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Background: This study aimed to: (1) assess healthcare providers' opinions on e-cigarette safety and compare them across professions; (2) evaluate providers' recommendations for e-cigarettes as a tobacco product cessation tool and identify any associations with their safety perceptions. Methods: A self-administered questionnaire was completed by 760 healthcare professionals (January–March 2020). The survey included eight opinions on e-cigarette safety with five Likert-scale answers and a question on recommending them for tobacco product cessation. Results: Among 760 healthcare providers (173 physicians/dentists, 69 pharmacists, and 518 nurses), only 20% reported prior experience with tobacco product cessation counseling. Providers expressed uncertainty regarding e-cigarette safety (mean ± SD: 2.5 ± 0.7 on a 5-point Likert scale), with no significant differences between professions (p = 0.836). Similarly, e-cigarette recommendations for tobacco product cessation remained low across professions (13%, 85/637), with no significant differences found (p = 0.072). The recommendation of e-cigarettes for tobacco cessation is associated with perceived safety, lower respiratory irritation, lower coughing, a lower risk of cancer, and a lower risk for secondhand smokers when compared to traditional cigarettes (p < 0.05). Conclusions: Most healthcare providers were unsure about the safety of e-cigarettes; about 13% of providers suggested using them for tobacco product cessation, with safety perceptions influencing recommendations. [ABSTRACT FROM AUTHOR]

In Thailand and worldwide, smartphone addiction among university students is a growing concern. This study aims to investigate behaviors of smartphone use, the prevalence of smartphone addiction, the duration of smartphone use, and their associated factors among pharmacy students at a university in northern Thailand. This cross-sectional study was conducted using an online self-administered questionnaire to collect data from January to February 2021. Smartphone addiction was measured using the Smartphone Addiction Scale: Thai Short Version (SAS-SV-TH). Of 281 students (70% female, average age of 21.1 (2.0), year 1 to 5), 87% used smartphones and tablets. Their average time spent on a smartphone was 7.5 (±3.1) hours daily on weekdays and 8.1 (±3.1) on weekends. The top three reasons for using smartphones were social networking (92.9%), education (90.3%) and entertainment (89.6%). Health-related problems associated with smartphone use were insomnia (51.3%), anxiety (41.3%), headache (38.8%) and stress (38.4%). The prevalence of smartphone addiction was 49% (95% CI: 44–55%); the associated factor comprised time spent on smartphones (>5 h/day). The prevalence of spending more than five hours daily on smartphones was 75% (95% CI: 70–80%) during weekdays and 81% (95% CI: 77–86%) during weekends; associated factors for during weekdays included a monthly smartphone bill of more than 500 THB (adjusted odds ratio: 4.30 (95% CI: 2.00–9.24) and for senior students (adjusted OR: 3.31 (95% CI: 1.77–6.19). The results remained the same for the weekend. In short, the results show that half of the pharmacy students were addicted to their smartphone; time spent on smartphones (>5 h/day) was associated with addiction. Therefore, university students should be encouraged to adopt healthy habits for smartphone use (such as limiting screen time and maintaining good posture while using a smartphone or tablet) and to increase their awareness of health-related problems. [ABSTRACT FROM AUTHOR]

An influenza vaccination is recommended for patients with diabetes mellitus (DM) or ischemic heart disease (IHD) to prevent cardiovascular events, but the vaccination coverage remains low. This cross-sectional study sought to investigate vaccination coverage, knowledge level on influenza and factors associated with influenza vaccination in patients with DM or IHD treated at a tertiary hospital in northern Thailand. Patients were interviewed from August to October 2017. Of 150 patients interviewed (51.3% women, mean age of 66.7 ± 8.3 years, 35.3% DM, 35.3% IHD, 29.3% DM and IHD), 45.3% (68/150) were vaccinated against influenza. The mean knowledge score was 9.68 ± 1.35 (total: 11) and did not differ between those receiving the immunization and those who did not (p = 0.056). Two factors remained significantly associated with their vaccination after multivariable logistic regression analysis: knowing their right to receive free vaccinations (adjusted OR 2.32, 95% CI: 1.06–5.10, p-value: 0.035), and needing to be vaccinated (adjusted OR 3.50, 95% CI: 1.51–8.12, p-value: 0.003). Overall, the vaccine coverage was low; less than one-half of patients received the influenza vaccine, but their knowledge level was high. Possessing the right and having a need were two factors associated with vaccination. Such factors should be carefully considered to encourage patients with DM and IDH to receive the influenza vaccination. [ABSTRACT FROM AUTHOR]

