Estimated causes of death in Thailand, 2005: implications for health policy

<p>Abstract</p> <p>Background</p> <p>Almost 400,000 deaths are registered each year in Thailand. Their value for public health policy and planning is greatly diminished by incomplete registration of deaths and by concerns about the quality of cause-of-death information. This arises from misclassification of specified causes of death, particularly in hospitals, as well as from extensive use of ill-defined and vague codes to attribute the underlying cause of death. Detailed investigations of a sample of deaths in and out of hospital were carried out to identify misclassification of causes and thus derive a best estimate of national mortality patterns by age, sex, and cause of death.</p> <p>Methods</p> <p>A nationally representative sample of 11,984 deaths in 2005 was selected, and verbal autopsy interviews were conducted for almost 10,000 deaths. Verbal autopsy procedures were validated against 2,558 cases for which medical record review was possible. Misclassification matrices for leading causes of death, including ill-defined causes, were developed separately for deaths inside and outside of hospitals and proportionate mortality distributions constructed. Estimates of mortality undercount were derived from "capture-recapture" methods applied to the 2005-06 Survey of Population Change. Proportionate mortality distributions were applied to this mortality "envelope" and ill-defined causes redistributed according to Global Burden of Disease methods to yield final estimates of mortality levels and patterns in 2005.</p> <p>Results</p> <p>Estimated life expectancy in Thailand in 2005 was 68.5 years for males and 75.6 years for females, two years lower than vital registration data suggest. Upon correction, stroke is the leading cause of death in Thailand (10.7%), followed by ischemic heart disease (7.8%) and HIV/AIDS (7.4%). Other leading causes are road traffic accidents (males) and diabetes mellitus (females). In many cases, estimated mortality is at least twice what is estimated in vital registration. Leading causes of death have remained stable since 1999, with the exception of a large decline in HIV/AIDS mortality.</p> <p>Conclusions</p> <p>Field research into the accuracy of cause-of-death data can result in substantially different patterns of mortality than suggested by routine death registration. Misclassification errors are likely to have very significant implications for health policy debates. Routine incorporation of validated verbal autopsy methods could significantly improve cause-of-death data quality in Thailand.</p

Cause-of-death ascertainment for deaths that occur outside hospitals in Thailand: application of verbal autopsy methods

Background: Ascertainment of cause for deaths that occur in the absence of medical attention is a significant problem in many countries, including Thailand, where more than 50% of such deaths are registered with ill-defined causes. Routine implementation of standardized, rigorous verbal autopsy methods is a potential solution. This paper reports findings from field research conducted to develop, test, and validate the use of verbal autopsy (VA) methods in Thailand.Methods: International verbal autopsy methods were first adapted to the Thai context and then implemented to ascertain causes of death for a nationally representative sample of 11,984 deaths that occurred in Thailand in 2005. Causes of death were derived from completed VA questionnaires by physicians trained in ICD-based cause-of-death certification. VA diagnoses were validated in the sample of hospital deaths for which reference diagnoses were available from medical record review. Validated study findings were used to adjust VA-based causes of death derived for deaths in the study sample that had occurred outside hospitals. Results were used to estimate cause-specific mortality patterns for deaths outside hospitals in Thailand in 2005.Results: VA-based causes of death were derived for 6,328 out of 7,340 deaths in the study sample that had occurred outside hospitals, constituting the verification arm of the study. The use of VA resulted in large-scale reassignment of deaths from ill-defined categories to specific causes of death. The validation study identified that VA tends to overdiagnose important causes such as diabetes, liver cancer, and tuberculosis, while undercounting deaths from HIV/AIDS, liver diseases, genitourinary (essential renal), and digestive system disorders.Conclusions: The use of standard VA methods adapted to Thailand enabled a plausible assessment of cause-specific mortality patterns and a substantial reduction of ill-defined diagnoses. Validation studies enhance the utility of findings from the application of verbal autopsy. Regular implementation of VA in Thailand could accelerate development of the quality and utility of vital registration data for deaths outside hospitals

Low vs standard dose of recombinant tissue plasminogen activator in treating East Asian patients with acute ischemic stroke

Background : Intravenous recombinant tissue plasminogen activator (rtPA) has been approved to treat eligible patients with acute ischemic stroke within 4.5 hours of onset. The rationale for using a lower dose in Asian patients came from concerns about intracerebral hemorrhage because of the racial differences in blood coagulation-fibrinolysis factors. Aim : The aim of this systemic review was to compare the data from previous studies to address the efficacy and safety of using low-dose vs standard-dose rtPA in treating patients with acute ischemic stroke. Material and Methods : Previous studies were searched and analyzed. The confidence interval was calculated at 95%. Baseline characteristics and outcomes of the patients were compared between two doses of rtPA (0.6 vs 0.9 mg/kg), using Z test for two independent proportions. Results : Patients who received standard-dose rtPA had significantly higher favorable outcome at 3 months (33.1 vs 47.2%, P<0.0001), without significant difference in the rates of symptomatic intracerebral hemorrhage (3.5 vs 4.3%, P = 0.42) and mortality (13.1 vs 11.7%, P = 0.56). However, patients in the low-dose group were older and had more severe stroke. Conclusions : Patients receiving standard-dose rtPA seem to have higher rates of favorable outcome. However, there were significant differences in baseline characteristics between the two groups. A further, well-designed, randomized study in the same population is still needed to clarify the suspected benefit of the standard dose for East Asian patients

