Search

Abstract Background Older cancer patients are vulnerable to poorer health outcomes during cancer treatment. Although the Thai elderly had their own preferences towards future medical care and advance care planning (ACP) could help cancer patients make informed decisions, Thai physicians report a low ACP engagement rate. Thus, this study aimed to explore the perceptions of older cancer patients and their families towards ACP engagement. Method We used a qualitative approach to explore the perceptions of non-haematological cancer patients aged ≥ 60 years old and their primary caregivers. The study was conducted at the Oncology Radiotherapy Referral Center, Songklagarind Hospital in Southern Thailand. Semi-structured in-depth interviews were conducted with the patients and their caregivers. Thematic analysis was used to identify and analyze recurring patterns and themes of perceptions regarding ACP engagement within the interview transcripts. Results Among the 138 families approached, 32 interviews were conducted. Three themes were found: (1) Advantageous opportunity: the patients believed ACP would help them realize their life values, and ensure that their preference would be respected; (2) contemplation and barriers to ACP: ACP is unfamiliar and unnecessary, might have low utility, worry patients and family members, take away optimism, would not be a proper activity for the patient at the current health situation; and (3) Cues for ACP initiation: perceived conformity with one’s religion, awareness of the current cancer state, having multiple comorbidity or experience suffering related with medical care, wishing not to burden family, having close family members, and trust in physicians. Conclusion ACP engagement could be hindered or promoted by perceptions of older patients and/ or their family members, as well as the communication skills of the care providers. Care professionals who aim to initiate ACP should minimize the potential barriers, make the ACP benefits salient, and watch for cues indicating a propitious time to start the ACP conversation.

Abstract Background The integration of Health System Science (HSS) in medical education emphasizes mastery of competencies beyond mere knowledge acquisition. With the shift to online platforms during the COVID-19 pandemic, there is an increased emphasis on Technology Enhanced Assessment (TEA) methods, such as video assessments, to evaluate these competencies. This study investigates the efficacy of online video assessments in evaluating medical students’ competency in HSS. Methods A comprehensive assessment was conducted on first-year medical students (n = 10) enrolled in a newly developed curriculum integrating Health System Science (HSS) into the Bachelor of Medicine program in 2021. Students undertook three exams focusing on HSS competency. Their video responses were evaluated by a panel of seven expert assessors using a detailed rubric. Spearman rank correlation and the Interclass Correlation Coefficient (ICC) were utilized to determine correlations and reliability among assessor scores, while a mixed-effects model was employed to assess the relationship between foundational HSS competencies (C) and presentation skills (P). Results Positive correlations were observed in inter-rater reliability, with ICC values suggesting a range of reliability from poor to moderate. A positive correlation between C and P scores was identified in the mixed-effects model. The study also highlighted variations in reliability and correlation, which might be attributed to differences in content, grading criteria, and the nature of individual exams. Conclusion Our findings indicate that effective presentation enhances the perceived competency of medical students, emphasizing the need for standardized assessment criteria and consistent assessor training in online environments. This study highlights the critical roles of comprehensive competency assessments and refined presentation skills in online medical education, ensuring accurate and reliable evaluations.

Abstract Background Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand. Methods A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter. Results This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%. Conclusions RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.

