Evaluation of a digital FFQ using 24 h recalls as reference method, for assessment of habitual diet in women with South Asian origin in Norway.

OBJECTIVE: Dietary assessment tools should be designed for the target population. We developed an FFQ designed to assess diet in South Asian women in Norway. The study objective was to evaluate this FFQ using 24-h dietary recalls as reference method. DESIGN: Approximately 3 weeks after the participants (n 40) had filled in the FFQ, the first of three non-consecutive 24-h dietary recalls was completed. The recalls were telephone-based, unannounced and performed by a trained dietitian, with 2-3 weeks between each interview. SETTING: The DIASA 1 study, in Oslo, Norway. PARTICIPANTS: Women of South Asian ethnic origin participating in the DIASA 1 study were invited to participate in the evaluation study. RESULTS: The WebFFQasia significantly overestimated the absolute intake of energy, protein, fat and carbohydrates compared with the 24-h dietary recalls. Absolute intakes of sugar, starch and fibre did not differ significantly between the methods. For energy percentages (E%), there were no significant differences, except for monounsaturated fat. Correlations were strong for E% from sugar and saturated fat and moderate for E% from fibre, carbohydrate, total fat and protein. Fourteen food groups out of twenty three were not significantly different compared with the reference method, and sixteen groups showed strong to moderate correlations. CONCLUSION: The WebFFQasia may be used to assess E% from habitual diet and can adequately estimate intakes and rank participants according to nutrient intake and main food categories at group level.

Investigating the effects of ultrafine bubbles on bacterial growth.

Several previous studies have considered ultrafine bubbles as a potential research target because their properties can be applied in many different research areas. In particular, the interaction between UFBs and microorganisms has always been one of the aspects that receives much attention due to the high difficulty in controlling a living system. The properties of UFBs, as mobile air-water interfaces, are greatly determined by their gas cores which play a critical role in regulating microbial growth. This study aims to investigate the effects of ultrafine bubbles on bacterial growth. Two well-studied organisms were chosen as models - Escherichia coli and Staphylococcus aureus. Their growing behavior was examined based on the growth rate, phenotype and biomass. Three types of Luria-Bertani cultures were tested, including a standard culture containing distilled water, an air ultrafine bubble culture, and a hydrogen ultrafine bubble culture. The UFBs were generated via ultrasonic cavitation and stabilized by 50 µM SDS, which was proven to have negligible effects on bacterial growth. By comparing among the three cultivation conditions, the bacterial growth rates were observed to be the highest in exposure to HUFBs. The results also signified that UFBs had an enhancement on cell proliferation. On the other hand, while proposing an increase in cell density, bacteria cultured in HUFB media have their sizes decreased uniformly and significantly (p-value < 0.05). This study confirmed that bacterial growth was promoted by UFBs; and better effects recorded were due to the HUFB present in the culture media. However, the average morphological size of bacteria was in negative correlation with their population size.

Effect of Red Mud and Rice Husk Ash-Based Geopolymer Composites on the Adsorption of Methylene Blue Dye in Aqueous Solution for Wastewater Treatment.

In this study, geopolymer originating from locally industrial byproducts as red mud (RM) was successfully prepared in the presence of different loadings of rice husk ash (RHA) used for the adsorption of methylene blue (MB) in wastewater. During geopolymerization, various mixing amounts between RM and RHA were conducted when the weight ratio of binder solution/activated alkali-metal solution (Na2SiO3/ NaOH 7 M) was 2.5 and the curing temperature was set at 60 °C for 24 h. As a result, the surface area value of the prepared geopolymer composited with RHA at 0 and 60% was increased from 19.2 to 29.5 m2/g, while the BJH pore size of the prepared geopolymer was reduced to 6.68 and 5.76 nm, respectively. In the dye removal test, higher additions of RHA in the RM-geopolymer maintained better retention of the MB ion due to the increase in the adsorption binding site. The maximum uptake amount of dyes performed at pH 8 was changed from 6.59 to 10.74 mg/g, while RHA was from 0 to 60% after 180 min of immersion in MB solution. The adsorption isotherms well obeyed the Langmuir model, as the relative coefficient R2 was 0.999. Based on these, the initial agricultural waste as RHA and industrial byproducts as RM were valued as functional materials used for dye treatment in wastewater.

