Factors associated with maternal attitudes towards condom education for children aged 12-14 years in Myanmar.

Condom education, an important part of comprehensive sexuality education, involves lessons on negotiating, motivating and demonstrating condom use. Expanding condom-related knowledge and skill reduces risks of unwanted pregnancy, HIV and sexually transmitted infections. Condom education for adolescents has been a controversial subject among parents, teachers, health professionals and the general public. Mothers are key stakeholders in efforts to implement such programmes. Therefore, this study explored factors associated with their attitudes towards the condom education for children aged 12-14 years. We used secondary data from the Myanmar Demographic and Health Survey. The sample includes mothers (N = 7011) who had at least one living child and responded to the question "Should children aged 12-14 be taught about condom use to prevent AIDS?" The answers yes, no and unsure were used as proxy for their attitudes. In total, 41.5% of the mothers agreed with the condom education. Mothers, who had an adolescent child, belonged to an ethnic minority, rural residents, low-educated, poor knowledge of HIV and condoms were less supportive of the condom education. These findings highlight the need for rural mothers in Myanmar to be given awareness about adolescent sexual and reproductive health focusing on HIV/AIDS and condom desensitization.

Willingness-to-pay in physical activity: how much older adults value the community-wide initiatives programs?

Background: Previous studies have shown insufficient physical activity (PA) as a significant global health concern and a major risk factor for non-communicable diseases (NCDs). Community-wide initiatives in physical activity (CWIPA) is considered as a best-buy for Community-wide initiatives in physical activity (CWIPA) is considered as a best-buy for NCDs prevention. However, assessment regarding resource allocation and cost-effectiveness of existing programs is lacking. This study investigated local residents' willingness-to-pay (WTP) for community PA programs in Southern Thailand. Methods: The contingent valuation method (CVM) using the payment card approach was employed to elicit the WTP of 472 residents aged 45 years and over in selected provinces in which community PA programs had been implemented. Respondents were asked to indicate their WTP for the continuous offering of free CWIPA by choosing how much they were willing to pay from eight bid-value options, payable through their monthly electricity bill. Results: The mean WTP of Thai older adults was found to be 72 baht/month ($2/month) or 868 baht/year ($25/year). This indicated the maximum amount an older person was willing to pay for any community-based PA program. More than half the sample (54.2%) chose zero as their answer, while there was a fairly large variation in other levels of WTP. The WTP was lower among older respondents and those who resided in rural areas but was higher among those with a history of participation in an organized PA program. Conclusion: The level of WTP can be interpreted as an indicator of community satisfaction with CWIPA. That finding can be used as evidence for the government and policy makers in allocating resources and designing future CWIPA. A variety of organized PA programs should be offered to all community members to ensure inclusivity and also to provide equal access for senior citizens.

Rethinking early childbearing in Indonesia: is it preceded by a premarital first birth?

PURPOSE: This study aimed to present the level and patterns of premarital first births in Indonesia, and its association with early childbearing. METHODS: This study used three rounds of the Indonesia Demographic and Health Survey, including a total of 29,483 women in 2002; 32,895 in 2007 and 45,607 in 2012. Those women who had their first child before reaching 19 years of age were defined as early child bearers, otherwise, the women were known as later child bearers. All conceptions that occurred 9 months after the first marriage were defined as timely births within marriage, thus, premarital first birth is a first birth that occurred less than 7 months after the first marriage. FINDINGS: About 7-11% of Indonesian women conceived their first child before marriage. Both early and later child bearers experienced their first birth less than 7 months after their first marriage, however, women who experienced conception before marriage were twice as likely to become early child bearers compared to women who had their first birth occurred timely. CONCLUSION: The results of the present analysis show that some Indonesian women had their first child before marriage. Although the unavailability of marriage and birth registrations is the most plausible explanation for the decline in premarital first births among the youngest cohort, regional differences suggest there is also an influence of socio-cultural diversity in the premarital sexual practices of Indonesian women.

State of household need for caregivers and determinants of psychological burden among caregivers of older people in Thailand: An analysis from national surveys on older persons.

