Developing a risk prediction model for death at first suicide attempt-Identifying risk factors from Thailand's national suicide surveillance system data.

More than 60% of suicides globally are estimated to take place in low- and middle-income nations. Prior research on suicide has indicated that over 50% of those who die by suicide do so on their first attempt. Nevertheless, there is a dearth of knowledge on the attributes of individuals who die on their first attempt and the factors that can predict mortality on the first attempt in these regions. The objective of this study was to create an individual-level risk-prediction model for mortality on the first suicide attempt. We analyzed records of individuals' first suicide attempts that occurred between May 1, 2017, and April 30, 2018, from the national suicide surveillance system, which includes all of the provinces of Thailand. Subsequently, a risk-prediction model for mortality on the first suicide attempt was constructed utilizing multivariable logistic regression and presented through a web-based application. The model's performance was assessed by calculating the area under the receiver operating curve (AUC), as well as measuring its sensitivity, specificity, and accuracy. Out of the 3,324 individuals who made their first suicide attempt, 50.5% of them died as a result of that effort. Nine out of the 21 potential predictors demonstrated the greatest predictive capability. These included male sex, age over 50 years old, unemployment, having a depressive disorder, having a psychotic illness, experiencing interpersonal problems such as being aggressively criticized or desiring plentiful attention, having suicidal intent, and displaying suicidal warning signals. The model demonstrated a good predictive capability, with an AUC of 0.902, a sensitivity of 84.65%, a specificity of 82.66%, and an accuracy of 83.63%. The implementation of this predictive model can assist physicians in conducting comprehensive evaluations of suicide risk in clinical settings and devising treatment plans for preventive intervention.

An International, Multidisciplinary Consensus Set of Patient-Centered Outcome Measures for Substance-Related and Addictive Disorders.

Background: In 1990, the United States' Institute of Medicine promoted the principles of outcomes monitoring in the alcohol and other drugs treatment field to improve the evidence synthesis and quality of research. While various national outcome measures have been developed and employed, no global consensus on standard measurement has been agreed for addiction. It is thus timely to build an international consensus. Convened by the International Consortium for Health Outcomes Measurement (ICHOM), an international, multi-disciplinary working group reviewed the existing literature and reached consensus for a globally applicable minimum set of outcome measures for people who seek treatment for addiction. Methods: To this end, 26 addiction experts from 11 countries and 5 continents, including people with lived experience (n = 5; 19%), convened over 16 months (December 2018-March 2020) to develop recommendations for a minimum set of outcome measures. A structured, consensus-building, modified Delphi process was employed. Evidence-based proposals for the minimum set of measures were generated and discussed across eight videoconferences and in a subsequent structured online consultation. The resulting set was reviewed by 123 professionals and 34 people with lived experience internationally. Results: The final consensus-based recommendation includes alcohol, substance, and tobacco use disorders, as well as gambling and gaming disorders in people aged 12 years and older. Recommended outcome domains are frequency and quantity of addictive disorders, symptom burden, health-related quality of life, global functioning, psychosocial functioning, and overall physical and mental health and wellbeing. Standard case-mix (moderator) variables and measurement time points are also recommended. Conclusions: Use of consistent and meaningful outcome measurement facilitates carer-patient relations, shared decision-making, service improvement, benchmarking, and evidence synthesis for the evaluation of addiction treatment services and the dissemination of best practices. The consensus set of recommended outcomes is freely available for adoption in healthcare settings globally.

Higher milk consumption is associated with a lower risk of diabetes mellitus: A case-control study.

