Community pharmacists' roles in providing contraceptive services: views and experiences of adolescents in urban Khon Kaen, Northeast Thailand.

OBJECTIVES: Adolescent pregnancy is a national public health priority in Thailand. While contraceptive methods are available to prevent adolescent pregnancy, Thai adolescent contraceptive usage is low. Community pharmacists are likely the first health professionals to contact adolescents engaged in unprotected sex and needing emergency contraception. However, there is limited research on Thai pharmacists' roles in promoting sexual and reproductive health. This study examines Thai adolescents' perspectives on community pharmacists' roles in promoting contraceptives and preventing unwanted pregnancies. METHOD: This qualitative study recruited 38 adolescents aged 15-19 from one vocational school and one secondary school in Khon Kaen, Thailand. Data were collected from focus group discussions and in-depth interviews and analysed using thematic analysis. KEY FINDINGS: Participants felt community pharmacists had potentially critical roles in promoting adolescent contraceptive use. Community pharmacists had relevant knowledge of effective contraceptive methods, the risks and benefits of each method, and the quality of different condoms available. Community pharmacists, at times, also provided emotional support to distressed adolescents who came to their store. However, participants reported pharmacists' age, gender, and non-empathetic and judgemental attitudes could be barriers to adolescents' ease of access to contraceptive services. CONCLUSION: This study highlights the potentially crucial role community pharmacists could play in providing contraceptive information for adolescents. It suggests the need for changes in government policies and education and training of community pharmacists to enhance their soft skills - empathetic and non-judgemental attitudes - and their roles in delivering youth-friendly sexual and reproductive health services.

Limited accrual of myxospores of Kudoa inornata (Cnidaria: Myxosporea) in their wild fish hosts, Cynoscion nebulosus (Teleostei: Sciaenidae).

Kudoa inornata is a myxosporean that infects the seatrout Cynoscion nebulosus. Increased prevalence of infection as fish age and absence of inflammation against plasmodia led to the hypothesis that seatrout retain and accumulate myxospores throughout their lives. However, opportunistic observations that wild-caught seatrout cleared infection when maintained in aquaculture conditions and evidence of encapsulated infected necrotic myofibers suggested that fish develop an immunity against this parasite, or that myxospores have a limited life span. To evaluate myxospore clearance and to test putative resistance to re-infection, we examined 44 wild-caught seatrout broodstock maintained in parasite-free water for 2-6 yr. Twenty-five fish served as negative controls (time zero of experiment), and 19 were exposed to water-borne K. inornata infective stages for 18 wk. Over 73% of the exposed fish became infected, compared to ~12% of control fish, indicating that fish were susceptible to re-infection by K. inornata. Whether plasmodia degenerate because K. inornata myxospores have a limited life span or seatrout develop an adaptive immunity against these life stages remains unknown. To test for accumulation of myxospores over time, we compared myxospore densities and intensities between sexes and across ages and sizes of wild seatrout. There was no significant difference in myxospore densities with size, age, or sex. However, intensities increased significantly with increasing fish age and size, indicating accrual of myxospores over time. These results combined with evidence of infection clearance suggest that K. inornata myxospores do not persist but nevertheless accrue in wild seatrout due to continuous contact with infective stages.

Effects of Opisthorchis viverrini infection on glucose and lipid profiles in human hosts: A cross-sectional and prospective follow-up study from Thailand.

Opisthorchis viverrini (OV) infection is endemic to the Northeast Thailand where the prevalence of Type 2 Diabetes mellitus (T2DM) is higher whilst the incidence of cardiovascular diseases (CVDs) is lower than the rest of Thailand. Helminth infection has both nutritional and immunological impact on their definitive hosts. Thus, a cross-sectional study was performed to see the effects of OV infection on glucose and lipid profiles. For this purpose, 200 each of OV infected and uninfected residents were recruited and their glycated hemoglobin (HbA1c), total cholesterol, triglycerides, low- and high-density lipoproteins (LDL and HDL) levels and anthropometric measurements, including BMI were examined. Then, as the prospective follow- up study, changes of those metabolic parameters of OV positive subjects (n = 120) before and after Praziquantel (PZQ) treatment were monitored for six months. The results showed that OV infection has a protective effect against hyperglycemia (OR 0.482 and p = .04) and metabolic disease risk group (OR 0.478 and p = .03). OV positive participants had lower HbA1c (5.5% Vs. 6.01%, p = .001) but higher HDL (54.07 Vs. 49.46 mg/dL, p = .001) than OV negative participants that are statistically significant. After PZQ treatment for OV-positive subjects, their serum levels of HbA1c (p < .05) and HDL (p < .05) significantly rose during the follow up. Apparently, OV infection lowers HbA1c but increases HDL in definitive human hosts.

