Health expectancies in the older Thai population

This study aims to investigate health expectancies in five domains: cognitive health, psychological health, physical health, functional ability and self-perceived global health (SPGH) in the older Thai population. There are few studies reporting health expectancies in multidimensional health domains, most of which reported only one health dimension. The dataset used was from the Bangkok Longitudinal Study by Siriraj Hospital for the Older Men and Women (BLOSSOM), which is a community cohort study in Bangkok, Thailand. This analysis is based on the cross-sectional data in the year 2005-2006 and includes 5936 participants aged 50 years and over from community settings within six suburban areas in Bangkok. The study found that women had a longer total life expectancy (LE), but had shorter cognitive impairment-free (CIFLE), physical illness-free (PHILE) and disability-free (DIFLE) LEs, than men. However, there was no difference between the life expectancies for living with good SPGH in men and in women. Differences in health expectations might explain this finding. Health promotion and disease prevention should be initiated at a younger age and should target all health domains.     

Studies on the Specific Degranulation of Mast Cell Sensitized by Several Allergens in vitro

Food allergy is a major health issue worldwide. Mast cells play a very important role in the immediate hypersensitivity for which mast cell degranulation needs to be studied extensively. In this study, an approach was taken to study the characteristics of sensitized mast cell degranulation in vitro, which associated with the study of mast cells and animal models. BALB/c mice were immunized respectively by several food allergens, then blood and peritoneal mast cells were collected at different time points. A dynamic determination was carried out between mast cells and serumal IgE. Comparative analysis on sequential time points showed that there was a close coincidence between mast cell degranulation and IgE antibody titers in sensitized BALB/c mice. Furthermore, it is interesting that sensitized mast cells could implement specific degranulation against the challenges in vitro, but the closely tropomyosins induced mast cell degranulation displayed cross reactions. This is very similar to IgE resisting the allergens in vivo. The study disclosed some characteristics on mast cells, coming from sensitized BALB/c mice, degranulation in vitro.     

Health workforce contributions to health system development: a platform for universal health coverage

Problem

In the 1970s, Thailand was a low-income country with poor health indicators and low health service coverage. The local health infrastructure was especially weak.

Approach

In the 1980s, measures were initiated to reduce geographical barriers to health service access, improve the health infrastructure at the district level, make essential medicines more widely available and develop a competent, committed health workforce willing to service rural areas. To ensure service accessibility, financial risk protection schemes were expanded.

Local setting

In Thailand, district hospitals were practically non-existent in the 1960s. Expansion of primary health care (PHC), especially in poor rural areas, was considered essential for attaining universal health coverage (UHC). Nationwide reforms led to important changes in a few decades.

Relevant changes

Over the past 30 years, the availability and distribution of health workers, as well as their skills and competencies, have greatly improved, along with national health indicators. Between 1980 and 2000 coverage with maternal and child health services increased substantially. By 2002, Thailand had attained UHC. Overall health system development, particularly an expanded health workforce, resulted in a functioning PHC system.

Lessons learnt

A competent, committed health workforce helped strengthen the PHC system at the district level. Keeping the policy focus on the development of human resources for health (HRH) for an extended period was essential, together with a holistic approach to the development of HRH, characterized by the integration of different kinds of HRH interventions and the linking of these interventions with broader efforts to strengthen other health system domains.     

The association between body mass index and Barrett's esophagus: a systematic review

Biological plausibility and evidence from case series indicate that an increased body mass index could be a risk factor for Barrett's esophagus. The aim of this study was to assemble and appraise the available evidence on the association of body mass index and Barrett's esophagus in a narrative approach. A systematic literature review identified a nested case-control study and 10 case-control studies, with sample sizes of between 129 and 953. Overall, cases were on average older than controls, more often male and white, but did not differ with regards to body mass index. An increased body mass index (≥30 and ≥35 kg/m²) was associated with greater risk of Barrett's esophagus in four studies (odds ratio range: 2.0−4.0). These studies, however, did not adjust for symptoms suggestive of gastroesophageal reflux disease. No significant association was reported in the other six studies. To conclude, the existing evidence on the association between body mass index and risk of Barrett's esophagus relates primarily to case-control studies and is inconsistent. Gastroesophageal reflux symptoms can be a potential confounder and further research should better address this issue. Evidence from cohort studies may help shed further light on this putative association, which is of relevance to public health and cancer control.     

Dlx5, a positive regulator of osteoblastogenesis, is essential for osteoblast-osteoclast coupling

The homeodomain protein Dlx5 is an activator of Runx2 (a key regulator of osteogenesis) and is thought to be an important regulator of bone formation. At present, however, the perinatal lethality of Dlx5-null mice has hampered the elucidation of its function in osteogenesis. Here we provide the first analysis of the effects of Dlx5 inactivation on bone development. Femurs of Dlx5-null mouse embryos at the end of gestation exhibit a reduction in both total and trabecular bone volume associated with increased trabecular separation and reduced trabecular number. These parameters are often associated with pathological conditions characterized by reduced osteoblast activity and increased bone resorption. Dlx5^−/− osteoblasts in culture display reduced proliferation and differentiation rate and reduction of Runx2, Osx, Osteocalcin and Bone Sialoprotein expression. In addition to impaired osteoblast function, Dlx5^−/− femurs exhibit significant increases in osteoclast number. As Dlx5 is not expressed by osteoclasts, we suggest that its osteoblastic expression might control osteoblast/osteoclast coupling. Cultured Dlx5^−/− osteoblasts displayed a higher RANKL/OPG ratio. Furthermore, Dlx5^−/− osteoblasts induced a higher number of TRAP-positive multinucleated cells in normal spleen cultures with a globally increased resorption activity. These findings suggest that Dlx5 is a central regulator of bone turnover as it activates bone formation directly and bone resorption indirectly.     

Clinical profiles of multiple myeloma in Asia—An Asian Myeloma Network study

The incidence of multiple myeloma (MM) is known to be variable according to ethnicity. However, the differences in clinical characteristics between ethnic groups are not well‐defined. In Asian countries, although the incidence of MM has been lower than that of Western countries, there is growing evidence that MM is increasing rapidly. The Asian Myeloma Network decided to initiate the first multinational project to describe the clinical characteristics of MM and the clinical practices in Asia. Data were retrospectively collected from 23 centers in 7 countries and regions. The clinical characteristics at diagnosis, survival rates and initial treatment of 3,405 symptomatic MM patients were described. Median age was 62 years (range, 19–106), with 55.6% of being male. Median overall survival (OS) was 47 months (95% CI 44.0–50.0). Stem cell transplantation was performed in 666 patients who showed better survival rates (79 vs. 41 months, P < 0.001). The first‐line treatments of 2,970 patients were analyzed. The overall response rate was 71% including very good partial response or better in 31% of the 2,660 patients those were able to be evaluated. New drugs including bortezomib, thalidomide, and lenalidomide were used in 36% of 2,970 patients and affected OS when used as a first‐line treatment. Am. J. Hematol. 89:751–756, 2014. © 2014 Wiley Periodicals, Inc.