Unmet need for contraception among married women in the Kyrgyz Republic using the datasets from the 2006, 2014 and 2018 Multiple Indicator Cluster Survey: a cross-sectional study.

BACKGROUND: Since the beginning of the family program in 1998, the proportion of married women who used contraception has fluctuated. An unmet need for contraception among women in Kyrgyzstan drastically increased from 2006 (1.1%) to 2014 (19.1%), and remained unchanged until 2018 (19.0%). This study aims to re-investigate the prevalence of an unmet need for contraception from 2006 to 2018 in a comprehensive manner, and examine the factors associated with an unmet need for contraception among married women over the course of 12 years in the Kyrgyz Republic. METHODS: This is a cross-sectional study using secondary data that derived from the Multiple Indicator Cluster Survey (MICS). The study employed three datasets from the MICS 2006, 2014, and 2018. The study included a total of 9,229 women aged 15-49 who were married and fecund, and whose status of the met/unmet need for contraception could be identified. Logistic regression was employed to estimate the relationship of an unmet need for contraception with independent factors. A P value < 0.05 was set as statistically significant. RESULTS: The prevalence of an unmet need for contraception was 19.9% in 2006, 20.4% in 2014, and 22.5% in 2018. Across 12 years, all reversible-contraceptive methods for women constantly declined. Although intrauterine devices were the prominent contraceptive method of usage among Kyrgyz women, the trend of usage drastically decreased over time. Factors associated with unmet need for contraception included women's age, area of residence, mother tongue of household head, age of husband, and number of children ever born. CONCLUSION: The unmet need for contraception among married Kyrgyz women slightly increased, and the trend of modern contraceptive usage declined from 2006 to 2018, particularly the use of pills, injections, and intra-uterine devices. Comprehensive sexual health education for young people and youth-friendly services should be promoted. An effective and reliable supply chain of contraceptive commodities should be prioritized and strengthened. Regular supportive supervision visits are essential to improve the knowledge and skills of healthcare providers to be able to provide intrauterine device service as a contraceptive choice for Kyrgyz women.

Erratum: Increased number of live births by migrant mothers shows areal inequality in Japan: A descriptive study.

[This corrects the article DOI: 10.1016/j.ssmph.2023.101531.][This corrects the article DOI: 10.1016/j.ssmph.2023.101447.].

Characteristics of adverse drug reactions due to nonsteroidal anti-inflammatory drugs: a cross-sectional study.

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used for treating pain and inflammation. Spontaneous adverse drug reaction (ADR) reports represent a rich data source for the detection of unknown and rare ADRs. This cross-sectional study aimed to analyze the characteristics of ADRs due to NSAIDs in Thailand. All ADR reports of NSAIDs for systemic use from 2015 to 2019 were extracted from the national database in Thailand. Patient characteristics, drug use information, adverse event information, and source of senders in 32,857 reports were analyzed. The annual number of ADR reports due to NSAIDs decreased from 7,008 in 2015 to 5,922 in 2019. The most frequently reported drug was ibuprofen (n=12,645, 38.5%) followed by diclofenac (n=7,795, 23.7%), most patients were 40-59 years old, and the major adverse reaction was angioedema (n=7,513, 22.9%). Serious reactions were recorded in 20.7% (n=6,801) of the total ADRs. Most patients (n=20,593, 62.7%) recovered without sequelae, but there were 5,420 patients (16.5%) who could not recover and 3,109 patients (9.5%) who were recovering. Eight patients (0.02%) died of Stevens-Johnson syndrome (n=3), toxic epidermal necrolysis (n=4), and anaphylactic shock (n=1), which were possibly related to ADRs. The number of ADR reports due to NSAIDs decreased from 2015 to 2019 in Thailand. Serious ADRs and death cases accounted for 20.7% and 0.02%, respectively. Most fatal cases exhibited severe drug-induced skin reactions.

Establishment and characterization of a non-gestational choriocarcinoma patient-derived xenograft model.

