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This study aims to explore the prevalence of decreased frontal lobe function and its associated factors in women with surgical menopause. This study is a retrospective analysis of a cross-sectional study conducted between October 2013 and July 2014. Data from 164 women with surgical menopause were analyzed. The Montreal Cognitive Assessment Thai version (MoCA-T) test was administered by a psychologist. The MoCA frontal lobe function score was derived from visuospatial/executive, abstraction, attention, and verbal fluency tests. Multivariable logistic regression was used to assess data associated with decreased frontal lobe function. The mean age of participants was 56.3 ± 6.9 years, and the mean time since menopause was 11.3 ± 7.4 years. The prevalence of decreased frontal lobe function score was 73.8%, with an average score of 6.21 ± 1.84. The independent factor associated with a lower MoCA frontal lobe function score was duration of education greater than 6 years. Our study adds information about decreased frontal lobe function in almost three-quarters of women with surgical menopause. Duration of education greater than 6 years was a protective factor. Menopause hormone therapy usage did not seem to increase the detrimental effect on frontal lobe function when initiated in young women with surgical menopause. [ABSTRACT FROM AUTHOR]

The issue of discharging waste, especially heavy metals from industrial activities into the environment, not only adversely impacts environmental quality but also has impacts on communities and human health. Removal and reduction of heavy metal contamination in rivers and wastewater are, therefore, critical initiatives that require significant attention. This work studied the removal of heavy metals, including Zn(II), Cu(II), As(III), and Pb(II) by utilizing an upcycled amidoxime low-density polyethylene sheet (AO-sheet). The synthesized AO-sheet was analyzed for various physical properties, including scanning electron microscope, energy-dispersive x-ray spectroscopy, Fourier transform infrared spectroscopy, and thermogravimetric analysis. For the batch adsorption experiment, parameters affecting adsorption capacity were studied: initial concentration, submerging time, and pH. Adsorption isotherms were also studied. The results of the heavy metal adsorption study showed that the initial concentration was the most significant parameter; the higher the initial concentration, the greater the adsorption capacity. The adsorption capacity of Zn(II) and Pb(II) increased with submersion time, which achieved 21.07 and 0.855 mg/g-adsorbent, respectively, after four weeks of submersion under the highest initial concentration studied. The adsorption capacity of Cu(II) was 7.98 mg/g-adsorbent after two weeks of optimal adsorption duration under the highest initial concentration studied. The adsorption capacity of As(II) was 1.07 mg/g-adsorbent after one week of optimal submersion time under the highest initial concentration studied. Moreover, the appropriate pH range for effective adsorption of Zn(II), Cu(II), and Pb(II) was identified as 8-9, while for As(III), it was 6-8, with an adsorption duration of 0.43 weeks (3 days). From the Langmuir isotherm, it was found that the adsorption of this work was characterized by monolayer adsorption. The results demonstrate that the AO-sheet can be effectively used to remove heavy metals from wastewater. Its potential for reusability was up to 8 cycles, with the Zn(II) adsorption capacity being reduced to about 20.37%., (© 2024. The Author(s).)

Objective: To explore the difference in chemotherapy completion and reasons for discontinuation between older (≥70 years) and younger (<70 years) patients., Design: Retrospective cohort study., Setting: Single tertiary centre in Thailand., Participants: The patients who received chemotherapy from 1 January 2009 to 30 June 2021 were included and followed up until 30 June 2022. Of the 757 patients with epithelial ovarian, fallopian tube and primary peritoneal cancer (EOC), 108 were in the older group and 649 were in the younger group., Primary and Secondary Outcome Measures: The difference in chemotherapy completion, the association between younger and older patients and early discontinuation of chemotherapy., Results: The proportion of chemotherapy completion was significantly lower in older versus younger patients (84.3% versus 92.6%, p=0.007). Excluding discontinuation due to disease progression, the chemotherapy completion was comparable (93.5 versus 95.7%, p=0.456). Dose reduction and grade 3-4 hematotoxicity occurred more often in the older group. The univariable logistic regression model showed that older age (≥70 years) was significantly associated with early chemotherapy discontinuation (OR 2.39; 95% CI 1.29-4.24). However, after adjusting for potential confounders, age was not significantly associated with early discontinuation (OR 1.20; 95% CI 0.54-2.66). Multiple comorbidities and types of surgery were identified as independent risk factors for chemotherapy discontinuation., Conclusion: The completion of chemotherapy was observed in a majority of older adults with EOC. Age is not the only determinant of chemotherapy completion. Comorbidity and disease status are crucial for determining chemotherapy discontinuation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

