Sleep Quality among Residents and Fellows in Rajavithi Hospital.

Background: Sleep is one of the basic needs of human beings and is important to their health. Medicine is one of the most stressful fields of education because of its highly demanding professional and academic requirements, and psychological stress and poor sleep are highly prevalent in resident and fellowship training; however, they are not well documented and have not yet been taken seriously. Objective: This study aimed to determine the prevalence of poor sleep and associated factors in resident and fellowship training in Rajavithi Hospital, a tertiary referral hospital in Bangkok, Thailand. Material and Method: This cross-sectional study was conducted between June and August 2015. The two hundred and fourteen participants were all residents or fellows in the academic year 2015. The data were collected using: 1) Demographics; 2) Suanprung stress test-20 items (SPST-20) modified by the Department of Mental Health, Ministry of Public Health, Thailand; 3) Health behavior; and 4) a Thai version of the Pittsburgh Sleep Quality Index (T-PSQI) questionnaire (score >5 indicates poor sleep). Binary logistic regression was used to identify factors associated with poor sleep status. This study was reviewed and approved by the ethics committee, Rajavithi Hospital. Results: Most of the participants were female with mean age (±SD) of 28.87±2.55 years (range 25-41 years). Subjects studying in the 1st, 2nd and 3rd year accounted for 48.1%, 32.2% and 19.7% respectively, and 36.9% of participants were involved in shift work. The mean ± SD of SPST-20 scores was 15.57±8.27, and the prevalence of poor sleep quality was 54.7%. Factors associated with poor sleep were shifting work schedule (OR 2.10, 95% CI 1.07-4.12, p = 0.031) and raised stress score (OR 1.15, 95% CI 1.09-1.21, p<0.001). Those who had poor sleep quality stated that the activities they pursued to relieve this condition were social media (42.0%), followed by reading books (32.4%) and watching television (16.8%). Only a few poor sleepers used sleeping pills (6.4%). Conclusion: There was a high prevalence of poor sleep quality, and factors associated with this were shifting work schedule and higher stress scores. Proper interventions should be made in the form of recommendations of measures to help to relieve sleep problems.

Breakfast Skipping among Personnel in Rajavithi Hospital.

Background: Breakfast skipping is considered to be an unhealthy eating habit and is linked with several health issues, including obesity, type 2 diabetes mellitus, and metabolic syndrome (MetS). Few studies on the breakfast consumption habits of hospital personnel have been carried out. Objective: This study aimed to determine the prevalence of breakfast skipping among Rajavithi Hospital personnel. Quality of life, knowledge of the importance of eating breakfast, and patterns of breakfast consumption were also assessed. Material and Method: A cross-sectional study was carried out of 356 personnel in the hospital between February and May 2015. Medical record data relating to annual check-ups were collected by means of a questionnaire which requested information regarding demographic data, breakfast patterns, knowledge of the importance of eating breakfast, and quality of life (WHOQOL-BREF-THAI). This study was approved by the ethics committee of Rajavithi Hospital. Results: The majority of the participants were female (87.1%) with mean age of 38.68±11.41 years. Most had normal BMI, were single, had a bachelor degree and worked in the cluster of nursing. The prevalence of breakfast skipping was 14%, and the main reasons given for not eating breakfast were lack of time (33.7%) and inconvenience (28.1%). Sleep hygiene and sleep quality differed between groups. A moderate level of knowledge about the importance of eating breakfast was found; however, this factor was not significantly associated with breakfast consumption. Overall quality of life (QOL) was moderate. The QOL for mental health in those who ate breakfast was significantly higher than in those who did not. Conclusion: The prevalence of breakfast skipping was low, and this is consistent with the findings of other studies in the literature. Mental health was significantly associated with breakfast consumption. In order to increase the rate of breakfast consumption, interventions should be developed for specific target groups.

Efficacy of Plai Cream in Adult Patients with Muscle Strain: A Randomized, Double-Blind, Placebo-Controlled Trial.

