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Thi LM, Manzano A, Ha BTT, Vui LT, Quynh-Chi NT, Duong DTT, Lakin K, Kane S, Mirzoev T, Trang DTH. Mental health stigma and health-seeking behaviors amongst pregnant women in Vietnam: a mixed-method realist study. Int J Equity Health 2024; 23:163. [PMID: 39152438 PMCID: PMC11328496 DOI: 10.1186/s12939-024-02250-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2024] [Accepted: 08/07/2024] [Indexed: 08/19/2024] Open
Abstract
BACKGROUND Approximately 15% of women in low-and middle-income countries experience common perinatal mental disorders. Yet, many women, even if diagnosed with mental health conditions, are untreated due to poor quality care, limited accessibility, limited knowledge, and stigma. This paper describes how mental health-related stigma influences pregnant women's decisions not to disclose their conditions and to seek treatment in Vietnam, all of which exacerbate inequitable access to maternal mental healthcare. METHODS A mixed-method realist study was conducted, comprising 22 in-depth interviews, four focus group discussions (total participants n = 44), and a self-administered questionnaire completed by 639 pregnant women. A parallel convergent model for mixed methods analysis was employed. Data were analyzed using the realist logic of analysis, an iterative process aimed at refining identified theories. Survey data underwent analysis using SPSS 22 and descriptive analysis. Qualitative data were analyzed using configurations of context, mechanisms, and outcomes to elucidate causal links and provide explanations for complexity. RESULTS Nearly half of pregnant women (43.5%) would try to hide their mental health issues and 38.3% avoid having help from a mental health professional, highlighting the substantial extent of stigma affecting health-seeking and accessing care. Four key areas highlight the role of stigma in maternal mental health: fear and stigmatizing language contribute to the concealment of mental illness, rendering it unnoticed; unconsciousness, normalization, and low literacy of maternal mental health; shame, household structure and gender roles during pregnancy; and the interplay of regulations, referral pathways, and access to mental health support services further compounds the challenges. CONCLUSION Addressing mental health-related stigma could influence the decision of disclosure and health-seeking behaviors, which could in turn improve responsiveness of the local health system to the needs of pregnant women with mental health needs, by offering prompt attention, a wide range of choices, and improved communication. Potential interventions to decrease stigma and improve access to mental healthcare for pregnant women in Vietnam should target structural and organizational levels and may include improvements in screening and referrals for perinatal mental care screening, thus preventing complications.
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Grants
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- MR/T023481/2 Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
- Joint Health Systems Research Initiative comprising Medical Research Council (MRC), Foreign, Commonwealth & Development Office (FCDO) and Wellcome Trust
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Affiliation(s)
- Le Minh Thi
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Hanoi, 10000, Vietnam.
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds, LS29JT, UK
| | - Bui Thi Thu Ha
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Hanoi, 10000, Vietnam
| | - Le Thi Vui
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Hanoi, 10000, Vietnam
| | | | | | - Kimberly Lakin
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Tolib Mirzoev
- London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E7HT, UK
| | - Do Thi Hanh Trang
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Hanoi, 10000, Vietnam
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Trang DTH, Ha BTT, Vui LT, Chi NTQ, Thi LM, Duong DTT, Hung DT, Cronin de Chavez A, Manzano A, Lakin K, Kane S, Mirzoev T. Understanding the barriers to integrating maternal and mental health at primary health care in Vietnam. Health Policy Plan 2024; 39:541-551. [PMID: 38597872 PMCID: PMC11145914 DOI: 10.1093/heapol/czae027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/27/2024] [Accepted: 04/08/2024] [Indexed: 04/11/2024] Open
Abstract
The prevalence of common perinatal mental disorders in Vietnam ranges from 16.9% to 39.9%, and substantial treatment gaps have been identified at all levels. This paper explores constraints to the integration of maternal and mental health services at the primary healthcare level and the implications for the health system's responsiveness to the needs and expectations of pregnant women with mental health conditions in Vietnam. As part of the RESPONSE project, a three-phase realist evaluation study, we present Phase 1 findings, which employed systematic and scoping literature reviews and qualitative data collection (focus groups and interviews) with key health system actors in Bac Giang province, Vietnam, to understand the barriers to maternal mental healthcare provision, utilization and integration strategies. A four-level framing of the barriers to integrating perinatal mental health services in Vietnam was used in reporting findings, which comprised individual, sociocultural, organizational and structural levels. At the sociocultural and structural levels, these barriers included cultural beliefs about the holistic notion of physical and mental health, stigma towards mental health, biomedical approach to healthcare services, absence of comprehensive mental health policy and a lack of mental health workforce. At the organizational level, there was an absence of clinical guidelines on the integration of mental health in routine antenatal visits, a shortage of staff and poor health facilities. Finally, at the provider level, a lack of knowledge and training on mental health was identified. The integration of mental health into routine antenatal visits at the primary care level has the potential help to reduce stigma towards mental health and improve health system responsiveness by providing services closer to the local level, offering prompt attention, better choice of services and better communication while ensuring privacy and confidentiality of services. This can improve the demand for mental health services and help reduce the delay of care-seeking.
