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Some studies found that providing micronutrient powder (MNP) causes adverse health outcomes, but modifying factors are unknown. We aimed to investigate whether Fe status and inherited Hb disorders (IHbD) modify the impact of MNP on growth and diarrhoea among young Lao children. In a double-blind controlled trial, 1704 children of age 6-23 months were randomised to daily MNP (with 6 mg Fe plus fourteen micronutrients) or placebo for about 36 weeks. IHbD, and baseline and final Hb, Fe status and anthropometrics were assessed. Caregivers provided weekly morbidity reports. At enrolment, 55·6 % were anaemic; only 39·3 % had no sign of clinically significant IHbD. MNP had no overall impact on growth and longitudinal diarrhoea prevalence. Baseline Hb modified the effect of MNP on length-for-age (LAZ) (P for interaction = 0·082). Among children who were initially non-anaemic, the final mean LAZ in the MNP group was slightly lower (-1·93 (95 % CI -1·88, -1·97)) v. placebo (-1·88 (95 % CI -1·83, -1·92)), and the opposite occurred among initially anaemic children (final mean LAZ -1·90 (95 % CI -1·86, -1·94) in MNP v. -1·92 (95 % CI -1·88, -1·96) in placebo). IHbD modified the effect on diarrhoea prevalence (P = 0·095). Among children with IHbD, the MNP group had higher diarrhoea prevalence (1·37 (95 % CI 1·17, 1·59) v. 1·21 (95 % CI 1·04, 1·41)), while it was lower among children without IHbD who received MNP (1·15 (95 % CI 0·95, 1·39) v. 1·37 (95 % CI 1·13, 1·64)). In conclusion, there was a small adverse effect of MNP on growth among non-anaemic children and on diarrhoea prevalence among children with IHbD.

Background: Anemia is a globally well-known major public health problem. In Southeast Asia where there is ethnic diversity, both iron deficiency (ID) and inherited hemoglobin disorders (IHDs) are prevalent and are considered to be the major factors contributing to anemia. However, little is known about the anemia burden among the ethnic minorities. In this study, we determine the burden of anemia, in relation to ID and IHDs, among the Karen ethnic minorities living in the rural area of lower northern Thailand., Methods: A cross-sectional community-based study was conducted at Ban Rai district, Uthai Thani province. Study participants included 337 Karen people aged over 18 years. Socio-economic and health-related information were obtained through interviews and recorded by local health staff. Anemia, IHDs and ID were diagnosed according to standard laboratory methods. Multivariate logistic regression analysis was applied to identify risk factors of moderate-to-severe anemia., Results: The prevalence of overall anemia was 27.9% (95% CI = 23.2-33.0). Mild and moderate anemia were detected in 18.7% (95% CI = 14.7-23.3) and 8.9% (95% CI = 6.1-12.5) respectively. Severe anemia was found in one case (0.3%). Various forms of IHDs were identified in 166 participants, constituting 49.3% (95% CI = 43.8-54.7). The most common form of IHDs was α+-thalassemia (32.9%), followed by β-thalassemia (12.2%), α0-thalassemia (4.2%), hemoglobin E (3.9%), and hemoglobin Constant Spring (0.9%). Among 308 participants who were investigated for ID, the prevalence was discovered to be 6.8% (95% CI = 4.3-10.2). Analysis of risk factors of moderate-to-severe anemia revealed that individuals with ID, β-thalassemia and age > 65 years were at high risk with adjusted odds ratio of 17 (95% CI = 3.8-75.2), 6.2 (95% CI = 1.4-27.8) and 8.1 (95% CI = 1.6-40.4) respectively., Conclusions: Anemia among the Karen is of public health significance; and IHDs are the major contributing factors. Because of the high risk of developing moderate-to-severe anemia, special attention should be paid to individuals affected with ID, β-thalassemia and the elderly. Public awareness of the health burden of severe thalassemia syndromes should also be campaigned., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Pyae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Health promotion and disease prevention (P&P) are essential components of primary health care. This study investigated the coverage of P&P services and barriers to services among primary care units in Thailand before and during the coronavirus disease 2019 (COVID-19) pandemic. A web-based cross-sectional survey was conducted to compare the data from primary care units across the 13 health regions in two fiscal years: October 2018 to September 2019 (before the pandemic) and October 2019 to September 2020 (during the pandemic). A total of 340 primary care units responded to the questionnaire. While most participating primary care units provided basic P&P services (n = 327, 96.2%) and community-based P&P services (n = 244, 71.8%), fewer offered area-based P&P services (n = 120, 35.3%) for all target populations. The high coverage of basic P&P services remained in place during the pandemic, while coverage of community-based P&P services for vulnerable and at-risk populations improved during the pandemic. Area-based P&P services improved for pregnant and postpartum women, preschoolers, children and adolescents, adults, and older people. Lack of human resources, materials and equipment, and financial support were cited as the primary challenges to offering P&P services. The higher coverage of P&P services in several target populations during the pandemic contributed to a heavy workload. Effective resource allocation, capacity building, and support from relevant parties, such as government and local agencies, are required to maintain high P&P service coverage., Competing Interests: The authors declare no conflict of interest., (© 2022 The Author(s).)

