Thai Adults Research Articles

Impact of sugar-sweetened beverage tax on dental caries: a simulation analysis

BackgroundThe tiered sugar-sweetened beverage (SSB) tax was implemented in Thailand to encourage industries to reduce sugar content in beverages, and consequently reduce sugar consumption in the population. The aim of the study is to explore the expected impact of the new SSB tax policy in Thailand, a middle-income country in Asia, and other alternative policies on oral health outcomes as measured by the prevalence and severity of dental caries among the Thai population.MethodsA qualitative system dynamics model that captures the complex interrelationships among SSB tax, sugar consumption and dental caries, was elicited through participatory stakeholder engagement. Based on the qualitative model, a quantitative system dynamics model was developed to simulate the SSB tax policy and other alternative scenarios in order to evaluate their impact on dental caries among Thai adults from 2010 to 2040.ResultsUnder the base-case scenario, the dental caries prevalence among the Thai population 15 years and older, is projected to increase from 61.3% in 2010 to 74.9% by 2040. Implementation of SSB tax policy is expected to decrease the prevalence of dental caries by only 1% by 2040, whereas the aggressive policy is projected to decrease prevalence of dental caries by 21% by 2040.ConclusionsIn countries where a majority of the sugar consumed is from non-tax sugary food and beverages, especially Asian countries where street food culture is ubiquitous and contributes disproportionately to sugar intake, SSB tax alone is unlikely to have meaningful impact on oral health unless it is accompanied with a comprehensive public health policy that aims to reduce total sugar intake from non-SSB sources.

Environmental consequences related to nutritional status of Thai populations

To quantify the cumulative environmental impact related to dietary preference of Thai adults classified by nutritional status. The study used the data from the Thailand National Food Consumption Survey in 2006. A sample of 4056 participants aged between 19 and 60 years were categorized (normal, overweight, and obesity) by body mass index (BMI) classification for Asians. Food consumption patterns were analyzed and amounts of popular food consumed were calculated. Each commodity’s input was converted into output during the life-cycle to CO2 equivalent (CO2-eq) using a Thai database. The most popular plant- and animal-based foods were selected to quantify their emission of GHGs (greenhouse gases) during transportation. Among the ten popular commodities, seven were plant-based foods. Annual GHG emissions by overweight and obesity were higher than that of the normal groups (367, 319, and 301 kgCO2-eq respectively). The highest GHG contributor was rice. Beef emitted more than other animal-based foods. Food choices ultimately result in impacts on the environment. They also have consequences on public health related to health outcomes. It is therefore recommended that environmentally friendly consumption practices should be encouraged for climate change and food security.

Universal coverage but unmet need: National and regional estimates of attrition across the diabetes care continuum in Thailand.

Diabetes is a growing challenge in Thailand. Data to assess health system response to diabetes is scarce. We assessed what factors influence diabetes care cascade retention, under universal health coverage. We conducted a cross-sectional analysis of the 2014 Thai National Health Examination Survey. Diabetes was defined as fasting plasma glucose ≥126mg/dL or on treatment. National and regional care cascades were constructed across screening, diagnosis, treatment, and control. Unmet need was defined as the total loss across cascade levels. Logistic regression was used to examine the demographic and healthcare factors associated with cascade attrition. We included 15,663 individuals. Among Thai adults aged 20+ with diabetes, 67.0% (95% CI 60.9% to 73.1%) were screened, 34.0% (95% CI 30.6% to 37.2%) were diagnosed, 33.3% (95% CI 29.9% to 36.7%) were treated, and 26.0% (95% CI 22.9% to 29.1%) were controlled. Total unmet need was 74.0% (95% CI 70.9% to 77.1%), with regional variation ranging from 58.4% (95% CI 45.0% to 71.8%) in South to 78.0% (95% CI 73.0% to 83.0%) in Northeast. Multivariable models indicated older age (OR 1.76), males (OR 0.65), and a higher density of medical staff (OR 2.40) and health centers (OR 1.58) were significantly associated with being diagnosed among people with diabetes. Older age (OR 1.80) and higher geographical density of medical staff (OR 1.82) and health centers (OR 1.56) were significantly associated with being controlled. Substantial attrition in the diabetes care continuum was observed at diabetes screening and diagnosis, related to both individual and health system factors. Even with universal health insurance, Thailand still needs effective behavioral and structural interventions, especially in primary health care settings, to address unmet need in diabetes care for its population.

