Hospital In Northeastern Thailand Research Articles

Modified Laboratory Risk Indicator and Machine Learning in Classifying Necrotizing Fasciitis from Cellulitis Patients

Necrotizing fasciitis (NF) is a severe and life-threatening soft tissue infection that requires timely and accurate diagnosis to improve patient outcomes. The early diagnosis of NF remains challenging due to its similarity to other subcutaneous soft tissue infections like cellulitis. This study aims to employ machine learning techniques to differentiate NF from cellulitis and enhance the diagnostic accuracy of NF by developing a modified LRINEC (MLRINEC) score. These modifications aimed to improve the sensitivity and specificity of NF diagnosis. The study utilized three machine learning classifiers—Logistic Regression, decision tree, and Random Forest—to assess their effectiveness in distinguishing between NF and cellulitis cases. The MLRINEC score was developed by incorporating six key blood test parameters: creatinine, hemoglobin, platelet count, sodium, white blood cell count, and C-reactive protein using laboratory data from Maha Sarakham Hospital in Northeastern Thailand. Our findings indicate that the decision tree classifier demonstrated superior performance, achieving the highest recall, particularly in accurately identifying NF cases. A feature importance analysis revealed that hemoglobin levels and white blood cell counts were the most critical factors influencing the model’s predictions. The platelet count (PT), C-reactive protein (CRP), and creatinine (CT) also played important roles, while sodium levels (NA) were the least influential. The MLRINEC score demonstrates high accuracy in classifying NF and cellulitis patients, paving the way for improved diagnostic protocols in clinical settings.

Trends in osteoporosis prevalence at a tertiary care referral center hospital in Northeastern Thailand: a 20-year analysis (2003-2022).

To investigate the prevalence trends of osteoporosis from 2003 to 2022 using data from the largest tertiary care referral center in Northeastern Thailand. Bone mineral density (BMD) measurements of community-dwelling individuals aged > 45years were reviewed from the medical record database of Srinagarind Hospital, Khon Kaen, Thailand, between 2003 and 2022. Osteoporosis was defined by a T-score of ≤ - 2.5. For each year, crude and age-standardized prevalence rates for osteoporosis stratified by site of measurement were calculated. Trend analysis was performed using the joinpoint regression method. A total of 36,306 BMD measurements were identified between 2003 and 2022. The crude prevalence of femoral neck (FN) osteoporosis increased from 2.4% to 9.2% in men and from 2.5% to 11.2% in women, while the age-standardized prevalence increased less, from 2.6% to 8.3% in men, and slightly decreased from 8.7% to 7.6% in women. Trend analysis revealed increased crude and age-standardized prevalence rates of FN osteoporosis in men, with an annual percent change (APC) of 4.0 (95%CI: - 4.1 to 14.7) and 2.3 (95%CI: - 4.9 to 10.0), respectively. In women, the crude prevalence increased significantly from 2003 to 2011 (APC: 20.8, 95%CI: 5.8-249.3) and plateaued from 2011 to 2022 (APC: 0.8, 95%CI: - 30.3 to 5.9). The age-standardized prevalence was relatively unchanged (APC: 0.1, 95%CI: - 4.2 to 5.4). We observed a significant increase in the crude prevalence of osteoporosis from 2003 to 2022 among individuals receiving BMD measurements in a tertiary care referral center in Northeastern Thailand. Meanwhile, the age-standardized prevalence increased more gradually.

Lack of Association of TLR1 and TLR5 Coding Variants with Mortality in a Large Multicenter Cohort of Melioidosis Patients.

