Screening high-risk population for hypertension and type 2 diabetes among Thais.

Background: waist circumference (WC) and body mass index (BMI) are simple screening tools for hypertension (HT) and type 2 diabetes (DM). Cutoffs of WC for BMI for Asians have been discussed. This study aimed to assess the accuracy of screening tools and associations of WC, BMI with HT and DM. Methods: Data from the national screening programme for metabolic syndrome conducted in 2010 in 21 provinces in the central region of Thailand were analysed. A total of 10 748 participants aged >35 years were included in the analysis with cutoffs of WC set at 90 cm for men, 80 cm for women, and BMI at 23 kg/m2 for both sexes. Results: WC produced low sensitivity and high specificity among male participants, and moderate sensitivity and specificity among female participants, while BMI produced moderate sensitivity and specificity in both sexes. Significant associations were found among those who had high WC only, high BMI only, and both high WC and BMI with HT and DM in both sexes. (males for HT, OR=1.63, 95%CI: 1.15–2.33, OR=1.22, 95%CI: 1.03–1.44 and OR=2.03, 95%CI: 1.07–2.42; males for DM, OR=1.39, 95%CI: 1.05–1.83), OR=1.77, 95%CI: 1.07–2.94 and OR= 2.05, 95%CI: 1.57–2.69, females for HT, OR=1.69: 95%CI 1.38–2.07, OR=1.32; 95%CI: 1.09–1.60 and OR=2.54, 95%CI: 2.11–2.91; females for DM, OR=1.45, 95%CI: 1.08–1.94, OR=1.45, 95%CI: 1.09–1.91 and OR=1.70, 95%CI: 1.39–2.09). When the cutoff WC was lowered among male participants to 85 cm, sensitivity increased, and significant strengths of associations with HT and DM were nearly the same. Conclusion: For Thailand, WC and BMI with appropriate cutoffs can be effective screening tools to recruit high-risk populations into health promotion programmes. However, WC and BMI should be implemented with other screening tools for other risk factors because of their moderate accuracy.

Association between nutritional status and dental caries in permanent dentition among primary schoolchildren aged 12-14 years, Thailand.

This cross-sectional study assessed associations between nutrition and dental caries in permanent dentition and identified oral hygiene indicators among older children aged 12-14 years in primary schools in Thailand. The study was comprised of 862 schoolchildren from five provinces representing five regions of Thailand, from both rural and urban areas, including Bangkok. The dental hygeine status was assessed by evaluating for decayed teeth, missing teeth due to decay, and filled teeth index (DMFT index). Weight and height were measured to evaluate the nutritional status; hygiene practices assessed by interview. The results show a negative relationship between nutritional status and the DMFT index, which increased when the nutritional status decreased (Spearman's rho correlation = -0.140, p < 0.001). The results from multiple logistic regression analysis showed normal weight and thin schoolchildren were more likely to have a DMFT of at least 1 by 1.94 times (OR = 1.94; 95%CI = 1.25-3.00, p = 0.004) and 2.22 times (OR = 2.22; 95%CI = 1.20-4.09, p = 0.001), respectively, compared to overweight and obese children. Normal and thin schoolchildren had a higher risk for dental caries than overweight and obese children aged 12-14 years in Thailand. School health promotion activities should emphasize eating habit improvement in order to reduce the incidence of caries.

Risk factors for multi-drug resistant Acinetobacter baumannii nosocomial infection.

