Journal of Preventive Medicine and Public Health

Original Articles

Symptoms, Mental Health, and Quality of Life Among Patients After COVID-19 Infection: A Cross-sectional Study in Vietnam: Hai Nguyen Thanh, Duc Cap Minh, Hien Hoang Thu, Duc Nguyen Quang; J Prev Med Public Health. 2024;57(2):128-137. Published online February 27, 2024; DOI: https://doi.org/10.3961/jpmph.23.511

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Abstract Summary PDF: Objectives
This study was conducted to characterize the symptoms, mental health, quality of life (QoL), and associated factors following the coronavirus disease 2019 (COVID-19) infection.
Methods
This cross-sectional study included 394 participants previously infected with COVID-19 in Ho Chi Minh City, Vietnam. Mental health was assessed using the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Participants self-reported health-related QoL was measured with the EuroQol 5-Dimension 5-Level (EQ-5D-5L) scale.
Results
Among the participants, 76.4% reported experiencing at least one symptom following COVID-19 infection. The most common symptoms were fatigue (42.1%), cognitive dysfunction (42.9%), and hair loss (27.9%). According to the DASS-21 results, the proportions of depression, anxiety, and stress were 28.7%, 26.4%, and 20.6%, respectively. The mean scores on the EQ-5D-5L and the EuroQol Visual Analog Scale were 0.94±0.11 and 84.20±13.11, respectively. Regarding QoL issues, the highest proportion of participants (32.7%) reported experiencing anxiety or depression, followed by pain or discomfort (25.4%). Multivariable logistic regression analysis revealed that factors associated with the presence of symptoms following COVID-19 infection included female (odds ratio [OR], 2.84; 95% confidence interval [CI], 1.65 to 4.91) and having QoL issues (OR, 3.25; 95% CI, 1.71 to 6.19).
Conclusions
The study investigated the prevalence rates of various symptoms following COVID-19 infection. These findings underscore the need to prioritize comprehensive care for individuals recovering from COVID-19 and to implement strategies to mitigate the long-term impact of the disease on mental health and QoL.; Summary

Key Message
This cross-sectional study in Vietnam investigated symptoms, mental health, and quality of life among patients recovering from COVID-19. The study found that most participants experienced post-infection symptoms, with fatigue, cognitive dysfunction, and hair loss being the most common. Mental health issues were prevalent, and participants reported varying levels of quality of life. The findings highlight the importance of comprehensive care and strategies to address the long-term impact of COVID-19 on mental health and quality of life.

Mental Health Among Healthcare Workers During the COVID-19 Pandemic in Vietnam: Nhan Phuc Thanh Nguyen, Ha Phan Ai Nguyen, Cao Khoa Dang, Minh Tri Phan, Huynh Ho Ngoc Quynh, Van Tuan Le, Chinh Van Dang, Tinh Huu Ho, Van Trong Phan, Thang Van Dinh, Thang Phan, Thi Anh Thu Dang; J Prev Med Public Health. 2024;57(1):37-46. Published online December 11, 2023; DOI: https://doi.org/10.3961/jpmph.23.327

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Abstract Summary PDF: Objectives
The objective of this study was to characterize mental health issues among Vietnamese healthcare workers (HCWs) and to identify related factors.
Methods
A cross-sectional study was conducted with 990 HCWs in 2021. Their mental health status was measured using the Depression, Anxiety, and Stress Scale.
Results
In total, 49.9%, 52.3%, and 29.8% of respondents were found to have depression, anxiety, and stress, respectively. The multivariable linear regression model revealed that factors associated with increased anxiety scores included depression scores (β, 0.45; 95% confidence interval [CI], 0.39 to 0.51) and stress scores (β, 0.46; 95% CI, 0.41 to 0.52). Factors associated with increased depression scores included being frontline HCWs (β, 0.57; 95% CI, 0.10 to 1.10), stress scores (β, 0.50; 95% CI, 0.45 to 0.56), and anxiety scores (β, 0.41; 95% CI, 0.36 to 0.47), while working experience was associated with reduced depression scores (β, -0.08; 95% CI, -0.16 to -0.01). Factors associated with increased stress scores included working experience (β, 0.08; 95% CI, 0.00 to 0.16), personal protective equipment interference with daily activities (β, 0.55; 95% CI, 0.07 to 1.00), depression scores (β, 0.54; 95% CI, 0.48 to 0.59), and anxiety scores (β, 0.45; 95% CI, 0.39 to 0.50), while age was associated with reduced stress scores (β, -0.12; 95% CI, -0.20 to -0.05).
Conclusions
Specific interventions are necessary to enhance and promote the mental health of HCWs so they can successfully cope with the circumstances of the pandemic.; Summary

