Knowledge and attitude towards stroke among the population of one rural community in southern Thailand: a survey.

OBJECTIVE: To evaluate attitude and knowledge of stroke in a rural community in southern Thailand. DESIGN: A survey. SETTING: A community in southern Thailand. PARTICIPANTS: All community members aged ≥18 years who were at home during the survey were invited to participate. PRIMARY AND SECONDARY OUTCOME MEASURES: Level of attitude and knowledge score towards stroke were assessed, and the associated factors were evaluated. METHODS: The questionnaire used in this survey was developed from a literature review, and the content validity and reliability were tested before use. Logistic and linear regression were used to determine factors associated with the level of attitude and knowledge score towards stroke. RESULTS: Among 247 participants, most were Muslim and the median age was 54.0 years. The median (Q1, Q3) score of stroke risk factors was 5 (2, 7) (full score: 9). Participants who knew about stroke, had an acquaintance diagnosed with stroke and had a high level of attitude had significantly higher scores. Two-thirds of the participants had a low-to-moderate level of attitude. Furthermore, most high-risk participants (99/113) had a low to no chance awareness of their risk to stroke. The median (Q1, Q3) score of stroke warning symptoms was 6 (3, 7) (full score: 10). The participants who had received education via the Face Arm Speech Time (FAST) campaign demonstrated a significantly higher proportion of correct answers to the symptoms mentioned in the FAST. CONCLUSION: About half of the participants in this community did not know some of the risk factors and warning symptoms of stroke. Moreover, most participants had a low-to-moderate level of attitude and underestimated their risk to stroke even in the high cardiovascular risk participants. The FAST may help people memorise the typical warning symptoms of stroke.

Sex and concepts of sexuality influence sexual problems and help-seeking behaviours of older people.

In this study, we aimed to examine the prevalence, associated factors, and management of sexual problems in older people at a primary care unit. We recruited people aged 60 years old and over, who visited the Primary Care Unit of Songklanagarind Hospital, a tertiary-care and referral centre in Southern Thailand, between June and August 2021, and used a self-administered questionnaire on sexuality, sexual problems, help-seeking behaviours, and clinical consultations for sexual problems in older people. There were 190 participants in this study (120 women, 70 men, mean age = 68.3). One hundred and five (55.3%) participants reported having sexual problems. Compared to their female counterparts, males were more likely to have sexual problems (adjusted OR = 3.11; 95% CI = 1.52,6.34; p-value = 0.001). The majority (77.3%) considered non-penetrative sexual activities (outercourse) when discussing sexuality in later life, and they had lower odds of having sexual problems compared to those who relied purely on sexual intercourse (adjusted OR = 0.27 for only outercourse and 0.30 for both intercourse and outercourse; p-value = 0.016). Only 2.1% (4/190) of participants reported that a physician had asked them about sexual problems. Participants reporting sexual problems (N = 105) often consulted their partners (25.7%) and friends (10.5%) or searched information from the internet (18.1%). According to this study, sexual problems in older people are common in primary care settings, but they tend to be poorly managed. Clinical discussions and interventions that are sensitive to gender differences and acknowledge the broadened concepts of sexuality in later life, e.g., encouragement to practice outercourse, may help improve sexual problems and well-being among older people.

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

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

Sexuality in Older Adults in A Primary Care Unit of Thailand during the COVID-19 Pandemic: A Cross-sectional Survey.

OBJECTIVES: To investigate sexuality in older Thai adults during the coronavirus disease (COVID-19) pandemic and the associated factors. METHODS: This cross-sectional survey was conducted on older adults visiting a primary care unit (PCU) in Thailand. A hundred and ninety older adults were enrolled by convenience sampling. Multiple logistic regression analysis with a backward stepwise algorithm was used to analyze factors associated with sexual desire and activity in older Thai adults. RESULTS: The median age of participants was 67.99 (60.01-88.57) years, and 63.2% were women. Overall, 37.4% of participants had sexual desires, and 54.2% were sexually active during the COVID-19 pandemic; however, more than half reported a decrease in sexual activity, fearing COVID-19 transmission as the most common reason. Men had more sexual desire and activity than women (adjusted OR [95% CI] = 13.92 [4.76, 40.73] and 6.63 [2.59, 16.94], respectively). CONCLUSIONS: Older Thai adults in the PCU displayed decreased sexual desire and activity during the COVID-19 pandemic. Sexual health is a lifestyle aspect that required investigation and care during the pandemic. CLINICAL IMPLICATIONS: Older Thai adults should be educated in that sexual activities can be broader than sexual intercourse, and sexual health should be cared for during an eventual new pandemic disease.

Prevalence and management of eosinophilia based on periodic health examinations in primary care clinics.

