Sleep Quality and Associated Factors Among Firefighters in Bangkok, Thailand: A Cross-sectional Study.

OBJECTIVES: Professional firefighters face various health hazards and are required to maintain both physical and mental fitness to effectively mitigate crises and respond to emergencies. Moreover, the long working hours and shift work of this profession impact sleep quality. This study investigated the quality of sleep and its associated factors among firefighters in Bangkok, Thailand. METHODS: This was a cross-sectional study of firefighters affiliated with the Bangkok Fire and Rescue Department, Bangkok Metropolitan Administration, Thailand between January 2023 and March 2023. A cluster random sampling technique was utilized to distribute 600 questionnaires to firefighters in 15 fire stations. The questionnaire addressed demographic, work-related, and environmental factors. Sleep quality was assessed using the Thai version of the Pittsburgh Sleep Quality Index (PSQI). Data analysis involved both descriptive and inferential statistics. Bivariate and multiple logistic regressions were performed. RESULTS: The response rate was 78.7% (n=472), and 44.1% of the firefighters reported poor sleep quality (PSQI score >5). Sleep quality was statistically associated with conflicting family relationships (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.1 to 2.9), additional part-time jobs (daytime, OR, 2.4; 95% CI, 1.3 to 4.4; or nighttime, OR, 4.3; 95% CI, 1.1 to 16.7), noisy sleeping areas (OR, 1.7; 95% CI, 1.1 to 2.8), and the availability of adequate bedding (OR, 3.0; 95% CI, 1.8 to 4.9). CONCLUSIONS: Poor sleep quality among firefighters was associated with various personal, work-related, and environmental factors. Organizations should promote policies that improve sleep quality through good sleep hygiene practices and facilities.

Medical evacuations among offshore oil and gas industries in the Gulf of Thailand.

BACKGROUND: Medical evacuation in the offshore oil and gas industry is costly and risky. Previous studies have found that the main cause of medical evacuation due to illness is increasing. In Thailand, there have been no studies on the causes and costs of medical evacuation in the offshore oil and gas industry. This study aims to study on the causes and costs of medical evacuation among offshore oil and gas industry in the Gulf of Thailand. MATERIALS AND METHODS: A retrospective review of data of medical evacuation among the offshore oil and gas industry in the Gulf of Thailand from 2016 to 2019 for a period of 36 months. RESULTS: During the research period, a total of 416 cases were evacuated. The majority of the causes of Medevac (84.13%) were illness. We found that 60.1% of all Medevacs were unpreventable or difficult to prevent, and only 39.9% were preventable. The cost of Medevac ranged from 10,000 to 880,000 THB per case. The cost of Medevac occurring from preventable causes was 17,160,000 THB for this period of 36 months. CONCLUSIONS: Reducing the cost of Medevac can be done by: 1) vaccination to prevent vaccine-preventable diseases, 2) screening to prevent people at risk of getting complications from pre-existing diseases to work offshore, and 3) increasing treatment capability of offshore facilities. Offshore oil and gas industry may consider cost-benefit of these approaches compared to status quo.

Lung function change in hyperbaric chamber inside attendants.