Patients with type 2 diabetes mellitus (T2DM) can be affected by clinical inertia, leading to abysmal results. Studies on a suitable timeframe for treatment intensification remain scarce—especially outside of developed countries. This study aimed to explore the association between time to treatment intensification and diabetes-related complications. A database from a tertiary care hospital in Thailand was retrieved in order to conduct a retrospective cohort study for the years 2011–2017. This study comprised outpatients with T2DM presenting an HbA1c of ≥7.0%. Eligible patients were divided into three groups based on the time of treatment intensification: no delayed treatment intensification, treatment intensification within 6 months, and treatment intensification after 6 months. A Cox proportional hazards model was used to investigate the association between time to treatment intensification and diabetes-related complications. A total of 686 patients were included in the final analysis. During 6.5 years of median follow-up, the group with treatment intensification within 6 months was more strongly associated with diabetic nephropathy compared to the group with no delayed treatment intensification (adjusted HR 2.35; 95%CI 1.35–4.09). Our findings reveal that delaying treatment intensification by even 6 months can increase the likelihood of diabetic nephropathy compared to no delayed treatment intensification. We suggest that patients with T2DM whose blood glucose levels are outside the target range promptly receive treatment intensification. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has forced analytical chemistry educators in Thailand to change methods of teaching and learning to new normal ones. Higher education has faced additional challenges because of a lack of hands-on experiments and an increasing number of students in foundation chemistry courses being hindered from practicing skills. This work aimed to develop a Lab-at-Home (LAH) for new normal, analytical chemistry experimentation. The LAH implemented a hands-on green chemistry experiment, i.e., colorimetric determination of iron using non-hazardous reagents (supporting Sustainable Development Goal (SDG) 12-responsible consumption and production). The LAH was sent to students at their location before the synchronous class, where the instructors were prompt to supervise. Thus, this supports SDG4-quality education and SDG10-reduced inequalities. The learning outcome achievements, i.e., the analytical characteristics and colorimetry principles comprehension, as well as the ability to perform data analysis, were evaluated by a quiz and laboratory report. LAH satisfaction was assessed by questionnaire and focus group discussion. The learning outcomes were successfully achieved, although students who performed the experiment individually received higher scores than those who did in groups. Students were very satisfied with the LAH as a tool for new normal experimentation, yet some students faced a poor Internet connection during the synchronous online class. [ABSTRACT FROM AUTHOR]

Objective: Age-associated decline in central cholinergic activity makes older adults susceptible to harmful effects of anticholinergics (ACs). Evidence exists of an association between effects of AC medications on cognition. This retrospective cohort study examines how ACs affect cognition among older adults with Alzheimer's disease (AD) who received acetylcholine esterase inhibitors (AChEIs) over the course of 12 months. Results: A total of 133 (80% women, mean age 78.38 years, SD 7.4) were recruited. No difference in sex, age and comorbid diseases was observed between participants who took ACs, benzodiazepines (BZDs) and AChEIs. The most common prescribed ACs was quetiapine, being used for behavioral and psychological symptoms (BPSD). Multilevel analysis showed that the change of mental state examination scores were significantly predicted in the group using ACs (t (169), − 2.52, p =.020) but not with the groups using BZD (t (162), 0.84, p =.440). Evidence showed that older adults with Alzheimer's disease and exposed to ACs exhibited lower global cognitive scores than those without AC exposure. Using ACs could be a trade-off between controlling BPSD and aggravating cognitive impairment. Highlighting the awareness of the potential anticholinergic effect is important and may be the best policy. [ABSTRACT FROM AUTHOR]

