The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study.

Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.

Contributing factors of birth asphyxia in Thailand: a case-control study.

BACKGROUND: Birth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia. METHODS: A case-control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software. RESULTS: The odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal-fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia. CONCLUSION: Birth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late-preterm, late-term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

Factors Influencing Pre-Cardiopulmonary Arrest Signs among Post-General Surgery Patients in Critical Care Service System.

Health service system factors can lead to pre-cardiopulmonary arrest signs (pre-CA), which refer to a critical condition in the body leading to a circulatory and respiratory system disruption. The purpose of this study was to assess the incidence rate of an event leading to pre-cardiopulmonary arrest signs within the first 24 h, and also to analyze the factors influencing the health service system in critical post-general surgery patients in the intensive care unit. These results of the study found the incidence rate of pre-CA was 49.05 per 1000 person-hours, especially 1 h after admission to the ICU. Hemodynamic instability, respiratory instability, and neurological alteration were the most common pre-CA symptoms. The patient factors associated with high pre-CA arrest sign scores were the age from 18-40 years, with an operation status as emergency surgery, elective surgery compared with urgent surgery, and the interaction of operation status and age in critical post-general surgery patients. The organization factors found advanced hospital level and nurse allocation were associated with pre-CA. To improve quality of care for critical post-general surgery patients, critical care service delivery should be delegated to nurses with nurse allocation and critical care nursing training. Guidelines must be established for critically ill post-general surgery patient care.

Estimation of the onset time of diabetic complications in type 2 diabetes patients in Thailand: a survival analysis.

BACKGROUND: This study aimed to identify factors associated with the onset time of diabetic complications in patients with type 2 diabetes mellitus (T2DM) and determine the best-fitted survival model. METHODS: A retrospective cohort study was conducted among T2DM patients enrolled from October 1, 2016 to July 15, 2020 at the National Health Security Office (NHSO). In total, 388 T2DM patients were included. Cox proportional-hazard and parametric models were used to identify factors related to the onset time of diabetic complications. The Akaike information criterion, Bayesian information criterion, and Cox-Snell residual were compared to determine the best-fitted survival model. RESULTS: Thirty diabetic complication events were detected among the 388 patients (7.7%). A 90% survival rate for the onset time of diabetic complications was found at 33 months after the first T2DM diagnosis. According to multivariate analysis, a duration of T2DM ≥42 months (time ratio [TR], 0.56; 95% confidence interval [CI], 0.33-0.96; p=0.034), comorbid hypertension (TR, 0.30; 95% CI, 0.15-0.60; p=0.001), mildly to moderately reduced levels of the estimated glomerular filtration rate (eGFR) (TR, 0.43; 95% CI, 0.24-0.75; p=0.003) and an eGFR that was severely reduced or indicative of kidney failure (TR, 0.38; 95% CI, 0.16-0.88; p=0.025) were significantly associated with the onset time of diabetic complications (p<0.05). CONCLUSION: Patients with T2DM durations of more than 42 months, comorbid hypertension, and decreased eGFR were at risk of developing diabetic complications. The NHSO should be aware of these factors to establish a policy to prevent diabetic complications after the diagnosis of T2DM.

Factors Associated with 24-Hour Clinical Outcome of Emergency Patients; a Cohort Study.

Introduction: Pre-hospital and in-hospital emergency management play an important role in quality of care for emergency patients. This prospective cohort study aimed to determine factors associated with the 24-hour clinical outcome of emergency patients. Methods: The sample included 1,630 patients, randomly selected through multi-stage stratified sampling from 13 hospitals in 13 provinces of Thailand. Data were collected during January-November 2018. Clinical outcome was determined using pre-arrest sign score. Data were analyzed via ordinal multivariate regression analysis. Results: Factors influencing 24-hour clinical outcome of emergency patients were age (OR: 0.965; 95% CI: 0.96-0.97), having coronary vascular disease (CAD) (OR: 1.41; 95% CI: 1.05-1.88), and severity of illness based on Rapid Emergency Medical Score (REMS) (OR:1.09; 95% CI: 1.05-1.15). Self-transportation and being transported by emergency medical service ambulance with non-advanced life support (EMS-Non-ALS) did not influence clinical outcome when compared to EMS-ALS transport. Being transported from a community hospital increased pre-arrest sign score 1.78 times when compared to EMS-ALS (OR: 1.78; 95% CI: 1.17-2.72). Increased transportation distance increased the risk of poor clinical outcome (OR: 1.01; 95% CI: 1.002-1.011). Length of stay in emergency department (ED-LOS) more than 4 hours (OR: 0.21; 95% CI: 0.15-0.29) and between 2-4 hours (OR: 0.60; 95% CI: 0.47-0.75) decreased the risk of poor clinical outcome when compared to ED-LOS less than 2 hours. Conclusion: Having CAD, severity of illness, increased transport distance, and ED-LOS less than 2 hours were found to negatively influence 24-hour clinical outcome of emergency patients.

