Publications by authors named "Ram Rangsin"

92 Publications

Rising prevalence of HIV infection and associated risk factors among young Thai Men in 2018.

Sci Rep 2021 Apr 8;11(1):7796. Epub 2021 Apr 8.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.

The prevalence of HIV among young Thai men stabilized at 0.5% from 2005 to 2011. A cross-sectional study was conducted among the male army conscripts in 2018 at 36 military training units nationwide. All new conscripts in each selected unit were invited to participate in the study. Questionnaires were used to determine risk factors to HIV infection that had been developed from related risk factors studies among young Thai men. Among 4629 participants, 44 (1.0%) HIV positive individuals were identified. The proportion subject reporting a history of sex with another man was 10.1%. The prevalence of HIV infection among men who have sex with men (MSM) was 4.0%. The proportion of consistent condom use with a male partner was 39.7%. The risk factors of HIV infection included having sex with another man, history of sexually transmitted infection and history of sex in exchange for gifts/money. Only 1.4% of MSM used pre-exposure prophylaxis (PrEP). HIV prevention programs including PrEP in Thailand should be emphasized among MSM in both rural and urban settings.
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http://dx.doi.org/10.1038/s41598-021-87474-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032696PMC
April 2021

Prevalence and associated factors of electrocardiographic left ventricular hypertrophy in a rural community, central Thailand.

Sci Rep 2021 Mar 29;11(1):7083. Epub 2021 Mar 29.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.

Left ventricular hypertrophy (LVH) is considered a cardiac condition with life-threatening complications. Detected LVH is a strong predictor of cardiovascular diseases and death. This condition is normally diagnosed at offices. We aimed to determine the prevalence and associated factors of electrocardiographic-LVH (ECG-LVH) among adults in a Thai rural community. A cross-sectional study was conducted in Na-Yao rural community of Thailand in 2020. A total of 638 individuals aged ≥ 20 years were interviewed using standardized structured questionnaires related to demographic information, risk behaviors, comorbidities and anthropometric measurements. LVH was determined by Sokolov-Lyon and Cornell criteria based on the collected electrocardiograms. The prevalence of ECG-LVH among adults was 6.6%. The factors independently associated with ECG-LVH were being male (AORs 2.04, 95% CI 1.05-3.98), history of diabetes mellitus (AORs 1.01, 95% CI 1.01-1.02), and hypertensive crisis ≥ 180/110 mmHg (AORs 7.24, 95% CI 1.31-39.92). However, resting heart rate was negatively associated with ECG-LVH (p < 0.05). Our data emphasized that LVH was one of the significant health problems among adults in a rural community. This condition could lead to severe complications. Thus, effective detection and public health interventions should be provided at the community level.
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http://dx.doi.org/10.1038/s41598-021-86693-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8007813PMC
March 2021

Prevalence and associated factors of uncontrolled hyperlipidemia among Thai patients with diabetes and clinical atherosclerotic cardiovascular diseases: a cross-sectional study.

BMC Res Notes 2021 Mar 25;14(1):118. Epub 2021 Mar 25.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.

Objectives: The research aimed to determine the prevalence and associated factors of uncontrolled hyperlipidemia among Thai patients with the disease and Clinical ASCVD.

Results: A total of 1,527 Thai diabetic patients with a history of ASCVD were included in the study. Uncontrolled hyperlipidemia was detected among 1,216 patients (79.6%; 95% CI 77.6-81.7). The independent factors associated with uncontrolled hyperlipidemia included being female (adjusted odds ratio (AORs); 1.5, 95% CI 1.2-2.0), using thiazolidinedione (AORs; 1.7, 95% CI 1.1-2.7), community hospital (AORs; 4.3, 95% CI 1.0-18.0) and BMI level at 18.5-22.9 kg/m (AORs; 2.2, 95% CI 1.2-4.0), 23.0-24.9 kg/m (AORs; 1.8 95% CI 0.9-3.3), 25.0-29.9 kg/m (AORs; 2.3 95% CI 1.3-4.3) and ≥ 30 kg/m (AORs; 2.5 95% CI 1.3-4.9).
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http://dx.doi.org/10.1186/s13104-021-05535-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993520PMC
March 2021

Six-year trend and risk factors of unsuccessful pulmonary tuberculosis treatment outcomes in Thai Community Hospital.

BMC Res Notes 2021 Mar 9;14(1):89. Epub 2021 Mar 9.

Department of Parasitology, Phramongkutklao College of Medicine, 315, Rajawithee Rd, Thung Phyathai Sub-District, Rajadhewi District, Bangkok, 10400, Thailand.

Objective: Tuberculosis (TB) is a major cause of morbidity and mortality globally. Despite efforts to eliminate TB in Thailand, the incidence rate has declined slowly. This study aimed to identify the incidence and risk factors of unsuccessful pulmonary TB treatment (failed, died and loss-to- follow up) in a community hospital in Chachoengsao Province, Thailand from 1st January 2013 to 31st December 2019.

Results: A total of 487 patients were eligible for the study. The incidence of unsuccessful treatment was 21.67/100 population person year. Risk factors of unsuccessful pulmonary TB treatment were unemployment (adjusted hazard ratio (AHR) 3.12, 95%CI 1.41-6.86), HIV co-infection (AHR 2.85, 95%CI 1.25-6.46), previous history of TB (AHR 2.00, 95%CI 1.04-3.81), positive sputum AFB at the end of the intensive phase (AHR 5.66, 95%CI 2.33-13.74), and sputum AFB was not performed at the end of the intensive phase (AHR 18.40, 95%CI 9.85-34.35). This study can be utilized to improve prevention and intervention of TB treatment by strengthening public health system on treatment quality especially TB patient monitoring tools or methods easy for accessing to patients in communities.
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http://dx.doi.org/10.1186/s13104-021-05504-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941995PMC
March 2021

National trends in the prevalence of diabetic retinopathy among Thai patients with type 2 diabetes and its associated factors from 2014 to 2018.

PLoS One 2021 22;16(1):e0245801. Epub 2021 Jan 22.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Introduction: Diabetic retinopathy (DR) is one of the most common and serious ocular complications in both developed and developing countries. To date, epidemiological data of DR and their associated factors in Southeast Asian countries especially in Thailand are scarce. We aimed to use the information from the Thailand Diabetes Mellitus/Hypertension (DM/HT) study to determine trends in DR prevalence and also risk factors among Thai patients with type 2 diabetes (T2D).

Methods: A series of cross-sectional surveys of clinical outcomes was conducted annually in 2014, 2015 and 2018 among patients with T2D aged >18 years receiving medical care for at least 12 months. A stratified single stage cluster sampling method that was proportional to the size sampling technique was used to select a nationally and provincially representative sample of patients with T2D in Thailand. A standardized case report form was used to obtain the required information from medical records.

Results: A total of 104,472 Thai patients with T2D were included in the study from 2014 to 2018. The dominant proportion of participants, 70,756 (67.7%), were females. The overall prevalence of DR declined from 6.9% in 2014 to 6.3% in 2015 and 5.0% in 2018 (p for trend <0.001). The independent associated factors with DR included survey year, greater duration of DM, geographic region, hospital level, social security scheme, dyslipidemia, insulin therapy, high HbA1c level and elevated pulse pressure.

