The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study

Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.

Estimation of the onset time of diabetic complications in type 2 diabetes patients in Thailand: a survival analysis

BACKGROUND

This study aimed to identify factors associated with the onset time of diabetic complications in patients with type 2 diabetes mellitus (T2DM) and determine the best-fitted survival model.

METHODS

A retrospective cohort study was conducted among T2DM patients enrolled from October 1, 2016 to July 15, 2020 at the National Health Security Office (NHSO). In total, 388 T2DM patients were included. Cox proportional-hazard and parametric models were used to identify factors related to the onset time of diabetic complications. The Akaike information criterion, Bayesian information criterion, and Cox-Snell residual were compared to determine the best-fitted survival model.

RESULTS

Thirty diabetic complication events were detected among the 388 patients (7.7%). A 90% survival rate for the onset time of diabetic complications was found at 33 months after the first T2DM diagnosis. According to multivariate analysis, a duration of T2DM ≥42 months (time ratio [TR], 0.56; 95% confidence interval [CI], 0.33-0.96; p=0.034), comorbid hypertension (TR, 0.30; 95% CI, 0.15-0.60; p=0.001), mildly to moderately reduced levels of the estimated glomerular filtration rate (eGFR) (TR, 0.43; 95% CI, 0.24-0.75; p=0.003) and an eGFR that was severely reduced or indicative of kidney failure (TR, 0.38; 95% CI, 0.16-0.88; p=0.025) were significantly associated with the onset time of diabetic complications (p<0.05).

CONCLUSION

Patients with T2DM durations of more than 42 months, comorbid hypertension, and decreased eGFR were at risk of developing diabetic complications. The NHSO should be aware of these factors to establish a policy to prevent diabetic complications after the diagnosis of T2DM.

Contributing factors of birth asphyxia in Thailand: a case-control study

BACKGROUND

Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia.

METHODS

A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software.

RESULTS

The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia.

CONCLUSION

Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

A Nationwide Survey and System Analysis of Emergency Triage System in Lao People's Democratic Republic

Objective: To assess the present status of the emergency department (ED) triage system in 162 hospitals across the Lao People's Democratic Republic (Lao PDR). Materials and Methods: The Lao PDR nationwide survey participants recruited ED administrators. The EDs were randomly recruited. The standard questionnaire package was used for data collection including patients’ demographics and triage systemic factors. Descriptive analysis was applied to analysis the outcome of interest. Results: A majority of triage officers were emergency room nurses (58.6%), general physicians (20.4%), or both (11.1%). Most hospitals (89.5%) used informal triage scales such as clinical experiences or colors to prioritize ED patients. Only 17 hospitals (10.5%) had a formal triage scale in their ED care systems and used it in their practice. Conclusion: These findings provide knowledge of the ED triage system in the Lao PDR. The results indicate that the Lao PDR lacks a formal ED triage scale but uses a variety of informal scales. Thus, it is necessary to set up a standard triage system at all hospitals to standardize ED healthcare across the country.

Factors Influencing Pre-Cardiopulmonary Arrest Signs among Post-General Surgery Patients in Critical Care Service System

Health service system factors can lead to pre-cardiopulmonary arrest signs (pre-CA), which refer to a critical condition in the body leading to a circulatory and respiratory system disruption. The purpose of this study was to assess the incidence rate of an event leading to pre-cardiopulmonary arrest signs within the first 24 h, and also to analyze the factors influencing the health service system in critical post-general surgery patients in the intensive care unit. These results of the study found the incidence rate of pre-CA was 49.05 per 1000 person-hours, especially 1 h after admission to the ICU. Hemodynamic instability, respiratory instability, and neurological alteration were the most common pre-CA symptoms. The patient factors associated with high pre-CA arrest sign scores were the age from 18-40 years, with an operation status as emergency surgery, elective surgery compared with urgent surgery, and the interaction of operation status and age in critical post-general surgery patients. The organization factors found advanced hospital level and nurse allocation were associated with pre-CA. To improve quality of care for critical post-general surgery patients, critical care service delivery should be delegated to nurses with nurse allocation and critical care nursing training. Guidelines must be established for critically ill post-general surgery patient care.

Factors Associated with 24-Hour Clinical Outcome of Emergency Patients; a Cohort Study

Introduction

Pre-hospital and in-hospital emergency management play an important role in quality of care for emergency patients. This prospective cohort study aimed to determine factors associated with the 24-hour clinical outcome of emergency patients.

