Journal of Health Science and Medical Research

Factors Associated with Pelvic Floor Muscle Strength in Women with Pelvic Floor Dysfunction Assessed by the Brink Scale

Sirirat Sarit-apirak, Jittima Manonai, Umaporn Udomsubpayakul — Tue, 29 Oct 2019 00:00:00 +0700

Objective: (1) to examine the pelvic floor muscle (PFM) function using the Brink scale and (2) to investigate the correlation between potential factors and PFM function.
Material and Methods: From January 2011 and December 2014, women with at least one pelvic floor symptom attending the urogynecology clinic were included in a medical record review. Demographic and pelvic floor symptoms were assessed. The Brink scoring system was used to assess the PFM function. The association between factors and Brink scale scores was measured using Pearson’s Correlation Coefficient.
Results: Five hundred and seventy-nine women with a mean age of 64.40±10.11 years were included in the analysis. Forty-seven women (8.1%) were unable to contract their pelvic floor muscle at all, while 55 (9.5%) could both powerfully and properly. The mean Brink scale score was 7.82±2.56. Elderly women had a significantly lower score than younger women (mean scores of 7.56±2.60 and 8.08±2.50, respectively) with the mean score in nulliparous and parous women being 8.66±2.63 and 7.76±2.55, respectively (p-value=0.046). A negatively weak correlation was found among those with higher total scores and advancing age (correlation (r)=-0.106), advanced anterior (r=-0.095) and apical compartment (r=-0.105) prolapse (p-value<0.05).
Conclusion: Almost all the women with pelvic floor dysfunction had compromised pelvic floor function. Important factors affecting PFM strength are age, parity, and history of hysterectomy. Increasing age, higher stage of anterior and apical compartment prolapse were negatively correlated with PFM function.

Quality of Life in Diabetic Patients in the Primary Care Unit

Fri, 08 Nov 2019 00:00:00 +0700

Objective: This study aimed to evaluate the level of quality of life and related factors in type 2 diabetic patients who were followed up at the Primary Care Unit of a university hospital in southern Thailand.
Material and Methods: A cross-sectional study was conducted in type 2 diabetes patients who were continuously followed up at the primary care unit. Quality of life was the primary outcome assessed by the World Health Organization Quality of Life Brief-Thai questionnaire and related factors were analyzed using the multivariate generalized linear model.
Results: This study included 158 patients who fit our eligibility criteria. The median age was 66 years old and median duration of diabetes was 10 years. Most had comorbidities and a quarter had diabetic complications. The results show 64.6% of the study sample had a good level of quality of life and no one had a bad level of quality of life. The results of multivariate generalized linear model show that no factors were associated with overall quality of life. Obesity was statistically significantly associated with a lower quality of life in the physical health dimension [odd ratio (OR)=0.35 (0.14, 0.89), p-value=0.027] and diabetic complications were associated with a lower quality of life in the psychological dimension [OR=0.27 (0.08, 0.85), p-value=0.025].
Conclusion: Most diabetic patients had a good quality of life. There were no factors associated with overall quality of life, but obesity and diabetic complications were statistically significantly associated with some dimensions of quality of life. Healthcare providers should assess aspects of quality of life in patients with chronic diseases.

