Mahidol University's Institutional Repository
คลังสารสนเทศสถาบันของมหาวิทยาลัยมหิดล
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Climate change and its differential impact on sexual and reproductive health and rights among women in Nepal
(2025-01-01) Ghimire J.; Poudel K.; Lamichhane K.; Timilsina A.; Dhakal M.P.; Phuyal P.P.; Pradhan S.; Devkota J.; Karki S.; Ghimire J.; Mahidol University
Background: Nepal is highly affected by climate change, experiencing glacier melting, untimely rainfall, floods, landslides, forest fires, and droughts, which collectively impact over 10 million people. There is a larger impact of climate change on human health, but its impact on women's and girls’ sexual and reproductive health and rights is yet to be explored. Thus, this study aims to understand the linkages between climate change and the unique impact on gender and sexual, and reproductive health and rights (SRHR). Methodology: This is an exploratory cross-sectional study conducted using a mixed method in Kailali, Arghakhanchi, and Kapilvastu districts. A total of 384 women were selected using systematic random sampling from the upper, middle, and downstream of Khutiya and Banganga river basins. Focus group discussions and key informant interviews were conducted to capture their experiences. Descriptive, bivariate, and multivariate analyses were carried out for quantitative data using SPSS, and a thematic analysis for qualitative data. Results: The women who experienced two or more climate-included disasters were more likely to face gender-based violence (P <.05). The study also showed that women's autonomy in making decisions on Sexual and Reproductive Health and Rights has increased among women exposed to a higher number of climate-related risk (P <.001). Though more than 3/4th of women did not want more children, women who are exposed to more climate-related risks wanted more children (P <.001). The survey found that more than three-quarters (76.3%) of respondents knew about the legality of abortion, and 85% of respondents knew the place to go for abortion services. The result also revealed a significant reduction in sexual desire among women who were exposed to a higher number of climate events. These findings are also aligned with the qualitative information in the study. Conclusion: The findings demand strengthening the resilience of healthcare systems to withstand the impact of climate change, ensuring that essential sexual and reproductive health services, including abortion, contraception, and maternal healthcare, are available and accessible even during the climate crisis. The findings indicate the need for interventions that empower women, address gender-based violence, and integrate sexual and reproductive health into climate change adaptation in policies and programs.
A Delphi Consensus on Clinical Features, Diagnosis, and Treatment of Chronic Rhinosinusitis With Nasal Polyps in the ASEAN Region
(2025-01-01) Abdullah B.; Govindaraju R.; Husain S.; Siow J.K.; Tantilipikorn P.; Teo N.W.Y.; Wang D.Y.; Anggraini D.; Charn T.C.; Chin C.W.D.; Kanjanawasee D.; Khaing M.M.; Leong J.L.; Tran L.V.; Singh H.; Tang I.P.; Thong K.T.M.; Vicente G.M.; Yap Y.Y.; Subramaniam S.; Abdullah B.; Mahidol University
Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) impacts patients' concentration, ability to work, and overall quality of life. Current treatment options include topical and oral medications, and surgery. Recent evidence supports the efficacy of biologics in improving symptoms and quality of life. This study addresses the lack of consensus in the ASEAN region, providing guidance for otolaryngologists on appropriate CRSwNP management. Methods: A modified Delphi panel was conducted to gather expert opinion and establish consensus on the use of biologics and management of CRSwNP among otolaryngologists in the ASEAN region. Statements were developed based on a literature review and inputs from a Steering Committee of eight experts from Malaysia, Singapore, and Thailand. A three-stage process was utilized for consensus generation: two online surveys for voting by at least 12 panelists from seven ASEAN countries, followed by moderated online Consensus Meetings with the Steering Committee. Results: Consensus was achieved on 61/69 statements (88%). In Rounds 1 and 2, 37/67 statements (55%) and 13/28 statements (46%) achieved consensus, respectively. During the moderated Consensus Meetings, consensus was achieved on 12/16 statements (75%). Key aspects addressed include symptoms, comorbidities, diagnosis, and treatment pathways, with a focus on biologics. Eligibility criteria and considerations for biologic use were also defined. Conclusions: Insights from this Delphi consensus provide guidance on biologic use for managing CRSwNP in the ASEAN region. Future efforts, such as developing a regional guideline, continued medical education, and further research are essential for appropriate biologic use.
