Integrating maternal, newborn, child health and non-communicable disease care in the sustainable development goal era.

Noncommunicable diseases (NCDs) and maternal newborn and child health (MNCH) are two deeply intertwined health areas that have been artificially separated by global health policies, resource allocations and programming. Optimal MNCH care can provide a unique opportunity to screen for, prevent and manage early signs of NCDs developing in both the woman and the neonate. This paper considers how NCDs, NCD modifiable risk factors, and NCD metabolic risk factors impact MNCH. We argue that integrated management is essential, but this faces challenges that manifest across all levels of domestic health systems. Progress toward Sustainable Development targets requires joined-up action.

Tobacco and electronic cigarette smoking among in-school adolescents in Vietnam between 2013 and 2019: prevalence and associated factors.

BACKGROUND: Smoking among adolescents in schools is a major global public health concern. There is limited evidence regarding prevalence and associated factors in Vietnam. OBJECTIVE: To compare the prevalence of smoking and associated factors among in-school adolescents aged 13-17 years in Vietnam between 2013 and 2019. METHODS: Data were collected from two rounds of the national representative Vietnam Global School-based Student Health Survey (GSHS) conducted in 2013 (n = 3,331) and 2019 (n = 7,690). Logistic regression was used to identify the factors associated with tobacco and electronic cigarette smoking among in-school adolescents. RESULTS: There was a significant reduction in the prevalence of current smoking (water pipes and cigarettes) from 5.4% (95% CI: 4.0-7.2) in 2013 to 2.8% (95% CI: 2.2-3.6) in 2019. In 2019, 2.6% of the in-school adolescents reported having used electronic cigarette products 30 days prior to the survey. Factors associated with a significantly higher likelihood of current smoking status included gender, loneliness, suicidal ideation, sexual activity, truancy, and alcohol consumption. Similar patterns were observed for e-cigarettes. CONCLUSION: Smoking among in-school adolescents in Vietnam decreased between 2013 and 2019. Follow-up studies are needed to further investigate causal factors so that future policies and communication programmes can be more effectively targeted to reduce smoking in adolescents.

Polymorphic Ga2S3 nanowires: phase-controlled growth and crystal structure calculations.

The polymorphism of nanostructures is of paramount importance for many promising applications in high-performance nanodevices. We report the chemical vapor deposition synthesis of Ga2S3 nanowires (NWs) that show the consecutive phase transitions of monoclinic (M) → hexagonal (H) → wurtzite (W) → zinc blende (C) when lowering the growth temperature from 850 to 600 °C. At the highest temperature, single-crystalline NWs were grown in the thermodynamically stable M phase. Two types of H phase exhibited 1.8 nm periodic superlattice structures owing to the distinctively ordered Ga sites. They consisted of three rotational variants of the M phase along the growth direction ([001]M = [0001]H/W) but with different sequences in the variants. The phases shared the same crystallographic axis within the NWs, producing novel core-shell structures to illustrate the phase evolution. The relative stabilities of these phases were predicted using density functional theory calculations, and the results support the successive phase evolution. Photodetector devices based on the p-type M and H phase Ga2S3 NWs showed excellent UV photoresponse performance.

High-density adherent culture of CHO cells using rolled scaffold bioreactor.

Rapid expansion of biopharmaceutical market calls for more efficient and reliable platforms to culture mammalian cells on a large scale. Stirred-tank bioreactors have been widely used for large-scale cell culture. However, it requires months of trials and errors to optimize culture conditions for each cell line. In this article, we extend our earlier studies on rolled scaffold (RS) bioreactors for high-density adherent cell culture and report two new implementations of RSs with greatly enhanced mass-manufacturability, termed as Mesh-RS and Fiber-RS. CHO-K1 cells were successfully expanded in Mesh-RS and Fiber-RS bioreactors with an average growth rate of 1.09 ± 0.04 1/day and 0.95 ± 0.07 1/day, which were higher than those reported in similar studies. Fiber-RS bioreactor exhibited a very high cell density of 72.8 × 106 cells/ml. Besides, a dialyzer was integrated into the RS bioreactor to remove cellular waste and to replenish nutrients without disturbing the cells. By collecting the dialyzed media separately, the dialysis efficiency was significantly improved. In conclusion, the developed RS bioreactor has a strong potential to provide a highly reliable and easily scalable platform for large-scale cell culture in the biopharmaceutical industry.

