Complete reference genomes of two ceftriaxone-resistant Neisseria gonorrhoeae strains identified in routine surveillance in Bangkok, Thailand, using Nanopore Q20+ chemistry, VolTRAX V2b, and Illumina sequencing.

Ceftriaxone-resistant Neisseria gonorrhoeae strains, mostly associated with Asia, threaten gonorrhea treatment. We report the reference genomes of two ceftriaxone-resistant isolates found in routine surveillance in Bangkok, Thailand. The genomes belonged to the more antimicrobial-susceptible genomic lineage B, illustrating that both ceftriaxone-resistant strains and the mosaic penA-60.001 ceftriaxone-resistance determinant are spreading.

The prevalences and levels of occupational exposure to dusts and/or fibres (silica, asbestos and coal): A systematic review and meta-analysis from the WHO/ILO Joint Estimates of the Work-related Burden of Disease and Injury.

BACKGROUND: The World Health Organization (WHO) and the International Labour Organization (ILO) are developing joint estimates of the work-related burden of disease and injury (WHO/ILO Joint Estimates), with contributions from a large number of individual experts. Evidence from human, animal and mechanistic data suggests that occupational exposure to dusts and/or fibres (silica, asbestos and coal dust) causes pneumoconiosis. In this paper, we present a systematic review and meta-analysis of the prevalences and levels of occupational exposure to silica, asbestos and coal dust. These estimates of prevalences and levels will serve as input data for estimating (if feasible) the number of deaths and disability-adjusted life years that are attributable to occupational exposure to silica, asbestos and coal dust, for the development of the WHO/ILO Joint Estimates. OBJECTIVES: We aimed to systematically review and meta-analyse estimates of the prevalences and levels of occupational exposure to silica, asbestos and coal dust among working-age (≥ 15 years) workers. DATA SOURCES: We searched electronic academic databases for potentially relevant records from published and unpublished studies, including Ovid Medline, PubMed, EMBASE, and CISDOC. We also searched electronic grey literature databases, Internet search engines and organizational websites; hand-searched reference lists of previous systematic reviews and included study records; and consulted additional experts. STUDY ELIGIBILITY AND CRITERIA: We included working-age (≥ 15 years) workers in the formal and informal economy in any WHO and/or ILO Member State but excluded children (< 15 years) and unpaid domestic workers. We included all study types with objective dust or fibre measurements, published between 1960 and 2018, that directly or indirectly reported an estimate of the prevalence and/or level of occupational exposure to silica, asbestos and/or coal dust. STUDY APPRAISAL AND SYNTHESIS METHODS: At least two review authors independently screened titles and abstracts against the eligibility criteria at a first stage and full texts of potentially eligible records at a second stage, then data were extracted from qualifying studies. We combined prevalence estimates by industrial sector (ISIC-4 2-digit level with additional merging within Mining, Manufacturing and Construction) using random-effects meta-analysis. Two or more review authors assessed the risk of bias and all available authors assessed the quality of evidence, using the ROB-SPEO tool and QoE-SPEO approach developed specifically for the WHO/ILO Joint Estimates. RESULTS: Eighty-eight studies (82 cross-sectional studies and 6 longitudinal studies) met the inclusion criteria, comprising > 2.4 million measurements covering 23 countries from all WHO regions (Africa, Americas, Eastern Mediterranean, South-East Asia, Europe, and Western Pacific). The target population in all 88 included studies was from major ISCO groups 3 (Technicians and Associate Professionals), 6 (Skilled Agricultural, Forestry and Fishery Workers), 7 (Craft and Related Trades Workers), 8 (Plant and Machine Operators and Assemblers), and 9 (Elementary Occupations), hereafter called manual workers. Most studies were performed in Construction, Manufacturing and Mining. For occupational exposure to silica, 65 studies (61 cross-sectional studies and 4 longitudinal studies) were included with > 2.3 million measurements collected in 22 countries in all six WHO regions. For occupational exposure to asbestos, 18 studies (17 cross-sectional studies and 1 longitudinal) were included with > 20,000 measurements collected in