The Journal of Chulabhorn Royal Academy <p>วารสารวิชาการราชวิทยาลัยจุฬาภรณ์ เป็นวารสารของ ราชวิทยาลัยจุฬาภรณ์ (Chulabhorn Royal Academy) รับตีพิมพ์บทความวิจัย และบทความวิชาการ ในสาขาวิชา แพทยศาสตร์ พยาบาลศาสตร์ วิทยาศาสตร์สุขภาพ สัตวแพทยศาสตร์และสัตววิทยา สิ่งแวดล้อม วิทยาศาสตร์และเทคโนโลยี การสาธารณสุขศาสตร์ และสาขาที่เกี่ยวข้อง</p> ราชวิทยาลัยจุฬาภรณ์ (Chulabhorn Royal Academy) en-US The Journal of Chulabhorn Royal Academy 2697-5203 <p>บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของราชวิทยาลัยจุฬาภรณ์</p> <p>ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับราชวิทยาลัยจุฬาภรณ์ และคณาจารย์ท่านอื่น ในราชวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว</p> Distinguishing Lipid-Poor Adrenal Adenoma from Non-Adenomatous Lesions: Accuracy of Identification and the Most Appropriate Contrast Washout Index Using the Contrast-Enhanced Washout Multidetector CT 10-Minute Delayed Imaging Protocol <p><strong>Background:</strong> Because of the contrast washout characteristic of adrenal adenoma, Siriraj Hospital uses the 10-minute delayed imaging computed tomography (CT) protocol to evaluate adrenal masses. No reports in Thailand have described the performance of this protocol to date.</p> <p><strong>Objective:</strong> This study was performed to identify the accuracy of identification and the most appropriate contrast washout index to distinguish lipid-poor adrenal adenoma from non-adenomatous lesions using the 10-minute delayed imaging CT protocol.</p> <p><strong>Materials and Methods:</strong> This retrospective review involved patients who underwent the CT adrenal protocol with 10-minute delayed imaging at Siriraj Hospital from January 2005 to December 2017. In total, 285 adrenal masses that were smaller than 4 cm and had a poor lipid component (density of &gt;10 HU) were assessed in 261 patients who were given a pathologic diagnosis or underwent follow-up imaging. Non-contrast images were obtained before intravenous contrast administration with an 80-second and 10-minute scan delay. The absolute percentage washout (APW) and relative percentage washout (RPW) of the adrenal masses were calculated. Receiver operating characteristic analysis was performed to evaluate the protocol performance and the most appropriate contrast washout value with which to identify lipid-poor adrenal adenoma.</p> <p><strong>Results:</strong> The test appeared to be the most accurate when using an APW of 47% and RPW of 34%. The APW of 47% showed a sensitivity of 96.5%, specificity of 89.3%, and accuracy of 95.8% (p &lt; 0.001), while the RPW of 34% showed a sensitivity of 89.5%, specificity of 96.4%, and accuracy of 90.2% (p &lt; 0.001).</p> <p><strong>Conclusion:</strong> An APW of 47% and RPW of 34% were the most appropriate washout indexes, offering high accuracy to distinguish lipid-poor adrenal adenoma from non-adenomatous lesions.</p> Parames Seevaleephan Nithida Na Songkhla Copyright (c) 2022 Chulabhorn Royal Academy 2022-07-11 2022-07-11 4 3 95 102 Factors Associated with False Positive Treadmill Exercise Stress Test Results <p><strong>Background:</strong> The treadmill exercise stress test (EST) is predominantly performed in patients who are symptomatic or suspected of having ischemic heart disease. This study was conducted to study the factors associated with false positive EST results for CAD.</p> <p><strong>Methods:</strong> This was a cross-sectional study. Patients who obtained a positive EST result at the Cardiovascular Division, Department of Internal Medicine, Phramongkutklao Hospital, and who subsequently underwent coronary angiography (CAG) or coronary computed tomography angiography (CCTA) between October 2013 and October 2016 were included. Patients were divided into two groups, true positive and false positive, depending upon the CCTA and CAG data. The two groups were compared with each other.