How can the ethical conduct of verbal autopsies be enhanced? Lessons from Southeast Asia
(2025-01-01) Htun N.S.N.; Adhikari B.; Phyo A.P.; Perrone C.; Phommasone K.; Kabir N.; Vanna M.; Lubell Y.; Peto T.J.; Htun N.S.N.; Mahidol University
Verbal autopsy research is vital for understanding community mortality, informing health interventions and policies in low- and middle-income countries. However, overlooking the community perspectives on deaths can undermine the ethical conduct and effectiveness of such research. This study explored community-based concepts of death, interpretations, and coping mechanisms in five Southeast Asian countries, with this manuscript highlighting key findings from the body mapping exercise that revealed diverse cultural and religious understandings on death. Participants’ views ranged from seeing death as a cessation to life's struggles to an inevitable end, reflecting deep cultural and spiritual beliefs. Coping mechanisms, often grounded in religious practice and community support, played a crucial role in managing grief. The study also underscores the importance of addressing emotional well-being for both participants and researchers. Recommendations include integrating mental health support into research protocols and tailoring practices to local cultural contexts. These findings inform the design of more ethically grounded verbal autopsy tools and procedures that are sensitive to local beliefs and emotional dynamics, ultimately improving data quality and community trust.
Effects of metabolic syndrome and its components on pulmonary function and functional capacity in children and adolescents with obesity
(2025-09-01) Limkul L.; Udomittipong K.; Charoensittisup P.; Mahoran K.; Limkul L.; Mahidol University
Obesity is a pervasive global health issue frequently associated with metabolic syndrome (MetS). Limited data exist regarding the impact of MetS and its individual components on pulmonary function in obese pediatric populations. This study investigated the relationship between MetS and lung function, and further identified specific MetS components that adversely affect pulmonary outcomes. We enrolled obese children and adolescents aged 7‒18 years. Anthropometric measurements and metabolic assessments were performed. All participants underwent spirometry and the six-minute walk test (6-MWT). Based on MetS criteria, participants were classified into MetS or non-MetS groups. Between-group comparisons were conducted, and regression analyses were used to identify MetS components predictive of lung function and exercise capacity. A total of 155 participants were evaluated (37 [23.9%] with MetS; 118 [76.1%] without). Those with MetS demonstrated a significantly lower 6-MWT distance z-score (‒0.61 ± 1.1 vs ‒0.07 ± 0.99; P = 0.006). No significant group differences were found in spirometric parameters. Obesity indices exerted a stronger negative effect on lung function than MetS status. Abdominal circumference (b = ‒0.03, P < 0.001) and elevated FBS (> 100 mg/dL; b = ‒0.50, P = 0.04) were associated with reduced 6-MWT distance z-scores; they also negatively influenced FEV1% predicted (abdominal circumference: b = ‒0.15, P < 0.04; elevated FBS: b = ‒9.04, P = 0.02). Conclusions: Obese children and adolescents with MetS show significantly diminished functional capacity as evidenced by lower 6-MWT performance. Among MetS components, increased abdominal circumference and elevated FBS (> 100 mg/dL) emerged as critical predictors of decreased functional capacity. (Table presented.)
Proton-activated chloride channel governs phagosome-mediated antibacterial immunity in peritoneal macrophages
(2025-11-03) Cheng H.Y.; Chu J.; Limjunyawong N.; Chen J.; Ye Y.; Chen K.H.; Koylass N.; Sun S.; Dong X.; Qiu Z.; Cheng H.Y.; Mahidol University
The success of phagosome degradation relies on the ability of phagocytes to regulate the maturation of phagosomes. However, its underlying molecular mechanisms remain poorly understood. Here, we identify the proton-activated chloride (PAC) channel as a key negative regulator of phagosome maturation. PAC deletion enhanced phagosomal acidification and protease activities, leading to augmented bacterial killing in large peritoneal macrophages (LPMs) upon Escherichia coli infection in mice. Surprisingly, phagosome degradation also stimulated STING-IRF3-IFN responses and inflammasome activation in LPMs, both of which are enhanced upon PAC deletion. The increased inflammasome activation induced the release of cleaved gasdermin D, which localized to the surface of bacteria in the peritoneum and further contributed to their killing. Finally, enhanced bacterial clearance by PAC-deficient LPMs reduced proinflammatory immune cell infiltration and peritoneal inflammation, resulting in improved survival in mice. Our study thus provides new insights into the molecular mechanism of phagosome maturation and the dynamics of host defense response following phagosome-mediated bacterial degradation in peritoneal macrophages.