Thai General Population Research Articles

EQ-5D-3L and EQ-5D-5L population norms for Thailand

BackgroundThe previous Thai norm-based scores for the EQ-5D-5L were established with Thai general population samples aged 20–70 years in 2019. Nevertheless, these values need to be updated after the COVID-19 pandemic because of its effects on both physical and mental health. This study therefore aimed to establish population norms of the Thai EQ-5D-3L, EQ-5D-5L and EQ-VAS scores as well as to estimate disutility values associated with self-reported main diseases.MethodsIndividual face-to-face interviews were conducted with 2000 adult (age ≥ 18 years) members of the general Thai population to estimate norm-based scores. Each participant completed the EQ-5D-3L and EQ-5D-5L as well as questions related to their sociodemographic factors and self-reported main diseases. Responses to the two instruments were converted to health utility (HU) scores on the basis of available value sets. Descriptive statistics were used to report the norm-based scores stratified by age and sex categories. Response redistribution determining the response consistency between EQ-5D versions was investigated. The HU score agreement from those two instruments was investigated using intraclass correlation coefficient (ICC). Tobit regression models were employed to investigate the relationships between sociodemographic factors and HU and EQ-VAS scores. Moreover, it was used to estimate the disutility values associated with self-reported main diseases.ResultsThe means (percentage of ceiling effects) of EQ-5D-3L, EQ-5D-5L, and EQ-VAS scores were 0.845 (57.80%), 0.923 (49.05%), and 79.83 (3.20%), respectively. The average percentage of inconsistent response was 1.09%. A good agreement level was found between both EQ-5D versions with the ICCs of 0.789 (95% CI: 0.558–0.878). Female, older, and unemployed participants and those with BMI ≥ 30 reported lower EQ-5D-3L and EQ-5D-5L than their counterparts. Bone/Joint disorder and stroke contributed to the largest disutility value for those two instruments.ConclusionsThe Thai norm-based scores from those two instruments were diminished when advancing age and among female, unemployed, and obese (BMI ≥ 30) participants. It is expected to provide information to policy makers to better allocate health care resources to those with diminished norm-based scores.

Prevalence Of Metabolic Syndrome and Its Associated Factors Among Thai Police Officers – A Population-Based Study

Objective: The prevalence of Metabolic Syndrome (MetS) in Thai police officers is unknown. This study aims to accurately determine the prevalence of MetS in this population compared to the Thai general population. Materials and Methods: We conducted a population-based cross-sectional study of 107,933 Thai police officers during the 2012 annual Police Health Care Center check-up. Metabolic syndrome was defined using the harmonized criteria of six international expert groups. Results: The prevalence of MetS among Thai police officers was 39.24%, with a higher prevalence among males compared to female police officers (40.9% male and 14.3% female). The prevalence was higher in male police officers (40.65% versus 23.80%, P<0.001), whereas it was lower in female officers (16.30% versus 31.59%, P<0.001) when compared to the general population. High blood pressure was the most common abnormal metabolic component in both genders (male 67.4 % female 33.3%). Whereas observation of low high-density lipoprotein cholesterol (HDL) in males (11.6%) and high fasting plasma glucose (FG) in females (16.3%). The adjusted odds ratio for MetS increased with age, wide pulse pressure, male gender, lower rank, alcohol drinking, and being in a non-metropolitan city. Conclusion: The prevalence of MetS is higher among Thai police officers compared to the general Thai population. These findings underscore the need for effective preventive measures and continuous monitoring to reduce the risk and burden of cardiovascular diseases.

Prevalence and DALYs of skin diseases in Ubonratchathani based on real-world national healthcare service data

