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Thin Nyein Nyein Aung,1 Yoshihisa Shirayama,2 Saiyud Moolphate,3 Myo Nyein Aung,4 Thaworn Lorga,5 Motoyuki Yuasa21Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan; 2Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan; 3Department of Public Health, Faculty of Science and Technology, Chiang Mai Rajabhat University, Chiangmai, Thailand; 4Advanced Research Institute for Health Science, and Faculty of International Liberal Arts, Juntendo University, Tokyo, Japan; 5Department of Research and Community Engagement, Research Coordinating Unit, Boromrajonani College of Nursing, Nakhon Lampang, ThailandBackground and purpose: When migrants go to a new country to work, they experience transition of epidemiological risk factors, a new system of access to healthcare and changing life styles. Their comprehension of health risk factors will depend on acculturation pattern. Moreover, musculoskeletal disorders (MSDs) are significantly prevalent in such a population due to the manual work in their jobs. Myanmar immigrant’s acculturation level has not yet been studied in relation to prevalent diseases. This study aimed to investigate health risk behaviors, the prevalence of musculoskeletal disorders, and associated factors.Methods: A cross-sectional study surveyed 414 Myanmar migrant workers in Chiangmai, Thailand. Face-to-face interviews administered structured questionnaires which comprised the transculturally validated East Asian Acculturation Measure scale, Standardized Nordic musculoskeletal questionnaires, Patient Health Questionnaires 2 and 9 for depression and questionnaires to screen health behaviors and jobs. Data analysis applied binary logistic regression.Results: About 26.3% were current smokers and 40.8% current drinkers. Of the 75.8% of participants did not exercise, 40.1% were overweight and obese, 44.7% had prehypertension, 27.1% hypertension, and 13% had depression. The prevalence of MSDs at any site over the previous 12 months was 53.4% and it was significantly associated (P-value≤0.05) with female (adjusted odd ratio (aOR)=1.75; 95% confidence interval (CI)=1.04–2.94), depression (aOR=2.19;CI=1.10–4.39), marginalization pattern of acculturation (aOR=1.87;CI=1.09–3.21) and MSDs at any site last week (aOR=8.41;CI=4.09–17.30).Conclusion: Health behaviors in this young, working migrant population are risky, and MSDs are common problems for migrant workers in northern Thailand. Findings of the current study highlighted health behaviors and cultural adaption as attributes to chronic, disabling, and common health problems of migrant workers. Public health interventions and recommendations considering this evidence may improve migrants’ health status, leading to better quality-of-life and productivity.Keywords: acculturation, depression, health risk behaviors, musculoskeletal disorders, Myanmar migrant workers, Thailand

Thaworn Lorga,1 Myo Nyein Aung,1,2 Prissana Naunboonruang,1 Piyatida Junlapeeya,1 Apiradee Payaprom31Boromarajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand; 2Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan; 3Thasongyang Hospital, Thasongyang, Tak, ThailandBackground: The double burden of communicable and noncommunicable diseases (NCD) is an increasing trend in low- and-middle income developing countries. Rural and minority populations are underserved and likely to be affected severely by these burdens. Knowledge among young people could provide immunity to such diseases within a community in the long term. In this study we aimed to assess the knowledge of several highly prevalent NCDs (diabetes, hypertension, and chronic obstructive pulmonary disease [COPD]) and several highly incident communicable diseases (malaria and diarrheal diseases) among Karen high school students in a rural district in far northwest of Thailand. The aim of the study is to explore information for devising life-course health education that will be strategically based in schools.Method: A cross-sectional survey approved by the ethics committee of Boromarajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand was conducted in Thasongyang, Tak province, from September 2011 to January 2012. Questionnaires for assessing knowledge regarding diabetes, hypertension, COPD, malaria, and diarrheal diseases were delivered to all 457 Karen high school students attending Thasongyang high school. A total of 371 students returned the questionnaires. Experts' validation and split-half reliability assessment was applied to the instrument.Results: Students' main sources of health information were their teachers (62%), health care workers (60%), television (59%), and parents (54%). Familial risk factors of diabetes and hypertension were not known to more than two thirds of the students. Except obesity and physical inactivity, lifestyle-related risk factors were also not known to the students. Though living in a malaria-endemic area, many of the Karen students had poor knowledge about preventive behaviors. Half of the students could not give a correct answer about the malaria and hygienic practice, which might normally be traditionally relayed messages.Conclusion: Health education and knowledge about common NCD and communicable diseases are yet to be prompted among the Karen students. A broader and more comprehensive school-based health education strategy for prevention of double burden diseases would benefit the rural minority population at the Thai-Myanmar border.Keywords: double burden diseases, Thai-Myanmar border, health information, youth, minority, adolescents

