The effectiveness of community-based interprofessional education for undergraduate medical and health promotion students.

BACKGROUND: Community-based interprofessional education (CBIPE) has been proven effective in enhancing the interprofessional competencies of medical and health professional students. However, there is a lack of evaluation on the impact of experiential CBIPE among undergraduate medical and health promotion students in Thailand. Therefore, the objective of this study is to assess the influence of CBIPE learning on the collaborative competencies of these students. METHODS: A one-group pre-posttest design in 193 (152 medical students and 41 health promotion) students were involved in the CBIPE program, later divided into 12 groups. Data was collected by direct observations of mentors using the Interprofessional Collaborative Competencies Attainment Survey (ICCAS). The Wilcoxon matched-pairs signed-rank test was conducted to evaluate the effectiveness of the CBIPE program. RESULTS: A total of 175 (90.67%) completed ICCAS and satisfaction questions before and after the CBIPE program. The mean age of respondents was 20.29 ± 1.63 years; 60.57% were women and 39.43% were men. The results showed a significant increase in collaborative competencies before and after the 2-week course. Gender-stratified analysis showed an improvement after CBIPE training for all subscales in women, while the communication, collaboration, conflict management, and functioning team skills segment score was significantly higher in the post-assessment among men. CONCLUSION: The implementation of CBIPE learning was successful in enhancing collaborative competencies among both medical and health promotion students. These findings will provide valuable insights for the design and improvement of CBIPE learning programs in other universities.

National survey: Evaluation of cardiovascular risk factors in Thai patients with type 2 diabetes and chronic kidney disease after the development of cardiovascular disease.

AIM: The aim of the present study was to evaluate the achievement in controlling the risk factors of cardiovascular diseases (CVD) in Thai patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). METHODS: The DMHT dataset from 2011 to 2012, which was the cross-sectional study of the national survey in Thai patients with T2DM was analyzed. RESULTS: There were 1254 of 15 149 diabetic patients with estimated glomerular filtration rate (eGFR) less than 60 mL/min per 1.73 m2 that had developed CVD for more than 12 months. The prevalence of CVD was 8.3%. The mean age in years was 68.2 with a standard deviation (SD) of 8.7. Males and females were 38.7 and 61.3%, respectively. The mean duration of diabetes was 8.5 (SD 0.2) years. The mean body mass index was 25.5 (SD 4.4) kg/m2 . The percentage of patients with the target level of blood pressure control at ≤130/80 mm Hg was 47.1%. The percentage of patients who received angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) was 58.9%. The percentage of patients with the target level of LDL control at <70 mg/dL was 17.2%. The percentage of patients with the target level of HbA1C at 7% was 39.2%. There were 63 (5.0%) patients having recurrent CVD. CONCLUSIONS: Most Thai patients with T2DM and CKD with eGFR < 60 mL/min per 1.73 m2 could not achieve the therapeutic goals after the development of CVD. The national health policy should be planned to improve the quality of care to increase the number of patients who achieve the recommended goals.

The impact of the quality of care and other factors on progression of chronic kidney disease in Thai patients with Type 2 Diabetes Mellitus: A nationwide cohort study.

OBJECTIVE: The present study investigates the impact of quality of care (QoC) and other factors on chronic kidney disease (CKD) stage progression among Type 2 Diabetes Mellitus (T2DM) patients. METHODS: This study employed a retrospective cohort from a nationwide Diabetes and Hypertension study involving 595 Thai hospitals. T2DM patients who were observed at least 2 times in the 3 years follow-up (between 2011-2013) were included in our study. Ordinal logistic mixed effect regression modeling was used to investigate the association between the QoC and other factors with CKD stage progression. RESULTS: After adjusting for covariates, we found that the achievement of the HbA1c clinical targets (≤7%) was the only QoC indicator protective against the CKD stage progression (adjusted OR = 0.76; 95%CI = 0.59-0.98; p<0.05). In terms of other covariates, age, occupation, type of health insurance, region of residence, HDL-C, triglyceride, hypertension and insulin sensitizer were also strongly associated with CKD stage progression. CONCLUSIONS: This cohort study demonstrates the achievement of the HbA1c clinical target (≤7%) is the only QoC indicator protective against progression of CKD stage. Neither of the other clinical targets (BP and LDL-C) nor any process of care targets could be shown to be associated with CKD stage progression. Therefore, close monitoring of blood sugar control is important to slow CKD progression, but long-term prospective cohorts are needed to gain better insights into the impact of QoC indicators on CKD progression.