Hospital Readmission Risks Screening for Older Adult with Stroke: Tools Development and Validation of a Prediction.

Hospital readmission of stroke elderly remains a need for detecting preventable risks. This study aims to develop a Readmission Stroke Screening Tool or RRST. The mixed research design was employed, phase1; systematic reviews from 193 articles extracting to be 14 articles, 9 experts' consensus, and try out the RRST Internal consistency; IOC = .93, ICC = between .93 and .56, phase 2; Data collecting 150 of strokes patients in the stroke units during 2019 to 2020; 30 nurses employed the RRST to screen stroke elderly before discharge. Statistical analysis, Exploring Principal Factor Analysis to test the best predictor factor, and Confirmatory Factor Analysis to test the model identity were employed. Results: The multi-domain RRST; 4 factors: Intra, inter, and external factors of patients can predict the hospital readmission of Stroke elderly at a high level in 28 days. The ADL: Activities in the Daily life domain was the highest level of predicting (Eigen Value = 6.76, 1.15, Variances = 79.19%) significantly. 53.3% of user nurses reflected; the RRST tool's effectiveness was achievable in usefulness, benefit, accuracy, and easy to use; however, the rest users identified to improve the RRST easier and quicker. Conclusion; The new RRST; can predict the high-risk readmission effectively = 92.5%. User nurses satisfied the RRST predicted quality. the multi-domain RRST could be detecting the Thai Stroke's high-risk group for reducing avoidable risks, suggestion; more effort will be investigated prospectively in readmission by expanded volume of the Asian' Stroke elderly for increasing accuracy predicting and extended tool quality utilized standard scored correctly.

District division administrative disaggregation data framework for monitoring leaving no one behind in the National Health Insurance Fund of Sudan: achieving sustainable development goals in 2030.

BACKGROUND: The aim of this study is to monitor the concept of 'leaving no one behind' in the Sustainable Development Goals (SDGs) to track the implications of the mobilization of health care resources by the National Health Insurance Fund (NHIF) of Sudan. METHODS: A cross-sectional study was used to monitor 'leaving no one behind' in NHIF by analyzing the secondary data of the information system for the year 2016. The study categorized the catchment areas of health care centers (HCCS) according to district administrative divisions, which are neighborhood, subdistrict, district, and zero. The District Division Administrative Disaggregation Data (DDADD) framework was developed and investigated with the use of descriptive statistics, maps of Sudan, the Mann-Whitney test, the Kruskal-Wallis test and health equity catchment indicators. SPSS ver. 18 and EndNote X8 were also used. RESULTS: The findings show that the NHIF has mobilized HCCs according to coverage of the insured population. This mobilization protected the insured poor in high-coverage insured population districts and left those living in very low-coverage districts behind. The Mann-Whitney test presented a significant median difference in the utilization rate between catchment areas (P value < 0.001). The results showed that the utilization rate of the insured poor who accessed health care centers by neighborhood was higher than that of the insured poor who accessed by more than neighborhood in each state. The Kruskal-Wallis test of the cost of health care services per capita in each catchment area showed a difference (P value < 0.001) in the median between neighborhoods. The cost of health care services in low-coverage insured population districts was higher than that in high-coverage insured population districts. CONCLUSION: The DDADD framework identified the inequitable distribution of health care services in low-density population districts leaves insured poor behind. Policymakers should restructure the equation of health insurance schemes based on equity and probability of illness, to distribute health care services according to needs and equity, and to remobilize resources towards districts left behind.

Incidence and Risk Factors of Clinical Deterioration during Inter-Facility Transfer of Critically Ill Patients; a Cohort Study.