A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90-120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow-up are possible target areas to improve hypertension control in Thailand., (© 2020 The Authors. The Journal of Clinical Hypertension published by Wiley Periodicals LLC.)

Background: Cardiovascular disease is the most common cause of death worldwide, and the detection of LDL-C contributes to reducing risks. However, the LDL-C is rarely evaluated according to the gold standard method because it is costly and time-consuming. This study aimed to determine the agreement of LDL-C among three equations, namely Friedewald's equation, Puavilai's equation, and Dansethakul's equation., Methods: A cross-sectional descriptive study., Results: Using the data of lipid measurement from a specific group of people in the remote rural area, we found that the Thai equations have more superior agreement with direct measurement than the Friedewald equation (ICC = 0.870, 95% CI = 0.857-0.882) when the agreement of continuous data was used for total analysis. Although the categorical analysis that gave better agreement was from Friedewald equation (K index = 0.730, 95% CI = 0.720-0.751), the findings from this study confirmed the population-specific use of Pauvilai's equation and Dansethakul's equation for determining the LDL-C., Conclusion: Pauvilai's equation showed better agreement with direct measurement for LDL-C. Thus, it could be considered as an alternative for the direct method, particularly in laboratories in rural areas in Thailand., (© 2020 The Authors. Journal of Clinical Laboratory Analysis published by Wiley Periodicals LLC.)

Objective: To establish a new indicator derived from reticulocyte hemoglobin (Ret-He) content and red blood cell (RBC) indices for screening for iron deficiency anemia (IDA) in an area in whch thalassemia is prevalent., Methods: Blood specimens from 304 women aged between 18 and 30 years residing in northeast Thailand were collected and measured for RBC and reticulocyte parameters. Iron deficiency was diagnosed when a participant had a serum ferritin level of less than 15 ng per mL. Thalassemia genotypes were defined by hemoglobin (Hb) and DNA analyses., Results: Of the total participants, 25% had iron deficiency (ID) and 50% carried the thalassemia gene. Various mathematical formulas were established and analyzed using the receiver operating characteristic (ROC) curve. The formula derived from Ret-He: (Ret-He/RDW-SD) × 10, was the best predictor for identifying ID among participants (area under the curve [AUC] = 0.812). Further testing of this indicator among individuals with positive thalassemia-screening results revealed stronger performance with an AUC of 0.874., Conclusions: The findings indicate that the formula derived from Ret-He might be applicable for screening ID in areas in which thalassemia is prevalent., (© American Society for Clinical Pathology 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Public health authorities in low- and middle-income countries face dramatic challenges in handling rapidly increasing non-communicable diseases (NCDs), due to the epidemiological- and particularly nutritional transition. Among major reasons for the development of NCDs are smoking and alcohol, but overnutrition and obesity are also major threats to population health. Obesity is related to diabetes and cancer, but also has a genetic background. It is difficult to recommend a healthy nutrition. This is because of conflicting nutritional conceptions, and given the complexity of human metabolism understanding this topic can be difficult for the laymen.  Public health measures advocating physical activity and refraining from high intake of energy, sugar and soft drinks need to be enhanced by supporting the 'intrinsic motivation' to preserve a good health. The mission of public health should be to increase awareness about the complexity of human metabolism, and the involvement of genetic and epigenetics in health and diseases. To maintain homeostasis, means to keep an optimal relationship between catabolism and synthesis, seems to be of particular interest. Preconditions for this is, that public health institutions within the administration- and academic sector follow up developments in life science and molecular biology and conduct population-based research making use of molecular epidemiology, especially those related to key metabolic steps and maintenance of 'homeostasis', in balancing catabolism and anabolism. A prospective biomarker for this situation might be α-2-macroglobulin., Competing Interests: No competing interests were disclosed., (Copyright: © 2019 Schelp FP et al.)