We compared the efficacy of 4 mg drospirenone (DRSP) progestin-only pills (POPs) versus combined oral contraceptive pills (COCs) containing 0.02 mg of ethinyl estradiol (EE) and 0.075 mg of gestodene (GS) in ovulation inhibition and inducing unfavorable cervical mucus changes using a delayed-starting approach. This randomized controlled trial involved 36 participants aged 18-45 years. The major outcomes included ovulation inhibition assessed using the Hoogland and Skouby score, and cervical mucus permeability, assessed using the modified World Health Organization score. The results demonstrated ovulation inhibition rates of 77.8% for the EE/GS group and 88.9% for the DRSP group. The risk ratio and absolute risk reduction were 0.50 (95% confidence interval [CI]: 0.10, 2.40) and - 0.11 (95% CI: - 0.35, 0.13), respectively, satisfying the 20% non-inferiority margin threshold. The median time to achieve unfavorable cervical mucus changes was comparable between the DRSP (3 days, interquartile range [IQR]: 6 days) and EE/GS (3.5 days, IQR: 4 days) groups. However, the DRSP group had a higher incidence of unscheduled vaginal bleeding (55.56% vs. 11.11%; p = 0.005). DRSP-only pills, initiated on days 7-9 of the menstrual cycle, were non-inferior to EE/GS pills in ovulation inhibition. However, they exhibited delayed unfavorable cervical mucus changes compared to the standard two-day backup recommendation.Clinical trial registration: Thai Clinical Trials Registry (TCTR20220819001) https://www.thaiclinicaltrials.org/show/TCTR20220819001 ., (© 2024. The Author(s).)

Background: Unintended pregnancies can adversely affect maternal health, preventable through timely postpartum contraception. During the COVID-19 pandemic, family planning services were constrained by policies that curtailed outpatient visits. We investigated the prevalence of postpartum contraceptive initiation at King Chulalongkorn Memorial Hospital (KCMH) during January to June 2020, comparing with the same period in 2019, and identified factors associated with such initiation., Methods: We reviewed the medical records of 4506 postpartum women who delivered at KCMH during the study period. Logistic regression was conducted to test the association between early COVID-19 phase deliveries and post-partum long acting reversible contraception (LARC) initiation including copper intrauterine devices, levonorgestrel intrauterine systems, contraceptive implants, and progestogen-only injectable contraceptives., Results: A total of 3765 women (83.6%), of whom 1821 delivered during the pandemic and 1944 during the historical cohort period, were included in this study. The proportion of women who initiated non-permanent modern contraceptives at six weeks postpartum was comparable between the COVID-19 (73.4%) and historical cohort (75.3%) (p = 0.27) periods. The proportion of women who initiated LARC at six weeks postpartumwas comparable between the historical cohort period (22.5%) and the COVID-19 (19.7%) (p = 0.05) period. Accessing a six-week postpartum check-up was independently associated with LARC initiation, of which the adjusted odds ratio (OR) (95% confidence interval) was 3.01 (2.26 to 4.02)., Conclusions: Our findings demonstrated that accessing postpartum care significantly associate with the use of LARC. The data suggest the strong influence of postpartum check-ups in facilitating the adoption of effective contraception, emphasizing the need for accessible postpartum care to sustain maternal health during health crises., (© 2024. The Author(s).)

Objectives: This study aimed to determine the proportion of participants whose uterine bleeding/spotting was interrupted for at least 7 days during the month after they received a combined hormonal injection. We also evaluated bleeding at 21 days and 12 weeks after the injection., Study Design: We conducted a randomized, double-blind, placebo-controlled trial in 46 contraceptive implant users who presented with bothersome uterine bleeding/spotting. A single dose of a combination injectable contraceptive or placebo was administered intramuscularly at enrollment., Results: The proportions of participants whose uterine bleeding/spotting was interrupted for at least 7 days the month after they received a combined hormonal injection were higher in the combination injectable contraception group than in the placebo group (87% vs 48%, p = 0.005). Participants who reported that they were bleeding free at 21 days after treatment were 52% and 35% in the combination injectable contraception group and placebo group, respectively (p = 0.24). At 12 weeks posttreatment, 17% of participants in the combination injectable contraception group and 4% in the placebo group reported cessation of bleeding with no recurrence (p = 0.34). The median days until the first bleeding interruption was shorter in the combination injectable contraception group compared with the placebo group (1 [interquartile range, 1-2] vs 8 [interquartile range, 1-28], p = 0.007)., Conclusions: The combination injectable contraception interrupted bothersome uterine bleeding/spotting in contraceptive implant(s) users compared with placebo. However, this effect was limited only within the month when the treatment was administered., Implications: Bothersome uterine bleeding/spotting is a common side effect leading to contraceptive implant(s) discontinuation. In implant users experiencing these symptoms with no estrogen contraindications, a combined injectable contraception appears to rapidly improve bleeding for the duration of injectable exposure (1 month)., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Cervical cancer is one of the leading causes of death among women in Thailand. General practitioners, within their primary healthcare role, play a vital role in the cervical cancer screening program, as they are the healthcare professionals most easily accessible to the general population. This study aims to determine the level of knowledge of cervical cancer and human papillomavirus (HPV) infection, HPV vaccination, and cervical cancer screening among last-year medical students., Methods: A cross-sectional study was conducted among sixth-year medical students using an electronic self-administered questionnaire. The two-part questionnaire comprised demographic data and 12 true/false questions that assessed knowledge regarding HPV infection, HPV vaccination, and cervical cancer screening recommendations. Pilot testing revealed a high Cronbach's alpha and test-retest reliability coefficient., Results: A 67% response rate was achieved. Among the 198 respondents, only one (0.5%) student correctly answered over 80% of the questions while most respondents (172, 71.7%) correctly answered less than 60% of the questions. Less than half of the respondents correctly identified crucial aspects such as the primary cause of cervical cancer, recommended vaccination age, cytology sensitivity compared to HPV testing, and the recommended screening frequency for average-risk women., Conclusions: This study highlights a significant lack of comprehension among Thai medical students concerning HPV infection, vaccination, and cervical cancer screening guidelines. Encouraging educational enhancement, effective communication, and heightened awareness of these crucial topics within the medical school curriculum are imperative., (© 2024. The Author(s).)

