Prevalence of cardiac arrhythmias in Thai community

The resting 12 leads electrocardiogram was recorded in 3,822 men and 4,969 women (aged 30 years or over), who participated in the First National Health Examination Survey of Thailand and the data was used to determine the prevalence of cardiac arrhythmias. In this apparently normal population 362 subjects (the standard age adjusted rate was 39.2 per thousand) had cardiac arrhythmia. The prevalence rate of atrial fibrillation was 3.6 per thousand (males 3.6, females 3.6) and ventricular premature beat was 12.1 per thousand (males 7.3, females 15.6). For atrial premature beat, complete and incomplete right bundle branch blocks, sinus arrhythmia, first degree atrioventricular block and delta wave, the prevalence rates were 4.0, 7.0, 4.6, 2.7, 2.4 and 1.3 per thousand respectively. Complete and incomplete left branch blocks, left anterior hemiblock, second degree antrioventricular block and short PR interval were rare in this survey.

A national survey of health-service use in Thai elders

OBJECTIVES

To examine the pattern of health-service use and associated factors among elderly people in Thailand.

DESIGN

A cross-sectional multi-stage random sampling household survey.

SUBJECTS

4480 People aged 60 and over.

MAIN OUTCOME MEASURES

Responses to illness among elderly Thai subjects and health-service utilization.

RESULTS

Of 1954 elderly Thai subjects who reported that they had had an illness without hospitalization during the last month, 93% had sought treatment and 7% did nothing. Just over a half (52.8%) used health services. Subjects who had self-limiting symptoms or diseases tended to not use health services, while subjects with chronic conditions did. Sixty-two percent paid for treatment themselves while 28% of them had their bills paid by their children. Independent determinants of health-service use included living in a rural area, being well-educated and better off, not drinking alcohol and the severity of illness identified.

CONCLUSIONS

We found a low rate of state health-service use. Children had an important role in taking care of parents.

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

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

Prevalence of coronary heart disease and major cardiovascular risk factors in Thailand

BACKGROUND

Coronary heart disease (CHD) is expected to become one of the major health problems in developing countries such as Thailand where prevalence data are scarce. This study reports the prevalence of CHD, as indicated by electrocardiogram (ECG) Minnesota coding, and its risk factors in Thailand.

METHODS

In 1991 we conducted a cross-sectional ECG survey in a multistage random sample of the Thai population, aged > or =30. All major cardiovascular risk factors were measured. Standard supine 12-lead ECG data were collected; amplitudes and intervals were measured manually and entered into a computer. Abnormal tracings were verified by five cardiologists, and agreement among at least three of them was accepted as final.

RESULTS

The total sample included 3822 men and 4967 women aged > or =30 years. The age-standardized prevalence rate of CHD was 9.9/1000 (men 9.2/1000, women 10.7/ 1000). The age-standardized level of major cardiovascular risk factors among men and women respectively were: total cholesterol 4.8 mmol/l (187.3 mg/dl), 5.1 mmol/l (197.7 mg/dl); hypercholesterolaemia (> or =6.2 mmol/l) 12.2%, 16.9%; systolic blood pressure (mmHg) 117.8, 117.7; diastolic blood pressure (mmHg) 76.9, 75.8; body mass index (kg/m2) 21.7, 22.8; fasting blood sugar 4.8 mmol/l (87.9 mg/dl), 5.0 mmol/l (90.3 mg/dl); hypertension (> or =160/95 +/- on antihypertensive drugs) 6.3%, 8.1%; smoking 65.1%, 8.5%; diabetes mellitus (> or =7.8 mmol/l) 2.4%, 3.7%; obesity (>25 kg/m2) 15.2%, 27.2%.

CONCLUSIONS

Most of the age-adjusted mean values and proportion of major cardiovascular disease risk factors as well as the prevalence of total CHD in the Thai population were much lower than the median of those values found in developing countries.

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

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

Failure of carbazochrome sodium sulfonate (AC-17) to prevent dengue vascular permeability or shock: a randomized, controlled trial

OBJECTIVE

We studied the ability of carbazochrome sodium sulfonate (AC-17) to prevent capillary permeability in dengue hemorrhagic fever/dengue shock syndrome.