This study assessed thalassemia and hemoglobinopathies in a group of the Tay ethnic minority. Participants included 289 women of reproductive-age who enrolled in a pilot screening program for thalassemia conducted at six communities of Thai Nguyen Province, northern Vietnam. Standard procedures including complete blood count (CBC), hemoglobin (Hb) and DNA analyses were performed for all samples. The prevalence of thalassemia in 289 Tay women was 15.6% (gene frequency 0.078) for α 0 -thalassemia (α 0 -thal), 10.0% (gene frequency 0.050) for α + -thal, 7.3% (gene frequency 0.036) for β-thalassemia (β-thal), 2.4% (gene frequency 0.012) for Hb Constant Spring [Hb CS; α142, Term→Gln, T AA> C AA (α2), HBA2 : c.427T>C] and 1.7% (gene frequency 0.009) for Hb E [β26(B8)Glu→Lys, G AG> A AG; HBB : c.79G>A]. Further analysis of β-globin gene abnormalities identified four mutations including codons 41/42 (-TCTT) ( HBB : c.126&#95;129delCTTT), codon 17 (A>T) ( HBB : c.52A>T), codons 71/72 (+A) ( HBB : c.216&#95;217insA), and -28 (A>G) ( HBB : c.78A>G). The results hint at the remarkably high frequencies of severe forms of thalassemia that indicate a serious public health problem requiring further exploration, and most probably, also intervention within the country.

A major consequence of all elements of the 'epidemiological transition' is the rapid emergence of non-communicable diseases (NCDs) in low- and middle-income countries. In contrast to the outcomes of the 'Alma Ata Conference for Primary Health Care', it has not yet been possible to introduce an equally powerful health policy for the prevention and control of NCDs. Major strategies so far are to advise individuals not to smoke and drink alcohol in excess. Additionally, 'healthy' nutrition and increased physical activity are also advocated. Policy for preventing and working against NCDs is now part of the Sustainable Development Goals, specifically target 3.4. So far, attempts to soften the influence of NCDs on the health of the people in low- and middle-income countries have been unsuccessful. It is argued here that additional concepts on how public health could operate against NCDs are needed.  Major risk factors for NCDs interfere with and alter complex steps within the human metabolism.  This paper explores how human metabolism works by assessing advances in molecular biology and research in genetics, epigenetics and gerontology. Recent developments in these scientific disciplines shed light on the complexity of how human health is maintained and diseases are invoked. Public health bodies should be aware, interested and possibly contribute to the aforementioned areas of interest, as far as NCDs are concerned, and translate major developments in a way, that could be useful in improving population health., Competing Interests: No competing interests were disclosed.

