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Nghiên cứu nhằm mục tiêu mô tả thực trạng nhiễm HIV và một số yếu tố liên quan đến hội chứng/bệnh thường gặp ở trẻ 10-15 tuổi nhiễm HIV đang điều trị ARV tại Bệnh viện Nhi Trung ương năm 2020. Phương pháp mô tả, cắt ngang thực hiện trên 187 bệnh nhân, trong đó tuổi trung bình là 12,84±1,65 tuổi, tỷ lệ nam/nữ là 1,2/1. Phần lớn trẻ nhiễm HIV được ghi nhận trong nghiên cứu này là lây nhiễm HIV từ mẹ (trên 90%). Tỷ lệ trẻ xác định nhiễm HIV > 1 năm là 98,93%, đây cũng là tỷ lệ của trẻ có thời gian điều trị ARV > 1 năm. Hội chứng suy mòn do nhiễm HIV (11,22%) và Lao (9,63%) là bệnh nhiễm trùng cơ hội thường gặp trước khi điều trị ARV được ghi nhận nhiều nhất trong bệnh án ngoại trú. Tại thời điểm nghiên cứu giai đoạn lâm sàng I chiếm tỷ lệ chủ yếu (97,86%), tải lượng virus dưới ngưỡng (81,3%), xét nghiệm T-CD4 ≥ 500 (82,9%), phác đồ 1 được sử dụng để điều trị chủ yếu (80,7%). Giới, địa bàn sinh sống, sự phát triển thể chất, phác đồ điều trị, nồng độ TCD-4, tải lượng virus, thời gian nhiễm HIV, thời gian điều trị ARV không liên quan đến nhiễm trùng cơ hội. Một số yếu tố liên quan có ý nghĩa tới việc mắc các bệnh nhiễm trùng cơ hội đó là Xquang phổi có bất thường và giai đoạn lâm sàng.

Aim This study assessed the Streptococcus pneumoniae colonisation rate and susceptibility to antibiotics among preschool children in rural Vietnam. Method Nasopharyngeal samples were collected from 546 preschool children aged 6-59 months living in 460 households in the rural BaVi District of Hanoi and their main caregivers completed questionnaires. The samples were cultured, and the Streptococcus pneumoniae colonisation rate and antibiotic susceptibility were investigated. Resistance data from this 2014 study were compared with studies in 1999 and 2007, to identify 15-year trends, together with clinical isolates from a national surveillance system of 16 Vietnamese hospital laboratories established in 2013. Results We found that 221/546 (40%) of the cultures were positive for Streptococcus pneumoniae. The susceptibility rates were trimethoprim-sulphamethoxazole (5%), erythromycin (8%), ciprofloxacin (12%), benzyl-penicillin (35%), tetracycline (49%), cefotaxime (55%), moxifloxacin (99%) and vancomycin (99%). All the susceptibility rates were lower in 2014 than 1999 and 2007, except tetracycline. Multi-drug resistance was 80% in 2014, compared to 60% in 2007 and 31% in 1999. Antibiotics was reported used by 191 (35%) within one month, mainly cephalosporins 86 (45%), amoxycillin/ampicillin 69 (36%) and macrolides 30 (16%). Conclusion Streptococcus pneumoniae showed remarkable high resistance to commonly used antibiotics, including cephalosporins. Multi-drug resistance rose from 31% to 80% during the 15-year study period.