Methods

The sample included 1,630 patients, randomly selected through multi-stage stratified sampling from 13 hospitals in 13 provinces of Thailand. Data were collected during January-November 2018. Clinical outcome was determined using pre-arrest sign score. Data were analyzed via ordinal multivariate regression analysis.

Results

Factors influencing 24-hour clinical outcome of emergency patients were age (OR: 0.965; 95% CI: 0.96-0.97), having coronary vascular disease (CAD) (OR: 1.41; 95% CI: 1.05-1.88), and severity of illness based on Rapid Emergency Medical Score (REMS) (OR:1.09; 95% CI: 1.05-1.15). Self-transportation and being transported by emergency medical service ambulance with non-advanced life support (EMS-Non-ALS) did not influence clinical outcome when compared to EMS-ALS transport. Being transported from a community hospital increased pre-arrest sign score 1.78 times when compared to EMS-ALS (OR: 1.78; 95% CI: 1.17-2.72). Increased transportation distance increased the risk of poor clinical outcome (OR: 1.01; 95% CI: 1.002-1.011). Length of stay in emergency department (ED-LOS) more than 4 hours (OR: 0.21; 95% CI: 0.15-0.29) and between 2-4 hours (OR: 0.60; 95% CI: 0.47-0.75) decreased the risk of poor clinical outcome when compared to ED-LOS less than 2 hours.

Conclusion

Having CAD, severity of illness, increased transport distance, and ED-LOS less than 2 hours were found to negatively influence 24-hour clinical outcome of emergency patients.

Comparison of hypertensive outcomes after the implementation of self-management program for older adults with uncontrolled hypertension in Krabi, Thailand: a quasi-experimental study

Purpose

This study aims to examine the effects of a self-management program (SMP) on self-care behavior, blood pressure and quality of life among older adults with uncontrolled hypertension.

Design/methodology/approach

A quasi-experimental design with repeated measures was conducted in two primary care units in Krabi, Thailand. One hundred and fifty-six older adults with uncontrolled hypertension were selected based on the inclusion criteria and divided into experimental and control groups with 78 participants in each. The experimental group received the SMP, including the intervention related to the self-management process (from the 1st to 4th weeks) and a follow-up phase (from the 5th to 16th weeks). The control group received standard care. The outcomes were measured over time, including self-care behavior (baseline, 4th and 16th weeks), blood pressure (baseline, 4th, 8th, 12th and 16th weeks) and quality of life (baseline and 16th week).

Findings

The generalized estimating equations showed that the SMP, compared with the control group, statistically significantly improved self-care behavior (p < 0.001), decreased blood pressure (p < 0.001) and improved quality of life (p < 0.001) at the 16th week.

Originality/value

The SMP improved the self-care behavior, decreased blood pressure and improved the quality of life among older adults with uncontrolled hypertension. Registered nurses could administer this program for long-term benefits and help reduce the burden on primary care services.

District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030

BACKGROUND

The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan.

METHODS

A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used.

RESULTS

The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts.

CONCLUSION

The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.

Incidence and Risk Factors of Clinical Deterioration during Inter-Facility Transfer of Critically Ill Patients; a Cohort Study

INTRODUCTION

Critically ill and injured patients are at a higher risk of developing clinical deterioration during inter-facility transfers. This study aimed to determine the incidence rate and risk factors of clinical deterioration among critically ill patients during inter-facility transfers in Thailand.

METHODS

The present cohort study was conducted in 22 referring hospitals and 7 receiving hospitals under the supervision of Ministry of Public Health, Thailand, between March 15 and December 31, 2018. The subjects were comprised of 839 critically ill patients aged 18 and over, 63 coordinator nurses in referral centers, and 312 referral team leaders. Data collected included pre-transfer risk score, clinical data of patient during transfer, characteristics of referral team leader, ambulance type, preparation time, time to definitive care, transfer distance, and National Early Warning Score (NEWS) (clinical deterioration). Multilevel mixed-effects regression analysis was performed.

