Thai falls risk assessment test (Thai-FRAT) developed for community-dwelling Thai elderly.

OBJECTIVE: To develop falls risk assessment test that is appropriate for community-dwelling Thai elderly, and to verify this test with the second set of population. MATERIAL AND METHOD: A cross-sectional study was performed in 270 elderly living in Bansrang subdistrict, Ayuttaya province to identify a combination of variables that effectively predicted fall status in order to develop the Thai-FRAT The Thai-FRAT was validated with a second set of population whose cohort data had been collected during 1997-2002 in the study named "CERB project". One hundred fifty six elderly subjects were recruited in the analysis. RESULTS: The newly developed Thai-FRAT was composed of six factors including "History of falls", "Impaired body balance", "Female", "Specific medication use", "Impaired visual acuity" and "Thai style house". Possible score of the Thai-FRAT ranged from 0-11. The best cutoff score identified by the receiver operating curve analysis was 4. Sensitivity and specificity were 0.92 and 0.83 respectively. The Thai-FRAT could predict recurrent fall after two years among the elderly subjects who had had a history of fall during the past six months in the second set of population. Association between the Thai-FRAT score and mortality was also shown. CONCLUSION: The Thai-FRAT is the first fall risk assessment test developed for Thai community-dwelling elderly. It is a valid and reliable measure of fall risk. An effect of environment on falls among Thai elderly was clarified in the present study.

Risk factors of acquired prothrombin complex deficiency syndrome: a case-control study.

BACKGROUND: Idiopathic vitamin K deficiency in infancy or acquired prothrombin complex deficiency (APCD) is a serious bleeding disorders in infants. It leads to a high mortality rate and permanent neurological sequele among the survivors. A low vitamin K intake by infants is suggested to have a major role in the pathogenesis. To reduce the incidence of this syndrome, its risk factors have to be identified. OBJECTIVE: To determine the risk factors of the acquired prothrombin complex deficiency syndrome in the early infantile period. MATERIAL AND METHOD: A case-control study was conducted in 20 cases and 60 age- and sex-matched controls who were admitted to the Queen Sirikit National Institute of Child Health in Bangkok during August 1991 to August 1993. Feeding type, maternal history of herb-liquor extracts (herbal medicine) use and no history of vitamin K1 prophylactics at birth were identified to be risk factors of the syndrome. All subjects were fed by breast milk with or without formula milk. None of the subjects fed by formula milk were in the case group (Chi-square for trend = 14.77, p = 0.001). RUSULTS: The rate of a maternal history of herb-liquor extracts use in the case group was significantly higher than that of the control group (p = 0.03). Vitamin K2MK4 level in breast milk obtained from the mothers of the infants with maternal history of herb-liquor extracts use was lower than that obtained from the mothers of the infants without maternal history of herb-liquor extracts use (p = 0.03). No infant with history of intramuscular K1 prophylactics was in the case group. Three out of eight infants with history of oral vitamin K1 regimen were cases. Although vitamin K1 and K2MK4 level in breast milk obtained from the cases' mothers were significantly lower than that obtained from the controls' mothers (p = 0.015 and p = 0.003 respectively), there was an overlapping of vitamin K levels among these two groups. CONCLUSION: This study demonstrated that vitamin K in breast milk has a main role in the pathogenesis of this disease. Herb-liquor extracts may be a cause of the APCD syndrome. Intramuscular vitamin K1 prophylactics should be routinely given to all newborn babies who will receive breast feeding. Effectiveness of oral vitamin K1 prophylactics regimen must be studied urgently.

Moving towards the elimination of rabies in Thailand.

Human rabies is regarded as a fatal disease; however, its occurrence is preventable. Prevention consists of post-exposure prophylaxis (PEP) for humans and controlling the main cause through dog vaccination. In Thailand, health care budgets are increasingly allocated to human PEP rather than eradication of rabies in dogs. This is the case, even if controlling rabies in the dog population is a more cost-effective, longterm approach to prevent human rabies than PEP. While the principal cause of rabies is the roaming stray dogs, the impetus for control and removal is hampered by a lack of awareness of its true impact. The declaration of an annual World Rabies Day, September 8, is an initial effort to raise global awareness of the ongoing and unnecessary tragedy of rabies.

Lumbar disc degeneration in Thai elderly: a population-based study.

OBJECTIVE: Determine the prevalence and related factors of lumbar disc degeneration in the Thai elderly. MATERIAL AND METHOD: A population-based study was done at Rom Klao community, Bangkok. Seven hundred and ninety-two cases (306 males, and 486 females) out of 1166 elderly people aged > or =50 (mean age of 61.07 +/- 7.8 years) were assessed. The lateral spinal radiographs were interpreted as spondylosis grade 0-3 according to the degree of severity. RESULTS: Males had more prevalence of grade 2-3 spondylosis than females (58.8% vs. 52.9%), but females had higher prevalence of spinal listhesis (14.4% vs. 8.8%). Age was a strong predicting factor for disc degeneration (OR = 1.088, 95% CI = 1.065-1.111, p = 0.000). Females had more risk to develop spinal listhesis (OR = 1.84, 95% CI = 1.11-3.05, p = 0.020) and low back pain (OR = 1.82, 95% CI = 1.29-2.56, p = 0.001). BMI was a predicting factor for spondylosis (OR = 1.066, 95% CI = 1.02-1.10, p = 0.000). About 27% of the cases reported moderate-severe low back pain and had lower Barthel ADL index (p = 0.018). CONCLUSION: Lumbar disc degeneration and low back pain were highly prevalent among the Thai elderly. Therefore, they need proper health care for disability prevention.

