The predictors of voluntary participation in pulmonary tuberculosis screening program: a study in a suburban community of southern Thailand

Background

The health belief model (HBM), baseline health condition, and sociocultural factors impact the decision to participate in a tuberculosis screening program.

Methods

This cross-sectional and descriptive study was carried out among the "Kao Taew" community dwellers aged 18 years and above, who voluntarily underwent the provided pulmonary tuberculosis (PTB) screening by chest radiographs (CXRs). The level of individual HBM domain perception, attitudes toward PTB prevention, and regularity of PTB prevention practices by the participants were evaluated. The significantly associated or correlated factors such as demographic characteristics, individual HBM domain perception, and attitudes toward PTB prevention with the regularity of PTB prevention practices from the univariate analysis were further analyzed by multiple linear regression (p < 0.05) to determine the independent significant predictors of PTB prevention practices.

Results

Among 311 participants comprising 65% women, 57.9% aged ≥ 65 years and 67.2% had an underlying disease. The study participants had a high level of perception of HBM domains but a low level of perception of the barrier. In addition, a high level of attitudes toward PTB prevention and a high regularity of PTB prevention practices were found. A multiple linear regression analysis revealed that the perceived benefits of PTB screening [Beta = 0.20 (0.04, 0.36) p = 0.016] and acquiring underlying diseases [Beta = 1.06 (0.38, 1.73), p = 0.002] were significant predictors for PTB prevention practices, while belief in Islam was a reverse predictor [Beta = -0.84 (-1.47, -0.21), p = 0.010].

Conclusions

The level of perception of the individual domain of HBM, health status, and religious belief significantly predicted voluntary participation in PTB screening programs. Careful consideration by integration of the relevant health psychology, physical, and sociocultural factors is crucial for planning a health screening program.

Health-related quality of life in Thai patients with chronic hepatitis B

Background

Chronic hepatitis B (CHB) significantly impacts the health-related quality of life (HRQoL), but remains underexplored in the Thai population. Health state utilities (HSU) are indicators reflecting HRQoL which serve as fundamental inputs for economic evaluation analyses. This study aimed at assessing differences in HRQoL across five CHB stages in Thai patients, including non-cirrhotic CHB, compensated cirrhosis, decompensated cirrhosis, early-/intermediate-stage hepatocellular carcinoma (HCC) and advanced-/terminal-stage HCC.

Methods

We conducted a cross-sectional study to collect HRQoL data from patients with CHB at five stages. The study included patients with CHB who were followed up at a super-tertiary care centre between March 2021 and February 2022. The participants completed the EQ-5D-5L questionnaire and provided demographic data. Disease stage and relevant data were obtained from medical records. HSU and Euroqol-visual analogue scale (EQ-VAS) scores, calculated using Thai-specific conversion coefficients, were assessed.

Results

Among 422 patients, 236 did not have cirrhosis, 92 had compensated cirrhosis, 13 had decompensated cirrhosis, 55 had early-/intermediate-stage HCC, and 26 had advanced-/terminal-stage HCC. The HSU scores for non-cirrhotic, compensated cirrhosis, decompensated cirrhosis, early-/intermediate-stage HCC and advanced-/terminal-stage HCC were 0.95 ± 0.08, 0.89 ± 0.16, 0.79 ± 0.19, 0.89 ± 0.12 and 0.52 ± 0.39, respectively. Similarly, the EQ-VAS scores for various CHB stages were 83.56 ± 12.90, 80.48 ± 13.03, 68.76 ± 17.40, 79.00 ± 14.38 and 62.92 ± 20.62, respectively. A significant correlation (r = 0.469, P < 0.001) was observed between the HSU and EQ-VAS scores. The disease progression led to a notable HSU decline, particularly in the advanced-/terminal-stage HCC group (regression coefficient: -0.436, P < 0.001). The EQ-VAS scores indicated reduced quality of life in advanced liver disease.

Conclusions

Later CHB stages compromise the HRQoL. Decompensated cirrhosis and advanced-/terminal-stage HCC profoundly affect physical health and quality of life, whereas patients with compensated cirrhosis and early-/intermediate-stage HCC report better HRQoL.

SARS-CoV-2 variant with the spike protein mutation F306L in the southern border provinces of Thailand

The southernmost part of Thailand is a unique and culturally diverse region that has been greatly affected by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) outbreak during the coronavirus disease-2019 pandemic. To gain insights into this situation, we analyzed 1942 whole-genome sequences of SARS-CoV-2 obtained from the five southernmost provinces of Thailand between April 2021 and March 2022, together with those publicly available in the Global Initiative on Sharing All Influenza Data database. Our analysis revealed evidence for transboundary transmissions of the virus in and out of the five southernmost provinces during the study period, from both domestic and international sources. The most prevalent viral variant in our sequence dataset was the Delta B.1.617.2.85 variant, also known as the Delta AY.85 variant, with many samples carrying a non-synonymous mutation F306L in their spike protein. Protein-protein docking and binding interface analyses suggested that the mutation may enhance the binding between the spike protein and host cell receptor protein angiotensin-converting enzyme 2, and we found that the mutation was significantly associated with an increased fatality rate. This mutation has also been observed in other SARS-CoV-2 variants, suggesting that it is of particular interest and should be monitored.

Factors associated with the worsening of COVID-19 symptoms among cohorts in community- or home-isolation care in southern Thailand

Introduction

This study aimed to investigate factors associated with time-to-referral due to worsening symptoms in patients with laboratory-confirmed COVID-19 in southern Thailand. While underlying diseases have been evaluated to assess COVID-19 severity, the influence of vaccinations and treatments is also crucial.