BACKGROUND & AIMS: Studies have determined that people with genetically defined lactase non-persistence have lower dairy intake that may lead to an increase risk of various non-communicable diseases. Furthermore, lactase non-persistence itself has been associated with insulin resistance. However, data on lactase non-persistence status and dairy intake in developing countries are sparse. We therefore aimed to define 1) the prevalence of lactase non-persistence among individuals with diabetes and non-diabetes in Thai population and 2) the links between lactase non-persistence, milk consumption, and risk of diabetes mellitus. METHODS: We conducted a case-control study from participants of the National Health Examination Survey. DNA was isolated from the blood for LCT -13910C>T (rs4988235) polymorphism and processed using the Bio-rad c1000 touch thermal cycler and MALDI-TOF Mass Spectrometry MassARRAY Typer v4.0 (Agena Bioscience, San Diego, CA, USA) at the Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital. Cases were participants with previously diagnosed diabetes mellitus or fasting plasma glucose ≥126 mg/dL (n = 1,756) vs. the controls (n = 2,380). RESULTS: We included 4,136 participants, 62% female, and 98.8% were > 30 years old. Homozygous CC genotype (i.e., lactase non-persistence) was noted in 98.6% and only 1.4% carried heterozygous CT. Most (76%) consumed milk <1 portion/month. Participants with either CC or CT genotype had comparable milk consumption and the risk of diabetes mellitus. Males, older adults, and lower education had a lower chance of consuming milk at least one portion per month. Besides various baseline variables, we found that higher milk consumption was associated with a lower DM risk (P = .01). CONCLUSION: The prevalence of lactase non-persistence in Thai population is very high. A significant difference in milk consumption frequency in relation to the lactase non-persistence status was not found. However, higher milk consumption is associated with a lower risk of diabetes mellitus.

Behavioral health and experience of violence among cisgender heterosexual and lesbian, gay, bisexual, transgender, queer and questioning, and asexual (LGBTQA+) adolescents in Thailand.

BACKGROUND: Assessment of health disparities between population groups is essential to provide basic information for resource prioritization in public health. The objective of this study is to assess the extent that behavioral health outcomes and experience of violence varied between cisgender heterosexual adolescents and those who identified as lesbian, gay, bisexual, transgender, queer and questioning, and asexual (LGBTQA+) in the 5th National School Survey on Alcohol Consumption, Substance Use and Other Health-Risk Behaviors. METHODS: We surveyed secondary school students in years 7, 9 and 11 in 113 schools in Thailand. We used self-administered questionnaires to ask participants about their gender identity and sexual orientation and classified participants as cisgender heterosexual, lesbian, gay, bisexual, transgender, queer and questioning, or asexual, stratified by sex assigned at birth. We also measured depressive symptoms, suicidality, sexual behaviors, alcohol and tobacco use, drug use, and past-year experience of violence. We analyzed the survey data using descriptive statistics with adjustment for sampling weights. RESULTS: Our analyses included data from 23,659 participants who returned adequately-completed questionnaires. Among participants included in our analyses, 23 percent identified as LGBTQA+ with the most common identity being bisexual/polysexual girls. Participants who identified as LGBTQA+ were more likely to be in older year levels and attending general education schools rather than vocational schools. LGBTQA+ participants generally had higher prevalence of depressive symptoms, suicidality, and alcohol use than cisgender heterosexual participants, whereas the prevalence of sexual behaviors, lifetime history of illicit drug use, and past-year history of violence varied widely between groups. CONCLUSION: We found disparities in behavioral health between cisgender heterosexual participants and LGBTQA+ participants. However, issues regarding potential misclassification of participants, limitation of past-year history of behaviors to the context of the COVID-19 pandemic, and the lack of data from youths outside the formal education system should be considered as caveats in the interpretation of the study findings.

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

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

Effects of cannabis legalization on the use of cannabis and other substances.

PURPOSE OF REVIEW: As more jurisdictions legalize cannabis for non-medical use, the evidence on how legalization policies affect cannabis use and the use of other substances remains inconclusive and contradictory. This review aims to summarize recent research findings on the impact of recreational cannabis legalization (RCL) on cannabis and other substance use among different population groups, such as youth and adults. RECENT FINDINGS: Recent literature reports mixed findings regarding changes in the prevalence of cannabis use after the adoption of RCL. Most studies found no significant association between RCL and changes in cannabis use among youth in European countries, Uruguay, the US, and Canada. However, some studies have reported increases in cannabis use among youth and adults in the US and Canada, although these increases seem to predate RCL. Additionally, there has been a marked increase in unintentional pediatric ingestion of cannabis edibles postlegalization, and an association between RCL and increased alcohol, vaping, and e-cigarette use among adolescents and young adults. SUMMARY: Overall, the effects of cannabis legalization on cannabis use appear to be mixed. Further monitoring and evaluation research is needed to provide longer-term evidence and a more comprehensive understanding of the effects of RCL.

