Kessarawan Nilvarangkul

A cross-sectional study of pre-travel health-seeking practices among travelers departing Sydney and Bangkok airports

BackgroundPre-travel health assessments aim to promote risk reduction through preventive measures and safe behavior, including ensuring travelers are up-to-date with their immunizations. However, studies assessing pre-travel health-seeking practices from a variety of medical and non-medical sources and vaccine uptake prior to travel to both developing and developed countries within the Asia-Pacific region are scarce.MethodsCross-sectional surveys were conducted between July and December 2007 to assess pre-travel health seeking practices, including advice from health professionals, health information from other sources and vaccine uptake, in a sample of travelers departing Sydney and Bangkok airports. A two-stage cluster sampling technique was used to ensure representativeness of travelers and travel destinations. Pre-travel health seeking practices were assessed using a self-administered questionnaire distributed at the check-in queues of departing flights. Logistic regression models were used to identify significant factors associated with seeking pre-travel health advice from a health professional, reported separately for Australian residents, residents of other Western countries and residents of countries in Asia.ResultsA total of 843 surveys were included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, pre-travel health information from any source was sought by 415 (49%) respondents with 298 (35%) seeking pre-travel advice from a health professional, the majority through general practice. Receipt of a pre-travel vaccine was reported by 100 (12%) respondents. Significant factors associated with seeking pre-travel health advice from a health professional differed by region of residence. Asian travelers were less likely to report seeking pre-travel health advice and uptake of pre-travel vaccines than Australian or other Western travelers. Migrant Australians were less likely to report seeking pre-travel health advice than Australian-born travelers.ConclusionsThis study highlights differences in health-seeking practices including the uptake of pre-travel health advice by region of residence and country of birth. There is a public health need to identify strategies targeting these travel groups. This includes the promotion of affordable and accessible travel clinics in low resource countries as traveler numbers increase and travel health promotion targeting migrant groups in high resource countries. General practitioners should play a central role. Determining the most appropriate strategies for increasing pre-travel health preparation, particularly for vaccine preventable diseases in travelers is the next stage in advancing travel medicine research.

Work-related musculoskeletal disorders among sugarcane farmers in north-eastern Thailand.

This cross-sectional analytical study aimed to identify prevalence and factors associated with work-related musculoskeletal disorders (WMSDs) among sugarcane farmers. Cluster random sampling was used to select 540 sugarcane farmers from 3 provinces in North-Eastern Thailand. Three related questionnaires, plus assessments by 2 expert physiotherapists, were used to check for factors associated with WMSDs and prevalence of WMSDs. Data were analyzed using descriptive statistics and multiple logistic regressions. The results indicated the prevalence of WMSDs among sugarcane farmers in the 7 days before the interview and looking back over the previous 12 months were 82.96% and 88.70%, respectively. Factors significantly associated with reporting WMSDs (P value < .05) during past 12 months were (a) repetitive motions (adjusted odds ratio [OR] = 1.90; 95% confidence interval [CI] = 1.05-3.43), (b) working in awkward postures (adjusted OR = 1.95; 95% CI = 1.01-3.77), (c) forceful exertions (adjusted OR = 2.78; 95% CI = 1.54-5.02), and (d) stress about future income (adjusted OR = 1.80; 95% CI = 1.02-3.16). Recommendations are made for risk prevention strategies.

Cardiovascular Diseases and the Work Environment

The International Commission on Occupation Health, Scientific Committee on Cardiology in Occupational Health, organized the recent International Conference on the Work Environment and Cardiovascular Diseases on the theme “Total Prevention of Cardiovascular Disease—From Social, Organizational and Clinical Perspectives,” held in Tokyo, Japan, in March 2013. Worldwide, cardiovascular disease (CVD) is a pandemic and a significant public health problem. The prevalence of CVDs is increasing because of epidemiological transitions, increasing urbanization, and globalization. CVDs are the number one cause of death and disability globally: More people die annually from CVDs than from any other cause.1,2 An estimated 17.3 million people died from CVDs in 2008, representing 30% of all global deaths.1 Of these deaths, an estimated 7.3 million were due to coronary heart disease and 6.2 million were due to stroke.3 CVDs are responsible for 151 377 million disability-adjusted life years, of which 62 587 million are due to coronary heart disease and 46 591 million due to cerebrovascular disease.3,4 More than 80% of the world’s deaths from CVDs occur in lowand middle-income countries as these populations are more exposed to the various risk factors leading to other noncommunicable diseases and not benefiting from prevention programs. They are less accessible to effective and equitable health care services.1 Some 9.4 million deaths each year, or 16.5% of all deaths can be attributed to high blood pressure.5 This includes 51% of deaths due to strokes and 45% of deaths due to coronary heart disease.4 It is projected that the number of people who die from CVDs, mainly from heart disease and stroke, will increase to 23.3 million by 2030.1,2 The transformation of society and the work environment has led to the increase in CVDs. Stressful and unhealthy working conditions, precarious work, overcrowding, high workload demands, long working hours, machine-based labor that does not involve much physical activity and leisure-time physical inactivity, depression, and anxiety, all lead to CVDs, coronary heart diseases, obesity, and metabolic syndrome. Stress, job strain, and undesirable lifestyles are known triggers of coronary heart disease events among vulnerable individuals.6-14 Stress at work is a major public health risk and thus strategies and intervention for stress reduction should be made for workers’ health so as to improve their quality of life. In this issue of the journal, majority of the articles are related to CVDs, namely, obesity and overweight, social determinants of CVDs, systematic review on the relationship between active transport to work and school, and cardiovascular health. Most CVDs can be prevented by addressing behavioral risk factors, such as tobacco use, unhealthy diet and obesity, physical inactivity, high blood pressure, diabetes mellitus, and

