Inhibition of Transglutaminase 2 Reduces Peritoneal Injury in a Chlorhexidine-Induced Peritoneal Fibrosis Model.

Long-term peritoneal dialysis (PD) is often associated with peritoneal dysfunction leading to withdrawal from PD. The characteristic pathologic features of peritoneal dysfunction are widely attributed to peritoneal fibrosis and angiogenesis. The detailed mechanisms remain unclear, and treatment targets in clinical settings have yet to be identified. We investigated transglutaminase 2 (TG2) as a possible novel therapeutic target for peritoneal injury. TG2 and fibrosis, inflammation, and angiogenesis were investigated in a chlorhexidine gluconate (CG)-induced model of peritoneal inflammation and fibrosis, representing a noninfectious model of PD-related peritonitis. Transforming growth factor (TGF)-ß type I receptor (TGFßR-I) inhibitor and TG2-knockout mice were used for TGF-ß and TG2 inhibition studies, respectively. Double immunostaining was performed to identify cells expressing TG2 and endothelial-mesenchymal transition (EndMT). In the rat CG model of peritoneal fibrosis, in situ TG2 activity and protein expression increased during the development of peritoneal fibrosis, as well as increases in peritoneal thickness and numbers of blood vessels and macrophages. TGFßR-I inhibitor suppressed TG2 activity and protein expression, as well as peritoneal fibrosis and angiogenesis. TGF-ß1 expression, peritoneal fibrosis, and angiogenesis were suppressed in TG2-knockout mice. TG2 activity was detected by α-smooth muscle actin-positive myofibroblasts, CD31-positive endothelial cells, and ED-1-positive macrophages. CD31-positive endothelial cells in the CG model were α-smooth muscle actin-positive, vimentin-positive, and vascular endothelial-cadherin-negative, suggesting EndMT. In the CG model, EndMT was suppressed in TG2-knockout mice. TG2 was involved in the interactive regulation of TGF-ß. As inhibition of TG2 reduced peritoneal fibrosis, angiogenesis, and inflammation associated with TGF-ß and vascular endothelial growth factor-A suppression, TG2 may provide a new therapeutic target for ameliorating peritoneal injuries in PD.

Etiologic agents of acute diarrhea in sentinel surveillance sites in Vientiane Capital, Lao People's Democratic Republic, 2012-2015.

This study aims to identify the pathogens of diarrhea in Vientiane Capital, Lao People's Democratic Republic (Lao PDR). The data of 2482 patients who visited eight health facilities due to diarrhea in 2012-2015 were retrospectively reviewed. Stool or rectal swabs collected from all patients were tested for bacteria. Children who were under 5 years old were additionally tested for rotavirus. Of 2482 cases, 1566 cases were under 5 years old, and at least one enteropathogen was detected in 475 cases (19.1%). Salmonella species was the most commonly detected bacterial pathogen. Enteropathogenic Escherichia coli (EPEC) and Salmonella species was the major pathogen in the dry season and the wet season, respectively. Eighty-seven patients tested positive for multiple bacteria. Rotavirus was detected in 291 children under 5 years old (32.4%), mostly from October to April. The major bacteria of coinfection with rotavirus were EPEC followed by Salmonella species. Salmonella species was the predominant bacterial pathogen of diarrhea of all ages, and rotavirus was the predominant pathogen among children under 5 years old. Further studies examining other types of pathogens for diarrhea and the introduction of a rotavirus vaccine for children are needed in Lao PDR.

Association between body mass index and ready-to-eat food consumption among sedentary staff in Nay Pyi Taw union territory, Myanmar.

