1
|
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.
Collapse
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
| |
Collapse
|
2
|
Dang LT, Luong TC, Nguyen DH, Hoang TA, Nguyen HT, Nguyen HC, Duong TH, Tran TT, Pham LV, Ngo TV, Nguyen HT, Trieu NT, Do TV, Trinh MV, Ha TH, Phan DT, Do BN, Yang SH, Wang TJ, Duong TV. The Associations of Suspected COVID-19 Symptoms with Anxiety and Depression as Modified by Hemodialysis Dietary Knowledge: A Multi-Dialysis Center Study. Nutrients 2022; 14:nu14122364. [PMID: 35745093 PMCID: PMC9230868 DOI: 10.3390/nu14122364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/22/2022] [Accepted: 06/02/2022] [Indexed: 02/06/2023] Open
Abstract
During the COVID-19 pandemic, it is essential to evaluate hemodialysis patients’ dietary knowledge, especially among those with COVID-19 related symptoms, in order to identify appropriate strategies in managing their mental health. The study’s purposes were to test the psychometric properties of the hemodialysis dietary knowledge (HDK) scale, and to investigate the modifying impact of HDK on the associations of suspected COVID-19 symptoms (S-COVID-19-S) with anxiety and depression among hemodialysis patients. A cross-sectional study was conducted from July 2020 to March 2021 at eight hospitals across Vietnam. Data of 875 hemodialysis patients were analyzed, including socio-demographic, anxiety (the generalized anxiety disorder scale, GAD-7), depression (the patient health questionnaire, PHQ-9), S-COVID-19-S, HDK, health literacy, and digital healthy diet literacy. Confirmatory factor analysis (CFA) and logistic regression models were used to analyze the data. The HDK scale demonstrates the satisfactory construct validity with good model fit (Goodness of Fit Index, GFI = 0.96; Adjusted Goodness of Fit Index, AGFI = 0.90; Standardized Root Mean Square Residual, SRMR = 0.05; Root Mean Square Error of Approximation, RMSEA = 0.09; Normed Fit Index, NFI = 0.96; Comparative Fit Index, CFI = 0.96, and Parsimony goodness of Fit Index, PGFI = 0.43), criterion validity (as correlated with HL (r = 0.22, p < 0.01) and DDL (r = 0.19, p < 0.01), and reliability (Cronbach alpha = 0.70)). In the multivariate analysis, S-COVID-19-S was associated with a higher likelihood of anxiety (odds ratio, OR, 20.76; 95% confidence interval, 95%CI, 8.85, 48.70; p < 0.001) and depression (OR, 12.95; 95%CI, 6.67, 25.14, p < 0.001). A higher HDK score was associated with a lower likelihood of anxiety (OR, 0.70; 95%CI, 0.64, 0.77; p < 0.001) and depression (OR, 0.72; 95%CI, 0.66, 0.79; p < 0.001). In the interaction analysis, the negative impacts of S-COVID-19-S on anxiety and depression were mitigated by higher HDK scores (p < 0.001). In conclusion, HDK is a valid and reliable tool to measure dietary knowledge in hemodialysis patients. Higher HDK scores potentially protect patients with S-COVID-19-S from anxiety and depression during the pandemic.
Collapse
Affiliation(s)
- Loan T. Dang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan;
- Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi 115-20, 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
| | - Dung H. Nguyen
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam; (D.H.N.); (T.A.H.)
| | - Trung A. Hoang
- Hemodialysis Department, Nephro-Urology-Dialysis Center, Bach Mai Hospital, Hanoi 115-19, Vietnam; (D.H.N.); (T.A.H.)
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
| | - Hoai T. Nguyen
- Division of Military Scientific Information, Vietnam Military Medical University, Hanoi 121-08, Vietnam;
| | - Hoang C. Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen 241-24, Vietnam; (H.C.N.); (T.H.D.)
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, Vietnam
| | - Thai H. Duong
- Director Office, Thai Nguyen National Hospital, Thai Nguyen 241-24, Vietnam; (H.C.N.); (T.H.D.)
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen 241-17, 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
| | - Linh V. Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam;
| | - Tuan V. Ngo
- Department of Hemodialysis, 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
| | - 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
| | - 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
| | - Tsae-Jyy Wang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112-19, Taiwan;
- Correspondence: (T.-J.W.); (T.V.D.); Tel.: +886-2-2822-7101 (ext. 3118) (T.-J.W.); +886-2-2736-1661 (ext. 6545) (T.V.D.)
