Hanoi School Of Public Health

This study aimed to assess the lasting effects of early-life dioxin exposure via breastfeeding on the endocrine and reproductive health of children at 14years of age, continuing a Vietnamese longitudinal cohort started in 2008. The participants were 68 mother-child pairs (38 from a dioxin hotspot and 30 from a non-exposure area). Serum steroid hormones in adolescents were quantified by liquid chromatography-tandem mass spectrometry and linked to their mother's breast milk dioxin congener levels collected within 4-16weeks postpartum. Secondary sexual characteristics in girls and testicular volume in boys were clinically assessed. The results showed sex-specific differences. In girls from the hotspot, body weight and head circumference were significantly lower than those in the non-exposure area and showed negative correlations with specific dioxin congeners and steroid hormones. Hormonal analysis revealed significantly lower levels of estrone and estradiol, but higher cortisol levels, in both exposed genders. Estrone and estradiol displayed negative correlations with dioxins, stronger in girls. Conversely, cortisol showed positive correlations with most dioxin congeners and total toxic equivalents (TEQs) in boys only. Additionally, allopregnanolone levels were higher and positively correlated with dioxin in boys, while androstenedione and androstanediol were significantly lower in hotspot girls. Notably, testicular volume in boys did not differ or correlate with dioxin exposure. In conclusion, lactational dioxin exposure might associated with long-term, sex-specific disruption of steroid hormone homeostasis and impaired physical growth during puberty, particularly in girls.

The simultaneous determination of multiple organic compounds in complex food and biological matrices is increasingly essential for ensuring food safety, understanding bioactive nutrient dynamics, and assessing chronic exposure to contaminants. This review provides a comprehensive evaluation of modern sample preparation strategies, including Quick, Easy, Cheap, Effective, Rugged, and Safe (QuEChERS); Solid-Phase Extraction (SPE); Dispersive Solid-Phase Extraction (d-SPE); Solid-Phase Microextraction (SPME); and Liquid–Liquid Extraction (LLE), for their applicability in extracting diverse classes of organic compounds ranging from pesticides, mycotoxins, to phytochemicals and environmental residues. Each technique was assessed for recovery efficiency, selectivity, matrix effect minimization, and integration with Gas Chromatography–Tandem Mass Spectrometry (GC-MS/MS) and Liquid Chromatography–Tandem Mass Spectrometry (LC-MS/MS), which are widely applied in food safety, environmental, and biomedical monitoring. Comparative analysis highlights that QuEChERS-based approaches offer rapid, solvent-saving workflows suitable for fruits, vegetables, and grain-based samples, whereas SPE and SPME exhibit superior performance in trace-level analysis of biofluids and lipid-rich matrices. The review further emphasizes the critical role of tailored sample preparation in improving data reliability and supporting downstream applications in dietary exposure assessment, functional food development, and food-medicine homology research. These findings reinforce the need for robust, matrix-adaptable, and automation-compatible preparation protocols to advance the analytical precision in food as medicine studies and contribute to public health strategies based on nutritional therapeutics.

The COVID-19 pandemic has posed unique challenges for people with disabilities, highlighting significant structural disparities in access to essential health information and services. In Vietnam, these challenges are pronounced, necessitating an investigation into the experiences of people with disabilities during the pandemic. This study aimed to investigate the experiences of people with disabilities in three major cities in Vietnam in accessing COVID-19 information and adhering to preventive measures. In-depth interviews were conducted with 23 adults with disabilities from Hanoi, Da Nang, and Ho Chi Minh City. Participants were purposively selected from government registers based on age, gender, residence location, and disability type. Data were analysed thematically. Respondents revealed significant barriers to accessing information on COVID-19 prevention. Key issues included the use of technical language, combined with low literacy among respondents, poor access to assistive and information-communication technology, and lack of accessible information formats or unsuitable adaptations. Difficulties in implementing preventive measures and heightened anxiety were common among participants, leading some to be unable to adequately protect themselves, while others undertook additional, unconventional measures. This research emphasizes the urgency of redefining disability inclusion in public health responses, particularly during crises like the COVID-19 pandemic. Tailored guidance and resources are essential to address the unique challenges faced by people with disabilities to ensure equitable health outcomes.

