Efficacy and safety of metformin for melasma treatment: a systematic review and meta-analysis

Objective: Metformin has recently been demonstrated to have an anti-melanogenic activity. Nevertheless, clinical evidence of the effectiveness of metformin in melasma is lacking. The objective of this study was to assess the efficacy and safety of metformin in the treatment of melasma. Methods: MEDLINE, Embase, PubMed, Cochrane Library (CENTRAL), Scopus, CINAHL, and grey literature databases were searched to 4 October 2022 and updated on 26 February 2023. Randomized controlled trials (RCTs), quasi-RCTs, observational studies, case series, and case reports investigating the efficacy and safety of metformin for melasma were included. The Melasma Area Severity Index (MASI) scores that changed from baseline were pooled using fixed-effects model and expressed as standardized mean differences (SMDs) and 95% confidence intervals (CIs). Results: Three RCTs including 140 patients with melasma were included. The results demonstrated that after 8 weeks, 15% topical metformin significantly reduced the Melasma Area Severity Index (MASI) score compared to placebo (1 trial; n = 60; MD, -0.56; 95% CI, -1.07 to -0.04; p = 0.034). Furthermore, when compared to triple combination cream (TCC), 30% topical metformin demonstrated similar efficacy in reducing the MASI score after 8 weeks (2 trials; n = 80; MD, 0.19, 95% CI, -0.25 to 0.63; p = 0.390). Patients using 30% topical metformin had fewer adverse events compared to TCC users, although no statistical difference was found. Conclusion: Topical metformin was as effective as triple combination cream (TCC) in decreasing changes in the MASI score in patients with melasma, with minimum adverse events. Further studies with larger sample sizes, longer follow-up times, and well-designed trials are required. Systematic Review Registration: Identifier PROSPERO (CRD42022351966).

Transcultural adaptation and psychometric validation of the Thai-Brief Resilient Coping Scale: a cross-sectional study during the coronavirus disease 2019 pandemic in Thailand

This study aimed to examine the transcultural adaptation, construct validity, and psychometric properties of the Thai-Brief Resilient Coping Scale (BRCS) among the general population and college students through the coronavirus disease 2019 (COVID-19) pandemic in Thailand. We invited the 4004 participants to complete sets of anchor-based measurement tools, including depressive symptoms, anxiety symptoms, perceived stress, well-being, and perceived social support. The scale factor structure of the Thai-BRCS was assessed using factor analysis, and nonparametric item response theory (IRT) analysis. The psychometric properties of the Thai-BRCS for validity (convergent and discriminant) and reliability (internal consistency and reproducibility) were assessed. Based on the construct validity testing, factor analysis, and nonparametric IRT analysis reaffirmed the unidimensionality with a one-factor structure of the Thai-BRCS version. For convergent validity, the scale was significantly correlated with all sets of anchor-based measurement tools (all P < 0.001). The discriminant validity was satisfactory with a group of medium and low resilience and the risk of adverse mental outcomes. For scale reliability, it revealed excellent internal consistency (alpha = 0.84, omega = 0.85) and reproducibility (intraclass correlation = 0.91). The Thai-BRCS version fulfills transcultural adaptation with satisfactory psychometric properties to measure psychological resilience in the Thai population during the COVID-19 pandemic.

Psychological Resilience and Adverse Mental Health Issues in the Thai Population during the Coronavirus Disease 2019 Pandemic

In light of the coronavirus disease 2019 (COVID-19) pandemic and the enormous amount of uncertainty caused by it, mental health issues have become a great concern. Evidence regarding the effects of psychological resilience on the Thai population is scarce. We evaluated psychological resilience during the first wave of the COVID-19 pandemic and its association with the risk of mental health outcomes, such as depression, anxiety, stress, and health-related well-being. This cross-sectional study was a part of the HOME-COVID-19 project, which conducted an online survey of 4004 members of the general population in Thailand using the Brief Resilience Coping Scale. Logistic regression was performed to identify the association between psychological resilience and mental health issues and well-being. Groups with prevalence rates of 43.9%, 39.2%, and 16.9% were classified as low, moderate, and high resilient copers, respectively. Using high resilient copers as a reference group, the low resilient copers had a higher chance of having mental health adversities. The adjusted odds ratio (OR) was 1.89 (95% confidence interval [CI], 1.39-2.56; p < 0.001) for depression, 2.13 (95% CI, 1.45-3.14; p < 0.001) for anxiety, 4.61 (95% CI, 3.30-6.45; p < 0.001) for perceived stress, and 3.18 (95% CI, 2.31-4.38; p < 0.001) for low well-being. For the medium resilient copers, only low well-being was found to be statistically significant (OR, 1.60; 95% CI, 1.16-2.20; p = 0.004). It is important that resilience be considered in the development of strategies for managing the COVID-19 pandemic to prevent or reduce adverse mental health outcomes.

