Classification of community-acquired outbreaks for the global transmission of COVID-19: Machine learning and statistical model analysis.

BACKGROUND: As Coronavirus disease 2019 (COVID-19) pandemic led to the unprecedent large-scale repeated surges of epidemics worldwide since the end of 2019, data-driven analysis to look into the duration and case load of each episode of outbreak worldwide has been motivated. METHODS: Using open data repository with daily infected, recovered and death cases in the period between March 2020 and April 2021, a descriptive analysis was performed. The susceptible-exposed-infected-recovery model was used to estimate the effective productive number (Rt). The duration taken from Rt > 1 to Rt < 1 and case load were first modelled by using the compound Poisson method. Machine learning analysis using the K-means clustering method was further adopted to classify patterns of community-acquired outbreaks worldwide. RESULTS: The global estimated Rt declined after the first surge of COVID-19 pandemic but there were still two major surges of epidemics occurring in September 2020 and March 2021, respectively, and numerous episodes due to various extents of Nonpharmaceutical Interventions (NPIs). Unsupervised machine learning identified five patterns as "controlled epidemic", "mutant propagated epidemic", "propagated epidemic", "persistent epidemic" and "long persistent epidemic" with the corresponding duration and the logarithm of case load from the lowest (18.6 ± 11.7; 3.4 ± 1.8)) to the highest (258.2 ± 31.9; 11.9 ± 2.4). Countries like Taiwan outside five clusters were classified as no community-acquired outbreak. CONCLUSION: Data-driven models for the new classification of community-acquired outbreaks are useful for global surveillance of uninterrupted COVID-19 pandemic and provide a timely decision support for the distribution of vaccine and the optimal NPIs from global to local community.

Comparison of three equations for estimating low-density lipoprotein-cholesterol in the rural northeastern region of Thailand.

BACKGROUND: Cardiovascular disease is the most common cause of death worldwide, and the detection of LDL-C contributes to reducing risks. However, the LDL-C is rarely evaluated according to the gold standard method because it is costly and time-consuming. This study aimed to determine the agreement of LDL-C among three equations, namely Friedewald's equation, Puavilai's equation, and Dansethakul's equation. METHODS: A cross-sectional descriptive study. RESULTS: Using the data of lipid measurement from a specific group of people in the remote rural area, we found that the Thai equations have more superior agreement with direct measurement than the Friedewald equation (ICC = 0.870, 95% CI = 0.857-0.882) when the agreement of continuous data was used for total analysis. Although the categorical analysis that gave better agreement was from Friedewald equation (K index = 0.730, 95% CI = 0.720-0.751), the findings from this study confirmed the population-specific use of Pauvilai's equation and Dansethakul's equation for determining the LDL-C. CONCLUSION: Pauvilai's equation showed better agreement with direct measurement for LDL-C. Thus, it could be considered as an alternative for the direct method, particularly in laboratories in rural areas in Thailand.

Using Multilevel Negative Binomial Modeling to Detect Active Smoking in Colorectal Cancer Screening.

BACKGROUND: Multilevel analysis, in several forms, has been extensively utilized over the past few decades. While utilizing for colorectal cancer (CRC) screening may be unclear, especially at community level. The study aimed to explain the use of multilevel negative binomial analysis, developed as a practical guide through data obtained from a study of CRC screening in Thailand. METHOD: We analyzed the data of 2,475 fecal immunochemical test (FIT) cases in treatment arms from a population-based randomized controlled trial for CRC screening in the Khon Kaen province of Thailand. We summarized the statistical methodology, highlighting the advantages and disadvantages of data analysis using a multilevel negative binomial method compared with a standard negative binomial approach based on the data obtained in the randomized controlled trial for CRC screening; where active smoking and fecal hemoglobin (f-Hb) concentration were considered as the main exposure and outcome, respectively. RESULTS: Our findings showed differences of significant value and magnitude in the effects of both methods. Active smoking was statistical significantly with an f-Hb concentration IRRadj = 1.47 (95%, CI: 1.01-2.14) through the use of the standard negative binomial method, whereas the multilevel negative binomial approach produced a non-statistical significance of IRRadj = 1.30 (95%, CI: 0.89-1.90). CONCLUSION: Utilizing a standard statistical approach in CRC screening, the data analyzed were equal to zero. Hierarchical data, based on contextual factors and using a multilevel modeling approach, must be addressed. The f-Hb concentration, occurred over-dispersion, which implies that further studies utilize over-dispersion for improved appropriate statistical analysis.

