Thai Journal of Public Health

Ethnicity- and Status-Based Stigma among Ethnic Minority High School Students in Chiang Rai, Thailand

Thapakorn Ruanjai — 2026-03-29

This school-based, cross-sectional analytical study aimed to investigate the prevalence and factors associated with stigma and discriminatory treatment based on ethnicity and status among ethnic minority senior high school students in Chiang Rai Province, Thailand. A validated questionnaire was administered to 360 ethnic minority senior high school students. Data were collected from March to July 2025. Descriptive statistics were used to estimate the prevalence of stigma and discriminatory treatment, and generalized estimating equations (GEE) were applied to identify associated factors. Statistical significance was considered at a p-value < 0.05. The results revealed that 360 participants were recruited for the study. Of these, 68.1% were female, with an average age of 16.7 years (SD=1.2). By ethnicity, 40.8% identified as Akha, 26.9% as Lahu, and 7.5% were non-Thai. The overall prevalence of past-year stigma and discriminatory treatment linked to ethnicity and social status among ethnic minority senior high school students was 46.4%. In the multivariable GEE model, three variables remained independently associated with past-year stigma and discriminatory treatment. Compared with Akha students, Hmong students had higher odds of experiencing stigma (aOR = 2.31; 95% CI: 1.15–4.65). Students in the foreign language track (aOR = 1.78; 95% CI: 1.07–2.96) and those in the vocational/sports track (aOR = 2.06; 95% CI: 1.42–2.98) also had higher odds compared with students in the science–mathematics track. A higher resilience score was associated with lower odds of experiencing past-year stigma and discriminatory treatment (aOR = 0.97; 95% CI: 0.93–0.98). In conclusion, to decrease the occurrence of stigma and discriminatory treatment among ethnic minority senior high school students, schools should implement comprehensive intervention strategies that give special attention to higher-risk groups, particularly Hmong students identified in this study, focus on students in study programs associated with higher odds of stigma, and strengthen students’ resilience.

Effects of a Theory of Planned Behavior-Based Program on E-Cigarette Prevention among Female Students in Bangkok

Wanattaporn Pimpan — 2026-04-30

This quasi-experimental study evaluated effects of program applying the Theory of Planned Behavior to preventive behavior from e-cigarette smoking among female junior high school students in Bangkok. Sixty Grade 8 students were equally assigned to an experimental group and a comparison group. The 6-week intervention comprised female peer-leader preparation and four participatory workshop sessions designed to improve attitudes, subjective norms, perceived behavioral control, and intention to abstain from e-cigarette use. Data were collected pre-intervention, post-intervention, and at two-week follow-up.

Research instruments included questionnaires assessing attitude, subjective norm, perceived behavioral control, intention, and prevention behaviors. Content validity was verified by three experts, yielding CVI values of 0.85–1.00. Reliability was high, with Cronbach’s alpha ranging from 0.80 to 0.96. Data were analyzed using Chi-Square test, Fisher’s Exact Test, Friedman Test, Wilcoxon Signed Rank Test, and Mann–Whitney U Test.

Results showed that, after the intervention and at follow-up, the experimental group had higher mean scores for attitude and subjective norm compared with baseline (p<.05). Perceived behavioral control and intention did not change. Prevention behavior increased post-intervention (p<.05) but was not maintained at follow-up. Between groups, the experimental group scored higher across variables (p<.05).

The findings indicate that the program improved attitudes, subjective norms, and short-term prevention behavior. Strategies are needed to strengthen perceived behavioral control, reinforce intention, and sustain change. Adapting the program for other adolescent female groups in non-formal education and working with families is recommended to support long-term outcomes.

Development and Psychometric Evaluation of a Psychological Capital Assessment Tool for University Students: A Pilot Study

