Prevalence of stress and related factors among healthcare students: a cross - sectional study in Can Tho City, Vietnam.

Background: Stress is a major public health issue that can impact both physical and mental well-being. It is prevalent in many areas of modern life, including education. Healthcare students are at a high risk of experiencing stress due to the unique demands of their fields of study. Study design and methods: An online survey was conducted on 2,515 undergraduate students pursuing degrees in medicine, preventive medicine, pharmacy, and nursing at Can Tho University of Medicine and Pharmacy in Can Tho City, Vietnam. Results: Using the Perceived Stress Scale-10 (PSS-10), it was found that 35.2% of students reported mild stress, 62.7% had moderate stress, and only 2.1% experienced severe stress. Multivariable logistic regression analysis revealed nine significant factors associated with students' stress levels (p ≤ 0.05). Particularly, medicine students exhibited a significantly higher level of moderate and severe stress (95% CI = 1.22-2.01), 1.57 times higher than preventive medicine students. Sixth-year students had a stress level 1.58 times higher (95% CI = 1.11-2.26) than first-year students. Students achieving excellent and very good academic performances in the last semester had a stress level 1.60 times higher (95% CI = 1.16-2.22) than students with average and lower academic performance. Students living at home had a stress level 1.73 times higher (95% CI = 1.05-2.84) than students living in their relatives' houses. Students who rarely or never had a part-time job during academic years had a stress level 1.70 times higher (95% CI = 1.31-2.20) than those who often or sometimes had a part-time job. Students with a family history of smoking addiction had a stress level 1.69 times higher (95% CI = 1.28-2.22) than students without such a family history. Students who rarely or never received concern and sharing from family had a stress level 7.41 times higher (95% CI = 5.07-10.84) than students who often or sometimes received concern and sharing from family. Students who were often or sometimes cursed by family had a stress level 2.04 times higher (95% CI = 1.09-3.81) than students who were rarely or never cursed by family. Students without close friends had a stress level 1.46 times higher (95% CI = 1.11-1.91) than students with close friends. Conclusions: The rates of mild and moderate stress levels were significantly higher than severe stress level among healthcare students. Research has provided scientific findings as the basis for determining risk factors and imposing solutions that aim to reduce the rate of stress in students. Therefore, it helps students overcome difficulties and enhance their physical and mental health.

Caesarean sections before and during the COVID-19 pandemic in western Sydney, Australia.

BACKGROUND: To determine the changes in emergency and elective caesarean section (CS) rates since the COVID-19 pandemic, identify the groups most affected, and examine changes in the factors associated with CS rates, and reasons for CS. METHODS: We conducted a retrospective cohort study using routinely collected data of 22,346 births from before the pandemic (January 2018-February 2020) and 18,597 births during the pandemic (March 2020-December 2021). Data were analysed using multinominal logistic regression. RESULTS: The CS rate increased by 4.1% (from 30.1% to 34.2%), reflecting increases of 2.3% in emergency CS (from 11.5% to 13.8%) and 1.7% in elective CS (from 18.7% to 20.4%). Large groups with notable increases were women who were nulliparous (7.2% increase), from South Asia (6.0%), obese (5.2%) and giving birth at a small hospital (6.1%). Compared to pre-pandemic, the relative risk of an emergency CS versus a vaginal delivery increased 1.36 times (adjusted relative risk ratio (aRRR) = 1.36; 95% CI = 1.27, 1.45) and the risk of having an elective CS increased 1.11 times (aRRR = 1.11; 95% CI = 1.04, 1.20). Factors associated with both emergency and elective CS were age, region of birth, reproductive history, body mass index, hypertension, diabetes, mode of antenatal care and hospital. Socio-Economic Indexes for Areas and antenatal care were only associated with elective CS. Baby gender was only associated with emergency CS. Preterm gestation at delivery was associated with reduced emergency but increased elective CS. Foetal compromise was the most common indication for emergency CS (43.2%) and increased the most (8.0%). Previous CS was the most common indication for elective CS (61.5%) and reduced the most (1.9%). CONCLUSIONS: Both emergency and elective CS rates increased significantly during the pandemic, with the former increasing at a higher rate. The persistent upward trend of CS rates, exacerbated by increasing proportions of nulliparous women undergoing CSs, is concerning.