Methods

A cohort of 8,638 patients quarantined in home or community isolation with laboratory-confirmed COVID-19 was analyzed. Survival analysis and the Cox proportional hazard ratio were employed to assess factors influencing time-toreferral.

Results

Age ≥ 60 years, neurologic disorders, cardiovascular disease, and human immunodeficiency virus infection were identified as significant risk factors for severe COVID-19 referral. Patients who received full- or booster-dose vaccinations had a lower risk of experiencing severe symptoms compared to unvaccinated patients. Notably, individuals vaccinated during the Omicron-dominant period had a substantially lower time-to-referral than those unvaccinated during the Delta-dominant period. Moreover, patients vaccinated between 1 and 6 months prior to infection had a significantly lower risk of time-to-referral than the reference group.

Discussion

These findings demonstrate early intervention in high-risk COVID-19 patients and the importance of vaccination efficacy to reduce symptom severity. The study provides valuable insights for guiding future epidemic management strategies and optimising patient care during infectious disease outbreaks.

Maternal-neonatal events resulting from medications for preventing hypertensive disorders in high-risk pregnant women: A systematic review and network meta-analysis

BACKGROUND

There have been few studies reporting on maternal and neonatal events in high-risk pregnant women receiving medications for preventing hypertensive disorders of pregnancy (HDP).

OBJECTIVE

To identify placental abruption, postpartum hemorrhage, neonatal intraventricular hemorrhage, and neonates with small for gestational age (SGA) or growth restriction resulting from medications for preventing HDP in high-risk pregnant women using a network meta-analysis.

SEARCH STRATEGY

All randomized controlled trials comparing the most commonly used medications (antiplatelet agents, anticoagulants, antioxidants, nitric oxide, and calcium) for preventing HDP in high-risk pregnant women were searched from the Cochrane Pregnancy and Childbirth's Specialized Register of Controlled Trials until July 31, 2020, without language restriction.

SELECTION CRITERIA

Two of the authors independently selected the eligible trials.

DATA COLLECTION AND ANALYSIS

Two authors independently extracted the data and assessed the methodological quality of the included trials. Pairwise and network meta-analyses were used to determine comparative risk ratios and 95% confidence intervals.

MAIN RESULTS

The 51 included trials involved 69 669 pregnant women. Compared with placebo/no treatment, antioxidants slightly reduced placental abruption with high-certainty evidence. Antiplatelet agents probably reduced SGA with low-certainty evidence and slightly increased neonatal intraventricular hemorrhage with moderate-certainty evidence.

CONCLUSION

Antiplatelet agents probably reduce SGA, but neonatal intraventricular hemorrhage should be monitored.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO, CRD42018096276.

Teamwork Management and Benefit of Telemedicine in COVID-19 Outbreak Control on an Offshore Vessel in the Gulf of Thailand, Songkhla Province, Thailand: A Case Report

In May 2021, there was a COVID-19 outbreak on board a construction support ship traveling from India to Thailand. Controlling the outbreak on this offshore vessel from 11 May to 2 June 2021 was applied. This case report describes the teamwork management of COVID-19 control on the vessel in the Gulf of Thailand. We summarized the COVID-19 outbreak control process on board, including active COVID-19-infected cases (CoIC) and close contacts (CoCC) identification, isolation, quarantine, treatment, and clinical monitoring using telemedicine to report their health measurements twice daily, including emergency conditions if they occurred. Active COVID-19 cases were identified by two rounds of reverse transcription polymerase chain reaction (RT-PCR) tests in all crew members, in which 7 of 29 (24.1%) showed positive results. Both the CoIC and CoCC were strictly and absolutely isolated and quarantined on the vessel. No serious medical conditions were reported during the monitoring. The third-round RT-PCR tests were conducted, and all tested negative one week later. Teamwork management in proactive COVID-19 case identification, isolation, comprehensive treatment, and close monitoring of health conditions using telemedicine devices is beneficial for controlling the COVID-19 outbreak on board.

Role of health locus of control in preventing occupational decompression sickness among deep-sea fisherman divers

Background

Indigenous fisherman divers frequently experience decompression sickness (DCS). This study aimed to evaluate the associations between the level of knowledge of safe diving, beliefs in the health locus of control (HLC), and regular diving practices with DCS among the indigenous fisherman divers on Lipe island. The correlations among the level of beliefs in HLC, knowledge of safe diving and regular diving practices were evaluated also.

Method

We enrolled the fisherman divers on Lipe island and collected their demographics, health indices, levels of knowledge of safe diving, beliefs in external and internal HLC (EHLC and IHLC), and regular diving practices to evaluate the associations with the occurrence of DCS by logistic regression analysis. Pearson's correlation was used to test the correlations among the level of beliefs in IHLC and EHLC, knowledge of safe diving, and regular diving practices.

Results

Fifty-eight male fisherman divers whose mean age was 40.39 (±10.61) (range 21-57) years were enrolled. Twenty-six (44.8%) participants had experienced DCS. Body mass index (BMI), alcohol consumption, diving depth, duration of time in the sea/dive, level of beliefs in HLC and regular diving practices were significantly associated with DCS (p < 0.05). Level of belief in IHLC had a significantly strong reverse correlation with that in EHLC and a moderate correlation with level of knowledge of safe diving and regular diving practices. By contrast, level of belief in EHLC had a significantly moderate reverse correlation with level of knowledge of safe diving and regular diving practices (p < 0.001).

Conclusions

Encouraging the fisherman divers' belief in IHLC could be beneficial for their occupational safety.