BACKGROUND: Hyperbaric oxygen therapy is one of new trends of additional treatment, especially for non-di- ving-related diseases in Thailand. Hyperbaric inside attendants have to work under hyperbaric environment to provide medical care for patients in the hyperbaric chamber. This study aims to investigate longitudinal change in lung function in hyperbaric inside attendants (HIAs) and the relationship with hyperbaric exposure. MATERIALS AND METHODS: This is a retrospective longitudinal study exploring the adverse long-term effects to the lungs in HIAs. All inside attendants (HIAs) who worked in the public hospitals or medical centres with multiplace hyperbaric chamber in Thailand were included. To be considered for inclusion in the study, inside attendants were required to have at least two follow-up lung function tests and minimum 1-year interval at baseline from annually periodic examination. Lung function of HIAs were compared against reference values of the Thai population. RESULTS: There were 51 subjects with 9.26-year mean period of follow-up. The HIAs showed a significantly decrease in measured lung function in average forced expiratory volume in 1 second (FEV1), forced expi- ratory flow at 25-75% of functional vital capacity (FEF25-75%) and FEV1/FVC ratio over time. The annual reductions in FEV1, FEF25-75% and FEV1/FVC ratio were 22.52 mL per year, 44.92 mL/s per year and 0.48% per year, respectively. The study showed significant differences in annual changes in FVC, FEF25-75% and FEV1/FVC ratio between HIAs and the lung function predicted values for the Thais. However, the results revealed no differences of annual change in FEV1 from predicted values. The average working depths, average session duration and total working hours as HIAs were related with the changes of lung function. CONCLUSIONS: Working in a hyperbaric environment does affect the lung function of HIAs. In addition to fitness to work implementation, periodic lung function evaluation should be encouraged to monitor further possible harm to the attendants.

Toxic jellyfish in Thailand.

Jellyfish stings are common in Thailand. Stings can range from mild skin irritation to severe systemic symptoms resulting in death. Jellyfish envenomation is becoming an important public health concern. The lethal box jellyfish and bluebottle jellyfish are found on the Gulf of Thailand and Andaman coasts, but there are still misconception and mismanagement of these types of severe stings. Prevention and awareness of jellyfish stings are important, as well as knowledge and first aid management of severe envenomation. Educational programmes should be provided to locals including school children, teachers, hotel and tour operators, and medical staff. This will greatly reduce the morbidity and mortality associated with fatal stings.

Attention Deficit Hyperactivity Disorder (ADHD): Clinical Outcomes Measurement Development.

Objective: To develop a reliable and valid treatment outcome checklist for the measurement of ADHD treatment for children in a clinical setting. Material and Method: The behavior indicators to assess the treatment outcomes of ADHD children were researched and developed by using multi-informants perspectives. The present study involved a qualitative study and two rounds of the Modified Delphi Techniques. In the first process, 11 parents/guardians of ADHD children aged 6 to 18 years were given a semi-structured interview on their expectation towards treatment outcomes at the Child and Adolescent Mental Health Rajanagarindra Institute. Items from literature reviews were also added before the first and second round evaluations using the Delphi by five different expert fields (six experts from each field). Final indicators from expert consensus were assessed from 180 ADHD patients, which were assessed by three child and adolescent psychiatrists. All items were analyzed for internal coefficient reliability. The Receiver Operating Characteristic (ROC) was used to calculate the cut off score. Results: Thirteen indicators were assessed by experts as good content validity for clinical outcomes of ADHD treatment with the reliability of 0.60. The optimal cut-off point was 4 (sensitivity: 0.80; specificity: 0.76). The Area under curve (AUC) of total score was considered at a good level (0.83). Conclusion: The ADHD clinical outcome checklist with 13 items has shown good validity and fair reliability. It can be a useful tool for ADHD treatment outcome assessment in clinical setting.

CAPACITY BUILDING PROCESS IN ENVIRONMENTAL AND HEALTH IMPACT ASSESSMENT FOR A THAI COMMUNITY.

This research aimed at exploring the development of the capacitybuilding process in environmental and health impact assessment, including the consideration of subsequent, capacity-building achievements. Data were gathered through questionnaires, participatory observations, in-depth interviews, focus group discussions, and capacity building checklist forms. These data were analyzed using content analysis, descriptive statistics, and inferential statistics. Our study used the components of the final draft for capacity-building processes consisting of ten steps that were formulated by synthesis from each respective process. Additionally, the evaluation of capacity building levels was performed using 10-item evaluation criteria for nine communities. The results indicated that the communities performed well under these criteria. Finally, exploration of the factors influencing capacity building in environmental and health impact assessment indicated that the learning of community members by knowledge exchange via activities and study visits were the most influential factors of the capacity building processes in environmental and health impact assessment. The final revised version of capacitybuilding process in environmental and health impact assessment could serve as a basis for the consideration of interventions in similar areas, so that they increased capacity in environmental and health impact assessments.