Pornpun Sudjai — 2026-04-30

Background: Environmental changes experienced by university students are contributing factors to their mental health problems. Therefore, enhancing students’ psychological capital can play a key role in preventing depression and promoting mental well-being. Objective: This study was aimed at developing a psychological capital assessment tool for university students and investigating the relationship between psychological capital, depression, and mental health status. Methods: This study was a pilot study with a cross-sectional design. A multi-stage random sampling method was employed to recruit of 409 participants from public and private universities in the central, eastern, and southern regions of Thailand. Data were collected using four instruments via paper from December 15, 2024, to February 28, 2025: (1) a demographic questionnaire, (2) the Psychological Capital Assessment for University Students, (3) a depression scale, and (4) a mental health status scale. Descriptive statistics and multiple regression analysis were used for data analysis. Results: The 50-item-developed assessment tool consisted of five components: (1) problem-solving ability, (2) organized thinking ability, (3) self-regulation ability, (4) self-efficacy ability, and (5) relationship ability. The tool demonstrated acceptable psychometric properties, with a content validity index of 0.84 and a Cronbach’s alpha coefficient of 0.90. Psychological capital was significantly negatively correlated with depression and mental health problems. Moreover, it accounted for 28% of the variance in depression and 25% of the variance in mental health status. Conclusion: The Psychological Capital Assessment for University Students has been proven to have acceptable content validity and internal consistency. It, therefore, can be used as a screening tool to identify students at risk of depression and mental health problems.

Arm Lymphedema Prevention Adherence Questionnaire: Validation and HAPA Model Application in Breast Cancer Postoperative Patients

Qiong Wu — 2026-04-30

Objective: Arm lymphedema is a common, lifelong postoperative complication in breast cancer survivors, and adherence to prevention behaviors may help reduce its occurrence. This study aimed to validate the modified questionnaire on adherence to arm lymphedema prevention behaviors and examine the strength of the relationship between constructs of the Health Action Process Approach (HAPA) model and adherence to arm lymphedema prevention behaviors among breast cancer postoperative patients. Methods: A cross-sectional study was conducted from August to November 2024. Exploratory factor analysis (EFA) assessed construct validity, and Cronbach’ s α evaluated reliability. Path analysis using Structural Equation Modelling (SEM) tested the HAPA model and relationships among variables. Results: EFA supported a three-factor structure for the modified questionnaire with an overall Cronbach’ s α of 0.92. In the pre-intentional motivational phase, the path coefficients demonstrated a statistically significant effect of risk perception, outcome expectancy and action self-efficacy on behavioral intention. In the post-intentional volition phase, the path from behavioral intention and coping planning to adherence to arm lymphedema prevention behaviors showed significant effects. However, the effect of coping self-efficacy and action planning on adherence to arm lymphedema prevention behaviors was not significant. Conclusion: The modified questionnaire demonstrated good construct validity and reliability. Risk perception, outcome expectancy and action self-efficacy were key determinants of behavioral intention; behavioral intention and coping planning (excluding coping self-efficacy and action planning) influenced adherence. The results provide a basis for interventions to improve adherence to arm lymphedema prevention behaviors in postoperative breast cancer patients, potentially reducing lymphedema incidence and improving postoperative quality of life.

Determinants and Fiscal Implications of Public Health Expenditure in Thailand, 1994–2023

Pasineesorn Semkham — 2026-04-30

This study is the first in Thailand to quantitatively assess three decades of government health spending using an integrated model. It aims to identify the long-term key factors driving public health expenditure, with a focus on fiscal sustainability amid rapid population aging. Using national-level time series data from 1994 to 2023, multiple linear regression was applied to examine the relationship between public health expenditure (as a percentage of GDP) and key drivers: population aging, GDP, public revenue, inflation, unemployment, medical technology imports, political cycles, and the COVID-19 pandemic. Diagnostic tests for multicollinearity, heteroscedasticity, and autocorrelation were conducted, with the Cochrane-Orcutt method confirming model robustness. The results show that population aging (p<0.001) and COVID-19 years (p<0.01) are significantly associated with increased government health spending. In contrast, GDP is negatively associated with spending in normal years (p<0.01) but reverses during crises, reflecting structural shifts in fiscal response. Public revenue and unemployment (p<0.01) show significant negative effects. Inflation, medical technology imports, and election years were not statistically significant. The findings highlight that aging is the most consistent long-term driver of fiscal pressure in Thailand’s health system. Policymakers should prioritize invest in geriatric and chronic care, shift from hospital-based to preventive and long-term community care, and build resilient financing mechanism to safeguard access to essential care. Future studies may consider using data on telehealth and medical technology to better understand their role in shaping health expenditure and strengthening system resilience.