Screening for thalassemia carriers should not only be conducted in middle-income countries but also can be possible in low-middle income countries, through cooperation of experienced professionals from middle income countries. We describe a collaborating model between two close neighboring countries in establishing such a screening program for thalassemia. After training and setting up of facilities, a total of 152 out of 187 hospital staff were screened as a pilot activity to encourage community participation. Referring system for sending blood samples to a reference center in Thailand was also established. Among 152 health staff, 12.5% α0-thal, 2% β-thal and 13% Hb E carriers were found. Applying thalassemia screening to 411 pregnant women and 71 spouses, 5 couples at risk of bearing a child of thalassemia disease were identified. The thalassemia screening program has a sensitivity of 99.5%, specificity of 77%, positive predictive value of 73%, and negative predictive value of 99.5%. Thus, it is possible to operate a thalassemia screening program with acceptable performance in a low-middle income country (Lao People’s Democratic Republic) with the cooperation of a referral center located within close proximity in a middle income country (Thailand).

We describe hematologic and molecular characteristics of a hitherto undescribed interaction between the Filipino deletional [beta](0)-thalassemia with Hb E and [alpha]-thalassemia in a Thai family. This study was conducted during the prenatal screening of a pregnant Thai woman and her family members. A prenatal diagnosis was performed at her second pregnancy by amniocentesis. Laboratory investigations identified that the pregnant woman was Hb E heterozygote with [alpha](+)-thalassemia, whereas her husband was a double heterozygote for the Filipino deletional [beta](0)-thalassemia and [alpha](+)-thalassemia. Their affected son was a patient with a previously undescribed condition of Hb E-[beta](0)-thalassemia with [alpha](+)-thalassemia. Both a combined gap-polymerase chain reaction (PCR) and allele-specific PCR were used successfully in the prenatal diagnosis, which identified an affected fetus with Hb E-[beta](0)-thalassemia without [alpha](+)-thalassemia. Beta globin gene haplotype analysis indicated the same origin of this Filipino [beta](0)-thalassemia in Asian populations. [ABSTRACT FROM AUTHOR]

We describe hematologic and molecular characteristics of a hitherto undescribed interaction between the Filipino deletional β0-thalassemia with Hb E and α-thalassemia in a Thai family. This study was conducted during the prenatal screening of a pregnant Thai woman and her family members. A prenatal diagnosis was performed at her second pregnancy by amniocentesis. Laboratory investigations identified that the pregnant woman was Hb E heterozygote with α+-thalassemia, whereas her husband was a double heterozygote for the Filipino deletional β0-thalassemia and α+-thalassemia. Their affected son was a patient with a previously undescribed condition of Hb E-β0-thalassemia with α+-thalassemia. Both a combined gap-polymerase chain reaction (PCR) and allele-specific PCR were used successfully in the prenatal diagnosis, which identified an affected fetus with Hb E-β0-thalassemia without α+-thalassemia. Beta globin gene haplotype analysis indicated the same origin of this Filipino β0-thalassemia in Asian populations. [ABSTRACT FROM AUTHOR]

To establish simple noninvasive prenatal diagnosis of common beta-thalassemia in Southeast Asia, we have evaluated the possibility of identifying the 3 most common beta-thalassemia genes [beta(E), beta(17A-T), and beta(41/42(-CTCC))] by analysis of fetal DNA in maternal plasma using combined conventional polymerase chain reaction (PCR) and real-time quantitative PCR. Maternal plasma was obtained from peripheral blood of Thai pregnant women collected during the first and second trimesters of gestation. DNA was prepared from 200 muL plasma using a QIAmp Blood Mini Kit. Identifications of the beta(E), beta(41/42(-CTTT)), and beta(17A-T) in plasma DNA were carried out using semi-nested (for beta(E)) and nested (for beta(41/42) and beta(17)) real-time allele-specific PCR methodologies, and the results were compared with those obtained on fetal tissue analysis with routine invasive procedure. Twenty-six fetal beta(E) genes were correctly identified by maternal plasma DNA analysis of 39 pregnant women investigated. The fetal beta(41/42) and beta(17) mutations were detectable in 6 of 12 and 4 of 9 maternal plasma specimens, respectively, which were in concordance with the results obtained by routine invasive procedure. The noninvasive prenatal diagnostic methods developed should potentially prove useful for detection of paternally inherited mutation and for providing the exclusion of pregnancies at risk for this common genetic disorder in the region. [ABSTRACT FROM AUTHOR]

