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Background: To determine the severity of dental fluorosis in selected populations in Chiang Mai, Thailand with different exposures to fluoride and to explore possible risk indicators for dental fluorosis. Methods: Subjects were male and female lifetime residents aged 8.13 years. For each child the fluoride content of drinking and cooking water samples were assessed. Digital images were taken of the maxillary central incisors for later blind scoring for TF index (10% repeat scores). Interview data explored previous cooking and drinking water use, exposure to fluoride, infant feeding patterns and oral hygiene practices. Results: Data from 560 subjects were available for analysis (298 M, 262 F). A weighted kappa of 0.80 was obtained for repeat photographic scores. The prevalence of fluorosis (TF 3+) for subjects consuming drinking and cooking water with a fluoride concentration of <0.9 ppm was 10.2%. For subjects consuming drinking and cooking water >0.9 ppm F the prevalence of fluorosis (TF 3+) rose to 37.3%. Drinking and cooking water at age 3, water used for infant formula and water used for preparing infant food all demonstrated an increase in fluorosis severity with increase in water fluoride level (p<0.001). The probability estimate for the presentation of aesthetically significant fluorosis was 0.53 for exposure to high fluoride drinking (.0.9 ppm) and cooking water (.1.6 ppm). Conclusions: The consumption of drinking water with fluoride content >0.9 ppm and use of cooking water with fluoride content >1.6 ppm were associated with an increased risk of aesthetically significant dental fluorosis. Fluoride levels in the current drinking and cooking water sources were strongly correlated with fluorosis severity. Further work is needed to explore fluorosis risk in relation to total fluoride intake from all sources including food preparation. [ABSTRACT FROM AUTHOR]

INTRODUCTION Perceptions, personal perspectives, and public awareness of e-cigarette information have a significant impact on e-cigarette smoking behavior, and provide comprehensive information that can help reduce interest in e-cigarette smoking and reduce the number of new smokers. This study aimed to investigate the perceptions towards e-cigarettes related to e-cigarette use and how that information related to people's use of them. METHODS The data for this cross-sectional study were collected via an online questionnaire. Thai nationals who were aged >18 years provided data between June 2021 and January 2022. Multivariable logistic regression and the chi-squared test were used to analyze the data. RESULTS There were 340 respondents, 76 e-cigarette users, and 264 non-e-cigarette users. Most of the perceptions of information that differed statistically significantly between e-cigarette users and non-e-cigarette users included information on regulations, products, health effects, and the effectiveness of smoking cessation. The association between factors and e-cigarette smoking behavior revealed that the perception of the product information and male gender were associated with e-cigarette smoking behavior (AOR=13.59; 95% CI: 2.35-78.60, and AOR=5.19; 95% CI: 2.87-9.40, respectively). CONCLUSIONS The perception of e-cigarette product information and male gender were associated with e-cigarette smoking behavior. [ABSTRACT FROM AUTHOR]

Background Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors. Methods This study was based on data from the 6th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years. Results We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19). Conclusions We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained. [ABSTRACT FROM AUTHOR]

Acute coronary syndrome is a chronic illness that influences physical and psychological health and well-being and requires continuous treatment and effective self-care. This two-group quasi-experimental study investigated the effectiveness of the Self-Care Support Program for People with Acute Coronary Syndrome. Sixty participants were purposively recruited from medical wards of a university-affiliated hospital in Bangkok, Thailand. A Self-Care Support Program based on Orem's self-care theory was integrated with a motivational interviewing approach. The experimental group (n = 30) received the 4-week intervention program with the usual care, while the comparison group (n = 30) received only usual care. Instruments for data collection included a Demographic and Health Data Form, the Self-Care Behavior for Acute Coronary Syndrome Questionnaire, the Veterans Specific Activity Questionnaire, and the Rehospitalization Record Form. Data analysis was performed using descriptive statistics, Chi-square test, Fisher's exact test, and two-way repeated measures analysis of variance. Results revealed that the experimental group had significantly improved self-care behavior and functional ability immediately and four weeks after program completion (week 8), compared to the comparison group. There was no difference in rehospitalization between the two groups. Nurses with advanced skills in motivational training can use this program to promote effective self-care practices, improve functional ability, and reduce rehospitalization. Further study using randomized controlled trials and other settings is needed before it can be widely used. [ABSTRACT FROM AUTHOR]

Background/Objectives: Regular follow-up treatment is important for the management of diabetes and to reduce the risk of complications. In this study, we aimed to evaluate the proportion of adult diabetic patients who miss appointments, in addition to the potential correlation between personal characteristics, personality, and the context of family structure and characteristics and missed appointments by adult patients with type 2 diabetes. Methods: This study was a cross-sectional descriptive study. The data were gathered through self-administered questionnaires and the patient medical records of 106 individuals who received healthcare services at the Khon Kaen Province primary care unit. Data were gathered from 1 November 2023 to 28 December 2023. Adjusted odds ratios (aORs) and Chi-Square statistics were used to evaluate the relationships with multivariate analyses via multinomial logistic regression and the Kruskal–Wallis test. Results: The majority of patients in the sample, 39.62%, regularly missed appointments. There was a significant association between occasionally missed appointments and middle adulthood (p-value 0.013) and regular exercise (p-value 0.025). A moderate level of the agreeableness personality trait showed a significant association with missed appointments (p-value 0.042). Conclusions: It is important to have a comprehensive understanding of the patient's personality and family characteristics to effectively plan their healthcare and provide optimal support for diabetes treatment. [ABSTRACT FROM AUTHOR]

Background/Objectives: The current study compared Self-Figure drawings from Thai and Indian adolescents to assess the cross-cultural applicability of a child abuse assessment tool. The research aims to understand the extent to which distinctions or similarities arise in Self-Figure drawings among adolescents from two culturally similar yet distinct backgrounds characterized by differences in religious affiliations, socioeconomic contexts, and political environments. Methods: Employing a mixed-methods approach, the study utilized quantitative measures, including the Traumatic Events Checklist (TEQ-5) and Medical Somatic Dissociation Questionnaire (MSDQ), alongside a qualitative analysis of Self-Figure drawings. Ethical approval was obtained with waived informed consent, and a convenience sample of 386 adolescents aged 13–18 years (193 from Thailand [M = 14.8, SD = 1.73; 135 females (69.9%) and 58 males (30.1%)], and 193 from India [M = 15.2, SD = 1.64; 135 females (69.9%) and 58 males (30.1%)]), who reported experiencing child abuse, participated in the study by completing questionnaires and drawing themselves. Results: The analysis revealed that Thai adolescents had higher MSDQ scores, while Indian adolescents exhibited more prominent pictorial indicators. Indian participants reported experiencing a broader range of event types, whereas Thai adolescents predominantly depicted verbal or emotional abuse. Variations in pictorial indicators were found significant, except for hair, cheek or chin, omitted legs or feet, and omitted eyes. Conclusions: These findings contribute to the understanding of how cultural factors influence adolescents' self-representations through drawing. The differences in pictorial indicators highlight the nuanced variations within similar cultures, emphasizing the cultural specificity of self-expression. [ABSTRACT FROM AUTHOR]

