Wongsa Laohasiriwong

Cost of treatment for breast cancer in central Vietnam

Background : In recent years, cases of breast cancer have been on the rise in Vietnam. To date, there has been no study on the financial burden of the disease. This study estimates the direct medical cost of a 5-year treatment course for women with primary breast cancer in central Vietnam. Methods : Retrospective patient-level data from medical records at the Hue Central Hospital between 2001 and 2006 were analyzed. Cost analysis was conducted from the health care payers’ perspective. Various direct medical cost categories were computed for a 5-year treatment course for patients with breast cancer. Costs, in US dollars, discounted at a 3% rate, were converted to 2010 after adjusting for inflation. For each cost category, the mean, standard deviation, median, and cost range were estimated. Median regression was used to investigate the relationship between costs and the stage, age at diagnosis, and the health insurance coverage of the patients. Results : The total direct medical cost for a 5-year treatment course for breast cancer in central Vietnam was estimated at

Survival probability and prognostic factors for breast cancer patients in Vietnam

975 per patient (range:

Work-related musculoskeletal disorders among sugarcane farmers in north-eastern Thailand.

11.7–

Prevalence of low back pain and associated factors among farmers during the rice transplanting process.

3,955). The initial treatment cost, particularly the cost of chemotherapy, was found to account for the greatest proportion of total costs (64.9%). Among the patient characteristics studied, stage at diagnosis was significantly associated with total treatment costs. Patients at later stages of breast cancer did not differ significantly in their total costs from those at earlier stages however, but their survival time was much shorter. The absence of health insurance was the main factor limiting service uptake. Conclusion : From the health care payers’ perspective, the Government subsidization of public hospital charges lowered the direct medical costs of a 5-year treatment course for primary breast cancer in central Vietnam. However, the long treatment course was significantly influenced by out-of-pocket payments for patients without health insurance.

Knowledge, attitudes, and care techniques of caregivers of PWE in northeastern Thailand

Background : Breast cancer is becoming a public health problem in Vietnam. The mortality to incidence ratio of the disease was ranked second among the most common cancers in women. This study estimates the survival probability at 1, 3, and 5 years following diagnosis and determines prognostic factors for breast cancer mortality in Vietnam. Methods : A survival analysis was conducted based on retrospective data from Hue Central Hospital and the Cancer Registry in Ho Chi Minh City. Using the Kaplan-Meier method, the survival probability of patients with breast cancer was estimated at 1, 3, and 5 years following diagnosis. The covariates among prognostic factors for survival time were studied using an extended Cox proportion hazards model, including time-dependent predictors. Results : Overall survival rates at 1, 3, and 5 years following diagnosis were 0.94, 0.83 and 0.74 respectively. Marital status, education level, stage at diagnosis, and hormone therapy were prognostic factors for mortality. For the stage at diagnosis, the relation to the risk of death for breast cancer was 1.32 (95% CI, 1.22–1.41). Married women faced a risk of death nearly 1.59 times higher than unmarried women (95% CI, 1.09–2.33). Women with higher levels of education and who received hormone therapy had approximately 10% (hazard ratio [HR]: 0.92; 95% CI, 0.89–0.96) and 80% (HR: 0.22; 95% CI, 0.12–0.41) risk reduction of death respectively, compared with those classified as illiterate and those without hormone therapy. Conclusions : The 5-year survival probability of breast cancer was lower in Vietnam than in countries with similar distributions of the stage at diagnosis. Screening programs and related support policies should be developed to increase the life expectancy of women with breast cancer in Vietnam.BACKGROUND Breast cancer is becoming a public health problem in Vietnam. The mortality to incidence ratio of the disease was ranked second among the most common cancers in women. This study estimates the survival probability at 1, 3, and 5 years following diagnosis and determines prognostic factors for breast cancer mortality in Vietnam. METHODS A survival analysis was conducted based on retrospective data from Hue Central Hospital and the Cancer Registry in Ho Chi Minh City. Using the Kaplan-Meier method, the survival probability of patients with breast cancer was estimated at 1, 3, and 5 years following diagnosis. The covariates among prognostic factors for survival time were studied using an extended Cox proportion hazards model, including time-dependent predictors. RESULTS Overall survival rates at 1, 3, and 5 years following diagnosis were 0.94, 0.83 and 0.74 respectively. Marital status, education level, stage at diagnosis, and hormone therapy were prognostic factors for mortality. For the stage at diagnosis, the relation to the risk of death for breast cancer was 1.32 (95% CI, 1.22-1.41). Married women faced a risk of death nearly 1.59 times higher than unmarried women (95% CI, 1.09-2.33). Women with higher levels of education and who received hormone therapy had approximately 10% (hazard ratio [HR]: 0.92; 95% CI, 0.89-0.96) and 80% (HR: 0.22; 95% CI, 0.12-0.41) risk reduction of death respectively, compared with those classified as illiterate and those without hormone therapy. CONCLUSIONS The 5-year survival probability of breast cancer was lower in Vietnam than in countries with similar distributions of the stage at diagnosis. Screening programs and related support policies should be developed to increase the life expectancy of women with breast cancer in Vietnam.

