PREVALENCE AND FACTORS INFLUENCING BETEL NUT CHEWING AMONG ADULTS IN WEST INSEIN TOWNSHIP, YANGON, MYANMAR.

Betel nut chewing can cause precancerous oral lesions and is common in Myanmar. We conducted a cross sectional study aimed to estimate prevalence and factors influencing betel nut chewing among 420 subjects aged ≥18 years in West Insein Township, Yangon, Myanmar in order to inform preventive health programs. The mean age of the study subjects was 45(±15) years. The overall prevalence of current betel nut chewing among study subjects was 55.2%. The mean age starting betel nut chewing was 29(±13) years, and the mean duration of chewing was 15(±13) years. The reasons given by study subjects for chewing betel nut included the addictive effect to betel nut, to release tension, to get rid of boredom and to stop smoking. Sixty-two point three percent of current betel nut chewers also chewed tobacco and 24.2% also smoked cigarettes. Factors significantly associated with betel nut chewing were male gender, current alcohol consumer, having no education or finishing primary or secondary school, having a low score regarding their attitude about the health effects of betel nut chewing, and having high score on interpersonal factors by family and peer pressure. Our results show a need to better educate the public about the health effects of betel nut chewing among the study population.

Oral health status and oral hygiene habits among children aged 12-13 years in Yangon, Myanmar.

We conducted a cross sectional study among children aged 12-13 years in Yongon, Myanmar to assess the oral health status and oral hygiene habits. The studied 220 students were from two high schools, one urban and the other rural. We conducted an oral health examination following WHO criteria and used a self-administrated questionnaire. The prevalence rate of dental caries among the study population was 53.2%. The mean number of decayed, missing and filled teeth (DMFT) was 1.7 +/- 2.1 teeth per person (decayed, 1.5 +/- 1.9); missing 0.0 +/- 0.2; filled, 0.1 +/- 0.4). Multivariate analysis revealed significant risk factors for dental caries were: the geographical location of the school (adjusted OR=2.24; 95% CI: 1.01-4.94), occupational status of the father (adjusted OR=2.83; 95% CI: 1.05-7.62) and the child's attitude about dental caries (adjusted OR=2.35; 95% CI: 1.18-4.67). Knowledge and oral hygiene habits were not associated with dental caries. The results of this study suggest the need to change from restoration orientated dentistry to dental public health care services, to reduce of the high level of dental caries in this age group.

Combined effects of hypertension and diabetes mellitus with stroke among Thais in the central region of Thailand: a cross-sectional study.

OBJECTIVE: To determine associations of individual and combined effects of hypertension and diabetes with stroke among Thais aged 55 years and older MATERIAL AND METHOD: Cross-sectional data from national screening program for metabolic syndrome in Thailand for the year 2010 among participants who lived in central region of Thailand were used. The number of participants was 13,268 in the analysis. RESULTS: The prevalence of stroke was 0.9%. Associations between hypertension and diabetes found among participants who had hypertension only, diabetes only, and both hypertension and diabetes were: 8.99 (95% CI 4.63-17.43), 3.72 (95% CI 1.03-13.37), 10.48 (95% CI 4.54-24.20) among males and 5.16 (95% CI 2.29-11.53), 6.55 (95% CI 2.19-19.55), and 9.29 (95% CI 3.81-22.68) among females, respectively. CONCLUSION: The present study suggested dramatically the strong effects of the association of combined hypertension and diabetes with stroke. Strengthening health promotion programs for the prevention of hypertension, diabetes, especially having both diseases after screening, is important among Thai population.

Prevalence and factors associated with metabolic syndrome among a group of Thai working population: a cross sectional study.

OBJECTIVE: To determine prevalence and factors associated with metabolic syndrome (MetS) among employees of the Electricity Generating Authority of Thailand based in Bangkok. MATERIAL AND METHOD: The present study was conducted among 2,544 participants (1,875 men, 669 women) enrolled in the cohort study of Faculty of Medicine, Ramathibodi Hospital. Baseline cross sectional data in 2009 was analyzed. The MetS was defined using NCEP ATP III criteria. Odds ratios (OR) and 95% confidence interval (95% CI) stratified by gender were computed. RESULTS: Overall prevalence of metabolic syndrome was 16.6%, 18.2% in males and 10.3% in females. More than half of the participants had a low intensity of physical activity. Significant non-modified factors associated with MetS among males were increased age (OR = 1.02; borderline 95% CI 1.00-1.04), levels of education were bachelor degree and lower compared with higher than bachelor degree (OR = 1.87; 95% CI 1.20-2.91 and OR = 2.28; 95% CI 1.32-3.93), working in a middle and lower type of job (OR = 1.44; 95% CI 1.01-2.05, OR = 2.08; 95% CI 0.98-4.40) compared with a high-end type of job. For females, significant factors associated with MetS were increased age (OR = 1.08; 95%CI 1.02-1.15), having middle income compared with high income (OR = 3.01; 95% CI 1.28-7.06). CONCLUSION: Modified risk factor in low physical activity should be managed by increased intensity of physical activity among participants in a low and middle type of job and income to reduce cardiovascular risk.

