National survey: Evaluation of cardiovascular risk factors in Thai patients with type 2 diabetes and chronic kidney disease after the development of cardiovascular disease.

AIM: The aim of the present study was to evaluate the achievement in controlling the risk factors of cardiovascular diseases (CVD) in Thai patients with type 2 diabetes (T2DM) and chronic kidney disease (CKD). METHODS: The DMHT dataset from 2011 to 2012, which was the cross-sectional study of the national survey in Thai patients with T2DM was analyzed. RESULTS: There were 1254 of 15 149 diabetic patients with estimated glomerular filtration rate (eGFR) less than 60 mL/min per 1.73 m2 that had developed CVD for more than 12 months. The prevalence of CVD was 8.3%. The mean age in years was 68.2 with a standard deviation (SD) of 8.7. Males and females were 38.7 and 61.3%, respectively. The mean duration of diabetes was 8.5 (SD 0.2) years. The mean body mass index was 25.5 (SD 4.4) kg/m2 . The percentage of patients with the target level of blood pressure control at ≤130/80 mm Hg was 47.1%. The percentage of patients who received angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) was 58.9%. The percentage of patients with the target level of LDL control at <70 mg/dL was 17.2%. The percentage of patients with the target level of HbA1C at 7% was 39.2%. There were 63 (5.0%) patients having recurrent CVD. CONCLUSIONS: Most Thai patients with T2DM and CKD with eGFR < 60 mL/min per 1.73 m2 could not achieve the therapeutic goals after the development of CVD. The national health policy should be planned to improve the quality of care to increase the number of patients who achieve the recommended goals.

Prevalence of chronic kidney disease associated with cardiac and vascular complications in hypertensive patients: a multicenter, nation-wide study in Thailand.

BACKGROUND: Hypertension and chronic kidney disease (CKD) are common conditions and both are major risk factors for cardiovascular events. The objectives were 1) to study the prevalence of CKD in hypertensive patients and 2) to study the association of CKD with cardiac and vascular complications in a multicenter, nation-wide fashion. METHODS: This cross-sectional study evaluated patients aged 20 years or older who were diagnosed with hypertension and who had been treated for at least 12 months at 831 public hospitals in Thailand during the 2012 study period. Outcome measurements included calculated glomerular filtration rate (GFR) and cardiac and vascular complications that included coronary artery disease, stroke, peripheral arterial disease, heart failure, and atrial fibrillation. Multivariable modeling was conducted to determine independent factors associated with increased risk of cardiac and vascular complications. RESULTS: A total of 28770 patients were enrolled. Average age was 62.8 years and 37% were male. Prevalence of CKD stage 3 and 4-5 was 33.2 and 4.3%, respectively. Prevalence of cardiac and vascular complications was 10.5% (5% having coronary artery disease, 3.9% stroke, 1.7% heart failure, and 1.2% atrial fibrillation). CKD was an independent risk factor associated with each of the complications and overall cardiac and vascular complications with an adjusted Odds ratio of 1.4 for CKD stage 3 and 1.9 for CKD stage 4-5. CONCLUSION: Prevalence of CKD stage 3-5 in hypertensive population was 37.5%. CKD is an independent risk factor for adverse cardiac and vascular outcome.

Breast Cancer Detection Rate, Incidence, Prevalence and Interval Cancer-related Mammography Screening Times among Thai Women.

BACKGROUND: A recent guideline by the American Cancer Society recommended that mammography (MMG) should be done for women starting in their mid-40s. In Thailand, information on opportunistic mammography screening is limited and data on the total incidence of breast cancer are also lacking. The purpose of this study was to estimate the breast cancer detection, incident and prevalence rates among Thai women. MATERIALS AND METHODS: We retrospectively reviewed the opportunistic mammography screening of normal women between 30 and 80 years who underwent the procedure between 2001 and 2010. All cases were followed until 2012. The detection rate was calculated for the whole period of observation using 'number of women with positive findings' divided by 'total number of women screened'. The incidence rate was calculated only at the first MMG while the subsequence rate was calculated based on all new cases detected at each subsequent MMG. RESULTS: Among the 47,430 women, there were 152,091 MMGs or approximately 3.2 occasions per person (range, 1-10). The average duration of the interval between each subsequence visit was 1.8 years. Overall, breast cancer was detected in 543 women, with a detection rate of 10.3 per 1,000 persons. The prevalence rate of breast cancer at the first visit was 5.78 per 1,000 persons. The incidence or new cases detected at any follow-up visit was 10.4 per 1,000 persons. The overall interval cancer was 0.91 per 1,000 women, mainly detected before their second and third MMG, with a rate of 0.0.47 and 0.76 per 1,000 women. CONCLUSIONS: Opportunistic mammography screening in Thailand detected 10 cases of breast cancer from each 1,000 women. This paper indicated a high rate of cancer detection during a two year interval, hence, a screening mammogram should be performed more often.

