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ObjectiveTo examine the relationship between baseline union status (ie, including marriage and cohabitation) and mortality, paying attention to gender differentials, through an 11-year follow-up of a large cohort in Thailand.DesignCohort data from Thai Cohort Study (TCS) were linked official death records over an 11-year follow-up period.SettingCommunity-based adults in Thailand.Participants87 151 Thai adults participated in TCS cohort.MethodCox regression models measured longitudinal associations between union status and 11-year mortality.ResultsFrom 2005 (baseline) to 2016, persons who cohabited and lived with a partner, married persons but not living with a partner and separated/divorced/widowed people were more likely to die compared with those married and living together with a partner. Those who did not have good family support had a higher death risk than those having good family support.Single or cohabiting women had higher risks of mortality than women who were married and living together with a partner throughout follow-up, while separated/divorced/widowed men had higher risks of mortality than counterpart males.ConclusionsOur study reveals the protective effect of marriage and living together on mortality in Thailand, an understudied setting where institutionalisation of cohabitation is low leading to a limited mortality protection. Public policies for moderating mortality should thus be gender nuanced, culturally and institutionally specific. Also, we demonstrate that in settings such as Thailand, where marital status is not always defined in the same way as in western cultures, the need to measure cohabitation in locally relevant terms is important.

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.

The risk of cardiovascular diseases may be reduced by residing in green environments. However, there are relatively few longitudinal cohort studies, especially in Southeast Asia, that focused on the health benefits of long-term greenness exposure in young adults. The present study examined the association between long-term exposure to residential greenness and self-reported morbidities in participants of the Thai Cohort Study (TCS) in Thailand from 2005 to 2013.The self-reported outcomes, including high blood pressure, high blood cholesterol, and diabetes, were reported in 2005, 2009, and 2013, where the study participants provided the exact year of disease occurrence. Greenness was assessed by the satellite-based Normalized Difference Vegetation Index (NDVI) and Enhanced Vegetation Index (EVI), with a spatial resolution of 250 m. Long-term exposure to NDVI and EVI of each participant's sub-district was averaged over the period of person-time. We used Cox proportional hazards models to examine the association between greenness and health outcomes. Associations with self-reported morbidity were measured using hazard ratios (HRs) per interquartile range (IQR) increase in NDVI and EVI.After adjusting for potential confounders, we observed that an IQR increase in NDVI was associated with lower incidence of high blood pressure (HR = 0.92, 95% CI: 0.89, 0.97) and high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.92), but not significantly associated with diabetes (HR = 0.93, 95%CI: 0.85, 1.01). EVI was also inversely associated with self-reported high blood pressure (HR = 0.92, 95%CI: 0.88, 0.96), high blood cholesterol (HR = 0.89, 95%CI: 0.87, 0.91), and diabetes (HR = 0.92, 95%CI: 0.85, 0.99).Long-term exposure to residential greenness was inversely associated with self-reported high blood pressure, high blood cholesterol, and diabetes in participants of TCS. Our study provides evidence that greenness exposure may reduce cardiovascular disease risk factors in adult population.

Background Thailand is a high injury burden setting. In 2015 it had the world’s second highest rate of road traffic fatalities. In order to develop strategies to reduce this burden an accurate understanding of the development of injury risk over the life course is essential. Methods A national cohort of adult Thais was recruited in 2005 (n = 87,151). Participants completed a health questionnaire covering geodemographic, behavioural, health and injury data. Citizen ID numbers were matched with death registration records, identifying deaths from any injury. Adjusted logistic regression models were used to measure associations between baseline exposures and injury deaths between 2005 and 2015. Results Injury mortality comprised 363 individuals, the majority (36%) from traffic injuries. Predictors of all-injury mortality were being male (AOR 3.55, 95% CI 2.57–4.89), Southern Thai (AOR 1.52, 95% CI 1.07–2.16), smoking (AOR 1.55, 95% CI 1.16–2.17), depression (AOR 1.78, 95% CI 1.07–2.96), previous injury (AOR 1.37, 95% CI 1.03–1.81) and drink driving history (AOR 1.37, 95%CI 1.02–1.85). Age and region of residence were stronger predictors for men, while anxiety/depression was a stronger predictor for women. Among males in the far south, assault caused the largest proportion of injury mortality, elsewhere traffic injury was most common. Conclusions This study identifies that a history of drink driving, but not regular alcohol consumption, increased injury risk. The associations between smoking and depression, and injury mortality also need further consideration.

Background Global annual reports of visceral leishmaniasis or kala-azar (“black fever”) reduced from 200,000 cases in 2012 to 23,804 in 2015. India, Bangladesh and Nepal reported 80% of the global cases in 2012, but 39% in 2015. We sought to identify major amenable barriers to early diagnosis of kala-azar in peripheral areas of Mymensingh district, an area of Bangladesh that was highly endemic for kala-azar. Methods We conducted sequential exploratory mixed methods research. Qualitative data were first derived from in-depth interviews and focus group discussions among 29 patients diagnosed with kala-azar, their families, and neighbours. Preliminary results from qualitative analysis were used to design a structured questionnaire, which was administered to collect data on the processes leading to the diagnosis of kala-azar from 102 patients. Qualitative and quantitative data were integrated consistent with the chronology for kala-azar patients seeking care. The study was conducted from September 2011 to May 2012 in Fulbaria and Gaffargaon sub-districts of Mymensingh. Results The median delay from fever onset to confirmatory diagnosis of kala-azar was 60 days, with 38% of the cases diagnosed within 30 days. Public health facilities and Gaffargaon sub-district achieved high proportions of early diagnosis. Individual barriers to early diagnosis were low awareness of symptoms and treatment facilities, poverty, and traditional beliefs. Other factors were the remoteness of health care centres, wet season transport difficulty, mis-diagnosis as typhoid, limited availability of rK-39 testing at the community level, and the inclusion of splenomegaly in the case definition. Conclusions Targeted community awareness campaigns appropriate for underprivileged communities will increase care seeking and consequently diagnosis. Improved diagnostic guidelines and a strong referral chain for kala-azar will accelerate diagnosis. These steps will contribute significantly to the National Kala-azar Elimination Program of Bangladesh, especially during the post-elimination era.

