Physically and psychologically hazardous jobs and mental health in Thailand.

This paper investigates associations between hazardous jobs, mental health and wellbeing among Thai adults. In 2005, 87 134 distance-learning students from Sukhothai Thammathirat Open University completed a self-administered questionnaire; at the 2009 follow-up 60 569 again participated. Job characteristics were reported in 2005, psychological distress and life satisfaction were reported in both 2005 and 2009. We derived two composite variables grading psychologically and physically hazardous jobs and reported adjusted odds ratios (AOR) from multivariate logistic regressions. Analyses focused on cohort members in paid work: the total was 62 332 at 2005 baseline and 41 671 at 2009 follow-up. Cross-sectional AORs linking psychologically hazardous jobs to psychological distress ranged from 1.52 (one hazard) to 4.48 (four hazards) for males and a corresponding 1.34-3.76 for females. Similarly AORs for physically hazardous jobs were 1.75 (one hazard) to 2.76 (four or more hazards) for males and 1.70-3.19 for females. A similar magnitude of associations was found between psychologically adverse jobs and low life satisfaction (AORs of 1.34-4.34 among males and 1.18-3.63 among females). Longitudinal analyses confirm these cross-sectional relationships. Thus, significant dose-response associations were found linking hazardous job exposures in 2005 to mental health and wellbeing in 2009. The health impacts of psychologically and physically hazardous jobs in developed, Western countries are equally evident in transitioning Southeast Asian countries such as Thailand. Regulation and monitoring of work conditions will become increasingly important to the health and wellbeing of the Thai workforce.

Association between occupational heat stress and kidney disease among 37,816 workers in the Thai Cohort Study (TCS).

BACKGROUND: We examined the relationship between self-reported occupational heat stress and incidence of self-reported doctor-diagnosed kidney disease in Thai workers. METHODS: Data were derived from baseline (2005) and follow-up (2009) self-report questionnaires from a large national Thai Cohort Study (TCS). Analysis was restricted to full-time workers (n = 17 402 men and 20 414 women) without known kidney disease at baseline. We used logistic regression models to examine the association of incident kidney disease with heat stress at work, after adjustment for smoking, alcohol drinking, body mass index, and a large number of socioeconomic and demographic characteristics. RESULTS: Exposure to heat stress was more common in men than in women (22% vs 15%). A significant association between heat stress and incident kidney disease was observed in men (adjusted odds ratio [OR] = 1.48, 95% CI: 1.01-2.16). The risk of kidney disease was higher among workers reporting workplace heat stress in both 2005 and 2009. Among men exposed to prolonged heat stress, the odds of developing kidney disease was 2.22 times that of men without such exposure (95% CI 1.48-3.35, P-trend <0.001). The incidence of kidney disease was even higher among men aged 35 years or older in a physical job: 2.2% exposed to prolonged heat stress developed kidney disease compared with 0.4% with no heat exposure (adjusted OR = 5.30, 95% CI 1.17-24.13). CONCLUSIONS: There is an association between self-reported occupational heat stress and self-reported doctor-diagnosed kidney disease in Thailand. The results indicate a need for occupational health interventions for heat stress among workers in tropical climates.

Social capital and health in a national cohort of 82,482 Open University adults in Thailand.

We report associations between social capital and health among 82,482 adults in a national cohort of Open University students residing throughout Thailand.After adjusting for covariates, poor self-assessed health was positively associated with low social trust (OR = 1.88; 95% CI 1.76-2.01) and low social support (OR = 1.79; 95% CI 1.63-1.95). In addition, poor psychological health was also associated with low social trust (OR = 2.52; 95% CI 2.41-2.64) and low social support (OR = 1.80; 95% CI 1.69-1.92). Females, elderly, unpartnered, low income, and urban residents were associated with poor health. Findings suggest ways to improve social capital and heath in Thailand and other middle-income countries.

Lifecourse Urbanization, Social Demography, and Health Outcomes among a National Cohort of 71,516 Adults in Thailand.

