Prevalence and risk factors of cardiovascular disease among people living with HIV in the Asia-Pacific region: a systematic review.

BACKGROUND: Cardiovascular diseases (CVD) due to atherosclerosis have become one of the major causes of death among people living with HIV (PLHIV) since effective antiretroviral therapy (ART) has been available throughout the world. However, the epidemiologic evidence of this problem from the Asia-Pacific region remains unclear. We conducted a systematic review of the situation and risk factors for CVD among PLHIV in countries with the greatest impact of CVD attributable to HIV in the Asia-Pacific region. METHODS: A systematic search in PubMed/MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews databases for articles published before 2019 was conducted. Publications reported situations and risk factors both traditional and HIV-specific for CVD among PLHIV in the region were included. Two reviewers working on duplicate and quality assessments, independently extracted data, and thematically analyzed the data. RESULTS: Among PLHIV, the prevalence of subclinical CVD ranged from 10 to 28% and the incidence rate of clinical CVD ranged from 0.37 to 1.17 /100 person-years. Clinical CVD was frequently observed in the early era of the highly active antiretroviral therapy. A higher prevalence of subclinical CVD such as abnormal cIMT and carotid plaques was frequently observed in the PLHIV rather than in the nonHIV population and a high proportion of early onset of CVD was found among young PLHIV adults. The traditional risk factors for CVD such as hypertension, diabetes and smoking behavior were prevalent in both PLHIV and nonHIV populations ranging from 5 to 45%. HIV-specific risk factor, and lower CD4 presented almost twice the significantly increased risks for CVD while the synergistic interaction among traditional risk factors, i.e., diabetes mellitus, dyslipidemia and family history steeply increased the risk for CVD among PLHIV by almost 20 times. CONCLUSION: The limited existing data suggested the risk of early CVD among PLHIV. We identified the crucial gaps in HIV/CVD work from the Asia-Pacific region and recommended longer prospective studies with larger sample sizes or meta-analyses to better capture CVD risk and interactions of crucial risk factors of this vulnerable population in this region. REGISTRATION NUMBER: INPLASY202290108 ( https://inplasy.com/inplasy-2022-9-0108/ ).

The resiliency of noncommunicable diseases services during the public health crisis: a lesson from Bangkok, Thailand.

BACKGROUND: The healthcare services for non-communicable diseases (NCD) are commonly affected by public health crises like the COVID-19 pandemic. During the pandemic, all healthcare facilities in Bangkok had been overwhelmed by the extreme caseload of COVID-19. Health service resiliency is crucial for the continued service of healthcare facilities post pandemic. This study aims to explore the impacts of COVID-19 on NCD service disruption and addressed the resilience of healthcare services at the operational level. METHODS: Healthcare facility-based surveys and in-depth interviews were conducted among representatives of the facilities in Bangkok from April 2021 to July 2021. The web-based, self-administered questionnaire, was sent to directors or authorities of all healthcare facilities in Bangkok Thailand (n = 169). Two healthcare facilities from three levels of health services were purposively selected. The directors or medical doctors and nurses who are in charge of the NCD service, and working at the six selected health facilities, were invited to participate in the in-depth interviews. Descriptive statistics were used to analyze the survey data, and thematic analysis was used to analyze the data from the in-depth interviews. RESULTS: The impact of COVID-19 on NCD service disruption in the second wave (2021) was more severe than in the first wave (2020). The main reasons for NCD service disruptions are insufficient staff, and the closure of some services offered by the healthcare facilities. Surprisingly, both the budget and medical supply for healthcare facilities in Bangkok are less affected by the COVID-19 pandemic. Our study revealed resilience capability i.e. absorptive, adaptive, and transformative capabilityamong the healthcare facilities that provide a continuum of care by increasing availability and accessibility to healthcare services for chronic illness as DM. The service disruption in Bangkok may alter from other provinces because of variations in COVID-19 incidence and health services contexts. CONCLUSION: During the public health crisis, using affordable and common digital technologies to ensure DM patients can access a continuum of care and providing alternative services such as mobile medical laboratories, medication delivery, and medical refill at drug stores can increase consistent monitoring of glycemic levels and use of prescribed medication.