There is little evidence to describe the burden of skin diseases in developing countries and its accuracy remained uncertain. We aimed to examine prevalence and disability adjusted life years (DALYs) of skin diseases in a Thai general population in Ubonratchathani. Based on real-world healthcare service data (diagnoses, prevalence, and cause-specific mortality) retrieved from the National Health Security Office reimbursement database, we used a simplified prevalence-based approach adopted in the Global Burden of Diseases to compute disease burden, measured as DALYs, of skin diseases. DALYs was calculated as the sum of years lost due to disability and years of life lost due to skin diseases, with adoption of previously published averaged disability weights and a 95% uncertainty interval (UI) estimated using a Bayesian bootstrap technique. From a total population of 1,503,945, 110,205 people were affected by skin disease in 2018—an overall prevalence of 7%. The prevalence varied across sex, age group and geographic areas. The most common skin diseases treated in Ubonratchathani’s healthcare services were dermatitis, bacterial skin diseases and urticaria (prevalence of 2.35%, 2.21% and 0.89% respectively). Overall DALYs of skin diseases in Ubonratchathani population was 26,125 (95%UI 24,783–27,467), and this was relatively higher in men than women. (DALYs 13,717 (12,846–14,588) and 12,408 (11,417–13,399) for men and women respectively). The greatest contributors of DALYs were cellulitis, decubitus ulcer and contact dermatitis (11,680, 4,806 and 1,598 years respectively). In conclusion, skin disease caused substantial disease burden in this Thai population, with cellulitis being the largest contributor.

Association of Mitochondrial DNA Polymorphisms With Pediatric-Onset Cyclic Vomiting Syndrome.

BackgroundCyclic vomiting syndrome (CVS) is a functional gastrointestinal disorder characterized by recurrent stereotypic episodes of vomiting. The pathophysiology of CVS remains obscure. Previous studies have supported the hypotheses of mitochondrial dysfunction. However, data on association studies between mitochondrial DNA (mtDNA) polymorphisms and pediatric-onset CVS are limited and inconsistent. The aims of this study were to describe clinical characteristics, evaluate association of mtDNA polymorphisms 16519T and 3010A with pediatric-onset CVS and identify new mtDNA candidate variants.MethodsThis study involved Thai patients diagnosed with CVS according to the Rome III or IV criteria before the age of 15 years. Patients' demographic data, clinical characteristics, previous investigations and treatment outcomes were obtained. Blood samples were collected for next-generation (whole exome) sequencing, followed by analysis of chromosome M (mitochondrial. Variants were filtered according to clinical significance using ClinVar and MITOMAP. mtDNA polymorphisms in 148 normal Thai individuals were used as controls.ResultsForty-eight children were enrolled in the clinical study, and 30 participated in the genetic analysis. The median age at onset and median age at diagnosis was 3.0 (1.5–5.6) and 6.3 (3.0–8.6) years, respectively. Maternal history of migraine was positive in 16.7%. About 45.7% (21 of 46) of the patients achieved complete clinical remission, with the mean symptom duration of 5.9 ± 3.3 years. The prevalence of mtDNA variants 16519T and 3010A among the patient group and Thai general population (control) were as follows: 40.0% (12/30) vs. 27.7% (P = 0.18) and 6.7% (2/30) vs. 0.7% (P = 0.07), respectively. Five known pathogenic variants were identified in 6 patients, including mtDNA 8528C in one patient who also had infantile hypertrophic cardiomyopathy. Six likely pathogenic variants were found but without statistical significance. We identified 11 variants with significant prevalence in the patient group. Though, these variants were classified as variants of unknown significance (VUS), several of them were located in mt functional regions and therefore they deserve further investigations as new candidates for association with pediatric CVS.ConclusionThere were no associations of mtDNA polymorphisms 16519T and 3010A with CVS in our pediatric cohort. Five pathogenic variants and 11 VUS were found associated with pediatric-onset CVS.

Incidence and factors associated with active tuberculosis among people living with HIV after long-term antiretroviral therapy in Thailand: a competing risk model

