Population-level approaches to universal health coverage in resource-poor settings: Lessons from tobacco control policy in Vietnam

Population-based health promotion and disease prevention approaches are essential elements in achieving universal health coverage; yet they frequently do not appear on national policy agendas. This paper suggests that resource-poor countries should take greater advantage of such approaches to reach all segments of the population to positively affect health outcomes and equity, especially considering the epidemic of chronic non-communicable diseases and associated modifiable risk factors. Tobacco control policy development and implementation in Vietnam provides a case study to discuss opportunities and challenges associated with such strategies

The development of Tobacco Harm Prevention Law in Vietnam: stakeholder tensions over tobacco control legislation in a state owned industry

Background: Building on its National Tobacco Control Policy initiated in 2000, Vietnam is currently considering introducing a comprehensive law to strengthen the implementation of tobacco control policy. This study analyses the positions of key stakeholders in the development of tobacco control legislation in the context of a largely state-owned industry, and discusses their implications for the policy process

Flocculation of Reactive Blue 19 (RB19) using Alum and the Effects of Catalysts Addition

There are a variety of primary coagulants which can be used in a water treatment plant. One of the earliest, and still the most extensively used, is aluminum sulfate, also known as alum. Aluminum Sulfate (Alum) is one of the most commonly used flocculent in waste water treatment processes. Effectiveness of Alum in flocculation process is determined by many factors such as the effluents pH, flocculent dose as well as the use of catalyst to improve efficiency rate of flocculation. Hence special attention to these factors especially the use of catalyst has been brought about by this study. Experiments were carried out using Reactive Blue 19 Dye as the contaminant of waste water and two catalysts namely Calcium Hydroxide (CaOH2) and Poly Aluminum Chloride (PACl) were evaluated. The results obtained proved that indeed after addition of catalysts, removal efficiency rates of Alum can be increased up to 25% using Calcium Hydroxide and up to 35% using Poly Aluminum Chloride compared to Alum alone. The optimum conditions for this study were at pH 5.5 ~7.5, 300 mg/L of Alum 30seconds of rapid mixing time with 300 rpm , 30rpm of mixing rate for 5 minutes and 30 minutes of settling time. Moreover, Alum showed the highest performance under these conditions and using 50 mg/L PACl as catalyst with 98.52% of COD reduction and 90.60% of color reduction. In conclusion, Alum with the support of PACl as catalyst is an effective coagulant, which can reduce the level of COD and Dye Color in Reactive Blue 19 contaminated wastewater

Biological dosimetry after radiosynoviorthesis with rhenium-186 sulphide and erbium-169 citrate

