Factors determining hospital admission of Thai elderly by a mailed survey.

OBJECTIVE: To study risk factors of hospital admission among older Thai adults. MATERIAL AND METHOD: Nationwide observational cross-sectional survey by mailed questionnaires. 1801 older adults who attended senior citizen clubs organized by local hospitals from 66 provinces of Thailand. RESULTS: 28.1% of subjects had been admitted to a hospital. Independent factors determining hospital admission were lung disease (adjusted OR 2.13), history of fall (adjusted OR 1.73), poor global self-rated health (adjusted OR 1.62), taking calcium tablets (adjusted OR 1.61), preferring fatty food (adjusted OR 1.59), being former smokers (adjusted OR 1.56), low body mass index (adjusted OR 1.52), hypertension (adjusted OR 1.37) and poor mobility ability (adjusted OR 1.16). CONCLUSION: Prevention of hospital admission among the elderly should involve preventing cigarette smoking, promoting healthy dietary habit, fall prevention and screening for hypertension.

Occurrence and protective level of influenza infections using serology in patients with COPD in vaccination study.

OBJECTIVE: To investigate the prevalence, occurrence and protective level of influenza infections using serology in patients with chronic obstructive pulmonary disease (COPD) during a one-year influenza vaccination study. MATERIAL AND METHOD: A total of 123 patients with COPD were enrolled during the period of 1997 to 1998. There were 61 patients in the vaccine group and 62 patients in the placebo group with a mean age +/- SD of 67.6 +/- 8.0 and 69.1 +/- 7.5, respectively. The vaccine was composed of influenza A/Texas/36/91 (H1N1), A/Nanchang/933/95 (H3N2) and B/Harbin/07/94 strains. Antibodies to influenza viruses were detected by hemagglutination inhibition (HI) test using antigens of vaccine strains. RESULTS: The incidence of influenza proven by serological examination was 22/123 (17.9%) cases. Among 17/62 (27.4%) influenza cases in the placebo group representing natural infections, 3 (17.6%) were diagnosed as A (H1N1), 8 (47.1%) as A (H3N2), 3 (17.6%) as type A, 1 (5.9%) as type B and 2 (11.8%) as untypeable viruses. The 8.2% of influenza cases found in the vaccine group was significantly lower than 27.4% of that in the placebo group (Chi-square test, p = 0.01). The protection rate of influenza vaccination was 71%. Among 23 acute blood samples from 22 influenza cases, the titers ranged from < 10 to 20 corresponding to its type/subtype. In the vaccine group, 5 influenza cases occurred at 7, 7, 10, 11 and 11 months after vaccination. The HI antibodies to influenza A (H1N1), A (H3N2) and B viruses at titers of > or = 10 vs > or = 40 were 50.4% vs 21.9%, 54.5% vs 28.5% and 17.9% vs 4.1%, respectively. CONCLUSION: The findings indicated that from 1997 to 1998, the occurrence of influenza as natural infection was 27.4%. Influenza A (H3N2) was more frequently prevalent than A (H1N1) and B viruses. The influenza vaccination in COPD patients was effective. The protective HI antibody titers were > or = 40. The patients without protective HI antibody to A (H1N1), A (H3N2) and B viruses were 78.1%, 71.5% and 95.9%, respectively. Such patients were considered to be at high-risk for influenza and recommended to have vaccination.

The most cost-effective screening method for chronic obstructive pulmonary disease among the Bangkok elderly.

Our previous studies demonstrated the high prevalence and incidence of Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly, as well as the cost-effectiveness of a questionnaire, chest radiography, and mini peak expiratory flow rate (miniPEF) as screening tools. This final study aimed to identify the most cost-effective screening method among individual, serial and parallel combinations of the above tools, based on the guidelines for diagnosing COPD of the Thoracic Society of Thailand. There were 3,094 elderly aged 60 years and over in 124 urban communities around Siriraj Hospital who participated and completed all the tests. The results showed that the most cost-effective screening method was the miniPEF at cut-off percentage of 62 per cent of predicted value. This needed to screen 19 elderly people at a cost of 923 baht to detect one case of COPD, with a false negative rate of 1.9 per cent (95%CI 1.3-2.5), a false positive rate of 17.5 per cent (95%CI 15.4-19.6). The questionnaire is the alternative choice of screening tool.

The cost-effectiveness of mini peak expiratory flow as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

This study aims to explore the cost-effectiveness of Mini Peak Expiratory Flow (miniPEF) as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities around Siriraj Hospital, using the gold standard of diagnosis based on the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated and completed all the tests. The results showed that the cut-off miniPEF percentage of predicted value of highest average accuracy was 62 per cent. The sensitivity was 72.7 per cent (95% CI 67.0-78.6) and the specificity was 81.1 per cent (95% CI 79.7-82.5) The cost of screening 19 elderly to detect one case of COPD is 923 baht, with a false negative rate of 1.9 per cent (95% CI 1.3-2.5%) and a false positive rate of 17.5 per cent (95% CI 15.4-19.6%). It is suggested that measuring a miniPEF is regarded as one of the cost-effective screening tests for COPD in the elderly.