BackgroundNeonatal sepsis is a leading cause of child mortality, and increasing antimicrobial resistance threatens progress towards the Sustainable Development Goals. Evidence to guide antibiotic treatment for sepsis in neonates and young infants from randomized controlled trials or observational studies in low- and middle-income countries (LMICs) is scarce. We aimed to describe patterns of antibiotic use, pathogens and outcomes in LMIC hospital settings globally to inform future clinical trials on the management of neonatal sepsis.Methods & FindingsHospitalised infants aged 206 different empiric antibiotic combinations were used, which were structured into 5 groups that were developed from the World Health Organisation (WHO) AWaRe classification. 25.9% (n=814) of infants started a WHO first line regimen (Group 1 -Access, penicillin-based regimen) and 13.8% (n=432) started WHO second-line cephalosporins (cefotaxime/ceftriaxone) (Group 2- ‘Low’ Watch). The largest group (34.0%, n=1068) started a regimen providing partial extended-spectrum beta-lactamase (ESBL)/pseudomonal coverage (piperacillin-tazobactam, ceftazidime, or fluoroquinolone-based) (Group 3 – ‘Medium’ Watch), 18.0% (n=566) started a carbapenem (Group 4 – ‘High’ Watch), and 1.8% (n=57) started a Reserve antibiotic (Group 5, largely colistin-based). Predictors of starting non-WHO recommended regimens included lower birth weight, longer in-hospital stay, central vascular catheter use, previous culture positive sepsis or antibiotic exposure, previous surgery and greater sepsis severity. 728/2880 (25.3%) of initial regimens in Group 1-4 were escalated, mainly to carbapenems, and usually for clinical indications (n=480; 65.9%).564 infants (17.6%) isolated a pathogen from their baseline blood culture, of which 62.9% (n=355) had a Gram-negative organism, predominantlyKlebsiella pneumoniae(n=132) andAcinetobacterspp. (n=72). These leading Gram-negatives were both mostly resistant to WHO-recommended regimens, and also resistant to carbapenems in 32.6% and 71.4% of cases respectively. MRSA accounted for 61.1% ofStaphylococcus aureus(n=54) isolates.Overall, 350/3204 infants died (11.3%; 95%CI 10.2-12.5%), with 17.7% case fatality rate among infants with a pathogen in baseline culture (95%CI 14.7-20.1%, n=99/564). Gram-negative infections accounted for 75/99 (75.8%) of pathogen-positive deaths, especiallyKlebsiella pneumoniae(n=28; 28.3%), andAcinetobacterspp. (n=24; 24.2%).ConclusionA very wide range of antibiotic regimens are now used to treat neonatal sepsis globally. There is common use of higher-level Watch antibiotics, frequent early switching and very infrequent de-escalation of therapy. Future hospital based neonatal sepsis trials will ideally need to account for the multiple regimens used as standard of care globally and include both empiric first line regimens and subsequent switching in the trial design.Author SummaryWhy was this study done?➢Increasing trends in antimicrobial resistance (AMR) disproportionately affect neonates and young infants with sepsis in LMIC settings and undermine the effectiveness of WHO-recommended antibiotics.➢Despite this, longitudinal data on antibiotic management strategies and outcomes of affected hospitalised neonates and young infants in LMIC settings are extremely limited, impeding the design of robust antibiotic trials.What did the researchers do and find?➢To our knowledge this is the first global, prospective, hospital-based observational study of clinically diagnosed neonatal sepsis across 4 continents including LMIC settings, with daily data on clinical status, antibiotic use and outcomes.➢There was a high mortality among infants with culture positive sepsis (almost 1 in 5), and a significant burden of antibiotic resistance.➢This study highlights wide variations in standard of care for sepsis in neonates and young infants with more than 200 different antibiotic combinations, significant divergence from WHO-recommended regimens, and frequent switching of antibiotics.What do these findings mean?➢These data demonstrate that patterns of routine antibiotic use are now markedly divergent from global guidance➢There is an urgent need for randomised controlled trials to address optimal empiric first and second line antibiotic treatment strategies in LMIC hospital settings with a significant AMR burden.➢Data from this study can inform the design of multicentre hospital-based neonatal antibiotic trials in LMIC settings.➢The wide range of multiple antibiotic regimens routinely used as Standard of Care (SOC) suggests the need for novel trial designs.

We report on the public health response generated by an outbreak of coronavirus disease (COVID-19) that occurred during March 2020 at Bach Mai Hospital (BMH) in Hanoi, northern Vietnam’s largest hospital complex. On March 18, a total of 3 distinct clusters of COVID-19 cases were identified at BMH. Diagnosis of the initial 3 COVID-19 cases led to contact tracing, symptom screening, and testing of 495 persons and limited quarantine of affected institutes or departments. When 27 staff members in the catering company tested positive for SARS-CoV-2, the entire BMH staff (7,664 persons) was put under quarantine. Contact tracing in the community resulted in an additional 52,239 persons being quarantined. After 3 weeks, the hospital outbreak was contained; no further spread occurred in the hospital. Rapid screening of cases, extensive testing, prompt quarantine, contact tracing, and social distancing contributed to prevent community transmission in Hanoi and northern Vietnam.

Objectives: The carbapenemase-encoding gene blaNDM-1 has been reported in Vietnam during the last 10 years, and blaNDM-producing Enterobacteriaceae are now silently and rapidly spreading. A key factor behind dissemination of blaNDM-1 is plasmids, mobile genetic elements that commonly carry antibiotic resistance genes and spread via conjugation. The diversity of blaNDM-1-encoding plasmids from neonates at a large Vietnamese hospital was characterized in this study. Methods: 18 fecal Klebsiella pneumoniae and Klebsiella quasipneumoniae isolates collected from 16 neonates at a large pediatric hospital in Vietnam were studied using optical DNA mapping (ODM) and next-generation sequencing (NGS). Plasmids carrying the blaNDM-1 gene were identified by combining ODM with Cas9 restriction. The plasmids in the isolates were compared to investigate whether the same plasmid was present in different patients. Results: Although the same plasmid was found in some isolates, ODM confirmed that there were at least 10 different plasmids encoding blaNDM-1 among the 18 isolates, thus indicating wide plasmid diversity. The ODM results concur with the NGS data. Interestingly, some isolates had two distinct plasmids encoding blaNDM-1 that could be readily identified with ODM. The coexistence of different plasmids carrying the same blaNDM-1 gene in a single isolate has rarely been reported, probably because of limitations in plasmid characterization techniques. Conclusions: The plasmids encoding the blaNDM-1 gene in this study cohort were diverse and may represent a similar picture in Vietnamese society. The study highlights important aspects of the usefulness of ODM for plasmid analysis. Funding: Erling-Persson foundation; Swedish Research Council (VR) via the Southeast Asia-Europe joint funding scheme for research and innovation; Swedish Research Council (VR) [330-2014-6356]; EU Marie Curie; Swedish Foundation for International Cooperation in Research and Higher Education (STINT) [SG 2015-5972]; Region Ostergotland; ALF-grants [LIO-899871]; SIDA

