Journal of Preventive Medicine Association of Thailand

Proposal for the Development of Lifestyle Medicine for Sustainable Prevention and Control of Non-communicable Diseases (NCDs) in Thailand

Srisiri Siriwanarangsun, Phudit Tejativaddhana — Mon, 29 Apr 2024 00:00:00 +0700

All countries around the world, including Thailand, are struggling to control and prevent chronic non-communicable diseases (NCDs), which cause a global death rate of up to 41 million people per year. Lifestyle Medicine (LM) is an evidence-based medical practice that helps individuals and communities with comprehensive lifestyle changes (including nutrition, physical activity, stress management, sleep hygiene, risky substance avoidance, and social connectedness) to help prevent, treat, and even reverse disease progression by addressing the underlying root causes of health problems, which is recognized as an important approach for effective prevention and control of NCDs. Thailand has developed Lifestyle Medicine starting with the production of preventive medicine doctors specialized in Lifestyle Medicine in 2022 and is developing the production of LM non-physician health personnel to work as a team with lifestyle medicine doctors in developing quality lifestyle medicine services equitably accessible to all Thai effectively. In the initial stages of development, there are gaps and challenges, which this article reveals using McKinsey's 7S concept as a framework for analysis. The authors propose for academic development and knowledge management in Lifestyle Medicine to close gaps that have not yet been implemented or are in the process of being implemented but have not yet reached the goals as recommended by the 5-year National Strategic Plan for NCDs Prevention and Control (2017 - 2021).

แคดเมียม (Cadmium) สารก่อมะเร็ง พิษต่อกระดูกสาเหตุโรคอิไต อิไต

Surachai Chokkhanchidchai — Tue, 30 Apr 2024 00:00:00 +0700

จากข่าวพบกากแร่เเคดเมียม กว่า 15,000 ตัน ในโรงงานจังหวัดสมุทรสาครโดยกากเเคดเมียมนี้ ได้มีการขนย้ายมาจากจังหวัดตาก ซึ่งกระทรวงสาธารณสุขได้เฝ้าระวังผลกระทบต่อสุขภาพ ประชาชนและสิ่งแวดล้อมซึ่งอาจจะมีผลกระทบเนื่องจากสารเเคดเมียมเป็นสารอันตรายต่อสุขภาพ สารแคดเมียมเป็นแร่โลหะหนัก เป็นโลหะสีเงินขาวแวววาว ไม่มีกลิ่น มีลักษณะเนื้ออ่อน นำมาใช้ประโยชน์ในอุตสาหกรรมหลายชนิดเช่น เคลือบเงาผิวโลหะต่าง ๆ เช่น เหล็ก ทองแดงและยังนำไปในการผลิตแบตเตอรี่ได้ด้วย สารแคดเมียม เข้าสู่ร่างกายได้หลายวิธี ได้แก่ การสัมผัสทางผิวหนัง การสูดดมละอองฝอย และอาจจะปนเปื้อนอาหารเข้า สู่ระบบทางเดินอาหารและจะเข้าสู่ระบบหมุนเวียนโลหิตจับกับโปรตีน albumin ถูกส่งไปที่ตับ

The Development of Head Injury Patient Care Model and Undergoing Cranial Surgery in Uthai Thani Hospital

Jariya Boonyalit, Jinda Pudpong, Maneerat Lueangwilai, Nissama Poochakhanit — Fri, 22 Mar 2024 00:00:00 +0700

