Cost-utility analysis of an alcohol policy in Thailand: a case study of a random breath testing intervention.

BACKGROUND: Road traffic injuries are a major concern worldwide, with Thailand facing high accident mortality rates. Drunk driving is a key factor that requires countermeasures. Random breath testing (RBT) and mass media campaigns recommended by the World Health Organisation intend to deter such behaviour. This study aimed to evaluate the cost-effectiveness of implementing RBT in combination with mass media campaigns in Thailand. METHODS: A Markov simulation model estimated the lifetime cost and health benefits of RBT with mass media campaigns compared to mass media campaigns only. Direct medical and non-medical care costs were evaluated from a societal perspective. The health outcomes were quality-adjusted life years (QALY). Costs and outcomes were discounted by 3% per year. Subgroup analyses were conducted for both sexes, different age groups, and different drinking levels. Probabilistic sensitivity analyses were conducted over 5,000 independent iterations using a predetermined distribution for each parameter. RESULTS: This study suggested that RBT with mass media campaigns compared with mass media campaigns increases the lifetime cost by 24,486 THB per male binge drinker and 10,475 THB per female binge drinker (1 USD = 35 THB) and results in a QALY gain of 0.43 years per male binge drinker and 0.10 years per female binge drinker. The intervention yielded incremental cost-effectiveness ratios (ICERs) of 57,391 and 103,850 THB per QALY for male and female drinkers, respectively. Moreover, the intervention was cost-effective for all age groups and drinking levels. The intervention yielded the lowest ICER among male-dependent drinkers. Sensitivity analyses showed that at a willingness-to-pay (WTP) threshold of 160,000 per QALY gained, the RBT combined with mass media campaigns had a 99% probability of being optimal for male drinkers, whereas the probability for females was 91%. CONCLUSIONS: RBT and mass media campaigns in Thailand are cost-effective for all ages and drinking levels in both sexes. The intervention yielded the lowest ICER among male-dependent drinkers. Given the current Thai WTP threshold, sensitivity analyses showed that the intervention was more cost-effective for males than females.

Physical Activity with Sports Scientist (PASS) programme to promote physical activity among patients with non-communicable diseases: a pragmatic randomised controlled trial protocol.

Physical activity (PA) effectively prevents and treats non-communicable diseases in clinical settings. PA promotion needs to be more consistent, especially in busy primary care. Sports scientists have the potential to support PA promotion in primary care. The Physical Activity with Sports Scientist (PASS) programme is created to personalise PA promotion led by a sports scientist in a primary care clinic. A pragmatic randomised controlled trial with two parallel groups will be conducted at a family medicine clinic. Physically inactive participants aged 35-70 years who have type 2 diabetes mellitus, hypertension or dyslipidaemia will be invited. The control group (n=60) will receive usual care. The intervention group (n=60) will receive the PASS programme and usual care. The PASS programme will consist of a tailored PA prescription after the physician's consultation at the first visit and monthly phone follow-ups. The primary outcome is the proportion of participants who have achieved the PA goal defined as aerobic activity (≥150 min/week of moderate to vigorous-intensity PA), muscle-strengthening activity (≥2 days/week of moderate or greater intensity) and multicomponent PA (≥2 days/week of moderate or greater intensity). Secondary outcomes are body composition and physical fitness. The primary and secondary outcomes will be measured and compared between the control and intervention groups at visit 1 (month 0: baseline measurements), visit 2 (months 3-4: follow-up measurements), visit 3 (months 6-8: end-point measurements) and visit 4 (months 9-12: continuing measurements). The study protocol was registered with the Thai Clinical Trials Registry. Trial registration number: TCTR20240314001.

Effect of online infographics for enhancing health literacy among patients with type 2 diabetes in primary care unit during the COVID-19 pandemic: a randomized controlled trial.

