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Nitt Hanprathet,1 Somrat Lertmaharit,1 Vitool Lohsoonthorn,1,2 Thanapoom Rattananupong,1 Palanee Ammaranond,3 Wiroj Jiamjarasrangsi1,2 1Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand; 2Department of Preventive and Social Medicine, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand; 3Department of Transfusion Medicine, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok 10330, ThailandCorrespondence: Wiroj JiamjarasrangsiDepartment of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Rama IV Road, Pathumwan, Bangkok 10330, ThailandTel +66 2 256 4000 ext. 3700Fax +662 256 4292Email wjiamja@gmail.comPurpose: The gender differential evidence of the association between shift work and type 2 diabetes risk remains scarce. This longitudinal study determines whether the association between shift-work exposure and type 2 diabetes risk and abnormal fasting plasma glucose (FPG) differs according to gender; the study aims to find the association between shift work and changes in physiological, behavioral, and psychosocial stress.Patients and methods: This retrospective cohort study was conducted among 5947 workers (4647 female and 1300 male) aged ≤60 years old in Bangkok, Thailand. Participants required a normal FPG level (

The article presents a study which explored the cost and burden of treating human papillomavirus (HPV)-related diseases and cervical cancer in Thailand. A health state-transition Markov model was developed for portraying the treatment algorithm. Results concluded the cost and health burdens imposed by HPV-related diseases in Thailand.

Objective: To compare the effect of unsupported arm elevation (UAE) in different planes on chest wall volumes, thoracoabdominal asynchrony (TAA), ventilatory demands, dyspnea, and arm fatigue in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects., Methods: Twenty-one patients with COPD and healthy-matched subjects performed UAE in shoulder flexion, scaption, abduction, and resting. Pulmonary total and regional chest wall volumes ( V RCp ), abdominal rib cage volume, abdominal volume, TAA, and ventilatory demands during arm positions were measured using optoelectronic plethysmography., Results: In both groups, V RCp and TAA were significantly affected during UAEs compared with the resting position. The healthy subjects had significantly decreased V RCp (L) ( p < 0.05) during scaption (0.14 ± 0.07) and abduction (0.15 ± 0.06) than during flexion (0.18 ± 0.07) and no significantly different TAA between UAEs. The COPD group had no significantly different V RCp between UAEs, had significantly increased TAA ( p < 0.05) during scaption (31.1°±9.5°) and abduction (32.3°±9.9°) than during flexion (29.7°±9.1°); and had significantly worse V RCp ( p = 0.007), TAA ( p = 0.0001), ventilatory demands ( p < 0.05), dyspnea (( p = 0.03), and arm fatigue ( p = 0.002)., Conclusions: In patients with COPD, UAE in different planes similarly restricted the upper chest wall volume. Shoulder scaption and abduction significantly impaired TAA, ventilation, dyspnea, and arm fatigue compared with flexion. These results may help to select the appropriate UAE during physical activities.

Mediators involving in inflammation induction and regulation have been investigated as biomarkers for severe joint pain induced by chikungunya virus (CHIKV) infection. In this report, observational study was conducted to determine levels of an antagonist of interleukin-1 receptor (IL-1Ra) and soluble vascular cell adhesion molecule-1 (sVCAM-1) in CHIKV patients with different disease severity. CHIKV infection patients presented without (n = 199) and with joint pain (n = 262) were included. IL-1Ra and sVCAM-1 levels in patient sera were determined. Levels of sVCAM-1 were strongly and significantly higher in the group of patients with joint pain than in the group without joint pain (p < 0.0001). The levels of both IL-1Ra and sVCAM-1 were not significantly increased with age., (Copyright © 2022. Published by Elsevier B.V.)

Abstract: This study identified the effects of pursed-lip breathing (PLB), forward trunk lean posture (FTLP), and combined PLB and FTLP on total and compartmental lung volumes, and ventilation in patients with chronic obstructive pulmonary disease (COPD). Sixteen patients with mild to moderate COPD performed 2 breathing patterns of quiet breathing (QB) and PLB during FTLP and upright posture (UP). The total and compartmental lung volumes and ventilation of these 4 tasks (QB-UP, PLB-UP, QB-FTLP, PLB-FTLP) were evaluated using optoelectronic plethysmography. Two-way repeated measures ANOVA was used to identify the effect of PLB, FTLP, and combined strategies on total and compartmental lung volumes and ventilation. End-expiratory lung volume of ribcage compartment was significantly lower in PLB-UP than QB-UP and those with FTLP (P < .05). End-inspiratory lung volume (EILV) and end-inspiratory lung volume of ribcage compartment were significantly greater during PLB-FTLP and PLB-UP than those of QB (P < .05). PLB significantly and positively changed end-expiratory lung volume of abdominal compartment (EELVAB ) end-expiratory lung volume, EILVAB, tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation than QB (P < .05). UP significantly increased tidal volume of pulmonary ribcage, tidal volume of abdomen, and ventilation and decreased EELVAB, end-expiratory lung volume, and EILVAB than FTLP (P < .05). In conclusion, combined PLB with UP or FTLP demonstrates a positive change in total and compartmental lung volumes in patients with mild to moderate COPD., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: To determine effects of different modes of upper limb training on dyspnea and quality of life of individuals with chronic obstructive pulmonary disease (COPD) having different disease severity., Methods: Randomized clinical trials were retrieved from five electronic databases. Risk of bias and quality of evidence were assessed using the Cochrane Collaboration's tool and the GRADE approach, respectively. Effects of upper limb training compared to control were identified using standardized mean difference and 95% confidence interval., Results: Fifteen studies with 514 subjects were included. When compared to control, upper limb endurance and strength training with moderate quality of evidence resulted in significant improvement in dyspnea. However, quality of life was not significantly different between upper limb training of all modes of and the control. The upper limb training was more effective in reducing dyspnea in patients with severe COPD than in those with mild to moderate levels of COPD. Although quality of life was slightly improved by upper limb training for those with moderate or severe level of COPD, such improvement did not reach a significant level when compared to the control., Conclusion: Upper limb endurance and strength training could significantly improve dyspnea in individuals with chronic obstructive pulmonary disease. Thus, incorporating the upper limb training into pulmonary rehabilitation is recommended to reduce dyspnea, especially for those with severe patients. Further studies with larger sample size and standardized training protocol are needed to confirm these finding (Registration No. CRD42018102805).

