Validation of the Job Content Questionnaire among hospital nurses in Vietnam.

OBJECTIVES: The aim of this study was to examine the reliability and validity of the Job Content Questionnaire (JCQ) in Vietnamese among hospital nursing staff. METHODS: The 22-items version of the JCQ was used. This includes four scales: (a) psychological demands (5 items); (b) job control (9 items); (c) supervisor support (4 items); and (d) coworker support (4 items). All 1258 nurses in a general hospital in Vietnam, excluding 11 who were due to retire, were invited to complete the cross-sectional survey. The internal consistency reliability was estimated using Cronbach's α. Construct validity was examined using exploratory factor analysis (EFA). Convergent validity was evaluated by calculating correlations between the JCQ scores and DASS 21 and overtime work. RESULTS: In total, 949 (75%) of the 1258 eligible nurses completed the survey. Cronbach's α values demonstrated acceptable internal consistency in two scales (supervisor support α = .87; coworker support α = .86), while Cronbach's α was below the acceptable threshold of 0.70 for job control (α = .45) and job demand (α = .50). EFA assuming a four-factor structure showed a factor structure that was almost identical to the original JCQ, with two items loading on other scales. The subscales of depression, anxiety, and stress response of DASS 21 and the subscales of JCQ were significantly correlated, as expected. CONCLUSION: The results suggest that the JCQ in Vietnamese can be used with some reliability and validity for examining psychosocial work environment among nurses. Further studies should be done to confirm and expand our findings in a variety of occupational groups and in other Asian low- and middle-income countries.

Quantitative value chain approaches for animal health and food safety.

Economic impact assessments are increasingly important in the context of animal health and food safety, although much of the existing literature does not address the broader systems context in which disease transmission takes place. In this paper, we discuss the role of system dynamics modeling in addressing the value chain impacts associated with animal health and food safety issues. System dynamics methods hold promise as a means of capturing the complex feedbacks that exist between the biology, economics, and behavioral aspects of food safety and animal health systems. We provide a proof-of-concept of this approach in the context of food safety and animal health in the smallholder pig sector of Viet Nam. Results highlight the important tradeoffs that exist between policy objectives and the costs required to achieve them.

Secular trend, seasonality and effects of a community-based intervention on neonatal mortality: follow-up of a cluster-randomised trial in Quang Ninh province, Vietnam.

BACKGROUND: Little is know about whether the effects of community engagement interventions for child survival in low-income and middle-income settings are sustained. Seasonal variation and secular trend may blur the data. Neonatal mortality was reduced in a cluster-randomised trial in Vietnam where laywomen facilitated groups composed of local stakeholders employing a problem-solving approach for 3 years. In this analysis, we aim at disentangling the secular trend, the seasonal variation and the effect of the intervention on neonatal mortality during and after the trial. METHODS: In Quang Ninh province, 44 communes were allocated to intervention and 46 to control. Births and neonatal deaths were assessed in a baseline survey in 2005, monitored during the trial in 2008-2011 and followed up by a survey in 2014. Time series analyses were performed on monthly neonatal mortality data. RESULTS: There were 30 187 live births and 480 neonatal deaths. The intervention reduced the neonatal mortality from 19.1 to 11.6 per 1000 live births. The reduction was sustained 3 years after the trial. The control areas reached a similar level at the time of follow-up. Time series decomposition analysis revealed a downward trend in the intervention areas during the trial that was not found in the control areas. Neonatal mortality peaked in the hot and wet summers. CONCLUSIONS: A community engagement intervention resulted in a lower neonatal mortality rate that was sustained but not further reduced after the end of the trial. When decomposing time series of neonatal mortality, a clear downward trend was demonstrated in intervention but not in control areas. TRIAL REGISTRATION NUMBER: ISRCTN44599712, Post-results.

Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam.

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts. TRIAL REGISTRATION: ISRCTN ISRCTN44599712 .

40 Gb/s optical subassembly module for a multi-channel bidirectional optical link.

A 40 Gb/s bidirectional optical link using four-channel optical subassembly (OSA) modules and two different wavelengths for the up- and down-link is demonstrated. Widely separated wavelengths of 850 nm and 1060 nm are used to reduce the optical crosstalk between the up- and down-link signals. Due to the integration capabilities of silicon, the OSA is implemented, all based on silicon: V-grooved silicon substrates to embed fibers and silicon optical benches (SiOBs) to mount optical components. The SiOBs are separately prepared for array chips of photodiodes (PDs), vertical-cavity surface-emitting lasers (VCSELs), and monitoring PDs, which are serially configured on an optical fiber array for direct coupling to the transmission fibers. The separation of the up- and down-link wavelengths is implemented using a wavelength-filtering 45° mirror which is formed in the fiber under the VCSEL. To guide the light signal to the PD another 45° mirror is formed at the end of the fiber. The fabricated bidirectional OSA module shows good performances with a clear eye-diagram and a BER of less than 10(-12) at a data rate of 10 Gb/s for each of the channels with input powers of -8 dBm and -6.5 dBm for the up-link and the down-link, respectively. The measured inter-channel crosstalk of the bidirectional 40 Gb/s optical link is about -22.6 dB, while the full-duplex operation mode demonstrates negligible crosstalk between the up- and down-link.

