Migration and Unrest in the Deep South Thailand: A Multilevel Analysis of a Longitudinal Study.

Although migration of Muslims from the southernmost provinces of Thailand to Malaysia has a long history, research suggests that the intensity of this migration has increased in the past 10 years along with increased unrest in the provinces. This study examines how migration in the three southernmost provinces is affected by the ongoing unrest. Data are drawn from household probability surveys conducted in 2014 and 2016. An individual sample of 3,467 persons who were household residents at the 2014 survey was followed to see who remained in the household of origin or moved out two years later (2016 survey). Data on violent events from the Deep South Watch, an independent organization, were used to measure exposure to violence. Results from a multilevel analysis show that net of other characteristics at the individual, household, and village levels, individuals who live in a village in which a violent event occurred in the previous year are more likely to move out than those who live in a village with no violent event in the previous year. Findings suggest that in addition to the economic reasons that have long motivated migration from this area, violent events accelerate this migration.

HIV Testing and Cross Border Migrant Vulnerability: Social Integration and Legal/Economic Status Among Cross Border Migrant Workers in Thailand.

The objective of this paper was to identify factors related to the use of HIV testing among cross border migrants in Thailand. Two measures of vulnerability (social integration and legal/economic status) as well as HIV knowledge, risk behaviour, and demographic factors were tested for association with HIV testing. Data were drawn from a survey of 2600 sexually active migrants age 15-59 in multiple provinces of Thailand. The measures of social integration (AOR = 1.14(95 % CI 1.09, 1.20) female; AOR = 1.12 (95 %CI 1.05, 1.19) male) and legal-income status (AOR = 1.12 (95 % CI 1.07, 1.18) female; AOR = 1.31 (95 %CI 1.20, 1.42) male) were positively related to the odds of reporting an HIV test for both male and female migrants. Exposure to AIDS programming including attending an AIDS meeting and possessing AIDS knowledge was also related to an increase in HIV testing. In addition, reproductive health factors including sexual risk behavior and childbirth increased the rate of HIV testing.

Social integration, AIDS knowledge and factors related to HIV prevention among migrant workers in Thailand.

Previous research on migrant health indicates that social integration may exert a strong influence on health behavior. However, to our knowledge, this factor has not been integrated into models for HIV prevention. Drawing constructs from the Health Belief Model, the objective of this paper was to determine whether social integration, demographic, relationship and other factors were related to migrants' ability to prevent HIV infection through AIDS knowledge and condom use. Data for the study were drawn from a survey of 3,405 male and female migrant laborers from Myanmar, Cambodia and Laos who were working in Thailand in 2010. Regression analysis showed that social integration, participation in an AIDS prevention program, self efficacy, demographic and relationship factors increased AIDS knowledge and condom use with regular and nonregular partners. The social integration of migrants into the Thai community strengthened HIV prevention efforts.

Role of social capital in response to and recovery from the first wave of COVID-19 in Thailand: a qualitative study.

OBJECTIVE: This study assesses the role of social capital among people and communities in response to the first wave of the pandemic in 2020. DESIGN: Qualitative study using focus group discussions. SETTING: Capital city (Bangkok) and the four regions (north, northeast, south and central) of Thailand. PARTICIPANTS: 161 participants of 19 focus groups with diverse backgrounds in terms of gender, profession, education and geography (urban/rural; regions). They are selected for different levels of impact from the pandemic. FINDINGS: The solidarity among the Thai people was a key contributing factor to societal resilience during the pandemic. Findings illustrate how three levels of social capital structure-family, community and local networks-mobilised resources from internal and external social networks to support people affected by the pandemic. The results also highlight different types of resources mobilised from the three levels of social capital, factors that affect resilience, collective action to combat the negative impacts of the pandemic, and the roles of social media and gender. CONCLUSION: Social capital plays significant roles in the resilience of individuals, households and communities to respond to and recover from the impacts of the pandemic. In many instances, social capital is a faster and more efficient response than other kinds of formal support. Social capital can be enhanced by interactions and exchanges in the communities. While face-to-face social contacts are challenged by the need for social distancing and travel restrictions, social media steps in as alternative socialisation to enhance social capital.