Using Action Research to prevent work-related illness among rubber farmers in Northeastern Thailand.

OBJECTIVES: This research aimed to enhance self-care among rubber farmers for preventing work-related illness. DESIGN AND SAMPLE: The project used Action Research's four phase iterative process: fact-finding to understand the problems, action planning, action plan implementation, and evaluation and reflection on action plan impacts. Sixty-six participants (46 rubber farmers and 20 community stakeholders) were purposively recruited from two villages in the top 10 rubber producing provinces in Northeastern Thailand. MEASURES: Demographic and work-related illness data were collected in face-to-face structured interviews, Focus group interviews and participant observations were used to collect data in each project phase. Night group meetings were held throughout the research phases. The intervention included training workshops and establishing a community health education team for ongoing farmer support. RESULTS: Results showed improved farmer self-care behaviors and establishment of a community health education team to encourage farmers to care for themselves properly. CONCLUSION: Community nurses, other health personnel, and the Thai government can build on initiatives like this to strengthen occupational health and safety practices and services policy for rubber farmers.

Development and validation of a work-related low back pain risk-assessment tool for sugarcane farmers.

This cross sectional study developed and validated a LBP risk-factor screening scale for use with sugarcane farmers. The scale was developed from a synthesis of LBP risk factors, pretested with 30 sugarcane farmers and administered to five hundred and forty sugarcane farmers to test its psychometric properties. Results indicated construct validity for three factors; physical factors (19 items) with factor loadings of 0.406 to 0.881 and communalities between 0.471 and 0.991; psychological factors (7 items) with factor loadings of 0.635 to 0.821 and communalities between 0.444 and 0.714, and third, working environment factors (2 items), with factor loadings between 0.345 and 0.347 and communalities between 0.946 and 0.953. The content validity index was 0.90 with reliability index of 0.87. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 82.02%, 30.49%, 62.65% and 54.40% respectively. The area under the receiver operating characteristic was 0.56. The scale's high specificity and sensitivity and comprehensive three risk-factor dimensions should make it a very useful screening tool in primary health care for early detection of LBP and for LBP risk-reduction and prevention advice. Future studies could focus on confirming content and predictive validity in other settings to assess generality of its usage.

Engaging community volunteers in participatory action research in Tamaki community of Auckland, New Zealand.

This article discusses the experiences of community volunteers' participation in a community-based participatory research project in Tamaki, a low socio-economic and ethnically diverse suburban community within greater Auckland City, New Zealand. In the Tamaki Community Action Research project, community volunteers were recruited and trained to conduct random household surveys (RHS) and asset mapping commissioned by community groups and government agencies in that area. The volunteers were involved in planning, coordination and ongoing governance of the project and ∼70 residents and local university students participated at different stages of the 2-year project. Over 600 RHS were completed and the volunteers' experiences were recorded in field notes, informal group discussions, daily team meetings and individual interviews and form the basis of this article. Only their experiences are discussed here, not the survey results which will be presented elsewhere. The project reflected the inherent asset-rich nature of the community via examples of individual volunteer empowerment and collective social/community capacity building. Volunteers increased their interpersonal and organizational skills, their understanding of the complexity of their community's logistics and cultural diversity, and gained an increased sense of community purpose and commitment. There was very strong endorsement of culturally sensitive research practice to recognize cultural differences and to engage productively within their richly ethnically diverse community. Full community volunteer participation in the project's governance (i.e. through design, training, implementation and ongoing consultation/management phases) was considered key to sustaining the life of project.

