Journal of Medical Bioscience

Association between physical fitness and musculoskeletal discomfort among firefighters under the Bangkok Metropolitan Administration

Naramon Iamareerat — 2023-12-14

Background: Musculoskeletal discomforts are common in firefighters. The associated factors of musculoskeletal discomforts among firefighters in Thailand are however limited.

Objectives: To study the relationship between factors-personal factors, occupational factors, and physical fitness factors-and musculoskeletal discomfort among firefighters in Bangkok.

Methods: A cross-sectional study was conducted among 234 firefighters in various fire stations in Bangkok. Data were collected from October to November 2022, by using questionnaires including personal factors, work-related factors, Nordic Musculoskeletal Questionnaire, and physical fitness test-body weight, height, grip strength, leg strength, and flexibility. The data were analyzed by descriptive and inferential statistics including bivariate analysis and multiple logistic regression.

Results: The results showed the related factors associated with musculoskeletal discomfort at any parts of the body, (as analyzed by logistic regression and adjusted by confounding factors), were history of previous job or extra job being at risk for musculoskeletal discomfort (OR 3.0, 95% CI = 1.5 - 6.2), ex-smokers (OR 2.2, 95% CI = 1.1 - 4.6) and ex-alcohol drinkers (OR 2.8, 95% CI 1.2 - 6.5). Regarding physical fitness, the associated factors with musculoskeletal discomforts were lower flexibility (OR 2.0, 95% CI 1.1 - 3.7) and lower grip strength (OR 0.5, 95.0% CU 0.3 - 1.0).

Conclusion: Musculoskeletal discomforts among firefighters are related to personal factors - including history of previous job or extra job, smoking, alcohol drinking, and physical fitness factor- i.e., lower flexibility. This study suggests health promotion programs to these firefighters to reduce modifiable risk factors, including smoking cessation campaign and regular exercise emphasizes in stretching.

Mental health, coping mechanism, social support, and the resilience of commercial pilots in Thailand during the period of COVID-19 situation

Chatchaval Tantisattamo — 2023-12-14

Background: The daily life of the commercial pilots in Thailand has greatly affected by the COVID-19 outbreak. These unpredictable situations impacted everyone directly and indirectly, especially, the commercial pilot’s mental health.

Objectives: This study aimed to investigate mental health, coping mechanisms, social support, resilience, and the related factors among commercial pilots during the COVID-19 pandemic.

Methods: Data were collected from 380 commercial pilots, including Thai AirAsia and Thai AirAsia X, between May to September 2022. Questionnaires were applied to collect data from samples including: 1) demographic data; 2) work information; 3) negative effects of COVID-19 among commercial pilots; 4) coping strategy; 5) social support; 6) resilience and 7) mental health.

Results: In all, 202 of the sample had abnormal mental health during the COVID-19 epidemic. Related factors to abnormal mental health that significantly less than 0.01 were lower income after the COVID-19 epidemic, having in debt, having psychiatric disorders, working for Thai AirAsia X, Overall effect from COVID-19 epidemic, e.g., effect on family, relationships, routine activities, work and career, finance and economy, and health, medium to high levels of emotionally focused coping, low level of social support on resource and material, low levels of resilience, e.g., withstand pressure, hope and encouragement, overcome obstacles, and overall of resilience. Single/divorced/widowed and low levels of overall social support were significant as P < 0.05. The significant predictors of abnormal mental health were having debt, working for Thai AirAsia X, being affected by routine activities, medium to high levels of emotionally focused coping, low level of social support on resources and material, low levels of resilience on withstand pressure, and hope and encouragement.

Conclusion: In all, 53.2% of the commercial pilots from a recent study had abnormal mental health during the COVID-19 epidemic. The predictor and factors that related to their abnormal mental health were having in debt, working for Thai AirAsia X, medium to a high level of affected by routine activity, medium to a high level of emotionally focused coping, low level of social support on resource and material, low level of resilience on withstand pressure, and hope and encouragement.

Effect of head-elevated prone position care for stable term neonates with tachypnea in transitional period: A randomized controlled trial

Namwan Kittikool — 2023-12-14

Background: Rapid shallow breathing in 2 - 6 hours after birth or transitional period is usually physiologic. Infants who still have respiratory rate over 60 breaths per minutes after two hours supportive care at Sirindhorn labor room must be admitted as sick newborn. This may cause an unnecessary admission and increase the risk of breastfeeding failure.

Objectives: Primary objective was to evaluate the benefit of prone position in reducing respiratory rate to 60 breaths per minute especially when complete two hours labor room treatment. Secondary objective was to compare the infants’ normal body temperature (36.5 - 37.5 °C) and optimum infants’ body temperature (36.8 - 37.2 °C) caring in different positions at two hours of age.