Screening high-risk population for hypertension and type 2 diabetes among Thais.

BACKGROUND: waist circumference (WC) and body mass index (BMI) are simple screening tools for hypertension (HT) and type 2 diabetes (DM). Cutoffs of WC for BMI for Asians have been discussed. This study aimed to assess the accuracy of screening tools and associations of WC, BMI with HT and DM. METHODS: Data from the national screening programme for metabolic syndrome conducted in 2010 in 21 provinces in the central region of Thailand were analysed. A total of 10 748 participants aged >35 years were included in the analysis with cutoffs of WC set at 90 cm for men, 80 cm for women, and BMI at 23 kg/m2 for both sexes. RESULTS: WC produced low sensitivity and high specificity among male participants, and moderate sensitivity and specificity among female participants, while BMI produced moderate sensitivity and specificity in both sexes. Significant associations were found among those who had high WC only, high BMI only, and both high WC and BMI with HT and DM in both sexes. (males for HT, OR=1.63, 95%CI: 1.15-2.33, OR=1.22, 95%CI: 1.03-1.44 and OR=2.03, 95%CI: 1.07-2.42; males for DM, OR=1.39, 95%CI: 1.05-1.83), OR=1.77, 95%CI: 1.07-2.94 and OR= 2.05, 95%CI: 1.57-2.69, females for HT, OR=1.69: 95%CI 1.38-2.07, OR=1.32; 95%CI: 1.09-1.60 and OR=2.54, 95%CI: 2.11-2.91; females for DM, OR=1.45, 95%CI: 1.08-1.94, OR=1.45, 95%CI: 1.09-1.91 and OR=1.70, 95%CI: 1.39-2.09). When the cutoff WC was lowered among male participants to 85 cm, sensitivity increased, and significant strengths of associations with HT and DM were nearly the same. CONCLUSION: For Thailand, WC and BMI with appropriate cutoffs can be effective screening tools to recruit high-risk populations into health promotion programmes. However, WC and BMI should be implemented with other screening tools for other risk factors because of their moderate accuracy.

Association between hypertension and stroke among young Thai adults in Bangkok, Thailand.

A hospital based case-control study was conducted to assess the association between hypertension and stroke among young Thai adults at a private hospital in Bangkok, Thailand. The study population was comprised of 98 inpatients with a first diagnosis of stroke and 98 inpatients without stroke admitted from 2006 to 2008, aged 18-45 years. Cases were matched with controls by sex and five year age group intervals. Risk factors for stroke, including hypertension were collected using a questionnaire. Significant finding on physical examination and blood testing were obtained from the patients' charts. Multivariate analysis revealed significant risk factors for stroke were: diagnosis of hypertension (adjusted OR 8.94; 95% CI 1.47-54.34), family history of stroke (adjusted OR 16.15; 95% CI 1.71-151.82), history of no or irregular exercise (adjusted OR 8.06; 95% CI 1.12-57.60) and having a low high density lipoprotein level (adjusted OR 5.93; 95% CI 1.11-31.52). Hypertension was the greatest risk factor for stroke among young Thai adults. Modification of lifestyle to reduce risk for stroke should focus on exercise, regular health check-ups and adequate treatment of hypertension.

Roles of parents in preventing dental caries in the primary dentition among preschool children in Thailand.

This study aimed to identify important roles of parents in preventing caries in primary dentition among preschool children in Thailand. A total of 664 preschool children aged 3 to 4 years and their parents were sampled from representative provinces of the 5 regions of Thailand. Dental examination to assess dental caries in preschool children was conducted. Questionnaires investigating roles of parents in caring for their children's teeth were used to interview parents. Preschool children were more likely to have at least 1 carious tooth if parents did not always clean their teeth every time they bathed them, did not always examine the cleanliness of children's teeth regularly, and always allowed children to consume snacks more than 3 times a day. Thai parents must be motivated to consistently spend the time required to take care of the primary dentition of their children by regular cleaning and controlling the snacking behavior of children.

