RESUMEN
Cohort studies are the preferred design in observational epidemiology, but few involving the general population have been performed in Asia, and most concern affluent urban populations. The Khon Kaen study has recruited about 25,000 subjects, aged mainly 35-64, from villages in the relatively underdeveloped north-east of Thailand. All subjects underwent simple physical examination, completed an interviewer-administered questionnaire (including sections on lifestyle, habits, and diet) and donated specimens of blood, which were processed and stored in a biological bank at -20 degrees C. Female subjects (about 16,500) were offered screening by Pap smear, and specimens of cells from the cervix were stored at -20 degrees C. This paper describes the methodology of the study, and the characteristics of the participants. Almost all subjects are peasant farmers, with low annual income and body mass, although 14.6% of women had a BMI in the obese range (>30 kg/m(2)). Smoking was common among men (78% regular smokers, most of whom used home-produced cigarettes), but rare among women. Fertility levels were relatively high, with a more than half the women having four or more live births. 23.4% of subjects were infected with the liver fluke Opisthorchis viverrini, known to be highly endemic in this region. Follow-up of the cohort is by record-linkage to the provincial cancer registry. By 2003, 762 cancer cases had occurred, the most common being cancers of the liver (363 cases) and cervix uteri (44 cases). The antecedents of these cancers are being investigated using a nested case-control approach. The cohort will yield increasing numbers of cancers for study in the next decade, giving important information on the relative importance of dietary and lifestyle factors in a rural population, undergoing gradual transition to a more westernised lifestyle.
Asunto(s)
Dieta , Predisposición Genética a la Enfermedad , Estilo de Vida , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/etiología , Neoplasias del Cuello Uterino/epidemiología , Neoplasias del Cuello Uterino/etiología , Adulto , Índice de Masa Corporal , Femenino , Fertilidad , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Fumar/efectos adversos , Tailandia/epidemiologíaRESUMEN
This quantitative and qualitative study describes the illness experience and the coping mechanisms of cervical cancer patients. Interviews were performed with 208 cervical cancer patients to determine their health seeking behavior and illness beliefs. Most began their treatment at local health services and district hospitals, and sought treatment in up to four different places before coming to the University Hospital. Most of the respondents were not sure about the cause of cervical cancer, and waited to see their symptoms before seeking treatment. Most perceived their condition as at an early stage. The qualitative research consisted of interviews with 79 selected patients and identified stigmatization from family and community members, problems with sexuality, and varied belief in meaning and causation of the disease. Many of the problems faced were coped with because of support from husbands, family and the community. It is recommended that better recording of patient data would allow a better follow-up service, and improved information for relatives would help them to understand the patient's problems, with both of these contributing to a better recovery environment for patients.
Asunto(s)
Adaptación Psicológica , Aceptación de la Atención de Salud/psicología , Neoplasias del Cuello Uterino/psicología , Femenino , Recursos en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Matrimonio , Estereotipo , TailandiaRESUMEN
An epidemiological survey of gynecological and sexually-transmitted diseases was conducted in 4 villages of Narmpong district, Khon Kaen, Thailand. It was focused on the reproductive health status of rural women. A mobile gynecological clinic was set up to collect materials and data including demographic characteristics, physical examination and specimen collection. Vaginal swabs were examined by microscope, Gram staining, pH measurement, KOH test and bacteriological cultivation. Endocervical swabs were examined for Chlamydia trachomatis, herpes simplex virus (HSV) and human papilloma virus (HPV) by polymerase chain reaction. Papanicolaou's test was applied for diagnosis of cytological abnormalities. Blood was tested by RPR and TPHA and urine was tested by LED test. The chief complaint was dysmenorrhea (44.8%). The others ranging from 43.4-3.0% were lower abdominal pain to genital ulcer. Prevalence of C. trachomatis, C. albicans, T. vaginalis, T. pallidum and G. vaginalis were found in 4.6, 10.9, 5.1, 2.7 and 1.0% of 586 women and HSV and HPV were found in 6.4% and 1.4% of 110 women, respectively. The three pathogens. C. trachomatis, C. albicans and T. vaginalis, were frequently found among women in the age of 20-49 years. The number of marriages and sex partners in the past year had an association with C. trachomatis infection while vaginal pH > 4.5, marital status, number of marriages and itching of genitalia had an association with T. vaginalis infection.
