Santisith Khiewkhern

Background: Pressure injuries are a major patient safety concern, particularly among hospitalized patients at high risk. Identifying factors associated with pressure injuries is essential for effective prevention. Therefore, this study aimed to identify factors associated with pressure injuries among high-risk hospitalized patients. Methods: A case–control study was conducted among 80 inpatients, including 40 with hospital-acquired pressure injuries (HAPIs) and 40 without HAPIs, admitted to the Department of Medicine, Mahasarakham Hospital, between April 2023 and December 2025. Data were obtained from medical records and structured data collection forms. Descriptive statistics and bivariable analyses using chi-square or Fisher’s exact tests were performed. Variables with p < 0.25 were considered for multivariable logistic regression. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Results: Patients with HAPIs had higher proportions of edema, incontinence, hypoalbuminemia, and nil per os (NPO) status. Bivariable analysis identified associations with Braden score ≤17, impaired level of consciousness, mechanical ventilation, inotropic/vasopressor use, physical restraint, edema, incontinence, low serum albumin, and NPO status (p < 0.05). In the final multivariable model, endocrine and metabolic diseases (AOR = 25.92; 95% CI: 1.06–633.10; p = 0.046), mechanical ventilator use (AOR = 104.79; 95% CI: 11.78–932.05; p < 0.001), inotropic/vasopressor use (AOR = 17.26; 95% CI: 1.15–258.41; p = 0.039), and diarrhea (AOR = 24.34; 95% CI: 1.88–315.36; p = 0.015) were statistically associated with HAPIs. Cardiovascular diseases showed a borderline association (AOR = 18.78; 95% CI: 1.00–354.36; p = 0.050), while physical restraint was not statistically significant (AOR = 5.40; 95% CI: 0.80–36.66; p = 0.084). Conclusions: Several clinical factors were associated with HAPIs. However, large AORs and wide CIs indicate substantial uncertainty in the magnitude of these associations. Findings should be interpreted cautiously and confirmed in larger prospective studies. Prevention should emphasize early risk identification, management of critically ill patients, and appropriate moisture and pressure injury prevention.

Microplastic contamination has become a major environmental health concern because of its widespread occurrence and potential risks to human health. Although environmental health literacy (EHL) is recognized as an important determinant of health-related decision-making, evidence regarding its influence on behaviors that reduce potential microplastic exposure remains limited, particularly in riverine communities of developing countries. This study assessed EHL, environmental health behaviors associated with potential microplastic exposure, and factors associated with these behaviors among urban residents living along the Mekong River in Thailand. A community-based cross-sectional study was conducted among 420 adults in Mueang Nakhon Phanom District, Thailand, between October and December 2024 using multistage random sampling. Face-to-face interviews were performed using a content-validated questionnaire assessing six EHL domains and environmental health behaviors related to microplastic exposure. Multivariable logistic regression was used to examine factors associated with poor environmental health behaviors. Overall, 41.7% of participants demonstrated good environmental health behaviors, whereas 58.3% exhibited poor behaviors. Participants had a moderate level of EHL (mean score, 2.30 ± 0.46), with decision-making representing the weakest domain. Insufficient EHL was strongly associated with poor environmental health behaviors (AOR = 8.06, 95% CI: 2.86–10.04; p < 0.001). Additional factors associated with poor environmental health behaviors included consumption of untreated river or other water sources, no physician visit during the previous month, age older than 60 years, and obtaining aquatic foods through self-capture, whereas trade occupation was associated with lower odds of poor behaviors. These findings support community-based EHL programs led by local authorities and public health practitioners that strengthen critical appraisal and decision-making skills, provide accessible and evidence-based information on microplastic risks, and promote practical actions such as reducing single-use plastics and improving household waste management.

Musculoskeletal pain is a common occupational health problem among emergency medical service personnel due to the physically demanding nature of their work. This study aimed to determine the prevalence of musculoskeletal pain and identify associated factors among emergency personnel in Nakhon Pathom Province, Thailand. A cross-sectional study was conducted among 466 emergency personnel using a structured questionnaire. The seven-day prevalence of musculoskeletal pain was 70.80%, while the twelve-month prevalence of lower back pain was 52.40%. The lower back, shoulders, and neck were the most commonly affected body regions. Multivariable logistic regression analysis showed that personnel with less than 10 years of work experience had higher odds of musculoskeletal pain (adjusted odds ratio [AOR] = 1.59; 95% CI: 1.04–2.44). Working more than 40 h per week was also associated with increased odds (AOR = 1.58; 95% CI: 1.04–2.42). Maintaining a sustained static posture for more than 5 min showed the largest adjusted odds ratio among the factors examined (AOR = 2.83; 95% CI: 1.86–4.30). These findings highlight the substantial occupational burden of musculoskeletal pain among emergency personnel and suggest the need for further evaluation of ergonomic and organizational strategies to address this occupational health problem.