Exploring the Complex Phenotypes of Impaired Finger Dexterity in Mild-to-moderate Stage Parkinson's Disease: A Time-Series Analysis

BACKGROUND

Impaired dexterity is an early motor symptom in Parkinson's disease (PD) that significantly impacts the daily activity of patients; however, what constitutes complex dexterous movements remains controversial.

OBJECTIVE

To explore the characteristics of finger dexterity in mild-to-moderate stage PD.

METHODS

We quantitatively assessed finger dexterity in 48 mild-to-moderate stage PD patients and 49 age-matched controls using a simple alternating two-finger typing test for 15 seconds. Time-series analyses of various kinematic parameters with machine learning were compared between sides and groups.

RESULTS

Both the more and less affected hands of patients with PD had significantly lower typing frequency and slower typing velocity than the non-dominant and the dominant hands of controls (p = 0.019, p = 0.016, p < 0.001, p < 0.001). The slope of the typing velocity decreased with time, indicating a sequence effect in the PD group. A typing duration of 6 seconds was determined sufficient to discriminate PD patients from controls. Typing error, repetition, and repetition rate were significantly higher in the more affected hands of patients with PD than in the non-dominant hand of controls (p < 0.001, p = 0.03, p < 0.001). The error rate was constant, whereas the repetition rate was steep during the initiation of typing. A predictive model of the more affected hand demonstrated an accuracy of 70% in differentiating PD patients from controls.

CONCLUSION

Our study demonstrated complex components of impaired finger dexterity in mild-to-moderate stage PD, namely bradykinesia with sequence effects, error, and repetition at the initiation of movement, suggesting that multiple neural networks may be involved in dexterity deficits in PD.

Integrative Effects between a Bubble and Seal Program and Workers' Compliance to Health Advice on Successful COVID-19 Transmission Control in a Factory in Southern Thailand

Applying health measures to prevent COVID-19 transmission caused disruption of businesses. A practical plan to balance public health and business sustainability during the pandemic was needed. Herein, we describe a "Bubble and Seal" (B&S) program implemented in a frozen seafood factory in southern Thailand. We enrolled 1539 workers who lived in the factory dormitories. First, the workers who had a high fatality risk were triaged by RT-PCR tests, quarantined and treated if they had COVID-19. Newly diagnosed or suspected COVID-19 workers underwent the same practices. The non-quarantined workers were regulated to work and live in their groups without contact across the groups. Workers' personal hygiene and preventive measures were strongly stressed. Between the 6th and 9th weeks of the program, the post-COVID-19 infection status (PCIS) of all participants was evaluated by mass COVID-19 antibody or RT-PCR tests. Finally, 91.8% of the workers showed positive PCIS, which was above the number required for program exit. Although no workers had received a vaccination, there was only one case of severe COVID-19 pneumonia, and no evidence of COVID-19 spreading to the surrounding communities. Implementation of the B&S program and workers' adherence to health advice was the key to this success.

Multi-label classification of symptom terms from free-text bilingual adverse drug reaction reports using natural language processing

Allergic reactions to medication range from mild to severe or even life-threatening. Proper documentation of patient allergy information is critical for safe prescription, avoiding drug interactions, and reducing healthcare costs. Allergy information is regularly obtained during the medical interview, but is often poorly documented in electronic health records (EHRs). While many EHRs allow for structured adverse drug reaction (ADR) reporting, a free-text entry is still common. The resulting information is neither interoperable nor easily reusable for other applications, such as clinical decision support systems and prescription alerts. Current approaches require pharmacists to review and code ADRs documented by healthcare professionals. Recently, the effectiveness of machine algorithms in natural language processing (NLP) has been widely demonstrated. Our study aims to develop and evaluate different NLP algorithms that can encode unstructured ADRs stored in EHRs into institutional symptom terms. Our dataset consists of 79,712 pharmacist-reviewed drug allergy records. We evaluated three NLP techniques: Naive Bayes—Support Vector Machine (NB-SVM), Universal Language Model Fine-tuning (ULMFiT), and Bidirectional Encoder Representations from Transformers (BERT). We tested different general-domain pre-trained BERT models, including mBERT, XLM-RoBERTa, and WanchanBERTa, as well as our domain-specific AllergyRoBERTa, which was pre-trained from scratch on our corpus. Overall, BERT models had the highest performance. NB-SVM outperformed ULMFiT and BERT for several symptom terms that are not frequently coded. The ensemble model achieved an exact match ratio of 95.33%, a F₁ score of 98.88%, and a mean average precision of 97.07% for the 36 most frequently coded symptom terms. The model was then further developed into a symptom term suggestion system and achieved a Krippendorff’s alpha agreement coefficient of 0.7081 in prospective testing with pharmacists. Some degree of automation could both accelerate the availability of allergy information and reduce the efforts for human coding.

Medications for preventing hypertensive disorders in high-risk pregnant women: a systematic review and network meta-analysis

OBJECTIVES

To determine the relative effectiveness of medications for preventing hypertensive disorders in high-risk pregnant women and to provide a ranking of medications using network meta-analysis.

METHODS

All randomized controlled trials comparing the most commonly used medications to prevent hypertensive disorders in high-risk pregnant women that are nulliparity and pregnant women having family history of preeclampsia, history of pregnancy-induced hypertension in previous pregnancy, obstetric risks, or underlying medical diseases. We received the search results from the Cochrane Pregnancy and Childbirth's Specialised Register of Controlled Trials, searched on 31st July 2020. At least two review authors independently selected the included studies and extracted the data and the methodological quality. The comparative risk ratios (RR) and 95% confidence intervals (CI) were analyzed using pairwise and network meta-analyses, and treatment rankings were estimated by the surface under the cumulative ranking curve for preventing preeclampsia (PE), gestational hypertension (GHT), and superimposed preeclampsia (SPE). Safety of the medications is also important for decision-making along with effectiveness which will be reported in a separate review.

