A scoping review of antibiotic use practices and drivers of inappropriate antibiotic use in animal farms in WHO Southeast Asia region.

Antibiotic use (ABU) plays an important role in the proliferation of antimicrobial resistance (AMR). Global antimicrobial consumption in food production is projected to rise by 67% from 2010 to 2030, but available estimates are limited by the scarcity of ABU data and absence of global surveillance systems. The WHO South-East Asia (WHO SEA) region is at high risk of emergence of AMR, likely driven by intensifying farm operations and worsening ABU hotspots. However, little is known about farm-level ABU practices in the region. To summarize emerging evidence and research gaps, we conducted a scoping review of ABU practices following the Arksey and O'Malley methodological framework. We included studies published between 2010 and 2021 on farm-level ABU/AMR in the 11 WHO SEA member states, and databases were last searched on 31 October 2021. Our search strategy identified 184 unique articles, and 25 publications underwent full-text eligibility assessment. Seventeen studies, reported in 18 publications, were included in the scoping review. We found heterogeneity in the categorizations, definitions, and ABU characterization methods used across studies and farm types. Most studies involved poultry, pig, and cattle farms, and only one study examined aquaculture. Most studies evaluated ABU prevalence by asking respondents about the presence or absence of ABU in the farm. Only two studies quantified antibiotic consumption, and sampling bias and lack of standardized data collection methods were identified as key limitations. Emerging evidence that farm workers had difficulty differentiating antibiotics from other substances contributed to the uncertainty about the reliability of self-reported data without other validation techniques. ABU for growth promotion and treatment were prevalent. We found a large overlap in the critically important antibiotics used in farm animals and humans. The ease of access to antibiotics compounded by the difficulties in accessing quality veterinary care and preventive services likely drive inappropriate ABU in complex ways.

Hydrogeogenic fluoride in groundwater and dental fluorosis in Thai agrarian communities: a prevalence survey and case-control study.

BACKGROUND: Dental fluorosis can be a disease of social inequity in access to safe drinking water. This dental public health issue becomes prominent in socially disadvantaged agrarian communities in fluoride endemic areas where the standard irrigation system is unavailable and groundwater containing natural fluoride is the major drinking water source. This study aimed to determine the prevalence and severity of dental fluorosis in children and to evaluate its association with fluoride in groundwater in the aforementioned setting in Thailand. METHODS: A cross-sectional survey of 289 children in Nakhon Pathom Province was conducted in 2015. Children with very mild to severe fluorosis were regarded as 'cases' while their counterparts were 'controls' for a subsequent case-control study. Records of fluoride concentrations in groundwater used for household supply corresponding to resident and number of years by age of each child during 2008-2015 were retrieved. Other exposure variables were measured using a questionnaire. Prevalence ratio (PR), a measure indicating the relative effect of different levels of fluoride on dental fluorosis, was obtained from Poisson regression with robust standard error. RESULT: There were 157 children with very mild to moderate dental fluorosis (54.3% prevalence). The univariable analysis revealed that the prevalence of dental fluorosis among children with fluoride concentrations in water sources of 0.7-1.49 (index category 1) and ≥ 1.5 ppm (index category 2) was 1.62 (95% CI; 0.78, 3.34) and 2.75 (95% CI; 1.42, 5.31) times the prevalence among those with fluoride < 0.7 ppm (referent category). After adjusting for all covariates, the adjusted prevalence ratios in both index categories were 1.64 (95% CI; 0.24, 11.24) and 2.85 (95% CI; 0.44, 18.52) which were close to their corresponding crude estimates. Since the magnitude of confounding, measured by (PRcrude-PRadjusted)/PRadjusted, were less than 10% for both index categories; this indicated the limited confounding effect of all covariates. CONCLUSIONS: In fluoride endemic areas, groundwater containing natural fluoride utilized for household consumption resulted in high dental fluorosis prevalence, particularly in the groundwater with fluoride concentrations of ≥ 1.5 ppm.

Intention to Extend Working Life among Thai Registered Nurses in Ministry of Public Health: A National Survey.

