rates across the six Asian subgroups were different by individuals’ naturalization status and labor force participation (i.e., significant three-way interactions). These results highlight that aggregated data cannot accurately represent Medicare and health insurance status of older Asians with different sub-ethnic backgrounds. Intragroup and intergroup differences in Medicare enrollment among foreign-born older Asians should be considered for targeted policy approaches for this group of older adults.

Informed by values of autonomy and self-determination, advance care planning assumes that individuals should independently take control of their future health. In this article, we draw on research conducted with Vietnamese health and community workers to problematize individualized approaches to planning ahead, reframe notions of “cultural and linguistic barriers,” and expose how homogeneous messages about care at the end of life are not readily translatable within and across diverse groups. Anthropological and feminist critiques of inclusion and exclusion are used to reorientate Anglophone framings of the individual and of cultural and linguistic differences. In this article, we suggest that it is the narrow singularity of care for the self—rather than diverse relationalities of care—that should be overcome if aging and end-of-life care policy and practice is to be broadened and made relevant to migrant and non-English-speaking groups. Refereed/Peer-reviewed

Objective:Effective handwashing practices help prevent the spread of coronavirus disease 2019 (COVID-19). This study examined the knowledge, frequency, and characteristics of handwashing practices among Vietnamese university students.Methods:An analytic cross-sectional study was conducted on all students enrolling at Phenikaa University in Vietnam. A self-developed questionnaire was used to collect information on the participants’ knowledge regarding the effectiveness of handwashing as a COVID-19 preventive measure, the moments for hand hygiene, the most appropriate practices in different situations, and frequency.Results:Among 728 study participants, 460 (63.2%) were from health-related faculties. Almost (97.9%; 713/728) all participants knew that handwashing could protect against the spread of infection, but less than half performed handwashing often in a normal day (47.4%; 345/728), after sneezing or coughing (48.9%; 356/728), and 7.4% (54/728) only washed hands when hands are visibly dirty. Health students used alcohol-based handrub in all situations, including those requiring handwashing with water and soap (P < 0.05).Conclusions:The levels of knowledge regarding the effectiveness of handwashing among study participants are high, but actual practices of handwashing are suboptimal. It is crucial to improve community education to help reinforce correct hand hygiene behaviors, including when to wash hands and which method should be used.

Summary Background Vietnam has emerged as one of the world's leading success stories in responding to COVID-19. After a prolonged period of little to no transmission, there was an outbreak of unknown source in July, 2020, in the Da Nang region, but the outbreak was quickly suppressed. We aimed to use epidemiological, behavioural, demographic, and policy data from the COVID-19 outbreak in Da Nang to calibrate an agent-based model of COVID-19 transmission for Vietnam, and to estimate the risk of future outbreaks associated with reopening of international borders in the country. Methods For this modelling study, we used comprehensive data from June 15 to Oct 15, 2020, on testing, COVID-19 cases, and quarantine breaches within an agent-based model of SARS-CoV-2 transmission to model a COVID-19 outbreak in Da Nang in July, 2020. We applied this model to quantify the risk of future outbreaks in Vietnam in the 3 months after the reopening of international borders, under different behavioural scenarios, policy responses (ie, closure of workplaces and schools), and ongoing testing. Findings We estimated that the outbreak in Da Nang between July and August, 2020, resulted in substantial community transmission, and that higher levels of symptomatic testing could have mitigated this transmission. We estimated that the outbreak peaked on Aug 2, 2020, with an estimated 1060 active infections (95% projection interval 890–1280). If the population of Vietnam remains highly compliant with mask-wearing policies, our projections indicate that the epidemic would remain under control even if a small but steady flow of imported infections escaped quarantine into the community. However, if complacency increases and testing rates are relatively low (10% of symptomatic individuals are tested), the epidemic could rebound again, resulting in an estimated 2100 infections (95% projected interval 1050–3610) in 3 months. These outcomes could be mitigated if the behaviour of the general population responds dynamically to increases in locally acquired cases that exceed specific thresholds, but only if testing of symptomatic individuals is also increased. Interpretation The successful response to COVID-19 in Vietnam could be improved even further with higher levels of symptomatic testing. If the previous approaches are used in response to new COVID-19 outbreaks, epidemic control is possible even in the presence of low levels of imported cases. Funding Ministry of Science and Technology (Vietnam). Translation For the Vietnamese translation of the abstract see Supplementary Materials section.

