Microplastic contamination in rivers: a survey from the Nan River, Thailand.

BACKGROUND: Since the 1970s, microplastic contamination has been discovered in various environments. These emerging pollutants threaten water quality and freshwater ecosystems. We aimed to assess microplastic contamination in the Nan River by quantifying their presence, characterising their morphology, and identifying their polymer composition. METHODS: The survey was conducted along the Nan River in northern Thailand, which is divided into three distinct zones based on land use (ie, community areas, agricultural areas, and natural areas). A wide array of samples, including surface water, sediment, and specimens from five aquatic species-Barbonymus altus, Laides hexanema, Kryptopterus cryptopterus, Pomacea canaliculata, and Pseudodon cambodjensis cambodjensis-were collected. The presence of microplastics was analysed via the wet peroxide oxidation process for sample digestion, morphological characteristics were assessed through microscopic examination, and Fourier transform infrared spectrophotometry was used to identify the polymer composition of the microplastics. FINDINGS: Natural areas had the highest mean concentration of microplastics in surface water (23·67 pcs/L, SD 14·22), whereas community areas had the highest mean concentration in soil sediment (24·67 pcs/g, 15·04). No statistically significant differences in the amounts of microplastics were observed among the various land-use zones. Microplastics were predominantly found in the gastrointestinal tracts of fish specimens, with varying quantities observed among different aquatic species; B altus had the highest concentration (11·80 pcs/g, 8·98). The primary microplastic shapes identified were filaments (53·99%), fragments (35·58%), and cylindrical forms (10·43%). We identified ten different polymer types, with polypropylene, nylons, and polymethyl methacrylate being the most prevalent among them. INTERPRETATION: Analysing microplastic pollution in this area brings attention to the issues affecting the rivers of Thailand and emphasises ecological risks, particularly microplastic presence in aquatic species. Because of the Nan River's ecological importance, we call for increased research and collaboration to address the increasing threat of microplastic pollution. FUNDING: Naresuan University.

Factors Correlated with Child Undernutrition in Rural Communities Affected by Sinabung Eruptions in Indonesia.

This study examined factors correlated with child undernutrition in rural communities affected by the Sinabung Eruptions in Indonesia. A cross-sectional survey of children (n = 444) was conducted. The results showed that the prevalence of being underweight, stunting, and wasting was 23.4%, 37.6%, and 11.3%, respectively. Multivariate analysis revealed that immunization status, child health, the number of children under five years old, household size, monthly income, and drinking water sources were statistically associated with child undernutrition. The study suggests that there should be intervention from Ministry of Health to increase the complete immunization as well as biannual vitamin A dose for the children.

Methods used to identify the prevalence of palliative care needs: An integrative review.

OBJECTIVES: Early identification of palliative care (PC) needs is crucial to provide appropriate holistic care to patients. The objective of this integrative review is to synthesize the methods used to identify the prevalence of PC needs. METHODS: An integrative review search of the Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus with full text, ProQuest, Wiley InterScience, ScienceDirect, Scopus, PubMed, and Web of Science with publications from 2010 to 2020 was carried out in English. Empirical studies examining the methods used to determine the prevalence of PC needs were included. The methods of data extraction of the included articles were categorized by data source, study setting, and data collector. Quality appraisal was performed using QualSyst. RESULTS: Of the 5,410 articles screened, 29 were included in this review. Two articles identified the prevalence of PC needs in a community that was supported by a network of volunteers, while 27 studies considered this at a continent, country, hospital, and/or primary care facility level as represented by physicians, nurses, and researchers. SIGNIFICANCE OF RESULTS: Various methods have been used to determine the prevalence of PC needs, and the outcomes are valuable for policymakers in developing PC services when allocating resources at the national and community levels. Future research to identify PC needs across health settings, especially primary care facilities, should consider providing PC across a spectrum of care settings.

The development of an instrument to measure interprofessional collaboration competency for primary care teams in the district health system of health region 2, Thailand.

BACKGROUND: Evidence shows that interprofessional collaboration (IPC) practice contributes to the quality of health care. However, there are limited instruments to assess IPC in providing primary care in the district health system (DHS) in Thailand. The aim of this study is to develop a valid and reliable instrument to assess the IPC competency of primary care team members in DHSs. METHODS: This study was designed as an exploratory mixed methods study. In the qualitative phase, 37 participants, including policymakers, practitioners, and academics with experience in primary care, were involved. Data were analysed using thematic analysis, and trustworthiness was verified by triangulation and peer debriefing. In the quantitative phase, content validity, exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and reliability were conducted, and the final version of the questionnaire was evaluated with 497 participants. RESULTS: The findings showed an I-CVI range of 0.86-1.00 and S-CVI/UA = 0.87 for 49 items with a 5-point Likert scale. EFA suggested six factors: 1) collaborative teamwork, 2) population- and community-centred care, 3) communication and mutual respect, 4) clarification of roles and responsibilities, 5) interprofessional reflection, and 6) interprofessional values and mixed skills. In the CFA results, the model fit indices were acceptable (CFI = 0.99, RMSEA = 0.049, SRMR = 0.043) or slightly less than the goodness-of-fit values (GFI = 0.84). All subscales showed acceptable Cronbach's alpha values with a range of 0.86-0.94. CONCLUSIONS: The developed IPC competency instrument was confirmed its validity and reliability that contributes to assessing the IPC competency of primary care teams in DHSs. This information provides evidence to support tailored intervention to promote the IPC competency of primary care team work to achieve a common goal.