Combined quality of life and survival for estimation of long-term health outcome of patients with stroke.

BACKGROUND: Advanced medical technologies can prolong life of stroke survivors. Dynamic change of health outcomes provides essential information to manage stroke. Mathematical models, to extrapolate health status over a lifetime from cross-sectional data, can be used to investigate long term health outcomes among stroke survivors. This study aimed to estimate the health outcomes of ischemic stroke (IS) and intracerebral hemorrhage (ICH) at each survival time point. METHODS: The cohort of 5391 patients with IS and ICH stroke, registered at Ramathibodi Hospital from 2005 to 2013, were followed up regarding survival status until 2016 with the National Mortality Registry. Survival functions were extrapolated over 50 years to age- and sex-matched referents simulated from the national data of the Thailand National Health Statistic Office. From July to December 2016, the EuroQoL 5-dimension questionnaire was used to measure quality of life (QoL) among 400 consecutive, cross-sectional subsamples. The survival functions were then adjusted by the utility values of QoL for the stroke cohort to estimate quality adjusted life expectancy (QALE). RESULTS: The average health utility values were lower in the initial months, then slowly increased to stable levels. However, male stroke survivors presented higher health utility than females. Throughout lifetime estimation, patients with IS stroke exhibit better health outcomes than those with ICH [10.2 vs. 7.5 quality-adjusted life years (QALYs)]. Patients with ICH presented a significantly decreased QoL than patients with IS (16.3 and 8.5 QALYs). CONCLUSION: Preventing stroke can save people from reduced years and QoL, which can be quantified by loss-of-QALE in QALY units to compare health benefits from prevention, clinical diagnosis and direct treatment.

Development of a protein energy malnutrition screening tool for older Thais in public residential homes.

OBJECTIVE: This study aimed to develop and validate protein energy malnutrition (PEM) screening tool for older adults in public residential homes, and to test its practicality. DESIGN: This cross-sectional study consisted of two phases: tool development/validation and tool practicality evaluation. In Phase 1, the questionnaire was developed based on literature review and tested for content validity. Older residents were interviewed using this questionnaire to identify potential PEM risk factors. A 24-h recall was used to collect dietary data, and body composition and serum albumin were measured. In Phase 2, practicality of new PEM screening tool was evaluated by intended users. Data were analysed by χ2 test, Fisher's exact test, t-test, Mann-Whitney U test and multiple logistic regression. Akaike Information Criterion (AIC) was used to estimate the best fit model. SETTING: Four public residential homes in central region, Thailand. PARTICIPANTS: 249 older residents residing in public residential homes and eight intended users. RESULTS: 26·9 % had PEM (serum albumin <3·5 g/dl). According to multiple logistic regression and AIC values, PEM predictors were having pressure ulcer, experiencing significant weight loss and taking ≥ 9 types of medicine daily. These predictors were included in PEM screening tool. Regarding the tool performance test, area under the ROC curve was 0·8 (P < 0·001) with sensitivity and specificity of 83·9 and 45·5 %, respectively. For its practicality, eight intended users reported that it was useful and easy to use. CONCLUSIONS: New screening tool may be capable of identifying PEM in older residents, and further testing is required before being recommended for use.

Effects of psychosocial factors on nonadherence to ART in Ganta, Nimba county, Liberia.