Prevalence and associating factors of atrial fibrillation in patients with hypertension: a nation-wide study.

BACKGROUND: Atrial fibrillation (AF) is a common cardiac arrhythmia and increases risk of ischemic stroke. Data on the prevalence of AF in Thailand is lacking especially in patients with hypertension. The objectives of this study were to determine prevalence of AF in patients with hypertension and to determine factors that are associated with increased prevalence of AF in a multicenter nationwide study. METHODS: A cross-sectional survey for the national outcome evaluation among hypertensive patients visiting 831 public hospitals in Thailand was conducted between 2011 and 2012 to evaluate status of standard care in hypertensive patients visiting public Thailand Ministry of Public Health (MoPH) hospitals. Inclusion criteria were hypertensive patients aged at least 20 years who had received medical care in the targeted hospital for at least 12 months. The main outcome measurement was AF rhythm, and was measured along with potential risk factors age, gender and cardiovascular risk factors. RESULTS: There were 13207 hypertensive patients who had ECG data recorded during the survey. AF was detected in 457 patients (3.46 %). Prevalence of AF increased with increasing age, was more common in males and in patients with chronic kidney disease (CKD). Multivariable modelling was conducted to assess which factors were most associated with increased prevalence of AF, and the results showed older age followed by male gender, low LDL-cholesterol and increased uric acid levels were the most important risk factors for AF in this population. CONCLUSIONS: Prevalence of AF in hypertensive patients was 3.46 %. Factors associated with increased risk of AF are old age, male gender, low LDL-cholesterol and elevated uric acid level.

Cost utility analysis of reduced intensity hematopoietic stem cell transplantation in adolescence and young adult with severe thalassemia compared to hypertransfusion and iron chelation program.

BACKGROUND: Hematopoieticic stem cell transplantation is the only therapeutic option that can cure thalassemia disease. Reduced intensity hematopoietic stem cell transplantation (RI-HSCT) has demonstrated a high cure rate with minimal complications compared to other options. Because RI-HSCT is very costly, economic justification for its value is needed. This study aimed to estimate the cost-utility of RI-HSCT compared with blood transfusions combined with iron chelating therapy (BT-ICT) for adolescent and young adult with severe thalassemia in Thailand. METHODS: A Markov model was used to estimate the relevant costs and health outcomes over the patients' lifetimes using a societal perspective. All future costs and outcomes were discounted at a rate of 3% per annum. The efficacy of RI-HSCT was based a clinical trial including a total of 18 thalassemia patients. Utility values were derived directly from all patients using EQ-5D and SF-6D. Primary outcomes of interest were lifetime costs, quality adjusted life-years (QALYs) gained, and the incremental cost-effectiveness ratio (ICER) in US ($) per QALY gained. One-way and probabilistic sensitivity analyses (PSA) were conducted to investigate the effect of parameter uncertainty. RESULTS: In base case analysis, the RI-HSCT group had a better clinical outcomes and higher lifetime costs. The incremental cost per QALY gained was US $3,236 per QALY. The acceptability curve showed that the probability of RI-HSCT being cost-effective was 71% at the willingness to pay of 1 time of Thai Gross domestic product per capita (GDP per capita), approximately US $4,210 per QALY gained. The most sensitive parameter was utility of severe thalassemia patients without cardiac complication patients. CONCLUSION: At a societal willingness to pay of 1 GDP per capita, RI-HSCT was a cost-effective treatment for adolescent and young adult with severe thalassemia in Thailand compared to BT-ICT.

Childhood cancer incidence and survival 2003-2005, Thailand: study from the Thai Pediatric Oncology Group.