Background This study investigates the socio-demographic factors associated with smoking status in five Southeast Asian countries: Malaysia, Thailand, Indonesia, Vietnam, and Philippines. Methods This cross-sectional study utilizes data of adults ≥15 years who completed the Global Adult Tobacco Surveys. Ordered probit analysis is used to account for the smoking statuses of non-smokers, occasional smokers, and daily smokers. Results Malaysian and Vietnamese households with more family members face lower smoking likelihoods than otherwise. Urbanites in Philippines and rural residents in Thailand and Indonesia are more likely to smoke on occasional and daily basis than others. Males are consistently more likely to smoke occasionally or daily and less likely to be non-smokers than females across all countries. Younger middle-age (retiree) individuals aged 30-35 (≥60) years in Malaysia and Thailand exhibit higher (lower) likelihoods to smoke occasionally or daily than their younger cohorts aged 15-29 years. Individuals aged 30 years and above in Indonesia, Vietnam, and Philippines display higher daily smoking propensities than others. Higher education levels dampens smoking likelihoods and increases non-smoking propensities in all countries. Non-government or self-employed workers in all countries are more likely to smoke occasionally or daily than unemployed persons. Being married is associated with higher non-smoking likelihoods in Thailand although this association is not evident in Malaysia. Conclusion These findings suggest that a portfolio of targeted interventions is necessary to meet the needs of specific subpopulations within the various countries. .

Background: Many instruments measure critical thinking ability in nursing education. The Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice) is a new tool to measure the level of critical thinking ability of nurses in a clinical setting. However, no study has evaluated the psychometric properties of the N-CT-4 Practice in Vietnam. Therefore, this study translated and evaluated the validity and reliability of the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice (V-v)).Results: The N-CT-4 Practice (V-v) questionnaire retained the meaning of the original English version and was clear, explicit and easy for nurses to understand. The item content validity index of the N-CT-4 Practice (V-v) was 1.0. The Cronbach’s alpha for the overall scales was .98. The intraclass correlation coefficient was .81. Confirmatory factor analysis indicated that this Vietnamese version fit the proposed model.Conclusions: The findings suggested that the N-CT-4 Practice (V-v) has acceptable reliability and validity for Vietnamese nurses in a clinical setting. Nurse managers and educators can use the N-CT-4 Practice (V-v) to measure the level of critical thinking ability of Vietnamese clinical nurses and make international comparisons possible.

Background and aims ROTAVIN-M1® (licensed, frozen vaccine) and ROTAVIN (second-generation, liquid candidate vaccine) are two rotavirus vaccine formulations developed from a live attenuated G1P8 (KH0118) strain by Center for Research and Production of Vaccines and Biologicals (POLYVAC), Vietnam. This study compared the safety and immunogenicity of these two formulations. Methods A Phase 3, randomized, partially double-blinded, active-controlled study was conducted in healthy infants aged 60–91 days in Vietnam. Infants received two doses of ROTAVIN or ROTAVIN-M1 in a ratio of 2:1 with an interval of 8 weeks. Solicited reactions were collected for 7 days after each vaccination. Blood samples were collected pre-vaccination and 4 weeks after the second vaccination in a subset of infants. Non-inferiority criteria required that the lower bound of 95% confidence intervals (CIs) of the post-vaccination anti-rotavirus IgA GMC (Geometric Mean Concentration) ratio of ROTAVIN/ROTAVIN-M1 should be >0.5. A co-primary objective was to compare the safety of the two vaccines in terms of solicited reactions. Results A total of 825 infants were enrolled. The post-vaccination GMC was 48.25 (95% CI: 40.59, 57.37) in the ROTAVIN group and 35.04 (95% CI: 27.34, 44.91) in the ROTAVIN-M1 group with an IgA GMC ratio of 1.38 (95% CI: 1.02, 1.86) thus meeting the pre-set criteria for non-inferiority. A total of 605 solicited reactions were reported in 297 (36.0%) participants with 35.4% in the ROTAVIN group and 37.2% in the ROTAVIN-M1 group. There were no cases of intussusception or death reported in the study. Conclusions Based on the data generated, it can be concluded that ROTAVIN is immunologically non-inferior and has similar safety profile to ROTAVIN-M1 when administered to infants in a two-dose schedule. Therefore, it can be considered as a more suitable option for programmatic use to prevent rotavirus diarrhoea in Vietnam and the Mekong region. Trial registration number ClinicalTrials.gov identifier: NCT03703336, October 11, 2018.

