ORGANOPHOSPHATES IN MECONIUM OF NEWBORN BABIES WHOSE MOTHERS RESIDED IN AGRICULTURAL AREAS OF THAILAND.

Organophosphates (OPs) are widely used for pest and weed control in many countries including Thailand. In addition to causing environmental pollution, OPs affect human health by overstimulating neurotoxicants, and OP exposure during pregnancy can lead to adverse health effects of mothers and their fetuses. Using gas chromatography-mass spectrometry with a dedicated extraction protocol to identify OPs in meconium of newborn babies (n = 68) from hospitals in Amnat Charoen, Kanchanaburi and Nakhon Sawan provinces, agricultural regions of Thailand, among ten OP types analyzed, eight were detected in 98% of meconium samples (chlorpyrifos (median ± interquartile range (IQR) 0.08 ± 0.03-0.16 µg/g) in 32% of samples, demeton-s-methyl (0.35 ± 0.26-0.49 µg/g) in 73%, dichlorvos (0.67 ± 0.58-0.71 µg/g) in 38%, dimethoate (0.43 ± 0.09-1.56 µg/g) in 50%, ethion (0.21 ± 0.19-0.26 µg/g) in 12%, malathion (0.28 ± 0.15-0.52 µg/g) in 50%, omethoate (5.63 ± 4.85-8.57 µg/g) in 34%, and tolclofos-methyl (0.08 ± 0.03-0.10 µg/g) in 41%). There are no significant differences in these parameters from babies whose mothers did and did not work in the agricultural or who lived near (within one km) and distant from farmland. The findings should be of benefit in developing programs to protect pregnant women and newborn babies from exposure to OP pesticides.

Factors associated with pneumococcal vaccination in elderly people: a cross-sectional study among elderly club members in Miyakonojo City, Japan.

BACKGROUND: Pneumonia is the third leading cause of death in Japan. All elderly people aged 65 years or older are recommended to receive a pneumococcal vaccine. A subsidy for part of the cost of routine pneumococcal vaccination in this age group was introduced in 2014. Factors related to vaccination behavior among elderly adults have not been well reported. The purpose of this study was to investigate factors associated with vaccine uptake among elderly people in Japan. METHODS: We conducted a cross-sectional study, using a self-administered questionnaire among elderly club members aged 65 years or older in one city of Japan in April 2017. The participants were selected from among all elderly club members in the study area. Variables extracted from the questionnaire were analyzed using logistic regression analysis. RESULTS: A total of 208 elderly club members participated in the study. The mean age (± SD) was 77.2 (± 5.3) years. The pneumococcal vaccination rate was 53.2%. Logistic regression analysis revealed three variables that had a significant association with pneumococcal vaccination: a recommendation for vaccination from medical personnel (aOR 8.42, 95% CI 3.59-19.72, p <  0.001), receiving influenza vaccination in any of the previous three seasons (aOR 3.94, 95% CI 1.70-9.13, p = 0.001), and perception of the severity of pneumonia (aOR 1.23, 95% CI 1.03-1.48, p = 0.026). CONCLUSIONS: Although the pneumococcal vaccination rate in this study was increased compared with previous reports, almost half of study participants had not yet received vaccination. Our findings could be helpful for developing vaccination strategies to increase the vaccine coverage in the elderly population.

POOR PROGNOSTIC FACTORS IN PATIENTS WITH BIRDSHOT RETINOCHOROIDOPATHY.