BackgroundAntiretroviral therapy (ART) is known to reduce tuberculosis (TB) incidence among people living with HIV (PLWH). However, studies describing the impact of long-term ART and CD4 count recovery on TB incidence remain scarce due to limited follow up in previous studies. We evaluated TB incidence in a long-term cohort of PLWH on ART in Thailand.MethodsWe conducted an analysis of PLWH aged ≥ 18 years who started ART between 1996 and December 2020. Participants were followed up every 6 months for routine HIV care. TB risk factors, body mass index (BMI), physical examination and full differential blood counts were evaluated at each clinic visit, and CD4 cell counts and HIV RNA every 12 months. Participants diagnosed with TB > 3 months after starting ART were classified as incident cases. Time to event models with death as a competing risk, were used to derive the TB cumulative incidence function (CIF) after ART initiation, and assess time-updated factors associated with incident TB using a six month lag.ResultsA total of 2,636 PLWH contributing 24,229 person years (PY) of follow-up on ART were analysed. Median age was 32.0 (IQR 27.4–37.6) years; 67.5% were male. Median CD4 cell count at ART initiation was 264 (IQR 167–379) cells/mm3 and median follow-up duration was 7.6 (IQR 1.9–15.7) years. During follow-up, 113 PLWH developed TB. The probability of incident TB was 0.7%, 1.7%, 3.3% and 4.3%, at 1, 2, 5 and 7 years after ART initiation, respectively. TB CIF was highest among participants with CD4 < 50 cells/mm3. The overall crude incidence of TB was 4.66 (95% CI 3.87–5.60) per 1000 PY. Low CD4 count, BMI < 18 kg/m2, and substance use in the previous six months were significantly associated with incident TB. Incidence declined with time on suppressive ART, but remained higher than the Thai general population 7 years after ART initiation (2.2 vs 1.5/1000 PY, respectively).ConclusionDespite a marked reduction in TB incidence following ART, ongoing TB risk remains high among PLWH, despite long-term suppressive ART. Those with low CD4 cell counts, who are underweight, or currently having substance abuse should be carefully monitored.

Prevalence and genotype distribution of hepatitis C virus within hemodialysis units in Thailand: role of HCV core antigen in the assessment of viremia

BackgroundIndividuals with end-stage renal disease have a higher risk of hepatitis C virus (HCV) acquisition during long-term hemodialysis (HD). Our report was designed to investigate HCV prevalence and genotype, in addition to the clinical use of HCV core antigen (HCVcAg), within multiple HD facilities in Thailand.MethodsThis cross‐sectional report was investigated between January and June 2019. HCV infection was assessed by anti-HCV and confirmed active infection by measuring HCV RNA and HCVcAg. HCV genotype was determined by phylogenetic analysis using nucleotide sequences of NS5B region.ResultsOverall, 140 of 3,305 (4.2%) patients in 15 dialysis centers had anti-HCV positive. Among them, HCV RNA was further assessed in 93 patients and was detectable in 59 (63.4%) persons. Considering HCV viremia, HCVcAg measurement exhibited high accuracy (96.8%), sensitivity (94.9%) and specificity (100%) in comparison with HCV RNA testing. Moreover, individuals infected with HCV received a longer duration of dialysis vintage when compared to anti-HCV negative controls. The major sub-genotypes were 1a, 1b, 3a, 3b, 6f and 6n. Regarding phylogenetic analysis, there were 7 clusters of isolates with high sequence homology affecting 17 individuals, indicating possible HCV transmission within the same HD centers.ConclusionsHCV frequency and common sub-genotypes in HD centers were different from those found in the Thai general population. HCVcAg might be an alternate testing for viremia within resource-limited countries. Enhanced preventive practices, dialyzer reuse policy and better access to antiviral therapy are crucial for HCV micro-elimination within HD facilities.

Factors associated with HIV testing and intention to test for HIV among the general population of Nonthaburi Province, Thailand.

BackgroundResearch on HIV testing in Thailand has largely focused on at-risk population groups, with limited information about the prevalence of correlates of HIV testing among the Thai general population. This study addresses this gap in research by using a population-based probability sample to examine correlates of HIV testing experience and intention to test.MethodsWe conducted a cross-sectional survey in Nonthaburi, Thailand during October-December 2012 using tablet computers to collect self-administered questionnaires from 2138 men and women (aged 15–59 years) identified through three-stage stratified cluster sampling.FindingsAlmost half of the respondents, 962 (45%), reported having been tested for HIV while an almost equal proportion, 1032 (48.3%), indicated their intention to test for HIV. Being sexually experienced, having a history of sexually transmitted infection, personally knowing someone infected with HIV, and youth were associated with both history of HIV testing and intention to test for HIV. High perceived risk of HIV, knowledge of an HIV testing location, and having been married were associated with having been tested for HIV. Having been tested for HIV and HIV/AIDS education were associated with intention to test for HIV. The most common reasons for testing were routine medical checkup and antenatal care. The major reasons for not testing were perception of having no or low risk.ConclusionA substantially low proportion of the respondents reported a history of HIV testing and intention to test for HIV. Culturally appropriate programs that address HIV risk perception and provide accurate information related to HIV infection and HIV testing may be beneficial in increasing uptake of HIV testing among the general population in Thailand.