A quality relationship between caregiver and care-receiver is an essential issue since it not only motivates the family to take on a caregiving role but also impacts all caregiving processes. Before this study there was no Thai instrument that measured this concept. This study aimed to develop the Thai Quality Relationship Scale for Family Caregivers of People with Cancer and test its psychometric properties. This paper focuses on the testing of the scale. The conceptual model and content domains were derived from a comprehensive literature review and semi-structured interviews. The instrument was verified for content validity by three experts and examined for clarity by 15 family caregivers. The construct validity of the revised scale was tested by exploratory factor analysis with 220 family caregivers of persons with cancer from the central part of Thailand. Results revealed that the scale was composed of four factors and accounted for 54% of variances, including feeling of love, concern about disease and treatment, sympathy for suffering, and concern with daily activities. The Cronbach's alpha coefficient of the total items was 0.87, and each factor was in an acceptable range. This instrument has good construct validity and reliability and would help measure quality relationships for family caregivers of people with cancer in Thailand. Future research is needed to confirm its adequate validity and reliability in other groups of family caregivers. Nurses can use this tool and the newly proposed conceptual structure of quality relationships to assess, design, and test nursing intervention to support family caregivers to continue providing good care for their care-receivers. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disorder common in children. Successful pediatric AD therapy requires parental assistance. Thus, evaluating parental knowledge, attitudes, and behaviors regarding childhood AD may lead to more educational recommendations to help children control AD in the future. This study examined parents' knowledge, attitudes, and conduct concerning AD in families with and without children with AD. Method: The Pediatric Department, Faculty of Medicine, Khon Kaen University, Thailand, conducted a cross-sectional study from June to December 2023. Parents of children who visited the dermatology clinic with or without AD were asked to complete a Google form questionnaire. Results: A total of 372 parents answered a questionnaire about AD pathophysiology, knowledge, attitudes, and practices. The participants were 293 (78.8%) female participants and 79 (21.2%) male participants. The average age was 29.79 (SD 4.91). Most parents (319, 85.8%) did not work in the medical field, and more than half (228 instances, 61.29%) had children diagnosed with AD. Conclusions: Parents of children with AD understood AD causes and triggers better than parents of children without AD. But, "exposure to furry toys" that may contain dust and allergies and "infection" that may cause AD flare-ups were the most common triggers, regardless of the group. Appropriate information should be supplied because both the parents of children with AD and those of children without AD reported immediate food avoidance without confirmatory testing, which might lead to malnutrition. Clinicians and families handling patients with AD require further education. [ABSTRACT FROM AUTHOR]

Background: While there is research on protective factors against smartphone addiction (SA) and phubbing, which impact adolescents' physical, psychological, interpersonal, and academic well-being, focused studies on these issues among Thai Muslim students in Southern Thailand remain scarce. Objectives: To bridge this gap, this research aimed to explore the influence of five family functioning factors—discipline, communication and problem-solving (CPS), relationship, emotional status, and family support—guided by family systems theory and the McMaster Model, on SA and phubbing. Methods: Data from 825 Thai Muslim adolescent secondary school students (Female N = 459 (55.7%), Mage = 15.11 ± 1.78) across three southern Thai provinces were analyzed utilizing structural equation modeling (SEM). Results: Significant connections were identified between family functioning factors, particularly emotional status and discipline, and SA, and their impact on phubbing behavior. SA was found to mediate the relationship between these two family factors and phubbing. Interestingly, a higher quality of family relationships was found to be associated with an increased risk of SA, while the other two family functions—CPS and family support—demonstrated no significant association with these digital behaviors. Conclusions: Despite its limitations, including a cross-sectional design and reliance on self-reports, the study underscores the importance of specific family functions in preventing and addressing adolescent SA and phubbing. [ABSTRACT FROM AUTHOR]

Background: Palliative care lower medical expenses and enhances quality of life, but misconception with euthanasia delays timely care and makes inappropriate patient management. Objective: To examine the magnitude of misconceptions between palliative care and euthanasia among Thai general practitioners, explore the association with knowledge, attitudes, and practical experience, and assess the association between misconception and confidence in practicing and referring patients to palliative care centers. Methods: All 144 general practitioners who were going to start residency training at Maharaj Nakorn Chiang Mai Hospital in 2021 participated in this observational cross-sectional study. A chi-square test was utilized to examine the relationship between misconception and knowledge, attitude, practical experience, confidence to practice, and confidence to refer patients. Multivariable logistic regression was carried out while controlling for age, sex, knowledge, attitude, and experience to examine the relationship between misconception and confidence to practice and refer patients for palliative care. Statistical significance was defined at p < 0.05. Results: About 41% of general physicians had misconceptions regarding palliative care and euthanasia. High knowledge was associated with a lower level of misconception (p = 0.01). The absence of misconceptions was weakly associated with a higher level of confidence in practicing palliative care, with an adjusted odds ratio of 1.51 (95% confidence interval 0.73 to 3.10, p = 0.07). Conclusion: High misconception rates between palliative care and euthanasia among young Thai physicians might impact their confidence in delivering palliative care. Training initiatives for medical students and practitioners can mitigate misconceptions, fostering better palliative care utilization in Thailand. [ABSTRACT FROM AUTHOR]

INTRODUCTION Smoking inside the home affects the health of both the smoker and family members via secondhand exposure. This research examined the impact of a community participation program on creating smoke-free homes in a suburban community in Thanyaburi district, Pathumthani province in Thailand. METHODS The study involved families, with a smoker in the home, that were randomly assigned to intervention and control groups each containing 27 families. The intervention group was administered with the community participation program for smoke-free homes for 5 sessions during the 6-month period of study. The program included providing information on secondhand smoking and harms, knowledge about quitting smoking and healthcare support, practice skills, campaigns in the community, visiting and encouraging, and reflecting and evaluation. The control group was normally treated by the community committee and health volunteers. Data collection was undertaken at baseline and at 6 months after implementation by an interview with questionnaires. RESULTS Our results show that after the implementation, the intervention group reported significantly higher mean score on skills in negotiating with smokers for a smoking-ban inside home and mean score on emotional support for nonsmoking inside the home than those at baseline and those of the control group. The proportion having smoking ban home rules in the intervention group was significantly higher than at baseline and that of the control group (92.6% vs 18.5%). The proportion of smoke-free homes was higher in the intervention than in the control group (75% vs 0%). CONCLUSIONS These findings suggest that community participation programs for smoke-free home may be effective in raising awareness on the impact of secondhand smoke among family members and in working together to manage smoke-free home environments. The program may be applicable for further development within communities to achieve smoke-free homes. [ABSTRACT FROM AUTHOR]

