Adiposity rebound from three to six years of age was associated with a higher insulin resistance risk at eight-and-a-half years in a birth cohort study.

AIM: The association between adiposity rebound and insulin resistance in middle childhood has seldom been studied. We examined the effect of body mass index (BMI) velocity and early adiposity rebound on the insulin resistance of prepubertal children. METHODS: BMI data from a longitudinal follow-up of a birth cohort in Thailand were used. The homoeostatic model assessment of insulin resistance (HOMA-IR) was calculated from 12-hour fasting plasma glucose and serum insulin at eight-and-a-half years of age. BMI velocity was calculated from four periods: zero to one, one to three, three to six and six to eight-and-a-half years of age. A multiple linear regression model was used to assess the association of BMI velocity during these four periods and insulin resistance at the age of eight-and-a-half years. RESULTS: In 814 children - 76.7% of the initial cohort - BMI velocities between years one to three, three to six and six to eight-and-a-half years were positively associated with HOMA-IR levels after adjusting for demographic, behavioural and socio-economic factors. Children who had BMI gains between three and six years had mean HOMA-IR values that were 43% higher than those who did not. CONCLUSION: BMI velocity during early and middle childhood, and early adiposity rebound between three and six years, was associated with a higher insulin resistance risk at eight-and-a-half years.

Factors associated with bed sharing and sleep position in Thai neonates.

BACKGROUND: Sleep in a supine position and in a bed separate from but proximate to adults is recommended, in several Western countries, to prevent Sudden Infant Death Syndrome (SIDS). Cultural differences and a lower rate of SIDS in Asian populations may affect concern with this problem and thus infant sleeping arrangements. Objective To study bed sharing and sleep position in Thai neonates and the relationship to infant and maternal characteristics. METHODS: A cross-sectional survey based on interviews with parents of infants aged 21 days old, was conducted under the Prospective Cohort Study of Thai Children. RESULTS: Of the total sample, 2236/3692 (60.6%) infants shared a bed with their parents. Sixty per cent of the parents placed their infants to sleep in a supine position, 32.2% on their side and 4.9% in a prone position. Bed sharing was associated with older maternal age, higher education, Muslim mother, and with work status of professional career or unemployed. Placing the infants to sleep in a prone position was associated with infant birth weight of greater than 2500 g, older maternal age, higher education, Buddhist mother, mother with professional career and middle-class household economic status. CONCLUSIONS: Infant bed sharing is a common practice in the Thai culture, as in other Asian countries. The prone sleep position is less common than in Western populations. The main factor associated with both bed sharing and putting infants to sleep in the prone position was a higher maternal socioeconomic status (SES), in contrast to previous studies in some Western countries in which both practices were associated with low maternal SES. Cultural differences may play an important role in these different findings.

Relationship between atopic dermatitis and wheeze in the first year of life: analysis of a prospective cohort of Thai children.

BACKGROUND: Patients with atopic dermatitis show increased risk of concomitant respiratory symptoms such as wheeze and cough. However, limited data is available on respiratory symptoms in atopic dermatitis patients when the disease is in remission. OBJECTIVE: The aim of this study was to investigate the relationship between atopic dermatitis and wheeze during periods of active disease and remission of atopic dermatitis. METHODS: The study formed part of the Prospective Cohort Study of Thai Children (PCTC) involving children born during the period October 2000 to September 2002. The principal caregiver in each family was identified and interviewed about socioeconomic factors, paternal health, and exposure to tobacco smoke. Data on wheeze and atopic dermatitis were collected from questionnaires administered at 6 and 12 months after birth. RESULTS: Of the 4245 live births included in the PCTC cohort, 4021 (94.7%) participated in the follow-up survey at age 6 months and 12 months. The prevalence of wheeze and eczema were 13.8% and 7.4%, respectively. There was also a significant association between current atopic dermatitis and wheeze in the same period (P < .01). However, no significant association was observed between previous atopic dermatitis and wheeze when atopic dermatitis was in remission. CONCLUSION: There is a significant increase in the risk of wheeze in infants with current atopic dermatitis but not in those in whom the disease is in remission.

