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1.
Stud Health Technol Inform ; 282: 273-287, 2021 Jun 04.
Artículo en Inglés | MEDLINE | ID: mdl-34085975

RESUMEN

Public hospitals should be designed to clover as wider inclusivity levels as possible forproviding access for all. Unfortunately, and for a variety of reasons, a quality service is not always provided. When evaluation of the service quality in healthcare organizations is carried out, it is mostly conducted in terms of medical service quality, whilst the physical layout, functionality and facilitating devices are not given as much scrutiny. Post Occupation Evaluation (POE) is notably an efficient process for checking the satisfaction of users after the building has been in-used for a certain period of times. However, hospital is generally a type of building and service that need to support users with a variety of physical capabilities thus, a conventional POE may not cover all requirements of users, so this research has employed the UD concepts as a basis to combined with POE for evaluating service performance of a hospital of the case study, Naresuan University hospital, THAILAND. Even though the POE delivered a good design suggestion that is beneficial to users with a wide range of physical ability but that may not guarantee the new design will be agreed by all stakeholders and implemented through success. As a matter of fact, to success an implementing of a good design does not depend solely on a designer, specifically for this case study, a universal design to a hospital. This research found that to make UD perfectly effects in a hospital (in Thailand context) may require more supportive factors beyond just pointing out problems related to physical conditions of the design and suggest a design solution. As in the context of Thailand, this research identified 4 factors contributing to the success of UD which the designer should be accountable for (1) public understanding of the basic concepts of UD (2) all the related background such as culture, tradition and economic etc. that contributed the attitudes of all stakeholders (of the hospital) towards people with physical impairments (3) the rights, laws, regulations and policies for people with disabilities in the context of the country and (4) the participation of all types of users. And in doing so, this research added an extensive evaluation to the general POE to cover as more factors as possible to those involved with the design implementation. Therefore, an extensive evaluation process so called "Comprehensive Post-Occupancy Evaluation C-POE" has been created and employed in this study for offering more comprehensive solution that cover all possibilities cause of problems, the evaluation processes are as follows; (1) evaluating physical features and users' behavior (the experimental access audit), (2) examining administrative policy, HA and UD principles and (3) interviewing attitude of executives about UD.


Asunto(s)
Políticas , Diseño Universal , Actitud , Hospitales Universitarios , Humanos , Tailandia
2.
J Environ Manage ; 292: 112804, 2021 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-34023789

RESUMEN

17α-ethynylestradiol (EE2) is a synthetic estrogen with very strong estrogenic potency. Due to its wide usage in human and livestock as well as its high recalcitration to biodegradation, it was ubiquitous in different environment. This review summarized EE2 concentration levels in surface waters among 32 countries across seven continents. EE2 concentrations varied greatly in different surface waters, which ranged from not detected to 17,112 ng/L. The top 10 countries ranked in the order of high to low average EE2 concentration in surface water, were Vietnam, Cambodia, China, Laos, Brazil, Argentina, Kuwait, Thailand, Indonesia and Portugal, with the respective mean concentrations of 27.7, 22.1, 21.5, 21.1, 13.6, 9.6, 9.5, 8.8, 7.6 and 6.6 ng/L. Generally speaking, the EE2 concentration levels in surface waters in developing countries were much higher than those in developed countries. EE2 in effluent of municipal wastewater treatment plant (WWTP) was the dominant source to most countries, which suggested that improving the EE2 removal performance of municipal WWTP is the key to mitigate EE2 contamination to surface water body. Livestock, hospital, pharmacy factory and aquaculture wastewaters were also the important sources, but further work should be performed to elucidate their contribution. Evaluation based on estrogenic effects, the EE2-derived estrogen equivalence in surface waters ranged from 0 to 33 ng E2/L, among which about 65% of surface waters among 32 countries were at risk or high risk, indicating global serious EE2 contamination. MAIN FINDING: EE2 concentration in surface waters across 32 countries were summarized, along which its potential estrogenic effects were evaluated.


Asunto(s)
Estrógenos , Contaminantes Químicos del Agua , Argentina , Brasil , Cambodia , China , Estrógenos/análisis , Etinilestradiol/análisis , Humanos , Indonesia , Portugal , Tailandia , Vietnam , Eliminación de Residuos Líquidos , Agua , Contaminantes Químicos del Agua/análisis
3.
J Environ Manage ; 292: 112778, 2021 Aug 15.
Artículo en Inglés | MEDLINE | ID: mdl-34051472

RESUMEN

The recent years have been marked by the role of green tech innovation in decreasing carbon emissions worldwide to attain the carbon neutrality target. Despite many studies examining the nexus between the former and energy consumption, tech innovation's effects on CO2 releases have not been extensively researched, and the extant empirical findings are often contradictory. Also, a major concern regarding the available literature is the scarcity of papers that scan the impact of tourism on carbon emissions, even though the industry has a high potential to affect ambient air pollution. In this case, the evidence is mixed, and no consensus among academics on the relationships between the two. Therefore, this study seeks to investigate the relevance of green innovation and tourism in decreasing environmental damage in Thailand based on the bootstrapping ARDL causality model suggested by (McNown et al., 2018). This specification includes a new cointegration feature and conventional ARDL bounds tests, which increases the power of the t- and of the f-test and has several advantages, being more adequate for dynamic models with more than one explanatory variable. Our findings reveal that green innovation and tourism lead to lower environmental damage by reducing CO2 emissions, similar to foreign investments and that green tech innovation improves the environmental quality via lower carbon emissions.