Conclusion: We reported a decreasing in trend in the prevalence of DR among Thai patients with T2D over one half decade. Patients with T2D should be encouraged to control their underlying diseases and engage in other effective interventions. When these modifiable risk factors can be inhibited, DR and other cardiovascular complications will be alleviated.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0245801PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822250PMC
January 2021

Urine albumin dipstick independently predicts cardiovascular and renal outcomes among rural Thai population: a 14-year retrospective cohort study.

BMC Nephrol 2021 01 8;22(1):18. Epub 2021 Jan 8.

Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Background: Albuminuria is an established risk marker for both cardiovascular and renal outcomes. In this study, we expected to use portable and inexpensive test strips to detect urine albumin level for risk stratification in cardiovascular and renal outcomes among rural Thai community.

Objective: To evaluate the relationship between urine albumin dipstick and cardiovascular and renal complications in rural Thai population.

Methods: We conducted a retrospective study in 635 rural Thai adults who tested urine albuminuria by using commercial urine albumin dipstick and the Micral-albumin test II strips at baseline. The subjects were divided into normoalbuminuria (albumin < 20 mg/L), microalbuminuria (albumin 20-200 mg/L), or macroalbuminuria (Urine dipstick at least 1+ or albumin > 200 mg/L). We collected data on the incidences of primary composite outcomes including cardiovascular or renal morbidity and mortality. Incident density and cox regression were analyzed to evaluate the association between albuminuria status and primary composite outcome.

Results: During an average 14-year follow-up, 102 primary composite events occurred including 59 (13.1%), 32 (20.6%) and 11 (39.3%) among 452, 155, and 28 subjects with normoalbuminuria, microalbuminuria, and macroalbuminuria, respectively. Incident densities of primary composite outcome were elevated continually according to the degree of albuminuria (9.36, 17.11 and 38.12 per 1000 person-years). Compared with the subjects without albuminuria, subjects with microalbuminuria and macroalbuminuria at baseline had higher risk for primary composite outcome in univariate model. After multivariate analysis was performed, the effect of macroalbuminuria was only persisted with 3.13-fold risk (adjusted HR 3.13; 95% CI 1.40-6.96, P= 0.005).

Conclusion: Albuminuria from semi-quantitative methods is an important factor predicting cardiovascular and renal risk among subjects in Thai rural population. Our findings support to also incorporating urine albumin dipstick into assessments of cardiovascular risk in the general population.
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http://dx.doi.org/10.1186/s12882-020-02215-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7791992PMC
January 2021

Prevalence and Risk Factors of Chronic Obstructive Pulmonary Disease Among Agriculturists in a Rural Community, Central Thailand.

Int J Chron Obstruct Pulmon Dis 2020 15;15:2189-2198. Epub 2020 Sep 15.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Purpose: The present study aimed to determine the prevalence and risk factors of chronic obstructive pulmonary disease (COPD) among agriculturists in a remote rural community in central Thailand.

Methods: A cross-sectional study was conducted in January 2020. Face-to-face interviews were conducted using standardized questionnaires to determine demographic characteristics and risk behaviors. COPD was defined by the spirometric criterion for airflow limitation constituting a postbronchodilator fixed ratio of FEV1/FVC <0.70 following the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines 2019. Multivariable logistic regression analysis was used to determine the risk factors for COPD, and the magnitude of association was presented as adjusted odds ratio (AOR) with 95% confidence interval (95% CI).

Results: A total of 546 agriculturists were enrolled in the study. The overall prevalence of COPD was 5.5% (95% CI: 3.6-7.4). The prevalence of COPD among males was 8.0% (95% CI: 4.7-11.3), and 3.2% (95% CI: 1.1-5.2) among females. The risk factors of COPD included age ≥60 years old (AOR 2.7, 95% CI: 1.1-7.0), higher intensity of smoking (AOR 1.1, 95% CI: 1.0-1.1), swine farm worker (AOR 4.1, 95% CI: 1.7-10.3), cattle farm worker (AOR 3.3, 95% CI: 1.4-8.2) and home cooking (AOR 2.7, 95% CI: 0.8-9.7).

Conclusion: Our data emphasized that COPD was one of the significant health problems among agriculturists in a rural community. Agricultural jobs such as animal farmers and behavioral factors such as smoking were associated with COPD. Effective public health interventions, especially, modifying risk behaviors, should be promoted in remote rural areas to prevent the disease and reduce its morbidity and mortality.
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http://dx.doi.org/10.2147/COPD.S262050DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7501975PMC
September 2020

Impaired Glomerular Filtration Rate in Type 2 Diabetes Mellitus Subjects: A Nationwide Cross-Sectional Study in Thailand.

J Diabetes Res 2020 12;2020:6353949. Epub 2020 Aug 12.

Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand.

Background: Type 2 diabetic mellitus (T2DM) patients with impaired renal function have a higher risk of mortality, and often progress to end-stage renal disease. The study aims to determine the prevalence of kidney disease and investigate the relationship between various factors and impaired renal function in a large population of patients with T2DM.

Methods: We conducted a cross-sectional study among 30,377 patients from a nationwide diabetes study involving 602 Thai hospitals. Impaired glomerular filtration rate (GFR) was defined as <60 mL/min per 1.73 m. Multivariate logistic regression was used to determine the association between standard risk factors and impaired GFR.

Results: The prevalence of impaired GFR in a T2DM population was 39.2%. After adjusting for multiple risk factors, advanced age (adjusted OR 11.69 (95%CI = 3.13 to 43.61)), macroalbuminuria (adjusted OR 3.54 (95%CI = 1.50 to 8.40)), high serum uric acid (adjusted OR 2.06 (95%CI = 1.73 to 2.46)), systolic BP 130-139 mmHg (adjusted OR 3.21 (95%CI = 1.30 to 7.96)), hemoglobinA1C (HA1C) <6% (adjusted OR 3.71 (95%CI = 1.65 to 8.32)), and HA1C >7% (adjusted OR 2.53 (95%CI = 1.38 to 4.63)) were found to be associated with a significantly increased risk of impaired GFR among T2DM patients.

Conclusion: Almost 40% of patients with T2DM in a nationwide cross-sectional study in Thailand had impaired GFR. Advanced age, albuminuria, hyperuricemia, hypertension, HA1C <6%, and HA1C >7% were independently associated with increased prevalence of impaired GFR.
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http://dx.doi.org/10.1155/2020/6353949DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7443026PMC
August 2020

Prevalence of HIV infection and related risk factors among young Thai men between 2010 and 2011.

PLoS One 2020 14;15(8):e0237649. Epub 2020 Aug 14.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Introduction: Understanding the current epidemiology of human immunodeficiency virus (HIV) infection in Thailand will facilitate more effective national HIV prevention programs. This study aimed to determine the prevalence and risk factors for HIV infection among young Thai men.

