Rassamee Sangthong

Workplace violence directed at nursing staff at a general hospital in southern Thailand

Workplace Violence Directed at Nursing Staff at a General Hospital in Southern Thailand: Chalermrat Kamchuchat, et al. Department of Community Medicine, Faculty of Medicine, Prince of Songkla University, Thailand—This study aimed to document the characteristics of workplace violence directed at nursing staff, an issue which has rarely been studied in a developing country. Two study methods, a survey and a key informant interview, were conducted at a general hospital in southern Thailand. A total of 545 out of 594 questionnaires sent were returned for statistical analysis (response rate=91.7%). The 12‐month prevalence of violence experience was 38.9% for verbal abuse, 3.1% for physical abuse, and 0.7% for sexual harassment. Psychological consequences including poor relationships with colleagues and family members were the major concerns. Patients and their relatives were the main perpetrators in verbal and physical abuse while co‐workers were the main perpetrators in cases of sexual harassment. Common factors to incidents of violence were psychological setting, illness of the perpetrators, miscommunication, and alcohol use. Logistic regression analysis showed younger age to be a personal risk factor. Working in the out‐patient unit, trauma and emergency unit, operating room, or medical or surgical unit increased the odds of violence by 80%. Training related to violence prevention and control was found to be effective and decreased the risk of being a victim of violence by 40%. We recommend providing training to high risk groups as a means of controlling workplace violence directed at nursing staff.

Prevalence and Management of Diabetes and Metabolic Risk Factors in Thai Adults: The Thai National Health Examination Survey IV, 2009

OBJECTIVE To determine the prevalence of impaired fasting glucose (IFG) and undiagnosed and diagnosed diabetes in Thai adults in 2009 and examine the extent of changes in proportions of diagnosis, treatment, and control for blood glucose, high blood pressure, and high total cholesterol between 2004 and 2009. RESEARCH DESIGN AND METHODS Data from the multistage cross-sectional National Health Examination Survey (NHES) IV of 18,629 Thai adults aged ≥20 years conducted in 2009 were used to analyze and compare with the data from NHES III in 2004. RESULTS The prevalence of IFG and diabetes was 10.6 and 7.5%, respectively. Of all diabetes diagnoses, 35.4% were not previously diagnosed, and the proportion was higher in men than in women (47.3 vs. 23.4%, P < 0.05). Compared with those in year 2004, the proportions of individuals with diabetes and concomitant hypertension did not significantly decrease in 2009 in both sexes, but the proportions of women with diabetes who were abdominally obese or had high total cholesterol (≥5.2 mmol/L) significantly increased in 2009 by 18.0 and 23.5%, respectively (all P < 0.01). The rates of treatment and control of blood glucose, high blood pressure, and high total cholesterol were favorably improved in 2009. However, in substantial proportions of individuals with diabetes these concomitants were still controlled suboptimally. CONCLUSIONS The prevalence of diabetes and IFG remained high in Thai adults. Improvement in detection and control of diabetes and associated metabolic risk factors, particularly obesity and high serum cholesterol, are necessary.

Changes in prevalence, awareness, treatment and control of hypertension in Thai population, 2004-2009: Thai National Health Examination Survey III-IV.

Objective: To determine the changes in prevalence, awareness, treatment and control of hypertension and their metabolic risk factors in Thai population between 2004 and 2009. Methods: The Thai National Health Examination Survey (NHES) in 2004 and 2009 data were used. Blood pressure and anthropometric measurements were performed. Prevalence, awareness, treatment and control of hypertension of Thai population aged at least 15 years were calculated. Analyses were weighted to the probability of sampling. Results: The prevalence of hypertension in 2004 and 2009 were relatively stable at approximately 21.0%. There was improvement in awareness of hypertension, from 18.2% for men and 33.0% for women in 2004 to 39.5 and 59.4% in 2009, respectively. The high blood pressure control rates improved from 4.8 to 14.4% for men and from 10.8 to 27.2% for women, respectively (all P < 0.05). The improvement in awareness, treatment and control of hypertension was also observed in individuals with diabetes, obesity and hypercholesterolemia. However, among hypertensive individuals, there were increases in proportions of obesity (BMI ≥ 25 kg/m2) between two surveys: from 39.1 to 47.5% in men and from 54.6 to 62.9% in women, respectively (all P < 0.05). Conclusion: Despite improvement in awareness and control of hypertension in Thai population, a large proportion of hypertensive individuals remained suboptimally controlled. Strengthening measures to control high blood pressure and metabolic risk factors, especially obesity and hypercholesterolemia, in individuals with hypertension are needed.

Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009

BackgroundInformation on the distribution of Metabolic syndrome (MetS) and its combinations by urban/rural areas in lower-middle income countries has been limited. It is not clear how the various combinations of MetS components varied by urban/rural population and if particular combinations of MetS are more common. This study aimed to estimate the prevalence of MetS and combinations of MetS components according to sex and urban/rural areas from a nationally representative sample of Thai adults.MethodsData from the fourth National Health Examination Survey of 19,256 Thai adults aged 20 years and over were analyzed. MetS was defined using the harmonized criteria of six international expert groups with Asian-specific cut-point for waist circumference.ResultsThe prevalence of MetS was 23.2% among adults aged ≥ 20 years (19.5% in men and 26.8% in women). Among men, the prevalence of MetS in urban was higher than those in rural areas (23.1% vs 17.9%, P < 0.05), but among women, the prevalence was higher in rural areas (27.9% vs 24.5%, P < 0.05). Overall, an individual component of low high density lipoprotein (HDL) and hypertriglyceridemia were more common in rural areas, while obesity, high blood pressure and hyperglycemia were more common in urban areas. The most common combination of MetS components in men was the clustering of low HDL, hypertriglyceridemia, and high blood pressure (urban: 3.4% vs. rural: 3.9%, adjusted OR 0.9, 95%CI 0.7, 1.1). Among women, the most common combination was the clustering of obesity, low HDL, and hypertriglyceridemia (urban: 3.9% vs rural: 5.9%, adjusted OR 0.8, 95%CI 0.6, 0.9), followed by the clustering of these three components with high blood pressure (urban: 3.1% vs. rural 4.5%, adjusted OR 0.8, 95%CI 0.7, 0.9).ConclusionMetabolic syndrome affects both urban and rural population with different pattern of MetS combinations. Dyslipidemia and obesity were the most common components among women in rural areas, hence, interventions to prevent and control these factors should be strengthened.

Prevalence and Trends of Obesity and Association with Socioeconomic Status in Thai Adults: National Health Examination Surveys, 1991–2009

We determined the prevalence of obesity in Thai adults aged 20 and over in 2009 and examined trends of body mass index (BMI) between 1991 and 2009. Data from Thai National Health Examination Survey for 19,181 adults in 2009 and 64,480 adults between 1991 and 2004 were used to calculate age-adjusted mean and prevalence. Logistic regression was used to examine the association of obesity with education level. In 2009, age-adjusted prevalence of obesity classes I (BMI 25–29.9 kg/m2) and II (BMI ≥30 kg/m2) in Thai adults aged ≥20 years were 26.0% and 9.0%, respectively. Compared with primary education, the odds of obesity class I were highest in men with university education. For women, the odds of obesity classes I and II were highest in those with primary education. BMI significantly increased from 21.6 kg/m2 in men and 22.8 kg/m2 in women in 1991 to 23.3 kg/m2 and 24.4 kg/m2 in 2009, respectively. The average BMI increases per decade were highest in men with secondary education (1.0 kg/m2, P < 0.001) and in women with primary education with the same rate. There were increasing trends in BMI with slight variation by SES groups in Thai men and women during 1991–2009.

Effects of a Phone Call Intervention to Promote Adherence to Antiretroviral Therapy and Quality of Life of HIV/AIDS Patients in Baoshan, China: A Randomized Controlled Trial

Background. Suboptimal adherence to antiretroviral therapy (ART) is still pervasive. The effect of using a mobile phone call intervention to improve patient adherence is currently not known. Objective. This study aims to investigate the effects of a phone call intervention on adherence to ART and quality of life (QOL) of treatment-naive and treatment-experienced patients. Methods. A randomized controlled trial was conducted in the three largest public hospitals. Adherence was measured by self-completed questionnaires. QOL was assessed by the WHOQOL-HIV BREF. Outcomes were assessed at day 15, at 1, 2, and 3 months after start of treatment for treatment-naive patients and at 3 months after study enrollment for treatment-experienced patients. Results. A total of 103 treatment-naive and 93 treatment-experienced HIV/AIDS patients were consecutively recruited. Results show that a phone call intervention could maintain high self-reported adherence among both treatment-naive and treatment-experienced patients. After three months, significant QOL improvements were observed in domains of physical health (P = 0.003), level of independence (P = 0.018), environment (P = 0.002), and spirituality/religion/personal beliefs (P = 0.021) among treatment-naive patients. Conclusion. A mobile phone call intervention to patients could maintain high adherence rates although no statistically significant differences were found. A phone call could improve some domains of QOL among treatment-naive patients.

Current situation and future challenges of tobacco control policy in Thailand

In Thailand, the prevalence of smoking has steadily declined over the past 20 years, suggesting an effective tobacco control policy. However, the prevalence has recently stabilised and youth smoking now appears to be on the rise. Tobacco use is the third highest risk factor contributing to the burden of disease in the country. This is an issue of concern and led to the present review of tobacco control measures in Thailand. The present evidence-based review shows that Thailands tobacco control measures are relatively strong and comply well with the WHO Framework Convention on Tobacco Control in terms of taxation, advertisement through popular media, and warning labels on cigarettes and other tobacco product packages. However, challenges remain in dealing with highly prevalent roll-your-own cigarettes, strict prohibition of tobacco sale to underage youths, household smoking, illicit trade of tobacco products, viable tobacco crop diversification for domestic tobacco growers and liability. If these challenges are met, the prevalence of tobacco consumption could possibly be further reduced.

