Medicine and Health Sciences Commons^™

PortugalʼS Response To Covid-19, Ana Santos Rutschman

All Faculty Scholarship

This essay for the Regulatory Review's special series on Comparing Nations’ Responses to COVID-19 examines the early response to the pandemic in Portugal. The essay focuses on measures adopted in connection with the declarations of state of emergency and state of calamity, as well as the treatment of migrant populations throughout the pandemic.

Mapping Misinformation In The Coronavirus Outbreak, Ana Santos Rutschman

All Faculty Scholarship

The coronavirus outbreak has sent ripples of fear and confusion across the world. These sentiments—and our collective responses to the outbreak—are made worse by rampant misinformation surrounding the new strain of the virus, COVID-2019. In this post, I survey some of the most pervasive areas of tentacular coronavirus-related misinformation that has proliferated online -- as well as the responses of social media companies like YouTube, Facebook, Pinterest and TikTok that may ultimately prove inadequate given the magnitude of the problem.

The Reemergence Of Vaccine Nationalism, Ana Santos Rutschman

All Faculty Scholarship

This short essay explores the reemergence of vaccine nationalism during the COVID-19 pandemic. The essay traces the pre-COVID origins of vaccine nationalism and explains how it can have detrimental effects on equitable access to newly developed vaccines.

Substance Use Disorder, Discrimination, And The Cares Act: Using Disability Law To Strengthen New Protections, Kelly K. Dineen, Elizabeth Pendo

All Faculty Scholarship

The COVID-19 pandemic is having devastating consequences for people with substance use disorders (SUD). SUD is a chronic health condition—like people with other chronic health conditions, people with SUD experience periods of remission and periods of exacerbation and relapse. Unlike people with most other chronic conditions, people with SUD who experience a relapse may face criminal charges and incarceration. They are chronically disadvantaged by pervasive social stigma, discrimination, and structural inequities. People with SUD are also at higher risk for both contracting the SARS-CoV-19 virus and experiencing poorer outcomes. Meanwhile, there are early indications that pandemic conditions have led to …

Protecting The Rights Of People With Disabilities, Elizabeth Pendo

All Faculty Scholarship

One in four Americans — a diverse group of 61 million people — experience some form of disability (Okoro, 2018). On average, people with disabilities experience significant disparities in education, employment, poverty, access to health care, food security, housing, transportation, and exposure to crime and domestic violence (Pendo & Iezzoni, 2019). Intersections with demographic characteristics such as race, ethnicity, gender, and LGBT status, may intensify certain inequities. For example, women with disability experience greater disparities in income, education, and employment (Nosek, 2016), and members of under-served racial and ethnic groups with disabilities experience greater disparities in health status and access …

Medicaid's Vital Role In Addressing Health And Economic Emergencies, Nicole Huberfeld, Sidney Watson

All Faculty Scholarship

Medicaid plays an essential role in helping states respond to crises. Medicaid guarantees federal matching funds to states, which helps with unanticipated costs associated with public health emergencies, like COVID-19, and increases in enrollment that inevitably occur during times of economic downturn. Medicaid’s joint federal/state structure, called cooperative federalism, gives states significant flexibility within federal rules that allows states to streamline eligibility and expand benefits, which is especially important during emergencies. Federal emergency declarations give the secretary of Health and Human Services temporary authority to exercise regulatory flexibility to ensure that sufficient health care is available to meet the needs …

Vaccine Hesitancy: Experimentalism As Regulatory Opportunity, Ana Santos Rutschman, Timothy L. Wiemken

All Faculty Scholarship

This symposium on patient innovation has prompted us to explore problems related to departures from official vaccination schedules. At a time in which vaccine confidence has been plummeting across the world, we argue that a more granular understanding—and ultimately a more finely tuned regulatory framework—is needed to reflect the current behavioral heterogeneity among indicated patients who choose to forego or delay administration of recommended vaccines. In particular, we focus on a phenomenon we term “vaccine staggering:” a departure from vaccination schedules in the form of delays in receiving one or more vaccines, which is motivated by the desire to boost …

Center For Progressive Reform Report: Protecting Workers In A Pandemic--What The Federal Government Should Be Doing, Thomas Mcgarity, Michael C. Duff, Sidney A. Shapiro