Background Recruitment and retention of health workers is a major concern. Policy initiatives emphasize financial incentives, despite mixed evidence of their effectiveness. Qualitative studies suggest that nurses especially may be more driven by altruistic motivations, but quantitative research has overlooked such values. This paper adds to the literature through characterizing the nature and determinants of nurses’ altruism, based on a cross-country quantitative study. Methods An experimental ‘dictator game’ was undertaken with 1064 final year nursing students in Kenya, South Africa and Thailand between April 2007 and July 2008. This presents participants with a real financial endowment to split between themselves and another student, a patient or a poor person. Giving a greater share of this financial endowment to the other person is interpreted as reflecting greater altruism. Results Nursing students gave over 30% of their initial endowment to others (compared with 10% in similar experiments undertaken in other samples). Respondents in all three countries showed greater generosity to patients and the poor than to fellow students. Conclusions Consideration needs to be given to how to appeal to altruistic values as an alternative strategy to encourage nurses to enter the profession and remain, such as designing recruitment strategies to increase recruitment of altruistic individuals who are more likely to remain in the profession. [ABSTRACT FROM PUBLISHER]

Since the outbreak of COVID-19, as reported by the WHO in December 2019 and subsequently declared a public health emergency of international concern, a distinct set of risk factors and vulnerabilities faced by migrants are affecting their exposure to the pandemic and its associated outcomes. This study aims to analyze the social determinants of health among migrants and their associated factors and compare the socio-demographic characteristics, patterns of COVID-19, and healthcare attendance and utilization among migrant workers and non-migrants. A descriptive study design was used to analyze COVID-19 morbidity among migrant workers. There were a total of 73,762 migrants living in the province by December 2021, with varied statuses and nationalities. Most of the migrants were from Myanmar, constituting about 80.1%. A total of 24,837 COVID-19 cases in Kanchanaburi province were recorded in 2020–2021. COVID-19 cases among migrant workers accounted for 22.3% during the period under review. Half, 2914 (52.7%) of the migrant female workers were victims of COVID-19 infections. Persons under the age of 18 accounted for about one-fifth of all the COVID-19 cases. Older, over 60 years old, Thais had about twice (10.1%) the COVID-19 cases compared with the older migrants (5.5%). There was a significant increase in healthcare attendance and utilization by non-migrants and migrants during the year under review. Migrants are at high risk of COVID-19 infection. Therefore, public health guidance for the prevention of COVID-19 should prioritize safeguarding the health of migrants by considering their individual characteristics and actions. Enhancing health insurance schemes for migrants, particularly vulnerable migrant groups, is critical for inclusive and expanded healthcare access. Physical, social, and economic environments that impact the health and well-being of migrants should be integral to pandemic prevention, preparedness, response, and recovery. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to examine the relationship between personal factors, smoke exposure at home, and respiratory problems in early childhood in Nakhon Si Thammarat Province, Thailand.Samples and Methods: This study was retrospective. There was a total of 414 samples in the study. The instruments included the questionnaire about the personal data of early childhood and their caregivers, the smoke exposure assessment form, and the early childhood respiratory problem assessment form. The relationship between personal factors, smoke exposure at home, and respiratory problems in early childhood was analyzed by the Chi-squared test and binary logistic regression.Results: The results revealed that smoke exposure at home in early childhood was moderate (52.2%). There 68.8% had respiratory problems. The relationship between birth weight, and smoke exposure at home in early childhood was found to be significantly related to respiratory problems (X2 =5.014 p< 0.05 and X2 = 85.711 p< 0.001, respectively). It was found that children with a birth weight ≤ 2500g had respiratory problems at 2.55 times of the samples with birth weight > 2500g (AOR = 2.55, 95% CI: 1.10– 5.96), and moderate-high smoke exposure had respiratory problems at 8.86 times of the samples with low smoke exposure (AOR = 8.86, 95% CI: 5.39– 14.60). Nutritional status and breastfeeding were not significantly related to respiratory problems in early childhood p > 0.05.Conclusion: The birth weight and smoke exposure at home factors were found to be related to their respiratory problems in early childhood. Thus, it is necessary to reduce stimuli, especially smoking at home. Moreover, the standard birth weight of their early childhood will reduce the rate of respiratory problems. [ABSTRACT FROM AUTHOR]

Background: Infertility can affect a couple's mental health and marital and social relationships. The study aimed to investigate the prevalence of depression among infertile couples and their relationships with other factors. Methods: This study employed a cross-sectional survey. Validated tools were used to assess anxiety and depression, marital satisfaction, personality traits and sufficiency economy. The actor–partner interdependence model (APIM) was used for dyadic analysis. Results: The prevalence of depression in infertile couples was 6.7%. Aggression, extraversion and neuroticism were significantly correlated with depression, whereas the expectation of having children, marital satisfaction and sufficiency economy were negatively correlated with depression. The APIM model suggested that neuroticism and marital satisfaction were significant predictors of depression. Partner effect between the expectation of having children and depression was observed (p = 0.039). Conclusions: Like other populations, depression in infertile couples seems to be associated with aggression, extraversion and neuroticism. However, there are specific variables related to infertility that impact the depression levels of these couples. For instance, the expectation of having children can affect the partners of infertile couples, while the role of the sufficiency economy is a new factor that has been examined for depression in this sample and requires further exploration. [ABSTRACT FROM AUTHOR]

Patients with critical illnesses and on intubation cannot express their needs through verbal language. Thus, nurses and other healthcare professionals might not meet their needs, resulting in frustration and more stress for nurses and patients. This situation may interfere with patients' recovery. In this quasi-experiment study, we developed and tested the effectiveness of the Needs Communicative Digital Technology Program. Sixty participants who were critically ill and intubated were recruited from an intensive care unit of a secondary care hospital in a province close to Bangkok, Thailand. They were alternately assigned weekly to the experimental (n = 30) and control groups (n = 30). The experimental group received the program for 48 hours, including the usual care in the intensive care unit. The control group received only usual care in the intensive care unit. Questionnaires for data collection were a demographic data form, the Met Needs Questionnaire, and the Effectiveness of Communication Questionnaire. Data were analyzed using descriptive statistics, a chi-squared test, a Fisher exact test, a t-test, and ANCOVA. Findings revealed that after 48 hours of program implementation, the experimental group had significantly higher mean scores on met needs and effective communication than before starting the program and higher than that of the control group. Thus, it can be concluded that this program effectively met the needs of intubated people with critical illnesses with advanced technology and communication strategies that can be used easily, conveniently, and quickly. Nurses can use this program in practice and further evaluate its effectiveness before widespread use in the country. [ABSTRACT FROM AUTHOR]

Objective: To identify physicians' views on the barriers to measuring cervical length for preventing preterm deliveries. Materials and methods: This prospective, descriptive implementation study had three phases. In Phase I, 20 physicians were interviewed. Phase II comprised questionnaire development and data validation. The questionnaire was distributed to 120 Phase III participants. Results and discussion: All 120 participants responded. In 44 cases, the physicians received support from their local Maternal and Child Health Boards for preterm-birth-prevention programs; the other 76 physicians did not. The doctors tended to believe that cervical length screening plays no role in preventing preterm births (4/44 (9.1%) and 24/76 (31.6%); OR, 4.615; 95% CI, 1.482–14.373; p = 0.005). They were unsure about the correct measurement procedures (13/44 (29.5%) and 37/76 (48.7%); OR, 2.262; 95% CI, 1.028–4.977; p = 0.040). A lack of cost-free drug support (progesterone) for women with short cervices was identified as a barrier to preventing preterm births (30/44 (68.2%) and 32/76 (42.1%); OR, 0.339; 95% CI, 0.155–0.741; p = 0.006). Conclusions: Many physicians are unconvinced that measuring cervical length prevents premature births, and are unsure about the correct measurement procedures. There is a lack of government funding for hormone-usage programs. [ABSTRACT FROM AUTHOR]