Methods: A total survey was conducted of Royal Thai Army new conscripts, participating in the national HIV surveillance in November 2010 and May 2011. Behavioral risk factors for HIV infection were determined using a standardized survey questionnaire in the total study population and men who have sex with men (MSM) subgroup.

Results: A total of 301 (0.5%) HIV infected young Thai men were identified from the total study population (63,667). Independent risk factors associated with HIV infection among the total study population included being single (adjusted Odds Ratio [AOR] 1.6, 95% Confidence Interval [CI] 1.1-2.2), having no formal education (AOR 6.5, 95% CI 2.3-18.4) or a bachelor's degree (AOR 1. 8, 95% CI 1.0-3.0), engaging in bisexual (AOR 3.7, 95% CI 2.4-5. 6) or exclusively homosexual activity (AOR 14.4, 95% CI 10.4-19.8), having a history of Sexually Transmitted Infection (STI) (AOR 2.3, 95% CI 1.6-3.3) and having sex in exchange for gifts/money (AOR 2.0, 95% CI 1. 5-2.8). A total of 4,594 (7.9%) MSM were identified, of which 121 (2.6%) were HIV infected. The prevalence of HIV infection among MSM in urban (2.8%) and rural (2.4%) areas were relatively comparable (p-value = 0.44). Of the identified MSM, 82.5% reported having sexual desire with females only. Risk factors associated with HIV infection in the MSM subgroup included living in the western region (AOR 3.5, 95% CI 1.2-10.4), having a bachelor's degree (AOR 2.7, 95% CI 1.2-5.7), having a history of exclusive receptive (AOR 3.6, 95% CI 1.6-7.7) or versatile anal sex (AOR 4.7, 95% CI 3.0-7.5) and history of having sex in exchange for gifts/money (AOR 2.3, 95% CI 1.5-3.5).

Conclusion: The prevalence of HIV infection among young Thai men has continued to be below 0.5% in 2010 and 2011. High risk sexual activity, including MSM, played a major role in the HIV epidemic among this population. Effective HIV prevention programs should cover MSM who have heterosexual desire as well as having sex in exchange for gifts/money and be implemented in both urban and rural areas.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237649PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7428352PMC
October 2020

Incidence and Risk Factors Associated with Outpatient Hypoglycemia in Patients with Type 2 Diabetes and Chronic Kidney Disease: A Nationwide Study.

Endocr Res 2020 Nov 14;45(4):217-225. Epub 2020 Jul 14.

Department of Medicine, University of Mississippi Medical Center , Jackson, MS, USA.

Background: Chronic kidney disease and hypoglycemia are common complications in individuals with diabetes. Currently, the association of renal function with hypoglycemic complications in type 2 diabetes mellitus (T2DM) is inconclusive. This study aims to assess the associations between estimated glomerular filtration rate (eGFR) and cumulative incidence of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia among T2DM patients in Thailand using a nationwide patient sample.

Methods: We conducted a nationwide retrospective cohort study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study assessed adult T2DM patients from 831 public hospitals in Thailand in the year 2012-2013. eGFR was categorized into ≥90, 60-89, 30-59, 15-29, and <15 mL/min/1.73 m. The associations between eGFR and hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia were assessed using multivariate logistic regression and Poisson regression.

Results: A total of 25,056 T2DM patients with available eGFR were included in the analysis. The mean age was 60.9 ± 10.5 years. The cumulative incidence of hypoglycemia and hypoglycemia-related hospitalizations was 3.6% and 1.7%, respectively. Incidence of outpatient hypoglycemia, mild hypoglycemia, and severe hypoglycemia was 2.99 (2.59-3.43), 2.47 (2.11-2.88), and 0.52 (0.36-0.72) per 100 patient-years, respectively. Patients with eGFR of 30-59, 15-29, and <15 mL/min/1.73 m were significantly associated with an increased risk of hypoglycemia, hypoglycemia-related hospitalizations, and incidence of outpatient hypoglycemia when compared to patients with eGFR of ≥90 mL/min/1.73 m.

Conclusion: Reduced eGFR was independently associated with increased hypoglycemia, hypoglycemia-related hospitalizations, and risk of outpatient hypoglycemia. Increasing awareness of the heightened risk of hypoglycemia with declining renal function may prompt changes to diabetic management for at-risk individuals.
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http://dx.doi.org/10.1080/07435800.2020.1792921DOI Listing
November 2020

Trends, prevalence and associated factors of obesity among adults in a rural community in Thailand: serial cross-sectional surveys, 2012 and 2018.

BMC Public Health 2020 Jun 3;20(1):850. Epub 2020 Jun 3.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.

Background: Obesity is one principle risk factor increasing the risk of noncommunicable diseases including diabetes, hypertension and atherosclerosis. In Thailand, a 2014 study reported obesity (BMI ≥25 kg/m) in a Thai population aged ≥15 years was 37.5, 32.9 and 41.8% overall and among males and females, respectively. The study aimed to determine trends in the prevalence of obesity among adults residing in a Thai rural community between 2012 and 2018 and investigate the associations between obesity and behavioral factors.

Methods: Serial cross-sectional studies were conducted in 2012 and 2018 among adults in Na-Ngam rural community. In 2012 and 2018, all 635 and 627 individuals, respectively, were interviewed using structured questionnaires related to demographics, risk behaviors, comorbidities and arthrometric measurement. Spot urine was collected by participants and obesity was defined as BMI ≥25 kg/m. The risk factors for obesity were analyzed in the 2018 survey.

Results: A total of 1262 adults in Na-Ngam rural community were included in the study. The prevalence of obesity was 33.9% in 2012 and 44.8% in 2018 (P < 0.001). The average BMI increased from 23.9 ± 4.2 kg/m in 2012 to 25.0 ± 4.52 kg/m in 2018 (P < 0.001). Obesity was associated with higher age (AOR 0.99; 95%CI 0.97-0.99), smoking (AOR 0.52; 95%CI 0.28-0.94), instant coffee-mix consumption > 1 cup/week (AOR 1.44; 95%CI 1.02-2.04), higher number of chronic diseases (≥1 disease AOR 1.82; 95%CI 1.01-2.68, > 2 diseases AOR 2.15; 95%CI 1.32-3.50), and higher spot urine sodium level (AOR 1.002; 95%CI 0.99-1.01).

Conclusion: Our data emphasized that obesity constituted a serious problem among adults residing in a rural community. A trend in significant increase was found regarding the prevalence of obesity and average BMI in the rural community over 6 years. Effective public health interventions should be provided at the community level to reduce BMI. Moreover, modifiable risk factors for obesity should be attenuated to inhibit the progression of metabolic syndrome, noncommunicable diseases and their complications.
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http://dx.doi.org/10.1186/s12889-020-09004-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7271557PMC
June 2020

The Association between Serum Uric Acid and Peripheral Neuropathy in Patients with Type 2 Diabetes Mellitus: A Multicenter Nationwide CrossSectional Study.

Korean J Fam Med 2020 May 20;41(3):189-194. Epub 2020 May 20.

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.

Background: The role of uric acid in the development of diabetic peripheral neuropathy remains unclear. This study aimed to determine the association between uric acid and peripheral neuropathy among type 2 diabetes mellitus (T2DM) patients.

