ORCID Profile
0000-0002-9492-1040
Current Organisations
The Chinese University of Hong Kong Faculty of Medicine
,
Prince of Songkla University
,
Maquarie University
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Publisher: BMJ
Date: 07-10-2010
Abstract: The outcome of systemic lupus erythematosus (SLE) has dramatically improved since the introduction of corticosteroids however, although many regimens of treatment have been supplemented, the mortality has not improved further. To describe the severity and outcome in patients diagnosed with SLE aged ≤18 years in a group of Thai children, compare gender and age differences, and our outcomes with those from developed countries. The authors retrospectively reviewed the files of patients aged ≤18 years diagnosed with SLE admitted to Songklanagarind University Hospital in southern Thailand, for the period 1985-2007. Patient survival rates were calculated. There were 213 SLE patients, 41 males and 172 females, average age 11.6±2.6 years, with a median follow-up of 3.6 years. Outcomes were alive (109), lost to follow-up (22), referred (31) or deceased (51). Of the patients who were alive, 23 were not on any treatment, 59 were on prednisolone alone while 27 were on prednisolone plus some other immunosuppressive drug. Total survival rates were 88%, 76% and 64% at 2, 5 and 10 years, respectively. Males had significantly worse survival than females at 2 and 5 years (78% vs 91% and 58% vs 80%, respectively, p=0.018). There were no differences in mortality between age groups. The 5-year survival rates in the periods 1985-1993, 1994-2000 and 2001-2007 were not significantly different. This retrospective study of patients with SLE in southern Thailand showed different outcomes compared to some studies and similar survival rates and treatment status to other studies, with one-fourth of surviving patients being free of medication.
Publisher: Springer Science and Business Media LLC
Date: 14-01-2012
Publisher: Wiley
Date: 19-10-2015
DOI: 10.1111/TMI.12611
Abstract: To compare the incidences of catastrophic health expenditure (CHE) and impoverishment, the risk protection offered by two health financial reforms and to explore factors associated with CHE and impoverishment among patients with cardiovascular diseases (CVDs) in rural Inner Mongolia, China. Cross-sectional study conducted in 2014 in rural Inner Mongolia, China. Patients with CVDs aged over 18 years residing in the s le areas for at least one year were eligible. The definitions of CHE and impoverishment recommended by WHO were adopted. The protection of CHE and impoverishment was compared between the New Cooperative Medical Scheme (NCMS) alone and NCMS plus National Essential Medicines Scheme (NEMS) using the percentage change of incidences for CHE and impoverishment. Logistic regression was used to explore factors associated with CHE and impoverishment. The incidences of CHE and impoverishment under NCMS plus NEMS were 11.26% and 3.30%, respectively, which were lower than those under NCMS alone. The rates of protection were higher among households with patients with CVDs covered by NCMS plus NEMS (25.68% and 34.65%, respectively). NCMS plus NEMS could protect the poor households more from CHE but not impoverishment. NCMS plus NEMS protected more than one-fourth of households from CHE and more than one-third from impoverishment. NCMS plus NEMS was more effective at protecting households with patients with CVDs from CHE and impoverishment than NCMS alone. An integration of NCMS with NEMS should be expanded. However, further strategies to minimise catastrophic health expenditure after this health finance reform are still needed.
Publisher: Springer Science and Business Media LLC
Date: 2008
Publisher: Elsevier BV
Date: 07-2012
DOI: 10.1016/J.YPMED.2012.04.022
Abstract: Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors. Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking ( 10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used. The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7). A longer duration of smoking cessation correlated with better health behaviors.
Publisher: Wiley
Date: 25-04-2002
DOI: 10.1002/HED.10063
Abstract: Metastatic cutaneous cancer is the most common parotid malignancy in Australia, with metastatic squamous carcinoma (SCC) occurring most frequently. There are limitations in the current TNM staging system for metastatic cutaneous malignancy, because all patients with nodal metastases are simply designated N1, irrespective of the extent of disease. The aim of this study was to analyze the influence of clinical stage, extent of surgery, and pathologic findings on outcome after parotidectomy for metastatic SCC by applying a new staging system that separates metastatic disease in the parotid from metastatic disease in the neck. A prospectively documented series of 87 patients treated by one of the authors (COB) over 12 years for clinical metastatic cutaneous SCC involving the parotid gland and a minimum of 2 years follow-up was analyzed. These patients were all previously untreated and were restaged according to the clinical extent of disease in the parotid gland in the following manner. P1, metastatic SCC of the parotid up to 3 cm in diameter P2, tumor greater than 3 cm up to 6 cm in diameter or multiple metastatic parotid nodes P3, tumor greater than 6 cm in diameter, VII nerve palsy, or skull base invasion. Neck disease was staged in the following manner: N0, no clinical metastatic disease in the neck N1, a single ipsilateral metastatic neck node less than 3 cm in diameter N2, multiple metastatic nodes or any node greater than 3 cm in diameter. Clinical P stages were P1, 43 patients P2, 35 patients and P3, 9 patients. A total of 21 patients (24%) had clinically positive neck nodes. Among these, 11 were N1, and 10 were N2. Conservative parotidectomies were carried out in 71 of 87 patients (82%), and 8 of these had involved surgical margins (11%). Radical parotidectomy sacrificing the facial nerve was performed in 16 patients, and 6 (38%) had positive margins, (p <.01 compared with conservative resections). Margins were positive in 12% of patients staged P1, 14% of those staged P2, and 44% of those staged P3 (p <.05). Multivariate analysis demonstrated that increasing P stage, positive margins, and a failure to have postoperative radiotherapy independently predicted for decreased control in the parotid region. Survival did not correlate with P stage however, many patients staged P1 and P2 also had metastatic disease in the neck. Clinical and pathologic N stage both significantly influenced survival, and patients with N2 disease had a much worse prognosis than patients with negative necks or only a single positive node. Independent risk factors for survival by multivariate analysis were positive surgical margins and the presence of advanced (N2) clinical and pathologic neck disease. The results of this study demonstrate that patients with metastatic cutaneous SCC in both the parotid gland and neck have a significantly worse prognosis than those with disease in the parotid gland alone. Furthermore, patients with cervical nodes larger than 3 cm in diameter or with multiple positive neck nodes have a significantly worse prognosis than those with only a single positive node. Also, the extent of metastatic disease in the parotid gland correlated with the local control rate. The authors recommend that the clinical staging system for cutaneous SCC of the head and neck should separate parotid (P) and neck disease (N) and that the proposed staging system should be tested in a larger study population.
Publisher: Wiley
Date: 05-2003
DOI: 10.1046/J.1445-2197.2003.02562.X
Abstract: Patients with advanced cancers of the larynx and hypopharynx have been treated with total laryngectomy at the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney in the past. Increasingly, these patients are being managed with organ-sparing protocols using chemo-therapy and radiotherapy. The aim of the present study was to review complication, recurrence and survival rates following total laryngectomy. Patients who had total laryngectomy for squamous carcinomas of the larynx or hypopharynx between 1987 and 1998 and whose clinicopathological data had been prospectively accessioned onto the computerized database of the Department of Head and Neck Surgery, Royal Prince Alfred Hospital, were reviewed. Patients whose laryngectomy was a salvage procedure for failed previous treatment were included. A total of 147 patients met the inclusion criteria for the study, including 128 men and 19 women with a median age of 63 years. Primary cancers involved the larynx in 90 patients and hypopharynx in 57. There were 30 patients who had recurrent (n = 24) or persistent disease (n = 6) after previous treatment with radiotherapy (26 larynx cases and four hypopharynx cases). Pharyngo-cutaneous fistulas occurred in 26 cases (17.7%) and, using multivariate analysis, the incidence did not correlate with T stage, previous treatment or concomitant neck dissection. Local control rates were 86% for the larynx and 77% for the hypo-pharynx groups and neck control was 84% and 75%, respectively. Five-year survival for the larynx cancer group was 67% and this was significantly influenced by T stage and clinical and pathological N stage. Survival in the hypopharynx group was 37% at 5 years and this did not significantly correlate with T or N stage. There was a non-significant trend to improved survival among previously treated patients whose laryngectomy was a salvage procedure. Patients with cancer of the larynx had a significantly better survival following total laryngectomy than patients with hypopharyngeal cancer. Those whose laryngectomy was carried out as a salvage procedure following failed previous treatment did not have a worse outcome than previously untreated patients.
Publisher: Wiley
Date: 2001
DOI: 10.1002/HED.1106
Abstract: The parotid lymph nodes represent an important group of nodes at risk for metastatic involvement from cutaneous malignancies of the head and neck. When treating patients with metastatic disease in the parotid gland it has been our custom to also remove the lymph nodes of the neck on the basis that these nodes represent other nodal groups at risk for metastatic involvement. The aim of this study is to determine the incidence of cervical node involvement among patients with clinical metastatic SCC or melanoma of the parotid to determine whether treatment of the clinically negative neck is warranted. The study group consists of 123 prospectively accessioned patients with clinical metastatic cutaneous squamous cell carcinoma (SCC) (n = 73) or melanoma (n = 50) involving the parotid gland and a minimum of 2 years of follow up, irrespective of the clinical status of the neck. Among 73 patients with metastatic SCC in the parotid, 19 (26%) had clinical neck involvement, and 16 of these were pathologically positive (84%). A total of 37 patients had elective neck dissections, and 13 were pathologically positive, which is an overall rate of 52% neck involvement among patients having neck dissection. Among 50 patients with metastatic melanoma in the parotid, 19 (38%) patients were initially seen with clinical neck disease, and all were pathologically positive. Among 31 patients with clinically negative necks, 26 had neck dissections and seven had positive nodes (27%). Overall, 58% of patients with melanoma who had a neck dissection had positive nodes. Patients with metastatic cutaneous SCC and melanoma involving the parotid gland had a high incidence of clinical (26% and 38%, respectively) and occult neck disease (35% and 27%). Treatment of the clinically negative neck in the presence of clinical metastatic parotid cancer should be considered to reduce the likelihood of failure in cervical nodes, to define the extent of disease, and to assist with patient selection for adjuvant therapy.
Publisher: Hindawi Limited
Date: 14-04-2019
DOI: 10.1155/2019/3980658
Abstract: Objective . To evaluate the infectivity of Mycobacterium tuberculosis ( M.tb ) genotypes of index cases in the classroom of adolescent schools in Guangxi, China. Methods . Adolescent school tuberculosis (TB) contact investigations were conducted for all reported index TB cases from November 2016 to December 2017 in Guangxi, China. Genotypes of index cases and contact cases were identified by 15-loci mycobacterial interspersed repetitive units–variable number tandem repeat and spoligotyping. Outcome variable was 5 levels’ order of tuberculin skin test (TST) results to new active TB [0-5 mm, 6-9 mm, 10-14 mm, ≥ 15 mm (without TB), and ≥15 mm (with TB)]. Multivariate ordered logistic regression analysis was performed to evaluate the independent effect of genotypes of index case on contact screening outcome. Results . Beijing genotype occurred more commonly in female index patients. One genotypic cluster of two index cases and one cluster of two contact cases were detected. The association between infectivity of Beijing genotype of index cases and outcome of contact investigation was statistically significant in univariate analysis but no so after adjustment for characteristics of contacts and sex of index cases ( P value =0.057). Female index cases increased the chance for TB infection/being active TB among contacts (ordinal odds ratio = 1.39, 95% confidence interval: 1.21, 1.60). Contacts who studied in the middle school, who with non-Han ethnicity and who without BCG scar had increased risk for TB infection/being active TB. Conclusion . There was not enough evidence from our data to support that Beijing strains were more infective than non-Beijing strains in TB transmission in school setting.
Publisher: Informa UK Limited
Date: 21-11-2012
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 02-2016
DOI: 10.1016/J.DRUGALCDEP.2015.12.028
Abstract: Studies investigating alcohol consumption related factors have rarely focused on the relationship between acculturation, religion and drinking patterns. The objective of this study is to explore the predictors of drinking patterns and their mutual relationships, especially acculturation, ethnicity and religion. A cross-sectional household survey using a multistage systematic s ling technique was conducted in Yunnan Province of China. A revised Vancouver Index of Acculturation (VIA) and Alcohol Use Disorder Identification Test (AUDIT) Chinese version were used to measure acculturation and drinking patterns. Structural equation modeling (SEM) was used to explore the structures of how predictors affect drinking patterns. A total of 977 subjects aged 12-35 years were surveyed. A higher percentage of binge drinking was found among Lisu people. However, the proportion of drinking until intoxication was highest among Han. Gender and enculturation had both direct (standardized β=-0.193, -0.079) and indirect effects (standardized β=-0.126, 0.033) on risky drinking pattern perceived risk of alcohol consumption (-0.065), family drinking environment (0.061), and friend drinking environment (0.352) affected risky drinking pattern directly, while education level (0.066), ethnicity (-0.038), acculturation (0.012), religious belief (-0.038), and age group (0.088) had indirect effects. Risky drinking pattern was associated with gender and aboriginal culture enculturation both directly and indirectly, and related to mainstream culture acculturation and religious belief indirectly. Other demographic (such as education level) and social family factors (friend drinking environment for ex le) also had effects on risky drinking pattern.
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.JHIN.2016.10.003
Abstract: Acinetobacter baumannii is a major hospital-acquired pathogen in Thailand that has a negative effect on patient survival. The nature of its transmission is poorly understood. To investigate the genotypic and spatiotemporal pattern of A. baumannii infection at a hospital in Thailand. The medical records of patients infected with A. baumannii at an 800-bed tertiary care hospital in southern Thailand between January 2010 and December 2011 were reviewed retrospectively. A. baumannii was identified at the genomospecies level. Carbapenemase genes were identified among carbapenem-resistant isolates associated with A. baumannii infection. A spatiotemporal analysis was performed by admission ward, time of infection and pulsed-field gel electrophoresis (PFGE) groups of A. baumannii. Nine PFGE groups were identified among the 197 A. baumannii infections. All A. baumannii isolates were assigned to International Clonal Lineage II. bla A. baumannii transmitted both within and between hospital wards. Better understanding and control of the transmission of A. baumannii are needed.
