Cameron Hurst

Fish sharing as a risk factor for Opisthorchis viverrini infection: evidence from two villages in north-eastern Thailand

BackgroundFoodborne trematodiasis (FBT) is a significant global health problem, with the liver flukes Opisthorchis viverrini, O. felineus, and Clonorchis sinensis contributing to half of the global burden of FBT. North-eastern Thailand where O. viverrini is endemic and un-cooked fish dishes remain an integral part of the food culture has the highest reported incidence of opisthorchiasis, including associated cholangiocarcinoma. Both food sharing and eating practices are potentially important factors in FTB, suggesting an important role for the social ecology of disease transmission in these rural communities.MethodsTwo rural Thai-Lao villages that were part of a 12-village project in Northeastern Thailand were selected for detailed investigation of O. viverrini infection risk associated with sharing of raw fish dishes among households. The project included screening individuals for infection and cholangiocarcinoma, a household questionnaire, and offering treatment options for positive individuals. Social network mapping was used to construct raw fish dish-sharing networks and create a proxy variable capturing variability in the degree of food sharing (DFS), measured as the number of different households with which each household shared fish dishes. Measures of associations between DFS, O. viverrini infection, the frequency of raw fish consumption, and the number of raw fish dishes consumed were generated using binary logistic regression, proportional odds ordinal logistic regression, and Poisson regression.ResultsThe results showed that the probability that a household has members infected with O. viverrini increased by ~7% (P < 0.01) for each additional household included in its network. Moreover, the frequency and number of types of raw fish dishes consumed increased significantly as the DFS increased. Of the two villages, that with the highest infection prevalence (48% versus 34.6%) had significantly higher social connectivity overall (P < 0.001).ConclusionsOur findings suggest that the social ecology of human settlements may be key to understanding the transmission dynamics of some FBT. In the case of O. viverrini in Thai-Lao communities, for which food sharing is a traditional practice supporting social cohesion, food sharing network mapping should be incorporated into community-based interventions. These should encourage fish dish preparation methods that minimize infection risk by targeting households with high DFS values.

Anterior Tragal Crease Is Associated With Atherosclerosis: A Study Evaluating Carotid Artery Intima–Media Thickness:

The utility of the ear crease sign, anterior tragal crease (ATC), as a marker of atherosclerosis is yet to be established. The intima–media thickness of the common carotid artery (IMT-CCA) has been used as a noninvasive surrogate marker for atherosclerosis. History of traditional risk factors for atherosclerosis was obtained from 147 volunteers; ear examination was also performed and venous blood was drawn for laboratory analysis. The volunteers then underwent an ultrasonography measurement of the IMT-CCA. In univariate analysis, presence of ATC, age, underlying hypertension, diabetes mellitus, ischemic heart disease, cerebrovascular disease, cigarette smoking, low-density lipoprotein, and high-sensitivity C-reactive protein were significantly associated with the IMT-CCA. Further multivariate analysis confirmed a significant association between the presence of ATC and IMT-CCA, when adjusted for other factors (adjusted βATC = .010, 95% confidence interval: 0.0021-0.019). Anterior tragal crease is a potential clinical sign that can predict atherosclerosis. The sign is easily recognizable and may help health-care professionals to identify those at risk of atherosclerosis, especially in people with no clinical signs of the disease.

Vietnamese Version of Diabetes Self-Management Instrument: Development and Psychometric Testing: VIETNAMESE DIABETES SELF-MANAGEMENT INSTRUMENT

Self-management plays a vital role in diabetes management for adults with type 2 diabetes (T2DM). While there are many people with T2DM in Vietnam, clinical understanding of diabetes self-management (DSM) in this context is limited due to the lack of a valid measurement instrument. Translation and back-translation processes were used to translate the Diabetes Self-Management Instrument (DSMI) into Vietnamese. Then, translation equivalence, face validity, construct validity, and internal consistency were assessed in a sample of 198 Vietnamese adults with T2DM. The Cronbachs alpha of the V-DSMI was .92, with a number of significant inter-item correlations. The Vietnamese version of the Diabetes Self-Management Instrument (V-DSMI) retained the meaning of the original English version, and the language of the V-DSMI was clearly understandable to adults with T2DM in Vietnam. Confirmatory factor analysis supported the goodness of fit between the data and the previously identified factor structure. These results indicated that the V-DSMI is acceptable for use with Vietnamese adults with T2DM in further practice and research. However, future studies would be beneficial to determine the test-retest reliability and criterion validity of the V-DSMI.

Psychometric Properties of Diabetes Management Self-Efficacy in Thai Type 2 Diabetes Mellitus Patients: A Multicenter Study

Objective The aims of this study were to translate and psychometrically evaluate the Thai version of diabetes management self-efficacy scale (T-DMSES) and to examine its association with HbA1c control in diabetic individuals. Methods This study recruited patients from outpatient diabetes clinics of both community and university hospitals. The first phases of this study involved translation of the existing DMSES into Thai, and in the second phase, we evaluated its psychometric properties. The construct validity was evaluated using confirmatory factor analysis. Criterion validity of DMSES was subsequently evaluated by examining DMSESs association with HbA1c control. Results The T-DMSES contains 20 items across four factors. Confirmatory factor analysis demonstrated the construct validity of T-DMSES (χ2 = 645.142, df = 164, p < 0.001, CFI = 0.98, RMSEA = 0.065, TLI = 0.977, and AGFI = 0.981). The T-DMSES was also shown to be criterion valid with most subscales highly associated with HbA1c control. Conclusion The T-DMSES was shown to have good psychometric properties. It is likely to provide valuable insights into the epidemiology of diabetes management self-efficacy and may also prove useful in evaluating interventions for raising diabetes management self-efficacy, which in turn, improve both patient self-management and blood sugar control.

