Sleep problems in out-patient of primary care unit.

OBJECTIVE: The prevalence and factors associated with sleep problems among out-patients of the Family Medicine Department in Ramathibodi Hospital were evaluated and their management was assessed. MATERIAL AND METHOD: Descriptive study, out-patients in family medicine clinic (n = 512) were selected by stratified random sampling. Sleep problems during the previous month were assessed by using questionnaires. Excessive daytime sleepiness (EDS) was assessed by Epworth sleepiness scale. The medical records of 45 patients with habitual insomnia during the previous 6 months were retrieved to study its management. The data were analyzed by Chi-square, Odds ratio, 95% Confident Interval and binary logistic regression. RESULTS: Half of the subjects (50.4%) had chronic diseases. Age range was 20-78 years old and 69.9% were female. Insomnia distributed almost equally in all age groups. Approximately 57.9% and 19.5% of the subjects reported insomnia and sleepiness. One fourth of the participants (24.7%) had snored and this was more often in men than women (OR 1.7). Anxiety score, female, and perception of their illness and disease were strong factors associated with insomnia. Most of them (71.1%) did not consult their doctors despite having habitual insomnia. From medical records reviewed, only one fourth of them (28.9% and 26.7%) were recorded about the insomnia and the prescriptions. CONCLUSION: More than half of the out-patients in primary care had sleep problems, especially insomnia, and excessive daytime sleepiness, but few of them consulted their doctors. This problem should not be overlooked Psychological problems and anxiety with their illness were associated with insomnia. Therefore, exploring and understanding their problems are important issues to manage and render advice for their quality sleep.

Psychotropic drug prescribing in the family medicine out-patient clinic, Ramathibodi Hospital.

BACKGROUND: Primary care physicians are playing an increasing role in providing mental health care. Psychotropic drugs prescription may be used evaluate primary care physicians in treating and caring for mental disorders. OBJECTIVE: Evaluate the prevalence, pattern, and rational of psychotropic drugs prescribing by primary care physicians in a tertiary care university hospital. MATERIAL AND METHOD: Four thousand four hundred ninety nine records of subjects aged 15 years old and older who received psychotropic drugs from a computer database between August 1, 2004 and January 31, 2005 were analyzed. Through systemic random sampling, rational drugs use from medical records of 575 patients was assessed. RESULTS: The rate ofpsychotropic drugs prescribing was 9.04%, which was found to increase with increasing age and female patients. Benzodiazepines were the most commonly prescribed (88.9%), followed by antidepressants (9.5%), and antipsychotics (1.1%). Lorazepam (34.7%), alprazolam (28.7%), and diazepam (19.2%) were the top three benzodiazepines prescribed. Polypharmacy was found at 13.4%. The drugs were prescribed for psychological conditions (74.8%; 51.7% by diagnosis and 23.1% by symptoms and/or signs), musculoskeletal disorder of the neck or spine (11.8%), chronic pain disorder (11.8%), and undocumented (1.6%). The psychological problems per se, physical problems per se, and the combination between psychological and physical problems were 21.6, 56.7, and 21.7% respectively. Insomnia, tension headache, and anxiety were the top three most common psychological diagnosis while hypertension, dyslipidemia, and low back pain were the top three most physical diagnosis. The long-term psychotropic drug use (2 months and above) comprised 25.9%. The follow up length ranged from less than 1 week to 24 weeks. The follow-up schedule was made in 73.9%. An actual return visit was 61.6%. Therefore, 12.3% was lost to follow up. CONCLUSION: The present study illustrates the prevalence, pattern, and rational use of psychotropic medications in primary care of a tertiary university hospital. Intermediate-acting benzodiazepines were the most commonly prescribed. They were prescribed not only for mental but also for musculoskeletal and chronic pain disorders. A quarter of the patients received psychotropic drugs as well as long-term medications without diagnosis. Some patients were put on psychotropic drugs combination. To optimize patient outcomes, a diagnosis should be encouraged The long-term use and polypharmacy should be minimized. The quality and appropriateness of prescribed medication should be part of a future research project.

Role of drowsy driving in traffic accidents: a questionnaire survey of Thai commercial bus/truck drivers.

OBJECTIVE: The authors assessed the relationship between traffic accidents and drowsiness. MATERIAL AND METHOD: A self-answered questionnaire survey of 4331 commercial bus/truck drivers was done. RESULT: Sixty-nine percent of the drivers reported accidents and one third of these accidents was attributable to drowsiness. Drowsy driving and microsleeps were experienced by 75% and 28% of drivers respectively. Forty-five percent of drivers had excessive daytime sleepiness based on the Epworth Sleepiness Scale (ESS score > or =11). This excessive daytime sleepiness was strongly associated with feeling drowsy, microsleeps, and accidents. The major causes of drowsiness were sleep deprivation (90%), medications that caused sleepiness (78%), drinking alcohol the previous night (23%), and chronic loud snoring with or without obesity (17%). 61% of drivers worked longer than 12 hours with no days off The feeling of drowsiness at the wheel was also closely related to long hours of driving (>4 hours). Countermeasures that drivers used to keep them awake were talking to someone, drinking coffee or caffeinated-energy drinks, chewing snacks or gum and pulling over to have a nap. CONCLUSION: There is a strong relationship between accidents and drowsiness in commercial bus/truck drivers. The main cause of drowsiness was sleep deprivation. The authors hope that this information will help the public authority develop a policy to reduce the traffic accidents attributable to drowsy driving in commercial bus/truck drivers.

Reliability of a Thai version of King's Health Questionnaire in Thai females with overactive bladder symptoms.

OBJECTIVES: To develop and test the reliability of a Thai version of the King's Health Questionnaire (KHQ). MATERIAL AND METHOD: Three Thai Urologists forward translated the original English KHQ into a Thai version. Back translations were performed by an independent group of physicians. A consensus was reached on a final Thai version after comparing the original KHQ and various translations. Fifty Thai female patients with symptoms of overactive bladder were tested and retested every two weeks using the Thai version (twice) as well as the English version (once) of the KHQ. Test-retest reliability of the Thai questionnaire was measured using the kappa statistic. RESULTS AND CONCLUSION: The Thai version of the KHQ was found to be reasonably reliable for use in Thai female patients with over active bladder symptoms.

An epidemiological study on insomnia in an elderly Thai population.

The authors investigated the one-month prevalence and associations of insomnia in an elderly Thai population. A random sample of 40,111 individuals was selected from those of persons over 60 years of age by multiple stage sampling. The subjects were interviewed using a sleep questionnaire. Prevalence of insomnia of the population was 46.3 per cent. Depression and poor perceived health were factors strongly associated with insomnia. On the basis of these findings, the authors consider the prevalence of insomnia among the Thai elderly to be rather high. The implications of this study are of great importance for the design and development of preventive strategies and community-based interventions.