A single dose of nevirapine to the mother, with or without a dose of nevirapine to the infant, added to oral zidovudine prophylaxis starting at 28 weeks' gestation, is highly effective in reducing mother-to-child transmission of HIV.
The incidence of breast cancer in Thailand has increased during the past decade. Besides, most of the patient present with the locally advanced stage. 1 Mammography has not reached all women in Thailand. Breast self-examination (BSE) is simple and feasible for breast cancer screening among developing countries comparing to mammography and clinical breast examination (CBE). 2 We evaluate a cohort study of 1 906 697 women without a history of breast cancer aged 30-70 years who participated in a breast cancer awareness program in Thailand. We excluded women with known breast cancer or in process of investigation. BSE program in this study was shown in Figure 1. The village health volunteers (VHV) helped reminding the cohorts to perform BSE regularly through the use of BSE record booklet. The innovative BSE record booklet contained the instruction to help cohort to perform BSE precisely and record monthly in the booklet which was verified by the VHV and confirmed by health personnel. The participants had been followed up from October 2012 to September 2017. The participants who reached the regularity (at least once in every 2 months) of BSE within 12 months before diagnosis were defined as regular BSE. When abnormalities presented, the participants were referred for screening by CBE then confirmed by imaging and pathology. The data of BSE and Breast Cancer Individual (BCI) Record Form were collected and analyzed. There were 2,956 women diagnosed with breast cancer in this study (Figure 2). Breast cancer size and stage were diagnosed according to the AJCC 7th staging system. We categorized tumor size into small (≤2 cm) and large (>2 cm) and stage into early (0-II) and late (III-IV). Death due to breast cancer was also recorded.Of 1 906 697 women who participated in this study, 61%were aged < 50 years. 72% of participants performed BSE regularly. During 5 years of follow-up, 2956 participants were diagnosed with breast cancer. The average incidence rate per year was 31 (range 27.5-33.5) per 100 000 women aged between 30 and70 years old (Table 1). 97.9% of them found a breast lump themselves and were sent for confirmation by imaging and histopathology. The other presenting symptoms were breast pain (12.8%) and unequal breast size (7.9%). Some of participants (1.2%) did not have any signs or symptoms. Data on breast cancer size were available for 2,031 patients (68.7% of all patients with breast cancer). The risk of a large tumor size in nonregular BSE patients was 1.348-fold higher than regular BSE patients. Data on breast cancer stage were available for 2659 patients (90.0% of all patients with breast cancer). Most of the patients were diagnosed with stage II, (47.9%) and 31.5% were diagnosed with stage III-IV.The risk of late-stage breast cancer in nonregular BSE patients was 1.319-fold higher than in regular BSE. Of 2956 patients, 176 (5.9%) died during 5 years of follow-up. The survival rate of regular BSE patients was significantly higher than nonregular BSE This is an open access article under the terms of the Cre...
, the prevalence of adult HIV infection in parts of sub-Saharan Africa will be over 30%: an unprecedented scale of human suffering. Yet this has been poorly understood in the rest of the world, simply because what happens there currently has a small impact on the global economy. How different will it be when the epidemic in populated Asian countries such as China, India, and Indonesia grows by "just" a few percent? It is not too late to avoid the disaster that is likely to follow, but prevention will depend on mobilization of the necessary forces. Science has certainly delivered tools to do the job and to repair policy misunderstandings, but the few success stories of countries turning the tide have involved strong commitments and sound strategies, supported by the national leadership at the highest level. Thailand and Uganda are deservedly cited as worth emulating. Brazil, with its universal access to antiretroviral therapy, can claim to be the greatest success story of all so far; it provides a good example of what community mobilization and a strong civil society can accomplish. After all, the Brazilian government was reluctantly drawn in at first. Community will play an even larger role in the scale-up of treatment as its efforts extend beyond advocacy and HIV prevention efforts to the delivery of medical care. The good news is that the scale-up has been spurred by new funding mechanisms such as the World Bank Multicountry AIDS Programme and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Antiretroviral drug prices have come down, and multiple organizations are providing technical assistance to the poorest countries. The World Health Organization (WHO) has also set the ambitious goal of providing drug therapy for 3 million people in resource-poor settings by the end of 2005. Sadly, despite these positive developments, we are still very far from meeting the WHO target. We need to move beyond the rhetoric and traditional ways of working to achieve sustainable provision of adequate therapy for millions. One of the biggest problems is that many of the hardest-hit countries in sub-Saharan Africa are "failed states" in which the public sector is unable to offer basic health services to the masses. Multilateral institutions such as WHO can only work within the constraints of such poorly functioning systems, and therefore cannot be expected to take the lead. The current U.S. unilateralism does not help to mend the situation. Donors and technical assistance agencies are falling over each other, often in clear competition, without addressing the essentials. One pivotal element in strengthening public-sector health care, often conveniently forgotten, is the need to motivate and retain skilled personnel through sufficient remuneration and attractive career prospects. Likewise, robust mechanisms for distributing drugs and medical supplies can be set up only if those involved are sufficiently rewarded. Why is it that we are always talking about the problem of drug distribution when there is virtually no place in A...
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