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan;
- Correspondence: (T.-J.W.); (T.V.D.); Tel.: +886-2-2822-7101 (ext. 3118) (T.-J.W.); +886-2-2736-1661 (ext. 6545) (T.V.D.)
| |
Collapse
|
3
|
Nguyen TT, Nguyen MH, Pham TTM, Le VTT, Nguyen TT, Luong TC, Do BN, Dao HK, Nguyen HC, Ha TH, Pham LV, Nguyen PB, Nguyen HTT, Do TV, Nguyen HQ, Trinh MV, Le TT, Tra AL, Nguyen TTP, Nguyen KT, Phan DT, Pham KM, Bai CH, Duong TV. Negative Impacts of COVID-19 Induced Lockdown on Changes in Eating Behavior, Physical Activity, and Mental Health as Modified by Digital Healthy Diet Literacy and eHealth Literacy. Front Nutr 2021; 8:774328. [PMID: 34869540 PMCID: PMC8633895 DOI: 10.3389/fnut.2021.774328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: The COVID-19-induced lockdown has been implemented in many countries, which may cause unfavorable changes in lifestyles and psychological health. People's health literacy, healthy diet, and lifestyles play important roles in mitigating the negative impacts of the pandemic. Therefore, we aimed to examine associations of COVID-19 lockdown with changes in eating behavior, physical activity, and mental health; and the modification effects by digital healthy diet literacy (DDL) and eHealth literacy (eHEALS) on the associations. Methods: We conducted an observational study on 4,348 outpatients from 7th April to 31st May 2020. Data from 11 hospitals in Vietnam included demographic characteristics, DDL, eHEALS, eating behavior, physical activity, and mental health changes. Multiple logistic regression and interaction models were performed to examine associations. Results: Patients under lockdown had a lower likelihood of having “unchanged or healthier” eating behavior (odds ratio, OR, 0.38; 95% confidence interval, 95%CI, 0.29 to 0.51; p < 0.001), “unchanged or more” physical activity (OR, 0.79; 95% CI, 0.69 to 0.90; p < 0.001), and “stable or better” mental health (OR, 0.77; 95% CI, 0.67 to 0.89; p < 0.001), as compared to those after lockdown. In interaction models, as compared to patients after lockdown and with the lowest DDL score, those under lockdown and with a one-score increment of DDL had a higher likelihood of having “unchanged or healthier” eating behavior (OR, 1.05; 95% CI, 1.02 to 1.07; p < 0.001), and “stable or better” mental health (OR, 1.02; 95% CI, 1.01 to 1.04; p < 0.001). Similarly, as compared to patients after lockdown and with the lowest eHEALS score, those under lockdown and with a one-score increment of eHEALS had a higher likelihood of having an “unchanged or more” physical activity (OR, 1.03; 95% CI, 1.01 to 1.05; p < 0.001). Conclusion: The COVID-19 lockdown measure could negatively affect eating behavior, physical activity, and mental health among outpatients. Better DDL and eHEALS were found to mitigate the negative impacts of the lockdown, which may empower outpatients to maintain healthy lifestyles and protect mental health. However, this study holds several limitations that may undermine the certainty of reported findings.
Collapse
Affiliation(s)
- Tham T Nguyen
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam
| | - Minh H Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Thu T M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Vinh-Tuyen T Le
- Department of Pharmacognosy-Traditional Pharmacy-Pharmaceutical Botanic, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan
| | - 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
| | - Thuc C Luong
- Director Office, Military Hospital 103, Hanoi, Vietnam.,Department of Cardiology, Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Hung K Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | - Huu C Nguyen
- Director Office, E Hospital, Hanoi, Vietnam.,Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Linh V Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam.,Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | | | - Hoai T T Nguyen
- Training and Direction of Healthcare Activity Center, Kien An Hospital, Hai Phong, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thuy T Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.,President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Anh L Tra
- Department of Physiotherapy and Rehabilitation, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Thao T P Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Hue, Vietnam
| | - Kien T Nguyen
- Department of Health Promotion, Faculty of Social and Behavioral Sciences, Hanoi University of Public Health, Hanoi, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam.,Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Vietnam.,President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Chyi-Huey Bai
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
4
|
Luong TC, Pham TTM, Nguyen MH, Do AQ, Pham LV, Nguyen HC, Nguyen HC, Ha TH, Dao HK, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Tran CQ, Tran KV, Duong TT, Pham HX, Do TT, Nguyen PB, Tra AL, Phan DT, Do BN, Duong TV. Fear, anxiety and depression among pregnant women during COVID-19 pandemic: impacts of healthy eating behaviour and health literacy. Ann Med 2021; 53:2120-2131. [PMID: 34761972 PMCID: PMC8592601 DOI: 10.1080/07853890.2021.2001044] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/27/2021] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic has been influencing people's psychological health, especially in pregnant women. We aimed to examine associated factors of fear of COVID-19, anxiety and depression among pregnant women during the pandemic where the impacts of healthy eating behaviour (HES) and health literacy (HL) were emphasized. METHODS A cross-sectional study was conducted between 14 February 2020 and 31 May 2020 in 18 health centres and hospitals across Vietnam. Data of 518 pregnant women were analysed, including socio-demographics, pregnant-related factors, HES, HL, health-related behaviours, fear of COVID-19 scale (FCoV-19S), anxiety (using the generalized anxiety disorder (GAD-7)) and depression (using the patient health questionnaire with 9 items (PHQ-9)). Regression analysis was utilized to explore the associations. RESULTS Pregnant women with higher scores of HES and HL had lower likelihood of anxiety (odds ratio, OR, 0.79; 95% confidence interval (95%CI), 0.73, 0.87; p < .001; and OR, 0.94; 95%CI, 0.90, 0.99; p = .018) and depression (OR, 0.84; 95%CI, 0.78, 0.91; p < .001; and OR, 0.96; 95%CI, 0.91, 0.99; p = .044), respectively. Pregnant women being employed had a lower FCoV-19S score (regression coefficient, B, -1.46; 95%CI, -2.51, -0.40; p = .007). Besides, other significant predictors of anxiety were eating healthier during the pandemic, unchanged or more physical activity, elevated gestational age and smoking. Other significant predictors of depression were eating healthier during the pandemic, elevated gestational age and smoking. CONCLUSIONS Among others, HES and HL had positive impacts on protecting pregnant women against anxiety and depression. Improving HES and HL should be addressed as a strategic approach to improve reproductive health during the pandemic.KEY MESSAGEThe COVID-19 pandemic influences antenatal mental disorders with the higher level as opposed to that before the pandemic.Healthy eating behaviour and better health literacy (HL) had critical roles in lowering prenatal anxiety and depression during the COVID-19 crisis.Strategic approaches for improving healthy eating and HL should be recommended for protecting pregnant women from mental health problems during the pandemic.
Collapse
Affiliation(s)
- Thuc C. Luong
- Department of Cardiology, Cardiovascular Center, Military Hospital 103, Hanoi, Vietnam
- Director Office, Military Hospital 103, Hanoi, Vietnam
| | - Thu T. M. Pham
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Minh H. Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Anh Q. Do
- International Ph.D. Program for Cell Therapy and Regeneration Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Obstetrics and Gynecology, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Linh V. Pham
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
- Director Office, 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
| | - Huu C. Nguyen
- Director Office, E Hospital, Hanoi, Vietnam
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam
| | - Tung H. Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Hung K. Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | - Manh V. Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thinh V. Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q. Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Thao T. P. Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Thua Thien Hue, Vietnam
| | - Cuong Q. Tran
- Director Office, Thu Duc District Health Center, Ho Chi Minh City, Vietnam
- Faculty of Health, Mekong University, Vinh Long, Vietnam
| | - Khanh V. Tran
- Director Office, Le Van Thinh Hospital (previously Hospital District 2), Ho Chi Minh City, Vietnam
| | - Trang T. Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City, Vietnam
| | - Hai X. Pham
- Director Office, Thu Duc District Health Center, Ho Chi Minh City, Vietnam
| | - Thao T. Do
- Department of Oral Pathology and Periodontology, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | | | - Anh L. Tra
- Department of Rehabilitation & Physiotherapy, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Dung T. Phan
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi, Vietnam
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam
| | - Binh N. Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam
- Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
5
|
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.
Collapse
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)
| |
Collapse
|
6
|
Nguyen MH, Pham TTM, Pham LV, Phan DT, Tran TV, Nguyen HC, Nguyen HC, Ha TH, Dao HK, Nguyen PB, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Nguyen NPT, Tran CQ, Tran KV, Duong TT, Nguyen TT, Pham KM, Nguyen LV, Vo TT, Do BN, Dang NH, Le TT, Do NT, Nguyen HTT, Mai TTT, Ha DT, Ngo HTM, Nguyen KT, Bai CH, Duong TV. Associations of Underlying Health Conditions With Anxiety and Depression Among Outpatients: Modification Effects of Suspected COVID-19 Symptoms, Health-Related and Preventive Behaviors. Int J Public Health 2021; 66:634904. [PMID: 34335139 PMCID: PMC8284590 DOI: 10.3389/ijph.2021.634904] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/28/2021] [Indexed: 12/18/2022] Open
Abstract
Objectives: We explored the association of underlying health conditions (UHC) with depression and anxiety, and examined the modification effects of suspected COVID-19 symptoms (S-COVID-19-S), health-related behaviors (HB), and preventive behaviors (PB). Methods: A cross-sectional study was conducted on 8,291 outpatients aged 18–85 years, in 18 hospitals and health centers across Vietnam from 14th February to May 31, 2020. We collected the data regarding participant's characteristics, UHC, HB, PB, depression, and anxiety. Results: People with UHC had higher odds of depression (OR = 2.11; p < 0.001) and anxiety (OR = 2.86; p < 0.001) than those without UHC. The odds of depression and anxiety were significantly higher for those with UHC and S-COVID-19-S (p < 0.001); and were significantly lower for those had UHC and interacted with “unchanged/more” physical activity (p < 0.001), or “unchanged/more” drinking (p < 0.001 for only anxiety), or “unchanged/healthier” eating (p < 0.001), and high PB score (p < 0.001), as compared to those without UHC and without S-COVID-19-S, “never/stopped/less” physical activity, drinking, “less healthy” eating, and low PB score, respectively. Conclusion: S-COVID-19-S worsen psychological health in patients with UHC. Physical activity, drinking, healthier eating, and high PB score were protective factors.