Australia has a very high caesarean section (CS) rate that varies greatly between groups of women with different socio-economic characteristics and reproductive histories. Information regarding changes in CS rate since the COVID-19 pandemic in Australia is limited. We conducted a study comparing CS rate before and during the pandemic, using routinely collected data. Both emergency and elective CS rates increased significantly during the pandemic with emergency CSs increased at a higher rate than elective CSs. Several groups of women experienced large increases in CS rate. Factors associated with and reasons for emergency CSs were different from those for elective CSs. Health services should be prepared to minimise effects of future pandemics on CS rate. To be most effective, interventions to reduce non-medically justified CSs should focus on women who are from South Asia, obese, admitted to a small hospital, and are nulliparous. Different approaches are needed to reduce emergency and elective CSs.

Using the Experiences and Perceptions of Health Care Workers to Improve the Health Care Response to the COVID-19 Pandemic.

BACKGROUND: We sought the opinions of health care workers (HCWs) at a designated COVID-19 facility receiving the first cases to identify workplace modifications and inform effective changes to maximize health and safety at the onset of a crisis. METHODS: A cross-sectional study utilized open- and close-ended questions gathered demographic and work details, experiences and perspectives on infection control, communication, support, and the workplace. Qualitative data were analyzed thematically and quantitative were analyzed using descriptive statistics. FINDINGS: Of 340 HCWs, most approved of the organization's response to minimizing risk (81.0%), infection control training (81.1%), and supplies (74.3%). Key actions included up-to-date guidelines (93.6%) and specialized infectious diseases clinics (94.9%). Conclusions: HCWs rated the organization's adaptive changes highly, noting areas for improvement such as transparency and timeliness of communication. Incorporating input from HCWs when responding to health crises was beneficial to maximize staff health and safety and consequently that of patients.

Effects of the COVID-19 Pandemic on the Use of Telehealth for Antenatal Care.

Aims: To determine changes in the use of telehealth and face-to-face consultations for antenatal care (ANC) associated with the COVID-19 pandemic and to identify the groups of women most affected. Materials and Methods: Routine administrative data from three public hospitals in a Local Health District in New South Wales, Australia, were analyzed. Data from 19,171 women who gave birth before the pandemic started (January 2018-January 2020) were compared with data of 5,479 women who gave birth after the pandemic started (December 2020-June 2021). Results: One in eight antenatal services after the pandemic started was a telehealth consultation. The average number of telehealth consultations per woman increased by 0.6 (0.7-1.3, adjusted incidence rate ratio [IRR] = 1.71, p < 0.001), while face-to-face visits decreased by 1.4 (10.6-9.2, adjusted IRR = 0.87, p < 0.001), resulting in an overall reduction of 0.8 (11.3-10.5, p < 0.001) services (7.1%). The increase in telehealth consultations was evident in all groups, but was greatest among women attending the smallest hospital, younger women, and Indigenous women. Most groups of women experienced a reduction in the number of face-to-face and total consultations, but the greatest reductions were among women who attended the largest hospital, received shared care, were older than 35 years, or had conceived through in vitro fertilization. Conclusions: Use of telehealth accounted for a small proportion of total ANC services; its increase did not compensate for the reduction in face-to-face visits, which might have resulted from the lack of suitable equipment, access to facilities, and skills or willingness to engage in telehealth. Ultimately there was an overall reduction of service utilization, which was not uniform among different groups of women.

Caesarean section by country of birth in New South Wales, Australia.

