Research Medical Journal

Effect of Positive Psychological Capital and Self-Management Model Interventions on Pain and Functional Difficulty in Persons With Osteoarthritis

2025-03-18T11:51:23+07:00

Background: Osteoarthritis is a prevalent global health challenge, particularly among the elderly, and leads to significant physical disability, emotional distress, and socioeconomic burden. Effective interventions addressing these multifaceted effects are limited, especially in patients with severe knee osteoarthritis awaiting a surgical intervention. This study was guided by 2 theoretical frameworks: the positive psychological capital (PsyCap) theory, which focuses on enhancing psychological resilience, motivation, and coping strategies; and the self-management model, which emphasizes goal setting, symptom tracking, and adherence to self-care behaviors.

Objectives: To evaluate the effectiveness of a novel intervention integrating PsyCap theory and self-management model strategies to enhance self-care behavior, alleviate pain, and reduce mobility difficulties among patients with severe knee osteoarthritis (Kellgren-Lawrence grades 3-4).

Methods: A quasi-experimental pretest-posttest design was used between May and July 2023 at the outpatient surgery department of a university hospital. A total of 34 patients with primary knee osteoarthritis were randomly assigned into experimental (n = 17) and control (n = 17) groups. The experimental group received a self-care behavior enhancement program integrating PsyCap and self-management principles. Outcomes were assessed at 3 time points: baseline, postintervention (4 weeks), and follow-up (12 weeks). Statistical analyses included descriptive statistics and 2-way repeated measures analysis of variance (ANOVA) to examine within- and between-group effects over time.

Results: Compared to the control group, the experimental group demonstrated significant improvements in self-care behaviors (F[1,32] = 24.982; P < .001; η² = 0.438), with significant time-group interaction effects (F[1.374,43.960] = 38.581; P < .001; η² = 0.547). Additionally, pain and mobility difficulties significantly decreased in the experimental group (F[1.640,52.473] = 42.261; P < .001; η² = 0.569), whereas no significant changes were observed in the control group.

Conclusions: Integrating PsyCap theory and the self-management model significantly improved self-care behavior and reduced pain and mobility difficulty in patients with severe knee osteoarthritis awaiting surgery. These benefits were sustained over 12 weeks.

Exploring Kratom Use in High-Prevalence Areas of Southern Thailand: Attitudes, Knowledge, and Consumption Patterns – A Mixed-Methods Study

2024-12-30T19:49:12+07:00

Background: Kratom (Mitragyna speciosa), a tropical tree native to Southeast Asia, has traditionally been used in Thailand for medicinal and recreational purposes. Although recently legalized for medicinal use, concerns remain regarding its safety and potential for abuse.

Objectives: To investigate kratom consumption patterns and identify demographic, behavioral, and cognitive predictors of current and harmful use in high-prevalence rural communities in southern Thailand.

Methods: A cross-sectional study was conducted among 169 participants from southern Thai communities with high kratom use. A structured questionnaire assessed demographics, attitudes, knowledge, and usage patterns. Harmful use was defined as consumption of more than 20 leaves per day. Multiple logistic regression analysis identified predictors of current and harmful use.

Results: Among participants, 45 (26.6%) were current users, and of those 22 (48.9%) met the criteria for harmful use. Predictors of current use included younger age (adjusted OR [AOR], 0.97; 95% CI, 0.94-0.99), tobacco use (AOR, 16.12; 95% CI, 5.01-51.86), poor mental health (AOR, 8.8; 95% CI, 2.2-35.16), and favorable attitudes toward kratom (AOR, 1.12 per point; 95% CI, 1.06-1.18). Harmful use was associated with long-term consumption (AOR, 10.54; 95% CI, 1.01-109.9), boiling as the method of use (AOR, 80.96; 95% CI, 4.98-1315.6), and lower knowledge scores (AOR, 17.8; 95% CI, 1.57-201.68).

Conclusions: Current and harmful kratom use are linked to specific demographic and behavioral factors. These findings support the need for targeted public health education and regulation in high-risk communities.

Nursing Students' Perceptions of Spiritual Care Competency: A Qualitative Study

2025-02-13T00:02:22+07:00

Background: Spiritual care is a crucial component of holistic nursing practice, as it addresses patients' emotional, psychological, and existential well-being. Nursing students play a vital role in providing spiritual support, yet their competencies in this area remain underexplored.

Objective: To explore nursing students' perceptions of their competencies in providing spiritual care to patients.

Methods: A descriptive qualitative research design was employed in this study. Ten fourth-year nursing students from the Faculty of Nursing at Ubon Ratchathani Rajabhat University were selected using purposive sampling and snowball techniques. Data were collected through in-depth interviews conducted between December 2024 and January 2025. The research instruments included a semi-structured interview guide, field notes, observational tools, and the researcher’s reflective journal. Content analysis was used to analyze the data.

