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The Depression, Anxiety and Stress Scale (DASS-21), an introductory scale used to identify common mental disorders (CMDs) among adults, was validated across cultures in Asian populations; nevertheless, its capacity for screening these disorders may be limited for some specified groups, including nursing students. This study attempted to investigate the psychometric scale’s unique features of DASS-21 for Thai nursing students in an online learning environment during the COVID-19 outbreak. A cross-sectional study using the multistage sampling technique recruited 3,705 nursing students from 18 universities located in south and northeast Thailand. The data were gathered using an online web-based survey, and then all respondents were divided into 2 groups (group 1, n = 2,000, group 2, n = 1,705). After using the statistical methods to reduce items, exploratory factor analysis (EFA) using group 1 was performed to investigate the factor structure of the DASS-21. Finally, group 2 used confirmatory factor analysis to verify the modified structure proposed by the EFA and assess the construct validity of the DASS-21. A total of 3,705 Thai nursing students were enrolled. For the factorial construct validity, a three-factor model was initially suggested containing 18 items (DASS-18) spread across 3 components: anxiety (7 items), depression (7 items) and stress (4 items). The internal consistency reliability was acceptable with Cronbach’s alpha in the range of 0.73–0.92for either the total or its subscales. For convergent validity, average variance extracted (AVE) showed that all the DASS-18 subscales achieved convergence effect with AVE in the range of 0.50–0.67. The psychometric features of the DASS-18 will support Thai psychologists and researchers to screen CMDs more easily among undergraduate nursing students in tertiary institutions who enrolled in an online learning environment during the COVID-19 outbreak.

Objective: To compare the effectiveness of topical ethyl chloride spray (ECS) and subcutaneous 1% lidocaine injection (LI) to reduce pain during the two rods system insertion. Materials and methods: One hundred and ten women, who underwent two rods contraceptive implant insertion during January 2021 to July 2021, were enrolled and randomly allocated to ECS and 1% LI groups. After the skin was sterilized, the assigned anesthetic method was administered before insertion of two rods contraceptive implant using the standard procedure. Pain levels during; (1) the administering of the anesthetic, (2) the insertion of the implant, (3) at 20 min after insertion and (4) overall pain levels, were evaluated, using a 10 levels visual analogue scale (VAS). Results: All basic clinical characteristics between the two groups showed no significant difference. Mean VAS during anesthetic in the ECS group were significantly lower than in the LI group (3.92 and 2.89, mean difference −1.03, 95%CI −1.76 to −0.31, p

Introduction: Most of the Cholangiocarcinoma (CCA) patients are commonly found in an advanced stage and often presents with Malignant Biliary Obstruction (MBO). Palliative treatment using biliary drainage plays a major role in the treatment modalities. However, only a few studies with small number of subjects have reported their long term outcomes. Aim: To compare the mortality rates of MBO patients in Endoscopic Ultrasound-guided Biliary Drainage (EUS-BD) era versus non-EUS-BD era. Materials and Methods: The present study was a retrospective cohort study which enrolled 132 MBO patients who had received palliative treatment between January 2014 to August 2020 at Thabo Crown Prince Hospital, Nong Khai, Thailand. The patients were treated either with EUS-BD (group l, n=30) or non-EUS-BD (group ll, n=94). Due to imbalance of follow-up time between two groups, the Overall Survival (OS) rates were compared using parametric survival analysis with restricted mean difference at 12 months follow-up, adjusted by other covariates, and presented in term of Kaplan-Meier curve, Hazard Ratio (HR) and 95% confidence interval. Results: Most of the patients (99.19%) were having CCA. The clinical characteristics between the two groups showed no significant difference, except the mean follow-up time that group II was shorter than group I (2.43 vs. 7.12 months; p

Introduction: Common Bile Duct Stone (CBDS) is concomitant with Gallstone (GS) in 10-18% of patients. The most common procedure to treat CBDS with GS is with Endoscopic Retrograde Cholangiopancreatography (ERCP) and Laparoscopic Cholecystectomy (LC) which has commonly been done using a sequential approach. Currently, the one-step synchronous approach is commonly practiced. However, superiority of one protocol over another is yet to be established. Aim: To compare the operative outcomes between synchronous approach LC followed by ERCP in the same anaesthetic time (group I) and sequentially separated LC and ERCP (group II). Materials and Methods: A retrospective review of 66 patients from May 2015 to June 2017. The patients were diagnosed as having GS and were suspected of also having CBDS. They were divided into two groups: Group I had 41 patients and Group II had 25 patients. The baseline characteristics, operative findings and outcomes including success rate, operative time, postoperative complications and the Length Of Hospital Stay (LOS) of the two groups were compared. Results: There were no significant difference between the operative outcomes of the two groups regarding the CBDS cannulation rate (95.1% versus 100.0%) and clearance rate (89.7% versus 80.0%). The cannulation rate difference was -5.0% (95% CI=-11.5to1.7; p-value=0.26) and the clearance rate difference was 9.7% (95% CI=-8.6 to 28.1; p-value=0.27). Postoperative complications showed no statistically significant difference, however the LOS was significantly lower in group I with a mean difference of -4.0 days (95% CI=-5.4 to -2.6; p-value

