Waist circumference, body mass index and health risk factors among middle aged Thais.

Body mass index (BMI) and waist circumference (WC) are important contributors to major causes of health risk factors such as high blood cholesterol, high fasting blood sugar and high blood pressure. This analysis was designed to assess the associations between WC, BMI and each health risk factor in suitable cut-off points for WC and BMI among middle aged men and women of Thai population. Cross sectional data from the Second National Health Survey in Thailand was analysed. This set of data collected by the Ministry of Public Health from 1996 to 1997 was obtained from a total of 998 subjects (comprising 396 men and 602 women) aged 45-50. Results from the Receiver Operating Characteristic curve (ROC curve) identified those with health risk factors demonstrating cut-off points for WC between 81.5-84 centimeters for men and 76-80.5 centimeters for women and BMI between 23.3-23.9 kg/m2 for both genders, respectively. Results from the Multiple logistic regression analysis demonstrated lower risks of having high blood cholesterol, high fasting blood sugar and high blood pressure with cutoff points 84 cm for men, 80 cm for women and BMI 23 kg/m2 for both genders compared to cut-off points 102 cm for men, 88 cm for women and BMI 25 kg/m2 for both genders as specified for the population in Western countries. This study has proposed a waist circumference of 84 cm (33.6 inches) for middle aged Thai men and 80 cm (32 inches) for middle aged Thai women and BMI of 23 kg/m2 for both genders. Monitoring changes in the waist circumference over time along with BMI may be convenient and useful for middle aged Thais to prevent health risk conditions, even in the absence of a change in BMI.

Primary verification: is the TRISS appropriate for Thailand?

The Trauma and Injury Severity Score (TRISS) is a well-accepted model used to evaluate the quality of trauma care in the US. This research aims to study whether TRISS can be applied to evaluate trauma care and classify outcomes of road traffic injury patients in Thailand. A retrospective study was used to review the Thailand's Injury Surveillance System database from the 1st January to the 31st of December 1996. The study subjects were severe road traffic injury patients with blunt injuries. The TRISS model was applied to compute the survival probability for each patient. The chi-square goodness-of-fit was used to compare the survival probability distribution between the American Major Trauma Outcome of Study (MTOS) and the road traffic injuries in Thailand. The accuracy, sensitivity and specificity of the survival prediction by TRISS were evaluated. The distribution of survival probability between American trauma patients and Thai road traffic injury patients was significantly different (p-value < 0.00001). The TRISS model had high accuracy and sensitivity, but low specificity, in predicting the survival of Thai road traffic injuries. The MTOS and Thai road traffic injuries had different distributions for various factors such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and ages which effect injury survival. Due to these factors the distribution of survival probability between MTOS and Thai road traffic injuries was also significantly different. By applying TRISS, the survival prediction of Thai road traffic injuries resulted in a high number of false positives.

Atheromatous risk factors among Thai labor forces by socioeconomic status.

The purpose of this study was to describe atheromatous risk factors among Thai labor forces by socioeconomic status (SES) such as income, education and occupation. Undesirable levels of artheromatous risk factors were specified as: total serum cholesterol (TC) > 200 mg per cent, body mass index (BMI) > 25 kg/m2, fasting blood sugar (FBS) > 126 mg/dL, systolic blood pressure (SBP) > 140 mmHg and diastolic blood pressure (DBP) > 90 mmHg. Data from the Second National Health Examination survey in Thailand from 1996 to 1997 was used, with a total number of 4,198 participants (1,634 males, 2,561 females) aged 13-60 years old. Results from multivariate analysis demonstrated differences in means TC, BMI, SBP and DBP among different age-groups, both in males and females (p < 0.001). TC, BMI, and SBP increased with age in both sexes, but DBP increased with age in females only. Males who lived in a municipality had a higher risk of having undesirable TC and DBP than those who did not. Risk of undesirable BMI varied according to levels of income in males. Males with an income of 5,001-10,000 and > 25,000 baht/month had OR = 1.57 (95% CI = 1.04-2.39) and OR = 2.59 (95% CI = 1.18-5.66) compared to males with an income of < 5,000 baht/month. TC and DBP varied with levels of income in females. For undesirable TC, females with an income of 5,001-10,000 and > 25,000 baht/month had OR = 1.48 (95% CI = 1.01-2.18) and OR = 2.17 (95% CI = 1.03-4.88) compared to females with an income of < 5,000 baht/month. For undesirable DBP, females with an income > 25,000 baht/month had OR = 3.39 (95% CI = 1.31-8.78) compared to females with income an < 5,000 baht/month. Among different levels of education in males, different risks of undesirable TC, BMI, SBP and DBP were not significant, except a borderline significance in TC among vocational graduates. The same phenomenon was observed among females, except that females only a primary education tended to have a higher risk of undesirable BMI (OR = 2.64, 95% CI = 1.39-5.02) compared to females with graduate studies. The level of occupation seemed not to affect the risk of unfavorable atheromatous risk factors among males. Nonetheless, females in the agricultural section seemed to have a lower risk of undesirable TC (OR = 0.38, 95% CI = 0.18-0.78) compared to the professional group. The results suggested the consideration of critical guidance of epidemiological studies in using SES as the control variable, or for selection of subjects or matching criteria. Specific preventive programs on atheromatous risk factors should be launched for some specific socio-demographic groups in order to prevent coronary heart diseases (CHD) in the future.