We examine the influence of urbanization on household structure, social networks, and health in Thailand. We compare lifetime urban or rural dwellers and those who were rural as children and urban as adults. Data derived from a large national cohort of 71,516 Sukhothai Thammathirat Open University adult students participating in an on-going longitudinal study of the health-risk transition in Thailand. The rural-urban group, one-third of cohort households, was significantly different from other groups (e.g., smaller households). The rural-rural and the urban-urban groups often were the two extremes. Urbanization, after adjusting for covariates, was a risk factor for poor overall health and depression. Urbanization is a mediator of the health-risk transition underway in Thailand. Health programs and policies directed at transitional health outcomes should focus on the health risks of the urbanizing population, in particular smoking, drinking, low social trust, and poor psychological health.

Has universal health insurance reduced socioeconomic inequalities in urban and rural health service use in Thailand?

This study analyses urban and rural health service use before and after the introduction of the Universal Coverage Scheme (UCS). Using data from the Thai national health surveys of 2001 and 2005, the study utilises age-sex adjusted concentration indices to measure within-area differences in use of health services among populations distinguished by socioeconomic status. Between 2001 and 2005, the UCS substantially reduced Thailand's uninsured population (from 42.5% to 7.0% in urban areas and from 24.9% to 2.7% in rural areas). The implementation of the UCS changed patterns of health services use, particularly for rural people and the urban poor, by placing greater emphasis on primary healthcare. Relevant policy recommendations should focus on continued improvement of primary health services, and ensuring adequate and timely referrals to secondary and tertiary health services when the need arises.

The association between overall health, psychological distress, and occupational heat stress among a large national cohort of 40,913 Thai workers.

BACKGROUND: Occupational heat stress is a well-known problem, particularly in tropical countries, affecting workers, health and well-being. There are very few recent studies that have reported on the effect of heat stress on mental health, or overall health in workers, although socioeconomic development and rapid urbanization in tropical developing countries like Thailand create working conditions in which heat stress is likely. OBJECTIVE: This study is aimed at identifying the relationship between self-reported heat stress and psychological distress, and overall health status in Thai workers. RESULTS: 18% of our large national cohort (>40,000 subjects) often works under heat stress conditions and males are exposed to heat stress more often than females. Furthermore, working under heat stress conditions is associated with both worse overall health and psychological distress (adjusted odds ratios ranging from 1.49 to 1.84). CONCLUSIONS: This association between occupational heat stress and worse health needs more public health attention and further development on occupational health interventions as climate change increases Thailand's temperatures.

Socioeconomic status, sex, and obesity in a large national cohort of 15-87-year-old open university students in Thailand.

BACKGROUND: As obesity increases, middle-income countries are undergoing a health-risk transition. We examine the association between socioeconomic status (SES) and emerging obesity in Thailand, and ascertain if an inverse relationship between SES and obesity has appeared. METHODS: The data derived from 87 134 individuals (54% female; median age, 29 years) in a national cohort of distance-learning Open University students aged 15-87 years and living throughout Thailand. We calculated adjusted odds ratios for associations of SES with obesity (body mass index, >or=25) across 3 age groups by sex, after controlling for marital status, age, and urbanization. RESULTS: Obesity increased with age and was more prevalent among males than females (22.7% vs 9.9%); more females were underweight (21.8% vs 6.2%). Annual income was 2000 to 3000 US dollars for most participants. High SES, defined by education, income, household assets, and housing type, associated strongly with obesity-positively for males and inversely for females-especially for participants younger than 40 years. The OR for obesity associated with income was as high as 1.54 for males and as low as 0.68 for females (P for trend <0.001). CONCLUSIONS: Our national Thai cohort has passed a tipping point and assumed a pattern seen in developed countries, ie, an inverse association between SES and obesity in females. We expect the overall population of Thailand to follow this pattern, as education spreads and incomes rise. A public health problem of underweight females could emerge. Recognition of these patterns is important for programs combating obesity. Many middle income countries are undergoing similar transitions.