Thaworn Lorga,1 Kannapatch Srithong,1 Pratumpan Manokulanan,1 Thin Nyein Nyein Aung,2 Myo Nyein Aung1,31Boromrajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand; 2University of Medicine, Mandalay, Myanmar; 3Department of Public Health, Graduate School of Medicine Juntendo University, Tokyo, JapanBackground and purpose: The public knowledge of diabetes is important for prevention of disease. This study aimed to evaluate knowledge of diabetes, risk factors, and the common warning signs of diabetes and complications among community participants in a rural Karen ethnic community.Methods: Participants were asked to answer a questionnaire regarding their knowledge of diabetes. Fasting blood glucose testing, blood pressure measurement, and body mass index (BMI) assessment were provided to the participants. The study was conducted at Thasongyang district, Tak province, Thailand.Results: A total of 299 Karen rural residents were included in the study. The median age was 45 years and median fasting blood glucose was 88 mg/dL. The response rate to the questionnaires was 91.97%. Half of the participants knew diabetes is a noncommunicable disease needing lifelong treatment. Overall, one-third of the community participants could correctly answer the knowledge assessment questions regarding risk factors and common features of diabetes. Whereas the other two-thirds either gave a wrong answer or were “not sure”. Female participants had poorer diabetes knowledge than the males.Conclusion: The public knowledge of diabetes, as represented by this sample of the Karen ethic community, is alarmingly low. There is significant gender difference in knowledge level. Culturally tailored and gender-sensitive diabetes health education interventions are urgently needed in this minority ethnic community.Keywords: health education, gender differences, ethnic minority, diabetes, Karen

Myo Nyein Aung,1,2 Thaworn Lorga,2 Janthila Srikrajang,2 Nongluk Promtingkran,2 Suchart Kreuangchai,2 Wilawan Tonpanya,2 Phatchanan Vivarakanon,2 Puangpet Jaiin,2 Nara Praipaksin,3 Apiradee Payaprom41Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan; 2Boromarajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand; 3Baan Rekati Health Station, Thasongyang, Thailand; 4Thasongyang Hospital, ThailandBackground: Hypertension is currently a global health concern. Rural and minority populations are increasingly exposed to risk factors as a result of urbanization, leading to hypertension and cardiovascular disease. We conducted a survey in the rural Karen community in Thasongyang District, Tak Province, Thailand, with the aims of determining: the distribution of blood pressure across different age groups; the prevalence of hypertension and other risk factors for cardiovascular diseases (CVDs), including diabetes, smoking, sedentary lifestyle, and excess alcohol use; knowledge and awareness of hypertension as a disease; and knowledge and awareness of risk factors for hypertension among the population at risk.Methods: This was a community-based, cross-sectional survey of 298 rural Karen residents. A set of questionnaires assessing lifestyle-related health risk behaviors and awareness and knowledge of hypertension were used. Blood pressure, fasting plasma glucose, weight, height, and waist circumference were measured.Results: Median systolic and diastolic blood pressures were 110 (range 100–120) mmHg and 70 (range 60–80) mmHg, respectively. High blood pressure was observed in more than 27% of the population, with 15% being hypertensive and 12% being prehypertensive. Multinomial logistic regression analysis showed that people in the Karen community who were aware of hypertension were less likely to be current smokers (odds ratio [OR] 0.53, confidence interval [CI] 0.29–0.97) and those with primary school education were more likely to be aware of hypertension than those who did not have a primary school education (OR 6.5, CI 1.9–22.24). Overall, our survey showed that less than half of the Karen community had such knowledge and awareness.Conclusion: It is urgently necessary to promote knowledge, awareness, and health literacy among the ethnic Karen tribes to prevent hypertension and associated CVDs.Keywords: hypertension, Karen, smoking, awareness, knowledge, CVDs