Association between an unhealthy lifestyle and other factors with hypertension among hill tribe populations of Mae Fah Luang District, Chiang Rai Province, Thailand.

An unhealthy lifestyle may lead to hypertension which can cause strokes and cardiovascular disease. The aim of this study was to identify the specific unhealthy lifestyle practices which could cause hypertension among hill tribe populations in Mae Fah Luang District of Chiang Rai Province, Thailand. In 2006, 196 patients with hypertension were selected from 2 district hospitals and 13 health centers as cases, and 196 normotensive subjects from a local neighborhood were chosen as controls. Trained health personnel collected data by interviewing subjects from both groups regarding unhealthy lifestyles and other factors. All participants had a physical examination at the time of interview. The results from multiple logistic regression analysis show the factors associated with hypertension among the hill tribe people studied were smoking (OR 2.48; 95% CI 1.43-4.30, p = 0.001), no or irregular exercise (OR 1.84; 95% CI 1.16-2.99, p = 0.005), being overweight (OR 2.96; 95% CI 1.69-5.18, p < 0.002), having obesity (OR 2.65, 95% CI 1.04-6.73, p < 0.018) and having a high frequency intake of fatty foods (OR 1.98, 95% CI 1.23-3.18, p < 0.013). The findings suggest the need for significant lifestyle changes in regards to smoking, eating habits and leisure time exercise programs. The adoption of such lifestyle changes would result in a reduced chance of being hypertensive, which could later reduce cardiovascular morbidity and mortality.

Association between nutritional status and dental caries in permanent dentition among primary schoolchildren aged 12-14 years, Thailand.

This cross-sectional study assessed associations between nutrition and dental caries in permanent dentition and identified oral hygiene indicators among older children aged 12-14 years in primary schools in Thailand. The study was comprised of 862 schoolchildren from five provinces representing five regions of Thailand, from both rural and urban areas, including Bangkok. The dental hygeine status was assessed by evaluating for decayed teeth, missing teeth due to decay, and filled teeth index (DMFT index). Weight and height were measured to evaluate the nutritional status; hygiene practices assessed by interview. The results show a negative relationship between nutritional status and the DMFT index, which increased when the nutritional status decreased (Spearman's rho correlation = -0.140, p < 0.001). The results from multiple logistic regression analysis showed normal weight and thin schoolchildren were more likely to have a DMFT of at least 1 by 1.94 times (OR = 1.94; 95%CI = 1.25-3.00, p = 0.004) and 2.22 times (OR = 2.22; 95%CI = 1.20-4.09, p = 0.001), respectively, compared to overweight and obese children. Normal and thin schoolchildren had a higher risk for dental caries than overweight and obese children aged 12-14 years in Thailand. School health promotion activities should emphasize eating habit improvement in order to reduce the incidence of caries.

Risk factors for multi-drug resistant Acinetobacter baumannii nosocomial infection.

OBJECTIVE: To assess factors associated with multi-drug resistant Acinetobacter baumannii (MDR-AB) nosocomial infection. MATERIAL AND METHOD: This hospital-based case-control study was conducted in patients admitted to Siriraj Hospital, Bangkok, Thailand between January 1, 2005 and December 31, 2005. The study population consisted of 155 cases with MDR-AB nosocomial infection and 310 controls without nosocomial infection. The cases were matched with controls by age and ward of admission with a ratio of 1:2. RESULTS: The average age of the present study population was 63.5 +/- 18.7 years among cases and 62.9 +/- 18.2 years among controls. The mean of length of stay in hospital among cases was 4.9 +/- 1.4 weeks and controls 1.8 +/- 1.0 weeks. The most common site of MDR-AB nosocomial infection was lower respiratory tract (74.8%). The antimicrobial susceptibility of MDR-AB was 3.9% to cetriaxone and 42.1% to cefoperazone/sulbactam. Multiple logistic regression analysis showed the following associated factors with MDR-AB nosocomial infection: duration of admission prior to MDR-AB nosocomial infection > 1 week (OR = 2.06; 95% CI 1.09-3.89), indwelling urinary catheter > 1 week (OR = 8.24; 95% CI 3.81-17.82), mechanical ventilation > 1 week (OR = 5.73; 95% CI 2.96-11.10), central venous line > 1 week (OR = 3.29; 95% CI 1.48-7.31), nasogastric intubation > 1 week (OR = 6.22; 95% CI 3.24-11.93), prior administration of 3rd-4th generation cephalosporins (OR = 1.80; 95% CI 1.04-3.13), metrodazole (OR = 2.59; 95% CI 1.21-5.56), and piperacillin-tazobactam (OR = 4.68; 95% CI 1.93-11.32). CONCLUSION: A case-control study in medical and surgical patients in Siriraj Hospital in 2005 revealed risk factors for AB nosocomial infection. Prolonged admission of more than 2 weeks, use of devices, and prior treatment with certain antimicrobials were found to be significant risk factors for the infection. To reduce the infection, strict infection control measures must be applied to the patients with these risk factors. Education to medical personnel and enforcement of infection control practices are all needed to reduce antimicrobial resistant bacterial nosocomial infection.

