Vajira Medical Journal: Journal of Urban Medicine

243-254

Authors: Nathamon Pansuksawat, Pinailug Tantilipikorn Earde, Patcharee Kooncumchoo, Bunyong Rungroungdouyboon, Noppol Pramodhyakul

Objective: To determine the effects of I-Walk (Robotic-assisted gait device) training compared with over-ground walking training on motor impairments assessed by lower extremity scores, lower extremity angles during walking, and gait performances in patients with chronic stroke. Methods: A single blinded randomized controlled trial was conducted. Twenty four chronic stroke patients were randomly assigned into two groups; experimental group (n=12) and control group (n=12). For gait performances, patients in an experimental group received I-Walk training, while those in a control group received over-ground walking training. The duration of training was 60 min per day, 3 days per week for 8 weeks. The outcome measures included motor impairments assessed by the Fugl-Meyer Assessment of Lower Extremity (FMA-LE) scores, lower extremity angles during walking (hips, knees, ankles), and gait performances (step length, cadence, walking speed, stride length, and step length symmetry ratio). All variables were measured before and after the training period. Results: There was a statistically significant difference in motor impairments assessed by the FMA-LE scores, lower extremity angles during walking on hips and knees, as well as gait performances, including step length, cadence, and walking speed, between the experimental and the control groups (p<0.05). In particular, the statistically significant changes were demonstrated in motor impairments assessed by the FMA-LE scores, lower extremity angles during walking on hips, knees, and ankles, as well as gait performances, including step length, cadence, walking speed, stride length, and step length symmetry ratio, before and after the I-Walk training in the experimental group (p<0.05). Conclusions: The I-Walking training could yield a statistically significant improvement of motor impairments assessed by FMA-LE scores, lower extremity angles during walking, and gait performances in chronic stroke patients. Nonetheless, further studies are recommended to elucidate and ratify the effective outcomes in patients with other stages of stroke, different ranges of lower extremity, and various spatiotemporal parameters.

263-274

Authors: Busaba Supawattanabodee, Woraphot Chaowawanit, Thanaporn Kittisiam, Budsaba Wiriyasirivaj, Siriwan Tangjitgamol

To evaluate the knowledge and attitudes of Bangkok Metropolitan women towards Human Papillomavirus (HPV) vaccinations. Thai women aged 25–65 years old who had lived in Bangkok for 5 years or over were invited to the study. Participants were asked to complete the questionnaire. 4,405 of 5,000 women completed the questionnaires. Approximately two-thirds of women had heard about HPV vaccination (61.4%). Approximately two-thirds of them had correct answers about the causes or risk factors of cervical cancer (65.7%), including HPV as an etiologic agent (67.4%). However, only few understood the relationship of HPV and cervical cancer (2.8%) or the types of HPV (6.2%). Regarding knowledge of cervical cancer and HPV, a quarter knew the method of HPV transmission (25.6%). Although most accepted the HPV vaccination (78.6%), only one-third knew about the particular groups of women who would benefit from this vaccination (34.6%). In conclusion, more than half of women knew about the cause of cervical cancer and HPV vaccine. However, only a few women knew about the relationship between HPV and cervical cancer or the types of HPV.