Thaworn Lorga1, Myo Nyein Aung1,2, Prissana Naunboonruang1, Payom Thinuan1, Nara Praipaksin3, Tida Deesakul3, Utumporn Inwan3, Tawatchai Yingtaweesak4, Pratumpan Manokulanan1, Srisomporn Suangkaew1, Apiradee Payaprom41Boromarajonani College of Nursing Nakhon Lampang (BCNLP), Lampang, Thailand; 2Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan; 3Baan Rekati Health Station, Thasongyang, Tak, Thailand; 4Thasongyang Hospital, Thasongyang, Tak, ThailandBackground: Diabetes is a growing epidemic in both urban and rural communities worldwide.Aim: We aimed to survey fasting plasma glucose (FPG) status and awareness of diabetes in the rural Karen ethnic community. We investigated the predictors of impaired fasting plasma glucose (IFG) status, which would be easily applicable for prevention of diabetes in a rural community.Materials and methods: This was a community-based cross-sectional study conducted at Thasongyang, the most north-western district in Thailand. A total of 299 Karen ethnic rural residents were included in the study. FPG, body mass index, and waist circumference were prospectively measured. We assessed the awareness of diabetes and lifestyle-related health behavior with closed questionnaires in a rural community setting.Results: On screening for FPG, 16.72% of the Karen ethnic residents had hyperglycemia: 3.68% in the diabetic range and 13.04% in the prediabetic range respectively. After adjustment for age, sex, and BMI, waist circumference (adjusted odds ratio [aOR] 3.5, 95% confidence interval [CI] 1.29–9.57), and having a diabetic blood relative (aOR 4.6, CI 1.81–11.71) are significant predictors of IFG status.Conclusion: It is necessary to promote awareness of diabetes among the Karen ethnic community. Application of simple evidence-based predictors of the prediabetic state may lead to timely and effective prevention of diabetes in rural settings.Keywords: diabetes, prediabetes, fasting plasma glucose, Thailand, Karen ethnic community, predictors, rural health

Background: Depression is a common mental disorder and the sixth leading cause of disability in Thailand. Chiang Mai has historically been a city of attraction for labour migration for Shan migrants from the adjacent Southern Shan State of Myanmar. Currently, only infectious diseases are screened during the pre-employment period. Prevention and early detection of noncommunicable diseases can improve a healthy workforce and reduce the healthcare burden on the host country. Therefore, we aimed to determine the prevalence of depression and associated factors., Methods: A cross-sectional survey was done among Myanmar migrant adults legally working in Chiang Mai, Thailand., Results: The final analysis included 360 participants and the prevalence of depression was 14.4%. Being female, duration of stay in Thailand of more than 10 years, co-residence with co-workers, and marginalisation pattern of acculturation were significant associated factors affecting depression in a multivariate regression analysis model., Conclusion: Although the culture and dialect were not different between the host and country of origin, Myanmar migrant workers of Shan ethnicity suffered from depression. Our findings highlighted the importance of social determinants beyond common predictors of depression among migrants and the need for public health measures to promote migrants' integration into the host culture.

Competing Interests: Competing interests: None declared.

