Effect of radiation on serum anti-Müllerian hormone during hysterosalpingography in female infertility.

RESEARCH QUESTION: Does radiation exposure during hysterosalpingography (HSG) negatively affect serum anti-Müllerian hormone (AMH) levels in infertile women? DESIGN: Prospective cohort study conducted at Songklanagarind Hospital, Thailand, between April 2021 and May 2023. Thirty-two infertile women and 34 control participants were enrolled. Serum AMH levels were assessed in the infertile group at baseline before the HSG procedure and at 1 and 3 months after the procedure. Control participants, who self-reported no medical conditions, underwent the same AMH level assessments. Changes in serum AMH levels were compared. RESULTS: Infertile women had a mean age of 32.4 ± 3.8 years, body mass index of 21.2 ± 2.0 kg/m2 and baseline mean AMH level of 3.66 ng/ml (95% CI 3.00 to 4.32), which did not significantly differ from the control group. One month after HSG, mean AMH level significantly declined (0.33 ng/ml, 95% CI -0.65 to -0.01; P = 0.045) in the infertile group. The change in serum AMH levels between baseline and 1 month was significantly different in the HSG group compared with controls (-0.33 ng/ml, 95% CI -0.65 to -0.01 versus 0.36 ng/ml, 95% CI 0.06 to 0.67; P = 0.002). Changes in serum AMH levels from baseline to 3 months did not differ between the two groups. CONCLUSIONS: One month after the HSG, infertile women experienced a significant decrease in serum AMH levels compared with controls. The change in serum AMH levels between baseline and 3 months after HSG did not significantly differ from that of the control group.

The anxiolytic effects of preoperative administration of pregabalin in comparison to diazepam and placebo.

We aimed to evaluate the potential anxiolytic effects of premedication with pregabalin, compared with diazepam and placebo. We conducted this non-inferiority, double-blind, randomized controlled trial in ASA classification I-II patients aged 18-70 years, scheduled for elective surgery under general anesthesia. They were allocated to receive pregabalin (75 mg the night before surgery and 150 mg 2 h before surgery), diazepam (5 and 10 mg in the same manner) or placebo. Preoperative anxiety was evaluated using verbal numerical rating scale (VNRS) and Amsterdam Preoperative Anxiety and Information Scale (APAIS) before and after premedication. Sleep quality, sedation level, and adverse effects were assessed as secondary outcomes. A total of 231 patients were screened and 224 completed the trial. The mean change (95%CI) in anxiety scores from before to after medication in pregabalin, diazepam, and placebo groups for VNRS were - 0.87 (- 1.43, - 0.30), - 1.17 (- 1.74, - 0.60), and - 0.99 (- 1.56, - 0.41), and for APAIS were - 0.38 (- 1.04, 0.28), - 0.83 (- 1.49, - 0.16), and - 0.27 (- 0.95, 0.40). The difference in change for pregabalin versus diazepam was 0.30 (- 0.50, 1.11) for VNRS and 0.45 (- 0.49, 1.38) for APAIS, exceeding the limit of inferiority for APAIS of 1.3. Sleep quality was statistically different between pregabalin and placebo groups (p = 0.048). Sedation in pregabalin and diazepam groups were significantly higher than placebo group (p = 0.008). No significant differences of other side effects, except dry mouth was higher in placebo group compared with diazepam (p = 0.006). The study filed to provide evidence at non-inferiority of pregabalin compared to diazepam. Furthermore, premedication with either pregabalin or diazepam did not significantly reduce the preoperative anxiety in comparison to placebo, despite the fact that both resulted in higher levels of sedation. Clinicians should weigh the benefits and risks of premedication with these 2 drugs.Thai Clinical Trials Registry: TCTR20190424001 (24/04/2019) Registry URL: https://www.thaiclinicaltrials.org/ .

The Health Impact of Long-Term Kratom (Mitragyna Speciosa) Use in Southern Thailand.