Prevalence of chronic kidney disease associated with cardiac and vascular complications in hypertensive patients: a multicenter, nation-wide study in Thailand.

BACKGROUND: Hypertension and chronic kidney disease (CKD) are common conditions and both are major risk factors for cardiovascular events. The objectives were 1) to study the prevalence of CKD in hypertensive patients and 2) to study the association of CKD with cardiac and vascular complications in a multicenter, nation-wide fashion. METHODS: This cross-sectional study evaluated patients aged 20 years or older who were diagnosed with hypertension and who had been treated for at least 12 months at 831 public hospitals in Thailand during the 2012 study period. Outcome measurements included calculated glomerular filtration rate (GFR) and cardiac and vascular complications that included coronary artery disease, stroke, peripheral arterial disease, heart failure, and atrial fibrillation. Multivariable modeling was conducted to determine independent factors associated with increased risk of cardiac and vascular complications. RESULTS: A total of 28770 patients were enrolled. Average age was 62.8 years and 37% were male. Prevalence of CKD stage 3 and 4-5 was 33.2 and 4.3%, respectively. Prevalence of cardiac and vascular complications was 10.5% (5% having coronary artery disease, 3.9% stroke, 1.7% heart failure, and 1.2% atrial fibrillation). CKD was an independent risk factor associated with each of the complications and overall cardiac and vascular complications with an adjusted Odds ratio of 1.4 for CKD stage 3 and 1.9 for CKD stage 4-5. CONCLUSION: Prevalence of CKD stage 3-5 in hypertensive population was 37.5%. CKD is an independent risk factor for adverse cardiac and vascular outcome.

Association of serum high-sensitivity C-reactive protein with metabolic control and diabetic chronic vascular complications in patients with type 2 diabetes.

AIMS: To determine an association between hs-CRP and metabolic control/diabetic chronic vascular complications (DCVCCxs) in the patients with type 2 diabetes (DM). In addition, the possibility of using hs-CRP levels to predict risk of DCVCCxs will also be validated. METHODS: This cohort study randomly enrolled 608 patients with DM during the 2007-2008 study period. We also recorded basic laboratory findings at baseline and at one year, to include fasting plasma glucose, HbA1c, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and hs-CRP. RESULTS: Logistic regressions of odds ratios between hs-CRP and DCVCCxs (coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy) showed significant correlations, except for cerebrovascular disease, as follows 0.2 (0.11-0.38), 0.09 (0.01-0.77), 0.06 (0.02-0.16), 0.31 (0.12-0.82), and 0.17 (0.07-0.43), respectively. Linear regression for changes in hs-CRP were significantly correlated with HbA1c (r=0.38), fasting plasma glucose (r=0.40), triglyceride (r=0.20), low-density lipoprotein cholesterol (r=0.12), and high-density lipoprotein cholesterol (r=-0.12). No correlation was found for total cholesterol (r=0.06). Based on receiver operating characteristic (ROC) analysis, the cut-off points for hs-CRP levels for prediction of DCVCCxs were 2.89, 2.25, 2.10, 2.25, and 2.82mg/L, for coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy, respectively. CONCLUSIONS: Our data showed that DCVCCxs were associated with hs-CRP in patients with DM. The cut-off point for hs-CRP can be used to predict association with DCVCCxs. Well-controlled metabolic components in diabetic patients, especially HbA1c, fasting plasma glucose, and triglyceride may reduce the level of hs-CRP.

