Prevalence of hypertriglyceridemia among Royal Thai Army personnel and its related cardiometabolic risk factors, from 2017 to 2021.

BACKGROUND: Hypertriglyceridemia is a common health problem independently associated with an increased risk of atherosclerosis cardiovascular diseases (ASCVD), including ischemic heart disease and stroke. This study aims to determine the prevalence of hypertriglyceridemia among Royal Thai Army (RTA) personnel and its behavioral and cardiometabolic risk factors using the RTA personnel database of the physical health examination from 2017 to 2021. METHODS: A serial cross-sectional study was conducted from 2017 to 2021. A total of 257,683 active-duty RTA personnel aged 35-60 years were included in the study. We defined hypertriglyceridemia as fasting triglyceride ≥150 mg/dL. Moreover, we performed a multivariable logistic regression analysis to investigate behavioral and cardiometabolic risk factors for the prevalence of hypertriglyceridemia. The magnitude of the association was presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). RESULTS: The hypertriglyceridemia prevalence among RTA personnel was 43.4% (95% CI: 42.9-43.8%) in 2017. It then continuously decreased to 40.3% (95% CI: 39.9-40.7%) in 2020 and slightly rose to 41.0% (95% CI: 40.6-41.4%) in 2021 (p for trend < 0.001). The prevalence of hypertriglyceridemia was higher for males than females (AOR 2.15; 95% CI: 2.07-2.23); RTA personnel aged 40-44 years compared with those aged 35-39 years (AOR 1.05; 95% CI: 1.02-1.08); and RTA personnel residing in the northeast (AOR; 1.15 95% CI: 1.11-1.18) and the north (AOR 1.05; 95% CI: 1.02-1.08) compared with those residing in Bangkok. The independent behavioral factors associated with hypertriglyceridemia included alcohol consumption, smoking, and sedentary behavior. Moreover, cardiometabolic risk factors, including higher body mass index, high fasting plasma glucose (≥ 100 mg/dL), high blood pressure (≥ 140/90 mmHg), and hypercholesterolemia (≥ 200 mg/dL), were significantly related to hypertriglyceridemia. CONCLUSION: Our data demonstrated that hypertriglyceridemia is a frequent health issue, especially among males, participants aged 40-44 years, and RTA personnel residing in the northeast and the north. The prevalence of hypertriglyceridemia in this population was greatly influenced by alcohol consumption, cigarette smoking, and sedentary behavior. Both behavioral and cardiometabolic risk factors are potential targets for intervention to enhance the primary prevention of sequelae of hypertriglyceridemia, including ASCVD.

Trends, prevalence and associated factors of obesity among adults in a rural community in Thailand: serial cross-sectional surveys, 2012 and 2018.

BACKGROUND: Obesity is one principle risk factor increasing the risk of noncommunicable diseases including diabetes, hypertension and atherosclerosis. In Thailand, a 2014 study reported obesity (BMI ≥25 kg/m2) in a Thai population aged ≥15 years was 37.5, 32.9 and 41.8% overall and among males and females, respectively. The study aimed to determine trends in the prevalence of obesity among adults residing in a Thai rural community between 2012 and 2018 and investigate the associations between obesity and behavioral factors. METHODS: Serial cross-sectional studies were conducted in 2012 and 2018 among adults in Na-Ngam rural community. In 2012 and 2018, all 635 and 627 individuals, respectively, were interviewed using structured questionnaires related to demographics, risk behaviors, comorbidities and arthrometric measurement. Spot urine was collected by participants and obesity was defined as BMI ≥25 kg/m2. The risk factors for obesity were analyzed in the 2018 survey. RESULTS: A total of 1262 adults in Na-Ngam rural community were included in the study. The prevalence of obesity was 33.9% in 2012 and 44.8% in 2018 (P < 0.001). The average BMI increased from 23.9 ± 4.2 kg/m2 in 2012 to 25.0 ± 4.52 kg/m2 in 2018 (P < 0.001). Obesity was associated with higher age (AOR 0.99; 95%CI 0.97-0.99), smoking (AOR 0.52; 95%CI 0.28-0.94), instant coffee-mix consumption > 1 cup/week (AOR 1.44; 95%CI 1.02-2.04), higher number of chronic diseases (≥1 disease AOR 1.82; 95%CI 1.01-2.68, > 2 diseases AOR 2.15; 95%CI 1.32-3.50), and higher spot urine sodium level (AOR 1.002; 95%CI 0.99-1.01). CONCLUSION: Our data emphasized that obesity constituted a serious problem among adults residing in a rural community. A trend in significant increase was found regarding the prevalence of obesity and average BMI in the rural community over 6 years. Effective public health interventions should be provided at the community level to reduce BMI. Moreover, modifiable risk factors for obesity should be attenuated to inhibit the progression of metabolic syndrome, noncommunicable diseases and their complications.