Abstract Background Health literacy (HL) in patients with type 2 diabetes mellitus (DM) can help control disease and prevent complications. However, most patients with type 2 DM have inadequate HL; therefore, their HL must be further improved. This study aimed to determine the effects of online infographics on improving HL among patients with type 2 DM. Methods This randomized controlled trial was conducted from July 2022 to September 2022, at the primary care unit of Songklanagarind Hospital, Thailand; 30 patients with type 2 DM were randomly assigned to the experimental (n = 15; three types of infographics) and control (n = 15; three types of pamphlets) groups. Infographics and pamphlets were distributed weekly via social media platforms. The S-TOFHLA Thai version and Thai-FCCHL were used to evaluate HL. Chi-square, Fisher’s exact, Wilcoxon rank-sum, t-test, paired t-test, and McNemar’s chi-square tests were used. Results The median age of 30 participants was 56 years. The mean duration of DM was 9.6 years, with a median HbA1c level of 7.5 mg%. Most participants (80%) had adequate HL in S-TOFHLA, whereas 63.3% had adequate HL in FCCHL. All participants in the infographic group who had inadequate HL in the S-TOFHLA pre-test achieved adequate HL. Meanwhile, only 50% of patients in the pamphlet group achieved adequate HL. Regarding FCCHL, 50% of patients in the infographic group and 60% in the pamphlet group who had inadequate HL in the pretest achieved adequate HL. However, no statistical significance in achieving adequate HL was found in either group. The mean differences (SD) in S-TOFHLA between before and after intervention were 12.53 (8.77; p = 0.0007) and 10.13 (9.88; p = 0.001) in the infographic and pamphlet groups, respectively. Regarding FCCHL, the mean differences (SD) were 3.47 (4.29) and 3.20 (2.91) in the infographic group (p = 0.003) and pamphlet (p = 0.002) groups, respectively. No statistical significance in the mean difference was found between both groups. Conclusions Novel online infographics and pamphlets did not significantly differ in achieving adequate HL among patients with type 2 DM who should receive health education about disease control and complication prevention. However, both interventions can increase and maintain HL levels. Online educational media can be appropriate during the COVID-19 pandemic. Nevertheless, further larger-scale studies should be performed to examine the impact of other DM educational media on HL promotion. Trial registration The Thai Clinical Trials Registry (TCTR) with registry ID TCTR20230425001 (date of registration 25/04/2023).

Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35–70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician’s consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3–4: follow-up measurements), visit 3 (months 6–8: end-point measurements) and visit 4 (months 9–12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry.Trial registration number: TCTR20240314001.

Objective: Increasing stray dog populations have transformed stray dog issues from a third-world problem to a global public health priority. This study aimed to determine factors related to feeding stray dogs and other factors that can impact stray dog-related issues. Material and Methods: This community-based cross-sectional study was conducted in Songkhla, Thailand, from the 4th to the 29th of January 2021. Data was collected via phone interviews. Logistic regression was performed to measure the association between the independent variables and problems related to stray dogs. Results: Among 168 participants, 137 (81.5%) reported having experienced a negative impact in connection with problems caused by stray dogs. The most common problem was garbage scavenging (62.5%), which predominantly occurred between 18:00 and midnight. Feeding stray dogs was significantly associated with stray dog-related problems (odds ratio [OR]=3.94 with a 95% confidence interval [CI] 1.26-17.41). Conclusion: Providing food to stray dogs causes problems and is also prohibited by law. It is important for media, community leaders, and other influential groups to create awareness and foster cooperation among communities to address this issue.

Abstract Purpose Vaccine-preventable diseases have decreased globally. However, measles and diphtheria outbreaks still occur in Southern Thailand, where Muslims are predominant with a documented low vaccine coverage. The purpose of this study was to investigate Muslim parents’ beliefs and factors influencing them to complete immunization of children aged 0–5 years in Y.L. province, Thailand. Method A descriptive qualitative study was conducted, using focus group discussion with 26 participants. They are parents whose children had complete or incomplete vaccination and community/religious leaders. Data were analyzed using content-analysis and triangulation method was used to ensure trustworthiness. Results Four major themes emerged from the analysis: (1) positive vaccine beliefs, which included knowledge and awareness of vaccination, trust in vaccine efficacy, and religious beliefs; (2) positive factors influencing positive beliefs and vaccine acceptance, which were accessibility of reliable sources, and imitation of leaders and health-community-network; (3) negative vaccine beliefs, including bias in vaccine efficacy and safety, personal beliefs about sources of vaccines, and religious misconceptions regarding the value of vaccines and Halal concerns; and (4) negative factors influencing negative beliefs and refusal of vaccination, which were perception of disadvantages of vaccines spread by word-of-mouth, trust in person over empirical evidence, religious views based on self-interpretation, and lack of public information on Halal vaccines. Conclusion Both positive and negative factors influencing complete immunization were found in this study. To enhance vaccine acceptance, health care providers should understand Muslim cultural beliefs by offering parents a chance to express their attitudes and encourage vaccination via religious leaders and community role models.

