Interaction between physicians and pharmaceutical representatives, an insight from Thailand.

BACKGROUND: Evidence from Western countries has shown that informal relationships between the pharmaceutical industry and physicians could have some effect on physicians' prescribing behavior Many countries have, therefore, developed conflict-of-interest policies to mitigate the effects of such interactions. Interactions between pharmaceutical representatives and physicians, one among those relationships, have never been systematically studied in Thailand. OBJECTIVE: To measure, for the first time, interaction between pharmaceutical industry representatives and resident physicians in Thailand and to assess physicians' attitudes toward this interaction, and factors which determined their frequency. MATERIAL AND METHOD: The authors surveyed 970 residentphysicians in May 2009 at a university hospital in Thailand using 3-page anonymous, self-administered questionnaire and analyzed their responses. RESULTS: Overall response rate was 71.6%. Three-fourth of trainees had weekly conversations with pharmaceutical representatives. Nearly 90% of physicians receive at least one gift per month. Residents in one of the specialties with the highest prescribing costs were most likely to have such interaction with an adjusted odds ratio (OR) of 7.91 (4.61-13.58)for having conversations and 5.18 (3.28-8.17) for receiving non-educational gifts. Those residents who perceived that it is impolite to decline gifts were more likely to accept non-educational gifts: adjusted OR of 1.68 (1.04-2.71). CONCLUSION: Frequency of interaction could have only been a marker for level of exposure, not a genuine influence on physicians' prescribing behavior Nevertheless, given that resident physicians in Thailand have frequent interaction with pharmaceutical industry representatives, guidance on managing conflict-of-interest should be included in medical training.

Obesity and appetite-related hormones.

OBJECTIVE: Alterations of hormones involved in food intake can lead to obesity and related-diseases. The aim of the present study was to measure plasma levels of appetite-related hormones: insulin, leptin, adiponectin, acylated ghrelin, and cortisol in connection with eating behaviors among obese and non-obese women. MATERIAL AND METHOD: The present study was performed in 53 non-obese and 33 obese Thai women (BMI < 23 and > or = 25 kg/m2 respectively), aged 25 to 45 years. Saliva and fasting blood samples were collected for hormone measurements. Subjects 'eating behavior was evaluated using Thai version of the Three-factor eating questionnaire (TFEQ) and their stress status was assessed by the Thai stress test (TST). RESULTS: In comparison to non-obese individuals, obese women showed higher disinhibition eating, plasma glucose, insulin, HOMA insulin resistance index, leptin, and triglyceride levels but lesser plasma adiponectin and HDLC. Lower adiponectin was directly associated with higher disinhibition eating. Plasma leptin related positively to fat mass and insulin resistance but negatively to acylated ghrelin level. The trend towards increased acylated ghrelin after adjusted for age, obesity and eating behaviors was shown in stress women. CONCLUSION: Increased insulin resistance, high leptin, and reduced adiponectin accompanied with disinhibition eating have been detected in obese women.

Establishment of the Thai version of National Institute of Health Stroke Scale (NIHSS) and a validation study.

BACKGROUND: The National Institute of Health Stroke Scale (NIHSS) is a well validated stroke severity assessment scale. The scale is used to assess neurological deficits, progression and degree of recovery in acute stroke settings. To date, no Thai version exists. OBJECTIVE: This study aimed to adapt and validate a Thai version of the NIHSS (NIHSS-T). MATERIAL AND METHOD: A cross-cultural adaptation of the NIHSS was developed according to the methods recommended by the International Quality of Life Assessment Project Group. Forward and backward translations were performed. A final version of the NIHSS-T was validated against initial MRI infarction volume and modified Rankin Scale (mRS) at 3 months in a consecutive series of acute stroke patients. The patients were prospectively evaluated by 3 different types of health care providers: 2 stroke fellows, 2 internists, and 2 stroke nurses. Mean NIHSS-T scores from all raters were used in the analysis. RESULTS: The study included 32 acute ischemic stroke patients with a mean age (+/- SD) of 64.53 +/- 14.97 years of age. Men comprised 71.9%. Mean NIHSS-T score (+/- SD) was 7.49 +/- 7.02. Intra-observer reliability demonstrated a high agreement with an intraclass correlation (ICC) of 0.98, 0.98, 0.96, 0.98, 0.90 and 0.98 for 2 stroke fellows, 2 internists and 2 stroke nurses respectively. Inter-observer reliability between 6 raters was excellent, i.e.; ICC, 0.99 (0.98, 0.99). Spearman rank correlation coefficients between the initial NIHSS-T score versus initial MRI lesion volume and mRS at 3 months were 0.53 and 0.69 with a p-value of 0.002 and < 0.001 respectively. CONCLUSION: The Thai version of NIHSS is valid for assessing acute stroke severity. The scale is also reliable when administered in a Thai-speaking setting by trained healthcare professionals.