Effect of Facilitation of Local Maternal-and-Newborn Stakeholder Groups on Neonatal Mortality: Cluster-Randomized Controlled Trial.

BACKGROUND: Facilitation of local women's groups may reportedly reduce neonatal mortality. It is not known whether facilitation of groups composed of local health care staff and politicians can improve perinatal outcomes. We hypothesised that facilitation of local stakeholder groups would reduce neonatal mortality (primary outcome) and improve maternal, delivery, and newborn care indicators (secondary outcomes) in Quang Ninh province, Vietnam. METHODS AND FINDINGS: In a cluster-randomized design 44 communes were allocated to intervention and 46 to control. Laywomen facilitated monthly meetings during 3 years in groups composed of health care staff and key persons in the communes. A problem-solving approach was employed. Births and neonatal deaths were monitored, and interviews were performed in households of neonatal deaths and of randomly selected surviving infants. A latent period before effect is expected in this type of intervention, but this timeframe was not pre-specified. Neonatal mortality rate (NMR) from July 2008 to June 2011 was 16.5/1,000 (195 deaths per 11,818 live births) in the intervention communes and 18.4/1,000 (194 per 10,559 live births) in control communes (adjusted odds ratio [OR] 0.96 [95% CI 0.73-1.25]). There was a significant downward time trend of NMR in intervention communes (p = 0.003) but not in control communes (p = 0.184). No significant difference in NMR was observed during the first two years (July 2008 to June 2010) while the third year (July 2010 to June 2011) had significantly lower NMR in intervention arm: adjusted OR 0.51 (95% CI 0.30-0.89). Women in intervention communes more frequently attended antenatal care (adjusted OR 2.27 [95% CI 1.07-4.8]). CONCLUSIONS: A randomized facilitation intervention with local stakeholder groups composed of primary care staff and local politicians working for three years with a perinatal problem-solving approach resulted in increased attendance to antenatal care and reduced neonatal mortality after a latent period.

Implementing knowledge into practice for improved neonatal survival; a cluster-randomised, community-based trial in Quang Ninh province, Vietnam.

BACKGROUND: Globally, almost 4 million newborns die during the first 4 weeks of life every year. By increased use of evidence-based knowledge in the healthcare system a large proportion of these neonatal deaths could be prevented. But there is a severe lack of knowledge on effective methods for successful implementation of evidence into practice, particularly in low- and middle-income countries. Recent studies have demonstrated promising results with increased survival among both mothers and newborns using community-based approaches. In Vietnam evidence-based guidelines on reproductive health were launched in 2003 and revised in 2009. The overall objective of the current project is to evaluate if a facilitation intervention on the community level, with a problem-solving approach involving local representatives if the healthcare system and the community, results in improvements of neonatal health and survival. METHODS/DESIGN: The study, which has been given the acronym NeoKIP (Neonatal Health - Knowledge Into Practice), took place in 8 districts composed by 90 communes in a province in northern Vietnam, where neonatal mortality rate was 24/1000 in 2005. A cluster randomised design was used, allocating clusters, as defined as a commune and its correponding Commune Health Center (CHC) to either intervention or control arm. The facilitation intervention targeted staff at healthcare centres and key persons in the communes. The facilitator role was performed by lay women (Women's Union representatives) using quality improvement techniques to initiate and sustain improvement processes targeting identified problem areas. The intervention has been running over 3 years and data were collected on the facilitation process, healthcare staff knowledge in neonatal care and their behaviour in clinical practice, and reproductive and perinatal health indicators. Primary outcome is neonatal mortality. DISCUSSION: The intervention is participatory and dynamic, focused on developing a learning process and a problem-solving cycle. The study recognises the vital role of the local community as actors in improving their own and their newborns' health, and applies a bottom-up approach where change will be accomplished by an increasing awareness at and demand from grass root level. By utilising the existing healthcare structure this intervention may, if proven successful, be well suited for scaling up. TRIAL REGISTRATION: Current Controlled Trials ISRCTN44599712.

Perinatal services and outcomes in Quang Ninh province, Vietnam.

