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Age gap between spouses has important implications for a range of outcomes—from fertility and longevity, to gender relationships, marital quality, and stability. This paper examines the age gap between spouses in 12 countries in South and Southeast Asia. The average age difference (husband's minus wife's age) is positive in all countries and ranges from 2.7 in Myanmar to 8.4 in Bangladesh. Age homogamous marriages accounted for 5% of all marriages in Bangladesh to close to half of all marriages in Thailand. The proportion of age hypogamous marriages was uniformly low in all the countries except for Myanmar where it reaches close to 10%. Men's marriage age has a stronger effect in determining the age gap. In general, the age gap for women with lower education was larger than for those with higher education. However, much of this effect was explained by the difference in marriage timing across educational groups. [ABSTRACT FROM AUTHOR]

This paper presents findings from a qualitative study that explored children's and families' experiences of alternative care in Thailand. The study used arts‐based methods to engage 160 children living in a range of care settings. This included government and NGO‐run residential care settings (RCS), children's villages, Buddhist temples, migrant learning centres and foster care homes. Interviews were also conducted with 20 parents/guardians who had placed their children in care. Findings show that despite the alternative care system presenting significant challenges, the participants revealed how they strived to preserve their family connections, and how they are 'doing family' in adversity. [ABSTRACT FROM AUTHOR]

Introduction: Rural doctors typically work in low resource settings and with limited professional support. They are sometimes pushed to the limits of their usual scope of practice to provide the medical care needed by their community. In a previous phenomenological study, we described the concept of clinical courage as underpinning rural doctors' work in this context. In this paper, we draw on rural doctors' experiences during the unfolding COVID pandemic to re examine our understanding of the attributes of clinical courage. Methods: Semi structured interviews were conducted with rural doctors from 11 countries who had experience preparing for or managing patients with COVID 19. Interviews were transcribed verbatim and coded using NVivo. A deductive thematic analysis was undertaken to identify common ideas and responses related to the features of clinical courage. Results: Thirteen interviews from rural doctors during the unfolding COVID 19 pandemic affirmed and enriched our understanding of the attributes of clinical courage, particularly the leadership role rural doctors can have within their communities. Conclusion: This study extended our understanding that rural doctors' experience of clinical courage is consistent amongst participants in many parts of the world, including developing countries. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence (AI) has gained increasing popularity in human society, and it is important to educate people about this emerging technology. Many countries have adopted school curricula to incorporate AI into their classrooms. However, developing tools for discovering AI concepts remains challenging. There are few studies on AI education tools, particularly in Thailand. Objectives: This study designs AIThaiGen, a web‐based learning platform for junior high school students that introduces AI concepts. It can communicate with remote hardware stations, allowing students to test their AI models in real‐world scenarios. Methods: A total of 106 students in 7th and 8th grade in Thailand participated, and a single‐group pre‐test‐post‐test research design was employed in this study. Pre‐post‐tests on the basic concepts of AI and the students' attitude questionnaire on AIThaiGen were used to collect and analyse data. Results and Conclusions: The results show that there is a significant improvement (p < 0.001) in the pre‐post‐tests on the basic concepts of AI, and the overall result of the students' attitude questionnaire on AIThaiGen is X¯=3.88, indicating positive outlooks. Furthermore, notable student projects are showcased, highlighting their ability to initiate new ideas for solving real problems after studying with AIThaiGen. Lay Description: What is already known about this topic: Several AI learning platforms with varying target audiences and presentations have been proposed in recent years.Visual programming languages are more suited to novice learners of AI. What this paper adds: This paper introduces an AIThaiGen platform that allows students to learn basic AI without prior programming knowledge.The AIThaiGen platform enables virtual and real hardware control for students by using their trained AI models.This study investigated students' attitudes towards learning AI programming with AIThaiGen and their comprehension of fundamental AI concepts. Implications for practice and/or policy: This study provides design ideas for creating an AI learning platform with a low entry barrier.This study highlights issues that one may encounter when using a web‐based AI learning tool in actual classrooms and suggests potential solutions. [ABSTRACT FROM AUTHOR]

This paper explores the impact of health communication using smartphones and the outcome of healthier purchases when young Thai consumers shop for groceries. A conjoint experiment was arranged whereby participants (n = 214) purchased grocery using information conveyed via quick response (QR) codes. Results show that a healthy food label, and a good consumer rating on the food's health, evoked the consumers' tendencies towards interacting with a smartphone in the purchasing situation. In addition, likelihood of buying increased. Further simulations revealed that health communication conveyed via QR codes can be a good investment for brands to increase healthier purchases. [ABSTRACT FROM AUTHOR]