BACKGROUND: Non-gestational choriocarcinoma (NGC) is a rare subtype of malignant germ cell tumour and there is no consensus on its treatment. The lack of suitable preclinical models for NGC is a challenge in drug discovery research. Patient-derived xenograft (PDX) models recapitulate the tumour microenvironment of the original cancer tissue. Therefore, they have received considerable attention for studies on rare cancer. Here, we aimed to establish a PDX model from a patient with recurrent NGC. METHODS: Fresh NGC tumour tissue was immediately transplanted into a severely immune-deficient mouse (NOD.Cg-Prkdcscid1l2rgtm1Wjl/SzJ) and maintained for more than three in vivo passages. Subsequently, we evaluated the molecular characteristics of the PDX model using immunohistochemistry, polymerase chain reaction, and RNA sequencing. Moreover, the PDX tumours were transplanted into BALB/c nude mice, and we evaluated their sensitivity for cisplatin and methotrexate. RESULTS: The PDX tumour maintained the morphological features of NGC. Moreover, Immunohistochemistry revealed that the human chorionic gonadotropin, cytokeratin 7, and EpCAM expression levels were similar to those in the primary tumour. Furthermore, serum human chorionic gonadotropin levels were elevated in both the primary tumour and the PDX models. Additionally, using PCR analysis with species-specific primers, we confirmed that the PDX tumour contained human genes and was derived from human tissue. Moreover, the gene expression profile of the NGC was compared with that of epithelial ovarian cancer samples and cell lines, and 568 dysregulated genes in the NGC were extracted. The expression of the dysregulated genes in PDX was significantly correlated with that in the primary tumour (R2 = 0.873, P < 0.001). Finally, we demonstrated that the PDX tumour was sensitive to cisplatin and methotrexate; therefore, its clinical response to the agents was similar to that of the primary tumour. CONCLUSIONS: We successfully established a PDX model of NGC, to the best of our knowledge, for the first time. The established PDX retained the molecular and transcriptome characteristics of the primary tumour and can be used to predict drug effects. It may facilitate further research and the development of novel therapeutic agents for NGC.

Strong Negative Association between Cesarean Delivery and Early Initiation of Breastfeeding Practices among Vietnamese Mothers-A Secondary Analysis of the Viet Nam Sustainable Development Goal Indicators on Children and Women Survey.

Early initiation of breastfeeding (EIBF) involves feeding a newborn with the mother's breast milk within the first hour of delivery. The prevalence of EIBF in Vietnam has recently shown a downward trend. The present study aimed to demonstrate the current prevalence of EIBF practices and identify factors associated with EIBF among Vietnamese mothers with children under 24 months of age. This study was a secondary analysis of data from the Viet Nam Sustainable Development Goal Indicators on Children and Women (SDGCW) survey 2020-2021. The study participants included 1495 mothers extracted from the SDGCW dataset. Descriptive statistics and logistic regression analyses were performed. The prevalence of EIBF practice was 25.5% among all mothers, 31.9% among vaginal-delivery mothers groups, and 9.0% among cesarean-section mothers groups. Factors negatively associated with EIBF were younger age (0.18 times), cesarean delivery (0.25 times), and absence of skin-to-skin contact with newborns immediately after birth (0.43 times). The prevalence of EIBF among Vietnamese mothers was found to be substantially low, especially among those who underwent cesarean delivery. EIBF should be promoted among younger mothers and those who underwent cesarean delivery.

Increased number of live births by migrant mothers shows areal inequality in Japan: A descriptive study.

Japan has not implemented policy of accepting many migrants, and the proportion of migrants in the total population is much smaller than that in other economically developed countries. Therefore, issues regarding the health status of migrants, especially migrant mothers and their children, have not been discussed enthusiastically in Japan. In the present study, we aimed to describe the epidemiology (time trend of the number, areal distribution, and frequency of maternal nationality of newborn births) of live births by migrant mothers in Japan, which contributes to the administration of medical policies on the perinatal care of migrant mothers. This study used data from the vital statistics reported by the Ministry of Health, Labour and Welfare (MHLW) of Japan and from foreign resident statistics reported by Immigration Services Agency (ISA) of Japan. To show areal inequality in the number of live births by migrant mothers, we applied the Gini coefficient. This study demonstrated that the number of live births by migrant mothers increased from 16,154 (1.31% of the total) in 1990 to 26,517 (3.08%) in 2020. It also showed stronger areal inequality at prefecture level by Japanese mothers (Gini coefficient; 0.64 vs 0.46 in 2020), and this areal inequality has increased during the last decade. This study also illustrated that the frequency of maternal nationality of newborns from migrant mothers has been altered in the last decade, especially in the composition of Asian countries. In conclusion, the number of live births by migrant mothers in Japan has been progressively increasing; however, this trend is excessively concentrated in specific areas in Japan. These tendencies are expected to become more prominent in the future, and their possible impacts on medical institutions and administrative agencies in specific areas that treat migrant mothers should be investigated and discussed.