Differences between surfactant-free Au@Ag and CTAB-stabilized Au@Ag star-like nanoparticles in the preparation of nanoarrays to improve their surface-enhanced Raman scattering (SERS) performance.

In this study, we assessed the controlled synthesis and efficacy of surface-enhanced Raman scattering (SERS) on two distinct types of star-like Au@Ag core-shell nanoarrays. These nanoarrays were designed based on gold nanostars (AuNSs), which were synthesized with and without CTAB surfactant (AuNSs-CTAB and AuNSs-FS, respectively). The AuNS-FS nanoparticles were synthesized via a novel modification process, which helped overcome the previous limitations in the free-surfactant preparation of AuNSs by significantly increasing the number of branches, increasing the sharpness of the branches and minimizing the adsorption of the surfactant on the surface of AuNSs. Furthermore, the differences in the size and morphology of these AuNSs in the created nanoarrays were studied. To create the nanoarrays, a three-step method was employed, which involved the controlled synthesis of gold nanostars, covering them with a silver layer (AuNSs-FS@Ag and AuNSs-CTAB@Ag), and finally self-assembling the AuNS@Ag core-shelled nanoparticles via the liquid/liquid self-assembly method. AuNSs-FS@Ag showed higher ability in forming self-assembled nanoarrays than the nanoparticles prepared using CTAB, which can be attributed to the decrease in the repulsion between the nanoparticles at the interface. The nano-substrates developed with AuNSs-FS@Ag possessed numerous "hot spots" on their surface, resulting in a highly effective SERS performance. AuNSs-FS featured a significantly higher number of sharp branches than AuNSs-CTAB, making it the better choice for creating nanoarrays. It is worth mentioning that AuNSs-CTAB did not exhibit the same benefits as AuNSs-FS. The morphology of AuNSs with numerous branches was formed by controlling the seed boiling temperature and adding a specific amount of silver ions. To compare the SERS activity between the as-prepared nano-substrates, i.e., AuNS-CTAB@Ag and AuNS-FS@Ag self-assembled nanoarrays, low concentrations of crystal violet aqueous solution were characterized. The results showed that the developed AuNSs-FS@Ag could detect CV at trace concentrations ranging from 1.0 ng mL-1 to 10 ng mL-1 with a limit of detection (LOD) of 0.45 ng mL-1 and limit of quantification (LOQ) of 1.38 ng mL-1. The nano-substrates remained stable for 42 days with a decrease in the intensity of the characteristic Raman peaks of CV by less than 7.0% after storage. Furthermore, the spiking method could detect trace amounts of CV in natural water from the Dong Nai River with concentrations as low as 1 to 100 ng mL-1, with an LOD of 6.07 ng mL-1 and LOQ of 18.4 ng mL-1. This method also displayed good reproducibility with an RSD value of 5.71%. To better understand the impact of CTAB stabilization of the Au@Ag star-like nanoparticles on their surface-enhanced Raman scattering (SERS) performance, we conducted density functional theory (DFT) calculations. Our research showed that the preparation of AuNSs-FS@Ag via self-assembly is an efficient, simple, and fast process, which can be easily performed in any laboratory. Furthermore, the research and development results presented herein on nanoarrays have potential application in analyzing and determining trace amounts of organic compounds in textile dyeing wastewater.

Pollution characteristics, associated risks, and possible sources of heavy metals in road dust collected from different areas of a metropolis in Vietnam.