Breast Cancer Detection Rate, Incidence, Prevalence and Interval Cancer-related Mammography Screening Times among Thai Women.

BACKGROUND: A recent guideline by the American Cancer Society recommended that mammography (MMG) should be done for women starting in their mid-40s. In Thailand, information on opportunistic mammography screening is limited and data on the total incidence of breast cancer are also lacking. The purpose of this study was to estimate the breast cancer detection, incident and prevalence rates among Thai women. MATERIALS AND METHODS: We retrospectively reviewed the opportunistic mammography screening of normal women between 30 and 80 years who underwent the procedure between 2001 and 2010. All cases were followed until 2012. The detection rate was calculated for the whole period of observation using 'number of women with positive findings' divided by 'total number of women screened'. The incidence rate was calculated only at the first MMG while the subsequence rate was calculated based on all new cases detected at each subsequent MMG. RESULTS: Among the 47,430 women, there were 152,091 MMGs or approximately 3.2 occasions per person (range, 1-10). The average duration of the interval between each subsequence visit was 1.8 years. Overall, breast cancer was detected in 543 women, with a detection rate of 10.3 per 1,000 persons. The prevalence rate of breast cancer at the first visit was 5.78 per 1,000 persons. The incidence or new cases detected at any follow-up visit was 10.4 per 1,000 persons. The overall interval cancer was 0.91 per 1,000 women, mainly detected before their second and third MMG, with a rate of 0.0.47 and 0.76 per 1,000 women. CONCLUSIONS: Opportunistic mammography screening in Thailand detected 10 cases of breast cancer from each 1,000 women. This paper indicated a high rate of cancer detection during a two year interval, hence, a screening mammogram should be performed more often.

Movement Disorders in Non-Wilsonian Hepatic Cirrhotic Patients: The Subgroup Analysis of Various Phenotypes and Associated Risk Factors.

OBJECTIVE: The aim of this subgroup analysis was to identify the risk factors associated with the development of various movement disorder phenotypes. METHODS: Eighty-three non-Wilsonian cirrhotic patients with abnormal movements were allocated into the following groups: intention tremor, bradykinesia, Parkinsonism, and abnormal ocular movements. These movement types were considered the primary outcomes as there was a sufficient sample size. Researchers took into consideration the gender, etiologies of cirrhosis, cirrhosis-related complications, hepatic encephalopathy, medical illness, and some neurological deficits as potential factors associated with these movement disorders. RESULTS: The male gender (p = 0.002) and alcoholic cirrhosis (p = 0.005) were significant factors for the prevalence of intention tremors. In bradykinesia, hepatic encephalopathy was highly statistically significant (p < 0.001), and females more commonly developed bradykinesia (p = 0.04). The Parkinsonism features in this study were confounded by hyperlipidemia (p = 0.04) and motor or sensory deficits (p = 0.02). Jerky pursuits and a horizontal nystagmus were detected. Jerky pursuits were significantly related to hepatic encephalopathy (p = 0.003) and bradykinesia, but there were no factors associated with the prevalence of nystagmus other than an intention tremor. CONCLUSIONS: The association of alcoholic cirrhosis with the development of intention tremor indicates that the persistent cerebellar malfunction in cirrhotic patients is due to alcohol toxicity. The slowness of finger tapping and jerky pursuit eye movements are significantly associated with hepatic encephalopathy. Thus, further studies are needed to evaluate the diagnostic value of these two signs for an early detection of mild hepatic encephalopathy.

Prevalence and associating factors of atrial fibrillation in patients with hypertension: a nation-wide study.

BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia and increases risk of ischemic stroke. Data on the prevalence of AF in Thailand is lacking especially in patients with hypertension. The objectives of this study were to determine prevalence of AF in patients with hypertension and to determine factors that are associated with increased prevalence of AF in a multicenter nationwide study. METHODS: A cross-sectional survey for the national outcome evaluation among hypertensive patients visiting 831 public hospitals in Thailand was conducted between 2011 and 2012 to evaluate status of standard care in hypertensive patients visiting public Thailand Ministry of Public Health (MoPH) hospitals. Inclusion criteria were hypertensive patients aged at least 20 years who had received medical care in the targeted hospital for at least 12 months. The main outcome measurement was AF rhythm, and was measured along with potential risk factors age, gender and cardiovascular risk factors. RESULTS: There were 13207 hypertensive patients who had ECG data recorded during the survey. AF was detected in 457 patients (3.46 %). Prevalence of AF increased with increasing age, was more common in males and in patients with chronic kidney disease (CKD). Multivariable modelling was conducted to assess which factors were most associated with increased prevalence of AF, and the results showed older age followed by male gender, low LDL-cholesterol and increased uric acid levels were the most important risk factors for AF in this population. CONCLUSIONS: Prevalence of AF in hypertensive patients was 3.46 %. Factors associated with increased risk of AF are old age, male gender, low LDL-cholesterol and elevated uric acid level.

Movement Disorders in Non-Wilsonian Cirrhotic Patients: A Report of the Prevalence and Risk Factors from a Study Done in a Medical School in an Agricultural-Based Community.

OBJECTIVE: Parkinsonism and other movement disorders have previously been reported in the acquired hepatocerebral degeneration associated with portosystemic shunting. However, there is no study to date about their prevalence as has been noted in general practice. METHODS: One hundred and forty-three patients with hepatic cirrhosis from the gastroenterology clinic and internal medicine wards were enrolled. Liver data included the diagnoses, etiologies, assessments of complications, and treatments for cirrhosis. Hepatic encephalopathy was classified with regard to the West Haven criteria for semi-quantitative grading for mental status. Neurological examination results and abnormal involuntary movements were recorded as primary outcomes. Neuro-radiology was used for the detection of severe brain lesions. RESULTS: Alcoholism was the most common cause of liver cirrhosis. Eighty-three patients (58%) presented with movement disorders. Asterixis was found in one of the cases. The most common movement disorder seen was an intentional tremor at 37.1%, which was followed by bradykinesia, Parkinsonism, and postural tremors at 29.4%, 10.5%, and 6.3%, respectively. The prevalence of movement disorders simultaneously increased with a high Child-Turcotte-Pugh score. The hepatic encephalopathy was grade 1 and 2. With the inclusion of age-range adjustments, we found that alcoholic cirrhosis and hepatic encephalopathy are statistically significant factors [p < 0.05, odds ratio (OR) = 6.41, 95% confidence interval (CI) 1.38-29.71 and p < 0.001, OR = 13.65, 95% CI 4.71-39.54] for the development of movement disorders in non-Wilsonian cirrhotic patients. CONCLUSIONS: Intentional tremor is a common abnormal movement. Alcoholic cirrhosis and hepatic encephalopathy are significant risk factors in the development of movement disorders in non-Wilsonian cirrhotic patients.

Factors Related to Erythropoietin Hyporesponsiveness in Peritoneal Dialysis Patients with Anemia.

Background: Anemia in peritoneal dialysis (PD) patients can be improved after treatment with erythropoietin (EPO). However, several factors previously reported can cause EPO hyporesponsiveness including nutritional deficiency, infection or inflammation, secondary hyperparathyroidism with bone marrow fibrosis, angiotensin converting enzyme inhibitor (ACEI) administration, and dialysis inadequacy. Correction of these factors may lower doses and costs of EPO for these patients. Objective: To calculate the prevalence of EPO hyporesponsiveness and the associated factors in PD patients with anemia. Material and Method: We reviewed medical records of 195 PD patients who received EPO treatment during January 2000 to June 2013.The doses of EPO were titrated maximally to 8,000 U/week to maintain a target Hematocrit (Hct) level between 33% and 36%. PD patients Hct less than 30% before and after EPO administration for 3 months were included in this study. There were 44 patients who were recruited by the criteria. They had no history of bleeding or red cell transfusions within 2 months. The EPO resistance index (ERI) was calculated as weekly EPO doses per Hct levels per kilograms body weight (kg). The EPO hyporesponsiveness was defined as the weekly EPO doses was >150 U/kg. The relationship between the ERI and continuous parameters was calculated by the student's t-test. Chi-square and Fisher's exact correlation were performed to analyze the relationship between ERI and categorical variables. The p-value <0.05 was considered statistically difference. Results: There were 13 (6.7%) patients having Hct less than 33% after the administration EPO >150 U/kg/week for 3 months. The statistically significant relationship between ERI and gender was detected. Female had higher rate of having EPO hyporesponsiveness (p = 0.02). Conclusion: The prevalence of EPO hyporesponsiveness was 6.7%. Female gender was a factor related to EPO hyporesponsiveness in our study.