Melioidosis, infection caused by Burkholderia pseudomallei, is characterized by robust innate immune responses. We have previously reported associations of TLR1 single nucleotide missense variant rs76600635 with mortality and of TLR5 nonsense variant rs5744168 with both bacteremia and mortality in single-center studies of patients with melioidosis in northeastern Thailand. The objective of this study was to externally validate the associations of rs76600635 and rs5744168 with bacteremia and mortality in a large multicenter cohort of melioidosis patients. We genotyped rs76600635 and rs5744168 in 1,338 melioidosis patients enrolled in a prospective parent cohort study conducted at nine hospitals in northeastern Thailand. The genotype frequencies of rs76600635 did not differ by bacteremia status (P = 0.27) or 28-day mortality (P = 0.84). The genotype frequencies of rs5744168 did not differ by either bacteremia status (P = 0.46) or 28-day mortality (P = 0.10). Assuming a dominant genetic model, there was no association of the rs76600635 variant with bacteremia (adjusted odds ratio [OR], 0.75; 95% CI, 0.54-1.04, P = 0.08) or 28-day mortality (adjusted OR, 0.96; 95% CI, 0.71-1.28, P = 0.77). There was no association of the rs5744168 variant with bacteremia (adjusted OR, 1.24; 95% CI, 0.76-2.03, P = 0.39) or 28-day mortality (adjusted OR, 1.22; 95% CI, 0.83-1.79, P = 0.21). There was also no association of either variant with 1-year mortality. We conclude that in a large multicenter cohort of patients hospitalized with melioidosis in northeastern Thailand, neither TLR1 missense variant rs76600635 nor TLR5 nonsense variant rs5744168 is associated with bacteremia or mortality.

Prognostic Accuracy of Screening Tools for Clinical Deterioration in Adults With Suspected Sepsis in Northeastern Thailand: A Cohort Validation Study.

We sought to assess the performance of commonly used clinical scoring systems to predict imminent clinical deterioration in patients hospitalized with suspected infection in rural Thailand. Patients with suspected infection were prospectively enrolled within 24 hours of admission to a referral hospital in northeastern Thailand between 2013 and 2017. In patients not requiring intensive medical interventions, multiple enrollment scores were calculated including the National Early Warning Score (NEWS), the Modified Early Warning Score, Between the Flags, and the quick Sequential Organ Failure Assessment score. Scores were tested for predictive accuracy of clinical deterioration, defined as a new requirement of mechanical ventilation, vasoactive medications, intensive care unit admission, and/or death approximately 1 day after enrollment. The association of each score with clinical deterioration was evaluated by means of logistic regression, and discrimination was assessed by generating area under the receiver operating characteristic curve. Of 4989 enrolled patients, 2680 met criteria for secondary analysis, and 100 of 2680 (4%) experienced clinical deterioration within 1 day after enrollment. NEWS had the highest discrimination for predicting clinical deterioration (area under the receiver operating characteristic curve, 0.78 [95% confidence interval, .74-.83]) compared with the Modified Early Warning Score (0.67 [.63-.73]; P < .001), quick Sequential Organ Failure Assessment (0.65 [.60-.70]; P < .001), and Between the Flags (0.69 [.64-.75]; P < .001). NEWS ≥5 yielded optimal sensitivity and specificity for clinical deterioration prediction. In patients hospitalized with suspected infection in a resource-limited setting in Southeast Asia, NEWS can identify patients at risk of imminent clinical deterioration with greater accuracy than other clinical scoring systems.

Genomic characterization of vancomycin-resistant Enterococcus faecium clonal complex 17 isolated from urine in tertiary hospitals in Northeastern Thailand.

Vancomycin-resistant Enterococci (VREs) have increasingly become a major nosocomial pathogen worldwide, earning high-priority category from the World Health Organization (WHO) due to their antibiotic resistance. Among VREs, vancomycin-resistant Enterococcus faecium (VREfm) is particularly concerning, frequently isolated and resistant to many antibiotics used in hospital-acquired infections. This study investigated VREfm isolates from rural tertiary hospitals in Northeastern Thailand based both antibiotic susceptibility testing and whole-genome sequencing. All isolates showed resistance to vancomycin, ampicillin, erythromycin, tetracycline, ciprofloxacin, norfloxacin, and rifampin. Nitrofurantoin and tigecycline resistance were also observed in nearly all isolates. Conversely, all isolates remained susceptible to chloramphenicol, daptomycin, and linezolid. Genomic characterization revealed that all VREfm isolates belonged to clonal complex 17 (CC17), primarily consisting of sequence type (ST) 80, followed by ST17, ST761, and ST117. Additionally, all isolates harbored numerous antimicrobial-resistant genes, including vanA, tet(L), tet(M), aac(6')-li, ant(6)-Ia, aph(3')-III, aac(6')-aph(2″), aph(2″)-la, ant(9)-la, erm(B), msr(C), erm(T), erm(A), fosB, dfrG, and cfr(B). Notably, all isolates contained virulence genes, for collagen adhesin (acm) and cell wall adhesin (efafm), while hylEfm (glycosyl hydrolase) was detected in VREfm ST80. This study provided important information for understanding the genomic features of VREfm isolated from urine.