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.

Reduction of rotavirus infection in children receiving bifidobacteria-supplemented formula.

This study was conducted at Pakkred Babies Home, Bangkok, Thailand; with the hypothesis that children receiving probiotic-supplemented milk-based formula may be protected from developing diarrheal diseases. Salivary rotavirus-specific IgA antibody was used as an indicator of rotavirus infection. One hundred and seventy-five children, aged 6-36 months, were enrolled in the study. They were divided into 3 groups according to the type of formula given. There were 81 episodes of diarrhea during an 8-month study period, most of which were caused by bacterial enteropathogens. Ninety-seven pairs of salivary samples were adequate for the analysis of rotavirus antibody. Among 23 children receiving milk-based follow-up formula and serving as control group, 30.4 per cent of them had > or = 4-fold increase in the antibody titre, indicating subclinical rotavirus infection. The majority of children in the other 2 study groups, receiving the same formula supplemented with either Bifidobacterium Bb12 alone or together with Streptococcus thermophilus, had no significant change in the antibody titres between the two time points. The results of this study support our hypothesis that children receiving bifidobacteria-supplemented milk-based formula may be protected against symptomatic rotavirus infection.

Exclusive breastfeeding among women on the plantations in Sri Lanka.

A cross-sectional questionnaire survey, using the current status method for the assessment of breastfeeding, was conducted among women working in the plantations in Sri Lanka. The exclusive breastfeeding rate was 32.4 per cent. The mothers' return to work and the feeling of having insufficient milk were significantly and negatively associated with exclusive breastfeeding. Women will sometimes start with powdered milk several weeks before going back to work, suggesting that work itself is not the only reason for introducing powdered milk. Although the health authorities have endorsed the concept of exclusive breastfeeding, further health education is needed for the full acceptance of exclusive breastfeeding in the population.

Family planning: knowledge, attitudes and practice survey in Zigone, Myanmar.

Perhaps the most important finding of this Zigone KAP survey was that about 50.3% (95% CI 46.2-54.2) of the married women of reproductive age were currently practicing modern methods of contraception. For a country like Myanmar, where the government has until recently favored a pronatalist population policy, this is indeed surprising. This 30 cluster survey, designed to determine the prevalence of various family planning methods adopted, as well as knowledge and attitudes, among villagers in rural Myanmar, covered a sample of 600 married women of reproductive age in Zigone township which has a population of 70,000. The survey results showed a high awareness of specific contraceptive methods among the target group and the ever-use rate of birth spacing methods was about 54% (95% CI 50.7-58.7). The most used method was oral contraceptives (64.6% of all users), followed by injectable contraceptives (32.3%). There was a small number of IUD users (1.1%), use of a permanent method (sterilization) was extremely low (0.3%). Seven out of ten married women of reproductive age did not want more children and one out of two women in this group were current users of contraception. Therefore a certain proportion of user was probably using these (mainly temporary) methods to terminate fertility rather than for birth spacing purposes. Moreover, only 63% of those wanting children, but not in the next 12 months, were using a contraceptive method. These findings demonstrated that there was a large group of potential contraceptive users who were currently not using a method. In an attempt to investigate the factor hindering the non-use of contraceptives when needed, the women were divided, according to their contraceptive practice, into two groups. Logistic regression was employed to compare the characteristics of women in the user and nonuser groups. After adjusting for covariates, it was found that economic group and number of living children had a positive effective effect on contraceptive use, while age and number of children under three years of age had a negative effect. The survey also found that about 48% of the contraceptive users were obtaining their supplies from the private sector and another 40% received supplies from government health officers. The reference by respondents to "health staff", as the source of supply, was assumed to be health staff working in their private practice, since the government's current health program does not cover the provision of contraceptives.

Impact of an educational program on the treatment practices of diarrheal diseases among pharmacists and drugsellers.

The impact of an intervention program, measured by changes in the prescription of ORS, antibiotics and antidiarrheal drugs by those pharmacists and drugsellers after administering the proposed educational package was assessed. The results of the study indicated that, before the educational program started, ORS was prescribed by pharmacists for 31.4% and 15.7% of watery diarrhea and dysentery episodes, respectively. Only 18.9% and 13.3% of drugsellers gave ORS to assessors in case of watery diarrhea and dysentery. Antibiotics and antidiarrheal agents were prescribed extensively, watery and dysenteric diarrhea (84% and 56% for watery diarrhea by pharmacists and drugsellers; 92% and 60% for dysentery). Antidiarrheal drugs were used as frequently. After the educational program, the assessment of the prescription behavior of the pharmacists showed no change in ORS, antibiotics and antidiarrheal drugs prescribed to treat watery diarrhea. In dysentery, the effective percent change in prescribing ORS between pre- and post- intervention program was much higher in intervention group than the control group. For drugsellers, effective percent change in ORS usage in treatment of watery diarrhea was 11.8% compared with -7.7% in the control group. No such change was observed in treatment of dysentery. There was a slight significant change in behavior concerning use of antibiotics among subjects getting information by mail, compared to those who got full intervention, when the pre-intervention behavior, store type and treatment type was taken into account.