PURPOSE: To identify prognostic factors for poor visual outcome in patients with birdshot retinochoroidopathy. METHODS: A case-control study of 98 patients with birdshot retinochoroidopathy (196 eyes) was evaluated with a follow-up period of at least 12 months. After exclusion of glaucoma, optic atrophy, and macular scar, the remaining eligible patients were categorized into two groups: poor visual outcomes and good visual outcomes. Poor visual outcome was defined as less than -6 mean deviation score on Swedish interactive threshold algorithm (SITA) short-wavelength automated perimetry (SWAP) test and abnormality (amplitude or implicit time) of 30 Hz flicker electroretinogram at 4-year follow-up and at the most recent visit for separate analysis. Potential factors between both groups were statistically analyzed by Chi-square test and logistic regression model. RESULTS: After the aforementioned exclusion, the remaining 77 patients with an average follow-up period of 52 ± 29 months (335 person-years, 36% with follow-up of more than 5 years) were divided into two groups. Sixteen patients were categorized as having poor visual outcome. Univariate analysis identified significant association of abnormal 30 Hz flicker electroretinogram amplitude (P = 0.004), implicit time (P = 0.002), and SITA SWAP mean deviation at the initial visit (P < 0.001) in the poor visual outcome group. Multivariate logistic regression analysis identified only SITA SWAP mean deviation to be associated with poor visual outcome (adjusted odds ratio, 32.50; 95% confidence interval [3.84-275.32]; P = 0.001) at the initial visit. To verify the model validity, an analysis of 42 patients at 4-year follow-up was performed and the outcome was confirmed (adjusted odds ratio, 8.80; 95% confidence interval [1.58-49.16]; P = 0.013). CONCLUSION: Worse SITA SWAP mean deviation at the initial visit is a predictor of poor visual outcome in patients with birdshot retinochoroidopathy, and may serve as a proxy marker for delayed effective steroid sparing therapy in patients with birdshot retinochoroidopathy.

HEALTH LITERACY, MEDICATION ADHERENCE, AND BLOOD PRESSURE LEVEL AMONG HYPERTENSIVE OLDER ADULTS TREATED AT PRIMARY HEALTH CARE CENTERS.

We conducted this study to explore the causal relationships between health literacy, individual characteristics, literacy, culture and society, cognitive ability, medication adherence, and the blood pressure levels of hypertensive older adults receiving health care services at Primary Health Care Centers in Sa Kaeo Province, Thailand. Six hundred hypertensive older adults had their blood pressure level recorded and were interviewed using questionnaires. Structural Equation Modeling (SEM) was used to determine the effect size, both direct and indirect, among factors. Almost half (48.7%) of studied subjects had inadequate health literacy, 98.3% had good medication adherence, and 80% had good blood pressure levels. The highest effect size on health literacy was literacy, followed by cognitive ability, and culture and society. Medication adherence was affected directly and indirectly by cognitive ability, literacy, and culture and society. Health literacy had not only a direct effect on medication adherence but was also the mediator. Finally, the highest effect size on blood pressure level was critical and communicative health literacy. These findings suggest that health literacy should be considered in the Health Literacy Program of the National Public Health Policy and Plan, Ministry of Public Health.

Combined effects of hypertension and diabetes mellitus with stroke among Thais in the central region of Thailand: a cross-sectional study.

OBJECTIVE: To determine associations of individual and combined effects of hypertension and diabetes with stroke among Thais aged 55 years and older MATERIAL AND METHOD: Cross-sectional data from national screening program for metabolic syndrome in Thailand for the year 2010 among participants who lived in central region of Thailand were used. The number of participants was 13,268 in the analysis. RESULTS: The prevalence of stroke was 0.9%. Associations between hypertension and diabetes found among participants who had hypertension only, diabetes only, and both hypertension and diabetes were: 8.99 (95% CI 4.63-17.43), 3.72 (95% CI 1.03-13.37), 10.48 (95% CI 4.54-24.20) among males and 5.16 (95% CI 2.29-11.53), 6.55 (95% CI 2.19-19.55), and 9.29 (95% CI 3.81-22.68) among females, respectively. CONCLUSION: The present study suggested dramatically the strong effects of the association of combined hypertension and diabetes with stroke. Strengthening health promotion programs for the prevention of hypertension, diabetes, especially having both diseases after screening, is important among Thai population.

Assessment of occupational exposure to malathion and bifenthrin in mosquito control sprayers through dermal contact.

