Active smoking in urban households: An association between urinary cotinine metabolite level and serum eGFR concentration.

INTRODUCTION: Smoking stands as a primary contributor to preventable deaths globally and is linked to an increased risk of developing kidney failure and other diseases. A few studies have focused on the negative correlation between serum cotinine and estimated glomerular filtration rate (eGFR), indicating decreased kidney function. This study investigated the associations between urinary cotinine metabolite concentration and serum eGFR among active smokers in urban households. METHODS: This was a cross-sectional study of active smokers in urban households' community Bangkok, Thailand from January to April 2023. The study involved 85 participants aged ≥18 years who were active smokers. Both urinary cotinine and serum eGFR concentrations were used as biomarkers. Independent sample t-tests were used to compare the urinary cotinine metabolite based on differences in the characteristic variable. We used multiple linear regression to test the association between cotinine metabolite and characteristics variables. Spearman's analysis was used to test the correlation between cotinine metabolite and eGFR concentration. RESULTS: The association between urinary cotinine metabolite and serum eGFR concentration decreased with increasing cotinine concentrations (r= -0.223, p=0.041), suggesting a decline in kidney function. However, this study found no significant difference between urinary cotinine metabolite and characteristic variables (p>0.05). Additionally, those who smoked for ≥10 years (117.40 ± 89.80 ng/mL), smoked ≥10 cigarettes per day (117.40 ± 89.80 ng/mL) and used conventional cigarettes (124.53 ± 115.10 ng/mL). The results of the multiple linear regression models analysis indicated that those who were smokers for ≥10 years (ß=0.076; 95% CI: -31.575-59.715) and those who were smoked ≥10 cigarettes/day (ß=0.126; 95% CI: -65.636-18.150) were not associated with urinary cotinine metabolite level. CONCLUSIONS: This study shows that the urinary cotinine metabolite level is associated with serum eGFR concentration among active smokers in urban households. The current study suggests that clinical identification and a prospective cohort study are needed before robust conclusions about how tobacco affects kidney efficiency.

Effect of children secondhand smoke exposure associated with GABA concentration: Influence from parents who are extremely heavy smokers in urban households.

BACKGROUND: Secondhand smoke (SHS) poses the most considerable health risk to children in urban households. However, limited evidence exists regarding the impact of children exposure to SHS on gamma-aminobutyric acid (GABA) levels. This study aimed to investigate the level of cotinine and GABA and their association with variables related to children exposed to SHS. METHODS: A cross-sectional analysis was conducted to assess urinary cotinine and GABA levels in respondents. The study involved 85 participants aged 2-4 years who resided with parents exhibiting heavy smoking habits in urban households in Bangkok, Thailand. Urinary cotinine and GABA concentrations were utilized as biomarkers and measured using an enzyme-linked immunosorbent assay kit. An independent t-test was employed to compare contributing factors with urinary cotinine metabolites. Spearman's correlation test was utilized to assess the relationship between cotinine metabolites and GABA concentration. RESULTS: The study found a correlation between urinary cotinine metabolites and GABA concentration among children's (r = 0.260, p-value = 0.016), particularly influenced by parents exhibiting extreme heavy smoking in urban households. Male children exhibited significantly higher urinary cotinine metabolite concentrations than females (p-value = 0.040). Moreover, significantly elevated levels of cotinine metabolites (57.37 ± 10.27 ng/ml) were observed in households where parents engaged in extreme heavy smoking. CONCLUSIONS: This research establishes a link between urinary cotinine metabolite levels and GABA concentration among children exposed to extreme heavy smoking by their parents in urban households. Consequently, smoking might impact neurobehavioral effects, potentially leading to insomnia. The study emphasizes the importance of promoting and safeguarding non-smokers from exposure to SHS in indoor workplaces, public spaces, and households, advocating for the implementation of smoke-free public health regulations.

Effect of Covid-19 pandemic on gender associated with risk factors: a retrospective data analysis, Thailand.