Key Message
A cross-sectional study of 990 Vietnamese healthcare workers in Vietnam, 2021 revealed significant mental health issues: 49.9 % suffered from depression, 52.3 % from anxiety, and 29.8 % from stress. The study found a correlation between these conditions, with frontline workers being particularly vulnerable to depression. These findings highlight the critical need for targeted mental health interventions for healthcare workers, particularly those new to the field and working on the front lines, in order to better manage pandemic-related stressors.

Healthcare Workers’ Knowledge and Attitudes Regarding the World Health Organization’s “My 5 Moments for Hand Hygiene”: Evidence From a Vietnamese Central General Hospital: Huy Van Nguyen, Hieu Trung Tran, Long Quynh Khuong, Thanh Van Nguyen, Na Thi Nhi Ho, An Thi Minh Dao, Minh Van Hoang; J Prev Med Public Health. 2020;53(4):236-244. Published online May 7, 2020; DOI: https://doi.org/10.3961/jpmph.19.319

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Abstract PDF

Objectives
Although the World Health Organization (WHO) initiative “My 5 Moments for Hand Hygiene” has been lauded as effective in preventing hospital-associated infections, little is known about healthcare workers (HCWs)’ hand hygiene behavior. In this study, we sought to assess knowledge and attitudes towards the concepts in this initiative, as well as associated factors, among Vietnamese HCWs at a general hospital.
Methods
A structured questionnaire was administered to HCWs at a central Vietnamese general hospital in 2015. Multiple logistic regression analysis was used to identify factors associated with HCWs’ knowledge and attitudes towards hand hygiene.
Results
Of 120 respondents, 65.8% and 67.5% demonstrated appropriate knowledge and a positive attitude, respectively, regarding all 5 hand hygiene moments. Logistic regression indicated better knowledge of hand hygiene in workers who were over 30 years old, who were direct HCWs (rather than managers), who had frequent access to clinical information, and who received their clinical information from training. Those who worked in infectious and tropical disease wards, who had frequent access to clinical information, and who received information from training were more likely to have a positive attitude towards hand hygiene than their counterparts.
Conclusions
Although many Vietnamese HCWs displayed moderate knowledge and positive attitudes towards the WHO hand hygiene guidelines, a key gap remained. Regular education and training programs are needed to increase knowledge and to improve attitudes and practices towards hand hygiene. Furthermore, a combination of multimodal strategies and locally-adapted interventions is needed for sustainable hand hygiene adherence.

Summary

Citations

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Objectively Measured Physical Activity of Vietnamese Adults With Type 2 Diabetes: Opportunities to Intervene: Vuong Van Do, Jonine Jancey, Ngoc Minh Pham, Chung Thanh Nguyen, Minh Van Hoang, Andy H. Lee; J Prev Med Public Health. 2019;52(2):101-108. Published online February 22, 2019; DOI: https://doi.org/10.3961/jpmph.18.213

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Abstract PDF

Objectives
To objectively determine and compare the physical activity (PA) levels of adults newly diagnosed with type 2 diabetes (T2D) and adults without T2D in Vietnam using an accelerometer.
Methods
A total of 120 participants with newly diagnosed T2D and 120 adults without T2D were recruited from a large hospital in Hanoi, the capital city of Vietnam. All participants wore an ActiGraph GT3X accelerometer for at least 5 days, including 1 weekend day. Freedson cut-off points were used to estimate different intensities of PA. In addition, comparisons between groups were made with respect to achieving the World Health Organization (WHO) and International Diabetes Federation (IDF) recommended PA guidelines.
Results
Men with T2D had significantly lower levels of PA than men without T2D. The respective multivariable-adjusted mean values of daily step count, daily light-intensity, moderate-intensity, and moderate-to-vigorous-intensity PA were approximately 14%, 19%, and 22% lower in the men with T2D than in their non-T2D counterparts. However, women with T2D accumulated a greater number of steps per day than women without T2D. Only 59.2% of the adults with T2D met the minimum recommended level of PA (WHO and IDF), compared to 74.2% of adults without T2D (p<0.05). After adjusting for potential confounders, participants with T2D experienced 50.0% significantly lower odds of achieving PA recommendations.
Conclusions
Vietnamese men with T2D were less physically active than those without T2D, and adults with T2D were less likely to meet PA guidelines. The results suggest a need for integrating PA into the self-management of this chronic condition.

