Journal of Medicine and Health Sciences

Menopausal symptoms and work productivity loss among nurses in a hospital in Bangkok

2024-12-22T17:12:35+07:00

Menopause is an inevitable phase in women’s lives, often affecting daily routines and professional roles. This study examines the association of menopausal symptoms and work productivity loss among nurses in one of hospitals in Bangkok. This census-based, cross-sectional study examined nurses aged 45-60. Questionnaires were used to collect the Menopausal symptoms using the Menopausal Rating Scale (MRS), categorized into no/little, mild, moderate, and severe symptoms, While work productivity loss was measured using the Work Productivity and Activity Impairment: General Health (WPAI:GH) questionnaire. Multiple logistic regressions analyzed factors linked to menopausal symptoms, Multiple linear regressions assessed their relationship to work productivity loss. A total of 182 responses were collected. The overall prevalence of menopausal symptoms among nurses in this study was 74.2%. In terms of severity, the frequencies and percentages for no/little, mild, moderate, and severe symptoms were 25.8%, 20.9%, 35.7%, and 17.6%, respectively. The top three symptoms reported were muscle/joint discomfort, physical and mental exhaustion, and sleep problems. Alcohol use was found to be significantly associated with menopausal symptoms, aOR 3.65 (95% CI 1.03-12.94). The means and standard deviations for percentages of absenteeism, presenteeism, and overall work impairment were 1.13 (6.99), 28.52 (20.18), and 29.00 (20.85), respectively. Severe menopausal symptoms were significantly associated with percent presenteeism and overall work impairment, with adjusted mean differences of 20.84 percentage point (pp) (95% CI 11.10-30.59) and 20.49 pp (95% CI 10.39-30.58), compared to no/little symptoms. The associations of menopausal symptoms and work productivity loss, presenteeism and overall work impairment, found in this study were consistent with prior studies. Mean differences in percentage of presenteeism and overall work impairment increased with symptom severity; however, the results were not statistically significant. Findings in this study suggest that nurses with severe symptoms should be identified, supported, and provided with appropriate interventions or treatments to prevent costs from health-related productivity loss. And early retirement increase work productivity and hospital quality service in the future.

Antioxidant activity and phytochemical of agricultural waste from Cannabis sativa

2024-12-16T11:23:04+07:00

Oxidative stress is a case of several diseases such as cancer, Alzheimer's disease, neuroinflammation and neurodegenerative diseases. The plant is an antioxidant agent that can inhibit the oxidative stress. Therefore, this study aimed to analyze the chemical composition and evaluate the antioxidant activity of waste parts from the Peanut Butter Breath strain, leaves, twig, roots, and stems. The results showed that cannabis leaves yielded the highest extract at 6.37% and exhibited the strongest antioxidant activity using DPPH and ABTS assays, with the IC50 values of 149.81 µg/mL and 39.06 µg/mL, respectively. Moreover, cannabis leaves contained the highest total phenolic compounds and total flavonoids with values of 83.44 mg GAE/g extract and 75.79 mg QE/g extract, respectively. Chemical composition analysis using gas chromatography mass spectrometry (GCMS) revealed a diversity of compounds in different plant parts. High levels of tetrahydrocannabinol (THC) and cannabinol (CBN) were found in leaves, while roots contained high amounts of triterpenes and sterols such as friedelan-3-one and friedelanol. This study highlights the potential of cannabis waste, particularly leaves, for development into antioxidant-rich products with possible applications in the pharmaceutical, cosmetic, and dietary supplement industries. Furthermore, utilizing cannabis waste aligns with the circular economy concept, adding value to agricultural byproducts and reducing environmental impact. However, further research on the safety and efficacy of extracts from various cannabis parts in real-world applications is necessary to develop high-quality and safe products for consumers.

