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.

Effect of online infographics for enhancing health literacy among patients with type 2 diabetes in primary care unit during the COVID-19 pandemic: a randomized controlled trial.

BACKGROUND: Health literacy (HL) in patients with type 2 diabetes mellitus (DM) can help control disease and prevent complications. However, most patients with type 2 DM have inadequate HL; therefore, their HL must be further improved. This study aimed to determine the effects of online infographics on improving HL among patients with type 2 DM. METHODS: This randomized controlled trial was conducted from July 2022 to September 2022, at the primary care unit of Songklanagarind Hospital, Thailand; 30 patients with type 2 DM were randomly assigned to the experimental (n = 15; three types of infographics) and control (n = 15; three types of pamphlets) groups. Infographics and pamphlets were distributed weekly via social media platforms. The S-TOFHLA Thai version and Thai-FCCHL were used to evaluate HL. Chi-square, Fisher's exact, Wilcoxon rank-sum, t-test, paired t-test, and McNemar's chi-square tests were used. RESULTS: The median age of 30 participants was 56 years. The mean duration of DM was 9.6 years, with a median HbA1c level of 7.5 mg%. Most participants (80%) had adequate HL in S-TOFHLA, whereas 63.3% had adequate HL in FCCHL. All participants in the infographic group who had inadequate HL in the S-TOFHLA pre-test achieved adequate HL. Meanwhile, only 50% of patients in the pamphlet group achieved adequate HL. Regarding FCCHL, 50% of patients in the infographic group and 60% in the pamphlet group who had inadequate HL in the pretest achieved adequate HL. However, no statistical significance in achieving adequate HL was found in either group. The mean differences (SD) in S-TOFHLA between before and after intervention were 12.53 (8.77; p = 0.0007) and 10.13 (9.88; p = 0.001) in the infographic and pamphlet groups, respectively. Regarding FCCHL, the mean differences (SD) were 3.47 (4.29) and 3.20 (2.91) in the infographic group (p = 0.003) and pamphlet (p = 0.002) groups, respectively. No statistical significance in the mean difference was found between both groups. CONCLUSIONS: Novel online infographics and pamphlets did not significantly differ in achieving adequate HL among patients with type 2 DM who should receive health education about disease control and complication prevention. However, both interventions can increase and maintain HL levels. Online educational media can be appropriate during the COVID-19 pandemic. Nevertheless, further larger-scale studies should be performed to examine the impact of other DM educational media on HL promotion. TRIAL REGISTRATION: The Thai Clinical Trials Registry (TCTR) with registry ID TCTR20230425001 (date of registration 25/04/2023).

Characteristics and factors associated with hypertensive crisis: a cross-sectional study in patients with hypertension receiving care in a tertiary hospital.

Background: The hypertensive crisis is characterized by poorly controlled hypertension, which can lead to unfavorable outcomes and high utilization. The purpose of this study was to examine the prevalence, clinical characteristics, and factors associated with hypertensive emergency. Material and Methods: This cross-sectional study collected data from the hospital information system that included patients greater than or equal to 18 years who were diagnosed with hypertensive crisis (blood pressure ≥180 and/or 120 mmHg) and receiving care from the primary care unit and emergency department from 2020 to 2022. The prevalence and clinical characteristics of these patients were examined. Multiple logistic regression analysis was used to analyze factors associated with hypertensive emergency. Results: Among 3329 patients with hypertension, 17.33% had a hypertensive crisis (16.64 vs. 0.69%, urgency and emergency types). Most patients were female (63.6%), with a median age of 66 years. Almost half the patients (42.2%) with hypertensive crisis presented without specific symptoms, and the most common presenting symptom was vertigo/dizziness (27.7%). The initial and after treatment blood pressures were 203/98 and 174/91 mmHg. In the hypertensive emergency, the most common end-organ damage was ischemic stroke (33.3%), hemorrhagic stroke (25%), and acute heart failure (20.8%). An oral angiotensin-converting enzyme (57.5%) was the most commonly administered medication. Multiple logistic regression was performed but did not reveal any statistically significant. Conclusion: Our result revealed a high prevalence of hypertensive crises; most were of hypertensive urgency. The most common presenting symptom was vertigo/dizziness. There was no factor significantly associated with the hypertensive emergency in this study. Further studies should explore the cause of the hypertensive crisis to improve care delivery to patients with hypertension.

