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Purpose: To assess the construct validity of the Thai EuroQoL (EQ-5D) among an occupational population in Thailand. Methods: Data were derived from a large cohort study among employees of the Electricity Generating Authority of Thailand. In 2008 and 2009, 4,850 participants completed the Thai EQ-5D and Short-Form 36 version 2 (SF-36v2). Thai preferences weights were used to convert EQ-5D health states into EQ-5D index scores. Construct validity of the Thai EQ-5D was examined by specifying and testing hypotheses about the relationships between the EQ-5D, SF-36v2, and participants' demographic and medical characteristics. Results: Construct validity of the Thai EQ-5D was supported by expected relationships with SF-36v2 scale and summary scores. For example, SF-36v2 scores on the mental health scale were much lower for participants who reported having problems on the EQ-5D anxiety/depression dimension compared to those reporting no problems (mean norm-based SF-36v2 scores: 52.9 vs. 41.8, p < 0.001). Additionally, reporting a problem in a given EQ-5D dimension was generally associated with lower SF-36v2 summary scores. The EQ-5D index score distinguished between groups of participants in the expected manner, on the basis of sex, age, education and self-reported health, thus providing evidence of known-groups validity. Conclusion: The study demonstrated good construct validity of the Thai EQ-5D in a large occupational population in Thailand. [ABSTRACT FROM AUTHOR]

Peripheral arterial disease (PAD) is a condition with high mortality, but it is amenable to secondary prevention. Data on its prevalence in Thailand are scarce. To study the prevalence of PAD in a middle-class, urban Thai population, a cross-sectional study was conducted at the Electric Generating Authority of Thailand's head plant, Nonthaburi, in 2002 and 2003 on all surviving and contactable employees and former employees who had participated in the first cardiovascular risk factors survey in 1985. Participants completed a structured questionnaire detailing their medical history, and they underwent a physical examination, A diagnosis of PAD was made when the ankle-brachial index (ABI) was < 0.9. Ankle-brachial index data were available for 98% of participants in the survey; 75% were men, and participants' ages ranged from 52 to 73 years. The overall prevalence of PAD was 5.2%. The age-standardized prevalence of PAD was 4% in men and 9% in women. Multiple logistic regression analysis found hypertension (OR = 1.7), female gender (OR = 1.9), current smoking (OR = 3.0), current alcohol drinking (OR = 0.41), and overweight (body mass index [BMI] > 25 kg/m², OR = 0.54) to be significant (P < .05) predictors of PAD. The prevalence of PAD in urban, middle-class Thais was similar to that in the population in developed countries. [ABSTRACT FROM AUTHOR]

The article presents a study on abdominal obesity and coronary heart disease (CHD) in Thai men. It states that obesity has always been reported as an important risk factor for CHD. Cardiovascular risk factors, such as hypertension, with which abdominal obesity is associated are cited. The CHD outcome for the study included both fatal and non-fatal myocardial infarction (MI) during a period of 17 years. The study found that waist-to-height ratio (WHtR) has the highest association with CHD risk.

OBJECTIVE -- The objective of this study was to develop and evaluate a risk score to predict people at high risk of diabetes in Thailand. RESEARCH DESIGN AND METHODS -- A Thai cohort of 2,677 individuals, aged 35-55 years, without diabetes at baseline, was resurveyed after 12 years. Logistic regression models were used to identify baseline risk factors that predicted the incidence of diabetes; a simple model that included only those risk factors as significant (P < 0.05) when adjusted for each other was developed. The coefficients from this model were transformed into components of a diabetes score. This score was tested in a Thai validation cohort of a different 2,420 individuals. RESULTS -- A total of 361 individuals developed type 2 diabetes in the exploratory cohort during the follow-up period. The significant predictive variables in the simple model were age, BMI, waist circumference, hypertension, and history of diabetes in parents or siblings A cutoff score of 6 of 17 produced the optimal sum of sensitivity (77%) and specificity (60%). The area under the receiver-operating characteristic curve (AUC) was 0.74. Adding impaired fasting glucose or impaired glucose tolerance status to the model slightly increased the AUC to 0.78; adding low HDL cholesterol and/or high triglycerides barely improved the model. The validation cohort demonstrated similar results. CONCLUSIONS -- A simple diabetes risk score, based on a set of variables not requiring laboratory tests, can be used for early intervention to delay or prevent the disease in Thailand. Adding impaired fasting glucose or impaired glucose tolerance or triglyceride and HDL cholesterol status to this model only modestly improves the predictive ability. [ABSTRACT FROM AUTHOR]