Background Several studies have shown the health effects of air pollutants, especially in China, North American and Western European countries. But longitudinal cohort studies focused on health effects of long-term air pollution exposure are still limited in Southeast Asian countries where sources of air pollution, weather conditions, and demographic characteristics are different. The present study examined the association between long-term exposure to air pollution and self-reported morbidities in participants of the Thai cohort study (TCS) in Bangkok metropolitan region (BMR), Thailand. Methods This longitudinal cohort study was conducted for 9 years from 2005 to 2013. Self-reported morbidities in this study included high blood pressure, high blood cholesterol, and diabetes. Air pollution data were obtained from the Thai government Pollution Control Department (PCD). Particles with diameters ≤10 μm (PM10), sulfur dioxide (SO2), nitrogen dioxide (NO2), ozone (O3), and carbon monoxide (CO) exposures were estimated with ordinary kriging method using 22 background and 7 traffic monitoring stations in BMR during 2005–2013. Long-term exposure periods to air pollution for each subject was averaged as the same period of person-time. Cox proportional hazards models were used to examine the association between long-term air pollution exposure with self-reported high blood pressure, high blood cholesterol, diabetes. Results of self-reported morbidity were presented as hazard ratios (HRs) per interquartile range (IQR) increase in PM10, O3, NO2, SO2, and CO. Results After controlling for potential confounders, we found that an IQR increase in PM10 was significantly associated with self-reported high blood pressure (HR = 1.13, 95% CI: 1.04, 1.23) and high blood cholesterol (HR = 1.07, 95%CI: 1.02, 1.12), but not with diabetes (HR = 1.05, 95%CI: 0.91, 1.21). SO2 was also positively associated with self-reported high blood pressure (HR = 1.22, 95%CI: 1.08, 1.38), high blood cholesterol (HR = 1.20, 95%CI: 1.11, 1.30), and diabetes (HR = 1.21, 95%CI: 0.92, 1.60). Moreover, we observed a positive association between CO and self-reported high blood pressure (HR = 1.07, 95%CI: 1.00, 1.15), but not for other diseases. However, self-reported morbidities were not associated with O3 and NO2. Conclusions Long-term exposure to air pollution, especially for PM10 and SO2 was associated with self-reported high blood pressure, high blood cholesterol, and diabetes in subjects of TCS. Our study supports that exposure to air pollution increases cardiovascular disease risk factors for younger population., Highlights • Evidence on health effects of long-term air pollution exposure are still limited in Southeast Asia. • SO2 was associated with an increased risks of self-reported high blood pressure, high blood cholesterol, and diabetes. • Increase of PM10 was also associated with the incidences of high blood pressure and high blood cholesterol. • The effects were observed even at the level below the National Standard Limit. • This study suggests air pollution increases cardiovascular disease risk factors for younger population.

SummaryIn the last 50 years Thailand has achieved advanced demographic and health transitions. Many infectious diseases are controlled and infant and maternal mortality rates are among the lowest in the region. Within such a low mortality setting, however, substantial variations in health persist, with education being a major driver. This paper assesses the ongoing mortality transition in Thailand, examining relationships between risk factors and mortality outcomes among a large nationwide cohort of distance-learning Open University students, as well as examining the differential mortality benefit enjoyed by this educated group when compared with the general Thai population. The cohort comprised 87,151 participants, who in 2005 completed a questionnaire collecting detailed information on socio-demographics, health behaviours and health outcomes. Participants were aged 15–87 at baseline and lived in all regions of the country. Cohort members’ citizen identification numbers were matched with official death registration records to identify mortality among participants. A total of 1401 deaths were identified up to November 2016. Results show cohort study participants experiencing mortality at approximately one-third of the rate of the general population in the same age and sex groups. The gap between the mortality rates in the two groups widened with increased age. Differential risk factor prevalence among the two populations, particularly lower overweight and obesity prevalence and lower cigarette smoking rates in the cohort, can explain some of this variation. The largely unmeasurable effect of aspiration for life improvement through distance education while embedded in their communities is shown by this study to have a powerful effect on mortality risk. With overall education levels, including higher education, rising in Thailand this growing group of educated aspirational Thais may represent future trends in Thai mortality. Identifying the drivers and characteristics of this mortality variation can help inform policies to provide health services and to help reduce mortality in the whole population.

Purpose The purpose of this paper is to assess the usefulness of nutrition labels in Thailand during nutrition transition from traditional to modern diets that increase salt, sugar, and calorie intake and to note socio-demographic interactions and associations with consumption of transitional processed foods. Design/methodology/approach The authors studied 42,750 distance learning Open University adults aged 23-96 years in 2013 residing nationwide and participating in an ongoing community-based prospective cohort study. The authors used multivariable logistic regression to relate nutrition label experiences (“read”, “good understand”, “frequent use”), socio-demographic factors, and consumption of four transitional foods. These foods included “unhealthy” instant foods, carbonated soft drinks, and sweet drinks, or “healthy” milk. Findings Overall, two-thirds reported good understanding and frequent use of nutrition labels. Unhealthy transition-indicator processed foods were frequently consumed: instant foods (7 per cent), (carbonated) soft drinks (15 per cent), and sweet drinks (41 per cent). Frequent users of nutrition labels (e.g. females, older persons, professionals) were less likely to consume unhealthy indicator foods. Those with the most positive overall nutrition label experience (“read” + “good understanding” + “frequent use”) had the best indicator food profiles: instant foods (odds ratio (OR) 0.63; 95%CI, 0.56-0.70); soft drinks (OR 0.56; 95%CI, 0.52-0.61); sweet drinks (OR 0.79; 95%CI, 0.74-0.85); milk (OR 1.87; 95%CI, 1.74-2.00). Originality/value Knowledge protected – those with most nutrition label experience were least likely to consume unhealthy foods. Results support government regulated nutrition labels, expanding to include sweet drinks. The study is remarkable for its large size and nationwide footprint. Study subjects were educated, represent Thais of the future, and show high awareness of transition-indicator foods.