</p> <p><strong>Results:</strong> One hundred and seventy-two patients were included, 67% of whom were male. Ninety-five (55.2%) patients, most of whom were male (65.3%), had a false positive EST result. The mean age in the true positive group was 64.6 years, and that in the false positive group was 59.7 years. There was no significant difference in blood pressure response between the two groups. In the univariate analysis, in female patients, risk factors, including diabetes and dyslipidemia, appropriate heart rate responsiveness, upslope ST depression, and downslope ST segment depression confined to the inferior leads, had a statistically significant correlation between groups. Multivariate analysis to determine the independent predictors of a false positive EST result identified female sex (odds ratio [OR], 3.90; 95% confidence interval [CI], 1.36–11.18; p = 0.011) and upslope ST segment depression (OR, 74.03; 95% CI, 7.74–707.65; p &lt; 0.001). The most commonly involved vessel was the left anterior descending artery (62, 81.58%), followed by the right coronary artery (52, 67.53%), and the left circumflex artery (49, 63.64%).</p> <p><strong>Conclusions:</strong> Female sex and upslope ST segment depression are associated with false positive EST results.</p> Viroj Muangsillapasart Chompol Piamsomboon Sopon Sanguanwong Preecha Uerojanaungkul Nakarin Sansanayudh Waraporn Tiyanon Thoranis Chantrarat Verapon Pinphanichakarn Tanyarat Aramsaruwong Hutsaya Prasitdumrong Copyright (c) 2022 Chulabhorn Royal Academy 2022-07-11 2022-07-11 4 3 103 110 The Survey of Problems, Needs for Development Among Nursing Personnel of Care Management for Patients with Dangerous Contagious Diseases, Emerging Diseases, and Re-Emerging Diseases <p>Nurses are the major health care human resources, who play a key role in the care management for patients with dangerous contagious disease, emerging disease, and re-emerging disease. Therefore, the development of nursing personnel to be able to work effectively and reduce the risk of exposure to the infectious diseases is urgently needed during the pandemics. The descriptive research aimed to survey problems, needs for development among nursing personnel of care management for patients with dangerous contagious disease, emerging disease, and re-emerging diseases. The samples were 140 nurses administering care for dangerous contagious disease, emerging disease, and re-emerging disease patients, and 15 nursing administrators. A survey questionnaire towards problem conditions and needs for professional development to improve patient care management process and an interview guide were used to collect data. Quantitative data were analyzed by using descriptive statistics and summarizing issues were employed to analyze data derived from the open-ended questions and interviews. The results revealed the top three of problems were insufficiency of manpower (25.07%), management of place and environment (21.33 %), insufficiency of tools and equipment (19.02 %), respectively. Needs for development among both groups were nursing practice guidelines, manpower management and personnel development. Additionally, need from nursing staff was knowledge about epidemiology. In summary, continuously personnel development to meet the needs of individuals and institution, and having effective monitoring and evaluation system will help to enhance the ability, confidence, and value of nurses in managing patients with dangerous contagious diseases, emerging diseases, and re- emerging diseases.</p> Somrak Sirikhetkon Somtavil Ampornareekul Anchaleeporn Amatayakul Copyright (c) 2022 Chulabhorn Royal Academy 2022-07-11 2022-07-11 4 3 111 120 Risk of Exposing to Prohibited Substances in Sports from Stakeholders in Thai Athletes <p><strong>Background:</strong> Obtaining prohibited substances intentionally or unintentionally in athletes may occur because of athletes or stakeholders. This can result in negative health effect of athletes and their future.</p> <p><strong>Objective:</strong> The objectives of this survey research were to quantify the risk of receiving prohibited substances from stakeholders in Thai national athletes and identify factors associated with risk of exposing to prohibited substances. Method: This is a crosssectional survey research. The sample was selected by multi-stage sampling. Data were collected by using questionnaire comprising two parts: demographic data and risk of obtaining prohibited substances from stakeholders with 5-point Likert scale (1=Absolutely, 5=Absolutely not). Data were analyzed by descriptive statistics. Statistical hypotheses were analyzed by one sample t-test and ordinal logistic regression with 5% type I error rate.