Summary

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Brief Report

Knowledge and Perceptions of Influenza Vaccinations Among College Students in Vietnam and the United States: Akiko Kamimura, Ha N. Trinh, Shannon Weaver, Alla Chernenko, Maziar M. Nourian, Nushean Assasnik, Hanh Nguyen; J Prev Med Public Health. 2017;50(4):268-273. Published online May 25, 2017; DOI: https://doi.org/10.3961/jpmph.17.061

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Abstract PDF

Objectives
Influenza is a significant worldwide public health issue. Knowledge and perceptions regarding the flu vaccination are associated with whether individuals obtain the vaccination. The purpose of this study was to examine how such perceptions were related to knowledge and self-efficacy regarding influenza and the flu vaccination in Vietnam and the US. Methods: College students (n=932) in Vietnam (n=495) and the US (n=437) completed a self-administered survey regarding knowledge and perceptions of influenza vaccinations in September and October 2016. Results: Vietnamese participants reported significantly lower levels of awareness about flu risk, higher levels of negative attitudes toward flu vaccination, lower levels of knowledge about the flu and vaccination, and lower levels of self-efficacy than US participants. Higher levels of flu and flu vaccination knowledge and self-efficacy regarding general responsible health practices were associated with lower levels of negative perceptions of flu risk and attitudes toward vaccination. At the same time, self-efficacy regarding responsible health practices was associated with higher levels of awareness of flu risk and lower levels of negative attitudes toward vaccination. Self-efficacy regarding exercise was associated with lower levels of perceptions of flu risk and higher levels of negative attitudes toward vaccination. Conclusions: Vietnam could benefit from influenza education based on this comparison with the US. In both countries, knowledge and self-efficacy were found to be important factors influencing perceptions of influenza risk and vaccination.

Summary

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Original Articles

Cancer Incidence in Korean Vietnam Veterans During 1992-2003: The Korean Veterans Health Study: Sang-Wook Yi; J Prev Med Public Health. 2013;46(6):309-318. Published online November 28, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.6.309

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Abstract PDF

Objectives

The aim of this study was to investigate the association between Vietnam experience including exposure to military herbicides and cancer incidence in Korean Vietnam War veterans.

Methods

The cancer cases of 185 265 Vietnam veterans from January 1, 1992 to December 31, 2003 were confirmed from the Korea National Cancer Incidence Database. The age-adjusted incidence and standardized incidence ratios (SIRs) were calculated using the male population during 1992 to 2003 as a standard population.

Results

The age-adjusted overall cancer incidence per 100 000 person-years was 455.3 in Vietnam veterans. The overall cancer incidence was slightly yet significantly lower in veterans (SIR, 0.97; 95% confidence interval, 0.95 to 0.99) than in the general population. The overall cancer incidence in enlisted soldiers was not lower (SIR, 1.00), whereas that in officers was significantly lower (SIR, 0.87) than in the general population. The incidences of prostate cancer and T-cell lymphoma in all veterans, and lung cancer and bladder cancer in enlisted soldiers, and colon cancer and kidney cancer in non-commissioned officers, and colon cancer, kidney cancer, and prostate cancer in officers, were higher than in the general population. The SIR for overall cancer among Vietnam veterans rose from 0.92 for 1992-1997 to 0.99 for 1998-2003.