Road dust samples were collected from different areas in Ho Chi Minh City (HCMC)-the largest city in Vietnam to explore pollution characteristics, ecological and human health risks, and sources of heavy metals (HMs). Results revealed the level of HMs found in the samples from residential and industrial zones of HCMC in the order of Mn > Zn > Cu > Cr > Pb > Ni > Co > As > Cd, Zn > Mn > Cu > Cr > Pb > Ni > Co > As > Cd. Due to the high enrichment of Cu, Zn in residential areas and Cu, Pb, Zn in industrial areas, the HM contamination in these areas remained moderate to severe. The findings also revealed a rising trend in the level of HMs in road dust from the east to the west of HCMC, and a heavy metal contamination hotspot in the west. In addition, industrial areas were more contaminated with HMs, posing greater associated risks than residential areas. Children living in urban areas of HCMC were found to be exposed to unacceptable health risks. Meanwhile, adults living in industrial areas face intolerable cancer risk. Among the nine HMs, Cd, Pb, and Cu posed the greatest ecological risk, while Cr and As were the main culprits behind health risks. HMs in road dust might derive from non-exhaust vehicular emissions, crustal materials, and industrial activities. The results suggested that industrial areas to the west of HCMC should focus more on reducing and controlling severe pollution of HMs.

E-Cigarette Use among University Students from One University in Hanoi, Vietnam, and Associated Factors.

OBJECTIVE: Describe the use of e-cigarettes and factors associated with e-cigarette use among university students from one university in Vietnam in 2021. METHODS: This cross-sectional study was conducted with a total of 554 full-time undergraduate students recruiting for the study. Data was collected using a structured self-administered questionnaire. A logistic regression analysis was performed to identify factors with significant association with students' use of e-cigarettes. RESULTS: The study revealed that 13.2% of students were current users. Students who had e-cigarette smokers in the family (aOR=6.1, 95% CI: 2.5-15.4; p<0.001), used traditional cigarettes (aOR=23.6, 95% CI: 10.5-53.4; p<0.001), consumed alcohol (aOR=5, 95%CI: 1.6 - 15.9; p<0.01), were exposed to e-cigarette advertising (aOR=2.6; 95%CI: 1.1-5.9; p<0.01), and  had inadequate knowledge about e-cigarettes (aOR=2.2; 95%CI: 1-4.7; p<0.01) were more likely to use e-cigarettes. CONCLUSION: This study updates the status of e-cigarette use among students in one university in Vietnam, thereby suggesting strategies to reduce the use of e-cigarettes among university students.

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey.

BACKGROUND: There are few studies reporting on self-medication, perceptions or difficulties older adults have with their medications. This study aimed to describe the uses and the perceptions of medications among older adults in France and to identify patient groups based on that information. METHODS: We used data from the 2020 'French Health Barometer' - a nationally-representative cross-sectional survey. We assessed polypharmacy (five or more medications), self-medication, and patient perceptions of medications. Robust Poisson regression was used to investigate socio-demographic and health-related factors associated with the outcomes. Latent class analysis was used to identify patient groups classified by the use and the perceptions of medications. Factors associated with group assignment were investigated by multinomial logistic regression. All analyses were weighted. RESULTS: The study sample comprised 1,623 respondents aged 70-85 years. Polypharmacy and self-medication were reported in 23.5 and 48.7% of the older population, respectively. Polypharmacy was associated with increasing age, low education, and impaired health status. Self-medication was associated with female sex and high education. Among individuals taking at least 1 medication, 8.2% reported not to understand all their medications, and 9.7% having difficulty taking medications as prescribed. Among individuals taking at least 2 medications, 23.2% thought that they took too many medications. Three patient groups were identified: 'Non-polypharmacy, positive perceptions' (62.5%), 'Polypharmacy, positive perceptions' (28.0%), and 'Negative perceptions' (9.5%). CONCLUSIONS: Polypharmacy and self-medication are common in French older adults. One segment of people reported negative perceptions of their medications regardless of their polypharmacy status. This underlines the difference between the objective and perceived measures of polypharmacy.

Crucial Role of Surfactants in Improving the Extraction Efficiency of ß-Amyrin from Dischidia major Using Ultrasound-Assisted Extraction Coupled with Gas Bubble Flotation.

Ultrasound-assisted extraction coupled with gas bubble flotation was developed as a green method for extracting ß-amyrin fromDischidia major. The solvent system was water:ethanol (9:1). To improve the adsorption of ß-amyrin onto the air/liquid interface during flotation, surfactants were employed; however, the positive effect was only observed with cationic surfactants. High-performance liquid chromatography with spectrophotometric detection (HPLC-PDA) was, for the first time, applied to quantify the ß-amyrin content in D. major and its extracts. With the assistance of surfactants, the foam layer collected from flotation showed high selectivity toward ß-amyrin. The product content was notably increased after surfactants had been removed from the solution.