Publisher: Hindawi Limited
Date: 2014
DOI: 10.1155/2014/850731
Abstract: Background . Tracheal intubation is a potentially life-saving procedure. This skill is taught to many anesthetic healthcare professionals, including nurse anesthetists. Our goal was to evaluate the learning ability of nurse anesthetist trainees in their performance of orotracheal intubation with the Macintosh laryngoscope. Methods . Eleven nurse anesthetist trainees were enrolled in the study during the first three months of their training. All trainees attended formal lectures and practice sessions with manikins at least one time on performing successful tracheal intubation under supervision of anesthesiology staff. Learning curves for each nurse anesthetist trainee were constructed with the standard cumulative summation (cusum) methods. Results . Tracheal intubation was attempted on 388 patients. Three hundred and six patients (78.9%) were successfully intubated on the trainees’ first attempt and 17 patients (4.4%) on the second attempt. The mean ± SD number of orotracheal intubations per trainee was 35.5 ± 5.1 (range 30–47). Ten (90.9%) of 11 trainees crossed the 20% acceptable failure rate line. A median of 22 procedures was required to achieve an 80% orotracheal intubations success rate. Conclusion . At least 22 procedures were required to reach an 80% success rate for orotracheal intubation using Macintosh laryngoscope in nonexperienced nurse anesthetist trainees.
Publisher: Springer Science and Business Media LLC
Date: 07-12-2012
Publisher: JMIR Publications Inc.
Date: 02-2022
Abstract: obile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital ide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers. he aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade. cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated. f 2115 participants, the β coefficients (95% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95% CI 0.22-0.34) and 0.51 (95% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use (β=–0.38 and β=–0.41), as were less educated subgroups (β=–0.24 and β=–0.27), and these two factors had nonsignificant direct effects on mHealth use. o overcome the mHealth use ide, it is important to improve digital access and digital use among older adults and less educated groups.
Publisher: Informa UK Limited
Date: 11-2018
DOI: 10.2147/RMHP.S170445
Publisher: Hindawi Limited
Date: 19-07-2018
DOI: 10.1155/2018/2698461
Abstract: Background. In Inner Mongolia of China, traditional Mongolian medicine (TMM), traditional Chinese medicine (TCM), and western medicine (WM) are all supported by the government. This study compares the background and performance of these three types of medicines. Methods. The World Health Organization’s Six Building Blocks framework was used for the system review. Data were collected from literature review and key informant interviews. A cross-sectional survey was conducted in three types of hospitals at the provincial, municipal (city), and prefectural (county) levels from April to August, 2016. Eight hospitals were included and, within each one, patients from four outpatient departments were selected. A total of 1,322 patients were interviewed about their expectations and perceptions of the health service. Results. Government support for TMM includes higher budget allocation and a higher reimbursement rate. TMM is preferred by Mongolian people, those living in pasturing areas, and those seeking treatment for musculoskeletal problems/injuries. Patients attending TMM hospitals had the highest expectations and perceptions of the health service in general. However, human resources and research capacity of TMM are relatively limited. Conclusion. To further enhance the role of the popular TMM for local minority’s health, human resources and research capacity strengthening are essential.
Publisher: Elsevier BV
Date: 07-2011
DOI: 10.1016/J.DRUGALCDEP.2010.12.007
Abstract: Multiple substance use is a common problem among heroin users. This study aims to describe patterns of multiple substance use one year before and during attendance at methadone maintenance treatment (MMT) programs and associated variables of continued heroin use in MMT clinics in Yunnan, China. The study was conducted among 168 heroin addicts who had received treatment for at least one year at two MMT clinics in Kunming city. A structured questionnaire, a medical record, and computer database were used to obtain history of substances use, significant clinical information, and treatment details, respectively. Heroin, tobacco, and alcohol were the most commonly used substances both before and during MMT. After one year in MMT, use of heroin, alcohol, tramadol, and triazolam significantly decreased whereas use of ephedrine increased. Simultaneous substance use was halved but the decrease was not statistically significant. The proportion of injecting users was reduced from 61% to 43%. History of heroin use in the preceding 6 months during MMT increased the odds of continued heroin use (OR=5.8, 95% CI=[2.9-11.3]). An average 10mg higher methadone dose increment was associated with a reduced odds of heroin use by 10%. MMT did not reduce the number of substances used, but the number of injecting heroin users after the first year of treatment decreased. Heroin use in the preceding 6 months during MMT treatment and lower methadone dose were associated with continued heroin use in MMT.
Publisher: Public Library of Science (PLoS)
Date: 03-07-2018
Publisher: Wiley
Date: 06-1993
DOI: 10.1111/J.1464-410X.1993.TB16076.X
Abstract: Accurate histological diagnosis and staging are critically important in determining the optimal management of patients with testicular cancer. We have assessed the importance of histological review of "outside" pathology reports from 87 patients referred to the Urological Cancer Research Unit. In 28 patients (32%), the reviewed pathology report differed from the outside report. In 10 of these patients (11%), the pathology review resulted in a change of treatment or prognosis from that which would have obtained in the absence of such histological review. Pathology review at a major cancer centre with a subspecialist interest in tumour pathology and a large experience in the management of germ cell malignancy is an essential first step in the treatment of testicular cancer.
Publisher: MDPI AG
Date: 24-12-2018
DOI: 10.3390/TROPICALMED4010002
Abstract: Myanmar is one of the highly affected countries by tuberculosis (TB) and human immunodeficiency virus (HIV) co-infection. We aimed to review the coverage of TB/HIV integrated services as well as to document the performance of this integrated services. A retrospective program review was conducted using the aggregated data of the National TB Programme (NTP) from 2005 to 2016. In Myanmar, TB/HIV services were initiated in seven townships in 2005. Townships were slowly expanded until 2013. After that, the momentum was increased by increasing the government budget allocation for NTP. In 2016, the whole country was eventually covered by TB/HIV services in different types of integration. Antiretroviral therapy (ART) coverage among HIV-positive TB patients remained low and it was the only significant difference among the three types of integration. Barriers of low ART coverage need to be investigated to reduce the burden of TB/HIV.
Publisher: Informa UK Limited
Date: 29-01-2017
Publisher: S. Karger AG
Date: 2018
DOI: 10.1159/000485790
Abstract: Acquired platelet dysfunction with eosinophilia (APDE) is a syndrome which manifests as a transient state of platelet dysfunction in the presence of eosinophilia. The aim of this work was to study the clinical course and outcomes of children diagnosed with APDE. The hospital records of children with APDE were retrospectively reviewed and a total of 69 children were included. The mean (standard deviation) age at diagnosis was 6.9 (3.1) years. All of the patients presented with ecchymoses on the extremities, body, and face. None had serious bleeding symptoms. Platelet counts were within the normal range but all of the patients had abnormal platelet morphology by light microscopy. Parasitic infestation was found in 38% and most (87%) were treated with antiparasitic drugs. The median time from the onset of symptoms to remission was 2.6 months (95% CI 1.8-3.1). The overall complete remission rates at 3, 6, and 12 months were 61, 90, and 94%, respectively, with a median follow-up time after remission of 14.0 months (interquartile range 6.0-30.8). Neither univariate nor multivariate analysis indicated any statistically significant determinants for remission time. In our study, APDE was transient with spontaneous remission, no serious bleeding manifestations, and had a benign clinical course.
Publisher: Wiley
Date: 30-05-2016
DOI: 10.1111/TMI.12719
Abstract: With the rapid economic development in China, millions of rural residents are migrating to the cities to gain employment, resulting in numerous left-behind children (LBC). Simultaneously, outbreaks of measles continue to occur, yet the effect of parental migration on children's vaccination status is largely unknown. This study aimed to evaluate the association between parental migration and children's timely measles vaccination in rural China, after adjusting for family socio-economic status (SES) indicators. We conducted a cross-sectional survey using multistage s ling among children aged 18-54 months in rural Guangxi of China. Information on measles vaccination status was obtained from the child's vaccination certificate, and data on SES were collected by interviewing the child's primary guardian. Family SES and vaccination coverage were compared between LBC and non-left-behind children (NLBC) using weighted logistic regression, while the delay in vaccination was compared using Kaplan-Meier survival analysis. Of the 1216 study children, 46% were LBC and 54% were NLBC. Compared to NLBC, the coverage of timely measles vaccination was significantly lower, and the median delay period was longer among LBC. After adjusting for SES indicators, LBC were significantly more likely to have an untimely vaccination for their first dose of measles vaccine than NLBC (OR = 1.33, 95% CI = 1.02-1.75). Due to the negative effect of parental migration and family SES, LBC were more likely to encounter serious delays of measles vaccination in rural China. Optimising vaccination policies could facilitate timely vaccination among LBC in rural China.
Publisher: Wiley
Date: 02-07-2015
DOI: 10.1111/CRJ.12334
Abstract: Laggera pterodonta, a traditional Chinese medicine, has been commonly used in respiratory tract infections for more than hundreds of years without any randomized controlled trials to evaluate its efficacy and safety. To evaluate the efficacy and safety of Laggera pterodonta in hospitalized children aged 3-24 months with acute bronchiolitis. A double-blind, randomized-controlled trial was conducted in three tertiary hospitals of Kunming, China. A total of 133 acute bronchiolitis children with an initial episode of wheezing were randomly assigned to a control mixture or Laggera pterodonta mixture. All recruited patients were given three doses of the mixture every 24 h for 5 days. Clinical symptoms and responses including adverse events in both groups were assessed and laboratory tests were done at enrolment and then after 120 h. Analysis was performed based on an intention-to-treat principle. Significantly more hospitalized children fulfilled the discharge criteria at 96 h and 120 h in the Laggera pterodonta mixture group compared to the control group (97% vs 75.8% P < 0.001 and 98.5% vs 89.4% P = 0.03), respectively. Better responses on clinical severity score, respiratory rate, oxygen saturation, wheezing and heart rate were also detected in the Laggera pterodonta mixture group along with lower white blood cell count, platelet count and aspartate aminotransferase. Vomiting and diarrhea were more common in the control group. Laggera pterodonta mixture is effective and safe to be prescribed in hospitalized children with acute bronchiolitis.
Publisher: Wiley
Date: 2004
DOI: 10.1002/HED.10335
Abstract: Chemical carcinogens induce squamous cell carcinoma (SCC) of the head and neck by targeting the p53 and the retinoblastoma (pRb) pathways. Human papillomavirus (HPV) might have an etiologic role in these cancers at particular sites. Few studies have compared cell cycle protein expression in HPV-positive and HPV-negative tumors in this region. Fifty tonsil SCCs were analyzed for HPV by PCR and for expression of cell cycle proteins (p53, pRb, p16(INK4A), p21(CIP1/WAF1), p27(KIP1), and cyclinD1) by immunohistochemistry. HPV was present in 42% almost all were type 16. There were statistical associations between HPV positivity and reduced expression of pRb and cyclinD1, overexpression of p16, and younger patient age. Tumor with down-regulated p27 tended to have down-regulated pRb and p21. HPV-positive tonsil SCCs have distinct molecular pathways. Their association with younger patient age suggests that they are biologically distinct from HPV-negative tumors.
Publisher: Informa UK Limited
Date: 09-2019
DOI: 10.2147/PPA.S219920
Publisher: Wiley
Date: 06-2003
DOI: 10.1097/00005537-200306000-00029
Abstract: Parotid malignancy may develop as a primary cancer of salivary tissue or by metastatic involvement of parotid lymph nodes. The aim of the study was to compare the clinical behavior of primary and metastatic parotid cancers by analyzing patterns of treatment failure and clinical outcomes. Retrospective review of clinical and pathologic data prospectively accessioned onto a computerized database. A prospectively documented series of 232 parotidectomies carried out for treatment of cancer from 1988 to 1999 was reviewed. There were 177 male and 55 female patients with a median age of 65 years (age range, 17-97 y). Median follow-up time was 4 years. Pathological groups included 54 patients with primary parotid cancer, 101 with metastatic cutaneous squamous cell carcinoma, 69 with metastatic melanoma, and 8 with other metastatic cancers. Neck nodes were clinically positive in 12 patients with primary cancer, 24 patients with squamous cell carcinoma, 16 with melanoma, and 2 with other metastatic malignancies. Conservative parotidectomy, preserving the main trunk of the facial nerve, was performed in 185 patients, and 47 patients had a radical parotidectomy sacrificing the facial nerve. There were 54 therapeutic and 110 elective neck dissections. Adjuvant radiotherapy was given to 39 patients with primary cancer, 86 with squamous cell carcinoma, 50 with melanoma, and 8 in the other metastatic group (78% of the patients in the series). Local control rates at 5 years in the four groups were 86%, 75%, 94%, and 100%, respectively (P <.01). Survival rates at 5 years were 77%, 65%, 46%, and 56%, respectively (P <.01). The pattern of parotid malignancy is unique in Australia because of the high incidence of skin cancer, which can metastasize to the parotid gland. Metastatic cutaneous malignancy predominates. The pattern of failure and outcome varied depending on histological findings. Local failure occurred most often in metastatic squamous cell carcinoma, whereas patients with melanoma had the highest incidence of distant spread.