Is Social Support Associated with Colorectal Cancer Care Utilization? A Multilevel Mixed-Effects Model of a Cross-Sectional Cohort Study in Vietnam.

OBJECTIVE: To investigate the relationship between the social support (SS) and colorectal cancer (CRC) care utilization of patients in the central region of Vietnam. METHODS: This was a cross-sectional cohort study in which the cohort was defined as all residential patients diagnosed with CRC in a tertiary hospital, Hue Central Hospital (HCH), in central Vietnam from 2013 to 2019. Social support was considered the main independent variable and was evaluated using the Medical Outcomes Study Social Support Survey (MOS-SSS), a self-administered 19-item SS survey. MOS-SSS is a widely used scale for assessing social support in CRC patients because it is brief, easy to use, reliable, and valid. In this study, we considered a data framework with a multilevel structure that included the patient level and duration of diagnosis as the second level. We estimated the magnitude of SS and CRC-specific treatment modalities using multilevel mixed-effects (MM) models under a hierarchical approach. RESULTS: The findings indicated that CRC care utilization rates were 89.9%, 48.5%, and 30.6% for surgical resection, chemotherapy, and radiation therapy, respectively. The overall trend of SS decreased significantly and affected the CRC care utilization. We found a positive effects of overall SS, as well as emotional and tangible support, on the number of hospitalization admissions and chemotherapy utilization. CONCLUSION: This study suggests that the use of the MOS-SSS should be continued in the long term for CRC patients to enhance medical accessibility and care utilization.

Use of glucometer and fasting blood glucose as screening tools for diabetes mellitus type 2 and glycated haemoglobin as clinical reference in rural community primary care settings of a middle income country.

BACKGROUND: Thailand is considered to be a middle income country, and to control and prevent type 2 diabetes mellitus (T2DM) is one of the main concerns of the Thai Ministry of Public Health (MoPH). Screening for T2DM and care for T2DM patients has been integrated into the primary health care system, especially in rural areas. The intention of this investigation is to link public health research at the academic level with the local health authorities of a district of a north-eastern province of the country. METHODS: Epidemiological methods were applied to validate the screening tools fasting capillary blood glucose (CBG), measured by glucometer and venous blood for the determination of plasma glucose (VPG), used for screening for T2DM among asymptomatic villagers. For assessing the validity of these two methods glycated haemoglobin (HbA1c) values were determined and used as the 'clinical reference'. RESULTS: All together 669 villagers were investigated. Determinations of CBG and VPG resulted in suspected T2DM cases, with 7.3% when assessed by CBG and 6.4% by VPG using a cutoff point of 7 mmol/L (126 mg/dl). Taking HbA1c determinations with a cutoff point of 7% into account, the proportion of T2DM suspected participants increased to 10.4%. By estimating sensitivity, specificity and the positive predictive value of CBG and VPG against the 'clinical reference' of HbA1c, sensitivity below 50% for both screening methods has been observed. The positive predictive value was determined to be 58.5% for CBG and 56.8% for VPG. The specificity of the two screening tests was over 96%. CONCLUSIONS: The low sensitivity indicates that using fasting CBG or VPG as a screening tool in the field results in a high proportion of diseased individuals remaining undetected. The equally low positive predictive values (below 60%) indicate a high working load for the curative sector in investigating suspected T2DM cases to determine whether they are truly diseased or false positive cases according to the screening method. Further implications of the results and the controversial discussion related to the use of HbA1c as clinical evidence for suffering from T2DM are also discussed.

The Accuracy of Fecal Immunochemical Test in Colorectal Cancer Screening: A Meta-Analysis.

