Direct costs of hypertensive patients admitted to hospital in Vietnam:a bottom-up micro-costing analysis

Background: There is an economic burden associated with hypertension both worldwide and in Vietnam. In Vietnam, patients with uncontrolled high blood pressure are hospitalized for further diagnosis and initiation of treatment. Because there is no evidence on costs of inpatient care for hypertensive patients available yet to inform policy makers, health insurance and hospitals, this study aims to quantify direct costs of inpatient care for these patients in Vietnam. Methods: A retrospective study was conducted in a hospital in Vietnam. Direct costs were analyzed from the health-care provider's perspective. Hospital-based costing was performed using both bottom-up and micro-costing methods. Patients with sole essential or primary hypertension (ICD-code I10) and those comorbid with sphingolipid metabolism or other lipid storage disorders (ICD-code E75) were selected. Costs were quantified based on financial and other records of the hospital. Total cost per patient resulted from an aggregation of laboratory test costs, drug costs, inpatient-days' costs and other remaining costs, including appropriate allocation of overheads. Both mean and medians, as well as interquartile ranges (IQRs) were calculated. In addition to a base-case analysis, specific scenarios were analyzed. Results: 230 patients were included in the study (147 cases with I10 code only and 83 cases with I10 combined with E75). Median length of hospital stay was 6 days. Median total direct costs per patient were US$65 (IQR: 37 -95). Total costs per patient were higher in the combined hypertensive and lipid population than in the sole hypertensive population at US$78 and US$53, respectively. In all scenarios, hospital inpatient days' costs were identified as the major cost driver in the total costs. Conclusions: Costs of hospitalization of hypertensive patients is relatively high compared to annual medication treatment at a community health station for hypertension as well as to the total health expenditure per capita in Vietnam. Given that untreated/undetected hypertension likely leads to more expensive treatments of complications, these findings may justify investments by the Vietnamese health-care sector to control high blood pressure in order to save downstream health care budgets

Refining Long Short-Term Memory Neural Network Input Parameters for Enhanced Solar Power Forecasting

This article presents a research approach to enhancing the quality of short-term power output forecasting models for photovoltaic plants using a Long Short-Term Memory (LSTM) recurrent neural network. Typically, time-related indicators are used as inputs for forecasting models of PV generators. However, this study proposes replacing the time-related inputs with clear sky solar irradiance at the specific location of the power plant. This feature represents the maximum potential solar radiation that can be received at that particular location on Earth. The Ineichen/Perez model is then employed to calculate the solar irradiance. To evaluate the effectiveness of this approach, the forecasting model incorporating this new input was trained and the results were compared with those obtained from previously published models. The results show a reduction in the Mean Absolute Percentage Error (MAPE) from 3.491% to 2.766%, indicating a 24% improvement. Additionally, the Root Mean Square Error (RMSE) decreased by approximately 0.991 MW, resulting in a 45% improvement. These results demonstrate that this approach is an effective solution for enhancing the accuracy of solar power output forecasting while reducing the number of input variables

Effect of molybdenum on growth and nitrogen metabolism of Brassica parachinensis L. and Brassica integrifolia L. under drought stress

Molybdenum (Mo) is an essential trace element that plays a critical role in various physiological processes of plants. Drought stress poses a significant threat to plant growth, making it imperative to study the effects of Mo in mitigating its impact on Brassica parachinensis L. and Brassica integrifolia L. This study aims to investigate the influence of molybdenum on the growth and nitrogen metabolism of Brassica species under drought-stress conditions. The study delves into the physiological and biochemical responses of these plants to Mo supplementation to comprehend the mechanisms by which Mo enhances drought tolerance and nitrogen assimilation. The results revealed that Mo supplementation (150 g ha-1) significantly improves the growth and nitrogen metabolism of Brassica species under drought-stress conditions. In particular, the application of Mo under drought stress leads to a notable increase in yield, as indicated by the improvement in productivity from 3.41 to 4.25 (kg m-2) and 3.89 to 4.97 (kg m-2) in Brassica parachinensis and Brassica integrifolia, respectively. Furthermore, Mo supplementation enhances chlorophyll levels, thereby promoting efficient photosynthesis. Additionally, it positively affects the accumulation of soluble sugars, starch, and proteins, indicating improved nutrient assimilation and utilization in the plants. These findings suggest that Mo supplementation plays a crucial role in enhancing drought tolerance and nitrogen assimilation in Brassica species. The study highlights the potential of Mo as a valuable tool for improving crop productivity and resilience under drought-stress condition