OBJECTIVE: To assess occupational exposure of malathion and bifenthrin concentrations by dermal contact and urinary 3-(2-chloro-3, 3, 3-trifluoro-1-propenyl)-2, 2-dimethyl-cyclopropanecarboxylic (TFP) acid, health symptoms developed and the relationship between bifenthrin concentrations and TFP acid in urine of the mosquito control sprayers. MATERIAL AND METHOD: The aerosols of these two pesticides were collected using 100 cm2 cotton patches attached on the skin of upper legs of 54 volunteer of mosquito control sprayers. Their urine samples were also collected before and after application. RESULTS: These subjects exposed to average malathion and bifenthrin concentrations of 0.18 and 0.32 microg/cm2, respectively After application, the average concentration of urinary TFP acid in the sprayers was 39.22 +/- 0.77 mg/g creatinine ranging from 0.58 to 261.19 mg/g creatinine. A significant difference was found between urinary TFP acid levels before and after application (p < 0.001) but the bifenthrin concentrations through dermal contact and urinary TFP acid levels were not significantly correlated (p > 0.05). CONCLUSION: The mosquito control sprayers had dermal contact with smoke of malathion and bifenthrin and some sprayers developed health symptoms after exposure. They should use protective clothing made ofplastic, nylon or polyester to protect sprayers from skin contact.

The urinary cotinine and serum 25 hydroxyvitamin D levels in male smokers.

OBJECTIVE: To assess urinary cotinine and the effects of smoking on 25(OH)D levels in 67 male smokers. MATERIAL AND METHOD: Urine and blood specimens were analyzed for cotinine and serum 25 hydroxyvitamin D (25(OH)D) concentrations by high performance liquid chromatography (HPLC) and chemiluminescent immunoassay, respectively. The accuracy, precision and detection limit of the HPLC method were also tested. RESULTS: The detection limit of urinary cotinine was 0.02 microg/ml. The recoveries of cotinine concentrations of 0.15-2.0 microg/ml were greater than 95%. Only 23.9% of smokers had sufficient levels of serum 25(OH)D at least 30 ng/ml. The smokers were divided into dairy co-operative smokers and other smokers. The average urinary cotinine concentrations of 1,421.42 and 1,866.52 microg/g creatinine were not significant different in dairy co-operative smokers and other smokers whereas the average 25(OH)D of 29.09 and 22.65 ng/ml, respectively, were significantly different at p-value of < 0.001. CONCLUSION: The 42.86% and 10.26% of the diary co-operative smokers and other smokers had sufficient serum 25(OH)D levels to prevent osteoporosis.

Factors affecting failure to quit smoking after exposure to pictorial cigarette pack warnings among employees in Thailand.

This study was carried out to determine whether health warning pictures(HWP) affect smoking cessation using a structured equation model for intending-to-quit smokers in work places. Data from a 1-year longitudinal followup of attempt-to-quit employees was obtained to determine if pack warnings affect tobacco cessation rates. Stratified simple random sampling, and Structured Equation Modeling (SEM) were employed. Approximately 20% of intending-to-quit smokers were successful. The integrated model, combining internal, interpersonal factors and health warning pictures as external factors, fit the fail to quit pattern of the model. Having a smoking father was the most significant proximate indicator linked with failure to quit. Although HWL pictures were an external factor in the decision to stop smoking, the direct and indirect causes of failure to quit smoking were the influence of the family members. Fathers contributed to the success or failure of smoking cessation in their children by having an influence on the decision making process. Future HWP should include information about factors that stimulate smokers to quit successfully. The role model of a father on quitting is also important.

Factors related to tobacco use among middle school students in China.

The objectives of this study were to determine the status of tobacco use among middle school students in China, and to identify factors related to tobacco use. The study was conducted in December 2009. An ecological model was used to formulate the conceptual framework of the study. Three thousand two hundred twenty-one middle school students aged 12-17 years were selected by three stage stratified cluster sampling. Data were collected by self-completed questionnaires and interviews. The prevalence of current smoking was 10.6%; 16.2% among males and 4.3% among females. The prevalence of ever having smoked was 19.7%, 25.3% among males and 13.4% among females. Zero point seven percent of middle school students used other forms of smoked tobacco products other than cigarettes. Multinomial logistical regression analysis found gender, age, knowledge, attitude, life skills, self-concept, parental smoking, friends smoking, friends attitudes toward smoking, peer pressure, family rules, availability of cigarettes, tobacco-free school environment, smoking intervention program, community tobacco control activities, and tobacco control policies had significant associations with smoking behavior. Structural equation modeling (SEM) analysis found intrapersonal factors had direct relationships with smoking behavior among smoking middle school students. Interpersonal factors, organizational factors and policies had indirect relationships with smoking behavior, and through intrapersonal factors affected smoker behavior among middle school smoking students.