Background: The COVID-19 pandemic is having a serious impact around the world. Many countries have experienced a two or three wave pattern in reported cases. The virus's spread in Thailand was a cluster event distributed over multiple locations, multi-spender, and multiple waves of outbreaks. Objective: This study aims to study gender associated with age, risk factors, and nationality during coronavirus pandemic in Thailand. Material and methods: A retrospective cohort study was conducted from January 2020 to May 2021 (17 months) to determine the number of confirmed cases and identify gender associated with, age, various risk factors and nationality were analyzed by chi square test and binary logistic regression analyses. Results: The results show that the number of cases increased by over 100,000 over the course of three waves of outbreaks. The logistic regression analysis revealed that genders were significantly related with age, various risk factors, and nationality across different waves (p < 0.01). Across the primary risk factors were community risk, community cluster and close contact with a previously confirmed patient on confirmed cases during COVID-19 pandemic. Conclusion: Significant differences between genders were significantly associated with age, various risk factors, and nationality may be due to weak social distancing policies and the lack of public health interventions. A COVID-19 vaccination plan is needed for people who are at risk of suffering severe symptoms as well as the general population in outbreak areas to increase immunity.

Satisfaction with COVID-19 Vaccines in Health Care Workers and the General Population: A Cross-Sectional Study in Urban Bangkok, Thailand.

Background: COVID-19 vaccination hesitancy is a global issue. Many people are concerned about experiencing side effects from the vaccine. This study evaluated satisfaction with the COVID-19 vaccine in the general population (GP) and healthcare workers (HCWs) in Bangkok, Thailand. Methods: A cross-sectional online survey was distributed from September-December 2021. Independent sample t-tests were used to compare GP and HCW participants' total vaccine satisfaction scores as well as their satisfaction with varying vaccine types. Multiple linear regression was used to identify predictors of satisfaction scores among GP and HCWs. Results: A total of 780 valid questionnaire responses were obtained. The majority of GP participants (n = 390) had received their first (93.3%) and second (88.5%) vaccination shots by viral vector vaccine; however, 90% had not received a third dose (booster). In contrast, the majority of HCW participants (n = 390) had received their first (92.8%) and second (82.8%) vaccination doses by the inactivated vaccine, and 83% had received a third vaccine dose. HCWs had significantly higher total satisfaction scores than GP participants (p = 0.034), and they were also significantly more satisfied with the mRNA vaccine as a third dose (p = 0.001). Multiple linear regression models found less association with vaccine satisfaction among GP participants who had not isolated following exposure to COVID-19 and those who have never been at risk of infection (ᵦ −0.159; 95% CI −12.867, −1.877; p = 0.009). Among HCWs, being married (ᵦ 0.157; 95% CI 0.794, 3.278; p = 0.001) or divorced (ᵦ 0.198; 95% CI 3.303, 9.596; p < 0.01) was more closely associated with vaccine satisfaction than being single. Conclusion: HCWs were more satisfied with the type and efficacy of inactivated, viral vector, and mRNA vaccines than GP participants, and the former were also more satisfied with the cost of vaccine boosters. Our results indicate that satisfaction with the COVID-19 vaccine is based on academic knowledge sharing and the government's promotion efforts. Future research will explore strategies to raise awareness about the importance of vaccination.

Burnout prevalence and contributing factors among healthcare workers during the COVID-19 pandemic: A cross-sectional survey study in an urban community in Thailand.

