Association between sociodemographic factors and health beliefs related to breast cancer screening behavior among Northern Thai women: a hospital-based study.

Early diagnosis of breast cancer is crucial for reducing mortality rates. The purpose of this study is to determine the impact of demographics/social determinants of health on beliefs about the practice of self-breast examination, using mammogram and ultrasound in the context of breast cancer screening among Thai women in a hospital-based setting for implying program planning and future research. A cross-sectional study was conducted in two health centers in Chiang Mai Province from August 2021 to December 2021, involving 130 Thai women ages 40 to 70 years. Data were collected by a survey using a questionnaire to gather sociodemographic information, and health beliefs about breast cancer and screening behavior utilizing the modified Thai version of Champion's Health Belief Model Scale (MT-CHBMS). Descriptive statistics, t-tests, ANOVA, and linear regression models were employed for examining association between sociodemographic factors and health beliefs about the practice of self-breast examination (BSE), using mammogram (MG) and ultrasound (UTS). Health insurance schemes were associated with Benefit-MG, Barrier-BSE, Barrier-MG and Barrier-UTS subscales. Additionally, monthly income was associated with Barrier-MG and Barrier-UTS subscales. The most common barriers reported were "embarrassment", "worry", and "takes too much time". To enhance breast cancer screening in Thailand, program planning and future research should focus on health insurance schemes, especially women with social security schemes, as they may be the most appropriate target group for intervention.

Psychometric assessment of the 10-item, revised experience of close relationship (ECR-R-10) in nonclinical and clinical populations of adults and older adults in Thailand.

The experiences of close relationships-revised (ECR-R) is a widely used 36-item self-report measurement for measuring adult attachment. However, various short versions of the ECR-R have been developed and tested psychometrically. Given the cultural impact, a short version of the Thai ECR-R should be derived from the existing Thai version of the ECR-R. This study aimed to develop a 10-item version of the ECR-R that demonstrates comparable psychometric properties to the previous Thai version and the 18-item ECR-R. This study included four studies with a total of 1,322 participants. In study 1, 434 adults in a nonclinical setting were used for the development of the 10-item Thai ECR-R and tested in an independent sample. Studies 2, 3, and 4 were conducted on 312 adults in the clinical setting, 227 older adults in the nonclinical, and 123 older adults in clinical settings. The Cronbach alphas and corrected correlations between the ECR-R-18 and the ECR-R-10 in each study were calculated. Confirmatory factor analysis of the first-order two-factor solution model with fit statistics was examined with each sample. Correlations of the ECR-R-18 and the ECR-R-10 with other measurements were presented and compared. Known-group validity and measurement invariance test were also examined. The Cronbach alphas of the ECR-R-10 among all samples were acceptable, ranging between .77 and .85 for avoidance subscales and between .82 and .86 for anxiety subscales. The corrected correlation between the ECR-R-18 and ECR-R-10 was between .61 (p < .001) and .82 (p < .001). The values of the comparative fit index and Tucker-Lewis index for the model of ECR-R-10 were between .903 and .985, whereas the root-mean-square error of approximation was between .082 and .036, indicating that the model fits were acceptable. The ECR-R-10 was related to the measurements with a similar construct; however, no difference in the magnitude of correlation was observed between ECR-R-18 and ECR-R-10. Known group validity was established. Measurement invariance was successfully established across different age and gender groups, although it was only partially achieved with respect to clinical status. The ECR-R-10 provided equal or superior psychometric properties to the ECR-R-18 across age groups and settings. As it is a briefer scale, the ECR-R-10 can be practically used in general and clinical samples to reduce the burden of assessment, especially with older adults. Further investigation is needed to test the scale's temporal stability.

Predictors for quality of life among older adults with depressive disorders: A prospective 3-month follow-up cohort study.