The relationships between the use of self-regulated learning strategies and depression among medical students: an accelerated prospective cohort study.

This cross-sectional analytical study aimed to identify prevalence and factors associated with work-related musculoskeletal disorders (WMSDs) among sugarcane farmers. Cluster random sampling was used to select 540 sugarcane farmers from 3 provinces in North-Eastern Thailand. Three related questionnaires, plus assessments by 2 expert physiotherapists, were used to check for factors associated with WMSDs and prevalence of WMSDs. Data were analyzed using descriptive statistics and multiple logistic regressions. The results indicated the prevalence of WMSDs among sugarcane farmers in the 7 days before the interview and looking back over the previous 12 months were 82.96% and 88.70%, respectively. Factors significantly associated with reporting WMSDs (P value < .05) during past 12 months were (a) repetitive motions (adjusted odds ratio [OR] = 1.90; 95% confidence interval [CI] = 1.05-3.43), (b) working in awkward postures (adjusted OR = 1.95; 95% CI = 1.01-3.77), (c) forceful exertions (adjusted OR = 2.78; 95% CI = 1.54-5.02), and (d) stress about future income (adjusted OR = 1.80; 95% CI = 1.02-3.16). Recommendations are made for risk prevention strategies.

Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand

[Purpose] The aim of this study was to investigate the prevalence of low back pain and associated factors in Thai rice farmers during the rice transplanting process. [Subjects and Methods] Three hundred and forty-four farmers, aged 20–59 years old, were asked to answer a questionnaire modified from the Standard Nordic Questionnaire (Thai version). The questionnaire sought demographic, back-related, and psychosocial data. [Results] The results showed that the prevalence of low back pain was 83.1%. Farmers younger than 45 years old who worked in the field fewer than six days were more likely to experience low back pain than those who worked for at least six days. Farmers with high stress levels were more likely to have low back pain. [Conclusion] In the rice transplanting process, the low back pain experienced by the farmers was associated with the weekly work duration and stress.

Benzodiazepines misuse: The study community level Thailand

Caregivers of persons with epilepsy (PWEs) in developing countries do not always have access to correct information related to the affliction of the patients they are entrusted to care for. Epilepsy can be difficult to manage for all those involved, whether it is a family member, the PWEs themselves, or the caregiver. Misconceptions are common about epilepsy, especially in undeveloped countries where a majority of the population have lower educational levels. This study aims to acquire baseline data about caregivers of PWEs related to their knowledge, attitudes, and methods of giving care to PWEs. A cross-sectional survey was administered to 83 PWE caregivers at a university epilepsy clinic in northeastern Thailand. The caregivers believed that knowledge about epilepsy was paramount; however, they felt that their own knowledge of the condition was insufficient. Educational level, relationship to the PWEs, and sex were correlated to various aspects related to epilepsy knowledge and attitudes in caregivers. A slight negative correlation was found between caregiver knowledge and attitudes toward epilepsy with Pearsons correlation coefficient (r=-0.38, P-value 0.001). Education and improved epilepsy information need to be provided to the caregivers of PWEs in northeastern Thailand.