Microplastic contamination has emerged as a growing environmental exposure concern in river-dependent rural populations, yet evidence on behavioral determinants remains limited. Health literacy is a key upstream determinant that may influence risk perception and preventive behavioral responses. This study examined the association between health literacy and preventive behaviors related to microplastic exposure among residents living along the Mun River in Buriram Province, Thailand. A community-based cross-sectional study was conducted among 268 adults selected using multistage sampling. Data were collected through structured interviewer-administered questionnaires. Health literacy was operationalized as a multidimensional construct covering six domains and categorized into sufficient and insufficient levels. Preventive behaviors were dichotomized as good or poor based on predefined scoring criteria. Multivariable logistic regression models were applied to estimate adjusted associations between health literacy and preventive behaviors while controlling for potential confounders, including sociodemographic and behavioral factors. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Insufficient health literacy was highly prevalent (70.9%) and was independently associated with poor preventive behaviors (AOR = 6.05, 95% CI: 3.08–11.90, p < 0.001) after adjustment for covariates. Domain-specific analysis identified action literacy (AOR = 2.67, 95% CI: 1.29–5.59, p = 0.008) and appraisal literacy (AOR = 3.19, 95% CI: 1.51–6.73, p = 0.002) as significant predictors. Frequent fish consumption was also independently associated with poor preventive behaviors (AOR = 3.25, 95% CI: 1.35–7.84, p = 0.009). Health literacy is a strong independent correlate of preventive behaviors related to microplastic exposure in rural riverine populations. Findings support targeted, domain-specific health literacy interventions—particularly action- and appraisal-oriented competencies—as a public health strategy to reduce environmental exposure risk.

This study investigates the efficacy of a nano-catalyzed Photocatalytic Oxidation (PCO) system for the proactive inactivation of resilient microbial spores within the confined environments of emergency medical vehicles. Addressing the limitations of conventional decontamination methods against persistent airborne pathogens, this research evaluated four PCO configurations in a 9 m3 simulated ambulance chamber. The system’s performance was quantified using two recalcitrant biological indicators Bacillus subtilis and Aspergillus niger. Experimental results demonstrated that while natural decay accounted for minimal spore reduction (<11%), the PCO system consistently achieved an inactivation efficiency exceeding 3.0-log (99.9%). Specifically, the UVA+TiO2 configuration exhibited the most stable and reproducible inactivation kinetics. These microbiological data were subsequently integrated into an empirical foundation for an EMS-based decision-support system. By formalizing the determined Total Kill Time (TKT) parameters—60 minutes for A. niger and 90 minutes for B. subtilis—this study proposes a data-driven Safe-to-Enter informatics framework. This framework transitions ambulance biosafety from subjective manual estimation to verifiable digital protocols, enhancing occupant safety through evidence-based informatics within the digital health ecosystem.

Microplastic contamination in freshwater ecosystems poses a critical environmental challenge, necessitating effective removal technologies in wastewater treatment. This research aims to evaluate the efficiency of a hybrid removal system for polyethylene microplastics (particle sizes 0.15–1 mm) by integrating chemical coagulation with simple sand filtration. The performance of three coagulants—alum, polyaluminium chloride (PAC), and ferric chloride—supplemented with chitosan as a coagulant aid, was optimized across various dosages and pH levels, followed by the evaluation of a sand filter column under different flow rates. The results indicated that coagulation efficacy was pH-dependent, peaking at pH 7, where PAC achieved the highest removal efficiency of 77.41 ± 4.47% for fine 0.15 mm particles, followed by alum (73.22 ± 3.54%) and ferric chloride (63.18 ± 3.63%); notably, the combined system operating at a flow rate of 15 mL/min (Experimental Set 1) attained an exceptional overall removal efficiency of 99.93%. These findings demonstrate that coupling chemical coagulation with low-cost sand filtration offers a robust and scalable solution for significantly reducing microplastic discharge in synthetic wastewater applications.

Background: Microplastic contamination in freshwater systems poses increasing environmental and public health risks, particularly for riverine communities. Health literacy may critically influence individuals’ capacity to recognize exposure pathways and adopt preventive behaviors. Objective: This study assessed health literacy and preventive behaviors related to microplastic contamination and examined factors associated with poor health literacy and preventive practices among communities in northeastern Thailand. Methods: A cross-sectional survey was conducted among 942 adults residing along the Mekong, Chi, and Mun River basins. Health literacy and preventive behaviors were assessed using a structured questionnaire. Multivariable logistic regression was performed to identify associated factors, whilst adjusted odds ratios (aOR) with 95% confidence intervals (CI) and statistical significance set at p < 0.05. Results: Nearly half of the participants exhibited insufficient health literacy, with decision-making identified as the weakest domain. While approximately half reported good preventive behaviors, insufficient health literacy was the strongest determinant of poor preventive practices (aOR=9.18; 95%CI: 6.62–12.72). Residents of rural (aOR=6.47; 95%CI: 4.47–9.37) and semi-urban (aOR=2.45; 95%CI: 1.76–3.41) communities and younger age groups were significantly more likely to have poor health literacy. Community type (semi-urban: aOR=2.61; 95%CI: 1.81–3.78) and longer duration of residence (>60 years: aOR=2.36; 95%CI: 1.37–4.06) were also significantly associated with preventive behaviors. Conclusion: Health literacy is a critical determinant of microplastic-related preventive behaviors. Interventions targeting higher-order literacy skills, particularly decision-making, should be integrated into environmental health and public health strategies to reduce microplastic exposure and promote sustainable preventive practices in riverine communities .

