Outcome Evaluation of a Transnational Postgraduate Capacity-Building Program Using the Objective Structured Clinical Examination.

Previous studies have applied interview-oriented self-reported or peer-centered evaluation methods, rather than an objective and quantitative method, to evaluate outcome of a postgraduate capacity-building program and have mainly focused on the cognitive level. To investigate the feasibility of the objective structured clinical examination (OSCE) in an international setting and report the results of the outcome evaluation for the behavioral aspect. A case-control study. Ninety examinees divided into 2 case-control groups: 17 program-experienced doctors and 17 control doctors in the first group, and 28 mentees of the program-experienced doctors and 28 control doctors in the second group. A six-station OSCE was implemented. The OSCE scores were measured to evaluate (1) the direct educational effect regarding learning in the first group and (2) the indirect educational effects regarding transfer in the second group. Written questionnaire and interview data were collected for qualitative analysis. The quantitative results of the overall or subcomponent OSCE scores indicated no significant differences in the comparisons of the first and second case-control groups. The qualitative data indicated that the program improved participants' medical knowledge, skills, and self-confidence, however, it also revealed limited learning environment provided by the program. This transnational study has demonstrated the process for introducing and successfully completing the testing of an OSCE in Laos. Discrepancy in the goals of the OSCE and the education program limited the usefulness of OSCE as an assessment tool, leading to the lack of significant differences in its results.

Current Status of Thalassemia in Lao People's Democratic Republic.

Thalassemia is a major public health and economical burden in Lao People's Democratic Republic (Lao PDR). This study is aiming to elaborate the current situation of Thalassemia in Laos. α- and ß-thalassemia (α- and ß-thal) includes the common Hb S (HBB: c.20A>T) and hemoglobins (Hbs) such as Hb Constant Spring (Hb CS or HBA2: c.427T>C) and Hb E (HBB: c.79G>A) that are prevalent in the country. Overall, the prevalence of α-thal in Lao PDR is 26.8%. There was high prevalence of homozygous (12.8%) and heterozygous (39.7%) Hb E among migrant workers from Lao PDR who crossed the border to work in Thailand. Iron chelation, blood transfusion, prenatal screening and diagnosis, comprehensive treatment are still the major problems. Splenectomy is still performed. A national registry has still not been established. This is a national economic burden for the country. Thalassemia prevention and control strategy should be established and advocated by the government in order to reduce morbidity and premature mortality.

Neonatal Birthmarks at the 4 Central Hospitals in Vientiane Capital, Lao PDR.

Newborn skin disorders are quite common and happen to occur during the neonatal period. Most of the birthmarks are transient; however, worried parents often seek medical advice from their child's physician regarding skin lesions. Thus, it is important to differentiate the skin lesions from pathologic ones to avoid unnecessary diagnostic or therapeutic procedures. This is the first published study in Lao neonates that carried out the data from 4 central hospitals in Vientiane Capital, Lao PDR from September 2019 to February 2020. Among 500 neonates, Sebaceous gland hyperplasia (53%), Mongolian patches (46.6%), and Erythema toxicum neonatorum (30%) were the 3 most common cutaneous conditions found in the Lao newborns. From a clinical point of view, these findings are often a source of parental anxiety and medical concern for inexperienced clinicians.

Southeast Asian diversity: first insights into the complex mtDNA structure of Laos.

BACKGROUND: Vast migrations and subsequent assimilation processes have shaped the genetic composition of Southeast Asia, an area of close contact between several major ethnic groups. To better characterize the genetic variation of this region, we analyzed the entire mtDNA control region of 214 unrelated donors from Laos according to highest forensic quality standards. To detail the phylogeny, we inspected selected SNPs from the mtDNA coding region. For a posteriori data quality control, quasi-median network constructions and autosomal STR typing were performed. In order to describe the mtDNA setup of Laos more thoroughly, the data were subjected to population genetic comparisons with 16 East Asian groups. RESULTS: The Laos sample exhibited ample mtDNA diversity, reflecting the huge number of ethnic groups listed. We found several new, so far undescribed mtDNA lineages in this dataset and surrounding populations. The Laos population was characteristic in terms of haplotype composition and genetic structure, however, genetic comparisons with other Southeast Asian populations revealed limited, but significant genetic differentiation. Notable differences in the maternal relationship to the major indigenous Southeast Asian ethnolinguistic groups were detected. CONCLUSIONS: In this study, we portray the great mtDNA variety of Laos for the first time. Our findings will contribute to clarify the migration history of the region. They encourage setting up regional and subpopulation databases, especially for forensic applications. The Laotian sequences will be incorporated into the collaborative EMPOP mtDNA database http://www.empop.org upon publication and will be available as the first mtDNA reference data for this country.

The 'hot-spot' of Hb E [beta26(B8)Glu-->Lys] in Southeast Asia: beta-globin anomalies in the Lao Theung population of southern Laos.

Hb E [beta26(B8)Glu-->Lys], is the most common abnormal hemoglobin (Hb) in Southeast Asian populations. The hitherto highest frequencies of the Hb E gene (HBB*E) in large population samples, approximately 0.3, were observed in the southern part of northeastern Thailand. The finding of even higher frequencies in a small, isolated Austroasiatic group in Northeast Thailand prompted us to examine samples of three Austroasiatic populations in southern Laos (official designation: Lao Theung), an area inhabited by numerous ethnic groups belonging to the Mon-Khmer branch. Blood samples were collected from a total of 603 adult subjects. The HBB*E frequencies were 0.426 in the So of Khammuan Province, 0.433 in the Alak/Ngeh of Sekong Province and 0.253 in the Oy of Attapeu Province. The HBB*E frequencies in the So and Alak/Ngeh are the highest observed in Southeast Asia in representative population samples. None of the common Southeast Asian beta-thalassemia (thal) mutations were found. The results are discussed with respect to natural selection by malaria, selection time, effects of beta-thal and the ethnic history of the population of Southeast Asia.

The Southeast Asian 12.5 KB (delta-beta) degrees-deletion: a common beta-thalassemia in Mon-Khmer groups (Lao Theung) of South Laos.

Seven patients with unexplained anemia and mild thalassemic features were ascertained during a survey of hemoglobinopathies in the Sekong Province in South Laos. These patients belong to the Austroasiatic (Mon-Khmer) population of South Laos (official designation Lao Theung). Hemoglobin electrophoresis on cellulose acetate showed absence of Hb A and two bands in the positions of Hb E and Hb F respectively. Sequencing of DNA isolated from venous blood revealed the codon 26 G-->A mutation characteristic of the HBB*E gene, but none of the common Southeast Asian beta-thalassemia mutations were found. Detailed studies in four of the seven subjects identified a 12.5 kb deletion encompassing part of the delta-globin gene and the entire beta-globin gene. We conclude that this deletion is a common, and possibly the predominant beta-thalassemia mutation of the Austroasiatic Lao Theung population. Similar deletions reported in single individuals in Laos, Thailand and Vietnam are probably due to migrational spreading to areas adjacent to South Laos.