Dengue Risk Score Development Towards Early Warning of Severe Dengue Infection Among Thai Adults

Dengue Risk Score Development Towards Early Warning of Severe Dengue Infection Among Thai Adults

Negative impacts of self-reported five-year incident tooth loss and number of teeth on oral health-related quality of life

Aims and Objectives: This cross-sectional study aimed to determine the impacts of five-year incident tooth loss on oral health-related quality of life (OHRQoL) in Southern Thai adults and the differences in OHRQoL regarding the number of teeth. Materials and Methods: The study samples included 657 dentate men and women, aged 35–65 years. The Thai version of the Oral Impacts on Daily Performances (OIDP) index was used to assess oral impacts. The number of teeth was grouped as 1–19 versus ≥20 teeth. Self-reported five-year incident tooth loss was classified as none, 1–2 teeth, or ≥3 teeth. Odd ratio (OR) and 95% confident interval (CI) were presented. All analyses were carried out using STATA software, version 13.1. Results: Approximately 22% of participants had fewer than 20 teeth. More than half (54%) of the participants had lost ≥ 1 tooth. OIDP were experienced by approximately 54% of participants, where impacts on eating were frequently reported. Adjusted multinomial logistic regression analyses showed that ≥3 lost teeth and having 1–19 retained teeth was significantly associated with the greater prevalence of oral impacts (OR = 9.80; 95% CI = 2.96–32.51). Conclusion: Tooth loss and its impacts affecting daily life were common among these study samples. The largest effect on impaired OHRQoL was presented by those with fewer teeth and a greater number of incident tooth loss during the past five years.

Assessing and analysing the socio-ethical impacts of plate waste: a case of university canteens in Thailand

Emerging consumers have driven the transformation of lifestyles and consumption patterns in Thailand to resemble industrialised countries. In Thailand, food waste generated from the consumption of consumers (plate waste) has become problematic and the number of research is still limited. This research conceptualises Thai consumers' roles to address plate waste and quantifies plate waste at university canteens for assessing and analysing socio-ethical impacts. Waste hierarchy and citizen-consumer concepts are used to analyse consumers' roles and to guide the analysis on socio-ethical impacts of plate waste. The canteens at Ubon Ratchathani University (UBU) became the investigation site. It is revealed that bringing in the citizen-consumer concept broadens what Thai consumers can do to address food waste, offering potentials to promote sustainable food provision systems and consumption practices. For the socio-ethical aspect, it is found that a week of plate waste from about 3,800 consumers could feed 116 Thai adults for one day.

85 Exploring the Feasibility of the Adapted Lifestyle - Integrated Functional Exercise (ALIFE) Programme to Prevent Falls among Older Adults in Thailand

Abstract Background Falls are the leading cause of injuries in older adults in Thailand. Exercise appears to be a strategy to reduce falls. There is a need to develop a fall prevention exercise programme to encourage participation and adherence. The adapted Lifestyle-integrated Functional Exercise (aLiFE) programme may be suitable by integrating exercise into daily routines as opposed to attending an exercise class. This study aimed to explore the acceptability and feasibility of the aLiFE programme in older Thai adults and identify if modifications are necessary for this population. Method To obtain older Thai adults' perspectives and stakeholders’ views, 40 community-dwelling older adults aged ≥ 60 years, in urban and rural locations in Thailand, and 14 stakeholders (e.g. healthcare professionals) working with older Thai adults were included. Qualitative methods were used to conduct focus groups and in-depth interviews with older adults, and semi-structured interviews with stakeholders. Thematic analyses using Framework Approach were conducted. Results Findings revealed positive views and identified four themes including: (a) individual factors, (b) perceptions of aLiFE, (c) recommendations for implementing aLiFE in Thailand, and (d) motivation. Older participants expressed interest in performing aLiFE in their daily activities, although some activities may need to be modified to fit the Thai cultural context. Stakeholders were concerned about how to motivate older Thai adults to adhere to aLiFE. Healthcare professionals and family members could play a major role to support older adults in uptake of aLiFE. Benefits (e.g. independence and fall prevention) may motivate older adults to engage in aLiFE. Clear and simple instructions were requested. Conclusion The aLiFE programme should be feasible and acceptable among older Thai adults. The aLiFE programme has been appropriately modified to be ‘Thai LiFE (TLiFE)’. A feasibility randomised controlled trial of the TLiFE programme has been conducted in older Thai adults.

