Perception of medical personnel on informed consent for research participation in Phramongkutklao Hospital and Phramongkutklao College of Medicine.

OBJECTIVE: To evaluate the perception of medical personnel and medical cadets toward informed consent obtained from potential research participants. MATERIAL AND METHOD: The authors conducted a study using self-administered questionnaires which included questions about perception on informed consent regarding its objectives, investigator's role, vulnerable subjects, family involvement and children's assent. The answer for each question was graded into 5 scales. RESULTS: A selection of 380, 30.5%, 37.6% and 31.8% of 669 were attending staff residents, and medical cadets, respectively. A total of 85.5% agreed that informed consent in therapeutic trials should be obtained by their own doctors. A total of 75.3% agreed that the primary objective of informed consent was to protect investigators from lawsuits. A total of 60.8% agreed that participant spouses had to be involved in the informed consent process. A total of 79.5% agreed that permission from children was necessary in research conducted in children. CONCLUSION: The role of investigators in therapeutic clinical trial, primary objectives of informed consent, and role of spouse were misunderstood among medical personnel and medical cadets. Education on research ethics should concentrate on these issues.

Combined clinical risk indices with quantitative ultrasound calcaneus measurement for identifying osteoporosis in Thai postmenopausal women.

OBJECTIVE: To examine the diagnostic performance of clinical risk indices combined with quantitative ultrasound calcaneus measurement (QUS) for identifying osteoporosis in Thai postmenopausal women. MATERIAL AND METHOD: The present study was designed as a cross-sectional investigation in 300 Thai women, aged between 38 and 85 years (mean age: 58). Femoral neck bone mineral density (BMD) was measured by DXA (Hologic QDR-4500; Hologic, Bedford, MA, USA). A BMD T-scores < or = -2.5 was defined as "osteoporosis"; otherwise, "non-osteoporosis". QUS was measured by Achilles+ (GE Lunar, Madison, WI, USA) and converted to T-score. The OSTA and KKOS score was calculated for each woman using her age and weight Women with OSTA/KKOS scores < or = -1 and > -1 were classified as "high risk" and "low risk", respectively. RESULTS: Using DXA as the gold standard, the sensitivity of QUS to identify osteoporosis was lower than the sensitivity of OSTA/KKOS (60 vs. 71/74%) but the specificity and PPV of QUS were higher than OSTA/KKOS. The sensitivity increased when using OSTA/KKOS combined with QUS to identify osteoporosis (approximately 87-89%) while the specificity, PPV and NPV were comparable with using clinical risk indices alone. The risk (odds ratio; OR) of osteoporosis when QUS T-score < or = -2.5 alone was 9.94 (95%CI: 4.74-20.87), which was higher than high risk by OSTA/KKOS alone (OR: 6.35, 95%CI: 2.99-13.47 for OSTA and 8.15, 95%CI: 3.76-17.66 for KKOS). Furthermore, individuals were classified "high risk" from OSTA/KKOS with QUS T-score < or = -2.5SD, the risk of osteoporosis was increased (OR: 43.68, 95%CI: 13.89-137.36 and OR: 60.92, 95%CI: 17.69-209.76 for OSTA and KKOS, respectively). CONCLUSION: Using the clinical risk indices combined with QUS could improve the accuracy of osteoporosis identification. This approach could be used in a primary care setting or community-based hospital where a DXA machine is not available.

The association between meconium-stained amniotic fluid and chorioamnionitis or endometritis.

OBJECTIVE: Assess the association between meconium-stained amniotic fluid and chorioamnionitis or endometritis in term pregnant women. MATERIAL AND METHOD: A five-year retrospective study was undertaken between January 1, 1999 and December 31, 2003. One thousand seventy-nine pregnant women who delivered at the Department of Obstetrics & Gynecology, Phramongkutklao Hospital were included in the present study. RESULTS: Five hundred andfifty-three pregnant women (51.25%) had meconium-stained amniotic fluid (group 1) and 526 (48.75%) pregnant women were clear of amniotic fluid (group 2). Two pregnant woman in group 1 (0.36%) and eight pregnant women in group 2 (1.52%) were found to have chorioamnionitis (OR = 0.235). Postpartum endometritis was detected in only one (0.18%) pregnant women in group 1 and nine (1.71%) pregnant women in group 2 (OR = 0.104). CONCLUSION: No association was found between meconium-stained amniotic fluids and chorioamnionitis or endometritis.

Screening for thalassemia and hemoglobinopathy in a rural area of Thailand: a preliminary study.

