Trends in, projections of, and inequalities in reproductive, maternal, newborn and child health service coverage in Vietnam 2000-2030: A Bayesian analysis at national and sub-national levels

Background: To assess the reproductive, maternal, newborn and child health (RMNCH) service coverage in Vietnam with trends in 2000-2014, projections and probability of achieving targets in 2030 at national and sub-national levels; and to analyze the socioeconomic, regional and urban-rural inequalities in RMNCH service indicators. Methods: We used national population-based datasets of 44,624 households in Vietnam from 2000 to 2014. We applied Bayesian regression models to estimate the trends in and projections of RMNCH indicators and the probabilities of achieving the 2030 targets. Using the relative index, slope index, and concentration index of inequality, we examined the patterns and trends in RMNCH coverage inequality. Findings: We projected that 9 out of 17 health service indicators (53%) would likely achieve the 2030 targets at the national level, including at least one and four ANC visits, BCG immunization, access to improved water and adequate sanitation, institutional delivery, skilled birth attendance, care-seeking for pneumonia, and ARI treatment. We observed very low coverages and zero chance of achieving the 2030 targets at national and sub-national levels in early initiation and exclusive breastfeeding, family planning needs satisfied, and oral rehydration therapy. The most deprived households living in rural areas and the Northwest, Northeast, North Central, Central Highlands, and Mekong River Delta regions would not reach the 80% immunization coverage of DPT3, Polio3, Measles and full immunization. We found socioeconomic, regional, and urban-rural inequalities in all RMNCH indicators in 2014 and no change in inequalities over 15 years in the lowest-coverage indicators. Interpretation: Vietnam has made substantial progress toward UHC. By improving the government\u27s health system reform efforts, re-allocating resources focusing on people in the most impoverished rural regions, and restructuring and enhancing current health programs, Vietnam can achieve the UHC targets and other health-related SDGs

Appropriate Antibiotic Use and Associated Factors in Vietnamese Outpatients

Background: Inappropriate antibiotic use among outpatients is recognized as the primary driver of antibiotic resistance. A proper understanding of appropriate antibiotic usage and associated factors helps to determine and limit inappropriateness. We aimed to identify the rate of appropriate use of antibiotics and identify factors associated with the inappropriate prescriptions. Methods: We conducted a cross-sectional descriptive study in outpatient antibiotic use at a hospital in Can Tho City, Vietnam, from August 1, 2019, to January 31, 2020. Data were extracted from all outpatient prescriptions at the Medical Examination Department and analyzed by SPSS 18 and Chi-squared tests, with 95% confidence intervals. The rationale for antibiotic use was evaluated through antibiotic selection, dose, dosing frequency, dosing time, interactions between antibiotics and other drugs, and general appropriate usage. Results: A total of 420 prescriptions were 51.7% for females, 61.7% with health insurance, and 44.0% for patients with one comorbid condition. The general appropriate antibiotic usage rate was 86.7%. Prescriptions showed that 11.0% and 9.5% had a higher dosing frequency and dose than recommended, respectively; 10.2% had an inappropriate dosing time; 3.1% had drug interactions; and only 1.7% had been prescribed inappropriate antibiotics. The risk of inappropriate antibiotic use increased in patients with comorbidities and antibiotic treatment lasting >7 days (p < 0.05). Conclusions: The study indicated a need for more consideration when prescribing antibiotics to patients with comorbidities or using more than 7 days of treatment

New method for measuring azimuthal distributions in nucleus-nucleus collisions

The methods currently used to measure azimuthal distributions of particles in heavy ion collisions assume that all azimuthal correlations between particles result from their correlation with the reaction plane. However, other correlations exist, and it is safe to neglect them only if azimuthal anisotropies are much larger than 1/sqrt(N), with N the total number of particles emitted in the collision. This condition is not satisfied at ultrarelativistic energies. We propose a new method, based on a cumulant expansion of multiparticle azimuthal correlations, which allows to measure much smaller values of azimuthal anisotropies, down to 1/N. It is simple to implement and can be used to measure both integrated and differential flow. Furthermore, this method automatically eliminates the major systematic errors, which are due to azimuthal asymmetries in the detector acceptance.Comment: final version (misprints corrected), to be published in Phys.Rev.

Opposing Effects of Prior Infection versus Prior Vaccination on Vaccine Immunogenicity against Influenza A(H3N2) Viruses

Prior vaccination can alternately enhance or attenuate influenza vaccine immunogenicity and effectiveness. Analogously, we found that vaccine immunogenicity was enhanced by prior A(H3N2) virus infection among participants of the Ha Nam Cohort, Viet Nam, but was attenuated by prior vaccination among Australian Health Care Workers (HCWs) vaccinated in the same year. Here, we combined these studies to directly compare antibody titers against 35 A(H3N2) viruses spanning 1968–2018. Participants received licensed inactivated vaccines containing A/HongKong/4801/2014 (H3N2). The analysis was limited to participants aged 18–65 Y, and compared those exposed to A(H3N2) viruses circulating since 2009 by infection (Ha Nam) or vaccination (HCWs) to a reference group who had no recent A(H3N2) infection or vaccination (Ha Nam). Antibody responses were compared by fitting titer/titer-rise landscapes across strains, and by estimating titer ratios to the reference group of 2009–2018 viruses. Pre-vaccination, titers were lowest against 2009–2014 viruses among the reference (no recent exposure) group. Post-vaccination, titers were, on average, two-fold higher among participants with prior infection and two-fold lower among participants with 3–5 prior vaccinations compared to the reference group. Titer rise was negligible among participants with 3–5 prior vaccinations, poor among participants with 1–2 prior vaccinations, and equivalent or better among those with prior infection compared to the reference group. The enhancing effect of prior infection versus the incrementally attenuating effect of prior vaccinations suggests that these exposures may alternately promote and constrain the generation of memory that can be recalled by a new vaccine strain.Annette Fox, Louise Carolan, Vivian Leung, Hoang Vu Mai Phuong, Arseniy Khvorov, Maria Auladell, Yeu-Yang Tseng, Pham Quang Thai, Ian Barr, Kanta Subbarao, Le Thi Quynh Mai, H. Rogier van Doorn, and Sheena G. Sulliva

Is the analysis of flow at the CERN SPS reliable?