Midlife sexuality among Thai adults: Adjustment to aging in the Thai family context.

The objective of the study is to assess views of age related changes in sexual behavior among married Thai adults age 53 to 57. Results are viewed in the context of life course theory. In-depth interviews were conducted with 44 Thai adults in Bangkok and the four regions of Thailand. Topics covered include changing sexual behavior with age, adjustment to this change, gender differences in behavior, attitudes toward commercial sex and other non-marital sexual partners, and condom use. Most respondents were aware of this change and saw a decrease in sexual activity and desire more often among women compared to men. At the same time, many respondents viewed sexuality as important to a marriage. Some respondents accepted the decrease in sexual activity and focused more on work, family and temple activities. Thai Buddhism was seen as an important resource for people who were dealing with changes due to aging. Other persons turned to other partners including both commercial and non-commercial partners. The influence of the HIV epidemic that began in the 1990s was seen in concerns about disease transmission with extramarital partners and consequent attitudes toward condom use. The acceptability of extramarital partners in the family and community ranged from acceptance to strong disapproval of extramarital relationships.

Psychiatric symptoms among migrants to Malaysia from the southernmost provinces of Thailand.

AIM: The objective of this paper is to examine the level of psychiatric symptoms and associated factors among Thai migrants from the southernmost Thai provinces of Pattani, Yala, and Narithiwat who are working in Malaysia. Comparisons will be made with the sending population in the southernmost provinces of Thailand. METHODS: Data are drawn from survey and in-depth interviews with Thai migrants who are working in Malaysia. Comparisons are made with a probability sample of working age adults in Thailand. The twenty item Self Reporting Questionnaire (SRQ) was the measure of mental health. RESULTS: The study found that the migrants, on average, have normal levels of psychiatric symptoms. However, although about 24% of migrants reported more eight or more symptoms that may indicate a need for evaluation. There are many stressors in their lives including distance from families, reduced social support, legal matters surrounding immigration, and discrimination/exploitation of migrant groups. CONCLUSION: The study highlights the need for policy makers and non-governmental organizations to give attention to migrants' mental health, well-being and sustainable livelihoods.

Evaluating and Extending the Informed Consent Ontology for Representing Permissions from the Clinical Domain.

The purpose of this study was to evaluate, revise, and extend the Informed Consent Ontology (ICO) for expressing clinical permissions, including reuse of residual clinical biospecimens and health data. This study followed a formative evaluation design and used a bottom-up modeling approach. Data were collected from the literature on US federal regulations and a study of clinical consent forms. Eleven federal regulations and fifteen permission-sentences from clinical consent forms were iteratively modeled to identify entities and their relationships, followed by community reflection and negotiation based on a series of predetermined evaluation questions. ICO included fifty-two classes and twelve object properties necessary when modeling, demonstrating appropriateness of extending ICO for the clinical domain. Twenty-six additional classes were imported into ICO from other ontologies, and twelve new classes were recommended for development. This work addresses a critical gap in formally representing permissions clinical permissions, including reuse of residual clinical biospecimens and health data. It makes missing content available to the OBO Foundry, enabling use alongside other widely-adopted biomedical ontologies. ICO serves as a machine-interpretable and interoperable tool for responsible reuse of residual clinical biospecimens and health data at scale.

A more informative approach for characterization of polymer monolithic phases: small angle neutron scattering/ultrasmall angle neutron scattering.