Asunto(s)
Carbono , Desarrollo Económico , Dióxido de Carbono/análisis , Tailandia , 59564
4.
Bull World Health Organ ; 99(4): 312-318, 2021 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-33953449

RESUMEN

Since January 2020, the coronavirus disease 2019 (COVID-19) pandemic has had a far-reaching impact on global morbidity and mortality. The effects of varying degrees of implementation of public health and social measures between countries is evident in terms of widely differing disease burdens and levels of disruption to public health systems. Despite Thailand being the first country outside China to report a positive case of COVID-19, the subsequent number of cases and deaths has been much lower than in many other countries. As of 7 January 2021, the number of confirmed COVID-19-positive cases in Thailand was 9636 (138 per million population) and the number of deaths was 67 (1 per million population). We describe the nature of the health workforce and function that facilitated the capacity to respond to this pandemic. We also describe the public health policies (laboratory testing, test-and-trace system and mandatory 14-day quarantine of cases) and social interventions (daily briefings, restriction of mobility and social gatherings, and wearing of face masks) that allowed the virus to be successfully contained. To enhance the capacity of health-care workers to respond to the pandemic, the government (i) mobilized staff to meet the required surge capacity; (ii) developed and implemented policies to protect occupational safety; and (iii) initiated packages to support morale and well-being. The results of the policies that we describe are evident in the data: of the 66 countries with more than 100 COVID-19-positive cases in health-care workers as at 8 May 2020, Thailand ranked 65th.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/organización & administración , Personal de Salud/organización & administración , Política de Salud , Técnicas y Procedimientos Diagnósticos , Humanos , Salud Mental , Salud Laboral , Pandemias , Tailandia
5.
Bull World Health Organ ; 99(5): 393-397, 2021 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-33958828

RESUMEN

Problem: To control the increasing spread of coronavirus disease 2019 (COVID-19), the government of Thailand enforced the closure of public and business areas in Bangkok on 22 March 2020. As a result, large numbers of unemployed workers returned to their hometowns during April 2020, increasing the risk of spreading the virus across the entire country. Approach: In anticipation of the large-scale movement of unemployed workers, the Thai government trained existing village health volunteers to recognize the symptoms of COVID-19 and educate members of their communities. Provincial health offices assembled COVID-19 surveillance teams of these volunteers to identify returnees from high-risk areas, encourage self-quarantine for 14 days, and monitor and report the development of any relevant symptoms. Local setting: Despite a significant and recent expansion of the health-care workforce to meet sustainable development goal targets, there still exists a shortage of professional health personnel in rural areas of Thailand. To compensate for this, the primary health-care system includes trained village health volunteers who provide basic health care to their communities. Relevant changes: Village health volunteers visited more than 14 million households during March and April 2020. Volunteers identified and monitored 809 911 returnees, and referred a total of 3346 symptomatic patients to hospitals by 13 July 2020. Lessons learnt: The timely mobilization of Thailand's trusted village health volunteers, educated and experienced in infectious disease surveillance, enabled the robust response of the country to the COVID-19 pandemic. The virus was initially contained without the use of a costly country-wide lockdown or widespread testing.


Asunto(s)
/epidemiología , Agentes Comunitarios de Salud/organización & administración , Vigilancia en Salud Pública/métodos , /prevención & control , Control de Enfermedades Transmisibles/organización & administración , Humanos , Pandemias , Tailandia/epidemiología , Voluntarios
6.
BMC Musculoskelet Disord ; 22(1): 454, 2021 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-34006259

