Journal of Associated Medical Sciences

Development of the Occupational Therapy Cognitive Outcome Measure-Computer-Based Assessment (OTCOM-CA) for older adults with cognitive impairment: A prototype mobile application

2026-04-22T13:33:27+07:00

Background: Cognitive impairment is common in older adults and increases with age. It affects independence in daily activities, such as financial management, meal preparation, medication management, and driving. In healthcare, outcome measurement tools are essential for evaluating a patient’s status, establishing baseline performance, guiding intervention planning, and monitoring intervention effectiveness. Computer-based assessments are feasible and well-accepted by patients, providing immediate and accurate scoring, real-time feedback, and automated reporting of results. However, in the Thai context, the availability of standardized assessment tools specifically designed for older adults with cognitive impairment remains limited. Consequently, occupational therapists require comprehensive and contextually appropriate instruments to effectively guide cognitive interventions throughout the continuum of care. To address this gap, a new assessment tool was developed and implemented as an Android tablet-based application to facilitate evidence-based practice.

Objectives: To develop the Occupational Therapy Cognitive Outcome Measure-Computer-Based Assessment (OTCOM-CA) for older adults with cognitive impairment and evaluate its content validity and feasibility.

Materials and methods: This study employed a research and development (R&D) design to establish the content and workflow structure of OTCOM-CA. Following the content validity evaluation, the application’s workflow and interface were designed in accordance with established user experience (UX) and user interface (UI) principles and subsequently validated. A pilot study involving 10 healthy older adults was conducted to evaluate the clarity of the workflow and the appropriateness of the language used within the application.

Results: Content validity evaluation of the OTCOM-CA’s structure, workflow, and screen design showed acceptable ratings for all items (IOC=0.66-1.00). Most participants understood the workflow and test instructions.

Conclusion: OTCOM-CA demonstrated acceptable content validity. The prototype Android version shows a good workflow and language validation. Once revisions are made, its psychometric properties should be evaluated.

Altered visfatin and adiponectin levels and their interaction with HEGF in the metabolic dyslipidemia of overt hypothyroidism: A case-control study

2026-01-19T12:01:31+07:00

Background: Hypothyroidism is a common endocrine disorder associated with significant metabolic dysregulation, including dyslipidemia. Adipokines such as visfatin and adiponectin are key regulators of metabolism, but their specific roles and potential as markers of metabolic dysfunction in overt, treatment-naive hypothyroidism require further elucidation.

Objectives: This study aimed to investigate the association of visfatin and adiponectin levels with hypothyroidism, assess their potential utility for metabolic risk assessment, and explore their associations with metabolic parameters and human epidermal growth factor (HEGF).

Materials and methods: This case-control study included 71 hypothyroid patients and 67 frequency-matched euthyroid controls. All patients were newly diagnosed and therapy‑naive. Serum levels of adipokines (visfatin, adiponectin), HEGF, thyroid hormones, and lipids were assessed. Statistical analyses included ROC curves, Spearman’s correlation, multivariate regression, and ANCOVA to adjust for BMI and age.

Results: After adjusting for BMI and age, hypothyroid patients had significantly lower visfatin (adjusted LS mean: 11.04±1.56 vs 19.36±1.59 ng/mL, p<0.001) and adiponectin (10.77±2.04 vs 23.61±2.09 ng/mL, p<0.001) compared to controls and exhibited atherogenic dyslipidemia (all p<0.001). A strong positive correlation was observed between visfatin and adiponectin (ρ=0.533 and p<0.001). Regression analysis revealed significant interactions in the hypothyroid group: visfatin×HEGF was associated with an increased LDL-C (β=0.1306, p=0.0188), while adiponectin×HEGF was associated with decreased LDL-C (=-0.0919, p=0.0062). Adiponectin showed a good screening for metabolic risk in hypothyroidism (AUC=0.80) compared to visfatin (AUC=0.68).