PURPOSE: The study aimed to investigate the predictive factors for quality of life among subjects with late-life depression. DESIGN AND METHODS: Data including depressive symptoms assessed by the Hamilton Rating Scale of Depression (HAMD), geriatric depression scale (GDS), perceived stress scale (PSS), multidimensional scale for perceived social support, and the EQ-5D scale were collected at baseline and at 3-month follow-up from 264 participants. FINDINGS: After controlling for covariates, time, GDS, PSS, HAMD, and living alone were confirmed predictors for change of EQ-5D scores. PRACTICE IMPLICATIONS: Perceived stress is important, and intervention to reduce stress especially in early treatment of depressive disorder should be encouraged.

Translation, Adaptation, and Validation of the Modified Thai Version of Champion's Health Belief Model Scale (MT-CHBMS).

BACKGROUND: While breast cancer is the leading cause of cancer death among Thai women, breast self-examination (BSE), mammography, and ultrasound use are still underutilized. There is a need to assess women's beliefs about breast cancer and screening in different cultural settings. As a result, a tool to measure the beliefs that influence breast-cancer-screening practices is needed. Champion's Health Belief Model Scale (CHBMS) is a valid and reliable tool for assessing individuals' attitudes toward breast cancer and screening methods, but it has not been validated in Thai women. The study aimed to translate and validate the CHBMS for breast self-examination and mammography among Thai women and to modify the original scale by adding ultrasound items for breast cancer screening. In addition, the purpose of this study was to create a modified Thai version of the CHBMS which could be used to better understand patients' beliefs regarding breast cancer screening in Thailand, in order to develop practical and effective interventions suited to their beliefs. METHODS: The CHBMS was translated into Thai, validated by a panel of experts, back-translated, modified by adding content about ultrasound for screening breast cancer, and pretested. Confirmatory factor analysis was used with a sample of 130 Thai women aged 40 to 70 years old. RESULT: The final MT-CHBMS consisted of 64 items determining ten subscales: susceptibility, seriousness, benefits-breast self-examination, benefits-mammogram, barriers-BSE, barriers-mammogram, confidence, health motivation, benefits-ultrasound, and barriers-ultrasound. The MT-CHBMS demonstrated excellent internal consistency. The ten-factor model was best fitted to the data. CONCLUSION: The MT-CHBMS was found to be a reliable and valid tool for measuring individuals' attitudes toward breast cancer and screening methods. The scale could be easily used by healthcare providers to determine the beliefs before planning appropriate interventions to increase early detection.

Construct Validity and Differential Item Functioning of the PHQ-9 Among Health Care Workers: Rasch Analysis Approach.

PURPOSE: The Patient Health Questionnaire (PHQ-9) is a widely used self-report questionnaire to screen depression. Its psychometric property has been tested in many populations including health care workers. We used Rasch measurement theory to examine the psychometric properties of PHQ-9 regarding item difficulty, item fit and the differences between subgroups of respondents classified by sex, age, education and alcohol user status, based on the same overall location of participants. PATIENTS AND METHODS: In total, 3204 health care workers of Maharaj Nakorn Chiang Mai Hospital participated and were administered the PHQ-9. Rating scale Rasch measurement modeling was used to examine the psychometric properties of the PHQ-9. RESULTS: The data fitted well to the Rasch model and no violations of the assumption of unidimensionality were observed. All 9 items could form a unidimensional construct of overall depressive severity. Suicidal ideation was the least endorsed while sleep problem was the most. No disordered category and threshold of the rating response were observed. No locally dependent items were observed. No items were found to show differential item functioning across age, sex, education and alcohol consumption. The item-person Wright map showed that the PHQ-9 did not target well with the sample, and a wide gap suggesting few or no items exist to differentiate participants at a certain ability level among the PHQ-9 items. CONCLUSION: The PHQ-9 can be used as a screening questionnaire for major depressive disorder as its psychometric property was verified based on Rasch measurement model. The findings are generally consistent with related studies in other populations. However, the PHQ-9 may be unsuitable for assessing depressive symptoms among health care workers who have low levels of depression.