Purpose We examined the associations between major and everyday discrimination and self-rated health among a national sample of ten Asian ethnic subgroups, including Vietnamese, Chinese, Hmong, Cambodians, Pakistanis, Indians, Bangladeshis, Japanese, Filipinos, and Koreans. Methods We used data from the 2016 National Asian American Survey (n = 4427). Logistic regression analyses were conducted to explore the associations between major and everyday discrimination and self-rated health among ten Asian ethnic subgroups, controlling for relevant sociodemographic factors. Results Findings showed that major discrimination was associated with higher odds of poorer self-rated health among Asians as a group. Subgroup analyses revealed that encounters with major discrimination were associated with poorer self-rated health among Vietnamese, Filipinos, Cambodians, and Hmong. Everyday discrimination was associated with poorer self-rated health only among Hmong. Conclusion Overall, the negative health consequences of everyday and major discrimination vary by Asian ethnic subgroup. Targeting certain forms of discrimination facing specific Asian ethnic groups is needed to reduce their risk of adverse health outcomes.

In 2019, a questionnaire was conducted among foreigners living in the Czech Republic focused on gambling, in which 110 respondents from Vietnam and 80 respondents from Ukraine answered. Firstly, the Attitudes towards gambling scale (ATGS-8) was used to discover respondents' attitudes to gambling. Secondly, their experience with gambling was examined with the help of the Problem Gambling Severity Index (PGSI) which allowed, among others, to estimate the level of prevalence of problem gambling in these groups. The methods used allowed us to compare both the Ukrainians to Vietnamese as well as Ukrainians and Vietnamese to Czechs, as similar survey was conducted among the major population of the country in 2017. The overall score of attitudes to gambling is slightly higher for the citizens of Ukraine (17.97) and Vietnam (18.29) compared to the majority. The Vietnamese living in the Czech Republic also have a significantly higher proportion of people in the category of pathological gamblers as based on the PGSI index (Vietnamese 4.2%), whilst the value of this index for Ukrainians (0.7%) is similar to the one of the majority. The analysis of immigrants' gambling behaviour shows that Ukrainians are more like the majority population. The Vietnamese immigrants differ from both the majority population and Ukrainians in terms of attitudes whilst gambling is for them as common problem as alcohol consumption, and an even bigger problem than smoking.

The PLATelet inhibition and patient Outcomes (PLATO) trial (NCT00391872) demonstrated that ticagrelor compared to clopidogrel significantly reduced the rate of death from cardiovascular causes, myocardial infarction or stroke in patients with acute coronary syndrome (ACS). The aim of this study is to analyze the long-term cost-effectiveness of ticagrelor compared to clopidogrel in ACS patients from a Vietnamese healthcare payers' perspective. A two-part cost-effectiveness model was developed to estimate long-term costs and quality-adjusted life-years (QALY). Cardiovascular event rates, hospital bed days, interventions, investigations, study drug utilization and EuroQol 5 Dimension (EQ-5D) data were derived from the PLATO trial. Unit costs of medical services were derived from the Vietnamese governmental price list, and drug costs were based on the weighted average price from the Vietnamese social security report (in VND; 10.000 VND = 0.405 USD). An annual discount rate of 3% was used. Probabilistic and deterministic sensitivity analyses were conducted to evaluate uncertainty of the results. Ticagrelor was associated with an incremental cost of VND 5.34 million (USD 216.49) and a QALY gain of 0.11. This resulted in a cost per QALY gained of VND 49.58 million (USD 2009.96) from the Vietnamese healthcare payers’ perspective. Probabilistic sensitivity analysis indicates that ticagrelor has 59% probability of being cost-effective compared with clopidogrel when using a willingness-to-pay threshold of one gross domestic products (GDP) per capita. Deterministic sensitivity analysis using clinical outcomes from the Asian sub-population of PLATO resulted in a cost per QALY of VND 42.25 million (USD 1712.80). Ticagrelor can be considered a cost-effective treatment for ACS compared with clopidogrel from a Vietnamese healthcare payers' perspective.