Quality of life in the general population of Mongolia: Normative data on WHOQOL-BREF.

No data on the quality of life (QOL) of the general population are available for Mongolia. This study aimed to determine normative data on the World Health Organization Quality of Life-Brief Version (WHOQOL-BREF) in the general population of Mongolia. This nationwide, population-based, cross-sectional study was conducted in 48 sampling centers across Mongolia in 2020. We used the WHOQOL-BREF and the Hospital Anxiety and Depression Scale (HADS) in our study and evaluated their associations with vital signs, body measurements, and lifestyle determinants. A total of 714 participants (261 men and 453 women) with a mean (standard deviation) age of 40.7 (13.2) years were recruited. The mean scores of WHOQOL-BREF subscales were 61.5 for physical health, 73.5 for psychological health, 70.1 for social relationship, and 67.2 for environmental health domains. The prevalence of poor QOL was 16.9% among the participants. Participants living in an apartment in urban areas with high HADS scores had a low QOL. All domains of WHOQOL-BREF were inversely correlated with anxiety score (r = -0.353 - -0.206, p < 0.001) and depression scores (r = -0.335 - -0.156, p < 0.001). Physical health was predicted by residency location, anxiety, and depression (R2 = 0.200, p < 0.001); psychological health by anxiety and depression (R2 = 0.203, p < 0.001); social relationship by residency location, age group, anxiety and depression (R2 = 0.116, p < 0.001); and environmental health by employment, anxiety, and depression (R2 = 0.117, p < 0.001). This is the first report on normative data on the QOL in the general population of Mongolia. Physical health was low compared with that determined using international data. Poor QOL was observed among those with mental health issues living in the urban areas.

A case of complete remission of intractable gestational choriocarcinoma with subsequent chemotherapy after pembrolizumab.

OBJECTIVE: Gestational choriocarcinoma is a gestational trophoblastic neoplasia (GTN) that originates from abnormal trophoblast proliferation. Although chemotherapy is effective for choriocarcinoma, personalized treatment becomes essential when patients develop chemoresistance. Here, we present the clinical course of a case of intractable choriocarcinoma that achieved complete remission with pembrolizumab following cytotoxic chemotherapy. CASE REPORT: A 38-year-old woman was initially diagnosed with low-risk GTN and treated with single- and multi-agent chemotherapy. She underwent a hysterectomy and was diagnosed with pathological choriocarcinoma with high-risk GTN. She was treated with multiple courses of several chemotherapy regimens. However, she did not achieve remission. Her choriocarcinoma showed high microsatellite instability; therefore, she took ten courses of pembrolizumab, but her hCG value increased. Subsequently, she underwent eight courses of paclitaxel and carboplatin alternating with paclitaxel and etoposide and achieved remission. CONCLUSION: This case suggests that pembrolizumab may improve the efficacy of subsequent chemotherapy.

Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study.

INTRODUCTION: This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan. METHODS: The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis. RESULTS: The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers. CONCLUSIONS: Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.

Period shaming behavior among male students in Luang Prabang Province, Lao People's Democratic Republic: A cross-sectional study.

Period shaming is defined as any negative and/or disrespectful behavior in relation to the menstrual cycle and menstruating girls. It is suggested that period shaming may limit girls' potential and ability to fully participate in school and community activities. This study aims to examine the prevalence and factors associated with period shaming among male students in Luang Prabang Province, Lao People's Democratic Republic (Lao PDR). This was a cross-sectional study which was conducted during November 19-27, 2020. This study included 1,232 male students from secondary school grade 9 to 12 in Luang Prabang Province, Lao PDR. Informed consent was obtained from the participants, parents/guardians, and teachers prior to data collection. The data was collected by a self-administered questionnaire. Logistic regression was employed to examine factors associated with period shaming behavior among male students. The mean age of the participants was 16.4 years old. Of all the male students, 18.8% admitted that they had shamed girls during their menstruation at least once. Of those who committed period shaming, they shamed girls some of the times (63.2%). Male students who had consumed alcohol during the last month before the data collection day (AOR = 1.83, 95% CI 1.32-2.55, P<0.001), had heard of menstruation (AOR = 1.76, 95% CI 1.27-2.44, P<0.001), and those who had attended activities/classes about sexual reproductive health (AOR = 1.90, 95% CI 1.29-2.78, P<0.01), were significantly associated with period shaming behavior. In conclusion, a single focus on providing biological health education may not be enough to address menstrual stigmatization and taboos. The school curriculum should integrate other life skill education with reproductive health, such as respect and gender equality, to encourage behavioral changes among male students, to address menstrual stigma and to support and empower girls' menstrual health at school and in the community.

