Most patients reported improvement in dyspnea at 24 hours after palliative care service consultation. Consistent with existing evidence, most patients with dyspnea received opioids but only the combination of opioids and BZDs was independently associated with improvement in dyspnea. Further research on the role of BZDs alone and in combination with opioids may lead to better treatments for this distressing symptom.

BackgroundUrbanization is considered to be one of the key drivers of noncommunicable diseases (NCDs) in Thailand and other developing countries. These influences, in turn, may affect an individual’s behavior and risk of developing NCDs. The Chiang Mai University (CMU) Health Worker Study aims to provide evidence for a better understanding of the development of NCDs and ultimately to apply the evidence toward better prevention, risk modification, and improvement of clinical care for patients with NCDs and NCD-related conditions.MethodsA cross-sectional survey of health care workers from CMU Hospital was conducted between January 2013 and June 2013. Questionnaires, interviews, and physical and laboratory examinations were used to assess urban exposure, occupational shift work, risk factors for NCDs, self-reported NCDs, and other NCD-related health conditions.ResultsFrom 5,364 eligible workers, 3,204 participated (59.7%). About 11.1% of the participants had high blood pressure (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and almost 30% were considered to be obese (body mass index ≥25 kg/m2). A total of 2.3% had a high fasting blood glucose level (≥126 mg/dL), and the most common abnormal lipid profile was high low-density lipoprotein (≥160 mg/dL), which was found in 19.2% of participants.DiscussionThe study of health workers offers three potential advantages. The first is that the study of migrants was possible. Socioenvironmental influence on NCD risk factors can be explored, as changes in environmental exposures can be documented. Second, it allows the investigators to control for access to care. Access to care is potentially a key confounder toward understanding the development of NCDs. Lastly, a study of health personnel allows easy access to laboratory investigations and potential for long-term follow-up. This enables ascertainment of a number of clinical outcomes and provides potential for future studies focusing on therapeutic and prognostic issues related to NCDs.

Background: This systematic review aims to answer three questions. First, how much do mindfulness-based interventions (MBIs) affect peripheral brain-derived neurotrophic factor (BDNF)? Second, do mindfulness exercise-based interventions (exercise-MBIs) and mindfulness meditation-based interventions (meditation-MBIs) affect peripheral BDNF differently? Third, does the age of participants and the accumulative hours of MBI practice affect peripheral BDNF? Methods: We included randomized controlled trials comparing MBI and no intervention in adults (age >18 years) who reported peripheral BDNF. Database searches included PubMed, CINAHL, CENTRAL, PsyInfo, and Scopus. Two reviewers independently selected the studies and assessed the trial quality. We used the standardized mean difference (SMD) as the effect size index and conducted moderator analyses. Results: Eleven studies are included in this systematic review. Five studies applying exercise-MBI and three studies applying meditation-MBI are included in the meta-analysis (N = 479). The pooled effect size shows a significantly greater increase of peripheral BDNF in MBI groups compared to the control groups (k = 8, N = 479, SMD = 0.72, 95% CI 0.31-1.14, I 2 = 78%). Significantly more increases of BDNF in the MBI groups are found in both subgroups of exercise-MBI and meditation-MBI. The effect sizes of both subgroups are not significantly different between subgroups (χ 2 = 0.02, p = 0.88). We find no significant correlation between the effect sizes and the age of participants (r = −0.0095, p = 0.45) or accumulative hours of MBI practice (r = 0.0021, p = 0.57). Gomutbutra et al. Mindfulness and BDNF Meta-Analysis Conclusion: The heterogeneous data of this small sample-size meta-analysis suggests that MBI can increase peripheral BDNF. Either exercise-MBI or meditation-MBI can increase peripheral BDNF.

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Background Pneumonia in cancer patients is often problematic in order to decide whether to admit and administer antibiotics or pursue a comfort care pathway that may avoid in-hospital death. We aimed to identify factors which are easily assessed at admission in Thailand’s healthcare context that could serve as prognostic factors for in-hospital death. Methods Regression analysis was utilized to identify the prognostic factors from clinical factors collected at admission. The primary outcome was in-hospital death. Data was collected from the electronic medical records of Chiang Mai University Hospital, Thailand, from 2016 to 2017. Data on adult cancer patients admitted due to pneumonia were reviewed. Results In total, 245 patients were included, and 146 (59.6%) were male. The median age of the patients was 66 years (IQR: 57–75). A total of 72 (29.4%) patients died during admission. From multivariate logistic regression, prognostic factors for in-hospital death included: Palliative Performance Scale (PPS) ≤ 30 (OR: 8.47, 95% CI: 3.47–20.66), Palliative Performance Scale 40–50% (OR: 2.79, 95% CI: 1.34–5.81), percentage of lymphocytes ≤ 8.0% (OR: 2.10, 95% CI: 1.08–4.08), and pulse oximetry ≤ 90% (OR: 2.01, 95% CI: 1.04–3.87). Conclusion The in-hospital death rate of cancer patients admitted with pneumonia was approximately 30%. The PPS of 10–30%, PPS of 40–50%, percentage of lymphocytes ≤ 8%, and oxygen saturation < 90% could serve as prognostic factors for in-hospital death. Further prospective studies are needed to investigate the usefulness of these factors.