Background: The body of evidence on surgical intensive care unit (SICU) mortality and its predictors is still being determined. This study analyzed the significant predicting factors for mortality in SICU patients. Materials and Methods: The medical records of patients in SICUs at Her Royal Highness Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, from June 2020 to July 2021, were retrospectively reviewed. Patients were excluded if transferred from other hospitals and not undergoing orthopedics, otolaryngology, obstetrics, and gynecology surgeries. Results: A total of 276 patients admitted to SICUs were included in this analysis, and 60.5% were men. The mean age was 60.07 ± 17.19 years. The average length of SICU stay was 8.1 ± 10.79 days, and the mortality rate was 23.6%. By univariate analysis, significant predictive factors for mortality rate in SICU patients were acute physiology and chronic health evaluation II (APACHE II) (p < 0.001), Glasgow coma scale (GCS) = 8 (p < 0.001), sequential organ failure assessment (SOFA) score (p < 0.001), serum albumin < 2.5 (p = 0.013), and sepsis or septic shock (p < 0.001). From receiver operating characteristics (ROC) curve analysis to predict mortality, the best cut-off point of APACHE II and SOFA scores were 15.5 and 5.5, respectively. The multivariate logistic regression analysis significantly identified APACHE II > 15, GCS = 8 and SOFA score > 5 as significant predictive factors associated with the mortality rate in SICU patients. Conclusions: APACHE II > 15, GCS = 8, and SOFA score > 5 are predictive mortality factors in SICU patients. Patients with these factors should be given priority for admission to the SICU when there is a discrepancy between the demand and the supply for SICU beds. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Dysphagia is a widespread clinical condition among older adults. Although known as a risk factor for nutritional status and dehydration, dysphagia also affects meal patterns. This study aimed to determine the relationship between dysphagia and undernutrition, as well as dietary consumption patterns in older adults. Methods: 268 older adults (144 women, 124 men) were included in the study. Mini Nutritional Assessment (MNA), dysphagia assessment (EAT-10), oral examination, and Semi-quantitative Food Frequency Questionnaire (SFFQ) were used for collecting data. Odds ratio and Chi square were used to compare independent variables in subjects with and without undernutrition as well as those who intake texture modified and non-texture modified diet. Results: Mean age of the undernutrition and normal nutrition groups was 68.9 ± 6.1 and 68.8 ± 6.0 years, respectively. The undernutrition group's activities of daily living (ADL) were 19.7 ± 0.9, and the normal nutrition group was 19.8 ± 0.7. Older adults with dysphagia were 4.8 times more likely to experience undernutrition than older adults without dysphagia (95% CI = 1.75-13.13, P =.002). There was a statistically difference between the meal patterns among the dysphagic older adult group and the normal-swallowing older adults' group at the.05 level. Conclusions: According to this study, dysphagia was associated with the nutritional status of older adults and dietary patterns. The study results suggested some recommendations for dental health personnel on oral care related to dietary consumption and dietary patterns in older adults. [ABSTRACT FROM AUTHOR]

Background: High-flow nasal cannula has been a promising initial respiratory support measure for patients with acute hypoxemic respiratory failure (AHRF) in the emergency department (ED). However, delayed detection of HFNC failure is associated with increased mortality. The ROX index is a tool that can help predict HFNC success. Nonetheless, its utility in ED patients is limited, and no studies have compared it with the HACOR scale, another tool that may be as accurate in predicting HFNC failure. Therefore, we aimed to compare the prognostic utility of the ROX index and the HACOR scale in emergency AHRF patients. Methods: This prospective observational study was conducted at the ED of Siriraj Hospital, Thailand, between August 2018 and February 2020. Adult patients with AHRF requiring HFNC in the ED were included. The ROX index and the HACOR scale were measured at 1, 2, and 6 h after HFNC initiation. The primary outcome was HFNC success, defined as no intolerance or escalation towards mechanical ventilation or non-invasive ventilation within 48 h. Results: A total of 75 patients were enrolled; 52 (69.3%) had a successful treatment. The ROX index was higher in the success group, while the HACOR scale was lower at all timepoints. The ROX index yielded generally higher discrimination capacity based on the area under the receiver operating characteristic curve (AUROC) than the HACOR scale [AUROC at 1, 2, and 6 h = 0.815, 0.784, 0.853 for ROX in predicting HFNC success and 0.733, 0.690, and 0.764 for HACOR in predicting HFNC failure]. The ROX index measured at 6 h at the cut-point of 4.88 had 92.98% sensitivity, 61.11% specificity, 88.33% positive predictive value, and 73.33% negative predictive value with a diagnostic accuracy of 85.33%. Conclusion: The ROX index had superior prognostic utility in predicting HFNC outcome (success/failure) compared to the HACOR scale in patients with AHRF in the ED setting. Moreover, it is less complex and more efficient to be employed at bedside. Therefore, the ROX index is a more appropriate tool to guide further management and potential escalation therapy for AHRF patients with HFNC therapy initiated in the ED. [ABSTRACT FROM AUTHOR]

Asthma control is the goal of management to prevent exacerbations and minimize the severity of asthma. To design effective interventions to control asthma, understanding of factors involved and how they work to influence asthma control is needed. This cross-sectional study aimed to develop and test a causal model of asthma control in Thai adults with asthma. A sample of 330 participants were recruited from asthma and chronic obstructive pulmonary disease clinics in four tertiary hospitals in eastern Thailand. Data were collected using a sociodemographic form; the Brief Illness Perception Questionnaire; the Hospital Anxiety and Depression Scale; Job Stress Scale; the Multidimensional Scale of Perceived Social Support; the Functional, Communicative, and Critical Health Literacy Scale; the Self-Efficacy Subscale of the Knowledge, Attitude, and Self-Efficacy Asthma Questionnaire; the Asthma Self-Management Behavior Instrument; and the Asthma Control Questionnaire. Structural Equation Modeling was used to test the asthma control model. After trimming the initial model, the final model explained 54% of the total variance in asthma control with self-management behaviors having the strongest direct effect. Health literacy, illness perception, and social support indirectly affected asthma self-management behaviors through asthma self-efficacy, then directly affected its control. Illness perception, depression, and social support indirectly affected asthma control via asthma self-management behaviors, whereas job stress directly and indirectly affected asthma control via asthma self-management behaviors. The results suggest that nurses can design an intervention to support asthma self-management behaviors by enhancing asthma self-efficacy through increasing health literacy, improving illness perception and social support, and reducing job stress and depression. This intervention should be combined with innovative technology and further tested for its effectiveness. [ABSTRACT FROM AUTHOR]