eight countries in five WHO regions (no data for Africa). For occupational exposure to coal dust, eight studies (all cross-sectional) were included comprising > 100,000 samples in six countries in five WHO regions (no data for Eastern Mediterranean). Occupational exposure to silica, asbestos and coal dust was assessed with personal or stationary active filter sampling; for silica and asbestos, gravimetric assessment was followed by technical analysis. Risk of bias profiles varied between the bodies of evidence looking at asbestos, silica and coal dust, as well as between industrial sectors. However, risk of bias was generally highest for the domain of selection of participants into the studies. The largest bodies of evidence for silica related to the industrial sectors of Construction (ISIC 41-43), Manufacturing (ISIC 20, 23-25, 27, 31-32) and Mining (ISIC 05, 07, 08). For Construction, the pooled prevalence estimate was 0.89 (95% CI 0.84 to 0.93, 17 studies, I2 91%, moderate quality of evidence) and the level estimate was rated as of very low quality of evidence. For Manufacturing, the pooled prevalence estimate was 0.85 (95% CI 0.78 to 0.91, 24 studies, I2 100%, moderate quality of evidence) and the pooled level estimate was rated as of very low quality of evidence. The pooled prevalence estimate for Mining was 0.75 (95% CI 0.68 to 0.82, 20 studies, I2 100%, moderate quality of evidence) and the pooled level estimate was 0.04 mg/m3 (95% CI 0.03 to 0.05, 17 studies, I2 100%, low quality of evidence). Smaller bodies of evidence were identified for Crop and animal production (ISIC 01; very low quality of evidence for both prevalence and level); Professional, scientific and technical activities (ISIC 71, 74; very low quality of evidence for both prevalence and level); and Electricity, gas, steam and air conditioning supply (ISIC 35; very low quality of evidence for both prevalence and level). For asbestos, the pooled prevalence estimate for Construction (ISIC 41, 43, 45,) was 0.77 (95% CI 0.65 to 0.87, six studies, I2 99%, low quality of evidence) and the level estimate was rated as of very low quality of evidence. For Manufacturing (ISIC 13, 23-24, 29-30), the pooled prevalence and level estimates were rated as being of very low quality of evidence. Smaller bodies of evidence were identified for Other mining and quarrying (ISIC 08; very low quality of evidence for both prevalence and level); Electricity, gas, steam and air conditioning supply (ISIC 35; very low quality of evidence for both prevalence and level); and Water supply, sewerage, waste management and remediation (ISIC 37; very low quality of evidence for levels). For coal dust, the pooled prevalence estimate for Mining of coal and lignite (ISIC 05), was 1.00 (95% CI 1.00 to 1.00, six studies, I2 16%, moderate quality of evidence) and the pooled level estimate was 0.77 mg/m3 (95% CI 0.68 to 0.86, three studies, I2 100%, low quality of evidence). A small body of evidence was identified for Electricity, gas, steam and air conditioning supply (ISIC 35); with very low quality of evidence for prevalence, and the pooled level estimate being 0.60 mg/m3 (95% CI -6.95 to 8.14, one study, low quality of evidence). CONCLUSIONS: Overall, we judged the bodies of evidence for occupational exposure to silica to vary by industrial sector between very low and moderate quality of evidence for prevalence, and very low and low for level. For occupational exposure to asbestos, the bodies of evidence varied by industrial sector between very low and low quality of evidence for prevalence and were of very low quality of evidence for level. For occupational exposure to coal dust, the bodies of evidence were of very low or moderate quality of evidence for prevalence, and low for level. None of the included studies were population-based studies (i.e., covered the entire workers' population in the industrial sector), which we judged to present serious concern for indirectness, except for occupational exposure to coal dust within the industrial sector of mining of coal and lignite. Selected estimates of the prevalences and levels of occupational exposure to silica by industrial sector are considered suitable as input data for the WHO/ILO Joint Estimates, and selected estimates of the prevalences and levels of occupational exposure to asbestos and coal dust may perhaps also be suitable for estimation purposes. Protocol identifier: https://doi.org/10.1016/j.envint.2018.06.005. PROSPERO registration number: CRD42018084131.