Etiology, risk factors and clinical outcomes of pediatric burn injuries at King Narai Hospital

2024-12-12T22:25:16+07:00

Burn injuries are a significant global public health problem, predominantly occurring in low- to middle-income countries, with children being the highest-risk group. These injuries impact patients and their families physically, mentally, emotionally, and socially. Additionally, they affect the growth, development, and quality of life of the patients. The aim of this retrospective study was to investigate the etiology, risk factors, and clinical outcomes of pediatric burn injuries at King Narai Hospital. The sample group consisted of pediatric patients aged 0–15 years who were diagnosed with burn injuries and admitted to King Narai Hospital between October 1, 2017 and September 30, 2023. There were 98 patients enrolled in the study. Data collection tools included a data recording form, and the data were analyzed using descriptive statistics and Poisson regression analysis. The research findings showed that 54 patients (55.10%) were male, and 69 patients (70.40%) were aged 0–5 years. The main cause was scalding in 97 patients (98.98%). The severity level was moderate burn in 85 patients (86.73%), and the depth of the burn was superficial-partial thickness burn in 57 patients (58.16%). The most common injury location was the lower extremities, found in 64 patients (65.30%). The average percentage of total body surface area (% TBSA) was 14.01±11.31. The incidents predominantly occurred as household accidents in 97 patients (98.98%). A total of 84 patients (85.71%) underwent debridement surgery. The most common complication was hypovolemic shock, observed in 12 patients (12.24%). This was followed by burn wound infection in 6 patients (6.12%), with no fatalities reported in the study. The factors significantly associated with complications in pediatric burn injuries (p < 0.05) were patients aged 0–5 years, Total Body Surface Area (TBSA) greater than or equal to 20% and maternal age under 25 years. In conclusion, burn injuries in pediatric patients at King Narai Hospital were caused by household accidents, specifically scalds. Most injuries were moderate and superficial-partial thickness burns. The factors associated with complications in pediatric burn injuries were patients aged 0–5 years, TBSA greater than or equal to 20% and maternal age under 25 years.

PONV prophylaxis effect of ondansetron combined with subhypnotic dose propofol or dexamethasone in women undergoing elective laparoscopic surgery

2025-03-14T08:54:14+07:00

Postoperative nausea and vomiting (PONV) is common postoperative complication, result of patient discomfort and other serious complications. Laparoscopy is high risk surgery for PONV. PONV prophylaxis with multiple drug strategy is more effectively than one drug especially in high risk patient. The objective of this study was to measure PONV incidence after prophylaxis with 2 drugs regimen, subhypnotic dose propofol 0.5 mg/kg combined with ondansetron 4 mg (P group) compared with dexamethasone 4 mg combined with ondansetron 4 mg (D group). This study was prospective randomized controlled trial. Inclusion criteria were female adult patients 18-60 years old undergoing elective laparoscopic surgery. Primary end point was PONV incidence in 24 hours postoperatively. Secondary outcomes were rescued antiemetic metoclopramide dose, PONV severity and extubation time. The result showed among 90 patients, found 9 cases of PONV. The incidence of PONV was 10%, P group 5 cases (11.11%) and D group 4 cases (8.89%). There were not statistically significance between the two groups (p-value 0.73). Most patients had PONV during 6-12 hours postoperatively. The most common PONV severity was grade 2. Metoclopramide dose and extubation time were not difference. Mean dose of propofol for PONV prophylaxis in P group was 32.13 ± 5.55 mg. This study concluded that PONV incidence in patients who received 2 drugs for PONV prophylaxis was 10%. Subhypnotic dose propofol plus ondansetron had similar PONV prophylaxis effect as dexamethasone plus ondansetron in female undergoing elective laparoscopic surgery.