Ideal cardiovascular health and all-cause or cardiovascular mortality in a longitudinal study of the Thai National Health Examination Survey IV and V.

The relationship of ideal cardiovascular health (CVH) and health outcomes has been rarely assessed in middle-income countries. We determined the ideal CVH metrics and association with all-cause and cardiovascular (CVD) mortality in the Thai population. We used baseline data from two rounds of the National Health Examination survey (15,219 participants in 2009 and 14,499 in 2014), and assessed all-cause and CVD deaths until 2020. The prevalence of 5-7 ideal CVH metrics in 2009 was 10.4% versus 9.5% in 2014. During a median follow-up of 7.1 years, the all-cause and CVD mortality rates were 19.4 and 4.6 per 1000 person-years for 0-1 ideal CVH metrics, and 13.0 and 2.1, 9.6 and 1.5, 6.0 and 1.0, and 2.9 and 0.4 per 1000 person-years for 2, 3, 4, and 5-7 ideal CVH metrics, respectively. Participants with 2, 3, 4, or 5-7 ideal metrics had a significantly lower risk of mortality than those with 0-1 ideal CVH metrics (adjusted hazard ratios: 0.75, 0.70, 0.60, and 0.47 for all-cause, and 0.54, 0.52, 0.50, and 0.31 for CVD, respectively). Individuals with a higher number of the modified ideal CVH metrics have a lower risk of all-cause and CVD mortality.

Inter-ethnic differences in self-reported alcohol-related harm to children in Han vs. Yi ethnic minority households in Yunnan Province, China.

China is a multi-ethnic country, but inter-ethnic disparities in alcohol-related harm to children have not been described. In this study, we assessed differences in prevalence of self-reported alcohol-related harm to children in Yi and Han households in Chuxiong Yi Prefecture, Yunnan Province, China. We conducted a cross-sectional study among caregivers in households with a child age less than 18 years using structured questionnaire interview. Participants included 241 Yi caregivers and 610 Han caregivers (overall refusal rate = 1.1%). Heavy drinking was more common in Yi households than Han households (41.9% vs. 30.8%, respectively), but there was no difference in alcohol-related harm to children (21.2% vs. 17.9%; Adjusted OR = 0.98; 95% CI = 0.65, 1.46). Caveats such as social desirability in reporting sensitive issues and the cross-sectional study design should be considered in the interpretation of the study findings.

Stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among general adult population: the results from the 6th Thai National Health Examination Survey (NHES VI).

Background: Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors. Methods: This study was based on data from the 6th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years. Results: We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19). Conclusions: We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained.

Prevalence of Alcohol-Related Harms in Yi and Han Ethnic Groups in a Prefecture in Yunnan Province, China.

BACKGROUND: Although differences in the prevalence of alcohol-related harm between ethnic minority and majority groups have been reported in many countries, such data are scarce in China. The findings of such assessment can provide empirical data to inform stakeholders in prioritization and allocation of resources for programs to manage and control alcohol-related problems. The objective of this study is to compare the prevalence of alcohol-related harm from others among Han and Yi populations in the Chuxiong Yi Autonomous Prefecture, Yunnan Province, China. METHOD: We conducted a cross-sectional study in 1370 households from 21 villages. Enumerators used convenient sampling to recruit one person aged 18 years or older from each selected household, obtained informed consent to participate, and conducted an interview using a structured questionnaire. The questionnaire included three parts: (1) demographic characteristics of the participant (including ethnic identity); (2) history of alcohol-related harm from other in the past 12 months, and; (3) drinking behaviors. We analyzed data using descriptive statistics and multivariate regression analyses, stratified by sex of the participant. RESULTS: The prevalence of experiencing alcohol-related harm from others in Han men, Yi men, Han females, and Yi females, were 69.9%, 62.1%, 75.3%, and 63.4%, respectively. The Han vs. Yi disparity was higher among females (Adjusted OR = 2.06; 95% CI = 1.41, 3.01) than males (Adjusted OR = 1.47; 95% CI = 1.05, 2.07). The most common type of harm was feeling scared or threatened (36.9% among males, 32.4% among females) and the least common type was financial difficulty (3% among males, and 3.3% among females). CONCLUSIONS: Yi ethnic minorities in Yunnan Province had lower prevalence of alcohol-related harm from others than Han persons in the same region. However, measurement and translation-related issues of the study instrument and limited generalizability should be considered as caveats in the interpretation of the study findings.