Prevalence of dyslipidemia associated with complications in diabetic patients: a nationwide study in Thailand.

BACKGROUND: Dyslipidemia is an important modifiable risk factor for cardiovascular disease. It is diagnosed by the presence of an abnormal lipid profile, primarily with elevated levels of plasma cholesterol, triglyceride, or both, or reduced levels of high-density lipoprotein cholesterol. However, some studies have reported increased risk of ischemic stroke with elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of cardiovascular mortality independent of LDL-C levels in type 2 diabetes mellitus (T2DM) patients. METHODS: In this cross-sectional study, data were included for Thai adults with diabetes from the Diabetes Mellitus/ Hypertension (DM/HT) study, 2010-2014 (data was collected by the Medical Research Network of the Consortium of Thai Medical Schools). The target population comprised T2DM patients who were treated at a hospital for more than 12 months. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to determine factors associated with dyslipidemia. RESULTS: In total, 140,557 participants (average age, 60 years) were enrolled, with a dyslipidemia prevalence of 88.9% in the cohort. The factors associated with dyslipidemia included female sex (aOR: 1.47, 95% CI: 1.38-1.56); age < 50 years (aOR: 1.16, 95% CI: 1.10-1.22); waist circumference ≥ 90 cm in males and ≥ 80 cm in females (aOR: 1.23, 95% CI: 1.16-1.31); treatment at a primary care unit (aOR: 1.28, 95% CI: 1.23-1.33); and a history of unknown stroke (aOR: 1.10, 95% CI: 1.02-1.19), coronary revascularization (aOR: 0.85, 95% CI: 0.79-0.91), diabetic nephropathy (aOR: 1.06, 95% CI: 1.01-1.12), or renal insufficiency (aOR: 1.08, 95% CI: 1.02-1.13). CONCLUSIONS: Dyslipidemia is prevalent among Thai T2DMpatients and is associated with gender; age; obesity; central obesity; treatment at a primary care unit; and a history of unknown stroke, coronary revascularization, diabetic nephropathy, and renal insufficiency. Our study results will help increase the awareness of healthcare providers regarding dyslipidemia in diabetic patients. To reduce cardiovascular risk, healthcare professionals should provide regular follow-up and proper advice and ensure primary prevention of vascular complications. Improved education and increased self-awareness regarding the need to change behaviors and regular intake of medication would help decrease dyslipidemia prevalence among diabetic patients.

Changes in Physical Fitness and Anthropometric of Medical Cadets Over Their Study Period in Phramongkutklao College of Medicine.

Objective: To assess changes in physical fitness level and anthropometric characteristics of medical cadets in Phramongkutklao College of Medicine (PCM). Material and Method: A prospective study was conducted in 73 male and 20 female medical cadets at PCM during their study through medical education between April 2008 and July 2012. Anthropometric measurement and physical fitness test were performed at initial, preclinical year, and clinical year including body weight, height, waist-hip circumference, body mass index (BMI), waist-hip ratio (WHR), waist-height ratio (WHtR), % body fat, grip and leg strength, maximal oxygen uptake (VO2 max), 2-minute push-ups, 2-minute sit-ups, and 2-kilometer run for time. Results: Through the course of medical education, significant increase (p<0.05) in body weight, height, waist circumference, hip circumference, BMI, WHR, WHtR, and % body fat were detected. The increments in body weight and BMI in males were greater than in females. When compared to initial fitness, medical cadets in preclinical year could improve physical fitness variables with statistical significance reported in VO2 max, numbers of push-ups, sit-ups, and 2-kilometer run. When compared to preclinical year, VO2max was significant decreased and run time was significant increased in clinical year (p<0.05). Conclusion: Male medical cadets tended to gain more weight over the four years spent at PCM. Health-related physical fitness of medical cadet improved in preclinical year and cardiorespiratory fitness declined in clinical year. To establish motivation to have regular physical activity in medical student, physical fitness test and anthropometric measurement should be integrated into the medical student's curriculum.