To establish simple noninvasive prenatal diagnosis of common β-thalassemia in Southeast Asia, we have evaluated the possibility of identifying the 3 most common β-thalassemia genes [βE, β17A-T, and β41/42(-CTCC)] by analysis of fetal DNA in maternal plasma using combined conventional polymerase chain reaction (PCR) and real-time quantitative PCR. Maternal plasma was obtained from peripheral blood of Thai pregnant women collected during the first and second trimesters of gestation. DNA was prepared from 200 μL plasma using a QIAmp Blood Mini Kit. Identifications of the βE, β41/42(-CTTT), and β17A-T in plasma DNA were carried out using semi-nested (for βE) and nested (for β41/42 and β17) real-time allele-specific PCR methodologies, and the results were compared with those obtained on fetal tissue analysis with routine invasive procedure. Twenty-six fetal βE genes were correctly identified by maternal plasma DNA analysis of 39 pregnant women investigated. The fetal β41/42 and β17 mutations were detectable in 6 of 12 and 4 of 9 maternal plasma specimens, respectively, which were in concordance with the results obtained by routine invasive procedure. The noninvasive prenatal diagnostic methods developed should potentially prove useful for detection of paternally inherited mutation and for providing the exclusion of pregnancies at risk for this common genetic disorder in the region. [Copyright &y& Elsevier]

BACKGROUND: It is customary in Southeast Asia to treat pregnant anemic women with iron supplements, but anemia in this region may be complicated by thalassemia and hemoglobinopathies, which lead to an ineffective response. OBJECTIVE: The aim was to determine whether routine iron supplementation during pregnancy in this area, which has a high prevalence of thalassemia and hemoglobinopathies, is an effective control strategy for iron deficiency anemia. DESIGN: A prospective study was conducted. Seventy-six pregnant women, including 43 who were heterozygous for the hemoglobin E (Hb E) gene, 20 who were heterozygous for Hb E and had alpha-thalassemia, and 13 who were homozygous Hb E, as well as 77 pregnant women who had no thalassemia gene, participated in this investigation. All pregnant women received a daily dose of 120 mg elemental Fe for an average of 133.5 d. Hematologic variables and serum ferritin concentrations were measured before supplementation and after supplementation at the gestational age of 28-32 wk. Differences in hematologic variables and serum ferritin were assessed. RESULTS: Significant differences in hemoglobin, mean corpuscular volume, and mean corpuscular hemoglobin responses were found between the nonthalassemia group and the 3 groups with the Hb E gene after adjustment for the following baseline values: age, body mass index, duration of iron supplementation, and ferritin concentration. Significant differences in the improvements in mean corpuscular volume and mean corpuscular hemoglobin values between the 3 groups indicate a poorer response at the cellular level in the pregnant women with the Hb E gene. Further analysis showed a significant difference in the hemoglobin response only for women who were homozygous for Hb E. CONCLUSION: Iron supplementation during pregnancy is not beneficial for pregnant women who are homozygous for Hb E, but a routine intervention should not cause iron overload, as judged from this short observation period. Copyright © 2007 American Society for Nutrition [ABSTRACT FROM AUTHOR]

Background and Aims: A pilot screening program for thalassemia was initiated in the Lao People's Democratic Republic. This study aimed to describe the genotype diversity and hematologic features of thalassemia among the participating pregnant women., Methods: Blood samples of 411 pregnant Laotian women were collected. Hemoglobin (Hb) profiles were determined using a capillary zone electrophoresis system. Mutations of α- and β-globin genes were investigated using a polymerase chain reaction and related techniques., Results: As many as 26 different thalassemia genotypes including non-transfusion-dependent thalassemia, i.e. Hb E-β-thalassemia, Hb H, and EA Bart's diseases, were identified. A variety of phenotypic expressions of hematologic features and Hb profiles were observed, including an unusual phenotype of Hb E-β0 thalassemia with 89.1% Hb E, 1.6% Hb F, and 9.3% Hb A2., Conclusions: The remarkable genotype-phenotype diversity indicates a need for careful laboratory interpretation in order to provide appropriate genetic counseling and care to the Laotian population., (© 2015 S. Karger AG, Basel.)

