Incidence and predictors of type 2 diabetes among professional and office workers in Bangkok, Thailand.

OBJECTIVES: To determine the incidence rates of type 2 diabetes and associated factors among professional and office workers in Bangkok. MATERIAL AND METHOD: Data on fasting glucose measurements and physical examination were obtained from a cohort of 6,924 workers in 43 establishments in Bangkok during 1999-2003. Impaired fasting glucose and diabetes were defined according to the American Diabetes Association criteria. The type 2 diabetes incidence rates were calculated based on the person-time of follow-up period. RESULTS: A total of 136 individuals developed type 2 diabetes during 11,581 person-years (py) of follow-up. The incidence rates of type 2 diabetes in individuals aged 35-60 years was 11.4 per 1000 py Men had a higher incidence rate than women (17.8 vs 9.2 per 1,000 py). The incidence rates increased with age. Factors associated with development of diabetes included baseline fasting plasma glucose (FPG) level, overweight and obesity status. Adjusted incidence rate ratios (IRR, 95%CI) for FPG of 93-99 mg/dl and 100-125 mg/dl were 3.2 [1.1-9.9] and 31.5 [11.4-86.8] respectively, compared to those with FPG < 93 mg/dl. The IRRs for those with BMI of 23-27.5 and > 27.5 kg/m2 were 1.5 [0.9-2.5] and 2.7 [1.6-4.5] respectively, compared to those with BMI < 23 kg/m2. CONCLUSION: Findings from the present study could serve as the first marking post for estimating the risk and magnitude of type 2 diabetes in other adult populations in Thailand.

Floor activity score.

OBJECTIVE: To propose an instrument to measure the amount of floor activities performed by an individual. MATERIAL AND METHOD: A list of 12 questionnaires relating to floor activities is proposed. A cross-sectional survey of the response to the questionnaires was tried on 3 communities representing rural, urban and metropolitan areas. The total number of enrolled people was 733. The scores of the questionnaires were tested for statistical difference (p< 0.05) among the communities by Chi-square and ANOVA nonparametric tests. RESULTS: The total scores among the three communities were significantly different. The rural civilians achieved the highest score, whereas the metropolitan area had the lowest score. CONCLUSION: The proposed instrument measuring floor activities is able to discriminate the activities of civilians in rural, urban and metropolitan areas.

Assessment of capacity for cardiovascular disease control and prevention in Thailand: a qualitative study.

The present study explored community members' knowledge and perceptions about cardiovascular disease (CVD), risk factors and prevention, and identified the current capacity of primary care providers to manage and control CVD at the provincial level. A qualitative study, including in-depth interviews and focus group discussions, was conducted in Suphan Buri Province, Thailand. Participants included community members, CVD patients and healthcare providers in health centers and hospitals. The results showed that community members had little knowledge about the symptoms and signs of heart attack or stroke. They perceived that existing health centers and community hospitals were not sufficiently equipped to treat CVD patients. Primary healthcare workers reported that they lacked skills to manage heart disease, particularly emergency care. Physicians said that they had too little time to educate patients and felt that medical schools should update their curricula, including practical training on CVD management in a low-resource setting. Nurses reported that they had inadequate training in health education for the prevention of CVD. There was a problem of inadequate feedback mechanisms in the existing referral system for continuing improvement. All of the health professionals agreed that more community participation and the involvement of non-health sectors and non-government organizations were needed in the national CVD control program. In conclusion, capacity building for strengthening CVD prevention and control at the primary care level should be implemented. The existing training and education systems have to be revised with an orientation towards health promotion and disease prevention. Publicity of CVD burden and preventive measures, and local programs, should be implemented with community participation.

Heterogeneity of daily pulmonary function in response to air pollution among asthmatic children.

Several epidemiological studies have demonstrated the association of short-term exposure to air pollution with transient declines in pulmonary function. Although the magnitudes of declines in pulmonary function found in these studies are relatively small, the effects vary among children. This study examined whether the variation is evidence of biological heterogeneity or due to random variation by analyzing data from a panel study of 83 asthmatic school children exposed to SO2 and PM10 in the Mae Moh district of Thailand. Daily pulmonary function testing was performed on the children for 61 days. General linear mixed models were used to examine and test for the null hypothesis of no variation in the subject-specific slopes of pulmonary functions in response to the air pollutants. The individual daily pulmonary functions measured were FVC, FEV1, PEFR, and FEF(25-75%). These were used as an outcome to compare with air pollutant concentrations as random effects, adjusting for height, gender, time, and temperature. The results indicate evidence of inter-individual variation for subject-specific changes in FVC, FEV1, and PEFR due to the effects of SO2 and PM10 on children. In conclusion, even at low concentrations of daily SO2 and PM10 in the study area, there is evidence of a heterogeneous response to short-term exposure to SO2 and PM10 in children.

