Modelling malaria in southernmost provinces of Thailand: a two-step process for analysis of highly right-skewed data with a large proportion of zeros.

BACKGROUND: Malaria remains a serious health problem in the southern border provinces of Thailand. The issue areas can be identified using an appropriate statistical model. This study aimed to investigate malaria for its spatial occurrence and incidence rate in the southernmost provinces of Thailand. METHODS: The Thai Office of Disease Prevention and Control, Ministry of Public Health, provided total hospital admissions of malaria cases from 2008 to 2020, which were classified by age, gender, and sub-district of residence. Sixty-two sub-districts were excluded since they had no malaria cases. A logistic model was used to identify spatial occurrence patterns of malaria, and a log-linear regression model was employed to model the incidence rate after eliminating records with zero cases. RESULTS: The overall occurrence rate was 9.8% and the overall median incidence rate was 4.3 cases per 1,000 population. Malaria occurence peaked at young adults aged 20-29, and subsequently fell with age for both sexes, whereas incidence rate increased with age for both sexes. Malaria occurrence and incidence rates fluctuated; they appeared to be on the decline. The area with the highest malaria occurrence and incidence rate was remarkably similar to the area with the highest number of malaria cases, which were mostly in Yala province's sub-districts bordering Malaysia. CONCLUSIONS: Malaria is a serious problem in forest-covered border areas. The correct policies and strategies should be concentrated in these areas, in order to address this condition.

Haematological, renal, and hepatic function changes among Rayong oil spill clean-up workers: a longitudinal study.

PURPOSE: The Rayong oil spill incident of 2013 leaked over 50,000 barrels of crude oil into the Gulf of Thailand. This study assessed trends and changes in the haematological, renal, and hepatic indices among the Rayong oil spill clean-up workers 5 years after the spill. METHODS: Haematological, renal, and hepatic indices measured for 570 oil spill clean-up workers at baseline and annually during 5-year follow-ups were analysed. Haemoglobin (Hb), haematocrit (Hct), white blood cell (WBC) count, red blood cell (RBC) count, and platelet count for haematological function, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) for hepatic function, and creatinine (Cr) and blood urea nitrogen (BUN) for renal function were assessed. The longitudinal measures of haematological, renal and hepatic indices were analysed using analysis of variance for repeated measures. The generalised estimating equations (GEE) were used to assess trends of these indices and associated factors, including exposure level. RESULTS: Increasing trends were observed per year for WBC (0.52 ± 0.03 × 103 cells/µL), Cr (0.01 ± 0.00 mg/dL), platelet (0.31 × 103 µL per year), and BUN (0.24 ± 0.03 mg/dL). Decreasing trends of aspartate aminotransferase (AST) were observed (1.54 ± 0.21 IU/L per year). Clean-up workers with high exposure to the oil spill had a significantly higher average of WBC and lower average of BUN than low-exposure and unknown-exposure workers. Gender and age were significantly associated with creatinine changes. CONCLUSION: Results of this study show the differences between baseline and follow-up haematological, renal, and hepatic indices and trends of these indices. The long-term changes in the indices in this study show worsening renal functions after oil spill and possibility of cardiovascular effects. These findings contribute to expanding knowledge on the long-term health effects of oil spills.

Bone Marrow Stromal Cells Promote Neuronal Restoration in Rats with Traumatic Brain Injury: Involvement of GDNF Regulating BAD and BAX Signaling.

BACKGROUND/AIMS: To investigate the effects of bone marrow stromal cells (BMSCs) and underlying mechanisms in traumatic brain injury (TBI). METHODS: Cultured BMSCs from green fluorescent protein-transgenic mice were isolated and confirmed. Cultured BMSCs were immediately transplanted into the regions surrounding the injured-brain site to test their function in rat models of TBI. Neurological function was evaluated by a modified neurological severity score on the day before, and on days 7 and 14 after transplantation. After 2 weeks of BMSC transplantation, the brain tissue was harvested and analyzed by microarray assay. And the coronal brain sections were determined by immunohistochemistry with mouse anti-growth-associated protein-43 kDa (anti-GAP-43) and anti-synaptophysin to test the effects of transplanted cells on the axonal regeneration in the host brain. Terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay and Western blot were used to detect the apoptosis and expression of BAX and BAD. RESULTS: Microarray analysis showed that BMSCs expressed growth factors such as glial cell-line derived neurotrophic factor (GDNF). The cells migrated around the injury sites in rats with TBI. BMSC grafts resulted in an increased number of GAP-43-immunopositive fibers and synaptophysin-positive varicosity, with suppressed apoptosis. Furthermore, BMSC transplantation significantly downregulated the expression of BAX and BAD signaling. Moreover, cultured BMSC transplantation significantly improved rat neurological function and survival. CONCLUSION: Transplanted BMSCs could survive and improve neuronal behavior in rats with TBI. Mechanisms of neuroprotection and regeneration were involved, which could be associated with the GDNF regulating the apoptosis signals through BAX and BAD.