OBJECTIVE: To determine rates of caesarean section by country of birth and by obstetric risks. METHODS: We analysed the New South Wales Perinatal Data Collection data of women giving birth between January 2013 and December 2015. Obstetric risk was classified using the Robson's 10-group classification. Multilevel logistic regression with a random intercept was used to measure the variation in caesarean section rate between immigrants from different countries and between regional immigrant groups. RESULTS: We analysed data from 283,256 women, of whom 90,750 had a caesarean section (32.0%). A total of 100,120 women were born overseas (35.3%), and 33,028 (33.0%) had a caesarean section. The caesarean section rate among women from South and Central Asia ranged from 32.6% for women from Pakistan to 47.3% for women from Bangladesh. For South East Asia, women from Cambodia had the lowest caesarean section rate (19.5%) and women from Indonesia had the highest rate (37.3%). The caesarean section rate for North Africa and the Middle East ranged from 28.0% for women from Syria to 50.1% for women from Iran. Robson groups that accounted for most of the caesarean sections were women who had previous caesarean section (36.5%); nulliparous women, induced or caesarean section before labour (26.2%); and nulliparous women, spontaneous labour (8.9%). CONCLUSIONS: The caesarean section rate varied significantly between women from different countries of birth within the same region. Women from some countries of birth had the higher caesarean section rates in some Robson groups.

Falls in Hospital Causing Injury.

AIMS: To describe falls causing injury, types of injuries, and the reporting of these falls. METHODS: Administrative and incident reporting datasets between July 2012 and June 2017 were analyzed. RESULTS: Using both datasets, 5,653 falls were identified (3.7 per 1,000 bed-days). Administrative and incident datasets accounted for 40.8% (2,299) and 84.4% (4,752) of falls, respectively. More than half the falls in the administrative data required only observation/examination (1,221 falls; 53.1%, 0.8 per 1,000 bed-days). The remaining 1,078 falls (46.9%; 0.7 per 1,000 bed-days) caused 1,533 injuries (1.0 per 1,000 bed-days). Most injuries happened in patients who were 65 years or older (73.9%), during the first episode of care (79.0%), in the acute care setting (70.4%), or on the same level (60.1%). The most common injuries were to the head (33.3%). Some injuries were serious (169; 11.0%; 0.11 per 1,000 bed-days). Falls resulting in injury in older patients, with a more severe medical condition and at smaller hospitals, were more likely to be recorded in the incident reporting system whereas subsequent falls were less likely to be recorded. CONCLUSIONS: Fewer than half of the falls recorded in administrative data resulted in injuries. A tenth of all falls caused serious injuries.

Variation in Hospital Use at the End of Life Among New South Wales Residents Who Died in Hospital or Soon After Discharge.

Objective: Hospital use increases in the last 3 months of life. We aimed to examine its association with where people live and its variation across a large health jurisdiction. Methods: We studied a number of emergency department presentations and days spent in hospital, and in-hospital deaths among decedents who were hospitalized within 30 days of death across 153 areas in New South Wales (NSW), Australia, during 2010-2015. Results: Decedents' demographics and health status were associated with hospital use. Primary care and aged care supply had no or minimal influence, as opposed to the varying effects of areal factors-socioeconomic status, remoteness, and distance to hospital last admitted. Overall, there was an approximate 20% difference in hospital use by decedents across areas. In all, 18% to 57% of areas had hospital use that differed from the average. Discussion: The observed disparity can inform targeted local efforts to strengthen the use of community care services and reduce the burden of end-of-life care on hospitals.

Variations in hospital inpatient palliative care service use: a retrospective cohort study.

