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Background Mongolia has made significant progress towards achieving Universal Health Coverage (UHC), but there are still challenges ahead with population ageing and non-communicable diseases (NCDs). The purpose of this study was to investigate patterns and determinants of outpatient and inpatient health service use amongst older people in Mongolia. Methods Data were collected using a questionnaire developed for the World Health Organization’s Study on global AGEing and adult health (WHO SAGE). There were 478 participants from rural areas and 497 participants from Ulaanbaatar (further divided into 255 ger/yurt district and 242 apartment district residents). Multivariable logistic regression analyses were used to investigate determinants of outpatient and inpatient health service use with reported adjusted Odds Ratios (AORs) and 95 % Confidence Intervals (CIs). Results Participants were aged 60 to 93 years. About 55 % of respondents used outpatient services in the past 12 months and 51 % used inpatient services in the past three years. Hypertension was the most common reason for health service use. Rural residents had longer travel times and were more likely to incur out-of-pocket expenditure (OOP). Multivariable logistic regression revealed that women were more likely to use outpatient services (AOR 1.88; 1.34-2.63). Compared to apartment residents in urban areas, ger residents in urban areas were less likely to use outpatient services (AOR 0.54; 0.36-0.83). There was no statistically significant differences in inpatient service by location. Increasing numbers of chronic conditions (1 and 2+ compared to none) were associated with both outpatient (AORs 2.59 and 2.78) and inpatient (AORs 1.97 and 3.01) service use. Conclusions This study highlights the needs to address disparities in outpatient service use for rural and urban ger populations. Compared with other WHO-SAGE countries, older Mongolians have relatively higher use of inpatient health care services. With a high prevalence of hypertension and an ageing population, efforts to achieve UHC would benefit from reorienting care services towards prevention and primary care management of NCDs to reduce the costs from hospital-based care.

Purpose The influence of social capital has been shown to improve health and wellbeing. This study investigates the relationship between changes in social capital and health outcomes during a 6-year follow-up in mid to later life in Australia. Methods Nationally representative data from the Household, Income and Labour Dynamics in Australia (HILDA) survey included participants aged 45 years and over who responded in 2006, 2010 and 2012 (N = 3606). Each of the three components of social capital (connectedness, trust and participation) was measured in Waves 2006 and 2010 and categorised as: ‘never low’, ‘transitioned to low’, ‘transitioned out of low’ and ‘consistently low’. Health outcomes in 2012 included self-rated overall health, physical functioning, and mental health based on the Short Form 36-item health survey (SF-36). Multivariable logistic regression assessed changes in social capital (measured in 2006 and 2010) predicted poor health (measured in 2012), adjusting for covariates. Results Consistently low trust was significantly associated with higher odds of transitions into poor physical functioning (AOR 1.54; 95% Confidence Interval 1.06–1.22), poor mental health (AOR 1.59; 95% CI 1.08–2.36) and poor self-rated health (AOR 1.86; 95% CI 1.27–2.72). Transition into low trust was also a predictor of poor self-rated health after adjusting for covariates (AOR 1.74; 95% CI 1.11–2.73). Changes in social connectedness in both directions (transitioned out of and into low) were statistically associated with poor self-rated health (AORs 1.40; 95% CI 1.00–1.97 and 1.61; 95% CI 1.11–2.34, respectively) after adjusting for confounders as well as other social capital components. Conclusions Our longitudinal findings reveal social capital dynamics and effects on health in mid to later life. Social trust and connectedness could be important enablers for older persons to be more active in the community and potentially benefit their health and wellbeing over time. Electronic supplementary material The online version of this article (doi:10.1007/s11136-017-1655-9) contains supplementary material, which is available to authorized users.

Background Low back pain (LBP) is a major cause of disability throughout the world. However, longitudinal evidence to relate low back pain and functional limitations is mostly confined to Western countries. In this study, we investigate the associations between low back pain and functional limitations in a prospective cohort of Thai adults. Methods We analysed information from the Thai Cohort Study of adult Open University adults which included 42,785 participants in both 2009 and 2013, with the majority aged 30 to 65 years and residing nationwide. We used multivariate logistic regression to explore the longitudinal associations between LBP in 2009 and 2013 (‘never’: no LBP in 2009 or 2013; ‘reverting’: LBP in 2009 but not in 2013; ‘incident’: no LBP in 2009 but LBP in 2013; and ‘chronic’: reporting LBP at both time points) and the outcome of functional limitations relating to Activities of Daily Living (ADL) in 2013. Results Low back pain was common with 30% of cohort members reporting low back pain in both 2009 and 2013 (‘chronic LBP’). The ‘chronic LBP’ group was more likely than the ‘never’ back pain group to report functional limitations in 2013: adjusted odds ratios 1.60 [95% Confidence Interval: 1.38–1.85] for difficulties getting dressed; 1.98 [1.71–2.30] for walking; 2.02 [1.71–2.39] for climbing stairs; and 3.80 [3.38–4.27] for bending/kneeling. Those with ‘incident LBP’ or ‘reverting LBP’ both had increased odds of functional limitations in 2013 but the odds were not generally as high. Conclusions Our nationwide data from Thailand suggests that LBP is a frequent public health problem among economically productive age groups with adverse effects on the activities of daily living. This study adds to the limited longitudinal evidence on the substantial impact of low back pain in Southeast Asia. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1380-5) contains supplementary material, which is available to authorized users.