RESUMEN

BACKGROUND: Low back pain (LBP) is a top musculoskeletal problem and a substantial cause of socioeconomic burden internationally. The STarT Back Screening Tool (SBST) is a useful screening tool to manage patients with LBP but it is unavailable in Thai. Therefore, the aims of this study were to translate and cross-culturally adapt the SBST into a Thai version (SBST-TH) and validate its psychometric properties (e.g., factor analysis, internal consistency, test-retest reliability, agreement, convergent validity and discriminative validity). METHODS: Translation and cross-cultural adaptation of the SBST into Thai version were conducted according to standard guidelines. A total of 200 participants with non-specific LBP were invited to complete the SBST, visual analogue scale for pain intensity, Roland-Morris disability questionnaire (RMDQ), fear-avoidance beliefs questionnaire, pain catastrophising scale, hospital anxiety and depression scale and the EuroQol five-dimensional questionnaire. Thirty participants completed the SBST-TH twice with an interval of 48 h to evaluate test-retest reliability. RESULTS: Factor analysis demonstrated two (physical and psychological) components for the SBST-TH (39.38% of the total variance). The Cronbach's alpha (0.86 for total score and 0.76 for psychosocial subscore) represent satisfactory internal consistency. The acceptability of intraclass correlation coefficient was found in the total (0.73) and subscore (0.79). The areas under the curve (AUC) for the total score ranged 0.67-0.85 and 0.66-0.75 for subscore. The excellent discriminative validity was observed (AUC = 0.85, 95% confidence interval = 0.72, 0.97) between the total score of the SBST-TH and disability (RMDQ). Spearman's correlation coefficients represented moderate to strong correlation (0.32-0.56) between the SBST-TH and all questionnaires. The findings suggest a good relationship between the SBST-TH and disability and quality of life. Owing to the results from the convergent and discriminative validity, construct validity of the SBST-TH can be supported. The minimal detectable changes of the total score and subscore were 2.04 and 1.60, respectively. Significant floor and ceiling effects were not found in the SBST-TH. CONCLUSION: The SBST-TH was successfully translated and adapted. It is a valid and reliable tool to classify Thai patients with non-specific LBP into low, moderate and high risks for chronicity. TRIAL REGISTRATION: TCTR20191009005 #.


Asunto(s)
Dolor de la Región Lumbar , Comparación Transcultural , Evaluación de la Discapacidad , Humanos , Dolor de la Región Lumbar/diagnóstico , Dolor de la Región Lumbar/epidemiología , Psicometría , Calidad de Vida , Reproducibilidad de los Resultados , Encuestas y Cuestionarios , Tailandia
7.
Medicine (Baltimore) ; 100(20): e26065, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34011125

RESUMEN

ABSTRACT: A good clinical prediction score can help in the risk stratification of patients with colorectal cancer (CRC) undergoing colonoscopy screening. The aim of our study was to compare model performance of binary logistic regression (BLR), polytomous logistic regression (PLR), and classification and regression tree (CART) between the clinical prediction scores of advanced colorectal neoplasia (ACN) in asymptomatic Thai patients.We conducted a cross-sectional study of 1311 asymptomatic Thai patients to develop a clinical prediction model. The possible predictive variables included sex, age, body mass index, family history of CRC in first-degree relatives, smoking, diabetes mellitus, and the fecal immunochemical test in the univariate analysis. Variables with a P value of .1 were included in the multivariable analysis, using the BLR, CART, and PLR models. Model performance, including the area under the receiver operator characteristic curve (AUROC), was compared between the model types.ACN was diagnosed in 53 patients (4.04%). The AUROCs were not significantly different between the BLR and CART models for ACN prediction with an AUROC of 0.774 (95% confidence interval [95% CI]: 0.706-0.842) and 0.765 (95% CI: 0.698-0.832), respectively (P = .712). A significant difference was observed between the PLR and CART models in predicting average to moderate ACN risk with an AUROC of 0.767 (95% CI: 0.695-0.839 vs AUROC 0.675 [95% CI: 0.599-0.751], respectively; P = .009).The BLR and CART models yielded similar accuracies for the prediction of ACN in Thai patients. The PLR model provided higher accuracy for ACN prediction than the CART model.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/etiología , Modelos Estadísticos , Anciano , Colonoscopía , Estudios Transversales , Detección Precoz del Cáncer , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Curva ROC , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Tailandia
8.
Stud Health Technol Inform ; 281: 630-634, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34042652

RESUMEN

Spatial density measures are an important tool for future healthcare planning, particularly in Northeast Thailand where the ageing population has rapidly increased for a decade. The objective of this study was to determine the relationship of geographic and elderly population density in Chiang Yuen district, Mahasarakham province, to ascertain suitable areas for elderly healthcare centres. The data of the elderly located in the villages were collected by the Global Position System (GPS) using Kernel density method to employ the analysis of population density, and GIS for healthcare mapping, and Analytical Hierarchy Process (AHP) as multiple criteria decision-making tools. Factors were determined by using the overlay analysis method, where social, physical and economic factors were variables of interest that were used for the analysis of suitable areas for Elderly Healthcare Centres. The results revealed that the spatial density of the elderly population could be divided into four levels: Low density for the agriculture areas, medium density for agricultural areas including small villages. High density for the areas near communities and public area services and highest density for the centre of towns. The most suitable area was an area with many elderly inhabitants in the community, near transportation routes including main highways leading to other areas. In conclusion, the results confirmed that the density of elderly and proximity to both local stores and transport would make the lower part of Chiang Yuen Sub-district a suitable area to establish a healthcare centre for the elderly, therefore, the authorities and stakeholders should recognise this in planning.