Background: As people in middle and lower income countries live longer, more people become sick, disabled, and frail and the demand for family caregiving grows. Thailand faces such challenges. This study investigates the relationship between caregiving and mental health among workers drawn from a large longitudinal cohort of Thai adults. Methods: Participants were drawn from the Thai Health-Risk Transition Study, a cohort study since 2005 of distance-learning adult Open University students residing nationwide. Caregiving status and binary psychological distress outcome (score 19–30 on Kessler 6) were recorded in 2009 and 2013 among cohort members who were paid workers at both years (n=33,972). Multivariate logistic regression was used to estimate the relationship between four-year longitudinal caregiving status and psychological distress in 2013, adjusting for potential covariates. Results: Longitudinal analyses revealed the transitional nature of care with 25% exiting and 10% entering the caring role during the four-year follow-up. Based on multivariate logistic regression, 2009–2013 caregiving status was significantly associated with psychological distress. Cohort members transitioning into caregiving and those who were caregivers in both 2009 and 2013 had a higher risk for psychological distress than non-caregivers (Adjusted Odds Ratios 1.40 [1.02–1.96] and 1.64 [1.16–2.33], respectively). Conclusion: Our findings provide evidence on caregiving and associated risk for psychological distress among working Thais. This adds to the limited existing literature in middle-income countries and highlights the potential pressure among caregivers in balancing work and care while preserving their own mental health. Keywords: Carers, Caregivers, Mental health, Work and health, Longitudinal data, Cohort study, Thailand

Background:Prehospital emergency care is cost-effective for improving morbidity and mortality of emergency conditions. However, such care has been discounted in the public health system of many lower middle-income countries (LMICs). Where it exists, the Emergency Medical Service (EMS) system is grossly inadequate, unpopular, and misrepresented. Many EMS reviews in developing countries have identified systemic problems with infrastructure and human resources, but they neglected impacts of sociocultural factors. This study examines the sociocultural dimensions of LMICs’ prehospital emergency systems in order to improve the quality and impact of emergency care in those countries.Methods:Qualitative studies on EMS systems in LMICs were systematically reviewed and analyzed using Kleinman’s health system theory of folk, popular, and professional health sectors. Also, the three-delay model of emergency care – seeking, reaching, and receiving – provided a guiding framework.Results:The search yielded over 3,000 papers and the inclusion criteria eventually selected 14, with duplicates and irrelevant papers as the most frequent exclusion. Both user and provider experiences with emergency conditions and the processes of prehospital care were described. Sociocultural factors such as trust and beliefs underlay the way emergency care was experienced. Attitudes of family and community shaped service-seeking behaviors. Traditional medicine was often the first point of care. Private vehicles were the main transportation for accessing care due to distrust and misunderstanding of ambulance services.Conclusion:The findings led to the discussion on how culture is woven into the patients’ pathway to care, and the recommendation for any future development to place a far greater emphasis on this aspect. Instead of relying purely on the biomedical sector, the health system should acknowledge and show respect for popular knowledge and folk belief. Such strategies will improve trust, facilitate information exchange, and enable stronger healer-patient relationships.

Background: Type 2 diabetes mellitus (T2DM) is increasingly prevalent in countries undergoing rapid development, including Thailand. We assessed T2DM incidence over an 8-year period in a nationwide cohort of Thai adults.Methods: Thai Cohort Study participants were surveyed in 2005, 2009 and 2013. The analysed cohort members were aged (15–88), did not have diabetes in 2005 and were followed up by questionnaire in 2013 (n=39 507). T2DM was ascertained using self-report, which has been validated using physician interviews. We calculated the 8-year cumulative incidence of T2DM. Multivariable logistic regression assessed associations between potential risk factors and T2DM incidence.Results: 8-year cumulative incidence of T2DM (2005 to 2013) was 177 per 10 000 (95% CI 164 to 190). Crude and age-standardised cumulative incidences of T2DM by sex were 249 per 10 000 (95% CI 226 to 272) and 222 per 10 000 (95% CI 219 to 225) for men; and 119 per 10 000 (95% CI 105 to 133) and 96 per 10 000 (95% CI 94 to 98) for women, respectively. T2DM increased significantly for both sexes with increasing age and body mass index (BMI) (p trend Conclusions: This study found that the sociodemographic and lifestyle changes that have accompanied Thailand's economic development are associated with T2DM risk in a large cohort of Thai adults. Our findings highlight the need to address these transitions to prevent a further increase in the national incidence of T2DM, particularly among Thai men.