INTRODUCTION: Critically ill and injured patients are at a higher risk of developing clinical deterioration during inter-facility transfers. This study aimed to determine the incidence rate and risk factors of clinical deterioration among critically ill patients during inter-facility transfers in Thailand. METHODS: The present cohort study was conducted in 22 referring hospitals and 7 receiving hospitals under the supervision of Ministry of Public Health, Thailand, between March 15 and December 31, 2018. The subjects were comprised of 839 critically ill patients aged 18 and over, 63 coordinator nurses in referral centers, and 312 referral team leaders. Data collected included pre-transfer risk score, clinical data of patient during transfer, characteristics of referral team leader, ambulance type, preparation time, time to definitive care, transfer distance, and National Early Warning Score (NEWS) (clinical deterioration). Multilevel mixed-effects regression analysis was performed. RESULTS: The incidence rate of clinical deterioration was 28.69%. The most common types of clinical deterioration were hemodynamic instability, respiratory instability, and neurological alteration. Time between 31-45 minutes was significantly associated with clinical deterioration (ß 0.133, P value 0.027). The following illnesses were associated with higher probability of clinical deterioration: body region injuries/head injury/burn/ingested poison (ß 0.670, P value 0.030), respiratory distress/convulsion (ß 0.919, P value 0.001), shock/ arrhythmias/chest pain/hemorrhage (ß 1.134, P value <0.001), comatose/alteration of consciousness/syncope (ß 1.343, P value <0.001), and post-cardiac arrest (ß 2.251, P value <0.001). Patients with unstable conditions (ß 1.689, P value 0.001) and pre-transfer risk score of 8 or higher (ß 0.625, P value 0.001) had a higher rate of deterioration. Transfer by non- emergency room (ER) nurses (ß 0.495, P value 0.008) and transportation in a mobile intensive care unit (ICU) were associated with a higher rate of deterioration (ß 0.848, P value 0.001). CONCLUSION: The incidence of clinical deterioration during inter-facility transfer in Thailand was high. Illnesses involving circulatory, respiratory, and neurological systems, clinical instability, high pre-transfer risk score, transport time of 31-45 minutes, transportation by non-ER nurse, and mobile ICU were associated with a higher rate of clinical deterioration.

Maternal and health service predictors of postpartum hemorrhage across 14 district, general and regional hospitals in Thailand.

BACKGROUND: Postpartum hemorrhage (PPH) is a preventable complication, however, it remains being the leading cause of maternal mortality and morbidity worldwide including Thailand. METHODS: A case-control study to examine the risk factors associated with PPH across the hospitals under the Ministry of Public Health in Thailand, was conducted. A total of 1833 patient birth records and hospital profiles including human and physical resources from 14 hospitals were obtained. A multiple logistic regression was used identifing the factors that are significantly associated with PPH. RESULTS: The results show that the rate of PPH varied across the hospitals ranging from 1.4 to 10.6%. Women with past history of PPH were more likely to have increased risk of having PPH by 10.97 times (95% CI 2.27,53.05) compared to those who did not. The odds of PPH was higher in district and general hospitals by 14 (95% CI 3.95,50.04) and 7 (95% CI 2.27,23.27) times respectively, compared to regional hospitals. The hospitals which had inadequate nurse midwife to patient ratio (OR 2.31,95% CI 1.08,4.92), lacked nurse midwives with working experience of 6-10 years (OR 2.35, 95% CI 1.41,3.92), as well as inadequate equipment and supplies for emergency obstetric care (OR 6.47, 95% CI 1.93,21.63), had significantly higher incidence of having PPH, respectively. CONCLUSIONS: This study provides interesting information that the rate of PPH varies across the hospitals in Thailand, in particular where essential nurse midwives, equipment, and supplies are limited. Therefore, improving health care services by allocating sufficient human and physical resources would contribute to significantly reduce this complication.

Factors associated with access to health services and quality of life in knee osteoarthritis patients: a multilevel cross-sectional study.