This open-label, randomized, controlled, crossover trial assessed the effect of daily virgin coconut oil (VCO) consumption on plasma lipoproteins levels and adverse events. The study population was 35 healthy Thai volunteers, aged 18–25. At entry, participants were randomly allocated to receive either (i) 15 mL VCO or (ii) 15 mL 2% carboxymethylcellulose (CMC) solution (as control), twice daily, for 8 weeks. After 8 weeks, participants had an 8-week washout period and then crossed over to take the alternative regimen for 8 weeks. Plasma lipoproteins levels were measured in participants at baseline, week-8, week-16, and week-24 follow-up visits. Results. Of 32 volunteers with complete follow-up (16 males and 16 females), daily VCO intake significantly increased high-density lipoprotein cholesterol by 5.72 mg/dL (p=0.001) compared to the control regimen. However, there was no difference in the change in total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels between the two regimens. Mild diarrhea was reported by some volunteers when taking VCO, but no serious adverse events were reported. Conclusion. Daily consumption of 30 mL VCO in young healthy adults significantly increased high-density lipoprotein cholesterol. No major safety issues of taking VCO daily for 8 weeks were reported. [ABSTRACT FROM AUTHOR]

Background: For investigations into cardiovascular disease, the first problematic event (ie, nonfatal acute coronary syndrome (ACS), nonfatal stroke, or all-cause mortality) generally was considered as the primary end point; however, ACS patients often experience subsequent events, which are rarely considered. This study reports an investigation into whether achieving a low-density lipoprotein cholesterol (LDL-C) goal of <70 mg/dL (1.8 mmol/L) is associated with a reduction in total recurrent cardiovascular events in a cohort of ACS patients hospitalized in northern Thailand.Methods: The medical charts and the electronic hospital database of ACS patients treated with statins at a tertiary hospital in Thailand between 2009 and 2012 were reviewed. Patients were checked for their LDL-C goal attainment, and then were followed for subsequent events until the last follow-up date, or to December 31, 2012. The Wei-Lin-Weissfeld method was used for multiple time-to-events data to investigate the association between achieving an LDL-C goal of <70 mg/dL and total recurrent cardiovascular events.Results: Of 405 eligible patients, 110 patients attained an LDL-C goal of <70 mg/dL. During a median follow-up of 1.94 years, the majority of patients (88.6%) had no subsequent cardiovascular events, while 46 patients experienced at least one recurrent cardiovascular event: 36 with one event, six with two events, two with three events, one with four events, and one with seven events. Compared to patients with an LDL-C ≥100 mg/dL, patients achieving an LDL-C of <70 mg/dL were significantly less likely to experience total cardiovascular events (adjusted hazard ratio =0.29; 95% confidence interval =0.09-0.87; P-value =0.028); the result was similar to patients with an LDL-C of 70-100 mg/dL, but it was not significant (adjusted hazard ratio =0.53; 95% confidence interval =0.23-1.26; P-value =0.154).Conclusion: ACS patients receiving statins who attained an LDL-C <70 mg/dL experienced a reduction in total recurrent cardiovascular events compared to those with LDL-C ≥100 mg/dL. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) patients are at very high cardiovascular risk and tend to have recurrent cardiovascular events. The clinical indicators for subsequent cardiovascular events are limited and need further investigation. This study aimed to explore clinical indicators that were associated with recurrent cardiovascular events following index hospitalization. Methods: The data of patients hospitalized with ACS at a tertiary care hospital in northern Thailand between January 2009 and December 2012 were retrospectively reviewed from medical charts and the electronic hospital database. The patients were classified into three groups based on the frequency of recurrent cardiovascular events (nonfatal ACS, nonfatal stroke, or all-cause death) they suffered: no recurrent events (0), single recurrent event (1), and multiple recurrent events (≥2). Ordinal logistic regression was performed to explore the clinical indicators for recurrent cardiovascular events. Results: A total of 405 patients were included; 60 % were male; the average age was 64.9 ± 11.5 years; 40 % underwent coronary revascularization during admission. Overall, 359 (88.6 %) had no recurrent events, 36 (8.9 %) had a single recurrent event, and 10 (2.5 %) had multiple recurrent events. The significant clinical indicators associated with recurrent cardiovascular events were achieving an LDL-C goal of < 70 mg/dL (Adjusted OR = 0.43; 95 % CI = 0.27--0.69, p-value < 0.001), undergoing revascularization during admission (Adjusted OR = 0.44; 95 % CI = 0.24--0.81, p-value = 0.009), being male (Adjusted OR = 1.85; 95 % CI = 1.29--2.66, p-value = 0.001), and decrease estimated glomerular filtration rate (Adjusted OR = 2.46; 95 % CI = 2.21--2.75, p-value < 0.001). Conclusion: The routine clinical practice indicators assessed in ACS patients that were associated with recurrent cardiovascular events were that achieving the LDL-C goal and revascularization are protective factors, while being male and having decreased estimated glomerular filtration rate are risk factors for recurrent cardiovascular events. These clinical indicators should be used for routinely monitoring patients to prevent recurrent cardiovascular events in ACS patients. [ABSTRACT FROM AUTHOR]