All Faculty Scholarship

The "re-opening" of the American economy while the coronavirus that causes COVID-19 is still circulating puts workers at heightened risk of contracting the deadly virus. In some blue-collar industries, the risk is particularly acute because of the inherent nature of the work itself and of the workplaces in which it is conducted. And the risk, for a variety of reasons, falls disproportionately on people of color and low-income workers. With governors stay-at-home orders and other pandemic safety restrictions, Center for Progressive Reform Member Scholars Thomas McGarity, Michael Duff, and Sidney Shapiro examine the federal government's many missed opportunities to stem …

Diploma Privilege And The Constitution, Claudia Angelos, Sara Berman, Mary Lu Bilek, Carol L. Chomsky, Andrea Anne Curcio, Marsha Griggs, Joan W. Howarth, Eileen R. Kaufman, Deborah Jones Merritt, Patricia Salkin, Judith W. Wegner

All Faculty Scholarship

The COVID-19 pandemic and resulting shutdowns are affecting every aspect of society. The legal profession and the justice system have been profoundly disrupted at precisely the time when there is an unprecedented need for legal services to deal with a host of legal issues generated by the pandemic, including disaster relief, health law, insurance, labor law, criminal justice, domestic violence, and civil rights. The need for lawyers to address these issues is great but the prospect of licensing new lawyers is challenging due to the serious health consequences of administering the bar examination during the pandemic.

State Supreme Courts are …

Boron Trifluoride Etherate Promoted Microwave Assisted Synthesis Of Antimalarial Acridones, Papireddy Kancharla, Rozalia A. Dodean, Yuexin Li, Jane X. Kelly

Chemistry Faculty Publications and Presentations

A microwave-assisted, rapid and efficient method using boron trifluoride etherate (BF3.Et2O) for the synthesis of acridones, via an intramolecular acylation of N-phenylanthranilic acid derivatives, has been developed. The reaction proceeds under solvent-free conditions, tolerates a wide range of functional groups, and provides rapid access to a range of acridones in good to excellent yields. Several of the synthesized acridones exhibited potent antimalarial activities against CQ sensitive and multi-drug resistant (MDR) parasites.

Synthesis Of Radioluminescent Caf2:Ln Core, Mesoporous Silica Shell Nanoparticles For Use In X-Ray Based Theranostics, Hayden Winter, Megan J. Neufeld, Lydia Makotamo, Conroy Sun, Andrea M. Goforth

Chemistry Faculty Publications and Presentations

X-ray radiotherapy is a common method of treating cancerous tumors or other malignant lesions. The side effects of this treatment, however, can be deleterious to patient quality of life if critical tissues are affected. To potentially lower the effective doses of radiation and negative side-effects, new classes of nanoparticles are being developed to enhance reactive oxygen species production during irradiation. This report presents the synthesis and radiotherapeutic efficacy evaluation of a new nanoparticle formulation designed for this purpose, composed of a CaF₂ core, mesoporous silica shell, and polyethylene glycol coating. The construct was additionally doped with Tb and Eu …

'Terroristic Threats' And Covid-19: A Guide For The Perplexed, Chad Flanders, Courtney Federico, Eric Harmon, Lucas Klein

All Faculty Scholarship

The first few months of the COVID-19 outbreak in the United States saw the rise of a troubling sort of behavior: people would cough or spit on people or otherwise threaten to spread the COVID-19 virus, resulting in panic and sometimes thousands of dollars’ worth of damages to businesses. Those who have been caught doing this — or have filmed themselves doing it — have been charged under so-called “terroristic threat” statutes. But what is a terroristic threat, and is it an appropriate charge in these cases? Surprisingly little has been written about these statutes given their long history and …

Covid-19 And The Conundrum Of Mask Requirements, Robert Gatter, Seema Mohapatra

All Faculty Scholarship

As states begin to loosen their COVID-19 restrictions, public debate is underway about what public health measures are appropriate. Many states have some form of mask-wearing orders to prevent the spread of COVID-19 infection. Public health guidance from the Centers for Disease Control and Prevention and the World Health Organization has conflicted. From a public health point of view, it is not clear what the right answer is. In the absence of directives, individuals are also making their own choices about mask use. At a time when public health measures, like shelter-in-place orders and social distancing, are being used to …