Aims: This paper aims to identify the frequency and nature of evidence–practice gaps in the initial neuro‐protective nursing care of patients with moderate or severe traumatic brain injury provided by Thai trauma nurses. Background: Little is known about how Thai trauma nurses use evidence‐based practice when providing initial neuro‐protective nursing care to patients with moderate or severe traumatic brain injury. Design A mixed methods design was used to conduct this study. Methods: Data were collected from January to March 2017 using observations and audits of the clinical care of 22 patients by 35 nurses during the first 4 h of admission to trauma ward. The study site was a regional hospital in Southern Thailand. Results: The major evidence–practice gaps identified were related to oxygen and carbon dioxide monitoring and targets, mean arterial pressure and systolic blood pressure targets and management of increased intracranial pressure through patient positioning and pain and agitation management. Conclusion: There were evidence–practice gaps in initial neuro‐protective nursing care provided by Thai trauma nurses that need to be addressed to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury. SUMMARY STATEMENT: What is already known about this topic? Traumatic brain injury is a global problem that is a major public health issue in low‐resource settings like Thailand.Evidence‐based practice improves patient outcomes and quality of care while reducing health‐care costs, which is particularly important in low‐resource environments. What this paper adds? There were evidence–practice gaps in the initial neuro‐protective nursing care of patients with moderate or severe traumatic brain injury provided by Thai trauma nurses that increase the risk of secondary brain injury.This study has identified a number of evidence–practice gaps related to oxygen and carbon dioxide monitoring and targets, mean arterial pressure and systolic blood pressure targets and management of increased intracranial pressure. The implications of this paper for practice/policy: The study results provide a snapshot of the evidence–practice gaps of neuro‐protective nursing care for patients with moderate or severe traumatic brain injury that need to be improved in the Thai trauma context, which is a low‐resource setting.The evidence–practice gaps identified in this study will enable targeted interventions to improve the safety and quality of care for Thai patients with moderate or severe traumatic brain injury. [ABSTRACT FROM AUTHOR]

The project 'Quality Decision-making by women and providers' (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women's birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the planned process evaluation, which aims to assess how and for whom QUALI-DEC worked, the mechanisms of change and their interactions with context and setting; adaptations to intervention and implementation strategies, feasibility of scaling-up, and cost-effectiveness of the intervention. We developed a project theory of change illustrating how QUALI-DEC might lead to impact. The theory of change, together with on the ground observations of implementation processes, guided the process evaluation strategy including what research questions and perspectives to prioritise. Main data sources will include: 1) regular monitoring visits in healthcare facilities, 2) quantitative process and output indicators, 3) a before and after cross-sectional survey among post-partum women, 4) qualitative interviews with all opinion leaders, and 5) qualitative interviews with postpartum women and health workers in two healthcare facilities per country, as part of a case study approach. We foresee that the QUALI-DEC process evaluation will generate valuable information that will improve interpretation of the effectiveness evaluation. At the policy level, we anticipate that important lessons and methodological insights will be drawn, with application to other settings and stakeholders looking to implement complex interventions aiming to improve maternal and newborn health and wellbeing. Trial registration: ISRCTN67214403. [ABSTRACT FROM AUTHOR]