RESULTS

This network meta-analysis included 83 randomized studies, involving 93,864 women across global regions. Three medications, either alone or in combination, probably prevented PE in high-risk pregnant women when compared with a placebo or no treatment from network analysis: antiplatelet agents with calcium (RR 0.19, 95% CI 0.04 to 0.86; 1 study; low-quality evidence), calcium (RR 0.61, 95% CI 0.47 to 0.80; 13 studies; moderate-quality evidence), antiplatelet agents (RR 0.69, 95% CI 0.57 to 0.82; 31 studies; moderate-quality evidence), and antioxidants (RR 0.77, 95% CI 0.63 to 0.93; 25 studies; moderate-quality evidence). Calcium probably prevented PE (RR 0.63, 95% CI 0.46 to 0.86; 11 studies; moderate-quality evidence) and GHT (RR 0.89, 95% CI 0.84 to 0.95; 8 studies; high-quality evidence) in nulliparous/primigravida women. Few included studies for the outcome of superimposed preeclampsia were found.

CONCLUSION

Antiplatelet agents, calcium, and their combinations were most effective medications for preventing hypertensive disorders in high-risk pregnant women when compared with a placebo or no treatment. Any high-risk characteristics for women are important in deciding the best medications. The qualities of evidence were mostly rated to be moderate.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018096276.

Suspected Cat-to-Human Transmission of SARS-CoV-2, Thailand, July-September 2021

A veterinarian in Thailand was diagnosed with COVID-19 after being sneezed on by an infected cat owned by an infected patient. Genetic study supported the hypothesis of SARS-CoV-2 transmission from the owner to the cat, and then from the cat to the veterinarian.

Immunogenicity and safety of an intradermal ChAdOx1 nCoV-19 boost in a healthy population

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. Two doses of an inactivated SARS-CoV-2 vaccine (CoronaVac) have been shown to be insufficient to protect against variants of concern (VOCs), while viral vector vaccines remain protective against the infection. Herein, we conducted a preliminary study to evaluate the safety and immunity in an adult population who received the conventional 2 dosage-regimen of inactivated SARS-CoV-2 vaccine; with an additional intradermal ChAdOx1 nCoV-19 reciprocal dosage (1:5). An Intramuscular ChAdOx1 nCoV-19 booster was also included as a control. Immediate and delayed local reactions were frequently observed in the fractional intradermal boost, but systemic side effects were significantly decreased compared to the conventional intramuscular boost. The anti-RBD-IgG levels, the neutralising function against delta variants, and T cell responses were significantly increased after boosting via both routes. Interestingly, the shorter interval elicited higher immunogenicity compared to the extended interval. Taken together, a reciprocal dosage of intradermal ChAdOx1 nCoV-19 booster reduces systemic adverse reactions and enhances non inferiority humoral and cellular immune responses compared to a full dose of intramuscular boosting. These findings provide for an effective vaccine management during the shortages of vaccine supply.

A Single Center Study on the Risks of Peri-Intervention Stroke in Thoracic Endovascular Aortic Repair (TEVAR) and Endovascular Abdominal Aortic Repair (EVAR)

(1) Background: The risk factors of peri-intervention stroke (PIS) in thoracic endovascular aortic repair (TEVAR) and endovascular abdominal aortic repair (EVAR) are different. This study aimed to compare the risks of PIS in both interventions. (2) Methods: Patients who had suffered a PIS related to TEVAR or EVAR from January 2008 to June 2015 in Songklanagarind Hospital were selected as the cases, while patients who had not suffered PIS were randomly selected to create a 1:4 case: control ratio for analysis. The associations between the factors from pre- to post-intervention and PISs in TEVAR or EVAR cases were analyzed by univariable analysis (p < 0.1). The independent risks of PIS were identified by multivariable analysis and presented in odds ratios (p < 0.05). (3) Results: A total of 17 (2.2%) out of 777 patients who had undergone TEVAR or EVAR experienced PIS, of which 9/518 (1.7%) and 8/259 (3.1%) cases were in TEVAR and EVAR groups, respectively. PIS developed within the first 24 h in nine (52.9%) cases. Large vessel ischemic stroke or watershed infarctions were the most common etiologies of PIS. The independent risks of PIS were the volume of intra-intervention blood loss (1.99 (1.88–21.12), p < 0.001) in the TEVAR-related PIS, and intervention time (2.16 (1.95–2.37), p = 0.010) and post-intervention hyperglycemia (18.60 (1.60–216.06), p = 0.001) in the EVAR-related PIS. There were no differences in the rate of PIS among the operators, intervention techniques, and status of the interventions performed. (4) Conclusion: The risks of PIS in TEVAR or EVAR in our center were different and possibly independent of the operator expertise and intervention techniques.