Objective: To update evidence on the effects of breathing exercises (BEs) on ventilation, exercise capacity, dyspnea, and quality of life (QoL) in chronic obstructive pulmonary disease (COPD) patients., Methods: Randomized controlled trials investigating the effects of BEs in COPD patients published through May 2018, were retrieved from five electronic databases (MEDLINE, CINAHL, Cochrane, Scopus, and ScienceDirect). Risk of bias and quality of evidence were assessed, using Cochrane Collaboration's tool, and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) approach, respectively., Results: Nineteen studies (n=745), were included. Quality of evidence, was low to moderate. When compared to the control groups, respiratory rate significantly (p≤0.001) improved in the pursed-lip breathing (PLB), ventilatory feedback (VF) plus exercise, diaphragmatic breathing exercise (DBE), and combined BEs. Additionally, PLB significantly improved tidal volume (p<0.001), inspiratory time (p=0.007), and total respiratory time (p<0.001). VF plus exercise significantly improved inspiratory capacity (p<0.001), and singing significantly improved the physical component of QoL, than did the control groups (p<0.001). All BEs did not significantly improve dyspnea, compared to the controls (p>0.05)., Conclusion: PLB, VF plus exercise, DBE, combined BEs, and singing could be used to improve ventilation and QoL. Based on low to moderate quality of evidence, use of these BEs to improve ventilation and QoL in COPD patients is conditional (Registration No. CRD42018102995).

Objectives: Previous epidemiological evidence for the association of shift work exposure and increased leukocyte count is cross-sectional in nature, thus limiting cause-effect inference. We therefore used a longitudinal design to: (i) compare leukocyte counts at baseline between shift and day workers and (ii) examine the time trend of leukocyte counts over the follow-up period for these workers., Methods: A retrospective cohort study was conducted among 6737 workers aged <60 years at two large organizations (a humanitarian organization and a university) in Bangkok, Thailand who had participated in at least two annual health check-ups during the period 2005-2016. Shift work exposure history was assessed by a self-administered questionnaire and categorized into day, former, and current shift workers. Data on leukocyte count were collected annually as part of worksite health screening during the observation period. Association of shift work exposure and increased leukocyte count was then examined cross-sectionally and longitudinally by using multiple linear regression and multilevel analysis of repeated measures data, respectively. In addition, trends for leukocyte count over the follow-up period and work years were examined using LOWESS smooth curves., Results: Compared to day work, the current shift work was associated with increased leukocyte counts. The magnitude of percentage increase was the highest for basophil counts, followed by eosinophil and lymphocyte counts. Both cross-sectional and longitudinal evidence revealed this association, although it was less pronounced longitudinally. For total leukocyte count, the magnitude of difference was constant across the 11-year follow-up period. However, for lymphocyte and basophil counts, these discrepancies tapered over the work years until they no longer differed (for lymphocyte count) or even differed in the opposite direction (for basophil count) in later work years., Conclusion: This study confirmed previous cross-sectional evidence that shift work exposure-increased leukocyte counts and that this was reversible. Whether this increase in immune cell count also results in an increased immune cell activity and serves as the intermediary in the association between shift work exposure and subsequent chronic disease development needs further investigation., (© The Author(s) 2019. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Purpose: Preeclampsia-eclampsia remains one of the leading causes of maternal and perinatal morbidity and mortality. Emerging evidence suggests that obstructive sleep apnea (OSA), which has been linked to hypertension in the general population, may play role in hypertensive disorders in pregnancy, including preeclampsia-eclampsia. However, little research has been conducted in Asia (no data in Thailand) on the effects of OSA on preeclampsia-eclampsia. We aimed to examine the association between OSA and preeclampsia-eclampsia among Thai pregnant women., Methods: We conducted a large prospective cohort study among Thai pregnant women who were in the second trimester of singleton pregnancy. The Berlin Questionnaire was administered to evaluate the risk for OSA. Preeclampsia-eclampsia was diagnosed by standard clinical assessment. Multivariate models were applied in adjustment for confounding factors., Results: Enrolled were 1345 pregnant women. The overall prevalence of high risk for OSA was 10.1% (95% confidence intervals [CIs] 8.5-11.7), and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio (OR) for preeclampsia-eclampsia in women with high risk for OSA was 2.72 (95% CI 1.33-5.57)., Conclusions: Pregnant women with high risk for OSA are at increased risks for preeclampsia-eclampsia compared to those with low risk for OSA. Our results support a role for screening for OSA by BQ during antenatal care.

