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Bangkok, Thailand

Plewma P.,Rajavithi Hospital
Journal of the Medical Association of Thailand | Year: 2013

Objective: The aim of the present study was to identify the prevalence of exclusive breast-feeding after 2,4, and 6 months in Rajavithi Hospital. The present study evaluated the factors associated with discontinuing breast-feeding before the first two months of life in order to target early nursing interventions to encourage and support continued breast-feeding and increase the exclusive breast-feeding rate.Material and Method: From September 2010 to May 2011, mothers were interviewed prior to hospital discharge from the maternity ward and follow-up phone calls were made after 2,4 and 6 months postpartum. Results: The prevalence of exclusive breast-feeding after 2, 4 and 6 months was 57.9% (252 out of 435), 32.0% (139 out of 435) and 4.8% (21 out of 435) respectively. At 2 months postpartum, multivariate analysis was carried out to identify whether maternal obesity and breast-feeding intervals of more than 3 hours had a statistically significant association with cessation of breast-feeding. The most common reason for cessation of exclusive breast-feeding by mothers was their return to work. Conclusion: The prevalence of exclusive breast-feeding at 2, 4, and 6 months was 57.9%, 32.0% and 4.8%, respectively. Maternal obesity, and maternal breast-feeding for intervals of more than 3 hours prior to hospital discharge were risk factorsof early breast-feeding cessation at 2 months postpartum. This is an area on which we would target nursing interventions to prevent early unintended weaning.

Sacks D.A.,Kaiser Foundation Hospital | Coustan D.R.,Brown University | Hadden D.R.,Regional Center for Endocrinology and Diabetes | Hod M.,Tel Aviv University | And 8 more authors.
Diabetes Care | Year: 2012

OBJECTIVE - To report frequencies of gestational diabetes mellitus (GDM) among the 15 centers that participated in the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) Study using the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria. RESEARCH DESIGN AND METHODS - All participants underwent a 75-g oral glucose tolerance test between 24 and 32 weeks' gestation. GDM was retrospectively classified using the IADPSG criteria (one or more fasting, 1-h, or 2-h plasma glucose concentrations equal to or greater than threshold values of 5.1, 10.0, or 8.5 mmol/L, respectively). RESULTS - Overall frequency of GDM was 17.8% (range 9.3-25.5%). There was substantial center-to-center variation in which glucose measures met diagnostic thresholds. CONCLUSIONS - Although the new diagnostic criteria for GDM apply globally, center-to-center differences occur in GDM frequency and relative diagnostic importance of fasting, 1-h, and 2-h glucose levels. This may impact strategies used for the diagnosis of GDM. © 2012 by the American Diabetes Association.

Ku G.,Sloan Kettering Cancer Center | Tan I.B.,National Cancer Center Singapore | Yau T.,University of Hong Kong | Boku N.,Kanagawa University | And 5 more authors.
The Lancet Oncology | Year: 2012

Colon cancer is seen with increasing frequency in the Asia-Pacific region, and it is one of the most important causes of cancer mortality worldwide. This article reviews the available evidence for optimum management of colon cancer-in particular, with respect to screening and early detection of colon cancer, laparoscopic surgical treatment, adjuvant treatment of individuals with high-risk stage II and stage III cancer, palliative treatment of patients with metastatic disease, and management of resectable and potentially resectable metastases-and how these strategies can be applied in Asian countries with different levels of health-care resources and economic development, stratified by basic, limited, enhanced, and maximum resource levels. © 2012 Elsevier Ltd.

Limvorraphan P.,Rajavithi Hospital
Journal of the Medical Association of Thailand | Year: 2016

Drug Rash with Eosinophilia and Systemic Symptoms (DRESS syndrome) is a severe adverse drug reaction. The drugs, which most commonly induce this condition, are anti-convulsants and sulfonamides. A 15-year-old Thai woman with no known underlying disease was prescribed co-trimoxazole, and two months after initiation, DRESS was diagnosed by RegiSCAR’s score. Her clinical symptoms were fever, laboratory abnormalities and maculopapular rash on her face, trunk and extremities. She was treated with antipyretics, antihistamines and steroid therapy, and her clinical and laboratory findings were restored to normal by the 10th day of treatment. Early diagnosis, discontinuation of the culprit drug, and management with steroids therapy can reduce the severity of DRESS syndrome. © 2016, Medical Association of Thailand. All rights reserved.

Objectives: To evaluate the relationship between the pass rate of the American Board of Internal Medicine (ABIM) certifying exam and the characteristics of residency programs. Methods: The study used a retrospective, cross-sectional design with publicly available data fromthe ABIM and theFellowship andResidency Electronic InteractiveDatabase. All categorical residency programs with reported pass rates were included. Using univariate andmultivariate, linear regression analyses, I analyzed how69 factors (e.g., location, general information, number of faculty and trainees, work schedule, educational environment) are related to the pass rate. Results:Of 371 programs, only one region had a significantly different pass rate from the other regions; however, as no other characteristics were reported in this region, I excluded program location from further analysis. In the multivariate analysis, pass rate was significantly associated with four program characteristics: ratio of full-time equivalent paid faculty to positions, percentage of osteopathic doctors, formal mentoring program, and on-site child care (OCC). Numerous factors were not associated at all, including minimum exam scores, salary, vacation days, and average hours per week. Conclusions: As shown through the ratio of full-time equivalent paid faculty to positions and whether there was a formal mentoring program, a highly supervised training experience was strongly associated with the pass rate. In contrast, percentage of osteopathic doctors was inversely related to the pass rate. Programs with OCC significantly outperformed programs without OCC. This study suggested that enhancing supervision of training programs and offering parental support may help attract and produce competitive residents. © 2015 Amporn Atsawarungruangkit.

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