Prevalence and Associated Factors of Delayed Diagnosis of Type 2 Diabetes Mellitus in a Tertiary Hospital: A Retrospective Cohort Study.

Objective: To determine the prevalence and associated factors of delayed diagnosis of type 2 diabetes mellitus (DM) among outpatients in a tertiary hospital. Methods: This retrospective cohort study was conducted among outpatients aged ≥35 years with twice fasting plasma glucose (FPG) levels ≥126 mg/dl between 1 January 2018, and 31 December 2020. The prevalence and pattern of delayed diagnosis of DM were defined using the Thai Clinical Practice Guideline (CPG) for Diabetes, 2017, and the American Diabetes Association (ADA) 2017. The cut-off time for FPG level confirmation of 3 months was used to evaluate delayed diagnoses and associated factors. Multiple logistic regression was used to identify variables associated with delayed diagnoses. Results: Of 260 participants, 96.9% and 85.4% had delayed diagnoses as defined by the Thai CPG and the ADA, respectively. Factors significantly associated with delayed diagnosis were hypertension, non-cash insurance, and >10 years of physician experience. Conclusion: Undiagnosed diabetes and diagnosis delay should be a concern in tertiary settings. Senior physicians should focus on patients with higher FPG levels, particularly those who have hypertension, and use non-cash insurance schemes.

The association between physical activity and prevalence of anxiety and depression in medical students during COVID-19 pandemic: A cross-sectional study.

BACKGROUND: The COVID-19 pandemic has affected medical students both physically and mentally. Medical students have had to take online classes, which may have decreased their physical activity (PA) and increased their risk of mental health. This research aimed to explore the association between mental health problems and PA levels. MATERIALS AND METHODS: A cross-sectional study was conducted on 1st-6thyear medical students, at a university in Southern Thailand; from September to October 2021. The participants completed online questionnaires; including, demographic data, Global Physical Activity, PHQ-9 and the GAD-7 questionnaire. The association between PA levels and mental health was assessed using ordinal logistic regression. RESULTS: Among 325 medical students, 42.8% were males and 51.1% were clinical medical students. The prevalence of moderate to severe depression and anxiety was 31% and 12.9%. In total, 49.7% of participants had low PA levels. Pre-clinical students had a higher risk of depression (OR 2.11 p-value 0.001) and anxiety (OR 2.20 p-value 0.045) than clinical students. We also found that moderate or high PA levels were not a significant factor with mental health status (p-value of depression 0.447, 0.823 and p-value of anxiety 0.362, p-value 0.574, respectively). CONCLUSION: There were a lot of medical students with moderate to severe depression and anxiety, and about half of those had low PA levels; especially, pre-clinical students that learned online study activities. There was no significant association between PA levels and mental health status. However, the faculty should reconsiderate their medical student to increase physical activities and redesign the curriculum to support their students during these challenging times.

Effect of the COVID-19 Pandemic and Other Predictors of True Therapeutic Inertia on Patients with Hypertension in a Primary Care Clinic in Thailand.

