Journal of Public Health and Development

Understanding perceived good death among older adults: A qualitative systematic review for model development

2025-07-01T11:13:15+07:00

The concept of a "good death" encompasses physical, psychological, social, and spiritual dimensions, emphasizing dignity and meaning at the end of life. However, the perceptions of older adults regarding this concept remain underexplored, particularly across diverse cultural and demographic contexts. This study aimed to conduct a qualitative systematic review to identify unique perceptions concerning a good death among adults aged 60 and above and to develop a comprehensive model addressing these aspects.
A qualitative systematic review methodology, guided by the Joanna Briggs Institute’s framework and PRISMA guidelines, synthesized 12 qualitative studies published between 2000–2022. Thematic synthesis, supported by a hybrid approach of human coding and automated analysis using DivoMiner software, then ensured robust findings through triangulation between machine-generated codes and human annotations. Five interconnected themes emerged: (1) peaceful and dignified death, (2) family and social influences, (3) autonomy and control, (4) spiritual and cultural perspectives, and (5) challenges associated with a bad death. The desires for pain-free experiences and autonomy were balanced with cultural and familial factors, underscoring the need for compassionate, culturally sensitive care. The present study proposes a comprehensive "Good Death" model to improve nursing practices through holistic, personalized, and culturally informed end-of-life care. By integrating spiritual and cultural sensitivity and emphasizing familial involvement, the model addresses gaps for future research and policy development, ultimately enhancing the quality of life and end-of-life experiences for older adults worldwide.

The transformative potential of digital anthropometry in pediatric health: mapping a decade of innovations in anthropometric assessment (2014–2023)

2025-07-13T19:33:30+07:00

Pediatric health is crucial for global well-being, as growth and development indicators significantly influence long-term outcomes. Traditional anthropometric methods often face inaccuracies. Digital anthropometry that uses technology like 3D scanners offers precise, efficient solutions that promise to enhance pediatric health monitoring. This review aims to explore the current state of digital anthropometry in pediatric health. The authors sourced articles from EBSCO, PubMed, ProQuest, ScienceDirect, and Scopus between 2014 and 2023. The studies were reviewed based on set criteria, synthesizing data according to technology types, measurement capabilities, contributions to pediatric health, and adoption challenges and opportunities. The use of digital technologies was highlighted using 32 studies, most of which used a 3D scanner. These technologies made significant contributions to pediatric health. For instance, 3D scanners were used to assess cranial deformation in infants, detect facial features associated with Williams Syndrome, and monitor body composition to identify risks of obesity. Digital anthropometry enhances measurement capabilities, particularly in assessing diverse body dimensions. It contributes to improved nutritional and growth assessment, diagnosis and management of health conditions, medical device design, and home use applications. Despite challenges such as technical failures in scan processing and measurement inaccuracies caused by child movement or suboptimal conditions, the non-invasive, portable, and automated nature of these technologies presents significant opportunities for advancing pediatric health. This review highlights the transformative potential of digital anthropometry in pediatric health, addressing a critical gap in previous literature, which has predominantly focused on adult populations or single technologies. By synthesizing diverse applications across digital tools specifically for children, this review helps clarify how these innovations can improve growth monitoring and promote global health equity. Despite adoption barriers, its integration into healthcare is crucial, and future research needs to address challenges and ensure sustainability.

Self-reported questionnaires for assessing medication adherence in coronary heart disease patients: A systematic review

2025-09-06T17:09:37+07:00

Medication adherence is essential for assessing the effectiveness of treatment in people with coronary heart disease (CHD). It is evaluated through self-report, which is the most economical and straightforward method. This systematic review aimed to identify validated self-report questionnaires that measure medication adherence in patients with CHD.The study adhered to the PRISMA guidelines for carrying out systematic reviews. A total of 23 articles were selected according to the inclusion criteria, from three databases, namely PubMed, ScienceDirect, and Scopus. The Joanna Briggs Institute (JBI) Critical Appraisal Instrument was used to independently evaluate the quality of the included articles.

The most generally used self-report questionnaires for assessing medication adherence in patients with CHD were the MMAS-4 and MMAS-8, each applied in 22% of the studies. These were followed by the MARS-5, MGLS, and ACDS, each used in 13% of the studies. The results showed that most questionnaires had acceptable reliability (Cronbach’s α = 0.739–0.898) and validity (content and construct). However, few articles evaluated questionnaires across diverse cultural contexts or assessed their sensitivity to partial or intermittent medication adherence.

The MMAS-4 and MMAS-8 were the most commonly used validated self-report adherence questionnaires. Despite presenting acceptable psychometric properties, questionnaires had limited cultural adaptation and sensitivity to partial or intermittent adherence. This emphasized the need for further validation and the development of tools better tailored to diverse clinical settings and study contexts.