Impact of COVID-19 Vaccination Rates and Public Measures on Case Rates at the Provincial Level, Thailand, 2021: Spatial Panel Model Analyses.

The coronavirus disease of 2019 (COVID-19) was a pandemic that caused high morbidity and mortality worldwide. The COVID-19 vaccine was expected to be a game-changer for the pandemic. This study aimed to describe the characteristics of COVID-19 cases and vaccination in Thailand during 2021. An association between vaccination and case rates was estimated with potential confounders at ecological levels (color zones, curfews set by provincial authorities, tourism, and migrant movements) considering time lags at two, four, six, and eight weeks after vaccination. A spatial panel model for bivariate data was used to explore the relationship between case rates and each variable and included only a two-week lag after vaccination for each variable in the multivariate analyses. In 2021, Thailand had 1,965,023 cumulative cases and 45,788,315 total administered first vaccination doses (63.60%). High cases and vaccination rates were found among 31-45-year-olds. Vaccination rates had a slightly positive association with case rates due to the allocation of hot-spot pandemic areas in the early period. The proportion of migrants and color zones measured had positive associations with case rates at the provincial level. The proportion of tourists had a negative association. Vaccinations should be provided to migrants, and collaboration between tourism and public health should prepare for the new era of tourism.

Real-World Effectiveness of COVID-19 Vaccines against Severe Outcomes during the Period of Omicron Predominance in Thailand: A Test-Negative Nationwide Case-Control Study.

Due to the widespread Omicron variant of SARS-CoV-2 in Thailand, the effectiveness of COVID-19 vaccines has become a major issue. The primary objective of this study is to examine the real-world effectiveness of COVID-19 vaccines based on secondary data acquired under normal circumstances in a real-world setting, to protect against treatment with invasive ventilation of pneumonia during January to April 2022, a period when Omicron was predominant. We conducted a nationwide test-negative case-control study. The case and control were matched with a ratio of 1:4 in terms of age, date of specimen collection, and hospital collection specimen and the odds ratio was calculated using conditional logistic regression. Overall, there was neither a distinction between mix-and-match regimens and homologous mRNA regimens against severe symptoms, nor was there a decline of the protective effect over the study period. The third and fourth dose boosters with ChAdOx1 nCoV-19 or mRNA vaccines provided high levels of protection against severe outcomes, approximately 87% to 100%, whereas two doses provided a moderate degree (70%). Thus, this study concludes that current national vaccine strategies provide favourable protective benefits against the Omicron variant. All Thais should receive at least two doses, while high-risk or vulnerable groups should be administered at least three doses.

Genetic basis of sudden death after COVID-19 vaccination in Thailand.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 vaccination reduces morbidity and mortality associated with coronavirus disease 2019 (COVID-19); unfortunately, it is associated with serious adverse events, including sudden unexplained death (SUD). OBJECTIVE: We aimed to study the genetic basis of SUD after COVID-19 vaccination in Thailand. METHODS: From April to December 2021, cases with natural but unexplained death within 7 days of COVID-19 vaccination were enrolled for whole exome sequencing. RESULTS: Thirteen were recruited, aged between 23 and 72 years; 10 (77%) were men, 12 were Thai; and 1 was Australian. Eight (61%) died after receiving the first dose of vaccine, and 7 (54%) died after receiving ChAdOx1 nCoV-19; however, there were no significant correlations between SUD and either the number or the type of vaccine. Fever was self-reported in 3 cases. Ten (77%) and 11 (85%) died within 24 hours and 3 days of vaccination, respectively. Whole exome sequencing analysis revealed that 5 cases harbored SCN5A variants that had previously been identified in patients with Brugada syndrome, giving an SCN5A variant frequency of 38% (5 of 13). This is a significantly higher rate than that observed in Thai SUD cases occurring 8-30 days after COVID-19 vaccination during the same period (10% [1 of 10]), in a Thai SUD cohort studied before the COVID-19 pandemic (12% [3 of 25]), and in our in-house exome database (12% [386 of 3231]). CONCLUSION: These findings suggest that SCN5A variants may be associated with SUD within 7 days of COVID-19 vaccination, regardless of vaccine type, number of vaccine dose, and presence of underlying diseases or postvaccine fever.