MODELING FOR DEMOGRAPHIC AND REGIONAL PREVALENCE AND TRENDS OF SMOKING IN THAI MALES.

This study aimed to describe using national survey data the demographic and regional prevalence and trends of smoking in Thai males during the past 25 years. Data from eight national surveys conducted by the National Statistics Office from 1986 to 2011 were used to examine the prevalence of smoking. Males aged 15 and older were included in this study. Logistic regression was used to model smoking patterns, according to year of survey, age group, urbanization, and Public Health Area (PHA). The prevalence of smoking among males aged 15 years and older in 2011 was 38.4%. Sharply increasing smoking prevalence was found in the 15-24 years-old age group in all surveys. Before survey year 1999, the prevalence of smoking started to level off near retirement age, and subsequently, it leveled off after 40 years of age. The prevalence of smoking in all age groups decreased after 1986 except in the 15-19 years-old age group. Higher prevalence of smoking was found in rural areas. Males from the Northeast and the lower South regions had the highest prevalence. More effective anti-smoking policies should focus on males aged below 25 years to reduce the increasing prevalence of smoking in this group.

EPIDEMIOLOGICAL PATTERNS OF TRANSPORT ACCIDENT MORTALITY IN THAILAND.

This study aimed to explore patterns of transport accident mortality in Thailand between 2004 and 2009. Vital Registration (VR) data were obtained from the Thai Ministry of Public Health and corrected causes of death were derived from Verbal Autopsy (VA) data collected in 2005. A total of 136,164 deaths were analyzed. Poisson regression was used for identifying mortality patterns with respect to gender-age groups and province-year groups. Regression coefficients were used to classify mortality trends for the 76 provinces. The estimated number of transport accident deaths was 2.2 times higher than VR records. The mean estimated transport accident mortality rate was 34.5 per 100,000 population. The estimated transport accident mortality rates were highest among males aged 20-29 years and in the central region, lower northern region and Nakhon Ratchasima Province in the northeastern region. The patterns of transport accident mortality rates were separated into nine groups. Increasing trends were found in three provinces in the northern region, four provinces in the central and eastern regions and five provinces in the southern region. Nine models developed for these nine groups may be helpful for estimating future transport accident mortality rates in Thailand and developing appropriate responses.

Use of cataract surgery in urban Beijing: a post screening follow-up of the elderly with visual impairment due to age-related cataract.

OBJECTIVE: To understand the perception for the use of cataract surgical services in a population of acceptors and non-acceptors of cataract surgery in urban Beijing. METHODS: From a community-based screening program a total of 158 patients with presenting visual acuity of less than 6/18 on either eye due to age-related cataract were informed about the possibility of surgical treatment. These patients were interviewed and re-examined 36 to 46 months after initial screening. The main reasons for not accepting surgery were obtained using a questionnaire. Vision function and vision-related quality of life scores were assessed in those who received and did not receive surgery. RESULTS: At the follow-up examination 116 of the 158 patients were available and 36 (31.0%) had undergone cataract surgery. Cases who chose surgery had higher education level than those who did not seek surgery (OR=2.64, 95% CI: 1.08-6.63, P=0.02). There were no significant differences in vision function (P=0.11) or quality of life scores (P=0.16) between the surgery group and the non-surgery group. Main reasons for not having surgery included no perceived need (50.0%), feeling of being "too old" (19.2%), and worry about the quality of surgery (9.6%). Cost was cited by 1 (1.9%) subject as the main reason for not seeking surgery. CONCLUSIONS: The data suggest that in China's capital urban center for patients with moderate visual impairment there is a relative low acceptance rate of cataract surgery, mainly due to people's perception of marginal benefits of surgery. Cost is not a determining factor as barrier to undergo surgery and patients with poorer education are less likely to undertake surgery.