Enhancing a Health-Related Quality-of-Life Model for Laotian Migrant Workers in Thailand

We undertook this action research study to enhance the health-related quality of life (HRQOL) of Laotian migrant workers, and to conceptualize a practical model for workers for use in similar situations. Seventy Laotian migrant workers, 3 researchers, and 18 stakeholders took part in the study. Several data collection methods were utilized, including in-depth interviews, focus groups, participant observations, and field notes. Content analysis was employed to analyze qualitative data. Findings suggest that because of their participation in the study, the workers improved certain aspects of their HRQOL through participation, consciousness raising, and empowerment, which enabled them to become more self-reliant, confident, and competent, and have greater strength to overcome their difficulties. The Enhancing Laotian Workers’ HRQOL Model was conceived as a practical model that could be used by community health nurses working with migrant workers in various contexts.

Self‐Reported Symptoms of Infection Among Travelers Departing From Sydney and Bangkok Airports

BACKGROUND Data on the burden of illness in travelers departing from both developing and developed countries within the Asia-Pacific region is scarce. We conducted a survey to assess symptoms of infection among travelers within the region. METHODS A self-administered questionnaire was distributed to travelers departing Sydney airport, Australia, for destinations in Asia and departing Bangkok Airport, Thailand, for Australian destinations during the respective winter months of 2007. A two-stage cluster sampling technique was developed to ensure representativeness and a weighting was applied to the Sydney sample. Travelers were assessed for symptoms of infection (fever, sore throat, diarrhea, rash, and myalgia), travel activities, and social contact in the 2 weeks prior to departure. RESULTS A total of 843 surveys was included in the final sample (Sydney 729, response rate 56%; Bangkok 114, response rate 60%). Overall, 45.6% of respondents were Australian residents and 26.7% were residents of countries in Asia. At least one symptom of infection was reported by 23.8% of respondents and 5.4% reported two or more symptoms of infection in the 2 weeks prior to departure. The proportion reporting symptoms was higher in those departing Bangkok compared to Sydney. Significant risk factors for the reporting of symptoms differed between residents and visitors departing each study site. Activities resulting in high rates of social contact prior to travel, particularly contact with febrile persons, were found to be independent predictors of reported symptoms. CONCLUSIONS Self-reported symptoms of infection were common in our sample of travelers. Infectious diseases in travelers can result in spread across international borders and may be associated with the frequency of social contacts and reported illness among travelers.

Perception of Stress in Laotian Migrant Workers in Thailand

Globalization and the movement of workers across borders in search of a better life or employment are presenting healthcare systems and researchers with problems of increasing complexity. This study focused on how migrant workers in Thailand from the Lao People’s Democratic Republic conceptualized their stress and stressing factors. Participant observation, in-depth interviews, and field notes were employed in the study, which analyzed data from seventy subjects through qualitative content analysis. The migrant workers in this sample perceived stress as a state of being unable to fulfill their preferences or expectations revolving around issues of: living with poverty, employment, loneliness, poor relationships, competition in the workplace combined with job uncertainty, and invisibility. To provide care for the minority migrant workers, nurses need to focus on identifying how these users perceive stress, and urgent action and further research are needed.

Health-Related Quality of Life of Laotian Migrant Workers in Thailand

The aim of this paper is to explore how migrant workers from the Lao Peoples Democratic Republic conceptualized their health-related quality of life while they worked and lived in Thailand. Seventy workers took part in the study. Data collected from participant observation and in-depth interviews were examined using content analysis. The findings showed that nearly all the workers perceived health-related quality of life as a state of general well-being expressed in the vernacular as u suk sabai. Living, social and employment conditions exerted variable effects on their perceptions of health-related quality of life.

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.