METHOD

A randomized, placebo-controlled trial in 95 children stratified by age and sex was conducted in two hospitals during 1992. AC-17 (n = 45 cases) or B vitamins as placebo (n = 50) were given as a bolus infusion and then as a continuous drip for 24 hours; a total of 300 mg of AC-17 was administered on the first 2 days and 150 mg on the third day.

RESULTS

The two groups were comparable in age, sex, duration of illness, and clinical manifestations. No significant difference in shock or pleural effusion was noted between the two groups. Shock developed in 8.9% (4/45) of patients in the AC-17 group and 6% (3/50) in the placebo group (p = 0.44). Pleural effusion was found at 0, 24, 48, and 72 hours after admission in 4.4%, 20%, 31.1%, and 20% in the AC-17 group and 2%, 14%, 28%, and 14% in the placebo group, respectively.

CONCLUSION

Administration of AC-17 does not prevent plasma leakage or shock in dengue hemorrhagic fever/dengue shock syndrome.

Working and living conditions of construction workers: comparison between large and small construction sites in northeastern Thailand

This study examined differences in working and living conditions of construction workers in large and small construction sites in Northeastern Thailand. Data were collected by questionnaires, through observation and interviewing. A total of 812 construction workers from 20 large sites and 24 small sites were studied. Working and living conditions among the construction workers were generally poor. However, they were better at the large sites than the small ones. The data suggest an urgent need to improve sanitation and safety conditions on the construction sites and camp sites, including personal protective devices and improved welfare for the workers and their families.

Rapid village survey to determine the size of the leprosy problem in Khon Kaen Province, Thailand

The rapid village survey (RVS) method has been developed as a simpler, less-expensive alternative to random sample surveys for determining the prevalence of leprosy and was compared with a total population survey (TVS). In the RVS, the cluster population receives clear information about the disease, and those with symptoms are invited to be examined by the survey team. A list of household contacts and suspects was made and those on the list were actively traced. The registered population was 20,815; 10 new patients were found among the 2034 people self-reporting in the RVS, 0 among the household contacts and suspects, and an additional 2 new patients in the TVS. There were 12 registered patients among the sample population. The prevalence rate found by the RVS was 1.06 per 1000(95% CI = 0.49-1.63) and in the TVS 1.16 per 1000 (95% CI = 0.5-1.77). The man-days and costs of an RVS are considerably less than those for a TVS. It was concluded that the RVS is a valid replacement for the TVS as conducted in Khon Kaen Province, Thailand. The RVS can be applied under low-endemic conditions and could be carried out by the general health staff.

Failure of high-dose methylprednisolone in established dengue shock syndrome: a placebo-controlled, double-blind study

OBJECTIVE

Steroids are widely used in Thailand and other dengue-endemic countries to treat severe dengue shock syndrome. This study was designed to determine whether a single high dose of methylprednisolone will reduce mortality in children with dengue shock syndrome who did not respond to simple fluid and plasma replacement therapy.

METHODS

A prospective, randomized, double-blind, controlled trial was conducted in two hospitals in Khon Kaen Thailand during June to September in 1987 and 1988. Sixty-three children with severe dengue shock syndrome were randomized into two groups; the first group received a single dose of methylprednisolone (30 mg/kg) and the second group received placebo.

RESULTS

There was no significant difference in mortality between the two groups (P = .63). The mortality rate was 12.5% (4/32) in the steroid group and 12.9% (4/31) in the group that received placebo. The sequelae at 2 weeks among treatment and control survivors were not significantly different. These two groups were comparable in age, sex, severity of illness, and duration of shock at the outset of the study. The two treatment groups were similar in subsequent hospital course as determined by maximum and minimum hematocrit level and bleeding severity. The numbers of patients in each group who had liver failure and evidence of disseminated intravascular clotting defect were also comparable. Complications such as occurrence of fever after shock, pneumonia, convulsion, cardiac arrest, pulmonary hemorrhage, and positive hemoculture were not significantly different in the treatment and control groups.