OBJECTIVE: Use of palliative care in hospitals for people at end of life varies. We examined rate and time of in-hospital palliative care use and associated interhospital variations. METHODS: We used admissions from all hospitals in New South Wales, Australia, within a 12-month period, for a cohort of adults who died in 73 public acute care hospitals between July 2010 and June 2014. Receiving palliative care and its timing were based on recorded use. RESULTS: Among 90 696 adults who died, 27% received palliative care, and the care was initiated 7.6 days (mean; SD: 3.3 days) before death. Over the 5-year period, the palliative care rate rose by 58%, varying extent across chronic conditions. The duration of palliative care before death declined by 7%. Patient (demographics, morbidities and service use) and hospital factors (size, location and availability of palliative care unit) explained half of the interhospital variation in outcomes: adjusted IQR in rate and duration of palliative care among hospitals were 23%-39% and 5.2-8.7 days, respectively. Hospitals with higher rates often initiated palliative care earlier (correlation: 0.39; p<0.01). CONCLUSION: Despite an increase over time in the palliative care rate, its initiation was late and of brief duration. Palliative care use was associated with patient and hospital characteristics; however, half of the between hospital variation remained unexplained. The observed suboptimal practices and variability indicate the need for expanded and standardised use of palliative care supported by assessment tools, service enhancement and protocols.

Variation in out-of-hospital death among palliative care inpatients across public hospitals in New South Wales, Australia.

BACKGROUND: Place of death is an important indicator in palliative care, as out-of-hospital death is often preferred by patients and is less costly for the healthcare system. AIM: To examine variation and contributing factors in out-of-hospital death after receiving palliative care in hospital to inform improvement in transition of care between hospitals and communities. METHODS: Using hospital linked data (July 2010, June 2015) we followed individuals aged 50 or older who received palliative care in hospital and within 3 months to death who were last admitted to a public acute-care hospital in New South Wales, Australia (73 hospitals). RESULTS: Among 25 359 palliative care inpatients, 3677 (14%) died out of hospital. The out-of-hospital death rate was lower for younger patients, males and those living in the most deprived areas; it was higher for cancer patients and those who received palliative care before their last admission. Hospital size, location and availability of hospice care unit were not influential. Across hospitals, the median crude rate of out-of-hospital death was 14% (interquartile range 10-19%). The contributing factors explained 19% of the variation, resulting in a rate difference of 44% between hospitals with high versus low rates; 25% of hospitals had a higher and 14% had a lower than average adjusted out-of-hospital death rate. CONCLUSION: The majority of patients who received palliative care in hospital stayed in hospital until death. The variation in out-of-hospital death across hospitals was considerable and mostly remained unexplained. This variability warrants investigation into transition of palliative care between hospitals and communities to inform interventions.

Caesarean section among immigrants with different obstetrical risks.

AIM: To determine the variation in caesarean section rates among immigrant populations. BACKGROUND: Australia is one of the most multicultural in the world and is also among those with the highest caesarean section rates. DESIGN: Secondary data analysis. METHODS: Routinely collected data from a Local Heath District between 2011 and 2015 were analysed. Women were categorized into regional groups based on country of birth. Obstetrical risk was classified using the Robson classification. RESULTS/FINDINGS: In total 48 711 women gave birth, of whom 64.0% were born overseas; 13 966 had a caesarean section (28.7%). South and Central Asia women had a high number of caesarean sections (n = 4139; 29.6% of all caesarean sections), a high overall adjusted caesarean section rate (31.4%; 95% CI, 30.5%-32.3%), and consistently high caesarean section rates among women with single cephalic term pregnancy without a previous caesarean section. High adjusted caesarean section rates were seen among South East Asia women with nulliparous, single cephalic, term pregnancy, and spontaneous labour. Demographic and clinical characteristics explained 83.5% of the variation in overall caesarean section rates between country of birth and 21.8% to 100% depending on Robson group. CONCLUSIONS: Caesarean section rates varied by country of birth and within some Robson groups. The studied factors had various effects on the variation in caesarean section rates between country of birth and Robson groups.

Meeting Management Standards and Improvement in Clinical Outcomes Among Patients With Hip Fractures.

