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In Vietnam, mental health in academic institutes is currently a topical issue that is significantly concerned by parents, schools, educational administrators and management levels. Research objective: To assess the current situation of extroverted behavior of students from 15 to 18 years old. Methodology: The study was conducted on a sample of 251 students in Hanoi, Vietnam, including: 46 15-year-old students, 77 16-year-old students, 34 17-year-old students and 94 18-year-old students. The method was applied is Youth Self Report (YSR) measure which is a part of the ASEBA built by psychologist T.M. Achenbach. Research results: research have shown that students' expression levels of extroverted behavior were quite diverse and mainly focused on delinquent and aggressive behavior. At the same time, there was a significant difference when comparing the delinquent and aggressive behavior with the students' conduct scores, in which for the weak conduct score students have the average score of delinquent behavior higher than the ones in the remaining conduct group (M1>M2, M3, M4; p=0.00).

Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. Results The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01–0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52–40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17–322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13–10.62). Conclusions This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.

BackgroundBlood culture (BC) sampling is recommended for all suspected sepsis patients prior to antibiotic administration. Here, we aimed to identify barriers and enablers to BC sampling in three Southeast Asian countries.MethodsWe conducted a systematic review of studies evaluating barriers/enablers to BC sampling from 1900 to 2020 globally (PROSPERO, CRD42020206557). Using the findings of the systematic review, we developed and conducted a Theoretical Domains Framework (TDF)-based survey with a case scenario question among doctors and final-year medical students in Indonesia, Thailand and Vietnam.FindingsIn the systematic review, we identified 6,175 unique records from the databases, of which 25 met the eligibility criteria. Studies were conducted in 37 high-income countries (HICs) and 41 low-and middle-income countries (LMICs). Of 14 TDF domains, three and seven were not assessed in HICs and LMICs by the studies included in the systematic review, respectively. 1,070 medical doctors and 238 final-year medical students completed the survey. The proportion of respondents who would definitely take BC in the case scenario was 89.8% for Thai, 50.5% for Vietnamese and 31.3% for Indonesians (pConclusionsEvidence on barriers and enablers to BC sampling is limited globally. We identified individual, socio-cultural and environmental barriers/enablers to BC sampling across different countries, which represent potential targets for interventions. Context-specific multifaceted interventions at both hospital and policy levels are required to improve diagnostic stewardship practices.FundingWellcome Trust, UK (220557/Z/20/Z).

ObjectivesAntibiotic overuse is one of the main drivers of antimicrobial resistance (AMR), especially in low and middle-income countries. This study aimed to gain an understanding of perceptions, views, and practices regarding AMR, antibiotic prescribing, and stewardship (AMS) among hospital physicians in Jakarta, Indonesia.Designcross-sectional, self-administered questionnaire-based survey, with descriptive statistics, exploratory factor analysis (EFA) to identify distinct underlying constructs in the dataset, and multivariable linear regression of factor scores to analyse physician subgroups.SettingSix public and private general hospitals in Jakarta in 2019.Participants1007 of 1896 (53.1% response rate) antibiotic prescribing physicians.ResultsEFA identified six latent factors (overall Crohnbach’s α=0.85): awareness of AMS activities; awareness of AMS purpose; views regarding rational antibiotic prescribing; confidence in antibiotic prescribing decisions; perception of AMR as a significant problem; and immediate actions to contain AMR. Physicians acknowledged the significance of AMR and contributing factors, rational antibiotic prescribing, and purpose and usefulness of AMS. However, this conflicted with reported suboptimal local hospital practices, such as room cleaning, hand hygiene and staff education, and views regarding antibiotic decision-making. These included insufficiently applying AMS principles and utilising microbiology, lack of confidence in prescribing decisions, and defensive prescribing due to pervasive diagnostic uncertainty, fear of patient deterioration or because patients insisted. Physicians’ factor scores differed across hospitals, departments, work experience and medical hierarchy.ConclusionsAMS implementation in Indonesian hospitals is challenged by institutional, contextual and diagnostic vulnerabilities, resulting in externalising AMR instead of recognising it as a local problem. Appropriate recognition of the contextual determinants of antibiotic prescribing decision-making will be critical to change physicians’ attitudes and develop context-specific AMS interventions.Strengths and limitations of this studyThe self-developed questionnaire in this study identified a relevant set of attributes through a factor analysis optimization process, with adequate content, face and construct validity and internal reliability. This study adds important value in the absence of adequately validated instruments regarding antimicrobial resistance and stewardship, with particular applicability for LMIC.This study had a large, varied respondent sample and high response rate among physicians at six public and private hospitals in Jakarta, Indonesia, and identified differences between physicians across hospitals, departments, work experience and medical hierarchy, which can guide priority-setting and tailoring of stewardship interventions.However, non-participation and the convenient hospital sample could have introduced selection bias, and the data are not necessarily representative for Jakarta or Indonesia.Factor analysis is based on using a “heuristic”, which leaves room to more than one interpretation of the same data and cannot identify causality.

