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Pawitra Jariyasakulwong,1 Doungrut Wattanakitkrileart,1 Kanaungnit Pongthavornkamol,1 Noppawan Piaseu,2 Weranuj Roubsanthisuk3 1Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand; 2Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Division of Hypertension, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Doungrut Wattanakitkrileart, Department of Medical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand, Email doungrut.wat@mahidol.ac.thIntroduction: Self-care practices are crucial for optimizing blood pressure control and are influenced by multilevel factors.Objective: To examine the influences of multilevel factors on hypertension self-care practices among individuals with uncontrolled hypertension and to determine the relationship between hypertension self-care practices and blood pressure.Methods: The study was conducted in primary, secondary, and tertiary care settings in Bangkok, selected for convenience, where individuals with uncontrolled hypertension were recruited using a convenience sampling method based on specific inclusion criteria. Data were collected using a demographic questionnaire, the Hypertension Knowledge Level Scale, the Newest Vital Sign, the Self-Efficacy to Manage Hypertension Scale, the revised Thai Multidimensional Scale of Perceived Social Support, the Communication Assessment Tool-Nurse, the Neighborhood Scales, and the Hypertensive Self-Care Activity Level Effects. The Cronbach’s alpha coefficients were 0.82, 0.84, 0.81, 0.92, 0.96, 0.73, and 0.72 to 0.96, respectively. Data were analyzed using descriptive statistics, logistic regression, and Pearson’s correlation.Results: A total of 326 participants were included and 80.1% of them had poor hypertension self-care practices. Individuals with moderate social support were 2.23 times more likely to have poor hypertension self-care practices compared to those with high social support (OR = 2.23; 95% CI = 1.11, 4.49; p-value < 0.05). Each unit increase in poorer resources was associated with a 1.05 times higher likelihood of poor hypertension self-care practices (OR = 1.05; 95% CI = 1.02, 1.09; p-value < 0.05). Four out of six domains of hypertension self-care practices—medication adherence, physical activity, smoking status, and alcohol consumption—were significantly associated with diastolic blood pressure (r = − 0.17, p < 0.01; r = − 0.11, p < 0.05; r = 0.23, p < 0.01; and r = 0.15, p < 0.05, respectively).Conclusion: Hypertension self-care practices could be improved through multilevel factors, including social support and neighborhood resources.Keywords: uncontrolled hypertension, self-care, social support, neighborhood resource

Byline: B. Ongphiphadhanakul (1), S. Chanprasertyothin (1), P. Payattikul (1), S. Saetung (1), N. Piaseu (1), L. Chailurkit (1), R. Rajatanavin (1) Keywords: Key words:Bone mass -- Estrogen receptor-[alpha] gene -- Genetics -- Osteoporosis -- Single nucleotide polymorphism Abstract: We report the association of a newly identified synonymous G2014A single nucleotide polymorphism (SNP) which does not alter the amino acid sequence in exon 8 of the estrogen receptor-[alpha] (ER[alpha]) gene with osteoporosis in Thai postmenopausal women. Subjects consisted of 228 postmenopausal women aged more than 55 years divided into two groups -- with vertebral or femoral osteoporosis (n= 106) or without osteoporosis (n= 122) -- according to bone mineral density (BMD) criteria. The exon 8 G2014A SNP, which is 6 nucleotides upstream from the end of the stop codon, was identified by PCR-RFLP. Data are expressed as the mean and 95% CI. The allele frequency of the G2014A polymorphism was 26.4% in osteoporotic subjects and was significantly higher than that in non-osteoporotic women (15.2%) (p&lt 0.05). By stepwise logistic regression analysis, it was found that the G2014A polymorphism was related to the presence of osteoporosis (odds ratio 2.7 per A allele, 95% CI 1.49--4.76) independently of body weight (odds ratio 0.93 per kg, 95% CI 0.89--0.96) and years since menopause (odds ratio 1.12 per year, 95% CI 1.08--1.19). In a multiple linear regression model, L2--L4 BMD of osteoporotic subjects was associated with body weight (p&lt 0.05), endogenous estradiol levels (p&lt 0.05) and the G2014A genotype (p&lt 0.001), while it was related only to body weight (p&lt 0.05) and estradiol levels in non-osteoporotic women (p&lt 0.05). We conclude that a G2014A SNP in exon 8 of ER[alpha] is associated with the presence and severity of postmenopausal osteoporosis. Linkage disequilibrium between this polymorphism and the 3 -untranslated region of the ER[alpha] gene which may participate in the regulation of ER[alpha] gene expression remains to be determined. Author Affiliation: (1) Department of Medicine and Research Center, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, TH Article note: Received: 17 October 2000 / Accepted: 11 June 2001