Dose-response relationship between physical exercise and risk of physician-diagnosed dementia in 206073 Thai community-dwelling men and women: HCUR study.

Little evidence exists to describe the incidence and risk factors for dementia in developing countries. This study aimed to examine the incidence and factors associated with the risk of developing dementia in a Thai general population. Data on 206073 men and women aged ≥50years participating in the Health Check Ubon Ratchathani Project in 2006 were merged with diagnostic information from the hospital's electronic medical records in the following 6years (2006-2012). The incidence of physician-diagnosed dementia over 6years was examined. Factors associated with the risk of developing dementia were examined using multivariate Cox proportional hazard regression. Over a total time at risk of 1196433 person-years, 480 individuals developed dementia; the incidence rate was 0.40 [95% confidence interval (CI) 0.37-0.44] per 1000 person-years. Dementia incidence rose exponentially with increasing age to 1.37 (95% CI 1.07-1.75) per 1000 person-years in those aged 80-84years and dropped after the age of 85years. Factors independently associated with the risk of developing dementia included increasing age, diabetes and lack of physical exercise. The risk of dementia rose by 7% for every 1year of age older [adjusted hazard ratio (aHR) 1.07, 95% CI 1.06-1.08]. Diabetes increased the risk of dementia by 51% (aHR 1.51, 95% CI 1.12-2.03). Compared to no physical exercise, having 3-5days/week and>5days/week of physical exercise reduced the risk of dementia by 37% and 59% (aHR 0.63, 95% CI 0.50-0.79, and 0.41, 95% CI 0.26-0.66, respectively). Dementia incidence in a Thai population was lower than Western populations and its independent risk factors included increasing age, diabetes and a lack of physical exercise. Adequate physical exercise may counterbalance the ageing process, the main drive of dementia.

Abstract 17048: Dederivation and Validation of a Simple Heart Risk Score in 608,544 Thai Adults: HCUR Study

Introduction: Most heart risk prediction equations were developed in Western populations. These risk scores are likely to perform less well in Asian populations, who have different background risk. Hypothesis: This study aimed to develop and validate a new risk algorithm for estimating 5-year risk of developing coronary heart disease (CHD) in a large retrospective cohort of Thai general population. Methods: This retrospective cohort was derived from the linkage of 2006 health checks data with diagnostic information from electronic health records of 608,544 men and women aged 20 years and above residing in Ubon Ratchathani. It was randomly and evenly divided into the derivation and validation cohorts. An outcome of interest was first recorded diagnosis of CHD over a period of 6 years between January 2006 and December 2012. A Cox proportional hazards model was used to estimate effects of risk factors on CHD risk and to derive a risk equation in the derivation cohort. Measures of discrimination, global model fits and calibration were calculated in the validation cohort. Results: The derivation cohort comprised of 304,272 individuals, who contributed 1,757,369 person-years of follow-up and 1,272 incident cases of CHD, while the validation cohort comprised of 304,272 individuals (1,757,312 person-years), with 1,290 incident cases of stroke. The risk equation was 0.0580 x Age (years) + 0.5739 x Sex (Male=1) + 0.3850 x Hypertension (present=1) + 0.7080 x Diabetes (present=1) + 0.0386 x Body mass index (kg/m 2 ) + 0.2117 x Central obesity (present=1) - 0.1389 (if exercise 1-2 days/week) or -0.3975 (if exercise 3-5 days/week) or - 0.5598 (if exercise &gt;5 days/week). The stroke risk equation had a reasonably good discriminatory ability in the validation cohort with the area under the receiver operating characteristic curve of 0.790 (95%CI 0.779-0.801). The risk equation had good global model fit as measured by Bayesian information criteria. The Gronnesby and Borgan test showed good calibration, with chi-square statistic of 809.45 (p&lt;0.001). Conclusions: This simple heart risk score is the first risk algorithm to estimate the 5-year risk of CHD in a Thai general population. The risk score does not need laboratory tests and can therefore be used in clinical settings and by the public.

