Wichuda Jiraporncharoen

Urbanization and non-communicable disease in Southeast Asia: a review of current evidence

OBJECTIVE Non-communicable diseases (NCDs) have been highlighted as a major public health issue in the Southeast (SE) Asian region. One of the major socio-environmental factors that are considered to be associated with such a rise in NCDs is urbanization. Urbanization is associated with behavioural changes such as eating an unhealthy diet, and a decrease in physical activities, which may result in associated obesity. The SE Asian region also has a substantive burden of infectious disease such as HIV and malaria, which may modify associations between urbanization and development of NCDs. STUDY DESIGN A systematic review was conducted until April 2013. METHODS Using four databases: EMBASE, PubMed, GlobalHealth and DigitalJournal, the systematic review pools existing evidence on urban-rural gradients in NCD prevalence/incidence. RESULTS The study found that in SE Asia, urban exposure was positively associated with coronary heart disease, diabetes and respiratory diseases in children. Urban exposure was negatively associated with rheumatic heart diseases. The stages of economic development may also modify the association between urbanization and NCDs such as diabetes. CONCLUSION There was pronounced heterogeneity between associations. It is recommended that future studies examine the major constituents of NCDs separately and also focus on the interplay between lifestyle and infectious risk factors for NCDs. Prospective studies are needed to understand the diverse causal pathways between urbanization and NCDs in SE Asia.

Urban Environments and Obesity in Southeast Asia: A Systematic Review, Meta-Analysis and Meta-Regression

Many environmental factors contribute to the rise in prevalence of obesity in populations but one key driver is urbanization. Countries in Southeast (SE) Asia have undergone rapid changes in urbanization in recent decades. The aim of this study is to provide a systematic review of studies exploring the relationship between living in an urban or rural environment (urbanicity) and obesity in Southeast Asia. In particular, the review will investigate whether the associations are uniform across countries and ages, and by sex. The literature search was conducted up to June 2014 using five databases: EMBASE, PubMed, GlobalHealth, DigitalJournal and Open Grey. Forty-five articles representing eight of the eleven countries in SE Asia were included in the review. The review found a consistent positive association between urbanicity and obesity in countries of Southeast Asia, in all age groups and both genders. Regional differences between the associations are partly explained by gross national income (GNI). In countries with lower GNI per capita, the association between urbanicity and obesity was greater. Such findings have implications for policy makers. They imply that population level interventions need to be country or region specific, tailored to suit the current stage of economic development. In addition, less developed countries might be more vulnerable to the negative health impact of urbanization than more developed countries.

Learning styles and academic achievement among undergraduate medical students in Thailand

Purpose: This study aimed to explore the associations between learning styles and high academic achievement and to ascertain whether the factors associated with high academic achievement differed between preclinical and clinical students. Methods: A survey was conducted among undergraduate medical students in Chiang Mai University, Thailand. The Index of Learning Styles questionnaire was used to assess each student’s learning style across four domains. High academic achievement was defined as a grade point average of at least 3.0. Results: Of the 1,248 eligible medical students, 1,014 (81.3%) participated. Learning styles differed between the preclinical and clinical students in the active/reflective domain. A sequential learning style was associated with high academic achievement in both preclinical and clinical students. A reflective learning style was only associated with high academic achievement among preclinical students. Conclusion: The association between learning styles and academic achievement may have differed between preclinical and clinical students due to different learning content and teaching methods. Students should be encouraged to be flexible in their own learning styles in order to engage successfully with various and changing teaching methods across the curriculum. Instructors should be also encouraged to provide a variety of teaching materials and resources to suit different learning styles.

Chiang Mai University Health Worker Study aiming toward a better understanding of noncommunicable disease development in Thailand: methods and description of study population