Trends in Serum Total Cholesterol and High Total Cholesterol Prevalence Among Royal Thai Army Personnel in Thailand, 2017-2022.

INTRODUCTION: High total cholesterol (TC) is a robust-documented risk factor for atherosclerosis cardiovascular diseases. Approximately one-fourth (23.5%) of Thai civilians had high TC. However, the information on high TC among the Royal Thai Army (RTA) personnel is limited. AIM: The study aimed to identify the trends in serum TC and high TC prevalence among RTA personnel from 2017 to 2022. METHODS: A serial cross-sectional study from 2017 to 2022 was conducted. A total of 318,353 active-duty RTA personnel aged 35-60 years were included in the study. High TC was defined as fasting TC ≥ 240 mg/dL. A multivariable log-binomial regression analysis was performed to investigate factors associated with high TC. RESULTS: The overall age- and sex-adjusted high TC prevalence was 26.3% in 2017 and dropped to 22.9% in 2020; then, it increased to 26.4% in 2022 (p for quadratic trend < 0.001). Younger-aged RTA personnel have significantly rising trends in sex-adjusted high TC prevalence over 6 years. In the south, the age- and sex-adjusted high TC prevalence was 24.4% in 2017 and substantially rose to 33.6% in 2022 (p for quadratic trend < 0.001). Meanwhile, in the northeast, it rose by 3.6% over 6 years. High body mass index, high blood pressure, and hyperglycemia were associated with high TC prevalence among this population. CONCLUSION: High TC was a common essential health issue among RTA personnel. Rising trends in mean serum TC and high TC prevalence from 2017 to 2022 were discovered, especially in younger participants and those residing in the south and northeast.

Rising trends in the predicted 10-year risk of cardiovascular diseases among Royal Thai Army personnel from 2017 to 2021.

Deaths from cardiovascular diseases (CVD) are becoming a growing threat to global health, including in Thailand. The aim of the present study was to identify the recent trends in the predicted 10-year risk of CVD among Royal Thai Army (RTA) personnel from 2017 to 2021. The predicted 10-year risk for CVD was calculated through the use of the 2008 updated version of the risk algorithm derived from the Framingham Heart Study data. The current study included 346,355 active-duty RTA personnel aged 30-60 years. The age- and sex-adjusted mean of the predicted 10-year risk for CVD significantly increased from 10.8% (95% CI: 10.8-10.9%) in 2017 to 11.7% (95% CI: 11.6-11.7%) in 2021 (p for trend < 0.001). The overall age- and sex-adjusted prevalence of intermediate-to-high predicted 10-year risk for CVD remarkably surged from 24.9% (95% CI: 24.4-25.4%) in 2017 to 29.5% (95% CI: 29.0-30.0%) in 2021 (p for trend < 0.001). The modifiable risk factors for CVD, including high systolic blood pressure, high body mass index, and current smoking in this population, should be alleviated to mitigate the risk for CVD in the future.

Prevalence, awareness, and control of hypertension and associated factors among Royal Thai Army personnel in Thailand from 2017 to 2021.

Hypertension (HTN) is a potential risk factor for cardiovascular diseases. We aimed to determine the prevalence, awareness, and control of HTN among RTA personnel in Thailand. We conducted a series of cross-sectional studies from 2017 to 2021. HTN was defined by systolic blood pressure (BP) ≥ 140 mmHg or a diastolic BP ≥ 90 mmHg from a physical health examination, a history of HTN diagnosed by medical personnel, or taking antihypertensive medication. A total of 504,484 participants were included in the present study. The overall HTN prevalence was 29.4%. The prevalence of HTN among males was 30.5%, while it was 17.1% among females. Of the RTA personnel with HTN, 35.9% were aware of their condition. The overall control of HTN among RTA personnel with HTN was 15.8% in 2017 and 17.6% in 2021. Behavioral factors associated with HTN were current smoking, alcohol consumption, and sedentary behavior. A higher BMI was associated with higher HTN prevalence and HTN awareness but less likely to have controllable HTN. Male participants, younger individuals, current alcohol use, and sedentary behavior were associated with a lower prevalence of HTN awareness and controlled HTN. Current tobacco use was also associated with a lower prevalence of HTN awareness.