Comparison between RISC II and TRISS in predicting 30-day mortality in primary trauma patients admitted at a university hospital in northeastern Thailand

Comparison between RISC II and TRISS in predicting 30-day mortality in primary trauma patients admitted at a university hospital in northeastern Thailand

Factors Associated with the Quality of Life among Family Caregivers of Cholangiocarcinoma Survivors in Northeastern Thailand.

Cholangiocarcinoma (CCA) is a common and usually lethal liver cancer especially in Southeast Asia. Family caregivers (FCs) and their quality of life (QOL) is important for the care process to operate effectively. However, there are only few research articles about the QOL of CCA FCs. The goal of this study was to assess the QOL and its associated factors among CCA FCs. This cross-sectional study was undertaken with 231 CCA FCs who were the primary FCs for CCA patients in a tertiary hospital in Northeastern Thailand. The QOL was measured using the Thai version of the World Health Organization's Quality of Life Questionnaire. Multivariate regression models were developed to investigate the predictors of the QOL, including the demographic characteristics, symptoms, anxiety and depression, and support care need. The CCA caregivers had moderate to high QOL for all of four domains: the mean score was 27.03 (SD=2.81) for physical, 23.13 (SD=2.81) for psychological, 11.32 (SD=1.08) for social relationships, and 28.08 (SD=2.81) for environment. Multivariable analysis shows that, symptoms, support care need, age and education level were significant predictors of FCs's QOL. Moreover. The QOL was lower in younger FCs (p<0.001). Symptoms, support care needs, age, and education level were associated with QOL among FCs for CCA patients. A holistic strategy that includes caregiver training, psychosocial therapies, and proper support may help these FCs for a better QOL.

Characteristics and one year outcomes of melioidosis patients in Northeastern Thailand: a prospective, multicenter cohort study

Melioidosis is a neglected tropical infection caused by the environmental saprophyte Burkholderia pseudomallei. We conducted a prospective, observational study at nine hospitals in northeastern Thailand, a hyperendemic melioidosis zone, to define current characteristics of melioidosis patients and quantify outcomes over one year. 2574 individuals hospitalised with culture-confirmed melioidosis were screened and 1352 patients were analysed. The median age was 55 years, 975 (72%) were male, and 951 (70%) had diabetes. 565 (42%) patients presented with lung infection, 1042 (77%) were bacteremic, 442 (33%) received vasopressors/inotropes and 547 (40%) received mechanical ventilation. 1307 (97%) received an intravenous antibiotic against B. pseudomallei. 335/1345 (25%) patients died within one month and 448/1322 (34%) of patients died within one year. Most patients had risk factors for melioidosis, but patients without identified risk factors did not have a reduced risk of death. Of patients discharged alive, most received oral trimethoprim-sulfamethoxazole, which was associated with decreased risk of post-discharge death; 235/970 (24%) were readmitted, and 874/1015 (86%) survived to one year. Recurrent infection was detected in 17/994 patients (2%). Patients with risk factors other than diabetes had increased risk of death and increased risk of hospital readmission. In northeastern Thailand patients with melioidosis experience high rates of bacteremia, organ failure and death. Most patients discharged alive survive one year although all-cause readmission is common. Recurrent disease is rare. Strategies that emphasize prevention, rapid diagnosis and intensification of early clinical management are likely to have greatest impact in this and other resource-restricted regions. US NIH/NIAID U01AI115520.