Helicobacter pylori infection and eradication outcomes among Vietnamese patients in the same households: Findings from a non-randomized study.

OBJECTIVE: Familial transmission can possibly influence the infection and treatment of Helicobacter pylori. This study aimed to describe the prevalence of H. pylori infection and outcomes of eradication treatment among Vietnamese patients who live in the same households. METHODS: We conducted a prospective cohort study of Vietnamese household members with upper gastrointestinal complaints. Participants received esophagogastroduodenoscopy and H. pylori testing. The H. pylori-positive patients were treated and asked to return for follow-up within 4 months. To explore factors associated with H. pylori infection at baseline, we performed multilevel logistic regression to account for the clustering effect of living in the same households. To explore factors associated with eradication failure, we used Poisson regression with robust variance estimation to estimate the risk ratio. RESULTS: The prevalence of H. pylori infection was 83.5% and highest among children <12 years old (92.2%) in 1,272 patients from 482 households. There were variations in H. pylori infection across households (intraclass correlation = 0.14, 95% confidence interval (CI) 0.05, 0.33). Children aged <12 years had higher odds of H. pylori infection (odds ratio = 3.41, 95%CI 2.11, 5.50). At follow-up, H. pylori was eradicated in 264 of 341 patients (77.4%). The risk of eradication failure was lower for the sequential regimen with tetracycline. CONCLUSION: H. pylori infection was common among people living in the same households. Eradication success for H. pylori was higher for the tetracycline sequential regimen. More research should be focused on how family factors influence H. pylori infection and on eradication treatment.

Contamination, source attribution, and potential health risks of heavy metals in street dust of a metropolitan area in Southern Vietnam.

This study investigates distribution, pollution indices, and potential risk assessment for human health and ecology of eight heavy metals in twenty-five street dust samples collected from metropolitan area-Ho Chi Minh City, Vietnam. Results showed that Zn was of the highest concentration (466.4 ± 236.5 mg/kg), followed by Mn (393.9 ± 93.2 mg/kg), Cu (153.7 ± 64.7 mg/kg), Cr (102.4 ± 50.5 mg/kg), Pb (49.6 ± 21.4 mg/kg), Ni (36.2 ± 15.4 mg/kg), Co (7.9 ± 1.9 mg/kg), and Cd (0.5 ± 0.5 mg/kg). The principal component analysis revealed that three sources of heavy metals measured in street dust include vehicular activities (32.38%), mixed source of vehicular and residential activities (26.72%), and mixture of industrial and natural sources (20.23%). The geo-accumulation index values showed levels of non-pollution to moderately pollution for Mn and Co; moderately pollution for Ni; moderately to strongly pollution for Cd, Cr, and Pb; and strongly pollution for Cu and Zn. The potential ecological risk values of all sampling sites were close to the high-risk category. Zn (28.9%), Cu (25.4%), and Mn (24.4%) dominantly contributed to the ecological risk. For non-carcinogenic risk, the hazard quotient values for both children and adults were within a safety level. For carcinogenic risk, the TCRChildren was about 3 times higher than TCRAdults, but still within a tolerable limit (1 × 10-6 to 1 × 10-4) of cancer risk. Cr was a major contribution to potential risks in humans. Such studies on heavy metal in street dust are crucial but are still limited in Vietnam/or metropolitan area in Southeast Asia. Therefore, this study can fill the information gap about heavy metal contaminated street dust in a metropolitan area of Vietnam.

Attention Deficit Hyperactivity Disorder (ADHD) and Associated Factors Among First-Year Elementary School Students.