Factors Associated with Survival Outcomes of Febrile Neutropenia in Hematologic Malignancy Patients.

Background: Febrile neutropenia (FN) is a common, life-threatening complication of hematologic malignancy patients who receive chemotherapy. The assessment of the epidemiology and related factors are necessary to improve survival outcomes of FN. Objective: To determine the epidemiology of FN and investigate the factors that are associated with outcomes of FN. Material and Method: This study is a retrospective cohort study. Medical records between 2012 and 2014 of fifty FN patients of the Her Royal Highness (HRH) Princess Maha Chakri Sirindhorn Medical Center were reviewed. Results: Of the 50 episodes with FN, the median age was 35.5 years (range from 15 to 81 years), and 39 patients (78%) were younger than 60 years of age. Thirty-three patients (66%) were treated with the first-line chemotherapy. Source of infections could not be identified in 58% of patients. For patients with a definite source of infection, 14% were lower respiratory tract infections. Gram-negative bacteria were more common than gram-positive organisms as found in blood cultures. The multivariate analysis has confirmed a significant association with no weight loss greater than 5% within 1 month (p<0.05), no blood loss requiring intravenous fluid (p = 0.01), and low Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.01) associated with survival outcomes of FN. The overall mortality was 28%. Conclusion: There was a high mortality rate in neutropenic patients with fever. The no significant weight loss, no blood loss requiring intravenous fluid, and low APACHE II score at the time of diagnosed FN were found to be associated factors with survival outcomes.

FACTORS ASSOCIATED WITH DIABETIC RETINOPATHY AMONG TYPE 2 DIABETIC PATIENTS: A HOSPITAL BASED CASE-CONTROL STUDY.

The objective of this study was to determine factors associated with diabetic retinopathy (DR) among type 2 diabetics in Thailand. We conducted a hospital based case-control study in Nakhon Nayok Province, between August 2008 and July 2010. The subjects were comprised of 230 cases (with DR) and 230 controls (without DR) who were gender and age matched. All subjects were interviewed and their medical records were reviewed. Seventy-five percent of subjects were married and 42% were aged 60-69 years. Fifty-five percent had a primary school education, 27% had no occupation and 67% had family income > 10,000 Baht per month. On multiple logistic regression analysis, factors associated with DR were: having a fasting plasma glucose (FPG) of 141-160 mg/dl, 161-180 mg/dl and > 180 mg/dl [OR = 7.23; 95% confidence interval CI: 2.80-18.72; OR = 4.33; 95% CI: 1.66-11.33, and OR = 3.76; 95% CI: 1.39-10.18], having a HbA1c > 9% (OR = 2.26; 95% CI: 1.15-4.43), having a BMI ≥ 30 kg/m2 (OR = 2.09; 95% CI: 1.04-4.19), and having hypertension (OR = 1.80; 95% CI: 1.19-2.71). Elevated blood sugar, blood pressure and body weight are all associated with DR. Further study is needed to determine if controlling these factors could reduce the prevalence of DR.

The Thai version of the Montreal Children's Hospital Feeding Scale (MCH-FS): psychometric properties.

