The effectiveness of traditional Thai massage versus massage with herbal compress among elderly patients with low back pain: A randomised controlled trial.

OBJECTIVES: To determine the effectiveness of including an herbal compress in a traditional Thai massage regimen for the care of low back pain in the elderly. DESIGN AND METHODS: This study was a randomised controlled trial. The sample consisted of 140 patients suffering from non-specific chronic low back pain, who were randomly assigned to either the TTM (n = 70) or TMH (n = 70) group. The primary outcome was pain intensity (Visual Analogue Scale), and the secondary outcomes were disability, back performance and quality of life. The outcome measurements were assessed at baseline, 6 weeks and 15 weeks. RESULTS: There were no statistically significant differences in the primary and secondary outcomes between the two study groups (p-value > 0.05). Although improvement was observed for both groups in pain intensity, disability, quality of life, and back performance. CONCLUSIONS: There was no additional benefit of including an herbal compress in a regimen of Thai massage for the care of low back pain in the elderly.

Genetic diversity and population structure of Plasmodium falciparum in Thailand, a low transmission country.

BACKGROUND: The population structure of the causative agents of human malaria, Plasmodium sp., including the most serious agent Plasmodium falciparum, depends on the local epidemiological and demographic situations, such as the incidence of infected people, the vector transmission intensity and migration of inhabitants (i.e. exchange between sites). Analysing the structure of P. falciparum populations at a large scale, such as continents, or with markers that are subject to non-neutral selection, can lead to a masking and misunderstanding of the effective process of transmission. Thus, knowledge of the genetic structure and organization of P. falciparum populations in a particular area with neutral genetic markers is needed to understand which epidemiological factors should be targeted for disease control. Limited reports are available on the population genetic diversity and structure of P. falciparum in Thailand, and this is of particular concern at the Thai-Myanmar and Thai-Cambodian borders, where there is a reported high resistance to anti-malarial drugs, for example mefloquine, with little understanding of its potential gene flow. METHODS: The diversity and genetic differentiation of P. falciparum populations were analysed using 12 polymorphic apparently neutral microsatellite loci distributed on eight of the 14 different chromosomes. Samples were collected from seven provinces in the western, eastern and southern parts of Thailand. RESULTS: A strong difference in the nuclear genetic structure was observed between most of the assayed populations. The genetic diversity was comparable to the intermediate level observed in low P. falciparum transmission areas (average HS = 0.65 +/- 0.17), where the lowest is observed in South America and the highest in Africa. However, uniquely the Yala province, had only a single multilocus genotype present in all samples, leading to a strong geographic differentiation when compared to the other Thai populations during this study. Comparison of the genetic structure of P. falciparum populations in Thailand with those in the French Guyana, Congo and Cameroon revealed a significant genetic differentiation between all of them, except the two African countries, whilst the genetic variability of P. falciparum amongst countries showed overlapping distributions. CONCLUSION: Plasmodium falciparum shows genetically structured populations across local areas of Thailand. Although Thailand is considered to be a low transmission area, a relatively high level of genetic diversity and no linkage disequilibrium was found in five of the studied areas, the exception being the Yala province (Southern peninsular Thailand), where a clonal population structure was revealed and in Kanchanaburi province (Western Thailand). This finding is particularly relevant in the context of malaria control, because it could help in understanding the special dynamics of parasite populations in areas with different histories of, and exposure to, drug regimens.

Physicians' attitudes and practices regarding advanced end-of-life care planning for terminally ill patients at Chiang Mai University Hospital, Thailand.

This study examined physicians' attitudes toward advanced directives and practices for the end-of-life care at Chiang Mai University Hospital, Thailand. The data were collected from 55 physicians (24 instructors and 31 residents) using self-reported questionnaires. The majority of the participants affirmed the usefulness of the advance directive (AD) for cardiopulmonary resuscitation and respected the patients' wish for this directive, although advanced end-of-life care and resuscitation planning with the patients was limited. Mostly, the relatives were consulted regarding ADs. This study suggests that, in traditional Thai culture, physicians and families are more inclined to make decisions for the patient when they feel that it is in the patient's best interest. Further research is needed to investigate how and to what extent such attitudes can affect medical practice for end-of-life care in the context of the rapid development and consequent changes taking place in Thailand.