PURPOSE: Attention deficit hyperactivity disorder (ADHD) is a mental health disorder commonly in children. This study aimed to examine the prevalence of ADHD and risk factors among first-year pupils in Vietnam's urban city. PATIENTS AND METHODS: A cross-sectional study was conducted in four randomly selected primary schools. Information on 525 pupils in grade 1 (ages 6 to 7 years) was collected from 525 parents/caregivers and 28 teachers. We used the Vanderbilt Assessment Scales with two separate versions for parents and teachers to screen children with ADHD symptoms. RESULTS: Among the total of 525 pupils, 24 (4.6%) were found to have ADHD symptom types (boy: 6.5%; girl: 2.1%). The combined ADHD type accounted for the highest proportion of 3.4%, followed by predominantly inattentive and predominantly hyperactivity type. ADHD prevalence rated by teachers was higher than those rated by parents. High agreement between parents and teachers was reported (κ > 0.6). The risk of ADHD increased in male participants (aOR=4.90, 95% CI 1.51-15.85), those having a first-degree relative with ADHD (aOR=85.2, 95% CI 1.66-4371.8), in-utero exposure to tobacco smoke (aOR=4.78, 95% CI 1.31-17.44), and prenatal alcohol drinking (aOR=8.87, 95% CI 2.29-34.42). CONCLUSION: These findings suggest the importance of ADHD screening for pupils attending elementary schools, particularly those with a family history of ADHD. Public health programs should reduce prenatal exposure to the potential risk factors of ADHD (smoking and alcohol consumption).

Variation between general practitioners in type 2 diabetes processes of care.

AIMS: To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. METHODS: Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. RESULTS: We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37-4.92). GPs' age >60 years and heavier workload were associated with poorer performance. CONCLUSION: We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.

Impact of Awareness of Breast Density on Perceived Risk, Worry, and Intentions for Future Breast Cancer Screening among Korean Women.

PURPOSE: This study sought to examine perceived risk and concerns for breast cancer according to awareness of breast density and states thereof among Korea women and to identify the impact of such awareness on screening intentions. MATERIALS AND METHODS: This study was based on the 2017 Korean National Cancer Screening Survey of a nationally representative and randomly selected sample of Koreans. Ordinal logistic regression was conducted to examine associations for awareness of and knowledge on breast density in relation to psychological factors. Multivariate logistic regression analyses were conducted to investigate significant factors associated with intentions to undergo breast cancer screening. RESULTS: Among a total of 1,609 women aged 40-69 years, 62.0% were unaware of their breast density, and only 29.7% had good breast density knowledge. Awareness of one's breast density and knowledge about breast density were positively associated with perceptions of absolute and comparative risk and cancer worry. Women aware of their breast density (adjusted odds ratio [aOR], 1.35 for women aware of having a non-dense breast; aOR, 4.17 for women aware of having a dense breast) and women with a good level of breast density knowledge (aOR, 1.65) were more likely to undergo future breast cancer screening. CONCLUSION: Breast density awareness and knowledge showed positive associations with psychological factors and breast cancer screening intentions. However, the majority of Korean women were not aware of their breast density status and demonstrated poor knowledge about breast density. These results demonstrate a need for better health communication concerning breast density.

Trends in prediabetes and diabetes prevalence and associated risk factors in Vietnamese adults.

OBJECTIVES: The prevalence of diabetes mellitus is rapidly increasing in Vietnam, particularly among adults aged over 45 years. This study estimated trends in diabetes and prediabetes prevalence and determined risk factors in Vietnamese adults (over 45 years). METHODS: A cross-sectional study was conducted based on data from an annual diabetes screening program among people aged 45-69 years in an urban city in central Vietnam (Da Nang). Joinpoint regression analyses were performed to calculate the annual percentage change and ptrend-values. Multinomial logistic regression analysis was used to determine risk factors. RESULTS: In total, 3,765 men and 9,149 women were included in this analysis. The age-adjusted prevalence of diabetes and prediabetes in 2017 was 11.4% and 52.9%, respectively. The prevalence of diabetes was higher in men (15.1%) than in women (10.3%), but that of prediabetes was similar in both genders (53.4% vs. 52.8%). The prevalence of prediabetes significantly increased during the study period, whereas no upward or downward trend for diabetes was observed. The prevalence of obesity, abdominal obesity, hypertension, and dyslipidemia showed no obvious trend. Obesity, a high waist-to-hip ratio, hypertension, more severe abdominal obesity, and dyslipidemia were significantly associated with a higher risk of diabetes and prediabetes. CONCLUSIONS: Diabetes and prediabetes were more prevalent among people aged over 45 years than in the general population. Da Nang has experienced a marked increase in the prevalence of prediabetes. These findings have significant implications regarding the need for nationwide public health interventions and management aiming at diabetes prevention and control.

