Primary verification: is the TRISS appropriate for Thailand?

The Trauma and Injury Severity Score (TRISS) is a well-accepted model used to evaluate the quality of trauma care in the US. This research aims to study whether TRISS can be applied to evaluate trauma care and classify outcomes of road traffic injury patients in Thailand. A retrospective study was used to review the Thailand's Injury Surveillance System database from the 1st January to the 31st of December 1996. The study subjects were severe road traffic injury patients with blunt injuries. The TRISS model was applied to compute the survival probability for each patient. The chi-square goodness-of-fit was used to compare the survival probability distribution between the American Major Trauma Outcome of Study (MTOS) and the road traffic injuries in Thailand. The accuracy, sensitivity and specificity of the survival prediction by TRISS were evaluated. The distribution of survival probability between American trauma patients and Thai road traffic injury patients was significantly different (p-value < 0.00001). The TRISS model had high accuracy and sensitivity, but low specificity, in predicting the survival of Thai road traffic injuries. The MTOS and Thai road traffic injuries had different distributions for various factors such as the Revised Trauma Score (RTS), Injury Severity Score (ISS), and ages which effect injury survival. Due to these factors the distribution of survival probability between MTOS and Thai road traffic injuries was also significantly different. By applying TRISS, the survival prediction of Thai road traffic injuries resulted in a high number of false positives.

Atheromatous risk factors among Thai labor forces by socioeconomic status.

The purpose of this study was to describe atheromatous risk factors among Thai labor forces by socioeconomic status (SES) such as income, education and occupation. Undesirable levels of artheromatous risk factors were specified as: total serum cholesterol (TC) > 200 mg per cent, body mass index (BMI) > 25 kg/m2, fasting blood sugar (FBS) > 126 mg/dL, systolic blood pressure (SBP) > 140 mmHg and diastolic blood pressure (DBP) > 90 mmHg. Data from the Second National Health Examination survey in Thailand from 1996 to 1997 was used, with a total number of 4,198 participants (1,634 males, 2,561 females) aged 13-60 years old. Results from multivariate analysis demonstrated differences in means TC, BMI, SBP and DBP among different age-groups, both in males and females (p < 0.001). TC, BMI, and SBP increased with age in both sexes, but DBP increased with age in females only. Males who lived in a municipality had a higher risk of having undesirable TC and DBP than those who did not. Risk of undesirable BMI varied according to levels of income in males. Males with an income of 5,001-10,000 and > 25,000 baht/month had OR = 1.57 (95% CI = 1.04-2.39) and OR = 2.59 (95% CI = 1.18-5.66) compared to males with an income of < 5,000 baht/month. TC and DBP varied with levels of income in females. For undesirable TC, females with an income of 5,001-10,000 and > 25,000 baht/month had OR = 1.48 (95% CI = 1.01-2.18) and OR = 2.17 (95% CI = 1.03-4.88) compared to females with an income of < 5,000 baht/month. For undesirable DBP, females with an income > 25,000 baht/month had OR = 3.39 (95% CI = 1.31-8.78) compared to females with income an < 5,000 baht/month. Among different levels of education in males, different risks of undesirable TC, BMI, SBP and DBP were not significant, except a borderline significance in TC among vocational graduates. The same phenomenon was observed among females, except that females only a primary education tended to have a higher risk of undesirable BMI (OR = 2.64, 95% CI = 1.39-5.02) compared to females with graduate studies. The level of occupation seemed not to affect the risk of unfavorable atheromatous risk factors among males. Nonetheless, females in the agricultural section seemed to have a lower risk of undesirable TC (OR = 0.38, 95% CI = 0.18-0.78) compared to the professional group. The results suggested the consideration of critical guidance of epidemiological studies in using SES as the control variable, or for selection of subjects or matching criteria. Specific preventive programs on atheromatous risk factors should be launched for some specific socio-demographic groups in order to prevent coronary heart diseases (CHD) in the future.

Compliance with the law on car seat-belt use in four cities of Thailand.