Choosing the optimal method of blood pressure measurement for limited-resource rural communities in the "Community Health Assessment Program-Philippines".

The Community Health Assessment Program-Philippines (CHAP-P) is an international collaboration of investigators whose aim is to adapt a previously proven Canadian community-based cardiovascular awareness and prevention intervention to the Philippines and other low-middle-income countries. Choosing a method of blood pressure measurement for the research program presents a challenge. There is increasing consensus globally that blood pressure measurement with automated devices is preferred. Recommendations from low-middle-income countries, including the Philippines, are less supportive of automated blood pressure devices. The value placed on factors including device accuracy, durability, cost, energy source, and complexity differ with local context. Our goal was to support the progress of local policy concerning blood pressure measurement while testing a comprehensive approach to community-based screening for cardiovascular risk. The authors describe the challenges in making a choice of blood pressure device and the approach to determine optimal method of measurement for our research program.

Role of socio-cultural and economic factors in cyprinid fish distribution networks and consumption in Lawa Lake region, Northeast Thailand: Novel perspectives on Opisthorchis viverrini transmission dynamics.

Opisthorchis viverrini (Ov) is a fish-borne parasite endemic in parts of Lao PDR, Cambodia, southern Vietnam and Northeast Thailand (Isaan) where an estimated 10 million people are infected. Human Ov infection, associated with hepatobiliary complications, including cholangiocarcinoma (CCA), occurs when infected fish are consumed raw or undercooked, a longstanding cultural tradition in the region. This mixed- methods descriptive study was carried out in Isaan villages around Lawa Lake, Khon Kaen Province, known for their Ov endemicity. Focus group discussions (FGDs) and in depth interviews (IDIs) were used to explore socio-cultural determinants underlying raw fish consumption practices, and global positioning system (GPS) devices to map local fish distribution networks. Qualitative data affirmed major socio-cultural and dietary lifestyle transitions occurring consequent on recent decades of modernization policies and practices, but also the persistence of Isaan traditional raw-fish eating practices and incorrect beliefs about infection risk avoidance. Fish traders/middlemen purchase most of the catch at the lakeshore and play the dominant role in district market fish distribution networks, at least for the larger and less likely infected, fish species. The lower economic value of the small potentially-infected cyprinid fish means local fishermen typically distribute them free, or sell cheaply, to family and friends, effectively concentrating infection risk in already highly Ov infected villages. Our study confirmed the persistence of traditional Isaan raw-fish meal practices, despite major ongoing socio-cultural lifestyle transitions and decades of Ov infection health education programs. We contend that diffuse socio-cultural drivers underpin this practice, including its role as a valued cultural identity marker. A "fish economics" factor was also evident in the concentration of more likely infected fish back into local villages due to their low economic value at district market level. The complexity of factors supporting "risky" fish-eating traditions in Isaan underscores the importance of integrated liver fluke infection control strategies to draw on transdisciplinary knowledge beyond biomedicine and also embrace participatory protocols for engaging communities in developing, implementing and evaluating interventions.

Risk factors for Clonorchis sinensis infection transmission in humans in northern Vietnam: A descriptive and social network analysis study.

Clonorchis sinensis is major fish-borne trematode, endemic in North Vietnam. Risk factors described so far include individual eating behaviors and environmental factors. Here, additional to conventional risk factors, we report on socially influenced liver fluke transmission in endemic communities. A cross-sectional study on risk factors and fish sharing networks was conducted in 4 villages of Gia Thinh Commune, Ninh Binh Province. A total of 510 residents in 272 households were recruited for risk factor analysis while 220 households, 28 fishermen and 10 fish-sellers were enrolled for social network study. Fecal examination for C. sinensis eggs was performed. Average C. sinensis infection rate at Gia Thinh commune was 16.5% (range 2% to 34.4%). Higher infection rates were significantly associated with males, lower educational levels, eating raw fish, and location of the villages. Social network analysis (SNA) showed a strong positive correlation between ego network size (number of households in fish sharing network) and quantity of raw fish consumed (r=0.603, P<0.05). The infection rate in people who ate raw-fish caught from a nearby river was significantly higher than those who consumed fish taken from farmed ponds (P<0.05). The amount of raw-fish meal consumed per resident/year was significantly higher in villages that had a strong network of sharing raw-fish food (P<0.001). This study reports for the first time on fish-food sharing among neighbors, proximity to water bodies, frequency of eating raw fish from natural water bodies and low education were key risk factors in C. sinensis infection transmission in northern Vietnam.