Factors Affecting Falls in the Dependent Elderly in Sukhothai Province, Thailand

2025-06-03T18:32:56+07:00

This cross-sectional survey aimed to study factors affecting falls in dependent elderly individuals in Sukhothai Province, Thailand, both in urban and rural areas. The study was conducted between October and November 2024, and 447 participants aged 60 years and older were selected using stratified random sampling. Data were collected using standardized, interviewer-administered questionnaires that included demographics, health status, sleep, physical activity, and home environment. Descriptive statistics and multivariable logistic regression were used to find significant predictors of falls. The results of the study showed that a majority of the informants had a history of falls (60.2%). The factors that could predict the chance of falls in the dependent elderly group with statistical significance at the 0.05 level were history of chronic illness (Adj OR = 9.52), insufficient Sleep (Adj OR = 5.90), area with different levels (Adj OR = 5.58), lack of exercise (Adj OR = 5.15), slippery floor (Adj OR = 4.63) and income inadequacy (Adj OR = 3.15). In conclusion, the management of risk factors affecting falls involves biology, economics and society, behaviors, and environment. These factors should be integrated into health promotion, environmental management, and income support strategies to effectively reduce the fall rate in the dependent elderly group and improve the quality of life of the elderly in the long term.

Factors Affecting Quality of Life in HIV/AIDS Patients: Clinical Model Analysis in Kendari, Indonesia

2025-06-17T16:52:09+07:00

Quality of life (QoL) of people living with HIV/AIDS (PLWHA) is a multifaceted issue involving physical, psychological, social, and environmental factors. Although antiretroviral therapy (ART) has improved life expectancy and health outcomes, significant challenges remain for PLWHA, including stigma, social support, and economic status. This study aimed to determine a clinical model of variables influencing QoL of PLWHA, with the hope of providing insights for more targeted interventions. The study design was cross-sectional analytic, conducted at a Voluntary Counseling and Testing (VCT) Clinic in Kendari, Indonesia, from April 2024 to January 2025. The sample consisted of 451 HIV/AIDS patients receiving ART therapy. Data were collected through a questionnaire that had been tested for reliability (Cronbach's alpha = 0.972) and analyzed using descriptive analysis, chi-square test, and logistic regression. Results showed that stigma, social support, spirituality, duration of infection, adherence to ART therapy, and access to health services significantly influenced QoL. Stigma and social support emerged as the main predictors of QoL, with adherence to ART therapy also contributing positively. These findings demonstrate the importance of psychosocial factors in determining QoL of PLWHA. Although stigma can be a barrier, social support and adherence to treatment can improve QoL. Longer duration of infection was associated with decreased QoL, suggesting the need for special attention to individuals who have been infected with HIV for longer periods. Interventions that focus on reducing stigma and increasing social support are essential for improving the QoL of PLWHA. Further research is needed to explore the role of personal resilience in this context. It is recommended to implement comprehensive psychosocial intervention programs aimed at reducing stigma and enhancing social support for people living with HIV/AIDS.

Factors affecting public acceptance of large-scale residential development projects in the environmental impact assessment process

2025-06-11T19:22:58+07:00

Large-scale residential development projects (LRDPs) in Thailand require an environmental impact assessment, which includes public participation and hearings to inform stakeholders, gather feedback, and develop appropriate mitigation measures to enhance project acceptance. This study examined the factors affecting public acceptance of large-scale residential development projects in urban communities. A cross-sectional study was conducted from September to December 2024 with 1,161 residents living within a 1-kilometer radius of three proposed development sites in urban communities in Khon Kaen, Chonburi, and Bangkok provinces. Data were collected using a validated questionnaire and analyzed with a generalized linear mixed model to determine adjusted odds ratios (AORs) and 95% confidence intervals (CIs). The overall acceptance rate was 80.45%. Key factors associated with acceptance included being younger than 30 years (AOR = 1.91; 95% CI: 1.24–2.95), working in retail or merchant businesses (AOR = 2.58; 95% CI: 1.11–6.00), living in rental or welfare housing (AOR = 1.88; 95% CI: 1.30–2.71), using property solely for commercial purposes (AOR = 2.08; 95% CI: 1.15–3.76), residing over 500 meters from the site (AOR = 9.68; 95% CI: 3.38–27.78), having high information perception (AOR = 4.71; 95% CI: 1.51–14.67), and holding positive attitudes toward project impacts (AOR = 8.26; 95% CI: 5.47–12.48). The findings emphasize the need for targeted community engagement, transparent communication, participatory planning, and effective environmental mitigation strategies to enhance public acceptance of LRDPs.

