John F. Smith

Risk factors for Clonorchis sinensis infection transmission in humans in northern Vietnam: A descriptive and social network analysis study

Clonorchis sinensis is major fish-borne trematode, endemic in North Vietnam. Risk factors described so far include individual eating behaviors and environmental factors. Here, additional to conventional risk factors, we report on socially influenced liver fluke transmission in endemic communities. A cross-sectional study on risk factors and fish sharing networks was conducted in 4 villages of Gia Thinh Commune, Ninh Binh Province. A total of 510 residents in 272 households were recruited for risk factor analysis while 220 households, 28 fishermen and 10 fish-sellers were enrolled for social network study. Fecal examination for C. sinensis eggs was performed. Average C. sinensis infection rate at Gia Thinh commune was 16.5% (range 2% to 34.4%). Higher infection rates were significantly associated with males, lower educational levels, eating raw fish, and location of the villages. Social network analysis (SNA) showed a strong positive correlation between ego network size (number of households in fish sharing network) and quantity of raw fish consumed (r=0.603, P<0.05). The infection rate in people who ate raw-fish caught from a nearby river was significantly higher than those who consumed fish taken from farmed ponds (P<0.05). The amount of raw-fish meal consumed per resident/year was significantly higher in villages that had a strong network of sharing raw-fish food (P<0.001). This study reports for the first time on fish-food sharing among neighbors, proximity to water bodies, frequency of eating raw fish from natural water bodies and low education were key risk factors in C. sinensis infection transmission in northern Vietnam.

News from the IAEH.

The context-dependent nature of infectious disease outcomes advocates considering ecological determinants and hence, when the host is human, the incorporation of human ecology, a social science. The importance of integrating social considerations into ecological studies of infectious diseases is essential for research on sustainable disease control. Taking into account the complex interactions from genes to communities across spatial and temporal scales is a fundamental necessity; however, practical implementation remains limited because transdisciplinary research that integrates knowledge from different unrelated disciplines (e.g. social science and ecology) and non-academic knowledge sources is rarely achieved. Increasingly, graduate programs acknowledge the need for integrative investigations of infectious diseases. Many emphasize the multidisciplinary nature of their curriculum where clinical, population, laboratory, and social sciences can be integrated. Yet despite these good intentions, the Ecohealth agenda is impeded by conceptual compartmentalization and the limited dialog among social, natural, biomedical, and public health sciences personnel. The lack of a cohesive conceptual framework that links disciplinespecific processes is often at the origin of this limitation. To rectify this historic trend and restore scholarly breadth of original university science, future or evolving graduate programs should consider incorporating in their curriculum a certain number of mandatory courses such as philosophy and history of science or ethics in science. Additionally, graduate programs may want to organize advanced workshops focusing on the concept of multiple working hypotheses and how to implement multi-scale causal inference in disease research. With a deepened philosophical background, students in health sciences should be able to establish solid foundations for critical thinking and intellectual openness and become the scientific leaders that will reconcile holistic and reductionist approaches in health sciences. Transdisciplinarity and the proper incorporation of social determinants also implies that institutions and individuals become immersed in the local culture for more than their sampling season, especially when research is conducted abroad. Researchers should also aim to involve themselves in the daily life of local communities, enabling individuals to better understand social networks and how they impact disease outcomes. Investigators should also be open to ‘‘intellectual out-breeding’’ and receptive to local wisdom. Finally, although pressure to publish is strong, researchers must not forget the true finality of their work: helping the community. These elements are rarely taught or even suggested in graduate programs because they are emerging ethical values often contingent on one’s life experience and exposure to real situations. Yet this ethical perspective is critical to better understand the socio-ecological determinants of disease dynamics. In practice, the support and organization of educational interventions describing the research-to-practice-to-community continuum (targeting both researchers and local stakeholders) are critical to make ethical principles operational. I recently took a post-doctoral position with the Tropical Disease Research Laboratory (TDR), a unit associated with the Faculty of Medicine, Khon Kaen University (KKU) in northeastern Thailand. The research focus of TDR is on Opistorchis viverrini (OV), a liver fluke that Correspondence to: Pierre Echaubard, e-mail: pn_echaubard@laurentian.ca EcoHealth 12, 4–7, 2015 DOI: 10.1007/s10393-014-0999-7