Disparities and Factors Associated with Coronavirus Disease-2019-Related Public Stigma: A Cross-Sectional Study in Thailand

Coronavirus disease 2019 (COVID-19)-related public stigma is a major challenge, with scarce available evidence. This study aimed to determine the disparities and factors associated with COVID-19-related public stigma in the Thai population. We conducted a cross-sectional study involving a voluntary online survey in Thailand from 21 April 2020 to 4 May 2020. We invited 4004 participants to complete a series of questionnaires, including the validated COVID-19 public stigma scale and questions on relevant COVID-19-related psychosocial issues. Multinomial logistic regression was performed to investigate the factors associated with COVID-19-related public stigma. The prevalence of COVID-19-related public stigma was 24.2% (95% confidence interval [CI], 22.2-26.2) for no/minimal, 35.5% (95% CI, 33.4-37.6) for moderate, and 40.3% (95% CI, 38.2-42.4) for high. We observed disparities in the prevalence of COVID-19-related public stigma according to participant characteristics and psychosocial factors. Using the no/minimal group as a reference group, the six predominant risk factors significantly associated with a moderate and high degree of COVID-19-related public stigma were middle-aged or older adults, male, divorced/widowed/separated, current quarantine status, moderate/severe fear of COVID-19, and medium/high perceived risk of COVID-19. Additional risk factors significantly related to a high degree of COVID-19-related public stigma were religion (Buddhist), region of residence (non-capital city), and exposure to COVID-19-related information. Disparities in COVID-19-related public stigma due to sociodemographic and psychosocial issues are frequent in the Thai population. To reduce public stigmatization, early identification of vulnerable groups and the development of tailored mitigation strategies should be implemented during the pandemic.

COVID-19 Public Stigma Scale (COVID-PSS): development, validation, psychometric analysis and interpretation

OBJECTIVE

Amid the COVID-19 pandemic, social stigma towards COVID-19 infection has become a major component of public discourse and social phenomena. As such, we aimed to develop and validate the COVID-19 Public Stigma Scale (COVID-PSS).

DESIGN AND SETTING

National-based survey cross-sectional study during the lockdown in Thailand.

PARTICIPANTS

We invited the 4004 adult public to complete a set of measurement tools, including the COVID-PSS, global fear of COVID-19, perceived risk of COVID-19 infection, Bogardus Social Distance Scale, Pain Intensity Scale and Insomnia Severity Index.

METHODS

Factor structure dimensionality was constructed and reaffirmed with model fit by exploratory and confirmatory factor analyses and non-parametric item response theory (IRT) analysis. Psychometric properties for validity and reliability were tested. An anchor-based approach was performed for classifying the proper cut-off scores.

RESULTS

After factor analysis, IRT analysis and test for model fit, we created the final 10-item COVID-PSS with a three-factor structure: stereotype, prejudice and fear. Face and content validity were established through the public and experts' perspectives. The COVID-PSS was significantly correlated (Spearman rank, 95% CI) with the global fear of COVID-19 (0.68, 95% CI 0.66 to 0.70), perceived risk of COVID-19 infection (0.79, 95% CI 0.77 to 0.80) and the Bogardus Social Distance Scale (0.50, 95% CI 0.48 to 0.53), indicating good convergent validity. The correlation statistics between the COVID-PSS and the Pain Intensity Scale and Insomnia Severity Index were <0.2, supporting the discriminant validity. The reliability of the COVID-PSS was satisfactory, with good internal consistency (Cronbach's α of 0.85, 95% CI 0.84 to 0.86) and test-retest reproducibility (intraclass correlation of 0.94, 95% CI 0.86 to 0.96). The proposed cut-off scores were as follows: no/minimal (≤18), moderate (19-25) and high (≥26) public stigma towards COVID-19 infection.

