The Depression, Anxiety and Stress Scale (DASS-21), an introductory scale used to identify common mental disorders (CMDs) among adults, was validated across cultures in Asian populations; nevertheless, its capacity for screening these disorders may be limited for some specified groups, including nursing students. This study attempted to investigate the psychometric scale’s unique features of DASS-21 for Thai nursing students in an online learning environment during the COVID-19 outbreak. A cross-sectional study using the multistage sampling technique recruited 3,705 nursing students from 18 universities located in south and northeast Thailand. The data were gathered using an online web-based survey, and then all respondents were divided into 2 groups (group 1, n = 2,000, group 2, n = 1,705). After using the statistical methods to reduce items, exploratory factor analysis (EFA) using group 1 was performed to investigate the factor structure of the DASS-21. Finally, group 2 used confirmatory factor analysis to verify the modified structure proposed by the EFA and assess the construct validity of the DASS-21. A total of 3,705 Thai nursing students were enrolled. For the factorial construct validity, a three-factor model was initially suggested containing 18 items (DASS-18) spread across 3 components: anxiety (7 items), depression (7 items) and stress (4 items). The internal consistency reliability was acceptable with Cronbach’s alpha in the range of 0.73–0.92for either the total or its subscales. For convergent validity, average variance extracted (AVE) showed that all the DASS-18 subscales achieved convergence effect with AVE in the range of 0.50–0.67. The psychometric features of the DASS-18 will support Thai psychologists and researchers to screen CMDs more easily among undergraduate nursing students in tertiary institutions who enrolled in an online learning environment during the COVID-19 outbreak.

Background. Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. A large number of studies have strongly described larger proportions of men being afflicted with NAFLD than women; however, recent studies investigating the role of gender and NAFLD have exposed the contrary. Methods. This cross-sectional study utilized data from the baseline survey of an ongoing cohort study called the Cholangiocarcinoma Screening and Care Program (CASCAP), conducted in the northeastern region of Thailand between March 2013 and September 2015. Information regarding socio-demographic, including gender, was collected using a standardized self-administered questionnaire. NAFLD was diagnosed with ultrasonography by board-certified radiologists. A binomial regression was used for estimating the prevalence differences, odds ratios (OR) and the 95% confidence intervals (CI) of NAFLD between men and women. Results. A total of 34,709 participants (27,073 females and 7,636 males) were recruited. The prevalence of NAFLD in women was 22.9% (95% CI: 22.5 to 23.5), whereas it was only 18.3% (95% CI: 17.4 to 19.2) in men. After adjusting for age and presence of diabetes mellitus and other underlying diseases, the prevalence was significantly higher in women, with adjusted prevalence difference of 4.2% (95% CI: 3.2 to 5.2) and adjusted OR of 1.3 (95% CI: 1.2 to 1.4). Women had a higher prevalence of NAFLD than men in all age groups and the largest difference was found in those aged 56-60 years (prevalence = 27.4% versus 21.2%; adjusted prevalence difference = 9.4%; 95% CI: 7.9 to 10.9; adjusted OR = 1.8; 95% CI: 1.8 to 2.0). Conclusion. NAFLD is more likely to affect women more than men, in particular, among the population 56-60 years of age, which is the post-menopausal transitional period. Therefore, post-menopausal women should be the target for interventions or further investigation for NAFLD.

Background. Nonalcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease. A large number of studies have strongly described larger proportions of men being afflicted with NAFLD than women; however, recent studies investigating the role of gender and NAFLD have exposed the contrary. Methods. This cross-sectional study utilized data from the baseline survey of an ongoing cohort study called the Cholangiocarcinoma Screening and Care Program (CASCAP), conducted in the northeastern region of Thailand between March 2013 and September 2015. Information regarding socio-demographic, including gender, was collected using a standardized self-administered questionnaire. NAFLD was diagnosed with ultrasonography by board-certified radiologists. A binomial regression was used for estimating the prevalence differences, odds ratios (OR) and the 95% confidence intervals (CI) of NAFLD between men and women. Results. A total of 34,709 participants (27,073 females and 7,636 males) were recruited. The prevalence of NAFLD in women was 22.9% (95% CI: 22.5 to 23.5), whereas it was only 18.3% (95% CI: 17.4 to 19.2) in men. After adjusting for age and presence of diabetes mellitus and other underlying diseases, the prevalence was significantly higher in women, with adjusted prevalence difference of 4.2% (95% CI: 3.2 to 5.2) and adjusted OR of 1.3 (95% CI: 1.2 to 1.4). Women had a higher prevalence of NAFLD than men in all age groups and the largest difference was found in those aged 56-60 years (prevalence = 27.4% versus 21.2%; adjusted prevalence difference = 9.4%; 95% CI: 7.9 to 10.9; adjusted OR = 1.8; 95% CI: 1.8 to 2.0). Conclusion. NAFLD is more likely to affect women more than men, in particular, among the population 56-60 years of age, which is the post-menopausal transitional period. Therefore, post-menopausal women should be the target for interventions or further investigation for NAFLD.

