Postoperative analgesic efficacy of nefopam after anorectal surgery: a retrospective observational study

Objective: To examine the effectiveness of nefopam on postoperative pain control after anorectal surgeries. Methods: We retrospectively reviewed the electronic medical records of patients who underwent anorectal surgeries from January 2019 to March 2022 at two medical centers. The data were divided into nefopam and conventional groups. The primary outcome was the number of patients who requested additional opioids in the 24-h postoperative period. The secondary outcomes were numeric rating pain scores (NRPS) within a 24-h postoperative period and analgesic drugs-related side effects. Results: Eighty-seven patients in the conventional group and 60 in the nefopam group were recruited. The nefopam group reported less additional opioid consumption than the conventional group in all dimensions of analysis, including overall, adjusted to anesthetic techniques and types of surgery. However, these did not reach statistical significance (P = 0.093). Only patients in the nefopam group who underwent hemorrhoidectomy under TIVA or spinal anesthesia significantly required fewer additional opioids (P = 0.016, 60% mean difference). Similarly, the 24-h postoperative morphine consumption was lower in the nefopam group (mean difference = -3.4, 95%CI: 0.72,6.08). Furthermore, significantly lower NRPS were reported in the nefopam group during the 12-18 h postoperative period (P = 0.009). On the other hand, analgesic drugs related side effects were similar in both groups. Conclusions: The administration of nefopam after major anorectal surgery is beneficially evident in reducing postoperative opioid requirements. (AU)

The Effects of Cognitive Training in Healthy Community Residing Thai Elderly: A Randomized Controlled Trial.

Purpose: Cognitive training intervention (CTI) is defined as any mechanism of action of a non-pharmacological procedure provided to improve cognitive function. CTI in healthy elderly has the potential to improve cognitive function; however, the effects of interactive computerized-CTI in old ages have been inconclusive. The present study aimed to determine the effects of low-technology CTI in community-based populations. Patients and Methods: The study was a 2-arm parallel single-blinded randomized controlled intervention trial. The main outcome measured global cognitive function utilizing the Thai Mental State Examination (TMSE); the minor outcomes were cognitive subdomains and psychosocial outcomes (ie, quality of life and depression). The primary endpoint assessed the treatment effect at the 12th week (T1), while the secondary endpoint evaluated the carry-over effect at the 24th week (T2). Results: Eighty-six eligible participants were recruited from a senior society on the edge of Bangkok. At baseline (T0), the mean age and TMSE score among CTI (n = 44) and wait-list (n = 42) groups were similar (age; 66.66 ± 5.52 and 67.52 ± 6.46; TMSE; 28.84 ± 1.38 and 28.83 ± 1.12, respectively). For the CTI group, the mean number of cognitive training sessions was 14.82 ± 7.62. By using intention-to-treat analysis at the primary endpoint, the mean difference score of TMSE in the CTI group was significantly higher than the wait-list group (∆TMSEbetween group at T1-T0 = 0.57; 95% CI = 0.07 to 1.08), while the effect size was 0.48. At the secondary endpoint, there was no significant difference observed between the CTI and wait-list groups (∆TMSEbetween group at T2-T0 = 0.33; 95% CI = -0.23 to 0.88), while the effect size was 0.25. The cognitive subdomains and psychosocial outcomes were discovered with no significant difference. Conclusion: CTI showed significant treatment effect for improvement in global cognitive function in healthy Thai elderly but did not demonstrate carry-over effect. This study provided preliminary evidence of the feasibility of implementing low-technology CTI in middle-income countries.

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

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

Is the number of daily walking steps in sedentary workers affected by age, gender, body mass index, education, and overall energy expenditure?

BACKGROUND: Healthy adults should take 10,000 steps per day to gain the resulting health benefits. Knowledge regarding the individual characteristics associated with daily walking steps would enhance resource allocation to those most likely to benefit from the 10,000-steps-per-day campaign. OBJECTIVE: To determine the extent to which age, gender, body mass index (BMI), education, and energy expenditure influence daily walking steps in white-collar workers and to assess the correlation of daily walking steps among pedometer, wristband activity tracker, and smartphone application. METHODS: A cross-sectional study was conducted on 49 sedentary workers. Daily walking steps were simultaneously assessed by three activity trackers in free-living conditions for 7 consecutive days. Associations between daily walking steps and individual factors were examined using linear regression. Correlation tests were conducted to assess the association among the three devices. RESULTS: Multiple regression analyses showed that BMI was associated with daily walking steps. A moderate to good correlation in daily walking steps was found between the wristband activity tracker and pedometer, as well as between the smartphone application and pedometer. CONCLUSIONS: BMI influenced daily walking steps in white-collar workers. Daily walking steps assessed by the wristband activity tracker and smartphone application differed from those assessed by the pedometer.