Byline: S. Domrongkitchaiporn (1), B. Ongphiphadhanakul (1), W. Stitchantrakul (1), N. Piaseu (1), S. Chansirikarn (1), G. Puavilai (1), R. Rajatanavin (1) Keywords: Key words:Calcium oxalate -- Calcium supplement -- Calcitriol -- Osteoporosis -- Supersaturation Abstract: Although calcium supplementation can cause hypercalciuria, the risk of nephrolithiasis has been shown to decrease rather than increase among subjects who had a higher calcium intake. Hypercalciuria is also a well-established side effect of calcitriol administration. However, the risk of nephrolithiasis is not well defined. The present study was undertaken to prospectively determine the effect of calcium with or without calcitriol on physicochemical risk factors associated with calcium oxalate nephrolithiasis in Thai postmenopausal women with osteoporosis. Subjects consisted of 53 Thai women more than 10 years postmenopausal who were randomly allocated to receive 750 mg of calcium carbonate supplement alone (n= 28) or 750 mg of calcium carbonate plus 0.5 mg calcitriol (n= 25) daily. Mean+-SEM for age was 65.3+-1.1 years, body weight 53.5+-1.3 kg. Urine samples for biochemical assays were collected at baseline and 3 months after treatment. Supersaturation for calcium oxalate stone formation was assessed from the 24 h urine constituents by the Tiselius's index, AP(CaOx). Three months of calcium supplement alone resulted in a modest, but not significant, increase in urinary calcium (baseline, 2.90+-0.43 mmol/day after treatment 3.58+-0.54 mmol/day) with no change in urinary oxalate, citrate or magnesium. In contrast, calcium together with calcitriol caused a significant increase in urinary calcium (baseline, 2.87+-0.41 mmol/day after treatment, 4.08+-0.57 mmol/day p&lt 0.05). No significant change in other urine constituents after treatment with calcium and calcitriol was detected. Therefore, AP(CaOx) did not significantly increase either after calcium alone (baseline, 1.17+-0.39 after treatment, 1.36+-0.28) or after calcium plus calcitriol (baseline, 1.09+-0.17 after treatment, 1.09+-0.19). However, after treatments, 12 subjects (23%) -- 6 receiving calcium supplement alone and 6 receiving calcium plus calcitriol supplement -- had high AP(CaOx) values (greater than the upper limit of 95% CI for AP(CaOx) derived from non-stone-forming Thai women). The post-treatment/baseline ratio was 3.21+-0.74 for urinary calcium, 1.01+-0.19 for urinary oxalate, and 2.23+-0.42 (median 1.15) for AP(CaOx). The post-treatment/baseline ratio of calcium, but not for urinary oxalate, had a significant correlation with the post-treatment/baseline ratio of AP(CaOx). Our findings suggest that the alteration in the risk of calcium oxalate nephrolithiasis based on urinary composition is related to the alteration in urinary calcium. The risk of calcium oxalate nephrolithiasis does not increase significantly after calcium or combined calcium and calcitriol supplement in the majority of postmenopausal women with osteoporosis. Author Affiliation: (1) Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, TH Article note: Received: 10 March 1999 / Accepted: 16 November 1999

Background: Patients with long COVID may experience various concomitant symptoms caused by inflammation, which affect their lives and well-being. In this study, we aimed to (1) investigate the prevalence of long COVID; (2) explore the levels of symptom severity and functional disability owing to long COVID, overall health, and their relationship; and (3) conduct exploratory factor analysis of long COVID-19 symptoms among experienced infected population in the capital of Thailand., Methods: A cross-sectional research design was used and a sample of 337 community members with previously COVID-19 infection in Bangkok, Thailand was recruited for this study. Purposive sampling was used. Data collection was performed using an online and a paper-based questionnaire. Descriptive statistics (number, percentage), odds ratio, exploratory factor analysis, and Spearman's rank correlation coefficient were used for the data analysis., Results: The prevalence of long COVID was 32.9%. The main reported symptoms included anxiety (28.5%), fatigue (26.1%), and dyspnea (13.4%). There was a significant relationship between symptom severity and functional disability (r s =0.385, p value < 0.01). Overall health was negatively correlated with symptom severity (r s  = - 0.291, p < .01) and functional disability (r s  = - 0.108, p < .05). Using principal component analysis with Promax rotation, three clusters were identified, explaining 71.44% of the total variance. The Clusters comprised (1) common symptoms of long COVID and communication, (2) fatigue, functioning, and nutritional concerns, and (3) psychosocial impacts., Conclusions: The present results might help multidisciplinary care teams understand the concurrent symptoms of patients with long COVID and develop rehabilitation care programs to ease all symptoms simultaneously and improve patients' quality of life., (© 2024. The Author(s).)

Background: Patients with lupus nephritis experience disease symptoms and side effects from treatment. Although self-management behaviors are important in patients with this disease, there is limited research on the factors influencing these behaviors., Objective: This study aimed to examine the factors influencing self-management behaviors in patients with lupus nephritis., Methods: This cross-sectional study was conducted in 240 patients with lupus nephritis at a university hospital in Thailand between August 2019 and December 2020 using a random sampling method. Data were collected using a demographic and clinical characteristic questionnaire, Self-Management Behavior Questionnaire, Self-efficacy for Managing Chronic Disease: A 6-item Scale, Knowledge about Lupus Nephritis Questionnaire, Family Support Scale, Social Networks in Adult Life Questionnaire, and Memorial Symptom Assessment Scale for Lupus Nephritis. Descriptive statistics and multiple linear regression analyses were employed., Results: The participants reported a moderate level of self-management behaviors. Multiple regression analyses revealed that disease duration, income, symptoms, self-efficacy, knowledge, family support, social networks, and classes of lupus nephritis significantly explained 21% of the variance in self-management behaviors (R 2 = 0.21; F (8,231) = 7.73; p <0.001). Family support (β = 0.32, p <0.001) and symptoms (β = -0.23, p <0.001) were significant determinants of self-management behaviors in patients with lupus nephritis., Conclusion: The findings provide valuable insight for nurses to better understand the factors influencing self-management behaviors in patients with lupus nephritis. Patients with low family support and high symptom severity may face difficulty in performing self-management behaviors. Nurses should pay more attention to these patients and provide family-based interventions to optimize self-management behaviors in this population., Competing Interests: None., (© The Author(s) 2024.)

