Prevalence of anemia and association with mortality in community-dwelling elderly in Thailand.

Anemia is one of the most common health problems in the elderly in low and middle income countries. Evidence from studies in high income countries suggests that the presence of anemia may predict mortality. We aimed to estimate the prevalence of anemia and the determine the relationship of hemoglobin, mean corpuscular volume (MCV) and mortality in community dwelling Thai elderly. Data from subjects aged ≥ 60 years from the Fourth Thai National Health Examination Survey were analyzed. Comorbidity and hematologic indexes including MCV were obtained. The Cox proportional hazard model was applied to explore associations with mortality. Data from 8,935 subjects were obtained. The mean age of participants was 69.2 years (SD 6.8). 3446 (38.2%) of subjects had anemia; 1931(56%) of these were classified as mild and normocytic. With a total 51,268 person-year of follow up, 753 participants with anemia died, and the cumulative all-cause mortality was 38.5 per 1,000 person-years. The presence of anemia was associated with an increased risk of mortality with HR of 1.66 (95% CI = 1.50-1.84 , p < 0.001). Among subjects with low MCV, hemoglobin level < 10 g/dl in men and < 9 g/dl in women significantly increased the risk of mortality (HR of 2.71, 95% CI = 1.88-3.91 and HR of 3.14, 95%CI = 2.11-4.67, respectively) Persons with anemia and normal MCV, the association with mortality was evident at hemoglobin levels below 11 g/dl for both males and females. (HR of 1.98, 95% CI = 1.67-2.35). Anemia is a moderate to severe public health significant in the population for community dwelling elderly in Thailand. At the same level of Hemoglobin, low MCV population seem to have lower mortality rate than normal MCV. Systematic screening for anemia should be implemented to identify patients at increased risk of mortality. The future research should be focus on causes of anemia and factors contributing to increased mortality in normal to high MCV would be of interest. If this could lead to identifying modifiable causes, it would be beneficial for improving mortality risk among older people.

Dose-response relationship between physical exercise and risk of physician-diagnosed dementia in 206 073 Thai community-dwelling men and women: HCUR study.

BACKGROUND AND PURPOSE: Little evidence exists to describe the incidence and risk factors for dementia in developing countries. This study aimed to examine the incidence and factors associated with the risk of developing dementia in a Thai general population. METHODS: Data on 206 073 men and women aged ≥50 years participating in the Health Check Ubon Ratchathani Project in 2006 were merged with diagnostic information from the hospital's electronic medical records in the following 6 years (2006-2012). The incidence of physician-diagnosed dementia over 6 years was examined. Factors associated with the risk of developing dementia were examined using multivariate Cox proportional hazard regression. RESULTS: Over a total time at risk of 1 196 433 person-years, 480 individuals developed dementia; the incidence rate was 0.40 [95% confidence interval (CI) 0.37-0.44] per 1000 person-years. Dementia incidence rose exponentially with increasing age to 1.37 (95% CI 1.07-1.75) per 1000 person-years in those aged 80-84 years and dropped after the age of 85 years. Factors independently associated with the risk of developing dementia included increasing age, diabetes and lack of physical exercise. The risk of dementia rose by 7% for every 1 year of age older [adjusted hazard ratio (aHR) 1.07, 95% CI 1.06-1.08]. Diabetes increased the risk of dementia by 51% (aHR 1.51, 95% CI 1.12-2.03). Compared to no physical exercise, having 3-5 days/week and> 5 days/week of physical exercise reduced the risk of dementia by 37% and 59% (aHR 0.63, 95% CI 0.50-0.79, and 0.41, 95% CI 0.26-0.66, respectively). CONCLUSIONS: Dementia incidence in a Thai population was lower than Western populations and its independent risk factors included increasing age, diabetes and a lack of physical exercise. Adequate physical exercise may counterbalance the ageing process, the main drive of dementia.

Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis.