OBJECTIVE: To investigate the accuracy of OC-Sensor and colorectal cancer screening in a population-based randomized controlled trial at Khon Kaen province, Thailand. METHODS: The MOOSE Guidelines for Systematic Reviews and Meta-Analyses of Observational Studies was applied. Eligibility criteria were English language, hand searching was conducted using Medline databases from 2010 to 2021 for identify literatures reviews of OC-Sensor and colorectal cancer screening. The initials screen based on the research titles and abstracts, final screenings based on full-text reports. Synthesis the results with meta-analysis using fixed effect model, random effect model, determined statistically significant with p-value < 0.05.  Confirmed the pooled effect sizes of high heterogeneity by meta-regression including tested precision of each estimates by bubble plot using STATA version 14. RESULTS: Meta-regression showed sensitivity of OC- sensor = 72.54% (95% CI: 65.82-79.25), and specificity of OC- sensor = 89.59% (95% CI: 87.23-91.95). CONCLUSIONS: Sample size and cut-off of fecal hemoglobin concentration in each study were differed but sub-group analysis and sensitivity analysis were not considered for this analysis because population, setting and location for detected cancer of included study are not differences. 
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Adult Height as a Risk Factor for Developing Colorectal Cancer: A Population-Based Cohort Study in Thailand.

BACKGROUND: Previous studies have shown that a taller stature has a higher risk of colorectal cancer (CRC) than a shorter stature. However, most prior studies were conducted in the Western region, with few studies and inconsistent results for Asians. To our best knowledge, no previous research has investigated the population of ASEAN countries, which is generally shorter in stature than the Western population. We aimed to examine the association between adult height and CRC risk in a Thai population. METHODS: This population-based cohort study was conducted in Khon Kaen, Thailand. Overall, 118 patients with CRC were histologically confirmed among 14,418 participants, who were recruited during 1990-2001 and followed up until December 31, 2020. A structured questionnaire was used to obtain baseline data, including demographic and environmental variables. The exposure of interest was measured in height and defined on the basis of the last recorded measurement. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were estimated using Cox proportional hazard regression analysis. RESULTS: Over a median of 21.7 years of follow-up (interquartile range: 19.9-25.6), 14,418 participants provided a total observation time of 303,899 person-years. The risk of CRC at the highest compared to the lowest height quintile was 1.29 (95% CI, 0.76-2.20; p=0.350). A trend similar to a U shape was observed (HR in Q1 vs. Q2=1.05; 95% CI, 0.62-1.75; Q1 vs. Q3=0.78; 95% CI, 0.43-1.39; Q1 vs. Q4=0.55; 95% CI, 0.29-1.05; and Q1 vs. Q5=1.29; 95% CI, 0.76-2.20). CONCLUSIONS: Although adult height was not statistically significant, its magnitude still indicated some clues to investigate as evidence, especially for people living in the context of ASEAN countries. Large-scale, comparable studies in such contexts should be considered for confirmation.

Role of literacy, fear and hesitancy on acceptance of COVID-19 vaccine among village health volunteers in Thailand.

BACKGROUND: The roles of literacy, fear and hesitancy were investigated for acceptance of COVID-19 vaccine (AV) types among village health volunteers (VHVs) in Thailand. MATERIALS AND METHODS: A cross-sectional study was conducted using an unidentified online questionnaire to assess literacy, fear and hesitancy of COVID-19 vaccine acceptance among Thai VHVs between 1 and 15 October 2021. The questionnaire was developed based on the HLVa-IT (Health Literacy Vaccinale degli adulti in Italiano) for vaccine literacy (VL), using an adult Vaccine Hesitancy Scale (aVHS) for COVID-19 vaccine hesitancy (VH) and Fear of COVID-19 scale (FCoV-19S) for the distress of COVID-19 vaccine. The effects of VL, VH and vaccine fear (VF) on AV were estimated using multivariable logistic regression. RESULTS: A total of 5,312 VHVs completed the questionnaire. After adjustment with variables in the multivariable analysis, the VL score was insignificantly associated with increased vaccination (aOR = 1.002; (95%CI: 0.994-1.01)), while VF and VH significantly decreased the chance of vaccination, aOR = 0.966 (95%CI: 0.953-0.978) and aOR = 0.969; (95%CI: 0.960-0.979), respectively and VF and VH were negatively associated with AV for all types of vaccine preference, with VL showing a reverse relationship only for mRNA-based vaccines. CONCLUSION: VL may not increase AV among VHVs. To increase attitudes toward receiving COVID-19 vaccination in Thailand, the government and health-related organizations should instigate policies to significantly reduce VF and VH among Thai VHVs.