287-296

Authors: Somnimit Luengratsameerung

Objective: To study the relationship between serum ferritin levels and biochemical markers of bone turnover in postmenopausal women. Methods: This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Bangkok, Thailand. One hundred and twenty four postmenopausal Thai women were recruited from menopause clinic between December 2015 and March 2016. The inclusion criteria were age 40 years or more, body mass index (BMI) of 19-30 kg/m2, not use menopausal hormone therapy (MHT) within the last 3 months, adequate cessation period of any bone antiresorptive agent, no underlying disease which possibly associated with chronic anemia, and no history of steroid hormone, anabolic agent, or anticoagulant use. The subjects were excluded if their blood specimens were unsuccessfully collected or incompletely analyzed. Two kinds of biochemical markers of bone turnover were selected to study. The first one was a bone-formation marker, called procollagen type I N- terminal propeptide (P1NP) and the second was a bone-resorption marker, namely C-terminal cross-linked telopeptide of type I collagen (CTx). Each marker was evaluated its relationship to serum ferritin. Results: After recruitment, one subject was excluded because her blood specimen was loss during transfer, therefore 123 cases were left for analysis. Mean (SD) age, BMI, duration of menopause, and number of parity of the overall subjects were 56.8 (4.2) years, 24.3 (3.1) kg/m2, 7.1 (5.3) years, and 1.3 (1.1), respectively. Mean (SD) serum ferritin, P1NP, and CTx levels were 147.75 (95.11), 63.90 (16.70), and 0.463 (0.154) ng/ml, respectively. Serum ferritin levels were negatively correlated with P1NP and with CTx levels (r = -0.149, p = 0.099 and r = -0.038, p = 0.677, respectively). Conclusion: Serum ferritin levels had non-significant inverse relationship with P1NP and CTx levels in postmenopausal women. The long-term effects of low iron storage on biochemical markers of bone turnover are needed to be further evaluated.

173-180

Authors: Supakit Chartchaiyarerk, Surapong Sungtra

Objectives: To compare the result of appendicitis treatment between laparoscopic surgery (LA) and open surgery (OA) in overweight patient. In term of hospital length of stay (LOS), intraoperative time, time to resume diet and postoperative complications. Methods: A retrospective study by reviewing medical records of overweight patients (BMI ≥ 23 kg/m2) in Bangkok Metropolitan Administration General Hospital with acute appendicitis who underwent LA and OA from January 2012 through December 2017. The data included personal information, intraoperative details, postoperative details and the data of those was analyzed and was compared between open and laparoscopic surgery. Results: There were 136 (71 male, 65 female) overweight patients underwent appendectomy. Subjects were divided into 2 groups; 68 in LA and 68 in OA. Median length of stay (LOS) for LA was better, 58.5 hours versus 85.5 hours for OA (P < 0.01), median operative blood loss for LA was better, 5 ml versus 20 ml for OA (P < 0.01) and primary wound closure rate was better, 100% for LA versus 85% for OA (P = 0.001). Other outcome measures were equivalent. Conclusion: LA can be performed safely with shorter LOS, less delayed primary wound closure and less operative blood loss in overweight patients and should be considered the procedure of choice for overweight patients with appendicitis.

193-204

Authors: Orain Winthachai, Chirakit Hengrussamee

Introduction: Emergency Medical Services (EMS) in Thailand are considered as multi-tiered response system providing medical care regarding the degrees of emergency and severity prioritization. Thus, effective triage tools are mandatory for efficient resource management to achieve productivity during pre-hospital emergencies and casualties. Objectives: To compare the agreement and consistency in severity assignment between the standard in-hospital emergency severity index (ESI) and the pre-hospital assessment tools, including the phone triage with criteria-based dispatch protocol and the on-scene triage using the National Early Warning Score (NEWS). Methods: This is a retrospective, descriptive study of EMS missions conducted by a single urban EMS center, Vajira Hospital. Data including phone triage medical dispatch codes, pre-hospital NEWS and ESI levels were collected and analyzed. Results: A total of 950 EMS missions were evaluated, among which 93.6% were categorized as ‘red code’. The phone triage medical dispatch demonstrated the over-triage rate of 26.2% and the under-triage rate of only 1.7% with slight reliability (Kappa 0.165; p-value < 0.001) when compared to ESI levels, whereas the pre-hospital NEWS resulted in the under-triage rate of 47.8% with fair reliability (Kappa 0.344; p-value < 0.001). Conclusion: For pre-hospital settings, the phone triage using medical dispatch codes provides more accurate severity assignment with optimal outcomes consistent with the international recommendations, whereas the NEWS seems to generate excessive undertriage rate.