Effectiveness of advance directives for the care of terminally ill patients in Chiang Mai University Hospital, Thailand.

The key hypothesis behind advance directives (ADs) proposes that, if an intervention enhances a person's right to choose, a dying person will not opt for expensive, life-prolonging medical care and an ethically acceptable saving of resources will result. In order to assess the acceptability and effectiveness of ADs in reducing cardiopulmonary resuscitation (CPR) attempts and in-hospital death among terminally ill patients in a tertiary care hospital in northern Thailand, a non-randomized, controlled intervention study using an after-only unequivalent control group design was conducted. The majority of the subjects and the surrogates preferred to employ ADs in expressing their preferences on CPR and there was a high level of agreement between the subjects and surrogates on the decision. The use of ADs appeared to be effective in reducing futile CPR attempts and the in-hospital mortality rate among subjects during the index hospitalization. Advance directives were accepted well in this study setting.

Creating and testing the concept of an academic NGO for enhancing health equity: a new mode of knowledge production?

CONTEXT: Collaborative action is required to address persistent and systematic health inequities which exist for most diseases in most countries of the world. OBJECTIVES: The Academic NGO initiative (ACANGO) described in this paper was set up as a focused network giving priority to twinned partnerships between Academic research centres and community-based NGOs. ACANGO aims to capture the strengths of both in order to build consensus among stakeholders, engage the community, focus on leadership training, shared management and resource development and deployment. METHODS: A conceptual model was developed through a series of community consultations. This model was tested with four academic-community challenge projects based in Kenya, Canada, Thailand and Rwanda and an online forum and coordinating hub based at the University of Ottawa. FINDINGS: Between February 2005 and February 2007, each of the four challenge projects was able to show specific outputs, outcomes and impacts related to enhancing health equity through the relevant production and application of knowledge. CONCLUSIONS: The ACANGO initiative model and network has demonstrated success in enhancing the production and use of knowledge in program design and implementation for vulnerable populations.

Importance of delayed perfusion with primary angioplasty on short-term mortality in acute myocardial infarction patients.

BACKGROUND: Early primary coronary interventions (PCI) in acute ST elevation myocardial infarction (STEMI) is associated with improved outcome and mortality rate but delayed reperfusion especially after 6 hours is still doubtful in terms of clinical benefits because most myocardial muscle are infarcted after 6 hours of onset of chest pain. OBJECTIVE: The aim of the present study was to compare the mortality rate of patients treated with PCI within 6 hours of symptom onset to those treated between 6 to 24 hours after the onset of STEMI. MATERIAL AND METHOD: The present study included consecutive patients from the data of the Fast Track Registry of King Chulalongkorn Hospital from June 1, 1999 to October 31, 2003 to compare the thirty-day mortality of patients treated with early or delayed PCI (0-6 hours vs. 6-24 hours after symptom of chest pain) for STEMI. RESULTS: Two hundred and sixteen patients who underwent PCI were enrolled. Male gender (82% vs. 64.9%, p = 0.03) and history of smoking (72.1% vs. 50%, p = 0.04) were predominant in the early treatment group (ETG) vs. the delayed treatment group (DTG). Mean age (60.5% vs. 61.03%, p = 0.11), diabetes (31.4% vs. 29.7%, p = 0.82), hypertension (64.0% vs. 54.1%, p = 0.20), dyslipidemia (58.1% vs. 60.8%, p = 0.73), and ejection fraction < 40% (22.8% vs. 32.0%, p = 0.625) were similar in both groups. There were no differences in angiographic finding and hospital management. Door to balloon and total delay time were 124.13 +/- 143.27 min and 407.94 +/- 268.183 min, respectively. The thirty-day mortality (9.01% vs. 12.76%, p = 0.379) and I year mortality (12.4% vs. 16 9%, p = 0.532) were not significantly determined by Log rank test in both groups. As for cardiogenic shock, ETG tended to have a lower thirty-day mortality than DTG but no statistically significant difference (12.5% vs. 50.0%, p = 0.0809). CONCLUSION: The delayed PCI up to 24 hours in STEMI does not increase short-term mortality at thirty days; therefore, it may still have benefit in STEMI patients. However it tended to have higher short-term mortality than early PCI especially in cardiogenic shock but showed no statistical significance.

Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study.

BACKGROUND: Psychosocial factors have been reported to be independently associated with coronary heart disease. However, previous studies have been in mainly North American or European populations. The aim of the present analysis was to investigate the relation of psychosocial factors to risk of myocardial infarction in 24767 people from 52 countries. METHODS: We used a case-control design with 11119 patients with a first myocardial infarction and 13648 age-matched (up to 5 years older or younger) and sex-matched controls from 262 centres in Asia, Europe, the Middle East, Africa, Australia, and North and South America. Data for demographic factors, education, income, and cardiovascular risk factors were obtained by standardised approaches. Psychosocial stress was assessed by four simple questions about stress at work and at home, financial stress, and major life events in the past year. Additional questions assessed locus of control and presence of depression. FINDINGS: People with myocardial infarction (cases) reported higher prevalence of all four stress factors (p<0.0001). Of those cases still working, 23.0% (n=1249) experienced several periods of work stress compared with 17.9% (1324) of controls, and 10.0% (540) experienced permanent work stress during the previous year versus 5.0% (372) of controls. Odds ratios were 1.38 (99% CI 1.19-1.61) for several periods of work stress and 2.14 (1.73-2.64) for permanent stress at work, adjusted for age, sex, geographic region, and smoking. 11.6% (1288) of cases had several periods of stress at home compared with 8.6% (1179) of controls (odds ratio 1.52 [99% CI 1.34-1.72]), and 3.5% (384) of cases reported permanent stress at home versus 1.9% (253) of controls (2.12 [1.68-2.65]). General stress (work, home, or both) was associated with an odds ratio of 1.45 (99% CI 1.30-1.61) for several periods and 2.17 (1.84-2.55) for permanent stress. Severe financial stress was more typical in cases than controls (14.6% [1622] vs 12.2% [1659]; odds ratio 1.33 [99% CI 1.19-1.48]). Stressful life events in the past year were also more frequent in cases than controls (16.1% [1790] vs 13.0% [1771]; 1.48 [1.33-1.64]), as was depression (24.0% [2673] vs 17.6% [2404]; odds ratio 1.55 [1.42-1.69]). These differences were consistent across regions, in different ethnic groups, and in men and women. INTERPRETATION: Presence of psychosocial stressors is associated with increased risk of acute myocardial infarction, suggesting that approaches aimed at modifying these factors should be developed.

Prevention of chronic kidney and vascular disease: toward global health equity--the Bellagio 2004 Declaration.

Chronic kidney disease (CKD) not only reflects target organ injury in systemic vascular disease in the general population and in association with diabetes, hypertension, and smoking, but it is recognized as one of the major risk factors in the pathogenesis and outcome of cardiovascular disease. Recent surveys have revealed that the prevalence of CKD, particularly the hidden mild form (mildly elevated levels of serum creatinine or urinary albumin excretion), is surprisingly high in the general population. In recent years, the global epidemic of type 2 diabetes has led to an alarming increase in the number of patients with CKD. Most patients with CKD (over 50 million individuals worldwide) succumb to cardiovascular events, while each year over 1 million develop end-stage renal failure, which requires costly treatment and in many countries of the world, unaffordable renal replacement therapy by chronic dialysis or renal transplantation. Alarmed by the immense challenge to human morbidity and the economic burden of CKD and ensuing systemic cardiovascular disease, the International Society of Nephrology convened a multidisciplinary group of expert physicians and public health leaders from around the world to develop strategies to delay and avert this bleak future by effective prevention of CKD based on awareness, early detection, and effective treatment.

