Background: Hip fracture incidence has risen significantly with population aging. Postoperative rehabilitation plays an important role in patient recovery. Home-based rehabilitation promotes continuous care. However, evidence of clinical outcomes and cost-effectiveness is needed. Objectives: To investigate the clinical effectiveness and cost-effectiveness of home-based rehabilitation compared with facility-based rehabilitation as the usual rehabilitation scheme after hip fracture surgery. Materials and methods: This study was a quasi-experimental design with cost-effectiveness analysis. One hundred and four participants were recruited (52 participants per arm). Both groups received interventions for 8 weeks, either at the patient’s home or at the hospital. Outcome variables included physical performance, ability to perform daily activities, fall efficacy, and quality of life. These outcomes were evaluated at baseline, postintervention, and at the 6-month follow-up. Moreover, we performed a cost-effectiveness analysis after the 6-month follow-up period. Results: The outcome variables would be evaluated and compared between groups and time points at baseline, after the 8-week intervention, and at the 6-month follow-up. The changes in clinical outcomes would be examined and reported for both between- and within-group comparisons. The cost-effectiveness at the 6-month follow-up would be specified as the incremental cost-effectiveness ratio (ICER), while also considering parameter uncertainty. Conclusion: Home-based rehabilitation following hip fracture surgery was expected to enhance functional recovery, quality of life, and cost-effectiveness. Moreover, this intervention could help solve patients’ problems related to accessibility and continuing care.
Background: Antiretroviral therapy (ART) effectively suppresses HIV replication and reduces HIV-related morbidity and mortality; however, HIV drug resistance (HIVDR) remains a major challenge to long-term treatment success. Objectives: This study investigated the prevalence of HIVDR, resistance-associated mutations (RAMs), antiretroviral susceptibility profiles, and factors associated with HIVDR among HIV-infected patients receiving ART at Queen Savang Vadhana Memorial Hospital, Thailand. Materials and methods: A retrospective study was conducted among 261 HIV-infected patients with HIV RNA levels >1,000 copies/mL who underwent HIVDR testing between January 2020 and December 2024. Drug resistance was determined using next-generation sequencing (NGS)-based assay simultaneously analyzes the protease (codons 1-99), reverse transcriptase (codons 1-376), and integrase (codons 1-288) regions of the HIV-1 pol gene. Variant-calling thresholds were 20% was applied to samples with HIV RNA ≥1,000 copies/mL, 5% was used for samples with HIV RNA ≥15,000 copies/mL, and resistance interpreted using the Stanford HIV Drug Resistance Database (HIVdb version 9.4). Results: Among 261 patients, 169 (64.8%) harbored genotypic drug resistance mutations. CRF01_AE was the predominant HIV-1 subtype (93.1%). Dual resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) was the most common resistance pattern (49.7%), followed by NNRTI-only resistance (24.3%). NNRTI resistance was the most prevalent resistance class (85.8%), followed by NRTI (65.1%), protease inhibitor (PI) (17.8%), and integrase strand transfer inhibitor (INSTI) resistance (4.1%). M184V and K103N were the most frequently detected NRTI- and NNRTI-associated mutations, respectively. Resistance to nevirapine, efavirenz, and abacavir was common, whereas susceptibility to darunavir/ritonavir, dolutegravir, and bictegravir remained high. Patients with CD4 counts <100 cells/μL and ART duration of 5-10 years were more likely to harbor drug resistant HIV strains, whereas second-line ART was associated with lower odds of HIVDR. Conclusion: Combined NRTI-NNRTI resistance remained the predominant HIVDR pattern during 2020-2024. Although INSTI-associated resistance emerged following the implementation of INSTI-based therapy in Thailand, its prevalence remained low, supporting the continued effectiveness of dolutegravir-based regimens. Continuous HIVDR surveillance remains essential to optimize long-term treatment outcomes.
