Correlation Between Fragmented QRS and Ventricular Function from Cardiac Magnetic Resonance in Patients with Repaired Tetralogy of Fallot.

Fragmented QRS is an abnormal sign in an ECG resulting from ventricular dyssynchrony. The presence of fragmented QRS (fQRS) is related to mortality in patients with repaired tetralogy of Fallot (rTOF). This study aimed to analyze the correlations between fQRS and ventricular function parameters from cardiac magnetic resonance (CMR) images. A total of 54 patients with rTOF or repaired DORV, TOF type who had been investigated by CMR at Songklanagarind Hospital from January 2012 to August 2019 were retrospectively reviewed. Most of the patients (47 patients, 87%) were diagnosed with TOF and most of these (57.4%) were treated with a transannular patch (TAP) on the right ventricular outflow tract (RVOT). Forty-four patients (81%) had fQRS. The median time interval between EKG and CMR was 4.2 months (IQR 1.1, 6.9). Patients with fQRS had significantly higher RVEDVi (145.6 [IQR 121.1, 173.1) vs. 115.9 [IQR 96.2, 146.9] mL/m2, p = 0.037), higher RVESVi (82.5 [IQR 62.9, 100.8] vs. 58.6 [IQR 46, 77.2] mL/m2, p = 0.032) and higher RVEDV/LVEDV ratio [1.6 (IQR 1.4, 1.9) vs. 1.4 (IQR 1.3, 1.5), p = 0.026]. The extent of fQRS was significantly associated with an increase in RVEDVi (r = 0.39, p = 0.004) and RVESVi (r = 0.45, p < 0.001) but a decrease in RVEF (r = - 0.37, p = 0.006). Fragmented QRS had higher sensitivity and lower specificity than prolonged QRS duration (≥ 160 ms) to predict all of the parameters indicating pulmonary valve replacement (PVR). Patients with rTOF who had fQRS were significantly associated with RV dilatation. The extent of fQRS had only low to moderate correlation with right ventricular parameters (RVEDVi, RVESVi and RVEF). Fragmented QRS could be used for early detection of RV dilatation and the need for PVR in patients with rTOF.

Survey on neutralizing antibodies against Zika virus eighteen months post-outbreak in two southern Thailand communities.

BACKGROUND: In 2016 and 2017, Zika virus (ZIKV) infection outbreaks occurred in two communities in southern Thailand. This re-immerging infection can widely spread by mosquito bites and cause serious complications in a central nervous system among children born to infected mothers. Thus, they should be protected. This study aims to (1) To determine the prevalence of neutralizing ZIKV antibodies in the post-outbreak areas among the general population and pregnancy women residing at various distances from the houses of the nearest index patients; (2) To examine the cross-neutralizing capacity of antibodies against ZIKV on other flaviviruses commonly found in the study areas; (3) To identify factors associated with the presence of neutralizing ZIKV antibodies. METHODS: The two post-outbreak communities were visited at 18 months after the outbreaks. We enrolled (1) 18 confirmed ZIKV infected (index) cases, (2) sample of 554 neighbors in the outbreak areas who lived at various distances from the index patients' houses, (3) 190 residents of non-outbreak areas, and (4) all pregnant women regardless of gestational age residing in the study areas (n = 805). All serum specimens underwent the plaque reduction neutralization test (PRNT). Ten randomly selected ZIKV seropositive and ten randomly selected seronegative specimens were tested for dengue virus serotypes 1-4 (DENV1-4) and Japanese encephalitis virus (JEV) antibodies using PRNT90. Serum titer above 1:10 was considered positive. Multiple logistic regression was used to assess factors associated with seropositivity. RESULTS: Out of all 18 index cases, 9 remained seropositive. The seroprevalence (95% CI) in the two outbreak areas were 43.7% (35.9-51.6%) and 29.7% (23.3-36.0%) in general population, and 24.3% (20.1-28.8%) and 12.8% (9.7-16.5%) in pregnant women. Multivariate analysis showed that seropositivity was independent of the distance gradient from the index's houses. However, being elderly was associated with seropositivity. DENV1-4 and JEV neutralizing antibodies were present in most ZIKV-positive and negative subsamples. CONCLUSION: Protective herd immunity for ZIKV infection is inadequate, especially among pregnant women in the two post-outbreak areas in southern Thailand.