Publisher: Elsevier BV
Date: 06-2022
Publisher: Public Library of Science (PLoS)
Date: 26-06-2019
Publisher: Wiley
Date: 30-08-2016
DOI: 10.1002/PBC.26178
Abstract: Initial clinical factors that can reliably predict a successful within-1-year resolution of childhood immune thrombocytopenia (ITP) are still unclear. This study aimed to determine factors associated with within-12-month resolution of newly diagnosed childhood ITP. The hospital records of 417 consecutive children aged less than 15 years with ITP were reviewed retrospectively and data related to the initial presentation were noted. Logistic regression analysis was used to determine which presenting features were associated with a favorable outcome within 12 months. Significant clinical and laboratory predictors for resolution of newly diagnosed childhood ITP within 12 months were abrupt onset less than 14 days, age less than 5 years, and platelet count at 4 weeks postdiagnosis of at least 100 × 10 Age less than 5 years, onset of bleeding less than 14 days, and follow-up platelet count at 4 weeks of at least 100 × 10
Publisher: Springer Science and Business Media LLC
Date: 07-2008
DOI: 10.1007/S00467-008-0775-4
Abstract: We have retrospectively reviewed the records of children aged >1 month to 16 years who had been referred to the Department of Pediatrics of Prince of Songkla University's Faculty of Medicine, a tertiary referral center in Thailand, between 1982 and 2005 and subsequently diagnosed with chronic kidney disease (CKD). Our aim was to evaluate the prevalence and etiology of CKD in southern Thailand. There were 101 cases of CKD, with one case each diagnosed in 1988, 1989 and 1993, respectively, and 98 cases diagnosed between 1994 and 2005. These latter cases were ided into two 6-year periods: an early period (1994-1999), with 32 cases, and a later period (2000-2005), with 66 cases. The majority of this pediatric population with CKD were male (62/101, 61.4%). The etiologies of CKD were 35 cases of chronic glomerulonephritis (CGN) (34.7%), 29 of genitourinary tract (GU) anomalies (28.7%), nine of systemic lupus erythematosus (SLE) (8.9%), four malignancies (4.0%), four miscellaneous (4.0%) and 19 of unknown causes (18.8%). The patients were ided into age groups of 6-10 years (22), >10-13 years (20) and >13 years (24). The etiologies of CKD were significantly different in each age group, with GU anomalies and glomerulonephritis being the major causes of CKD in children aged 6 years (40/65, 61.5%), respectively. In conclusion, the incidence of CKD in our university hospital situation was not rare, with the prevalence doubling during the past 6 years, and the etiologies varying by age group.
Publisher: Informa UK Limited
Date: 11-08-2022
DOI: 10.1080/08880018.2021.1963360
Abstract: Childhood lymphoblastic lymphoma (LL) is a highly aggressive neoplasm which has achieved favorable survival outcomes in many developed countries. However, few studies have reported treatment outcomes of childhood LL in resource-limited counties, nor has a prognostic scoring system been developed. The objectives of this study were to evaluate survival outcomes and identify prognostic factors associated with inferior outcomes of childhood LL in a referral center in March 1985 and April 2017 were retrospectively reviewed. Seventy-five advanced-stage LL patients were included, 47 (62.7%) of whom had stage IV at initial diagnosis. The 5-year DFS and OS rates were 44.6% and 44.7%, respectively. There were 3 significant prognostic factors associated with worse outcomes: presence of B symptoms, low albumin level 500 IU/L. From these three factors, we assigned a score of 1 for each and total scores of 0, 1, 2, and 3 could predict 5-year OS rates of 92.3%, 50.9%, 24.7% and 0%, respectively (
Publisher: Oxford University Press (OUP)
Date: 22-04-2015
Abstract: Although varied methods are used in estimating alcohol consumption, there has been no methodological comparison of these methods in China. The aim of this study is to compare different methods used for estimating drinking indices, such as annual per capita consumption, and proportions of risk drinking. A cross-sectional household survey using a multistage systematic s ling technique was conducted in Yunnan Province of China. The beverage-specific quantity frequency (BSQF), tri-level, last 7-day (L7D) and beverage-specific yesterday (BSY) methods were used. A total of 977 subjects aged 12-35 years were surveyed. The BSQF yielded the highest annual per capita consumption (2094.2 g), followed by the tri-level (1430.8), L7D (983.0) and BSY (409.7 g) methods. The annual per drinker consumption quantities were 1762.1, 938.5, 865.7 and 493.3 g for tri-level, BSQF, L7D and BSY methods, while the proportions of high-risk drinking were 13.4, 9.4, 4.8 and 2.5%, respectively. The BSQF method is more suitable for measurement of annual per capita alcohol consumption in this population. The tri-level approach is a promising substitution of the graduated quantity frequency (GF) method if implemented with caution for both quantity and pattern of alcohol consumption.
Publisher: Informa UK Limited
Date: 06-2020
DOI: 10.2147/RMHP.S248772
Publisher: S. Karger AG
Date: 2019
DOI: 10.1159/000497443
Abstract: b i Background: /i /b The strong association between kidney and urinary tract anomalies and childhood urinary tract infection (UTI) often leads to imaging tests being performed. b i Objective: /i /b To describe the epidemiology, characteristics, and imaging findings in Thai children with UTI and compare results between boys and girls. b i Methods: /i /b We retrospectively reviewed the medical records of children with UTI aged & #x3c 15 years. Demographic characteristics and findings of investigations are presented. b i Results: /i /b One hundred seventy-eight boys and 170 girls with 432 UTI episodes were identified. The median (interquartile range) age at presentation was 1.4 (0.6–3.4) years, 1.0 for boys and 2.1 for girls ( i /i & #x3c 0.001). Renal ultrasound, voiding cystourethrogram and sup m /sup Tc dimercaptosuccinic acid (DMSA) renal scans were performed in 273, 223 and 113 children, respectively. Overall, 283 children (81.3%) had at least one imaging study done and anomalies of the kidney and urinary tract were detected in 158 (45.4%). Primary vesicoureteral reflux was detected in 73 (32.7%) children. The remaining abnormalities were hydronephrosis ( i n /i = 54). DMSA scans detected 54 children with dysplastic or scarred kidneys. b i Conclusions: /i /b First UTI in a group of Thai children occurred in approximately equal proportion in boys and girls but boys were younger at diagnosis. Kidney and urinary tract anomalies were detected in half of the children.
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.2147/IDR.S257936
Publisher: F1000 Research Ltd
Date: 05-07-2016
DOI: 10.12688/F1000RESEARCH.9095.1
Abstract: Background : In clinical practice, the physician’s treatment decision making is influenced by many factors besides the patient’s clinical conditions and is the fundamental cause of healthcare inequity and discrimination in healthcare settings. Type 2 diabetes mellitus (T2DM) is a chronic disease with high prevalence, long average length of stay and high hospitalization rate. Although the treatment of T2DM is well guideline driven, there is a large body of evidence showing the existence of treatment disparities. More empirical studies from the provider side are needed to determine if non-clinical factors influence physician’s treatment choices. Objective : To determine the hospital and patient influencing factors of treatment schemes given to T2DM inpatients in Inner Mongolia, China. Methods : A cross-sectional, hospital-based survey using a cluster s ling technique was conducted in three tertiary hospitals and three county hospitals in Inner Mongolia, China. Treatment schemes were categorized as lifestyle management, oral therapy or insulin therapy according to the national guideline. Socio-demographic characteristics and variables related to severity of disease at the in idual level and hospital level were collected. Weighted multinomial logistic regression models were used to determine influencing factors of treatment schemes. Results : Regardless of patients’ clinical conditions and health insurance types, both hospital and patient level variables were associated with treatment schemes. Males were more likely to be given oral therapy (RRR=1.72, 95% CI=1.06-2.81) and insulin therapy (RRR=1.94, 95% CI=1.29-2.91) compared to females who were given lifestyle management more frequently. Compared to the western region, hospitals in the central regions of Inner Mongolia were less likely to prescribe T2DM patients oral therapy (RRR = 0.18, 95% CI=0.05-0.61) and insulin therapy (RRR = 0.20, 95% CI=0.06-0.67) than lifestyle management. Compared with non-reformed tertiary hospitals, reformed tertiary hospitals and county hospitals were less likely to give T2DM patients oral therapy (RRR = 0.07 and 0.1 respectively) and insulin therapy (RRR = 0.11 and 0.17 respectively). Conclusion : Gender was the only socio-demographic factors associated with treatment scheme for T2DM patients. Hospitals from different regions have different T2DM treatment patterns. Implementation of reform was shown to be associated with controlling medication use for T2DM inpatients. Further studies are needed to investigate the causes of unreasonable treatment disparities so that policies can be generated accordingly.
Publisher: Elsevier BV
Date: 06-2019
DOI: 10.1016/J.AJP.2019.05.026
Abstract: To estimate the average cost of an integrated alcohol intervention program at community hospitals of Thailand and identify patient predictors and sources of variation of the program cost. Activity-based costing was conducted under a societal perspective among 113 outpatient alcohol users (29 low-risk, 43 high-risk and 41 dependent drinkers), aged 15 years and older, at four community hospitals in southern Thailand. Multivariate regression models were performed to identify in idual-level determinants of cost components. The average cost per low-risk, high-risk, and dependent drinkers were 516 (16 USD), 2,961 (94 USD), and 5,325 baht (168 USD), respectively, of which labor and patient costs were the major components. Regardless of drinking risk level, past-year functional disturbance lasting more than 20 days (β = 0.215, p = 0.035) and increasing number of previous treatment episodes (β = 0.035, p = 0.046) independently increased overall program cost. Variation in the program cost was mainly caused by length of hospital stay followed by staff time for screening and delivering interventions. The study underlines the important role of pretreatment alcohol-related problems and human resources in alcohol intervention programs. Efforts should be focused on adequacy of treatment for the very first episode of alcohol problems to reduce the high healthcare costs.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2009
Publisher: Springer International Publishing
Date: 2019
Publisher: Wiley
Date: 17-03-2014
DOI: 10.1111/AAS.12305
Abstract: This study aimed to determine the safety and efficacy of intraoperative intensive glycaemic treatment with modified glucose-insulin-potassium solution by hyperinsulinemic normoglycaemic cl in cardiopulmonary bypass surgery patients. We hypothesised that the treatment would reduce infection rates in this group of patients. A prospective, randomised, double-blind trial was conducted in cardiopulmonary bypass surgery patients. A total of 199 adult patients (out of a planned 400) were randomly allocated to intensive or conventional treatment with target glucose levels of 4.4-8.3 mmol/l and < 13.8 mmol/l, respectively. The primary outcomes were clinical infection and cytokine levels, including interleukin (IL)-6 and IL-10. The secondary outcomes were morbidity and mortality. The study was terminated early because of safety concerns (hypoglycaemia). The clinical post-operative infection rate was 17% in the intensive group and 13% in the conventional group (P = 0.53). The proportion of patients with hypoglycaemia was significantly higher in the intensive group (23%) compared with the conventional group (3%) (P 2 h (vs. ≤ 2 h), pre-operative IL-6 level > 15 pg/ml (vs. ≤ 15 pg/ml) and post-operative IL-6 level 56-110 pg/ml (vs. ≤ 55 pg/ml) were independent predictors for post-operative infection. Intraoperative intensive glycaemic treatment significantly increased the risk of hypoglycaemia, but its effect on post-operative infection by clinical assessment could not be determined. Anaesthetic duration, pre-operative and post-operative IL-6 levels can independently predict post-operative infection.
Publisher: Elsevier BV
Date: 02-2002
Publisher: Walter de Gruyter GmbH
Date: 27-11-2017
Abstract: Short stature is one of the common disorders referred for investigation of an endocrine disorder. The etiologies of short stature vary and are commonly grouped into pathological and non-pathological disorders. The objective of the study was to determine the etiologies and describe the characteristics of short stature patients who attended the Pediatric Endocrinology Clinic and to compare factors between normal variant short stature (NVSS) and growth hormone deficiency (GHD). This was a retrospective review of 572 patients referred for evaluation of short stature between January 2004 and December 2015. Short stature was defined as height below −2 standard deviation score (SDS) by gender and age based on population data of Thai children. In total, 521 patients were identified as having short stature. NVSS was the most common etiology (44.9%) and pathological short stature was found in 35.3% of the cases, of which 21.2% had GHD. The median age at presentation of NVSS patients was 8.6 years while that of pathological short stature patients was 2.1 years (p .001). Patients with NVSS had significantly higher median height SDS (HSDS) than patients with pathological diseases. The common etiologies in severe short patients, defined by HSDS ≤−3, were syndromic short stature (16.2%) and GHD (14.1%). In the moderate short stature group (HSDS between −2 and −3), constitutional delay of growth and puberty (CDGP) was the most common etiology (34.1%). NVSS was the most common etiology of short stature, followed by syndromic short stature and GHD. Physical examination is crucial to identify GHD from syndromic short patients.
Publisher: Springer Science and Business Media LLC
Date: 12-2018
Publisher: Springer Science and Business Media LLC
Date: 2017
Publisher: American Medical Association (AMA)
Date: 07-2003
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.JIAC.2014.07.016
Abstract: This study was conducted to investigate the protective efficacy of a single dosage of 200 mg doxycycline against leptospiral infection and leptospirosis and associated risk factors among residents exposed to flooding in southern Thailand. Of 641 participants, 600 received doxycycline while 41 did not. Twenty two participants were infected with Leptospira and six developed leptospirosis. Having a laceration wound was significantly associated with leptospiral infection (odds ratio [OR] = 37.20 P < 0.001) and leptospirosis (OR = 18.24 P = 0.003) whereas exposure to flood more than 3 h per day was associated with only leptospiral infection (OR = 3.70 P = 0.038). Seventeen participants who received doxycycline and five who did not, were infected with Leptospira, resulting a protective efficacy of 76.8% (95% confidence interval [CI] = 34.3%-92.0%). Four who received doxycycline and two who did not, developed leptospirosis, resulting a protective efficacy of 86.3% (CI = -9.8%-98.2%). Among the participants with laceration wound, the protective efficacy for leptospiral infection was 92.0% (CI = 81.2%-96.6%) and for leptospirosis was 95.6% (CI = 78.2%-99.3%). Among the participants exposed to flood water less than or equal to 3 h per day, the protective efficacy for leptospiral infection was 89.2% (95% CI 63.6%-96.67%). A single dosage of 200 mg doxycycline for prophylaxis might be effective for preventing leptospirosis among flood victims with laceration wound after recent flood exposure.
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.UROLOGY.2017.09.014
Abstract: To evaluate the imaging results of childhood urinary tract infection (UTI) in our setting, and examine if it would be appropriate to apply the recent guideline changes regarding imaging studies as routine practice in Thailand. Medical records of children with UTI aged 0-15 years were reviewed, with focus on renal ultrasound (RUS), cystogram, and A total of 142 boys and 129 girls had at least 1 imaging study after UTI. Their median (interquartile range) age was 1.0 (0.5-2.7) year: 0.7 and 1.4 years for boys and girls, respectively (P = .006). A total of 262 children had an RUS performed, of which 99 (37.8%) were abnormal. Cystograms were performed in 221 children, from which 83 (37.6%) CAKUTs were detected, and 108 children had a DMSA performed, of which 53 (49.1%) were abnormal. Overall, CAKUTs were detected in 148 (54.6%) children, of which 43 were severe. RUS together with cystogram provided higher sensitivity (100% vs 88.9%) and specificity (53.8% vs 42.4%) to detect severe CAKUT than RUS together with DMSA. A CAKUT was detected in more than half of the children with first UTI, with one-third having severe CAKUT. In our setting, RUS combined with cystogram is still the most reliable way to detect potentially harmful post-UTI problems, and the new western guidelines are not appropriate.