Background Vietnam and Southeast Asia are hotspots for antimicrobial resistance; however, little is known on the prevalence of carriage of carbapenem resistance in non-hospitalized humans and in animals. Carbapenem-resistant Enterobacteriaceae (CRE), particularly Escherichia coli (CREC) and Klebsiella pneumoniae (CRKP) and also Acinetobacter baumannii (CRAB) are emerging threats worldwide. Methods We investigated healthy humans (n = 652), chickens (n = 237), ducks (n = 150) and pigs (n = 143) in 400 small-scale farms in the Mekong Delta of Vietnam. Samples (rectal swabs, faecal swabs) were investigated for carriage of CRE/CRAB and were further characterized phenotypically and genotypically. Results In the Mekong Delta of Vietnam, the prevalence of CRE isolates in human rectal swabs was 0.6%, including 4 CREC and 1 CRKP. One pig was infected with CREC (prevalence 0.7%). CRAB was isolated from chickens (n = 4) (prevalence 2.1%) and one duck (prevalence 0.7%). CRKP was isolated from a human who was also colonized with CREC. The CRKP strain (ST16), from an 80 year-old person with pneumonia under antimicrobial treatment, genetically clustered with clinical strains isolated in a hospital outbreak in southern Vietnam. The prevalence of CRE was higher among humans that had used antimicrobials within 90 days of the sampling date than those had not (4.2% versus 0.2%) (P = 0.005). All CRE/CRAB strains were MDR, although they were susceptible to colistin and neomycin. The carbapenemase genes identified in study strains were blaNDM and blaOXA. Conclusions The finding of a CRKP strain clustering with previous hospital outbreak raises concerns about potential transmission of carbapenem-resistant organisms from hospital to community settings or vice-versa.

Mục tiêu: Mô tả chất lượng cuộc sống (CLCS) và một số yếu tố liên quan ở trẻ vị thành niên 10-15 tuổi nhiễm HIV đang điều trị ARV ngoại trú tại Bệnh viện Nhi trung ương. Đối tượng và phương pháp: Nghiên cứu cắt ngang được thực hiện trên 190 trẻ từ 10-15 tuổi nhiễm HIV đang được quản lý điều trị ARV ngoại trú tại Bệnh viện Nhi trung ương từ 6-12/2020. CLCS được đánh giá bằng công cụ PedsQL 4.0 với 23 câu hỏi liên quan đến 4 lĩnh vực về thể chất, tình cảm, xã hội và học tập. Điểm số càng cao tương ứng với CLCS càng tốt. Kết quả: Điểm trung bình CLCS chung 72,2; về sức khỏe thể chất 80,3; sức khỏe tâm lý xã hội 75,6; xã hội 82,2; cảm xúc 76,3; và học tập 68,3. Tỷ lệ CLCS tốt tính chung là 56,8%; về sức khỏe thể chất 67,9%; sức khỏe tâm lý xã hội 57,4%; về xã hội 73,2%, cảm xúc 57,9% và học tập 45,3%. Trẻ thuộc các hộ gia đình nghèo, trẻ có NCS có học vấn thấp (từ THCS trở xuống) và trẻ có thời gian từ nhà đến phòng khám từ 60 phút trở lên có CLCS thấp hơn (p

Backgroud Pneumonia is one of the leading causes of death in children under 5 years old. Viruses have historically been the most common cause of community-acquired pneumonia in children. Co-infections in severe pneumonia are more concern by clinicians. Method It was a perspective and descriptive study. Real-time polymerase chain reaction (RT-PCR) is a modern test that was used to detect many new pathogens, including microbiological co-infections. RT-PCR technique was used in this study to investigate the causes of severe pneumonia. Results Through the analysis of nasopharyngeal aspiration samples from 95 children with severe community-acquired pneumonia, the positive RT-PCR rate was 90.5%. Viral-bacterial co-infection accounted for the highest proportion (43.1%), followed by bacterial co-infection (33.7%), viral infection (7.4%), bacterial infection (6.3%) and the remaining 9.5% was unknown. In the co-infections groups, the five main bacteria species detected by PCR were Streptococcus pneumoniae, Haemophilus influenzae, MRSA, Moraxella catarrhalis and Mycoplasma pneumoniae. Conclusion Antibiotic treatment should focus on detected microbes in cases of severe pneumonia for having a good result.

