A cross-sectional study of sleep disturbance among middle-aged cancer patients at Vietnam National Cancer Hospital.

AIM: Sleep disorders are common in cancer patients and have negative consequences for patient well-being and treatment outcomes. This study aimed to investigate sleep quality and related factors in Vietnamese middle-aged cancer patients. METHODS: A cross-sectional study was conducted on 246 middle-aged in-patient cancer patients at Vietnam National Cancer Hospital (VNCH) from 1/2021 to 7/2021. Sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), with a cutoff of 5. RESULTS: The results showed a male/female ratio of 0.85 with an average age of 52. The five most prevalent cancer types were breast, colorectal, lung, and esophagus-stomach cancer, primarily in the late stage and treated with chemotherapy. The prevalence of sleep disturbances was 58.5%. The mean PSQI score was 7.5, with sleep duration and latency of 5.4 h and 1 h, respectively. Approximately 44% of participants reported poor sleep quality, nearly 9% had daytime dysfunction, and 10.6% used sleep medication. The multivariate logistic regression results indicate that people with depression were 8.89 times more likely to have poor sleep than those without depression (95% CI:2.63-28.27, p < .001). CONCLUSION: Sleep problems are common among middle-aged people with cancer in Vietnam, especially individuals with depression. It is necessary to have more effective approaches to sleep management for cancer patients with limited resources.

Membrane distillation of wastewater: comparison of model and real organics.

Fouling behaviour in membrane distillation (MD) processes plays a crucial role in determining their widespread acceptability. Most studies have primarily focused on model organic foulants, such as humic acid (HA) and sodium alginate (SA). This study investigates the fouling of a polytetrafluoroethylene membrane in a direct contact MD (DCMD) using model organics (i.e., HA and SA) and real wastewater. The results indicated that the flux decline (5-60%) was only observed during the initial phase of the operation with model organic foulants. In contrast, real wastewater caused a gradual decline in flux throughout the experiment in both the concentrate (40%) and continuous (90%) modes. The study also found significant differences in the fouling layer morphology, composition, and hydrophobicity between the model organic foulants and real wastewater. Fourier transform infrared spectroscopy findings demonstrated that the fouling layer formed by real wastewater varied significantly from model organics, which primarily comprised of protein-like and polysaccharide-like functional groups. Finally, liquid chromatography-organic carbon detection revealed that the fouling layer of the MD membrane with real wastewater was composed of 40.7% hydrophobic and 59.3% hydrophilic organics. This study suggests that model organics may not accurately reflect real wastewater fouling.

Rapidly developing communications materials during public health emergencies: the Âu CÆ¡ campaign in the USA.

During public health emergencies, health communication materials to contain the outbreak are needed promptly, which prevents the use of standard approaches for getting feedback from the intended audience. We propose a strategy for rapidly obtaining community feedback on new health communication materials during the public health emergencies. We illustrate this with COVID-19 testing campaign in a Vietnamese-American enclave in the USA. The project included community-based COVID-19 testing and communication activities to increase the awareness of the testing centers and encourage frequent testing. Our strategy involves two main components: (i) use of a research team with an existing trust relationship with the community and that includes researchers from that community and (ii) co-design of communication materials using community-based gatekeepers and a cultural broker. We developed brochures and posters to increase the awareness of the COVID-19 testing services. The cultural broker and community-based partners identified salient message concepts and worked with the researchers to define the objectives and content of the materials, which were then reviewed by the entire team. In lieu of standard pretesting, we relied on feedback on mockups of the materials and subsequent revisions from the community-based gatekeepers and cultural broker. Our strategy strikes a balance between the need to urgently disseminate new materials and the need for community input. One key takeaway is that effective planning for public health emergencies must start long before the crisis occurs.

Predicting Anxiety and Depression Among Erectile Dysfunction Patients: A Cross-Sectional Study.