BACKGROUND: Mitragyna speciosa or Kratom has been used in Thailand traditionally for its medicinal value. Despite case reports of kratom consumption causing adverse effects, research on its long-term health impact is limited. This study examines the long-term health impact of kratom use among people in Southern Thailand. METHODS: Three community-based surveys were conducted from 2011 to 2015. In the first and second surveys (2011 and 2012) a total of 1,118 male respondents comprising 355 regular kratom users, 171 occasional kratom users, 66 ex-users, and 592 non-users aged 25 or above, were recruited from 40 villages. All respondents were followed up in this study. However, not all respondents were successfully followed up throughout the entire set of studies. RESULTS: Common health complaints were no more common among kratom users than ex- and non-users, but more regular than occasional users claimed kratom to be addictive. Those with high kratom dependence scores were more likely to experience intense withdrawal symptoms, which developed 1-12 h after the last kratom intake. Over half (57.9%) of regular users had experienced intoxication effects compared to only 29.3% of occasional users. Kratom users were less likely to have a history of chronic diseases such as diabetes, hypertension, dyslipidemia than ex- and non-users. CONCLUSION: Regular long-term chewing of fresh kratom leaves was not related to an increase in common health complaints, but may pose a drug dependence risk. Severe kratom dependents were more likely to suffer from intense withdrawal symptoms. Medical records revealed no death due to traditional kratom use, but the high prevalence of tobacco or/and hand rolled cigarette smoking among kratom users should be of concern.

Employment intentions among rural order-oriented medical students in inner mongolia autonomous region, China.

BACKGROUND: The program of the "Free Training of Chinese Rural Order-Oriented Medical Students" is a plan to train general practitioners who can work at rural medical institutions. However, many students have been unwilling to fulfill their commitments and actually work in their assigned locations. OBJECTIVE: This study aimed to provide some explanation by exploring factors influencing the employment intentions of rural order-oriented medical students in Inner Mongolia Autonomous Region of China to provide a basis for formulating relevant supporting policies to help increase the fulfillment rate of medical students. METHODS: We conducted a cross-sectional study with a stratified cluster sampling method at four medical universities in Inner Mongolia using a survey questionnaire. Multivariate logistic regression was used to identify factors that were significantly associated with employment intentions. RESULTS: Approximately 67% of students were willing to work in rural areas, whereas 33% were not. Order-oriented medical students who were dissatisfied with, or indifferent to, training, were unclear about policy, were of Han ethnicity, or came from an urban area, had lower intentions to accept employment in rural areas. The training satisfaction in particular had the greatest predictive effect. CONCLUSION: The implementation of the program "Free Training of Chinese Rural Order-Oriented Medical Students" has been affected by the low actual employment intentions. This study may provide a useful basis on which medical educators and health policy makers can formulate relevant supporting policies and develop strategies to increase the number of order-oriented medical students who working in rural areas where they are most needed.

Is ABO Blood Group a Predictive Factor for the Amount of Opioid Consumption in the First 24 Hours After Cesarean Section?

BACKGROUND: Cesarean section is the most common major surgery performed globally. Blood group O has been found as a factor affecting pain severity after cesarean section. We aimed to evaluate the predictive factors, including ABO blood group, for the amount of opioid consumption (measured as milligrams of morphine equivalent [MME]) within the first 24 hrs after cesarean section. METHODS: This retrospective study was done in 1530 pregnant women who had a cesarean section under the same regimen of spinal anesthesia (2.2 mL of 0.5% hyperbaric bupivacaine and morphine 0.2 mg). All were prescribed regular paracetamol and ibuprofen for postoperative pain control. Univariate and multinomial regression analyses were performed to identify the predictive factors for opioid consumption in the first 24 hrs postoperatively. RESULTS: About 2/5 of them (43.3%) received 0 mg MME, while 25.6%, 23.7% and 7.4% received 1-5, 6-10 and >10 mg MME, respectively. The majority have blood group O (40.6%), while 23.4%, 28% and 8% have blood group A, B and AB, respectively. After univariate and multinomial regression analyses, operation time, opioid consumption in PACU, maximum VNRS within the first 24 hrs and consumption of both paracetamol and ibuprofen were identified as predictive factors for postoperative opioid consumption. ABO blood group exhibited no correlation for opioid requirement postoperatively. CONCLUSION: ABO blood group is not a predictive factor for opioid requirement within the first 24 hrs following cesarean section. Duration of operation, opioid given in PACU, maximum VNRS on ward and consumption of both paracetamol and ibuprofen have been found to be predictive factors for postcesarean opioid requirement.

Healthcare seeking preferences of Myanmar migrant seafarers in the deep south of Thailand.

