Background Identification of patients who might benefit from palliative care among countries with different socioeconomic and medical contexts is challenging. The Supportive and Palliative Care Indicators Tool for a Low-income Setting (SPICT-LIS) was designed to help physicians identify patients in low-income setting who might benefit from palliative care. We aimed to systematically adapt and refine the SPICT-LIS for Thai general palliative care providers. Methods We followed the WHO guidelines for translation, cross-cultural adaptation and validation of an instrument for the SPICT-LIS. Three expert panel members did the initial adaptation using forward and backward translations with pretested data. Two iterations of pretesting were conducted to test for applicability and reliability. The case vignettes which were used in the pretesting were modified hospital medical records. The pretesting was done with 30 respondents from various specialties in a community health center and 34 general palliative care providers from a regional referral hospital in the first and second iterations, respectively. To examine instrument reliability, interrater reliability and internal consistency were evaluated. Cognitive interviewing was conducted using semi-structured interviews with general practitioners (GPs) using the “think aloud strategy” and “probing questions”. Results The adapted Thai SPICT-LIS had a total of 34 indicators which included 6 general and 28 clinical indicators. The assessment of the adapted Thai SPICT-LIS found that it provided consistent responses with good agreement among the GPs, with a Fleiss kappa coefficient of 0.93 (0.76–1.00). The administration time was 2.3–4.3 min per case. Most respondents were female. The 8 interviewed GPs said they felt that the SPICT-LIS was appropriate for use in a general setting in Thailand. Conclusion The study found that the Thai SPICT-LIS could be an applicable, acceptable, and reliable tool for general palliative care providers in Thailand to identify patients who might benefit from palliative care.

Objective: To estimate the prevalence of patients requiring palliative care in outpatient clinics and associated factors.Materials and Methods: A cross-sectional study was conducted by retrospectively reviewing the electronic medical records of cancer patients visiting the outpatient clinics in the major tertiary care institution in southern Thailand during 1 January– 31 December 2018 from the Hospital Information System. The Supportive and Palliative Care Indicators Tool in Low Income Settings (SPICT-LISTM) was used to determine if the patients would benefit from palliative care. Forward stepwise multiple logistic regression was used to assess associations between potential factors and the need for palliative care.Results: Nine thousand nine hundred and ninety medical records were reviewed. 3,628 (36.3%) patients were male and 6,324 (63.3%) were female with a median age of 58.7 years. The prevalence of cancer patients requiring palliative care according to the SPICT-LISTM criteria was 7.8%. Age was the main factor associated with palliative care need [odds ratio (OR)=1.03, 95% confidence interval (CI)=1.02-1.04]. Muslim patients had a significantly higher requirement for palliative care compared with Buddhist patients (OR=1.62, 95% CI=1.09-2.37). Although not statistically significant, malignant neoplasms of bone and articular cartilage were associated with higher palliative care need than lip, oral cavity and pharynx cancers (OR=5.35, 95% CI=0.69-29.40).Conclusion: Muslim religion and having malignant neoplasms of bone and articular cartilage were associated with the highest palliative care need. Future studies should focus on more in-depth examination of the reasons these groups have higher needs for palliative care.

Objective: To find the correlation between type 2 diabetic patients who had abnormal ankle-brachial index (ABI) among factors affected diabetes and cardiovascular outcomes including acute coronary syndrome (ACS), myocardial infarction (MI), coronary revascularization stroke, renal replacement therapy, leg revascularization and limb amputation Material and Methods: Retrospective cohort study collecting the data of 548 diabetic patients examined ABI at Outpatient Departments from 1st January 2009 to 31st December 2015. Results: From 548 medical records including only normal-ABI group and low-ABI group, we found that hypertension, chronic kidney disease (CKD), smoking, history of previous MI, history of previous stroke and age were the significant associated factor of low-ABI. The survival analyses revealed the significantly higher rate of ACS, MI, and coronary revascularization in low-ABI group (p-value=0.04, <0.01, <0.01 respectively) after exposed to low-ABI around 4 years. However, the study found no significant difference of other outcomes between the 2 groups. Conclusion: Songklanagarind’s diabetic patients with low-ABI were associated with the significantly higher rate of multiple cardiovascular risk factors including  hypertension, CKD, smoking, history of previous MI, history of previous stroke and age and they tend to significantly experience more ACS, MI and coronary revascularization after 4 years exposed to low-ABI.

Objective: To describe the probability of appropriate hand hygiene behaviors among outpatients and visitors at a primary care unit before and after installation of additionally strategically placed hand rub dispensers and empirically-designed behavioral nudges.  Material and Methods: We conducted a quasi-experimental study at a suburban primary care unit in southern Thailand. The intervention consisted of included installation of hand rub dispensers and attachment of behavioral nudges. We designed the behavioral nudges using qualitative data from a focus-group discussion with local residents, who identified disgust and normative expectations from children as the main behavioral drivers for following appropriate hand hygiene behaviors. We then conducted surreptitious observations of hand hygiene behaviors among outpatients and visitors before intervention delivery during Wave 1 and Wave 2 of the pandemic (Phase 1 and Phase 2, respectively), after installation of the hand gel dispensers alone (Phase 3), and after attaching behavioral nudge signs to the dispensers (Phase 4).  Results: The probability of appropriate hand hygiene behavior increased from 0.6 percent in Phase 1 to 13.5 percent in Phase 4. However, the increase was statistically significant only from Phase 2 to Phase 3 in the zones where the dispensers were located (adjusted odds ratio 10.58; 95% confidence interval 1.95, 57.24). Conclusion: The probability of appropriate hand hygiene behavior after installation of the dispensers was significantly higher than at pre-intervention, but the difference in appropriate hand hygiene before and after attachment of the nudges to the dispensers was not statistically significant. The study findings could nonetheless contribute empirical evidence on observed changes in hand hygiene behaviors in a primary care setting.

Objective: To determine incidence of various health problems among Prince of Songkla University (PSU) students, and its distribution among disciplines. Material and Methods: A Retrospective study, collecting secondary de-identified hospital records of 45,093 PSU students, over the 6-year period of study; from 1st, January 2012 to 31st, December 2017. Results: According to data from 45,093 students, there were 8 groups of influential health problems that were shared in approximately 80 percent of all diagnoses. Acute upper respiratory tract infections played the greatest incidence among all disease groups. Apart from that, common health issues found in adolescence consisted of; common skin diseases, traffic accidents, and diseases of the digestive system also played a part as the most common problems. Even if the traffic accidents rate seemed to be overlooked by its number, its incidence rate was 17.41 per 1,000, which was above the provincial rate as well as country rate. Disciplines in the medical group and freshmen group were the highest of patients having most of the common problems. Each health problem incidence rate, which varied within the university campus, seemed to be from the difference of disease burden among disciplines; rather than the ease of facility accessibility. Conclusion: The collegians experienced wide ranges of common health problems, which were predominated in adolescents, and adults. Medical sciences students and freshmen were the highest number of patients for almost all health issues. Overall, health problems among the collegians probably varied in the campus due to specific characteristics in each disciplines, and differed as to the different context in other universities.