Nutrition Label Literacy and Nutritional Status of Village Health Volunteers in Prakhon Chai District, Buriram Province

Manlika Maiprakhon — 2026-04-30

This study aimed to assess nutritional label literacy and nutritional status among village health volunteers (VHVs) and to identify factors associated with overnutrition in VHVs. A cross-sectional study was conducted among 1,440 VHVs. Data were collected using a structured questionnaire and anthropometric measurements. Nutritional label literacy was assessed across three components: awareness and accessibility, understanding, and evaluation and application. Nutritional status was classified using Body Mass Index (BMI). Descriptive statistics were used to summarize participant characteristics. Multiple logistic regression analysis was used to identify factors associated with overnutrition. The results indicated that overall nutritional label literacy level among VHVs was moderate in 47.5% of participants, high in 48.7%, and low in 11.7%. More than half of the participants were classified as obese (50.2%), while 19.0% were classified as overweight. Based on multiple logistic regression analysis, participants aged over 60 years were significantly less likely to be overnourished than those under 40 years of age (Adjusted OR = 0.45, 95% CI: 0.28–0.69). In contrast, participants with underlying diseases were more likely to be overnourished (Adjusted OR = 1.54, 95% CI: 1.20–1.99). Nutritional label literacy was not found to be significantly associated with overnutrition. Despite moderate to high levels of nutrition label literacy among VHVs, overnutrition remains prevalent. This highlights the importance of community-based interventions that integrate nutrition literacy with efforts to reduce behavioral and health-related risks.

Factors Influencing Maternal Knowledge and Attitudes Toward Childhood Vaccination in Mosul City, Iraq

Sarah Asaad Yaseen — 2026-04-30

Background: Childhood vaccination remains one of the most effective strategies for preventing infectious diseases and reducing child morbidity and mortality worldwide. Maternal knowledge and attitudes play a critical role in vaccine acceptance and adherence to immunization schedules. However, misconceptions and access-related barriers continue to challenge immunization efforts, particularly in fragile healthcare settings such as Iraq. Aim: This study aimed to assess mothers’ knowledge and attitudes toward childhood vaccination in Mosul City, with a focus on misconceptions, reasons for non-compliance, and socio-demographic determinants. Methods: A cross-sectional study was conducted between January 15 and April 20, 2025, in six primary health care centers in Mosul. A total of 400 mothers of children aged ≤5 years were recruited using convenience sampling. Data was collected through face-to-face administration of a structured, validated questionnaire covering socio-demographic characteristics, knowledge, and attitudes. The instrument demonstrated good internal consistency (Cronbach’s α = 0.80). Data was analyzed using descriptive statistics, Chi-square tests, and binary logistic regression to identify independent predictors. Statistical significance was set at p < 0.05. Results: Overall, 62.8% of mothers demonstrated good knowledge, and 72.5% expressed positive attitudes toward childhood vaccination. While most participants recognized vaccines as safe and effective, 42.0% incorrectly considered mild illness a contraindication, and 18.5% reported fear of serious side effects. Non-compliance (28.0%) was primarily associated with vaccine unavailability (33.9%) and concerns about side effects (26.8%). Logistic regression analysis identified maternal education and employment status as significant independent predictors of both knowledge and attitudes (p < 0.05). Conclusion: Mothers in Mosul demonstrated generally adequate knowledge and positive attitudes toward childhood vaccination; however, important misconceptions and access-related barriers persist. These findings highlight the need for targeted, evidence-based public health strategies addressing knowledge gaps and system-level challenges. Further interventional research is recommended to evaluate approaches aimed at improving vaccination adherence.

Psychological Resilience and its Associated Factors among Hill Tribe Junior High School Students in Northern Thailand: A School-Based Cross-Sectional Study