Functional-Belief-Based Alcohol Use Questionnaire (FBAQ) as a Pre-Screening Tool for High-Risk Drinking Behaviors among Young Adults: A Northern Thai Cross-Sectional Survey Analysis.

BACKGROUND: an alcohol-use disorders identification test (AUDIT) is a standard screening tool for high-risk drinking behavior. Standard drink calculation is difficult to comprehend and may lead to inaccurate estimates. This study intended to develop a practical pre-screening tool for the identification of high-risk drinkers among young adults. METHODS: a cross-sectional survey was conducted in Northern Thailand from July 2016 to December 2016. Data was collected on relevant characteristics and health beliefs about drinking. The 12-month AUDIT was used as the reference standard. Logistic regression was used for the score derivation. The discriminative ability was measured with an area under the receiver operating characteristic curve (AuROC). RESULT: a total of 1401 young adults were included. Of these, 791 people (56.5%) were current drinkers. Three functional-belief items were identified as independent predictors of high-risk drinking and were used to develop the functional-belief-based alcohol-use questionnaire (FBAQ). The FBAQ demonstrated an acceptable discriminative ability-AuROC 0.74 (95% confidence interval (CI) 0.70, 0.77). CONCLUSION: The FBAQ contains only three simple belief questions and does not require unintelligible standard drink calculation. Implementing the FBAQ score and the AUDIT in a serial manner might be a more effective method in a mass-screening program for alcohol-use disorder in young adults.

Predictors of Passive and Active Suicidal Ideation and Suicide Attempt Among Older People: A Study in Tertiary Care Settings in Thailand.

PURPOSE: This study compared predictors of passive suicidal ideation (SI), active SI, and suicide attempt (SA) among elderly Thai patients in tertiary care settings. PATIENTS AND METHODS: Psychiatric diagnoses and suicidality of 803 older people were assessed using the Mini-International Neuropsychiatric Interview and the Structured Clinical Interview for DSM-IV-TR. All participants completed the Montreal Cognitive Assessment, multidimensional scale of perceived social support (MSPSS), 15-item Thai geriatric depression scale (TGDS-15), 10-item perceived social scale and the Core Symptoms Index. The chi-square test, t-test and ANOVA were used for bivariate analysis of predictors of specific suicidality types. Multiple logistic regression was used to determine the predictors for each type of suicidality. RESULTS: The patients' mean age was 69.24 ± 6.90 years, and the majority were female (69.74%). Passive SI, active SI and SA were found among 20.42%, 3.74% and 2.37%, respectively, of the patients. Major depressive disorder (MDD) was a predictor of both passive and active SI (OR = 2.06 and 3.74, respectively). Other predictors of passive SI included hypomania (OR = 8.27) and positive score on the TGDS-15 (OR = 1.29). Predictors of active SI included agoraphobia (OR = 6.84) and hypomania (OR = 7.10). Predictors of SA included a family history of alcohol dependence (OR = 14.16), a history of depression (OR = 4.78) and agoraphobia (OR = 19.89). Surprisingly, hypertension and self-reported anxiety symptoms were protective factors for passive SI (OR = 0.51 and 0.85, respectively). Likewise, MSPSS was a protective factor for SA (OR = 0.90). CONCLUSION: Predictors of each type of suicidality differed. MDD was the main predictor for SI; however, agoraphobia and poor perceived social support were more pronounced among individuals with SA. Further investigation, especially in longitudinal fashion, should be warranted.

Mediation model of comorbid anxiety disorders in late-life depression.

