Professional Socialization of Nurses in Humanized Care: A Qualitative Study.

Background: Professional socialization of nurses is the process of transferring knowledge, skills, techniques, attitudes, and values among nursing professionals in order to enhance their capacity consistently. The objective of this research was to study the professional socialization of nurses in humanized care in 2 phases: in a nursing study phase, and in a nursing professional phase. Materials and Methods: The study was implemented in the form of a qualitative study by using an in-depth interview technique for the data collection. The informants of the study were 12 professional nurses who were granted the Award of Ratchaphiphat Role Model of Best Moral Practice. Results: During the nursing study phase, it was found that the professional socialization of nurses operated through course content, teaching management, extra-curricular activities, the interaction between nursing instructors and students, interaction among peers, observation of nursing instructors, and observation of nurses. On the other hand, in the nursing professional phase, professional socialization is performed through orientation, on-the-job training, supervision, ethical and moral promoting activities, and interaction with and observation of colleagues. Conclusions: Based on the findings, some recommendations were proposed as guidelines to develop nursing educational management for promoting humanized care in the development of nursing students and professionals.

Multiple self-care behaviors and associated factors in community-dwelling patients with hypertension in Myanmar.

This study aimed to identify the prevalence of self-care behaviors and the associated factors among hypertensive patients in primary care in Myanmar. This cross-sectional study was conducted from April to May 2019 among 410 hypertensive patients in Myitkyina Township, Kachin State, Myanmar. Hypertensive patients aged 30-70 years old and being registered at the community health centers in Myitkyina Township were selected using multi-stage cluster random sampling. Self-care behaviors were measured by Hypertensive Self-Care Activity Level Effect (H-SCALE). Chi-square test and multiple logistic regression analysis were used to explore the associated factors. Prevalence of adherence to multiple self-care behaviors were low: avoidance of tobacco use at 50.2%, followed by physical activity at 24.9%, medication at 24.1%, weight management at 9.5%, and healthy diet at 2.7%, while abstinence from harmful alcohol drinking was high at 97.8%. Multiple logistic regression analysis indicated that younger patients, low family income, inadequate knowledge, and no comorbidity were associated with non-adherence to medication. Living in rural area and having poor self-efficacy were associated with non-adherence to weight management, while being younger, female and having poor self-efficacy were also associated with non-adherence to physical activity. Compared with Kachin, other ethnics were more likely to be non-adherent to avoidance of tobacco use. Although a majority of respondents were not harmful drinkers, adherence to medication, healthy diet, physical activity, weight management and avoidance of tobacco use were very low. Health practitioners should provide education programs for hypertensive patients to direct them towards practical techniques in managing their blood pressure.

Dietary Diversity, Social Support and Stunting among Children Aged 6-59 Months in an Internally Displaced Persons Camp in Kayin State, Myanmar.

Children living in the internally displaced person (IDP) camp are at higher risk of stunting. This cross-sectional study aimed to assess the prevalence and to identify the associated factors of stunting among children aged 6-59 months at Myaing-Gyi-Ngu IDP camp in Kayin State, Myanmar. According to the World Health Organization Child Growth Standards, children with a height-for-age Z-scores below -2 standard deviation of the reference median (HAZ ≤ -2) were classified as stunted. Multiple logistic regression analysis was performed to identify the strong predictors. Prevalence of stunting has been found very high (59.4%). Adjusted model revealed that children living with illiterate mothers (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.07-3.24), being third/later-birth child (OR, 1.88; 95% CI, 1.13-3.14), consuming less than 4 food groups (OR, 4.22; 95% CI, 1.94-9.16), and older age of child (OR, 6.36 for 13-24 months; 95% CI, 2.74-14.74, 7.45 for 25-36 months; 95% CI, 3.21-17.25 and 12.75 for 37-59 months; 95% CI, 5.51-29.52) had higher odds of becoming stunted. The levels of support availability, presumed support and support received of mothers were generally low, but no significant associations were observed. In conclusion, this study showed high prevalence of stunting, but low dietary diversity and social support in the IDP camp. Due to the significant association of dietary diversity scores with stunting, interventions aiming at improving dietary diversity should be taken to reduce the stunting among children in the IDPs camp.

Two-year results of a community-based randomized controlled lifestyle intervention trial to control prehypertension and/or prediabetes in Thailand: a brief report.