A study of Thai cobra (Naja kaouthia) bites in Thailand.

This study evaluated factors affecting the severity of bite site necrosis and systemic symptoms resulting from envenomation among patients bitten by Thai cobras (Naja kaouthia) in Thailand. We studied 45 victims prospectively. An additional 40 medical records were obtained for a retrospective study. Collected data included gender of the victims, anatomic locations of bites, where attacks took place, and predisposing factors and how they might have affected the clinical course. Most patients were asymptomatic or mildly symptomatic. Neurotoxic symptoms and respiratory failure developed in 31.11% and 12.50% in the prospective and retrospective groups, respectively. Only one patient died, from the effects of prolonged respiratory failure. There was some degree of tissue necrosis at the bite site for almost all victims. One victim required amputation of a digit in the retrospective study, and 33.60% of the prospective group and 20% of the retrospective group required minor surgical debridement. Snakebites in Thailand are still a public health problem, although rapid urbanization has decreased the number of victims because of degradation of the snake's habitat.

A study of 225 Malayan pit viper bites in Thailand.

This study evaluated factors affecting the severity of bite site necrosis and systemic symptoms resulting from envenomation among patients bitten by Malayan pit vipers (Calloselasma rhodostoma) in Thailand. We studied 145 victims prospectively. An additional 80 medical records were obtained for a retrospective study. Collected data included gender of the victims, anatomic locations of bites, where attacks took place, and predisposing factors and how they might have affected the clinical course. Most patients presented with minimal to moderate symptoms. Only eight patients required surgical wound debridement. None required amputation. However, 27 subjects developed permanently swollen limbs, presumably because of lymphatic or vascular injury. Significant coagulopathies were common (52.48%), and the only two deaths were attributable to intracranial hemorrhage. The improved clinical outcomes in the prospective and retrospective groups, compared with older series, might have been attributable to better public education, improved road infrastructure, and more health care facilities. Less reliance on nonprofessional healers and fewer applications of tourniquets also might have influenced clinical outcomes. Malayan pit viper antivenin, manufactured in Thailand, appears to be effective in reversing dangerous coagulopathies.

Patterns, appropriateness, and predictors of antimicrobial prescribing for adults with upper respiratory infections in urban slum communities of Bangkok.

Upper respiratory tract infections (URIs) are the most common infections worldwide. Their frequent inappropriate treatment with antibiotics is likely to increase antibiotic resistance, contribute to morbidity and mortality, and waste scarce resources. Using data from registration books and prescriptions, we measured patterns and assessed appropriateness and predictors of antibiotic prescribing for viral and bacterial URIs treated in health centers located in two slum communities in Bangkok, Thailand. Based on recorded diagnoses and symptoms, 91% of the patients probably had viral URIs; 60% of viral and 89% of bacterial URI patients were prescribed an antibiotic. Compliance with the national treatment guideline was 36.4% for treatment of viral URIs and only 1.7% for treatment of bacterial URIs. Amoxicillin was the most frequently prescribed antibiotic regardless of diagnosis. Among viral URI patients, those who were young, male, and self-paying were more likely to receive antibiotics; part-time physicians were more likely to prescribe antibiotics for these patients. Among patients with bacterial URIs, those who paid for drugs by themselves were more likely to receive antibiotics compared to patients covered by the national health insurance plan. We used these formative results as input to the design of health center and community interventions to encourage more appropriate prescribing for URI among adults.

Factors affecting the experiences of drug use by adolescents in a Bangkok slum.