OBJECTIVES: To determine the association between management standards and clinical outcomes among patients with hip fracture (HF). METHODS: Data from a prospective cohort study were linked with hospital administration data. RESULTS: In 2014 and 2015, 493 patients had surgery for HF. The proportion of patients meeting care standards ranged from 69% for surgery within 48 hours to 96% for being seen by a geriatrician. Thirty-nine per cent of patients received all the standards. The mean waiting time for surgery was 44 hours (median, 34 hours; interquartile range [IQR], 22-58 hours). The mean length of stay for patients who were alive at discharge was 17 days (median, 13 days; IQR, 6-24 days). Fifty-six patients were readmitted within 28 days of discharge (12%), and 40 patients died within 28 days of admission (8.1%). Patients who received all standards were less likely to be readmitted or die. Surgery within 48 hours and being seen by a physiotherapist were associated with a lower mortality rate. CONCLUSIONS: The management standards, collectively and in particular, assessment by a physiotherapist and surgery within 48 hours were significantly associated with better clinical outcomes.

Validity of routinely collected data in identifying hip fractures at a major tertiary hospital in Australia.

OBJECTIVES: To examine the validity of routinely collected data in identifying hip fractures (HFs) and to identify factors associated with incorrect coding. METHOD: In a prospective cohort study between January 2014 and June 2016, HFs were identified using physician diagnosis and diagnostic imaging and were recorded in a Registry. Records of HFs in the health information exchange (HIE) were identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification/Australian Classification of Health Interventions/Australian Coding Standards codes. New HFs were estimated by episode of care, hospital admission and with an algorithm. Data from the HIE and the Registry were compared. RESULTS: The number of HFs as the principal diagnosis (PD) recorded by episode (864) was higher than by admission (743), by algorithm (711) and in the Registry (638). The sensitivity was high for all methods (90-93%) but the positive predictive value was lower for episode (68%) than for admission (80%) or algorithm (81%). The number of HFs with surgery recorded in the PD by episode (639), algorithm (630) and in the Registry (623) was similar but higher than by admission (589). The episode and algorithm methods also had higher sensitivity (91-92%) than the admission method (84%) for HFs with surgery. Factors associated with coding errors included subsequent HF, long hospital stay, intracapsular fracture, younger age, male, HF without surgery and death in hospital. CONCLUSIONS: When it is not practical to use the algorithm for regular monitoring of HFs, using PD by admission to estimate total HFs and PD by episode in combination with a procedure code to estimate HFs with surgery can produce robust estimations.

Evaluation of Combination Measles-Mumps-Rubella-Varicella Vaccine Introduction in Australia.

Importance: Incorporating combination vaccines, such as the measles-mumps-rubella-varicella (MMRV) vaccine, into immunization schedules should be evaluated from a benefit-risk perspective. Use of MMRV vaccine poses challenges due to a recognized increased risk of febrile seizures (FSs) when used as the first dose in the second year of life. Conversely, completion by age 2 years of measles, mumps, rubella, and varicella immunization may offer improved disease control. Objective: To evaluate the effect on safety and coverage of earlier (age 18 months) scheduling of MMRV vaccine as the second dose of measles-containing vaccine (MCV) in Australia. Design, Setting, and Participants: Prospective active sentinel safety surveillance comparing the relative incidence (RI) of FSs in toddlers given MMRV and measles-mumps-rubella (MMR) and a national cohort study of vaccine coverage rates and timeliness before and after MMRV vaccine introduction were conducted. All Australian children aged 11 to 72 months were included in the coverage analysis, and 1471 Australian children aged 11 to 59 months were included in the FS analysis, with a focus on those aged 11 to 23 months. Main Outcomes and Measures: MMRV vaccine safety, specifically, the RI of FSs after MMRV vaccine at age 18 months, compared with risk following MMR vaccine and vaccine uptake for 2-dose MCV and single-dose varicella vaccine, focusing on timeliness. Results: Of the 1471 children, the median age at first FS was 21 months (interquartile range [IQR], 14-31 months). Three hundred ninety-one children were aged 11 to 23 months and had at least 1 FS included in the analysis; of these, 207 (52.9%) were male. A total of 278 children (71.1%) had received MMR followed by MMRV vaccine, 97 (24.8%) had received MMR vaccine only, and 16 (4.1%) had received neither vaccine. There was no increased risk of FSs (RI, 1.08; 95% CI, 0.55-2.13) in the 5 to 12 days following MMRV vaccine given as the second MCV to toddlers. Febrile seizures occurred after dose 1 of MMR vaccine at a known low increased risk (RI, 2.71; 95% CI, 1.71- 4.29). Following program implementation, 2-dose MCV coverage at age 36 months exceeded that obtained at age 60 months in historical cohorts recommended to receive MMR vaccine before school entry, and on-time vaccination increased by 13.5% (from 58.9% to 72.4%). Despite no change in the scheduled age of varicella vaccine, use of MMRV vaccine was associated with a 4.0% increase in 1-dose varicella vaccine coverage. Conclusions and Relevance: To our knowledge, this is the first study to provide evidence of the absence of an association between use of MMRV vaccine as the second dose of MCV in toddlers and an increased risk of FSs. Incorporation of MMRV vaccine has facilitated improvements in vaccine coverage that will potentially improve disease control.

