Obesity and mortality among older Thais: a four year follow up study

BACKGROUND: To assess the association of body mass index with mortality in a population-based setting of older people in Thailand. METHODS: Baseline data from the National Health Examination Survey III (NHES III) conducted in 2004 was linked to death records from vital registration for 2004-2007. Complete information regarding body mass index (BMI) (n = 15997) and mortality data were separately analysed by sex. The Cox Proportional Hazard Model was used to test the association between BMI and all-cause mortality controlling for demographic, socioeconomic, and health risk factors. RESULTS: During a mean follow-up time of 3.8 years (60545.8 person-years), a total of 1575 older persons, (936 men and 639 women) had died. A U-shaped and reverse J-shaped of association between BMI and all-cause mortality were observed in men and women, respectively. However there was no significant increased risk in the higher BMI categories. Compared to those with BMI 18.5-22.9 kg/m(2), the adjusted hazard ratios (HR) of all-cause mortality for those with BMI <18.5, 23.0-24.9, 25.0-27.4, 27.5-29.9, 30.0-34.9, and ≥35.0 were 1.34 (95% CI, 1.14-1.58), 0.79 (95% CI, 0.65-0.97), 0.81 (95% CI, 0.65-1.00), 0.67 (95% CI, 0.48-0.94), 0.60 (95% CI, 0.35-1.03), and 1.87 (95% CI, 0.77-4.56), respectively, for men, and were 1.29 (95% CI,1.04-1.60), 0.70 (95% CI, 0.55-0.90), 0.79 (95% CI, 0.62-1.01), 0.57 (95% CI, 0.41-0.81), 0.58 (95% CI, 0.39-0.87), and 0.78 (95% CI, 0.38-1.59), respectively, for women. CONCLUSIONS: The results of this study support the obesity paradox phenomenon in older Thai people, especially in women. Improvement in quality of mortality data and further investigation to confirm such association are needed in this population

Prevalence, Awareness, Treatment and Control of Coexistence of Diabetes and Hypertension in Thai Population

Diabetes and hypertension are major independent risk factors for cardiovascular and renal diseases; however, prevalence and characteristics of the coexistence in general population is not clear. Data from Thai National Health Examination Survey III were used to estimate the prevalence of coexistence of diabetes and hypertension, and to estimate the proportion of awareness, treatment and control of both conditions. A total of 36,877 (male 17,614 and female 19,263) participants were included in the study. The prevalence of people with diabetes and hypertension was 3.2% (male 2.8% and female 3.6%). Approximately half of the diabetes patients (49.0%, 95%CI 45.6, 52.5) had hypertension, and 14.4% (95%CI 13.0, 16.0) of hypertensive patients had diabetes. After controlling for covariates, factors associated with coexistence of diabetes and hypertension included; age ≥60 years (adjust odds ratio 1.38, 95%CI 1.14, 1.73), having education less than 6 years (1.83, 95%CI 1.03, 3.38) and abdominal obesity (2.49, 95%CI 2.00, 3.10). More than 80% were unaware of having both conditions. Target for control of both glucose and blood pressure among those treated was achieved in only 6.2%. In conclusion, patients with diabetes or hypertension should be promoted to have weight control and screening for the comorbidity

Copayment and recommended strategies to mitigate its impacts on access to emergency medical services under universal health coverage: a case study from Thailand

Abstract Background Although bodies of evidence on copayment effects on access to care and quality of care in general have not been conclusive, allowing copayment in the case of emergency medical conditions might pose a high risk of delayed treatment leading to avoidable disability or death. Methods Using mixed-methods approach to draw evidence from multiple sources (over 40,000 records of administrative dataset of Thai emergency medical services, in-depth interviews, telephone survey of users and documentary review), we are were able to shed light on the existence of copayment and its related factors in the Thai healthcare system despite the presence of universal health coverage since 2001. Results The copayment poses a barrier of access to emergency care delivered by private hospitals despite the policy proclaiming free access and payment. The copayment differentially affects beneficiaries of the major 3 public-health insurance schemes hence inducing inequity of access. Conclusions We have identified 6 drivers of the copayment i.e., 1) perceived under payment, 2) unclear operational definitions of emergency conditions or 3) lack of criteria to justify inter-hospital transfer after the first 72 h of admission, 4) limited understanding by the service users of the policy-directed benefits, 5) weak regulatory mechanism as indicated by lack of information systems to trace private provider’s practices, and 6) ineffective arrangements for inter-hospital transfer. With demand-side perspectives, we addressed the reasons for bypassing gatekeepers or assigned local hospitals. These are the perception of inferior quality of care and age-related tendency to use emergency department, which indicate a deficit in the current healthcare systems under universal health coverage. Finally, we have discussed strategies to address these potential drivers of copayment and needs for further studies