The present study aimed to screen thalassemia and hemoglobinopathy in Baan Na-Ngam, Chachoengsao Province, Thailand. Blood samples were obtained from 266 volunteers; 105 males and 161 females aged 7 to 49 years. Blood samples screened for thalassemia combining the OF and modified DCIP precipitation tests. CBC, RBC indices, hemoglobin typing, HbA2 and Hb E were determined. Combined OF and DCIP tests found that in normal subjects, 128 out of 155 were negative for both, 3 were -/+ pattern, 22 were +/- pattern and 2 was positive for both. Interestingly, one sample showed an abnormal hemoglobin pattern, which could not be determined by automated LPLC. Three beta-thalassemia trait subjects were positive for only the OF test. For the Hb E trait, 57 out of 94 were -/+ pattern; 37 were positive for both tests. Moreover, 14 homozygous Hb E subjects were positive for both tests. The prevalence of beta-thalassemia trait was 1.1%, Hb E trait was 35.3% and homozygous Hb E was 5.3%. Since DNA analysis was not performed, alpha-thalassemia1 and alpha-thalassemia2 traits cannot be excluded. In conclusion, a combination of the OF and DCIP tests is suitable for preliminary screening for thalassemia and hemoglobinopathy. However, RBC parameters, hemoglobin typing and PCR analysis will provide more specific diagnosis, especially in alpha-thalassemias.

Teaching medical ethics: Phramongkutklao College of Medicine's model.

BACKGROUND: Third-year (first preclinical year) Royal Thai Army (RTA) medical cadets were exposed to a rural community in a community medicine field activity. The poor, kind rural people gave good conditions for student's professional development and empathy. OBJECTIVES: To report a community medicine field work activity for professional development of the RTA medical school. MATERIAL AND METHOD: Descriptive analysis on two occasions to evaluate the third-year RTA medical cadets' impressions immediately after the community medicine field activity in a rural area in central Thailand and one year later using baseline scores of cadets' impressions against our institute's objectives. RESULTS: At the end of the field work, 90.9% of the cadets reported they achieved several institute objectives. The four most frequent mentioned were ethical development (70.6%), professionalism (84.3%), human relationship & communication skills (92.2%), and capability to work in the cmmunity (64.7%). Furthermore, RTA medical cadets rated the staff as good role models (51%). CONCLUSION: The community field work course provided a good environment for the third year medical cadets in building morality and professional development to be good doctors.

BVBLUE test for diagnosis of bacterial vaginosis in pregnant women attending antenatal care at Phramongkutklao Hospital.

BACKGROUND: Bacterial vaginosis (BV) is a disorder of the vaginal ecosystem characterized by a shift in the vaginal flora form the normally predominated lactobacillus to one dominated by sialidase enzyme-producing mixed flora. OBJECTIVES: To compare the sensitivity of BVBLUE test for diagnosis of bacterial vaginosis with Gram stain by using Nugent score as a gold standard. MATERIAL AND METHOD: From April to June, 2004, a total of 173 pregnant women who received antenatal care at Phramongkutklao Hospital had reached the study criteria. The speculum for this exam, used in the process of collecting vaginal secretions, must not be lubricated with any lubricants. The vaginal discharge was collected from the lower 1/3 of the vaginal wall. Gram stain score and BVBLUE test were conducted and compared. RESULTS: 173 patients were enrolled in the present study. BVBLUE test was compared to the standard method for the diagnosis of BV by Gram stain using Nugent score as a gold standard. The sensitivity, specificity, accuracy, positive and negative predictive value of BVBLUE test versus the Gram stain score for diagnosis of bacterial vaginosis were 94%, 96%, 96% 86%, and 98%, respectively. CONCLUSION: BVBLUE test for diagnosis of bacterial vaginosis had high sensitivity, specificity, accuracy, positive and negative predictive value (94%, 96%, 96%, 86%, and 98%, respectively).

Prevalence and an analysis of noise--induced hearing loss in army helicopter pilots and aircraft mechanics.

BACKGROUND AND OBJECTIVE: Hearing impairment from noise exposure has been reported in fix-wing pilots, especially in civilized countries. However, there are few studies on rotary wing aviators and aircraft mechanics, especially in developing countries whose hearing conservative program is not well established. The present study, therefore, was done to evaluate the prevalence of noise induced hearing loss and the contributing factors that may effect both groups of noise-exposed population. MATERIAL AND METHOD: Report questionnaires were reviewed and physical examination combined with audiometric records of 34 pilots and 42 mechanics in the Royal Thai Army Aviation Center, Lobburi, were examined. Hearing loss was studied using four categories of significant threshold shift (STS). Amplitude of noise radiated by aircraft was also measured at different distances. RESULTS: No significant difference was found in prevalence of hearing loss in aviators (32.4%) and aircraft mechanics (47.6%), but in the aircraft mechanics group there were more damage of frequency involvement including speech frequency and high frequency and more decibels loss than aviators. The type of hearing protection and smoking index were strongly correlated with hearing loss. Age, flight time and alcohol habit had no significant effect and ninety percent of the subjects had no self awareness of hearing loss. CONCLUSION: Aircraft mechanics had more severity on hearing loss than aviators. Types of noise protector and cigarette smoking had significant association with hearing loss.

