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Objective: To investigate the cause of a botulism outbreak in several provinces in Viet Nam in 2020. Methods: An initial investigation was conducted to confirm the outbreak and to form hypotheses about the potential causes, followed by a case–control assessment of the plausible causative food item. Collected food samples were tested to identify the pathogen, and mouse bioassays were performed. Control measures were introduced to stop the outbreak and to prevent similar events in the future. Results: Twelve people in six southern provinces of Viet Nam were identified as having symptoms of botulism, of whom 11 were in critical condition requiring breathing support. A history of foods eaten in the 4 days before illness onset indicated that all the cases had eaten a tinned vegetarian pate, and a case–control assessment showed that this was significantly associated with the outbreak, with an odds ratio of 35.2 (95% confidence interval: 3.4–infinity). Clostridium botulinum type B was detected in three of eight pâté samples collected from the houses of cases. In the mouse bioassay for the toxicity of the pâté samples, all the mice died with clinical symptoms of botulism. Discussion: A tinned vegetarian pate was the plausible cause of a botulism outbreak in Viet Nam in 2020. Revision of food safety regulations to improve quality control of tinned foods to prevent future outbreaks is recommended.

ObjectivesWhile CT scanning plays a significant role in healthcare, its increasing use has raised concerns about inappropriate use. This study investigated factors driving the changing use of CT among people admitted to tertiary hospitals in Western Australia (WA).Design and settingA repeated cross-sectional study of CT use in WA in 2003–2005 and 2013–2015 using linked administrative heath data at the individual patient level.ParticipantsA total of 2 375 787 tertiary hospital admissions of people aged 18 years or older.Main outcome measureRate of CT scanning per 1000 hospital admissions.MethodsA multivariable decomposition model was used to quantify the contribution of changes in patient characteristics and changes in the probability of having a CT over the study period.ResultsThe rate of CT scanning increased by 112 CT scans per 1000 admissions over the study period. Changes in the distribution of the observed patient characteristics were accounted for 62.7% of the growth in CT use. However, among unplanned admissions, changes in the distribution of patient characteristics only explained 17% of the growth in CT use, the remainder being explained by changes in the probability of having a CT scan. While the relative probability of having a CT scan generally increased over time across most observed characteristics, it reduced in young adults (−2.8%), people living in the rural/remote areas (−0.8%) and people transferred from secondary hospitals (−0.8%).ConclusionsOur study highlights potential improvements in practice towards reducing medical radiation exposure in certain high risk population. Since changes in the relative probability of having a CT scan (representing changes in scope) rather than changes in the distribution of the patient characteristics (representing changes in need) explained a major proportion of the growth in CT use, this warrants more in-depth investigations in clinical practices to better inform health policies promoting appropriate use of diagnostic imaging tests.

(1) Background: Pulmonary embolism (PE) can be fatal. Computed tomography pulmonary angiography (CTPA) can accurately diagnose PE, but it should be used only when reasonable pre-test probability exists. Overtesting with CTPA exposes patients to excess ionizing radiation and contrast media, while PE overdiagnosis leads to the treatment of small emboli unlikely to cause harm. This study assessed trends in CTPA use and diagnostic yield. We also assessed trends in PE hospitalizations and mortality to indicate PE severity. (2) Methods: Analysis of Western Australian linked administrative data for 2003–2015 including hospitalizations, emergency department (ED) attendances, and CTPA performed at hospitals. Age-sex standardized trends were calculated for CTPA use, PE hospitalizations, and mortality (as a proxy for severity). Logistic regression assessed diagnostic yield of CTPA following unplanned ED presentations. (3) Results: CTPA use increased from 3.3 per 10,000 person-years in 2003 (95% CI 3.0–3.6) to 17.1 per 10,000 person-years (16.5–17.7) in 2015. Diagnostic yield of CTPA increased from 12.7% in 2003 to 17.4% in 2005, declining to 12.2% in 2015 (p = 0.049). PE hospitalizations increased from 3.8 per 10,000 (3.5–4.1) in 2003 to 5.2 per 10,000 (4.8–5.5) in 2015. Mortality remained constant at 0.50 per 10,000 (0.39–0.62) in 2003 and 0.42 per 10,000 (0.32–0.51) in 2015. (4) Conclusions: CTPA increased from 2003 to 2015, while diagnostic yield decreased, potentially indicating overtesting. PE mortality remained constant despite increasing hospitalizations, likely indicating a higher proportion of less severe cases. As treatment can be harmful, this could represent overdiagnosis.

