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Le LTH, Hoang TNA, Nguyen TT, Dao TD, Do BN, Pham KM, Vu VH, Pham LV, Nguyen LTH, Nguyen HC, Tran TV, Nguyen TH, Nguyen AT, Nguyen HV, Nguyen PB, Nguyen HTT, Pham TTM, Le TT, Nguyen TTP, Tran CQ, Quach HL, Nguyen KT, Duong TV. Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis. JMIR Public Health Surveill 2024; 10:e50189. [PMID: 38564248 PMCID: PMC10989720 DOI: 10.2196/50189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 12/22/2023] [Accepted: 01/30/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences. OBJECTIVE This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences. METHODS The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the "less unhealthy" group and the "more unhealthy" group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the "more unhealthy" group. RESULTS The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the "more unhealthy" group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the "more unhealthy" group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the "more unhealthy" group. CONCLUSIONS The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post-COVID-19 health and well-being.
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Affiliation(s)
- Lan T H Le
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
| | | | - Tan T Nguyen
- Department of Orthopedics, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Director Office, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Tien D Dao
- Institute of Oncology and Nuclear Medicine, Military Hospital 175, Ho Chi Minh City, Vietnam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Ha Noi, Vietnam
- Department of Military Science, Vietnam Military Medical University, Ha Noi, Vietnam
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Vinh H Vu
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
| | - Linh V Pham
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Lien T H Nguyen
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Hoang C Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Tuan V Tran
- Neurology Department, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Trung H Nguyen
- Director Office, Gang Thep Hospital, Thai Nguyen, Vietnam
| | - Anh T Nguyen
- Director Office, Hospital for Tropical Diseases, Hai Duong, Vietnam
| | - Hoan V Nguyen
- Infectious and Tropical Diseases Department, Viet Tiep Hospital, Hai Phong, Vietnam
- Department of Infectious Diseases, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | | | - Hoai T T Nguyen
- Training and Direction of Healthcare Activity Center, Kien An Hospital, Hai Phong, Vietnam
| | - Thu T M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Thuy T Le
- President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Thao T P Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Cuong Q Tran
- Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
| | - Ha-Linh Quach
- Centre for Ageing Research & Education, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Ha Noi, Vietnam
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- International Master/Ph.D. Program in Medicine, Taipei Medical University, Taipei, Taiwan
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Pham TTM, Duong TV, Nguyen LTK, Vu MT, Pham KM, Nguyen MH, Luong TC, Do BN, Le LTH, Dang NH, Nguyen TTP, Le HP, Tran CQ, Nguyen KT, Hu CJ, Chan CC, Hsu HC, Bai CH. Association between Hypertension and Stroke Recurrence as Modified by Pro-oxidant-Antioxidant Balance: A Multi-Center Study. Nutrients 2023; 15:nu15102305. [PMID: 37242188 DOI: 10.3390/nu15102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/10/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Hypertension and oxidative stress are involved in the pathophysiological mechanism of stroke. We aimed to investigate the modification impact of the pro-oxidant-anti-oxidant balance (PAB) on the association between hypertension and stroke recurrence (SR). METHODS A cross-sectional design was conducted from December 2019 to December 2020 in 951 stroke patients in six hospitals across Vietnam. Hypertension was defined using antihypertensive medication or systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. PAB was estimated using weighting methods based on smoking, drinking, and overweight/obesity with pro-oxidant capacity, diet quality, fruit intake, vegetable intake, and physical activity with antioxidant capacity. The higher PAB scores indicated a beneficial balance shifting toward antioxidant dominance. SR was diagnosed by neurologists. Moreover, sociodemographic and health conditions were included as covariates. Multiple logistic regression analyses were used to explore the associations and interactions. RESULTS The hypertension and SR proportions were 72.8% and 17.5%, respectively. hypertension was associated with an increased SR likelihood (odds ratio (OR) = 1.93; p = 0.004), whereas a higher PAB score was associated with a lowered SR likelihood (OR = 0.87; p = 0.003). Moreover, hypertension interacting with every one-point increment of PAB was associated with a lowered SR likelihood (OR = 0.83; p = 0.022). CONCLUSIONS The harmful impact of hypertension on SR could be alleviated by PAB. The interplay of health behaviors should be highlighted in the intervention strategies for stroke prevention.
