Body size dynamics in young adults: 8-year follow up of cohorts in Brazil and Thailand.

Increase in body size has appeared as an epidemic in Western countries and is now rapidly emerging in low- and middle-income countries, contributing to the rise in non-communicable diseases worldwide. Brazil and Thailand have gone through similar economic and health transitions, and this unique comparative study investigates changes in body size (body mass index) in relation to socioeconomic status in two cohorts of similar age followed from 2004/2005 to 2012/2013. At 20-24 years of age, Pelotas cohort members had a much higher prevalence of overweight and obesity (20.7 and 8.6%) than the Thai cohort (6.0 and 1.7%); these proportions rose to 34.6% and 22.9% vs 15.8% and 5.1%, respectively, in their early 30s. An association between a higher socioeconomic status and increase in overweight and obesity was observed among males; but an inverse pattern was noted for females in both cohorts and remained statistically significant after 8 years of follow up. Our comparative longitudinal analyses highlight the relationship between two middle-income settings facing rapid increases in body size (2-3 fold increase in the rate of overweight and obesity). Long-term follow up and a lifecourse approach for effective prevention of obesity will minimize adverse health burdens in later life.

Risk factors for injury in a national cohort of 87,134 Thai adults.

BACKGROUND: Information is needed regarding risk factors associated with injury. In middle- and lower-income countries, injury studies have focused on road traffic injuries and less attention has been given to other types of injuries. METHODS: This study is part of overarching health-risk transition research in Thailand with a large national cohort study that began in 2005 (n = 87,134). Associations between potential determinants and overall injury were measured, as well as injury by location (transport, home, work and sport), using data gathered from the baseline questionnaire. RESULTS: In total, 21.5% of the cohort reported at least one incidence of injury over the last 12 months. Risk factors associated with injury were being male [odds ratio (OR) 1.20], having lower income (OR 1.70), having problems with vision (OR 1.46), having epilepsy (OR 3.02), having depression/anxiety (OR 1.62), poor self-assessed health (OR 1.68), being obese (OR 1.24) and death of father due to injury (OR 1.59). Analysis of injury by location provided more specific information on risk factors. For example, females were more likely to report injuries at home, while males, urban residents and regular alcohol drinkers were more likely to report transport injuries. CONCLUSIONS: The risk of injury in Thailand varies considerably by location, sociodemographic group and several categories of co-existing morbidities. Such epidemiological information identifying risk factors for injury is useful for designing targeted injury prevention programmes in Thailand and other middle-income countries.

Explanation of inequality in utilization of ambulatory care before and after universal health insurance in Thailand.

Thailand implemented a Universal Coverage Scheme (UCS) of national health insurance in April 2001 to finance equitable access to health care. This paper compares inequalities in health service use before and after the UCS, and analyses the trend and determinants of inequality. The national Health and Welfare Surveys of 2001 and 2005 are used for this study. The concentration index for use of ambulatory care among the population reporting a recent illness is used as a measure of health inequality, decomposed into contributing demographic, socio-economic, geographic and health insurance determinants. As a result of the UCS, the uninsured group fell from 24% in 2001 to 3% in 2005 and health service patterns changed. Use of public primary health care facilities such as health centres became more concentrated among the poor, while use of provincial/general hospitals became more concentrated among the better-off. Decomposition analysis shows that the increasingly common use of health centres among the poor in 2005 was substantially associated with those with lower income, residence in the rural northeast and the introduction of the UCS. The increasing use of provincial/general hospitals and private clinics among the better-off in 2005 was substantially associated with the government and private employee insurance schemes. Although the UCS scheme has achieved its objective in increasing insurance coverage and utilization of primary health services, our findings point to the need for future policies to focus on the quality of this primary care and equitable referrals to secondary and tertiary health facilities when required.

Personal Wellbeing Index in a National Cohort of 87,134 Thai Adults.

Satisfaction with life correlates with other measures of subjective wellbeing and correlates predictably with individual characteristics and overall health. Social indicators and subjective wellbeing measures are necessary to evaluate a society and can be used to produce national indicators of happiness. This study therefore aims to help close the gap in wellbeing data for Thailand. The specific aims are to: (1) calculate the Thai PWI and domain scores using a large scale sample; (2) examine the level of life satisfaction of Thais when compared to international standards; (3) examine the Thai PWI and domains in relation to demographic, socioeconomic, and geographic characteristics. Our report derives from the findings on the Personal Wellbeing Index (PWI) in a large national cohort of Sukhothai Thammathirat Open University adult students living all over Thailand (n = 87,134). This Thai cohort had an overall PWI of 70.0 on a scale from 0 to 100 which is consistent with Western populations. The 'spirituality and religion' domain had the highest average score. 'Standard of living', 'future security' and 'achievement in life' made the largest contribution to overall 'satisfaction in life as a whole'. These domains also show a positive trend with increasing age, being married, higher income, more education, more household assets, and rural residence. The PWI will be an important tool for policymakers to understand the subjective wellbeing of population groups especially as Thailand is undergoing a political and economic transition.