Browsing by Subject "Vietnam"
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Item Has your patient been to Viet Nam?: diseases to be considered(1967-02-23) Sanford, Jay P.Item Influences on Mental Health Service Utilization for Vietnamese Young Adults(2012-08-15) Phan, Hang Tu; Stewart, Sunita M.; Lee, Simon Craddock; Chiu, Chung-YiBACKGROUND: Vietnamese-Americans underutilize mental health services. Several factors have been proposed to influence rates of service utilization within this population, including cultural identification and families' acceptance of such services. Most measures of cultural identification are lengthy and burdensome. Furthermore, studies examining the link between parental attitudes towards mental health services and their children's attitudes have only included children who were under the age of 18 - therefore unable to legally seek their own services. This study was designed to address these gaps by developing and testing brief scales of identification with Vietnamese and American culture, and obtaining information about the influence of parents' attitudes on older adolescents and young adults in this cultural group where a strong family orientation persists through the lifespan. A third aim of the study was to examine the role of the participants' acceptance of mental health services both as a predictor for utilization of such services, and as a mediator between other predictors and utilization. SUBJECTS: The participants in the study included a total of 87 Vietnamese-American young adults between the ages of 18 to 30 years old. Participants were recruited from the Texas Exes Asian Alumni Network (TEAAN) in Austin, Texas and from the Mother of Perpetual Faith Catholic Church's youth group. Recruitment also occurred through a method called the "snowball effect," where those involved in the study were asked to help recruit additional participants. METHOD: Surveys were completed on-line. Participants reported their mental health service utilization in the past 12 months. They also were administered measures of potential predictors: cultural identification scales, the participants' distress level, perceived stigma towards mental health services, perceived parental acceptance of mental health services, and their own (personal) acceptance of mental health services. RESULTS: The psychometric properties of the brief cultural identification scales were examined; the scales have good validity, but slightly low reliability. None of the proposed factors were found to be significant predictors of formal mental health service utilization, but items assessing distress level were found to correlate with service utilization at a trend level. The only factor found to predict personal acceptance was perceived parental acceptance of these services. Because personal acceptance was not found to be a predictor of mental health service use, it could not serve as a mediating variable between the other factors and service utilization. DISCUSSION: Before the originally developed cultural identity scales can be used for research, further development of the scales will be necessary. A limitation of this study is that there were very few participants who reported formal mental health service utilization, reducing the power to determine prediction to this variable. In this sample, only distress was found to be even a marginal predictor of mental health service use, suggesting that the low rates of mental health service utilization found in these Vietnamese young adults may in fact be due to actual low levels of psychological distress. The fact that parental acceptance significantly predicted personal acceptance of mental health services among participants supports the idea that parental attitudes towards mental health services may have been adopted by their children, even after they were independent enough to seek their own services. Future research and clinical implications are discussed.Item Secondary Prevention: A Cost-Effective Yet Underutilized Strategy for Reducing the Stroke Burden in Resource-Limited Settings(2015-03-25) Rimmer, Kathryn; Gebreyohanns, MehariBACKGROUND: Over two-thirds of global stroke occur in low- and middle-income countries (LMIC), where the populations are affected on average 15 years younger. Those who survive potentially lose their livelihood and are financially vulnerable to health care expenses. On a national level, stroke DALYs rob the developing economy of its workforce. Cost-effective prevention strategies and interventions could help reduce the stroke burden in LMIC. Primary prevention is considered the top priority, but it necessitates sufficient infrastructure and human resources for successful campaigns. In resource-limited health systems, the population at greatest risk for stroke are likely not receiving regular health maintenance. OBJECTIVE: Secondary prevention targets the cohort seeking medical attention for an incident stroke. It is hypothesized to be a more feasible strategy of improving stroke rates in LMIC by reducing recurrence in high-risk populations. The objectives of this study are to compare stroke risk and secondary prevention practices across four different countries of varying income level, and to determine which secondary prevention drug regimen would be optimal for resource-limited settings. METHODS: Current economic and health indicator data were collected from the World Bank and the World Health Organization (WHO) on the United States, France, Vietnam, and Peru. Death and disability-adjusted life-years (DALYs) rates along with risk factor prevalences for each country were accessed from the WHO. Literature reviews on secondary prevention of recurrent stroke and healthcare-utilization in the developing world were conducted on MEDLINE and Pubmed databases using the following key words: stroke, epidemiology, risk factors, stroke burden, secondary prevention, secondary prevention drugs, cost-effectiveness, healthcare-utilization, resource-limited settings, developing world, developing countries, and LMIC. Articles that addressed thesis objectives were selected for review. Additionally, the latest country-specific guidelines for secondary prevention of stroke were retrieved online from the relevant national stroke organizations. RESULTS: Vietnam experienced the highest death (109) and DALY (729) rates for both genders despite having a young population. Peru has the next highest incidence of death (45.8) and DALYs (385) from stroke. There was a trend of increasing stroke burden with decreasing country GNI per capita among the four countries. Each country had a signature risk factor profile; the United States with raised total cholesterol and obesity; France with hypertension, raised total cholesterol, and smoking; Vietnam with the greatest risk of hypertension and the highest prevalence of smoking among men; and Peru with risk of high BMI. Regarding clinical practice, both the United States and France have an established national guidelines on secondary prevention of stroke. Vietnam recently established its own quality standards based on the Royal College of Physicians' recommendations. Peru does not have its own clinical guidelines for secondary prevention, and adherence to evidence-based recommendations is likely variable among Peruvian neurologists. CONCLUSION: In the absence of a health system that can adequately screen and monitor common risk factors in its population, most susceptible patients will go untreated until a cerebrovascular event brings them to medical attention. The opportunity to intervene in the high-risk population is at the moment of incident stroke. Secondary prevention is a cost-effective strategy that can be implemented in the interim while sufficient healthcare capacity develops to maximize primary prevention in the future. LMIC must economize according to the constraints of their resources. Therefore, it would be practical to initiate secondary prevention drug therapy according to the top one or two risk factors in the population.