Sleep duration and risk of high blood pressure in Thai adolescents: the Thai National Health Examination Survey V, 2014 (NHES-V).

BACKGROUND: Sleep duration has been proposed to be associated with high blood pressure. However, nationwide studies regarding this association in adolescents remain limited. This study aimed to explore the national prevalence of high blood pressure among Thai adolescents and to determine the association between sleep duration and high blood pressure. METHODS: Data from adolescents aged 10-19 years from the Thai National Health and Examination Survey V were included. We collected demographic data (including age and gender), height, weight, waist circumference, blood pressure, fasting blood chemistries and sleep duration data. Sleep durations were categorized as short, normal or long for each age group based on the United States National Sleep Foundation's recommendations. High blood pressure was diagnosed using the 2017 guidelines of the American Academy of Pediatrics. Factors associated with high blood pressure were analyzed using multivariate logistic regression. RESULTS: A total of 3505 adolescents (1785 female) were included. The prevalence of high blood pressure was 9.4% (95% CI 8.5-10.4%). The high blood pressure group had higher BMI z-score, LDL-C, triglyceride and lower HDL-C than the normotensive group. In the multivariate analysis, BMI z-score, LDL-C and HDL-C were independently associated with high blood pressure. However, there was no association between sleep duration and high blood pressure. CONCLUSIONS: High blood pressure risk was increased in adolescents with high BMI z-score. Neither short nor long sleep duration was associated with an increased risk of high blood pressure.

Metabolic syndrome in Thai adolescents and associated factors: the Thai National Health Examination Survey V (NHES V).

BACKGROUND: Presence of metabolic syndrome (MetS) in early life may influence cardiovascular outcome later in adulthood. There is limited data regarding MetS among Thai adolescents. This study aimed to estimate the prevalence of MetS and related factors in Thai adolescents. METHODS: Data on MetS components of 1934 Thai adolescents aged 10-16 years were obtained from the 5th National Health Examination Survey. Age at first screen time exposure, duration of screen time, frequency of food intake and physical activities were collected from interviews. MetS was defined according to 3 definitions: International Diabetes Federation (IDF), Cook's, and de Ferranti's. RESULTS: The prevalence of MetS was 4.1% by IDF, 8.0% by Cook's, and 16.8% by de Ferranti's definition. The overall prevalence was higher in male (19.0%) than female adolescents (15.3%). The most common MetS components composition among Thai adolescents was high waist circumference with high serum triglyceride and low HDL-cholesterol (40.0% for IDF, 22.6% for Cook's and 43.5% for de Ferranti's definition). Exposure to screen media during the first 2 years of life had a 1.3- fold increased odds of MetS by 1 out of 3 definitions (OR 1.30, 95% CI. 1.01-1.68). Duration of physical activity associated with decreased odds of MetS by Cook's definition (OR 0.96, 95% CI. 0.92-0.99). CONCLUSIONS: The prevalence of MetS among Thai adolescents was higher than previously reported by other studies. Screen media exposure during the first 2 years of life should be discouraged and measures to promote physical activity among children and adolescents should be strengthen.

Socio-economic inequalities in the association between alcohol use disorder and depressive disorder among Thai adults: a population-based study.

