The effectiveness of tobacco cessation programs for university students: A systematic review and meta-analysis.

INTRODUCTION: This systematic review and meta-analysis aimed to explore the existing tobacco interventions and synthesize whether those interventions affected tobacco use among university students. METHODS: We searched and found 1799 studies in PubMed, ClinicalKey for Nursing, Embase, and SCOPUS between 2009 and 2022. The risk of bias was assessed using similar criteria for RCT and non-randomized studies guided by the Cochrane Handbook for Systematic Reviews. The heterogeneity of studies was evaluated using Cochran's Q and I2 index. The GRADE system was used to distinguish the quality of evidence, and Egger's linear regression test was performed to assess publication bias. RESULTS: Eighteen studies used data extraction and analyses, and only eleven were meta-analyzed, which found that the estimate obtained via the fixed-effects model was statistically significant. Technology-based and motivational interview interventions found pooled ORs of statical significance, while reinforcer interventions showed the smallest effect size. The level of heterogeneity was considered substantial. The assessment for quality of evidence showed low overall certainty of evidence due to imprecision of outcome and suspicion of publication bias. Egger's test showed no publication bias among included studies (p=0.38). CONCLUSIONS: There were numerous tobacco cessation interventions for university students, but the most effective intervention to change tobacco consumption behavior was still inconclusive and uncertain. TRIAL REGISTRATION: This systematic review was registered with PROSPERO. The registration number is CRD42019142491.

The influence of workplace stress and coping on depressive symptoms among registered nurses in Bangladesh.

Background: Nurses report high levels of workplace stress, which has been linked to an increased risk for experiencing depressive symptoms. Nurses' workplace stress is also linked to increased absenteeism and decreased job satisfaction. Objectives: The objectives of this study were to examine: (1) the incidence of depressive symptoms among hospital-based registered nurses in Bangladesh; (2) common sources of workplace stress and their relationships to individual characteristics and depressive symptom scores; and (3) the potential mediating roles of coping strategies in the relationship between workplace stress and depressive symptoms. Methods: A cross-sectional study design involved three hundred and fifty-two registered nurses. Data were collected using a demographic questionnaire and three standardized tools measuring sources of nurses' workplace stress, coping strategies, and depressive symptoms. Results: More than half of the participants scored ≥ 16 on the CES-D, which was associated with a major depression episode. Total NSS scores had a small but significant influence on scores on the depression scale. Coping strategies had no mediated effect on the relationship between workplace stress and scores on the depression scale. Low-reliability coefficients for subscales of two of the standardized tools highlight the challenge for researchers in developing countries to address contextual differences that may influence the meanings attached to individual items. Conclusion: Findings suggest that the mental health of registered nurses in Bangladesh requires immediate attention in part by attending to workplace stressors. Further research should focus on a deeper understanding of Bangladeshi registered nurses' work experiences and the unique contribution that workplace stressors have on their physical and mental health.

The Effectiveness of the Transitional Care Program Among People Awaiting Coronary Artery Bypass Graft Surgery: A Randomized Control Trial.

PURPOSE: This study examined the effectiveness of the Transitional Care Program (TCP) on the anxiety, depression, cardiac self-efficacy, number of hospitalizations, and satisfaction with care among people awaiting elective coronary artery bypass graft (CABG) surgery. DESIGN: The study design was a randomized controlled trial. METHODS: The participants with coronary artery disease who met the study criteria (n = 104) were randomly assigned to the intervention group (n = 52) receiving the TCP plus routine care, or the control group (n = 52) receiving routine care only. The TCP, developed based on the Transitional Care Model, comprised hospital discharge planning and six weekly home telephone follow-ups to provide health education, counseling, monitoring, and emotional support tailored to the individual's needs. Data were collected at baseline, and then at weeks 1, 6, and 8 after program enrollment. Data were analyzed using descriptive statistics, repeated-measures analysis of variance, and the Z test. FINDINGS: The intervention group had lower anxiety and depression than did the control group at weeks 1, 6, and 8 after program enrollment. At weeks 6 and 8, the intervention group exhibited higher cardiac self-efficacy and satisfaction with care than the control group. Further, the intervention group had a significantly lower number of hospitalizations than the control group at week 8. CONCLUSIONS: The TCP can reduce anxiety, depression, and number of hospitalizations, while increasing cardiac self-efficacy and satisfaction with care among people awaiting CABG. CLINICAL RELEVANCE: Nurses are in a pivotal position to make care transitions safer. Provision of discharge education and regular telephone contacts could enhance positive outcomes regarding patients awaiting elective cardiac surgery.