Background Urbanization is considered to be one of the key drivers of noncommunicable diseases (NCDs) in Thailand and other developing countries. These influences, in turn, may affect an individual’s behavior and risk of developing NCDs. The Chiang Mai University (CMU) Health Worker Study aims to provide evidence for a better understanding of the development of NCDs and ultimately to apply the evidence toward better prevention, risk modification, and improvement of clinical care for patients with NCDs and NCD-related conditions. Methods A cross-sectional survey of health care workers from CMU Hospital was conducted between January 2013 and June 2013. Questionnaires, interviews, and physical and laboratory examinations were used to assess urban exposure, occupational shift work, risk factors for NCDs, self-reported NCDs, and other NCD-related health conditions. Results From 5,364 eligible workers, 3,204 participated (59.7%). About 11.1% of the participants had high blood pressure (systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg) and almost 30% were considered to be obese (body mass index ≥25 kg/m2). A total of 2.3% had a high fasting blood glucose level (≥126 mg/dL), and the most common abnormal lipid profile was high low-density lipoprotein (≥160 mg/dL), which was found in 19.2% of participants. Discussion The study of health workers offers three potential advantages. The first is that the study of migrants was possible. Socioenvironmental influence on NCD risk factors can be explored, as changes in environmental exposures can be documented. Second, it allows the investigators to control for access to care. Access to care is potentially a key confounder toward understanding the development of NCDs. Lastly, a study of health personnel allows easy access to laboratory investigations and potential for long-term follow-up. This enables ascertainment of a number of clinical outcomes and provides potential for future studies focusing on therapeutic and prognostic issues related to NCDs.

Predictors of quality of life of medical students and a comparison with quality of life of adult health care workers in Thailand

IntroductionThere have been few studies which have compared the quality of life between medical students and adult health care workers.Aims(1) To compare health related quality of life (HRQoL) between medical students and adult health care workers and (2) to identify factors associated with quality of life of medical students.MethodsA cross sectional survey of medical students at Chiang Mai University and health care workers at Chiang Mai University Hospital in 2013.ResultsCompared with the population of adult health care workers, medical students had a higher physical HRQoL but similar mental HRQoL. This is potentially mediated by the presence of depression, as the prevalence of depressive symptoms was similar in both groups. Higher academic achievement and absence of underlying biomedical conditions were associated with higher HRQoL in medical students.ConclusionThe psychological burden for medical students in Thailand could be at similar levels to that of their adult health care counterparts.

Active commuting and cardiovascular risk among health care workers

BACKGROUND Although the benefit of physical activity on cardiovascular health has been well demonstrated, being physically active can be difficult for health care workers. Active commuting such as walking or cycling may be a good way to promote physical activity. AIMS To investigate the relationship between active commuting and cardiovascular disease risk factors in health care workers. METHODS A cross-sectional study of health care workers conducted in Chiang Mai University Hospital, Thailand. Information on demographics and lifestyle, including active commuting, was obtained from questionnaires. Results were analysed with multiple logistic regression, adjusting for other physical activity and possible confounders. RESULTS Among 3204 participants, fewer than half engaged in active commuting. After adjustment for poss ible confounders, low active commuting was associated with increased risk of hypertension [adjusted odds ratio (aOR) 1.3, 95% confidence interval (CI) 1.1-1.7]. High active commuting was associated with central obesity (aOR 1.4, 95% CI 1.0-1.8). Compared with non-active commuters, younger active commuters (aged under 40) had reduced prevalence of hypertension (aOR 0.4, 95% CI 0.2-1.0), while older active commuters (aged 40 or over) demonstrated increased hypertension (aOR 1.6, 95% CI 1.1-2.3) and central obesity (aOR 1.5, 95% CI 1.1-2.1). CONCLUSIONS We found conflicting evidence on the relationship between active commuting and cardiovascular risk factors. Reverse causation may explain the association between active commuting and hypertension and central obesity and should be investigated further.

Sedative and Analgesic Drugs Online: A Content Analysis of the Supply and Demand Information Available in Thailand

ABSTRACT Background: Evidence from other countries has suggested that many controlled drugs are also offered online, even though it is illegal to sell these drugs without a license. Objectives: To evaluate the current contents related to the supply and demand of sedatives and analgesic drugs available online in Thailand, with a particular focus on Facebook. Methods: A team of reviewers manually searched for data by entering keywords related to analgesic drugs and sedatives. The contents of the website were screened for supply and demand-related information. Findings: A total of 5,352 websites were found publicly available. The number of websites and Facebook pages containing the information potentially related to the supply and demand of analgesic drugs and sedatives was limited. Nine websites sold sedatives, and six websites sold analgesics directly. Fourteen Facebook pages were found, including 7 sedative pages and 7 analgesic pages. Within one year, the three remaining active pages multiplied in the number of followers by three- to nine-fold. The most popular Facebook page had over 2,900 followers. Conclusions: Both the internet and social media contain sites and pages where sedatives and analgesics are illegally advertised. These websites are searchable through common search engines. Although the number of websites is limited, the number of followers on these Facebook pages does suggest a growing number of people who are interested in such pages. Our study emphasized the importance of monitoring and developing potential plans relative to the online marketing of prescription drugs in Thailand.

