Complex segregation analysis of leprosy in Southern Vietnam

To investigate the nature of the genetic component controlling susceptibility to leprosy and its subtypes, 402 nuclear families were ascertained through a leprosy patient followed at the Dermatology Hospital in Ho Chi Minh City, Vietnam; 285 families were of Vietnamese origin and 117 were of Chinese origin with a higher proportion of lepromatous forms among Chinese patients. Segregation analyses were conducted using the model developed by Abel and Bonney [(1990) Genet Epidemiol 7:391–407], which accounted for variable age of onset and time-dependent covariates. Three phenotypes were considered: leprosy per se (all forms of leprosy together), nonlepromatous leprosy, and lepromatous leprosy. For each of this phenotype, analyses were performed on the whole sample and separately on the Vietnamese and the Chinese families. The results showed that a single Mendelian gene could not account for the familial distributions of leprosy per se and its two subtypes in the whole sample. However, these results were different according to the ethnic origin of the families. In the Vietnamese subsample, there was evidence for a codominant major gene with residual familial dependences for the leprosy per se phenotype, and borderline rejection of the Mendelian transmission hypothesis for the nonlepromatous phenotype. In Chinese families, strong rejection of Mendelian transmission was obtained in the analysis of leprosy per se, and no evidence for a familial component in the distribution of the nonlepromatous phenotype was observed. For the lepromatous phenotype, the discrimination between models was poor, and no definitive conclusion could be reached. Referring to immunological data, we suggest that these results could be explained by a heterogeneity in the definition of the lepromatous phenotype. It is likely that progress in the understanding of the genetic components involved in the expression of leprosy will come from a better definition of the phenotype under study, and immunological studies are ongoing in this population to investigate this hypothesis. © Wiley-Liss, Inc.     

Beyond constructionism and pessimism: theoretical implications of leprosy destigmatisation campaigns in Thailand

Based on a study of leprosy destigmatisation campaigns conducted in Thailand since the 1970s, this article examines the difficulties in their implementation, the extent of their success and the degree to which they are actually needed. The findings indicate that these campaigns are doomed to fail because of problems inherent in any attempt to transmit a normalising message, and also because of stigmatisation derived from the metaphorical use of leprosy in spoken language. The study also found that educating the public about leprosy only increased the risk of stigmatisation. However, it appears that the stigma itself bears the potential for destigmatisation, since the worse the image of the disease, the less likely its identification with the patients diagnosed today, thus sparing them actual negative reactions. These conclusions serve as a basis for examining assumptions about knowledge and power underlying the constructionist analysis of destigmatisation processes. The paper calls to abandon these presuppositions, as they have led constructionism to a pessimistic view of the possibility of destigmatising diseases and disabilities.     

对麻风受累者家属的疾病相关知识、态度、行为调查

目的研究麻风受累者家属的疾病相关知识、态度、行为,为开展针对性健康教育提供指导。方法使用多阶段抽样方法对从浙江省既往4个麻风流行区绍兴、上虞、桐乡、萧山选择的278例患者家属进行疾病相关知识、态度、行为调查,调查问卷自行设计,由当地麻风防治人员登门调查,表格当场填写完成。结果278例麻风受累者家属麻风相关知识总体知晓率为66.91%,知晓麻风会出现皮肤损害,可以在家庭治疗,治疗多长时间者分别占47.12%,42.45%和43.88%,但对于不规则服药的害处,本地麻风防治机构,治愈后注意事项的知晓率均在80%以上;在态度方面,愿意与病人一起生活者为82.01%,愿意与病人一起吃饭者为57.91%,但是不害怕麻风者仅为28.06%。在行为方面,督促病人规则治疗与残疾预防者占87.41%,在病人苦闷时予以劝解疏导者占57.91%,曾经接受麻风体检者占51.44%,寻求过服用药物预防麻风者占17.99%。结论麻风受累者家属相关知识有待提高,促进麻风病人家属对病人的心理疏导以及提高麻风病人家属的麻风预防保健意识十分必要。     