Overall Survival Rate of Vietnamese Patients with Colorectal Cancer: A Hospital-Based Cohort Study in the Central Region of Vietnam.

BACKGROUND: This study investigated the overall survival (OS) at 1-year, 3-years, and 5-years after colorectal cancer (CRC) diagnosis and examined the prognostic factors of mortality among patients with CRC in Vietnam's central region. METHODS: This ambidirectional cohort study included patients newly diagnosed with CRC at a tertiary hospital in Vietnam's central region between 2013 and 2019. Survival duration was calculated from the surgery date or the first day of CRC-specific treatment until the date of death or the study's end date, July 31, 2020. Kaplan-Meier methods and log-rank test were used to estimate and compare the OS between the subgroups, respectively. The Cox proportional-hazards (PH) regression analysis was applied to estimate the magnitude of the effects between prognostic factors and outcome. RESULTS: The median follow-up was 24 months (interquartile range: 13-43 months). The OS rate dropped significantly to 84.7%, 56.19%, and 45.01% at 1-year, 3-years, and 5-years after diagnosis, respectively. The median OS was 48.59 months (39.34 -57.93 months) for the rectum and colon cases. In the multivariate analysis, a higher mortality risk was observed in patients with an advanced-stage CRC (HRadj, 3.04; 95% confidence interval [CI], 1.79-5.18), who were underweight (<18.5 kg/m2; HRadj, 1.65; 95%CI, 1.03-2.65), and had elevated preoperative carcinoembryonic antigen (CEA) level (>5.0 ng/mL; HRadj, 1.63; 95%CI, 1.03-2.59). Additionally, younger patients (<50 years) had a poorer OS than the middle-aged group (60-69 years). CONCLUSION: Our findings indicate that <50% of Vietnamese patients with CRC survive until 5-years after diagnosis. Several individual factors that contribute to the poor OS of patients with CRC, including young age, underweight, and elevated preoperative CEA level, should be evaluated and managed. Early diagnoses through active routine examination of or screening programs for high-risk groups should be prioritized.

Sex Differences in the Heterogeneous Dynamic Incidence of Oral Cancer: A Comparison between Taiwan and Thailand.

BACKGROUND: This study aims at investigating differences in oral cancer (OC) incidence trends between two populations in Taiwan and Thailand. METHODS: We used the population-based cancer registry data from Taiwan (1979-2016) and Khon Kaen (KK), Thailand (1985-2016). We performed joinpoint analyses to detect the trend change points for the OC incidence and to quantify the time trends in both sexes and regions. Age-period-cohort curves were plotted to explain the incidence trends. RESULTS: In Taiwan, the estimated annual increases in OC were approximately 6.0% in males, although the increase slowed after 2009, and 2.6% in females. In KK, the OC incidence steadily decreased by -2.5% per year in females, but there was no obvious change in males. A strong period effect observed in those aged 45-69 years in Taiwanese males resulted in a peak incidence in the middle age group. Decreased period and cohort effects were observed in females in KK. CONCLUSIONS: Taiwanese males are the predominant sex affected by OC in Taiwan, and the trend has decelerated since 2009. Age, period, and cohort effects were different between males and females in the two regions.

Spatial analysis of hepatobiliary abnormalities in a population at high-risk of cholangiocarcinoma in Thailand.