Objectives: Developing of head injury patient care model and undergoing cranial surgery by applying a model to Enhanced Recovery After Surgery (ERAS) and study the results of head injury patient care model and undergoing cranial surgery. Methods: This research was research and development. The samples group in this study were 30 professional nurses with experience working and caring for head injury patients who had undergone cranial surgery and medical record of 30 patients who had undergone cranial surgery by selecting purposive sampling. This was consists of 3 phases as following: Phase 1: study the nursing situation for patients undergoing cranial surgery by tools include data recording form and semi-structured interview group discussion guide. Phase 2: develop of head injury patient care model and undergoing cranial surgery in Uthai Thani Hospital. The research tools consisted of (1) nursing model for head injury patient care and undergoing cranial surgery by applying a model to Enhanced Recovery After Surgery (ERAS). Phase 3: study the results before and after using the model. The research tools consisted of (1) a questionnaire regarding general information of professional nurses (2) a recording form for evaluation nursing practice for head injury patients who received cranial surgery, consisting of preoperative, intra-operative and postoperative nursing care and (3) patient outcome records collect information from medical records. The research instrument was checked for content validity with an item consistency index equal to 1.00 and Cronbach's alpha coefficient was used to find confidence equal to the appropriateness at 0.95 - 0.98. Qualitative data were analyzed in Phases 1 and 2 by content analysis and drawing conclusions. Quantitative data was analyzed in Phases 1 and 3. Quantitative data was analyzed using descriptive statistics. Comparative statistics: Paired t-test and Independent t-test were performed for data collection in June to December 2023. Results: Developing of head injury patient care model and undergoing cranial surgery consisting of preoperative, intra-operative and postoperative nursing care. The results was a higher adherence to the guidelines than before used, with a statistically significant difference (p < .05, p < .01, p< .001). The nursing outcomes for head injured patients that undergoing cranial surgery on the patient after using the model had better results than before using the model. Including postoperative death, Length of Stay (LOS) and re-operation are decreased. As for surgical wound infection, there was no significant difference. Conclusion: The development of head injury patient care model and undergoing cranial surgery by applying a model to Enhanced Recovery After Surgery (ERAS) could increase nursing care outcomes for head injury patients who undergoing cranial surgery and could be better result nursing care for head injury patient care model and undergoing cranial surgery.

Situation and Correlation Between Outcomes and Severity of Diabetic Ketoacidosis at Phra Nakhon Si Ayutthaya Hospital in 2022

Watcharanan Muenanan — Thu, 28 Mar 2024 00:00:00 +0700

Objective: Diabetic ketoacidosis is acute life-threatening complication of diabetes mellitus and also important health burden in Thailand, affected mortality and resource expenditure. The objective was to study situation, mortality rate and correlation between outcomes and severity of diabetic ketoacidosis at Phra Nakhon Si Ayutthaya hospital in 2022. Methods: A single center, retrospective cohort study was collected data from 5,193 hospitalized diabetes patients aged more than 15 years old, included by criteria according to American Diabetes Association at Phra Nakhon Si Ayutthaya hospital in 2022. Results: The rate of hospitalization for DKA was 2.5 per 100 persons with diabetes mellitus. 130 patients were enrolled with mean age 52.9 years (SD=19), mean height 159.6 centimeters (SD=11), mean body mass index 23.5 kilograms per square meter (SD=5). The female accounted more than male in all the groups. Patient with type 2 diabetes mellitus accounted mostly for 73.9% of all the patients. First diagnosed diabetes mellitus accounted for 10.8% presented with diabetic ketoacidosis. Hypertension is the most common underlying disease, second one is dyslipidemia. The mean duration of stay was 10.8 days (SD=12.3). The occurrence of acute kidney injury was 45.4%. The requirement of intensive care unit was 12.3% and needed invasive ventilation 36.2%. The mortality rate was higher in this study 24.6% compared with the previous study. Conclusion: The mortality rate, intensive care unit stay and requiring invasive ventilation was found correlated significantly with severity of diabetic ketoacidosis (p-value 0.021, 0.049, <0.001 respectively). From this study, the author concern about health burden of the patients and we should encourage and develop the care of patients with diabetic ketoacidosis in Phra Nakhon Si Ayutthaya hospital to decrease the life-threatening complication, mortality and promote the good quality of life.