Abstract P016: Physical Activity as Key Risk Factors for Incident Dementiain a Thai Population: Health Checks Ubon Ratchathani (HCUR) Study

Introduction: There is little evidence to describe risk factors for dementia in a Thai general population. Hypothesis: This study was aimed to examine factors associated with the risk of developing dementia in a Thai general population in Ubon Ratchathani. Methods: Data on 761,935 men and women participating in the Health Check Ubon Ratchathani (HCUR) Project in 2006-7 were merged with diagnostic information from hospital’s electronic medical records in the following 5 years (2006-2012). Using a retrospective cohort study design, we examined the incidence of physician-diagnosed dementia over 5 years. Factors independently associated with the risk of developing dementia were examined using multivariate cox proportional hazard regression. Results: Over a total time at risk of 4,407,201 person-years, 519 individuals developed dementia, the incidence rate of dementia was 0.12 (95%CI 0.11-0.13) per 1,000 person-years. Factors independently associated with the risk of developing dementia in multivariate cox regression included increasing age, diabetes and lack of physical exercise. The risk of dementia rose by 9% for every one year of age older (Hazard ratio (HR) of 1.09 (1.08-1.09), p&lt;0.001). Diabetes increased the risk of dementia by almost 2 times (HR 1.67 (1.26-2.23), p&lt;0.05). Compared to no physical exercise, regular physical exercise of 3-5 days/week and &gt;5 days/week reduced the risk of dementia by 36% and 57% (HR 0.64 (0.52-0.78) and 0.43 (0.28-0.67) respectively). These associations remained significant after controlling for sex, hypertension, systolic blood pressure, smoking, body mass index, waist circumference, high salt diet and alcohol drinking. Discussion: In this Thai general population, the incidence of dementia was modest and its independent risk factors included increasing age, diabetes and lack of physical exercise. Regular physical exercise may counter balance aging process, the main drive of dementia. The more physical exercise you do, the lower risk of dementia.

Abstract 21329: Derivation and Validation of Simple Stroke Risk Score in a Thai Population

Introduction: Most stroke risk prediction equations were developed in Western populations. These risk scores perform less well in Asian populations, who have different background risk. Hypothesis: This study aimed to develop and validate a new stroke risk algorithm for estimating 5-year risk of developing stroke in a Thai general population using large electronic health records. Methods: This retrospective cohort was derived from the linkage of health checks data with diagnostic information from electronic health records of 483,285 men and women residing in Ubon Ratchathani. It was randomly and evenly divided into the derivation and validation cohorts. An outcome of interest was first recorded diagnosis of stroke over a period of 6 years between January 2006 and December 2012. A Cox proportional hazards model was used to estimate effects of risk factors on stroke risk and to derive a risk equation in the derivation cohort. Measures of discrimination, global model fits and calibration were calculated in the validation cohort. Results: The derivation cohort comprised of 241,643 individuals aged ≥30 years, who contributed 1,393,990 person-years of follow-up and 1,884 incident cases of stroke, while the validation cohort comprised of 241,642 individuals (1,393,420 person-years), with 1,915 incident cases of stroke. The risk equation was 0.0584 x Age (years) + 0.4538 x Sex (Male=1) + 0.0040 x Systolic BP (mmHg) + 0.2886 x Hypertension (present=1) + 0.5214 x Diabetes (present=1) + 0.0266 x Body mass index (kg/m 2 ) - 0.0039 (if exercise 1-2 days/week) or -0.2827 (if exercise 3-5 days/week) or -0.3179 (if exercise &gt;5 days/week). The stroke risk equation had a reasonably good discriminatory ability in the validation cohort, with the area under the receiver operating characteristic curve of 0.756 (95%CI 0.750-0.772). The risk equation had good global model fit as measured by Bayesian information criteria. The Gronnesby and Borgan test showed good calibration, with chi-square statistic of 701.43 (p&lt;0.001). Conclusions: This simple stroke risk score is the first risk algorithm to estimate the 5-year risk of stroke in a Thai general population. The risk score does not need laboratory tests and can therefore be used in clinical settings and also by the public.