Background. Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. A large number of studies have strongly described larger proportions of men being afflicted with NAFLD than women; however, recent studies investigating the role of gender and NAFLD have exposed the contrary. Methods. This cross-sectional study utilized data from the baseline survey of an ongoing cohort study called the Cholangiocarcinoma Screening and Care Program (CASCAP), conducted in the northeastern region of Thailand between March 2013 and September 2015. Information regarding socio-demographic, including gender, was collected using a standardized self-administered questionnaire. NAFLD was diagnosed with ultrasonography by board-certified radiologists. A binomial regression was used for estimating the prevalence differences, odds ratios (OR) and the 95% confidence intervals (CI) of NAFLD between men and women. Results. A total of 34,709 participants (27,073 females and 7,636 males) were recruited. The prevalence of NAFLD in women was 22.9% (95% CI: 22.5 to 23.5), whereas it was only 18.3% (95% CI: 17.4 to 19.2) in men. After adjusting for age and presence of diabetes mellitus and other underlying diseases, the prevalence was significantly higher in women, with adjusted prevalence difference of 4.2% (95% CI: 3.2 to 5.2) and adjusted OR of 1.3 (95% CI: 1.2 to 1.4). Women had a higher prevalence of NAFLD than men in all age groups and the largest difference was found in those aged 56-60 years (prevalence = 27.4% versus 21.2%; adjusted prevalence difference = 9.4%; 95% CI: 7.9 to 10.9; adjusted OR = 1.8; 95% CI: 1.8 to 2.0). Conclusion. NAFLD is more likely to affect women more than men, in particular, among the population 56-60 years of age, which is the post-menopausal transitional period. Therefore, post-menopausal women should be the target for interventions or further investigation for NAFLD.

Background. Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. A large number of studies have strongly described larger proportions of men being afflicted with NAFLD than women; however, recent studies investigating the role of gender and NAFLD have exposed the contrary. Methods. This cross-sectional study utilized data from the baseline survey of an ongoing cohort study called the Cholangiocarcinoma Screening and Care Program (CASCAP), conducted in the northeastern region of Thailand between March 2013 and September 2015. Information regarding socio-demographic, including gender, was collected using a standardized self-administered questionnaire. NAFLD was diagnosed with ultrasonography by board-certified radiologists. A binomial regression was used for estimating the prevalence differences, odds ratios (OR) and the 95% confidence intervals (CI) of NAFLD between men and women. Results. A total of 34,709 participants (27,073 females and 7,636 males) were recruited. The prevalence of NAFLD in women was 22.9% (95% CI: 22.5 to 23.5), whereas it was only 18.3% (95% CI: 17.4 to 19.2) in men. After adjusting for age and presence of diabetes mellitus and other underlying diseases, the prevalence was significantly higher in women, with adjusted prevalence difference of 4.2% (95% CI: 3.2 to 5.2) and adjusted OR of 1.3 (95% CI: 1.2 to 1.4). Women had a higher prevalence of NAFLD than men in all age groups and the largest difference was found in those aged 56-60 years (prevalence = 27.4% versus 21.2%; adjusted prevalence difference = 9.4%; 95% CI: 7.9 to 10.9; adjusted OR = 1.8; 95% CI: 1.8 to 2.0). Conclusion. NAFLD is more likely to affect women more than men, in particular, among the population 56-60 years of age, which is the post-menopausal transitional period. Therefore, post-menopausal women should be the target for interventions or further investigation for NAFLD.

Objective: To study the effect of a 50 mg caffeine coffee consumption on bowel function recovery after cesarean delivery. Materials and Methods: A randomized controlled trial was conducted. One hundred sixty-two post-cesarean delivery patients were enrolled and allocated to one of the two groups, Group 1, which included 81 volunteers, with a cup of 50 mg caffeine coffee and Group 2, which also included 81 volunteers, with a cup of warm water at postpartum ward, two hours after the operation. The primary outcome was to compare the time to first flatus after surgery between patients of each group. The secondary outcome was to compare the time to first defecation, time to tolerate a solid diet, and the incidence of postoperative ileus between groups. Results: The mean time to first flatus and standard deviation was 28.93±20.20 and 30.52±16.27 hours, time to first defecation was 62.45±28.00 and 63.45±25.53 hours, and the incidence of postoperative ileus was 17.28% and 19.75%. All results in both groups were not significantly different in the 50 mg caffeine coffee group and the warm water group. Conclusion: Drinking coffee with a cup of 50 mg caffeine coffee after cesarean delivery did not significantly improve the bowel function recovery. The higher dosage of caffeine coffee needs further studies. [ABSTRACT FROM AUTHOR]