Mechanistic And Functional Shades Of Mucins And Associated Glycans In Colon Cancer, Ramesh Pothuraju, Shiv Ram Krishn, Shailendra K. Gautam, Priya Pai, Koelina Ganguly, Sanjib Chaudhary, Satyanarayana Rachagani, Sukhwinder Kaur, Surinder K. Batra

Journal Articles: Biochemistry & Molecular Biology

Mucus serves as the chief protective barrier against pathogenic and mechanical insults in respiratory, gastrointestinal, and urogenital tracts. Altered mucin expression, the major component of mucus, in conjunction with differential glycosylation has been strongly associated with both benign and malignant pathologies of colon. Mucins and their associated glycans arbitrate their impact sterically as well as mechanically by altering molecular and microbial spectrum during pathogenesis. Mucin expression in normal and pathological conditions is regulated by nonspecific (dietary factors and gut microbiota) and specific (epigenetic and transcriptional) modulators. Further, recent studies highlight the impact of altering mucin glycome (cancer-associated carbohydrate antigens including …

Molecular Implications Of Muc5ac-Cd44 Axis In Colorectal Cancer Progression And Chemoresistance, Ramesh Pothuraju, Satyanarayana Rachagani, Shiv Ram Krishn, Sanjib Chaudhary, Rama Krishna Nimmakayala, Jawed A. Siddiqui, Koelina Ganguly, Imayavaramban Lakshmanan, Jesse L. Cox, Kavita Mallya, Sukhwinder Kaur, Surinder K. Batra

Journal Articles: Biochemistry & Molecular Biology

BACKGROUND: Differential expression of mucins has been associated with several cancers including colorectal cancer (CRC). In normal physiological conditions, secretory mucin MUC5AC is not expressed in the colonic mucosa, whereas its aberrant expression is observed during development of colon cancer and its precursor lesions. To date, the molecular mechanism of MUC5AC in CRC progression and drug resistance remains obscure.

METHODS: MUC5AC expression was determined in colon tissue microarray by immunohistochemistry. A RNA interference and CRISPR/Cas9-mediated system was used to knockdown/knockout the MUC5AC in CRC cell lines to delineate its role in CRC tumorigenesis using in vitro functional assays and in …

Distribution Of Human Exposure To Ozone During Commuting Hours In Connecticut Using The Cellular Device Network, Owais Gilani, Simon Urbanek, Michael J. Kane

Faculty Journal Articles

Epidemiologic studies have established associations between various air pollutants and adverse health outcomes for adults and children. Due to high costs of monitoring air pollutant concentrations for subjects enrolled in a study, statisticians predict exposure concentrations from spatial models that are developed using concentrations monitored at a few sites. In the absence of detailed information on when and where subjects move during the study window, researchers typically assume that the subjects spend their entire day at home, school, or work. This assumption can potentially lead to large exposure assignment bias. In this study, we aim to determine the distribution of …

The Mosaic Of Coronavirus Vaccine Development: Systemic Failures In Vaccine Innovation, Ana Santos Rutschman

All Faculty Scholarship

Scientists are racing to develop vaccines against the novel coronavirus. While some vaccine candidates may enter the market in record time, the current vaccine innovation ecosystem exposes governance lacunas at both the international and domestic levels.

Factors Affecting Sports Sponsorship Alliance Formation, Supalux Suvathi

Chulalongkorn University Theses and Dissertations (Chula ETD)

The purposes of this study were four substances. First, to examine the effect of five variables, namely; value maximization, level of business network, risk of potential negative outcomes from scandal, congruence, and process manageability on sponsors' intention to end sports sponsorship alliance formation. Second, to examine the effect of five variables on properties' intention. Third, to compare the degree of the factors' effect on intention between sponsor and property. Fourth, to compare the degree of the factors' effect on intention between sponsor and property with direct experience in sporting industry and those without direct experience in sporting industry. This research …

Clinical Diagnosis, Ultrastructural Study And Antigenic Characterization Of Platynosomum Fastosum In Cats, Babi Kyi Soe

Chulalongkorn University Theses and Dissertations (Chula ETD)