The serious shortage of registered nurses (RNs) in Thailand has made the Thai government tentatively propose a policy to extend the working life of Ministry of Public Health nurses. This study aimed to estimate the proportion of those RNs who intend to extend their working life and analyzed the associations between general characteristics, quality of work life, and job characteristics of the RNs and their intention to work past retirement age. This cross-sectional study was conducted from October 2016 to April 2017. Self-administered questionnaires were distributed nationally to 3,629 RNs in the age group 55-59 years and working for the Ministry of Public Health (MoPH), Thailand. The response rate was 85.0% (3,092 RNs). Due to the small number of male participants (n=74), males were excluded from the study. The analysis was limited to the 3,018 participants who returned the questionnaire and met the inclusion criteria. Descriptive statistics and multiple logistic regression were used for data analysis. Of the 3,018 participants, the proportion of RNs intending to extend their working life from 60 to 65 years was 30.5%. In the Service Department, the factors significantly associated with intention to extend working life were perceived good or very good health status, no shift work, monthly income more than 50,000 THB (1,595 USD), and having moderate or good working resources (p<0.01). In the four Academic Departments, perceived good or very good health status, monthly income more than 50,000 THB, family members not against the working life extension, and moderate or good working resources were the factors affecting intention to extend working life (p<0.01). This study indicated that understanding the various factors related to the intention to extend working life among RNs could lead to the design of appropriate programs to encourage them to continue working after the current retirement age.

Norovirus Monitoring in Oysters Using Two Different Extraction Methods.

Detection of noroviruses in bivalve shellfish is difficult because of the low concentration of norovirus and the presence of reverse transcription (RT)-PCR inhibitors. This study aimed to assess the presence of noroviruses in oysters extracted using a proteinase K extraction (ISO 15216 method) and an adsorption-elution method. Seventy oyster samples were extracted using the two extraction methods and evaluated using RT-nested PCR. The results showed norovirus detection rates at an equal frequency of 28.6%, of which a total of 48 (68.6%) samples had corresponding positive or negative results, while there were 22 (31.4%) samples with discrepant results. Norovirus genogroup (G)I, GII, and mixed GI and GII were detected in 20%, 4.3%, and 4.3% of samples, respectively, by the proteinase K extraction method, which comprised of GI.2, GI.5b, GI.6b, GII.4, and GII.17 genotypes. With the adsorption-elution method noroviruses were detected in 17.1%, 8.6%, and 2.9% of samples, respectively, which comprised of GI.2, GII.2, GII.4, and GII.17 genotypes. All norovirus-positive oyster samples were further estimated for genome copy number using RT-quantitative PCR. The oyster samples processed using the adsorption-elution method contained norovirus GI of 3.36 × 101-1.06 × 105 RNA copies/g of digestive tissues and GII of 1.29 × 103-1.62 × 104 RNA copies/g. Only GII (2.20 × 101 and 7.83 × 101 RNA copies/g) could be quantified in samples prepared using the proteinase K extraction method. The results demonstrate the different performance of the two sample-processing methods, and suggest the use of either extraction method in combination with RT-nested PCR for molecular surveillance of norovirus genotypes in oysters.

Evaluation of a questionnaire to assess nutritional knowledge, attitudes and practices in a Thai population.

BACKGROUND: The rapid increase in non-communicable chronic diseases in people of working age has had a major effect on health care utilization, productivity and economy. Lifestyle and diet are recognized as being major risk determinants involved. Disease prevention strategies need to be based on people's understanding of nutritional knowledge, attitudes and practice. This study evaluates the validity of a new nutritional knowledge and practice questionnaire specifically developed for assessing individuals of working age in a Thai population. METHODS: The questionnaire was constructed and based on previous relevant literature and its content validity was scrutinized by an expert panel. An exploratory factor analysis (EFA) was performed to reduce the number of questions included. Subsequently, data from a cross-sectional study of 1,032 participants were used to evaluate the reliability and validity of this questionnaire. The validity of the questionnaire constructed for assessing knowledge and attitude was evaluated using Confirmatory Factor Analysis (CFA). For the practice component, set criteria were applied to determine the final variables used. RESULTS: CFA of the nutritional knowledge component suggested that all the variables in the model fitted with the data (χ2 = 80.17, df = 66, p > 0.05, CFI = 0.99, RMSEA = 0.01, SRMR = 0.02). The CFA final model for the nutritional knowledge included three factors (food recommendation, nutrients related to diseases, and healthy diet) with a total of 14 questions. For nutrition attitude, CFA also revealed a good fit (χ2 = 178.14, df = 93, p < 0.001, CFI = 0.99, RMSEA = 0.03, SRMR = 0.03). The final CFA model for nutritional attitude included three factors (food choice, healthy diet and food recommendation) with a total of 16 questions. For practice items, the number of questions was reduced from 76 to 60. CONCLUSIONS: Questionnaire development should use a logical, systematic and structured approach. Results from our evaluation process demonstrates the construction validity of the nutritional knowledge and practice questionnaire developed. This questionnaire can be further modified for use in other countries within the region.