Real-World Effectiveness of Mix-and-Match Vaccine Regimens against SARS-CoV-2 Delta Variant in Thailand: A Nationwide Test-Negative Matched Case-Control Study.

The objective of this study is to explore the real-world effectiveness of various vaccine regimens to tackle the epidemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant in Thailand during September-December 2021. We applied a test-negative case control study, using nationwide records of people tested for SARS-CoV-2. Each case was matched with two controls with respect to age, detection date, and specimen collection site. A conditional logistic regression was performed. Results were presented in the form vaccine effectiveness (VE) and 95% confidence interval. A total of 1,460,458 observations were analyzed. Overall, the two-dose heterologous prime-boost, ChAdOx1 + BNT162b2 and CoronaVac + BNT162b2, manifested the largest protection level (79.9% (74.0-84.5%) and 74.7% (62.8-82.8%)) and remained stable over the whole study course. The three-dose schedules (CoronaVac + CoronaVac + ChAdOx1, and CoronaVac + CoronaVac + BNT162b2) expressed very high degree of VE estimate (above 80.0% at any time interval). Concerning severe infection, almost all regimens displayed very high VE estimate. For the two-dose schedules, heterologous prime-boost regimens seemed to have slightly better protection for severe infection relative to homologous regimens. Campaigns to expedite the rollout of third-dose booster shot should be carried out. Heterologous prime-boost regimens should be considered as an option to enhance protection for the entire population.

Rapid method through routine data to evaluate real-world vaccine effectiveness against coronavirus disease 2019 (COVID-19) infection: lessons from Thailand.

The objective of this article is to draw lessons from the Thai experience in estimating vaccine effectiveness (VE) for coronavirus disease 2019 (COVID-19) based on routine service data. We found that a matched case-control design, using probability-based controls representing the varying vaccine coverage across the population over time, yielded a valid result for VE assessment. The proposed design has an advantage in its applicability drawing from the routine data monitoring system. Future studies that exercise other designs, such as test-negative and cohort studies, are recommended in order to compare and contrast the findings across different designs. To implement a continuous monitoring system on VE, the integration of data from different sources is needed. This requires long-term investment in the data monitoring system for the entire healthcare system.

Investigation of a Cluster of Immunization Stress-Related Reactions after Coronavirus Disease 2019 (COVID-19) Vaccination, Thailand, 2021.

On 28 April 2021, the investigation team of the Department of Disease Control, Ministry of Public Health, was notified of a cluster of people developing neurological symptoms following COVID-19 vaccination in a province in eastern Thailand. We conducted an investigation from 29 April to 20 May 2021 to confirm the outbreak, describe the epidemiological characteristics and identify possible risk factors. A matched case-control study was conducted. Matching factors were gender and vaccination site. A confirmed case was a person receiving COVID-19 vaccination in the province and developed at least one neurological symptom between 21 April and 20 May 2021. The rapid assessment of the vaccination cold chain system was carried out. We found a total of 36 cases out of 3920 vaccinees (attack rate = 0.92%), all cases were recovered and classified as an immunization stress-related reaction (ISRR) by the National AEFI Expert Committee. An analytic study found that menstruation was significantly associated with ISRR (AOR = 6.84 [95%CI = 1.09-42.91]). The environmental survey suggested that the cold chain system was properly managed. Further studies on other precipitating causes of ISRR should be performed. In terms of recommendation, health providers should pay greater attention to women menstruating during and after COVID-19 immunization.

Predicted Impact of Vaccination and Active Case Finding Measures to Control Epidemic of Coronavirus Disease 2019 in a Migrant-Populated Area in Thailand.