Publisher: Elsevier BV
Date: 10-2012
DOI: 10.1093/BJA/AES226
Abstract: Risk factors for reintubation in post-anaesthetic care units related to anaesthetic processes have not previously been reported. Our goal was to identify risk factors for reintubation in general surgical patients. A time-matched, case-control study was conducted on anaesthetic patients between 2001 and 2011. One hundred and sixty-four reintubated patients were compared with 656 randomly selected controls. Independent risk factors for reintubation were age <1 yr vs age 30-49 yr [odds ratio (OR)=16.4, 95% confidence interval (CI)=5.7-47.7], chronic pulmonary disease (OR=2.1, CI=1.1-4.0), preoperative hypoalbuminaemia (OR=4.9, CI=2.4-10), creatinine clearance 60 (OR=4.1, CI=1.2-13.4), emergency case (OR=1.8, CI=1.0-3.1), operative time >3 vs <1 h (OR=3.0, CI=1.5-6.2), airway surgery (OR=32.2, CI=13.6-76), head and neck surgery (OR=3.4, CI=1.8-6.2), cardiac surgery (OR=3.8, CI=1.1-13.4), thoracic surgery (OR=6.3, CI=1.9-21.2), cardiac catheterization (OR=2.5, CI=1.1-5.5), ASA physical status III (OR=3.8, CI=1.4-10), and the use of certain types of neuromuscular blocking agent (P<0.001). Age 3 h were operative factors, while certain neuromuscular blocking agents and ASA physical status III were anaesthetic factors for reintubation.
Publisher: Public Library of Science (PLoS)
Date: 23-08-2019
Publisher: Wiley
Date: 10-2009
DOI: 10.1111/J.1440-1797.2009.01126.X
Abstract: To evaluate the cost-effectiveness of a repeat urine culture after a few days of antibiotic therapy in childhood urinary tract infection (UTI) in southern Thailand. A retrospective review of the medical record of children diagnosed with UTI aged less than 15 years in Songklanagarind Hospital from January 1995 to December 2004 was performed. Patient demographics were collected. The results of repeat urine culture after starting antibiotic were evaluated. The risk factors that indicated positive repeat urine culture were determined. Four hundred and forty-nine patients (245 boys and 204 girls) with 533 UTI episodes were analyzed, of which 49 (9.2%) had a repeat urine culture with significant growth. Multivariate analysis showed that age less than 1 year, aetiological agents Enterococci spp., fever of more than 72 h, inappropriate antibiotics and kidney, ureter and bladder anomalies were the most significant risk factors for a positive repeat culture, while sex, vesicoureteral reflux and recurrent UTI episodes were not significant risk factors. If the treatment protocol during the study period had indicated that children with at least one of the above risk factors should receive a repeat urine culture, then only 356 cases (66.8% +/- 2.0%) would have received a repeat test and $US 655 would have been saved, while five positive repeat urine cultures would have been missed. The present study in a group of Thai children indicates that a repeat urine culture during antibiotic therapy should still be recommended.
Publisher: Wiley
Date: 2001
DOI: 10.1002/HED.1112
Abstract: Potential lymphatic drainage patterns from cutaneous melanomas of the head and neck are said to be variable and frequently unpredictable. The aim of this article is to correlate the anatomic distribution of pathologically involved lymph nodes with primary melanoma sites and to compare these findings with clinically predicted patterns of metastatic spread. A prospectively documented series of 169 patients with pathologically proven metastatic melanoma was reviewed by analyzing the clinical, operative, and pathologic records. Clinically, it was predicted that melanomas of the anterior scalp, forehead, and face could metastasize to the parotid and neck levels I-III the coronal scalp, ear, and neck to the parotid and levels I-V the posterior scalp to occipital nodes and levels II-V and the lower neck to levels III-V. Minimum follow up was 2 years. There were 141 therapeutic (97 comprehensive, 44 selective) and 28 elective lymphadenectomies (4 comprehensive dissections, 21 selective neck dissections, and 3 cases in which parotidectomy alone was performed). Overall, there were 112 parotidectomies, 44 of which were therapeutic and 68 elective. Pathologically positive nodes involved clinically predicted nodal groups in 156 of 169 cases (92.3%). The incidence of postauricular node involvement was only 1.5% (3 cases). No patient was initially seen with contralateral metastatic disease however, 5 patients (2.9%) failed in the contralateral neck after therapeutic dissection. In 68% of patients, metastatic disease involved the nearest nodal group, and in 59% only a single node was involved. Cutaneous malignant melanomas of the head and neck metastasized to clinically predicted nodal groups in 92% of patients in this series. Postauricular and contralateral metastatic node involvement was uncommon.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.AJP.2015.09.003
Abstract: To help decrease the burden of substance-related problems, the World Health Organization developed the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST) - a sensitive screening questionnaire to help identify misuse of alcohol and other substances - linked to Brief Intervention (BI). This paper compares the effectiveness of the ASSIST followed either by its linked BI or by simple advice (SA). The trial was conducted in southern Thailand. The ASSIST was used to screen patients attending primary care units and categorise them into 'low-risk', 'moderate-risk' and 'high-risk' groups. Patients at 'moderate-risk' were randomised to receive ASSIST-linked BI (n=120) or SA (n=116). The outcome measures were changes in the ASSIST-Specific Substance Involvement Scores (ASSIST-SSIS), ASSIST-Total Substance Involvement Scores (ASSIST-TSIS) and proportions of patients whose scores at three and six months had decreased from the 'moderate-risk' to 'low-risk' category. 147 patients (72 BI 75 SA) completed the six-month trial. There were significant reductions in both ASSIST-SSIS and ASSIST-TSIS, with no significant difference between groups. The percentages of patients converted to the 'low-risk' category were 36.7% and 38.8% at month 3, and 53.3% and 53.4% at month 6, for the BI and SA groups, respectively. In conclusion, in primary care administering the ASSIST and telling patients their score, followed either by formal brief intervention or simple advice, are equally effective in decreasing substance use for up to six months.
Publisher: Elsevier BV
Date: 10-2014
DOI: 10.1016/J.YRTPH.2014.06.007
Abstract: Herbal containing medicine consumption has increased while the awareness of adverse drug reaction (ADR) was less than conventional medicine. Early detection of unexpected numbers of ADRs from herbal medicines' reports which are abnormal from the whole database needs quantification. Disproportionality analysis has been performed for signal detection by using reporting odds ratio (ROR) as measurement. The impact of having medicine as exposures in each ADR should be measured by using reported population attributable risks (RPAR). This study aimed to quantify the contribution of Thai traditional medicine (TTM) to ADR reports and to assess the association between TTMs and serious adverse drug reactions. Data were retrieved from the adverse drug reaction surveillance database, Thai-Food and Drug Administration from 2002 to 2013. Crude and adjusted RORs for each drug-ADR pair and RPARs were computed. TTM contributed only 0.001% of all serious ADRs reported. Out of 4208 TTM-ADR pairs were examined, three had the statistically significant RORs, namely Andrographis paniculata and anaphylactic shock (ROR 2.32, 95% CI 1.03, 5.21) green traditional medicine and Stevens-Johnson syndrome (ROR 13.04, 95% CI 5.4-31.51) and Derris scandens Benth and angioedema (ROR 2.71, 95% CI 1.05-6.95). Their RPARs ranged from 0.05% to 0.16%. We conclude that TTMs need more intensive surveillance.
Publisher: Springer Science and Business Media LLC
Date: 18-06-2020
DOI: 10.1186/S12889-020-09090-W
Abstract: The comorbid presence of tuberculosis and diabetes mellitus has become an increasingly important public health threat to the prevention and control of both diseases. Thus, household contact investigation may serve a dual purpose of screening for both tuberculosis and diabetes mellitus among household contacts. We therefore aimed to evaluate the coverage of screening for tuberculosis and diabetes mellitus among household contacts of tuberculosis index cases and to determine predictors of tuberculosis screening. A household-based survey was conducted in February 2019 in Muang district of Phatthalung Province, Thailand where 95 index tuberculosis patients were newly diagnosed with pulmonary or pleural tuberculosis between October 2017 and September 2018. Household contacts of the index patients were interviewed using a structured questionnaire to ascertain their past-year history of tuberculosis screening and, if appropriate, diabetes mellitus screening. For children, the household head or an adult household member was interviewed as a proxy. Coverage of tuberculosis screening at the household level was regarded as households having all contacts screened for tuberculosis. Logistic regression and mixed-effects logistic regression models were used to determine predictors of tuberculosis screening at the household and in idual levels, respectively, with the strengths of association presented as adjusted odds ratios (AOR) and 95% confidence intervals (CI). Of 61 responding households (64%), complete coverage of tuberculosis screening at the household level was 34.4% and among the 174 household contacts was 46.6%. About 20% of contacts did not receive any recommendation for tuberculosis screening. Households were more likely to have all members screened for tuberculosis if they were advised to be screened by a healthcare professional rather than someone else. At the in idual level, contacts aged ≥35 years (AOR: 30.6, 95% CI: 2.0–466.0), being an employee (AOR: 0.1, 95% CI: 0.0–0.8) and those who had lived more than 5 years in the same household (AOR: 0.1, 95% CI: 0.0–0.8) were independent predictors for tuberculosis screening. Coverage of diabetes mellitus screening was 80.6% with lack of awareness being the main reason for not being screened. Compared to diabetes screening, the coverage of tuberculosis screening was low. A better strategy to improve coverage of tuberculosis contact screening is needed.
Publisher: Japan Epidemiological Association
Date: 07-2017
Publisher: Informa UK Limited
Date: 12-2012
DOI: 10.1080/17441692.2012.733719
Abstract: Pregnant women giving birth in Nepal need to use out-of-pocket payment for delivery care services due to a lack of insurance policies. The objective of this study was to examine the ability of pregnant Nepalese women to pay for delivery care services and the effects of the current household health expenditure on impoverishment due to hospital-based delivery services, especially normal delivery (ND) and caesarean section (CS). A cross-sectional study was conducted from May to August 2009 at Tribhuvan University Teaching Hospital. Ability to pay was defined as the current health spending being less than 5% of annual household income. Poverty occurred when a household's per capita income fell to less than US$1 per day. Impoverishment was considered as poverty headcount and normalised poverty gap. On average, the percentage of annual household income spent on current delivery care was 5.9% in the ND group and 9.7% in the CS group. The CS group had a stronger impoverishment effect resulting in a high per cent change of payment-induced poverty headcount by 78.1% and poverty gap by 97.3% compared to 7.7 and 24.1% in the ND group, respectively. There is a strong need to develop a well-prepared financial system to prevent the issue of poverty and impoverishment.
Publisher: Wiley
Date: 30-06-2004
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2006
Abstract: OBJECTIVES. The objectives of this study were to review the prevalence, cause, and morbidity and mortality rates of acute renal failure in a large tertiary care institution in southern Thailand, to examine any differences in acute renal failure cases diagnosed during a 22-year period, and to determine the risk factors indicating death. METHODS. The case records for children 1 month to 17 years of age who were diagnosed as having acute renal failure between February 1982 and December 2004, in the Department of Pediatrics, Songklanagarind Hospital, in southern Thailand, were reviewed. RESULTS. A total of 311 children with 318 episodes of acute renal failure were included, that is, 177 boys (55.7%) and 141 girls (44.3%), 1 month to 16.7 years of age (mean age: 7.6 ± 5.1 years median age: 7.8 years). The causes of acute renal failure in each age group were significantly different. Overall, sepsis was the major cause of acute renal failure, accounting for 68 episodes (21.4%), followed by hypovolemia, poststreptococcal glomerulonephritis, systemic lupus erythematosus, and infectious diseases. Renal replacement therapy was performed in 55 cases (17.3%). The overall mortality rate was 41.5%. Logistic regression analysis showed that disease groups and creatinine levels were significant independent predictors of outcomes. CONCLUSIONS. The incidence of acute renal failure in Songklanagarind Hospital was 0.5 to 9.9 cases per 1000 pediatric patients, with a mortality rate of 41.5%. Sepsis was a major cause of acute renal failure and death. Causes of acute renal failure and serum creatinine levels were significant independent predictors of death.
Publisher: EpiSmart Science Vector Ltd
Date: 12-2018
Publisher: Elsevier BV
Date: 10-2003
Publisher: Oxford University Press (OUP)
Date: 05-2009
DOI: 10.1111/J.1708-8305.2009.00331.X
Abstract: Current data on risk of travelers' diarrhea (TD) among visitors to Thailand largely comes from US military personnel, Peace Corps volunteers, or expatriates. We performed a 14-month systematic study of the incidence rate and characteristics of TD and a smaller study of etiology of the disease among visitors to Phuket and Chiang Mai. One randomly selected day each week from August 2005 until October 2006, data were collected from foreign tourists departing from airports serving Phuket and Chiang Mai. A separate subgroup of subjects with TD acquired in Phuket were invited to submit a stool s le for enteropathogens. Based on 22,401 completed questionnaires, the attack rate for TD was highest among residents from Australia or New Zealand (16%), while those from the United States and Europe had attack rates of 7% to 8%. Independent risk factors for the development of TD were eating outside the hotel and eating meat. In contrast, a history of drinking tap water and consuming ice cream were protective. In 56 subjects studied for etiology, Aeromonas spp were found in 8 subjects (14%), enterotoxigenic Escherichia coli (ETEC) or Vibrio spp each was found in 7 (13%) with O1 V. cholera (cholera) seen in one, mixed pathogens were found in 3 (5%), with no pathogen being detected in 33 (59%). Phuket and Chiang Mai should not be considered high-risk destinations for development of TD among US and European travelers to Thailand. In the study, Aeromonas, ETEC, and Vibrio spp were the most frequent enteropathogens identified.