Results: The findings revealed that nursing students perceived their spiritual care competencies as encompassing 3 key areas: 1) assessing and diagnosing spiritual issues; 2) planning and implementing spiritual care, which included: maintaining a positive attitude and respecting patients’ spiritual beliefs, communication and counseling, empathy and compassion, encouraging patients to practice their faith and beliefs, and referring patients to spiritual care specialists; and 3) evaluating spiritual care practices.

Conclusions: While nursing students show confidence in certain aspects of spiritual care, the study highlights the need for enhanced training. Integrating comprehensive spiritual care education and practical experiences into the curriculum, along with support from spiritual care professionals, is essential for strengthening students' competencies.

Effects of a Health Literacy Enhancement Programs for COVID-19 Prevention on Health Literacy and COVID-19 Preventive Behaviors Among Caregivers of Dependent Older People

2025-06-04T12:49:26+07:00

Background: Older people with dependent conditions are highly vulnerable to COVID-19 due to exposure to respiratory droplets from talking, coughing, sneezing, or close contact with caregivers.

Objectives: To evaluate the effectiveness of a health literacy enhancement program on caregivers' health literacy and preventive behaviors.

Methods: This quasi-experimental study was conducted in Phak Hai district, Phra Nakhon Si Ayutthaya province, from September 2023 to January 2024. The study included 50 caregivers selected through simple random sampling and divided into the experimental group (n = 25) and control groups (n = 25). The experimental group participated in an 8-week COVID-19 prevention program based on Nutbeam's health literacy framework, while the control group received standard care. The instruments used for data collection included 3 components: a personal information questionnaire; the COVID-19 Health Literacy Questionnaire (content validity index [CVI] = 0.88, Cronbach a = 0.84); and the COVID-19 Preventive Behavior Questionnaire (CVI = 0.88, Cronbach a = 0.76). Statistical tests included t tests, the Wilcoxon signed rank test, the Mann-Whitney U test, and analyses of covariance (ANCOVA).

Results: The experimental group achieved significantly higher postintervention health literacy scores compared to their preintervention scores and the control group (P < .05). Improvements were observed in accessing information, decision-making, and health behavior changes (P < .05). Also, postintervention preventive behavior scores of the experimental group were significantly higher in the control group, even after adjusting for baseline differences (P < .05).

Conclusions: This study has reinforced the importance of health literacy programs in effectively empowering caregivers to prevent COVID-19. Primary healthcare units should implement this program to better protect dependent older people from COVID-19.

Vitamin D Deficiency and Bone Turnover in People Living With HIV Switching to Tenofovir Disoproxil Fumarate/Lamivudine/Dolutegravir Versus Continuing Nonnucleoside Reverse Transcriptase Inhibitor or Protease Inhibitor Regimens in Thailand

2025-03-27T22:40:08+07:00

Background: People living with HIV (PLWH) frequently have low bone mineral density, with vitamin D deficiency as a key risk factor. Recently, World Health Organization (WHO) and Thai national HIV guidelines recommend dolutegravir as first-line therapy, replacing nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen.

Objectives: To compare vitamin D levels and bone changes in PLWH switching from NNRTI- or boosted protease inhibitor (PI)-containing regimens to DTG-based therapy versus those continuing NNRTI- or PI-based therapy.

Methods: This post hoc analysis used data from a randomized controlled trial (2020-2022) at Suddhavej Hospital, a university-affiliated tertiary care hospital in Maha Sarakham, Thailand. PLWH aged 18 years or older without virologic failure were randomized to either continue current NNRTI/boosted PI-containing combined antiretroviral therapy (control group, CG) or switch to tenofovir disoproxil fumarate/lamivudine/dolutegravir (TDF/3TC/DTG) (switch group, SG). The primary outcome was vitamin D deficiency at 48 weeks; secondary outcomes assessing changes in bone metabolism markers.

Results: Thirty-nine patients completed follow-up (20 CG, 19 SG). After 48 weeks, vitamin D deficiency prevalence increased in both groups (CG: 15% to 35%; SG: 15.8% to 31.6%) with no significant difference (P = .905). Osteocalcin increased in SG but decreased in CG (P = .036). Beta-crosslaps increased in both groups (P = .461 between groups). Procollagen type 1 amino-terminal propeptide showed a nonsignificant decrease in both (P = .960).

Conclusions: Switching to TDF/3TC/DTG had minimal impact on vitamin D status but was associated with increased osteocalcin, suggesting a possible positive effect on bone formation. No significant differences were seen in bone resorption or other formation markers.

Pleural Fluid Volume for Cytological Diagnosis of Malignancy: How Much Is Optimum

2025-07-04T13:54:45+07:00

Background: Pleural fluid cytology is essential for evaluating effusions and detecting atypical and malignant cells. However, the optimal fluid volume for accurate diagnosis remains unclear.

Objective: To determine the optimal pleural fluid volume for detecting atypical to malignant cells by analyzing diagnostic yield across different volume groups.