BACKGROUND: Burnout is associated with an increased risk for severe COVID-19. Few studies have examined burnout prevalence related to healthcare workers during the pandemic. This study investigated the burnout prevalence and contributing factors among HCWs, including medical staff and support staff, during the COVID-19 pandemic in an urban community in Thailand. METHODS: A cross-sectional online survey was distributed among HCWs in Bangkok, Thailand, from July-August 2021. The independent t-test and one-way analysis of variance (ANOVA) were used to compare the contributing factors and burnout items. Variable factors associated with burnout among HCWs were used in multiple linear regression models. RESULTS: A total of 517 HCWs' survey responses were received. Most participants were medical staff (55.3%), female (83.4%), and over the age of 35 (59.4%); most participants (65.6%) did not have any diseases but had family members that did (63.6%). The prevalence of overall burnout presented among medical staff (25.9%). The results of the multiple linear regression models found that female (vs. male, ß 0.088; 95% CI 0.033, 6.614) was higher associated with overall burnout score. In addition, hours of sleep as > 6 hr./day (vs. ≤ 6 hr./day, ß -0.120; 95% CI -6.012, -0.969) was lower associated with overall burnout score. CONCLUSION: This study highlights the importance of addressing burnout among HCWs, in which female medical staff who slept less than six hours per day were associated with burnout. Our study further suggested that both intervention and identification are needed of frontline HCWs to prevent and reduce the risk of burnout, as the proportion of females compared to males is high. Thus, the government should provide support in these areas to prevent a humanitarian crisis.

Prevalence of perceived stress and coping strategies among healthcare workers during the COVID-19 outbreak at Bangkok metropolitan, Thailand.

BACKGROUND: Healthcare workers (HCW), who are crucial workforce, have experienced stress during the COVID-19 pandemic. They have been learning to fight against and support patients as much as possible. Thus, this study aims to account for the psychological impact of the COVID-19 outbreaks on the healthcare workers of medical school hospitals in terms of their perceived stress and coping styles. METHOD: This cross-sectional study was conducted from June to August, 2021. 517 HCWs self-administered the online survey. Perceived Stress Scale (PSS-10) in Thai-version was used to examine the perceived stress symptoms. Brief-COPE score was used to determine the coping strategies. Independent sample t-test, one-way analysis of variance (ANOVA), and multivariable regression analysis were utilized. The level of significance was set at p-value < 0.05. RESULT: The prevalence of perceived stress among the HCWs was 41.97%. Coping strategies were used to deal with stress during the outbreak for problem-solving (Mean ± SD = 0.25 ± 0.60) and positive attitude (Mean ± SD = 2.85 ± 0.62). Significant difference was observed in the use of coping strategies among those who differ in marital status (F2, 514 = 7.234, p-value = 0.001), having children (t515 = -4.175, p-value < 0.001), and days off (t515 = -1.992, p-value = 0.047). Multivariable regression analysis reported who those perceived stress symptoms using social support more than those normal stress (AOR 1.54, 95% CI 1.070-2.236, p-value = 0.02). The perceived stress symptoms group used the avoidance strategy 2.03 times more than the other group (AOR 2.03, 95% CI 1.406-2.934, p-value < 0.001). Interestingly, the participants who perceived stress symptoms applied a positive attitude strategy lesser than those who experienced normal stress (57.5%) (AOR 0.42, 95% CI 0.307-0.590, p-value < 0.001). CONCLUSION: The impact of the COVID-19 pandemic on mental distress remains. The findings of this study suggest further study to assess the HCWs' stress after the pandemic. HCWs should consider merging each of the coping strategies to balance work and lifestyle in pandemic situations.

The Relationship between Attitudes and Satisfaction Concerning the COVID-19 Vaccine and Vaccine Boosters in Urban Bangkok, Thailand: A Cross-Sectional Study.