Validation and application of U.N. model life tables against Thailand data, 1973-1983.

The author applies models of age and sex mortality, developed by the United Nations in 1982 for developing countries, to data for Thailand for the years 1973-1983. Following a discussion of the development of the four mortality patterns and their models, the author traces changes in Thailand's mortality trends using the U.N. model life tables. "This study reveals the change of mortality patterns in Thailand, moving from [the] Latin American to [the] Far Eastern pattern.... The proportional mortality ratio of population over 60 years of age has gradually increased from 28.7% in 1973 to 42.0% in 1983 and the sex ratio of mortality in this group [has] also slightly increased during this decade." (SUMMARY IN TUR)

Effect of passive immunity to tetanus in DTP vaccinated infants.

Tetanus antitoxin levels in DTP unvaccinated and vaccinated infants whose mothers had either received no dose or two doses of absorbed tetanus toxoid at present pregnancy were determined by the enzyme immunosorbent assay (EIA). It was found that the percentage of protective infants born from non-immunized and immunized mothers were 95.4 and 100 respectively. The transplacental tetanus immunity in infants of immunized mothers was higher than those of non-immunized mothers, however, it was significantly reduced in both groups of infants within two months. After the first dose of DTP vaccine, infants born from non-immunized mothers were able to respond well in producing antibody whereas the infants from immunized mothers were not. In the second and third dose of DTP vaccine both groups of infants had a similar range of tetanus antitoxin.

Transfer rate of transplacental immunity to tetanus from non-immunized and immunized mothers.

Tetanus antitoxin was quantitatively measured in 912 pregnant women by indirect hemagglutination test. The mothers who received no dose, one dose and two doses of tetanus toxoid were 64.6%, 10.1% and 25.3% respectively. The percentage of mothers with protective antibodies in the groups receiving none, one, and two doses of tetanus toxoid were 95.4, 100 and 100. The level of protective antibody in the newborn and the magnitude of transfer rate of passive immunity to tetanus depended directly upon the level of tetanus antitoxin in maternal serum. Mothers who had tetanus antitoxin of 1.28 IU/ml or more could transfer protection to almost all of the newborns (97%-100%) irrespective of doses of tetanus toxoid administration. However, mothers who had received two doses of tetanus toxoid during pregnancy not only confer good protection but also transfer a high tetanus antitoxin levels to their newborns.

Epidemiologic study of risk factors in cancer of the cervix uteri in Thai women.

PIP: A case control study was conducted to identify various environmental factors associated with cervical cancer and the extent or degree of association of those factors with the disease. The cases were 212 histologically confirmed cervical cancer patients admitted to the gynecological ward in 4 Thailand hospitals. The controls were 212 patients diagnosed with other gynecological conditions except cancer (confirmed by pelvic examination and papanicolaou smear) who were admitted to those hospitals during the same period as the cases. The cases and controls were matched by age, using 5 year intervals. Questionnaires containing information such as sociodemographic data, marital status, pregnancy and delivery history, past history of illness, especially with genital tract infections, and husband's illness history including venereal diseases were distributed. Questionnaires were the same for case and control. Cases and controls were similar in demographic and social characteristics. All cases were younger at 1st intercourse and had a higher number of pregnancies and parity than controls. Various factors presented significantly more in the cases than the controls. The suspected risk factors in cervical cancer were: parity, with cases showing higher parity than control; positive history of vaginal infections; higher number of marriages; younger age at 1st intercourse and history of husband's sexually transmitted disease. Circumcision in the husband indicated a protective factor to this disease, although the number of husbands who had circumcision in this study were very few. The risk factor of highest relative risk value was the marriage factor, followed by factors of high parity. Women who had 3 or more live births were 3 times more prone to cervical cancer than women with lower fertility. Women who had multiple marriages also ran a higher risk to this disease, as did those who had history of vaginal infection and husband's history of sexually transmitted disease. Women with a history of irregular menstruation both of amount and frequency were twice as prone to cervical cancer than normal women. The degree of association between risk factors and cervical cancer as expressed by odd ration was shown by various combinations of the risk factors, such as high parity and positive history of vaginal infection. These 2 characteristics were about 9 times more prone to cervical cancer than women without these characteristics. Women with 4 risk factors combined had the greatest risk compared to those who did not have those factors.^ieng