Parenting stress of mothers and fathers of young children with cognitive delays in Vietnam.

BACKGROUND: This research examined the effects of child and family variables on stress experienced by mothers and fathers of young children with cognitive delays in Vietnam. METHODS: The mothers (n = 106) and fathers (n = 93) whose children (age range = 3-6 years) were identified as having cognitive delays participated in the interview survey. The survey consisted of a set of the standardized questionnaires that were translated into Vietnamese and assessed for the content validity in the Vietnamese context. RESULTS: Mothers experienced more stress than fathers. Path analyses were conducted for mothers and fathers separately. Mothers with female children, those with children of lower intellectual functioning, and those whose husbands had health conditions experienced more stress than the other mothers. Fathers with lower economic status and a smaller social support network were more stressed than the other fathers. Both mothers and fathers were more stressed when they experienced stronger stigma, although the effects were not significant when other variables were considered together in path analyses. CONCLUSIONS: The findings revealed traditional gender roles. Mothers were more affected by the child's characteristics and the spouse's functioning; they anticipated future problems related to the child's functioning more than fathers did. Fathers were more affected by concerns about the family's connection to the wider world such as economic issues and the social support network. Longitudinal studies of how social support and stigma affect families would be valuable.

Amniotic fluid index measurements in normal pregnancy after 28 gestational weeks.

OBJECTIVE: The purpose of this study is to establish a normative scale of amniotic fluid index (AFI) or four-quadrant amniotic fluid index throughout gestation in uncomplicated singleton pregnancies, and to identify the lower and upper limits for each gestational week. METHOD: A prospective longitudinal study was used. One hundred seventeen uncomplicated singleton pregnancies were examined every 4 weeks between 28 and 42 week's gestation. The uterine cavity was divided into four quadrants. With the use of linear-array, real-time B-scanning, the vertical diameter of the largest pocket in each quadrant was measured. The amniotic fluid index is the sum of these four quadrants. RESULTS: The amniotic fluid index observations from regression equation curve were stratified in week-specific normative curves. The variation between mean AFI of the total population and the means of the preterm was significantly greater than term pregnancies (P<. 05). The AFI 2.5%, 5%, 10%, 90% 95% and 97.5% limits about the 50th (124 mm) were 68, 81, 90, 135, 144 and 145 mm, respectively, in term gestation. The 5th and 95th percentile serves as lower and upper limits of normal, respectively for 28-42 weeks gestation. CONCLUSIONS: Gestational age-specific values of AFI were established, determining the significant trends of changes in the amniotic fluid volume with gestation. The normogram may have a clinical benefit to accurate, reliable and semiquantitative diagnosis of oligohydramnios and polyhydramnios.

Village-based primary health care in the Central Highlands of Vietnam.

This paper describes the first year of an ongoing village health care and economic development project in the Krong Buk district of Dak Lak province in Vietnam's Central Highlands. The project serves 21 villages with a total population of just over 15,000. Most belong to ethnic minority groups. Physicians from the province capital of Boun Me Thuot were trained by a multi-disciplinary team of American health care workers to be trainers and supervisors of 21 village health care workers (VHWs). Two months later, a VHW from each village was trained in primary and preventive health care by the physician-supervisors. Since this initial training, each VHW has been provided with materials, medicines and monthly supervision by the physician-supervisors. The health care component has been complemented by an economic development project based on a system of small loans. Data from the first year of monthly reports and from a baseline survey are presented in this paper.

Changes in the health care system of Vietnam in response to the emerging market economy.

This paper discusses the impact on the Vietnamese health care system of the change from a centralized socialist system to a market economy. It discusses recent policies based on expectations in relation to actual outcomes, and the impacts these changes have had on health care delivery and health infrastructure in Vietnam. It has become clear that the private medical sector is draining resources from the State rather than complementing the weakened national health system. Impacts on health education, pharmaceuticals, infrastructure support, geographic distribution of physicians, and equity are all discussed in terms of recent economic changes. It is suggested that adjustments must be made to ensure adequate health care for all Vietnamese including those in rural areas and the urban poor. The State must develop mechanisms to support the national health service before further deterioration occurs.

