Prevalence of Nicotine Dependence Among Industrial Workers in Myanmar

Smoking is one of the major public health concerns and it is harmful to people’s health status. This cross sectional survey was conducted to study the Nicotine dependence among industrial workers in Myanmar. Mandalay city was purposively selected where the second largest industrial zone is situated. A total of two hundred and ninety two industrial workers aged sixteen years old and above participated. Data collection was done by using an interviewer administered questionnaire. Data analysis was done by using SPSS version 23 and descriptive findings were interpreted as frequency and percentage, and the chi-squared test was used to find the association of nicotine dependence. The significance level of all statistical tests was determined with the p value < 0.05. All of the respondents were male (100%) and the mean age of the respondents was 30.7. About 75% of the industrial workers showed low and very low dependence from the nicotine while the rest 25% showed medium to very high dependence. There was a statistically significance association between age (p < 0.001), marital status (p = 0.031), education status (p < 0.001), income (p < 0.001), age at first cigarette smoked (p < 0.001) and number of years cigarette smoked (p < 0.015) and nicotine dependence. Further studies with similar setting are recommended to conduct on nicotine dependence and its correlation among the industrial workers in Myanmar, and the government authority should plan and conduct the effective intervention on health education and awareness program about smoking and nicotine dependence.

Factors affecting the willingness to join community-based health insurance (CBHI) scheme: A case study survey from Savannakhet Province, Lao P.D.R

PURPOSE

Community-based health insurance (CBHI) targets independent worker (self-employed) is currently struggling with inadequate size of risk pooling, low enrollment, and high dropout rate as well as financial sustainability. The objective of this study is to find out the factors that significantly affect the CBHI enrollment incentive. The study applied cross-sectional study design to perform situation analysis, in which the Andersen behavioral model was used as a guideline to identify preliminary characteristics that involved with enrolling incentive.

FINDINGS

The model found that existence of both outpatient department (OPD) and inpatient department (IPD) health service utilization had significant impact on the CBHI enrollment, this statement is strongly related to adverse selection issues. Households resides in Kaysone Phomvihane district had higher probability of joining the scheme in comparison with relatively less-developed Champhone district. Households with no CBHI knowledge were also more likely to enroll the scheme. Occupation was also found to be a significant factors; of which farmers and laborers had lower possibility enrollment.

CONCLUSIONS

Economic condition of the district has a significant impact on enrolment. However, the increase in personal income does not directly enhance the desire for enrolment. Most of the high-income households prefer to use a local, private clinic, and foreign hospitals in Thailand or Vietnam. Households with unemployed heads had the highest possibility of enrolling. The reason is the unemployed respondents include the elderly who stay at home without performing major tasks in exchange for their living. That group of people has the highest probability of either OPD or IPD.

Factors Associated With Access to Dental Services of Adults With Physical Disabilities in Thailand

OBJECTIVES: To determine factors associated with access to dental services of community-dwelling adults with physical disabilities in Thailand.METHODS: This cross-sectional study was conducted at the Center of Independent Living, community club for individuals with disabilities in Pathum Thani province, Thailand, in February 2018. Individual participants were interviewed by a trained interviewer using a structured questionnaire that consisted of (1) questions on demographic characteristics and (2) adapted questions that were based on the modified Penchansky and Thomas’s dimensions of access (accessibility, availability, acceptability, affordability, accommodation and awareness). Enter method of binary logistic regression analysis was used.RESULTS: We included 198 individuals with physical disabilities. Most participants had not attended dental care services in the previous 12 months (77.3%) and gave negative responses for all questions regarding the dimensions of access. Although we did not observe any statistically significant differences in age and the six dimensions of access between participants who had attended at least one dental appointment and those who had not, in multivariate analysis, we found a statistically significant association indicated that participants who had education < primary were 3.35 times more likely to had not attended at least one dental appointment (p = 0.002).CONCLUSION: Our findings have uncovered factors associated with access to dental services of community-dwelling adults with physical disabilities in Thailand. Individuals with physical disabilities are in need of oral health education programs regarding proper oral health behaviors such as regular dental services attendance, appropriate oral hygiene practices and dental care benefits. 

