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Gabarrell-Pascuet A, Domènech-Abella J, Rod NH, Varga TV. Variations in sociodemographic and health-related factors are linked to distinct clusters of individuals with depression based on the PHQ-9 instrument: NHANES 2007-2018. J Affect Disord 2023; 335:95-104. [PMID: 37156277 DOI: 10.1016/j.jad.2023.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Depression is a heterogeneous disease. Identification of latent depression subgroups and differential associations across these putative groups and sociodemographic and health-related factors might pave the way toward targeted treatment of individuals. METHODS We used model-based clustering to identify relevant subgroups of 2900 individuals with moderate to severe depression (defined as scores ≥10 on the PHQ-9 instrument) from the NHANES cross-sectional survey. We used ANOVA and chi-squared tests to assess associations between cluster membership and sociodemographics, health-related variables, and prescription medication use. RESULTS We identified six latent clusters of individuals, three based on depression severity and three differentially loaded by somatic and mental components of the PHQ-9. The Severe mental depression cluster had the most individuals with low education and income (P < 0.05). We observed differences in the prevalence of numerous health conditions, with the Severe mental depression cluster showing the worst overall physical health. We observed marked differences between the clusters regarding prescription medication use: the Severe mental depression cluster had the highest use of cardiovascular and metabolic agents, while the Uniform severe depression cluster showed the highest use of central nervous system and psychotherapeutic agents. LIMITATIONS Due to the cross-sectional design we cannot make conclusions about causal relationships. We used self-reported data. We did not have access to a replication cohort. CONCLUSIONS We show that socioeconomic factors, somatic diseases, and prescription medication use are differentially associated with distinct and clinically relevant clusters of individuals with moderate to severe depression.
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Affiliation(s)
- Aina Gabarrell-Pascuet
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Joan Domènech-Abella
- Epidemiology of Mental Health Disorders and Ageing Research Group, Sant Joan de Déu Research Institute, Esplugues de Llobregat, Spain; Research, Teaching, and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
| | - Naja H Rod
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Tibor V Varga
- Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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Maștaleru A, Abdulan IM, Ștefăniu R, Lefter N, Sandu IA, Pîslaru AI, Leon-Constantin MM, Alexa ID, Ilie AC. Relationship between Frailty and Depression in a Population from North-Eastern Romania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095731. [PMID: 35565126 PMCID: PMC9099999 DOI: 10.3390/ijerph19095731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/25/2022]
Abstract
(1) Background: In the older population, depression often affects people with chronic medical illnesses, cognitive impairment, or disability. Frailty is another important issue affecting older adults, being difficult to clinically distinguish from frailty in advanced old age. Well-designed interventional studies and clinical strategies targeting both frailty and depression are rare or nonexistent. (2) Methods: We realized a retrospective study in which we included a total of 411 patients that were admitted to the Geriatric Clinic from “Dr. C. I. Parhon” Hospital from Iasi for a period of 13 months. The aim of our study was to investigate the relationship between depression and frailty in a geriatric population due to the fact that the quality of life is negatively influenced by both frailty and depression. (3) Results: The prevalence of the depressive symptoms screened by the GDS-15 was 66.7%, with women being more depressed than men. Furthermore, an obvious relationship between depression and the dependence degree in performing daily activities has been observed. In addition, the mean MMSE score decreased with an increasing degree of depression. (4) Conclusions: Our study demonstrates the association between frailty and depression, one of them being a risk factor in the development of the other. A poor acknowledgment of the problem and an underdiagnosis of these conditions are important public health concerns due to the high healthcare costs. Thus, an active primary prevention would be imperiously needed in order to diagnose frailty and depression at an early stage, increasing the quality of life of the elderly and also their successful aging.
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Affiliation(s)
- Alexandra Maștaleru
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
| | - Irina Mihaela Abdulan
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (I.M.A.); (M.M.L.-C.)
| | - Ramona Ștefăniu
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (R.Ș.); (N.L.); (I.A.S.); (A.I.P.); (I.D.A.); (A.C.I.)
| | - Nicoleta Lefter
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (R.Ș.); (N.L.); (I.A.S.); (A.I.P.); (I.D.A.); (A.C.I.)
| | - Ioana Alexandra Sandu
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (R.Ș.); (N.L.); (I.A.S.); (A.I.P.); (I.D.A.); (A.C.I.)
| | - Anca Iuliana Pîslaru
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (R.Ș.); (N.L.); (I.A.S.); (A.I.P.); (I.D.A.); (A.C.I.)
| | - Maria Magdalena Leon-Constantin
- Department of Medical Specialties I, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania;
- Correspondence: (I.M.A.); (M.M.L.-C.)
| | - Ioana Dana Alexa
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (R.Ș.); (N.L.); (I.A.S.); (A.I.P.); (I.D.A.); (A.C.I.)
| | - Adina Carmen Ilie
- Department of Medical Specialties II, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iaşi, Romania; (R.Ș.); (N.L.); (I.A.S.); (A.I.P.); (I.D.A.); (A.C.I.)