Prevalence and Predictive Factors of Postpartum Depression in Chumphae Hospital, Khon Kaen

Pongsak Junngam — Wed, 03 Apr 2024 00:00:00 +0700

Objective: To study the prevalence of postpartum depression, and factors that can predict postpartum depression among postpartum mothers in Chumphae Hospital, Khon Kaen. Methods: This is cross-sectional analytical research. The samples were purposively selected to recruit 306 postpartum mothers within 48-72 hours after giving birth, who gave birth at Chumphae Hospital, Khon Kaen Province, between July and October 2023. The tools used were a general information questionnaire, Stress Test Questionnaire (ST5), and Edinburgh Postnatal Depression Scale (EPDS≥11), which are standard assessments of the Ministry of Public Health, used in maternal and infant health records. The Cronbach's alpha coefficient of ST5 in this study was .81, and EPDS was .75. The data were analyzed using descriptive statistics, and statistical analysis chi-square and binary logistic regression. Results: The prevalence of postpartum depression was found to be 8.5%. Factors that predict postpartum maternal depression, there are mental health problems (OR_adj=44.18, p<0.001), had postpartum complications (OR_adj=7.34, p=0.014), planned to breastfeed for less than 6 months (OR_adj=8.34, p<0.001), and had a birth weight less than 2,500 grams (OR_adj=10.08, p<0.001), and explained 33.9% of the variation in postpartum maternal depression (R²=0.339, p<0.001). Conclusions: This study found that the prevalence of depression in the 48-72 hours after birth was quite high. There are the factors of mental health problems, postpartum complications, plan for breastfeeding, and newborn baby weight, which can explain variations in postpartum depression. Therefore, every mother should be assessed for postpartum depression before discharge, to provide mothers with prompt care and assistance, and to prevent, and monitor the occurrence of postpartum depression.

Studying the Relationship Between Health Literacy and Health Behaviors 3E.2S. of the Elderly at Risk for Hypertension Ban Hua Den Subdistrict Health Promoting Hospital, Bang Khut Subdistrict, Sankhaburi District Chainat Province

Chonticha Aungkab, Ajcharapan Kayadee, Sasima Watthana, Saowalak Siengnan — Thu, 04 Apr 2024 00:00:00 +0700

Objectives: This research was to study the relationship between health literacy and the 3E.2S. healthcare behavior of the elderly at risk of Hypertension in Ban Hua Den Subdistrict Health Promoting Hospital. Methods: This study used Nutbeam's framework of health literacy as a guideline for the study. The sample group selected by simple random sampling of 176 elderly people at risk of hypertension aged 60 years and over. using a questionnaire regarding general characteristics, health literacy, knowledge about hypertension, and self-care behavior related to hypertension. Data were analyzed using descriptive statistics and Pearson correlation statistics. Results: Showed that the health literacy of sample had a low level and health behavior had a moderate level. The research results found that there is a relationship between health literacy and health behavior, according to the principles of 3E.2S. This study yielded statistically significant outcomes (p < .01) expect for decision making. Conclusion: Health literacy is important for self-care behavior. Health teams should find methods to develop health literacy among the elderly at risk Hypertension. To be able to use knowledge judiciously in selecting self-care behaviors so that high blood pressure can be properly controlled.

Studying the Situation of Abortion Following the Enforcement of the Amendment to the Criminal Code (No. 28) B.E. 2564 (2021)

Patchareewan Jensarikorn — Wed, 10 Apr 2024 00:00:00 +0700

Objective: To investigate the knowledge and attitudes towards Amendment (Act) No. 28 of the Criminal Code, as well as to explore the situation of policy execution and the operational aspects of abortion services following the enactment of this Amendment, B.E. 2564 (2021). Methods: This research was a descriptive study. The sample group included 29 executives and practitioners at the policy and local levels for qualitative data, and 521 individuals responsible for providing counseling and safe abortion services in public hospitals for quantitative data. Data were collected through interviews, questionnaires, and group discussions, and analyzed using content analysis for qualitative data and descriptive statistics for quantitative data. Results: The results revealed a deficiency in knowledge and understanding among practitioners regarding the substantive changes in the amended Act. A positive attitude towards the amendment facilitated a sense of comfort among practitioners in executing their duties lawfully and had a beneficial impact on service recipients, enabling access to legal abortion services for women with unplanned pregnancies. However, there were concerns about negative attitudes, fearing that the amendment might lead to decreased contraception use and promote premarital sexual activities. A qualitative analysis within an ecological framework highlighted several operational challenges in abortion services: 1) At the microsystems level, there was a lack of cooperation and personnel shortage among practitioners, as well as conflicts within families regarding the decision to abort; 2) At the mesosystems level, complexities in service procedures and inadequate service coverage across all locations were observed; 3) At the exosystems level, societal and community stigma towards abortion led to the concealment of such practices. These problems stemmed from personal beliefs viewing abortion as sinful; 4) At the macrosystems level, practitioners were found to be unaware of the guidelines for operating under the amended Act. Conclusion: There is a need to enhance knowledge and understanding of the Criminal Code Amendment (Act No. 28), B.E. 2564 among practitioners. Additionally, a change in societal mindset towards abortion, considering its socio-economic impacts, is crucial.