Candidate gene association study for diabetic retinopathy in Chinese patients with type 2 diabetes.

PURPOSE: To investigate whether variants in a set of eight candidate genes are associated with diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: Case-control study. Patients with T2DM were recruited from the Desheng community in urban Beijing and assigned into a DR group or diabetic without retinopathy (DWR) group, based on the duration of diabetes and grading of fundus images. Twenty-six single-nucleotide polymorphisms (SNPs) within eight candidate genes, including PPARγ, vascular endothelial growth factor (VEGF) and its receptor kinase insert domain receptor (KDR), erythropoietin, aldose reductase, protein kinase C-ß, angiotensin-converting enzyme, and intercellular adhesion molecule 1, were analyzed using the MassARRAY genotyping system. RESULTS: A total of 500 patients with T2DM (216 with DR and 284 with DWR) were enrolled in the study. Significant associations of DR were noted with genotypes of four SNPs-rs699947 (p<0.001), rs833061 (p = 0.001), rs13207351 (p<0.001), and rs2146323 (p=0.006)--in the VEGF gene and one variant, rs2071559, in the KDR gene (p=0.034). After adjustment for covariates, significant association of DR remained with the homozygous genotype of the minor allele for the SNPs rs699947 (odds ratio [OR] = 3.54, 95% confidence interval [CI]: 1.12-11.19), rs833061 (OR = 3.72, 95% CI: 1.17-11.85), rs13207351 (OR = 3.76, 95% CI: 1.21-11.71), and rs2146323 (OR = 2.8, 95% CI: 1.46-5.37) in the VEGF gene as well as the SNP rs2071559 (OR = 1.62, 95% CI: 1.08-2.41) in the KDR gene. However, only rs699947 and rs13207351 in the VEGF gene remained statistically significant after Bonferroni correction. No associations were found in other genes tested. CONCLUSIONS: These data expanded previous observations on the association of DR with variants in the VEGF gene in Chinese patients with T2DM. Moreover, a possible association between DR and KDR polymorphisms is suggested.

Spatial and temporal variations in tuberculosis incidence, Nepal.

Tuberculosis (TB) is an important public health problem in Nepal. The aim of this study was to investigate the spatial and temporal variations in TB incidence in Nepal. Data regarding TB cases were obtained from the Nepal National Tuberculosis Center (NTC) for 2003-2010 and analyzed. Models were developed for TB incidence by gender, year and location using linear regression of log-transformed incidence rates. Apart from a relatively small number of outliers, these models provided a good fit, as indicated by residual plots and the r-squared statistic (0.94). The overall incidence of TB was 1.31 cases per 1,000 population with a male to female incidence rate ratio of 1.83. There were trends of increasing incidence in TB for recent years among both sexes. There were marked variations by location with higher rates occurring in the Terai region and relatively moderate and low rates of TB in the Hill and Mountain regions, respectively. TB incidence was also higher in the capital city Kathmandu and other metropolitan cities. A log-linear regression model can be used as a simple method to model TB incidence rates that vary by location and year. These findings provide information for health authorities to help establish effective prevention programs in specific areas where the disease burden is relatively high.

Association of C(-106)T polymorphism in aldose reductase gene with diabetic retinopathy in Chinese patients with type 2 diabetes mellitus.