BACKGROUND: Ready-to-eat (RTE) food consumption has become popular in the working community with the increase in full-time jobs and the limited time to prepare food. Although RTE food is essential for this community, its consumption causes obesity. In Myanmar, obesity is a modifiable risk factor for non-communicable diseases, causing increases in morbidity and mortality. This study aimed to identify the association between body mass index (BMI) and RTE food consumption among sedentary staff in Nay Pyi Taw Union Territory, Myanmar. METHODS: A cross-sectional study was conducted in 2018, in which 400 respondents participated in face-to-face interviews. The study area was selected using simple random sampling and drawing method. Measuring tape and digital weighing scale were used to measure the height and weight of the respondents. BMI was calculated by dividing the weight by height squared (kg/m2). Overweight and obesity were categorized by World Health Organization cut-off points. The collected data were analyzed using multiple logistic regression to estimate the adjusted odds ratio (AOR), and the 95% confidence interval (CI). RESULTS: This study revealed that sedentary staff who consumed RTE food once or more per month were nearly five times more likely to be overweight and obese (AOR = 4.78, 95% CI 1.44-15.85) than those who consumed RTE food less frequently. In addition, five factors namely being older than 32 years (AOR = 3.97, 95% CI 1.82-8.69), preference for RTE food (AOR = 8.93, 95% CI 2.54-31.37), light-intensity of physical exercise (AOR = 3.55, 95% CI 1.63-7.73), sedentary leisure activities (AOR = 3.32, 95% CI 1.22-9.03), and smoking (AOR = 5.62, 95% CI 1.06-29.90) were positively associated with overweight and obesity. CONCLUSION: Frequent consumers of RTE food and less physically active sedentary staff were more likely to be overweight and obese. This study highlights the urgent need to raise awareness regarding healthy lifestyle behaviors among the working community to reduce the burden of obesity-related chronic diseases. Moreover, sedentary workers should be aware of the food-based dietary guidelines of the country. Policy makers should strictly enforce nutritional labeling of RTE food, and strictly prohibit over-branding of RTE food.

Geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar.

BACKGROUND: Diagnosis by computed tomography (CT) and magnetic resonance imaging (MRI) is important for patient care. However, the geographic distribution and utilisation of these machines in countries with limited resources, such as Myanmar, have not been sufficiently studied. Therefore, this study aims to identify the geographic distribution and utilisation of CT and MRI services at public hospitals in Myanmar. METHODS: This nationwide, cross-sectional study was conducted at 43 public hospitals in Myanmar. Data were collected retrospectively using a prepared form from 1st January 2015 to 31st December 2017 at public hospitals in Myanmar. A descriptive analysis was performed to calculate the number of CT and MRI units per million population in each state and region of Myanmar. The distribution of CT and MRI units was assessed using the Lorenz curve and Gini coefficient, which are indicators of inequality in distribution. RESULTS: In total, 45 CT and 14 MRI units had been installed in public hospitals in Myanmar by 2017. In total, 205,570 CT examinations and 18,981 MRI examinations have been performed within the study period. CT units per million population in 2017 varied from 0.30 in Rakhine State to 3.22 in Kayah State. However, MRI units were available only in public hospitals in five states/regions. The Gini coefficient for CT and MRI was 0.35 and 0.69, respectively. An upward trend in the utilisation rate of CT and MRI was also observed during the study period, especially among patients aged between 36 and 65 years. CONCLUSIONS: Throughout Myanmar, CT units were more equally distributed than MRI units. CT and MRI units were mostly concentrated in the Yangon and Mandalay Regions, where the population density is higher. The geographic distribution and utilisation rate of CT and MRI units varied among states, regions, and patients' age group. However, the utilisation rates of CT and MRI increased annually in all states and regions during the review period. The Ministry of Health and Sports in Myanmar should consider the utilisation and population coverage of CT and MRI as an important factor when there will be procurement of those medical equipment in the future.

Epidemiological characteristics and trends of a Nationwide measles outbreak in Mongolia, 2015-2016.