Biological Risk Factors of each Type of Developmental Delay among Children in Lampang Hospital

Pakawadi Vuttipittayamongkol, Kawinratt Srisutheenon, Prakasit Wannapaschaiyong — Thu, 11 Apr 2024 00:00:00 +0700

Objective: To identify risk factors affecting developmental delays in early childhood in Lampang Province to develop monitoring processes and promote age-appropriate development for children at risk of developmental delays. Methods: This retrospective case-control study collected data from the medical patient files of children with developmental delays whom developmental and behavioral pediatricians diagnosed and typically developing children born at the same time as children with developmental delays in Lampang Hospital, from 2 months to 5 years of age, from 1 January 2020 to 31 December 2021. Biological risk factors affecting developmental delay were identified by using multivariate risk difference regression analysis. Results: A total of 447 children were recruited for this study, divided into 149 children with developmental delays and 298 with typical development. Among children with delayed development, 57% have delayed language development. After risk difference regression analysis, the biological risk factors that were significantly associated with delayed development included males, history of birth asphyxia, microcephaly, more than five hospitalization days in the neonatal intensive care unit, hearing loss, malnutrition, twin pregnancy, maternal anemia, and maternal chorioamnionitis. Conclusion: Biological risk factors that affect developmental delays in children include maternal illness and malnutrition during pregnancy, perinatal complications, and children’s illness and nutritional status. Certain risk factors can be monitored and prevented to reduce developmental delays in early childhood. In addition, recognizing the risk factors for developmental delays can lead healthcare providers and parents to closely monitor developmental problems and promote the development of children with these risk factors from birth.

Development of a Nursing Service Model for Stroke Patients in Bueng Kan Hospital

Saowanee Deewala, Wallapha Changjeraja — Wed, 17 Apr 2024 00:00:00 +0700

Objectives: 1) To develop a nursing service model for stroke patients in Bueng Kan Hospital. 2) To evaluate the outcomes of the nursing service model for stroke patients in terms of: 1) service providers, 2) quality, and 3) service users. Methods: This was a research and development (R&D) study. Data were collected between July 20, 2023 and January 31, 2024. The samples were: 1) stroke patients admitted to Bueng Kan Hospital between November 1, 2023 and January 31, 2024, and 2) 74 professional nurses working in the care of stroke patients in the male medical ward (12 nurses), female medical ward (12 nurses), male surgical ward (12 nurses), female surgical ward (12 nurses), special ward (9 nurses), and intensive care unit (17 nurses). The research instruments were: 1) a questionnaire on the nursing service situation for stroke patients, 2) an evaluation form for the nursing service model for stroke patients in Bueng Kan Hospital, 3) the nursing model for stroke patients in Bueng Kan Hospital, 4) a knowledge assessment form for professional nurses on stroke nursing, 5) a satisfaction assessment form for professional nurses on the nursing model for stroke patients in Bueng Kan Hospital, 6) a record form for compliance with the nursing service model for stroke patients in Bueng Kan Hospital, 7) a data record form for stroke patients with ischemic stroke, 8) the Barthel Index (BI-ADL) for assessing the ability to perform daily activities, and 9) a satisfaction assessment form for patients/caregivers on the nursing practice guidelines for stroke patients in Bueng Kan Hospital. Descriptive statistics and Paired Samples t-test were used for data analysis. Results: The nursing service model for stroke patients in Bueng Kan Hospital consisted of 2 components: 1) Guidelines for the administration of nursing workforce for stroke patient care. 2) Nursing practice guidelines for stroke patients. The evaluation of the nursing service model for stroke patients showed that: 1) The knowledge of professional nurses about stroke nursing after using the nursing service model for stroke patients had a mean score increase and was statistically significant (p<.005). 2) The level of satisfaction with the nursing model for stroke patients in Bueng Kan Hospital was at a very satisfied level (60.8%), followed by the most satisfied level (35.1%). The overall mean score was 3.98. 3) Compliance with the nursing practice guidelines for stroke patients showed that all 7 activities of the nursing practice guidelines for stroke patients were highly practiced. The overall mean score was 13.5. 4) Compliance with the guidelines for the administration of nursing workforce for stroke patient care showed that all 7 activities of the guidelines for the administration of nursing workforce for stroke patient care were highly practiced. The overall mean score was 13.8. 5) No complications of increased intracranial pressure, pressure sores, and pneumonia were found after using the nursing model for stroke patients. The incidence of urinary tract infection was 1.70%. The average length of stay was 4.8 days. 6) The level of ability to perform daily activities (BI-ADL) before discharge was higher than that at admission. 7) The satisfaction of patients/caregivers with the nursing practice guidelines for stroke patients had an overall mean score of 3.93, which was at a very satisfied level (62.3%), followed by the most satisfied level (20.8%). Conclusion: The nursing service model for stroke patients in Bueng Kan Hospital, which was developed, resulted in high satisfaction of service users and a reduction in complications. Service providers had increased knowledge and high satisfaction.