Methods: Two hundred subjects were randomized into head-elevated prone group and supinepositioned group. The subjects were term Thai neonate with stable tachypnea in transitional period. Both groups were received the same supporting care except for the care positions. The subjects’ respiratory rate and the relation between the duration were monitored and analyzed for normal respiratory rate and difference in positional care.

Results: The duration used for normal respiratory rate in a head-elevated prone group was significantly shorter than a supine-positioned group (P = 0.0004). Head-elevated prone care significantly increased cumulative number of subjects with normal respiratory rate within four hours (P = 0.01) and within six hours (P = 0.002) but no significant increase in cumulative number of subjects with normal respiratory rate within two hours (P = 0.234). At aged two hours, both groups had normothermia but the headelevated prone group had more optimum body temperature range (P = 0.02).

Conclusion: Head-elevated prone position care for stable term neonate with tachypnea in transitional period can significantly decrease infants’ respiratory rate within four hours compared to supine-positioned care.

Burn-out after COVID-19 pandemic: A survey of flight attendants of an airlines company in Thailand

Parawee Wattanasin — 2023-12-14

Background: Several airlines in Thailand underwent organizational difficulties following the COVID-19 outbreak, which had an impact on their flight attendants. Burn-out has become as an increasing concern, However, there are few studies on burn-out issues in the pandemic period among airline workers in Thailand.

Objective: This study aimed to prevalence of medium to high scale of burn-out and analyze the associated factors among flight attendants after COVID-19 pandemic.

Methods: This survey was conducted among 358 flight attendants from June to November 2022. The subjects completed a self-administered questionnaire including: 1) personal and work-related questionnaire; 2) stressful event questionnaire; 3) questionnaire examining the effects of the COVID-19 outbreak; and 4) the Maslach burnout inventory-general survey (MBI-GS) Thai version. Descriptive were used to report collected data and t - tests and one-way analysis of variance (ANOVA) were used to determine associated factors before identifying predictive factors by using multiple linear regression analysis.

Results: The study recruited 358 flight attendants (age range 26 - 58, mean age 39.0 ± 7.4 years). The prevalence of medium to high scale in emotional exhaustion, cynicism, and professional efficacy was 46.6%, 63.7%, and 56.4%, respectively. Predictive factors of emotional exhaustion included older age (P = 0.015), increased indebtedness (P = 0.01), schedule dissatisfaction (P = 0.012), a lower number of qualified aircraft (P = 0.007), decreased feelings of work stability (P < 0.001), sleeplessness (P = 0.041), higher stress scores (P < 0.001), and worse mental health (P = 0.011). Predictive factors of cynicism were non-leadership position (P < 0.001), schedule dissatisfaction (P = 0.001), decreased feelings of work stability (P < 0.001), higher stress scores (P < 0.001), and worse mental health (P = 0.015). Only nonleadership position was associated with professional efficacy (P < 0.001).

Conclusion: This study identified predictive factors of burn-out in three elements including personal, work-related, and mental health factors which are older age, financial stress, schedule dissatisfaction, decreased feelings of work stability, mental health status, stress levels, and sleep quality.

Comparison of intubation performance with different airway manikins by inexperienced hands, cross-over manikin study

Narong Jongaramrueng — 2023-12-14

Background: Endotracheal intubation (ETI) delay or failure may adversely affect patient outcomes. Therefore, airway simulation can solve this problem, but we must choose appropriate manikins for medical students.

Objectives: This study aimed to compare the application of various manikins for intubation performed by inexperienced hands and find the most effective manikins for simulation training.

Methods: This study was a prospective, randomized cross-over study. Subjects were randomly assigned to perform endotracheal intubation (ETI) using the direct laryngoscope and the video laryngoscope on three different manikins.

Results: The 32 subjects were divided into twelve internship physicians and twenty 6th year medical students. Their mean age is 24.8 ± 1.3 years, and the median number of successful intubations is 3.5 [interquartile range (IQR), 2.0 - 6.0]. The first intubation success rate in direct laryngoscope with mannikin 1 - 3 was 90.6%; Mannikin 1 illustrated the shortest time to successful ETI and showed all subjects can ETI on the first attempt. Manikin 3 with a direct laryngoscope, one internship, and two 6th year medical students failed first-time ETI. The internship group took less time than the 6th year medical student group.

Conclusion: Regarding the first intubation success rate, time to ETI, and ease of use, the manikin study demonstrated manikin 1 [Airway management trainer model (Laerdal, Norway)] is the most effective manikin for simulation training by inexperienced physicians.