Ethion exposure and biological monitoring in vegetable farmers.

OBJECTIVE: To modify the method of analysis of urinary diethyl phosphate (DEP) in order to determine the relationship between atmospheric ethion concentration and urinary DEP concentration. MATERIALS AND METHOD: A cross-sectional study was conducted by collecting atmospheric ethion in the breathing zone of 28 farmers following the NIOSH 5600 method. Urine samples were also collected to analyze urinary DEP concentrations by a modified method using a Gas Chromatography-Flame Photometric Detector (FPD). RESULTS: The average atmospheric ethion concentration in the breathing zone of farmers was 0.036 +/- 0.018 mg/m3. The average urinary DEP in pre-shift and post-shift was 0.030 +/- 0.06 and 0.851 +/- 1.80 mg/g of creatinine respectively. The average DEP during work shifts was 0.53 +/- 0.27, and ranged from 0.12 to 1.16 mg/g of creatinine. A high correlation coefficient (r = 0.645) was found between atmospheric ethion concentrations and urinary DEP concentrations at p < 0.001. CONCLUSION: The modified method provided a reliable result and the urinary DEP during work shifts was found to be a reliable biomarker of ethion exposure.

Factors Associated with Musculoskeletal Disorders Among Female Readymade Garment Workers in Bangladesh: A Comparative Study Between OSH Compliant and Non-Compliant Factories.

PURPOSE: Musculoskeletal Disorders (MSDs) are one of the most common occupational diseases responsible for work restriction and absenteeism. The purpose of the study was to compare the prevalence of MSDs between ready-made garment (RMG) factories that are compliant versus non-compliant with International Labor Organization (ILO) based Occupational Safety and Health (OSH) standards, and to identify other factors associated with a higher prevalence of MSDs. METHODS: A multicenter cross-sectional study was conducted among 410 randomly selected female workers (age: >18 years; ≥1 year of work experience) from 12 randomly selected RMG factories in the Dhaka district of Bangladesh from February to December 2019. Factories were stratified as OSH compliant or non-compliant. Data were collected using a structured questionnaire consist of socio-demographic, work-related factors, and Nordic Musculoskeletal Questionnaire (NMQ) for MSD assessment. Robust Poisson regression was used to investigate the association of MSDs with OSH compliance, socio-demographic and other work-related factors. RESULTS: Respondents' mean age was 26.9 ± 5.9 years. A total of 235 (57%) of the workers reported musculoskeletal pain in at least one body part during the last month. Among the nine reported MSDs, the prevalence of lower back pain was highest (41%) followed by pain in the knees (33%). Multivariable analysis showed lower prevalence of any MSD among workers in OSH compliant factories [aPR = 0.43, 95% CI: 0.31-0.58], and workers with regular working hours (8 hrs/day) [aPR = 0.79, 95% CI: 0.62-1.00]. The risk of developing any MSD was significantly higher for age group 25-30 years [aPR = 1.16, 95% CI: 1.01-1.33] and age group ≥31 years [aPR = 1.21, 95% CI: 1.04-1.1.39]. CONCLUSION: The study found a high burden of musculoskeletal disorders among female RMG workers, especially those in non-OSH compliant factories that work long hours. Enforcement of minimum ILO-based OSH standards and introduction of low-cost interventions to improve working conditions in non-compliant factories would help sustain the pace of development in this sector in Bangladesh, and ensure the health of the women who work there.

Urinary glyphosate biomonitoring of sprayers in vegetable farm in Thailand.