A Study on the Concept of Field Hospitals for Pandemic Disaster Management in Thailand: A Case Study of the COVID-19 Outbreak

Isra Aksharanugraha, Pachanat Nunthaitaweekul, Thanapoom Rattananupong — Fri, 19 Apr 2024 00:00:00 +0700

Objective: To study the concept of the establishment of field hospital for disaster management in Thailand with the epidemic of COVID-19 as a case study. Methods: This research is descriptive research. Data was collected from interviews and questionnaires to administrators and employees in field hospitals in Thailand, by selecting a field hospital that represents the public health agency in the area and using the Delphi technique to gather the consistent opinion of the expert’s group. Results: There are 8 consistent opinions for model of the development in setting up of field hospital: 1) the meaning and role of a field hospital, 2) important features of a field hospital, 3) elements in setting up a field hospital, 4) method or process of operation, 5) Preparation for setting up a field hospital in the future, 6) Main problems in setting up and working in a field hospital, 7) The most important obstacles in operating a field hospital and the principles for solving problems in field hospitals, and 8) Solving problems in field hospitals. Conclusions: To Develop a model for setting up a field hospital, we need to consider the elements in setting up a field hospital and the model of operation as an important factor.

The Study of Cooking Recipes to Reduce Advanced Glycation End Products by Adding Antioxidants Herbs in Fried Pork Cuisine

Fri, 19 Apr 2024 00:00:00 +0700

Objective: To study the cooking recipes with antiglycation compounds in order to reduce advanced glycation end products (AGEs). Methods: This experimental study had been trailed a group of recipes by mixing antiglycation-antioxidant herbal vegetables, whether each selected mixing recipe could reduce AGEs in the group of fried pork recipes. The study was conducted in experimental research by analyzing AGEs from protein extract from the well-cooked samples during May-June 2023 via enzyme-linked immunosorbent assay (ELISA) equipment at Laboratory section in Bamras-naradura Institute. Results: The study found that AGEs in the samples: fried pieced pork (Fpp) found 114.45 ± 6.56 µg/ml, Fpp+Garlic 103.51 ± 10.50 µg/ml, Fpp+Curcumin 109.69 ± 7.80 µg/ml, Fpp+Krachai 109.65 ± 4.35 µg/ml, Fpp+Sesame seeds 108.65 ± 9.10 µg/ml, Fpp+lemonade squeeze 104.57 ± 9.45 µg/ml. The item of Fpp+Garlic showed a significance (p=0.032) in reducing AGEs. Fried minced pork (Fmp) found 105.25 ± 6.35 µg/ml, Fmp+Garlic 101.59 ± 8.27 μg/ml, Fmp+Curcumin 99.30 ± 6.46 µg/ml, Fmp+Krachai 96.93 ± 11.79 µg/ml, Fmp+Sesame seeds 105.83 ± 5.48µg/ml, Fmp+ Lemonade squeeze 111.10 ± 3.41 µg/ml, the item of Fmp was found less AGEs than Fpp with significance (p=0.037). Conclusion: This study found that Garlic extra-added in fried pieced pork could help reducing AGEs with statistical significance, also fried minced pork found less amount of AGEs than fried pieced pork.