BACKGROUND: Health literacy (HL) in patients with type 2 diabetes mellitus (DM) can help control disease and prevent complications. However, most patients with type 2 DM have inadequate HL; therefore, their HL must be further improved. This study aimed to determine the effects of online infographics on improving HL among patients with type 2 DM. METHODS: This randomized controlled trial was conducted from July 2022 to September 2022, at the primary care unit of Songklanagarind Hospital, Thailand; 30 patients with type 2 DM were randomly assigned to the experimental (n = 15; three types of infographics) and control (n = 15; three types of pamphlets) groups. Infographics and pamphlets were distributed weekly via social media platforms. The S-TOFHLA Thai version and Thai-FCCHL were used to evaluate HL. Chi-square, Fisher's exact, Wilcoxon rank-sum, t-test, paired t-test, and McNemar's chi-square tests were used. RESULTS: The median age of 30 participants was 56 years. The mean duration of DM was 9.6 years, with a median HbA1c level of 7.5 mg%. Most participants (80%) had adequate HL in S-TOFHLA, whereas 63.3% had adequate HL in FCCHL. All participants in the infographic group who had inadequate HL in the S-TOFHLA pre-test achieved adequate HL. Meanwhile, only 50% of patients in the pamphlet group achieved adequate HL. Regarding FCCHL, 50% of patients in the infographic group and 60% in the pamphlet group who had inadequate HL in the pretest achieved adequate HL. However, no statistical significance in achieving adequate HL was found in either group. The mean differences (SD) in S-TOFHLA between before and after intervention were 12.53 (8.77; p = 0.0007) and 10.13 (9.88; p = 0.001) in the infographic and pamphlet groups, respectively. Regarding FCCHL, the mean differences (SD) were 3.47 (4.29) and 3.20 (2.91) in the infographic group (p = 0.003) and pamphlet (p = 0.002) groups, respectively. No statistical significance in the mean difference was found between both groups. CONCLUSIONS: Novel online infographics and pamphlets did not significantly differ in achieving adequate HL among patients with type 2 DM who should receive health education about disease control and complication prevention. However, both interventions can increase and maintain HL levels. Online educational media can be appropriate during the COVID-19 pandemic. Nevertheless, further larger-scale studies should be performed to examine the impact of other DM educational media on HL promotion. TRIAL REGISTRATION: The Thai Clinical Trials Registry (TCTR) with registry ID TCTR20230425001 (date of registration 25/04/2023).

Estimated cost of extra work hours from co-workers' drinking in Thailand.

INTRODUCTION: Alcohol's harm to others (AHTO) in workplaces has received little attention. A few studies from high-income countries have estimated the cost of AHTO in workplaces, while data from the low- and middle-income countries are lacking. This study aimed to estimate the cost of AHTO in workplaces and to explore factors associated with the cost of AHTO in workplaces. METHODS: Data were taken from 1392 employed respondents who participated in a survey conducted in Thailand from September 2012 to March 2013. The cost of extra work hours was estimated from the hourly wage and extra hours of work. The hourly wage was computed by converting monthly income to weekly income and dividing weekly income by weekly working hours. The gamma regression with log link was used to determine factors associated with the cost of extra working hours. RESULTS: The past-year prevalence of harm from co-workers' drinking was 17.8% among the employed population. The prevalence of working extra hours was 6.1%. On average, an affected worker worked 16.0 extra hours due to co-workers' drinking. In total, 28.8 million hours of extra work was attributed to co-workers' drinking in 1 year. The cost of these extra work hours was 1.8 billion Thai baht (57.8 million USD). Age, education and type of employment were associated with the cost of working extra hours. DISCUSSION AND CONCLUSIONS: The burden of alcohol in workplaces extends beyond drinking workers. Our findings indicate that alcohol imposes a significant cost on co-workers of drinkers.

From Shadows to Spotlight: Exploring the Escalating Burden of Alcohol-Associated Liver Disease and Alcohol Use Disorder in Young Women.

INTRODUCTION: The burden of alcohol-related complications is considerable, particularly alcohol-associated liver disease and alcohol use disorder (AUD). However, there are deficiencies in comprehensive epidemiological research focusing on these issues, especially among young women who display higher susceptibility to such complications compared with their male counterparts. We thus aimed to determine the global burden of these conditions in this vulnerable group. METHODS: Leveraging data from the Global Burden of Disease Study 2019, we analyzed the prevalence, mortality, and disability-adjusted life years of alcohol-associated cirrhosis (AC), liver cancer from alcohol, and AUD in young women. The findings were categorized by region, nation, and sociodemographic index. RESULTS: The highest age-standardized prevalence rates were observed in AUD (895.96 [95% uncertainty interval (UI) 722.6-1,103.58]), followed by AC (65.33 [95% UI 48.37-86.49]) and liver cancer from alcohol (0.13 [95% UI 0.09-0.19]) per 100,000 people. The highest age-standardized mortality rates were observed in AC (0.75 [95% UI 0.55-0.97]), followed by AUD (0.48 [95% UI 0.43-0.53]) and liver cancer from alcohol (0.06 [95% UI 0.04-0.09]). The highest burdens of AC and AUD were observed in Central Europe, whereas the high-income Asia Pacific had the highest burden of liver cancer from alcohol. DISCUSSION: Throughout the past decade, the trend of AUD varied among regions while the impact of alcohol-associated liver disease has increased, requiring urgent public health strategy to mitigate these complications, particularly in female patients in Europe and the Asia-Pacific region.