Methods: This retrospective study analyzed pleural fluid samples collected between 2020 and 2021, correlating to cases with confirmed malignancy in pleural cavities. Samples were categorized into volume groups and classified using the International System for Serous Fluid Cytopathology: nondiagnostic (ND), negative for malignancy (NFM), atypia of undetermined significance (AUS), suspicious for malignancy (SFM), and malignant (MAL).

Results: Of 1794 pleural fluid samples, the detection rates of atypical to malignant cells in the samples were < 25 mL (35.87%), 25-49 mL (40.77%), 50-74 mL (45.38%), 75-99 mL (37.89%), 100-249 mL (29.67%), 250-499 mL (21.99%), and ³ 500 mL (40.97%). Considering the samples with evidence of pleural involvement by malignancy (n = 497), detection rates of atypical to malignant cells in the samples were < 25 mL (83.72%), 25-49 mL (91.67%), 50-74 mL (90.41%), 75-99 mL (93.33%), 100-249 mL (72.06%), 250-499 mL (44.17%), and ³ 500 mL (82.14%). The proportion of AUS and SFM categories among the atypical and malignant samples were low (< 20%) in the 50-74 mL and 75-99 mL volume groups.

Conclusions: Intermediate volumes (50-100 mL) provide adequate cellular material while maintaining manageable sample processing. Implementing this volume range in clinical practice may enhance diagnostic accuracy.

Factors Associated With Transitional Stress Among Relatives During Transferring Critically Ill Patients From ICU-to-Ward

2025-07-14T14:04:50+07:00

Background: The intensive care unit (ICU) provides effective care for critically ill patients and can significantly reduce mortality rates. However, ICU hospitalization is not only a crisis for patients, but also for their relatives, who often experience high levels of transitional stress. This stress can negatively impact their ability to provide loving care to the patient after the transfer to a general ward.

Objectives: To describe the level of transitional stress and determine the relationship between uncertainty, hope, and preparedness with transitional stress among relatives during transferring critically ill patients from ICU-to-Ward.

Methods: This study used a descriptive correlational cross-sectional research design. A total of 112 participants were recruited during December 2022 to September 2023 by selecting participants randomly, following the inclusion criteria. The research instruments included a demographic questionnaire, the Herth Hope Index, the Family Relocation Stress Scale, the Care Preparedness Scale, and the Parents’ Perception of Uncertainty in Illness Scale-Family Member. The reliability of the scales was 0.87, 0.88, 0.82, and 0.86, respectively. Descriptive statistics and Pearson product moment correlation were used to perform data analysis.

Results: The mean (SD) score of transitional stress was 36.5 (6.2), indicating a moderate level of stress. Uncertainty was positively correlated with transitional stress (r = 0.75, P < .001). However, hope and preparedness were negatively correlated with transitional stress (r = -0.40, P < .001; r = -0.44, P < .001 respectively).

Conclusions: Clinical nurses should develop nursing interventions to reduce transitional stress among a patient’s relatives by promoting their preparedness and hope, and communicate effectively to reduce the relatives’ uncertainty about the patient’s illness.

Bilateral Third Nerve Palsies Secondary to Pituitary Apoplexy: A Case Report

2025-02-05T22:55:46+07:00

Background: Bilateral third cranial nerve palsies resulting from pituitary apoplexy with bilateral lateral expansion compressing bilateral third cranial nerves at the cavernous sinuses walls are uncommon.

Case Presentation: A 31-year-old healthy male complained of an acute severe headache, bilateral ptosis, and binocular horizontal diplopia for about 4 days. Eye examinations revealed incomplete ptosis, partial limitation of supraduction, infraduction, complete limitation of adduction, and dilated pupils in both eyes associated with bitemporal hemianopia. A brain computerized tomography (CT) scan with contrast revealed an intra- and suprasellar pituitary mass. Brain magnetic resonance imaging (MRI) reported a heterogenous mass measuring 3.0 × 3.1 × 3.8 cm involving the sphenoid sinus, sella turcica, and suprasellar cistern. Hormonal workup revealed the first diagnosis of type 2 diabetes mellitus, hyperprolactinemia, central hypothyroidism, and hypogonadotropic hypogonadism. The patient received hormonal supplements and the tumor was successfully treated by endoscopic surgery. Pathological confirmation of pituitary hemorrhage was found. All ocular and neurological deficits were completely resolved within 6 months postsurgery. Follow-up MRIs at 3 months and 1 year showed no residual tumor; however, hypogonadotropic hypogonadism and postoperative diabetes insipidus persisted for 4 months.

Conclusions: Localization of the third cranial nerve palsy was significant in determining the possibility of a lesion and detecting an emergency condition causing potential life-threatening complications. Most cases of third cranial nerve palsy from pituitary tumors effect one side, but this case is unusual because it involved both sides, showing a rare pattern of tumor growth and compression.