Abstract Background This study describes the inequalities in access to a medication delivery service (MDS) during the COVID-19 pandemic and identifies the social determinants of health-related inequalities among non-communicable disease (NCD) patients. Methods Data were obtained from a study on the impact of health behaviours and modifications in health behaviours during the COVID-19 pandemic in the Thai population in 2021. The participants were recruited from Bangkok and all four regions of Thailand. The concentration index was used to examine the inequality among income quintiles, which were standardised by age, sex, living area, job type, health insurance scheme, and education level. Logistic regression was used to examine the associations between socio-demographics and access to regular services and new NCD MDSs, adjusted for age, sex, and other covariates. Results Among 1,739 NCD patients, greater income inequalities in accessing regular NCD services and collecting medicines at registered pharmacies during the COVID-19 pandemic were observed, for which the concentration index indicated utilisation inequalities in favour of richer households. In contrast, receiving medicine at primary care centres, by postal delivery, and delivered by village health volunteers were the new NCD MDSs, which favoured less wealthy households. NCD patients living in rural areas were more likely to access new NCD MDSs, compared to those in urban areas (adjusted odds ratio = 2.30; 95% confidence interval [CI]: 1.22–4.34). Significant associations with receiving medicine at hospitals were also observed for the income quintiles. Individuals in the lowest and 2nd lowest income quintiles were more likely to access new MDSs than those in the richest quintiles. Conclusions This study highlighted a disproportionate concentration of access to new NCD MDSs during the COVID-19 pandemic in Thailand, which was more concentrated in lower-income groups. The government should further study and integrate MDSs with the highest cost benefits into nationwide regular systems, while addressing systematic barriers to access to these services, such as the lack of shared health data across health facilities and tele pharmacy equipment. This will promote access to public services among patients in the less advantaged groups and reduce the health inequality gap.

Abstract Background The main objective of this study was to investigate the association between parental supply of alcohol, alcohol–related harms, and the severity of alcohol use disorder in Thai 7th grade middle school students. Methods A cross–sectional descriptive study obtained the baseline data from the project named the Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study Cohort in Secondary School Students in 2018. The sample size was 1187 students who have ever sipped or drank alcohol in the past 12 months. Pearson’s Chi square, binary logistic regression, and ordinal logistic regression are applied in the analysis. Results A single source of parental supply is not significantly associated with any alcohol-related harm and the severity of alcohol use disorder, while parental supply with peers and siblings supply of alcohol plays an important role in both outcomes. The increasing number of sources of alcohol supply increases the risk of alcohol–related harm and the severity of alcohol use disorder. Other risk factors found in both associations included binge drinking, alcohol flushing, low household economic status, distance from the student’s family, and poor academic performance. Gender, exposure to alcohol ads on social media and location of residency were not associated with alcohol–related harms or severity of alcohol use disorder. Conclusions The results did not support parental guidance in teaching or giving children a drink or sip of alcohol within family to prevent related harms when drinking outside with their peers.

Abstract Background Protective behaviours (e.g., mask-wearing, handwashing, avoiding social gatherings) and mass vaccination are effective ways to control the coronavirus disease 2019 (COVID-19) pandemic. Previous studies found that people who get vaccinated may change their protective behaviours. The Thai government has endorsed several mix-and-match vaccine regimens to eliminate the insufficiency of each vaccine brand. This study aimed to determine levels of protective behavioural changes after COVID-19 vaccination and its relationship with various vaccine regimens in Thailand. Methods A descriptive cross-sectional study was conducted between September 13, 2021, and January 14, 2022. Data were collected using an online questionnaire distributed via social media platforms and posters in public places in Thailand. The questionnaire comprised six items for demographic characteristics, seven items for COVID-19 vaccine regimens, and four items for protective behaviours. The vaccinated Thai population aged ≥ 18 years were surveyed. Statistical analyses included a Chi-squared test, Wilcoxon signed rank test, and multivariate logistic regressions. Results Of the 469 participants, more than half were females (67.4%), single (57.4%), and lived in an urban area (67.2%). Significant differences were observed with regard to median scores in handwashing (5.0 vs. 5.0, p-value