Risk scores to predict decreased glomerular filtration rate at 10\xa0years in an Asian general population

BackgroundAsians have among the highest prevalence of chronic kidney disease (CKD) or end-stage renal disease in the world. A risk score capable of identifying high risk individuals at the primary care level could allow targeted therapy to prevent future development of CKD. Risk scores for new CKD have been developed in US general populations, but the impact of various risks factors for development of CKD may differ in Asian subjects. In this study, we aimed to develop risk models and simplified risk scores to predict the development of decreased glomerular filtration rate (GFR) at 10 years in an Asian general population using readily obtainable clinical and laboratory parameters.MethodsEmployees of EGAT (The Electric Generating Authority of Thailand) were studied prospectively. Multivariable logistic regression models were used to assess risk factors and used to derive risk models and risk scores for developing decreased GFR at 10 years: Model 1 (Clinical only), Model 2 (Clinical + Limited laboratory tests), and Model 3 (Clinical + Full laboratory tests). The performance of the risk models or risk scores to predict incident cases with decreased GFR were evaluated by tests of calibration and discrimination.ResultsOf 3186 subjects with preserved GFR (eGFR ≥60) at baseline, 271 (8.5%) developed decreased GFR (eGFR < 60) at 10 years. Model 1 (Age, sex, systolic blood pressure, history of diabetes, and waist circumference) had good performance (χ2 = 9.02; AUC = 0.72). Model 2 (Age, Sex, systolic blood pressure, diabetes, glomerular filtration rate) had better discrimination (χ2 = 10.87, AUC = 0.79) than Model 1. Model 3 (Model 2+ Uric acid, Hemoglobin) did not provide significant improvement over Model 2. Based on these findings, simplified categorical risk scores were developed for Models 1 and 2.ConclusionsClinical or combined clinical and laboratory risk models or risk scores using tests readily available in a resource-limited setting had good accuracy and discrimination power to estimate the 10-year probability of developing decreased GFR in a Thai general population. The benefits of the risk scores in identifying high risk individuals in the Thai or other Asian communities for special intervention requires further studies.

Gambling disorders, gambling type preferences, and psychiatric comorbidity among the Thai general population: Results of the 2013 National Mental Health Survey.

Background and aimsTo estimate the prevalence of problem and pathological gambling, gender and age-group differences in gambling types, and comorbidities with other psychiatric disorders among the Thai general population.MethodsAnalysis was conducted on 4,727 participants of Thailand’s 2013 National Mental Health Survey, a multistage stratified cluster survey, using the Composite International Diagnostic Interview. Diagnoses of problem and pathological gambling and other psychiatric disorders were based on the DSM-IV-TR criteria with the following additional criteria for gamblers: more than 10 lifetime gambling episodes and a single year loss of at least 365 USD from gambling.ResultsThe estimated lifetime prevalence rates of pathological and problem gambling were 0.90% [95% confidence interval (CI): 0.51–1.29] and 1.14% (95% CI: 0.58–1.70), respectively. The most popular type of gambling was playing lotteries [69.5%, standard error (SE) = 1.9], the prevalence of which was significantly higher among females and older age groups. The most common psychiatric disorders seen among pathological gamblers were alcohol abuse (57.4%), nicotine dependence (49.5%), and any drug use disorder (16.2%). Pathological gambling was highly prevalent among those who ever experienced major depressive episodes (5.5%), any drug dependence (5.1%), and intermittent explosive disorder (4.8%). The association between pathological gambling was strongest with a history of major depressive episode [adjusted odds ratio (AOR) = 10.4, 95% CI: 2.80–38.4].ConclusionThe study confirms the recognition of gambling disorders as a public health concern in Thailand and suggests a need for culturally specific preventive measures for pathological gamblers and those with a history of substance use disorders or major depression.

Knowledge, attitudes, and practices about tuberculosis and choice of communication channels in Thailand.

