Community-acquired pneumonia in southeast Asia: the microbial differences between ambulatory and hospitalized patients

STUDY OBJECTIVES: To determine microbial agents causing community-acquired pneumonia (CAP) in Southeast Asia. DESIGN: A prospective study. SETTING: Three general hospitals in Thailand. PATIENTS: Two hundred forty-five adult patients fulfilling the clinical criteria of CAP from September 1998 to April 2001. INTERVENTIONS: Investigations included sputum Gram stain and culture, blood culture, pleural fluid culture (if presented), urine antigen for Legionella pneumophila and Streptococcus pneumoniae, and serology for Mycoplasma pneumoniae, Chlamydia pneumoniae, and L pneumophila. RESULTS: There were 98 outpatients and 147 hospitalized patients included in the study, and an organism was identified in 74 of 98 outpatients (75.5%) and 105 of 147 of the hospitalized patients (71.4%). C pneumoniae (36.7%), M pneumoniae (29.6%), and S pneumoniae (13.3%) were the most frequent causative pathogens found in outpatients, while S pneumoniae (22.4%) and C pneumoniae (16.3%) were the most common in hospitalized patients. There was a significantly higher incidence of C pneumoniae (36.7% vs 16.3%, respectively; p < 0.001) and M pneumoniae (29.6% vs 6.8%; p < 0.001, respectively) in the outpatients than in the hospitalized patients. The incidence of S pneumoniae, L pneumophila, and mixed infections was not different between the groups. Mixed infections were presented in 13 of 98 outpatients (13.3%) and 9 of 147 hospitalized patients (6.1%), with C pneumoniae being the most frequent coinfecting pathogen. CONCLUSIONS: The data indicate that the core organisms causing CAP in Southeast Asia are not different from those in the Western countries. The guidelines for the treatment of patients with CAP, therefore, should be the same.     

Pubertal effects of 17α-methyltestosterone on GH-IGF-related genes of the hypothalamic-pituitary-liver-gonadal axis and other biological parameters in male, female and sex-reversed Nile tilapia

The influence of 17α-methyltestosterone (MT) on growth responses, biological parameters and the expression of genes involved in the GH-IGF pathway of the hypothalamic-pituitary-liver-gonadal axis were investigated in female, male, and sex-reversed Nile tilapia to evaluate the relationship between sex and MT-induced changes in these parameters. Female fish had a lower growth rate than male and sex-reversed fish, and MT increased growth performance and duodenal villi in females. Most but not all biological parameters of sex-reversed fish were similar to those of male fish. Male fish had higher red blood cell counts and hemoglobin levels than female and sex-reversed fish, suggesting that these hematological indices reflect a higher metabolic rate in male fish. Greater blood triglyceride levels indicated the vitellogenin process in female fish. MT increased the alternative complement activity in female fish (P<0.05). Sex and MT had no significant effects on the hypothalamic mRNAs of GHRH and PACAP. Although not statistically significant, females tended to have higher GH mRNA levels than male and sex-reversed fish. Additionally, MT tended to decrease and increase GH mRNA levels in female and male fish, respectively. There were significant differences among sexes in the expression of GHR, and IGF mRNAs at the peripheral level in the liver and gonads. Females had lower hepatic GHRs and higher ovarian GHRs than male and sex-reversed fish. While the mRNA levels of IGF-1 were lower in the ovary, the levels of IGF-2 were higher compared with those in testes. A significant correlation between GHRs and IGFs was demonstrated in the liver and gonad (except for IGF-1). Multiple regression analysis showed a significant relationship between GH mRNA and both GHRs and IGFs in the liver and gonad. MT exerted androgenic and, to some extent, estrogenic effects on several physiological parameters and GH-IGF action.     

ONE SIZE DOES NOT FIT ALL: INVESTIGATING DOCTORS' STATED PREFERENCE HETEROGENEITY FOR JOB INCENTIVES TO INFORM POLICY IN THAILAND

This study investigates heterogeneity in Thai doctors' job preferences at the beginning of their career, with a view to inform the design of effective policies to retain them in rural areas. A discrete choice experiment was designed and administered to 198 young doctors. We analysed the data using several specifications of a random parameter model to account for various sources of preference heterogeneity. By modelling preference heterogeneity, we showed how sensitivity to different incentives varied in different sections of the population. In particular, doctors from rural backgrounds were more sensitive than others to a 45% salary increase and having a post near their home province, but they were less sensitive to a reduction in the number of on‐call nights. On the basis of the model results, the effects of two types of interventions were simulated: introducing various incentives and modifying the population structure. The results of the simulations provide multiple elements for consideration for policy‐makers interested in designing effective interventions. They also underline the interest of modelling preference heterogeneity carefully. Copyright © 2013 John Wiley & Sons, Ltd.     

Types,Clinical Features,and Survival Outcomes of Patients with Acute Myeloid Leukemia in Thailand: A 3-Year Prospective Multicenter Study from the Thai Acute Leukemia Study Group (TALSG)

BackgroundAcute myeloid leukemia (AML) is a common, challenging hematologic malignancy worldwide. Thai data on its characteristics and outcomes have never been systematically reported, to our knowledge. The objective of this study was to determine the clinical features and outcomes of Thai patients with AML.Patients and MethodsThis was a prospective observational study of nine academic hospitals. Patients with newly diagnosed AML were invited to register online.ResultsA total of 679 patients with AML were included. The presence of circulating peripheral blood blasts was correlated with a high white blood cell count. Acute promyelocytic leukemia (APL) had predominantly lower white blood cell counts and higher proportions without peripheral blood blasts compared with non-APL AML. Disseminated intravascular coagulation was commonly presented in APL (37.7%). Splenomegaly and normal platelet count were more frequently seen in patients with Philadelphia chromosome–positive AML. The median follow-up time for those who survived more than 1 year was 28.0 months. One-year overall survival rates for non-APL AML and APL were 31.9% and 88.2%, respectively; 2-year overall survival rates were 29.6% and 88.2%, respectively. Hematopoietic stem cell transplantation could improve survival in non-APL AML.ConclusionAPL should be considered despite absence of peripheral blood blast. This study demonstrates poor outcome of Thai AML and more research to improve outcomes are underway. Expanding access to hematopoietic stem cell transplantation should be considered in Thailand.     

