Lampang Medical Journal

Exploratory Factor Analysis and Reliability of a Self-Management Assessment Instrument in Patients with End-Stage Renal Disease Undergoing Hemodialysis

Penpayome Sakorn — 2026-04-10

Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis often experience reduced self-care capacity and increased caregiver burden. Effective self-management can mitigate complications and improve quality of life; however, a valid and context-appropriate instrument to assess self-management behaviors among Thai hemodialysis patients remains limited. This study modified and enhanced an existing 37-item questionnaire to improve its validity and applicability in clinical practice.
Objective: To examine the exploratory factor structure and internal consistency of a self-management assessment tool for patients with ESRD undergoing hemodialysis.
Materials and Methods: A descriptive study was conducted among 150 ESRD patients receiving hemodialysis at three private dialysis centers in Bangkok between August and September 2024. The newly developed self-management assessment was evaluated using exploratory factor analysis (EFA). Component extraction was based on eigenvalues >1 and total variance explained. Principal component analysis with varimax rotation was applied. Data suitability was assessed using the Kaiser–Meyer–Olkin (KMO) measure and Bartlett’s test of sphericity. Internal consistency reliability was analyzed using Cronbach’s alpha.
Results: Participants had a mean age of 54.2 ± 13.1 years, and 52.0% were male. The data were suitable for factor analysis (KMO = 0.93; Bartlett’s test p < 0.001). Seven components were initially extracted, with eigenvalues ranging from 1.07 to 17.69, explaining 72.18% of the total variance. Factor loadings ranged from 0.48 to 0.87, indicating good associations between items and latent components. Due to the limited number of indicators in components 3–7, items were synthesized into three refined components: communication and engagement in care, adherence to medical recommendations, and self-monitoring and prevention. The final instrument demonstrated excellent internal consistency (Cronbach’s alpha = 0.96).
Conclusion: The developed instrument demonstrated strong reliability and a clear factor structure, covering key self-management behaviors relevant to the health outcomes of ESRD patients undergoing hemodialysis. It is suitable for individual assessment, nursing care planning, and development of targeted self-management enhancement programs in dialysis settings. Further confirmatory factor analysis is recommended to validate the structural model in diverse populations.

Factors Associated with the Use of High-Flow Nasal Cannula, Endotracheal Intubation, and Length of Hospital Stay Among Children with Bronchiolitis at Thanyaburi Hospital

Jinchanya Tamgal — 2026-05-08

Background: Bronchiolitis is the most common lower respiratory tract infection in children under 24 months and a major cause of hospitalization. Standard treatment is mainly supportive, while the use of high-flow nasal cannula (HFNC) has become increasingly popular for patients with severe symptoms. However, data from community hospitals in Thailand remain limited.
Objective: To identify factors associated with HFNC therapy, respiratory failure requiring intubation, and length of hospital stay (LOS) among children under 24 months with bronchiolitis admitted to Thanyaburi Hospital.
Methods: A retrospective cohort study was conducted among children under 24 months hospitalized with acute bronchiolitis between January 1, 2019 and December 31, 2023. Factors associated with HFNC use and respiratory failure requiring intubation were analyzed using Poisson regression, and factors associated with LOS were analyzed using quantile regression.
Results: A total of 648 patients were included. Most were male (61.4%) with a mean age of 11.1 ± 6.6 months. HFNC therapy was used in 35.2% of patients. Factors associated with HFNC use included bronchodilator nebulization (aRR 13.02; 95% CI 1.86–91.18), inhaled corticosteroid therapy (aRR 1.56; 95% CI 1.31–1.87), and intravenous corticosteroids (aRR 2.03; 95% CI 1.68–2.46), whereas low-flow oxygen and COVID-19 infection were associated with reduced risk. Intubation occurred in 1.9% and was associated with age <12 months and intravenous corticosteroid use. The median LOS was 5 days [IQR 4–7], and longer hospitalization was associated with age <12 months, cerebral palsy, COVID-19 infection, and corticosteroid use.
Conclusion: Age <12 months and corticosteroid use, particularly intravenous, were associated with Intubation and prolonged hospitalization. Early risk assessment and cautious corticosteroid use are essential in community hospital settings.