BACKGROUND: Previous evidence indicates significant associations between depressive disorders and alcohol use disorder (AUD) and their strong links with social conditions. This study aims to investigate the association between major depressive episode (MDE) and AUD across various socio-economic groups. METHODS: We analysed data from the 2014 Thai National Health Examination Survey containing a random sample of 13,177 adults aged > 20 years from the general population. The Alcohol Use Disorder Identification Test was used to classify respondents into non-problem drinking (score 0-7), hazardous drinking (score 8-15), and harmful-dependent drinking (score 16-40). MDE was identified using questions based on the DSM-IV. Adjusted odds ratios (AOR) and 95% confidence intervals (CI) were calculated using multinomial logistic regression to determine the strength of associations between MDE as a predictor and AUD as an outcome variable across different socio-economic levels. RESULTS: The prevalence of MDE, hazardous, and harmful-dependent drinking was 2.5, 10.3, and 1.9%, respectively. The association between MDE and AUD was modified by wealth index, education level and area of residence. AORs for the association between MDE and harmful-dependent drinking were high among those in the highest (AOR = 8.68, 95% CI: 5.34, 14.11) and lowest (AOR = 7.14, 95% CI: 3.71, 13.73) levels of wealth index but not significant among those in the middle level (AOR = 1.78, 95% CI: 0.74, 4.25). Education had the strongest effect on the relationship between MDE and harmful-dependent drinking (AOR = 16.0, 95% CI: 10.30, 24.90 among those completing secondary school or higher and AOR = 1.44, 95% CI: 0.63, 3.33 among those completing primary school only). The association between MDE and harmful-dependent drinking was higher among people who lived in urban areas (AOR = 8.50, 95% CI: 5.50, 13.13) compared to those living in rural areas (AOR = 4.73, 95% CI: 3.31, 6.77). CONCLUSION: Socio-economic factors modify the association between alcohol use disorder and major depressive disorder among Thai people.

Motivational interviewing by general practitioners for Type 2 diabetes patients: a systematic review.

Background: Motivational interviewing (MI) is an effective tool to help clinicians with facilitating behavioural changes in many diseases and conditions. However, different forms of MI are required in different health care settings and for different clinicians. Although general practitioners (GPs) play a major role in Type 2 diabetes management, the effects of MI delivered by GPs intended to change the behaviours of their Type 2 diabetes patients and GP outcomes, defined as GP knowledge, satisfaction and practice behaviours, have not been systematically reviewed. Methods: An electronic search was conducted through Cochrane Library, Scopus, ProQuest, Wiley Online Library, Ovid MEDLINE, PubMed, CINAHL, MEDLINE Complete and Google Scholar from the earliest date of each database to 2017. Reference lists from each article obtained were reviewed. Measured changes in GP satisfaction, knowledge, and practice behaviours, and patient outcomes were recorded. Results: Eight out of 1882 studies met the criteria for inclusion. Six studies examined the effects of MI on Type 2 diabetes patient outcomes, only one of which examined its effects on GP outcomes. Two-thirds of the studies (4/6) found a significant improvement in at least one of the following patient outcomes: total cholesterol, low-density lipoproteins, fasting blood glucose, HbA1c, body mass index, blood pressure, waist circumference and physical activity. The effects of MI on GP outcomes yielded mixed results. Conclusions: Few studies have examined evidence for the effectiveness of MI delivered by GPs to Type 2 diabetes patients. Evidence to support the effectiveness of MI on GP and patient outcomes is weak. Further quality studies are needed to examine the effects of MI on GP and patient outcomes.

The Development of a Readiness Scale for Changing Farmers' Behaviors of Using Pesticides.

BACKGROUND AND OBJECTIVE: Inappropriate pesticide-using behaviors impose significant negative impacts on health and environment. Developmentalprograms to change such behaviors offarmers should target those who are ready to change in order to achieve efficiency. The objective was to develop a readiness scale in changing behavior ofusing pesticides offarmers. The scale of this study is expected to be used in recruiting targetfarmers in developmental programs. MATERIAL AND METHOD: A cross-sectional study was divided into two phases. The first phase, qualitative method, performed on 17farmers participated to seek factors related to the farmers' safe use of pesticides. The second phase, quantitative method to develop the readiness scale, an exploratoryfactor analysis (EFA) was analyzed on 230farmers and was randomly selected to measure the scale's construct validity, internal consistency (reliability), one-dimensionality and the appropriate cut-off point, respectively. RESULTS: Farmers' pesticide use, safety behaviors involved several factors, and are applied to create a set ofquestions on the readiness scale; there were 33 main items (with 40 sub-items), which could be grouped into 8 factors associated with farmers using pesticide safety, the scale, the best way to predict farmers who are ready to change. Finally, they were reduced to 23 main questions with 30 sub-questions in the scale. CONCLUSION: The development of a readiness scale application of changing behaviors as a guide, to assess content validity using index of item-objective congruence measurement (IOC), the exploratory factor analysis was used to determine an item and to test reliability on the scale. The scale can be a useful tool for recruiting farmers into intervention program in changing pesticide use, safety behaviors.