Spatiotemporal evolution of SARS-CoV-2 Alpha and Delta variants during large nationwide outbreak of COVID-19, Vietnam, 2021

We analyzed 1,303 SARS-CoV-2 whole-genome sequences from Vietnam, and found the Alpha and Delta variants were responsible for a large nationwide outbreak of COVID-19 in 2021. The Delta variant was confined to the AY.57 lineage and caused >1.7 million infections and >32,000 deaths. Viral transmission was strongly affected by nonpharmaceutical interventions

Alcohol Use, Risk Taking, Leisure Activities and Health Care Use Among Young People in Northern Vietnam

Alcohol consumption is associated with a wide range of health and social consequences. It is also associated with a number of risk taking behaviours. These include illicit drug use and unsafe sex.  Alcohol consumption appears to be increasing in Vietnam. The purpose of this paper is to examine the patterns of alcohol consumption and its relationship with a number of other risk taking behaviours amongst young people.  Information was also obtained concerning leisure activities and use of health care. The paper also sets out to examine possible gender differences in relation to alcohol consumption and risk behaviour and to propose the development and implementation of alcohol monitoring and prevention programs in Vietnam.  The study involved a cross-sectional, community survey using a standardised interview.  This was conducted during face-to-face interviews with 1,408 young people aged 10-19 years.  Respondents were recruited randomly through the lists of the households from 12 selected communes in three areas in Northern Vietnam. The findings presented here were part of a larger health risk behaviour survey.  Levels of alcohol use were low. Overall, 16.5% of participants were experienced drinkers, and only 4% of them were current drinkers. Males were significantly more likely than females to report drinking. This study also showed that rates of alcohol consumption were associated with age, education, geographical area, gender, tobacco smoking, involvement in violence, watching television, computer use and playing computer games, wearing safety helmets and use of health services. Alcohol consumption tended to increase with age for both males and females.  Alcohol and its effects on young people are clearly a growing public health issue in Vietnam.  Because of this, more detailed behavioral research should be conducted into the relationship between alcohol consumption and other risky behaviours amongst young people.  It is also recommended that alcohol harm reduction policies should be implemented and integrated into measures to reduce levels of other health problems such as HIV/AIDS and non communicable diseases. Such policies should ideally be evidence-based and evaluated

Mapping for engagement: setting up a community based participatory research project to reach underserved communities at risk for Hepatitis C in Ho Chi Minh City, Vietnam

Background: Approximately 1. 07 million people in Vietnam are infected with hepatitis C virus (HCV). To address this epidemic, the South East Asian Research Collaborative in Hepatitis (SEARCH) launched a 600-patient cohort study and two clinical trials, both investigating shortened treatment strategies for chronic HCV infection with direct-acting antiviral drugs. We conducted ethnographic research with a subset of trial participants and found that the majority were aware of HCV infection and its implications and were motivated to seek treatment. However, people who inject drugs (PWID), and other groups at risk for HCV were under-represented, although injecting drug use is associated with high rates of HCV. Material and Methods: We designed a community-based participatory research (CBPR) study to engage in dialogues surrounding HCV and other community-prioritized health issues with underserved groups at risk for HCV in Ho Chi Minh City. The project consists of three phases: situation analysis, CBPR implementation, and dissemination. In this paper, we describe the results of the first phase (i.e., the situation analysis) in which we conducted desk research and organized stakeholder mapping meetings with representatives from local non-government and community-based organizations where we used participatory research methods to identify and analyze key stakeholders working with underserved populations. Results: Twenty six institutions or groups working with the key underserved populations were identified. Insights about the challenges and dynamics of underserved communities were also gathered. Two working groups made up of representatives from the NGO and CBO level were formed. Discussion: Using the information provided by local key stakeholders to shape the project has helped us to build solid relationships, give the groups a sense of ownership from the early stages, and made the project more context specific. These steps are not only important preliminary steps for participatory studies but also for other research that takes place within the communities

A Time to Mourn: Cultural Considerations and Community Preferences for Verbal Autopsy in Vietnam