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International audience; In recent years, serosurveillance has gained momentum as a way of determining disease transmission and immunity in populations, particularly with respect to vaccine preventable diseases. At the end of 2017, the Oxford University Clinical Research Unit and the National Institute of Hygiene and Epidemiology held a meeting in Vietnam with national policy makers, researchers, and international experts to discuss current seroepidemiologic projects in Vietnam and future needs and plans for nationwide serosurveillance. This report summarizes the meeting and the plans that were discussed to set up nationwide serosurveillance in Vietnam.

Background Streptococcus suis is a zoonotic disease mainly affecting men of working age and can result in death or long-term sequelae, including severe hearing loss and vestibular dysfunction. We aimed to quantify the burden of disease and economic impact of this infection in Viet Nam. Methods The annual disease incidence for the period 2011–2014 was estimated based on surveillance data using a multiple imputation approach. We calculated disease burden in disability-adjusted life years (DALYs) and economic costs using an incidence-based approach from a patient’s perspective and including direct and indirect impacts of S. suis infection and its long-term sequelae. Results The estimated annual incidence rate was 0.318, 0.324, 0.255 and 0.249 cases per 100 000 population in 2011, 2012, 2013 and 2014, respectively. The corresponding DALYs lost were 1832, 1866, 1467 and 1437. The mean direct cost per episode was US$1635 (95% confidence interval 1352–1923). The annual direct cost was US$370 000–500 000 and the indirect cost was US$2.27–2.88 million in this time period. Conclusions This study showed a large disease burden and high economic impact of S. suis infection and provides important data for disease monitoring and control.

Background Ventilator-associated pneumonia (VAP) is the commonest hospital-acquired infection (HAI) in intensive care. In Asia, VAP is increasingly caused by resistant gram-negative organisms. Despite the global antimicrobial resistance crisis, the epidemiology of VAP is poorly documented in Asia. Methods We systematically reviewed literature published on Ovid Medline, Embase Classic, and Embase from 1 January 1990 to 17 August 2017 to estimate incidence, prevalence, and etiology of VAP. We performed a meta-analysis to give pooled rates and rates by country income level. Results Pooled incidence density of VAP was high in lower- and upper-middle-income countries and lower in high-income countries (18.5, 15.2, and 9.0 per 1000 ventilator-days, respectively). Acinetobacter baumannii (n = 3687 [26%]) and Pseudomonas aeruginosa (n = 3176 [22%]) were leading causes of VAP; Staphylococcus aureus caused 14% (n = 1999). Carbapenem resistance was common (57.1%). Conclusions VAP remains a common cause of HAI, especially in low- and middle-income countries, and antibiotic resistance is high., Ventilator-associated pneumonia (VAP) is the commonest infection in intensive care. Our systematic review and meta-analysis found VAP incidence rates to be highest in low-income compared with high-income countries in Asia. Antimicrobial resistance rates are also alarmingly high.

Hightlights • Severe hearing and vestibular impairment persists in many S. suis survivors. • Hearing function tends to only improve in the first 3 months post discharge. • Vestibular dysfunction shows little recovery during the follow-up time period. • Survivors reported significantly lower health status and quality of life. • Appropriate patient management strategies are needed to reduce disease impact., Summary Objectives Streptococcus suis is a zoonotic cause of severe meningitis and sepsis in humans. We aimed to assess the long-term outcomes in patients who survived S. suis infection, in particular the progress and impact of vestibulocochlear sequelae. Methods This case-control study evaluated outcomes of S. suis infection at discharge and 3 and 9 months post-discharge for 47 prospectively enrolled cases and at 11–34 months for 31 retrospectively enrolled cases. Outcomes in patients were compared to 270 controls matched for age, sex and residency. Results The prevalence ratio (PR) of moderate-to-complete hearing loss was 5.0(95%CI 3.6–7.1) in cases at discharge, 3.7(2.5–5.4) at 3 months, 3.2(2.2–4.7) at 9 months, and 3.1(2.1–4.4) in retrospective cases compared to controls. Hearing improvement occurred mostly within the first 3 months with a change in hearing level of 11.1%(95%CI 7.0–15.1%) compared to discharge. The PR of vestibular dysfunction was 2.4(95%CI 1.7–3.3) at discharge, 2.2(1.4–3.1) at 3 months, 1.8(1.1–2.5) at 9 months, and 1.8(1.1–2.6) for retrospective cases compared to controls. Cases also indicated more problems with mobility, self-care and usual activities. Conclusions Both hearing and vestibular impairment were common and persist in cases. Appropriate patient management strategies are needed to reduce the incidence and impact of these sequelae.