Objectives: We aimed to create a mnemonic for acute coronary syndrome (ACS) warning symptoms and determine its diagnostic performance.Methods: This retrospective cross-sectional study included patients visiting the emergency room with symptoms of suspected ACS during 2020–2021. The mnemonic was created using symptoms with an odds ratio (OR) for predicting ACS >1.0. The mnemonic with the highest OR and sensitivity was identified. Sensitivity analysis was performed to test the diagnostic performance of the mnemonic by patient subgroups commonly exhibiting atypical symptoms.Results: ACS prevalence was 12.2% (415/3,400 patients). The mnemonic, “RUSH ChesT” [if you experience referred pain (R), unexplained sweating (U), shortness of breath (S), or heart fluttering (H) together with chest pain (C), visit the hospital in a timely (T) manner] had the best OR [7.81 (5.93–10.44)] and sensitivity [0.81 (0.77–0.85)]. This mnemonic had equal sensitivity in men and women, the elderly and adults, smokers and non-smokers, and those with and without diabetes or hypertension.Conclusion: The “RUSH ChesT” mnemonic shows good diagnostic performance for patient suspected ACS. It may effectively help people memorize ACS warning symptoms.

BackgroundIn Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU)×ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. ObjectiveThis study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU×ThaiSook Healthier Challenge. MethodsWe conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80% of the participation period (≥23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80% of the participation period. ResultsOf the 827 participants, most were female (734/827, 88.8%), belonged to a medium-sized group of 6-10 members (479/827, 57.9%), and belonged to generation Y (377/761, 49.5%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95% CI 1.31-4.92; generation X AOR 1.96, 95% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95% CI 1.58-5.16; medium groups AOR 2.06, 95% CI 1.47-2.88). Water logging was most used (806/827, 97.5% participants), followed by food, sleep, and workout logging. ConclusionsThe MED PSU×ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P

BackgroundBeing overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. ObjectiveThis study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. MethodsA secondary data analysis was performed using data collected from the “MED PSU×ThaiSook Healthier Challenge,” a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ≥30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (≥80%) and inconsistent (3%). ResultsOf 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was −3.85% (IQR −3.40% to −4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of −1.08% (IQR −2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). ConclusionsMore than half of the “MED PSU×ThaiSook Healthier Challenge” participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction.

Objective: To determine the prevalence and associated factors of delayed diagnosis of type 2 diabetes mellitus (DM) among outpatients in a tertiary hospital.Methods: This retrospective cohort study was conducted among outpatients aged ≥35 years with twice fasting plasma glucose (FPG) levels ≥126 mg/dl between 1 January 2018, and 31 December 2020. The prevalence and pattern of delayed diagnosis of DM were defined using the Thai Clinical Practice Guideline (CPG) for Diabetes, 2017, and the American Diabetes Association (ADA) 2017. The cut-off time for FPG level confirmation of 3 months was used to evaluate delayed diagnoses and associated factors. Multiple logistic regression was used to identify variables associated with delayed diagnoses.Results: Of 260 participants, 96.9% and 85.4% had delayed diagnoses as defined by the Thai CPG and the ADA, respectively. Factors significantly associated with delayed diagnosis were hypertension, non-cash insurance, and >10 years of physician experience.Conclusion: Undiagnosed diabetes and diagnosis delay should be a concern in tertiary settings. Senior physicians should focus on patients with higher FPG levels, particularly those who have hypertension, and use non-cash insurance schemes.