BACKGROUND: Thailand experienced the first wave of Coronavirus Disease 2019 (COVID-19) during March-May 2020 and has been facing the second wave since December 2020. The area facing the greatest impact was Samut Sakhon, a main migrant-receiving province in the country. The Department of Disease Control (DDC) of the Thai Ministry of Public Health (MOPH) considered initiating a vaccination strategy in combination with active case finding (ACF) in the epidemic area. The DDC commissioned a research team to predict the impact of various vaccination and ACF policy scenarios in terms of case reduction and deaths averted, which is the objective of this study. METHODS: The design of this study was a secondary analysis of quantitative data. Most of the data were obtained from the DDC, MOPH. Deterministic system dynamics and compartmental models were exercised. A basic reproductive number (R0) was estimated at 3 from the beginning. Vaccine efficacy against disease transmission was assumed to be 50%. A total of 10,000 people were estimated as an initial population size. RESULTS: The findings showed that the greater the vaccination coverage, the smaller the size of incident and cumulative cases. Compared with a no-vaccination and no-ACF scenario, the 90%-vaccination coverage combined with 90%-ACF coverage contributed to a reduction of cumulative cases by 33%. The case reduction benefit would be greater when R0 was smaller (~53% and ~51% when R0 equated 2 and 1.5, respectively). CONCLUSION: This study reaffirmed the idea that a combination of vaccination and ACF measures contributed to favourable results in reducing the number of COVID-19 cases and deaths, relative to the implementation of only a single measure. The greater the vaccination and ACF coverage, the greater the volume of cases saved. Though we demonstrated the benefit of vaccination strategies in this setting, actual implementation should consider many more policy angles, such as social acceptability, cost-effectiveness and operational feasibility. Further studies that address these topics based on empirical evidence are of great value.

A cross sectional study of unmet need for health services amongst urban refugees and asylum seekers in Thailand in comparison with Thai population, 2019.

BACKGROUND: Although the Thai government has introduced policies to promote the health of migrants, it is still the case that urban refugees and asylum seekers (URAS) seem to be neglected. This study aimed to explore the degree of healthcare access through the perspective of unmet need in URAS, relative to the Thai population. METHODS: A cross-sectional survey, using a self-reporting questionnaire adapted from the Thai Health and Welfare Survey (HWS), was performed in late 2019, with 181 URAS completing the survey. The respondents were were randomly selected from the roster of the Bangkok Refugee Center. The data of the URAS survey were combined with data of the Thai population (n = 2941) from the HWS. Unmet need for health services was defined as the status of needing healthcare in the past 12 months but failing to receive it. Bivariate analysis was conducted to explore the demographic and unmet need difference between URAS and Thais. Multivariable logistic regression and mixed-effects (ME) model were performed to determine factors associated with unmet need. RESULTS: Overall, URAS were young, less educated and living in more economically deprived households, compared with Thais. About 98% of URAS were uninsured by any of the existing health insurance schemes. The prevalence of unmet need among URAS was significantly higher than among Thais in both outpatient (OP) and inpatient (IP) services (54.1% versus 2.1 and 28.0% versus 2.1%, respectively). Being uninsured showed the strongest association with unmet need, especially for OP care. The association between insurance status and unmet need was more pronounced in the ME model, relative to multivariable logistic regression. URAS migrating from Arab nations suffered from unmet need to a greater extent, compared with those originating from non-Arab nations. CONCLUSION: The prevalence of unmet need in URAS was drastically high, relative to the prevalence in Thais. Factors correlated with unmet need included advanced age, lower educational achievement, and, most evidently, being uninsured. Policy makers should consider a policy option to enrol URAS in the nationwide public insurance scheme to create health security for Thai society.

Psychological factors associated with protected sex among indirect female sex workers in Denpasar, Bali, Indonesia.

A cross-sectional study was conducted among indirect FSWs (a type of FSWs who provide sex services under the cover of entertainment or recreational enterprises) in Denpasar, Bali from August to October 2017 to investigate factors associated with protected sex with clients using the Health Belief Model (HBM) framework. The protected sex as a dependent variable was identified through self-reported consistency in using condoms with clients in the last month. Independent variables consisted of six HBM constructs and three main groups of modifying factors (personal, sex work, and interventional factors). Binary logistic regression was employed to identify the determinants. The prevalence of protected sex with clients in last month was 50.17% (95%CI = 41.50-80.83). Indirect FSWs were more likely to use condoms consistently if they completed senior high school or higher. Meanwhile, those working in a karaoke lounge, bar, or café were less likely to have protected sex than those in a massage parlour, spa, or beauty salon. Based on HBM, an increase of one-score of these following constructs increased likelihood of protected sex: perceived susceptibility, self-efficacy, and cues to action. Low protected sex among indirect FSWs indicates the need for public health interventions at individual, interpersonal, and institutional level.