The Proportion of Occupationally Related Cholangiocarcinoma: A Tertiary Hospital Study in Northeastern Thailand.

Simple SummaryNortheastern Thailand has the world’s highest incidence rate of cholangiocarcinoma (CCA), whereas a consequence, approximately 14,000 patients die annually. In most cases, the causal factors are identified, but, for some, they remain unknown. Legally imported industrial chemicals such as 1,2-dichloropropane (1,2-DCP), dichloromethane (DCM), and asbestos fibers are defined as occupational causes of CCA. An investigation into these vis-à-vis the diagnosis of occupationally related CCA in Thailand has not been conducted, but is important for understanding the potential magnitude of the problem. The current study found that the proportion of occupationally related CCA was approximately 5.5%, as well as a lower proportion of occupational history taken by treating physicians. Improving physician skills and developing an assistive tool for exploring occupational history might improve the documentation of work-related conditions.Northeastern Thailand registers the highest worldwide incidence of cholangiocarcinoma (CCA). Most of the cases are associated with liver flukes, while unknown causes comprise approximately 10–30% of cases, and these could be due to occupational exposures. Our aim was to determine the magnitude of occupational causes of CCA in a tertiary hospital in northeastern Thailand. We conducted a cross-sectional study with a sample of 220 patients between March and November 2021. Descriptive statistics were used to analyze the findings. Clinical information and telephone interviews were used to explore significant occupational histories. An occupational consensus meeting was held with two occupational physicians, an industrial hygienist, and a hepatobiliary surgeon to decide on the final diagnosis. The response rate was 90.9% (200/220). Based on the medical records and telephone interviews, researchers found that 11 participants had significant exposure. After occupational consensus, it was agreed that the eleven had possible occupational causes, 5.5% (11/200)–54.5% (6/11) being due to asbestos fibers, 45.5% (5/11) due to dichloromethane, and 9.1% (1/11) due to 1,2-dichloropropane. Only 4% (8/200) had occupational histories collected by their treating physicians. Taken together, occupationally related CCA appears to have been underestimated, so improving occupational history taking is needed to properly identify and classify work-related CCA—both for patient treatment and occupational hazard prevention.

Quality of Life among Older Patients with Chronic Illnesses and Associated Factors at the Outpatient Clinic of a University Hospital in Northeastern Thailand

Objective: Patient quality of life (QoL) is a key factor when improving the healthcare system. Older patients with chronic illnesses in the Medicine outpatient clinic might face a poorer QoL in Thailand but the data are limited. The authors aimed to explore the level of quality of QoL and associated factors among older patients in Thailand. Material and methods: This was a cross-sectional study conducted at the Medicine outpatient clinic of a university hospital between May 2019 and May 2020. The Thai version of the WHO Quality of Life-Old (WHO QoL-Old) was used to evaluate patient QoL. The authors collected baseline characteristics including (a) cognitive status assessed using the Rowland Universal Dementia Assessment Scale (RUDAS-Thai), and (b) depression assessed using the Thai Geriatric Depression Scales-15 (TGDS-15). The associated factors of QoL were explored. Results: Two hundred and fifty participants were enrolled. The median age was 69 (IQR 64,75) and 46.4% were male. Majority of participants (74.8%) had a high QoL and 25.2% had a moderate QoL. The factors associated with a high QoL were age [OR 1.26 (1.06 to 1.53)], monthly income &gt;30,000 bahts [OR 1,093 (6.7 to 178,384)], increased RUDAS score [OR 2.55 (1.78 to 3.65)], and increased TGDS-15 score [OR 0.29 (0.16 to 0.52)]. Conclusion: The QoL among older patients with chronic illnesses was high. Factors associated with a QoL were age, monthly income, cognitive function, and depression, so strategies focusing on these modifiable factors might improve QoL among older patients. Keywords: Quality of life; Elderly; Older adults; End of life care; Quality of care

