Lampang Medical Journal

Incidence and Associated Factors of Delirium in Elderly Patients with Hip Fractures at Nan Hospital

Siripong Jongrak — Thu, 25 Dec 2025 00:00:00 +0700

Background: Delirium is a psychiatric disorder caused by acute physical illness, which, if left untreated, may increase morbidity and mortality. Studies on delirium in older adults with hip fractures in Thailand have mainly been conducted in university hospitals in Bangkok and have focused only on the postoperative period. Data from regional hospitals remain limited.
Objective: To determine the incidence and associated factors of delirium in older adults with hip fractures treated at Nan Hospital, both preoperatively and postoperatively, including non-surgical cases.
Materials and Methods: This prospective observational cohort study included patients aged ≥60 years with hip fractures from low-energy trauma admitted to Nan Hospital between November 1, 2023, and November 30, 2024. Exclusion criteria were fractures due to malignancy or other pathology, multiple fractures, or delirium ≤1 month before injury. Delirium was assessed within 24 hours of admission and once daily pre- and postoperatively for 4 days using the Thai 3D-CAM, confirmed by DSM-5 criteria. Baseline, preoperative, and postoperative data were collected. Comparisons between delirium and non-delirium groups were analyzed using Fisher’s exact test, t-test, and Mann–Whitney U test. Associated factors were examined using univariate logistic regression.
Results: Of 242 patients, 220 were enrolled (mean age 80.3±8.1 years; 74.5% female). Delirium occurred in 11.8% (26/220), including 22.2% in non-surgical patients (2/9) and 11.4% in surgical patients (24/211), with equal preoperative and postoperative incidence (5.7% each). Significant factors included male sex, age ≥80 years, hearing impairment, prior delirium, medical comorbidities, preoperative fever, preoperative pain score >5, and anemia. The strongest associations were prior delirium (OR 12.5, 95%CI 2.0–78.9), hearing impairment (OR 5.3, 95%CI 2.0–14.2), and male sex (OR 5.1, 95%CI 2.2–11.9). In surgical patients, key factors were prior delirium (OR 37.2, 95%CI 3.1–445.7), postoperative hyponatremia (OR 15.2, 95%CI 3.0–78.6), and postoperative fever (OR 13.0, 95%CI 3.6–46.2).
Conclusion: Delirium occurred in 11.8% of older adults with hip fractures. Key associated factors were prior delirium, hearing impairment, male sex, high pain score, fever, anemia, age ≥80 years, and comorbidities. Postoperative delirium (5.7%) was associated with prior delirium, hyponatremia, postoperative fever or pneumonia, male sex, hearing impairment, additional treatments, and age ≥80 years.

Effectiveness of a Health Behavior Change Promotion Program for Patients with Type 2 Diabetes on Glycated Hemoglobin Levels in Primary Care Units

Sani Panyajonglert — Thu, 25 Dec 2025 00:00:00 +0700

Background: Type 2 diabetes is a major public health issue. Current management emphasizes promoting healthy behaviors through Diabetes Self-Management Education and Support (DSMES), which has been shown to reduce glycated hemoglobin (HbA1c) levels. However, primary care units in Thoen District have not yet systematically integrated DSMES. Consequently, Thoen Hospital developed the DSMES-based health behavior change promotion program.
Objective: To evaluate the effectiveness of the health behavior change promotion program among type 2 diabetes patients on HbA1c levels, antidiabetic medication use, and antidiabetic medication costs.
Materials and Methods: A pre-experimental one-group pretest-posttest study was conducted using retrospective data from patients with type 2 diabetes who participated in the program at 19 primary care units in Thoen District, Lampang Province, from April to July 2024. Baseline and 3-month follow-up data were analyzed using paired
t-test and Wilcoxon signed-rank test.
Results: A total of 265 patients participated, of whom 196 (74.0%) were female. The mean age was 57.5 ± 8.7 years, and the median duration of diabetes was 4.1 years. After the program participation, the mean HbA1c decreased from 7.6 ± 1.6% to 7.4 ± 1.0% (p=0.016). Patients with baseline HbA1c of 8.1–9.9% and ≥10% showed significantly reductions of HbA1c (-0.9% and -2.1%, respectively, p<0.001). Most patients maintained the same antidiabetic medication regimen (85.7%), while 11.7% reduced medications and 2.6% required additional medications. Median antidiabetic medication cost decreased from 15.90 to 12.60 Thai baht/person/month (p < 0.001).
Conclusion: The health behavior change promotion program effectively reduced HbA1c, especially in patients with baseline HbA1c > 8.0%. Most participants maintained their previous dosages of antidiabetic medications, while the cost of antidiabetic drugs showed a slight decrease.