Cardiovascular Risk Assessment in Developing World

Many international and national authorities recommend that cardiovascular risk assessment using multivariate risk scores be used to identify individuals at high risk of cardiovascular disease (CVD). This approach is likely to assure that resources in developing countries are allocated to those who need it most. However, not many developing countries have implemented this approach and different countries have varying progresses in adopting the concept. While many developing countries solely described estimated cardiovascular risk by applying existing CVD risk scores to their population’s cross-sectional data, a number of countries have validated and recalibrated existing risk scores and only a few have developed new risk scores specific to their populations. To enhance the adoption of such a policy in developing countries, new CVD risk prediction charts for low- and medium-resource settings were developed and endorsed by the WHO and International Society of Hypertension. However, a number of issues need to be addressed, including development of population-specific risk scores, recalibration of available risk scores and uncertainty over cost-effectiveness of CVD risk assessment in developing countries. Although this high risk approach might represent an effective and practical strategy for developing countries, a complementary population-based approach is also needed to maximize benefits for CVD prevention

Association of Serum Bisphenol A with Hypertension in Thai Population

Objective. The present study aimed to examine the association between serum BPA and hypertension and evaluated whether it was influenced by estradiol level. Methods. A subsample of 2588 sera randomly selected from the Thai National Health Examination Survey IV, 2009, was measured for serum BPA and estradiol. Logistic regression was used to examine the association controlling for age, sex, diabetes, body mass index, and estradiol level. Results. Compared with the lowest quartile, the adjusted odds ratio (AOR) of hypertension for the fourth quartile of serum BPA was 2.16 (95% CI 1.31, 3.56) in women and 1.44 (0.99, 2.09) in men. There was no interaction between serum BPA and estradiol level. For analysis using log(BPA) as a continuous variable, the AOR per unit change in log(BPA) was 1.09 (95% CI 1.02, 1.16). Among postmenopausal women, the AOR for the fourth quartile of BPA was 2.33 (95% CI 1.31, 4.15) and, for premenopausal women, it was 2.12 (95% CI 0.87, 5.19). Conclusion. Serum BPA was independently associated with hypertension in women and was not likely to be affected by estrogen; however, its mechanism related to blood pressure needs further investigation

Assessing system-based trainings for primary care teams and quality-of-life of patients with multimorbidity in Thailand: patient and provider surveys.

BACKGROUND: Strengthening primary care is considered a global strategy to address non-communicable diseases and their comorbidity. However, empirical evidence of the longer-term benefits of capacity building programmes for primary care teams contextualised for low- and middle-income countries is scanty. In Thailand, a series of system-based capacity building programmes for primary care teams have been implemented for a decade. An analysis of the relationship between these systems-based trainings in diverse settings of primary care and quantified patient outcomes was needed. METHODS: Facility-based and community-based cross-sectional surveys were used to obtain data on exposure of primary care team members to 11 existing training programmes in Thailand, and health profiles and health-related quality of life of their patients measured in EuroQol-5 Dimension (EQ-5D) scale. Using a multilevel modelling, the associations between primary care provider's training and patient's EQ-5D score were estimated by a generalized linear mixed model (GLMM). RESULTS: While exposure to training programmes varied among primary care teams nationwide, District Health Management Learning (DHML) and Contracting Unit of Primary Care (CUP) Leadership Training Programmes, which put more emphasis on bundling of competencies and contextualising of applying such competencies, were positively associated with better health-related quality of life of their multimorbid patients. CONCLUSIONS: Our report provides systematic feedback to a decade-long investment on system-based capacity building for primary care teams in Thailand, and can be considered as new evidence on the value of human resource development in primary care systems in low- and middle-income countries. Building multiple competencies helps members of primary care teams collaboratively manage district health systems and address complex health problems in different local contexts. Coupling contextualised training with ongoing programme implementation could be a key entity to the sustainable development of primary care teams in low and middle income countries which can then be a leverage for improving patients outcomes