Conclusion: Hypothyroidism is associated with altered adipokine levels and a specific interplay with HEGF that influences LDL-C. Adiponectin shows promise as adjunctive marker for assessing metabolic dysfunction severity in hypothyroidism, and the HEGF-adipokine network represent

Preliminary study: Effect of breathing exercise on hemodynamics and heart rate variability in hypertension

2025-10-24T11:35:07+07:00

Background: Various types of breathing exercises (BE) have been investigated, mostly focusing on their effects on blood pressure (BP) in hypertension (HT). However, each study has had a different BE program, and strong evidence based on a standard protocol is lacking.

Objective: The present study was designed to compare the effects of BE across different breathing patterns within the same protocol on hemodynamic and heart rate variability (HRV) parameters.

Materials and methods: The study was a randomized crossover design. 20 hypertensive patients performed deep and slow, pursed-lip, and bee-humming breathing in a random sequence of the three breathing patterns. Hemodynamics and HRV parameters were measured before and immediately after exercise.

Results: At a rate of six breaths/min for ten minutes, there was a significant effect of time on SBP (F (1,19)=5.17, p<0.05). The post hoc Bonferroni test indicated a significant reduction in SBP during pursed-lip breathing compared to baseline (p<0.01). In addition, no significant differences were found in DBP, HR, and HRV parameters. Moreover, pursed-lip breathing showed the largest change in mean difference with 95% CI in SBP (-3.9 (-6.6, -1.1)). While deep and slow and bee-humming breathing were (-3.5(-7.4, 0.5)) and (-0.4(-4.4, 3.6)), respectively.

Conclusion: Among the three breathing exercises, only pursed-lip breathing significantly reduced SBP after a single 10-minute session at six breaths per minute, while no significant changes were observed in DBP, HR, or HRV parameters. These findings suggest that pursed-lip breathing may be the most effective technique for short-term BP reduction in hypertensive patients under standardized conditions.

Effectiveness and satisfaction of the elastic ankle support devices for walking and mobility among healthy people

2026-04-17T16:24:06+07:00

Background: A plastic non-hinged ankle-foot orthosis (AFO) is a standard ankle support device (ASD) commonly prescribed for individuals with walking impairments in general clinical settings of a developing country. Although it promotes toe clearance during the swing phase, its inherent rigidity can limit ankle rocker during the stance phase, thereby facilitating the development of compensatory strategies that affect walking and mobility in these individuals.

Objectives: To develop an alternative practical ASD assisting movements not only the swing but also the stance phases and compare their effects to a non-hinged AFO and no-ASD conditions on walking and mobility of healthy participants.

Materials and methods: This study developed elastic ASDs from a 3- to 4-inch bandage, called a long ankle sling, and elastic bands with buttonholes, called elastic ankle support equipment (EASE). Their effects and satisfaction were compared with those of no-ASD and non-hinged AFO in 18 healthy participants. Outcomes were measured as spatiotemporal gait variables, mobility using the timed up and go test (TUG), and satisfaction using a self-report questionnaire.

Results: Spatiotemporal and TUG data of the elastic ASD conditions showed no significant differences from the no-ASD condition, but significantly better than those of the AFO condition. The elastic ASDs met the criteria for dimensions, weight, safety, and effectiveness (p<0.001). The EASE was also comfortable and easy to adjust, whereas the AFO was durable (p<0.01).

Conclusion: The present study suggests the potential clinical benefit of elastic ASDs as they did not hinder the walking and mobility of healthy participants, i.e., allowed healthy participants to maintain walking ability and mobility comparable to unassisted walking. Given its ease of adjustment and application, the EASE is a particularly promising and user-friendly ASD for implementation in various clinical and community settings.

Analysis of associations between personal attributes, emotional state, and functional performance after stroke

2026-03-02T18:23:02+07:00

Background: Emotional problems such as depression, anxiety, and apathy frequently occur after stroke and can negatively impact the functional recovery process. However, most previous studies have focused on specific emotional factors or examined the relationship between emotional and functional variables in a predominantly one-directional manner. Because emotional management is also important in stroke rehabilitation, further research is needed to clarify the complex associations among emotional, functional, and personal variables.