Sickness absence among employees of healthcare organizations in the public sector in Mongolia: A cross-sectional study.

OBJECTIVES: This study aimed to understand the rate of sickness absence (SA) among employees of public healthcare organizations in Mongolia, to identify factors associated with long-term SA, and to estimate costs due to SA. METHODS: This cross-sectional study included employees of public healthcare organizations who had certified SA from 2016 to 2018. Sociodemographic and occupational characteristics of absentees and the data on absences were collected. A logistic regression analysis was performed to identify factors associated with long-term SA (≥15 days) among employees who had SA. Absence parameters and the average costs due to SA were calculated and the total cost due to SA at all public healthcare organizations was estimated. RESULTS: From 2016 to 2018, there were 13 653 absentees and 21 043 SA, and the absence rate was 0.9%. The average absence length per absence and absentee were 9.63 days and 14.85 days, respectively. Factors associated with long-term SA were age ≥40 years, 10-19 years in employment, working at the second and tertiary levels, and night shift. The average cost per absentee was 295.5 USD, and the estimated total cost for all health organizations was 1 796 993 USD per year. CONCLUSIONS: The absence rate was 0.9% and older age, longer work experience, higher organizational level, and night shift were associated with taking a long-term SA. To reduce the costs of absenteeism and promote the health of employees in healthcare organizations, policymakers should review the policies related to SA and develop national guidelines on SA for employers, healthcare managers, and employees.

Reporting system on mortality statistics in Lao People's Democratic Republic.

The system to collect information on mortality statistics in Lao PDR is not well established, accurate and timely death information is therefore not available. This article reports the system and process to make the mortality statistical data of Lao PDR. The country has a paper-based resident registration system, using a death notification document, a death certificate, and a family census book. The death notification document is important as it provides the cause of death, which is issued from a health facility and the village office. In the event of a death occurring at home, the family representative needs to report to the village office verbally to obtain a death notification document. On the other hand, if the death occurred in a medical facility, a death notification document from a health facility is provided. The family representative should bring the death notification document to the district Home Affairs office to register the death and obtain a death certificate. After that, the family representative needs to bring the death certificate to the district Public Security office for an amendment in the family census book. ICD-10 is under development regarding death notification from health facilities under the Ministry of Health. However, it is unclear how death notification from village offices can adopt ICD-10 as the majority of deaths occur outside health facilities. A comprehensive and integrated mortality reporting system is necessary in order to create a holistic health policy and welfare for the country.

Validation of the abbreviated version of the World Health Organization Quality of Life in Mongolia: a population-based cross-sectional study among adults in Ulaanbaatar.

There is currently no validated tool to measure the quality of life (QOL) in the Mongolian language. This study aimed to validate the Mongolian version of the World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire for the general population of Mongolia. The subjects were 301 adults aged 18-65 years selected randomly by a computer from 30 centers in 8 districts of Ulaanbaatar, Mongolia, in 2020. Reliability was measured using Cronbach's α and intraclass correlation coefficients. Convergent, discriminant, and construct validities were examined using exploratory and confirmatory factor analyses for a four-domain factor structure. Among the participants, 56.1% were women, 32.9% held a bachelor's degree or higher, 48.8% were employed, and 61.8% were married. The overall Cronbach's α coefficient of the WHOQOL-BREF questionnaire was 0.804. Correlations between the component scores of the WHOQOL-BREF ranged from 0.581-0.822. All items showed higher item-total correlations with their corresponding domains than with other domains, except the mobility item from the physical domain. Discriminative validity was evident in physical and psychological domains. Exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 24 items that provided an acceptable fit to the data (RMSEA=0.084; CFI=0.860). In conclusion, the Mongolian version of the WHOQOL-BREF demonstrated evidence of good reliability and validity for assessing QOL in the general population of Mongolia. These findings indicate that it allows the comparison of QOL of adults in Mongolia with those in other countries.

