Publications by authors named "Chaisiri Angkurawaranon"

46 Publications

Pre-screening Ability of the Functional-Belief-Based Alcohol Use Questionnaire (FBAQ) among Chiang Mai University Undergraduates: An External Validation Study.

Drug Alcohol Depend 2021 Aug 28;227:109002. Epub 2021 Aug 28.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros, Sriphum, Mueng, Chiang Mai 50200, Thailand. Electronic address:

Background: High-risk drinking behavior is common in university students, which often leads to negative consequences. Several standard screening tools to identify high-risk drinkers have been validated in this domain. However, most tools rely on drinking frequency and require standard drink calculations. The Functional-Belief-Based Alcohol use Questionnaire (FBAQ) was recently proposed as a pre-screening tool for high-risk drinkers in the young adult population. We aimed to validate the pre-screening accuracy of the FBAQ when applied to external data of university undergraduates.

Methods: Data from two prospective cross-sectional surveys of Chiang Mai University undergraduates were used for validation of the FBAQ. A high-risk drinker was defined as a person with the 12-month AUDIT score ≥ 8. Pre-screening performance and accuracy indices were presented separately for dataset I, dataset II, and the combined dataset. The pooled area under the receiver operating characteristic curve (AuROC), sensitivity, and specificity were estimated using individual patient data meta-analysis methods.

Results: From the two datasets, 1641 students were included, 811 students in 2019 and 830 students in 2020. Of these, 387 (23.6 %) students were classified as high-risk drinkers. The combined AuROC of the FBAQ score was 0.83 (95 %CI 0.75-0.92) in discriminating high-risk drinkers. The pooled sensitivity and specificity at the FBAQ score cutoff ≥ 6 were 92.8 % (95 %CI 88.0-95.7 %) and 51.6 % (95 %CI 41.1-62.0 %).

Conclusions: In this external validation, the FBAQ shows excellent discriminative ability and is proven to be highly sensitive in detecting high-risk drinkers among Chiang Mai University undergraduates. Therefore, incorporating the FBAQ as a pre-screening tool to the AUDIT could make the initiation of the screening process easier and reduce extensive AUDIT evaluations in students with low risk.
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http://dx.doi.org/10.1016/j.drugalcdep.2021.109002DOI Listing
August 2021

Social networking site usage: A systematic review of its relationship with social isolation, loneliness, and depression among older adults.

Aging Ment Health 2021 Aug 24:1-9. Epub 2021 Aug 24.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai,Thailand.

Objective: Older adults, age ≥ 60years, are at risk of depression, which is aggravated by loneliness and social isolation. The use of social networking sites (SNS) has been reported to be beneficial to help people stay in touch with their families and communities. The purpose of this study was to examine the relationship between SNS usage and social isolation, loneliness, and depression among older adults.

Methods: The online electronic search for literature was conducted up to June 2020 using three databases and searching from reference lists to find potential studies. The inclusion criteria were based on three main study characteristics: (i) a study population of adults age ≥ 60 years, (ii) examine SNS usage, and (iii) report depression or loneliness or social isolation as outcomes.

Results: Fifteen articles were included: ten observational and five experimental studies. Five studies focused on depression and five studies on loneliness/social isolation, while five studies reported on both outcomes. Among observational studies, there was some evidence that SNS usage was associated with lower levels of depression and loneliness scores, but a very limited number of experimental studies were able to obtain similar results. For social isolation, no study found significant associations between SNS usage and lower levels of social isolation.

Conclusions: This review found very limited evidence, especially from experimental studies, to support associations between SNS use with depression, loneliness, and social isolation among older adults. More studies are needed to enhance understanding to make valid conclusions.

The systematic review was registered in the PROSPERO database on 10 April 2019 and updated in July 2020 (CRD42019125267).
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http://dx.doi.org/10.1080/13607863.2021.1966745DOI Listing
August 2021

Utilization of Health Care Services and Common Disease Diagnoses among University Students: An Analysis of 35,249 Students from Thailand.

Int J Environ Res Public Health 2021 07 4;18(13). Epub 2021 Jul 4.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

The health care services for university students are important to improve student health and well-being. Analyzing the database of health conditions in the health service system will identify common health problems, which could be useful in further appropriate and specific health service planning. This study aims to investigate the utilization of health care services and common disease diagnoses among university students enrolled at Chiang Mai University during the academic year of 2018. A retrospective study was carried out using health data from the electronic health records (EHR) database of the university hospital. Ethical procedures were followed. Out of the overall 35,249 students in the academic year 2018, 17,284 students (49.03%) had visited an outpatient department (65,150 outpatient department visits), and 407 students (1.15%) had been admitted to the hospital (458 inpatient department admissions). The proportions of utilization between each field of education and training were similar across both groups. The top five categories of diagnosis, for both outpatient department visits and inpatient department admissions, differed between gender. Some of the most common diseases included trauma and injury conditions, respiratory diseases, and mental health. The conclusion of the study is that integration of a health promotion program with preventive methods, especially regarding traffic injury, transmitted diseases, mental health support, and safe environments are essential for university students. A general overview of utilization and common diseases among university students, which is still lacking in the literature, could be useful as a platform to enhance health care services for common diseases.
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http://dx.doi.org/10.3390/ijerph18137148DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8297256PMC
July 2021

Feasibility of accelerated 3D T1-weighted MRI using compressed sensing: application to quantitative volume measurements of human brain structures.

MAGMA 2021 Jun 28. Epub 2021 Jun 28.

Philips (Thailand) Ltd., Bangkok, Thailand.

Objective: Scan time reduction is necessary for volumetric acquisitions to improve workflow productivity and to reduce motion artifacts during MRI procedures. We explored the possibility that Compressed Sensing-4 (CS-4) can be employed with 3D-turbo-field-echo T1-weighted (3D-TFE-T1W) sequence without compromising subcortical measurements on clinical 1.5 T MRI.

Materials And Methods: Thirty-three healthy volunteers (24 females, 9 males) underwent imaging scans on a 1.5 T MRI equipped with a 12-channel head coil. 3D-TFE-T1W for whole-brain coverage was performed with different acceleration factors, including SENSE-2, SENSE-4, CS-4. Freesurfer, FSL's FIRST, and volBrain packages were utilized for subcortical segmentation. All processed data were assessed using the Wilcoxon signed-rank test.