Development of Self-Active Aging Index (S-AAI) among rural elderly in lower northern Thailand classified by age and gender.

This study aimed to develop a Self-Active Aging Index (S-AAI) for the rural community of Thailand using the World Health Organization (WHO) framework, and score it according to age and gender. Overall, 1,098 elderly people were randomly selected. The self-reported questionnaires were categorized into three segments: health, participation, and security according to the WHO framework. An exploratory factor analysis was used to determine appropriate components. The S-AAI comprised 28 indicators and 9 factors: (1) mental/subjective health; (2) physical health; (3) health behavior and chronic disease; (4) vision and hearing; (5) oral health; (6) social participation; (7) stability in life; (8) financial stability; and (9) secure living. The overall S-AAI for all components was 0.65, with the index inversely proportional to age, but with no gender differences. The S-AAI is potentially Thailand's first multi-dimensional interactive aging assessment tool with a unique cultural context for rural areas. Although this tool is valid, it requires reliability testing.

Effects of Home-Based Boxing Training on Trunk Performance, Balance, and Enjoyment of Patients With Chronic Stroke.

OBJECTIVE: To investigate the effect of 6 weeks of home-based boxing training on trunk performance, balance, fear of falling, and level of therapy enjoyment in individuals with chronic stroke. METHODS: Eighteen participants with chronic stroke were randomly divided into boxing and control groups (9 patients per group). The boxing group received home-based boxing training for 25 minutes plus balance and trunk exercise training for 15 minutes, while the control group received only home-based balance and trunk exercise training for 40 minutes, three days a week for 6 weeks. The Trunk Impairment Scale (TIS), Mini-Balance Evaluation Systems Test (Mini-BESTest), Activities-specific Balance Confidence (ABC) scale, and Physical Activity Enjoyment Scale (PACES) were assessed at baseline, and at 2, 4, and 6 weeks post-training. The Wilcoxon signed rank test and Mann-Whitney U-test were used to determine differences between pre- and post-training within and between groups. Statistical significance was set at p<0.05. RESULTS: The TIS scores significantly increased from 13 to 17 points in the boxing group (p<0.05) compared to an increase from 15 to 17 points in the control group (p<0.05). The Mini-BESTest scores significantly increased from 14 to 22 points in the boxing group (p<0.05) compared to an increase from 17 to 20 points in the control group (p<0.05). There were no differences in the TIS, Mini-BESTest, ABC, and PACES scores between the two groups. CONCLUSION: Home-based boxing training with balance and trunk exercise training had a similar training effect compared to home-based balance and trunk exercise training.

Assessment of competencies in the prevention and control of chronic diseases and their influencing factors among health assistants in Bhutan: a cross-sectional study.

BACKGROUND: The morbidity and mortality of chronic diseases are increasing worldwide. The literature confirms that the prevention and control of chronic disease necessitates a robust primary health care system with a competent health care workforce. Studies on competencies in the prevention and control of chronic diseases and their determinants among health assistants (HAs) in Bhutan are scarce. This cross-sectional survey aimed to examine the level of competencies and investigate the factors influencing competencies in the prevention and control of chronic diseases among HAs. METHODS: The sample consisted of 330 HAs who were recruited through simple random sampling. A validated and reliable self-administered questionnaire was used to collect data through a web-based Google Form. Data were analysed using descriptive statistics and multiple regression analysis. RESULTS: The findings showed that the mean summed competency score was 191 (SD = 25.7). Approximately 96% of the participants perceived that they were competent in the prevention and control of chronic diseases. The multiple regression analysis indicated that work environment (ß = 0.473), sex (ß = 0.126), location of the health facility (ß = - 0.114), and organizational support (ß = 0.117) affected competencies in the prevention and control of chronic diseases by 31.4% with statistical significance (R2 = 0.314) (p < 0.05). CONCLUSIONS: This study suggested that improving the number of staff and availability of learning resources, considering training for both sexes, especially female primary health care workers, enhancing mentorship and supervision in rural areas, and establishing the recognition and encouragement of primary health care workers are needed.

Health Service Readiness, Availability, and Utilization of Primary Health Care Facilities for Non-Communicable Diseases in Shan State, Myanmar.