Assessment of the validity and reliability of an urban household health expenditure (HHE) questionnaire in Kuala Lumpur, Malaysia

Purpose

Out-of-pocket (OOP) payments continue to be a major method of financing healthcare in many low- and middle-income countries including Malaysia. Although macro-level data show that this is a substantial percentage of national health expenditure, at the grassroots level, the amount spent on health by households remains unknown in Malaysia. The purpose of this paper is to assess the validity and reliability of an adapted-for-purpose questionnaire designed to capture urban household health expenditures (HHEs) among Malaysian households.

Design/methodology/approach

This two-part study assessed content validity of the questionnaire using three experts and the reliability of the questionnaire through a test-retest study among 50 OOP-paying patients followed up at one private primary care clinic in Kuala Lumpur. This study was approved by the Malaysian Research Ethics Committee (NMRR-16-172-29311-IIR).

Findings

The validity of the 83-item questionnaire was high, with an item content validity index of 1.00 and a scale content validity index average score of 1.0 agreed to among the evaluating experts. In the test-retest reliability study, the majority of the categorical questionnaire items had perfect agreement values (k=0.81-1.00). Continuous questionnaire items were also found to be highly reliable with no significant differences between the test-retest segments and high correlation coefficient values (intra-class correlation coefficient>0.7).

Originality/value

The HHE questionnaire had excellent content validity and very high test-retest reliability. The results of this study suggest that this questionnaire could be used in Malaysian studies to determine actual urban HHE which is a first step toward developing universal health coverage for all.

Perspectives and experiences of Thai adults using wheelchairs regarding barriers of access to dental services: a mixed methods study

PURPOSE

To explore the perspectives and experiences of Thai wheelchair users regarding barriers of access to dental services and report potential solutions in terms of customer satisfaction.

PARTICIPANTS AND METHODS

We conducted a 2-phase cross-sectional study with quantitative and qualitative components at a community club for individuals with disabilities in Pathum Thani province, Thailand, in February 2018. In quantitative phase, participants were interviewed using a structured questionnaire that consisted of 1) questions on demographic characteristics and 2) adapted questions that were based on the modified Penchansky and Thomas dimensions of access. Enter method of binary logistic regression analysis was used. Regarding qualitative phase, focus group discussions were conducted using the themes of a semi-structured discussion guide. Thematic analysis was used.

RESULTS

A total of 156 wheelchair users participated in the quantitative phase. Most study participants had not attended dental care services in the previous year (78.2%). Multivariate analysis found a statistically significant association that indicated that participants who had education level ≤primary education were 3.5 times more likely to had not attended a dental appointment in the previous year (P=0.003). In the qualitative phase, 33 participants were included in 3 focus groups (each comprising 11 participants), they were wheelchair users with education >primary, who did not go to see a dentist in the previous 12 months. Findings of the 3 focus groups suggest generally negative views about Thai dental services for all dimensions of access.

CONCLUSION

This study reflects the unheard voices of wheelchair users and provides rigorous evidence in Thai context that difficulties of access to dental services persist. Policy makers and oral health professionals in oral health system should be alerted to the explicit barriers reported, such that equitable and equal dental services for disabled individuals can be developed.

Ability of HIV Advocacy to Modify Behavioral Norms and Treatment Impact: A Systematic Review

BACKGROUND

HIV advocacy programs are partly responsible for the global community's success in reducing the burden of HIV. The rising wave of the global burden of noncommunicable diseases (NCDs) has prompted the World Health Organization to espouse NCD advocacy efforts as a possible preventive strategy. HIV and NCDs share some similarities in their chronicity and risky behaviors, which are their associated etiology. Therefore, pooled evidence on the effectiveness of HIV advocacy programs and ideas shared could be replicated and applied during the conceptualization of NCD advocacy programs. Such evidence, however, has not been systematically reviewed to address the effectiveness of HIV advocacy programs, particularly programs that aimed at changing public behaviors deemed as risk factors.

OBJECTIVES

To determine the effectiveness of HIV advocacy programs and draw lessons from those that are effective to strengthen future noncommunicable disease advocacy programs.