Introduction: The COVID-19 pandemic has significantly impacted Thailand, including urban centers like Bangkok and surrounding areas, highlighting a critical need for effective management within densely populated communities to mitigate its effects., Methods: This qualitative study sought to explore community management strategies developed in Khlong Toei, a large, congested urban community in Bangkok, Thailand. Seven in-depth interviews ( n =7), six focus groups ( n =23), and two brainstorming sessions ( n =12) were conducted for this study. Data were collected using Zoom, an online communication platform, and through on-site interviews between August 2021 and March 2022 in the congested urban community of Bangkok, Thailand. The data were analyzed using content analysis., Results: All informants (age range: 20-66 years, female respondents: 73.33%) were recruited by a community leader and the abbot of Saphan Temple, the community waiting area in Khlong Toei. The findings revealed two main themes: (1) Caring people, including two subthemes, and (2) Caring community, including two subthemes., Discussion: The study's findings provide guiding inputs for management of public fear to prevent emerging or re-emerging infectious pandemics within congested urban communities., Competing Interests: The authors declare no relevant conflicts of interest or financial relationships, and there have been no previous publications of the work., (© Suwatjana Noinam et al., 2024; Published by Mary Ann Liebert, Inc.)

In urban Chinese women with normal body weight during pregnancy, we implemented a comprehensive dietary intervention program aimed at enhancing nutrition literacy, dietary quality, and gestational weight gain. The methods included both online and offline health education on prenatal nutrition, weekly weight monitoring, family back education practices, and real-time dietary guidance. The intervention was delivered to randomly assigned control and intervention group participants from gestational week 12 to week 24. The intervention group ( n = 44; 100% complete data) showed significant differences (mean (SD)) compared to the control group ( n = 42; 95.5% complete data) in nutrition literacy (53.39 ± 6.60 vs. 43.55 ± 9.58, p < 0.001), restrained eating (31.61 ± 7.28 vs. 28.79 ± 7.96, p < 0.001), Diet Quality Distance (29.11 ± 8.52 vs. 40.71 ± 7.39, p < 0.001), and weight gain within the first 12 weeks of intervention (4.97 ± 1.33 vs. 5.98 ± 2.78, p = 0.029). However, there was no significant difference in the incidence of gestational diabetes (2 (4.5%) vs. 4 (9.5%), p = 0.629). Participants in the intervention group reported an overall satisfaction score of 4.70 ± 0.46 for the intervention strategy. These results emphasize the positive role of comprehensive dietary intervention in promoting a healthy diet during pregnancy.

This study evaluated the effectiveness of nursing case management on self-care, clinical outcomes, and quality of life in community-dwelling older adults with poorly controlled type 2 diabetes in Thailand. The research employed a quasi-experimental, single-group, pretest - posttest design. Methods: Twenty-three participants participated in a 12-week nursing case management program, which was tailored to the individual's needs and abilities, as well as their family, community, and healthcare context. Self-care behaviors increased significantly ( p  = .000) after implementation of the case management program, while waist circumference, fasting capillary blood glucose, and hemoglobin A1c decreased significantly ( p  = .001, p  = .000, p  = .003, respectively) from pre-intervention values. Quality of life was significantly better after the program ( p  = .000) than before. Results suggest that implementing tailored nursing case management could increase self-care behaviors and quality of life while decreasing waist circumference, fasting capillary blood glucose, and hemoglobin A1c in community-dwelling older adults with poorly controlled type 2 diabetes. The effectiveness of nursing case management depends on the healthcare context, the training and expertise of case managers, as well as the patient's needs and preferences. Furthermore, the availability of families and communities can influence the nursing case management outcomes.

Objectives: The combination of protein supplementation and resistance exercise shows promise for improving and maintaining muscle mass, strength, and performance in older adults with sarcopenia. This systematic review aimed to evaluate the effects of this combination on muscle mass, muscle strength, and physical performance in community-dwelling older adults with sarcopenia., Methods: We conducted a comprehensive search of 4 electronic databases: PubMed, Scopus, Embase, and the MEDLINE Library. The search covered literature from January 2013 to January 2023 and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two independent reviewers assessed the methodological quality of each study using the standard critical appraisal tool from the Joanna Briggs Institute (JBI). Meta-analysis was performed with the JBI Sumari program., Results: The review included 7 randomized controlled trials and 1 quasi-experimental study, encompassing a total of 854 participants aged 60 years and above. The study durations ranged from 10 weeks to 24 weeks. An analysis of standardized mean differences (SMDs) showed that protein supplementation combined with resistance exercise significantly increased muscle mass (SMD, 0.95; 95% confidence interval [CI], 0.13 to 1.78; p<0.05) and muscle strength (SMD, 0.32; 95% CI, 0.08 to 0.56; p<0.05)., Conclusions: Although the limited number of randomized controlled trials restricts the robustness of our conclusions, the evidence suggests that protein supplementation combined with resistance exercise is effective in enhancing muscle mass and strength in community-dwelling older adults with sarcopenia.

