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Objective:The purpose of this study was to translate, adjust and evaluate the validity and reliability of the Champion's Health Belief Model scale, so as to measure the beliefs of self-examination practices of Vietnamese women. Material and Methods:The adaptation and psychometric characteristics test of the Vietnamese HBM scale was performed, with 40 participants, from October 2021 to June 2022. Of these, 10 women were initially randomized to adjust the translation version, and 30 women were to evaluate the reliability of the scale. The content value of the scale is measured by the opinion of 5 experts. Reliability was measured by Cronbach's alpha, while An estimation of stability is commonly assessed by a test–retest reliability analysis (ICC). Result:The Vietnamese version of the Health Belief Model scale (V-HBMS) demonstrated good content validity, with the Items content validity index (I-CVI) score for all 42 items> 0.79. Internal consistency with Cronbach's alpha ranges from .715 to .954 and the reliability of the ICC re-test ranged from .954-.000 (p-value = 0.000) determined with good results. Conclusion:The Vietnamese version of the Health Belief Model scale can be considered a valid tool to survey the belief of Vietnamese women in the implementation of breast self-examination behavior.

The investigations on the effects of biochar application in improving the physio-chemical properties of soil have been carried out in many studies; however, there are very few studies on the combined use of both biochar and clay-rich soil for poor nutrient soil reclamation. Therefore, this study demonstrates improved water retention and nutrient retention of sandy soil by using biochar and biochar combined with clay-rich soil. The experiments were conducted on a small scale (greenhouse) with nine different application rates of biochar and clay-rich soil were mixed and then cultivated peanut, along with the drip irrigation technique using field moisture limit (about 70-80%) was applied under the condition of ensuring a sufficient supply of NPK for plant’s growth. The results showed that at the rates from 10.0-15.0% (w/w) clay-rich soil mixed with from 0.5-1.5% (w/w) of biochar applied to the tested sandy soil resulted in the positive effects on soil water holding, bulk density, permeability, pH, CEC, OM, total N, total P and peanut yield. The physical and chemical characteristics of the tested sandy soil have been improved by time and the application rate of 10.0% clay-rich soil and 0.5% biochar had the highest efficiency of pod fresh weight and pod dry weight during three studied seasons.

The main aims of this study is to explore the intention to use smart watches from consumers perspective. The study applied the extended theory of planned behavior by integrating two additional variables including: aesthetic design and perceived price in addition to variables in the original intended behavior theory model, specifically: attitudes towards smartwatch purchases, perceived behavioral control and social norms to explain consumers' intent to buy smartwatches in Nha Trang city. This study adopts partial least squares structural equation modeling (PLS-SEM) technique to test the reliability and validity of the measures based on a sample of 200 consumers in Nha Trang. The results indicate that five proposed hypotheses are supported by data with an increasing degree of impact, which are perceived behavioral control (ß = 0.58), attitudes towards smartwatch purchases (ß = 0.20), aesthetic design (ß = 0.15), perceived price (ß = 0.14) and social norms (ß = 0.11). The research results are expected to make significant contributions both in academic research and practical research through useful and practical recommendations for watch product consumption.

