Multicriteria assessment of advanced treatment technologies for micropollutants removal at large-scale applications

© 2016 Elsevier B.V. With the introduction and discharge of thousands of new micropollutants (MPs) every year, traditional water and wastewater treatment plants may be incapable of tackling them all. With their low concentrations and diversity in nature, MP removal encounters numerous challenges. Although some MPs are effectively eliminated via conventional treatment methods, most of them can easily escape and are retained in the discharged effluent. Therefore, advanced methods such as (i) adsorption, (ii) oxidation and advanced oxidation processes (O3 and O3-based advanced oxidation processes, UV/H2O2), (iii) membrane processes, and (iv) membrane bioreactors, become an inevitable approach. Despite the unsurprisingly vast number of papers on MP treatment available at present, most of these studies were carried out at a laboratory scale while only a few pilot- and full-scale studies have experimented. Nevertheless, an in-depth assessment of real-world MP treatment methods is extremely crucial for practitioners. To date, no paper has been dedicated to look at this issue. Therefore, this paper aims to review these large-scale treatment methods. First, the paper goes through the regulations and standards which deal with MPs in water courses. It will then assess these methods in various case-studies with reference to different criteria towards serving as a reference for further practical applications

Epidemiological features and risk factors of Salmonella gastroenteritis in children resident in Ho Chi Minh City, Vietnam.

Non-typhoidal Salmonella are an important but poorly characterized cause of paediatric diarrhoea in developing countries. We conducted a hospital-based case-control study in children aged 2 children (cases 20∙8%, controls 10∙2%; OR 2∙32, 95% CI 1∙2-4∙7). Our findings indicate that Salmonella are an important cause of paediatric gastroenteritis in this setting and we suggest that transmission may occur through direct human contact in the home

Demand and willingness to pay for different treatment and care services among patients with heart diseases in Hanoi, Vietnam

Bach Xuan Tran,1,2 Giang Thu Vu,3 Thu Hong Thi Nguyen,4 Long Hoang Nguyen,5 Dat Dinh Pham,4 Viet Quang Truong,4 Thao Phuong Thi Thai,6 Thuc Minh Thi Vu,7 Tuan Quoc Nguyen,8 Vu Nguyen,9 Trang Huyen Thi Nguyen,10 Carl A Latkin,2 Cyrus SH Ho,11 Roger CM Ho12 1Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 2Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 3Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 4Hanoi Heart Hospital, Hanoi, Vietnam; 5Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 6Department of General Planning and Department of Cardiology, Friendship Hospital, Hanoi, Vietnam; 7Tam Anh Hospital, Hanoi, Vietnam; 8Hanoi Department of Health, Hanoi, Vietnam; 9Department of Neurosurgery Spine-Surgery, Hanoi Medical University Hospital, Hanoi, Vietnam; 10Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 11Department of Psychological Medicine, National University Hospital, Singapore, Singapore; 12Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore Introduction: In Vietnam, cardiovascular diseases (CVDs) are serious health issues, especially in the context of overload central heart hospitals, insufficient primary healthcare, and lack of customer-oriented care and treatment. Attempts to measure demand and willingness-to-pay (WTP) for different CVD treatments and care services have been limited. This study explored the preferences and WTP of patients with heart diseases for different home- and hospital-based services in Hanoi, Vietnam. Methods: A cross-sectional survey was performed at the Hanoi Heart Hospital from July to December 2017. A contingent valuation was adopted to determine the preferences of patients and measure their WTP. Interval regressions were employed to determine the potential predictors of patients’ WTP. Results: Hospital-based services were most preferred by patients, with demand ranging from 45.6% to 82.3% of total participants, followed by home-based (45.4%–45.8%) and administrative services (28.9%–34%). WTP for hospital-based services were in the range of US$9.8 (US$ 8.4–11.2)–US$21.9 (US$ 20.3–23.4), while figures for home-based and administrative services were US$9.8 (US$ 8.4–11.2)–US$22 (US$ 18.7–25.3) and 1.9 (US 1.6–2.2)–US 7.5 (US$ 6.3–8.6), respectively. Patients who lived in urban areas, were employed, were having higher level of education, and were not covered by health insurance were willing to pay more for services, especially home-based ones. Conclusion: Demand and WTP for home-based services among heart disease patients were moderately low compared with hospital-based ones. There is a need for more policies supporting home-based services, better communication of services’ benefits to general public and patients, and introduction of services packages based on patients’ preferences. Keywords: willingness to pay, preference, heart disease, service, Vietna

Adherence to antiretroviral therapy among HIV/AIDS patients in the context of early treatment initiation in Vietnam