The Development of a Readiness Scale for Changing Farmers' Behaviors of Using Pesticides.

BACKGROUND AND OBJECTIVE: Inappropriate pesticide-using behaviors impose significant negative impacts on health and environment. Developmentalprograms to change such behaviors offarmers should target those who are ready to change in order to achieve efficiency. The objective was to develop a readiness scale in changing behavior ofusing pesticides offarmers. The scale of this study is expected to be used in recruiting targetfarmers in developmental programs. MATERIAL AND METHOD: A cross-sectional study was divided into two phases. The first phase, qualitative method, performed on 17farmers participated to seek factors related to the farmers' safe use of pesticides. The second phase, quantitative method to develop the readiness scale, an exploratoryfactor analysis (EFA) was analyzed on 230farmers and was randomly selected to measure the scale's construct validity, internal consistency (reliability), one-dimensionality and the appropriate cut-off point, respectively. RESULTS: Farmers' pesticide use, safety behaviors involved several factors, and are applied to create a set ofquestions on the readiness scale; there were 33 main items (with 40 sub-items), which could be grouped into 8 factors associated with farmers using pesticide safety, the scale, the best way to predict farmers who are ready to change. Finally, they were reduced to 23 main questions with 30 sub-questions in the scale. CONCLUSION: The development of a readiness scale application of changing behaviors as a guide, to assess content validity using index of item-objective congruence measurement (IOC), the exploratory factor analysis was used to determine an item and to test reliability on the scale. The scale can be a useful tool for recruiting farmers into intervention program in changing pesticide use, safety behaviors.

Toward integrated opisthorchiasis control in northeast Thailand: the Lawa project.

Human liver fluke, Opisthorchis viverrini, a food-borne trematode is a significant public health problem in Southeast Asia, particularly in Thailand. Despite a long history of control programmes in Thailand and a nationwide reduction, O. viverrini infection prevalence remains high in the northeastern provinces. Therefore, a new strategy for controlling the liver fluke infection using the EcoHealth/One Health approach was introduced into the Lawa Lake area in Khon Kaen province where the liver fluke is endemic. A programme has been carried using anthelminthic treatment, novel intensive health education methods both in the communities and in schools, ecosystem monitoring and active community participation. As a result, the infection rate in the more than 10 villages surrounding the lake has declined to approximate one third of the average of 50% as estimated by a baseline survey. Strikingly, the Cyprinoid fish species in the lake, which are the intermediate host, now showed less than 1% prevalence compared to a maximum of 70% at baseline. This liver fluke control programme, named "Lawa model," is now recognised nationally and internationally, and being expanding to other parts of Thailand and neighbouring Mekong countries. Challenges to O. viverrini disease control, and lessons learned in developing an integrative control programme using a community-based, ecosystem approach, and scaling-up regionally based on Lawa as a model are described.

Cryopreservation of Greenshell™ mussel (Perna canaliculus) sperm.

Cryopreservation is a valuable technique for aquaculture as it enables a library or bank of genetically valuable animals to be maintained in a cost-effective manner. Here, we describe a method to cryopreserve the sperm of the Greenshell™ mussel (Perna canaliculus) and how to use the sperm post-thawing to maximize larval production from thawed sperm in selective breeding.

