Mahidol University's Institutional Repository
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Recent Submissions
Outcomes in Critically Ill Patients Aged 90 Years and Older: A Scoping Review
(2025-01-01) Kitisin N.; Pattamin N.; Thongpibul N.; Raykateeraroj N.; Kitisin N.; Mahidol University
The growing population of nonagenarians has led to increased intensive care unit (ICU) admissions among elderly patients. However, evidence on their outcomes and optimal management strategies remains limited and fragmented. This scoping review aimed to explore mortality outcomes, factors associated with mortality, and treatment intensity in nonagenarians, comparing them to younger patients. A systematic search of MEDLINE and Embase from 1946 to September 2024 identified studies reporting ICU, in-hospital, and long-term mortality in nonagenarians. Twenty-nine studies involving 21,420 nonagenarians and 244,323 younger patients were included. ICU mortality among nonagenarians ranged from 1.42% to 66.7%, with an overall rate of 17.05% (2,738/16,062). In-hospital mortality ranged from 5.6% to 47%, with an overall rate of 26.54% (5,563/20,962). Long-term (one-year) mortality varied from 19% to 77%, with an overall rate of 53.45% (7,020/13,134). Key predictors of mortality included comorbidities, high severity scores (APACHE II, SAPS II), and less aggressive treatment. Despite these factors, nonagenarians had comparable mortality rates to younger patients when adjusted for illness severity. Nonagenarians in ICUs display variable but acceptable mortality rates, suggesting that age alone should not determine care intensity. Their heightened vulnerability after discharge calls for more effective and personalized post-ICU and post-hospital discharge care plans to better address their ongoing risks.
Validation of a Sexual Health Literacy Scale for Secondary School Students in High-Risk Area of Thailand
(2026-01-01) Zaw K.; Phuwasuwan N.; Kittipichai W.; Zaw K.; Mahidol University
Adolescents need strong sexual health literacy to make decisions that help avoid unintended pregnancies and sexually transmitted infections. This study validated the Sexual Health Literacy Scale for Secondary School Students (SHLSS) in high-risk area of Thailand, using Confirmatory Factor Analysis (CFA). Secondary data from a 2018 cross-sectional survey involving 319 secondary school students in Chonburi Province, Thailand, were used. The SHLSS consists of 28 items across four dimensions: Access, Understand, Appraise, and Apply. CFA results demonstrated strong reliability, with a Cronbach’s alpha of 0.90, and satisfactory construct validity, as composite reliability values ranged from 0.88 to 0.91. Factor loadings varied between 0.43 and 0.81, indicating moderate to strong correlations. However, the Access dimension exhibited lower convergent validity (AVE = 0.28), suggesting need for refinement. These findings highlight need for further validation across diverse cultural groups and support the SHLSS as a promising framework for guiding sexual health education and policy development for adolescents.
Heat Acclimatization among New Conscripts in Army Training Units in Bangkok, Thailand: A Prospective Cohort Study
(2026-01-01) Chumnum T.; Jirapongsuwan A.; Tipayamongkholgul M.; Kalampakorn S.; Deepreecha K.; Chumnum T.; Mahidol University
Heat-related illness (HRI) remains a major occupational health concern among new conscripts undergoing military training in tropical environments. This study aimed to evaluate heat acclimatization and its influencing factors among new military conscripts in Bangkok, Thailand. A prospective cohort study was conducted among 383 conscripts recruited from 11 randomly selected training units during November–December 2022. Eligible participants aged 21–29 years were classified by body mass index (BMI) and participation in the Health Promotion and Prevention Medicine (HPPM) exercise program, which incorporated aerobic and resistance training with progressive overload, structure rest, and supervision to enhance cardiovascular and thermoregulatory adaptation. Heat acclimatization was assessed using repeated measures of skin temperature, heart rate, and sweat response. Associations were analyzed using chi-square tests and multiple logistic regression. Overall, 18.5% of conscripts achieved full heat acclimatization by week 4. Participation in the HPPM program was associated with a higher rate of acclimatization in later training weeks (20.8% vs 17.1%). Higher BMI was negatively associated with acclimatization (AOR = 0.271, 95% CI: 0.102–0.719, p = 0.009), whereas higher knowledge levels (AOR = 4.054, p = 0.019) and strong peer support (AOR = 2.654, p = 0.006) significantly increased the likelihood of acclimatization. Environmental factors, including temperature and humidity, were also significant. In conclusion, heat acclimatization remains limited among new conscripts. The HPPM program shows beneficial effects, and targeted interventions for high-risk groups should be integrated into military training policies to reduce HRI risk and improve occupational health outcomes.