Cholangiocarcinoma (CCA) is a serious health challenge with low survival prognosis. The liver fluke, Opisthorchis viverrini, plays a role in the aetiology of CCA, through hepatobiliary abnormalities: liver mass (LM), bile duct dilation, and periductal fibrosis (PDF). A population-based CCA screening program, the Cholangiocarcinoma Screening and Care Program, operates in Northeast Thailand. Hepatobiliary abnormalities were identified through ultrasonography. A multivariate zero-inflated, Poisson regression model measured associations between hepatobiliary abnormalities and covariates including age, sex, distance to water resource, and history of O. viverrini infection. Geographic distribution was described using Bayesian spatial analysis methods. Hepatobiliary abnormality prevalence was 38.7%; highest in males aged > 60 years (39.8%). PDF was most prevalent (20.1% of males). The Standardized Morbidity Ratio (SMR) for hepatobiliary abnormalities was highest in the lower and upper parts of the Northeast region. Hepatobiliary abnormalities specifically associated with CCA were also more common in males and those aged over 60 years and distributed along the Chi, Mun, and Songkram Rivers. Our findings demonstrated a high risk of hepatobiliary disorders in Northeast Thailand, likely associated with infection caused by O. viverrini. Screening for CCA and improvement of healthcare facilities to provide better treatment for CCA patients should be prioritized in these high-risk areas.

Effect of metabolic syndrome on incidence of oral potentially malignant disorder: a prospective cohort study in Taiwan.

OBJECTIVES: We aimed to assess the effect of metabolic syndrome (MetS) on incident oral potentially malignant disorder (OPMD). DESIGN: We conducted a prospective cohort study of the Changhua community-based integrated screening (CHCIS) programme and nationwide oral cancer screening programme during the period between 2005 and 2014. SETTING: CHCIS, Taiwan. PARTICIPANTS: We enrolled 17 590 participants aged 30 years and older. MAIN OUTCOMES AND MEASURES: We assessed the impact of MetS on the outcome measured by incident OPMD. RESULTS: The incidences of OPMD among subjects with and without MetS were 7.68 ‰ and 5.38 ‰, respectively. After adjusting for confounders, subjects with MetS exhibited a statistically greater risk of developing OPMD compared with those who were free of MetS by 33% (adjusted rate ratio, aRR=1.33, 95% CI 1.14 to 1.55). Individual components of MetS still remained significant, including central obesity (aRR=1.22, 95% CI 1.04 to 1.44), hypertriglyceridaemia (aRR=1.26, 95% CI 1.07 to 1.49) and hyperglycaemia (aRR=1.20, 95% CI 1.02 to 1.41). Central obesity and hypertriglyceridaemia were also statistically associated with a subtype of OPMD, namely, leukoplakia. CONCLUSION: The temporal influence of MetS on the risk of incident OPMD was noted in our prospective cohort study. Therefore, promoting an MetS prevention and control programme might reduce the occurrence of OPMD and oral cancer.

Lack of Association between Red Meat Consumption and a Positive Fecal Immunochemical Colorectal Cancer Screening Test in Khon Kaen, Thailand: a Population- Based Randomized Controlled Trial

Background: There is convincing evidence from epidemiological studies that meat consumption increases colorectal cancer (CRC) risk. However, assessment of any association with a positive fecal immunochemical test (FIT) in CRC screening has been limited. If a link could be shown this might be helpful for establishing a risk group for colonoscopy. Objective: This study aimed to assess any association between meat consumption and other lifestyle factors and a positive FIT result in a Thai population. Methods: A cross-sectional analytical study was conducted with 1,167 participants in a population-based randomized controlled trial. CRC was screened from May 2016 - February 2017. Subjects aged 45-74 years who met the eligibility criteria were randomly allocated to the study arm. A positive FIT was determined with cut-off 100 ng/mL. Multiple logistic regression was used to analyze any relationship between lifestyle factors and a positive FIT. Result: The total number of subjects was 1,060 (90.8% return rate of FIT). With FIT100, FIT150, and FIT200, positive tests were found in 92 (8.68%), 74 (6.98%), and 60 (5.66%), respectively. No significant associations were noted with any of the variables, except for being aged 60-74 years (ORadj = 1.62, 95% CI: 1.03-2.54) Borderline significance was observed for high consumption of vegetables (ORadj = 0.62, 95% CI: 0.36-1.07) and being male (ORadj = 1.39, 95% CI: 0.87-2.22). Conclusion: Despite the evidence from the literature, no association was here found between a positive FIT result and meat consumption or other well-established lifestyle parameters. Being aged 60-74 years was a risk factor which should be taken into account in CRC screening strategy in countries like Thailand with limited access to endoscopy.