AIM: We report baseline results of a community-based randomized trial for improved neonatal survival in Quang Ninh province, Vietnam (NeoKIP; ISRCTN44599712). The NeoKIP trial seeks to evaluate a method of knowledge implementation called facilitation through group meetings at local health centres with health staff and community key persons. Facilitation is a participatory enabling approach that, if successful, is well suited for scaling up within health systems. The aim of this baseline report is to describe perinatal services provided and neonatal outcomes. METHODS: Survey of all health facility registers of service utilization, maternal deaths, stillbirths and neonatal deaths during 2005 in the province. Systematic group interviews of village health workers from all communes. A Geographic Information System database was also established. RESULTS: Three quarters of pregnant women had ≥3 visits to antenatal care. Two hundred and five health facilities, including 18 hospitals, provided delivery care, ranging from 1 to 3258 deliveries/year. Totally there were 17 519 births and 284 neonatal deaths in the province. Neonatal mortality rate was 16/1000 live births, ranging from 10 to 44/1000 in the different districts, with highest rates in the mountainous parts of the province. Only 8% had home deliveries without skilled attendance, but those deliveries resulted in one-fifth of the neonatal deaths. CONCLUSION: A relatively good coverage of perinatal care was found in a Vietnamese province, but neonatal mortality varied markedly with geography and level of care. A remaining small proportion of home deliveries generated a substantial part of mortality.

Persistent neonatal mortality despite improved under-five survival: a retrospective cohort study in northern Vietnam.

AIM: To examine trends in neonatal, infant and under-five mortality rates in a northern Vietnamese district during 1970-2000, and to analyze socioeconomic differences in child survival over time. METHODS: Retrospective interviews with all women aged 15-54 years in Bavi district in Northern Vietnam (n = 14 329) were conducted. Of these women, 13 943 had been pregnant, giving birth to 26 796 children during 1970-2000. RESULTS: There was a dramatic reduction in infant and under-five mortality rate (47%) over time. However, the neonatal mortality rate (NMR) showed a very small reduction, thus causing its proportion of the total child mortality to increase. Mortality trends followed the political and socioeconomic development of Vietnam over war, peace and periods of reforms. There were no differences in under-five and neonatal mortalities associated with family economy, while differentials related to mothers' education and ethnicity were increasing. CONCLUSION: Interventions to reduce child mortality should be focused on improving neonatal care. In settings with a rapid economic growth and consequent social change, like in Vietnam, it is important that such interventions are targeted at vulnerable groups, in this case, families with low level of education and belonging to ethnic minorities.

Oral and constitutional manifestations of HIV-infected hospital patients in Northern Vietnam.

This study reports clinical features, with emphasis on oral lesions and constitutional signs, of 170 patients in a regional hospital in northern Vietnam, of whom 56 were HIV positive. The purpose of the study was to investigate the relationship of oral hairy leukoplakia (OHL) and oropharyngeal candidiasis (OPC) with HIV infection and late stage HIV disease. Late stage HIV disease was defined as WHO stage III or IV and/or a total lymphocyte count below 1200 cells/mm3. The 56 HIV positive patients included all patients with a positive HIV test between July 7th and September 9th 2002. A total of 114 HIV negative controls were included as well. All patients had a detailed medical history and examination as well as a thorough oral examination, which were all done without prior knowledge of the patient's HIV serostatus. HIV positive patients were then grouped according to WHO clinical stage and total lymphocyte count. Thirty-six patients (64.3%) out of 56 HIV positives were in WHO stage III+IV and 28 patients (50.0%) had a total lymphocyte count below 1200 cells/mm3. The presence of OPC, weight loss of more than 10% of body weight and/or chronic fever of more than one month's duration showed a significant association and high positive prediction with HIV infection, especially late stage HIV disease [all with odds ratio (OR) and 95% confidence interval (CI > 1)]. The presence of OHL only showed a significant association with positive HIV serostatus and WHO stage III+IV. It can be concluded that in North Vietnam, HIV positive patients and patients suspected of having HIV infection would benefit from initial and repeat oral examinations. OPC, together with other signs of progressive infection (constitutional signs, such as weight loss and chronic fever) may serve as indicators for institution of prophylactic drugs against opportunistic infections and even antiretroviral (ARV) therapy, when available. However, further research is needed to demonstrate the role of OHL in HIV patients in North Vietnam.

Impact of improved vaccination programme and intensive care facilities on incidence and outcome of tetanus in southern Vietnam, 1993-2002.

Unvaccinated individuals throughout the world are vulnerable to tetanus, but there are few data regarding the impact of focused vaccination programmes and modern intensive care facilities on the disease, particularly in the developing world. The Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam admitted 2422 patients with tetanus aged > or =1 year between April 1993 and December 2002, during which time vaccine coverage and treatment facilities improved. The proportion of children < or =10 years old admitted with tetanus fell from 11.1 to 5.6% over the 10 year period (P = 0.002). The proportion of women aged 20-40 years fell from 10.1 to 1.2% (P < 0.001). Mortality rates fell from a maximum of 27.81% in 1994 to 10.04% in 2002 (P < 0.001). Thus, a marked reduction in tetanus incidence has occurred in age groups specifically targeted by the national vaccination programme. However, tetanus continues to be a major cause of morbidity and mortality in individuals outside the target population. Improved intensive care facilities, such as mechanical ventilation and low-cost infection control procedures are associated with a significant reduction in mortality.