The cost-effectiveness of a questionnaire as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

This study aimed to explore the cost-effectiveness of using a questionnaire as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the Bangkok elderly residing around Siriraj Hospital. The gold standard used for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. The questionnaire consisted of 10 questions on smoking status, respiratory symptoms and previous history of pulmonary tuberculosis. There were 3,094 elderly who participated, completed the questionnaire, and underwent spirometry as well as chest radiography in the community. The results showed that elderly individuals who are smokers (> 0.5 pack-year) or have ever experienced sudden cough with chest oppression or dyspnea when the weather changes or who have expectorated more than two tablespoons of sputum would be suspected of having COPD with a sensitiviy of 81.4 per cent (95% CI 79.4-83.4), specificity of 62.2 per cent (95% CI 60.4-64.0) false negative rate 1.2 per cent (95% CI 0.7-1.7) and false positive rate 38 per cent (95% CI 35.3-40.7) and subsequently required spirometry and chest X-ray for definitive diagnosis. The test needed to screen 17 elderly individuals to detect one COPD case at a cost of 1,538 baht. This questionnaire is also a self-assessment tool for COPD screening among the elderly in order to encourage them to seek for early medical attention and it is recommended that this should be publicized via the mass media.

The cost-effectiveness of chest radiography as a screening test for chronic obstructive pulmonary disease among the Bangkok elderly.

Regular screening with chest radiography (CXR) in an annual physical check up of the elderly is most frequently practiced. This study aimed to identify the CXR indices and the cost-effectiveness of CXR as a screening test for Chronic Obstructive Pulmonary Disease (COPD) among the elderly in 124 urban communities of Bangkok around Siriraj Hospital. The gold standard for diagnosing COPD followed the guidelines of the Thoracic Society of Thailand. There were 3,094 subjects who participated, completed spirometry and a CXR. The selected nine indices from PA and lateral CXR for diagnosing COPD were based on the presence of hyperinflation. The positive criteria of each index were reported. The cut-off point of best average accuracy ie, Z score of the CXR was 0.07 with a sensitivity of 75.9 per cent (95% CI 70.2-81.6%), specificity of 72.4 per cent (95% CI 70.8-74.0%) and the best average accuracy of 74.1 per cent (95% CI 72.5-75.7%) whereas the cost-effective cut-off point of a Z score of CXR as a screening test for COPD was 0.04 at the lowest grand total cost. The cost to detect one case of COPD was 2,008 baht and needed to screen 17 elderly. It is suggested that CXR is probably not a suitable screening test for COPD in the elderly due to the complicated derivation of the CXR indices. However, its efficacy may be of some value in in-office diagnosis of COPD.

Nationwide survey of the health status and quality of life of elderly Thais attending clubs for the elderly.

Thailand is seen as a developing Southeast Asian country with a fast-growing number of senior citizens. Meanwhile, they are also encouraged to attend a local club for the elderly for the sake of health promotion and disease prevention. Knowledge of the quality of life as well as the health status of elderly people in this setting would be invaluable for further planning. 1811 individuals from 66 provinces, who attended clubs for the elderly were recruited. Structured questionnaires with detailed instructions were distributed to clubs for the elderly nationwide. 61.4 per cent had a good quality of life. The independent factors determining poor quality of life were as follows: not living with a spouse, poor financial status, no regular exercise, sleeping or hearing difficulty, not taking milk regularly, suffering from joint pain or diabetes mellitus, history of a fall within the last 6 months and a poor mobility score and score of instrumental activities of daily living. No regular exercise had the highest adjusted odds ratio (2.38: 95% CI: 1.61-3.51). The main factors determining a poor quality of life in any region of the country were socioeconomic background in the northern region, having less exercise and joint pain in the eastern part and diabetes mellitus in the western region. Conclusion: All these factors should be part of the geriatric assessment among elderly Thais. Socioeconomic factors could be employed to screen for those who are at risk while the other reversible factors should be highlighted and treated properly in order to reduce the outcomes of poor quality of life in those attending clubs for the elderly.

The prevalence of obstructive sleep apnea among professional hospital drivers.