In Vietnam, erectile dysfunction (ED) is prevalent and recognized to be associated with mental disorders; however, societal taboos impede a comprehensive understanding of this connection. Our study aims to investigate the factors related to higher levels of anxiety and/or depression (HAD) in individuals with ED. Between November 2022 and March 2023, a face-to-face survey was conducted at the Center for Andrology of Viet Duc University Hospital, involving 390 patients diagnosed with ED. The survey included 51 questions covering general patient information, the International Index of Erectile Function-15 (IIEF-15), the Patient Health Questionnaire-9 (PHQ-9), and the Generalized Anxiety Disorder-7 (GAD-7). The stepwise Akaike Information Criterion (AIC) method was used to identify factors associated with HAD. The study revealed an average age of 37.63 (11.84) years among participants, with a HAD prevalence of 17.69%. Several factors were associated with a higher likelihood of belonging to the HAD group in ED patients. These factors included non-office workers (OR: 1.11; 95% CI: [1.01, 1.21], p = .025), medium and high levels of work-related stress (OR: 1.23; [1.06, 1.44], p = .008; OR: 1.22; [1.04, 1.45], p = .018), multiple shameful experiences related to ED (OR: 1.16; [1.08, 1.25], p < .001), moderate and severe ED (OR: 1.17; [1.03, 1.32], p = .013; OR: 1.31; [1.14, 1.51], p < .001), and dissatisfaction with intercourse skills (OR: 1.09; [1.01, 1.17], p = .028). Our findings suggest a 16% higher likelihood of HAD status in individuals with multiple shameful experiences related to ED, while moderate and severe ED are associated with respective increases of 17% and 31% in the likelihood. These findings emphasize the importance of considering mental health in the care of individuals with ED.

Treatment outcomes of EGFR-TKI with or without locoregional brain therapy in advanced EGFR-mutant non-small cell lung cancer patients with brain metastases.

Introduction: This study aimed to evaluate the treatment outcomes of epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) therapy alone or in combination with locoregional brain therapy for advanced EGFR-mutant non-small cell lung cancer (NSCLC) patients with brain metastases. Material and methods: A retrospective study involving 72 advanced EGFR-mutant NSCLC patients with brain metastases at the Vietnam National Cancer Hospital were conducted. Patients were divided into 2 groups: EGFR-TKI (erlotinib) monotherapy and EGFR-TKI combined with locoregional therapy (γ knife surgery - GKS or whole-brain radiation therapy). Evaluation criteria included clinical and laboratory characteristics, central nervous system (CNS) progression time, progression-free survival (PFS), overall survival (OS), T790M mutation rate, and adverse events. Results: Epidermal growth factor receptor tyrosine kinase inhibitor monotherapy patients had better performance status (PS), fewer CNS symptoms, and significantly fewer brain metastases (p < 0.05). Median PFS and OS were 11 and 25 months, respectively, in both groups. Patients with PS 0-1 had longer median PFS (15 months) than those with PS 2 (7 months) (p = 0.039). Exon 19 deletion patients in both groups had longer median OS (26 months) than those with L858R exon 21 (15 months) (p = 0.023). Patients with T790M mutation who received osimertinib after progression had longer median OS (41 months vs. 23 months, p = 0.0001). Median time to CNS progression was 13.9 months (48 patients). Longer time to CNS progression correlated with longer OS (R2 = 0.89). Conclusions: Epidermal growth factor receptor tyrosine kinase inhibitor therapy, with or without locoregional therapy, is effective for advanced EGFR-mutant NSCLC patients with brain metastases. Exon 19 deletion patients had better prognosis.

Investigation on Methylene Blue Dye Adsorption in Aqueous by the Modified Mussel Shells: Optimization, Kinetic, Thermodynamic and Equilibrium Studies.