ObjectivesTo compare the accuracy of the SOFA and APACHE II scores in predicting mortality among ICU patients with sepsis in an LMIC.DesignA multicentre, cross-sectional study.SettingA total of 15 adult ICUs throughout Vietnam.ParticipantsWe included all patients aged ≥ 18 years who were admitted to ICUs for sepsis and who were still in ICUs from 00:00 hour to 23:59 hour of the specified study days (i.e., 9thJanuary, 3rdApril, 3rdJuly, and 9thOctober of the year 2019).Primary and secondary outcome measuresThe primary outcome was hospital all-cause mortality (hospital mortality). We also defined the secondary outcome as all-cause deaths in the ICU (ICU mortality).ResultsOf 252 patients, 40.1% died in hospitals, and 33.3% died in ICUs. SOFA (AUROC: 0.688 [95% CI: 0.618-0.758]; cut-off value ≥ 7.5; PAUROCAUROCAUROCAUROCConclusionsIn this study, SOFA and APACHE II scores were worthwhile in predicting mortality among ICU patients with sepsis. However, due to better discrimination for predicting ICU mortality, the SOFA was preferable to the APACHE II score in predicting mortality.Clinical trials registry – India: CTRI/2019/01/016898Strengths and limitations of this studyAn advantage of the present study was data from multi centres, which had little missing data.Due to the absence of a national registry of intensive care units (ICUs) to allow systematic recruitment of units, we used a snowball method to identify suitable units, which might have led to the selection of centres with a greater interest in sepsis management.Due to the study’s real-world nature, we did not make a protocol for microbiological investigations. Moreover, we mainly evaluated resources utilized in ICUs; therefore, the data detailing the point-of-care testing and life-sustaining treatments were not available. Additionally, to improve the feasibility of conducting the study in busy ICUs, we opted not to collect data on antibiotic resistance and appropriateness.Due to our independent variables (e.g., SOFA score that was greater than or equal to the cut-off value) that might be associated with primary outcome only measured upon ICU admission, the mixed-effects logistic regression model could not be used to predict discrete outcome variables measured at two different times, i.e., inside and outside the ICU settings.Although the sample size was large enough, the confidence interval was slightly wide (±6.03%), which might influence the normal distribution of the sample.

Budgeting is an important tool helping managers in planning and controlling during the operation of universities. Budgeting plays a vital role in controlling budgeting activities in the short-term and provides appropriate implementation plans to achieve strategic objectives. This study aims to evaluate the management effectiveness of budgeting activities in Vietnamese public universities. Data was collected from 53 public universities in Vietnam through questionnaire. After collecting, the data is cleansed and analyzed on SPSS software by tools such as: Frequency statistics, price statistics, average, comparing. The research results showed that: (1) The application of budgeting is comprehensive; that includes income and expenditure budget, enrollment budget, and teaching budget; (2) Monitoring and evaluation of budgeting activities are strictly implemented, (3) The main budgeting method is preparing general budgets for the entire university, and the other method is preparing budgets for each department (4) The main method of evaluating budgeting is comparing variances while variance analysis and finding underlying causes were not applied. This study proposes solutions to improve the process, content and quality of budgeting, thereby contributing to improving management efficiency in public universities in Vietnam. JEL Classification: M10, M40, M41.

Background The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam. Methods We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models. Results Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671). Conclusion In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings. Clinical trial registration Clinical trials registry–India: CTRI/2019/01/016898

Background: There is growing interest among low- and middle-income countries to introduce electronic immunization registries (EIRs) that capture individual-level vaccine data. While practical EIR guidance documents are available, the real-world implementation experience varies by country. There is an opportunity to learn from countries that have experience implementing EIRs to inform other countries considering the same. Methods: This qualitative study provides a cross-case comparison of the design, development, and deployment of EIRs in three countries: Vietnam, Tanzania, and Zambia. The countries were selected based on PATH’s role in providing technical support to the governments to introduce and scale their EIRs. Through desk review and thematic analyses, we consider findings related to four implementation factors: time, partnerships, financial costs, and technology and infrastructure.Results: The country cases highlight the multi-year timeline required to implement an EIR at scale. Of the 3 countries, only Vietnam has achieved nationwide scale of the EIR after implementing a series of iterative cycles to pilot and redesign the system over 7 years. In terms of partnerships, all three case countries established interdisciplinary national teams with experience in leadership, technology, and immunization, and incorporated end user perspectives from subnational levels in the EIR design and development. It was important for the national government to play an active role to ensure country ownership and sustainability. Financial investment was necessary for design and development, as well as to maintain the EIR beyond the initial deployment, including all recurring costs for system maintenance, updates, and end user support. Finally, technology and infrastructure were important considerations in the EIR design and choice of equipment in each country, and all 3 countries have a local partner to provide ongoing technical support.Conclusions: Comparing implementation factors across these cases highlights practical experience and recommendations that complement existing EIR guidance documents. The findings and recommendations from this study can inform other countries considering or in the process of implementing an EIR.

