Prevalence of Suspected Cholangiocarcinoma Based on Ultrasonography Screening and its Associated Factors in Northeastern Thailand.

Background Ultrasonography of the liver allows detection of liver mass and bile duct dilatation which are findings of suspected Cholangiocarcinoma so that early stage Cholangiocarcinoma can be detected. Objective To estimate the prevalence of suspected Cholangiocarcinoma as well as its associated factors. Method These reported results were obtained from the baseline screening for Cholangiocarcinoma as of July 2013 of an ongoing project the Cholangiocarcinoma Screening and Care Program conducted in Northeastern Thailand. Participants were northeasterners who were at least one of the followings: 40 years or older, ever been infected with liver fluke, ever been treated with praziquantel, or ever been consumed raw fresh water fish. Ultrasonography was done by well-trained medical radiologists. Result Of the total 1,196,685 participants, 58.9% were females with a mean age of 58.2 (standard deviation ± 9.9) years. Suspected Cholangiocarcinoma was found in 15,186 (2.6%; 95% CI: 2.56 to 2.65) individuals. The results observed that the participants with higher age group had high association as compared to younger age group (AOR=1.98; 95% CI: 1.77 to 2.21; p-value < 0.001), hepatitis B infected participants were highly significant as compared to the non- hepatitis B infected (AOR=1.22; 95% CI: 1.07 to 1.39; p-value = 0.002) and participants having Hepatitis C were also significantly associated with Cholangiocarcinoma infection (AOR=1.46; 95% CI: 1.04 to 2.05; p-value = 0.029) based on ultra-sonographic screening respectively. However, patients having diabetes were less likely to be associated with Cholangiocarcinoma (AOR=0.87; 95% CI: 0.81 to 0.93; p-value < 0.001). Conclusion About one out of a hundred cases required further investigations such as Magnetic resonance imaging or Computed Tomography. Early age of ultrasonography screening for Cholangiocarcinoma enhanced the opportunities for early detection of Cholangiocarcinoma and might reduce irrational requests for expensive or invasive methods of diagnosis.

Protective factors for caries of a school-based oral health program in Bangkok, Thailand: a retrospective cohort study.

OBJECTIVES: The aim of the study was to assess protective factors of a school-based oral health preventive program on caries in permanent teeth in students and to identify other risk and protective factors associated with caries in this group. STUDY DESIGN: This is a retrospective cohort study. METHODS: A total of 433 students were examined in the 1st grade and followed up until the 6th grade. Each student was annually assessed for caries as per the World Health Organization index. Binary simple and multiple logistic regressions were performed to assess risk or protective factors with a P-value ≤0.05. RESULTS: In 1st graders, the caries prevalence in deciduous teeth was 87.2%, and the mean decayed, missing and filled teeth (dmft) index was 6.44 (±4.4); in 6th graders, the caries prevalence in permanent teeth was 51.7%, and the mean DMFT was 1.37 (±1.84). Protective factors for caries in permanent teeth were complete participation in the program, receiving fluoride varnish >4 times, and sealant applications on all first molars. Risk factors were female sex and caries prevalence in deciduous teeth. After multiple logistic regression, sealant application only remained significant, with an odds ratio (OR) of 0.19 (95% confidence interval [CI] = 0.06-0.63, P = 0.007), and for risk factor, caries prevalence in deciduous teeth only remained significant, with an OR of 5.44 (95% CI = 2.23-13.27, P < 0.001). CONCLUSIONS: There is an association between deciduous dentition caries and permanent dentition caries. Early prevention in school settings by applying fluoride varnish and dental sealants onto molars is protective and feasible. The study suggests that regular fluoride varnish and sealant applications should be extended to similar low-income area schools.

Effect of osteogenic periosteal distraction by a modified Hyrax device with and without platelet-rich fibrin on bone formation in a rabbit model: a pilot study.

This study evaluated the effect of a modified Hyrax device and platelet-rich fibrin (PRF) on osteogenic periosteal distraction (OPD). Twelve adult male New Zealand white rabbits were separated into two main groups (six in each) according to the duration of the consolidation period (4 or 8 weeks). In each main group, the animals underwent OPD of the left and right sides of the mandible and were divided into four subgroups (three animals per group): device vs. device+PRF, and PRF vs. sham. Radiographic, histological, histomorphometric, and micro-computed tomography (micro-CT) analyses were performed. New bone formation was observed on the lateral and vertical sides of the mandible of all groups. Micro-CT and histomorphometry showed that the device+PRF group presented the highest percentages of bone volume and bone area at 4 weeks (56.67 ± 12.67%, 41.37 ± 7.57%) and at 8 weeks (49.67 ± 8.33%, 55.46 ± 10.67%; significantly higher than the other groups, P<0.001), followed by the device group at 4 weeks (33.00 ± 1.73%, 33.21 ± 11.00%) and at 8 weeks (30.00 ± 3.00%, 23.25 ± 5.46%). In conclusion, the modified Hyrax device was used successfully for OPD in a rabbit model to gain vertical ridge augmentation, and greater bone maturation was achieved with the addition of PRF.

Model for predicting the burden and cost of treatment in cervical cancer and HPV-related diseases in Thailand.