Results: The results obtained from SENSE-2 were considered as references. For SENSE-4, the maximum signal-to-noise ratio (SNR) drop was detected in the Accumbens (51.96%). For CS-4, the maximum SNR drop was detected in the Amygdala (10.55%). Since the SNR drop in CS-4 is relatively small, the SNR in all of the subcortical volumes obtained from SENSE-2 and CS-4 are not statistically different (P > 0.05), and their Pearson's correlation coefficients are larger than 0.90. The maximum biases of SENSE-4 and CS-4 were found in the Thalamus with the mean of differences of 1.60 ml and 0.18 ml, respectively.

Conclusion: CS-4 provided sufficient quality of 3D-TFE-T1W images for 1.5 T MRI equipped with a 12-channel receiver coil. Subcortical volumes obtained from the CS-4 images are consistent among different post-processing packages.
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http://dx.doi.org/10.1007/s10334-021-00939-8DOI Listing
June 2021

Palliative Performance Scale and survival in patients with cancer and non-cancer diagnoses needing a palliative care consultation: a retrospective cohort study.

BMC Palliat Care 2021 May 26;20(1):74. Epub 2021 May 26.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.

Background: Palliative Performance Scale (PPS) has been frequently used to estimate the survival time of palliative care patients. The objective was to determine the associations between the PPS and survival time among cancer and non-cancer patients in Thailand.

Methods: This is a retrospective cohort study. All in-patient adults who received a palliative care consultation at Chiang Mai University Hospital between 1 July 2018 to 31 July 2019 were included in the study and were followed-up until 26 June 2020. The Palliative Performance Scale was assessed using the validated Thai-Palliative Performance Scale for Adults. Survival analysis was used to determine the association between the Palliative Performance Scale and survival time among cancer and non-cancer patients.

Results: Out of 407 patients, 220 were male (54.1%). There were 307 cancer patients (75.4%) and 100 non-cancer patients (24.6%). The PPS and survival time in cancer patients were significantly correlated. Cancer patients with PPS 10, 20, 30, 40-60, and 70-80% had a median survival time of 2, 6, 13, 39, and 95 days, respectively. Non-cancer patients with PPS 10, 20, and 30% had a median survival time of 8, 6, and 24 days, respectively.

Conclusions: While useful for estimating survival time for cancer patients, other factors should be taken into account in estimating the survival time for non-cancer patients.
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http://dx.doi.org/10.1186/s12904-021-00773-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8157447PMC
May 2021

An Implementation Framework for Telemedicine to Address Noncommunicable Diseases in Thailand.

Asia Pac J Public Health 2021 Apr 19:10105395211008754. Epub 2021 Apr 19.

Thai Hypertension Society, Bangkok, Thailand.

To maintain the continuity of noncommunicable disease (NCD) services and ascertain the health outcomes of patients with NCDs during the COVID-19 (coronavirus disease 2019) outbreak in Thailand, various telemedicine services have been developed. To achieve this determination, the implementation framework has been constructed based on recommendations from multidisciplinary experts (Thai NCD Collaboration Group). Within the framework, all key elements are illustrated with their priority and expected collaborations. Ultimately, active collaborations from multi-stakeholders are vitally important to ensure that telemedicine services for NCDs will finally become practical, successful, and sustainable.
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http://dx.doi.org/10.1177/10105395211008754DOI Listing
April 2021

Construct Validity and Differential Item Functioning of the PHQ-9 Among Health Care Workers: Rasch Analysis Approach.

Neuropsychiatr Dis Treat 2021 8;17:1035-1045. Epub 2021 Apr 8.

Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Kingdom of Thailand.

Purpose: The Patient Health Questionnaire (PHQ-9) is a widely used self-report questionnaire to screen depression. Its psychometric property has been tested in many populations including health care workers. We used Rasch measurement theory to examine the psychometric properties of PHQ-9 regarding item difficulty, item fit and the differences between subgroups of respondents classified by sex, age, education and alcohol user status, based on the same overall location of participants.

Patients And Methods: In total, 3204 health care workers of Maharaj Nakorn Chiang Mai Hospital participated and were administered the PHQ-9. Rating scale Rasch measurement modeling was used to examine the psychometric properties of the PHQ-9.

Results: The data fitted well to the Rasch model and no violations of the assumption of unidimensionality were observed. All 9 items could form a unidimensional construct of overall depressive severity. Suicidal ideation was the least endorsed while sleep problem was the most. No disordered category and threshold of the rating response were observed. No locally dependent items were observed. No items were found to show differential item functioning across age, sex, education and alcohol consumption. The item-person Wright map showed that the PHQ-9 did not target well with the sample, and a wide gap suggesting few or no items exist to differentiate participants at a certain ability level among the PHQ-9 items.

Conclusion: The PHQ-9 can be used as a screening questionnaire for major depressive disorder as its psychometric property was verified based on Rasch measurement model. The findings are generally consistent with related studies in other populations. However, the PHQ-9 may be unsuitable for assessing depressive symptoms among health care workers who have low levels of depression.
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http://dx.doi.org/10.2147/NDT.S271987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8041649PMC
April 2021

Tenofovir disoproxil fumarate in pregnancy for prevention of mother to child transmission of hepatitis B in a rural setting on the Thailand-Myanmar border: a cost-effectiveness analysis.

BMC Pregnancy Childbirth 2021 Feb 22;21(1):157. Epub 2021 Feb 22.

Division of Global and Tropical Health, Menzies School of Health Research, Charles Darwin University, Casuarina, Australia.

Background: Hepatitis B Virus (HBV) is transmitted from mother to child which can be prevented via birth dose vaccine combined with three follow up hepatitis B vaccines, hepatitis B immunoglobulins (HBIG), and maternal antiviral treatment with Tenofovir Disoproxil Fumarate (TDF). This study evaluates the cost effectiveness of six strategies to prevent perinatal HBV transmission in a resource limited setting (RLS) on the Thailand-Myanmar border.

Methods: The cost effectiveness of six strategies was tested by a decision tree model in R. All strategies included birth and follow up vaccinations and compared cost per infection averted against two willingness to pay thresholds: one-half and one gross domestic product (GDP) per capita. Strategies were: 1) Vaccine only, 2) HBIG after rapid diagnostic test (RDT): infants born to HBsAg+ are given HBIG, 3) TDF after RDT: HBsAg+ women are given TDF, 4) TDF after HBeAg test: HBeAg+ women are given TDF, 5) TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF, 6) HBIG & TDF after high HBV DNA: women with HBV DNA > 200,000 are given TDF and their infants are given HBIG. One-way and probabilistic sensitivity analyses were conducted on the cost-effective strategies.