Validity of clock drawing test (CDT), scoring by Chula clock-drawing scoring system (CCSS) in screening dementia among Thai elderly in community.

OBJECTIVE: The present paper was to study the validity of screening dementia among Thai elderly by clock drawing test (CDT). MATERIAL AND METHOD: The scoring method selected to apply with CDT was Chula clock-drawing scoring system (CCSS) that was originally developed as clinically-based in Thai elderly patients. The 669 elderly subjects gathered from "Rom Klao" community in Bangkok, Thailand were asked to perform CDT and be examined by a neurologist, using NINCDS-ADRDA diagnosis criteria for probable Alzheimer's disease (AD). CDT was scored by psychiatrists using CCSS. RESULTS: The authors found the demented by clinical diagnosis in 25 cases. Using a CCSS cutoff score of 7, CDT produced positive test results in 191 subjects. Sensitivity was 88%, the specificity was 74% and the area under receiver operation characteristics (ROC) curve was 0.91. The results also showed that comparatively to cutoff point 7, a cutoff point 6 would contribute the higher specificity of 82% and have a similar sensitivity of 88% in this community-based sample. CONCLUSION: The present study provided strong support that CDT scoring by CCSS is efficient to screen dementia in the general community with satisfactory sensitivity and specificity. However modifying the CCSS cutoff score from 7 to 6 increases the specificity and is proposed to be applied in the community.

Determining public health priorities for an ageing population: the value of a disability survey.

In order to determine which diseases and health problems were most strongly associated with long-term disability among the Thai elderly and to determine their public health priority, a national cross-sectional multistage random sampling survey was conducted in 1997. Four thousand and forty-eight Thai older persons aged 60 years and over were recruited and interviewed by trained interviewers. Overall, 769 (19%) people reported having a long-term disability. Participants with long-term disability (LD) reported having between one and 21 long-term diseases or health problems. Eighteen of these problems were independently associated with LD in logistic regression analysis. Nearly half of the cases with LD (46.4%) suffered from two or more health problems. The odds of LD increased with the number of problems suffered. The problems contributing most to the population burden of disease as assessed by population attributable risk fractions were hemiparesis, arthritis, accidents (unintentional injuries), blindness and other eye diseases, kyphosis, weakness of limbs, deafness, and hypertension. This ranking of public health priority differs from conventional approaches using mortality statistics and disability adjusted life years (DALYs). In conclusion, national disability surveys provide a valuable means of assessing the population burden of disability and determining the underlying causes of disability. These methods provide a direct assessment of disability prevalence and disease priorities for rapidly ageing transitional countries where death certification may be incomplete or inaccurate.

Digoxin toxicity in Thai medical patients: clinical manifestations and an appropriate diagnostic serum level.

This study considers the clinical manifestations and risk factors of digoxin toxicity and establishes an appropriate cut-off serum level for the diagnosis of toxicity. A retrospectivestudy of 125 hospitalized patients whose serum digoxin was assayed in 1998 was conducted. Of the 125 subjects, 42 (33.6%) were classified as having definite digoxin toxicity, 9 (7.2%) were classified as having probable digoxin toxicity, and 74 (59.2%) were classified as non-toxicated. Of the patients with definite digoxin toxicity, 24 (57.1%) had cardiac manifestations, seven (16.7%) had non-cardiac manifestations, and 11 had manifestations of both types. The commonest manifestation was atrial fibrillation with block. Average daily doses of digoxin in the patients with definite digoxin toxicity and those without intoxication varied from 0.125 to 0.5 ng/ml. There was no significant statistical difference in digoxin dosage between those with and those without digoxin toxicity. Seven univariate factors of digoxin toxicity were examined: logistic regression analysis showed that, serum BUN and serum chloride were independent associated factors of digoxin toxicity: the finding suggests that renal impairment and volume contraction are strong determinants of digoxin toxicity. Mean (SD) serum digoxin levels among the patients with and without toxicity were 2.28 (1.3) and 1.05 (0.6) ng/ml respectively (p = 0.000). The best cut-off level determined by Receiver Operating Characteristic (ROC) analysis was 1.97 ng/ml. However, a low sensitivity and a high specificity make serum digoxin levels a diagnostic rather than a screening tool. The manifestations of digoxin toxicity among Thai inpatients are no different from those of other populations. The best cut-off level of serum digoxin for the diagnosis of toxicity is 2 ng/ml.