OBJECTIVE: To identify the possible association between C(-106)T polymorphism of the aldose reductase (ALR) gene and diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: From November 2009 to September 2010, patients with T2DM were recruited and assigned to DR group or diabetic without retinopathy (DWR) group according to the duration of diabetes and the grading of 7-field fundus color photographs of both eyes. Genotypes of the C(-106)T polymorphism (rs759853) in ALR gene were analyzed using the MassARRAY genotyping system and an association study was performed. RESULTS: A total of 268 T2DM patients (129 in the DR group and 139 in the DWR group) were included in this study. No statistically significant differences were observed between the 2 groups in the age of diabetes onset (P=0.10) and gender (P=0.78). The success rate of genotyping for the study subjects was 99.6% (267/268), with one case of failure in the DR group. The frequencies of the T allele in the C(-106)T polymorphism were 16.0% (41/256) in the DR group and 19.4% (54/278) in the DWR group (P=0.36). There was no significant difference in the C(-106)T genotypes between the 2 groups (P=0.40). Compared with the wild-type genotype, odds ratio (OR) for the risk of DR was 0.7 (95% CI, 0.38-1.3) for the heterozygous CT genotype and 0.76 (95% CI, 0.18-3.25) for the homozygous TT genotype. The risk of DR was positively associated with microalbuminuria (OR=4.61; 95% CI, 2.34-9.05) and insulin therapy (OR=3.43; 95% CI, 1.94-6.09). CONCLUSIONS: Microalbuminuria and insulin therapy are associated with the risk of DR in Chinese patients with T2DM. C(-106)T polymorphism of the ALR gene may not be significantly associated with DR in Chinese patients with T2DM.

Socioeconomic inequalities in child and adolescent mental health in Australia: the role of parenting style and parents' relationships.

BACKGROUND: Socioeconomic inequalities in health and their determinants have been studied extensively over the past few decades. However, the role of parenting style and parents' couple relationships in explaining mental health inequalities is limited. Therefore, this study aims to investigate the distributional impact of parenting style (angry parenting, consistent parenting, and inductive parenting) and parents' couple relationships (e.g., argumentative, happy relationships) on socioeconomic inequalities and by extension on mental health status of Australian children and adolescents. METHODS: This study utilized data from the Longitudinal Study of Australian Children (Waves 1-7), specifically focusing on intact biological parent families, while excluding single-parent and blended-family households. We applied the decomposition index and the Blinder Oaxaca method to investigate the extent of the contribution and temporal impact of parenting style and parents' couple relationships on the mental health status of Australian children and adolescents. RESULTS: This study revealed that poor parenting style is the single most important factor that leads to developing mental health difficulties in children and adolescents, especially from low socioeconomic status, and it contributes almost 52% to socioeconomic inequalities in mental health status. Conversely, household income, maternal education, employment status, and parents' couple relationships contributed 28.04%, 10.67%, 9.28%, and 3.34%, respectively, to mental health inequalities in children and adolescents. CONCLUSION: Overall, this study underscores the importance of parenting style and parents' couple relationships as significant predictors of mental health outcomes in children and adolescents. These results highlight the need for targeted interventions to support families from low socioeconomic backgrounds to address the significant mental health inequalities observed in the study population.

Statistical modeling for identifying chikungunya high-risk areas of two large-scale outbreaks in Thailand's southernmost provinces.

Chikungunya fever (CHIKF) has re-emerged in the southernmost Thailand and presents a significant threat to public health. The problem areas can be identified using appropriate statistical models. This study aimed to determine the geographic epidemic patterns and high-risk locations. Data on CHIKF's case characteristics, including age, gender, and residence sub-district, were obtained from the Office of Disease Prevention and Control of Thailand from 2008 to 2020. A logistic model was applied to detect illness occurrences. After removing records with no cases, a log-linear regression model was used to determine the incidence rate. The results revealed that two large-scale infections occurred in the southernmost provinces of Thailand between 2008 and 2010, and again between 2018 and 2020, indicating a 10-year epidemic cycle. The CHIKF occurrence in the first and second outbreaks was 28.4% and 15.5%, respectively. In both outbreaks of occurrence CHIKF, adolescents and working-age groups were the most infected groups but the high incidence rate of CHIKF was elderly groups. The first outbreak had a high occurrence and incidence rate in 39 sub-districts, the majority of which were in Narathiwat province, whilst the second outbreak was identified in 15 sub-districts, the majority of which were in Pattani province. In conclusion, the CHIKF outbreak areas can be identified and addressed by combining logistic and log-linear models in a two-step process. The findings of this study can serve as a guide for developing a surveillance strategy or an earlier plan to manage or prevent the CHIKF outbreak.

Latent Trajectories of Haematological, Hepatic, and Renal Profiles after Oil Spill Exposure: A Longitudinal Analysis.