Empowering village health volunteers in Ubon Ratchathani Province through experiential learning models: Enhancing understanding of hyperglycemia and kidney health

2025-06-26T18:54:25+07:00

This study investigated the impact of integrating experiential learning activities into a physical learning model on the conceptual understanding of hyperglycemia and its effects on kidney function among Village Health Volunteer (VHV) visitors, local individuals who may initially lack in-depth knowledge of the topic. The aim was to explore participants’ learning experiences and perceptions of the physical learning models. Both quantitative and qualitative methods were employed. Forty participants

attended a one-hour training session that incorporated experiential learning activities into the physical learning model. Pre- and post-test evaluations were conducted to assess changes in their conceptual understanding. Participants’ perceptions were gathered through a 5-point Likert-scale questionnaire, and semi-structured interviews were held to explore their learning experiences after the session. Results from the pre/post-test and questionnaire showed significant improvements in understanding of Signs of Diabetes Mellitus (p = 0.001), Kidney Structure and Function (p < 0.001), Diagnosis and Nature of Diabetes Mellitus (p = 0.046), The Role of Glomeruli (p = 0.046), and Effects of Chronic High Blood Sugar (p = 0.026). However, no significant changes were observed in Glucose Uptake (p = 0.248) and Diabetes Mellitus Risk (p = 0.564). Regarding perceptions of the learning process, participants reported high satisfaction with the learning activities, particularly in understanding its benefits (4.85 ± 0.43), interest (4.83 ± 0.46), and impact on kidney health (4.82 ± 0.44). However, concerns were raised about insufficient time (3.85 ± 1.17) and the practical application of the learning (4.48 ± 0.75). Finally, the interview results revealed that participants gained foundational knowledge about hyperglycemia and kidney health, which may guide future behaviors. Future research should expand this approach to other health topics and adapting it for various populations, including underserved communities, could enhance its reach and inclusivity.

Home pharmacy care program in community pharmacy to improve outcome of hypertension: A quasi-experimental study

2025-07-03T15:05:53+07:00

Home Pharmacy Care (HPC) is a program implemented by the Ministry of Health of the Republic of Indonesia to deliver the highest quality healthcare services to individuals dealing with degenerative conditions, such as hypertension. This study sought to assess the efficacy of HPC interventions in hypertensive patients in Denpasar, Bali, Indonesia. From March to June 2024, this investigation implemented a quasi-experimental pre- and post-design with control in a community pharmacy. A randomized sampling technique was employed to select 100 patients with uncontrolled hypertension, who were distributed into two groups. The intervention group was provided with HPC, which consisted of a medication reminder card, education on hypertension, home blood pressure monitors, and hypertension control. Patients in the control group received standard care. ³It was found that the decrease in SBP in intervention group D±SD 13.06 ± 6.14 was better than control group D±SD 3.32 ± 5.35, while DBP intervention group D±SD 7.64 ± 4.25 was better than control group D±SD 5.06 ± 4.69. The effect of HPC on blood pressure showed a significant difference (P=0.00), and 56% of the patients in the HPC group had controlled BP. Our study demonstrated that the implementation of HPC in community pharmacies for hypertensive patients can significantly aid them in managing their blood pressure, thereby reducing the cardiovascular risks associated with hypertension. Additionally, the potential to improve patient satisfaction with pharmacist-provided care exists through the effective implementation of HPC.

Assessing factors related to student entrepreneurial intentions: a quantitative study in Vietnam

2025-07-10T18:29:08+07:00

Nowadays, entrepreneurship is regarded as one of the primary economic activities in many countries, including Vietnam. The Vietnamese government has progressively implemented regulations to support startup initiatives, particularly those led by students. Despite the support from policies and many students participating, the rate of students intending to engage in entrepreneurship in Vietnam remains relatively low. We aimed to assess the factors related to Can Tho University of Medicine and Pharmacy students' startup intentions. Implementing a cross-sectional descriptive design, a convenience sampled population of 1,202 students was used, and data processing was undertaken during the period from January 1, 2023 to September 30, 2023. This study utilized Cronbach's Alpha testing methods and exploratory factor analysis (EFA). After evaluating the Cronbach's Alpha, 27 items in the independent components and 4 items in the dependent components satisfied the conditions for retention. The discriminant validity test showed that the relationship between subjective norms, perceived behavioral control, attitude and intention were all significant (p < 0.01). In addition, the CFA and SEM results also reached p < 0.01, confirming the appropriate statistical significance level. This study also found that the older the students are, the lower the intention to engage in entrepreneurship. Attitude factors and subjective norms both have a weak effect on entrepreneurial intention.

Effectiveness of strength training on handgrip strength in overweight and obese older women in Indonesia: A quasi-experimental study

2025-05-09T17:43:26+07:00

Obesity remains the predominant comorbid condition, particularly among the elderly population in Indonesia. It is a degenerative condition that leads to physiological and morphological dysfunction. Consequently, there is a decline in muscular strength, flexibility, and functional capacity, which impairs daily activities and increases the risk of cardiovascular disease. Strength training is effective in increasing muscle strength, especially hand grip strength (HGS). The evaluation of overall body strength in aged individuals often involves the use of handgrip strength as a key indicator. Therefore, this study investigated the effect of strength training on dominant and non-dominant handgrip strength (HGS) among overweight and obese female participants aged 60 to 69 years. A pretest-posttest control group design was employed in this quasi-experimental study to compare the control group, which received no treatment with the intervention group, which underwent strength training (60 minutes per session, two sets, twice a week). The statistical test results indicate a tendency for increased average grip strength in both the dominant and non-dominant hands in the treatment group, although it is not significant. In contrast, the control group shows a significant decrease in average grip strength in both hands. When compared between groups, the average grip strength of both the dominant and non-dominant hands in the treatment group increased statistically following the strength training intervention compared to the control group (p < .05). The eight-week strength training program was effective in maintaining and increasing handgrip strength in overweight and obese older adults. Such programs have the potential to improve physical health and can be implemented effectively at home or in healthcare facilities (integrated health care posts) with support from family members and qualified fitness trainers.