Results: Vaccine only was the least costly option with TDF after HBeAg test strategy as the only cost-effective alternative. TDF after HBeAg test had an incremental cost-effectiveness ratio of US$1062; which would not be considered cost-effective with the lower threshold of one-half GDP per capita. The one-way sensitivity analysis demonstrated that the results were reasonably robust to changes in single parameter values. The PSA showed that TDF after HBeAg test had an 84% likelihood of being cost effective at a willingness to pay threshold of one GDP per capita per infection averted.

Conclusions: We found that TDF after HBeAg test has the potential to be cost-effective if TDF proves effective locally to prevent perinatal HBV transmission. The cost of TDF treatment and reliability of the RDT could be barriers to implementing this strategy. While TDF after RDT may be a more feasible strategy to implement in RLS, TDF after HBeAg test is a less costly option.
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http://dx.doi.org/10.1186/s12884-021-03612-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901182PMC
February 2021

Outcomes for 298 breastfed neonates whose mothers received ketamine and diazepam for postpartum tubal ligation in a resource-limited setting.

BMC Pregnancy Childbirth 2021 Feb 9;21(1):121. Epub 2021 Feb 9.

Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Tak, Thailand.

Background: Anesthesia in lactating women is frequently indicated for time-sensitive procedures such as postpartum tubal ligation. Ketamine and diazepam are two of the most commonly used anesthetic agents in low resource settings, but their safety profile in lactating women has not been established.

Methods: Medical records of post-partum tubal ligations between 2013 and 2018 at clinics of the Shoklo Malaria Research Unit were reviewed for completeness of key outcome variables. Logistic regression identified presence or absence of associations between drug doses and adverse neonatal outcomes: clinically significant weight loss (≥95th percentile) and neonatal hyperbilirubinemia requiring phototherapy.

Results: Of 358 records reviewed, 298 were lactating women with singleton, term neonates. There were no severe outcomes in mothers or neonates. On the first postoperative day 98.0% (290/296) of neonates were reported to be breastfeeding well and 6.4% (19/298) had clinically significant weight loss. Phototherapy was required for 13.8% (41/298) of neonates. There was no association between either of the outcomes and increasing ketamine doses (up to 3.8 mg/kg), preoperative oral diazepam (5 mg), or increasing lidocaine doses (up to 200 mg). Preoperative oral diazepam resulted in lower doses of intraoperative anesthetics. Doses of intravenous diazepam above 0.1 mg/kg were associated with increased risk (adjusted odds ratio per 0.1 mg/kg increase, 95%CI) of weight loss (1.95, 95%CI 1.13-3.35, p = 0.016) and jaundice requiring phototherapy (1.87, 95%CI 1.11-3.13, p = 0.017).

Conclusions: In resource-limited settings ketamine use appears safe in lactating women and uninterrupted breastfeeding should be encouraged and supported. Preoperative oral diazepam may help reduce intraoperative anesthetic doses, but intravenous diazepam should be used with caution and avoided in high doses in lactating women.
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http://dx.doi.org/10.1186/s12884-021-03610-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7874624PMC
February 2021

Functional-Belief-Based Alcohol Use Questionnaire (FBAQ) as a Pre-Screening Tool for High-Risk Drinking Behaviors among Young Adults: A Northern Thai Cross-Sectional Survey Analysis.

Int J Environ Res Public Health 2021 02 5;18(4). Epub 2021 Feb 5.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

Background: an alcohol-use disorders identification test (AUDIT) is a standard screening tool for high-risk drinking behavior. Standard drink calculation is difficult to comprehend and may lead to inaccurate estimates. This study intended to develop a practical pre-screening tool for the identification of high-risk drinkers among young adults.

Methods: a cross-sectional survey was conducted in Northern Thailand from July 2016 to December 2016. Data was collected on relevant characteristics and health beliefs about drinking. The 12-month AUDIT was used as the reference standard. Logistic regression was used for the score derivation. The discriminative ability was measured with an area under the receiver operating characteristic curve (AuROC).

Result: a total of 1401 young adults were included. Of these, 791 people (56.5%) were current drinkers. Three functional-belief items were identified as independent predictors of high-risk drinking and were used to develop the functional-belief-based alcohol-use questionnaire (FBAQ). The FBAQ demonstrated an acceptable discriminative ability-AuROC 0.74 (95% confidence interval (CI) 0.70, 0.77).

Conclusion: The FBAQ contains only three simple belief questions and does not require unintelligible standard drink calculation. Implementing the FBAQ score and the AUDIT in a serial manner might be a more effective method in a mass-screening program for alcohol-use disorder in young adults.
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http://dx.doi.org/10.3390/ijerph18041536DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915812PMC
February 2021

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand.

J Clin Hypertens (Greenwich) 2021 04 27;23(4):702-712. Epub 2021 Jan 27.

World Health Organization Country Office for Thailand, Nonthaburi, Thailand.

A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90-120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow-up are possible target areas to improve hypertension control in Thailand.
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http://dx.doi.org/10.1111/jch.14193DOI Listing
April 2021

Scalable solution for delivery of diabetes self-management education in Thailand (DSME-T): a cluster randomised trial study protocol.

BMJ Open 2020 10 5;10(10):e036963. Epub 2020 Oct 5.

Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health,London School of Hygiene and Tropical Medicine, London, UK.

Introduction: Type 2 diabetes mellitus is among the foremost health challenges facing policy makers in Thailand as its prevalence has more than tripled over the last two decades, accounting for considerable death, disability and healthcare expenditure. Diabetes self-management education (DSME) programmes show promise in improving diabetes outcomes, but this is not routinely used in Thailand. This study aims to test a culturally tailored DSME model in Thailand, using a three-arm cluster randomised controlled trial comparing a nurse-led model, a peer-assisted model and standard care. We will test which model is effective and cost effective to improve cardiovascular risk and control of blood glucose among people with diabetes.

Methods And Analysis: 21 primary care units in northern Thailand will be randomised to one of three interventions, enrolling a total of 693 patients. The primary care units will be randomised (1:1:1) to participate in a culturally-tailored DSME intervention for 12 months. The three-arm trial design will compare effectiveness of nurse-led, peer-assisted (Thai village health volunteers) and standard care. The primary trial outcomes are changes in haemoglobin A1c and cardiovascular risk score. A process evaluation and cost effectiveness evaluation will be conducted to produce policy relevant guidance for the Thai Ministry of Public Health. The planned trial period will start in January 2020 and finish October 2021.

Ethics And Dissemination: Ethical approval has been obtained from Thailand and the UK. We will share our study data with other researchers, advertising via our publications and web presence. In particular, we are committed to sharing our findings and data with academic audiences in Thailand and other low-income and middle-income countries.