This study assessed the methylene blue adsorption using natural and modified mussel shell powders in the aqueous solution. The mussel shell samples were processed in a NaClO solution then modified with sodium dodecyl sulfate and ethylenediaminetetraacetic acid. The characteristics of mussel shell samples before and after modification were demonstrated using infared spectroscopy, thermogravimetric analysis, scanning electron microscopy, nitrogen adsorption/desorption, energy dispersive X-ray, water contact angle, and dynamic light scattering methods. Some factors such as the pH of the medium, adsorption temperature, and adsorption time had a significant effect on the methylene blue adsorption of mussel shell samples. The adsorption isotherm models and kinetics of methylene blue adsorption by mussel shell samples were also studied. A quadratic regression equation was selected with experimental planning following the Box-Behnken model combined with Design Expert 11.1.0.1 software to optimize the methylene blue adsorption process by mussel shell samples. These results open a promising direction for using naturally derived materials to remove organic pollutants from contaminated water.

Social support and community embeddedness protect against post-disaster depression among immigrants: a Vietnamese American case study.

Immigrants often face increased vulnerabilities to disaster-related poor health and recovery, compared to mainstream populations. Little is known about Hurricane Harvey's impacts among the storm affected area's large Vietnamese American population. Our study documented diverse psychological experiences and recovery challenges 1 year post-storm among a sample of 120 Vietnamese Americans residing in the Houston, Texas area. Using linear regression modeling, we examined the association between social support and depressive symptom development among these storm-affected Vietnamese Americans. Social support encapsulating both social embeddedness and perceived support was measured by the Louisville Social Support Scale and depressive symptom development was measured by 18 items that assessed emotional distress. These items included loss of appetite, loss of concentration, exposure to persistent pain, and the exhibition of hopelessness, tiredness, sadness, frustration, discouragement, desperation, exhaustion, disgraced, anger, and craziness. We found adverse post-disaster health outcomes, as well as potential avenues to mitigate them, that should be taken into consideration in the design and implementation of inclusive disaster programs. A high level of social support lowered depressive symptomology among Vietnamese Americans post-Hurricane Harvey, even when accounting for Hurricane Harvey-related home damages and injuries/illness. The negative association between social support and depressive symptom development remained after accounting for both post-storm self-rated mental and physical health. Our results suggested that public health practitioners and emergency management entities should prioritize social support resources to foster mental well-being after hurricanes among Vietnamese Americans as future hurricanes are expected to be stronger and more prevalent along the United States Gulf Coast.

Factors Associated With Poor Health Outcomes Among Vietnamese Americans After Hurricane Harvey, Houston, Texas, 2018-2019.

OBJECTIVE: Immigrants typically experience poor health outcomes after disasters but are often excluded in disaster studies. We assessed physical and mental health outcomes among Houston-area Vietnamese American residents after Hurricane Harvey and hurricane-related characteristics associated with poor health outcomes. METHODS: We conducted in-person structured surveys among 120 Vietnamese Americans from November 2018 through February 2019. We used the physical and mental component scores of the 12-Item Short-Form Health Survey to assess health outcomes. We used descriptive statistics for health outcomes and hurricane-related effects and examined the associations between hurricane-related characteristics and health outcomes. RESULTS: Overall mean (95% CI) physical and mental component scores were 39.8 (29.7-49.9) and 32.6 (27.6-37.6), respectively. The odds of poor physical health poststorm were significantly higher among participants reporting ≥5 versus <5 depressive symptoms (odds ratio [OR] = 3.04; 95% CI, 1.11-8.29; P = .03) and significantly lower among participants with versus without health insurance (OR = 0.25; 95% CI, 0.09-0.71; P = .01). The odds of experiencing poor mental health more than a year after the hurricane were significantly higher among those sustaining versus not sustaining a serious injury/illness because of the hurricane (OR = 3.34; 95% CI, 1.12-9.94; P = .03) and among those who were married/partnered versus not married/partnered (OR = 4.16; 95% CI, 1.32-13.07; P = .02). Receiving versus not receiving free health care services after the hurricane and having high versus low levels of acculturation protected against poor mental health (P < .05 for both). CONCLUSIONS: Our findings highlight the inequalities of postdisaster health outcomes in this immigrant population and emphasize the need for improved disaster recovery programs that account for these factors.