Thai version of Three-Factor Eating Questionnaire.

The English version of Three-Factor Eating Questionnaire (TFEQ) was translated into the Thai language. The TFEQ Thai version shows good internal consistency and test-retest reliabilities. Restraint and disinhibition scores, which were higher in females than males were correlated with body fat but did not relate to BMI. Disinhibition varied positively with restraint and hunger while restraint was negatively associated with hunger. Lowest restraint was shown in the group that reported liking carbohydrate, which is a major daily macronutrient among Thai populations. TFEQ Thai version is valid for future study of eating behaviors associated with health problems and diseases.

Prevalence of post-traumatic stress disorder in students 23 months after tsunami.

OBJECTIVE: To study the prevalence of post-traumatic stress disorder (PTSD) in the 4th-9th grade students in an affected school 23 months after tsunami. METHOD: Two-stage screening procedure was used in a diagnostic study designed to identify post-traumatic stress disorder in the 4th-9th grade students in a school in Takaupa district, Phang Nga province, 23 months after the 2004 tsunami. Impact of Events Scale (IES) was used as a screening questionnaire in the first stage. In the second stage, the students were assessed by a psychiatrist to identify PTSD according to DSM-IV criteria. SPSS 10.0, inferential statistics and Chi-square test were used to analyze the data. RESULT: A total of 436 students participated in the study. Forty of them were diagnosed with PTSD. The prevalence of PTSD was 15.1%. The sensitivity, specificity and negative predictive value of IES were 0.75, 0.54 and 0.92 respectively. CONCLUSION: The prevalence of PTSD in students in a school 23 months after tsunami was 15.1%.

Premenstrual syndrome in Thai nurses.

OBJECTIVE: To investigate prevalence of premenstrual syndrome (PMS) and its associated factors among Thai nurses. METHODS: The study was conducted in 423 nurses in a university hospital during October 2005 to March 2006. Prevalence of PMS was determined using a validated Thai version of Premenstrual Symptoms Screening Tool (PSST). Factors associated with PMS were analyzed using Student t-test and Chi-square test. RESULTS: The prevalence of PMS in Thai nurses was 25.1%. Nurses with younger age, nulligravida, lower income, more coffee consumption, dysmenorrhea, and negative attitude toward menstruation had higher prevalence of PMS. After multiple logistic regression analysis, the significant factors associated with PMS were coffee consumption > 1 cups/day and negative attitude toward menstruation; odds ratios (95% confidence interval) were 2.322 (1.257 to 4.288) and 5.768 (2.096 to 15.872), respectively. CONCLUSION: According to the Thai PSST, 25.1% of Thai nurses are suffering from PMS. The significant associated factors were more coffee consumption and negative attitude toward menstruation.

The development of the Pictorial Thai Quality of Life.

BACKGROUND: "Quality of life" has become a main focus of interest in medicine. The Pictorial Thai Quality of Life (PTQL) was developed in order to measure the Thai mental illness both in a clinical setting and community. OBJECTIVES: The purpose of this study was to develop the Pictorial Thai Quality of Life (PTQL), having adequate and sufficient construct validity, discriminant power, concurrent validity, and reliability. MATERIAL AND METHOD: To develop the Pictorial Thai Quality of Life Test, two samples groups were used in the present study: (1) pilot study samples: 30 samples and (2) survey samples were 672 samples consisting of normal, and psychiatric patients. The developing tests items were collected from a review of the literature in which all the items were based on the WHO definition of Quality of Life. Then, experts judgment by the Delphi technique was used in the first stage. After that a pilot study was used to evaluate the testing administration, and wording of the tests items. The final stage was collected data from the survey samples. RESULTS: The results of the present study showed that the final test was composed 25 items. The construct validity of this test consists of six domains: Physical, Cognitive, Affective, Social Function, Economic and Self-Esteem. All the PTQL items have sufficient discriminant power It was found to be statistically significant different at the. 001 level between those people with mental disorders and normal people. There was a high level of concurrent validity association with WHOQOL-BREF, Pearson correlation coefficient and Area under ROC curve were 0.92 and 0.97 respectively. The reliability coefficients for the Alpha coefficients of the PTQL total test was 0.88. The values of the six scales were from 0.81 to 0:91. CONCLUSIONS: The present study was directed at developing an effective psychometric properties pictorial quality of life questionnaire. The result will be a more direct and meaningful application of an instrument to detect the mental health illness poor quality of life in Thai communities.

