In recent years, many low- and middle-income countries are experiencing public health reforms, and Vietnam is one of those leading countries moving towards universal health coverage. Nevertheless, the government is currently facing challenges in sustaining health finance and reaching the entire population due to issues surrounding the design of the scheme and organisational practice.
Objectives
  This paper has two objectives. The first objective is to summarise the history of the health insurance scheme and its design by collecting information from official documents in order to provide up-to-date information for a better understanding of the Vietnamese health system. The second objective is to review existing reports and related literature to identify the challenges and problems arising from the design of the health insurance system including premiums, benefit packages and payment rules, and organisational practices such as health service delivery.
Method
  To collect information, decrees and laws as well as existing documents and reports by Vietnamese government agencies and related literature are thoroughly reviewed.
Results
  We found that the government needs major revision of premiums and subsidies in terms of complexity of the design such as subdivided premiums for different statuses and large subsidies that could lead to unsustainable health finance. Also, hidden distorted incentives of health service providers such as unnecessary expensive technologically advanced medical treatment and inappropriate prescription of drugs are challenges. These embezzlements have increased both OOP payment and the financial burden on the health insurance budget.

The optimal timing of cardiac surgery for infective endocarditis in patients with severe brain complication remains unclear. We present here the successful surgical treatment of a case of infected mitral endocarditis with intractable heart failure, disseminated intravascular coagulation (DIC), and cerebral infarction with hemorrhage. A 37 year-old woman who received chemotherapy for breast cancer developed mitral infective endocarditis perhaps caused by infection of the implanted central venous access device and was referred to our hospital for an emergency operation. On admission, she had a mild fever and showed motor aphasia and right-sided hemiplegia. Brain CT scan findings revealed a cerebral infarction in the area of the left middle cerebral artery and a cerebral hemorrhage in the right occipital lobe. Echocardiography showed severe mitral regurgitation with huge mobile vegetation. Chest X-ray revealed severe pulmonary congestion and laboratory data showed DIC. After the mitral valve replacement with a bioprosthetic valve following complete excision of infected tissue, she was extubated on the first postoperative day with dramatic improvement of infectious signs and heart failure. Postoperative brain CT showed a new small brain hemorrhage, but no aggravation of the preoperative cerebral lesion. After she underwent surgical drainage for brain abscess on the 15th postoperative day, her postoperative course was uneventful. Even though this report is limited to a single case, only aggressive and prompt surgical intervention could relieve the intractable conditions in such a patient with extremely high risk.

[Objectives] Acupuncture has shown to be beneficial for pseudomyopia and asthenopia patients through the improvement of hypermyotonia of the masculus ciliaris. Since acupuncture leads to visual acuity improvement and increases the retinal blood-flow volume, we wished to examine whether acupuncture results in higher retinal sensitivity.
[Methods] Eleven healthy adults were recruited for this study. They received acupuncture (leaving needle) of LI4 (Hegu), Taiyang, and shang-jingming on both sides for 10 minutes in the supine position. Ten minutes of supine position with rest was used as a control. Retinal sensitivity before and after acupuncture, was measured using the blue-on-yellow program of the Humphrey Field Analyzer (HFA). The increase of mean deviation parameter (MD), foveal sensitivity, and examination time were analyzed.
[Results] Acupuncture did not influence the MD or foveal sensitivity in this study. However, examination time was significantly prolonged in the control (p< 0.05), but this was suppressed by acupuncture. The number of volunteers with a shorter examination time was significantly larger than the control (p< 0.05).
[Conclusions] A significant improvement in healthy volunteers was not detected by HFA. However, acupuncture may influence both the improvement of asthenopia and the concentration of the volunteers, leading to shortened examination times.