Exploring health-related quality of life among non-Hodgkin's lymphoma survivors after completion of primary treatment: a cross-sectional study in Thailand.

PURPOSES: To investigate health-related quality of life (HR-QoL) and its influencing factors among non-Hodgkin's lymphoma (NHL) survivors after completion of primary treatment. METHODS: A cross-sectional study with 312 NHL survivors after completing primary treatment using self-reported data collected through face-to-face interviews or postal survey between May 2019 and December 2019. Sociodemographic factors, clinical characteristics, physical symptom distress, anxiety, depression, unmet supportive care needs, and adaptation (post-traumatic growth and post-traumatic stress disorder) were assessed. Data analysis included ANOVA tests to investigate HR-QoL among NHL survivors at different time points and GEE to assess predictors of HR-QoL. RESULTS: The mean score of HR-QoL was 136.05 (SD 19.12). HR-QoL scores reported by NHL survivors in phase I (6 months or less post-treatment) were significantly lower than those in phase II (> 6 months-4 years), phase III (> 4-9 years), and phase IV (over 9 years post-treatment). Regarding HR-QoL domains, NHL survivors in phase I had significantly lower physical well-being and functional well-being scores than those in phases II, III, and IV; and significantly lower lymphoma domain score than those in phase III. GEE analysis showed that physical symptom distress, anxiety, depression, unmet supportive care needs, poor adaptation, and receiving chemotherapy disrupted HR-QoL (all P < .001). CONCLUSIONS: Healthcare providers should re-prioritize intervention guidelines and survivorship care planning to promote HR-QoL among NHL survivors, particularly in phase I, through reducing physical and psychological symptom distress, addressing unmet needs, and enhancing adaptation outcomes.

Ethnic Disparities in Utilization of Maternal and Child Health Services in Rural Southwest China.

BACKGROUND: Studies in China on ethnic disparities in access to health care in remote and rural population remain insufficient. This study aimed to assess the disparities in utilization of maternal and child health (MCH) services, including antenatal care (ANC), hospital birth, child growth monitoring, and immunization compliance between Han and ethnic minority women in Yunnan Province. METHODS: A multi-stage sampling scheme was used to randomly recruit women from 40 townships in 14 remote prefectures of extremely remote areas in Yunnan. From birth records, we identified and recruited 303 Han women and 222 ethnic minority women who had given birth to a child within 3 years for an interview. RESULTS: Overall, 96% of women used the ANC checkups and more than 95% had infants born in hospitals. However, the proportion of women compliant with early ANC visits (having antenatal care in the first trimester) was 22.5% lower in minority women than in Han women (61.3% vs. 83.8%, p < 0.001) with an adjusted odds ratio (aOR) of 2.04 (95% confidence interval (CI) of 1.13-3.66) for the minority group. The proportion of children under one year old with immunizations completed in a timely manner was also lower in minority families than in Han families (80.2% vs. 86.8%, p < 0.05) with an aOR of 1.99 (95% CI = 1.16-3.40). CONCLUSIONS: Ethnic disparities remain in utilization of early ANC visits and timely immunization completion for newborns. Ethnic minority women tended to lag behind for both. Further intervention should focus on assisting minority women living in extremely rural areas to comply with the MCH policy. Culturally-sensitive policies and skills are needed, and priority should be given to improve utilization of early ANC and timely immunization completion.