Hypertension prevention behavior and its predictors among rural adults in Bangladesh: A community survey using the theory of planned behavior

2025-06-29T17:00:26+07:00

Bangladesh faces a rising burden of non-communicable diseases (NCDs), with rural communities being particularly vulnerable due to limited healthcare access. Despite hypertension (HTN) being preventable, the disease is often overlooked in rural areas. This study aimed to assess health practices related to HTN prevention and its determinants among rural Bangladeshi adults using the theory of planned behaviour (TPB) and the World Health Organization's 4X4 NCD prevention model. A community-based survey was conducted with 355 rural participants selected via multi-stage sampling in the latter half of 2023. Data were collected through face-to-face interviews using a validated, pretested questionnaire. The average age of the respondents was 41.5 years, with 66.8% of them being male participants. The findings revealed inadequate knowledge, negative attitudes, and poor self-control regarding HTN prevention. Socioeconomic factors, including gender, income, education, and region, significantly influenced HTN prevention behaviors (p<0.05), while knowledge, attitude, and self-control were strongly linked to HTN prevention practices (p<0.05). The study’s causal model based on the TPB demonstrated a good fit, showing that attitude (β=0.34, p<0.001), motivation (β=0.16, p<0.05), and self-control significantly influenced intention (β=0.34, p<0.001), which strongly predicted hypertension prevention practices (β=0.54, p<0.001). Rural populations displayed reluctance to adopt healthy practices for HTN prevention. Enhancing community awareness and promoting behavioral change, therefore, should be prioritized in policy development to improve HTN prevention practices in rural Bangladesh.

The effects of experiential learning for cardiopulmonary resuscitation and the use of automated external defibrillator training among community volunteers in Thailand: A quasi-experimental study

2025-08-03T16:39:34+07:00

This study evaluated the effectiveness of experiential learning on knowledge, attitudes, subjective norms, perceived behavioral control, intention, and skills in cardiopulmonary resuscitation (CPR) and the use of automated external defibrillators (AEDs) among community volunteers in Thailand. A quasi-experimental one-group pretest-posttest study was conducted from October to December 2024. Fifty community volunteers from Khlong Sam Wa District, Bangkok, were purposively sampled based on the inclusion criteria. The intervention, the Experiential Learning for Cardiopulmonary Resuscitation and Using Automated External Defibrillator Training Program, was based on Kolb’s (1984) experiential learning model. Data were collected before and after the training program using a demographic form, knowledge and attitude assessments, subjective norm and perceived behavioral control measures, intention scales, and skill checklists. Content was validated by three experts (IOC = 0.67–1.00), and reliability was confirmed (Cronbach’s alpha > 0.80). Descriptive statistics and the Wilcoxon Signed Rank Test were used for analysis. Post-intervention, participants showed significantly higher scores in knowledge (Z = -5.75, p < 0.001), attitudes (Z = -5.14, p < 0.001), subjective norms (Z = -6.18, p < 0.001), perceived behavioral control (t = -6.09, p < 0.001), and intention (t = -5.37, p < 0.001). All participants successfully demonstrated CPR and AED skills. Experiential learning significantly improved knowledge, attitudes, subjective norms, perceived behavioral control, intention, and skills in CPR and AED use among community volunteers. This approach may enhance community preparedness for cardiac emergencies.

Developing a community-based COVID-19 surveillance system for Rural Kalasin, Thailand

2025-09-04T20:00:59+07:00

The transition of COVID-19 from a dangerous communicable disease to a notifiable disease in Thailand highlights the need for robust post-pandemic surveillance systems. Particularly in rural areas, limited resources can affect the performance of disease surveillance. This study aimed to develop a community-based COVID-19 surveillance system. Amixed-methods research approach was employed, consisting of a quantitative phase to evaluate the surveillance system and determine the factors associated with its operation and a qualitative phase to develop and evaluate a surveillance system using Kemmis and McTaggart’s framework. The study was conducted from January 2022 to May 2024 and involved 568 public health officials, 414 case reports, and 52 stakeholders who collaboratively designed a surveillance system with brainstorming and used it to support quantitative findings. To analyze the data, multiple linear regression analyses, independent samples t-tests, chi-square tests, and content analyses were employed. Most of the respondents were female (76.06%), with a mean age and surveillance experience of 35.7 and 8.51 years, respectively. The COVID-19 surveillance system, comprising five proactive activities—surveillance strengthening, guideline development, agility, strategic planning, and after-action reviews—showed improvements in data quality, timeliness, and staff operational performance (P < 0.05) within the experimental area. The COVID-19 surveillance operational performance of the staff was strongly associated with case notification and verification (β = 0.428, 95%CI: 0.879, 1.108, P< 0.001), application of surveillance data for action (β = 0.328, 95%CI: 0.589, 0.762, P< 0.001) and epidemiological data collection and analysis (β = 0.297, 95%CI: 0.439, 0.552 P< 0.001), with an adjusted R² value of 0.854. These findings highlight the need for standardized guidelines, context-specific strategies, interagency collaboration, targeted training, and advanced digital tools —such as real-time mobile reporting and outbreak prediction tools— to enhance system performance, strengthen workforce capacity, and improve preparedness for future epidemics.