Sleep quality and associated factors among the elderly living in rural Chiang Rai, northern Thailand.

OBJECTIVES: This study aimed to characterize the prevalence of poor sleep quality and to identify associated factors among community-dwelling elderly individuals in northern Thailand. METHODS: A cross-sectional study was conducted among 266 randomly selected elderly people in a sub-district in rural Chiang Rai Province, northern Thailand. The participants were interviewed using the Thai version of the Pittsburgh Sleep Quality Index (PSQI). RESULTS: Roughly 44.0% of the participants had poor sleep quality (PSQI score, >5), 9.4% used sleep medication, 27.1% had poor family relationships, and 12.0% had mild depression. Multiple logistic regression analysis indicated that being female (odds ratio [OR], 1.74; 95% confidence interval [CI], 1.10 to 3.02), a higher education level (OR, 3.03; 95% CI, 1.34 to 6.86 for primary school; OR, 2.48; 95% CI, 1.31 to 5.44 for higher than primary school), mild depression (OR, 2.65; 95% CI, 1.11 to 6.36), and poor family relationships (OR, 3.65; 95% CI, 1.98 to 6.75) were significantly associated with poor sleep quality. CONCLUSIONS: The prevalence of poor sleep quality among the elderly was moderately high. Healthcare providers should regularly conduct screenings for sleep quality and depression; provide sleep health education; and conduct interventions to encourage participating in family activities, resolving conflicts, sharing ideas, and making compromises within the family.

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.

Young Men Who Have Sex with Men at High Risk for HIV, Bangkok MSM Cohort Study, Thailand 2006-2014.

High HIV incidence has been reported in young men who have sex with men (YMSM) in North America and Western Europe, but there are limited data from Southeast Asia suggesting MSM may be the driver of the HIV epidemic in this region. We described HIV incidence and risk factors among 494 YMSM enrolled in a cohort study in Bangkok, Thailand. The HIV incidence was 7.4 per 100 person-years. In multivariable analysis, reporting use of an erectile dysfunction drug in combination with club drugs, having receptive or both insertive and receptive anal intercourse with men, having hepatitis A infection, having rectal Chlamydia trachomatis, having hepatitis B infection prior to HIV seroconversion, and reporting not always using condoms with male steady partners were significantly associated with HIV incidence in YMSM. Reduction in new HIV infections in YMSM are critical to reach targets set by Thailand and the region.

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.

Rotavirus infection in children and adults with acute gastroenteritis in Thailand.

and young children, but rotavirus gastroenteritis in adults is uncommon. In this study, 260 stool samples collected in Thailand from January 2006 to February 2007 from patients, of all ages with acute gastroenteritis, were tested for group A rotavirus and compared with rotavirus infections in children and adults. Rota- virus was detected in 42% of the patients' samples, but children (< 18 years old) have a significantly higher prevalence (57%) of rotavirus infection than adults (≥ 18 years old) (27%) (OR 3.55; 95% CI: 2.11-5.96; p < 0.001). The highest attack rate was found in the age group of < 2 years old (14%), followed by 2-4 years of age (9%), 18-59 years of age (8%), 5-17 years of age (6%) and ≥ 60 years of age (5%). The dominant genotype was G1P[8] (27%), followed by G2P[4] (7%), G3P[8] (1%), and G9P[8] (1%). The rare genotypes identified were G1P[4], G1P[6], G2P[6], G2P[8], and G3P[6]. Mixed infections mostly occurred in children, comprising G1P[4]/P[8], G1P[4]/P[6], G1P[6]/P[8], G1/G2P[4], G1/G3P[4], and G1/G3P[4]/P[8]. Rotaviruses G3, G9, and P[4] were found only in children and genotype P[6] was found in adults (75%) at a higher frequency than in children (25%) (p < 0.001). The number of rotavirus in children was 1.99x10(8)/ml and in adult patients was 7.32x10(6)/ ml. The present study highlights the higher prevalence of rotavirus infection in children compared to adults and rotavirus genetic heterogeneity. Rotaviruses are the most important cause of severe diarrhea in infants

The effort-reward imbalance work-stress model and daytime salivary cortisol and dehydroepiandrosterone (DHEA) among Japanese women.