[Purpose]Acupuncture stimulation is known to improve visual acuity. Since this improvement was frequently disassociated with refractive change, we determined the mechanism by examining the patients without lens accommodation.
[Methods]Patients (n = 30) receiving cataract surgery in 2005 at Meiji University of Oriental Medicine Hospital were examined (mean age: 73.0). Bilateral LI4, Taiyang and shang-jingming points were stimulated by acupuncture needles for 10 min (acupoints stimulation). On a different day, the same patients received sham points stimulation at 1 cm above or lateral from the above-mentioned acupoints. Both uncorrected visual acuity (UCVA) and best corrected visual acuity (BCVA) was measured with a logMAR scale at pre-and post-acupuncture stimulations. Furthermore, the patients with improved UCVA and BCVA typically (n = 4) received topical tropicamide eyedrops for suppression of pupil diameter change. UCVA and BCVA were measured at pre-and post-acupuncture stimulation.
[Results]Acupoints stimulation significantly improved both UCVA (0.39 to 0.30, p < 0.0006) and BCVA (0.15 to 0.08, p < 0.0001). Although sham points stimulation also significantly improved both UCVA (0.38 to 0.32, p < 0.02) and BCVA (0.14 to 0.09, p < 0.0001), there was no significant difference in comparison with acupoints stimulation controls. Under mydriasis after tropicamide eyedrops, acupuncture stimulation did not improved UCVA, and the variation of BCVA was significantly different from control (p < 0.013).
[Discussion]Acupuncture stimulation improved UCVA and BCVA even in elderly patients that lack accommodation. Our results imply that as pupil diameter changes, a subsequent pinhole effect may be a critical mechanism for UCVA and BCVA improvement by acupuncture stimulation. In addition, the phenomena are not specific effects of acupoints and imply a response via sensory nerves.

Objective: The diagnostic criteria for the metabolic syndrome (MetS) were published in Japan in April 2005. However, there have been no large-scale studies in rural areas to confirm these criteria. We examined the prevalence of MetS in subjects who had undergone a routine medical health checkup at our hospital, located in a rural area. This data was used to investigate the appropriateness of the diagnostic criteria for MetS.Subjects and Methods: The MetS status was examined retrospectively in 2340 subjects (1408 men, 932 women ; mean age 49.6 ± 9.7 years) who underwent a routine medical health checkup at our hospital between April 2004 and March 2005.Results: Of the 1408 men and 932 women, 209 men (14.8%) and 23 women (2.5%) were diagnosed with MetS. Forty-four men (3.1%) and 4 women (0.4%) met all three diagnostic criteria for metabolic disorders. In the female group, only 8.7% of the 932 women met the waist circumference criterion of ≥90 cm. Because this waist circumference criterion was used during the first screening but was not met by most of the women, they were eliminated from our study. Using receiver operating characteristic (ROC) analysis, the cutoff values for waist circumference were 85.0 cm (sensitivity 0.750, specificity 0.564) in men and 79.5 cm (sensitivity 0.787, specificity 0.709) in women. If the women's waist circumference criterion had been set at the value of ≥79.5 cm, this would have resulted in 48 (5.2%) women meeting the criterion.Conclusion: From the viewpoint of preventive medicine, the Japanese male MetS diagnostic criteria are fairly appropriate. However, for the women, the waist circumference criterion of ≥90 cm has been set too high and was not met by most of the female subjects. Therefore, the Japanese MetS criteria for women, particularly the cutoff value for waist circumference, requires further verification.
Human Females ; Male population group ; diagnostic criteria ; Japanese language ; Health