Use of routinely collected data in reporting falls in hospitals in a local health district in New South Wales, Australia.

OBJECTIVE: To examine the quality of the two routinely collected sets of data, the Incident Information Management System (IIMS) and the health information exchange (HIE) in hospitals in New South Wales, Australia. METHOD: IIMS records indicating a fall and its location were examined. HIE data were examined using International Classification of Diseases (ICD)-10-AM codes W00-W19 and an indicator, 'onset of the condition' for falls in hospital. If onset of the condition was not recorded, ICD-10-AM code for place of occurrence (Y92.22 = Health service area) immediately following ICD-10-AM code for the fall was used. Comprehensive criteria were applied to exclude records of earlier documented falls. IIMS and HIE data were linked. Characteristics of falls that were recorded in one data set but not in the other were determined. RESULTS: Between January 2010 and December 2014, 8647 falls in hospitals were recorded in IIMS, 2169 were recorded in HIE and 9338 were recorded in either data set (rate of 3.2 falls per 1000 bed days). IIMS captured 93% and HIE captured 23% of these falls. Of the falls recorded in HIE, 677 (31%) were not recorded in IIMS. These were more likely to be subsequent falls, by patients who were female, younger than 65 years, who underwent a non-allied health procedure or had length of stay less than 1 week. CONCLUSIONS: IIMS captured the vast majority of falls in hospitals but failed to report one-third of falls recorded in HIE.

User characteristics, experiences and continuation rates of copper intrauterine device use in a cohort of Australian women.

BACKGROUND: Copper intrauterine device (Cu-IUD) use in Australia is low despite being a highly effective, cost effective non-hormonal contraceptive with reported 12-month continuation rates of 85% compared to 59% for oral contraception. AIMS: To describe the characteristics of Cu-IUD users in the Australian context, their experiences of side effects, continuation rates and reasons for discontinuation. METHODS: Between August 2009 and January 2012 we undertook a prospective cohort study of consecutive women presenting for Cu-IUD insertion to three family planning clinics in Queensland and New South Wales. We used survival analysis for continuation rates and univariate and multivariable analyses to characterise users, their experiences up to three years and reasons for discontinuation. RESULTS: Of the 211 enrolled women, a third (36.0%) were aged under 30 and a third were nulliparous (36.5%). Efficacy and lack of hormones were the most frequently cited reasons to choose the method. Four women were lost to follow-up. Overall continuation rates were 79.1% at one year and 61.3% at three years. Early discontinuation was reduced in those with two or more children (adjusted hazards ratio 0.22, 95% CI 0.09-0.50). Heavy menstrual bleeding was the commonest reason for removal in 28 of 59 (47.5%) discontinuations due to complications or side effects. One uterine perforation and one method failure resulting in an ectopic pregnancy occurred. CONCLUSIONS: Cu-IUDs were chosen for their efficacy and lack of hormones by a range of Australian women, including young and nulliparous women. While bleeding-related side effects were relatively common, overall continuation rates were high. Serious complications and failures were rare.

Febrile seizures following measles and varicella vaccines in young children in Australia.