Background: The hemoglobin E (Hb E) trait, which is highly prevalent in Southeast Asia and may co-occur with α-thalassemia, often exhibits heterogeneous complete blood count profiles; notably, some individuals with the Hb E trait have near-normal MCV and MCH values, increasing the risk of misclassification during routine hematological screening. Objective: This study aimed to develop and externally validate an interpretable machine-learning model to screen for Hb E trait using routine Complete Blood Count (CBC) data. Materials and methods: We analyzed 5,787 standardized CBC records using two processing pipelines: a standard dataset and an SMOTE-NC oversampled dataset. We selected features using ReliefF and evaluated nine machinelearning algorithms. We interpreted the optimal model using SHAP values and validated it on an independent external cohort (n=625). Results: Discrimination for Hb E trait was moderate-to-good and consistent between internal and external evaluation. Erythrocyte indices-Z-MCV, Z-MCH, and Z-RBC-were the most discriminative features. Among nine algorithms, a support vector machine gave the best combination of sensitivity and discrimination (internal AUC 0.881, sensitivity 70.66%, specificity 87.92%; external AUC 0.879, sensitivity 72.38%, specificity 87.39%). With the decision threshold tuned for screening, external sensitivity rose to approximately 91% with negative predictive value above 94%. SHAP analysis confirmed the model’s reliance on biologically plausible drivers (low MCV/MCH with a relatively preserved RBC count). Conclusion: An explainable machine-learning model utilizing routine CBC parameters offers a viable, low-cost pre-screening tool for Hb E trait. Internal and external performance are concordant, and with local calibration and threshold tuning, the model triages patients for confirmatory testing and definitive genotyping rather than replacing them, supporting optimized diagnostic workflows in endemic regions.
Background: The difficulty of alcohol abstinence and recovery from unhealthy living patterns is influenced by individual context. There is still limited evidence to reveal concepts and processes of sustained alcohol abstinence in people with experienced alcohol use disorder, including Northeastern Thais. Objectives: This study aimed to develop a conceptual model explaining how Thais with alcohol use disorder in the northeastern region sustain their alcohol abstinence. Materials and methods: Charmaz’s constructivist grounded theory guided the development of a conceptual model. Data collection was done in Khon Kaen, Thailand. Fourteen participants who had sustained alcohol abstinence for at least one year voluntarily participated in semi-structured, in-depth interviews between December 2024 and December 2025. Constant comparative analysis was used on 27 transcripts, 23 observation notes, and memos. Co-researchers rechecked and agreed on the substantive model, and two participants confirmed their data in the model to strengthen trustworthiness. Results: The conceptual model of a healthy pattern promoting alcohol abstinence was developed with four themes interlinking sequentially: acceptance of alcohol addiction, anchoring a better life’s goal, shifting identity formation, and self-determination on a health pattern. The first two concepts indicated initial awareness of the negative impacts of alcohol addiction, then the others emphasized maintaining the determination of a healthy routine without alcohol. Conclusion: All concepts emerged from the first-hand experiences of alcohol abstinence, guided the development of a health pattern promoting sustained abstinence related to the context, and provided ideas for the healthcare providers in further development of a supportive clinical program to prevent addictive relapse.
Background: Basketball is a high-intensity intermittent sport that requires both aerobic and anaerobic energy systems. Physical demands vary across playing positions; however, evidence in adolescent players remains limited. Objectives: To compare aerobic and anaerobic capacities across different playing positions in basketball players aged 13-16 years Materials and methods: This cross-sectional study included 60 adolescent basketball players in Chiang Mai Province. Participants were categorized into five positional roles: point guard, shooting guard, small forward, power forward, and center. Aerobic capacity was assessed using estimated maximal oxygen consumption (VO₂max) from the 20-meter shuttle run test, while anaerobic capacity was evaluated using fatigue index (FI). The body composition variables were recorded, including body mass index, body fat percentage, and muscle mass percentage. Differences among groups were analyzed using one-way ANOVA with Bonferroni post hoc analysis. Results: No significant differences in anaerobic capacity (FI) were found among the five positions (p>0.05). In contrast, aerobic capacity (VO₂max) differed significantly between positions (p<0.05), with point guards demonstrating significantly higher VO₂max compared to centers. Other positional comparisons were not statistically significant. Conclusion: Aerobic capacity differed only between point guards and centers, with point guards demonstrating higher estimated VO₂max than centers, whereas anaerobic capacity appeared comparable across playing positions. These findings suggest that playing position may be associated with differences in aerobic performance and should be considered when designing training programs for adolescent basketball players.