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Affiliation(s)
- Do Thi Hanh Trang
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Bui Thi Thu Ha
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Le Thi Vui
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | | | - Le Minh Thi
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Doan Thi Thuy Duong
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Dang The Hung
- Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Ha Noi 10000, Vietnam
| | - Anna Cronin de Chavez
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
| | - Ana Manzano
- School of Sociology and Social Policy, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Kimberly Lakin
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Sumit Kane
- Nossal Institute for Global Health Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia
| | - Tolib Mirzoev
- Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, United Kingdom
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Mhango W, Crowter L, Michelson D, Gaysina D. Psychoeducation as an active ingredient for interventions for perinatal depression and anxiety in youth: a mixed-method systematic literature review and lived experience synthesis. BJPsych Open 2023; 10:e10. [PMID: 38088162 PMCID: PMC10755556 DOI: 10.1192/bjo.2023.614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 09/22/2023] [Accepted: 10/14/2023] [Indexed: 12/31/2023] Open
Abstract
BACKGROUND Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited. AIMS This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth. METHOD For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12). RESULTS In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping. CONCLUSIONS Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, UK; and Department of Psychology, University of Malawi, Malawi
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Mhango W, Michelson D, Gaysina D. "I felt I needed help, but I did not get any": A multiple stakeholder qualitative study of risk and protective factors, and barriers to addressing common mental health problems among perinatal adolescents in Malawi. Glob Ment Health (Camb) 2023; 10:e73. [PMID: 38024806 PMCID: PMC10663692 DOI: 10.1017/gmh.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 09/26/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Common mental health problems (particularly depression and anxiety) are common among adolescents during the perinatal period. Previous research has identified the distinctive needs of this group and called for contextually appropriate psychosocial interventions. The current study conducted in Malawi aimed to explore risk and protective factors for common mental health problems, and barriers to accessing mental health care, among perinatal adolescents, to develop a contextually relevant intervention for preventing and treating perinatal depression and anxiety. An exploratory qualitative study was conducted in antenatal and postnatal clinics in Zomba district, Malawi in January-March 2022. In-depth individual interviews were completed with perinatal adolescents aged ≤19 (n = 14); their family members (n = 4); and healthcare workers (n = 8). Interview data were subjected to thematic framework analysis. Data were organised around two themes: "psychosocial risk and protective factors" (potential causes of common mental health problems among adolescents); and "health care services" (maternal and mental health services available, and adolescents' experiences of using these services). Interventions need to go beyond targeting symptoms of depression and anxiety to addressing the wider contextual risk factors and barriers to care at the different socioecological levels.