Mental health problems from direct vs indirect exposure to violent events among children born and growing up in a conflict zone of southern Thailand.

PURPOSE: This study aims to examine and compare the effects of direct and indirect exposure to armed conflicts on the mental health of primary school students in the three southernmost provinces of Thailand. METHODS: A school-based survey was conducted. Detailed exposure of traumatic events both directly and indirectly were measured by a self-completed questionnaire. Behavioral-emotional problems were measured by the Strength and Difficulty Questionnaire and screening for post-traumatic stress disorder (PTSD) was done using the Children's Revised Impact of Events Scale (CRIES). Multivariate analysis adjusted for gender and other covariates was used to determine the effect of direct and indirect exposure of armed conflict on mental health problems. RESULTS: Out of 941 students included in the study, almost half had direct exposure to an armed conflict event. Overall, 42.1% of students had at least one behavioral-emotional problem (47.6% and 38.5% in the direct- and indirect-exposed groups, respectively) and 30.5% was found to have PTSD (37.3% and 25.9% in the direct- and indirect-exposed groups, respectively). Students who had direct exposure to an armed conflict event had a two times higher odds of mental health problems than their peers. Other modifiable factors of mental health problems were receiving news from two sources including other adults and media, and exposure to other non-conflict-related traumatic life events. CONCLUSIONS: Children living in armed conflict areas of southern Thailand, although without any direct exposure to traumatic events, also suffered from mental health problems. Research on appropriate interventions for these children should be further conducted.

Energy and Macronutrient Intakes and Food Sources in Preschool Children: Thai NHES IV.

OBJECTIVE: Examine intakes of energy and macronutrients, and identify their food sources, in Thai preschool children. MATERIAL AND METHOD: Data from the Thai National Health Examination Survey (NHES) IV were used. Mothers/caregivers were interviewed regarding their children's 24-hour-dietary intake. Dietary data were analyzed for energy and macronutrients, and their food sources were investigated. Due to skewed data, Mann-Whitney U test was used to compare energy and macronutrient intake between sexes and age groups. RESULTS: Among 256 preschool children, more than 90% had protein intakes higher than the recommended level. Only 12.7 to 29.0% met the recommended intake for energy. Amounts of carbohydrate and fat consumed varied from below to above the Dietary Reference Intake (DRI) recommendation. Intakes of carbohydrate in boys and fat in girls were statistically different between age groups (p < 0.05). Fifty to 60% of energy came from dairy products, grains and starchy products. The major carbohydrate contributors were grains and starchy products. Dairy products were the main source of protein. Important food sources of fat were dairy products for one- to three-year-old children and fat and oils for four- to five-year-old children. CONCLUSION: Thai preschool children have inappropriate intakes of energy and macronutrients. Dairy products and grains and/or starchy products were the main sources of energy, carbohydrate, and protein. Dietary fat sources varied by age group.

Characteristics and determinants of Thailand's declining birth rate in women age 35 to 59 years old: data from the Fourth National Health Examination Survey.

OBJECTIVE: To describe characteristics and determinants of Thailand's declining birth rate using national representative survey data. MATERIAL AND METHOD: The Fourth National Health Examination Survey was conducted between 2008 and 2009. Four stages of stratified probability samples, proportionate to size, were used to represent the whole Thai population. Information from women aged 35 to 59 years old was included in the analysis. Curve estimation was used to characterize the correlation between the number of children ever born and the age of married and un-married women. Binary logistic regression analysis was used to identify predictors of having fewer than two children among ever married women. RESULTS: Of all 4120 women, the number of children decreased sharply among the oldest women aged 45 to 59 years old, decreased less sharply for women younger than 45 years of age, reached the lowest level at the age of 37 and 38 years old, and then increased minimally among the younger women surveyed. Among those who were ever married (n = 3,761), the independent predictors of having one or no child instead of having two or more children were aged 45 to 49 compared to 50 to 59 years old (OR = 1.66; 95% CI = 1.37-2.00), age 35 to 44 compared to 50 to 59 years old (OR = 1.39; 95% CI = 1.16-1.68), living in households with wealth index level 3 compared to level 1 (OR = 1.28; 95% CI = 1.01-1.63), urban residence (OR = 1.33; 95% CI = 1.14-1.57), attaining secondary school education (OR = 1.35; 95% CI = 1.11-1.64), and having junior college diploma or higher level of education compared to elementary or no education (OR = 1.81; 95% CI = 1.39-2.34). CONCLUSION: Birth rate of Thai women declined steeply in the past then less steeply, and might have begun to rise minimally in recent years. Younger age, living in an urban area, and having higher socioeconomic status were predictors of having fewer than two children.