Background: Intracavernous carotid aneurysms (ICCAs) are rare, frequently asymptomatic, with a low rupture risk, which, however, can lead to life-threatening epistaxis. The aim of this study was to assess the effect of the treatment of asymptomatic ICCAs with flow diverters (FD) on sphenoid bone erosion or dehiscence in a selected cohort of patients., Methods: We retrospectively reviewed all asymptomatic ICCAs with sphenoid bone erosion or dehiscence detected on cone beam CT (CBCT) and treated with FD between December 2018 and December 2022. Patients were followed-up with CBCT and bone reconstruction was blindly evaluated by two interventional neuroradiologists and classified as unchanged, partial, or complete., Results: A total of 10 patients (women: 90%, mean age 58 years) treated with an FD for an asymptomatic ICCA with associated sphenoid bone erosion or dehiscence were included in this cohort. Sphenoid bone erosion was present in seven patients and dehiscence was observed in the remaining three. After treatment with FD, complete reconstruction of the sphenoid sinus wall occurred in seven cases, and partial reconstruction in two cases. Sphenoid bone erosion remained unchanged after treatment in only one patient., Conclusions: The decision to treat asymptomatic and unruptured ICCAs remains challenging due to their benign natural history and low hemorrhagic risk. The presence of sphenoid sinus erosion or dehiscence should not be overlooked since it could be considered as an indication for prophylactic treatment of life-threatening epistaxis. The mechanisms of bone erosion by the aneurysm and of reconstruction after treatment are still to be fully elucidated., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

In this qualitative study, we provided an in-depth understanding of how Community-Integrated Intermediary Care (CIIC), a new service model for family-based long-term care (LTC), was perceived by its users. The CIIC, established in Chiang Mai, Northern Thailand, consisted of three main interventions: (1) A temporary respite care center; (2) A family-centered care capacity building; (3) Functional training delivered as community group exercise and home exercise to improve healthy ageing for independent older adults. Ten pairs of dependent Thai older adults, their primary family caregivers, and ten village health volunteers were recruited using the purposive sampling method. Data were collected via semistructured in-depth interviews. A thematic descriptive qualitative analysis was used for data analysis. The findings revealed that CIIC helped reduce the burden of family caregivers by providing respite, relief, and care coordination. The experiences of the CIIC users indicated possibilities for service redesign, development, and delivery strategies to better meet the LTC needs of older adults and family caregivers. Following the local stakeholders' commitment and local community health volunteers' network, a well-integrated formal and informal care CIIC model can be implied as an effective and sustainable ageing care service model in Thailand and other Asian countries in the future.

Extreme weather can cause ill health in older persons due to a direct thermal effect on the body's thermoregulation and difficulties in maintaining a healthy lifestyle and accessing the health services they need. To understand experiences in relation to their exposures to extreme weather and how they responded to such weather conditions, including cold snaps, heat and air pollution in northern Thai communities, a descriptive qualitative study was conducted to uncover details and the essence of perspectives and experiences of older persons and family members. Three focus group discussions with 15 older persons and 15 family members occurred in three communities in Chiang Rai, a northern province of Thailand. Thematic analysis was performed. Experiences of older persons and families in relation to extreme weather conditions were described in five themes: local actions against weather changes, the double challenges, awareness and reactions to weather changes, protective and comfortable living environments, and mitigation of the impacts of weather conditions. Seasonal adaptability was key for older persons to stay safe and healthy during extreme weather changes. Heat, cold snaps, and air pollution made health and daily living routine maintenance among older persons challenging, especially among those with declining health. Older persons and families employed predictive and adaptive strategies to avoid and minimise extreme weather impacts and maximise their comfort and optimal living.