BACKGROUND: It has been widely noted that lifetime adherence to antiretroviral therapy (ART) is necessary for HIV treatment outcome; however, retention on ART among people living with HIV (PLWH) remains a great challenge to achieve the Global AIDS Strategy: End inequalities, End AIDS. Nonadherence to ART is one of the HIV care problem in Liberia despite the availability of free ART. Psychosocial factors, i.e., perceived stigma and social support likely contributed to nonadherence to ART. We investigated associations among clinical factors, psychosocial factors, and nonadherence to ART. METHODS: A community-based cross-sectional study was conducted among 185 PLWH, age ≥ 18 years receiving ART in Ganta, Nimba county, Liberia at least 3 months. The structured questionnaire was used to collect data from April to May 2020. Associated factors of nonadherence to ART were identified using multivariable binary logistic regression, and the p-value < 0.05 was considered statistically significant. RESULTS: Of 185 respondents, 62.2% showed nonadherence to ART. Females reported higher nonadherence compared with males (64.4% vs. 56.6%). Multivariable binary logistic regression revealed strong experiences of stigma (PORadj = 2.392, p-value = 0.018), poor information support (PORadj = 2.102, p-value = 0.026) increased prevalence of ART nonadherence among Liberian PLWH. CONCLUSIONS: The healthcare providers may apply interventions to reduce perceived stigma and to enhance continuous information provision in addition to support from health care providers and family members. An intensive monitoring of ART side effects is needed to be strengthened in particular among newly started ART patients.

Hospital and patient factors influencing the health status among patients with schizophrenia, thirty days after hospital discharge: multi-level analysis.

BACKGROUND: The time between discharge from hospital and transition to community and home is a critical period for health status among patients with a mental illness, including patients with schizophrenia. This study aimed to investigate crucial patient factors (patient-level) and hospital factors (hospital-level) affecting health status and see whether patient factor effects on health status vary with hospital factors, 30 days after hospital discharge. METHODS: This is a prospective study of 1255 patients with schizophrenia and their primary caregivers from 13 public mental hospitals across Thailand. Logistic regression and multi-level logistic regression was used to investigate the effects of patient and hospital factors simultaneously on health status, 30 days after hospital discharge. RESULTS: The intraclass correlation coefficient indicated that 14% of the change in health status was explained by the differences between hospital. Poor health status was identified in 14.26% of patients, 30 days after hospital discharge. The majority of participant patients were male (69.8%), single (71.87%), and the average age was 38.09 (SD = 9.74). The finding also showed that the patient factors; being female (ORadj .53, 95%CI .31,.92), perceived moderate and high levels of positive aspect of caregiving (ORadj .24, 95%CI .14,.42 and ORadj .05, 95%CI .02,.09), perceived readiness for hospital discharge (ORadj .21, 95%CI .13,.33), partial and full adherence to treatment (ORadj .24, 95%CI .14,.42 and ORadj .31, 95%CI .20,.47) showed a reduced likelihood of developing poor health status except substance use (ORadj 1.55, 95%CI .98, 2.44). Hospital factors; discharge planning process and nurse-patient ratio (ORadj 1.64, 95%CI 1.17, 2.30 and ORadj 1.16, 95%CI 1.09, 1.22) showed an increased likelihood of developing poor health status, 30 days after hospital discharge. CONCLUSIONS: Findings provide relevant information on how both patient and hospital factors determine health status. These results might lead to better targeting of mental health service policy and enable more precise information gathering and allocation of resources. However, future research should be more focused and continue investigating the pathways through which hospital factors influence health status post-discharge.

Prevalence and distribution pattern of mood swings in Thai adolescents: a school-based survey in the central region of Thailand.

BACKGROUND: Mood swings (MS) are a widely discussed psychiatric ailment of youthful patients. However, there is a lack of research about MS in this population. METHODS: A school-based, cross-sectional study was conducted to investigate the prevalence and distribution pattern of mood swings due to personal and contextual determinants in Thai adolescents in the central region of Thailand. Participants were 2598 students in high schools and vocational schools in Bangkok and three provinces in the central region of Thailand. RESULTS: The prevalence of mood swings was 26.4%. It was highest among vocational students in Bangkok at 37.1%. MS were more common in adolescents who exhibited risk behaviors and who resided in hazardous situations. The probabilities of MS by characteristic in 15-24 years olds were: bullying involvement 36.9% (n = 1293), problematic social media use 55.9%(n = 127), high expressed emotion in family 36.6% (n = 1256), and studying in a vocational program 29.5% (n = 1216) and school located in Bangkok 32.4% (n = 561). Also, substance use was a risk for MS with cannabis use at 41.8%(n = 55) and heroin use at 48.0% (n = 25). Hierarchical logistic regression analysis showed that female gender, having a family history of mental problems, bullying involvement, problematic social media use, high expression of emotion in the family, and the interaction between vocational program enrollments and metropolitan/urban residence associated adolescent mood swings (p < .05). CONCLUSIONS: Findings indicate that the pattern of mood swings was associated with significant bullying involvement, social media use, family circumstance, and school characteristics. The public needs greater awareness of MS patterns and the positive implications of MS screening. Early preventive interventions that may limit later mental illness are needed.