We assessed consumption of raw pig blood, which is a risk factor for Streptococcus suis infection in Vietnam, by using a mix-method design. Factors associated with consumption included rural residency, age, sex, occupation, income, and marital status. We identified risk groups and practices and perceptions that should be targeted by communication programs.

SUMMARYPorcine reproductive and respiratory syndrome (PRRS) outbreaks in pigs are associated with increased susceptibility of pigs to secondary bacterial infections, including Streptococcus suis – an important zoonotic pathogen causing bacterial meningitis in humans. This case-control study examined the association between human S. suis infection and PRRS outbreaks in pigs in northern Vietnam. We included 90 S. suis case-patients and 183 non-S. suis sepsis controls from a referral hospital in Hanoi in 2010, a period of major PRRS epizootics in Vietnam. PRRS exposure was determined using data from the National Centre of Veterinary Diagnosis. By univariate analysis, significantly more S. suis patients were reported residing in or adjacent to a PRRS district compared to controls [odds ratio (OR) 2·82, 95% confidence interval (CI) 1·35–5·89 and OR 3·15, 95% CI 1·62–6·15, respectively]. Only residency in adjacent districts remained significantly associated with risk of S. suis infection after adjusting for sex, occupation, and eating practices. SaTScan analysis showed a possible cluster of S. suis infection in humans around PRRS confirmed locations during the March–August period. The findings indicate an epidemiological association between PRRS in pigs and S. suis infections in humans. Effective strategies to strengthen control of PRRS in pigs may help reduce transmission of S. suis infection to humans.

Forty-four Thai isolates phenotypically assigned to the genus Gluconobacter were examined for 16S-23S rDNA ITS restriction analysis by MboII and SduI (=Bsp1286I) digestions. The Thai isolates tested were divided into seven groups: Group I for fourteen isolates, Group IX for one isolate, Group X for two isolates, Group V-2 for four isolates, Group XI for three isolates, Group IV for one isolate, and Group III for nineteen isolates. There were no isolates of either Group II or Group V-1 that were identified as G. cerinus. The isolates of Group III, Group IV, and Group XI were subjected to an additional 16S-23S rDNA ITS restriction analysis by AvaII, TaqI, BsoBI, and BstNI digestions. The isolates of Group III were divided into three groups and two subgroups: Group III-2 for five isolates, Group III-6 for two isolates, and Group III-4, which was divided into two subgroups, Subgroup III-4a for four isolates and Subgroup III-4b for eight isolates. The fourteen isolates of Group I were identified as G. oxydans, and the two isolates of Group X were temporarily identified as G. oxydans. The five isolates of Group III-2 and the one isolate of Group IV were identified as G. frateurii. The remaining twenty-two isolates of Group V-2, Group III-4, Group III-6, Group IX, and Group XI were not identified but are candidates for several new species.