Objective: Few data have linked socioeconomic status (SES) to incident hypertension, and little information on the relationship between SES and hypertension are available from developing countries. We thus investigated the long-term effects of SES on incident hypertension and changes in blood pressure in Thailand., Methods: In 1985, baseline data were collected from 3499 participants in the Electricity Generating Authority of Thailand study. Participants were re-examined in 1997, 2002 and 2007. Logistic regression models, Cox-proportional hazard models and time-dependent covariates were used to calculate the relationship between SES and prevalent hypertension in 1985, incident hypertension in 1997 and 2007, respectively., Results: The prevalence of hypertension was 20% and the level of income, but not education, was inversely related to prevalent hypertension. Adjusting for several risk factors, compared to those who had tertiary education, participants who had primary education had 30% increased risk of incident hypertension in 1997 [hazard ratio 1.30, 95% confidence interval (CI) 1.09-1.54] and 20% in 2007 (1.20, 1.05-1.37); both P for trend was less than 0.01. Participants who had higher education also had substantially lower increments in SBP and DBP across 22 years (P < 0.0001 for SBP and P = 0.015 for DBP). Level of income was similarly negatively related to the progression of SBP, with a 3.6 mmHg difference between the highest income group and the lowest (P < 0.0001)., Conclusion: Hypertensive counseling and surveillance should be emphasized within socioeconomically disadvantaged populations.

Background: The impact of the presence and awareness of individual health states on quality of life (HRQoL) is often documented. However, the impacts of different health states have rarely been compared amongst each other, whilst quality of life data from Asia are relatively sparse. We examined and compared the effects of different health states on quality of life in a Thai population., Methods: In 2008-2009, 5,915 corporate employees were invited to participate in a survey where HRQoL was measured by the Short Form 36 (SF-36) questionnaire. The adjusted mean SF-36 scores were calculated for each self-reported illness, number of chronic conditions, lifestyle factors and awareness of diabetes and hypertension. The effect sizes (ES) were compared using Cohen's d., Results: The response rate was 82% and 4,683 (79.1%) had complete data available for analysis. Physical and Mental Component Summary (PCS and MCS) scores decreased as the number of chronic conditions increased monotonically (p<0.0001). Diabetes and hypertension negatively influenced PCS (mean score differences -0.6 and -1.5, p<0.001 respectively) but not MCS, whereas awareness of diabetes and hypertension negatively influenced MCS (-2.9 and -1.6, p<0.005 respectively) but not PCS. Arthritis had the largest ES on PCS (-0.37), while awareness of diabetes had the largest ES on MCS (-0.36). CVD moderately affected PCS and MCS (ES -0.34 and -0.27 respectively). Obesity had a negative effect on PCS (ES -0.27). Exercise positively affected PCS and MCS (ES +0.08 and +0.21 (p<0.01) respectively)., Conclusion: Health promotion to reduce the prevalence of chronic diseases is important to improve the quality of life in Asian populations. Physical activity is an important part of such programs. Awareness of diseases may have greater impacts on mental health than having the disease itself. This has implications for the evaluation of the cost-benefit of screening and labeling of individuals with pre-disease states.

The association between serum lipids and mortality has not previously been established in Thailand. Baseline data from the Electricity Generating Authority of Thailand (EGAT) cohort study, plus a resurvey of the cohort 15 years later were analyzed. Participants were employees of EGAT: 2,702 men and 797 women. Total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), and triglycerides (TG) were taken as predictive variables; age, sex, hypertension, diabetes, cigarette smoking, alcohol drinking, and body mass index were taken as confounders. Dependent variables were all-causes and specific causes of mortality over 17 years of follow-up. The major cause of death among men was cardiovascular disease (CVD); among women, it was cancer. Relative risks (RR) for specific causes of death, for a mmol/L increase in each lipid, were estimated after adjustment for confounding factors using Cox proportional hazards regression. TC and LDL-C were negatively associated with liver cirrhosis mortality, although it was likely that the low cholesterol concentration was a consequence of the disease. HDL-C was negatively associated with CVD mortality (RR = 0.59; 95% confidence interval [CI], 0.39-0.93), coronary heart disease (CHD) mortality (RR = 0.36; 95% CI, 0.17-0.75) and all cause-mortality (RR = 0.68; 95% CI, 0.54-0.87). TG was not associated with mortality. HDL-C is an important risk factor for CVD in middle-class urban Thais. Health promotion programs to improve lipid profiles, such as effective exercise campaigns and dietary advice, are required to increase HDL-C and to help prevent CVD and premature death in Thailand.