Traumatic chiasmal syndrome and traumatic third nerve palsies are rare entities usually caused by severe, high-speed, closed-head road accidents that require a thorough diagnostic work-up and complex medical and surgical management. This report presents the case of a young adult who was involved in a motorcycle accident and sustained blunt frontal head trauma, resulting in optical chiasmal syndrome and complete unilateral third nerve palsy. Ophthalmological examination demonstrated a right complete ptosis, a downward and outward position of the right eye with a fixed and dilated pupil, and bitemporal hemianopsia. In addition, funduscopy revealed bilateral optical nerve atrophy. After stabilisation and during follow-up, strabismus surgery was performed with improvement of ocular alignment in the primary position. Subsequently, eyelid surgery was carried out with good amplification of the visual field, particularly on the left side. Although challenging, surgical intervention in these cases should be considered for both functional and cosmetic reasons., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To address the problems related to drug resistance and medication safety, the rational drug use (RDU) policy has been implemented in Thailand since 2014. Theoretically, the policy was supposed to bring drastic changes to the way clinicians prescribe medications and its impacts on clinical practice, however, it has not yet been investigated. The study aimed to describe the experience of community health nurses with regard to the impact of RDU policy implementation on their practices., Methods: Focus group interviews and in-depth interviews with community nurses were conducted. Thematic analysis was performed., Results: Five themes emerged from the analysis, namely, (1) a welcome opportunity, (2) RDU as the quality of healthcare, (3) multidisciplinary collaboration, (4) reinventing productive interactions between nurses and patients, and (5) challenges over control of medications prescribed or purchased elsewhere., Conclusions: Implementing RDU in primary care provides opportunities for protecting individual patients and public health as well as safeguarding against professional prescription error. This can be made possible by adopting a systemic approach to changes. Additional educational and organizational support will optimize health professionals' contribution to the implementation and hence optimal outcomes of this important policy.

Background: Non-communicable diseases (NCDs) are showing an increasing trend worldwide, and the COVID-19 pandemic may interrupt or delay NCD care, the leading cause of mortality in Thailand, which is hosting 2-3 million migrant workers. The transition of epidemiological risk factors, limited access to health-promoting activities, and pandemic containment measures may adversely impact NCD risks. Therefore, hypertension and associated risk factors were determined among registered Myanmar migrant workers in Thailand., Methods: A cross-sectional survey with structured questionnaires was conducted in Thailand in 2017. Having hypertension was analyzed as a dependent variable, and the associated risk factors were explored by binary logistic regression analysis., Results: A total of 414 participants with a mean age of 29.45 ± 9.03 years were included, and 27.8 percent of the study participants were hypertensive, which was a rate higher than that in their host country (24.7%) and country of origin (26.4%). An older age, being male, current alcohol drinking, and being overweight and obese with reference to the body mass index (BMI) were significantly associated with hypertension., Conclusions: Our findings reaffirmed the idea that NCDs are important public health concerns, and a simple BMI measurement would be a valuable tool with which to determine hypertension risks. Targeted surveillance and an appropriate health policy are necessary for such a vulnerable population in Thailand.

Thailand hosts many workers who have migrated from neighboring countries and is facing a large burden of non-communicable diseases (NCDs). Health screening for migrant workers routinely emphasizes infectious diseases but overlooks NCDs. We surveyed prevalent health behaviors for NCDs and their influencing factors, particularly cultural adaptation patterns among Myanmar migrant workers in Chiang Mai, Northern Thailand. A total of 414 migrant workers consented to participate in the study. Lack of exercise (75.8%), current alcohol consumption (40.8%), current smoking (26.9%), and central obesity (24.3%) were major lifestyle problems. Being female and uneducated was associated with a lack of exercise. Current alcohol consumption was significantly associated with being male and being of Myanmar ethnicity, with an integrative strategy for acculturation, and with a higher income. Male participants and participants with a lower mean score of marginalization were more likely to smoke. Central obesity was associated with being older than 40 years, being female, engaging in an assimilation strategy, and being uneducated. These findings highlight the need for gender inclusive health promotion, the screening of NCD risk behaviors, and timely health education for migrant workers. It may assist authorities to devise strategies to extend health promotion and universal health coverage to the migrant population.

