Association between Health Literacy, Self-care Behavior, and Blood Sugar Level among Older Patients with Type 2 Diabetes in Rural Thai Communities.

BACKGROUND: Diabetes mellitus is a major problem worldwide. Moreover, older patients with significantly limited health literacy (HL) tend to have worse self-care behaviors and health outcomes. This study aimed to describe the associations of HL, self-care behavior, and blood sugar levels among older patients with type 2 diabetes in rural Thai communities. METHODS: This cross-sectional study included 415 patients with diabetes who were purposively selected from rural Thai communities. Data were collected using questionnaires and analyzed using descriptive statistics, Pearson correlation, Spearman rho, and stepwise multiple linear regression. RESULTS: The results revealed that most participants were women (66.50%). The respondents had moderate overall HL (2.68±0.64). On average, the respondents had fair overall self-care behavior (4.0±0.33). We discovered that HL was significantly positively correlated with self-care behavior (r=0.90) but not with blood sugar level. In addition, self-care behavior was significantly negatively correlated with blood sugar level (r=-0.50). Self-care behaviors and blood sugar levels were significant predictors of HL in patients with type 2 diabetes (total variance, 28.4%). CONCLUSION: The results suggested increased HL in patients with diabetes would improve self-care behavior and, consequently, decrease their blood sugar level. Our findings indicate the need to involve nurses and multidisciplinary healthcare teams when developing health promotion programs to encourage blood sugar control.

Healthcare Workers' Burdens During the COVID-19 Pandemic: A Qualitative Systematic Review.

BACKGROUND: The global healthcare system is continuing to confront major challenges during the current COVID-19 pandemic, with the second wave the deadliest one to date. This study aimed to identify and explore the challenges and burdens of frontline healthcare workers during the current pandemic, and to help prepare workforce support plans for them now and in the future. METHODS: A qualitative systematic review method involving thematic synthesis without meta-analysis was used to analyze relevant studies from five databases from November 2020 to February 2021: MEDLINE via PubMed, CINAHL Complete, Embase through Ovid, Scopus, and Web of Science. The quality of the studies was evaluated using the Critical Appraisal Skills Program Qualitative Research Checklist appraisal tools. This systematic review was conducted in accordance with the PRISMA statement. The informants are healthcare workers working at the frontlines and providing care to COVID-19 patients. RESULTS: Ten studies revealed the burden of healthcare providers during the COVID-19 pandemic, with having the related challenges experienced by 498 participants (doctors, nurses, pediatric nurses, paramedical staff, support staff, and physiotherapists). Our findings fell into four main themes as follows: inadequate preparedness; emotional challenges; insufficient equipment and information; and work burnout. CONCLUSION: The study results demonstrate that the COVID-19 pandemic has had an impact on all aspects of life, especially for healthcare providers, who work on the frontlines. The pandemic has affected the frontline workers' physical and psychological health, causing them to experience emotional distress such as fear, anxiety, depression, and stress. In addition, the pandemic can increase posttraumatic stress disorder, leading to burnout and discontinuity of healthcare workloads to ensure the patients' safety and the high quality of care provided to the patients.

Optimal Nutritional Factors Influencing the Duration of Mechanical Ventilation Among Adult Patients with Critical Illnesses in an Intensive Care Unit.

OBJECTIVE: This study aims to identify the impact of nutritional factors on mechanical ventilation duration for critical patients. PATIENTS AND METHODS: The current study was a single-center, prospective observational design which enrolled one-hundred critically ill patients who were admitted to an intensive care unit (ICU). It demonstrates purposive sampling and also performs the descriptive nutritional factors influencing the mechanical ventilation duration. Daily calories target requirement scale (DCRS), subjective global assessment form (SGA), dyspnea assessment form, and APACHE II have been used as methods in the study along with time to initial enteral nutrition (EN) after 24-hour admission and daily calories target requirement over 7 days to assess patients. Data is analyzed using the multiple regressions. RESULTS: As a result, nutritional status monitoring, time to initial EN, calories and target requirements are statistically positive significance associated with the mechanical ventilation duration respectively (R = 0.54, R = 0.30, R= 0.40, p < 0.05). However, age, illness severity, and dyspnea scales are not associated with the mechanical ventilation duration (p> 0.05). Therefore, the nutritional status, malnutrition scores and calorie target requirements can be used to significantly predict the mechanical ventilation duration. The predictive power is 58 and 28.0% of variance. The most proper influencer to predict the mechanical ventilation duration is nutritional status or malnutrition scores. CONCLUSION: The research findings show that the nutritional status, time to initial EN, and calorie target requirement within 7 days of admission are associated with the mechanical ventilation duration in the critical patients. Therefore, it can be used to develop guidelines reducing the mechanical ventilation duration and to promote the ventilator halting for critical patients.

"I am afraid that others will feel scared and disgusted with me. So, I will keep it a secret until I die": A qualitative study among patients with tuberculosis receiving DOTS regimen in Thailand.

Background: Tuberculosis (TB) has become a significant public health problem leading to a top ten morality. Directly Observed Therapy, Short-course (DOTS) is recommended as a critical element for curing and preventing TB. However, patients who have been living with TB often receive barriers and challenges, which may lead them to discontinue the DOTS treatment. Objective: This study aimed to understand patients' experiences living with TB and receiving DOTS regimens. Methods: A qualitative descriptive study was employed. Semi-structured interviews were done among twenty tuberculosis patients selected using convenience sampling from the slum community in Bangkok, Thailand. The thematic approach was used for data analysis. Results: Two main themes were developed: (1) troublesome disease and (2) emotional challenges. The first theme comprises three subthemes: confronting death, accepting lifestyle change, and DOTS challenges. The second theme consists of two subthemes: isolation from others and stigma. Conclusion: The findings could guide nurses and other healthcare professionals to develop the treatment guideline and the DOTS strategy using a holistic approach.