The aim of the study was to assess the 2-year effect of a community-based randomized controlled lifestyle intervention on glucose and blood pressure levels in Thailand. Participants (N=443, with prediabetes and/or prehypertension) received a six 2-hr group sessions lifestyle intervention (physical activity and nutrition) over 6 months. Measurements were at baseline, 12 months (89%) and at 24 months (84.7%). Statistically significant interaction effects on fasting plasma glucose and DBP at 12 months were not maintained at 24 months, while significant interaction effects were found on high-density lipoprotein and low-density lipoprotein cholesterol at 24 months. Improvements were found for fasting plasma glucose, SBP, DBP and total cholesterol, but no significant interaction effect was detected. The development of type 2 diabetes was higher in the control than in the intervention group, but it was not reaching significance (P=0.181), while 3.0% in the intervention group and 2.6% in the control group developed hypertension at 24 months. No significant group differences were found in psycho-behavioral variables. The lifestyle intervention did not provide additional benefits compared to the control group at 24-month follow-up. Trial registration number: TCTR20170721001.

Non-adherence to anti-retroviral therapy among HIV infected adults in Mon State of Myanmar.

BACKGROUND: The provision of Anti-Retroviral Therapy (ART) was started in Myanmar in 2005 in collaboration with the National AIDS Program and the private sector. Successful clinical management of HIV-infected patients is subject to optimal adherence. The aim of the study was to determine the prevalence of adherence to ART and identify factors associated with non-adherence to ART among HIV infected adults registered in a private sector setting in Mon State, Myanmar. METHODS: This cross-sectional study was conducted with adults living with HIV receiving ART at an HIV outpatient clinic between April and May 2016. A total of three hundred People Living with HIV(PLHIV) were interviewed using a pretested and structured questionnaire. The 30 days Visual Analog Scale (VAS) adherence instrument was used to assess the level of adherence. Multivariable logistic regression analysis was used to determine factors associated with non-adherence to ART. RESULTS: Among 300 patients (male 37.7% and female 62.3%, with a mean age of 41.3 years, standard deviation 8.7), 84% reported ≥95% adherence to ART in the past month. Among 16% of those reporting non-adherence, major reasons for skipping the medication were being busy (23%), being away from home (17.7%) and being forgetful (12.3%). In multivariable logistic rgeression, low behavioural skills on ART adherence (OR = 0.31, 95% CI: 0.10-0.94), tobacco use (OR = 3.22, 95% CI:1.28-8.12), having disclosed their HIV status (OR = 0.07, 95% CI: 0.01-0.69), having a partner who was not on ART (OR = 4.25, 95% CI: 1.70-10.64) and among men, having erectile dysfunction (OR = 15.14, 95% CI: 1.41-162.66) were significant associated with ART non-adherence. CONCLUSION: Non-adherence to ART was associated with individual moderating factors and behavioral skills. Priority measures such as addressing risk behaviour and behavioural change communication tailored to individual patients' lifestyles requires comprehensive interventions to improve adherence.

Can a community-based multidisciplinary intervention effectively restore renal function? A non-randomized clinical trial.

There is insufficient evidence in the literature to indicate whether the promotion of lifestyle changes to prevent renal dysfunction and activate regeneration is effective. We examined the effectiveness of a community-based intervention program on renal restoration using a non-randomized clinical trial design with a follow-up period of six months. The training focused on lifestyle changes, including health education and personal consultation with a multidisciplinary health team. Our study included 120 patients with fractional excretion of magnesium levels of > 2%, who were assigned to experimental or control groups. Fractional excretion of magnesium levels were significantly decreased within six months in the experimental group; however, changes in the estimated glomerular filtration rate were not identified in either of the groups. These results suggest that screening of the fractional excretion of magnesium level and the "Healthy Kidney Program" had an effect in preventing chronic kidney disease or restoring kidney function.

Knowledge, attitudes, and practices about tuberculosis and choice of communication channels in Thailand.

INTRODUCTION: The aim of this study was to assess tuberculosis (TB) knowledge, attitudes, and practices in both the general population and risk groups in Thailand. METHODOLOGY: In a cross-sectional survey, a general population (n = 3,074) and family members of a TB patient (n = 559) were randomly selected, using stratified multistage sampling, and interviewed. RESULTS: The average TB knowledge score was 5.7 (maximum = 10) in the Thai and 5.1 in the migrant and ethnic minorities general populations, 6.3 in Thais with a family member with TB, and 5.4 in migrants and ethnic minorities with a family member with TB. In multivariate linear regression among the Thai general population, higher education, higher income, and knowing a person from the community with TB were all significantly associated with level of TB knowledge. Across the different study populations, 18.6% indicated that they had undergone a TB screening test. Multivariate logistic regression found that older age, lower education, being a migrant or belonging to an ethnic minority group, residing in an area supported by the Global Fund, better TB knowledge, having a family member with TB, and knowing other people in the community with TB was associated having been screened for TB. CONCLUSION: This study revealed deficiencies in the public health knowledge about TB, particularly among migrants and ethnic minorities in Thailand. Sociodemographic factors should be considered when designing communication strategies and TB prevention and control interventions.