Trial Registration Number: NCT03938233.
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http://dx.doi.org/10.1136/bmjopen-2020-036963DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537447PMC
October 2020

Risky injection practices and HCV awareness in Chiang Mai Province, Thailand: a respondent-driven sampling study of people who inject drugs.

BMC Public Health 2020 Sep 24;20(1):1450. Epub 2020 Sep 24.

French National Research Institute for Sustainable Development (IRD), IRD174/PHPT, 195 Kaew Nawarat Road (3-4 Fl.) Wat Ked, Muang Chiang Mai, 50000, Thailand.

Background: People who inject drugs (PWID) are the most exposed to hepatitis C virus (HCV). In Thailand, drug use is highly criminalized, and harm reduction services are scarce. This study estimates risky injection practices and assesses the proportion of HCV awareness and screening in the PWID population in Northern Thailand.

Methods: We used respondent-driven sampling (RDS) to recruit PWID in Chiang Mai Province. Social and behavioural data were collected through face-to-face interviews at an addiction treatment facility. Weighted population estimates were calculated to limit biases related to the non-random sampling method. Univariate and multivariate analyses were performed to study factors associated with HCV awareness and screening.

Results: One hundred seventy-one PWID were recruited between April 2016 and January 2017. Median age was 33 (Interquartile range: 26-40) years, 12.2% were women, and 49.4% belonged to a minority ethnic group. Among participants, 76.8% injected heroin, 20.7% methadone, and 20.7% methamphetamine. We estimate that 22.1% [95% CI: 15.7-28.6] of the population had shared needles in the last 6 months and that 32.0% [95% CI: 23.6-40.4] had shared injection material. Only 26.6% [95% CI: 17.6-35.6] had heard of HCV. Factors independently associated with knowledge of HCV included belonging to a harm reduction organization (adjusted odds ratio (aOR) = 5.5 [95% CI: 2.0-15.3]) and voluntary participation in a drug rehabilitation programme (aOR = 4.3 [95% CI: 1.3-13.9]), while Lahu ethnicity was negatively associated (aOR = 0.3 [95% CI: 0.1-0.9]). We estimate that 5% of the PWID population were screened for HCV; the only factor independently associated with being screened was membership of a harm reduction organization (aOR = 5.7 [95% CI: 1.6-19.9]).

Conclusion: Our study reveals that the PWID population is poorly informed and rarely screened for HCV, despite widespread risky injection practices. A public health approach aimed at reducing the incidence of HCV should target the PWID population and combine harm reduction measures with information and destigmatization campaigns. Civil society organizations working with PWID are a major asset for the success of such an approach, based on their current positive interventions promoting awareness of and screening for HCV.
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http://dx.doi.org/10.1186/s12889-020-09549-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517806PMC
September 2020

Prevention of mother-to-child transmission of hepatitis B virus: protocol for a one-arm, open-label intervention study to estimate the optimal timing of tenofovir in pregnancy.

BMJ Open 2020 09 13;10(9):e038123. Epub 2020 Sep 13.

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

Introduction: Hepatitis B virus (HBV) remains a public health threat and the main route of transmission is from mother to child (MTCT). Tenofovir disoproxil fumarate (TDF) treatment can reduce MTCT of HBV although the optimal timing to attain undetectable HBV DNA concentrations at delivery is unknown. This protocol describes the procedures following early initiation of maternal TDF prior to 20 weeks gestation to determine efficacy, safety and feasibility of this approach in a limited-resource setting.

Methods And Analyses: One hundred and seventy pregnant women from the Thailand-Myanmar border between 12 and <20 weeks gestational age will be enrolled into a one-arm, open-label, TDF treatment study with cessation of TDF 1 month after delivery. Sampling occurs monthly prenatal, at birth and at 1, 2, 4 and 6 months post partum. Measurement of tenofovir concentrations in maternal and cord plasma is anticipated in 10-15 women who have detectable HBV DNA at delivery and matched to 20-30 women with no detectable HBV DNA. Infant HBsAg status will be determined at 2 months of age and HBV DNA confirmed in HBsAg positive cases. Adverse events including risk of flare and adherence, based on pill count and questionnaire, will be monitored. Infants will receive HBV vaccinations at birth, 2, 4 and 6 months and hepatitis B immunoglobulin at birth if the mother is hepatitis B e antigen positive. Infant growth and neurodevelopment at 6 months will be compared with established local norms.

Ethics And Dissemination: This study has ethical approval by the Ethics Committee of the Faculty of Tropical Medicine, Mahidol University (FTM ECF-019-06), Johns Hopkins University (IRB no: 00007432), Chiang Mai University (FAM-2559-04227), Oxford Tropical Research Ethics Committee (OxTREC Reference: 49-16) and by the local Tak Community Advisory Board (TCAB-02/REV/2016). The article will be published as an open-access publication.

Trial Registration Number: NCT02995005, Pre-results.
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http://dx.doi.org/10.1136/bmjopen-2020-038123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7488796PMC
September 2020

Lowered blood pressure targets identify new, uncontrolled hypertensive cases: patient characteristics and implications for services in Thailand.

BMC Health Serv Res 2020 Sep 14;20(1):869. Epub 2020 Sep 14.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawarorot Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand.

Background: According to the new hypertension treatment guidelines blood pressure (BP) readings need to be kept below or equal to 130/80 mmHg in patients aged less than 65 years old. This study shows the change in proportion of identified cases of uncontrolled blood pressure in light of these changes.

Methods: The data was collected from 248 hypertensive patients who had visited an outpatient clinic at the Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand. Patients were classified into three groups: The 3 groups were: 1) controlled BP group (BP is 130/80 mmHg or lower); 2) newly identified uncontrolled group (BP between 130/80 mmHg and 140/90 mmHg) and 3) existing uncontrolled group (BP higher than 140/90 mmHg). Health behaviors, past history related to hypertensive disease and current pharmacological treatments were compared.

Results: Of the total 248 patients, 56% were female and the mean age was 58.8 (sd 5.99) years old. Following application of the new guidelines, the group designated as uncontrolled increased from 21.7 to 74.2%, an additional 52.4% due to new BP targets. Higher BMI was associated with uncontrolled HT (p = 0.043). While the average number of medication taken was similar across the three groups, it was poor medication adherence (p < 0.013) which was associated with the uncontrolled disease.

Conclusions: Lower BP targets will increase the number of identified hypertensive patients. While intensifying pharmacological treatment may be considered, our study suggests that two behavioral factors should not be overlooked. Weight reduction and enhancement of medication adherence remains an important mainstream treatment strategy.
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http://dx.doi.org/10.1186/s12913-020-05719-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7490895PMC
September 2020

Exploring perceptions, attitudes and beliefs of Thai patients with type 2 diabetes mellitus as they relate to medication adherence at an out-patient primary care clinic in Chiang Mai, Thailand.