CONCLUSIONS

A single high dose of methylprednisolone does not reduce mortality in severe dengue shock syndrome which does not respond to conventional critical care.

Familial clustering of presumptive sudden unexplained death syndrome (PSUDS)

Regarding the suggestion that presumptive sudden unexplained death syndrome (PSUDS) may be genetically associated, we recently conducted a study to reveal the clustering of the PSUDS in extended families. The data collection was done through case searching, interviewing using structured questionnaires and cross-referencing among informants. The precise criteria were used to identify the SUNDS cases. The collected data were age, sex, time and place of death, details of events at death, and vital statistics of relatives. There were forty-nine families with 418 family members included in the study. Twenty-five cases of PSUDS were reported from 14 families. All were men, with the mean age (+/- SD) 31.26 (+/- 7.01) years and the age range was 25-50. There were 6 clusters of SUNDS in sibling groups. Three of the clusters consisted of three siblings each and the other three clusters consisted of two siblings each. Most of the individuals in the siblings clusters had different occupations and died in different places and in different years. The aggregation of PSUDS in families is demonstrated. However, whether it is genetically related needs further study.

The pattern of diarrhea in children in Khon Kaen, northeastern Thailand: I. The incidence and seasonal variation of diarrhea

The incidence, seasonal variation and risk factors of diarrhea in children in Thailand are not well defined. The objective of this study is to identify the incidence and seasonal variation of diarrhea in a rural community. A cohort of 481 children under five years of age from 14 villages in rural northeastern Thailand was followed for 1 year, from May 1988 to April 1989. The data were collected daily by 5 participant observers who resided in the villages during the study period. During the 25,012 person weeks of surveillance, 384 episodes of diarrhea occurred; 279 episodes (72.7%) were watery diarrhea and 105 episodes (27.3%) were dysentery-like diarrhea. The incidence of diarrhea was 2.1, 1.76, 0.96 and 0.45 episodes per child per year for children aged 0-6 months, 7-12 months, 1 year and above 2 years, respectively. Males were affected as frequently as females. The average duration of illness was 4.9, 2.1, 1.5 and 0.5 days per child per year for children aged under 1 year, 1-2 years, 2-3 years and more than 3 years old, respectively. Both dysentery and watery diarrhea rates peaked for children of all ages from May to July, during the early rainy season. A second peak of watery diarrhea in the winter from November to January and was seen primarily in children less than 2 years old. The monthly incidence of diarrhea was associated with rainfall, ambient temperature and occupational behavior of people in each season.

Assessment of observer variation in measuring the Radiographic Vertebral Index in patients with multiple myeloma

The Radiographic Vertebral Index (RVI) was assessed as a possible outcome measure for bone disease in myeloma by evaluating within and between reader reproducibility. Four readers (2 radiologists and 2 clinical hematologists) independently scored, on two separate occasions, the RVI on 40 radiographs from patients with myeloma. Each vertebra from third thoracic (T3) to fifth lumbar (L5) received a score of "1" if normal, "2" if biconcave and "4" if crushed or fractured. RVI global scores, therefore, could vary from a minimum of 15, for no damage, to a potential maximum of 60 in which all vertebrae are collapsed. Agreement was determined for each vertebra using crude percentage agreement and the kappa statistic (which corrects for chance-expected agreement) for categorical data, and for global score using analysis of variance and calculating intra-class correlation. With increasing mean abnormality score on individual vertebrae there was a corresponding increase in kappa and reduction in crude percentage agreement. Within readers, the mean percentage agreement across all vertebrae varied from 85.6 to 90.3% and the observed differences just reach statistical significance (p = 0.048). Mean kappa values ranged from 0.48 to 0.63 and were similar across readers. Differences in intra-reader agreement were not related to subspecialty. When between reader percentage agreement and kappa scores were assessed for radiologists and non-radiologist clinicians, no difference could be detected. Agreement with respect to intra-reader mean global RVI scores was excellent as illustrated by the intra-class correlation coefficient which varied from 0.89 to 0.94. The mean intra-class correlation for radiologists was 0.92, compared with 0.91 for non-radiologists.(ABSTRACT TRUNCATED AT 250 WORDS)