Incense burning, a source of household indoor air pollution, is possible to effect on cardiovascular system. Our study sought to examine the association of long-term exposure to household incense smoke with increased carotid intima-media thickness (CIMT). A cross-sectional study was conducted 132 adults aged ≥35 years. Participants were stratified into 3 groups by their long-term household incense use; nonexposed group, non-daily exposed group, and daily exposed group. A combined mean CIMT (mean difference = 0.04 mm; P < .01) and combined maximum CIMT (mean difference = 0.09 mm; P < .01) in the daily exposed group had greater than the nonexposed group. The mean CIMT and maximum CIMT of the left common carotid artery in the daily exposed group was significantly greater than the nonexposed group ( P < .01). These findings suggest that incense burning inside the house may be a risk factor for cardiovascular disease morbidity and mortality.

Objective: To develop a reliable and valid treatment outcome checklist for the measurement of ADHD treatment for children in a clinical setting., Material and Method: The behavior indicators to assess the treatment outcomes of ADHD children were researched and developed by using multi-informants perspectives. The present study involved a qualitative study and two rounds of the Modified Delphi Techniques. In the first process, 11 parents/guardians of ADHD children aged 6 to 18 years were given a semi-structured interview on their expectation towards treatment outcomes at the Child and Adolescent Mental Health Rajanagarindra Institute. Items from literature reviews were also added before the first and second round evaluations using the Delphi by five different expert fields (six experts from each field). Final indicators from expert consensus were assessed from 180 ADHD patients, which were assessed by three child and adolescent psychiatrists. All items were analyzed for internal coefficient reliability. The Receiver Operating Characteristic (ROC) was used to calculate the cut off score., Results: Thirteen indicators were assessed by experts as good content validity for clinical outcomes of ADHD treatment with the reliability of 0.60. The optimal cut-off point was 4 (sensitivity: 0.80; specificity: 0.76). The Area under curve (AUC) of total score was considered at a good level (0.83)., Conclusion: The ADHD clinical outcome checklist with 13 items has shown good validity and fair reliability. It can be a useful tool for ADHD treatment outcome assessment in clinical setting.

Objective: The aim of this study was to evaluate the risk of obstructive sleep apnea (OSA) to preterm delivery (PTD), using the Berlin Questionnaire (BQ)., Methods: This was a large, prospective cohort study among pregnant Thai women. The BQ was employed for symptom-based OSA screening during the second trimester, and PTD was recorded in 1345 pregnant women. Multivariate models were applied in controlling for potential confounders., Results: The overall prevalence of the high risk of OSA was 10.1 %, and it was significantly associated with pre-pregnancy body mass index and score on the Perceived Stress Scale. An adjusted odds ratio for PTD in women with a high risk of OSA was 2.00 (95 % confidence intervals (CIs) = 1.20, 3.34). Stratified analyses, after adjusting for confounding factors, indicated that a high risk of OSA was associated with an increased risk of spontaneous preterm delivery (odds ratio (OR) = 2.45, 95 % CI = 1.20, 5.02), but not with preterm premature rupture of membranes (OR = 1.61, 95 % CI = 0.61, 4.26), and medically indicated preterm delivery (OR = 1.83, 95 % CI = 0.72, 4.64)., Conclusion: Pregnant women with a high risk of OSA are at an increased risk of having PTD, compared with pregnant women with a low risk of OSA.

We conducted this study to fill the noted gap in the available literature by evaluating the prevalence of poor sleep quality in this understudied population and to explore the relationship between sleep quality and psychological problems among undergraduates in Thailand. This study used a cross-sectional survey. Self-administrated questionnaires included the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale, the Depression, Anxiety and Stress Scale and the Thai General Health Questionnaire. The study group included 1,055 undergraduates, aged 18-25 years. The prevalence of poor sleep quality was 42.4%. Students classified as poor quality sleepers reported significantly more psychological problems, indicating a linear trend of progressively worse global sleep quality associated with greater mood and anxiety symptomatology. Prospective studies that include objective measures of sleep duration and quality are needed to more fully develop focused health promotion strategies for Southeast Asian undergraduates.

Delivering diabetes self-management support is an enormous challenge for healthcare providers with limited human resources. We conducted a cluster randomized controlled trial to assess the effectiveness of a DSMS program incorporating the computer-assisted instruction. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was applied to evaluate the DSMS program. Ten Public Health Centers in Bangkok, Thailand were randomized into either DSMS program or usual care. Forty eligible patients with type 2 diabetes in each Public Health Center were randomly selected. Totally, 403 patients (200 controls and 203 interventions) participated. About 93.8% participants completed the six-month follow-up. Over six months, adjusted mean changes of hemoglobin A1c (-0.14%, 95% confidence interval = -0.02 to -0.26, fasting plasma glucose (-6.37 mg/dL, -1.95 to -10.78), health behaviors (3.31 score, 2.27 to 4.34), and quality of life (1.41 score, 0.69 to 2.12) were significantly improved in intervention compared to control group. In conclusion, the DSMS program facilitates Public Health Centers to accomplish their support for people with diabetes., (© 2015 Wiley Publishing Asia Pty Ltd.)