Objective: This systematic review and meta-analysis aimed to assess the prevalence and identify factors associated with sarcopenia in older Thais., Methods: Research studies were searched in online databases, including PubMed, Embase, Scopus, and Thai-Journal Citation Index. The articles included in this review were limited to being published between January 1, 2013 and January 31, 2023 and observational study designs. The research quality was evaluated using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. A meta-analysis was performed using the JBI SUMARI software. The review protocol has been registered on PROSPERO with the assigned ID CRD42023420514., Results: A total of 265 research articles were initially identified, out of which 17 articles were included in this study, including a total of 4,668 participants aged 60 years and over, consisting of 1,380 (29.6%) men and 3,288 (70.4%) women. The overall prevalence of sarcopenia in Thai older adults was 20.7% (95% CI 14.4%-27.8%). Subgroup analysis of the sarcopenia prevalence based on the study areas revealed that the prevalence was 33.4% (95% CI 28.7%-38.3%) in hospitalized individuals, 23.2% (95% CI 12.5%-35.9%) in outpatient clinic settings, and 17.3% (95% CI 9.4%-26.8%) in community-living older adults. Advanced age ( OR  = 4.60, 95% CI 3.07-6.91), being male ( OR  = 2.30, 95% CI 1.37-3.85), low body mass index (BMI) ( OR  = 8.95, 95% CI 6.05-13.25), and malnutrition ( OR  = 2.78, 95% CI 2.09-3.70) are strong predictors of sarcopenia in older adults in Thailand., Conclusions: This systematic review represents the first assessment of the overall prevalence and factors associated with sarcopenia in Thai older adults, indicating its significant concern within this population. These findings are of importance for public health management aimed at preventing and managing sarcopenia in the country., (© 2023 The Authors.)

Background: Coronavirus disease 2019 (COVID-19) can develop into a long-term COVID in some cases, which can have a major impact on various health systems requiring appropriate treatment involving multi-disciplinary healthcare. The COVID-19 Yorkshire Rehabilitation Scale (C19-YRS) is a standardized tool widely used for screening the symptoms and severity of long-term COVID. Translation of the English version of the C19-YRS into the Thai language and testing it is essential for the psychometric evaluation of the severity of the long-term COVID syndrome prior to providing rehabilitation care for community members., Methods: Forward-and back-translations including cross-cultural aspects were conducted in order to develop a preliminary Thai version of that tool. Five experts evaluated the content validity of the tool and produced a highly valid index. A cross-sectional study was then conducted on a sample of 337 Thai community members recovering from COVID-19. Assessment of internal consistency and individual item analyses were also performed., Results: The content validity resulted in valid indices. The analyses showed that 14 items had acceptable internal consistency, based on the corrected item correlations. However, five symptom severity items and two functional ability items were deleted. The Cronbach's alpha coefficient of the final C19-YRS was 0.723, indicating acceptable internal consistency and reliability of the survey instrument., Conclusions: This study indicated that the Thai C19-YRS tool had acceptable validity and reliability for the evaluation and testing of the psychometric variables in a Thai community population. The survey instrument also had acceptable validity and reliability for screening the symptoms and severity of long-term COVID. Further studies are warranted in order to standardize the various applications of this tool., (© 2023. The Author(s).)

Objectives: The purpose of this study was to investigate the factors related to flood preparedness literacy and the relationship between flood preparedness literacy and behaviors., Methods: A quantitative descriptive correlational study. The sample included 134 people residing in a central Thai province. Descriptive statistics, point-biserial correlation coefficient, and Spearman's rank correlation were used in the data analysis., Results: The results revealed that the factors related to flood preparedness literacy with a statistical significance were marital status (rpb = 0.207; P < 0.01), hearing ability (r = 0.197; P < 0.05), instrumental activities of daily living (r = 0.226; P < 0.01), and social support (r = 0.388; P < 0.01). Flood preparedness literacy was correlated with flood preparedness behaviors (r = 0.281; P < 0.01)., Conclusion: The factors related to flood preparedness literacy as mentioned above should be assessed to identify vulnerable groups for specific care provision. Furthermore, nurses should promote these factors to contribute to effective responses during flood disasters.

The COVID-19 pandemic has a severe and immediate impact on unemployment and reduced household income, resulting in global food insecurity. Women play a major role as household food providers who manage food insecurity in Thai community. In this qualitative study researchers aimed to understand how communities engage in management of food insecurity resulting from COVID-19. Participants included 12 female food providers who were community volunteers, four community leaders, and four health providers. Focus group interviews were conducted. Data were analyzed using content analysis. We explain community engagement to manage food insecurity through strategies including connecting through empathy, community empowerment, and engaging for sustainability. We present findings to illustrate how women's groups may work through a public-private partnership to achieve sustainable food security.

Background and Aims: Diabetic foot ulcers are the leading cause of lower extremity amputations, which require more effective prevention. Even though previous nursing studies on diabetic foot ulcers have been well performed, programs implementing self- and family management are limited and even underexplored. Therefore, the purpose of the study was to investigate the effect of 3-month self- and family management support programs on clinical outcomes among Indonesians with diabetic foot ulcers., Method: The randomized controlled trial design was used to answer the research question of the study. A total of 56 eligible participants were enrolled, with 27 in the experimental group and 29 in the control group. The experimental group received self- and family management support programs for three months. Meanwhile, the control group received usual care. Descriptive statistics, multivariate analysis of variance, and Generalized Estimating Equations were used to analyze the data. The significance level was considered at .05 for hypothesis testing., Results: The study showed that there were statistically significant improvements in self-management, family supports, hemoglobin A1c, and wound size after implemented the programs for three months (p < .05)., Conclusions: With regard to the result of the study, implementing the 3-month self- and family management support programs improves the patients' and families' abilities to perform diabetic foot ulcer care at home., Competing Interests: Declaration of competing interest The authors reported no potential conflict of interest., (Copyright © 2020 Diabetes India. Published by Elsevier Ltd. All rights reserved.)

