Revolving drug funds: a step towards health security

The establishment of a revolving drug fund project in Viet Nam is described and the factors responsible for its success are considered. As well as being a tool for cost recovery a revolving drug fund can serve as an entry point for strengthening health care and improving health security at local and district level.     

Epidemiological survey of thyroid volume and iodine intake in schoolchildren,postpartum women and neonates living in Ulaan Baatar

OBJECTIVE: Although endemic goiter had been recognized in most parts of the country, there are few available data on iodine-deficiency disorders (IDDs) in Mongolia. This study aimed to characterize the current status of iodine deficiency in Ulaan Baatar, Mongolia's capital city. DESIGN: Cross-sectional, observational study designed and performed according to the surveillance methods for IDD prevalence recommended by WHO/UNICEF/ICCIDD. SUBJECTS: A total of 505 schoolchildren aged 9-14 years (237 girls and 268 boys) and 138 mothers and their neonatal infants were selected to clinical and biochemical examination of the thyroid in 1996 and 1999. MEASUREMENTS: The anthropometric measurements, thyroid volume determined by ultrasound, blood TSH and FT4 concentrations, urinary iodine concentration and iodine content of salt consumed in households. RESULTS: Median thyroid volumes based on age were generally higher than those in iodine-sufficient areas and comparative to those reported in mild iodine-deficiency areas. Application of the updated WHO/ICCIDD reference values in iodine-replete European schoolchildren to the Mongolian children aged 10-12 years resulted in a goiter prevalence of 43.3%. The median value of urinary iodine concentration was 152.5 micro g/l (1.20 micro mol/l) and 40.3% of children excreted iodine below 100 micro g/l. Iodized salt (> 40 ppm) was consumed in 63.1% of households and in the children using noniodized salt their urinary iodine concentration was lower than those using ionized salt. In postpartum women, median thyroid volume and urinary iodine concentration were 11.3 ml and 107 micro g/l (0.84 micro mol/l), respectively, and 46% of women excreted less than 100 micro g/l (0.79 micro mol/l) of iodine. Of their neonates, 17.8% had elevated blood TSH levels (> 5 mU/l). In a 1999 survey, the goiter prevalence and ratio of low iodine excretion in schoolchildren decreased to 29.8% and 31.3%, respectively, while median urinary iodine concentration remain unchanged (160 micro g/l; 1.26 micro mol/l). CONCLUSION: The present study clearly indicates the presence of mild iodine deficiency in Mongolia. Enlarged thyroid gland and normal iodine excretion observed in schoolchildren living in Ulaan Baatar may result from the residual effects of iodine deficiency previously and presumably still exist in the city. Slight reduction in the rate of children with enlarged thyroid and low urinary iodine excretion after the onset of national iodinization programme suggests incomplete normalization of thyroid volume in children and that the correction of iodine deficiency is now in progress in Ulaan Baatar. Further nationwide surveys together with monitoring the progress of the national programme eliminating IDD are required in suburban areas surrounding the city and also in rural areas.     

Hyperventilation versus standard ventilation for infants in postoperative care for congenital heart defects with pulmonary hypertension

Purpose  In infants undergoing surgery for cardiac defects with left-to-right shunt, a hyperventilation strategy has been applied to prevent pulmonary hypertensive crisis (PHC). Hyperventilation with a large tidal volume and/or higher airway pressure, however, may be detrimental to the lung. This randomized study compared the effects of hyperventilation versus standard ventilation. Methods  We enrolled 22 infants with a preoperative pulmonary-to-systemic blood pressure ratio of more than 0.7. Hyperventilation, with a tidal volume of 10–12 ml·kg⁻¹ to keep between 30 and 35 mmHg, was randomly applied in 11 patients for 16 h or more. The other 11 patients were randomly assigned to standard ventilation, with a 6- to 8- ml·kg⁻¹ tidal volume. Results  The peak inspiratory pressure was higher (20 ± 3 vs 18 ± 2 cmH₂O; P = 0.018), and (34 ± 5 vs 42 ± 7 mmHg; P = 0.003) and positive end-expiratory pressure (3 ± 0 vs 5 ± 0; P < 0.0001) were significantly lower in the hyperventilation than in the standard ventilation group. The /inspiratory fraction of oxygen ratio decreased from 244 ± 160 mmHg at the onset of postoperative ventilation, to 177 ± 96 mmHg at 24 h (P = 0.038) in the hyperventilation group, versus a decrease from 240 ± 89 to 220 ± 97 mmHg in the standard ventilation group not significant (NS). Serum interleukin (IL)-6 level, measured at 24 h postoperatively, was significantly lower (P = 0.02) in the standard ventilation than in the hyperventilation group, suggesting an attenuated postoperative systemic inflammatory response. A single patient in each group developed PHC. Conclusion  Hyperventilation may cause lung injury and systemic inflammation in infants with pulmonary hypertension undergoing corrective heart surgery. T. Umenai and N. Shime contributed equally to this study.     

Evaluation of chewing activity in the elderly person

In the present study, we examined the chewing performance of 70 elderly persons. Self‐assessment of chewing problems and clinical classification using the modified Eichner index showed little correlation (Kappa value = 0.28; 95% confidence interval (CI) = 0.05–0.51). The sensitivity and specificity were 0.52 and 0.76, respectively. On the other hand, the mastication score determined by evaluation of a questionnaire on food intake and classification using the modified Eichner index showed high agreement (Kappa value = 0.73; 95% CI = 0.50–0.96). The sensitivity and specificity were 0.76 and 0.95, respectively. The mastication score showed significant correlation with other masticatory functions such as maximum biting force, occlusal contact area and the number of missing teeth ( P < 0.01). These results suggest that the use of a questionnaire on food intake would be informative for epidemiological surveys of chewing activity in the elderly.     

Effect of working status on tobacco, alcohol, and drug use among adolescents in urban area of Thailand

To examine the relationship between working status and behavior of substance use such as tobacco, alcohol, and drug among adolescents, a survey of 215 students in the seventh to ninth grades was conducted in urban area of Thailand. The sample consisted of 100 workers (46.5%) and 115 nonworkers (53.5%). The percentages of participants with some experiences of smoking, drinking alcohol, and drug use were 17.2%, 48.8%, and 3.3%, respectively. The participants with experiences of smoking and drinking alcohol in the working group were significantly higher than in the nonworking group (P<0.001), while the relationship between working status and drug use was weaker than the other relationships between working status and tobacco or alcohol use. The backward logistic regression analysis was refined until it included three independent variables: tobacco use, alcohol use, and household income. On the other hand, it was found that working condition, including working hours and working at night, had little impact on smoking, drinking alcohol, and drug use. However, the type of job was significantly related to tobacco use (P<0.05) by binary analysis and multiple regression analysis. These findings suggest that employment of young adolescents in urban area of Thailand has an influence on smoking and drinking alcohol. Especially, working status probably affect smoking behavior among young adolescents in the urban area of Thailand.