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.DRUGALCDEP.2014.01.021
Abstract: Meth hetamine has become one of the most widely used illicit substances in the world. We measured the prevalence and identified the correlates of meth hetamine use amongst current injection drug users (IDUs) in a China-Myanmar border region. A cross-sectional survey including interviews and serological testing was conducted in 2012. Chinese IDUs who had injected within the past six months and aged ≥ 18 years were recruited using respondent-driven s ling (RDS). Logistic regression indentified factors associated with current meth hetamine use. Among 370 IDUs recruited, prevalence of lifetime and current meth hetamine use was 84.2% and 75.2% respectively. Amongst 293 current users, 18.1% ever purchased meth hetamine from Myanmar while 8.9% ever used it there during the past 6 months. IDUs who had cross-border activities, including purchasing drugs (AOR: 1.20 95% CI: 1.10, 1.31) and visiting family/friends, doing business or odd jobs in Myanmar (AOR: 1.13 95% CI: 1.02, 1.24) were more likely to use meth hetamine in the past six months. Other factors independently associated with current meth hetamine use included being younger (aged ≤ 25 years, AOR: 1.24 95% CI: 1.09, 1.41), being syphilis positive (AOR: 1.17 95% CI: 1.03, 1.33), having used previously self-used needle/syringe (AOR: 1.20 95% CI: 1.08, 1.34) and recently received prevention services (AOR: 1.15 95% CI: 1.04, 1.28). Meth hetamine has become another major drug of use and poses the serious concern among injecting drug users living in the China/Myanmar border region. The bi-national cooperation is urgently needed to develop targeted effective intervention strategies.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2016
Publisher: Informa UK Limited
Date: 05-2023
DOI: 10.2147/RMHP.S400667
Publisher: Springer Science and Business Media LLC
Date: 04-04-2017
Publisher: MDPI AG
Date: 15-10-2017
Publisher: Akademiai Kiado Zrt.
Date: 09-2016
Publisher: Springer Science and Business Media LLC
Date: 29-09-2018
Publisher: Springer Science and Business Media LLC
Date: 18-05-2019
DOI: 10.1007/S00127-019-01732-8
Abstract: This study aims to examine and compare the effects of direct and indirect exposure to armed conflicts on the mental health of primary school students in the three southernmost provinces of Thailand. A school-based survey was conducted. Detailed exposure of traumatic events both directly and indirectly were measured by a self-completed questionnaire. Behavioral-emotional problems were measured by the Strength and Difficulty Questionnaire and screening for post-traumatic stress disorder (PTSD) was done using the Children's Revised Impact of Events Scale (CRIES). Multivariate analysis adjusted for gender and other covariates was used to determine the effect of direct and indirect exposure of armed conflict on mental health problems. Out of 941 students included in the study, almost half had direct exposure to an armed conflict event. Overall, 42.1% of students had at least one behavioral-emotional problem (47.6% and 38.5% in the direct- and indirect-exposed groups, respectively) and 30.5% was found to have PTSD (37.3% and 25.9% in the direct- and indirect-exposed groups, respectively). Students who had direct exposure to an armed conflict event had a two times higher odds of mental health problems than their peers. Other modifiable factors of mental health problems were receiving news from two sources including other adults and media, and exposure to other non-conflict-related traumatic life events. Children living in armed conflict areas of southern Thailand, although without any direct exposure to traumatic events, also suffered from mental health problems. Research on appropriate interventions for these children should be further conducted.
Publisher: Wiley
Date: 09-1999
DOI: 10.1046/J.1440-1622.1999.01651.X
Abstract: Total thyroidectomy is widely practised in Australasia for papillary and follicular thyroid carcinoma. Data from large overseas series have demonstrated that patients with these cancers may be separated into risk groups based on clinicopathological prognostic factors. Furthermore, evidence suggests that low-risk patients may be safely treated with less than total thyroidectomy. The aim of the present paper was to determine what proportion of our patients with papillary and follicular thyroid cancer were in the low-risk group in order to select candidates for less aggressive treatment. A prospectively documented series of 175 previously untreated patients with papillary and follicular thyroid carcinoma, treated principally by total thyroidectomy over a 10-year period, was ided into risk groups using the Mayo Clinic, Lahey Clinic and Memorial Hospital prognostic scoring systems. Complication rates for 103 patients treated by total thyroidectomy were also studied and reported. Women outnumbered men by 2.3:1. There were 128 papillary carcinomas (73%) and 47 follicular cancers (27%). These tumours were < 4 cm in diameter in 81% of patients, and 41% of patients were 40 years of age or younger. Low-risk patients accounted for 75, 81 and 45% of the study group, respectively, when the three prognostic scoring systems were applied to our patient population. The rates for recurrent laryngeal nerve palsy and permanent hypoparathyroidism for patients having total thyroidectomy were 1 and 1.9%, respectively. In the low-risk group there were no permanent complications. Most patients treated at Royal Prince Alfred Hospital during the past 10 years were low-risk patients who may have been eligible for less aggressive surgical treatment.
Publisher: S. Karger AG
Date: 2018
DOI: 10.1159/000493417
Abstract: b i Background: /i /b There is scarce information on the efficacy of alternative medicine (AM) alone as a treatment for newly diagnosed acute leukemia in children. We aimed to compare overall survival (OS) between children with newly diagnosed acute leukemia who received AM alone as the first-line treatment and those treated with conventional chemotherapy (CCT). b i Methods: /i /b Two-to-one nearest-neighbor propensity score-matching using sex, initial white blood cell count, phenotype of leukemia, and period of diagnosis was performed on 184 patients who received CCT and 92 who received AM alone after being diagnosed with leukemia. A multivariable Cox proportional-hazards regression model was then applied to assess the effect of treatment on OS after adjusting for potential confounders. Hazard ratios (HR) and 95% confidence intervals (CI) are provided. b i Results: /i /b After adjusting for initial white cell count and subtype of leukemia, children treated with AM alone had worse OS (HR 5.14, 95% CI 3.75–7.04) than those given CCT. The 5-year OS rate for newly diagnosed acute leukemia treated with AM medicine alone was 0%. b i Conclusion: /i /b AM without CCT is associated with poorer survival when compared with CCT.
Publisher: Copernicus GmbH
Date: 25-11-2021
DOI: 10.5194/ACP-21-17185-2021
Abstract: Abstract. Aerosol particles are a complex component of the atmospheric system which influence climate directly by interacting with solar radiation, and indirectly by contributing to cloud formation. The variety of their sources, as well as the multiple transformations they may undergo during their transport (including wet and dry deposition), result in significant spatial and temporal variability of their properties. Documenting this variability is essential to provide a proper representation of aerosols and cloud condensation nuclei (CCN) in climate models. Using measurements conducted in 2016 or 2017 at 62 ground-based stations around the world, this study provides the most up-to-date picture of the spatial distribution of particle number concentration (Ntot) and number size distribution (PNSD, from 39 sites). A sensitivity study was first performed to assess the impact of data availability on Ntot's annual and seasonal statistics, as well as on the analysis of its diel cycle. Thresholds of 50 % and 60 % were set at the seasonal and annual scale, respectively, for the study of the corresponding statistics, and a slightly higher coverage (75 %) was required to document the diel cycle. Although some observations are common to a majority of sites, the variety of environments characterizing these stations made it possible to highlight contrasting findings, which, among other factors, seem to be significantly related to the level of anthropogenic influence. The concentrations measured at polar sites are the lowest (∼ 102 cm−3) and show a clear seasonality, which is also visible in the shape of the PNSD, while diel cycles are in general less evident, due notably to the absence of a regular day–night cycle in some seasons. In contrast, the concentrations characteristic of urban environments are the highest (∼ 103–104 cm−3) and do not show pronounced seasonal variations, whereas diel cycles tend to be very regular over the year at these stations. The remaining sites, including mountain and non-urban continental and coastal stations, do not exhibit as obvious common behaviour as polar and urban sites and display, on average, intermediate Ntot (∼ 102–103 cm−3). Particle concentrations measured at mountain sites, however, are generally lower compared to nearby lowland sites, and tend to exhibit somewhat more pronounced seasonal variations as a likely result of the strong impact of the atmospheric boundary layer (ABL) influence in connection with the topography of the sites. ABL dynamics also likely contribute to the diel cycle of Ntot observed at these stations. Based on available PNSD measurements, CCN-sized particles (considered here as either nm or nm) can represent from a few percent to almost all of Ntot, corresponding to seasonal medians on the order of ∼ 10 to 1000 cm−3, with seasonal patterns and a hierarchy of the site types broadly similar to those observed for Ntot. Overall, this work illustrates the importance of in situ measurements, in particular for the study of aerosol physical properties, and thus strongly supports the development of a broad global network of near surface observatories to increase and homogenize the spatial coverage of the measurements, and guarantee as well data availability and quality. The results of this study also provide a valuable, freely available and easy to use support for model comparison and validation, with the ultimate goal of contributing to improvement of the representation of aerosol–cloud interactions in models, and, therefore, of the evaluation of the impact of aerosol particles on climate.
Publisher: SAGE Publications
Date: 29-04-2013
Abstract: Lupus nephritis (LN) is more common and severe in childhood-onset systemic lupus erythematosus (SLE) than in adults. It is one of the major causes of acute kidney injury (AKI) and chronic kidney disease (CKD) in children. Steroid therapy has been used as the first-line treatment for SLE since 1970, and has improved the survival of SLE patients from ∼ 50% to %. Over the years many immunosuppressive drugs, including pulse methylprednisolone, oral cyclophosphamide, pulse intravenous cyclophosphamide, mycophenolate mofitil, rituximab, and tacrolimus, have been combined with prednisolone, further improving survival rates to 90%–95%. However, the effectiveness of these drugs is still uncertain, as most seem very good in the beginning, but in studies examining longer-term follow-up the remission of disease does not remain. Fatal infection is still a major complication of aggressive chemotherapy, and the potential benefits as well as adverse events from each drug need to be considered. Induction of remission is the major aim of therapy, with safe and effective maintenance therapy for long-term remission. The survival rates of many published studies vary widely because of differences in patients and treatment modalities, severity of disease, renal histopathology, racial factors, and duration of follow-up. Finding the optimal treatment for SLE and related co-morbidities is highly challenging, and will likely involve a complex combination of different drugs for different patients in the search for giving them an opportunity to be free from this debilitating disease.
Publisher: Public Library of Science (PLoS)
Date: 09-09-2014
Publisher: Baishideng Publishing Group Inc.
Date: 2009
DOI: 10.3748/WJG.15.3382
Publisher: Springer Science and Business Media LLC
Date: 12-2013
Publisher: Public Library of Science (PLoS)
Date: 05-02-2014
Publisher: Springer Science and Business Media LLC
Date: 20-11-2018
Publisher: Elsevier BV
Date: 02-2015
DOI: 10.1016/J.JIAC.2014.10.002
Abstract: Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is one of the most important healthcare associated diseases worldwide. Although antibiotic use is recognized as a risk factor for CRAB infection, the impact of antibiotic class and length of use on CRAB infection is still unclear. A case-control study was conducted in adult intensive care units and general wards of Songklanagarind Hospital, a tertiary-care hospital in southern Thailand, to investigate the effect of different antibiotic exposure and the duration of use on the risk of developing CRAB infection. Cases were defined as patients with carbapenem-susceptible A. baumannii (CSAB) or CRAB infection. Controls were randomly selected from patients and matched 1:1 with cases using ward and date of admission. Multinomial logistic regression was used to compute relative risk ratios (RRR) and 95% confidence intervals (CI) for CRAB infection. Of 197 cases with A. baumannii infection, there were 139 with CRAB infection and 58 with CSAB infection. Compared to the control group, use of fluoroquinolones, broad-spectrum cephalosporins and carbapenems for more than three days increased the risk of CRAB infection with RRR (95% CI) of 81.2 (38.1-862.7), 31.3 (9.9-98.7) and 112.1 (7.1-1770.6), respectively. The RRR (95% CI) for one to three day treatment of fluoroquinolones, broad-spectrum cephalosporins and carbapenems were 5.4 (0.8-38.7), 6.2 (0.1-353.2) and 63.3 (15.6-256.9), respectively. Long-term use of certain antibiotics and even short term use of carbapenems increased the risk of CRAB infection. In this setting, use of these antibiotics, especially carbapenems, should be limited to reduce CRAB infection.
Publisher: Informa UK Limited
Date: 08-2019
DOI: 10.2147/TCRM.S203883
Publisher: Springer Science and Business Media LLC
Date: 07-01-2020
DOI: 10.1186/S13756-019-0672-6
Abstract: Misuse of antibiotics in food animals contributes to an increase of antibiotic resistant bacteria transmitting to humans. China is the largest producer and user of antibiotics in the world, of which animals share more than half of the total consumption. This study aimed to explore Chinese farmer’s practice of antibiotic use and the factors associated with their use. In this cross-sectional survey, we interviewed farmers from 88 chicken farms in northwestern China. We defined two kinds of misuse: 1) using antibiotics in the Chinese prohibited list, and 2) using antibiotics within the recommended withdrawal period. Factor analysis was used to select farmers’ knowledge variables and multinomial logistic regression was used to determine factors associated with antibiotic misuse. All the participating farmers used antibiotics on their farms. Amoxicillin was the most common antibiotic used (76.5%), followed by norfloxacin, ofloxacin, ceftriaxone and oxytetracycline. 75% of farmers used antibiotics in the prohibited list while 14.8% continued to use antibiotics during the withdrawal period. Hierarchical cluster analysis revealed three patterns of antibiotic use: 1) excessive use of non-prohibited and prohibited antibiotics or an excessive user, 2) low use of a few types of non-prohibited and moderate use of prohibited antibiotics or a low user, 3) multiple use of a variety (≥ 7 types) of non-prohibited and prohibited antibiotics or a moderate user. Farmers from medium size, family-based farms, those with a low education level and low income were more likely to misuse antibiotics. Prior formal agricultural training was associated with reducing multiple types of antibiotic use. There was a huge gap between policy and reinforcement causing antibiotic misuse in the study community. Antibiotics are commonly used on chicken farms misuse of antibiotics is high improvement in farm sanitation, education on antibiotic use for farmers and veterinarians harmacists and enforcement of the regulations may reduce antibiotic use on chicken farms in China.