213-222

Authors: Nichanan Boonon; Wongpun Limpaseni

Objectives: To study the physical aspect and convenience of walking and to analyze the behavior, satisfaction and needsof pedestrians inorder to propose ways to improve sidewalks in Bangkok. Methods: This research was a quantitative research coupled with qualitative research using the ADB Pedestrian Preference Survey Form adapted to suit local conditions. The survey was conducted for each of the section from one station to another of the light green sky train line (Silom line) to evaluate convenience of walking (Walkability index) for each section of the sidewalk. Notes, video and notes were taken in order to use the information to analyze for problems and obstacles along the sidewalk. Questionnaire on behavior and satisfaction of pedestrian was conducted on samples without using probability theory (Non-Probability) employing Haphazard or Accidental Sampling of pedestrians on 12 sidewalk sections, 17 samples each section for a total of 204 samples. The questionnaire consists of 2 parts: part 1 is basic information and part 2 is the behavior and satisfaction of pedestrians. The questionnaire was multiple choices and preference ranking. Data were analyzed by frequency distribution percentage. Results: Survey results of walking convenience found obstacles to walking on sidewalk include (1) lack of equipment and facilities for the disabled (ramp, blind block) (2) safety from crime (3) equipment and facilities for pedestrians. Questionnaire on satisfaction of pedestrian have the following results: (1) Ease of walking was low (55.39%) (2) Pedestrian safety was low (58.33%) (3) Improvements needs were safety from crime (street light, CCTV, and risky spots 22.06%), width and surface quality of sidewalk (21.08%). If there is improvement to sidewalk, there would be high preference to use the sidewalks (61.76%) Conclusion: Obstacles that cause walking inconvenience and in line with the preference of pedestrians to improve sidewalks are (1) Lack of equipment and facilities for pedestrians and disabled people (2) Safety from crime (3) Continuation of sidewalk, pedestrian crossing, obstacles to walking and driving on sidewalk. Improvements to the sidewalk will increase number of pedestrians leading to better health of people and help reduce road traffic and pollution in Bangkok.

97-108

Authors: Anchalee Samngammee, Kaysorn Sumpowthong, Nontiya Homkham

Introduction: The purposes of this article are to examine preventive behaviors regarding diabetes and hypertension among support staff at Lampang Rajabhat University, northern Thailand, and to explore factors related to preventive behaviors for diabetes and hypertension among support staff at Lampang Rajabhat University. Conceptual framework was explained according to the PRECEDE framework. Methods: The research design was analytical cross sectional study. Samples were 220 supporting staff at Lampang Rajabhat University. Data were analyzed by descriptive statistics and logistic regression. Results: Thesample preventive behaviors of diabetes and hypertension were at a moderate level. There was a statistically significant correlation between predisposing, enabling, and reinforcing factors for preventive behaviors for diabetes and hypertension (p-value <0.05). These included gender, average family income in baht per month, knowledge, attitude, information received from media, and family support, respectively. There was no correlation with preventive behaviors for diabetes and hypertension with personnel policy on health promotion and support from colleagues Conclusion: Gender, average family income in baht per month, knowledge, attitude, information received from media, and family support were the factors associated with promote the prevention of diabetes and hypertension . These findings suggest that personnel should be encouraged to develop more preventive behaviors to avoid diabetes and hypertension by providing health information and organizing training activities to promote disease prevention behaviors and awareness raising on effective preventive healthcare.

117-124

Authors: Dennopporn Sudjai, Adjima Soongsatitanon

Objective: To compare pregnancy outcomes between women aged 35 years and older with those under 35 years old. Methods: A retrospective cohort study was conducted at Vajira hospital, Navamindradhiraj University from 1 October 2012 to 31 December 2013. Total 896 gravidas whose aged at least 20 years old at delivery were obtained. The study group (n = 448) consisted of women with aged 35 years and older while the control group (n = 448) were those 20-34 years old. Pregnancy outcomes between the two groups were compared including GDM, preeclampsia, placenta previa, preterm birth, operative vaginal delivery, rate of cesarean section (CS), PPH, birth weight, Apgar score at 5 minutes, fetal anomalies and perinatal death. Results: Data of all 896 women were obtained. The study group had significantly higher risks of GDM, preeclampsia, preterm birth, cesarean delivery and PPH than the control group. The rate of low birth weight and low Apgar score at 5 minutes were different in both groups. Conclusion: Women with advanced maternal age (AMA) had significantly higher risks of adverse pregnancy outcomes than women aged 20-34. This information may aid the clinicians to aware of adverse outcome in AMA.