Association Between the Triglyceride–Glucose Index and Major Cardiovascular Events in Patients with Prior Ischemic Stroke: A Retrospective Cohort Study

Supitcha Kitjanukit — 2026-05-08

Background: Patients with ischemic stroke have a high incidence of major adverse cardiovascular events (MACE), ranging from 15% to 30%, despite receiving standard secondary prevention. Individualized cardiovascular risk assessment is therefore crucial in optimizing preventive strategies. The triglyceride–glucose (TyG) index is a convenient and low-cost surrogate marker of insulin resistance; however, evidence in Thai patients with ischemic stroke remains limited.
Objectives: To investigate the association between the TyG index and the risk of MACE among patients with ischemic stroke, and to identify an optimal cut-off value for discriminating high-risk patients in the Thai context.
Materials and Methods: A retrospective cohort study was conducted among newly diagnosed ischemic stroke patients treated at Pasang Hospital, Lamphun Province, Thailand, between January 2019 and December 2024. A total of 281 eligible patients underwent fasting triglyceride and glucose testing to calculate the TyG index and were followed for the occurrence of 3-point MACE. The median follow-up duration was 2.5 years. Cox proportional hazards regression was used to evaluate the association, and ROC curve analysis was applied to determine the optimal cut-off value.
Results: Among 281 patients with ischemic stroke, the incidence of MACE was 24.2% (68 patients). Patients in the highest TyG tertile (>8.9) had a significantly higher risk of MACE compared with those in the lowest tertile (<8.4) (adjusted HR 2.08; 95% CI 1.23–3.49; p=0.006). ROC analysis showed that the TyG index had moderate predictive ability (AUC 0.65; 95% CI 0.57–0.73; p<0.001). The optimal cutoff value was TyG index ≥9.0, which provided a specificity of 80.0% and sensitivity of 45.1%. This cutoff remained associated with an increased risk of MACE after adjustment for major confounding factors (adjusted HR 1.96; 95% CI 1.13–3.41; p=0.017).
Conclusion: A higher TyG index was associated with an increased risk of MACE among Thai patients with ischemic stroke, with an optimal cutoff value of ≥9.0. However, the study population had relatively high baseline TyG index values with a narrow distribution, resulting in only moderate discriminatory ability. Therefore, the TyG index should be used as an adjunct to other clinical risk factors rather than as a standalone predictor.

Prevalence of Group B Streptococcus Colonization During Pregnancy and Associated Neonatal Outcomes at Vachira Phuket Hospital

Ratikorn Saejong — 2026-05-15

Background: Group B Streptococcus (GBS) colonization is a major cause of early-onset neonatal sepsis. Despite implementation of universal screening at Vachira Phuket Hospital, screening uptake and neonatal transfer rates remained concerns.
Objectives: To determine GBS prevalence, evaluate screening coverage, and identify factors associated with neonatal transfer, NICU admission, and length of stay (LOS).
Materials and Methods: A retrospective cohort study included all live births at Vachira Phuket Hospital, between January 2023 and December 2024. Maternal GBS status was determined by universal or reflex culture screening. Multivariable logistic and linear regression analyses identified predictors of neonatal transfer, NICU admission, and LOS.
Results: Among 6,173 live births, overall GBS screening coverage was 27.4% (95% CI 26.3–28.5). GBS prevalence among screened women was 6.2%, higher in Thai than non-Thai mothers (6.9% vs 3.2%, p=0.012). Among 1,691 screened mother–newborn pairs, 49.2% of neonates required transfer and 6.7% were admitted to the NICU. Maternal GBS colonization was not associated with neonatal transfer, NICU admission, or LOS. Gestational age was the strongest predictor: each additional week reduced the risk of transfer (OR 0.8, p<0.001), NICU admission (OR 0.8, p=0.013), and shortened LOS by 2.4 days (p<0.001). Higher birth weight was associated with shorter LOS, while non-spontaneous delivery increased transfer risk.
Conclusions: GBS prevalence at Vachira Phuket Hospital was 6.2%, while screening coverage remained inadequate. Maternal GBS colonization was not independently associated with neonatal outcomes in this cohort, prematurity and low birth weight remained dominant determinants of adverse neonatal outcomes. However, this finding should be interpreted cautiously due to limited screening coverage and potential residual bias. The absence of association does not exclude a clinically relevant effect, and standard GBS prevention strategies should continue to be emphasized.