Energy and Macronutrient Intakes and Food Sources in Preschool Children: Thai NHES IV.

OBJECTIVE: Examine intakes of energy and macronutrients, and identify their food sources, in Thai preschool children. MATERIAL AND METHOD: Data from the Thai National Health Examination Survey (NHES) IV were used. Mothers/caregivers were interviewed regarding their children's 24-hour-dietary intake. Dietary data were analyzed for energy and macronutrients, and their food sources were investigated. Due to skewed data, Mann-Whitney U test was used to compare energy and macronutrient intake between sexes and age groups. RESULTS: Among 256 preschool children, more than 90% had protein intakes higher than the recommended level. Only 12.7 to 29.0% met the recommended intake for energy. Amounts of carbohydrate and fat consumed varied from below to above the Dietary Reference Intake (DRI) recommendation. Intakes of carbohydrate in boys and fat in girls were statistically different between age groups (p < 0.05). Fifty to 60% of energy came from dairy products, grains and starchy products. The major carbohydrate contributors were grains and starchy products. Dairy products were the main source of protein. Important food sources of fat were dairy products for one- to three-year-old children and fat and oils for four- to five-year-old children. CONCLUSION: Thai preschool children have inappropriate intakes of energy and macronutrients. Dairy products and grains and/or starchy products were the main sources of energy, carbohydrate, and protein. Dietary fat sources varied by age group.

Characteristics and determinants of Thailand's declining birth rate in women age 35 to 59 years old: data from the Fourth National Health Examination Survey.

OBJECTIVE: To describe characteristics and determinants of Thailand's declining birth rate using national representative survey data. MATERIAL AND METHOD: The Fourth National Health Examination Survey was conducted between 2008 and 2009. Four stages of stratified probability samples, proportionate to size, were used to represent the whole Thai population. Information from women aged 35 to 59 years old was included in the analysis. Curve estimation was used to characterize the correlation between the number of children ever born and the age of married and un-married women. Binary logistic regression analysis was used to identify predictors of having fewer than two children among ever married women. RESULTS: Of all 4120 women, the number of children decreased sharply among the oldest women aged 45 to 59 years old, decreased less sharply for women younger than 45 years of age, reached the lowest level at the age of 37 and 38 years old, and then increased minimally among the younger women surveyed. Among those who were ever married (n = 3,761), the independent predictors of having one or no child instead of having two or more children were aged 45 to 49 compared to 50 to 59 years old (OR = 1.66; 95% CI = 1.37-2.00), age 35 to 44 compared to 50 to 59 years old (OR = 1.39; 95% CI = 1.16-1.68), living in households with wealth index level 3 compared to level 1 (OR = 1.28; 95% CI = 1.01-1.63), urban residence (OR = 1.33; 95% CI = 1.14-1.57), attaining secondary school education (OR = 1.35; 95% CI = 1.11-1.64), and having junior college diploma or higher level of education compared to elementary or no education (OR = 1.81; 95% CI = 1.39-2.34). CONCLUSION: Birth rate of Thai women declined steeply in the past then less steeply, and might have begun to rise minimally in recent years. Younger age, living in an urban area, and having higher socioeconomic status were predictors of having fewer than two children.

Integrated Care Model by the Village Health Volunteers to Prevent and Slow down Progression of Chronic Kidney Disease in a Rural Community, Thailand.