A causal model of factors influencing the quality of nursing care in psychiatric and substance abuse wards in hospitals under the Office of the Permanent Secretary, Ministry of Public Health, Thailand

2025-09-06T17:12:00+07:00

The quality of nursing care in psychiatric and substance abuse wards directly affects patient outcomes. The objective of this study was to examine the causal factors affecting the quality of nursing care in psychiatric and substance abuse wards in Thailand. A multi-site cross-sectional study was employed among 480 registered nurses with at least a Bachelor’s degree and experience in psychiatric and substance abuse care. Participants were purposively and conveniently sampled from 130 Ministry of Public Health hospitals across Thailand. Data were collected by an online survey using validated instruments, including the Practice Environment Scale of the Nursing Work Index (PES-NWI), a Nurses’ Clinical Competency Scale, a Work Engagement Scale, a Burnout Assessment Tool, and a Quality Nursing Care Scale. Structural Equation Modeling (SEM) was applied to test the hypothesized model, assessing both direct and indirect effects of study variables. The final model demonstrated a good fit (χ²/df = 2.67, RMSEA = 0.06, GFI = 0.96, TLI = 0.95, SRMR = 0.05). Nurses’ clinical competency had the strongest direct effect on the quality of nursing care (β = 0.63, p < 0.001), followed by work engagement (β = 0.16, p < 0.05). Burnout negatively influenced the quality of nursing care both directly (β = -0.09, p < 0.05) and indirectly through work engagement. Job satisfaction had an indirect effect on the quality of nursing care, whereas the nursing practice environment had no significant direct effect. Overall, the model explained 61% of the variance in the quality of nursing care. The findings suggested that improving nursing care quality in psychiatric and substance abuse settings requires enhancing clinical competency, work engagement, and reducing burnout. Implementation efforts should focus on training and burnout prevention, while future studies should examine the long-term effects and include diverse hospital settings.

Factors influencing health literacy among undergraduates in northeast Thailand: A cross-sectional study

2025-09-11T18:42:51+07:00

To enable enlightened health decisions and sustain overall well-being, health literacy (HL) is fundamental. For university students in Thailand, HL influences lifestyle choices, healthcare access, and academic performance. The purpose of this research was to evaluate the variables linked to HL among university students. To guarantee sufficient statistical power, a descriptive cross-sectional study including 559 students was performed, and the sample size was established using power analysis. Data collection included a personal information form and a health literacy questionnaire based on the "3A2S" framework, covering six dimensions including health knowledge, information access, communication, decision-making, behavior modification, and information sharing. High reliability (Cronbach's alpha = 0.97) was exhibited by the questionnaire. The findings revealed significant associations between HL levels and gender, academic department, underlying disease status, and GPA (p < 0.05). Those in the nursing department (p = 0.035) and students with a GPA ≥3.0 (p < 0.001) were more prone to exhibit higher levels of HL, as revealed by multiple logistic regression analysis. These findings highlight the necessity for targeted measures, such as customized educational programs and seminars, to improve health literacy among students, especially those pursuing non-health-related disciplines. Future studies should develop and evaluate such programs to support informed health practices within academic communities.

Factors related to the management of infectious waste from caring for dependent elderly in the community, Maha Sarakham Province, Thailand

2025-09-19T18:16:01+07:00

This cross-sectional study investigated factors related to the management of infectious waste generated from caring for dependent elderly in community settings. The sample consisted of 429 caregivers of dependent elderly, selected through multi-stage stratified random sampling. Data collection was conducted between October 2023 and February 2024 in 12 sub-district health-promoting hospitals in Maha Sarakham Province. The research instrument was a structured questionnaire comprising five sections including 1) general information about caregivers for dependent elderly, 2) types and quantities of infectious and other waste, 3) knowledge regarding infectious waste management, 4) attitudes toward infectious waste management, and 5) practices in managing infectious waste from caring for dependent elderly. Data were analyzed using descriptive statistics and bivariate analysis, odds ratios and 95% confidence intervals, with statistical significance set at p < 0.05.