Background The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, particularly in low- to middle-income countries (LMICs). Previous studies have shown high rates of CRE colonisation among patients at hospitals in LMICs, with increased risk of hospital-acquired infections. Methods We isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from faecal samples collected in 2017 from patients at admission and discharge at a Vietnamese neonatal intensive care unit (NICU). 126 CRKP were whole-genome sequenced. The phylogenetic relationship between the isolates and between clinical CRKP isolates collected in 2012–2018 at the same hospital were investigated. Results NDM-type carbapenemase-(61%) and KPC-2-encoding genes (41%) were the most common carbapenem resistance genes observed among the admission and discharge isolates. Most isolates (56%) belonged to three distinct clonal clusters of ST15, carrying blaKPC-2, blaNDM-1 and blaNDM-4, respectively. Each cluster also comprised clinical isolates from blood collected at the study hospital. The most dominant ST15 clone was shown to be related to isolates collected from the same hospital as far back as in 2012. Conclusions Highly resistant CRKP were found colonising admission and discharge patients at a Vietnamese NICU, emphasising the importance of continued monitoring. Whole-genome sequencing revealed a population of CRKP consisting mostly of ST15 isolates in three clonally related clusters, each related to blood isolates collected from the same hospital. Furthermore, clinical isolates collected from previous years (dating back to 2012) were shown to likely be clonally descended from ST15 isolates in the largest cluster, suggesting a successful hospital strain which can colonise inpatients.

HIV/AIDS is still an important public health issue in Vietnam and other developing countries. In Vietnam, Community-based organizations (CBOs) were officially considered as the key partners to approach vulnerable groups at high risks of HIV infection since 2010. Funds for HIV/AIDS prevention and control are facing difficulties due to rapid reduction by international organizations, while domestic funding has not yet met the demand, especially funding for prevention and communication activities. Our study aimed to assess the fundraising capacity of several CBOs in Ho Chi Minh City, Vietnam and analyze the challenges that they are facing now and in future in their work of HIV/AIDS management for community. The 03 typical and representative CBOs (G3VN, Smile and Strong Ladies) were chosen in our cross-sectional descriptive study. The electronic questionnaire was about fundraising reports over 3 years (2017-2019), organization structure (staff, mission, strategies) and the advantages and disadvantages in fundraising. Funds received over the year increased in total, but unstable in each projects. To have more funds, CBOs must invest time and money to have professional staff in fundraising and writing proposals. To meet requirement and survive, some CBO shifted to social enterprises and faced many difficulties in laws when being treated like profit companies. In Vietnam context, the key challenges which affect the role of funding are including: 1) Legal status; 2) Small scale; 3) Capacity of fundraising (finding calls, writing competence proposals); 4) Fewer funds on HIV/AIDS. In future, we should pay attention in scaling up and building fundraising capacity for CBOs in order to help them in applying for international funds in community projects or even in HIV/AIDS research for CBOs, social enterprises in the context of funds for nation-level phased out of Vietnam.

ObjectiveTo gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR).DesignA web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns.Setting39 NNUs from 12 countries.PatientsAny neonate admitted to one of the participating NNUs.InterventionsThis was an observational cohort study.ResultsThe number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions ConclusionAMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.

The carbapenemase-encoding gene bla18 fecal Klebsiella pneumoniae and Klebsiella quasipneumoniae isolates collected from 16 neonates at a large pediatric hospital in Vietnam were studied using optical DNA mapping (ODM) and next-generation sequencing (NGS). Plasmids carrying the blaAlthough the same plasmid was found in some isolates, ODM confirmed that there were at least 10 different plasmids encoding blaThe plasmids encoding the bla

Objectives To assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU’s) at the Vietnamese National Children’s Hospital. Method CRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status. Results CRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR − 3.2, p Conclusion Admission CRE screening and cohort care in pediatric ICU’s significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.