Exposure to polycyclic aromatic hydrocarbons (PAHs) and volatile organic compounds (VOCs) in crude oil has carcinogenic effects on various organ systems. This longitudinal cohort study examined the effects of oil spill exposure on the haematological, hepatic, and renal profiles of Rayong oil spill clean-up workers. The sample included 869 clean-up workers from the Rayong oil spill. Latent class mixture models were used to investigate and classify the longitudinal trajectories and trends of the haematological, hepatic, and renal indices. Subgroup analysis was used to evaluate the association between the urinary metabolites of PAHs and VOCs and haematological, hepatic, and renal parameters. Most clean-up workers (97.6%) had increasing levels of white blood cells (WBCs) (0.03 × 103 cells/µL), 94.90% of the workers had a significantly increasing trend of blood urea nitrogen (0.31 mg/dL per year), and 87.20% had a significantly increasing trend of serum creatinine (0.01 mg/dL per year). A high-decreasing trend of WBCs was seen in 2.42% (-0.73 × 103 per year). Post-exposure changes in haematological, renal, and hepatic profiles are present in workers exposed to the Rayong oil spill. This indicates possible long-term health complications and worsening renal function after exposure to PAHs and VOCs in crude oil.

Feeding habits of four-finger threadfin fish, Eleutheronema tetradactylum, and its diet interaction with co-existing fish species in the coastal waters of Thailand.

This study assessed the feeding habits of four-finger threadfin fish, Eleutheronema tetradactylum, and its diet relationship with other fish species in the tropics. Fish samples were collected from four locations along the coastal regions of Thailand. A whole year field sampling event was conducted to investigate the diet relationship of threadfin fish with other ten co-existing fish species in Pattani Bay during January 2021 and January 2022. E. tetradactylum was an active and specific predator with significant diet shift during ontogeny. Specifically, the juvenile fish fed largely on zooplankton especially Acetes/shrimp postlarvae, and small sized-fish fed on penaeid shrimps, while medium and large-sized fish shifted their diets to a combination of penaeid shrimp, fish and squid. Size and sex of fish as well as site of collection significantly affected gut fullness index and average number of food type (p < 0.05). Transitional sex fish predated almost entirely on other fishes (87.2%), whereas male and female fish fed mainly on penaeid shrimp (66.5%) and other fish (51.3%), respectively. Fish size and mouth opening controlled the size of prey, with the larger fish with larger mouth-opening fed primarily on the larger size of prey. Moreover, E. tetradactylum shared its diets inclusively with Epinephelus coioides, Johnius belangerii, Scomberomorus commerson, Scomberoides lysan, Otolithes ruber and Lutjanus russelli. Penaeid shrimp and teleost fish were the main food types shared by these fishes. This study provided important information on the feeding habits of E. tetradactylum and its diet relationship with other co-existing fish species living in the same habitat of a tropical coastal region.

Reproductive characteristics of the hermaphroditic four-finger threadfin, Eleutheronema tetradactylum (Shaw, 1804), in tropical coastal waters.

This study investigated the reproductive traits of the hermaphroditic four-finger threadfin, Eleutheronema tetradactylum, along the coasts of Thailand during January to December 2021. Fish samples were collected from Pattani Bay, Thailand to assess the sex ratio, gonadosomatic index (GSI), maturity stage and fecundity. Additional fish samples were also collected from other areas to evaluate the length and weight at first sex change (Ls50 and Ws50) and length at first maturity (Lm50). The overall sex ratio for male and female was 1:0.69 with male being predominant throughout the year. Threadfin fish spawn the whole year round with peaks during moderate rainy and heavy rainy seasons. Histological examination confirmed its protandrous hermaphrodite posing multiple spawning habits. The average fecundity was 1.85 × 105 ± 1.05 × 105 eggs and positively related with standard length, body weight, gonad weight, and egg diameter (p < 0.05). The Ls50 and Ws50 were 27.58 cm and 419.39 g, and 29.71 cm and 457.28 g, for fish from Pattani Bay and Samut Prakan province, respectively. The Lm50 of male from Pattani Bay and Samut Prakan province were 25.78 cm and 25.56 cm, respectively, which were larger than those from Satun and Nakhon Sri Thammarat provinces. The Lm50 of females from Pattani Bay was smaller than that from Samut Prakan province. This study provided fundamental information on the reproductive characteristics of E. tetradactylum, which can be implemented to support management of natural fish stock and aquaculture development.

Association of glutathione S-transferase pi isoform single-nucleotide polymorphisms with exudative age-related macular degeneration in a Chinese population.