Application of Bayesian networks to identify factors influencing acceptability of HIV pre-exposure prophylaxis in Guilin, China.

Pre-exposure prophylaxis (PrEP) is an effective strategy to prevent uninfected individuals from contracting human immunodeficiency virus (HIV), however it must be acceptable to stakeholders in order to be effective. This study aimed to assess the acceptability of PrEP and related influencing factors. A cross-sectional survey was conducted among female sex workers (FSW), people who inject drugs (PWID), and men who have sex with men (MSM) using respondent driven sampling. Factors influencing PrEP acceptability were estimated using ordinal logistic regression and Bayesian networks. The survey included 765 eligible participants. The mean score of the perceived acceptability index was 3.9 (SD = 1.97). Multivariable logistic regression analysis revealed a higher acceptance of PrEP was associated with elder age, having other medical insurance, higher perceived utility of PrEP in facilitating prevention of HIV, higher perceived ease of use, higher perceived risk of increased risk behavior, higher perceived privacy problem in using PrEP, higher perceived comparative advantage over condom use, higher perceived comparative advantage of having sex when the urge arises, and higher perceived image of PrEP user as having sexual risky behavior, as public-minded and as health-conscious. The Bayesian network model showed perceived ease of use, perceived image of user as health-conscious, and perceived comparative advantage of having sex when the urge arises were directly associated with acceptability of PrEP. If these three factors were at a high level, 74.6% of the participants would have a high level of acceptability of PrEP. Effective education strategies to promote the acceptance of PrEP are needed. Implementation strategies should incorporate more inclusive messaging and build positive publicity for PrEP to reduce the stigma that PrEP use indicates risky behavior.

Association between electronic cigarette use and depression among Thai adolescents: The Thailand National Health Examination Survey 2019-2020.

INTRODUCTION: Depression and e-cigarette use among adolescents are two health burdens. However, the association between these dual problems have been less studied, especially in low- and middle-income countries. This study examined the association between depression and e-cigarette use among adolescents in Thailand. METHODS: This cross-sectional study used the sub-sample of the sixth Thai National Health Examination Survey conducted between 2019 and 2020. A total of 4237 adolescents aged 10-19 years were included. Self-reported depression was captured using the 20-item Centre for Epidemiologic Studies Depression Scale (CES-D). We applied a complex survey multiple logistic regression to assess whether e-cigarette use was associated with depression. RESULTS: The mean age of the participants was 14.6 years, 5.3% were ever e-cigarette users, and 2.9% were current e-cigarette users. 37.8% of the participants were categorized at risk for depression. Among e-cigarette users, 51.6% of ever e-cigarette users and 52.9% of current e-cigarette users were at risk for depression. Multiple logistic regression revealed that ever e-cigarette users were at higher risk for depression (AOR=1.66; 95% CI: 1.02-2.71; p=0.042) than never e-cigarette users. Current e-cigarette was not associated with a higher risk for depression (AOR=1.37; 95% CI: 0.77-2.45; p=0.263). CONCLUSIONS: E-cigarette use and depression among adolescents are global public health concerns. There is also a need for effective screening, prevention, and intervention to reduce adverse outcomes of e-cigarette use and depression. In addition, the government should strengthen current policies and close legal loopholes to prevent the tobacco industry tactics and keep e-cigarettes away from adolescents.