Thailand's antimicrobial stewardship strategy has focussed on promoting 'rational drug use' in the public sector, to reduce the threat of drug resistance and control healthcare expenditure. The strategy's next ambition is to attend to the private sector, where antibiotics are widely available over the counter without prescription. Using ethnographic and survey data, this paper follows antibiotics through community pharmacies, to explore drug distribution and access, and identify potential challenges for stewardship. We extend the analytical frame beyond 'irrational' dispenser-customer transactions, to explore the logics of practice of a multiplicity of actors in the context of a highly competitive pharmaceutical market. Highlighting the role of the pharmaceutical industry in mystifying medicines, we show how antibiotics are collapsed into a category of 'strong medicines' and requested by customers using 'prescriptions by proxy'. We further examine how Thailand's drug regulation and classificatory systems, historically orientated around access to medicines, enable the proliferation of antibiotics in the context of contemporary efforts to control distribution. Recognising the negotiations involved in dispensing antibiotics in a pluralistic health system, we attempt to reconfigure allocations of responsibility, advocating for stewardship approaches that take into account local ecologies of care, as well as implications for access, equity, and accountability. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10‐year cardiovascular disease risk (CVD‐R) scores and low quality of life (QOL).There is a lack of understanding about CVD‐R scores in people diagnosed with early psychosis and no studies have quantified CVD‐R using the QRISK®3 calculator in this client group.Establishing potential relationships between modifiable lifestyle behaviours/treatment characteristics with CVD‐R or QOL may identify targets for early intervention. What the paper adds to existing knowledge?: This is the first study to quantify the individual 10‐year CVD‐R of people diagnosed with early psychosis utilising the QRISK®3 calculator.This is also the first study to investigate relationships between QOL and CVD‐R and lifestyle factors in a cohort of Thai people diagnosed with early psychosis.We observed low levels of physical health‐related QOL and high levels of CVR‐R despite participants reporting relatively positive lifestyle behaviours. What are the implications for practice?: The cardiometabolic health state of this client group warrants as much attention as for those with an enduring severe mental illness; early preventative interventions are warranted.It may be useful to routinely quantify the CVD‐R of people diagnosed with early psychosis using the QRISK®3 calculator, even in the absence of immediate concerns about lifestyle behaviours.Mental health nurses should utilise evidence‐based approaches such as increasing activity levels, dietary counselling and behaviour change interventions to mitigate poor physical health in this client group. Introduction: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10‐year cardiovascular disease risk (CVD‐R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims: To quantify CVD‐R in people diagnosed with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD‐R/QOL. Method: Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK®3, BMI and waist circumference). Participants self‐reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD‐R were explored. Results: Participants' relative risk for CVD over 10 years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD‐R or QOL with treatment characteristics and lifestyle factors. Discussion: Despite positive lifestyle behaviours, participants had elevated CVD‐R scores and poor physical health‐related QOL. Quantifying CVD‐R with QRISK®3 may highlight the need for health promotion interventions. Implications for practice: Mental health professionals should be aware that elevated CVD‐R exists in the context of relatively healthy lifestyle behaviours and utilise evidence‐based interventions to address these issues. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is already known about this topic?: Individuals with severe mental illness (SMI) have elevated risks for physical health problems and low screening rates.No previous studies have compared the physical health promotion needs of people with SMI using the same screening tool across different international settings. What this paper adds to existing knowledge?: It appears feasible to use the HIP to profile and compare physical health‐related risks in people with SMI across different international settings.The HIP tool identified significant differences in areas of risk across the four countries. What are the implications for practice?: The HIP could be used to identify unique clusters of health promotion needs in different countries.Use of HIP health checks may support implementation of individualized interventions. Introduction: To date, no studies have contrasted physical health profiles of people with severe mental illness (SMI) in different countries. Aim: To evaluate feasibility of using the Health Improvement Profile (HIP) to compare and contrast physical health and health behaviours of people with SMI from four countries. Method: An observational feasibility study using secondary analysis of pooled health state and lifestyle data. Physical health checks using modified versions of HIP were administered in four countries. Results: Findings suggest feasibility of HIP screening to profile and compare physical health and health behaviours of people with SMI across international settings. High overall numbers of risk items (red flags) were identified in all but the Thailand sample. Despite some commonalities, there were important differences in health profiles across countries. Discussion: This is the first study to demonstrate feasibility of the HIP to compare health risks in individuals with SMI across countries. Future multi‐national HIP studies should recruit a fully powered stratified random sample of people with SMI that is representative of each setting. Implications for practice: It appears feasible to utilize the HIP to identify specific areas of health risk in different countries, which may help to better focus nursing interventions and use of resources. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Established research from the United States and other Western countries has found that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide.Suicidality among LGBT individuals is understudied in Thailand and other Asian countries, warranting additional research to better understand risk factors and to create effective treatment and suicide prevention interventions. What the paper adds to existing knowledge?: The study examined rates and predictors of suicidality in Thai LGBT adults.Study findings suggest that general (e.g. stress and loneliness) and minority stressors (e.g. discrimination and victimization) played important roles in predicting lifetime and past‐year suicidal ideation, while socio‐demographic and health‐related factors (e.g. living in high poverty area and having chronic diseases) were associated with suicide attempts among LGBT individuals. What are the implications for practice?: Changes in the nursing curriculum and continuing education resources are needed to improve knowledge and core competencies in the mental health and treatment needs of LGBT individuals in Thailand.Among LGBT serving practitioners, routine assessment of suicidality is needed to increase the early identification and treatment of individual at risk for suicidal behaviours.Standardized measures of sexual orientation and gender identity should be included in all patient intake forms.In conducting research on strategies to improve mental health outcomes among LGBT populations, standardized measures of sexual orientation/gender identity and minority‐specific stressors should be used.Suicide prevention interventions aimed at reducing general and minority stress among LGBT populations should be a priority in mental health nursing. Introduction: A large and rigorous body of research in the United States has demonstrated that lesbian, gay, bisexual and transgender (LGBT) populations are at an elevated risk for suicide. However, scant research aimed at understanding the rates and predictors for suicidality among Thai LGBT individuals exists. Aim: To examine rates and predictors of suicidality among Thai LGBT adults (N = 411). Method: Data collection was conducted via online and in‐person surveys. Guided by the Minority Stress Model, standardized measures of demographics, health‐related factors, general and minority‐specific stressors and suicidality were completed. Results: Thirty‐nine per cent of participants reported lifetime suicidal ideation, 19.0% past 12‐month suicidal ideation and 13.1% lifetime suicide attempts. Lifetime suicidal ideation was associated with higher levels of social discrimination, stress, loneliness and chronic disease (OR = 1.12, 1.16, 2.75, and 1.46, p ≤.05, R2 = 0.327). Past‐year suicidal ideation was associated with victimization, stress, loneliness and being a former smoker (OR = 1.52, 1.20, 2.34, and 4.89, p <.05, R2 = 0.345). Suicide attempts were associated with internalized homophobia, poverty, chronic disease, alcohol use and physical health (OR = 1.44, 1.06, 1.59, 1.45 and 0.95, p ≤ 0.05, R2 = 0.187). Discussion: General and minority‐specific stressors negatively impacted suicidality among LGBT participants. Implication for practice: Study findings have implications for nursing education, practice and research. Nursing education should include information about the influence of sexual orientation and gender identity on mental health outcomes. Further, systematic screening for suicidality should be conducted by LGBT serving psychiatric and mental health nurses. Finally, research is needed to determine best practices for interventions aimed at reducing suicidality risk among LGBT individuals. [ABSTRACT FROM AUTHOR]