Background: This study investigated trends in computed tomography (CT) utilization across different triage categories of injury presentations to tertiary emergency departments (EDs) and associations with diagnostic yield measured by injury severity, hospitalization and length of stay (LOS), and mortality. Methods: A total of 411,155 injury-related ED presentations extracted from linked records from Western Australia from 2004 to 2015 were included in the retrospective study. The use of CT scanning and diagnostic yield measured by rate of diagnosis with severe injury, hospitalizations and LOS, and mortality were captured annually for injury-related ED presentations. Multivariable regression models were used to calculate the annual adjusted rate of CT scanning for injury presentations and hospitalizations across triage categories, diagnosis with severe injury, LOS, and mortality. The significance of changes observed was compared among patients with CT imaging relative to those without CT. Results: While the number of ED presentations with injury increased by 65% from 2004 to 2015, the use of CT scanning in these presentations increased by 176%. The largest increase in CT use was among ED presentations triaged as semi-/nonurgent (+256%). Injury presentations with CT, compared to those without, had a higher rate of diagnosis with moderate/severe injury and hospitalization but no difference in LOS and mortality. The probability/rate observed in the outcomes of interest had a greater decrease over time in those with CT scanning compared with those without CT scanning across triage categories. Conclusions: The reduction in diagnostic yield in terms of injury severity and hospitalization found in our study might indicate a shift toward overtesting using CT in ED for injury or a higher use of CT to assist in the management of injuries. This helps health care policymakers consider whether the current increase in CT use meets the desired levels of quality and efficient care.

Background Literature highlighted the importance of timely access and ongoing care provided at primary care settings in reducing hospitalisation and health care resource uses. However, the effect of timely access to primary care has not been fully captured in most of the current continuity of care indices. This study aimed to develop a time-duration measure of continuity of primary care (“cover index”) capturing the proportion of time an individual is under the potentially protective effect of primary health care contacts. Methods An observational study was conducted on 36,667 individuals aged 45 years or older with diabetes mellitus extracted from Western Australian linked administrative data. Threshold effect models were used to determine the maximum time interval between general practitioner (GP) visits that afforded a protective effect against avoidable hospitalisation across complication cohorts. The optimal maximum time interval was used to compute a cover index for each individual. The cover was evaluated using descriptive statistics stratified by population socio-demographic characteristics. Results The optimal maximum time between GP visits was 9–13 months for people with diabetes with no complication, 5–11 months for people with diabetes with 1–2 complications, and 4–9 months for people with diabetes with 3+ complications. The cover index was lowest among those aged 75+ years, males, Indigenous people, socio-economically disadvantaged and those in very remote areas. Conclusions This study developed a new measure of continuity of primary care that adds a time parameter to capturing longitudinal continuity. Cover has the potential to better capture underuse of primary care and will significantly contribute to the sparsely available methods for analysis of linked administrative data in evaluating continuity of care for people with chronic conditions.

ObjectiveThis study aimed to examine trends in number of CT scans requested by tertiary emergency department (ED) physicians in Western Australia (WA) from 2003 to 2015 across broad demographic and presentation characteristics, anatomical areas and presented symptoms.DesignAn observational cross-sectional study over study period from 2003 to 2015.SettingLinked administrative health service data at individual level from WA.ParticipantsA total of 1 666 884 tertiary hospital ED presentations of people aged 18 years or older were included in this studyMain outcome measureNumber of CT scans requested by tertiary ED physicians in an ED presentation.MethodsPoisson regression models were used to assess variation and trends in number of CT scans requested by ED physicians across demographic characteristics, clinical presentation characteristics and anatomical areas.ResultsOver the entire study duration, 71 per 1000 ED episodes had a CT requested by tertiary ED physicians. Between 2003 and 2015, the rate of CT scanning almost doubled from 58 to 105 per 1000 ED presentations. After adjusted for all observed characteristics, the rate of CT scans showed a downward trend from 2009 to 2011 and subsequent increase. Males, older individuals, those attending ED as a result of pain, those with neurological symptoms or injury or with higher priority triage code were the most likely to have CT requested by tertiary ED physicians.ConclusionsNoticeable changes in the number of CTs requested by tertiary ED physicians corresponded to the time frame of major health reforms happening within WA and nationally.