Burnout syndrome among medical personnel involved in care of patients with neurological conditions at a tertiary care hospital in Bangkok Metropolis.

Anchalee Lertmingchaimongkol — 2023-12-14

Background: Medical personnel involved in care of patients with neurological conditions is dealing with unique group of patients with impairment of conscious and behavioral disturbances. Their job is assumed to be stressful and under pressure. However, the study on burnout syndrome in this group of medical personnel in Thailand is still lacking.

Objectives: The objective of this study was to investigate the prevalence and associated factors of burnout syndrome among medical personnel at a tertiary care hospital in Thailand.

Methods: A total of 107 medical personnel who are currently working with neurological patients were recruited. The questionnaires consist of: 1) Personal and work-related information; 2) 17 - item Happiness at work and job insecurity questionnaire; 3) Workplace violence questionnaire; and 4) Thai version of Maslach Burnout Inventory. Data were analyzed by descriptive and inferential statistics.

Results: The study showed 19.6% of subjects had a high level of burnout. Using logistic regression analysis, the factors significantly associated with high level of burnout are working with neurological patients on both inpatient and outpatient settings (OR = 10.43, 95% CI = 2.20 - 49.44, P < 0.05), had experienced psychological effects from verbal violence (OR = 3.75, 95% CI = 1.14 - 12.32, P < 0.01), and a score on item 4 of work happiness questionnaire (feeling of being motivated and empowered in workplace) (OR = 0.29, 95% CI = 0.12 - 0.69, P < 0.05).

Conclusion: Almost one-fifth of medical personnel caring for patients with neurological conditions had high level of burnout. The emphasis on work burden, treating others with respect especially verbally, and encouraging motivated and empowered activities in the workplace is essential to prevent high burnout.

Effect of self-concept clarity and social comparison on subjects’affect score

Dana Visitchaichan — 2023-12-14

Background: Self-concept clarity relates to one’s self-perception as clear, consistent, and temporarily stable. Social comparison is used to define the self, especially when uncertain about their own abilities and opinions.

Objectives: This study aimed to examine whether a self-concept clarity threat prime (versus control) influenced affect, after being exposed to an upward comparison target.

Methods: The study adopted a 2 (Self-Concept Clarity Prime: Threat versus Control)×2 (Comparison Target: Upward versus Control) between-subjects design. Subjects were randomly allocated into a selfconcept clarity priming manipulation threat (or control) and read about an upward social comparison target (or control), then rated their affect.

Results: Subjects primed with self-concept clarity threat showed significantly lower affect than control. Exposure to upward comparison (versus control) showed no significant difference in affect. Additionally, the affect was significantly worse for threatened subjects (versus control) following upward comparison (versus control).

Conclusion: These findings provide broad implications and could act as a strategy to raise the affect score of those with low self-concept clarity during the social comparison procedure by boosting a reflection response from them. Future studies should diversify the sample to include a variety of cultures and ages to limit sample selection bias.

Stress of grade 9 students taking an extra course for the admission examination of Triam Udom Suksa School and Mahidol Wittayanusorn School

Wijittaporn Somchai — 2023-12-14

Background: Students are stressed for various reasons during their studies. Major stress for grade 9 students is the admission examination for the potential high school. Thus, they prepared themselves by taking an extra course.

Objective: This study aimed to investigate the level of stress and the relationship of factors related to stress among the students in grade 9 who prepared themselves for high school, Triam Udom Suksa School and Mahidol Wittayanusorn School by taking extra courses.

Methods: A total of 312 students in grade 9, who took an extra course for the admission examination of Triam Udom Suksa School and Mahidol Wittayanusorn School, were recruited. The measurements were 5-demographic sections and the Suanprung Stress Test (revised).

Results: Most of the grade 9 students from the recent study were female. Their mean age was 14.7 years. Most of them had severe stress levels (62.8%) followed by high-stress levels (14.7%). The statistically significant factors that were relevant to students’ stress included female students, the family had debt, studying affect stress, moderated satisfaction levels with one’s preparation, and reasons for choosing schools.

Conclusion: Most students had stress. The results showed that competitive exams for the higher potential high school had meaning to them especially encouraging their future. Thus, oneself, family, friends, teachers, and social expectations will push more stress on their academic performance. Relevant people should be concerned about students’ mental health, especially stress.

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Stability of anti-N clone 1391G2 antibody secreting cell line

Siriporn Ponsen — 2023-12-14

Background: Cell line secreted anti-N (1391G2) is a murine monoclonal hybridoma cell that Antiserum and standard cell preparation section, National Blood Centre, Thai Red Cross Society used for culture and expand in large scale for harvest supernatant to produce blood group reagent anti-N for distributing to blood bank and hospital in Thailand. Therefore, this cell line must be regularly tested for stability of antibody secreting.