Violence and non-fatal injuries among Vietnamese in-school adolescents: national prevalence estimates and associated factors.

School violence and injury are major public health problems worldwide. The data of this study were from the Viet Nam Global School-based Student Health Survey (GSHS) - a nationally representative survey conducted in 2019, with a sample size of 7690 students aged 13-17 years old. We found the prevalence of violence and non-fatal injury to be 14.5% and 21.4%, respectively. Factors related to higher odds of violence and non-fatal injuries in both sexes included smoking cigarettes, drinking alcohol, having mental health problems (loneliness, worrying and suicidal thinking), and truancy. In contrast, parental monitoring was associated with lower odds of violence, and parental respect was a protective factor of both violence and non-fatal injuries. Students who experienced violence had a higher likelihood of having non-fatal injuries in both sexes. Future policies should consider individual factors and parent-child bonding, to mitigate the burden of violence and injury among in-school adolescents in Viet Nam.

Clustering Lifestyle Risk Behaviors among Vietnamese Adolescents and Roles of School: A Bayesian Multilevel Analysis of Global School-Based Student Health Survey 2019.

BACKGROUND: Adolescence is a vulnerable period for many lifestyle risk behaviors. In this study, we aimed to 1) examine a clustering pattern of lifestyle risk behaviors; 2) investigate roles of the school health promotion programs on this pattern among adolescents in Vietnam. METHODS: We analyzed data of 7,541 adolescents aged 13-17 years from the 2019 nationally representative Global School-based Student Health Survey, conducted in 20 provinces and cities in Vietnam. We applied the latent class analysis to identify groups of clustering and used Bayesian 2-level logistic regressions to evaluate the correlation of school health promotion programs on these clusters. We reassessed the school effect size by incorporating different informative priors to the Bayesian models. FINDINGS: The most frequent lifestyle risk behavior among Vietnamese adolescents was physical inactivity, followed by unhealthy diet, and sedentary behavior. Most of students had a cluster of at least two risk factors and nearly a half with at least three risk factors. Latent class analysis detected 23% males and 18% females being at higher risk of lifestyle behaviors. Consistent through different priors, high quality of health promotion programs associated with lower the odds of lifestyle risk behaviors (highest quality schools vs. lowest quality schools; males: Odds ratio (OR) = 0·67, 95% Highest Density Interval (HDI): 0·46 - 0·93; females: OR = 0·69, 95% HDI: 0·47 - 0·98). INTERPRETATION: Our findings demonstrated the clustering of specific lifestyle risk behaviors among Vietnamese in-school adolescents. School-based interventions separated for males and females might reduce multiple health risk behaviors in adolescence. FUNDING: The 2019 Global School-based Student Health Survey was conducted with financial support from the World Health Organization. The authors received no funding for the data analysis, data interpretation, manuscript writing, authorship, and/or publication of this article.

Early Essential Newborn Care can still be used with mothers who have COVID-19 if effective infection control measures are applied.

We describe the first infant born to a woman with COVID-19 in Vietnam, by Caesarean section at 36 weeks and 5 days of gestation. The mother and baby remained together during their hospital stay and prolonged skin-to-skin contact and early and exclusive breastfeeding were achieved. This was in line with the World Health Organization's Early Essential Newborn Care (EENC) recommendations, the national Vietnamese standard of care since 2014. The baby remained virus-free throughout the 34-day postpartum follow-up. CONCLUSION: The EENC approach can still be used with mothers who have COVID-19 if effective infection control measures are applied.

Acceptability and Usability of HCV Self-Testing in High Risk Populations in Vietnam.