SEARCH METHODS

We searched for evidence regarding the effectiveness of HIV advocacy programs in medical databases: PubMed, The Cumulative Index to Nursing and Allied Health Literature Plus, Educational Resources and Information Center, and Web of Science, with articles dated from 1994 to 2014. Search criteria. The review protocol was registered before this review. The inclusion criteria were studies on advocacy programs or interventions. We selected studies with the following designs: randomized controlled design studies, pre-post intervention studies, cohorts and other longitudinal studies, quasi-experimental design studies, and cross-sectional studies that reported changes in outcome variables of interest following advocacy programs. We constructed Boolean search terms and used them in PubMed as well as other databases, in line with a population, intervention, comparator, and outcome question. The flow of evidence search and reporting followed the standard Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

DATA COLLECTION AND ANALYSIS

We selected 2 outcome variables (i.e., changing social norms and a change in impact) out of 6 key outcomes of advocacy interventions. We assessed the risk of bias for all selected studies by using the Cochrane risk-of-bias tool for randomized studies and using the Risk of Bias for Nonrandomized Observational Studies for observational studies. We did not grade the collective quality of evidence because of differences between the studies, with regard to methods, study designs, and context. Moreover, we could not carry out meta-analyses because of heterogeneity and the diverse study designs; thus, we used a narrative synthesis to report the findings.

MAIN RESULTS

A total of 25 studies were eligible, of the 1463 studies retrieved from selected databases. Twenty-two of the studies indicated a shift in social norms as a result of HIV advocacy programs, and 3 indicated a change in impact. We drew 6 lessons from these programs that may be useful for noncommunicable disease advocacy: (1) involving at-risk populations in advocacy programs, (2) working with laypersons and community members, (3) working with peer advocates and activists, (4) targeting specific age groups and asking support from celebrities, (5) targeting several, but specific, risk factors, and (6) using an evidence-based approach through formative research. Author conclusions. HIV advocacy programs have been effective in shifting social norms and facilitating a change in impact.

PUBLIC HEALTH IMPLICATIONS

The lessons learned from these effective programs could be used to improve the design and implementation of future noncommunicable disease advocacy programs.

Ability of HIV Advocacy to Modify Behavioral Norms and Treatment Impact: A Systematic Review

Background. HIV advocacy programs are partly responsible for the global community’s success in reducing the burden of HIV. The rising wave of the global burden of noncommunicable diseases (NCDs) has prompted the World Health Organization to espouse NCD advocacy efforts as a possible preventive strategy. HIV and NCDs share some similarities in their chronicity and risky behaviors, which are their associated etiology. Therefore, pooled evidence on the effectiveness of HIV advocacy programs and ideas shared could be replicated and applied during the conceptualization of NCD advocacy programs. Such evidence, however, has not been systematically reviewed to address the effectiveness of HIV advocacy programs, particularly programs that aimed at changing public behaviors deemed as risk factors.

Objectives. To determine the effectiveness of HIV advocacy programs and draw lessons from those that are effective to strengthen future noncommunicable disease advocacy programs.

Search methods. We searched for evidence regarding the effectiveness of HIV advocacy programs in medical databases: PubMed, The Cumulative Index to Nursing and Allied Health Literature Plus, Educational Resources and Information Center, and Web of Science, with articles dated from 1994 to 2014.

Search criteria. The review protocol was registered before this review. The inclusion criteria were studies on advocacy programs or interventions. We selected studies with the following designs: randomized controlled design studies, pre–post intervention studies, cohorts and other longitudinal studies, quasi-experimental design studies, and cross-sectional studies that reported changes in outcome variables of interest following advocacy programs. We constructed Boolean search terms and used them in PubMed as well as other databases, in line with a population, intervention, comparator, and outcome question. The flow of evidence search and reporting followed the standard Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Data collection and analysis. We selected 2 outcome variables (i.e., changing social norms and a change in impact) out of 6 key outcomes of advocacy interventions. We assessed the risk of bias for all selected studies by using the Cochrane risk-of-bias tool for randomized studies and using the Risk of Bias for Nonrandomized Observational Studies for observational studies. We did not grade the collective quality of evidence because of differences between the studies, with regard to methods, study designs, and context. Moreover, we could not carry out meta-analyses because of heterogeneity and the diverse study designs; thus, we used a narrative synthesis to report the findings.

Main results. A total of 25 studies were eligible, of the 1463 studies retrieved from selected databases. Twenty-two of the studies indicated a shift in social norms as a result of HIV advocacy programs, and 3 indicated a change in impact. We drew 6 lessons from these programs that may be useful for noncommunicable disease advocacy: (1) involving at-risk populations in advocacy programs, (2) working with laypersons and community members, (3) working with peer advocates and activists, (4) targeting specific age groups and asking support from celebrities, (5) targeting several, but specific, risk factors, and (6) using an evidence-based approach through formative research.