Conclusions

The overall cancer incidence in Vietnam veterans was not higher than in the general male population. Vietnam veterans and military rank subcohorts experienced a higher incidence of several cancers, including prostate cancer, T-cell lymphoma, lung cancer, bladder cancer, kidney cancer, and colon cancer than the general population. The SIR for overall cancer increased over time in Vietnam veterans.

Summary

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Serum 2,3,7,8-Tetrachlorodibenzo-p-dioxin Levels and Their Association With Age, Body Mass Index, Smoking, Military Record-based Variables, and Estimated Exposure to Agent Orange in Korean Vietnam Veterans: Sang-Wook Yi, Heechoul Ohrr, Jong-Uk Won, Jae-Seok Song, Jae-Seok Hong; J Prev Med Public Health. 2013;46(5):226-236. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.226

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Abstract PDF

Objectives

The aim of this study was to examine the levels of serum 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and evaluate their association with age, body mass index, smoking, military record-based variables, and estimated exposure to Agent Orange in Korean Vietnam veterans.

Methods

Serum levels of TCDD were analyzed in 102 Vietnam veterans. Information on age, body mass index, and smoking status were obtained from a self-reported questionnaire. The perceived exposure was assessed by a 6-item questionnaire. Two proximity-based exposures were constructed by division/brigade level and battalion/company level unit information using the Stellman exposure opportunity index model.

Results

The mean and median of serum TCDD levels was 1.2 parts per trillion (ppt) and 0.9 ppt, respectively. Only 2 Vietnam veterans had elevated levels of TCDD (>10 ppt). The levels of TCDD did not tend to increase with the likelihood of exposure to Agent Orange, as estimated from either proximity-based exposure or perceived self-reported exposure. The serum TCDD levels were not significantly different according to military unit, year of first deployment, duration of deployment, military rank, age, body mass index, and smoking status.

Conclusions

The average serum TCDD levels in the Korean Vietnam veterans were lower than those reported for other occupationally or environmentally exposed groups and US Vietnam veterans, and their use as an objective marker of Agent Orange exposure may have some limitations. The unit of deployment, duration of deployment, year of first deployment, military rank, perceived self-reported exposure, and proximity-based exposure to Agent Orange were not associated with TCDD levels in Korean Vietnam veterans. Age, body mass index and smoking also were not associated with TCDD levels.

Summary

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Agent Orange exposure and risk of death in Korean Vietnam veterans: Korean Veterans Health Study
Sang-Wook Yi, So-Yeon Ryu, Heechoul Ohrr, Jae-Seok Hong
International Journal of Epidemiology.2014; 43(6): 1825. CrossRef

Agent Orange Exposure and Prevalence of Self-reported Diseases in Korean Vietnam Veterans: Sang-Wook Yi, Heechoul Ohrr, Jae-Seok Hong, Jee-Jeon Yi; J Prev Med Public Health. 2013;46(5):213-225. Published online September 30, 2013; DOI: https://doi.org/10.3961/jpmph.2013.46.5.213

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Abstract PDF

Objectives

The aim of this study was to evaluate the association between Agent Orange exposure and self-reported diseases in Korean Vietnam veterans.

Methods

A postal survey of 114 562 Vietnam veterans was conducted. The perceived exposure to Agent Orange was assessed by a 6-item questionnaire. Two proximity-based Agent Orange exposure indices were constructed using division/brigade-level and battalion/company-level unit information. Adjusted odds ratios (ORs) for age and other confounders were calculated using a logistic regression model.

Results

The prevalence of all self-reported diseases showed monotonically increasing trends as the levels of perceived self-reported exposure increased. The ORs for colon cancer (OR, 1.13), leukemia (OR, 1.56), hypertension (OR, 1.03), peripheral vasculopathy (OR, 1.07), enterocolitis (OR, 1.07), peripheral neuropathy (OR, 1.07), multiple nerve palsy (OR, 1.14), multiple sclerosis (OR, 1.24), skin diseases (OR, 1.05), psychotic diseases (OR, 1.07) and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the division/brigade-level proximity-based exposure analysis, compared to the low exposure group. The ORs for cerebral infarction (OR, 1.08), chronic bronchitis (OR, 1.05), multiple nerve palsy (OR, 1.07), multiple sclerosis (OR, 1.16), skin diseases (OR, 1.05), and lipidemia (OR, 1.05) were significantly elevated for the high exposure group in the battalion/company-level analysis.