BACKGROUND: Previous population-based incidences of childhood cancer in Thailand were achieved by extrapolating from data limited to a small number of cancer registries, not from the whole country. In addition, survival of childhood cancer patients is often described in specialized hospitals and/or institutions, but not in the general population. METHODS: All children aged 0-15 years who were newly diagnosed as having cancer were registered from 18 treatment centers during 2003-5 and classified into 12 diagnostic groups according to the International Classification of Childhood Cancer. Incidences were calculated by a standard method and survival was investigated using the ThaiPOG (Thai Pediatric Oncology Group) population-based registration data. Overall survival was calculated by the Kaplan Meier method. RESULTS: In the study period (2003-5) 2,792 newly diagnosed cases of childhood cancer were registered, with mean and median ages of 6.5 (SD=0.13) and 5.0 (0-14) years, respectively. The age-peak was between 1 and 4 years and the age-standardized rate (ASR) was 74.9 per million. Leukemia was the most common cancer (N=1421, ASR 38.1) followed by lymphoma (N=266, ASR 6.4) and neoplasms of the central nervous system (CNS, N=246, ASR 6.3). The follow-up duration totaled 101,250 months. The death rate was 1.11 per 100 person-months (95%CI: 1.02 -1.20). The 5-year overall survival was 54.9% (95%CI: 53.0%-56.9%) for all cancers. The respective, 5-year overall survival for (1) acute lymphoblastic leukemia (ALL), (2) acute non-lymphoblastic leukemia (ANLL), (3) lymphoma, (4) retinoblastoma, (5) renal tumors, (6) liver tumors, (7) germ cell tumors, (8) CNS tumors, (9) neuroblastoma, (10) soft tissue tumors and (11) bone tumors were (1) 64.5%, (2) 35.1%, (3) 59.5%, (4) 73.1%, (5) 70.4%, (6) 44.5%, (7) 70.6%, (8) 41.7%, (9) 33.6%, (10) 50.1%, and (11) 33.7%. CONCLUSIONS: The incidence of childhood cancer is lower than in western countries. Respective overall survival for ALL, lymphoma, renal tumors, liver tumors, retinoblastoma, soft tissue tumors is lower than those reported in developed countries while for CNS tumors, neuroblastoma and germ cell tumors the figures are comparable.

Breast cancer in the Thai Cohort Study: an exploratory case-control analysis.

Breast cancer incidence may be increasing in Thailand but very little research has assessed core breast cancer risk factors in this country. We used baseline questionnaire data from a national cohort study of Thai Open University students in an exploratory case-control study of breast cancer. The study included 43 female cases and 860 age-matched controls selected from the remaining 47,271 female cohort participants. Odds ratios and 95% confidence intervals were calculated using conditional logistic regression. The women were predominantly premenopausal. Taller women had an increased risk of breast cancer (OR=2.3, 95% CI 1.1-4.8, for height >or=160cm vs

Respiratory and skin health among glass microfiber production workers: a cross-sectional study.

BACKGROUND: Only a few studies have investigated non-malignant respiratory effects of glass microfibers and these have provided inconsistent results. Our objective was to assess the effects of exposure to glass microfibers on respiratory and skin symptoms, asthma and lung function. METHODS: A cross-sectional study of 102 workers from a microfiber factory (response rate 100%) and 76 office workers (73%) from four factories in Thailand was conducted. They answered a questionnaire on respiratory health, occupational exposures, and lifestyle factors, and performed spirometry. Measurements of respirable dust were available from 2004 and 2005. RESULTS: Workers exposed to glass microfibers experienced increased risk of cough (adjusted OR 2.04), wheezing (adjOR 2.20), breathlessness (adjOR 4.46), nasal (adjOR 2.13) and skin symptoms (adjOR 3.89) and ever asthma (adjOR 3.51), the risks of breathlessness (95%CI 1.68-11.86) and skin symptoms (1.70-8.90) remaining statistically significant after adjustment for confounders. There was an exposure-response relation between the risk of breathlessness and skin symptoms and increasing level of microfiber exposure. Workers exposed to sensitizing chemicals, including phenol-formaldehyde resin, experienced increased risk of cough (3.43, 1.20-9.87) and nasal symptoms (3.07, 1.05-9.00). CONCLUSION: This study provides evidence that exposure to glass microfibers increases the risk of respiratory and skin symptoms, and has an exposure-response relation with breathlessness and skin symptoms. Exposure to sensitizing chemicals increased the risk of cough and nasal symptoms. The results suggest that occupational exposure to glass microfibers is related to non-malignant adverse health effects, and that implementing exposure control measures in these industries could protect the health of employees.