Associations between serum lipids and causes of mortality in a cohort of 3,499 urban Thais: The Electricity Generating Authority of Thailand (EGAT) study.

The association between serum lipids and mortality has not previously been established in Thailand. Baseline data from the Electricity Generating Authority of Thailand (EGAT) cohort study, plus a resurvey of the cohort 15 years later were analyzed. Participants were employees of EGAT: 2,702 men and 797 women. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were taken as predictive variables; age, sex, hypertension, diabetes, cigarette smoking, alcohol drinking, and body mass index were taken as confounders. Dependent variables were all-causes and specific causes of mortality over 17 years of follow-up. The major cause of death among men was cardiovascular disease (CVD); among women, it was cancer. Relative risks (RR) for specific causes of death, for a mmol/L increase in each lipid, were estimated after adjustment for confounding factors using Cox proportional hazards regression. TC and LDL-C were negatively associated with liver cirrhosis mortality, although it was likely that the low cholesterol concentration was a consequence of the disease. HDL-C was negatively associated with CVD mortality (RR = 0.59; 95% confidence interval [CI], 0.39-0.93), coronary heart disease (CHD) mortality (RR = 0.36; 95% CI, 0.17-0.75) and all cause-mortality (RR = 0.68; 95% CI, 0.54-0.87). TG was not associated with mortality. HDL-C is an important risk factor for CVD in middle-class urban Thais. Health promotion programs to improve lipid profiles, such as effective exercise campaigns and dietary advice, are required to increase HDL-C and to help prevent CVD and premature death in Thailand.

Survival of patients with advanced non-small-cell lung cancer at Ubon Ratchathani Cancer Center, Thailand.

This survival analysis was conducted at Ubon Ratchathani Cancer Center to determine the prognostic factors for survival of patients with stage IIIA, stage IIIB, and stage IV non-small-cell lung cancer (NSCLC) patients treated at the center between 1997-2001. The study sample included 210 patients with non-small-cell lung cancer. Diagnosis and staging were defined employing the TNM system. The majority of lung cancer patients were smokers (66.7%), lived in Ubon Ratchathani Province (40.0%), male (77.6%), and agriculturalists (74.8%). Seventy-seven percent of patients died within five years, 19.5% were lost to follow-up and 2.9% were still alive in 2003. The estimated median survival time was 6.3 months (95% CI 5.4-7.3); the median survival times for stages IIIA, IIIB, and IV were 16.3, 7.0, and 4.5 months, respectively. The overall 1-, 2- and 3-year survival rates of NSCLC were 28.9, 7.9, and 3.3, respectively. The differences in survival of patients in the various stages of the disease were statistically significant (p < 0.0001), adjusted for age and sex. Treatment with combination methods and at an early stage in the disease were associated with significant prolongation of survival. For stage IIIA, the estimated median survival times by treatment with chemotherapy was 7.0 months, radiotherapy was 16.0 months, surgery and others 16.3 months, and chemotherapy plus radiotherapy was 19.5 months. However, only chemotherapy versus surgery and others was significantly different (p = 0.0307). The median survival times for stage IIIB patients treated with chemotherapy, radiotherapy, surgery and others, chemotherapy and radiotherapy, and supportive treatment were 7.0, 7.0, 9.0, 14.7, and 3.0 months, respectively. The differences between surgery and others versus supportive treatment, chemotherapy and radiotherapy versus supportive treatment were significantly different (p = 0.0392, p = 0.0433, respectively). For stage IV, the median survival times for patients treated with chemotherapy, radiotherapy, chemotherapy and radiotherapy, and supportive treatment were 5.0, 4.3, 6.5, and 1.0 months, respectively. The differences between chemotherapy, radiotherapy, chemotherapy and radiotherapy versus supportive treatment, all were significantly different (p = 0.0020, p < 0.0001, p < 0.0001, respectively). The 2-year survival rates for stages IIIA, IIIB, and IV were 16.0, 4.1, and 2.2%, respectively. The results of the study show that stage IIIA has the longest survival time. They also show that appropriate treatment is a significant factor in improving the survival of lung cancer patients.