Background: Cholangiocarcinoma (CCA) survivors continue to face challenges that affect their health-related quality of life (HRQOL) along the survivorship trajectory. Objective: This study intends to investigate the association and to create a model for explaining the link between unmet needs, physical symptoms, psychological well-being, and HRQOL in CCA survivors. Method: This cross-sectional study consecutively recruited 231CCA survivors from an oncology unit of a university hospital in Khon Kaen, Thailand. Cancer-related unmet need, physical symptoms, psychological well-being and HRQOL were all assessed using the questionnaire, and medical records were used to acquire demographic and clinical data. We use a path analysis to create a hypothesized model in which symptoms, unmet need, anxiety, and depression, support care need predicting HRQOL. Results: The mean total of HRQOL score was 75.59±6.24 (95%CI: 74.78-76.39) indicated that the subjects had a low level of HRQOL as a whole. The hypothesis model was found to fit the actual data and explained 39.8% of the variance of HRQOL. Symptoms and anxiety had a significant negative effect on HRQOL (β = -0.62, p< 0.001) and (β=-0.18, p<0.001), respectively. However, the relationship between HRQOL and other mediators was not found significant association. Conclusion: According to our findings, the research model can be used to investigate how symptoms affect HRQOL. It also means that cancer care providers should be aware of these factors while caring for CCA survivors in order to enhance their HRQOL.

Background: Unmet needs of cancer patients and caregivers are also closely linked with patients and their family well-being. Identifying and focusing on caregivers’ unmet need have been recommended to reduce their burden and improve their quality of life (QOL). This study aimed to evaluate the psychometric properties of the Thai version of Supportive Care Needs Survey for Partners and Caregivers (T-SCNS-P&C) among Cholangiocarcinoma (CCA) caregivers. Methods: The T-SCNS-P&C was developed using standardized translation methodology. A total of 231 CCA caregivers completed the T- SCNS-P&C. The internal consistency of the scale was examined with Cronbach’s alpha. Construct validity was analyzed using Pearson correlations coefficient with the physical effects, stage, anxiety and depression, age, and education level. To assess the factorial validity of the T-SCNS-P&C, confirmatory factor analysis (CFA) was performed. Results: The T- SCNS-P&C indicated good readability and high content validity for use as an assessment tool among Thai CCA caregivers. All Cronbach’s α coefficients were above the minimum acceptable criterion of ≥0.70. For construct validity, higher physical effect scores and higher anxiety and depression scores, as well as poorer QOL scores and younger caregivers, were significantly positively associated with higher levels of unmet needs. CFA indicated that the four factor structure of the T-SCNS-P&C was a good fit to the data. Conclusion: The T-SCNS-P&C demonstrated acceptable reliability and validity for assessing unmet needs among CCA caregivers in Thailand. Using this simple assessment to target the individual needs of these caregivers can help healthcare professionals providing effective personalized care.

The Thai version of the 12-item Zarit Burden Interview (ZBI) is valid for measuring caregiver burden in psychiatric caregivers. Nevertheless, it has not been verified in a larger palliative care (PC) context. The aim of this study was to validate the 12-item ZBI in PC among caregivers of palliative care patients. A methodological study examining the validity of the 12-item ZBI was carried out with informal caregivers of palliative care patients of two district health service networks. The data were gathered using self-administered questionaries, and then all participants were randomly split into two sub-samples for exploratory factor analysis (EFA) (n = 150) and confirmatory factor analysis (CFA) (n = 155). After utilizing statistical approaches for reducing items, EFA was used with group 1 to analyze the factor structure of the 12-item ZBI. Finally, CFA was employed with group 2 to confirm the amended structure indicated by the EFA and to evaluate the construct validity of the 12-item ZBI. A total of 305 palliative caregivers were enrolled. The principal component analysis of the 12 items yielded a loading based on a two-factor model of personal strain and role strain accounting for 61.4% of the variance. Cronbach’s alpha (0.83) and item-total correlations (rho = 0.38–0.70) showed that the 12-item Zarit had acceptable reliability. For convergent validity, the average variance extracted (AVE) values revealed that all 12-item ZBI subscales had a convergence effect, with AVEs ranging from 0.50–0.53. Additionally, this tool had a significant positive correlation with depressive symptoms (r = 0.48), anxiety (r = 0.38), and stress (r = 0.56). The 12-item ZBI is a brief, precise, and valid instrument for assessing burden among Thai palliative caregivers. We discovered high evidence of reliability in this sample, along with convergent and construct validity. Likewise, EFA revealed that the 12-item ZBI was a two-dimensional scale. Thus, health care practitioners may utilize the ZBI in research and clinical settings to determine burden in palliative caregivers.