IntroductionComputed tomography (CT) has become an essential part of clinical practice. However, repeat CT scans has raised a concern about unnecessary exposure to ionising radiation and waste of health care resource. While substantial effort is underway to reduce inappropriate use of diagnostic imaging tests including CT, little evidence of any change in repeat CT use and its associated factors. Objectives and ApproachThis study aimed to measure trend in repeat CT use and identify factors associated with repeat CT use in tertiary hospitals in Western Australia (WA). This study used WA linked administrative records from hospital morbidity, emergency department presentations, and picture archiving and communication system datasets to capture all tertiary hospitalisations and number of CT use during the admission from 2003 to 2015. Multivariate logistic regression was used to examine trend and determine characteristics associated with repeat CT, for admissions with and without major surgery during hospitalisation. ResultsAmong 303,439 admissions with CT scan 11.9% had repeat CT scan in the same anatomic areas. While the probability of repeat CT among admission with surgery remained unchanged over the study period, its counterpart significantly reduced about 4% per year. Regardless of surgical status, repeat CT scanning was significantly lower among females, Indigenous and older age groups but higher among people living in rural and remote areas. We found that admissions for circulatory conditions, injuries, cancer or multimorbidity had significantly higher probability of having repeat CT. Conclusion / ImplicationsThis study indicates that clinical factors such as cancer, injury and multimorbidity are factors contributing to repeat CT. A reduction of repeat CT over the study period among admissions without surgical procedure suggests a potential reduction of unnecessary CT scan, although further study is needed to fully capture whether this is an actual change in practice.

Aims We aimed to characterise use of general practitioners (GP) simultaneously across multiple attributes in people with diabetes and examine its impact on diabetes related potentially preventable hospitalisations (PPHs). Methods Five-years of panel data from 40,625 adults with diabetes were sourced from Western Australian administrative health records. Cluster analysis (CA) was used to group individuals with similar patterns of GP utilisation characterised by frequency and recency of services. The relationship between GP utilisation cluster and the risk of PPHs was examined using multivariable random-effects negative binomial regression. Results CA categorised GP utilisation into three clusters: moderate; high and very high usage, having distinct patient characteristics. After adjusting for potential confounders, the rate of PPHs was significantly lower across all GP usage clusters compared with those with no GP usage; IRR = 0.67 (95%CI: 0.62–0.71) among the moderate, IRR = 0.70 (95%CI 0.66–0.73) high and IRR = 0.76 (95%CI 0.72–0.80) very high GP usage clusters. Conclusions Combination of temporal factors with measures of frequency of use of GP services revealed patterns of primary health care utilisation associated with different underlying patient characteristics. Incorporation of multiple attributes, that go beyond frequency-based approaches may better characterise the complex relationship between use of GP services and diabetes-related hospitalisation.

Our study measured the change in head injuries and deaths among motorcycle users in Cu Chi district, a suburban district of Ho Chi Minh City.Hospital records for road traffic injuries (RTIs) were collected from the Cu Chi Trauma Centre and motorcycle-related death records were obtained from mortality registries in commune health offices. Head injury severity was categorized using the Abbreviated Injury Score (AIS). Rate ratios (RRs) were used to compare rates pre- and post-law (2005/2006-2009/2010). Cu Chi's population, stratified by year, age, and sex, was used as the denominator.Of records identifying the transportation mode at the time of injury, motorcyclists accounted for most injuries (3,035, 87%) and deaths (238, 90%). Head injuries accounted for 70% of motorcycle-related hospitalizations. Helmet use was not recorded in any death records and not in 97% of medical records. Males accounted for most injuries (73%) and deaths (88%). The median age was 28 years and 32 years for injuries and deaths, respectively. Compared to the pre-law period, rates of motorcycle injuries (RR = 0.53; 95% confidence interval [CI], 0.49-0.58), head injuries (RR = 0.35; 95% CI, 0.31-0.39), severe head injuries (RR = 0.47; 95% CI, 0.34-0.63), and deaths (RR = 0.69; 95% CI, 0.53-0.89) significantly decreased in the post-law period.Rates of head injuries and deaths among motorcycle riders decreased significantly after implementation of the mandatory helmet law in Vietnam. To further examine the impact of the motorcycle helmet law, including compliance and helmet quality, further emphasis should be placed on gathering helmet use data from injured motorcyclists.

