Factors related to changes in severity among adult and older adult patients at an internal medicine department clinic: an embedded mixed-method study.

The changes in aging plus the pathology of diseases can influence the changes in severity levels. This study aimed to examine the changes in levels of severity in patients while waiting to see a doctor. The study was conducted at an outpatient clinic in northeastern Thailand with a total of 421 patients who were assessed twice for levels of severity using the Emergency Severity Index. The 38 triage nurses screened patients, and 18 were interviewed when severity level changes were observed. Data were collected April 1-30, 2021. Quantitative data were analyzed by Chi-square test, Fisher's exact test, and logistic regression. Qualitative data were analyzed by content analysis. Most patients were female, between 18 and 59 years old. Most patients did not change their level of severity. However, increasing levels of severity were found in older adults. Factors related to the changes in severity levels were age group, chronic disease, chief complaint, educational level, the duration of travel to the outpatient clinic, type of vehicle, aging process and comorbidity, pathology of diseases, reassessment interval, nurse's experience, bypassing the patient triage process, patient's self-preparation, management of triage nurses, and assignment of direct healthcare staff until the end of the treatment. Increased severity was more frequently found in older adults, so closely monitored during waiting times at a clinic is needed. Setting rescreening as a policy and having sensitive screening guidelines and tools specific to older adults would contribute to early detection and immediate treatment of deteriorating symptoms and illness to help reduce complications and morbidity.Trial registration: https://osf.io/fp3j2 .

Effects of symptom management program on selected health outcomes among older people with chronic obstructive pulmonary disease: a quasi-experimental study.

Older adults have limitations from their aging process and chronic disease, so developed interventions must pay attention and concern to their aging degeneration and needs. This study aims to study the effects of a symptom management program on selected health outcomes among older people with chronic obstructive pulmonary disease. The quasi-experimental research included the 15 older patients in the control group receiving routine nursing care, while the other 15 in the experimental group received a 4-week symptom management program. First, the general information was analyzed using descriptive statistics. Next, the average health outcomes were analyzed using independent and dependent t-tests, Mann-Whitney U Test, and Wilcoxon Signed Ranks Test. In addition, the readmission rate was compared using Fisher's Exact Test. Results revealed that most of the older patients were men (96.7%), aged 60-88 years (Mean = 71.57, SD = 7.75), with a smoking history (93.3%). The improvements were found in dyspnea (p < .01), its severity during activities (p < .01), and the quality of life (p = .04) among patients who attended the program. However, both groups did not have a different pulmonary function (p = .25) and the proportion of readmission within 28 days (p = .50). This study shows that the symptom management program can reduce dyspnea and severity during activities and improve the quality of life. Older people suffer from chronic obstructive pulmonary disease, especially when experiencing dyspnea. Therefore, it is crucial to have a symptom management program for older patients, especially a program developed to respond to changes in the aging process and the limitations of older people. This developed program was age-friendly to deal with symptoms and improve quality of life. However, this program should be explored in typical situations without the effects of the coronavirus disease (COVID-19) pandemic. In addition, more extensive population-based studies and randomized controlled trials should be adopted to increase credibility and ensure generalization.Clinical Trial Registration Number: https://osf.io/6sj7y (October 4, 2021).

Study of medication use and effects of medication among hospitalized older Buddhist monks: An embedded mixed-method study.

AIM: The aim was to study medication use, effects of medication and perspective of participants involved in medication use among hospitalized older Buddhist monks. DESIGN: An embedded mixed-method study. METHODS: This study included 71 hospitalized older Buddhist monks and 23 participants involved in medication use. Quantitative data were collected from medical and medication records. Meanwhile, qualitative data were collected by using in-depth interviews. Data were analysed using descriptive statistics and content analysis. The study lasted from February to July 2021. RESULTS: Over 77% of the monks had chronic diseases. The median of medicine use was seven medicines/person and 6 days of use. Effects of the medication were as expected (52.04%), not as expected (2.22%) and unmeasurable results (45.74%). Unexpected results were hypo-hyperglycaemia, nausea/vomiting, high blood pressure and confusion. From the interview, participants perceived and did not perceive unique practices and medication use in Buddhist monks. In addition, the Buddhist monks received medication following standards and Buddhist doctrine. Finally, recommendations for medication use were adhering to the standard, following Buddhist doctrine and being flexible as deemed necessary. CONCLUSION: The results revealed medication use problems and medication effects among hospitalized older Buddhist monks. IMPACT: Older adults and Buddhist monks have specific needs and practices related to culture and religion, affecting typical treatment, especially medication use. Cultural diversity and sensitivity should be a concern for healthcare staff. The results can be utilized to promote an understanding of cultural diversity and increase the safety of medication administration for hospitalized older Buddhist monks. PATIENT AND PUBLIC CONTRIBUTION: Patient and public contributions were involved in this study. Participants involved in medication use were interviewed to answer the research objective. Moreover, a senior Buddhist monk at Wat Thai Washington D.C. reviewed content related to the Pali Canon for the final draft of the manuscript. CLINICAL TRIAL REGISTRATION NUMBER: https://osf.io/b6p3e.