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The relationship between physical activity and polypharmacy with Ikigai in a population. EUREKA: HEALTH SCIENCES 2022. [DOI: 10.21303/2504-5679.2022.002348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim: The Japanese word “ikigai” indicates “something to live for” and “having a purpose in life”. Ikigai or well-being, has been associated with many positive outcomes in the physical and mental health of elderly people. In this study, the relationship between ikigai and level of physical activity and polypharmacy was examined in a Turkish population.
Material and methods: Both telephonic interviews and face-to-face interviews were conducted with 307 participants (59.2 % women) who completed the Ikigai-9 Turkey Scale and provided demographic information.
Results: Correlations between groups (polypharmacy vs. non-polypharmacy) were analyzed with an independent t-test and analysis of variance. The means of the ikigai scores were statistically significant in the polypharmacy (24.04±8.72) and non-polypharmacy 32.64±7.53) groups (p<0.05). The number of drugs used was negatively correlated with duration of exercise per week (1.32±1.82, correlation coefficient = 0.538, p<0.05).
Conclusions: The level of ikigai was negatively correlated with polypharmacy and positively correlated with duration of physical activity. An individual’s ikigai should be assessed by healthcare providers to maximize positive outcomes later in life
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Mesonero F, Fernández C, Sánchez-Rodríguez E, García-García Paredes A, Senosiain C, Albillos A, López-Sanromán A. Polypharmacy in Patients With Inflammatory Bowel Disease: Prevalence and Outcomes in a Single-center Series. J Clin Gastroenterol 2022; 56:e189-e195. [PMID: 34864790 PMCID: PMC8843391 DOI: 10.1097/mcg.0000000000001647] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/10/2021] [Indexed: 12/10/2022]
Abstract
BACKGROUND Polypharmacy can complicate the course and management of chronic diseases, and has been little explored in patients with inflammatory bowel disease (IBD) to date. AIM The aim of this study was to determine the prevalence of polypharmacy in a series of IBD patients, describing associated factors and its correlation with poor disease outcomes. MATERIALS AND METHODS Retrospective study of a single-center series. Polypharmacy was defined as the simultaneous use of 5 or more drugs. Disease outcomes, IBD treatment nonadherence and undertreatment were evaluated at 1 year. RESULTS A total of 407 patients were included [56% males, median age: 48 y (interquartile range, 18 to 92 y)], of whom 60.2% had Crohn's disease; Chronic comorbidity and multiple comorbidities were present in 54% and 27% of patients, respectively. Median number of prescriptions per patient was 3 (range: 0 to 15). Polypharmacy was identified in 18.4% of cases, inappropriate medication in 10.5% and use of high-risk drugs in 6.1% (mainly opioids). In multivariate analysis, polypharmacy was associated with chronic comorbidity [odds ratio (OR)=10.1, 95% confidence interval (CI): 2.14-47.56; P˂0.003], multiple comorbidities (OR=3.53, 95% CI: 1.46-8.51; P=0.005) and age above 62 years (OR=3.54, 95% CI: 1.67-7.51; P=0.001). No association with poor disease outcomes was found at 12 months. However, polypharmacy was the only factor associated with IBD treatment nonadherence (OR=2.24, 95% CI: 1.13-4.54, P=0.02). CONCLUSIONS Polypharmacy occurs in around 1 in 5 patients with IBD, mainly in older adults and those with comorbidity. This situation could interfere with adherence to IBD treatment and therapeutic success.