Factors associated with self-management among Vietnamese adults with type 2 diabetes

The study described diabetes self‐management (DSM), diabetes knowledge, family and friends’ support, healthcare providers’ support, belief in treatment effectiveness and diabetes management self‐efficacy, and explored DSMs associations among Vietnamese adults with type 2 diabetes mellitus (T2DM).

Development of the Thai Cannabis Risky Use Screening Test

Cannabis use may affect drug users’ health and vitality, but few cannabis users seek health care assistance. This study’s objective is to develop an instrument to identify cannabis use disorder among Thai people and investigate its psychometric properties. A two-stage mixed-method research design was implemented. The first phase was conducted by literature review, in-depth interviews, a focus group, cognitive testing, and exploratory factor analysis. The second phase was conducted using a two-stage screening procedure in a field survey conducted among 1,120 subjects. The gold standard for diagnosis was based on one psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) criteria. The optimal cut-off point was ⩾9.56 (sensitivity, 92%; specificity, 92%). Confirmatory factor analysis revealed two factors, namely loss of control and impacts of cannabis, with good model fit (comparative fit index [CFI] = 0.926, Tucker–Lewis index [TLI] = 0.909, root mean square error approximation [RMSEA] = 0.049). The final instrument, consisting of 13 items, was named “Thai Cannabis Risky Use Screening Test” or TCRUST.

Reliability and validity of the Thai Drug Hypersensitivity Quality of Life Questionnaire: a multi-center study

Objective To adapted the Drug Hypersensitivity Quality of Life (DrHy-Q) Questionnaire from Italian into Thai and assessed its validity and reliability. Design Prospectively recruited during January 2012-May 2017. Setting Multicenter; six Thai tertiary university hospitals. Study Participants Total of 306 patients with physician-diagnosed drug hypersensitivity. Interventions Internal consistency and test-retest reliability were evaluated among 68 participants using Cronbachs ɑ and intra-class correlation coefficient (ICC). The validity of Thai DrHy-Q was assessed among 306 participants who completed World Health Organization Quality of Life-BREF (WHOQOL-BREF-THAI). Construct and divergent validities were assessed for Thai DrHy-Q. Known-groups validity assessing discriminating ability was conducted in Thai DrHy-Q and WHOQOL-BREF-THAI. Main outcome measures Validity; reliability; single vs. multiple drug allergy; non-severe cutaneous adverse reactions (SCAR) vs. SCAR. Results Thai DrHy-Q showed good reliability (Cronbachs ɑ = 0.94 and ICC = 0.8). Unidimensional factor structure was established by confirmatory factor analysis (CFI&TLI = 0.999, RMSEA = 0.02). Divergent validity was confirmed by weak correlation between Thai DrHy-Q and WHOQOL-BREF-THAI domains (Pearsons r = -0.41 to -0.19). Known-groups validity of Thai DrHy-Q was confirmed with significant difference between patients with and without life-threatening SCAR (P = 0.02) and patients with multiple implicated drug classes vs. those with one class (P < 0.01); while WHOQOL-BREF-THAI could differentiate presence of life-threatening SCAR (P < 0.01) but not multiple-drug allergy. Conclusions Thai DrHy-Q was reliable and valid in evaluating quality of life among patients with drug hypersensitivity. Thai DrHy-Q was able to discriminate serious drug allergy phenotypes from non-serious manifestations in clinical practice and capture more specific drug-hypersensitivity aspects than WHOQOL-BREF-THAI.

Impact of Myopia on Corneal Biomechanics in Glaucoma and Nonglaucoma Patients

Purpose We evaluated the impact of myopia on corneal biomechanical properties in primary open-angle glaucoma (POAG) and nonglaucoma patients, and the effect of modification of glaucoma on myopic eyes. Methods This cross-sectional study included 66 POAG eyes (33 myopia, 33 nonmyopia) and 66 normal eyes (33 myopia, 33 nonmyopia). Seven corneal biomechanical parameters were measured by ultra-high-speed Scheimpflug imaging, including corneal deformation amplitude (CDA), inward/outward corneal applanation length (ICA, OCA), inward/outward corneal velocity (ICV, OCV), radius, and peak distance (PD). Results Mean age (SD) of the 65 male (49%) and 67 female (51%) patients was 59 (9.82) years. Myopia was associated with significantly higher CDA (adjusted effect = 0.104, P = 0.001) and lower OCV (adjusted effect = −0.105, P < 0.001) in the POAG group. Within the nonglaucoma group, myopic eyes had a significantly lower OCV (adjusted effect = −0.086, P < 0.001) and higher CDA (adjusted effect = 0.079, P = 0.001). All parameters except PD suggested that glaucoma modified the effect of myopia on corneal biomechanics. Percentage differences in the adjusted myopic effect between POAG and nonglaucoma patients was 31.65, 27.27, 31.65, 50.00, 22.09, and 60.49 for CDA, ICA, OCA, ICV, OCV, and radius, respectively. Conclusions Myopia had a significant impact on corneal biomechanical properties in the POAG and nonglaucoma groups. The differences in corneal biomechanical parameters suggest that myopia is correlated with significantly lower ocular rigidity. POAG may enhance the effects of myopia on most of these parameters.

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels

BackgroundThis study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional).MethodsType 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community).ResultsRegardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs.ConclusionsSpecialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.