BACKGROUND: Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS: A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS: A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (-3.12 mm Hg, [95% confidence intervals -4.78, -1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS: Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.

Detection of airborne Mycobacterium tuberculosis complex in high-risk areas of health care facilities in Thailand.

In high-risk areas (sputum collection room in a tuberculosis [TB] clinic, patient rooms in a TB ward, the emergency department and the bronchoscopy unit) in seven health care facilities located in central Thailand. To detect airborne Mycobacterium tuberculosis complex and other environmental parameters using the liquid impinger and real-time quantitative polymerase chain reaction (real-time qPCR) technique in high-risk areas. Cross-sectional study. M. tuberculosis was detected in 3 of 99 (3.0%, 95%CI 0.6-8.6) areas: one sputum collection room and one TB in-patient room in one facility and one sputum collection room in another facility. In these three areas, the M. tuberculosis copy number/m³ ranged from 9.6 to 1671. Lower air change rate (<6 h-1), higher relative humidity (>65%), and contact with coughing patient(s) were more common in airborne M. tuberculosis-positive areas than in M. tuberculosis-negative areas. Air sampling using a liquid impinger followed by real-time qPCR is effective for quantitative detection of airborne M. tuberculosis in high-risk areas. Our findings indicate TB risk among health care workers, and suggest that improved ventilation, enhanced appropriate cough etiquette and respiratory protection are needed to mitigate M. tuberculosis transmission. .

Frailty index to predict all-cause mortality in Thai community-dwelling older population: A result from a National Health Examination Survey cohort.

BACKGROUND: Frailty is a clinical state of increased vulnerability from aging-associated decline. We aimed to determine if a Thai Frailty Index predicted all-cause mortality in community-dwelling older Thais when accounting for age, gender and socioeconomic status. METHODS: Data of 8195 subjects aged 60 years and over from the Fourth Thai National Health Examination Survey were used to create the Thai Frailty Index by calculating the ratio of accumulated deficits using a cut-off point of 0.25 to define frailty. The associations were explored using Cox proportional hazard models. RESULTS: The mean age of participants was 69.2 years (SD 6.8). The prevalence of frailty was 22.1%. The Thai Frailty Index significantly predicted mortality (hazard ratio = 2.34, 95% CI 2.10-2.61, p < 0.001). The association between frailty and mortality was stronger in males (hazard ratio = 2.71, 95% CI 2.33-3.16). Higher wealth status had a protective effect among non-frail older adults but not among frail ones. CONCLUSIONS: In community-dwelling older Thai adults, the Thai Frailty Index demonstrated a high prevalence of frailty and predicted mortality. Frail older Thai adults did not earn the protective effect of reducing mortality with higher socioeconomic status. Maintaining health rather than accumulating wealth may be better for a longer healthier life for older people in middle income countries.

Serum C3 epimer of 25-hydroxyvitamin D and its determinants in adults: a national health examination survey in Thais.

UNLABELLED: A high percentage have detectable C3 epimer of 25-hydroxyvitamin D3 (3-epi-25(OH)D3) in the population of Thai National Health Examination Survey IV. INTRODUCTION: C3 epimers of vitamin D have recently been shown to contribute significantly to 25-hydroxyvitamin D (25(OH)D) levels in an infant population. However, the findings in the general adult population are unclear. Therefore, the purpose of the present study is to determine the percentage of the C3 epimer of 25(OH)D (3-epi-25(OH)D) and its determinants in an adult population. METHODS: A subsample of 1148 sera randomly selected from the Thai National Health Examination Survey IV (2009) samples were measured for serum 25(OH)D2, 25(OH)D3, 3-epi-25(OH)D2, and 3-epi-25(OH)D3 by LC-MS/MS method. The relative 3-epimer contribution (%) was used to express the amount of 3-epimer-25(OH)D3 as a percentage of total 25(OH)D3 (the sum of 25(OH)D3, and 3-epi-25(OH)D3). RESULTS: A high proportion of subjects had detectable 3-epi-25(OH)D3 that was <10 % of the total 25(OH)D levels. Since the level of total 25(OH)D2 is low, only a minority of subjects had detectable 3-epi-25(OH)D2. Multivariate analysis suggested that age, male gender, and rural residence were independently related to the 3-epi-25(OH)D3/total 25(OH)D3 ratio. CONCLUSIONS: A high percentage of Thai adults had detectable 3-epi-25(OH)D3 that was <10 % of the total 25(OH)D levels. Age, gender, and living in a rural area were associated with the relative amount of 3-epi-25(OH)D3 to total 25(OH)D3.