Shift Work and Leukocyte Count Changes among Workers in Bangkok.

OBJECTIVES: Previous epidemiological evidence for the association of shift work exposure and increased leukocyte count is cross-sectional in nature, thus limiting cause-effect inference. We therefore used a longitudinal design to: (i) compare leukocyte counts at baseline between shift and day workers and (ii) examine the time trend of leukocyte counts over the follow-up period for these workers. METHODS: A retrospective cohort study was conducted among 6737 workers aged <60 years at two large organizations (a humanitarian organization and a university) in Bangkok, Thailand who had participated in at least two annual health check-ups during the period 2005-2016. Shift work exposure history was assessed by a self-administered questionnaire and categorized into day, former, and current shift workers. Data on leukocyte count were collected annually as part of worksite health screening during the observation period. Association of shift work exposure and increased leukocyte count was then examined cross-sectionally and longitudinally by using multiple linear regression and multilevel analysis of repeated measures data, respectively. In addition, trends for leukocyte count over the follow-up period and work years were examined using LOWESS smooth curves. RESULTS: Compared to day work, the current shift work was associated with increased leukocyte counts. The magnitude of percentage increase was the highest for basophil counts, followed by eosinophil and lymphocyte counts. Both cross-sectional and longitudinal evidence revealed this association, although it was less pronounced longitudinally. For total leukocyte count, the magnitude of difference was constant across the 11-year follow-up period. However, for lymphocyte and basophil counts, these discrepancies tapered over the work years until they no longer differed (for lymphocyte count) or even differed in the opposite direction (for basophil count) in later work years. CONCLUSION: This study confirmed previous cross-sectional evidence that shift work exposure-increased leukocyte counts and that this was reversible. Whether this increase in immune cell count also results in an increased immune cell activity and serves as the intermediary in the association between shift work exposure and subsequent chronic disease development needs further investigation.

Immediate risk of myocardial infarction following physical exertion, tea, and coffee: A case-crossover study in Thailand.

BACKGROUND: Physical exertion and caffeine consumption are associated with acute myocardial infarction (MI). However, physical exertion and caffeine consumption have not been examined as immediate triggers of MI in low and middle-income countries. OBJECTIVE: Using a self-matched case-crossover design, we examined the acute risk of MI in the hour following episodes of physical exertion, caffeinated coffee, and tea consumption among MI survivors in Thailand. METHODS: A total of 506 Thai participants (women = 191, men = 315) were interviewed between 2014 and 2017 after sustaining an acute MI. We compared each subject's exposure to physical exertion and consumption of caffeine- containing beverages in the hour preceding the onset of MI with the subject's expected usual frequency in the prior year to calculate relative risks (RRs) and 95% confidence intervals (95%CIs). RESULTS: Of the 506 participants, 47 (9.3%) engaged in moderate or heavy physical exertion, 6 (1.2%) consumed tea, and 21 (4.2%) consumed coffee within the hour before MI. The relative risk of MI after moderate or heavy physical exertion was 3.0 (95% CI 2.2-4.2) compared to periods of no exertion, with a higher risk among more sedentary participants compared to active participants. Compared to times with no caffeinated beverage consumption, there was a higher risk of MI in the hour following consumption of caffeinated tea (RR = 3.7; 95%CI: 1.5-9.3) and coffee (RR = 2.3; 95%CI: 1.4-3.6). CONCLUSION: Physical exertion, coffee and tea consumption were associated with a higher risk of MI in the subsequent hour compared to times when the participants were sedentary or did not consume caffeinated beverages. Our study identifies high-risk populations for targeted screening and intervention to prevent acute MI.

Increased Risk Of Type 2 Diabetes And Abnormal FPG Due To Shift Work Differs According To Gender: A Retrospective Cohort Study Among Thai Workers In Bangkok, Thailand.