PURPOSE: To investigate the association between single-nucleotide polymorphisms in the pi isoform of glutathione S-transferase (GSTP1) gene and the risk of exudative age-related macular degeneration (AMD) in a Chinese case-control cohort. METHODS: A total of 131 Chinese patients with exudative AMD and 138 control individuals were recruited. Genomic DNA was extracted from venous blood leukocytes. Two common nonsynonymous single-nucleotide polymorphisms in GSTP1 (rs1695 and rs1138272) were genotyped by polymerase chain reaction followed by allele-specific restriction enzyme digestion and direct sequencing. RESULTS: Significant association with exudative AMD was detected for single-nucleotide polymorphism, rs1695 (P = 0.019). The risk G allele frequencies were 21.8% in AMD patients and 12.7% in control subjects (P = 0.007). Compared with the wild-type AA genotype, odds ratio for the risk of AMD was 1.91 (95% confidence interval, 1.09-3.35) for the heterozygous AG genotype and 2.52 (95% confidence interval, 0.6-10.61) for the homozygous GG genotype. In contrast, rs1138272 was not associated with exudative AMD (P = 1.00). The risk G allele frequencies of rs1138272 were 0.4% in AMD patients and 0.4% in control subjects (P = 1.00). CONCLUSION: Our data suggest that the GSTP1 variant rs1695 moderately increases the risk of exudative AMD. The variant rs1138272 was rare and was not associated with exudative AMD in this Chinese cohort.

Influence of husband domestic support on maternal morbidity in rural Nepal.

This study aimed to determine the associations between socio-demographic factors, maternal health knowledge and husband domestic support and last pregnancy problems among reproductive age women (aged 15-49 years) in Bahuni, Morang, Nepal. Data were collected during February and March 2010 from 144 women who had at least one child <5 years old. The women completed a questionnaire designed to elicit socio-demographic status, maternal health care knowledge and recent delivery experience. The results were used to construct two indices, the first encapsulating the woman's knowledge of maternal health care and the second summarizing problems experienced during and after her last pregnancy; these indices were found to be negatively associated. The method used in this study may be applied more widely for health planning to reduce maternal morbidity in Nepal.

Apolipoprotein E gene and age-related macular degeneration in a Chinese population.

PURPOSE: To examine the association between apolipoprotein E (APOE) polymorphisms and age-related macular degeneration (AMD) in a Chinese population. METHODS: The study consisted of 712 subjects, including 201 controls, 363 cases with early AMD, and 148 cases with exudative AMD. Genomic DNA was extracted from venous blood leukocytes. Common allelic variants of APOE (ε2, ε3, and ε4) were analyzed by PCR and direct sequencing. RESULTS: APOE ε3ε3 was the most frequent genotype, with a frequency of 72.6% in controls, 72.5% in early AMD, and 70.3% in exudative AMD. Frequency of the ε2 allele was 6.7% in controls, 7.4% in early AMD, and 8.8% in exudative AMD. Frequency of the ε4 allele was 8.7% in controls, 7.7% in early AMD, and 7.8% in exudative AMD. No statistically significant difference in APOE genotype and allele frequency distribution was observed among controls, cases with early AMD, and cases with exudative AMD. For ε2 allele carriers, the odds ratio was 1.12 (95% confidence interval [CI], 0.65-1.93) for early AMD and 1.06 (95% CI, 0.53-2.10) for exudative AMD. For ε4 allele carriers, the odds ratio was 1.04 (95% CI, 0.61-1.75) for early AMD and 0.83 (95% CI, 0.42-1.62) for exudative AMD. CONCLUSIONS: Our data provide no evidence to support an association of APOE polymorphisms with early or exudative AMD, suggesting that APOE is less likely to be a major AMD susceptibility gene in the Chinese population.

Polymorphisms in the vascular endothelial growth factor gene and the risk of diabetic retinopathy in Chinese patients with type 2 diabetes.