Japanese encephalitis among hospitalized pediatric and adult patients with acute encephalitis syndrome in Hanoi, Vietnam 1995.

The etiologic spectrum of acute encephalitis syndrome (AES) has not been well defined in Vietnam. Cohort and case-control studies were performed on all adult and pediatric AES patients admitted to the Neurology Service of Bach Mai Hospital between June 5 and August 3, 1995. Among pediatric AES patients, 31 (67%) of 46 had acute Japanese encephalitis (JE), compared with only two (6%) of 33 adult AES patients (P < 0.0001). For confirmed JE cases, serum specimens obtained 15-21 days after symptom onset had the highest mean anti-JE IgM signal-to-noise (P/N) ratios (8.08 + 1.09 SE). A serosurvey of adult household members did not reveal any cases of recent subclinical JE infection, although 26% had evidence of past JE infection. The use of bed netting was nearly universal but did not appear to reduce the risk of AES or JE. Given the high incidence of JE, particularly among children, Vietnam seems well suited for the development of a targeted JE vaccination strategy.

Double-blind studies with mefloquine alone and in combination with sulfadoxine-pyrimethamine in 120 adults and 120 children with falciparum malaria in Vietnam.

In 120 adult Vietnamese patients with uncomplicated falciparum malaria the efficacy of, and tolerance to, mefloquine (M) vs the combination of mefloquine + sulfadoxine + pyrimethamine (MSP) was studied in a double-blind, randomized comparative trial with chloroquine. Also, a double-blind dose finding study of MSP was performed in 120 Vietnamese children with uncomplicated falciparum malaria. In the adults the mean parasite clearance time with M was 3.8 d and with MSP 3.6 d. Defervescence occurred in 2.9 and 3.0 d respectively for M and MSP. There was a 36.8% resistance rate in 38 patients treated with chloroquine. 96% of the children were sensitive or showed a delayed RI response. The lowest dose of MSP (10 mg/kg M + 20 mg/kg S + 1.0 mg/kg P, 1 tablet Fansimef) was as effective as 1.5-2x this dose in children weighing 23-30 kg. Side effects were mild, except for vomiting which required alternative therapy in 4 patients.

The influence of traditional medicine in shaping medical care practices in Vietnam today.

In Third World countries today one must have a knowledge of and appreciation for traditional medical beliefs and practices if one is to understand each nation's particular adaptation to a modern health care system. Taking the particular example of Vietnam, we discuss the current formal health care system and the traditional herbal medicines, dietary regulations and dermal techniques which are still important elements in the peoples' choice and perception of health care. There is then a discussion of how traditional medical beliefs and practices have shaped the practice of health care in Vietnam today.

Convenience and the occurrence of births: induction of labor in the United States and Canada.

This paper, using data for the United States and Canada on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. For both the United States and Canada, it is found that substantially fewer births occur on Saturdays, Sundays, and holidays than on weekdays. Controlling for such factors as prenatal care, race, education, legitimacy, birth weight, and time trend strongly suggests that the induction of labor is responsible for the patterns found. The paper concludes by discussing the framework within which the practice of elective induction of labor should be evaluated and justified.

Elective induction and stimulation of labor and the health of the infant.

This study examines a large heterogeneous sample to determine whether elective induction and stimulation of labor have a beneficial or deleterious effect on the health of the infant. Previous studies have reached contradictory results, partly because of the small sample sizes employed. This study uses a multiple regression analysis of New York City birth certificate data from 1968. We find a small, but significant, negative effect on the newborn of both elective induction of labor and elective stimulation of labor. When hospital care context is allowed to vary, much larger negative effects were found within municipal hospitals and to a lesser extent on service wards of voluntary hospitals. Although 1968 findings cannot be applied to 1978, the implications are clear.

Patterns of births: implications for the incidence of elective induction.

This paper, using data for the State of Wisconsin on number of births by day of the week, presents indirect evidence for the widespread incidence of the practice of elective induction. It is found that substantially fewer births occur on Saturdays, Sundays, and holidays. Controls for birth order, type of delivery, and time trend reinforce the possibility that elective inductions are responsible for the patterns found. Implications of the patterns found are discussed.