Factors associated with blood zinc, chromium, and lead concentrations in residents of the Nam Pong River in Thailand

We conducted this study to determine the relationships between the use of self-regulated learning strategies (SRL) and depression scores among medical students. An accelerated prospective cohort study among 623 students at a public medical university in Vietnam was carried out during the academic year 2012–2013. The Depression, Anxiety and Stress Scales (21 items) was used to measure depression scores as the primary research outcome, and to measure anxiety and stress scores as the confounding variables. Fourteen SRL subscales including intrinsic/extrinsic goal orientation, task value, self-efficacy for learning, control of learning beliefs, rehearsal, elaboration, organization, critical thinking, meta-cognitive strategies, time and study environment, effort regulation, peer learning, and help seeking were measured using the Motivated Strategies for Learning Questionnaire. Data were collected at two points in time (once each semester). There were 744 responses at the first time (95.88%) and 623 at time two (drop-out rate of 16.26%). The generalized estimating equation was applied to identify any relationships between the use of each SRL subscale and depression scores at time 2, adjusting for the effects of depression at time 1, anxiety, stress, within cluster correlation, and potential demographic covariates. Separate multivariate GEE analysis indicated that all SRL subscales were significantly negatively associated with depression scores, except for extrinsic goal orientation and peer learning. Whereas full multivariate GEE analysis revealed that self-efficacyT1, help-seekingT1, time and study environmentT2 were found to be significantly negatively associated with depressionT2, adjusting for the effects of depressionT1, anxiety, stress, and demographic covariates. The results should be used to provide appropriate support for medical students to reduce depression.

Socioeconomic disparities and chronic respiratory diseases in Thailand: The National Socioeconomics Survey

AIMS The aim of this study was to compare the achievement of clinical targets for patients with type 2 diabetes mellitus (T2DM) in general medical clinics (GMCs) and specialist diabetes clinics (SDCs) for different hospital types (regional, provincial and community) in Thailand. METHODS We used the medical records of patients (n=26,860) with T2DM from 595 hospitals (26 regional, 70 provincial and 499 community) across all 77 provinces in Thailand. Generalized linear mixed models were used to conduct multi-level modeling to evaluate the achievement of individual outcomes (A - glycated hemoglobin (HbA1c) <7.0% (53 mmol/mol), B - Blood Pressure (BP) <140/80 mmHg and C - LDL-Cholesterol <100mg/dL) and aggregated outcomes (AllABC - achieved all three of the targets, AnyABC - achieved at least one target, ABCcount - the number of targets achieved: 0, 1, 2 or 3). RESULTS Neither clinic types (SDCs or GMCs) were consistency superior across all hospital types. For regional hospitals, SDCs were associated with higher odds of achieving BP, AnyABC, and ABCcount (OR=1.55, 95%CI: 1.25-1.92, p<0.001; OR=1.35, 95%CI: 1.02-1.79; p=0.04; RR=1.10, 95%CI: 1.01-1.20, p=0.03, respectively). For provincial hospitals, SDCs exhibited higher achievement of BP and LDL-C (OR=1.52, 95%CI: 1.23-1.87, p<0.001; OR=1.28, 95%CI: 1.04-1.58, p=0.02, respectively). For community hospitals, however GMCs demonstrated higher achievement of BP and AnyABC (OR=0.81, 95%CI: 0.67-0.98, p=0.03; OR=0.74, 95%CI: 0.56-0.97, p=0.03, respectively). CONCLUSIONS In larger (regional and provincial) hospitals, SDCs outperform GMCs in several (but not all) clinical targets. In contrast, in community hospital, where most patients with T2DM are serviced, GMCs were shown to have superior performance.