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Affiliation(s)
- Wezi Mhango
- School of Psychology, University of Sussex, Brighton, UK
- Department of Psychology and Medical Humanities, University of Malawi, Zomba, Malawi
| | - Daniel Michelson
- School of Psychology, University of Sussex, Brighton, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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Nguyen HTH, Hoang PA, Do TKL, Taylor-Robinson AW, Nguyen TTH. Postpartum depression in Vietnam: a scoping review of symptoms, consequences, and management. BMC Womens Health 2023; 23:391. [PMID: 37496038 PMCID: PMC10369808 DOI: 10.1186/s12905-023-02519-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 06/30/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a major health issue that can affect both mothers and their newborn children. In Vietnam, approximately 20% of mothers suffer from PPD. However, there is a lack of synthesized evidence regarding the case management of PPD in the Vietnamese context. A review of early symptoms, consequences, and management strategies of PPD will help to inform best practices to reduce complications and shorten the recovery time after parturition. METHODS This scoping review aims to analyze and synthesize the findings of studies on PPD examining the symptoms, consequences, and management strategies among Vietnamese women. MEDLINE, CINAHL, PubMed, ScienceDirect, EBSCOHost, Google Scholar, and a networked digital library of projects, theses, and dissertations published between 2010 and 2022 in Vietnam were accessed following search terms including "Vietnam", "depression", "postpartum", "symptom/experience", "consequence", and "management". FINDINGS The most-reported symptoms were sadness, tiredness, the feeling of being ignored, lack of interest in the baby, reduced appetite, and sleep disturbance. The recognized consequences were child stunting and slow growth, without mentioning its long-term effects on mothers. Our findings indicated that PPD in Vietnam has not been sufficiently managed; mothers tend to seek help from 'fortune-tellers' or 'word-of-mouth' practices rather than from evidence-based modern medicine. CONCLUSION This scoping review provides an initial stage of PPD symptoms, consequences, and management along with facilitating an interventional program to support this vulnerable group of women. A large survey of Vietnamese mothers' symptoms, effects, and management strategies is needed.
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Affiliation(s)
- Huyen Thi Hoa Nguyen
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam.
- Faculty of Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Phuong Anh Hoang
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam
- Faculty of Nursing and Midwifery, Hanoi Medical University, No 1 Ton That Tung, Dong Da, 100000, Hanoi, Vietnam
| | - Thi Kim Ly Do
- University Medical Center Schleswig-Holstein, Lübeck campus, Ratzeburger Allee 96, Lübeck, 23562, Germany
| | - Andrew W Taylor-Robinson
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam
| | - Thi Thanh Huong Nguyen
- College of Health Sciences, VinUniversity, Vinhomes Ocean Park, Hanoi, Da Ton, Gia Lam, 100000, Vietnam
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Nguyen HTT, Hoang AP, Do LTK, Schiffer S, Nguyen HTH. The Rate and Risk Factors of Postpartum Depression in Vietnam From 2010 to 2020: A Literature Review. Front Psychol 2021; 12:731306. [PMID: 34777111 PMCID: PMC8578872 DOI: 10.3389/fpsyg.2021.731306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Postpartum depression (PPD) is commonly seen in women after birth and can lead to adverse effects on both the health of mothers and child(ren) development. In Vietnam, there have been a number of studies examining the rate and risk factors of PPD, but none has provided a systematic review. Aim: This current literature review aims to summarize and synthesize the current state of knowledge of studies conducted in Vietnam to provide a comprehensive understanding of the PPD phenomena during the last 10 years. Data Sources: A literature search was conducted relying on the most common online databases—MEDLINE/PubMed, ScienceDirect, and Google Scholar, which included articles if they (i) examined prevalence or risk factors of PPD; (ii) were conducted among Vietnamese participants using either quantitative, qualitative, or mixed-method, and (iii) were published from 2010 to 2020. After the filtering process, 18 articles were eligible to be reviewed. Results: Research studies in Vietnam on PPD are conducted among women at and after 1-month delivery. The rate of PPD reported in Vietnam among mothers at postnatal time points from 1 to 12 months ranged from 8.2 to 48.1%. Risk factors can be clustered into three groups: personal factors, family factors, and environmental factors. Recommendation: Further research studies should focus on examining PPD at an earlier stage within the first month after birth. The investigation of risk factors in a comprehensive manner for Vietnamese mothers would also be recommended.