Aim: This study aimed to appropriately establish a Japanese style healthcare program under the ISO9001:2008 (ISO: International Organization for Standardization) in Minowa, Japan and Rayong, Thailand to improve problem areas and inspect its effectiveness. Furthermore, we want to make this health promotion through ISO widely available in Asian countries and to make an international contribution., Method: We implemented a 6-month health program in the c Rayong city, Thailand, and a 12 month health program in the Minowa town, Japan. This study assessed findings from pedometry, anthropometry and blood pressure measurements, physical fitness, blood chemistry, and brain function tests., Results: The comparisons were made using interaction effects between the participants in Rayong and Minowa. They showed significant differences in the 10-m obstacle walk, the 6-minute walk, HDL, the reverse and reverse differentiation time, the total number of forgets, the total number of mistakes, and the total number of brain function errors., Conclusions: To improve the brain function in participants from Rayong through this health education program, measures such as increasing the number of steps, adding muscular strength/stretching exercises, and home training every day is suggested.

Background/objectives: Low consumption of fruit and vegetable is frequently viewed as an important contributor to obesity risk. With increasing childhood obesity and relatively low fruit and vegetable consumption among Thai children, there is a need to identify the determinants of the intake to promote fruit and vegetable consumption effectively., Subjects/methods: This cross-sectional study was conducted at two conveniently selected primary schools in Nakhon Pathom. A total of 609 students (grade 4-6) completed questionnaires on personal and environmental factors. Adequate fruit and vegetable intakes were defined as a minimum of three servings of fruit or vegetable daily, and adequate total intake as at least 6 serves of fruit and vegetable daily. Data were analyzed using descriptive statistics, the chi-square test, and multiple logistic regression., Results: The proportion of children with a sufficient fruit and/or vegetable intakes was low. Covariates of child's personal and environmental factors showed significant associations with sufficient intakes of fruit and/or vegetable ( P < 0.05). Logistic regression analyses showed that the following factors were positively related to sufficient intake of vegetable; lower grade, a positive attitude toward vegetable, and fruit availability at home; and that greater maternal education, a positive child's attitude toward vegetable, and fruit availability at home were significantly associated with sufficient consumption of fruits and total fruit and vegetable intake., Conclusions: The present study showed that personal factors like attitude toward vegetables and socio-environmental factors, such as, greater availability of fruits were significantly associated with sufficient fruit and vegetable consumption. The importance of environmental and personal factors to successful nutrition highlights the importance of involving parents and schools., Competing Interests: CONFLICT OF INTEREST: The authors declare no potential conflicts of interests.

Background: Food insecurity is a dynamic, global issue requiring our constant attention today, and practical assessment instruments are needed to detect food insecurity in various populations and countries. A screening tool for food insecurity was developed and tested its psychometric properties., Material and Method: The Food Insecurity Screening Instrument (FISI) was developed based on literature review and qualitative data from a sample of 30 female who were family food providers in crowded urban communities in Bangkok., Results: Content validity was determined by five experts, resulting in a good content validity index. It was tested with another 350 food providers, resulting in high reliability Item analysis revealed good internal consistency of items to total scale, except for two items which were deleted. Construct validity was determined using exploratoiy factor analysis, and revealed four factors, consisting of 33 items, food quantity, food quality, food safety, and anxiety about food These factors together explained 74.9% of total variance of the new tool., Conclusion: This new tool provides a valid and reliable means of screening for food insecurity in families and communities. Policy makers in Thailand have supported the usefulness of the instrument which has already been used across the country for the National Survey, and after the 2011 Thai floods.

In this qualitative study we aimed to describe how older women in a crowded urban community perceive the food insecurity experience and deal with it. In-depth interviews were conducted among 30 Thai older women. Results revealed that older women perceived their food insecurity experience as a negative effect of the current economic downturn globally. They felt that they were confronting a crisis. Problems they dealt with included six issues. The women employed management strategies around food, health, money, and family. Our results suggest a need for welfare reform that facilitates management strategies aimed to meet food security.

Leptin, a hormone produced by fat cells, possesses several physiological functions not limited to energy balance. Recently, leptin has been shown to inhibit bone formation through its action at the hypothalamus. In the present study, the authors explored the association of leptin with bone mineral density (BMD) in men and women according to menopausal status. Subjects consisted of 75 men, 51 premenopausal women and 63 postmenopausal women aged 20-80 years. All were healthy and did not take medication which may affect bone metabolism. BMD was measured at L2-4 and femoral neck by DEXA. Serum leptin concentrations were measured by radioimmunoassay. Serum leptin in males was independently related to BMD at L2-4 (r = -0.36, p < 0.05) and the femoral neck (r = -0.32, p < 0.05) in a multiple linear regression model with age, body mass index (BMI), serum free testosterone, estradiol and leptin as independent variables. In premenopausal women, serum leptin correlated negatively to L2-4 (r = -0.29, p < 0.01) and femoral neck BMD (r = -0.29, p < 0.05) independently of age and BMI. However, in postmenopausal women, no association of leptin with BMD was found after controlling for age and BMI. The authors concluded that circulating leptin is negatively associated with BMD in men and premenopausal women, but not in postmenopausal women. The negative associations found in both premenopausal women and men in the present study strengthen the notion that leptin may inhibit bone formation during the accumulation of bone mass early in life

Food insecurity is a public health problem. Information on how cultures perceive the experience of a financial crisis and resultant food insecurity is limited. Our purpose in this study was to understand how poor families residing in urban slums in Thailand perceive their food situation. Interviews were conducted with 30 women aged 20-65 years who were household food providers. Content analysis revealed three themes: experiencing changes, being vulnerable to not having enough food, and getting support. Policy changes to address access to social and health services and development of additional welfare programs must be made to achieve food security.