Most existing tools for measuring sensory patterns of children have been developed in Western countries. These tools are complex and may not be culturally appropriate for other contexts that require specific knowledge in the clinical perspective. The aim of this study was to develop a simplified tool called the Thai Sensory Patterns Assessment (TSPA) tool for children. It is designed for children ages 3–12 years old to be completed by their caregiver. The process of creating the tool consisted of drafting a questionnaire and interpreting the result. Partial psychometrics were completed during item development, content validity of items was assessed by five expert ratings. Construct validity and internal consistency were assessed using data from 414 caregivers and intra-rater reliability was assessed with 40 caregivers. The two parts of the TSPA tool for children results, sensory preference, and sensory arousal, were designed to be presented as a sensory pattern in a radar chart/plot. The data analysis showed that both parts of the TSPA tool for children had acceptable psychometric properties with the retained 65 items. Only proprioceptive sensory arousal had a low Cronbach's α coefficient, suggesting more information sharing between caregivers and professionals is needed. This research is an initial study and must be continuously developed. Future development of this tool in technology platforms is recommended to support use within healthcare services. [ABSTRACT FROM AUTHOR]

Job stress is an important occupational risk factor for nurses that may affect both their physical and mental health, as well as the health of their patients. The Effort-reward Imbalance Questionnaire is a popular tool that can be used to monitor job stress among nurses. However, several versions of the translated instrument demonstrated different structures of subscales than the original version, and these may affect its validity. Hence, within we report on construct validity of the Thai version of this instrument, and its association with psychological health among nurses working within a university hospital in Southern Thailand. The study design was a cross-sectional survey. The questionnaire measured job strain, using the Thai Effort-reward Imbalance Questionnaire, and psychological health, using the Thai General Health Questionnaire-28. Exploratory and confirmatory factor analysis was conducted to evaluate the construct validity. Association between job strain and psychological health was evaluated by logistic regression models. The analysis included 725 nurses. Factor analysis found that effort and reward both consisted of two subscales, which demonstrated good fit across several goodness of fit indices and acceptable reliability. The prevalence was 34.5% for high job strain, and 19.9% for poor psychological health. The modified high job strain and high overcommitment were statistically significantly associated with poor psychological health, with an odds ratio of 1.74 and 3.42, respectively. Further study should be conducted to confirm the construct of the Thai Effort-rewards Imbalance Questionnaire among nurses found in this study. Prevalence of job strain and poor psychological health was high which indicates the need for further interventions. [ABSTRACT FROM AUTHOR]

This study explored the extent to which Malaysian and Thai smokers believe "light" and menthol cigarettes are less harmful than "regular" cigarettes and the correlates of these beliefs. The study used data from wave 1 of the International Tobacco Control Southeast Asia Survey. 2006 adult smokers (95.3% male) from Malaysia and 2000 adult smokers (94.5% male) from Thailand were interviewed face to face in 2005. 29% of Malaysian respondents reported currently smoking light cigarettes and 14% menthols, with 19% agreeing that lights are less harmful and 16% agreeing that menthols are less harmful. 38% of Thai respondents reported currently smoking light cigarettes and 19% menthols, with 46% agreeing that lights are less harmful and 35% agreeing that menthols are less harmful. Malaysian smokers reporting current use of light or menthol cigarettes were more likely to believe that they are less harmful. Reported use of lights did not relate to beliefs for Thai respondents. The belief that light and/or menthol cigarettes are less harmful was strongly related to the belief that they have smoother smoke. The experience of smoother smoke is likely to produce some level of belief in reduced harm, regardless of how brands are labelled and whether or not Federal Trade Commission FTC/International Organisation for Standardisation tar, nicotine and carbon monoxide yield figures are used. [ABSTRACT FROM AUTHOR]

Organic farming is becoming popular in Southeast Asia as part of sustainable agriculture systems. This study aims to compare the opinions and attitudes towards organic farming systems by organic rice farmers (OF) and non-organic rice farmers (NOF) in Surin province, north-eastern Thailand. The comparison was drawn from opinions of OF and NOF interviewees who are engaged in jasmine rice farming. The data presented were based on information collected from 100 OF interviewees and 100 NOF interviewees. The interviews enabled us to compare their attitudes towards organic farming based on four aspects, namely: organic farming knowledge, environment, marketing, and costs and benefits. Comparisons were made not only of socio-economic indicators, but also their opinions. Chi-square and t-test were employed to quantify correlations in this study. It was found that there was a correlation of attitudes of both OF and NOF interviewees in the four aspects examined. Additionally, educational level, farm holding and extensionworker contact affected opinions and attitudes of OF interviewees. Among NOF interviewees, their farming experiences affected their attitude towards organic farming. [ABSTRACT FROM AUTHOR]

Purpose: Thailands' informal workers are faced with job insecurity and poor working conditions. Good health status can promote lifelong working and increase quality of life. This study analyzed factors associated with the health status of the community informal workers. Methods: A cross-sectional study was conducted with 390 informal workers aged 15 to 59 years in Thasala district, Nakhon Si Thammarat, southern Thailand. A multi-stage sampling method using proportional to size selection was employed in various types of informal workers. The interviews on self-reported health status, health behaviors, occupational hazards, healthcare utilization, occupational health and safety (OHS) access are reported as descriptive. The multivariate association was explored using the simple logistic regression. Findings: The results revealed that 80.77% of the participants had good health, 57.44% had healthy behavior, 76.41% had safe work practices, 22.05% had moderate to high exposed of occupational hazards, and 56.41% had the low OHS access. Safe work practices, moderate to high OHS access, low exposed to occupational hazards, and low income were more likely to produce good health status, which yielded the adj. OR 2.57, 1.86, 0.39, and 0.48, respectively. Conclusions: The community informal workers health status was associated by income, work practices, occupational hazards, and OHS access. To strengthening the informal workers' health, the OHS program should be managed intensively by the primary care services, especially the OHS risk management. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to translate and evaluate the psychometric properties of the Thai version of the Diabetes Self-Management Scale (T-DSMS). Design: A cross-sectional study. Methods: This study was performed in two phases: 1) a forward-backwards translation of the existing version of the Diabetes Self-Management Scale (DSMS); and 2) evaluation of its psychometric properties using confirmatory factor analysis. Between February to June 2016, a total of 700 type 2 diabetes mellitus (T2DM) patients were recruited from outpatient diabetes clinics of both community and university hospitals in Khon Kaen and Bangkok province Thailand, using a self-administered questionnaire. Results: The results, based on confirmatory factor analysis using Unweighted Least Squares, confirmed the construct validity of the T-DSMS (CFI = 0.985; RMSEA = 0.258; TLI = 0.981; SRMR = 0.040). The T-DSMS contains 13 items across four domains: Diet, Blood, Exercise, and Foot care. Conclusion: We translated and appropriately validated the DSMS in Thai T2DM patients. The T-DSMS was shown to have good psychometric properties, including content validity and criterion validity. The T-DSMS is an adequate instrument with which to assess diabetes self-management in Thai T2DM patients, and can provide valuable insights into the epidemiology of diabetes self-management, and enable evaluation of prevention programs for diabetes selfmanagement in T2DM patients. [ABSTRACT FROM AUTHOR]