Background: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of coronary artery disease. Current guidelines recommend an LDL-C target of <70 mg/dL (<1.8 mmol/L) for acute coronary syndrome (ACS) patients, and the first-line treatment to lower lipids is statin therapy. Despite current guidelines and the efficacious lipid-lowering agents available, about half of patients at very high risk, including ACS patients, fail to achieve their LDL-C goal. This study assessed LDL-C goal attainment according to use of high and low potency statins in routine practice in Thailand. Methods: A retrospective cohort study was performed by retrieving data from medical records and the electronic hospital database for a tertiary care hospital in Thailand between 2009 and 2011. Included were ACS patients treated with statins at baseline and with follow-up of LDL-C levels. Patients were divided into high or low potency statin users, and the proportion reaching the LDL-C goal of <70 mg/dL was determined. A Cox proportional hazard model was applied to determine the relationship between statin potency and LDL-C goal attainment. Propensity score adjustment was used to control for confounding by indication. Results: Of 396 ACS patients (60% males, mean age 64.3±11.6 years), 229 (58%) were treated with high potency statins and 167 (42%) with low potency statins. A quarter reached their target LDL-C goal (25% for patients on high potency statins and 23% on low potency statins). High potency statins were not associated with increased LDL-C goal attainment (adjusted hazards ratio 1.22, 95% confidence interval 0.79-1.88; P=0.363). Conclusion: There was no significant effect of high potency statins on LDL-C goal attainment. Moreover, this study showed low LDL-C goal attainment for patients on either low or high potency statins. The reasons for the low LDL-C goal attainment rate warrants further investigation. [ABSTRACT FROM AUTHOR]

The prevalence of smoking among young adults in Thailand has gradually increased. Therefore, this study aimed to identify factors associated with cigarette smoking among undergraduate students. This cross-sectional study used a self-administered, anonymous online questionnaire to gather data from undergraduate students across four universities in Chiang Mai Province, Thailand. All 1126 participants were an average age of 21.30 years old (SD 1.48). The findings revealed seven factors significantly associated with cigarette smoking (p < 0.05), including male sex, having no medical conditions, consuming alcohol daily and consuming alcohol in the past, having brothers or sisters who smoked cigarettes, having a father or mother who smoked cigarettes, having parents who considered smoking acceptable and having parents who had uncertain concerns about smoking, and had or have used electronic cigarettes (e-cigarettes). These associated factors could be useful in implementing appropriate tobacco-control programs to prevent cigarette smoking among undergraduate students. Relevant organizations, universities and healthcare professionals should communicate correct and appropriate information about the illness and diseases caused by using tobacco products to strengthen the correct perceptions of the harms of cigarette smoking and e-cigarette use among undergraduate students. Furthermore, smoke-free policies should be monitored and strictly enforced, particularly in university areas. [ABSTRACT FROM AUTHOR]

Background and Objectives: Clinical inertia is a key obstacle that leads to suboptimal care in patients with type 2 diabetes mellitus (T2DM). It can occur at any stage of T2DM treatment. However, the effect of clinical inertia on diabetes complications has not been studied sufficiently. This study aimed to evaluate the effect of clinical inertia on the risk of diabetes complications among patients with T2DM. Materials and Methods: A retrospective cohort study was conducted at a tertiary teaching hospital in Thailand between 2011 and 2017. Outpatients with T2DM, aged 40–65 years, presenting an HbA1c greater than 7% were included in this study. Clinical inertia was identified when patients did not get treatment intensification at the index date and a subsequent prescription. The association between clinical inertia and diabetes complications, including a composite of macrovascular complications and a composite of microvascular complications, was determined using a Cox proportional hazard model. Propensity score methods were applied, to control confounding by indication. Results: Of 686 patients with T2DM, 165 (24.0%) experienced clinical inertia. Baseline low-density lipoprotein cholesterol, blood pressure, body mass index, the estimated glomerular filtration rate, and medication between the two groups did not differ significantly. Our study found that clinical inertia was associated with a significantly increased risk of diabetic nephropathy (adjusted HR 1.51, 95% CI 1.01–2.27). The results remained the same as when using propensity score methods. According to the post hoc analysis, lowering the HbA1c levels by 1% results in a significant decrease in the rate of diabetic complications (adjusted HR 0.92, 95% CI 0.86–0.99), the composite of microvascular complications (adjusted HR 0.91, 95% CI 0.84–0.98) and diabetic nephropathy (adjusted HR 0.89, 95% CI 0.80–0.98). Conclusions: Our results demonstrated a significant effect of clinical inertia on diabetic nephropathy. Patients with an HbA1c level over the target range should have their medication intensified to reduce the risk of diabetic nephropathy. [ABSTRACT FROM AUTHOR]