Objective: During the COVID-19 pandemic, physical distancing is one of the non-pharmaceutical measures that was recommended to reduce COVID-19 spread. Studies regarding physical distancing intervention and its effectiveness in Thailand have rarely been reported. This study aimed to evaluate physical distancing compliance among newly developed media interventions. Methods: We used accidental sampling and the data collection method was observation via CCTV, at the university canteen. Three interventions, including an attractive picture, a flashing red-light, a speech alarm sound and the conventional intervention were employed to 400 customers. Each intervention was monitored in non-prime hours. Results: The quasi-experimental study of 400 participants, the success rate of developed intervention including a flashing red light (6.0%, p = 0.279), an attractive picture (5.0%, p = 0.445) and a speech alarm sound (4.0%, p = 0.683) in promoting physical distancing compliance was not statistically significant from conventional intervention (2.0%). However, there was a statistically significant enhancement of physical compliance in some marking positions in our intervention. Conclusion: The effectiveness of the innovative device was not statistically significant to enhance physical distancing compliance among customers of the university canteen. The compliance statistically significantly enhances in some marking points. The integration of the use of media into conventional interventions provides an alternative for enhancing physical distancing.

Background Many knowledge gaps exist in the area of alcohol-related harms in children research such as the potential impact of other’s drinking and their social demography. Thus, this study aims to evaluate the effects of characteristics of household members and others’ alcohol drinking on harms to children in Thailand. Data and methods This study examined 952 parents caring for children and adolescents under 18 years of age, using the questionnaire (i.e., The Harm to Others from Drinking under the WHO/ThaiHealth International Collaboration Research Project). They were interviewed between September 2012 and March 2013. Results The study found that 15.89% of children and young people were affected by someone’s drinking in at least one category of harms. People over 60 years of age were less likely to cause alcohol-related harm to children than those aged 18 to 29 (adjusted odds ratio [AOR] 0.19, 95% confidence interval [Cl]: 0.06–0.58). Households with a binge drinker or regular drinker (≥1 time/week) were more likely to have children at higher risk of suffering alcohol-related harm in comparison to households without alcohol drinker (AOR 4.75 and 1.92, respectively). Conclusion This study found that children whose family members are young adult or consume alcohol (i.e., weekly drinker or binge drinker) were significantly adversely affected. The most common problems were domestic violence and verbal abuse. Most of the problems, affecting children, were caused mostly by their parents.

Septic shock represents a subset of sepsis with severe physiological aberrations and a higher mortality rate than sepsis alone. Currently, the laboratory tools which can be used to identify the state of septic shock are limited. In pre-clinical studies, extracellular vesicles (EVs), especially large EVs (lEVs), have been demonstrated a role as functional inflammatory mediators of sepsis. However, its longitudinal trend during the disease course has not been explored. In this study, the quantities and subtypes of plasma-derived lEVs were longitudinally compared between patients with septic shock (n = 21) and non-sepsis infection (n = 9), who presented within 48 h of their symptom onset. Blood specimens were collected for seven consecutive days after hospital admission. lEVs quantification and subtyping were performed using an imaging flow cytometer. The experiments revealed a higher lEVs concentration in septic shock patients than infected patients at the onset of the disease. In septic shock patients, lEVs concentration decreased over time as opposed to infected patients whose lEVs concentration is relatively static throughout the study period. The major contributors of lEVs in both septic shock and infected patients were of non-leukocyte origins; platelets, erythrocytes, and endothelial cells released approximately 40, 25, and 15% of lEVs, respectively. Among lEVs of leukocyte origins, neutrophils produced the highest number of EVs. Nevertheless, the proportion of each subtype of lEVs among the given amount of lEVs produced was similar between septic shock and infected patients. These findings raise the possibility of employing lEVs enumeration as a septic shock identifying tool, although larger studies with a more diverse group of participants are warranted to extrapolate the findings to a general population.

Sepsis is one of the well-established diseases with specific patterns of neutrophil dysfunctions. Previous studies demonstrated sepsis-related neutrophil dysfunctions in comparison with subjects without infection. Since sepsis and infection are recently recognized as distinctive processes, whether these neutrophil dysfunctions are associated with sepsis or infection are not known. Therefore, we longitudinally compared neutrophil functions, widely-cited as exhibiting sepsis-related changes, between patients with septic shock and infection. The surface level of cluster of differentiation 64 (CD64), C-C motif chemokine receptor 2 (CCR2), C-X-C motif chemokine receptor 2 (CXCR2); apoptosis; and NETosis were measured from peripheral blood neutrophils for seven consecutive days using flow cytometry. The between-group comparisons of neutrophil functions were made both on a day-by-day basis and as linear regression between time and measured neutrophil functions (sepsis status included as model predictors). Our study found that, among neutrophil functions studied, only CXCR2 surface level is associated with sepsis. At disease onset, CXCR2 level decrease, with a dose-response relationship with clinical severity. Its level reverts to resemble infected patients by the end of the week. The relationship between CD64 surface level, CCR2 surface level, NETosis, and sepsis are mediated through the effect of infection. Apoptosis activity between these groups are similar, hence, not sepsis-related.