Background: Non-communicable diseases (NCDs) are increasing in Myanmar. There have been limited studies to assess the health service system for NCDs patients at the primary health care (PHC) level. We aimed to assess and compare the health service readiness, availability, and utilization of PHC facilities for NCDs in districts in Myanmar. Methods: This cross-sectional study collected data by questionnaires from 242 health care providers working at PHC facilities in three districts in Shan State, Myanmar from January 2020 to January 2021. Differences were calculated with the ANOVA test for NCD capacity readiness and NCD service availability and the Kruskal-Wallis test for NCD service utilization. Results: PHC facilities had a mean score of greater than 70% for NCD capacity readiness of health workforces, health information systems, and essential medicines and equipment domains, but there were large gaps for improvement in financing and governance of health. Almost all PHC facilities had NCD services available, and the differences were not significant among the three districts. However, the mean scores of NCD services availability for chronic respiratory diseases and cancers were lower in all districts. Regarding NCD service utilization, the screening and new patient rates had significant differences among districts (P-value < 0.05). Conclusion: We revealed the situation and gaps in managing NCDs in Myanmar's PHC facilities. These findings can inform policymakers at the state and district levels to implement programs for improving health services for NCDs, particularly in rural areas.

Self-perceived knowledge, attitudes, and training needs regarding medical cannabis among health care providers and health volunteers in district health systems, Phitsanulok Province.

BACKGROUND: Health care providers and health volunteers play an important role in the collaborative provision of patient access and care regarding medical cannabis in district health systems (DHSs) according to their roles and responsibilities. However, there is limited evidence on the self-perceived knowledge, attitudes, and training needs regarding medical cannabis use by health care providers and health volunteers in DHSs. The aim of this study was to compare self-perceived knowledge, attitudes, and training needs regarding medical cannabis among health care providers and health volunteers in Phitsanulok Province, Thailand. METHODS: A cross-sectional study was conducted in Phitsanulok Province. A total of 836 participants consisting of 166 health care providers and 670 health volunteers were recruited by stratified cluster random sampling. Descriptive and inferential statistics, including independent sample t tests and chi-square tests, were employed for data analyses. RESULTS: The results revealed that self-perceived knowledge of medical cannabis was not significantly different between the health care providers and health volunteers (p = 0.875), whereas attitudes about medical cannabis were significantly different between the two groups (p < 0.001). The mean scores of attitudes were 29.10 for the health care providers and 31.84 for the health volunteers. Regarding training needs, the health care providers proposed training topics, including adverse effects of medical cannabis (27.5%), information on prescribing cannabis drugs (20.5%) and information on prescribing drugs that contain cannabis substances (14.7%). On the other hand, health volunteers preferred to obtain training on cannabis legislation (23.5%), information on caring for patients who used drugs containing cannabis substances (21.4%), and a history of medical cannabis use (17.6%). CONCLUSION: In summary, to ensure effective care in the DHSs, health care providers and health volunteers should be trained to be confident in their knowledge and attitudes towards the use of medical cannabis. Training topics should be designed with consideration for the role and responsibility of each group to prepare professionals and nonprofessional to achieve patients quality and safety with respect to medical cannabis use.

Exploration of the definition and components of food and nutrition literacy among junior secondary school students: a qualitative study.

BACKGROUND: Food and nutrition literacy (FANLit) has been proposed to promote healthy diet behaviour and is believed to decrease the prevalence of overweight, obesity and chronic disease. However, the perspective of junior secondary school students, aged 12-15 years and stakeholders towards FANLit is not well-defined. Thus, this study aims to explore the definition and components of FANLit. METHODS: This qualitative study was carried out in Health region 2 including Phitsanulok, Sukhothai, Tak, Uttradit and Pethchboon. 49 participants from national and regional levels of Thailand were recruited. Data were collected by in-depth interview and focus group discussion using semi-structured questionnaire. Interview data were transcribed verbatim and analysed using thematic analysis. RESULTS: FANLit is defined as an individual's level of knowledge and skills (fundamental, interactive and critical) that relates to food and nutrition for appropriate selection of food and nutrient. Four themes of FANLit were identified as follows: 1) food and nutrition knowledge (Subthemes: food knowledge, food understanding, nutrition knowledge and nutrition understanding), 2) functional food and nutrition literacy (Subthemes: accessing to food and nutrition information, food selection, food preparation, daily food and nutrition planning and management), 3) interactive food and nutrition literacy (Subthemes: communication with others, sharing and discussion), and 4) critical food and nutrition literacy (Subthemes: information used in decision making, healthy food selection and effective budgeting). CONCLUSION: The results presented beneficial information regarding FANLit definition which is the initial stage to develop the assessing instrument and the intervention to improve FANlit in the adolescent group.