RESULTS

The incidence rate of clinical deterioration was 28.69%. The most common types of clinical deterioration were hemodynamic instability, respiratory instability, and neurological alteration. Time between 31-45 minutes was significantly associated with clinical deterioration (β 0.133, P value 0.027). The following illnesses were associated with higher probability of clinical deterioration: body region injuries/head injury/burn/ingested poison (β 0.670, P value 0.030), respiratory distress/convulsion (β 0.919, P value 0.001), shock/ arrhythmias/chest pain/hemorrhage (β 1.134, P value <0.001), comatose/alteration of consciousness/syncope (β 1.343, P value <0.001), and post-cardiac arrest (β 2.251, P value <0.001). Patients with unstable conditions (β 1.689, P value 0.001) and pre-transfer risk score of 8 or higher (β 0.625, P value 0.001) had a higher rate of deterioration. Transfer by non- emergency room (ER) nurses (β 0.495, P value 0.008) and transportation in a mobile intensive care unit (ICU) were associated with a higher rate of deterioration (β 0.848, P value 0.001).

CONCLUSION

The incidence of clinical deterioration during inter-facility transfer in Thailand was high. Illnesses involving circulatory, respiratory, and neurological systems, clinical instability, high pre-transfer risk score, transport time of 31-45 minutes, transportation by non-ER nurse, and mobile ICU were associated with a higher rate of clinical deterioration.

Effects of Four Noble Truths Practice on Hypertension Control

Objective: To examine the effects of Four Noble Truths practice in controlling blood pressure with three-group comparison, involving a Mobile Web group, Guidebook group and usual care group in patients with stage 1 hypertension.Methods: This randomized controlled trial was conducted in one university hospital setting.  145 participants were recruited into the study by randomized selection and were randomly assigning to the three groups. Of these, 45 participated as Mobile Web users, 50 as Guidebook users and 50 in the control group. The Mobile Web and Guidebook were developed using the guidance of the Four Noble Truths and received a phone call every two weeks for three times while control received a usual care. Then, the outcomes were measured including blood pressure and satisfaction at two-month after recruitment. The average blood pressure and satisfaction were compared by comparative descriptive statistic. Finally, analysis of covariance (ANCOVA) was used to analyze the covariate that may influence the outcomes with the post hoc analysis by Bonferroni. Results: Participants who received Mobile Web and Guidebook had reduced their blood pressure more than those receiving usual care, with statistical significance (P < 0.05). It was found that blood pressures could be lowered to a maximum level of 5.09 ± 9.62mmHg within 8 weeks of treatment. Altogether, both groups were satisfied with healthcare services more than those receiving usual care, with statistical significance (P < 0.05).Conclusion: The program could be applied to control high blood pressure in patients with stage 1 hypertension. The outstanding of this program could support overall difference in healthcare of each patient with fast efficacy.

Changes in health-related quality of life scores in patients with depression in the Thai health care delivery system

Purpose

Although health-related quality of life (HRQOL) has become an important outcome, specifically in regard to the impact of illness and treatment in patients with depression, few studies have explored the HRQOL of patients from different types of hospitals. This study aimed at examining a change in HRQOL of patients from various types of hospitals

Design/methodology/approach

A repeated measure was used in this study. Thirty participants in psychiatric outpatient units per center from the different types of hospitals, including a psychiatric hospital, regional hospital, general hospital and community hospital, were assessed with the Thai version of the World Health Organization Quality of Life Brief (WHOQOL-BREF-THAI) questionnaire at the first visit, and after the 6th and 12th weeks of the treatment course.

Findings

The HRQOL scores for the participants were increased in each type of hospital from their first visit to the 6th week and 12th week (p < 0.001; except for the 6th week in the regional hospital, p < 0.01).

Originality/value

The findings reflected HRQOL in patients with depression in terms of the resources available in different types of hospitals that could be used as baseline data for the development of Thai mental health service systems.

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand

Background

Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand.

Methods

A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH.

Results

The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95,50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6–10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively.

Conclusions

This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study

BACKGROUND

The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients.

METHODS

A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL.

RESULTS

The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (β = .10, p = .01) and patient factors (β = .29, p = .00 for self-management and β = -.49, p = .00 for disease factors). Access to health services was determined by self-management (β = .10, p = .01), but it was not significantly associated with QoL (β = .00, p = 1.0).

CONCLUSIONS

This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.

Retention of medical doctors and nurses in rural areas of Odisha state, India – a policy analysis

Purpose

Retention of medical doctors and nurses in remote and rural areas is a key issue in India. The purpose of this paper is to assess the relevant policies and provisions with respect to health care professionals, aiming to develop feasible retention strategies in rural areas of Odisha state of India.