Asunto(s)
Enfermedades de los Genitales Femeninos/prevención & control , Salud Rural , Enfermedades de Transmisión Sexual/prevención & control , Adolescente , Adulto , Estudios Transversales , Femenino , Enfermedades de los Genitales Femeninos/epidemiología , Humanos , Persona de Mediana Edad , Unidades Móviles de Salud , Oportunidad Relativa , Prevalencia , Factores de Riesgo , Enfermedades de Transmisión Sexual/epidemiología , Factores Socioeconómicos , Tailandia/epidemiologíaRESUMEN
A cross sectional study was designed to investigate the prevalence of Chlamydia trachomatis among different groups of rural women in the northeast Thailand. The presence of chlamydial antigens in endocervical swabs was detected by ELISA. The prevalences of Chlamydia trachomatis were 6.8% (31/485), 5.2% (24/466) and 6.7% (12/179) in women attending antenatal, postpartum and family planning clinics respectively. The average prevalences of C. trachomatis among hospital-based and community-based women were 6.1% (67/1,103) and 3.6% (15/411) respectively. In addition, the prevalences of some pathogens including Candida albicans, Trichomonas vaginalis, Treponema pallidum and Neisseria gonorrhoea among hospital-based and community-based women were 14.2, 2.8, 0.7, 0.2 and 10.9, 5.1, 2.7, 0.0% respectively. It was concluded that C. trachomatis was a problem of woman's reproductive health.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis , Complicaciones Infecciosas del Embarazo/epidemiología , Salud Rural/estadística & datos numéricos , Salud de la Mujer , Adolescente , Adulto , Distribución por Edad , Candidiasis Vulvovaginal/complicaciones , Candidiasis Vulvovaginal/diagnóstico , Infecciones por Chlamydia/sangre , Infecciones por Chlamydia/complicaciones , Infecciones por Chlamydia/diagnóstico , Infecciones por Chlamydia/inmunología , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Gonorrea/complicaciones , Gonorrea/diagnóstico , Humanos , Persona de Mediana Edad , Vigilancia de la Población , Embarazo , Complicaciones Infecciosas del Embarazo/sangre , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/inmunología , Prevalencia , Estudios Seroepidemiológicos , Sífilis/complicaciones , Sífilis/diagnóstico , Tailandia/epidemiología , Vaginitis por Trichomonas/complicaciones , Vaginitis por Trichomonas/diagnóstico , Frotis VaginalAsunto(s)
Neoplasias/mortalidad , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Neoplasias/epidemiología , Neoplasias/prevención & control , Servicios Preventivos de Salud , Sistema de Registros/estadística & datos numéricos , Análisis de Supervivencia , Tasa de Supervivencia , Tailandia/epidemiologíaRESUMEN
OBJECTIVE: To test a self-scraping device as a mass screening device against a routine scraping method and to evaluate the acceptance of the self-scraping device by a group of rural females from Northeast Thailand. STUDY DESIGN: From a rural area of Northeast Thailand, 552 women were trained and motivated, through primary health care structures, to participate in a cervical cancer screening exercise using a self-scraping device. After one week, the same females were reexamined by gynecologists using the routine scraping method. In both cases the specimens were stained according to Papanicolaou. Through questionnaires the acceptance of the self-scraping device was evaluated. RESULTS: Through the self-scraping method, 13 cases suspicious for malignancy were detected. Specimens obtained through examination by physicians confirmed 11 cases to be suspicious for malignancy. No false negative cases were found. In the detection of inflammation, the self-scraping method was not as accurate as examination by a physician. The device was accepted by the females who participated in the study. CONCLUSION: In the rural areas of developing countries, where physicians and other trained medical personnel are not often available to carry out regular screening tests on a population basis, the self-scraping method can be applied as an integral part of primary health care for mass screening for uterine cervical cancer.