BACKGROUND: Mongolia was one of the four countries that received a measles-elimination certificate from the World Health Organization Regional Office for the Western Pacific in 2014. Following the outbreaks in many countries including China, a large measles outbreak occurred in Mongolia in 2015. This study reports 2015-2016 measles outbreak incidence, mortality, and complications, according to time, geographical distribution, and host characteristics. METHODS: The epidemiological characteristics and trends of measles outbreak were analyzed using the Mongolian national surveillance data reported to the Center for Health Development, Ministry of Health, from January 2015 to December 2016. RESULTS: In total, 23,464 cases of measles including eight deaths were reported in 2015, and 30,273 cases of measles including 132 deaths were reported in 2016, which peaked in June 2015 and March 2016, respectively. Majority of the cases were reported from Ulaanbaatar (35,397, 65.9%). The highest attack rates were 241 per 10,000 population in Darkhan-Uul aimag, and 263 per 10,000 population in Ulaanbaatar. Measles-related death, nosocomial infection, and complications were most frequent among children aged < 1 year. CONCLUSIONS: Following no reports of measles since 2011, a large nationwide outbreak occurred in Mongolia, despite the high vaccination coverage in the past. The highest incidence rate was reported in Ulaanbaatar city, and Umnugovi aimag in 2015 and Darkhan-Uul aimag in 2016. The most affected age group were aged < 1 year and those aged 15-24 years. Mortality cases were prominent among children aged < 1 year who were not eligible for vaccination. A systematic vaccination strategy is required to prevent another measles outbreak.

Consumption of foods containing prohibited artificial colors among middle-school children in Nay Pyi Taw union territory, Myanmar.

BACKGROUND: Food safety control in Myanmar is regulated by the Department of Food and Drug Administration (FDA). FDA conducts food safety education programs in schools and regular market surveys of foods containing prohibited artificial colors. However, the consumption of foods containing FDA-prohibited artificial colors among school children is understudied. This study aimed to assess the consumption of foods containing FDA-prohibited artificial colors among middle-school children in Nay Pyi Taw Union Territory, Myanmar. METHODS: A cross-sectional study was conducted at eight public schools in Nay Pyi Taw Union Territory in 2017. The schools were selected using simple random sampling with a drawing method. In total, 776 students (359 boys and 417 girls) participated in face-to-face interviews using a structured questionnaire and photos of foods containing artificial color published by FDA. A multiple logistic regression was performed to estimate adjusted odds ratio (AOR) for consumption of such foods. RESULTS: In total, 519 (66.9%) children consumed foods with the FDA-prohibited colors. It was revealed that students at suburban schools were nearly five times more likely to consume foods containing FDA-prohibited artificial colors (AOR = 4.84; 95% confidence interval (CI) 2.99-7.82) compared to those at urban schools. In addition, being in the seventh grade (AOR = 3.38; 95% CI 2.30-4.98), availability of prohibited food in school canteen (AOR = 6.16; 95% CI 2.67-14.22), and having a less educated father (AOR = 1.76; 95% CI 1.06-2.92) were positively associated with consumption of the foods with the prohibited colors. CONCLUSION: More than half of the students consumed foods with the prohibited colors. Consumption was more frequent among students from suburban schools, those with unsafe foods accessible at their school canteen, seventh graders, and students with a less educated father. The findings highlighted that school food safety programs, which focus on preventing consumption of foods containing FDA-prohibited artificial colors, are urgently required. Food safety regulation is also required to ban the sale of unsafe food, especially in school canteens.

Free and universal access to primary healthcare in Mongolia: the service availability and readiness assessment.