Design/methodology/approach

The study employed documentary review and key informant interviews with policy elites (health planners, policy maker, researchers, etc.). The document review included published and unpublished reports, policy notifications and articles on human resources for health (HRH) in Odisha and similar settings. Throughout the study, the authors adapted World Health Organization’s framework to study policies relevant to HRH retention in rural areas. The adapted framework comprised of the four policy domains, education, regulation, financial incentives, professional and personal support, and 16 recommendations.

Findings

In Odisha, the district quota system for admission is not practiced; however, students from special tribal and caste (Scheduled Tribe and Scheduled Caste) communities, Socially and Educationally Backward Classes of citizens, and Persons with Disabilities have some allocated quota to study medicine and nursing. Medical education has a provision of community placement in rural hospitals. In government jobs, the newly recruited medical doctors serve a minimum of three years in rural areas. Doctors are given with location-based incentives to work in remote and difficult areas. The government has career development, deployment, and promotion avenues for doctors and nurses; however, these provisions are not implemented effectively.

Originality/value

The government could address the rural retention problems, as illustrated in the study and put in place the most effective policies and provisions toward recruitment, deployment and attraction of HRH in remote and rural areas. At the same time, implementation HRH strategies and activities must be rigorously monitored and evaluated effectively.

Effectiveness of the Dual Approach Program to promote sexual abstinence in Thai early female adolescents and improve parent-daughter sexual communication

Purpose

The purpose of this paper is to examine the effectiveness of abstinence-based sexual education programs delivered in parallel to Thai parents and their early adolescent daughters to promote sexual abstinence and improve communication regarding sexual topics between them and their parents.

Design/methodology/approach

A quasi-experimental design included groups of parent/daughter dyads; Group 1 (controls) (n=40), Group 2 Adolescent Program (n=40) and Group 3 Adolescent Parent Program (APP) (n=42). Outcome measures included parent–adolescent communications and adolescents’ sexual abstinence cognitions and intent to abstain from sexual behaviors, measured at five and nine weeks post-programs.

Findings

Generalized estimating equation analyses indicated that the dual program (APP) was more effective in increasing parental communication with their daughters compared with Group 1 (p-value<0.05) and only the daughters in the APP program reported more positive subjective norms, sense of perceived behavioral control and intent to abstain than did Group 1 (p-value<0.05).

Originality/value

The overarching goal of supporting the development of family environments where female adolescents are able to talk about sexuality is essential for adolescent sexual health promotion. The data provide further evidence that a dual program with simultaneous parent and female adolescent interactive activities over three sessions is superior compared with programs that target either the parents or the adolescents only. Hence, further replication with more parent–daughter dyads and then within more diverse cultures and populations is warranted. Developing and testing a similarly structured program for parents and sons is also required.

Needs of patient with advanced stages of cancer in a Thai community

Purpose

The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.

Design/methodology/approach

A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting.

Findings

The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports.

Originality/value

The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.

Revisiting proportion estimators

Proportion estimators are quite frequently used in many application areas. The conventional proportion estimator (number of events divided by sample size) encounters a number of problems when the data are sparse as will be demonstrated in various settings. The problem of estimating its variance when sample sizes become small is rarely addressed in a satisfying framework. Specifically, we have in mind applications like the weighted risk difference in multicenter trials or stratifying risk ratio estimators (to adjust for potential confounders) in epidemiological studies. It is suggested to estimate p using the parametric family (see PDF for character) and p(1 - p) using (see PDF for character), where (see PDF for character). We investigate the estimation problem of choosing c 0 from various perspectives including minimizing the average mean squared error of (see PDF for character), average bias and average mean squared error of (see PDF for character). The optimal value of c for minimizing the average mean squared error of (see PDF for character) is found to be independent of n and equals c = 1. The optimal value of c for minimizing the average mean squared error of (see PDF for character) is found to be dependent of n with limiting value c = 0.833. This might justifiy to use a near-optimal value of c = 1 in practice which also turns out to be beneficial when constructing confidence intervals of the form (see PDF for character).