</p> <p><strong>Results:</strong> Of 264 athletes sampled from 30 sports, 139 were males. The average age was 23.25 years. The maximum average score of obtaining prohibited substances was by pharmacist (2.34) while the lowest score was from sports association executives (1.98). However, the average scores from all stakeholder groups were significantly less than 3 (<em>p</em>-value&lt;0.005). Athletes with more than 5-10 years’ experience were more likely to receive prohibited substances, compared with those with experiences ≤5 years, from executives of sports association (OR=2.53, <em>p</em>-value=0.006), nurses (OR=1.95, <em>p</em>-value=0.040), physiotherapists (OR=2.55, <em>p</em>-value=0.005), sports psychologists (OR=2.80, <em>p</em>-value=0.002), sports scientists (OR=2.25, <em>p</em>-value=0.015), sports nutritionists (OR=2.39, <em>p</em>-value=0.008), sports physiologists (OR=2.24, <em>p</em>-value=0.013), sports educators (OR=1.98, <em>p</em>-value=0.033) and team managers (OR=1.99, <em>p</em>-value=0.034).</p> <p><strong>Conclusion:</strong> Thai national athletes are less likely to obtain prohibited substances from all stakeholders. Athletes with greater than 5-10 years’ experience are more likely to be exposed to prohibited substances from some groups of stakeholders than those with ≤5 years’ experience. Therefore, athletes and stakeholders should focus on prohibited substances in sports to prevent negative consequences.</p> Thanawut Saengboon Sawaeng Watcharathanakij Copyright (c) 2022 Chulabhorn Royal Academy 2022-07-11 2022-07-11 4 3 121 132 Predictive Factors towards Behavior in Practice to Prevent COVID-19 in the Area of Phra Nakhon Si Ayutthaya City Municipality <p><strong>Objective:</strong> 1) Study behavior in practice to prevent COVID-19 of the people in Phra Nakhon Si Ayutthaya city municipality, 2) Study predictive factors such as knowledge, attitude, social supporting forces with the behavior and practice to prevent COVID-19.</p> <p><strong>Method:</strong> The sample group consisted of 377 households representing who lived in Phra Nakhon Si Ayutthaya city municipality, selected by system random sampling. The research instrument was a questionnaire which were divided into 5 parts. The quality of the tool was checked by 5 experts with the conformity index was 0.71, difficult value was 0.36, discrimination power was 0.71, and reliability at a level of 0.954. The statistics used for the data analysis were percentage, mean, standard deviation, and stepwise multiple regression.</p> <p><strong>Results:</strong> The research revealed that the most of sample having behaviors in practice to prevent COVID-19 at a high accurate level equal to 246 persons or 65.25 percent. The knowledge factor on COVID-19, social support forces in the aspect of receiving information to prevent COVID-19, attitude to prevent COVID-19 were a predictive factors for behavior in practice to prevent COVID-19 of the people in Phra Nakhon Si Ayutthaya city municipality area at 26.40 percent (R2 =0.264, p=&lt;.01) with a statistical significance level of .01.</p> Panitan Grasung Jerasak Thappha Jirachaya Pholsit Copyright (c) 2022 Chulabhorn Royal Academy 2022-07-22 2022-07-22 4 3 141 150 Effects of Phthalate Exposure in House Dust on Non-Communicable Diseases in the Elderly <p>The causes of non-communicable diseases (NCDs) are multiple and varied. Over the past decade, however, environmental pollution has been identified as another cause of non-communicable diseases. Continued exposure to chemicals in plastics causes human health problems. Phthalate is a chemical that increases plastic softness and flexibility and can be found in a diverse range of industrial products and consumer goods. Because phthalate has no covalent bond with plastic, phthalate easily is released from plastic products and may contaminate water, food or even the air inside houses. Humans and animals can come into contact with phthalate from house dust in many ways. Previous studies have shown correlations between phthalate and undesirable health outcomes. When humans, particularly older adults who spend most of their time at home, come into contact with phthalate continually, this causes effects on non-communicable diseases, which are likely to increase. Therefore, the main goal of this article is to present the effects of phthalate on non-communicable diseases among the elderly, particularly respiratory, metabolic and cardiovascular diseases.</p> Narisara Sripo Thanate Tienthong Orawan Kaewboonchoo Copyright (c) 2022 Chulabhorn Royal Academy 2022-07-22 2022-07-22 4 3 133 140