Collapse
Affiliation(s)
- Minh H Nguyen
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - 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
| | - Linh V Pham
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam.,Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam.,Nursing Office, Thien an Obstetrics and Gynecology Hospital, Hanoi, Vietnam
| | - Tien V Tran
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Director Office, Military Hospital 103, Hanoi, 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
| | - Huu C Nguyen
- Director Office, E Hospital, Hanoi, Vietnam.,Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Hung K Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | | | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Thao T P Nguyen
- Health Management Training Institute, Hue University of Medicine and Pharmacy, Thua Thien Hue, Vietnam.,Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Nhan P T Nguyen
- General Planning Department, Da Nang Oncology Hospital, Da Nang, Vietnam
| | - Cuong Q Tran
- Director Office, Thu Duc District Health Center, Ho Chi Minh City, Vietnam.,Faculty of Health, Mekong University, Vinh Long, Vietnam
| | - Khanh V Tran
- Director Office, Hospital District 2, Ho Chi Minh City, Vietnam
| | - Trang T Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City, 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
| | - Khue M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam.,President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Lam V Nguyen
- Aesthetic Plastic Surgery & Skin Care Center, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam.,President Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tam T Vo
- Director Office, Trieu Phong District Health Center, Quang Tri, Vietnam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Nga H Dang
- Training and Direction of Healthcare Activity Center, Thai Nguyen National Hospital, Thai Nguyen, Vietnam.,Department of Quality Control, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
| | - Thuy T Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam.,President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Ngoc T Do
- Nursing Office, E Hospital, Hanoi, Vietnam
| | - Hoai T T Nguyen
- Training and Direction of Healthcare Activity Center, Kien an Hospital, Hai Phong, Vietnam
| | - Thuy T T Mai
- Nursing Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Dung T Ha
- Nursing Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Huong T M Ngo
- Nursing Office, Quang Ninh Obstetric and Pediatric Hospital, Quang Ninh, Vietnam
| | - Kien T Nguyen
- Department of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Chyi-Huey Bai
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Public Health, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
7
|
Tran TV, Nguyen HC, Pham LV, Nguyen MH, Nguyen HC, Ha TH, Phan DT, Dao HK, Nguyen PB, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Nguyen NPT, Tran CQ, Tran KV, Duong TT, Pham HX, Nguyen LV, Vo TT, Do BN, Duong TH, Pham MK, Pham TTM, Nguyen KT, Yang SH, Chao JCJ, Duong TV. Impacts and interactions of COVID-19 response involvement, health-related behaviours, health literacy on anxiety, depression and health-related quality of life among healthcare workers: a cross-sectional study. BMJ Open 2020; 10:e041394. [PMID: 33293320 PMCID: PMC7722826 DOI: 10.1136/bmjopen-2020-041394] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We examined impacts and interactions of COVID-19 response involvement, health-related behaviours and health literacy (HL) on anxiety, depression, and health-related quality of life (HRQoL) among healthcare workers (HCWs). DESIGN A cross-sectional study was conducted. Data were collected 6 April to 19 April 2020 using online-based, self-administered questionnaires. SETTING 19 hospitals and health centres in Vietnam. PARTICIPANTS 7 124 HCWs aged 21-60 years. RESULTS The COVID-19 response-involved HCWs had higher anxiety likelihood (OR (95% CI)=4.41 (3.53 to 5.51)), higher depression likelihood (OR(95% CI)=3.31 (2.71 to 4.05)) and lower HRQoL score (coefficient, b(95% CI)=-2.14 (-2.89 to -1.38)), compared with uninvolved HCWs. Overall, HCWs who smoked or drank at unchanged/increased levels had higher likelihood of anxiety, depression and lower HRQoL scores; those with unchanged/healthier eating, unchanged/more physical activity and higher HL scores had lower likelihood of anxiety, depression and higher HRQoL scores. In comparison to uninvolved HCWs who smoked or drank at never/stopped/reduced levels, involved HCWs with unchanged/increased smoking or drinking had lower anxiety likelihood (OR(95% CI)=0.34 (0.14 to 0.83)) or (OR(95% CI)=0.26 (0.11 to 0.60)), and lower depression likelihood (OR(95% CI)=0.33 (0.15 to 0.74)) or (OR(95% CI)=0.24 (0.11 to 0.53)), respectively. In comparison with uninvolved HCWs who exercised at never/stopped/reduced levels, or with those in the lowest HL quartile, involved HCWs with unchanged/increased exercise or with one-quartile HL increment reported lower anxiety likelihood (OR(95% CI)=0.50 (0.31 to 0.81)) or (OR(95% CI)=0.57 (0.45 to 0.71)), lower depression likelihood (OR(95% CI)=0.40 (0.27 to 0.61)) or (OR(95% CI)=0.63 (0.52 to 0.76)), and higher HRQoL scores (b(95% CI)=2.08 (0.58 to 3.58)), or (b(95% CI)=1.10 (0.42 to 1.78)), respectively. CONCLUSIONS Physical activity and higher HL were found to protect against anxiety and depression and were associated with higher HRQoL. Unexpectedly, smoking and drinking were also found to be coping behaviours. It is important to have strategic approaches that protect HCWs' mental health and HRQoL.