INTRODUCTION: Chronic kidney disease (CKD) is a major health problem in Thailand and health behaviors are central to its risk and progression. Because of the shortage of healthcare personnel, village health volunteers (VHVs) have been collaborating in the primary health care system. However, the contribution of VHVs to CKD reduction has not been evaluated yet. This study aimed to evaluate the efficacy of the VHV-integrated model in preventing and slowing down CKD and its risk factors. METHODS: The population-based cohort study was conducted in a rural community of Thailand between 2017 and 2019. Baseline clinical and behavioral characteristics including CKD, diabetes, hypertension, and other high-risk factors of the participants were collected. The integrated care model was initiated by the multidisciplinary care team that facilitated, empowered, and trained VHVs targeting risk factors of CKD, health literacy, and health promotion. Then the participants were educated and trained for lifestyle modification and were monitored continuously for 18 months by VHVs. Changes in the CKD risk factors, and kidney functions before and after the application of integrated care model were compared. RESULTS: A total of 831 subjects participated in the study with an average age of 57.5 years, and 69.5% were female. Among them, 222 participants (26.7%) were diagnosed as having CKD, the vast majority (95%) of which were in the early stages (G1-G3 and A1-A2). CKD risk factors such as high salt intake, smoking, alcohol consumption, self-NSAID (non-steroidal anti-inflammatory drugs) use were significantly decreased after application of the care model. Also, hemoglobin A1c was significantly reduced in diabetic patients, and blood pressure was controlled better than before in the hypertensive patients. Most importantly, a decline of estimated glomerular filtration rate of the CKD group was improved and lower than the non-CKD group. CONCLUSION: The integrated care model through VHV significantly attenuated the risk factors associated with CKD in the general and high-risk population and effectively slowed down the progression of CKD.

Sodium intake and socio-demographic determinants of the non-compliance with daily sodium intake recommendations: Thai NHES IV.

OBJECTIVE: To estimate daily intake of sodium and examine the relation of socio-demographic factors with sodium intake exceeding the recommendations. MATERIAL AND METHOD: Data from the Thai National Health Examination Survey IV (NHES IV) conducted during 2008-2009 were used. The 24-hour-dietary-recall data were available for a subsample of 10% of the total participants. All food and beverage data were analyzed for amount of total daily sodium intake for each person. In statistical analyses, descriptive statistics were employed to describe participants' characteristics, quantities of dietary sodium and percentages of participants noncompliant with daily sodium intake recommendations. Logistic regression was used to examine socio-demographic determinants of sodium intake exceeding the recommendations. RESULTS: 2,969 participants participated in this study. Sodium intake varied by socio-demographics. Percentages of participants non-compliant with sodium intake recommendations ranged from 75.3 (> or = 1,500 mg) to 52.0 (> or = 2,400 mg) for those aged < 16 years and from 86.3 (> or = 1,500 mg) to 67.6 (2,400 mg) for those aged > or = 16 years. In the younger group, age and region were key determinants of consuming sodium exceeding all recommendations. Having family income between 5,000 and < 10,000 baht/month was significantly associated with sodium intake exceeding recommendation targets. In the older group, being female and increasing age reduced a risk of non-compliance with some recommendations; oppositely, region and residential area participants lived significantly, increased non-compliant risk. CONCLUSION: Most participants consumed dietary sodium exceeding current recommendations. Effective programs to reduce sodium intake in Thais are critical.

Higher milk consumption is associated with a lower risk of diabetes mellitus: A case-control study.

BACKGROUND & AIMS: Studies have determined that people with genetically defined lactase non-persistence have lower dairy intake that may lead to an increase risk of various non-communicable diseases. Furthermore, lactase non-persistence itself has been associated with insulin resistance. However, data on lactase non-persistence status and dairy intake in developing countries are sparse. We therefore aimed to define 1) the prevalence of lactase non-persistence among individuals with diabetes and non-diabetes in Thai population and 2) the links between lactase non-persistence, milk consumption, and risk of diabetes mellitus. METHODS: We conducted a case-control study from participants of the National Health Examination Survey. DNA was isolated from the blood for LCT -13910C>T (rs4988235) polymorphism and processed using the Bio-rad c1000 touch thermal cycler and MALDI-TOF Mass Spectrometry MassARRAY Typer v4.0 (Agena Bioscience, San Diego, CA, USA) at the Center for Medical Genomics, Faculty of Medicine Ramathibodi Hospital. Cases were participants with previously diagnosed diabetes mellitus or fasting plasma glucose ≥126 mg/dL (n = 1,756) vs. the controls (n = 2,380). RESULTS: We included 4,136 participants, 62% female, and 98.8% were > 30 years old. Homozygous CC genotype (i.e., lactase non-persistence) was noted in 98.6% and only 1.4% carried heterozygous CT. Most (76%) consumed milk <1 portion/month. Participants with either CC or CT genotype had comparable milk consumption and the risk of diabetes mellitus. Males, older adults, and lower education had a lower chance of consuming milk at least one portion per month. Besides various baseline variables, we found that higher milk consumption was associated with a lower DM risk (P = .01). CONCLUSION: The prevalence of lactase non-persistence in Thai population is very high. A significant difference in milk consumption frequency in relation to the lactase non-persistence status was not found. However, higher milk consumption is associated with a lower risk of diabetes mellitus.