System dynamics analysis of dental caries status among Thai adults and elderly

Purpose The purpose of this paper is to estimate the changes of dental caries status among Thai adults and elderly under the different policy options using system dynamics modeling. Design/methodology/approach A multi-sector system dynamics model was developed to capture the dynamic interrelationship between dental caries status changes and oral health behavior – including self-care, dental care utilization and sugar consumption. Data used to populate the model was obtained from the Thai national oral health survey in 2000, 2006, 2012 and Thailand Official Statistics Registration. Three policy scenarios were experimented in the model: health promotion policy, dental personnel policy and affordable dental care service policy. Findings Dental caries experiences among Thai adults and elderly were projected to increase from now to 2040, as the elderly population increases. Among all policies experimented herein, the combined policies of health promotion, increased affordability and capacity of dental health service were found to produce the highest improvement in dental caries status with 3.7 percent reduction of population with high decayed, missing and filled teeth (DMFT) and 5.2 percent increase in population with very low DMFT. Originality/value This study is the first comprehensive simulation model that attempts to explore the dynamic interrelationship among dental caries experiences and behavioral factors that impact on oral health outcomes. In addition, the simulation model herein offers a framework for policy experimentation that provides policymakers with additional insights to inform health policy planning.

Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease

ObjectivesThe cross-sectional study aimed to assess left ventricular systolic function using global longitudinal strain (GLS) by speckle-tracking echocardiography (STE) and arterial stiffness using cardio-ankle vascular index (CAVI) in Thai adults with rheumatoid arthritis (RA) and no clinical evidence of cardiovascular disease (CVD).MethodsConfirmed RA patients were selected from a list of outpatient attendees if they were 18 years (y) without clinical, ECG and echocardiographic evidence of CVD, diabetes mellitus, chronic kidney disease, and excess alcoholic intake. Controls were matched with age and sex to a list of healthy individuals with normal echocardiograms. All underwent STE and CAVI.Results60 RA patients (females = 55) were analysed. Mean standard deviation of patient and control ages were 50 ± 10.2 and 51 ± 9.9 y, respectively, and mean duration of RA was 9.0 ± 6.8 y. Mean DAS28-CRP and DAS28-ESR were 2.9 ± 0.9 and 3.4 ± 0.9, respectively. There was no between-group differences in left ventricular ejection fraction (LVEF), LV sizes, LVMI, LV diastolic function and CAVI were within normal limits but all GLSs values was significantly lower in patients vs. controls: 17.6 ± 3.4 vs 20.4 ± 2.2 (p = 0.03). Multivariate regression analysis demonstrated significant correlations between GLSs and RA duration (p = 0.02), and GLSs and DAS28-CRP (p = 0.041).ConclusionsPatients with RA and no clinical CV disease have reduced LV systolic function as shown by lower GLSs. It is common and associated with disease activity and RA disease duration. 2D speckle-tracking GLSs is robust in detecting this subclinical LV systolic dysfunction.

Early management of sepsis in medical patients in rural Thailand: a single-center prospective observational study

BackgroundThe burden of sepsis is highest in low- and middle-income countries, though the management of sepsis in these settings is poorly characterized. Therefore, the objective of this study was to assess the early management of sepsis in Thailand.MethodsPre-planned analysis of the Ubon-sepsis study, a single-center prospective cohort study of Thai adults admitted to the general medical wards and medical intensive care units (ICUs) of a regional referral hospital with community-acquired sepsis.ResultsBetween March 2013 and January 2017, 3,716 patients with sepsis were enrolled. The median age was 59 years (IQR 44-72, range 18-101), 58% were male, and 88% were transferred from other hospitals. Eighty-six percent of patients (N = 3,206) were evaluated in the Emergency Department (ED), where median length of stay was less than 1 hour. Within the first day of admission, most patients (83%, N = 3,089) were admitted to the general medical wards, while 17% were admitted to the ICUs. Patients admitted to the ICUs had similar age, gender, and comorbidities, but had more organ dysfunction and were more likely to receive measured sepsis management interventions. Overall, 84% (N = 3,136) had blood cultures ordered and 89% (N = 3,308) received antibiotics within the first day of hospital admission. Among the 3,089 patients admitted to the general medical wards, 38% (N = 1,165) received an adrenergic agent, and 21% (N = 650) received invasive mechanical ventilation. Overall mortality at 28 days was 21% (765/3,716), and 28-day mortality in patients admitted to the ICUs was higher than that in patients admitted to the general medical wards within the first day (42% [263/627] vs. 16% [502/3,089], p < 0.001).ConclusionsSepsis in a regional referral hospital in rural Thailand, where some critical care resources are limited, is commonly managed on general medical wards despite high rates of respiratory failure and shock. Enhancing sepsis care in the ED and general wards, as well as improving access to ICUs, may be beneficial in reducing mortality.Trial registrationThe Ubon-sepsis study was registered on clinicaltrials.gov (NCT02217592).