Background In rich countries, smokers, active or passive, often belong to disadvantaged groups. Less is known of tobacco patterns in the developing world. Hence, we seek out to investigate mental and physical health consequences of smoke exposure as well as tobacco-related inequality in transitional middle-income Thailand. Methods We studied a nationwide cohort of 87,151 middle-aged and older adults that we have been following for eight years (2005–2013) for emerging chronic diseases. Logistic regression was used to identify attributes associated with passive smoke exposure. Longitudinal associations between smoke exposure and wellbeing (SF-8) or psychological distress (Kessler 6) were investigated with multiple linear regression or multivariate logistic regression analysis. Results A high proportion of cohort members, especially females, were passive smokers at home and at public transport stations; males were more exposed at workplace and recreational places. We observed a social gradient with more passive smoking in poorer people. We also observed a dose response relationship linking graded smoke exposures (current, former, passive, non-exposed) to less wellbeing and more psychological distress (p-trend

Background There is limited evidence on the association between oral health and general health in middle-income countries. This study analysed data from 60,569 adult students enrolled at Sukhothai Thammathirat Open University and residing throughout Thailand who reported oral health impacts at the 2005 baseline and 2009 health status based on Short Form (SF-8) survey. Findings In 2005, 16.4% had difficulty chewing and/or swallowing, 13.4% reported difficulty speaking and/or discomfort with social interaction, and 10.8% of the cohort reported having pain associated with teeth or dentures. Cohort members reporting one or more oral health impacts in 2005 had lower SF-8 mean scores in 2009. In particular, monotonic dose–response gradients in 2005–2009 associations based on multivariate linear regression were found between an increase in number of oral impacts (0, 1, 2, 3) and a decline in SF-8 Physical Component Summary scores (adjusted means of 50.5, 49.2, 48.6, 47.9) as well as SF-8 Mental Component Summary scores (adjusted means of 43.2, 40.9, 40.3, 38.6) in younger cohort members. Similar dose response gradients were found in older cohort members. Conclusions We found strong association between oral health impacts and adverse health and quality of life among Thai adults. This finding confirms that oral health is one of the key determinants of population health.

Increase in body size has appeared as an epidemic in Western countries and is now rapidly emerging in low- and middle-income countries, contributing to the rise in non-communicable diseases worldwide. Brazil and Thailand have gone through similar economic and health transitions, and this unique comparative study investigates changes in body size (body mass index) in relation to socioeconomic status in two cohorts of similar age followed from 2004/2005 to 2012/2013. At 20–24 years of age, Pelotas cohort members had a much higher prevalence of overweight and obesity (20.7 and 8.6%) than the Thai cohort (6.0 and 1.7%); these proportions rose to 34.6% and 22.9% vs 15.8% and 5.1%, respectively, in their early 30s. An association between a higher socioeconomic status and increase in overweight and obesity was observed among males; but an inverse pattern was noted for females in both cohorts and remained statistically significant after 8 years of follow up. Our comparative longitudinal analyses highlight the relationship between two middle-income settings facing rapid increases in body size (2–3 fold increase in the rate of overweight and obesity). Long-term follow up and a lifecourse approach for effective prevention of obesity will minimize adverse health burdens in later life.

Background Oral health in later life results from individual's lifelong accumulation of experiences at the personal, community and societal levels. There is little information relating the oral health outcomes to risk factors in Asian middle-income settings such as Thailand today. Methods Data derived from a cohort of 87,134 adults enrolled in Sukhothai Thammathirat Open University who completed self-administered questionnaires in 2005. Cohort members are aged between 15 and 87 years and resided throughout Thailand. This is a large study of self-reported number of teeth among Thai adults. Bivariate and multivariate logistic regressions were used to analyse factors associated with self-reported number of teeth. Results After adjusting for covariates, being female (OR = 1.28), older age (OR = 10.6), having low income (OR = 1.45), having lower education (OR = 1.33), and being a lifetime urban resident (OR = 1.37) were statistically associated (p < 0.0001) with having less than 20 teeth. In addition, daily soft drink consumptions (OR = 1.41), current regular smoking (OR = 1.39), a history of not being breastfed as a child (OR = 1.34), and mother's lack of education (OR = 1.20) contributed significantly to self-reported number of teeth in fully adjusted analyses. Conclusions This study addresses the gap in knowledge on factors associated with self-reported number of teeth. The promotion of healthy childhoods and adult lifestyles are important public health interventions to increase tooth retention in middle and older age.

Background A relationship between happiness and mortality might seem obvious, but outside of affluent settings in developed countries there is almost no actual evidence that this is so. Findings We report our findings on happiness and mortality in Buddhist Southeast Asia. Our data are derived from a prospective nationwide cohort study of 60,569 Thai adults reporting in 2009 and followed up for all-cause mortality over the next four years (296 deaths). We also gathered data on a wide array of covariates and included these in the final model of the unhappiness-mortality effect. All final effect estimates were mutually adjusted odds ratios (AOR) and cohort members who reported being happy ‘little’ or ‘none of the time’ in 2009 were more likely to die (AOR 2.60, 95% Confidence Interval 1.17-5.80). Other significant covariates include being female (