Feeding and eating disorders among hospitalized children and adolescents in Thailand: A 5-year secondary national database analysis.

AIMS: This study aimed to present national data for children and adolescents requiring hospitalization in Thailand. BACKGROUND: Feeding and eating disorders can cause life-threatening and negative health impacts. In Asia, the prevalence is rising. Data from children and adolescents in Thailand are limited. DESIGN: This study is a retrospective study of the national database. METHODS: Data from the National Health Security Office database on Universal Health Insurance Coverage (2015-2019) of 0-17-year-olds were analysed by diagnosis (anorexia nervosa, bulimia nervosa, vomiting associated with psychological disturbances, other eating disorders and unspecified eating disorders). Descriptive statistics, chi-square test and multinomial logistic regression were used. RESULTS: There were 163 patients, averaging 9.4 ± 5.2 years old, requiring 205 admissions. Most diagnoses showed stable trends, except for a slight decrease in anorexia and unspecified eating disorders. Most admissions were due to unspecified eating disorders and psychogenic vomiting, followed by anorexia nervosa. The overall prevalence was 3.86 per 100 000 admissions. Anorexia had the highest hospital costs and re-admission rates. Anorexia nervosa was most prevalent in early adolescence and females, while bulimia nervosa was most prominent in middle adolescence and had a male predominance. CONCLUSION: Early recognition in clinical practice could increase early detection and improve outcomes.

Five-Year Trend of Adolescent Hospitalizations and Deaths in Thailand: A Secondary National Data Health Situation Analysis.

Adolescence is a critical phase for achieving human potential, serving as the foundation for later health. In 2010, the major causes of hospital admissions and deaths in Thai adolescents were related to preventable causes, specifically engagement in high-risk behaviors such as unprotected sexual intercourse, substance use and unsafe driving. We retrieved data from 1,761,667 adolescent (10-17 years) hospital admissions and 6362 deaths between 2015 and 2019 from the National Health Security Office database. Trends of hospital admissions and deaths, length of stay and medical expenses by sex, age: early (10-13 years) and middle adolescents (14-17 years), and geographical regions were analyzed by ICD-10 disease group and single diagnosis. Hospital admissions increased in relation to the same age population from 2015 to 2019. Trends of the top 3 diagnoses shifted between disease groups from 2015 to 2019. Pregnancy retreated from the first (17.8%) to the third rank (12.2%), and arthropod-borne viral fevers advanced from the third (13.1%) to the first rank (17.1%). Injury and poisoning remained at the second rank (14.5-14.4%). Females were admitted more than males, but males had significantly longer hospital stays. Early adolescents were admitted less than middle adolescents and their hospital stay was significantly shorter. Trends of the top 3 diagnoses for deaths by disease groups remained stable: injury and poisoning (41.2%), neoplasms (10.2%), and respiratory infections (9.5%). The average direct health care cost utilized on adolescent health care was 3813 million Baht (115.54 million US Dollars) per year. Considering the top 3 disease groups, injury and poisoning had the highest average cost per hospital admission and net cost per year consuming 26.4% of the total cost. Our study highlights the cause of hospital admissions and deaths in Thai adolescents, which are mainly preventable. Adolescent health care will improve with more investment in prevention through policy, service, and education reform.

HEEADSSS up: pediatric residents' confidence and practice in adolescent health care before and after mandatory adolescent medicine rotations in Thailand.

Background The field of adolescent medicine is an emerging area of specialization in Thailand. Adolescent medicine was made a mandatory rotation in general pediatric residency training programs for the class of 2013. Objective This study aims to explore the difference in pediatric residents' confidence and the frequency in providing aspects of care to adolescents. Subjects Participants included two groups of pediatric residents; the former curriculum group (FCG) in 2012 and the mandatory curriculum group (MCG) in 2015. Methods Participants in this cross-sectional study answered a 41-item self-administered questionnaire and results were analyzed by descriptive statistics. Results There were 91 participants, 50.05% were in the MCG. The FCG reported a higher percentage of feeling "more confident" on physical examination (p = 0.031, V = 0.23) and growth assessment (p = 0.040, V = 0.22). The MCG reported a higher percentage of "more frequently" carrying out the psychosocial assessment (p = 0.035, V = 0.22). Conclusion The FCG reported higher levels of confidence than the MCG in most of the items, while the MCG reported higher levels of frequency in providing care. The psychosocial (HEEADSSS) assessment, a key aspect of the adolescent clinical visit, was the item that the MCG reported doing more frequently than the FCG which remained significant when only the postgraduate year of training (PGY) 4s were compared.