We examined the influence of work-related effort-reward imbalance and overcommitment to work (OC), as derived from Siegrist's Effort-Reward Imbalance (ERI) model, on the hypothalamic-pituitary-adrenocortical (HPA) axis. We hypothesized that, among healthy workers, both cortisol and dehydroepiandrosterone (DHEA) secretion would be increased by effort-reward imbalance and OC and, as a result, cortisol-to-DHEA ratio (C/D ratio) would not differ by effort-reward imbalance or OC. The subjects were 115 healthy female nursery school teachers. Salivary cortisol, DHEA, and C/D ratio were used as indexes of HPA activity. Mixed-model analyses of variance revealed that neither the interaction between the ERI model indicators (i.e., effort, reward, effort-to-reward ratio, and OC) and the series of measurement times (9:00, 12:00, and 15:00) nor the main effect of the ERI model indicators was significant for daytime salivary cortisol, DHEA, or C/D ratio. Multiple linear regression analyses indicated that none of the ERI model indicators was significantly associated with area under the curve of daytime salivary cortisol, DHEA, or C/D ratio. We found that effort, reward, effort-reward imbalance, and OC had little influence on daytime variation patterns, levels, or amounts of salivary HPA-axis-related hormones. Thus, our hypotheses were not supported.

Health-science students' self-efficacy, social support, and intention to work in rural areas of the Lao People's Democratic Republic.

INTRODUCTION: The Lao People's Democratic Republic (PDR), like almost all countries, is faced with a shortage of qualified health workers in rural and remote areas. The situation has worsened due to the unbalanced distribution of the health workforce, resulting from a tendency to gravitate to more central areas. METHODS: This cross-sectional study aimed to assess the proportion and associated factors affecting intention to work in a rural area among health science students in Vientiane, Lao PDR. All 403 final-year undergraduate and postgraduate students at the University of Health Sciences (UHS) in Vientiane - the only tertiary education facility that produces medical, family medicine, dentistry, pharmacy, medical technology, and nursing students - were asked to fill out self-administered questionnaires. In total, 356 respondents returned the completed questionnaires, yielding a response rate of 88.3%. RESULTS: Of the respondents, 40.7% (145/356) reported an intention to work in a rural area; 90.0% (131/145) preferred to work at district level; 21.3% reported high self-efficacy, whereas 79.8% reported low perceived social support for working in a rural area. Multiple logistic regression analysis revealed four variables were associated with intention to work in a rural area: hometown in a rural area; moderate/high self-efficacy; father having a secondary/high school education; and being a medical, family medicine/dentistry/pharmacy student. CONCLUSIONS: To increase the proportion of UHS graduates intending to work in a rural area, improved recruitment of students from rural areas, and enhanced self-efficacy and social support, are required.

Quality of life of stroke survivors: a 3-month follow-up study.

The assessment of stroke survivors' quality of life (QoL) is essential for planning poststroke therapy strategies. This study aimed to assess, compare, and identify predictors of unsatisfactory QoL in different dimensions of stroke survivors at 1 month and 3 months poststroke. A total of 125 stroke survivors were recruited from 4 public hospitals under the auspices of the Department of Medical Services, Bangkok Metropolitan Administration, Thailand, and followed for 3 months. QoL was assessed using the self-administered SF-36 Health Survey, version 2.0. Six specific dimensions of QoL--physical function, role-physical, bodily pain, general health, vitality, and role-emotional--were significantly improved at 3 months poststroke; however, 2 dimensions--social function and mental health--were not. Multiple logistic regression analysis revealed that at 1 month poststroke, significant predictors of unsatisfactory QoL were being dependent (Barthel Index score <80), severe cognitive impairment (Canadian Neurological Scale score <7), right hemisphere lesions, being single or widowed, age ≥ 60 years, and being unemployed poststroke. At 3 months poststroke, significant predictors of unsatisfactory QoL were being dependent (Barthel Index score <80), severe cognitive impairment (Canadian Neurological Scale score <7), being single or widowed, being unemployed poststroke, and self-supporting/other support for treatment fees. This follow-up study demonstrated a significant improvement in QoL from 1 month to 3 months poststroke. Predictors of QoL varied both over time poststroke and over the specific dimensions of QoL being considered.

Improvement of district hospital service system to increase treatment adherence among tuberculosis patients in Pakistan.