OBJECTIVES: To explore the levels and trends of household need for caregivers of older people and to explore the impact of potential determinants of psychological burden among caregivers of older people in Thailand. METHODS: The secondary data analysis was performed using the Survey of Older Persons in Thailand 2007, 2011, and 2014 datasets which conducted by the National Statistical Office of Thailand. The household need for caregivers of older persons refers to having at least one older person in the household who needs a caregiver for assistance with activities of daily living. Caregiver mental health, which is confined to the available 2011 data, is defined as a state of psychological burden. Ordinal logistic regression models were used to explore the impact of potential determinants of psychological caregiver burden. RESULTS: The household need for caregivers in Thailand tends to be increasing, from 5.0% in 2007 to 6.6% in 2014. The levels of the household need for caregivers were significantly higher in urban areas, Bangkok, and high socioeconomic households. In terms of psychological caregiver burden, the Thai Mental Health Indicators in 2011 produced, on average, a fair level of mental health, but one-fourth of caregivers had poor mental health. Duration of care for older people, household wealth, and functional dependency significantly predict total caregiver burden. Household characteristics are vital in predicting psychological caregiver burden, and the adjusted effect of the fifth quintile of household wealth was high (odds ratio = 2.34; 95% confidence interval = 1.47-3.73). CONCLUSION: The increasing need for caregiving in households with an older person can lead to a higher caregiver burden, particularly among those caregivers who care for dependent older people in poor households. Longer duration of caregiving is a factor that mitigates this burden.

Drivers of Physicians' Engagement in Addressing Eco-health Problems.

Physicians are in a unique position to be first-hand observers of the effects of environmental factors on population health. As a source of information which is highly trusted, they are also well-suited to raise awareness about the linkages between ecosystem and population health. Yet, current clinical practice in many parts of the world rarely includes environmental health assessments and patient education. The empirical evidence on the reasons for this lack of engagement is limited by the small number of studies published, its narrow geographical scope and the dearth of multivariate statistical analysis. This study used a mixed-methods approach to investigate the determinants of whether physicians at selected hospitals in Thailand assess the environmental history of their patients and provide environmental health advice. Using an ordered logistic regression model, it was found that physicians' engagement was associated with their knowledge, personal motivation, perception of being supported by senior staff and ability to discuss with colleagues. According to key informants, possible remedies for the observed lack of physicians' engagement include revisions of the medical school curriculum, clear strategies for addressing eco-health linkages in the clinical context at the national and hospital level, and better cooperation between relevant government institutions in Thailand.

Differential inhibition of cardiac and neuronal Na(+) channels by the selective serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine.

Duloxetine and venlafaxine are selective serotonin-norepinephrine-reuptake-inhibitors used as antidepressants and co-analgesics. While venlafaxine rather than duloxetine induce cardiovascular side-effects, neither of the substances are regarded cardiotoxic. Inhibition of cardiac Na(+)-channels can be associated with cardiotoxicity, and duloxetine was demonstrated to block neuronal Na(+)-channels. The aim of this study was to investigate if the non-life threatening cardiotoxicities of duloxetine and venlafaxine correlate with a weak inhibition of cardiac Na(+)-channels. Effects of duloxetine, venlafaxine and amitriptyline were examined on endogenous Na(+)-channels in neuroblastoma ND7/23 cells and on the α-subunits Nav1.5, Nav1.7 and Nav1.8 with whole-cell patch clamp recordings. Tonic block of the cardiac Na(+)-channel Nav1.5 and rat-cardiomyocytes (CM) revealed a higher potency for duloxetine (Nav 1.5 IC50 14±1µM, CM IC50 27±3µM) as compared to venlafaxine (Nav 1.5 IC50 671±26µM, CM IC50 452±34µM). Duloxetine was as potent as the cardiotoxic antidepressant amitriptyline (IC50 13±1µM). While venlafaxine almost failed to induce use-dependent block on Nav1.5 and cardiomyocytes, low concentrations of duloxetine (1, 10µM) induced prominent use-dependent block similar to amitriptyline. Duloxetine, but not venlafaxine stabilized fast and slow inactivation and delayed recovery from inactivation. Duloxetine induced an unselective inhibition of neuronal Na(+)-channels (IC50 ND7/23 23±1µM, Nav1.7 19±2µM, Nav1.8 29±2). Duloxetine, but not venlafaxine inhibits cardiac Na(+)-channels with a potency similar to amitriptyline. These data indicate that an inhibition of Na(+)-channels does not predict a clinically relevant cardiotoxicity.