The burden of chronic kidney disease among people with diabetes by insurance schemes: Findings from a primary referral hospital in Thailand

Background: Chronic Kidney Disease (CKD), a microvascular complication of diabetes, poses a significant threat of pre-mature deaths and morbidities globally, including Thailand. This study aimed to assess the burden of CKD among people with diabetes by their health insurance schemes in rural Thailand.Methods: Cross-sectional data were collected from a clinical registry of 4050 people with diabetes attending a primary referral hospital in northeastern Thailand between January 2015 and December 2015. CKD was defined based on the determination of the estimated glomerular filtration rate (<60 mL/min/1.73 m2). Blood pressure, blood glucose, and anthropometry were measured. Information about insurance schemes, namely, civil service medical benefits, social security, and universal coverage, were obtained from the participant's healthcare card. We performed multivariable logistic regression to determine the association of CKD with the corresponding insurance schemes.Results: The majority of the participants were aged at or over 60 years (56.6%), were female (64.3%), were farmers (60.1%), completed secondary level education (70.7%), and were hypertensive (57.3%). Among all, 25.3% of participants had CKD (n = 1027), ranging from 26.9% in the universal coverage scheme to 11.8% in the social security scheme. Under the civil service medical benefits scheme, people were less likely [adjusted odds ratio: 0.8, 95% confidence interval: (0.6–0.9)] to have CKD than people with universal coverage scheme. CKD was also greater among 50–59 [2.3 (1.3–3.5)], 60–69 [6.4 (4.3–9.5)], and ≥70-year-old [17.2 (12.5–28.1)] people than <50 years. People living with diabetes and hypertension also had a higher odd of having CKD [1.8 (1.5–2.1)] than the normotensive people.Conclusions: A significant number of people who had CKD attended the primary care hospital for receiving the management of diabetes. Primary healthcare facilities can provide CKD screening opportunities and diabetes care under the universal coverage scheme package and offer self-management education programmes for rural people.

Adverse Childhood Experiences among Thai Patients with Depressive Disorders: A University/Tertiary Care Hospital Experiences

Background: Childhood trauma and adverse experiences are common in patients with depressive disorders, and yet, there is a lack of research in this area in Thailand. Objective: To determine the prevalence and types of adverse childhood experiences (ACEs) among patients with depressive disorders and the association between ACEs and some characteristics of depressive patients. Materials and Methods: A cross-sectional descriptive study was conducted in patients with depressive disorders at a university hospital in northeastern Thailand. The patients were interviewed using the ACEs questionnaire, investigating the 10 most common types of childhood trauma. Statistical analyses included descriptive statistics and association analyses. Results: Among the 119 patients who completed the questionnaire, 98 (82.4%) had major depressive disorder (MDD) and 21 (17.6%) had persistent depressive disorder (PDD). Most (62.2%) had at least one type of ACEs with 60.2% in MDD and 71.4% in PDD. The three most common traumatic events were emotional neglect (37.8%), verbal abuse (27.7%), and having family members with alcohol or substance abuse (21%). Only emotional neglect was related to further suicidal risk. A total score of 4 or more significantly increased the risk of admission (OR 23.42, 95% CI 5.73 to 95.78) and suicide attempts (OR 3.68, 95% CI 1.14 to 11.9). Conclusion: About two-thirds of patients with a depressive disorder had at least one type of childhood trauma, and the most common type was emotional neglect. In patients with depression, a history of ACEs should be evaluated before formulating the psychological trauma treatment plan. The authors recommend pro-active strategies for educating and counseling parents regarding appropriate parenting to reduce the incidence of ACEs for their children. Keywords: Adverse Childhood Experiences (ACEs), Depression, Childhood trauma

Medication use evaluation for Clostridium difficile infection: a case of super tertiary care hospital in northeastern Thailand

Medication use evaluation for Clostridium difficile infection: a case of super tertiary care hospital in northeastern Thailand

Interepidemic Detection of Chikungunya Virus Infection and Transmission in Northeastern Thailand