Diagnostic Performance of a Mnemonic for Warning Symptoms in Predicting Acute Coronary Syndrome Diagnosis: A Retrospective Cross-Sectional Study.

Objectives: We aimed to create a mnemonic for acute coronary syndrome (ACS) warning symptoms and determine its diagnostic performance. Methods: This retrospective cross-sectional study included patients visiting the emergency room with symptoms of suspected ACS during 2020-2021. The mnemonic was created using symptoms with an odds ratio (OR) for predicting ACS >1.0. The mnemonic with the highest OR and sensitivity was identified. Sensitivity analysis was performed to test the diagnostic performance of the mnemonic by patient subgroups commonly exhibiting atypical symptoms. Results: ACS prevalence was 12.2% (415/3,400 patients). The mnemonic, "RUSH ChesT" [if you experience referred pain (R), unexplained sweating (U), shortness of breath (S), or heart fluttering (H) together with chest pain (C), visit the hospital in a timely (T) manner] had the best OR [7.81 (5.93-10.44)] and sensitivity [0.81 (0.77-0.85)]. This mnemonic had equal sensitivity in men and women, the elderly and adults, smokers and non-smokers, and those with and without diabetes or hypertension. Conclusion: The "RUSH ChesT" mnemonic shows good diagnostic performance for patient suspected ACS. It may effectively help people memorize ACS warning symptoms.

Association of Generation and Group Size With the Usage of a Mobile Health App in Thailand: Secondary Analysis of the ThaiSook Cohort Study.

BACKGROUND: In Thailand, The National Science and Technology Development Agency developed ThaiSook, a behavior-tracking app, to promote healthy lifestyles. The Faculty of Medicine, Prince of Songkla University (MED PSU)×ThaiSook Healthier Challenge encouraged employees to use the app over a 28-day period (from July 11 to August 7, 2022). Until recently, no previous studies have examined the association of generations and group sizes with mobile health (mHealth) app use. Understanding these relationships can inform the design of effective mHealth interventions and facilitate targeted interventions. OBJECTIVE: This study aimed to (1) compare the overall app usage and logging function across different generations and group sizes and (2) describe the demographic characteristics of the participants of the MED PSU×ThaiSook Healthier Challenge. METHODS: We conducted a secondary data analysis of the data from the ThaiSook prospective cohort study. Data were collected through the app and comprised demographic characteristics (ie, age, sex, weight, height, and group size) and behaviors (ie, water consumption, fruit and vegetable consumption, sleep hours, and exercise). The outcomes consisted of users who used the app for at least 80% of the participation period (≥23 days). Bivariate tests (Pearson chi-square test for categorical variables and Mann-Whitney U and Kruskal-Wallis tests for continuous variables) were conducted over sex, generations, initial BMI, and group size. Finally, multiple logistic regression models were used to examine the relationship between the independent variables used by the ThaiSook app and consistent users who had used the app for at least 80% of the participation period. RESULTS: Of the 827 participants, most were female (734/827, 88.8%), belonged to a medium-sized group of 6-10 members (479/827, 57.9%), and belonged to generation Y (377/761, 49.5%). Multivariate analysis revealed that the overall app usage was 2.09 times higher in women than in men (adjusted odds ratio [AOR] 2.09, 95% CI 1.27-3.44). The older generations used all logging functions more frequently than did generation Y (baby boomers AOR 2.54, 95% CI 1.31-4.92; generation X AOR 1.96, 95% CI 1.42-2.72). The use of all logging functions was higher among participants belonging to larger groups than among those belonging to smaller groups (large groups AOR 2.85, 95% CI 1.58-5.16; medium groups AOR 2.06, 95% CI 1.47-2.88). Water logging was most used (806/827, 97.5% participants), followed by food, sleep, and workout logging. CONCLUSIONS: The MED PSU×ThaiSook Healthier Challenge participants were mostly females from generation Y and medium-sized groups. Water logging was most frequently used, followed by fruit and vegetable logging. The results indicate that generation and group size were significantly associated with consistent and daily usage (P<.05). Older generations and larger groups engaged with the app more consistently than younger generations and smaller groups and individuals.