PURPOSE: The gender differential evidence of the association between shift work and type 2 diabetes risk remains scarce. This longitudinal study determines whether the association between shift-work exposure and type 2 diabetes risk and abnormal fasting plasma glucose (FPG) differs according to gender; the study aims to find the association between shift work and changes in physiological, behavioral, and psychosocial stress. PATIENTS AND METHODS: This retrospective cohort study was conducted among 5947 workers (4647 female and 1300 male) aged ≤60 years old in Bangkok, Thailand. Participants required a normal FPG level (<100 mg/dL) at baseline and at least two health check-up results from 2009 to 2016. Shift-work exposure history was assessed using a self-administered questionnaire; FPG levels were measured annually. Cox proportional hazard models were used to assess the aforementioned association. RESULTS: During the follow-up period, 1470 new abnormal FPG and 154 new type 2 diabetes cases developed. Stratified analysis of male workers' data revealed an association was significant in the unadjusted model, which tended to be stronger after adjustment for demographic data and the baseline values of anthropometric and biochemical parameters. This was the case both for type 2 diabetes [Hazard Ratio (HR) (95% Confidence Interval (CI))=2.98 (1.58-5.62)] and abnormal FPG [HR (95% CI)=1.86 (1.43-2.41)]; this association was less obvious among women. CONCLUSION: Shift work is a risk factor for type 2 diabetes and abnormal FPG; this risk is gender differential, being more pronounced in men. Preventive measures aiming at ameliorating shift work induced type 2 diabetes risk should pay more attention to men.

Obstructive sleep apnea as a risk factor for preeclampsia-eclampsia.

PURPOSE: Preeclampsia-eclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality. Emerging evidence suggests that obstructive sleep apnea (OSA), which has been linked to hypertension in the general population, may play role in hypertensive disorders in pregnancy, including preeclampsia-eclampsia. However, little research has been conducted in Asia (no data in Thailand) on the effects of OSA on preeclampsia-eclampsia. We aimed to examine the association between OSA and preeclampsia-eclampsia among Thai pregnant women. METHODS: We conducted a large prospective cohort study among Thai pregnant women who were in the second trimester of singleton pregnancy. The Berlin Questionnaire was administered to evaluate the risk for OSA. Preeclampsia-eclampsia was diagnosed by standard clinical assessment. Multivariate models were applied in adjustment for confounding factors. RESULTS: Enrolled were 1345 pregnant women. The overall prevalence of high risk for OSA was 10.1% (95% confidence intervals [CIs] 8.5-11.7), and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio (OR) for preeclampsia-eclampsia in women with high risk for OSA was 2.72 (95% CI 1.33-5.57). CONCLUSIONS: Pregnant women with high risk for OSA are at increased risks for preeclampsia-eclampsia compared to those with low risk for OSA. Our results support a role for screening for OSA by BQ during antenatal care.

Effects of a group activity-based motivational enhancement therapy program on social media addictive behaviors among junior high school students in Thailand: a cluster randomized trial.

PURPOSE: This study aimed to assess the effects of a group activity-based motivational enhancement therapy (GA-MET) program on social media addictive behaviors among junior high school students. MATERIALS AND METHODS: This cluster randomized trial was performed in 245 junior high school students who used social media in the lower part of northeast Thailand. The GA-MET program group and the control group sessions lasted 8 weeks and were followed up 4 weeks later. The addictive social media behaviors, average duration of social media usage during weekdays and weekends (hours/day), child behaviors, self-esteem, and depression were investigated using a self-reported questionnaire. Multivariable linear regression was used to compare the mean and 95% CIs between two groups. RESULTS: The GA-MET program significantly decreased the average duration of social media usage during weekdays and weekends (hours/day) (-1.27, 95% CI: -2.18,-0.37 and -1.25, 95% CI: -2.22, -0.29, respectively), emotional behavior (-0.69, 95% CI: -1.18, -0.19), and depression (-4.03, 95% CI: -6.07, -1.99) in the treated group compared to the control group. CONCLUSION: The GA-MET program could reduce the risk of social media addictive behaviors in junior high school students in Thailand by decreasing time spent on social media, emotional behaviors, and depression.

Incense Smoke and Increasing Carotid Intima Media Thickness: A Cross-Sectional Study of the Thai-Vietnamese Community.