Platynosomum fastosum is a cat liver fluke causing hepatobiliary diseases in cats. To evaluate the criterior to support the suspicion index for early disease detection during subclinical infection, the biochemical parameters composed of liver, pancreatic enzymes, tumor markers were evaluated in 14 P. fastosum naturally-infected cats. As a result, alanine transaminase (ALT) and gamma glutamyl transferase (GGT) were found elevated in 57.8% (8/14) of infected cats. For the diagnostic imaging, bile sediments were present in 85.7% (12/14) of infected cats in their gallbladders. Since the number of bile-derived P. fastosum eggs were significantly higher than that from fecal samples (p=0.001), …

Fabrication Of Three-Dimensional (3-D) Corneal Transplantable Model From Silk Fibroin/Gelatin-Based Biomaterial, Chutirat Torsahakul

Chulalongkorn University Theses and Dissertations (Chula ETD)

Canine corneal blindness is a common cause of vision loss and visual impairment worldwide. While the demand of canine corneal graft is continuously elevated, the clinical useable grafts are limited to acellular biomaterials and allograft. This study aimed to generate the tissue-engineered canine cornea in the part of corneal epithelium and underlying stroma based on cLESCs (canine limbal epithelial stem cells) seeded silk fibroin and gelatin (SF/G) film and cCSSCs (canine corneal stromal stem cells) seeded SF/G scaffold respectively. Both cell types were successfully isolated by collagenase I. SF/G films and scaffolds served as the prospective substrates for cLESCs and …

Comparison Of Canine Urinary Bacterial Population In Calcium Oxalate Urolithiasis And Healthy Conditions, Nichamon Rakprakobkij

Chulalongkorn University Theses and Dissertations (Chula ETD)

Urolithiasis is one of the most common lower urinary tract diseases in dogs. Struvite is the most canine uroliths reported, and the second reported is calcium oxalate (CaOx). However, the proportion of CaOx urolithiasis tends to be increased. CaOx urolithiasis has high incidence of recurrence after the treatment and the pathogenesis of the stone formation is uncleared. Recent studies revealed that oxalate degrader bacteria in the gastrointestinal tract has important roles in CaOx stone formation but no research has been done to study the composition and the role of microbiome in the urinary tract of dogs with CaOx urolithiasis. This …

Development Of Nanostructured Lipid Carrier Clove Oil As Anesthetic Agent In White Shrimp (Litopenaeus Vannamei), Somrudee Kaewmalun

Chulalongkorn University Theses and Dissertations (Chula ETD)

Clove oil is an essential oil extracted from the dried buds and leaves of the clove plant (Syzygium aromaticum). Clove oil contains eugenol as the main active ingredient. Clove oil used as an anesthesia functions as calming effect, loss of equilibrium, non-reactivity and consciousness in lead to reduce activity, physiological stress, mortality rate, and preventing cannibalism method during handling and transportation. However, the component of clove oil is insoluble in water and must be dissolved in ethanol. So, clove oil ethanolic solution leading to toxic and irritation in animal and user. In this study, to avoid this side effect, the …

Antimicrobial Resistance In Salmonella Enterica Isolated From Dogs And Cats In Northern And Northeastern Thailand, Thanich Chantharothaiphaichit

Chulalongkorn University Theses and Dissertations (Chula ETD)

Antimicrobial resistance (AMR) is One Health issue involved in humans, animals and environment and a unified One Health approach is required to contain this problematic issue. However, data on AMR in companion animals is limited. Dogs and cats are popular pet animals and are known to carry many bacterial pathogens that are of public health importance, including Salmonella. This study aimed to identify serovars of Salmonella and phenotypically and genetically characterize AMR in Salmonella isolated from dogs and cats in Northern and Northeastern Thailand. A total of 178 S. enterica isolates from dogs (n= 159) and cats (n= 19) collected …

The Influence Of Polycyclic Aromatic Hydrocarbons In Fcgriib -/- Lupus Mice, Kanyarat Udompornpitak

Chulalongkorn University Theses and Dissertations (Chula ETD)