The Effectiveness of a Multi-Sensory Sleep-Promotion Program on Sleep Quality among Hospitalized Older Adults of Thailand: A Quasi-Experimental Study.

BACKGROUND/OBJECTIVE: Older adults suffer from sleep disturbances, especially during hospitalization, affecting their health condition, recovery, and in-hospital mortality. Therefore, we aimed to explore the effectiveness of a multi-sensory sleep-promotion program on sleep quality among hospitalized Thai older adults. METHODS: In a quasi-experimental study, the 52 eligible older adults in a private medical ward were equally assigned into two groups. The experimental group received a sleep quality assessment after the first night of admission, the 60-minute multi-sensory sleep-promotion program for three nights, and an outcome evaluation on the last night after the intervention. In contrast, the control group received routine care for the same period. Sleep quality was measured by the Verran and Snyder-Halpern Sleep Scale (Thai version). In addition, independent and paired samples t-tests compared the sleep quality between and within the two groups. RESULTS: The older adults in the experimental group had better sleep quality than those who did not (p < .001). Those who participated in the multi-sensory sleep-promotion program markedly improved their sleep quality over five days (p < .001). CONCLUSION: A multi-sensory sleep-promotion program can promote the sleep quality of older adults. The five alternative methods to promote sleep are effective without the deleterious effects of hypnotics and sedatives often experienced among older adults. Therefore, nurses and other healthcare professionals can implement this program as standard practice. In addition, they may adjust it to fit the acuity level and care dependencies of older adults in other cultures to promote sleep quality.

Tooth Loss, Cognitive Impairment and Fall Risk: A Cross-Sectional Study of Older Adults in Rural Thailand.

Tooth loss is associated with both cognitive impairment and fall risk. However, the relationships between these variables are complex and bidirectional. Observed associations have been reported in separate studies but data on rural-dwelling older adults remain sparse. This cross-sectional study investigated socioeconomic and dental factors affecting cognitive functions, and the association between tooth loss, cognitive functioning, and fall risk. Two hundred and thirty-one rural-dwelling older adults (60−74 years old) were recruited from a single Dental Service Unit. Cognitive function and fall risk were assessed with the Mini-Mental State Examination and the Morse Fall Scale, respectively. Oral examinations were performed by a dentist using the Community Periodontal Index of Treatment Needs form. 38.1%, had >16 tooth loss. Socioeconomic data and health status were obtained from a questionnaire and interviews. Age, Activities of Daily Living (ADL) score, and the number of teeth lost was significantly associated with impaired cognitive function. Chi-square analysis showed that cognitive function was also associated with fall risk. Past research suggests that much cognitive impairment and fall risk is induced by tooth loss. Service planners need to be aware of the complex bidirectional relationships between these variables and give higher priority to dental services that can improve the general health status and social functioning of older rural adults.

Acceptability and Feasibility of Smart Phone Application "OSOMO Prompt" for Health Surveillance in Older Adults by Community Health Workers.

The magnanimous functionalities and flexibility of smartphone device make them well suited for collecting field data, especially for the local healthcare professional. This paper describes the results of the acceptability and feasibilityfor community health workers (CHWs) after using smartphone application called 'OSOMO prompt' app. The results indicated that the comparison of means of one sample t-test responses to the questions on the perceived usefulness and perceived ease of use of 'OSOMO prompt' app. The CHWs found that the high average scores of using the 'OSOMO prompt' app were useful in their job (mean=3.97±.68) and easy to use (Mean=3.95±.62). The app also had high score point of improving the quality of CHWs work, easy to do CHWs job, clearly and stability app while all items of perceived usefulness and perceived ease of use were statistical significantly (p-value <.001). In conclusion, challenging of smartphone 'OSOMO prompt' app was feasible and acceptable to CHWs.