Author conclusions. HIV advocacy programs have been effective in shifting social norms and facilitating a change in impact.

Public health implications. The lessons learned from these effective programs could be used to improve the design and implementation of future noncommunicable disease advocacy programs.

EFFECTIVENESS OF COMMUNITY SERVICE MODEL FOR INCREASING ROUTINE IMMUNIZATION COVERAGE AT PRIMARY HEALTHCARE FACILITIES IN A RURAL DISTRICT OF PAKISTAN: A QUASI-EXPERIMENTAL STUDY

BACKGROUND

In Pakistan Routine Immunization coverage has been reported to be significantly low due to multiple factors that results in high number of deaths in children under 5. This study was conducted to assess the effectiveness of integrating Community Services to improve Routine immunization coverage in rural district of Pakistan.

METHODS

A quasi-experimental study with control and intervention arms was conducted in government Basic Health unit's catchment population of Panjgur by interviewing household head/Fathers. Total 234 household head including fathers were interviewed during this baseline survey. Community service model was used for to increase routine immunization coverage at catchment area of Basic Health unit (BHU) in intervention group while routine services were given in control BHU.

RESULTS

230 parents completed the questionnaire during the end line after three months of intervention. There were no significant differences found between two groups at baseline but after the intervention, there was statistically significance difference (< 0.05) between both group's knowledge and practices regarding routine immunization. Moreover, there was no statistically significant difference in control group reported (> 0.05) after the intervention period. Overall immunization status after intervention where fully immunization status in intervention group after intervention was 88.8% as compared to control group after intervention was 13.6% for partial immunization status in intervention group after intervention was 11.1% as compared to control group after intervention was 81.1 for the Non-Immunization status in intervention group after intervention was 0% as compared to control group after intervention was 5.1%.

CONCLUSIONS

Community Service Model has significantly improved the Knowledge & Practices among households/parents of children under 5 in the intervention arm.

The Impact of Community Based Health Insurance in Enhancing Better Accessibility and Lowering the Chance of Having Financial Catastrophe Due to Health Service Utilization: A Case Study of Savannakhet Province, Laos

The Lao population mostly relies on out-of-pocket expenditures for health care services. This study aims to determine the role of community-based health insurance in making health care services accessible and in preventing financial catastrophe resulting from personal payment for inpatient services. A cross-sectional study design was applied. Data collection involved 126 insured and 126 uninsured households in identical study sites. Two logistic regression models were used to predict and compare the probability of hospitalization and financial catastrophe that occurred in both insured and uninsured households within the previous year. The findings show that insurance status does not significantly improve accessibility and financial protection against catastrophic expenditure. The reason is relatively simple, as catastrophic health expenditure refers to a total out-of-pocket payment equal to or more than 40% of household income minus subsistence. When household income declines as a result of inability to work due to illness, the 40% threshold is quickly reached. Despite this, results suggest that insured households are not significantly better off under community-based health insurance. However, compared to uninsured households, insured households do have better accessibility and a lower probability of reaching the financial catastrophe threshold.

Expediting support for the pregnant mothers to obtain antenatal care at public health facilities in rural areas of Balochistan province, Pakistan

Objectives:

To identify, and compare relative importance of, factors associated with antenatal care (ANC) utilization in rural Balochistan, toward framing a policy to increase such utilization.

Methods:

This cross sectional study was conducted among 513 pregnant women in Jhal Magsi District, Balochistan, in 2011. A standardized interviewer-administered questionnaire was used. Predisposing, enabling, and reinforcing factors were evaluated with generalized linear models (Poisson distribution and log link).

Results:

Prevalence of any ANC was only 14.4%. Predisposing, enabling, and reinforcing factors were all important determinants of ANC utilization. Reinforcing factors were clearly most important, husband’s support for ANC was more important than support from other community members. Among predisposing factors, higher income, education, occupation, and better knowledge regarding benefits of ANC were positively and statistically significantly associated with ANC However increased number of children showed negative association. Complications free pregnancy showed positive significant association with ANC at public health facility among enabling factors.

Conclusion:

It is very important to increase antenatal care utilization in the study area and similar areas. Policy to achieve this should focus on enhancing support from the husband.