Syftet med studien är att skapa en förståelse över hur idrottslärare i årskurs 7-9 motiverar bollspel i undervisningen med relation till kursplanen och det centrala innehållet, samt hur idrottslärare i årskurs 7-9 relaterar momentet bollspel till kunskapskraven. Hur motiverar idrottslärare i årskurs 7-9 bollspel som momentet i undervisningen med relation till kursplanen och det centrala innehållet? Hur relaterar idrottslärare i årskurs 7-9 bollspel som momentet i undervisningen till kunskapskraven? Metod: vi har valt att använda en kvalitativ intervjustudie med semistrukturerade frågor och de använda teorierna som varit till hjälp för att tolka resultatet är läroplansteorin och KASAM. Sex utbildare idrottslärare inom ämnet idrott och hälsa för årskurs 7-9 intervjuades och valdes ut med ett bekvämlighetsurval. De intervjuade arbetade i både Stockholms län och Uppsala län. Resultat: Informanterna anpassade undervisningen genom progression och modifiering av momentet bollspel. Detta gav eleven en möjlighet att utöva bollspel på sin nivå och med progression arbeta sig mot kursplanens mål och syfte. Det som samtliga informanter kopplade bollspel i undervisningen till var kunskapskravet “Eleven kan delta i lekar, spel och idrotter som innefattar komplexa rörelser i olika miljöer och varierar och anpassar sina rörelser till aktiviteten och sammanhanget” (Skolverket, 2011. s. 51). Detta gjordes genom att de ansåg bollspel som en komplex rörelse där eleverna behöver anpassa sina rörelser till aktiviteten och för att bollspel kan utövas i olika miljöer, såsom utomhus och inomhus.

Background HIV Pre-exposure prophylaxis (PrEP) is being considered for implementation among MSM nationwide in Vietnam. However, there may be concerns about potential obstacles for PrEP adherence among Vietnamese MSM. This study aims to assess the acceptability to use PrEP, potential barriers and facilitators, and the preferences for PrEP service accessibility and delivery among Vietnamese MSM. Methods Four focus group discussions (FGDs) were conducted with 30 HIV-negative MSM in January 2018 in Hanoi, Vietnam. FGDs explored MSM’s awareness regarding PrEP, perceived benefits and barriers of PrEP use, and willingness to use PrEP. FGDs were audio-recorded and transcribed verbatim. Content analysis was used. Results The mean age of participants was 23.9 years old. Most participants realized the advantages of PrEP given its efficacy in HIV risk reduction and expressed high motivation and interest to use PrEP in the future. PrEP was considered as a supplement alongside condoms. Common concerns about PrEP included side-effects, forgetting to take the pill daily, stigmatization due to using PrEP, negative attitudes toward PrEP from other MSM and accessibility of PrEP. Participants would prefer an injectable PrEP regime if available as it was seen as easier to adhere to. Concerns were also raised that PrEP usage could be interpreted as an indication of engaging in sexual risk behavior for HIV, potentially causing suspicion in love relationships or by family and friends. Participants preferred to receive PrEP in civil business organizations and MSM-friendly clinics, and recommended that pharmacy stores would not be suitable for PrEP implementation due to lack of trust and fear of fake drugs. Conclusion This study indicated a high level of willingness to use PrEP among MSM in Vietnam in combination with condom. Strategies to raise awareness of PrEP, reduce stigma towards PrEP, and improve the accessibility among MSM in Vietnam is needed. Existing MSM-friendly clinics were recommended to implement PrEP programs in Vietnam.

There is a lack of quantitative data regarding the determination of minimum distances between weld joints in offshore structures. Existing welding standards, codes and specifications provide recommendations for minimum distances between two adjacent weld joints. The issue arises when violations of the minimum recommendations are discovered in the field or need to be exceeded during construction. This paper is a continuation on a previous paper by the same authors, where the focus was to study the mechanical and material properties of welds in close proximity. The interest in this paper is to study the residual stresses that appear during the welding process, where metal undergoes heating and cooling cycles. This process induces significant levels of residual stresses, leading to increased fatigue failure potential during the operational phase of the structural elements. The measurements were obtained by using ultrasound measurement technique. The results were later verified using X-ray Diffraction and Incremental Centre-Hole Drilling. The ultrasound measurement technique detected a distinct change in residual stresses in the weld joints, with max peaks in the weld centre line. One interesting observation from the Incremental Centre-Hole Drilling measurement in one of the as-welded specimens weld joints was that the longitudinal residual stress was in tension while the transverse direction was in compression, which was also shown in the ultrasonic measurement. In the future, a contour plot measurement would be useful to confirm the results. Another interesting observation was the high compression stresses induced locally on the specimen’s surface likely due to manual grinding with abrasive paper. The outcome of this specific experimental setup can provide a baseline for performing further investigations.

This manuscript presents the results from an experimental investigation performed to study the material and mechanical properties of two weld joints manufactured within close proximity. The experiment has been designed using seven welded S420G2 + M 500 × 300 × 15 mm structural steel plates, with varying distances between two parallel adjacent weld toes at 44, 12 and 1.3 mm. All these distances were less than the distance that has normally been recommended in standards, codes and specifications. A common requirement is four times the plate thickness, which in this experiment is 60 mm for a 15-mm-thick plate. The scope of the study was to analyze the effect the variation of distance had on the mechanical and material properties. A welding procedure specification was created and approved for the manufacturing of the weld joints. All subsequent welds were based on this welding procedure specification, in order to maintain conformance and uniformity. The non-destructive and destructive testing included: visual testing, radiographic examination, bending testing, Vickers hardness testing, Charpy V impact testing, tensile testing, as well as macro and microscopic examination. The results from the testing showed no adverse effects on the mechanical properties in the initial weld joint. This includes a complete heat-affected zone overlap in the specimen with 1.3 mm between the weld toes. These findings challenge the notion that the minimum distance requirements are based on metallurgical reasons. The outcome of this specific experimental setup can provide a baseline for performing further investigations.