Methods: We conducted a nationwide cross-sectional study based on the diabetes and hypertension study of the Medical Research Network of the Consortium of Thai Medical Schools. Adult T2DM patients from 831 public hospitals in Thailand were evaluated. The serum uric acid level was categorized into five groups based on quintiles (<4.4, 4.4-5.3, 5.3-6.2, 6.2-7.3, and >7.3 mg/dL). A multivariate logistic regression model was used to assess the independent association between serum uric acid level and peripheral neuropathy.

Results: In total, 7,511 T2DM patients with available data about serum uric acid levels were included in the analysis. The mean age of the participants was 61.7±10.9 years, and approximately 35.6% were men. The prevalence rate of peripheral neuropathy was 3.0%. Moreover, the prevalence rates of peripheral neuropathy stratified according to uric acid levels <4.4, 4.4-5.3, 5.3-6.2, 6.2-7.3, and >7.3 mg/dL were 2.5%, 2.8%, 2.4%, 2.5%, and 4.7%, respectively. A serum uric acid level ≥7.3 mg/dL was found to be associated with an increase in odds ratio (1.54; 95% confidence interval, 1.02-2.32) for peripheral neuropathy compared with a serum uric acid level <4.4 mg/dL.

Conclusion: Serum uric acid level is independently associated with peripheral neuropathy in T2DM patients, and elevated serum uric acid levels should be considered a risk factor for diabetic peripheral neuropathy in clinical practice.
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http://dx.doi.org/10.4082/kjfm.18.0205DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7272369PMC
May 2020

Rate of kidney function decline and factors predicting progression of kidney disease in type 2 diabetes mellitus patients with reduced kidney function: A nationwide retrospective cohort study.

Ther Apher Dial 2020 Dec 6;24(6):677-687. Epub 2020 Mar 6.

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.

Currently, the data on independent risk factors for the progression of kidney disease in type 2 diabetes mellitus (T2DM) patients with CKD are limited. This study aimed to investigate CKD progression in T2DM patients who have reduced kidney function with baseline estimated glomerular filtration rate (eGFRs) between 15 and 59 mL/min/1.73 m . This study was composed of a nationwide retrospective cohort of adult T2DM patients from 831 public hospitals in Thailand during the year 2015. T2DM patients with CKD stages 3 and 4 were followed up, until development of CKD stage 5, requirement of chronic dialysis, loss to follow-up, death, or 31 May 2018, whichever came first. Cox proportional hazard regression was utilized for analysis. A total of 8464 participants were included; 30.4% were male. The mean age was 69 ± 10 years. The mean eGFR was 45 ± 11 mL/min/1.73 m . The incidence of CKD stage 5 or the need for chronic dialysis was 16.4 per 1000 person-years. The annual rate of eGFR decline during a mean follow-up of 29 months was -2.3 mL/min/1.73 m ; 14.4% had a rapid decline in eGFR. The risk factors associated with progression to CKD stage 5 or the need for chronic dialysis were diabetes duration, systolic blood pressure, serum uric acid, albuminuria, and baseline eGFR. Conversely, older age and the use of renin-angiotensin aldosterone system blockade were associated with decreased risks for rapid CKD progression and incidence CKD stage 5 or dialysis. This study identifies multiple predictive risk factors that support a multifaceted approach to prevent progression of advanced CKD.
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http://dx.doi.org/10.1111/1744-9987.13480DOI Listing
December 2020

Characteristics of Poor Tuberculosis Treatment Outcomes among Patients with Pulmonary Tuberculosis in Community Hospitals of Thailand.

Am J Trop Med Hyg 2020 03;102(3):553-561

Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand.

Pulmonary tuberculosis (TB) is a major global public health problem. Thailand is listed as one of the countries with a high burden of pulmonary TB. Various factors are known to contribute to unsuccessful pulmonary TB treatment. However, studies in Thailand remain limited, especially in rural settings. This study aimed to identify the prevalence and associated factors of unsuccessful pulmonary TB treatment in community hospitals. A cross-sectional study was conducted from June-July 2019. We enrolled all patients receiving treatments in four community hospitals in central Thailand. The collected data included baseline characteristics, comorbid illnesses, a history of directly observed treatment-short course (DOTS), sputum acid-fast bacilli smear results, and chest radiography and treatment outcomes. Univariate and multivariate analyses were used to identify factors associated with unsuccessful pulmonary TB treatment. A total of 786 patients were enrolled in the study. Prevalence of unsuccessful treatment was 18.7%. Associated factors of unsuccessful pulmonary TB treatment were previously treated TB (adjusted odds ratio [AOR]: 2.1, 95% CI: 1.2-3.7), existence of comorbid illnesses (AOR: 2.8, 95% CI: 1.5-5.0), DOTS not performed (AOR: 2.5, 95% CI: 1.4-4.5), chest radiography showing multiple lung lesions at first diagnosis (AOR: 3.0, 95% CI: 1.7-5.2), no chest radiography improvement in the first follow-up (AOR: 17.7, 95% CI: 8.2-38.0), and unknown status of chest radiography in the first follow-up (AOR: 48.1, 95% CI: 22.3-103.5). Health promotion and primary care should be implemented in the communities to achieve ultimate successful treatment.
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http://dx.doi.org/10.4269/ajtmh.19-0564DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7056434PMC
March 2020

Prevalence and associated factors of internet gaming disorder among secondary school students in rural community, Thailand: a cross-sectional study.

BMC Res Notes 2020 Jan 6;13(1):11. Epub 2020 Jan 6.

Department of Parasitology, Phramongkutklao College of Medicine, 317/5 Ratchavithi Rd, Ratchathewi, Payathai, Bangkok, 10400, Thailand.

Objective: Internet gaming disorder (IGD) is an emerging mental problem for adolescent that has been increasingly piqued interest over the last decade. Although many studies have been conducted, very few studies have studied populations with low technological access. Therefore, this study aimed to estimate the prevalence and associated factors of internet gaming disorder among secondary school students in an area with a comparatively lower technological access in a large community sample. We used Chachoengsao province, Thailand as our sample area with a comparatively lower access to technology. This cross-sectional study was conducted during December 2017-January 2018 among 12 secondary schools in Chachoengsao province, Thailand.

Results: 5.4% of the 5497 subjects were positive for IGD. The associated factors found were male gender (odds ratio (OR) = 1.4), not living with both parents (OR = 1.75), use of online dating (OR = 1.53), being bullied at school (OR = 1.51), depression (OR = 1.92), anxiety (OR = 1.62) and stress (OR = 3.57) after being adjusted for age, family composition, failure of an exam, limit of internet use, use of online dating, bully perpetration, bully victimization, cyber bully perpetration, cyber bully victimization, suicidal ideation, use of alcohol, depression, anxiety, and stress.
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http://dx.doi.org/10.1186/s13104-019-4862-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6945594PMC
January 2020

Association between serum uric acid and chronic kidney disease in patients with hypertension: A multicenter nationwide cross-sectional study.