Adherence to medication regimen is essential for tuberculosis (TB) treatment success. We carried out quasi-experimental, single group intervention study at Rawalpindi District Hospital to improve TB patient treatment adherence using a Chronic Care Model (CCM). Ninety-nine newly diagnosed TB patients at the TB Clinic, Rawalpindi District Hospital, during February-March 2009, were included in the study. A set of four quality indicators were determined based on current scientific evidence: quality of service system, patient satisfaction, treatment adherence and cure rate. Care quality changes over time were analyzed by paired t-test. Significant improvements in service quality were seen post-intervention. Overall, the hospital service system quality improved to "good" (from 1.0% to 28.3%), and patient satisfaction increased to "good" (10.2% to 54.1%). Treatment adherence increased (from 23.2% to 56.1%). The quarterly cure rate increased notably (5.3% to 17.2%). The overall mean scores for hospital service system quality, patient satisfaction, and TB patient treatment adherence, improved significantly 6 month post-intervention (p<0.001).

Self-efficacy, self-care behaviors and glycemic control among type-2 diabetes patients attending two private clinics in Yangon, Myanmar.

This cross-sectional study aimed to estimate the prevalence of glycemic control and its associated factors among type-2 diabetes patients attending two private clinics in Yangon, Myanmar. Two hundred sixty-six diabetes patients attending two private diabetes clinics in Yangon during February and March, 2009 were included in the study. The participants completed a structured questionnaire. HbA(1c) was used as the index for glycemic control. The prevalence of successful glycemic control (HbA(1c) < or =7%) was 27.1%. The median HbA(1c) value was 7.8%. About 62.0% of patients had high self-efficacy levels, and 30.8% had good self-care behavior. Multiple logistic regression analysis revealed four variables associated with glycemic control: age > or =60 years (OR 2.46, 95% CI 1.17-5.21), taking one oral hypoglycemic agent (OHA) (OR 2.56, 95% CI 1.26-5.19), being overweight (OR 2.01, 95% CI 1.02-3.95) and having a high self-efficacy level (OR 5.29, 95% CI 2.20-12.75). Interventions to increase diabetic patient self-efficacy levels and self-care behavior, especially related to diet and exercise, are needed to reduce poor glycemic control.

Job strain among rubber-glove-factory workers in central Thailand.

Job strain has become a major concern because of its potential impacts on worker well-being and performance. This cross-sectional study aimed to assess the prevalence of, and examine factors associated with, job strain among workers in a rubber-glove factory, in a central province of Thailand. A total of 200 workers aged 18-55 yr, who had worked at the factory for at least 6 months, completed the Job Content Questionnaire (JCQ) (Thai Version). Two of 5 scales in the JCQ were used to measure job strain, i.e.; job control and psychological job demand. The prevalence of job strain was 27.5%. Multiple logistic regression analysis indicated two variables significantly associated with job strain: low supervisor social support (adjusted OR=3.08; 95%CI: 1.38-6.91) and high job insecurity (adjusted OR=2.25; 95%CI: 1.04-4.88). Effective training for supervisors, to create good relationships among workers and supervisors, and ensuring steady and secure jobs for good employees, are necessary.

Serum cholinesterase levels of Thai chilli-farm workers exposed to chemical pesticides: prevalence estimates and associated factors.

OBJECTIVE: To estimate the prevalence of, and factors associated with, abnormal serum cholinesterase (SChE) levels among chilli-farm workers in Chatturat District, Chaiyaphum Province. METHODS: A total of 350 chilli-farm workers aged 18-60 yr were randomly sampled and interviewed. A reactive-paper finger-blood test was used to assess SChE levels. RESULTS: The prevalence of abnormal SChE levels was 32.0%. The most common pesticide-related symptoms were dizziness (38.0%), headache (30.9%), nausea/vomiting (26.9%), and fever (26.9%). Multiple logistic regression analysis revealed 7 factors were independently associated with abnormal SChE level: male gender, single/separated/divorced, being a permanent worker, spraying pesticide more than 3 times per month, having moderate or poor pesticide-use behaviors, and low perceived susceptibility and severity of pesticide use. CONCLUSIONS: The prevalence of abnormal SChE levels among chilli-farm workers was quite high. It would be beneficial to decrease pesticide use and encourage alternative measures. Effective preventive interventions to increase correct perceptions of pesticide use, the use of personal protective measures and continuing monitoring for blood cholinesterase, especially for male permanent farm workers, are recommended.