Muslim parents' beliefs and factors influencing complete immunization of children aged 0-5 years in a Thai rural community: a qualitative study.

PURPOSE: Vaccine-preventable diseases have decreased globally. However, measles and diphtheria outbreaks still occur in Southern Thailand, where Muslims are predominant with a documented low vaccine coverage. The purpose of this study was to investigate Muslim parents' beliefs and factors influencing them to complete immunization of children aged 0-5 years in Y.L. province, Thailand. METHOD: A descriptive qualitative study was conducted, using focus group discussion with 26 participants. They are parents whose children had complete or incomplete vaccination and community/religious leaders. Data were analyzed using content-analysis and triangulation method was used to ensure trustworthiness. RESULTS: Four major themes emerged from the analysis: (1) positive vaccine beliefs, which included knowledge and awareness of vaccination, trust in vaccine efficacy, and religious beliefs; (2) positive factors influencing positive beliefs and vaccine acceptance, which were accessibility of reliable sources, and imitation of leaders and health-community-network; (3) negative vaccine beliefs, including bias in vaccine efficacy and safety, personal beliefs about sources of vaccines, and religious misconceptions regarding the value of vaccines and Halal concerns; and (4) negative factors influencing negative beliefs and refusal of vaccination, which were perception of disadvantages of vaccines spread by word-of-mouth, trust in person over empirical evidence, religious views based on self-interpretation, and lack of public information on Halal vaccines. CONCLUSION: Both positive and negative factors influencing complete immunization were found in this study. To enhance vaccine acceptance, health care providers should understand Muslim cultural beliefs by offering parents a chance to express their attitudes and encourage vaccination via religious leaders and community role models.

Workout Logging Through an mHealth App for Weight Reduction Among Different Generations: Secondary Analysis of the MED PSU×ThaiSook Healthier Challenge.

BACKGROUND: Being overweight or obese presents a major risk factor for noncommunicable diseases (NCDs) such as cardiovascular disease, diabetes, and musculoskeletal disorders. These problems are preventable and solvable via weight reduction and increased physical activity and exercise. The number of adults who are overweight or affected by obesity has tripled in the last 4 decades. Using mobile health (mHealth) apps can help users with health issues, including reducing their weight by restricting their daily calorie intake, which can be recorded along with other parameters, such as physical activity and exercise. These features could further enhance health and prevent NCDs. ThaiSook, a Thai mHealth app developed by the National Science and Technology Development Agency, aims to promote healthy lifestyles and reduce the risk behaviors of NCDs. OBJECTIVE: This study aimed to determine whether ThaiSook users were successful in 1-month weight reduction and identify which demographic factors or logging functions were associated with significant weight reduction. METHODS: A secondary data analysis was performed using data collected from the "MED PSU×ThaiSook Healthier Challenge," a month-long challenge to encourage a healthy lifestyle. We enrolled 376 participants to evaluate the study outcomes. The variables, comprising demographic characteristics (ie, sex, generation, group size, and BMI), were classified into 4 groups: normal (18.5-22.9 kg/m2), overweight (23-24.9 kg/m2), obese I (25-29.9 kg/m2), and obese II (BMI ≥30 kg/m2). Logging functions (ie, water, fruit and vegetables, sleep, workout, step, and run) were classified into 2 groups: consistent (≥80%) and inconsistent (<80%) users. Weight reduction was categorized into 3 groups: no weight reduction, slight weight reduction (0%-3%), and significant weight reduction (>3%). RESULTS: Of 376 participants, most were female (n=346, 92%), had normal BMI (n=178, 47.3%), belonged to Generation Y (n=147, 46.7%), and had a medium group size (6-10 members; n=250, 66.5%). The results showed that 56 (14.9%) participants had 1-month significant weight loss, and the median weight reduction of the group was -3.85% (IQR -3.40% to -4.50%). Most participants (264/376, 70.2%) experienced weight loss, with an overall median weight loss of -1.08% (IQR -2.40% to 0.00%). The factors associated with significant weight reduction were consistently logging workouts (adjusted odds ratio [AOR] 1.69, 95% CI 1.07-2.68), being Generation Z (AOR 3.06, 95% CI 1.01-9.33), and being overweight or being obese compared to those with normal BMI (AOR 2.66, 95% CI 1.41-5.07; AOR 1.76, 95% CI 1.08-2.87, respectively). CONCLUSIONS: More than half of the "MED PSU×ThaiSook Healthier Challenge" participants achieved a slight weight reduction, and 14.9% (56/376) of users lost significant weight. Factors including workout logging, being Generation Z, being overweight, and being obese were associated with significant weight reduction.