To the Editor: Streptococcus suis, an opportunistic pathogen of swine, is an emerging zoonotic pathogen among humans (1). In Vietnam, S. suis is the leading cause of human acute bacterial meningitis (2). Infection in humans is associated with direct exposure to infected pigs or infected raw or undercooked pork products (3). Of the 35 S. suis serotypes, only a limited number are pathogenic for pigs, and clinical cases in humans have most frequently been attributed to serotype 2 (SS2) (1). In Vietnam during September 2006–November 2007, the carrier rate of S. suis among slaughterhouse pigs was 41% (222/542); SS2 was the most frequently identified serotype in 14% (45/317) of S. suis isolations (4). Porcine respiratory and reproductive syndrome (PRRS) is a major disease affecting the swine industry globally; the severity of PRRS in pigs can be increased by co-infection with S. suis (5). In 2010, PRRS outbreaks in swine were reported in 49 of 63 Vietnamese provinces (Technical Appendix Figure) (6). To understand the potential implications of swine PRRS outbreaks for human S. suis disease, we investigated co-infections of S. suis and PRRS virus (PRRSV) in sick pigs in 3 provinces of Vietnam during the PRRS outbreaks in 2010 (Technical Appendix Figure). We sampled 108 farms reporting pigs that had a clinical syndrome consistent with PRRSV infections in the provinces of Thai Binh (May), Tien Giang (July), and Soc Trang (July). Samples were blood from sick febrile pigs and postmortem tissue from freshly culled pigs. To confirm swine PRRS outbreaks, we performed reverse transcription real-time PCR on 1 randomly selected plasma sample from each farm (7). A total of 103 (95%) plasma samples from 103 farms tested positive for PRRSV (Chinese genotype). We additionally selected 3 PRRSV-positive farms per province for comprehensive PRRSV screening of all 42 sampled pigs; 100% of samples from the 9 farms were PRRSV positive. After swine outbreaks ended, blood samples from 52 healthy pigs from 10 farms that had no recent history of PRRS were collected from Tien Giang Province (March 2011). None of the 52 plasma samples from the 10 control farms tested positive for PRRSV. We investigated the presence of SS2 in blood and tissue samples from pigs on PRRS- and non-PRRS–affected farms by bacterial culture (Technical Appendix Table). A total of 534 specimens from sick pigs yielded 9 (1.7%) SS2 isolates. One (2%) of 52 specimens from the healthy control pigs yielded a non-SS2 S. suis isolate. S. suis has been proposed to contribute to the spread of antimicrobial resistance genes to other human pathogenic streptococci (8). The antimicrobial susceptibility results of 9 SS2 isolates by disk diffusion (9) revealed a high prevalence (6/9, 66%) of resistance to tetracycline, tobramycin, enrofloxacin, and either marbofloxacin or chloramphenicol. PCR amplification of the 16SrDNA gene (10) and the cps2J gene (2) was performed on all blood samples to detect S. suis and SS2, respectively. Ninety-two (18%) of 521 sick pigs from PRRSV outbreak farms were systemically infected with S. suis. In contrast, no healthy pigs from control farms were positive for S. suis by PCR (Technical Appendix Table). The SS2-cps2J–specific PCR was positive for 58 (11%) of 521 samples, and the S. suis-16SrDNA PCR was positive for 55 (11%). Twenty-one of the 16SrDNA-positive samples also were positive for cps2J-PCR, which indicated that 34 (7%) sick pigs were infected with non-SS2 strains. Therefore, SS2 accounted for most (58 [63%] of 92) S. suis–positive detections. The bacterial load of SS2 in blood ranged from 1 × 103 CFU/mL–1 to 8.3 × 106 CFU/mL–1 (median 9.2 × 103 CFU/mL–1). Overall, SS2 was found in 58 (11%) sick pigs and on 33 (32%) PRRS outbreak farms. The higher prevalence (92 [18%]) of systemic infections of S. suis and SS2 with high bacterial load in pigs from PRRS outbreak farms compared with prevalence on nonoutbreak farms (1 [2%] of 52) suggests increased systemic S. suis infections during swine PRRS outbreaks (p = 0.001, Fisher exact test). We investigated the possible association between swine PRRS outbreaks and human S. suis infection. Case reports of confirmed human infections during 2007–2010 at the 2 tertiary referral hospitals in Hanoi and Ho Chi Minh City were reviewed. The number of human S. suis infection cases increased in August 2010 in southern Vietnam and doubled in northern Vietnam during May–August and October–November 2010 (Figure). Swine PRRS outbreaks were reported during June–September and March–December 2010 in southern and northern provinces, respectively (6) (Technical Appendix Figure). Most patients with S. suis infection during these periods resided in provinces reporting swine PRRS outbreaks. Our data suggest a possible temporal association between swine PRRS outbreaks and human S. suis infections. Figure Monthly distribution of human Streptococcus suis infections in 2 referral hospitals, Vietnam, 2007–2010. Humans infected with S. suis during 2007–2009 are presented as mean total cases per month. Dark gray and black bars represent the ... We demonstrated increased prevalence of systemic S. suis and SS2 infection in pigs co-infected with PRRSV during the 2010 swine outbreaks in Vietnam. The results indicate an increased risk for potential zoonotic transmission of S. suis to humans during outbreaks of PRRS in swine. Technical Appendix: Systemic Streptococcus suis infections in sick pigs from farms with confirmed porcine reproductive and respiratory syndrome and temporal distribution of outbreaks of porcine reproductive and respiratory syndrome in swine, 3 provinces, Vietnam, 2010. Click here to view.(151K, pdf)