Incense burning, a source of household indoor air pollution, is possible to effect on cardiovascular system. Our study sought to examine the association of long-term exposure to household incense smoke with increased carotid intima-media thickness (CIMT). A cross-sectional study was conducted 132 adults aged ≥35 years. Participants were stratified into 3 groups by their long-term household incense use; nonexposed group, non-daily exposed group, and daily exposed group. A combined mean CIMT (mean difference = 0.04 mm; P < .01) and combined maximum CIMT (mean difference = 0.09 mm; P < .01) in the daily exposed group had greater than the nonexposed group. The mean CIMT and maximum CIMT of the left common carotid artery in the daily exposed group was significantly greater than the nonexposed group ( P < .01). These findings suggest that incense burning inside the house may be a risk factor for cardiovascular disease morbidity and mortality.

Factors associated with intention to take non-occupational HIV post-exposure prophylaxis among Thai men who have sex with men.

BACKGROUND: Men who have sex with men (MSM) are disproportionately infected with HIV in Thailand. Factors affecting their intention to take non-occupational HIV post-exposure prophylaxis (nPEP) are not well understood. This study sought to determine factors associated with an intention to take nPEP in this population. METHOD: This is a two-phase mixed-method study. Phase I was a cross-sectional survey of intention to take nPEP in 450 MSM attending for HIV testing, using a self-administered questionnaire. Phase II was a prospective descriptive study, using an in-depth interview among 40 MSM who had been exposed to HIV in the past 72 hours. Multiple logistic regression was used to evaluate factors relating to the intention to use nPEP. RESULTS: Among 450 MSM seeking HIV testing in Bangkok, 7% had ever taken nPEP. Only 40% expressed an intention to take it to prevent HIV acquisition, despite the fact that they were at high risk as evidenced by an 18.9% prevalence of HIV-positive status. Factors associated with an intention to take nPEP were awareness about nPEP, HIV knowledge, mode of sexual intercourse and circumcision. Among 40 MSM who were eligible for and offered nPEP, 39 agreed to take it, and all but one completed the 4-week course. Condom use increased and all 32 individuals who could be contacted tested HIV negative after nPEP. CONCLUSION: A high HIV prevalence was found in MSM testing for HIV in this study. However, fewer than half of the participants expressed the intention to take nPEP if they were at risk for HIV infection. Efforts to create nPEP awareness and improve HIV knowledge in MSM are crucial to the successful implementation of nPEP as part of a combination package for HIV prevention in this high-risk population.

SCREENING FOR TYPE 2 DIABETES MELLITUS AND PREDIABETES USING POINT-OF-CARE TESTING FOR HBA1C AMONG THAI DENTAL PATIENTS.

Diabetes mellitus type 2 (DM) is associated with oral diseases. Some studies indicated that patients who seek dental treatment could have undiagnosed hyperglycemic condition. The aim of this study was to assess the prevalence of undiagnosed hyperglycemia and selected associated factors among Thai dental patients. Dental patients without a history of hyperglycemia were recruited from the Special Clinic, Faculty of Dentistry, Mahidol University, Bangkok, Thailand and His Majesty the King's Dental Service Unit, Thailand. The patients were randomly selected and a standardized questionnaire was used to collect demographic data from each patient. Blood pressure, body mass index (BMI), and waist circumference were recorded for each subject. The number of missing teeth, periodontal status, and salivary flow rate were also investigated. HbA1c was assessed using a finger prick blood sample and analyzed with a point-of-care testing machine. Hyperglycemia was defined as a HbA1c ≥5.7%. The prevalence of hyperglycemia among participants was calculated and multivariate logistic regression analysis was used to identify risk factors. A total of 724 participants were included in the study; 33.8% had hyperglycemia. On multiple logistic regression analysis, older age, family history of DM, being overweight (BMI ≥23 kg/m2), having central obesity and having severe periodontitis were significantly associated with hyperglycemia. The high prevalence of hyperglycemia in this study of dental patients suggests this setting may be appropriate to screen for patients with hyperglycemia.

Relationship between Poor Sleep Quality and Psychological Problems among Undergraduate Students in the Southern Thailand.

We conducted this study to fill the noted gap in the available literature by evaluating the prevalence of poor sleep quality in this understudied population and to explore the relationship between sleep quality and psychological problems among undergraduates in Thailand. This study used a cross-sectional survey. Self-administrated questionnaires included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Depression, Anxiety and Stress Scale and the Thai General Health Questionnaire. The study group included 1,055 undergraduates, aged 18-25 years. The prevalence of poor sleep quality was 42.4%. Students classified as poor quality sleepers reported significantly more psychological problems, indicating a linear trend of progressively worse global sleep quality associated with greater mood and anxiety symptomatology. Prospective studies that include objective measures of sleep duration and quality are needed to more fully develop focused health promotion strategies for Southeast Asian undergraduates.