Economic development and road traffic injuries and fatalities in Thailand: an application of spatial panel data analysis, 2012-2016.

BACKGROUND: Road traffic injuries (RTIs) have been one of the most critical public health problems in Thailand for decades. The objective of this study was to examine to what extent provincial economy was associated with RTIs, road traffic deaths and case fatality rate in Thailand. METHODS: A secondary data analysis on time-series data was applied. The unit of analysis was a panel of 77 provinces during 2012-2016. Data were obtained from relevant public authorities, including the Ministry of Public Health. Descriptive statistics and econometric models, using negative binomial (NB) regression, negative binomial regression with random-effects (RE) model, and spatial Durbin model (SDM) were employed. The main predictor variable was gross domestic product (GDP) per capita and the outcome variables were incidence proportion of RTIs, traffic deaths and case fatality rate. The analysis was adjusted for key covariates. RESULTS: The incidence proportion of RTIs rose from 449.0 to 524.9 cases per 100,000 population from 2012 till 2016, whereas the incidence of traffic fatalities fluctuated between 29.7 and 33.2 deaths per 100,000 population. Case fatality rate steadily stood at 0.06-0.07 deaths per victim. RTIs and traffic deaths appeared to be positively correlated with provincial economy in the NB regression and the RE model. In the SDM, a log-Baht increase in GDP per capita (equivalent to a growth of GDP per capita by about 2.7 times) enlarged the incidence proportion of injuries and deaths by about a quarter (23.8-30.7%) with statistical significance. No statistical significance was found in case fatality rate by the SDM. The SDM also presented the best model fitness relative to other models. CONCLUSION: The incidence proportion of traffic injuries and deaths appeared to rise alongside provincial prosperity. This means that RTIs-preventive measures should be more intensified in economically well-off areas. Furthermore, entrepreneurs and business sectors that gain economic benefit in a particular province should share responsibility in RTIs prevention in the area where their businesses are running. Further studies that explore others determinants of road safety, such as patterns of vehicles used, attitudes and knowledge of motorists, investment in safety measures, and compliance with traffic laws, are recommended.

Evaluation of a hospital-based injury surveillance system for monitoring road traffic deaths in Phuket, Thailand.

Objectives: The objective of this study was to evaluate and injury surveillance (IS) system's ability to monitor road traffic deaths and the coverage of road traffic injury and death surveillance in Phuket, Thailand. Methods: U.S. Centers for Disease Control and Prevention guidelines on surveillance system evaluation were used to qualitatively and quantitatively evaluate IS. Interviews with key stakeholders focused on IS's usefulness, simplicity, flexibility, acceptability, and stability. Active case finding of 2014 road traffic deaths in all paper and electronic hospital record systems was used to assess system sensitivity, positive predictive value, and data quality. Electronic data matching software was used to determine the implications of combining IS data with other provincial-level data sources (e.g., death certificates, electronic vehicle insurance claim system). Results: Evaluation results indicated that IS was useful, flexible, acceptable, and stable, with a high positive predictive value (99%). Simplicity was limited due to the burden of collecting data on all injuries and use of paper-based data collection forms. Sensitivity was low, with IS only identifying 55% of hospital road traffic death cases identified during active case finding; however, IS cases were representative of cases identified. Data accuracy and completeness varied across data fields. Combining IS with active case finding, death certificates, and the electronic vehicle insurance claim system more than doubled the number of road traffic death cases identified in Phuket. Conclusion: An efficient and comprehensive road traffic injury and death surveillance system is critical for monitoring Phuket's road traffic burden. The hospital-based IS system is a useful system for monitoring road traffic deaths and assessing risk behaviors. However, the complexity of data collection and limited coverage hinders the ability of IS to fully represent road traffic deaths in Phuket Province. Combining data sources could improve coverage and should be considered.

Hand, foot and mouth disease in Yunnan Province, China, 2008-2010.