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Affiliation(s)
- Thu T M Pham
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
| | - Lien T K Nguyen
- Rehabilitation Department, Hanoi Medical University, Hanoi 115-20, Vietnam
- Rehabilitation Center, Bach Mai Hospital, Hanoi 115-19, Vietnam
- Rehabilitation Department, Viet Duc University Hospital, Hanoi 110-17, Vietnam
| | - Manh-Tan Vu
- Department of Internal Medicine, Haiphong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
- Cardiovascular Department, Viet Tiep Friendship Hospital, Hai Phong 047-08, Vietnam
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
| | - Minh H Nguyen
- School of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 121-08, Vietnam
| | - Thuc C Luong
- Director Office, Military Hospital 103, Hanoi 121-08, Vietnam
- Department of Cardiology, Cardiovascular Center, Military Hospital 103, Hanoi 121-08, Vietnam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam
- Division of Military Science, Military Hospital 103, Hanoi 121-08, Vietnam
| | - Lan T H Le
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Nga H Dang
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Department of Quality Control, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Thao T P Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam
| | - Hoang P Le
- Department of Internal Medicine, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam
| | - Cuong Q Tran
- Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam
- Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi 119-10, Vietnam
| | - Chaur-Jong Hu
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan
- Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City 235-61, Taiwan
| | - Chang-Chuan Chan
- Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, Taipei 100-55, Taiwan
- Innovation and Policy Center for Population Health and Sustainable Environment (Population Health Research Center, PHRC), College of Public Health, National Taiwan University, Taipei 100-55, Taiwan
- Global Health Program, College of Public Health, National Taiwan University, Taipei 100-55, Taiwan
| | - Hui-Chuan Hsu
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
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Le LTH, Tran TT, Duong TV, Dang LT, Hoang TA, Nguyen DH, Pham MD, Do BN, Nguyen HC, Pham LV, Nguyen LTH, Nguyen HT, Trieu NT, Do TV, Trinh MV, Ha TH, Phan DT, Nguyen TTP, Nguyen KT, Yang SH. Digital Healthy Diet Literacy and Fear of COVID-19 as Associated with Treatment Adherence and Its Subscales among Hemodialysis Patients: A Multi-Hospital Study. Nutrients 2023; 15:nu15102292. [PMID: 37242175 DOI: 10.3390/nu15102292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
Treatment adherence (TA) is a critical issue and is under-investigated in hemodialysis patients. A multi-center study was conducted from July 2020 to March 2021 on 972 hemodialysis patients in eight hospitals in Vietnam to explore the factors associated with TA during the COVID-19 pandemic. Data were collected, including socio-demographics, an End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), 12-item short-form health literacy questionnaire (HLS-SF12), 4-item digital healthy diet literacy scale (DDL), 10-item hemodialysis dietary knowledge scale (HDK), 7-item fear of COVID-19 scale (FCoV-19S), and suspected COVID-19 symptoms (S-COVID19-S). Bivariate and multivariate linear regression models were used to explore the associations. Higher DDL scores were associated with higher TA scores (regression coefficient, B, 1.35; 95% confidence interval, 95%CI, 0.59, 2.12; p = 0.001). Higher FCoV-19S scores were associated with lower TA scores (B, -1.78; 95%CI, -3.33, -0.24; p = 0.023). In addition, patients aged 60-85 (B, 24.85; 95%CI, 6.61, 43.11; p = 0.008) with "very or fairly easy" medication payment ability (B, 27.92; 95%CI, 5.89, 44.95; p = 0.013) had higher TA scores. Patients who underwent hemodialysis for ≥5 years had a lower TA score than those who received <5 years of hemodialysis (B, -52.87; 95%CI, -70.46, -35.28; p < 0.001). These findings suggested that DDL and FCoV-19S, among other factors, should be considered in future interventions to improve TA in hemodialysis patients.