The Spatio-temporal Epidemiology of Asthma Patient Visits in Relation to Meteorological Parameters and Air Pollution Factors as a Result of Seasonal Change in Songkhla Province

Objective: To investigate the demographic characteristics, seasonal variations, effects associated with air pollution, and geographic morbidity of asthma in Songkhla.Material and Methods: This research conducted a time series analysis of secondary data from 1 January, 2013 to 31 December, 2017. The distributed lag non-linear model was employed to analyze associations between air pollutants and daily asthma outpatient visits, and the Bayesian hierarchical modelling was used to map asthma morbidity spatiotemporally.Results: A total of 250,127 asthma diagnoses corresponding to 36,761 patients were found in the medical records. Most asthma outpatients were female (61.1%); males (1-5 years) constituted the majority of individuals during the first peak, while females (40-50 years) predominated the second peak. The trend analysis revealed a seasonal variation in the number of asthma outpatient visits; the highest rates were during the June-December period. The regression coefficient analysis revealed carbon monoxide (CO), nitrogen dioxide (NO2 ), relative humidity, and visibility to have the most significant positive effect on asthma, while the cos (wind direction) had the highest negative effect/impact. Significant associations were found between outpatient gender and age and CO, NO2 , sulfur dioxide, ozone, and particulate matter less than 10 micron. The Hat Yai and Central districts of Songkhla province were identified as morbidity hotspots.Conclusion: The number of asthma-related outpatient visits increased during the rainy season. Asthma affected primarily young boys and middle-aged women in this province, and they constitute the most sensitive group to air pollutants such as CO and NO2 and meteorological conditions like relative humidity and visibility. The highest morbidity rates were found in urbanized habitats.

Diarrhea in tube-fed hospitalized patients: Feeding formula is not the most common cause

BACKGROUND AND AIM

Clostridium difficile-associated diarrhea (CDAD) and enteral nutrition (EN)-associated diarrhea are the most common recognized etiologies of nosocomial diarrhea. However, in clinical practice, the data regarding how each etiology contributes to the diarrheal episodes are limited. We identify the causes and factors associated with post-feeding diarrhea.

METHODS

Using the data of patients enrolled in "Effect of Psyllium Fiber Supplementation on Diarrhea Incidence in Enteral Tube-Fed Patients: A Prospective, Randomized, and Controlled Trial", the randomized controlled trial showed no difference in diarrheal incidences between fiber-added and fiber-free formulas. Hence, we analyzed the data of all enrolled patients. The causes of diarrhea were classified according to pre-specified definitions. The factors associated with diarrhea were analyzed using logistic regression.

RESULTS

Diarrhea was found in 37.3% (n = 31/83). The most common cause was medication associated (61.3%). CDAD and EN-associated diarrhea were found in only 9.7% and 6.5%, respectively. Patients with baseline albumin <3 g/dL and underlying cerebrovascular disease were more likely to develop diarrhea (adjusted odds ratio 5.70, 95% confidence interval 1.79-20.51, and adjusted odds ratio 10.83, 95% confidence interval 2.96-48.57, respectively). Compared with those without diarrhea, the length of hospital stay in CDAD patients was significantly longer (+23.1 days, P = 0.02), a trend of longer hospital stay in patients with diarrhea from other causes was observed (+3.2 days, P = 0.096).

CONCLUSIONS

Our study found that the most common cause of post-feeding diarrhea is medication associated. Review and cessation of possible drugs should be undertaken before EN modification. CDAD accounts for <10% of diarrhea causes, but it impacts the clinical outcome and should be identified and treated properly.

Factors Influencing Job Retention and Quality of Life amongst Nasopharyngeal Carcinoma Patients

Objective:

To evaluate the quality of life (QoL) amongst Thai nasopharyngeal cancer patients (NCP) and identify associated factors with QoL.

Methods:

This study was based on secondary data from a cross-sectional study that aimed to develop the Thai version of functional assessment of cancer therapy with nasopharyngeal cancer subscale demographic data, clinical information of participants, and Functional Assessment of Cancer Therapy with Nasopharyngeal cancer subscale (FACT-NP) were utilized. Data were analyzed using Student’s t-test, rank-sum test, variance analysis, and the Kruskal-Wallis test. Multiple linear regression with the stepwise model was used to determine multiple variable analysis. Statistical significance was defined at p-value < 0.05.

Results:

Two hundred and thirty NCP were included in the study with a mean age of 50.3±12.4 years. According to our findings, 68.3% were male, 81.7% were married or living with a partner, and 86.1% were Buddhism had the Eastern Cooperative Oncology Group (ECOG) performance status between 0-2 (95.2 %). The employment status, education level, economic status, ECOG, stage , and disease status significantly influenced patients’ QoL. Patients who had active treatment and received prophylactic percutaneous gastrostomy were also impacted by the FACT-NP score. In the multivariate analysis, employment status, ECOG, and disease status were shown to be significant factors that were associated with their QOL in the final model.

Conclusion:

Employment status was a socioeconomic factor that led to positive QOL amongst NCP.

Tumor volume as a prognostic factor on the median survival in locally advanced oral cancer treated with definitive chemoradiotherapy

BACKGROUND

Surgery has been the mainstay treatment for oral cancer. Those patients, who do not receive surgery are generally treated with concurrent chemoradiotherapy (CCRT). Many factors play a role in patients' survival; tumor volume might be one of those factors. This study aims to determine the effect of the pretreatment tumor volume on the survival of oral cancer.

METHODS

Retrospective study of patients with histological confirmed squamous cell carcinoma, stage III-IV oral cancer, who received definitive CCRT. Tumor volume from pretreatment computed tomography (CT) scans were reviewed and analyzed. The optimal cut-off tumor volume was evaluated by receiver operating characteristic (ROC) curve analysis.