Are countries' self-reported assessments of their capacity for infectious disease control reliable? Associations among countries' self-reported international health regulation 2005 capacity assessments and infectious disease control outcomes.

BACKGROUND: This study aimed to evaluate associations among countries' self-reported International Health Regulation 2005 (IHR 2005) capacity assessments and infectious disease control outcomes. METHODS: Countries' self-reported assessments implemented by percentages as IHR Monitoring Tools (IHRMT) in 2016 and 2017 were used to represent national capacity regarding infectious disease control. WHO Disease Outbreak News and matched diseases reports on ProMED-mail were collected in 2016 to represent disease control outcomes of countries. Disease control outcomes were divided in good, normal and bad groups based on the development of outbreaks listed in the reports. The Human Development Index (HDI), density of physicians and nurses, health expenditure, number of arrivals of international tourists were also collected for control. Chi-square test and logistic regression were applied for analysis. RESULTS: A total of 907 cases occurred in 92 countries. For all diseases, cases occurring in high international travel volume countries presented twice the risk of having a bad disease control outcomes than cases occurring in low international travel volume countries (OR = 2.19 for IHR 2016, OR = 2.97 for IHR 2017). Cases occurring in low IHR average score countries had significant higher risk (OR = 7.83 for IHR 2016 and OR = 2.23 for IHR 2017) of having a bad disease control outcomes than countries with high IHR average scores. For only human diseases, cases occurring in high international travel volume countries presented twice the risk of having a bad disease control outcomes than cases occurring in low international travel volume countries for IHR 2017 (OR = 2.79). Cases occurring in low IHR average score countries had significant higher risk (OR = 11.16 for IHR 2016 and OR = 3.45 for IHR 2017) of having a bad disease control outcomes than countries with high IHR average scores. The HDI, health workforce density and total health expenditure were all positively associated with disease control outcomes. CONCLUSIONS: Countries' self-reported infectious disease control capacities positively correlated with their disease control outcomes. While the self-reported IHR scores were accountable to some degree, this approach was useful for understanding global capacity in infectious disease control and in allocating resources for future preparedness.

Dietary Iron Intake and Availability in Hill Tribe and Urban Women, Chiang Rai Province, Northern Thailand.

Data were collected as part of a cross-sectional study. The objectives were to compare dietary intakes of iron and enhancers and inhibitors of non-heme iron absorption in hill tribe and urban women of Chiang Rai province, northern Thailand, and compare iron- and vitamin C- containing foods sold in markets in both settings. Dietary data were collected using three 24- hour recalls from 128 women aged 19-50 years (hill tribe: n = 65; urban n = 63), and proportions of low-, medium- and high-iron/vitamin C containing foods were surveyed in local markets. Hill tribe women consumed less iron, animal protein, vitamin C and calcium, but market availability of iron/vitamin C foods was similar. Future interventions should focus on food choice modification, to improve intakes of iron and foods that enhance its absorption, especially among hill tribe women.

Food Consumption and Accessibility in Hill Tribe and Urban Women, Chiang Rai Province, Northern Thailand.

This analytical cross-sectional study aimed to examine the associations between setting and food consumption and accessibility in two districts of Chiang Rai province, northern Thailand. 128 women (65 in hill tribe setting and 63 in urban setting) were surveyed using an interviewer-administered questionnaire. Traditional and mobile markets were well utilized in both settings, in spite of the growth of multinational retailers. Consumption of ready-to-eat food and home-grown/reared or wild foods was associated with socioeconomic status. Fewer hill tribe women had eaten ready-to-eat food, although some reported fairly regular consumption. Consumption of home-grown/reared or wild foods was more evident in the hill tribe group, showing their continued utilization of traditional food resources.