Purpose: To assess perceptions of food insecurity (FI), socioeconomic change, and health among urban poor households in Thailand. Research questions were: (a) what are the experiences of food insecurity among households living in slum areas? and (b) what are the socioeconomic conditions, basic needs, food-related behaviors, and perceptions of health that have changed in this group since the 1997 economic recession?, Methods: A cross-sectional descriptive survey was conducted to identify experiences of FI and perceptions of health in households living in slum areas. Questionnaires on food security, health, and nutritional assessment, including 3-day dietary records, and anthropometric measurements, were collected from 199 female food providers of households., Findings: Only 44.2% of the households reported food security, and 39.2%, 13.6%, and 3% reported FI without hunger, FI with moderate hunger, and FI with severe hunger, respectively. Overall, households reported lower income and worse health and life satisfaction as a result of the economic recession. In addition, a decrease in income led to difficulty meeting their basic needs, such as access to health service and food provision., Conclusions: FI was prevalent and the reported experiences of those with FI indicate areas for improvement of health policy for urban poor families. The results of the study are constructive for developing health programs to empower the urban poor and contribute to health promotion of food security in Thailand.

Unlabelled: Age and sex related changes in bone metabolism are of interest in the pathogenesis of osteoporosis. However, most data in the literature were studied in Western countries. In a tropical country, such as Thailand, little is known of vitamin D status and bone remodeling. Thus, the aim of this study was to determine the changes of vitamin D levels and biochemical markers of bone turnover in healthy women and men of various age groups between 20-80 years who were living in Bangkok. From the results, vitamin D levels of various age groups did not alter significantly between men and women except in the sixth decade of women. However, men had higher levels of vitamin D than women. In women, all biochemical markers of bone turnover increased with age, with a sharp increase at the onset of menopause. In contrast, biochemical markers of bone turnover in men gradually declined with advancing age., Conclusion: There was no evidence of vitamin D deficiency in the Bangkok population. Women and men showed different age-related changes in bone metabolism.

The goal of health education is to provide information to affect attitudes, beliefs, and intentions for behavior change. However, little is known about the effects of changes in knowledge on behaviors for osteoporosis prevention. Our objective is to develop and test theoretical models of the effects of knowledge, attitude, and self-efficacy on exercise and calcium intake among young women before and after an intervention program. First, we hypothesized that knowledge would positively predict attitude, self-efficacy, calcium intake, and exercise. Second, attitude would positively predict self-efficacy, calcium intake, and exercise. Third, self-efficacy would positively predict calcium intake and exercise. Fourth, attitude and self-efficacy would mediate the effect of knowledge on calcium intake and exercise. At the beginning and end of the study, participants in the control group and intervention group completed the osteoporosis knowledge test, the osteoporosis health belief scale, the osteoporosis self-efficacy scale, a self-report for food records, and exercise. The causal model was examined as a result of our study. After the intervention program, calcium intake and exercise were predicted by knowledge when mediated by attitudes and self-efficacy. The final model accounted for 30% and 45% of the variance in calcium intake and exercise, respectively. We conclude that interventions to enhance young women's knowledge and self-efficacy may result in increased calcium intake and exercise.

Unlabelled: Decreased bone mineral density (BMD) with age is an increasing health problem, especially for postmenopausal women. Multiple factors have been reported to affect BMD including both genetic and environmental factors such as calcium intake and physical activity. For Thailand, people residing in different regions may differ in BMD due to these factors. However, there is a paucity of data concerning this issue. The objectives of this study were to identify the lifestyle factors which may influence BMD and to investigate the association between BMD and these factors in postmenopausal women who have been living in Bangkok and other provinces in Thailand. Subjects consisted of 466 postmenopausal women aged 46-90 years including 236 Bangkokians (116 early postmenopausals and 120 late postmenopausals) and 230 non-Bangkokians (134 early postmenopausals and 96 late postmenopausals). All were healthy and ambulatory. BMD was measured by dual energy X-ray absorptiometry (DEXA, Expert XL). Calcium intake was assessed by food-frequency questionnaire. Data were expressed by mean + /- SEM. There were 22 per cent (n=52), 5.9 per cent (n=14), and 4.2 per cent (n=10) of postmenopausal Bangkokians while 13.9 per cent (n=32), 4.3 per cent (n=10), and 2.2 per cent (n=5) of postmenopausal non-Bangkokians who had low BMD at spine, femoral neck, and at both sites, respectively. Spine BMD (SPBMD) and femoral neck BMD (FNBMD) increased significantly across the quartiles of calcium intake in both groups of subjects (P<0.05) and a significant difference was found between the lowest and the highest quartiles of calcium intake (P<0.05). Moreover, BMD at both regions was shown to be correlated with calcium intake, exercise and sunlight exposure in these subjects (P<0.001). Further analysis revealed higher BMD at spine (0.992 + 0.02 vs 0.945 +/- 0.02 g/cm2, P<0.05) and at femur (0.780 +/- 0.01 vs 0.740 +/- 0.01 g/cm2, P<0.05), calcium intake (348.9 +/- 12.7 vs 316.3 +/- 8.0 mg/day, P<0.05), exercise (2.8 +/- 0.1 vs 2.4 +/- 0.1 h/wk, P<0.001) and sunlight exposure (2.9 +/- 0.06 vs 1.9 +/- 0.04 h/day, P<0.001) were found in late postmenopausal women in other provinces than their counterparts in Bangkok. Nevertheless, no significant difference of BMD at both sites, calcium intake and exercise was found in the early postmenopausal groups of these two areas., Conclusions: There were significant differences in BMD and lifestyle factors between late postmenopausal women in Bangkok and other provinces. Environmental factors especially calcium intake, exercise and sunlight exposure, may influence BMD in late postmenopausal Thai women.