Adherence to Hypertensive Treatment among Vietnamese Patients in New Orleans.

OBJECTIVES: Our principal objectives were to identify the level of adherence and identify the attitudes, beliefs, and behaviors that influence adherence to antihypertensive treatment among Vietnamese patients in New Orleans, Louisiana. METHODS: By partnering with a community health center serving the Vietnamese community in New Orleans, we conducted reviews of 250 medical records of hypertensive patients receiving care there, 3 provider interviews, and 8 patient interviews. Descriptive and thematic analyses were used. RESULTS: The level of treatment nonadherence in our sample population was 20.40%. Findings highlighted several key factors that may contribute to adherence, including easy access to providers, who are culturally competent and have used several strategies to help increase adherence, and the social support network of patients within a close-knit community. Other sociodemographic factors, such as age, sex, and tobacco and alcohol use also may play a role in adherence. CONCLUSIONS: Adherence to antihypertensive treatment among Vietnamese patients in New Orleans was relatively high compared with other ethnic and racial groups in the United States. Further assessment of the characteristics of patients, providers, and the community may improve adherence to other chronic conditions in this population and patients of other ethnicities and races.

The effect of sampling health facilities on estimates of effective coverage: a simulation study.

BACKGROUND: Most existing facility assessments collect data on a sample of health facilities. Sampling of health facilities may introduce bias into estimates of effective coverage generated by ecologically linking individuals to health providers based on geographic proximity or administrative catchment. METHODS: We assessed the bias introduced to effective coverage estimates produced through two ecological linking approaches (administrative unit and Euclidean distance) applied to a sample of health facilities. Our analysis linked MICS household survey data on care-seeking for child illness and childbirth care with data on service quality collected from a census of health facilities in the Savanes region of Cote d'Ivoire. To assess the bias introduced by sampling, we drew 20 random samples of three different sample sizes from our census of health facilities. We calculated effective coverage of sick child and childbirth care using both ecological linking methods applied to each sampled facility data set. We compared the sampled effective coverage estimates to ecologically linked census-based estimates and estimates based on true source of care. We performed sensitivity analyses with simulated preferential care-seeking from higher-quality providers and randomly generated provider quality scores. RESULTS: Sampling of health facilities did not significantly bias effective coverage compared to either the ecologically linked estimates derived from a census of facilities or true effective coverage estimates using the original data or simulated random quality sensitivity analysis. However, a few estimates based on sampling in a setting where individuals preferentially sought care from higher-quality providers fell outside of the estimate bounds of true effective coverage. Those cases predominantly occurred using smaller sample sizes and the Euclidean distance linking method. None of the sample-based estimates fell outside the bounds of the ecologically linked census-derived estimates. CONCLUSIONS: Our analyses suggest that current health facility sampling approaches do not significantly bias estimates of effective coverage produced through ecological linking. Choice of ecological linking methods is a greater source of bias from true effective coverage estimates, although facility sampling can exacerbate this bias in certain scenarios. Careful selection of ecological linking methods is essential to minimize the potential effect of both ecological linking and sampling error.

Preliminary results of adapting the stepped care model for depression management in Vietnam.