Dietary iron intake and availability are related to maternal education level in overweight/obese adolescents.

PURPOSE: To compare intakes of dietary iron and enhancers and inhibitors of iron absorption between overweight/obese (OW/OB) adolescents and their normal weight (NW) peers, and between parental education levels stratified by weight status. METHODS: This was a comparative cross-sectional study of adolescents (n 121 OW/OB and n 102 NW) aged 12-14 years, attending a secondary school in Nonthaburi province, Thailand. Socio-demographic data were obtained from participants' parents using a questionnaire. Participants recorded their intakes for 3 non-consecutive days, using a prospective food record. RESULTS: Compared with NW adolescents, OW/OB adolescents consumed more total protein and animal protein after adjustment for energy intake (both p = 0.047). OW/OB adolescents whose mothers were less educated consumed more total iron and available iron after adjustment for energy intake, compared with their OW/OB peers whose mothers were more educated (p = 0.045 and p = 0.040). NW adolescents with more highly educated mothers had higher absolute and energy-adjusted fibre intakes (both p = 0.047). However, NW adolescents of mothers with a high-intermediate level of education consumed less calcium, after adjustment for energy intake (p = 0.028). CONCLUSIONS: OW/OB adolescents with less educated mothers had higher energy-adjusted intakes of iron and available iron. Dietary differences in OW/OB adolescents relative to maternal education, and other socioeconomic indicators, should be explored in a nationally representative data set.

Participatory capacity building for improving quality of childcare centers in Thailand.

INTRODUCTION: Childcare centers (CCCs) with good quality standards can be effective in reducing the risk of diseases being easily spread from person to person. The aim of the present study's program, adapted from a method used by the United Nations Development Program, was to increase the capacity of local administrators(s) and heads of CCCs to improve quality standards. METHODS: This study was quasi-experimental, with a one group pretest-post-test design. In this study the authors describe the effects and impacts of the program in Chonburi Province in eastern Thailand. Six LAs and 48 CCC heads were trained regarding (1) knowledge of the Thai Department of Health quality standards, (2) implementation and assurance and (3) program evaluation. The program consisted of three sequential participatory workshops. Effects at the center level were increased overall knowledge of quality standards of CCCs (QCCC), and developed skills of improvement plans. The impact at the center level was CCCs achieving the QCCC. At the child level it was the reduction in the period prevalence of three diseases and two symptoms. RESULTS: The significant (p<0.05) effects and impacts at the center level were increased overall knowledge of QCCC in LAs and CCC heads and increased overall managerial skills of CCC heads. At the child level, the period prevalence of chickenpox and diarrhea symptom were reduced. CONCLUSION: Participatory capacity building is an appropriate way to enhance the managerial skills of LAs and heads of CCCs for improving quality of CCCs to meet the local authority and the Ministry of Public Health quality standards.

Assessing disaster preparedness and mental health of community members in Aceh, Indonesia: a community-based, descriptive household survey of a national program.

INTRODUCTON: Disaster preparedness of the community is an essential disaster-mitigation strategy to protect human life and to prevent injuries and property damage. This study aimed to assess the knowledge of disaster, and the disaster preparedness of community members in Aceh, Indonesia. METHODS: A community-based descriptive household survey was conducted in 40 villages of three tsunami-affected districts in Aceh State, Indonesia. In total, 827 randomly selected community members were interviewed with structured questionnaires during the period September-October 2014. RESULTS: About 57.6% of community members had good knowledge of disaster, while 26.0% had good community disaster preparedness. Neither knowledge of disaster nor disaster preparedness of community members achieved the target of the Community Mental Health Nurse Program outcome indicators (<70.0%). CONCLUSIONS: The proportions of people with good knowledge of disaster and disaster preparedness were quite low. The government of Aceh State should revitalize the program to improve the effectiveness of community mental health nurses in transferring the knowledge of disasters and disaster preparedness to the community's members, then expand it to other provinces of Indonesia, using standard approaches and the lessons learned from Aceh.