BACKGROUND: A number of studies have been conducted on risk factors of comorbid anxiety disorders regarding late-life depression (LLD). This study investigated the associated factors and their relationship to comorbid anxiety disorders in LLD. METHODS: Participants included 190 elderly Thais (73.2% female, with a mean age of 68.39 ± 6.74 years) with depressive disorders, diagnosed according to DSM-IV Diagnosis Axis I disorders assessed by Mini-International Neuropsychiatric Interview. Demographic data, medical and psychiatric history, family psychiatric history, past depression, family history of depression, Neuroticism Inventory and 7-Item Hamilton Depression Rating Scale (HAMD-7) were analyzed for path analysis using Structural Equation Model framework. The bootstrapping method was used for testing indirect effects. RESULTS: Being female was associated with comorbid anxiety disorders with an indirect effect (ß = - 0.032, P = 0.018) through neuroticism, depression severity, history and family history of depression. Family history of depression had no effect on comorbidity (P = 0.090). Neuroticism had an indirect effect on comorbid anxiety disorders (ß = 0.075, P = 0.019) via depression severity as reflected by HAMD-7 score (ß = 0.412, P = < 0.001). Total variance explained from this model was 11%. This model had good-fit index with Chi-square > 0.05, CFI and TLI > 0.95 and RMSEA < 0.06. CONCLUSION: Neuroticism mediates the effect of relationship between sex, family history and history of depressive disorders and comorbid anxiety disorders in LLD. Moreover, depression severity is a mediator for neuroticism and comorbid anxiety disorders. Longitudinal studies are warranted to indicate the importance of effective treatment of depression to lower the risk of developing comorbid anxiety disorders among depressed elderly.

Health-Risk Behaviours and Injuries among Youth and Young Adults in Chiang Mai, Thailand: A Population-Based Survey.

This study aimed to identify the prevalence of health-risk behaviours (alcohol use, tobacco smoking and gambling) and the associations between health-risk behaviours and injuries among youth (15-24 years) and young adults (25-39 years). A multi-stage cluster sampling survey was conducted in Chiang Mai, Thailand. The associations between health-risk behaviours and injuries were analysed using logistic regression and adjusted for potential confounders. Sample weights were applied in all analyses. Six-hundred-and-thirty participants were included. Fifty-three percent of males and 12.3% of females drank in the past three months. Smoking in the past three months was higher among males (38.5%) than females (0.7%). About a quarter of men and a fifth of the women had gambled in the past year. A total of 6.4% of males and 4.8% of females sought medical attention in the past year due to injuries. Compared to those without any of the three health-risk behaviours, the odds ratio for injuries requiring medical attention was 3.81 (95% CI: 1.33 to 10.90, p = 0.013) for those with two health-risk behaviours and 13.8 (95% CI: 4.24 to 45.10, p < 0.001) for those with all three health-risk behaviours. Injury prevention policies may need to incorporate interventions designed to assess multiple health-risk behaviours.

Risk of harm from alcohol use and heavy alcohol consumption: Its association with other NCD risk factors in Thailand.

While there is an abundance of literature examining the relation between quantity of alcohol consumption and risk factors for non-communicable diseases (NCD), there is less evidence on whether the risk of harm from alcohol use would have a similar relationship with NCD risk factors. The study aims to determine the association between level of harm from alcohol use and NCD risk factors. A cross-sectional survey was conducted among health care workers in Thailand in 2013. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) was used to assessed risk of harm from alcohol use. The results suggest that higher risk of harm from alcohol use was associated with two of the eight NCD risk factors among women (higher blood pressure and higher triglyceride level) and five of the eight NCD risk factors among men (smoking, physical inactivity, higher blood pressure, higher blood glucose and higher triglyceride level). For men, assessing risk of harm could be incorporated as part of NCD programs as practitioners do not have to worry about the accuracy of the alcohol quantification and conversion to standard drinks. However, among women, quantifying volume may still be needed.

Prevalence and associated factors of comorbid anxiety disorders in late-life depression: findings from geriatric tertiary outpatient settings.