Ideal cardiovascular health and all-cause or cardiovascular mortality in a longitudinal study of the Thai National Health Examination Survey IV and V.

The relationship of ideal cardiovascular health (CVH) and health outcomes has been rarely assessed in middle-income countries. We determined the ideal CVH metrics and association with all-cause and cardiovascular (CVD) mortality in the Thai population. We used baseline data from two rounds of the National Health Examination survey (15,219 participants in 2009 and 14,499 in 2014), and assessed all-cause and CVD deaths until 2020. The prevalence of 5-7 ideal CVH metrics in 2009 was 10.4% versus 9.5% in 2014. During a median follow-up of 7.1 years, the all-cause and CVD mortality rates were 19.4 and 4.6 per 1000 person-years for 0-1 ideal CVH metrics, and 13.0 and 2.1, 9.6 and 1.5, 6.0 and 1.0, and 2.9 and 0.4 per 1000 person-years for 2, 3, 4, and 5-7 ideal CVH metrics, respectively. Participants with 2, 3, 4, or 5-7 ideal metrics had a significantly lower risk of mortality than those with 0-1 ideal CVH metrics (adjusted hazard ratios: 0.75, 0.70, 0.60, and 0.47 for all-cause, and 0.54, 0.52, 0.50, and 0.31 for CVD, respectively). Individuals with a higher number of the modified ideal CVH metrics have a lower risk of all-cause and CVD mortality.

Stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among general adult population: the results from the 6th Thai National Health Examination Survey (NHES VI).

Background: Thailand has an ongoing action plan to reduce human immunodeficiency virus (HIV) discrimination and stigma. We aimed to monitor the level of stigmatizing and discriminatory attitudes toward people living with HIV/AIDS (PLWHA) among the general adult population and to investigate its related factors. Methods: This study was based on data from the 6th Thai National Health Examination Survey, a large-scale country-wide survey in 2019-2020. We used a multistage sampling technique and included 11 843 adults aged 20 to 59. We collected data through face-to-face interviews which included six items related to HIV stigma domains. We weighted all analyses to account for the probability of sampling the Thai population aged 20 to 59 years. Results: We found that anticipated stigma had the highest percentage of negative stigmatizing attitude responses (78.5%), followed by perceived stigma (66.6%), fear of HIV infection (54.4%), and social judgment (28.2%). Regarding the UNAIDS global indicator for discriminatory attitude, 48.6% of respondents had negative perceptions to questions about experienced stigma or discrimination. Multiple logistic regression showed that factors associated with discriminatory attitudes toward PLWHA were being aged 20-39 (adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.18-1.47) or 50-59 (aOR = 1.23, 95% CI = 1.09-1.40) compared to being aged 40-49, being Muslim compared to Buddhist (aOR = 1.73, 95% CI = 1.46-2.06), being married compared to being single (aOR = 1.15, 95% CI = 1.04-1.28), holding certificate degree or higher compared to not studying or studying at a primary level (aOR = 0.81, 95% CI = 0.68-0.97), living in the Northeast (aOR = 1.27, 95% CI = 1.12-1.45) and Bangkok (aOR = 1.30, 95% CI = 1.12-1.51) compared to living in the North, having no HIV/AIDS infected relative or acquaintance compared to having an HIV/AIDS infected relative or acquaintance (aOR = 1.56, 95% CI = 1.41-1.73), and not obtaining an HIV test compared to obtaining it (aOR = 1.10, 95% CI = 1.02-1.19). Conclusions: We found that HIV stigmatizing and discriminatory attitudes toward PLWHA decreased, but remained concerning among Thai adult people. A public education and awareness campaign, as well as an intervention to reduce HIV-related stigma and discrimination in the country's health care facilities, must still be maintained.