The purpose of this research was to study the demography, financial status, social status, knowledge of amphetamines, perceived harmfulness of amphetamines, and life skills in the prevention of drug abuse in adolescents. The factors leading to drug use among young people were also studied. The study group was composed of 354 subjects aged 12 to 22 years, living in 2 slums in Bangkok. The research showed that about 7% of the sample group had used drugs before. Four percent had never used drugs, but someone had tried to talk them into using them. Almost 20% had friends who had used drugs, and 11% had friends who were still using drugs. About 13% of the adolescents in the study group had family members who used drugs and another 9% had family members who were still using drugs. In our study, we found that the most common drug group was amphetamines. On average, the participants had a low level of understanding about drug abuse, especially of the symptoms, side effects, and legal penalties. Most of the adolescents realized how harmful amphetamines and other drugs were and had a high degree life skills. Factors influencing adolescent drug use were (1) personal factors, such as monthly income/allowance and life skills; (2) family environment, such as drug abuse history in the family; and (3) social environment, such as a drug abuse history among friends. When studying the life skill factors of the adolescents, which is an independent factor capable of influencing the experience with drugs, the researchers found that the time spent with other members of the family and the family members' drug experiences were the only factors leading to life skills in the prevention of drug abuse in adolescents. In addition to letting children learn on their own, training them to acquire life skills is beneficial when faced with problematic situations. Creating relationships between adolescents and other members of the family, friends, and society can increase their life skills, diminishing the risk of drug abuse.

Prescription pattern for treatment of hemorrhoids under the universal coverage policy of Thailand.

The Universal Coverage Policy (UCP) or "30 Baht Scheme" was launched in Thailand in 2001. The policy caused a cutback in the budgets of all public hospitals and health service centers. Traditional medicine was then viewed as an alternative to save costs. This study examines whether this had any influence on hemorrhoid treatment prescription patterns, ratio of traditional/modern medicine, or the cost of hemorrhoid treatment after the UCP was implemented at a community hospital. The traditional medicine prescribed was Petch Sang Kart and the modern alternative was Proctosedyl. All hemorrhoid prescriptions at a community hospital from October 2000 to January 2003 were surveyed. Segmented Regression Analysis was applied to evaluate prescription trends, the ratios between the types of medicine, and the hemorrhoid treatment cost. A total of 256 prescriptions were analyzed. The average number of traditional medicine prescriptions per month were more than modern medicine (41 versus 16). During the study period, the trend of modern medicine use and the treatment cost was decreased (p < 0.01). The ratio of traditional/modern medicine increased 0.2 times (p = 0.02).

The Thai version of the quality-of-life in epilepsy inventory (QOLIE-31-Thai version): translation, validity and reliability.

OBJECTIVE: To assess the validity and reliability of the QOLIE-31-Thai Version. MATERIAL AND METHOD: The original questionnaire of the QOLIE-31 was first translated into Thai and, then, item comprehension was assessed. Back translation into English and cross-cultural modification were conducted. Its reliability was assessed using a sample of consenting epileptics aged 18-65 years visiting community hospitals in Nakhon Ratchasima Province, Thailand. RESULTS: One hundred and sixty one epileptics completed the questionnaire. The internal consistency of each scale of the QOLIE-31 was above the accepted standard of 0.7, except for Cognitive Functioning, Medication Effect and Social Functioning. CONCLUSION: The QOLIE-31-Thai Version is reliable for use in Thai rural epileptics even for low educated epileptics but interviews might have to be used instead.

Demographic and epidemiologic transition in the developing world: role of albuminuria in the early diagnosis and prevention of renal and cardiovascular disease.

The developing world is facing a real pandemic of renal and cardiovascular disease. With the decrease of infectious disease morbidity and mortality, and the exposure to more westernized life style, signs of increasing renal and cardiovascular disease is particularly shown in the tremendous rise in type 2 diabetes and its sequelae. A group of doctors and scientists from all over the world have convened in Bellagio to halt this dramatic disease change and burden to the developing countries. They came to the conclusion that screening and treatment should clearly focus on cost-beneficial strategies, among which blood pressure and urinary albumin measurement, as well as effective and affordable treatment strategies to lower blood pressure and albuminuria, are essential.

Sexual behaviors and opinions on sexuality of adolescents in a slum community in Bangkok.