Food Access, Food Consumption, and Children's Nutritional Status of Smallholder Farmer in Sinabung's Eruptions-Prone Areas, Indonesia.

Destructive impacts resulting from volcanic eruptions affect food production severely, leading to the deterioration of food access and food consumption. Thus, we spotted the urgency of researching food access, household food consumption, and nutritional status of children in Sinabung's eruptions-prone areas, Indonesia. A cross-sectional study was carried out among 368 (158 farmers only and 228 farmers plus farm laborers) households headed by farmers. An interviewer-administered questionnaire was used for data collection. Three indices were used for assessing the nutritional status of children namely weight-for-age (WAZ), height-for-age (HAZ), and weight-for-height (WHZ). Data on household food consumption were collected by using the food consumption score (FCS). The household food consumption among the two groups of farmers was significantly different. Farmers plus farm laborers had a slightly better variety of food since they could collect free vegetables and fruits from the fields where they were working as a farm laborers. Household food consumption was significantly associated with the nutritional status of children. But in the group of farmers-only, the correlation between household food consumption and underweight was not significantly associated. To improve food access and food consumption, the policymakers should provide information about other job opportunities (as an agricultural laborer on another farm) to the farmers, and help them to reach out to those jobs, especially during unpredictable circumstances like Sinabung's eruptions.

The Development of the Community-based Palliative Care Model in a District Health System, Phitsanulok Province, Thailand.

CONTEXT: Palliative care (PC) refers to a set of basic health services in Thailand and is in the early stage of implementation. AIM: The aim of this study is to develop a community-based PC model in a district health system (DHS) based on the form of action and evaluation. METHODS: A three-step action research: look, think, and act was designed with mixed methods of data collection. RESULTS: A key finding was the confusion on the terminology of the PC, challenge of the referral system of PC patients in DHS, medical equipment and supplies for the PC patients, and insufficient access to opioid analgesics at home. The model of development comprised the training of health professionals, the management of the medical equipment and supplies by people sector, and the development of a referral guideline of the PC patient in DHS. The evaluation showed the higher score of the accessibility to PC than the score of accommodation for patients. It also showed the higher score of the care continuity over the longitudinal continuity for patients. For the carers, the score of guilt is higher than the score of the care burden. CONCLUSIONS: A community-based PC model should be monitored by district health managment. The methods of this study are expected to be useful advice on how to solve similar problems in the other regions of similar context.

Facility type and primary care performance in sub-district health promotion hospitals in Northern Thailand.

BACKGROUND: Poor and middle-income Thai people rely heavily on primary care health services. These are staffed by a range of professionals. However, it is unknown whether the performance of primary care varies according to the staffing and organization of local service delivery units. Tambon (sub-district) health promotion hospitals (THPHs) were introduced in 2009 to upgrade the services offered by the previous health centres, but were faced with continuing shortages of doctors and nurses. The Ministry of Public Health (MoPH) designated three categories of THPH, defined according to whether they were regularly staffed by a medical practitioner, a qualified nurse or non-clinical public health officers. This study aimed to compare the performance of primary care offered by the three different types of primary care facilities in one public health region of Northern Thailand (Public Health Region 2). METHODS: A cross-sectional survey was undertaken in 2013. Data were collected on accessibility, continuity, comprehensiveness, co-ordination and community orientation of care from 825 patients attending 23 primary care facilities. These were selected to include the three officially-designated types of Tambon (sub-district) health promotion hospitals (THPHs) led by medical, nursing or public health personnel. Survey scores were compared in unadjusted and adjusted analyses. RESULTS: THPHs staffed only by public health officers achieved the highest performance score (Mean = 85.14, SD. = 7.30), followed by THPHs staffed by qualified nurses (Mean = 82.86, SD. = 7.06). THPHs staffed by a doctor on rotation returned the lowest scores (Mean = 81.63, SD. = 7.22). CONCLUSIONS: Differences in overall scores resulted mainly from differences in reported accessibility, continuity, and comprehensiveness of care, rather than staff skill-mix per se. Policy on quality improvement should therefore focus on improving performance in these areas.

Seven attributes of primary care in Thailand.

UNLABELLED: Primary care must be defined with a given country's contexts because primary care services vary across countries. This study aimed to define the concept of primary care in Thailand, which had not been systematically formulated. METHODS: of in-depth interview, focus group discussion, and Delphi were used to derive the attributes of primary care from 66 participants, including primary care providers, community representatives, general population, and national experts.The study yielded a total of 7 attributes of primary care categorized into 3 dimensions: medical care services (accessibility, continuity, comprehensiveness, and coordination), individual and family (trust and patient-centeredness), and population and community (population and community orientation).These 7 attributes provide a conceptual framework of how primary care in Thailand should be evaluated. RESULTS: of the evaluation will offer insights on which aspects of primary care need to be improved to achieve better health care.