Identification of Optimal Thalassemia Screening Strategies for Migrant Populations in Thailand: A Mixed-Methods Approach

BACKGROUND: Severe thalassemia is common in Southeast Asia (SEA) and can lead to transfusion dependent anemia, growth retardation, and perinatal death. Prevention and control of thalassemia can be approached either preconceptionally (through carrier screening, reproductive planning, or preimplantation diagnosis) or antenatally (through prenatal screening and diagnosis and termination of pregnancy). Thailand's national thalassemia program focuses on antenatal interventions, provided free to citizens. However, there is a growing population of migrant workers from neighboring countries who face barriers to healthcare and likely have varied beliefs towards pregnancy termination. We conducted a mixed-methods study using survey, interview, and focus group data to identify key barriers to and optimal strategies for thalassemia screening in migrant communities in Thailand. METHODS: Myanmar and Cambodian migrant workers and agents, Thai healthcare providers, and Thai adults (aged 18-49 years) at Laem Chabang Hospital (Chonburi, Thailand) participated in a knowledge, attitudes, and practices (KAP) survey, interviews, and focus groups. All sessions were conducted in Thai or English, audio recorded, transcribed and translated into English, and analyzed thematically using MAXQDA. Codes were developed iteratively and used to answer key explanatory questions arising from the KAP survey. Ethical approval for the study was obtained from Mahidol and Duke Universities. RESULTS: Both quantitative and qualitative data showed dramatically lower thalassemia awareness in migrants vs Thai (Table 1). Furthermore, providers perceived migrants to be disinterested in thalassemia screening, though migrant narratives illustrated significant language barriers, economic barriers, lack of health literacy, and competing social stressors - all of which may contribute to perceived indifference towards thalassemia screening. Both Thai and migrants had misconceptions about thalassemia, believing it to be contagious and sexually transmitted, or equating thalassemia carrier status with disease and vice versa (Table 1). These misconceptions may contribute to the stigmatization and isolation of individuals with thalassemia and disincentivize carrier screening for fear of discrimination. Participants supported thalassemia prevention and identified antenatal care (ANC) as the main access point for thalassemia education, screening, and prevention. However, they described key limitations of this antenatal approach, including the inability to offer termination in pregnancies presenting late to ANC; couples' hesitation to terminate; cost of prenatal testing (for migrants); and reliance on male partners to present for prenatal testing. In addition, migrants expressed more negative attitudes towards termination of pregnancy on the survey (Table 1). Participants associated this attitude with the perception that migrants were more religious, less educated, less knowledgeable about genetic disease risk, and more eager to have children. Participants proposed a number of solutions, including targeted education, delivered in migrants' native languages through ANC or public media, and universal carrier screening as a more acceptable approach to thalassemia prevention and control in migrant communities. Recommended settings for screening include schools or universities, hospitals, and workplaces. Migrants also reported relying heavily on employers for access to healthcare. Therefore, employer engagement in thalassemia education and screening efforts is critical, though employment discrimination remains a concern. CONCLUSION: This study provides insight from a variety of stakeholders into potential barriers and strategies for thalassemia screening in SEA migrant populations. Findings highlight a profound lack of thalassemia awareness among migrants leading to apparent disinterest in thalassemia screening, misconceptions and stigma surrounding thalassemia, and negative attitudes towards termination of pregnancy. Promotion of public education and carrier screening is an optimal strategy for migrant populations in Thailand. Furthermore, this approach can be adopted regionally and cooperatively by member states of the Association of SEA Nations (ASEAN) to better address the shared public health problem of thalassemia. Disclosures Telen: Pfizer: Other: Member of a clinical trial steering committee; Novartis: Other: Member of a safety monitoring committee; Forma Therapeutics: Research Funding.