Asunto(s)
Sistemas de Información Geográfica , Transportes , Anciano , Ciudades , Prestación de Atención de Salud , Humanos , Tailandia
9.
Stud Health Technol Inform ; 281: 784-788, 2021 May 27.
Artículo en Inglés | MEDLINE | ID: mdl-34042685

RESUMEN

BACKGROUND: Hepatotoxicity is very frequent and is a dangerously adverse effect of anti-TB medications. This effect can reduce the effectiveness of the treatment by compromising treatment regimens. Among these first-line quadruple therapy drugs (INH, RMP, PZA, and EMB), INH, RMP, and PZA are metabolized mostly by the liver, and due to this, are likely hepatotoxic. However, the survival times of hepatotoxicity among patients with TB in Thailand are currently not available. The aims of the present study were to assess the prevalence and survival time of drug-induced hepatotoxicity in patients with TB. METHODS: A cross-sectional retrospective study was performed to explore the survival time of the development of drug-induced hepatotoxicity among 327 patients with TB who received standard drug treatment at the TB clinic in Phichit Hospital. Data was collected from the HOSxP program and medical records from 2016 to 2018. Kaplan-Meier and Cox's regressions were used for data analysis. RESULTS: The results showed that prevalence of drug-induced hepatotoxicity was 6.42% and confirmed that patients with TB who were <50 years of age will be a median survival time on drug-induced hepatotoxicity is 17 days and 30 days for those who age group ≥50 years. CONCLUSION: The median survival time of drug-induced hepatotoxicity among patients with TB who were <50 years of age is 17 days. So, patients with TB whose ages are less than 50 years should receive liver function tests such as AST and ALT and investigate risk behavior before receiving the anti- TB treatment.


Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas , Preparaciones Farmacéuticas , Antituberculosos/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/tratamiento farmacológico , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Estudios Transversales , Humanos , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Tailandia/epidemiología
10.
BMC Public Health ; 21(1): 839, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33933064

RESUMEN

BACKGROUND: Young Thai women are growing up amidst conflicting influences of globalization and traditional Thai culture. They experience confusion about which aspects of their sexuality they can express and must hide. This study examined forms of sexual control and sexual negotiation among young Thai women in secondary and vocational schools. METHODS: Semi-structured interviews and focus group discussions were conducted among 13-to 18-year-old female students attending secondary and vocational schools in six regions of Thailand. Additional semi-structured interviews were conducted with instructors of sex education, school administrators, and parents of students. NVIVO 10 was used to manage, code and assist with data analysis. RESULTS: Socio-cultural control on young women's sexualities was found from members of their families, schools, communities, and other students. Young women expressing their sexualities openly through verbal expressions, clothing, and behaviors were deemed negatively and stigmatized as dekkaedaet or "kids pretending to be grownups" as it is believed that they are too young and too immature to be responsible for their own decisions on their bodies and sexuality. This dominant discourse subsequently stigmatize and embarrass sexually active women. However, some young women try to negotiate and create options, by utilizing strategies that ensure secrecy. CONCLUSION: Comprehensive sexuality education is needed and should be based on the respect for human dignity and sexual and reproductive rights.


Asunto(s)
Negociación , Conducta Sexual , Adolescente , Femenino , Humanos , Educación Sexual , Estudiantes , Tailandia
11.
BMC Infect Dis ; 21(1): 431, 2021 May 07.
Artículo en Inglés | MEDLINE | ID: mdl-33962558

RESUMEN

BACKGROUND: Self-management interventions aim to enable people living with chronic conditions to increase control over their condition in order to achieve optimal health and may be pertinent for young people with chronic illnesses such as HIV. Our aim was to evaluate the effectiveness of self-management interventions for improving health-related outcomes of adolescents living with HIV (ALHIV) and identify the components that are most effective, particularly in low-resource settings with a high HIV burden. METHODS: We considered randomised controlled trials (RCTs), cluster RCTs, non-randomised controlled trials (non-RCTs) and controlled before-after (CBA) studies. We did a comprehensive search up to 1 August 2019. Two authors independently screened titles, abstracts and full texts, extracted data and assessed the risk of bias. We synthesised results in a meta-analysis where studies were sufficiently homogenous. In case of substantial heterogeneity, we synthesised results narratively. We assessed the certainty of evidence using GRADE and presented our findings as summaries in tabulated form. RESULTS: We included 14 studies, comprising 12 RCTs and two non-RCTs. Most studies were conducted in the United States, one in Thailand and four in Africa. Interventions were diverse, addressing a variety of self-management domains and including a combination of individual, group, face-to-face, cell phone or information communication technology mediated approaches. Delivery agents varied from trained counsellors to healthcare workers and peers. Self-management interventions compared to usual care for ALHIV made little to no difference to most health-related outcomes, but the evidence is very uncertain. Self-management interventions may increase adherence and decrease HIV viral load, but the evidence is very uncertain. We could not identify any particular components of interventions that were more effective for improving certain outcomes. CONCLUSION: Existing evidence on the effectiveness of self-management interventions for improving health-related outcomes of ALHIV is very uncertain. Self-management interventions for ALHIV should take into account the individual, social and health system contexts. Intervention components need to be aligned to the desired outcomes. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019126313.


Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Adolescente , África , Fármacos Anti-VIH/uso terapéutico , Enfermedad Crónica , Ensayos Clínicos Controlados como Asunto , Conocimientos, Actitudes y Práctica en Salud , Humanos , Ensayos Clínicos Controlados Aleatorios como Asunto , Automanejo , Tailandia , Resultado del Tratamiento
12.
BMJ Open ; 11(4): e047650, 2021 04 30.
Artículo en Inglés | MEDLINE | ID: mdl-33931412

RESUMEN

OBJECTIVE: The COVID-19 situation in Thailand was controlled with various social measures. Much of the information covered in the media and in studies focused on the public health and economic aspects of the pandemic. This study aimed to explore the psychological well-being of older people, which is important especially in an ageing society categorised as low income or middle income due to the limits of economic and healthcare resources. SETTING: The impact of COVID-19 on older persons in Thailand, an online survey, taken across nine provinces within the five regions of the country. PARTICIPANTS: Information was collected from 1230 adults aged at least 60 years old.If an older person was illiterate, unable to access the internet or had a disability preventing them from responding to the survey, an intermediary residing in the community conducted the survey interview. PRIMARY AND SECONDARY OUTCOME MEASURES: The analysis focused on the worries of older adults and the factors associated with psychological distress experienced during the pandemic using logistic regression analysis. RESULTS: The majority of people aged at least 60 years old experienced psychological distress during COVID-19. Employment loss (OR 1.08, 95% CI 0.78 to 1.38), inadequate income (OR 1.77, 95% CI 1.28 to 2.44) and debt incursion (OR 2.74, 95% CI 1.57 to 4.80) were detrimental to psychological well-being. The negative changes in the perception of their health status (OR 1.92, 95% CI 1.23 to 2.99) and decreased life satisfaction (OR 1.49, 95% CI 0.45 to 1.87) also weighed on older Thais. The protective factors for psychological well-being were residing in rural areas (OR 0.46, 95% CI 0.35 to 0.61) and being married (OR 0.75, 95% CI 0.55 to 1.01). CONCLUSION: Observing the concerns of the older population is important for introducing policies that can alleviate their precarious financial and health statuses.


Asunto(s)
Distrés Psicológico , Anciano , Anciano de 80 o más Años , Estudios Transversales , Países en Desarrollo , Humanos , Persona de Mediana Edad , Pandemias , Tailandia/epidemiología
13.
Med Sci Monit ; 27: e932220, 2021 May 11.
Artículo en Inglés | MEDLINE | ID: mdl-33972496

RESUMEN

Coronavirus may have a negative impact not only on physical, but also on mental wellbeing. Despite the different approaches of countries to stop the spread of the virus and different infection rates, the dynamically developing pandemic has already affected the entire world. The consequences of the coronavirus for our mental health can be divided into those related to strategies for the prevention of infection, like isolation, quarantine, limitation of social contacts, and remote work, and those related to the direct impact of infection on our nervous system. This review aims to highlight the global effects of the Coronavirus Disease 2019 (COVID-19) pandemic on public mental health following social restrictions, to identify how infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may have direct neurophysiological effects and to compare the impact on public mental health between the USA, Australia, and Poland with Taiwan and Thailand.


Asunto(s)
/psicología , Salud Mental/estadística & datos numéricos , Salud Pública/estadística & datos numéricos , Australia/epidemiología , Humanos , Pandemias , Polonia/epidemiología , Taiwán/epidemiología , Tailandia/epidemiología , Estados Unidos/epidemiología
14.
BMC Public Health ; 21(1): 1009, 2021 05 29.
Artículo en Inglés | MEDLINE | ID: mdl-34051772