Smoking behaviour and associated factors of illicit cigarette consumption in a border province of southern Thailand.

BACKGROUND: Illicit cigarette consumption has increased worldwide. It is important to understand this problem thoroughly. OBJECTIVES: To investigate behaviours and factors associated with illicit cigarette consumption in southern Thailand. DESIGN: A survey and qualitative study were conducted in a border province in southern Thailand next to Malaysia. A modified snowballing technique was used to recruit 300 illicit and 150 non-illicit cigarette smokers. A questionnaire was used to interview subjects. Illicit cigarette packs were obtained in order to identify their characteristics. Bivariate and multivariate logistic regression was used for data analysis. RESULTS: Smoking of illicit cigarettes has become accepted in the communities. They were available in supermarkets and vendor shops. Friends and other illicit smokers known by illicit cigarette smokers were an important source of information for access to illicit cigarette products. The main factors associated with smoking illicit cigarettes, compared with smoking non-illicit cigarettes, were younger age, higher education and higher average monthly expenditure on cigarettes (most illicit smokers smoked illicit cigarettes (average price per packet = 33 THB (US$1.1), while most non-illicit smokers smoked hand-rolled cigarettes (average price per packet = 7 THB (US$0.2)) and knowledge of other illicit cigarette smokers. The low price of illicit cigarettes was the main reason for their use. Selling strategies included sale of singles, sale in shops and direct sale through social networking. CONCLUSIONS: Illicit cigarette consumption has become more acceptable especially among young adult smokers. Age and extent of social networks are important factors associated with smoking illicit cigarettes.

Free survival time of recurrence and malignant transformation and associated factors in patients with supratentorial low-grade gliomas.

OBJECTIVE: To determine the recurrence and malignancy free survival time and associated factors with recurrence and malignant transformation of patients with low-grade gliomas after primary surgical resection. MATERIAL AND METHOD: The present study was retrospective. Patients who underwent surgery and were diagnosed with low-grade gliomas between January 2000 and October 2009 were recruited. Time to recurrence and malignant transformation were analyzed using Kaplan-Meier method and multivariate Cox proportional hazard regression models. RESULTS: Seventy-seven patients underwent surgery for low-grade glioma. The pathological reports were diffuse astrocytoma in 55 patients (71%), oligodendroglioma in 19 patients (25%), and oligoastrocytoma in three patients (40%). The types of tumor resection were biopsy in 39 patients (50%), subtotal resection 34 patients (44%), and total resection in four patients (5%). The overall mean time to follow-up was 40 months, the median recurrence and malignant transformation times were 14 and 24 months. The 5-year recurrence-free and malignant-free survival rate was 50% and 68%. Factors associated with tumor recurrence were age, sex, presenting symptoms, preoperative Karnofsky performance status (KPS) score, tumor volume, and contrast enhancement. None of these factors showed statistically significant association with malignant transformation. CONCLUSION: One fourth of the patients had tumor recurrence and malignant transformation in a short period of time. Delayed recurrence and malignant transformation after primary resection are associated with several factors. The type of surgery especially total-subtotal resection might favor prognosis.

Sodium intake and socio-demographic determinants of the non-compliance with daily sodium intake recommendations: Thai NHES IV.