Background: To evaluate the use of MCV and MCH cutoffs for thalassemia screening in areas with a high frequency of thalassemia and hemoglobinopathies using different hematology analyzers., Methods: Blood samples of known α(0)-thalassemia and β-thalassemia carriers were analyzed to establish the appropriate cutoffs for each analyzer. These selected cutoffs were validated prospectively for screening of α-thalassemia, β-thalassemia in combination with the dichlorophenolindophenol test for hemoglobin E on another 288 Thai and 325 Laotian students. Genotypes were defined by standard hemoglobin and DNA analyses., Results: The appropriate cutoffs for the Sysmex XS-800i and Sysmex XN-1000, Coulter LH 780, and Pentra ES-60 were found to be 78 fL for MCV and 25 pg for MCH. These were 82 fL and 25 pg for the Cell-Dyn Ruby. Further validation on Thai and Laotian students revealed 100% sensitivity and specificity of higher than 80% for all analyzers., Conclusions: While using MCV in screening requires establishment of appropriate cutoffs, MCH appears to be applicable to all analyzers. Each analyzer should be evaluated and appropriate cutoffs should be established before application in the field.

Little is known of the different freezing and thawing techniques for post-thaw survival of spermatozoa in Sambar deer. So, this study determined the effect of seminal plasma, egg yolk and glycerol extenders and their concentrations, plus cooling, freezing, and thawing protocols on the post-thaw quality of their semen. Semen samples were collected by electro-ejaculation from four Thai Sambar deer stags (Cervus unicolor equinus). As evaluated by post-thaw progressive motility and acrosome integrity removal of seminal plasma was beneficial; Tris-egg yolk was the most efficient extender; a 20% egg yolk concentration was better than the 0%, 10%, or 30%; and a 3% glycerol concentration was better than 5%, 7%, or 9%. Using the optimum dilution techniques, semen was loaded in 0.5 ml plastic straws. Cooling times from ambient temperature to 5°C in 3 hr resulted in higher post-thaw progressive motility and acrosome integrity than 1, 2, or 4 hr. Suspending the straws 4 cm above the surface for 15 min before plunging into liquid nitrogen was better than suspending at 2 or 6 cm. For thawing frozen semen, an intermediate thawing (50°C, 8 sec) protocol was more effective than the slower (37°C, 10 sec) or faster (70°C, 5 sec) thawing rates. Timed insemination following estrus synchronization of 10 hinds resulted in six confirmed pregnancies at 60 days. Five hinds delivered live fawns. This study provides an effective approach for semen cryopreservation and artificial insemination (AI), which should be valuable to scientists for genetics and reproductive management of Sambar deer in developing countries., (© 2015 Wiley Periodicals, Inc.)

The screening of 609 villagers in rural areas of northeastern Thailand resulted in the detection of 110 (18.1%) new cases of type 2 diabetes (T2DM). The diagnoses were made on the basis of a glycated hemoglobin (HbA1c) value ≤ 6.5%. Among all those screened, 243 (40%) reported having a father or mother with T2DM. Among the new cases, 66 (60%) reported a first-degree relative, predominantly their mothers, who had the disease. Together with age and the body mass index, a mother or father with DM was strong risk factor for the development of T2DM (adjusted odds ratio = 2.9, 95% confidence interval = 1.84-4.57) when compared with the absence of a first-degree relative with DM. It is concluded that family history of a first-degree relative is an important additional information that might improve the validity of the screening procedure., (© 2014 APJPH.)

The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area., (© 2012 APJPH.)