Obstructive sleep apnea and the risk of preterm delivery.

OBJECTIVE: The aim of this study was to evaluate the risk of obstructive sleep apnea (OSA) to preterm delivery (PTD), using the Berlin Questionnaire (BQ). METHODS: This was a large, prospective cohort study among pregnant Thai women. The BQ was employed for symptom-based OSA screening during the second trimester, and PTD was recorded in 1345 pregnant women. Multivariate models were applied in controlling for potential confounders. RESULTS: The overall prevalence of the high risk of OSA was 10.1 %, and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio for PTD in women with a high risk of OSA was 2.00 (95 % confidence intervals (CIs) = 1.20, 3.34). Stratified analyses, after adjusting for confounding factors, indicated that a high risk of OSA was associated with an increased risk of spontaneous preterm delivery (odds ratio (OR) = 2.45, 95 % CI = 1.20, 5.02), but not with preterm premature rupture of membranes (OR = 1.61, 95 % CI = 0.61, 4.26), and medically indicated preterm delivery (OR = 1.83, 95 % CI = 0.72, 4.64). CONCLUSION: Pregnant women with a high risk of OSA are at an increased risk of having PTD, compared with pregnant women with a low risk of OSA.

PREVALENCE AND ASSOCIATED RISK FACTORS OF INTESTINAL PARASITES IN HUMANS AND DOMESTIC ANIMALS ACROSS BORDERS OF THAILAND AND LAO PDR: FOCUS ON HOOKWORM AND THREADWORM.

Hookworm and threadworm infections are major public health problems in developing countries. A cross sectional study comprising 843 participants (346 males and 497 females) was conducted in three populations: i) Thai residents (TR) of Ubon Ratchathani Province, Thailand; ii) Laotian immigrant workers (LI) in the same province; and iii) Laotian residents (LR) in Champasak Province, Lao PDR. Participants were interviewed based on a structured questionnaire regarding their health status. Stool samples from participants and 300 samples from domestic animals (277 dogs and 23 cats) living in the participants households were collected and examined for parasitic infection using a formalin-ether concentration and a Harada-Mori filter paper culture techniques. Approximately one-third of TR and LI populations and domestic animals in Thailand were positive for parasitic infections, while almost half of LR population and domestic animals were positive. We confirmed by PCR and DNA sequencing a case of Ancylostoma ceylanicum infection in a Thai man. We also observed infections of other parasites, such as Taenia spp and Opisthorchis viverrini. Multivariate analysis indicated that risk factors for hookworm infection were population group and walking barefoot. Factors associated with threadworm infection were population group, adult male, lack of previous antiparasitic treatment and of knowledge of parasitic infection, and failure to wash hands after contact with domestic animals. Our results highlight the high prevalence of both hookworm and threadworm infections especially among LI population and domestic animals in both countries. Our findings emphasize the need for public health intervention to control the spread of parasitic infections in Thailand and Lao PDR.

Psychometric properties and factor structure of the General Health Questionnaire as a screening tool for anxiety and depressive symptoms in a multi-national study of young adults.

BACKGROUND: Globally, common psychiatric disorders such as depression and anxiety are among the leading causes of morbidity and mortality. The 12-item General Health Questionnaire (GHQ-12) is a widely used questionnaire for screening or detecting common psychiatric disorders. The purpose of this study was to examine the reliability, construct validity and factor structure of the GHQ-12 in a large sample of African, Asian and South American young adults. METHODS: A cross-sectional study was conducted among 9077 undergraduate students from Chile, Ethiopia, Peru and Thailand. Students aged 18-35 years were invited to complete a self-administered questionnaire that collected information about lifestyle, demographics, and GHQ-12. In each country, the construct validity and factorial structures of the GHQ-12 questionnaire were tested through exploratory and confirmatory factor analyses (EFA and CFA). RESULTS: Overall the GHQ-12 items showed good internal consistency across all countries as reflected by the Cronbach's alpha: Chile (0.86), Ethiopia (0.83), Peru (0.85), and Thailand (0.82). Results from EFA showed that the GHQ-12 had a two-factor solution in Chile, Ethiopia and Thailand, although a three-factor solution was found in Peru. These findings were corroborated by CFA. Indicators of goodness of fit, comparative fit index (CFI), root mean square error of approximation (RMSEA), and standardized root mean squared residual, were all in acceptable ranges across study sites. The CFI values for Chile, Ethiopia, Peru and Thailand were 0.964, 0.951, 0.949, and 0.931, respectively. The corresponding RMSEA values were 0.051, 0.050, 0.059, and 0.059. CONCLUSION: Overall, we documented cross-cultural comparability of the GHQ-12 for assessing common psychiatric disorders such as symptoms of depressive and anxiety disorders among young adults. Although the GHQ-12 is typically used as single-factor questionnaire, the results of our EFA and CFA revealed the multi- dimensionality of the scale. Future studies are needed to further evaluate the specific cut points for assessing each component within the multiple factors.