Neutron scattering techniques have been used frequently to characterize geological specimens and to determine the structures of glasses and of polymers as solutions, suspensions, or melts. Little work has been reported on their application in determining polymers' structural properties relevant to separations. Here, we present a comparison of characterization results from nitrogen porosimetry and from combined small angle neutron scattering (SANS) and ultrasmall angle neutron scattering (USANS) experiments. We show that SANS is extremely sensitive to the pore characteristics. Both approaches can provide information about porosity and pore characteristics, but the neutron scattering techniques provide additional information in the form of the surface characteristics of the pores and their length scales. Fits of the scattering data show that cylindrical pores are present with diameters down to 0.6 µm and that, for length scales down to approxmately 20 Å, the material shows self-similar (fractal) slopes of -3.4 to -3.6. Comparison of these characteristics with other examples from the scattering literature indicate that further investigation of their meaning for chromatographic media is required.

Expressing and Executing Informed Consent Permissions Using SWRL: The All of Us Use Case.

The informed consent process is a complicated procedure involving permissions as well a variety of entities and actions. In this paper, we discuss the use of Semantic Web Rule Language (SWRL) to further extend the Informed Consent Ontology (ICO) to allow for semantic machine-based reasoning to manage and generate important permission-based information that can later be viewed by stakeholders. We present four use cases of permissions from the All of Us informed consent document and translate these permissions into SWRL expressions to extend and operationalize ICO. Our efforts show how SWRL is able to infer some of the implicit information based on the defined rules, and demonstrate the utility of ICO through the use of SWRL extensions. Future work will include developing formal and generalized rules and expressing permissions from the entire document, as well as working towards integrating ICO into software systems to enhance the semantic representation of informed consent for biomedical research.

Lessons Learned for Identifying and Annotating Permissions in Clinical Consent Forms.

BACKGROUND: The lack of machine-interpretable representations of consent permissions precludes development of tools that act upon permissions across information ecosystems, at scale. OBJECTIVES: To report the process, results, and lessons learned while annotating permissions in clinical consent forms. METHODS: We conducted a retrospective analysis of clinical consent forms. We developed an annotation scheme following the MAMA (Model-Annotate-Model-Annotate) cycle and evaluated interannotator agreement (IAA) using observed agreement (A o), weighted kappa (κw ), and Krippendorff's α. RESULTS: The final dataset included 6,399 sentences from 134 clinical consent forms. Complete agreement was achieved for 5,871 sentences, including 211 positively identified and 5,660 negatively identified as permission-sentences across all three annotators (A o = 0.944, Krippendorff's α = 0.599). These values reflect moderate to substantial IAA. Although permission-sentences contain a set of common words and structure, disagreements between annotators are largely explained by lexical variability and ambiguity in sentence meaning. CONCLUSION: Our findings point to the complexity of identifying permission-sentences within the clinical consent forms. We present our results in light of lessons learned, which may serve as a launching point for developing tools for automated permission extraction.

Cognitive functioning is related to physical functioning in a longitudinal study of women at midlife.

BACKGROUND: Studies have reported declines with age in cognitive or physical functioning, but rarely identify whether these are parallel or linked events in the same study. Furthermore, most research in this area has focused on persons in late life rather than midlife. OBJECTIVE: The objective of the study was to determine (1) if cognitive functioning was related to physical functioning and whether this relationship persisted after adjustment for age, menopause status, metabolic status, depression and socioeconomic resources, and (2) if changes in physical functioning were associated with changes in cognitive functioning over a 4-year follow-up period. METHODS: Data were from the Study of Women's Health Across the Nation (SWAN), a multi-site, longitudinal study of women aged 46-56 years at follow-up examination 4. Three follow-up examinations (study years 04, 06 and 08) included measures of physical functioning perception (MOS SF-36) and cognitive functioning [Symbol Digit Modality Test (SDMT), Digit Span Backward Test (DSBT), and East Boston Memory Test (EBMT)] (n = 2,405). RESULTS: Women with lower cognitive functioning scores also had lower perceived physical functioning scores. While adjustment for covariates attenuated the association between perceived physical functioning and both the SDMT and EBMT cognitive measures, these associations remained statistically significant. Additionally, the 4-year change in perceived physical functioning was significantly associated with the 4-year change in the EBMT. CONCLUSIONS: At midlife, there were associated declines in cognitive and perceived physical functioning scores, commencing at midlife in women.