Objectives The aim of this study was to understand the natural bacterial hosts of antimicrobial resistance genes (ARGs) and their impact on the processes of evolution, spread and positive selection of acquired ARGs. Methods Environmental carbapenem-resistant Gram-negative bacteria in Vietnam were screened for based on a One Health approach. Whole-genome sequencing (WGS) and comparative genomic analysis of the isolates were performed. WGS of three carbapenem-resistant Shewanella xiamenensis strains (SxND_W2_2018, SxND_W5_2018 and SxND_W9_2018) isolated from canals in Truc Ninh District and Nghia Hung District, Nam Dinh Province, Vietnam, in 2018 was performed using an Illumina MiniSeq system. ARGs in the draft genome sequences were detected using ResFinder, and comparison of genomic regions was performed using BLASTn and Easyfig. Results TheblaOXA-48-like carbapenem-hydrolysing class D β-lactamase genes blaOXA-48, blaOXA-252 and blaOXA-547 were detected in chromosomal contigs of SxND_W2_2018, SxND_W5_2018 and SxND_W9_2018, respectively. Comparative analysis of the surrounding regions of the blaOXA-48-like genes, including both 10 kb upstream and 10 kb downstream of the genes, showed that the genomic regions were highly conserved in all three isolates. Conclusion This study analysed the draft genome sequences of carbapenem-resistantS. xiamenensis strains isolated from a water environment in Vietnam. All of the strains carried blaOXA-48-like gene variants in their chromosomes. This information will contribute to highlight the evolution of blaOXA-48 family carbapenemase genes in nature and the importance of S. xiamenensis as a natural reservoir of important ARGs in the environment in Vietnam.

There are growing concerns on stress among nurses in low- and middle-income countries (LMICs) in South-East Asia. It is important to improve mental health among nurses in these countries. The objective of this study was to examine the efficacy of two types of newly developed smartphone-based stress management programs in improving depressive and anxiety symptoms among hospital nurses in Vietnam. This study was a three-arm (including two intervention groups and one control group) randomized trial. Participants were recruited from nurses in a large general hospital in Hanoi, Vietnam. Two types (free-choice and fixed sequential order) of smartphone-based stress management programs were developed. Participants were randomly allocated to Program A (a free-choice, multimodule stress management), Program B (a fixed-order, internet cognitive behavioral therapy, iCBT), or a control group (treatment as usual). The depressive and anxiety symptoms were measured by using the Depression Anxiety and Stress Scales at baseline, 3-, and 7-month follow-up surveys. 951 participants were randomly allocated to each of the three groups. Program B showed a statistically significant effect on improving depressive symptoms at 3-month (p = 0.048), but not at 7-month (p = 0.92); Cohen’s d was − 0.18 (95% CI − 0.34 to − 0.02) and 0.03 (95% CI − 1.00 to 1.05), respectively. Program A failed to show a significant intervention effect on any of the outcomes at 3- or 7-month follow-up (p > 0.05). Despite the small effect size, the present fixed-order iCBT program seems effective in improving depression of hospital nurses in Vietnam. A public health impact of the intervention can be scalable, when considering its accessibility and minimal cost.Trial registration number: The study protocol is registered at the UMIN Clinical Trials Registry (UMINCTR; ID = UMIN000033139). Registered date of the protocol is 1st Jul. 2018. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037796

Background: ImageJ software is used to quantify the joint space width (JSW) of hand and wrist in patients with rheumatoid arthritis (RA) as well as in the healthy control group. Method: Forty-one RA patients and 31 healthy controls were included in this study. All of 72 participants underwent digital radiography of the bilateral hand and wrist; then, all the images were opened by ImageJ software to measure the width of wrist and hand joint space (total 2160 joints). Joint space narrowing (JSN) was defined if the width was less than the mean - 2SD of the control group. Result: The mean JSW of all sites of wrist and hand joints of RA patients were significantly reduced as compared to those in the control group (p Conclusion: ImageJ software is simple and convenient that helps rheumatologists quantify the width of joint space for diagnosis and follow-up in RA patients.