Thitaporn Kaewboonchoo — 2026-04-30

A school-based cross-sectional study was carried out to explore the psychological resilience and its associated factors among junior hill tribe high school students in Chiang Rai Province, Thailand. A multistage sampling method was used to randomly select participants from four secondary schools located in a hill tribe village across three districts in Chiang Rai Province. Data were collected using validated questionnaires, including the Resilience Inventory (RI-9), from December 2023 to March 2024. Data were analyzed using descriptive statistics and binary logistic regression, with a statistically significant p-value set at <0.05. A total of 396 participants were included in this study. Of these, 63.9% were female, with an average age of 14.16 years (SD = 0.98), 40.9% identified as Akha, and 23.0% identified as Hmong. The prevalence of low psychological resilience was 26.8%. Multivariable logistic regression analysis identified five factors significantly associated with low psychological resilience: female sex (aOR = 2.35, 95% CI: 1.38–3.99), smoking (aOR = 2.43, 95% CI: 1.08–5.47), negative life events (aOR = 2.92, 95% CI: 1.41–6.04), low family support (aOR = 2.68, 95% CI: 1.13–6.38), moderate family support (aOR = 1.90, 95% CI: 1.03–3.49), and inadequate-to-problematic mental health literacy (aOR = 2.05, 95% CI: 1.11–3.80). In conclusion, a considerable proportion of junior hill tribe high school students had low psychological resilience. Targeted public health interventions should be developed to promote psychological resilience, particularly among students who are female, smoke, have experienced negative life events, report low family support, or have limited mental health literacy.

Cost Analysis of Personalized Intensive Lifestyle Modification for NCD Risk Populations in Thailand

orawan quansri — 2026-04-30

Background: Non-communicable diseases (NCDs) remain the leading cause of morbidity, mortality, and healthcare expenditure in Thailand, yet real-world cost evidence for personalized intensive lifestyle interventions is limited. Objective: To estimate the cost of implementing the Personalized Intensive Lifestyle Modification Program (PILM) for populations at risk of NCDs in Thailand. Methods: A cross-sectional retrospective cost analysis was conducted using an activity-based costing approach from the provider perspective. Fiscal year 2023 cost data were collected from 12 service settings (hospitals, municipal health facilities, and public institutions). Core PILM components delivered across settings included baseline risk assessment, individualized lifestyle counseling/coaching, structured diet and physical activity planning, and continuous follow-up via face-to-face visits and digital communication. Costs were classified as labor, material, and capital. Unit cost per participant was calculated for a six-month program cycle and reported in U.S. dollars. Results: A total of 477 participants received PILM services across 12 settings. Labor accounted for 63% of total cost, followed by capital (29%) and material (8%). The mean unit cost was USD 83 per participant (range: USD 24.97–156.71). Conclusion: PILM implementation costs varied across settings, with labor as the primary cost driver. These findings support budgeting and service design for integrating personalized NCD prevention into Thailand’s universal health coverage.

Translation, Cross-Cultural Adaptation, and Validation of the Thai Version of the Six-Factor Questionnaire for Obesity

Chanita Unhapipatpong — 2026-04-30

Obesity is a global health problem associated with numerous complications. Classification of the psycho-behavioral phenotype of obesity using the 27-item Six-Factor Questionnaire (6-FQ) represents a precision-medicine strategy to improve the effectiveness of obesity counseling. The aim was to conduct a translation and validation study of the Thai version of the 6-FQ, as well as to perform a psychometric evaluation of the instrument. Comprehensibility and item difficulty were assessed using the Item Comprehensibility Index (I-CI) and Item Difficulty Index (I-DI), respectively, following ISPOR principles; results were summarized as the Scale Comprehensibility Index (S-CI) and Scale Difficulty Index (S-DI) for both individuals with obesity (n = 50) and healthcare professionals (HCPs; n = 50). Relevance was evaluated by 50 HCPs using the Item Content Validity Index (I-CVI) and the Scale Content Validity Index (S-CVI). Subsequently, we validated the Thai 6-FQ by assessing its internal consistency and test–retest reliability in 150 individuals with obesity. Exploratory factor analysis (EFA) was used to assess the questionnaire’s construct validity. Six items were modified to enhance cultural relevance. After synthesis and adaptation, individuals with obesity rated the Thai 6-FQ as having excellent comprehensibility and ease of completion (S-CI = 0.91; S-DI = 0.91). HCPs regarded comprehensibility and difficulty as acceptable (S-CI = 0.84; S-DI = 0.88) and judged relevance acceptable (S-CVI = 0.85). The instrument demonstrated excellent internal consistency (Cronbach’s alpha = 0.953) and good test–retest reliability (intraclass correlation coefficient = 0.79). EFA identified five factors that explained 69.19% of the total variance. The Thai translation and cultural adaptation of the 6-FQ preserved the instrument’s original meaning and purpose, supporting its use by individuals with obesity and healthcare professionals in the Thai context. In practice, clinicians can use the score from questionnaire at each visit to monitor progress, and both clinicians and adults with obesity can identify remaining barriers that may contribute to unsuccessful weight reduction.