The activation of aryl hydrocarbon receptor (Ahr) through polycyclic aromatic hydrocarbons (PAHs), the major components of particulate matter at 2.5 micron (PM2.5) in the polluted air, might aggravate inflammation and lupus activity. Hence, 1,4-chrysenequinone (1,4-CQ), a substance in the PAHs group, was tested in a lupus model from FcgRIIb deficiency (FcgRIIb-/-) using macrophages and mice. Although the activation by 1,4-CQ alone was unable to induce inflammation, the pre-conditioning by lipopolysaccharide (LPS), a representative inflammatory-activator, before 1,4-CQ (LPS/1,4-CQ) induced more predominant inflammation in macrophages when compared with LPS or 1,4-CQ activation alone as determined by supernatant cytokines (TNF-α, IL-6 and IL-10). …

Molecular Detection Of Viable Mycobacterium Tuberculosis Complex In Clinical Specimens, Suthidee Petsong

Chulalongkorn University Theses and Dissertations (Chula ETD)

Tuberculosis (TB) is the global health concern because of the rising incidence and mortality. TB is caused by Mycobacterium tuberculosis complex (MTBC) and transmitted via inhalation of infectious droplet nuclei circulating in the air. The World Health Organization (WHO) recommends the use of Acid-fast (AFB) smear microscopy, MTBC culture, and molecular detection of MTBC DNA for diagnosis of TB. The response to treatment should be acquired as soon as possible to reduce disease transmission and drug resistance. Although MTBC culture is a gold standard, it is laborious, expensive, and may take up to 8 weeks. The AFB staining and molecular …

Predictive Factors For Identifying Macrolide Responder In Treating Chronic Rhinosinusitis, Kachorn Seresirikachorn

Chulalongkorn University Theses and Dissertations (Chula ETD)

Background: A low-dose macrolide (LDM) has antineutrophilic activity, so they should not work for eosinophilic inflammation. Clinical predictors are required to select favorable patients for LDM therapy appropriately. This study aims to assess individual predictive factors and propose suitable multiple predictive factors for identifying a macrolide responder in treating CRS. Methodology: Prospective cohort study was done in adult CRS patients. Clinical data collection, Lund-Mackay CT score, visual analog scale (VAS), and sino-nasal outcome test 22 (SNOT-22) were assessed. Patients received 150 mg of roxithromycin once daily plus saline irrigation for 12 weeks. VAS was evaluated at every visit. If the …

Antioxidant And Antimicrobial Activities Of Crude Extracts Of Actinomycetes From Soils, Khaing Zar Wai

Chulalongkorn University Theses and Dissertations (Chula ETD)

A total of 17 actinomycetes isolated from soil collected from Nong Khai, Nakhon Ratchasima, Khon Kaen, Phichit, Chachoengsao and Udonthani Province, were evaluated on antimicrobial and antioxidant activities. They were identified as Streptomyces (16 strains) and Micromonospora (1 strain) based on their phenotypic and chemotaxonomic characteristics including 16S rRNA gene sequences analysis. Strain JA03 showed 98.95% similarity of 16S rRNA gene sequence to S. puniciscabiei DSM 41929T. Strain JA03 was found to be the novel species of genus Streptomyces based on whole genome average nucleotide identity (ANI). All these strains were evaluated on antimicrobial and antioxidant activities. Based on agar …

Effect Of Jorunnamycin A On Cancer Stem Cells Of Human Lung Cancer H460 Cells, Somruethai Sumkhemthong

Chulalongkorn University Theses and Dissertations (Chula ETD)

It has been recognized that cancer stem-like cells (CSCs) in tumor tissue crucially contribute to therapeutic failure, resulting in a high mortality rate in lung cancer patients. Due to their stem-like features of self-renewal and tumor formation, CSCs can lead to drug resistance and tumor recurrence. Herein, the suppressive effect of jorunnamycin A, a bistetrahydroisoquinolinequinone isolated from Thai blue sponge Xestospongia sp., on cancer spheroid initiation and self-renewal in the CSCs of human lung cancer cells is revealed. The depletion of stemness transcription factors, including Nanog, Oct-4, and Sox2 in the lung CSC-enriched population treated with jorunnamycin A (0.5 µM), …

ความรอบรู้ด้านอาชีวอนามัยของบุคลากรในโรงพยาบาลแห่งหนึ่งในสังกัดกรุงเทพมหานคร, วีรนุช เชาวกิจเจริญ

Chulalongkorn University Theses and Dissertations (Chula ETD)