BACKGROUND: The Thai marine fishing industry depends on migrant workers. Public healthcare services are officially available to all registered migrant workers, but the extent of their utilisation by migrant seafarers is unknown. The aim of the study was to document sociodemographic characteristics, working conditions, illness history and healthcare-seeking preference among Myanmar migrant seafarers in southern Thailand. MATERIALS AND METHODS: Questionnaire-based interviews were conducted among 385 migrant seafarers and selected participants qualitatively interviewed. Factors related to illness experience and to healthcare- -seeking preference were identified using logistic regression. RESULTS: Past-one-year illness was reported by 307 (80%) participants, among whom 91% had illness while at sea and 22% an emergency condition requiring immediate transfer ashore. Only 118 (38%) illness events involved visiting a public hospital; another 38% involved private healthcare facilities or drug stores. Illness was associated with supervisory job, alcohol consumption habit, age > 20 years, ethnicity and exposure to hazardous marine life. Compared with the choice of public hospital, use of private healthcare facilities was associated with having at least primary school education and shorter-duration trips at sea. Obtaining medications from a drug store was associated with the job of sorting, packing/storing the catch, non-drinking and low income. Not holding their identity and health-insurance documents and language barrier were major reasons for reluctance to seek treatment at a public hospital. CONCLUSIONS: Illness was common among the migrant seafarers. Utilisation of public hospitals was low. Allowing migrants to keep their identity and health insurance documents themselves and providing materials in the Myanmar language might promote utilisation of public health facilities.

Obstructive sleep apnea and sudden unexpected death in epilepsy in unselected patients with epilepsy: are they associated?

PURPOSE: We aimed to determine (1) the frequency of high-risk sudden unexpected death in epilepsy (SUDEP) in patients with epilepsy who have had obstructive sleep apnea (OSA) in different stages of sleep using the revised SUDEP risk inventory (rSUDEP-7) score instrument and (2) the factors associated with high risk SUDEP in patients with epilepsy who have had OSA. METHODS: We conducted a cross-sectional study of consecutive subjects who are more than 15 years old without known sleep disorders, recruited from a single epilepsy clinic in a tertiary care facility. Participants underwent polysomnography. Scoring was performed by two blinded board-certified sleep physicians. The relationships between rSUDEP-7 scores and OSA measures were evaluated using Wilcoxon rank-sum test, chi-squared test, and quantile regression. RESULTS: Our study population consisted of 95 participants. Overall median (IQR) apnea-hypopnea index (AHI) of our populations was 2.3 (0.7,7.5) events rate per hour; 12 (75%) patients had moderate OSA and 4 (25%) patients had severe OSA. Nine patients had a rSUDEP-7 score of 5 to 7. There was no significant difference between total rSUDEP-7 score or rSUDEP-7 score of > 5 or < 5 and total AHI, supine AHI, non-supine AHI, NREM AHI, or REM AHI; similarly, (2) there was no significant difference in total rSUDEP-7 score between AHI of < 15 or > 15. CONCLUSION: Our study reveals no association between AHI score, OSA, and total rSUDEP-7 score or rSUDEP-7 score of > 5. The pathophysiology underlying SUDEP appears complex. We need further studies on SUDEP to help elucidate the cardiorespiratory mechanisms and predisposing factors.

A Context-Specific Instrument to Record Drinking Behaviour: A Pilot Study on Implications of Identifying the Context of Risky Drinking.

A context-specific quantity-frequency (CSQF) questionnaire has been developed to accurately measure alcohol consumption using probing questions on drinking context. The study aimed to describe the drinking context associated with different drinking intensities in a community of southern Thailand using the CSQF. A cross-sectional survey was conducted among adults aged > 15 years in Songkhla Province, Thailand. Among 804 participants, there were 183 current drinkers with 412 drinking events (215 low-, 79 medium-, and 118 high-intensity). More than half of these events occurred in special situations (i.e., holiday, party, and cultural drinking). About half of the drinking events occurred outside the drinker's house and most drinking events occurred among friends. Higher drinking intensity was associated with higher level of education [adjusted odds ratio (aOR) 4.74 for medium- and aOR 5.23 for high-intensity] and with a special drinking situation (aOR 2.46 for medium- and aOR 2.78 for high-intensity).

Work-related discomfort among floor-sitting sedge weavers: a cross-sectional survey.

