SUMMARYThe circadian system plays a role in regulating metabolism. Night-shift work, a form of circadian misalignment, is associated with increased type 2 diabetes risk. This study aimed to determine if night-shift workers with type 2 diabetes experience poorer glycaemic control than non-shift workers. Patients with type 2 diabetes (104 unemployed, 85 day workers and 60 night-shift workers) participated. Sleep duration, sleep quality, morningness-eveningness preference, depressive symptoms and dietary intake were assessed using standardized questionnaires. Haemoglobin A1c levels were measured. Night-shift workers had significantly higher haemoglobin A1c levels compared with others, while there were no differences between day workers and unemployed participants (median 7.86% versus 7.24% versus 7.09%, respectively). Additionally, night-shift workers were younger, had a higher body mass index, and consumed more daily calories than others. Among night-shift workers, there were no significant differences in haemoglobin A1c levels between those performing rotating versus non-rotating shifts (P = 0.856), or those with clockwise versus counterclockwise shift rotation (P = 0.833). After adjusting for age, body mass index, insulin use, sleep duration, morningness-eveningness preference and percentage of daily intake from carbohydrates, night-shift work, compared with day work, was associated with significantly higher haemoglobin A1c (B = 0.059, P = 0.044), while there were no differences between unemployed participants and day workers (B = 0.016, P = 0.572). In summary, night-shift work is associated with poorer glycaemic control in patients with type 2 diabetes.
Study design:A cross-sectional study.Objectives:To study prevalence of pressure ulcers (PrUs), quality of life (QoL) and effect of wheelchair cushions used by Thai wheelchair users with chronic spinal cord injury (SCI).Setting:Maharaj Hospital, Chiang Mai, Thailand.Methods:Thai chronic SCI wheelchair users, aged over 18 years and non-ambulatory with ASIA impairment scale A, B or C were recruited. They completed the PrUs questionnaire and rated the EuroQoL-5D and their health status with a visual analog scale (VAS). Demographic data of each participant were extracted from medical records. The EQ-5D health states were transformed to utility scores by using the Thai algorithm and the prevalence of PrUs was reported. The EQ-5D, the utility scores and the health status VAS were compared between those with and without current PrUs and between those participants using foam and air-filled cushions.Results:Of 129 participants, 26.4% had current PrUs at the time of the study, 27.9% had healed PrUs and 45.7% never had PrUs. The median VAS score for health status was 70 (Q1=50, Q3=80). Based on the EQ-5D, only one dimension (anxiety/depression) was significantly different between those with and those without current PrUs (P=0.015). Those using an air-filled cushions had a mean utility score four times higher than of those using a foam cushion (0.131 vs 0.032, P=0.089) but not statistically significant.Conclusions:PrUs are still prevalent among Thai wheelchair users with chronic SCI. Anxiety/depression is associated with current ulcers.
To investigate the cost-effectiveness of same day surgery compared with overnight stay surgery in Thailand. METHODS: An economic analysis was conducted to compare the cost-effectiveness of same day surgery and overnight stay among20 procedures in 6 hospitals in NHSO Region10. The analysis was based on a decision tree model, which was developed in consultation with Anesthesiologists and Nurse Anesthetists. The model took the perspective of societal perspective and healthcare provider perspective. Health outcomes were shown as costs and quality-adjusted life years (QALYs). RESULTS: Totally 513 eligible patients were recruited, 460 patients (89.67%) for overnight stay surgery and 53 patients (10.33%) for same day surgery. Results show that same day surgery was more cost-effective compared with overnight stay surgery. The QALY gained from both types of surgery were similar. The amount of cost-savings from same day surgery were approximately 1,356 Thai Baht per case. CONCLUSIONS: Same day surgery is cost-effective in Thailand and can reduce costs of treatment with same health outcomes from overnight surgery.
average age was 54 years (standard deviation ϩ 11 years, range 17-85 years) with the majority being female (78%), white (87%), having a some college education or more (73%) and having health insurance (87%). Approximately 58% of patients reported medication nonadherence. No significant differences were observed between adherent and nonadherent patients with regard to age, sex, race, insurance status, condition, or number of medications taken. Reasons significantly associated with nonadherence were forgetting, don't like to take pills/give injection, cost of medication, symptoms improved so stopped taking medication, side effects too severe, and poor knowledgeable about their medications. CONCLUSIONS: Medication nonadherence is common and patient reported reasons for nonadherence include motivational factors, lack of understanding or knowledge, and treatmentrelated characteristics. Interventions that motivate, educate and individualize drug therapy according to patients' preferences and affordability may improve adherence.
ackground: Quit-Calendar has been developed and initially tested in Phase I for the Quit-For-King project. The effectiveness and satisfaction of its properties were later investigated among village health volunteers. Objective: To investigate the Quit-Calendar effectiveness, factors related to quit success, and its satisfaction under the ‘Quit-For-King’ Project. Materials and Methods: One hundred eleven current smokers underwent the program. Each participant needed to go ‘cold turkey’ technique, which mean to stop smoking at once, then received 5A counseling and a Quit-Calendar. The measuring parameters included continuous abstinence rate (CAR) and point prevalence abstinence rate (PAR), investigated at 2-weeks, 1-, 3-, and 6- month periods via statistical analysis. Results: Most of the participants were males (96.4%), smoked 10 cigarettes per day (53%), heavy smokers. They were mostly in ‘preparation stage’ of change (49%). CAR was 26.11% and PAR values increased by the end of the 6-month. There were statistically significant differences between the numbers of quitters using Quit-Calendar (p<0.001). Only three factors, including numbers of cigarettes, minor illness, and levels of readiness to quit significantly affected quit success (p<0.001). The smokers stated that the Quit-Calendar could possibly help them to quit smoking. Nonetheless, some limitations need to be resolved. Conclusion: Quit-For-King project has been successful over a 3-year period. The Quit-Calendar is one of the cessation aids that promote quit success and help quitters to overcome nicotine withdrawal. Keywords: Quit-For-King, Quit-Calendar, Continuous abstinence rate (CAR), Point prevalence abstinence rate (PAR), Village health volunteers
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