Stress, but not Helicobacter pylori, is associated with peptic ulcer disease in a Thai population.

The purpose of this study was to clarify the relation between psychological and other risk factors, notably helicobacter pylori (H. pylori) infection, in contributing to the occurrence of peptic ulcer (PU) disease. A retrospective case-control study was conducted at Siriraj Hospital, Bangkok from March to December 2000. Seventy endoscopically diagnosed patients with new PU or peptic perforation were compared with 70 patients with other diseases as well as blood donors control matched for age and sex. Historical risk factors, H. pylori Immunoglobulin G antibody (H. pylori IgG Ab), stress (Perceived Stress Questionnaire) and hostility (MMPI Hostility Scale) were assessed. Data were analyzed using logistic regression analysis. The results showed that PU was associated with chronic stress (aOR 2.9, p = 0.01; 95% CI, 1.3-6.5) and family history of PU (aOR 2.4, p < 0.03; 95% CI, 1.1-5.1), with an interaction effect between stress and irregular mealtimes (aOR 4.8, p = 0.01; 95% CI, 1.3-16.9). The incidence rate of H. pylori infection in PU patients was similar to the control group (61.4% and 50.0%, respectively, OR 1.2). The authors conclude that stress and family history, not H. pylori infection, are important risk factors for PU in this population. This finding supports previous studies in Thailand, showing a high prevalence of H. pylori in the population but a low association with PU, in contrast to developed countries. It remains to be seen whether the impact of a family history is due to genetic factors or shared life-style patterns.

Quality of life and functional status of patients with hip fractures in Thailand.

Measurement of quality of life and functional status provides important additional information for priority setting in health policy formulation and resource allocation. Hip fracture has been a concern in health planning in developing countries due to an increasing trend, as reported in several studies. Ironically, in developing countries, studies of the impacts of hip fracture on quality of life and functional status are rare. This prompted our team to seek evidence of the impacts using a longitudinal follow-up approach in a Thai setting. In this study, health-related quality of life (HRQOL) before and after hip fractures was evaluated in 250 Thai patients. Measurement of HRQOL was based on a modified SF-12 questionnaire, which was developed with a realization of the following demands: 1) cultural sensitivity of measurement tools; 2) disease-specific HRQOL measurement and 3) feasibility of conducting field work. Functional status was measured using an adapted version of the Index of Activity of Daily Living (ADL), which was previously developed in another setting in Thailand. Mild, moderate and severe deficits in quality of life were found in 36%, 60%, and 4% respectively, of surviving patients. The number of patients with physical functioning dependency, as measured by the ADL, also increased significantly in all 10 activities assessed. Comorbidities were associated with deficits in health-related quality of life but age, sex, income, education level, and surgery were not. Our findings indicate that hip fracture could lead to crippling consequences, with a pronounced effect on the quality of life of Thai patients. Further studies using control groups and longitudinal design are needed to validate the results of this study.

Prevalence estimation of dementia among Thai elderly: a national survey.

OBJECTIVE: To determine the prevalence of dementia and its associated factors among Thai elderly. DESIGN: A one-stage cross-sectional national survey. SETTING: National communities in Thailand. SUBJECTS: 4,048 elderly subjects aged 60 and above. RESULTS: There were 668 (16.5%) elderly with a CMT score below 15. Among these elderly, 132 were dependent as to certain aspects of self-care. According to the definition of dementia used in this one-stage survey design (i.e. subjects with a low CMT score and self-care dependence), 3.3 per cent of Thai elderly (95% confidence interval = 2.7-3.8) were classified as having dementia. After adjusting to geographic and municipal area, the prevalence rate was 3.4 per cent (95% confidence interval = 2.8-4). Age-specific prevalence rate increased dramatically from 1.0 per cent in the 60-64 age-group to 31.3 per cent in the 90+ age-group. The prevalence rate of dementia among Thai elderly found in this study did not differ from the prevalence rates among the elderly in other Asian and developed countries. Using a logistic regression analysis, 3 independent factors associated with dementia were age, literacy (writing) and geographic area. CONCLUSION: With a one-stage survey design for determining the prevalence of dementia, the prevalence rate and age-specific prevalence rate among the Thai elderly did not differ from those found in other Asian and developed countries.

Physical activity and risk factors for hip fractures in Thai men.

To test the hypothesis that hip fracture is associated with physical activity in Thai elderly men, a case-control study was conducted in Bangkok, Thailand. A total of 187 men aged 51 years over, resident in Bangkok, admitted consecutively with a radiologically confirmed first hip fracture were studied. 177 age-matched community controls were randomly recruited from the same neighborhood of the cases. Physical activity was independently associated with reduced risk of hip fracture after controlling for confounding factors. Very active and active past physical activity markedly reduced risk of hip fracture in comparison to subjects with inactive past physical activity. Recent active physical activity was also protective against hip fracture. This prompts a need to identify strategy to promote physical activity among the elderly and at an early age.

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.

Coverage of public reimbursement scheme for traffic accident victims in Thailand.