Nexplanon is an etonogestrel contraceptive implant that comes with an applicator, making it easier to insert and remove. Complications related to insertion and removal procedures, such as neural-vascular injuries, are rare. We describe a case of reversible median nerve neuropathy and local muscle irritation resulting from blind removal attempts of an iatrogenically migrated implant. The patient presented with an unusual pain at the surgical site along with abnormal sensations and numbness in her left hand that worsened after blind attempts to remove the implant. Radiographs revealed that the rod was 3 cm from her insertion scar and deeply embedded in her left arm. The patient then underwent left arm exploration and implant removal under fluoroscopic guidance by an orthopedic surgeon. The rod was placed intramuscularly, adjacent to the median nerve under the basilic vein. The abnormal sensations and numbness in her left hand could be attributed to median nerve involvement, while the atypical pain at the surgical site could be a result of local irritation from the intramuscularly migrated implant from attempts at removal. The symptoms gradually resolved after surgery. This indicates that patients with impalpable contraceptive implants should be referred for implant removal by specialists familiar with the procedure to prevent further deterioration of adjacent structures from iatrogenic implant migration., (© 2023. The Author(s).)

Background: Pre-existing diabetes mellitus (DM) is a challenging pregnancy complication as poor glycemic control is associated with adverse maternal and fetal outcomes. In this study, we aimed to investigate DM-related knowledge, attitudes, preconception care practices, and contraceptive prevalence in women with DM., Methods: This descriptive cross-sectional survey was conducted among reproductive-aged Thai women receiving DM treatment at King Chulalongkorn Memorial Hospital between August 1, 2021, and June 30, 2022. Patients with DM who were not pregnant or trying to conceive and could be contacted via the phone were included and a validated self-administered questionnaire was distributed electronically., Results: A total of 238 participants were included in the final analysis, yielding 69.4% response rates. The mean (standard deviation) score for knowledge of pregnancy planning and pregnancy-related risks was 6.8 (3.5) out of 15. Only about half of the participants had discussed pregnancy planning with their physicians. Multivariable analysis showed that younger age at DM diagnosis, non-Buddhism, married, higher education, and medical personnel were significantly associated with higher knowledge scores. Women aged > 45 years and those with higher practice scores had significantly higher adjusted odds of using highly effective contraception; the most common methods included male condoms and combined oral contraceptive pills. There was an unmet need for contraception in 9.5% of women with DM., Conclusions: Although highly effective contraception is safe for patients with DM, only about half of our participants used tier one or two contraceptives or had received consultation regarding preconception planning. There was a notable gap in care coordination among specialists; integrating reproductive healthcare into DM therapy would improve access to preconception care., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objective: This study aimed to examine clients' experiences with telehealth use for contraceptive implant consultation., Methods: An online, self-administered survey was conducted with women who used contraceptive implants and faced adverse effects, inquired about side effects, or had concerns. Clients received consultations via LINE, which is a free chat application widely used in Thailand. Participants completed a questionnaire regarding their experiences and satisfaction within 7 days after using the service and a follow-up questionnaire to inquire about the need for in-person services 30 days after using the service., Results: The participants were 200 women, with a response rate of 82%. Overall, 94% of participants were satisfied with the consultation. Moreover, 37.5% received a message response within 6 hours, and most (89.5%) got a response within 24 hours. The three most frequently reported symptoms were abnormal bleeding or spotting, mood swings, and itching or pain at the surgical site. Most adverse effects were managed through online consultation. Approximately one-third of the participants required in-person visits 30 days after telehealth consultation., Conclusions: Telehealth consultation for contraceptive implant follow-up resulted in high client satisfaction. Most adverse effects could be managed using telehealth services. Therefore, telehealth could ensure sustained accessibility to reproductive healthcare during and post-COVID-19., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2023.)

Background: During the COVID-19 pandemic, telemedicine has become a popular adjunct to in-person visits, including for family planning services. This study determined the proportion of clients participated in telemedicine services and the association between sociodemographic factors and telemedicine participation during the COVID-19 pandemic. The adverse effects within the first seven days post-insertion were also reported., Methods: This retrospective cohort study considered data from all women initiating contraceptive implantation between June 2020 and August 2021 at King Chulalongkorn Memorial Hospital. Clients were offered the following two options for follow-up visits: in-person or communication via an online LINE® Official Account (LINE® OA), a free chat application widely used among the Thais. Logistic regression analyses were used to assess the association between socio-demographic factors and telehealth usage., Results: In total, 574 of 947 (60.6%) clients participated in telemedicine follow-up services during the period considered. A significant association between telemedicine usage and the following were observed: the peak of second wave COVID-19 outbreak in Thailand, using the period preceding the second wave as a reference [adjusted odds ratio (aOR) = 1.47 (95% confidence interval [CI]: 1.12-1.96)]; participants receiving governmental benefits for contraceptive implant payment (aOR: 3.23, 95% CI: 1.86-5.60), and timing of contraceptive implant(s) initiation, using interval insertion as a reference for which aORs of postpartum and immediate postpartum insertions were 0.62 (95% CI: 0.43-0.90) and 0.35 (95% CI: 0.24-0.52), respectively. Significant ecchymosis at the insertion site was observed in 13.1% of participants., Conclusion: This study emphasizes the significance of telemedicine during the COVID-19 epidemic, particularly in facilitating contraceptive implant initiation. Our data show a significant increase in the uptake and utilization of telemedicine during the pandemic's peak. The data also shows that during the period of Thailand's second COVID-19 epidemic, government benefits for contraceptive implant payment, and the timing of contraceptive implant initiation, are significantly associated with telemedicine use. This finding supports the continued use of telemedicine in healthcare, particularly for services like family planning, where remote follow-ups can provide safe, efficient, and timely care., (© 2023. The Author(s).)

