The Pattern of Uveitis in a Pediatric Population at a Tertiary Center in Thailand.

PURPOSE: To describe the clinical characteristics and longitudinal pattern of visual acuity (VA) of pediatric patients with uveitis at a tertiary center in Thailand. METHODS: We retrospectively reviewed the records of children with uveitis ≤16 years who presented to the clinic between January 2010 and June 2020. RESULTS: The mean age at onset was 9.1(±4.3) years; the main characteristics were chronic (64.4%), unilateral (68.6%), and panuveitis (39%). The common etiologies were ocular toxoplasmosis (11.9%), herpetic uveitis (10.2%), and ocular toxocariasis (6.8%). Further, 40% of the eyes presented with VA of ≤20/200; mean VA at baseline improved from 0.93 to 0.72 logMAR at 3 months after presentation (P < .001), the baseline VA of ≤20/200 was significantly associated with poor VA outcome at 1 year. CONCLUSION: Chronic, unilateral, and panuveitis represented the majority of our children with uveitis. Infectious etiology was common. Significant VA improvement can be achieved with optimum management.

Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar.

Purpose: We investigated the association of TB patients and their household contacts with diabetes mellitus (DM) and hypertension compared to the general population, and the mediating effects of risk behaviors including current smoking, alcohol drinking, and poor diet quality. Patients and Methods: A cross-sectional study on screening for DM, hypertension, and risk behaviors among newly diagnosed TB patients (n = 221) and their household contacts (n = 257) aged 25-74 years in Yangon in 2018. Health data of the general population (n = 755) were obtained from an NCD risk factor survey in Yangon. A directed acyclic graph is used to identify possible pathways of association between variables. Associations are presented as adjusted odds ratios (aOR). Results: Compared to the general population, both TB patients and their household contacts were associated with current smoking and drinking, and TB patients were more likely to be underweight. Without considering mediating effects, TB patients had higher odds of DM (aOR = 6.3, 95% CI: 3.8-10.6), but both TB patients and household contacts had lower odds of hypertension (aOR = 0.54; 95% CI: 0.33-0.87) and (aOR = 0.68; 95% CI: 0.47-0.98), respectively. The body mass index-mediated pathway reduced the odds of DM and hypertension among TB patients (aOR = 3.4; 95% CI: 2.2-5.3) and (aOR = 0.3; 95% CI: 0.2-0.5), respectively. Conclusion: The shared risk behaviors among TB patients and household contacts with high burden of DM in TB patients endorse screening of risk behaviors and strengthening the integration of NCD services among TB patients and household contacts in this dual-burden country.

Effects of Character Strength-Based Intervention vs Group Counseling on Post-Traumatic Growth, Well-Being, and Depression Among University Students During the COVID-19 Pandemic in Guangdong, China: A Non-Inferiority Trial.

Purpose: This study assessed the effects of character strengths-based invention (CSI) vs group counseling (GC) on mental health outcomes (ie, post-traumatic growth, well-being, and depression) among university students in Guangdong Province, China. Materials and Methods: We conducted a randomized non-inferiority trial among 124 undergraduates at a medical university during the COVID-19 pandemic. We randomly allocated students to receive either CSI (n=62) or GC (n=62). A qualified psychologist delivered both activities on campus during two consecutive weekends with a total of 7.5 hours and also gave assignments to students during weekdays. We measured the outcomes at pre-intervention, post-intervention, and 1-month follow-up. We then analyzed data using descriptive statistics and a general linear mixed model. Results: CSI and GC groups had similar baseline characteristics. Both CSI and GC experienced an increase in post-traumatic growth and well-being. The mean±SD scores for post-traumatic growth were significantly higher in CSI compared to GC groups (87.70±14.22 vs 78.15±20.72, respectively), whereas well-being scores were similar between CSI and GC (82.58±16.57 vs 83.68±15.59, respectively). Neither CSI nor GC experienced a reduction in depression scores. Conclusion: CSI had non-inferior effects compared to GC with regards to improvement of post-traumatic growth and well-being during the COVID-19 pandemic. However, caveats regarding lack of blinding of investigator and limited generalizability should be considered in the interpretation of the study findings.