Objectives: The purpose of this study was to examine the bidirectional associations between emotional factors and functional performance in stroke patients undergoing inpatient rehabilitation and to explore the role of personal factors in emotional status.

Materials and methods: The study was conducted with 102 stroke patients hospitalized in a rehabilitation hospital. Emotion was assessed using the Korean version of the Positive and Negative Affect Schedule (PANAS), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale-Anxiety (HADS-A), and the Apathy Evaluation Scale (AES). Function was measured by cognitive function (MMSE), balance ability (BBS), gait ability (FAC), and activities of daily living (K-MBI). Personal factors included sex, age, duration of illness (DISEASE_DUR), and length of stay (LOS). Statistical analyses included simple and multiple regression.

Results: Simple regression analysis showed that better functional performance was associated with lower negative affect, depression, and anxiety. Conversely, higher negative affect, depression, and anxiety were associated with poorer cognitive function, balance, gait ability, and activities of daily living. Apathy showed a limited positive association with cognitive function. Among personal factors, positive affect decreased slightly with increasing age, and apathy was higher in patients with a shorter illness duration. Multiple regression analysis showed that most relationships disappeared, but depression remained independently associated with functional performance after adjustment for other emotional variables. Among functional domains, only activities of daily living independently explained emotional state.

Conclusion: Emotional state and functional performance in stroke patients were significantly associated, particularly with respect to negative emotions and depression. These findings suggest that a functional-focused rehabilitation approach alone may be insufficient, highlighting the potential need for rehabilitation strategies that integrate emotional interventions with functional training. This study can serve as foundational data for developing integrated rehabilitation models to promote recovery in stroke patients.

The interplay between serum Interleukin-33 and vitamin D3 in childhood asthma: Diagnostic utility and severity predictors in an Iraqi community

2026-04-21T11:28:55+07:00

Background: The epithelial alarmin Interleukin-33 (IL-33) and the immunomodulator vitamin D3 are implicated in asthma pathogenesis, yet their combined clinical utility and interplay in pediatric populations remain underexplored.

Objectives: This study aimed to investigate the diagnostic performance and predictive value of serum IL-33 and vitamin D3 in childhood asthma, and their association with disease severity.

Materials and methods: A case-control study was conducted involving 120 children (60 asthmatics and 60 age- and gender-matched healthy controls) in Karbala, Iraq. Serum levels of IL-33 and 25-hydroxyvitamin D3 were quantified using enzyme-linked immunosorbent assay (ELISA). Diagnostic utility was evaluated via Receiver Operating Characteristic (ROC) curve analysis, and independent predictors were identified using multivariate binary logistic regression.

Results: Asthmatic children exhibited significantly elevated IL-33 (395.56±218.75 vs 159.95±55.32 ng/L, p<0.001) and lower vitamin D3 (17.01±7.38 vs 28.20±10.60 ng/mL, p<0.001) than controls. A strong inverse correlation was observed between IL-33 and Vitamin D3 (r = -0.614, p<0.001), both of which showed a dose-dependent relationship with asthma severity. ROC analysis revealed exceptional diagnostic accuracy for IL-33 (AUC=0.933). Multivariate regression identified body mass index (aOR = 1.528, p=0.014) and IL-33 (aOR=1.015 per 1 ng/L increase, p=0.020) as significant independent predictors of asthma, yielding an overall model accuracy of 95.8%. Notably, male asthmatics exhibited significantly lower vitamin D3 levels than females (p<0.001).

Conclusion: The inverse relationship between elevated IL-33 and vitamin D3 deficiency underscores their synergistic role in asthma exacerbation. IL-33 serves as a highly accurate diagnostic biomarker, highlighting the potential for targeted anti-alarmin therapies and gender-stratified nutritional interventions in pediatric asthma management.

Predicting dyscalcemia using machine learning models based on routine laboratory data

2026-02-24T10:39:37+07:00

Background: Dyscalcemia is associated with significant clinical complications, and the demand for calcium testing is rising disproportionately.

Objectives: This study aimed to develop machine learning (ML) models to predict total calcium abnormalities using routine available demographic and laboratory data to optimize laboratory test utilization.