IntroductionThe Resourceful Adolescent Program (RAP) is an evidence-based resilience intervention for adolescents. Operating in a strength-focused paradigm, the programme uses an integration of cognitive behavioural therapy and interpersonal psychotherapy to improve coping skills and build resilience. This study aims to establish whether a culturally and linguistically adapted intervention informed by RAP principles is effective in increasing resilience, enhancing coping skills and preventing symptoms of depression and anxiety.Methods and analysisWe will translate, back-translate and culturally adapt the RAP for adolescents and training materials for facilitators, and the adapted intervention will be called Happy House. A two-arm parallel controlled trial will be conducted in eight high schools in the north of Vietnam. In each of the selected schools, all students from four randomly selected grade 10 classes (an estimation of about 1204 students) will be invited to participate. The control group will receive the usual curriculum. The intervention group will receive six weekly 90 min school-based group sessions of Happy House in addition to the usual curriculum. The primary outcome, depressive symptoms, will be measured using a locally validated version of the Centre for Epidemiologic Studies Depression Scale Revised. Secondary outcomes are mental well-being, coping self-efficacy, school connectedness, anger management and health risk behaviours. Data will be collected at recruitment, and at two weeks and six months post intervention. Mixed-effect logistic regression for the main outcome and mixed-effect linear and logistic regression models for the secondary outcomes will be conducted to estimate the effects of the intervention on the outcomes.Ethics and disseminationThis trial has been approved by Monash University Human Research Ethics Committee (No. 21455) and the Institutional Review Board of the Hanoi School of Public Health (488/2019/YTCC-HD3). Dissemination of findings will include peer-reviewed publications, international and national conferences, seminar and media presentations, national policy briefings in Vietnam, local language reports and lay language summaries for participants.Trial registration numbersRegistered with the Australian New Zealand Clinical Trials Registry, registration number: ACTRN12620000088943 (3/2/2020).WHO Universal Trial Number: U1111-1246-4079.

Background Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam’s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the “axes of scale,” to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations.

Colistin is one of the antibiotics of last resort for human health. However, the dissemination of the plasmid-mediated colistin resistance gene mcr-1 is of great concern globally. In the One Health framework, the environment is an important component for managing antimicrobial resistance. However, little information is available concerning the prevalence of mcr-1 in water environments. We aimed to reveal the prevalence of mcr-1 in different water environments in Hanoi, Vietnam. Quantitative PCR was applied to detect mcr-1 in four urban drainages receiving untreated domestic wastewater, three rivers, five lakes and two groundwater samples. Urban drainages contained higher concentrations of mcr-1, suggesting that urban residents carry the gene. The class 1 integron-integrase gene was identified as a good surrogate of antibiotic resistance genes including mcr-1. A significant correlation was found between the levels of mcr-1 and the human-specific cross-assembly phage, which is an indicator of human faecal pollution. These results indicated that the primary source of mcr-1 in urban water environments is human faeces, which is consistent with the fact that most domestic wastewater is untreated in Hanoi. The control of untreated wastewater is critical for alleviating the spread of mcr-1 in water environments in Vietnam.

BACKGROUND Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). OBJECTIVE The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. METHODS Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. RESULTS The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95% CI –0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. CONCLUSIONS The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. CLINICALTRIAL University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2018-025138

Objectives The present study investigated the reliability and validity of a newly developed Vietnamese version of the 9‐item Utrecht Work Engagement Scale (UWES‐9‐V) in a sample of hospital nurses in Hanoi, Vietnam. Methods The UWES‐9 was translated into Vietnamese following a standard procedure. A survey was conducted of 949 registered nurses in a large tertiary general hospital in Hanoi, Vietnam, in 2018, using a self‐administered questionnaire including the Vietnamese UWES‐9, other scales measuring health status, work performance, job demand, job control, and workplace social support, and questions pertaining to demographic variables. Cronbach’s alpha and interclass correlation coefficients (ICC) were calculated to assess reliability. Explanatory and confirmatory factor analyses were conducted to assess factorial validity. Convergent validity was tested based on associations between the UWES‐9‐V and subscales and other scales. Results The Cronbach’s alpha coefficients of the UWES‐9‐V and the Vigor, Absorption, and Dedication subscales were 0.93, 0.86, 0.77, and 0.90, respectively. ICC of the UWES‐9‐V in a subsample after 3 months was 0.48. Confirmatory factor analyses indicated an acceptable fit of both one‐factor and three‐factor structures, with the three‐factor model having the better fit. The UWES‐9‐V and its subscales correlated with depression, anxiety and stress, health‐related quality of life and health condition, job performance, and psychosocial work environment. Conclusions The study findings suggest that the UWES‐9‐V is a reliable and valid instrument to measure work engagement among hospital nurses in Vietnam, a low‐ and middle‐income country. Future studies should confirm the validity and reliability of the UWES‐9‐V among various occupations.