Polydrug use among kratom users: Findings from the 2011 Thailand National Household Survey

ABSTRACT Despite the availability of numerous anecdotal reports of polydrug use in kratom users, few studies have been carried out in Thailand. This study aimed to explore the problem of polydrug use among Thai kratom users. A national household survey on the prevalence of substance use was conducted in 2011 using a multistage random sampling technique. Participants were interviewed using a structured questionnaire. The frequency of other substance use was compared between respondents with and without a history of kratom use. Of the total sample (18,457), 544 (2.9%) acknowledged kratom use. Eighty-nine (46.1%) used it almost every day. The mean age of users (SD) was 42.7 (12.8) years old, 459 (84.4%) were male, and 264 (48.5%) had used other illicit drugs in the past. Kratom users were significantly more likely to use heroin, ecstasy, and ice with adjusted odds ratios of 39.7, 30.5, and 29.1, respectively. Of 195 who acknowledged kratom use in the past 12 months, 22 (11.3%) concurrently used other illicit drugs, including cannabis, amphetamine-type stimulants (ATSs), and inhalants. Polydrug use is common in Thai kratom users who are more likely to use opiates and ATSs in their lifetime. Another drug concurrently used was cannabis. Health personnel need to be aware of polydrug use in this population.

Sedative use: its association with harmful alcohol use, harmful tobacco use and quality of life among health care workers in Thailand

Abstract Background: Health care workers (HCWs) may be at higher risk for sedative misuse due to potential access and self-medication behavior. Objectives: To examine risk factors for harmful sedative use (HSedU) and its association with harmful alcohol use (HAlcU), harmful tobacco use (HTobU) and quality of life (QoL). Methods: A survey was conducted in 2013 at an urban university hospital in Northern Thailand. Risk of harm was measured using The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Harmful substance use defined as having at least moderate risk of harm. QoL was measured using SF-36 questionnaire. Results: A sample of 3204 HCWs (59.7% response) participated. The prevalence of HSedU in past 3 months was 4.2%. Health professionals involved with prescribing or dispensing medication were at higher risk of HSedU (OR 1.80, 95% CI 1.21–2.67). Adjusting for confounders, HSedU was associated with HAlcU (OR 3.35, 95% CI 1.81–6.20) but not associated with HTobU. HSedU was associated with lower QoL score which was 7.78 and 5.52 points lower for physical (95% CI −10.4 to −5.18) and mental QoL (95% CI −7.11 to −3.93), respectively. Conclusions: HCWs were at higher risk of HSedU. HSedU was associated with HAlcU and associated with lower physical and mental health QoL.

Recent Trends in Alcohol Outlet Density, Distances from Educational Institutions and Sales Campaigns in Chiang Mai Municipality (Metropolitan), Thailand: Should We Be Worried for Our Youths?

AIMS Since 2008, alcohol control policies in Thailand have been considered quite comprehensive. The study aimed to investigate the subsequent changes in alcohol outlet density and patterns of sales promotion, which may be useful for monitoring the effectiveness of policies and helpful for planning prevention strategies to reduce alcohol-related harms. METHODS All accessible routes in the Chiang Mai Municipality (Metropolitan: CMM) were surveyed in 2009, 2011 and 2014. During each round of survey, the geographical coordinates of alcohol outlets and educational institutions in the CMM were recorded using the Global Navigation Satellite System (GNSS). In addition, alcohol sales campaigns were documented. RESULTS Three main trends emerged by 2014. The first was that alcohol outlet density had increased. Second, the average distances between alcohol outlets and educational institutions decreased with evidence of clustering near educational institutions. Lastly, increased advertising of alcohol promotions and new sales campaigns not previously seen in 2009 and 2011 promoted high volume drinking in Chiang Mai Municipality (CMM). CONCLUSION Our study reflects the potential gaps between some of the intended consequences of alcohol control policies and the actural trends emerging in Chiang Mai, Thailand. Young people in CMM may be at a particularly high risk for alcohol-related problems due to high exposure to alcohol outlets and sales campaigns near their educational institution.