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

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

The effect of daily walking steps on preventing neck and low back pain in sedentary workers: a 1-year prospective cohort study.

OBJECTIVE: This study aimed to investigate the causal relationship between daily walking steps and the 1-year incidence of neck and low back pain in workers with sedentary jobs. METHODS: A 1-year prospective study was carried out among 387 workers who reported no spinal symptoms in the previous 3 months with pain intensity greater than 30 mm on a 100-mm visual analog scale. Data were gathered using a self-administered questionnaire, physical examination, and pedometer. Follow-up data were collected every month for the incidence of musculoskeletal disorders and every 3 months for daily walking steps. Two regression models were built to analyze the effect of daily walking steps on the 1-year incidence of neck and low back pain. RESULTS: Among 367 (95 %) participants followed for 1 year, 16 and 14 % reported incident neck and low back pain, respectively. After adjusting for confounders, a negative association between daily walking steps and onset of neck pain was found. Increasing daily walking steps by 1,000 reduced the risk of neck pain by 14 %. No significant association between daily walking steps and the onset of low back pain was found. CONCLUSIONS: Increasing daily walking steps is a protective factor for onset of neck pain in those with sedentary jobs. Interventions to reduce neck pain should include attempts to increase daily walking steps.

Circadian rhythm characteristics, poor sleep quality, daytime sleepiness and common psychiatric disorders among Thai college students.

INTRODUCTION: To investigate the relationship between common psychiatric disorders (CPDs) and sleep characteristics (evening chronotype, poor sleep quality and daytime sleepiness) among Thai college students. METHODS: A cross-sectional study was conducted among 2,970 undergraduate students in Thailand. Students were asked to complete a self-administered questionnaire that collected information about lifestyle and demographic characteristics. The Horne and Ostberg Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate circadian preference, sleep quality and daytime sleepiness, respectively. The General Health Questionnaire-12 (GHQ-12) was used to evaluate presence of CPDs. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of CPDs in relation to the covariates of interest. RESULTS: A total of 337 students were classified as having CPDs (11.2%; 95% CI 10.1-12.3%). Evening chronotype (OR = 3.35; 95% CI 2.09-5.37), poor sleep quality (OR = 4.89; 95% CI 3.66-6.54) and excessive daytime sleepiness (OR = 1.95; 95% CI 1.54-2.47) were statistically significantly associated with CPDs. DISCUSSION: Our study demonstrated that CPDs are common among Thai college students. Further, evening chronotype, poor sleep quality and excessive daytime sleepiness were strongly associated with increased risk of CPDs. These findings highlight the importance of educating students and school administrators about the importance of sleep and their impact on mental health.

FACTORS ASSOCIATED WITH DELAY IN TUBERCULOSIS TREATMENT AT 10 TERTIARY LEVEL CARE HOSPITALS IN THAILAND.

Tuberculosis (TB) is common in Thailand. Delay in initiating tuberculosis treatment is a major public health problem. Delay in treatment can result in more severe diseases, risk for death, and greater risk of tuberculosis transmission in the community. We attempted to determine the duration from onset of TB symptoms to the date of first consultation (patient delay) and the factors associated with that delay at 10 tertiary level care hospitals in Thailand. All participants aged 18 years who were willing to participate were included in the study, which was conducted from January to December 2012. A structured questionnaire and medical records were used to collect data. One hundred ninety-nine TB patients were included in the study. The mean age of subjects was 48 years (SD = 15.9); 69.8% were male. The median duration from onset of symptoms to first medical consultation was 30 days. On multivariate analysis, living in an urban area (adjusted odds ratio = 2.81; 95% CI: 1.29-6.14) was an independent risk factor for the delay. Delay in seeking help is a common problem among TB patients in Thailand. At risk populations need to be educated on the importance of presenting for early medical consultation if they have symptoms of TB.