Expression and Prognostic Significance of c-Myc, ALK, ROS1, BRAF, and PD-L1 Among Patients With Non-Small Cell Lung Cancer.

Background: Non-small cell lung cancer (NSCLC) remains a leading cause of cancer death worldwide, for which better knowledge in molecular prognostic factors is needed to improve clinical outcome. This study aimed to investigate the clinical significance of c-Myc, ALK, ROS1, BRAF, and PD-L1 in NSCLC patients. Methods: Formalin-fixed paraffin-embedded tissue specimens were obtained from 124 NSCLC patients. Of these, 66 matched specimens of normal respiratory epithelial and tumor tissue from patients with stages I-III, who underwent surgical resection, and 58 NSCLC specimens from stage IV patients were recruited into this analysis. Immunohistochemistry staining along with semiquantitative criteria were used to evaluate the expression of the interested proteins. Results: Of the 66 patients with stages I-III, positive expression of c-Myc was detected in 12 specimens (18.2%) of NSCLC tissue, whereas none of the normal respiratory epithelial tissue was found to have c-Myc expression (P < .001). Of the 66 NSCLC patients, 28 (43.8%) had PD-L1-positive staining on 1%-49% tumor cells and 7 (10.9%) patients expressed PD-L1 in ⩾50% tumor cells. One (2.3%) adenocarcinoma patient was found to have ROS1 rearrangement. Patients with no expression of c-Myc and PD-L1 (co-negative expression) tended to have a better prognosis than other subgroups. Conclusions: NSCLC tissue significantly expressed more c-Myc and PD-L1, compared with the matched normal respiratory epithelium, emphasizing the important role of these key drivers in tumorigenesis. Therapeutic approach to precisely inhibit the targetable molecular pathways should be considered on an individual patient basis to improve survival outcome.

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.

Copy number gains of chromosome 17 identified by dual in situ hybridization in non-small cell lung cancer tissue correlate with overexpression of c-Myc.

Background: c-Myc regulates multiple genes involved in cell proliferation in various cancer types including non-small cell lung cancer (NSCLC). Copy number gains of cytoband 17q25.3, along with chromosome 17, have been reported in NSCLC patients, emphasizing the clinical significance as a potential molecular target for therapy. The upregulation of c-Myc has been found to accelerate tumor development associated with duplication of the syntenic human cytoband 17q25.3. This study aimed to explore and compare the correlations of chromosome 17 copy number and c-Myc expression in NSCLC with the paired-normal respiratory epithelium and to examine their role as potential molecular targets for NSCLC therapy. Methods: A total of 66 NSCLC tissue samples with paired-normal respiratory epithelium were examined. The copy number of chromosome 17 was determined by human epidermal growth factor receptor 2 (HER2)/centromeric enumeration probe of chromosome 17 (CEP17) dual in situ hybridization (DISH). Results: Copy number gains of chromosome 17 were identified in 8 of 60 (13.3%) available NSCLC specimens. No copy number gains of chromosome 17 were demonstrated in the paired-normal respiratory epithelium. The mean HER2 (1.2±0.3) and CEP17 (1.4±0.3) copy numbers of the normal respiratory epithelium were significantly lower than those of the NSCLC tissue [1.8±1.0 vs. 2.0±0.8, respectively (P<0.001)]. Twelve of 66 (18.2%) NSCLC patients had overexpression of c-Myc. Five (41.7%) of the patients whose tumors positive for c-Myc had HER2 gene amplification [1] or copy number gain of chromosome 17 [4]. HER2 gene amplification or copy number gain of chromosome 17 and high expression of c-Myc were associated with decreased overall survival. Conclusions: Both biomarkers deserve further investigation to identify NSCLC patients with poorer survival outcomes requiring better therapeutic approaches.

Programmatic Cost-Effectiveness of a Second-Time Visit to Detect New Tuberculosis and Diabetes Mellitus in TB Contact Tracing in Myanmar.