PURPOSE: To investigate whether single nucleotide polymorphisms (SNPs) in the vascular endothelial growth factor (VEGF) gene are associated with diabetic retinopathy (DR) in a cohort of Chinese patients with type 2 diabetes mellitus (T2DM). METHODS: A total of 268 patients with T2DM (129 with DR and 139 without DR) were recruited and enrolled in the study. Patients with T2DM were assigned to a DR group or a diabetic-without-retinopathy group, based on the duration of diabetes and grading of fundus images. Genotypes of eight SNPs in the VEGF gene (rs699947, rs833061, rs13207351, rs2010963, rs833069, rs2146323, rs3025021, and rs3025039) were analyzed using a mass-array genotyping system, and an association study was performed. RESULTS: After adjusting for covariates, a significant association of DR was observed with the homozygous genotype of the minor allele for promoter SNPs rs699947 (odds ratio (OR)=3.54, 95% confidence interval (CI): 1.12-11.19), rs833061 (OR=3.72, 95% CI: 1.17-11.85) and rs13207351 (OR=3.76, 95% CI: 1.21-11.71). A significant association of DR was also observed with haplotype ACA, as defined by minor alleles of promoter SNPs rs699947, rs833061, and rs13207351 (OR=1.52, 95% CI: 1.03-2.24), and haplotype GAA, as defined by SNPs rs2010963, rs833069, and rs2146323 (OR=1.62, 95% CI: 1.08-2.41). CONCLUSIONS: Our data suggest that polymorphisms in the promoter region of the VEGF gene increase the risk of DR in Chinese patients with T2DM.

Hospital admission for type 2 diabetes mellitus under the Universal Coverage Scheme in Thailand: A time- and geographical-trend analysis, 2009-2016.

BACKGROUND: Descriptive analyses of 2009-2016 were performed using the data of the Universal Coverage Scheme (UCS) which covers nearly 70 percent of the Thai population. The analyses described the time and geographical trends of nationwide admission rates of type 2 diabetes mellitus (T2DM) and its complications, including chronic kidney disease (CKD), myocardial infarction, cerebrovascular diseases, retinopathy, cataract, and diabetic foot amputation. METHODS AND FINDINGS: The database of T2DM patients aged 15-100 years who were admitted between 2009 and 2016 under the UCS and that of the UCS population were retrieved for the analyses. The admitted cases of T2DM were extracted from the database using disease codes of principal and secondary diagnoses defined by the International Classification of Diseases 9th and 10th Revisions. The T2DM admission rates in 2009-2016 were the number of admissions divided by the number of the UCS population. The standardized admission rates (SARs)were further estimated in contrast to the expected number of admissions considering age and sex composition of the UCS population in each region. A linearly increased trend was found in T2DM admission rates from 2009 to 2016. Female admission rates were persistently higher than that of males. In 2016, an increase in the T2DM admission rates was observed among the older ages relative to that in 2009. Although the SARs of T2DM were generally higher in Bangkok and central regions in 2009, except that with CKD and foot amputation which had higher trends in northeastern regions, the geographical inequalities were fairly reduced by 2016. CONCLUSION: Admission rates of T2DM and its major complications increased in Thailand from 2009 to 2016. Although the overall geographical inequalities in the SARs of T2DM were reduced in the country, further efforts are required to improve the health system and policies focusing on risk factors and regions to manage the increasing T2DM.

Maternal and fetal mortality and complications associated with cesarean section deliveries in teaching hospitals in Asia.

AIM: To compare the mortality, morbidity of emergency and elective cesarean section with vaginal delivery among Asian teaching hospitals. METHODS: Hospital based prospective study at 12 centers of 9 countries. RESULTS: 12 591 vaginal deliveries, 3062 elective and 4328 emergency cesarean section were followed up to 5 days postpartum. Maternal deaths (95% CI) per 1000 births among vaginal deliveries being 0.47 (0.17, 1.03) was not significantly different from 0.31 (0.01, 1.73) of elective cesarean section and both rates were significantly lower than 2.87 (1.53, 4.91) per 1000 births of emergency section. The vaginal delivery group had significantly lower incidences of all major complication except significantly higher chance of secondary operations and non-significantly different risk for endometritis. Corresponding neonatal mortality per 1000 deliveries among the three groups were 7 (5.6, 8.6), 2.2 (0.9, 4.6) and 12.4 (9.3, 16.2) (P < 0.001). Vaginal delivery also had higher rates of severe asphyxia and palsy than elective cesarean section. CONCLUSION: Maternal complications were increased by cesarean delivery but elective section may reduce neonatal complication.