Background: COVID-19 vaccine hesitancy is a global concern. Many individuals are concerned about the potential side-effects of the COVID-19 vaccine and vaccine boosters. The purpose of this study was to assess attitudes and satisfaction concerning COVID-19 vaccines and vaccine boosters in the population in Bangkok, Thailand. Methods: A cross-sectional online survey measuring COVID-19 vaccine attitudes and satisfaction was distributed from September to December 2021. Multiple linear regression was used to explore associations between demographic variables and questionnaire results. Spearman's correlation analysis was used to examine associations between attitude and satisfaction scores. Results: A total of 780 questionnaire responses were obtained. The largest groups of participants reported having obtained a first vaccination dose via viral vaccine (52.8%), a second vaccination booster via viral vaccine (49.5%), and a third vaccination booster via mRNA vaccine (28.8%). Multiple linear regression revealed a lower association between vaccine attitude scores and having earned less than a bachelor's degree (ß −0.109; 95% CI −2.541, −0.451) and infection risk without self-isolating (ß −0.154; 95% CI −4.152, −0.670) compared with attaining a bachelor's degree or higher and never having being at risk of infection, respectively. Higher vaccine satisfaction scores were more closely associated with being married than being single (ß 0.074; 95% CI −0.073, 3.022), whereas lower vaccine satisfaction scores were less closely associated with non-healthcare workers (ß −0.143; 95% CI −4.698, −0.831) and infection risk without self-isolating (ß −0.132; 95% CI −6.034, −0.502) compared with non-healthcare workers and never being at risk of infection. There was weak but significant positive correlation between attitude and satisfaction scores (r = 0.338, p-value < 0.001). Hence, a gradual decline in protection following vaccination and the positive effects of a booster dose after primary vaccination have made the decision to administer booster doses. Conclusion: The results suggest that policymakers need to develop more effective strategies to raise awareness about the importance of vaccination.

Knowledge, attitudes, and practices related to the COVID-19 pandemic among pregnant women in Bangkok, Thailand.

BACKGROUND: Pregnancy is associated with increased risk for severe COVID-19. Few studies have examined knowledge, attitudes, and practices (KAP) related to pregnancy during the pandemic. This study investigated the association between socio-demographic characteristics and KAP related to COVID-19 among pregnant women in an urban community in Thailand. METHODS: A cross-sectional online survey was distributed among pregnant women in Bangkok, Thailand from July-August 2021. Binary logistic regression was conducted to test the association between socio-demographic characteristics and KAP related to COVID-19, and a Spearman's analysis tested correlations between KAP scores. RESULTS: A total of 150 pregnancy survey responses were received. Most participants were third trimester (27-40 weeks gestation; 68.0%). Pregnancy had never been risked contracting COVID-19 (84.7%). Most expressed concerns about being infected with COVID-19 during pregnancy and following birth (94.0 and 70.0%, respectively). The results of binary logistic regression analysis found associations between knowledge and marital status (OR = 4.983, 95%CI 1.894-13.107). In addition, having a bachelor's degree or higher was associated with higher attitude scores (OR = 2.733, 95%CI 1.045-7.149), as was being aged 26-30 (OR = 2.413 95%CI 0.882-6.602) and 31-35 years of age (OR = 2.518-2.664, 95%CI 0.841-8.442). Higher practice scores were associated with having a bachelor's degree or higher (OR = 2.285 95%CI 1.110-6.146), and income ≥15,001 bath (OR = 4.747 95%CI 1.588-14.192). Correlation analysis found a weak positive correlation between knowledge and practice scores (r = 0.210, p-value = 0.01). CONCLUSION: Participants overall had high KAP scores. This study can guide public health strategies regarding pregnant women and COVID-19. We recommend that interventions to improve and attitude and practice scores. Knowledge on pregnancy and COVID-19 should focus on reducing fear and improving attitudes toward the care of patients as well as the promotion of preventive practices.

Covid-19 knowledge, attitudes, and practices among healthcare workers in urban community Bangkok, Thailand.

Objective: This study examined associations between socio-demographic characteristics and knowledge, attitudes, and practices (KAP) related to COVID-19 among healthcare workers in Bangkok, Thailand. Materials and methods: A cross-sectional online survey was distributed among healthcare workers in Bangkok, Thailand from July - August 2021. Results: A total of 637 responses were received. Most participants were clinical workers (68.4%), and nearly half (47.3%) had been at risk of infection with COVID-19 (ever screening test). Binary logistic regression analysis found associations between high knowledge scores and the 26-35-year age group (OR=1.776-1.562, 95%CI 1.021-2.853), having a bachelor's degree or higher (OR=1.672, 95%CI 1.058-2.644), and clinical workers (OR=1.784, 95CI% 1.188-2.678). The 36 year and above age group was associated with higher attitude scores (OR=2.406, 95%CI 1.567-3.695). Higher practice scores were associated with females (OR=1.913, 95%CI 1.057-3.464), and clinical workers (OR=1.903, 95CI% 1.170-3.095). Correlation analysis found a positive correlation between practice scores and knowledge (r=0.322, p <0.001) and attitudes (r=0.263, p <0.001). Conclusion: Although healthcare workers demonstrated overall high knowledge, attitude, and practice scores, this study identified several factors that influence KAP. This study can guide public health strategies regarding healthcare workers during the third wave of the COVID-19 pandemic in Thailand.

