The ideal implant for the treatment of an unstable intertrochanteric femoral fracture is still a matter of discussion. The aim of this systematic review is to conduct a network meta-analysis of randomized controlled trials (RCTs) comparing clinical outcomes between dynamic hip screws (DHS), Medoff sliding plating, percutaneous compression plating (PCCP), proximal femoral nails (PFN), Gamma nails and less invasive stabilization system fixation in femoral trochanteric fractures in the elderly. These clinical outcomes consist of total intra-operative time, intra-operative fluoroscopy time, intra-operative blood loss, blood component transfusion, length of hospital stay, postoperative general complications, wound complications, late complications and reoperation rates. This systematic review was conducted using PubMed and Scopus search engines for RCTs comparing clinical outcomes between treatments from inception to February 22, 2015. Thirty-six of 785 studies identified were eligible. Compared to the other implants, PCCP showed the lowest total operative time and units of blood transfusion with an unstandardized mean difference (UMD) of 29.27 min (95% CI 5.24, 53.50) and 0.89 units (95% CI 0.52, 1.25). The lowest incidence of general complications, wound complications and late complications of PCCP was 0.09 (95% CI 0.04, 0.18), 0.01 (95% CI 0.01, 0.04) and 0.05 (95% CI 0.02, 0.11), respectively, when compared to others. The lowest fluoroscopic time was with DHS with an UMD of 0.24 min (95% CI 0.16, 0.32), whereas the lowest blood loss and shortest hospital stay were with PFN with an UMD of 233.61 ml of blood loss (95% CI 153.17, 314.04) and 7.23 days of hospital stay (95% CI 7.15, 7.31) when compared to all other fixation methods. Reoperation rates of all implants had no statistically significant difference. The network meta-analysis suggested that fixation with PCCP significantly shortens operative time and decreases the units of blood transfusion required, while also lowering risks of general complications, wound complications and late complications when compared to fixation. Use of PFN showed the least intra-operative blood loss and shortest hospital stay. Multiple active treatment comparisons indicate that PCCP fixation in trochanteric fractures in the elderly is the treatment of choice in terms of intra-operative outcomes and postoperative complications.
Obesity is an essential health issue leading to noncommunicable diseases (NCDs) as well as atherosclerotic cardiovascular diseases. We aimed to determine the trends in obesity prevalence among Royal Thai Army (RTA) personnel and their associated factors using the health examination of RTA personnel database. A series of cross-sectional studies were conducted from 2017 to 2021. A self-report guide was created using a standardized case report form to obtain demographic characteristics and determine behavioral risk factors. Obesity was defined as BMI $$\ge$$ ≥ 25 kg/m2, and a total of 512,476 RTA personnel nationwide were included. Obesity prevalence rose from 42.1% (95% CI 41.7–42.4) in 2017 to 44.2% (95% CI 43.9–44.5) in 2021 (p for trend < 0.001). A significant surge was observed in obesity prevalence among young RTA personnel aged 18–24 years from 23.7% in 2017 to 28.4% in 2021 (p for trend < 0.001). Higher age individuals, male participants and RTA personnel residing in Bangkok tended to have a significantly higher risk for obesity. Further, regular exercise was a protective factor for obesity. Our data emphasized that obesity among the RTA personnel has been continuously rising over one half-decade, especially among young adults.
Deaths from cardiovascular diseases (CVD) are becoming a growing threat to global health, including in Thailand. The aim of the present study was to identify the recent trends in the predicted 10-year risk of CVD among Royal Thai Army (RTA) personnel from 2017 to 2021. The predicted 10-year risk for CVD was calculated through the use of the 2008 updated version of the risk algorithm derived from the Framingham Heart Study data. The current study included 346,355 active-duty RTA personnel aged 30–60 years. The age- and sex-adjusted mean of the predicted 10-year risk for CVD significantly increased from 10.8% (95% CI: 10.8–10.9%) in 2017 to 11.7% (95% CI: 11.6–11.7%) in 2021 (p for trend < 0.001). The overall age- and sex-adjusted prevalence of intermediate-to-high predicted 10-year risk for CVD remarkably surged from 24.9% (95% CI: 24.4–25.4%) in 2017 to 29.5% (95% CI: 29.0–30.0%) in 2021 (p for trend < 0.001). The modifiable risk factors for CVD, including high systolic blood pressure, high body mass index, and current smoking in this population, should be alleviated to mitigate the risk for CVD in the future.
Background Hypertriglyceridemia is a common health problem independently associated with an increased risk of atherosclerosis cardiovascular diseases (ASCVD), including ischemic heart disease and stroke. This study aims to determine the prevalence of hypertriglyceridemia among Royal Thai Army (RTA) personnel and its behavioral and cardiometabolic risk factors using the RTA personnel database of the physical health examination from 2017 to 2021. Methods A serial cross-sectional study was conducted from 2017 to 2021. A total of 257,683 active-duty RTA personnel aged 35–60 years were included in the study. We defined hypertriglyceridemia as fasting triglyceride ≥150 mg/dL. Moreover, we performed a multivariable logistic regression analysis to investigate behavioral and cardiometabolic risk factors for the prevalence of hypertriglyceridemia. The magnitude of the association was presented as an adjusted odds ratio (AOR) with a 95% confidence interval (CI). Results The hypertriglyceridemia prevalence among RTA personnel was 43.4% (95% CI: 42.9–43.8%) in 2017. It then continuously decreased to 40.3% (95% CI: 39.9–40.7%) in 2020 and slightly rose to 41.0% (95% CI: 40.6–41.4%) in 2021 (p for trend < 0.001). The prevalence of hypertriglyceridemia was higher for males than females (AOR 2.15; 95% CI: 2.07–2.23); RTA personnel aged 40–44 years compared with those aged 35–39 years (AOR 1.05; 95% CI: 1.02–1.08); and RTA personnel residing in the northeast (AOR; 1.15 95% CI: 1.11–1.18) and the north (AOR 1.05; 95% CI: 1.02–1.08) compared with those residing in Bangkok. The independent behavioral factors associated with hypertriglyceridemia included alcohol consumption, smoking, and sedentary behavior. Moreover, cardiometabolic risk factors, including higher body mass index, high fasting plasma glucose (≥ 100 mg/dL), high blood pressure (≥ 140/90 mmHg), and hypercholesterolemia (≥ 200 mg/dL), were significantly related to hypertriglyceridemia. Conclusion Our data demonstrated that hypertriglyceridemia is a frequent health issue, especially among males, participants aged 40–44 years, and RTA personnel residing in the northeast and the north. The prevalence of hypertriglyceridemia in this population was greatly influenced by alcohol consumption, cigarette smoking, and sedentary behavior. Both behavioral and cardiometabolic risk factors are potential targets for intervention to enhance the primary prevention of sequelae of hypertriglyceridemia, including ASCVD.
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