Materials and Methods: This retrospective study analyzed data from 7,951 patients at Siriraj Hospital between April 2023 and March 2024. Feature selection identified ten predictors, including patient status, absolute lymphocyte count, albumin, bicarbonate, hematocrit, hemoglobin, platelet count, potassium, red blood cell count, and total protein. Seven ML algorithms were developed and validated using an 80:20 training-testing split with 10-fold cross-validation and hyperparameter tuning. The Synthetic Minority Oversampling Technique was applied to address class imbalance. Additionally, model calibration was evaluated using Brier scores, and Platt scaling was applied to ensure the reliability of predicted probabilities.

Results: XGBoost achieved the highest AUC (0.84), indicating slightly better discriminative performance, and the highest specificity (0.86), reflecting a stronger ability to correctly identify normal cases. Random forest yielded the highest F1 score (0.71) and recall (0.76), indicating a better balance between precision and recall, with higher sensitivity for detecting abnormal cases.
Following Platt scaling, the calibrated models achieved robust Brier scores (e.g., 0.1496 for random forest and 0.1497 for XGBoost), demonstrating highly accurate probability risk estimation. SHAP analysis identified albumin as the most influential feature, followed by total protein and hemoglobin.

Conclusion: ML models utilizing demographic and laboratory data can accurately predict plasma total calcium status, and probability calibration ensures reliable risk estimates. XGBoost and random forest demonstrated robust performance with complementary strengths. These models show promise as screening tools for identifying high-risk patients and optimizing rational laboratory utilization.

Comparison of radiation and light field congruence between a developed collimator test tool and a standard collimator test tool in the general X-ray units of Lamphun Province hospitals

2026-01-12T10:29:00+07:00

Background: Assessment of radiation and light-field congruence is a key quality-control procedure for general X-ray machines. This process typically requires a standard collimator test tool, which can be costly. Therefore, the author developed an innovative collimator test tool as a cost-effective alternative for evaluating the congruence between the radiation field and the collimator light field.

Objectives: The present study aims to evaluate and compare radiation and light-field congruence measured using the developed collimator test tool and a standard tool on general X-ray units across eight hospitals in Lamphun Province.

Materials and methods: The developed collimator test tool was constructed from an etched stainless-steel plate measuring 20×25 cm, with scale resolutions of 2.5 mm and 5 mm. The standard collimator test tool (GAMMEX, Model 161B) is made from a brass plate of the same dimensions with a scale resolution of 5 mm. Measurements followed the 2023 diagnostic X-ray quality standards established by the Department of Medical Sciences, Ministry of Public Health. Radiation and light field borders were measured three times on each of four sides, yielding a total of 96 measurements. Error and percentage error were calculated, and a paired-sample t-test analysis was performed.

Results: Comparison of radiation and light-field congruence between the developed collimator and the standard collimator test tools revealed a maximum error of 0.5 mm, corresponding to a percentage error of 3%, which is below the acceptable limits of 1 mm or 5%. Statistical analysis using a paired-sample t-test (p<0.05) indicated no significant difference between measurements obtained from the two test tools (p≥0.05).

Conclusion: The developed collimator test tool can be used as an alternative to the standard tool for radiation and light field congruence testing in general X-ray units. It offers a cost-effective option for self-quality control and monitoring in radiology departments while maintaining the same measurement accuracy.

Effect of prospective memory training on instrumental activities of daily living skills among individuals with mild dementia

2026-05-18T11:13:20+07:00

Background: Dementia is a neurodegenerative disease brought on by a longterm, progressive illness that impairs decision-making, behavior, emotions, memory, and other brain processes that interfere with day-to-day functioning. Mild dementia is an early stage of cognitive decline that interferes with daily activities but allows for independent function in many areas. Prospective memory (PM), which enables one to remember to carry out delayed intentions, is crucial for everyday functioning.

Objectives: This study aims to determine the effect of prospective memory training on instrumental activities of daily living skills among individuals with mild dementia.