Background Overweight and obesity have been shown to be risk factors for a range of non-communicable diseases, especially cardio-metabolic conditions, worldwide. But less is known about the effects of weight change on adults' overall health and wellbeing, particularly in transitional low- and middle-income countries. This study aimed to assess the relationship between 8-year weight change and measures of self-assessed health among Thai adults. Methods Data were collected from Thai adults aged 25–40 years (n = 27,003) enrolled in the Thai cohort Study and surveyed in 2005, 2009, and 2013. We used self-reported weight and height measurements at baseline and 2013, as well as three standard health questions regarding overall health, energy, and emotion asked at the two time points, to investigate the effects of weight change on health. Results Between 2005 and 2013, 6.0% of participants lost more than 5% of their baseline weight; 38.5% were stable (5%–10%); 22.8% gained moderate weight (>10%–20%); and 9.4% had heavy weight gain (>20%). Moderate (>10%–20%) and heavy weight gain (>20%) were both associated with an increased risk of reporting ‘poor or very poor‘ overall health in 2013 among participants who had a normal body mass index (BMI) (adjusted odds ratio [AOR] 1.39; 95% confidence interval [CI], 1.13–1.71 and AOR 1.44; 95% CI, 1.09–1.90, respectively), were overweight (AOR 1.53; 955 CI, 1.01–2.29 and AOR 1.82; 95% CI, 1.04–3.19, respectively) or had obesity (AOR 2.47; 95% CI, 1.74–3.51 and AOR 3.20; 95% CI, 2.00–5.16, respectively) in 2005. Weight gain of over 20% also had a negative impact on energy level among cohort members with a normal BMI in 2005 (AOR 1.36; 95% CI, 1.11–1.65) and among participants with obesity in 2005 (AOR 1.93; 95% CI, 1.38–2.71). For those who were underweight, had a normal BMI, or had obesity at baseline, weight loss of more than 5% was associated with reporting emotional problems. Excessive weight gain adversely impacted participants who were underweight or had obesity at baseline. Conclusion Our study found that weight change, in particular weight gain, was associated with negative health outcomes, and this effect appeared to increase at higher levels of body size. The present findings may be useful to promote weight maintenance and healthy lifestyles., Highlights • This study investigated 8-year weight change and overall health among Thai adults. • Weight gain was associated with poor emotional well-being and lower levels of energy. • Findings highlight the importance of monitoring weight change and health effects.

In recent decades, a health-risk transition with changes in diet and lifestyle in low and middle-income countries (LMICs) led to an emergence of chronic diseases. These trends in Southeast Asian LMICs are not well studied. Here, we report on transitional dietary patterns and their socio-demographic predictors in Thai adults. Dietary data in 2015 were from a random sub-sample (N = 1075) of 42,785 Thai Cohort Study (TCS) members who completed all three TCS surveys (2005, 2009, 2013). Principle Component Analysis identified dietary patterns and multivariable linear regression assessed associations (Beta estimates (ß) and confidence intervals (CIs)) between socio-demographic factors and dietary intake pattern scores. Four dietary patterns emerged: Healthy Transitional, Fatty Western, Highly Processed, and Traditional. In women, higher income (≥30,001 Baht/month vs. ≤10,000) and managerial work (vs. office assistant) was associated with lower scores for Traditional (ß = −0.67, 95% CI −1.15, −0.19) and Fatty Western diets (ß = −0.60, 95% CI −1.14, −0.05), respectively. University education associated with lower Highly Processed (ß = −0.57, 95% CI −0.98, −0.17) and higher Traditional diet scores (ß = 0.42, 95% CI 0.03, 0.81). In men and women, urban residence associated with higher Fatty Western and lower Traditional diets. Local policy makers should promote healthy diets, particularly in urban residents, in men, and in low-SEP adults.

Thailand has experienced dramatic growth of large national and international modern food retailers, such as supermarkets, hypermarkets and convenience stores in large cities and regional centres in the last two decades. Nevertheless, Thai consumers continue to purchase perishables (fruits, vegetables and animal products) from fresh markets (wet markets, talat sot) contradicting predictions from analysts that modern food retail chains will rapidly replace fresh markets as the preferred venue for purchasing all types of foods. This paper examines trust in food retail systems as an under-explored dimension lying behind the continued patronage by Thais of fresh markets to purchase perishable items. It derives from a research program commenced in 2005 that includes fieldwork visits, interviews and questionnaires. In the context of the Thai food retail transition, we propose that trust affects relationships between consumers and (1) individual fresh market-based vendors, (2) the food products sold at fresh markets and (3) the food retail system more broadly. If fresh markets can be maintained in the face of sustained pressure from modern national and international food retailers, Thais will continue to use them. Meanwhile, trust is a relatively unrecognised dimension that is supporting the continued existence of traditional food retail formats.

BACKGROUND: We analyzed population-based injury trends and the association between injury and alcohol consumption patterns in Thailand, a middle-income country undergoing rapid social change. METHODS: A nationwide cohort of 42 785 Thai adult Open University students, who were aged 15 to 87 years at enrolment, participated in cross-sectional assessments at baseline (2005) and 8 years later (2013). Incident non-fatal traffic and non-traffic injuries were recorded. Alcohol consumption patterns were categorized as follows: non-drinkers, occasional light drinkers, occasional heavy drinkers, regular drinkers, and ex-drinkers. Logistic regression was used to assess associations in 2005 and 2013 between injuries and alcohol consumption. We adjusted odds ratios (ORs) for socio-demographic factors, stress, health behaviors, and risk-taking behaviors. RESULTS: Incidence estimates in 2013 were standardized to the age structure of 2005: the standardized rates were 10% (95% confidence interval [CI], 9.32-9.89) for participants with at least one non-traffic injury and 5% (95% CI, 4.86-5.29) for those with at least one traffic injury. Both standardized incidences for non-traffic and traffic injuries were significantly lower than corresponding rates in 2005 (20% and 6%, respectively). Alcohol consumption was significantly associated with non-traffic injury in 2005, but the association disappeared in 2013. For example, non-traffic injury was associated with regular drinking (adjusted OR 1.17; 95% CI, 1.01-1.40) in 2005, but not in 2013 (adjusted OR 0.89; 95% CI, 0.73-1.10). In both survey years, traffic injury was not associated with occasional heavy drinking when adjusted for health and risk-taking behavior. CONCLUSIONS: We examined non-fatal injury and the health-risk transition in Thailand in 2005 and 2013. Our data revealed decreases in alcohol consumption and non-fatal injury in the Thai Cohort between 2005 and 2013. Alcohol-related injury in Thailand today could be amenable to preventive intervention. Language: en