Health behaviors among short- and long- term ex-smokers: results from the Thai National Health Examination Survey IV, 2009.

BACKGROUND: Although numerous studies have shown the health behaviors of ex-smokers to be better than those in regular smokers, the differences in health behaviors among ex-smokers at varying durations of cessation have not been investigated. This study aims to examine the relationship between different durations of smoking cessation and health behaviors. METHODS: Data on dietary intake, alcohol consumption, physical activity, and smoking behavior from the Thai National Health Examination Survey IV for subjects aged 15-98 years (n=19 371) were included in the analysis. Trends between health behaviors among regular smokers, ex-smokers with different durations of smoking (<1 year, 1-10 years, >10 years), and never smokers were tested. Logistic regression models adjusted for sex, age, and economic status were used. RESULTS: The prevalences of regular smoking, ex-smoking, and never smoking were 22.3%, 12% , and 65.7%, respectively. A trend was found for consumption of fruit, beans and meats, dairy and soy milk, whole-grain products, nutritional supplements, and eating habits. Average daily alcohol consumption (g) was lowest among ex-smokers who had quit for>10 years ex-smokers (16.4) followed by 1-10 years ex-smokers (27.2), and <1 year ex-smokers (33.7). CONCLUSION: A longer duration of smoking cessation correlated with better health behaviors.

From health situation to health education and health service reforms for Thai society.

BACKGROUND: Health problems and service utilization patterns among Thai populations have changed significantly over the past three decades. It is imperative to scrutinize the changes so that the health service and human resource development systems can appropriately respond to the changing health needs. OBJECTIVE: To synthesize critical issues for future planning of health service reforms, medical education reforms and health research for Thai society. MATERIAL AND METHOD: The authors analyzed data on health service utilization, types of illnesses and hospital deaths among Thais in the fiscal year 2010. Information on the illnesses of in-/out-patients and hospital deaths was extracted from the three main health insurance schemes providing coverage to 96% of the population. The authors then synthesized the key issues for reforming medical education and health services. RESULTS: In summary, Thai patients have better access to health services. The total number of out-patient visits was 326,230,155 times or 5.23 visits per population. The total number of in-patient admissions was 6,880,815 times or 0.11 admissions per population. The most frequent users were between 40-59 years of age. The most common conditions seen at OPD and IPD and the causes of in-hospital mortality varied between age-groups. The key health issues identified were: psychosocial conditions, health behaviour problems, perinatal complications, congenital malformations, teenage pregnancy, injury, infectious diseases, cardiovascular diseases and neoplasms. Medical education reforms need to be designed in terms of both undergraduate and post-graduate education and/or specialty clinical needs. Health service reforms should be designed in terms of patient care systems, roles of multidisciplinary teams and community involvement. CONCLUSION: The government and other responsible organizations need to actively respond by designing the health service systems and human resource development systems that are relevant, appropriate and integrated. Different levels of care need to work collaboratively in order to achieve the greatest quality and efficiency.

Association between electronic cigarette use and depression among Thai adolescents: The Thailand National Health Examination Survey 2019-2020.

INTRODUCTION: Depression and e-cigarette use among adolescents are two health burdens. However, the association between these dual problems have been less studied, especially in low- and middle-income countries. This study examined the association between depression and e-cigarette use among adolescents in Thailand. METHODS: This cross-sectional study used the sub-sample of the sixth Thai National Health Examination Survey conducted between 2019 and 2020. A total of 4237 adolescents aged 10-19 years were included. Self-reported depression was captured using the 20-item Centre for Epidemiologic Studies Depression Scale (CES-D). We applied a complex survey multiple logistic regression to assess whether e-cigarette use was associated with depression. RESULTS: The mean age of the participants was 14.6 years, 5.3% were ever e-cigarette users, and 2.9% were current e-cigarette users. 37.8% of the participants were categorized at risk for depression. Among e-cigarette users, 51.6% of ever e-cigarette users and 52.9% of current e-cigarette users were at risk for depression. Multiple logistic regression revealed that ever e-cigarette users were at higher risk for depression (AOR=1.66; 95% CI: 1.02-2.71; p=0.042) than never e-cigarette users. Current e-cigarette was not associated with a higher risk for depression (AOR=1.37; 95% CI: 0.77-2.45; p=0.263). CONCLUSIONS: E-cigarette use and depression among adolescents are global public health concerns. There is also a need for effective screening, prevention, and intervention to reduce adverse outcomes of e-cigarette use and depression. In addition, the government should strengthen current policies and close legal loopholes to prevent the tobacco industry tactics and keep e-cigarettes away from adolescents.