Surveys to determine the scope of compliance with the law requiring seat-belt use in Thailand were conducted by observation and interviews with drivers in four cities: namely, Bangkok Metropolis, Chiang Mai, Phuket and Nakhon Ratchasima. The work was carried out in two separate sessions: during the first month following enactment of the law, and six months after its enactment. The sample comprised 46,949 vehicles in the first session (January 1996) and 76,188 vehicles in the second session (July 1996). The results showed that 42.7 per cent of drivers used seat-belts in January and 30.7 per cent in July. When the data were disaggregated according to cities, it was found that more Bangkok drivers complied with the seat-belt law than in Phuket, 24.6 per cent; Chiang Mai, 22.1 per cent; and Nakhon Ratchasima, 18.3 per cent relatively low compliance rate was encountered among drivers of pick-up trucks (including those with modified roofs) and vans, particularly farmers and the self-employed. Women drivers tended to abide by the law more often than men (OR = 1.7, 95% CI = 1.12, 1.23). Inter-city travelers wore seat-belts more than those traveling in the city (OR = 1.74, 95% CI = 1.68, 1.80). About one-fifth of non-users or those who rarely used seat-belts were unsure of the effectiveness of seat-belts in preventing serious injury or death in the case of an accident. Discomfort associated with using seat-belts and the perception that they were rendered unnecessary because of slow traffic in cities were other reasons for non-compliance in 50.6 per cent and 43.9 per cent of cases, respectively. The decline in compliance with the law six months after its enactment indicates that there may be a problem with uniform and consistent enforcement of the law.

Reduction of rotavirus infection in children receiving bifidobacteria-supplemented formula.

This study was conducted at Pakkred Babies Home, Bangkok, Thailand; with the hypothesis that children receiving probiotic-supplemented milk-based formula may be protected from developing diarrheal diseases. Salivary rotavirus-specific IgA antibody was used as an indicator of rotavirus infection. One hundred and seventy-five children, aged 6-36 months, were enrolled in the study. They were divided into 3 groups according to the type of formula given. There were 81 episodes of diarrhea during an 8-month study period, most of which were caused by bacterial enteropathogens. Ninety-seven pairs of salivary samples were adequate for the analysis of rotavirus antibody. Among 23 children receiving milk-based follow-up formula and serving as control group, 30.4 per cent of them had > or = 4-fold increase in the antibody titre, indicating subclinical rotavirus infection. The majority of children in the other 2 study groups, receiving the same formula supplemented with either Bifidobacterium Bb12 alone or together with Streptococcus thermophilus, had no significant change in the antibody titres between the two time points. The results of this study support our hypothesis that children receiving bifidobacteria-supplemented milk-based formula may be protected against symptomatic rotavirus infection.

Family planning: knowledge, attitudes and practice survey in Zigone, Myanmar.

Perhaps the most important finding of this Zigone KAP survey was that about 50.3% (95% CI 46.2-54.2) of the married women of reproductive age were currently practicing modern methods of contraception. For a country like Myanmar, where the government has until recently favored a pronatalist population policy, this is indeed surprising. This 30 cluster survey, designed to determine the prevalence of various family planning methods adopted, as well as knowledge and attitudes, among villagers in rural Myanmar, covered a sample of 600 married women of reproductive age in Zigone township which has a population of 70,000. The survey results showed a high awareness of specific contraceptive methods among the target group and the ever-use rate of birth spacing methods was about 54% (95% CI 50.7-58.7). The most used method was oral contraceptives (64.6% of all users), followed by injectable contraceptives (32.3%). There was a small number of IUD users (1.1%), use of a permanent method (sterilization) was extremely low (0.3%). Seven out of ten married women of reproductive age did not want more children and one out of two women in this group were current users of contraception. Therefore a certain proportion of user was probably using these (mainly temporary) methods to terminate fertility rather than for birth spacing purposes. Moreover, only 63% of those wanting children, but not in the next 12 months, were using a contraceptive method. These findings demonstrated that there was a large group of potential contraceptive users who were currently not using a method. In an attempt to investigate the factor hindering the non-use of contraceptives when needed, the women were divided, according to their contraceptive practice, into two groups. Logistic regression was employed to compare the characteristics of women in the user and nonuser groups. After adjusting for covariates, it was found that economic group and number of living children had a positive effective effect on contraceptive use, while age and number of children under three years of age had a negative effect. The survey also found that about 48% of the contraceptive users were obtaining their supplies from the private sector and another 40% received supplies from government health officers. The reference by respondents to "health staff", as the source of supply, was assumed to be health staff working in their private practice, since the government's current health program does not cover the provision of contraceptives.