Purpose. This cross-sectional survey aimed to evaluate and identify risk factors of work-related discomfort among floor-sitting Thai sedge handicraft weavers. Materials and methods. Sedge weavers (N = 285) were interviewed face to face using a modified standardized Nordic questionnaire. Data were subjected to weighted analysis and risk factors identified using logistic regression models based on a pre-compiled directed acyclic graph. Results. Most sedge weavers were elderly (65.9% ≥ 50 years) with >20 years' experience. Mats were the most common product. Buttocks (72.7%) and lower back (67.3%) were the commonest regions for discomfort. Neck, shoulders and upper back were less commonly involved (56.9, 56.7 and 52.6% respectively). Higher body mass index and lack of exercise were positively associated with buttock discomfort, and shorter sleep duration, not using a cushion, older age and having dyslipidaemia associated with lower back discomfort. Conclusions. The majority of sedge weavers experienced work-related discomfort. Taking regular exercise, having sufficient sleep and sitting on a cushion may reduce the discomfort experienced by these sedge-weavers.

Factors Associated with Male Health Professions Students' Smoking in Inner Mongolia.

Objectives: In this study, we describe the smoking patterns of male health professions students in Inner Mongolia, China, and identify factors associated with smoking status. Methods: First- to fourth-year male health professions students (N = 1074) in Inner Mongolia Medical University were interviewed in 2017 regarding their smoking pattern and exposures potentially influencing their smoking status (current-, ex- or never-smoker). We used logistic regression to identify exposures potentially influencing their smoking status. Results: Overall, one-third were current-smokers, among whom three-fifths had moderate or high nicotine dependence. The relative probability of being a current smoker was higher with exposure to a smoking mother, being unsure of the parents' acceptance of their smoking, and witnessing teachers smoking; it was lower with better knowledge of smoking-related harm and better smoking-related risk perception. Knowledge of smoking-related harm and risk perception may have a greater impact on smoking behavior than exposure to others' smoking. Conclusion: Promoting knowledge and risk perception related to smoking, and stricter enforcement of the smoke-free policy on campus may be feasible ways to reduce smoking among male health professions students who are future practitioners.

Prevalence and risk factors of strongyloidiasis in patients with systemic lupus erythematosus in Southern Thailand.

Background: Strongyloidiasis can be fatal in systemic lupus erythematosus (SLE) patients, but few epidemiological studies have investigated the burden of this tropical disease among the SLE population. This study aimed to assess the prevalence and associated factors of strongyloidiasis among SLE patients in Southern Thailand. Methods: A cross-sectional study was conducted on 180 SLE patients attending the Rheumatology Clinic at Songklanagarind Hospital. Stool specimens were collected and examined using the direct smear technique and agar plate culture technique. Serum anti-Strongyloides stercoralis IgG was measured by IgG-ELISA. Results: The overall prevalence of strongyloidiasis by combined parasitologyl and/or serology was 15.6%. The prevalence of strongyloidiasis by parasitological methods was 2.2%. Positive parasitology and/or serology was associated with male sex and a SLE disease duration of less than two years. Conclusion: Strongyloidiasis is highly prevalent among the SLE population. A combination of serological and parasitological methods increases the rate of diagnosis of strongyloidiasis in SLE patients.

Alcohol Advertisements, Hazard Warnings, Knowledge of Alcohol-Related Harm and Health-Profession Students' Drinking in Inner Mongolia.

Background: Consumption of alcohol among adults in Inner Mongolia is high even among health professionals. Little is known of the alcohol consumption patterns of health-profession students. Objectives: To assess the association of knowledge of alcohol-related harm (KAH), and exposure to media-based promotional alcohol sales advertisements (PASA) and alcohol hazard warnings (AHW) with drinking frequency of health-profession university students. Methods: Health-profession students (N = 1277) in the Medical University of Inner Mongolia were interviewed in 2017 regarding their alcohol drinking frequency, KAH, and exposure to PASA and AHW. Multinomial logistic regression was used to evaluate associations between exposure and drinking frequency. Results: Overall, 9% were nondrinkers, 35% occasional drinkers, and 56% frequent drinkers. Females were slightly less commonly drinkers but more commonly frequent drinkers. The prevalence of drinking decreased with age. Mongolians were more commonly frequent drinkers than Han. A majority of students had low KAH. Exposure to PASA was more common among drinkers, and exposure to AHW more common among nondrinkers. The main reason for drinking was social gathering. The relative probability of being an occasional or frequent drinker was lower among older students, those with higher KAH, and those exposed to AHW on television and internet but higher among those exposed to PASA in mini-supermarkets on campus. Conclusions: Students' drinking behavior was associated with low KAH and exposure to alcohol advertisements and warning media messages. Prevalence of frequent drinking might be reduced by wider use of AHW on internet and television and improving the level of knowledge of alcohol-related harm.