Assessment of the underlying causes of adult deaths using a short version of verbal autopsy in Xaiyabouli Province, Lao People's Democratic Republic.

BACKGROUND: In developing countries, it is difficult to collect the data of the underlying cause of death (UCOD), especially when a death does not occur in a health facility. This study aimed to develop a short version of verbal autopsy (VA) and identify the UCOD of adults in Lao People's Democratic Republic (Lao PDR). METHODS: A short version of VA for deaths outside health facilities was developed. This study included all deaths of people aged 15 years old or older in Xaiyabouli Province in 2020. Socio-demographic factors, place of death, and UCOD of the deceased were collected from health facilities or from family members using a questionnaire including the short VA form. UCOD was compared between home deaths and hospital deaths, between the age group of 15-59 years old and the age group ≥ 60 years old, and between males and females. RESULTS: Of all the 1,235 deaths included in this study, 1,012 deaths (81.9%) occured at home and 223 deaths (18.1%) at hospitals. The most common UCOD was senility (13.3%), followed by heart/renal failure (10.5%), pneumonia (9.6%) and traffic accident (7.1%). Compared to hospital deaths, home deaths had more people who were females, 75 years old or older, and Lao-Tai. Home deaths had more deaths than hospital deaths due to accident/injury (16.0% vs. 8.1%), tumor (4.7% vs. 1.8%), and senility (16.2% vs. 0%); fewer deaths due to heart/renal disease (15.1% vs. 32.3%), respiratory disease (12.2% vs. 18.8%), liver/gastro-intestine disease (5.3% vs. 9.0%), and infection (3.1% vs. 14.3%). The age group of 15-59 years had more deaths in the categories of accident/injury (28.1% vs. 4.4%), liver/gastro-intestine disease (8.1% vs. 4.4%), infection (7.2% vs. 3.5%), and tumor (6.0% vs. 2.8%). Males had more deaths due to tumor (5.2% vs. 3.0%) and fewer natural deaths (11.2% vs. 15.9%) than females. CONCLUSIONS: The major UCOD category was heart/renal disease in the adult generation in Xaiyabouli Province. Cost-effective interventions based on the multisectoral noncommunicable disease prevention plan should be appropriately implemented. Mortality surveillance using the short VA tool should be conducted for all home deaths in Lao PDR.

Causes of death, three delays, and factors associated with Delay 1 among maternal deaths in Myanmar: The maternal death surveillance in 2019.

OBJECTIVE: The maternal mortality ratio (MMR) in Myanmar was the highest in Southeast Asia in 2017. The Three Delay Model is used to evaluate delays that contribute to maternal deaths. This study aims to identify MMR, causes of death, the three delays related to maternal deaths, and the factors associated with Delay 1, which is the time of delay in deciding to seek health care (from the start of the woman's illness to the time when the problem is recognized to be requiring care), in Myanmar. STUDY DESIGN: A cross-sectional study. PARTICIPANT: This study included 934 cases of maternal deaths reported from all states and regions throughout Myanmar in 2019 that were not caused by accidents and injuries. MATERIALS AND METHODS: Socio-demographic factors, obstetrical factors, information about deaths, and assessment of delays were obtained from the Maternal Death Surveillance and Response System, the database of maternal deaths. Distribution of maternal deaths by states and regions, causes of maternal death, and types of delay that contributed to maternal deaths were descriptively summarized. Logistic regression analysis was performed to identify factors associated with Delay 1 among 567 maternal deaths without any missing data and unknown information on delays. FINDINGS: In 2019, the MMR was 106 (95% confidence interval, 99-112) per 100,000 live births. Of the 934 maternal deaths, 80.5% of deaths had at least one delay, and Delay 1 was the major delay (72.9%). Eclampsia/pre-eclampsia (21.6%), postpartum hemorrhage (18.2%), and abortion-related complications (13.2%) were the major causes of maternal death. The husband's low education, low household income, unplanned pregnancy, and no antenatal care were associated with Delay 1. KEY CONCLUSIONS AND IMPLICATION FOR PRACTICE: The MMR was lower in 2019 than that in 2017 but remained high. Moreover, we demonstrate that most maternal deaths had at least one delay, mostly Delay 1. To prevent maternal deaths caused by Delay 1, the family planning should be promoted to prevent unplanned pregnancies. Educational training for healthcare providers who deliver antenatal care should be strengthened. Furthermore, education on the danger signs of pregnancy and during childbirth should be provided not only to pregnant women and their husbands in communities at health facilities.