BACKGROUND: The government of Mongolia mandates free access to primary healthcare (PHC) for its citizens. However, no evidence is available on the physical presence of PHC services within health facilities. Thus, the present study assessed the capacity of health facilities to provide basic services, at minimum standards, using a World Health Organization (WHO) standardized assessment tool. METHODS: The service availability and readiness assessment (SARA) tool was used, which comprised a set of indicators for defining whether a health facility meets the required conditions for providing basic or specific services. The study examined all 146 health facilities in Chingeltei and Khan-Uul districts of Ulaanbaatar city, including private and public hospitals, family health centers (FHCs), outpatient clinics, and sanatoriums. The assessment questionnaire was modified to the country context, and data were collected through interviews and direct observations. Data were analyzed using SPSS 21.0, and relevant nonparametric tests were used to compare median parameters. RESULTS: A general service readiness index, or the capacity of health facilities to provide basic services at minimum standards, was 44.1% overall and 36.3, 61.5, and 62.4% for private clinics, FHCs, and hospitals, respectively. Major deficiencies were found in diagnostic capacity, supply of essential medicines, and availability of basic equipment; the mean scores for general service readiness was 13.9, 14.5 and 47.2%, respectively. Availability of selected PHC services was 19.8%. FHCs were evaluated as best capable (69.5%) to provide PHC among all health facilities reviewed (p < 0.001). Contribution of private clinics and sanatoriums to PHC service provisions were minimal (4.1 and 0.5%, respectively). Service-specific readiness among FHCs for family planning services was 44.0%, routine immunization was 83.6%, antenatal care was 56.5%, preventive and curative care for children was 44.5%, adolescent health services was 74.2%, tuberculosis services was 53.4%, HIV and STI services was 52.2%, and non-communicable disease services was 51.7%. CONCLUSIONS: Universal access to PHC is stipulated throughout various policies in Mongolia; however, the present results revealed that availability of PHC services within health facilities is very low. FHCs contribute most to providing PHC, but readiness is mostly hampered by a lack of diagnostic capacity and essential medicines.

TGF-ß1-VEGF-A pathway induces neoangiogenesis with peritoneal fibrosis in patients undergoing peritoneal dialysis.

The characteristic features of chronic peritoneal injury with peritoneal dialysis (PD) are submesothelial fibrosis and neoangiogenesis. Transforming growth factor (TGF)ß and vascular endothelial growth factor (VEGF)-A are the main mediators of fibrosis and neoangiogenesis, respectively; however, the effect of the interaction between them on the peritoneum is not well known. In this study, we investigated the relationship between TGF-ß1 and VEGF-A in inducing peritoneal fibrosis by use of human tissues and dialysate, cultured cells, and animal models. The VEGF-A concentration correlated with the dialysate-to-plasma ratio of creatinine (D/P Cr) ( P < 0.001) and TGF-ß1 ( P < 0.001) in human PD effluent. VEGF-A mRNA levels increased significantly in the peritoneal tissues of human ultrafiltration failure (UFF) patients and correlated with number of vessels ( P < 0.01) and peritoneal thickness ( P < 0.001). TGF-ß1 increased VEGF-A production in human mesothelial cell lines and fibroblast cell lines, and TGF-ß1-induced VEGF-A was suppressed by TGF-ß receptor I (TGFßR-I) inhibitor. Incremental peak values of VEGF-A mRNA stimulated by TGF-ß1 in human cultured mesothelial cells derived from PD patients with a range of peritoneal membrane functions correlated with D/P Cr ( P < 0.05). To evaluate the regulatory mechanisms of VEGF-A and neoangiogenesis in vivo, we administered TGFßR-I inhibitor intraperitoneally in a rat chlorhexidine-induced peritoneal injury (CG) model. TGFßR-I inhibitor administration in the CG model decreased peritoneal thickness ( P < 0.001), the number of vessels ( P < 0.001), and VEGF-A levels ( P < 0.05). These results suggest that neoangiogenesis is associated with fibrosis through the TGF-ß1-VEGF-A pathway in mesothelial cells and fibroblasts. These findings are important when considering the strategy for management of UFF in PD patients.

Waiting time in the outpatient clinic at a national hospital in Vietnam.