Hemoglobin is an oxygen-transport protein in red blood cells that interacts with multiple ligands, e.g., oxygen, carbon dioxide, carbon monoxide, and nitric oxide. Genetic variations in hemoglobin chains, such as those underlying sickle cell disease and thalassemias, present substantial clinical challenges. Here, we review the progress in research, including the use of allosteric modulators, pharmacological chaperones, and antioxidant treatments, which has begun to improve hemoglobin stability and oxygen affinity. According to UniProt (as of 7 August 2024), 819 variants of the α-hemoglobin subunit and 771 variants of the β-hemoglobin subunit have been documented, with over 116 classified as unstable. These data demonstrate the urgent need to develop variant-specific stabilizing options. Beyond small-molecule drugs/binders, novel protein-based strategies—such as engineered hemoglobin-binding proteins (including falcilysin, llama-derived nanobodies, and α-hemoglobin-stabilizing proteins)—offer promising new options. As our understanding of hemoglobin's structural and functional diversity grows, so does the potential for genotype-driven approaches. Continued research into hemoglobin stabilization and ligand-binding modification may yield more precise, effective treatments and pave the way toward effective strategies for hemoglobinopathies. [ABSTRACT FROM AUTHOR]

A community-based survey was conducted to determine the prevalence and gene frequency of Hemoglobin Constant Spring (Hb CS) and other forms of thalassemia among an ethnic minority in Vietnam. A total of 298 ethnic minority women, the Có-Tu, participated. Hematological parameters and hemoglobin profiles were analyzed using standard automated analyzers. Alpha- and beta-thalassemia mutations were identified using polymerase chain reaction (PCR) based technology. Of the 298 women, 141 (47.3%) carried thalassemia genes. Hemoglobin Constant Spring (Hb CS) is the most common with a markedly high frequency of 0.143 (overall prevalence=26.2%). The heterozygous state of Hb CS was found in one-fifth (20.5%) of women participating. Seven women (2.4%) were Hb CS homozygote. The overall prevalence for Hb E was 13.8%, and 10.7% for α(+)-thalassemia. Other forms of thalassemia included 0.67% β-thalassemia, and 0.34% Hb Paksé. None of the participants had the α(0)-thalassemia gene. The study provides basic epidemiological information about Hb CS as well as other forms of thalassemia for a specific group of an ethnic minority in Vietnam. The data will be useful for further study on the distribution of thalassemia in Southeast Asia., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Rationale: Since 2001, antiretroviral therapy (ART) for people living with HIV (PLHIV) has been available in the Lao People's Democratic Republic (PDR). A key factor in the effectiveness of ART is good adherence to the prescribed regimen for both individual well-being and public health. Poor adherence can contribute to the emergence of drug resistant strains of the virus and transmission during risky behaviors. Increased access to ART in low-income country settings has contributed to an interest in treatment adherence in resource-poor contexts. This study aims to investigate the proportion of adherence to ART and identify possible factors related to non-adherence to ART among people living with HIV (PLHIV) in Lao PDR., Methods: A cross-sectional study was conducted with adults living with HIV receiving free ART at Setthathirath hospital in the capital Vientiane and Savannakhet provincial hospitals from June to November 2011. Three hundred and forty six PLHIV were interviewed using an anonymous questionnaire. The estimation of the adherence rate was based on the information provided by the PLHIV about the intake of medicine during the previous three days. The statistical software Epidata 3.1 and Stata 10.1 were used for data analysis. Frequencies and distribution of each variable were calculated by conventional statistical methods. The chi square test, Mann-Whitney test and logistic regression were used for bivariate analyses. Multiple logistic regression analysis was conducted to determine the predictors of non-adherence to ART. A p-value < 0.05 was considered to indicate statistical significance., Results: Of a total of 346 patients, 60% reported more than 95% adherence to ART. Reasons for not taking medicine as required were being busy (97.0%), and being forgetful (62.2%). In the multivariate analysis, educational level at secondary school (OR=3.7, 95% CI:1.3-10.1, p=0.012); illicit drug use (OR=16.1, 95% CI:1.9-128.3, p=0.011); dislike exercise (OR=0.6, 95% CI:0.4-0.9, p=0.028), and forgetting to take ARV medicine during the last month (OR=2.3, 95% CI:1.4-3.7, p=0.001) were independently associated with non-adherence., Conclusions: Non-adherence to ART was associated with individual factors and exposure to ART. Priority measures to increase adherence to ART should aim to intensify counseling and comprehensive interventions, such as guidance for PLHIV on medication self-management skills, tailoring the regimen to the PLHIV life style, and improving adherence monitoring and health care services.