Inequalities in access to new medication delivery services among non-communicable disease patients during the COVID-19 pandemic: findings from nationally representative surveys in Thailand.

BACKGROUND: This study describes the inequalities in access to a medication delivery service (MDS) during the COVID-19 pandemic and identifies the social determinants of health-related inequalities among non-communicable disease (NCD) patients. METHODS: Data were obtained from a study on the impact of health behaviours and modifications in health behaviours during the COVID-19 pandemic in the Thai population in 2021. The participants were recruited from Bangkok and all four regions of Thailand. The concentration index was used to examine the inequality among income quintiles, which were standardised by age, sex, living area, job type, health insurance scheme, and education level. Logistic regression was used to examine the associations between socio-demographics and access to regular services and new NCD MDSs, adjusted for age, sex, and other covariates. RESULTS: Among 1,739 NCD patients, greater income inequalities in accessing regular NCD services and collecting medicines at registered pharmacies during the COVID-19 pandemic were observed, for which the concentration index indicated utilisation inequalities in favour of richer households. In contrast, receiving medicine at primary care centres, by postal delivery, and delivered by village health volunteers were the new NCD MDSs, which favoured less wealthy households. NCD patients living in rural areas were more likely to access new NCD MDSs, compared to those in urban areas (adjusted odds ratio = 2.30; 95% confidence interval [CI]: 1.22-4.34). Significant associations with receiving medicine at hospitals were also observed for the income quintiles. Individuals in the lowest and 2nd lowest income quintiles were more likely to access new MDSs than those in the richest quintiles. CONCLUSIONS: This study highlighted a disproportionate concentration of access to new NCD MDSs during the COVID-19 pandemic in Thailand, which was more concentrated in lower-income groups. The government should further study and integrate MDSs with the highest cost benefits into nationwide regular systems, while addressing systematic barriers to access to these services, such as the lack of shared health data across health facilities and tele pharmacy equipment. This will promote access to public services among patients in the less advantaged groups and reduce the health inequality gap.

Predictors of adverse perinatal outcomes in fetal growth restriction using a combination of maternal clinical factors and simple ultrasound parameters.

OBJECTIVE: To identify predictors of adverse perinatal outcomes in pregnancies with fetal growth restriction (FGR) using a combination of maternal clinical factors and simple ultrasound parameters and develop a risk-scoring model for predicting adverse perinatal outcomes. METHODS: A retrospective study of 370 non-anomalous singleton pregnancies with FGR was conducted. Multivariate logistic regression analysis was used to identify factors associated with adverse perinatal outcomes; P < 0.05 was considered statistically significant. The discriminative ability was measured with the area under the receiver operating characteristic curve (AUC). A weighted score for each predictor was calculated. RESULTS: Adverse perinatal outcomes occurred in 165/370 (44.6%) cases. There were eight predictive factors, including a history of pregnancy-induced hypertension (PIH) (score = 1), chronic hypertension (score = 3), PIH (score = 2), maternal weight gain less than 8 kg (score = 1), early-onset FGR (score = 1), estimated fetal weight less than 5th percentile (score = 2), amniotic fluid index less than 5 cm (score = 3), and abnormal umbilical artery Doppler (score = 2), with total scores ranging from 0 to 15. AUC for the eight-item predictive model was 0.799 (95% confidence interval 0.753-0.845). CONCLUSION: A combination of maternal clinical factors and simple ultrasound parameters showed acceptable predictive performance for adverse perinatal outcomes in FGR.

Prevalence and Associated Factors of Delayed Diagnosis of Type 2 Diabetes Mellitus in a Tertiary Hospital: A Retrospective Cohort Study.

