Reproductive health and quality of life of young Burmese refugees in Thailand

BACKGROUND: Of the 140,000 Burmese* refugees living in camps in Thailand, 30% are youths aged 15-24. Health services in these camps do not specifically target young people and their problems and needs are poorly understood. This study aimed to assess their reproductive health issues and quality of life, and identifies appropriate service needs. METHODS: We used a stratified two-stage random sample questionnaire survey of 397 young people 15-24 years from 5,183 households, and 19 semi-structured qualitative interviews to assess and explore health and quality of life issues. RESULTS: The young people in the camps had very limited knowledge of reproductive health issues; only about one in five correctly answered at least one question on reproductive health. They were clear that they wanted more reproductive health education and services, to be provided by health workers rather than parents or teachers who were not able to give them the information they needed. Marital status was associated with sexual health knowledge; having relevant knowledge of reproductive health was up to six times higher in married compared to unmarried youth, after adjusting for socio-economic and demographic factors. Although condom use was considered important, in practice a large proportion of respondents felt too embarrassed to use them. There was a contradiction between moral views and actual behaviour; more than half believed they should remain virgins until marriage, while over half of the youth experienced sex before marriage. Two thirds of women were married before the age of 18, but two third felt they did not marry at the right age. Forced sex was considered acceptable by one in three youth. The youth considered their quality of life to be poor and limited due to confinement in the camps, the limited work opportunities, the aid dependency, the unclear future and the boredom and unhappiness they face. CONCLUSIONS: The long conflict in Myanmar and the resultant long stay in refugee camps over decades affect the wellbeing of these young people. Lack of sexual health education and relevant services, and their concerns for their future are particular problems, which need to be addressed. Issues of education, vocational training and job possibilities also need to be considered.*Burmese is used for all ethnic groups

Effectiveness of Back Exercise and Education for Lower Back Pain Prevention among Nurses at a Tertiary Hospital in Bangkok, Thailand

Objective:  To examine the effectiveness of back exercise and education to promote lower back pain relief among nurses at a tertiary hospital. Methods:  This quasi-experimental study was conducted using a sample of sixty nurses working at Siriraj Hospital. Eligible criteria included full-time registered or practical nurses who had undergone direct contacted with patients for at least six months and suffered from chronic lower back pain. The subjects were randomly divided into a training group and a control group. The training group followed a back exercise program including pelvic tilting, back extension, and knee to chest at least 3 days a week for 12 weeks while the control group performed daily activities as normal.  Data were collected using a questionnaire at baseline, 4th, 8th, and 12th weeks. Results: Significant differences of pain score and the Thai version of the Oswestry questionnaire were scored between the training and control groups (P-value < 0.001), while beneficial effects improved significantly during the time points of exercise (P-value < 0.001). Conclusion:  Back exercises and education can effectively relieve lower back pain and improve disabilities among nursing staff. Following our recommended procedures will improve the safety aspect for nurses working in tertiary hospitals

Management Pattern and Hospital Charge of Repairing Cleft Palate at Siriraj Hospital

Management pattern and hospital charge for repairing cleft palate at Siriraj Hospital during 1996-1999 were studied retrospectively. From the examination of 100 patient records, four cases were excluded since no surgical correction was performed during hospitalization. Fifty-nine percent were female and the average age was 5.54 years old. Fever and otitis media were associated with two and three cases respectively. Other underlying diseases included hypothyroidism, patent ductus arteriosus and ventricular septal defect were found one in each case. The cleft palate was successfully repaired in all cases. Surgical correction was done in 84 percent of cases within the first five days of hospitalization. The average length of stay was 5.89 ± 2.85 days and ranged from 2-20 days. The hospital charge for cleft palate repair was 7,031.22 ± 1,365.33 Baht per case. This study illustrate that a small variation is practiced in the management of a reasonably straight forward condition and better preparation of the patients before hospitalization could reduce the hospital stay or avoid unnecessary hospitalization

Effects of cytochrome P450 2C19 and paraoxonase 1 polymorphisms on antiplatelet response to clopidogrel therapy in patients with coronary artery disease.

Clopidogrel is an antiplatelet prodrug that is recommended to reduce the risk of recurrent thrombosis in coronary artery disease (CAD) patients. Paraoxonase 1 (PON1) is suggested to be a rate-limiting enzyme in the conversion of 2-oxo-clopidogrel to active thiol metabolite with inconsistent results. Here, we sought to determine the associations of CYP2C19 and PON1 gene polymorphisms with clopidogrel response and their role in ADP-induced platelet aggregation. Clopidogrel response and platelet aggregation were determined using Multiplate aggregometer in 211 patients with established CAD who received 75 mg clopidogrel and 75-325 mg aspirin daily for at least 14 days. Polymorphisms in CYP2C19 and PON1 were genotyped and tested for association with clopidogrel resistance. Linkage disequilibrium (LD) and their epistatic interaction effects on ADP-induced platelet aggregation were analysed. The prevalence of clopidogrel resistance in this population was approximately 33.2% (n = 70). The frequencies of CYP2C19*2 and *3 were significantly higher in non-responder than those in responders. After adjusting for established risk factors, CYP2C19*2 and *3 alleles independently increased the risk of clopidogrel resistance with adjusted ORs 2.94 (95%CI, 1.65-5.26; p<0.001) and 11.26 (95%CI, 2.47-51.41; p = 0.002, respectively). Patients with *2 or *3 allele and combined with smoking, diabetes and increased platelet count had markedly increased risk of clopidogrel resistance. No association was observed between PON1 Q192R and clopidogrel resistance (adjusted OR = 1.13, 95%CI, 0.70-1.82; p = 0.622). Significantly higher platelet aggregation values were found in CYP2C19*2 and *3 patients when compared with *1/*1 allele carriers (p = 1.98 × 10(-6)). For PON1 Q192R genotypes, aggregation values were similar across all genotype groups (p = 0.359). There was no evidence of gene-gene interaction or LD between CYP2C19 and PON1 polymorphisms on ADP-induced platelet aggregation. Our findings indicated that only CYP2C19*2 and *3 alleles had an influence on clopidogrel resistance. The risk of clopidogrel resistance increased further with smoking, diabetes, and increased platelet count