PURPOSE: The study evaluated the prevalence of comorbid anxiety disorders in late-life depression (LLD) and identified their associated factors. PATIENTS AND METHODS: This study involved 190 elderly Thais with depressive disorders diagnosed according to the Mini-International Neuropsychiatric Interview (MINI). Anxiety disorders were also diagnosed by the MINI. The 7-item Hamilton Depression Rating Scale (HAMD-7), Montreal Cognitive Assessment, Geriatric Depression Scale (GDS), Core Symptoms Index, Neuroticism Inventory, Perceived Stress Scale and Multidimensional Scale for Perceived Social Support were completed. Descriptive statistics and ORs were used for analysis. RESULTS: Participants included 139 females (73.2%) with a mean age of 68.39±6.74 years. The prevalence of anxiety disorders was 7.4% for generalized anxiety disorder (GAD), 4.7% for panic disorder, 5.3% for agoraphobia, 1.1% for social phobia, 2.1% for obsessive-compulsive disorder and 3.7% for post-traumatic stress disorder, with an overall prevalence of 16.84%. The comorbidity of anxiety disorders was associated with gender (P=0.045), history of depressive disorder (P=0.040), family history of depressive disorder (P=0.004), GDS (P=0.037), HAMD-7 (P=0.001), suicidality (P=0.002) and neuroticism (P=0.003). History of alcohol use was not associated. CONCLUSION: The prevalence of anxiety in LLD was comparable to other studies, with GAD and agoraphobia being the most prevalent. This study confirmed the role of depression severity and neuroticism in developing comorbid anxiety disorders.

Prevalence, clinical and psychosocial variables of depression, anxiety and suicidality in geriatric tertiary care settings.

OBJECTIVE: The study investigated the prevalence of depressive and anxiety disorders and suicide risk in geriatric outpatients in tertiary care hospitals. MATERIALS AND METHODS: An observational, cross-sectional study was conducted with 803 participants aged 60 and above attending geriatric outpatient clinics in tertiary care hospitals in Thailand. Participants were assessed using DSM-IV-TR criteria to calculate the prevalence of deressive and anxiety disorders, and their suicide risk. Montreal Cognitive Assessment (MoCA), Perceived Stress Scale (PSS), Multidimensional Scale of Perceived Social Support, Core Symptom Index (CSI), 15-item Geriatric Depression Scale (GDS-15), Neuroticism Inventory (NI) and the Revised Experience of Close Relationships Questionnaire (ECR-R) were administered. Quality of life was assessed using the EuroQoL (EQ-5D). RESULTS: The prevalence rate for depressive disorders was 23.7%, anxiety disorders was 6.4%, and current suicide risk was 20.4%. PSS, MSPSS, GDS, CSI, and NI scores were significantly higher in all clinical disorders and a suicide group compared with nonclinical subjects. MoCA and ECR-R did not differentiate between clinical disorder and nonclinical samples. Comparing all four outcomes, the EQ-5D differed most in the mixed depressive-anxiety disorder and nonclinical groups (t = 12.20, p < .001). CONCLUSION: The present findings revealed a high prevalence of depression, anxiety and suicidality among elderly patients attending tertiary care hospitals. Perceived stress, perceived social support, and neuroticism scores were significantly higher in this group. Role of sociodemographic, clinical and psychosocial variables as risk factors for these clinical disorders should be further examined.

Predictors of polypharmacy among elderly Thais with depressive and anxiety disorders: findings from the DAS study.