Vietnam is facing a problem of over-crowding in public hospitals. Long waiting time is a major dissatisfaction for patients. Reducing waiting time benefits not only patients but also hospitals in decreasing overall workload. To identify factors contributing to long waiting time in outpatient clinics, a cross-sectional study was conducted at a national hospital in Vietnam. The time for each process of 7,931 patients who visited the outpatient clinics within Thong Nhat Hospital from 5 to 9 September 2016 was collected from the computerized clinical database. Characteristics of patients (age, sex, address, day of visit, registration time, visited department and test) and waiting times were studied at the outcome measures. Multivariate analyses using the linear regression model was carried out to evaluate the contribution of these factors to the total waiting time. Among 7,931 patients, 52.3% were women, 46.3% were 60-80 years, and 64.8% registered between 5:30 and 9:30. The mean total waiting time was 104.1 minutes. The analysis on total waiting time among 4,564 patients who visited one department without any test showed that department group and registration time were significantly associated with a total waiting time. In 1,259 patients who visited one department with one test, early registration and undergoing blood tests were significantly associated with a longer total waiting time. These results showed that old age, visiting internal medicine departments, early registration time, and undergoing blood tests were factors contributing to a longer total waiting time in the outpatient clinics within Thong Nhat Hospital.

Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

BACKGROUND: Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. METHODS: A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. RESULTS: The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. CONCLUSION: The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the available resources.

Medical facility statistics in Japan.

Medical facility statistics provide essential information to policymakers, administrators, academics, and practitioners in the field of health services. In Japan, the Health Statistics Office of the Director-General for Statistics and Information Policy at the Ministry of Health, Labour and Welfare is generating these statistics. Although the statistics are widely available in both Japanese and English, the methodology described in the technical reports are primarily in Japanese, and are not fully described in English. This article aimed to describe these processes for readers in the English-speaking world. The Health Statistics Office routinely conduct two surveys called the Hospital Report and the Survey of Medical Institutions. The subjects of the former are all the hospitals and clinics with long-term care beds in Japan. It comprises a Patient Questionnaire focusing on the numbers of inpatients, admissions, discharges, and outpatients in one month, and an Employee Questionnaire, which asks about the number of employees as of October 1. The Survey of Medical Institutions consists of the Dynamic Survey, which focuses on the opening and closing of facilities every month, and the Static Survey, which focuses on staff, facilities, and services as of October 1, as well as the number of inpatients as of September 30 and the total number of outpatients during September. All hospitals, clinics, and dental clinics are requested to submit the Static Survey questionnaire every three years. These surveys are useful tools for collecting essential information, as well as providing occasions to implicitly inform facilities of the movements of government policy.

Characteristics of adverse drug reactions due to nonsteroidal anti-inflammatory drugs: a cross-sectional study.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for treating pain and inflammation. Spontaneous adverse drug reaction (ADR) reports represent a rich data source for the detection of unknown and rare ADRs. This cross-sectional study aimed to analyze the characteristics of ADRs due to NSAIDs in Thailand. All ADR reports of NSAIDs for systemic use from 2015 to 2019 were extracted from the national database in Thailand. Patient characteristics, drug use information, adverse event information, and source of senders in 32,857 reports were analyzed. The annual number of ADR reports due to NSAIDs decreased from 7,008 in 2015 to 5,922 in 2019. The most frequently reported drug was ibuprofen (n=12,645, 38.5%) followed by diclofenac (n=7,795, 23.7%), most patients were 40-59 years old, and the major adverse reaction was angioedema (n=7,513, 22.9%). Serious reactions were recorded in 20.7% (n=6,801) of the total ADRs. Most patients (n=20,593, 62.7%) recovered without sequelae, but there were 5,420 patients (16.5%) who could not recover and 3,109 patients (9.5%) who were recovering. Eight patients (0.02%) died of Stevens-Johnson syndrome (n=3), toxic epidermal necrolysis (n=4), and anaphylactic shock (n=1), which were possibly related to ADRs. The number of ADR reports due to NSAIDs decreased from 2015 to 2019 in Thailand. Serious ADRs and death cases accounted for 20.7% and 0.02%, respectively. Most fatal cases exhibited severe drug-induced skin reactions.

Reporting system on mortality statistics in Lao People's Democratic Republic.