J Evid Based Med 2019 Nov 4;12(4):235-242. Epub 2019 Sep 4.

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi.

Introduction: Current data on the role of hyperuricemia as a risk factor for renal progression in patients with hypertension is inconclusive. This study aimed to assess the association of uric acid and chronic kidney disease (CKD) in hypertensive patients using a nationwide patient sample.

Methods: We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult patients with hypertension from 831 Thailand public hospitals in the year 2014. Serum uric acid (SUA) was categorized into quintiles (≤4.5, 4.6 to 5.4, 5.5 to 6.2, 6.3 to 7.4, ≥7.5 mg/dL). CKD was defined as estimated glomerular filtration rate of ≤ 60 mL/min/1.73 m . Multivariate logistic regression was performed to assess the association between SUA and CKD using uric acid of ≤4.5 mg/dL as the reference group.

Results: A total of 9776 hypertensive patients with available SUA were included in the analysis. The mean SUA was 6.1±1.8 mg/dL. The prevalence of CKD in hypertensive patients was 31.8%. SUA of 4.6 to 5.4, 5.5 to 6.2, 6.3 to 7.4, and ≥7.5 mg/dL were associated with an increased CKD with ORs of 1.57 (95% CI 1.28 to 1.92), 2.15 (95% CI 1.74 to 2.66), 3.31 (95% CI 2.72 to 4.04), and 7.11 (95% CI 5.76 to 8.78), respectively. The restricted cubic spline showed significant increased CKD prevalence when uric acid ≥4.6 mg/dL.

Conclusion: Higher SUA was associated with increased CKD prevalence in patients with hypertension. SUA should be monitored in hypertensive patients for CKD prevention.
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http://dx.doi.org/10.1111/jebm.12364DOI Listing
November 2019

Prevalence and associated factors of uncontrolled hypertension among hypertensive patients: a nation-wide survey in Thailand.

BMC Res Notes 2019 Jul 4;12(1):380. Epub 2019 Jul 4.

Department of Pharmacology, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.

Objectives: The objectives of the research were to determine the prevalence and factors associated of uncontrolled blood pressure among Thai hypertensive patients in a nationwide survey.

Results: A total of 65,667 patients with hypertension were included in this study. The greater proportion of participants, 40,834 (62.2%), were females. The average age of participants was 63.9 ± 11.1 years. Uncontrolled hypertension was detected among 16,122 patients (24.6%; 95% CI 24.2-24.9). Among males and females, uncontrolled hypertension was 25.6% (95% CI 25.1-26.2) and 23.9% (95% CI 23.5-24.3) respectively. Multivariate analysis showed that the uncontrolled hypertension was significantly associated with being male, age, regions, hospital levels, diabetes comorbidity, higher body mass index, low density lipoprotein cholesterol level and the number of antihypertensive medications.
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http://dx.doi.org/10.1186/s13104-019-4417-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610935PMC
July 2019

Cardiovascular and Renal Outcomes in an Excellent Chronic Kidney Disease Clinic Compared with an Outpatient Clinic in a Primary Care Setting: A Retrospective Cohort Study.

Kidney Dis (Basel) 2019 Jun 3;5(3):144-152. Epub 2019 Jan 3.

Department of Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Background: Chronic kidney disease (CKD) is associated with increased cardiovascular morbidity and mortality. In standard care, the physician attempts to control all known risk factors, but treatment goals are achieved with difficulty. Assistance by a multidisciplinary care team may improve outcomes.

Objective: To compare the cardiovascular and renal endpoints between patients with CKD receiving care from excellent CKD and outpatient clinics.

Methods: A retrospective cohort study was conducted in a primary care setting in Thailand. Patients with CKD stages 3 and 4 in excellent CKD ( = 96) and outpatient clinics ( = 192) were matched in a 1: 2 ratio with the propensity score. We collected data from electronic medical records concerning the incidences of primary composite outcomes including rapid renal progression, end-stage renal disease, myocardial infarction, congestive heart failure, stroke, and mortality. Multidisciplinary team care in the excellent CKD clinic consisted of physician, nurse, pharmacist, dietitian, physical therapist, and applied Thai traditional physician. The outpatient clinic consisted of physician care only.

Results: Subjects' mean age was 64.54 ± 10.96 years, and 52.1% were female. During an average 49.63 ± 8.36 months of follow-up, 74 events occurred including 35 (47.30%) patients who experienced renal events, 29 (39.19%) who experienced cardiovascular events, and 10 (13.51%) who experienced loss of life. The Kaplan-Meier curve indicated a higher percentage of subjects without primary composite outcomes in the excellent CKD clinic than those in the outpatient clinic (66.85%; 95% CI 0.48-0.80 vs. 44.71%; 95% CI 0.29-0.60; = 0.005). From multivariate analysis, the excellent CKD clinic group had a 64% lower risk for primary composite outcomes compared with those in the outpatient clinic (adjusted HR 0.36; 95% CI 0.18-0.74; = 0.005).

Conclusion: A multidisciplinary care system can reduce composition outcomes including cardiovascular and renal outcomes for the growing CKD population. The optimal outcomes arise from the medical personnel's teamwork, not from one physician alone.
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http://dx.doi.org/10.1159/000495464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6587207PMC
June 2019

Trends in the prevalence of obesity among young Thai men and associated factors: from 2009 to 2016.

Mil Med Res 2019 04 30;6(1):13. Epub 2019 Apr 30.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, 10400, Thailand.

Background: The prevalence of obesity has been increasing in both males and females worldwide. In Thailand, the National Health Examination Surveys reported that the prevalence of obesity (body mass index (BMI) ≥30 kg/m) among Thai male adults aged 20-59 years increased from 1.7% in 1991 to 6.8% in 2009. Obesity has been confirmed to lead to health problems, including noncommunicable diseases. In the present study, we report trends in the prevalence of obesity among new conscripts from 2009 to 2016. We also investigated the associated factors of obesity.

Methods: Serial cross-sectional studies were conducted from 2009 to 2016 among male Royal Thai Army (RTA) conscripts whose weight and height had been measured to determine BMI after being inducted. Each subject completed a detailed risk factor questionnaire. Obesity was defined as BMI ≥ 30 kg/m.

Results: A total of 26,540 young Thai males conscripted into the RTA were included in this study. The prevalence of obesity was 2.2% in 2009, 3.4% in 2010, 2.5% in 2011, 2.9% in 2012, 3.4% in 2013, 4.4% in 2014, 5.0% in 2015, and 4.8% in 2016 (P for trend < 0.0001). The independent risk factors for obesity were coming from the north central and south regions compared with the northeast, higher education level, indoor occupation and no regular exercise.

Conclusions: Our data emphasized that obesity constitutes a serious problem among young Thai men. We could apply these findings in military units to other groups at any age. Regular exercise should be provided to young adults and other age groups to slow the process of obesity, so that associated complications, especially noncommunicable diseases, will cease.
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http://dx.doi.org/10.1186/s40779-019-0201-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6489215PMC
April 2019

Prevalence of dyslipidemia associated with complications in diabetic patients: a nationwide study in Thailand.