Ambulances are enclosed environments that carry a high risk of airborne and surface microbial transmission, yet effective disinfection technologies remain limited. This study evaluated four photocatalytic oxidation (PCO) configurations—O₃+UVA + TiO₂, UVA + TiO₂, O₃+UVC + ZnO, and UVC + ZnO—against B. subtilis spores. The testing employed a prototype air purification system for ambulance applications, where the photocatalyst TiO ₂ or ZnO was integrated into a filter medium. This system operated in combination with its corresponding UV light source (UVA or UVC) and an optional ozone generator; all housed within a laboratory-simulated ambulance cabin. (8.998 m³), where spores at 1.5 × 10⁸ CFU/mL (8 mL) were spray misted using a nebulizer and sampled using an Andersen Impactor, following the NIOSH method. Disinfection efficacy was quantified as the percentage reduction of B. subtilis spores in the air and on surfaces. Among the tested systems, efficacy ranked as UVA + TiO₂ > O₃+UVA + TiO₂ > O₃+UVC + ZnO > UVC + ZnO. UVA + TIO ₂ achieved the most rapid and stable disinfection among the tested systems under controlled conditions, reducing airborne spores by > 80% within 15 min, achieving complete removal within 90 min, and reducing surface contamination by 96.77% at 120 min. In contrast, ZnO- and UVC-based systems exhibited lower or inconsistent performance. These findings identify UVA + TiO₂ photocatalysis as a safe, ozone-free, and highly effective strategy for ambulance air purification. Its rapid and durable antimicrobial action demonstrates clear advantages over approaches based on ozone or UVC, offering practical benefits for infection control in emergency medical services and providing a foundation for further optimization of photocatalytic technologies in healthcare settings.

Background: Type 2 diabetes mellitus (T2DM) is a major public health problem in Thailand, particularly in rural areas where individuals have limited access to structured diabetes care and education. Poor self-management contributes to uncontrolled glycemic levels and long-term complications. Objectives: This study evaluated the effectiveness of a community-based health care program on glycemic control and self-care behaviors among adults with uncontrolled T2DM. Methods: A quasi-experimental study was conducted among 80 patients with uncontrolled T2DM in Kalasin Province. Participants were assigned to either an intervention group (n = 40) or a comparison group (n = 40). The 12-week intervention consisted of diabetes self-management education, individualized lifestyle support, and community/family engagement. Diabetes self-care behavior and glycated hemoglobin (HbA1c) were assessed at baseline and Week 12. Statistical analyses included paired t-test, independent t-test, and 95% confidence intervals. Results: The intervention group demonstrated a significant improvement in self-care behavior (MD = 14.83; p < 0.0001), compared with a minimal change in the comparison group (0.80; p = 0.756). HbA1c levels significantly decreased in the intervention group (−0.47%; 95% CI: −0.61 to −0.33; p < 0.0001), while a slight nonsignificant increase was observed in the comparison group (0.11%; p = 0.210). The between-group analysis showed a significant reduction in HbA1c favoring the intervention (−0.92%; p < 0.0001), supported by a large effect size (Hedges’ g = 0.87). Conclusions: This community-based health care program effectively enhanced diabetes self-management behaviors and improved glycemic control. Integrating such behavioral support into primary health care services may strengthen long-term diabetes management and reduce complications among patients with uncontrolled T2DM.

Ambulances are enclosed environments that carry a high risk of airborne and surface microbial transmission, yet effective disinfection technologies remain limited. This study evaluated four photocatalytic oxidation (PCO) configurations—O₃+UVA+TiO₂, UVA+TiO₂, O₃+UVC+ZnO, and UVC+ZnO—against B. subtilis spores. Experiments were conducted in a laboratory-simulated ambulance cabin (8.998 m³), where spores at 1.5×10⁸ CFU/mL (8 mL) were spray misted using a nebulizer and sampled using an Andersen Impactor, following the NIOSH method. Disinfection efficacy was quantified as the percentage reduction of B. subtilis spores in the air and on surfaces. Among the tested systems, efficacy ranked as UVA+TiO₂ > O₃+UVA+TiO₂ > O₃+UVC+ZnO > UVC+ZnO. UVA+TiO₂ achieved the most rapid and stable disinfection, reducing airborne spores by >80% within 15 minutes, achieving complete removal within 90 minutes, and reducing surface contamination by 96.77% at 120 minutes. In contrast, ZnO- and UVC-based systems exhibited lower or inconsistent performance. These findings identify UVA+TiO₂ photocatalysis as a safe, ozone-free, and highly effective strategy for ambulance air purification. Its rapid and durable antimicrobial action demonstrates clear advantages over approaches based on ozone or UVC, offering practical benefits for infection control in emergency medical services and providing a foundation for further optimization of photocatalytic technologies in healthcare settings.