BMC Fam Pract 2020 08 21;21(1):173. Epub 2020 Aug 21.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Muang, Chiang Mai, 50200, Thailand.

Background: Within the sphere of diabetes self-management, much emphasis has been placed on medication adherence. There has been a shift in thinking about medication adherence, moving from "compliance" and historically paternalistic models of care, to seeking better ways of characterizing dynamic and complex relationships that determine medication adherence and diabetes control. This study sought to understand the relationship between patient's attitudes and medication adherence for oral anti-diabetics in Thailand.

Methods: In-depth interviews of patients with type 2 diabetes mellitus, taking oral anti-diabetic drugs, at the out-patient clinic run by the Department of Family Medicine, Chiang Mai University between May and December 2016. Thematic analysis followed the WHO framework for medication adherence in chronic disease to explore patient's attitudes and their influence on medication compliance.

Results: Of 24 patients, 9 were men. The mean age was 62 years (SD 8.9 years). 67% had high compliance. Four themes were identified as important factors related to medication adherence: attitudes toward disease, attitudes toward treatment, attitudes toward family support and attitudes toward health care team. Specifically, symptoms at diagnosis, understanding and acceptance in taking medication, the presence of family support and the perception of concern by the doctor relate to improved medication compliance.

Conclusions: Medication adherence in Thai patients with diabetes requires support from both the health care providers and the family. The patient's perception of the doctor's concern creates greater patient trust in the health care team. This trust, along with family support, helps deepen patients' understanding of the disease, accept the chronic nature of their disease, and engenders a positive attitude towards taking medication that can improve medication adherence.
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http://dx.doi.org/10.1186/s12875-020-01233-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7442984PMC
August 2020

Incorporating the patient-centered approach into clinical practice helps improve quality of care in cases of hypertension: a retrospective cohort study.

BMC Fam Pract 2020 06 12;21(1):108. Epub 2020 Jun 12.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Inthawarorot Rd., Sriphum, Muang, Chiang Mai, 50200, Thailand.

Background: Treating hypertensive patients by integrating the patient-centered approach would influence the practice and outcome of treatment. Our purpose was to determine whether the implementation of a patient-centered approach in health care delivery can improve adhering to guidelines and the quality-of-care.

Methods: A retrospective study was conducted using secondary data from the electronic medical records of the patients treated in the two primary care outpatient settings at the Family Medicine (FM) and Social Security (SS) clinics. A key feature of the FM clinic is the incorporation of a patient-centered approach in its service delivery. Individual information regarding initial assessment and treatment at the follow-up visits was reviewed for 1 year. Comparison of adherence to treatment guidelines between the two primary care clinics was performed by using chi-square, Fisher's exact test or a t-test. To explore the difference in blood pressure and BP control between the two clinics, linear and logistic regression analysis respectively were performed with an adjustment for CV risk score in 2016 as a key confounder.

Results: The evidence included 100 records from each clinic, showed variation between the two primary care sites. The FM clinic had more complete records regarding family history of hypertension, assessment for secondary causes, prescription for lifestyle modification and appropriate adjustment of medication. Higher levels of blood pressure control were recorded in the FM clinic, specifically systolic pressure 2.92 mmHg (p = 0.073) and diastolic pressure 5.38 mmHg (p <  0.001) lower than those recorded in the SS clinic. There was a 2.96 times higher chance for BP goals to be achieved in patients in receipt of hypertensive care at the FM clinic (p = 0.004).

Conclusions: Adopting a patient-centered approach in service delivery could improve the quality of care for hypertension patients in primary care in Thailand.
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http://dx.doi.org/10.1186/s12875-020-01183-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7293111PMC
June 2020

Health-Risk Behaviours and Injuries among Youth and Young Adults in Chiang Mai, Thailand: A Population-Based Survey.

Int J Environ Res Public Health 2020 05 24;17(10). Epub 2020 May 24.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.

This study aimed to identify the prevalence of health-risk behaviours (alcohol use, tobacco smoking and gambling) and the associations between health-risk behaviours and injuries among youth (15-24 years) and young adults (25-39 years). A multi-stage cluster sampling survey was conducted in Chiang Mai, Thailand. The associations between health-risk behaviours and injuries were analysed using logistic regression and adjusted for potential confounders. Sample weights were applied in all analyses. Six-hundred-and-thirty participants were included. Fifty-three percent of males and 12.3% of females drank in the past three months. Smoking in the past three months was higher among males (38.5%) than females (0.7%). About a quarter of men and a fifth of the women had gambled in the past year. A total of 6.4% of males and 4.8% of females sought medical attention in the past year due to injuries. Compared to those without any of the three health-risk behaviours, the odds ratio for injuries requiring medical attention was 3.81 (95% CI: 1.33 to 10.90, = 0.013) for those with two health-risk behaviours and 13.8 (95% CI: 4.24 to 45.10, < 0.001) for those with all three health-risk behaviours. Injury prevention policies may need to incorporate interventions designed to assess multiple health-risk behaviours.
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http://dx.doi.org/10.3390/ijerph17103696DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7277339PMC
May 2020

Choosing where to give birth: Factors influencing migrant women's decision making in two regions of Thailand.

PLoS One 2020 2;15(4):e0230407. Epub 2020 Apr 2.

Department of Community Medicine and Global Health and Centre for Global Health, Oslo Group on Global Health Policy, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.

Background: Choosing where to give birth can be a matter of life and death for both mother and child. Migrants, registered or unregistered, may face different choices and challenges than non-migrants. Despite this, previous research on the factors migrant women consider when deciding where to give birth is very limited. This paper addresses this gap by examining women's decision making in a respective border and urban locale in Thailand.

Methods: We held focus group discussions [13] with 72 non-Thai pregnant migrant women at non-government clinics in a rural border area and at two hospitals in Chiang Mai, a large city in Northern Thailand in 2018. We asked women where they will go to give birth and to explain the factors that influenced their decision.

Results: Women identified getting the relevant documentation necessary to register their child's birth, safe birth and medical advice/quality care, as the top three factors that influenced their care seeking decision making. Language of service, free or low cost care, language of services, proximity to home, and limited alternate options for care were also identified as important considerations.

Conclusion: Understanding factors that migrant women value when choosing where to deliver can help health care providers to create services that are responsive to migrants' preferences and encourage provision of relevant information which may influence patient decision making. The desire to obtain birth documentation for their child appears to be important for migrants who understand the importance of personal documentation for the lives of their children. Healthcare institutions may wish to introduce processes to facilitate obtaining documentation for pregnant migrant women and their newborns.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230407PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7117675PMC
July 2020

Pharmacokinetics of oral tenofovir disoproxil fumarate in pregnancy and lactation: a systematic review.