HIV self-testing has emerged as a safe and effective approach to increase the access to and uptake of HIV testing and treatment, especially for key populations. Applying self-testing to hepatitis C virus (HCV) may also offer an additional way to address low coverage of HCV testing and to accelerate elimination efforts. To understand the potential for HCV self-testing (HCVST), an observational study was conducted to assess the acceptability and usability of the OraQuick® HCV Self-Test (prototype) among people who inject drugs (PWID) and men who have sex with men (MSM) in Thai Nguyen, a province in northern Vietnam. A total of 105 PWID and 104 MSM were eligible and agreed to participate in the study. Acceptability, defined as the proportion of participants among eligible subjects who agreed to participate in the study, was 92.9% in PWID and 98.6% in MSM. Compared to MSM, PWID were older (median age: 45 vs. 22 years; p < 0.0001) and had a lower education level (high school and college: 38.1% vs. 100%; p < 0.0001). HCVST usability was high among MSM with fewer observed mistakes, difficulties, or participants requiring assistance (33.7%, 28.8%, and 17.3%, respectively) compared to PWID (62.9%, 53.3%, and 66.7%, respectively; all p < 0.0001)). Inter-reader and inter-operator agreement were good in both groups (Kappa coefficient range: 0.61-0.99). However, the concordance between HCVST and study staff -read or performed HCV testing was lower among PWID than MSM (inter-reader concordance 88.6% vs. 99.0% and inter-operator concordance 81.9% vs. 99%). Overall, HCVST was highly acceptable with moderate to high usability among PWID and MSM in Thai Nguyen. Efforts to provide support and assistance may be needed to optimize performance, particularly for PWID populations and for those who are older and with lower literacy or education levels.

Anisotropic 2D SiAs for High-Performance UV-Visible Photodetectors.

Recently, extensive efforts have been directed at finding novel 2D-layered structures with anisotropic crystal structures. Herein, the in-plane anisotropic optical and (photo)electrical properties of 2D SiAs nanosheets synthesized using a solid-state reaction and subsequent mechanical exfoliation are reported. The angle-resolved polarized Raman spectrum shows high in-plane anisotropy of the phonon vibration modes, which are consistent with the theoretical prediction. Field-effect transistor devices fabricated using the SiAs nanosheets demonstrate significant anisotropy in the hole mobility with an anisotropic ratio as high as 5.5. Photodetectors fabricated with single SiAs nanosheet exhibit high sensitivity in the UV-visible region, and the anisotropic ratio of the photocurrent reaches 5.3 at 514.5 nm and 2.3 at 325 nm. This work lays the foundation for future research in anisotropic 2D materials.

Modelling the expected impact of cigarette tax and price increases under Vietnam's excise tax law 2015-2020.

BACKGROUND: Vietnam's national tobacco control strategy aims to reduce the rate of smoking among male adults from 45% in 2015 to 39% by 2020. The aim of this paper is to assess what contribution cigarette tax increases under Vietnam's current excise tax plan can be expected to make to this target, and to discuss what additional measures might be implemented accordingly. METHODS: This study uses a mix of administrative datasets and predictive modelling techniques to assess the expected impact of tax and price increases on cigarette consumption, tobacco tax revenues and the rate of smoking between 2015 and 2020. FINDINGS: The average retail price of cigarettes is estimated to have increased by 16% (sensitivity analysis: 14%-18%) in inflation-adjusted terms between 2015 and 2020, while cigarette consumption is projected to decrease by 5.1% (4.5%-5.5%). The rate of smoking among males is projected to decrease to 42.8% (42.1%-43.6%) compared with the target of 39%. Total tax revenues from cigarettes are projected to increase by 21% (19%-23%), reflecting an extra ₫3300 billion in inflation-adjusted revenues for the government. CONCLUSION: The current excise tax law is expected to have only a modest impact on the rate of smoking in Vietnam, though it has generated tax revenues. If Vietnam is to achieve its tobacco control targets, the government should implement a mixed excise system with a high-specific component to promote public health by raising the price of cigarettes more significantly.

Improvement in Compliance With Smoke-Free Environment Regulations at Hotels and Restaurants in Vietnam After an Administrative Intervention.

INTRODUCTION: Vietnam is among the countries with the highest smoking prevalence among male adults, as well as high prevalence of secondhand smoke exposure at indoor places. In many countries, including Vietnam, exposure to tobacco smoking is greatest in restaurants/bars and hotels. This study aims to analyze the compliance of hotels and restaurants to smoke-free environment regulations before and after an intervention. METHODS: Direct observations were done at the receptions, conference rooms, designated smoking areas, restaurants, and lobbies of 140 hotels and the dining rooms, kitchens, and toilets of 160 restaurants before and after an intervention. The intervention was a training course conducted by police officers followed by 3 monthly supervision visits by police officers. Compliance with smoke-free enviornment regulations was observed and assessed to generate a compliance score for each location and overall. Tobit regression was used to examine the relationship between compliance scores and the intervention and other variables such as hotel and restaurant characteristics. RESULTS: Before the intervention, the highest compliance rates were found for "no tobacco advertisement" and "no cigarette selling" regulations (95%-100%) in almost all sites in hotels and restaurants. The lowest compliance rates were found for "having nonsmoking signs." The rate of compliance with all regulations was only 5% for hotels and 0.06% of restaurants. Improvement after intervention was clearly observed, in the rate of compliance with all regulations by more hotels (15.7%) and overall compliance scores of hotels and restaurants. CONCLUSIONS: The intervention with participation of the police officers proved to be effective in improving compliance with smoke-free regulations. It is recommended to continue this intervention in the same areas as well as to expand the intervention to other areas.