Background: The recently amended Thai abortion law allows pregnant women to undergo abortions up to the gestational age of 12 weeks. Medical abortion is significant because it has revolutionized access to safe abortion care-abortion medicine can now be safely and effectively administered outside of a healthcare facility to women in early pregnancy. This contribution supports the pharmacists' role in interprofessional safe abortion teamwork. Adequate knowledge of the current laws regarding safe abortion services will increase pharmacists' competence in providing services. However, safe abortions as a subject have not been formally incorporated into the curriculum for Thai pharmacy students. Therefore, this study aimed to evaluate the knowledge, attitude, and intended practice of fifth-year pharmacy students at Chulalongkorn University., Methods: A cross-sectional study was conducted using an electronic self-administered questionnaire adapted from previously published studies to evaluate participants' knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. The invitations were sent to all fifth-year pharmacy students at Chulalongkorn University., Results: Among all invitations sent, 104/150 (69.3%) participants responded to the survey. Only a third of the participants (31.7%) had good knowledge scores. Based on five questions regarding the gestational age limit for legal abortion, most participants (52.7%) answered questions incorrectly. Although more than half of the participants (52.5%) disagreed with two pro-choice statements, an overwhelming majority (87.5%) agreed that abortion was a woman's right. Safe abortion services were mostly agreed upon with serious fetal defects (91.9%), non-HIV maternal health conditions (82.2%), and sexual assaults (77.4%). A positive attitude toward abortion affects the intention to perform an abortion under socioeconomic conditions., Conclusion: Most participants lacked knowledge on the amended abortion law, especially on the gestational limits of abortion. Participants with favorable attitudes toward abortion tended to be more liberal regarding safe abortion services., (© 2023. The Author(s).)

Postmenopausal status is a risk factor for distal sensory polyneuropathy-the most common type of peripheral neuropathy. We aimed to investigate associations between reproductive factors and history of exogenous hormone use with distal sensory polyneuropathy among postmenopausal women in the United States using data from the National Health and Nutrition Examination Survey 1999-2004, and to explore the modifying effects of ethnicity on these associations. We conducted a cross-sectional study among postmenopausal women aged ≥ 40 years. Women with a history of diabetes, stroke, cancer, cardiovascular disease, thyroid disease, liver disease, weak or failing kidneys, or amputation were excluded. Distal sensory polyneuropathy was measured using a 10-g monofilament test, and a questionnaire was used to collect data on reproductive history. Multivariable survey logistic regression was used to test the association between reproductive history variables and distal sensory polyneuropathy. In total, 1144 postmenopausal women aged ≥ 40 years were included. The adjusted odds ratios were 8.13 [95% confidence interval (CI) 1.24-53.28] and 3.18 (95% CI 1.32-7.68) for age at menarche < 11 years and time since menopause > 20 years, respectively, which were positively associated with distal sensory polyneuropathy; adjusted odds ratios were 0.45 for the history of breastfeeding (95% CI 0.21-0.99) and 0.41 for exogenous hormone use (95% CI 0.19-0.87) were negatively associated. Subgroup analysis revealed ethnicity-based heterogeneity in these associations. Age at menarche, time since menopause, breastfeeding, and exogenous hormone use were associated with distal sensory polyneuropathy. Ethnicity significantly modified these associations., (© 2023. The Author(s).)

Objectives: Following the amendment of the Thai abortion law in February 2021, the authors conducted an anonymous survey to assess knowledge, attitude, and intended practice toward abortion among fifth-year medical students at Chulalongkorn University., Study Design: The authors developed a self-administrated questionnaire consisting of three parts: knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. Pilot testing showed a high Cronbach's alpha and test-retest reliability coefficient., Results: Of the 292 surveyed medical students, 70% completed the questionnaire. The mean ± standard deviation of the knowledge part was 6.9 ± 1.8, of which the maximum score was 10. Nearly half of the participants (45.6%) answered at least 80% of the knowledge statements correctly. Sixty-four percent of participants answered correctly on the gestational limit for first-trimester abortion. Around one-third of participants answered correctly on the gestational limit for second-trimester abortion. Most participants (86.8%) agreed that abortion is a woman's right. The most acceptable conditions for abortion were pregnancy as a result of rape (93%) and serious anomalies that cause a nonviable neonate (95.6%)., Conclusions: Participants exhibited a lack of understanding regarding the legal gestational limit, which is a key aspect of the amendment. The findings of this study urge medical schools to emphasize the revised Thai abortion law in the Obstetrics and Gynecology curriculum., Implications: Our results show that encouraging medical students to have up-to-date knowledge regarding the amendment of Thai abortion law may support their future decision to provide safe abortion services., (© 2023 The Author(s).)