Development of a Health Savings Model through Multi-Program Promotion of Working-Age Health to Support an Aging Society in Thai Communities

Suparerk Suerungruang, Kingpikul Chamnankong — Thu, 25 Apr 2024 00:00:00 +0700

Objective: This research and development has the objective to develop health promotion and evaluate desirable health savings model through multi-program health promotion and evaluate desirable health behaviors of working-age individuals to support an aging society in the community. Methods: The sample group consisted of 130 health and working age leaders in the sub-district areas of Chiang Mai (Gr.1), Nakhon Sawan (Gr.2), and Phatthalung (Gr.3) Data was collected using questionnaires, interviews, and daily behavioral records for desired health behaviors in 9 activities including food and nutrition, drinking water, exercise, mood, sleep, breast cancer screening, smoking, drinking alcohol and oral health care. Descriptive statistics used to analyze and describe general information. Repeated measures ANOVA were used to evaluate the effectiveness of the program between the 3 groups. Results: The mean percentage of desired health behavior patterns of all 3 groups was as high as 83.8% (good level). However, when analyzed according to activities, it was found that 5 activities were below the mean, including oral health care (39.2%), breast cancer self-examination (48.5%), exercise (53.1%), food (53.1%), and managing emotions and stress (69.3%), respectively. The mean scores of the 9 desired health behaviors were significantly different between Gr.1 and Gr.3 (p<0.001) and Gr.2 and Gr.3 (p<0.001), but there was no statistically significant difference between Gr.1 and Gr.2. For health outcomes, waist circumference in Gr.1 decreased significantly (p<0.05) and BMI decreased in Gr.2 (p<0.05). Moreover, both BMI and waist circumference decreased significantly in Gr.3 (p<0.01). The mean of monthly desired health behavior scores were significantly different in Gr.1 (p<0.001) and Gr.2 (p<0.001). However, the scores of Gr.3 did not change because they consistently maintained good health behaviors. Conclusions: Accumulating health behaviors through a multi-program approach leads to a continuous and consistent pattern of good behavior, resulting in the development of healthy habits. The findings suggest that the Ministry of Public Health of relevant Departments, the National Health Security Office and the National Social Security Office should develop systematic welfare and incentives to promote healthy behavior patterns using incentives such as health points, contributions to savings accounts, or diverse rewards appropriate to the economic and social conditions in Thailand.

The Effectiveness of Art Therapy Program on Preventing and Slowing the Progression of Dementia among Older Adult

Nongnart Chuancheang — Fri, 26 Apr 2024 00:00:00 +0700

Objective: Dementia is a condition which the cognitive and intellectual functions deteriorate and often occur in the elderly. There was a few research which apply art therapy for delay dementia progression. Thus the purpose of this quasi-experiment study with quasi-experiment design was to determine the effectiveness of art therapy for the elderly to improve MMSE scores in order to delay dementia. Methods: The study was conducted in Chalerm Rajakumari Elderly Home (Luang Pho Pern) by applying a brain test (The Mini Mental Status Examination Thai 2002: Thai MMSE 2002) before and after receiving 4 times of art therapy. Thirty-five participants enrolled this study by using statistic sample size for matched sample continuous outcome. Paired-t-test was utilized for comparing MMSE scores before and after using art therapy. Results: The results showed that MMSE score of the elderly after joining the activity increase by 3.29 (1.70-4.86) with p-value <.001. This means that after the elderly got the art therapy program, they had higher level of the cognitive and intellectual functions than previous. Conclusions: The art therapy program effectively raised MMSE score of elderly. Their mental and physical health were healed and recovered preventing them far from dementia. Therefore art therapy should be one main activity to prevent or slow progression of dementia under elderly care policy of government.