Background Continuity of care with a general practitioner (GP) is vital for management of chronic conditions including diabetes as it provides proactive care facilitating opportunities to prevent or delay progression of disease. Aim To capture the proportion of time people with diabetes are under the protective effect of contact with a GP using the Cover Index and its effect on potentially preventable hospitalisation (PPH) and length of stay (LOS). Methods The linked self-report and administrative health service data of 267,153 participants in the 45 and Up study in New South Wales (NSW) in 2006-2009, obtained from the NSW Centre for Health Record Linkage and the Australian Government Department of Human Services, were used. A cohort of 21,965 people aged 45+ years identified with diabetes before July 2009 and followed up to 2015 were included in the analysis. Time duration protective effect of GP contact was estimated according to severity of diabetes using threshold effect models and then used to calculate the Cover Index. The effect of levels of GP cover on PPH and unplanned PPH and related LOS were estimated using negative binomial models weighted for the inverse probability of treatment to control for observed pre-treatment covariate imbalance. Results Perfect GP cover was observed among 56% of people in the study cohort. Compared with low GP cover, having perfect GP cover was significantly associated with lower PPH (IRR 0.21, 95%CI 0.13-0.35), LOS for PPH (IRR 0.12, 95%CI 0.06-0.24), unplanned PPH (IRR 0.36, 95%CI 0.19-0.68) and LOS for unplanned PPH (IRR 0.39, 95%CI 0.17-0.85) after controlling for the observed pre-treatment covariate imbalance. Conclusion This study suggests that longitudinal continuity of care measured by incorporating a time protective effect of a GP (cover) may be an important factor associated with reduction in PPHs and length of stay independent of other measures of longitudinal continuity.

Objective This study aimed to develop a risk stratification strategy for evaluating the relationship between complications of diabetes and the risk of diabetic-related hospitalization to accurately classify diabetes severity. Methods The study used administrative health records for 40,624 individuals with diabetes aged ≥ 18 years in Western Australian. The adapted Diabetes Complication Severity Index (DCSI), socio-demographic and clinical characteristics were used in random effects negative binomial and threshold effect models to determine the optimal stratification strategy for diabetes severity based on the homogeneity of the risk of hospitalization in response to variation of the DCSI. Results The optimal stratification of people with diabetes was specified by four sub-populations. The first sub-population was no complications with an inverse association with the risk of hospitalizations (coefficient − 0.247, SE 0.03). Further three sub-populations with DCSI at one (coefficient 0.289, SE 0.01), two (coefficient 0.339, SE 0.01) and three or more (coefficient 0.381, SE 0.01) were used to accurately describe the impact of DCSI on the risk of hospitalization. Conclusion A stratification into four subpopulations based on the homogeneous impact of diabetes DCSI on the risk of hospitalization may be more suitable for evaluating health care interventions and planning health care provision.

Background To respond to growing prevalence of hypertension in Vietnam, it is critical to have an in-depth understanding about quality of life (QOL) among people living with hypertension and related factors. This study aimed to measure QOL among hypertensive people in a rural community in Vietnam, and its association with socio-demographic characteristics and factors related to treatment. Methods This study was conducted in a rural community located 60 km from Ho Chi Minh City. Face-to-face interviews were conducted among 275 hypertensive people aged 50 years and above using WHOQOL-BREF questionnaire. Descriptive statistics were used to examine mean scores of quality of life. Cronbach’s alpha coefficient and Pearson’s correlation coefficient were applied to estimate the internal consistency, and the level of agreement between different domains of WHOQOL-BREF, respectively. Independent T-test and ANOVA test followed by multiple linear regression analyses were used to measure the association between QOL domains and independent variables. Results Both overall WHOQOL-BREF and each domain had a good internal consistency, ranging from 0.65 to 0.88. The QOL among hypertensive patients was found moderate in all domains, except for psychological domain that was fairly low (mean = 49.4). Backward multiple linear regressions revealed that being men, married, attainment of higher education, having physical activities at moderate level, and adherence to treatment were positively associated with QOL. However, older age and presence of co-morbidity were negatively associated with QOL. Conclusion WHOQOL-BREF is a reliable instrument to measure QOL among hypertensive patients. The results revealed low QOL in psychological domain and inequality in QOL across socio-demographic characteristics. Given the results, encouraging physical activities and strengthening treatment adherence should be considered to improve QOL of hypertensive people, especially for psychological aspect. Actions to improve QOL among hypertensive patients targeted towards women, lower educated and unmarried patients are needed in the setting.