Hue Thi Mai,1 Giang Minh Le,1,2 Bach Xuan Tran,1,3,4 Ha Ngoc Do,5 Carl A Latkin,3 Luong Thanh Nguyen,6 Thao Phuong Thi Thai,7,8 Huong Thi Le,9 Anh Toan Ngo,10 Cuong Tat Nguyen,11 Cyrus SH Ho,12 Roger CM Ho13 1Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 2Center for Research and Training on HIV/AIDS (CREATA), Hanoi Medical University, Hanoi, Vietnam; 3Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 4Vietnam Young Physician Association, Hanoi, Vietnam; 5Youth Research Institute, Vietnam (YRI)-Ho Chi Minh Communist Youth Union, Hanoi, Vietnam; 6Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 7Department of General Planning, Friendship Hospital, Hanoi, Vietnam; 8Department of Cardiology, Friendship Hospital, Hanoi, Vietnam; 9Vietnam Administration of HIV/AIDS Control, Hanoi, Vietnam; 10National Hospital of Obstetrics and Gynecology, Hanoi, Vietnam; 11Institute for Global Health Innovations, Duy Tan University, Da Nang, Vietnam; 12Department of Psychological Medicine, National University Hospital, Singapore, Singapore; 13Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore Purpose: This study aimed to assess the antiretroviral therapy (ART) compliance among patients with HIV/AIDS and its associated factors in the context of universal ART initiation in Vietnam. Patients and methods: A cross-sectional survey was conducted in five ART clinics located in three provinces, such as Hanoi, Thanh Hoa, and Lao Cai, from July to September 2017. Overall, adherence to ART in the last month was measured using a 100-point Visual Analog Scale (VAS). Besides, information about forgetting doses in the last 4 days and delaying taking pills in the last 7 days was also reported. Results: Among 482 patients, the suboptimal adherence rate was 54.5%. Noncurrent smoking (coefficient =4.19, 95% CI 0.42–7.97), higher baseline CD4 count (coefficient =4.35, 95% CI 0.58–8.13), and no traveling difficulties (coefficient =6.17, 95% CI 2.27–10.06) were predictors of higher VAS adherence score. Suboptimal adherence was associated with mountainous residence (OR =5.34, 95% CI 2.81–10.16). Female respondents were less likely to delay taking pills in the last 7 days (OR =0.19, 95% CI 0.07–0.52). Conclusion: Our study embraced early ART initiation in Vietnam; however, this approach should be parallel with appropriate resource allocation and service delivery. Keywords: HIV/AIDS, antiretroviral therapy, ART adherence, Visual Analog Scale, VA

Catastrophic health expenditure of Vietnamese patients with gallstone diseases – a case for health insurance policy revaluation

Bach Xuan Tran,1,2,* Tho Dinh Tran,3,* Nila Nathan,4 Chau Quy Ngo,5 Loi Thi Nguyen,6 Long Hoang Nguyen,7 Huong Lan Thi Nguyen,8 Cuong Tat Nguyen,8 Huyen Phuc Do,7 Trang Huyen Thi Nguyen,9 Tung Thanh Tran,9 Thao Phuong Thi Thai,10,11 Anh Kim Dang,8 Nam Ba Nguyen,7 Carl A Latkin,2 Cyrus SH Ho,12 Roger CM Ho7,13 1Department of Health Economics, Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam; 2Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 3Department of Hepatobiliary Surgery, Vietnam-Germany Hospital, Hanoi, Vietnam; 4University of California, Santa Barbara, Santa Barbara, CA, USA; 5Department of Internal Medicine, Hanoi Medical University, Hanoi, Vietnam; 6Woolcock Institute of Medical Research Vietnam, Hanoi, Vietnam; 7Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 8Institute for Global Health Innovations, Duy Tan University, Danang, Vietnam; 9Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 10Department of General Planning, Friendship Hospital, Hanoi, Vietnam; 11Department of Cardiology, Friendship Hospital, Hanoi, Vietnam; 12Department of Psychological Medicine, National University Hospital, Singapore; 13Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore *These authors contributed equally to this work Purpose: Despite gallstone diseases (GSDs) being a major public health concern with both acute and chronic episodes, none of the studies in Vietnam has been conducted to investigate the household expenditure for the GSD treatment. The objective of this study was to estimate the costs of managing GSD and to explore the prevalence and determinants of catastrophic health expenditure (CHE) among Vietnamese patients.Materials and methods: A cross-sectional study was conducted from June 2016 to March 2017 in the Department of Hepatobiliary and Pancreatic Surgery, Viet Duc Hospital in Hanoi, Vietnam. A total of 206 patients were enrolled. Demographic and socioeconomic data, household income, and direct and indirect medical costs of patients seeking treatment for GSD were collected through face-to-face interview. Multivariate logistic regression was used to explore factors associated with CHE.Results: The prevalence of CHE in patients suffering from GSD was 35%. The percentage of patients who were covered by health insurance and at risk for CHE was 41.2%, significantly higher than that of those noninsured (15.8%). Proportions of patients with and without health insurance who sought outpatient treatment were 30.6% and 81.6%, respectively. Patients who were divorced or widowed and had intrahepatic gallstones were significantly more likely to experience CHE. Those who were outpatients, were women, had history of pharmacological treatment to parasitic infection, and belong to middle and highest monthly household income quantile were significantly less likely to experience CHE.Conclusion: The findings suggested that efforts to re-evaluate health insurance reimbursement capacity, especially for acute diseases and taking into account the varying preferences of people with different disease severity, should be conducted by health authority. Further studies concerning CHE of GSD in the context of ongoing health policy reform should consider utilizing WHO-recommended measures like the fairness in financial contribution index, as well as taking into consideration the behavioral aspects of health care spending. Keywords: catastrophic health expenditure, gallstone, health insurance, out-of-pocket payments, Vietnam &nbsp