OBJECTIVE: To estimate daily intake of sodium and examine the relation of socio-demographic factors with sodium intake exceeding the recommendations. MATERIAL AND METHOD: Data from the Thai National Health Examination Survey IV (NHES IV) conducted during 2008-2009 were used. The 24-hour-dietary-recall data were available for a subsample of 10% of the total participants. All food and beverage data were analyzed for amount of total daily sodium intake for each person. In statistical analyses, descriptive statistics were employed to describe participants' characteristics, quantities of dietary sodium and percentages of participants noncompliant with daily sodium intake recommendations. Logistic regression was used to examine socio-demographic determinants of sodium intake exceeding the recommendations. RESULTS: 2,969 participants participated in this study. Sodium intake varied by socio-demographics. Percentages of participants non-compliant with sodium intake recommendations ranged from 75.3 (> or = 1,500 mg) to 52.0 (> or = 2,400 mg) for those aged < 16 years and from 86.3 (> or = 1,500 mg) to 67.6 (2,400 mg) for those aged > or = 16 years. In the younger group, age and region were key determinants of consuming sodium exceeding all recommendations. Having family income between 5,000 and < 10,000 baht/month was significantly associated with sodium intake exceeding recommendation targets. In the older group, being female and increasing age reduced a risk of non-compliance with some recommendations; oppositely, region and residential area participants lived significantly, increased non-compliant risk. CONCLUSION: Most participants consumed dietary sodium exceeding current recommendations. Effective programs to reduce sodium intake in Thais are critical.

Health behaviors among short- and long- term ex-smokers: results from the Thai National Health Examination Survey IV, 2009.

BACKGROUND: Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors. METHODS: Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1 year, 1-10 years, >10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used. RESULTS: The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7). CONCLUSION: A longer duration of smoking cessation correlated with better health behaviors.

Current situation and future challenges of tobacco control policy in Thailand.

In Thailand, the prevalence of smoking has steadily declined over the past 20 years, suggesting an effective tobacco control policy. However, the prevalence has recently stabilised and youth smoking now appears to be on the rise. Tobacco use is the third highest risk factor contributing to the burden of disease in the country. This is an issue of concern and led to the present review of tobacco control measures in Thailand. The present evidence-based review shows that Thailand's tobacco control measures are relatively strong and comply well with the WHO Framework Convention on Tobacco Control in terms of taxation, advertisement through popular media, and warning labels on cigarettes and other tobacco product packages. However, challenges remain in dealing with highly prevalent roll-your-own cigarettes, strict prohibition of tobacco sale to underage youths, household smoking, illicit trade of tobacco products, viable tobacco crop diversification for domestic tobacco growers and liability. If these challenges are met, the prevalence of tobacco consumption could possibly be further reduced.

Consequences and associated factors of youth gambling.

OBJECTIVE: To examine gambling behaviors, consequences and its associated factors among Thai youths. MATERIAL AND METHOD: A cross-sectional survey of 1,694 students from Matthayom 1 (grade 7) to university undergraduate level was conducted using a self-administered questionnaire. Questionnaire items consisted of socio-economic characteristics, health behaviors, attitudes towards gambling and consequences of gambling. Factors associated with gambling experience were identified by multivariate logistic regression. RESULTS: Approximately 20% of youth gambling was reported. Gamblers had higher proportion of males, studying in vocational schools and lower GPA and history of smoking and alcohol consumption. Card games were the most common type of gambling, followed by football-betting. Approximately 10% of the gamblers potentially had pathological gambling. Factors positively associated with gambling included having friends (adjusted OR = 4.82) and relatives (adjusted OR = 2.48) who gambled. Having a GPA > or = 3.0 was negatively associated with gambling (adjusted OR = 0.58). The present study reported negative consequences of gambling including feeling of guilt, perception of poorer health and depression or insomnia after losing. CONCLUSION: Gambling prevention program should be developed and focused on student with poor study performance and wrecked relationships in family. Also, a surveillance system for health risk behaviors among youth in school and community should be established by the participation of multiple organizations.

Determinants of subjective well-being among migrant and local elderly in China: a cross-sectional study.