Antivir Ther 2019 ;24(7):529-540

Department of Internal Medicine and Tropical Diseases, Amsterdam University Medical Center, location Academic Medical Center Amsterdam, Amsterdam, the Netherlands.

Background: Tenofovir disoproxil fumarate (TDF), the oral prodrug of tenofovir (TFV), is advocated in pregnancy for prevention of mother-to-child transmission (PMCT) with failure of hepatitis B immunoglobulin and vaccination. The pharmacokinetics of TDF monotherapy for PMCT-HBV is important if deployment is to emulate the success of multiple antiretrovirals (ARVs) for PMCT-HIV in resource-constrained settings.

Methods: This systematic review followed a protocol and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA) guidelines. We included studies that enrolled pregnant women who received oral TDF therapy as monotherapy or in combination with other ARVs: irrespective of the reason for receiving the drug (for example, HIV, HBV or pre-exposure prophylaxis); and reported pharmacokinetics.

Results: The area under the concentration-time curve (AUC), maximum plasma concentrations (C) and last measurable plasma concentration (C) of TFV were decreased in the second and third trimester compared with first trimester or post-partum. In none of the manuscripts was the non-pregnant HBV threshold of C of 300 ng/ml reached, but the 50% effective concentration (EC) of TFV is lower for treatment of HBV compared with HIV. The TFV concentration in breastfed infants was 0.03% of the recommended infant dose.

Conclusions: Most knowledge of pharmacokinetics of TFV in pregnancy results from studies on HIV involving multiple ARVs. Increased TFV clearance occurred in the second and third trimester when optimal TFV concentrations are required to maximize suppression of HBV in the window before birth. Dose or duration adjustments will be better conceptualized with concurrent analysis of the pharmacokinetics of TFV monotherapy and hepatitis B pharmacodynamics in pregnancy.
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http://dx.doi.org/10.3851/IMP3341DOI Listing
October 2020

Risk of harm from alcohol use and heavy alcohol consumption: Its association with other NCD risk factors in Thailand.

Sci Rep 2019 11 8;9(1):16343. Epub 2019 Nov 8.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, 110 Intawaroros Road, Muang, Chiang Mai, 50200, Thailand.

While there is an abundance of literature examining the relation between quantity of alcohol consumption and risk factors for non-communicable diseases (NCD), there is less evidence on whether the risk of harm from alcohol use would have a similar relationship with NCD risk factors. The study aims to determine the association between level of harm from alcohol use and NCD risk factors. A cross-sectional survey was conducted among health care workers in Thailand in 2013. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assessed risk of harm from alcohol use. The results suggest that higher risk of harm from alcohol use was associated with two of the eight NCD risk factors among women (higher blood pressure and higher triglyceride level) and five of the eight NCD risk factors among men (smoking, physical inactivity, higher blood pressure, higher blood glucose and higher triglyceride level). For men, assessing risk of harm could be incorporated as part of NCD programs as practitioners do not have to worry about the accuracy of the alcohol quantification and conversion to standard drinks. However, among women, quantifying volume may still be needed.
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http://dx.doi.org/10.1038/s41598-019-52754-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842002PMC
November 2019

Utilisation of Electronic Health Records for Public Health in Asia: A Review of Success Factors and Potential Challenges.

Biomed Res Int 2019 8;2019:7341841. Epub 2019 Jul 8.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Muang, Chiang Mai, 50200, Thailand.

Introduction: Electronic health records offer a valuable resource to improve health surveillance and evaluation as well as informing clinical decision making. They have been introduced in many different settings, including low- and middle-income countries, yet little is known of the progress and effectiveness of similar information systems within Asia. This study examines the implementation of EHR systems for use at a population health level in Asia and to identify their current role within public health, key success factors, and potential barriers in implementation.

Material And Methods: A systematic search process was implemented. Five databases were searched with MeSH key terms and Boolean phrases. Articles selected for this review were based on hospital provider electronic records with a component of implementation, utilisation, or evaluation for health systems or at least beyond direct patient care. A proposed analytic framework considered three interactive components: the content, the process, and the context.

Results: Thirty-two articles were included in the review. Evidence suggests that benefits are significant but identifying and addressing potential challenges are critical for success. A comprehensive preparation process is necessary to implement an effective and flexible system.

Discussion: Electronic health records implemented for public health can allow the identification of disease patterns, seasonality, and global trends as well as risks to vulnerable populations. Addressing implementation challenges will facilitate the development and efficacy of public health initiatives in Asia to identify current health needs and mitigate future risks.
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http://dx.doi.org/10.1155/2019/7341841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6644215PMC
January 2020

"I can't read and don't understand": Health literacy and health messaging about folic acid for neural tube defect prevention in a migrant population on the Myanmar-Thailand border.

PLoS One 2019 13;14(6):e0218138. Epub 2019 Jun 13.

Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Mae Sot, Thailand.

Health literacy is increasingly recognized as an important determinant of health outcomes, but definition, measurement tools, and interventions are lacking. Conceptual frameworks must include both individual and health-systems domains which, in combination, determine an individual's health literacy. Validated tools lack applicability in marginalized populations with very low educational levels, such as migrant worker communities on the Myanmar-Thailand border. We undertake a comprehensive health literacy assessment following a case study of a recent public health campaign promoting preconceptual folic acid uptake in this community. A mixed-methods design utilized quantitative analysis of the prevalence and predictors of low Health literacy, and focus group discussions to gather qualitative data from women about proposed and actual posters used in the campaign. Health literacy was measured with a locally developed tool that has been used in surveys of the population since 1995. Health literacy was low, with 194/525 (37.0%) of tested women demonstrating adequate health literacy, despite 63.1% (331/525) self-reporting being literate. Only one third of women had completed 4th grade or above and reported grade level attained in school was more predictive of health literacy than self-reported literacy. Focus group discussions revealed that low literacy, preconceived associations, and traditional health beliefs (individual domain) interacted with complex images, subtle concepts, and taboo images on posters (health-systems domain) to cause widespread misunderstandings of the visuals used in the campaign. The final poster still required explanation for clarity. Low health literacy is prevalent among pregnant women from this migrant community and barriers to communication are significant and complex. Public health posters need piloting prior to implementation as unanticipated misperceptions are common and difficult to overcome. Verbal communication remains a key method of messaging with individuals of low health literacy and educational system strengthening and audiovisual messaging are critical for improvement of health outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0218138PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6564004PMC
March 2020

Nutrition in transition: historical cohort analysis summarising trends in under- and over-nutrition among pregnant women in a marginalised population along the Thailand-Myanmar border from 1986 to 2016.