BACKGROUND: The main purpose of health service systems is to improve patients' quality of life (QoL) and to ensure equitable access to health services. However, in reality, nearly half of knee osteoarthritis (OA) patients present to the health system do not have access to health services, and their QoL remains poor. These circumstances raise important questions about what (if any) factors can improve health care accessibility and QoL for knee OA patients. METHODS: A multicenter, cross-sectional survey was performed with 618 knee OA patients who received care at 16 hospitals in Thailand. Structural equation modeling (SEM) was conducted to investigate the association of health service factors and patient factors with access to health services and QoL. RESULTS: The QoL of knee OA patients was very poor (mean score = 33.8). Only 2.1% of the knee OA patients found it easy to obtain medical care when needed. Approximately 39.4% of them were able to access appropriate interventions before being referred for knee replacement. More than 85% of orthopedic health services had implemented chronic disease management (CDM) policy into practice. However, the implementation was basic, with an average score of 5.9. SEM showed that QoL was determined by both health system factors (ß = .10, p = .01) and patient factors (ß = .29, p = .00 for self-management and ß = -.49, p = .00 for disease factors). Access to health services was determined by self-management (ß = .10, p = .01), but it was not significantly associated with QoL (ß = .00, p = 1.0). CONCLUSIONS: This study provides compelling information about self-management, access to health services and QoL from the individual and health service system perspectives. Furthermore, it identifies a need to develop health services that are better attuned to the patient's background, such as socioeconomic status, disease severity, and self-management skills.

Factors influencing prehospital delay time among patients with peripheral arterial occlusive disease.

BACKGROUND: Only one-third of patients with peripheral arterial occlusive disease (PAOD) seek medical care after perceiving the symptoms of PAOD, and most PAOD patients only visit the physician when they develop ulceration and gangrene. Delay can result in lower extremity amputation and death within three years. The aim of this study was to predict prehospital delay time from sociodemographic characteristics and clinical characteristics, social support, knowledge about PAOD, depression and fear, and treatment-seeking behaviors among patients with PAOD. METHOD AND RESULTS: Data were collected in three university hospitals in Bangkok, Thailand. A sample of 212 patients with PAOD who were newly diagnosed or diagnosed within the preceding four months was recruited into the study. Questionnaires and interviewing were used to collect data. Stepwise multiple regression analysis was performed to identify the factors influencing prehospital delay time. Significant determinants of prolonged prehospital delay time were male gender, low monthly income (less than 10,000 Thai baht or 213 Euros), high level of perceived social support, and several treatment seeking behaviors. Depression, high level of fear, and self-pay of medical expenses were associated with short prehospital delay time. Overall, the model explained 41.0% of the variance in prehospital delay time. CONCLUSION: Clinicians need to develop intervention programs and national campaigns to increase knowledge about PAOD among patients in these high risk groups.

Development of the Electronic Surveillance Monitoring System on Web Applications.

This paper presents the electronic surveillance monitoring system (ESMS) via the web based application used especially for the health sector. The system is created for three purposes, the alert function for the surveillance and rapid response team (SRRT), the monitoring for inspection and evaluation, and the back-office report. With the import and export functions that are capable to retrieve electronic health record and edit the R506 and R507 data, the SRRT and local team can easily set up and manage their resources. The GPS function helps care takers to identify the geographical data for any countermeasure and action. The program is designed to submit reports automatically to the Ministry of Public Health (MOPH). The SRRT module can operate in both on-line and off-line conditions.

The Impact of Cigarette Plain Packaging on Health Warning Salience and Perceptions: Implications for Public Health Policy.

The study employed a mixed methods design using focus group interviews with 6 student groups and self-administered questionnaires with 1239 students. The participants were nonsmoking, current smokers, and quit-smoking teenagers from secondary schools and colleges. Focus group revealed that although nonsmoking teenagers perceived fear appeals to warning messages, current smokers did not perceive fear appeals to health. Black and white backgrounds of the cigarette package were chosen as the best color for plain packaging. However, most participants suggested various pictorials and a bigger size of pictorial warnings for greater and more effective fear appeal. Odds ratio showed that males had 2.43 times the odds to perceive intention not to smoke. Teenagers who had never smoked and those who had quit smoking had 13.27 and 3.61 times the odds, respectively, to perceive intention not to smoke.

Predictors of Intention to Use HIV Testing Service Among Sexually Experienced Youth in Thailand.

