Contextual and individual demographic determinants of alcohol consumption and smoking: a comparative study in southwestern China and southern Thailand.

The aim of this study was to investigate the association between contextual and individual demographic characteristics and alcohol consumption and smoking in southwestern China and southern Thailand. In 2000, a cross-sectional study was carried out in southern Thailand on 703 subjects > or = 45 years old, and in 2005 in southwestern China on 6,006 subjects. Each participant was interviewed by trained interviewers using a standard questionnaire. Information regarding demographic characteristics, alcohol drinking and smoking was obtained. Multilevel logistic regression was used to model variation in the prevalence of alcohol consumption and tobacco smoking. The findings in both countries indicate that age was negatively associated with the probability of consuming alcohol and males were more likely to consume alcohol and tobacco than females. Chinese communities with a lower level of education were more likely to smoke. Thai individuals with a higher educational level were less likely to smoke. Yi ethnicity was associated with a higher probability of drinking both at the contextual level and at the individual level in China. Non-Muslims were more likely to consume alcohol in Thailand. Future contextual and individual level interventions regarding alcohol drinking and smoking are needed in China, and further studies with larger sample sizes are needed in Thailand before conclusions can be drawn.

Gender and ethnic differences in cardiovascular risks in Songkhla province, Thailand: the interASIA-south.

The subset of data on southern Thai InterAsia study conducted in 2000 was revisited in order to document gender and ethnic breakdown of prevalence of risk factors for cardiovascular diseases (CVD). Three hundred and seventy-five men and 630 women with overall mean +/- SD age of 53.2 +/- 11.7 years were recruited. Combined gender prevalences were: 21.1% for smoking, 15.5% for drinking, 21.8% for hypertension (systemic blood pressure > or = 140/90 mmHg), 49.8% for impaired fasting plasma glucose (FPG 110-125 mg/dl), 9.9% for diabetes mellitus (FPG > or = 126 mg/dl), 10% for body mass index > or = 30 kg/m2, 43.5% for large waist circumference (WC > or = 90 cm in men and > or = 80 in women), 62.8% for total serum cholesterol (TC), > 200 mg/dl, 38.5% for TC divided by high density lipoprotein cholesterol (HDL-C) > or = 5 and 61.6% for low-density-lipoprotein cholesterol (LDL-C), > or = 130 mg/dl. After using logistic regression, adjusting the effects of age and community of residence, women were less likely than men to be smokers, drinkers, or showed impaired FPG but significantly more likely to have large WC, TC > or = 200 mg/dl and LDL-C > or = 130 mg/dl. Muslims showed significantly lower risk for drinking and large WC but higher risk for low HDL-C. The differences require further research. In conclusion, gender and age have stronger association with various risk factors than ethnicity in this selected population.

Accuracy in diagnosis of acute appendicitis by comparing serum C-reactive protein measurements, Alvarado score and clinical impression of surgeons.

OBJECTIVE: To compare the accuracy of a surgeon's clinical diagnosis of acute appendicitis with Alvarado's predictive model and C-reactive protein (CRP) measurements. METHOD: The records of 231 adult patients between 14-75 years admitted to the hospital with suspected appendicitis from August 1999 to November 2001 were studied prospectively. Serum CRP measurements (217 patients) and Alvarado scores (231 patients) were performed before operations but were not taken into account prior to the decision to perform a laparotomy to compare the surgeon's clinical diagnosis. RESULTS: Based on the surgeon's clinical diagnosis, 193 patients underwent surgery, and 38 patients were observed. Histopathologic findings found acute appendicitis, confirming the surgeon's clinical impression, in 178 patients (positive predictive value = 92%) and normal appendix in 15 patients. Of the observed patients, 8 subsequently underwent operation for appendicitis (negative predictive value = 79%). Compared with the surgeon's clinical diagnosis (sensitivity 96% and specificity 67%), diagnosis based on an Alvarado score of > or = 7 had a lower sensitivity (79%) and that based on CRP of > 10 mg/l a much lower sensitivity (62%) and lower specificity (56%). Overall accuracy of these three diagnostic modalities were 90 per cent, 72 per cent and 61 per cent, respectively. However, median serum CRP value increased from 5 mg/l (range 3-188 mg/l) in patients with normal appendix, to 14 mg/l (range 3-222 mg/l) in patients with non-perforated appendicitis and 65 mg/l (range 3-213 mg/l) in patients with perforated or gangrenous appendicitis. CONCLUSION: The clinical assessment in diagnosing appendicitis by an experienced surgeon remains reliable and superior to either Alvarado score or CRP measurement. Nevertheless, Alvarado score and serum CRP measurements may be of value to the inexperienced surgeon, and a high Alvarado score and serum CRP should not be ignored.