Health Utility Scores of Hearing-Impaired Thais

Fri, 22 Nov 2019 00:00:00 +0700

Objective: To assess the health utility scores of Thais with hearing loss, which can be used as a reference value for assessing health-related quality of life and economic evaluations in any interventions among hearing-impaired persons in Thailand.
Material and Methods: All hearing-impaired persons who visited Songklanagarind Hospital between January and June 2019 were recruited for the study. The demographic and clinical data of the participants including gender, age, and type and degree of hearing loss were collected. A health-related quality of life interview was conducted using the EuroQoL five dimensional questionnaire, Thai version. Independent t-test and multiple linear regression analysis were performed to assess which factors were associated independently with the health utility scores.
Results: One hundred and eleven participants, 46 males and 65 females, ranging in age from 22 to 92 years, were recruited for the study. The average health utility scores were 0.81 and 0.86 for subjects not using and using hearing aids, respectively, similar to the results from other nations. The average health utility score of subjects with underlying diseases (0.79) was lower than the average health utility score of subjects without underlying diseases (0.87) with statistical significance (p-value=0.038). Additionally, the pure tone average in the better ear was the only variable significantly associated with the health utility scores (regression coefficient: -0.004, p-value=0.002).
Conclusion: The average health utility scores among hearing-impaired Thais were 0.81 and 0.86 for subjects not using and using hearing aids, respectively.

Ergonomic Recommendation of Suitable Toilet Seat Height for Older Thai People

Pornthip Tharbthong, Samerjit Homrossukon, Pagamas Piriyaprasarth — Tue, 26 Nov 2019 00:00:00 +0700

Objective: This study aimed to determine the main factors affecting older people as they rise from a toilet seat and to identify the suitable toilet seat height for this population.
Material and Methods: Data from 342 older people both male and female aged 60 years and older were used to design a mock-up toilet with a specified seat width according to the 95th percentile of hip breadth. The data of lower leg length were used to design toilet seat height levels in the second phase in another 30 older participants at 100.0%, 110.0% and 120.0% of an individual’s lower leg length (LLL). Rectus femoris and gluteus maximus muscle activity, time taken while rising, pressure under the thighs and satisfaction of the older participants were compared across three toilet seat height levels; using the repeated analysis measurements of variance. These three potential factors were then analyzed together with the prioritized factor indicated by the specialists using the Analytic Hierarchy Process.
Results: Rectus femoris muscle activity, time taken while rising, and satisfaction of the older participants in rising from toilet seat heights 100.0, 110.0 and 120.0% LLL were significantly different (p-value<0.05).
Conclusion: It was found that the suitable toilet seat height level for older people for industrial ergonomic purposes was at 110.0% LLL, which was also equivalent to the 95th percentile of male and female LLL.

Assessment of Type 2 Diabetes Patients’ Knowledge of Oral Hypoglycemic Agents

Mon, 02 Dec 2019 00:00:00 +0700

Objective: Considering that adherence level affects diabetes treatment success and maintenance of glycemic control greatly, the aim of this study was to examine diabetes patients’ adherence to oral hypoglycemic agents (OHAs) and knowledge about their mechanism of action, dosing regimen, and side effects.
Material and Methods: This cross-sectional study was conducted on a sample of 100 patients with type 2 diabetes in order to assess their knowledge of OHAs using anonymous questionnaires.
Results: Most patients had used OHAs between 2 and 5 years (61.0%), where 78.0% were treated with metformin, and the remaining 22.0% were prescribed sulfonylurea derivatives. Besides drugs used for the treatment of type 2 diabetes, 58.0% of patients took another 1-3 drugs daily for the treatment of other conditions. Although 75.0% achieved a score of 5-6 out of the maximum score of 8, only 2.0% of respondents listed at least 2 side effects of the OHA they used, and none of them could explain its mechanism of action. Most of the information about OHAs was given to patients by endocrinologists (53.0%).
Conclusion: More than half of participants considered their knowledge of OHAs insufficient. Results clearly indicate that the respondents were not sufficiently familiar with the mechanism of action and possible side effects of such medications. Information about OHAs given in written form as well as via community pharmacists would contribute to educating type 2 diabetes patients significantly.

Caring for Thai Traumatic Brain Injury Survivors in a Transitional Period: What Are the Barriers?

