Metabolic effects of kidney donation: A Bayesian analysis of matched cohorts.

The kidney is a notable site of glycolysis, gluconeogenesis, and fatty acid oxidation. Loss of a kidney after kidney donation might, therefore, affect the glucose and lipid metabolism of the donors. This matched cohort study investigated the effect of nephrectomy on glucose and lipid metabolisms using Bayesian hypothesis testing. There were 77 pairs of matched donor-control pairs in the present study. Clinical and laboratory data of the participants, at baseline and 1-year, were extracted from electronic medical records. Comparisons between donor and control groups were performed using the Bayesian independent samples t-test or Bayesian Mann-Whitney test. The Bayes Factor for alternative hypothesis over null hypothesis (BF10 ) was used to compare the two competing hypotheses. The BF10 of 3 or more was considered evidence for the alternative hypothesis. Comparing changes from baseline to 1-year between donors and controls, the BF10 of triglycerides, high-density lipoprotein cholesterol (HDL-C), triglyceride-glucose (TyG) index of insulin resistance, and estimated glomerular filtration rate (eGFR) were 7.95, 3.96, 30.13, and 1.32 x 1041 , respectively signifying that the change of these variables in the donors differed from those in the controls (alternative hypothesis). Triglyceride, HDL-C, and TyG index of the donors increased more than those of the controls while eGFR of the donor decreased more than that of the controls. Our data suggest that triglycerides and insulin resistance increase after donor nephrectomy. Kidney donors should be informed about these metabolic changes and should adhere to lifestyle recommendations that may mitigate insulin resistance.

Predictive validity of the Stopping Elderly Accidents, Deaths & Injuries (STEADI) program fall risk screening algorithms among community-dwelling Thai elderly.

BACKGROUND: Fall risk screening using multiple methods was strongly advised as the initial step for preventing fall. Currently, there is only one such tool which was proposed by the U.S. Centers for Disease Control and Prevention (CDC) for use in its Stopping Elderly Accidents, Death & Injuries (STEADI) program. Its predictive validity outside the US context, however, has never been investigated. The purpose of this study was to determine the predictive validity (area under the receiver operating characteristic curve: AUC), sensitivity, and specificity of the two-step sequential fall-risk screening algorithm of the STEADI program for Thai elderly in the community. METHODS: A 1-year prospective cohort study was conducted during October 2018-December 2019. Study population consisted of 480 individuals aged 65 years or older living in Nakhon Ratchasima Province, Thailand. The fall risk screening algorithm composed of two serial steps. Step 1 is a screening by the clinician's 3 key questions or the Thai Stay Independent brochure (Thai-SIB) 12 questions. Step 2 is a screening by 3 physical fitness testing tools including Time Up and Go test (TUG), 30-s Chair Stand, and 4-stage balance test. Participants were then followed for their fall incidents. Statistical analyses were conducted by using Cox proportional hazard model. The AUC, sensitivity, specificity, and other relevant predictive validity indices were then estimated. RESULTS: The average age of the participants was 73.3 ± 6.51 years (range 65-95 years), and 52.5% of them were female. The screening based on the clinician's 3 key questions in Step 1 had a high AUC (0.845), with the sensitivity and specificity of 93.9% (95% CI 88.8, 92.7) and 75.0% (95% CI 70.0, 79.6), respectively. Appropriate risk categorization however differed slightly from the original STEADI program. CONCLUSIONS: With some modification, the fall risk screening algorithm based on the STEADI program was applicable in Thai context.

Effect of behavioral activation on time and frequency domain heart rate variability in older adults with subthreshold depression: a cluster randomized controlled trial in Thailand.