Background: Crystal methamphetamine (ice) has become the substance of choice among young men who have sex with men (YMSM) in urban Thailand. Yet, there is scarce data on this phenomenon, partly due to the difficulty in accessing men who will disclose and openly discuss the social contexts, meanings and risks surrounding ice practice. We present an ethnography of ice parties, critically discussing the in-depth social meanings of ice; the sexual socialities and the secrecy surrounding its use; the transactions between older and younger men; and the role of the Internet and mobile technology.Methods: Forty repeated narrative interviews (life stories), ten focus group discussions, as well as systematic online and offline observations were conducted over a three-year period. Purposive sampling was used to recruit study participants in a variety of online and offline spaces and through working closely with local Thai community-based organizations serving MSM. To be eligible, participants had to be between 18 and 29 years, able to converse in Thai, had used ice, and had anal sex with another man in the past 6 months. We also strived for sample variability with respects to socio-demographic characteristics (e.g., age, educational attainment and living situation). Data analysis was conducted in Thai by two researchers using the constant comparative method based on grounded theory.Results: On surface, participants described ice parties as exclusive, in trend, luxurious, fun and pleasurable-a kind of modern camaraderie among beautiful men. In reality, however, this group phenomenon was a social hierarchy containing several important players with relational power to one another, to the ice itself and to the physical space where ice was being consumed. These players included ice suppliers, party hosts, party guests and "icetenders." The paper also discusses the sociality of secrecy that surrounds ice parties as well as the power relations between older relatively rich men who provide ice and the younger men who crave for the chemical, pointing to the risks associated with engagement at ice parties, including instances of rape, violence and unsafe sex. For some participants, ice use was part of their "everyday life," or even believed to be a "rites of passage." For others, it involved sexual silence in cases where they were forced to have (unprotected) sex with certain persons or engage in high-risk activities against their will.Conclusions: Ice parties, where high-risk practices were common, power and agency quickly became relational and negotiable. This paper illuminated the secret sociality of ice so that public health efforts will be better equipped with understanding and reaching out to young men who may be at heightened risk for HIV, STI, violence and other health concerns. Ice parties can, for example, be seen as opportunities for harm-reduction strategies whereby young men are not judged for the activities they engage, but are instead respected and approached in a contextualized, non-judgmental way. Finally, icetenders and party hosts may be individuals where public health practitioners can target and include in the development of novel harm-reduction programs. [ABSTRACT FROM AUTHOR]

Objective: To determine prevalence of abnormal serum acetylcholinesterase (AChE) and behavioral risks associated behaviors from pesticide exposure. Methods: Cross-sectional data were collected from agriculture workers in Trang Province, Thailand in 2013-2014. Agricultural workers in Trang Province filled out questionnaires provided by the Ministry of Public Health and gave blood samples. Risk scores were calculated based on questionnaire responses and a reactive-paper finger-blood test was used to evaluate AChE levels. Results: A total of 6,222 agricultural workers filled out questionnaires and 3,431 workers gave blood samples. The prevalence of abnormal AChE results was 12.5%. Females had a higher prevalence of abnormal serum AChE levels (15.2%) than males (10.2%). The most common self-reported symptoms were coughing (5.7%), being tired (5.4%), dizziness (5.1%), and dry skin and irritation (4.8%). However, those with abnormal serum AChE levels were most likely to report dizziness (12.4%) as their main symptom. Male agricultural workers had significantly higher risk than female farmers after adjusting for sex and risk level (OR = 1.56, P < 0.05). Conclusions: Abnormal serum AChE levels associated with pesticide exposure are associated with AChE levels and symptoms such as coughing, being tired, dizziness, and dry skin and irritation. Educating farmers about the effects of pesticide use and encouraging better personal protective equipment practices could also assist in reducing pesticide exposure. [ABSTRACT FROM AUTHOR]

In the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15-87 at baseline and lived in all regions of the country. Cohort members' citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population. [ABSTRACT FROM AUTHOR]

Background: This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms. Purpose: The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers. Methods: Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity. Results: Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried. Conclusions: The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force. [ABSTRACT FROM AUTHOR]

The HIV epidemic has had a widespread impact on global scientific and cultural discourses related to gender, sexuality, and identity. ‘Male sex workers’ have been identified as a ‘key population’ in the global HIV epidemic; however, there are methodological and conceptual challenges for defining inclusion and exclusion of transgender women within this group. To assess these potential implications, this study employs self-critique and reflection to grapple with the empiric and conceptual implications of shifting understandings of sexuality and gender within the externally re-created etic category of ‘MSM’ and ‘transgender women’ in epidemiologic HIV research. We conducted a sensitivity analysis of our previously published meta-analysis which aimed to identify the scope of peer-reviewed articles assessing HIV prevalence among male sex workers globally between 2004 and 2013. The inclusion of four studies previously excluded due to non-differentiation of cisgender male from transgender women participants (studies from Spain, Thailand, India, and Brazil: 421 total participants) increased the overall estimate of global HIV prevalence among ‘men’ who engage in sex work from 10.5% (95% CI 9.4–11.5%) to 10.8% (95% CI 9.8–11.8%). The combination of social science critique with empiric epidemiologic analysis represents a first step in defining and operationalising ‘reflexive epidemiology’. Grounded in the context of sex work and HIV prevention, this paper highlights the multiplicity of genders and sexualities across a range of social and cultural settings, limitations of existing categories (i.e. ‘MSM’, ‘transgender’), and their global implications for epidemiologic estimates of HIV prevalence. [ABSTRACT FROM AUTHOR]