This study aimed to determine the prevalence and associated factors of frailty among Thai older persons. A cross-sectional study was conducted with a representative sample of 1806 older persons aged 60 years or older. Frailty was assessed by Fried's frailty phenotypes, which consists of five criteria, namely, unintended weight loss, exhaustion, slow walking, weak handgrip and decreased physical activity. Older people who met 3 in 5, 1-2 in 5, and none of the criteria were considered frail, pre-frail and non-frail respectively. The prevalence was calculated and multinomial logistic regression was performed. Prevalence rates of frailty, pre-frailty and non-frailty were 13.9% (95% CI 9.9 to 18.8), 50.9% (95% CI 47.5 to 54.1) and 35.1% (95% CI 31.5 to 39.9), respectively. Increasing age, lower education, having no spouse, poorer health perception, increasing number of comorbidities, osteoarthritis and smaller mid-arm circumference increased the risk of frailty ( p < 0.001). The prevalence of geriatric frailty syndrome in this study was much higher than that of developed countries but was lower than that of less developed countries. Factors associated with frailty reflect common characteristics of disadvantaged older persons in Thailand.

Aims and Objectives: The objective of this study was to explore the influence of the environmental landscape on the physical activity of older persons experiencing frailty., Background: This manuscript describes the second phase of an unpublished larger study in the northern province of Lampang, Thailand. Phase One revealed that 14% of 1,788 older persons surveyed were found to have experienced frailty according to Fried's frailty phenotypes, and low physical activity was associated with frailty. In the light of frailty, how older persons experience physical activity in their day-to-day living environments warrants in-depth exploration., Design: This was a qualitative study guided by narrative inquiry., Methods: In-depth interviews and observations were conducted with 13 older persons living with frailty. The method of analysis was thematic and performance analysis., Results: Two broad themes relating to the environmental landscapes were as follows: (a) limiting environmental landscapes and (b) engaging environmental landscapes. These landscapes, which change across time, refer to physical and social spaces, and beliefs of older persons and their family that have either positive or negative impacts on physical activity of frail older persons., Conclusion: Complex interactions between physical and social spaces and beliefs of older persons and family influence the physical activity behaviours of older persons living with frailty., Implications for Practice: This study warrants education and policy aiming at creating optimal environmental landscapes to promote physical activity in frail older persons., (© 2019 John Wiley & Sons Ltd.)

Background: Smoking cessation is an achievable behavioral change, which reduces the risks of cardiovascular diseases, cancers and tobacco-related diseases. There is a need for an effective smoking cessation service for low and middle income country settings where the smoking rate is generally very high whilst a cessation service is not usually accessible. This study devised a new smoking cessation service package and assessed its effectiveness in the primary health care setting of northern Thailand., Methods: This randomized controlled trial was centered at Maetha district hospital, Lampang province, Thailand, and its network of mobile non-communicable disease clinics at seven primary care units. A total of 319 eligible patients who consented to participate in the study, were randomly allocated to an intervention arm (160) and a control arm (159), applying block randomization. The multi-component intervention service consisted of: (1) regular patient motivation by the same nurse over a 3-month period; (2) a monthly piCO+ Smokerlyzer test for 3 months; (3) continual assistance from a trained family member, using a smoking-cessation- diary; and (4) optional nicotine replacement chewing gum therapy. The control group received the routine service comprising of brief counseling and casual follow-up. Smoking cessation, confirmed by six months of abstinence and the piCo+ Smokerlyzer breath test, was compared between the two services after a year follow-up. The trial is registered as an international current control trial at the ISRCTN registry. ISRCTN89315117., Results: The median age of the participants was 64 years, with females constituting 28.84%. Most of the participants smoke hand-rolled cigarettes (85%). The intervention arm participants achieved a significantly higher smoking cessation rate than the control arm 25.62% vs 11.32%, with an adjusted odd ratio of 2.95 and 95% confidence interval 1.55-5.61., Conclusion: In relation to accessing smoking cessation services within the primary health care setting, participants who received the evidence-based intervention package were about three times more likely to succeed in giving up smoking than those who received the routine service. Utilizing community resources as major intervention components, the evidence from this trial may provide a useful and scalable smoking cessation intervention for low and middle income countries., Trial Registration: Current controlled trials ISRCTN89315117 . WHO international clinical trial identifier number: U1111-1145-6916; 3/2013.