RESUMEN

BACKGROUND: This feasibility pilot of the Parenting for Lifelong Health for Young Children program in Thailand aimed to: 1) explore the feasibility of study evaluation approaches; 2) assess the feasibility of delivering an adapted program; 3) report indicative effects on child maltreatment and related outcomes; and 4) examine intervention content associated with key mechanisms of change perceived by caregivers and facilitators. METHOD: Sixty primary caregivers of children aged 2-9 years were recruited for an 8-week parenting program embedded within the local health system. Mixed-methods approaches included quantitative caregiver-report and observational data from standardized instruments, and qualitative data from individual and group interviews with caregivers and program facilitators. Analyses involved Wilcoxon signed-rank tests, paired t-tests, Friedman's ANOVA, and thematic analysis. RESULTS: Participants reported that most (65%) were grandparents or great-grandparents. Study retention and response rates were high, and enrolled caregivers attended an average of 93% of sessions. Primary outcomes showed caregiver-reported pre-post reductions in overall child maltreatment (d = - 0.58, p < 0.001), as well as reductions in physical (d = - 0.58, p < 0.001) and emotional abuse (d = - 0.40, p < 0.001). Combined caregiver report and observational assessments using the HOME Inventory showed reductions in abusive and harsh parenting (d = - 0.52, p < 0.001). Secondary outcomes demonstrated decreases in child neglect; dysfunctional parenting; poor child monitoring and supervision; parental sense of inefficacy; child behavior problems; daily report on child problem behavior; parent overall depression, anxiety, and stress; and attitudes supporting physical punishment and harsh discipline. There were increases in overall positive parenting, daily positive parenting behavior, as well as HOME Inventory assessments on parent-child relationships. Thematic analyses from interviews and focus group data identified six key program themes associated with strengthened parent-child relationships, reduced child behavior problems, improved attitudes and strategies toward discipline, and improved management of parental stress. CONCLUSIONS: This study represents one of few evaluations to test the feasibility of an evidence-based parenting program embedded within routine public health service delivery in a low- or middle-income country. Findings show preliminary effectiveness in reducing child maltreatment, improvements on 22 of 24 secondary outcomes, and perceived mechanisms of change that support quantitative findings. Prospects are promising for program scalability, pending randomized controlled trial results. TRIAL REGISTRATION: 11/01/2019, ClinicalTrials.gov, ID# NCT03539341 .


Asunto(s)
Responsabilidad Parental , Salud Pública , Niño , Preescolar , Estudios de Factibilidad , Humanos , Relaciones Padres-Hijo , Tailandia , Estados Unidos
15.
BMJ Open ; 11(5): e050105, 2021 05 13.
Artículo en Inglés | MEDLINE | ID: mdl-33986070

RESUMEN

INTRODUCTION: Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in intensive care units (ICUs). Using short-course antibiotics to treat VAP caused by Gram-negative non-fermenting bacteria has been reported to be associated with excess pneumonia recurrences. The "REducinG Antibiotic tReatment Duration for Ventilator-Associated Pneumonia" (REGARD-VAP) trial aims to provide evidence for using a set of reproducible clinical criteria to shorten antibiotic duration for individualised treatment duration of VAP. METHODS AND ANALYSIS: This is a randomised controlled hierarchical non-inferiority-superiority trial being conducted in ICUs across Nepal, Thailand and Singapore. The primary outcome is a composite endpoint of death and pneumonia recurrence at day 60. Secondary outcomes include ventilator-associated events, multidrug-resistant organism infection or colonisation, total duration of antibiotic exposure, mechanical ventilation and hospitalisation. Adult patients who satisfy the US Centers for Disease Control and Prevention National Healthcare Safety Network VAP diagnostic criteria are enrolled. Participants are assessed daily until fever subsides for >48 hours and have stable blood pressure, then randomised to a short duration treatment strategy or a standard-of-care duration arm. Antibiotics may be stopped as early as day 3 if respiratory cultures are negative, and day 5 if respiratory cultures are positive in the short-course arm. Participants receiving standard-of-care will receive antibiotics for at least 8 days. Study participants are followed for 60 days after enrolment. An estimated 460 patients will be required to achieve 80% power to determine non-inferiority with a margin of 12%. All outcomes are compared by absolute risk differences. The conclusion of non-inferiority, and subsequently superiority, will be based on unadjusted and adjusted analyses in both the intention-to-treat and per-protocol populations. ETHICS AND DISSEMINATION: The study has received approvals from the Oxford Tropical Research Ethics Committee and the respective study sites. Results will be disseminated to patients, their caregivers, physicians, the funders, the critical care societies and other researchers. TRIAL REGISTRATION NUMBER: NCT03382548.


Asunto(s)
Neumonía Asociada al Ventilador , Adulto , Antibacterianos/uso terapéutico , Duración de la Terapia , Humanos , Nepal , Neumonía Asociada al Ventilador/tratamiento farmacológico , Ensayos Clínicos Controlados Aleatorios como Asunto , Singapur , Tailandia
16.
BMJ Open ; 11(5): e043862, 2021 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-33958338