BACKGROUND: Integration of diabetes mellitus screening in home visits for contact tracing for tuberculosis could identify hidden patients with either tuberculosis or diabetes mellitus. However, poor compliance to the first home screening has been reported. A second time visit not only increases screening compliance but also the cost. This study aimed to determine if an additional second time visit was cost effective based on the health system perspective of the tuberculosis contact tracing program in Myanmar. METHODS: This cross-sectional study was based on usual contact tracing activity in the Yangon Region, Myanmar, from April to December 2018 with integration of diabetes mellitus screening and an additional home visit to take blood glucose tests along with repeated health education and counseling to stress the need for a chest X-ray. New tuberculosis and diabetes mellitus cases detected were the main outcome variables. Programmatic operational costs were calculated based on a standardized framework for cost evaluation on tuberculosis screening. The effectiveness of an additional home visit was estimated using disability-adjusted life years averted. The willingness to pay threshold was taken as 1250.00 US dollars gross domestic product per capita of the country. RESULTS: Single and additional home visits could lead to 42.5% and 65.0% full compliance and 27.2 and 9.3 additional years of disability-adjusted life years averted, respectively. The respective base costs and additional costs were 3280.95 US dollars and 1989.02 US dollars. The programmatic costs for an extra unit of disability-adjusted life years averted was 213.87 US dollars, which was lower than the willingness to pay threshold. CONCLUSIONS: From the programmatic perspective, conducting the second time visit for tuberculosis contact tracing integrated with diabetes mellitus screening was found to be cost effective.

Sensory stimulation program improves developments of preterm infants in Southwest China: A randomized controlled trial.

Preterm infants are prone to growth and developmental delay, especially social-emotional development. Sensory stimulation may benefit developmental outcomes for these vulnerable infants. This study aims to determine whether 5-integrated sensory stimulation (5-ISS) improves preterm infant social-emotional development. A randomized, parallel trial was conducted from November 2018 to January 2020 at three tertiary hospitals in Kunming, China. Preterm infants were eligible if gestational ages were from 28 to 36 weeks based on ultrasound results when discharged from neonatal wards. Two hundred preterm infants (male n = 110, female n = 90) were randomly allocated to the 5-ISS intervention group (n = 98) and the standard care group (n = 102). Social-emotional development was assessed with the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE). Temperament was assessed with the Infant Behavior Questionnaire-Revised. Anthropometry, which included weight, length, and head circumference, was measured at corrected ages of 1, 3, and 6 months. Demographic and clinical characteristics were similar between the intervention and the standard care groups. At 1- and 3-month corrected age, no significant differences between the two groups were observed in terms of infant development and temperament. At 6 months, significant disparities were found in the social-emotional development scale (mean difference -0.29, 95% CI: -0.58, < -0.001, p = 0.01), infant length (mean difference 0.70, 95% CI: < 0.001, 1.4, p = 0.03), distress to limitation (p = 0.04), and sadness (p = 0.03). A mixed model revealed that the 5-ISS intervention positively affected social-emotional development, length, distress to limitation, and sadness for preterm infants. Integrated sensory stimulation has benefits on social-emotional development, temperament, and length for preterm infants. This program provides a feasible method to promote social-emotional development for preterm infants.

The effects of others' drinking on the harms to children in Thailand: Lessons from the WHO-ThaiHealth project.

BACKGROUND: Many knowledge gaps exist in the area of alcohol-related harms in children research such as the potential impact of other's drinking and their social demography. Thus, this study aims to evaluate the effects of characteristics of household members and others' alcohol drinking on harms to children in Thailand. DATA AND METHODS: This study examined 952 parents caring for children and adolescents under 18 years of age, using the questionnaire (i.e., The Harm to Others from Drinking under the WHO/ThaiHealth International Collaboration Research Project). They were interviewed between September 2012 and March 2013. RESULTS: The study found that 15.89% of children and young people were affected by someone's drinking in at least one category of harms. People over 60 years of age were less likely to cause alcohol-related harm to children than those aged 18 to 29 (adjusted odds ratio [AOR] 0.19, 95% confidence interval [Cl]: 0.06-0.58). Households with a binge drinker or regular drinker (≥1 time/week) were more likely to have children at higher risk of suffering alcohol-related harm in comparison to households without alcohol drinker (AOR 4.75 and 1.92, respectively). CONCLUSION: This study found that children whose family members are young adult or consume alcohol (i.e., weekly drinker or binge drinker) were significantly adversely affected. The most common problems were domestic violence and verbal abuse. Most of the problems, affecting children, were caused mostly by their parents.