OBJECTIVES: The study aimed to examine the association between individual and community levels in relation to subjective well-being (SWB) among the migrant and local elderly. It particularly focuses on the extent to which and the ways in which the residential environment of migrant and local elderly influences their SWB. DESIGN: A cross-sectional study. SETTING: Our study was conducted in Dongguan City, China. PARTICIPANTS: Two groups of elderly (aged >60 years), including migrants and local residents, were recruited. A total of 470 migrants and 422 local residents participated in this study. MAIN OUTCOME MEASURES: SWB was assessed by the Memorial University of Newfoundland Scale of Happiness. RESULTS: The community-level health facility density had a positive association with SWB (B=0.38, p<0.01), whereas the financial facility density had a negative association (B=-0.42, p<0.01). The density of health and financial facilities affected the local elderly more than the migrant elderly. Social cohesion is an aspect of the social environment of the community that influenced elders' SWB (B=0.72, p<0.001). CONCLUSIONS: The primary determinants of SWB for both the migrant and local elderly included individual, societal and environmental factors.

Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009.

BACKGROUND: Information on the distribution of Metabolic syndrome (MetS) and its combinations by urban/rural areas in lower-middle income countries has been limited. It is not clear how the various combinations of MetS components varied by urban/rural population and if particular combinations of MetS are more common. This study aimed to estimate the prevalence of MetS and combinations of MetS components according to sex and urban/rural areas from a nationally representative sample of Thai adults. METHODS: Data from the fourth National Health Examination Survey of 19,256 Thai adults aged 20 years and over were analyzed. MetS was defined using the harmonized criteria of six international expert groups with Asian-specific cut-point for waist circumference. RESULTS: The prevalence of MetS was 23.2% among adults aged ≥ 20 years (19.5% in men and 26.8% in women). Among men, the prevalence of MetS in urban was higher than those in rural areas (23.1% vs 17.9%, P < 0.05), but among women, the prevalence was higher in rural areas (27.9% vs 24.5%, P < 0.05). Overall, an individual component of low high density lipoprotein (HDL) and hypertriglyceridemia were more common in rural areas, while obesity, high blood pressure and hyperglycemia were more common in urban areas. The most common combination of MetS components in men was the clustering of low HDL, hypertriglyceridemia, and high blood pressure (urban: 3.4% vs. rural: 3.9%, adjusted OR 0.9, 95%CI 0.7, 1.1). Among women, the most common combination was the clustering of obesity, low HDL, and hypertriglyceridemia (urban: 3.9% vs rural: 5.9%, adjusted OR 0.8, 95%CI 0.6, 0.9), followed by the clustering of these three components with high blood pressure (urban: 3.1% vs. rural 4.5%, adjusted OR 0.8, 95%CI 0.7, 0.9). CONCLUSION: Metabolic syndrome affects both urban and rural population with different pattern of MetS combinations. Dyslipidemia and obesity were the most common components among women in rural areas, hence, interventions to prevent and control these factors should be strengthened.

Dual dietary intake problems among under-five years old children living in an armed conflict area of southern Thailand.

This survey examined nutritional intake and the effects of armed conflict on energy-protein inadequacy amonng children aged one to less than five years. Fifty health centers were randomly selected. Three children were randomly selected from each 12-month old interval age groups in each health center. Four hundred seventy eight children and their primary caregivers were recruited. Food intake was collected from a single 24-hour food recall and was computed to percentage of the Thai Dietary Reference Intake (DRI). Violent event rates were classified by quartiles. Dietary intake stratified by age groups was examined. Logistic regression was used to examine association between armed conflict and inadequacy of food intake. Average of DRI was above 100% for both energy and protein intake. Snacks contributed to one-fourth of energy intake. Inadequacy of energy and protein intake was 27% and 7%, respectively. There was no association between armed conflict and inadequacy of energy and protein consumption.

Three years experience of suprasellar tumors in neuro-ophthalmology clinic.