There is insufficient information available in existing welding standards, codes and specifications regarding the implications of having two or several adjacently fabricated weld joints in close proximity. This has introduced fatigue life performance uncertainties, due to a lack of understanding of the inherent behaviour of weld joints in the presence of adjacent welds. Hence, it is vital to investigate the fatigue life performance and obtain quantitative data for future assessments. This experiment has been designed using six welded, and one unwelded, S420G2+M 500 × 300 × 15 mm structural steel plate. Two of these plates were used for fatigue testing, having 44 mm and 12 mm between the adjacent weld toes. These distances were less than normally recommended in standards codes and specifications. The preparation of the samples was conducted in accordance with ASTM E466-15 for homogenous materials subjected to high-cycle fatigue. The experiment was not able to detect any detrimental effect by having welds in close proximity using this specific preparation method and weld setup. The weld metal and corresponding heat-affected zones had a higher fatigue strength than that of the surrounding base material. All tested specimens failed in the base metal. The material and welding method did not seem to introduce any degrading effect on the weld joint. Important to note is that the fabrication method required a surface roughness of 0.2 µm and had likely introduced an outer layer of compressive residual stresses at yield point level 50 µm into the surface and bottom surfaces of the specimens. This might have improved the resistance to crack formation in the surface. The residual stress was obtained by using ultrasonic stress measurement technique and x-ray diffraction presented in a parallel study by the same authors.

Background Electronic health (eHealth) interventions are promising in HIV and sexually transmitted infections (STIs) prevention among men who have sex with men (MSM), given a high rate of the Internet use in this population. This study determined the preferences for eHealth interventions to prevent HIV and STIs among MSM in Hanoi, Vietnam to guide the development of future eHealth interventions. Methods Five focus group discussions (FGD) were conducted with 35 MSM recruited by purposive sampling in January 2018 in Hanoi, Vietnam. The FGDs addressed attitudes towards the feasibility and uptake of HIV/STI interventions via online modalities such as smartphone applications (apps, social network sites, or emails); preferences and concerns regarding an online HIV/STI intervention. FGDs were audio-recorded and transcribed verbatim. Content analysis was used to determine themes. Results MSM reported that they commonly searched for information regarding HIV/STI and sexual health on Facebook and a variety of mobile apps. They perceived a lack of reliable online sources, a high need, and interest for an online intervention. Most of them preferred short and concise messages without perceived sensitive words such as “HIV” or “STI”. Diversity of online modalities were preferred with information from credible sources about HIV/STI symptoms, testing and treatment, safe sex practices and testing locations with a focus on safe MSM-friendly clinics. Concerns about the need to trust the organization behind the online information and interventions, and the importance of confidentiality when participating in online interventions were raised. Conclusion High acceptance and perceived need for an online HIV/STI intervention were reported. The importance of establishing trust within the MSM community as a reliable source of information was emphasized, as well as the importance of confidentiality.

Background: Gag protein of human immunodeficiency virus (HIV) has been reported to play a crucial role in establishing infection, viral replication, and disease progression; thus, gag might be related to treatment response. The objective of this study was to investigate molecular genotypes of the gag gene, particularly the important functional binding domains in relation to treatment outcomes. Methods: HIV-infected children enrolled and treated at Vietnam National Children’s Hospital were recruited in the study. A total of 25 gag sequences were generated and used to construct phylogenetic trees and aligned with a reference sequence comparing 17 functional domains. Results: We found that all patients in a treatment failure (TF) group belonged to one cluster of the phylogenetic tree. In addition, the rate of mutations was significantly higher in TF compared with a treatment success (TS) group, specifically the PIP2 recognition motif, and the nucleocapsid basic and zinc motif 2 domains [median and (interquartile range (IQR): 12.5 (6.25–12.5) versus 50 (25–50), p Conclusion: Gag mutations in certain domains might be associated with increased viral load; therefore, studying the molecular genotype of the gag gene might be beneficial in monitoring treatment response in HIV-infected children.

Previous research showed that supervision during psychotherapy training sometimes includes negative alliance and harmful events. The aim of this study was to investigate how such events were relate...

Resistance among Klebsiella pneumoniae to the last-resort antibiotics carbapenems and colistin is increasing worldwide. In this study, whole-genome sequencing was used to determine the colistin resistance mechanisms in clinical isolates of carbapenem- and colistin-resistant K. pneumoniae from Vietnam. Alterations in the regulatory gene mgrB, via mutations and insertion sequence transpositions, were found in 30 of 31 isolates, emphasising the importance of this resistance mechanism in colistin-resistant K. pneumoniae.