Home delivery in Southern Lao PDR: Challenges to achieving MDG 4 and 5 targets

@#<p style="text-align: justify;">This study investigated rural Lao PDR village women's views and experiences of recent, or impeding, childbirth to better understand barriers to maternity service usage. Lao PDR has the highest maternal mortality rate (MMR) in the South-East Asian region with very low utilization rates for skilled birth assistance and health sector delivery services. The study site, Sekong, a southern Lao province, was lowest in the country on virtually all indicators of reproductive and maternal health, despite several recent maternal health service interventions. The study's aim was to gain a fuller understanding of barriers to maternity services usage to contribute towards maternity services enhancement, and district and national policy-making for progressing towards 2015 MDG 4 & 5 targets.</p> <p style="text-align: justify;">A descriptive cross-sectional study was used. First, face-to-face questionnaires were used to collect demographic and reproductive health and health care experience data from 166 village woman (120 with a child born in the previous year, and 46 who were currently pregnant). In-depth individual interviews then followed with 23 purposively selected woman, to probe personal experiences and perspectives on why women preferred home birthing.</p> <p style="text-align: justify;">The majority of the woman had given at home, assisted by untrained birth attendants (relatives or neighbours). While seventy percent had accessed some antenatal services, postpartum follow-up attendance was very low (17 percent). Limited finances, lack of access to transport and prior negative health service experiences were important factors influencing women's decision making. Giving birth at home was seen by many, not just as unavoidable, but, as the preferred option.</p> <p style="text-align: justify;">Recent top-down maternal health initiatives have had little impact in this region. Improving maternal and child-health strategies requires much greater community participation and use of participatory action methodologies, to increase women's engagement in policy and planning and subsequent usage of health service developments.</p>

Action research to strengthen women weavers' self-care in North-East Thailand.

OBJECTIVE: The objective of this research was to improve self-care and work safety practices among women weavers in North-East Thailand. DESIGN AND SAMPLE: Action research was used with a sample of 107 weavers and 15 community and local government stakeholders from six rural villages. Formative and summative evaluation was carried out over 10 months following initial implementation of five action plans, and after 5 years. MEASURES: Qualitative data were collected via focus groups, formal and informal interviews and research field notes. Women's self-care issues and safety problems, and weaving-related environmental pollution emerged from the content analyses. Five action plans were created. RESULTS: Results showed that through action research the women were empowered to identify personal and work-related health issues, environmental contamination concerns, and lack of social and community support systems. Over time they developed capacity for working collectively to address these. Five year follow-up revealed many of the changes made were ongoing, and well-integrated into community life. CONCLUSIONS: The study reaffirmed the potential for public health or community nurses and other health personnel for enhancing community health status via action research with vulnerable populations; in this case, rural village women weavers in North-East Thailand.

Pyrethroid insecticide tolerance in bean leaf beetle, Cerotoma trifurcata, in the Mississippi Delta.

BACKGROUND: Pyrethroid insecticides have historically been effective for controlling bean leaf beetles in soybeans. Perceived field efficacy in the Mississippi Delta region has been lower over the past several years. Laboratory and field data were collected to determine whether there has been a reduction in pyrethroid insecticide susceptibility. RESULTS: Laboratory and field data both confirmed that control of bean leaf beetles with pyrethroid insecticides is poorer in the Delta regions of Mississippi and Louisiana than in all other regions tested. However, it was not possible to show that this reduced susceptibility changed over time. Furthermore, insect movement appeared to make insecticide susceptibility regional, so that localized insecticide applications had little impact on the susceptibility of successive generations. CONCLUSION: Lack of field control owing to low efficacy of pyrethroid insecticides against bean leaf beetle populations in the Delta region should be expected. Selection pressure on a regional basis may further decrease efficacy. Carbamate insecticides generally still provide high levels of control.

Community participation efforts for strengthening community well-being through conflict management

This participatory action research aimed to enhance a community's potential in strengthening sub-district well-being, a grass-root community of Northeast Thailand. Community Participation had three patterns. The first pattern-involved determining the five community commitments in which the members relied on an honest living, followed a "sufficiency economy" process, practiced local traditions, engaged in community development, and prevented their community from conflicts under the community justice system. The second participation was processed through community meetings with volunteer voting. Three workshops were arranged for volunteer training to develop instruction media for raising consciousness, distributing their knowledge, and resolving any controversies among the community members. The third participation was to advocate human rights among the community members by broadcasting via the local news tower, religious ceremonies, and career meetings. These activities helped encourage generosity among the community members, praised the respectful members , maintained traditions, developed communication, and built careers for the children, handicapped, poor, sick or elderly as well as supporting a community's proactive role in using the justice system to settle conflicts among its members.

Towards cryopreservation of Greenshell mussel (Perna canaliculus) oocytes.