The response rate was 96.40%. The majority of caregivers were female (86.7%) with an average age of 53.93 years (S.D. = 9.11). Most were married (77.8%) with primary education (50.8%) and an average family income below 18,000 baht (93.0%) (S.D. = 9293.4). Factors significantly associated with infectious waste management from caring for dependent elderly in the community included: caregivers aged 50 years and above (OR 2.162, 95%CI 1.146-4.078), caregivers who received training about elderly care (OR 4.285, 95%CI 1.938-9.476), training about infectious waste management in elderly care (OR 3.211, 95%CI 1.573-6.555), caregivers with good knowledge (OR 2.418, 95% CI 1.227-4.766), and caregivers with positive attitudes toward waste management (OR 2.002, 95%CI 1.008-3.975). Caregivers aged ≥50 years, with training experience, good knowledge, and positive attitudes showed significantly better performance for infectious waste management practices. The findings underscore the urgent need for specialized training programs and evidence-based policy interventions to enhance safety protocols and environmental sustainability in community-based elderly care.

Trends of hot extremes in Thailand during 1970-2024 and increased population exposure

2025-09-18T09:13:13+07:00

Trends in three nonoverlapping types of hot extremes (independent hot day [IHD], independent hot night [IHN], and compound hot event [CHE]) during the hottest month in Thailand were analyzed for the period 1970-2024. Analysis shows that Thailand experienced more frequent, longer duration, and stronger intensity of IHN and CHE. Their frequency, intensity and duration tended to accelerate in recent years, consistent with a step-up in the warming rate of global surface temperature. Another feature associated with the nighttime-accentuated events is that hot-extreme types in Thailand as a whole shifted from a gradual decline in IHD to the dominance of increasing IHN and CHE. Estimation of population exposure to hot extremes demonstrates that from 2002 to 2024, total population exposure to IHN and CHE at the selected 62 districts where the weather stations are located increased by more than 145% relative to the 2002-2006 period. The change in exposure to hot extremes was mainly caused by climatic effects (99.8%-182%), highlighting that increased hot extremes by themselves substantially escalate population exposure in the selected districts. Continuous exposure to sustained period of hot extremes may bear larger health risk in the coming years, as Thailand's transition to an ageing society is accelerating. However, additional studies based on available high‐resolution gridded population and climate projections in combination with epidemiological, demographic and socioeconomic data are needed. Their results will provide a full picture of changes in different types of hot extremes and how the whole Thai population will be exposed to them in the future

Determinants of healthcare access among older adults in Mandalay Region, Myanmar: A cross-sectional analysis

2025-10-04T15:35:52+07:00

Population ageing is accelerating globally and poses significant challenges to health systems, especially in low- and middle-income countries. In Myanmar, access to healthcare services among older persons is under-researched, particularly in the Mandalay Region. This study investigates healthcare utilization patterns and associated socio-demographic factors among older adults in three high ageing-index districts: Meikhtila, Nyaung U, and Myingyan. A cross-sectional analytical design was employed, with data collected from June to August 2021. Results from a multivariate logistic regression revealed that older adults living in rural areas, those with moderate ability to perform daily activities, and those experiencing hearing difficulties were more likely to use public hospitals. In contrast, residents of Myingyan District were less likely to access public health facilities. Use of private hospitals was more common among older adults with moderate self-rated health and those residing in Myingyan. However, individuals with moderate functional ability and those with vision difficulties were significantly less likely to use private hospitals. Utilization of charity clinics was higher among older adults who were employed, including unpaid family workers, and among those who required regular follow-up care or had vision impairments. Conversely, those living in rural areas and individuals from wealthier households were less likely to use charity clinics. These findings highlight the complex and uneven patterns of healthcare access among older persons in Myanmar. They underscore the importance of addressing socio-demographic disparities—particularly in rural areas and among those with physical or sensory limitations—to promote equitable and effective healthcare delivery for an ageing population.

Data-driven diagnosis of cardiovascular disease in patients with comorbid hypertension, dyslipidemia or diabetes using classification techniques

2025-10-06T15:42:22+07:00

Cardiovascular disease (CVD) is a leading cause of death globally, especially among individuals with chronic comorbidities such as hypertension, diabetes, and dyslipidemia. Early identification of high-risk individuals is essential for timely intervention, yet conventional risk models often underperform in complex clinical populations. Using real-world clinical data, this study aimed to develop and evaluate machine learning (ML) models for predicting CVD with a focus on optimizing sensitivity and interpretability. We used hospital-based clinical data from patients with at least one of the following comorbidities: hypertension, diabetes or dyslipidemia. The applied ML algorithms included logistic regression, naive Bayes, k-nearest neighbors, decision tree (DT), random forest, support vector machine (SVM), and artificial neural networks. Repeated 10x10-fold cross-validation and downsampling were used to address class imbalance, and systematic hyperparameter tuning was performed. Model performance was evaluated using accuracy, precision, sensitivity, F1 score, and area under the curve (AUC). Shapley Additive Explanations (SHAP) was applied to interpret the final model and identify key features. The SVM model achieved the highest sensitivity, indicating suitability for use in CVD screening, while the DT also showed relatively strong sensitivity. Final SVM performances included a sensitivity of 89.29%, a precision of 57.94%, an F1-score of 69.97%, and an AUC of 75.65%. SHAP analysis revealed creatinine, systolic blood pressure, low-density lipoprotein, fasting blood sugar, and triglycerides as the top predictors of CVD, aligning with established cardiovascular risk factors. We present an interpretable ML model with high sensitivity for CVD prediction in patients with metabolic comorbidities. By integrating SHAP with robust validation techniques, the model supports personalized risk assessment and is suitable for screening applications aimed at early detection and preventive care in clinical settings.