Asunto(s)
Tamizaje Masivo/métodos , Prueba de Papanicolaou , Neoplasias del Cuello Uterino/diagnóstico , Frotis Vaginal/métodos , Adulto , Anciano , Femenino , Humanos , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , TailandiaRESUMEN
This is the first analytic study to identify the unit cost in the University Hospital using the standard method of analysis in health economics. The unit costs in the report can be used to calculate the cost of each service for any disease. The costs of the hospital administration cost center and the supportive cost center were both allocated to the patient care service center by the simultaneous allocation method. The cost of teaching personnel was excluded from the analysis because it is quite difficult to estimate and differentiate the ratio of teaching costs to service costs. The hotel cost of the inpatient ward varied from 77.81 baht to 604.7 baht per day. The unit cost per service per day is different from the charge which is presently used at Srinagarind Hospital. Some services, such as in-house transportation are not included in the charge. This study was conducted to identify the unit cost of each service. The decision to establish charges can depend partly on this data and partly on the administrator's judgement. Other factors, such as patient poverty can dictate the final decision. In any case, the hospital and health service center should identify their own unit costs to be able to plan for effective budget management.
Asunto(s)
Costos de la Atención en Salud , Hospitales Universitarios/economía , Asignación de Costos , Costos y Análisis de Costo , Humanos , TailandiaRESUMEN
Vulvar carcinoma, although rare, is difficult to manage. We conducted a study to describe the management in our hospital. From 1978 to 1991, 69 patients with primary carcinoma of the vulva were treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University. Forty-two patients underwent radical vulvectomy and lymphadenectomy. The data presented the techniques, surgical events and outcome of the operations. The 5 and 10-yr survival rates for the operable cses were 88.5 per cent and only 22 per cent for those who were non-operable. Surgery is still the recommended primary treatment for this rare malignancy of the female genital tract.
Asunto(s)
Vulva/cirugía , Neoplasias de la Vulva/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Complicaciones PosoperatoriasRESUMEN
From 1985 to 1990, 3040 patients with carcinoma of the uterine cervix were diagnosed and treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. The epidemiological aspects including ages and geographical distributions, histology, stages, treatment and outcome were presented and compared with those of the previous report.
Asunto(s)
Neoplasias del Cuello Uterino/epidemiología , Adenocarcinoma/epidemiología , Factores de Edad , Carcinoma de Células Escamosas/epidemiología , Femenino , Humanos , Estadificación de Neoplasias , Tailandia/epidemiología , Resultado del Tratamiento , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patologíaRESUMEN
From 1978 to 1991, 69 cases of primary carcinoma of the vulva were diagnosed and treated at Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. The average age was 56 years at the time of diagnosis. Five patients (7.2%) were in FIGO Stage I, 25 (36.2%) Stage II, 28 (40.6%) Stage III and 11 (15.9%) Stage IV. Histologically, 60 cases were squamous cell carcinoma, large cell non-keratinizing type, 2 (2.9%) of squamous cell carcinoma, large cell keratinizing type, 2 (2.9%) of adenocarcinoma, 1 (1.4%) of basal cell carcinoma and 1 (1.4%) of malignant melanoma. Radical vulvectomy with inguino-femoral lymphadenectomy were performed in 42 patients. The rest were rejected or unsuitable for surgery. The actuarial 5 and 10-year survival rate for 61 patients followed up 1 to 14 years was 66.0%. The 5-year survival rate for operable cases was 88.5% but for unoperable cases it was only 22.0%. The authors still confirm surgery as the primary treatment of choice for this rare malignancy.