Development of the Electronic Surveillance Monitoring System on Web Applications

This paper presents the electronic surveillance monitoring system (ESMS) via the web based application used especially for the health sector. The system is created for three purposes, the alert function for the surveillance and rapid response team (SRRT), the monitoring for inspection and evaluation, and the back-office report. With the import and export functions that are capable to retrieve electronic health record and edit the R506 and R507 data, the SRRT and local team can easily set up and manage their resources. The GPS function helps care takers to identify the geographical data for any countermeasure and action. The program is designed to submit reports automatically to the Ministry of Public Health (MOPH). The SRRT module can operate in both on-line and off-line conditions.

The Impact of Cigarette Plain Packaging on Health Warning Salience and Perceptions: Implications for Public Health Policy

The study employed a mixed methods design using focus group interviews with 6 student groups and self-administered questionnaires with 1239 students. The participants were nonsmoking, current smokers, and quit-smoking teenagers from secondary schools and colleges. Focus group revealed that although nonsmoking teenagers perceived fear appeals to warning messages, current smokers did not perceive fear appeals to health. Black and white backgrounds of the cigarette package were chosen as the best color for plain packaging. However, most participants suggested various pictorials and a bigger size of pictorial warnings for greater and more effective fear appeal. Odds ratio showed that males had 2.43 times the odds to perceive intention not to smoke. Teenagers who had never smoked and those who had quit smoking had 13.27 and 3.61 times the odds, respectively, to perceive intention not to smoke.

Predictors of Intention to Use HIV Testing Service Among Sexually Experienced Youth in Thailand

This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.

Not chewing food among the Thai elderly with complete denture

OBJECTIVE

The study aims to investigate the use of a complete denture in terms of not chewing food and determining the strength of association between not chewing food and several potential risk factors among the Thai elderly.

MATERIAL AND METHOD

Under the support of the "Khao Aroi" or "Delicious Rice" or "Dental Implant" Project of Institute of Dentistry, Department of Medical Services, Ministry of Public Health, and in co-operation with the Ministry of Science and Technology during 2007-2011, a cross-sectional survey by multi-stage cluster sampling was conducted in 2008, in 21 provinces, 87 hospitals, with 2,676 Thai elderly. The sample was drawn from a sampling frame of 58,043 target Thai people aged 60 years and over under the Dental Prosthesis Service Campaign (DPSC) project during 2005 and 2007. All Thai elderly, who received a complete denture from the DPSC project at least three months prior were surveyed from May to October 2008 through questionnaires. Data were analyzed by a set of descriptive analyses and binary logistic regression models.

RESULTS

Not chewing food among the Thai elderly, after receiving a complete denture, was 12.5%, quite a bit more effective than ordinary work. Nontaluck found 38% for the proportion not wearing dentures in the 30-baht health care program. This finding is confirmed by the work of Dalodom et al that the use of dentures by Thai elderly was 93% in the DPSC project. The important risk factors that influenced not to chew food were satisfaction with dentures, patients satisfaction with the denture fitting and care, while controlling the amount of dentures, respectively.

CONCLUSION

Satisfaction of patients with their dentures, good oral health care in fitting denture work, and good communication between dentists and patients are important keys affecting the use of dentures.

Risk factors for malaria infection among rubber tappers living in a malaria control program area in southern Thailand

Rubber tappers work begins at midnight during the feeding time of Anopheles maculatus and An. minimus, two common malaria vectors in southern Thailand. We studied the association between rubber tapper behavior and malaria infections as reported to the Notified Disease Surveillance System during 2010 in Prachuab Khiri Khan Province, Thailand. In that province insecticide treated bednets are distributed free to the population and insecticide residual spraying is performed annually. A random sample of 394 rubber tapper households was interviewed from October 2010 to May 2011. Twenty-six households (6.6%) had at least one family member who contracted malaria during 2010. Poisson regression was used to identify potential characteristics associated with malaria. Multilevel Poisson regression was used to test for simultaneous effects of tapper behavior and household risk for malaria infection. The estimated incidence rate ratio (IRR) for contracting malaria among those owning a farming hut was 2.9 (95% CI 1.1-7.3, p < 0.05) after controlling for other variables. Even in areas where control programs are in place, malaria infection among rubber tappers is common. Given the Thai Government's plan to expand the rubber plantation areas to other regions of the country without specific prevention for this at-risk population, the malaria burden in Thailand may increase.

Consequences and associated factors of youth gambling

OBJECTIVE

To examine gambling behaviors, consequences and its associated factors among Thai youths.