Comparison of drinking prevalence among Thai youth before and after implementation of the Alcoholic Beverage Control Act.

BACKGROUND: Underage drinking contributes to numerous health and social problems among adolescents. The Alcoholic Beverage Control Act, issued in Thailand in 2008, contains several clauses aiming at preventing underage and novice drinking, such as raising the minimum legal purchasing age from 18 to 20, banning alcohol sale and consumption in places frequented by youth, and banning alcohol advertisements. OBJECTIVES: To estimate the changes in the prevalence of alcohol consumption and perceptions of drinking norms among high-school students 8 years after the Act was implemented. METHODS: Data from the Thai national high-school surveys in 2007 (N = 50,033; 49.9% female) and 2016 (N = 38,535; 49.8% female), using similar questionnaires, were analyzed. Prevalence rates and group norms toward drinking were compared between the two surveys, using weighted Poisson regression and prevalence ratios. RESULTS: Drinking prevalence significantly increased in females, with prevalence ratios ranging from 1.2 for 30-day intoxication to 2.1 for 30-day binging. In males, the 12-month drinking prevalence increased in 2016, but a non-significant change for binge drinking and a 40% decrease for intoxication was seen. Higher proportions of students in 2016 perceived that most of their friends also drank alcohol compared to students in 2007 (16.8% vs. 11.2%; 49.8% increase). A significant effect of the year of survey on drinking patterns was seen across all school levels. CONCLUSION: Drinking rates decreased among males, but increased in females. These changes may be somewhat due to the Act, or to changes in the social environment in Thailand over this 8-year period.

Physical ergonomic risk factors of carpal tunnel syndrome among rubber tappers.

This study evaluated physical ergonomic risk factors associated with carpal tunnel syndrome (CTS) among rubber tappers in Thailand. The Boston Carpal Tunnel Syndrome Questionnaire and Phalen's test and Tinel's sign were used to identify 133 cases with CTS and 401 non-CTS controls. Video recordings and Rapid Upper Limb Assessment used to evaluate the level of ergonomic risk in right and left hand postures. Significant physical ergonomic risk factors of CTS were higher number of trees tapped at or below knee level and collecting latex. Among right-handed tappers, tapping at higher than chest level involved significantly higher proportion of right wrist flexion and/or extension, and left wrist radial and/or ulnar deviation and twist than tapping at a lower level.

Factors associated with the doctor-patient relationship: doctor and patient perspectives in hospital outpatient clinics of Inner Mongolia Autonomous Region, China.

PURPOSE: The doctor-patient relationship (DPR) in People's Republic of China is very tense. This study aimed to provide some explanation by exploring factors influencing the DPR from doctors' and patients' perspectives. METHODS: A cross-sectional study was conducted in one provincial and one city-level general public hospital in Inner Mongolia Autonomous Region of People's Republic of China. The Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) and the Patient-Doctor Relationship Questionnaire (PDRQ-9) were used to assess the quality of the DPR from 226 doctors, and 713 patients' perspectives, respectively. Multivariate linear regression was used to identify factors significantly associated with the doctors' and patients' perceptions of the DPR by assessing coefficients of total effect and their 95% confidence interval. RESULTS: The result revealed that provincial-level doctors had a higher DDPRQ-10 score than city-level doctors. Worse DDPRQ-10 scores were seen for doctors who worked in the Internal Medicine departments were aged between 31 and 40 years, held a master's degree, were dissatisfied with their income, worked more than 40 hrs per week, felt pressure at work, considered the hospital environment to be bad, often felt affected by negative media reports and had defensive behaviors. Patients visiting the provincial hospital had a lower PDRQ-9 score than those from the city-level hospital. Lower PDRQ-9 scores were also seen for patients who were of Mongolian ethnicity, were dissatisfied with their income, waited longer to see the doctor, had a shorter doctor consultation time, had lower expectations of their treatment result, had a low level of trust in the doctor, regarded the hospital environment as bad and those who were frequently influenced by negative media reports. CONCLUSION: This study may provide a useful model to raise the quality of the DPR and to supply evidence for health policy makers and administrators to formulate strategies for reducing the problem of tense DPR in Chinese hospitals.

