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.

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.

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.

Effects of Opisthorchis viverrini infection on glucose and lipid profiles in human hosts: A cross-sectional and prospective follow-up study from Thailand.

Opisthorchis viverrini (OV) infection is endemic to the Northeast Thailand where the prevalence of Type 2 Diabetes mellitus (T2DM) is higher whilst the incidence of cardiovascular diseases (CVDs) is lower than the rest of Thailand. Helminth infection has both nutritional and immunological impact on their definitive hosts. Thus, a cross-sectional study was performed to see the effects of OV infection on glucose and lipid profiles. For this purpose, 200 each of OV infected and uninfected residents were recruited and their glycated hemoglobin (HbA1c), total cholesterol, triglycerides, low- and high-density lipoproteins (LDL and HDL) levels and anthropometric measurements, including BMI were examined. Then, as the prospective follow- up study, changes of those metabolic parameters of OV positive subjects (n = 120) before and after Praziquantel (PZQ) treatment were monitored for six months. The results showed that OV infection has a protective effect against hyperglycemia (OR 0.482 and p = .04) and metabolic disease risk group (OR 0.478 and p = .03). OV positive participants had lower HbA1c (5.5% Vs. 6.01%, p = .001) but higher HDL (54.07 Vs. 49.46 mg/dL, p = .001) than OV negative participants that are statistically significant. After PZQ treatment for OV-positive subjects, their serum levels of HbA1c (p < .05) and HDL (p < .05) significantly rose during the follow up. Apparently, OV infection lowers HbA1c but increases HDL in definitive human hosts.

Choosing the optimal method of blood pressure measurement for limited-resource rural communities in the "Community Health Assessment Program-Philippines".

The Community Health Assessment Program-Philippines (CHAP-P) is an international collaboration of investigators whose aim is to adapt a previously proven Canadian community-based cardiovascular awareness and prevention intervention to the Philippines and other low-middle-income countries. Choosing a method of blood pressure measurement for the research program presents a challenge. There is increasing consensus globally that blood pressure measurement with automated devices is preferred. Recommendations from low-middle-income countries, including the Philippines, are less supportive of automated blood pressure devices. The value placed on factors including device accuracy, durability, cost, energy source, and complexity differ with local context. Our goal was to support the progress of local policy concerning blood pressure measurement while testing a comprehensive approach to community-based screening for cardiovascular risk. The authors describe the challenges in making a choice of blood pressure device and the approach to determine optimal method of measurement for our research program.

Community-Based Health Education and Communication Model Development for Opisthorchiasis Prevention in a High Risk Area, Khon Kaen Province, Thailand.

BACKGROUND: This study aimed to evaluate the impact of a community-based health education and communication programme on reducing liver fluke infections caused by the consumption of uncooked fish among people in a high-risk area of Thailand. MATERIALS AND METHODS: The study was quasi-experimental in nature, with three-stages. Stage 1 involved a situational and capacity analysis of designated communities in Khon Kaen province. This was followed by the development of a model for community-based health education and communication to prevent liver fluke infections among high-risk people, and, lastly, implementation and evaluation of the model were performed. Data were collected using both qualitative and quantitative methods. In total, 390 people were surveyed, and quasi-experimental and comparison groups, each with 90 people, were assessed between May 2011 and April 2012. Analysis was using statistical OR, 95 % CI, the Willcoxon matched pairs signed ranks test, the chi-square test, and the Mann-Whitney U test. RESULTS: The findings showed that most respondents had a high level of knowledge and understanding of liver fluke disease (89.5%, 95% CI:86.0-92.4), and positive attitudes toward the prevention of the disease (94.4%, 95% CI:91.6-96.4). However, with regard to changes in consumption of uncooked fish, most respondents were still in the pre-contemplation phase (55.1%, 95% CI:50.0-60.1), followed by the contemplation phase, 22.6%. Furthermore, four factors were found to be associated with the consumption of uncooked fish--the consumption of alcohol (OR 4.16, 95% CI:1.79-9.65), gender (OR 3.17 , 95% CI:1.53-6.54), smoking (OR 3.03, 95% CI:1.31-7.05), and age 40 years and above (OR 2.68, 95% CI:1.02-7.05). After nine months of the health education and communication programme using local media based on local wisdom, culture and persons, the results showed that, compared to the control group, members of the experimental group had a higher level of knowledge, a better attitude and lower levels of ill- advised consumption behaviour. Also, it was found that consumption of uncooked fish, by an assessment of the level of stage of change, was reduced. (p-value 0.002). CONCLUSIONS: The health education and communication programme developed as part of the study was effective in changing the consumption of uncooked fish. Therefore, this approach should be promoted in other high-risk areas in Thailand in the future.

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.

Religious affiliation and disparities in risk of non-communicable diseases and health behaviours: findings from the fourth Thai National Health Examination Survey.

This study aims to compare the health-related behaviours and risk of non-communicable diseases (NCDs) between Muslims and non-Muslims in Thailand, a predominantly Buddhist country in which Muslims are the second largest religious group. Data from the fourth Thai National Health Examination Survey (NHES IV) conducted in 2009 were used to run multivariate survey logistic regression models with adjustment for age, gender and socio-economic status indicators. Data from 20,450 respondents, of whom 807 (3.9%) were Muslims, were included in the study. Muslims were significantly more likely to have daily consumption of deep-fried food (adjusted odds ratio [OR]=1.35; 95% confidence interval [CI]=1.15-1.58) and packaged snacks (adjusted OR=1.55; 95% CI=1.30-1.86), and have inadequate control of hypercholesterolemia (adjusted OR=2.95; 95% CI=1.30-6.68). In conclusion, we found disparity in the majority of risk factors for NCDs between Muslim and non-Muslim Thais.

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.

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.

Diagnostic performance of 2 h postprandial capillary and venous glucose as a screening test for abnormal glucose tolerance.

AIMS: To evaluate the diagnostic performance of postprandial venous and capillary glucose to screen for abnormal glucose tolerance in primary care setting. METHODS: Both post-breakfast venous plasma and capillary blood glucose were taken simultaneously from a consecutive sample of volunteer civil service workers in Khon Kaen, Thailand between June and December 2009. The 75-g oral glucose tolerance test was performed within 3 days of the baseline visit. Both postprandial capillary and venous glucose were assessed for sensitivity, specificity, area under the receiver operating characteristic (ROC) curve and likelihood ratio using the oral glucose tolerance test (OGTT) results for the diagnosis of abnormal glucose tolerance as a gold standard. RESULTS: 1102 volunteers participated, of whom 874 (79.3%) completed the full study protocol. Five-hundred and four (57.8%) of 874 participants were female. The mean age was 39.9 years (SD=12.16) and the mean BMI was 24.3 kg/m(2) (SD=6.86). The sensitivity and specificity at the optimal cut-off point for venous glucose were 68.28% (95% CI 60.04-75.75) and 67.90% (95% CI 64.38-71.28), respectively. The sensitivity and specificity at the optimal cut-off point for capillary glucose were 63.45% (95% CI 55.05-71.28) and 64.06% (95% CI 60.46-67.55), respectively. The area under the ROC curve was 0.73 (95% CI 0.68-0.78) for venous glucose and 0.69 (95% CI 0.64-0.74) for capillary glucose. The subgroup analysis involving individuals with waist circumference>90 cm improved the area under the curve (AUC) to 0.76 (95% CI 0.68-0.83). CONCLUSIONS: Postprandial blood glucose testing had a moderate discriminating characteristic for the diagnosis of abnormal glucose tolerance. Careful consideration is needed when using it to screen for this condition in general population.