Dietary pattern and metabolic syndrome in thai adults.

Objectives. To determine the dietary patterns of middle-aged Thais and their association with metabolic syndrome (MetS). Methods. The Thai National Health Examination Survey IV data of 5,872 participants aged ≥30-59 years were used. Dietary patterns were obtained by factor analysis and their associations with Mets were examined using multiple logistic regression. Results. Three major dietary patterns were identified. The first, meat pattern, was characterized by a high intake of red meat, processed meat, and fried food. The second, healthy pattern, equated to a high intake of beans, vegetables, wheat, and dairy products. The third, high carbohydrate pattern, had a high intake of glutinous rice, fermented fish, chili paste, and bamboo shoots. Respondents with a healthy pattern were more likely to be female, higher educated, and urban residents. The carbohydrate pattern was more common in the northeast and rural areas. Compared with the lowest quartile, the highest quartile of carbohydrate pattern was associated with MetS (adjusted odds ratio: 1.82; 95% CI 1.31, 2.55 in men and 1.60; 95% CI 1.24, 2.08 in women), particularly among those with a low level of leisure time physical activity (LTPA). Conclusion. The carbohydrate pattern with low level of LTPA increased the odds of MetS.

Prevalence of obesity in Thailand.

The prevalence of obesity in Thailand has been doubled in the past two decades. Data from three consecutive National Health examination surveys (NHES) have shown a secular trend, as the prevalence of obesity with body mass index > or =25 kg m(-2) in adults increased from 13.0% in men and 23.2% in women in 1991 to 18.6% and 29.5% in 1997 and 22.4% and 34.3% in 2004 respectively. Obesity prevalence in children, using weight for height criteria, increased from 5.8% in 1997 to 7.9% in 2001 for the 2-5-year-olds and from 5.8% to 6.7% for the 6-12-year-olds. The data also show disproportionate increases of obesity in the rural area, which indicates the problem no longer restricts to the higher socioeconomic group.

Prevalence, awareness, treatment and control of hypertension and diabetes mellitus among the elderly: the 2004 National Health Examination Survey III, Thailand.

INTRODUCTION: This study aims to determine the prevalence of hypertension, diabetes mellitus, and both conditions combined, and to examine factors related to awareness, treatment and control among the elderly in Thailand. METHODS: Data from a multistaged National Health Examination Survey III of 19,374 individuals aged 60 years and older in Thailand was used. Information on the socioeconomic status was obtained by interview. Blood pressure was measured with a sphygmomanometer. Fasting plasma glucose was obtained. Logistic regression models were used to examine the determinants of awareness, treatment and control of blood pressure and plasma glucose. RESULTS: Age-adjusted prevalence of hypertension was 51.1 percent, diabetes mellitus 14.0 percent, and diabetes mellitus with hypertension 8.0 percent. Overall, the proportion of unawareness for hypertension, diabetes mellitus and both conditions combined were 56.1, 41.2 and 21.9 percent, respectively. For those undergoing treatment for the control of blood pressure (less than 140/90 mmHg) was 12.4 percent, diabetes mellitus (fasting plasma glucose less than 140 mg/ dL) 26.4 percent, and control of both conditions combined was 7.4 percent. Factors associated with unawareness and inadequate controls of the illnesses were subjects from rural areas, with low income, low educational levels, currently working, and the oldest age group. CONCLUSION: There was a high prevalence of hypertension and diabetes mellitus among the older people in Thailand, with high percentages of unawareness and inadequate control for those treated. Screening programmes for early detection, treatment and control of hypertension and diabetes mellitus need to be improved.