CONCLUSIONS

The COVID-PSS is practical and suitable for measuring stigma towards COVID-19 in a public health survey. However, cross-cultural adaptation may be needed.

Global prevalence of mental health issues among the general population during the coronavirus disease-2019 pandemic: a systematic review and meta-analysis

To provide a contemporary global prevalence of mental health issues among the general population amid the coronavirus disease-2019 (COVID-19) pandemic. We searched electronic databases, preprint databases, grey literature, and unpublished studies from January 1, 2020, to June 16, 2020 (updated on July 11, 2020), with no language restrictions. Observational studies using validated measurement tools and reporting data on mental health issues among the general population were screened to identify all relevant studies. We have included information from 32 different countries and 398,771 participants. The pooled prevalence of mental health issues amid the COVID-19 pandemic varied widely across countries and regions and was higher than previous reports before the COVID-19 outbreak began. The global prevalence estimate was 28.0% for depression; 26.9% for anxiety; 24.1% for post-traumatic stress symptoms; 36.5% for stress; 50.0% for psychological distress; and 27.6% for sleep problems. Data are limited for other aspects of mental health issues. Our findings highlight the disparities between countries in terms of the poverty impacts of COVID-19, preparedness of countries to respond, and economic vulnerabilities that impact the prevalence of mental health problems. Research on the social and economic burden is needed to better manage mental health problems during and after epidemics or pandemics. Systematic review registration: PROSPERO CRD 42020177120.

Mental health circumstances among health care workers and general public under the pandemic situation of COVID-19 (HOME-COVID-19)

BACKGROUND

After the spread of the coronavirus disease 2019 (COVID-19) globally, upgraded quarantine and physical distancing strategy, strict infection measures, and government's strict lockdown have been abided to confront the spread of the COVID-19 in Thailand. During the COVID-19 pandemic, concerns about the mental health and psychosocial problems among health care workers and the general population are now arising. Yet, information on mental health and psychosocial problems among health care workers and the general population have not been comprehensively reported in Thailand. As such, we conduct a cross-sectional study, a national online survey to describe the short- and long-term consequences of the COVID-19 pandemic on mental health and psychosocial problems among health care workers and the general population in Thailand.

METHODS

This study is a repeated cross-sectional study, an open online voluntary national-based survey during the wave I (April 21-May 4, 2020) follow-up in the wave II (August 3-16, 2020), wave III (November 15-28, 2020), and a 1-year follow-up survey (wave IV: April 21-May 4, 2021) in Thailand. Health care workers at the hospitals and the adult general population will be invited to participate in the online survey via the SurveyMonkey that limits one-time participation per unique internet protocol address. The target sample size of at least 1182 health care workers and 1310 general populations will be required to complete the online survey for each wave of the survey. Sociodemographic characteristics and a set of measurement tools for mental and psychosocial problems for each subcohort including depression, anxiety, stress, resilient copings, neuroticism, perceived social support, wellbeing, somatic symptoms, insomnia, burnout (for healthcare workers), and public stigma toward COVID-19 infection (for the general population) will be collected. For all estimates of prevalence, we will weigh data for all wave analyses under the complex design of the survey. Subgroup analyses stratified by key characteristics will also be done to analyze the proportion differences. For the repeated cross-sectional survey, we will combine the data from the wave I to wave IV survey to analyze changes in the mental health status. We will perform multilevel logistic regression models with random intercepts to explore associations with individual-level and region-level/hospital-level predictors. We also plan to perform an ancillary systematic review and meta-analysis by incorporating data from our findings to all available evidence.

RESULTS

Our findings will provide information on the short- and long-term mental health status as well as the psychosocial responses to the COVID-19 outbreak in a national sample of health care workers and the general population in Thailand.

CONCLUSION

This prospective, nationally based, a repeated cross-sectional study will describe the mental health status and psychosocial problems among health care workers and the general population in Thailand during the COVID-19 pandemic.

ETHICS AND DISSEMINATION

Ethical approval for the study was obtained from the Faculty of Public Health and Faculty of Pharmacy, Chiang Mai University. The findings will be disseminated through public, scientific, and professional meetings, and publications in peer-reviewed journals.

THAI CLINICAL TRIALS REGISTRY (TCTR) REGISTRATION NUMBER

TCTR20200425001.