RESULTS

From 67 patients, half of the primary tumor sites were oral tongue. The median total tumor volume (TTV) was 73.25 cm3, while the median survival was 12.5 months (95% CI 10.9-20.3). The optimal cut-off TTV =52.9 cm3 (P < 0.0001). The median survival of the patients, who had tumor volume <52.9 cm3 were 34.4 months, and for tumor volume =52.9 cm3 were 8.6 months (P < 0.0001). Multivariate analysis showed that TTV =52.9 cm3, and intensity-modulated radiotherapy (IMRT) or volumetric modulated arc (VMAT) technique had significantly influenced on the overall survival.

CONCLUSIONS

TTV had an influence on the overall survival of locally advanced oral cancer. In addition, TTV may be considered as a factor in selecting the appropriate treatment option for these patients.

Validation of the Functional Assessment of Cancer Therapy with Cervical Cancer Subscale (FACT-CX) for Quality of Life in Thai Patients Prior to Chemoradiotherapy

Objective:

Cervical cancer is the second most common cancer in Thailand. For cervical cancer, there is no cancer specific quality of life questionnaire. This study aims to develop and validate Thai FACT-CX.

Methods:

The cross-sectional study included all women aged ≥18 years with stage IB2-IIIB who planned to undergo chemoradiotherapy. Those who did not understand Thai language, had other cancers (except for skin cancer), were diagnosed with impaired cognition and/or overt psychosis, and major depression were excluded. The FACT-CX comprises 42 items with 5 domains and a score range of 0-168. The WHOQOL-BREF comprises 26 items with 4 domains and a score range of 26-130. The participants were interviewed about demographic and clinical data. Both questionnaires were self-completed. Factor analysis was used to compare our data with the previous structure. The reliability used Cronbach’s alpha. Spearman’s correlation determined relationship between the domains of the modified FACT-CX and WHOQOL-BREF. Both questionnaires were compared with socioeconomic and clinical variables using the Ranksum test and Kruskal-Wallis test. P-value > 0.05 considered significant.

Results:

The 245 participants included. Expletory factor analysis revealed an accumulative variance of 0.42 with 4 factors. The internal consistency was 0.84, 0.81, 0.78, 0.77 and 0.90 for perception of self, suffering symptoms, family support, life resilience and total questions. There was correlation between the domains of the modified FACT-CX and WHOQOL-BREF. Both the modified FACT-CX and WHOQOL-BREF could identify differences between the groups of patients.

Conclusion:

Finally, the Thai modified FACT-CX was found to be reliable and valid for measuring quality of life among untreated cervical cancer patients.

Predictors of early recurrent seizure after first seizure presentation to an emergency service: A retrospective cohort study

PURPOSE

To identify the predictors of seizure recurrence after a first seizure (FS) presentation to an emergency service.

METHODS

The clinical characteristics of FS patients presenting to the emergency department (ED) of our university hospital from January 2001 to December 2014 were retrospectively reviewed. Recurrence of seizures following the FS was classified as: early recurrence (0-1 month), intermediate recurrence (>1-3 months), and late recurrence (>3-12 months). The significant predictors of seizure recurrence in each period were identified by Cox proportional hazard ratios (p < 0.05).

RESULTS

648 FS patients of the 1248 overall seizures patients were initially enrolled. 414 FS patients were eligible for statistical analysis. Following the FS, 134 patients (32.4%) had recurrent seizures in which half of the first recurrences occurred within 3 months. The significant predictors of overall recurrence were remote symptomatic seizure (RSS) (adjusted hazard ratio [adj. HR] = 2.21 (1.38, 3.55), p = 0.003) and nocturnal onset seizure (NOS) (adj. HR = 1.53 (1.03, 2.26), p = 0.039). Those of early recurrence were NOS (adj. HR = 2.78 (1.44, 5.37), p = 0.002) and anti-epileptic drug (AED) prescription (adj. HR = 2.19 (1.00, 4.80), p = 0.038). Those of intermediate recurrence were RSS (adj. HR = 3.96 (1.63, 9.60), p = 0.006) and AED prescription (adj. HR = 4.90 (1.42, 16.95), p = 0.003). No predictor of late recurrence was identified.

CONCLUSION

The seizure recurrence rate was high in the first 3 months following the FS. The significant predictors were RSS, NOS and AED prescription.

Hepatitis B screening rates and reactivation in solid organ malignancy patients undergoing chemotherapy in Southern Thailand

Background/Aims

Hepatitis B virus reactivation (HBVr) following chemotherapy (CMT) is well-known among hematologic malignancies, and screening recommendations are established. However, HBVr data in solid organ malignancy (SOM) patients are limited. This study aims to determine hepatitis B surface antigen (HBsAg) screening rates, HBV prevalence, and the rate of significant hepatitis caused by HBVr in SOM patients undergoing CMT.

Methods

Based on the Oncology unit’s registration database from 2009–2013, we retrospectively reviewed records of all SOM patients ≥18 years undergoing CMT at Songklanagarind Hospital who were followed until death or ≥6 months after CMT sessions. Exclusion criteria included patients without baseline liver function tests (LFTs) and who underwent CMT before the study period. We obtained and analyzed baseline clinical characteristics, HBsAg screening, and LFT data during follow-up.

Results

Of 3,231 cases in the database, 810 were eligible. The overall HBsAg screening rate in the 5-year period was 27.7%. Screening rates were low from 2009–2012 (7.8–21%) and increased in 2013 to 82.9%. The prevalence of HBV among screened patients was 7.1%. Of those, 75% underwent prophylactic antiviral therapy. During the 6-month follow-up period, there were three cases of significant hepatitis caused by HBVr (4.2% of all significant hepatitis cases); all were in the unscreened group.