BACKGROUND: Due to economic and social development in Thailand, cardiovascular disease (CVD) and cerebrovascular disease (CVA) have been gradually replacing infectious diseases and have become the main threat to health in this country. METHOD: This study used the 2005 baseline data of 42785 members of the Thai cohort study (TCS) to identify health risk factors correlated with incidence of CVD and/or CVA over 8 years (2005- 2013). We applied multivariate logistic regression to investigate associations between demographic and socioeconomic factors, health conditions, and personal lifestyle factors and CVD and/or CVA incidence. RESULTS: The cumulative incidence of CVD and/or CVA in males was more than three times that in females. CVD and/or CVA incidence was correlated with ageing, obesity (AOR: 1.67, 95% CI: 1.16-2.40) and previous diagnosis with diabetes (AOR: 3.09, 95% CI: 1.80-5.30), hyperlipidaemia (AOR: 1.54, 95% CI: 1.08-2.19), hypertension (AOR: 1.71, 95% CI: 1.13-2.59), chronic kidney disease (AOR: 2.35, 95% CI: 1.35-4.10), and depression/anxiety (AOR: 2.76, 95% CI: 1.64-4.63). Short sleep time was positively associated with CVD and/or CVA in the Thai Cohort Study. An inverse association between performing housework and the incidence of CVD and/or CVA was also identified. However, current smoking had a significant positive correlation with the incidence of CVD and/or CVA for participants. CONCLUSION: Older age, obesity, underlying diseases, short sleep time, and current smoking were the risk factors for CVD and/or CVA incidence for the participants. However, housework, as an incidental exercise, could protect people against the risk of CVD and/or CVA.

ObjectiveDietary intake is a leading risk factor for hypertension. We aimed to assess longitudinal associations between overall dietary patterns and incident hypertension among adults in Thailand.DesignProspective large Thai Cohort Study (TCS) conducted nationwide from 2005 to 2013. Dietary patterns were identified using factor analysis based on usual intake of fourteen food groups. Multivariable logistic regression assessed associations between dietary patterns and hypertension prevalence and incidence.SettingEmerging hypertension and changing diets in Thailand.SubjectsTCS participants who were normotensive at baseline in 2005.ResultsAmong 36293 participants without hypertension at baseline, 1831 reported incident hypertension (5·1 % incidence) at follow-up. Two dietary patterns were identified: ‘Modern’ and ‘Prudent’. The Modern dietary pattern (high intakes of roasted/smoked foods, instant foods, canned foods, fermented fruits/vegetables, fermented foods, soft drinks, deep-fried foods) was associated with increased incident hypertension (comparing extreme quartiles, OR for incident hypertension=1·51; 95 % CI 1·31, 1·75 in 2013). The Prudent dietary pattern (high intakes of soyabean products, milk, fruits, vegetables) was not associated with incident hypertension in a fully adjusted model. The association between the Modern dietary pattern and hypertension was attenuated by BMI.ConclusionsModern dietary pattern was positively associated with hypertension among Thai adults. BMI had a great impact on the relationship between the Modern dietary pattern and incidence of hypertension. Reduction of Modern diets would be expected to prevent and control hypertension. Such a strategy would be worth testing.

Highlights • Thai food labels show transition from closed agriculture to global agribusiness • Thai food quality follows investment in food science and technology after WW2 • Thai food labels address transition from hunger to plenty and international rules • It is difficult to harmonize nutrition labels among the countries of SE Asia • Domestic protection versus global food trade creates tension and new rules, This paper reviews the evolution of Thai food and nutrition label policies and Thailand’s international role relating to food product safety and standards. The historical record has been interpreted to identify future trends and challenges related to food labelling. These challenges are arising in Thailand and many similar emerging economies. Thailand has a good reputation in world food markets and is now becoming a global leader in food production and export. It has become deeply involved with regulations and standards applied by World Trade Organization and Codex Alimentarius while serving its own population with a safe and secure food supply. For consumers considering Thai food products, food labels can provide useful nutrition information and help build trust. Thais began a century ago with policies and laws to enhance food safety and to protect Thai consumers. During the lengthy journey from national to global standards Thai food labels have evolved and now contribute to international food labelling policies. This contribution comes from the perspective of a leading middle income south-east Asian food producer now trading with high income countries around the world. The story of that journey – a case study for many other countries in a similar situation – has not previously been told. This article provides information for policy makers dealing with food labelling, embedding trends and tensions for one middle income food exporter in a long history. Information captured here should be helpful for other middle income countries, especially those with limited records. This strategic knowledge will enable better decisions for future policies.

objectives To better inform local management of TB–diabetes collaborative activities, we aimed to determine the prevalence of diabetes among persons with and without TB and to determine the association between TB and diabetes in Kiribati, a Pacific Island nation. methods We compared consecutively enrolled TB cases to a group of randomly selected community controls without evidence of TB. Diabetes was diagnosed by HbA1c, and clinical and demographic data were collected. A tuberculin skin test was administered to controls. The chi-square test was used to assess significance in differences between cases and controls. We also calculated an odds ratio, with 95% confidence intervals, for the odds of diabetes among cases relative to controls. Unweighted multivariate logistic regression was performed to adjust for the effects of age and sex. results A total of 275 TB cases and 499 controls were enrolled. The diabetes prevalence in cases (101, 37%) was significantly greater than in controls (94, 19%) (adjusted odds ratio: 2.8; 95% CI 2.0–4.1). Fifty-five percent (108) of all diabetic diagnoses were new; this proportion was higher among controls (64.8%) than cases (46.5%). Five patients with TB were screened to detect one patient with diabetes. conclusions There is a strong association between TB and diabetes in Kiribati and bidirectional screening should be conducted in this setting.