Turn signal use among motorcyclists and car drivers: The role of environmental characteristics, perceived risk, beliefs and lifestyle behaviours.

Turn signal neglect is considered to be a key contributor to crashes at intersections, yet relatively little research has been undertaken on this topic, particularly in developing countries. Using a case study of Vietnam, this research aimed to explore the role of environmental characteristics, perceived risk, beliefs and lifestyle behaviours on the frequency of turn signal use at intersections. A self-administered questionnaire was distributed to motorcyclists (n = 527) and car drivers (n = 326) using online and offline methods. Using partial least squares structural equation modelling (PLS-SEM), key findings indicate that perceived risk, beliefs and environmental characteristics play a significant role in affecting the frequency of turn signal use among motorcycle riders and car drivers at intersections. While lifestyle behaviours were not found to be a good predictor of turn signal use among car drivers, they were found to indirectly affect turn signal use among motorcycle riders through the mediation of beliefs and perceived risk. The findings can help inform the development of more targeted measures to increase turn signal use.

Ethnic and gender differences in the management of type 2 diabetes: a cross-sectional study from Norwegian general practice.

BACKGROUND: Ethnic minority groups from Asia and Africa living in Western countries have a higher prevalence of type 2 diabetes (T2DM) than the general population. We aimed to assess ethnic differences in diabetes care by gender. METHODS: Population-based, cross-sectional study identified 10,161 individuals with T2DM cared for by 282 General Practitioners (GP) in Norway. Ethnicity was based on country of birth. Multilevel regression models adjusted for individual and GP factors were applied to evaluate ethnic differences by gender. RESULTS: Diabetes was diagnosed at a younger mean age in all other ethnic groups compared with Westerners (men: 45.9-51.6 years vs. 56.4 years, women: 44.9-53.8 years vs. 59.1 years). Among Westerners mean age at diagnosis was 2.7 years higher in women compared with men, while no gender difference in age at diagnosis was found in any minority group. Daily smoking was most common among Eastern European, South Asian and Middle East/North African men. In both genders, we found no ethnic differences in processes of care (GPs' measurement of HbA1c, blood pressure, LDL-cholesterol, creatinine). The proportion who achieved the HbA1c treatment target was higher in Westerners (men: 62.3%; women: 66.1%), than in ethnic minorities (men 48.2%; women 53.5%). Compared with Western men, the odds ratio (OR) for achieving the target was 0.45 (95% CI 0.27 to 0.73) in Eastern European; 0.67 (0.51 to 0.87) in South Asian and 0.62 (0.43 to 0.88) in Middle Eastern/North African men. Compared with Western women, OR was 0.49 (0.28 to 0.87) in Eastern European and 0.64 (0.47 to 0.86) South Asian women. Compared with Westerners, the blood pressure target was more often achieved in South Asians and Middle Easterners/North Africans in both genders. Small ethnic differences in achieving the LDL-cholesterol treatment target by gender were found. CONCLUSION: Diabetes was diagnosed at a considerably earlier age in both minority men and minority women compared with Westerners. Several minority groups had worse glycaemic control compared with Westerners in both genders, which implies that it is necessary to improve glucose lowering treatment for the minority groups. Smoking cessation advice should particularly be offered to men in most minority groups.

Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients.

BACKGROUND: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. AIM: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. DESIGN & SETTING: A cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations. METHOD: Summary statistics with adjustments and binary logistic regression models were used. RESULTS: In total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l). CONCLUSION: The diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.

Turn signal use among car drivers and motorcyclists at intersections: a case study of Da Nang, Vietnam.

