Feeding and eating disorders among hospitalized children and adolescents in Thailand: A 5-year secondary national database analysis

AIMS

This study aimed to present national data for children and adolescents requiring hospitalization in Thailand.

BACKGROUND

Feeding and eating disorders can cause life-threatening and negative health impacts. In Asia, the prevalence is rising. Data from children and adolescents in Thailand are limited.

DESIGN

This study is a retrospective study of the national database.

METHODS

Data from the National Health Security Office database on Universal Health Insurance Coverage (2015-2019) of 0-17-year-olds were analysed by diagnosis (anorexia nervosa, bulimia nervosa, vomiting associated with psychological disturbances, other eating disorders and unspecified eating disorders). Descriptive statistics, chi-square test and multinomial logistic regression were used.

RESULTS

There were 163 patients, averaging 9.4 ± 5.2 years old, requiring 205 admissions. Most diagnoses showed stable trends, except for a slight decrease in anorexia and unspecified eating disorders. Most admissions were due to unspecified eating disorders and psychogenic vomiting, followed by anorexia nervosa. The overall prevalence was 3.86 per 100 000 admissions. Anorexia had the highest hospital costs and re-admission rates. Anorexia nervosa was most prevalent in early adolescence and females, while bulimia nervosa was most prominent in middle adolescence and had a male predominance.

CONCLUSION

Early recognition in clinical practice could increase early detection and improve outcomes.

Sleep, social media use and mental health in female adolescents aged 12 to 18 years old during the COVID-19 pandemic

BACKGROUND

Adolescents with high social media (SM) use experienced poor sleep quality and high anxiety and depression levels. The study aimed to investigate the characteristics of sleep, use of SM, mental health in female aged 12 to 18 years old, and to assess the association between poor sleep, SM usage, and mental health.

METHODS

In total, 219 Thai female adolescents were recruited between December 2019 and September 2020 and completed self-administrative questionnaires three periods of time (baseline, 3 months and 6 months later). The questionnaires included: the Pittsburgh Sleep Quality Index (PSQI), depression screening (PHQ-9), Screen for Child Anxiety Related Emotional Disorders (SCARED). Demographic and use of social media data were also included. Cochran's Q test, correlation coefficient, and binary logistic regression were performed.

RESULTS

Participants' mean age was 14.52 (range 12-17) years. Average Thai-PSQI global scores did not differ during 3 periods (p = 0.13) but average time of sleep latency, sleep duration, and SM usage were significant different (p = 0.002, p = 0.001, and p = < 0.001, respectively). There were positive correlations between PSQI scores and total SM usage at baseline (r = 0.14; P < 0.05) and 6 months (r = 0.20; P < 0.05). Anxiety, depression, and self-perception of poor sleep were significantly related to poor sleep quality during the 3 periods. After adjusting for confounding factors, depression and self-reported poor sleep were the only significant factors predicting poor sleep quality.

CONCLUSIONS

Poor sleep was associated with SM usage, depression, and anxiety in this population. Time-limited SM usage should be implemented for Thai female adolescents to improve sleep-related outcomes.

Five-Year Trend of Adolescent Hospitalizations and Deaths in Thailand: A Secondary National Data Health Situation Analysis

Adolescence is a critical phase for achieving human potential, serving as the foundation for later health. In 2010, the major causes of hospital admissions and deaths in Thai adolescents were related to preventable causes, specifically engagement in high-risk behaviors such as unprotected sexual intercourse, substance use and unsafe driving. We retrieved data from 1,761,667 adolescent (10-17 years) hospital admissions and 6362 deaths between 2015 and 2019 from the National Health Security Office database. Trends of hospital admissions and deaths, length of stay and medical expenses by sex, age: early (10-13 years) and middle adolescents (14-17 years), and geographical regions were analyzed by ICD-10 disease group and single diagnosis. Hospital admissions increased in relation to the same age population from 2015 to 2019. Trends of the top 3 diagnoses shifted between disease groups from 2015 to 2019. Pregnancy retreated from the first (17.8%) to the third rank (12.2%), and arthropod-borne viral fevers advanced from the third (13.1%) to the first rank (17.1%). Injury and poisoning remained at the second rank (14.5-14.4%). Females were admitted more than males, but males had significantly longer hospital stays. Early adolescents were admitted less than middle adolescents and their hospital stay was significantly shorter. Trends of the top 3 diagnoses for deaths by disease groups remained stable: injury and poisoning (41.2%), neoplasms (10.2%), and respiratory infections (9.5%). The average direct health care cost utilized on adolescent health care was 3813 million Baht (115.54 million US Dollars) per year. Considering the top 3 disease groups, injury and poisoning had the highest average cost per hospital admission and net cost per year consuming 26.4% of the total cost. Our study highlights the cause of hospital admissions and deaths in Thai adolescents, which are mainly preventable. Adolescent health care will improve with more investment in prevention through policy, service, and education reform.