RESUMEN

OBJECTIVE: To determine the effect of gender on clinical outcomes of Asian non-valvular atrial fibrillation patients. DESIGN: This is a cohort study. SETTING: 27 university and regional hospitals in Thailand. PARTICIPANTS: Patients with non-valvular atrial fibrillation. PRIMARY AND SECONDARY OUTCOMES MEASURES: The clinical outcomes were ischaemic stroke/transient ischaemic attack (TIA), major bleeding, intracerebral haemorrhage (ICH), heart failure and death. Follow-up data were recorded every 6 months until 3 years. Differences in clinical outcomes between males and females were determined. Multivariate analysis was performed to assess the effect of gender on clinical outcomes. Survival analysis and log-rank test were performed to determine the time-dependent effect of clinical outcomes, and the difference between males and females. Effect of oral anticoagulant (OAC) on outcomes and net clinical benefit of OAC was assessed. The analysis was performed both for the whole dataset and propensity score matching with multiple imputation. RESULTS: A total of 3402 patients (mean age: 67.4±11.3 years; 58.2% male) were included. Average follow-up duration 25.7±10.6 months (7192.6 persons-year). Rate of ischaemic stroke/TIA, major bleeding, ICH, heart failure and death were 1.43 (1.17-1.74), 2.11 (1.79-2.48), 0.70 (0.52-0.92), 3.03 (2.64-3.46) and 3.77 (3.33-4.25) per 100 person-years. Females had increased risk for ischaemic stroke/TIA and heart failure and males had increased risk for major bleeding and ICH. Ischaemic stroke/TIA risk in females and major bleeding and ICH risk in males remained even after correction for age, comorbid conditions and anticoagulation treatment. OAC reduced the risk of ischaemic stroke/TIA in males and females, and markedly increased the risk of major bleeding and ICH in males. CONCLUSIONS: Females had a higher risk of ischaemic stroke/TIA and heart failure, and a lower risk of major bleeding and ICH compared with males. OAC reduced risk of ischaemic stroke/TIA in females, and markedly increased risk of major bleeding and ICH in males.


Asunto(s)
Fibrilación Atrial , Isquemia Encefálica , Accidente Cerebrovascular , Administración Oral , Anciano , Anticoagulantes/efectos adversos , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/epidemiología , Isquemia Encefálica/tratamiento farmacológico , Isquemia Encefálica/epidemiología , Isquemia Encefálica/prevención & control , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/prevención & control , Tailandia
17.
Zhongguo Zhong Yao Za Zhi ; 46(8): 1951-1959, 2021 Apr.
Artículo en Chino | MEDLINE | ID: mdl-33982504

RESUMEN

Kaempferiae Parviflorae Rhizoma is the dried rhizome of Kaempferia parviflora in Zingiberaceae. It is originated and widely distributed in Thailand and other tropical and subtropical regions, where it has been used as food and medicine for thousands of years. K. parviflora is also planted in Yunnan and other places of China, but its traditional Chinese medicine properties are not clear, which greatly limits its compatibility with traditional Chinese medicines. In this article, the English and Chinese literatures of K. parviflora were searched from Web of Science, PubMed, Scopus, CNKI, Wanfang, and VIP databases for research and analysis. The medicinal properties of K. parviflora were preliminarily discussed based on the theory of traditional Chinese medicine under the guidance of clinical application and research literatures. The traditional Chinese medicine properties of K. parviflora were inferred as follows: flat, acrid, sweet. The channel tropisms of K. parviflora included kidney, spleen, stomach, and liver. The function of K. parviflora included tonifying kidney to strengthen essence, tonifying Qi and invigorating spleen, soothing liver and relieving depression. K. parviflora was clinically applied for the diseases such as syndrome of kidney essence deficiency, sex apathy, deficiency of spleen Qi, lassitude and asthenia, a weary spirit, obesity, diabetes, liver Qi stagnation, depression, and restless. The equivalent of dry power is 1.5 g·d~(-1) and the equivalent of decoction is 1.5-6 g·d~(-1). The determination of traditional Chinese medicine properties of K. parviflora has indeed laid a theoretical foundation for its application in the field of traditional Chinese medicine and enriched traditional Chinese medicine resources.


Asunto(s)
Medicamentos Herbarios Chinos , Zingiberaceae , China , Medicina China Tradicional , Rizoma , Tailandia
18.
BMC Public Health ; 21(1): 835, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33933062