Cryopreservation is a powerful tool for selective breeding in aquaculture as it enables genetic material from selected stock to be stored and crossed at will. The aim of this study was to develop a method for cryopreserving oocytes of the Greenshelltrade mark mussel (Perna canaliculus), New Zealand's main aquaculture species. The ability of oocytes to be fertilized post-thawing was used as the criterion for success in initial experiments and then subsequently, the ability of frozen oocytes to develop further to D-stage larvae was assessed. Ethylene glycol, propylene glycol, dimethyl sulphoxide and glycerol were evaluated at a range of concentrations with and without the addition of 0.2M trehalose using post-thaw fertilization as the endpoint. Ethylene glycol was most effective, particularly when used in combination with trehalose. A more detailed investigation revealed that ethylene glycol at 9% or 10% in the presence of 0.2-0.4M trehalose afforded the best protection. In experiments varying sperm to egg ratio and egg density in post-thaw fertilization procedures, D-larval yield averaged less than 1%. Following these results, a detailed experiment was conducted to determine the damaging steps in the cryopreservation process. Fertilization losses occurred at each step whereas D-larval yield approximately halved following CPA addition and was almost zero following cooling to -10 degrees C. Cryomicroscopy studies and fertilization results suggest that the inability of oocytes to develop to D-larvae stage after cooling to -10 degrees C and beyond are most likely related to some form of chilling injury rather than extracellular ice triggering intracellular ice formation. Further research is needed to determine the causes of this injury and to reduce CPA toxicity and/or osmotic effects.

Help-seeking at the time of stroke: stroke survivors' perspectives on their decisions.

Stroke is a major cause of death and disability in many countries. Early access to the most appropriate medical treatment can improve health outcomes. Despite this, only 30-60% of people who experience a stroke seek medical help within the recommended 3-hour timeframe. This study used open-ended interviews to explore patients' views on factors that influenced their decision to seek help at the time of stroke. Twenty participants were recruited from five centres: three hospitals, a community-based stroke support service and a primary healthcare service focused on providing health care for Maori. A qualitative methodology drawing on Grounded Theory informed data collection and analysis. Four main themes influenced the decision to seek help: making sense of symptoms, maintaining a sense of normality, presence and influence of another person and perception of medical services. Participants appeared to go through a process of recognition, interpretation and negotiation during their decision-making. Each of the four themes seemed to influence this process, either assisting or delaying help-seeking behaviour. The more time spent going through this process (or repeating each step), the longer the delay appeared to be. Our key findings which add to current help-seeking literature, include: (1) people tended to prioritise everyday commitments and responsibilities over their own health; (2) at times the presence and influence of another person contributed to delays in seeking help; and (3) people had different personal thresholds for when they perceived themselves to be 'sick enough' to seek medical help.

Effects of scrotal heating on sperm surface protein PH-20 expression in sheep.

Sperm surface protein PH-20 expression was studied during spermatogenesis in pubertal and adult sheep, using molecular and histological methods. The effects of 24 hr of insulation raising scrotal temperatures to 39 degrees C on PH-20 expression in ejaculated sheep sperm were also determined. A 282 nt cDNA fragment of ovine PH-20 was identified in total RNA extracts of sheep testes, which exhibited 76% identity at the nucleotide level with the equivalent region of the human sequence. Ovine PH-20 mRNA and immunoreactivity were identified only in adult ram testis and not in peri-pubertal ram testis tubules lacking round spermatids, nor in adult sheep brain, pituitary, heart, spleen, lung, liver, kidney, epididymis, or ovary. Ovine PH-20 protein was distributed predominantly on the postacrosomal membrane and was also present on the anterior membrane of the sperm head in fresh, unheated sheep semen. Scrotal heating caused a significant, transient decrease in the percentage of PH-20 immunoreactive sperm, but did not change the pattern of PH-20 staining on the sperm head. The results strongly suggest that ovine PH-20 is postmeiotically expressed in haploid germ cells in sheep testis and is arrayed on the membrane of the mature ovine spermatozoon. Scrotal heating appears to have few effects on PH-20 expression and distribution on ejaculated sperm.