Oral cancer is one of the drastic human cancers due to its aggressiveness and high mortality rate. Of all oral cancers, squamous cell carcinoma is the most common accounting for more than 90%. Epithelial-mesenchymal transition (EMT) is suggested to play an important role during cancer invasion and metastasis. Recently, emerging knowledge on EMT in carcinogenesis is explosive, tempting us to analyze previous studies on EMT in oral squamous cell carcinoma (OSCC). In this paper, we have first addressed the general molecular mechanisms of EMT, evidenced by alterations of cell morphology during EMT, the presence of cadherin switching, turning on and turning off of many specific genes, the activation of various signaling pathways, and so on. The remaining part of this paper will focus on recent findings of the investigations of EMT on OSCC. These include the evidence of EMT taking place in OSCC and the signaling pathways employed by OSCC cells during their invasion and metastasis. Collectively, with the large body of new knowledge on EMT in OSCC elaborated here, we are hopeful that targeting treatment for OSCC will be developed. [ABSTRACT FROM AUTHOR]

The opening of the Thai tobacco market, following action brought by the US Trade Representative under the General Agreement on Tariffs and Trade, is seen as a key case study of the tensions between trade and health policy. Interpretations of the dispute cast it, either as an example of how trade agreements undermine national policy-making, or how governments can adopt effective public health protections compliant with international trade rules. As a UK-based company, British American Tobacco has been regarded as peripheral to this dispute. This paper argues that its close monitoring of the illegal trade during this period, the role of smuggling in the company's global business strategy, and its management of the relative supply and pricing of legal and illegal products after market opening provide a fuller understanding of the interests and roles of transnational tobacco companies and the government in this dispute. The findings have important policy implications, notably the role of effective governance in countries facing pressure to open their tobacco sectors, need to better understand corporate-level activities within an increasingly globalised tobacco industry, and need to address the intertwined legal and illegal trade in implementing the WHO Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products. [ABSTRACT FROM PUBLISHER]

This paper assesses the relationship between gender and HIV-related stigma experiences among people living with HIV (PLHIV) – enacted and anticipated stigma – and PLHIV caregivers – courtesy stigma – in Northern Thailand, along with the underlying reasons for stigmatising attitudes towards PLHIV – instrumental and symbolic stigma – expressed in the general population. We used data from the Living With Antiretrovirals (LIWA) study conducted on all PLHIV receiving antiretroviral treatment in four district hospitals in Northern Thailand (n = 513) and on a community sample of adults from the general population (n = 500). Women living with HIV and female caregivers of PLHIV reported higher rates of HIV-related stigma experiences than men. Gender interacted with other predictors – the period of HIV diagnosis and age – to increase the level of stigma experienced. Among the general population, attitudes of contact avoidance were infrequent. However, stereotypes depicting PLHIV as blameworthy were highly pervasive, with women perceived as the “victims” of their spouse's irresponsible sexual behaviours. In this context, women were yet more often subjected to HIV-related stigma than men, in particular women diagnosed in the pre-antiretroviral therapy era and younger female caregivers. The role of gender in shaping disparities in HIV-related stigma experiences is discussed. [ABSTRACT FROM PUBLISHER]

Despite two recent government-sponsored ‘wars on drugs', methamphetamine use continues to be a pervasive problem in Thailand. Out of concern for reported human rights abuses, there has been a call from the international community to take a different approach from the government's ‘zero tolerance’. This paper describes the adaptation of the Connect to Protect® coalition formation process from urban U.S. cities to three districts in northern Thailand's Chiang Mai province, aimed to reduce methamphetamine use by altering the risk environment. Project materials, including manuals and materials (e.g. key actor maps and research staff memos), were reviewed to describe partnering procedures and selection criteria. Potential community partners were identified from various government and community sectors with a focus on including representatives from health, police, district and sub-district government officials. Of the 64 potential partners approached, 59 agreed to join one of three district-level coalitions. Partner makeup included 25% from the health sector, 22% who were sub-district government officials and 10% were representatives from the police sector. Key partners necessary for endorsement of and commitment to the coalition work included district-level governors, police chiefs and hospital directors for each district. Initial coalition strategic planning has resulted in policies and programs to address school retention, youth development initiatives and establishment of a new drug treatment and rehabilitation clinic in addition to other developing interventions. Similarities in building coalitions, such as the need to strategically develop buy-in with key constituencies, as well as differences of whom and how partners were identified are explored. [ABSTRACT FROM AUTHOR]

This paper investigates associations between hazardous jobs, mental health and wellbeing among Thai adults. In 2005, 87 134 distance-learning students from Sukhothai Thammathirat Open University completed a self-administered questionnaire; at the 2009 follow-up 60 569 again participated. Job characteristics were reported in 2005, psychological distress and life satisfaction were reported in both 2005 and 2009. We derived two composite variables grading psychologically and physically hazardous jobs and reported adjusted odds ratios (AOR) from multivariate logistic regressions. Analyses focused on cohort members in paid work: the total was 62 332 at 2005 baseline and 41 671 at 2009 follow-up. Crosssectional AORs linking psychologically hazardous jobs to psychological distress ranged from 1.52 (one hazard) to 4.48 (four hazards) for males and a corresponding 1.34-3.76 for females. Similarly AORs for physically hazardous jobs were 1.75 (one hazard) to 2.76 (four or more hazards) for males and 1.70-3.19 for females. A similar magnitude of associations was found between psychologically adverse jobs and low life satisfaction (AORs of 1.34-4.34 among males and 1.18-3.63 among females). Longitudinal analyses confirm these cross-sectional relationships. Thus, significant dose– response associations were found linking hazardous job exposures in 2005 to mental health and wellbeing in 2009. The health impacts of psychologically and physically hazardous jobs in developed, Western countries are equally evident in transitioning Southeast Asian countries such as Thailand. Regulation and monitoring of work conditions will become increasingly important to the health and wellbeing of the Thai workforce. [ABSTRACT FROM AUTHOR]