Family caregivers undertake roles to assist survivors of stroke in all life aspects. However there are burdens for family caregivers brought on by their duties and responsibilities and difficulties related to life changes and adjusting to their new roles. In this cross-sectional, model testing study the aim was to examine factors influencing burden among family caregivers of survivors of stroke, during the first six months after stroke. A convenience sample of 200 caregivers of survivors of stroke from two hospitals in Central Thailand was recruited. Six instruments were used, including one to gather demographic data of survivors of stroke and caregivers, the Zarit Burden Interview, the Health Perception Scale, the Barthel Index, the General Perceived Self-Efficacy Scale, and the Revised Multi-dimensional Scale of Perceived Social Support. Descriptive statistics and structural equation modeling by AMOS were used to analyze data. Results found that the final model of caregiving consisted of functional status of survivors of stroke, duration of care giving, self-efficacy, and number of hours of care with total variance explained 39%. Functional status and duration of care giving had direct and indirect effects on burden. Hours of care mediated functional status and caregiver burden, whereas self-efficacy mediated both functional status and duration of care giving and caregiver burden. Assessment for family caregiver burden prior to patient hospital discharge is essential. Nurses might consider innovative approaches to care, such as partnering with multidisciplinary team to develop online / mobile apps that families may access for current evidence in caregiving, practical tips for reducing burden, and enhancing self-efficacy through virtual support groups. [ABSTRACT FROM AUTHOR]

Background: Treating hypertensive patients by integrating the patient-centered approach would influence the practice and outcome of treatment. Our purpose was to determine whether the implementation of a patient-centered approach in health care delivery can improve adhering to guidelines and the quality-of-care. Methods: A retrospective study was conducted using secondary data from the electronic medical records of the patients treated in the two primary care outpatient settings at the Family Medicine (FM) and Social Security (SS) clinics. A key feature of the FM clinic is the incorporation of a patient-centered approach in its service delivery. Individual information regarding initial assessment and treatment at the follow-up visits was reviewed for 1 year. Comparison of adherence to treatment guidelines between the two primary care clinics was performed by using chi-square, Fisher's exact test or a t-test. To explore the difference in blood pressure and BP control between the two clinics, linear and logistic regression analysis respectively were performed with an adjustment for CV risk score in 2016 as a key confounder. Results: The evidence included 100 records from each clinic, showed variation between the two primary care sites. The FM clinic had more complete records regarding family history of hypertension, assessment for secondary causes, prescription for lifestyle modification and appropriate adjustment of medication. Higher levels of blood pressure control were recorded in the FM clinic, specifically systolic pressure 2.92 mmHg (p = 0.073) and diastolic pressure 5.38 mmHg (p < 0.001) lower than those recorded in the SS clinic. There was a 2.96 times higher chance for BP goals to be achieved in patients in receipt of hypertensive care at the FM clinic (p = 0.004). Conclusions: Adopting a patient-centered approach in service delivery could improve the quality of care for hypertension patients in primary care in Thailand. [ABSTRACT FROM AUTHOR]

Adaptive sports participation has been found to benefit participants physically, emotionally, cognitively, and psychologically. These sports may also serve as a vehicle to combat society's negative attitudes toward individuals with disabilities. To further explore this possibility, the purpose of the present study was to examine the impact of an international adaptive sport training on Thai college student and professor attitudes toward individuals with physical disabilities. Twenty-one participants completed the Multidimensional Attitudes Scale toward Persons with Disabilities (MAS). A series of one-way RM ANOVAs and descriptive statistics were utilized to compare participant scores across time. Findings indicated that there were no significant changes in attitudes as measured by the MAS. Measurement and program design issues are considered. More work is needed to develop an appropriate tool to evaluate changing attitudes. Implications for research and recreational therapy practice are discussed. [ABSTRACT FROM AUTHOR]

Nurses are a cornerstone in providing care for people at primary care units, so the evaluation of the nurses' work performance is important to improve service quality. Nurses' performance has been assessed in many counties, including the United States of America, Canada, England, New Zealand, South Africa, and South Korea. Currently, there is a scarcity of tools for assessing all aspects of the work performance of nurses in Thai primary care units, so we undertook this study to develop and test the work performance scale of nurses. The study design was instrument development and psychometric testing. Qualitative methods using focus group discussions and expert reviews were applied for the items' construction. Quantitatively we examined the psychometric properties of this scale with 662 nurses working at primary care units in Thailand. Only the quantitative data and results are presented here. Exploratory factor analysis revealed 71 items comprising ten factors: Basic treatment for common health problems and continuing care, School health care, Self-development, Research and innovation, Women and child care, Health resource management, Planning and budget management, Standard of care and assurance, Health data management, Disease prevention and environmental health care, and Disaster management. The Cronbach's alpha coefficient of the total 71 items and for each domain are in acceptable ranges. The Work Performance Scale for Nurses at Primary Care Units achieved good validity and reliability scores and can be used to evaluate the work performance of nurse to improve their practices. However, it requires further confirmatory testing with nurses in Thailand at a range of primary care units. [ABSTRACT FROM AUTHOR]

Few studies have addressed health-related quality of life and smoking cessation although known improvements can encourage smokers to quit. This cross-sectional study examined smoking quit rates and health-related quality of life among smokers receiving cessation services in ten Quit Clinic Hospitals throughout Thailand. A random sample of 715 smokers participated in the study. Data were collected from medical records and via telephone interviews from March to July 2015. Research instruments included demographic questions, a smoking screening form, the Quit Smoking Questionnaire; and the EuroQol-5 Dimensions 5 Levels Questionnaire (Thai version). Data were analyzed using descriptive statistics, Chi-square, and independent sample t-test. Most participants (97.1%) were male and between 25 and 64 years of age. Most had heaviness of smoking index scores less than four, indicating low nicotine dependence. The self-reported continuous abstinence rate at 6-months was 40.5%. The participants who stopped smoking by 6 months had higher average scores on the health-related quality of life than those who continued to smoke. As nurses are recognized as influential persons in the health care team, they can implement tobacco cessation interventions through a variety of strategies, such as providing brief advice, and referring for advanced treatment. Likewise, nurses need to consider assessing health-related quality of life of smokers and use such information to advocate smokers to quit. [ABSTRACT FROM AUTHOR]

