Alcohol consumption among high-risk Thai youth after raising the legal drinking age.

OBJECTIVE: Methamphetamine and alcohol are the leading substances abused by Thai youth. In 2008 the government passed laws that limited alcohol availability and increased the legal drinking age from 18 to 20. We assessed whether the law reduced drinking among methamphetamine-using 18-19 year olds in Chiang Mai. METHOD: The study compares drinking patterns among methamphetamine smokers aged 18-19 years (n=136) collected prior to the legal changes, to a comparable post-law sample (n=142). Statistical tests for differences between the pre- and post-law samples on problem drinking and recent drinking frequency and drunkenness were conducted. Logistic regression modeled the relative odds of frequent drunkenness, controlling for demographic characteristics. RESULTS: A high prevalence of problematic drinking was present in both samples, with no difference detected. The post-law sample reported a significantly higher median days drunk/month (9 vs. 4, p≤0.01); in adjusted analysis, frequent drunkenness (>5.5 days/month) was more common in the post-law compared to pre-law period in the presence of other variables (AOR: 2.2; 95%CI: 1.3, 3.9). Post-law participants demonstrated a low level of knowledge about the law's components. CONCLUSIONS: The study suggests that the new laws did not reduce drinking among high-risk, methamphetamine-smoking 18-19 year olds; rather, the post-law period was associated with increased drinking levels. The data indicate that the law is not reaching high-risk under-aged youth who are at risk of a number of deleterious outcomes as a result of their substance use.

Are there adverse consequences of quizzing during informed consent for HIV research?

INTRODUCTION: While quizzing during informed consent for research to ensure understanding has become commonplace, it is unclear whether the quizzing itself is problematic for potential participants. In this study, we address this issue in a multinational HIV prevention research trial enrolling injection drug users in China and Thailand. METHODS: Enrolment procedures included an informed consent comprehension quiz. An informed consent survey followed. RESULTS: 525 participants completed the informed consent survey (Heng County, China»255, Xinjiang, China»229, Chiang Mai, Thailand»41). Mean age was 33 and mean educational level was 8 yrs. While quizzing was felt to be a good way to determine if a person understands the nature of clinical trial participation (97%) and participants did not generally find the quiz to be problematic, minorities of respondents felt pressured (6%); anxious (5%); bored (5%); minded (5%); and did not find the questions easy (13%). In multivariate analysis, lower educational level was associated with not minding the quizzing (6e10 yrs vs 0e5 yrs: OR»0.27, p»0.03; more than 11 yrs vs 0e5 yrs: OR»0.18, p»0.03). There were also site differences (Heng County vs Xinjiang) in feeling anxious (OR»0.07; p»<0.01), not minding (OR»0.26; p»0.03), being bored (OR»0.25; p»0.01) and not finding the questions easy (OR»0.10; p»<0.01). CONCLUSIONS: Quizzing during the informed consent process can be problematic for a minority of participants. These problems may be associated with the setting in which research takes place and educational level. Further research is needed to develop, test and implement alternative methods of ensuring comprehension of informed consent. TRIAL REGISTRATION: clinicaltrials.gov number NCT00270257.

Penile modification in young Thai men: risk environments, procedures and widespread implications for HIV and sexually transmitted infections.

OBJECTIVES: To determine the prevalence and types of penile modification and describe the circumstances surrounding this practice among a sample of young methamphetamine users in Thailand. METHODS: A mixed methods study was conducted in Chiang Mai, Thailand, in 2005-6. One hundred young men were surveyed for the quantitative study and in-depth interviews were administered to 9 men, 11 women and 1 transgender. RESULTS: The prevalence of penile modification was 51%, with the most common type being inlaying with muk(s) (61%). The majority of modifications were performed in prison or juvenile detention (80%) by a friend (90%). Motivations for penile modification included peer pressure and perceived enhanced female sexual pleasure. In prison, the practice was veiled in secrecy, the conditions under which modification was performed were unhygienic, sometimes leading to infection, and sharing equipment was common. Men and women reported that condom use was more difficult post modification as condoms were more likely to break or leak and less likely to fit correctly. In addition, sexual intercourse was often painful for the female partner. CONCLUSION: Penile modification is prevalent in this group of young methamphetamine users and is associated with behaviours and consequences that could facilitate the spread of HIV and other sexually transmitted infections.

Children's attitudes toward behavior management techniques used by dentists.