OBJECTIVE: To standardize and evaluate the psychometric properties of the Thai version of the Montreal Children's Hospital Feeding Scale (MCH-FS). MATERIAL AND METHOD: The MCH-FS was translated and the cultural effects of the Thai version (Thai.MCH-FS) were reviewed. Caregivers of 200 children between the age of12 and 48 months were interviewed and completed the Thai.MCH-FS. In addition to demographic information, each child had a physical exam and anthropometric measures were taken. Each child was classified with or without feeding problems by at least two of three pediatricians who were blind to the results of the feeding scale. RESULTS: Internal consistency for reliability was high (Cronbach's alpha at 0.835). The area under the ROC curve was 0.864. With a discrimination score of 40, both sensitivity (72%) and specificity (80.67%) were at acceptable levels. Factor analysis resulted in three factors accounting for 52.3%. Of the 200 children, 150 children were classified with nofeedingproblems and 50 with feeding problems. There were no significant differences in the characteristics of the two groups; however the Thai.MCH-FS scores were significantly different for the two groups. CONCLUSION: The Thai version of the MCH-FS has been shown to be a valid and reliable short scale for detecting feeding problems in a pediatric care setting.

Association between serum uric acid level and microalbuminuria to chronic vascular complications in Thai patients with type 2 diabetes.

AIMS: To investigate an association between serum uric acid/microalbuminuria and chronic micro/macro-vascular complications in type 2 diabetic patients. METHODS: This cross-sectional study enrolled 608 patients with type 2 diabetes. All subjects were examined and basic information on health of the subjects was recorded for inclusion criteria. Several chemical parameters (fasting plasma glucose, triglyceride, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, uric acid, and microalbuminuria), and related chronic vascular complications were measured and recorded in data forms. RESULTS: Logistic regressions were used to analyse odds ratios between uric acid/microalbuminuria levels and several chronic vascular complications. Prevalence of chronic vascular complications in T2DM patients, namely coronary arterial disease, cerebrovascular disease, diabetic nephropathy, diabetic retinopathy, and diabetic peripheral neuropathy was significantly correlated with increase of uric acid level [2.29 (1.01-5.2), 16.01 (4.74-54.09), 9.99 (4.4-22.8), 4.43 (1.3-15.1), 4.37 (1.5-12.9)], and of microalbuminuria level [7.0 (3.6-13.8), 3.2 (1.2-8.7), NA, 14.7 (5.1-42.7), 7.2 (2.9-17.7)]. CONCLUSION: Both elevated uric acid and microalbuminuria levels were significantly associated with diabetic chronic micro/macro-vascular complications. Monitoring of uric acid and microalbuminuria levels provides a predictive value for a presence of chronic micro/macro-vascular complications in patients with type 2 diabetes.

Reduction of atherogenic risk in patients with type 2 diabetes by curcuminoid extract: a randomized controlled trial.

Curcumin is a phytocompound found in the root of turmeric, a common herbal ingredient in many Asian cuisines. The compound contains anti-inflammatory activity, which is mediated through an up-regulation of adiponectin and reduction of leptin. Consumption of curcumin was shown to prevent some deteriorative conditions caused by inflammation, such as ulcerative colitis, rheumatoid arthritis and esophagitis, and so on. Inflammation-associated cardiovascular conditions such as atherosclerosis are common in diabetes patients. The anti-inflammation effect of curcumin might be beneficial to prevent such condition in these patients. We aim to evaluate an antiatherosclerosis effect of curcumin in diabetes patients. Effects of curcumin on risk factors for atherosclerosis were investigated in a 6-month randomized, double-blinded and placebo-controlled clinical trial that included subjects diagnosed with type 2 diabetes. An atherosclerosis parameter, the pulse wave velocity, and other metabolic parameters in patients treated with placebo and curcumin were compared. Our results showed that curcumin intervention significantly reduced pulse wave velocity, increased level of serum adiponectin and decreased level of leptin. These results are associated with reduced levels of homeostasis model assessment-insulin resistance, triglyceride, uric acid, visceral fat and total body fat. In summary, a 6-month curcumin intervention in type 2 diabetic population lowered the atherogenic risks. In addition, the extract helped to improve relevant metabolic profiles in this high-risk population.