MATERIAL AND METHOD

A cross-sectional survey of 1,694 students from Matthayom 1 (grade 7) to university undergraduate level was conducted using a self-administered questionnaire. Questionnaire items consisted of socio-economic characteristics, health behaviors, attitudes towards gambling and consequences of gambling. Factors associated with gambling experience were identified by multivariate logistic regression.

RESULTS

Approximately 20% of youth gambling was reported. Gamblers had higher proportion of males, studying in vocational schools and lower GPA and history of smoking and alcohol consumption. Card games were the most common type of gambling, followed by football-betting. Approximately 10% of the gamblers potentially had pathological gambling. Factors positively associated with gambling included having friends (adjusted OR = 4.82) and relatives (adjusted OR = 2.48) who gambled. Having a GPA > or = 3.0 was negatively associated with gambling (adjusted OR = 0.58). The present study reported negative consequences of gambling including feeling of guilt, perception of poorer health and depression or insomnia after losing.

CONCLUSION

Gambling prevention program should be developed and focused on student with poor study performance and wrecked relationships in family. Also, a surveillance system for health risk behaviors among youth in school and community should be established by the participation of multiple organizations.

Factors affecting failure to quit smoking after exposure to pictorial cigarette pack warnings among employees in Thailand

This study was carried out to determine whether health warning pictures(HWP) affect smoking cessation using a structured equation model for intending-to-quit smokers in work places. Data from a 1-year longitudinal followup of attempt-to-quit employees was obtained to determine if pack warnings affect tobacco cessation rates. Stratified simple random sampling, and Structured Equation Modeling (SEM) were employed. Approximately 20% of intending-to-quit smokers were successful. The integrated model, combining internal, interpersonal factors and health warning pictures as external factors, fit the fail to quit pattern of the model. Having a smoking father was the most significant proximate indicator linked with failure to quit. Although HWL pictures were an external factor in the decision to stop smoking, the direct and indirect causes of failure to quit smoking were the influence of the family members. Fathers contributed to the success or failure of smoking cessation in their children by having an influence on the decision making process. Future HWP should include information about factors that stimulate smokers to quit successfully. The role model of a father on quitting is also important.

Efficacy and safety of generic and original pioglitazone in type 2 diabetes mellitus: a multicenter, a double-blinded, randomized-controlled study

OBJECTIVE

To compare the efficacy and safety of generic (Utmos) and original (Actos) 30 mg Pioglitazone tablets.

STUDY DESIGN

A multicenter, parallel randomized, double-blinded, controlled study.

MATERIAL AND METHOD

Type 2 diabetic patients, with glycosylated hemoglobin (HbA,) > or = 7.0%, who received Metformin not less than 1000 mg/day over three months were recruited. Patients were randomized to receive either generic or original Pioglitazone 30 mg/day for 24 weeks.

RESULTS

Eighty-five patients were enrolled, forty-four patients received generic Pioglitazone andforty-one received original Pioglitazone. There were no significant differences in baseline characteristics between generic and original Pioglitazone group. There were significantly reduced HbA(1c), fasting plasma glucose (FPG) and significantly increased HDL-cholesterol from baseline (p < 0.0001) without statistically differences between the two groups. Headache and edema were found in both groups at comparable rates (p > 0.05).

CONCLUSION

Generic Pioglitazone (Utmos) is effective in controlling blood glucose and has similar effects on lipid profile as the original one. Both generic (Utmos) and original (Actos) 30 mg Pioglitazone tablets were not different in the efficacy and safety profiles.

The effectiveness of program developed from cognitive-experiential self-theory and life skills technique on adolescent coping with stress