Tracking and decomposing health and disease inequality in Thailand.

PURPOSE: In middle-income countries, interest in the study of inequalities in health has focused on aggregate types of health outcomes, like rates of mortality. This work moves beyond such measures to focus on disease-specific health outcomes with the use of national health survey data. METHODS: Cross-sectional data from the national Health and Welfare Survey 2003, covering 52,030 adult aged 15 or older, were analyzed. The health outcomes were the 20 most commonly reported diseases. The age-sex adjusted concentration index (C *) of ill health was used as a measure of socioeconomic health inequality (values ranging from -1 to +1). A negative (or positive) concentration index shows that a disease was more concentrated among the less well off (or better off). Crude concentration indices (C) for four of the most common diseases were also decomposed to quantify determinants of inequalities. RESULTS: Several diseases, such as malaria (C * = -0.462), goiter (C * = -0.352), kidney stone (C * = -0.261), and tuberculosis (C * = -0.233), were strongly concentrated among those with lower incomes, whereas allergic conditions (C * = 0.174) and migraine (C * = 0.085) were disproportionately reported by the better off. Inequalities were found to be associated with older age, low education, and residence in the rural Northeast and rural North of Thailand. CONCLUSIONS: Pro-equity health policy in Thailand and other middle-income countries with health surveys can now be informed by national data combining epidemiological, socioeconomic and health statistics in ways not previously possible.

Multicenter randomized controlled trial of a home walking intervention after outpatient cardiac rehabilitation on health-related quality of life in women.

BACKGROUND: Poor health-related quality of life (HRQL) has been shown to be predictive of adverse outcomes in cardiac patients. As women with coronary heart disease have been shown to have lower HRQL than men with coronary heart disease, women are at greater risk of a poor clinical outcome. This study tested the effect of a 12-week home walking intervention after completion of outpatient cardiac rehabilitation (OCR) on HRQL and maintenance of physical activity among women. DESIGN: Multicenter two-group randomized trial. METHODS: After completion of OCR, participants were randomly allocated to the intervention or usual care groups. The outcomes were HRQL (assessed using the MacNew Heart Disease HRQL instrument) and self-reported physical activity (assessed using the Stages of Change model of exercise behavior) at 3, 6, and 12 months after OCR. RESULTS: Seventy-two women were randomized to the intervention and 81 to usual care. Attrition was greater in the treatment group (13 vs. 1%). HRQL scores increased relative to the base level in both arms and were significantly higher in the intervention group at 6 months, but not at 3 or 12 months. Maintenance of physical activity declined over time in both groups, however, this decline was significantly reduced among women in the intervention group. CONCLUSION: HRQL improved in both groups, but seemed to increase earlier among women in the intervention group. As maintenance of physical activity was higher among women in the intervention group, this minimal intervention could be used to facilitate women's progression from supervised to independent exercise.

Used and foregone health services among a cohort of 87,134 adult open university students residing throughout Thailand.

There are limited data on the frequency of foregone health service use in defined populations. Here we describe Thai patterns of health service use, types of health insurance used and reports of foregone health services according to geo-demographic and socioeconomic characteristics. Data on those who considered they had needed but not received health care over the previous year were obtained from a national cohort of 87,134 students from the Sukhothai Thammathirat Open University (STOU). The cohort was enrolled in 2005 and was largely made up of young and middle-age adults living throughout Thailand. Among respondents, 21.0% reported use of health services during the past year. Provincial/governmental hospitals (33.4%) were the most attended health facilities in general, followed by private clinics (24.1%) and private hospitals (20.1%). Health centers and community hospitals were sought after in rural areas. The recently available government operated Universal Coverage Scheme (UCS) was popular among the lower income groups (13.6%), especially in rural areas. When asked, 42.1% reported having foregone health service use in the past year. Professionals and office workers frequently reported 'long waiting time' (17.1%) and 'could not get time off work' (13.7%) as reasons, whereas manual workers frequently noted it was 'difficult to travel' (11.6%). This information points to non-financial opportunity cost barriers common to a wide array of Thai adults who need to use health services. This issue is relevant for health and workplace policymakers and managers concerned about equitable access to health services.

