Linh Bui

Background: The Planetary Health Diet Index (PHDI) quantifies adherence to the planetary health diet, aiming to promote human health and environmental sustainability. While self-reported PHDI is linked to lower cardiometabolic risk, the underlying biological pathways remain unclear. We aimed to identify a metabolomic signature of PHDI and evaluate its association with cardiovascular disease (CVD) and mortality.Methods: In this prospective cohort study, we included 11,190 adults from three US cohorts (Nurses’ Health Study [NHS], NHS II, and Health Professionals Follow-up Study) with up to 30 years of follow-up. Self-reported PHDI and covariates, including body-mass index (BMI), sociodemographic, and lifestyle factors, were derived from the two questionnaires closest to blood draw. Plasma metabolites were profiled using liquid chromatography-tandem mass spectrometry. We used elastic net regression to identify a metabolomic signature of the PHDI. Associations with incident CVD (1,861 events) and mortality (3,788 deaths) were assessed using Cox proportional hazards models. Findings were replicated in the Women’s Health Initiative (WHI; n=1,711).Findings: We identified an 84-metabolite signature of PHDI (Pearson r=0·46), characterised by higher long-chain highly unsaturated lipids and plant-related amino acids and lower carnitines and saturated lipid species, reflecting favourable lipid remodelling and oxidative stress modulation. Higher metabolomic PHDI was associated with lower risks of CVD (hazard ratio [HR] per 1-SD increment 0·95 [95% CI 0·90-1·00]) and total mortality (0·93 [0·89-0·96]), independently of self-reported PHDI, BMI, and other conventional risk factors. The signature was replicated in WHI for CVD (0·92 [0·84-1·00]).Interpretation: We identified and validated a metabolomic signature of PHDI that captures biological pathways linking adherence to a sustainable dietary pattern with cardiovascular health. These findings provide mechanistic insight into the potential cardiometabolic benefits of the planetary health diet and identify metabolic pathways that could inform future prevention strategies.

Undergraduate students of veterinary science are a key future workforce for zoonotic disease (ZD) prevention and One Health implementation, yet in Vietnam, their understanding of zoonosis-related knowledge, attitudes, and practices (KAP) remains limited. This study aimed to assess KAP toward ZD prevention among veterinary students enrolled at Vietnamese universities and identified factors associated with KAP performance. A cross-sectional survey was conducted between January and November 2021 among undergraduate veterinary science students recruited from ten universities across Vietnam. Participants were invited to complete an online self-administered questionnaire on social demographic characteristics and KAP regarding ZD prevention. Multivariable regression was used to identify factors associated with KAP levels. Among 446 eligible responses to our survey, only 9.6% achieved good knowledge, 83.9% had positive attitudes, and 26.5% reported good practices toward ZDs. Better knowledge was associated with a higher prevalence of positive attitudes (PR 1.13, 95% CI: 1.02–1.27), whereas positive attitudes showed a strong association with good practice (PR 4.66, 95% CI: 2.14–10.17). Senior students (in years 3–5) were more likely to have good knowledge than juniors (PR 2.29, 95% CI: 1.15–4.57), but were less likely to report good practices (PR 0.59, 95% CI: 0.41–0.84). Students in the Central Highlands had lower prevalence of both good knowledge and positive attitudes than those in the North–Central region (PR 0.42, 95% CI: 0.18–0.95 and 0.76, 95% CI: 0.66–0.87, respectively). While veterinary students in Vietnam have a positive professional attitude, there are critical gaps in foundational knowledge and preventive practice relating to ZDs. These findings suggest that strengthening theoretical training, expanding competency-based instruction, and standardizing infection prevention and control protocols may help improve veterinary students’ preparedness and support Vietnam’s One Health strategy.

PURPOSE: This study explores the views of health care providers (HCPs), regulators, patients with cancer, and caregivers in Vietnam on the barriers to safe access to opioids for cancer pain relief and suggested solutions. MATERIALS AND METHODS: We conducted a qualitative, descriptive study using semistructured interviews. Five HCPs, six patients with cancer/caregivers, and six regulators (n = 17) were purposefully sampled across Vietnam. Audio recordings were transcribed verbatim and subjected to inductive content analysis using a Framework method. RESULTS: Five categories of barriers were identified: (1) Patient-related barriers (fear of addiction and other side effects, morphine's association with impending death); (2) professional-related barriers (knowledge and experience deficit, fear of addiction and other side effects, and concerns about diversion and liabilities); (3) medicine-related barriers (limited oral morphine availability, limited manufacturers and suppliers, and difficulties accessing parenteral opioids); (4) regulatory barriers (difficulties obtaining certifications of continued need for opioid use, overly strict regulation enforcement, lack of information on opioid distribution channels); and (5) services delivery barriers (scarce palliative and home care services). Potential solutions include strengthening education for patients, communities, and health care professionals; mandating oral morphine availability at district levels; diversifying opioid variety and enhancing domestic manufacturing; establishing an electronic prescription monitoring system; expanding palliative care training and implementation across all health care system levels; and using telemedicine. CONCLUSION: Barriers to opioid access for cancer pain control in Vietnam are multifactorial and interrelated, necessitating interdisciplinary solutions.