Comparision of overweight and obesity in medical cadets before and after 6 months studying at Phramongkutklao College.

OBJECTIVE: To evaluate prevalence of overweight and obesity in second-year medical cadets and to determine risk behaviors before and after 6 months studying at Phramongkutklao College of Medicine (PCM). MATERIAL AMD METHOD: Data on self-report behavioral questionnaires was collected from 92 medical cadets before and after 6 months studying at PCM in 2008. Body weight, height, waist circumference, blood pressure and body fat were measured according to standard protocols. RESULTS: Overall, prevalence of overweight and obese medical cadets before studying at PCM was 16.30% and 15.22% according to BMI and 27.17% and 15.22% by percent body fat. After 6 months of study, overall mean of body fat and systolic blood pressure were significantly reduced. For males, the mean of weight, BMI and waist circumference were reduced significantly. In contrast, the mean of body weight and BMI of females were significantly increased. The prevalence of overweight in total participants determined by body fat was significantly reduced from 27.17% to 15.22%. Determination by BMI, obesity was significantly reduced from 34.29% to 14.29% only in males. Behaviors that were found to be significantly increased (p < 0.001) were regular physical activity, night eating, sugar-sweet beverage consumption, amount and frequency of coffee or tea consumption. Significant decrease in time of watching TV or using a computer, and duration of sleep was also determined. CONCLUSION: The present study indicated that overweight, obesity, waist circumference and body fat of medical cadets were decreased after study at PCM which is possibly due to increasing exercise. Nevertheless, behavioral risks for obesity were also increasing, therefore, it might result in increased the prevalence of obesity in the future.

Associated factors of blood pressure control and complications of hypertension in hypertensive rural Thai populations of Baan Nayao, Chachoengsao Province.

OBJECTIVE: To assess associated factors of uncontrolled blood pressure and complications of hypertension in hypertensive rural Thai populations. MATERIAL AND METHOD: A cross-sectional study was conducted in hypertensive rural Thai people aged > or =35 years-old in Baan Nayao, Chachoengsao Province, Thailand. Blood pressure (BP) was measured and questionnaires were answered. After 12-hr fasting, blood samples were taken for determining plasma glucose, lipid profiles and serum creatinine. Morning urine samples were collected for microalbuminuria testing and electrocardiography (ECG) was performed to detect left ventricular hypertrophy (LVH). RESULTS: Of the 289 participants (97 males and 192 females) mean duration of hypertension was 4.29 +/- 4.95 years and 61.5% did not achieve target BP control. Among participants who had ECG performed and urine sample investigation, 15.7% demonstrated LVH and 25.3% had microalbuminuria. In uncontrolled BP participants, 20% had LVH and 24.8% had microalbuminuria whereas in controlled BP participants, 7.8% had LVH and 26.1% had microalbuminuria. Uncontrolled BP was associated with males, dyslipidemia, diabetes, abdominal obesity, metabolic syndrome, always having salty food and salts added for seasoning. The independent risks of uncontrolled BP were hypertensive male (OR = 2.48, 95% CI = 1.07-5.76) and metabolic syndrome (OR = 2.59, 95% CI = 1.24-5.40). Males were also at risk for LVH (OR = 2.86, 95% CI = 1.31-6.23) and history of lipid disorders was a risk of microalbuminuria (OR = 3.13, 95% CI = 1.47-6.67). CONCLUSION: Males and metabolic syndrome were independently associated with uncontrolled BP in hypertensive participants. Males had more risk than females to develop LVH and having history of lipid disorders lead to microalbuminuria occurrence. Thus, life style modification may prove beneficial to these rural hypertensive participants.

Model development to improve primary care services using an innovative network of homecare providers (WinCare) to promote blood pressure control among elderly patients with noncommunicable diseases in Thailand: a prospective cohort study.