Thai SF-36 health survey: tests of data quality, scaling assumptions, reliability and validity in healthy men and women.

BACKGROUND: Since its translation to Thai in 2000, the SF-36 Health Survey has been used extensively in many different clinical settings in Thailand. Its popularity has increased despite the absence of published evidence that the translated instrument satisfies scoring assumptions, the psychometric properties required for valid interpretation of the SF-36 summated ratings scales. The purpose of this paper was to examine these properties and to report on the reliability and validity of the Thai SF-36 in a non-clinical general population. METHODS: 1345 distance-education university students who live in all areas of Thailand completed a questionnaire comprising the Thai SF-36 (Version 1). Median age was 31 years. Psychometric tests recommended by the International Quality of Life Assessment Project were used. RESULTS: Data quality was satisfactory: questionnaire completion rate was high (97.5%) and missing data rates were low (< 1.5% for all items). The ordering of item means within scales generally were clustered as hypothesized and scaling assumptions were satisfied. Known groups analysis showed good discriminant validity between subgroups of healthy persons with differing health states. However, some areas of concern were revealed. Possible translation problems of the Physical Functioning (PF) items were indicated by the comparatively low ceiling effects. High ceiling and floor effects were seen in both role functioning scales, possibly due to the dichotomous format of their response choices. The Social Functioning scale had a low reliability of 0.55, which may be due to cultural differences in the concept of social functioning. The Vitality scale correlated better with the Mental Health scale than with itself, possibly because a healthy mental state is central to the concept of vitality in Thailand. CONCLUSION: The summated ratings method can be used for scoring the Thai SF-36. The instrument was found to be reliable and valid for use in a general non-clinical population. Version 2 of the SF-36 could improve ceiling and floor effects in the role functioning scales. Further work is warranted to refine items that measure the concepts of social functioning, vitality and mental health to improve the reliability and discriminant validity of these scales.

Infant sleeping environment and asthma at 7 years: a prospective cohort study.

OBJECTIVES: We investigated the role of infant bedding items, as part of a composite bedding environment, in the development of childhood wheezing. METHODS: This prospective cohort investigation involved 863 children who participated in an infant survey in 1988 and an asthma study in Tasmania, Australia, in 1995. The derived 3 composite infant bedding categories corresponded to increasing numbers of house dust mite (HDM)-rich bedding items used. Outcomes measured included recent and frequent wheezing. RESULTS: Composite infant bedding used was associated with recent wheezing. Effects increased at increasing levels of HDM-rich bedding items used. Effects were further enhanced by home environmental factors of bedroom heating, recent bedroom painting, and absence of bedroom carpeting. When any 2 or more of these environmental factors were present, a strong dose-response relationship was evident. CONCLUSIONS: Our results show that bedding exposures in infancy are prospectively associated with childhood wheezing and that home environmental conditions may modify this association.

Job strain, job insecurity, and health: rethinking the relationship.

Job strain (high demands and low control) is a widely used measure of work stress. The authors introduce a new way of looking at work stress by combining job strain with job insecurity, a combination increasingly prevalent in contemporary economies, using data from a cross-sectional survey (N = 1,188) of mid-aged Australian managers and professionals. Those reporting both strain and insecurity showed markedly higher odds for mental and physical health problems (depression: odds ratio [OR] 13.88, 95% confidence interval [CI] 5.67-34.01; anxiety: OR 12.88, CI 5.12-32.39; physical health problems: OR 3.97, CI 1.72-9.16; and poor self-rated health: OR 7.12, CI 2.81-18.01). Job strain and insecurity showed synergistic associations with health, and employees experiencing both could be at heightened health risk.

Around-the-clock: parent work schedules and children's well-being in a 24-h economy.