OBJECTIVE: To examine pre-treatment ophthalmic presentations and treatment results and to identify factors that may influence improved visual outcomes in patients with suprasellar tumor MATERIAL AND METHOD: The medical records of patients with suprasellar tumors who were diagnosed between July 2005 and June 2008 in the neuro-ophthalmology clinic of Songklanagarind Hospital were retrospectively reviewed by two ophthalmologists. Pre-treatment ophthalmic presentations and treatment results were analyzed. Determinants of improved visual outcomes were identified by using univariate and multivariate regression analysis. RESULTS: Of 40 patients, 55% were male and 45% were female, with a median age of 38 years. The most common pre-treatment ophthalmic presentations were blurred vision (92.5%), headache (10%) and eye pain (5%). The most common tumor was pituitary adenoma (macroadenoma and prolactinoma). Visual improvement was achieved in pituitary adenoma in 20 of 25 eyes (80%), meningioma in 8 of 12 eyes (67%) and other tumors in 2 of 5 eyes (40%). No determinants related to better visual outcomes were found. CONCLUSION: The most common presentation of suprasellar tumor was blurred vision. There were no pre-treatment factors that related to visual outcomes in the present study.

Antibiotic use in chicken farms in northwestern China.

Background: Misuse of antibiotics in food animals contributes to an increase of antibiotic resistant bacteria transmitting to humans. China is the largest producer and user of antibiotics in the world, of which animals share more than half of the total consumption. This study aimed to explore Chinese farmer's practice of antibiotic use and the factors associated with their use. Methods: In this cross-sectional survey, we interviewed farmers from 88 chicken farms in northwestern China. We defined two kinds of misuse: 1) using antibiotics in the Chinese prohibited list, and 2) using antibiotics within the recommended withdrawal period. Factor analysis was used to select farmers' knowledge variables and multinomial logistic regression was used to determine factors associated with antibiotic misuse. Results: All the participating farmers used antibiotics on their farms. Amoxicillin was the most common antibiotic used (76.5%), followed by norfloxacin, ofloxacin, ceftriaxone and oxytetracycline. 75% of farmers used antibiotics in the prohibited list while 14.8% continued to use antibiotics during the withdrawal period. Hierarchical cluster analysis revealed three patterns of antibiotic use: 1) excessive use of non-prohibited and prohibited antibiotics or an excessive user, 2) low use of a few types of non-prohibited and moderate use of prohibited antibiotics or a low user, 3) multiple use of a variety (≥ 7 types) of non-prohibited and prohibited antibiotics or a moderate user. Farmers from medium size, family-based farms, those with a low education level and low income were more likely to misuse antibiotics. Prior formal agricultural training was associated with reducing multiple types of antibiotic use. There was a huge gap between policy and reinforcement causing antibiotic misuse in the study community. Conclusion: Antibiotics are commonly used on chicken farms; misuse of antibiotics is high; improvement in farm sanitation, education on antibiotic use for farmers and veterinarians/pharmacists and enforcement of the regulations may reduce antibiotic use on chicken farms in China.

Combined Tuberculosis and Diabetes Mellitus Screening and Assessment of Glycaemic Control among Household Contacts of Tuberculosis Patients in Yangon, Myanmar.

BACKGROUND: This study aimed to identify the prevalence of diabetes mellitus (DM) and tuberculosis (TB) among household contacts of index TB patients in Yangon, Myanmar. METHOD: Household contacts were approached at their home. Chest X-ray and capillary blood glucose tests were offered based on World Health Organization and American Diabetes Association guidelines. Crude prevalence and odds ratios of DM and TB among household contacts of TB patients with and without DM were calculated. RESULTS: The overall prevalence of DM and TB among household contacts were (14.0%, 95% CI: 10.6-18.4) and (5%, 95% CI: 3.2-7.6), respectively. More than 25% of DM cases and almost 95% of TB cases among household contacts were newly diagnosed. Almost 64% of known DM cases among household contacts had poor glycaemic control. The risk of getting DM among household contacts of TB patients with DM was significantly higher (OR-2.13, 95% CI: 1.10-4.12) than those of TB patients without DM. There was no difference in prevalence of TB among household contacts of TB patients with and without DM. CONCLUSION: Significant proportions of the undetected and uncontrolled DM among household contacts of index TB patients indicate a strong need for DM screening and intervention in this TB-DM dual high-risk population.

Effect of a computer network-based feedback program on antibiotic prescription rates of primary care physicians: A cluster randomized crossover-controlled trial.