Aims This study aimed to compare the findings of the quality of nursing doctoral education survey across seven countries and discuss the strategic directions for improving quality. Background No comparative evaluation of global quality of nursing doctoral education has been reported to date despite the rapid increase in the number of nursing doctoral programmes. Design A descriptive, cross-country, comparative design was employed. Methods Data were collected from 2007-2010 from nursing schools in seven countries: Australia, Japan, Korea, South Africa, Thailand, UK and USA. An online questionnaire was used to evaluate quality of nursing doctoral education except for Japan, where a paper version was used. Korea and South Africa used e-mails quality of nursing doctoral education was evaluated using four domains: Programme, Faculty (referring to academic staff), Resource and Evaluation. Descriptive statistics, correlational and ordinal logistic regression were employed. Results A total of 105 deans/schools, 414 faculty and 1149 students/graduates participated. The perceptions of faculty and students/graduates about the quality of nursing doctoral education across the seven countries were mostly favourable on all four domains. The faculty domain score had the largest estimated coefficient for relative importance. As the overall quality level of doctoral education rose from fair to good, the resource domain showed an increased effect. Conclusions Both faculty and students/graduates groups rated the overall quality of nursing doctoral education favourably. The faculty domain had the greatest importance for quality, followed by the programme domain. However, the importance of the resource domain gained significance as the overall quality of nursing doctoral education increased, indicating the needs for more attention to resources if the quality of nursing doctoral education is to improve. [ABSTRACT FROM AUTHOR]

In this paper, I describe the experience of ‘outsourced’ patients who are sent by their governments or insurers through contractual arrangements to a hospital in another country for treatment. I present case studies of nine patients and their accompanying families from the Gulf Cooperation Council (GCC) who were interviewed in a Thai hospital as part of a broader study of medical travel from patients' perspectives. The health systems of the GCC suffer shortages in infrastructure, human resources and management skills, and as a consequence patients with particular needs, especially in neurology, orthopaedics and oncology may be sent overseas for treatment. Patients experience long stays overseas producing a considerable burden to their families supporting them. Such patients complicate notions of medical travel but their status also contrasts markedly from stereotypes held about Gulf patients within Thailand. Despite their appreciation of government sponsoring, for many patients the experience of care in Thailand underscored perceived inadequacies of their home health systems and governments. For some, outsourcing represented a betrayal of the obligations of their states to its citizens. [ABSTRACT FROM PUBLISHER]

This qualitative descriptive study, underpinned by the naturalistic inquiry, explored the lived experiences of individuals awaiting coronary artery bypass grafting in Thailand. Eleven northern Thai individuals volunteered to participate. Data were gathered through in-depth interviews and analyzed using content analysis. Two major themes arose: uncertainty of life and striving to balance well-being. The first of these themes is presented in this paper. Uncertainty of life was recognized as a dynamic emotional state of being unsure or insecure in life, but its occurrence depended on the individual situation; it was described through two subthemes that had a profound effect on the participants: fear of death and fear of disability. Participants' uncertainty of life encompassed being unsure about the risks of dying from illness, both prior to and following the surgery, and surviving the surgery with a disability. These findings provide insight into the experiences of individuals awaiting coronary artery bypass grafting and will assist nurses and other healthcare providers in creating timely programs and appropriate interventions to reduce uncertainty of life while awaiting surgery. [ABSTRACT FROM AUTHOR]

Background: Thailand has a shortage of community health nurses for supporting the self‐management of type 2 diabetes, which is prevalent and poorly controlled. Aim: This study examined the feasibility and acceptability of a self‐care assistance programme for poorly controlled type 2 diabetes mellitus. The SukapapNet programme consisted of automated interactive voice response calls to patients and automated follow‐up email notifications to their nurses. Design: Single‐arm pre‐post trial. Methods: Six nurses and 35 type 2 diabetes patients were recruited from primary care settings in suburban provinces in Thailand. The study was conducted from June 2017 to November 2017. We assessed patients before and after 12 weeks of the SukapapNet intervention. Results: Mean glycated haemoglobin decreased by 0.9%. Patients reported reduced carbohydrate consumption, increased physical activity, increased medication adherence, improved sleep quality, and more frequent foot care. Patients and nurses both recommended using the intervention, although nurses expressed concerns regarding increased workload. Conclusions: The study programme could improve outcomes in Thai type 2 diabetes patients. Further study of the impact of technology upon nurses' workload is warranted. SUMMARY STATEMENT: What is already known about this topic? Prevalence of type 2 diabetes is increasing in Thailand, and nurses who play an important role in health care at the community level are limited.Mobile health strategies including short message service, automated telephonic monitoring, and internet‐based education have been successfully applied in Thailand with prenatal care, depression, Parkinson disease, cardiac rehabilitation, and diabetes.Although mobile health is a promising way to bridge gaps in managing type 2 diabetes, an effect of automated mobile health with nurse follow‐up has never been investigated in primary care settings. What this paper adds? Automated interactive voice response monitoring of diabetes patients with emailed updates to nurses is acceptable to Thai patients with poorly controlled type 2 diabetes.Mobile health strategies could also improve Thai nurses' ability to help diabetes patients with glycaemic control.To reduce burden for nurses, summaries of patients' responses should be emailed on a less‐than‐daily basis. The implications of this paper: This study contributes to the knowledge of how mobile health strategies could help Thai patients with type 2 diabetes achieve glycaemic control and increase nurses' engagement with these patients.Innovative use of automated interactive voice response with feedback to community health nurses should be further developed in Thailand.Future research should investigate a mobile health benefit to diabetes glycaemic control through a large‐scale randomized controlled trial. [ABSTRACT FROM AUTHOR]