Family life in developed economies has undergone a fundamental change--shifting from single-breadwinner households (typical of the post war decades) to families where both parents are employed. Equally dramatic has been the emergence of around-the-clock economies, altering the way work is organised, especially working time. Many more children now live in households where one or both parents work non-standard hours (evenings, nights or on weekends). Are there any implications for children's well-being when parents work non-standard schedules? There has been virtually no investigation of how children are faring in these around-the-clock households, despite evidence that non-standard work times affect family functioning and are stressful for parents. Using data from a representative sample of 4433 dual-earner Canadian families and their 2--11-year-old children (N children=6361), we compared families where both parents worked standard hours, with families where one or both worked non-standard times (evenings, nights or weekends). In nearly three-quarters of the families one or both parents regularly worked non-standard times. We found associations between children's well-being and parent work schedules, with higher odds ratios for child difficulties when parents worked non-standard times. These associations persisted after adjusting for several confounding factors including socio-economic status, parent part-time or full-time work, and childcare use, and were evident whether mothers, fathers or both parents worked non-standard times. The findings raise questions about the implications for children of the 24-h economy.

A prediction model of 1-year mortality for acute ischemic stroke patients.

OBJECTIVE: To develop a prediction model for 1-year mortality in patients with acute ischemic stroke, with the model to be at least as useful and accurate as other previously developed prediction models. DESIGN: Retrospective cohort study. SETTING: Neurology department at an Australian tertiary teaching hospital. PARTICIPANTS: Four hundred forty consecutive patients diagnosed with acute ischemic stroke between July 1, 1995, and June 30, 1997. INTERVENTIONS: Two hundred twenty-three (51%) patients were randomly assigned to the derivation sample to develop a prediction model using the Cox proportional hazards model. The model was then validated in a validation sample of 217 (49%) patients. MAIN OUTCOME MEASURE: One-year mortality. RESULTS: Eight clinical predictors were included in the final model: unconsciousness (3 points), dysphagia (7 points), urinary incontinence (9 points), both sides affected (4 points), hyperthermia (4 points), ischemic heart disease (3 points), peripheral vascular disease (3 points), and diabetes mellitus (2 points). Patients with scores of 10 or higher were allocated to the high-risk group, which had a 1-year mortality rate of 76%, compared with a 1-year mortality rate of 8% in the low-risk group. There was no statistically significant difference in terms of sensitivity, specificity, and positive predictive value in the validation sample. CONCLUSION: We developed a predictive model for 1-year mortality in acute ischemic stroke patients. The model is easy to use and is comparable in its accuracy with other predictive models.

Ecologic analysis of some immune-related disorders, including type 1 diabetes, in Australia: latitude, regional ultraviolet radiation, and disease prevalence.

The apparent immune-suppressive effect of ultraviolet radiation (UVR) has suggested that this environmental exposure may influence the development of immune-related disorders. Self-reported prevalence rates of type 1 diabetes mellitus, rheumatoid arthritis (RA), eczema/dermatitis, and asthma, from the 1995 Australian National Health Survey, were therefore examined by latitude and ambient level of UVR. A positive association of type 1 diabetes mellitus prevalence was found with both increasing southern latitude of residence (r = 0.77; p = 0.026) and decreasing regional annual ambient UVR (r= -0.80; p = 0.018); a 3-fold increase in prevalence from the northernmost region to the southernmost region was evident. In contrast, asthma correlated negatively with latitude (r = -0.72; p = 0.046), although the change in asthma prevalence from the north to the south of Australia was only 0.7-fold. For both RA and eczema/dermatitis, there were no statistically significant associations between latitude/UVR and disease prevalence. These ecologic data provide some support for a previously proposed beneficial effect of UVR on T-helper 1-mediated autoimmune disorders such as type 1 diabetes. The inverse association of type 1 diabetes prevalence with UVR is consistent with that previously reported for another autoimmune disease, multiple sclerosis, in Australia, and also with type 1 diabetes latitudinal gradients in the Northern Hemisphere. The finding also accords with photoimmunologic evidence of UVR-induced immunosuppression and may suggest a beneficial effect of UVR in reducing the incidence of such autoimmune conditions. In light of this study, analytic epidemiologic studies investigating risk of immune disorders in relation to personal UVR exposure in humans are required.