Case Experiences, Attitudes, and Educational Environment of Dental Public Health Students in Thailand

Nilubol Panbuth — 2026-04-30

Dental public health officers in Thailand lack standardized training requirements across institutions. This study aimed to assess case experiences, attitudes toward dental practice, and educational environmental factors among final-year dental public health students from multiple colleges to inform curriculum standardization. A cross-sectional study was conducted in October – November 2024 among 200 final-year dental public health students from five colleges representing all regions of Thailand with 167 respondents. Data were collected using a validated 4-part questionnaire covering demographics, case experiences, attitudes (5-point scale), and educational environment (modified DREEM). Descriptive statistics, Kruskal-Wallis and Post-hoc tests were used for analysis. The results indicated that students performed a median of 7.00 oral treatment records, 12.00 tooth sealants, and 7.00 Class I resin composite fillings. Most students had moderate-level attitudes toward dental practice (mean score: 2.79±0.41 out of 5). Overall educational environment was rated as 'more positive than negative' (69.7%). Significant variations between colleges were found in all nearly dental procedure experiences (p <0.05), overall attitudes (H=15.377, p=0.004), and teacher perception (H=19.342, p=0.001).Thai dental public health students demonstrate competency in most dental procedures but show significant inter-college variations in clinical experiences, attitudes, and teacher perception, indicating need for curriculum standardization. Colleges should establish minimum case requirements for graduation and standardize teaching methods through inter-institutional collaboration. The Ministry of Public Health should clarify the scope of dental practice for dental public health officers.

Predictors of Quality of Life among Older Adults in Nursing Homes in Wenzhou, China

Ruoruo Lu — 2026-04-30

The quality of life (QOL) of older adults is a key indicator of their physical and mental health and overall well-being. This study aimed to examine the factors influencing QOL among older adults in nursing homes in Wenzhou, China. The four predictive factors included the older adults' functional status, care satisfaction, perceived social support, and depression. The samples consisted of 142 older adults in nursing homes in Wenzhou. Simple random sampling was used to recruit the samples. Data were collected from March 1 to June 2, 2024. QOL, functional status, perceived social support, care satisfaction, and depression were measured using the Chinese versions of the World Health Organization Quality of Life Instrument—Older Adults Module (WHOQOL-OLD), Barthel Index, Multidimensional Scale of Perceived Social Support (MSPSS), Satisfaction with the Nursing Home Instrument (SNHI), and 15-item Geriatric Depression Scale (GDS-15), respectively. Descriptive statistics and multiple regression analysis were used for data analysis. The mean QOL score was 68.05 (SD = 9.60). The multiple regression analysis showed that perceived social support, care satisfaction, depression, functional status could explain 65.2% of the variance in QOL (F (4, 142) = 66.972, p < 0.05). The strongest predictor was perceived social support (β= 0.786, p < 0.001), followed by care satisfaction (β= 0.728, p < 0.001), depression (β= -0.536, p < 0.001), and functional status (β= 0.110, p = 0.001). These findings provided preliminary evidence on factors influencing QOL among older adults in nursing homes. Interventions targeting social support, care satisfaction, depression, and functional status might help improve their QOL.

Validation of a Sexual Health Literacy Scale for Secondary School Students in High-Risk Area of Thailand

Kaung Zaw — 2026-04-30

Adolescents need strong sexual health literacy to make decisions that help avoid unintended pregnancies and sexually transmitted infections. This study validated the Sexual Health Literacy Scale for Secondary School Students (SHLSS) in high-risk area of Thailand, using Confirmatory Factor Analysis (CFA). Secondary data from a 2018 cross-sectional survey involving 319 secondary school students in Chonburi Province, Thailand, were used. The SHLSS consists of 28 items across four dimensions: Access, Understand, Appraise, and Apply. CFA results demonstrated strong reliability, with a Cronbach’s alpha of 0.90, and satisfactory construct validity, as composite reliability values ranged from 0.88 to 0.91. Factor loadings varied between 0.43 and 0.81, indicating moderate to strong correlations. However, the Access dimension exhibited lower convergent validity (AVE = 0.28), suggesting need for refinement. These findings highlight need for further validation across diverse cultural groups and support the SHLSS as a promising framework for guiding sexual health education and policy development for adolescents.