BACKGROUND: Febrile seizures (FS) are common in childhood with incidence peaking in the second year of life when measles and varicella-containing vaccines are administered. This study aimed to examine the vaccine-attributable risk of FS following separate administration of MMR and monovalent varicella vaccines (VV) prior to a planned change to MMRV as the second dose of measles-containing vaccine at 18 months of age. METHODS: All FS cases in children aged <5 years from 1st January 2012 to 30th April 2013 were identified from emergency department (ED) and inpatient databases at five Australian tertiary paediatric hospitals participating in PAEDS (Paediatric Active Enhanced Disease Surveillance). Immunization records were obtained from the Australian Childhood Immunization Register (ACIR). The relative incidence (RI) of FS following MMR dose 1 (MMR1) and VV in children aged 11-23 months was determined using the self-controlled case series (SCCS) method and used to calculate attributable risk. RESULTS: There were 2013 FS episodes in 1761 children. The peak age at FS was 18 months. The risk of FS was significantly increased 5-12 days post receipt of MMR1 at 12 months (RI=1.9 [95% CI: 1.3-2.9]), but not after VV at 18 months (RI=0.6 [95% CI: 0.3-1.2]. The estimated excess annual number of FS post MMR1 was 24 per 100,000 vaccinated children aged 11-23 months (95% CI=7-49 cases per 100,000) or 1 per 4167 doses. CONCLUSIONS: Our study detected the expected increased FS risk post MMR1 vaccine at 12 months, but monovalent varicella vaccine at age 18 months was not associated with increased risk of FS. This provides baseline data to assess the risk of FS post MMRV, introduced in Australia as the second dose of measles-containing vaccine at 18 months of age in July 2013.

Comparing retention in treatment and mortality in people after initial entry to methadone and buprenorphine treatment.

UNLABELLED: AIM To compare retention in treatment and mortality among people entering methadone and buprenorphine treatment for opioid dependence. DATA SOURCES: The Pharmaceutical Drugs of Abuse System (PHDAS) database records start- and end-dates of all episodes of methadone and buprenorphine treatment in New South Wales, and the National Death Index (NDI) records all reported deaths. METHODS: Data linkage study. First entrants to treatment between June 2002 and June 2006 were identified from the PHDAS database. Retention in treatment was compared between methadone and buprenorphine. Names were linked to the NDI database, and 'good matches' were identified. Deaths were classified as occurring during induction, maintenance and either post-methadone or post-buprenorphine, depending on the latest episode of treatment prior to death. The numbers of inductions into treatment, of total person-years spent in each treatment, and person-years post-methadone or buprenorphine, were calculated. Risk of death in different periods, and different treatments, was analysed using Poisson regression. RESULTS: A total of 5992 people entered their first episode of treatment-3349 (56%) on buprenorphine, 2643 on methadone. Median retention was significantly longer in methadone (271 days) than buprenorphine (40 days). During induction, the risk of death was lower for buprenorphine (relative risk = 0.114, 95% confidence interval = 0.002-0.938, P = 0.02, Fisher's exact test). Risk of death was lowest during treatment, significantly higher in the first 12 months after leaving both methadone and buprenorphine. Beyond 12 months after leaving treatment, risk of death was non-significantly higher than during treatment. CONCLUSIONS: Buprenorphine was safer during induction. Despite shorter retention in treatment, buprenorphine maintenance was not associated with higher risk of death.

Antenatal care procedures and information reported by women in three rural areas of Vietnam.