We previously reported that the fathers of the Bien Hoa birth cohort in Vietnam showed altered brain regional gray matter volumes, as measured by magnetic resonance imaging, and social anxiety traits associated with perinatal dioxin exposure. In the present study, we aimed to compare gray matter volumes and social anxiety scale scores between dioxin-exposed fathers in Bien Hoa and unexposed controls in an unsprayed area. Fat-based bioassay-toxic equivalency levels in serum were used to indicate dioxin exposure in adulthood. Results indicated that the longer Bien Hoa residency group (≥30 years) exposed to dioxins during the perinatal period and early childhood showed higher gray matter volumes in the right and left temporal lobes than controls. However, no significant differences in temporal lobe gray matter volumes were found between the shorter Bien Hoa residency group (<30 years) and controls. Furthermore, the longer, but not shorter, Bien Hoa residency group showed higher social–emotional subscale scores than controls. Additionally, fat-based bioassay-toxic equivalency levels were inversely correlated with gray matter volumes in several right temporal gyri. These findings suggest biphasic life stage-dependent adverse effects of dioxin exposure: perinatal dioxin exposure increases gray matter volumes, especially in the temporal lobe, which leads to neurodevelopmental disorders with socio-emotional disturbances, whereas dioxin exposure after brain development decreases cortical gray matter volumes, possibly leading to cognitive dysfunction.

BackgroundSeasonal influenza poses an enormous burden worldwide, with older adults facing preventable morbidity and mortality. However, seasonal influenza vaccination coverage is poor among older populations in China. Pay-it-forward (giving a person a free vaccine and an opportunity to donate to support others) and financial incentives (e.g. free vaccination) could be effective in improving influenza vaccine uptake, but there are no prospective comparisons of these two strategies among older adults. The proposed study aims to compare the effectiveness of the pay-it-forward strategy in increasing influenza vaccination against free vaccination and user-paid vaccination among older adults in China.MethodsThis study is a three-arm cluster randomized controlled trial, which will be conducted in 21 community health centers across seven cities in China. A total of 1113 eligible older adults aged ≥ 60 years will be recruited. Three clusters in each city (total of 21 clusters in 7 cities) will be randomized into three arms in a 1:1:1 ratio, including (1) pay-it-forward arm: free vaccination and participants donate any amount of money to help other people; (2) free vaccination arm; and (3) standard-of-care arm (user-paid vaccination). The primary outcome is influenza vaccination verified by administrative records. Secondary outcomes include willingness to be vaccinated, willingness to donate, amount of donation, and incremental cost-effectiveness ratio. The primary outcome will be calculated for each arm and compared using one-way variance analysis.DiscussionThis study will examine the effectiveness of pay-it-forward strategy in comparison to the free vaccination and user-paid vaccination in improving influenza vaccination among older adults. Our findings will provide insights into better strategies for enhancing influenza vaccination, and support evidence-based policy decisions for promoting influenza vaccination.Trial registrationChinese Clinical Trial Registry (No. ChiCTR2400086840). Registered on 11 July 2024.