The development of the Thai Psychiatric Satisfaction Scale.

BACKGROUND: Satisfaction with mental services is an important quality and outcome variable. The Thai Psychiatric Satisfaction Scale (TPSS) is developed in order to measure service satisfaction. OBJECTIVE: The purpose of the present study was to develop the Thai Psychiatric Satisfaction Scale (TPSS), having adequate and sufficient validity and reliability. MATERIAL AND METHOD: A sample of people with mental illness in the Department of Psychiatry, Siriraj Hospital was assessed. The TPSS was administered. Then factor analysis, internal consistency and test-retest reliability were analized. RESULTS: The Thai Psychiatric Satisfaction Scale (TPSS) contains seven domains: Professionals' Skills and Behavior, Information, Access, Efficacy, Type of Intervention, Relative's Involvement, and Environment and Setting. The infinity coefficient for the TPSS was 0.97 (95% CI 0.94-0.97) and ranged from 0.70 (95% CI 0.68-0.76) to 0.96 (95% CI 0.94-0.97). Test-retest for TPSS was 0.82. (95% CI 0.78-0.85). CONCLUSION: This TPSS is a validated and reliable multi-dimensional scale which measures the satisfaction of patients with mental health services for routine clinical practice in mental health service.

Prevalence and incidence of depression in the Thai elderly.

The purposes of this study were to study the prevalence and incidence of depression in elderly Thais. A field survey study was implemented. The sample consisted of 1,713 elderly people in 35 communities from 4 districts surrounding Siriraj Hospital Bangkok Noi, Bangkok Yai, Taling Chun and Bang Plud. These areas are the peripheral part of Bangkok and most of them have extended family. The Thai Geriatric Depression Scale (TGDS) and the Thai Mini Mental State Examination (TMSE) were used as screening tests, for data collection. The prevalence of depression was 12.78 per cent, of which 8.23 per cent had only depressive symptomatology (male 5.43%, female 9.63%) while 4.55 per cent had both depression and cognitive impairment (male 2.8%, female 5.54%). The point incidence (one year) of depression was 7.27 (male 1.58%, female 5.68%). The major contributing factors in depression were financial, poor family relationships and physical illness. The prevention and management of these factors may bring about a better quality of life for the elderly in Thailand.

Research on development of the manual for self detection of depression in the Thai elderly.

The purposes of this study were to develop an effective manual for the early self detection of depression in the Thai elderly, to detect the comorbidity of depression (pattern of drug and alcohol abuse, suicidal idea) and to ascertain the quality of life. A quasi experimental field research methodology (Randomized Control Group Pretest-Posttest Design) was implemented. The sample consisted of 1,390 elderly people in 35 communities from 4 districts surrounding Siriraj Hospital-Bangkok Noi, Bangkok Yai, Taling Chan and Bang Phlat. These areas are the peripheral parts of Bangkok and most of them have extended families. The result showed that: 1. The internal consistency reliability of the nine criteria of the manual for the self detection of depression in the Thai elderly ranged from 0.84 to 0.94. The validity tested by epidemiological methods, disclosed that the sensitivity was 82.14 per cent and the specificity was 97.56 per cent. 2. There was a statistically significant difference in the incidence of depression between the study and the control group (p<0.000); self referred cases = 86.7 per cent and 9.8 per cent respectively. The study group was able to detect depression in 42 days, while the control group did so in 122 days. In addition, in the associated comorbidity, there were differences in the patterns of drug and alcohol abuse, suicidal ideas and quality of life after the experiment. These findings showed a decreasing pattern of self medication for depression, and suicidal ideas and an improvement in the quality of life in the study group.