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Chen C, Feng Z, Fu Q, Wang J, Zheng Z, Chen H, Feng D. Predictors of Polypharmacy Among Elderly Patients in China: The Role of Decision Involvement, Depression, and Taking Chinese Medicine Behavior. Front Pharmacol 2021; 12:745688. [PMID: 34938179 PMCID: PMC8685318 DOI: 10.3389/fphar.2021.745688] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction: The prevalence of polypharmacy is gradually increasing in geriatrics, which may contribute to adverse effects, such as potential drug-drug and drug-disease interactions. These side effects remain an important challenge in patient safety, which has a significant impact on mortality and incidence rate. Aims: Therefore, this study aims to understand the epidemiology of polypharmacy and identify factors that have an impact on the management of potentially inappropriate prescribing. Methods: This study is a cross-sectional study, analyzing the prescription data from 720 hospitalized patients aged 50+ with a random cluster sampling method. We used inverse probability treatment weighting (IPTW) method to group and match polypharmacy and non-polypharmacy patients, and logistic regression was conducted to explore the factors associated with polypharmacy. Results: The prevalence of polypharmacy accounted for 50.14% among the old patients in this study. Female patients (67.34%) have more polypharmacy than male patients, and key predictors associated with polypharmacy in the logistic regression model included the following: domicile (AOR = 0.63, 95% CI 0.42-0.95), annual income (AOR = 0.38, 95% CI 0.20-0.70), the number of chronic diseases (AOR = 3.68, 95% CI 2.69-5.06), taking Chinese medicine (AOR = 1.70, 95% CI 1.22-2.36), decision involvement (AOR = 1.49 95% CI 1.10-2.03), and depression (AOR = 1.42, 95% CI 1.03-1.96). Conclusion: Polypharmacy is common among the participants with chronic diseases in Hubei province, China. The study emphasizes that gerontology practitioners should be prudent in applying clinical guidelines to provide personalized, comprehensive assessment of decision making of prescriptions, especially in socioeconomically deprived areas.
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Affiliation(s)
- Chaoyi Chen
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zhanchun Feng
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qian Fu
- School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wang
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Zehao Zheng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Hao Chen
- Second People's Hospital of Yichang City, Yichang, China
| | - Da Feng
- School of Pharmacy, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
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Prevalence and Factors Associated with Potential Drug-Drug Interactions in Older Community-Dwelling Adults: A Prospective Cohort Study. Drugs Aging 2021; 38:1025-1037. [PMID: 34632551 PMCID: PMC8594274 DOI: 10.1007/s40266-021-00898-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/04/2022]
Abstract
Background Older patients are at increased risk of drug-drug interactions (DDIs) due to polypharmacy. Cardiovascular and central nervous system (CNS) drugs are commonly implicated in serious DDIs. Objectives This study aimed to determine the prevalence and factors associated with potential ‘severe’ cardiovascular and CNS DDIs among older (≥ 70 years) community-dwellers. Methods This was a prospective cohort study using linked data from a national pharmacy claims database and waves 1 and 2 of The Irish LongituDinal study on Ageing (TILDA). ‘Severe’ cardiovascular and CNS DDIs were identified using the British National Formulary 77 and Stockley’s Drug Interactions. The prevalence of ‘severe’ DDIs (any DDI vs. none) was calculated. Logistic regression was used to examine the association between sociodemographic, functional ability, and medication-related factors and the risk of DDI exposure between waves 1 and 2. Results A total of 1466 patients were included [mean age (standard deviation) = 78 (5.5) years; female n = 795, 54.2%]. In total, 332 community-dwellers aged ≥ 70 years [22.65%, 95% confidence interval (CI) 20.58–24.86] were potentially exposed to at least one ‘severe’ cardiovascular or CNS DDI, with more than half (54.82%) of this cohort dispensed the same DDI for a prolonged time (≥ 3 consecutive claims). Aspirin-warfarin was the most frequently dispensed (co-prescribed) DDI (n = 34, 10.24%, 95% CI 7.39–14.00), followed by atorvastatin-clarithromycin (n = 19, 5.72%, 95% CI 3.64–8.81). Polypharmacy [≥ 10 vs. < 5 drugs, odds ratio (OR) 13.40, 95% CI 8.22–21.85] and depression (depressed vs. not, OR 2.12, 95% CI 1.34–3.34) were significantly associated with these DDIs, after multivariable adjustment. Conclusion ‘Severe’ cardiovascular and CNS DDIs are prevalent in older community-dwellers in Ireland, and those with polypharmacy and depression are at a significantly increased risk. Supplementary Information The online version contains supplementary material available at 10.1007/s40266-021-00898-8.