This study examined the predictors of intention to use HIV counseling and testing (HCT) services among those who had never used HCT services in a sample of 2,536 Thai youth in Bangkok (ages 15-24). Web-based questionnaires included assessments of HIV knowledge, HIV testing attitude, AIDS stigma, and youth-friendly HCT (YFHCT) service expectation. More than 80% of the sexually experienced youth had never used HCT services but among this group 74.06% reported having intentions to do so. The significant predictors consisted of favorable expectations of YFHCT services (p < .001), positive attitude toward HIV testing (p < .005), perceived high risk for HIV infection (p < .01), having multiple sex partners while also using condoms consistently (p < .01), willingness to pay (p < .001), and being informed about HCT and knowing service locations (p < .001). Policy makers, as well as health promotion program developers and researchers can use these findings to increase intention and use of HCT services among at-risk youth.

The intake of energy and selected nutrients by thai urban sedentary workers: an evaluation of adherence to dietary recommendations.

Rapid changes in Thailand's nutrition and lifestyles have led to increasing diet-related pathologies among people with sedentary occupations. This study examines the extent to which the dietary intake of nutrients and energy by a sample of Thai sedentary workers conforms to the Thai Dietary Reference Intakes (Thai DRIs). The nutrients and energy intake estimates were based on self-reported information collected with a single 24-hour dietary recall and nonweighed 2-day food record. The study participants were Thai adults aged 20-50 years employed in sedentary occupations. A convenience sample of 215 healthy individuals (75 males and 140 females) was based on four randomly selected worksites in the Bangkok metropolitan area. For male participants, the study found a median energy intake of 1,485 kcal/day, with 54.4% of energy coming from carbohydrate, 15.9% from protein, and 29.6% from fat. Females' median energy intake was 1,428 kcal/day, 56% of which came from carbohydrate, 16.2% from protein, and 28.6% from fat. Both genders showed insufficient intake of fiber and most micronutrients. This study provides the material for preventive public health interventions focusing on nutrition-related diseases affecting Thailand's rapidly growing sedentary workforce.

A generalization of Chao's estimator for covariate information.

This note generalizes Chao's estimator of population size for closed capture-recapture studies if covariates are available. Chao's estimator was developed under unobserved heterogeneity in which case it represents a lower bound of the population size. If observed heterogeneity is available in form of covariates we show how this information can be used to reduce the bias of Chao's estimator. The key element in this development is the understanding and placement of Chao's estimator in a truncated Poisson likelihood. It is shown that a truncated Poisson likelihood (with log-link) with all counts truncated besides ones and twos is equivalent to a binomial likelihood (with logit-link). This enables the development of a generalized Chao estimator as the estimated, expected value of the frequency of zero counts under a truncated (all counts truncated except ones and twos) Poisson regression model. If the regression model accounts for the heterogeneity entirely, the generalized Chao estimator is asymptotically unbiased. A simulation study illustrates the potential in gain of bias reduction. Comparisons of the generalized Chao estimator with the homogeneous zero-truncated Poisson regression approach are supplied as well. The method is applied to a surveillance study on the completeness of farm submissions in Great Britain.

Not chewing food among the Thai elderly with complete denture.

OBJECTIVE: The study aims to investigate the use of a complete denture in terms of not chewing food and determining the strength of association between not chewing food and several potential risk factors among the Thai elderly. MATERIAL AND METHOD: Under the support of the "Khao Aroi" or "Delicious Rice" or "Dental Implant" Project of Institute of Dentistry, Department of Medical Services, Ministry of Public Health, and in co-operation with the Ministry of Science and Technology during 2007-2011, a cross-sectional survey by multi-stage cluster sampling was conducted in 2008, in 21 provinces, 87 hospitals, with 2,676 Thai elderly. The sample was drawn from a sampling frame of 58,043 target Thai people aged 60 years and over under the Dental Prosthesis Service Campaign (DPSC) project during 2005 and 2007. All Thai elderly, who received a complete denture from the DPSC project at least three months prior were surveyed from May to October 2008 through questionnaires. Data were analyzed by a set of descriptive analyses and binary logistic regression models. RESULTS: Not chewing food among the Thai elderly, after receiving a complete denture, was 12.5%, quite a bit more effective than ordinary work. Nontaluck found 38% for the proportion not wearing dentures in the 30-baht health care program. This finding is confirmed by the work of Dalodom et al that the use of dentures by Thai elderly was 93% in the DPSC project. The important risk factors that influenced not to chew food were satisfaction with dentures, patients satisfaction with the denture fitting and care, while controlling the amount of dentures, respectively. CONCLUSION: Satisfaction of patients with their dentures, good oral health care in fitting denture work, and good communication between dentists and patients are important keys affecting the use of dentures.