Evaluation of mass drug administration in the program to control imported lymphatic filariasis in Thailand.

BACKGROUND: Migration plays a major role in the emergence and resurgence of lymphatic filariasis (LF) in many countries. Because of the high prevalence of Imported Bancroftian Filariasis (IBF) caused by nocturnally periodic Wuchereria bancrofti and the intensive movement of immigrant workers from endemic areas, Thailand has implemented two doses of 6 mg/kg diethylcarbamazine (DEC) with interval of 6 months to prevent IBF. In areas where immigrants are very mobile, the administration of DEC may be compromised. This study aimed to evaluate DEC administration and its barriers in such areas. METHODS: A cross-sectional study with two-stage stratified cluster sampling was conducted. We selected Myanmar immigrants aged >18 years from factory and fishery areas of Samut Sakhon Province for interview with a structured questionnaire. We also interviewed health personnel regarding the functions of the LF program and practice of DEC delivery among immigrants. Associations were measured by multiple logistic regression, at P <0.05. RESULTS: DEC coverage among the immigrants was 75 %, below the national target. All had received DEC only once during health examinations at general hospitals for work permit renewals. None of the health centers in each community provided DEC. Significant barriers to DEC access included being undocumented (adjusted OR = 74.23; 95 % CI = 26.32-209.34), unemployed (adjusted OR = 5.09; 95 % CI = 3.39-7.64), daily employed (adjusted OR = 4.33; 95 % CI = 2.91-6.46), short-term immigrant (adjusted OR = 1.62; 95 % CI = 1.04-2.52) and living in a fishery area (adjusted OR = 1.57; 95 % CI = 1.04-2.52). Incorrect perceptions about the side-effects of DEC also obstructed DEC access for Myanmar immigrants. All positive LF antigenic immigrants reported visiting and emigrating from LF-endemic areas. CONCLUSION: Hospital-based DEC administration was an inappropriate approach to DEC delivery in areas with highly mobile Myanmar immigrants. Incorporating health-center personnel in DEC delivery twice yearly and improving the perceptions of DEC side effects would likely increase DEC coverage among Myanmar immigrants.

Spatial analysis of social determinants for tuberculosis in Thailand.

OBJECTIVE: The present study aimed to investigate the association between social factors and spatial risk of TB in Thailand. MATERIAL AND METHOD: Ecological study and spatial statistics were employed to examine effects of social factors on age-standardized morbidity ratios of TB (SMR) in 76 provinces in Thailand during 2006-2009. RESULTS: The autoregressive model reveals similarity of TB risk in proximal areas (Moran's I = 0.612; p < 0.05). After adjusting for HIV epidemic and spatial autocorrelation (rho = 0.581, p < 0.001), a spatial autoregressive model revealed significant relationship of unemployment rate (beta = 0.073) and household income (beta = 0.134) to spatial risk of TB with variance of explanation 55%. CONCLUSION: The present study indicated the area at risk of TB is in areas with high employment rate and household income, which are specific characteristics of an urban area. Therefore, in urban areas that are vulnerable to TB transmission, a development of specific TB surveillance and prevention and control programs is need.

Matters of Gender and Social Disparities Regarding Postnatal Care Use Among Nepalese Women: A Cross-Sectional Study in Morang District.

Objective: The study compares the uses of postnatal care (PNC) and women's autonomy gradients across social caste and used intersectionality concepts to estimate odds ratio of women's autonomy and social caste on complete PNC. Methods: A community-based cross-sectional study among 600 women aged 15-49 years who had at least one child younger than the age of 2 years in Morang District, Nepal, was conducted from April to July 2019. PNC, women's autonomy (decision-making power, freedom of movement, and control over finances) and social caste were collected by both methods. Multivariable logistic regressions were used to determine associations between women's autonomy, social caste, and complete PNC. Results: Complete PNC totaled 13.5% of respondents. About one-fourth of respondents reported poor overall autonomy; however, non-Dalit demonstrated higher autonomy than Dalit. Non-Dalit exhibited greater odds of complete PNC by four times. Women exhibited high women's autonomy in decision-making power, control over finance, and freedom of movement and have greater odds of complete PNC than low autonomy by 17, 3, and 7 times, respectively. Conclusion: The study raises awareness of intersectionality (gender and social caste), relating to maternal health in caste-based system countries. To improve maternal health outcomes, health care personnel should identify and systematically address barriers that women of lower-caste membership face and offer these women appropriate advice or resources to obtain care. A multilevel change program that involves different actors like husbands and community leaders is needed for improving women's autonomy and lessening stigmatized perceptions, attitudes, or practices toward non-Dalit caste-members.