The system to collect information on mortality statistics in Lao PDR is not well established, accurate and timely death information is therefore not available. This article reports the system and process to make the mortality statistical data of Lao PDR. The country has a paper-based resident registration system, using a death notification document, a death certificate, and a family census book. The death notification document is important as it provides the cause of death, which is issued from a health facility and the village office. In the event of a death occurring at home, the family representative needs to report to the village office verbally to obtain a death notification document. On the other hand, if the death occurred in a medical facility, a death notification document from a health facility is provided. The family representative should bring the death notification document to the district Home Affairs office to register the death and obtain a death certificate. After that, the family representative needs to bring the death certificate to the district Public Security office for an amendment in the family census book. ICD-10 is under development regarding death notification from health facilities under the Ministry of Health. However, it is unclear how death notification from village offices can adopt ICD-10 as the majority of deaths occur outside health facilities. A comprehensive and integrated mortality reporting system is necessary in order to create a holistic health policy and welfare for the country.

Rates and Factors Associated With Serious Outcomes of Patient Safety Incidents in Malaysia: An Observational Study.

Introduction: This study aimed to examine the reporting rate and the factors associated with serious outcomes of patient safety incidents at public hospitals in Malaysia. Methods: All patient safety incidents reported in the e-Incident-Reporting System from January to December 2019 were included in the study. A descriptive study was used to describe the characteristics of incidents, and logistic models were used to identify factors associated with low reporting rates and severe harm or death outcomes of incidents. Results: There were 9431 patient safety incidents reported in the system in 2019. The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. The major category of incidents was drug-related incidents (32.4%). No-harm incidents contributed to 56.1% of all the incidents, while 1.1% resulted in death. More hospitals in the eastern (odds ratio [OR], 12.1) and southern regions (OR, 6.1) had low reporting rates compared to the central region. Incidents with severe harm or death outcomes were associated with more males (OR, 1.4) than females and with the emergency department (OR, 10.6), internal medicine (OR, 5.7), obstetrics and gynecology (OR, 2.4), and surgical department (OR, 5.0) more than the pharmacy department. Compared to drug-related incidents, operation-related (OR, 3.0), procedure-related (OR, 3.5), and therapeutic-related (OR, 4.8) incidents had significantly more severe harm or death outcomes, and patient falls (OR, 0.4) had less severe harm or death outcomes. Conclusion: The mean reporting rate was 2.1/1000 patient bed-days or 1.5% of hospital admissions. More hospitals in the eastern and southern regions had low reporting rates. Certain categories of incidents had significantly more severe outcomes.

Children with neuro-developmental disorders at Center for Child and Adolescent Mental Health in Cambodia.

The Center for Child and Adolescent Mental Health (CCAMH) is one of the centers that have psychiatric specialists for children in Cambodia. This study aims to understand the characteristics of children with neuro-developmental disorders, especially autism spectrum disorder (ASD), at CCAMH. This study included 440 cases that were randomly chosen from 2,147 new patients at CCAMH in 2018-2019 and were aged 0-12 years. Socio-demographic factors, parent's information, obstetrical factors, and clinical data were collected from patients' records. A logistic regression analysis and Pearson's chi-square test were used to compare the characteristics between children who were finally diagnosed with ASD and the others (non-ASD). Of the 440 patients, most were male (75.2%), 0-4 years old (57.7%), and diagnosed with ASD (50.0%). Common symptoms were delay of speech, playing alone, and hyperactivity. ASD was significantly more prevalent in male patients compared to females and in the 0-4 years age group compared to the 5-12 years age group. Parents who lived in Phnom Penh and had high education were more likely to visit the CCAMH with their children who were diagnosed with ASD. Regarding treatment, approximately half of all 440 patients had family counselling and psychosocial education. ASD patients had more speech therapy, special education and structured teaching, and networking and coordination therapy compared to non-ASD patients. To provide education and therapy to children with ASD and their parents from the early stage, information about the center and ASD should be widely distributed to all parents in Cambodia.

Underlying cause of death at medical facilities in Xaiyabouli Province, Lao People's Democratic Republic.