Br J Nutr 2019 06 22;121(12):1413-1423. Epub 2019 Apr 22.

Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine,Mahidol University,Mae Sot 63110,Thailand.

The objective of the present study is to summarise trends in under- and over-nutrition in pregnant women on the Thailand-Myanmar border. Refugees contributed data from 1986 to 2016 and migrants from 1999 to 2016 for weight at first antenatal consultation. BMI and gestational weight gain (GWG) data were available during 2004-2016 when height was routinely measured. Risk factors for low and high BMI were analysed for <18·5 kg/m2 or ≥23 kg/m2, respectively. A total of 48 062 pregnancies over 30 years were available for weight analysis and 14 646 pregnancies over 13 years (2004-2016) had BMI measured in first trimester (<14 weeks' gestational age). Mean weight at first antenatal consultation in any trimester increased over the 30-year period by 2·0 to 5·2 kg for all women. First trimester BMI has been increasing on average by 0·5 kg/m2 for refugees and 0·6 kg/m2 for migrants, every 5 years. The proportion of women with low BMI in the first trimester decreased from 16·7 to 12·7 % for refugees and 23·1 to 20·2 % for migrants, whereas high BMI increased markedly from 16·9 to 33·2 % for refugees and 12·3 to 28·4 % for migrants. Multivariate analysis demonstrated low BMI as positively associated with being Burman, Muslim, primigravid, having malaria during pregnancy and smoking, and negatively associated with refugee as opposed to migrant status. High BMI was positively associated with being Muslim and literate, and negatively associated with age, primigravida, malaria, anaemia and smoking. Mean GWG was 10·0 (sd 3·4), 9·5 (sd 3·6) and 8·3 (sd 4·3) kg, for low, normal and high WHO BMI categories for Asians, respectively.
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http://dx.doi.org/10.1017/S0007114519000758DOI Listing
June 2019

Maternal Hepatitis B Infection Burden, Comorbidity and Pregnancy Outcome in a Low-Income Population on the Myanmar-Thailand Border: A Retrospective Cohort Study.

J Pregnancy 2019 25;2019:8435019. Epub 2019 Feb 25.

Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot 63110, Thailand.

Objectives: Hepatitis B virus (HBV) was believed to have minimal impact on pregnancy outcomes apart from the risk of perinatal transmission. In more recent years, there have been reports of adverse associations, most consistently preterm birth (PTB), but this is in the context of high rates of caesarean section. The aim of this study was to explore the association of HBV on pregnancy outcomes in marginalized, low-income populations on the Myanmar-Thailand border.

Methods: HBsAg positive (+) point of care rapid detection tests results were confirmed by immunoassays. Women with a confirmed HBsAg status, HIV- and syphilis-negative at first antenatal care screening, singleton fetus and known pregnancy outcome (Aug-2012 to Dec-2016) were included. Logistic regression analysis was used to evaluate associations between HBV group (controls HBsAg negative, HBsAg+/HBeAg-, or HBsAg+/HBeAg+) and pregnancy outcome and comorbidity.

Results: Most women were tested, 15,046/15,114 (99.6%) for HBV. The inclusion criteria were not met for 4,089/15,046 (27.2%) women due mainly to unavailability of pregnancy outcome and nonconfirmation of HBsAg+. In evaluable women 687/11,025 (6.2%) were HBsAg+, with 476/11,025 (4.3%) HBsAg+/HBeAg- and 211/11,025 (1.9%) were HBsAg+/HBeAg+. The caesarean section rate was low at 522/8,963 (5.8%). No significant associations were observed between pregnancy comorbidities or adverse pregnancy outcomes and HBV status.

Conclusions: The results highlight the disease burden of HBV in women on the Myanmar-Thailand border and support original reports of a lack of significant associations with HBsAg+ irrespective of HBeAg status, for comorbidity, and pregnancy outcomes in deliveries supervised by skilled birth attendants.
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http://dx.doi.org/10.1155/2019/8435019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6413357PMC
July 2019

Appropriate Total cholesterol cut-offs for detection of abnormal LDL cholesterol and non-HDL cholesterol among low cardiovascular risk population.

Lipids Health Dis 2019 Jan 26;18(1):28. Epub 2019 Jan 26.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Suthep, Muang, Chiang Mai, 50200, Thailand.

Background: Current guidelines suggest screening for dyslipidemia in early adulthood. In Thailand, a screening total cholesterol level is most commonly used potentially due to the costs of the test. However, the appropriate TC cut-off point that correlates with elevated low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (Non-HDL-C) levels for the low cardiovascular risk younger population have not been examined extensively in the literature.

Methods: This study identified 1754 subjects with low cardiovascular risk. All participants had a physical examination and a venous blood sample sent for laboratory assessment of fasting blood glucose, TC, LDL-C, HDL-C levels. A non-HDL-C level for everyone was calculated by subtracting HDL-C levels from their total cholesterol levels. Sensitivity and specificity of different TC cutoff points in detection of abnormal LDL-C levels (≥ 130 mg/dL and ≥ 160 mg/dL) and abnormal non-HDL-C levels (≥ 160 mg/dL and ≥ 190 mg/dL) were calculated. Receiver operating characteristics (ROC) curve analysis was used to evaluate the predictive utility of TC for the abnormal LDL-C and abnormal non-HDL-C levels.

Results: The conventional range TC cut off point, between 200 to 240, had varying diagnostic properties for detection of elevated LDL-C and Non-HDL-C within this low risk population. A TC cut off point 210 would have a sensitivity of 70% and specificity of 92.5% for detection of LDL-C ≥ 130 and a sensitivity of 96.7% and specificity of 85.6% for identifying those with Non-HDL-C ≥ 160. The TC cut off point of 230 had a sensitivity of 74.9% and specificity of 92.0% in identifying those with LDL-C ≥ 160 and a sensitivity of 98.6% and specificity of 89.8% in detection of non-HDL-C ≥ 190.

Conclusions: Early screening for dyslipidemia in young adults is suggested by many guidelines. This population is likely to be those with lower cardiovascular risk and may needed to have repeated screening over time. Screening using TC with appropriate a cut off points may be a more cost-effective screening test in settings with limited resources, coverage and accessibility.
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http://dx.doi.org/10.1186/s12944-019-0975-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6347761PMC
January 2019

US Immigration Westernizes the Human Gut Microbiome.