OBJECTIVE: To assess factors associated with multi-drug resistant Acinetobacter baumannii (MDR-AB) nosocomial infection. MATERIAL AND METHOD: This hospital-based case-control study was conducted in patients admitted to Siriraj Hospital, Bangkok, Thailand between January 1, 2005 and December 31, 2005. The study population consisted of 155 cases with MDR-AB nosocomial infection and 310 controls without nosocomial infection. The cases were matched with controls by age and ward of admission with a ratio of 1:2. RESULTS: The average age of the present study population was 63.5 +/- 18.7 years among cases and 62.9 +/- 18.2 years among controls. The mean of length of stay in hospital among cases was 4.9 +/- 1.4 weeks and controls 1.8 +/- 1.0 weeks. The most common site of MDR-AB nosocomial infection was lower respiratory tract (74.8%). The antimicrobial susceptibility of MDR-AB was 3.9% to cetriaxone and 42.1% to cefoperazone/sulbactam. Multiple logistic regression analysis showed the following associated factors with MDR-AB nosocomial infection: duration of admission prior to MDR-AB nosocomial infection > 1 week (OR = 2.06; 95% CI 1.09-3.89), indwelling urinary catheter > 1 week (OR = 8.24; 95% CI 3.81-17.82), mechanical ventilation > 1 week (OR = 5.73; 95% CI 2.96-11.10), central venous line > 1 week (OR = 3.29; 95% CI 1.48-7.31), nasogastric intubation > 1 week (OR = 6.22; 95% CI 3.24-11.93), prior administration of 3rd-4th generation cephalosporins (OR = 1.80; 95% CI 1.04-3.13), metrodazole (OR = 2.59; 95% CI 1.21-5.56), and piperacillin-tazobactam (OR = 4.68; 95% CI 1.93-11.32). CONCLUSION: A case-control study in medical and surgical patients in Siriraj Hospital in 2005 revealed risk factors for AB nosocomial infection. Prolonged admission of more than 2 weeks, use of devices, and prior treatment with certain antimicrobials were found to be significant risk factors for the infection. To reduce the infection, strict infection control measures must be applied to the patients with these risk factors. Education to medical personnel and enforcement of infection control practices are all needed to reduce antimicrobial resistant bacterial nosocomial infection.

Survival of patients with advanced non-small-cell lung cancer at Ubon Ratchathani Cancer Center, Thailand.

This survival analysis was conducted at Ubon Ratchathani Cancer Center to determine the prognostic factors for survival of patients with stage IIIA, stage IIIB, and stage IV non-small-cell lung cancer (NSCLC) patients treated at the center between 1997-2001. The study sample included 210 patients with non-small-cell lung cancer. Diagnosis and staging were defined employing the TNM system. The majority of lung cancer patients were smokers (66.7%), lived in Ubon Ratchathani Province (40.0%), male (77.6%), and agriculturalists (74.8%). Seventy-seven percent of patients died within five years, 19.5% were lost to follow-up and 2.9% were still alive in 2003. The estimated median survival time was 6.3 months (95% CI 5.4-7.3); the median survival times for stages IIIA, IIIB, and IV were 16.3, 7.0, and 4.5 months, respectively. The overall 1-, 2- and 3-year survival rates of NSCLC were 28.9, 7.9, and 3.3, respectively. The differences in survival of patients in the various stages of the disease were statistically significant (p < 0.0001), adjusted for age and sex. Treatment with combination methods and at an early stage in the disease were associated with significant prolongation of survival. For stage IIIA, the estimated median survival times by treatment with chemotherapy was 7.0 months, radiotherapy was 16.0 months, surgery and others 16.3 months, and chemotherapy plus radiotherapy was 19.5 months. However, only chemotherapy versus surgery and others was significantly different (p = 0.0307). The median survival times for stage IIIB patients treated with chemotherapy, radiotherapy, surgery and others, chemotherapy and radiotherapy, and supportive treatment were 7.0, 7.0, 9.0, 14.7, and 3.0 months, respectively. The differences between surgery and others versus supportive treatment, chemotherapy and radiotherapy versus supportive treatment were significantly different (p = 0.0392, p = 0.0433, respectively). For stage IV, the median survival times for patients treated with chemotherapy, radiotherapy, chemotherapy and radiotherapy, and supportive treatment were 5.0, 4.3, 6.5, and 1.0 months, respectively. The differences between chemotherapy, radiotherapy, chemotherapy and radiotherapy versus supportive treatment, all were significantly different (p = 0.0020, p < 0.0001, p < 0.0001, respectively). The 2-year survival rates for stages IIIA, IIIB, and IV were 16.0, 4.1, and 2.2%, respectively. The results of the study show that stage IIIA has the longest survival time. They also show that appropriate treatment is a significant factor in improving the survival of lung cancer patients.