Collapse
Affiliation(s)
- Tien V Tran
- Department of Infectious Diseases, Vietnam Military Medical University, Ha Noi, Viet Nam
- Director Office, Military Hospital 103, Hanoi, Hanoi, Viet Nam
| | - Hoang C Nguyen
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Viet Nam
- President Office, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Viet Nam
| | - Linh V Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Haiphong, Viet Nam
- Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Haiphong, Viet Nam
| | - Minh H Nguyen
- International Ph.D. Program in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huu Cong Nguyen
- Director Office, E Hospital, Hanoi, Hanoi, Viet Nam
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Viet Nam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi, Viet Nam
| | - Dung T Phan
- Nursing Office, Thien An Obstetrics and Gynecology Hospital, Hanoi, Viet Nam
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Viet Nam
| | - Hung K Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, UK
| | | | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Viet Nam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Quang Ninh, Viet Nam
| | - Hung Q Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Viet Nam
| | - Thao T P Nguyen
- Health Management Training Institute, University of Medicine and Pharmacy, Hue University, Thua Thien Hue, Viet Nam
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Nhan P T Nguyen
- General Planning Department, Danang Oncology Hospital, Danang, Viet Nam
| | - Cuong Q Tran
- Director Office, Thu Duc District Health Center, Ho Chi Minh, Viet Nam
- Faculty of Health, Mekong University, Vinh Long, Viet Nam
| | - Khanh V Tran
- Director Office, Hospital District 2, Ho Chi Minh, Viet Nam
| | - Trang T Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh, Viet Nam
| | - Hai X Pham
- Director Office, District 9 Health Center, Ho Chi Minh, Viet Nam
| | - Lam V Nguyen
- President Office, Can Tho University of Medicine and Pharmacy, Can Tho, Viet Nam
- Aesthetic Plastic Surgery & Skin Care Center, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Viet Nam
| | - Tam T Vo
- Director Office, Trieu Phong District Health Center, Quang Tri, Viet Nam
| | - Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Ha Noi, Viet Nam
- Division of Military Science, Military Hospital 103, Hanoi, Hanoi, Viet Nam
| | - Thai H Duong
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Viet Nam
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Viet Nam
| | - Minh Khue Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Viet Nam
- President Office, Hai Phong University of Medicine and Pharmacy, Haiphong, Viet Nam
| | - Thu T M Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Haiphong, Viet Nam
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kien Trung Nguyen
- Department of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Viet Nam
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jane C J Chao
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
8
|
Nguyen TT, Le NT, Nguyen MH, Pham LV, Do BN, Nguyen HC, Nguyen HC, Ha TH, Dao HK, Nguyen PB, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Nguyen NPT, Tran CQ, Tran KV, Duong TT, Pham TTM, Duong TV. Health Literacy and Preventive Behaviors Modify the Association between Pre-Existing Health Conditions and Suspected COVID-19 Symptoms: A Multi-Institutional Survey. Int J Environ Res Public Health 2020; 17:E8598. [PMID: 33228096 PMCID: PMC7699410 DOI: 10.3390/ijerph17228598] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023]
Abstract
People with pre-existing health conditions (PEHC) are vulnerable to viral infection while health literacy (HL) and preventive behaviors (PB) have been shown to benefit people during the COVID-19 pandemic. The aim of this study was to examine the association between PEHC and suspected COVID-19 symptoms (S-COVID-19-S), and to investigate the modification effect of HL and PB. A cross-sectional study was conducted on 8291 participants visiting outpatient departments at 18 hospitals and health centers across Vietnam from 14 February to 31 May 2020. Data were collected regarding participant's characteristics, HL, PB, PEHC, and S-COVID-19-S. Regression models were used for analyzing the associations. Results showed that people with PEHC had a 3.38 times higher likelihood of having S-COVID-19-S (odds ratio, OR, 3.38; 95% confidence interval, 95% CI, 3.01, 3.79; p < 0.001). In comparison to participants without PEHC and with the lowest HL score, those with PEHC and one HL score increment had a 7% lower likelihood of having S-COVID-19-S (OR, 0.93; 95% CI, 0.92, 0.94; p < 0.001). In comparison to participants without PEHC and not adhering to mask wearing, those with PEHC and adhering to mask wearing had a 77% lower likelihood of having S-COVID-19-S (OR, 0.23; 95% CI, 0.16, 0.32; p < 0.001). Higher HL and adherence to mask wearing can protect people from having S-COVID-19-S, especially in those with PEHC.