Background: Shortage and maldistribution of the health workforce is a major problem in the Thai health system. The expansion of healthcare access to achieve universal health coverage placed additional demand on the health system especially on the health workers in the public sector who are the major providers of health services. At the same time, the reform in hospital payment methods resulted in a lower share of funding from the government budgetary system and higher share of revenue from health insurance. This allowed public hospitals more flexibility in hiring additional staff. Financial measures and incentives such as special allowances for non-private practice and additional payments for remote staff have been implemented to attract and retain them. To understand the distributional effect of such change in health workforce financing, this study evaluates the equity in health workforce financing for 838 hospitals under the Ministry of Public Health across all 75 provinces from 2008-2012., Methods: Data were collected from routine reports of public hospital financing from the Ministry of Public Health with specific identification on health workforce spending. The components and sources of health workforce financing were descriptively analysed based on the geographic location of the hospitals, their size and the core hospital functions. Inequalities in health workforce financing across provinces were assessed. We calculated the Gini coefficient and concentration index to explore horizontal and vertical inequity in the public sector health workforce financing in Thailand. Separate analyses were carried out for funding from government budget and funding from hospital revenue to understand the difference between the two financial sources., Results: Health workforce financing accounted for about half of all hospital non-capital expenses in 2012, about a 30 % increase from the level of spending in 2008. Almost one third of the workforce financing came from hospital revenue, an increase from only one fourth 5 years earlier. The study reveals a big difference in health workforce expenditure per capita across provinces. Health workforce spending from government budget was less equal than that from hospital revenues as shown by the higher Gini coefficient. The concentration indices show that the financing of hospital workforce was higher per capita in lower resource provinces., Conclusion: Our analysis of equalities in health workforce spending shows an improving trend in equity across provinces from 2008-2012. Expansion of healthcare and health insurance coverage and financing reform towards a demand-side financing helped improve the distribution of funding for health workforce across the provinces. The findings from this study can be useful for other countries with ongoing reform towards universal health coverage.

Introduction: To investigate the relationship between common psychiatric disorders (CPDs) and sleep characteristics (evening chronotype, poor sleep quality and daytime sleepiness) among Thai college students., Methods: A cross-sectional study was conducted among 2,970 undergraduate students in Thailand. Students were asked to complete a self-administered questionnaire that collected information about lifestyle and demographic characteristics. The Horne and Ostberg Morningness-Eveningness Questionnaire (MEQ), Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) were used to evaluate circadian preference, sleep quality and daytime sleepiness, respectively. The General Health Questionnaire-12 (GHQ-12) was used to evaluate presence of CPDs. Logistic regression models were used to estimate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) of CPDs in relation to the covariates of interest., Results: A total of 337 students were classified as having CPDs (11.2%; 95% CI 10.1-12.3%). Evening chronotype (OR = 3.35; 95% CI 2.09-5.37), poor sleep quality (OR = 4.89; 95% CI 3.66-6.54) and excessive daytime sleepiness (OR = 1.95; 95% CI 1.54-2.47) were statistically significantly associated with CPDs., Discussion: Our study demonstrated that CPDs are common among Thai college students. Further, evening chronotype, poor sleep quality and excessive daytime sleepiness were strongly associated with increased risk of CPDs. These findings highlight the importance of educating students and school administrators about the importance of sleep and their impact on mental health., (Copyright © 2014 Wiley Publishing Asia Pty Ltd.)

Background: Parkinson's disease (PD) is a ubiquitous disease. However, PDs prevalence in the population of agricultural communities lacks understanding and there has been no epidemiological study on the association between pesticides exposure factors and risk for PD., Objectives: To investigate the potential association between organophosphate pesticides exposure and Parkinsonism by using a screening questionnaire in agricultural areas., Material and Methods: Ninety elderly people living in agricultural areas participated in a cross-sectional study conducted at Tambon Hua-Rua Health Promoting Hospital in April 2014. Screening questionnaires for Parkinson's disease, Test-mate ChE (Model 400) for blood cholinesterase (ChE) levels of both blood enzymes erythrocyte cholinesterase (AChE), and plasma cholinesterase (PChE) were used as measurement tools. Descriptive statistics for frequencies and percentage distributions were used primarily to summarize and describe the data. Sensitivity, specificity, positive and negative predictive values were calculated., Results: The age range of the participants was 50 to 59 years old, with an average age of 53.9±2.87 years. The majority of the participants were female (62.2%), 82.2% of respondents were farmers. Most of participants (76.7%) reported that they applied insecticides in their farms. Ninety persons participated and completed the 11-item questionnaire. Of these, 17 (18.9%) felt that they lost balance when turning or that they needed to take a few steps to turn right around and 16.7% of participants indicated that they felt the need to move slowly or stiffly. The study found the prevalence of abnormal AChE levels was 28.9% (95%CI=19.81-39.40) and 17.8% of PChE levels (95%CI=10.52-27.26). To predict Parkinsonism, AChE, and PChE level, with a cutoff score of 5 or higher there had to be a sensitivity of 0.31, specificity of 1.00, positive predictive value (PPV) of 1.00 and negative predictive value (NPV) of 0.78 for AChE. While PChE, the score value of 5 or more had a sensitivity of 0.19, specificity of 0.93, PPV of 0.38 and NPV of 0.84., Conclusions: This study described an association between pesticides exposure and Parkinsonism. The questionnaire appears to be useful for Thai agriculturists as a screening tool for Parkinsonism and cholinesterase levels regarding to pesticides exposure.