Thailand's national death registration reform: verifying the causes of death between July 1997 and December 1999.

A fundamental aspect of public health is the accuracy of death certification. Assessing the death registration system is a step toward improving the quality of death reporting. Thailand implemented a more rigorous and informative pilot death registration system in March 2001 in 18 provinces, followed by nationwide implementation in August 2003. Since Thailand is an industrializing nation, its experiences will be of interest to other developing nations planning similar reforms. The causes of all deaths in the 15 provincial pilot projects (of Thailand's 76 provinces) and a random sampling in Bangkok were investigated between July 1997 and December 1999. Health workers interviewed close relatives and three medical doctors reviewed hospital records to verify the causes of death. We were able to interview 78% of the relatives (i.e. 47,632 in number). Three-quarters (76%) of the deceased had sought prior medical care; 41% died in hospital and 54% at home. The overall agreement between the causes of death in our survey vs. that reported on the death certificate was 29%. The highest agreement was for: 'Ill-defined' causes (33%), 'Cancer and Tumors' (17%), 'External Causes' (16%), and 'Infectious Diseases' (10%). Considering the different patterns among age groups and sex, hypertension with stroke, cancer of the liver and bile duct, and HIV infection, were the highest ranking causes among females. Infectious diseases (especially HIV/AIDS), hypertension with stroke and accidents, were the leading causes of deaths among males. External causes were highest among children and young adults.

A national survey of health-service use in Thai elders.

OBJECTIVES: To examine the pattern of health-service use and associated factors among elderly people in Thailand. DESIGN: A cross-sectional multi-stage random sampling household survey. SUBJECTS: 4480 People aged 60 and over. MAIN OUTCOME MEASURES: Responses to illness among elderly Thai subjects and health-service utilization. RESULTS: Of 1954 elderly Thai subjects who reported that they had had an illness without hospitalization during the last month, 93% had sought treatment and 7% did nothing. Just over a half (52.8%) used health services. Subjects who had self-limiting symptoms or diseases tended to not use health services, while subjects with chronic conditions did. Sixty-two percent paid for treatment themselves while 28% of them had their bills paid by their children. Independent determinants of health-service use included living in a rural area, being well-educated and better off, not drinking alcohol and the severity of illness identified. CONCLUSIONS: We found a low rate of state health-service use. Children had an important role in taking care of parents.

Factors associated with state hospital utilisation among Thai elderly who had illnesses which needed hospitalisation.

Of the 4,480 elderly subjects in a multistage random sampling household survey of a National Survey of the Welfare of the Elderly in Thailand (SWET), 669 (14.9%) reported that they had been hospitalised during the last year and were recruited in an analysis which aimed to examine associated factors of state hospital utilisation among Thai elderly. Seventy eight per cent had been admitted once during the last year. Mean (standard deviation) duration of hospital stay during the last year was 11.9 (20.1) days. For the last period of hospitalisation, 532 elderly (79.5%) were admitted to state hospitals. One hundred and nineteen elderlies (17.8%) used private hospitals. Only 18 elderly (2.3%) used both state and private hospitals. According to the causes of hospitalisation, the elderly who used state hospitals were not more severely ill than those who used private hospitals. Nine univariate factors associated with state hospital utilisation were entered in a logistric regression model in which five independent determinants were identified including 'do not have electricity', 'heads of the family are not their children', 'do not have own savings', 'live in rural area', and 'have heard about free health care programme'. The Ministry of Public Health and organisations which are concerned with the elderly should allocate more resources to advertising a free health care programme for Thai elderly.

Falls and their associated factors: a national survey of the Thai elderly.