Factors associated with multidrug-resistant tuberculosis (MDR-TB) in Bhutan: A nationwide case-control study.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) is a growing public health concern globally. In Bhutan, the rates of MDR-TB are high. Data on the risk factors of MDR-TB that can help inform policies are limited in Bhutan. This study aimed to determine the risk factors associated with MDR-TB. METHODS: A nationwide unmatched case-control study was conducted that included 79 MDR-TB cases and 118 controls. Data was collected by trained health workers through interviews using a structured questionnaire. Logistic regression analysis was performed to identify the risk factors associated with MDR-TB. RESULTS: The mean age of the participants was 32.4 and 33.7 years among the cases and the controls, respectively. In the multivariate analysis, the odds of having MDR-TB was higher among those who slept for less than 9 hours a day (AOR: 2.77, 95%CI: 1.11-6.92), frequently travelled in public transport (AOR: 2.96, 95% CI: 1.36-6.48), and had previous TB treatment (AOR: 5.90, 95%CI: 2.55-13.64). A greater number of rooms was also marginally associated with odds of having MDR-TB. CONCLUSIONS: The findings suggest previous TB treatment, inadequate sleep duration, and travelling by public transport to be the risk factors associated with having MDR-TB in Bhutan. Intensification of early case detection, strengthening directly observed treatment strategy, improving treatment adherence, and increasing awareness can help control the rising MDR-TB epidemic.

Academic Stress among High School Students in a Rural Area of Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: The period of adolescence undergoes many physical and mental changes. Changing emotional and physical status along with increasing social, family, and academic pressure lead to various impairments in the mental health of adolescents. Academic failure leads to the suicide rate in adolescents, predominantly high during the declaration of exam results which is significantly high in a rural area in comparison with urban. The study examined the prevalence of academic stress among high school students in a rural area of Rolpa, Nepal. METHODS: A descriptive cross-sectional study was conducted in 6 schools in Rolpa from July to October 2019. The sample size calculated was 521. A convenient sampling technique was used for this study. The target population was adolescents enrolled in high schools of Rolpa. Ethical approval was taken before data collection. The scale for assessing academic stress was used to find out the prevalence. A questionnaire was translated in local language and pre-testing was done in Nepal Police School,Sanga among 10% of the calculated sample size. Data entry was done in Statistical Package for the Social Sciences version 18. Descriptive statistical analysis was done for prevalence calculation. RESULTS: Out of a total of 521 students, the prevalence of academic stress was seen among 138 (26.5%)students at a 95% confidence interval (22.72-30.28). CONCLUSIONS: The prevalence of academic stress in our study was high and was consistent with other South Asian studies. Understanding academic stress and providing help and support to the students would help ease the burden for them.

Factors affecting quality management at the Thai national institute of health.

PURPOSE: The purpose of this paper is to confirm and examine organization-related factors that could affect quality management at the Thai national reference laboratory known as National Institute of Health. DESIGN/METHODOLOGY/APPROACH: The authors invited 340 laboratory staff members to complete a questionnaire that enquired about their skills, opinions, perceptions, leadership, work environment, organizational culture and organizational commitment in relation to quality management. Confirmatory factor analysis (CFA) and multiple linear regression were used to analyze the data. FINDINGS: In total, 65 percent of institute members responded to the questionnaire. CFA revealed that all factors were related to quality management. Three factors, leadership, organizational commitment and work environment, significantly affected quality management, but organizational culture did not. RESEARCH LIMITATIONS/IMPLICATIONS: Other data types should be collected for an in-depth understanding, i.e. focus groups or in-depth interviews. A longitudinal study could also enhance quality management understanding to see how each variable changes over time. ORIGINALITY/VALUE: Analyzing quality management through confirmatory factor and regression analysis showed that the four analyzed variables are statistically significant in relation to quality management at the laboratory. Managers could apply this information to revise the current policy.

Leadership and quality management measurement models: an empirical study.

PURPOSE: The purpose of this paper is to explore, confirm and verify leadership with regards to quality management measurement models. This research focused on identifying individual staff members' leadership attributes at the Thai National Institute of Health in relation to quality management. DESIGN/METHODOLOGY/APPROACH: The research instrument used in this study was a modified questionnaire on self-leadership and quality management that was distributed to the institute's staff. Leadership and quality management construct variables were observed and measured through staff perceptions, attitudes, practices and existing facts at the institute. Exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to examine the data. FINDINGS: The questionnaire had a 65 percent response rate. EFA revealed six factors from 27 questionnaire items and CFA was used to confirm the measurement models that were fitted to the data. The leadership attributes of staff members at the institute were statistically associated to and impacted on quality management by SEM analysis. RESEARCH LIMITATIONS/IMPLICATIONS: In-depth understanding of leadership and quality management could be done through a longitudinal study because the two factors would change over time. Even though this model is not a longitudinal study, it could help the institute facilitate and manage quality in practice through leadership. ORIGINALITY/VALUE: A cross-sectional study is used to examine the effect of leadership on quality management through factor analysis and SEM, which provided empirical evidence for future research. Leadership and quality management measurement models have statistically proven to be appropriately, technically and theoretically correct by design for observing variables used in the leadership measurement model that affects quality management.