Lack of exercise related to poor self-management can lead to a low level of physical fitness in people with prehypertension and obesity. Self-management has the potential to enhance exercise performance with moving people from the beginning of behavior change to action and maintenance behavior. This study investigated the effect of the Self-Management Exercise Program on physical fitness in persons with prehypertension and obesity developed by primary investigator. A total of 32 participants were randomly assigned to two groups: the experimental group (n=16) receiving the Self-Management Exercise Program and the control group (n=16) receiving conventional care. Physical fitness was evaluated by the 3-minute step test, 60 second chair stand, and sit and reach test at baseline and 12-week. Data analyzed using descriptive statistics, Chi-square test, Independent t-test, and Paired t-test. The results demonstrated that the experimental group had significantly higher physical fitness compared to before the program; and significantly higher than those compared to the control group. The Self-Management Exercise Program is effective and improves physical fitness in people with prehypertension and obesity including cardiorespiratory fitness, muscular endurance, and flexibility. Nurses can apply the program to enhance physical fitness in this population by increasing exercise behavior through self-management skills. Further study is needed to confirm whether the physical fitness increases over an extended time using the program. [ABSTRACT FROM AUTHOR]

Stroke is a major cause of disability and death. However, there needs to be wider community knowledge of stroke and its severity and symptoms that require prompt treatment as a vital management of stroke risks. This study aimed to identify the level of knowledge of strokes and awareness of stroke severity and its impacts, and to explore the correlation between knowledge and awareness of stroke impacts on older people with stroke risk, on those without stroke risk, and on the younger family members living with older people. This cross-sectional descriptive study was conducted in two sub-districts in Chiang Mai Province, Thailand among 233 and 189 elders with and without stroke risk, and 202 family members. They were purposively selected to complete the Personal Demographic Questionnaire, the Stroke Knowledge and Sources of Knowledge Questionnaire, and the Stroke Awareness Questionnaire. Results revealed that stroke knowledge and awareness of its impacts were high in all three groups and their mean scores were significantly different. The association between knowledge and awareness was statistically significant in older people with stroke risk, those without stroke risk, and the younger family members. Although the stroke knowledge and awareness of these populations were high, the maintenance of stroke knowledge and awareness of stroke severity is required. The provision of the first aid programs that incorporate stroke management and awareness is warranted at the community level as well, and nurses can be involved in such education and health promotion. [ABSTRACT FROM AUTHOR]

Medication adherence is crucial to achieving diabetic control. This quasi-experimental two-group pre-/post-test design aimed to evaluate the effects of a medication education intervention integrated in routine services of a diabetes clinic. People with uncontrolled type 2 diabetes treated by oral medication and history of non-adherence to medication were assigned to an intervention group (n=39) and a comparison group (n=37). The intervention group received medication education intervention four times consisting of a short individual education session provided by the physician and group counseling session provided by a nurse in a diabetes clinic at weeks 1 and 3, then individual follow-up telephone counseling by a nurse at weeks 6 and 9. The comparison group received patient education as routine service. Outcome variables including knowledge of medication use, beliefs and adherence, and blood glucose level were assessed at weeks 1 and 12, using an interview questionnaire and laboratory test of HbA1c values. The results showed the intervention group had significantly better mean changes of knowledge of medication use, medication beliefs and medication adherence, than the comparison group. In addition, HbA1c in the intervention group decreased more significantly than the comparison group. The findings imply a success of the integrated medication education intervention. Nurses within healthcare teams can initiate this education intervention in routine services of diabetes clinics. However, further testing of the intervention with other populations is required to substantiate its effects. [ABSTRACT FROM AUTHOR]

Depression is a mental health problem worldwide, often a co-occurring condition with disabilities and contributes to a low quality of life and suicide. Older women are more likely to experience depression than older men and need specific interventions to reduce their depressive symptoms. This randomized controlled trial examined the effect of a group administered cognitive behavior therapy program for reducing depressive symptoms among older women. Sixty Thai older women living in the community, who met the inclusion criteria and presented at primary care units in Northern Thailand, were randomly assigned into either a group undertaking a cognitive behavior therapy program (n=30) or a usual care control condition (n=30). Depression was measured using the Patient Health Questionnaire-9, Thai version at baseline, immediately after the time needed to complete The Thai Group CBT Intervention Program, and then at 1 and 3 months follow-up. Repeated measures analysis of variance (ANOVA) and independent sample t-test were used to test the program efficacy. Results indicated that the mean depression scores in the CBT condition at every point were significantly lower than at baseline and also statistically lower than those of the usual care condition after completing the program. Thus, The Thai Group CBT Intervention Program was found to be efficacious in reducing depression. Nurses should consider integrating this intervention for older persons with depression into primary care; however, further study is needed to demonstrate the durability of the depression reduction effects. [ABSTRACT FROM AUTHOR]

Background: Musculoskeletal disorders (MSDs) are a major public health problem among registered nurses (RNs) in Thailand. Information on their burdens at a national level is limited. This study estimated the prevalence of MSDs among RNs using the 2009 Thai Nurse Cohort, a nationally representative sample of RNs in Thailand. Methods: This study is part of the first wave survey of the Thai Nurse Cohort Study (TNCS) conducted in 2009. Members of the cohort consisted of 18,756 RNs across Thailand. A 13-page self-administered questionnaire was sent to participants where MSDs were measured by self-reported answers to questions related to experiencing MSDs during a previous year. However, 1070 RNs were excluded from this study since they were unemployed during a previous year, therefore the final sample size was 17,686 RNs. A 12-month prevalence of MSDs and its 95% confidence interval (95% CI) were estimated based on normal approximation to binomial distribution. Chi-square test for trend was used. Results: Of the 17,686 RNs, 47.8% (95% CI: 47.0-48.5) reported having MSDs during the previous 12 months. The prevalence of MSDs significantly increased with age, body mass index, and working duration (all P < 0.001). Compared to the non-MSD group, RNs with MSDs had a higher proportion who perceived MSDs as a long-term, chronic medical condition (78.1% vs 20.7%; p < 0.001), being currently on medication (49.4% vs 14.7%; p < 0.001), using pain relief medication almost every day (9.0% vs 1.9%; p < 0.001), experiencing sickness absence (15.7% vs 1. 1%; p < 0.001), seeking medical specialist consultations (odds ratio, OR 2.2; 95% CI: 2.0-2.3; p < 0.001), and seeking alternative medications (OR 2.5; 95% CI: 2.3-2.7; p < 0.001). Conclusions: Musculoskeletal disorders affected almost half of the RNs in Thailand annually. They placed a major healthcare burden and were a major cause of working days lost due to sick leaves, diminished productivity and quality of patient care. More attention should be paid to the prevention and effective management of MSDs in RNs in Thailand. Further study on ergonomics related to MSDs and its prevention are needed. [ABSTRACT FROM AUTHOR]