Scombrotoxin fish poisoning (SFP) is caused by the ingestion of certain fish species with elevated concentrations of histamine due to decomposition. In fall 2019, the U.S. Food and Drug Administration (FDA) was notified of 51 SFP cases including two hospitalizations from 11 states through the FDA consumer complaint system or directly from state partners. A case patient was defined as an individual who experienced a histamine-type reaction after consumption of tuna imported from Vietnam and an illness onset between 14 August and 24 November 2019. A traceback investigation was initiated at 19 points of service to identify a common tuna source. The FDA and state partners collected 34 product samples throughout the distribution chain, including from a case patient's home, points of service, distributors, and the port of entry. Samples were analyzed for histamine by sensory evaluation and/or chemical testing. Case patients reported exposure to tuna imported from Vietnam. The traceback investigation identified two Vietnamese manufacturers as the sources of the tuna. Twenty-nine samples were confirmed as decomposed by sensory evaluation and/or were positive for elevated histamine concentrations by chemical testing. Both Vietnamese companies were placed on an import alert. Seven U.S. companies and one Vietnamese company initiated voluntary recalls. The FDA released public communication naming the U.S. importers to help suppliers and distributors identify the product and effectuate the foreign company's recall. This SFP outbreak investigation highlights the complexities of the federal outbreak response, specifically related to imported food. Cultural considerations regarding imported foods should be addressed during outbreak responses when timing is critical. Collaboration with countries where confidentiality agreements are not in place can limit information sharing and the speed of public health responses. HIGHLIGHTS

Objective Asian Americans are underutilizing mental health services. The aim of the current systematic review was to identify protective and risk factors of mental health help-seeking patterns among the disaggregated Asian Americans and to classify types of help. Methods A systematic literature review was conducted using the PRISMA guidelines. The Health Belief Model served as the theoretical framework for this review. Thirty-four articles were reviewed, and the studies investigated one of the following Asian ethnic subgroups: Chinese, Filipino, Asian Indian, Korean, or Vietnamese. Data were extracted based on the study characteristics, sample characteristics, and protective and risk factors to mental health help-seeking patterns. Results Predisposing factors like female gender, higher levels of English proficiency, and history of mental illness increased the likelihood for help-seeking across several ethnic groups. Interestingly, cues to action and structural factors were under-examined. However, cues to action like having a positive social network did increase the likelihood of using formal support services among Chinese and Filipinx participants. Structural factors like lacking ethnic concordant providers and access to healthcare served as barriers for Korean and Vietnamese participants. Discussion The findings showed a need for ethnic tailored approaches when supporting mental health help-seeking patterns. Asian ethnic group’s immigration status, acculturation level, and psychological barriers to help-seeking should continue to be emphasized. Psychoeducational groups can be beneficial to expand the knowledge base surrounding mental illness and to link group members to culturally responsive resources.