Regional Variations of Fertility Control Behavior among Rural Reproductive Women in Bangladesh: A Hierarchical Analysis.

Women's fertility decision is quite difficult in male-dominant rural culture due to their poor reproductive autonomy. A cross-sectional survey was conducted in rural community of Bangladesh between November 2017 and February 2018 among 1285 respondents selected by multi-stage stratified sampling to explore regional variations of rural women's fertility control behavior and its determinants using hierarchical and other inferential statistics. Data collection was done by face-to-face interview using questionnaire. Average parity was 2.5 per woman and 41% respondents had three or more children. About 60% of them used modern contraceptives (MCs) and oral contraceptive pill (OCP) was their first choice. Male participation in contraceptive use was less than 5%. Regional variation, women's empowerment, fertility control knowledge, family planning (FP) attitude, social influence, perceived behavioral control (PBC) and fertility intention were significant predictors of fertility control behavior (p < 0.05). Significant regional variations were determined in fertility control behavior of rural women (p < 0.05). Almost all of its predictors explained by Theory of Planned Behavior (TPB) also showed significant regional variations (p < 0.05). Current fertility control policy should be strengthened more not only to improve fertility behavior of rural women but also to establish regional equity in fertility control by improving their reproductive decision-making in a rational way.

Testing the nicotine dependence measure mFTQ for adolescent smokers: A multinational investigation.

BACKGROUND AND OBJECTIVES: As a measure of nicotine dependence among adolescent smokers, the modified Fagerström Tolerance Questionnaire (mFTQ; seven items), has been successfully used in the United States (USA). Nonetheless, the validity and reliability of mFTQ at the international level is still needed. The current study is the first to test the validity and reliability of mFTQ in four countries: Thailand, Spain, the USA, and Russia. METHODS: In a cross-sectional survey, mFTQ, risk factors of nicotine dependence, and sociodemographic characteristics were assessed. Risk factors included age of first cigarette, frequency of alcohol use, frequency of marijuana use, and number of cigarettes smoked yesterday. Salivary cotinine was also obtained in Thailand and Spain. RESULTS: For all four countries, mFTQ exhibited a single factor structure, as supported by previous work in the USA. For all studied countries except Thailand, mFTQ presented acceptable internal reliability. Overall, risk factors of nicotine dependence have predicted mFTQ scores across countries. Frequency of alcohol use in the USA and frequency of marijuana use in Thailand and Spain were not associated with mFTQ scores. DISCUSSION AND CONCLUSIONS: mFTQ is a single-factor measure of nicotine dependence that shows acceptable internal consistency and validity across countries. Further work can advance the scale and tailor it to different cultures. SCIENTIFIC SIGNIFICANCE: mFTQ can be a clinically practical international measure of nicotine dependence. This study provides initial support for the utility of the mFTQ among Thai, Spanish, American, and Russian adolescents. Further research is needed to test and advance mFTQ across cultures. (Am J Addict 2017;26:689-696).

Three-month effects of Project EX: A smoking intervention pilot program with Thai adolescents.

Adolescent smoking is a major public health problem around the world, including Thailand. The current study provides a three-month follow-up evaluation of the Project EX tobacco use cessation program among Thai adolescents. The intervention was tested involving a quasi-experimental trial with 185 smokers, with two program and two control condition schools (within each condition, one school in Bangkok Province and one school in Nakhon Pathom Province). At 3-month follow-up, the intent-to-treat (ITT) quit rate was 23% in the program group and 11% in the standard care control group (p<0.02). The intervention also lowered the level of last 30-day smoking at follow-up among persons who did not quit in the program condition, while no change in level of smoking was reported in the control condition. These results are promising for teen tobacco use cessation programming in Thailand.

New mathematical formula for differentiating thalassemia trait and iron deficiency anemia in thalassemia prevalent area: a study in healthy school-age children.