Traffic injury is a major threat to public health. Loss of lives and property due to traffic accidents raise concern not only among the public but also the government. As a result, the Motor Vehicle Accident Victim Protection Act was enacted in order to provide compensation for traffic accident victims and their relatives in 1992. Three years after the Accident Victim Protection Act came into effect, this study, through telephone survey, revealed that less than 10 per cent of traffic accident victims were reimbursed for medical care cost by the law. The process of reimbursement was found to be cumbersome. In addition, only 18 per cent of motor vehicles were found holding insurance policies as required by the law.

Retailers' compliance to the law banning cigarette sale to minors.

In order to prevent smoking addiction, a law banning cigarette sales to minors was enacted in 1992. In market economy countries, studies have shown that enforcement of such a law is not effective(1,2). Almost three years after enactment of the law in this country, there is no evidence regarding the extent of law enforcement. If law enforcement is going to be effective, concerns of politicians and authorities must be mobilized. This study aims at testing retailer compliance to the law. Students aged 9-17 years were sent into 773 stores to buy a pack of cigarettes. The stores were located on main streets in 5 major cities. It was found that nearly all (90.6%) of the retailers violated the law. Ten per cent of the stores showed a sticker stating that "cigarette sale to children under 18 years is banned". However, all of them did sell cigarettes to the students. A set of intervention will be tested to find out effective approaches for law enforcement.

A multicenter study on hip fractures in Thailand.

The present study is a multicenter study on hip fractures aimed at estimating the incidence among Thais. It also describes treatment modalities, associated medical care costs, complications, outcome of orthopedic care, length of stay in hospitals and duration of delay in seeking orthopedic care after occurrence of fractures. An extremely low hip fracture incidence of 7.05 per 100,000 population was found. Hip fracture was shown to increase steeply with age. An average of 26.44 days of delay in seeking orthopedic care following occurrence of hip fractures was reported. In contrast to the belief in Western countries that almost all hip fractures will seek orthopedic care, 7.8 per cent of these Thai cases denied orthopedic care during admission to hospitals. Median of charge to patients was 11205.00 baht, over one fourth of the national income per capita (36,563).

Situation of hypertension in some Bangkok slums.

A cross-sectional epidemiologic survey was undertaken in slums in the catchment areas of two health centers in Bangkok. Two hundred and sixty representative households were randomly selected. All adults (993) aged 20 years and over who lived in the households were asked to participate. The results were, however, based on 809 subjects (89%) who responded and whose data were completed. It was found that prevalence of hypertension (blood pressure > or = 160/95 mmHg) was 14 per cent with a 95 per cent confidence interval of 11.8 and 16.4 per cent. Nearly half of the hypertensives were found to be mild cases (diastolic blood pressure = 95-105 mmHg). Less than half of the hypertensives were aware of their condition. Even a lower proportion was under treatment and had their blood pressure controlled. The results confirmed earlier studies that slum inhabitants seem to be at high risk of hypertension. Furthermore, the status of hypertensives in terms of awareness, treatment and control was unacceptably poor. This prompts a need to develop community programmes to cope with the problems.

An investigation of hypertension in a slum of Nakhon Ratchasima.

There is evidence that Thai people living in slums may be at high risk of developing hypertension. The present study was undertaken on a random sample of 1,000 subjects aged 20 and over living in a slum in Muang district of Nakhon Ratchasima during 1 February to 31 may 1988. This study consisted of measurements of blood pressure and body build, with administration of an interview on demographic characteristics, sociocultural factors and food frequency patterns. The results were based on 804 respondents. It was found that the prevalence of hypertension was 16.9%, nearly half of the hypertensives being mild cases. Only a low proportion of the proven cases was both aware of their condition and receiving treatment. About one fifth of the treated cases had blood pressure under 160 mm Hg systolic and 95 mm Hg diastolic. Based on these findings, it is concluded that these slum inhabitants are at high risk of developing hypertension. Community interventions are needed in order to prevent complications related to hypertension. Health education aimed at increasing community awareness of hypertension should be a major component of the community intervention.

Prevalence, detection and control of hypertension in Thai population of a central rural community.

Epidemiolagical survey of hypertension was carried out on 2,374 villagers, aged 15 years and above, residing in Bang-Pa-in district, Ayutthaya province. The overall prevalence of hypertension was 11.3 per cent. The prevalence rate of pure systolic hypertension rose with age up to elderly; whereas the prevalence rate of diastolic hypertension increased with age up to late middle age, then declined in the elderly. Regarding the detection of hypertension, only 41.6 per cent of the cases were previously detected. And only 30.1 per cent of the cases were under current treatment. Females had a greater proportion of previously detected and currently treated cases than males. Among those currently treated hypertensive patients, 50.5 per cent went to see a physician, 29.5 per cent went to the local health centers; the rest sought the services of local quacks, traditional healers and drug stores. It yielded only 24.7 per cent of the treated cases whose BP were under control. Since the people prefer seeking help from local personnel, the role of community health personnel should be strengthened to bring more effective control of the disease.