Curcumin extract for prevention of type 2 diabetes.

OBJECTIVE: To assess the efficacy of curcumin in delaying development of type 2 diabetes mellitus (T2DM) in the prediabetic population. RESEARCH DESIGN AND METHODS: This randomized, double-blinded, placebo- controlled trial included subjects (n = 240) with criteria of prediabetes. All subjects were randomly assigned to receive either curcumin or placebo capsules for 9 months. To assess the T2DM progression after curcumin treatments and to determine the number of subjects progressing to T2DM, changes in ß-cell functions (homeostasis model assessment [HOMA]-ß, C-peptide, and proinsulin/insulin), insulin resistance (HOMA-IR), anti-inflammatory cytokine (adiponectin), and other parameters were monitored at the baseline and at 3-, 6-, and 9-month visits during the course of intervention. RESULTS: After 9 months of treatment, 16.4% of subjects in the placebo group were diagnosed with T2DM, whereas none were diagnosed with T2DM in the curcumin-treated group. In addition, the curcumin-treated group showed a better overall function of ß-cells, with higher HOMA-ß (61.58 vs. 48.72; P < 0.01) and lower C-peptide (1.7 vs. 2.17; P < 0.05). The curcumin-treated group showed a lower level of HOMA-IR (3.22 vs. 4.04; P < 0.001) and higher adiponectin (22.46 vs. 18.45; P < 0.05) when compared with the placebo group. CONCLUSIONS: A 9-month curcumin intervention in a prediabetic population significantly lowered the number of prediabetic individuals who eventually developed T2DM. In addition, the curcumin treatment appeared to improve overall function of ß-cells, with very minor adverse effects. Therefore, this study demonstrated that the curcumin intervention in a prediabetic population may be beneficial.

Incidence and patterns of registered injuries among children in Ongkharak District, Nakhon Nayok, Thailand.

OBJECTIVE: To describe the pattern of injury incidence and to illustrate the magnitude and the burden of childhood injury in an agricultural area in Thailand. MATERIAL AND METHOD: A retrospective descriptive study of new registered injury cases was conducted in a Ongkharak District, Nakhon Nayok Province, Thailand, including the population of 12,017 aged of 0-14 years. Data were collected for one year period from September 2006-August 2007 from medical records from 6 hospitals in the province and 14 health centers in the district, including death certificates from local authority vital registration were reviewed over the period of one year. The ICD-10 was used for injury classification. Proportions with 95% confidence intervals were estimated. RESULTS: There were 1,098 records of injuries during one year of the study. Annual incidence rate of injury was found to be 90.5 per 1,000 population (95% CI: 85.4-95.7) with the mortality rate of 24.96 per 100,000 population (95% CI: -3.28-53.2). About 5% of the injured children need hospital admission and 0.3% of injures are fatal. The injuries are common in the age groups of 4-12 years. Injuries in boys are 1.5 time more common than those in girls. Common causes of injuries are non-animate and animate forces, falls and transportations. CONCLUSION: The findings from this community-wide study could be a baseline information for comparisons within this community and other agriculture-based area and also for developing preventive measures to reduce injury and the burden.

Topical antifungal agents for seborrheic dermatitis: systematic review and meta-analysis.