Background : Several reports have suggested that about one-fifth of car accidents are sleep-related and obstructive sleep apnea (OSA) is one of the major causes of increased daytime sleepiness. Various reports from western countries have shown that different groups of drivers, especially truck drivers have a high prevalence of OSA, which may play a part in the occurrence of car accidents. Objectives : To determine the frequency of OSA and other sleep related problems in a group of professional drivers. Study design : Descriptive study. Methods : All 21 male professional drivers at one government hospital, aged between 27-57 years old, were recruited to the study. Data were collected by clinical examination, questionnaire and overnight polysomnography. OSA was defined as a Respiratory Disturbance Index (RDI) or an apnea / hypopnea index of over 5 events per hour. Results : The prevalence of OSA was 4%. Only 1 subject had severe OSA with an RDI of 102. None of them reported having car accidents but 71% reported symptoms of daytime sleepiness. Conclusion : OSA was not very common among professional drivers in this study but there were other sleep related problems reported which might relate to an increased risk of car accident. Further study of sleep disorders and their association with car accidents in a larger and broader group of drivers is needed.

Tranexamic acid in patients with hemoptysis.

Hemoptysis is a common respiratory symptom leading to admission to hospital. The main management of hemoptysis depends on treating the underlying cause. The use of tranexamic acid is recommended by many doctors without much information available. MATERIAL AND METHOD: This study was a randomized double blinded placebo controlled trial in using tranexamic acid (Transamine) in hemoptysis patients. The study period was one week. Patients with hemoptysis were separated into 3 groups depending on the amount of blood. Group 1 consisted of patients with blood streak sputum. Group 2 coughed up less than 20 ml of frank blood. Patients in Group 3 were those who coughed up 20-500 ml of blood per day. A record of the amount of bleeding and drug side effects was done. RESULTS: From June 1994 to May 1997, 46 patients with hemoptysis completed the study. There were 21 in the tranexamic acid group and 25 in the placebo group. The placebo group had a tendency not to have underlying lung disease and more patients who had a normal chest X-ray. The benefit of tranexamic acid in shortening the days of hemoptysis is not shown in this study. There was a low incidence of side effects of tranexamic acid in this study. CONCLUSION: This randomized double blinded placebo controlled trial could not demonstrate the benefit of tranexamic acid in shortening the days of hemoptysis and confirm the low incidence of side effects of this drug.

Respiratory centre sensitivity and exercise tolerance in healthy Thais and in Thai COPD patients.

This study was conducted with the aim of determining the range of normal value of respiratory centre sensitivity and exercise tolerance in healthy Thais and any divergence from the normal range in those with COPD. Findings in healthy subjects disclosed that the end-tidal PCO2 and tidal volume response to CO2 were higher and exercise tolerance was lower among the elderly compared with younger subjects; only in young males was the ventilatory response to CO2 higher than in females. In the group of Thai COPD patients, all data were comparable to those of the match healthy subjects, with the exception that one-third of the patients experienced stronger ventilatory drive while breathing room air and a lower musculo-ventilation transfer index during room-air breathing as well as CO2 rebreathing.

Tuberculosis of the cervical lymph nodes.

Analysis of 188 patients with pathological diagnosis of tuberculosis or findings consistent with tuberculosis of the cervical lymph nodes during the period 1985-1988 disclosed the following pertinent findings: (1) The histo-pathological diagnoses, based on findings of chronic granuloma with or without the presence of acid-fast bacilli (AFB) on staining, were “probable tuberculosis” in 38.8 percent of the cases, and “consistent with tuberculosis” in 61.2 percent of them. It is worthy of note that proof for AFB in the 1973 report (from the same laboratory) was available only in 1.58 percent of the cases.1 (2) The supraclavicular group was the frequently diseased of the lymph nodes as found in a previous study;1 this finding also conforms to the high incidence of palpable supraclavicular lymph nodes in pulmonary tuberculosis patients.5 This persistent prevalence of the site of tuberculous involvement may be used as evidence in support of early post-primary haematogenous dissemination of the pathogenic organism, rather than the less occurring lymphogenous spread from the site of upper digestive tract infection, as recently suggested.4

Infectious pneumonia among COPD patients.

This communication described our experiences on pneumonia’s in patients with chronic obstructive pulmonary disease (COPD) exclusive of bronchial asthma (based on cases admitted during the past three years at the Siriraj Hospital), compared to pneumonia’s in previously healthy persons. There were conspicuous discrepancies between the two groups of patients in respects to their clinical manifestations (symptoms, physical signs, chest radiographic features, complete blood counts and arterial blood gas analysis), microbiological profiles, medical treatment and outcome.

Microbial florac in sputum of patients with chronic obstructive pulmonary disease.

This study was conducted to determine the variety of micro-organisms in the sputum of COPD patients, comparing those found in the stable quiescent stage with those appearing during acute exacerbation. The results showed no clear-cut differences in the distribution of either normal florae or potential pathogens in both of the diseased states. Haemophilus influenzae and pneumoniac seemed to no role in the occurence of acute exacerbation of COPD. Findings of Gram-negative bacilli in high rates, during the acute exacerbation and the quiescent states, possibly accounted for the presence of acute infection pneumonia but not the perpetuation of acute exacerbation in COPD patients.