Cyberbullying Among Adolescents with Chronic Illnesses in Thailand: Prevalence and Relationship with Health-Risk Behaviors

BACKGROUND

The use of social media may enhance the quality of life in adolescents living with chronic illnesses but may increase the risk of cyberbullying.

OBJECTIVE

The aim of this study was to estimate the prevalence of cyberbullying among adolescents with chronic illnesses and relationship with health-risk behaviors.

METHODS

This is an online survey of randomly recruited adolescents aged 11 to 18 years with chronic illness managed at Siriraj Hospital, Thailand, during 2019 to 2020. Participants were asked to respond anonymously to validated online questionnaires to evaluate health-risk behaviors, experience with cyberbullying, and depression-screening questions.

RESULTS

Three hundred forty-one participants with a mean age of 15.02 ± 2.17 years (interquartile range 12.8, 17.2) responded. Reported risk behaviors included sexual activity in 42 participants (12.3%) with almost half (47.6%) having practiced unsafe sex. Alcohol drinking and polysubstance use were also found in 8.5% and 1.2%, respectively. 38 (11.1%) felt depressed within the previous 2-week period. 56 (16.4%) had been a cyberbully victim. Among the victims, 25 (44.6%) were also cyberbullies themselves. Chronically ill adolescents were more likely to be a victim of cyberbullying if they knew someone who had also been a victim (adjusted odds ratio [aOR] 5.25 [95% confidence interval [CI] = 1.80-15.29], p < 0.001) or had a positive depression screening (aOR 6.182 [95% CI = 2.41-15.85], p < 0.001). Underlying diseases, age, sex, risky behaviors, and time spent online were not associated with being cyberbullied.

CONCLUSION

Thai adolescents with chronic illness were similar to their healthy peers regarding health-risk behaviors and the likelihood of being a victim of cyberbullying. Screening for risky behaviors, evidence of depression, and online activity during routine medical visits was an opportunity to prevent cyberbullying.

Comparison of factors associated with successful transition of care in patients with HIV versus other chronic diseases

BACKGROUND

Transfer of pediatric patients to adult care is an integral part of optimizing care of chronically ill patients and requires advanced infrastructure and availability of a multidisciplinary team. Thus, assessing factors associated with transition to adult care in this and the other chronic disease group will aid in the targeting intervention programs. The aim of the study was to compare factors associated with transitional readiness and health risk behaviors between adolescents with HIV infection and other chronic diseases.

METHODS

Participants ages 14 to 18 were recruited from chronic care clinics at Siriraj hospital between 2015 and 2016. Self-assessment questionnaires composed of health risk behaviors and a 25-item Likert Scale transition readiness questionnaire with possible scores ranging from 25 to 100 were administered. Analysis was done by SPSS 18.

RESULTS

There were 165 adolescents who participated in the study. Median age was 16 years (range, 14-18). The overall transitional readiness average score was 54.15 ± 8.4 which showed no difference between HIV group (HIVG) and other chronic illness group (non-HIVG). The subjects in the HIVG scored significantly higher in self-management skills (13.03 ± 2.1 vs.12.09 ± 2.8, p < 0.05) than their non-HIV counterparts. However, they scored lower in their perception of transition readiness than non-HIVG (13.6 ±2.1 vs. 14.85 ± 2.5, p < 0.05). Adolescents who were not HIV-infected were more likely to not want to attend school because of their illness (OR = 4.33, 95% CI = 0.97-19.24.) Conversely, HIV-infected adolescents were more likely to used social media (OR=10.2, 95% CI = 3.26-31.98), consume alcohol beverage (OR = 2.83, 95% CI =1.23-6.49), smoked cigarettes (OR = 4.17, 95% CI =1.31-13.26), and lack STD knowledge (OR = 3.63, 95% CI = 1.49-8.81) rather than non-HIV infected adolescents.

