Dung Phung

Body mass index and risk of pneumonia: a systematic review and meta-analysis

The aims of our meta‐analysis were to examine the pattern and genders influence on body mass index (BMI) – pneumonia relationship. Published studies were searched from PubMed, Web of Science, Cochrane Library databases using keywords of pneumonia, BMI and epidemiologic studies. Random‐effects analysis was applied to estimate pooled effect sizes from individual studies. The Cochrane Q‐test and index of heterogeneity (I2) were used to evaluate heterogeneity, and Eggers test was used to evaluate publication bias. Random‐effects meta‐regression was applied to examine the pattern and genders influence on BMI–pneumonia relationship.

Ambient temperature and risk of cardiovascular hospitalization: An updated systematic review and meta-analysis

The association between temperatures and risk of cardiovascular mortality has been recognized but the association drawn from previous meta-analysis was weak due to the lack of sufficient studies. This paper presented a review with updated reports in the literature about the risk of cardiovascular hospitalization in relation to different temperature exposures and examined the dose-response relationship of temperature-cardiovascular hospitalization by change in units of temperature, latitudes, and lag days. The pooled effect sizes were calculated for cold, heat, heatwave, and diurnal variation using random-effects meta-analysis, and the dose-response relationship of temperature-cardiovascular admission was modelled using random-effect meta-regression. The Cochrane Q-test and index of heterogeneity (I(2)) were used to evaluate heterogeneity, and Eggers test was used to evaluate publication bias. Sixty-four studies were included in meta-analysis. The pooled results suggest that for a change in temperature condition, the risk of cardiovascular hospitalization increased 2.8% (RR, 1.028; 95% CI, 1.021-1.035) for cold exposure, 2.2% (RR, 1.022; 95% CI, 1.006-1.039) for heatwave exposure, and 0.7% (RR, 1.007; 95% CI, 1.002-1.012) for an increase in diurnal temperature. However no association was observed for heat exposure. The significant dose-response relationship of temperature - cardiovascular admission was found with cold exposure and diurnal temperature. Increase in one-day lag caused a marginal reduction in risk of cardiovascular hospitalizations for cold exposure and diurnal variation, and increase in latitude was associated with a decrease in risk of cardiovascular hospitalizations for diurnal temperature only. There is a significant short-term effect of cold exposure, heatwave and diurnal variation on cardiovascular hospitalizations. Further research is needed to understand the temperature-cardiovascular relationship for different climate areas.

Biological monitoring of chlorpyrifos exposure to rice farmers in Vietnam.

Chlorpyrifos is the most common organophosphate insecticide registered for use in Vietnam and is widely used in agriculture, particularly rice farming. However, chlorpyrifos exposure to and adverse effects on farmers has not been evaluated. In this study, biological monitoring of chlorpyrifos exposure in a group of rice farmers was conducted after a typical application event using back-pack spraying. Urine samples (24 h) were collected from the rice farmers before and post insecticide application. Samples were analysed for 3,5,6-trichloropyridinol (TCP), the major urinary metabolite of chlorpyrifos, using an enzymatic pre-treatment before extraction followed by HPLC-MS/MS. Absorbed Daily Dose (ADD) of chlorpyrifos for farmers were then estimated from urinary TCP levels, expressed as μg g(-1)creatinine. The analytical method for urinary TCP had a low detection limit (0.6 μg L(-1)), acceptable recovery values (80-114%), and low relative percentage differences in duplicate and repeated samples. Post-application chlorpyrifos ADD of farmers varied from 0.4 to 94.2 μg kg(-1) (body weight) d(-1) with a mean of 19.4 μg kg(-1) d(-1) which was approximately 80-fold higher than the mean baseline exposure level (0.24 μg kg(-1) d(-1)). Hazard Quotients (ratio of the mean ADD for rice farmers to acute oral reference dose) calculated using acute oral reference doses recommended by United States and Australian agencies varied from 2.1 (Australian NRA), 4.2 (US EPA) to 6.9 (ATSDR). Biological monitoring using HPLC-MS/MS analysis of urinary TCP (24 h) was found to be an effective method for measuring chlorpyrifos exposure among farmers. This case study found that Vietnamese rice farmers had relatively high exposures to chlorpyrifos after application, which were likely to have adverse health effects.