BACKGROUND: Increased prevalence of depression highlights the need for effective interventions. Behavioral activation (BA), which can easily be adapted for non-clinical populations, has been the recommended treatment for depression. It is based on a model of psychopathology explaining that losses or chronically low levels of positive reinforcement yield behavioral and emotional changes in depression and that encouraging individuals to increase their engagement in reinforcing activities can improve their mood and enhance their valuable life experiences. Heart rate variability (HRV) provides indices of autonomic function related to depression, but only a few studies have investigated the effect of BA on HRV, particularly among older adults with subthreshold depression. Accordingly, we aimed to investigate the effect of BA on HRV in older adults with subthreshold depression. METHODS: We conducted a 9-month cluster randomized controlled trial in two Health Promoting Hospitals (HPHs). Eighty-two participants were randomized into either intervention (BA with usual care) or control (usual care only) groups, with 41 participants per group. Daily step count was collected weekly during the 12-week BA intervention period, while HRV parameters, including the Standard Deviation of the Normal-to-Normal interval (SDNN), High Frequency (lnHF), Low Frequency (LF), and Low Frequency/High Frequency ratio (LF/HF), were examined at 0, 3, 6 and 9 months. Generalized Estimating Equations (GEEs) were used in the data analysis. RESULTS: Over nine months, the intervention and control groups differed significantly in the unadjusted mean change of HRV, SDNN [7.59 ms (95% CI: 1.67, 13.50)], lnHF [0.44 ms2 (95% CI: 0.04, 0.85)], and LF [0.53 ms2 (95% CI: 0.09, 0.98)], whereas the groups did not differ significantly in LF/HF ratio [0.01 ms2 (95% CI: -0.04, 0.06)]. CONCLUSION: Our results suggest that BA may have a therapeutic effect on depression symptoms of older adults with subthreshold depression via improved HRV. TRIAL REGISTRATION: TCTR20211019003 , thaiclinicaltrials.org, retrospectively registered on 19 October 2021.

Identification of Potential Leverage Points for Self-Management Support Intervention in Thais with Type 2 Diabetes.

Background: Although social-ecological models and multi-level interventions have been recommended for implementing the holistic self-management support for patients with type 2 diabetes, they are complex, costly, and need long-term effort. A more realistic approach would be to identify and implement a single or limited leverage point(s) that is most effective and feasible to create change. Objective: To assess the independent relationships of the social-environmental supports with self-management behaviors in Thai patients with type 2 diabetes. Material and Method: A cross-sectional survey was conducted among 1,000 type 2 diabetic patients from 64 healthcare facilities throughout Bangkok. A set of structured questionnaires were used to collect data related to social-environmental supports, and self-management behaviors. The predictor-outcome relationships were presented by beta (ß) coefficients (95% confidence limits). Results: Personal support was significantly associated with the overall self-management, dietary, physical activity, and medication taking behaviors. Neighborhood support was significantly associated with the overall self-management, physical activity, and medication taking behaviors. Personal support was found to interact negatively with neighborhood support on the overall self-management and medication taking behaviors. Conclusion: Personal and neighborhood supports are two potential leverage points for self-management support interventions for Thai patients with type 2 diabetes. Patients with low and high personal supports may need different strategies for neighborhood support.

Validation and comparison study of three urbanicity scales in a Thailand context.

BACKGROUND: Validity and reliability of an urbanicity scale is of utmost importance in developing effective strategies to minimize adverse social and health consequences of increased urbanization. A number of urbanicity scales for the quantitative assessment of the "static" feature of an urban environment has been invented and validated by the original developers. However, their comparability and robustness when utilized in another study context were not verified. This study aimed to examine the comparability, validity, and reliability of three urbanicity scales proposed by Dahly and Adair, Jones-Smith and Popkin, and Novak et al. in a Thailand context. METHODS: Urban characteristics data for 537 communities throughout Thailand were obtained from authoritative sources, and urbinicity scores were calculated according to the original developers' algorithms with some modifications to accommodate local available data. Comparability, dimensionality, internal consistency, and criterion-related and construct validities of the scores were then determined. RESULTS: All three scales were highly correlated, but Dahly and Adair's and Jones-Smith and Popkin's were more comparable. Only Dahly and Adair's scale achieved the unidimensionality assumption. Internal consistency ranged from very poor to high, based on their Chonbach's alpha and the corrected item-scale correlation coefficients. All three scales had good criterion-related validity (when compared against the official urban-rural dichotomy and four-category urbanicity classification) and construct validity (in terms of their relation to the mean per capita monthly income and body mass index). CONCLUSIONS: This study's results ensure the utility of these three urbanicity scales as valid instruments for examining the social and health impacts of urbanicity/urbanization, but caution must be applied with comparisons of urbanicity levels across different studies when different urbanicity scales are applied.

Effectiveness of a self-management support program for Thais with type 2 diabetes: Evaluation according to the RE-AIM framework.