Secondhand Tobacco Smoke Exposure in Indoor Workplaces in Viet Nam and Associated Factors: Findings from Two Rounds of Global Adult Tobacco Surveys (GATS) 2010 and 2015.

OBJECTIVES: This paper explores changes in the level of secondhand smoke (SHS) exposure at indoor workplaces between 2010 and 2015 in Viet Nam and the association between the exposure and various demographic factors, using data from Viet Nam's Global Adult Tobacco Surveys (GATS) 2010 and 2015. METHODS: Data was pooled from the two GATS surveys and analysed using descriptive and Poisson regression analyses. RESULTS: There was a highly statistically significant reduction in the level of SHS exposure at indoor workplaces from 55.9% to 42.6% (p.

Phase Controlled Growth of Cd3As2 Nanowires and Their Negative Photoconductivity.

The bottom-up synthesis process often allows the growth of metastable phase nanowires instead of the thermodynamically stable phase. Herein, we synthesized Cd3As2 nanowires with a controlled three-dimensional Dirac semimetal phase using a chemical vapor transport method. Three different phases such as the body centered tetragonal (bct), and two metastable primitive tetragonal (P42/nbc and P42/nmc) phases were identified. The conversion between three phases (bct → P42/nbc → P42/nmc) was achieved by increasing the growth temperature. The growth direction is [110] for bct and P42/nbc and [100] for P42/nmc, corresponding to the same crystallographic axis. Field effect transistors and photodetector devices showed the nearly same electrical and photoelectrical properties for three phases. Differential conductance measurement confirms excellent electron mobility (2 × 104 cm2/(V s) at 10 K). Negative photoconductance was first observed, and the photoresponsivity reached 3 × 104 A/W, which is ascribed to the surface defects acting as trap sites for the photogenerated electrons.

Controllable p-n junctions in three-dimensional Dirac semimetal Cd3As2 nanowires.

We demonstrate a controllable p-n junction in a three-dimensional Dirac semimetal (DSM) Cd3As2 nanowire with two recessed bottom gates. The device exhibits four different conductance regimes with gate voltages, the unipolar (n-n and p-p) and bipolar (n-p and n-p) regimes, where p-n junctions are formed. The conductance in the p-n junction regimes decreases drastically when a magnetic field is applied perpendicular to the nanowire. In these regimes, the device shows quantum dot behavior, whereas the device exhibits conductance plateaus in the n-n regime at high magnetic fields. Our experiment shows that the ambipolar tunability of DSM nanowires can enable the realization of quantum devices based on quantum dots and electron optics.

Development of rolled scaffold for high-density adherent cell culture.

Bioreactors for large-scale culture of mammalian cells are playing vital roles in biotechnology and bioengineering. Various bioreactors have been developed, but their capacity and efficiency are often limited by insufficient mass transfer rate and high shear stress. A rolled scaffold (RS) is a fully defined scaffold for high-density adherent culture of mammalian cells. The RS is a polymer film with spacers, that is rolled into a cylinder with a pre-determined gap between each turn. Cells are cultured on its inner surfaces, while media flows through the gap. The RS exhibits high surface-area-to-volume ratio over 100 cm2/mL and can transport nutrients and gases with significantly reduced shear stress via convection in a unidirectional laminar flow, rather than diffusion and random turbulent flow as in stirred-tank bioreactors. In this paper, we expanded Chinese Hamster Ovary cells with RS bioreactors and demonstrated cell culture density over 60 million cells/mL with a growth rate higher than conventional suspension culture. Besides, murine embryonic stem cells were successfully expanded without losing their pluripotency. The RS will provide an affordable, scalable, and reliable platform for large-scale culture of recombinant cells in biopharmaceutical industries and shear-sensitive stem cells for tissue engineering.

