A prospective study of diet, lifestyle, and genetic factors and the risk of cancer in Khon Kaen Province, northeast Thailand: description of the cohort.

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.

Illness experience and coping with gynecological cancer among northeast Thai female patients.

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.

An epidemiological survey of female reproductive health status: gynecological complaints and sexually-transmitted diseases.

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.

The prevalence of Chlamydia trachomatis infection in rural Thai women.

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.

Unit cost analysis in a university hospital: an example from Srinagarind Hospital, Khon Kaen.

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.

Radical vulvectomy and lymphadenectomy at Srinagarind Hospital.

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.

Epidemiology of cancer in Khon Kaen.

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.

Cass scores as a preoperative prediction for recurrences of cervical cancer after radical hysterectomy and pelvic lymphadenectomy at Srinagarind Hospital.

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.

Risk factors for survival in patients performed radical hysterectomy for cervical carcinoma.

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.