Mon, 09 Dec 2019 00:00:00 +0700

Objective: We aimed to explore the situations and experiences of Thai traumatic brain injury (TBI) caregivers and nurses who care for TBI patients during their transition from hospital to home.
Material and Methods: A descriptive qualitative study was conducted in a tertiary hospital, in Songkhla province, Thailand. Five TBI family caregivers and nine nurses, who cared for TBI patients from admission to discharge, were selected for in-depth interviews and focus group discussions. Reviews of existing documents related to caring for someone during a transition period; such as: the caregiver’s booklet manual, nurse’s guideline, discharge education, and the service plan were also analyzed. Content analysis was used to explore caring for someone during a TBI situation, within the Thai context.
Results: The findings revealed six main barriers in the current care system for TBI caregivers and nurses. These included: (1) inadequate discharge teaching information, (2) less time in caregiver’s supervision and support, (3) lack of a comprehensive discharge plan, (4) lack of coordination and communication in follow-up care, (5) less confidence in providing care without support at home, and (6) poor availability of resources and time for consultation.
Conclusion: Caregivers require more information and supportive care in order to enhance their adaptation in taking care of TBI patients in the long term. Developing a tele-nursing based caregiver transitional support program among TBI caregivers is suggested.

A Comparison of Intra-Observer and Inter-Observer Reliability of Plain Radiographs, Standard Computed Tomography Scans and Mobile Computed Tomography Scans in the Assessment of Distal Radius Fractures: A Cadaveric Study

Thu, 26 Dec 2019 00:00:00 +0700

Objective: Diagnosis of a distal end radius fracture relies on various imaging studies. However, the relative usefulness of these studies is still a matter of some controversy. The aim of this study was to compare the intra-observer and inter-observer reliability of plain radiographs, standard computed tomography (CT) scans and mobile CT scans in the assessment of distal radius fractures as categorized by the Fernandez classification method. The secondary objective was to compare the dosages of radiation between the different imaging modalities.
Material and Methods: Sixteen fresh cadaveric wrist bones were used in this experimental study. The desired fractures were created in the bones to mimic Fernandez types I-V fractures and plain radiographs were taken in 4 views. Standard CT and mobile CT scans were also taken with the fractured bones in the same four positions. Interobserver reliability was assessed using Kappa statistics to determine the diagnostic consistency among the nine observers. Inter-observer agreement was assessed based on the Fernandez classification system diagnoses.
Results: Overall, the inter-observer agreement was substantial for the Fernandez classifications (Kappa range 0.636 0.727) in all types of imaging. For intra-observer agreement, the analysis found higher agreement for both standard CT scans and mobile CT scans. The standard CT images imparted a higher average dose of radiation than both the mobile CT scans and the plain radiographs.
Conclusion: The mobile CT scan can provide an alternative imaging method for precise diagnosis of distal end radius fractures, with the additional benefits of mobility and lower radiation exposure.

The First Awake Craniotomy for Eloquent Glioblastoma in Southern Thailand

Thu, 19 Dec 2019 00:00:00 +0700

Awake craniotomy (AC) with direct cortical stimulation is becoming the gold standard for functional brain mapping. It is used to identify the safe brain area before pathologic resection. This method indicates the pathology near or at the eloquent cortex, such as gliomas or metastasis. AC can optimize the patient’s quality of life and oncologic outcome. This task requires the active cooperation of a patient care team familiar with advanced neuroscience and challenging to learn. We report the first time this operation which performed in our institute with technical details, in terms of anesthesia, and surgical aspects.

Multiple Cranial Neuropathies Caused by Lymphoma-Associated Central Nervous System Involvement in an Immunodeficiency Virus Patient

Sumonthip Leelawai, Pat Korathanakhun — Thu, 26 Dec 2019 00:00:00 +0700

Human immunodeficiency virus (HIV) infections increase the risk of malignant lymphoma. Although, lymphoma is a rare cause of central nervous system involvement, it can present as an initial HIV symptom. We report the case of a 35-year-old HIV patient who developed multiple cranial neuropathies. He was diagnosed with diffuse large B-cell lymphoma with meningeal metastasis.