Waist-to-Height Ratio Is a Good Predictor of Metabolic Syndrome in Adolescents: A Report From the Thai National Health Examination Survey V, 2014.

This study aimed to assess the performance of waist-to-height ratio (WHtR) in the prediction of metabolic syndrome and to determine the appropriate cutoff value in Thai adolescents. Demographic data, blood pressure, fasting blood glucose, and lipid profile were obtained from the Thai National Health Examination Survey V database. The performances of WHtR, waist circumference, body mass index (BMI), and BMI z-score were analyzed by the receiver operating characteristics. Among 2644 adolescents, metabolic syndrome was identified in 4.27%. The areas under the receiver operating characteristic curves of WHtR, waist circumference, BMI, and BMI z-score were comparable (0.924-0.960). Performance of WHtR was more constant across age groups compared with other parameters. Using the cutoff value of WHtR at 0.5 resulted in the sensitivity and specificity of 98.5%/83.4% and 88.9%/86.0% in males and females, respectively. In conclusion, the cutoff value of WHtR at 0.5 provided good sensitivity and specificity for identifying metabolic syndrome in both genders. However, the other clinical risk factors or more definite scores should be considered when further assessment.

Urban and rural variation in clustering of metabolic syndrome components in the Thai population: results from the fourth National Health Examination Survey 2009.

BACKGROUND: Information on the distribution of Metabolic syndrome (MetS) and its combinations by urban/rural areas in lower-middle income countries has been limited. It is not clear how the various combinations of MetS components varied by urban/rural population and if particular combinations of MetS are more common. This study aimed to estimate the prevalence of MetS and combinations of MetS components according to sex and urban/rural areas from a nationally representative sample of Thai adults. METHODS: Data from the fourth National Health Examination Survey of 19,256 Thai adults aged 20 years and over were analyzed. MetS was defined using the harmonized criteria of six international expert groups with Asian-specific cut-point for waist circumference. RESULTS: The prevalence of MetS was 23.2% among adults aged ≥ 20 years (19.5% in men and 26.8% in women). Among men, the prevalence of MetS in urban was higher than those in rural areas (23.1% vs 17.9%, P < 0.05), but among women, the prevalence was higher in rural areas (27.9% vs 24.5%, P < 0.05). Overall, an individual component of low high density lipoprotein (HDL) and hypertriglyceridemia were more common in rural areas, while obesity, high blood pressure and hyperglycemia were more common in urban areas. The most common combination of MetS components in men was the clustering of low HDL, hypertriglyceridemia, and high blood pressure (urban: 3.4% vs. rural: 3.9%, adjusted OR 0.9, 95%CI 0.7, 1.1). Among women, the most common combination was the clustering of obesity, low HDL, and hypertriglyceridemia (urban: 3.9% vs rural: 5.9%, adjusted OR 0.8, 95%CI 0.6, 0.9), followed by the clustering of these three components with high blood pressure (urban: 3.1% vs. rural 4.5%, adjusted OR 0.8, 95%CI 0.7, 0.9). CONCLUSION: Metabolic syndrome affects both urban and rural population with different pattern of MetS combinations. Dyslipidemia and obesity were the most common components among women in rural areas, hence, interventions to prevent and control these factors should be strengthened.

Women and other risk factors for chronic kidney disease of unknown etiology in Thailand: National Health Examination V Survey.