宁波市2004-2010年新发麻风疫情分析

目的：对2004-2010年宁波市新发现的麻风患者进行回顾性分析,为进一步防治麻风提供依据。方法：调查新发现的麻风病患者相关情况并进行统计分析。结果：2004-2010年新发现麻风患者26人,男17人,女9人;年平均发现率为0.0446/10万,多菌型占84.62%;23例为散发输入性病例,确诊发病年龄平均为31.05岁,平均延迟期为16.92个月,家庭内接触感染9例,皮肤科门诊发现24例,患者家属及接触者检查发现病人2例。结论：宁波市麻风病处于输入性散发为主的低流行地区,今后防治的最佳对策是加强综合性医院就诊检查麻风病,结合接触者检查和疫点调查,并开展来自高流行地区流动人口的健康教育和筛查。     

毕节市开展消除麻风病危害普查效果分析

目的实施消除麻风病危害普查,最大限度地发现患者,加速毕节市实现消除麻风病危害。方法政府参与,逐级签订目标责任书;加强宣传培训工作,开展村民和学生皮肤病检查,发现麻风病确诊和可疑病例逐级上报,并对2012年1—6月的普查结果和2013年情况进行对比分析。结果召开县（区）级以上消除麻风病危害工作会议24次,举办233期培训班,村民走访82629人,村民和学生皮肤病检查率分别为94．03％和92．64％,报告麻风病可疑线索1984条。2012年与2013年新发现麻风病例情况比较：多菌型（MB）、2级畸残率差异有统计学意义（P〈0．05和P〈0．01）,发现方式构成比差异无统计学意义（P〉0．05）。结论开展消除麻风病危害普查能有效发现麻风病例,麻风病疫情仍较严峻,今后工作重点是加强麻风病早期症状监测和麻风病知识宣传,实施政府行政干预,通过主动走访、线索调查、接触者检查、报病奖励等方式,及时发现、诊断及规则治疗麻风新病例,减少传播,消除麻风危害。     

麻风畸残程度影响因素的逐步回归分析

探讨少菌型麻风治疗后发生麻风反应神经炎合并大疱性类天疱疮的临床特点。

对1例麻风治愈者在出现麻风反应后合并发生类天疱疮的治疗进行分析。

患者接受麻风规范治疗后5年,无明显诱因情况下出现四肢红斑、水泡,并进行性加重。结合临床诊断及病理检查诊断为类天疱疮,给予激素治疗麻风反应以及抗免疫治疗,同时对症支持治疗。

麻风反应与类天疱疮均与机体免疫力有关,但是两者同时发生的情况较为少见,所以在临床过程中要高度重视,做到早发现、早诊断、早治疗,避免对患者造成更大伤害。

     

Social network influences on reproductive health behaviors in urban northern Thailand

Prevention approaches for reproductive health have evolved from an emphasis on individually focused models of behavior change to a recognition that risk reduction occurs within a context of social norms. Prevention programs can be improved by understanding how social structure influences sexual behavior and using that understanding to develop strategies for positive change. In a dynamic, urban context, communities are better conceptualized as informal networks of ties. These network structures may help to protect, or conversely, expose members to reproductive risk behaviors. Using data from a study of social and sexual networks conducted in northern Thailand, this article describes partner relations and social structure in the modern, urban context, and illustrates the links between individual, relational and structural properties and reproductive risk behaviors. Triangulation of ethnographic, survey and social network data collection and analytic tools provide an opportunity to interpret individual behaviors, meanings of relationships and structural properties of networks. Intervention approaches should build on existing networks, and address the complex meanings of romantic and sexual partnerships.     

A test of nonrandom segregation

Within a family, associations between a disease and a marker locus are often inferred when affected offspring share marker alleles more often than is expected by chance. Generally, this is due to nonrandom parental transmission of marker alleles and specifically could be due to linkage, epistatic gene action, or segregation distortion at the marker locus. In this paper, we discuss the statistical properties of a general test of nonrandom segregation of a marker gene. The exact probability distribution of the test under the null hypothesis of random segregation is derived, as is the distribution under the alternative hypothesis of genetic linkage. We compute the mean and variance of these distributions as a means of judging the adequacy of random segregation to explain disease-marker data but also provide a method for computing the exact significance value under the null hypothesis. These methods have been utilized for studying HLA segregation in families with tuberculoid leprosy. On the assumption that this type of leprosy is autosomal recessive, we find evidence that a gene controlling susceptibility to infection by Mycobacterium leprae resides on human chromosome 6, approximately 13 map units away from the HLA locus in males.     

Expected epidemiological impacts of introducing an HIV vaccine in Thailand: a model-based analysis

Background

The RV144 trial conducted in Thailand was the first to demonstrate modest protective efficacy of an HIV vaccine. Its estimated initial efficacy was ∼74%, but this waned considerably over time.