Identification of the prediction model for dengue incidence in Can Tho city, a Mekong Delta area in Vietnam

The Mekong Delta is highly vulnerable to climate change and a dengue endemic area in Vietnam. This study aims to examine the association between climate factors and dengue incidence and to identify the best climate prediction model for dengue incidence in Can Tho city, the Mekong Delta area in Vietnam. We used three different regression models comprising: standard multiple regression model (SMR), seasonal autoregressive integrated moving average model (SARIMA), and Poisson distributed lag model (PDLM) to examine the association between climate factors and dengue incidence over the period 2003-2010. We validated the models by forecasting dengue cases for the period of January-December, 2011 using the mean absolute percentage error (MAPE). Receiver operating characteristics curves were used to analyze the sensitivity of the forecast of a dengue outbreak. The results indicate that temperature and relative humidity are significantly associated with changes in dengue incidence consistently across the model methods used, but not cumulative rainfall. The Poisson distributed lag model (PDLM) performs the best prediction of dengue incidence for a 6, 9, and 12-month period and diagnosis of an outbreak however the SARIMA model performs a better prediction of dengue incidence for a 3-month period. The simple or standard multiple regression performed highly imprecise prediction of dengue incidence. We recommend a follow-up study to validate the model on a larger scale in the Mekong Delta region and to analyze the possibility of incorporating a climate-based dengue early warning method into the national dengue surveillance system.

The association between particulate air pollution and respiratory admissions among young children in Hanoi, Vietnam.

While the effects of ambient air pollution on health have been studied extensively in many developed countries, few studies have been conducted in Vietnam, where the population is exposed to high levels of airborne particulate matter. The aim of our study was to examine the short-term effects of PM10, PM2.5, and PM1 on respiratory admissions among young children in Hanoi. Data on daily admissions from the Vietnam National Hospital of Paediatrics and daily records of PM10, PM2.5, PM1 and other confounding factors as NO2, SO2, CO, O3 and temperature were collected from September 2010 to September 2011. A time-stratified case-crossover design with individual lag model was applied to evaluate the associations between particulate air pollution and respiratory admissions. Significant effects on daily hospital admissions for respiratory disease were found for PM10, PM2.5 and PM1. An increase in 10μg/m3 of PM10, PM2.5 or PM1 was associated with an increase in risk of admission of 1.4%, 2.2% or 2.5% on the same day of exposure, respectively. No significant difference between the effects on males and females was found in the study. The study demonstrated that infants and young children in Hanoi are at increased risk of respiratory admissions due to the high level of airborne particles in the citys ambient air.

Probabilistic assessment of chlorpyrifos exposure to rice farmers in Viet Nam

Chlorpyrifos is the most common organophosphate compound registered for agricultural use in Vietnam. The aim of this study was to evaluate chlorpyrifos exposure to rice farmers in Vietnam, using a probabilistic approach. Urine samples on a 24-h basis were collected from farmers before and post application of pesticide. Samples were analysed for 3,5,6-trichloro-2-pyridinol (TCP), the major urinary metabolite of chlorpyrifos, using an enzymatic pre-treatment for extraction and HPLC-MS/MS. Absorbed daily doses (ADD) of chlorpyrifos for farmers were subsequently estimated from the urinary TCP levels. The baseline and post-application exposure levels were evaluated at the 5th, 50th, and 95th percentile representing low, medium and high-exposure groups in the population. Regression analysis was applied to examine the association between exposure level and factors. The baseline exposure level, which ranged from 0.03 to 1.98 μg/kg/day was below the chronic guidelines recommended by international and national bodies. However, the post-application exposure level, which ranged from 0.35 to 94 μg/kg/day exceeded most of the acute guidelines at the 95th percentile level. Multivariate analysis provided strong evidence for a relationship between post-application exposure level and amount of chlorpyrifos used, as well as body coverage of personal protective equipment.

Temporal and spatial analysis of hand, foot, and mouth disease in relation to climate factors: A study in the Mekong Delta region, Vietnam

This study examined the temporal and spatial patterns of hand, foot, and mouth disease (HFMD) in the Mekong Delta region in Vietnam. A time-series analysis was used to examine the temporal patterns of HFMD in relation to climate factors while a retrospective space-time scan was used to detect the high-risk space-time clusters of this disease. A 1°C increase in average temperature was associated with 5.6% increase in HFMD rate at lag 5days (95% CI 0.3-10.9). A 1% increase in humidity had equal influence of 1.7% increases on HFMD rate at both lag 3days and 6days (95% CI 0.7-2.7 and 95% CI 0.8-2.6, respectively). An increase in 1 unit of rainfall was associated with a 0.5% increase of HFMD rate on the lag 1 and 6days (95% CI 0.2-0.9 and 95% CI 0.1-0.8, respectively). The predictive model indicated that the peak of HFMD was from October to December - the rainy season in the Mekong Delta region. Most high-risk clusters were located in areas with high population density and close to transport routes. The findings suggest that HFMD is influenced by climate factors and is likely to increase in the future due to climate change related weather events.

