Breastfeeding Duration and Childhood Caries: A Cohort Study.

This cohort study was conducted in Khon Kaen, Thailand, to test the hypothesis that a longer breastfeeding duration increases the risk for dental caries in primary teeth. We collected information on infant feeding practices and potential confounders using a structured questionnaire to interview mothers or caregivers during the second trimester of pregnancy and after birth at 21 days and at 3, 12, 18, 24, and 36 months. Regardless of other liquids and foods, full breastfeeding was defined as feeding breast milk but not formula, while any breastfeeding was feeding breast milk with or without formula. Two calibrated dentists measured dental caries when the children were 3-4 years of age using the decayed, missing, and filled surfaces (dmfs) index following the World Health Organization criteria. Negative binomial regression with a generalized linear model was used to estimate relative risks (RRs) and 95% confidence intervals (CIs) using dmfs as an outcome. Log-binomial regression was performed to model the caries prevalence. Of 556 children, 88.1% had dental caries with a mean dmfs of 14.2. Full breastfeeding for 6-11 months was significantly associated with a lower dmfs (adjusted RR 0.77, 95% CI 0.63, 0.93) and a lower caries prevalence (adjusted RR 0.45, 95% CI 0.22, 0.90). The frequency of sleeping while breast- or bottle-feeding increased the caries risk in a dose-response manner. There was no association between duration of any breastfeeding and dental caries. In conclusion, full breastfeeding for 6-11 months may protect against dental caries in primary teeth. Prolonged breastfeeding was not associated with dental caries in this population.

Quality of acute ischemic stroke care in Thailand: a prospective multicenter countrywide cohort study.

BACKGROUND: Data concerning quality of acute stroke care and outcome are scarce in developing countries. OBJECTIVE: This study aimed to evaluate quality of acute stroke care and stroke outcomes in Thailand. METHODS: We performed a multicenter countrywide prospective cohort study. Consecutive patients with an acute ischemic stroke admitted to the participating institutions between June 2008 and November 2010 were included. Baseline characteristics, process measures including thrombolysis use, acute stroke unit admission, initiation of aspirin within 48 hours, and antithrombotic and/or anticoagulation medication at discharge were recorded. Main outcome measures were death and disability at discharge as well as in-hospital complications. RESULTS: A total of 1222 patients were included with a mean (±SD) age of 65.0 ± 13 years, and 55.0% were men. Median National Institutes of Health Stroke Scale score was 6.5. Patients were given aspirin within 48 hours, admitted to acute stroke unit, and given thrombolytic therapy in 71.1%, 24.6%, and 3.8%, respectively. Good recovery at discharge (modified Rankin scale score 0-1) was found in 26.1%, and 3.2% of patients died during hospitalization. The median length of stay was 4 days. Factors predicting poor outcome (modified Rankin scale score 5-6) at discharge included: age (by 10-year increments: adjusted odds ratio [OR] 1.23; 95% confidence interval [CI], 1.06-1.43), female sex (adjusted OR 1.52; 95% CI, 1.05-2.19), initial National Institutes of Health Stroke Scale score (adjusted OR 1.35; 95% CI, 1.27-1.43), and in-hospital complications (adjusted OR 3.16; 95% CI, 1.58-6.35). CONCLUSIONS: Limited access to acute ischemic stroke care interventions were observed in many domains especially thrombolysis and stroke unit admission. These findings emphasize an urgent need for strategies to improve standard acute stroke care among developing countries.

National trends in the prevalence of glycemic control among patients with type 2 diabetes receiving continuous care in Thailand from 2011 to 2018.

Diabetes is one of the largest global health problems and exhibits a constantly increasing trend. A series of nationwide hospital-based cross-sectional surveys of clinical outcomes was performed annually from 2011 to 2015 and 2018 among patients with type 2 diabetes aged ≥ 20 years receiving medical care for at least 12 months. A two-stage stratified cluster that was proportional to the size sampling technique was used to select a nationally and provincially representative sample of patients with type 2 diabetes in Thailand. A total of 186,010 patients with type 2 diabetes were enrolled in the study from 2011 to 2018. The prevalence of adequate glycemic control (hemoglobinA1c level < 7.0%) among patients with type 2 diabetes were estimated to be 34.5% (95%CI 33.8-35.2%) in 2011, 33.0% (95%CI 32.4-33.6%) in 2012, 34.7% (95%CI 34.1-35.4%) in 2013, 35.5 (95%CI 34.9-36.1%) in 2014, 35.6 (95%CI 35.0-36.2%) in 2015, and 35.6% (95%CI 35.0-36.2%) in 2018, respectively (p for trend < 0.001). Independent factors related to poor glycemic control (hemoglobinA1c ≥ 7%) were being female, younger aged, living in the northeastern region, received care form hospitals lower than regional level, under universal health coverage scheme, greater duration of diabetes, higher body mass index level and absence of hypertension comorbidity.