Design and Implementation of Web-Based Nutrition Database for Early Childhood Teachers in Ethnic Minority Schools in Northern Thailand

Siwarak Kitchanapaibul — 2026-04-30

The objective of this study was to design and implement an innovative web-based nutrition database system for early childhood teachers in ethnic minority schools in northern Thailand. This study employed a research and development (R&D) design using the ADDIE (Analysis, Design, Development, Implementation, Evaluation) model, which consists of five phases: Phase 1: qualitative analysis of the situation and needs among early childhood ethnic minority school teachers and caretakers under the Therd Thai Subdistrict Administrative Organization, Mae Fah Luang District, Chiang Rai Province. Phase 2: designed the system structure and interface prototypes using the information from Phase 1 and the literature review. Phase 3: developed the system, conducted CVI validation, and pilot testing. Phase 4: Provided a one-day training and implemented the system for 8 weeks. Phase 5: evaluation satisfaction through post-implementation evaluation. Data were collected from March 2023 to September 2024. The results showed that the innovative web-based nutrition database system consists of 5 functions, including: (1) Child health profile management system, (2) Nutrition data management and surveillance System, (3) Nutrition education and promotion module, (4) Individual child nutritional assessment, (5) Area-based nutritional status surveillance dashboard. Moreover, post-implementation satisfaction evaluation yielded a total score of 4.67 (SD = 0.46), indicating a high level of satisfaction. In conclusion, encouraging the adoption of this innovative web-based nutrition database system for sustainable use and expansion to other child care centres is recommended.

Heat Acclimatization among New Conscripts in Army Training Units in Bangkok, Thailand: A Prospective Cohort Study

Tabpanaphan Chumnum — 2026-04-30

Heat-related illness (HRI) remains a major occupational health concern among new conscripts undergoing military training in tropical environments. This study aimed to evaluate heat acclimatization and its influencing factors among new military conscripts in Bangkok, Thailand. A prospective cohort study was conducted among 383 conscripts recruited from 11 randomly selected training units during November–December 2022. Eligible participants aged 21–29 years were classified by body mass index (BMI) and participation in the Health Promotion and Prevention Medicine (HPPM) exercise program, which incorporated aerobic and resistance training with progressive overload, structure rest, and supervision to enhance cardiovascular and thermoregulatory adaptation. Heat acclimatization was assessed using repeated measures of skin temperature, heart rate, and sweat response. Associations were analyzed using chi-square tests and multiple logistic regression. Overall, 18.5% of conscripts achieved full heat acclimatization by week 4. Participation in the HPPM program was associated with a higher rate of acclimatization in later training weeks (20.8% vs 17.1%). Higher BMI was negatively associated with acclimatization (AOR = 0.271, 95% CI: 0.102–0.719, p = 0.009), whereas higher knowledge levels (AOR = 4.054, p = 0.019) and strong peer support (AOR = 2.654, p = 0.006) significantly increased the likelihood of acclimatization. Environmental factors, including temperature and humidity, were also significant. In conclusion, heat acclimatization remains limited among new conscripts. The HPPM program shows beneficial effects, and targeted interventions for high-risk groups should be integrated into military training policies to reduce HRI risk and improve occupational health outcomes.

Exposure and Health Risk Assessment of Phthalates in House Dust among Schoolchildren in Phatthalung, Thailand