Static microdroplet array generated by spraying and analyzed with automated microscopy and image processing.

Microdroplets have received increasing interest as practical platforms for high-throughput biochemical analysis. Typically, numerous discrete aqueous microdroplets containing biochemical targets are generated in a continuous oil phase and characterized using a flow-through configuration. Although this approach is capable of extremely high throughput, it is challenging to provide dynamic characterization of time-dependent reaction kinetics. In this paper, we present a practical and affordable method to create and analyze a massive array of static aqueous microdroplets immersed in oil for biochemical analysis. The discrete microdroplets were produced by an air-spray gun, imaged by automated microscopy, and then characterized by image processing. The location, area, and fluorescence intensity of randomly generated individual microdroplets were automatically registered for high-throughput characterization. With this approach, we rapidly produced and characterized a static microdroplet array of over 0.7 million microdroplets with an average volume of 300 fL and a mean population density of 1.5*105 microdroplets/cm2. Using the developed setup, we demonstrated the dependency of the microdroplets' fluorescence intensity on their volume, as well as characterized the time-dependent enzyme reaction kinetics of ß-galactosidase-mediated cleavage of the substrate fluorescein di-ß-d-galactopyranoside (FDG). The new approach described herein provides an inexpensive alternative solution for high-throughput analysis of dynamic biochemical processes.

Synthesis of Polytypic Gallium Phosphide and Gallium Arsenide Nanowires and Their Application as Photodetectors.

One-dimensional semiconductor nanowires often contain polytypic structures, owing to the co-existence of different crystal phases. Therefore, understanding the properties of polytypic structures is of paramount importance for many promising applications in high-performance nanodevices. Herein, we synthesized nanowires of typical III-V semiconductors, namely, gallium phosphide and gallium arsenide by using the chemical vapor transport method. The growth directions ([111] and [211]) could be switched by changing the experimental conditions, such as H2 gas flow; thus, various polytypic structures were produced simultaneously in a controlled manner. The nanobeam electron diffraction technique was employed to obtain strain mapping of the nanowires by visualizing the polytypic structures along the [111] direction. Micro-Raman spectra for individual nanowires were collected, confirming the presence of wurtzite phase in the polytypic nanowires. Further, we fabricated the photodetectors using the single nanowires, and the polytypic structures are shown to decrease the photosensitivity. Our systematic analysis provides important insight into the polytypic structures of nanowires.

Two dimensional MoS2 meets porphyrins via intercalation to enhance the electrocatalytic activity toward hydrogen evolution.

Two-dimensional MoS2 meets porphyrin molecules to form unique 1T' phase intercalated complexes via a one-step procedure of hydrothermal reactions. The resultant Mn-porphyrin-MoS2 exhibits excellent electrocatalytic activity toward the hydrogen evolution reaction, with a Tafel slope of 35 mV dec-1 and 10 mA cm-2 at an overpotential of 0.125 V. Spin-polarized density functional theory calculations confirmed that the intercalation of Mn-porphyrin into 1T'-MoS2 is quite favourable due to strong charge transfer from Mn metals. Their outstanding catalytic performance could be ascribed to the high electron concentration as well as the low activation barrier of the Heyrovsky reaction.

Exosomes from Nischarin-Expressing Cells Reduce Breast Cancer Cell Motility and Tumor Growth.

Exosomes are small extracellular microvesicles that are secreted by cells when intracellular multivesicular bodies fuse with the plasma membrane. We have previously demonstrated that Nischarin inhibits focal adhesion formation, cell migration, and invasion, leading to reduced activation of focal adhesion kinase. In this study, we propose that the tumor suppressor Nischarin regulates the release of exosomes. When cocultured on exosomes from Nischarin-positive cells, breast cancer cells exhibited reduced survival, migration, adhesion, and spreading. The same cocultures formed xenograft tumors of significantly reduced volume following injection into mice. Exosomes secreted by Nischarin-expressing tumors inhibited tumor growth. Expression of only one allele of Nischarin increased secretion of exosomes, and Rab14 activity modulated exosome secretions and cell growth. Taken together, this study reveals a novel role for Nischarin in preventing cancer cell motility, which contributes to our understanding of exosome biology. SIGNIFICANCE: Regulation of Nischarin-mediated exosome secretion by Rab14 seems to play an important role in controlling tumor growth and migration.See related commentary by McAndrews and Kalluri, p. 2099.