Risk Factors for HIV Infection among Young Thai Men during 2005-2009.

BACKGROUND: Thailand is one of several countries with a continuing generalized HIV epidemic. We evaluated the risk factors for HIV prevalence among 17-29 year old men conscripted by a random process into the Royal Thai Army (RTA) in 8 cohorts from 2005-2009. METHODS: A series of case-cohort studies were conducted among the male RTA conscripts who had been tested for HIV seroprevalence after they were inducted. Men who were HIV positive were compared with a systematic random sample (1 in 30-40) of men from the total population of new conscripts. Each subject completed a detailed risk factor questionnaire. RESULTS: A total of 240,039 young Thai men were conscripted into the RTA and were screened for HIV seroprevalence between November 2005 and May 2009. Of 1,208 (0.5%) HIV positive cases, 584 (48.3%) men were enrolled into the study. There were 7,396 men who were enrolled as a comparison group. Among conscripts who had an education lower than a college-level, the independent risk factors for HIV infection were age in years (AOR 1.38, 95% CI 1.28-1.48), a history of sex with another man (AOR 3.73, 95% CI 2.70-5.13), HCV infection (AOR 3.89, 95% CI 2.56-5.90), and a history of sex with a female sex worker (FSW) (AOR 1.35, 95% CI 1.10-1.66). Among conscripts who had a college degree, the independent risk factor for HIV infection was a history of sex with another man (AOR 23.04, 95% CI 10.23-51.90). Numbers of sexual partners increased and the age at first sex, as well as the use of condoms for sex with a FSW decreased in successive cohorts. CONCLUSION: The HIV seroprevalence among cohorts of 17-29 years old men has remained at about 0.5% overall during 2005-2009. The most significant behavior associated with HIV prevalence was a history of sex with another man. Our data indicate continuing acquisition of HIV among young men in Thailand in recent years, especially among men with a history of same sex behavior.

Associated factors of blood pressure control and complications of hypertension in hypertensive rural Thai populations of Baan Nayao, Chachoengsao Province.

OBJECTIVE: To assess associated factors of uncontrolled blood pressure and complications of hypertension in hypertensive rural Thai populations. MATERIAL AND METHOD: A cross-sectional study was conducted in hypertensive rural Thai people aged > or =35 years-old in Baan Nayao, Chachoengsao Province, Thailand. Blood pressure (BP) was measured and questionnaires were answered. After 12-hr fasting, blood samples were taken for determining plasma glucose, lipid profiles and serum creatinine. Morning urine samples were collected for microalbuminuria testing and electrocardiography (ECG) was performed to detect left ventricular hypertrophy (LVH). RESULTS: Of the 289 participants (97 males and 192 females) mean duration of hypertension was 4.29 +/- 4.95 years and 61.5% did not achieve target BP control. Among participants who had ECG performed and urine sample investigation, 15.7% demonstrated LVH and 25.3% had microalbuminuria. In uncontrolled BP participants, 20% had LVH and 24.8% had microalbuminuria whereas in controlled BP participants, 7.8% had LVH and 26.1% had microalbuminuria. Uncontrolled BP was associated with males, dyslipidemia, diabetes, abdominal obesity, metabolic syndrome, always having salty food and salts added for seasoning. The independent risks of uncontrolled BP were hypertensive male (OR = 2.48, 95% CI = 1.07-5.76) and metabolic syndrome (OR = 2.59, 95% CI = 1.24-5.40). Males were also at risk for LVH (OR = 2.86, 95% CI = 1.31-6.23) and history of lipid disorders was a risk of microalbuminuria (OR = 3.13, 95% CI = 1.47-6.67). CONCLUSION: Males and metabolic syndrome were independently associated with uncontrolled BP in hypertensive participants. Males had more risk than females to develop LVH and having history of lipid disorders lead to microalbuminuria occurrence. Thus, life style modification may prove beneficial to these rural hypertensive participants.