Exposure and Health Risk Assessment of Phthalates in House Dust among Schoolchildren in Phatthalung, Thailand
(2026-01-01) Laemun N.; Tantrakarnapa K.; Kaewboonchoo O.; Intrakun S.; Laemun N.; Mahidol University
Phthalates are widely used chemicals that are not chemically bonded to materials. Therefore, they can be readily released into house dust. Children are at high risk of phthalate exposure through dust ingestion due to inadequate hygiene practices, which may adversely affect their health. Settled house dust samples were collected from 310 households of elementary school children in Phatthalung, Thailand, using a vacuum cleaner. Ten phthalates were then analyzed by gas chromatography-mass spectrometry. A quantitative health risk assessment for children via ingestion was conducted using the United States Environmental Protection Agency (US EPA) methodology. Di-2-ethylhexyl phthalate (DEHP) was the most abundantly detected compound, followed by di-n-octyl phthalate (DnOP) and dibutyl phthalate (DBP) (detection rates > 60%), with median concentrations ranging from 6.90 to 150.91 µg/g. The median concentration of total phthalates (Σ10PAEs) was 190.71 µg/g. The median estimated daily intakes (EDIs) of DEHP, DnOP, DBP, and Σ10PAEs ranged from 3.95 to 112.56 ng/kg bw/day and 13.18 to 375.22 ng/kg bw/day under central-tendency and upper-percentile scenarios, respectively. The EDIs of DEHP, DnOP, and Σ10PAEs in children aged ≥ 9 years were significantly higher than those in younger children. The hazard quotient (HQ) and hazard index (HI) values for the three phthalates were less than 1. The CR for DEHP was below 1×10-4; however, one child exceeded this threshold under the upper-percentile scenario (1.001×10-4). These findings suggest that DEHP exposure warrants attention given its potential carcinogenic risk, highlighting the need for appropriate risk management strategies to reduce phthalate exposure in indoor environments.
Effects of a Theory of Planned Behavior-Based Program on E-Cigarette Prevention among Female Students in Bangkok
(2026-01-01) Pimpan W.; Auemaneekul N.; Powwattana A.; Kalampakorn S.; Pimpan W.; Mahidol University
This quasi-experimental study evaluated effects of program applying the Theory of Planned Behavior to preventive behavior from e-cigarette smoking among female junior high school students in Bangkok. Sixty Grade 8 students were equally assigned to an experimental group and a comparison group. The 6-week intervention comprised female peer-leader preparation and four participatory workshop sessions designed to improve attitudes, subjective norms, perceived behavioral control, and intention to abstain from e-cigarette use. Data were collected pre-intervention, post-intervention, and at two-week follow-up. Research instruments included questionnaires assessing attitude, subjective norm, perceived behavioral control, intention, and prevention behaviors. Content validity was verified by three experts, yielding CVI values of 0.85–1.00. Reliability was high, with Cronbach’s alpha ranging from 0.80 to 0.96. Data were analyzed using Chi-Square test, Fisher’s Exact Test, Friedman Test, Wilcoxon Signed Rank Test, and Mann–Whitney U Test. Results showed that, after the intervention and at follow-up, the experimental group had higher mean scores for attitude and subjective norm compared with baseline (p<.05). Perceived behavioral control and intention did not change. Prevention behavior increased post-intervention (p<.05) but was not maintained at follow-up. Between groups, the experimental group scored higher across variables (p<.05). The findings indicate that the program improved attitudes, subjective norms, and short-term prevention behavior. Strategies are needed to strengthen perceived behavioral control, reinforce intention, and sustain change. Adapting the program for other adolescent female groups in non-formal education and working with families is recommended to support long-term outcomes.