Background: Depression is the leading burden of mental disease, especially in low-and-middle-income countries like Vietnam. The Stepped Care Model is a promising approach to managing depression in the community with low resources. This is the first study that implemented the adapted Stepped Care Model for depression management in the Vietnamese context and evaluated the initial effectiveness of this community-based intervention in the Thai Nguyen community. Materials and methods: A quasi-experimental study with a 3-month follow-up was conducted in 10 selected communes in Thai Nguyen province. The most important modifications in the Stepped Care Model for depression management were the screening focused on the high-risk individuals living in the community; the combination of 8-session group psychotherapy with animation activities at commune health stations (CHS); and using psychotherapy as first-line treatment. From August 2020 to January 2021, quantitative data were collected using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form. The descriptive analyses were performed to describe the demographic characteristics and the change in the questionnaires' mean score at the baseline and 3-month follow-up. Results: A total of 1,891 people were approached in the community, of which 359 voluntary people met the study criteria and attended group psychotherapy. During group psychotherapy, the average PHQ-9 scores gradually decreased, and after the 8th session, this figure dropped by 2.65 times compared to the beginning. After 3 months, the percentage of the group with mild-moderate depression shrank from 95.5 to 9.3%, and there were no more severe cases. Moreover, life satisfaction increased by 32% and the anxiety level significantly dropped according to Q-LES-Q-SF and GAD-7 accordingly. Conclusion: The preliminary results after 3-month follow-up showed that the Stepped Care Model with group psychotherapy at the CHS was promising to manage the depression in the community. This task shifting approach with limited resources should be further disseminated and studied for long-term effectiveness in low-and-middle-income countries like Vietnam.

Differential pulse voltammetry determination of salbutamol using disulfite tungsten/activated carbon modified glassy carbon electrode.

In the present article, the disulfide tungsten/activated carbon derived from Eichhornia crassipes (WS2/AC) was synthesized by the hydrothermal process. The received materials were examined by X-ray diffraction, scanning electron microscopy, energy-dispersive X-ray - mapping, and nitrogen adsorption/desorption isotherms. The morphology of WS2/AC was tailored to have a micro/meso/macro structure that facilized large electric conductivity and quick ion diffusion. The WS2/AC sample was used as an electrode modifier for developing an electrochemical sensor for salbutamol detection. WS2/AC exhibited excellent oxidation toward salbutamol. Through some optimized conditions, the electrochemical signal of the proposed sensor varied linearly to the salbutamol concentration ranging from 1 to 210 µM with a low LOD (detection limit) of 0.52 µM. The developed sensor showed several merits: easy producing, convenient usage, fabulous selectivity, and good repeatability as well as reproducibility. Finally, the suggested technique can be applied to determine salbutamol in people's biological fluid with satisfactory recoveries of 98.5-104.4% and without statistics different from standard HPLC.

Mental Health Problems Among Front-Line Healthcare Workers Caring for COVID-19 Patients in Vietnam: A Mixed Methods Study.

Aim: Healthcare workers have directly provided care for COVID-19 patients, and have faced many additional sources leading to poor mental health. The study aimed to investigate the mental health problems and related factors among healthcare staff in Vietnam. Methods: A descriptive cross-sectional mixed methods study, combining quantitative and qualitative research methods, was performed among 400 healthcare workers working at the National Hospital for Tropical Diseases and Ninh Binh General Hospital from the first day of treatment for COVID-19 patients to May 01, 2020. Results: The results showed that 8.0% of participants had stress, 17.5% of participants had anxiety, and 14.8% of participants had depression. Approximately 50% of participants reported that they had at least one of these symptoms. The findings illustrated that stress, anxiety, and depression were associated with the position in a hospital, health status during the COVID-19 pandemic, family members/relatives infected with COVID-19, physical and mental support from friends, family, and community, department, years of working, and the average work hours per day of healthcare workers exposed to COVID-19. Conclusion: During the COVID-19 pandemic, healthcare workers who worked in the hospital providing treatment and care for COVID-19 patients dealt with mental health problems such as stress, anxiety, and depression. It is necessary to promote mental health among healthcare workers, to contribute to the fight against the COVID-19 outbreak in Vietnam.

A review on the determination of veterinary drug residues in food products.

In this paper, we discuss veterinary medicine and its applications in the food industry as well as the risk to the health of humans and animals caused by these residues. We review how the veterinary residues enter and cause some detrimental effects. We also mention two techniques to determine the residue of veterinary medications that exist in food originating from animals, including classic and advanced techniques. Finally, we discuss the potential of various developed methods and compare them with some traditional techniques.