BackgroundDiabetes is a major global health concern. However, with proper treatment and management, individuals can lead healthy and fulfilling lives. Shared medical appointment (SMA), an integrated health service, effectively improves the clinical and behavioral outcomes of people living with diabetes (PLWD). Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, this review aimed to evaluate the impact of SMA on PLWD treatment and management to inform the feasibility, sustainability, scalability, and equity of future SMA implementation.MethodsEight electronic databases were searched for randomized controlled trials, non-randomized grouped controlled trials, pre/post studies, and interrupted time series model studies published in English and Chinese until February 2024. The information extraction was guided by the framework for outcome evaluation in implementation science, the RE-AIM framework. We performed meta-analyses for all randomized controlled trials (RCTs) using a random-effects model and presented Forrest plots and test statistics (Cochran's Q and I2) for heterogeneity analysis. Other results that did not lend themselves to quantitative analysis were summarized qualitatively.ResultsForty-seven studies were included in the review. The studies were evaluated according to the RE-AIM framework, and most studies reported effectiveness well, while all other dimensions were poorly reported. Most studies demonstrated that SMA effectively improved patients' Hemoglobin A1c (HbA1c) and Systolic Blood Pressure (SBP) levels and reduced healthcare costs. However, the SMA was a highly resource-demanded and complex intervention package.DiscussionThe available evidence suggests that the SMA was beneficial in improving PLWD management and health outcomes among PLWD. However, its complexity would constrain its feasibility and scalability. Future research should assess the effect size of each intervention component and evaluate the implementation process, costs, and maintenance of SMA intervention, especially in resource-limited settings, to improve its sustainability, scalability, and equity.

BackgroundPatient satisfaction is increasingly recognized as a key measure of quality care, reflecting patients’ judgments on its quality and effectiveness. Ensuring that patient expectations and needs are met is a professional responsibility of healthcare providers. This study aims to assess the satisfaction of patients enrolled in the National Health Insurance Program (NHIP) across its various components.MethodsWe conducted a cross-sectional study at 22 health facilities across 3 provinces of Nepal. We utilized client-exit interviews among 468 patients enrolled and utilizing the health services under NHIP using convenience sampling. We used a Health Insurance Satisfaction Questionnaire (HISQ) incorporating the various dimensions of the NHIP along with various contextual sociodemographic characteristics. We calculated mean score and percentages of patient satisfaction across the four domains of health insurance. To determine the association between various dimensions of patient satisfaction and sociodemographic characteristics of the patient, we used multi-ordinal logistic regressions.ResultsAmong 468 patients, the mean age was 46 ± 16 years and over half (57.9%) had attained a secondary or higher level of education. Most respondents (76.5%) had been enrolled in the National Health Insurance Program (NHIP) for over one year, with 18.8% enrolled as a subsidized group. Regarding the satisfaction level of insured clients with NHIP, highest proportion (98.9%) of satisfied patients were in service utilization. Similarly, the domains of knowledge and administrative had satisfaction rates of 70.1% and 85.5% respectively. Conversely, satisfaction rate was observed lowest in service availability domain (60.7%). Sociodemographic factors influenced knowledge of NHIP, with education above secondary level (AOR: 7.71; 95% CI: 3.39–17.50) and age over 60 years (AOR: 1.56; 95% CI: 1.05–2.32) being significant predictors. Other sociodemographic variables such as family size, subsidy status, and occupation were associated with multiple dimensions of satisfaction (p < 0.05).ConclusionAs lower satisfaction in the service availability and knowledge domains were identified, it is essential to maintain and disseminate information about the NHIP schemes across the country. Additionally, consistent monitoring and supply of medicines and drugs can help restore consumer trust in the insurance program, as many are currently burdened by out-of-pocket expenses for these necessities despite being enrolled as NHIP beneficiaries.

Fan-verbal aggression conflict is a worldwide universal phenomenon. As opposed to condemning fans as reckless or irrational, our work provides an evolutionary psychology perspective to give a possible explanation of this phenomenon. This paper points out that people in modern society join alliances for shared interests and then face an anti-exploitation mechanism. To preserve the right to gain resources and avoid losing benefits from an alliance, showing verbal aggression in public affirms ones role as a contributor rather than a cheater or free rider. Eventually, when conflict occurs, instead of mediating, getting involved or keeping silent are usually the only choices, leaving the dispute to heat up. We reveal this psychological computation from the theory of welfare tradeoff ratios. The group members WTR to the aggressor will be higher than their WTR to the non-aggressor. Participants in college with experience in idol chasing (N=500) will be involved.