Intimate partner violence among women in slum communities in Bangkok, Thailand.

INTRODUCTION: This study aims to describe the prevalence of intimate partner violence and associated factors among married women in slum communities in Bangkok. METHODS: A cross-sectional survey was carried out. A total of 580 married women aged 15 years or older were randomly sampled from seven slum communities in Bangkok. Information on age, education, occupation, income, family size, alcohol use, and experience of partner violence were interviewed. Logistic regression was used to identify risk factors associated with the violence. RESULTS: The prevalence of intimate partner violence was 27.2 percent. Most of the violent episodes were triggered either by factors related to the couple's personal character, such as having a bad temper (89.9 percent) and being grumpy (83.5 percent), or circumstantial factors, such as financial problems (74.7 percent) and suspicions of adultery (28.5 percent). 12 percent of the abuse were moderate violence and 34.2 percent were severe violence. The factors associated with partner violence included a young age group (younger than 35 years) with adjusted odds-ratio (OR) of 3.13 (95 percent confidence interval [CI] 1.33-7.34) compared to those aged 55 years or older; inadequate income for family expenses (OR 1.97, 95 percent CI 1.20-3.22); and regular alcohol use (OR 3.72, 95 percent CI 2.02-6.89). CONCLUSION: Intimate partner violence was commonly found in slum communities and is strongly related to the socioeconomic status, personality characteristics and alcohol consumption of the couples.

Obesity indices and cardiovascular risk factors in Thai adults.

OBJECTIVE: To examine the relationship of body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHpR) and waist-to-height ratio (WHtR) with cardiovascular risk factors and diabetes in Thai population. DESIGN: A national cross-sectional survey of cardiovascular risk factors. SUBJECTS: Five thousand and three hundred five Thai adults aged > or =35 years. MEASUREMENTS: Body weight, height, waist and hip circumference and cardiovascular risk factors including blood pressure, total plasma cholesterol, high-density lipoprotein, triglyceride and fasting plasma glucose were measured. Age- and sex-specific means and prevalence of cardiovascular risk factors were calculated and compared among anthropometric measurements. RESULTS: There were increasing trends of severity of cardiovascular risk factors and prevalence of morbidity conditions across increasing levels of BMI, WC, WHpR and WHtR categories. For age group > or =65 years, WC, WHpR and WHtR provided more consistent association with cardiovascular risk factors than BMI. Area under the curve indicated that measurement of central obesity could predict cardiovascular risk better than BMI. The optimal cutoff points for anthropometric measurements were in line with the Asia-Pacific recommendation; however, similar cutoff point for men and women between 82 and 85 cm was observed. CONCLUSION: Central obesity indices were slightly better associated with cardiovascular risk factors compared to BMI in Thai adults aged > or =35 years.

Fat distribution is strongly associated with plasma glucose levels and diabetes in Thai adults-the InterASIA study.