In Thailand, glyphosate is popular herbicide to control pests in the agricultural sector. This study aimed to measure glyphosate exposure concentrations through inhalation, dermal contact, and urinary glyphosate concentrations among 43 vegetable farmers spraying glyphosate in Bungphra Subdistrict, Phitsanulok Province. Four types of spraying equipment were used, manual pump backpack (n = 3), motorized spray backpack (n = 22), battery pump backpack (n = 16), and high pressure pump (n = 2). Breathing zone air samples were collected using glass fiber filters; dermal contact samples were collected using 100 cm2 cotton patches attached on 10 body locations and urine samples were collected at 3 time points: morning void urine the day before spraying, the end of spraying event, and the morning void urine the next day of spraying. The results showed that the geometric mean (GM; geometric standard deviation [GSD]) of breathing zone concentrations of glyphosate exposure were 9.37 (10.17) µg/m3. The GM (GSD) of total dermal patches exposure concentrations were 7.57 (0.01) mg/h. The legs, back, and arms were the most exposed body areas. The GM (GSD) of urinary glyphosate was found highest among vegetable farmers using manual backpack 46.90 (1.35) µg/g creatinine. Farmers should wear masks and boots to reduce glyphosate exposure by inhalation and dermal contact.

Norovirus GII-4 2006b variant circulating in patients with acute gastroenteritis in Thailand during a 2006-2007 study.

Noroviruses (NoVs) are recognized as a significant cause of acute gastroenteritis in children and adults. A 14-month study, from January 2006 to February 2007, was undertaken in a hospital in Thailand to determine the prevalence and genetic characterization of NoVs in patients of all ages with acute gastroenteritis. Based on reverse transcription-nested polymerase chain reaction (RT-nested PCR), NoVs were detected in 122 of 273 (44.7%) collected stool samples. Of the 122 NoV-positive samples, 28 (23%) belonged to GI, 79 (64.8%) belonged to GII, and 15 (12.2%) were mixed infections of GI and GII strains. Three NoV GI-positive and 42 NoV GII-positive samples were characterized successfully by DNA sequencing of the RT-nested PCR products and phylogenetic analysis. For NoV GI, two genotypes were identified: GI-2 (one sample) and GI-6 (two samples). NoV GII could be classified further into five distinct genotypes: GII-2 (1 sample), GII-3 (3 samples), GII-4 (14 samples), GII-6 (3 samples), and GII-17 (2 samples), and one unclassified genotype (19 samples). All NoV GII-4 strains showed 88-98% nucleotide identity with NoV GII-4 2006b variants reported worldwide. Among genotypes of NoV characterized, one co-infected stool sample exhibited NoVs GI-6 and GII-4 2006b. This study suggests that there is an important role of NoVs as etiologic agents in patients with acute gastroenteritis. The predominant circulating genotype of NoV infections is GII-4 2006b variant.

Parental decision-making on human papillomavirus vaccination for daughters in Japan.

BACKGROUND: In June 2013, the fear of adverse events compelled the government to withdraw its recommendation of the Human papillomavirus (HPV) vaccine. Since then, the rate of vaccination among Japanese girls has dropped dramatically. OBJECTIVE: This study aims to assess how the Japanese government's policy change against HPV vaccination influenced the degree to which parents in remote areas in Japan accepted the vaccine for their daughters, and to analyze related factors. METHODS: A self-administered questionnaire was distributed to parents with daughters attending secondary schools or high schools in two remote areas of the country. RESULTS: Out of 700 eligible parents, 246 (35%) responded. The percentage of parents in the "accept group" (those whose daughters had already been vaccinated or those who intended to have their daughters vaccinated) dropped from 54% before the government withdrew its HPV vaccine recommendation to only 4.5% after the withdrawal (1.5% of whom intended to vaccinate and 3% of whom had already had their daughters vaccinated). Vaccine acceptance was higher in parents who were employed as healthcare workers, had been educated through to the completion of high school, had good levels of knowledge about cervical cancer and the HPV vaccine, had low perceived barriers against the HPV vaccine, and received high levels of social support. CONCLUSION: The acceptance of HPV vaccination among parents was low overall. Higher acceptance may be possible if the government restores its recommendation and healthcare providers disseminate appropriate information about the HPV vaccination and cervical cancer.

Health risk among asbestos cement sheet manufacturing workers in Thailand.