Collapse
Affiliation(s)
- Tan T. Nguyen
- Department of Orthopedics, Can Tho University of Medicine and Pharmacy, Can Tho 941-17, Vietnam;
- Director Office, Can Tho University of Medicine and Pharmacy Hospital, Can Tho 941-17, Vietnam
| | - Nga T. Le
- Allied Health & Human Performance, Higher Degree Research, University of South Australia, Adelaide, SA 5000, Australia;
| | - Minh H. Nguyen
- International Ph.D. Program in Medicine, Taipei Medical University, Taipei 110-31, Taiwan;
| | - Linh V. Pham
- Department of Pulmonary & Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, Vietnam;
- Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong 042-12, 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
| | - 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
| | - Huu C. Nguyen
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi 113-08, Vietnam;
- Director Office, 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;
| | - Phuoc B. Nguyen
- Director Office, Kien An Hospital, Hai Phong 046-09, 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, Hue University of Medicine and Pharmacy, Thua Thien Hue 491-20, Vietnam;
- Department of Health Economics, Corvinus University of Budapest, 1093 Budapest, Hungary
| | - Nhan P. T. Nguyen
- General Planning Department, Da Nang Oncology Hospital, Da Nang 506-06, Vietnam;
| | - Cuong Q. Tran
- Director Office, Thu Duc District Health Center, Ho Chi Minh City 713-10, Vietnam;
- Faculty of Health, Mekong University, Vinh Long 852-16, Vietnam
| | - Khanh V. Tran
- Director Office, 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;
| | - Thu T. M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong 042-12, Vietnam;
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 110-31, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei 110-31, Taiwan
| |
Collapse
|
9
|
Pham KM, Pham LV, Phan DT, Tran TV, Nguyen HC, Nguyen MH, Nguyen HC, Ha TH, Dao HK, Nguyen PB, Trinh MV, Do TV, Nguyen HQ, Nguyen TTP, Nguyen NPT, Tran CQ, Tran KV, Duong TT, Nguyen LV, Do TT, Vo TT, Do BN, Duong TH, Pham TTM, Le TT, Do NT, Nguyen HTT, Mai TTT, Ha DT, Ngo HTM, Nguyen KT, Yang SH, Chao JCJ, Duong TV. Healthy Dietary Intake Behavior Potentially Modifies the Negative Effect of COVID-19 Lockdown on Depression: A Hospital and Health Center Survey. Front Nutr 2020; 7:581043. [PMID: 33304917 PMCID: PMC7701254 DOI: 10.3389/fnut.2020.581043] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/08/2020] [Indexed: 12/13/2022] Open
Abstract
Background: The COVID-19 pandemic causes a huge burden for affected countries. Several public health interventions were applied to contain the infection. However, the pandemic itself and the lockdown measure negatively influence people's lifestyles and psychological health. Purpose: To explore determinants of healthy dietary intake and depression, and examine the interaction between healthy dietary intake and COVID-19 lockdown on depression. Methods: A cross-sectional study was conducted at 18 hospitals and health centers from February 14 to May 31, 2020. Data of 8,291 outpatients were collected including patients' characteristics, clinical parameters, health literacy, healthy dietary intake (using the healthy eating score, HES), other health-related behaviors, and depression (using the patient health questionnaire, PHQ). Depression was defined as PHQ score ≥ 10. Results: Protective factors of healthy dietary intake and depression were higher education, better medication payment ability, higher social status, more physical activity, and higher health literacy, whereas older age, ever married, own business or other types of occupation, lockdown, suspected COVID-19 symptoms, and comorbidity were associated with lower HES scores and a higher depression likelihood. Besides, overweight/obesity and alcohol drinking were associated with lower HES scores. As compared with patients not under lockdown and with lowest HES score, those who were under lockdown and with lowest HES score had 10.6 times higher depression likelihood (odds ratio, OR, 10.60; 95% CI 6.88, 16.32; p < 0.001), whereas people with higher HES score had 15% lower depression likelihood (OR 0.85; 95% CI 0.82, 0.89; p < 0.001). Conclusions: Healthy dietary intake and depression were determined by several sociodemographic, clinical, and behavioral factors. Lockdown measure affects people's dietary intake behavior and depression. Importantly, healthy dietary intake potentially modifies the negative effect of lockdown on depression.