Lipids Health Dis 2019 Apr 6;18(1):90. Epub 2019 Apr 6.

Department of Physiology, Phramongkutklao College of Medicine, 315 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand.

Background: Dyslipidemia is an important modifiable risk factor for cardiovascular disease. It is diagnosed by the presence of an abnormal lipid profile, primarily with elevated levels of plasma cholesterol, triglyceride, or both, or reduced levels of high-density lipoprotein cholesterol. However, some studies have reported increased risk of ischemic stroke with elevated low-density lipoprotein cholesterol (LDL-C) levels and increased risk of cardiovascular mortality independent of LDL-C levels in type 2 diabetes mellitus (T2DM) patients.

Methods: In this cross-sectional study, data were included for Thai adults with diabetes from the Diabetes Mellitus/ Hypertension (DM/HT) study, 2010-2014 (data was collected by the Medical Research Network of the Consortium of Thai Medical Schools). The target population comprised T2DM patients who were treated at a hospital for more than 12 months. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated to determine factors associated with dyslipidemia.

Results: In total, 140,557 participants (average age, 60 years) were enrolled, with a dyslipidemia prevalence of 88.9% in the cohort. The factors associated with dyslipidemia included female sex (aOR: 1.47, 95% CI: 1.38-1.56); age < 50 years (aOR: 1.16, 95% CI: 1.10-1.22); waist circumference ≥ 90 cm in males and ≥ 80 cm in females (aOR: 1.23, 95% CI: 1.16-1.31); treatment at a primary care unit (aOR: 1.28, 95% CI: 1.23-1.33); and a history of unknown stroke (aOR: 1.10, 95% CI: 1.02-1.19), coronary revascularization (aOR: 0.85, 95% CI: 0.79-0.91), diabetic nephropathy (aOR: 1.06, 95% CI: 1.01-1.12), or renal insufficiency (aOR: 1.08, 95% CI: 1.02-1.13).

Conclusions: Dyslipidemia is prevalent among Thai T2DMpatients and is associated with gender; age; obesity; central obesity; treatment at a primary care unit; and a history of unknown stroke, coronary revascularization, diabetic nephropathy, and renal insufficiency. Our study results will help increase the awareness of healthcare providers regarding dyslipidemia in diabetic patients. To reduce cardiovascular risk, healthcare professionals should provide regular follow-up and proper advice and ensure primary prevention of vascular complications. Improved education and increased self-awareness regarding the need to change behaviors and regular intake of medication would help decrease dyslipidemia prevalence among diabetic patients.
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http://dx.doi.org/10.1186/s12944-019-1034-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6451778PMC
April 2019

Prevalence and associated factors of hospitalization for dysglycemia among elderly type 2 diabetes patients: A nationwide study.

World J Diabetes 2019 Mar;10(3):212-223

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States.

Background: The prevalence of older individuals with type 2 diabetes mellitus (T2DM) is increasing due to the aging population and improved medical care. These patients are very susceptible to disease and treatment-related hospitalizations, resulting in higher health care costs, morbidity, and decreased quality of life. However, data of treatment-related complications, especially dysglycemia-related hospitalizations, are lacking.

Aim: To assess the prevalence and associated factors for dysglycemia-related hospitalizations among elderly diabetic patients in Thailand using nationwide patient sample.

Methods: T2DM patients aged ≥ 65 years who received medical care at public hospitals in Thailand in the year 2014 were included. The prevalence of hospitalization due to dysglycemia within one year was examined. Multivariable logistic regression was performed to assess the independent factors associated with hospitalization due to hypoglycemia and hyperglycemia.

Results: A total of 11404 elderly T2DM patients were enrolled in this study. The mean age was 72.9 ± 5.5 years. The prevalence of hospital admissions due to diabetic ketoacidosis, hyperosmolar hyperglycemic state, hyperglycemic dehydration syndrome, and hypoglycemia among elderly T2DM patients in the year 2014 was 0.1%, 0.1%, 1.7% and 3.1%, respectively. Increased hospitalization due to hypoglycemia was associated with older age, female sex, had hypertension, dementia, lower body mass index, elevated hemoglobin A1C (HbA1C), decreased kidney function, insulin use. Increased hospitalization due to hyperglycemia was associated with dementia, depression, lower body mass index, elevated HbA1C, and insulin use.

Conclusion: The prevalence of dysglycemia-related hospitalization in elderly T2DM patients in Thailand was 4.9%. Close monitoring of blood glucose should be provided in high-risk patients for prevention and early detection for these complications.
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http://dx.doi.org/10.4239/wjd.v10.i3.212DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6422861PMC
March 2019

Associations of renal function with diabetic retinopathy and visual impairment in type 2 diabetes: A multicenter nationwide cross-sectional study.

World J Nephrol 2019 Feb;8(2):33-43

Division of Nephrology, Department of Medicine, University of Mississippi Medical Center, Jackson, MS 39216, United States.

Background: Diabetic retinopathy (DR) separately has been noted as a major public health problem worldwide as well. Currently, many studies have demonstrated an association between diabetic nephropathy and DR in type 1 diabetes mellitus (T1DM) patients, but this association is less strong in T2DM. The evidence for an association between renal function and DR and visual impairment among T2DM patients is limited, particularly in the Asian population.

Aim: To assess the association between glomerular filtration rate (GFR) and DR, severe DR, and severe visual impairment among T2DM patients in Thailand.

Methods: We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients from 831 public hospitals in Thailand in the year 2013. GFR was categorized into ≥ 90, 60-89, 30-59 and < 30 mL/min/1.73 m. The association between GFR and DR, severe DR, and severe visual impairment were assessed using multivariate logistic regression.

Results: A total of 13192 T2DM patients with available GFR were included in the analysis. The mean GFR was 66.9 ± 25.8 mL/min/1.73 m. The prevalence of DR, proliferative DR, diabetic macular edema, and severe visual impairment were 12.4%, 1.8%, 0.2%, and 2.1%, respectively. Patients with GFR of 60-89, 30-59 and < 30 mL/min/1.73 m were significantly associated with increased DR and severe DR when compared with patients with GFR of ≥ 90 mL/min/1.73 m. In addition, increased severe visual impairment was associated with GFR 30-59 and < 30 mL/min/1.73 m.

Conclusion: Decreased GFR was independently associated with increased DR, severe DR, and severe visual impairment. GFR should be monitored in diabetic patients for DR awareness and prevention.
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http://dx.doi.org/10.5527/wjn.v8.i2.33DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6388308PMC
February 2019

Prevalence and associated factors of uncontrolled blood pressure among hypertensive patients in the rural communities in the central areas in Thailand: A cross-sectional study.

PLoS One 2019 19;14(2):e0212572. Epub 2019 Feb 19.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Introduction: Hypertension is a common cardiovascular disease at present. Uncontrolled blood pressure leads to further complications including heart attack, stroke and chronic kidney disease. In Thailand, most of the information related to this issue is collected by hospitals or hospital-based organizations rather than at the community level. The objectives of this study were to determine the prevalence of uncontrolled hypertension and to assess the relationship between patient characteristics (socio-behavioral and clinical) and uncontrolled blood pressure among hypertensive patients in the rural communities in the central areas in Thailand.