The utilization of traditional, complementary and alternative medicine for non-communicable diseases and mental disorders in health care patients in Cambodia, Thailand and Vietnam.

BACKGROUND: The purpose of our study was to determine the prevalence of traditional, complementary and alternative medicine (TCAM) use in patients with chronic diseases in lower Mekong countries. METHODS: A cross-sectional study was conducted in a health care setting using a random sample of 4799 adult patients (Mean age: 52.3 years, SD = 22.7) with chronic diseases in Cambodia, Vietnam and Thailand. The measure included the International Questionnaire to measure usage of complementary and alternative medicine (I-CAM). RESULTS: The 1 year prevalence of consulting TCAM providers was 26.0%; 27.0% in Cambodia, 26.3% in Thailand, 23.9% in Vietnam. The most commonly consulted TCAM providers were the herbalist (17.3%), massage therapist (6.0%), and acupuncturist (5.5%). For all different types of TCAM providers more than 80% of participants perceived the consultation as very or somewhat helpful. The own use of herbal medicine was 41.0%, own use of vitamins 26.5% and the own use of other supplements 9.7% in the past 12 months. The most common self-help practices in the past 12 months included praying for your own health (30.1%), meditation (13.9%) and relaxation techniques (9.9%). In multivariate logistic regression analyses, older age, rural residence and having two or more chronic conditions was associated with the use a TCAM provider; being female, urban residence, residing in Vietnam and having two or more chronic conditions was associated with the use of TCAM products; and being female, older age, rural residence, higher formal education, and residing in Cambodia was associated with the use of TCAM self-help practices. CONCLUSIONS: TCAM use is common among chronic disease patients in lower Mekong countries and is associated with several sociodemographic and disease specific factors.

Conjoint moderate or high-risk alcohol and tobacco use among male out-patients in Thailand.

OBJECTIVE: To better understand conjoint alcohol and tobacco use among male hospital out-patients, the purposes of this study were: (1) to assess the prevalence of conjoint use and (2) to determine the factors associated with the conjoint alcohol use and tobacco use. METHODS: In a cross-sectional survey, consecutive male out-patients from four district hospitals in Nakhon Pathom province in Thailand were assessed with the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), Hospital Anxiety and Depression Scale (HADS), self-reported chronic conditions and health-seeking behaviour. The sample included 2208 study participants, with a mean age of 36.2 years (SD = 11.7) and an age range of 18-60 years. RESULTS: Overall, 34.5% of the male hospital out-patients were conjoint moderate or high-risk alcohol and tobacco users, and 31.1% were moderate or high-risk alcohol or tobacco users. In multivariate analysis, younger age, having primary or less education, being separated, divorced or widowed, not having diabetes and not being obese were associated with conjoint moderate or high-risk alcohol and tobacco use. CONCLUSION: High prevalence and several risk factors of conjoint alcohol and tobacco use were found among hospital male out-patients. The findings of this study call for dual-intervention approaches for both alcohol and tobacco.

Screening and concurrent brief intervention of conjoint hazardous or harmful alcohol and tobacco use in hospital out-patients in Thailand: a randomized controlled trial.

BACKGROUND: The aim of this study was to conduct a cluster randomized control trial to assess the efficacy of screening and brief intervention (SBI) for conjoint alcohol and tobacco use among hospital out-patients. METHOD: In all 620 hospital out-patients who screened positive for both tobacco and alcohol moderate risk in four hospitals were randomized into 2 control and 1 intervention condition using the hospital as a unit of randomization (2 intervention and 2 control hospitals) to 405 patients in the two control groups (tobacco only intervention, n=199, and alcohol only intervention, n=206) and 215 in the intervention group. The intervention or control consisted of three counselling sessions. RESULTS: Results of the interaction (Group × Time) effects using GEE indicated that there were statistically significant differences between the three study groups over the 6-month follow-up on the ASSIST tobacco score (Wald χ(2) = 8.43, P=0.004), and past week tobacco use abstinence (Wald χ(2)=7.34, P=0.007). Although there were no significant interaction effects on the other outcomes (Alcohol ASSIST score, low alcohol risk score, past week tobacco abstinence or low alcohol risk score, and past week tobacco abstinence and low alcohol risk score), the scores in all of the six outcome measures showed consistent improvements. For past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the integrated alcohol and tobacco intervention. For the outcome of low alcohol risk, the alcohol only intervention and the integrated alcohol and tobacco intervention was more effective than the tobacco only or alcohol only intervention. CONCLUSIONS: The study found that for past week tobacco abstinence the tobacco only intervention was more effective than the alcohol only intervention and the polydrug use (alcohol and tobacco) integrated intervention.