Collapse
Affiliation(s)
- Khue M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- President Office, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
| | - Linh V. Pham
- Department of Pulmonary and Cardiovascular Diseases, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
- Director Office, Hai Phong University of Medicine and Pharmacy Hospital, Hai Phong, Vietnam
| | - Dung T. Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam
- Nursing Office, Viet Duc University Hospital, Hanoi, Vietnam
| | - Tien V. Tran
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam
- Director Office, Military Hospital 103, Hanoi, 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
| | - Minh H. Nguyen
- International Master/Ph.D. Program in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Huu C. Nguyen
- Director Office, E Hospital, Hanoi, Vietnam
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam
| | - Tung H. Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Hung K. Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | | | - Manh V. Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thinh V. Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q. Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Thao T. P. Nguyen
- Health Management Training Institute, Hue University of Medicine and Pharmacy, Hue, Vietnam
- Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Nhan P. T. Nguyen
- General Planning Department, Da Nang Oncology Hospital, Da Nang, Vietnam
| | - Cuong Q. Tran
- Director Office, Thu Duc District Health Center, Ho Chi Minh City, Vietnam
- Faculty of Health, Mekong University, Vinh Long, Vietnam
| | - Khanh V. Tran
- Director Office, Hospital District 2, Ho Chi Minh City, Vietnam
| | - Trang T. Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh City, Vietnam
| | - Lam V. Nguyen
- President Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
- Aesthetic Plastic Surgery & Skin Care Center, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Thao T. Do
- Department of Oral Pathology and Periodontology, Faculty of Odonto-Stomatology, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
| | - Tam T. Vo
- Director Office, Trieu Phong District Health Center, Quang Tri, Vietnam
| | - Binh N. Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam
- Division of Military Science, Military Hospital 103, Hanoi, Vietnam
| | - Thai H. Duong
- Director Office, Thai Nguyen National Hospital, Thai Nguyen, Vietnam
- Department of Internal Medicine, Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam
| | - Thu T. M. Pham
- Faculty of Public Health, Hai Phong University of Medicine and Pharmacy, Hai Phong, Vietnam
- International Master/Ph.D. Program in Medicine, Taipei Medical University, Taipei, Taiwan
| | - Thuy T. Le
- Faculty of Medical Laboratory Science, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
- President Office, Da Nang University of Medical Technology and Pharmacy, Da Nang, Vietnam
| | - Ngoc T. Do
- Nursing Office, E Hospital, Hanoi, Vietnam
| | - Hoai T. T. Nguyen
- Training and Direction of Healthcare Activity Center, Kien an Hospital, Hai Phong, Vietnam
| | - Thuy T. T. Mai
- Nursing Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Dung T. Ha
- Nursing Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Huong T. M. Ngo
- Nursing Office, Quang Ninh Obstetric and Pediatric Hospital, Quang Ninh, Vietnam
| | - Kien T. Nguyen
- Department of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Shwu-Huey Yang
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Research Center of Geriatric Nutrition, Taipei Medical University, Taipei, Taiwan
| | - Jane C.-J. Chao
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
- Nutrition Research Center, Taipei Medical University Hospital, Taipei, Taiwan
- Master Program in Global Health and Development, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
10
|
Do BN, Tran TV, Phan DT, Nguyen HC, Nguyen TTP, Nguyen HC, Ha TH, Dao HK, Trinh MV, Do TV, Nguyen HQ, Vo TT, Nguyen NPT, Tran CQ, Tran KV, Duong TT, Pham HX, Nguyen LV, Nguyen KT, Chang PWS, Duong TV. Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey. J Med Internet Res 2020; 22:e22894. [PMID: 33122164 PMCID: PMC7674138 DOI: 10.2196/22894] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 09/25/2020] [Accepted: 10/28/2020] [Indexed: 01/16/2023] Open
Abstract
Background The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic. Objective The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown. Methods We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations. Results The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34% of variance; satisfactory criterion validity as correlated with HL (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95% CI 0.57-1.45, P<.001; B=0.72, 95% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95% CI 1.25-2.05, P<.001; B=0.60, 95% CI 0.34-0.86, P<.001), doctors (B=1.29, 95% CI 0.73-1.84, P<.001; B 0.56, 95% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95% CI 1.56-2.37, P<.001; B=0.64, 95% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95% CI 0.10-0.15, P<.001; B=0.22, 95% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95% CI 1.01-1.06, P=.001; OR 1.04, 95% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95% CI 1.02-1.03, P<.001; OR 1.04, 95% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95% CI 0.96-0.98, P<.001; OR 0.96, 95% CI 0.95-0.98, P<.001), respectively. Conclusions The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs’ HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences.