Chikungunya fever is a viral mosquito-borne, acute febrile illness associated with rash, joint pain, and occasionally prolonged polyarthritis. Chikungunya outbreaks have been reported worldwide including many provinces of Thailand. Although chikungunya virus (CHIKV) occurs in Thailand, details on its epidemiology are lacking compared with dengue, a common mosquito-borne disease in the country. Therefore, study on CHIKV and its epidemiology in both humans and mosquitoes is required to better understand its importance clinically and dynamics in community settings. So a prospective examination of virus circulation in human and mosquito populations in northeastern Thailand using serological and molecular methods, including the genetic characterization of the virus, was undertaken. The study was conducted among febrile patients in eight district hospitals in northeastern Thailand from June 2016 to October 2017. Using real-time PCR on the conserved region of nonstructural protein 1 gene, CHIKV was detected in eight (4.9%) of 161 plasma samples. Only one strain yielded a sequence of sufficient size allowing for phylogenetic analysis. In addition, anti-CHIKV IgM and IgG were detected in six (3.7%) and 17 (10.6%) patient plasma samples. The single sequenced sample belonged to the East/Central/South Africa (ECSA) genotype and was phylogenetically similar to the Indian Ocean sub-lineage. Adult Aedes mosquitoes were collected indoors and within a 100-m radius from the index case house and four neighboring houses. CHIKV was detected in two of 70 (2.9%) female Aedes aegypti mosquito pools. This study clearly demonstrated the presence and local transmission of the ECSA genotype of CHIKV in the northeastern region of Thailand.

Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand.

Latent tuberculosis infection (LTBI) can develop into tuberculosis (TB). The WHO requires the discovery and management of LTBI among high-risk groups. Health care workers (HCWs) constitute a high-risk group. Factors associated with LTBI among HCWs in Thailand need further study. The current study aimed to explore the factors related to LTBI among Thai HCWs. A hospital-based, matched case-control study was conducted. All cases and controls were HCWs at a tertiary hospital in northeastern Thailand. Between 2017 and 2019, a total of 85 cases of interferon-γ release assays (IGRAs)-proven LTBI, and 170 control subjects were selected from a hospital (two controls per case). The two recruited controls were individually matched with LTBI cases by sex and age (±5 years). Secondary data were obtained from the occupational health and safety office. Case HCWs had a higher proportion of significant factors than control HCWs (i.e., working closely with pulmonary TB—94.1% vs. 88.8%, and working in the area of aerosol-generating procedures (AGPs) 81.2% vs. 69.4%). The bivariate conditional logistic regression showed that the occurrence of LTBI in HCWs was statistically significant (p-value < 0.05), particularly with respect to: workplaces of AGPs (crude OR = 1.90, 95% CI: 1.01–3.58, p = 0.041); among HCWs performing AGPs (crude OR = 2.04, 95% CI: 1.20, 3.48, p = 0.007); and, absent Bacille Calmette-Guérin (BCG) scar (crude OR = 2.59, 95% CI: 1.50–4.47, p = 0.001). Based on the multivariable conditional logistics analysis, HCWs who performed AGPs while contacting TB cases had a statistically significant association with LTBI (adjusted OR = 1.82, 95% CI: 1.04–3.20, p = 0.035). HCWs who reported the absence of a BCG scar had a statistically significant association with LTBI (adjusted OR = 2.49, 95% CI: 1.65–5.36, p = 0.001), whereas other factors including close contact with TB (adjusted OR = 2.44, 95% CI: 0.74, 8.09, p = 0.123) were not significantly associated with LTBI. In conclusion, HCWs who performed AGPs and were absent a BCG scar had a significant association with LTBI, while other factors played a less critical role.