Conclusions

Korean Vietnam veterans with high exposure to Agent Orange experienced a higher prevalence of several self-reported chronic diseases compared to those with low exposure by proximity-based exposure assessment. The strong positive associations between perceived self-reported exposure and all self-reported diseases should be evaluated with discretion because the likelihood of reporting diseases was directly related to the perceived intensity of Agent Orange exposure.

Summary

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Nutritional Status and the Characteristics Related to Malnutrition in Children Under Five Years of Age in Nghean, Vietnam.: Nguyen Ngoc Hien, Sin Kam; J Prev Med Public Health. 2008;41(4):232-240.; DOI: https://doi.org/10.3961/jpmph.2008.41.4.232

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Abstract PDF

OBJECTIVES
This study was conducted to assess the nutritional status and characteristics related to malnutrition in children less than five years of age in Nghean, Vietnam. METHODS: In this study, which was conducted in November 2007, 650 child-mother pairs were selected using a two-stage cluster sampling methodology. A structured questionnaire was then administered to the mothers in their home settings. Anthropometric measurement was then used to determine if children were underweight (weight-for-age), wasting (weight-for-height) and stunting (height-for-age) based on reference data from the National Center for Health Statistics (NCHS)/World Health Organization (WHO). Logistic regression analysis was then used to describe the hierarchical relationships between potential risk factors and malnutrition. RESULTS: The mean Z-scores for weight-for-age, heightfor-age and weight-for-height were -1.46 (95% CI=-1.57, -1.35), -1.44 (95% CI=-1.56, -1.32) and -0.71 (95% CI=-0.82, -0.60), respectively. Of the children included in this study, 193 (31.8%) were underweight, 269 (44.3%) were stunting and 72 (11.9%) were wasting. Region of residence, the mother's level of education and occupation, household size, number of children in the family, weight at birth and duration of exclusive breastfeeding were found to be significantly related to malnutrition. CONCLUSIONS: The findings of this study indicate that malnutrition is still an important problem among children less than five years of age in Nghean, Vietnam. In addition, maternal, socio-economic and environment factors were found to be significant factors for malnutrition among children under five.

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Pilot Study on Recruiting Medical Checkup Participants by Mail Survey among Korean Vietnam Veterans.: Sang Wook Yi, Jae Seok Hong, Heechoul Ohrr; Korean J Prev Med. 2003;36(2):171-178.

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Abstract PDF: OBJECTIVE
The aim of this study was to identify the validity of recruiting medical checkup participants of Vietnam veterans using a mail survey, and to identify the 'Vietnam service related characteristics' and `general characteristics' of Vietnam veterans groups. METHOD: In this study, a total 900 veterans were randomly selected from the list of Vietnam veterans from 1964 to 1973. The veterans were classified into 5 groups, taking into consideration their registered status in the Ministry of Patriots and Veterans Affairs; the VRD (veterans who have agent orange-related diseases), VSD (veterans who have agent orange-suspected disease), VM (veterans who performed meritorious deeds during the war), VR (veterans who were registered with the Ministry of Patriots and Veterans Affair) and OV (other veterans) groups. By means of postal surveys, the veterans' intention to participate in the medical checkup for our research, and their socioeconomic and general characteristics were investigated. 52 surveys were returned due to the subjects not residing at the listed address, and were excluded from the analysis. RESULT: 699 of the 848 veterans (82.4%) responded to the survey, of which 619 (88.6%) intended to participate in the medical checkup for our research. The 5 veterans groups all had similar ages, Vietnam service period, Agent Orange exposure, troop characteristic and wartime class, with the exception of VM, who were older, and with a greater number of officers than the other 4 groups. There was a big difference in the health statius among the Vietnam veterans group. The VM and OV were much healthier than VRD, VSD and VR groups. The socioeconomic stati of the VRD, VSD and VR groups were lower than those of the VM and OV groups. CONCLUSION: Although there were some limitations, the recruitment, by mail, of medical checkup participants from Vietnam veterans is a valid and feasible method. The VM and OV groups were much healthier, and with higher socioeconomic stati, than the VRD, VSD, and VR groups.; Summary

Validation Studies

A Proposal of Study Designs and Methods for Evaluating the Adverse Health Effects of Agent Orange among Korean Vietnam Veterans.: Sang Wook Yi, Jong Uk Won, Jae Seok Hong, Heechoul Ohrr; Korean J Prev Med. 2001;34(3):228-236.