CONCLUSION

HIV-infected adolescents perceived their self-management skills to be higher than adolescent with other chronic diseases. However, HIV-infected adolescents still possess increased health risk behaviors. To effectively formulate transitional care practice in the Thai context, the program should be focused on health risk behaviors.

HEEADSSS up: pediatric residents' confidence and practice in adolescent health care before and after mandatory adolescent medicine rotations in Thailand

Background The field of adolescent medicine is an emerging area of specialization in Thailand. Adolescent medicine was made a mandatory rotation in general pediatric residency training programs for the class of 2013. Objective This study aims to explore the difference in pediatric residents' confidence and the frequency in providing aspects of care to adolescents. Subjects Participants included two groups of pediatric residents; the former curriculum group (FCG) in 2012 and the mandatory curriculum group (MCG) in 2015. Methods Participants in this cross-sectional study answered a 41-item self-administered questionnaire and results were analyzed by descriptive statistics. Results There were 91 participants, 50.05% were in the MCG. The FCG reported a higher percentage of feeling "more confident" on physical examination (p = 0.031, V = 0.23) and growth assessment (p = 0.040, V = 0.22). The MCG reported a higher percentage of "more frequently" carrying out the psychosocial assessment (p = 0.035, V = 0.22). Conclusion The FCG reported higher levels of confidence than the MCG in most of the items, while the MCG reported higher levels of frequency in providing care. The psychosocial (HEEADSSS) assessment, a key aspect of the adolescent clinical visit, was the item that the MCG reported doing more frequently than the FCG which remained significant when only the postgraduate year of training (PGY) 4s were compared.

Adolescent health in Asia: insights from Thailand

BACKGROUND

Adolescence in an age of opportunity in Thailand. The main health issues of this age group are related to pregnancy, injuries and poisoning, all which should be preventable.

OBJECTIVE AND METHODS

This article presents the experiences of Thai physicians, who received adolescent medicine fellowship training in North America and brought their experience, knowledge, skills, and adolescent health care principles and practice back to Thailand. The anticipations and the facts faced in everyday practice, training, research, and collaboration in a place with their own culture and societal norms are described.

RESULTS

Currently, there are six adolescent medicine specialists who work with experienced specialist in the subcommittee of adolescent health under the Royal College of Pediatricians of Thailand. There has been collaboration with both the public sector and health care sector, government and non-government organizations with regards to health care service and promotion. Many hospitals especially residency training institutes have increased the cut-off age of patients to be seen by pediatricians to 15 or 18 years of age. Since 2011, adolescent medicine was made one of the mandatory rotations in all pediatric resident training programs.

CONCLUSION

There is still more work to be done - issues around policies for confidentiality and a lower age of consent, collaboration between other specialties to enable a large-scale youth-friendly one-stop services, and multicenter research opportunities are still awaiting.

Psychosocial needs of perinatally HIV-infected youths in Thailand: lessons learnt from instructive counseling

Identifying psychosocial needs of perinatally HIV-infected (pHIV) youth is a key step in ensuring good mental health care. We report psychosocial needs of pHIV youth identified using the "Youth Counseling Needs Survey" (YCS) and during individual counseling (IC) sessions. pHIV youth receiving care at two tertiary-care hospitals in Bangkok or at an orphanage in Lopburi province were invited to participate IC sessions. The youths' psychosocial needs were assessed using instructive IC sessions in four main areas: general health, reproductive health, mood, and psychosocial concerns. Prior to the IC session youth were asked to complete the YCS in which their concerns in the four areas were investigated. Issues identified from the YCS and the IC sessions were compared. During October 2010-July 2011, 150 (68.2%) of 220 eligible youths participated in the IC sessions and completed the YCS. Median age was 14 (range 11-18) years and 92 (61.3%) were female. Mean duration of the IC sessions was 36.5 minutes. One-hundred and thirty (86.7%) youths reported having at least one psychosocial problem discovered by either the IC session or the YCS. The most common problems identified during the IC session were poor health attitude and self-care (48.0%), lack of life skills (44.0%), lack of communication skills (40.0%), poor antiretroviral (ARV) adherence (38.7%), and low self-value (34.7%). The most common problems identified by the YCS were lack of communication skills (21.3%), poor health attitude and self-care (14.0%), and poor ARV adherence (12.7%). Youth were less likely to report psychosocial problems in the YCS than in the IC session. Common psychosocial needs among HIV-infected youth were issues about life skills, communication skills, knowledge on self-care, ARV adherence, and self-value. YCS can identify pHIV youths' psychosocial needs but might underestimate issues. Regular IC sessions are useful to detect problems and provide opportunities for counseling.