This study aimed to examine the association between obstructive sleep apnea (OSA) and obesity among young adults. A total of 2911 college students in Thailand participated in the study. Anthropometric measurements and blood pressure were taken by trained research staff. Overall, 6.3% of college students had OSA determined by the Berlin Questionnaire, 9.6% were overweight (BMI: 25-29 kg/m 2 ), 4.5% were obese (BMI≥30 kg/m 2 ); 12.4% had abdominal obesity (men: waist circumference≥90 cm; women: waist circumference≥80 cm). There were significant associations between OSA and overweight (odds ratio (OR)=1.72; 95% confidence interval (CI)=1.04-1.85) and obesity (OR=24.23; 95% CI=15.20-38.61), independent of demographic and lifestyle factors, blood pressure, and psychological distress. Students with OSA were more likely to have abdominal obesity than those without OSA (OR=2.09; 95% CI=1.19-3.67). OSA was significantly related to joint effects of general and abdominal obesity. The OSA-obesity associations were robust and evident for both genders, individuals with normal and elevated blood pressure, and those with and without psychological distress. This study shows independent associations of OSA with general and abdominal obesity among young adults. OSA could be a risk factor for obesity and consequent cardiovascular morbidities. OSA screening and treatment might be important for young adults.

We conducted this study to evaluate the prevalence of daytime sleepiness and evening chronotype, and to assess the extent to which both are associated with the use of caffeinated stimulants among 3,000 Thai college students. Demographic and behavioral characteristics were collected using a self-administered questionnaire. The Epworth Sleepiness Scale and the Horne and Ostberg Morningness-Eveningness Questionnaire were used to evaluate prevalence of daytime sleepiness and circadian preference. Multivariable logistic regression models were used to evaluate the association between sleep disorders and consumption of caffeinated beverages. Overall, the prevalence of daytime sleepiness was 27.9 % (95% CI: 26.2-29.5%) while the prevalence of evening chronotype was 13% (95% CI: 11.8-14.2%). Students who use energy drinks were more likely to be evening types. For instance, the use of M100/M150 energy drinks was associated with a more than 3-fold increased odds of evening chronotype (OR 3.50; 95% CI 1.90-6.44), while Red Bull users were more than twice as likely to have evening chronotype (OR 2.39; 95% CI 1.02-5.58). Additionally, those who consumed any energy drinks were more likely to be daytime sleepers. For example, Red Bull (OR 1.72; 95% CI 1.08-2.75) or M100/M150 (OR 1.52; 95% CI 1.10-2.11) consumption was associated with increased odds of daytime sleepiness. Our findings emphasize the importance of implementing educational and prevention programs targeted toward improving sleep hygiene and reducing the consumption of energy drinks among young adults.

The purpose of this study was to test the relationship between Buddhist religious practices and blood pressure. A cross-sectional survey of Buddhist religious practices and blood pressure was conducted with 160 Buddhist elderly in rural Uttaradit, northern Thailand. After controlling for the variables of gender, status, education, salary, underlying hypertension, exercise, salt intake, and taking antihypertensive medications, it was found that lower systolic and diastolic blood pressure is associated with the Buddhist religious practice of temple attendance. The Buddhist older people who regularly attended a temple every Buddhist Holy day (which occurs once a week) were found to have systolic and diastolic blood pressure readings lower than people who did not attend as regularly. It is recommended that nurses advocate for temple attendance in the care protocols for older Buddhist hypertensive patients both in Thailand and internationally., (© 2013 Wiley Publishing Asia Pty Ltd.)

Background: Obstructive sleep apnea (OSA) has been linked to hypertension among middle-aged and older adults in Western countries. Few studies have focused on young adults, especially those in Southeast Asian countries undergoing epidemiologic transitions and experiencing elevated noncommunicable disease burden. We investigated associations of high risk for OSA with hypertension among Asian young adults., Methods: A total of 2,911 college students in Thailand participated in this study. The high risk for OSA was assessed using the Berlin Questionnaire. Blood pressure (BP) and anthropometric measurements were taken by trained research staff. Elevated BP and hypertension were defined as BP ≥ 120/80 mm Hg and ≥ 140/90 mm Hg, respectively. Multivariable logistic regression models were fit to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of elevated BP and hypertension. Stratified analyses were conducted to examine whether observed associations varied by weight status., Results: High risk for OSA was significantly associated with elevated BP (OR = 2.38; 95% CI = 1.68-3.39) and hypertension (OR = 2.55; 95% CI = 1.57-4.15) after adjustment for demographic and lifestyle factors. When body mass index was further controlled for, observed associations were greatly attenuated. The associations were only evident among overweight and obese students., Conclusions: The high risk for OSA among overweight and obese young adults is associated with elevated BP and hypertension. Enhanced efforts directed toward screening and diagnosing OSA and weight control among young adults could be one strategy for improving cardiovascular health.