Delivering diabetes self-management support is an enormous challenge for healthcare providers with limited human resources. We conducted a cluster randomized controlled trial to assess the effectiveness of a DSMS program incorporating the computer-assisted instruction. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was applied to evaluate the DSMS program. Ten Public Health Centers in Bangkok, Thailand were randomized into either DSMS program or usual care. Forty eligible patients with type 2 diabetes in each Public Health Center were randomly selected. Totally, 403 patients (200 controls and 203 interventions) participated. About 93.8% participants completed the six-month follow-up. Over six months, adjusted mean changes of hemoglobin A1c (-0.14%, 95% confidence interval = -0.02 to -0.26, fasting plasma glucose (-6.37 mg/dL, -1.95 to -10.78), health behaviors (3.31 score, 2.27 to 4.34), and quality of life (1.41 score, 0.69 to 2.12) were significantly improved in intervention compared to control group. In conclusion, the DSMS program facilitates Public Health Centers to accomplish their support for people with diabetes.

Effects of an exercise programme on preventing neck pain among office workers: a 12-month cluster-randomised controlled trial.

OBJECTIVES: This study aimed to evaluate the effects of an exercise programme focusing on muscle stretching and endurance training on the 12-month incidence of neck pain in office workers. METHODS: A 12-month prospective cluster-randomised controlled trial was conducted in healthy office workers with lower-than-normal neck flexion movement or neck flexor endurance. Participants were recruited from 12 large-scale enterprises. A total of 567 healthy office workers were randomly assigned at the cluster level into either intervention (n=285) or control (n=282) groups. Participants in the intervention group received an exercise programme that included daily stretching exercise and twice-a-week muscle endurance training. Those in the control group received no intervention. The primary outcome measure was the 12-month incidence of neck pain, and the secondary outcome measures were pain intensity, disability level, and quality of life and health status. Analyses were performed using the Cox proportional hazard models. RESULTS: Over the 12-month follow-up, 12.1% of participants in the intervention group and 26.7% in the control group developed incident neck pain. Hazard rate ratios showed a protective effect of the exercise programme for neck pain (HR=0.45, 95% CI 0.28 to 0.71) after adjusting for biopsychosocial factors. There was no significant difference in pain intensity, disability and quality of life and health status between those who reported incident neck pain in the intervention and control groups. CONCLUSIONS: The exercise programme reduced incident neck pain and increased neck flexion movement for office workers with lower-than-normal neck flexion movement.

A prospective, cluster-randomized controlled trial of exercise program to prevent low back pain in office workers.

PURPOSE: The objective of this study was to evaluate the effects of an exercise program focusing on muscle stretching and endurance training on the 12-month incidence of low back pain (LBP) in office workers. METHODS: A 12-month prospective cluster-randomized controlled trial was conducted in healthy office workers with lower-than-normal trunk extension flexibility or trunk muscle endurance. Healthy office workers (n = 563) were randomly assigned at the cluster level into either intervention (n = 282) or control (n = 281) groups. Participants in the intervention group received an exercise program that included daily stretching exercise and twice-a-week muscle endurance training. Those in the control group received no intervention. The 12-month incidence of LBP was the primary outcome. Secondary outcome were pain intensity, disability level, and quality of life and health status. Analyses were performed using the Cox proportional hazard models. RESULTS: Over the 12-month follow-up, 8.8% of participants in the intervention group and 19.7% in the control group developed incidence of LBP. Hazard rate ratios showed a protective effect of the exercise program for LBP (HR = 0.37, 95% CI 0.22-0.64) after adjusting for biopsychosocial factors. There was no significant difference in pain intensity, disability, and quality of life and health status between those who reported incidence of LBP in the intervention and control groups. CONCLUSION: An exercise program consisting of muscle stretching and endurance training is an effective intervention to reduce incident LBP for office workers with lower-than-normal trunk extension flexibility or trunk muscle endurance.

Assessment of tuberculosis transmission probability in three Thai prisons based on five dynamic models.