INTRODUCTION: Hypertension (HT) has a significant impact on health care worldwide. Therapeutic inertia (TI) is defined as the failure to intensify therapy in the absence of an optimal goal and is widely used as a quality of care parameter. The coronavirus disease 2019 (COVID-19) pandemic has affected many health-care systems, including HT care. Therefore, the present study assessed the impact of the COVID-19 pandemic on TI and its predictors in patients with HT. METHODS: The electronic medical records of patients with HT who attended a primary care clinic at a tertiary hospital during pre-COVID-19 (February 2019 to February 2020) and COVID-19 (March to August 2020) periods were reviewed. RESULTS: Our study included 6089 visits during the 12-month pre-COVID-19 period and 2852 visits during the 6-month COVID-19 period. Most of the baseline characteristics of the HT patients were not significantly different between the two time periods. During the COVID-19 period, the percentage of uncontrolled HT visits decreased from 43% to 31%. Similarly, the prevalence of TI decreased from 81% to 77%. False TI was predominantly due to physicians' concerns regarding the in-clinic blood pressure measurement being inaccurate during both the periods. CONCLUSION: After readjustment for the physicians 'reasons, the true TI was 64% and 60% in the pre-COVID-19 and COVID-19 period. For adjusted physician and patient-related factors, multilevel modeling was used. Senior medical staff visits, elderly patients, prior diabetes mellitus diagnosis, patients who used more than one type of anti-HT medication, and patients with systolic blood pressure >150 mmHg were all predictors of TI. The COVID-19 period, on the other hand had no effect on TI with an adjusted odds ratio of 0.82 (95% confidence interval, 0.67-1.01).

Risk factors for a five-year death in the interASIA-south cohort.

OBJECTIVE: To determine the mortality rate and risk factors for death in a selected population in Songkhla province in southern Thailand. MATERIAL AND METHOD: The southern subjects were part of the Thai cohort which together with the cohort from China comprised the InterASIA survey which was conducted in the year 2000. Collected variables were the conventional ones and included the 2 ethnic groups which are specific for southern Thailand, i.e. Malay Muslims and Thai-Chinese Buddhists. Causes of death were determined by reviewing hospital records, verbal autopsies and a consensus by 2-3 physicians. Kaplan Meier's model was used to evaluate the independent factors related to death. RESULTS: The follow-up was 5 years. Out of the original 1,006 subjects, the status could be examined in 86% and of these, 50 had died giving the Kaplan Meier 5-year survival rate of 94.3%. Sixteen died from cardiovascular diseases (CVD), 6 from strokes and 10 from coronary heart disease, and 15 died from cancer. Half of the deaths occurred in subjects older than 70 years. Independent risks for death were age, hypertension and diabetes mellitus. Risk for the major causes of death did not include ethnicity. Similar to the only existing prospective report of risk factors for death in Thailand (the Electricity Generating Authority of Thailand study), neither high total cholesterol, high triglyceride nor obesity were independent risks for death from CVD, but the present study differed in that the high density lipoprotein cholesterol was not found to be a protective factor for CVD death. CONCLUSION: Risk factors for death in a five-year follow-up in Southern Thailand did not include lipids, ethnicity or urbanization but hypertension and diabetes mellitus did.

Socio-demographic and environmental factors associated with Aedes breeding places in Phuket, Thailand.

This study aimed to determine the socio-demographic and environmental factors influencing potential breeding sites of the dengue vector in Phuket Province. Three hundred houses were recruited by cluster random sampling for larval inspection. Of all the types of water containers, a high proportion of tires and discarded items were infested by Aedes larva (42% and 32%, respectively). Due to the abundance of water tanks, jars for using water and discarded containers (1.7, 2.1, 0.8 per house), these were the main breeding sites (0.29, 0.35, and 0.28 infested containers per house, respectively). Buddhists' houses were significantly more likely to have a larvae-infested flower vase than Muslims' houses. Townhouses had relatively few infested containers, while those on rubber plantations had 18.3 times higher odds of having at least one container with larva. No window screens increased the odds of larva infestation in the discarded containers by 4.2 times. With this information and given a reliable piped water supply, the number of water containers can be reduced to minimize the breeding places. Garbage should be properly disposed of. Screens should be installed, if possible. Buddhists should be advised on the proper protection of flower vases.