Comparison of Different Waves during the COVID-19 Pandemic: Retrospective Descriptive Study in Thailand.

BACKGROUND: Coronavirus disease (COVID-19) is an infectious disease caused by a newly discovered coronavirus. An outbreak is called an epidemic when there is a sudden increase in cases. Many countries have experienced a two-wave pattern in the reported cases of COVID-19. The spread of COVID-19 in Thailand was a cluster event distributed over multiple locations. This study aims to compare the characteristics of different waves during the COVID-19 pandemic in Thailand. METHODS: A retrospective cohort study was conducted from January 2020 to May 2021 (17 months) to determine the number of COVID-19 screenings and confirmed cases and deaths as well as sociodemographic characteristics such as gender, age, nationality, and source population at risk factors. The categorical data were compared using a chi-square test. RESULTS: Three waves of the COVID-19 pandemic occurred within 17 months in Thailand, and the number of cases increased by over 100,000 due to source population at risk factors such as close contact with a previously confirmed patient, community risk, cluster communities, and active and community surveillance. The chi-square test revealed significant differences between the three waves (p < 0.01). CONCLUSION: Significant differences between pandemic phases or waves may be due to weak social distancing policies and the lack of public health interventions. A COVID-19 vaccination plan is needed for people at risk of suffering severe symptoms and the general population in outbreak areas to increase immunity.

A randomized controlled trial comparing concurrent chemoradiation versus concurrent chemoradiation followed by adjuvant chemotherapy in locally advanced cervical cancer patients: ACTLACC trial.

OBJECTIVE: To compare response rate and survivals of locally advanced stage cervical cancer patients who had standard concurrent chemoradiation therapy (CCRT) alone to those who had adjuvant chemotherapy (ACT) after CCRT. METHODS: Patients aged 18-70 years who had International Federation of Gynecology and Obstetrics stage IIB-IVA without para-aortic lymph node enlargement, Eastern Cooperative Oncology Group scores 0-2, and non-aggressive histopathology were randomized to have CCRT with weekly cisplatin followed by observation (arm A) or by ACT with paclitaxel plus carboplatin every 4 weeks for 3 cycles (arm B). RESULTS: Data analysis of 259 patients showed no significant difference in complete responses at 4 months after treatment between arm A (n=129) and arm B (n=130): 94.1% vs. 87.0% (p=0.154) respectively. With the median follow-up of 27.4 months, 15.5% of patients in arm A and 10.8% in arm B experienced recurrences (p=0.123). There were no significant differences of overall or loco-regional failure. However, systemic recurrences were significantly lower in arm B than arm A: 5.4% vs. 10.1% (p=0.029). The 3-year progression-free survival (PFS) and 3-year overall survival (OS) of the patients in both arms were not significantly different. The hazard ratio of PFS and OS of arm B compared to arm A were 1.26 (95% CI=0.82-1.96; p=0.293) and 1.42 (95% CI=0.81-2.49; p=0.221) respectively. CONCLUSIONS: ACT with paclitaxel plus carboplatin after CCRT did not improve response rate and survival compared to CCRT alone. Only significant decrease of systemic recurrences with ACT was observed, but not overall or loco-regional failure. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02036164, Thai Clinical Trials Registry Identifier: TCTR 20140106001.

Factors associated with early age at menarche among Thai adolescents in Bangkok: A cross-sectional study.