Many methodologies to decrease stress in adolescents have been introduced and implemented. However, it seems that the problems in their physical, mental, emotional, and learning conditions still exist, especially for long-term. The proposed program with some booster was used to solve the long run problems. To examine the effectiveness of program developed from cognitive-experiential self-theory and life skills technique on adolescent coping with stress. A quasi-experimental research in two groups is used to modify theoretical concepts of cognitive-experiential self-theory and life skills technique on adolescent coping with stress. The students of secondary schools in Nakhon Sawan Province Thailand were the target population. Two schools were randomly chosen, one for control and the other for experiment. The sample size of 84 students was randomly selected and requested to be volunteers and 44 volunteers were trained on concept of thinking, strategies to resolve the problem and control emotion for 5 days and booster in school for 9 months in every fortnight and was measured 5 times, before and after interventions at 3rd, 6th and 9th months. We used independent t-test, paired t-test, analysis of variance and covariance for data analysis. There were no difference in the mean of summation of knowledge, attitude and practice of pre-test score between treatment and control group (P = 0.124). After the training program, the volunteers showed significant improvement of knowledge, attitude and practice (P < 0.05) and the level of stress decreased was statistically significant (P < 0.05). The results indicated that the training program with modify theoretical concepts of cognitive-experiential self-theory and life skills technique on adolescent enabled the participants to improve knowledge, attitude and practice in coping with stress.

Prevalence and risk factors of low back pain among nurses in a Thai public hospital

OBJECTIVE

To determine the prevalence and risk factors causing low back pain in Thai nurses working in a public hospital.

MATERIAL AND METHOD

A cross-sectional study was conducted among 265 Thai Hospital nurses between July and August 2008. A self-reported questionnaire was used to collect the data onsite. Risk factors including personal factors, working factors, job stress, health behavior, and work environment were measured. Data were analyzed by frequency distribution, mean, standard deviation, and logistic regression.

RESULTS

The prevalent rate of low back pain based upon the nurses' report in the previous 12 months was 61.5%. Logistic regression analysis indicated that moving patients in bed without assistance and a lack of back muscle exercise were the significant risk factors causing low back pain among nurses (p < 0.05).

CONCLUSION

The prevalence of low back pain among Thai Hospital nurses was high. Further steps should be taken to prevent LBP by designing and implementing preventive factor-based interventions.

Potential effectiveness of health warning labels among employees in Thailand

OBJECTIVE

Explore and investigate the perceptions and responses of employees regarding the effects of a Health Warning Label (HWL) on their decision to encourage quitting and stages of change in smoking behavior.

MATERIAL AND METHOD

One thousand six hundred thirty seven employees in workplaces from four regions, including Bangkok city, were studied during the year 2005-2006. Six hundred nine employees (both non- or cigarette smokers) were part of a cohort study using qualitative and quantitative approaches. Questionnaires were used to sample the cohort twice and two individuals per factory were interviewed in-depth.

RESULTS

The New-HWL that made the best impression was the "cancer caused by cigarette smoking" and 3.8% stopped smoking after seeing the New-HWL. Moreover, New-HWL increased employees "pro" attitudes about smoking cessation. Decisional balance that reflected different "con" to quit, among non-quitting and quitting smokers.

CONCLUSION

New-HWL significantly increased attitudes about smoking cessation.

Evaluating occupational health nursing units in Bangkok textile factories: exploring the world through international occupational health programs

The purpose of this study was to examine the service quality of nursing units in Bangkok textile factories. Descriptive survey research was combined with a qualitative design using participative observation. The sample consisted of factory managers, nurses, and employees. Data were collected between November 2001 and February 2002 using questionnaires, observation, in-depth interviews, and focus groups. Nurses' education levels and quality of design and arrangement of nursing units explained 15.7% of the variance in service quality. Furthermore, qualitative data supported clients' satisfaction with service quality, except for the tangibility of the service. These findings suggest that the quality of nursing service units could be improved by management's attention to unit design, arrangement of nursing units, and nurses' education levels. Hiring registered nurses and restructuring nursing units are recommended.

Estimating the number of drug users in Bangkok 2001: A capture–recapture approach using repeated entries in one list

BACKGROUND

Conventionally, capture-recapture techniques involving different lists such as police or hospitals are used for quantifying populations which are difficult to count, such as illicit drug user populations. Here, a novel approach is suggested based upon repeated entries in one list, which is less dependent on matching entries from different sources as in the conventional approach.

METHODS

For this purpose, a population-based study was conducted that utilizes all data on treatment episodes of drug users from all 61 health treatment centers in the Bangkok metropolitan region to estimate the size of drug use in the Bangkok metropolitan region. The data stem from the drug treatment surveillance system of the Office of the Narcotics Control Board (ONCB) and cover the period from October 1 to December 31, 2001. Based upon the frequency of treatment episodes of each patient, a count distribution arose which could be modelled well by means of a Poisson mixture model. Using this count model, an estimate for the number of unobserved drug users could be constructed.