Purpose: Many types of antihistamines used for the treatment of allergic rhinitis induce drowsiness as a side effect. Whether or not patients taking the internal drugs know of this untoward effect is a matter of importance. Recently we conducted a questionnaire survey to know how many patients are aware of this.Method: The subjects were 257 patients who visited our hospital for treatment of alergic rhinitis and took the prescription from February through March this year. The patients filled in a questionnaire given at the window of the dispensary. All the participants in this survey gave their informed consent.Results: Effective replies (90.3%) were obtained from 232 patients (mean age: 53.5±17.5; sex: 85 males and 147 females). Of those respondents, 45 individuals (19.9%) said they did not know that the antihistamines produce drowsiness. Furthermore, the survey found that 24 out of the 45 individuals were actually taking the type of antihistamine that caused drowsiness and 21 individuals were not given any explanation of the side effect by their doctors. The patients said that if they knew of the side effect they would not have taken the medicine. Moreover, it was found that 10 out of the 21 patients drove their cars while they felt drowsy.Conclusions: The survey revealed the hard fact that the drowsiness as side reaction the patients might have after taking antihistamines was made light of. The findings brought home to us the importance of giving clear directions to the patients about the medicine and the precaution against the side effects.
Drowsiness ; Surveys ; Antihistamines ; adverse effects ; Effective

The WFAS Houston 2016 annual conference was held in the Royal Sonesta Hotel, Houston, Texas, USA from 31 October to 2 November 2014. The theme of the conference was "East Meets West -Shaping the Future of Healthcare", and more than 900 acupuncture practitioners and scientists participated. The number of papers presented was 216, including 6 keynote lectures. Papers from Japan numbered 11.
At the Executive Committee (EC) meeting, 39 of the 76 EC members were present (10 EC members sent a letter of attorney in advance), including 3from Japan. Although Tokyo was approved as a host city of WFAS 2016 last year, we proposed changing the venue to the Tsukuba International Congress Center, which was approved.

A 72-year-old man who suddenly felt an excessive thirst and developed pollakisuria and high fever on Sept. 29, 2001. A general practitioner initially diagnosed him as having urinary tract infection on the same day. Vomiting and unconscionsnes occurred on Oct. 3. He was brought to our hospital by ambulance. Laboratory data on admission showed plasma glucose of 1110 mg/dl, blood pH of 7.167 and HCO3- of 7.6mmol/L, and positive urinary ketone bodies, compatible with diabetic ketoacidosis. Serum amylase was elevated, but he had no symptoms of acute pancreatitis. Insulin therapy was started immediately and hyperglyvemia was improved. He has never had diabetes mellitus and his HbA1c was normal (5.3%). His urinary C-peptide was very low (2.4 μg/day) and diabetes-related autoantibodies including anti-GAD, IA-2 antibodies and ICA were negative. So his case was diagnosed as fulminant type 1 diabetes mellitus. Fulminant type 1 diabetes, which has been brought to light by Dr Imagawa’s group, is characterized by near-nomal HbA1c despite diabetic ketoacidosis, rapid loss of insulin secretion and absence of diabetes-related autoantibodies.Great care is needed to recognize the patients with fulminant type 1 diabetes among the elderly with symptoms of urinary tract infection. Here, we reported the case of an aged man who developed aypical fulminant type 1 diabetes.
Diabetes Mellitus, Insulin-Dependent ; Diabetes Mellitus ; symptoms <1> ; Type 1 ; Urinary tract infection

An 11-year-old boy experienced right flank pain on October 12, 2005. The pain was once alleviated but recurred on the following day, and the patient visited our hospital on October 13, 2005. An imaging study revealed a tumor, sized approximately 12.0 × 7.5 × 8.0 cm, in the right kidney without metastases, for which right nephrectomy was performed. The tumor was solid, although degenerative necrosis and hemorrhage were partially observed inside the tumor. A histopathological study revealed poorly-defined, almost round tumor cells which were strongly stained with vimentin but not with cytokeratin or epithelial membrane antigen (EMA). Based on these findings, a diagnosis of clear cell sarcoma of the kidney in Stage II was made. A review of 10 previous cases reported in Japan during the past 10 years revealed that the affected patients were mostly aged 1 month to 4 years, while our case, occurring in an 11-year-old patient, was uncommon in respect to age.
Neoplasms ; Japan ; Procedures on Kidney ; Cases ; Review of