Outcomes of a Comprehensive Youth Program for HIV-infected Adolescents in Thailand

We developed an intervention program for HIV-infected Thai adolescents with two group sessions and two individual sessions, focusing on four strategies: health knowledge, coping skills, sexual risk reduction, and life goals. An audio computer-assisted self-interview (ACASI) was administered to assess knowledge, attitudes, and practices (KAP) regarding antiretroviral therapy management, reproductive health, and HIV-associated risk behavior. The program was implemented in two HIV clinics; 165 (84%) adolescents (intervention group) participated in the program; 32 (16%) completed the ACASI without participating in the group or individual sessions (nonintervention group). The median age was 14 years, and 56% were female. Baseline KAP scores of the intervention and nonintervention groups were similar. Two months after the intervention, knowledge and attitude scores increased (p < .01) in the intervention group, and the increase was sustained at 6 months. KAP scores did not change from baseline in the nonintervention group at 6 or 12 months after enrollment.

Comparison between the Efficacy of Switch Therapy and Conventional Therapy in Pediatric Community-Acquired Pneumonia

OBJECTIVE

Compare the treatment outcomes ofswitch therapy and conventional therapy inpediatricpatients aged one month to five years old, diagnosed with community-acquired pneumonia who required hospitalization.

MATERIAL AND METHOD

The present study was performed and approved by the Siriraj Research Ethics Committee. With informed consent, 57 patients whofitted the inclusion criteria were randomized into two groups, 1) the switch therapy group (SWT), who switched their method of receiving antibiotics from IV to oral within 24 hours after clinical improvement and body temperature under 37.8 °C at least eight hours, and 2) the control group, the group treated as routine general practice. Chi-square tests, Fisher's exact tests, unpaired t-tests, and Mann-Whitney U tests were used in analysis. A non-inferiority analysis to estimate 1-sided 95% CIs was performed to determine the greatest difference (worst case) between groups.

RESULTS

There were no significant differences in age, sex, clinical presentations, and antibiotics provided between the two groups. A statistically significant reduction in length of hospital stay was found in the SWT group (P = 0.019), whereas the readmission rate for both groups was not significantly different (p = 0.66). Morbidity and mortality were not found in either groups. The SWT group demonstrated non-inferior efficacy comparing to control group (difference 20%; p<0. 001).

CONCLUSION

In pediatric community-acquired pneumonia, early switching from administer IVantimicrobial agents to oral form when clinical signs improved were safe and effective. Switch therapy showed non-inferiority outcomes compared to conventional therapy, and had advantages in shortening the length ofstay and indirectly lowering the cost of hospitalization.

Missed appointment in adolescent clinic; perspective from tertiary care hospital, Thailand

OBJECTIVE

To determine the missed appointment rate and evaluate the factors related to appointment adherence in adolescent patients, based on the patients' characters and services provided.

MATERIAL AND METHOD

All medical records in adolescent clinic at Siriraj Hospital between 2004 and 2009 were reviewed Patients that visited the clinic at least twice with the follow-up visit order were recruited. Data analyses were performed by Chi-square test and Fisher's exact test wherever appropriated.