Zur Abschätzung der radiobiologischen Sicherheit des Verfahrens wird in dieser Arbeit die Radiosynoviorthese (RSO) mit Re-186 und Er-169 hinsichtlich biologischer Strahleneffekte untersucht. Bei 23 Patienten wurde eine RSO mit Rhenium-186-Sulfid- (10 Patienten) oder Erbium-169-Zitratkolloid (13 Patienten) durchgeführt. Das behandelte Gelenk wurde anschließend ruhig gestellt. Bei allen Patienten erfolgte vor und 17–19 Tage (Re-186) bzw. 45–50 Tage (Er-169) nach der RSO eine venöse Blutentnahme. Zur Analyse der Strahlenexposition wurde die Häufigkeit von dizentrischen Chromosomen in Lymphozyten der ersten Zellteilung in vitro bestimmt. Pro Patient wurden mindestens 1000 Zellen vor und nach der RSO untersucht, was nach längerer Einwirkung niederenergetischer Strahlung ausreichend ist, um im bestrahlten Kollektiv die im Rahmen der RSO erwarteten Strahlendosen nachzuweisen. Ergänzend wurde bei den mit Re-186 behandelten Patienten der Aktivitätsabtransport aus dem Gelenk mittels Ganzkörperszintigraphie bestimmt. In der Untersuchung von insgesamt 47017 Zellen fanden sich vor RSO mit Re-186 bzw. Er-169 40 bzw. 88, danach 59 bzw. 105 dizentrische Chromosomen in Lymphozyten des peripheren Blutes. Eine signifikante Zunahme der dizentrischen Chromosomen nach der RSO zeigte sich nicht. Der Aktivitätsabtransport nach RSO mit Re-186 lag durchschnittlich unter 5 % (unter 3 MBq) und ist damit als gering einzustufen. Die Ergebnisse der Untersuchung von Chromosomenaberrationen und des Aktivitätsabtransports nach Radiosynoviorthese mit Rhenium-186 und Erbium-169 sprechen für eine geringe Strahlenexposition der Patienten und damit für die Sicherheit des Verfahrens.The aim of the present studies was to investigate the biological radiation effect of radiosynoviorthesis (RSO) with Re-186 and Er-169 in order to evaluate the safety of this procedure. RSO with rhenium-186 sulfide colloid (10 patients) or erbium-169 citrate colloid (13 patients) was carried out in a total of 23 patients. Afterwards, the treated joint was immobilised for three days using splints. From all patients, blood was drawn immediately before and 17 to 19 days (Re-186) or 45 to 50 days (Er-169) after RSO. To evaluate the radiation dose, the yield of dicentric chromosomes in lymphocytes was determined exclusively in metaphases of the first cell cycle in vitro. At least 1000 cells per patient have been analysed before and after RSO which is sufficient to find potential radiation effects after long-term exposure to low energy radiation such as to expect after RSO. In addition, for Re-186 the activity leakage from the treated joint was measured by whole-body scintigraphy. In a total of 47017 cells analysed from 46 blood samples, 40 and 88 before and 59 and 105 dicentrics after RSO with Re-186 and Er-169 were found. This showed no statistically significant increase in the number of dicentric chromosomes. The measured average activity leakage of less than 5 % (less than 3 MBq) was considered to be low. The results of chromosome analysis and activity measurement after RSO prove that this procedure is associated with a low effective dose in treated patients and thus can be considered a safe treatment

Safety and efficacy of fluoxetine on functional outcome after acute stroke (AFFINITY): a randomised, double-blind, placebo-controlled trial

Background Trials of fluoxetine for recovery after stroke report conflicting results. The Assessment oF FluoxetINe In sTroke recoverY (AFFINITY) trial aimed to show if daily oral fluoxetine for 6 months after stroke improves functional outcome in an ethnically diverse population. Methods AFFINITY was a randomised, parallel-group, double-blind, placebo-controlled trial done in 43 hospital stroke units in Australia (n=29), New Zealand (four), and Vietnam (ten). Eligible patients were adults (aged ≥18 years) with a clinical diagnosis of acute stroke in the previous 2–15 days, brain imaging consistent with ischaemic or haemorrhagic stroke, and a persisting neurological deficit that produced a modified Rankin Scale (mRS) score of 1 or more. Patients were randomly assigned 1:1 via a web-based system using a minimisation algorithm to once daily, oral fluoxetine 20 mg capsules or matching placebo for 6 months. Patients, carers, investigators, and outcome assessors were masked to the treatment allocation. The primary outcome was functional status, measured by the mRS, at 6 months. The primary analysis was an ordinal logistic regression of the mRS at 6 months, adjusted for minimisation variables. Primary and safety analyses were done according to the patient's treatment allocation. The trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12611000774921. Findings Between Jan 11, 2013, and June 30, 2019, 1280 patients were recruited in Australia (n=532), New Zealand (n=42), and Vietnam (n=706), of whom 642 were randomly assigned to fluoxetine and 638 were randomly assigned to placebo. Mean duration of trial treatment was 167 days (SD 48·1). At 6 months, mRS data were available in 624 (97%) patients in the fluoxetine group and 632 (99%) in the placebo group. The distribution of mRS categories was similar in the fluoxetine and placebo groups (adjusted common odds ratio 0·94, 95% CI 0·76–1·15; p=0·53). Compared with patients in the placebo group, patients in the fluoxetine group had more falls (20 [3%] vs seven [1%]; p=0·018), bone fractures (19 [3%] vs six [1%]; p=0·014), and epileptic seizures (ten [2%] vs two [<1%]; p=0·038) at 6 months. Interpretation Oral fluoxetine 20 mg daily for 6 months after acute stroke did not improve functional outcome and increased the risk of falls, bone fractures, and epileptic seizures. These results do not support the use of fluoxetine to improve functional outcome after stroke