Consumption of Calcium and Knowledge About Calcium Sources and Nutrition Labels Among Lower Secondary School Students in Thailand.

OBJECTIVE: A three study research program was conducted to identify high calcium products available in the market (study I), identify high calcium products that were known or consumed by lower secondary school students in the last three months (study II), and identify the amount and sources of calcium that students had consumed in the prior 24 hours, their knowledge about sources of high calcium and how to interpret calcium information on nutrition labels of food packages (study III). METHODS: In study I, a cross-sectional market survey was employed. In studies II and III, a school-based cross-sectional survey was employed. The survey population was students enrolled in grades 7-9 (11-14 years old) in a medium-sized lower secondary school in semi-urban Khon Kaen, Thailand. A total of 309 students were invited, with 168 and 209 students participating in studies II and III, respectively. Data were collected with self-administered questionnaires. RESULTS: Ninety-three high calcium products were identified. Only 49 were known or consumed by students in the last three months. The median amount of calcium consumed in the previous 24 hours was 410 mg (IQR: 160, 983). Only 31.1% of students (65/209) consumed more than the Thai recommended daily intake (TRDI) of calcium (800mg) in the previous 24 hours. Their main source of calcium was milk. Other high calcium items that were consumed were malt drink, minnow, canned fish, calcium fortified soy milk and Chinese kale. The overall average knowledge score was 6.5±2.4 out of a maximum of 17. The average knowledge scores for high calcium food sources and for interpreting the calcium information on a sample nutrition label were 4.6+1.8 (out of 12), and 1.9±1.2 (out of 5), respectively. DISCUSSION: Students should be introduced to high calcium products in their community such as hard tofu, minnow, and small freshwater shrimp. Educational programs on nutrition label interpretation are needed.

Awareness, Intention to Act and Action in the Exercising of Patients' Rights: A Case Study of Patients in Khmer Soviet Friendship Hospital, Phnom Penh, Cambodia.

BACKGROUND AND OBJECTIVES: In Cambodia, the patients' rights guideline was officially released in 2007 as a measure of the government policy to promote greater awareness and empower Cambodian people to exercise their rights as patients. The aim of this study was to identify the proportion of patients aware of the existence of patients' rights and compare the proportions of patients intending to exercise their rights and those actually exercising their rights among the aware and unaware groups. METHODS: Data were collected with a structured questionnaire, using face-to-face interview technique, from 142 randomly selected outpatients visiting the Khmer Soviet Friendship Hospital in Phnom Penh, Cambodia. Intention to exercise patients' rights was measured on a 5-point Likert scale (ranging from 1 "definitely not" to 5 "definitely yes"). RESULTS: The proportion of Cambodian patients who were aware of the existence of patients' rights was 31.0% (95% CI: 23.5, 39.3). The average intention to act scores was 4.0±0.5 for the whole group, and 4.3±0.4 and 3.9±0.5 for those aware and unaware of the existence of patients' rights, respectively. The difference in the mean scores of intentions to act between the aware and unaware groups was statistically significant (mean difference =0.40, 95% CI: 0.22, 0.58, t140=4.514, P< 0.001). Patients reported a total of 250 situations in which they believed they should take action to exercise their rights and 96 times that they took action (38.4%, 95% CI: 35.46, 41.34). CONCLUSION: The proportion of Cambodian outpatients aware of the existence of patients' rights and the proportion of outpatients that exercised their rights were both low. Nevertheless, it appeared that raising awareness of the existence of patients' rights raised patient's intention to act, which corresponds to the hierarchy-of-effects behavioral model.

Immediate Effects of Traditional Thai Massage on Psychological Stress as Indicated by Salivary Alpha-Amylase Levels in Healthy Persons.