Methods

We developed a mathematical model to reflect historical and current HIV trends across different at-risk populations in Thailand. The model was used to estimate the expected number of infections that would be averted if a vaccine with outcome characteristics similar to the RV144 vaccine was implemented in Thailand at varying levels of coverage.

Results

In the absence of a vaccine, we projected roughly 65,000 new HIV infections among adults during the period between 2011 and 2021. Due to the waning efficacy of the vaccine, vaccination campaigns were found to have modest long-term public health benefit unless re-vaccination occurred. We forecast that an RV144-like vaccine with coverage of 30% of the population would lead to a 3% reduction in HIV incidence during the next 10 years. In comparison, 30% coverage of annual or biennial re-vaccination with the vaccine was found to result in 23% and 14% reductions in incidence, respectively. Coverage of 60% without re-vaccination resulted in a 7% reduction. Epidemiological outcomes were found to depend primarily on three factors: vaccination coverage, vaccine efficacy, and the duration of protection the vaccine provided.

Discussion

Due to the short duration of protection the vaccine provides without re-vaccination, our model predicts modest benefit from a vaccination campaign with an RV144-like HIV vaccine in Thailand. Annual or biannual re-vaccination is predicted to greatly increase the long-term public health benefits of a vaccination campaign. The feasibility of vaccine implementation, as well as its economic viability, remains to be determined.     

Further tests of nonrandom segregation with special reference to linkage

For an autosomal recessive disease, a statistical procedure is developed for detecting nonrandom segregation of marker haplotypes from an unaffected parent to affected children, specifically for the case when the alternative hypothesis of linkage between the disease and marker loci is postulated. The test procedure is locally most powerful and, depending on family size and number of families sampled, any one of the three test statistics proposed can be used. An application of this procedure provides evidence of linkage between tuberculoid leprosy and HLA.     

Spatiotemporal patterns of malaria incidence in northern Thailand

We present a detailed analysis of long-term time series of malaria incidence in northern Thailand. Positive cases for Plasmodium falciparum and P. vivax have been recorded monthly from 1977-2002 at 13 provinces in the region. Time series statistical methods are used to examine the long-term trends and seasonal dynamics of malaria incidence at regional and provincial scales. Both malarial types are declining throughout the region, except in the two provinces that share a large border with Myanmar. The rate of decline in P. vivax has decreased across the region since the end of the 1980s, and this may be a signal of developing resistance or changing vector potential. Both species display a two-peak annual seasonality that may be attributed to patterns of vector occurrence, farming practice and migration of individuals across international borders. In a number of provinces, the importance of the first seasonal peak has grown in recent years, possibly owing to increases in vector densities. The medium-term fluctuations of both species exhibit a clear spatial organisation. There is some evidence of a subtle close to 4-year super annual cycle in P. falciparum, which we suggest is driven by extrinsic factors relating to the climate of the region.     

Segregation analysis of cancer in families of glioma patients

A small proportion of brain tumors are attributed to a genetic predisposition; however, the hereditary proportion is undetermined. This study evaluates the degree of familial aggregation of cancer in a large series of brain tumor patients. Our study included 5,088 relatives of 639 probands (3,810 first- and 1,278 second-degree), diagnosed with a glioma between June 1992 and June 1995 at The University of Texas M. D. Anderson Cancer Center, Houston, Texas, with diagnosis under age 65 years, and residents of the United States or Canada. We conducted an in-person or telephone interview with patients and/or their next-of-kin, and obtained family histories for the probands' first-degree (parents, siblings, offspring) and selected second-degree relatives (aunts, uncles, grandparents) using a sequential sampling strategy. Reported cancers were documented by medical records and/or death certificates (if the relative was deceased and medical records were unavailable). We conducted segregation analysis using the Pedigree Analysis Program (PAP). The analyses were divided into two categories: (1) all 639 families, and (2) a subset of families whose gliomas stained positive on p53 immunohistochemistry analysis. We demonstrated that a multifactorial Mendelian model was favored, while a model postulating a purely environmental cause of brain cancer was rejected. This study indicates that familial cancer in relatives of glioma patients are probably a result of multigenic action, and familial clustering of cancer among relatives of glioma patients may involve unknown environmental exposures.     