ThalPred: a web-based prediction tool for discriminating thalassemia trait and iron deficiency anemia

BackgroundThe hypochromic microcytic anemia (HMA) commonly found in Thailand are iron deficiency anemia (IDA) and thalassemia trait (TT). Accurate discrimination between IDA and TT is an important issue and better methods are urgently needed. Although considerable RBC formulas and indices with various optimal cut-off values have been developed, distinguishing between IDA and TT is still a challenging problem due to the diversity of various anemic populations. To address this problem, it is desirable to develop an improved and automated prediction model for discriminating IDA from TT.MethodsWe retrospectively collected laboratory data of HMA found in Thai adults. Five machine learnings, including k-nearest neighbor (k-NN), decision tree, random forest (RF), artificial neural network (ANN) and support vector machine (SVM), were applied to construct a discriminant model. Performance was assessed and compared with thirteen existing discriminant formulas and indices.ResultsThe data of 186 patients (146 patients with TT and 40 with IDA) were enrolled. The interpretable rules derived from the RF model were proposed to demonstrate the combination of RBC indices for discriminating IDA from TT. A web-based tool ‘ThalPred’ was implemented using an SVM model based on seven RBC parameters. ThalPred achieved prediction results with an external accuracy, MCC and AUC of 95.59, 0.87 and 0.98, respectively.ConclusionThalPred and an interpretable rule were provided for distinguishing IDA from TT. For the convenience of health care team experimental scientists, a web-based tool has been established at http://codes.bio/thalpred/ by which users can easily get their desired screening test result without the need to go through the underlying mathematical and computational details.

1403. Infectious Causes of Acute Meningitis Among Thai Adults: A University Hospital Setting

BackgroundAcute meningitis is a medical emergency which needs immediate assessment and treatment. Knowing the epidemiology of acute meningitis may guide the physician for promptly empirical therapy as well as minimize morbidity and mortality. In Thailand, there are few studies regarding acute meningitis in adults and most of them have not been updated. We aimed to determine etiology, clinical manifestations, cerebrospinal fluid (CSF) findings and outcomes of patients with acute meningitis.MethodsA retrospective cohort study was conducted among adult (age >15 years) patients with acute meningitis who were treated at Ramathibodi Hospital between 2013 and 2017. The list of the patients was retrieved from the hospital database using the International Classification of Diseases, 10th revision (ICD-10) codes. Comparisons of clinical presentations and laboratory investigations between patients with bacterial meningitis and those with non-bacterial meningitis were analyzed.ResultsA total of 89 patients were included. Of all, 48 (53.9%) patients were men and median age (interquartile range; IQR) was 49 (32.1–63.8) years. The most common coexisting condition was HIV infection (30%), receiving prednisolone (16.9%), and diabetes mellitus (15.7%). Causes of acute meningitis were Cryptococcus neoformans (37%), bacteria (31.5%), Mycobacterium tuberculosis (27%), and virus (4.5%). Common clinical presentations were fever (74%), headache (70.8%), and confusion (31.5%). Older age, higher proportion of patients with diabetes, lower proportion of HIV infection, higher median white blood cells (WBCs) in complete blood count (CBC), lower median platelet, higher median aspartate aminotransaminase, higher median alkaline phosphatase, higher median WBCs, and polymorphonuclear neutrophils (PMNs) percentage in CSF were found in patients with acute bacterial meningitis. By multivariate logistic regression, predicting factors of acute bacterial meningitis were WBCs in CBC (OR 1.02 per 100 cells/mm3 increased; 95% CI 1.01–1.04, P = 0.001), WBCs in CSF (OR 1.04 per 10 cells/mm3 increased; 95% CI 1.01–1.07, P = 0.012) and PMNs percentage in CSF (OR 1.21 per 5% increased; 95% CI 1.07–1.37, P = 0.002). Overall, the median (IQR) duration of hospitalization was 23 (11–29) days. A total of 26 (29%) patients had a complication, such as septic shock, hydrocephalus, seizure, and brain edema. The mortality rate was 7.9%.ConclusionIn this setting, the most common cause of acute meningitis in adults is cryptococcosis. In addition, tuberculosis is not uncommon. Awareness of update epidemiology may guide the physicians to initiate appropriate antimicrobial therapy.Disclosures All authors: No reported disclosures.