BACKGROUND: Nonsteroidal anti-inflammatory drugs are a standard treatment option for muscle strain; however, side effects persist. OBJECTIVE: This clinical trial was designed to compare the efficacy of Plai cream compared to placebos in adult patients with muscle strain. MATERIAL AND METHOD: In this randomized, double-blind, placebo-controlled trial, 140 participants aged over 18 years with muscle strain were randomized to receive either Plai cream (n = 70 patients, treatment group) or placebos (n = 70 patients, control group) . Outcome assessments included the visual analog scale (VAS), quality of life (QoL), the amount of remaining cream, and the number of acetaminophen tablets used. RESULTS: After 2 weeks, the mean pain scores following treatment with both Plai cream and placebos in patients with muscle strain decreased from baseline to the end of the study at week 2. However, no significant difference for VA S score was found. The QoL of the two groups showed improvements in QoL as witnessed by increased mean QoL scores from baseline to week 2; however, these differences were not statistically significant. In general, mean QoL scores above 50 indicate good quality of life. The amount of Plai cream used reduced from baseline to week 2, but no significant difference in the amount of cream remaining was found between the two groups at each visit. Similarly, the number of acetaminophen tablets used was not statistically different between the treatment and control groups. CONCLUSION: There was no difference in pain reduction in the 2-week period between patients with muscle strain using Plai cream and those given placebos, but Plai cream tended to reduce pain in the long term. No side effects were found from Plai cream, so this non-invasive treatment may be offered to patients.

Trends of Metabolic Syndrome Components in Personnel at the Rajavithi Hospital.

OBJECTIVE: Metabolic syndrome (MetS) is a combination of medical disorders which increases the risk of developing diabetes. Studies have shown variable prevalence of this syndrome, but being elderly has often been found to increase the likelihood of developing Mets. This study aims to determine trends in Mets components among Rajavithi Hospital personnel. MATERIAL AND METHOD: A cross-sectional study was carried out from 2009 to 2011. Participants were aged 35 years or more, and the numbers of participants were 504, 1,029 and 1,057 in 2009, 2010 and 2011, respectively. Using medical records after an annual check-up, MetS was defined in accordance with the updated National Cholesterol Educational Program Adult Treatment Panel III (NCEP-ATPIII) guideline. Binary logistic regression was used to assess the factors associated with Mets. RESULTS: Most participants were female, and the mean ages were 45.8 ± 7.6, 45.6 ± 7.9 and 46.1 ± 7.1 years in 2009, 2010 and 2011, respectively. In each of the three years, mean age, BMI, waist circumference, triglycerides, glucose and uric acid were all significantly higher in individuals who had Mets. The prevalence of Mets in 2009, 2010 and 2011 was 7.1%, 5.9% and 4.6%, respectively. Hypertension was the most common abnormal metabolic risk factor in both sexes. The most frequent cluster of MetS components was a combination of hypertension, hypertriglyceridemia and glucose in males, but hypertension, abdominal obesity, and high triglyceride levels in females. The prevalence of MetS was associated with advancing age, male gender and individuals who worked in administration. CONCLUSION: The prevalence of Mets was low and decreased slightly each year. Associated risk factors of Mets were increasing age, male gender and working in administration. Some components of MetS, especially waist circumference, blood pressure, triglyceride levels and glucose, are risk factors of metabolic syndrome and should be avoided in order to decrease its prevalence.

Determinants of childhood lead exposure in the postleaded petrol era: The Tooth Fairy cohort from Newcastle upon Tyne.

Lead is an environmental contaminant causing irreversible health effects in children. We used dentine lead levels as a measure of early-life lead exposure and explored determinants of lead exposure in children living in Newcastle upon Tyne, a historically industrialised UK city, in a cohort born since legislation was introduced to remove lead from petrol, paint and water pipes. The "Tooth Fairy study" cohort comprised 69 children aged 5-8 years. We collected upper deciduous incisors from children and questionnaire data from their parents in 2005. We measured lead levels in pre- and postnatal enamel and dentine using laser ablation inductively coupled plasma mass spectrometry, and assessed associations between dentine lead levels and residential, dietary, lifestyle and socio-economic characteristics. Dentine lead levels were low (mean 0.26 µg/g, range 0.06-0.77); however, we observed considerable variability in dentine lead levels within and between children suggestive of differing exposure levels and/or exposure sources across this population. Variables earlier documented to be associated with childhood lead levels were not found to be significant determinants of dentine lead levels in this study. Exposure pathways should continue to be investigated to enable targeted interventions and prevention of lead-induced health impacts in vulnerable populations.