Mastectomy without drain at pectoral area: a randomized controlled trial.

OBJECTIVES: Mastectomy is still one of the standard alternative procedures for the management of female breast cancer. Axillary node dissection is also performed to establish the accurate staging. After operation, the axilla must be drained because of lymphatic leakage. Whether the raw surface at the pectoral area should be drained or not is an interesting controversial point. The authors conducted a randomized controlled trial to compare outcomes after modified radical mastectomy (MRM) with and without drainage at the pectoral area. METHODS: Sixty patients who agreed to be treated with MRM and had given their consent were enrolled. Mastectomy was performed to remove the breast tissue proper by scalpel in order to minimize tissue injury. The axillary contents were removed by sharp instrument. After bleeding had stopped, patients were randomly allocated to one or other of 2 groups: group I (n = 30): only 1 drain was inserted at the axilla area; group II (n = 30): 2 conventional drains were inserted into the pectoral area and axilla area. The size of tube drain and negative suction pressure were constant in all cases. Volume of contents was recorded daily. Subcutaneous seroma or hematoma were carefully observed and confirmed by ultrasonography 3-5 days after operation. Overall drainage contents and complications were compared. RESULTS: The mean weight of breast tissue of group I was 632.1 g and group II 654.0 g (p = 0.81). Total drainage contents (median) from the two groups were 250 cm3 and 231 cm3 respectively (p = 0.796). Complications occurred in 1 case in group I and 2 cases in group II (p = 0.35). None of the above differences were statistically significant. CONCLUSION: Mastectomy by scalpel can be performed without drainage at the pectoral area. Overall complications in the conventional group and the group without drain did not differ significantly.

Invasive streptococcal group A infection and toxic shock syndrome in Songklanagarind hospital.

BACKGROUND AND OBJECTIVES: Streptococcal group A infection is reported as a medical problem in several parts of the world. The most serious complication of this infection is streptococcal toxic shock syndrome (STSS) which is associated with a very high mortality rate. The present study aimed to determine the clinical manifestations, including underlying conditions, mortality and prognostic factors, of invasive streptococcal group A infection and STSS from southern Thailand (Songklanagarind Hospital). METHOD: The medical records of infected patients from January 1, 1995 to June 30, 1999 were reviewed retrospectively. Criteria for diagnosis of STSS were as follows (JAMA 1993). Prognostic factors were analyzed by logistic regression model. RESULT: 176 cases of STSS and streptococcal group A infection, 89.9 per cent were community acquired infections. About 70 per cent of the infected patients had previous underlying conditions, the most common was cancer. The commonest site of infection was the skin and soft tissue (80.1%). The total mortality rate from streptococcal group A infection was 9.1 per cent. STSS was identified in 12 patients (6.8%), with a 50 per cent mortality rate. Prognostic factors for mortality in this infection were diabetic mellitus (odds ratio 9.67, p<0.025), history of steroid use (odds ratio 11.17, p<0.017), STSS (odds ratio 22.16, p<0.005) and received cancer chemotherapy (odds ratio 115.19, p<0.003). Predictive factors for STSS couldn't be identified, while age >65 years and steroid use were suggested protective factors for this condition [odds ratio 0.02, p<0.0001 and odd ratio 0.07, p<0.027 respectively].