Respirable silica and noise exposures among stone processing workers in northern Thailand

Silica and noise are highly prevalent occupational exposures in the stone processing industry. Monitoring for silica and noise are expensive tasks that may be especially difficult to perform in low-resource settings, but exposure awareness is vital for protecting worker health. This study evaluated personal noise and silica measurements at a stone processing facility in northern Thailand to investigate the differing exposure potentials and risk for overexposure among the varying job categories. Our research team performed repeated personal noise and respirable silica measurements on 46 workers, over three separate workshifts for each of 46 workers. While 36.2% of noise measurements exceeded the recommended exposure limit of 85 dBA, only three silica measurements (2.4%) were above the threshold limit value (TLV) of 25 µg/m³. Self-reported personal protective equipment use was low, with only 27.5% of participants wearing hearing protection in noisy environments during their monitored shift and 29.7% of workers wearing respiratory protection during dusty portions of their shift. We identified a significant positive correlation between measured noise and silica levels (r = 0.54, p < 0.01), with stone loaders having the highest average noise (mean = 89 dBA, standard deviation = 4.9 dBA) and silica (geometric mean = 6.4 µg/m³, geometric standard deviation = 1.8) exposure levels. In a multivariate model, the stone loader job category was a significant predictor of exposure to detectable levels of respirable silica (p < 0.01). These results provide useful guidance regarding the need for noise and silica exposure interventions in order to reduce incidences of workplace disease in the stone processing industry.     

A qualitative exploration of psychosocial challenges of perinatally HIV-infected adolescents and families in Bangkok,Thailand

Thailand has the highest HIV prevalence in Asia, with 9600 HIV+ adolescents and thousands of additional younger HIV+ children. Studies from other settings suggest perinatally HIV-infected (PHIV+) adolescents are at high risk for mental health problems and engagement in risk behaviors that threaten individual and public health. Yet, few studies exist in Thailand, and few evidence-based psychosocial interventions have been developed for and studied in this population, despite great need. The current study qualitatively explored psychosocial issues among Thai PHIV+ adolescents to inform development or adaptation of interventions. Thai and US-based researchers and clinicians conducted two focus group discussions with PHIV+ adolescents aged 12–16 and their adult caregivers, and six in-depth key informant interviews with health/social work providers at a large clinic for PHIV+ youth in Bangkok, Thailand. Data were analyzed thematically using framework analysis. Multiple challenges for PHIV+ youth and caregivers were identified. Adherence to antiretroviral treatment was a significant challenge attributed to lack of adult support, side effects, feeling too well to take medicines and avoiding acknowledging sickness. Poor child–caregiver communication and conflict was a key concern, explained in part by cultural expectation of obedience and generation gaps. Concerns about societal stigma and discrimination emerged strongly and influenced delay or avoidance of disclosing HIV status to children and others. Respondents identified positive approaches to addressing these issues and highlighted the need for interventions to improve child–caregiver communication and generate peer and community support for PHIV+ youth. Thai PHIV+ adolescents and families experience significant psychosocial challenges, similar to those seen in other contexts. Cultural adaptation of an existing evidence-based clinic-based family group intervention is recommended to rapidly address these needs.     

贵州省麻风病密切接触者麻风病核心知识知晓率调查

目的 了解贵州省麻风病密切接触者麻风病核心知识知晓情况,为今后制定贵州省麻风病健康教育提供科学依据。方法 对贵州省2005年1月1日-2013年12月31日发现的所有存活的麻风病患者的密切接触者进行入户调查,采用麻风病问卷评价调查对象对麻风病核心知识的知晓情况。结果 5 497名调查对象中,答对≥ 5题被调查者数为4 275人,核心知识知晓率为77.77%,单一核心信息知晓率在70.00%~84.00%;密切接触者获得核心知识的主要来源为宣传材料（47.88%,2 562人）,其次为通过家人、朋友或同事获得（46.72%,2 500人）和医生咨询（44.70%,2 392人）;女性、13岁~及≥ 60岁人群,小学以下文化程度是影响知晓率水平的主要因素。结论 麻风病密切接触者麻风病防治核心知识知晓率较高,可尝试利用他们对周围人群进行健康宣传。     

An updated cost-effectiveness analysis of pneumococcal conjugate vaccine among children in Thailand