The present study investigated the internal consistency reliability, construct validity, and item response characteristics of a newly developed Vietnamese version of the Kessler 6 (K6) scale among hospital nurses in Hanoi, Vietnam. The K6 was translated into the Vietnamese language following a standard procedure. A survey was conducted of nurses in a large general hospital in Hanoi, Vietnam, using a questionnaire including the Vietnamese K6, other scales (DASS21, health-related QOL, self-rated health, and psychosocial work environment), and questions about demographic variables. Internal consistency reliability (Cronbach's alpha coefficient) was calculated. A confirmatory factor analysis was conducted. Eleven hypotheses were tested (as Pearson's correlations with the K6) to assess the scale's construct validity. Item response theory (IRT) analysis was conducted to identify the item response characteristics. The Cronbach's alpha coefficient was 0.864. The explanatory and confirmatory factor analyses indicated a one-factor structure. Most hypotheses tested for construct validity were supported. IRT analysis indicated that response categories were located in order according to severity. K6 provided reliable information regarding higher levels of psychological distress. The findings suggest that the Vietnamese version of the K6 is a reliable and valid instrument to measure psychological distress among hospital nurses in Vietnam.

Haemoglobin (Hb) E is the most common Hb variant in Asia where its gene frequency approaches 0.3 in some areas. We studied genetic background of Hb E genes among Southeast Asian populations. This study examined β-globin gene haplotypes linked to haemoglobin E (Hb E) in diverse groups of Southeast Asian populations. The study was conducted on southern Thai (22 alleles), Cambodian (84 alleles), Laotian (120 alleles), Vietnamese (87 alleles) and Burmese (one allele) subjects. Results were compared with those of previous studies in northeast Thailand, the Yunnan of China, West India and Europe. Ten different haplotypes were observed. The four most common haplotypes were haplotypes 1 (- + - + + + -) and 2 (+ - - - - + -) on chromosomes with framework 2 and haplotypes 6 (- + - + + - +) and 7 (+ - - - - - +) on chromosomes with framework 3 variety. Phylogenetic analysis indicated that haplotype 1 is a relatively recent haplotype found in all populations, whereas haplotype 6 is found predominately in Cambodians. The results indicate that at least two genetic origins of Hb E are responsible for the high prevalence and spread of Hb E among Southeast Asian populations.

Thalassemia is a genetic condition that can result in long and expensive treatments, and severe thalassemia may lead to death if left untreated. Couples contributing two genes for thalassemia place their children at particular risk for severe thalassemia. Gene frequency of thalassemia varies in Vietnam, but presents remarkably high levels among some ethnic minority groups. Limited information about thalassemia frequency makes prevention and control of thalassemia difficult. This study aimed to determine gene frequency of certain types of thalassemia among 390 women of reproductive age of the Ta-Oi ethnic minority. Hemoglobin and DNA analyses were carried out to diagnose thalassemia and hemoglobinopathies. Of the total participants, 56.1% (95% CI = 51.1–61.1) carried thalassemia genes. A remarkably high frequency of hemoglobin Constant Spring (Hb CS) of 23.8% (95% CI = 19.7–28.4) was noted. The frequency of α+-thalassemia (−3.7 kb deletion) was 26.4% (95% CI = 22.1–31.1), while hemoglobin E (Hb E) and hemoglobin Paksé (Hb Ps) were identified at frequencies of 14.6 (95% CI = 11.2–18.5) and 2.6% (95% CI = 1.4–5.0), respectively. Further analysis of α-globin gene haplotype revealed the same Hb CS haplotype (+ − M + + −) as of the Co-Tu minority, a neighboring minority of the Ta-Oi, indicating that these two minorities may share the same ancestors. This information will be helpful for further studies in population genetics, as well as the development prevention and control program in the region.