Impact of case-based learning on self-reflection and academic achievement in clinical hematology education

2025-03-31T23:08:47+07:00

Case-Based Learning (CBL) is a widely used educational approach that encourages active learning and critical thinking. According to situated cognition learning theory, learning occurs more effectively when students engage in real-world scenarios. While CBL has been extensively used in medical education, its impact on self-reflection and academic performance in specific hematology topics, such as anemia and bleeding disorders, remains unclear. This study aims to evaluate the effects of CBL on self-reflection and academic performance among fourth-year medical students, focusing on anemia and coagulation disorders. This randomized controlled trial (RCT) included 70 fourth-year medical students, divided into a CBL group and a Lecture-Based Learning (LBL) group. Both groups completed pre-tests, post-tests, and submitted two self-reflection reports. The study covered two topics: (1) Anemia and Thalassemia and (2) The Bleeding Disorders and Snake bite. The self-reflection process was assessed using a rubric score. Results: found that students in the CBL group demonstrated significantly higher levels of self-reflection than those in the LBL group (p=0.002), particularly in areas such as integrating new knowledge with prior understanding, evaluating clinical decision-making, and synthesizing case-based information. In contrast, students in the LBL group more likely to remember contents than LBL group. Regarding academic performance, the LBL group achieved higher post-test scores than the CBL group, especially in topics requiring in-depth understanding of thalassemia and the clinical evaluation of snakebite envenomation (p=0.014 and p=0.044, respectively). These topics involve recognizing specific hematological conditions and applying standard treatment guidelines. In conclusion, this study highlights the importance of CBL in enhancing self-reflection and analytical skills in medical students. However, LBL may be more effective for content requiring memorization and structured learning. A combined approach incorporating both CBL and LBL could maximize learning outcomes.

Association between tumor location, tumor-to-skin distance, and axillary lymph node metastasis in breast cancer

2025-03-13T20:06:30+07:00

Breast cancer is the most commonly diagnosed cancer in women. Axillary lymph node metastasis (ALNM) is an essential prognostic factor, as a higher number of metastatic lymph nodes is associated with increased mortality and recurrence rates. The majority of lymphatic drainage from the breast occurs via dermal and subareolar plexuses. This study hypothesized that tumors located closer to the skin or within the subareolar region may have a higher propensity for ALNM via lymphatic pathways. These findings could guide future treatment strategies for breast cancer. However, only a limited number of studies have explored this hypothesis. This study was conducted a retrospective review of invasive breast cancer patients diagnosed and treated at Phrachomklao Hospital, Phetchaburi Province, from June 1, 2020, to June 30, 2024. Bivariate and multivariate logistic regression analyses were performed to evaluate the relationship between tumor location and tumor-to-skin distance with ALNM. Of the 200 eligible patients, 102 patients (51%) had positive axillary lymph node status. The analysis revealed tumors located in the subareolar region were significantly associated with an increased likelihood of ALNM (adjusted odds ratio: 13.82, 95% confidence interval: 1.59-119.51, p=0.017). However, the tumor-to-skin distance did not show a statistically significant relationship with ALNM. In summary, sonographic tumor location can serve as a prognostic factor for ALNM. Specifically, tumors located in the subareolar region are significantly associated with an increased likelihood of ALNM.

Prevalence of poor sleep quality and its associated factors among older adults attending the outpatient department at Phramongkutklao hospital

2025-03-21T08:41:34+07:00

The world is rapidly transitioning into an aging society. One of the common health problems among older adults is insomnia, which can lead to reduced quality of life and affect both physical and mental health. This study aimed to determine the prevalence of poor sleep quality among older adults and its associated factors including the prevalence of mild cognitive impairment and depressive disorder through a cross-sectional study of 200 adults aged 60 years and above who sought services at the outpatient department of Phramongkutklao hospital from November to December 2024. Data collection was conducted using interview questionnaires about demographic and general health information, the Thai Pittsburgh Sleep Quality Index (Thai-PSQI), Sleep Hygiene Assessment, Mini-Cognitive Assessment (Mini-Cog), and the Thai Geriatric Depression Scale (TGDS-15). Analysis employed descriptive statistics and multivariate logistic regression to identify factors associated with poor sleep quality. Results showed that the sample had a mean age of 69.6 years (S.D.=6.0), with a prevalence of poor sleep quality at 79.5% (95%CI: 73.4-84.6) and a median Thai-PSQI score of 8.5 (IQR=6-11). The analyses of related factor revealed that sleep efficiency reduced the risk of poor sleep quality with an adjusted OR=0.73 (95%CI: 0.63-0.84), while education below associate degree level increased the risk with an adjusted OR=9.79 (95%CI: 1.070-89.46). In this population, the prevalence of suspected cognitive impairment was 61.5% (95%CI: 54.6-68.0) and suspected depression was 9.5% (95%CI: 6.2-14.4). In conclusion, most older adults experience poor sleep quality and show a high prevalence of concurrent psychiatric and neurological conditions. Healthcare professionals should therefore focus on screening, promoting, and preventing sleep disorders in older adults, with emphasis on providing knowledge to improve sleep efficiency and caring for those with education below associate degree level to enhance quality of life and reduce the risk of related diseases.