In Lao PDR, Ministry of Health introduced District Health Information Software 2 (DHIS2) in 2013. Although DHIS2 includes cause of death, Lao government did not request to report cause of death through DHIS2, resulting in no information on frequency of underlying cause of death even for the deaths at medical facility. This study aimed to collect the information on the underlying cause of death at all medical facilities in Xaiyabouli province, a rural area in Lao PDR. As well as the point estimate of the proportion, a 95% confidence interval (CI) based on a binomial distribution was calculated for each cause of death. According to the local government request, 226 deaths (128 males and 98 females) in 2019 were reported from all medical facilities in the province. Among them, infectious diseases were the most frequent (33.6%, 95% CI 27.5-40.2%); sepsis (16.8%, 95% CI 12.2-22.3%), pneumonia (8.8%, 95% CI 5.5-13.3%), and meningitis (4.9%, 95% CI 2.5-8.5%). Heart diseases were 15.9% (95% CI 11.4-21.4%) including heart failure and myocardial infarction. Injury was 10.2% (95% CI 6.2-14.4%) including brain injury. Neonatal death was 10.6% (95% CI 6.9-15.4%). Among those, preterm death was common (8.8%, 95% CI 5.3-13.3%). Renal failure was 8.0% (95% CI 4.8-12.3%). According to civil registration covering all deaths both at facilities and outside facilities, deaths at facilities were 16.8% of the whole deaths (1,372 deaths) in Xaiyabouli province. Although deaths outside facilities were not included, this is the first report demonstrating cause of death in one province in Lao PDR.

Satisfaction With Health Care Services at the Pediatric Specialist Clinic of the National Referral Center in Malaysia: Cross-sectional Study of Caregivers' Perspectives.

BACKGROUND: The concept of customer satisfaction is gaining hold in all corporate sectors worldwide, and a satisfaction survey is used as a tool to discover service problems and as a chance for customers to rate their experience with health care services. A high degree of patient satisfaction with the services given has been found in numerous studies conducted in Malaysian public health care facilities. However, there is limited information available on caregiver satisfaction with pediatric clinics run by the Ministry of Health (MoH) of Malaysia. OBJECTIVE: This was the first research performed at a public hospital's pediatric clinic, which was the first hospital to adopt the public-private-partnership model under the MoH, with the aim of discovering the prevalence and factors affecting the satisfaction of caregivers at the national referral center. METHODS: Cross-sectional research using the standard self-administered SERVQUAL questionnaire was conducted among caregivers accompanying their children to the clinic. The questionnaire consists of 16 paired statements to evaluate their expectations and experiences with the clinic services. RESULTS: A total of 459 caregivers were involved in this study with a majority aged between 30 and 39 years (n=254, 55.4%). Caregivers from the Indian community (adjusted odds ratio [AOR] 2.91, 95% CI 1.37-6.18) and lower income groups (AOR 2.94, 95% CI 1.87-4.64), and those with lower educational backgrounds (AOR 3.58, 95% CI 1.19-10.72) were more likely to be satisfied with the quality of pediatric clinic services. Housewives/househusbands (AOR 0.48, 95% CI 0.25-0.90), on the other hand, appeared less likely to be satisfied with the services provided during their visit to the clinic. Looking at overall patient satisfaction, 50.5% (n=232) of caregivers demonstrated satisfaction with the quality of services, compared to 49.5% (n=227) of dissatisfied respondents. CONCLUSIONS: This paper suggests that, although most caregivers are satisfied with the services, greater emphasis must be placed on delivering reliable service in response to the MoH's mission to provide quality and integrated people-centered health services in Malaysia.

Patient delay and health system delay of patients with newly diagnosed pulmonary tuberculosis in Mongolia, 2016-2017.