Reliable mortality data becomes necessary to realise the full functioning of national health systems. Verbal autopsy (VA) is a viable tool to identify cause-of-death in Vietnam and has already utilised in a number of studies. This qualitative study (in-depth interviews and focus group discussions) had been done with the aim to examine the views of six ethnic groups in Vietnam on the suitable timing for implementing VA after a death. Recommendations on what were the suitable timing varied significantly between minorities ethnic groups, reflecting their particular cultural beliefs and burial practices. For the dominant Kinh people, the suitable timing for VA was around 49-100 days after the funeral. By providing better understanding of the best timing for VA interview, our study enables researchers to optimally use VA methods, producing more reliable data for mortality rates and cause of death in the lack of a complete vital registration in Vietnam

Feasibility of wearable monitors to detect heart rate variability in children with hand, foot and mouth disease

Hand foot and mouth disease (HFMD) is caused by a variety of enteroviruses, and occurs in large outbreaks in which a small proportion of children deteriorate rapidly with cardiopulmonary failure. Determining which children are likely to deteriorate is difficult and health systems may become overloaded during outbreaks as many children require hospitalization for monitoring. Heart rate variability (HRV) may help distinguish those with more severe diseases but requires simple scalable methods to collect ECG data.We carried out a prospective observational study to examine the feasibility of using wearable devices to measure HRV in 142 children admitted with HFMD at a children's hospital in Vietnam. ECG data were collected in all children. HRV indices calculated were lower in those with enterovirus A71 associated HFMD compared to those with other viral pathogens.HRV analysis collected from wearable devices is feasible in a low and middle income country (LMIC) and may help classify disease severity in HFMD

Antibiotic use and prescription and its effects on Enterobacteriaceae in the gut in children with mild respiratory infections in Ho Chi Minh City, Vietnam. A prospective observational outpatient study.

BACKGROUND AND OBJECTIVES: Treatment guidelines do not recommend antibiotic use for acute respiratory infections (ARI), except for streptococcal pharyngitis/tonsillitis and pneumonia. However, antibiotics are prescribed frequently for children with ARI, often in absence of evidence for bacterial infection. The objectives of this study were 1) to assess the appropriateness of antibiotic prescriptions for mild ARI in paediatric outpatients in relation to available guidelines and detected pathogens, 2) to assess antibiotic use on presentation using questionnaires and detection in urine 3) to assess the carriage rates and proportions of resistant intestinal Enterobacteriaceae before, during and after consultation. MATERIALS AND METHODS: Patients were prospectively enrolled in Children's Hospital 1, Ho Chi Minh City, Vietnam and diagnoses, prescribed therapy and outcome were recorded on first visit and on follow-up after 7 days. Respiratory bacterial and viral pathogens were detected using molecular assays. Antibiotic use before presentation was assessed using questionnaires and urine HPLC. The impact of antibiotic usage on intestinal Enterobacteriaceae was assessed with semi-quantitative culture on agar with and without antibiotics on presentation and after 7 and 28 days. RESULTS: A total of 563 patients were enrolled between February 2009 and February 2010. Antibiotics were prescribed for all except 2 of 563 patients. The majority were 2nd and 3rd generation oral cephalosporins and amoxicillin with or without clavulanic acid. Respiratory viruses were detected in respiratory specimens of 72.5% of patients. Antibiotic use was considered inappropriate in 90.1% and 67.5%, based on guidelines and detected pathogens, respectively. On presentation parents reported antibiotic use for 22% of patients, 41% of parents did not know and 37% denied antibiotic use. Among these three groups, six commonly used antibiotics were detected with HPLC in patients' urine in 49%, 40% and 14%, respectively. Temporary selection of 3rd generation cephalosporin resistant intestinal Enterobacteriaceae during antibiotic use was observed, with co-selection of resistance to aminoglycosides and fluoroquinolones. CONCLUSIONS: We report overuse and overprescription of antibiotics for uncomplicated ARI with selection of resistant intestinal Enterobacteriaceae, posing a risk for community transmission and persistence in a setting of a highly granular healthcare system and unrestricted access to antibiotics through private pharmacies. REGISTRATION: This study was registered at the International Standard Randomised Controlled Trials Number registry under number ISRCTN32862422: http://www.isrctn.com/ISRCTN32862422