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Affiliation(s)
- Lan T H Le
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Tu T Tran
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
| | - Loan T Dang
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi 115-20, Vietnam
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan
| | - Trung A Hoang
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam
| | - Dung H Nguyen
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam
| | - Minh D Pham
- Department of Nutrition, Military Hospital 103, Hanoi 121-08, Vietnam
- Department of Nutrition, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Binh N Do
- Department of Military Science, Vietnam Military Medical University, Hanoi 121-08, Vietnam
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Hoang C Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
| | - Linh V Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam
| | - Lien T H Nguyen
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam
| | - Hoi T Nguyen
- Director Office, Hai Phong International Hospital, Hai Phong 047-08, Vietnam
| | - Nga T Trieu
- Hemodialysis Division, Hai Phong International Hospital, Hai Phong 047-08, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Ha Long 011-21, Vietnam
| | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Ha Long 011-08, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi 125-16, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi 116-22, Vietnam
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi 112-06, Vietnam
| | - Thao T P Nguyen
- Institute for Community Health Research, University of Medicine and Pharmacy, Hue University, Hue 491-20, Vietnam
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi 119-10, Vietnam
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei 110-31, Taiwan
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei 110-31, Taiwan
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4
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Vu DN, Phan DT, Nguyen HC, Le LTH, Nguyen HC, Ha TH, Dao HK, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Le TT, Tran CQ, Tran KV, Duong TT, Pham HX, Le VTT, Van Duong T. Impacts of Digital Healthy Diet Literacy and Healthy Eating Behavior on Fear of COVID-19, Changes in Mental Health, and Health-Related Quality of Life among Front-Line Health Care Workers. Nutrients 2021; 13:nu13082656. [PMID: 34444814 PMCID: PMC8398620 DOI: 10.3390/nu13082656] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/23/2021] [Accepted: 07/28/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND We aimed to examine the impacts of digital healthy diet literacy (DDL) and healthy eating behaviors (HES) on fear of COVID-19, changes in mental health, and health-related quality of life (HRQoL) among front-line healthcare workers (HCWs). METHODS An online survey was conducted at 15 hospitals and health centers from 6-19 April 2020. Data of 2299 front-line HCWs were analyzed-including socio-demographics, symptoms like COVID-19, health literacy, eHealth literacy, DDL, HES, fear of COVID-19, changes in mental health, and HRQoL. Regression models were used to examine the associations. RESULTS HCWs with higher scores of DDL and HES had lower scores of FCoV-19S (regression coefficient, B, -0.04; 95% confidence interval, 95% CI, -0.07, -0.02; p = 0.001; and B, -0.10; 95% CI, -0.15, -0.06; p < 0.001); had a higher likelihood of stable or better mental health status (odds ratio, OR, 1.02; 95% CI, 1.00, 1.05; p = 0.029; and OR, 1.04; 95% CI, 1.00, 1.07; p = 0.043); and HRQoL (OR, 1.02; 95% CI, 1.01, 1.03; p = 0.006; and OR, 1.04; 95% CI, 1.02, 1.06; p = 0.001), respectively. CONCLUSIONS DDL and HES were found as independent predictors of fear of COVID-19, changes in mental health status, and HRQoL in front-line HCWs. Improving DDL and HES should be considered as a strategic approach for hospitals and healthcare systems.
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Affiliation(s)
- Dinh N. Vu
- Director Office, Military Hospital 103, Hanoi 121-08, Vietnam;
- Department of Trauma and Orthopedic Surgery, Vietnam Military Medical University, Hanoi 121-08, Vietnam
| | - Dung T. Phan
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi 112-06, Vietnam;
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi 116-22, Vietnam
| | - Hoang C. Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam; (H.C.N.); (L.T.H.L.)
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen City 241-17, Vietnam
| | - Lan T. H. Le
- Director Office, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam; (H.C.N.); (L.T.H.L.)
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
- Biochemistry Department, Thai Nguyen National Hospital, Thai Nguyen City 241-24, Vietnam
| | - Huu C. Nguyen
- Director Office, E Hospital, Hanoi 113-08, Vietnam;
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi 113-08, Vietnam
| | - Tung H. Ha
- Director Office, General Hospital of Agricultural, Hanoi 125-16, Vietnam;
| | - Hung K. Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh 161-23, Vietnam;
| | - Manh V. Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh 011-08, Vietnam;
| | - Thinh V. Do
- Director Office, Bai Chay Hospital, Quang Ninh 011-21, Vietnam;
| | - Hung Q. Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh 011-24, Vietnam;
| | - Thao T. P. Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Thua Thien Hue 491-20, Vietnam;
- Department of Health Economics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Thuy T. Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang 502-06, Vietnam;
- President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang 502-06, Vietnam
| | - Cuong Q. Tran
- Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam; (C.Q.T.); (H.X.P.)
- Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
| | - Khanh V. Tran
- Director Office, Le Van Thinh Hospital (Previously Hospital District 2), Ho Chi Minh City 711-13, Vietnam;
| | - Trang T. Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City 720-16, Vietnam;
| | - Hai X. Pham
- Director Office, Thu Duc City Health Center, Ho Chi Minh City 713-10, Vietnam; (C.Q.T.); (H.X.P.)
| | - Vinh-Tuyen T. Le
- Department of Pharmacognosy-Traditional Pharmacy-Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho 941-17, Vietnam;
- Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei 110-31, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
- Correspondence: ; Tel.: +886-2-2736-1661 (ext. 6545)
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