This study was a survey research aiming to investigate sexual behaviors and opinions on sexuality of adolescents in a slum community. The study group comprised of 377 adolescents aged 12-22 years in a slum community in Bangkok randomly selected, and data were collected using self-administered questionnaires. Results indicated that 18.8% of the adolescents were sexually experienced with the average age of 15 years old at first intercourse. 63.1% of the adolescents had unprotected sexual intercourse with lovers or friends. Almost one-third of the population believed that premarital sexual activity was acceptable. One-sixth of the adolescents agreed that having sexual intercourse with a lover is safe, assuming that they had trustworthy partners and that having sexual intercourse was the best way to prevent their lover from having sexual activities with other partners. In addition, gender and age range were found to be the factors that significantly related to the adolescents' opinions that premarital sexual activity was acceptable and having sexual intercourse with a lover was safe (p < 0.05), whereas the relationship between the opinions and education level was statistically insignificant. It is recommended that familial, academic, community and public health support are necessary in educating the adolescents on reproductive health and family planning in order to reduce high risk behaviors associated with acquiring HIV and other STDs.

Compliance with treatment of adult epileptics in a rural district of Thailand.

BACKGROUND: Epilepsy, a disease when seizures can occur from antiepileptic drug withdrawal, requires regular drug taking. Non-compliance, therefore, is a major factor contributing to sub-optimal control of the seizures. PURPOSE: To determine the factors associated with noncompliance in epileptics in rural Thailand. METHOD: All epileptics, registered in the Pak Thong Chai District and their caregivers were invited to be interviewed and examined by a neurologist in their village. RESULTS: Of a total of 93 epileptics registered, 83 with their caregivers were interviewed and examined by the neurologist (T.A.) and of those 72 were adults. Of the 72 adult epileptics, 41 (56.9%) were 100 per cent compliant and factors found to be significantly associated with compliance were gender, household income and patient's health insurance (p-value < 0.05). The major reasons for non-compliance were misunderstanding (48.4%), forgetfulness (16.1%) and economic problem (12.9%). CONCLUSION: To improve patient-compliance, the real factors for non-compliance, which are unique to patients in a specific area, need to be identified.

Single hydrogen peroxide vaginal douching versus single-dose oral metronidazole for the treatment of bacterial vaginosis: a randomized controlled trial.

OBJECTIVE: To compare the effectiveness of single hydrogen peroxide vaginal douching and a single oral dose of metronidazole for the treatment of bacterial vaginosis. METHOD: A randomized trial was performed at the outpatient clinic in King Chulalongkorn Memorial Hospital. 142 patients diagnosed as having bacterial vaginosis were randomly allocated into two groups. The subjects in the first group were douched with 20 milliliters of 3 per cent hydrogen peroxide and received an oral placebo. The subjects in the second group received oral metronidazole 2 grams orally and were douched with a placebo. The cure rate in each group was assessed using Amsel's criteria 2 weeks after treatment. RESULT: The cure rate in the subjects treated with hydrogen peroxide douching was lower than the cases who received oral metronidazole (62.5% versus 78.6%, p-value = 0.036). Rate of gastrointestinal side effects in metronidazole group was higher than in the hydrogen peroxide group (48.6% versus 13.9%, p-value < 0.001). CONCLUSION: Single hydrogen peroxide vaginal douching was less effective than a single oral dose of metronidazole in the treatment of bacterial vaginosis.

Prevalence of epilepsy in rural Thailand: a population-based study.

BACKGROUND: A study of the community-based burden of illness based upon prevalence is needed to plan intervention strategy. PURPOSE: To determine the prevalence of epilepsy in a rural population in Thailand. METHOD: From January to June, 2000, all of the people in Talardkav sub-district were invited to be interviewed and examined by a neurologist who visited their village. RESULTS: Of the 2,069 people in 553 households who gave information (72.2% of the total households), 43 had a history of seizure and of the 43, 15 were epileptics. The prevalence of epilepsy was estimated at 7.2 per 1,000 population. The highest two peaks were in the age groups of 5-9 and 25-34 years (17.0, 17.4/1,000, respectively). CONCLUSION: The prevalence of epilepsy in rural Thailand is low, although probably underestimated, but it is the best to date for rural Thailand.