OBJECTIVE: Antibiotic overuse is one of the major prescription problems in rural China and a major risk factor for antibiotic resistance. Low antibiotic prescription rates can effectively reduce the risk of antibiotic resistance. We hypothesized that under a paperless, computer-based feedback system the rates of antibiotic prescriptions among primary care physicians can be reduced. METHODS: A cluster randomized crossover open controlled trial was conducted in 31 hospitals. These hospitals were randomly allocated to two groups to receive the intervention for three months followed by no intervention for three months in a random sequence. The feedback intervention information, which displayed the physicians' antibiotic prescription rates and ranking, was updated every 10 days. The primary outcome was the 10-day antibiotic prescription rate of the physicians. RESULTS: There were 82 physicians in group 1 (intervention first followed by control) and 81 in group 2 (control first followed by intervention). Baseline comparison showed no significant difference in antibiotic prescription rate between the two groups (30.8% vs 35.2%, P-value=0.07). At the crossover point, the relative reduction in antibiotic prescription rate was significantly higher among physicians in the intervention group than in the control group (33.1% vs 20.3%, P-value<0.001). After a further 3 months, the rate of decline in antibiotic prescriptions was also significantly greater in the intervention group compared to the control group (14.2% vs 4.6%, P-value<0.001). The characteristics of physicians did not significantly determine the change in rate of antibiotic prescriptions. CONCLUSION: A computer network-based feedback intervention can significantly reduce the antibiotic prescription rates of primary care outpatient physicians and continuously affected their prescription behavior for up to six months. TRIAL REGISTRATION: ChiCTR1900021823.

Smoking Trends among Thailand's Youths from 1996-2015: An Age-Period-Cohort Analysis of National Health Surveys.

BACKGROUND: This study aimed to investigate secular trends of smoking among Thailand's youths. METHODS: We combined 8 datasets from national representative surveys between 1996 and 2015. Multi-stage cluster sampling was applied in all studies. Overall, 231459 participants aged 11-26 yr were included and analyzed. Participants were classified as current smokers if they responded "yes" to the question "Do you currently smoke?", and former smoker if they reported no current smoking but had smoked previously. Age-period-cohort (APC) models were used to estimate age, period, and cohort effects on smoking for investigating secular trend of smoking. RESULTS: The prevalence of smoking tended to decrease over time. Among those aged 11-14, the prevalence of current and former smoking was low but not negligible. Rates of underage smoking remained quite steady, around 3.8% in 1996 and 3.6% in 2015. The results of the APC model show that the prevalence of smoking among young male cohorts was lower than in older cohorts. CONCLUSION: Thailand's tobacco control program has been effective in deterring youths from smoking. The prevalence of smoking in this population needs to be reduced further though, something achieved by reorienting tobacco consumption prevention campaigns towards this age group.

Nothing Like Living with a Family: A Qualitative Study of Subjective Well-Being and its Determinants among Migrant and Local Elderly in Dongguan, China.

Chinese economic development has led to a significant rise in internal migration over the last 20 years, including large numbers of elderly. When elderly Chinese people migrate, they still register their residency to their place of origin and often do not register with the new administrative office at the destination due to the household registration (hukou) system in China. Thus, most of these migrant elderly do not receive full social services, possibly leading to poor subjective well-being. This study aims to qualitatively examine the level of subjective well-being and its determinants among migrants and local elderly in Dongguan City of Guangdong province, one of the most rapid economically developing areas in China. We also present the results of in-depth interviews among 27 elderly, 15 elderly migrants and 12 local elderly living in Dongguan. The results reveal that the overall subjective well-being of the two groups were good. Most migrants believed their well-being had remained stable or even improved over time due to family reunion and a better physical environment. Elderly's most valuable needs and the main reason of migration is family reunion; however, inadequacy of social support, including community support and government support (e.g., gift during holiday season, free health examination, healthcare expenditure reimbursement), cannot be neglected for maintaining a good level of well-being. The well-being of migrant elderly can be further enhanced by promoting social services and welfare, recreational activities, and enhancing healthcare reimbursement in their new home.