การวิจัยนี้เป็นการศึกษาเชิงพรรณนาภาคตัดขวาง วัตถุประสงค์เพื่อศึกษาความรอบรู้ด้านอาชีวอนามัย และปัจจัยที่มีความสัมพันธ์กับความรอบรู้ด้านอาชีวอนามัยของบุคลากรในโรงพยาบาลแห่งหนึ่งในสังกัดกรุงเทพมหานคร กลุ่มตัวอย่างคือบุคลากรในโรงพยาบาล จำนวน 415 คน คัดเลือกด้วยการสุ่มตัวอย่างแบบชั้นภูมิตามสัดส่วนของตำแหน่งงาน เก็บข้อมูลโดยใช้แบบประเมินความรอบรู้ด้านอาชีวอนามัยของบุคลากรในโรงพยาบาลแบบตอบด้วยตนเอง ซึ่งได้รับการตรวจสอบคุณภาพโดยการตรวจสอบความเที่ยงตรงเชิงเนื้อหาด้วยวิธีการหาค่าดัชนีความสอดคล้อง มีคะแนนอยู่ในช่วง 0.60-1.00 และการตรวจสอบความเชื่อมั่นด้วยการหาสัมประสิทธิ์แอลฟาของครอนบาค พบความเชื่อมั่นรายด้านอยู่ที่ 0.81-0.93 และทั้งฉบับอยู่ที่ 0.96 วิเคราะห์ข้อมูลด้วยสถิติเชิงพรรณนาและสถิติถดถอยพหุคูณ ผลการศึกษาพบว่ากลุ่มตัวอย่างมีความรอบรู้ด้านอาชีวอนามัยอยู่ในระดับปานกลาง โดยมีคะแนนเฉลี่ยร้อยละ 72.41 รายด้านที่มีคะแนนสูงที่สุดคือการจัดการสุขภาพของตนเองด้านอาชีวอนามัย (ร้อยละ 74.53) และรายด้านที่คะแนนน้อยที่สุดคือทักษะการสื่อสารข้อมูลด้านอาชีวอนามัย (ร้อยละ 67.27) ปัจจัยที่มีความสัมพันธ์กับความรอบรู้ด้านอาชีวอนามัยที่ดี ได้แก่ เพศหญิง (p-value=0.011) อายุไม่เกิน 45 ปี (p-value<0.001) ไม่มีการทำงานเป็นกะหรือทำงานล่วงเวลา (p-value=0.029) มีประวัติการอบรมด้านอาชีวอนามัย (p-value=0.002) มีนโยบายด้านอาชีวอนามัยและความปลอดภัย (p-value<0.001) และมีการสนับสนุนที่ดีจากหน่วยงาน (p-value=0.011) โดยสรุปการเสริมสร้างความรอบรู้ด้านอาชีวอนามัยให้กับกลุ่มบุคลากรในโรงพยาบาลควรเน้นเรื่องทักษะการสื่อสารข้อมูลด้านอาชีวอนามัย การจัดบริการด้านอาชีวอนามัยให้เหมาะสมกับกลุ่มบุคลากร การจัดอบรมการวางแผนงานนโยบายด้านอาชีวอนามัย รวมถึงให้การสนับสนุนอย่างต่อเนื่อง เพื่อให้บุคลากรสามารถพัฒนาสมรรถนะการดำเนินงานด้านอาชีวอนามัยได้อย่างปลอดภัยและมีประสิทธิภาพ

ความเหนื่อยล้าและปัจจัยที่สัมพันธ์กับความเหนื่อยล้าของญาติผู้ดูแลผู้ป่วยมะเร็งระยะสุดท้าย, ชลดา แสงนาค

Chulalongkorn University Theses and Dissertations (Chula ETD)