BACKGROUND: Thailand has been rapidly approaching an aging society in conjunction with an increase in noncommunicable diseases (NCDs) especially hypertension and type 2 diabetes. Demographics and epidemiologic transitions create several challenges to the health system in Thailand in the case of long term care policies, in particular, modality to support home care. Therefore, the model development to facilitate primary care home services for elderly patients with NCDs using an innovative network of homecare providers (WinCare) was established. The study aimed to evaluate the effectiveness of WinCare to improve blood pressure (BP) control as well as health-related quality of life (HRQoL) among elderly patients with NCDs. METHODS: A prospective cohort study was conducted between July 2019 and January 2020 in a suburban area, Chiang Mai Province, Thailand. The intervention included WinCare providers and WinCare application. WinCare provided check-in visits to measure subjects blood pressure and body weight (once weekly), played the roles of other home caregivers for the patients and recorded measurements and activities in the WinCare app for 6 months. The primary outcomes of the study were differences in systolic BP, diastolic BP, and controlled BP (systolic BP < 140 mmHg and diastolic BP < 90 mmHg) at 6-month follow-up between the intervention and control groups, adjusting for age, sex, marital status, comorbidities, alcohol consumption and smoking status. RESULTS: A total of 104 subjects were initially recruited. Of the remaining 98 individuals, 52 were allocated to the intervention group and 46 to the control group. After adjusting baseline characteristics, no association existed between decreasing average systolic BP and intervention groups. However, diastolic BP of patients in the intervention group was on average 5.19 mmHg (95% CI -8.22, - 2.17) lower compared than that of the control group at 6-month follow-up. Furthermore, compared with patients in the control group, those in the intervention group were more likely to control BP, (AOR 3.03; 95% CI 1.02-9.01) at 6-month follow-up. CONCLUSION: Establishing a network of homecare providers (WinCare) was feasible in a community setting. This innovative network was able to facilitate elderly patients with NCDs residing in a suburban community to improve BP control at least at 6-month follow-up. TRIAL REGISTRATION: Trial identification number was TCTR20200312007 , First submitted date:12/03/2020.

Rising trends in obesity prevalence among Royal Thai Army personnel from 2017 to 2021.

Obesity is an essential health issue leading to noncommunicable diseases (NCDs) as well as atherosclerotic cardiovascular diseases. We aimed to determine the trends in obesity prevalence among Royal Thai Army (RTA) personnel and their associated factors using the health examination of RTA personnel database. A series of cross-sectional studies were conducted from 2017 to 2021. A self-report guide was created using a standardized case report form to obtain demographic characteristics and determine behavioral risk factors. Obesity was defined as BMI [Formula: see text] 25 kg/m2, and a total of 512,476 RTA personnel nationwide were included. Obesity prevalence rose from 42.1% (95% CI 41.7-42.4) in 2017 to 44.2% (95% CI 43.9-44.5) in 2021 (p for trend < 0.001). A significant surge was observed in obesity prevalence among young RTA personnel aged 18-24 years from 23.7% in 2017 to 28.4% in 2021 (p for trend < 0.001). Higher age individuals, male participants and RTA personnel residing in Bangkok tended to have a significantly higher risk for obesity. Further, regular exercise was a protective factor for obesity. Our data emphasized that obesity among the RTA personnel has been continuously rising over one half-decade, especially among young adults.

Trends in the prevalence of obesity among young Thai men and associated factors: from 2009 to 2016.

BACKGROUND: The prevalence of obesity has been increasing in both males and females worldwide. In Thailand, the National Health Examination Surveys reported that the prevalence of obesity (body mass index (BMI) ≥30 kg/m2) among Thai male adults aged 20-59 years increased from 1.7% in 1991 to 6.8% in 2009. Obesity has been confirmed to lead to health problems, including noncommunicable diseases. In the present study, we report trends in the prevalence of obesity among new conscripts from 2009 to 2016. We also investigated the associated factors of obesity. METHODS: Serial cross-sectional studies were conducted from 2009 to 2016 among male Royal Thai Army (RTA) conscripts whose weight and height had been measured to determine BMI after being inducted. Each subject completed a detailed risk factor questionnaire. Obesity was defined as BMI ≥ 30 kg/m2. RESULTS: A total of 26,540 young Thai males conscripted into the RTA were included in this study. The prevalence of obesity was 2.2% in 2009, 3.4% in 2010, 2.5% in 2011, 2.9% in 2012, 3.4% in 2013, 4.4% in 2014, 5.0% in 2015, and 4.8% in 2016 (P for trend < 0.0001). The independent risk factors for obesity were coming from the north central and south regions compared with the northeast, higher education level, indoor occupation and no regular exercise. CONCLUSIONS: Our data emphasized that obesity constitutes a serious problem among young Thai men. We could apply these findings in military units to other groups at any age. Regular exercise should be provided to young adults and other age groups to slow the process of obesity, so that associated complications, especially noncommunicable diseases, will cease.