Purpose: Poor sleep and heavy use of caffeinated beverages have been implicated as risk factors for a number of adverse health outcomes. Caffeine consumption and use of other stimulants are common among college students globally. However, to our knowledge, no studies have examined the influence of caffeinated beverages on the sleep quality of college students in Southeast Asian populations. We conducted this study to evaluate the patterns of sleep quality and to examine the extent to which poor sleep quality is associated with consumption of energy drinks, caffeinated beverages, and other stimulants among 2,854 Thai college students., Methods: A questionnaire was administered to ascertain demographic and behavioral characteristics. The Pittsburgh Sleep Quality Index was used to assess sleep habits and quality. Chi-square tests and multivariate logistic regression models were used to identify statistically significant associations., Results: Overall, the prevalence of poor sleep quality was found to be 48.1 %. A significant percent of students used stimulant beverages (58.0 %). Stimulant use (odds ratios (OR) 1.50; 95 % confidence intervals (95 % CI) 1.28-1.77) was found to be statistically significant and positively associated with poor sleep quality. Alcohol consumption (OR 3.10; 95 % CI 1.72-5.59) and cigarette smoking (OR 1.43; 95 % CI 1.02-1.98) also had a statistically significant association with increased daytime dysfunction due to sleepiness. In conclusion, stimulant use is common among Thai college students and is associated with several indices of poor sleep quality., Conclusion: Our findings underscore the need to educate students on the importance of sleep and the influences of dietary and lifestyle choices on their sleep quality and overall health.

Objective: To investigate cytokine profile in patients with chikungunya virus (CHIKV) infection., Methods: Twenty eight pairs of serum samples collected from CHIKV infected patients during the outbreak of chikungunya fever in South Thailand in 2008 were obtained. A multiple cytokine assay for detection of 17 cytokines was performed., Results: In the acute stage of CHIKV infection, the patients had significantly higher levels of interleukin-6, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein 1 and tumor necrosis factor alpha than the control (P<0.001, P=0.023, P=0.015, P<0.001 and P=0.024, respectively). When the disease developed to the recovery stage, the patients had significantly lower levels of interleukin-6, granulocyte-macrophage colony-stimulating factor, monocyte chemotactic protein 1 and macrophage inflammatory protein beta than in the acute stage (P<0.001)., Conclusions: This study provides additional information that these cytokines could play roles in pathogenesis of CHIKV infection and could be used as disease biomarkers or drug targets., (Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.)

Metabolic syndrome (MetS) and hyperuricemia are important risk factors for cardiovascular disease, hypertension and renal disease. The relationship between serum uric acid (UA) levels and MetS remains unclear. In the present study we determined the presence of MetS and measured UA levels among personnel at the Thai Red Cross Society and Chulalongkorn University to evaluate the possible presence of an association between the two. We conducted this cross sectional study in 2009. A total of 2,804 persons, aged 35-60 years (628 men and 2176 women) filled out questionnaires, had laboratory testing and were included in the study. MetS was defined by criteria harmonized from six international expert groups. The association between MetS and UA levels was determined using multivariable logistic regression. The overall prevalences of MetS were 25.1, 21.1, and 18.2% when a BMI > or = 23 kg/m2, a BMI > or = 25 kg/m2 or waist circumference were used to classify abdominal obesity, respectively. Body mass index, waist circumference, blood pressure, and triglycerides significantly elevated in both men and women with elevated UA levels (all a p-value < 0.005). After adjustment for potential confounders, the odds ratio of having MetS in the fourth quartile compared with the first quartile of a UA level was 2.77 times for men (95% CI 1.60-4.79) and 8.04 times for women (95% CI 5.43-11.91). There wes a stronger association between the presence of MetS and UA in women than men. UA levels were associated with the presence of MetS.

This study assessed the effect of intensive education on self-reported frequency of hand washing (FHW), measured quality of hand washing (QHW), and measured scores of knowledge, attitude, and practice (KAP) after 7 days and 90 days home-based intensive education of participants (aged >7 years) in households with a influenza-positive child. The authors provided intensive hand washing education using interactive participation including individual training, self-monitoring diary, provision of soap, and so on. There were significant improvements on FHW and QHW on day 7, control group (n(1) = 135) reported 3.9 hand washing episodes/day, whereas the intervention group (n(2) = 140) reported 5.7 episodes/day; control group (n(1) = 164) obtained a 3.2 measured quality score, whereas the intervention group (n(2) = 166) obtained a score of 6.4. Pre-education and 90 days post-education, FHW significantly improved by 2 episodes/day and QHW increased by 3 scores/episode. Knowledge of influenza and hand washing following coughing/sneezing showed significant improvement, but attitude modification toward severity of influenza requires a more intensified and longer intervention.