Thirty-seven Haemophilus influenzae strains from nasopharyngeal swabs (NP) and 44 H. influenzae strains from cerebrospinal fluid (CSF) were investigated. Of the 37 H. influenzae isolates from NP, the serotypes of 30 isolates were nontypeable, 4 were type b, 2 were type c, and 1 was type a, whereas all of the 44 isolates from CSF were type b. The MICs of 16 antibiotics for the H. influenzae isolates from NP and CSF were similar, and no β-lactamase-negative ampicillin-resistant strain was found. Molecular typing by pulsed-field gel electrophoresis (PFGE) showed that the 37 H. influenzae strains from NP had 22 PFGE patterns, with none predominating, and the 44 H. influenzae strains from CSF had 9 PFGE patterns, with patterns α (22 isolates) and β (12 isolates) predominating. Our results indicate that two predominant types of H. influenzae type b strains have the potential to spread among children with meningitis in Hanoi, Vietnam.

An unsupervised competitive neural network for efficient classification of image textures is proposed. The proposed neural network architecture, called centroid neural network with Chi square distance measure (CNN-χ2), employs the Chi square measure as its distance measure and utilizes the local binary pattern (LBP) as an effective feature extraction tool for image data. The proposed CNN-χ2 is applied to image texture classification problems on the Brodatz texture album database. The results are compared with those of conventional approaches including the HMT (hidden Markov tree), IMM (independence mixture model), and WES (wavelet energy signatures). The evaluated results demonstrate that the proposed CNN-χ2 classification algorithm outperforms the conventional algorithms in terms of classification accuracy.

An unsupervised competitive neural network for efficient recognition of facial images is proposed. The proposed unsupervised competitive neural network, called centroid neural network with Chi square distance measure (CNN-χ2), employs the Chi square measure as its distance measure and utilizes the local binary pattern (LBP) as an effective feature extraction tool for image data. The proposed CNN-χ2 is applied to a face recognition problem on the Yale face database. The results are compared with those of well-known approaches including KFD (Kernel Fisher Discriminant based on eigenfaces), RDA (Regularized Discriminant Analysis), and Sobel faces combined with 2DPCA (two dimensional Principle Component Analysis). The evaluated results demonstrate that the proposed CNN-χ2 algorithm outperforms recent state-of-art algorithms in terms of recognition rate.

A novel approach for the extraction of rectangular boundaries from aerial image data is proposed and presented in this paper. In this approach, a Centroid Neural Network (CNN) with a metric of line segments is also proposed for connecting low-level linear structures or grouping similar objects. Extracting rectangular boundaries for building rooftops from an edge image without height information of buildings such as stereo pairs or digital elevation models is very challenging and difficult. We introduce an approach that involves a combination of many algorithms to identify rectangular boundaries in a bottom-up manner. After the straight lines are extracted from an edge image using the CNN, rectangular boundaries are then found by using an edge-based grouping approach originating from perceptual concepts. We present the steps of the proposed building rooftop recognition method and experimental results on an edge image.

Forty-four Thai isolates phenotypically assigned to the genus Gluconobacter were examined for 16S-23S rDNA ITS restriction analysis by MboII and SduI (=Bsp1286I) digestions. The Thai isolates tested were divided into seven groups: Group I for fourteen isolates, Group IX for one isolate, Group X for two isolates, Group V-2 for four isolates, Group XI for three isolates, Group IV for one isolate, and Group III for nineteen isolates. There were no isolates of either Group II or Group V-1 that were identified as G. cerinus. The isolates of Group III, Group IV, and Group XI were subjected to an additional 16S-23S rDNA ITS restriction analysis by AvaII, TaqI, BsoBI, and BstNI digestions. The isolates of Group III were divided into three groups and two subgroups: Group III-2 for five isolates, Group III-6 for two isolates, and Group III-4, which was divided into two subgroups, Subgroup III-4a for four isolates and Subgroup III-4b for eight isolates. The fourteen isolates of Group I were identified as G. oxydans, and the two isolates of Group X were temporarily identified as G. oxydans. The five isolates of Group III-2 and the one isolate of Group IV were identified as G. frateurii. The remaining twenty-two isolates of Group V-2, Group III-4, Group III-6, Group IX, and Group XI were not identified but are candidates for several new species.