Objective: To determine the prevalence and associated factors of delayed diagnosis of type 2 diabetes mellitus (DM) among outpatients in a tertiary hospital. Methods: This retrospective cohort study was conducted among outpatients aged ≥35 years with twice fasting plasma glucose (FPG) levels ≥126 mg/dl between 1 January 2018, and 31 December 2020. The prevalence and pattern of delayed diagnosis of DM were defined using the Thai Clinical Practice Guideline (CPG) for Diabetes, 2017, and the American Diabetes Association (ADA) 2017. The cut-off time for FPG level confirmation of 3 months was used to evaluate delayed diagnoses and associated factors. Multiple logistic regression was used to identify variables associated with delayed diagnoses. Results: Of 260 participants, 96.9% and 85.4% had delayed diagnoses as defined by the Thai CPG and the ADA, respectively. Factors significantly associated with delayed diagnosis were hypertension, non-cash insurance, and >10 years of physician experience. Conclusion: Undiagnosed diabetes and diagnosis delay should be a concern in tertiary settings. Senior physicians should focus on patients with higher FPG levels, particularly those who have hypertension, and use non-cash insurance schemes.

The Association among Alcohol Consumption Patterns, Drink-Driving Behaviors, and the Harm from Alcohol-Related Road Traffic Injuries Due to the Drinking of Others in Thailand.

Thailand has one of the highest rates of traffic-related fatalities and alcohol-related road traffic injuries globally. Previous studies focused on alcohol consumption and road traffic injuries. However, no existing studies investigate the association between drink-driving behaviors and road traffic injuries due to the drinking of others. This study aims to explore any potential associations among alcohol drinking patterns, drink-driving behaviors, and the harm from alcohol-related road traffic injuries due to the drinking of others. The Thai Tobacco and Alcohol Use Household National Survey data in 2017 (n = 80,797) were analyzed using multiple logistic regression. This study found that current drinkers and binge drinkers were more likely to suffer from road traffic injuries due to others' drink-driving behavior, i.e., 1.50 times (95% CI: 1.49-1.51) and 2.31 times (95% CI: 2.30-2.33), respectively, compared with non-drinkers. In addition, we found that drink-driving behavior was associated with harm from road traffic injuries due to others' drink-driving behavior by 2.12 times (95% CI: 2.10-2.14) compared with the non-drinker group. This study calls for effective measures to reduce drink-driving behaviors to prevent road traffic injuries due to the drinking of others.

Association of supply sources of alcohol and alcohol-related harms in adolescent drinkers: the baseline characteristics of a high school cohort across Thailand.

BACKGROUND: The main objective of this study was to investigate the association between parental supply of alcohol, alcohol-related harms, and the severity of alcohol use disorder in Thai 7th grade middle school students. METHODS: A cross-sectional descriptive study obtained the baseline data from the project named the Thailand Parental Supply and Use of Alcohol, Cigarettes & Drugs Longitudinal Study Cohort in Secondary School Students in 2018. The sample size was 1187 students who have ever sipped or drank alcohol in the past 12 months. Pearson's Chi square, binary logistic regression, and ordinal logistic regression are applied in the analysis. RESULTS: A single source of parental supply is not significantly associated with any alcohol-related harm and the severity of alcohol use disorder, while parental supply with peers and siblings supply of alcohol plays an important role in both outcomes. The increasing number of sources of alcohol supply increases the risk of alcohol-related harm and the severity of alcohol use disorder. Other risk factors found in both associations included binge drinking, alcohol flushing, low household economic status, distance from the student's family, and poor academic performance. Gender, exposure to alcohol ads on social media and location of residency were not associated with alcohol-related harms or severity of alcohol use disorder. CONCLUSIONS: The results did not support parental guidance in teaching or giving children a drink or sip of alcohol within family to prevent related harms when drinking outside with their peers.

Changes in preventive behaviour after COVID-19 vaccination in Thailand: a cross-sectional study.