BACKGROUND: Polypharmacy is a geriatric syndrome defined variously as the use of potentially inappropriate drugs and/or the concurrent use of multiple medications including prescription and over-the-counter drugs. An association has been shown between polypharmacy and physical health, increased morbidity and increased mortality. However, there is little information regarding the association between polypharmacy and physical disease, personality trait and mental health problems in elderly. The aim of this study was to investigate potential predictive psychosocial factors related to polypharmacy in elderly Thai people. METHODS: The study analysed the secondary data from the Depressive Disorders, Anxiety Disorders, Suicide Risk and Associated Factors Among Elderly Thai People Program (DAS Study) which was funded by National Research Council of Thailand and conducted between January 2012 and April 2013. Demographic and baseline clinical characteristics including sex, age, education, living alone or with others, access to health care privilege and monthly income were described. The number of medication, physical diseases and mental health problems (i.e. depression, anxiety, and personality trait of neuroticism) were analyzed using descriptive statistics, chi-square and proportional odds logistic regression. RESULTS: The 803 participants consumed an average of 2.13 prescribed medicines daily (SD 1.46, median = 2). The largest group used 3 medications (18.6%). Predictors found to be associated with polypharmacy in the logistic regression model included hypertension (OR = 1.985, 95% CI = 1.420-2.775), anxiety disorder (OR = 4.402, 95% CI = 2.630-7.367), number of diseases (OR = 2.140, 95% CI = 1.874-2.445), depressive disorder (OR = 1.470, 95% CI = 1.080-2.001), diabetes mellitus (OR = 1.864, 95% CI = 1.122-3.098) and dyslipidemia (OR = 0.511, 95%CI = 0.325-0.803). CONCLUSIONS: The prevalence of polypharmacy among Thai elderly was relatively high compared to other related studies. Several aspects should be taken into consideration before starting an additional medication in elderly patients. In addition to the number of physical disease that leads to polypharmacy, general practitioners should be aware of anxiety, depression, and personality trait of neuroticism that may be related to polypharmacy. Early detection for such condition as well as non-pharmacological intervention could be one way to help reduce polypharmacy in the elderly.

Functional beliefs and risk minimizing beliefs among Thai healthcare workers in Maharaj Nakorn Chiang Mai hospital: its association with intention to quit tobacco and alcohol.

BACKGROUND: Individual health beliefs are likely to play a key role in how people respond to knowledge and information about the potential harm from smoking and alcohol abuse. The objectives of the study were to 1) explore whether functional beliefs and risk minimizing beliefs were associated with intention to quit smoking and confidence to quit smoking and 2) explore whether functional beliefs and risk minimizing beliefs were associated with intention to quit alcohol drinking and confidence to quit alcohol drinking. METHODS: A cross-sectional survey was conducted in 2013 among health care workers working in Thailand. Using predicted factor scores from factor analysis, the relationship between factor scores for each of the two beliefs and intention to quit and confidence to quit were tested using ANOVA and further adjusted for age and sex using linear regression. RESULTS: Functional beliefs were inversely associated with the intention to quit and confidence to quit smoking. Both functional beliefs and risk minimizing beliefs were each inversely associated with the intention to quit and confidence to quit alcohol drinking. CONCLUSION: Our study enhances the understanding of the complexities of health beliefs regarding these two commonly abused substances. As functional beliefs were associated with smoking and alcohol use, interventions to counter the cultural values and individual beliefs about the benefits of smoking and alcohol use are needed. Tackling risk minimizing beliefs by providing individualized feedback regarding harm may also be useful in alcohol drinkers.

Risk-Minimizing Belief: Its Association with Smoking and Risk of Harm From Smoking in Northern Thailand.

Risk-minimizing beliefs refer to the underestimation of the health risks of particular behaviors. The aim of the study was to investigate the associations between risk-minimizing belief with smoking and the risk of harms from smoking in Northern Thailand (N=3,865). Adjusting for potential confounders, risk-minimizing belief was inversely associated with lifelong abstinence, positively associated with increased risk of being a current smoker, and weakly associated with increased risk of harm from smoking. Targeting risk-minimizing beliefs in current smokers and those who have never smoked may be useful in the Northern Thai population.

Chiang Mai University Health Worker Study aiming toward a better understanding of noncommunicable disease development in Thailand: methods and description of study population.