348. Kidney Function Decline Among HIV-infected Thai Adults: Is Low Vitamin D One of the Factors?

BackgroundThe prevalence of both hypovitaminosis D and Chronic Kidney disease (CKD) are high among Thai HIV-infected adults. Therefore, we examined the association of hypovitaminosis D and kidney function decline among HIV-infected Thai adults.MethodsUsing data prospectively collected from the HIV-NAT long-term cohort, we selected patients who were on ART, and virologically suppressed for ≥6 months. Baseline was defined as when the patient had a serum 25 OHD measured, with estimated Glomerular filtration rate (eGFR) above 60 mL/minute. Participants with eGFR measured at least twice a year were analyzed in the study. The primary outcome was kidney function impairment assessed as eGFR decline. Generalised estimating equations (GEE) were used to assess associations between the outcome and patient comorbidities and disease-related characteristics, including age, sex, body mass index (BMI) hypertension, gout, diabetes mellitus, co-infections with Hepatitis B or C viruses HIV-viral load and co-variate interactions with vitamin D status defined as normal, insufficient or deficient.ResultsA total of 435 participants were observed longitudinally through observations over the median follow-up of 24 (IOR 12–48) months. The median age of the participants was 46.6 (IOR 38.06–54.29) years. Median serum 25 OHD was 23.4 (IQR 18.5–29) ng/mL, and 209 (48%) and 126(29%) had insufficient and deficient 25 OH levels, respectively. Median baseline eGFR was 95 (IQR 82.70–104.93) mL/minute/l.73 m2. We found a significant interaction between BMI and vitamin D concentration (P = 0.02). In our multivariate model, the adjusted mean predictions of eGFR change at 24 months for patients with BMI ≥25 kg/m2 and deficient, insufficient and sufficient vitamin D were 89.8 (88.3–91.4), 91.2 (90.1–92.4) and 92.8 (91.3–94.4), respectively. In those with BMI <25 kg/m2 and deficient, insufficient and sufficient Vitamin D the adjusted mean predictions in eGFR change were 92.0 (91.1–93.0), 91.6 (90.9–92.3) and 92.3 (91.3–93.3), respectively.ConclusionHIV-infected Thai adults with high BMI (25 and above) but who are vitamin D deficient had a statistically significant eGFR decline. Further studies in larger populations with multi-ethnic groups are warranted. Disclosures All authors: No reported disclosures.

Validation of Thai version of the Health Literacy in Dentistry scale: Validation among Thai adults with physical disabilities.

To validate the Thai version of the Health Literacy in Dentistry scale (HeLD-Th) among Thai adults with physical disabilities. The original Health Literacy in Dentistry (HeLD) was translated into Thai (HeLD-Th). The final version of the HeLD-Th was evaluated through a cross-sectional study of 160 participants in Thailand. Interview questionnaires and oral examination were performed. The reliability and validity of the HeLD-Th were determined. The internal consistency was acceptable, with an overall Cronbach's alpha of 0.76. The face and content validity were confirmed. Sufficient construct validity was revealed by exploratory factor analysis. The convergent validity (P≤.013) and discriminant validity (P=.017) were estimated. The concurrent validity and predictive validity were confirmed by significantly higher HeLD-Th scores (P<.001). Multiple linear regression analyses indicated that approximately 60% of the variation in the HeLD-Th scores was explained by the final model. The HeLD-Th has sufficient psychometric properties to assess the oral health literacy of Thai adults with mild to moderate disabilities. There are some limitations of the study due to the small sample size, and the results are specific to Thai adults with disabilities. Future studies using the HeLD-Th scale are recommended.

