Mobilizing morality: how caregivers in Vietnam handle the challenges of daily diabetes care.

BACKGROUND: As a chronic disease, type 2 diabetes (T2D) often involves long-term care obligations for patients' family members. Understanding the socially and culturally specific challenges that family caregivers face and how they cope with them is crucial in developing targeted and effective interventions to support both caregivers and patients with T2D. This research examined family caregiving for people with T2D living in rural northern Vietnam. Although there is a growing literature on family support in Vietnam, little is known about the personal experiences of family caregivers for people with T2D. This paper seeks to fill this gap revealing some of the challenges and coping strategies of family caregivers to people with T2D. METHODS: This qualitative study is based on ethnographic research using primarily semi-structured interviews with 21 caregivers to a person with T2D in Vietnam. The research was conducted in 2022 by a Vietnamese-Danish research team. Each interview was voice-recorded, transcribed verbatim and thematically coded. RESULTS: Four major challenges emerged from the analysis: physical health concerns, psychological exhaustion, economic burdens, and lack of support. Caregivers expressed motivation to overcome these challenges as they felt a deep sense of responsibility towards their family member with diabetes. The primary caregiver's sense of responsibility toward their family would often cause them not to share the burdens from caregiving with other family members to avoid burdening them as well. However, negative experiences from caregiving were decreased and positive feelings increased in the instances where caregiving was shared between multiple family members. CONCLUSION: While family members expressed motivation to take care of the patient because of moral obligations, some caregivers, specifically primary caregivers, did not want to burden other family members with care tasks and were reluctant to ask for assistance. For families who did share the caregiving tasks among several family members, some of the negative sentiments associated with caregiving were diminished. Having multiple members of a family forming a caregiving community thus motivated people in handling care challenges.

Age distribution of dengue cases in southern Vietnam from 2000 to 2015.

BACKGROUND: Dengue is the most common vector-borne viral infection. In recent times, an increase in the age of cases with clinical dengue has been reported in the national surveillance system and published literature of Vietnam. This change not only alter the risk of transmission and disease burden in different populations but also will impact for prevention and control strategies. A retrospective study was conducted from 2000 to 2015 in 19 provinces of southern Vietnam to describe the changes in age distribution of dengue cases and circulating serotypes. METHODOLOGY/PRINCIPAL FINDINGS: The study is a time trend analysis of the data aggregated from the database of dengue surveillance system. The database consisted of clinically diagnosed and laboratory-confirmed cases of dengue in southern Vietnam from 2000 to 2015. In the study period, the mean age of dengue cases increased from 12.2 ± 8.8 years old (y/o) to 16.8 ± 13.3 y/o between 2000 and 2015. Majority of severe cases were observed in the age group of 5-9 y/o and 10-14 y/o. Overall, the mortality and case fatality rates (CFR) were lowest during 2010 to 2015, and all four serotypes of dengue were observed. CONCLUSIONS/SIGNIFICANCE: With the exception of severe form, the age distribution of clinical cases of dengue appears to be shifting towards older age groups. An increase in the mean age of clinical cases of dengue has been observed in southern Vietnam over the past decade, and the highest incidence was observed in age group of 5-14 y/o. All serotypes of dengue were in circulation.

An Innovation Perspective to Explore the Ecology and Social Welfare Efficiencies of Countries.

This study aims to measure the ability of 29 countries in producing competitive products and services that fulfill individual needs and improve the level of welfare with less utilization of natural resources. We build a two-stage network production process model to investigate the ecology efficiency and social welfare efficiency of the countries and then further discriminate the efficient countries in post-analysis. The two-stage network directional distance function is applied to assess the efficiencies of countries, and the network-based ranking approach is used to further discriminate the efficient countries following the panel data between the years 2013 and 2016. Results show that Poland and Spain are strongly referenced by other countries in the ecology stage, whereas Bulgaria, the United States, and Sweden are leaders in the social welfare stage. A remarkable observation is an absence of countries' efficiency in both ecology and social welfare efficiencies. Most of the 29 countries have lower efficiency in the social welfare stage than in the ecology stage. This study suggests the strengths and highlights the weaknesses of the countries to help the governments efficiently improve and operate their countries.

Everyday disease diplomacy: an ethnographic study of diabetes self-care in Vietnam.

BACKGROUND: Understanding people's subjective experiences of everyday lives with chronic health conditions such as diabetes is important for appropriate healthcare provisioning and successful self-care. This study explored how individuals with type 2 diabetes in northern Vietnam handle the everyday life work that their disease entails. METHODS: Detailed ethnographic data from 27 extended case studies conducted in northern Vietnam's Thái Bình province in 2018-2020 were analyzed. RESULTS: The research showed that living with type 2 diabetes in this rural area of Vietnam involves comprehensive everyday life work. This work often includes efforts to downplay the significance of the disease in the attempt to stay mentally balanced and ensure social integration in family and community. Individuals with diabetes balance between disease attentiveness, keeping the disease in focus, and disease discretion, keeping the disease out of focus, mentally and socially. To capture this socio-emotional balancing act, we propose the term "everyday disease diplomacy." We show how people's efforts to exercise careful everyday disease diplomacy poses challenges to disease management. CONCLUSIONS: In northern Vietnam, type 2 diabetes demands daily labour, as people strive to enact appropriate self-care while also seeking to maintain stable social connections to family and community. Health care interventions aiming to enhance diabetes care should therefore combine efforts to improve people's technical diabetes self-care skills with attention to the lived significance of stable family and community belonging.