Factors relating to acceptance of hepatitis B virus vaccination by nursing students in a tertiary hospital, Pakistan.

This cross-sectional study aimed at assessing the prevalence of, and factors relating to, the acceptance of hepatitis B virus (HBV) vaccination by nursing students in a tertiary hospital in Pakistan. In total, 210 nursing students of Year 2 to Year 4 were invited to participate in the study; of them, 196 (93.3%) returned completed questionnaires. Overall, the prevalence of acceptance of HBV vaccination among them was 75.0%. Of these, 37.2% (73/196) were completely vaccinated, and 25.0% (49/196) had not been vaccinated at all. More than half (27/49, 55.1%) of the unvaccinated nursing students stated that they would accept vaccination if offered. Multiple logistic regression analysis indicated three variables significantly related to acceptance of HBV vaccination: history of accidental exposure to blood or blood products, acceptable knowledge about HBV infection, and adequate budget for HBV vaccination. Health institutions should allocate adequate budgets to vaccinate their nursing students. Effective intervention programmes designed to increase knowledge about HBV infection and adhering to universally-accepted precautions are needed.

Participatory supervision model: building health promotion capacity among health officers and the community.

INTRODUCTION: The Thai traditional health supervision model has been developed since 1991. However, many supervisors lack supervisory knowledge and skills. This study aimed to compare and identify the strengths and challenges of two different supervision models, in order to determine their effects on enhancing the health promotion capacity of health officers in two primary care units (PCU) in Chiang Mai Province, northern Thailand. METHODS: The two models were implemented at two PCU in one semi-district, Chiang Mai Province, over a six-month period. The first model involved supervisors from the district level, with the full participation of health officers at the sub-district level. The second model was designed with the addition of community involvement in the supervision process. Before implementing the models, the district supervisors attended a retraining course to enhance their supervisory knowledge and ability. Questionnaires were used to assess health officers' job satisfaction, clients' perceived service quality and care satisfaction. Semi-structured interviews and qualitative observations were used to explore the involvement of health officers and the community, and to determine the strengths and challenges of each supervisory model. RESULTS: Both before and after the intervention, the PCU health officers appeared to have good and comparable job satisfaction levels. Bivariate analysis indicated that after the intervention, both supervisory models appeared effective in terms of clients' perceived service quality and satisfaction with care, among those who utilized the PCU. However, the second model, which allowed the community to participate in the supervision process, achieved better results. The qualitative findings suggested that the involvement of health officers caused a rapid change and improvement after the supervision. The involvement of the community helped the community itself to identify problems and formulate alternatives to meet the community's needs. CONCLUSIONS: This study shows positive outcomes for two forms of participatory supervision in a rural setting. There appear to be additional positive outcomes for the model that involved community participation. To ensure successful implementation, several issues, such as the supervisor's knowledge and ability, health officer workload and supervisory communication skills, need to be improved.

Behaviors and perceptions of Japanese tourists affecting diarrheal illness and health care need assessment: A questionnaire study.

OBJECTIVES: To measure the prevalence rate of, and determine the association between food and drink related behaviors and diarrheal illness among Japanese tourists, and assess their health care needs. METHODS: Eligible Japanese tourists (1,480) aged ≥15 years traveling in Chiangmai Province in the north, Ayutthaya Province in the center, Kanchanaburi Province in the west, Pattaya City in the east, and Krabi Province in the south of Thailand were enrolled in the study. Of these tourists, 1,318 consented to participate in this study and completed questionnaires in Japanese, giving a response rate of 89.1%. RESULTS: Among these Japanese tourists 21.3% had diarrheal illness, and of these tourists, 5.0% had classical travelers' diarrhea (TD), 11.8% had mild TD, 3.3% had good food and drink related behaviors, and 75.4% had moderate level of perception of diarrhea related to drinking and eating. Multiple logistic regression analysis indicated three significant diarrheal illness predictors: large number of previous visits to Thailand, longer stay in Thailand, and the experience of visiting other countries. Furthermore, 56.9% suggested providing an adequate number of toilets at tourist destinations; 53.9% suggested providing a 24-hour emergency call facility for a public ambulance; and 51.9% suggested providing garbage bins and garbage disposal facilities at tourist destinations. CONCLUSIONS: TD still affects experienced Japanese tourists who visit Thailand. Although the proportions of the good levels of food and drink related behaviors were low, there were indications that Japanese tourists perceived the risk of contracting TD.