A state-of-the-art review on the nanomaterial-based sensor for detection of venlafaxine.

Venlafaxine (denoted as VFX), a member of the most extensively prescribed antidepressants, is used to handle major depressive disorder, panic disorder and anxiety. This medication affects brain chemistry, which could cause an imbalance in depressed people. VFX and its metabolites, on the other hand, are pollutants in the water environment. Through movement and transformation in several procedures like adsorption, photolysis, hydrolysis and biodegradation, they have harmed living creatures, resulting in the enhancement of diverse active chemicals found in the environment. As a result, determining VFX at modest concentrations with excellent sensitivity, specificity and repeatability are critical. To quantify VFX, various analytical methodologies have been developed. Electroanalytical processes, on the other hand, have piqued interest because of their superior benefits over traditional techniques such as speed, sensitivity, directness and affordability. Subsequently, the purpose of this article is to show how to determine VFX electrochemically using a wide range of electrodes, including CPE, GCE, MCE, SPE, PGE and ISE.

A state-of-the-art review on graphene-based nanomaterials to determine antibiotics by electrochemical techniques.

Antibiotics might build up into the human body by foodstuff metabolism, posing a serious threat to human health and safety. Establishing simple and sensitive technology for quick antibiotic evaluation is thus extremely important. Nanomaterials (or NMTs) with the advantage of possessing merits such as remarkable optical, thermal, mechanical, and electrical capabilities have been highlighted as a piece of the best promising materials for rising new paths in the creation of the future generation biosensors. This paper presents the most recent advances in the use of graphene NMTs-based biosensors to determine antibiotics. Gr-NMTs (or graphene nanomaterials) have been used in the development of a biosensor for the electrochemical signal-transducing process. The rising issues and potential chances of this field are contained to give a plan for forthcoming research orientations. As a result, this review provides a comprehensive evaluation of the nanostructured electrochemical sensing approach for antibiotic residues in various systems. In this review, various electrochemical techniques such as CV, DPV, Stripping, EIS, LSV, chronoamperometry, SWV were employed to determine antibiotics. Additionally, this also demonstrates how graphene nanomaterials are employed to detect antibiotics.

Electrochemical sensor to detect terbutaline in biological samples by a green agent.

In this research, reduced graphene oxide (RGO) which is a form of graphene oxide (GO) was formed through a reduction process using a "green agent" called Ascorbic acid (AA). RGO was then modified on the surface of the glassy carbon electrode (GCE) to generate RGO/GCE (an advanced electrode). The RGO/GCE was then used to detect Terbutaline (TB) in urine samples of volunteer athletes (n = 5) using well-known spectrophotometric analyses including X-ray diffraction analysis (XRD), Fourier-transform infrared spectroscopy (FT-IR), ultraviolet-visible Spectroscopy (UV-Vis), and Raman and electrochemical methods using voltammetric analyses such as differential pulse anodic stripping voltammetry (DP-ASV) and cyclic voltammetry (CV). Comparing various analysis methods using RGO/GCE to detect TB in human urine samples, voltammetric analysis specifically DP-ASV demonstrated higher sensitivity and selectivity in detecting TB than spectrophotometric analyses. Thus, in this study, several factors that would affect the voltammetric signals such as pH and interferents were evaluated and the electroactive surface area was also calculated. Our findings indicated that the RGO/GCE showed excellent repeatability, reproducibility, and long-term stability suggesting that TB could be detected more effectively using RGO/GCE than bare GCE. The detection limit of 0.0052 µM achieved in this study indicated that RGO/GCE can effectively detect TB in human urine while demonstrating reasonable selectivity and sensitivity.

Orchestrating Extracellular Vesicle With Dual Reporters for Imaging and Capturing in Mammalian Cell Culture.