Poor antiretroviral therapy (ART) adherence leads to drug resistance and treatment failures. The options for second and third line ART regimens, particularly for pediatric patients, are very limited in low and middle-income countries. HIV-infected children are mostly passive drug-takers, thus caretakers play a very important role in assuring ART adherence. Pediatric ART adherence is still a challenging problem in Vietnam since non-adherence is the major risk factor for treatment failure. Our study explores and measures caretakers' barriers in order to improve pediatric ART adherence in future.Exploring caretakers' barriers was conducted through a qualitative study with Focus Group Discussion (FGD) on two topics: 1. Current society - family support and difficulties in taking care children under ART; 2. Stigma experience. Based on the finding from the qualitative study a quantitative study measuring caretakers' barriers was conducted through a designed questionnaire. Study methods strictly followed the consolidated criteria with 32-item checklist for interviews and focus groups.In total eight FGDs with 53 participants were conducted. Common caretakers' barriers to children's ART adherence, were financial burden, lack of ART KP (Knowledge-Practice), stigma, depression, shifting caretaker, drug taste and side effects, lack of family support, fixed health check-up schedule and HIV non-disclosure. In the questionnaire study a total of 209 caretakers participated. The most commonly reported caretakers' barriers were: financial burden (144; 69%), KP burden (143; 68%), depression (85; 41%) and stigma (30; 14.8%). Some caretakers' characteristics that significantly associated with reported barriers (p0.05). Rural caretakers reported significantly more financial burden (OR=2.26) and stigma (OR=3.53) than urban. Caretakers with under high school level education reported significantly more financial burdens (OR=2.08) and stigma (OR=4.15) compared to caretakers with high school education or over.Financial burden, KP burden, depression and stigma were common reported caretakers' barriers to pediatric ART adherence. Family residence, caretaker's education level and job were considered as the key factors determining caretakers' barriers related to financial burden and stigma. These findings may be important for policy makers and researchers in order to develop effective interventions regarding to caretakers' burdens and associated factors. Furthermore, a tool for nurses in monitoring caretakers' barriers to pediatric ART adherence was developed first with FDG, and then interview questionnaire. This tool could be applied and modified easily in any pediatric ART clinic settings in accordance to economic, social and cultural circumstances.

The COVID-19 (coronavirus disease-2019) pandemic has affected almost all countries in the world. When the first cases were reported from Hubei, China, in late December 2019, the Vietnamese authorities acknowledged the potential risk of an epidemic having had the experience of severe acute respiratory syndrome (SARS) and the Avian flu. When it was clear that there was human-to-human transmission in the epidemic in Wuhan that started in January 2020, the Vietnamese government, health care system, and civil society were rapidly mobilized. How has a country with a population of about 100 million and a long porous border to China managed to prevent a larger outbreak? This case history is about how Hai Phong city implemented the initial COVID-19 response. Hai Phong reacted quickly after the COVID-19 outbreak in China by, quarantining people coming from pandemic areas, and carrying out contact tracing and extensive testing, closing schools and universities and implementing two weeks of social distancing measures. There are no detected positive cases until May 18, 2020 in Hai Phong.

To evaluate effect and costs of pertussis vaccination at Vietnam National Children's Hospital.Pertussis cases were defined by positive laboratory tests of children under 5 years January 2015-June 2018, and data on patient characteristics, clinical data and hospitalisation costs were collected through patient records.Of 909 inpatients, 400 (44%) were2 months, the age for first DPT vaccination, and mechanical ventilation was more common than in children2 months (9% vs 4%, OR = 2.3, CI 1.3-3.9), as well as persistent cough (99%), violent cough (87%) and pneumonia (91%). Comparing non-vaccinated (172 cases, 19%) and DPT vaccinated patients2 months of age hospitalisation was 106-fold higher (149.6 vs 1.39 per 100 000 population), and proportion of severe patients, length of hospital stay and hospitalisation costs were significantly greater (23.9% vs 12.8%; 13 vs 10 days; 826 USD vs 582 USD, CI 23-423, P = .03).Incidence and proportion of complications among under 2-month infants were higher than in older patients. DPT vaccination protects children from pertussis infection, and in case of pertussis infection decreases severity. Results indicate that the Ministry of Health should consider adding a booster vaccine for pregnant women in an extended vaccination programme.