To determine the association between diabetes and the clinical features and treatment outcomes of TB in Kiribati.We enrolled consecutive patients with TB who presented from August 2010 to February 2012 and compared clinical features and TB treatment outcomes for patients with and without diabetes, as measured by haemoglobin A1c assay. Poor outcome was defined as death, default or treatment failure, and good outcome as treatment success or cure.Two hundred and seventy-five eligible persons with TB disease were enrolled; 101 (37%) had diabetes. TB patients with diabetes were more likely to have acid-fast bacilli (AFB) seen on sputum smear microscopy (RR: 1.3; 95% CI: 1.03-1.62). The risk of poor outcome did not differ between patients with or without diabetes (RR: 1.1; 95% CI: 0.5-2.7).TB patients with diabetes are more likely than those without to have sputum with AFB on microscopy. This could increase transmission in the community. Early detection of TB by screening patients with diabetes, and the converse, could be important public health interventions where diabetes and TB are prevalent.

Copepod Mesocyclops as biological control agents for dengue was previously proven to be effective and sustainable in the Northern and Central provinces of Vietnam. We aim to study social sustainability of Mesocyclops intervention in south Vietnam. Both quantitative and qualitative approaches were used. An entomological survey was carried out in 100 random households of Chanh An commune, Vinh Long Province. Aedes larval indices and Mesocyclops prevalence were compared with historical pre- and post-intervention values. In the same commune, using purposeful sampling, sixteen semi-structured interviews (1 villager leader, 1 local doctor, 10 villagers, 2 teachers, 2 entomology officials), and a focus group discussion (6 Mesocyclops program collaborators) explored water storage habits, beliefs about dengue prevention and behaviour related to Mesocyclops. Thematic analysis was conducted to interpret the qualitative findings. Aedes abundance increased after responsibility for Mesocyclops intervention moved from government to community in 2010, with post-transfer surges in Breteau Index, Container Index, and Larval Density Index. Larval increments coincided with decrease in Mesocyclops prevalence. Villagers had some knowledge of dengue but it was conflated with other mosquito borne diseases and understanding of Mesocyclops was incomplete. Program adoption among the villagers was limited. With reduced government support program collaborators reported limited capacity to conduct population monitoring, and instead targeted 'problem' households. Although the Mesocyclops program was highly sustainable in northern and central provinces of Vietnam, the intervention has not been consistently adopted by southern households in Chanh An commune. Limited education, household monitoring and government support are affecting sustainability. Findings were based on a small household sample visited over a short time period, so other evaluations are needed. However, our results suggest that government support for the Mesocyclops program is still required in this part of Vietnam.

Background Body mass index (BMI) cut-off values (>25 and >30) that predict diabetes risk have been well validated in Caucasian populations but less so in Asian populations. We aimed to determine the BMI threshold associated with increased type 2 diabetes (T2DM) risk and to calculate the proportion of T2DM cases attributable to overweight and obesity in the Thai population. Methods Participants were those from the Thai Cohort Study who were diabetes-free in 2005 and were followed-up in 2009 and 2013 (n = 39,021). We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the BMI-T2DM association. We modelled non-linear associations using restricted cubic splines. We estimated population attributable fractions (PAF) and the number of T2DM incident cases attributed to overweight and obesity. We also calculated the impact of reducing the prevalence of overweight and obesity on T2DM incidence in the Thai population. Results Non-linear modelling indicated that the points of inflection where the BMI-T2DM association became statistically significant compared to a reference of 20.00 kg/m2 were 21.60 (OR = 1.27, 95% CI 1.00–1.61) and 20.03 (OR = 1.02, 95% CI 1.02–1.03) for men and women, respectively. Approximately two-thirds of T2DM cases in Thai adults could be attributed to overweight and obesity. Annually, if prevalent obesity was 5% lower, ~13,000 cases of T2DM might be prevented in the Thai population. Conclusions A BMI cut-point of 22 kg/m2, one point lower than the current 23 kg/m2, would be justified for defining T2DM risk in Thai adults. Lowering obesity prevalence would greatly reduce T2DM incidence. Electronic supplementary material The online version of this article (10.1186/s12889-017-4708-7) contains supplementary material, which is available to authorized users.

We studied a community cohort of 193 individuals exposed to endemic Schistosoma japonicum infection in the Dongting Lake region of China to assess subclinical morbidity and the 2-year benefit of curative therapy (praziquantel) administered in 1996. Prevalence and intensity of S. japonicum infection before treatment were 28% and 192 eggs per gram faeces (epg), respectively. Two years after cure, 22% of the cohort were reinfected, but with a lighter intensity (67 epg). Sixty-four subjects (37%) showed significant improvement in ultrasound parenchyma images after treatment and 51 subjects (54%) showed significant improvement of periportal fibrosis. Left-lobe enlargement also reversed (P < 0·05) and splenomegaly reversed in 6 of 8 cases and developed in only 1. Two years post-treatment a dilated portal vein became less frequent, but the decline was not significant (16% vs 11 %, P > 0·05). The serum levels of laminin and collagen IV associated with reinfection and intensity and hyaluronic acid levels correlated with ultrasound findings (P < 0·01). Overall, treatment induced a marked decrease in subclinical hepatosplenic morbidity attributable to S. japonicum although low-intensity re-infection after treatment remained relatively frequent. Stratified analysis and logistic models evaluated potential confounding factors for assessment of treatment effects on hepatic fibrosis. S. japonicum infection and moderate-heavy alcohol intake interacted: improvement in parenchymal morbidity was impeded among drinkers (P < 0·05). Chemotherapy focused on at-risk residents controls prevalent subclinical hepatic fibrosis but re-infection indicates the need for complementary control strategies