Prevalence and determinants of overweight and obesity in Thai adults: results of the Second National Health Examination Survey.

To describe the prevalence of overweight and obesity and examine their relationship with socio-demographic factors in Thai adults. Using data from a cross-sectional survey, the National Health Examination Survey II (NHESII), the authors examined the prevalence of overweight (BMI > or = 25 kg/m2) and obesity (BMI > or = 30 kg/m2) in 3,220 Thai adults aged 20-59 yr. Univariate analyses and Logistic regression models were used to examine the association of overweight and obesity with socio-demographic and behavioral risk factors. The overall age-adjusted prevalence of overweight and obesity were 28.3% and 6.8% respectively, with a higher prevalence for women than for men (overweight: 33.9% vs 19.2% and obesity: 8.8% vs 3.5%). The prevalence of overweight and obesity was greater among older compared to younger people and among residents of urban (34.8% and 9.9%) compared to rural areas (26.4% and 5.9%). The prevalence of overweight and obesity varied by region in line with the level of economic development--Bangkok, Central, North, South and North-East. By using logistic regression analysis, overweight was associated with a number of characteristics as follows: age (per ten years increase) with adjusted Odds Ratio (OR) of 1.3; women 1.4; married 2.2; being a current smoker 0.4, and living in Bangkok and the central region 1.6 (compare to North-East). There was no clear difference in prevalence of overweight and obesity among education levels and type of occupation after controlling for other covariates. In conclusion, women of middle age, married, and living in Bangkok and the Central region, are at greater risk of overweight and obesity. Without effective lifestyle modification programs to curb these physiologic risk factors at population level, it is likely that related disease burden will ensue. Public health surveillance and intervention to modify the risk factors of excessive weight should be implemented.

Acute effects of SO2 and particles from a power plant on respiratory symptoms of children, Thailand.

Epidemiological studies to evaluate the acute effects of ambient SO2 on the respiratory health of children provide inconclusive results. A panel study to examine the association of short-term exposure to ambient SO2 and respiratory symptoms of 196 children for a period of 107 days was conducted in Thailand. Generalized Estimating Equations were used to examine the association of daily variation of air pollution with daily respiratory symptoms. During the study period, SO2 was not associated with respiratory symptoms in either asthmatics or non-asthmatics, whereas a 10 microg/m3 increase in PM10 was modestly associated with increases of lower respiratory symptom incidence (OR=1.03, 95%CI=0.98, 1.09) and cough (OR=1.04, 95% CI=1.00, 1.08) in asthmatics. At the low ambient air pollution concentrations observed, particulate matter rather than SO2 was associated on a microg/m3 basis with acute daily respiratory symptoms.

Assessment of public opinion on legislation to deter drunk driving.

Existing legislative measures on blood-alcohol control of drivers failed to show a substantial effect in reducing the incidence of crash injury and mortality. Recently, a government initiative to limit locations and operating time (service hours) of nighttime entertainment venues was introduced. A telephone interviewed-survey of 500 random-samples to assess public opinion on the initiative and other legislative measures was conducted in Bangkok. The results showed that 88 per cent of the respondents supported the idea of prohibiting alcohol sale to youngsters aged <21 years old and 91 per cent agreed to limit the operating time of pubs, bars and nightclubs to no later than 2 a.m. The majority asserted that laws against drink driving were seldom enforced. More than half of the respondents agreed with the ideas of restricting medical care benefit for injured drunk drivers, and of prosecuting the related alcohol-sellers. Eighteen per cent of male respondents had drunk alcohol and driven in the past one month. A telephone survey is an efficient tool for providing timely information for policy decisions. More stringent enforcement of laws against drunk drivers should be implemented in parallel with traffic safety programs and other social control initiatives.

The diagnosis and reporting of occupational diseases: the performance of physicians in Thailand.

The diagnosis and reporting of occupational diseases are important components of any occupational disease surveillance system. These two factors were assessed in 222 Thai physicians by using a self-administered questionnaire. Study results show that a proper diagnosis of occupational disease is hampered by the following: lack of knowledge about occupational medicine; a shortage of environmental data; a lack of consultation services and laboratory facilities. Concern about possible legal implications also prevents physicians from making a diagnosis of occupational disease. Evidence shows that financial incentive seems to play a crucial role in physicians' compliance with the reporting system. A number of remedial approaches are proposed, including the improvement of professional training, the development of standard practice guidelines, and novel financial measures for healthcare providers. Improvement calls for the collaborative effort of all responsible agencies and warrants further research that will guide policy and practice.