Materials And Methods: This was a cross-sectional study conducted in Na-Yao and Phra-Pleong rural communities of Thailand in 2018 using the total design method. In all, 406 individuals aged ≥18 years were interviewed using structured questionnaires related to demographic information, higher risk behavior, comorbidities and arthrometric measurement. Blood pressure was assessed for all participants. Uncontrolled hypertension was defined as BP ≥140/90 mmHg.

Results: The prevalence of uncontrolled hypertension was 54.4% (males: 59.8%; females: 52.4%). Uncontrolled blood pressure was associated with neck circumference more than 35.75 cm for males and 32.75 cm. for females (adjusted odds ratio; 1.66, 95% confidence interval; 1.03-2.68), sedentary behavior more than 5 hours a day (adjusted odds ratio; 2.03, 95% confidence interval; 1.28-3.23) and missed doctor appointments (adjusted odds ratio; 3.29, 95% confidence interval; 1.09-9.94).

Conclusion: Approximately one half of hypertensive patients in these rural communities had uncontrolled blood pressure. The Ministry of Public Health and health care providers should provide further strategies to prevent uncontrolled blood pressure's complications.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0212572PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6380583PMC
November 2019

Prevalence and associates of obesity and overweight among school-age children in a rural community of Thailand.

Korean J Pediatr 2019 May 8;62(5):179-186. Epub 2019 Feb 8.

Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand.

Purpose: Information about overweight and obesity among students in rural areas of Thailand is limited. Therefore, we aimed to determine overweight and obesity prevalences and associated factors among school-aged children in a rural community of Thailand.

Methods: We selected 9 public schools through cluster sampling in 2 provinces located in central Thailand in 2016. Anthropometric measurements were measured using standard techniques, classified as overweight (>1 standard deviation [SD]) and obese (>2 SD) with respect to their age and sex using 2007 World Health Organization reference charts. Standardized questionnaires on risk factors were sent to parents to be completed together with their child.

Results: Among 1,749 students, 8.98% had overweight and 7.26% had obesity. Mean age (range) was 11.5 years (5-18 years). Independent factors associated with overweight and obesity included primary school student (reference as secondary school) (adjusted odds ratio [aOR], 2.25; 95% confidence interval [CI], 1.24-4.08; P=0.07), mother's body mass index (aOR, 1.07; 95% CI, 1.02-1.12; P=0.001), selfemployed father (aOR, 1.99; 95% CI, 1.12-3.55; P=0.018), number of siblings (aOR, 0.61; 95% CI, 0.47-0.81; P=0.001), having sibling(s) with obesity (aOR, 1.82; 95% CI, 1.20-2.77; P=0.005), more than one (aOR, 7.16; 95% CI, 2.40-21.32; P<0.001), consuming 2-3 ladles of rice/meal (aOR, 2.14; 95% CI, 1.38-3.32; P=0.001), consuming >3 ladles of rice/meal (aOR, 2.69; 95% CI, 1.11-6.46; P= 0.27), watching <2 hours of television/day (aOR, 2.18; 95% CI, 1.19-4.01; P=0.012), and watching >2 hours of television/day (aOR, 2.60; 95% CI, 1.36-4.96; P=0.004).

Conclusion: Many sociodemographic, dietary, and behavioral factors were related to overweight and obesity among school-aged children not only in urban but also rural communities of Thailand.
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http://dx.doi.org/10.3345/kjp.2018.06499DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6528063PMC
May 2019

Incidence and Associated Factors of Type 2 Diabetes: A Community-Based Cohort Study in the Central Region of Rural Community in Thailand.

Asia Pac J Public Health 2019 01 7;31(1):72-83. Epub 2019 Jan 7.

4 Department of Parasitology, Phramongkutklao College of Medicine, Bangkok, Thailand.

The present study aimed to evaluate the incidence of type 2 diabetes mellitus (T2DM) and associated risk factors among adults in a rural community of Thailand. A prospective cohort study was conducted in a rural community of Thailand. Among 1358 nondiabetics ≥18 years, fasting plasma glucose (FPG) was measured at baseline in 2008 to 2010 and at follow-up evaluation in 2015. After follow-up of 5213 person-years, 122 new cases of T2DM were ascertained corresponding to cumulative incidence of 23.40 per 1000 person-years. The independent factors associated with T2DM were age, male, prehypertension, hypertension, waist circumference, and impaired FPG. The incidence of T2DM in Thailand is high, and many risk factors are converging. The focus of public health efforts should be on abdominal obesity, hypertension, and impaired FPG. Special attention in terms of preventive strategies must be paid to individuals with impaired FPG, as this state is the most prominent predictor of developing T2DM.
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http://dx.doi.org/10.1177/1010539518822441DOI Listing
January 2019

The association between renal function and neurological diseases in type 2 diabetes: a multicenter nationwide cross-sectional study.

Hosp Pract (1995) 2019 Feb 25;47(1):46-52. Epub 2018 Nov 25.

d Division of Nephrology, Department of Medicine , University of Mississippi Medical Center , Jackson , MS , USA.

Background: The evidence for an association between renal function and neurological diseases among type 2 diabetes mellitus (T2DM) patients, particularly in the Asian population, is limited. This study aimed to assess the association between glomerular filtration rate (GFR) and various neurological diseases among T2DM patients in Thailand using a nationwide patient sample.

Methods: We conducted a nationwide cross-sectional study based on the DM/HT study of the Medical Research Network of the Consortium of Thai Medical Schools. This study evaluated adult T2DM patients receiving care at public Thailand hospitals in the year 2014. GFR was categorized into ≥60, 30-59, and < 30 mL/min/1.73 m. Neurological diseases studied included ischemic stroke/transient ischemic attack (TIA), hemorrhagic stroke, dementia, all cerebrovascular disease, and peripheral neuropathy. Multivariate logistic regression was performed to assess the association between GFR and neurological diseases.

Results: A total of 30,423 T2DM patients with available GFR data were included in the analysis. The mean GFR was 68.18 ± 26.45 mL/min/1.73 m. The prevalence of ischemic stroke/TIA, hemorrhagic stroke, dementia, any cerebrovascular diseases and peripheral neuropathy were 2.9%, 0.3%, 0.1%, 3.2%, and 3.1%, respectively. Patients with GFR of 30-59 and <30 mL/min/1.73 m were significantly associated with increased rates of ischemic stroke/TIA, any cerebrovascular diseases, and peripheral neuropathy when compared with patients with GFR of ≥60 mL/min/1.73 m. This association remained significant after adjustment for potential confounders.

Conclusion: Decreased GFR was associated with increased ischemic stroke/TIA, all cerebrovascular diseases, and peripheral neuropathy. GFR should be monitored in diabetic patients for neurological disease awareness and prevention.
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http://dx.doi.org/10.1080/21548331.2019.1549916DOI Listing
February 2019

Temporal trends in optimal diabetic care and complications of elderly type 2 diabetes patients in Thailand: A nationwide study.