The effect of the public or private status of health care facility in acute coronary syndrome: data from Thai ACS Registry.

BACKGROUND: Few data showed the differences between public and private hospitals in management practices and outcomes of patients with acute coronary syndrome. Furthermore, no data is available in Thailand. OBJECTIVE: To determine the patients' characteristics, management practices, and in-hospital outcomes differences between public and private hospitals in Thailand for patients with acute coronary syndrome. MATERIAL AND METHOD: Data from the Thai Acute Coronary Syndrome Registry (TACSR), which was a prospective observational study on ACS in Thailand from 2003 to 2005, was used. This registry provided clinical characteristics, medical management and outcomes of patients with ACS during hospitalization. All data were then compared based on type of admitting hospitals; public and private hospitals. To determine the relationship between type of hospital and major cardiac outcomes, multivariate logistic regression analysis was performed and represented as odd ratio (OR) and 95% confidence interval (95%CI). RESULTS: Eight thousand one hundred sixty four patients were admitted to public hospitals (n = 13), and 1,209 were admitted to private hospitals (n = 4). Patients in public hospitals were older (65.4 +/- 12.1 vs. 63.4 +/- 13.3 years, p < 0.001) and more female gender (41.7% vs. 30.1%, p < 0.001). Diagnosis of acute ST-elevation myocardial infarction were lower in public hospitals compared to private hospitals (39.6% vs. 50%, p < 0.001). After adjusting for baseline patient characteristics and management, in-hospital outcomes were higher in public hospitals for total mortality (13.6% vs. 5.9%, OR 2.3, 95%CI 1.76-3.12, p < 0.001), cardiac mortality (10.6% vs. 4.8%, OR = 2.1, 95%CI 1.55-2.91, p< 0.001) and major bleeding (6.3% vs. 3.2%, OR = 2.1, 95%CI 1.48-3.23, p < 0.001). Compared with the patients in the public hospital, patients in the private hospitals were more likely to undergo coronary angiography, percutaneous coronary intervention and coronary bypass grafting. CONCLUSION: In Thailand, management of patients with acute coronary syndrome is influenced by the public or private status of the hospitals. Patients were more likely to undergo coronary angiography and coronary revascularization procedures in private hospitals. The length of hospital stays and in-hospital mortality was higher in public hospitals.

Predictors of in-hospital mortality in non-ST elevation acute coronary syndrome in Thai Acute Coronary Syndrome Registry (TACSR).

OBJECTIVE: To determine baseline prognostic factors of in-hospital mortality in Thai patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). MATERIAL AND METHOD: Among 5,537 NSTE-ACS patients enrolled in Thai Acute Coronary Syndrome Registry, a univariate analysis and multivariate analysis were used to estimate the relationship of baseline clinical variables and in-hospital mortality. Variables examined included demographics, history and presenting characteristics. RESULTS: The in-hospital mortality rate was 9.5%. The statistically significant, adjusted baseline prognostic factors of in-hospital death were older age > or =65 years) (odds ratio [OR] 2.2, 95% confidence interval [CI] = 1.54-3.09), shock at presentation (OR 4.6, 95%CI = 2.91-7.32), heart failure (OR 3.1, 95%CI = 2.15-4.38), positive cardiac marker (OR 1.7, 95%CI = 1.18-2.53), arrhythmia (OR 12.3, 95%CI = 8.71-17.35), major bleeding (OR 2.9, 95%CI = 1.84-4.51), and cerebrovascular accident (OR 4.9, 95% CI = 2.42-9.97). While dyslipidemia (OR 0.6, 95%CI = 0.45-0.87), having percutaneous coronary intervention (OR 0.6, 95% CI = 0.39-0.94), receiving aspirin (OR 0.6, 95%CI = 0.33-0.94), beta-blocker (OR 0.5, 95% CI = 0.40-0.73), angiotensin converting enzyme inhibitor (OR 0.6, 95% CI = 0.43-0.78) and nitrate (OR 0.5, 95%CI= 0.35-0.76) were associated with lower in-hospital mortality. CONCLUSION: The in-hospital mortality is higher in Thai NSTE-ACS patients compared to other populations. The present study supports and confirms the prognostics importance of several baseline characteristics reported in previous studies.