The Metabolic Syndrome and Health Behaviors in School Children Aged 13-16 Years in Ubon Ratchathani: UMeSIA Project.

BACKGROUND: Although metabolic syndrome (MetS) has become a significant public health problem worldwide, little evidence exists to describe the prevalence of MetS in school children using MetS different classifications, and its association with health-related behaviors. METHODS: Using data on 393 children and adolescents aged 13-16 years participating in the Ubon Ratchathani Metabolic Syndrome in Adolescent (UMeSIA) Project, the prevalence of MetS was determined using the International Diabetes Federation (IDF) 2007 definition and other three classifications reported in the previous literature. The prevalence of the MetS was compared across sex, a family history of diabetes, type of schools, and health behaviors using chi-square test. The prevalence of MetS and proportion of abnormalities in MetS components were compared across different MetS classifications using Cochran Q test. RESULTS: The prevalence of MetS in Thai school children was 3.1%, 5.8%, 6.9%, and 11.2% when using IDF, Cook's, Ford's, and De Ferranti's classifications respectively (Difference in MetS prevalence across the four MetS classifications, P < 0.001). Using IDF classification, prevalence was higher in male than female students (5.9% and 1.2%, respectively, P < 0.001) and higher in those with a family history of diabetes than those without (8.5% and 2.3%, respectively, P < 0.001). Students from a sports school had considerably lower MetS prevalence than those from conventional schools (1.9% and 3.5% respectively, P < 0.001). Those with MetS spent significantly longer time watching TV than those without (median (interquartile range) time to watch TV 180.0 (120.0, 240.0) and 120.0 (60.0, 180.0) min per day respectively, P = 0.002). CONCLUSIONS: The prevalence of MetS in Thai school children was modest and varied greatly when different MetS definitions were applied. Interventions to optimize time spent watching TV and increase physical activity may be beneficial in reducing the risk of the MetS in children and adolescents.

Adverse birth outcomes and childhood caries: a cohort study.

OBJECTIVES: To examine the association between adverse birth outcomes and dental caries in primary teeth. METHODS: This study included children in Khon Kaen, Thailand, who participated in the Prospective Cohort Study of Thai Children. Preterm was defined as a birth at <37 weeks gestation, low birthweight (LBW) as birthweight <2500 g, and small-for-gestational age (SGA) as birthweight <10th percentile of expected weight for gestational age. Two calibrated dentists measured dental caries in primary teeth when the children were 3-4 years old using decayed, missing and filled surfaces (dmfs) index following the World Health Organization criteria. We used negative binomial regression with generalize linear models to estimate relative risks (RRs) and their 95% confidence intervals (CIs), adjusted for confounding factors. Of 758 children with gestational age data and 833 with birthweight data, the 544 (follow-up rate of 71.8% in preterm and 65.3% in LBW) who had dental data available were included in the analysis. RESULTS: Dental caries was observed in 480 children (88.2%), with a mean dmfs of 14.3 (standard deviation 12.8). The adjusted RR for dental caries was 0.61 (95% CI 0.43, 0.85) for preterm, 0.89 (95% CI 0.67, 1.21) for LBW, and 0.96 (95% CI 0.74, 1.26) for SGA. CONCLUSIONS: There was an inverse association between preterm and childhood caries. LBW and SGA were not associated with dental caries in this population.

Sociobehavioral factors associated with caries increment: a longitudinal study from 24 to 36 months old children in Thailand.

The aim of this study is to investigate sociobehavioral risk factors from the prenatal period until 36 months of age, and the caries increment from 24 to 36 months of the child in Thailand. The data utilized in this study come from the prospective cohort study of Thai children (PCTC) from prenatal to 36 months of the child in Mueang Nan district, Northern Thailand. The total sample size recruited was 783 infants. The sample size with dental caries data was 603 and 597, at 24 months and at 36 months, respectively. The sample size of having two assessment points with a dental examination (at 24 months and at 36 months) was 597. Results indicate that the caries increment was 52.9%, meaning from 365 caries free children at 24 months 193 had developed dental caries at 36 months. The prevalence of dental caries was 34.2% at 24 months (n = 206) and 68.5% at 36 months of age (n = 409). In bivariate analysis, higher education of the mother, lower household income, bottle feeding of the infant, frequent sweet candy consumptions, and using rain or well water as drinking water were associated with dental caries increment, while in multivariate conditional logistic regression analysis lower household income, higher education of the mother, and using rain or well water as drinking water remained associated with dental caries increment. In conclusion, a very significant increase in caries development was observed, and oral health may be influenced by sociobehavioural risk factors.