Prevalence of the metabolic syndrome, and its association factors between percentage body fat and body mass index in rural Thai population aged 35 years and older.

OBJECTIVES: To obtain the prevalence of metabolic syndrome (MS) and its associated socioeconomic factors, and also to evaluate the association between percentage body fat (BF) and body mass index (BMI) in a rural Thai population. MATERIAL AND METHOD: MS defined by the National Cholesterol Education Program Adult Treatment Panel III criteria. The prevalence of the MS was then determined using the NCEP III criteria with and without the modified waist circumference criteria. BMI indicating normal weight, overweight and obesity as re-defined for the Asian by International Association for the Study of Obesity (IASO), WHO. Four-hundred and four rural Thai men and women aged 35 years and older were evaluated. Data on anthropometry, blood pressure, socioeconomic status, lifestyle-related information, blood studies, and bioelectrical impedance (BIA) values had been collected. RESULTS: The prevalence of the MS in the rural Thai people was 18%, but increased to 23% with the modified Asian criteria. High BMI, female gender, and older age were associated with increased odds of the MS. Household income, dietary composition, smoking and drinking status were not associated with increased odds of the MS. There was significant association between percent BF and BMI in men and women in rural Thai population. CONCLUSION: The MS was present in about 18% of the rural Thai population and was significantly influenced by body mass index, gender and age. Metabolic syndrome becomes an important problem in rural Thai populations who even live basic lifestyle in the non-urbanized and non-industrialized areas. Identification and clinical management of this high-risk group is an important strategy for coronary heart disease prevention.

The comparative study of bone mineral density between premenopausal women receiving long term suppressive doses of levothyroxine for well-differentiated thyroid cancer with healthy premenopausal women.

OBJECTIVE: To compare bone mineral density (BMD) of lumbar spines (LS) and femoral neck (FN) by Dual energy X-ray absorptiometry (DEXA) in premenopausal well-differentiated thyroid carcinoma women S/P total or near total thyroidectomy with a control group and the effect of Levothyroxine (LT4) to BMD between short term and long term treatment. MATERIAL AND METHOD: DEXA were performed at LS (L1-L4) and FN in 22 premenopausal thyroid carcinoma women S/P total or near total thyroidectomy followed by 1-131 ablation and long term suppressive dose LT4 and 22 healthy premenopausal women. RESULTS: Mean BMD of LS and FN were not significantly different between thyroid cancer group and control (LS 1.023 +/- 0.088 VS 0.980 +/- 0.075 g/cm2, p > 0.05, FN 0.800 +/- 0.068 VS 0.770 +/ - 0.061 g/cm2, p > 0.05). Period of time taking suppressive doses LT4 was divided into 3 groups (2-5 6-10 yrs and 11-14 yrs). Mean LS BMD +/- S.D of 2-5 yrs, 6-10 yrs and 11-14 yrs therapy are 1.042 +/- 0.135, 1.004 +/- 0.044 and 1.042 +/- 0.055 respectively (p > 0.05). Mean FN BMD +/- S.D of 2-5 yrs, 6-10 yrs and 11-14 yrs therapy are 0.808 +/- 0.084, 0.781 +/- 0.067 and 0.816 +/- 0.013 respectively (p > 0.05). CONCLUSION: The suppressive doses LT was not the risk factor of osteoporosis. Although, there was no 4 statistically significant difference of BMD between short and long-term suppressive doses LT groups, the present sample size was not enough to conclude that long-term suppressive doses LT did not decrease BMD.

Dyslipidemia in Thai rural adults.

The present study aimed to determine the prevalence of dyslipidemia in adults in a rural area of Thailand. Random sampling was conducted in 443 volunteers, 187 males and 256 females, aged > or = 35 years in Chachoengsao Province. After a 12-hour fast, the blood was drawn for the analysis of total cholesterol, triglycerides, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol. Mean serum lipids of cholesterol, LDL cholesterol, HDL cholesterol and triglycerides were 207.79 +/- 46.98, 117.26 +/- 36.59, 50.53 +/- 2.14 and 201.21 +/- 131.07 mg/dL, respectively. Nineteen percent of them had cholesterol > or = 240 mg/dL and 10% had LDL cholesterol > or = 160 mg/dL. Seven percent had HDL cholesterol < or = 35 mg/dL. However, LDL/HDL cholesterol ratios > 5, were found in only 0.9%. In conclusion, the prevalence of dyslipidemia was high in rural Thai adults. Further surveillance in this population is essential in verifying the impact of dyslipidemia as a risk of cardiovascular disease in rural Thai adults.