การศึกษาครั้งนี้เป็นการวิจัยแบบเชิงพรรณนา ณ จุดเวลาใดเวลาหนึ่ง เพื่อศึกษาถึงความเหนื่อยล้าและปัจจัยที่สัมพันธ์กับความเหนื่อยล้าของญาติผู้ดูแลผู้ป่วยมะเร็งระยะสุดท้าย โดยมีกลุ่มตัวอย่างเป็นญาติผู้ดูแลผู้ป่วยมะเร็งระยะสุดท้าย เป็นบุคคลที่มีความสัมพันธ์ทางสายเลือดกับผู้ป่วยมะเร็งระยะสุดท้ายจำนวน 194 คน เก็บข้อมูลระหว่างเดือนเมษายน ถึง เดือนมิถุนายน 2563 โดยคัดเลือกกลุ่มตัวอย่างจากแผนกผู้ป่วยนอก และที่คลินิกการแพทย์ผสมผสานผู้ป่วยมะเร็งและญาติ ณ โรงพยาบาลจุฬาภรณ์ ซึ่งมีคุณสมบัติตามที่กำหนด เครื่องมือที่ใช้ในการศึกษาครั้งนี้ประกอบด้วย แบบสอบถามข้อมูลส่วนบุคคล แบบสอบถามความเหนื่อยล้า แบบสอบถามภาวะทางสุขภาพกาย แบบสอบถามความเข้มแข็งในการมองโลก แบบสอบถามภาระในการดูแล และแบบสอบถามการสนับสนุนทางสังคม สถิติที่ใช้ได้แก่ สถิติเชิงพรรณนาเพื่อนำเสนอลักษณะทั่วไปของกลุ่มตัวอย่าง การแจกแจงจำนวน ร้อยละ ค่าเฉลี่ย ส่วนเบี่ยงเบนมาตรฐาน สถิติเชิงอนุมานใช้อธิบายความสัมพันธ์ระหว่างตัวแปรปัจจัยส่วนบุคคลกับความเหนื่อยล้า และใช้สถิติวิเคราะห์ถดถอยพหุ เพื่อหาปัจจัยทำนายความเหนื่อยล้า โดยมีนัยสำคัญทางสถิติที่ระดับ 0.05 ผลการศึกษาพบว่า กลุ่มตัวอย่างมีความเหนื่อยล้าโดยรวมอยู่ในระดับปานกลาง คิดเป็นร้อยละ 71.1 ซึ่งปัจจัยที่มีความสัมพันธ์กับความเหนื่อยล้าของญาติผู้ดูแลผู้ป่วยมะเร็งระยะสุดท้ายได้แก่ ชนิดมะเร็งของผู้ป่วย ชนิดการรักษาที่ผู้ป่วยได้รับตั้งแต่อดีตจนถึงปัจจุบัน จำนวนชั่วโมงที่ดูแลผู้ป่วย ลักษณะงานที่ช่วยดูแลผู้ป่วย ผู้ช่วยเหลือในการดูแลผู้ป่วย ภาวะทางสุขภาพกาย ความเข้มแข็งในการมองโลก ภาระในการดูแล และการสนับสนุนทางสังคม อีกทั้งการศึกษายังพบว่า ปัจจัยชนิดมะเร็งต่อมน้ำเหลือง การรักษาแบบประคับประคอง ชั่วโมงที่ให้การดูแลผู้ป่วย ภาวะทางสุขภาพกาย ปัจจัยภาระในการดูแล และปัจจัยการสนับสนุนทางสังคม ทั้ง 6 ตัวแปรสามารถทำนายความเหนื่อยล้าของญาติผู้ดูแลผู้ป่วยมะเร็งระยะสุดท้ายได้ร้อยละ 45.3 อย่างมีนัยสำคัญทางสถิติ การศึกษาครั้งนี้แสดงให้เห็นว่า จำนวนชั่วโมงที่ให้การดูแลผู้ป่วยน้อยกว่า 8 ชั่วโมงต่อวัน การลดลงของภาระในการดูแล การเพิ่มขึ้นของการรับรู้ภาวะทางสุขภาพกายของญาติผู้ดูแลรวมไปถึงการได้รับการสนับสนุนทางสังคม มีส่วนช่วยให้ญาติผู้ดูแลผู้ป่วยมะเร็งระยะสุดท้ายมีความเหนื่อยล้าจากการดูแลผู้ป่วยน้อยลง ผลการศึกษาครั้งนี้สามารถใช้เป็นข้อมูลให้บุคลากรทางการแพทย์หรือหน่วยงานที่เกี่ยวข้องพัฒนาแนวทางในการจัดการกับความเหนื่อยล้าและวางแผนในการช่วยเหลือทั้งผู้ป่วยและญาติผู้ดูแลได้อย่างเหมาะสมต่อไป