Prevalence of Metabolic Syndrome and Its Prediction by Simple Adiposity Indices in Thai Adults

Objective: Thai adults, have increased risk of being diagnosed with metabolic syndrome (MetS). Hence, early discrimination of MetS, with a simple and high accuracy index, appears necessary. However, the application of the discriminating ability of Lipid Accumulation Product (LAP), which is an emergent indicator of central lipid accumulation, to MetS among Thai people has not been investigated. This present study’s purposes were to investigate the nationwide prevalence of MetS, and the ability of LAP in discriminating this disorder. Material and Methods: Cross-sectional secondary data analysis was performed in 2018, using primary data from the Thai National Health Examination Survey, 2009. A total of 18,642 Thailanders ≥18 years were recruited. MetS was diagnosed by the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP) and International Diabetes Federation (IDF). Results: Overall, the prevalence of MetS-NCEP/ATP and MetS-IDF in Thai adults was 20.0% and 27.0%, respectively. LAP showed outstanding discriminating ability for MetS in both definitions (the cut-off point of 34.38 and 37.96 cm.mmol/L; area under the curve of 0.889 and 0.915 for NCEP/ATP and IDF, respectively). LAP performed the closest agreement in discriminating MetS-NCEP/ATP (κ=0.598, p-value<0.001) and MetS-IDF (κ=0.577, p-value<0.001). Logistic regression analysis exhibited a strong association of the LAP cut-off point with MetS, with the odds ratio being from 23.37 to 27.22 (p-value<0.001). Conclusion: These study results revealed that LAP was strongly associated with MetS, had an outstanding and reliable diagnostic accuracy for discriminating MetS in Thai adults, which might be helpful for early detection of MetS among vulnerable populations

Recognition of Three Common Work-Related Hand Diseases in a Teaching Hospital

OBJECTIVE Musculoskeletal disorders (MSDs) of the hands are increasingly affecting workers in various occupations. They reduce productivity and cause economic loss. In Thailand, work-related MSDs are considered underdiagnosed and under-reported. This study aimed to determine the proportion of three major recognized hand diseases that are work-related and to examine factors associated with that recognition and work-relatedness. METHODS This is a cross-sectional study, recruiting and interviewing patients with carpal tunnel syndrome (CTS), trigger finger (TF), and de Quervain’s tenosynovitis (DQT) aged 18-65 years old who visited the Hand Clinic in the Orthopedics Department, Ramathibodi Hospital between 25 October 2023 and 15 March 2024. Patient medical records were reviewed to determine work-relatedness using NIOSH criteria. Recognition was determined by taking patient work histories. Logistic regression was used to examine the associations between work and MSDs, and between recognition and patients’ factors. RESULTS A total of 270 patients were included: 127 CTS cases, 96 TF cases, and 47 DQT cases. Almost two-thirds (63.0%) of the diseases were attributed to work-related conditions. Factors associated with work-relatedness of the three diseases were: working for 26 or more hours per week (adjusted ORs 3.26-4.63), tool use (ORadj 7.92, 95%CI [2.83, 22.17]), computer use (ORadj 4.72, 95%CI [1.84,12.14]), writing (ORadj 4.88, 95%CI [1.53, 15.61]), and having a single job (ORadj 10.13, 95%CI [2.59,39.57]). The proportion of recognition by physicians of the connection between working history and MSDs was only 13.0%. There were no significant associations between patients’ personal/work factors and recognition by doctors. CONCLUSIONS This study showed that 63.0% three common hand diseases of patients are attributed to work-related conditions, but the recognition by doctors of that relationship was only 13.0%. Factors associated with work-relatedness were mostly aspects of patients’ work. The hospital should improve its system for identifying the work-related MSDs to help ensure patients receive appropriate health-related welfare and benefits. Further studies should be conducted to explore means of increasing physician recognition of work-related MSDs. KEYWORDS work-related hand disease, carpal tunnel syndrome, trigger finger, De Quervain’s tenosynoviti