Background: Differentiating uterine LMS from uterine leiomyoma is difficult. Therefore, this study aimed to compare preoperative NLR of uterine leiomyosarcoma (LMS) with leiomyoma and secondary objective aimed to identify the clinical characteristics to distinguish between uterine LMS and uterine leiomyoma including the appropriate NLR cut off value to differentiate LMS from leiomyoma., Methods: This was a matched case-controlled study with 1:4 ratio. We collected data of patients with uterine LMS and leiomyoma from 2011 to 2020 at King Chulalongkorn Memorial Hospital. Patients with uterine LMS (case group) and leiomyoma (control group) were matched in terms of year of the surgery and size of the uterine mass. Statistical analysis was conducted using SPSS version 22.0 and STATA version 17. Conditional logistic regression analysis with a p-value of <0.05 was used., Results: Twenty-seven patients who were diagnosed with uterine LMS met the inclusion criteria; 13 patients who had incomplete data and one patient who was had concurrent breast cancer were excluded. Thirteen patients were included in the final analysis. From 2,587 patients in control group; 52 patients were matched. The baseline characteristics in both groups were comparable except for menopausal status Women with uterine LMS had a higher NLR than those with leiomyoma (mean, 4.56 ± 2.5 and 2.4 ± 1.15 in the case and control groups, respectively). Conditional logistic regression determined that the NLR cut-off value of 2.8 was a statistically significant factor for determining uterine LMS (OR = 3.24; 95% CI 1.01-10.43). No significant difference was found in the other factors., Conclusions: Patients who were diagnosed with uterine LMS had a significantly higher NLR than those diagnosed with leiomyoma. The NLR is a simple and effective method for predicting the presence of a uterine LMS in patients who are pre-operatively diagnosed with a uterine mass.

Background: Postpartum sterilization in Thailand has relatively few barriers compared to other countries. The procedure is covered by some healthcare plans, and paid out-of-pocket for others. We aim to determine if healthcare coverage and other socioeconomic factors affect the rate of postpartum sterilization in an urban, tertiary hospital., Methods: We conducted a secondary analysis of data from a retrospective cohort of 4482 postpartum women who delivered at our hospital. Multivariable logistic regression was conducted to determine if sterilization reimbursement affects immediate postpartum sterilization rate., Results: Overall immediate postpartum sterilization rate was 17.8%. Route of delivery and parity were similar in those who were reimbursed and those who were not. Women aged over 25 were more likely to have a healthcare plan that does not cover postpartum sterilization. Women whose healthcare plan reimbursed the procedure trended towards postpartum sterilization when compared to women who were not (aOR 1.05, 95% CI 0.86-1.28, p-value = 0.632). Women who delivered via cesarean section were more likely to undergo sterilization at the time of delivery (aOR = 5.87; 95% CI 4.77-7.24, p-value = < 0.001). Women aged 40-44 years were 2.70 times as likely to choose sterilization than those aged 20-24 years (aOR = 2.70; 95% CI 1.61-4.53, p-value < 0.001)., Conclusions: Healthcare coverage of the procedure was not associated with increased postpartum sterilization in our setting., (© 2023. The Author(s).)

In 2021, Thailand decriminalized abortions to allow for legal abortions on request up to 12 weeks' gestation and conditionally up to 20 weeks' gestation, or in the case of sexual assault, maternal mental or physical harm, or fetal abnormality. We intend to say that healthcare practitioners' positive attitudes toward abortion will destigmatize abortion for both themselves and their patients. We explored the knowledge, attitudes, and intended practices of nursing students toward safe abortion practices in light of the recent law reform. This was a cross-sectional study using a self-administered questionnaire. The questionnaire consisted of 4 parts: a demographic information questionnaire; and measures to assess their knowledge, moral attitudes, and intended practice regarding safe abortion care. Questionnaires were sent to 206 nursing students who had completed the Midwifery and Maternal-Newborn Nursing rotation in Bangkok, Thailand. The survey response rate was 90.8%. Mean (standard deviation) knowledge score was 6.72 (1.86) out of 10. Buddhist students were more likely to have a positive attitude toward abortions. Most students intended to practice safe abortions in pregnancies that affect maternal physical or mental health, or in pregnancies that resulted from unlawful sexual contact. Students were more ambivalent toward abortion practices for socioeconomic reasons. Better knowledge of abortion legislation was associated with a more positive attitude toward abortions and safe abortion practice intention. Approximately 1 year after the abortion law reform in Thailand, nursing students had incomplete knowledge of the amendment. Most students were inclined to provide abortion care services for certain conditions.