Prevalence and hematological parameters of thalassemia in Tha Kradarn subdistrict Chachoengsao Province, Thailand.

OBJECTIVE: To determine the prevalence, molecular characteristics and hematological study of thalassemia in Tha Kradarn Subdistrict Chachoengsao Province. MATERIAL AND METHOD: The present study population consisted of266 participants from Moo 19 Baan Na-Ngam, Chachoengsao Province, Thailand. After blood collection, all samples were screened for thalassemia by initial screening with the OF and DCIP tests and additional testing by CBC, RBC indices, hemoglobin typing and determination of Hb A2 and Hb E. All common alpha-thalassemia mutations were determined using the PCR with allele specific primers and Gap PCR for common deletions. RESULTS: The prevalence of alpha-thal 1, alpha-thal 2 and beta-thal were found as 2.72%, 11.26% and 0.97%, respectively. Regarding the abnormal hemoglobins, the prevalence of Hb E, Hb Constant Spring and Hb Pakse was 38.45%, 3.69% and 0.78%, respectively. MCV and MCH were significantly different between P-thalassemia as well as a-thal 1 carriers and normal subjects. In all alpha-thal 1 traits, it was found that the MCV and MCH were less than 75 fL and 25 pg, therefore, these parameters can be used for alpha-thal 1 screening. CONCLUSION: In the present study, the prevalence of thalassemia was similar to previous studies. Moreover, using the combination of OF and DCIP tests compared with MCV, MCH and DCIP tests for the initial thalassemia screening, it was found that the OF and DCIP tests gave more false positive results, which increased the need for further Hb typing. Hence, the MCV and MCH combined with DCIP tests provide cost minimization and practical for a large population-based screening program.

Prevalence of disease and non-battle injury, anxiety and depression in the Royal Thai Armed Forces during the operation of the United Nations in Burundi.

OBJECTIVE: To determine the prevalence and impact of common disease and non-battle injuries (DNBI) among the military personnel deployed to the operations of the United Nations (UN) in Burundi from June to December 2005. MATERIALS AND METHODS: The study population consisted of 175 Thai military personnel. A pre- and post deployment questionnaire assessing demographic data, general health, dental problems, underlying disease and health risk behaviors was performed. The information of DNBI was collected weekly. Data on initial visits for 27 DNBI categories were complied at the unit and event data on morbidity measures for each DNBI category were aggregated for all reporting units on a weekly basis. Anxiety and depression were assessed using the Hospital Anxiety and Depression (HAD) scale. RESULTS: The majority of the troops was in good health at pre- and post deployment. The total weekly initial visit DNBI rate was 337.6 visits per 1,000 persons, which was rather high compared to the Joint Chiefs of Staff (JCS) reference rate. The most common DNBI categories were respiratory illnesses (21.9%), medical/surgical injuries (19.8%) and recreational injuries (15.5%). CONCLUSION: The present data indicated that despite modern preventive medicine measures, illnesses and non-battle injuries were still common, which had a significant impact on military readiness and operational efficiency.

How we teach military medicine to medical cadets at Phramongkutklao College of Medicine.