Pneumonia and sepsis are two prevalent diseases in Southeast Asia. Pneumonia is a respiratory disease which is often caused by bacteria, viruses, or fungi. The bacteria then inflames air sacs in the lungs, known as alveoli, and blocks the interstitial space with fluid or pus, leading to breathing difficulties. Sepsis is a potentially life-threatening condition caused by the body's response to an infection. This study analyzes over 900 pneumonia entries and over 450 sepsis entries from hospitals in Vietnam, collected by a research team from the Karolinska Institutet, one of the world's leading medical universities. Analysis results exhibited that recovery rates were associated with gender and the month that patients were admitted into the hospital. They also indicated a seasonal trend of pneumonia cases, in which the disease peaked when season changes approached. Finally, this study reveals relationships between the duration in days in which patients stay in the hospital and their health insurance status, age, gender, occupation, and diagnoses. The goal of this paper is to reveal patterns and biases in medical treatment so that doctors and hospitals may improve their overall service. The findings in the data provide an overview of the distribution of pneumonia and sepsis cases in Vietnam. Additionally, these findings may be useful in assisting healthcare organizations to formulate prevention methods and maximize efficiency in staff and material management.

Background Carbapenem-resistant Klebsiella pneumoniae are becoming increasingly common in hospital settings worldwide and are a source of increased morbidity, mortality and health care costs. The global epidemiology of carbapenem-resistant K. pneumoniae is characterized by different strains distributed geographically, with the strain ST258 being predominant in Europe and USA, and ST11 being most common in East Asia. ST15 is a less frequently occurring strain but has nevertheless been reported worldwide as a source of hospital outbreaks of carbapenem-resistant K. pneumoniae. Methods In this study, whole-genome sequencing and antimicrobial susceptibility testing was used to characterize 57 clinical isolates of carbapenem-resistant K. pneumoniae belonging to a strain of ST15, which were collected at a Vietnamese pediatric hospital from February throughout September 2015. Results Aside from the carbapenem resistance gene blaKPC-2, which was carried by all isolates, prevalence of resistance genes to other antibiotics including aminoglycosides, macrolides, quinolones, fosfomycin and trimethoprim, was also high. All isolates were multidrug-resistant. Susceptibility was highest to ceftazidime/avibactam (96%), gentamicin (91%) and tigecycline (82%). Notably, the colistin resistance rate was very high (42%). Single-nucleotide polymorphism analysis indicated that most isolates belonged to a single clone. Conclusions The diverse variety of antibiotic resistance genes and the high antibiotic resistance rates to last-resort antibiotics such as carbapenems and colistin, is indicative of a highly adaptable strain. This emphasizes the importance of implementation of infection controls measures, continued monitoring of antibiotic resistance and prudent use of antibiotics to prevent further selection of resistant strains and the emergence of pan-resistant clones.

Background Antibiotic resistance (ABR) is an increasing burden for global health. The prevalence of ABR in Southeast Asia is among the highest worldwide, especially in relation to hospital acquired infections (HAI) in intensive care units (ICU). However, little is known about morbidity and mortality attributable to ABR in neonates. Aim This study aimed to assess mortality and the length of hospitalization attributable to ABR in gram-negative bacteria (GNB) causing HAI in a Vietnamese neonatal ICU (NICU). Methods We conducted a prospective cohort study (n = 296) in a NICU in Hanoi, Vietnam, from March 2016 to October 2017. Patients isolated with HAI caused by GNB were included. The exposure was resistance to multiple antibiotic classes, the two outcomes were mortality and length of hospital stay (LOS). Data were analysed using two regression models, controlling for confounders and effect modifiers such as co-morbidities, time at risk, severity of illness, sex, age, and birthweight. Results The overall case fatality rate was 44.3% and the 30 days mortality rate after infection was 31.8%. For every additional resistance to an antibiotic class, the odds of a fatal outcome increased by 27% and LOS increased by 2.1 days. These results were statistically significant (p amp;lt; 0.05). Conclusion ABR was identified as a significant risk factor for adverse outcomes in neonates with HAI. These findings are generally in line with previous research in children and adults. However, heterogeneous study designs, the neglect of important confounders and varying definitions of ABR impair the validity, reliability, and comparability of results. Funding Agencies|Swedish Foundation for International Cooperation in Research and Higher Education (STINT); ReAct; Karolinska Institutet; TRAC (Training and Research Academic Collaboration) Sweden-Vietnam

Background Ventilator-associated respiratory infection (VARI) is a significant problem in resource-restricted intensive care units (ICUs), but differences in casemix and etiology means VARI in resource-restricted ICUs may be different from that found in resource-rich units. Data from these settings are vital to plan preventative interventions and assess their cost-effectiveness, but few are available. Methods We conducted a prospective observational study in four Vietnamese ICUs to assess the incidence and impact of VARI. Patients ≥ 16 years old and expected to be mechanically ventilated > 48 h were enrolled in the study and followed daily for 28 days following ICU admission. Results Four hundred fifty eligible patients were enrolled over 24 months, and after exclusions, 374 patients’ data were analyzed. A total of 92/374 cases of VARI (21.7/1000 ventilator days) were diagnosed; 37 (9.9%) of these met ventilator-associated pneumonia (VAP) criteria (8.7/1000 ventilator days). Patients with any VARI, VAP, or VARI without VAP experienced increased hospital and ICU stay, ICU cost, and antibiotic use (p