133-144

Authors: Kan Limsirisawt, Kobtun Khongthanarat, Napat Wongmat, Teerapat Kuntolbut, Premanan Sinchaipanit, Atawee Tangpontirak, Sumittra Muangkhoua

Objective: To study the food consumption behaviors, attitudes towards food consumption and factors relating to food consumption behaviors of third-year to fifth-year medical students at the Faculty of Medicine Vajira Hospital. Methods: The study design was cross-sectional descriptive study. The data were collected by questionnaires. The samples were a total of 170 third-year to fifth-year medical students, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, academic year 2016. Data were analyzed by using frequency, percentage, mean, standard deviation, median, interquartile range, Mann-Whitney U Test, and Kruskal-Wallis Test, p-value less than 0.05 was considered statistically significant. Results: The food consumption behaviors of medical students had a moderate level (84.1%), good level (15.9%). The attitudes towards food consumption had a good level (60.0%), moderate level (38.2%), and low level (1.8%). Class times start, age, and attitudes towards food consumption were factors associated with food consumption behaviors at the 0.05 significant level. Conclusion: The food consumption behaviors of medical students had a moderate level and attitudes towards food consumption had a good level. Medical students had class times start, age, and attitudes towards food differed were different in food consumption behaviors. These findings should be used to promote appropriate food consumption behaviors of medical students.

159-164

Authors: Chavanant Sumanasrethakul

Objective: Define the definition of Urban Medicine in Thailand and recommend for Urban medicine development Methods: Qualitative research by documentary search and interview stakeholder working in public health and medicine at management level of health units Results: Urban medicine were defined based on disease and health risk which definite prevalence data or have health impact and health service system in urban context, especially urban underserved population Urban medicine development should be done based on multidisciplinary work and inter-organization work Conclusion: Urban medicine development for improvement of urban health status

11-22

Authors: Kannikar Booranavanich, Krit Cheawcharnprapan

Objective: To determine risk factors related to the mother, labor and newborn toward the occurrence rate of perinatal asphyxia in the Faculty of Medicine Vajira Hospital. Study design: Case control study. Methods: The sample group covered 450 subjects of life birth newborns divided into study group of 150 subjects (apgar score at 1 minute was 7) and control group of 300 subjects (apgar score at 1 minute more than 7) (ratio 1:2). Results: There were 5 risk factors associated with perinatal asphyxia including placenta previa [Odds Ratio(OR) 4.54, 95% CI 2.961-6.973], birth weight less than 2,500 grams (OR 3.20, 95% CI 2.156-5.227), fetal distress (OR 3.11, 95% CI 2.041-4.741), mother younger than 20 years old (OR 2.51, 95% CI 1.252-5.024) and gestational age less than 34 weeks (OR 2.07, 95% CI 1.758-4.612). Conclusion: According to the study, there were 5 risk factors associated with perinatal asphyxia that difficult to changing or prevention. However, knowing the newborn at risk of perinatal asphyxia is useful to prepare an appropriate neonatal resuscitation.