Background: Distal sensory polyneuropathy (DSP) is a common peripheral neuropathy subtype. We aimed to determine the association between breastfeeding and DSP among postmenopausal women aged 40-70 years, and the effect modification of obesity on this association. Methods: A cross-sectional study was conducted using data from the National Health and Nutrition Examination Survey 1999-2004. Postmenopausal women aged 40-70 years were included. Women with diabetes, stroke, cancer, cardiovascular disease, thyroid disease, liver disease, weak/failing kidneys, or amputation were excluded. Binary logistic regression was used to analyze the association between breastfeeding and DSP. Results: Among 798 participants, 386 (44.30%) reported breastfeeding history and 51 (5.29%) were defined as having DSP using the monofilament test. A significant inverse association was observed between breastfeeding and DSP (odds ratio [OR] = 0.29; 95% confidence interval [CI]: 0.11-0.79; p  = 0.017) after adjusting for other confounding variables. In subgroup analysis, this adjusted association was observed only in the obese group (OR = 0.21; 95% CI: 0.06-0.73, p  = 0.013). Conclusions: Breastfeeding was found to have potential benefits in the presence of DSP in postmenopausal women aged 40-70 years, and obesity modified the association between breastfeeding and DSP. Promoting breastfeeding may reduce the burden of peripheral neuropathy in middle-aged postmenopausal women.

Background: The abortion act in Thailand is approximately 60 years old. However, because of increasing problems due to unsafe abortions, the act was recently amended to accord a legal status for abortions. In the southernmost provinces of Thailand, most people follow the Islamic faith, according to which induced abortion is a sin for both the providers and the pregnant women. This may affect the attitude of the medical staff, such as registered nurses, who play an important role in abortion services. Our study aims to evaluate the knowledge of the amended abortion act, attitude toward abortions and the intentions behind them, and willingness to perform abortions among registered nurses., Methods: A cross-sectional study was conducted from January 2022 to February 2022 wherein a self-administrated questionnaire was electronically distributed to 450 registered nurses practicing at a tertiary hospital in the southernmost province of Thailand. Linear regression analysis and Fisher's exact test were conducted to evaluate the association between basic characteristics, knowledge scores, and attitudes toward induced abortion., Results: A total of 375 nurses (83.3%) completed the survey. Most participants were Muslim (58.9%), and 18.7% of them correctly answered > 80% of the knowledge questions. Among all the participants, 41.4% had a favorable attitude toward induced abortion, of which 21.3% were willing to provide safe abortion services. Knowledge scores were independently associated with practicing in obstetrics-gynecology departments and a lower age. Participants practicing Buddhism and having good knowledge scores tended to have favorable attitudes toward abortion., Conclusions: Nurses in the southernmost province of Thailand lack knowledge regarding the amended abortion act and do not have a favorable moral attitude toward abortion. Favorable attitudes toward abortions, support toward intentions behind abortions, and a willingness to provide abortion services were all lesser among the Muslim participants than among the Buddhist participants. Compared with participants who scored lower, those with higher knowledge scores had a better moral attitude toward abortion and, in turn, demonstrated a greater intention to provide abortion services. Encouraging nurses to gain better knowledge may improve their attitude toward abortion, which may positively influence future medical practices., (© 2022. The Author(s).)

Objective: To assess the effects of using an animated local language educational video to counsel postpartum adolescents on the benefits and use of long-acting reversible contraception (LARC)., Materials and Methods: A two-stage, single group, experimental study was conducted. A total of 124 female adolescents aged < 20 years who had given birth within the last six weeks participated in the study. An educational video and a questionnaire were developed and validated. Participants were asked to fill out a questionnaire on basic demographic data, contraception preferences, and 10 true/false statements to test general contraceptive knowledge, after which they were shown an educational video in a private room. Following this, participants completed the second part of the questionnaire that assessed their knowledge using the same true/false statements and contraception preferences administered earlier., Results: The mean age (standard deviation) of participants was 18.1 (1.5) years. Participants' mean age (SD) at the time of their first sexual intercourse was 16.2 (1.6) years. Among the 124 participants, 31 (25%) indicated that they would use LARC before viewing the educational video. After viewing the educational video, this number increased to 48 (38.7%). The participants' knowledge score was independently associated with their preference to select LARC (adjusted odds ratio 1.46, 95% confidence interval 1.09- 1.97)., Conclusion: This study demonstrated that counseling tools such as animated local language educational video might effectively improve contraceptive knowledge and the preference for LARC in postpartum adolescents. An educational video regarding LARC could be used as a counseling tool for postpartum adolescents., (© 2022. The Author(s).)

Background: Cesarean section scars are post-surgical problems in women. Many active ingredients have been found to diminish scar formation. Clinical investigations on the onion extract have gained more attention due to its properties, such as improvement of scar appearance and texture. However, published studies evaluating the usefulness of the onion extract in the treatment of scars are controversial., Methods: The three-month study period followed a prospective, randomized, and double-blinded design. Each enrolled subject's post-cesarean completely sealed wounds were divided into two halves along the closure axis. Each half was randomly assigned to the treatment with either silicone gel containing 5% onion extract or the silicone gel containing vitamin C. All subjects were respectively evaluated at the one, two, and three months of the treatment., Results: After the three-month follow-up, there was a statistically significant difference in scar improvement between before and after treatment. None of statistically significant difference in the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) scores and melanin value was found between silicone gel containing 5% onion extract and the control silicone gel. However, the improvement of scar erythema by treatment with the silicone gel containing 5% onion extract was significantly greater than in the control group. No adverse effects were reported in either group., (© 2021 Wiley Periodicals LLC.)