Background Low back pain (LBP) is a major cause of disability throughout the world. However, longitudinal evidence to relate low back pain and functional limitations is mostly confined to Western countries. In this study, we investigate the associations between low back pain and functional limitations in a prospective cohort of Thai adults. Methods We analysed information from the Thai Cohort Study of adult Open University adults which included 42,785 participants in both 2009 and 2013, with the majority aged 30 to 65 years and residing nationwide. We used multivariate logistic regression to explore the longitudinal associations between LBP in 2009 and 2013 (‘never’: no LBP in 2009 or 2013; ‘reverting’: LBP in 2009 but not in 2013; ‘incident’: no LBP in 2009 but LBP in 2013; and ‘chronic’: reporting LBP at both time points) and the outcome of functional limitations relating to Activities of Daily Living (ADL) in 2013. Results Low back pain was common with 30% of cohort members reporting low back pain in both 2009 and 2013 (‘chronic LBP’). The ‘chronic LBP’ group was more likely than the ‘never’ back pain group to report functional limitations in 2013: adjusted odds ratios 1.60 [95% Confidence Interval: 1.38–1.85] for difficulties getting dressed; 1.98 [1.71–2.30] for walking; 2.02 [1.71–2.39] for climbing stairs; and 3.80 [3.38–4.27] for bending/kneeling. Those with ‘incident LBP’ or ‘reverting LBP’ both had increased odds of functional limitations in 2013 but the odds were not generally as high. Conclusions Our nationwide data from Thailand suggests that LBP is a frequent public health problem among economically productive age groups with adverse effects on the activities of daily living. This study adds to the limited longitudinal evidence on the substantial impact of low back pain in Southeast Asia. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1380-5) contains supplementary material, which is available to authorized users.

Background: The global prevalence of type 2 diabetes mellitus (T2DM) is high and is increasing in countries undergoing rapid socio-economic development, including Thailand. Sugar-sweetened beverage (SSB) intake may contribute to the risk of developing T2DM. However, few studies have assessed this association in Asian populations, and the results have been inconsistent. We aimed to assess that association in a prospective study of Thai adults. Methods: Data were from Thai Cohort Study participants surveyed in 2005, 2009 and 2013. The nation-wide sample included adult cohort members who were free of diabetes in 2005 and who were followed-up in 2013 (n=39 175). We used multivariable logistic regression to assess associations between SSB intake and eight-year T2DM incidence. We used a counterfactual mediation analysis to explore potential mediation of the SSB intake and T2DM-risk relationship. Results: In women (but not men) consuming SSBs once or more per day (versus rarely) was associated with increased T2DM incidence at the 8-year follow-up (odds ratio (OR)=2.4, 95% confidence interval (CI) 1.5–3.9). Obesity in 2009 was found to mediate ~23% of the total association between SSB intake in 2005 and T2DM risk in 2013 (natural indirect effect 1.15, 95% CI (1.02, 1.31). Conclusions: Frequent SSB consumption associated with higher T2DM incidence in women but not men. We found that a moderate proportion of the SSB-T2DM relationship was mediated through body mass index (BMI). Our findings suggest that targeting SSB consumption can help prevent a national rise in the incidence of T2DM.

Purpose– The purpose of this paper is to investigate whether the food retail transition underway in Thailand, a transitional middle-income setting, is associated with increased consumption of processed foods high in fat, salt and energy. Such “problem foods” are important risks for avoidable cardio-vascular disease and diabetes burdens.Design/methodology/approach– The source population were members of the nationwide Thai Cohort Study (TCS) followed since 2005 (n=87,151) for a study of the health-risk transition. For this report we used a multi-region sub-sample (n=1,516) of TCS members responding to an additional questionnaire about food environments, shopping patterns and food consumption. By using a TCS sub-sample we gained access to four years (2005-2009) of longitudinal observations on a wide array of variables related to health and wellbeing from an informative group.Findings– Overall 85 per cent of the sample now have access to supermarkets; ten years ago the figure was 47 per cent, and when aged ten years, 5 per cent. Now half the participants regularly visit supermarkets and convenience stores, especially urban dwellers with higher incomes. Frequent shopping at supermarkets and convenience stores associated with consumption of six “problem foods” (soft drinks, snack foods, processed meats, western style bakery items, instant foods and deep fried foods). Frequent fresh market shopping was associated with increased vegetable intake. There was no association between food shopping and body mass index , diabetes or hypertension but supermarket shopping was related to hyperlipidaemia.Research limitations/implications– Modernization of food retailing is changing Thai diets and creating diet-related health risks.Originality/value– The paper addresses a knowledge gap on links between modernizing food retail in Asia and consumption of unhealthy foods, revealing strong linkage in transitional Thailand.

OBJECTIVE: Thailand is experiencing a substantial reduction in overall mortality, an ageing society and increasing prevalence of non-communicable diseases. There is an urgent need to understand locally important risk factors for this new disease burden and their distribution. We investigated risk factors for mortality in a large cohort of Thai adults and report on key trends. PARTICIPANTS: A nationwide cohort of 87,151 Thai adults followed up since 2005 with their data records linked to the Thai civil registration system to monitor mortality up to the end of 2016. METHODS: We used logistic regression models to measure associations between a large range of socio-demographic, health behaviour and health status variables and all-cause mortality. RESULTS: 1402 cohort members died between 2005 and 2016. In fully-adjusted models higher income, female sex, and higher education had the strongest protective effects against mortality. Normal body weight also protected (AOR 0.71 [0.52-0.96] with Obese as reference). Heavy smoking (AOR 1.48 [1.29-1.70]), and regular alcohol consumption (AOR 1.37 [1.12-1.68]) were associated with the highest mortality. Experiencing injury in the year proceeding the baseline survey also associated with increased mortality, while urbanising since childhood had a protective effect. CONCLUSION: This study adds to evidence regarding risks for all-cause mortality in Thailand. Results indicate the need for Thailand to maintain successful tobacco control programs and to address the effects of increased alcohol consumption. The protective effect of higher education is particularly important in Thailand given the growing proportion of the population who are finishing high school and moving to higher education.