A cohort study to define the age-specific incidence and risk factors of Shigella diarrhoeal infections in Vietnamese children: a study protocol

BACKGROUND: Shigella spp. are one of the most common causes of paediatric dysentery globally, responsible for a substantial proportion of diarrhoeal disease morbidity and mortality, particularly in industrialising regions. Alarming levels of antimicrobial resistance are now reported in S. flexneri and S. sonnei, hampering treatment options. Little is known, however, about the burden of infection and disease due to Shigella spp. in the community. METHODS/DESIGN: In order to estimate the incidence of this bacterial infection in the community in Ho Chi Minh City, Vietnam we have designed a longitudinal cohort to follow up approximately 700 children aged 12-60 months for two years with active and passive surveillance for diarrhoeal disease. Children will be seen at 6 month intervals for health checks where blood and stool samples will be collected. Families will also be contacted every two weeks for information on presence of diarrhoea in the child. Upon report of a diarrhoeal disease episode, study nurses will either travel to the family home to perform an evaluation or the family will attend a study hospital at a reduced cost, where a stool sample will also be collected. Case report forms collected at this time will detail information regarding disease history, risk factors and presence of disease in the household.Outcomes will include (i) age-specific incidence of Shigella spp. and other agents of diarrhoeal disease in the community, (ii) risk factors for identified aetiologies, (iii) rates of seroconversion to a host of gastrointestinal pathogens in the first few years of life. Further work regarding the longitudinal immune response to a variety of Shigella antigens, host genetics and candidate vaccine/diagnostic proteins will also be conducted. DISCUSSION: This is the largest longitudinal cohort with active surveillance designed specifically to investigate Shigella infection and disease. The study is strengthened by the active surveillance component, which will likely capture a substantial proportion of episodes not normally identified through passive or hospital-based surveillance. It is hoped that information from this study will aid in the design and implementation of Shigella vaccine trials in the future

The Role of Maternally Acquired Antibody in Providing Protective Immunity Against Nontyphoidal Salmonella in Urban Vietnamese Infants: A Birth Cohort Study

Background: Nontyphoidal Salmonella (NTS) organisms are a major cause of gastroenteritis and bacteremia, but little is known about maternally acquired immunity and natural exposure in infant populations residing in areas where NTS disease is highly endemic. Methods: We recruited 503 pregnant mothers and their infants (following delivery) from urban areas in Vietnam and followed infants until they were 1 year old. Exposure to the dominant NTS serovars, Salmonella enterica serovars Typhimurium and Enteritidis, were assessed using lipopolysaccharide (LPS) O antigen-specific antibodies. Antibody dynamics, the role of maternally acquired antibodies, and NTS seroincidence rates were modeled using multivariate linear risk factor models and generalized additive mixed-effect models. Results: Transplacental transfer of NTS LPS-specific maternal antibodies to infants was highly efficient. Waning of transplacentally acquired NTS LPS-specific antibodies at 4 months of age left infants susceptible to Salmonella organisms, after which they began to seroconvert. High seroincidences of S. Typhimurium and S. Enteritidis LPS were observed, and infants born with higher anti-LPS titers had greater plasma bactericidal activity and longer protection from seroconversion. Conclusions: Although Vietnamese infants have extensive exposure to NTS, maternally acquired antibodies appear to play a protective role against NTS infections during early infancy. These findings suggest that prenatal immunization may be an appropriate strategy to protect vulnerable infants from NTS disease