This study aimed to estimate the prevalence and influencing factors of COVID-19 vaccine hesitancy and willingness to pay in Thailand. A descriptive cross-sectional study was conducted from 13 September 2021 to 14 January 2022. Data were collected using an online questionnaire consisting of demographic characteristics, COVID-19 vaccine hesitancy (delay in acceptance and denying vaccination), determinants of vaccine hesitancy (complacency, convenience, and confidence), and willingness to pay. The general Thai population aged ≥18 years were surveyed. Among 705 respondents, 10.4% reported hesitancy, with significant determinants being low complacency and confidence in the vaccine; low convenience was not a significant determinant. Multivariate analysis revealed vaccine hesitancy among women, those with higher education, non-healthcare workers, and those who lived in rural areas. Furthermore, 77.2% of respondents were willing to pay, with the majority willing to pay in the range of THB 501–1000 ( USD 1 = THB 33) per dose. Increased monthly income, no impact of COVID-19 on income, and time period (before mRNA vaccine availability) significantly affected willingness to pay.

Extracorporeal membrane oxygenation (ECMO) is a treatment option considered for acute respiratory distress syndrome (ARDS) patients who are refractory to conventional treatments. However, treatment with ECMO has not shown significant reduction of mortality which may be due to inappropriate selection criteria. Thus, we aim to evaluate the treatment outcomes of patients treated with ECMO in our center and determine an optimal cutoff level of the Respiratory ECMO Survival Prediction (RESP) score for case selection. This was a retrospective case-control study conducted at Songklanagarind Hospital, Thailand, from January 2014 to August 2018. ECMO patients were randomly matched to a control group of patients with severe ARDS within the same time period. There were 19 cases diagnosed with ARDS and treated with ECMO and 57 controls with ARDS. The patients in both groups had an average APACHE II score of 30.2 (SD = 4.7) and mainly had bacterial pneumonia. The in-hospital mortality was not significantly different between the cases and controls (68.4% vs 63.2%, respectively); however, the ECMO cases had a significantly longer length of intensive care unit stay and cost of hospitalization. Active malignancy, male gender, PaO 2 /FiO 2 ratio, and hypotension needing vasopressors were the risk factors for mortality. The RESP score did not discriminate between the survivors and nonsurvivors. Thus, more patient is needed to construct a better selection criterion.

There are many survey instruments to determine drinking patterns and alcohol consumption levels in the general population. This study aims to compare the context-specific quantity-frequency (CSQF) and beverage-specific quantity-frequency (BSQF) methods to estimate alcohol consumption indices at individual and sample levels. A community-based cross-sectional study was conducted among a population aged 15 years and older in Songkhla Province, Thailand. The BSQF and CSQF questionnaires with a 3-month retrospective time frame and in random order were applied to each participant. The CSQF was developed to ask more about the drinking contexts. The questions elicited information on location, partner, beverage, quantity, and frequency for five common drinking situations. Among 804 participants, 183 drank alcohol in the last three months. At the individual level, total alcohol consumption of almost all types of beverage by the CSQF was higher than the BSQF in approximately 50% of current drinkers and was mainly accounted for by the higher report of average quantity. At the sample level, there were no significant differences in the average daily intake, 3-month intake per drinker or per capita consumption between instruments. The interview duration and burden of answering the questions by the participants for the CSQF were not significantly higher than those for the BSQF. In summary, the fuller picture of drinking behaviors from the CSQF has several valuable methodological advantages and provides information allowing alcohol policies to be more directly specific to certain target populations or situations. The CSQF is a prototype questionnaire and forms the basis for a contextual approach. However, additional methodological studies need to be explored.