Publisher: Hindawi Limited
Date: 2013
DOI: 10.1155/2013/580974
Abstract: Background . Suboptimal adherence to antiretroviral therapy (ART) is still pervasive. The effect of using a mobile phone call intervention to improve patient adherence is currently not known. Objective . This study aims to investigate the effects of a phone call intervention on adherence to ART and quality of life (QOL) of treatment-naive and treatment-experienced patients. Methods . A randomized controlled trial was conducted in the three largest public hospitals. Adherence was measured by self-completed questionnaires. QOL was assessed by the WHOQOL-HIV BREF. Outcomes were assessed at day 15, at 1, 2, and 3 months after start of treatment for treatment-naive patients and at 3 months after study enrollment for treatment-experienced patients. Results . A total of 103 treatment-naive and 93 treatment-experienced HIV/AIDS patients were consecutively recruited. Results show that a phone call intervention could maintain high self-reported adherence among both treatment-naive and treatment-experienced patients. After three months, significant QOL improvements were observed in domains of physical health ( P = 0.003 ) , level of independence ( P = 0.018 ) , environment ( P = 0.002 ) , and spirituality/religion ersonal beliefs ( P = 0.021 ) among treatment-naive patients. Conclusion . A mobile phone call intervention to patients could maintain high adherence rates although no statistically significant differences were found. A phone call could improve some domains of QOL among treatment-naive patients.
Publisher: MDPI AG
Date: 05-06-2022
Abstract: Mobile health (mHealth) applications (apps) have been developed in hospital settings to allocate and manage medical care services, which is one of the national strategies to improve health care in China. Little is known about the comprehensive effects of hospital-based mHealth app use on client satisfaction. The aim of this study was to determine the relationship between the full range of mHealth app use and satisfaction domains among clients attending outpatient clinics. A cross-sectional survey was conducted from January to February 2021 in twelve tertiary hospitals in Inner Mongolia. After the construction of the mHealth app use, structural equation modeling was used for data analysis. Of 1889 participants, the standardized coefficients β on environment/convenience, health information, and medical service fees were 0.11 (p 0.001), 0.06 (p = 0.039), and 0.08 (p = 0.004), respectively. However, app use was not significantly associated with satisfaction of doctor–patient communication (β = 0.05, p = 0.069), short-term outcomes (β = 0.05, p = 0.054), and general satisfaction (β = 0.02, p = 0.429). Clients of the study hospitals were satisfied with the services, but their satisfaction was not much associated with mHealth use. The limitation of the mHealth system should be improved to enhance communication and engagement among clients, doctors, and healthcare givers, as well as to pay more attention to health outcomes and satisfaction of clients.
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.AMJSURG.2012.11.016
Abstract: Although there has been growing evidence from off-label use of recombinant activated factor VII (rFVIIa) in surgical bleeding, there is limited information on prediction scores. A retrospective study was conducted from 2004 to 2009. The primary outcome was efficacy of bleeding control. Multivariate logistic regression was performed to develop a new prediction score for success of rFVIIa. A total of 320 bleeding episodes from 243 nonhemophilic patients who underwent surgery were analyzed. Effective bleeding control was demonstrated in 153 patients. The overall in-hospital mortality rate was 40%. Multivariate analysis identified 4 independent predictors for effective bleeding control: timing of rFVIIa administration, intraoperative blood loss, postoperative international normalization ratio values, and total units of platelets transfused. A rFVIIa success prediction score was developed. The use of this new prediction score may support decision making by identifying patients with a high probability of obtaining effective bleeding control from rFVIIa therapy.
Publisher: Springer Science and Business Media LLC
Date: 09-09-2016
Publisher: Oxford University Press (OUP)
Date: 27-01-2018
Abstract: Aim of this study is to assess women's utilization and expectation of community-based antenatal and delivery care services in Myanmar and determine associated factors for disparity of services received with services women expected to receive. A cross-sectional survey was conducted among 6-month postpartum women in three townships of Myanmar during May-September 2016. Associated factors for the services with disparity were identified using multinomial logistic regression models. Of 1743 women, the percentages of antenatal care (ANC) attended by a skilled provider, at least four ANC visits, and early ANC were 89, 60 and 36%, respectively. The percentage of non-facility delivery was 65%. Many ANC services received and services expected to receive had lower than 80% coverage. Services with significant disparity included blood hemoglobin and urinary protein testing, and iron supplementation. Low access to ANC, women's socio-economic status, pregnancy and delivery complications, and out-of-pocket cost were associated with disparity of these services. Utilization and expectation of community-based ANC services and facility delivery is low in Myanmar. Disparities of the services received with the services women expected to receive were common in ANC. Improving women's expectations on essential services during pregnancy is needed as well as strengthening community participation.
Publisher: Elsevier BV
Date: 03-2003
Publisher: Maad Rayan Publishing Company
Date: 11-05-2021
Abstract: Background: As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. Methods: Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. Results: A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P .001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P .001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P .001) compared to urban patients. Conclusion: Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.
Publisher: Elsevier BV
Date: 2019
Publisher: Informa UK Limited
Date: 09-04-2020
Publisher: Informa UK Limited
Date: 18-03-2011
DOI: 10.3109/00952990.2010.535578
Abstract: To describe the patterns of patients' attendance over the first three quarters of a year under methadone maintenance treatment (MMT) clinics in Yunnan Province, China. Data were obtained from drug abuse treatment databases from five MMT clinics in Yunnan Province. Patients registered between April 2007 and December 2007 were included in the analysis. The study period was ided into three phases consisting of 3 months each. Logistic regression was used to predict factors determining whether the patients attended the clinic on each day with repetition of the patients taken into account. The median number of days attending the clinics was 61 in the total treatment period, and the likelihood of a patient attending the clinic in the second and third phases was significantly less [odds ratio (OR) = .44 and .30, 95% confidence interval (CI) = .40-.49 and .26-.34] compared with the first phase. The predictors for attendance at clinic were being unmarried (OR = .63, 95% CI = .49-.82), self-employed (OR = .18, 95% CI = .11-.28), having a history of syringe sharing (OR = .67, 95% CI = .48-.92), and having been in a detoxification program (OR = 1.59, 95% CI = 1.09-2.33). Heroin users attended MMT programs irregularly and their periods of attendance significantly declined by duration of the time they stayed in the treatment program. Additional interventions should be employed to help patients adhere to this long-term treatment program.
Publisher: Hindawi Limited
Date: 23-12-2018
DOI: 10.1155/2018/8267059
Abstract: Background . The incidence of liver and bile duct cancer continues to rise, especially in Thailand. We aimed to project the trends in incidence of this rare but lethal cancer in southern Thailand in order to determine its future disease burden. Methods . Gender-specific trends in age-standardized incidence rates per 100,000 person-years for hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) cases in Songkhla province of southern Thailand diagnosed between 1989 and 2013 were estimated and projected up to year 2030 using three different modeling techniques: a joinpoint model, an age-period-cohort model, and a modified age-period-cohort model. Results . Of 2,676 liver and bile duct (LBD) cancer cases identified, 73% were males, 51% were aged between 50 and 69 years, and HCC (44.4%) was slightly more common than CCA (38.1%). The models all predicted an increase in the incidence rate of CCA up to 2025 for both sexes whereas the incidence of HCC is expected to decrease among males and stabilize among females. The incidence rates of HCC and CCA among males in 2030 could reach 6.7 and 9.4 per 100,000 person-years, respectively, whereas the expected rates of HCC and CCA among females are expected to be around 1.5 and 3.9 per 100,000 person-years, respectively. Conclusions . The incidence of cholangiocarcinoma is expected to increase in Songkhla and will contribute a larger proportion of LBD cancers in the future. Future public health efforts and research studies should focus on this increasing trend.
Publisher: Oxford University Press (OUP)
Date: 27-09-2011
DOI: 10.1093/NDT/GFR477
Abstract: Acute kidney injury (AKI) is a common contributor to morbidity and mortality in newborns, with prevalences varying by population and hospital. A study of AKI in newborns in tertiary care centers in Thailand, a developing country with limited resources, has not been conducted yet. The aim of this study was to determine the prevalence of AKI in newborns in a tertiary care hospital in southern Thailand and to investigate the etiology, mortality and risk factors of mortality. The records of patients aged <30 days with high serum creatinine, admitted from 1984 to 2007, were retrospectively reviewed. Eighty-eight boys and 51 girls were enrolled 61.4% were premature and 56.5% had a birth weight <2500 g. The prevalence of newborn AKI increased from 0.9 to 6.3% during the 24-year study period. Thirty-nine and 65% had renal failure within 2 and 7 days post-birth, respectively. Sepsis was the most common cause of AKI (30.9%) followed by hypovolemia (18.7%), kidney, ureter and bladder (KUB) anomalies (12.2%), congestive heart failure (12.2%) and birth asphyxia (11.5%). Indomethacin caused AKI in 24.4% with gestational age <32 weeks. Sepsis-induced AKI had the highest mortality rate (65.1%) with an overall mortality rate of 38.8% and nearly 14 times the risk of death compared to hypovolemia-induced AKI. The prevalence of newborn AKI in our Thai tertiary center over 24 years was 6.3% of admitted newborns. Sepsis was the most common cause of AKI and sepsis-induced AKI is the most common cause of death. Disease etiology was the only risk factor for mortality.
Publisher: Korean Cancer Association
Date: 15-01-2017
DOI: 10.4143/CRT.2016.045
Publisher: Wiley
Date: 2005
DOI: 10.1002/HED.20129
Abstract: Patients with advanced cervical metastases from mucosal squamous cell carcinoma have a poor prognosis because of their high risk of regional and distal failure. This study aims to evaluate the outcomes of patients with clinical N2 or N3 disease managed with surgery and postoperative radiotherapy. From a comprehensive computerized database, 181 entered patients who had neck dissection for N2 or N3 disease between 1988 and 1999 were evaluated. The mean age was 62 years, and minimum follow-up was 3 years. A total of 233 neck dissections were performed in 181 patients, including 163 comprehensive and 70 selective dissections. Postoperative radiotherapy was given in 82% of cases. The local control rate was 75% at 5 years, and control of disease in the treated neck was achieved in 86%. Macroscopic extracapsular spread (ECS) significantly increased regional recurrence (p = .001). Adjuvant radiotherapy significantly improved neck control (p = .004) but did not alter survival. Patients with ECS (both microscopic and macroscopic) who received radiotherapy had a significantly better survival than did patients with ECS who did not receive radiotherapy. Disease-specific survival for the entire group was 39% at 5 years. By use of multivariate analysis, macroscopic ECS and N2c neck disease were independent adverse prognostic factors for survival (p = .001). Despite a high rate of control in the treated neck, the poor survival (39%) in this patient group indicates that adjuvant therapeutic strategies need to be considered.
Publisher: Wiley
Date: 03-06-2003
DOI: 10.1002/IJC.11261
Abstract: Mutations in the p53 and retinoblastoma (pRb) pathways associated with the use of tobacco and alcohol are common in squamous cell carcinoma (SCC) of the head and neck. Cell cycle proteins are also affected by human papillomavirus (HPV), which may also have an aetiological role in cancers at particular sites, most notably the tonsil. Attempts to identify prognostic molecular markers in head and neck cancers have met with conflicting results, but few studies have been undertaken with tumours of known HPV status at a single anatomic site. In our study 86 tonsil cancers were analysed for HPV status by sequence analysis of polymerase chain reaction products and for the expression of cell cycle proteins (p53, p21 CIP1/WAF1 , pRb, p16 INK4A , cyclin D1 and p27 KIP1 ) by immunohistochemistry. The HPV status could be established in 67 of the tumours. Thirty‐one (46%) of these were HPV‐positive, predominantly (28/31) for HPV16. Findings were related to tumour recurrence and patient survival. None of the cell cycle proteins independently predicted recurrence or survival. Patients with HPV‐positive tumours, however, were significantly less likely ( p 0.05) to have recurrence or to die of disease than those with HPV‐negative tumours, after adjusting for the effects of the cell cycle proteins, clinical stage, pathological node status, tumour grade, age, gender and treatment. These findings support the concept that HPV‐positive tonsil cancers may be a distinct biological group with less aggressive characteristics. Screening of tonsil cancers for HPV DNA may help optimise treatment and provide more accurate prognostic information. © 2003 Wiley‐Liss, Inc.
Publisher: BMJ
Date: 02-02-2009
Abstract: The study aimed to examine the effects of village income and household income on child nutrition status through basic sanitation and hygiene behaviours. A survey was conducted in a rural cross-border area of Yunnan, China. Data on village income in 2002-2006 and household income in 2002-2007 were obtained from an official report and a household survey respectively. Anthropometric measurement of the children aged 6 months to 5 years (n = 1801) was used to determine their nutrition status. Child caretakers were interviewed about household sanitation facilities and their hygiene behaviours using a structured questionnaire. Households with incomes below the national poverty line decreased from 22% in 2002 to less than 8% in 2007. The coverage of safe drinking water and water-sealed latrines gradually increased, but was still inadequate. The prevalence of stunting and underweight in children was 37% and 17.5% respectively. Village income had a greater positive effect than household income on exclusive breastfeeding, drinking boiled water, handwashing with soap, as well as reducing the prevalence of stunting. Village income at one lag year had the greatest effect on the availability of basic sanitation compared with other lag years, while household income had a small but significant effect through all lag years. Rapid economic growth is not always followed by improved child nutrition status. Village income has a greater effect than household income on sanitation facilities, hygiene behaviours of caretakers and child nutrition status.