Asunto(s)
Carcinoma de Células Escamosas/patología , Neoplasias de la Vulva/patología , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/terapia , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma Basocelular/mortalidad , Carcinoma Basocelular/patología , Carcinoma Basocelular/terapia , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/terapia , Femenino , Estudios de Seguimiento , Humanos , Melanoma/mortalidad , Melanoma/patología , Melanoma/terapia , Persona de Mediana Edad , Estadificación de Neoplasias , Paridad , Estudios Retrospectivos , Análisis de Supervivencia , Tailandia , Neoplasias de la Vulva/mortalidad , Neoplasias de la Vulva/terapiaRESUMEN
This study was carried out to determine the clinical and immune response of a stage IB voluminous uterine cervical cancer to thiophosphoric acid alkaloid derivatives from Chelidoniium majus L. (Ukrain). The drugs were administered 10 mg intramuscularly every other day, for up to 10 injections. The two largest diameters and tumour volumes were measured and laboratory and immunological tests were performed before and after Ukrain administration. The patients were then operated on with type III Piver's radical hysterectomy. Three out of nine eligible cases had partial responses while six cases remained stable. Decreased total B lymphocytes and suppressor T lymphocytes were observed as well as increased total numbers of T lymphocytes and helper T lymphocytes. There was no single case of clinical or haematological toxicity apart from mild nausea. Two patients were treated with adjuvant radiotherapy due to lymphatic involvement and all nine patients were still alive at least six months after follow-up.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Alcaloides/uso terapéutico , Antineoplásicos Fitogénicos/uso terapéutico , Carcinoma de Células Escamosas/tratamiento farmacológico , Neoplasias del Cuello Uterino/tratamiento farmacológico , Adenocarcinoma/inmunología , Adulto , Alcaloides/efectos adversos , Antineoplásicos Fitogénicos/efectos adversos , Linfocitos B/efectos de los fármacos , Alcaloides de Berberina , Carcinoma de Células Escamosas/inmunología , Carcinoma de Células Escamosas/cirugía , Terapia Combinada , Femenino , Humanos , Histerectomía , Inyecciones Intramusculares , Persona de Mediana Edad , Fenantridinas , Linfocitos T/efectos de los fármacos , Neoplasias del Cuello Uterino/inmunología , Neoplasias del Cuello Uterino/cirugíaRESUMEN
Risk factors for recurrence after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital was studied from 218 patients operated between 1976 to June 30, 1988. Four preoperative risk factors i.e., cell types, age, stages and size of the lesions were computed and cross-tabulated with the recurrence rate from the data of the whole patients. The correlation was found to be statistical significant. This scoring system should be called from the first letter of the factor as 'CASS' and used for selection of the patients for radical hysterectomy and pelvic lymphadenectomy.
Asunto(s)
Histerectomía , Escisión del Ganglio Linfático , Neoplasias del Cuello Uterino/cirugía , Adulto , Factores de Edad , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Humanos , Estadificación de Neoplasias , Pelvis , Cuidados Preoperatorios , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Tailandia , Neoplasias del Cuello Uterino/patologíaRESUMEN
The prospective and retrospective data collection of cancer cases in all the hospitals and death certificates in Khon Kaen province were reported as a population-based cancer registry of Khon Kaen province. Liver cancer especially cholangiocarcinoma and cervical cancer lead the group. The age-standardized incidence rate of cancer of Khon Kaen was about 72.4 to 173.3 per 100,000 population per year and it is higher in males than in females.
Asunto(s)
Neoplasias/epidemiología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Neoplasias Hepáticas/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Estudios Retrospectivos , Tailandia/epidemiologíaRESUMEN
Risk factors for survival were analyzed for 208 women diagnosed with invasive cervical cancer at Srinagarind hospital, Faculty of Medicine, Khon Kaen University between January 1, 1976 and December 31, 1987. All underwent radical hysterectomy and pelvic lymphadenectomy. The clinical data, operative data, histology, complications and follow-up profiles were analyzed by cross-tabulation and chi-square test. The main significant factors were analyzed for survival functions by the Cutler-Ederer method with Breslow and Mantel-Cox tests. Recurrences of the disease, FIGO stages, sizes and types of the lesions, histology, lengths of the uterus and modes of removal of left ovaries were all significant risk factors. The first five factors have been mentioned in previous literature but the latter two were not and need further investigation.