OBJECTIVE: Assess the efficacy of topical antifungal agents for seborrheic dermatitis treatment. MATERIAL AND METHOD: A systematic review and meta-analysis of all relevant randomized vehicle-controlled trials of topical antifungal agents for seborrheic dermatitis treatment were searched. The quality of the enrolled studies was measured by criteria from Cochrane Collaboration, followed by data extraction. Two reviewers independently assessed the present study articles. When there was a disagreement between the two reviewers, a consensus was made by the third reviewer. Pooled relative risk (PRR) statistical analysis was used to determine the efficacy of treatment. RESULTS: One thousand ninety five studies were reviewed and nine studies were included. Four reports studied the efficacy of ketoconazole, two of metronidazole, two of ciclopirox, and one of bifonazole. Ketoconazole was more effective than vehicle [PRR is 5.78 (95% CI, 2.17-15.40)], as was metronidazole [PRR is 1.83 (95% CI: 1.05-3.17)] ciclopirox [PRR is 3.00 (95% CI, 1.86-4.84)], and bifonazole [PRR is 1.86 (95% CI: 0.96-3.59)]. CONCLUSION: The meta-analysis in the present study showed that the topical antifungal agents that demonstrated strong and moderate evidence of the efficacy for seborrheic dermatitis treatment were ketoconazole and ciclopirox, respectively. They could be used as an alternative treatment for seborrheic dermatitis.

Recent trends and patterns in breast cancer incidence among Eastern and Southeastern Asian women.

BACKGROUND: Incidence of breast cancer is rising in Asian countries, and breast cancer is the most common cancer among Asian women. However, there are few recent descriptive reports on the epidemiology of breast cancer among Eastern and Southeastern Asian populations. METHODS: We examined incidence trends for invasive breast cancer in women aged ≥20 years from 15 registries in Eastern (China, Japan, the Republic of Korea, Taiwan) and Southeastern Asia (the Philippines, Singapore, Thailand) for the period 1993-2002 mainly using data from Cancer Incidence in Five Continents, Volumes VIII and IX. We compared trends in annual incidence rates and age-specific incidence curves over a 10-year period. We also compared the incidence rates of Asian-Americans with the rates of their Asian counterparts. RESULTS: Breast cancer incidence rates increased gradually over time in all study populations. Rates were relatively high in Southeastern Asia and became progressively lower along a south-to-north gradient, with a fourfold geographic variation within the study populations. Age-specific incidence curves showed patterns that gradually changed according to incidence rates. Breast cancer incidence among Asian women living in the United States was 1.5-4 times higher than the corresponding incidence rate in the women's respective countries of origin. CONCLUSION: Breast cancer incidence is expected to continue to increase for the next 10 years in Asia and may approach rates reported among Asian-Americans. The number and mean age of breast cancer cases is expected to increase as the female Asian population ages, the prevalence of certain risk factors changes (early menarche, late menopause, low parity, late age at first live birth, and low prevalence of breastfeeding), and as Asian countries introduce mass screening programs.

Factors affecting soft tissue level around anterior maxillary single-tooth implants.

BACKGROUND: Peri-implant soft tissue recession is a major esthetic concern for the anterior implants. The aim of this study was to determine the factors that affected the facial marginal mucosal level and papilla level around single-tooth implants in the anterior maxilla. METHODS: Forty single-tooth implants in the anterior maxilla were studied. Variables possibly associated with the soft tissue level were obtained from clinical measurements, study models, peri-apical radiographs, and computerized tomograms. Fisher's exact test, analysis of variance, and binary logistic regression analysis were used to determine the influence of each factor on the facial marginal mucosal level and papilla level. RESULTS: The majority of the implants (75%) replaced the upper central incisors. The facial mucosal margin of the implant was 0.5+/-0.9 mm more apical than that of the contralateral tooth. Half or more of papilla fill was observed in 89% of the samples. More apical level of the facial mucosal margin at the implant sites was significantly influenced by many factors including a thin peri-implant biotype, a proclined implant fixture angle, more apical level of the facial bone crest, increased distance from the contact point to the bone crest, contact point to the platform, and contact point to implant bone. A thin biotype was the most significant factor in determining the facial marginal mucosal level. Increased distance from the contact point to the bone crest was the only factor significantly associated with less papilla fill. CONCLUSIONS: The papilla level around single-tooth implants in the anterior maxilla was mainly influenced by the interproximal bone crest level of the adjacent tooth. Facial marginal mucosal level, on the other hand, was affected by multiple factors including the peri-implant biotype, the facial bone crest level, the implant fixture angle, the interproximal bone crest level, the depth of implant platform, and the level of first bone to implant contact.