Nuttapong Leamun — 2026-04-30

Phthalates are widely used chemicals that are not chemically bonded to materials. Therefore, they can be readily released into house dust. Children are at high risk of phthalate exposure through dust ingestion due to inadequate hygiene practices, which may adversely affect their health. Settled house dust samples were collected from 310 households of elementary school children in Phatthalung, Thailand, using a vacuum cleaner. Ten phthalates were then analyzed by gas chromatography-mass spectrometry. A quantitative health risk assessment for children via ingestion was conducted using the United States Environmental Protection Agency (US EPA) methodology. Di-2-ethylhexyl phthalate (DEHP) was the most abundantly detected compound, followed by di-n-octyl phthalate (DnOP) and dibutyl phthalate (DBP) (detection rates > 60%), with median concentrations ranging from 6.90 to 150.91 µ g/g. The median concentration of total phthalates (Σ10PAEs) was 190.71 µg/g. The median estimated daily intakes (EDIs) of DEHP, DnOP, DBP, and Σ10PAEs ranged from 3.95 to 112.56 ng/kg bw/day and 13.18 to 375.22 ng/kg bw/day under central-tendency and upper-percentile scenarios, respectively. The EDIs of DEHP, DnOP, and Σ10PAEs in children aged ≥ 9 years were significantly higher than those in younger children. The hazard quotient (HQ) and hazard index (HI) values for the three phthalates were less than 1. The CR for DEHP was below 1×10^-4; however, one child exceeded this threshold under the upper-percentile scenario (1.001×10^-4). These findings suggest that DEHP exposure warrants attention given its potential carcinogenic risk, highlighting the need for appropriate risk management strategies to reduce phthalate exposure in indoor environments.

Effects of a Continuing Care Model for Older Adults with Stroke in Can Tho City, Vietnam

HANH TRAN — 2026-04-30

Stroke is a leading cause of death and disabilities in Vietnam. Although stroke care in the acute phase has been achieved; a continuing care model and its effect has not been developed and evaluated at the district hospitals in Vietnam. A mixed-method study was conducted to develop and examine effects of the continuing care program for older adults with stroke living in Can Tho City, Vietnam. First, a continuing care model was developed based on the qualitative data from in-depth interview and focus group discussion. Second, the proposed model was implemented among older adults with Stroke, who registered at the selected district hospitals in Can Tho City. The intervention group received a 12-week continuing care program, including 1) stroke care management, 2) family caregiver’s training, 3) family caregiver’s support 4) resource allocation, 5) monitoring for stroke, 6) rehabilitation care and 7) family reintegration. The comparison group received the usual care. According to Mann-Whitney U-test, quality of life and self-care agency of the intervention group (n=23) were better than the comparison group (n=32) and better than before the intervention (p < 0.05), respectively. The findings support that the continuing care model can improve health outcomes for older adults with stroke in Can Tho City. In addition, community nurses should be trained to manage and monitor stroke outcomes for older adults, after the first 3-month. Further research with larger sample size should be scaling to improve the quality of care and quality of life for older adults with stroke.

Nutritional Approaches to Reducing the Risk of Stroke

Thanyarat Varundee — 2026-04-30

Stroke remains a leading cause of mortality and long-term disability worldwide, with diet representing a major modifiable risk factor. Although substantial evidence links nutrition to stroke prevention, effective translation into clinical practice requires integration of dietary patterns, specific nutrients, biological mechanisms, and emerging personalized approaches. This review aimed to synthesize current evidence on nutritional strategies for stroke prevention, encompassing macronutrients, micronutrients, dietary patterns, nutrigenomics, chrononutrition, and gut microbiome–related mechanisms, and to translate these findings into practical clinical implications. A systematic narrative review was conducted in accordance with PRISMA 2020 principles. PubMed/MEDLINE, Scopus, Web of Science, and ScienceDirect were searched for peer-reviewed English-language studies published between January 2000 and April 2024. Eligible studies included randomized controlled trials, observational studies, systematic reviews, and meta-analyses evaluating dietary exposures and stroke-related outcomes. Due to heterogeneity in study design and outcomes, 48 eligible studies were synthesized narratively. Evidence consistently supports the protective role of comprehensive dietary patterns—particularly the Mediterranean, DASH, and MIND diets—in reducing stroke risk. These patterns exert benefits through convergent mechanisms, including blood pressure reduction, lipid profile improvement, attenuation of inflammation and oxidative stress, and preservation of endothelial function. Macronutrient quality, especially fat type and dietary fiber intake, and key micronutrients such as potassium, magnesium, folate, and sodium further modulate stroke risk. Emerging evidence indicates that genetic variation, meal timing, and gut microbiome composition may influence individual responses to dietary interventions. In conclusion, nutrition plays a central role in both primary and secondary stroke prevention. Integrating evidence-based dietary patterns with attention to nutrient quality, chrononutrition, and individual risk profiles may enhance clinical effectiveness. Future randomized trials are needed to strengthen causal inference and support implementation of personalized nutritional strategies in clinical and public health practice.