Phramongkutklao College of Medicine has a unique curriculum for "Military Medicine." Military Medicine involves prevention, threat assessment, evacuations and clinical management of diseases and injuries resulting from military occupational exposures. The Military Medicine curriculum covers all the entities of knowledge of Military Sciences, Combat Medical Skills, Military Preventive Medicine, Military Applied Physiology and Military Contingency Medicine. The highlight of the curriculum is "Operation Petcharavut" that represents simulated battlefield operations, involving multidisciplinary clinical integration and military regulation. In this course, medical cadets review all the knowledge that they have learnt and in addition, Medical Platoon leader strategies, Advanced Cardiac Life support and Phramongkutklao Traumatic Life support, crucial medical practices. Medical cadets would experience simulated patients with minimal injuries to critical wounds and complications including combat stress syndromes in various situations, from advancing to retreating units and from Battalion Aid Station to Division Medical Operations Center, whether during day or night. Since the medical cadets experience all Military Medicine courses from the second to the sixth year class and pass all medical knowledge-based examinations, Phramongkutklao College of Medicine expects all graduates to be excellent in not only all standard requirements of the medical professional set forth by the Medical Council of Thailand but also ready to serve the nation effectively in the Royal Thai Armed Forces.

Seroprevalence of hepatitis A in thai army medical cadets and nursing students: a reflection of regional risk differences.

A cross-sectional study of 432 army college students comprising 278 medical cadets and 154 nursing students, ages ranging from 15 to 26 years, was conducted in 2001 to determine the seroprevalence of hepatitis A virus (HAV) antibody. Serum specimens were tested for HAV antibody by a commercial enzyme immunoassay method. Anti-HAV was detected in 14.0%, 17.5%, and 15.3% of medical cadets, nursing students, and the total cohort, respectively. There was no statistically significant difference in seroprevalence between medical cadets and nursing students. Increasing prevalence of HAV correlated with increasing age. Significantly higher seroprevalence was detected in students from provinces outside of Bangkok compared to those who were from Bangkok (18.7% vs. 9.8%). The highest HAV seroprevalence was observed in subjects from the northeastern region of Thailand, suggesting that this region may be associated with greater risk for infection and should be the focus of preventive health strategies.

Spore shedding pattern of Enterocytozoon bieneusi in asymptomatic children.

Stool samples from seven human immunodeficiency virus (HIV)-negative and two HIV-positive children with asymptomatic Enterocytozoon bieneusi infections were daily examined to quantify spore shedding using Gram-chromotrope staining under light microscopy. The spore shedding pattern and intensity in these children was variable. Mean spore concentrations in the stool samples from these children ranged from 2.4 x 10(2) to 1.2 x 10(5) spores per gram. Light microscopy could detect spores in stool specimens for 9-33 days, while PCR was able to detect E. bieneusi in stool specimens for 3-40 days longer. This suggests that light microscopy may not detect low levels of spore shedding. Considering that the asymptomatic group are a potential source of infection, detection methods with a higher sensitivity should be used.

Teaching medical ethics: Phramongkutklao College of Medicine's model.

BACKGROUND: Third-year (first preclinical year) Royal Thai Army (RTA) medical cadets were exposed to a rural community in a community medicine field activity. The poor, kind rural people gave good conditions for student's professional development and empathy. OBJECTIVES: To report a community medicine field work activity for professional development of the RTA medical school. MATERIAL AND METHOD: Descriptive analysis on two occasions to evaluate the third-year RTA medical cadets' impressions immediately after the community medicine field activity in a rural area in central Thailand and one year later using baseline scores of cadets' impressions against our institute's objectives. RESULTS: At the end of the field work, 90.9% of the cadets reported they achieved several institute objectives. The four most frequent mentioned were ethical development (70.6%), professionalism (84.3%), human relationship & communication skills (92.2%), and capability to work in the cmmunity (64.7%). Furthermore, RTA medical cadets rated the staff as good role models (51%). CONCLUSION: The community field work course provided a good environment for the third year medical cadets in building morality and professional development to be good doctors.

Albuminuria in rural Thai people: a community-based screening with Combur Test and Micral Test strips.