Prevalence and classification of traumatic orbital fractures using computed tomography: A study from Phranakorn Sri Ayutthaya hospital

2025-03-28T21:30:34+07:00

Orbital fracture was often found after trauma to orbital or periorbital regions. The etiology of orbital fracture was caused by pressure effect to orbit or periorbital regions then result in orbital fracture. Some patients have improved symptom without any treatment. Some patients have more than half of orbital fracture and have complications including enopthalmos and muscle entrapment, result in blurred vision and decreased visual acuity if no immediate treatment in the proper time. The radiologist has the important role to diagnose orbital fracture and further proper operative management. A descriptive study was performed. 416 patients who received a computed tomography of maxillofacial bone in Phranakorn Sri Ayutthaya Hospital investigation between January 1, 2022 and December 31, 2023 were identified in 2 years. All patients were reviewed for CT imaging by one radiologist. Data recorded included gender, age, location of fracture and etiology of fracture. Descriptive analysis was used for reporting the prevalence of orbital fracture and the etiology of injury and types of fracture. 354 patients with diagnosed orbital fracture were found (85.1%). 294 patients (83.1%) of the patients were males. Most orbital fracture found between 21-30 years (n=86, 24.3%). The most common cause of orbital fractures was motor vehicle accident (n=380, 91.3%). The most common type of orbital fracture was combined fracture (n=330, 93.2%). The most common number of wall fracture was more than one wall (n=280, 79.1%) The most common location of orbital fracture was a floor fracture (n=276, 78%). The results of this study could be help the physician for accurate diagnosis and planning iteration particularly in ginger male who had car accident group.

Predictive model for cerebrovascular disease risk factors using ant-miner algorithm

2025-03-03T07:57:40+07:00

Stroke remains a leading cause of mortality and disability worldwide, with a significant impact on public health. Early accurate risk assessment and diagnosis are crucial for effective prevention and treatment strategies. This study aimed to analyze medical data of cerebrovascular disease from an international database, extract beneficial risk factors related to diagnosis, and create an advanced model for stroke diagnosis using data mining techniques. Methods: We analyzed data from the Stroke Prediction Dataset, comprising 5,110 patient records with 11 clinical attributes. Multivariate logistic regression analysis was employed to identify significant risk factors. The Ant-Miner Algorithm, inspired by ant colony behavior, was utilized to develop a diagnostic model for stroke. The model's performance was evaluated using 5-fold cross-validation and compared with other machine learning techniques, including Decision Trees and Random Forest. The results found that identified age over 65 years (OR = 3.72, 95% CI = 2.86-4.84), hypertension (OR = 2.98, 95% CI = 2.31-3.84), heart disease (OR = 2.75, 95% CI = 2.07-3.66), and high blood glucose levels (OR = 2.45, 95% CI = 1.89-3.17 for >150 mg/dL) as the most significant risk factors for stroke. The Ant-Miner Algorithm-based model excelled in handling imbalanced medical data, generating interpretable clinical rules high and valuable for clinical decisions. It achieved 98.24% accuracy, 92.00% precision, 90.20% sensitivity, and 91.09% F1-score. These explainable rules, like “IF (age>65) AND (avg_glucose>150) AND (hypertension=1) THEN high stroke risk with OR = 27.12”, are applicable in real-world stroke diagnostics. In conclusion, the Ant-Miner algorithm model proved to be an accurate and stroke diagnostic model which simply identifies risk factors and diagnostic rules that can aid in early detection and prevention of stroke, potentially improving clinical decision-making through this data mining innovation. Further studies are recommended to validate the model's performance in other diseases of diverse populations and to explore its potential applications in clinical practice and public health interventions. The integration of this model with electronic health records and the development of user-friendly applications for healthcare professionals could significantly enhance stroke risk assessment and management tools.