The Antibiotics Smart Use (ASU) programme was introduced in Thailand as a model to promote the rational use of medicines, starting with antibiotics. The programme's first phase consisted of assessing interventions intended to change prescribing practices; the second phase examined the feasibility of programme scale-up. Currently the programme is in its third phase, which centres on sustainability. This paper describes the concept behind ASU, the programme's functional modalities, the development of its conceptual framework and the implementation of its first and second phases. To change antibiotic prescription practices, multifaceted interventions at the individual and organizational levels were implemented; to maintain behaviour change and scale up the programme, interventions at the network and policy levels were used. The National Health Security Office has adopted ASU as a pay-for-performance criterion, a major achievement that has led to the programme's expansion nationwide. Despite limited resources, programme scale-up and sustainability have been facilitated by the promotion of local ownership and mutual recognition, which have generated pride and commitment. ASU is clearly a workable entry point for efforts to rationalize the use of medicines in Thailand. Its long-term sustainability will require continued local commitment and political support, effective auditing and integration of ASU into routine systems with appropriate financial incentives. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Prevention of drinking initiation is a significant challenge in low- and middle-income countries that have a high prevalence of abstainers, including life-time abstainers. This paper aims to encourage a debate on an alternative alcohol taxation approach used currently in Thailand, which aims specifically to prevent drinking initiation in addition to reduce alcohol-attributable harms. Methods Theoretical evaluation, simulation and empirical analysis. Result The taxation method of Thailand, 'Two-Chosen-One' (2C1) combines specific taxation (as a function of the alcohol content) and ad valorem taxation (as a function of the price), resulting in an effective tax rate that puts a higher tax both on beverages which are preferred by heavy drinkers and on beverages which are preferred by potential alcohol consumption neophytes, compared to either taxation system alone. As a result of these unique properties of the 2C1 taxation system, our simulations indicate that 2C1 taxation leads to a lower overall consumption than ad valorem or specific taxation alone. In addition, it puts a relatively high tax on beverages attractive to young people, the majority of whom are currently abstaining. Currently, the abstention rates in Thailand are higher than expected based on its economic wealth, which could be taken as an indication that the taxation strategy is successful. Conclusion 'Two-chosen-one' (2C1) taxation has the potential to simultaneously reduce alcohol consumption and prevent drinking initiation among youth; however, additional empirical evidence is needed to assess its effectiveness in terms of the public health impact in low- and middle-income countries. [ABSTRACT FROM AUTHOR]

This paper explores factors influencing parent-child interaction of parents with children age 13-36 months old and working in the industrial setting in the eastern region of Thailand. An ethnographic study was conducted with 22 families. Data were collected through in-depth interviews, participant observation, audiotape/videotape recording and field notes from October 2008 to September 2009. The data were analyzed by means of (i) quantitative data using frequency and percentage and (ii) qualitative data using Roper and Shapira's strategies of content analysis. The factors influencing parent-child interaction include the parental knowledge about child development, their intention and time availability. Other influences noted were economic burdens and support from parents, the factory and the community. These findings provide a greater understanding of the factors influencing parent-child interaction among Thai families with young children. Also, the findings may be useful in the development of effective interventions and/or guidelines that improve the quality of parent-child interaction. [ABSTRACT FROM AUTHOR]

lundberg p.c. & thrakul s. (2012) Type 2 diabetes: how do Thai Buddhist people with diabetes practise self-management? Journal of Advanced Nursing 68(3), 550-558. Abstract Aims. This paper is a report of a study of how Thai Buddhist people with type 2 diabetes practice self-management. Background. The importance of diabetes self-management is recognized in the literature. However, research on self-care management in Thailand, in particular concerning Buddhist people with type 2 diabetes, is scarce. Methods. A descriptive qualitative study was conducted. Purposive convenience sampling was used, and thirty men and women with diabetes, aged 28-79 years, participated. Data were collected from June to August 2009 and analysed by use of manifest and latent content analysis. Findings. Five themes of self-management among Thai Buddhist people with type 2 diabetes were identified: cultural influence on disease control, Buddhism and Thai culture, struggle for disease control, family support and economy a high priority. Conclusion. Even though the Buddhist people with diabetes had certain self-management capabilities, many had poor control of their blood sugar levels and needed assistance. Reference to Buddhist moderation can be an effective means of helping the people with diabetes better manage their disease and change their lifestyles. In addition to cultural and religious traditions, family, economy and social environment should be taken into account both in the care and in interventions aimed at helping people with diabetes cope and empowering them to control their disease. [ABSTRACT FROM AUTHOR]