Anxiety at First and Subsequent Pregnancies and Its Associated Factors: A Historical Cohort Study From Northeastern Thailand

Objective: To estimate and compare the prevalences of anxiety at first and subsequent pregnancies and explore its associated factors.Material and Methods: The study was conducted among multiparous women aged &lt;34 years admitted to the postpartum ward in a regional hospital in northeastern Thailand during April-September 2014. Information on levels of anxiety, social support, financial stressors, self-esteem and socio-demographic characteristics was collected. Anxiety at the first pregnancy and the most recent pregnancy were assessed. Factors associated with the anxiety were analyzed by multiple logistic regression.Results: Of the 447 women enrolled in the study, 24.0% had experienced high-level anxiety when becoming aware of being pregnant for the first pregnancy which was associated with the pregnancy being unplanned, high financial stressors and low social support. Sixty percent of the women felt that the degree of anxiety in their current pregnancy was lower. Decreased anxiety was more likely to be found in women who changed employment status from unemployed to employed, those with increased social support, and those with decreased financial stressors, and less likely in women with increased financial stressors.Conclusion: One-fourth of the women reported anxiety at their first pregnancy which decreased in subsequent pregnancies. Social support and financial stressors during pregnancy should be explored and strategies on how to improve these conditions at antenatal care services should be studied.

Pattern of shiftwork and health status among nurses in a university hospital in northeastern Thailand

This study was aimed to explore shiftwork patterns and health status among nurses at a university hospital in northeastern Thailand. A descriptive study was conducted. The study population was 1,221. The data were collected via self-reported questionnaire including personal information and the last month shift schedule. Descriptive statistics were applied using STATA v 10. The response rate was 68.1 % (831/1,221) and completion rate was 59.1% (721/1,221). There were 82.2% (593/721) participants had performed shiftwork. The shiftwork patterns were (a) day shift plus over time, (b) day and evening shift, (c) day and night shift, and (d) rotational shift. All of rotational shift were fast rotation with irregular shift pattern (n=531; 89.5%). Even though there was no pure forward or backward rotations, the researcher divided the participants into three groups (namely, primarily forward, primarily backward, and evenly split between backward and forward). Most shift workers performed primarily backward rotational pattern (n=479; 90.2%). A minority (n=143; 24.1%) did extended shifts: median extended shift was once a month (IQR 1-3). The majority (n=523; 88%) of participants did quick return shifts (88%) (median=11 times/month, IQR7-13) Nearly one-third (28.0%) of participants had underlying diseases such as allergic rhinitis (7.9%), asthma (1.9%), and/or dyslipidemia (1.8%). Based on a BMI > 25 kg/m2, 17.5 % of the participants were obese. Over one-tenth (12.2%) of the participants had a sleep disorder and 14.9% used sleepiness- or drowsiness-inducing medication. Most of the participants had no depression (86.4%) and were at low risk of obstructive sleep apnea (76.0%). Comparing characteristics of shift and non-shift personnel, median age, proportion of married nurses and caffeine needed were lower for shift workers than the non-shift workers. Working experiences were shorter in shift workers than the non-shift workers and there was a statistically significant difference among job position, task, work unit, and salary. Likewise, shift workers had fewer underlying diseases, using sleepiness or drowsiness drug and depression. In conclusion, there was a high proportion of shift workers represented in the study, and most nurses did rotational shift with primarily backward rotation, quick return and extended shifts which are associated with a higher health risk. The health effect from shiftwork on the current study could not be concluded however, nearly one-third revealed some kinds of underlying diseases. The association of effect from shiftwork will be presented elsewhere.

Prevalence of HIV infection, access to HIV care, and response to antiretroviral therapy among partners of HIV-infected individuals in Thailand.