AIMS/HYPOTHESIS: Asian populations have high risks of disease at low levels of BMI and weight, possibly because of high rates of abdominal obesity. In such populations, waist circumference and WHR (measures of fat distribution) may better capture the effects of adiposity. METHODS: The strengths of the associations between different measures of adiposity and glucose levels and diabetes were investigated in the Thai component of the International Collaborative Study of Cardiovascular Disease in Asia (InterASIA), a multi-stage cross-sectional survey of risk factors in Thai adults aged 35 years or over. The analyses included 5,302 men and women. RESULTS: All four measures of adiposity were positively associated with plasma glucose and the odds of having diabetes (all p<0.001), but the associations were stronger for measures of fat distribution. The age- and sex-adjusted fasting plasma glucose level increased linearly across each fifth of weight, BMI, waist and WHR by 0.12 mmol/l (SE 0.02), 0.12 (0.02), 0.17 (0.02) and 0.16 (0.02), respectively. The corresponding odds ratios for diabetes were 1.41 (95% CI 1.27-1.56), 1.43 (1.28-1.59), 1.64 (1.47-1.83) and 1.70 (1.52-1.90), respectively. Multivariate analyses incorporating different combinations of adiposity measures, as well as analyses of receiver operating characteristics, confirmed the greater predictive value of measures of fat distribution. CONCLUSIONS/INTERPRETATION: Waist circumference and WHR were more strongly associated with fasting plasma glucose and diabetes than were weight and BMI. These measures of abdominal adiposity are likely to be more useful for assessing the obesity-related risk of cardiovascular diseases in Asian populations.

Air pollution and respiratory symptoms: results from three panel studies in Bangkok, Thailand.

Several studies in North American cities have reported associations between air pollution and respiratory symptoms. Replicating these studies in cities with very different population and weather characteristics is a useful way of addressing uncertainties and strengthening inferences of causality. To this end we examined the responses of three different panels to particulate matter (PM) air pollution in Bangkok, Thailand, a tropical city characterized by a very warm and humid climate. Panels of schoolchildren, nurses, and adults were asked to report daily upper and lower respiratory symptoms for 3 months. Concentrations of daily PM(10) (PM with a mass median aerodynamic diameter less than 10 microm) and PM(2.5) (airborne particles with aerodynamic diameters less than 2.5 microm) were collected at two sites. Generally, associations were found between these pollution metrics and the daily occurrence of both upper and lower respiratory symptoms in each of the panels. For example, an interquartile increase of 45 microg/m(3) in PM(10) was associated with about a 50% increase in lower respiratory symptoms in the panel of highly exposed adults, about 30% in the children, and about 15% in the nurses. These estimates were not appreciably altered by changes in the specification of weather variables, stratification by temperature, or inclusion of individual characteristics in the models; however, time trends in the data cause some uncertainty about the magnitude of the effect of PM on respiratory symptoms. These pollutants were also associated with the first day of a symptom episode in both adult panels but not in children. The estimated odds ratios are generally consistent with and slightly higher than the findings of previous studies conducted in the United States.

Compliance with the law on car seat-belt use in four cities of Thailand.

Surveys to determine the scope of compliance with the law requiring seat-belt use in Thailand were conducted by observation and interviews with drivers in four cities: namely, Bangkok Metropolis, Chiang Mai, Phuket and Nakhon Ratchasima. The work was carried out in two separate sessions: during the first month following enactment of the law, and six months after its enactment. The sample comprised 46,949 vehicles in the first session (January 1996) and 76,188 vehicles in the second session (July 1996). The results showed that 42.7 per cent of drivers used seat-belts in January and 30.7 per cent in July. When the data were disaggregated according to cities, it was found that more Bangkok drivers complied with the seat-belt law than in Phuket, 24.6 per cent; Chiang Mai, 22.1 per cent; and Nakhon Ratchasima, 18.3 per cent relatively low compliance rate was encountered among drivers of pick-up trucks (including those with modified roofs) and vans, particularly farmers and the self-employed. Women drivers tended to abide by the law more often than men (OR = 1.7, 95% CI = 1.12, 1.23). Inter-city travelers wore seat-belts more than those traveling in the city (OR = 1.74, 95% CI = 1.68, 1.80). About one-fifth of non-users or those who rarely used seat-belts were unsure of the effectiveness of seat-belts in preventing serious injury or death in the case of an accident. Discomfort associated with using seat-belts and the perception that they were rendered unnecessary because of slow traffic in cities were other reasons for non-compliance in 50.6 per cent and 43.9 per cent of cases, respectively. The decline in compliance with the law six months after its enactment indicates that there may be a problem with uniform and consistent enforcement of the law.