Objectives: This study aimed to maintained and select perfectly cell line secreted anti-N (1391G2) 3 generations.

Methods: Cell line secreted anti-N 1st generation namely 1391G2 was thawed from liquid nitrogen and selected the best single cell line with character of good growth rate and high titer antibody secreting using limiting dilution method. After that, selected cell line will be frozen in liquid nitrogen for 7 days. In addition, the 1st generation cell line that separated from freezing was cultured for harvest supernatant to serology test. The 2ndgeneration cell line was thawed after frozen for 7 days for limiting dilution method again until 3rd generation. Serology test of supernatant from all generation cell line consisted of antibody identification with panel cell and antibody titration with red blood cell group O that has M-N+ and M+N+ antigen.

Results: Anti-N cell line 3 generations stably expressed anti-N which antibody titer with M-N+ and M+N+ were 128 and 64, respectively.

Conclusion: All generation of anti-N titer was comparable to American Association of Blood Banks (AABB) standard. This result validates the quality of anti-N production for blood typing reagent from Nation blood center, Thai red cross society to ensure safety of blood donation and transfer process.

Comprehensive violence safety checklist for Psychiatric Outpatient Clinic

Aschara Loybundid — 2023-12-14

Background: The prevalence of violence in psychiatric outpatient services is on the rise, posing risks to the well-being and safety of medical personnel. This includes physical and verbal aggression, resulting in injuries, disabilities, deaths, and increased anxiety levels.

Objectives: This study aimed to address the need for violence prevention and response in outpatient psychiatric services by developing a comprehensive safety checklist.

Methods: A qualitative study was conducted, incorporating in-depth interviews with 12 medical personnel and a literature review. The findings were utilized to develop the comprehensive safety checklist, which underwent revision and validation by five mental health experts to ensure its construct validity. Subsequently, 50 mental healthcare professionals evaluated their services using the checklist, and the collected data were analyzed to assess the checklist’s quality.

Results: The comprehensive violence safety checklist comprises 40 rating-scale items. The scale demonstrated excellent content validity, with a score of 0.98. The internal consistency of the checklist was high, indicated by a Cronbach’s Alpha value of 0.88. All items exhibited a Corrected Item-total Correlation greater than 0.2. Furthermore, 65.0% (26/40) of the items significantly discriminated between the 25th and 75th percentile groups.

Conclusion: The developed comprehensive safety checklist serves as a valuable tool for evaluating the level of security for violence within psychiatric out-patient services. Its exceptional quality, high internal consistency, and satisfactory discriminative power make it an effective instrument for enhancing safety in psychiatric settings.

Impacts of integrated multidisciplinary care in heart failure clinic among tertiary care level hospitals: A retrospective cohort study

Artit Torpongpun — 2023-12-14

Background: Heart failure (HF) causes a high morbidity and mortality rate and is also one of the most common causes of unscheduled hospital admissions.

Objective: To determine clinical outcomes of high-risk heart failure patients treated by multidisciplinary care at Chonburi HF clinic.

Methods: A retrospective cohort study was conducted in the HF clinic at Chonburi Hospital. Data included rehospitalization, quality of life score, knowledge score, 6 minute walk test, left ventricular ejection fraction (LVEF), percent of achieving a standard dose of HF medications, and cost of HF hospitalization at baseline and 6^thto 12^th month follow-up.

Results: Eighty-two patients were treated and followed up at the HF clinic from 1^st February 2017 to 19^th February 2020. Mean age was 56.7 ± 14.5 years, and 43 patients (51.2%) were male. Sixty-seven patients (81.7%) were previously admitted from acute decompensated HF. The baseline means LVEF (%) was 33.2 ± 12.8. After entering the HF clinic, the total HF hospitalization was reduced from 1.4 times/person-year to 0.2 times/person-year (7 time reduction). The mean LVEF (%) was increased to 45.0 ± 15.4 and 49.9 ± 13.1 at the 6^th and 12^th months, respectively. The 6 minute walk test (meter) had improved from 369.0 ± 132.2 (in the 6^th month) to 399.0 ± 153.3 (in the 12^th month). The cumulative hospitalization cost before the HF clinic of 1,831,660.00 Baht was reduced to 105,128.75 Baht (17-time reduction).

Conclusions: A multidisciplinary approach to managing high-risk HF patients can substantially reduce rehospitalization rates and costs. These programs have improved LVEF, symptoms, quality of life, and HF knowledge and helped achieve the treatment to target dose of HF standard medications.

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