Purpose The purpose of the current study was to examine normative nasalance values in Vietnamese adult speakers with Southern dialect and to investigate the effects of vowels and tones on nasalance. Previous studies examining nasalance have been mainly conducted with Indo-European languages. Limited information on nasalance is available in tone languages other than Chinese. Furthermore, tone and vowel effects on nasalance scores in tone languages have not been fully examined. Method Nasalance scores of various speech stimuli including passages, syllables, and prolonged vowels were obtained from Vietnamese-speaking adults with Southern dialect ( M age = 23 years) using a nasometer (KayPENTAX 6450). Results The average nasalance scores of Southern Vietnamese adult speakers were 24.16%, 38.17%, and 70.03% for the oral, oral–nasal, and nasal passages, respectively. Southern Vietnamese speakers produced the highest nasalance scores on the vowel /a/, followed by /i/ and /u/. Nasalance scores of stimuli produced with the falling and restricted tone were significantly lower than those produced with the other tones. Conclusions The normative nasalance values of the current study will contribute as a reference index for the Vietnamese language. The effects of vowels and tones can also provide insight into the development of nasalance testing stimuli and for characterizing nasalance values across languages.

In this paper, I argue that genetic screening for beta thalassemia major is ethically justified in the context of Vietnam. First, I differentiate genetic screening from the moral objections commonly associated with eugenics on the basis of the primary motive for screening (avoidance of suffering) and the preservation of voluntary choice. To lay the groundwork for ethical discussion, I explain the basics of beta thalassemia biochemistry and screening and the clinical picture of beta thalassemia major. I then elaborate on a specific example of the challenges of beta thalassemia major in Cyprus before moving on to the case of Vietnam and discuss the improbability of treatment for this disorder in Vietnam and therefore, the extensive suffering that it causes the Vietnamese people. This leads to my argument that a beta thalassemia screening in Vietnam would hold up the ethical principle of nonmaleficence and also preserves and enhances reproductive choice. I then propose that Vietnam's successful COVID-19 response can be used as a roadmap for beta thalassemia screening.

Purpose This study reports on selected psychometric properties of the adapted Buddhist Death Acceptance Scale (BDAS) for Vietnamese persons with cancer. Methods The original 13-item BDAS was developed based on Buddhist perspectives toward death and life and was translated from Thai into Vietnamese. Item content checking with five Vietnamese local experts suggested three items of the original BDAS were irrelevant in Vietnamese culture and hence should be excluded. Psychometric properties of the 10-item BDAS Vietnamese version were tested using a convenience sample of 193 Vietnamese Buddhists with cancer. Results The internal consistency coefficient of the scale was found to be 0.73. Exploratory factor analysis showed that the 10 items of the BDAS Vietnamese version constituted 2 factors, explaining 51.1% of the variance of death acceptance. The first factor was “acceptance of natural process of death” and the second was “preparing for death.” Both factors reflected explicitly Buddhist viewpoints toward death acceptance and were consistent with the original Thai BDAS. However, although similar factors were found, some items in the Vietnamese BDAS did not load to same factors as in the Thai BDAS. Conclusions The BDAS Vietnamese version provides an initial suitable measurement for death acceptance among Vietnamese Buddhists. Its availability will enable cross-cultural research to investigate death acceptance among Buddhist patients with cancer in Vietnam. However, the differences in item loadings between the Thai and Vietnamese scales suggest that further conceptual and empirical works to refine the measurement are needed.

We investigate the long-term effects of the 1944-45 Great Vietnam Famine on early-life survivors and their offspring using census data, household survey data and historical administrative data. Unlike previous famine studies, we measure famine severity using a unique, more direct, and "plausibly exogenous" metric of food availability: province-level excess paddy (rice) production per capita in 1944. Our study makes two novel contributions. First, we overcome several selection problems associated with the estimation of true famine effects, given the short duration and spatial variation of the Vietnamese famine. Second, we investigate the intergenerational effects of famine, focusing specifically on the occupation of the survivors' parents and the school participation of the survivors' offspring. Our preferred specification estimates generalized triple differences that allow us to control for birth-year and birth-province fixed effects and nation-wide shocks. Our findings suggest that the Vietnamese famine reduced literacy by around 3 percent, BMI by 5.6%-8.4%, arm-length by 4.5%-6.7% (1.1-1.7 cm), height by 2.2%-3.2% (3.4-5 cm), and weight by 10%-14% (4.7-6.9 kg) among the affected cohort. These detrimental famine effects also extended to economic welfare, in the form of lower household incomes and lower non-food household expenditures in adulthood. We also document a 4.9%-7.2% reduction in school participation among survivors' offspring, which has major implications for the exogenous origins of social mobility, inequality, and poverty.