Long-term civil conflict, migration, and the mental health of adults left behind in Thailand: a longitudinal study.

OBJECTIVES: A long-term civil conflict has been occurring in the southernmost provinces of Thailand, and migration to Malaysia has been accelerated by this conflict. The objective of this work was to examine the influence of perceived effects of the unrest, migration of a household member, and children left behind on the reporting of psychiatric symptoms of working age adults. METHODS: A first round of data collection was conducted in 2014 including interviews with a probability sample of 1102 households and individual interviews with 2058 males and females aged 18-59. In 2016, a second round of data collection was conducted. A fixed effects model was used in the analysis. RESULTS: The perceived effect of the unrest on the household was associated with an increased reporting of psychiatric symptoms. Furthermore, the migration of a household member for work and the presence of children left behind were related to an increased reporting of psychiatric symptoms among adults, especially among females. CONCLUSIONS: The unrest and its associated migration was related to an increased reporting of psychiatric symptoms among working age adults in the study population.

Coming of age in a conflict area: Mental health, education, employment, migration and family formation in the southernmost provinces of Thailand.

OBJECTIVES: Three southern provinces of Thailand - Pattani, Yala and Narathiwat - have been involved in a long period of unrest. Young people in these provinces have lived with this violence for many years. The objectives of this article are to assess the prevalence of psychiatric symptoms of young adults aged 18-24 years and to examine the perceived effects of the conflict on education, employment, social and religious life. METHODS: Data were drawn from a probability sample of 2,053 Muslim adults aged 18-59 years conducted in 2014. Mental health was assessed using World Health Organization's (WHO) Self Reporting Questionnaire (SRQ) of 20 questions, the Thai Mental Health questionnaire and a Happiness scale. In-depth interviews with 30 respondents were also used to assess the perceived effects of the conflict on daily life, education, employment and settlement. RESULTS: Most respondents reported low levels of psychiatric symptoms, though a small proportion reported a large high enough number to be of concern. Most of them also reported high levels of happiness. Respondents who wished to migrate to work in another area reported more psychiatric symptoms and lower levels of happiness. Many respondents reported concerns about the violence in their daily lives, although some may have become habituated to its effects. There were many obstacles reported toward obtaining education including the threat of violence, financial cost and drug use. Male respondents had concerns about consequences of being suspected to be involved in the violence and drug use. The limited employment and the threat of violence were related to the plan to migrate or to settle in the three provinces. CONCLUSION: In summary, most young people in the area move forward with their lives and many display some habituation to the violence. However, the economic depression due to the violence and the threat of violence often affected their daily lives.

The Access to Antenatal and Postpartum Care Services of Migrant Workers in the Greater Mekong Subregion: The Role of Acculturative Stress and Social Support.

The objective of this paper is to determine whether social support and acculturative stress were related to obtaining antenatal and postpartum care for pregnant female migrants, as well as access to health care for migrant children. The study utilized data of 987 migrant workers in Thailand who originated from hill tribes and mountain communities in Myanmar and Cambodia. Regression analysis showed that the language barrier, a crucial factor behind acculturative stress, adversely influenced access to maternal care. Social support reduced the impact of acculturative stress. Migrants with support are more likely to access health care. Based on the Multidimensional Scale of Perceived Social Support, more sources of support either from friends, family members, or other supporters who are significant could increase health care access. Besides friends and family, the support from the Migrant Health Worker Program and Migrant Health Volunteer Program allowed the formal health sector to utilize the informal social networks to improve care for migrants.

Mental health in a conflict area: Migration, economic stress and religiosity in the three southernmost provinces of Thailand.