Mid-Term Outcomes of Chimney Endovascular Aortic Aneurysm Repair: A Systematic Review and Meta-analysis

BACKGROUND: To provide an overview of the literature on the mid-term outcomes of chimney EVAR (ChEVAR) for the treatment of juxtarenal abdominal aortic aneurysms (JAAA). METHODS: Different electronic databases were searched for published articles up to January 2020. The eligibility criteria were studies describing mid- or long-term outcomes of chimney EVAR (mean follow-up at least 1 year) for treatment of JAAA, including more than 10 cases, published in English, and with full text available. The outcomes measure were overall survival rate, target vessel patency, and freedom from reintervention at 3 years. Quality of the included studies was analyzed using the MINORS criteria. Pooled effect estimates were analyzed using random-effect models and heterogeneity was tested using I2 statistics. RESULTS: Thirteen articles met the inclusion criteria. The included studies described 1,019 patients. According to the quality assessment, methodological quality was moderate to poor. The pooled overall survival, freedom from reintervention, and target vessel patency at 3 year was 81.4 % (95%CI 73.8-87.9), 85.7% (95%CI 75.6-93.5), and 95.1% (95%CI 89.3-98.7) respectively. CONCLUSIONS: The results of this review show good to acceptable short and mid-term survival and good mid-term durability, which supports that ChEVAR as a suitable alternative in high-risk JAAA. However, proper patient selection for ChEVAR seems essential to attain good mid-term outcomes, and further large prospective and good quality studies are required to demonstrate its long-term results and enable conclusions on specific determinants for outcome

Standardized linkage disequilibrium coefficient (D′) and correlation coefficient (r) among three polymorphisms in CYP2C19 and PON1.

<p><i>D′</i> values are shown in the lower triangle, and <i>r</i> values are shown in the upper triangle.</p><p>Standardized linkage disequilibrium coefficient (D′) and correlation coefficient (r) among three polymorphisms in CYP2C19 and PON1.</p

Distribution of CYP2C19*2, *3 and PON1 genotypes in clopidogrel responders and non-responders.

<p><b>*</b> Comparison of genotype and allele frequencies between non-responders and responders.</p>†<p>Statistically significant difference at p<0.05.</p>‡<p>p-value of Hardy-Weinberg equilibrium.</p><p>Distribution of CYP2C19*2, *3 and PON1 genotypes in clopidogrel responders and non-responders.</p

Estimated risk of clopidogrel resistance in patients with at least one of the following risk factors: CYP2C19*2, CYP2C19*3, smoking, diabetes mellitus, increase in platelet count adjusted for age and sex.

<p>*Estimated OR for each risk factor category compared to men with no CYP2C19 mutation (wild type), with average age (66.25 year-old), average platelet count (255,900 platelets/mm³), who do not smoke and do not have diabetes. Platelet variable is calculated per ×1,000 platelet increased. Log odds for clopidogrel resistance were calculated using multivariate logistic regression as a function of CYP2C19*2+CYP2C19*3+Smoking+Diabetic Status+increased Platelet Count.</p>†<p>Risk is statistically significant when compared to the reference genotype at p-value<0.05.</p><p>Estimated risk of clopidogrel resistance in patients with at least one of the following risk factors: CYP2C19*2, CYP2C19*3, smoking, diabetes mellitus, increase in platelet count adjusted for age and sex.</p

Interaction among polymorphisms in CYP2C19*2, *3 and PON1 Q192R and the effects on ADP-induced platelet aggregation.

<p>A) Effects of PON1 Q192R polymorphism on platelet aggregation stratified by <i>CYP2C19*2</i> genotype; B) Effects of <i>PON1</i> Q192R polymorphism on platelet aggregation stratified by <i>CYP2C19*3</i> genotype; C) Effects of <i>CYP2C19*2</i> on platelet aggregation stratified by <i>CYP2C19*3</i> genotype</p

ADP induced platelet aggregation level by CYP2C19*2, *3 and PON1 Q192R polymorphisms in clopidogrel treated patients with coronary artery disease.

<p>p-values assuming additive genetic model represent the association between genotype and ADP-induced platelet aggregation (U) at p-value<0.05.</p><p>ADP induced platelet aggregation level by CYP2C19*2, *3 and PON1 Q192R polymorphisms in clopidogrel treated patients with coronary artery disease.</p