Current Perspectives on the Determinants of Acceptability of Pre-Exposure Prophylaxis and Nonoccupational Post-Exposure Prophylaxis among People at Risk for HIV: A Scoping Review.

Pre-exposure prophylaxis (PrEP) and nonoccupational post-exposure prophylaxis (nPEP) were found to be effective HIV biomedical interventions. However, several barriers to acceptance of these interventions were discovered among populations at risk for HIV, and the Coronavirus Disease 2019 (COVID-19) pandemic may also exacerbate these. The current scoping review aims to update information in regards to facilitators and barriers for PrEP and nPEP acceptability among key populations collected in the past two years and to identify any existing knowledge gaps during the time of the COVID-19 pandemic. Of 1453 studies retrieved, 16 met the final inclusion criteria. The review synthesized a range of individual, PrEP-specific, psychosocial, and health system factors that may affect the acceptability of PrEP or nPEP. The conclusion from this scoping review is that more research is needed to enable a comprehensive understanding of the determinants of acceptability of PrEP and nPEP in the context of COVID-19, particularly among PWID and FSWs.

Alcohol Recognition and Desire to Drink of Extended Alcohol Brand Logos.

Alcohol companies in Thailand have adopted surrogate marketing that uses similar logos on non-alcoholic products. We aimed to assess variations of the alcohol recognition using reaction time and desire to drink among consumers exposed to original logos and modified logos (i.e., black logos, partial logos, logos on non-alcoholic beverages and other merchandise). Participants aged ≥19 years took part in this cross-sectional study. The primary independent variables were types of logos: original logos, modified logos (i.e., black logos, partial logos, logos on non-alcoholic beverages, and logos on other merchandise). An in-house-developed online survey randomly presented the logos. Alcohol recognition and the desire to drink alcohol were assessed. The study included 1185 participants. More time (estimated coefficient of reaction time <0.5 s) was required to recognize the modified logos than the original logos. Younger participants (19-24 years) reacted significantly faster than the older participants (>25 years) after seeing all types of logos. The desire to drink alcohol (<0.5 point) upon seeing the modified logos was lower than the original logos. No significant difference in the desire was observed between the younger and older participants upon seeing the original and partial logos. The modified logos reminded consumers of the alcohol products of that brand with a tiny difference in reaction time and the desire to drink without practical significance.

Modification of the association between experience of economic distress during the COVID-19 pandemic and behavioral health outcomes by availability of emergency cash reserves: findings from a nationally-representative survey in Thailand.

Background: Studies have suggested that economic distress is associated with behavioral health outcomes, while availability of cash reserves for emergencies is associated with a reduction in economic distress. The objective of this study was to assess the extent that the availability of emergency cash reserves modified the association between experience of economic distress during the COVID-19 pandemic and behavioral health outcomes in the general adult population of Thailand. Methods: We conducted a nationally-representative phone-based survey in late April 2021. Survey questions included questions on experience of economic distress, and a question on what participants would do to cover a 5,000 Thai Bahts (THB) emergency expense within one week, anxiety and depression screening questions, and questions regarding sleep, exercise, gambling, smoking, and drinking behaviors. We analyzed data using descriptive statistics and multivariate logistic regression analyses with adjustment for complex survey designs, and stratified analyses with assessment of heterogeneity of odds ratios between strata and assessment of additive and multiplicative interactions. Results: A total of 1,555 individuals from 15 provinces participated in the survey (participation rate = 68.3%). Approximately 19.6% ± 1.0% of the participants reported that they would cover the 5,000 THB emergency expense only with cash or cash equivalent without resorting to other means. Experience of economic distress was associated with anxiety disorder after adjusting for covariables (Adjusted Odds Ratio (OR) = 2.47; 95% CI [1.45-4.19]). There was no evidence that availability of emergency cash reserves significantly modified the stated association, nor the association between experience of economic distress and other outcomes. However, with regard to anxiety disorder, depressive symptoms and history of gambling in past 30 days, the p-for-trend values (p-for-trend < 0.001) suggested that those with emergency cash reserves had lower prevalence of these outcomes than those without emergency cash reserves. Conclusions: The study findings did not support our hypothesis that availability of emergency cash reserves modified the association between experience of economic distress and behavioral health outcomes. Nonetheless, the study findings can serve as potentially useful basic information for relevant stakeholders. Future studies should consider qualitative data collection and longitudinal study design in order to explore these associations at greater depths.