Association with low muscle mass in patients with knee osteoarthritis in rural areas of Surin province

2025-04-12T23:06:00+07:00

Sarcopenia in patients with knee osteoarthritis (OA) contributes to increased disease severity, including decreased physical performance, increased risk of falls, increased pain intensity, and abnormal knee alignment. Previous studies on the prevalence of sarcopenia among older adults with knee OA have mostly been conducted in urban areas using various diagnostic tools, resulting in inconsistent findings. This study aimed to determine the prevalence and associated factors of sarcopenia among patients with knee osteoarthritis living in rural areas. A cross-sectional study was conducted among 197 individuals aged 50 years and older diagnosed with knee OA, attending sub-district health-promoting hospitals in Sangkha District, Surin Province, Thailand. Data were collected using general demographic questionnaires, the Mini Nutritional Assessment (MNA), and the SARC-F questionnaire for sarcopenia screening. Descriptive statistics, chi-square test, Fisher’s exact test, and independent t-test were used for data analysis.The demographic and clinical characteristics showed that most participants were female (82.2%) with a mean age of 66 years. The most common age group was 60–69 years (41.1%). Most participants (66%) had comorbidities, with an average knee pain duration of 61 months. Normal body mass index (BMI) was observed in 35% of participants, while 28.9% were classified as obese class II (BMI ≥ 30 kg/m²). Most participants had low physical activity levels (44.2%). Regarding nutritional status, 51.8% had normal nutrition, 44.7% were at risk of malnutrition, and 3.6% were malnourished. The prevalence of sarcopenia among knee OA patients was 56.9%. Factors significantly associated with sarcopenia included age group, education level, physical activity level, duration of knee pain, pain intensity, and nutritional status. The high prevalence of sarcopenia among patients with knee OA in rural areas highlights the need for early screening and assessment by physicians, physical therapists, and multidisciplinary healthcare teams. Integrating sarcopenia assessment into knee OA management plans may lead to more appropriate and effective interventions tailored to individual patient needs.

Efficacy of sublingual misoprostol with intravenous oxytocin for reducing blood loss after vaginal delivery in women at risk of postpartum hemorrhage: A double-blind randomized controlled trial

2025-04-11T22:45:52+07:00

Postpartum hemorrhage is the most common obstetric complication in those with risk factors. Therefore, consideration of uterotonic agents in addition to standard drugs to prevent early postpartum hemorrhage is necessary. This study aims to examine efficacy of sublingual Misoprostol with intravenous Oxytocin for reducing blood loss after vaginal delivery in women at risk of postpartum hemorrhage. The samples were term pregnant women with risk factors. The experimental group (112) received sublingual misoprostol 400 mcg plus intravenous oxytocin 10 IU; the control group received intravenous oxytocin plus placebo tablets after delivery. Primary outcomes to compare the mean blood loss, and decreased hemoglobin. Secondary outcomes to examine the rate of early postpartum hemorrhage, and adverse avents. Statistical analysis were chi-square test, Mann-Whitney U test, and Independent t-test. Results: there were no statistical differences characteristic in both groups: age, gravida, parity, gestational age, BMI, hemoglobin, risk factors, delivery time, and birth weight. The mean blood loss was significantly lower in the experimental group than the control group (394.73±135.80 ml, 455.79±169.67 ml, p=0.003), mean decreased hemoglobin was significantly lower than the control group (0.88±0.35, 1.11±0.73 g/dl, p=0.026), rate of early postpartum hemorrhage was significantly lower than the control group (17.86, 29.72 %, p=0.043). The experimental group had more shivering and fever than the control group (17.86, 1.75 %, p=0.000 and 51.79, 2.63 %, p=0.000). Conclusion: Sublingual Misoprostol 400 mcg with intravenous Oxytocin 10 IU is effective for reducing blood loss and the rate of early postpartum hemorrhage in women at risk of postpartum hemorrhage. There are no severe side effects, and manageable.