OBJECTIVE: To assess asbestos exposure and calculate the relative risks of lung cancer among asbestos cement roof sheet workers and to predict the incidence rate of lung cancer caused by asbestos in Thailand. MATERIAL AND METHOD: A cross-sectional study was conducted in four asbestos cement roof factories. Both area and personal air samples were collected and analyzed employing NIOSH method # 7400 and counting rule A for all procesess and activities. The time weight average exposures were calculated for each studied task using average area concentrations of the mill and personal concentrations. Then, cumulative exposures were estimated based on the past nation-wide air sampling concentrations and those from the present study. The relative risk (RR) of lung cancer among asbestos cement sheet workers was calculated and the number of asbestos related lung cancer case was estimated. RESULTS: The roof fitting polishers had the highest exposure to airborne asbestos fiber (0.73 fiber/ml). The highest average area concentration was at the conveyor to the de-bagger areas (0.02 fiber/ml). The estimated cumulative exposure for the workers performed studied-tasks ranged in between 90.13-115.65 fiber-years/ml while the relative risk of lung cancer calculated using US. EPA's model were 5.37-5.96. Based on the obtained RR, lung cancer among AC sheet in Thailand would be 2 case/year. CONCLUSION: In case that AC sheet will not be prohibited from being manufactured, even though only chrysotile is allowed, the surveillance system should be further developed and more seriously implemented. The better control measures for all processes must be implemented. Furthermore, due to the environmental persistence of asbestos fiber, its life cycle analysis should be conducted in order to control environmental exposure of general population.

Microbial air quality and standard precaution practice in a hospital dental clinic.

OBJECTIVE: A cross-sectional study was carried out to assess standard precaution practices among dental personnel and to investigate microbial counts in indoor air samples collected from a hospital dental clinic before and during dental works. MATERIAL AND METHOD: Thirty dental personnel who voluntarily participated were interviewed using a questionnaire towards demographic information and standard precaution practices between May and August 2007. Additionally, 138 indoor air samples (72 from dental treatment units, 48 from dental supporting units and offices and 18 from patient waiting area) were collected before and during dental works for 6 days (Monday to Saturday) to investigate bacterial and fungal counts. Data were analyzed by using descriptive statistics. Paired t-test was used for analyzing the difference of mean + standard deviation between microbial counts before and during dental procedures. The statistical significance was expressed in term of p-value and the critical level was set at alpha = 0.05. RESULTS: The results revealed that standard precaution practices towards wearing personal protective equipments regularly during dental procedures ranged from 50% to 100%, whereas, cleaning and disinfecting dental unit after each patient treatment and cleaning dental unit water lines with antiseptics every week were done regularly only 36.7%. The mean score of standard precaution was 8.4 +/- 2.5 (moderate level, total score of 13). The means of bacterial and fungal counts in air samples collected from dental treatment units significantly increased during dental procedures when compared with those collected before dental works (p < 0.001), whereas, those were not significantly different in the dental supporting units and offices, p > 0.05. CONCLUSION: This study demonstrated the moderate level of standard precaution practice score among studied dental personnel and significantly higher microbial counts (bacterial and fungal counts) in air samples collected from dental treatment units during dental procedures were demonstrated. To reduce the occupational risk among this group, standard precaution practices should be strengthened.

Hazard Exposure with Health and Safety Outcomes Hinder the Work Ability of Salt Farm Workers in Thailand.

OBJECTIVE: Unsafe environments and occupational hazards have been documented and are contributing to health risks for salt farm workers in Thailand. Whether exposures with various health hazards and outcomes affect work ability among these workers is uncertain. This study aimed to examine the effects of hazard exposures with health risks and outcomes, including accidents, for work ability among salt farm workers. METHODS: A cross-sectional study was completed with 120 salt farm workers recruited from the largest salt farm company in Samutsakorn Province during January and February 2014. Face to face interviews were conducted using a structured questionnaire comprised of worker characteristics, working conditions, safety and health problems related to work, and a work ability index (questionnaire reliability =0.84) through a worksite visit. The MIMIC model was used to determine direct and indirect causal effects of work-related health hazards and outcomes on work ability. RESULTS: Among 120 salt farmers, 61% were female and 77% had primary educations. Average age and work experience was 49.5 years (SD = 13.7) and 23.7 years (SD = 13.5), respectively. 66% worked more than 5 days per week and 21.3% had at least one accident in the past 3 months. The results of structure equation analysis revealed that healthy skin was related to heat exposure (ß=.35, p=.01) and directly influenced work ability (ß=.37, p=.01), Eye irritation was influenced by length of work time (ß=.24, p=.05), and harmonized the predictive value of the model at a high level (χ2=94.51, df=73, p-value =0.05, χ2/df=1.29. RMSEA= 0.066). CONCLUSION: Results for the MIMIC model indicate that two factors, bright sunlight and strong wind exposure over an extended work period, could be having crucial impacts on skin and eye health of salt farm workers. These factors might be protected against using PPE and health examinations with positive health outcomes directly improving work ability. Substantial governmental action with community leadership is needed immediately so action plans are instituted to improve occupational safety and health.