Several heavy ion experiments at SPS have measured azimuthal distributions of particles with respect to the reaction plane. These distributions are deduced from two-particle azimuthal correlations under the assumption that they result solely from correlations with the reaction plane. In this paper, we investigate other sources of azimuthal correlations: transverse momentum conservation, which produces back-to-back correlations, resonance decays, HBT correlations and final state interactions. These correlations increase with impact parameter: most of them vary with the multiplicity N like 1/N. When they are taken into account, the experimental results of the NA49 collaboration at SPS are significantly modified. These correlations might also explain an important fraction of the pion directed flow observed by WA98. Data should be reanalyzed taking into account carefully these non--flow correlations.Comment: Revised version (minor corrections), 13 pages, LaTeX, 6 Postscript figures included. Submitted to Physical Review

Flow analysis from multiparticle azimuthal correlations

We present a new method for analyzing directed and elliptic flow in heavy ion collisions. Unlike standard methods, it separates the contribution of flow to azimuthal correlations from contributions due to other effects. The separation relies on a cumulant expansion of multiparticle azimuthal correlations, and includes corrections for detector inefficiencies. This new method allows the measurement of the flow of identified particles in narrow phase-space regions, and can be used in every regime, from intermediate to ultrarelativistic energies.Comment: 31 pages, revtex. Published version (references added

HIV-Associated TB in An Giang Province, Vietnam, 2001–2004: Epidemiology and TB Treatment Outcomes

BACKGROUND: Mortality is high in HIV-infected TB patients, but few studies from Southeast Asia have documented the benefits of interventions, such as co-trimoxazole (CTX), in reducing mortality during TB treatment. To help guide policy in Vietnam, we studied the epidemiology of HIV-associated TB in one province and examined factors associated with outcomes, including the impact of CTX use. METHODOLOGY/PRINCIPAL FINDINGS: We retrospectively abstracted data for all HIV-infected persons diagnosed with TB from 2001-2004 in An Giang, a province in southern Vietnam in which TB patients receive HIV counseling and testing. We used standard WHO definitions to classify TB treatment outcomes. We conducted multivariate analysis to identify risk factors for the composite outcome of death, default, or treatment failure during TB treatment. From 2001-2004, 637 HIV-infected TB patients were diagnosed in An Giang. Of these, 501 (79%) were male, 321 (50%) were aged 25-34 years, and the most common self-reported HIV risk factor was sex with a commercial sex worker in 221 (35%). TB was classified as smear-positive in 531 (83%). During TB treatment, 167 (26%) patients died, 9 (1%) defaulted, and 6 (1%) failed treatment. Of 454 patients who took CTX, 116 (26%) had an unsuccessful outcome compared with 33 (70%) of 47 patients who did not take CTX (relative risk, 0.4; 95% confidence interval [CI], 0.3-0.5). Adjusting for male sex, rural residence, TB smear status and disease location, and the occurrence of adverse events during TB treatment in multivariate analysis, the benefit of CTX persisted (adjusted odds ratio for unsuccessful outcome 0.1; CI, 0.1-0.3). CONCLUSIONS/SIGNIFICANCE: In An Giang, Vietnam, HIV-associated TB was associated with poor TB treatment outcomes. Outcomes were significantly better in those taking CTX. This finding suggests that Vietnam should consider applying WHO recommendations to prescribe CTX to all HIV-infected TB patients

A possible new syndrome with growth-hormone secreting pituitary adenoma, colonic polyposis, lipomatosis, lentigines and renal carcinoma in association with familial testicular germ cell malignancy: A case report

BACKGROUND: Germ-cell testicular cancer has not been definitively linked to any known hereditary cancer susceptibility disorder. Familial testicular cancer in the presence of other findings in affected and unaffected family members might indicate a previously-unidentified hereditary cancer syndrome. CASE PRESENTATION: The patient was diagnosed with a left testicular seminoma at age 28, and treated with left orchiectomy followed by adjuvant cobalt radiation. His family history is significant for testicular seminoma in his son, bladder cancer in his sister, and lipomatosis in his father. His evaluation as part of an etiologic study of familial testicular cancer revealed multiple colon polyps (adenomatous, hyperplastic, and hamartomatous) first found in his 50 s, multiple lipomas, multiple hyperpigmented skin lesions, left kidney cancer diagnosed at age 64, and a growth-hormone producing pituitary adenoma with associated acromegaly diagnosed at age 64. The patient underwent genetic testing for Cowden syndrome (PTEN gene), Carney complex (PRKAR1A gene), and multiple endocrine neoplasia syndrome type 1 (MEN1 gene); no deleterious mutations were identified. DISCUSSION: The constellation of benign and malignant neoplasms in the context of this patient's familial testicular cancer raised the possibility that these might be manifestations of a known hereditary susceptibility cancer syndrome; however, genetic testing for the three syndromes that were most likely to explain these findings did not show any mutation. Alternatively, this family's phenotype might represent a novel neoplasm susceptibility disorder. This possibility cannot be evaluated definitively on the basis of a single case report; additional observations and studies are necessary to investigate this hypothesis further