Publisher: Elsevier BV
Date: 08-2003
DOI: 10.1016/S0266-4356(03)00119-0
Abstract: The clearance of surgical margins at the primary site is widely thought to influence the subsequent course of the disease in patients operated on for oral and oropharyngeal carcinoma. In some reports the adverse impact of close or involved margins was not negated by postoperative radiotherapy. These findings, in addition to descriptive histopathological studies, have led some authors to recommend margins of more than a macroscopic clearance of 1cm at certain subsites. We have therefore examined the relation between the condition of surgical margins and local recurrence and disease-specific survival. Identical treatment protocols were used to treat two independent groups of patients (Sydney, Australia, n=237 Lanarkshire, n=95) who presented with previously untreated carcinoma of the mouth or oropharynx. All patients were operated on with the primary objective of achieving a macroscopic clearance of 1cm. Postoperative radiotherapy was used according to a protocol. Data about patients were entered into comprehensive computerised databases prospectively. Known clinical and pathological prognostic indicators, in addition to the condition of surgical margins, were analysed to find out if they were predictive of local recurrence and disease-specific survival using the Cox proportional hazard model. Local recurrence was predicted by the presence of perineural invasion at the primary site in both groups. Disease-specific survival was predicted by the presence and extent of regional lymph node metastases in both groups. The condition of surgical margins (clear, close, or involved) did not predict local recurrence, or disease-specific survival on multivariate analysis. A macroscopic margin of 1cm seems adequate in the surgical management of oral and oropharyngeal carcinoma. For most patients who have close or involved margins the biology of the disease influences the subsequent course irrespective of the width of clearance of tumour.
Publisher: Springer Science and Business Media LLC
Date: 17-04-2018
Publisher: Wiley
Date: 12-12-2016
DOI: 10.1111/APA.13639
Abstract: The association between adiposity rebound and insulin resistance in middle childhood has seldom been studied. We examined the effect of body mass index (BMI) velocity and early adiposity rebound on the insulin resistance of prepubertal children. BMI data from a longitudinal follow-up of a birth cohort in Thailand were used. The homoeostatic model assessment of insulin resistance (HOMA-IR) was calculated from 12-hour fasting plasma glucose and serum insulin at eight-and-a-half years of age. BMI velocity was calculated from four periods: zero to one, one to three, three to six and six to eight-and-a-half years of age. A multiple linear regression model was used to assess the association of BMI velocity during these four periods and insulin resistance at the age of eight-and-a-half years. In 814 children - 76.7% of the initial cohort - BMI velocities between years one to three, three to six and six to eight-and-a-half years were positively associated with HOMA-IR levels after adjusting for demographic, behavioural and socio-economic factors. Children who had BMI gains between three and six years had mean HOMA-IR values that were 43% higher than those who did not. BMI velocity during early and middle childhood, and early adiposity rebound between three and six years, was associated with a higher insulin resistance risk at eight-and-a-half years.
Publisher: Oxford University Press (OUP)
Date: 25-04-2009
DOI: 10.1093/NDT/GFP173
Abstract: Lupus nephritis (LN) is the major indicator of morbidity and mortality in systemic lupus erythematosus (SLE). Many studies have found a significantly worse patient survival rate in patients with LN class IV than patients with other LN classes. The aim was to describe the severity and outcomes of LN in a group of Thai children. We retrospectively reviewed the patient files of children diagnosed with SLE aged < or =18 years in Songklanagarind Hospital, Southern Thailand, from 1985 to 2007. Of 216 SLE patients, 180 had renal biopsy results, and the others were excluded from analysis. There were 33 males and 147 females, average age 11.8 +/- 2.6 years (range 3.6-18.0), with a median follow-up period of 3.9 years (range 9 days to 19.4 years). Using the WHO LN classification, there were 9, 55, 5, 94 and 14 patients of classes I-V, respectively, as well as 2 with end-stage renal disease and 1 with IgM nephropathy. The mortality rate was 23% (42/180). Patients with LN class II had a similar renal and patient survival compared to patients with LN class IV (P = 0.3 and 0.2, respectively). Cox proportional hazard regression analysis in 177 patients (3 patients who had a renal biopsy result outside the WHO classification were omitted) showed that gender was an independent risk factor for survival. Males had 2.6 times the hazard rate compared to females (95% CI 1.2-5.7, P = 0.03), but LN classification, age and timing of the renal biopsy were not significant. Renal and patient survival in LN classes II and IV were similar. Gender was the only independent risk factor of mortality, with males at greater risk than females.
Publisher: BMJ
Date: 15-12-2011
DOI: 10.1136/TOBACCOCONTROL-2011-050008
Abstract: Illicit cigarette consumption has increased worldwide. It is important to understand this problem thoroughly. To investigate behaviours and factors associated with illicit cigarette consumption in southern Thailand. A survey and qualitative study were conducted in a border province in southern Thailand next to Malaysia. A modified snowballing technique was used to recruit 300 illicit and 150 non-illicit cigarette smokers. A questionnaire was used to interview subjects. Illicit cigarette packs were obtained in order to identify their characteristics. Bivariate and multivariate logistic regression was used for data analysis. Smoking of illicit cigarettes has become accepted in the communities. They were available in supermarkets and vendor shops. Friends and other illicit smokers known by illicit cigarette smokers were an important source of information for access to illicit cigarette products. The main factors associated with smoking illicit cigarettes, compared with smoking non-illicit cigarettes, were younger age, higher education and higher average monthly expenditure on cigarettes (most illicit smokers smoked illicit cigarettes (average price per packet = 33 THB (US$1.1), while most non-illicit smokers smoked hand-rolled cigarettes (average price per packet = 7 THB (US$0.2)) and knowledge of other illicit cigarette smokers. The low price of illicit cigarettes was the main reason for their use. Selling strategies included sale of singles, sale in shops and direct sale through social networking. Illicit cigarette consumption has become more acceptable especially among young adult smokers. Age and extent of social networks are important factors associated with smoking illicit cigarettes.
Publisher: Elsevier BV
Date: 1993
DOI: 10.1016/0959-8049(93)90374-O
Abstract: In a partially blinded randomised cross-over trial, 78 patients receiving cisplatinum based chemotherapy were assigned to receive two forms of antiemetic therapy: SAD, a regimen composed of serenace (haloperidol), ativan (lorazepam), and dexamethasone followed by low dose maxolon (metoclopramide) and STADMAX, a regimen composed of scopolamine (hyoscine), tavegyl (clemastine), ativan, dexamethasone and high dose maxolon. Each antiemetic regimen was given in random order, with the first and second cycles of cytotoxic chemotherapy. 66 (85%) patients completed both cycles of antiemetic therapy and were available for the cross-over comparison. Significantly less acute vomiting, as assessed by nurse observer (P < 0.0001), and less delayed vomiting, as assessed by patient diary (P = 0.03), were seen with STADMAX. In the first 18 h, complete control of vomiting (no episodes) was achieved in 30 (45%) patients with STADMAX compared with 10 (15%) receiving SAD. Overall, major control of emesis (< or = 2 episodes) was achieved in 56 (85%) patients with STADMAX compared with 35 (53%) receiving SAD. Vomiting was also better controlled on STADMAX in the week after this initial 18 hour period based on the 7 day patient diary with no vomiting episodes in 18/65 (28%) on STADMAX vs. 13/65 (20%) on SAD. However, no significant differences in appetite, nausea or vomiting were found when based on linear analogue self assessment (LASA) scales recorded by patients. Significant differences in side effects of the two antiemetic regimens were noted on LASA scales with more dry mouth (P = 0.01), blurred vision (P = 0.03) and diarrhoea (P = 0.04) associated with STADMAX and more restlessness (P = 0.002) associated with SAD. Significantly, no episodes of dystonic reactions were seen among patients on either regimen. In the 68 patients who completed both cycles and were in a position to express a preference, 46 (68%) preferred STADMAX compared with only 20 (29%) who preferred SAD (P = 0.001), while 2 patients expressed no preference. It is concluded that STADMAX is the preferred regimen to SAD for the control of cisplatinum-related emesis. It has a role, both where specific serotonin 3 antagonists are not available and as a model for building more effective combinations where these agents are available.
Publisher: Cambridge University Press (CUP)
Date: 29-08-2014
DOI: 10.1017/S0950268814002301
Abstract: Intra-home and kindergarten transmissions were the reported major modes of hand, foot, and mouth disease (HFMD) transmission in preschool children. However, infection at home is not common and 65–80% of cases do not attend preschool. We conducted a matched case-control study to explore the role of public playgrounds in the transmission of HFMD in addition to direct and indirect exposure to HFMD patients. We used 156 hospital source cases and 156 community source controls. Univariate analysis was followed by conditional logistic regression with attributable fraction computed. Adjusted odds ratios were 11·70 [95% confidence interval (CI) 1·26–109·40] for having HFMD cases in the same class, 14·19 (95% CI 3·55–56·74) for having HFMD cases within the 20 nearest neighbourhoods, 6·03 (95% CI 2·84–12·80) for exposure to public playgrounds, 2·13 (95% CI 1·05–4·32) for finger sucking and 0·29 (95% CI 0·11–0·78) for hand washing with soap before meals. The attributable fractions for the first four risk factors were 6·4%, 20·9%, 57·2% and 27·5%, respectively, while the population prevented fraction for hand washing with soap before meals was 18·7%. Based on our findings, hand washing with soap should be advocated. Health education could include topics which underline the precautions which need to be taken and the advice given regarding avoiding the use of public playgrounds during epidemic periods, especially when children have been getting sick.
Publisher: JMIR Publications Inc.
Date: 19-05-2022
DOI: 10.2196/36962
Abstract: Mobile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital ide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers. The aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade. A cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated. Of 2115 participants, the β coefficients (95% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95% CI 0.22-0.34) and 0.51 (95% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use (β=–0.38 and β=–0.41), as were less educated subgroups (β=–0.24 and β=–0.27), and these two factors had nonsignificant direct effects on mHealth use. To overcome the mHealth use ide, it is important to improve digital access and digital use among older adults and less educated groups.
Publisher: EpiSmart Science Vector Ltd
Date: 10-2022
Publisher: Wiley
Date: 11-2003
DOI: 10.1002/HED.10324
Abstract: Previous studies have demonstrated that tumor thickness might influence prognosis in oral cancer, but the significant point at which outcome changes has varied from 1.5 mm to 6 mm. The clinical relevance of thickness remains unclear, and a reproducible prognostic "breakpoint" needs to be defined. Tumor thickness was measured in 145 oral cavity squamous cancers, clinically staged T1 (n = 62) or T2 (n = 83). Clinical and pathologic data were collected prospectively between 1988 and 2000, but thickness was measured on paraffin sections for this study. Minimum follow-up was 2 years, and thickness was correlated with local control, cervical node involvement, and survival. Patients with clinically positive nodes (n = 21) were not excluded. Overall, 55 patients had pathologic node involvement at some time in their disease. Median tumor thickness was 6.2 mm, and there was little variation between sites: tongue, 6.4 mm floor of mouth, 6.6 mm and other sites, 5.7 mm. Median thickness for T1 tumors was 4.3 mm, significantly less than the T2 group, 8 mm (p <.01). Median thickness also varied significantly for tumors with associated nodal disease (8.5 mm) and without nodal disease (5.8 mm) (p <.01). Prognosis changed significantly at a cutoff of 4 mm with local control, nodal disease, and survival rates of 91%, 8%, and 100%, respectively, for tumors <4 mm compared with 84%, 48%, and 74% for those 4 mm or more thick (p <.01). Subgrouping greater than and less than 3 mm and 5 mm also showed a difference but with poorer discrimination. Thickness and pathologic nodal involvement were highly significant independent prognostic factors. Tumor thickness is a highly significant, objectively measurable prognostic factor in early stage oral cancers. There is a need to standardize techniques of measurement to allow a multi-institutional study to be carried out. This will facilitate the development of strategies aimed at improving the outcome of higher risk patients.
Publisher: Galenos Yayinevi
Date: 02-03-2017
Publisher: Asian Pacific Organization for Cancer Prevention
Date: 11-04-2016
DOI: 10.7314/APJCP.2016.17.3.1235
Abstract: A school-based smoke free home (SFH) program is useful in empowering the mother and child to reduce secondhand smoke exposure but the effects of pretesting on knowledge and attitude has been largely ignored. We aimed to test whether such a program can be effective in Southern Thailand with an additional assessment of the net effect of the pretest. A Solomon four-group design was used. Twelve rural primary schools were assigned to one of the four conditions (each with 3 schools): intervention with and without a pretest, control with and without the same pretest. The intervention was performed in the classroom and home over a period of 1 month. Outcomes were assessed at baseline and 3 months after the intervention on whether the home was smoke free and related knowledge and attitude. The intervention could lead to a smoke-free home without statistical significance. Attitude, knowledge and self-confidence on creating a smoke-free home, and self-confidence in avoidance of secondhand smoke exposure and persuading smokers to not smoke in their home were significantly improved. No pretest effect was observed. Gain in attitude, knowledge and self-confidence among family members from the brief school-based education should be enhanced by other measures.
Publisher: Informa UK Limited
Date: 07-2020
DOI: 10.2147/CMAR.S259195
Publisher: Wiley
Date: 26-01-2010
DOI: 10.1111/J.1465-3362.2009.00168.X
Abstract: Multiple substance use leads to greater levels of psycho-behavioural problems, unsafe sex, and therefore a high risk of contracting sexually transmitted diseases, and is also more difficult to treat. This study aims to determine pattern of lifetime multiple substance use among Chinese heroin users before entering methadone maintenance treatment clinic. A survey to obtain retrospective longitudinal data on lifetime multiple substance use was conducted among 203 heroin users in two of the biggest methadone maintenance clinics in Kunming City, Yunnan province. All participants used more than one substance in their lifetime. Most of them used four or more substance groups (range two to seven groups). The most common substance patterns in lifetime use were alcohol, tobacco, opiates and depressants. Approximately 80% of them had a history of simultaneous substance use (co-use). The most common combination of co-use pattern was heroin with depressant. Common reasons for co-use were to get high, to experiment, to sleep and to increase the potency of other drugs. Determinants of co-use were education, marital status and family relationship. Multiple substance use is highly prevalent among Chinese heroin users. Depressants are the most common substances used in combination with heroin.