Neck circumference as a predictor of metabolic syndrome: A cross-sectional study

BackgroundData relating to the association between neck circumference (NC) and metabolic syndrome (MetS) in Southeast Asian population are scarce. AimsWe aimed to investigate association between NC and MetS in Thai adults, and to determine gender-specific NC cutoff values for predicting MetS. MethodsThis cross-sectional study enrolled patients aged ≥18years that attended the health examination center at Siriraj Hospital (Bangkok, Thailand) during February 2016 to January 2017. Demographic, clinical, anthropometric data, and biochemical investigations for diagnosing MetS were collected. Results390 patients (age 35.5±9.7years with range 20–73years; 81.3% women) were included. Mean NC was significantly higher in MetS than in non-MetS (p<0.001). Receiver operating characteristic curve analysis revealed NC ≥38cm and ≥33cm to be the optimal cutoff points for MetS in men and women, respectively. Body mass index and anthropometric indices were positively correlated with NC in both men and women. Among women, all components of MetS were significantly associated with NC. ConclusionsUsing the identified gender-specific cutoff values, NC is a useful tool for predicting MetS in Thais. NC was found to be well-correlated with almost all of the metabolic risk factors, anthropometric indices, and MetS components evaluated in this study.

Socioeconomic inequality and dental caries among Thai working age population

Purpose The purpose of this paper is to determine the relationship between socioeconomic status (SES) and oral health among Thai adults. Design/methodology/approach This study is a cross-sectional analytical study using secondary data from the 7th Thailand National Oral Health Survey (2012). Age group 35–44 years old samples were used to represent the working age population. Oral health outcome was determined by untreated dental caries. SES was indicated by income, education and occupational groups. Demographic background, oral health-related behavior and access to dental service were adjusted for analysis. Binary logistic regression analysis was performed to determine the relationship between independent variables and oral health outcome. Findings People with lower education showed a higher odds ratio for having untreated dental caries before and after controlling for related variables. Those living in the north and northeast, using additional cleaning tools and going to the public provider for dental service also showed better oral health. Research limitations/implications The limitation of this study is that the cross-sectional study cannot indicate casual relationships. The national oral health survey was not designed to find relationships between factors. The access to data and measurement of SES was limited. The policy maker should emphasize on people with lower education which have a higher risk for dental caries to improve oral health in disadvantaged groups. Future research should include all related factors in the study including diet and knowledge about oral health. Moreover, oral health outcome is a long-term effect which accumulated through a lifetime. The social class might change over time and so do behaviors. Originality/value There is socioeconomic inequality in dental caries of Thai working age population.

A Nationwide Survey of the Seroprevalence of Hepatitis E Virus Infections Among Blood Donors in Thailand.

Hepatitis E virus (HEV) is a common cause of acute hepatitis infections. Our previous 3-year study at two large Thai hospitals established an occurrence of 4-5% of HEV infections from swine HEV genotype 3 in suspected acute hepatitis patients, with the high incidence in older adults. This study was a serosurvey to determine the prevalence of HEV infections among Thai adults. We obtained sera from 630 healthy blood donors with a median age of 38 (18-64) years who attended Thai Red Cross transfusion units throughout Thailand. The donors were domiciled in 16 provinces in the northern (n = 159), central (n = 193), northeastern (n = 158), and southern (n = 120) regions. The seroprevalence of IgG antibody to HEV (anti-HEV) was determined by the EUROIMMUN test kit, using indirect enzyme-linked immunosorbent assay (ELISA) based on recombinant antigens derived from ORF2 of HEV genotypes 1 and 3. Demographic data, including information related to HEV infection risk (the number of pigs and the proportion of Muslims in each province), were also obtained. The overall anti-HEV prevalence among Thai adults was 29.7%. The frequencies of anti-HEV found in the northern (28.9%, 95% confidence interval [CI] = 22.4-36.4), northeastern (34.8%, 95% CI = 27.8-42.5), and central (35.8%, 95% CI = 29.3-42.7) regions were similar, whereas the frequency in the southern (14.2%, 95% CI = 9.0-21.5) region, known to have a large Muslim population, was low. An increasing frequency of the specific antibody was observed among the elderly. A low HEV infection rate was associated with an Islamic population where there are low number of pigs and low swine consumption. Furthermore, the higher anti-HEV incidences in the northeastern provinces might relate to the local cultural practice of consuming undercooked pork. Besides the need for an HEV vaccination in the future, there is a requirement for rapid early diagnosis; the undertaking of prevention-management campaigns might also reduce the number of infected patients.

Knowledge and use of antibiotics in Thailand: A 2017 national household survey.