PURPOSE: Cervical cancer is a significant health burden in many countries. Long-term cost of care is still not well understood. We aimed to evaluate the long-term burden of illness and healthcare resource utilization associated with cervical cancer, cervical intraepithelial neoplasia (CIN) and genital warts from the care provider perspective. METHOD: We developed a health state-transition Markov model to portray the algorithm of treatment of stages of cervical cancer, CIN and genital warts by tracking a hypothetical lifetime cohort of 12-year-old girls. Costs in this study were unit cost; capital costs and labor costs were included in the unit cost for inpatients and out-patients. RESULTS: The highest incidence of CIN and genital warts was observed in women aged 20-30 years old. For cervical cancer, the highest incidence was 45-55 years. Death rate was estimated at 2%, 8%, 84% and 94% in cervical cancer Stage IA1, IA2-IIA, IIB-IVA and IVB, respectively. The estimated mean direct cost per patient with cervical cancer Stage IA1, IA2-IIA, IIB-IVA, IVB, CIN1, CIN2/3 and genital warts were 41,117 Thai Baht ($1,277 US), 97,250 Thai Baht ($3,020 US), 402,683 Thai Baht ($12,506 US), 322,619 Thai Baht ($10,019 US), 5,381 Thai Baht ($167 US), 49,933 Thai Baht ($1.551 US) and 3,585 Thai Baht ($111 US), respectively. Cost for survival or death case was indifferent. The overall lifetime costs from the provider perspective were evaluated at 859.1 million Baht ($26.7 million US) per a cohort of 100,000 women which corresponds to approximately 4,244 million Baht ($131.8 million US) for the current number of Thai 12-year-old girls. CONCLUSIONS: HPV-related diseases impose health and cost burdens in Thailand. The national immunization programme to reduce this burden as well as further research to evaluate the impact is keenly expected.

Autonomous public organization policy: a case study for the health sector in Thailand.

This paper describes factors affecting autonomous public organization (APO) policy agenda setting and policy formation through comparison of policy processes applied to one educational institute under the Ministry of Education and the other educational institute under the Ministry of Public Health in Thailand. This study employs mixed method including a qualitative approach through documentary research, in-depth interviews, and participant observation. Factors that facilitated the formulation of the APO policy were: (1) awareness of need; (2) clarity of strategies; (3) leadership, advocacy, and strategic partnerships, (4) clear organizational identity; (5) participatory approach to policy formulation, and (6) identification of a policy window. Factors that impeded the formulation of the APO policy were: (1) diverting political priorities; (2) ill-defined organizational identity; (3) fluctuating leadership direction, (4) inadequate participation of stakeholders; and (5) political instability. Although findings cannot be generalized, this case study does offer benchmarking for those in search of ways to enhance processes of policy formulation.

The effectiveness of program developed from cognitive-experiential self-theory and life skills technique on adolescent coping with stress.

Many methodologies to decrease stress in adolescents have been introduced and implemented. However, it seems that the problems in their physical, mental, emotional, and learning conditions still exist, especially for long-term. The proposed program with some booster was used to solve the long run problems. To examine the effectiveness of program developed from cognitive-experiential self-theory and life skills technique on adolescent coping with stress. A quasi-experimental research in two groups is used to modify theoretical concepts of cognitive-experiential self-theory and life skills technique on adolescent coping with stress. The students of secondary schools in Nakhon Sawan Province Thailand were the target population. Two schools were randomly chosen, one for control and the other for experiment. The sample size of 84 students was randomly selected and requested to be volunteers and 44 volunteers were trained on concept of thinking, strategies to resolve the problem and control emotion for 5 days and booster in school for 9 months in every fortnight and was measured 5 times, before and after interventions at 3rd, 6th and 9th months. We used independent t-test, paired t-test, analysis of variance and covariance for data analysis. There were no difference in the mean of summation of knowledge, attitude and practice of pre-test score between treatment and control group (P = 0.124). After the training program, the volunteers showed significant improvement of knowledge, attitude and practice (P < 0.05) and the level of stress decreased was statistically significant (P < 0.05). The results indicated that the training program with modify theoretical concepts of cognitive-experiential self-theory and life skills technique on adolescent enabled the participants to improve knowledge, attitude and practice in coping with stress.

Burkitt-like lymphoma presenting as a periodontal disease in AIDS patients: a report of two cases.

Burkitt-like lymphoma of the oral cavity is relatively uncommon in patients with acquired immunodeficiency syndrome (AIDS). The lesion usually appears as a solitary ulcerated mass with rapid onset. Some may present initially as gingival inflammation which delays final diagnosis and treatment. This report describes the presentations of multifocal intraoral Burkitt-like lymphoma in two Thai heterosexual men with AIDS. The clinical features and the radiographic findings in both cases mimicked a periodontal disease, showing extensive widening of the periodontal ligament space and loss of lamina dura in all segments of the molar teeth. The patients eventually died 5 and 14 months after they were diagnosed with HIV infection.

AIDS-related non-Hodgkin's lymphoma presenting as delayed healing of an extraction wound.

Non-Hodgkin's lymphoma (NHL) of the oral cavity frequently occurs in patients infected with human immunodeficiency virus (HIV). This report describes a lesion presenting as delayed healing of an extraction wound with hyperaemic swollen gingivae and ulceration in an apparently healthy 34-year-old Thai fisherman. The lesion was the first evidence of his HIV-positivity. It is, therefore, imperative that clinicians should consider a diagnosis of HIV infection in cases of non-healing extraction wounds in patients in high risk categories.