There are limited data on chronic kidney disease of unknown etiology (CKDu) from Southeast Asia. Initially described in working age men, a common approach to detect CKDu that includes all adults has recently been proposed. We determined the prevalence, and risk factors for CKDu using data from a cross-sectional, nationally representative survey of the adult population of Thailand. We used a proxy for CKDu as age < 70 with impaired kidney function (eGFR < 60) in the absence of diabetes and hypertension (CKDu1) and heavy proteinuria (CKDu2). Prevalence estimates were probability-weighted for the Thai population. The associations between risk factors and CKDu or elderly subjects with eGFR < 60 without traditional causes were assessed by multivariable logistic regression. Of 17,329 subjects, the prevalence were: eGFR < 60, 5.3%; CKDu1 0.78%; CKDu2, 0.75%. CKDu differed by 4.3-folds between regions. Women, farmers/laborers, older age, gout, painkillers, rural area, and stones were independent risk factors for CKDu. Women, age, rural, gout, painkillers were significant risk factors for both CKDu and elderly subjects. These data collected using standardized methodology showed that the prevalence of CKDu in Thailand was low overall, although some regions had higher risk. Unlike other countries, Thai women had a two-fold higher risk of CKDu.

Increasing glycaemia is associated with a significant decline in HDL cholesterol in women with prediabetes in two national populations.

Internationally, studies have shown associations between lipids and glycemia; however, whether the link varies by gender and population has been rarely examined. We investigated relationships between glycemia and HDL- and Non-HDL-cholesterol and their modification by gender. We undertook a cross-sectional analysis from the National Health Examination Survey for Thailand (NHES-Thailand) and the Health Survey for England (HS-England) in adults aged 18-75 year. Glycaemia was assessed by FPG in Thailand and by HbA1c in the UK. In population- and gender-stratified analyses, the relationships between glycemia and lipids were explored. A total of 15,145 Thai and 3484 UK adults with blood measurement were included. The prevalences of prediabetes were: in NHES-Thailand, 16% (SE = 0.004), based on FPG (5.6 to < 7.0 mmol/L) and in HS-England, 19% (0.007) based on HbA1c (39 to < 48 mmol/mol). Increasingly abnormal glucose homeostasis was associated with increasing age, adiposity, SBP, proportion of antihypertensive and lipid-lowering agent use and with decreasing HDL-cholesterol. Independent of age, adiposity, smoking, alcohol, physical activity, and lipid and BP lowering drug use, increasing glycemia was associated with decreasing HDL-cholesterol specifically in women with prediabetes (NHES-Thailand, beta-coefficient - 0.07 (95% CI - 0.15, - 0.001) p = 0.04 and HS-England, - 0.03 (- 0.04, - 0.006) p = 0.01). In both populations, among those with prediabetes, increasing glycaemia is associated with an adverse, significant decline in HDL cholesterol, specifically in women. These adverse effects are apparent in widely-differing international populations.

Health behaviors in the development and maintenance process of homosexual identity.

BACKGROUND: Health behaviors of men who have sex with men (MSM) affect their health status in many aspects. Rate of HIV infection among Thai male prostitutes in 2005 was 15.4%. Among these, 28.3% were MSM. Thirty percent of youth suicides were conducted by gays and lesbians. OBJECTIVE: To explore the health behaviors related to the development and maintenance process of men who have sex with men. MATERIAL AND METHOD: This was a qualitative study. The study population was MSM in Mukdahan province. The subjects were recruited gradually, by snowball sampling, until the required data were saturated. In-depth interviews and participant observations were performed over a period of 17 months. A triangulation technique was applied to check reliability of the data. Data were analyzed by content analysis and compared with the Troiden's stages of development and maintenance process of homosexual identity. RESULTS: Eleven Thai MSM were recruited and followed up. Health behaviors of them were different according to the stages of development and maintenance process regarding Troiden's theory. Physical, psychological, social and sexual aspects of health behaviors were identified in various stages. It was found that many factors affect health behaviors of MSM. These include health promoting and undermining factors. CONCLUSION: Health behaviors of MSM varied in each stage of development and maintenance of homosexual identity. Health promotion campaigns and policies for MSM should be designed accordingly.