Drug library screening identifies histone deacetylase inhibition as a novel therapeutic strategy for choriocarcinoma.

BACKGROUND: Choriocarcinoma is a rare and aggressive gynecological malignancy. The standard treatment is systemic chemotherapy as choriocarcinoma exhibits high chemosensitivity. However, refractory choriocarcinoma exhibits chemoresistance; thus, the prognosis remains very poor. This study aimed to identify novel therapeutic agents for choriocarcinoma by utilizing a drug repositioning strategy. METHODS: Three choriocarcinoma cell lines (JAR, JEG-3, and BeWo) and a human extravillous trophoblast cell line (HTR-8/SVneo) were used for the analyses. The growth inhibitory effects of 1,271 FDA-approved compounds were evaluated in vitro screening assays and selected drugs were tested in tumor-bearing mice. Functional analyses of drug effects were performed based on RNA sequencing. RESULTS: Muti-step screening identified vorinostat, camptothecin (S, +), topotecan, proscillaridin A, and digoxin as exhibiting an anti-cancer effect in choriocarcinoma cells. Vorinostat, a histone deacetylase inhibitor, was selected as a promising candidate for validation and the IC50 values for choriocarcinoma cells were approximately 1 µM. RNA sequencing and subsequent pathway analysis revealed that the ferroptosis pathway was likely implicated, and key ferroptosis-related genes (i.e., GPX4, NRF2, and SLC3A2) were downregulated following vorinostat treatment. Furthermore, vorinostat repressed tumor growth and downregulated the expression of GPX4 and NRF2 in JAR cell-bearing mice model. CONCLUSION: Vorinostat, a clinically approved drug for the treatment of advanced primary cutaneous T-cell lymphoma, showed a remarkable anticancer effect both in vitro and in vivo by regulating the expression of ferroptosis-related genes. Therefore, vorinostat may be an effective therapeutic candidate for patients with choriocarcinoma.

Factors associated with positive cancer screening for the uterine cervix and breast in Jakarta Province, Indonesia: a cross-sectional study.

BACKGROUND: In many middle-income countries, cancer incidence and mortality are rapidly increasing, but data for developing a strategy of cancer control are rarely collected or analyzed. This study aimed to identify factors associated with positive cancer screening for the uterine cervix and breast in Jakarta Province, Indonesia. METHODS: The data of 79,660 women who had visual inspection with acetic acid (VIA) and 83,043 women who had clinical breast examination (CBE) in the Jakarta Women Cancer Screening program in 2019 were included in this study. Socio-demographic factors, reproductive factors, lifestyle factors, family history, and the results of VIA and CBE were used for analyses. Binary and multivariate logistic regression analyses were performed to identify factors associated with VIA positive or CBE positive. RESULTS: The positive rate was 0.9% for both VIA and CBE among the screening participants. Factors associated with VIA positive were age < 30 years old, age at menarche ≤ 11 years old, remarriage, lower educational level, having an occupation, partner's occupation other than being an employee, alcohol consumption, smoker, inadequate physical activity, cancer family history, and no Pap smear history. Factors associated with CBE positive were age at menarche ≤ 11 years old, widowed, high education, having an occupation, no breastfeeding history, birth control history, alcohol consumption, smoker, inadequate physical activity, cancer family history, and breast tumor history. CONCLUSION: Factors associated with VIA positive and CBE positive among Indonesian women were revealed. To promote female cancer prevention in Indonesia, the prevalence of screenings should be increased and education about the risk factors should be provided to medical professionals.

Children with neuro-developmental disorders at Center for Child and Adolescent Mental Health in Cambodia.