Pesticide regulations and farm worker safety: the need to improve pesticide regulations in Viet Nam

Agricultural pesticide use in Viet Nam has more than tripled since 1990. However, pesticide legislation and regulations have not been developed in response to this large increase in usage, as a result of which pesticides pose a serious threat to human health and the environment. This paper identifies the need to improve pesticide regulations in Viet Nam through a comparative analysis of pesticide regulations in Viet Nam and the United States of America, where the rate of acute poisoning among agricultural workers is much lower than in Viet Nam and where information pertaining to pesticide regulations is made accessible to the public. The analysis identified several measures that would help to improve Viet Nams pesticide regulations. These include enhancing pesticide legislation, clarifying the specific roles and active involvement of both the environmental and health sectors; performing a comprehensive risk-benefit evaluation of pesticide registration and management practices; improving regulations on pesticide suspension and cancellation, transport, storage and disposal; developing import and export policies and enhancing pesticide-related occupational safety programmes.

Drinking water salinity and risk of hypertension: A systematic review and meta-analysis.

ABSTRACT We summarized epidemiological studies assessing sodium in drinking water and changes in blood pressure or hypertension published in English from 1960 to 2015 from PubMed, Scopus, and Web of Science. We extracted data on blood pressure level or prevalence of hypertension and calculated pooled estimates using an inverse variance weighted random-effects model. The pooled standardized mean difference (SMD) in 7 studies (12 data sets) comparing the low and high water sodium exposure groups for systolic blood pressure (SBP) was 0.08 (95% CI, −0.17 to 0.34) and for diastolic blood pressure (DBP) was 0.23 (95% CI, 0.09–0.36). Of the 3 studies that assessed the association between high water sodium and odds of hypertension, 2 recent studies showed consistent findings of higher risk of hypertension. Our systematic review suggests an association between water sodium and human blood pressure (more consistently for DBP) but remain inconclusive because of the small number of studies (largely in young populations) and the cross-sectional design and methodological drawbacks. In the context of climate-change-related sea level rise and increasing saltwater intrusion into drinking water sources, further research is urgently warranted to investigate and guide intervention in this increasingly widespread problem.

Temperature as a risk factor for hospitalisations among young children in the Mekong Delta area, Vietnam

Background The Mekong Delta is the most vulnerable region to climate change in South-East Asia; however, the association between climate and childrens health has rarely been studied in this region. Objective We examined the short-term association between daily temperature and hospital admissions for all causes, gastrointestinal and respiratory infection, among young children in the Mekong Delta area in Vietnam. Methods Daily paediatric hospital admissions and meteorological data were obtained from January 2008 to December 2012. A time-series approach was used with a combination of a Poisson regression and constrained distributed lag models to analyse the data. The long-term and seasonal trends, as well as other time-varying covariates, were adjusted using spline functions. Temperature—pediatric admission relationship was evaluated by age-specific (0–2 and 3–5-year-olds) and cause of admission groupings. Results A 1°C increase in the 2-day moving average temperature was significantly associated with a 3.4% (95% CI 1.2% to 5.5%), 4.6% (95% CI 2.2% to 7.3%), 2.6% (95% CI 0.6% to 4.6%), 4.4% (95% CI 0.6% to 8.2%) and 3.8%(95% CI 0.4% to 7.2%) increase in hospital admissions with 0–2-year-old children, 3–5-year-old children, all causes, gastrointestinal infection and respiratory infection, respectively. The cumulative effects from 1-day to 6-day moving average temperature on hospital admissions were greater for 3–5-year-old children and gastrointestinal infection than for 0–2-year-old children and other causes. Conclusions Temperature was found to be significantly associated with hospital admissions in young children with the highest association between temperature and gastrointestinal infection. The government agencies of Mekong Delta should implement measures to protect children from the changing temperature conditions related to climate change.