RESULTS

One hundred twenty six patients met the inclusion criteria. Patients'mean age were 14.3-year-old (SD = 2.7) and the majority (95%) were students. Seventy one point five percent of principle diagnosis related to behavioral problems while 90% had at least one risky behavior detected Comparing between missed and non-missed appointment, only the acute illness and the history of appointment cancellation were significant different characters between groups (p < 0.001). Of 429 visits, 409 (95.3%) got telephone reminder a few days prior the appointment date, 48 (11.2%) remained non-complying and 40 (9.7%) had rescheduled. Only 18 (4.2%) of the visits were the patients themselves made re-appointments, which all complied with the new visit. Having rescheduled after being reminded and having history of a missed previous appointment were the most significant predictors for next appointment adherence (p = 0. 01 and p = 0.02 respectively).

CONCLUSION

In adolescents, appointment non-compliance is a challenging issue for clinicians. Predicting factors found in this study might help foster appointment adherence. Interestingly, services provided such as telephone reminder short waiting time, appointment time did not influence adherence in this population.

Stimulant methamphetamine and dextromethorphan use among Thai adolescents: implications for health of women and children

For over a decade, amphetamine-type stimulants have made their way into the adolescent culture of Thailand. Coupled with the more recent emergence of the legal, over-the-counter cough medicine dextromethorphan (DM), they represent the most commonly abused substances among Thai youths today. Methamphetamine is the second most popular drug of abuse in Thailand, the first being cannabis. It is available in the crystalline version, ICE, and the less pure methamphetamine tablets. The tablets are frequently crushed and smoked. Its use has gained enormous popularity among teenagers and young adults, including women of child-bearing age. As such, it has become the most common drug being detected in the urine of peripartum women, resulting in peripartum and postpartum complications for both mother and child. DM is a newer drug which has gained popularity among middle school and high school students due to its easy availability as a single product over the counter. It is usually taken with soft drinks at parties and gathering. It is metabolized by CYP4502D6 to dextrorphan, the substance responsible for the feeling of euphoria. Consequently, those who are poor metabolizers often experience the "negative" effects associated with the drug. The recreational use of methamphetamine and dextromethorphan in teenagers and young adults in Thailand is a serious problem. Recognizing not only the toxicological but also the emotional and psychosocial impacts of these drugs on Thai youth is an integral part of approaching the problem.

Weight change associated with corticosteroid therapy in adolescents with systemic lupus erythematosus

Physical appearance is very important to adolescents and weight gain secondary to corticosteroid (CS) treatment may have a direct impact on adolescent development. Understanding weight gain in adolescents with SLE who are being treated with CS will help clinicians develop strategies for prevention of nonadherence, obesity and eating disorders in this population.

Methods:

Patients aged 11–18 years old with newly diagnosed SLE between January,1995 and December, 2006 were identified through the Rheumatology database at the Sickkids hospital, Canada. All charts were reviewed. Patients were categorized based on final BMI status as normal, overweight and obese. Risk factors for being obese were examined by logistic regression model analysis.

Results:

Of 236 patients, 78% fulfilled the criteria. 85% were female with mean age at onset of diagnosis was 14 ± 1.7 years. Mean duration of CS treatment was 50 ± 31 months and mean cumulative CS dosage was 34.11 ± 32.7 g of prednisone. At baseline, 10% had BMI >25 kg/m2 while at the end of the study, 20% were overweight and 10.4% were obese. In addition, 61% gained <10 kg while 15% gained ≥20 kg. Initial BMI was a significant predictors for final BMI (OR = 27.59, 95%CI = 6.04–126.09, p < .001) while male (OR = 8.50, 95%CI = 2.95–24.5, p < 0.000) and cumulative CS dosage (OR = 1.53, 95%CI = 1.05–2.23, p < .05) were the significant predictors for weight gain >10 kg. Duration of CS treatment did not correlate with obesity.

Conclusion:

Although a significant number of patients became overweight or obese after being treated with CS, most gained <10 kg. Obesity secondary to CS treatment in SLE patients was significantly correlated with baseline BMI, gender and cumulative CS dosage.

Promoting factors for transition readiness of adolescent chronic illnesses: experiences in Thailand

OBJECTIVE

Health care transition, a unique process of providing continuity of care from pediatrics to adult care system, has succeeded in some countries, particularly in the developed world. In Thailand, transition readiness has been in the forefront to improve health care system. The present study aimed to determine the factors correlated to transition readiness in chronically ill adolescents.

MATERIAL AND METHOD

Participants aged 14 to 20 years old having varieties of chronic illness, from randomized hospitals in the upper southern part of Thailand, were voluntarily interviewed and completed validated self-administered questionnaires related to studied factors.