To minimize chemical waste and protect the environment, our team has used green analysis with natural reagents. In this work, we designed a natural-reagent assay kit for iron determination and implemented it in chemistry education in Thailand. The iron assay method was adapted from Thai local wisdom of testing water quality using guava leaves. The guava leaf powder served as a natural reagent in the assay. The kit included equipment, standard and buffer solutions and a manual. A smart device with a built-in camera was used as a detector. Educators in six universities in Thailand implemented the kit in laboratories with modifications depending on their learning outcomes. The kit implementation was evaluated using a survey with questions in four aspects: usability, learning achievement, green chemistry and portability. The high average scores for all questions (> 4.00 of 5.00 points), with the average overall score of 4.53 ± 0.60, indicated satisfaction regarding in all aspects. Using a locally available bio-resource as a natural reagent for green analysis in chemistry education supported sustainable education in Thailand, in terms of quality education (SDG 4) and reduced inequalities (SDG 10) and environmental sustainability (SDG 6—Clean water and sanitation, 12—Responsible consumption and production and 14—Life be-low water). [ABSTRACT FROM AUTHOR]

Miang or fermented tea leaf has been a part of the Mae Kampong community, one of northern Thailand's famous tourist attractions, for a long time. Although the demand and popularity of Miang are decreasing, Miang is still important to the community lifestyle in various ways. Thus, this study aimed to investigate Miang consumption behavior, lifestyle, and wisdom in the Mae Kampong community, which would lead to sustainable development. The study involved a cross-sectional survey and a qualitative study. The research was done in Mae Kampong Village, Mae On District, Chiang Mai, Thailand. A total of 335 participants participated; 60.9% were female with an average age of 61.3 ± 12.2 years old. In all, 93.7% of the participants consumed Miang daily, mostly as a snack (86.5%). Consuming Miang as a staple food and beverage were less common. Furthermore, only 2.5% of the participants considered Miang as medicine. Miang is also the primary source of income and a tourist attraction. Additionally, Miang is an item in religious and local rituals. The Miang culture and the local lifestyle are bonded deeply as a sustainable economy, society, and environment. The wisdom in Miang culture encourages a better quality of life for the Mae Kampong community. [ABSTRACT FROM AUTHOR]

Providing smoking cessation services is one role of community pharmacists in Thailand. This cross-sectional study aimed to investigate activities and barriers related to smoking cessation services provided in community pharmacies in Thailand, as well as to compare these activities and barriers between those pharmacists providing and those not providing smoking cessation services. A postal questionnaire was conducted to collect information from community pharmacists across Thailand. In all, 413 valid responses were received from 5235 questionnaires, giving a 7.9% response rate. Of the 413 respondents, 152 (37%) pharmacists provided smoking cessation services in their pharmacy. The activities of smoking cessation services varied. Time for counseling each smoker varied, a mean of 15.1 ± 10.9 min (range 1–60) per person for the first time, and 8.9 ± 6.7 min (range 1–30) for each follow-up visit. Community pharmacists, providing smoking cessation services, were more likely to have pharmacist assistants, be a member of the Thai Pharmacy Network for Tobacco Control, and have more than 1 pharmacist on duty. The most dispensed pharmaceutical product for smoking cessation was nicotine gum. Their most perceived barriers were being unable to follow-up and inadequate staff. In conclusion, only a minority of community pharmacists in Thailand are engaged in smoking cessation activities, even though some perceived barriers existed. [ABSTRACT FROM AUTHOR]