AIM: Three southern provinces of Thailand, Pattani, Yala and Narathiwat, have been involved in a long period of unrest due to differences between the population in the provinces and the Thai government with regard to language, culture and governance. The objectives of this article are to examine the effects of everyday stressors due to the conflict, including economic stress and migration, as well as the effect of religiosity on the reporting of psychiatric symptoms among adults in the three provinces. METHODS: Data were drawn from a survey conducted in 2014. The survey included a probability sample of 2,053 Muslim adults aged 18-59 years.Mental health was assessed using World Health Organization's (WHO) Self-Reporting Questionnaire (SRQ) of 20 questions. Multilevel models were estimated to examine the influence of economic stress due to the conflict, as well as community and individual aspects of migration and religion on mental health. RESULTS: The data showed that migration from the household and the community and the economic effects of the unrest were associated with reporting of more psychiatric symptoms among adults in the southern provinces. Religion was related to reporting of fewer psychiatric symptoms at the individual and the community levels. CONCLUSION: The study documented increased reporting of psychiatric symptoms among persons reporting perceived household economic stress due to the conflict and the migration of family members.

A workplace intervention program and the increase in HIV knowledge, perceived accessibility and use of condoms among young factory workers in Thailand.

Vulnerability to Human Immunodeficiency Virus (HIV) infection among factory workers is a global problem. This study investigated the effectiveness of an intervention to increase AIDS knowledge, perceived accessibility to condoms and condom use among young factory workers in Thailand. The intervention was a workplace program designed to engage the private sector in HIV prevention. A cross-sectional survey conducted in 2008 to measure program outcomes in factories in Thailand was used in this study. The workplace intervention included the development of policies for management of HIV-positive employees, training sessions for managers and workers, and distribution of educational materials and condoms. A multi-level analysis was used to investigate the effect of HIV/AIDS prevention program components at the workplace on HIV/AIDS knowledge, perceived accessibility to condoms and condom use with regular sexual partners among 699 young factory workers (aged 18-24 years), controlling for their individual socio-demographic characteristics. Interventions related to the management and services component including workplace AIDS policy formulation, condom services programs and behavioral change campaigns were found to be significantly related to increased AIDS knowledge, perceived accessibility to condoms and condom use with regular partners. The effect of the HIV/AIDS training for managers, peer leaders and workers was positive but not statistically significant. With some revision of program components, scaling up of workplace interventions and the engagement of the private sector in HIV prevention should be seriously considered.

A longitudinal study of the predictors of prevalence and severity of symptoms commonly associated with menopause.

OBJECTIVE: To delineate the role of hormone levels, menopause status, exogenous hormone use, and personal characteristics in the changing prevalence and impact of menopause symptoms. DESIGN: Annual longitudinal data were from Michigan Bone Health Study enrollees aged 24 to 44 years at baseline and followed up for a 10-year period beginning in 1992. In self-administered interviews, women reported the presence of and degree of bother (values from 1 = low to 8 = high) for symptoms related to sexuality, vasomotor, sleep/fatigue, negative mood, hair/skin, and urinary problems. Annually, collected sera samples were analyzed for estradiol, follicle-stimulating hormone, and testosterone concentrations. RESULTS: Increasing age consistently predicted the development and bother of the measured symptoms. Transition to postmenopause and higher levels of follicle-stimulating hormone were significantly predictive only of the sexuality and vasomotor constructs, whereas higher estradiol levels were protective against increasing frequency and bother from sexuality and vasomotor constructs. Problems with sleeping, and secondarily, vasomotor symptoms, were the most bothersome constructs. Higher body mass index and current smoking behavior were highly related to increased bother with many symptom constructs, but especially vasomotor symptoms. Exogenous hormone use was associated with more bother from all symptom constructs. CONCLUSIONS: Sexuality and vasomotor symptom constructs seem to be more related to menopause than other constructs. The frequency of other constructs in the pre-menopause and their very strong association with increasing age suggest caution in attributing these factors directly to neuroendocrine events of the menopause transition. The strong associations between smoking and body size with symptoms, particularly vasomotor symptoms, suggest that interventions directed at these personal characteristics might be effective in dampening their impact.

A randomized, double-blind, placebo-controlled, phase 2 study of RMP-7 in combination with carboplatin administered intravenously for the treatment of recurrent malignant glioma.