J Evid Based Med 2019 Feb 5;12(1):22-28. Epub 2018 Nov 5.

Division of Nephrology/Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA.

Background: This study aimed to assess the nationwide trends in optimal diabetic care and complications of elderly type 2 diabetes mellitus (T2DM) patients over a 6-year period in Thailand.

Methods: T2DM patients aged 65 years or older who received medical care at public hospitals in Thailand from 2010 to 2015 were included. The optimal T2DM care in elderly patients was defined as (1) blood pressure (BP) < 140/90, (2) hemoglobin A1C (HbA1c) < 7%, (3) low-density lipoprotein cholesterol (LDL-C) < 100 mg/dL, (4) use of antiplatelet medications, and (5) use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) in hypertensive patients. T2DM treatment-related complications included hospital admissions due to dysglycemia.

Results: A total of 54 295 elderly T2DM patients were enrolled in this study. From 2010 to 2015, there was an increasing trend in the achievement of BP control and use of antiplatelet medications (P for trend < 0.01), whereas there was a decreasing trend in the achievement of HbA1c and LDL-C control among elderly T2DM patients (P for trend < 0.001). There was an increasing trend in the use of ACEI/ARB among elderly T2DM patients with hypertension (P for trend < 0.001). Hospital admissions due to dysglycemia decreased over the study period (P for trend < 0.001).

Conclusion: There has been a trend change for diabetic care among elderly T2DM patients in Thailand. Further studies are needed to assess the impact on patient outcomes.
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http://dx.doi.org/10.1111/jebm.12318DOI Listing
February 2019

Association between semi-quantitative microbial load and respiratory symptoms among Thai military recruits: a prospective cohort study.

BMC Infect Dis 2018 Sep 14;18(1):462. Epub 2018 Sep 14.

Phramongkutklao Hospital, Bangkok, 10400, Thailand.

Background: Multiplex real-time polymerase chain reaction assays have improved diagnostic sensitivity for a wide range of pathogens. However, co-detection of multiple agents and bacterial colonization make it difficult to distinguish between asymptomatic infection or illness aetiology. We assessed whether semi-quantitative microbial load data can differentiate between symptomatic and asymptomatic states for common respiratory pathogens.

Methods: We obtained throat and nasal swab samples from military trainees at two Thai Army barracks. Specimens were collected at the start and end of 10-week training periods (non-acute samples), and from individuals who developed upper respiratory tract infection during training (acute samples). We analysed the samples using a commercial multiplex respiratory panel comprising 33 bacterial, viral and fungal targets. We used random effects tobit models to compare cycle threshold (Ct) value distributions from non-acute and acute samples.

Results: We analysed 341 non-acute and 145 acute swab samples from 274 participants. Haemophilus influenzae type B was the most commonly detected microbe (77.4% of non-acute and 64.8% of acute samples). In acute samples, nine specific microbe pairs were detected more frequently than expected by chance. Regression models indicated significantly lower microbial load in non-acute relative to acute samples for H. influenzae non-type B, Streptococcus pneumoniae and rhinovirus, although it was not possible to identify a Ct-value threshold indicating causal etiology for any of these organisms.

Conclusions: Semi-quantitative measures of microbial concentration did not reliably differentiate between illness and asymptomatic colonization, suggesting that clinical symptoms may not always be directly related to microbial load for common respiratory infections.
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http://dx.doi.org/10.1186/s12879-018-3358-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6137728PMC
September 2018

Epidemiology and Transmission of Respiratory Infections in Thai Army Recruits: A Prospective Cohort Study.

Am J Trop Med Hyg 2018 10;99(4):1089-1095

Phramongkutklao Hospital, Bangkok, Thailand.

Military recruits are at high risk of respiratory infections. However, limited data exist on military populations in tropical settings, where the epidemiology of respiratory infections differs substantially from temperate settings. We enrolled recruits undertaking a 10-week military training at two Royal Thai Army barracks between May 2014 and July 2015. We used a multiplex respiratory panel to analyze nose and throat swabs collected at the start and end of the training period, and from participants experiencing respiratory symptoms during follow-up. Paired sera were tested for influenza seroconversion using a hemagglutinin inhibition assay. Overall rates of upper respiratory illness and influenza-like illness were 3.1 and 2.0 episodes per 100 person-weeks, respectively. A pathogen was detected in 96% of samples. The most commonly detected microbes were type B (62.7%) or non-type B (58.2%) and rhinovirus (22.4%). At baseline, bacterial colonization was high and included type B (82.3%), non-type B (31.5%), (14.6%), (8.5%), and (8.5%). At the end of follow-up, colonization with non-type B had increased to 74.1%, and to 33.6%. In the serology subset, the rate of influenza infection was 3.4 per 100 person-months; 58% of influenza infections resulted in clinical disease. Our study provides key data on the epidemiology and transmission of respiratory pathogens in tropical settings. Our results emphasize the need for improved infection prevention and control in military environments, given the high burden of illness and potential for intense transmission of respiratory pathogens.
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http://dx.doi.org/10.4269/ajtmh.18-0219DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6159564PMC
October 2018

Personal risk factors associated with heat-related illness among new conscripts undergoing basic training in Thailand.

PLoS One 2018 4;13(9):e0203428. Epub 2018 Sep 4.

Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok, Thailand.

Cases of exertional heat stroke have been reported every year during basic training for Royal Thai Army (RTA) conscripts. Prevention is an important strategy to reduce the incidence of heat-related illnesses. We conducted a study to identify potential indicators for the prevention and monitoring of heat-related illnesses among military conscripts undergoing basic training in Thailand. All newly inducted RTA conscripts in 5 basic training units in 5 regions in Thailand were invited to participate in a prospective cohort study from May 1 to July 9, 2013. The incidence rate of heat-related illnesses and the incidence rate ratio (IRR) based on a Poisson regression model were used to identify the independent factors associated with heat-related illnesses, daily tympanic (body) temperatures higher than 37.5°C, >3% decreases in body weight in one day, and the production of dark brown urine. Eight hundred and nine men aged 21.4 (±1.13) years were enrolled in this study. The prevalence of a body mass index (BMI) ≥30 kg/m2 was 5.5%. During the study period, 53 subjects (6.6%) representing 3.41/100 person-months (95% confidence interval (CI), 2.55-4.23) developed heat-related illnesses (excluding heat rash), and no subjects experienced heat stroke. The incidence rates of a daily tympanic temperature >37.5°C at least once, body weight loss of >3% per day, and the production of dark brown urine at least once were 8.27/100 person-months (95% CI, 7.69-8.93), 47.91/100 person-months (95% CI, 44.22-51.58), and 682.11/100 person-months (95% CI, 635.49-728.52), respectively. The sole identified independent factor related to the incidence of heat-related illnesses was a BMI ≥30 kg/m2 (adjusted IRR = 2.66, 95% CI, 1.01-7.03). In conclusion, a high BMI was associated with heat-related illnesses among conscripts undergoing basic training in Thailand. Daily monitoring of heat-related illnesses, body temperature, body weight and urine color in each new conscript during basic military training was feasible.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203428PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6122829PMC
February 2019