Cell 2018 11;175(4):962-972.e10

Bioinformatics and Computational Biology Program, University of Minnesota, Minneapolis, MN 55455, USA; Biotechnology Institute, University of Minnesota, Minneapolis, MN 55455, USA; Department of Computer Science and Engineering, University of Minnesota, Minneapolis, MN 55455, USA. Electronic address:

Many US immigrant populations develop metabolic diseases post immigration, but the causes are not well understood. Although the microbiome plays a role in metabolic disease, there have been no studies measuring the effects of US immigration on the gut microbiome. We collected stool, dietary recalls, and anthropometrics from 514 Hmong and Karen individuals living in Thailand and the United States, including first- and second-generation immigrants and 19 Karen individuals sampled before and after immigration, as well as from 36 US-born European American individuals. Using 16S and deep shotgun metagenomic DNA sequencing, we found that migration from a non-Western country to the United States is associated with immediate loss of gut microbiome diversity and function in which US-associated strains and functions displace native strains and functions. These effects increase with duration of US residence and are compounded by obesity and across generations.
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http://dx.doi.org/10.1016/j.cell.2018.10.029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6498444PMC
November 2018

Translation and validation of the PACIC+ questionnaire: the Thai version.

BMC Fam Pract 2018 07 19;19(1):123. Epub 2018 Jul 19.

Department of General Practice and Health Services Research, Marsilius-Arkaden Turm West, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.

Background: The number of patients with chronic illness is increasing worldwide. These patients usually receive care from a primary care facility. The Patient Assessment of Chronic Illness Care (PACIC) is a tool that is increasingly used in several countries to measure how the patients perceive the care they receive. The goal of this validation study is to provide and validate an extended version of the tool, the PACIC+ questionnaire, in Thailand.

Methods: In this observational validation study, patients with type 2 diabetes from the outpatient clinic at a university hospital in Thailand completed the PACIC+ at the clinic. For follow-up, they received the questionnaire per mail after four weeks. The Thai PACIC+ comprises 26 items, which map onto 5 subscales and a summary score related to the Chronic Care Model (CCM) and 5 subscales and a summary score related to the 5A model, a counseling model for behavioral changes. Data-analysis focused on the use of most extreme answering categories (> 15%), internal consistency (Cronbach's alpha), and test-retest reliability. An exploratory factor analysis (EFA) was performed for the CCM and the 5A model separately to examine the factor structure.

Results: A total of 151 patients participated. The average age of the sample was 63 ± 9 years (range 29-86 years). Fifty-three percent of the respondents were female. In the Delivery System subscale, 20% of patients reported the highest possible value; in all other subscales, relative frequencies of the most extreme categories did not exceed 15%. Cronbach's alpha per subscale varied from 0.58 to 0.81, while that of the summary scores were 0.89 and 0.91. The mean difference from the test-retest varied from - 0.06 to 0.17 across subscales. The Kaiser-Meyer-Olkin criterion for sampling adequacy (KMO) was good for both models as well as the Bartlett's test for sphericity p. While the factor loadings in rotated factor solution showed good concordance with the CCM, concordance was not as good for the 5A model, especially for the subscales "Assess" and "Advice".

Conclusion: A validated Thai version of the PACIC+ is now available to measure how the patients perceive the care they receive.
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http://dx.doi.org/10.1186/s12875-018-0801-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053714PMC
July 2018

'Because the baby asks for it': a mixed-methods study on local perceptions toward nutrition during pregnancy among marginalised migrant women along the Myanmar-Thailand border.

Glob Health Action 2018 ;11(1):1473104

a Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit , Mahidol University , Mae Sot , Thailand.

Background: Under- and over-nutrition during pregnancy are known risk factors for pregnancy complications and adverse pregnancy and infant outcomes. Understanding perceptions around nutrition in pregnancy can create culturally appropriate interventions for improved health outcomes.

Objective: A mixed-methods study was performed to explore local perceptions and practices of diet and physical activity in pregnancy in a marginalised population along the Myanmar-Thailand border.

Methods: From April to July 2017, a cross-sectional survey and focus group discussions were conducted with pregnant women reporting to antenatal care; in-depth interviews were conducted with senior midwives at participating organisations along the Myanmar-Thailand border.

Results: A total of 388 pregnant women were interviewed at two clinic sites along the Myanmar-Thailand border. A high proportion of women had limited knowledge of and poor dietary practices. Consuming a sweetened drink in the last 24 hours as well as being a non-teenage, multigravida woman was significantly associated with high body mass index (BMI) compared to normal BMI. Qualitative analysis combined focus group discussions (n = 66) and in-depth interviews (n = 4) summarising emergent themes: common foods eaten or avoided and rationale; benefits of nutrition; perceptions of overweight and weight gain during pregnancy; barriers to a healthy diet; and sources of diet information.

Conclusions: There is limited awareness about healthy diets and lifestyle in these marginalised, migrant communities along the Myanmar-Thailand border. This study suggests that simple, culturally appropriate messaging should be provided to women and communities with low health literacy to generate awareness about healthy lifestyles and their effects on pregnancy outcomes as an important element of a broader strategy to address maternal nutrition in this population. However, more studies to determine the effectiveness of a broad range of interventions in low- and middle-income countries (LMIC) are needed, especially in marginalised migrant populations.
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http://dx.doi.org/10.1080/16549716.2018.1473104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965027PMC
October 2018

Cannabis and Kratom online information in Thailand: Facebook trends 2015-2016.

Subst Abuse Treat Prev Policy 2018 05 9;13(1):15. Epub 2018 May 9.

Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.

Background: Our study aims to evaluate the trends in online information about cannabis and kratom on Facebook in Thailand, where there is current discussion regarding legalizing these drugs.

Methods: Between April and November 2015, reviewers searched for cannabis and kratom Facebook pages in the Thai language via the common search engines. Content analysis was performed and the contents of each page were categorized by the tone of the post (positive, negative or neutral). Then, a one-year follow-up search was conducted to compare the contents.

Results: Twelve Facebook pages each were initially identified for cannabis and for kratom. Follower numbers were higher for cannabis pages. Kratom pages were less active but were open for a longer time. Posts with positive tones and neutral tones were found for both drugs, but none had negative tones. Other drugs were mentioned on the cannabis pages, but they were different from those mentioned on the kratom pages. Issues regarding drug legalization were found on the cannabis pages but not on the kratom pages during the searching period. One year later, the tone of the posts was in the same direction, but the page activity had increased.

Conclusions: The information currently available on the sampled Facebook pages was positive towards the use of cannabis and kratom. No information about harm from these drugs was found through our search.
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http://dx.doi.org/10.1186/s13011-018-0155-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944008PMC
May 2018
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