This study aimed to assess and compare the probability of tuberculosis (TB) transmission based on five dynamic models: the Wells-Riley equation, two Rudnick & Milton-proposed models based on air changes per hour (ACH) and liters per second per person (L/s/p), the model proposed by Issarow et al, and the Applied Susceptible-Exposed-Infected-Recovered (SEIR) TB transmission model. This study also aimed to determine the impact of model parameters on such probabilities in three Thai prisons. A cross-sectional study was conducted using data from 985 prison cells. The TB transmission probability for each cell was calculated using parameters relevant to the specific model formula, and the magnitude of the model agreement was examined by Spearman's rank correlation and Bland-Altman plot. Subsequently, a multiple linear regression analysis was conducted to investigate the influence of each model parameter on the estimated probability. Results revealed that the median (Quartiles 1 and 3) of TB transmission probability among these cells was 0.052 (0.017, 0.180). Compared with the pioneered Wells-Riley's model, the remaining models projected discrepant TB transmission probability from less to more commensurate to the degree of model modification from the pioneered model as follows: Rudnick & Milton (ACH), Issarow et al., and Rudnick & Milton (L/s/p), and the applied SEIR models. The ventilation rate and number of infectious TB patients in each cell or zone had the greatest impact on the estimated TB transmission probability in most models. Additionally, the number of inmates in each cell, the area per person in square meters, and the inmate turnover rate were identified as high-impact parameters in the applied SEIR model. All stakeholders must urgently address these influential parameters to reduce TB transmission in prisons. Moreover, further studies are required to determine their relative validity in accurately predicting TB incidence in prison settings.

The Association Between PM2.5 Exposure and Diabetes Mellitus Among Thai Army Personnel.

OBJECTIVES: This study investigated the association between baseline exposures to particulate matter with a diameter < 2.5 microns (PM2.5) and subsequent temporal changes in PM2.5 exposure with the incidence of type 2 diabetes among Royal Thai Army personnel. METHODS: A retrospective cohort study was conducted using nationwide health check-up data from 21 325 Thai Army personnel between 2018 and 2021. Multilevel mixed-effects parametric survival statistics were utilized to analyze the relationship between baseline (i.e., PM2.5-baseline) and subsequent changes (i.e., PM2.5-change) in PM2.5 exposure and the occurrence of type 2 diabetes. Hazard ratios (HRs) and 95% confidence intervals (CIs) were employed to assess this association while considering covariates. RESULTS: There was a significant association between both PM2.5 baseline and PM2.5-change and the incidence of type 2 diabetes in a dose-response manner. Compared to quartile 1, the HRs for quartiles 2 to 4 of PM2.5-baseline were 1.11 (95% CI, 0.74 to 1.65), 1.51 (95% CI, 1.00 to 2.28), and 1.77 (95% CI, 1.07 to 2.93), respectively. Similarly, the HRs for quartiles 2 to 4 of PM2.5-change were 1.41 (95% CI, 1.14 to 1.75), 1.43 (95% CI, 1.13 to 1.81) and 2.40 (95% CI, 1.84 to 3.14), respectively. CONCLUSIONS: Our findings contribute to existing evidence regarding the association between short-term and long-term exposure to PM2.5 and the incidence of diabetes among personnel in the Royal Thai Army.

Risk factors for the onset and persistence of neck pain in undergraduate students: 1-year prospective cohort study.

BACKGROUND: Although neck pain is common in young adulthood, studies on predictive factors for its onset and persistence are scarce. It is therefore important to identify possible risk factors among young adults so as to prevent the development of neck pain later in life. METHODS: A prospective study was carried out in healthy undergraduate students. At baseline, a self-administered questionnaire and standardized physical examination were used to collect data on biopsychosocial factors. At 3, 6, 9, and 12 months thereafter, follow-up data were collected on the incidence of neck pain. Those who reported neck pain on ≥ 2 consecutive follow-ups were categorized as having persistent neck pain. Two regression models were built to analyze risk factors for the onset and persistence of neck pain. RESULTS: Among the recruited sample of 684 students, 46% reported the onset of neck pain between baseline and 1-year follow-up, of whom 33% reported persistent neck pain. The onset of neck pain was associated with computer screen position not being level with the eyes and mouse position being self-rated as suitable. Factors that predicted persistence of neck pain were position of the keyboard being too high, use of computer for entertainment < 70% of total computer usage time, and students being in the second year of their studies. CONCLUSION: Neck pain is quite common among undergraduate students. This study found very few proposed risk factors that predicted onset and persistence of neck pain. The future health of undergraduate students deserves consideration. However, there is still much uncertainty about factors leading to neck pain and more research is needed on this topic.

Development of a risk score for low back pain in office workers--a cross-sectional study.