Objective: To investigate the benefits and constraints of a screening attempt as initiated by the Ministry of Public Health (MoPH) measuring over-nutrition, hypertension and type 2 diabetes mellitus (T2DM) undertaken by the local health officials on sub-district level., Material and Method: Capillary blood glucose (CBG), body mass index (BMI), blood pressure, and history of type 2 diabetes mellitus (T2DM) of first degree relatives was assessed following the direction of the Ministry of Public Health (MoPH) by the local health officials., Results: The proportions of obesity, hypertension, and T2DM from 7,698 villagers were about 35%, 20%, and suspected to be 9%, respectively. This was similar to previous investigations except for the history of T2DM of first-degree relatives, which strongly relates to elevated CBG levels. A high percentage of missing value was recognized for all variables., Conclusion: The screening of non-communicable disease program executed by the lower level of the health delivery system is an achievement by itself It can detect new cases of diseases. However incompleteness of variables is a constraint observed due to high workload of the health staff To decrease the burden of the public health staff and the curative sector and increase accuracy, the proportion of the population eligible for screening should be restricted to a higher age, being obese, and having a first-degree relative with diabetes mellitus.

Background and Aims: Information about the extent to which anemia is related to thalassemia and iron deficiency (ID) is not available in Vietnam. This study investigated the burden of anemia in relation to thalassemia and ID among Vietnamese pregnant women., Methods: A cross-sectional study was conducted in Thua Thien Hue, Central Vietnam. Blood samples taken from 399 pregnant women with a gestational age <12 weeks were analyzed. Anemia was defined as Hb levels <11 g/dl, and ID as ferritin values <15 ng/ml., Results: Out of 399 participants, 77 (19.3%) were anemic. While the prevalence of ID was 20.1%, the prevalence of ID anemia was 6.0%. The overall prevalence of thalassemia was 7.3%. Of the 77 anemic women, 24 (31.2%) had ID, and 20 (26.0%) had thalassemia genes. The rest (42.9%) were anemic due to unknown causes., Conclusions: The results indicate that ID remains a significant health burden among the study population, together with anemia caused by unknown factors. Thalassemias appear not to contribute to a great extent to anemia among Vietnamese pregnant women. Other causes need to be investigated further in order to develop an effective control program for anemia within the population., (Copyright © 2013 S. Karger AG, Basel.)

A community-based assessment of thalassemias and hemoglobinopathies was conducted at the Thua Thien Hue Province, Central Vietnam. By cluster sampling, a total of 410 pregnant women attending the antenatal care service at 30 commune health centers were recruited consecutively from September 2011 to June 2012. Hemoglobin (Hb) analysis was performed using an automated Hb analyzer. α-Thalassemia (α-thal) genes were identified by polymerase chain reaction (PCR)-based techniques. Out of the 410 pregnant women, 2.7% carried α(0)-thal and 1.2% were β-thal carriers. One woman with the - -(THAI) deletion was also found. Among the females under survey, structural Hb variants with 3.2% Hb E [β26(B8)Glu→Lys, GAG>AAG; HBB: c.78G>C] and 3.7% Hb Constant Spring [Hb CS; α142, Term→Gln, TAA>CAA (α2); HBA2: c.427T>C] were found. Assessing the frequency of thalassemias and hemoglobinopathies by ethnicity, Kinh (Vietnamese) and ethnic minority groups, Hb CS with a high frequency of 24.0% was observed in the ethnic minority groups. These results provide basic population-based information, are useful not only for implementing measures for prevention and control of thalassemias in the region but also for studying the importance of thalassemias and hemoglobinopathies in ethnic minorities within Southeast Asia.