Environmental and health impact assessment for ports in Thailand.

Port development in Thailand is an essential part of the national maritime interest in connection with ship and shore activities. The growth of maritime industry and transportation has led to the expansion of ports' areas and capacity. Each port type causes different environmental impacts. Therefore, the Port Authority of Thailand has set up guidelines on ports' environmental management. This is divided into 3 major phases; namely, planning, construction and operation commencement periods. The Report of Environmental and Health Impact Assessment (EIA, HIA and EHIA) is regarded as the environmental management process in the planning period. It is a key tool to anticipate and prevent any adverse effects that might occur on the environment as well as community health resulting from the project implementation. This measure, in turn, creates advance preparation on both the preventive and problem-solving means before the project gets off the ground. At present, the majority of new projects on port development have still been in the process of information gathering for EHIA submission. Some cannot start to operate due to their EHIA failure. For example, the Tha-sala port which did not pass EHIA, mainly because emphasis had been focused on adhering to legal regulations without taking into consideration the in-depth analysis of data being conducted by community entities in the area. Thus caused the project to be finally abolished. Impact assessment on environment and health should be aimed at detailed understanding of the community in each particular area so that effective data of objective achievement in preventing environmental problems could actually be carried out and welcomed by the concerned society.

Industrial distributions of severe occupational injuries among workers in Thailand.

BACKGROUND: In industrializing countries, occupational safety and health have been affected by globalization. However, a lack of reliable data prevents evaluation of this situation. Therefore, we examined industrial distributions and risks of severe occupational injuries among workers in Thailand, which is one of the few industrializing countries that compiles nationwide data. METHODS: Data on workers who made claims for occupational injuries from 2007 to 2009 were extracted from the Workmen's Compensation Fund records in Thailand. Among 501,334 claimants, we evaluated the industrial distributions of severe occupational injuries (i.e., permanent disability and death). We then examined the associations between industry and those injuries, using proportionate ratios (PRs) between each industrial category and the overall distribution of occupational injuries. RESULTS: The number of workers in manufacturing making claims for severe occupational injuries was the largest among all industrial categories (319,114/501,334 injuries), although the total number of occupational injuries recently declined. Additionally, workers in manufacturing experienced severe occupational injuries more often compared with the overall distribution of occupational injuries. The PRs (95% confidence interval) for manufacturing were 1.17 (1.14-1.20) in men and 1.33 (1.27-1.38) in women. After adjusting for individual characteristics, the results did not substantially change. CONCLUSIONS: Manufacturing seems to have the largest burden of occupational injuries in industrializing countries like Thailand.

Overweight/Obesity and related factors among thai medical students.

This study was conducted to assess the prevalence of overweight/obesity and the related demographic data and health behaviors of Thai medical students. A cross-sectional study of 5441 medical students from all the 13 medical schools in Thailand was conducted in 2006 by means of a self-administered questionnaire. Demographic data, health behaviors, and self-reported body weight and height were recorded. The results revealed that Thai medical students have a lower prevalence of overweight/obesity than the general population of the same age group. The multiple logistic regression analysis showed that higher academic year was associated with being overweight or obesity in males, having improper dietary habits were associated with being overweight or obesity in both genders, whereas alcohol consumption was associated with being overweight in male only. Therefore, medical curricula should place an emphasis not only on knowledge but also on attitudes and behaviors for healthy lifestyles.

Testing a health impact assessment tool by assessing community opinion about a public park.