Iron deficiency anemia (IDA) and thalassemias are common diseases especially in the Mediterranean, Middle East and Asian regions. Both conditions show the same clinical findings of hypochromic and microcytic red blood cells. Although previous studies have devised mathematical formulae to differentiate between these two conditions, the prevalence of alpha- and beta-thalassemias among the affected populations may undermine the accuracy of these formulae. This study generated a new formula that was able to differentiate IDA and thalassemia traits and to determine the incidence rates of IDA and thalassemia traits. A total of 345 healthy Thai children with a mean age (+/- SD) of 11.3 (+/- 1.7) years were enrolled. Complete blood count, iron status, hemoglobin typing and DNA for alpha-1 thalassemia identification were investigated. Discriminant analysis was used to create a new mathematical formula containing significant variables to differentiate between IDA and thalassemia traits. The new formula of (1.5 Hb-0.05 MCV >14) had a receiver operator characteristic curve of 0.92 in differentiating thalassemia traits from IDA, with sensitivity and specificity of 84.6 and 87.5%, respectively. The incidence of IDA and thalassemia traits in the study group was 12% and 32%, respectively. This formula should be useful as a screening tool to differentiate between these two conditions.

Oral health status and oral hygiene habits among children aged 12-13 years in Yangon, Myanmar.

We conducted a cross sectional study among children aged 12-13 years in Yongon, Myanmar to assess the oral health status and oral hygiene habits. The studied 220 students were from two high schools, one urban and the other rural. We conducted an oral health examination following WHO criteria and used a self-administrated questionnaire. The prevalence rate of dental caries among the study population was 53.2%. The mean number of decayed, missing and filled teeth (DMFT) was 1.7 +/- 2.1 teeth per person (decayed, 1.5 +/- 1.9); missing 0.0 +/- 0.2; filled, 0.1 +/- 0.4). Multivariate analysis revealed significant risk factors for dental caries were: the geographical location of the school (adjusted OR=2.24; 95% CI: 1.01-4.94), occupational status of the father (adjusted OR=2.83; 95% CI: 1.05-7.62) and the child's attitude about dental caries (adjusted OR=2.35; 95% CI: 1.18-4.67). Knowledge and oral hygiene habits were not associated with dental caries. The results of this study suggest the need to change from restoration orientated dentistry to dental public health care services, to reduce of the high level of dental caries in this age group.

Development of natural helper characteristic scale (NHCS): an instrument for identifying natural helpers for health area in Thai context.

BACKGROUND: Volunteerism in health through cadres of village health volunteers (VHV) has been common since the "health for all" campaign. At present, with political support, the VHV receives monthly financial support, and this creates a conflict of interest and competition among the VHV groups. Therefore, a tool to identify the VHV who has natural helper characteristics, a voluntary mind set and a readiness to help is needed. OBJECTIVE: The purpose of the present study was to develop and test the quality of the natural helper characteristic scale (NHCS). MATERIAL AND METHOD: The present study used a multi-methods design to identify natural helper characteristic constructs in the Thai public health context by interviewing community leaders and public health professionals who have experience in working with natural helpers successfully. Suggested constructs have been validated with key informants using telephone interview to confirm the common constructs before reconfirmation with factor analysis and reliability statistical test. RESULTS: Qualitative data indicated 3 constructs is commonly found and statistically tested by exploratory factor analysis revealed a 30-item with a five-factor solution (altruism, role recognition, openness to new experiences, family readiness, and social acceptance) that accounted for 62.24% of the variance. The finding of confirmatory factor analysis indicated that the 5-factor model with 24 items demonstrated acceptable fit indicated a good fit to the data (2 = 439.91; df = 217 (p < 0.001); chi2/ df = 2.02; RMSEA = 0.05; GFI = 0.90; and, CFI = 0.96). Cronbach's alpha coefficients of the total scale's Cronbach's alpha was 0.94. CONCLUSION: The NHCS demonstrated evidence of the content and construct validity, and adequate internal consistency reliability. The NHCS can be used for identifying natural helpers in working for the health programs.

A multilevel study of smoking among youths in school at Buriram Province.