Reconstructing the life-time lead exposure in children using dentine in deciduous teeth.

Data are presented to demonstrate that the circumpulpal dentine of deciduous teeth can be used to reconstruct a detailed record of childhood exposure to lead. By combining high spatial resolution laser ablation ICP-MS with dental histology, information was acquired on the concentration of lead in dentine from in utero to several years after birth, using a true time template of dentine growth. Time corrected lead analyses for pairs of deciduous molars confirmed that between-tooth variation for the same child was negligible and that meaningful exposure histories can be obtained from a single, multi-point ablation transect on longitudinal sections of individual teeth. For a laser beam of 100 µm diameter, the lead signal for each ablation point represented a time span of 42 days. Simultaneous analyses for Sr, Zn and Mg suggest that the incorporation of Pb into dentine (carbonated apatite) is most likely controlled by nanocrystal growth mechanisms. The study also highlights the importance of discriminating between primary and secondary dentine and the dangers of translating lead analyses into blood lead estimates without determining the age or duration of dentine sampled. Further work is in progress to validate deciduous teeth as blood lead biomarkers.

Experimental comparative study of the efficacy and side effects of Cissus quadrangularis L. (Vitaceae) to Daflon (Servier) and placebo in the treatment of acute hemorrhoids.

OBJECTIVE: To investigate efficacy and side effects of Cissus quadrangularis L. and micronised purified flavanoid fraction (MPFF) in treatment of hemorrhoids. MATERIAL AND METHOD: A prospective double blind randomized study was designed in acute hemorrhoidal patients from three hospitals. In each hospital, eighty patients received the flavanoid mixture, C. quadrangularis, or placebo (3 x 2 p.c. for 4 days and then 2 x 2 p.c. for 3 days). Patients were evaluated on bleeding, pain, discharge, pruritis, erythema, and direct patient interviews. Each symptom was scored on a graded severity scale from 0 to 3 on the first day and the seventh day. Blood tests and monitoring of treatment-related side effects were conducted. RESULTS: Five hundred seventy patients (299 females, 271 males) were enrolled. No significant difference regarding age, gender, occupation, and history of disease was recorded. Mostly acute bleeding ceased at the second day in all groups. Analysis on all groups revealed improvement in all symptoms with non-significant difference. No adverse events, no blood chemistry changes were reported. CONCLUSION: The therapeutic efficacy of flavanoid mixture, C. quadrangularis L. and placebo are not different indicating that they play no role in improving early hemorrhoidal symptoms. Long-term studies should be conducted for effects in preventive and curative action.

Risk factors for gallstone disease in a Thai population.

BACKGROUND: Gallstone disease (GSD) is a major public health problem that is associated with a number of risk factors. METHODS: We conducted a case-control study of 407 participants comprising 207 cases with GSD and 200 controls without GSD, as confirmed by ultrasonography. The participants completed a questionnaire and underwent physical and ultrasonographic examination. The risk factors examined were age, sex, BMI, use of oral contraceptives, diabetes mellitus, cirrhosis, thalassemia, dyspepsia, family history of gallstone disease, smoking status, alcohol consumption, and dietary history. RESULTS: BMI, fat content of dietary meat, and smoking were associated with GSD. When compared to participants with a BMI below 25, participants with a BMI of 25 or higher had a multivariate relative risk of 4.1 (95% CI, 2.5-6.7). Participants who consumed meat with moderate fat content or high fat content had respective relative risks of 2.5 and 2.9 (95% CI, 1.5-4.2 and 1.5-5.6), when compared to those who consumed meat with a low fat content. Also, the multivariate relative risk for former smokers, as compared to never smokers, was 2.4 (95% CI, 1.1-5.2). CONCLUSIONS: High BMI, consumption of high-fat meat, and smoking were associated with gallstone disease.