Joinpoint Analysis Trends in the Incidence of Colorectal Cancer in Khon Kaen, Thailand (1989 ­ 2012)

Objective: This study focused on recent changes in the incidence of colorectal cancer (CRC) in Khon Kaen, Thailand. Methods: Data for CRC over the period 1989 to 2012 from the population-based cancer registry of Khon Kaen province were employed. Age-standardized incidence rates (ASR) were calculated and classified into 4 age-groups for comparison. Joinpoint regression analysis was used to detect changes in trends among each line segment and an overall line was generated, whether increasing or decreasing, with annual percent change (APC) and average annual percent change (AAPC). Results: There were 3,364 CRC cases included in the analysis, 72.2% histological confirmed and 53.5% in men. Trends of ASRs generally demonstrated gradual increase over the period 1989 to 2012. For those aged under 45 or 50 years there was slight overall increase, with a somewhat zigzag pattern. From joinpoint analysis, the trends of all aged groups were found to be increasing among both men and women: aged 45 years and older group AAPC=3.40, 2.30 and 3.90, respectively); aged 50 years and older group AAPC=2.90, 2.20 and 3.40; aged under 45 years AAPC=6.30, 6.00 and 6.90; and aged under 50 years (AAPC=5.70, 3.20 and 5.70. Conclusions: ASRs for CRC have been gradually increasing in the northeast region of Thailand. Future studies should consider the subsite distribution.

Preliminary Results: Colorectal Cancer Screening Using Fecal Immunochemical Test (FIT) in a Thai Population Aged 45-74 Years: A Population-Based Randomized Controlled Trial

Objective: The aim of this paper is to provide some details and the results to date of a colorectal cancer screening trial using a fecal immunochemical test (FIT). Methods: A population-based randomized controlled trial began in May, 2016. All people aged 45 to 74 years living in Nam Phong District, Khon Kaen Province, Thailand, and willing to participate are being recruited using an outreach method. Enrolled participants are randomly allocated by a computer-generated randomization program either to a study arm (receive sample kit for FIT) or to a control arm (no provision of kit). Positive FIT cases are subsequently confirmed by a colonoscopy examination, and negative FIT cases are re-tested with FIT every two years. The preliminary results to date were analysed using descriptive statistics. Results: A total of 1,060 enrolled participants provided a complete set of data. Of those randomly assigned to the study arm and tested by FIT, 92 (8.7%) were found to be positive, 39 (11.5%) males and 53 (7.4%) females. The f-Hb concentrations at the 75th, 90th and 95th percentiles for all age groups were higher in males than in females, and the distributions of f-Hb concentration varied with age, especially at the 95th percentile where f-Hb concentrations increased with age. Conclusion: The preliminary results of our screening trial have indicated that the prevalence of positive FIT cases is higher than in a similar recent and, at the time unique, previous study in Thailand. This finding is especially the case for males and those in the older age groups.

The surveillance system in health centers in northeastern Thailand.

In this study we assessed the existing communicable disease surveillance system in health centers of a province in northeastern Thailand. The first part of the study was an examination of medical records from 11 local health centers: 649 were examined for sensitivity, positive predictive value, and representativeness; and 433 were examined for timeliness and data quality. The second part of the study looked at 50 local officers from 11 local health centers, 1 district health office, 1 community hospital, and 8 sub-district administrative organizations. Quantitative data was collected through a review of medical records. Qualitative data was collected by focus groups and in-depth interviews. The reporting of suspected cases was 50.8%. Sensitivity was low for common diseases. Positive predictive value was lowest for fever of unknown origin (0%). Data quality for the date of onset and diagnosis was low. Case reporting was considered timely in only 45% of cases. Health officers perceived the surveillance system as not being up-to-date. They only collected data in a district without data analysis; the information provided by the system is not representative of the true epidemiological situation countrywide and cannot be used to help monitor disease patterns and trends. In conclusion, health officers should report diseases according to symptoms and analyze data continuously to identify urgent problem and elicit prompt responses.