BACKGROUND: The age at menarche in the Thai population has not been determined since 1997. This study recruited adolescents in Bangkok Metropolis to determine the age at menarche and its associations with health and socioeconomic status. METHODS: This cross-sectional study used a two-step stratified sampling strategy to recruit 1,020 female students, aged 10-16 years, from schools in Dusit district, Bangkok, Thailand. Self-reported data on age at menarche and social determinants of health were collected from participants and their parents. A trained research nurse collected anthropometric data. RESULTS: Mean age at menarche was 11.8 ± 1.0 years, and age at menarche was significantly correlated with year of birth (r = -0.4, p < 0.001). Students from schools that are part of Bangkok Metropolis had the lowest mean age at menarche. Participants born in 2000-2003 having their first period at < 11.8 years numbered 5.5 times (95% CI: 3.80-8.18) and 5.0 times (95% CI: 3.6-8.0) greater than those born in 1997-1999 by univariate and multivariate analysis, respectively. Year of birth significantly associated with age at menarche in univariate and multivariate analysis (p = 0.001). CONCLUSION: The mean age at menarche among female adolescents in Bangkok Metropolis was occurring earlier and was inversely associated with year of birth in this cohort. Only year of birth were associated with age at menarche in the multivariate regression models to adjust for potential confounders.

Prevalence and Associated Factors of Abnormal Cervical Cytology and HighRisk HPV DNA among Bangkok Metropolitan Women.

BACKGROUND: Many strategies are required for cervical cancer reduction e.g. provision of education cautious sexual behavior, HPV vaccination, and early detection of preinvasive cervical lesions and invasive cancer. Basic health data for cervical cytology/ HPV DNA and associated factors are important to make an appropriate policy to fight against cervical cancer. AIMS: To assess the prevalence of abnormal cervical cytology and/or HPV DNA and associated factors, including sexual behavior, among Bangkok Metropolitan women. MATERIALS AND METHODS: Thai women, aged 25to65 years old, had lived in Bangkok for ≥5 years were invited into the study. Liquidbased cervical cytology and HPV DNA tests were performed. Personal data were collected. MAIN OUTCOMES MEASURES: Rates of abnormal cytology and/ or highrisk HPV (HRHPV) and factors associated with abnormal test(s) were studied. RESULTS: Abnormal cytology and positive HRHPV were found in 6.3% (279/4442 women) and 6.7% (295/4428), respectively. The most common abnormal cytology was ASCUS (3.5%) while the most common HRHPV genotype was HPV 16 (1.4%) followed by HPV 52 (1.0%), HPV 58 (0.9%), and HPV 18 and HPV 51 at equal frequency (0.7%). Both tests were abnormal in 1.6% (71/4428 women). Rates of HRHPV detection were directly associated with severity of abnormal cytology: 5.4% among normal cytology and 13.0%, 30.8%, 40.0%, 39.5%, 56.3% and 100.0% among ASCUS, ASCH, AGCNOS, LSIL, HSIL, and SCC, respectively. Some 5% of women who had no HRHPV had abnormal cytology, in which 0.3% had ≥ HSIL. Factors associated with abnormal cytology or HRHPV were: age ≤40 years, education lower than (for cytology) or higher than bachelor for HRHPV), history of sexual intercourse, and sexual partners ≥2. CONCLUSIONS: Rates for abnormal cytology and HRHPV detection were 6.3% and 6.7% HRHPV detection was directly associated with severity of abnormal cytology. Significant associated factors were age ≤40 years, lower education, history of sexual intercourse, and sexual partners ≥2.

Age at menarche and performance intelligence quotients of adolescents in Bangkok, Thailand: a cross-sectional study.