HIV vaccine acceptability among immigrant Thai residents in Los Angeles: a mixed-method approach

Abstract This study examined HIV vaccine acceptability among immigrant Thai residents in Los Angeles, California. We combined a qualitative research method (focus groups) with an innovative market research method (conjoint analysis). Focus groups explored social issues, concerns, barriers and motivators associated with HIV vaccine acceptability. Conjoint analysis was used to assess preferences among eight hypothetical HIV vaccines with varying attribute profiles and the impact of various attributes on acceptability. Five main themes were identified in the focus groups regarding acceptance and utilization of preventive HIV vaccines: (1) vaccine characteristics, such as efficacy, physical side-effects and cost, (2) fear of a vaccine, (3) vaccine acceptability and optimism, (4) social and family responses and (5) behavioral disinhibition. Conjoint analysis revealed HIV vaccine acceptability ranging from 7.4 (SD = 19.4) to 85.2 (SD = 24.3) across eight hypothetical vaccines. The vaccine with the highest acceptability had the following attributes: 99% efficacy, no side-effects, 10 years of protection, protects against one sub-type, free, one dose and given by injection. Vaccine efficacy had the greatest impact on acceptability (51.4, p=.005), followed by side-effects (11.1, p=.005) and duration of protection (8.3, p=.005). Despite some apprehensions and concerns, Thai residents perceived an HIV vaccine as making an important contribution to society and to protecting oneself and ones family from HIV infection. Nevertheless, acceptability of a partially efficacious vaccine may be low, suggesting the need for tailored social marketing interventions that might emphasize a collectivistic rather than an individualistic focus. Assessing HIV vaccine acceptability using a mixed-method approach is feasible with Thai residents and should lend itself to HIV vaccine research with other Asian Pacific Islander populations in the US.

Multiple substance use among heroin-dependent patients before and during attendance at methadone maintenance treatment program, Yunnan, China

BACKGROUND Multiple substance use is a common problem among heroin users. This study aims to describe patterns of multiple substance use one year before and during attendance at methadone maintenance treatment (MMT) programs and associated variables of continued heroin use in MMT clinics in Yunnan, China. METHODS The study was conducted among 168 heroin addicts who had received treatment for at least one year at two MMT clinics in Kunming city. A structured questionnaire, a medical record, and computer database were used to obtain history of substances use, significant clinical information, and treatment details, respectively. RESULTS Heroin, tobacco, and alcohol were the most commonly used substances both before and during MMT. After one year in MMT, use of heroin, alcohol, tramadol, and triazolam significantly decreased whereas use of ephedrine increased. Simultaneous substance use was halved but the decrease was not statistically significant. The proportion of injecting users was reduced from 61% to 43%. History of heroin use in the preceding 6 months during MMT increased the odds of continued heroin use (OR=5.8, 95% CI=[2.9-11.3]). An average 10mg higher methadone dose increment was associated with a reduced odds of heroin use by 10%. CONCLUSION MMT did not reduce the number of substances used, but the number of injecting heroin users after the first year of treatment decreased. Heroin use in the preceding 6 months during MMT treatment and lower methadone dose were associated with continued heroin use in MMT.

Lifetime multiple substance use pattern among heroin users before entering methadone maintenance treatment clinic in Yunnan, China

INTRODUCTION AND AIMS Multiple substance use leads to greater levels of psycho-behavioural problems, unsafe sex, and therefore a high risk of contracting sexually transmitted diseases, and is also more difficult to treat. This study aims to determine pattern of lifetime multiple substance use among Chinese heroin users before entering methadone maintenance treatment clinic. DESIGN AND METHODS A survey to obtain retrospective longitudinal data on lifetime multiple substance use was conducted among 203 heroin users in two of the biggest methadone maintenance clinics in Kunming City, Yunnan province. RESULTS All participants used more than one substance in their lifetime. Most of them used four or more substance groups (range two to seven groups). The most common substance patterns in lifetime use were alcohol, tobacco, opiates and depressants. Approximately 80% of them had a history of simultaneous substance use (co-use). The most common combination of co-use pattern was heroin with depressant. Common reasons for co-use were to get high, to experiment, to sleep and to increase the potency of other drugs. Determinants of co-use were education, marital status and family relationship. DISCUSSION AND CONCLUSIONS Multiple substance use is highly prevalent among Chinese heroin users. Depressants are the most common substances used in combination with heroin.