Consequences and associated factors of youth gambling.

OBJECTIVE: To examine gambling behaviors, consequences and its associated factors among Thai youths. MATERIAL AND METHOD: A cross-sectional survey of 1,694 students from Matthayom 1 (grade 7) to university undergraduate level was conducted using a self-administered questionnaire. Questionnaire items consisted of socio-economic characteristics, health behaviors, attitudes towards gambling and consequences of gambling. Factors associated with gambling experience were identified by multivariate logistic regression. RESULTS: Approximately 20% of youth gambling was reported. Gamblers had higher proportion of males, studying in vocational schools and lower GPA and history of smoking and alcohol consumption. Card games were the most common type of gambling, followed by football-betting. Approximately 10% of the gamblers potentially had pathological gambling. Factors positively associated with gambling included having friends (adjusted OR = 4.82) and relatives (adjusted OR = 2.48) who gambled. Having a GPA > or = 3.0 was negatively associated with gambling (adjusted OR = 0.58). The present study reported negative consequences of gambling including feeling of guilt, perception of poorer health and depression or insomnia after losing. CONCLUSION: Gambling prevention program should be developed and focused on student with poor study performance and wrecked relationships in family. Also, a surveillance system for health risk behaviors among youth in school and community should be established by the participation of multiple organizations.

Factors influencing the presence of peripheral arterial disease among Thai patients with type 2 diabetes.

BACKGROUND: Little is known about factors predicting peripheral arterial disease (PAD) development in Thai type 2 diabetes patients. This study aims to identify factors related to PAD in type 2 diabetes and the best predictors for PAD development. METHODS AND RESULTS: A case-control study was conducted in which 405 type 2 diabetes patients were recruited from four tertiary care hospitals in Bangkok, Thailand. Cases were type 2 diabetes patients with PAD who were compared to those without PAD. An ankle-brachial index (ABI) < 0.9 was used for PAD diagnosis. An ABI between 0.91 and 1.30 was used to define those without PAD. Demographic characteristics, the diabetes self-care activities score and chief complaints were measured. Thai type 2 diabetes patients with PAD were older (65.45 ± 12.2 years), had no formal schooling, and were more likely to be a local vendor than those without PAD (p < 0.05). Type 2 diabetes patients with PAD had diabetes longer than those without PAD (p < 0.05). Hypertension, coronary heart disease and chronic kidney disease were significantly more common in type 2 diabetes patients with PAD than those without PAD (p < 0.05). Age > 70 years, having coronary heart disease as a comorbid illness, and having a body mass index of 25-29.9 kg/m(2) were predictive for PAD development (all p < 0.05). These three variables explained 12.3% of the variance in the incidence of PAD among type 2 diabetes patients. The demographic and clinical factors were the best predictors for PAD development. CONCLUSION: Thai type 2 diabetes patients who are elderly, have coronary heart disease as a comorbid condition, or have a normal weight should be considered at risk for PAD development.

Risk factors for malaria infection among rubber tappers living in a malaria control program area in southern Thailand.

Rubber tappers work begins at midnight during the feeding time of Anopheles maculatus and An. minimus, two common malaria vectors in southern Thailand. We studied the association between rubber tapper behavior and malaria infections as reported to the Notified Disease Surveillance System during 2010 in Prachuab Khiri Khan Province, Thailand. In that province insecticide treated bednets are distributed free to the population and insecticide residual spraying is performed annually. A random sample of 394 rubber tapper households was interviewed from October 2010 to May 2011. Twenty-six households (6.6%) had at least one family member who contracted malaria during 2010. Poisson regression was used to identify potential characteristics associated with malaria. Multilevel Poisson regression was used to test for simultaneous effects of tapper behavior and household risk for malaria infection. The estimated incidence rate ratio (IRR) for contracting malaria among those owning a farming hut was 2.9 (95% CI 1.1-7.3, p < 0.05) after controlling for other variables. Even in areas where control programs are in place, malaria infection among rubber tappers is common. Given the Thai Government's plan to expand the rubber plantation areas to other regions of the country without specific prevention for this at-risk population, the malaria burden in Thailand may increase.