BACKGROUND: The presence of an association between age at the onset of puberty and intelligence quotient (IQ) in young adolescents remains controversial. The aim of this study was to explore the association between age at menarche and performance IQ scores of young female adolescents in Bangkok, Thailand. METHODS: A cross-sectional study was conducted among 537 students aged 11-15 years attending primary and secondary schools in the Dusit district of Bangkok, Thailand. The participants were selected based on two-step stratified sampling. Age at menarche and health and socioeconomic status were determined using a self-report questionnaire completed by participants. Performance IQ scores were determined using the Standard Progressive Matrices intelligence test (Thai version) administered by registered clinical psychologists. RESULTS: Of the 537 participants, 0.4 had reached menarche at 8 years of age, 1.9 at 9 years, 10.1 at 10 years, 36.1 at 11 years, 37.6 at 12 years, 10.4 at 13 years, 3.4 at 14 years, and 0.2 % at 15 years. Age at menarche was inversely correlated with performance IQ (Pearson correlation -0.087, p = 0.047). The regression equation predicting performance IQ by age at menarche was performance IQ = 128.06 - 1.16*age at menarche (R (2) = 0.008). In univariate analysis, performance IQ was inversely correlated with age at menarche, body mass index (BMI), time spent watching television, and time sleeping, but was directly correlated with maternal age at birth (all p < 0.05). In multivariate analysis, age at menarche and BMI remained significantly inversely correlated with performance IQ (p < 0.05), while maternal age at birth was directly correlated with performance IQ. The model consisting of age at menarche, BMI, and maternal age at birth best predicted performance IQ. CONCLUSION: After adjusting for confounders, multiple regression analysis showed that age at menarche and BMI of young female adolescents living in the Dusit district of Bangkok, Thailand, were inversely correlated with performance IQ, whereas maternal age at birth was directly correlated with performance IQ.

Knowledge, Attitudes and Behavior of Bangkok Metropolitan Women Regarding Cervical Cancer Screening.

PURPOSE: To assess knowledge, attitudes and cervical cancer screening behavior of Bangkok Metropolitan women. MATERIALS AND METHODS: Thai women, aged 25-to-65 years old, having lived in Bangkok for 5 years or more were invited to participate in the study. After signing informed consent, all women were asked to complete a self-questionnaire (Thai language) with literate assistance if needed. The questionnaire was divided into 3 parts: (I) demographic data; (II) knowledge about cervical cancer screening; and (III) behavior and attitudes, towards cervical cancer screening. Adequate screening was defined as women who had ≥two cervical cancer screening tests except women aged 25-30 years who may have only one screening, and the last screen was within 5 year or had had regular screening. RESULTS: Of 4,339 women, there were 1,857 (42.8%) with adequate screening and 2,482 (57.2%) with inadequate screening. Significant factors associated with inadequate screening included age < 45 years, pre-menopausal status, family monthly income <625 USD, no reported sexual intercourse, nulliparous, no knowledge, lack of awareness and poor attitudes. Three major reasons provided by women for inadequate screening were no symptoms (54.4%), fear of pain (33.2%), and embarrassment (34.6%). CONCLUSIONS: Personal features, knowledge, and attitudes influence screening behavior of Bangkok Metropolitan women. The three most common reasons of women for not undergoinging screening are no symptoms, fear of pain, and embarrassment. These factors should be the focus of attention to improve coverage of cervical cancer screening in Bangkok.

Adjuvant chemotherapy after concurrent chemoradiation for locally advanced cervical cancer.