RESUMEN

BACKGROUND: The coronavirus disease of 2019 (COVID-19) has quickly spread to all corners of the world since its emergence in Wuhan, China in December of 2019. The disease burden has been heterogeneous across regions of the world, with Americas leading in cumulative cases and deaths, followed by Europe, Southeast Asia, Eastern Mediterranean, Africa and Western Pacific. Initial responses to COVID-19 also varied between governments, ranging from proactive containment to delayed intervention. Understanding these variabilities allow high burden countries to learn from low burden countries on ways to create more sustainable response plans in the future. METHODS: This study used a mixed-methods approach to perform cross-country comparisons of pandemic responses in the United States (US), Brazil, Germany, Australia, South Korea, Thailand, New Zealand, Italy and China. These countries were selected based on their income level, relative COVID-19 burden and geographic location. To rationalize the epidemiological variability, a list of 14 indicators was established to assess the countries' preparedness, actual response, and socioeconomic and demographic profile in the context of COVID-19. RESULTS: As of 1 April 2021, the US had the highest cases per million out of the nine countries, followed by Brazil, Italy, Germany, South Korea, Australia, New Zealand, Thailand and China. Meanwhile, Italy ranked first out of the nine countries' total deaths per million, followed by the US, Brazil, Germany, Australia, South Korea, New Zealand, China and Thailand. The epidemiological differences between these countries could be explained by nine indicators, and they were 1) leadership, governance and coordination of response, 2) communication, 3) community engagement, 4) multisectoral actions, 5) public health capacity, 6) universal health coverage, 7) medical services and hospital capacity, 8) demography and 9) burden of non-communicable diseases. CONCLUSION: The COVID-19 pandemic manifests varied outcomes due to differences in countries' vulnerability, preparedness and response. Our study rationalizes why South Korea, New Zealand, Thailand, Australia and China performed better than the US, Italy and Brazil. By identifying the strengths of low burden countries and weaknesses of hotspot countries, we elucidate factors constituting an effective pandemic response that can be adopted by leaders in preparation for re-emerging public health threats.


Asunto(s)
Pandemias , África , Américas , Asia Sudoriental , Australia/epidemiología , Brasil , China/epidemiología , Europa (Continente) , Alemania , Humanos , Italia , Nueva Zelanda/epidemiología , República de Corea , Tailandia , Estados Unidos
19.
BMC Public Health ; 21(1): 914, 2021 05 13.
Artículo en Inglés | MEDLINE | ID: mdl-33985465

RESUMEN

BACKGROUND: Like many developing countries, Thailand has experienced a rapid rise in obesity, accompanied by a rapid change in occupational structure. It is plausible that these two trends are related, with movement into sedentary occupations leading to increases in obesity. National health examination survey data contains information on obesity and socioeconomic conditions that can help untangle the relationship, but analysis is challenging because of small sample sizes. METHODS: This paper explores the relationship between occupation and obesity using data on 10,127 respondents aged 20-59 from the 2009 National Health Examination Survey. Obesity is measured using waist circumference. Modelling is carried out using an approach known as Multiple Regression with Post-Stratification (MRP). We use Bayesian hierarchical models to construct prevalence estimates disaggregated by age, sex, education, urban-rural residence, region, and occupation, and use census population weights to aggregate up. The Bayesian hierarchical model is designed to protect against overfitting and false discovery, which is particularly important in an exploratory study such as this one. RESULTS: There is no clear relationship between the overall sedentary nature of occupations and obesity. Instead, obesity appears to vary occupation by occupation. For instance, women in professional occupations, and men who are agricultural or fishery workers, have relatively low rates of obesity. CONCLUSION: Bayesian hierarchical models plus post-stratification offers new possibilities for using surveys to learn about complex health issues.


Asunto(s)
Obesidad , Ocupaciones , Adulto , Teorema de Bayes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Prevalencia , Tailandia/epidemiología , Adulto Joven
20.
BMC Res Notes ; 14(1): 197, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34020710

RESUMEN

OBJECTIVES: We employed the Illumina NGS platform to sequence genomes of 4 different strains of the pathogenic oomycete Pythium insidiosum, the causative agent of pythiosis. These strains were isolated from humans in Thailand (n = 3) and the United States (n = 1), and phylogenetically classified into clade-I, -II, and -III. Our study augmented the completeness of the P. insidiosum genome database for exploration of the biology, evolution, and pathogenesis of the pathogen. DATA DESCRIPTION: One paired-end library (180-bp insert) was prepared from a gDNA sample of P. insidiosum strains ATCC200269 (clade-I), Pi19 (clade-II), MCC18 (clade-II), and SIMI4763 (clade-III) for whole-genome sequencing by Illumina HiSeq2000/HiSeq2500 NGS platform. A range of 28.4-59.4 million raw reads, accounted for 3.0-7.3 Gb, were obtained and assembled into the genome sizes of 47.1 Mb (15,153 contigs; 85% completeness; 19,329 open reading frames [ORFs]) for strain ATCC200269, 35.4 Mb (14,576 contigs; 83% completeness; 13,895 ORFs) for strain Pi19, 34.5 Mb (11,084 contigs; 84% completeness; 13,249 ORFs) for strain MCC18, and 47.1 Mb (15,162 contigs; 85% completeness; 19,340 ORFs) for strain SIMI4763. The genome data can be downloaded from the NCBI/DDBJ databases under the accessions BCFN00000000.1 (ATCC200269), BCFS00000000.1 (Pi19), BCFT00000000.1 (MCC18), and BCFU00000000.1 (SIMI4763).


Asunto(s)
Pitiosis , Pythium , Animales , Genoma , Humanos , Pitiosis/genética , Pythium/genética , Análisis de Secuencia de ADN , Tailandia
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