Publisher: Informa UK Limited
Date: 04-2014
DOI: 10.1080/17441692.2014.894549
Abstract: This study aims to compare the health-related behaviours and risk of non-communicable diseases (NCDs) between Muslims and non-Muslims in Thailand, a predominantly Buddhist country in which Muslims are the second largest religious group. Data from the fourth Thai National Health Examination Survey (NHES IV) conducted in 2009 were used to run multivariate survey logistic regression models with adjustment for age, gender and socio-economic status indicators. Data from 20,450 respondents, of whom 807 (3.9%) were Muslims, were included in the study. Muslims were significantly more likely to have daily consumption of deep-fried food (adjusted odds ratio [OR]=1.35 95% confidence interval [CI]=1.15-1.58) and packaged snacks (adjusted OR=1.55 95% CI=1.30-1.86), and have inadequate control of hypercholesterolemia (adjusted OR=2.95 95% CI=1.30-6.68). In conclusion, we found disparity in the majority of risk factors for NCDs between Muslim and non-Muslim Thais.
Publisher: Informa UK Limited
Date: 11-2016
DOI: 10.2147/PPA.S112771
Publisher: Wiley
Date: 30-03-2016
DOI: 10.1111/NEP.12615
Abstract: To determine the nature of primary vesicoureteral reflux (VUR) and the association of VUR with hydronephrosis and renal damage. The medical records of children ≤ 15 years diagnosed with VUR, attending the Department of Pediatrics, Prince of Songkla University, Thailand between 1987 and 2013 were reviewed. Renal ultrasound and technetium-99m dimercaptosuccinic acid renal scan (DMSA) results were examined to determine the severity of hydronephrosis and renal damage, respectively. There were 177 boys and 211 girls. 350 (90.2%) were diagnosed following urinary tract infection (UTI). The median (IQR) age at diagnosis of first VUR was 7.6 (4.3-12.2) months in boys and 18.6 (9.0-46.6) months in girls (P < 0.001). Renal ultrasound was performed in 340 patients. Hydronephrosis was found in 105 patients and 135 kidneys and 22.5% VUR kidneys and 11.0% non-VUR kidneys (P = 0.01). The severity of hydronephrosis was associated with VUR grade (44.2% of grades IV and V VUR had hydronephrosis vs 11.9% of grades I-III VUR, P < 0.001). DMSA was performed in 332 patients. Abnormalities were found in 30.1% VUR kidneys and 4.1% non-VUR kidneys (P < 0.001). Abnormal DMSA results were strongly associated with VUR grade (17.8% for VUR grades I-III vs 60.5% for VUR grades IV and V, P < 0.001). Primary VUR in this group was most commonly diagnosed following investigation of UTI and detected during infancy, earlier in boys. Hydronephrosis and renal damage were associated with severity of VUR.
Publisher: BMJ
Date: 03-2008
Abstract: Of the 363 Thai children upon whom a voiding cystouretrogram was performed, a vesicoureteral reflux was detected in 22.8% (17.1%-28.5%) of those for whom it was performed within 7 days (n = 215) of a urinary tract infection diagnosis and in 24.3% (17.4%-31.2%) of those for whom it was performed 7 days (n = 148) after diagnosis. There was no statistically significant difference in reflux prevalence between these two groups.
Publisher: Elsevier BV
Date: 04-2011
DOI: 10.1016/J.ANNEPIDEM.2010.12.002
Abstract: The aims of this study were to assess the incidence of dengue infection (DEN) and chikungunya fever (CHIK) and determine the direction and speed of CHIK between August 2008 and June 2009 in lower southern Thailand. The National Communicable Disease Surveillance System database and a geographic information system containing data on case locations were combined. R and ArcView were used for identifying incidence, direction, and speed of disease outbreaks. A total of 27,166 patients were identified, of which 3319 and 23,847 had DEN and CHIK, with incidences of 73 and 521 per 100,000, respectively. The direction of the CHIK outbreak moved from south to north with a median speed of 7.5 km per week. CHIK cases increased after 6 weeks of increasing cumulative rainfall with variation of average daily temperatures (23.7-30.7 degrees C) per week. There was no clear association of DEN with climate variables. The combination of surveillance and geographic information system data of DEN and CHIK can be used to determine the speed and direction of disease spread. DEN is endemic, but CHIK is an emerging disease. Because of the rapid spread of CHIK, strict and timely integrated vector control programs after case notification must be implemented.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.IJPORL.2019.04.011
Abstract: The age-based formula is commonly used to predict tracheal tube (TT) sizes although its inaccuracy has been reported to reach as high as 60%. We aim to determine a practical formula using age in months and weight in kilograms to predict uncuffed tracheal tube (TT) size in children and infants. A retrospective cross-sectional study was conducted on data obtained from a prospective study on children aged less than 9 years who came for elective surgery and received general anesthesia with oroendotracheal tube intubation at Songklanagarind Hospital between September 2008 and December 2012. The uncuffed TT sizes were based on the age-based formulae and the discretion of the attending anesthesiologist. The age (in months), weight (in kg), and final TT size were measured. Univariate and multivariate linear regression analyses were used to find potential predictors of final uncuffed TT size and therefore the best formula. The correlation coefficient (r) for each model was calculated. The kappa statistic was used to measure the agreement between predicted and actual TT size. A total of 668 patients were recruited. The age/weight formulae for infants aged ≤12 months and children aged >12 months were 3.15 + (age [months] × 0.05) + (weight [kg] × 0.05) with r value of 0.75 (n = 216) and 3.83 + (age [months] × 0.017) + (weight [kg] × 0.017) with r value of 0.85 (n = 452), respectively. The formulae correctly predicted 69.0% and 65.0% of actual TT sizes for infants and children, respectively (both p < 0.001). The formulae for malnourished infants and children whose weights were less than the 3rd percentile for age were 2.70 + (weight [kg] × 0.21) (n = 43) and 3.59 + (age [months] × 0.012) + (weight [kg] × 0.056) (n = 105) with r values of 0.81 and 0.87, respectively. The age/weight formula can be used to estimate TT size in infants and children. In failure to thrive children, our formula for malnourished children and infants provided high correlation with final TT sizes.
Publisher: Springer Science and Business Media LLC
Date: 12-2012
Publisher: Korea Health Personnel Licensing Examination Institute
Date: 14-06-2015
Abstract: Purpose: This study aimed to describe the system of continuing medical education (CME) in the Guangxi Zhuang Autonomous Region and to ascertain the perceived needs related to that system, in order to improve the performance of health professionals in Chinese township health centers (THCs). Methods: In-depth key informant interviews were conducted to gain insights into the current CME system. A cross-sectional survey using a self-administered structured questionnaire was also carried out from March to August 2014 in order to identify perceived needs among THC personnel in the Guangxi Zhuang Autonomous Region. Logistic regression was used to identify factors related to respondents’ interest in pursuing different levels of degree study. Results: The areas of need perceived by the respondents included general clinical competence and emergency or first aid knowledge. Most respondents wanted to study at medical colleges in order to obtain a higher degree. Respondents aged below 45 years with neutral or positive attitudes about the benefit of degree study for the licensure examination were more likely to attend a bachelor-level CME program than their older peers and respondents with negative attitudes towards degree study. Female respondents and respondents aged below 45 years were more likely to attend a junior college CME program than males and older respondents, respectively. Conclusion: It is necessary to develop degree-linked CME programs to meet the need for young health professionals in Chinese THCs therefore, this programs can improve the expertise of poorly educated young health workers, who overwhelm rural Chinese heath systems.
Publisher: Informa UK Limited
Date: 06-2018
DOI: 10.2147/PPA.S163416
Publisher: Springer Science and Business Media LLC
Date: 12-05-2013
Abstract: Psoriasis is a chronic inflammatory skin disease with a genetic basis. Its ill-defined causes make it difficult to diagnose. This study aims to develop a diagnostic checklist for psoriasis classification in the context of traditional Chinese medicine. A Delphi study was conducted with three rounds by a panel of 16 dermatology experts to develop a checklist for traditional Chinese medicine symptoms and signs of psoriasis. Dermatology experts in psoriasis research, nine in Yunnan and seven in Beijing, were selected as the expert panel. The initial list of symptoms and signs in psoriasis was developed by reviewing the literature retrieved from Chinese and English journals. Experts rated each item of the list on a 5-point Likert scale. The list was revised and re-evaluated in the same manner for a total of 3 rounds before it was finalized. One hundred and thirty items were extracted from the literature review. After three rounds of expert ratings, 96 items were retained with eight domains: color, type and shape of skin lesion, physical expression, tongue and coating, pulse, associated factors, and living environment. Intraclass correlation coefficient and Kappa statistics indicated an inter-rater agreement in the final checklist. A checklist containing 96 items in 8 domains was developed for psoriasis diagnosis using traditional Chinese medicine symptoms and signs.
Publisher: Wiley
Date: 11-1993
DOI: 10.1111/J.1464-410X.1993.TB16222.X
Abstract: Thirty patients with hormone-refractory prostate cancer were treated with cycles of oral cyclophosphamide (100 mg/m2/day for 14 days, with a 14-day gap). Eighteen patients had a significant improvement in symptoms of advanced disease, 6 had objective partial remissions and 13 had stabilisation of disease (criteria of National Prostatic Cancer Project). The median survival from the time of diagnosis was 33.3 months, and from the commencement of cyclophosphamide 12.7 months. The treatment was well tolerated. oral cyclophosphamide is active in the treatment of advanced hormone-refractory prostate cancer and yields symptomatic and objective remissions without undue side effects. This observation requires validation, with further testing of its impact on survival in randomised clinical trials.
Publisher: Wiley
Date: 30-04-2000
Publisher: Informa UK Limited
Date: 07-2019
DOI: 10.2147/PPA.S189345
Publisher: Wiley
Date: 28-04-2017
DOI: 10.1002/PBC.26598
Abstract: There is limited information on long-term follow-up and prognostic factors for remission among children diagnosed with chronic immune thrombocytopenia (ITP). The aim of this study was to determine clinical outcomes and factors influencing remission in childhood chronic ITP. The hospital records of children aged 0-15 years diagnosed with chronic ITP were retrospectively reviewed. Kaplan-Meier curves were fit to estimate the median time to complete remission with 95% confidence intervals (CIs). Multivariate Cox proportional hazards regression models were used to identify independent factors for remission. A total of 113 patients were included in the analysis. The number of children achieving complete remission was 49 (46%) and the median time to remission was 7.1 years (95% CI: 4.8-11.0). The remission rates at 3, 5, 10, and 20 years were 25, 43, 60, and 75%, respectively. Factors influencing remission were platelets >60 × 10 The spontaneous complete remission rates of chronic ITP were 43 and 60% at 5 and 10 years, respectively, and reached 75% at 20 years. A higher platelet level at diagnosis of chronic ITP and form of treatment were statistically significant indicators for achieving complete remission.
Publisher: American Society for Microbiology
Date: 07-2014
DOI: 10.1128/AAC.02992-14
Abstract: The role of Acinetobacter nosocomialis and Acinetobacter pittii , which belong to the A. calcoaceticus - A. baumannii complex, in hospital-acquired infections is increasingly recognized. Here we describe a retrospective cohort study of hospital-acquired A. calcoaceticus - A. baumannii complex infections at a university hospital in Thailand. A total of 222 unique cases were identified between January 2010 and December 2011. The genomospecies of the A. calcoaceticus - A. baumannii complex isolates were classified as follows: A. baumannii , 197 (89%) A. nosocomialis , 18 (8%) and A. pittii , 7 (3%). All A. nosocomialis and A. pittii isolates were susceptible to imipenem and meropenem. The patients infected with A. nosocomialis and A. pittii had lower 30-day mortality than those infected with carbapenem-susceptible A. baumannii ( P = 0.025) and carbapenem-resistant A. baumannii ( P = 0.013). The factors influencing 30-day mortality were infection with non- baumannii A. calcoaceticus - A. baumannii complex (hazard ratio [HR], 0.12 95% confidence interval [CI], 0.03 to 0.51 P = 0.004), infection with carbapenem-resistant A. baumannii (HR, 1.57 95% CI, 0.89 to 2.79 P = 0.105), appropriate empirical antimicrobial therapy (HR, 0.38 95% CI, 0.23 to 0.61 P 0.001), and higher acute physiology and chronic health evaluation II (APACHE II) score (HR, 1.15 95% CI, 1.10 to 1.19 P 0.001). In Galleria mellonella assays, the survival rates were significantly higher for the larvae infected with A. nosocomialis or A. pittii than for those infected with either carbapenem-susceptible A. baumannii or carbapenem-resistant A. baumannii , but no differences in survival rates were observed between carbapenem-susceptible A. baumannii and carbapenem-resistant A. baumannii . These findings suggest intrinsic differences in virulence between non- baumannii A. calcoaceticus - A. baumannii complex species and A. baumannii but not between carbapenem-susceptible and resistant A. baumannii .
Publisher: Wiley
Date: 05-2010
DOI: 10.1111/J.1465-3362.2009.00157.X
Abstract: The aim of this study is to identify the predictors of early dropout of patients in methadone maintenance treatment (MMT) clinics in Yunnan province, China. A cohort study was conducted on 218 patients starting treatment in five MMT clinics between 1 March 2008 and 31 August, with follow up to 28 February 2009. Patients were interviewed using a semistructured questionnaire covering socio-demographic characteristics and drug abuse history. Attendance at clinic and daily dose were abstracted from the clinic records. The mean average daily dose per patient in each period was compared across three periods, 0-1, >1-3 and >3-6 months, using analysis of variance and random-intercept mixed linear regression modelling. Cox regression model with time-varying average daily dose within each period was performed to identify factors predicting dropout in the MMT program. Cumulative probability of retention at 1, 3 and 6 months was 94%, 75% and 57%, respectively. There was no relationship between dose and probability of dropout in periods 1 and 2. However, after 3 months higher average daily dose (>60 mg) was associated with lower probability of dropout. Dropout was more likely among the Han ethnic group [hazard ratio (HR) = 1.86, 95% confidence interval (CI): 1.65-3.26], in those who had to spend over 30 min to visit the clinic (HR = 1.63, 95% CI: 1.07-2.49) and in those living with other drug users (HR = 2.71, 95% CI: 1.55-4.74). Patients' early dropout was related to ethnicity, clinic accessibility, living with drug users and methadone dose. A higher methadone dose as appropriate for maintenance treatment is recommended.
Location: Hong Kong
No related grants have been discovered for Edward Braddon McNeil.