Occupational injuries and illnesses and associated costs in Thailand

Background

The purpose of this study was to enumerate the annual morbidity and mortality incidence and estimate the direct and indirect costs associated with occupational injuries and illnesses in Bangkok in 2008. In this study, data on workmen compensation claims and costs from the Thai Workmen Compensation Fund, Social Security Office of Ministry of Labor, were aggregated and analyzed.

Methods

To assess costs, this study focuses on direct costs associated with the payment of workmen compensation claims for medical care and health services.

Results

A total of 52,074 nonfatal cases of occupational injury were reported, with an overall incidence rate of 16.9 per 1,000. The incidence rate for male workers was four times higher than that for female workers. Out of a total direct cost of $13.87 million, $9.88 million were for medical services and related expenses and $3.98 million for compensable reimbursement. The estimated amount of noncompensated lost earnings was an additional $2.66 million.

Conclusion

Occupational injuries and illnesses contributed to the total cost; it has been estimated that workers' compensation covers less than one-half to one-tenth of this cost.

Respiratory symptoms and patterns of pulmonary dysfunction among roofing fiber cement workers in the south of Thailand

OBJECTIVE

This study examined the associations between respiratory symptoms and patterns of pulmonary dysfunction of 115 male roofing cement workers compared with 134 unexposed subjects.

METHODS

A cross-sectional study was conducted. Environmental samplings and spirometry measurements were also collected.

RESULTS

The exposed workers had higher respiratory dust exposure levels (0.65 mg/m3) compared with the unexposed groups (0.32 mg/m3). The exposed group had significantly higher prevalence than the unexposed group for shortness of breath (OR=2.19). The exposed group also had higher but insignificant prevalence of chronic cough (OR=1.34), chest tightness (OR=1.64), and wheezing (OR=1.89). The ventilatory respiratory function values (FEV1 and FVC) were slightly lower for the exposed group.

CONCLUSION

An association between higher cement dust levels and a decline in ventilatory function among roofing fiber cement workers suggests that the respiratory health of roofing cement workers should be protected through policies or work standards.

Access to health care: the role of a community based health insurance in Kenya

BACKGROUND

Out-of-pocket payments create financial barriers to health care access. There is an increasing interest in the role of community based health insurance schemes in improving equity and access of the poor to essential health care. The aim of this study was to assess the impact of Jamii Bora Health Insurance on access to health care among the urban poor.

METHODS

Data was obtained from the household health interview survey in Kibera and Mathare slums, which consisted of 420 respondents, aged 18 and above who were registered as members of Jamii Bora Trust. The members of Jamii Bora Trust were divided into two groups the insured and the non-insured.

RESULTS

In total, 17.9% respondents were hospitalized and women (19.6%) were more likely to be admitted than men (14.7%). Those in the poorest quintile had the highest probability of admission (18.1%). Those with secondary school education, large household size, and aged 50 and above also had slightly greater probability of admission (p<0.25). 86% of admissions among the insured respondents were covered JBHI and those in the poorest quintile were more likely to use the JBHI benefit. Results from the logistic regression revealed that the probability of being admitted, whether overall admission or admission covered by the JBHI benefit was determined by the presence of chronic condition (p<0.01).

CONCLUSION

Utilization and take up of the JBHI benefits was high. Overall, JBHI favoured the members in the lower income quintiles who were more likely to use health care services covered by the JBHI scheme.

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.

Cost and effectiveness evaluation of prophylactic HPV vaccine in developing countries

BACKGROUND

Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year.

OBJECTIVES

We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18.

METHODS

We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually.

RESULTS

Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%.

CONCLUSION

Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand.

Tuberculosis treatment with mobile-phone medication reminders in northern Thailand

Thailand's implementation of the Directly Observed Treatment, Short course (DOTS) strategy to increase tuberculosis (TB) control program efficacy has not achieved the World Health Organization (WHO) TB key targets. We defined two TB control models in the study. Patients in Model 1 were treated with a conventional DOTS strategy and in Model 2, patients were treated the same as Model method 1 but were given a phone call reminder to take their medication. Multi-drug resistant tuberculosis (MDR-TB) and non-MDR-TB patients were randomized into either Model 1 or 2. Treatment outcomes were given as cure rates, completion rates, failure rates or success rates at 18 months in the MDR-TB group and 6 months in the non-MDR-TB group. The sputum conversion rate at 1 month were evaluated for both groups. In the MDR-TB group, the sputum conversion rate was 20% (95% CI 8-45) in Model 1 and 90% (95% CI 73-98) in Model 2 (p < 0.001). In the non-MDR-TB group, the sputum conversion rate was 52% (95% CI 36-70) in Model 1 and 37% (95% CI 22-56) in Model 2 although the difference was not significant (p = 0.221). The Model 2 success rates were significantly higher (73.7%, 96.7%) in both the MDR-TB and non-MDR-TB groups (p < 0.001, p = 0.047). The MDR-TB rate in northern Thailand decreased from 4.1% during April-September 2008 to 1.8% during April-September 2009. Further study of the association between implementation of Model 2 and MDR-TB incidence reduction needs to be carried out.