BackgroundHealth care providers usually focus on index HIV-infected patients and seldom obtain information from their partners. We aimed to determine HIV-preventative measures among couples, the prevalence of HIV infection, and treatment outcomes of partners.MethodsThis cross-sectional study was conducted in two hospital settings, a university hospital in Bangkok and a general hospital in northeastern Thailand, from January 2011-October 2015. Factors associated with serodiscordant relationships were determined by logistic regression.ResultsA total of 393 couples were enrolled for analysis; 156 (39.7%) were serodiscordant. The median relationship duration of serodiscordant couples was shorter than that of seroconcordant couples (6.4 years vs 11.6 years, p < 0.001). Of 237 HIV-infected partners, 17.7% had AIDS-defining illness, the median nadir CD4 count (interquartile range) was 240 (96–427) cells/mm3, 83.5% received antiretroviral therapy (ART), 98.3% had adherence > 95%, 90.3% had undetectable HIV RNA, and 22.9% had a prior history of treatment failure. There was no significant difference in condom usage in the prior 30 days between serodiscordant and seroconcordant couples. Factors of index HIV-infected patients associated with serodiscordant relationships were younger age (odds ratio [OR] 1.04 per 5 years; 95% confidence interval [CI] 1.01–1.06), receiving care at the general hospital (OR 1.73; 95% CI 1.08–2.78), a shorter duration of relationship (OR 1.04 per year; 95% CI 1.01–1.07), a higher nadir CD4 count (OR 1.06 per 50 cells/mm3; 95% CI 1.1–1.13), and not receiving a protease inhibitor-based regimen (OR 2.04; 95% CI 1.06–3.96).ConclusionsA high number of serodiscordant couples was determined. Partners’ information should be retrieved as a holistic approach. Interventions for minimizing HIV transmission within serodiscordant couples should be evaluated and implemented.

Efficacy of district tuberculosis co-ordinating team on health service performance for suspected TB patient in district hospital

Purpose The purpose of this paper is to study the efficacy of a district tuberculosis (TB) co-ordinating team on health service performance for suspected TB patients in a district hospital in northeastern Thailand. Design/methodology/approach A comparison study of pre- and post-evaluations of TB system improvement was conducted in a district hospital in northeastern Thailand between October 2016 and June 2017. Data collection reviewed the record of suspected TB cases reported in the district hospital in the past nine months as a base line for describing the health service performance in term of received investigation for TB diagnosis. Participants from a TB clinic, district health office and health center set up a TB co-ordinating team to explore situations and systematic gaps. The TB co-ordinating team gave recommendations of health service performance for suspected TB patients over a nine-month period. Records of suspected TB cases health service performance were collected nine months after intervention. Data analysis by descriptive statistics and to test the effect of intervention was performed. Findings The records from 324 and 379 suspected TB cases reported in the hospital from the 9 months preceding and 9 months, respectively, after intervention were reviewed. A TB co-ordinating team was set up to improve the system and health service performance in terms of investigation for TB diagnosis. The results revealed that health service performance in terms of complete microscopy and investigation in both chest radiography and microscopy increased after intervention. When comparing between pre- and post-intervention, suspected cases received both chest radiography and microscopy in 176 cases and 283 cases, respectively (p-value=0.001). There were 27 cases diagnosed for smear positive TB in pre-intervention and 51 cases diagnosed in post-intervention (p-value=0.011). There were 21 cases pre- and 36 cases post-intervention that had referral documents from health center with no statistically significant difference. Originality/value The TB co-ordinating team had the role to improve health service performance for suspected TB cases to enroll in investigation process for increase TB diagnosis in district hospital.

Loss of Control: Experiences of Depression in Thai Men

In comparison to Thai women, Thai men do not seek care or treatment for depressive symptoms. The literature on men with depression reports that depressive symptoms are viewed as unmasculine. However, little is known about how Thai men experience depression. This qualitative study aimed to understand how Thai men understand having a depressive disorder. Twenty-one male patients were recruited from a psychiatric out-patient clinic and a university hospital in northeastern Thailand. The patients lived with major depressive disorder for at least one year. Data were collected by in-depth interviews and were tape-recorded. Data were transcribed verbatim and analyzed by content analysis. Six themes emerged which were related to masculinity: (a) a loss of control, (b) feeling upside-down, (c) personal weakness, (d) a lack of understanding, (e) social isolation, and (f) a wish to lean on something. The findings are discussed in the context of existing research on depression in men and within the context of masculinity. Recommendations for future research on male depression and implications for clinical practice with men are presented.