Conclusions

The prevalence of HBV in SOM patients undergoing CMT in our study was similar to the estimated prevalence in general Thai population, but the screening rate was quite low. Cases of HBVr causing significant hepatitis occurred in the unscreened group; therefore, HBV screening and treatment in SOM patients should be considered in HBV-endemic areas.

Decreasing Trend of Surgical Site Infections among Surgical Patients in a University Hospital in Thailand after an Active Surveillance Program

Background: Reports from high-quality healthcare systems have shown that active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes. Methods: This study aimed to appraise the incidence trend of SSIs during the 10-year period between 2007 and 2016 in a university hospital in a middle-income country, focusing on six high-risk and high-volume procedures. The study also examined factors associated with SSIs and their impact on surgical outcomes. Results: A total of 10,139 procedures in 9,661 cases were reviewed. The overall incidence of SSI was 2.98%. The incidence increased substantially with increasing risk score according to the National Nosocomial Infection Surveillance (NNIS) system risk score. The incidence trend decreased over time during the 10-year period studied. The procedures with the highest SSI incidence were craniotomy, colonic surgery, and cholecystectomy, which were also the three procedures that had standardized infection ratios (SIR) higher than 1.0 in all risk score categories. Univariable analysis found that diabetes mellitus was the only risk factor associated with SSI (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.2-2.73). The majority of the positive cultures were gram-negative bacteria (45%) and 49% of all reported organisms were drug resistant. There were two important consequences of the infections: length of hospitalization increased substantially from 13 days to 24 days (p < 0.01) and patients with SSI had more than three times higher mortality rate (7% compared with 1.9%, p < 0.001). Conclusion: With active surveillance, the incidence of SSIs decreased to less than 2.0% over the 10-year study period. More intensive surveillance should implemented for operations with high SIR and cases with diabetes mellitus.

Integrating participatory ergonomic management in non-weight-bearing exercise and progressive resistance exercise on self-care and functional ability in aged farmers with knee osteoarthritis: a clustered randomized controlled trial

Background

Ergonomic hazards are the most important cause of knee osteoarthritis (OA) in aged para rubber farmers. Ergonomic management comprising improvement of working conditions and muscle-strengthening exercise has been well documented in terms of workers' health benefit. However, those interventions were not adequate to sustain the advantage. Few studies have demonstrated the effect of integrating participatory ergonomic management (PEM) in non-weight-bearing exercise (NWE) and progressive resistance exercise (PRE), and none has focused on aged para rubber farmers with knee OA.

Purpose

This study investigated the effect of PEM-NWE, PEM-PRE, and standard treatment (ST) on self-care and functional ability in the aged population.

Materials and methods

A single-blinded, clustered randomized controlled trial was carried out. Participants (n=75) from three different communities in southern Thailand were randomly assigned to PEM-NWE, PEM-PRE, and ST. Self-care and functional ability (pain, stiffness, and physical function) were examined at baseline (B), during the intervention at Week 5 (W5), and after its completion at Week 9 (W9). Mean comparison of those outcomes over time was made using Generalized Linear Mixed Models (GLMMs).

Results

Compared to the standard treatment, the means of both groups, PEM-NWE and PEM-PRE, were significantly increased in self-care and functional ability. However, no significant difference between PEM-NWE and PEM-PRE was found.

Conclusion

Either or both interventions should be incorporated into nursing practice in order to promote occupational health and enhance quality of work life for Thai aged farmers. Further study on their cost-effectiveness is highly recommended.

Comparison of Glycemic Control between Continuous Regular Insulin Infusion and Single-dose Subcutaneous Insulin Glargine Injection in Medical Critically Ill Patients

Background and Aims:

This study aimed to compare glycemic control between continuous intravenous regular insulin infusion and single-dose subcutaneous insulin glargine injection in medical critically ill patients.

Subjects and Methods:

A prospective noninferiority study was conducted in medical critically ill patients who developed hyperglycemia and required regular insulin infusion by the Intensive Care Unit glycemic control protocol. The eligible patients were switched from the daily regular insulin requirement to single-dose subcutaneous insulin glargine injection by a 100% conversion dose. Arterial blood glucose was checked every 2 h for 24 h. Success cases were blood glucose levels of 80–200 mg/dL during the study period. The mean time-averaged area under the curves (AUCs) of blood glucose levels between the two types of insulin were compared by t-test.

Results:

Of 20 cases, 14 cases (70%) were successful. The mean time-averaged AUCs of blood glucose levels between the two types of insulin were not significantly different (155.91 ± 27.54 mg/dL vs. 151.70 ± 17.07 mg/dL, P = 0.56) and less than the predefined noninferior margin. No severe hypoglycemic cases were detected during the study period.

Conclusions:

Single-dose subcutaneous insulin glargine injection was feasibly applied for glycemic control in medical critically ill patients. The glycemic control in the critically ill patients by a single dose of subcutaneous insulin glargine was comparable to standard intravenous regular insulin infusion. A conversion dose of 100% of the daily requirement of regular insulin is suggested.

Characteristics of Creatine Kinase Elevation in Trauma Patients and Predictors of Acute Kidney Injury

INTRODUCTION

Rhabdomyolysis in general trauma patients is a cause of acute kidney injury. However, there are limited data on prevalence, risk factors and the dynamics of creatine kinase (CK) as a surrogate marker for rhabdomyolysis.

AIM

This study aimed to examine the characteristics of CK elevation in general trauma patients and identify the risk factors of acute kidney injury (AKI).