The purpose of this study was to assess a health impact assessment (HIA) tool to determine the perceived health impact by the public of a public park. The authors conducted a cross-sectional study from March to April, 2011, using this HIA questionnaire to collect data and through focus group discussions. We also assessed community concerns about the park and obtained recommendations of how to mitigate possible negative aspects of the parks. Four aspects were listed as possible benefits of the park: physical, mental, social, and spiritual health. The negative aspects mentioned by participants were that a park could be a potential place of assembly for teenagers, a place for theft and crime and accidents among children. The HIA tool used for this research seemed appropriate. The next challenge is to use this tool to assess a more controversial project.

Health impact assessment: a case study on renovation of a slaughterhouse.

The purpose of this study was to conduct a health impact assessment (HIA) in a community where an old slaughterhouse was to be renovated. The authors conducted a cross-sectional study in March, 2011. Questionnaires were used to collect data and focus group discussions were conducted to solicit the community concerns and recommendations regarding the project. The results reveal positive impacts in 4 aspects of health: physical, mental, social, and spiritual. The current substandard slaughterhouse was perceived negatively by the surrounding community. They were happy the slaughterhouse would be renovated, and some preferred it moved elsewhere. This HIA had 2 positive results: first, we tested our HIA tool in a real situation and found it practical on a small scale; second, the municipality obtained the community's opinions and concerns and the community knew their opinions reached the municipality, so they were more positive about the municipality.

Effects of an incinerator project on a healthcare-waste management system.

This evaluative research study aimed to assess the effects of the central healthcare incinerator project on waste management in Yala Province. The study data were collected twice: at baseline and during the operational phase. A combination of structured interview and observation were used during data collection. The study covered 127 healthcare facilities: government hospitals, healthcare centres, and private clinics. The results showed 63% of healthcare risk waste (HCRW) handlers attended the HCRW management training. Improvements in each stage of the HCRW management system were observed in all groups of facilities. The total cost of the HCRW management system did not change, however; the costs for hospitals decreased, whereas those for clinics increased significantly. It was concluded that the central healthcare waste incinerator project positively affected HCRW management in the area, although the costs of management might increase for a particular group. However, the benefits of changing to a more appropriately managed HCRW system will outweigh the increased costs.

Developing tools for health impact assessment in environmental impact assessment in Thailand.

The purpose of this research was to develop tools applicable to the Health Impact Assessment (HIA) in Environmental Impact Assessment (EIA) in a Thai context. The relevant documents and articles were extensively reviewed, analyzed, and drafted. The first draft was presented to a research advisory committee for their review, and the recommended changes were subsequently made. The second draft was then presented to respondents from 6 groups of key stakeholders-expert review committees under the Office of Natural Resources and Environmental Policy and Planning (ONREPP), EIA registered consulting firms, non-government organizations, members of the ONREPP, local government organizations, and government organizations responsible for issuing permission to the proposed projects. Their commentary and recommendation were considered, and modifications were made as necessary. The third draft was finally reviewed by the research advisory committee before the tryout step. The final revised version is presented in this paper.

Shift work and type 2 diabetic patients' health.

OBJECTIVE: To compare the health between type 2 diabetic patients doing day work and shift work. MATERIAL AND METHOD: Two hundred and forty workers (120 day workers, 120 shift workers) aged 30-60 years were selected from the Social Security Clinic in five hospitals in Bangkok and its vicinity. All participants in the present study filled out the questionnaires that included questions for detecting hypoglycemic symptoms, Thai GHQ--12 questionnaires, and Suanprung Stress Test--20 questionnaires. Fasting blood glucose during the last six months, blood pressure during the last six months, and body mass index (BMI) were collected from the patient's medical records. All results were collected and compared between day workers and shift workers. RESULTS: Good glycemic control was significantly higher in day workers versus shift workers (28.3% vs. 15.8%). A higher proportion of shift workers had hypoglycemic symptoms and abnormal mental health compared to day workers. CONCLUSION: Shift work may have a negative effect on type 2 diabetic patients' health. Consequently, type 2 diabetic shift-worker needs more attention from physicians and employers at their work place.

Utilize the modified Delphi technique to develop trauma care indicators.