Background: Conscripts are a vulnerable population group for HIV infection. Their serostatus has been monitored in Thailand as part of the national sentinel surveillance since 1997. Given the nature of the military environment, an innovative program is needed to promote safe sex to reduce the rate of sexually transmitted infections (STIs) and HIV., Objective: The present study proposed to evaluate the program of "Squad Leader Mentors through Short Message Services on Mobile Phones" in improving the required knowledge, attitudes, and the safe sex practice among conscript groups., Material and Method: A quasi-experimental design was applied in separate areas. The subjects were recruited by multistage sampling techniques. One hundred forty eight conscripts from the Lop Buri Military District were randomly selected to be the study group, and 114 conscripts from the Sara Buri Military District were the control group. The study and control groups were matched for background characteristics. The changes in knowledge, attitudes, and safe sex practice were measured by pre- and post-test questionnaires over a six-month period., Results: There were significant changes in overall scores of knowledge of safe sex and STIs. Benefits of using SMS and squad leaders that acted as mentors in the study groups (p-value < 0.001**) were observed. The safe sex practices in the study group showed significant increase in condom use with risky partners such as sex workers and other men (p-value < 0.001**). Therefore, it is believe that conscripts can be mentors in promoting safe sex (p-value = 0.006*)., Conclusion: The presented program can genuinely increase knowledge and practice of safe sex among conscripts in the study group.

Background: Approximately 80% of cervical cancer cases occur in developing countries. In Thailand, cervical cancer has been the leading cancer in females, with an incidence of 24.7 cases per 100,000 individuals per year., Objectives: We constructed a decision model to simulate the lifetime economic impact for women in the context of human papillomavirus (HPV) infection prevention. HPV-related diseases were of interest: cervical cancer, cervical intraepithelial neoplasia, and genital warts. The two strategies used were 1) current practice and 2) prophylactic quadrivalent vaccine against HPV types 6, 11, 16, and 18., Methods: We developed a Markov simulation model to evaluate the incremental cost-effectiveness ratio of prophylactic HPV vaccine. Women transition through a model either healthy or developing HPV or its related diseases, or die from cervical cancer or from other causes according to transitional probabilities under the Thai health-care context. Costs from a provider perspective were obtained from King Chulalongkorn Memorial Hospital. Costs and benefits were discounted at 3% annually., Results: Compared with no prophylactic HPV vaccine, the incremental cost-effectiveness ratio was 160,649.50 baht per quality-adjusted life-year. The mortality rate was reduced by 54.8%. The incidence of cervical cancer, cervical intraepithelial neoplasia grade 1, cervical intraepithelial neoplasia grade 2/3, and genital warts was reduced by up to 55.1%., Conclusion: Compared with commonly accepted standard thresholds recommended by the World Health Organization Commission on Macroeconomics and Health, the nationwide coverage of HPV vaccination in girls is likely to be cost-effective in Thailand., (Copyright © 2012 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.)

Objective: To determine health related quality of life (QoL) of patients diagnosed with cervical intraepithelial neoplasia (CIN) and cervical cancer compared QoL among stages of cancer and to study the association between QoL and patients' characteristics., Material and Method: The questionnaire elicited information and QoL using Functional Assessment of Cancer Therapy General (FACT-G) questionnaire. The study population was patients with a diagnosis of one of the four FIGO stages of cervical cancer, Results: One hundred seventy two patients completed the present study. The adjusted mean scores QoL was 78.76. There were no significant differences between FIGO stages on the global QoL and subscale. The authors found negative association between age and physical wellbeing scores (p = 0.049) and a positive association between age and emotional wellbeing scores (p = 0.004). Lower educational attainment was associated with higher emotional wellbeing scores (p = 0.004)., Conclusion: For many patients, family, religion, or psycho-social support may be considered a necessity. The younger and better-educated groups may require more information and psycho-emotional support.

Objective: To develop an assessment tool of Thai menopause-specific quality of life in Surat Thani Province, Thailand., Material and Method: The present study divided research design into three phases. Phase I Concept clarification, a thorough study of related literature was conducted to search for the concept of menopause-specific quality of life and its existing instruments to guide developing instrument. Phase II Item development, in-depth interviews with 30 Thai menopausal women in Surat Thani was conducted and an initial pool of items relating to menopause-specific quality of life was generated to develop the instrument, then, tested with 399 menopausal women. Phase III psychometric test, the developed questionnaire was tested for validity and reliability with 402 menopausal women., Results: The Thai Menopause-Specific Quality of Life instrument was well developed with 63 items, internal consistency reliability coefficient obtained 0.952, comprised of three domains including physic-psychological well-being (51 items), sexual-socio-economic well-being (9 items) and vasomotor well-being (3 items)., Conclusion: The present study was directed to develop an effective instrument with integrity of psychometric property. This instrument was more meaningful to detect quality of life specific to Thai menopausal women.

Aims: To estimate the prevalence of insulin resistance (HOMA-IR) and to study its relationship with selected cardiovascular disease risk factors among Thai adults., Methods: This cross-sectional study was comprised of 227 men and 990 women undergoing routine health check-up. The prevalence of insulin resistance was estimated using diagnostic criteria previously employed in Asian and other populations. Spearman's rank correlation coefficients were used to evaluate associations of HOMA-IR with selected cardiovascular disease risk factors. Multivariable logistic regression procedures were used to evaluate associations of hypertriglyceridemia, low HDL-Cholesterolemia, and hypertension with varying HOMA-IR values., Results: Approximately 25.1% of men (HOMA-IR>or=1.56) and 21.5% of women (HOMA-IR>or=1.64) were classified as having insulin resistance. HOMA-IR values were statistically significantly and positively associated with body mass index, body fat percentage, waist circumference, and serum triglycerides. The values were inversely correlated with HDL-Cholesterol. When compared with those whose HOMA-IR values were within the lowest quartile (<0.45), men with HOMA-IR values in the highest quartile (>or=1.58) had higher risks of hypertriglyceridemia (adjusted OR=2.83), low HDL-Cholesterolemia (adjusted OR=2.79), and hypertension (adjusted OR=2.76). Similar associations were observed among women., Conclusion: Insulin resistance, as determined using HOMA-IR, was positively associated with selected cardiovascular disease risk factors among Thai adults., (Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.)