The aim of this study was to assess tuberculosis (TB) knowledge, attitudes, and practices in both the general population and risk groups in Thailand. In a cross-sectional survey, a general population (n = 3,074) and family members of a TB patient (n = 559) were randomly selected, using stratified multistage sampling, and interviewed. The average TB knowledge score was 5.7 (maximum = 10) in the Thai and 5.1 in the migrant and ethnic minorities general populations, 6.3 in Thais with a family member with TB, and 5.4 in migrants and ethnic minorities with a family member with TB. In multivariate linear regression among the Thai general population, higher education, higher income, and knowing a person from the community with TB were all significantly associated with level of TB knowledge. Across the different study populations, 18.6% indicated that they had undergone a TB screening test. Multivariate logistic regression found that older age, lower education, being a migrant or belonging to an ethnic minority group, residing in an area supported by the Global Fund, better TB knowledge, having a family member with TB, and knowing other people in the community with TB was associated having been screened for TB. This study revealed deficiencies in the public health knowledge about TB, particularly among migrants and ethnic minorities in Thailand. Sociodemographic factors should be considered when designing communication strategies and TB prevention and control interventions.

HLA-B (*) 58:01 for Allopurinol-Induced Cutaneous Adverse Drug Reactions: Implication for Clinical Interpretation in Thailand.

Background: The aim of this study was to investigate the predisposition to different types of allopurinol-induced cutaneous adverse drug reactions (CADR), including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN; SJS-TEN, n = 13), drug reaction with eosinophilia and systemic symptoms (DRESS, n = 10) and Maculopapular eruption (MPE; n = 7), conferred by HLA-B*58:01 in a Thai population.Methods: This case-control association study compares 30 patients with allopurinol-induced CADR, allopurinol-tolerant control patients (n = 100), and a Thai general population (n = 1095). Patients' human leukocyte antigen type B (HLA-B) alleles were genotyped by using a two-stage sequence-specific oligonucleotide probe system.Results: Of a total 30 patients with CADR due to allopurinol, 29 (96.7%) patients were found to be at least heterozygous for HLA-B*58:01, compared to only 4.0% in allopurinol-tolerant patients (p < 0.001). Odds ratio (OR) for the association of HLA-B*58:01 with allopurinol-induced CADR in this population was 696.0 (95% CI: 74.8–6475.0). The HLA-B*58:01 allele was present in all patients with allopurinol-induced SJS-TEN (OR = 579.0, 95%CI: 29.5–11362.7, p < 0.001) and DRESS (OR 430.3, 95%CI: 22.6–8958.9, p < 0.001). Additionally, OR of HLA-B*58:01 was highly significant in the allopurinol-induced MPE patients (OR 144.0, 95%CI: 13.9–1497.0, p < 0.001).Conclusion: In this study we confirmed the association between HLAB*58:01 and allopurinol-induced SJS-TEN in a Thai population. In addition, we identified an association between HLA-B*58:01 and allopurinol-induced DRESS and MPE in this population. Therefore, HLA-B*58:01 can be used as a pharmacogenetic marker for allopurinol-induced CADR including SJS-TEN, DRESS and MPE. These results suggest that screening for HLA-B*58:01 alleles in patients who will be treated with allopurinol would be clinically helpful in preventing the risk of developing CARD in a Thai patients.Summary Regardless of phenotype, this is the first pharmacogenetic study of allopurinol-induced CADR in patients of Thai ancestry.In this study we confirmed the association between HLA-B*58:01 and allopurinol-induced SJS-TEN, DRESS, and MPE in Thai population.Regarding to our findings, the pharmacogenetic interpretation could be generalized to drug hypersensitivity including DRESS, SJS-TEN, and MPE.

PHP110 - Long-Term Survival After Intensive Care Unit Discharge in Thailand: A Retrospective Study

Economic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country. In this retrospective cohort study, data from a regional tertiary hospital in northeast Thailand and the regional death registry were linked and used to assess patient survival time after ICU discharge. Adult ICU patients aged at least 15 years who had been discharged alive from an ICU between 1 January 2004 and 31 December 2005 were included in the study, and the death registry was used to determine deaths occurring in this cohort up to 31st December 2010. These data were used in conjunction with standard mortality life tables to estimate annual mortality and life expectancy. This analysis included 10,321 ICU patients. During ICU admission, 3,251 patients (31.5%) died. Of 7,070 patients discharged alive, 2,527 (35.7%) were known to have died within the five-year follow-up period, a mortality rate 2.5 times higher than that in the Thai general population (age and sex matched). The mean LE was estimated as 18.3 years compared with 25.2 years in the general population. Post-ICU patients experienced much higher rates of mortality than members of the general population over the five-year follow-up period, particularly in the first year after discharge. Further work assessing Health Related Quality of Life (HRQOL) in both post-ICU patients and in the general population in developing countries is needed.