Collapse
Affiliation(s)
- Binh N Do
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam.,Director Office, Military Hospital 103, Hanoi, Vietnam
| | - Tien V Tran
- Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.,Division of Military Science, Military Hospital 103, Hanoi, Vietnam.,Director Office, Military Hospital 103, Hanoi, Vietnam
| | - Dung T Phan
- Faculty of Nursing, Hanoi University of Business and Technology, Hanoi, Vietnam.,Nursing Office, Viet Duc University Hospital, Hanoi, 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
| | - Thao T P Nguyen
- Health Management Training Institute, Hue University of Medicine and Pharmacy, Thua Thien Hue, Vietnam.,Department of Health Economics, Corvinus University of Budapest, Budapest, Hungary
| | - Huu C Nguyen
- Department of Thoracic and Cardiovascular Surgery, E Hospital, Hanoi, Vietnam.,Director Office, E Hospital, Hanoi, Vietnam
| | - Tung H Ha
- Director Office, General Hospital of Agricultural, Hanoi, Vietnam
| | - Hung K Dao
- Director Office, Bac Ninh Obstetrics and Pediatrics Hospital, Bac Ninh, Vietnam
| | - Manh V Trinh
- Director Office, Quang Ninh General Hospital, Quang Ninh, Vietnam
| | - Thinh V Do
- Director Office, Bai Chay Hospital, Quang Ninh, Vietnam
| | - Hung Q Nguyen
- Director Office, Quang Ninh Obstetrics and Pediatrics Hospital, Quang Ninh, Vietnam
| | - Tam T Vo
- Director Office, Trieu Phong District Health Center, Quang Tri, Vietnam
| | - Nhan P T Nguyen
- General Planning Department, Da Nang Oncology Hospital, Da Nang, Vietnam
| | - Cuong Q Tran
- Director Office, Thu Duc District Health Center, Ho Chi Minh, Vietnam.,Faculty of Health, Mekong University, Vinh Long, Vietnam
| | - Khanh V Tran
- Director Office, Hospital District 2, Ho Chi Minh, Vietnam
| | - Trang T Duong
- Nursing Office, Tan Phu District Hospital, Ho Chi Minh, Vietnam
| | - Hai X Pham
- Director Office, District 9 Health Center, Ho Chi Minh, Vietnam
| | - Lam V Nguyen
- President Office, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam.,Aesthetic Plastic Surgery & Skin Care Center, Can Tho University of Medicine and Pharmacy Hospital, Can Tho, Vietnam
| | - Kien T Nguyen
- Department of Health Education, Faculty of Social Sciences, Behavior and Health Education, Hanoi University of Public Health, Hanoi, Vietnam
| | - Peter W S Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan.,Department of Public Health and Community Medicine, Tufts University School Of Medicine, Boston, MA, United States
| | - Tuyen Van Duong
- School of Nutrition and Health Sciences, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
11
|
Abstract
Feeding rats a diet deficient in choline results in fatty liver within 1 d. We studied the effect of short-term (1-3 d) choline deficiency on rat liver Z protein (fatty acid-binding protein). Groups of three females Sprague-Dawley rats were fed ad libitum a purified diet lacking choline and L-methionine or were supplemented with 0.2% choline chloride and 0.82% L-methionine. Animals were killed after 1, 2 or 3 d of consuming control or experimental diets and hepatic Z protein was prepared. Z protein in livers from experimental and control rats were estimated with the fluorescent probe dansylamino undecanoic acid. The corresponding fatty acid-binding activity was also determined. One day of choline-deficient diet increased Z protein concentration threefold, reaching a plateau on the second and third day. Fatty acid-binding activity of Z protein remained unchanged.
Collapse
|