OBJECTIVE: As Thailand modernizes an ensuing health risk transition associates with rising chronic non-communicable diseases, especially hypertension. This is a driving force for emerging vascular disease, especially stroke and hypertension. Studies in other countries have shown hypertension is associated with obesity. Longitudinal information is needed forthailand and here we present our cohort data collected over 8 years And recording incidence of hypertension and exposure to elevated abnormal BMI. DESIGN & METHODS: BMI effects on incident hypertension were investigated prospectively in a nationwide Thai Cohort Study (TCS) from 2005 to 2013. Data were derived from 42 785 off-campus Sukhothai Thammathirat Open University students returning mail-based questionnaire surveys in both 2005 and 2013. Participants analysed were normotensive at the start (40 548). Multivariable regression estimated adjusted relative risks estimate linking obesity (measured by BMI) and hypertension (self-reported) among Thai men and women. RESULTS: In Thailand from 2005 to 2013 the TCS 8-Year Incidence of hypertension was 5.1% (men 7.1%, women 3.6%), which meant 1958 participants developed hypertension. BMI was directly associated with an increased risk of hypertension. Compared to participants with a normal BMI (18.5-22.9 Kg/M2), The relative risks (95% confidence interval) of developing hypertension with a BMI of ≤ 18.5.23.0–24.9, 25-29.9 and >30 Kg/m2 were 0.54 (0.3-0.97), 1.8(1.49-2.18), 3.27 (2.73-3.91) and 6.73 (5.1-8.97) for men and 0.65 (0.45-0.95), 2.28 (1.81-2.88), 3.71 (2.96-4.64) and 9.72 (7.09-13.32) for women respectively (p-trend

This paper investigates associations between hazardous jobs, mental health and wellbeing among Thai adults. In 2005, 87 134 distance-learning students from Sukhothai Thammathirat Open University completed a self-administered questionnaire; at the 2009 follow-up 60 569 again participated. Job characteristics were reported in 2005, psychological distress and life satisfaction were reported in both 2005 and 2009. We derived two composite variables grading psychologically and physically hazardous jobs and reported adjusted odds ratios (AOR) from multivariate logistic regressions. Analyses focused on cohort members in paid work: the total was 62 332 at 2005 baseline and 41 671 at 2009 follow-up. Cross-sectional AORs linking psychologically hazardous jobs to psychological distress ranged from 1.52 (one hazard) to 4.48 (four hazards) for males and a corresponding 1.34–3.76 for females. Similarly AORs for physically hazardous jobs were 1.75 (one hazard) to 2.76 (four or more hazards) for males and 1.70–3.19 for females. A similar magnitude of associations was found between psychologically adverse jobs and low life satisfaction (AORs of 1.34–4.34 among males and 1.18–3.63 among females). Longitudinal analyses confirm these cross-sectional relationships. Thus, significant dose–response associations were found linking hazardous job exposures in 2005 to mental health and wellbeing in 2009. The health impacts of psychologically and physically hazardous jobs in developed, Western countries are equally evident in transitioning Southeast Asian countries such as Thailand. Regulation and monitoring of work conditions will become increasingly important to the health and wellbeing of the Thai workforce.

Background: We investigated risk factors for fracture among young adults, particularly body mass index (BMI) and physical activity, which although associated with fracture in older populations have rarely been investigated in younger people. Methods: In 2009, 4 years after initial recruitment, 58 204 Thais aged 19 to 49 years were asked to self-report fractures incident in the preceding 4 years. Conditional logistic regression was used to calculate odds ratios (ORs) and 95% CIs for associations of fracture incidence with baseline BMI and physical activity. Results: Very obese women had a 70% increase in fracture risk (OR = 1.73, 95% CI 1.21-2.46) as compared with women with a normal BMI. Fracture risk increased by 15% with every 5-kg/m2increase in BMI. The effects were strongest for fractures of the lower limbs. Frequent purposeful physical activity was also associated with increased fracture risk among women (OR = 1.52, 95% CI 1.12-2.06 for 15 episodes/week vs none). Neither BMI nor physical activity was associated with fracture among men, although fracture risk decreased by 4% with every additional 2 hours of average sitting time per day (OR = 0.96, 95% CI 0.93-0.99). Conclusions: The increase in obesity prevalence will likely increase fracture burden among young women but not young men. While active lifestyles have health benefits, our results highlight the importance of promoting injury prevention practices in conjunction with physical activity recommendations, particularly among women.

Global warming will increase heat stress at home and at work. Few studies have addressed the health consequences in tropical low and middle income settings such as Thailand. We report on the association between heat stress and workplace injury among workers enrolled in the large national Thai Cohort Study in 2005 (N=58,495). We used logistic regression to relate heat stress and occupational injury separately for males and females, adjusting for covariate effects of age, income, education, alcohol, smoking, Body Mass Index, job location, job type, sleeping hours, existing illness, and having to work very fast. Nearly 20% of workers experienced occupational heat stress which strongly and significantly associated with occupational injury (adjusted OR 2.12, 95%CI 1.87-2.42 for males and 1.89, 95%CI 1.64-2.18 for females). This study provides evidence connecting heat stress and occupational injury in tropical Thailand and also identifies several factors that increase heat exposure. The findings will be useful for policy makers to consider work-related heat stress problems in tropical Thailand and to develop an occupational health and safety program which is urgently needed given the looming threat of global warming.