Suthee Panichkul

Diagnostic performance of quantitative ultrasound calcaneus measurement in case finding for osteoporosis in Thai postmenopausal women

Aim:  Dual‐energy X‐ray absorptiometry (DXA) is currently considered the gold standard for the diagnosis of osteoporosis. Quantitative ultrasound (QUS) can be an alternative method that is less expensive, portable, and can be used at a primary care level to indicate osteoporosis in women. The present study aimed to assess the diagnostic performance of QUS calcaneus measurement in a case finding for osteoporosis in Thai postmenopausal women using DXA as a gold standard.

Systematic Review of Physical Fitness Testing to Evaluate the Physical Combat Readiness of Royal Thai Armed Forces

Physical combat readiness of military personnel ensures maximal effectiveness of combat forces during wartime. Combat readiness has always been linked to the Army Physical Fitness Test (APFT). Each raw score is converted to a standard score and corrected for age and gender. There is no standard measurement to evaluate combat readiness in the Royal Thai Army. To determine standardized criteria for physical combat readiness of Royal Thai Army personnel through systematic review, the APFT was used to determine fitness levels and to promote health. To pass the test, each soldier in each unit must attain a minimal standard score for each individual subtest. At present, each unit in the armed forces derives its own standard, based on different missions. The APFT might be an acceptable method to measure physical combat readiness. However, no studies have established the general measurements to evaluate combat readiness.

Cost-Effectiveness Analysis of Various Screening Methods for Osteoporosis in Perimenopausal Thai Women

Objective: To perform a health economics analysis of 5 screening programs for osteoporosis in perimenopausal Thai women comparing two alternatives; without intervention and universal treatment without screening. Design: A decision analysis was performed to evaluate five screening strategies: Dual energy X-ray absorptiometry (DXA), Quantitative ultrasound sonography (QUS), risk index (clinical risk factors), two-step screening with QUS followed by DXA, and screening with risk index followed by DXA, comparing outcomes without intervention and universal treatment without screening. Results: The costs for universal treatment, screening by DXA with treatment, screening by QUS with treatment, screening by Risk index with treatment, screening by QUS and DXA with treatment, and screening by Risk index and DXA with treatment strategies to prevent one fracture were 207.82, 88.42, 147.05, 127.67, 71.33, and 60.30 USD, respectively. The cost for no intervention to prevent one fracture is 8.49 USD (1 USD = 40 Thai baht). Conclusion: At present, no intervention is the most cost effective strategy. However, screening with risk index and DXA with treatment became the most cost effective when the patients reached the postmenopausal period and had a high risk index, for which the prevalence of osteoporosis will increase. Cost effective screening guidelines still cannot be explicitly established until further data addressing the association between bone mass measurements in the hip and hip fracture risk, are available.

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