33-40

Authors: Supakit Chartchaiyarerk

Objective: To compare the result of appendicitis treatment between laparoscopic surgery (LA) and open surgery (OA). In term of duration of hospital stay, intraoperative time, postoperative pain, hospital and medical expenses. Materials and methods: A retrospective study by reviewing medical records of appendicitis patients who were treated from 1st January, 2011 to 31st December, 2013. The data included personal information, intraoperative details, postoperative details and the data of those was analyzed and was compared between open and laparoscopic surgery. Results: From the collecting data, 560 patients (433 patients from open surgery and 122 from laparoscopic surgery were studied retrospectively. According to this study, laparoscopic appendectomy was associated with a less blood loss (10 mL in LA and 19 mL in OA, p-value = 0.017, 95% CI = -16.181-(-1.564)), shorter hospital stay (3.1 in LA and 3.6 in OA, p-value = 0.039, 95% CI = -0.969-(-0.004)), and lower postoperative pain from day 1 to day 3 (p-value = <0.001, 95% CI = -0.673-(-0.327), p-value = <0.001, 95% CI = -0.948- (-0.521), and p-value = <0.001, 95% CI = -1.421-(-0.894), respectively). In contrast, intraoperative time in laparoscopic surgery was longer than open surgery significantly (73 min in LA and 54 min in OA, p-value = <0.001, 95% CI = 14.096- 23.566) and cost was higher, too (p-value = <0.001, 95% CI = 7819-11891 ). All factors were statistically significant. Conclusion: The treatment of appendicitis by using laparoscopic surgery provides a better result in the term of duration of hospital stay, recovering time, postoperative pain but it requires more operative time and more cost too.

59-70

Authors: Jariya Chuensirimongkol, Walaya Tupanich, Suteekarn Chaiyalap, Chanipa Yoryuenyong, Siriporn Kruttakart

This research aimed to examine perception towards Family Care Team project of disabled, elderly, chronic and palliative care patients in Bangkok; and to explore Family Care Team operations in Bangkok. Research population were disabled, elderly, chronic and palliative care patients living in Bangkok. A sample of 374 cases living in Taling Chan district, Ladphrao district, Bangplad district, Dusit district, Thonburi district and Bang Sue district were selected to the study. Research tools comprised a questionnaire of perception towards Family Care Team project and a questionnaire of operation performance in accordance with Family Care Team criteria adapted from a questionnaire created by Prof.Dr.Paiboon Suriyawongpaisan and staff (2015) used in the study of Assessment of health policy on promoting family care team with Cronbach’s alpha coefficient reliability at 0.78. Statistics used to analyze the data were frequency, percentage, mean, and standard deviation. The results of the study were as follows. 1. Perception towards Family Care Team project of disabled, elderly, chronic and palliative care patients in Bangkok revealed that 63.6% of samples received information about Family Care Team from Health team, 20.1% of samples knew name of doctors of Family Care Team, and 5.6% of samples knew telephone numbers of doctors of Family Care Team. 2. Operation performance of Bangkok Family Care Team resulted as follows. 1) For service access, 93.3% of samples found it was convenient to receive healthcare service at the public health center they regularly visited, 58.8% of samples indicated the public health center they regularly visited provided part-time clinic, and 50% of samples were able to contact Family Care Team for their health problem. 2) For disease prevention, 50-80% of samples received information about disease prevention and healthcare in all aspects, 35% of samples were informed about cancer screening and 42% of samples received flu vaccine. 3) For disease screening, most samples received healthcare services to measure their blood pressure measurement 70-90%, weight, blood glucose and blood cholesterol. 4) For data access and care coordination, 85.6% of samples found that it was convenient to seek for data file as well as samples were able to see personal file and asked for a copy of their examination records when they needed (26.2% and 20.6% respectively). Moreover, 28.3% of samples were helped with appointment and transfer for specialist visits and 24.9% of samples indicated that their specialist doctor visits were monitored. 5) For patient-centered care services, most samples showed their opinions were respectful and they got detail explanation for their doubts (92% and 90.2% respectively) whereas 31.3% of samples got a home-visit. 6) For self-care supporting system, samples revealed that Family Care Team provided ongoing follow-up appointment and explained about complications, diseases, how to conduct home self-care, treatment options, in addition, they invited them to join health promotion activities (65.5-71.1%). Also,59.4% of samples indicated that Family Care Team visited their house to give advice and help.