BACKGROUND: Current standard treatment for patients with cervical cancer who have locally advanced stage disease (International Federation of Gynecology and Obstetrics (FIGO) stage IIB to IVA) is concurrent chemoradiation therapy (CCRT). However, less than two-thirds of patients in this group survive for longer than five years post treatment. Adjuvant chemotherapy (ACT) can be given in an attempt to improve survival by eradicating residual disease in the pelvis and treating occult disease outside the pelvic radiation field. However, inconsistency in trial design, inclusion criteria for participants, interventions and survival benefit has been noted among trials of ACT after CCRT for locally advanced cervical cancer (LACC). OBJECTIVES: To evaluate the effect of adjuvant chemotherapy (ACT) after concurrent chemoradiation (CCRT) on survival of women with locally advanced cervical cancer compared with CCRT alone. SEARCH METHODS: We searched the Cochrane Gynaecological Review Group Trial Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and conference proceedings to March 2014. We handsearched citation lists of relevant studies. SELECTION CRITERIA: Randomised controlled trials (RCTs) comparing CCRT alone versus CCRT plus ACT were included. Patients were diagnosed with cervical cancer FIGO stage IIB to IVA with a histopathology of squamous cell carcinoma, adenosquamous cell carcinoma, adenocarcinoma or undifferentiated carcinoma. DATA COLLECTION AND ANALYSIS: Two review authors (ST, KK) selected relevant trials, extracted data, assessed risk of bias independently, compared results and resolved disagreements by discussion. MAIN RESULTS: We identified two RCTs involving 978 women with cervical cancer stage IIB to IVA. As the trials were significantly different clinically, we did not perform meta-analyses. One industry-funded trial involving 515 women compared CCRT (cisplatin) versus CCRT (cisplatin and gemcitabine) plus ACT (two additional cycles). This trial reported significant improvement in progression-free survival (PFS) and overall survival (OS) in women who were given CCRT plus ACT compared with those treated with CCRT alone: Three-year PFS was 74.4% versus 65.0% (hazard ratio (HR) 0.68, 95% confidence interval (CI) 0.49 to 0.95, P value 0.027), and three-year OS was 80% versus 69% (HR 0.68, 95% CI 0.49 to 0.95, P value 0.022). However, as the CCRT chemotherapy differed between the two arms, we considered the findings to be at high risk of bias.The second trial was a four-arm study from which we extracted data on 463 women in two study arms receiving CCRT (intravenous mitomycin C and oral 5-fluorouracil (5-FU)) or CCRT plus ACT (oral 5-FU for three cycles). The HR for OS in women who received ACT after CCRT compared with the HR for OS in those who were given CCRT alone was 1.309 (95% CI 0.795 to 2.157), and the HR for disease-free survival (DFS) was 1.125 (95% CI 0.799 to 1.586).Haematological adverse events were more common in the ACT arms of both trials. Quality of life (QoL) was not reported in either trial. AUTHORS' CONCLUSIONS: With limited data from only two trials, we found insufficient evidence to support the use of ACT after CCRT. Future large trials are required to demonstrate efficacy, toxicities and QoL.

Cost-utility analysis of treatments for stage IB cervical cancer.

OBJECTIVE: To analyze the cost-utility of two common clinical practices for stage IB cervical cancer patients from provider and societal viewpoints. METHODS: A DECISION TREE MODEL WAS CONDUCTED TO EXAMINE VALUE FOR EXPENDITURE BETWEEN THE FOLLOWING: (1) radical hysterectomy with pelvic lymph node dissection (RHPLND) with or without postoperative adjuvant therapy according to the risk of recurrence and (2) concurrent chemoradiotherapy (CCRT). The relevant studies were identified to extract the probability data, and meta-analysis was performed. Direct medical costs were estimated from hospital database and medical records review. Direct non-medical costs and utility parameters were obtained through interviews with patients to estimate quality-adjusted life years (QALYs) outcome. The time horizon was according to the life expectancy of Thai women. RESULTS: From provider viewpoint, RHPLND and CCRT resulted in approximate costs of US $5,281 and US $5,218, respectively. The corresponding costs from societal viewpoint were US $6,533 and US $6,335, respectively. QALYs were 16.40 years for RHPLND and 15.94 years for CCRT. The estimated incremental cost effectiveness ratio of RHPLND in comparison to CCRT from provider and societal viewpoints were US $100/QALY and US $430/QALY, respectively. RHPLND had more cost-effectiveness than CCRT if patients did not need adjuvant therapy. The most effective parameter in model was a direct medical cost of CCRT. At the current ceiling ratio in Thailand, RHPLND provides better value for money than CCRT, with a probability of 75%. CONCLUSION: RHPLND is an efficient treatment for stage IB cervical cancer. This advantage is only for patients who require no adjuvant treatment.