BACKGROUND: Low back pain (LBP) is common among office workers and is the most common cause of work-related disability in people under 45 years of age. The aetiology of LBP is widely accepted to be multi-factorial. Prognostic research into office workers at risk of developing LBP has received limited attention. The aims of this study were to develop a risk score to identify office workers likely to have LBP and to evaluate its predictive power. METHODS: 397 office workers filled out a self-administered questionnaire and underwent physical examination. The questionnaire gathered data on individual, work-related physical and psychosocial data as well as the presence of low back pain in the previous 4 weeks. The physical examination included measurement of body weight, height, waist circumference, hamstrings length, spinal scoliosis, spinal curve, Backache Index and lumbar stability. Logistic regression was used to select significant factors associated with LBP to build a risk score. The coefficients from the logistic regression model were transformed into the components of a risk score. RESULTS: The model included six items: previous history of working as an office worker, years of work experience, continuous standing for >2 hrs/d, frequency of forward bending during work day, chair having lumbar support and Backache Index outcome. The risk score for LBP in office workers (The Back pain Risk score for Office Workers: The BROW) was built with a risk score ranging from 0 to 9. A cut-off score of ≥ 4 had a sensitivity of 80% and a specificity of 58%. The positive predictive value and negative predictive values were 70% each. CONCLUSIONS: The BROW is easy and quick to administer. It appears to have reasonable sensitivity, specificity, positive predictive value and negative predictive values for the cut-off point of ≥ 4. The BROW is a promising tool for use to identify office workers in need of early interventions. Further prospective study is needed to validate the predictive performance of the BROW.

Development of needs and resources for self-management assessment instrument in Thais with type 2 diabetes: cross-cultural adaptation.

OBJECTIVE: (1) To develop the Chronic Illness Resources Survey (CIRS) questionnaire for Thais with type 2 diabetes and (2) to examine validity and reliability of the instrument. MATERIAL AND METHOD: The present study consisted of two phases, phrase I was development of the comprehensive assessment form, for which the qualitative study was utilized and Glasgow's original CIRS was used as the initial input, and phrases II was tested for validity and reliability of the assessment form, for which quantitative study design was utilized. RESULTS: Final version of Thai comprehensive CIRS composed of 60 items in seven subscales, physician and health care team, family and friends, personal, community, neighborhood, media and policy, and community organization. Worksites subscale was deleted if it differed from original version. Its internal consistency was 0.93 (Cronbach's alpha coefficient = 0.93, p < 0.05). CONCLUSION: The present study demonstrates that the Thai CIRS is appropriate for Thai patients with type 2 diabetes. The instrument has acceptable validity and reliability. However, further research is required to evaluate these properties in other areas. Furthermore, the Thais CIRS should examine psychometric properties before it will be used in other chronic illness patients.

Cost and effectiveness of screening methods for abnormal fasting plasma glucose among Thai adults participating in the annual health check-up at King Chulalongkorn Memorial Hospital.

BACKGROUND: In Thailand, type 2 diabetes screening was implementing at national level by the Ministry of Public Health (MOPH) recommendation but screening methods have not been fully evaluated Objective: To compare the performance, cost, and cost-effectiveness offour screening methods in identifying individuals with abnormal fasting plasma glucose among Thai adults participating in the annual health check-up at King Chulalongkorn Memorial Hospital. MATERIAL AND METHOD: Individuals aged 35 to 60 years old with no known abnormal fasting plasma glucose (2977 persons) were recruited All subjects completed a set of screening questionnaires and were tested for venous fasting plasma glucose (FPG). One-time screening performance and costs were analyzed. RESULTS: Sensitivities of all screening methods ranged from 71 to 92%, while specificities were between 31 and 57%. The total costs ofscreening per one newly detected case were 59.12 to 69.62 U.S. dollars (2022 to 2381 bahts). Compared to the universal FPG test, all screening methods using questionnaires were relatively more cost-effective. Their relative cost-effectiveness was, however, not obviously different. CONCLUSION: Other factors should also be considered in selecting type 2 diabetes screening method for specific population in Thailand

Development of diabetes telephone-linked care system for self-management support and acceptability test among type 2 diabetic patients.