This study is aimed at evaluating the results of the universal preoperative screening for COVID-19 in gynecologic cases operated on during its outbreak in a tertiary care hospital in Bangkok, Thailand. A retrospective descriptive study was done on all patients who underwent elective or emergency gynecologic surgeries during the pandemic period in Thailand (April 15 to June 5, 2020). The COVID-19 screening results by symptom-based screening, risk-based screening, and RT-PCR for COVID-19 were collected from the electronic medical records. Among 129 patients who underwent gynecologic surgeries, none had a positive RT-PCR for COVID-19. Symptom-based screening found no patients with positive symptoms for COVID-19. Risk-based screening found 4 patients (3.1%) who were in contact with suspected or confirmed COVID-19 cases and 4 patients (3.1%) who were healthcare personnel. In conclusion, routine preoperative RT-PCR for COVID-19 may need to be reconsidered among asymptomatic individuals in a low-prevalence country during the well-controlled COVID-19 situation. Larger studies are required to ascertain the benefit of universal preoperative COVID-19 testing., Competing Interests: The authors declare that there is no conflict of interests regarding the publication of this paper., (Copyright © 2021 Wilasinee Areeruk et al.)

We assessed the discontinuation rate and the reason for discontinuation of common contraceptives used by reproductive-aged Thai women. We recruited 1880 women aged 18-45 years from the Family Planning Clinic of the Chulalongkorn Hospital in Bangkok. The participants were followed at three, six and twelve months. A Cox proportional hazards model was used to determine personal risks of discontinuing contraceptives. The incidence rate for discontinuation of combined oral contraceptive pills (COCs), depot medroxyprogesterone acetate (DMPA), copper intrauterine device (IUD), and contraceptive implant(s) were 21.3, 9.2, 4.4, and 2.3/100 person-years, respectively. Most of the women who discontinued (185/222) discontinued contraceptives due to side effects. Compared to contraceptive implant users, the adjusted hazard ratios (aHRs) [95% confidence intervals (CIs)] of discontinuing COCs, DMPA, and the copper IUD were 9.6 (4.3-21.8), 4.2 (1.8-10.0), and 2.2 (0.8-5.9), respectively. Lower income, higher parity, history of miscarriage, and history of abortion were independent predictors of contraceptive discontinuation in a multivariable model.

The objective of this study was to determine the adsorbent potential of rice husk and its modified form for phosphate and nitrate removal from synthetic and swine-farm wastewater. The mechanism of adsorption as well as the potential of phosphate-/nitrate- adsorbed rice husk as nutrient rich residue was also investigated. Two-step modification of RH (using base-washing (BW) and chemical modification (CM) was conducted to compare the phosphate and nitrate removal. The effects of several factors (pH, sorbent dosage, contact time, initial concentration, and coexistence of both ions) were investigated to gain insight into the adsorption rate, behavior, and mechanism of the modified RH regarding phosphate and nitrate removal. The results of Fourier-transform infrared spectroscopy showed that the modification was successful by crosslinking with the amine group of the chemical agent. Fitting the adsorption kinetic data of phosphate showed physical adsorption, intraparticle diffusion, and chemisorption, whereas for nitrate, the data indicated mainly chemisorption. Fitting the adsorption isotherm data of phosphate and nitrate together showed adsorption on a monolayer coating of anions on the homogeneous sorbent's surface. The maximum phosphate and nitrate adsorption capacities were 6.94 and 2.46 mg/g, respectively, for a single adsorbate and 11.14 and 1.76 mg/g, respectively, for the binary solution. In real swine wastewater, removal efficiencies of phosphate, nitrite, nitrate, sulfate, and ammonia were 83.8%, 65.0%, >45.0%, 36.6%, and 2.6%, respectively, indicating that the modified RH would be effective for phosphate and nitrate removal from real wastewater. Finally, nutrient analysis of the phosphate- and nitrate-sorbed RH showed increases in nitrogen and phosphorus, which would be beneficial for further use of the RH as nutrient or fertilizer after adsorption.

Objective: To examine healthcare providers' adherence to professional recommendations for advanced prescription of emergency contraceptive pills (ECPs)., Methods: We conducted a retrospective chart review of 432 visits by 282 unique nonpregnant women 14 to 25 years of age seen at an obstetrics and gynecology teaching clinic to determine the percentage of visits during which advanced prescriptions of ECPs were provided when indicated. A logistic regression model, which accounted for nonindependent observations through generalized estimating equations, was used to identify factors associated with the provision of ECP advanced prescriptions., Results: Approximately one-fifth of eligible visits (19.9%) and eligible patients (19.1%) had documentation of an ECP advanced prescription when indicated. Healthcare providers in this clinical setting were more likely to prescribe ECPs to adolescents and women whose primary contraceptive methods were associated with higher failure rates in typical use, such as condoms. Compared with women aged 20 to 25 years, the adjusted odds ratio of receiving an advanced prescription for ECPs was 5.94 (95% confidence interval [CI] 2.85-12.41) for adolescents. Compared with users of depot medroxyprogesterone acetate, the adjusted odds ratio was 4.25 (95% CI 1.62-11.15) for condom users, and 3.90 (95% CI 1.54-9.86) for users of other short-term hormonal contraceptives., Conclusions: Despite clear professional recommendations for ECP advanced prescriptions for all women at risk for unintended pregnancy, a substantial gap exists between this standard of care and routine clinical service provision in an obstetrics and gynecology teaching clinic.