RESULTS

From 11,222 drug users found during the period, 7063 (62.9%) were heroin users, 3346 (29.8%) metamphetamine users, and the remaining 813 (7.3%) distributed under 15 drug categories, none above 1%. The study concentrated on heroin and metamphetamine users who were predominantly male (96.2% for heroin and 91.8% for metamphetamine). Metamphetamine users were younger than heroin users (22.3 years 95% CI: 22.1-22.5 vs. 30.8 years 95% CI: 30.6-31.0). By using the truncated Poisson mixture model, an estimate of the unobserved frequency of drug users with zero treatment episodes could be constructed leading to an estimate of 11,296 (95% CI: 8,964-13,628) heroin users (completeness of identification: 38.42, 95% CI: 34.03-44.04%) and 32,105 (95% CI: 24,647-39,563) metamphetamine users (completeness of identification: 9.44, 95% CI: 7.79-11.97%) for the Bangkok metropolitan region.

CONCLUSIONS

The proposed model showed excellent goodness-of-fit, unspecified for drug type and also if specified for the major drug types which allowed the prediction of the unobserved number of drug users in a realistic way, avoiding artefacts due to severe matching problems when using several, different sources. The technique is also easy to implement and can be used routinely to monitor drug user populations in space and time.

A comparison of non-iterative and iterative estimators of heterogeneity variance for the standardized mortality ratio

This paper continues work presented in Böhning et al. (2002b, Annals of the Institute of Statistical Mathematics 54, 827-839, henceforth BMSRB) where a class of non-iterative estimators of the variance of the heterogeneity distribution for the standardized mortality ratio was discussed. Here, these estimators are further investigated by means of a simulation study. In addition, iterative estimators including the Clayton-Kaldor procedure as well as the pseudo-maximum-likelihood (PML) approach are added in the comparison. Among all candidates, the PML estimator often has the smallest mean square error, followed by the non-iterative estimator where the weights are proportional to the external expected counts. This confirms the theoretical result in BMSRB in which an asymptotic efficiency could be proved for this estimator (in the class of non-iterative estimators considered). Surprisingly, the Clayton-Kaldor iterative estimator (often recommended and used by practitioners) performed poorly with respect to the MSE. Given the widespread use of these estimators in disease mapping, medical surveillance, meta-analysis and other areas of public health, the results of this study might be of considerable interest.

No effect of garlic extract supplement on serum lipid levels in hypercholesterolemic subjects

OBJECTIVE

The authors assessed the effects of an enteric-coated Thai garlic extract tablet standardized for allicin-releasing potential on serum lipid levels in hypercholesterolemic subjects.

SUBJECTS AND METHOD

The authors performed a randomized, double-blind, placebo-controlled trial in 136 hypercholesterolemic subjects (cholesterol concentrations > or = 5.2 mmol/L; mean age +/- SD: 47.0 +/- 6.6 yr). All subjects were given dietary advice to lower fat intake within 4 weeks and were advised to eat normally during the study period. The subjects were randomly assigned to receive an enteric-coated Thai garlic extract tablet once daily (standardized to 1.12% allicin or 5.6 mg/tablet), or placebo after the evening meal for 12 weeks. Seventy subjects (32.9% male; mean age +/- SD and BMI of 47.0 +/- 6.6 yr and 24.6 +/- 3.3 kg/m2) received the garlic extract treatment while 66 subjects (37.9% male, mean age +/- SD and BMI of 47.0 +/- 6.0 yr and 24.3 +/- 3.4 kg/m2) received placebo.

RESULTS

There were no statistically significant changes in serum total cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol after the 12-week treatment as analyzed on repeated measures by analysis of variance. In addition, no changes in plasma glucose, liver and renal functions were found.

CONCLUSIONS

Treatment with an enteric garlic-coated Thai garlic extract and dietary advice did not produce any significant changes in lipid levels in subjects with hypercholesterolemia.

Some general points in estimating heterogeneity variance with the DerSimonian-Laird estimator

In this paper we consider estimating heterogeneity variance with the DerSimonian-Laird (DSL) estimator as typically used in meta-analysis. In its general form the DSL estimator requires inverse population-averaged study-specific variances as weights, in which case the estimator is unbiased. It has become common practice, however, to use estimates of the study-specific variances instead of their population-averaged versions. This can lead to considerable bias. Simulations illustrate these findings.