Background: Recent technological advancements have enabled live-cell imaging of intracellular organelles to monitor their biogenesis in mammalian cells. However, applying this method to gain insight into extracellular organelles, such as extracellular vesicles (EVs), presents unique challenges that require special considerations in design and engineering. Results: We have developed a dual-reporter system that combines genetic fusion, fluorescence microcopy and magnetic beads capture of EVs to study the biogenesis of EVs in mammalian cell cultures. First, we genetically produced a series of reporters by fusing a green fluorescent protein (GFP) and an affinity peptide (6xHis), with either the endogenous transmembrane protein, CD63, or EVs targeting vesicular stomatitis viral glycoprotein (VSVG). Transfection of these reporters into human 293T cells resulted in expression and integration of these reporters into pre-exosome compartments, which were subsequently released into the culture medium. Confocal imaging and nano-particle tracking analysis demonstrated that EVs were appropriately labeled and exhibited a single dominant peak in the 80-110 nm size range, indicating that isolated EVs were comprised of micro-vesicles and/or exosome subpopulations. Incubation of isolated EVs with nickel-coated magnetic beads resulted in successful capture of GFP-positive EVs. Finally, addition of EVs into culture medium was able to reveal the cellular uptake of GFP-labeled EVs by recipient cells. Taken together, our dual-reporter system provides a powerful method for both monitoring and capturing of EVs in mammalian cell culture systems. Conclusion: A dual-reporter system provides a robust tool to study the life cycle of EVs in mammalian cells from biogenesis and excretion to cellular uptake.

Intersecting Stigmas among HIV-Positive People Who Inject Drugs in Vietnam.

HIV-related stigma remains a barrier to ART adherence among people living with HIV (PLWH) globally. People who inject drugs (PWID) may face additional stigma related to their behavior or identity; yet, there is little understanding of how these stigmas may co-exist and interact among these key populations. This study aims to explore the existence of multiple dimensions of HIV-related stigma, and how they may intersect with stigma related to drug injection. The study took place in Vietnam, where the HIV epidemic is concentrated among 3 key population groups; of those, PWID account for 41% of PLWH. The vast majority (95%) of PWID in Vietnam are male. Data came from in-depth interviews with 30 male PWID recruited from outpatient clinics, where they had been receiving ART medications. Deductive, thematic analysis was employed to organize stigma around the 3 dimensions: enacted, anticipated, and internalized stigma. Findings showed that HIV- and drug use-related stigma remained high among participants. All 3 stigma dimensions were prevalent and perceived to come from different sources: family, community, and health workers. Stigmas related to HIV and drug injection intersected among these individuals, and such intersection varied widely across types of stigma. The study revealed nuanced perceptions of stigma among this marginalized population. It is important for future studies to further investigate the influence of each dimension of stigma, and their interactive effects on HIV and behavioral outcomes among PWID.

The effects of cumulative natural disaster exposure on adolescent psychological distress.

Natural disasters are becoming more frequent and destructive due to climate change and have been shown to be associated with a variety of adverse mental health outcomes in children and adolescents. This study utilizes data from three cohort studies of Hurricane Katrina survivors-including low-income mothers from New Orleans; displaced and highly impacted families from Louisiana and Mississippi; and Vietnamese immigrants in New Orleans-to examine the relationship between cumulative natural disaster exposure and adolescent psychological distress approximately 13 years after Katrina. Among 648 respondents with children ages 10-17, 112 (17.2%) reported that their child had exhibited one or more symptoms of psychological distress in the past month. Overall, respondents had experienced an average of 0.6 (SD 1.0) natural disasters following Hurricane Katrina. Each additional natural disaster experienced by the respondent was associated with 1.41 (95% CI 1.05, 1.88) greater odds of his or child experiencing psychological distress in the past month. This relationship was not significantly moderated by any measures of family resilience or vulnerability, nor by race/ethnicity or socioeconomic status, although family functioning, parental coping, and caregiver mental health were independently associated with adolescent psychological distress. The results of this analysis suggest that natural disasters have cumulative, detrimental impacts on adolescent mental health.