OBJECTIVE: Develop performance indicators reflecting the quality of trauma-patient-care in the emergency room and hospitalization within the first 48 hours. MATERIAL AND METHOD: A two-round Delphi technique was conducted. A panel of 11 expert surgeons experienced in the fields of trauma care was consulted. The panel was initially asked to rate performance indicators that reflected the quality of trauma care given in the emergency department setting and hospitalization in the first 48 hours using a 5-point on visual analogue scale. The statement of indicators that was collected from the first round was analyzed and necessary changes were before resending to the same experts. Each indicator statement was considered consensus if the expert's opinion rating was 4 or 5 for more than 70% (8 out of 11 experts). RESULTS: Fifty-three performance indicators were proposed in four domains of trauma care in emergency room and four domains of trauma care in hospitalization within 48 hours. Altogether 35 indicators reached consensus reflecting quality of trauma performance after two rounds. Twenty-one of these were trauma care indicators in emergency room and 14 were trauma care indicators in hospitalization within 48 hours. CONCLUSION: Twenty-one indicators of quality of trauma care in the emergency room and 14 in the hospitalization within 48 hours have been developed. They will be used as the tool by specialist for quality evaluation in the next phase.

Longevity of Thai physicians: phase 2 and policy implications.

This is Phase 2 of the authors study on long-lived Thai physicians. After obtaining quantitative data from Phase 1, the authors approached 11 male and 5 female physicians whose ages were older than general population's life expectancy. The authors conducted an in-depth interview using semi-structured questions asking about their life, work, lifestyle, and relevant factors. Then the authors synthesized the factors influencing longevity. The authors found that they are genetic, financial stability/security, trying to be disease-free by increasing positive lifestyle (such as exercise) and decrease negative lifestyle (such as drug addict, alcohol consumption), mind-set to be non-attachment (either doing nothing or busy doing everything), and being mentally ready to die. The authors also proposed policy implications for Thai physicians and people accordingly.

Survey of mental health status of Thai physicians.

This survey was aimed at obtaining a screening survey on mental health status of Thai physicians. We systematically sampled to obtain 440 Thai physicians from the directory of Thai Center for Continuing Medical Education (CCME). Then, we obtained their mental health status by mailing a questionnaire containing Thai GHQ-28 and asking them to reply, later we obtained through telephone interview. The response rate was 86.3 percent, and 60.3 percent of them were male. The result revealed that 15 male and 13 female physicians had abnormal mental health status. The overall prevalence rate of abnormal mental health status was 7.4 percent. We also found a significant negative association between mental health status and career satisfaction and the use of sedatives in the past 6 months. This study pointed out that mental health of some Thai physicians was to be concerned. These problems, along with their physical health problems, should be tackled systematically and preventatively in order to have the majority of Thai physicians in good health and able to serve the population more effectively.

Risk factors for suicide among Thai physicians.

OBJECTIVES: To investigate the risk factors for suicide in Thai physicians. METHOD: The study focused on 18 doctors who had committed suicide before January 2002, identified by death certificates and the reported data from Thai Medical Council. Consensus case reports were assembled by using the psychological autopsy method. Study methods included semi-structured and in-depth interviews of next of kin and interviews of classmates, colleagues and medical or mental health services workers who had treated the suicide victims. RESULTS: The sample consisted of 18 subjects (17 males, one female). The age range was 30-49 years old. Most victims were specialists (11 out of 18; 3 gynecologists, 2 psychiatrists, 2 pediatricians, 2 surgeons and 1 internist, 1 radiologist). The methods of suicide were 6 hanging, 5 gun shots, 5 intravenous injections, 1 jumping and 1 drug over-dose. Psychiatric disorders were found in 11 out of 18 cases, and depressive disorder was the most common disorder. Interpersonal conflict and/or loss were the most common factors leading to suicide (6 out of 18), the second factor was psychiatric illness and the third factor was work problems. CONCLUSION: In assessing suicidal risk, a history of interpersonal conflicts and loss and the presence of co-morbid psychiatric disorders are particularly important. The important strategies for suicide prevention in Thai physicians are early detection and proper management of psychiatric illness especially depressive disorder and recognition the significance of family support.