Background: Asian American and Native Hawaiian/Pacific Islanders (AANHPI) are the fastest growing minority in the United States. Cancer is the leading cause of death for AANHPIs, despite relatively lower cancer morbidity and mortality. Their recent demographic growth facilitates a detailed identification of AANHPI populations with higher cancer risk. Methods: Age-adjusted, sex-stratified, site-specific cancer mortality rates from California for 2012 to 2017 were computed for AANHPI groups: Chinese, Filipino, South Asian, Vietnamese, Korean, Japanese, Southeast Asian (i.e., Cambodian, Hmong, Laotian, Thai), and Native Hawaiian and Other Pacific Islander (NHOPI). Regression-derived mortality rate ratios (MRR) were used to compare each AANHPI group to non-Hispanic whites (NHW). Results: AANHPI men and women (total 40,740 deaths) had lower all-sites-combined cancer mortality rates (128.3 and 92.4 per 100,000, respectively) than NHWs (185.3 and 140.6) but higher mortality for nasopharynx, stomach, and liver cancers. Among AANHPIs, both NHOPIs and Southeast Asians had the highest overall rates including for colorectal, lung (men only), and cervical cancers; South Asians had the lowest. NHOPI women had 41% higher overall mortality than NHWs (MRR = 1.41; 95% CI, 1.25–1.58), including for breast (MRR = 1.33; 95% CI, 1.08–1.65) and markedly higher for endometrial cancer (MRR = 3.34; 95% CI, 2.53–4.42). Conclusions: AANHPI populations present with considerable heterogeneous cancer mortality patterns. Heightened mortality for infection, obesity, and tobacco-related cancers in Southeast Asians and NHOPI populations highlight the need for differentiated priorities and public health interventions among specific AANHPI populations. Impact: Not all AANHPIs have favorable cancer profiles. It is imperative to expand the focus on the currently understudied populations that bear a disproportionate cancer burden.

Background This study examined the financial toxicity faced by breast cancer (BC) patients in Vietnam and the factors associated with the risk and degree of that toxicity. Methods A total of 309 BC patients/survivors completed an online survey (n=209) or a face-to-face interview (n=100) at two tertiary hospitals. Descriptive statistics and χ2 tests were used to identify and analyse the forms and degree of financial toxicity faced by BC patients/survivors. A Cragg hurdle model assessed variation in risk and the degree of financial toxicity due to treatment. Results 41% of respondents faced financial toxicity due to BC treatment costs. The mean amount of money that exceeded BC patients/survivors’ ability to pay was 153 million Vietnamese Dong (VND) ($6602) and ranged from 2.42 million VND to 1358 million VND ($104–58,413). A diagnosis at stage II or III of BC was associated with 16.0 and 18.0 million VND (~$690–777) more in the degree of financial toxicity compared with patients who were diagnosed at stage 0/I, respectively. Being retired or married or having full (100%) health insurance was associated with a decrease in the degree of financial toxicity. Conclusions A significant proportion of Vietnamese BC patients/survivors face serious financial toxicity due to BC treatment costs. There is a need to consider the introduction of measures that would attenuate this hardship and promote uptake of screening for the reduction in financial toxicity as well as the health gains it may achieve through earlier detection of cancer.