Although diagnosis and treatment of tuberculosis (TB) have been improved in many countries, delays in the diagnosis and treatment remain problematic in resource-limited countries. This study aimed to identify factors affecting delays in TB care in Mongolia. Data on TB cases registered from January 2016 to December 2017 were obtained from the national registry of TB at the Department of TB Surveillance and Research in National Center for Communicable Disease. The total number of TB cases registered in these two years was 8,166, including 3,267 cases of newly diagnosed pulmonary TB. Pulmonary TB cases (1,836 males and 1,431 females) were analyzed to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Patient delays longer than the median (28 days) were significantly associated with patient age >32 years (aOR=1.31, 95%CI: 1.14-1.51), residence in areas other than Ulaanbaatar (aimags) (aOR=1.38, 95%CI: 1.20-1.59), and smear-negative (aOR=0.57, 95%CI: 0.47-0.69). Health system delays longer than the median (7 days) were significantly associated with patient age >32 years (aOR=1.16, 95%CI: 1.00-1.33), residence in aimags (aOR=0.82, 95%CI: 0.71-0.95), special facilities including a prison hospital (aOR=4.40, 95%CI: 2.42-7.83), registration in 2017 relative to 2016 (aOR=0.83, 95%CI: 0.71-0.95), and smear-negative (aOR=1.72, 95%CI: 1.42-2.07). Total delays longer than the median (45 days) were significantly associated with patient age >32 years (aOR=1.39, 95%CI: 1.21-1.60), residence in aimags (aOR=1.27, 95%CI: 1.11-1.47), and smear-negative (aOR=0.74, 95%CI: 0.62-0.90). To shorten the total delay, improvement of the access to medical facilities in aimags is necessary.

Development of a Vietnamese version of the Revised Hasegawa's Dementia scale.

As the aging population grows worldwide, the problem of age-related health is becoming an important public health concern. Dementia is a devastating disease that places a significant physical, emotional, and financial burden on patients, their caregivers, and society. It is predicted to increase in developing countries. The Revised Hasegawa's Dementia Scale (HDS-R) has been used in many Asian countries to measure cognitive function. However, there is still no Vietnamese version of the HDS-R. Therefore, this paper describes the development of the HDS-R scale and manual in Vietnamese language. Two Vietnamese researchers translated the HDS-R from English to Vietnamese. To confirm the accuracy of the translation, two other Vietnamese researchers conducted a back-translation. Another pair of Vietnamese researchers compared the back-translated English version to the original one. All six researchers discussed the inconsistencies between English HDS-R scale and manual and derived the most suitable version for the Vietnamese context. In Questions 4 and Question 7, we changed the words from "cherry blossom" and "train" to "daisy flower" and "bicycle" for the first option, and from "plum blossom" to "rose" for the second option. We also changed the expressions in some places in the manual to fit the Vietnamese language. Future studies are needed to validate this version to be able to access cognitive function in both clinical and public healthcare settings.

Factors associated with severe dengue in Savannakhet Province, Lao People's Democratic Republic.

This study aimed to describe the socio-demographic and clinical characteristics of dengue inpatients at a provincial hospital, and to identify factors associated with severe dengue. This is a retrospective study involving 402 dengue patients admitted to the Savannakhet Provincial Hospital, Lao People's Democratic Republic (Lao PDR), between January 2018 and April 2019. Socio-demographic factors, clinical signs and laboratory data on admission, final diagnosis, use of health care services before admission, admission date, and hospitalization period were collected from patient records. The number of dengue inpatients was higher in the rainy season than in the dry season. Of the 402 patients, 205 patients (51.0%) were finally diagnosed with severe dengue. Children aged <15 years had more symptoms, higher proportion of severe dengue (69.8% vs. 35.9%), and longer hospitalization (3.5 days vs. 3.0 days) than adults aged ≥15 years. In multivariable analyses, factors associated with severe dengue were nausea on admission (adjusted odds ratio=3.57, 95% CI=1.05-12.09, P=0.04) in children and persistent vomiting on admission (adjusted odds ratio=3.82, 95% CI=1.23-11.92, P=0.02) in adults. In adults, the creatinine level on admission was significantly higher in patients with a final diagnosis of severe dengue compared to the others. The proportion of severe dengue in our study was higher than that in other countries. Nausea and persistent vomiting on admission were suggested to be predictive factors for severe dengue. To reduce the incidence of severe dengue in Lao PDR, improvements in access to health care, referral system, and training of health care workers are needed.