Estimation of financial burden due to oversupply of medications for chronic diseases

Given the potential of financial burden due to oversupply of medications for chronic diseases, this study aims to determine the prevalence of oversupply and to estimate the magnitude of financial loss in Thailand. Electronic patient database in a university-affiliated hospital in Thailand was used. Based on the utilization of top 5 high drug expenditure in 2005, the prevalence and the financial loss of oversupply (medication possession ratio [MPR] >1.00) were estimated. In total, 1893 patients were included in this study. The average age was 65.2 years and the majority were female (56%). The prevalence of oversupply ranged from 23.2% to 62.8%, whereas the annual financial loss ranged from US $4108 to US $10 517. The total amount of loss was US $32 903 or 3.77% of total medication costs. In summary, because of the high prevalence and associated high financial loss, oversupply of medication is a significant financial burden on hospitals and society.     

Subgrouping Persons with Snoring and/or Apnea by Using Anthropometric and Cephalometric Measures

Craniofacial and anthropometric characteristics are identified risk factors for obstructive sleep apnea syndrome (OSAS). Phase 1 of this study used cephalometric radiographs to record craniofacial measurements from 60 OSAS subjects with a respiratory disturbances index (RDI) of 20 or greater (group A) and 60 subjects with a history of loud snoring and an RDI less than 20 (group B). From this data set, a craniofacial risk index (CRI) was constructed using age, body mass index (BMI), and 14 cephalometric measures previously reported to be associated with OSAS. A separating boundary (CRIS) was established by using discriminant analysis to differentiate between the two groups. All measurements were determined by an investigator who was blinded to the subjects' RDI score. Phase 2 used a second sample of 19 group A and 47 group B subjects to test the ability of the CRI derived from the first sample to classify subjects in this second sample into the correct age group. The CRI was able to classify correctly 72.3% (34 of 47) of the group A subjects when all variables were used in the discriminant model. Using only four variables (age, BMI, hyoid mandibular plane distance, and tongue length) selected by the stepwise method, 72.3% (34 of 47) of the group B subjects and 78.7% of group A subjects were classified correctly. These results suggest that a stepwise CRI could be used to classify heterogeneous groups of individuals with increased RDI into subgroups with varying degrees of anatomic risk for disease. Such subgrouping by anatomic risk could be important in determining the pathophysiology of OSAS because it is likely that differences in upper airway anatomy among individuals interacts with a variety of other factors to produce clinical illness.     

Preliminary genetic evidence of two different populations of <Emphasis Type="Italic">Opisthorchis viverrini</Emphasis> in Lao PDR

Opisthorchis viverrini is a major public health concern in Southeast Asia. Various reports have suggested that this parasite may represent a species complex, with genetic structure in the region perhaps being dictated by geographical factors and different species of intermediate hosts. We used four microsatellite loci to analyze O. viverrini adult worms originating from six species of cyprinid fish in Thailand and Lao PDR. Two distinct O. viverrini populations were observed. In Ban Phai, Thailand, only one subgroup occurred, hosted by two different fish species. Both subgroups occurred in fish from That Luang, Lao PDR, but were represented to very different degrees among the fish hosts there. Our data suggest that, although geographical separation is more important than fish host specificity in influencing genetic structure, it is possible that two species of Opisthorchis, with little interbreeding, are present near Vientiane in Lao PDR.     

Psychometric Properties of the Thai Version of Supportive Care Needs Survey-Partners and Caregivers (T- SCNS-P&C) for Cholangiocarcinoma Caregivers

Background:Unmet needs of cancer patients and caregivers are also closely linked with patients and their family well-being. Identifying and focusing on caregivers’ unmet need have been recommended to reduce their burden and improve their quality of life (QOL). This study aimed to evaluate the psychometric properties of the Thai version of Supportive Care Needs Survey for Partners and Caregivers (T-SCNS-P&C) among Cholangiocarcinoma (CCA) caregivers. Methods:The T-SCNS-P&C was developed using standardized translation methodology. A total of 231 CCA caregivers completed the T- SCNS-P&C. The internal consistency of the scale was examined with Cronbach’s alpha. Construct validity was analyzed using Pearson correlations coefficient with the physical effects, stage, anxiety and depression, age, and education level. To assess the factorial validity of the T-SCNS-P&C, confirmatory factor analysis (CFA) was performed. Results:The T- SCNS-P&C indicated good readability and high content validity for use as an assessment tool among Thai CCA caregivers. All Cronbach’s α coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores and higher anxiety and depression scores, as well as poorer QOL scores and younger caregivers, were significantly positively associated with higher levels of unmet needs. CFA indicated that the four factor structure of the T-SCNS-P&C was a good fit to the data.Conclusion: The T-SCNS-P&C demonstrated acceptable reliability and validity for assessing unmet needs among CCA caregivers in Thailand. Using this simple assessment to target the individual needs of these caregivers can help healthcare professionals providing effective personalized care.Key Words: Caregivers, Thai, psychometric validation, supportive care, unmet needs