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Affiliation(s)
| | - Anh Phuong Hoang
- College of Health Sciences, Vin University, Hanoi, Vietnam.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Ly Thi Kim Do
- 47B General Surgery Department, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Phoosuwan N, Manasatchakun P, Eriksson L, Lundberg PC. Life situation and support during pregnancy among Thai expectant mothers with depressive symptoms and their partners: a qualitative study. BMC Pregnancy Childbirth 2020; 20:207. [PMID: 32272908 PMCID: PMC7147066 DOI: 10.1186/s12884-020-02914-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/30/2020] [Indexed: 11/12/2022] Open
Abstract
Background Expectant parents may have positive and negative emotions during pregnancy and receive support from different sources. Studies on life situation and support among couples have rarely been conducted. This study aims to explore life situation and support during pregnancy among expectant mothers with depressive symptoms and their partners. Methods Twenty-seven expectant mothers, in the last trimester of pregnancy with depressive symptoms (Edinburgh Postnatal Depression Scale score ≥ 7) from seven public antenatal care clinics in Sakonnakhon, a north-eastern province of Thailand, and their partners were interviewed. In total, 54 semi-structured interviews were subjected to content analysis. Results Four categories emerged: (1) Having obstacles in life, (2) Facing life transition, (3) Enhancing confidence, and (4) Dissatisfaction with support. The informants described obstacles regarding economy, fear of health problems, getting an abnormal child and partners’ behaviours. They received support from family members and social networks, but some were dissatisfied with the support from the healthcare. For example, expectant fathers wished to receive more health information and be more involved. Conclusions Healthcare professionals should be aware of the influence of cultural and contextual factors when providing antenatal care to expectant parents. Male involvement in the care must not be neglected.
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Affiliation(s)
- Nitikorn Phoosuwan
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden. .,Department of Community Health, Faculty of Public Health, Kasetsart University Chalermphrakiat Sakonnakhon Province Campus, Sakon Nakhon, Thailand.
| | | | - Leif Eriksson
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Pranee C Lundberg
- Department of Public Health and Caring Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
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Nguyen DV, Vidal C, Chu HC, van Nunen S. Human leukocyte antigen-associated severe cutaneous adverse drug reactions: from bedside to bench and beyond. Asia Pac Allergy 2019; 9:e20. [PMID: 31384575 PMCID: PMC6676067 DOI: 10.5415/apallergy.2019.9.e20] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 04/22/2019] [Indexed: 12/11/2022] Open
Abstract
Despite their being uncommon, severe cutaneous adverse drug reactions (SCARs) result in a very great burden of disease. These reactions not only carry with them a high mortality (10%-50%) and high morbidity (60%) with severe ocular complications, alopecia, oral and dental complications and development of autoimmune diseases, but also create a substantial economic burden for patients' families and society. SCARs are, therefore, an important medical problem needing a solution in many countries, especially in Asia. The clinical spectrum of SCARs comprises Stevens-Johnson syndrome, toxic epidermal necrolysis, DRESS (drug rash with eosinophilia and systemic symptoms) (also known as drug hypersensitivity syndrome or drug-induced hypersensitivity syndrome) and acute generalised exanthematous pustulosis. Recent crucial advances in determining genetic susceptibility and understanding how T cells recognise certain medications or their metabolites via the major histocompatibility complex and the effects of cofactors, have led to the implementation of cost-effective screening programs enabling prevention in a number of countries, and to further understanding of the patho-mechanisms involved in SCARs and their significance. In this review, we document comprehensively the journey of SCARs from bedside to bench and outline future perspectives in SCARs research.
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Affiliation(s)
- Dinh Van Nguyen
- Division of Respiratory, Allergy and Clinical Immunology, Vinmec International Hospital, Times City and VinUni Project, Hanoi, Vietnam
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Allergy and Clinical Immunology, Hanoi Medical University, Hanoi, Vietnam
| | - Christopher Vidal
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hieu Chi Chu
- Centre of Allergology and Clinical Immunology, Bach Mai Hospital, Hanoi, Vietnam
| | - Sheryl van Nunen
- Northern Clinical School, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia
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