Prevalence of chronic kidney disease in Thai adults: a national health survey

<p>Abstract</p> <p>Background</p> <p>The prevalence of patients with end stage renal disease (ESRD) who need dialysis and/or transplantation has more than doubled in Thailand during the past two decades. It has been suggested that therapeutic strategies to reduce the risk of ESRD and other complications in CKD are now available, thus the early recognition and the institution of proven therapeutic strategies are important and beneficial. We, therefore, aimed to determine the prevalence of CKD in Thai adults from the National Health Examination Survey of 2004.</p> <p>Methods</p> <p>Data from a nationally representative sample of 3,117 individuals aged 15 years and older was collected using questionnaires, physical examination and blood samples. Serum creatinine was measured by Jaffé method. GFR was estimated using the Chinese modified Modification of Diet in Renal Disease Study equation. Chronic kidney Disease (CKD) stages were classified based on Kidney Disease Outcome Quality Initiative (K/DOQI).</p> <p>Results</p> <p>The prevalence of CKD in Thai adults weighted to the 2004 Thai population by stage was 8.1% for stage 3, 0.2% and 0.15% for stage 4 and 5 respectively. Compared to non-CKD, individuals with CKD were older, had a higher level of cholesterol, and higher blood pressure. Those with cardiovascular risk factors were more likely to have CKD (stage 3-5) than those without, including hypertension (OR 1.6, 95%CI 1.1, 3.4), diabetes (OR 1.87, 95%CI 1.0, 3.4). CKD was more common in northeast (OR 2.1, 95%CI 1.3, 3.3) compared to central region. Urinalysis was not performed, therefore, we could not have data on CKD stage 1 and 2. We have no specific GFR formula for Thai population.</p> <p>Conclusion</p> <p>The identification of CKD patients should be evaluated and monitored for appropriate intervention for progression to kidney disease from this screening.</p

Regional variation and determinants of vitamin D status in sunshine-abundant Thailand

<p>Abstract</p> <p>Background</p> <p>Vitamin D insufficiency is highly prevalent. Most of the studies concerning vitamin D status were generated from countries situated at temperate latitudes. It is less clear what the extent of vitamin D insufficiency is in countries situated in the tropics and how geographical regions within country would affect vitamin D status. In the present study, we investigated vitamin D status in Thais according to geographical regions and other risk factors.</p> <p>Methods</p> <p>Subjects consisted of 2,641 adults, aged 15 - 98 years, randomly selected from the Thai 4th National Health Examination Survey (2008-9) cohort. Serum 25 hydroxyvitamin D were measured by liquid chromatography/tandem mass spectrometry. Data were expressed as mean ± SE.</p> <p>Results</p> <p>Subjects residing in Bangkok, the capital city of Thailand, had lower 25(OH)D levels than other parts of the country (Bangkok, central, northern, northeastern and southern regions: 64.8 ± 0.7, 79.5 ± 1.1, 81.7 ± 1.2, 82.2 ± 0.8 and 78.3 ± 1.3 nmol/L, respectively; <it>p </it>< 0.001). Within each region, except for the northeastern part of the country, subjects living inside municipal areas had lower circulating 25(OH)D (central, 77.0 ± 20.9 nmol/L vs 85.0 ± 22.1 nmol/L, <it>p </it>< 0.001; north 79.3 ± 22.1 nmol/L vs 86.8 ± 21.8 nmol/L, <it>p </it>< 0.001; northeast 84.1 ± 23.3 nmol/L vs 87.3 ± 20.9 nmol/L, <it>p </it>= 0.001; south, 76.6 ± 20.5 nmol/L vs 85.2 ± 24.7 nmol/L, <it>p </it>< 0.001). Overall, the prevalence of vitamin D insufficiency was 64.6%, 46.7%, and 33.5% in Bangkok, municipal areas except Bangkok, and outside municipal area in other parts of the country, respectively. In addition, the prevalence of vitamin D insufficiency according to geographical regions was 43.1%, 39.1%, 34.2% and 43.8% in the central, north, northeast and south, respectively. After controlling for covariates in multiple linear regression analysis, the results showed that low serum 25(OH)D levels were associated with being female, younger age, living in urban and Bangkok.</p> <p>Conclusions</p> <p>Vitamin D insufficiency is common and varies across geographical regions in Thailand.</p