Background: Markers of bone formation and resorption may be useful as early indicators of response to therapy. Our aim in this study was to investigate the use of bone markers for monitoring of intervention for bone loss in early postmenopausal women and to assess the relationships between these markers and changes in bone mineral density (BMD)., Methods: Subjects were randomly assigned to the following groups: a control group; a group receiving calcium alone; groups receiving calcium plus low or conventional doses of conjugated equine estrogen; and groups receiving calcium plus low or conventional doses of calcitriol. At baseline and at 1 and 3 months after intervention, we measured serum intact osteocalcin, serum N-terminal midfragment osteocalcin, serum C-terminal telopeptide of type I collagen (CTx), urinary deoxypyridinoline cross-links, and urinary CTX: The BMD of the lumbar spine and the femoral neck was measured at baseline and after 1 and 2 years of intervention., Results: No marker changed significantly in the control group except urinary CTx, which increased at 3 months. Serum CTx decreased in all regimens at 1 or 3 months of intervention. In addition, the changes of all markers at 3 months were inversely associated with the change in the BMD of the lumbar spine at 1 or 2 years (r = -0.144 to -0.314), whereas only the changes of bone resorption markers at 3 months were inversely correlated with the changes in femoral BMD at 1 or 2 years (r = -0.143 to -0.366)., Conclusions: Biochemical markers of bone turnover appear to be of use in assessing early response to therapy. Bone resorption markers, especially serum CTx, are better indicators than bone formation markers for estimating the response to intervention in early postmenopausal women. However, the early changes in bone markers were weakly related to the later changes in BMD.

This study determined the genotype distribution of apolipoprotein E (apo E) gene and its relation to serum lipids in 217 healthy Thais consisting of 79 males and 138 females. Serum total cholesterol (TC), HDL-cholesterol (HDL-C) and triglyceride (TG) concentrations were determined by enzymatic-colorimetric methods, while serum LDL-cholesterol (LDL-C) levels were calculated using Friedewald formula. Apo E genotypes were determined by PCR-RFLP. Out of 217 subjects, apo E genotype frequencies were 5.5 per cent for E2/E2, 12.4 per cent for E2/E3, 81.1 per cent for E3/E3 and 0.9 per cent for E4/E4. In men, advancing age was associated with increased serum TC (r = 0.28, P < 0.05) and LDL-C (r = 0.27, P < 0.01). Subjects having the E2 allele had lower TC (r = -0.27, P < 0.05) and LDL-C. (r = -0.25, P < 0.05). Age and apo E genotypes were not associated with HDL-C and TG in men. In women, increasing age was related to higher serum TC (r = 0.45, P < 0.001), LDL-C (r = 0.44, P < 0.001), TG (r = 0.40, P < 0.001) and lower HDL-C (r = -0.36, P < 0.001). The presence of E2 allele was related to lower TC (r = -0.24, P < 0.001), LDL-C (r = -0.26, P < 0.001), TG (r = -0.15, P < 0.05) and higher HDL-C (r = 0.20, P < 0.01) independent of age and menopausal status. We concluded that the epsilon 4 allele of apo E gene is rare in Thais. The presence of the epsilon 2 allele is associated with a more favorable lipid profile and there is a sexual dimorphism concerning the effect of apo E genotype on serum HDL-C and TG.

In the present study, the relation of serum leptin to adiposity, gender and metabolic covariates in normal Thais was examined. Subjects consisted of 224 individuals aged between 20-79 years. Eighty two were men while 142 were women. Data were expressed as mean +/- SEM. Serum leptin was associated with total body fat assessed by dual-energy X-ray absorptiometry in both men (r = 0.80, P < 0.0001) and women (r = 0.73, P < 0.0001). Compared to women, serum leptin concentrations was lower in men (P < 0.0001). The difference still persisted after controlling the adiposity. Compared to premenopausal women, postmenopausal women had higher serum leptin independent of adiposity (P < 0.0001). In men, serum free testosterone was negatively associated with serum leptin (r = -0.36, P < 0.001) while there was no association between serum estradiol and leptin. The relation between serum FT and leptin in men no longer persisted after controlling for adiposity. Body fat was associated with fasting insulin levels in both men (r = 0.26, P < 0.05) and women (r = 0.18, P < 0.05). However, the association between fasting insulin levels and body fat in both men and women no longer existed after adjusting for leptin. We concluded that serum leptin concentrations are associated with total body adiposity and serum leptin may mediate the effect of body fat on insulin sensitivity. There appears to be a sexual dimorphism of serum leptin unrelated to sex hormone status and the amount of body fat.