Background Cardiovascular disease (CVD) is the most costly disease in Australia. Measuring the impact of ageing on its costs is needed for planning future healthcare budget. The aim of this study was to measure the impact of changes in population age structure in Western Australia (WA) on the costs of hospitalisation for CVD. Methods All hospitalisation records for CVD occurring in WA in 1993/94 and 2003/04 inclusive were extracted from the WA Hospital Morbidity Data System (HMDS) via the WA Data Linkage System. Inflation adjusted hospitalisation costs using 2012 as the base year was assigned to all episodes of care using Australian Refined Diagnosis Related Group (AR-DRG) costing information. The component decomposition method was used to measure the contribution of ageing and other factors to the increase of hospitalisation costs for CVD. Results Between 1993/94 and 2003/04, population ageing contributed 23% and 30% respectively of the increase in CVD hospitalisation costs for men and women. The impact of ageing on hospitalisation costs was far greater for chronic conditions than acute coronary syndrome (ACS) and stroke. Conclusions Given the impact of ageing on hospitalisation costs, and the disparity between chronic and acute conditions, disease-specific factors should be considered in planning for future healthcare expenditure. Electronic supplementary material The online version of this article (doi:10.1186/s12913-014-0554-9) contains supplementary material, which is available to authorized users.

Background Developing countries are poorly equipped for health issues related to ageing populations making multimorbidity challenging. As in Vietnam the focus tends to be on single conditions. Hence little is known about burden of multimorbidity. This study aimed to examine the prevalence and the determinants of multimorbidity among older people in Southern Vietnam. Methods A cross-sectional study was conducted in two provinces of Southern Vietnam with a sample of 2400 people aged 60 years and older. The presence of chronic disease was ascertained by medical examination done by physicians at commune health stations. Information on social and demographic factors was collected using structured questionnaire. Univariate and multivariable logistic regression analyses were used to examine the factors associated with multimorbidity. Results Nearly 40 % of older people had multimorbidity. Currently not working, and healthcare utilisation were associated with higher prevalence of multimorbidity. Living in urban areas and being literate were associated with lower prevalence of multimorbidity. Conclusion The study found a high burden of multimorbidity among illiterate, especially those living in rural areas. This highlights the need for targeted community based programs aimed at reducing the burden of chronic disease.

Background Chronic hepatitis B infection is a significant cause of morbidity and mortality worldwide; low- and middle-income countries (LMICs) are disproportionately affected. Economic evaluations are a useful decision tool to assess costs versus benefits of hepatitis B virus (HBV) screening. No published study reviewing economic evaluations of HBV screening in LMICs has been undertaken to date. Methods The following databases were searched from inception to 21 April 2017: MEDLINE, PubMed, EMBASE, CINAHL Plus, the Cochrane Library, Global Health and the Cost-effectiveness Analysis Registry. English-language studies were included if they assessed the costs against the benefits of HBV screening in LMICs. PROSPERO registration: CRD42015024391, 20 July 2015. Results Nine studies fulfilled the eligibility criteria. One study from Thailand indicated that adding hepatitis B immunoglobulin (HBIG) to HBV vaccination for newborns following screening of pregnant women might be cost-effective for some LMICs, though inadequate total funding and health infrastructure were likely to limit feasibility. A similar study from China indicated a benefit to cost ratio of 2.7 from selective HBIG administration to newborns, if benefits were considered from a societal perspective. Of the two studies assessing screening amongst the general adult population, a single cost-benefit analysis from China found a benefit to cost ratio (BCR) of 1.73 with vaccination guided by HBV screening of adults aged 21–39, compared to 1.42 with vaccination with no screening, both from a societal perspective. Community-based screening of adults in The Gambia with linkage to treatment yielded an incremental cost per disability-adjusted life year averted of $566 (in 2017 USD), less than two-times gross domestic product per capita for that country. Conclusions Screening with ‘catch-up’ vaccination for younger adults yielded benefits above costs, and screening linked with treatment has shown cost-effectiveness that may be affordable for some LMICs. However, interpretation needs to account for total cost implications and further research in LMICs is warranted as there were only nine included studies and evidence from high-income countries is not always directly applicable. Electronic supplementary material The online version of this article (10.1186/s12889-018-5261-8) contains supplementary material, which is available to authorized users.