Aim: The purpose was to compare the fracture strength between restorations containing the metal pin (MP) and those containing the glass fiber pin (GFP)., Materials and Methods: Forty-five healthy bovine anterior teeth were used in this study. A preparation of 4 mm × 4 mm was created on the incisal surface of each tooth. All teeth were prepared in the same way. The teeth were randomly divided into three groups (n = 15): group I-control: teeth restored with resin composite (RC) only, without reinforcement; group II-Each tooth was restored with a MP and RC; group III-Each tooth was restored with a GFP and RC. The specimens were left in an oven at a temperature of 37°C for 24 hours before performing the fracture strength tests. The fracture strength test was performed in a universal test machine at an angle of 90°., Results: The Tukey test (p ≤ 0.05) showed that for the variable maximum force (kgf), there was no statistically significant difference among the groups (p = 0.272). The chi-square test showed that groups II and III presented over 70% of cohesive-adhesive type fractures when compared with group I (over 70% of adhesive fractures), and this difference was statistically significant (p < 0.05)., Conclusion: The pins tested did not increase the fracture resistance of the restorations (RC) in comparison with group I (without reinforcement); however, with the use of the MP and GFP, there was a predominance of cohesive-adhesive fractures (groups II and III)., Clinical Significance: Evaluate if the new GFP can generate greater resistance to fracture of RC restorations.

Background: Smoking cessation is a high-priority intervention to prevent CVD events and deaths in developing countries. While several interventions to stop smoking have been proved successful, the question of how to increase their effectiveness and practicality in developing countries remains. In this study, a newly devised evidence-based smoking cessation service package will be compared with the existing service in a randomized controlled trial within the community setting of Thailand., Method/design: This randomized control trial will recruit 440 current smokers at CVD risk because of being diabetic and/or hypertensive. Informed, consented participants will be randomly allocated into the new service-package arm and the routine service arm. The study will take place in the non-communicable disease clinics of the Maetha District Hospital, Lampang, northern Thailand. The new smoking-cessation service-package comprises (1) regular patient motivation and coaching from the same primary care nurse over a 3-month period; (2) monthly application of piCO + smokerlyzer to sustain motivation of smoker's quitting attempt and provide positive feedback over a 3-month period; (3) assistance by an assigned family member; (4) nicotine replacement chewing gum to relieve withdrawal symptoms. This new service will be compared with the traditional routine service comprising the 5A approach in a 1-year follow-up. Participants who consent to participate in the study but refuse to attempt quitting smoking will be allocated to the non-randomized arm, where they will be just followed up and monitored. Primary outcome of the study is smoking cessation rate at 1-year follow-up proven by breath analysis measuring carbomonoxide in parts per million in expired air. Secondary outcomes are smoking cessation rate at the 6-month follow-up, blood pressure and heart rate, CVD risk according to the Framingham general cardiovascular risk score, CVD events and deaths at the 12-month follow-up, and the cost-effectiveness of the health service packages. Intention-to-treat analysis will be followed. Factors influencing smoking cessation will be analyzed by the structure equation model., Discussion: This multicomponent intervention, accessible at primary healthcare clinics, and focusing on the individual as well as the family and social environment, is unique and expected to work effectively., Trial Registration: Current Controlled Trials ISRCTN89315117.

Tuberculosis (TB) and human immunodeficiency virus (HIV) co-epidemics form a huge burden of disease in the Southeast Asia region. Five out of eleven nations in this region are high TB/HIV burden countries: Myanmar, Thailand, India, Indonesia and Nepal. The trends of TB incidence in these countries have been rising in recent years, in contrast to a falling global trend. Experts in the field of TB control and health service providers have been perplexed by the association of TB and HIV infections which causes a mosaic clinical presentation, a unique course with poor treatment outcomes including death. We conducted a review of contemporary evidence relating to TB/HIV control with the aims of assisting integrated health system responses in Southeast Asia and demystifying current evidence to facilitate translating it into practice.