OBJECTIVE: To investigate the association of high sensitivity C-reactive protein (hsCRP) concentrations and metabolic syndrome among Thai adults. METHODS: This cross-sectional study is comprised of 467 Thai participants (209 men and 258 women) receiving annual health check-up. Spearman's rank correlation coefficients were used to assess associations of metabolic parameters (age, waist circumference, blood pressure, triglycerides, HDL-C, fasting plasma glucose, fasting insulin and uric acid) with hsCRP concentrations for men and women, respectively. Multivariable logistic regression procedures were used to estimate the risk (odds ratios [OR] and 95% confidence intervals [95% CI]) of metabolic syndrome according to low, moderate and high hsCRP concentrations (<1.0, 1.0-3.0 and >3.0 mg/l, respectively). RESULTS: Measures of adiposity and fasting insulin were positively and significantly correlated with hsCRP concentrations among women with and without metabolic syndrome. Similar associations were observed among men without metabolic syndrome. After controlling for confounders, moderately elevated hsCRP concentrations were associated with a 2.38-fold increased risk of metabolic syndrome (OR=2.38, 95% CI: 1.20-4.72) among men. Men with high hsCRP concentrations had a 5.45-fold increased risk of metabolic syndrome (OR=5.45, 95% CI: 2.24-13.27) when compared with those who had low hsCRP concentrations. The corresponding odds ratios for women with moderately elevated and high hsCRP concentrations were 4.92 (OR=4.92, 95% CI: 2.34-10.35) and 11.93 (OR=11.93, 95% CI: 5.54-25.72), respectively. CONCLUSIONS: These findings are consistent with the literature suggesting a role of hsCRP as a biomarker for metabolic syndrome.

The purpose of the present study was to examine the association between abnormal hepatocellular functions and abnormal fasting glucose level in the employees in a university hospital in Bangkok, Thailand. A cross-sectional data analysis was conducted among 2790 workers who were 35-60 years old and participated in both the annual fasting plasma glucose (FPG) examination and the baseline questionnaire survey during 2001-2005. The prevalence rates (95% confidence interval; CI) of impaired fasting glucose (IFG) were 10.4 (9.1-11.7) and 20.3 (17.0-23.9) percent respectively for women and men, while those of type 2 diabetes were 3.1 ( 2.4-3.9) and 6.5 (4.6-8.9) respectively. After controlling for conventional risk factors, only the alanine aminotransferase (ALT) level was significantly associated with increased abnormal FPG This association was particularly obvious for the DM. In conclusion, the present study demonstrated that the type 2 diabetes and ALT association was also evident in the Thai population.

Objective: To evaluate the efficiency of quality control performance for a general x-ray machine between computed radiography (CR) and film method., Material and Method: CR performance as a quality control method for a general x-ray machine was compared to the film method. Two raters independently analyzed the result of quality control from both methods. Economic evaluation was performed by cost-minimization analysis. All data (result for quality control and cost) were collected from Phramongkutklao Hospital from August 2007 to January 2008., Result: Quality control performances of a general x-ray machine by using CR and film method were equivalent. Interobserver agreement for analysis of quality control measurements was almost perfect. Unit cost, test performance time, radiation dose for quality control by CR were less than the film method (p < 0.001)., Conclusion: The performances of quality control of a general x-ray machine done by the CR method are more efficient than the film method. Using the CR method for quality control performance of the general x-ray machines will save cost enormously.

Background: To examine the relation between elevated liver marker concentrations (alanine aminotransferase [ALT], aspartate aminotransferase [AST], and alkaline phosphatase [ALP]) and risk of metabolic syndrome (MetS)., Methods: This cross-sectional study was comprised of 1,391 Thai participants (451 men and 940 women) receiving annual health check-ups. Multivariable logistic regression procedures were used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) of MetS risk according to quartiles of each liver marker concentration with the lowest quartile specified as the referent group., Results: Overall, mean concentrations of AST, ALT and ALP increased and mean AST:ALT ratio decreased with increasing presence of metabolic abnormalities (p-value=0.059 for AST in men, all other p-values <0.001). After adjusting for confounders, men with ALT concentrations in the extreme quartiles (>40 units/L), had a 2.77-fold increased risk of MetS (95%CI: 1.18-6.53), as compared with men who had values in the lowest quartile (≤21 units/L). The OR for extreme quartiles of ALP concentrations was 3.72 (95%CI: 1.49-9.29). In women, elevated ALT concentrations were also associated with MetS risk. Those with the highest ALT concentrations (>23 units/L) had a 2.55-fold increased risk of MetS (95%CI: 1.22-5.35) compared to women with concentrations ≤13 units/L., Conclusions: These findings add to an emerging body of literature that suggests elevated liver enzymes may be related with MetS risk. However, prospective studies are needed to more fully determine the practical value of elevated liver enzymes as a clinical risk predictor of MetS and related disorders among Thai adults.