OBJECTIVE: Develop the diabetes telephone-linked care system for self-management support and test acceptability in terms of system uses, satisfaction and perception of easiness, helpfulness, and emotion with the system. MATERIAL AND METHOD: The automated telephone system with diabetes knowledge interactive voice response (IVR) subsystem was developed to provide diversified curriculum arrangement including general knowledge module (Knowledge IVR, suggestive segment module (Suggestive IVR) and 10 QA sets for assessment with tailored information feedback (QA IVR). The system could deliver 1,120 messages over five weeks among 112 intervened participants of the on-going randomized controlled trial on its impact on glycemic control. The system analyzed the level of completed responses. RESULTS: Overall, 25.9% of the responses were intermittent, 46.4% had consistent adherences, 14.3% were poor responses, and 13.4% were non-responses. The total time use of the system, among 97/112 participants, was 6,189 minutes (mean 63.80, SD 26 63). The degree of call completeness did not vary according to the participant's socio-economic status, glycemic level, or years of diabetes diagnosis. The satisfaction of participants to the program was done by interviewed by telephone among 95 of 112 participants. Most study participants reported that they were very/moderately satisfied with the program (89.5%) regarding its usefulness and helpfulness on awareness, understanding and reminding behavior change attempts. In all, 95.8% of the responders planned to participate in the next program. Duration of time uses of the TLC was significantly correlated to the total scores of helpfulness and of emotion (p < 0.01; r = 0.38 and 0.31 respectively). CONCLUSION: This prototype of diabetes telephone-linked care for Thai diabetes is a step forward in response to diabetes self-management education need. Further studies are needed about its efficacies on diabetes self-management improvement and glycemic control, as well as its cost-effectiveness.

The relationship between upper extremity musculoskeletal symptoms attributed to work and risk factors in office workers.

PURPOSE: Office workers are exposed to various individual, work-related and psychosocial factors during work that have been associated with the development of musculoskeletal symptoms. There is an increasing in evidence that suggests that musculoskeletal symptoms in the upper extremity are very common among office workers. The aim of this study was to examine the effects of individual, work-related physical and psychosocial factors on the prevalence of shoulder, elbow and wrist/hand symptoms attributed to work in office workers. METHODS: A self-administered questionnaire was delivered to 2,000 office workers in 54 workplaces in Bangkok, registered at the Social Security Office of Thailand. RESULTS: A total of 1,428 subjects (71%) returned the questionnaire, of whom 1,185 were eligible for the study. Alcohol consumption, frequency of working in an uncomfortable posture and relationships with colleagues were each significantly related to the prevalence of experiencing shoulder symptoms. No significant association between the investigated factors and the prevalence of experiencing elbow symptoms was found. Frequency of working in the position that hands were above the shoulder level and self-rated perception of air circulation in the office were significantly associated with the prevalence of experiencing wrist/hand symptoms. CONCLUSIONS: Various individual, work-related and psychosocial factors were identified to be associated with high prevalence of musculoskeletal symptoms attributed to work in the shoulder and wrist/hand among office workers. Further research investigating the causal relation between these factors and musculoskeletal symptoms should be conducted.

Efficiency and cost-effectiveness of dyslipidemia screening methods among workers in Bangkok.

Dyslipidemia is now a worldwide health problem. Secondary prevention in the form of early detection of dyslipidemia and risk modification via drug and non-drug procedures, particularly among the high-risk group, is thus imperative. The objective of this study was to determine the sensitivity and specificity, cost, and cost-effectiveness of dyslipidemia screening methods which were proposed by the Royal Thai Medical Association (RTMA), the United States National Cholesterol Education Program (NCEP), British Hyperlipidemia Association (BHA), and our modified screening instrument (MSI). A cross-sectional descriptive study was conducted among 2,000 workers aged > or = 35 years taking annual health examination from a university hospital during July-September, 2008. Sensitivity and specificity of the screening methods were analyzed using the universal serum lipid testing as the gold standard. Their total and unit costs, and cost-effectiveness were then calculated. Overall, the sensitivities for detecting any type of serum lipid abnormalities ranged between 29.9-99.4 %, while the specificities ranged between 0.5-74.1%. The total costs per 1,000 people screened ranged between THB 88,742 - 184,750. No screening method was obviously more cost-effective when using the cost per case detected of the universal blood test as the reference.

Effectiveness of Behavioral Activation in Treating Thai Older Adults with Subthreshold Depression Residing in the Community.