Background: Lack of data in marginalized populations on knowledge, attitudes and practices (KAP) hampers efforts to improve modern contraceptive practice. A mixed methods study to better understand family planning KAP amongst refugee and migrant women on the Thailand-Myanmar border was conducted as part of an ongoing effort to improve reproductive health, particularly maternal mortality, through Shoklo Malaria Research Unit (SMRU) antenatal and birthing services. Methods: Cross-sectional surveys and focus group discussions (FGDs) in currently pregnant women; and in-depth interviews (IDIs) in selected post-partum women with three children or more; were conducted. Quantitative data were described with medians and proportions and compared using standard statistical tests. Risk factors associated with high parity (>3) were identified using logistic regression analysis. Qualitative data were coded and grouped and discussed using identified themes. Results: In January-March 2015, 978 women participated in cross-sectional studies, 120 in FGD and 21 in IDI. Major positive findings were: > 90 % of women knew about contraceptives for birth spacing, >60 % of women in the FGD and IDI reported use of family planning (FP) in the past and nearly all women knew where they could obtain FP supplies. Major gaps identified included: low uptake of long acting contraception (LAC), lack of awareness of emergency contraception (>90 % of women), unreliable estimates of when child bearing years end, and misconceptions surrounding female sterilization. Three was identified as the ideal number of children in the cross-sectional survey but less than half of the women with this parity or higher in the IDI actually adopted LAC leaving them at risk for unintended pregnancy. Discussing basic female anatomy using a simple diagram was well received in FGD and IDIs. LAC uptake has increased particularly the IUD from 2013-2015. Conclusion: Definitive contextual issues were identified during this study and a significant range of action points have been implemented in FP services at SMRU as a result, particularly in regard to the IUD. The importance of the role and attitudes of husbands were acknowledged by women and studies to investigate male perspectives in future may enhance FP practice in this area. [ABSTRACT FROM AUTHOR]

Study design:A cross-sectional study.Objectives:To study prevalence of pressure ulcers (PrUs), quality of life (QoL) and effect of wheelchair cushions used by Thai wheelchair users with chronic spinal cord injury (SCI).Setting:Maharaj Hospital, Chiang Mai, Thailand.Methods:Thai chronic SCI wheelchair users, aged over 18 years and non-ambulatory with ASIA impairment scale A, B or C were recruited. They completed the PrUs questionnaire and rated the EuroQoL-5D and their health status with a visual analog scale (VAS). Demographic data of each participant were extracted from medical records. The EQ-5D health states were transformed to utility scores by using the Thai algorithm and the prevalence of PrUs was reported. The EQ-5D, the utility scores and the health status VAS were compared between those with and without current PrUs and between those participants using foam and air-filled cushions.Results:Of 129 participants, 26.4% had current PrUs at the time of the study, 27.9% had healed PrUs and 45.7% never had PrUs. The median VAS score for health status was 70 (Q1=50, Q3=80). Based on the EQ-5D, only one dimension (anxiety/depression) was significantly different between those with and those without current PrUs (P=0.015). Those using an air-filled cushions had a mean utility score four times higher than of those using a foam cushion (0.131 vs 0.032, P=0.089) but not statistically significant.Conclusions:PrUs are still prevalent among Thai wheelchair users with chronic SCI. Anxiety/depression is associated with current ulcers. [ABSTRACT FROM AUTHOR]

Background Currently, there is an increased prevalence of diabetes mellitus among the elderly. To minimize adverse effects on glycemic control, prevention and management of general and oral complications in diabetic patients is essential. The purpose of the present study is to assess the effectiveness of a Lifestyle Change plus Dental Care (LCDC) program to improve glycemic and periodontal status in the elderly with type 2 diabetes. Methods A quasi-experimental study was conducted in Health Centers 54 (intervention) and 59 (control) from October 2013 to January 2014. 66 diabetic patients per health center were included. At baseline, the intervention group attended a 20 minute lifestyle and oral health education program, individual lifestyle counseling using motivational interviewing (MI), application of self regulation manual, and individual oral hygiene instruction. The intervention group received booster education every visit by viewing a 15 minute educational video. The control group received a routine program. Participants were assessed at baseline and 3 month follow up for glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), body mass index (BMI), periodontal status, knowledge, attitude and practice of oral health and diabetes mellitus. Data were analyzed by using descriptive statistic, Chi-square test, Fisher's exact test, t-test, and multiple linear regression. Results After the 3 month follow up, a multiple linear regression analysis showed that the intervention group was significantly negatively correlated in both glycemic and periodontal status. Participants in the intervention group had significantly lower glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), plaque index score, gingival index score, pocket depth, clinical attachment level (CAL), and percentage of bleeding on probing (BOP) when compared to the control group. Conclusions The combination of lifestyle change and dental care in one program improved both glycemic and periodontal status in the elderly with type 2 diabetes. [ABSTRACT FROM AUTHOR]

Study design:A cross-sectional study.Objectives:To primarily explore types of ambulatory assistive device (AAD) used and secondarily describe walking performance in independent ambulatory patients with spinal cord injury (SCI) who walked without and with various AADs as determined using walking speed and distance walked in 6 min.Setting:A tertiary rehabilitation center and community hospitals, Thailand.Methods:The data of 195 independent ambulatory patients with SCI were used to describe the use of an AAD. Among these, only 140 subjects were assessed for their walking speed and distance walked in 6 min.Results:More than half of the subjects (64%) walked with an AAD in which most of them used a standard walker (45%), followed by a single-tip cane (11%) and bilateral crutches (8%), respectively. The walking speed and distance showed significant differences among the groups (P<0.001), except those who used walker versus crutches, and those who used crutches versus cane (P>0.05). Among the significant variables, types of AAD used had the greatest influence on walking speed and distance of the subjects.Conclusion:More than half of ambulatory subjects with SCI walked with an AAD in which most of them used a standard walker. However, the non-significant differences of walking performance between the groups may suggest the heterogeneity of walking ability in subjects who used the same type of AAD. Therefore, a method to facilitate the use of an AAD with less supportive ability would increase levels of independence for the patients. [ABSTRACT FROM AUTHOR]

Background Illicit cigarette consumption has increased worldwide. It is important to understand this problem thoroughly. Objectives To investigate behaviours and factors associated with illicit cigarette consumption in southern Thailand. Design A survey and qualitative study were conducted in a border province in southern Thailand next to Malaysia. A modified snowballing technique was used to recruit 300 illicit and 150 non-illicit cigarette smokers. A questionnaire was used to interview subjects. Illicit cigarette packs were obtained in order to identify their characteristics. Bivariate and multivariate logistic regression was used for data analysis. Results Smoking of illicit cigarettes has become accepted in the communities. They were available in supermarkets and vendor shops. Friends and other illicit smokers known by illicit cigarette smokers were an important source of information for access to illicit cigarette products. The main factors associated with smoking illicit cigarettes, compared with smoking non-illicit cigarettes, were younger age, higher education and higher average monthly expenditure on cigarettes (most illicit smokers smoked illicit cigarettes (average price per packet ¼ 33 THB (US$1.1), while most non-illicit smokers smoked hand-rolled cigarettes (average price per packet ¼ 7 THB (US$0.2)) and knowledge of other illicit cigarette smokers. The low price of illicit cigarettes was the main reason for their use. Selling strategies included sale of singles, sale in shops and direct sale through social networking. Conclusions Illicit cigarette consumption has become more acceptable especially among young adult smokers. Age and extent of social networks are important factors associated with smoking illicit cigarettes. [ABSTRACT FROM AUTHOR]