BACKGROUND: Protective behaviours (e.g., mask-wearing, handwashing, avoiding social gatherings) and mass vaccination are effective ways to control the coronavirus disease 2019 (COVID-19) pandemic. Previous studies found that people who get vaccinated may change their protective behaviours. The Thai government has endorsed several mix-and-match vaccine regimens to eliminate the insufficiency of each vaccine brand. This study aimed to determine levels of protective behavioural changes after COVID-19 vaccination and its relationship with various vaccine regimens in Thailand. METHODS: A descriptive cross-sectional study was conducted between September 13, 2021, and January 14, 2022. Data were collected using an online questionnaire distributed via social media platforms and posters in public places in Thailand. The questionnaire comprised six items for demographic characteristics, seven items for COVID-19 vaccine regimens, and four items for protective behaviours. The vaccinated Thai population aged ≥ 18 years were surveyed. Statistical analyses included a Chi-squared test, Wilcoxon signed rank test, and multivariate logistic regressions. RESULTS: Of the 469 participants, more than half were females (67.4%), single (57.4%), and lived in an urban area (67.2%). Significant differences were observed with regard to median scores in handwashing (5.0 vs. 5.0, p-value < 0.001), physical distancing (4.0 vs. 5.0, p-value = 0.019), and avoiding social activity (4.0 vs. 5.0, p-value = 0.010) in pre- and post-vaccination situations. Approximately 70-90% of the participants did not report changes in protective behaviours after vaccination. Overall, 17.4%, 13.9%, and 12.7% of participants showed improvements in avoiding social activity, physical distancing, and handwashing respectively. Multivariate analysis revealed that improvements in protective behaviours were significantly associated with the age group (between 18 and 24 years), non-healthcare worker status, and those who lived in urban areas. No significant evidence of vaccine regimens was found relative to improved protective behaviours. CONCLUSION: This evidence revealed that Thai people maintain their protective behaviours after vaccination but rather improved them. Moreover, demographic data were significantly associated with improved protective behaviours, but various vaccine regimens were not. These findings might be useful for implementing policies to maintain personal protective behaviours after vaccination against COVID-19.

Alcohol Recognition and Desire to Drink of Extended Alcohol Brand Logos.

Alcohol companies in Thailand have adopted surrogate marketing that uses similar logos on non-alcoholic products. We aimed to assess variations of the alcohol recognition using reaction time and desire to drink among consumers exposed to original logos and modified logos (i.e., black logos, partial logos, logos on non-alcoholic beverages and other merchandise). Participants aged ≥19 years took part in this cross-sectional study. The primary independent variables were types of logos: original logos, modified logos (i.e., black logos, partial logos, logos on non-alcoholic beverages, and logos on other merchandise). An in-house-developed online survey randomly presented the logos. Alcohol recognition and the desire to drink alcohol were assessed. The study included 1185 participants. More time (estimated coefficient of reaction time <0.5 s) was required to recognize the modified logos than the original logos. Younger participants (19-24 years) reacted significantly faster than the older participants (>25 years) after seeing all types of logos. The desire to drink alcohol (<0.5 point) upon seeing the modified logos was lower than the original logos. No significant difference in the desire was observed between the younger and older participants upon seeing the original and partial logos. The modified logos reminded consumers of the alcohol products of that brand with a tiny difference in reaction time and the desire to drink without practical significance.

Self-Reported COVID-19 Vaccine Hesitancy and Willingness to Pay: A Cross-Sectional Survey in Thailand.

This study aimed to estimate the prevalence and influencing factors of COVID-19 vaccine hesitancy and willingness to pay in Thailand. A descriptive cross-sectional study was conducted from 13 September 2021 to 14 January 2022. Data were collected using an online questionnaire consisting of demographic characteristics, COVID-19 vaccine hesitancy (delay in acceptance and denying vaccination), determinants of vaccine hesitancy (complacency, convenience, and confidence), and willingness to pay. The general Thai population aged ≥18 years were surveyed. Among 705 respondents, 10.4% reported hesitancy, with significant determinants being low complacency and confidence in the vaccine; low convenience was not a significant determinant. Multivariate analysis revealed vaccine hesitancy among women, those with higher education, non-healthcare workers, and those who lived in rural areas. Furthermore, 77.2% of respondents were willing to pay, with the majority willing to pay in the range of THB 501-1000 ( USD 1 = THB 33) per dose. Increased monthly income, no impact of COVID-19 on income, and time period (before mRNA vaccine availability) significantly affected willingness to pay.

The effects of others' drinking on the harms to children in Thailand: Lessons from the WHO-ThaiHealth project.

