Udomsak Saengow

Background: Hypertension affects more than 1.28 billion adults globally and remains the leading modifiable risk factor for cardiovascular disease, stroke, renal failure, and premature death. This burden is inconsistently distributed across Low- and Middle-Income Countries (LMICs), where nearly three-quarters of adults live with hypertension. This gap is largely driven by poor adherence and low retention. This systematic review aims to assess the effectiveness of nurse-led interventions on retention in care, medication adherence, and blood pressure among adult patients with hypertension in primary health care settings in LMICs. Methods: The protocol was registered (PROSPERO CRD420251136515) following the PRISMA guidelines. We searched PubMed, Scopus, and Cochrane for articles published between 2000 and 2026. Eligibility criteria included: adults (≥18 years) with hypertension receiving care from primary care clinics; nurse-led interventions; usual care as comparator; primary outcome: retention rates; secondary outcomes: medication adherence, blood pressure (BP) control. Inclusion: experimental, quasi-experimental, and prospective cohort studies. Dual independent screening and data extraction were performed. Quality assessment was performed using Cochrane Risk of Bias 2(RoB2) for randomized controlled trials and Joanna Briggs Institute (JBI) tools for quasi-experimental and observational studies. Due to heterogeneity in intervention duration, outcome measures, and follow-up periods, a narrative synthesis was employed. Results: Eleven unique studies ( n = 19,005) were identified: 63.6% RCTs, 18.2% quasi-experimental, and 18.2% observational. Seven studies were conducted in Africa and four in Asia. The mean age range was 52.0–67.4 years; 51.3%−76.0% were female. Risk-of-bias assessment revealed high or unclear risk in the missing outcomes data domain for most RCTs. Ten studies used multicomponent interventions. Retention rates varied with appointment attendance (12.6–96.5%), routine clinical retention (27.0–62.8%), and study completion of follow-up (83.8% to 97.2%). Four studies reported medication adherence with varying effects in the intervention group compared to the control or baseline. Ten studies reported systolic blood pressure (SBP) outcomes; 9 reported mean SBP after intervention; the majority reported the mean reduction of SBP was greater than 10 mmHg. Nine studies reported diastolic blood pressure (DBP) outcomes; all studies reported a reduction in DBP after the intervention, with a range of −1.8 mmHg to −20.6 mmHg. Reported SBP and DBP reductions included both within-group controlled estimates; these should not be interpreted as a pooled effect. Conclusion: This systematic review included 11 studies that showed nurse-led interventions improved blood pressure control in primary health care facilities of LMICs. But retention in care showed substantial variability in nurse-led interventions in primary health care facilities of LMICs. Nurse-led interventions in LMICs are a promising strategy for improving blood pressure control. However, retention in care was substantially and variably due to heterogeneous definitions and evidence on medication adherence was limited. Future research should prioritize standardized outcome measures and robust study designs to strengthen the evidence base and inform sustainable scale-up of these models in LMICs.

Sobriety campaigns (e.g., Dry January (UK), Dry July (Australia), and Thailand’s three-month sobriety campaign) have emerged as strategies to reduce alcohol use, with evidence suggesting sustained effects of such campaigns on drinking behavior for several months post-campaign. However, the relationship between campaign completion and intention to quit (a predictor of quitting behavior) remains underexplored. This study aims to examine the association between completing a sobriety campaign and intention to quit drinking. This is a pooled cross-sectional analysis of three waves of a nationally representative survey, using multivariate logistic regression. Intention to quit drinking was the dependent variable, and completion of the campaign (completely abstaining versus decrease in drinking) was the explanatory variable in the model, adjusting for demographic and drinking-related covariates. Overall, 12.6% of those completing the recent-year campaign expressed an intention to quit drinking. Completing the recent-year campaign was strongly associated with higher odds of intention to quit (adjusted OR 4.75; 95% CI, 3.17–7.34). The findings suggest that temporary sobriety campaigns may serve as an entry point for longer-term behavioral change. Policymakers should consider sobriety campaigns as a complementary strategy to reduce alcohol use alongside the WHO’s recommended interventions.

Thailand’s temporary abstinence campaign aims to persuade drinkers to abstain from alcohol for three months during Buddhist Lent. In recent years, a decline in the popularity of the campaign has been observed. This study aims to determine factors associated with success in complete abstinence during the campaign period and to determine whether the associations change over time to provide insight into the decline in complete abstinence. This study analyzes pooled data of 5898 current drinkers from three waves (2015, 2018, and 2021) of the campaign evaluation survey. The primary outcome is complete abstinence during the campaign. Multivariable analysis indicated that campaign media exposure was associated with complete abstinence (OR, 1.42; 95% CI 1.17–1.72). Similarly, the year 2018, older age, lesser drinking frequency prior to the campaign, and higher level of affordability were positively associated with complete abstinence. There was a statistically significant interaction between year and drinking frequency prior to the campaign (p < 0.001). The decline in complete abstinence was plausibly explained by reduced campaign media exposure, increased drinking frequency among drinkers, and the 2021 period effect (presumably COVID-19). Diversifying campaign media distribution across traditional, community-based, and digital platforms may enhance the campaign’s success by ensuring wider exposure to campaign messages.