Unintentional injury is the leading cause of death in adolescents especially in low-middle-income countries including Vietnam. However, there is limited evidence on first aid (FA) knowledge, attitude, and skills among Vietnamese adolescents. Our study aims to assess the knowledge, attitudes, and skills regarding FA; and evaluate how these domains improve after implementing FA training programs among high school students in Hue city. A single-group pre-post-intervention study was conducted on high school students between June and September 2020 in Hue City, Vietnam. The training materials were developed based on international guidance on FA and adjusted to a low-middle-income country context, particularly in Vietnam. The training program provided students with essential knowledge and skills focused on the management of common injuries in Vietnam to enhance a positive attitude toward FA. The students’ responses on FA knowledge and attitude were collected using self-reported questionnaires and FA skills were evaluated by skill checklists. At baseline (n = 806), the average score of FA knowledge, attitude, and skills over a 100-point scale were 44.0 (95% CI: 38.6, 49.5), 59.4 (95% CI: 55.5, 63.4) and 39.2 (95% CI: 35.8, 42.6) respectively. Following the intervention phase (n = 106), which included a 3-hour FA training session, a significant increase in FA skill scores was observed, with a mean difference of 37.0 points (SE: 1.6). The findings demonstrated the feasibility and significant impact of a short course of FA training on improving FA skills among high school students. The results of the multivariable regression model showed baseline scores of FA attitude, FA knowledge or having previous FA training were not significantly associated with the improvement in FA skill scores in this pre-post intervention. The study findings highlighted the low level of FA knowledge, attitude, and skills; and provided evidence of the effectiveness of FA training in improving FA skills among high school students in Hue City, Vietnam.

PURPOSE: We aimed to assess knowledge, attitudes, and perceived barriers among health care professionals (HCPs), policymakers, and regulators in Vietnam related to opioid therapy for cancer pain. METHODS: We conducted a cross-sectional study in Vietnam from June to August 2022. Participants completed a questionnaire on their demographic characteristics, knowledge and attitudes toward opioid therapy, and barriers to accessing opioids for cancer pain. RESULTS: Two hundred seven HCPs and 15 policymakers/regulators completed the questionnaire. Poor knowledge about opioids in cancer pain was found in 63.3% of HCPs and 80.0% of policymakers/regulators. Poor knowledge was associated with a lack of training in cancer pain management or palliative care (PC; prevalence ratio [PR], 1.14 [95% CI, 1.04 to 1.24]). Negative attitudes toward opioid therapy in cancer pain were held by 64.7% of HCPs and 80.0% of policymakers/regulators. Negative attitudes were associated with the unavailability of oral morphine in the workplace (PR, 1.10 [95% CI, 1.01 to 1.20]). The most common major barriers reported were the absence of national policy on pain management and PC (34.7%), inadequate training in opioid use for cancer pain (33.8%), lockdown of health facilities during the COVID-19 pandemic (32.4%), limited opioid availability in local health facilities (32.4%), and excessively restrictive regulation of opioid dispensing in pharmacies (32.4%). CONCLUSION: This study found a knowledge deficit and negative attitudes toward opioid therapy for cancer pain among HCPs and policymakers/regulators. Improving education and training in opioid therapy is essential. Recognizing major barriers can guide strategies to enhance safe opioid accessibility for cancer pain management in Vietnam.

Background: Few standardized and open-source tools exist for calculating dietary pattern indexes from dietary intake data in epidemiological and clinical studies. Miscalculations of dietary indexes, with suspected erroneous findings, are occasionally noted in the literature. Objective: The primary aim is to develop and validate dietaryindex, a user-friendly and versatile R package that standardizes the calculation of dietary indexes. Methods: Dietaryindex utilizes a two-step process: an initial calculation of serving size for each food and nutrient category, followed by the calculation of individual dietary indexes. It includes generic functions that accept any preprocessed serving sizes of food groups and nutrients, with the standard serving sizes defined according to the methodologies used in well-known prospective cohort studies. For ease of use, dietaryindex also offers one-step functions that directly reference common datasets and tools, including the National Health and Nutrition Examination Survey (NHANES) and Block Food Frequency Questionnaire, eliminating the need for data preprocessing. At least two independent researchers validated the serving size definitions and scoring algorithms of dietaryindex. Results: Dietaryindex can calculate multiple dietary indexes of high interest in research, including Healthy Eating Index (HEI) - 2020, Alternative Healthy Eating Index 2010, Dietary Approaches to Stop Hypertension Index, Alternate Mediterranean Diet Score, Dietary Inflammatory Index, American Cancer Society 2020 dietary index, and Planetary Health Diet Index from the EAT-Lancet Commission. In our validation process, dietaryindex demonstrated full accuracy (100%) in all generic functions with two-decimal rounding precision in comparison to hand-calculated results. Similarly, using NHANES 2017-2018 data and ASA24 and DHQ3 example data, the HEI2015 outputs from dietaryindex aligned (99.95% - 100%) with results using the SAS codes from the National Cancer Institute. Conclusions: Dietaryindex is a user-friendly, versatile, and validated informatics tool for standardized dietary index calculations. We have open-sourced all the validation files and codes with detailed tutorials on GitHub ( https://github.com/jamesjiadazhan/dietaryindex ).