Acceptability of Pre-Exposure Prophylaxis and Non-Occupational Post-Exposure Prophylaxis among Men Who Have Sex with Men in Guilin, China.

Pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP) are both effective strategies for preventing HIV. There is limited information about the acceptability of these prevention measures in undeveloped areas of China. We aimed to examine the acceptability of PrEP and nPEP and their determinants among men who have sex with men (MSM). 219 MSM were recruited in Guilin, China. In total, 28.6% (95% CI: 20.0-41.0) and 35.9% (95% CI: 27.3-49.5) of the participants had heard of PrEP and nPEP, respectively, while 57.0% (95% CI: 43.1-68.2) and 58.6 (95% CI:44.8-68.8) reported they would be willing to use PrEP and nPEP after the methods were explained. A higher acceptability of PrEP was seen among participants who were previously married (aOR = 3.30; 95% CI: 1.22-9.19), working as a laborer (aOR = 5.13; 95% CI: 1.64-17.59), migrant workers/farmers (aOR = 2.56; 95% CI: 1.15-5.79), government employees (aOR = 4.76; 95%CI: 1.80-13.02), had higher social support (aOR = 1.05; 95% CI: 1.03-1.08), and had been previously tested for HIV (aOR = 2.79; 95% CI: 1.36-5.94). A higher acceptability of nPEP was associated with those having higher social support (aOR = 1.06; 95% CI: 1.04-1.09), not knowing their sexual partner's HIV status (aOR = 2.72; 95% CI: 1.23-6.12), and having a prior HIV test (aOR = 5.53; 95% CI: 2.58-12.51). PrEP and nPEP are acceptable, especially among MSM with higher social support and had received a previous HIV test. Effective education and different dissemination strategies to promote the acceptance of PrEP and nPEP among MSM are needed.

Association between family behaviors and self-care activities among type-II diabetes mellitus patients at a teaching hospital in Kathmandu, Nepal.

BACKGROUND: Self-care activities are associated with prognosis of type-II diabetes mellitus patients and include medication adherence, dietary adherence, physical activity, self-monitoring of blood glucose (SMBG), and appropriate foot care. The behaviors of a patient's family members can influence the patient's self-care activities, but little data exist on this association. The objective of this study was to assess the extent of the association between behaviors of family members of Type-II diabetes patients and the patients' self-care activities. MATERIALS AND METHODS: We conducted a cross-sectional study at a teaching hospital in Kathmandu, Nepal, and interviewed 411 outpatients with Type-2 diabetes mellitus. We used exploratory factor analysis to group family members' behaviors into 3 domains ("authoritarian," "supportive," and "planning" behaviors) and graded the level of the behavior into 3 categories ("high" vs. "medium" vs. "low") according to its ranking distribution in each domain. We assessed the association between domains of family behavior and self-care activities using multivariate logistic regression with Bonferroni correction. RESULTS: High (vs. low) level of supportive behavior was associated with compliance to SMBG (58% vs. 11%; adjusted odds ratio [OR] =7.44; 95% confidence interval [CI] =2.41, 23.01). High (vs. low) level of planning behavior was associated with high level of foot care adherence (64% vs. 21%; adjusted OR = 6.03; 95% CI = 3.01, 12.11). CONCLUSIONS: We found associations between behaviors of diabetes patients' family members and the patients' own self-care behaviors. However, the incongruence between the family behavior measurement questions and the self-care of interest limited the implications of the findings.

Medical cannabis use in Thailand after its legalization: a respondent-driven sample survey.