Long-term survival after intensive care unit discharge in Thailand: a retrospective study

IntroductionEconomic evaluations of interventions in the hospital setting often rely on the estimated long-term impact on patient survival. Estimates of mortality rates and long-term outcomes among patients discharged alive from the intensive care unit (ICU) are lacking from lower- and middle-income countries. This study aimed to assess the long-term survival and life expectancy (LE) amongst post-ICU patients in Thailand, a middle-income country.MethodsIn this retrospective cohort study, data from a regional tertiary hospital in northeast Thailand and the regional death registry were linked and used to assess patient survival time after ICU discharge. Adult ICU patients aged at least 15 years who had been discharged alive from an ICU between 1 January 2004 and 31 December 2005 were included in the study, and the death registry was used to determine deaths occurring in this cohort up to 31st December 2010. These data were used in conjunction with standard mortality life tables to estimate annual mortality and life expectancy.ResultsThis analysis included 10,321 ICU patients. During ICU admission, 3,251 patients (31.5%) died. Of 7,070 patients discharged alive, 2,527 (35.7%) were known to have died within the five-year follow-up period, a mortality rate 2.5 times higher than that in the Thai general population (age and sex matched). The mean LE was estimated as 18.3 years compared with 25.2 years in the general population.ConclusionsPost-ICU patients experienced much higher rates of mortality than members of the general population over the five-year follow-up period, particularly in the first year after discharge. Further work assessing Health Related Quality of Life (HRQOL) in both post-ICU patients and in the general population in developing countries is needed.

Estimating Population-Based Values for EQ-5D Health States in Thailand

Objective To derive EuroQol five-dimensional (EQ-5D) health states values from the Thai general population. Methods Forty-eight trained individuals successfully conducted interviews with a representative sample of 1409 respondents in 2007. A total of 12 sets of health states were used with one set allocated to each respondent. A respondent was requested to assign values for 11 states using the ranking and visual analogue scale methods and 10 states using the time trade-off method. The variables from the three existing models were used in model specifications and the best model was chosen on the basis of the extent of logical inconsistency in the estimated scores, predictive performance, parsimony, and sensitivity to changes in health. Results Eighty-six health states were valued. The mean age of respondents was 44.6 years old. The highly consistent respondents tend to give higher scores for mild states and lower scores for severe states, compared with those given by the highly inconsistent respondents. The best model used variables from the Dolan 1997 study and estimated from the scores given by the respondents with fewer than 11 inconsistencies. The estimated scores are completely consistent, R 2 is 0.448. The second highest score was 0.766 given to state 11112 and the lowest score was –0.454 for state 33333. Conclusion Values for EQ-5D health states were estimated from the Thai general population. This is the first Thai generic health state value results to be used in evaluating health interventions in Thailand.

A Survey of Knowledge on Diabetes in the Central Region of Thailand

The objectives of this study were to evaluate the level of knowledge of diabetes among the Thai general population, identify areas of deficiency for targeted health education effort, and identify respondent characteristics that may be associated with knowledge of diabetes. A survey involving 1000 respondents (age > or = 15 years) was conducted in the central region of Thailand. A 42-item pre-tested questionnaire to assess general and specific knowledge of diabetes (e.g., risk factors, symptoms, treatment, etc.) was administered. Scores of <50%, > or =50% to <80%, and > or =80% were classified as "poor,""fair," and "good," respectively, according to expert consensus. Mean age of respondents was 33.8 years (SD 13.4), with 57.5% being female. Mean diabetes knowledge score was fair: 25.02 of 42 (59.6%), SD 8.35 (19.9%). Respondents performed best in the risk factor section: mean (%) score was 2.88 of 4 (72%), SD 1.11 (27.8%); and worst in the section on diabetes in women: mean (%) score was 0.82 of 3 (27.3%), SD 0.96 (32.0%). In multiple linear regression analyses, education level, older age, own self having diabetes, and having a family member/relative/friend with diabetes were significantly associated with knowledge of diabetes. Knowledge of diabetes among the Thai respondents was fair. Areas of deficiency and factors associated with knowledge of diabetes were identified. Our findings would be useful in informing targeted health education programs.