Prevalence of Computer Vision Syndrome and Risk Factors for Dry Eye among Digital Arts Students

Worasa Wongwarit, Phongvarin Naksaranyuyottana — Tue, 30 Dec 2025 00:00:00 +0700

Background: Prolonged use of digital devices can lead to computer vision syndrome (CVS), which is commonly reported among university students, particularly those requiring continuous computer use such as digital arts students. CVS may adversely affect health, yet evidence in the Thai context remains limited.
Objective: To determine the prevalence of CVS, dry eye, and musculoskeletal symptoms, as well as to identify risk factors for dry eye among digital arts students.
Materials and Methods: This cross−sectional survey was conducted between June and October 2023 among undergraduate students of the Faculty of Digital Arts, Rangsit University. Data on digital device usage were collected. CVS was assessed using the CVS questionnaire, dry eye symptoms using the Ocular Surface Disease Index, and musculoskeletal symptoms using a structured assessment. Descriptive statistics were applied, Chi−square tests were used to compare groups with and without dry eye, and logistic regression was employed to analyze risk factors.
Results: A total of 233 students were included (mean age: 20.3±1.6 years), the majority being female (60.5%). The average screen time was 10.5±3.9 hours/day. The most common musculoskeletal symptoms were neck, shoulder, and back pain (82.8%) and headache (51.9%). The most frequent ocular symptom was eye strain (66.1%). The prevalence of CVS was 50.6% (118 students), with mild, moderate, and severe cases accounting for 36.5%, 10.7%, and 3.4%, respectively. The prevalence of dry eye was 46.4% (108 students), and was significantly higher among females and those perceiving poor screen sharpness compared with their counterparts (75.9% vs. 47.2%, p<0.001; 32.4% vs. 11.2%, p<0.001). Risk factors for dry eye included female sex (OR 3.53, 95% CI 2.01−6.20, p<0.001) and the perception of poor screen sharpness (OR 3.80, 95% CI 1.91−7.55, p<0.001).
Conclusion: Among digital arts students, the prevalence of CVS and dry eye were 50.6% and 46.4%, respectively. Female sex and perception of poor screen sharpness were identified as significant risk factors for dry eye.

Supernumerary Teeth in Nonsyndromic Patients: A Case Series and Literature Review

Koonnaree Borisuth — Thu, 25 Dec 2025 00:00:00 +0700

Supernumerary teeth are defined as teeth exceeding the normal dental count. Their etiology remains unclear. Although more frequently associated with genetic or syndromic conditions, they can also occur in the general population. The condition tends to be more common in males than females, in the maxilla than the mandible, and most are impacted within the jawbone. This article presents three nonsyndromic cases with different clinical characteristics: an impacted supernumerary tooth between teeth 45 and 46 in the right mandible, an impacted supernumerary tooth distal to tooth 28 in the left maxilla, and an erupted supernumerary tooth on the lingual aspect of tooth 44 in the right mandible. All patients underwent surgical removal under local anesthesia without short-term complications. At 3-month follow-up, healing was uneventful and all patients proceeded with orthodontic treatment. These cases highlight the importance of systematic radiographic evaluation and individualized treatment planning to prevent complications to adjacent teeth and to facilitate other dental procedures. The article also includes a literature review on the etiology, prevalence, diagnosis, and treatment options of supernumerary teeth.