RMP-7, a bradykinin analog, temporarily increases the permeability of the blood-brain tumor barrier to chemotherapy drugs like carboplatin. We conducted a randomized, controlled trial of carboplatin and RMP-7 versus carboplatin and placebo in patients with recurrent malignant glioma. The primary outcome measure was time to tumor progression (TTP). Adults with recurrent glioblastoma multiforme or anaplastic glioma were randomized in a 1:1 ratio to receive carboplatin and either RMP-7 or placebo. Radiation therapy had failed in all patients, and they may have received prior chemotherapy. Carboplatin (dosed to achieve an area under the curve of 5 mg/ml x time for patients who had received prior chemotherapy, or 7 mg/ml x time for those who had not) was given intravenously every 4 weeks, followed by intravenous infusion of either RMP-7 or placebo (300 ng/kg). TTP, tumor response, neuropsychological assessments, functional independence, and quality of life assessments were analyzed every 4 weeks. There were 122 patients enrolled, 62 in the RMP-7 and carboplatin group and 60 in the placebo and carboplatin group. Median TTP was 9.7 weeks (95% CI, 8.3-12.6 weeks) for the RMP-7 and carboplatin group and 8.0 weeks (95% CI, 7.4-12.6 weeks) for the placebo and carboplatin group. Median survival times were 26.9 weeks (95% CI, 21.3-37.6 weeks) for the RMP-7 group and 19.9 weeks (95% CI, 15.0-31.3 weeks) for the placebo group. No differences were noted for time to worsening of neuropsychological assessments, functional independence, or quality of life assessments. The use of RMP-7 had no effect on the pharmacokinetics or toxicity of carboplatin. At the dose and schedule used in this trial, RMP-7 did not improve the efficacy of carboplatin. Recent preclinical pharmacokinetic modeling of RMP-7 suggests that higher doses of RMP-7 may be required to increase carboplatin delivery to tumor.

Social influence, AIDS/STD knowledge, and condom use among male clients of female sex workers in Bali.

The importance of social networks is increasingly being recognized in research on HIV risk behaviors. The objective of this article is to examine the association of AIDS and sexually transmitted disease (STD) knowledge, perceived susceptibility to HIV/STD infection, condom beliefs, demographic variables, and peer influence on the condom use of clients of Indonesian sex workers. Data for the study are drawn from the Bali STD/AIDS study conducted from 1997 to 1999 in Bali, Indonesia. During the project 2,026 men were selected for interviews in low price brothels. Statistical methods included multivariate regression models. Results of the study showed that younger men, men who have resided in Bali for at least a year, and more educated men were more likely to use condoms. Furthermore, men with stronger AIDS and STD knowledge and condom beliefs were more likely to use condoms. Men whose friends knew that they visited sex workers were less likely to use condoms. However, men who reported that their friends used condoms with sex workers and that their friends encouraged them to use condoms with sex workers were more likely to use condoms with sex workers. Implications for prevention of HIV infection are discussed.

Voluntary HIV testing, disclosure, and stigma among injection drug users in Bali, Indonesia.

Recently, large increases have been noted in injection drug use and HIV prevalence in Indonesia. Because voluntary HIV counseling and testing can play an important role in HIV prevention, it is important to understand factors related to its use. The objective of this study was to identify factors related to the use of voluntary HIV testing among drug users. In-depth interviews were conducted with a sample of 40 drug users in the Denpasar area of Bali, Indonesia. Drug users may be interested in testing if they have enough information about AIDS to know that they are at risk and that they need this information to protect themselves and others from infection. Barriers toward testing included the fear of a positive result, fear of reactions from family and community members and stigmatization. Other obstacles include a feeling of hopelessness, problems with testing, unavailability and side effects of AIDS drugs and other factors. Many persons would not disclose their status to community members and sexual partners. There were serious concerns about others being ashamed of them and the impact of HIV on relationships with spouses and sexual partners and on employment.