The prevalence of burnout and the COVID-19 risk exposure control measure among health workers during pandemic in hospitals in Thailand

2024-12-12T22:17:11+07:00

This study aimed to investigate the prevalence of burnout among health workers and evaluate the COVID-19 risk exposure control (REC) measures as preventive strategies in hospitals. A cross-sectional study was conducted to evaluate healthcare personnel involved in patient care across 30 hospitals, assessing their perception of preventive measures to reduce COVID-19 exposure risk based on the hierarchy of hazard control principles, along with evaluations of knowledge, attitudes, and practices. Additionally, personnel were assessed for burnout using the Maslach Burnout Inventory (MBI), and the data were analyzed for associations using the Generalized Linear Model (GLM). The study found that among 3,086 personnel from 30 public and private hospitals, most hospitals had a high level of perceived implementation of COVID-19 exposure control measures. The majority of participants were nurses, practical nurses, or nurse aides (53.3%), while physicians accounted for 1.1%. The prevalence of burnout was 7.3%, comprising 6.2% with high burnout and 1.1% with moderate burnout, respectively. In addition, burnout was categorized into three groups: overextended (4.0%), disengaged (4.9%), and ineffective (24.4%). Being aged 40 years or younger increased the risk of high burnout by 1.6 times (95% CI: 1.1–2.3) and COVID-19-related anxiety also increased the risk of high burnout by 1.6 times (95% CI: 1.4–1.9). Whereas practice scores and effective COVID-19 risk exposure control measures reduced high burnout by 13% and 4.7%, respectively. The study found that burnout affects work errors. Effective COVID-19 exposure control measures are another strategy that helps reduce burnout, minimize work errors, and maintain high standards of patient care during a pandemic.

Influence of intrinsic factors and rehabilitation strategies on walking ability in patients with spinal cord injury

2025-04-10T00:10:34+07:00

Spinal cord injury (SCI) is a devastating condition that results in damage to the contents in vertebral foramen, which can be caused by traumatic causes or other non-traumatic events. The resulting injury affects sensory and motor function after SCI which minimize the ability of patients to control movement, especially for complex tasks such as walking. Therefore, walking recovery depends on various internal factors and the rehabilitation approaches obtained. This review highlights that critical intrinsic factors that influence walking recovery after SCI. These include age, severity of injury, clinical syndrome, muscle strength, reflex recovery, sensory restoration, and fear of falling, all of which are associated with walking recovery in individuals with SCI. Conversely, sex and spasticity have shown inconsistent results, and their impact remains unclear. Moreover, the etiology of the injury does not appear to significantly influence gait recovery. Additionally, rehabilitation strategies play a crucial role in enhancing functional outcomes. This article recommends that physicians and physical therapists should individually plan rehabilitation programs according to the patient’s ability, emphasizing task-specific gait training. However, if whole-gait training is too difficult for patients, this review recommends decomposing the task into smaller sub-tasks (part-task practice). Each component should be practiced until the patients achieve mastery in those sub-tasks before being progressively integrated into the full movement sequence through whole-task practice, thereby facilitating the acquisition of complex motor skills. In addition, rehabilitation gait training should be variability and closely related to real-life situations at home and in their communities. In conclusion, this review provides evidence-based information for healthcare professionals, particularly physicians and physical therapists, in making clinical decisions regarding prognosis, length of stay, rehabilitation duration, and the selection of appropriate rehabilitation techniques.