Developing primary care occupational health services for informal sector workers in Thailand

This study demonstrates action research’s emancipatory traditions in enabling community stakeholders in rural Thai settings to increase self-reliance and collaboration in improving primary care occupational health services. Most of the Thai workforce are informal sector workers outside Thai labor law protections, health and safety regulatory frameworks, and without specific occupational health services to provide for work-related health needs. This project brought together community leader teams, village health volunteers and informal workers themselves to collaboratively develop community services for this underserved group. Significant changes were effected at community team level, with improvements in networking and community nurses’ health care for the workers and in their oversight and supervision of village health volunteers (VHVs) in the community. Most notably, VHVs’ self-confidence improved at providing illness prevention and health promotion support in workers’ homes and work settings congruent with their daily lifestyle and work schedules. Informal workers’ health self-care behaviors improved.

Using Action Research to prevent work-related illness among rubber farmers in Northeastern Thailand

OBJECTIVES This research aimed to enhance self-care among rubber farmers for preventing work-related illness. DESIGN AND SAMPLE The project used Action Researchs four phase iterative process: fact-finding to understand the problems, action planning, action plan implementation, and evaluation and reflection on action plan impacts. Sixty-six participants (46 rubber farmers and 20 community stakeholders) were purposively recruited from two villages in the top 10 rubber producing provinces in Northeastern Thailand. MEASURES Demographic and work-related illness data were collected in face-to-face structured interviews, Focus group interviews and participant observations were used to collect data in each project phase. Night group meetings were held throughout the research phases. The intervention included training workshops and establishing a community health education team for ongoing farmer support. RESULTS Results showed improved farmer self-care behaviors and establishment of a community health education team to encourage farmers to care for themselves properly. CONCLUSION Community nurses, other health personnel, and the Thai government can build on initiatives like this to strengthen occupational health and safety practices and services policy for rubber farmers.

Development and validation of a work-related low back pain risk-assessment tool for sugarcane farmers

This cross sectional study developed and validated a LBP risk-factor screening scale for use with sugarcane farmers. The scale was developed from a synthesis of LBP risk factors, pretested with 30 sugarcane farmers and administered to five hundred and forty sugarcane farmers to test its psychometric properties. Results indicated construct validity for three factors; physical factors (19 items) with factor loadings of 0.406 to 0.881 and communalities between 0.471 and 0.991; psychological factors (7 items) with factor loadings of 0.635 to 0.821 and communalities between 0.444 and 0.714, and third, working environment factors (2 items), with factor loadings between 0.345 and 0.347 and communalities between 0.946 and 0.953. The content validity index was 0.90 with reliability index of 0.87. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 82.02%, 30.49%, 62.65% and 54.40% respectively. The area under the receiver operating characteristic was 0.56. The scale’s high specificity and sensitivity and comprehensive three risk-factor dimensions should make it a very useful screening tool in primary health care for early detection of LBP and for LBP risk-reduction and prevention advice. Future studies could focus on confirming content and predictive validity in other settings to assess generality of its usage.

Choosing the optimal method of blood pressure measurement for limited‐resource rural communities in the “Community Health Assessment Program—Philippines”

The Community Health Assessment Program—Philippines (CHAP‐P) is an international collaboration of investigators whose aim is to adapt a previously proven Canadian community‐based cardiovascular awareness and prevention intervention to the Philippines and other low‐middle–income countries. Choosing a method of blood pressure measurement for the research program presents a challenge. There is increasing consensus globally that blood pressure measurement with automated devices is preferred. Recommendations from low‐middle–income countries, including the Philippines, are less supportive of automated blood pressure devices. The value placed on factors including device accuracy, durability, cost, energy source, and complexity differ with local context. Our goal was to support the progress of local policy concerning blood pressure measurement while testing a comprehensive approach to community‐based screening for cardiovascular risk. The authors describe the challenges in making a choice of blood pressure device and the approach to determine optimal method of measurement for our research program.