Effects of a fall prevention program with Ruesie Dutton exercises applied to a revised self-and family management framework on fall prevention behaviors among community-dwelling older adults with diabetes in Bangkok, Thailand: Randomized Controlled Trial

2025-10-15T10:32:28+07:00

This randomized controlled trial aimed to evaluate the effectiveness of a fall prevention program with Ruesie Dutton exercises by applying a revised self- and family- management framework to improve the fall prevention behaviors among community-dwelling older adults with diabetes in Bangkok, Thailand. Eighty six community-dwelling older adults with diabetes aged 60-75 years were selected with multi-stage computer-generated random sampling. Then they were divided into experimental and control groups of 43 each. The control group continued living normal daily lives, while the experimental group participated in 8-weeks fall prevention program with Ruesie Dutton exercises. The program consisted of activities involving the fall prevention education, Ruesie Dutton exercises, fall prevent dressing, and handbooks. Additionally, the older adults received home visits and infographics about preventing falls were sent through a LINE group. Afterwards, the participants in the experimental group were instructed to perform Ruesie Dutton exercises with 7 postures over a period of 8 weeks. The instruments used in data collection were a demographic data questionnaire and a fall prevention behavior questionnaire. Pre- and posttest data were analyzed using descriptive analysis, independent t-test and paired t-test statistics.

The findings revealed that the experimental group had a higher mean posttest score for fall prevention behavior than the mean pretest score and a higher mean score than the control group with statistical significance (p <.001). The findings will guide healthcare providers in developing better ways to prevent falls among older adults in communities. Additionally, it will enhance family efforts to keep older adults with diabetes safe from falls in the future.

Exploring community-based long-term care needs and predicting factors among older adults in China: A cross-sectional study

2025-10-29T18:50:24+07:00

The rapid growth of the aging population makes providing adequate long-term care (LTC) services for the elderly a critical social issue in China. However, older adults’ LTC needs may differ as LTC services develop and traditional cultural norms change. Therefore, this study examines LTC service needs and predicting factors among community-dwelling older adults in Huanggang, China. A cross-sectional design was performed on 518 older people in Huanggang, China, selected by the cluster sampling method. Data collection employed a self-administered questionnaire consisting of six components: predisposing factors, enabling factors, activities of daily living, Self-Rating Anxiety Scales, the Geriatric Depression Scales, and the Long-Term Care Needs Scale. Multiple linear regression was performed to identify factors associated with LTC needs. Of the participants, 52.12% were female and 47.88% were male; the mean age was 70 years. The highest mean LTC need was in the dependency domain (mean = 3.50, SD = 0.80), and the lowest was in the living needs domain (mean = 2.16, SD = 1.12). Multiple linear regression showed that anxiety (β = 0.676, p < 0.001) and depressive symptoms (β = 0.309, p < 0.001) were positively associated with greater LTC needs, whereas lower activities of daily living (ADL) scores (β = −0.087, p = 0.001) predicted higher LTC needs. These findings indicate that LTC needs among older adults are strongly influenced by functional status and psychological distress, underscoring the importance of addressing these factors to enhance the quality and availability of LTC services.

Depressive symptoms as key predictor of health-related quality of life in post-COVID-19 Undergraduate Students: A multivariate analysis with EQ-5D-5L and EQ VAS

2025-10-29T18:57:54+07:00

In the post COVID-19 era, Health-Related Quality of Life (HRQoL), a multidimensional construct reflecting individuals’ physical, psychological, and social well-being, has become an important public health issue. The EuroQol 5 Dimensions 5 Levels (EQ-5D-5L) and the EuroQol Visual Analogue Scale (EQ-VAS) are widely recognised tools for assessing HRQoL. This study aimed to evaluate HRQoL using the EQ-5D-5L and EQ-VAS and to identify predictive factors associated with HRQoL among post-COVID-19 undergraduate students. A cross-sectional survey was conducted between May and July 2023 among 451 undergraduate students. Data were analysed using descriptive statistics, the Mann-Whitney U test, the Kruskal-Wallis test, Spearman’s correlation and stepwise multiple linear regression, with the significance level set at 0.05. The mean utility score derived from the EQ-5D-5L was 0.96 (SD = 0.07), and the mean EQ-VAS score was 82.9 (SD = 14.5). Most participants reported no problems across the EQ-5D-5L domains, except for pain/discomfort (23.3%) and anxiety/depression (28.8%). Significant differences in HRQoL scores were observed based on gender, age, GPA, medical history, depressive symptoms, monthly expenses and health-related behaviours (p < 0.05). Regression analysis revealed that depressive symptoms (PHQ-9) and medical history were negatively associated with both EQ-5D-5L and EQ-VAS scores, while GPA was a positive predictor of the utility score. Age and year of study were also associated with variations in EQ-VAS scores. These findings underscore the need for mental health and academic support interventions aimed at improving HRQoL among post-COVID-19 student populations. Universities should consider providing targeted support, particularly for students in higher-risk academic years.