Incidence and Associated Factors of Type 2 Diabetes: A Community-Based Cohort Study in the Central Region of Rural Community in Thailand.

The present study aimed to evaluate the incidence of type 2 diabetes mellitus (T2DM) and associated risk factors among adults in a rural community of Thailand. A prospective cohort study was conducted in a rural community of Thailand. Among 1358 nondiabetics ≥18 years, fasting plasma glucose (FPG) was measured at baseline in 2008 to 2010 and at follow-up evaluation in 2015. After follow-up of 5213 person-years, 122 new cases of T2DM were ascertained corresponding to cumulative incidence of 23.40 per 1000 person-years. The independent factors associated with T2DM were age, male, prehypertension, hypertension, waist circumference, and impaired FPG. The incidence of T2DM in Thailand is high, and many risk factors are converging. The focus of public health efforts should be on abdominal obesity, hypertension, and impaired FPG. Special attention in terms of preventive strategies must be paid to individuals with impaired FPG, as this state is the most prominent predictor of developing T2DM.

Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand.

PURPOSE: Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand. METHODS: We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child. RESULTS: Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5-18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24-4.08; P=0.07), mother's body mass index (aOR, 1.07; 95% CI, 1.02-1.12; P=0.001), selfemployed father (aOR, 1.99; 95% CI, 1.12-3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47-0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20-2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40-21.32; P<0.001), consuming 2-3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38-3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11-6.46; P= 0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19-4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36-4.96; P=0.004). CONCLUSION: Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.

Personal risk factors associated with heat-related illness among new conscripts undergoing basic training in Thailand.

Cases of exertional heat stroke have been reported every year during basic training for Royal Thai Army (RTA) conscripts. Prevention is an important strategy to reduce the incidence of heat-related illnesses. We conducted a study to identify potential indicators for the prevention and monitoring of heat-related illnesses among military conscripts undergoing basic training in Thailand. All newly inducted RTA conscripts in 5 basic training units in 5 regions in Thailand were invited to participate in a prospective cohort study from May 1 to July 9, 2013. The incidence rate of heat-related illnesses and the incidence rate ratio (IRR) based on a Poisson regression model were used to identify the independent factors associated with heat-related illnesses, daily tympanic (body) temperatures higher than 37.5°C, >3% decreases in body weight in one day, and the production of dark brown urine. Eight hundred and nine men aged 21.4 (±1.13) years were enrolled in this study. The prevalence of a body mass index (BMI) ≥30 kg/m2 was 5.5%. During the study period, 53 subjects (6.6%) representing 3.41/100 person-months (95% confidence interval (CI), 2.55-4.23) developed heat-related illnesses (excluding heat rash), and no subjects experienced heat stroke. The incidence rates of a daily tympanic temperature >37.5°C at least once, body weight loss of >3% per day, and the production of dark brown urine at least once were 8.27/100 person-months (95% CI, 7.69-8.93), 47.91/100 person-months (95% CI, 44.22-51.58), and 682.11/100 person-months (95% CI, 635.49-728.52), respectively. The sole identified independent factor related to the incidence of heat-related illnesses was a BMI ≥30 kg/m2 (adjusted IRR = 2.66, 95% CI, 1.01-7.03). In conclusion, a high BMI was associated with heat-related illnesses among conscripts undergoing basic training in Thailand. Daily monitoring of heat-related illnesses, body temperature, body weight and urine color in each new conscript during basic military training was feasible.

Systematic review of physical fitness testing to evaluate the physical combat readiness of Royal Thai Armed Forces.

Physical combat readiness of military personnel ensures maximal effectiveness of combat forces during wartime. Combat readiness has always been linked to the Army Physical Fitness Test (APFT). Each raw score is converted to a standard score and corrected for age and gender. There is no standard measurement to evaluate combat readiness in the Royal Thai Army. To determine standardized criteria for physical combat readiness of Royal Thai Army personnel through systematic review, the APFT was used to determine fitness levels and to promote health. To pass the test, each soldier in each unit must attain a minimal standard score for each individual subtest. At present, each unit in the armed forces derives its own standard, based on different missions. The APFT might be an acceptable method to measure physical combat readiness. However, no studies have established the general measurements to evaluate combat readiness.

A Pharmacological Examination of the Cardiovascular Effects of Malayan Krait (Bungarus candidus) Venoms.

