The Development of Dental Informatics of Oral Cancer Screening for Prevention in Community Level: A Prototype Study in Thailand.

OBJECTIVE: The purpose of this study is to identify general dentists' information needs for oral cancer screening in community and the information sources they use to meet those needs in clinical settings so as to inform the design of dental information systems. METHODS: A semi-structured interview was conducted with a convenience sample of 8 general dentists and 5 dental assistant in the Public Health Region 9 area during clinical hours. One hundred and five patient cases were reported by these dentists. Interview transcripts were coded and analyzed using thematic analysis with a constant comparative method to identify categories and themes regarding information needs and information source use patterns. RESULTS: Two top-level categories of information needs were identified: foreground and background information needs. To meet these needs, dentists used four types of information sources: clinical information/tasks, risk factor of oral cancer in general people, surveillance in community and referral to oral cancer treatment. Major themes of dentists' unmet information needs include: (1) timely access to information on various subjects; (2) better visual representations of dental problems; (3) access to patient-specific evidence-based information; and (4) accurate, complete and consistent documentation of patient records. Resource use patterns include: (1) dentists information needs matched information source use; (2) little use of electronic sources took place during treatment; (3) source use depended on the nature and complexity of the dental problems; and (4) dentists and dental nurse routinely practiced cross-referencing to verify patient information. CONCLUSIONS: Dentists have various information needs of oral cancer at the point of care. For future development of dental information or clinical decision support systems, developers should consider integrating high-quality, up-to-date clinical evidence into comprehensive and easily accessible EDRs as well as supporting dentists' resource use patterns as identified in the study.

The intake of energy and selected nutrients by thai urban sedentary workers: an evaluation of adherence to dietary recommendations.

Rapid changes in Thailand's nutrition and lifestyles have led to increasing diet-related pathologies among people with sedentary occupations. This study examines the extent to which the dietary intake of nutrients and energy by a sample of Thai sedentary workers conforms to the Thai Dietary Reference Intakes (Thai DRIs). The nutrients and energy intake estimates were based on self-reported information collected with a single 24-hour dietary recall and nonweighed 2-day food record. The study participants were Thai adults aged 20-50 years employed in sedentary occupations. A convenience sample of 215 healthy individuals (75 males and 140 females) was based on four randomly selected worksites in the Bangkok metropolitan area. For male participants, the study found a median energy intake of 1,485 kcal/day, with 54.4% of energy coming from carbohydrate, 15.9% from protein, and 29.6% from fat. Females' median energy intake was 1,428 kcal/day, 56% of which came from carbohydrate, 16.2% from protein, and 28.6% from fat. Both genders showed insufficient intake of fiber and most micronutrients. This study provides the material for preventive public health interventions focusing on nutrition-related diseases affecting Thailand's rapidly growing sedentary workforce.

The diamond level health promoting schools (DLHPS) program for reduced child obesity in Thailand: lessons learned from interviews and focus groups.

Overweight and obesity prevalence among children is increasing globally. Health promoting school policy has been initiated in Thailand to tackle this problem. The schools that best conduct obesity management programs are rated as diamond level health promoting schools (DLHPS). However, the methods used by these schools and their efficacies have not been well-documented. This qualitative study aims to analyze the processes and activities used by four DLHPSs in obesity management programs. In-depth interviews were used to obtain information from school directors, teachers, and cooks, whereas focus group discussions were used for students. School-based obesity management programs have resulted from health promoting school policy and the increasing prevalence of overweight students. Teamwork has been a key strategy in program implementation. Policy diffusion and division of labor have been effected by school directors. A monitoring process is put in place to ensure program delivery. The most evident success factor in the present study has been intersectoral cooperation. Challenges have included confusion about the criteria in obtaining the DLHPS status, parental involvement, and students' resistance to consume vegetables and other healthy foods. From the student focus groups discussions, three activities were most valued: class health and nutrition learning; provision of healthy foods and drinks, together with removal of soft drinks and seasoning from the cafeteria; and exercise for health. Intersectoral cooperation is the key success factor for the operationality of DLHPS, especially in making healthy foods available and physical activity the norm, at school and home.

An outcome based nutrition curriculum for counselors at HIV voluntary counseling and testing facilities in Vietnam.

We developed, monitored and evaluated an outcome based nutrition curriculum for counselors at HIV voluntary counseling and testing (VCT) facilities in Can Tho City, Vietnam. This outcome based education (OBE) focused on expected competencies appropriate to the local context. The curriculum was designed to train 37 counselors working in HIV VCT centers in Can Tho City, Vietnam regarding nutrition. Lectures and learning activities were developed and assessment criteria were determined. The curriculum content was evaluated and modified by feedback from reviewers. During training, the HIV VCT counselors gave the curriculum a satisfactory rating. More than 80% of HIV VCT counselors stated the subject matter was easily or very easily understand. Testing revealed a significant mean increase in the HIV VCT counselor's competency by the end of training (p = 0.001). More than 89% of HIV VCT counselors felt confident in performing nutritional counseling. These findings suggest the usefulness of this OBE nutrition curriculum for training HIV VCT counselors.

Participatory action project in reducing childhood obesity in Thai primary schools.

UNLABELLED: The project aimed to improve nutrition and activity among primary schoolchildren via targeted activities. A preliminary nutritional survey was carried out involving 5126 children in 4 Bangkok public schools. Participatory action research involving students, teachers, and parents was conducted. After a 2-day training course, teachers integrated project concepts into their course curriculum. Seminars on weight management were given separately to parents and students. After 8 months, postnutritional survey was conducted. Preprogram and postprogram evaluation of obese and normal groups was done using questionnaires on dietary intake and exercise. RESULTS: showed that high caloric dietary intake significantly decreased for the obese group (P < .001). Aerobic exercise activity also increased in both groups (P < .001) and prevalence of obesity declined from 19.3% to 16.8%. Thus, a long-term, participatory effort to promote healthy diets and physical exercise could be effective with primary school students and may establish habits that last to later life.

Risk factors for cholangiocarcinoma in Khon Kaen, Thailand: a nested case-control study.

The present nested case-control study within the Khon Kaen cohort study was conducted to assess risk factors for cholangiocarcinoma (CCA) development. Cases were 108 subjects with proven CCA, by ultrasound at least, and controls also numbered 108, matched by sex, age (not more than 3 years difference) and period of recruitment to the cohort (not more than 3 months difference). A questionnaire was constructed based on that employed for the Khon Kaen cohort study recruitment. McNemar's chi-square test and conditional logistic regression were used for crude analysis and multiple conditional logistic regression for multivariate analysis. Results revealed a sex ratio of 2:1 for males:females. The current study found a statistically significant relationship when adjusted for other potential covariate factors between cholangiocarcinoma and the consumption of total fruits 3-4.6 times per day (OR= 0.32, 95% CI= 0.12-0.88) and history of Opisthorchis viverrini eggs in stools at recruitment plus consumption of meat <0.45 times per day (OR= 2.99, 95% CI= 1.04-8.62). The findings suggest that O. viverrini infestation is the strongest risk factor for development of cholangiocarcinoma and also suggests decrease in risk among individuals who consume more fruit.