Barriers to health care utilisation and coping strategies during the COVID-19 pandemic: A cross-sectional survey among the public in Malaysia

2025-11-01T18:36:02+07:00

The COVID-19 pandemic disrupted global healthcare systems, which created significant barriers to accessing services. This cross-sectional study explored the barriers to healthcare access, coping mechanisms, and their consequences among Malaysians during the pandemic. Conducted online from October to November 2020, the survey targeted adults aged 18 and above who used healthcare services from January to October 2020, excluding those unable to understand Malay or English. The validated questionnaire was adapted from NHMS 2019 and existing literature, underwent expert review, translation, and pre-testing. Data were collected via snowball sampling and analysed using SPSS 26.0, guided by the modified Penchansky and Thomas’s theory of access. Significance was set at p < 0.05. Of the 4,062 respondents, most were female (71.4%), adults (73.3%), of Malay ethnicity (69.7%), married (62.8%), and had a tertiary education (81.3%). Approximately one in three respondents reported barriers, mainly in the awareness (70%) and accommodation (18.1%) domains. Significant factors included ethnicity (Chinese), acute conditions, and vehicle ownership. Nearly 70% adopted positive coping strategies, with 70.5% purchasing medication at pharmacies. Improved outcomes (81.9%) were linked to acute conditions, vehicle ownership, and positive coping mechanisms. The findings underscore the need for targeted policies to address healthcare disparities and strengthen healthcare resilience, especially during public health crises.

An overview of school welfare among elementary school students in East Java, Indonesia

2025-11-02T19:00:45+07:00

School welfare is an important predictor of students' life quality. This research identified the factors that influence the school welfare of elementary school students in East Java, Indonesia. Cluster sampling was employed to select 1,008 elementary school students as samples, from whom data were collected using the school welfare instrument. The data of this research were analyzed using the logistic regression analysis and multiple linear regression analysis. The independent variables include academic problems (X1), victimization (X2), loneliness (X3), work enjoyment (X4), classroom distraction (X5), academic assistance (X6), schoolwork disruption (X7), friendship (X8), schoolwork satisfaction (X9), supportive peers (X10), and supportive teachers (X11), with school welfare as the dependent variable (Y). The partial analysis showed that of the 11 dependent variables, 8 were significantly correlated, with a significance figure (P<0.05). Meanwhile, the other three variables; namely academic problems, victimization, and supportive peers, were not significantly correlated with a significance figure (P>0.05). This research concludes that there is a simultaneous influence between academic problems, victimization, loneliness, schoolwork enjoyment, classroom distraction, required academic assistance, schoolwork disruption, friendship job satisfaction, supportive peers, and supportive teachers on school welfare among elementary school students in East Java, Indonesia

Predictors of gangrenous complications in diabetic foot ulcers: A cross-sectional study from Indonesia

2025-11-15T18:27:56+07:00

Type 2 diabetes mellitus (T2DM) is highly prevalent in Indonesia, where diabetic foot ulcer (DFU) affects 26% of patients, far above the global average. DFU, especially when complicated by gangrene, leads to severe morbidity and mortality, yet evidence related to its predictors remains limited. This study therefore aims to assess the prevalence of gangrene and the factors associated with a history of previous diabetic foot ulcers, insulin treatment and the development of gangrene. The analytical cross-sectional study involved T2DM patients with DFU admitted to the Margono Hospital in Central Java, Indonesia, from 2018 to 2024. Generalized linear mixed models (GLMM) employing a logistic regression model and adjusted odds ratio (AOR) with 95% CI were provided. Out of 859 patients with DFU, 30.97% (95%CI:27.96-34.15) were diagnosed with gangrene during the study period, which was higher in those with a history of DFU (AOR:3.59; 95%CI:1.28-10.08); those using insulin therapy (AOR:3.35; 95%CI:2.25-4.98); those diagnosed with renal disease (AOR:2.22; 95%CI:1.34-3.67); and those with normal weight or underweight of body mass index (BMI) (AOR:1.87; 95%CI:1.24-3.67). However, hypertensive patients with DFU (AOR:1.68; 95%CI:1.12-2.53) were more likely to develop gangrene. Nearly one-third of the DFU patients are diagnosed with gangrene in Indonesia. A previous history of DFU, insulin therapy, renal disease, and lower body mass index (normal or underweight) were significant predictors of gangrene, while hypertension appeared to have a protective association. The findings underscore the importance of early screening and management of comorbidities, particularly renal disease, nutritional status, and blood pressure control to reduce the risk of gangrenous complications among DFU patients.