Attitudes of developing world physicians to where medical research is performed and reported.

BACKGROUND: Little is known about the influence of the site of research or publication on the impact of the research findings on clinical practice, particularly in developing countries. The International Clinical Epidemiology Network (INCLEN) is dedicated to improving the quality of health research in the Developing World through institutional capacity building for evidence based medicine, and provided the opportunity to examine the likely impact of research location and journal location on physicians' practice in a number of the participating countries. METHODS: Physicians from secondary and tertiary hospitals in six cities located in China, Thailand, India, Egypt and Kenya were enrolled in a cross-sectional questionnaire survey. The primary outcome measures were scores on a Likert scale reflecting stated likelihood of changing clinical practice depending on the source of the research or its publication. RESULTS: Overall, local research and publications were most likely to effect change in clinical practice, followed by North American, European and regional research/publications respectively, although there were significant variations between countries. The impact of local and regional research would be greater if the perceived research quality improved in those settings. CONCLUSION: Conducting high quality local research is likely to be an effective way of getting research findings into practice in developing countries.

The health of the Australian workforce: 1998-2001.

OBJECTIVE: To describe the health of the Australian workforce in relation to occupational status. METHODS: Data on 9,167 workers, collected between 1998 and 2001, were obtained from the Campbell National Health Monitor, a cross-sectional national, health survey. Professional, white-collar and blue-collar workers were compared on five health outcomes: self-rated health, long-and short-term conditions, reduced activity days and work absences. RESULTS: One in 10 workers (M:11%; F:10%) rated their health as poor. Two-thirds (M: 60%; F: 64%) reported long-term conditions with four in five (M:77%; F: 83%) reporting short-term conditions. Smaller proportions took health-related actions, with 21% of men and 28% of women reducing their activity, and 17% of men and 20% of women taking time off work in a given month. Occupational inequalities in self-rated health were evident for both men and women, with professionals reporting the best health and blue-collar workers the worst (p < 0.001). Male, but not female, white- and blue-collar workers also had higher rates of short-term conditions (OR 1.25, 1.06-1.50 and 1.25, 1.07-1.46, respectively) and reduced activity days due to health (OR 1.43, 1.20-1.71 and 1.25, 1.07-1.47, respectively) compared with professionals. However, blue-collar workers reporting health problems were the least likely to take time off work (poor health: p = 0.043; short-term conditions: p = 0.001; long-term conditions: p = 0.003). CONCLUSIONS AND IMPLICATIONS: Blue-collar workers are the least healthy occupational grouping. They are also the most likely to present to work unwell. With employment conditions rapidly changing, better understanding of the impact of these changes on workers' health is vital.

The MacNew heart disease health-related quality of life instrument: reference data for users.

OBJECTIVE: To report reference data for the heart-specific MacNew Heart Disease Health-Related Quality of Life instrument. METHODS: One thousand five hundred and six patients with myocardial infarction (n = 346), heart failure (n = 201), and ischaemic heart disease (IHD, n = 959) were surveyed 4 months after hospital discharge. Quality of life scores were determined, stratified by diagnostic category, age and sex. Changes in scores from 4 to 8 months post-discharge were calculated for a subset of 830 patients, stratified by age and sex. RESULTS: At 4 months there were no significant differences in scores between myocardial infarction and electively admitted IHD patients, however the scores of heart failure patients were significantly lower (indicating poorer quality of life) than those of patients with other diagnoses. There were few significant differences between age groups or sexes when comparing within diagnostic groups. Change from 4 to 8 months was not associated with diagnosis, age, or sex but was associated with events within the period (readmission or revascularisation). The change data suggest that a value of 0.5 may be a useful indicator of the minimal clinically important difference. CONCLUSIONS: These reference data will assist in sample size calculations and with comparison of results in other studies, and will be of use to researchers who are using or intending to use the MacNew instrument.