Quality of life among Thai women diagnosed with cervical cancer and cervical intraepithelial neoplasia at King Chulalongkorn Memorial Hospital

OBJECTIVE

To determine health related quality of life (QoL) of patients diagnosed with cervical intraepithelial neoplasia (CIN) and cervical cancer compared QoL among stages of cancer and to study the association between QoL and patients' characteristics.

MATERIAL AND METHOD

The questionnaire elicited information and QoL using Functional Assessment of Cancer Therapy General (FACT-G) questionnaire. The study population was patients with a diagnosis of one of the four FIGO stages of cervical cancer

RESULTS

One hundred seventy two patients completed the present study. The adjusted mean scores QoL was 78.76. There were no significant differences between FIGO stages on the global QoL and subscale. The authors found negative association between age and physical wellbeing scores (p = 0.049) and a positive association between age and emotional wellbeing scores (p = 0.004). Lower educational attainment was associated with higher emotional wellbeing scores (p = 0.004).

CONCLUSION

For many patients, family, religion, or psycho-social support may be considered a necessity. The younger and better-educated groups may require more information and psycho-emotional support.

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.

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.

Social support among elderly in Khon Kean Province, Thailand

The purpose of this research was to assess perceived social support and its factors among the elderly. The study group included 734 elders who were aged 60 years old or more, and living in eight villages in Khon Kaen Province, Thailand. A structured questionnaire was used to collect the information, and perceived social support was measured by PRQ85. This study found a high level of social support was perceived among the elderly. According to the PRQ85, the highest dimension of social support was the availability of information, emotional, and material support; while the lowest dimension was being an integral part of a group. Results from multiple regressions indicate that education level, number of close friend, knowing community health staff, working status, elderly club member, and religious activities were statistically significantly related to perceived social support. In conclusion, the elderly had a high level of social support. Close friends and community health staff are important sources of support among the elderly.

Influenza vaccination among the elderly in Bangkok

This study aimed to determine the effectiveness of influenza vaccinations among the elderly in Bangkok in reducing influenza-like illness (ILI) and influenza-related complications. Using a non-randomized, controlled, prospective methodology, healthy, active people aged 60 years or more, living in the Bangkok Metropolitan Administration (BMA) area, were studied. The two study cohorts comprised 519 persons in the vaccinated group and 520 in the non-vaccinated group. The outcome under study was influenza-like illness (ILI), as reported by the study volunteers. The two groups were comparable for most socio-demographic characteristics, except for gender, level of education, marital status, and smoking habit. The age range was 60-88 years (mean: 68 years). Females outnumbered males in both groups, with ratio of female to male of 2.6:1 and 1.9:1 in the vaccinated and non-vaccinated groups, respectively. The top three co-morbidities among these groups were hypertension, diabetes mellitus, and heart disease, in that order. Only 1% of the volunteers reported lung disease as co-morbidity. During the 12-month study period, a total of 107 volunteers reported ILI in both groups, with 38 persons in the vaccinated group and 69 persons in the non-vaccinated group. There were 46 ILI episodes in the vaccinated group, and 86 in the non-vaccinated group, for a total of 132 episodes. The incidence rates rates of influenza in this population, therefore, were 8.9% for the vaccinated and 16.9% for the non-vaccinated groups; with a reduction in the rate of reported ILI and doctor visits of 8%. Vaccine effectiveness was rated at 47.6%, crude risk ratio at 1.9 (1.33-2.75), and adjusted risk ratio at 1.92 (95% CI: 1.25-2.95), after adjustment for gender, marital status, education, and smoking habit. No complications due to ILI were observed in this population during the study period. Hospitalizations during this period were due to non-ILI related causes, such as cancer and accident.