Ethnic Groups and Father's Job Influencing Nutritional Status of Children (0-30 months) from Myanmar Migrant Community in Southern Thailand.

BACKGROUND: Thailand has millions of migrants working in different sectors of industries. Pattani is a deep southern provincial city having thousands of Myanmar migrants working in fishery-related jobs. Children from those migrant families are vulnerable and lack from proper care and raising by their parents. OBJECTIVES: The aim of the study is to describe the nutritional status of Myanmar migrant children and identify conditions which are responsible for undernutrition in that community. METHODS AND STUDY DESIGN: A cross-sectional study was conducted from December 2016 to April 2017 among mothers and children under 2.5 years of age in that community. A total number of 100 children were involved in statistical analysis after excluding 2 comorbid children. Nutritional status of migrant children was classified by WHO Anthro version 3.2.2. RESULTS: Prevalence of abnormal nutritional status was reported by (19.6%) stunted, (10.8%) underweight, and (7.8%) wasted. Other ethnic children rather than Mon and Dawei were more likely to be stunted (p < 0.007). Being occupied by a fisherman father was significantly associated with stunting (p < 0.005). DISCUSSION: To improve feeding practices in infant and young children, a migrant-friendly health education program should be launched and evaluated in this community.

Occupational Tasks Influencing Lung Function and Respiratory Symptoms Among Charcoal-Production Workers: A Time-Series Study.

BACKGROUND: Tasks involved in traditional charcoal production expose workers to various levels of charcoal dust and wood smoke. This study aimed to identify specific tasks influencing lung function and respiratory symptoms. METHODS: Interviews, direct observation, and task/symptom checklists were used to collect data from 50 charcoal-production workers on 3 nonwork days followed by 11 workdays. The peak expiratory flow rate (PEFR) was measured four times per day. RESULTS: The PEFR was reduced and the prevalence of respiratory symptoms increased over the first 6-7 workdays. The PEFR increased until evening on nonwork days but not on workdays. Loading the kiln and collecting charcoal from within the kiln markedly reduced the PEFR and increased the odds of respiratory symptoms. CONCLUSION: Tasks involving entry into the kiln were strongly associated with a short-term drop in the PEFR and the occurrence of respiratory symptoms, suggesting a need for the use of protective equipment and/or the operation of an effective kiln ventilation system.

Factor Analytical Investigation of Krathom (Mitragyna speciosa Korth.) Withdrawal Syndrome in Thailand.

Krathom (Mitragyna speciosa Korth.) is an addictive and illicit substance used in Thailand and other Southeast Asian countries. It has become the most commonly used substance among villagers. The study aimed to explore the factor structure of the krathom withdrawal syndrome based on the findings of an earlier qualitative study. The current study was divided into two stages. Cross-sectional data collections were employed in both phases. The samples comprised, respectively, 196 and 330 krathom users aged over 25 years. The characteristics of krathom withdrawal symptoms and signs were identified and the factor structure examined using exploratory factor analysis (EFA). Confirmatory Factor Analysis (CFA) was used to examine the construct validity and multivariate linear regression was used to identify factors predicting the intensity of krathom withdrawal symptoms. The final scale comprised 20 items with four factors: craving-fatigue syndrome; musculoskeletal system and insomnia; mood symptoms; and autonomic nervous system/physical sickness. Symptoms and signs of krathom withdrawal similar to those of the withdrawal syndrome of opioid substances appear to be present in regular krathom users. The krathom withdrawal intensity is predicted by duration of krathom use, frequency, and daily amount of krathom use.

Goat farm management and Brucella serological test among goat keepers and livestock officers, 2011-2012, Nakhon Si Thammarat Province, southern Thailand.