This study was done to assess the epidemic features of hand, foot and mouth disease in Yunnan Province. Surveillance data from the beginning of 2008 through the end of 2010 were analyzed to conduct the demographic data of patients and morbidity as well as the estimation between possible risk factors for severe or fatal cases. Of the 75109 cases reported, laboratory tests confirmed 3691 cases. Thus, the average annual incidence proportion was 55 per 100000 population with a total case fatality rate of 0.04%. A seasonal peak was observed in May, along with a smaller winter peak in 2010. Most severe and fatal cases were caused by enterovirus 71. It is demonstrated that most of the severe and fatal cases occurred in very young children and that delayed access to health care led to the higher likelihood of serious illness.

Parenting styles and emotional intelligence of HIV-affected children in Thailand.

The purpose of this study was to examine the impact of parenting styles on emotional intelligence of HIV-affected children in Thailand. This study uses data from 205 HIV-affected children in northern and northeastern Thailand. Correlation and regression analyses were used to examine the predictors of emotional intelligence. Children reporting higher levels of stress reported less caring parenting style (standardized beta [B]=-0.18, p=0.050). Children with higher self-esteem were also more likely to perceive their parents as caring (B=0.48, p=0.002). Children who scored lower on their self-esteem reported their parents to be more overprotective (B=-0.30, p=0.030), and children reporting higher levels of stress reported their parents to be more overprotective (B=0.12, p=0.010). Children reporting caring parenting style were significantly more likely to report higher emotional intelligence (B=0.66, p=0.001). Parenting styles play an important role in the emotional intelligence. Identifying and testing interventions to help parents improve their parenting styles, while helping their HIV-affected children cope with stress and self-esteem, are essential in promoting mental health of HIV-affected children in Thailand.

Improving the health and mental health of people living with HIV/AIDS: 12-month assessment of a behavioral intervention in Thailand.

OBJECTIVES: We examined findings from a randomized controlled intervention trial designed to improve the quality of life of people living with HIV in Thailand. METHODS: A total of 507 people living with HIV were recruited from 4 district hospitals in northern and northeastern Thailand and were randomized to an intervention group (n = 260) or a standard care group (n = 247). Computer-assisted personal interviews were administered at baseline and at 6 and 12 months. RESULTS: At baseline, the characteristics of participants in the intervention and standard care conditions were comparable. The mixed-effects models used to assess the impact of the intervention revealed significant improvements in general health (B = 2.51; P = .001) and mental health (B = 1.57; P = .02) among participants in the intervention condition over 12 months and declines among those in the standard care condition. CONCLUSIONS: Our results demonstrate that a behavioral intervention was successful in improving the quality of life of people living with HIV. Such interventions must be performed in a systematic, collaborative manner to ensure their cultural relevance, sustainability, and overall success.

Stigma, social support, and depression among people living with HIV in Thailand.

BACKGROUND: People living with HIV/AIDS (PLWHA) in Thailand face tremendous challenges, including HIV-related stigma, lack of social support, and mental health issues such as depression. This study aims to examine complex relationships among demographics, HIV-related stigma, and social support and their impact on depression among PLWHA in Thailand. METHODS: This study uses data collected in northern and northeastern Thailand. A total of 408 PLWHA were recruited and interviewed in 2007. HIV-related stigma was measured by two subscales: "Internalized Shame" and "Perceived Stigma." Based on correlation analyses, hierarchical multiple regression models were used to examine the predictors of depression, social support, and HIV-related stigma, controlling for demographic characteristics. RESULTS: Correlational analysis revealed that depression was significantly associated with both dimensions of stigma: internalized shame and perceived stigma. Self-reported emotional social support was negatively associated with depression. We found that internalized shame and emotional social support were significant predictors of depression after controlling for gender, age, income, and education. CONCLUSIONS: HIV-related stigma has a negative impact on psychological wellbeing of PLWHA in Thailand, and emotional social support remains a protective factor against depression. Intervention developers and clinicians working with PLWHA may find it useful to incorporate the association between stigma and depression into their programs and treatments, and to address social support as a protective effect for the mental health of PLWHA.