This open-label, single-center, Phase 3 study (NCT03546842) assessed the immunogenicity and safety of the nine-valent human papillomavirus (9vHPV; HPV6/11/16/18/31/33/45/52/58) vaccine in Vietnamese males and females, with the aim to support 9vHPV vaccine licensure in Vietnam. Participants aged 9–26 years received three 9vHPV vaccine doses (Day 1, Month 2, Month 6). Serum samples were obtained on Day 1 (pre-vaccination) and at Month 7 (one month post-Dose 3) for the measurement of anti-HPV antibodies. Geometric mean titers (GMTs) and seroconversion percentages were obtained using the HPV-9 competitive Luminex immunoassay. Injection-site adverse events (AEs), systemic AEs, serious AEs (SAEs), and study discontinuations due to AEs were recorded. Of 201 participants enrolled, 200 (99.5%) received ≥1 vaccine dose. All participants who received the three-dose regimen (198/200, 98.5%) seroconverted for all 9vHPV vaccine types by Month 7. Robust anti-HPV GMT responses were also observed. Half of participants (50.5%) reported ≥1 AE; the majority were injection-site-related (45.0%) and mild (43.0%). There were no deaths, vaccine-related SAEs, or discontinuations due to AEs. Administration of three 9vHPV vaccine doses was highly immunogenic and resulted in acceptable seropositivity percentages for all vaccine HPV types. The 9vHPV vaccine was generally well tolerated among this study population. Region of origin: Vietnam Trial registration: clinicaltrials.gov Identifier NCT03546842

Aim To measure the level of critical thinking among Vietnamese professional nurses and to identify the related factors. Design A cross‐sectional design was used. Methods The total sample included 420 professional nurses. Data were collected from July to September 2019 in three public hospitals located in Southwestern Vietnam. The level of critical thinking was measured using the Vietnamese version of the Nursing Critical Thinking in Clinical Practice Questionnaire. The data were analysed using the independent Student's t tests, ANOVA, Pearson's correlation and regression analysis. Results Most of the participants had a low (48.3%) or moderate (45.5%) level of critical thinking. Age, gender, ethnicity, education level, health condition, duration of working as a nurse, duration of working in the current hospital, having heard the term “critical thinking” and work position had an impact on the critical thinking ability. Work position and gender explained 11% of the total variance in critical thinking ability.

Background Understanding concerns for receiving COVID-19 vaccines is key to ensuring appropriately tailored health communications to increase vaccine uptake. However, limited data exists about vaccine concerns among Asian Americans and Pacific Islanders (AAPI). Methods Data from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS), a cross-sectional, national survey for AAPI adults in the U.S. were used (N=1,646). Descriptive statistics were used to assess sample characteristics including proportions of AAPI with various COVID-19 vaccine concerns, categorized as none, side-effects only, unsafe only, and multiple reasons, and differences in vaccine concerns by socio-demographics. Ordinary multivariable logistic regression analyses were conducted to evaluate associations between a characteristic and having any vaccine concerns. Results Overall, 76% of the respondents reported having at ≥1 concerns about the vaccine. The most common concern was side effects (65%). Vietnamese Americans reported less concerns (vs. Chinese Americans). Those who were 30-39 and 40-49 years old (vs. Discussion AAPI is a diverse population and this study revealed differences in vaccine concerns across AAPI groups. Findings revealed potential targets for patient education needs. Effective strategies to address various vaccine concerns across subgroups of AAPI will be crucial to ensure equity in vaccination uptake.

Although Vietnam has been successful in the fight against the first wave of COVID-19, domestic outbreaks have continued to occur. Given university students constitute a significant proportion of the population in Vietnam, to improve the prevention and control of COVID-19 in Vietnam and comparable countries, we examined their knowledge, attitude, and practice (KAP) towards face mask use which is an important preventive measure and the association between the levels of COVID-19 knowledge and KAP towards face mask use. A cross-sectional survey was conducted on all students studying at Phenikaa University, Hanoi, using a self-developed questionnaire consisted of 42 questions regarding KAP towards face mask use as well as reuse of cloth mask, and COVID-19 knowledge. Among 728 participants, 40.9% (298/728) were male, 63.2% (460/728) were from health-related faculties, 46% (335/728) lived in urban areas, and 51.9% (378) had good levels of COVID-19 knowledge. Regarding face mask, most (89.7%, 653/728) participants had good knowledge scores, 72.8% (530/728) had positive attitudes, and 76.5% (557/728) had good practice scores. The most common types of masks used were surgical mask (57.6%, 419/728), followed by non-antibacterial cloth mask (23.1%, 168/728). Among 168 participants using non-antibacterial cloth mask, 43.5% reused masks (73/168), of whom 6.8% (5/73) did not wash their masks at least daily. Face mask use knowledge was statistically associated with COVID-19 knowledge (P