Association between socioecological factors and electronic cigarette use among Thai youth: an institution-based cross-sectional study.

OBJECTIVES: This study aimed to examine cigarette use distribution, pattern of e-cigarette use and to determine socioecological model (SEM) factors associated with e-cigarette use among Thai youth (aged 15-24). DESIGN: An institution-based cross-sectional study. PARTICIPANTS: The study conducted in five regions: the north, south, central, northeast and Bangkok area of Thailand from May to October 2021. An internet-based, self-administered questionnaire was developed based on the SEM. We enrolled 13 139 students who understood Thai and voluntarily consented to participate in the study. Hierarchical generalised estimating equations identified the related factors to e-cigarette use consistent with the SEM. RESULTS: Of 12 948 respondents (95.5%), 181 were excluded due to a lack of cigarette use status. Of 12 767, the prevalence of cigarette use was 4.3%, e-cigarette use was 3.5% and dual-use was 2.4%. E-cigarettes were a much more favourable choice among female youth than cigarettes. E-cigarette users tended to express more positive beliefs towards e-cigarettes than non-users. Although the use of e-cigarettes is illegal in Thailand, 66% of users obtained e-cigarettes from online markets and 4% from grocery stores. We found that having a girlfriend or boyfriend who uses e-cigarettes increased the odds of e-cigarette use by 3.239 times. Interestingly, higher odds of e-cigarette use were associated with peer use than with sibling use among e-cigarette users. (Adjusted OR 2.786, 95% CI 1.844 to 4.208 and 2.485, 95% CI 1.402 to 4.404, respectively). Exposure to e-cigarette use in school increased the odds of e-cigarette use by four times. CONCLUSION: This institution-based cross-sectional study revealed that youth e-cigarette use is a significant problem. To prevent the increasing rate of e-cigarette use, health literacy about e-cigarette use, including media and information literacy, should be launched across all levels of the school environment to enlist youth to stand against the negative impacts of e-cigarette use among all those of school age.

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.

Molecular characterization of human bocavirus in recycled water and sewage sludge in Thailand.

The study aimed to assess the presence and molecular characterization of human bocavirus (HBoV) in recycled water and sewage sludge samples in Thailand. One hundred and two recycled water and eighty-six sewage sludge samples collected from a wastewater treatment plant were tested for the presence of HBoV using nested PCR with broad-range primer pairs targeting the capsid proteins VP1 and VP2. HBoV DNA was detected in recycled water of 9/102 (8.8%) samples and sewage sludge of 27/86 (31.4%) samples. Based on DNA sequencing and phylogenetic analysis, the HBoV DNA sequences had 98.8-100.0% nucleotide identity to the sequences from HBoV reported globally. Thirty-five HBoV-positive samples were identified to genotypes as the predominant HBoV2; 26 followed by HBoV3; 8 and the rare HBoV4; 1 sample. Concerning recycled water, HBoV2 was detected in 3 (2.9%) and HBoV3 was detected in 5 (4.9%) of all samples. The sewage sludge samples were characterized as HBoV2 in 23 (26.7%), HBoV3 in 3 (3.5%) and HBoV4 in 1 (1.2%) of all samples. The frequency of HBoV detected in recycled water and sewage sludge samples significantly differed in sample type (p-value = 0.007). The findings of three HBoV genotypes in recycled water and sewage sludge emphasized the circulation of the virus in the environment and the potential source of transmission to the community.