BackgroundA previous cost-effectiveness analysis (CEA) showed that Pneumococcal Conjugate Vaccine (PCV) 10 and PCV13 were not cost-effective for universal immunization among children in Thailand. Given recent changes in the evidence of efficacy, herd effects and price, a CEA of PCVs should be revisited. This study aimed to determine the cost-effectiveness of PCV10 and PCV13 compared to no PCV vaccination in Thai children.Material and methodsA Markov model was developed under a societal perspective with a lifetime horizon. Inputs were derived from a comprehensive literature review. Costs were calculated using the Thai National Electronic Database and converted to the year 2017 value. All costs and outcomes were discounted at a rate of 3%. The findings were reported as incremental cost-effectiveness ratios (ICERs) in Thai Baht (THB) per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed. A cost-effectiveness acceptability curve was generated with the cost-effectiveness threshold of 160,000 THB/QALY.ResultsBase-case analysis of 2 + 1 dose schedule and five-year protection, with no consideration of herd effect showed that ICER for PCV10 was 170,437 THB/QALY, while ICER for PCV13 was 73,674 THB/QALY. With consideration of herd effect, both PCV10 and PCV13 had lower costs and higher QALYs compared to no PCV vaccination. Based on our probabilistic sensitivity analysis at willingness-to-pay of 160,000 THB/QALY, PCV13 had 93% of being cost-effective, while 4.7% and 2.3%, for PCV10 and no PCV vaccination, respectively.ConclusionAt current prices, PCV13 is cost-effective, while PCV10 is not cost-effective in Thailand. When considering herd-effect, both PCV10 and PCV13 are cost-effective.     

Development and pre-clinical assessment of a 73 kD chimeric fusion protein as a defined sub-unit vaccine for leprosy

Despite the advances toward the elimination of leprosy through widespread provision of multi-drug therapy to registered patients over the last 2 decades, new case detection rates have stabilized and leprosy remains endemic in a number of localized regions. A vaccine could overcome the inherent limitations of the drug treatment program by providing protection in individuals who are not already harboring the Mycobacterium leprae bacilli at the time of administration and effectively interrupt the transmission cycle over a wider timespan. In this report we present data validating the production of 73f, a chimeric fusion protein incorporating the M. leprae antigens ML2028, ML2346 and ML2044. The 73f protein was recognized by IgG in multibacillary (MB) leprosy patient sera and stimulated IFNγ production within whole blood assays of paucibacillary (PB) leprosy patient and healthy household contacts of MB patients (HHC). When formulated with a TLR4L-containing adjuvant (GLA-SE), 73f stimulated a strong and pluripotent Th1 response that inhibited M. leprae-induced inflammation in mice. We are using these data to develop new vaccine initiatives for the continued and long-term control of leprosy.     

Quality of life among people living with HIV/AIDS in northern Thailand: MOS-HIV Health Survey

OBJECTIVES: Translation and psychometric evaluation of a Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) in Thailand. METHODS: A cross-sectional survey in Chiang Mai province, northern Thailand, with data collected in face-to-face interviews using a structured questionnaire designed to measure 10 scales of quality of life (QOL). We recruited 200 people with HIV/AIDS attending self-help groups in the municipal area. Standard guidelines were followed for questionnaire translation and psychometric evaluations. RESULTS: Item-level internal consistency and discriminant validity were reasonably established. Success rates were 93.8 and 97.4%, respectively. Scale-level internal consistency reliability of multi-item scales was satisfactory, ranging from 0.74 to 0.88, with all exceeding inter-scale correlations. Principal components analysis of item and scale scores identified two hypothesized dimensions of the MOS-HIV. The mental health component was strongly loaded by health distress, mental health, vitality and cognitive function scales, and physical health by role, physical and social functions, and pain scales. Respondents manifesting symptoms or reporting worsening health status scored significantly lower on all scales. CONCLUSIONS: These preliminary studies have shown the Thai version of the MOS-HIV to have psychometric properties comparable with those reported in previous surveys. Further testing and modification should make it useful as an HIV-specific QOL measure in Thailand.     

合肥市麻风病防治工作现况调查

目的了解合肥市麻风病防治工作现状,为加强麻风病防治工作,提高麻风病防治能力,提供参考依据。方法调查全市麻风病防治机构和人员状况、麻风病防治工作实施情况,按照合肥市麻风病防治工作考核管理办法相关指标进行评估。结果合肥市现有麻风病患者10人,全市防治专业人员32人,麻风病防治工作开展情况差异较大,有麻风病现症病人的县（区）开展了部分工作,其它县（市）区麻风病防治工作基本没有开展。结论合肥市麻风病防治队伍不稳定,防治工作基本处于停滞状态。