RCT of effectiveness of motivational enhancement therapy delivered by nurses for hazardous drinkers in primary care units in Thailand.

AIMS: To determine the effectiveness of Motivational Enhancement Therapy (MET) for hazardous drinkers in Primary Care Unit (PCU) settings in rural Thailand. METHODS: A randomized controlled trial was conducted in eight PCUs in Ubonratchatanee and Chachoengsao provinces in Thailand. Hazardous drinkers were identified using the World Health Organization-recommended Alcohol Use Disorder Identification Test. Of 117 eligible participants (91% male), 59 were randomized to the intervention group to receive MET in three individual appointments with a trained nurse and 58 to an assessment-only control group. Outcome evaluations were carried out after 6 weeks, 3 months and 6 months. RESULTS: Follow-up data were available on 84, 94 and 91% of subjects, respectively, at the three intervals. Self-reported drinks per drinking day, frequency of hazardous drinking assessed either on a daily or weekly basis, and of binge drinking sessions were reduced in the intervention group more than in the control group (P < 0.05) after both 3 and 6 months. The groups did not generally differ at 6 weeks. However, although self-reported consumption in both groups fell from baseline to 6-month follow-up, serum gamma-glutamyl transferase increased in both groups, which raises doubts about the validity of this marker in this sample and/or the validity of the self-reported data in this study. CONCLUSION: MET delivered by nurses in PCUs in Thailand appears to be an effective intervention for male hazardous drinkers. Uncertainties about the validity of self-reported data jeopardize the safety of this conclusion.

Using risk-assessment sheet to improve effectiveness of health examination service.

BACKGROUND: Several techniques to improve compliance of physicians toward health examination guidelines of many countries were studied. However the method to improve compliance of Thai physicians toward Thailand's guidelines has never been studied. OBJECTIVES: To determine the effectiveness of using risk-assessment sheets to improve the compliance of physicians toward Thailand's health examination service guideline. MATERIAL AND METHOD: Risk-assessment sheets were constructed based on recommendations in Guide to Periodic Health Examination and Maintenance for Thai People. One hundred and two adult clients who came for health examination service from January to March 2003 were asked to fill in risk-assessment sheets and compared them with 103 recorded health examination report from the hospitals computer before the risk-assessment sheets were developed. RESULTS: Clients using the risk-assessment sheets group received recommended health examination significantly more than those in the non-using group (p < 0.01). In the using group, rates of providing chest x-ray, tumor markers and average number of laboratory investigations were statistically significant lower (p < 0.01) and contrary to the rate of Pap test was statistically significant higher (p < 0.016) than the non-using group. The average expenditure of the using-group was 41.3% lower than non-using group. CONCLUSION: Using a risk-assessment sheet in health examination statistically and practically increased the compliance of physicians toward health examination guidelines and reduced unnecessary expenditure.

Peak inspiratory flow rate and the ability to use the Turbuhaler in Thai children aged 3-7 years.

A Turbuhaler is a dry powder inhaler device commonly used by asthmatic patients. Its superiority over a metered-dose inhaler device includes easy technique, convenience in handling and absence of chloro fluoro carbon (CFC). However, the use of this device has some limitations in young children who may not be able to generate the inspiratory flow rate high enough to assure adequate medication delivery. Even though the Turbuhaler has been used in Thailand for many years, the study of inspiratory flow rate and the ability to use this device in Thai preschool children is lacking. In the present study, the authors aimed to evaluate the ability to use the Turbuhaler in Thai preschool children by measuring the peak inspiratory flow rate, peak inspiratory flow rate through the Turbuhaler as well as positive test of the Turbutester. Subjects included 468 Thai preschool children, aged 3-7 years old. They were assigned to perform the test with In-Check Dial, Mini-Wright Peak Flow Meter and Turbutester. The authors found that the ability to use the device correlated directly with age and children with age of 5 years or more could perform significantly better. Children weight of 20 kilograms or more, or a height of 113 centimeters or more were also able to generate adequate inspiratory flow rate for medication delivery. The authors concluded that children from the age of five years, or with a weight from 20 kilograms or a height from 113 centimeters were able to generate adequate inspiratory flow rate for effective medication delivery by the Turbuhaler.

Increased esophageal regulatory T cells and eosinophil characteristics in children with eosinophilic esophagitis and gastroesophageal reflux disease.

Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have similar clinical presentations. The immunoregulatory mechanisms involved in both diseases are not clearly defined. We studied cellular inflammation in pediatric patients with EE and GERD compared to normal controls (NC). Pathology records were reviewed of 10 EE, 8 GERD, and 10 NC children who were seen at Texas Children's Hospital in the past 3 yr. FOXP3, CD4, CD8, CD25, eotaxin-3, and IL-5 immunohistochemical stains were performed on formalin-fixed, paraffin-embedded esophageal tissue sections and assessed by a blinded observer. The numbers of FOXP3(+), CD25(+), and CD8(+) cells were significantly increased in both EE and GERD compared with NC. No significant differences in the numbers of FOXP3(+), CD4(+), CD8(+), and CD25(+) cells were detected between the patients with EE and GERD. Eotaxin-3(+) was found in mature epithelial cells and IL-5 was detected in esophageal intravascular space in all 3 groups. Eosinophil degranulation and microabscesses were significantly increased in EE compared to GERD. IL-5 was detected in vessels of the affected esophageal area and eotaxin-3 is produced locally by mature epithelial cells. Increased numbers of esophageal FOXP3(+) regulatory T cells, and CD8(+) T cells in both EE and GERD suggest that a negative feedback mechanism may regulate the inflammatory response.