A Trp64Arg mutation in the beta3-adrenergic receptor gene has been implicated in the pathophysiology of non-insulin-dependent diabetes mellitus and obesity. However, the findings have been controversial due to the use of different populations and different methods for the estimation of body fat. In the present study, the prevalence of Trp64Arg mutation of the beta3-adrenergic receptor gene was determined and its relation to body fat as assessed by dual-energy x-ray absorptiometry (DEXA) was evaluated in Thai men and women. The effect on insulin sensitivity as assessed by the serum insulin to glucose ratio was also examined. The subjects were 76 men and 135 women aged 20 to 80 years. Body fat and its regional distribution were assessed by DEXA. Mutation in the beta3-adrenergic receptor gene was determined by polymerase chain reaction (PCR)-restriction fragment length polymorphism. Data are expressed as the mean +/- SEM. Fifty-nine subjects (28.0%) had the Trp64Arg mutation in the beta3-adrenergic receptor gene; 54 (25.6%) were heterozygotes and five (2.4%) were homozygotes. The gene frequency of Trp64Arg mutation was 15.2% in these subjects. In women, Trp64Arg mutation was not associated with the difference in total body fat (Trp/Arg or Arg/Arg, 19.4 +/- 1.0 kg; Trp/Trp, 19.2 +/- 0.6 kg) or percent body fat (Trp/Arg or Arg/Arg, 34.6% +/- 1.2%; Trp/Trp, 34.3% +/- 0.6%). In contrast to the findings in women, men with Trp64Arg mutation had lower total body fat after controlling for age (Trp/Arg or Arg/Arg, 13.2 +/- 1.1 kg; Trp/Trp, 15.8 +/- 0.7 kg; P < .05). However, no difference was found in percent body fat (Trp/Arg or Arg/Arg, 20.9% +/- 1.3%; Trp/Trp, 23.3% +/- 0.7%). No difference in the fasting insulin resistance index (FIRI) was found between subjects with and without Trp64Arg mutation. The data suggest that Trp64Arg mutation of the beta3-adrenergic receptor is common in Thais and appears to exert effects on total body fat but not percent body fat in men. Trp64Arg mutation is not associated with insulin resistance as assessed by the FIRI in Thais.

The levels of intake and food sources of zinc and copper in 231 20-80 yr old healthy adults living in Bangkok and surrounding districts were determined. Dietary data from 3-d food records collected and validated at Research Center, Ramathibodi Hospital were analyzed. Levels of zinc and copper intake were compared between sexes and age groups (20-39, 40-59, and 60-80 yr). Mean daily zinc and copper intakes (+/-SEM) in men were 6.3+/-0.2 and 1.9+/-0.1 mg, respectively. Mean daily zinc and copper intakes (+/-SEM) estimated in women (5.5+/-0.2 and 1.6+/-0.1 mg) were significantly lower. Higher zinc and copper intakes were found in the younger (20-39 yr) age group of both sexes. This could be explained by higher density and percentage from animal source of both nutrients. Consumption of various types of meat, fish, egg, and milk accounted for 42 and 22%, and rice, the staple food of Thai people for 9 and 23% of total dietary zinc and copper, respectively.

Measuring bone mineral density (BMD) is currently the best modality to diagnose osteoporosis and predict future fractures. The use of risk factors to predict BMD and fracture risk has been considered to be inadequate for precise diagnostic purpose, but it may be helpful as a screening tool to determine who actually needs BMD assessment. Recently, artificial neural network (ANN), a nonlinear computational model, has been used in clinical diagnosis and classification. In the present study, we evaluated the risk factors associated with low BMD in Thai postmenopausal women and assessed the prediction of low BMD using an ANN model compared to a logistic regression model. The subjects consisted of 129 Thai postmenopausal women divided into 2 groups, 100 subjects in the training set and the remaining 29 subjects in the validation set. The subjects were classified as having either low BMD or normal BMD by using BMD value 1 SD lower than the mean value of young adults as the cutoff point. Decreased body weight, decreased hip circumference and increased years since menopause were found to be associated with low BMD at the lumbar spine by logistic regression. For the femoral neck, increased age and decreased urinary calcium were associated with low BMD. The models had a sensitivity of 85.0 per cent, a specificity of 11.1 per cent and an accuracy of 62.0 per cent for the diagnosis of low BMD at the lumbar spine when tested in the validation group. For the femoral neck, the sensitivity, specificity and accuracy were 90.5 per cent, 12.5 per cent, and 69.0 per cent, respectively. Models based on ANN correctly classified 65.5 per cent of the subjects in the validation group according to BMD at the lumbar spine with a sensitivity of 80.0 per cent and a specificity of 33.3 per cent while it correctly classified 58.6 per cent of the subjects at the femoral neck with a sensitivity of 76.2 per cent and a specificity of 12.5 per cent. There was no significant difference in terms of accuracy, sensitivity and specificity in the prediction of low BMD at the lumbar spine or the femoral neck between ANN model and logistic regression model. We concluded that ANN does not perform better than convention statistical methods in the prediction of low BMD. The less than perfect performance of the prediction rules used in the prediction of low BMD may be due to the lack of adequate association between the commonly used risk factors and BMD rather than the nature of the computational models.