The evolution of social health insurance in Vietnam and its role towards achieving universal health coverage

Our research examines the development of social health insurance (SHI) in Vietnam between 1992 and 2016 and SHI's role as a financial mechanism towards achieving universal health coverage (UHC). We reviewed and analysed legislation from the Government of Vietnam (GoV) and performance data from the GoV and the World Bank. Stages of development were identified from legislative change leading to change in SHI functioning as a public financing mechanism: revenue collection, pooling of risk, and purchasing. Movement towards UHC was assessed relative to: population coverage, benefit coverage, and financial protection. Vietnam has implemented SHI through five stages: Stage I (1992–1998), Stage II (1998–2005), Stage III (2005–2008), Stage IV (2008–2014), and Stage V (2014 onwards). Coverage has widened from a compulsory scheme for civil servants and pensioners and a voluntary scheme for others, to a scheme that targets the entire population. However, UHC has not been achieved with 19% of the population uninsured in 2016 and high out-of-pocket payments. The benefit package includes a wide range of services and many expensive medications and considered to be generous. It is recommended that Vietnam focus on improving population coverage rather than further expanding the benefit package to achieve UHC

Effectiveness and safety of in vitro maturation of oocytes versus in vitro fertilisation in women with high antral follicle count : Study protocol for a randomised controlled trial

This work was supported by Ferring grant number 000323 and sponsored by My Duc Hospital.Peer reviewedPublisher PD

Community, Family, and Partner-Related Stigma Experienced by Pregnant and Postpartum Women with HIV in Ho Chi Minh City, Vietnam

Pregnant and postpartum women with HIV often face stigma and discrimination at home and in the community. In Vietnam, associations between HIV and the “social evils” of drug use and sex work contribute to stigmatization of people with HIV. We conducted a qualitative study to explore discrimination experienced by HIV-positive pregnant and postpartum women in Ho Chi Minh City at home and in the community. We conducted 20 in-depth interviews and two focus group discussions. Participants described managing disclosure of their HIV infection because of fear of stigma and discrimination, particularly to the wider community. In cases where their HIV status was disclosed, women experienced both discrimination and support. The findings highlight the need for targeted interventions to support pregnant and postpartum women with HIV, particularly during this period when they are connected to the healthcare system and more readily available for counseling

B-fields and Dust in Interstellar Filaments Using Dust Polarization (BALLAD-POL). I. The Massive Filament G11.11–0.12 Observed by SOFIA/HAWC+

We report the first measurement of polarized thermal dust emission toward the entire infrared dark cloud G11.11−0.12 taken by the polarimeter SOFIA/HAWC+ at 214 μm. The obtained magnetic fields (B-fields) from the polarized emission of the early-stage and massive filament tend to be perpendicular to its spine. We produce a map of B-field strengths for the center region of the filament. The strengths vary in the range of 100–600 μG and are strongest along the filament's spine. The central region is sub-Alfvénic and mostly subcritical, meaning that B-fields dominate over turbulence and are strong enough to resist gravitational collapse. The alignment and properties of dust grains in the filament are studied using radiative torque (RAT) theory. We find the decrease of polarization degree P with emission intensity I, i.e., depolarization effect, of the form P∝ I−α ∼ 0.8–0.9, implying a significant loss of grain alignment in the filament's spine. The depolarization can be explained by the decrease in RAT alignment efficiency toward the denser regions with weaker radiation field, which cannot be explained by B-field tangling. We study the effect of the enhanced magnetic relaxation by embedded iron inclusions on RAT alignment and find that the high polarization fraction P ∼ 20%–30% in the outer layer of the filament is potential evidence for the magnetically enhanced RAT alignment mechanism. This is the first time this effect is evaluated in a filament. Based on the polarization fraction and RAT alignment theory, we also find evidence for grain growth in the filament

Characteristics of Patent Ductus Arteriosus in Congenital Rubella Syndrome

This study investigated the characteristics of congenital rubella syndrome (CRS)-associated cardiac complications, particularly patent ductus arteriosus (PDA). We reviewed the medical records of patients with CRS who were admitted to the Children’s Hospital 1 in Vietnam between December 2010 and December 2012, and patients with CRS who underwent PDA transcatheter occlusion therapy at the cardiology department between December 2009 and December 2015. We compared the characteristics of PDA treated with transcatheter closure between children with CRS (CRS-PDA) and those without CRS (non-CRS-PDA) who underwent PDA transcatheter closure between July 2014 and December 2015. One-hundred-and-eight children with CRS were enrolled. Cardiac defects (99%), cataracts (72%), and hearing impairment (7%) were detected. Fifty CRS-PDA and 290 non-CRS-PDA patients were examined. CRS-PDA patients had smaller median birthweight (p < 0.001), more frequent pulmonary (p < 0.001) and aortic stenosis (p < 0.001), higher main pulmonary artery pressure, and higher aortic pressure in systole/diastole (p < 0.001 for each) than did non-CRS-PDA patients. The proportion of tubular-type PDA was higher in CRS-PDA patients (16%) than in non-CRS-PDA patients (3%) (p = 0.020). Tubular-type PDA was frequently seen in patients with CRS and accompanied by pulmonary/systemic hypertension and pulmonary/aortic stenosis; in these patients, more cautious device selection is needed for transcatheter PDA closure

Extraction of anthocyanins from Butterfly pea (Clitoria ternatea L. Flowers) in Southern Vietnam: Response surface modeling for optimization of the operation conditions

