Which diagnostic criteria of metabolic syndrome are predictors of cardiovascular diseases in elderly populations?

INTRODUCTION: Metabolic syndrome (MetS) is one contributing factor to cardiovascular diseases (CVD). Although there have been several reports showing MetS to be a risk factor for CVD, there are limited data available on which of the diagnostic criteria for MetS carries the greatest risk for CVD in the elderly population. This study thus aimed to evaluate these criteria in terms of risk of CVD in this population. METHODS: This was a retrospective cohort study conducted at three referral hospitals in Thailand. The study period was between January 1, 2007 and December 31, 2016. Eligible patients were identified whether presence of MetS or not at the beginning of study and followed until the end of study. The primary outcome of study was presence of CVD. Predictors for CVD were analyzed by Cox proportional-hazards regression. RESULTS: During the study period, there were 1080 patients who met the study criteria, 253 (23.42%) of whom had CVD. There were five factors significantly associated with CVD occurrence including age, smoking, SBP, FPG, and HDL-c. The two factors with the highest adjusted hazard ratio were FPG and SBP at 2.92 and 2.34, respectively. CONCLUSIONS: The three MetS criteria including SBP, FPG, and HDL-c may be predictors for cardiovascular diseases in elderly populations. Physician may need to focus on these particular factors of MetS in terms of CVD prevention in elderly patients.

Formative Evaluation and Learning Achievement in Epidemiology for Preclinical Medical Students.

BACKGROUND: Teaching epidemiology and biostatistics is a challenge for medical teachers. Formative evaluation has been shown to improve the learning outcomes in various medical subjects. However, the effectiveness of formative evaluation in the subject of epidemiology has yet to be clearly demonstrated. OBJECTIVE: The aim of this study is to investigate the association between formative evaluation and learning outcomes of medical students. MATERIALS AND METHODS: We retrospectively reviewed the prospectively collected learning data of 266 third-year medical students who were enrolled in an epidemiology course in 2016. All learning data and outcomes were analyzed. RESULTS: Nearly all students (97.4%) attended the formative evaluation. Learning outcomes were deemed unsatisfactory in 9.8% of cases. Multivariate analysis revealed that gender, the students' medical training program, laboratory attendance, and the amount of calculation students do during the formative examination were factors that were associated with learning outcomes. CONCLUSION: The formative evaluation was effective at improving learning outcomes in the subject of epidemiology. The parameters indicated that the attention of the medical students, such as laboratory attendance, and the amount of calculation done during the formative examination, were associated with learning outcomes.

The Stop-Bang Questionnaire as a Screening Tool for Obstructive Sleep Apnea-Induced Hypertension in Asian Population.

Obstructive sleep apnea (OSA) is a common public health issue. If left untreated, OSA may cause a large health economic burden from cardiovascular complications particularly stroke. The diagnosis of OSA can be made by polysomnography, but its availability is limited in the developing countries in Asia. STOP-BANG questionnaire is a good screening tool but may need some adjustment for Asian population. STOP-BANG stands for: Snoring history, Tired during the day, Observed stop breathing while sleep, High blood pressure, body mass index (BMI) more than 35 kg/m(2), Age more than 50 years, Neck circumference more than 40 cm and male Gender. We compared clinical features in STOP-BANG questionnaire between 42 OSA induced hypertension patients and 82 healthy control subjects in the Faculty of Medicine, Khon Kaen University, Thailand. The best cutoff point for the BMI and the neck circumference were 24.5 kg/m(2) and 36 cm, respectively. The sensitivity and specificity of the BMI cutoff point were 97.2% and 91.40, while those of the neck circumference were 94.7% and 82.9%. In conclusion, the appropriate cutoff points of BMI and neck circumference for Thai STOP-BANG questionnaire were 25 kg/m(2) and 36 cm.

PULMONARY TB AMONG MYANMAR MIGRANTS IN SAMUT SAKHON PROVINCE, THAILAND: A. PROBLEM OR NOT FOR THE TB CONTROL PROGRAM?

Most transnational migrant workers in Thailand are from Myanmar, a country with a high tuberculosis prevalence. We investigated the prevalence of suspected pulmonary tuberculosis (TB) among Myanmar migrants in communities of Mueang District, Samut Sakhon Province, Thailand. Symptom screening for those with a productive cough of more than 2 weeks was conducted by face-to-face home interviews with 4,874 participants aged at least 15 years. Most subjects (75%) were aged 15-34 years (75%), 52% were male and 60% were married. Subjects typically lived with fellow nationals in crowded, poorly ventilated apartments or row houses. Ten subjects had suspected TB, giving a prevalence rate of 0.2%. Ninety-seven percent were working in Thailand legally but 80% had no health insurance. None had sought community health services; all preferred self-medication and private clinics due to stigma associated with TB, medication costs and health center waiting times. Providing information about health insurance and introducing TB prevention and control in this group should be considered. Further studies are needed to develop a TB control program and communicable disease surveillance among migrant communities, in Thailand.

Effects of an influenza prevention program using non-pharmaceutical prevention measures to improve the knowledge, attitudes and practices of elementary school students in Nakhon Phanom province, Thailand.

We evaluated an influenza prevention educational program using educational media, e-books and cartoons conducted among students in grades 4 through 6. The course was 8 hours long. The study was conducted at 4 schools; 230 students at each school were in the experimental group and 224 students at each school were in the control group (no educational intervention). The data were analyzed using the Wilcoxon matched-pair signed-rank test. The students in the experimental group had significantly greater knowledge (p<0.001), attitudes (p<0.001) and practices (p<0.001) scores after the intervention. However, the control group also had significantly greater knowledge (p<0.001) and attitudes (p<0.001) scores but not practices scores (p = 0.326). Further studies are needed to determine the factors that influenced these differences.

Missed appointments at a tuberculosis clinic increased the risk of clinical treatment failure.

We investigated the charts of 381 new smear-positive tuberculosis patients at Khon Kaen Medical School during 1997-2001 using World Health Organization definitions to evaluate associations among treatment success or failure (defaulted, failed, died, or not evaluated) and tuberculosis clinic contact, demographics and clinical characteristics of the patients. Multinomial logistic regression was used for three-category outcome analysis: treatment success, transferred-out and clinical treatment failure. The treatment success and clinical treatment failure rates were 34.1% and 34.4%, respectively. About 46.5% and 85.8% of patients missed appointments at the tuberculosis clinic in the treatment success and treatment failure groups, respectively. The results show that patients who were absent from the tuberculosis clinic were 5.95 times more likely to have clinical treatment failure than treatment success, having adjusted for the effect of transfering-out and the effect of the treatment regimen and the sputum conversion status (adjusted odds ratio = 5.95; 95% CI: 2.99 to 11.84). The review showed that absence from the tuberculosis clinic was an independent risk factor for clinical treatment failure. We recommended that all new smear-positive tuberculosis patients should be followed closely at a tuberculosis clinic.