PURPOSE: Many behavior management techniques (BMTs) are used in dental offices. The objective of this study was to evaluate how children felt towards the BMT used in the dental office by using the newly invented "attitude meter." METHODS: Two hundred forty children 6 to 17 years old were selected randomly to participate in the study. Each student was asked to watch 8 video scenes of live BMTs. The BMTs used consisted of: (1) tell-show-do (TSD); (2) rewards; (3) general anesthesia; (4) papoose board; (5) hand-holding; (6) mouthprop; (7) voice control; and (8) hand-over-mouth exercise (HOME). After watching each BMT scene, the children were instructed to express their attitude towards the BMT by drawing a "line of favor"--the newly invented attitude meter. RESULTS: It was found that TSD and HOME were the most and least favorite BTM, respectively. Those who had dental experience appeared to have worse attitudes. Older and younger children had different opinions towards some BMTs. The older children preferred the papoose board and hand-holding to the mouthprop. All children preferred the use of the papoose board and hand-holding to voice control. CONCLUSIONS: Children appeared to judge a behavior management technique according to the way it looked. The "line of favor" is a reliable tool to measure attitudes of children over 6 years old.

Cardiovascular autonomic nervous system dysfunction in patients with rheumatoid arthritis and systemic lupus erythematosus.

Although peripheral and central nervous system involvement have been well recognized in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), autonomic nervous system (ANS) involvement has rarely been studied, and has shown conflicting results. We performed cardiovascular ANS assessment in 34 RA and 37 SLE patients, using standard cardiovascular reflex tests. The results in each patient were compared with age- and sex-matched healthy controls. Forty-seven percent of the RA patients and 19% of the SLE patients had symptoms suggesting ANS dysfunction. The heart rate variation in response to deep breathing was significantly decreased in both the RA and SLE patients (p = 0.001). This diminished heart rate response showed no correlation with the disease duration, the number of swollen joints, the Ritchie articular index, ESR, or rheumatoid factor in the RA group, or the disease duration, the SLEDAI score or ESR in the SLE group. The clinical significance of the diminished cardiovascular ANS response needs to be investigated.

Entomological and epidemiological investigations of malaria transmission in relation to population movements in forest areas of north-west Thailand.

Transmission of forest-related malaria was observed entomologically and epidemiologically for 2 transmission seasons in 1990 and 1991 in 5 villages of Mae Sariang district, Mae Hong Son Province, north-west Thailand. The entomological study included collections of mosquitos and determination of infection rate by using enzyme-linked immunosorbent assay in the residential villages and the farm huts. The epidemiological study included fortnightly visits to 30% of the households to interview and record movement activities and illness of villagers. Circumsporozoite proteins, in most cases of Plasmodium falciparum, were detected in Anopheles minimus species A, An. dirus s.l., An. maculatus s.s. and An. sawadwongporni in residential villages and/or farm huts, suggesting transmission could occur there. Movement of people away from their residences occurred throughout the year for several reasons with a sharp peak in July for agricultural activity, mainly ploughing and planting for rice cultivation. The relative risk of infection for people engaged in agricultural activity was 3 times that of people living in the residential villages. Although a higher biting density of vectors was generally evident at the farm huts, the estimated inoculation rates in the 2 settings were similar. Movement for forest activity increased after harvesting rice in the cool dry season and carried the highest malaria risk, suggesting different epidemiological and probably entomological conditions which need further investigation. The significance is discussed of discrepancies between the case classification system used by this study and that used by malaria sector staff.

Entomological evaluation of community-wide use of lambdacyhalothrin-impregnated bed nets against malaria in a border area of north-west Thailand.

This paper reports 2 studies. (i) After a year of baseline data collection, lambdacyhalothrin-treated bed nets were introduced into 3 of 5 villages in north-west Thailand, the remaining 2 being treated with placebo. Human bait collections were carried out in each village on 2 nights per month, for 8 months of each year, and the biting densities were compared between the first year and the second year. The treated bed nets did not have any significant impact on the density or parous rates of Anopheles sawadwongporni and A. maculatus s.s. populations. The results for A. dirus s.l. were not conclusive because of the low number caught. Significant reductions in biting and parous rates of A. minimus species A were observed in only one of the 3 treated villages, and there was no overall difference between treated and control groups. However, the trial suffered from the washing of nets by villagers and the low rate of reimpregnation. (ii) A short-term study involved 4 villages in a cross-over design, and lasted 48 d. For the first 24 d, residents of 2 villages were given new treated nets while the other 2 villages retained their own untreated nets. For the second 24 d, this situation was reversed. Daily light-trapping revealed no significant difference in the indoor densities or parous rates of A. minimus species A between the periods with treated or untreated nets.(ABSTRACT TRUNCATED AT 250 WORDS)