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Hsu HF, Chen KM, Belcastro F, Chen YF. Polypharmacy and pattern of medication use in community-dwelling older adults: A systematic review. J Clin Nurs 2020; 30:918-928. [PMID: 33325067 DOI: 10.1111/jocn.15595] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/13/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
AIM To synthesise current study findings on the diseases and the corresponding medications that are potentially associated with polypharmacy in community-dwelling older adults. BACKGROUND Polypharmacy is receiving increased attention as a potential problem for the older population. Although several scientific investigations have studied polypharmacy, most of them were carried out in long-term care facilities or mixed settings rather than in community settings solely. METHODS This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Relevant studies published in the English language in peer-reviewed journals were identified from searches of seven electronic databases for the period of January 2000 through December 2019. Inclusion criteria were: (1) Participants were older adults aged 65 years and older; (2) Polypharmacy was defined by medication count; (3) Medication classes associated with polypharmacy were revealed; (4) Studies were conducted in outpatient care or community settings. The Joanna Briggs Institute critical appraisal checklists for cross-sectional studies and for cohort studies were used to assess the methodological quality. RESULTS Ten studies were considered having appropriate and acceptable quality to be reviewed, comprising nine cross-sectional studies and one cohort study. Polypharmacy was most defined as concurrently using five or more medications. Polypharmacy prevalence ranged between 7%-45%. Older age, comorbidity, poor self-perceived health status, limitations in physical activity, history of falls, depression, and pain were positively associated with polypharmacy. The most prevalent medication taken by older adults with polypharmacy was cardiovascular drugs. CONCLUSIONS The prevalence of polypharmacy in older adults varying widely may be due to geographical locations, clinical practice guidelines, and polypharmacy definition used. RELEVANCE TO CLINICAL PRACTICE Validated measurements to investigate medications associated with polypharmacy are required. How polypharmacy develops over time needs to be investigated in longitudinal studies in order to formulate strategies for reducing polypharmacy.
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Affiliation(s)
- Hui-Fen Hsu
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kuei-Min Chen
- College of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Frank Belcastro
- Department of Education and Psychology, University of Dubuque, Dubuque, IA, USA
| | - Yih-Fung Chen
- Graduate Institute of Natural Products, College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
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Wongpakaran N, Wongpakaran T, Sirirak T, Jenraumjit R, Jiraniramai S, Lerttrakarnnon P. Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study. BMC Geriatr 2018; 18:309. [PMID: 30541459 PMCID: PMC6292154 DOI: 10.1186/s12877-018-1001-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/30/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Polypharmacy is a geriatric syndrome defined variously as the use of potentially inappropriate drugs and/or the concurrent use of multiple medications including prescription and over-the-counter drugs. An association has been shown between polypharmacy and physical health, increased morbidity and increased mortality. However, there is little information regarding the association between polypharmacy and physical disease, personality trait and mental health problems in elderly. The aim of this study was to investigate potential predictive psychosocial factors related to polypharmacy in elderly Thai people. METHODS The study analysed the secondary data from the Depressive Disorders, Anxiety Disorders, Suicide Risk and Associated Factors Among Elderly Thai People Program (DAS Study) which was funded by National Research Council of Thailand and conducted between January 2012 and April 2013. Demographic and baseline clinical characteristics including sex, age, education, living alone or with others, access to health care privilege and monthly income were described. The number of medication, physical diseases and mental health problems (i.e. depression, anxiety, and personality trait of neuroticism) were analyzed using descriptive statistics, chi-square and proportional odds logistic regression. RESULTS The 803 participants consumed an average of 2.13 prescribed medicines daily (SD 1.46, median = 2). The largest group used 3 medications (18.6%). Predictors found to be associated with polypharmacy in the logistic regression model included hypertension (OR = 1.985, 95% CI = 1.420-2.775), anxiety disorder (OR = 4.402, 95% CI = 2.630-7.367), number of diseases (OR = 2.140, 95% CI = 1.874-2.445), depressive disorder (OR = 1.470, 95% CI = 1.080-2.001), diabetes mellitus (OR = 1.864, 95% CI = 1.122-3.098) and dyslipidemia (OR = 0.511, 95%CI = 0.325-0.803). CONCLUSIONS The prevalence of polypharmacy among Thai elderly was relatively high compared to other related studies. Several aspects should be taken into consideration before starting an additional medication in elderly patients. In addition to the number of physical disease that leads to polypharmacy, general practitioners should be aware of anxiety, depression, and personality trait of neuroticism that may be related to polypharmacy. Early detection for such condition as well as non-pharmacological intervention could be one way to help reduce polypharmacy in the elderly.
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Affiliation(s)
- Nahathai Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Tinakon Wongpakaran
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Thanitha Sirirak
- Department of Family Medicine and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, 90112, Thailand
| | - Rewadee Jenraumjit
- Department of Pharmaceutical care, Faculty of Pharmacy, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Surin Jiraniramai
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand
| | - Peerasak Lerttrakarnnon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200, Thailand.
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