Impact of an educational program on the treatment practices of diarrheal diseases among pharmacists and drugsellers.

The impact of an intervention program, measured by changes in the prescription of ORS, antibiotics and antidiarrheal drugs by those pharmacists and drugsellers after administering the proposed educational package was assessed. The results of the study indicated that, before the educational program started, ORS was prescribed by pharmacists for 31.4% and 15.7% of watery diarrhea and dysentery episodes, respectively. Only 18.9% and 13.3% of drugsellers gave ORS to assessors in case of watery diarrhea and dysentery. Antibiotics and antidiarrheal agents were prescribed extensively, watery and dysenteric diarrhea (84% and 56% for watery diarrhea by pharmacists and drugsellers; 92% and 60% for dysentery). Antidiarrheal drugs were used as frequently. After the educational program, the assessment of the prescription behavior of the pharmacists showed no change in ORS, antibiotics and antidiarrheal drugs prescribed to treat watery diarrhea. In dysentery, the effective percent change in prescribing ORS between pre- and post- intervention program was much higher in intervention group than the control group. For drugsellers, effective percent change in ORS usage in treatment of watery diarrhea was 11.8% compared with -7.7% in the control group. No such change was observed in treatment of dysentery. There was a slight significant change in behavior concerning use of antibiotics among subjects getting information by mail, compared to those who got full intervention, when the pre-intervention behavior, store type and treatment type was taken into account.

The epidemiological study on risk factors of ischaemic heart disease: A case study in chest hospital non-buri.

This study intends to identify some risk in the development of Ischaemic Heart Disease. This knowledge can be used in official health planning for preventition of Ischaemic Heart Disease. Data were collected from 1983 – 1985 through in-patient hospital records of the Chest Hospital in Nonburi Province. 192 cases of Ischaemic Heart Disease were matched to 192 controls for age, sex, marital status and systolic blood pressure. Results revealed at 0.05 significance level, that the significant risks of Ischaemic Heart Disease were residence, occupation, body weight and blood sugar. Those who were urban residents, non-labourer, higher body weight (> 50 kgs) and higher Blood sugar (≥ 120 mg/ ml.) were more likely to develop Ischaemic Heart Disease than those who were not. However, it was also found that for those rural residents with high body weight, eventhough they were labourers. They also had a higher risk to develop Ischaemic Heart Disease.

Effect of passive immunity to tetanus in DTP vaccinated infants.

Tetanus antitoxin levels in DTP unvaccinated and vaccinated infants whose mothers had either received no dose or two doses of absorbed tetanus toxoid at present pregnancy were determined by the enzyme immunosorbent assay (EIA). It was found that the percentage of protective infants born from non-immunized and immunized mothers were 95.4 and 100 respectively. The transplacental tetanus immunity in infants of immunized mothers was higher than those of non-immunized mothers, however, it was significantly reduced in both groups of infants within two months. After the first dose of DTP vaccine, infants born from non-immunized mothers were able to respond well in producing antibody whereas the infants from immunized mothers were not. In the second and third dose of DTP vaccine both groups of infants had a similar range of tetanus antitoxin.

Transfer rate of transplacental immunity to tetanus from non-immunized and immunized mothers.

Tetanus antitoxin was quantitatively measured in 912 pregnant women by indirect hemagglutination test. The mothers who received no dose, one dose and two doses of tetanus toxoid were 64.6%, 10.1% and 25.3% respectively. The percentage of mothers with protective antibodies in the groups receiving none, one, and two doses of tetanus toxoid were 95.4, 100 and 100. The level of protective antibody in the newborn and the magnitude of transfer rate of passive immunity to tetanus depended directly upon the level of tetanus antitoxin in maternal serum. Mothers who had tetanus antitoxin of 1.28 IU/ml or more could transfer protection to almost all of the newborns (97%-100%) irrespective of doses of tetanus toxoid administration. However, mothers who had received two doses of tetanus toxoid during pregnancy not only confer good protection but also transfer a high tetanus antitoxin levels to their newborns.