In this paper, the Response Surface Methodology (RSM), in conjunction with Central Composite Design (CCD), was used to optimize the extraction of anthocyanins from Butterfly pea (Clitoria ternatea L.Flowers) cultivated in Southern Vietnam. The effect of extraction temperatures of solvent ethanol (50-70 °C), duration of extraction (40-50 min) and solid-liquid ratios (20:1-30:1) was measured as independent variables on the total extraction anthocyanins in the response function. The highest anthocyanin content of 132.756 mg/L of butterfly pea anthocyanin was collected at the solid liquid ratio of 23:1, extraction time of 46 min, and temperature 60.6°C. Butterfly pea anthocyanins yield detailed significant correlation with high F values, low P values (<0.0001), and desirable determination coefficient (R2 = 0.9994)

AIDS-defining events and deaths in HIV-infected children and adolescents on antiretrovirals: a 14-year study in Thailand

BACKGROUND: Data are scarce on the long-term clinical outcomes of perinatally HIV-infected children and adolescents receiving antiretroviral therapy (ART) in low/middle-income countries. We assessed the incidence of mortality before (early) and after (late) 6-month of ART and of the composite outcome of new/recurrent AIDS-defining-event or death >6 months after ART start (late AIDS/death) and their associated factors. METHODS: Study population was perinatally HIV-infected children (≤18 years) initiating ART within the Program for HIV Prevention and Treatment observational cohort (NCT00433030). Factors associated with late AIDS/death were assessed using competing risk regression models accounting for loss-to-follow-up, and included baseline and time-updated variables. RESULTS: Among 619 children, "early" mortality incidence was 99 deaths per 1000-PYFU (95%CI; 69-142) and "late" mortality 6 per 1000-PYFU (95%CI; 4-9). Of the 553 children alive >6 months after ART initiation, median age at ART initiation was 6.4 years, CD4% 8.2% and HIV-RNA 5.1 log10 copies/mL. 38 (7%) children developed late AIDS/death after median time of 3.3 years: 24 died and 24 experienced new/recurrent AIDS-defining-events (10 subsequently died). Factors independently associated with late AIDS/death were: current age ≥13 years (adjusted sub-distribution hazard-ratio 4.9; 95%CI; 2.4-10.1), HIV-RNA always ≥400 copies/mL (12.3; 4.0-37.6), BMI-z-score always <-2 SD (13.7; 3.4-55.7), and hemoglobin <8g/dL at least once (4.6; 2.0-10.5). CONCLUSIONS: After the initial 6 months of ART, being an adolescent, persistent viremia, poor nutritional status and severe anemia were associated with poor clinical outcomes. This supports the need for novel interventions that target children, particularly adolescents with poor growth and uncontrolled viremia

Experience in Using Mobile Laboratory for Monitoring and Diagnostics in the Socialist Republic of Vietnam

The aim was to present the experience of using mobile laboratory for monitoring and diagnostics (MLMD) during the epizootiological monitoring of the northern provinces of Vietnam. MLMD was transferred by Federal Service for Surveillance in the Sphere of Consumers Rights Protection and Human Welfare to the Socialist Republic of Vietnam as part of implementation of cooperation programs on combating infectious diseases. The use of MLMD made it possible to obtain new information on the circulation of pathogens of natural-focal infectious diseases on the territory of Vietnam. It also provided the necessary conditions for conducting research using methods of express diagnostics, bacteriological analysis, performing a full cycle of work – from the receipt of samples to the disinfection and destruction of infected material in compliance with the requirements of biological safety in the field. The effectiveness of using mobile laboratories in response to the emergencies of sanitary and epidemiological nature, both to strengthen stationary laboratory bases and to organize diagnostic studies in remote regions, has been shown. The use of MLMD for the diagnosis of COVID‑19 has been an effective component of countering the new coronavirus infection in Vietnam and significantly increased the volume of testing in the country

Meta-analysis of the diagnostic performance of stress perfusion cardiovascular magnetic resonance for detection of coronary artery disease

<p>Abstract</p> <p>Aim</p> <p>Evaluation of the diagnostic accuracy of stress perfusion cardiovascular magnetic resonance for the diagnosis of significant obstructive coronary artery disease (CAD) through meta-analysis of the available data.</p> <p>Methodology</p> <p>Original articles in any language published before July 2009 were selected from available databases (MEDLINE, Cochrane Library and BioMedCentral) using the combined search terms of magnetic resonance, perfusion, and coronary angiography; with the exploded term coronary artery disease. Statistical analysis was only performed on studies that: (1) used a [greater than or equal to] 1.5 Tesla MR scanner; (2) employed invasive coronary angiography as the reference standard for diagnosing significant obstructive CAD, defined as a [greater than or equal to] 50% diameter stenosis; and (3) provided sufficient data to permit analysis.</p> <p>Results</p> <p>From the 263 citations identified, 55 relevant original articles were selected. Only 35 fulfilled all of the inclusion criteria, and of these 26 presented data on patient-based analysis. The overall patient-based analysis demonstrated a sensitivity of 89% (95% CI: 88-91%), and a specificity of 80% (95% CI: 78-83%). Adenosine stress perfusion CMR had better sensitivity than with dipyridamole (90% (88-92%) versus 86% (80-90%), P = 0.022), and a tendency to a better specificity (81% (78-84%) versus 77% (71-82%), P = 0.065).</p> <p>Conclusion</p> <p>Stress perfusion CMR is highly sensitive for detection of CAD but its specificity remains moderate.</p