METHOD

A retrospective study of trauma patients at Songklanagarind Hospital from January 2009 to August 2014 using CK, clinical characteristics and trauma severity as predictors and AKI as defined by the Acute Kidney Injury Network, 2005 criteria as the outcomes.

RESULTS

Of the 372 patients included in the study, the prevalence of rhabdomyolysis was 40.3%, the mean injury severity score (ISS) was 19.5 and 7% had AKI. The CK level peaked at 40 hours after admission with a rate change of 50.98 U/L/h. An initial mean arterial pressure < 65 mmHg, ISS ≥ 25 and CK elevation > 1,000 U/L/h were independently associated with AKI.

CONCLUSION

Traumatic rhabdomyolysis resulting in AKI occurs in patients with a high peak CK with an increasing rate of change and a high ISS. These parameters could identify patients who needed close monitoring of CK and renal function.

Clinical presentations as predictors of prolonged mechanical ventilation in Guillain-Barré syndrome in an institution with limited medical resources

INTRODUCTION

Severe Guillain-Barré syndrome (GBS) causes ventilatory insufficiency and the need for prolonged artificial ventilation. Under circumstances where medical care for patients with severe GBS is required in a resource-limited institution, identifying initial clinical presentations in GBS patients that can predict respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) may be helpful for advanced care planning.

METHODS

The medical records of patients diagnosed with GBS in a tertiary care and medical teaching hospital from January 2001 to December 2010 were retrospectively reviewed. The demographic data and clinical presentations of the patients were summarised using descriptive statistics. Clinical predictors of respiratory insufficiency and the need for prolonged mechanical ventilation (> 15 days) were identified using univariate logistic regression analysis.

RESULTS

A total of 55 patients with GBS were included in this study. Mechanical ventilation was needed in 28 (50.9%) patients. Significant clinical predictors for respiratory insufficiency were bulbar muscle weakness (odds ratio [OR] 5.08, 95% confidence interval [CI] 1.31-21.60, p = 0.007) and time to peak limb weakness ≤ 5 days (OR 0.75, 95% CI 0.62-0.91, p < 0.001). Bulbar muscle weakness (p = 0.006) and time to peak limb weakness ≤ 5 days (p < 0.001) were also found to be significantly associated with the need for prolonged mechanical ventilation (> 15 days).

CONCLUSION

Bulbar weakness and time to peak limb weakness ≤ 5 days were able to predict respiratory insufficiency and the need for prolonged mechanical ventilation in patients with GBS.

Erratum to: 36th International Symposium on Intensive Care and Emergency Medicine: Brussels, Belgium. 15-18 March 2016

[This corrects the article DOI: 10.1186/s13054-016-1208-6.].

Incidence and Prognostic Factors for Mortality of Abdominal Hypertension in Critically Ill Surgical Patients in THAI-SICU Study

OBJECTIVE

This study aimed to investigate the incidence and prognostic factors of mortality in intra-abdominal hypertension that developed during admission in the surgical intensive care units in Thailand.

MATERIAL AND METHOD

This was a prospective observational study in nine university-based surgical intensive care units in Thailand. (THAI-SICU) The suspected patients who had the intra-abdominal pressure more than 12 mmHg were defined as intra-abdominal hypertension (IAH). The patients were followed until discharge.

RESULTS

Among 4,652 cases, a total of 71 cases (1.5%) developed IAH. The average age was 53.05+20.26 years. The median APACHE II score was 13 (9-15). Eighteen patients received surgical decompression as treatment. Metabolic acidosis (pH <7.2) and abdominal aortic surgery were the significant factors for mortality in intra-abdominal hypertension patients.

CONCLUSION

The incidence of intra-abdominal hypertension in the critical surgical care units was low in this cohort. Intraabdominal hypertension in patients who previously received abdominal aortic surgery and who had concomitant acidosis was the independent risk factor of mortality.

Implementation of evidence-based medicine in a health promotion teaching block for Thai medical students

BACKGROUND

Evidence-based medicine (EBM) is well known in medical practice. Although health promotion (HP) is promoted worldwide, there is still some debate as to whether EBM is needed or useful in the teaching of health promotion.

OBJECTIVE

To assess the perceived usefulness of EBM in the teaching of HP among medical students and faculty members.

METHODS

A comparative study was conducted between two groups of fourth-year medical students in the academic year 2012 during the five-week Health Promotion Teaching Block at Prince of Songkla University, southern Thailand. A one-week EBM course was conducted with half the students in the first week of the block and the other half of the students in the last week of the block. All activities in the HP block were similar except for the different periods of the one-week of EBM teaching. The effect on knowledge, ability and perceived application of EBM in future practice was assessed by student self-evaluations before versus after taking the EBM course, and by faculty member evaluation of the students' end-of-block presentations. All evaluation items were rated from 1 (lowest) to 5 (highest). Data were analyzed using a t-test or Wilcoxon test, as appropriate.

RESULTS

The students' self-evaluations of knowledge and ability on EBM between the two groups were similar. The perception that teaching EBM is beneficial in health promotion and future practice increased significantly ( p<0.001) in both groups. Faculty members rated higher scores for the first group than the second group, although the rating differences were not at the level of significance. Ninety percent of the students believed that EBM was a useful addition to the teaching of HP.

CONCLUSIONS

Medical students and faculty members perceived that EBM is useful in the HP context. Future studies to evaluate the effect of using evidence-based teaching for health promotion are needed.

Breast Conserving Therapy and Quality of Life in Thai Females: a Mixed Methods Study

BACKGROUND

To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT).

MATERIALS AND METHODS

In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods.

RESULTS

Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age.

CONCLUSIONS

Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.