Hearing Loss in Agricultural Workers Exposed to Pesticides and Noise.

Agricultural workers who have concurrent exposure to pesticides and noise are at increased risk of hearing loss. We recruited 163 Thai conventional and 172 organic farmers to answer our questionnaires about personal demographics, agricultural activities, and pesticide and agricultural machinery use. This information was used to calculate the years of conventional (pesticide use) farming and the years of agricultural noise exposure, and to estimate semiquantitative metrics for pesticide exposure (cumulative intensity score-years) and cumulative noise exposure (dB(A)-years) for each conventional farmer. All participants underwent pure tone audiometric testing. The mean hearing threshold in the low-frequency band (0.5-2 kHz) and high-frequency band (3-6 kHz) were used for analysis. Years involved in conventional farming and years using agricultural machinery were associated with an increase in the average hearing threshold for the high-frequency band after controlling for age, ever exposed to industrial noise and cigarette smoking. The highest category of cumulative insecticide exposure (score-years), cumulative organophosphates exposure (score-years) and cumulative noise exposure (dB(A)-years) were also associated with an increased high-frequency band hearing threshold among conventional farmers. Results from the full cohort and the subcohort of conventional farmers support each other and the hypothesis that pesticide and noise have an additive effect on hearing, since no model interactions were significant.

Clinical features and differences between child and adult dengue infections in Rayong Province, southeast Thailand.

A retrospective study was conducted among patients with dengue infection admitted to Rayong Hospital during September 2004-September 2005. Data were collected from medical charts and outpatient records created when the patients came to the hospital. Of the patients diagnosed with dengue, only 301 who met the WHO criteria for dengue fever and DHF/DSS were selected. The study cohort was comprised of 147 children (76 males, 71 females) and 154 adults (71 males, 83 females), with an overall mean age of 17.6 years. Some adult clinical symptoms were different from the children. Headache and myalgia were more common among adults (p < 0.05), but cough, vomiting, abdominal pain, and rash were more common among children (p < 0.05). Among the major bleeding symptoms, epistaxis (nasal bleeding) was more common in children (p = 0.012) and gum bleeding was more common in adults (p < 0.001). Myalgia was more likely in less severe grades of infection. Adults showed some different clinical manifestations of dengue infection from children. It is necessary for health personnel to take these differences into consideration when seeing probable cases of dengue infection.

Potential effectiveness of health warning labels among employees in Thailand.

OBJECTIVE: Explore and investigate the perceptions and responses of employees regarding the effects of a Health Warning Label (HWL) on their decision to encourage quitting and stages of change in smoking behavior. MATERIAL AND METHOD: One thousand six hundred thirty seven employees in workplaces from four regions, including Bangkok city, were studied during the year 2005-2006. Six hundred nine employees (both non- or cigarette smokers) were part of a cohort study using qualitative and quantitative approaches. Questionnaires were used to sample the cohort twice and two individuals per factory were interviewed in-depth. RESULTS: The New-HWL that made the best impression was the "cancer caused by cigarette smoking" and 3.8% stopped smoking after seeing the New-HWL. Moreover, New-HWL increased employees "pro" attitudes about smoking cessation. Decisional balance that reflected different "con" to quit, among non-quitting and quitting smokers. CONCLUSION: New-HWL significantly increased attitudes about smoking cessation.