BACKGROUND: Many knowledge gaps exist in the area of alcohol-related harms in children research such as the potential impact of other's drinking and their social demography. Thus, this study aims to evaluate the effects of characteristics of household members and others' alcohol drinking on harms to children in Thailand. DATA AND METHODS: This study examined 952 parents caring for children and adolescents under 18 years of age, using the questionnaire (i.e., The Harm to Others from Drinking under the WHO/ThaiHealth International Collaboration Research Project). They were interviewed between September 2012 and March 2013. RESULTS: The study found that 15.89% of children and young people were affected by someone's drinking in at least one category of harms. People over 60 years of age were less likely to cause alcohol-related harm to children than those aged 18 to 29 (adjusted odds ratio [AOR] 0.19, 95% confidence interval [Cl]: 0.06-0.58). Households with a binge drinker or regular drinker (≥1 time/week) were more likely to have children at higher risk of suffering alcohol-related harm in comparison to households without alcohol drinker (AOR 4.75 and 1.92, respectively). CONCLUSION: This study found that children whose family members are young adult or consume alcohol (i.e., weekly drinker or binge drinker) were significantly adversely affected. The most common problems were domestic violence and verbal abuse. Most of the problems, affecting children, were caused mostly by their parents.

The Concentration of Large Extracellular Vesicles Differentiates Early Septic Shock From Infection.

Septic shock represents a subset of sepsis with severe physiological aberrations and a higher mortality rate than sepsis alone. Currently, the laboratory tools which can be used to identify the state of septic shock are limited. In pre-clinical studies, extracellular vesicles (EVs), especially large EVs (lEVs), have been demonstrated a role as functional inflammatory mediators of sepsis. However, its longitudinal trend during the disease course has not been explored. In this study, the quantities and subtypes of plasma-derived lEVs were longitudinally compared between patients with septic shock (n = 21) and non-sepsis infection (n = 9), who presented within 48 h of their symptom onset. Blood specimens were collected for seven consecutive days after hospital admission. lEVs quantification and subtyping were performed using an imaging flow cytometer. The experiments revealed a higher lEVs concentration in septic shock patients than infected patients at the onset of the disease. In septic shock patients, lEVs concentration decreased over time as opposed to infected patients whose lEVs concentration is relatively static throughout the study period. The major contributors of lEVs in both septic shock and infected patients were of non-leukocyte origins; platelets, erythrocytes, and endothelial cells released approximately 40, 25, and 15% of lEVs, respectively. Among lEVs of leukocyte origins, neutrophils produced the highest number of EVs. Nevertheless, the proportion of each subtype of lEVs among the given amount of lEVs produced was similar between septic shock and infected patients. These findings raise the possibility of employing lEVs enumeration as a septic shock identifying tool, although larger studies with a more diverse group of participants are warranted to extrapolate the findings to a general population.

Effect of the COVID-19 Pandemic and Other Predictors of True Therapeutic Inertia on Patients with Hypertension in a Primary Care Clinic in Thailand.

INTRODUCTION: Hypertension (HT) has a significant impact on health care worldwide. Therapeutic inertia (TI) is defined as the failure to intensify therapy in the absence of an optimal goal and is widely used as a quality of care parameter. The coronavirus disease 2019 (COVID-19) pandemic has affected many health-care systems, including HT care. Therefore, the present study assessed the impact of the COVID-19 pandemic on TI and its predictors in patients with HT. METHODS: The electronic medical records of patients with HT who attended a primary care clinic at a tertiary hospital during pre-COVID-19 (February 2019 to February 2020) and COVID-19 (March to August 2020) periods were reviewed. RESULTS: Our study included 6089 visits during the 12-month pre-COVID-19 period and 2852 visits during the 6-month COVID-19 period. Most of the baseline characteristics of the HT patients were not significantly different between the two time periods. During the COVID-19 period, the percentage of uncontrolled HT visits decreased from 43% to 31%. Similarly, the prevalence of TI decreased from 81% to 77%. False TI was predominantly due to physicians' concerns regarding the in-clinic blood pressure measurement being inaccurate during both the periods. CONCLUSION: After readjustment for the physicians 'reasons, the true TI was 64% and 60% in the pre-COVID-19 and COVID-19 period. For adjusted physician and patient-related factors, multilevel modeling was used. Senior medical staff visits, elderly patients, prior diabetes mellitus diagnosis, patients who used more than one type of anti-HT medication, and patients with systolic blood pressure >150 mmHg were all predictors of TI. The COVID-19 period, on the other hand had no effect on TI with an adjusted odds ratio of 0.82 (95% confidence interval, 0.67-1.01).