Background: Early skin-to-skin contact (SSC) after birth is recommended as part of the United Nations Children's Fund (UNICEF) baby friendly health initiative to promote optimum breastfeeding. This paper reports rates of breastfeeding initiation and duration in a low resource environment, where early SSC is not practised, and explores views of pregnant women and midwives surrounding breastfeeding and swaddling. Methods: Data from records from a single hospital on the Thai-Myanmar border where refugee women gave birth during a one-year period (2010) were used to determine breastfeeding initiation rates and the time of the first breastfeed, and duration of breastfeeding of the previous alive child in multigravidae. Focus group discussions (FGD) were conducted to obtain information from pregnant women attending antenatal care about their intended or previous duration of breastfeeding and views on breastfeeding. Interviews with local midwives explored reasons for high rates of breastfeeding in this setting and the practice of newborn swaddling. Results: Of 1404 live births in 2010 in Maela refugee camp there were 982 evaluable mother-newborn pairs, including 80 infants born before 37 weeks gestation. Initiation of breastfeeding within the first hour after birth and exclusive breastfeeding at discharge in term mother-newborn pairs was 91.2% (823/902) and 99.3% (896/902); and before 37 weeks gestation, 48.8% (39/80) and 98.8% (79/80). Reported duration of previous breastfeeding was 19 (range 2 to 72) months. During FGD all primigravidae (n = 17) intended to breastfeed and all multigravidae (n = 33) had previously breastfed; expected or previous duration of feeding was for more than one year or longer. The major theme identified during FGD was breastfeeding is "good". Women stated their intention to breastfeed with certainty. This certainty was echoed during the interviews with midwifery staff. SSC requires a delay in early swaddling that in Karen people, with animistic beliefs, could risk loss of the spirit of the newborn or attract malevolent spirits. Conclusions: In a population with a strong culture of breastfeeding and robust breastfeeding practices, high rates of initiation and duration of breastfeeding were found despite a lack of early skin-to-skin contact. Local preferences, traditions and practices that protect, support and maintain high rates of breastfeeding should be promoted. [ABSTRACT FROM AUTHOR]

This study explores the ways in which women's contraceptive behavior in a rural area of Thailand is shaped by both past and present context, based on the life course framework. Although the importance of contextual influences for contraceptive behavior is well established in the literature, relatively little research has been conducted that explores how behavior is influenced by historical and contemporaneous contextual factors and by individual life experiences. In addition, much of this research has neglected the role of the normative environment within which contraceptive use takes place. The focus of this paper centers on the effect of contraceptive environment at both early and late stages of the life course and on how this effect is shaped by individual experience with migration to urban areas. This study takes advantage of a unique, prospective longitudinal data set with detailed information on community context at multiple points in time, an important improvement upon prior research. The results show that contraceptive behavior is particularly responsive to current community context, with past context primarily exerting an indirect effect on behavior through shaping current contextual influences. [ABSTRACT FROM AUTHOR]

In many countries, including Thailand, there is an increasing impetus to use economic evaluation to allow more explicit and transparent healthcare priority setting. However, an important question for policy makers in low- and middle-income countries is whether it is appropriate and feasible to introduce economic evaluation data into healthcare priority-setting decisions. In addition to ethical, social and political issues, information supply challenges need to be addressed. This paper systematically reviewed the literature on economic evaluation of health technology in Thailand published between 1982 and 2005. Its aim was to analyse the quantity, quality and targeting of economic evaluation studies that can provide a framework for those conducting similar reviews in other settings. The review revealed that, although the number of publications reporting economic evaluations has increased significantly in recent years, serious attention needs to be given to the quality of reporting and analysis. Furthermore, there is an absence of economic evaluation publications for 15 of the top 20 major health problems in Thailand, indicating a poor distribution of research resources towards the determination of cost-effective interventions for diminishing the disease burden of certain major health problems. If economic evaluation is only useful for policy makers when performed correctly and reported accurately, these findings depict information barriers to using economic evaluation to assist health decision-making processes in Thailand. [ABSTRACT FROM AUTHOR]

The International Code of Marketing of Breast‐milk Substitutes (the Code) adopted by the World Health Assembly (WHA) in 1981 and regularly updated through subsequent WHA resolutions, represents the international policy framework for protecting breastfeeding against inappropriate marketing practices. By March 2016, at least 135 countries had some measures covering provisions of the Code in their legislation. The translation of the International Code into national measures was investigated in the context of the advocacy efforts undertaken by the Alive & Thrive (A&T) initiative with UNICEF and partners. A real‐time evaluation was carried out over 22 months in seven Southeast Asian countries (Cambodia, Indonesia, Lao People's Democratic Republic [Lao PDR], Myanmar, Thailand, Vietnam, and Timor‐Leste) and two African countries (Burkina Faso and Ethiopia). Drivers of policy change and progress were examined. Two theory‐based approaches were used: developmental evaluation and contribution analysis. Data collection methods included participant observation, key informant meetings, in‐depth interviews, reflective practice, and desk review. Overall, countries made significant progress in translating the International Code into national measures and in moving forward throughout the policy cycle. The main driver of policy change was the creation of a strategic group, which engaged key relevant actors and supported the government in the performance of 15 critical tasks, which the analysis reveals is a second driver. Those critical tasks are described in this paper and could help public health advocates to anticipate the stages and challenges of policy change and develop more effective strategies to translate the Code into their legal framework. [ABSTRACT FROM AUTHOR]