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Abstract PDF: OBJECTIVES
To propose a feasible, valid and appropriate study designs and epidemiologic methods for evaluating the adverse health effects of Agent Orange-chemical defoliants used in Vietnam- in Korea. METHODS: A literature study was performed on Agent Orange, herbicides, pesticides and dioxins. The study subjects, study design, exposure assessment and health outcomes assessment were examined in each study. The potential data sources for the study subjects, study design, exposure assessment and health outcomes assessment in Korea were investigated. RESULTS AND CONCLUSION: In earlier Korean studies, research subjects for studying the effects of Agent Orange were identified from the patients or persons who claimed to have Agent Orange-related diseases due to the difficulties in identifying the entire population of Vietnam veterans in Korea. In this study, an attempt was made to identify the total number of Vietnam veterans in Korea. As a result, the addresses of 20,000 Vietnam veterans were obtained. It is proposed that a retrospective cohort design on a sample of the total number of Vietnam veterans is a feasible and appropriate study design. Self report questionnaires and military records were proposed to assess the exposure level. It is believed that measuring the plasma or tissue TCDD should be used only for a validation study assessing the level of exposure. For the health outcomes assessment, it is possible to obtain the mortality, cancer frequency, physical examination, screening and medical insurance record data.; Summary

Original Article

A Study on the Health Status of Korean Vietnam Veterans' Children: A Result of Questionnaire Survey on Vietnam Veterans of Pusan Area Who Diagnosed as Cases by Korean Veteran's Hospital Diagnostic Criteria.: Jin Ho Chun, Hak Joon Kim, Hae Sook Sohn, Sang Hwa Urm, Soo Kyung Park, Byung Chul Yu, Jong Tae Lee; Korean J Prev Med. 2000;33(1):17-24.

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Abstract PDF: OBJECTIVES
To propose the referential data to evaluate the health impacts of Vietnam veterans' children whose father were exposed to herbicides in Vietnam War. METHODS: Vietnam veterans who visited to Pusan Veteran Hospital for medical care were recruited from April to October, 1998. They were 71 and asked about their own combat history, symptoms and illness, and health status of their 182 children. The informations were collected by direct and phone interview. Exposure estimation was also performed as exposure score depending on year and unit of participation, and personal episodes related to exposure to herbicide in the war. It classified into three groups; lower(<18.0), moderate(18-53), high(> or =53) exposure group. RESULTS: The mean age and the period into the combat of the veterans were 52.8 years and 15.0 months. The mean exposure score was 18.1+/-9.9, and mainly distributed in lower (46.5%) and moderate(52.1%) exposure group. Most(90.1%) of them were diagnosed as sequelae(21 cases) and suspected sequelae(43 cases) of the herbicides by Korean veteran's hospital diagnostic criteria. The major sequelae was peripheral neuropathy 13 cases, chloracne 5 cases, and the major suspected sequelae was hypertension 20 cases, diabetes mellitus 18 cases, liver disease 12 cases, central neuropathy 11 cases, etc. About birth, 42.2% and 16.9% experienced spontaneous abortion and stillbirth, respectively. The mean exposure score was higher in stillbirth experience group(p<0.05). About half of the children(90 cases, 49.5%) hold the abnormal health status: those were skin pigmentation 38 cases, rash 23 cases, congenital anomaly 15 cases, general weakness 12 cases, purpura 8 cases, visual disturbance 8 cases, etc. These health problems had no association with father's exposure level(p>0.05). CONCLUSIONS: These results were depend on their own answers, and expectation for compensation did not excluded, therefore, this study may have limitations: inaccuracy of informations due to recall bias and response bias. Nevertheless, through this study, we could image the fundamental aspect for health impacts of Vietnam veterans' children for preparing the national control program and policy. A large scale epidemiologic study with valid exposure assessment on the health impacts of Vietnam veterans' children is recommneded.; Summary

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