BACKGROUND: Many countries now allow the consumption of cannabis or cannabinoids for medical purposes with varying approaches concerning products allowed and the regulatory frameworks prevailing their endowment. On 18 February 2019 Thailand passed legislation allowing the use of cannabis for medical purposes. This study aimed to examine patterns and purposes for consumption of medical cannabis, and consumers' perceptions and opinions towards benefits and harms of cannabis and related policies in 2019-2020. METHODS: A cross-sectional study using a respondent-driven sampling (RDS) method was conducted in four sites across Thailand. Participants were 485 adults aged 18 years and over, living in the study region, who had used cannabis for medical purposes within the past 12 months. Face-to-face interviews using a structured questionnaire were used to collect data on (1) demographic characteristics, (2) pattern of consumption, (3) source of information and perception of benefits and harms of medical cannabis, and (4) opinion towards cannabis policies. Data were analyzed using RDS Analyst and presented as percentage and mean with 95% confidence interval (CI). RESULTS: Most participants (84.7%, 95% CI [78.9-90.5]) used an oral form of crude oil extract while 9.2% (95% CI [4.1-14.2]) used the raw form. The most common uses were for treatment of cancers (23.3%, 95% CI [16.1-30.4]), neuropsychiatric symptoms (22.8%, 95% CI [17.5-28.0]), and musculoskeletal pains (21.6%, 95% CI [16.7-26.6]). Illegal sources such as underground traders (54.5%, 95% CI [40.8-68.3]), friends and relatives (12.2%, 95% CI [6.2-18.3]), not-for-profit provider groups (5.2%, 95% CI [0.5-10.9]), and clandestine growers or producers (2.9%, 95% CI [0.6-5.3]) were the main suppliers. Most (>80%) perceived cannabis could treat cancers, chronic pains, insomnia, Parkinson's disease and generalized anxiety disorder. Less than half perceived that cannabis could cause adverse conditions e.g., palpitation, panic, memory impairment and schizophrenic-like psychosis. Most respondents agreed or strongly agreed with the policies regarding permission to use cannabis for medical purposes (95.1%, 95% CI [92.0-98.2]), for the legal sale of medical cannabis products (95.9%, 95% CI [93.7-98.2]), and for people to grow cannabis for medical use (94.2%, 95% CI [91.8-96.5]). However, only two-thirds agreed with policies concerning the sales of cannabis (65.3%, 95% CI [56.9-73.7]) and home-grown cannabis for recreational purposes (61.3%, 95% CI [52.7-69.9]). CONCLUSION: Our study reports the experiences of consumers of medical cannabis in the first year after its legalization in Thailand. Consumers reported various patterns and indications of consumption that were not supported by scientific evidence, but had positive perception of the results of consumption. These findings highlight ongoing policy challenges for Thailand and can be a lesson to be learned for other countries in the region.

Expected Years Of Life Lost Due To Alcohol Consumption In Thai Adults: A 16-Year Follow-Up Cohort Of National Health Examination Survey 2004-2019.

AIMS: Evidence of premature death attributable to alcohol, a modifiable risk factor, is crucial for guiding public health policy for alcohol control. The aim of this study was to estimate alcohol-related mortality and potential years of life lost (PYLL) in Thailand in 2004-2019. METHODS: We analysed data of the third National Health Examination Survey in 2004 linked to National Death Registry data of 2004-2019. Causes of death were based on International Classification of Diseases version 10. PYLL was calculated by cause of death, age group and sex. All analyses were weighted to take into account the probabilities for the multi-stage sampling of the 2004 Thai population aged ≥15 years. RESULTS: There were 10,704 deaths with a follow-up time of 507,771.7 person-years. The crude mortality rate of the initial sample was 868.6 per 100,000 population. The mortality rate attributable to alcohol was 18.6 per 100,000 population (30.7 per 100,000 population in males and 6.8 per 100,000 population in females). The top leading cause of alcohol-attributable deaths was unspecified liver diseases in both males and females (6.1 and 3.1 per 100,000 population, respectively). The total years of life lost (YLL) at baseline were 9.4 million years or 49.5 years per person on average, with significantly more years in males. Mortality rate and expected YLL were highest in ages of 30-44 years, followed by 15-29 years. CONCLUSION: Males were 4-fold more likely to die from all alcohol-attributable causes compared with females. Young adults had a greater loss of life years than older adults.