The objective was to identify factors related to antenatal care (ANC) procedures and information reported by women in Long An, Ben Tre, and Quang Ngai Provinces. Cross-sectional surveys were conducted. Women who had ANC during a previous pregnancy were asked if they had received any of 13 procedures and information. The Donabedian quality of health model was used to select potential related factors. Data from 857 women were available for analyses. Only 24% of the women reported ten items or more. The mean number of items reported was seven. Factors related to reporting fewer items were living in Quang Ngai (OR = 0.3, 95% Cl = 0.2-0.6), having ANC at private facilities (OR = 0.4, 95% Cl = 0.2-0.7), having ANC delivered by nurses or assistant doctors (OR = 0.6, 95% Cl = 0.3-0.9), and unplanned pregnancy (OR = 0.5, 95% Cl = 0.3-0.9). Factors related to reporting more items were being housewives (OR = 1.7, 95% Cl = 1.0-2.8), consumption of iron/folate tablets (OR = 4.2, 95% Cl = 2.2-8.2), more use of ANC services (OR = 2.1, 95% Cl = 1.4-3.2 for sufficient utilization and OR = 3.8, 95% Cl = 2.1-7.0 for sufficient plus), more perceived helpfulness of ANC (OR = 3.0, 95% Cl = 1.9-4.8) and high satisfaction with ANC received (OR = 1.6, 95% Cl = 1.0-2.6). The most effective interventions would be to improve the quality of health facilities and of ANC providers, and to educate women to make sufficient number of ANC visits and to seek ANC from qualified ANC providers.

Determinants of antenatal care utilization in three rural areas of Vietnam.

OBJECTIVE: To identify factors associated with any use of antenatal care (ANC), gestational age at entry to ANC, number of visits, and overall ANC utilization in the three provinces of Long an, Ben tre, and Quang ngai. DATA: The Vietnam-Australia Primary Health Care Project conducted cross-sectional surveys in 1998-1999. Data from 1,335 eligible women were available for analysis. METHODS: Explanatory variables were selected using the Andersen Health Seeking Behavior Model and analyzed using multivariate regression techniques. RESULTS: External environment, predisposing characteristics, and need, which existed before contact with ANC providers, were most related to using any ANC and gestational age at entry to ANC. However, ANC services provided to women and personal health care during pregnancy, which could have resulted from initial contact with ANC providers, were most related to continuation of ANC visits and overall ANC utilization. Significant variability in the use of ANC existed between provinces and between subsets of women in each province. CONCLUSION: To have more women who attend ANC and attend early, promotion should be targeted at high-risk groups of women. However, to improve the number of ANC visits and overall utilization, the quality of ANC services should be improved.

Anaemia in pregnant, postpartum and non pregnant women in Lak district, Daklak province of Vietnam.

OBJECTIVES: To determine anaemia prevalence and related factors in pregnant women (PW), post partum women (PPW) and non pregnant women (NPW) in a remote mountainous district. METHODS: A cross-sectional survey was conducted in 2001. All PW, all PPW within 6 months of delivery and a random number of NPW equivalents to the number of PW in each commune were selected. Hemoglobin (Hb) was measured using Hemocue method. Mild anaemia was defined as Hb=7 g/dL-11 g/dL in PW, and 8 g/dL-12 g/dL in NPW and PPW. Severe anaemia was defined as Hb<7 g/dL in PW, and<8 g/dL in NPW and PPW. Pregnancy status was determined using urine pregnancy test and calculation of expected menstruum. RESULTS: There were 901 women surveyed: 281 PW, 348 PPW and 272 NPW. More than half (58%) were anaemic: 54% mild and 4% severe. Mean Hb was 11.1g/dL. More PPW had anaemia (62%; OR=1.4; 95%CI=1.1-2.1 compared to NPW) than NPW (54%) and PW (53%). Other related factors were being BoY, Ede and Koho ethnics (OR=2.7; 95%CI=1.4-5.0 compared to Kinh ethnic), having primary education or lower (OR=1.5; 95%CI=1.1-2.1 compared to secondary education or higher). Among PW, being pregnant during the third trimester increased anaemia (OR=2.2; 95%CI=1.3-3.8 compared to being pregnant during the second trimester). Among PPW, women aged 30 or older were more anaemic (OR=1.7, 95%CI=1.1-2.9 compared to women aged 20-29). CONCLUSION: Anaemia prevalence was very high. Interventions should be focused on PPW, PW during the last trimester, minority ethnic women, low-educated and older women.