Chronic cadmium exposure is linked to bone loss, but its effect on the short-term progression of bone mineral density (BMD) in previously exposed populations is not well understood. This study aimed to investigate the association between baseline urinary cadmium (U-Cd) levels and the subsequent three-year change in BMD in a chronically exposed cohort in northwestern Thailand. We conducted a three-year longitudinal study of 393 residents (40 men, 353 women) aged 35 and older. Baseline (2019) U-Cd was the primary exposure, and BMD at the calcaneus was measured in 2019 and 2022. Dual-energy X-ray absorptiometry was used for BMD measurements and atomic absorption spectrometry for U-Cd analysis. The mean U-Cd levels in males (7.18 ± 1.35 μg/g creatinine) were significantly higher (p < 0.001) than in females (3.68 ± 2.13 μg/g creatinine). This study found a statistically significant decrease in BMD in the group with the lowest U-Cd levels (<2.0 μg/g creatinine, p = 0.001) and in the overall sample (from 0.392 ± 0.079 μg/g creatinine in 2019 to 0.384 ± 0.094 μg/g creatinine in 2022, p = 0.004). However, no statistically significant changes were observed in groups with U-Cd levels above 2.0 μg/g creatinine. Osteoporosis prevalence remained stable in both males and females. The Linear Mixed-Effects Model analysis revealed significant associations between BMD and several factors: increasing age, female sex, diabetes status and BMI. Age and female sex were negatively associated with BMD, while BMI showed a positive relationship. U-Cd levels were not significantly associated with BMD changes over the three-year period (coefficient = −0.002, p = 0.073), though a slight downward trend in BMD was observed across all cadmium exposure levels. This study underscores the complexity of cadmium’s effects on bone health and emphasizes the need for longer-term follow-up studies to better understand the potential cumulative impact of cadmium exposure on BMD.

Rationale A small number of earlier studies have suggested an effect of temporary abstinence campaigns on alcohol consumption. However, all were based on self-reported consumption estimates. Objectives Using a time series of 23-year monthly alcohol sales data, this study examined the effect of an annual temporary abstinence campaign, which has been organised annually since 2003 during the Buddhist Lent period (spanning 3 months), on population-level alcohol consumption. Methods Data used in the analysis included a time series of monthly alcohol sales data from January 1995 to September 2017 and the midyear population counts for those years. Generalised additive models (GAM) were applied to estimate trends as smooth functions of time, while identifying a relationship between the Buddhist Lent abstinence campaigns on alcohol consumption. The sensitivity analysis was performed using a seasonal autoregressive integrated moving average with exogenous variables (SARIMAX) model. Intervention The Buddhist Lent abstinence campaign is a national mass media campaign combined with community-based activities that encourages alcohol abstinence during the Buddhist Lent period, spanning 3 months and varying between July and October depending on the lunar calendar. The campaign has been organised annually since 2003. Main outcome Per capita alcohol consumption using monthly alcohol sales data divided by the midyear total population number used as a proxy. Results Median monthly per capita consumption was 0.43 (IQR: 0.37 to 0.51) litres of pure alcohol. Over the study period, two peaks of alcohol consumption were in March and December of each year. The significant difference between before-campaign and after-campaign coefficients in the GAM, −0.102 (95% CI: −0.163 to –0.042), indicated an effect of the campaign on alcohol consumption after adjusting for the time trend and monthly seasonality, corresponding to an average reduction of 9.97% (95% CI: 3.65% to 24.18%). The sensitivity analyses produced similar results, where the campaign was associated with a decrease in consumption of 8.1% (95% CI: 0.4% to 15.7%). Conclusions This study demonstrated that the temporary abstinence campaign was associated with a decrease in population-level alcohol consumption during campaign periods. The finding contributed to a growing body of evidence on the effectiveness of emerging temporary abstinence campaigns.

Introduction: Alcohol's harm to others (AHTO) in workplaces has received little attention. A few studies from high-income countries have estimated the cost of AHTO in workplaces, while data from the low- and middle-income countries are lacking. This study aimed to estimate the cost of AHTO in workplaces and to explore factors associated with the cost of AHTO in workplaces.Methods: Data were taken from 1392 employed respondents who participated in a survey conducted in Thailand from September 2012 to March 2013. The cost of extra work hours was estimated from the hourly wage and extra hours of work. The hourly wage was computed by converting monthly income to weekly income and dividing weekly income by weekly working hours. The gamma regression with log link was used to determine factors associated with the cost of extra working hours.Results: The past-year prevalence of harm from co-workers' drinking was 17.8% among the employed population. The prevalence of working extra hours was 6.1%. On average, an affected worker worked 16.0 extra hours due to co-workers' drinking. In total, 28.8 million hours of extra work was attributed to co-workers' drinking in 1 year. The cost of these extra work hours was 1.8 billion Thai baht (57.8 million USD). Age, education and type of employment were associated with the cost of working extra hours.Discussion and Conclusions: The burden of alcohol in workplaces extends beyond drinking workers. Our findings indicate that alcohol imposes a significant cost on co-workers of drinkers.

Introduction: Despite comprehensive tobacco control policies being in place since 1992, smoking prevalence in Thailand has not declined since 2009, indicating a potential need for individual-level measures. This study examined factors influencing successful smoking cessation attempts in...