Background. Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. A large number of studies have strongly described larger proportions of men being afflicted with NAFLD than women; however, recent studies investigating the role of gender and NAFLD have exposed the contrary. Methods. This cross-sectional study utilized data from the baseline survey of an ongoing cohort study called the Cholangiocarcinoma Screening and Care Program (CASCAP), conducted in the northeastern region of Thailand between March 2013 and September 2015. Information regarding socio-demographic, including gender, was collected using a standardized self-administered questionnaire. NAFLD was diagnosed with ultrasonography by board-certified radiologists. A binomial regression was used for estimating the prevalence differences, odds ratios (OR) and the 95% confidence intervals (CI) of NAFLD between men and women. Results. A total of 34,709 participants (27,073 females and 7,636 males) were recruited. The prevalence of NAFLD in women was 22.9% (95% CI: 22.5 to 23.5), whereas it was only 18.3% (95% CI: 17.4 to 19.2) in men. After adjusting for age and presence of diabetes mellitus and other underlying diseases, the prevalence was significantly higher in women, with adjusted prevalence difference of 4.2% (95% CI: 3.2 to 5.2) and adjusted OR of 1.3 (95% CI: 1.2 to 1.4). Women had a higher prevalence of NAFLD than men in all age groups and the largest difference was found in those aged 56-60 years (prevalence = 27.4% versus 21.2%; adjusted prevalence difference = 9.4%; 95% CI: 7.9 to 10.9; adjusted OR = 1.8; 95% CI: 1.8 to 2.0). Conclusion. NAFLD is more likely to affect women more than men, in particular, among the population 56-60 years of age, which is the post-menopausal transitional period. Therefore, post-menopausal women should be the target for interventions or further investigation for NAFLD.

Objective: To study the incidence and factors associated with inadequate endometrial tissue for pathological evaluation from uterine curettage in patients with abnormal uterine bleeding (AUB) at Udon Thani Hospital. Materials and Methods: The electronic medical records of women aged 35 years and older with AUB that underwent endometrial curettage in a regional hospital between October 2018 and November 2019 were retrospectively reviewed. The incidence of inadequate endometrial tissue for pathological evaluation was studied. Multiple logistic regression analysis was performed to determine the factors associated with inadequate curettage. Results: Three hundred fifty-two patients with AUB that underwent endometrial tissue curettage and had complete medical records were included in the present study. The mean age was 48.09±8.01 years. The incidence of inadequate endometrial tissue for pathological evaluation was 23.30% (95% CI 18.98 to 28.07). Postmenopausal status (adjusted OR 3.80, 95% CI 1.93 to 7.50), the low experience of the clinician (adjusted OR 2.20, 95% CI 1.15 to 3.87), and the uterine cavity length measured by uterine sound (adjusted OR 0.66 for each 1 cm increment, 95% CI 0.54 to 0.80) were significant factors associated with inadequate tissue for pathological evaluation. Conclusion: The incidence of inadequate endometrial tissue for pathological evaluation from endometrial curettage was one-quarter of all cases. The associated factors of inadequate endometrial tissue included postmenopausal status, inexperience operators, and shorter uterine length. [ABSTRACT FROM AUTHOR]

Introduction & Objective: EUS-guided biliary drainage (EUS-BD) has been increasingly used for the management of high grade malignant biliary obstruction (HGMBO). Nevertheless, the type of stent that is most suitable for EUS-BD remains controversial. The aim of the present study was to compare operative outcomes between fully covered self-expandable metal stent (FCSEMS) and partially covered self-expandable metal stent (PCSEMS) in HGMBO patients. Methods: The present retrospective cohort study included HGMBO patients who underwent EUS-BD between April 2017 and August 2020. The endpoints were operative outcomes after stent placement. Two-step analysis was performed. Logistic regression was used to calculate a propensity score (PS). Multi-level mixed model stratified by PS were used for comparing the primary and secondary outcomes between groups and are presented in term of adjusted RR, mean difference, hazard ratios and their 95% confidence intervals. Results: There were 53 patients in the study, 41 in the PCSEMS group and 12 in the FCSEMS group. Baseline characteristics were not statistically different. After adjusting for PS, by using the PCSEMS group as the reference, there were no statistically significant differences in the outcomes between PCSEMS and FCSEMS. These include technical success rates (both 100%), clinical success rates (89% vs. 67%; p = 0.489), early and late complications (5% vs 8%; p = 0.493 and 50% vs. 92%; p = 0.110, respectively). Moreover, overall deaths were not significant different (83% vs. 100%; p = 0.971). Conclusion: FCSEMS and PCSEMS in HGMBO were comparable in terms of technical and clinical success. However, PCSEMS patients were less likely to die or have late complications. [ABSTRACT FROM AUTHOR]