The authors' objective was to describe the distribution of serum lipids and the prevalence of dyslipidaemia using US lipid-lowering guidelines in an adult Thai population. Fasting serum lipids were measured in a population-based survey that included 5305 rural and urban Thai adults aged 335 years. The US National Cholesterol Education Program (NCEP) guidelines were used to determine the eligibility of each individual for lipid-lowering therapy. Compared with urban residents, rural residents had lower mean levels of total cholesterol (men. 4.80 vs 5.54 mmol/L, women: 5.18 vs 5.71 mmol/L, both p < 0.001) and high density lipoprotein cholesterol (men: 1.06 vs 1.19 mmol/L, women: 1.13 vs 1.34 mmol/L, both p < 0.001). Mean triglyceride levels were higher in rural compared to urban populations, for both men (2.15 vs 1.88 mmol/L, p = 0.001) and women (1. 73 vs 1.51 mmol/L, p = 0.01). Direct application of the NCEP guidelines identified up to 37% of the adult population (or 10 million adult Thais) as eligible for lipid-lowering drug therapy, which is an unfeasibly high proportion of the population. Urgent strategies are required to prevent increasing levels of dyslipidaemia in Thailand, as well as to develop and promulgate treatment guidelines that incorporate locally-relevant risk prediction functions.

Objective: The aim of this study was to determine in Thai adults aged >or=35 years the prevalence and management of diabetes and the associations of diabetes with cardiovascular risk factors., Research Design and Methods: The International Collaborative Study of Cardiovascular Disease in Asia was a complex sample survey. Data from a structured questionnaire, brief physical examination, and blood sample were collected from 5,105 individuals aged >or=35 years (response rate 68%). Population estimates were calculated by applying sampling weights derived from the 2000 Thai census., Results: The estimated national prevalence of diabetes in Thai adults was 9.6% (2.4 million people), which included 4.8% previously diagnosed and 4.8% newly diagnosed. The prevalence of impaired fasting glucose was 5.4% (1.4 million people). Diagnosed diabetes, undiagnosed diabetes, and impaired fasting glucose were associated with greater age, BMI, waist-to-hip ratio, systolic blood pressure, total cholesterol, and serum creatinine levels. The majority of individuals with diagnosed diabetes had received dietary or other behavioral advice, and 82% were taking oral hypoglycemic therapy. Blood pressure-lowering therapy was provided to 67% of diagnosed diabetic patients with concomitant hypertension., Conclusions: Diabetes is common in Thailand, but one-half of all cases are undiagnosed. Because diagnosed diabetes is likely to be treated with proven, low-cost, preventive therapies such as glucose lowering and blood pressure lowering, initiatives that increased diagnosis rates would be expected to produce substantial health benefits in Thailand.

Background: Vascular mortality is increasing in economically developing countries such as Thailand but reliable data about the determinants of these changes are few., Methods: In 1985, male and female employees of the Electricity Generating Authority of Thailand took part in a cardiovascular risk factor survey. In 1997, a follow-up survey was conducted and causes of death were determined for those subjects known to have died. Changes in levels of vascular risk factors over 12 years, and the associations of baseline risk factors with vascular mortality, were calculated., Results: The 1985 survey recruited 3499 volunteers (average age 43 years) of whom 23% were female. In 1997, vital status was determined for 3318 (95%) and 2967 (85%) of the study participants were resurveyed. Mean levels of systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index, total cholesterol and high density lipoprotein (HDL) cholesterol all increased over the 12-year follow-up period. Over the same time, the prevalence of diabetes also rose but the proportion of current smokers decreased. Vascular diseases were the most frequent cause of death during follow-up (n = 46), were positively associated with baseline age, SBP, DBP, smoking, diabetes, male sex, and total cholesterol, and were negatively associated with HDL cholesterol., Conclusions: Levels of most vascular risk factors worsened over the 12-year period between 1985 and 1997. The associations between baseline risk factor levels and vascular mortality were consistent with those observed in other populations. Interventions that control vascular risk factors have the potential to avert much premature vascular disease in Thailand.