Introduction: Intrauterine devices and contraceptive implants are recommended as first-line contraceptives by health care professional societies. However, uptake among US women lags substantially behind other developed countries. Little information is available on the extent to which clinicians document discussion about long-acting reversible contraception (LARC) in this patient population. We sought to determine the frequency with which clinicians document LARC discussion with eligible women aged 14 to 25 years in a training clinic and evaluate factors associated with LARC discussion and uptake., Methods: We conducted a retrospective chart review of all visits of nonpregnant women aged 14 to 25 years seen at an obstetrics and gynecology resident physician clinic during a calendar year. A logistic regression model was used to assess demographic factors associated with LARC education and uptake., Results: Among 450 visits by eligible patients, LARC discussion was documented during 47.8% (215/450) of visits. Among visits with documentation of LARC counseling, 45.6% (98/215) had documentation of a LARC placement plan. Among patients who decided to initiate LARC, 40.8% (40/98) had a device placed at the same visit. LARC placement was documented during 8.9% (40/450) of visits. Clinicians documented LARC counseling for women aged 14 to 19 years more frequently than for women aged 20 to 25 years. Compared with women who did not use any method of contraception, clinicians documented LARC counseling less frequently for women who used short-term hormonal contraception., Discussion: Clinicians in a training clinic did not document LARC counseling for more than half of eligible patients. Every clinical visit is an opportunity to assess risk of unintended pregnancy and ensure that contraceptive needs are addressed., (© 2018 by the American College of Nurse-Midwives.)

Background: Oral contraceptives (OCs), aside from contraceptive efficacy, have been widely known for their non-contraceptive benefits. Different progestogens component of the OCs have been shown to improve the skin, hair, menstrual cycle related disorders and dysmenorrhoeic pain. Thus, we compared the efficacy of OCs containing ethinyl estradiol (EE) and chlormadinone acetate (CMA) versus OCs containing EE and drospirenone (DRSP) for the treatment of acne and dysmenorrhea., Methods: This study was an investigator-blinded, randomized, parallel group study conducted at the Family Planning Clinic, Department of Obstetrics and Gynaecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. Women aged between 18 and 45 years were randomly assigned into two treatment groups, either EE/CMA at the dosage of 30 mcg/2 mg once daily (OD) or EE/DRSP at the dosage of 30 mcg/3 mg OD. The subjects were evaluated for the OC's efficacy for the treatment of acne and dysmenorrhea at baseline visit and after 1, 3, and 6 months of treatment., Results: A total of 180 women were randomized into the study. Each group had 90 women. Baseline characteristics between both groups were comparable. At Month 6, there was a significantly greater reduction of total acne lesion in the EE/CMA group than EE/DRSP (72.2% vs 64.5%; p  = 0.009). As per the investigator's global assessment of acne treatment, a higher proportion of the subjects from the EE/CMA group was rated "excellent" than those from the EE/DRSP (75.3% vs 49.4%). More subjects from the EE/CMA group had graded their improvement in acne as "excellent" compared to the EE/DRSP group (66.3% vs 48.3%). A higher proportion of the subjects in the EE/CMA group reported a decrease in dysmenorrhoeic pain as "much decrease" and "decrease". The absence of dysmenorrhea pain was more frequently found in the EE/CMA group and significantly seen as early as Month 1 also in the EE/CMA group compared to EE/DRSP (47.2% vs 27.3%, respectively). The treatments were generally well-tolerated in both groups. There were no significant differences between both groups for adverse events., Conclusions: EE/CMA is more effective for the treatment of acne and dysmenorrhea in women with mild to moderate acne vulgaris and dysmenorrhea than EE/DRSP., Trial Registration: Thai Clinical Trial Registry ID: TCTR20170518001 (date of registration: May 17, 2017; retrospectively registered)., Competing Interests: The study was approved by the Institutional Review Board of the Faculty of Medicine, Chulalongkorn University (IRB No. 498/55) and was conducted in accordance with the ethical principles of the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. Signed informed consent were obtained from every patient prior to study enrollment.Not applicableThe authors declare that they have no competing interests.

Rates of chlamydia (CT) and gonorrhea (GC) have risen for the first time in the United States since 2006. Certain population groups are disproportionately affected by these sexually transmitted infections (STIs) as well as HIV. The Centers for Disease Control and Prevention (CDC) and professional societies have published screening guidelines for these STIs for women under the age of 25. We aimed to quantify physician adherence to GC/CT and HIV screening guidelines and to determine demographic factors associated with GC/CT and HIV screening recommendations among women 14-25 years old in Honolulu, Hawai'i. We conducted a retrospective chart review of all visits to an OB/GYN teaching clinic in 2014 to determine rates of STI screening recommendations and evaluate differences in screening recommendations by demographic factors such as patient age, race, insurance type, visit type, and visit number during the study period. Electronic medical records of 726 visits by 446 patients were reviewed. Among visits by patients with indications for screening, 71.0% and 21.6% received screening recommendations for GC/CT and HIV, respectively. Age group, race, and visit type were significantly associated with receiving screening recommendations. A lack of appropriate documentation regarding the assessment of risk factors for GC/CT and HIV screening was observed. Emphasis should be placed on more thorough ascertainment and documentation of patients' risk factors for STI acquisition to determine screening needs at each clinical visit based on professional guidelines, as substantial public health benefits may be gained through the identification and prompt treatment of GC/CT and HIV infections., Competing Interests: None of the authors identify any conflicts of interest related to this publication.