OBJECTIVES: To identify albuminuria prevalence and examine the association of albuminuria with plasma glucose, blood pressure and body mass index in rural Thai people aged 35 and older. MATERIAL AND METHOD: All volunteer adults aged 35 and older at Ban Nayao, Chachoengsao Province were recruited in this cross-sectional study. Macroalbuminuria and microalbuminuria were tested in first morning urine using Combur and Micral Test strips. Fasting plasma glucose, blood pressure, weight and height were determined. Chi-square and multiple logistic regression analysis were used for analysis. RESULTS: Of the 357 participants, 26.61% had microalbuminuria, 3.08% had macroalbuminuria, and 9.2%, 19%, 7.3% had diabetes, hypertension, and obese, respectively. The prevalence of microalbuminuria and macroalbuminuria in people with diabetes were 30.30% and 15.15%, respectively. In the obese, the prevalence was 50% and 3.8% and was 30.88% and 7.35% in the hypertensive group, respectively. Strong significant associations between plasma glucose (p = 0.013), and body mass index (p = 0.008) with the progression of albuminuria were observed. According to multiple logistic regression analysis, diabetes and obesity were independent risk factors for albuminuria statistically significant (p = 0.036 and p = 0.005, respectively, 95% CI). CONCLUSION: The present study showed increased risk of albuminuria in diabetes and in obese people in a rural area of Thailand. Thus, community-controlled diabetes and weight program should be introduced to the rural community.

Dietary behaviors and nutritional status of adolescents in a remote rural area of Thailand.

INTRODUCTION: Nutritional status among adolescents is an important health indicator. The up-to-date information about nutritional status and food consumption pattern in the remote rural area is required for the effective public health intervention in the rural area of the country. The present study aimed to demonstrate the prevalence of malnutrition, eating behavior and nutritional knowledge among secondary school students in a remote rural area in Thailand. MATERIAL AND METHOD: Body weight and height data were collected from 298 secondary school students for nutritional status calculation using the Institute of Nutrition Research, Mahidol University, INMU-Thaigrowth program. Eating behavior and nutritional knowledge were observed by self-administrated questionnaires. RESULTS: The prevalence low height-for-age (<-2SD) 6.1% and it was 0.7% for low weight-for-height (<-2SD). Fruits (69%) and vegetables (79.4%) consumptions were in the high level. The authors found that the students always consumed commercial snacks especially salted chips more often than regular Thai dessert (74.0% VS 52.3%). The inappropriate behavior found in the present study included always drinking caffeine beverage (43.5%), always drinking alcoholic beverage (6.5%) and always consuming instant noodles (64.4%). CONCLUSION: The prevalence of malnutrition was low among this population. The studied population had a fair knowledge about nutrition. The authoes found that regular consumption of highly commercialized snack products especially salted chips and instant noodles were at a high level in this remote rural area of Thailand. The pattern of nutritional problems in Thailand may have changed in which a public health program for children in rural areas of the country should recognize this transition.

Screening for thalassemia and hemoglobinopathy in a rural area of Thailand: a preliminary study.

The present study aimed to screen thalassemia and hemoglobinopathy in Baan Na-Ngam, Chachoengsao Province, Thailand. Blood samples were obtained from 266 volunteers; 105 males and 161 females aged 7 to 49 years. Blood samples screened for thalassemia combining the OF and modified DCIP precipitation tests. CBC, RBC indices, hemoglobin typing, HbA2 and Hb E were determined. Combined OF and DCIP tests found that in normal subjects, 128 out of 155 were negative for both, 3 were -/+ pattern, 22 were +/- pattern and 2 was positive for both. Interestingly, one sample showed an abnormal hemoglobin pattern, which could not be determined by automated LPLC. Three beta-thalassemia trait subjects were positive for only the OF test. For the Hb E trait, 57 out of 94 were -/+ pattern; 37 were positive for both tests. Moreover, 14 homozygous Hb E subjects were positive for both tests. The prevalence of beta-thalassemia trait was 1.1%, Hb E trait was 35.3% and homozygous Hb E was 5.3%. Since DNA analysis was not performed, alpha-thalassemia1 and alpha-thalassemia2 traits cannot be excluded. In conclusion, a combination of the OF and DCIP tests is suitable for preliminary screening for thalassemia and hemoglobinopathy. However, RBC parameters, hemoglobin typing and PCR analysis will provide more specific diagnosis, especially in alpha-thalassemias.