Materials and methods: A True experimental study was conducted. A total of 45 participants were initially screened using the Mini-Mental State Examination (MMSE). Based on the inclusion criteria, 30 participants with mild dementia were selected. Through simple randomization, 30 participants were divided into two groups: the experimental group (N=15) and the control group (N=15). The Lawton and Brody Instrumental Activities of Daily Living (IADL) Scale was used to assess functional performance. The experimental group received prospective memory training focused on improving instrumental activities of daily living, while the control group underwent conventional occupational therapy for 3 months, with sessions held 3 days per week (36 sessions), each lasting 45 minutes. Data analysis was performed using IBM SPSS version 23.0 with paired and independent t-test.

Results: Post-test scores showed statistically significant improvements in the experimental group for instrumental activities of daily living skills (p=0.000, which p<0.001). The results of this study showed that prospective memory training was effective in enhancing instrumental activities of daily living skills among individuals with mild dementia.

Conclusion: This study found that prospective memory training improves instrumental activities of daily living among individuals with mild dementia.

Complications of hyaluronic acid fillers in HIV-positive patients: A narrative review

2026-04-27T09:15:45+07:00

Background: The introduction of antiretroviral therapy (ART) has improved the survival of people living with HIV, yet facial lipoatrophy remains a visible and stigmatizing complication. Hyaluronic acid (HA) fillers are widely used for volume restoration due to their safety, biocompatibility, and reversibility.

Objectives: This narrative review focuses exclusively on HA fillers in HIV-positive patients, aiming to clarify their complication profile.

Materials and methods: A comprehensive search of PubMed, Scopus, and Google Scholar (2000-2024) identified 120 records. After screening and eligibility assessment, 13 studies were included. Data on study design, population, filler type, complications, and management were extracted and narratively synthesized, with results summarized in tabular form.

Results: Early adverse events, such as swelling and erythema, occurred in 50-80% of patients, and bruising in ~50%. Intermediate complications included nodules in 5-10% and indurations up to 30%, usually resolving with conservative management or hyaluronidase. Delayed infections (2-4%) were most often due to Staphylococcus epidermidis, Propionibacterium acnes, or atypical mycobacteria and required antibiotics or drainage. Granulomatous reactions and abscesses were rare (<5%) and typically occurred in patients with prior permanent filler exposure. No severe vascular events were reported in HIV-specific cohorts, though such risks remain relevant.

Conclusion: HA fillers are effective and generally safe for treating HIV-associated facial lipoatrophy, with most complications being mild and transient. However, immune dysregulation, low CD4 counts, and prior filler history may predispose to granulomas or infections. This review highlights the need for careful patient selection, meticulous technique, and further prospective research to establish standardized safety guidelines.

Work performance assessment in Thai homeless shelters: An exploratory factor analysis

2026-05-18T10:24:16+07:00

Background: Institutional sheltering can lead to occupational deprivation and psychosocial disengagement, particularly among adults with mental health-related disabilities. In Thailand, homeless shelters operate under rigid custodial systems that may hinder functional recovery, highlighting the need for culturally adapted assessment tools.

Objectives: To validate an adapted version of the Assessment of Work Performance (AWP) for use in Thai homeless shelters and to identify functional skill patterns and psychosocial barriers that inform allied health service planning.

Materials and methods: A cross-sectional study was conducted with 60 adults with mental health-related disabilities residing in a governmentoperated destitute shelter. Participants completed a work-based AWP task rated across 14 work-skill items. Exploratory factor analysis (EFA) examined the underlying factor structure, while regression analysis tested the predictive value of extracted factors on occupational performance.

Results: The EFA supported a two-factor solution: 1) task adaptation and relational organization, and 2) communication and expression-accounting for 56.78% of the total variance (KMO=0.696, Bartlett’s test significant). Regression analysis showed that task adaptation and relational organization significantly predicted occupational performance, explaining 69.6% of the variance (R²=0.696)

Conclusion: Task adaptation and environmental structuring are key determinants of occupational engagement in institutional shelter settings. Performance-based assessment, combined with structured observation during task engagement, provides a culturally relevant strategy for allied health professionals to guide individualized rehabilitation for marginalized populations in Thai homeless shelters.