BACKGROUND: In recent years, behavioral activation (BA) has attracted increased interest as an effective depression treatment. However, empirical evidence supporting its effectiveness in non-Western countries is currently limited. OBJECTIVE: To examine the effectiveness of BA in reducing depressive symptoms, stress, and anxiety among Thai older adults with subthreshold depression. METHODS AND SUBJECTS: A clustered randomized controlled trial was conducted in two health promoting hospitals (HPHs) in the Samut Songkhram province of Thailand. One hospital was used for the intervention (BA+usual care group) and the other for the control (usual care-only group). Each HPH randomly selected 41 eligible older adults residing in their jurisdictions to take part in the study. Mental health outcomes were assessed using the Thai Geriatric Depression Scale (TGDS) and Depression Anxiety Stress Scales (DASS). The BA effectiveness was evaluated using generalized estimating equations (GEE) at a group level and the reliable change index (RCI) at the individual level. RESULTS: Over 9 months, the adjusted mean change in depression (TGDS) scores [-2.47 (95% CI: -3.84, -1.00)], mental health status (DASS), specifically depression and stress score [-1.47 and -1.87 (95% CI: -2.43, -0.50 and -2.94, -0.79, respectively)], improved significantly in the BA+usual care group compared to the usual care-only group, whereas anxiety score improved significantly only at 6 months [-0.87 (95% CI: -1.52, -0.23)]. Additional RCI analysis showed that BA was directly associated with 14.63 to 24.39% points increase in the reliable improvement of depressive outcome compared to the usual care-only group. CONCLUSION: This study showed that the BA effectively improved depression, stress, and anxiety in older adults with subthreshold depression in a Thai community setting. Future research should evaluate the longer-term effectiveness of BA in diverse population groups.

Incidence and risk factors associated with injuries during static line parachute training in Royal Thai Army.

BACKGROUND: Incidence and risk factors of parachute injuries has been studied in developed countries, but not in trainees of the airborne forces in the Royal Thailand Army. METHODS: A prospective cohort study was conducted among 992 military personnel who attended the basic airborne training program from February to July 2018. Information sheets were used to collect data about (a) personal demographics; (b) environmental conditions surrounding the parachute practice; and (c) parachute-related injuries. The incidence rate of injury was then calculated. Risk factors were examined using multilevel Poisson regression analysis and presented as incidence rate ratio (IRR) and 95% confidence interval (95% CI). RESULTS: A total of 166 parachute-related injuries occurred in 4677 jumps. The incidence rate of injury was 35.50 per 1000 jumps (95%CI: 30.04-41.21). Factors significantly related to parachute injury included: jumping with equipment versus without equipment [adjusted IRR (95% CI): 1.28 (0.88-1.87)], higher wind speed [1.54 (1.27-1.87) per knot], airplane versus helicopter exit [1.75(0.68-4.55)], side versus rear exit [2.13 (1.43-3.23)], night versus day jumping [2.19 (0.81-5.90)], and presence of motion sickness [3.43 (1.93-6.92)]. CONCLUSIONS: To prevent military static line parachute injuries, the following factors should be taken into consideration: type of aircraft, aircraft exit, time of the day, equipment, motion sickness and wind speed. TRIAL REGISTRATION: The project was certified by the Research Ethics Committee, Faculty of Medicine, Chulalongkorn University (IRB No. 697/60).

Predictive validity of three home fall hazard assessment tools for older adults in Thailand.

This study aimed to examine the predictive validity of two internationally well-known instruments, the Modified Home Falls and Accidents Screening Tool (Modified HOME FAST) and the Modified Home Falls and Accidents Screening Tool-Self Report (Modified HOME FAST-SR), and the newly developed Thai Home Falls Hazard Assessment Tool (Thai-HFHAT) (69 items) in predicting falls among older Thai adults. It also aimed to examine the predictive validity of the two abbreviated versions (44 and 27 items) of the Thai-HFHAT, which were developed post hoc to accommodate older adults' limited literacy and poor vision and to facilitate the identification of high-impact home fall hazards that are prevalent in the Thailand context. A prospective cohort study was conducted among 450 participants aged 60 years and above who were assessed by the aforementioned tools at baseline, for which data on fall incidence were then collected during the one-year follow-up. The Cox proportional hazard model was applied to estimate hazard ratios (HRs); then, Harrell's C-statistics and receiver operating characteristic (ROC) analyses were conducted to identify the best cutoff point, sensitivity and specificity for each instrument. The results showed that the fall hazard rate was 2.04 times per 1,000 person-days. Taking into account both the predictive validity and applicability, the Thai-HFHAT (44 items) was found to be the most suitable screening tool due to its highest sensitivity and specificity (93% and 72%) at the cutoff score of 18. In conclusion, our study showed that these internationally validated home fall hazard assessment tools were quite applicable for Thailand, but further tailoring the tools into a specific local context yielded even more highly valid tools in predicting fall risk among older Thai adults. Although these findings were well reproducible by inferring from the internal validation results, further external validation in the independent population is necessary.