RESULTS

Transition readiness had statistical significant positive correlation with self-esteem and psychosocial support (r = 0. 38, p < 0.01, r = 0.39, p < 0.01, respectively), while anxiety showed strongly negative correlation (r = -0.25, p < 0.05).

CONCLUSION

To improve the health care transition system in Thailand, clinicians should focus on the process of preparing the patients. Building patients 'self-esteem and providing rich psychosocial rapport as well as training stress management to the adolescent patients is an essential task that builds from the routine education on disease knowledge.

A comparison of body-image perception, health outlook and eating behavior in mildly obese versus moderately-to-severely obese adolescents

BACKGROUND

Adolescent obesity is rapidly becoming a majorpubic health concern in Thailand. Factors that contribute to adolescent obesity are increasingly sedentary behaviors, changes in eating habits and physical activity Body-image perception and peer influence are substantial for adolescents. As a result, knowing the obesity-relatedpsychological impacts in adolescent will be the great benefit for health care providers in taking care of obese adolescents.

OBJECTIVE

The purpose of this study was to investigate the impact ofobesity has on the behaviors and attitudes regarding self-perception, health outlook, and eating behavior in the mildly obese and the moderately-to-severely obese Thai adolescents.

MATERIAL AND METHOD

Participants were obese students who were being followed at the school-based Teen Health Clinic on a regular basis. All participants were followed regularly at their respective school-based Teen Health Clinics. Each participant s percent weight for height was calculated by using Thai National Growth charts. Participants were categorized into 2 groups according to the percent weight for height (% WFH). Those with% WFH below 120% was considered not obese and excluded from the study. The two participating groups were% WFH of 120-140% who are mildly obese (M-O group) and % WFH of greater than 140% who are moderately-severely obese (M-S-O group). A 3-part questionnaire was used to assess the impact of obesity on emotional and psychosocial aspects of each participant, their eating and nutritional attitude and their level of physical activity.

RESULTS

Of the 5366 students, grade 7-12 who attended 2 metropolitan Bangkok schools, 678 were diagnosed as overweight or obese. There were 175 obese students who attended the clinic regularly were asked to participate in this study and there were 167 adolescents who completed the questionnaires recruited for this study. Both the M-O and M-S-O groups reported dissatisfaction with their body weight (85.9% and 91.7% respectively) and perceived their need for weight reduction. The M-S-O groups expressed more concerns to lose their weight for medical reasons than the M-O group (52.1% vs. 35.2%, p-value < 0.03). Being obese was shown to have more significant impact to their confidence in M-S-O group than the M-O group (71.9% vs. 50.7%, p < 0.005). The students in M-O group eat lunch regularly otherwise M-S-O group, few of them, skips lunch meal (100% vs. 93.8%, p < 0.032).

CONCLUSION

From our study, significant obese adolescents were shown to have poorer self-image with greater prevalence being shown in the significantly obese group.

Dextromethorphan abuse in Thai adolescents: A report of two cases and review of literature

INTRODUCTION

Dextromethorphan is an opiod-derived, easily available cough remedy that, when used in large quantities, can have stimulatory effects which mimic that of amphetamine and other psychedelic drugs. Due to its easy availability, dextromethorphan is gaining widespread popularity as a recreational drug among Thai youths. Symptoms of overdose are directly related to its pharmacodynamic and pharmacokinetic properties. Dextromethorphan is metabolized by cytochrome p450 2D6, an isoenzyme that exhibit polymorphism in Asians. The drug is also a serotonin-reuptake inhibitor and has significant interactions with other drugs that exert their effects through the serotonin pathway such as the amphetamines, cocaine, and Lysergic Acid (LSD).

CASE REPORT

We report here two cases of dextromethorphan overdose that presented to the Pediatric Toxicology Service at Siriraj Hospital, Bangkok, Thailand. Both cases presented with hyper-agitation, confusion, with signs of sympathomimetic overdose. Both patients were treated with supportive care and fully recovered within 24 hours without sequalae.

CONCLUSION

Although the acute toxicity of dextromethorphan is abated within 24 hours, its pharmacological properties still render it a dangerous drug to use alone or in combination with other drugs.