OBJECTIVE: The purpose of this cross-sectional study was to determine status of smoking among youths in school and to identify both student-level and school-level factors on smoking. MATERIAL AND METHOD: A stratified two stage cluster sampling was employed to recruit 2,557 students in grades 10-12 and 30 teachers from 30 high schools in academic years 2010 in Buriram province, using a multilevel logistic analysis. RESULTS: The current smoking status was 9.0% overall, 19.0% and 1.3% for male and female respectively. The results from multilevel logistic analysis revealed that only 10.5% of variation in smoking was associated with difference in school characteristics. The following student-level factors entered into the multilevel logistic regression model according to their importance were self-efficacy-with the moderate and low self-efficacy having a higher risk of smoking compared with high (OR 8.76, 5.80)-alcohol drinking (OR 5.42). Males were more likely to smoke than females (OR 4.56), perceived benefit on non-smoking-with the moderate and low perception having a greater chance of smoking compared with the higher level of perception (OR 2.31, 1.93). School-level factors including type of school, health promoting school policy, student-teacher ratio, proportion of teachers who smoked and availability of cigarettes near the school were also taken into account, but were not related to the status of smoking among the students. CONCLUSION: The present study confirmed that school factors had no significant relationship to smoking among youths. Strict smoke-free policy at school is recommended. School program should focus more on self-efficacy Social marketing campaign/ education should focus on friends and family as non-smoking role models.

Screening high-risk population for hypertension and type 2 diabetes among Thais.

BACKGROUND: waist circumference (WC) and body mass index (BMI) are simple screening tools for hypertension (HT) and type 2 diabetes (DM). Cutoffs of WC for BMI for Asians have been discussed. This study aimed to assess the accuracy of screening tools and associations of WC, BMI with HT and DM. METHODS: Data from the national screening programme for metabolic syndrome conducted in 2010 in 21 provinces in the central region of Thailand were analysed. A total of 10 748 participants aged >35 years were included in the analysis with cutoffs of WC set at 90 cm for men, 80 cm for women, and BMI at 23 kg/m2 for both sexes. RESULTS: WC produced low sensitivity and high specificity among male participants, and moderate sensitivity and specificity among female participants, while BMI produced moderate sensitivity and specificity in both sexes. Significant associations were found among those who had high WC only, high BMI only, and both high WC and BMI with HT and DM in both sexes. (males for HT, OR=1.63, 95%CI: 1.15-2.33, OR=1.22, 95%CI: 1.03-1.44 and OR=2.03, 95%CI: 1.07-2.42; males for DM, OR=1.39, 95%CI: 1.05-1.83), OR=1.77, 95%CI: 1.07-2.94 and OR= 2.05, 95%CI: 1.57-2.69, females for HT, OR=1.69: 95%CI 1.38-2.07, OR=1.32; 95%CI: 1.09-1.60 and OR=2.54, 95%CI: 2.11-2.91; females for DM, OR=1.45, 95%CI: 1.08-1.94, OR=1.45, 95%CI: 1.09-1.91 and OR=1.70, 95%CI: 1.39-2.09). When the cutoff WC was lowered among male participants to 85 cm, sensitivity increased, and significant strengths of associations with HT and DM were nearly the same. CONCLUSION: For Thailand, WC and BMI with appropriate cutoffs can be effective screening tools to recruit high-risk populations into health promotion programmes. However, WC and BMI should be implemented with other screening tools for other risk factors because of their moderate accuracy.

Violence against children by parents.

The study aimed to identify the characteristics and frequency of physical and emotional violence against children by their biological parents and the relationship between children's characteristics, family factors and the extent of violent acts against children. The sample consisted of 212 grade six students in Muang District, Amnatcharoen Province. The data were collected from February 8 to 20, 1999. The results showed that 95.3 per cent of respondents perceived being treated violently by their biological parents, as 76.7 per cent were physical violence and 95.0 per cent were emotional violence. The most common physical and emotional acts of violence were beating by a cane or belt and scolding with rude language respectively. However, the violent acts occurred only occasionally. Only the factors of self-esteem and child's gender could predict the violent acts by fathers for 10.5 per cent; whereas family crises, family relations and self-esteem could predict the violent acts by mothers for 13.0 per cent. Therefore, building self-esteem, encouraging a healthy home environment, and creating proper coping skills against family crises are necessary for reducing violent acts.