BACKGROUND: Urbanization is considered to be one of the key drivers of noncommunicable diseases (NCDs) in Thailand and other developing countries. These influences, in turn, may affect an individual's behavior and risk of developing NCDs. The Chiang Mai University (CMU) Health Worker Study aims to provide evidence for a better understanding of the development of NCDs and ultimately to apply the evidence toward better prevention, risk modification, and improvement of clinical care for patients with NCDs and NCD-related conditions. METHODS: A cross-sectional survey of health care workers from CMU Hospital was conducted between January 2013 and June 2013. Questionnaires, interviews, and physical and laboratory examinations were used to assess urban exposure, occupational shift work, risk factors for NCDs, self-reported NCDs, and other NCD-related health conditions. RESULTS: From 5,364 eligible workers, 3,204 participated (59.7%). About 11.1% of the participants had high blood pressure (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and almost 30% were considered to be obese (body mass index ≥25 kg/m(2)). A total of 2.3% had a high fasting blood glucose level (≥126 mg/dL), and the most common abnormal lipid profile was high low-density lipoprotein (≥160 mg/dL), which was found in 19.2% of participants. DISCUSSION: The study of health workers offers three potential advantages. The first is that the study of migrants was possible. Socioenvironmental influence on NCD risk factors can be explored, as changes in environmental exposures can be documented. Second, it allows the investigators to control for access to care. Access to care is potentially a key confounder toward understanding the development of NCDs. Lastly, a study of health personnel allows easy access to laboratory investigations and potential for long-term follow-up. This enables ascertainment of a number of clinical outcomes and provides potential for future studies focusing on therapeutic and prognostic issues related to NCDs.

Situational analysis of palliative care education in thai medical schools.

OBJECTIVE: The Thai Medical School Palliative Care Network conducted this study to establish the current state of palliative care education in Thai medical schools. METHODS: A questionnaire survey was given to 2 groups that included final year medical students and instructors in 16 Thai medical schools. The questionnaire covered 4 areas related to palliative care education. RESULTS: An insufficient proportion of students (defined as fewer than 60%) learned nonpain symptoms control (50.0%), goal setting and care planning (39.0%), teamwork (38.7%), and pain management (32.7%). Both medical students and instructors reflected that palliative care education was important as it helps to improve quality of care and professional competence. The percentage of students confident to provide palliative care services under supervision of their senior, those able to provide services on their own, and those not confident to provide palliative care services were 57.3%, 33.3%, and 9.4%, respectively. CONCLUSIONS: The lack of knowledge in palliative care in students may lower their level of confidence to practice palliative care. In order to prepare students to achieve a basic level of competency in palliative care, each medical school has to carefully put palliative care content into the undergraduate curriculum.

Diagnosing delirium in elderly Thai patients: utilization of the CAM algorithm.

BACKGROUND: Delirium is a common illness among elderly hospitalized patients. However, under-recognition of the condition by non-psychiatrically trained personnel is prevalent. This study investigated the performance of family physicians when detecting delirum in elderly hospitalized Thai patients using the Thai version of the Confusion Assessment Method (CAM) algorithm. METHODS: A Thai version of the CAM algorithm was developed, and three experienced Thai family physicians were trained in its use. The diagnosis of delirium was also carried out by four fully qualified psychiatrists using DSM-IV TR criteria, which can be considered the gold standard. Sixty-six elderly patients were assessed with MMSE Thai 2002, in order to evaluate whether they had dementia upon admission. Within three days of admission, each patient was interviewed separately by a psychiatrist using DSM-IV TR, and a family physician using the Thai version of the CAM algorithm, with both sets of interviewers diagnosing for delirium. RESULTS: The CAM algorithm tool, as used by family physicians, demonstrated a sensitivity of 91.9% and a specificity of 100.0%, with a PPV of 100.0% and an NPV of 90.6%. Interrater agreement between the family physicians and the psychiatrists was good (Cohen's Kappa = 0.91, p < 0.0001). The mean of the time the family physicians spent using CAM algorithm was significantly briefer than that of the psychiatrists using DSM-IV TR. CONCLUSIONS: Family physicians performed well when diagnosing delirium in elderly hospitalized Thai patients using the Thai version of the CAM algorithm, showing that this measurement tool is suitable for use by non-psychiatrically trained personnel, being short, quick, and easy to administer. However, proper training on use of the algorithm is required.