Turn signal neglect is a major cause of traffic crashes, particularly rear-end collisions. However, little research has investigated the use of turn signals among motorists, particularly in developing countries with high levels of motorcycle use. This research aimed to investigate the prevalence and factors associated with turn signal use at intersections among car drivers and motorcyclists in Da Nang, Vietnam. Cross-sectional roadside observations were undertaken at 24 sites across Da Nang City during weekday and weekend periods. A total of 17,142 vehicles were observed, including 2392 cars and 14,750 motorcycles. Turn signal use among car drivers (68.27%) was found to be significantly higher than motorcyclists (40.13%). Binary logistic regression modelling showed that turn signal neglect at intersections was associated with making a right turn, not carrying passengers, travelling outside of the city centre, travelling on weekdays, and the absence of separate car lanes, pedestrian crossings and traffic lights. Despite national legislation regulating turn signal use in Vietnam, the use of turn signals is relatively low compared with developed countries. The findings highlight the need for both greater and more targeted enforcement of existing legislation combined with extensive road safety education.

The use of a standardized Chinese herbal formula in patients with advanced lung cancer: a feasibility study.

OBJECTIVE: Increasing numbers of cancer patients are using Chinese herbs (CHs). However, differences among prior studies make it difficult to draw firm conclusions about the clinical usefulness of any specific CH formula. The primary objective of this study was to establish the acceptability of taking a standardized CH formula for patients with advanced lung cancer. The secondary objective was to identify any toxicities attributable to this CH formula and to measure changes in quality of life. METHODS: A single-arm, prospective study of a 6-week intervention with a selected CH formula in 15 patients with stage 4 nonsmall-cell lung cancer (NSCLC, Seventh American Joint Committee on Cancer TNM staging system). RESULTS: Patients with advanced lung cancer were interested in using the CH formula. Completion (93%) and adherence (98%) levels were very high and most patients perceived the CH treatment as easy to take and were willing to take the CHs used in the study again if it was available. About half of the patients reported adverse events, all of which were mild (Grade 1 or 2) and only a small minority (8%) were potentially related to CHs. No biochemical or hematological evidence of toxicity was observed. Overall, there were improvement in quality of life, and reduced feelings of tiredness and sleepiness. CONCLUSION: This study provides preliminary evidence that short-term use of a carefully selected and prepared CH formula in patients with stage 4 NSCLC is acceptable and safe.

Are general practitioners characteristics associated with the quality of type 2 diabetes care in general practice? Results from the Norwegian ROSA4 study from 2014.

OBJECTIVE: To explore the associations between general practitioners (GPs) characteristics such as gender, specialist status, country of birth and country of graduation and the quality of care for patients with type 2 diabetes (T2DM). DESIGN: Cross-sectional survey. SETTING AND SUBJECTS: The 277 GPs provided care for 10082 patients with T2DM in Norway in 2014. The GPs characteristics were self-reported: 55% were male, 68% were specialists in General Practice, 82% born in Norway and 87% had graduated in Western Europe. Of patients, 81% were born in Norway and 8% in South Asia. Data regarding diabetes care were obtained from electronic medical records and manually verified. MAIN OUTCOME MEASURES: Performance of recommended screening procedures, prescribed medication and level of HbA1c, blood pressure and LDL-cholesterol stratified according to GPs characteristics, adjusted for patient and GP characteristics. RESULT: Female GPs, specialists, GPs born in Norway and GPs who graduated in Western Europe performed recommended procedures more frequently than their counterparts. Specialists achieved lower mean HbA1c (7.14% vs. 7.25%, p < 0.01), a larger proportion of their patients achieved good glycaemic control (HbA1c = 6.0%-7.0%) (49.1% vs. 44.4%, p = 0.018) and lower mean systolic blood pressure (133.0 mmHg vs. 134.7 mmHg, p < 0.01) compared with non-specialists. GPs who graduated in Western Europe achieved lower diastolic blood pressure than their counterparts (76.6 mmHg vs. 77.8 mmHg, p < 0.01). CONCLUSION: Several quality indicators for type 2 diabetes care were better if the GPs were specialists in General Practice. Key Points Research on associations between General Practitioners (GPs) characteristics and quality of care for patients with type 2 diabetes is limited. Specialists in General Practice performed recommended procedures more frequently, achieved better HbA1c and blood pressure levels than non-specialists. GPs who graduated in Western Europe performed screening procedures more frequently and achieved lower diastolic blood pressure compared with their counterparts. There were few significant differences in the quality of care between GP groups according to their gender and country of birth.