<span style="font-size:11.0pt;font-family: "Times New Roman","serif";mso-fareast-font-family:"Times New Roman";mso-bidi-font-family: Mangal;mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language: HI" lang="EN-GB">Effectiveness of the court-type traditional Thai massage <i style="mso-bidi-font-style:normal">versus </i>topical diclofenac in treating patients with myofascial pain syndrome in the upper trapezius</span>

30-34<span style="font-size:11.0pt;font-family: " times="" new="" roman","serif";mso-fareast-font-family:"times="" roman";mso-bidi-font-family:="" mangal;mso-ansi-language:en-gb;mso-fareast-language:en-us;mso-bidi-language:="" hi"="" lang="EN-GB">A single-blind randomized controlled trial was conducted to examine the effectiveness <span style="font-size:11.0pt; font-family:" times="" new="" roman","serif";mso-fareast-font-family:"times="" roman";="" mso-bidi-font-family:mangal;mso-ansi-language:en-gb;mso-fareast-language:en-us;="" mso-bidi-language:hi;mso-bidi-font-weight:bold"="" lang="EN-GB">of the court-type traditional Thai massage in reducing pain and stiffness in patients with myofascial pain syndrome in the upper trapezius. Ninety patients were randomly allocated into two groups. The treatment group (n=45) received a session of 30-minute massage twice a week, for 6 weeks. The control group (n=44, one dropped out) received topical diclofenac (4 gm t.i.d.) for 6 weeks. Pain intensity, cervical range of motion and pressure pain threshold were assessed at week 0 (baseline), week 6 (completed intervention), week 8 and week 12 (follow-ups). Quality of life was assesses at week 0 and week 12 using the 36 – Item Short Form Health Survey. The age, gender, height, weight, pain period, and side of pain were not statistically significant different between two groups (p > 0.05) at baseline. After intervention and follow-ups, there were statistically significant improvements in pain intensity, quality of life, all cervical range of motion and pressure pain threshold (p < 0.05). The results revealed the effectiveness of the court-type traditional Thai massage for patients with myofascial pain syndrome in the upper trapezius.</span

Stroke Outcomes in Thai Elderly Patients Treated with and without Intravenous Thrombolysis

Higher mortality was found in very old patients with acute ischemic stroke treated with intravenous recombinant tissue-plasminogen activator (rtPA) as compared to younger patients. The benefit of thrombolytic treatment in this particular subgroup is still a subject of debate. The purpose of this study was to compare stroke outcomes in Thai patients aged over 70 years treated with and without intravenous rtPA. This was a retrospective review of sequential cases and was not a randomized controlled study. One-hundred and five patients with acute ischemic stroke aged over 70 years who were treated with intravenous rtPA and 105 patients without rtPA treatment (control group) were included in the study. Patients’ base-line characteristics and study outcomes of interest were compared. There were significant differences in the base-line characteristics of the two groups. However, for the subgroup of patients aged over 80 years, these characteristics were similar. Those who were treated with intravenous rtPA had a higher rate of favorable outcomes (40% vs 16%; P=0.137) and a lower rate of mortality (22% vs 44%; P=0.128) than patients who did not receive rtPA treatment. In well-matched subgroups of patients aged over 80 years, our retrospective review revealed there was a trend of a higher rate of favorable outcome and lower mortality in patients receiving rtPA treatment. More study is needed to further confirm the suggested benefit of thrombolysis in Asian octogenarian acute stroke patients

Elevation of Plasma Malondialdehyde Levels Associated with The Severity of Coronary Atherosclerosis in Coronary Artery Disease Patients

The present study aims to investigate the relationship between plasma MDA and the severity of coronary artery disease in CAD patients. A total of 159 newly diagnosed CAD patients were enrolled in the study with an average age of 65.5 ± 11.3 years old and 63% were male. Participants underwent an investigation of blood biochemistry and plasma MDA before the measurement of coronary artery angiography. They were then divided into four groups as control (non-CAD), single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD) groups. The results showed high plasma MDA levels were observed in SVD, DVD, and TVD patients (1.64 ± 0.56, 2.32 ± 0.57, 2.52 ± 0.76, respectively) when compared with the control group (1.44 ± 0.54, P &lt; 0.001). Interestingly, plasma MDA was associated with fasting blood glucose (r = 0.183, P = 0.024), total cholesterol (r = 0.231, P = 0.004), triglyceride levels (r = 0.269, P &lt; 0.001), HDL-cholesterol levels (r = -0.221, P = 0.006), and LDL-cholesterol levels (r = 0.164, P = 0.044). ROC analysis was performed using both control and CAD patients as subjects. The cut-off for plasma MDA was 1.624 ?mol/L with 83.6% sensitivity and 28.0% specificity. The findings of this research showed that plasma MDA levels were associated with the severity of CAD