Background Work engagement is important for employee well-being and work performance. However, no intervention study has investigated the effect of an eMental Health intervention on work engagement among workers in low- and middle-income countries (LMICs). Objective The aim of the study was to examine the effects of a newly developed smartphone-based stress management program (ABC Stress Management) on improving work engagement among hospital nurses in Vietnam, an LMIC. Methods Full-time registered nurses (n=949) were randomly assigned to one of 2 intervention groups or a control group. The intervention groups were a 6-week, 6-lesson program offering basic cognitive behavioral therapy (CBT-based stress management skills), provided in either free-choice (program A) or fixed order (program B). Work engagement was assessed at baseline and 3-month and 7-month follow-ups in each of the 3 groups. Results The scores of work engagement in both intervention groups improved from baseline to 3-month follow-up, and then decreased at the 7-month follow-up, while the score steadily increased from baseline to 7-month follow-up in the control group. Program B showed a significant intervention effect on improving work engagement at the 3-month follow-up (P=.049) with a small effect size (Cohen d= 0.16; 95% CI 0.001 to 0.43]). Program A showed nonsignificant trend (d=0.13; 95% CI –0.014 to 0.41; P=.07) toward improved engagement at 3 months. Neither program achieved effectiveness at the 7-month follow-up. Conclusions The study demonstrated that a fixed order (program B) delivery of a smartphone-based stress management program was effective in improving work engagement in nurses in Vietnam. However, the effect was small and only temporary. Further improvement of this program is required to achieve a greater effect size and more sustained, longer lasting impact on work engagement. Trial Registration University Hospital Medical Information Network Clinical Trials Registry UMIN000033139; tinyurl.com/55gxo253 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-025138

Being among major competitive industries in the future, tourism is an advantageous sector of Khanh Hoa which greatly contributes to the economic growth and the province’s restructuring. According to Khanh Hoa Bureau of Statistics (2014), 2014 tourism revenue reached 4280.47 billion VND which increased 27.76% compared to 2013; the number of visitors in the year was 14.6 million, an exceeding 16.48% compared to the previous year (tourists travelling by sea are excluded). Therefore, Khanh Hoa is currently concentrating on developing international travel, aiming at international tourism as a prime motivation for the growth of domestic tourism and service industry in the international economic integration phase. This study, which utilized Technology Acceptance Model – TAM and E-Commerce Acceptance Model – ECAM, reviewed the factors that affect the e-commerce applications at Khanh Hoa tourism enterprises. Employing regression analysis on a sample of 158 tourism enterprises in Khanh Hoa, we found that six factors including Hardware, Software, Information system, Internal resources of SMEs (Small to Medium Enterprises); Policies and management of the Government, and Cultural & social factors have a positive impact on the level of e-commerce usage in Khanh Hoa hospitality industry. We subsequently clarify the most suitable model for our data. The research findings outlined meaningful proposals for hospitality enterprises in Khanh Hoa as well as assist in enhancing the society performance.

Eleven years after Trastuzumab was approved for use in the treatment of early stage human epidermal growth factor receptor positive breast cancer (HER2+) its clinical benefit has been demonstrated in short and long term follow up studies. The cost-effectiveness of the therapy in this context remains the subject of debate with a wide range of Incremental Cost Effectiveness Ratios (ICERs) reported in the literature. While several reviews of the literature have been undertaken these have not provided a critical analysis of the factors that might underlie this heterogeneity. In this review we provide a critical overview of the literature and discuss potential sources of heterogeneity in reported ICERs. We identify gaps in the current literature and provide a rationale for filling these gaps.

The success of an artificial neural network depends much on the training phase. Techniques for training neural network based on gradient are partially satisfying and are widely used in practice. However, in several cases which has special error surface similar to a deep cleft, these algorithms seem to work slowly and encounter local extreme values. Authors of this paper propose the use of genetic algorithm in combination with the “cleft-overstep” algorithm to improve the training process of neural network which has special error surface and illustrate this usage through a simple application in text recognition. First, An MLP artificial neural network with cleft-similar error surface is trained using back propagation algorithm and the results are analyzed. Next, the paper describes the usage of the proposed method to improve the training process of neural network on two aspects: correctness and rate of convergence. Implementation is done in and results obtained from Matlab environment.