BackgroundThe Thailand National Strategic Plan on Antimicrobial Resistance (AMR) 2017–2021, endorsed by the Thai Cabinet in 2016, aims to increase public knowledge about antibiotics and AMR awareness by 20% by 2021. This study assesses the prevalence of antibiotics use, clinical indications and sources; knowledge and access to information related to antibiotics and AMR; and factors related to level of knowledge and access to information among Thai adult population.MethodsAn AMR module was developed and embedded into the 2017 Health and Welfare Survey; a cross-sectional, two-stage stratified sampling, nationally representative household survey carried out biannually by National Statistical Office. The survey applied a structured interview questionnaire. The survey was conducted in March 2017 where 27,762 Thai adults were interviewed of the AMR module. Data were analyzed using descriptive and inferential statistics.ResultsThe one-month prevalence of antibiotic use was 7.9% for three common conditions; flu (27.0%), fever (19.2%) and sore throat (16.8%). The majority of antibiotics (70.3%) were provided by public or private healthcare facilities, and 26.7% by pharmacies. Thai adults have low levels of knowledge about antibiotics; only 2.6 gave correct answers to all six statements related to antibiotics, while 13.5% gave wrong answers to all six statements. A few factors associated with knowledge and having received information on antibiotics were assessed. People who have higher education levels, and belong to richer wealth quintiles, and receive antibiotics and AMR information have significantly higher levels of knowledge about antibiotics. In the last 12 months, only 17.8% of respondents had heard information about the proper use of antibiotics and AMR; mostly from doctors (36.1%), health workers (24.8%) and pharmacists (17.7%).ConclusionsThere is a large gap of public knowledge about the use of antibiotics. The main communication channel is through healthcare professionals, which indicates they are key persons in communicating information about the proper use of antibiotics to the public.

&lt;p&gt;Association between polymorphisms of &lt;em&gt;LEP&lt;/em&gt;,&lt;em&gt; LEPR&lt;/em&gt;, &lt;em&gt;DRD2&lt;/em&gt;, &lt;em&gt;HTR2A&lt;/em&gt; and&lt;em&gt; HTR2C&lt;/em&gt; genes and risperidone- or clozapine-induced hyperglycemia&lt;/p&gt;

ObjectiveTo determine whether genetic polymorphisms related to pharmacodynamics with metabolic adverse effects, namely leptin promoter (LEP) rs7799039, leptin receptor rs1137101, dopamine D2 rs4436578, serotonin 5-HT2A rs6313, and serotonin 5-HT2C rs518147 and rs12836771, are associated with hyperglycemia induced by risperidone or clozapine in adult Thai patients with psychosis.MethodsA total of 180 patients treated with risperidone-based (n=130) or clozapine-based (n=50) regimens were included in this study. Blood samples were analyzed for genotyping of the candidate genes and biochemical testing. Genotyping was performed by conducting a TaqMan real-time polymerase chain reaction-based analysis.ResultsThe prevalence of hyperglycemia was higher in patients receiving clozapine (64.0%) than in those receiving risperidone (30.8%). Among the candidate genes, only the LEP rs7799039 polymorphism demonstrated a significant association with hyperglycemia (χ2=9.879, P=0.008) in patients treated with risperidone; patients with the AA genotype had the highest risk (41.1%), followed by those with AG (20.8%) and GG (0%) genotypes. Using the recessive genetic model (AA vs AG + GG), the odds ratio and 95% CI were 3.28 and 1.44 −7.50, respectively. None of the genes were associated with hyperglycemia in patients treated with clozapine. A binary logistic regression revealed that the LEP rs7799039 polymorphism demonstrated a significant association with hyperglycemia, independent of body-mass index (BMI) in patients receiving risperidone; the odds ratio (95% CI) was 3.188 (1.399–7.262), P=0.006. By contrast, none of the pharmacodynamic genetic factors, except for BMI, were significantly associated with hyperglycemia in patients receiving clozapine.ConclusionThe risk of type 2 diabetes mellitus is associated with the LEP rs7799039 polymorphism in Thai adults receiving risperidone but not in those receiving clozapine. Clarifying underlying mechanisms and risk of hyperglycemia provides an opportunity to prevent impaired glucose metabolism in patients receiving risperidone or clozapine.