Longevity of Thai physicians.

The objectives of this study were to explore characteristics of the long-lived Thai physicians. We sent 983 posted questionnaires to 840 male and 143 female physicians. We obtained 327 of them back after 2 rounds of mailing, yielding a response rate of 33.3 percents. The response rate of male physicians was 32.4 percents and that of female physicians was 38.5 percents. Their ages were between 68-93 years (75.1 +/- 4.86 years on average). The majority were married, implying that their spouses were also long-lived. Around half of them still did some clinical work, one-fourth did some charity work, one-fourth did various voluntary works, one-fifth did some business, one-fifth did some academic work, and some did more than one type of work. Most long-lived physicians were not obese, with BMI of 16.53-34.16 (average 23.97 +/- 2.80). Only 8 had BMI higher than 30. BMIs were not different between male and female physicians. However, four-fifths of them had diseases that required treatment, and some of them had more than one disease. The five most frequent diseases were hypertension, diabetes, ischemic heart disease, dyslipidemia, and benign prostate hypertrophy, respectively. Most long-lived physicians did exercise (87.8%), and some did more than one method. The most frequent one was walking (52.3%). Most did not drink alcohol or drank occasionally, only 9.0% drank regularly. Most of them slept 3-9 hours per night (average 6.75 +/- 1.06). Most (78.3%) took some medication regularly; of most were medicine for their diseases. Most did not eat macrobiotic food, vegetarian food, or fast food regularly. Most long-lived physicians practiced some religious activities by praying, paying respect to Buddha, giving food to monks, practicing meditation, and listening to monks' teaching. They also used Buddhist practice and guidelines for their daily living and work, and also recommended these to their younger colleagues. Their recreational activities were playing musical instruments (15%), singing (27%), doing hobbies (64.0%), and others (51.8%). Most did not reply on question whether they achieved their self-actualization target of their lives, this might result from the fact that this was rather an abstract question. Our first part study revealed some characteristics of long-lived Thai physicians that seem to be in agreement with other studies indicating that physicians compared favorably with the general population in mortality from physical illness. This may result from several factors: the medical student selective process leading to "healthy worker effect", knowledge in medicine, access to care, and their healthy behaviors (such as nutrition, exercise, religious activities which help improve their spiritual well-being).

Thai physicians health survey.

Physicians often conduct research on other occupations' health or general populations' health, but their health has hardly been studied systematically. The authors conducted a cross-sectional descriptive survey on 440 physicians systematically selected from their medical license numbers. The response rate was 86.4% (380 out of 440). Two-hundred and twenty-nine were male, and 151 were female. Their average age was 40.8 years (range: 22-74). Most of them were Buddhists (93.9%), specialists (64.2%), married only once and still lived with their spouses (59.5%), and concurrently practiced medicine (95.5%). Their overall satisfaction as physicians was 60.2% high, and 37.2% moderate. Their average sleep time was 6-8 hours per night for 58.9%. Most had eye problems (74.9%) and most were refractive errors such as myopia. Most (63.8%) of them did not have any prevalent diseases. Whereas those who had diseases had (in order) allergy, hypertension, asthma, diabetes, and cancer. Their current illnesses included respiratory tract infection. Most physicians did not smoke (94.2%) nor drink alcohol (70.5%). Most of them were not vegetarians (60.4%), did not eat fast food (99.2%). Interestingly, 41.4% of them were accounted for spending less than twice per week for exercise. As expected, 23.7% of them were exposed to blood, 14.5% to respiratory tract secretion, and 13.7% to pus/secretion from wounds. This study serves as a basis for health promotion approach to medical community and does create awareness of health among Thai physicians.