The Center for Child and Adolescent Mental Health (CCAMH) is one of the centers that have psychiatric specialists for children in Cambodia. This study aims to understand the characteristics of children with neuro-developmental disorders, especially autism spectrum disorder (ASD), at CCAMH. This study included 440 cases that were randomly chosen from 2,147 new patients at CCAMH in 2018-2019 and were aged 0-12 years. Socio-demographic factors, parent's information, obstetrical factors, and clinical data were collected from patients' records. A logistic regression analysis and Pearson's chi-square test were used to compare the characteristics between children who were finally diagnosed with ASD and the others (non-ASD). Of the 440 patients, most were male (75.2%), 0-4 years old (57.7%), and diagnosed with ASD (50.0%). Common symptoms were delay of speech, playing alone, and hyperactivity. ASD was significantly more prevalent in male patients compared to females and in the 0-4 years age group compared to the 5-12 years age group. Parents who lived in Phnom Penh and had high education were more likely to visit the CCAMH with their children who were diagnosed with ASD. Regarding treatment, approximately half of all 440 patients had family counselling and psychosocial education. ASD patients had more speech therapy, special education and structured teaching, and networking and coordination therapy compared to non-ASD patients. To provide education and therapy to children with ASD and their parents from the early stage, information about the center and ASD should be widely distributed to all parents in Cambodia.

Epidemiologic study on gestational trophoblastic diseases in Japan.

OBJECTIVE: This study aims to estimate the population-based incidence of gestational trophoblastic diseases (GTDs) and to identify the characteristics of gestational trophoblastic neoplasia (GTN) in Japan. METHODS: The annual number of GTD and live births from 1974 to 2018 were used to estimate the incidence of GTD. The data of 1,574 GTN cases from 1999 to 2018 were analyzed to identify the characteristics of low-risk GTN, high-risk GTN, placental site trophoblastic tumor (PSTT), and epithelioid trophoblastic tumor (ETT). RESULTS: The incidence of hydatidiform mole was 2.02 per 1,000 live births on average which decreased from 1974 to 2008 and increased from 2009 to 2018. The incidence of low-risk GTN, high-risk GTN, PSTT, and ETT was 15.3, 3.5, 0.3, and 0.07 per 100,000 live births, respectively. The estimated incidence of post-molar GTN was 9.8% of molar patients. High-risk GTN was diagnosed more pathologically, had more various kinds of antecedent pregnancies, and had longer intervals after the antecedent pregnancy compared to low-risk GTN. Furthermore, 8.2% of high-risk GTN occurred after the subsequent non-molar pregnancy of hydatidiform mole. The cumulative percentage of developing high-risk GTN after hydatidiform mole reached 89.3% at the 60th month. CONCLUSION: The incidence of hydatidiform mole, low-risk GTN, high-risk GTN was 2.02 per 1,000 live births, 15.3 per 100,000 live births, and 3.5 per 100,000 live births, respectively. High-risk GTN was diagnosed more pathologically and later after the antecedent pregnancy than low-risk GTN. Following molar patients for five years is needed to improve the mortality of malignant GTN.

Underlying cause of death at medical facilities in Xaiyabouli Province, Lao People's Democratic Republic.

In Lao PDR, Ministry of Health introduced District Health Information Software 2 (DHIS2) in 2013. Although DHIS2 includes cause of death, Lao government did not request to report cause of death through DHIS2, resulting in no information on frequency of underlying cause of death even for the deaths at medical facility. This study aimed to collect the information on the underlying cause of death at all medical facilities in Xaiyabouli province, a rural area in Lao PDR. As well as the point estimate of the proportion, a 95% confidence interval (CI) based on a binomial distribution was calculated for each cause of death. According to the local government request, 226 deaths (128 males and 98 females) in 2019 were reported from all medical facilities in the province. Among them, infectious diseases were the most frequent (33.6%, 95% CI 27.5-40.2%); sepsis (16.8%, 95% CI 12.2-22.3%), pneumonia (8.8%, 95% CI 5.5-13.3%), and meningitis (4.9%, 95% CI 2.5-8.5%). Heart diseases were 15.9% (95% CI 11.4-21.4%) including heart failure and myocardial infarction. Injury was 10.2% (95% CI 6.2-14.4%) including brain injury. Neonatal death was 10.6% (95% CI 6.9-15.4%). Among those, preterm death was common (8.8%, 95% CI 5.3-13.3%). Renal failure was 8.0% (95% CI 4.8-12.3%). According to civil registration covering all deaths both at facilities and outside facilities, deaths at facilities were 16.8% of the whole deaths (1,372 deaths) in Xaiyabouli province. Although deaths outside facilities were not included, this is the first report demonstrating cause of death in one province in Lao PDR.