Of the 7,713 subjects aged 50 and over in a multistage random sampling national survey of Thailand, 4,480 Thai elders aged 60 and over were interviewed in a study which aimed to determine rate, characteristics and the associated factors of falls in the last six months. Eight hundred and thirty-six elders (18.7%) had one or more falls. Female elders (21.5%) fell more often than their male counterparts (14.4%). There was no association between age and falls among Thai elder population. Most of the falls occurred outside (65%) and during the day time (85%). Multiple regression analysis showed that independent factors associated with falls among male elder were a bad or fairly bad health, reported hypertension, problems with walking in the house, problems with crouching and a lack of electricity in the house. Independent factors associated with falls among female elders were a bad or fairly bad health, joint problems, illness which made her unable to have normal activities during the last year, problems with crouching, going to buy food everyday, very lonely feeling, having less than 3 meals a day, a lack of electricity in the house and living in a Thai style house or hut. This study revealed that environmental and intrinsic health factors which affected balance and gait were the main factors associated with falls among Thai elders. Nutritional status as a contributing factor to falling among elderly women was also suggested.

Cultural study of diarrhoeal illnesses in central Thailand and its practical implications.

A cultural study of diarrhoeal illness was conducted using the Explanatory Model Interview for Cultural Assessment (EMIC) to compare two socioeconomically distinct subdistricts of central Thailand and to determine the practical implications of illness-related perceptions, beliefs and practices. Subjects specified 12 terms for diarrhoeal illnesses that were grouped into four locally meaningful groups, namely, tong-sia, a non-specific term for diarrhoea, bid, associated with colicky abdominal pain, ahiwa, referring to severe illness, often cholera; and taae-tua, diarrhoea associated with milestones of growth and development. To compare pre-existing beliefs and practices with the experience of caretakers when actually confronted with an episode of illness, we inquired about each of the terms and about index cases in subsequent interviews over the course of a six-month surveillance period. Patterns of distress, perceived causes, and preferences for help seeking and treatment elicited by the EMIC identified cultural features of the four groups of diarrhoeal illness. Perceived causes of diarrhoea associated with sanitation, hygiene and infection, which most respondents considered preventable, were prominent explanations for three of the four categories, and the fourth was viewed as a normal feature of growth and development, rather than medical illness. We discuss these and other findings with reference to use of ORS and other issues related to the prevention and control of diarrhoeal illness, concluding with recommendations for public health policy and research.

PIP: Between October 1987 and March 1988, research assistants used the explanatory model interview for classification to interview households in 2 villages in Banna subdistrict and 3 villages in Sam-Tai subdistrict in Ayutthaya province, Thailand. Researchers analyzed the data to examine the respondents' diarrhea-related perceptions, beliefs, and practices. The people used 12 terms for diarrhea. The mean number of terms/person was 6. Everyone used the term tong-sia (generic diarrhea). The Ministry of Public Health used the term ahiwa (severe diarrhea such as cholera) in its health education campaigns but only 39.3% of the people knew this term. 99.1% attributed a transitional phase in normal growth and development to be the cause of taae-tua. Bad child's and mother's food was frequently perceived as the cause of ahiwa, tong-sia, and bid (colicky abdominal pain). Everyone, 93.1%, and 67.5% mentioned flies and germs (sanitation and hygienic practices) as the cause of ahiwa, tong-sia, and bid, respectively. The responses were different between theory and actual practice, however. For example, 91% believed bad food and poor sanitation and hygiene were responsible for tong-sia, but only 34.4% gave this response when referring to index cases. Few people attributed supernatural causes or sorcery to bring about diarrhea illness. Most villagers were impressed with modern drugs and injections but they did not understand their nature. They sought treatment from professional sources that should know appropriate diarrhea treatment but did not. Only 51% used oral rehydration solution (ORS) to treat diarrhea and just 3.5% of them believed ORS to be the most useful treatment. Health education efforts should include descriptions of cholera rather than using the work ahiwa, emphasis on the need to treat diarrhea regardless of its perceived cause, promotion of improved sanitation and hygiene, and communication of appropriate expectations of ORS and its ability to prevent and ameliorate dehydration and reduce mortality.