Brucellosis, a zoonotic disease particularly affecting goats, emerged in Thailand in 2003, resulting in both an occupational hazard for goat keepers and livestock officers, and production losses. Farm management practices have been identified as risk factors associated with Brucella sero-positivity in many studies. Our finding in this study should be considered in order to strengthen the system of biosecurity control in farm animals as one health approach. The objectives of the study were to describe the distribution of potential risk factors by types of goat farms and to document the prevalence of human Brucella sero-positivity among goat keepers and livestock officers in Nakhon Si Thammarat, Thailand. A cross-sectional study was conducted from September to December 2012. The study population included three types of goat farms: standard, community enterprise and private goat farms that were located in Nakhon Si Thammmarat Province in southern Thailand. Information on whether the farm had any Brucella sero-positivity goats since 2011 was retrieved from the local livestock office records. Information on farming management was also traced back to 2011. Field researchers collected information from goat keepers of the selected farms using a structured questionnaire. Goat keepers on all farms pre-identified (January to June 2012) as having had at least one positive goat were considered to have been exposed. Goat keepers on a random sample of farms having all goats with negative results were considered to be unexposed. Venous blood samples were collected from goat keepers exposed and unexposed and from livestock officers and the samples were tested by IgG ELISA. Statistical analysis was done under the complex survey design in R software. Fourteen standard farms, 66 community enterprise farms and 68 private farms participated in the study; 82.4% (122/148) used public pasture and 53.4% (79/148) shared breeder goats with other farms. Farm management practices corresponding to pre-identified risk factors were more common in private farms. Large herd size (≥ 51 goats) and having dogs and/or rats on the farm were significantly associated with Brucella infection in animals (P < 0.05). Similar proportions of goat keepers in positive goat farm and livestock officers were positive for Brucella antibody (8.3% and 8.8% respectively). Several goat farming management practices in the study area may increase the risk of Brucella infection in animals. Livestock officers in the area have a high risk of being infected with Brucella. Improving goat farm biosecurity practices in needed to reduce the risk of brucellosis in this area.

Pre- and in-therapy predictive score models of adult OSAS patients with poor adherence pattern on nCPAP therapy.

OBJECTIVES: To identify patterns of adherence to nasal continuous positive airway pressure (nCPAP) use in the first 3 months of therapy among newly diagnosed adult patients with obstructive sleep apnea/hypopnea syndrome (OSAS) and their predictors. To develop pretherapy and in-therapy scores to predict adherence pattern. METHODS: Newly diagnosed adult OSAS patients were consecutively recruited from March to August 2013. Baseline clinical information and measures such as Epworth Sleepiness Scale (ESS), Fatigue Severity Scale (FSS), Zung's Self-Rating Depression Scale (SDS), and The Pittsburgh Sleep Quality Index (PSQI) at baseline and at the end of 3rd-week therapy were collected. Twelve weeks' adherence data were collected from the nCPAP memory card, and K-means cluster analysis was used to explore adherence patterns. Predictive scores were developed from the coefficients of cumulative logit models of adherence patterns using variables available at baseline and after 3 weeks of therapy. Performance of the score was validated using 500 bootstrap resamples. RESULTS: Seventy six patients completed a 12-week follow-up. Three patterns were revealed. Patients were identified as developing an adherence pattern that was poor (n=14, mean ± SD, 2.3±0.9 hours per night), moderate (n=19, 5.3±0.6 hours per night), or good (n=43, 6.8±0.3 hours per night). Cumulative logit regression models (good → moderate → poor) revealed independent baseline predictors to be ESS (per unit increase) (OR [95% CI], 0.763 [0.651, 0.893]), SDS (1.461 [1.238, 1.724]), and PSQI (2.261 [1.427, 3.584]); and 3-week therapy predictors to be ESS (0.554 [0.331, 0.926]), PSQI (2.548 [1.454, 4.465]), and the changes (3rd week-baseline data) in ESS (0.459 [0.243, 0.868]), FSS (3.556 [1.788, 7.070]), and PSQI (2.937 [1.273, 6.773]). Two predictive score formulas for poor adherence were developed. The area under the curve (AUC) of the receiver operating characteristics (ROC) curves for baseline and 3-week formulas were 0.989 and 0.999, respectively. Bootstrap analysis indicated positive predictive values of baseline and 3-week predictive scores in our patient population of 0.82 (95% CI [0.82, 0.83]) and 0.94 (95% CI [0.93, 0.94]), respectively. CONCLUSION: A high level of prediction of poor adherence pattern is possible both before and at the first 3 weeks of therapy. The predictive scores should be further evaluated for external validity.