BACKGROUND Stress can cause psychological and physiological changes. Many studies revealed that massage can decrease stress. However, traditional Thai massage has not been well researched in this regard. The purpose of this study was to investigate the immediate effects of traditional Thai massage (TTM) on salivary alpha-amylase levels (sAA), heart rate variability (HRV), autonomic nervous system (ANS) function, and plasma renin activity (PRA). MATERIAL AND METHODS Twenty-nine healthy participants were randomly allocated into either a traditional Thai massage (TTM) group or Control (C) group, after which they were switched to the other group with a 2-week wash-out period. Each of them was given a 10-minute mental arithmetic test to induce psychological stress before a 1-hour session of TTM or rest. RESULTS Within-groups comparison revealed that sAA was significantly decreased (p<0.05) in the TTM group but not in the C group. HRV and ANS function were significantly increased (p<0.05) and PRA was significantly decreased (p<0.05) in both groups. However, low frequency per high frequency ratio (LF/HF ratio) and ANS balance status were not changed. Only sAA was found to be significantly different between groups (p<0.05). CONCLUSIONS We conclude that both TTM and rest can reduce psychological stress, as indicated by decreased sAA levels, increased parasympathetic activity, decreased sympathetic activity, and decreased PRA. However, TTM may have a modest effect on stress reduction as indicated by a reduced sAA.

The Prevalence and Associated Factors of Alcohol Consumption: A Cross-Sectional Study in Khon Kaen, Thailand.

BACKGROUND AND OBJECTIVE: Knowledge of the situation and risk factors associated with alcohol consumption are essential for prevention and control measures of health consequences. This study aims to explore the prevalence of alcohol consumption and the factors associated with alcohol consumption in the population aged 12-65 years. MATERIAL AND METHOD: This was a descriptive study. This survey used multi-stage sampling and face-to-face interviews, carried out in both urban and rural areas. Those interviewed were a representative sample of 876 people in the ratio ofone male and one female to represent the household. Data were collected by interviewers between 1 January and 28 February 2012. The data were analyzed by frequency, percentage, mean, standard deviation, Chi-square, multiple logistic regression, OR and 95% CI of OR. This study was approved by the ethics and research institutional review board of Khon Kaen University No. HE53121. RESULTS: The mean age of the respondents was 41.7 years (SD 13.6). The majority of the respondents were the head of the family (33.9%), those educated to primary school level (44.6%), living in rural areas (55.9%), who were married (70.7%), and who were farmers (35.3%). The prevalence of alcohol consumption during the previous week was 6.3% (95% CI: 4.7 to 7.9), during the previous month was 35.2% (95% CI: 32.0 to 38.3), and during the previous year was 41.0% (95% CI: 37.7 to 44.2). The factors associated with alcohol consumption were gender (male/female) AOR 6.5 (95% CI 4.4 to 8.9, p-value < 0.001) age group (25-44/45-65) AOR 1.6 (95% CI 1.1 to 2.4, p-value = 0.011) location (rural/urban) AOR 1.7 (95% C1 1.3 to 2.4, p-value < 0.001) educational attainment (bachelor or master degree/primary school) AOR 1.7 (95% CI 1.1 to 2.8, p-value = 0.031) and the occupation (laborer) AOR 1.6 (95% CI 1.1 to 2.4, p-value = 0.015). CONCLUSION: Knowing the prevalence and factors associated with alcohol consumption are essential to understanding the situation, solving related problems and using the information in the campaign for the prevention and control of alcohol consumption

Psychological Stress Can Be Decreased by Traditional Thai Massage.

OBJECTIVE: The purpose of this study was to investigate the immediate effects of traditional Thai massage (TTM) on psychological stress and heart rate variability (HRV). MATERIAL AND METHOD: Thirty healthy participants were randomly allocated in two groups, a TTM group (n = 15) who received a 1-hour session with moderate pressure of whole body TTM or a control group (n=15) who rested on the bedfor 1 hour All ofthem were given a 10-minute mental arithmetic test to induce psychological stress after which they received a 1-hour session of TTM or bed rest. Psychological stress and HR V were measured at baseline and immediately after mental arithmetic test, and immediately after TTM or bed rest. RESULTS: The studyfound that psychological stress was signficantly increased (p<0.05) after mental arithmetic test in both groups. Comparison on these measures between immediately after mental arithmetic test and after TTM or bed rest revealed that psychological stress was significantly decreased (p<0.05) and HR Vwas significantly increased (p<0.05) in both groups. Root mean square of successive differences (RMSSD) and low frequency were significantly increased (p<0.05) only in the TTM group. However; all of these measures were found without significant difference when groups were compared. CONCLUSION: TTM and bed rest could decrease psychological stress and HRV