Cardiovascular effects (e.g., tachycardia, hypo- and/or hypertension) are often clinical outcomes of snake envenoming. Malayan krait (Bungarus candidus) envenoming has been reported to cause cardiovascular effects that may be related to abnormalities in parasympathetic activity. However, the exact mechanism for this effect has yet to be determined. In the present study, we investigated the in vivo and in vitro cardiovascular effects of B. candidus venoms from Southern (BC-S) and Northeastern (BC-NE) Thailand. SDS-PAGE analysis of venoms showed some differences in the protein profile of the venoms. B. candidus venoms (50 µg/kg-100 µg/kg, i.v.) caused dose-dependent hypotension in anaesthetised rats. The highest dose caused sudden hypotension (phase I) followed by a return of mean arterial pressure to baseline levels and a decrease in heart rate with transient hypertension (phase II) prior to a small decrease in blood pressure (phase III). Prior administration of monovalent antivenom significantly attenuated the hypotension induced by venoms (100 µg/kg, i.v.). The sudden hypotensive effect of BC-NE venom was abolished by prior administration of hexamethonium (10 mg/kg, i.v.) or atropine (5 mg/kg, i.v.). BC-S and BC-NE venoms (0.1 µg/kg-100 µg/ml) induced concentration-dependent relaxation (EC50 = 8 ± 1 and 13 ± 3 µg/mL, respectively) in endothelium-intact aorta. The concentration-response curves were markedly shifted to the right by pre-incubation with L-NAME (0.2 mM), or removal of the endothelium, suggesting that endothelium-derived nitric oxide (NO) is likely to be responsible for venom-induced aortic relaxation. Our data indicate that the cardiovascular effects caused by B. candidus venoms may be due to a combination of vascular mediators (i.e., NO) and autonomic adaptation via nicotinic and muscarinic acetylcholine receptors.

Albuminuria in rural Thai people: a community-based screening with Combur Test and Micral Test strips.

OBJECTIVES: To identify albuminuria prevalence and examine the association of albuminuria with plasma glucose, blood pressure and body mass index in rural Thai people aged 35 and older. MATERIAL AND METHOD: All volunteer adults aged 35 and older at Ban Nayao, Chachoengsao Province were recruited in this cross-sectional study. Macroalbuminuria and microalbuminuria were tested in first morning urine using Combur and Micral Test strips. Fasting plasma glucose, blood pressure, weight and height were determined. Chi-square and multiple logistic regression analysis were used for analysis. RESULTS: Of the 357 participants, 26.61% had microalbuminuria, 3.08% had macroalbuminuria, and 9.2%, 19%, 7.3% had diabetes, hypertension, and obese, respectively. The prevalence of microalbuminuria and macroalbuminuria in people with diabetes were 30.30% and 15.15%, respectively. In the obese, the prevalence was 50% and 3.8% and was 30.88% and 7.35% in the hypertensive group, respectively. Strong significant associations between plasma glucose (p = 0.013), and body mass index (p = 0.008) with the progression of albuminuria were observed. According to multiple logistic regression analysis, diabetes and obesity were independent risk factors for albuminuria statistically significant (p = 0.036 and p = 0.005, respectively, 95% CI). CONCLUSION: The present study showed increased risk of albuminuria in diabetes and in obese people in a rural area of Thailand. Thus, community-controlled diabetes and weight program should be introduced to the rural community.

Teaching medical ethics: Phramongkutklao College of Medicine's model.

BACKGROUND: Third-year (first preclinical year) Royal Thai Army (RTA) medical cadets were exposed to a rural community in a community medicine field activity. The poor, kind rural people gave good conditions for student's professional development and empathy. OBJECTIVES: To report a community medicine field work activity for professional development of the RTA medical school. MATERIAL AND METHOD: Descriptive analysis on two occasions to evaluate the third-year RTA medical cadets' impressions immediately after the community medicine field activity in a rural area in central Thailand and one year later using baseline scores of cadets' impressions against our institute's objectives. RESULTS: At the end of the field work, 90.9% of the cadets reported they achieved several institute objectives. The four most frequent mentioned were ethical development (70.6%), professionalism (84.3%), human relationship & communication skills (92.2%), and capability to work in the cmmunity (64.7%). Furthermore, RTA medical cadets rated the staff as good role models (51%). CONCLUSION: The community field work course provided a good environment for the third year medical cadets in building morality and professional development to be good doctors.