Factors Associated with Medical Checkup among Patients of Family Medicine Department of Lerdsin Hospital

Samitra Kleebbubpha — Fri, 26 Apr 2024 00:00:00 +0700

Objective: To determine the factors associated with medical checkup among patients of Family Medicine Department, Lerdsin Hospital. Methods: This study was a cross-sectional analytical study that focused on individuals aged 18-60 years who visited the out-patient Family Medicine Department of Lerdsin Hospital, Thailand. Data were collected between March 1^st to May 31^st, 2023 by using questionnaire which comprising basic sample information and a 20-items health perception questionnaire. The descriptive statistics, univariate analysis, multivariate analysis and logistic regression analysis were performed, with gender, age, occupation, income, education level, history of family illness and health perception as independent variable and having medical checkup as dependent variable. Results: The total of 857 participants, 536 (62.5%) were female, with an average age of 39.59±12.81 years. Most participants (75.02%) have previous medical checkups annually, females (63.9%), aged 51-60 years (29.1%), company employee (41.1%), low income (less than 15,000 baht) (29.7%), Bachelor's Degree (57.7%) and moderate health perception. Those who are gender female (OR=1.438, 95%CI=1.017-2.033, p=0.040), age 51-60 yrs (OR=3.264, 95%CI= 1.357-7.847, p=0.008) and high income (more than 50,000 baht) (OR=6.786, 95%CI= 1.953-23.580, p=0.003) were factors associated with medical checkup significantly. Conclusions: This study concluded that female, older, and high-income individuals tend to more undergo medical checkup. Therefore, health system or medical services should emphasize on health promotion and health prevention, providing accurate and comprehensive appropriate information about medical checkup for all recipients, regardless of gender or age, while addressing financial constraints in accessing medical checkup service.

Patient Survival and Factors Affecting Mortality on Automated Peritoneal Dialysis in Phra Nakhon Si Ayutthaya Hospital

Saowalak Chowpontong — Mon, 29 Apr 2024 00:00:00 +0700

Objective: To study the survival rate and factors affecting mortality in end-stage renal disease patients undergoing automated peritoneal dialysis under the universal coverage scheme treated at Phra Nakhon Si Ayutthaya Hospital during June 1^st2021 – 30^thJune 2023. Methods: This was a retrospective cohort study by reviewing electronic medical records. Data was collected from end-stage renal disease patients on continuous ambulatory peritoneal dialysis (CAPD) who met the criteria for switching to APD treatment. Patients were then trained to use the automated peritoneal dialysis machine. Treatment was adjusted by determining dialysate volume and dwell cycles to achieve adequate peritoneal dialysis targets of weekly KT/V urea ≥1.7, CCr >45L/week/1.73 m2, and mean ultrafiltration >0.75L/day. Patient data and laboratory results were collected and analyzed statistically to determine survival rates and factors affecting mortality during June 1^st2021 - 30^thJune 2023. Results: There were 58 patients with a mean age of 56 years, predominantly female (51.7%). The causes of renal failure were diabetes mellitus 58.62%, unknown 18.96%, glomerulonephritis 10.34%. There were 3 HIV-positive patients and 1 pure red cell aplasia patient. The mean albumin was 3.36 ± 0.051 g/dL. Thirty-six percent were anuric patients. Follow-up showed 59.6% achieved weekly KT/V urea ≥1.7, mean CCr 42.5 ± 3.2 L/week/1.73 m2, mean ultrafiltration 0.78 ± 0.29 L/day. During the study period, 26 patients discontinued APD treatment, with 15 deaths (25.86%). The leading cause of death was cardiovascular disease (46.66%), followed by COVID-19 pneumonia (13.33%), and PD-related peritonitis (6.66%). Nine patients (15.51%) transitioned to hemodialysis. The 1-year and 2-year survival rates of APD patients at Phra Nakhon Si Ayutthaya Hospital were 68.8% and 59%, respectively. Conclusion: The 1-year and 2-year survival rates of APD patients at Phra Nakhon Si Ayutthaya Hospital during June 2021 - June 2023 were 68.8% and 59%, respectively. After controlling for other factors, patients with weekly KT/V urea <1.7 had a 3.37 times higher risk of mortality compared to those with weekly KT/V urea ≥1.7. Patients with treatment-resistant peritonitis had a 16.67 times higher risk of mortality compared to those without treatment-resistant peritonitis.