Background: Eosinophilia is a common, hematologic abnormality detected in periodic health checkups with diverse etiologies. There are a few clinical practice guidelines for the management of eosinophilia. Objectives: To determine the prevalence of eosinophilia among patients undergoing periodic health examinations, evaluate its management and outcomes, and identify its associated factors. Methods: We conducted a retrospective study that included patients with eosinophilia diagnosed during the 2018 periodic health examinations at Songklanagarind Hospital. Results: The prevalence rate of eosinophilia was 9.6% (988/10,299), and most patients (52.6%) were male with a median age of 53.0 (42.0-61.0) years. Only 174 patients (17.6%) were diagnosed and further examined to identify the cause of eosinophilia; including an examination of medical history (18.4%), physical examination (93.1%), laboratory analysis (9.2%), and consultation with internists (14.9%). Empirical anthelmintic therapy was administered in 130 patients (74.7%), and 49.2% achieved resolution. The possible causes of eosinophilia were identified in 20.7% (204/988), the most common cause being atopic disease (51.5%). Patients with moderate-to-severe eosinophilia were significantly more likely to be diagnosed, undergo further laboratory tests, and proceed with consultations with internists (adjusted OR [95% CI] = 3.52 [1.97-6.32], 17.13 [5.74-51.11], and 6.38 [1.95-20.93], respectively). Conclusions: Eosinophilia is commonly identified in periodic health examinations, and most primary physicians lack knowledge regarding the diagnostic work-up required to determine the cause of eosinophilia. Empirical anthelmintic therapy showed satisfactory efficacy for the management of eosinophilia in areas where parasite infection is endemic.

Usage of herbal medicines among the elderly in a primary care unit in Hat Yai, Songkhla province, Thailand.

Background: The prevalence of chronic diseases in the elderly is high, and some use herbal medicines instead of, or together with, conventional medicine. Herbal medicine usage may cause adverse events. Objectives: To determine the prevalence of herbal medicine usage among the elderly attending a primary care unit (PCU) of Songklanagarind Hospital, a tertiary teaching hospital in Hat Yai, Songkhla province, Thailand, and associated factors, reasons for use, principles considered before use, perceived effects, and history of consultation with medical professionals concerning their herbal medicine usage. Methods: We conducted a cross-sectional survey of a convenience sample of elderly patients who visited the PCU. Questionnaires were used to obtain data. Results: We included 204 patients who met the eligibility criteria. About two-thirds were women, with a median age of 69.0 years. Most had underlying diseases and were educated. The all time prevalence of herbal medicine usage was 60.8%. Being educated was significantly associated with herbal medicine usage. Among 124 users, 79% did not consider any principles for safe use of herbal medicine, 63% had no knowledge of possible interactions with conventional medicines, and 73% had never been asked about their use of herbal medicines by their health care professionals. Conclusions: There is a high prevalence of herbal medicine usage among the elderly Thai patients attending the PCU, especially by the educated. The majority did not consider the principles for safe use of herbal medicine. Health care providers should be more aware of herbal medicine usage and should increase their role in initiating a discussion about herbal medicine usage with elderly patients.

The triglyceride-glucose index, a predictor of type 2 diabetes development: A retrospective cohort study.

AIMS: The triglycerides-glucose (TyG) index, the product of fasting plasma glucose (FPG) and triglycerides (TG) is a novel index. Many previous studies have reported that the TyG index might be a strong predictor of incident type 2 diabetes. We determined whether the TyG index could be a useful predictor for diabetes diagnosis and compared it to the FPG and TG as predictors of type 2 diabetes. METHODS: A total of 617 subjects without baseline diabetes were examined and followed up for a median period of 9.2 years. We performed a mixed effect cox regression analysis to evaluate the risk of developing diabetes across the quartiles of the TyG index, calculated as ln[triglyceride (mg/dl)×FPG (mg/dl)/2], and plotted a receiver operating characteristic (ROC) curve to assess discrimination among TyG, FPG and TG. RESULTS: During 4,871.56 person-years of follow-up, there were 163 incident cases of diabetes. The risk of diabetes increased across the quartiles of the TyG index. Those in the highest quartile of TyG had a higher risk of developing diabetes (adjusted HR 3.38 95% CI 2.38-4.8, ptrend<0.001) than those in the lowest quartile. The area under the curve (AUC) of the ROC plots were 0.79 (95% CI 0.74-0.83) for FPG, 0.64 (95% CI 0.60-0.69) for TyG and 0.59 (95% CI 0.54-0.64) for TG. CONCLUSION: The TyG index was significantly associated with risk of incident diabetes and could be a valuable biomarker of developing diabetes. However, FPG appeared to be a more robust predictor of diabetes.