Air Pollution inside Vehicles: Making a Bad Situation Worse.

Thailand has successfully forwarded Article 8, Protection from Exposure to Tobacco Smoke, of the World Health Organization's Framework Convention on Tobacco Control (WHO FCTC). It achieved its 100% smoke-free goals in public places in 2010, next pursuing other bans in outdoor places to lower particulate matter air pollution (PM2.5). Our aim was to expose the secondhand smoke levels in vehicles since SHS is a danger to everyone, but especially to children and youth. This is the first experimental study of its kind in Thailand. We measured PM2.5 for 20 min under four conditions in 10 typical Thai vehicles, including commonly used sedans and small pickup trucks. We used an established protocol with two real-time air monitoring instruments to record PM2.5 increases with different vehicle air exchange and air conditioning conditions. Monitoring was recorded in the vehicle's front and back seats. The most common Thai ventilation condition is all windows closed with fan/air conditioning (AC) in operation because of Thai tropical conditions. Mean exposure levels were three and nearly five times (49 and 72 µg/m3) the 24 h WHO standard of 15 µg/m3 in the back and front seats, respectively. These high PM2.5 exposure levels warrant action to limit vehicle smoking for public health protection.

Electronic Cigarette Harms: Aggregate Evidence Shows Damage to Biological Systems.

Evidence of the harms of e-cigarettes has been unfolding slowly and has been documented in many reviews and reports worldwide. A narrative review of new evidence is presented since, as research has continued, newly aggregated evidence of the dangers of electronic cigarettes on the brain, heart, and lungs is vital to inform decisions on restricting the use of e-cigarettes. Several biomedical research databases were searched for electronic cigarette health effects, emphasizing reviews, systematic reviews, and meta-analyses. Over 50 review studies, primarily in 2022 and 2023, illustrate some of the latest information on e-cigarette harms. Results show studies of respiratory, neurological, and cardiovascular effects. Researchers call for expanding studies through new methods to elaborate on initial findings of multiple harms emerging in clinical investigations. Since the use of electronic cigarettes for adult cessation is not sanctioned in most countries, it is clear that health authorities see significant costs to the health of the general population if the promotion and use of electronic cigarettes occur worldwide. Regulatory action to control electronic cigarettes should consider the substantial evidence of electronic cigarette harm.

Risk behaviors screening in Thai adolescents with acute and chronic illnesses.

BACKGROUND: Adolescence is considered as a transition period from childhood to adulthood. This transition leads to various types of risk behaviors. Ten percent of adolescents suffer from a chronic illness that can limit their daily activities and which may exhibit higher rates of risk behaviors than those without chronic illnesses. OBJECTIVE: To evaluate the prevalence of risk behaviors in chronically ill adolescents compared to adolescents without chronic illnesses and their associated risk factors. METHODS: We enrolled 312 patients aged 10-20 years who visited Ramathibodi Hospital from January 2015 to December 2017. There were 161 adolescents with chronic illnesses and 151 without a chronic illness. We used a computer-based program for the Youth Risk Behaviors Survey as well as a confidentiality interview. Statistical analyses included the chi-squared (χ2) and Student's t-tests as appropriate. RESULTS: The risk behaviors in chronically ill adolescents were the following: learning problems, 86.3%; excessive screen time, 62.3%; unintentional injuries, 60.2%; depression, 38.5%; low self-esteem, 18.1%; substance abuse, 13% and sexual behavior, 6.2%. Youths with a chronic illness were more likely to report significantly higher risk of excessive screen time (62.3% vs. 48%, p = 0.01), depression (38.5% vs. 15.9%, p < 0.01) and, also low self-esteem (18.1% vs. 8.6%, p = 0.01) compared to those without chronic illness. CONCLUSIONS: These results indicated that adolescents with chronic illnesses engage more in health risk behaviors and are prone to mental health and learning problems. These data emphasize the importance of health risk behavior screening and preventive counseling for young patients with chronic illnesses where these risks might worsen their disease.

Prevalence of significant QTc prolongation and long QT syndrome in adolescents with syncope.

A total of 664 high school students having >or=1 episode of syncope and 560 students without syncope (controls) underwent 12-lead ECG. A significant QT prolongation was defined as corrected QT (QTc)>470 ms in male and >480 ms in female. A diagnosis of LQTS was made by Schwartz's score. Most students had only 1 episode of syncope (66.1%), 2 (16.9%), 3 (11.6%), and >or=4 (5.4%). Most syncopal episodes were related to non-exertional events with only 11.4% related to exertion. The QTc distribution of the study group was almost identical to controls with mean QTc of 405.1+/-23.2 vs 402.5+/-23.4 ms, respectively. Only one male (0.15%) in the study group had significant QTc prolongation. None met the criteria for diagnosis of LQTS (score>or=4). In conclusion, the prevalence of LQTS in adolescents having syncope seems to be low in this cohort study.

Migraine in Thai children: prevalence in junior high school students.

A cross-sectional study to determine the prevalence of migraine in seventh grade Thai students in 4 junior high schools in Bangkok, Thailand, according to the diagnostic criteria of the second edition of the Classification of Headache of the International Headache Society was conducted in July 2004. The study included a screening self-administered questionnaire and face-to-face interview with physical examination. The diagnosis of migraine was made and confirmed by 2 pediatric neurologists. All of 1789 students in participating schools completed the questionnaire. After 2 interviews, 248 students (13.8%) were diagnosed with migraine. The prevalence in girls was higher than that in boys (16.2% vs 11.7%). Migraine as having aura was diagnosed in 34 students (13.7%). One student had sporadic hemiplegic migraine. Among 248 children, 176 (71%) reported the duration of headache between 1 and 2 hours. The leading precipitating factor of migraine was the stress related to daily school activities (17.7%). There were 32 students (12.9%) with frequent and intense headache who were referred to their primary physicians for further management. This study had disclosed a high prevalence of migraine in seventh grade Thai students in Bangkok City and reflected the existing burden of this illness in Thai students.

Cardiac dimensions and function in children with obesity.

BACKGROUND: Obesity can cause alterations in cardiac dimensions and function. Cardiac dysfunction during childhood may affect the quality of life in adulthood. This study evaluated left ventricular (LV) dimensions, systolic function and left ventricular myocardial performance index (LMPI) in children with obesity. METHODS AND RESULTS: Thirty-three obese children with mean age of 9.8 +/- 2.4 years, weight 61.3 +/- 20.8 kg, BMI 29.5 +/- 5.8 kg/m2 and percentage of actual weight to ideal body weight for height (%IBW) 170 +/- 25%, underwent echocardiography to assess LV dimensions, systolic and global functions. There were 2, 14 and 17 children with mild (160%IBW), respectively. The mean ratio of left ventricular end-diastolic dimension (LVEDD) to predicted LVEDD expressed in percentage (%LVEDD) was 98.3 +/- 7.8%, the left ventricular shortening fraction (LVFS) was 37.5 +/- 4.9% and the left ventricular ejection fraction (LVEF) was 67.5 +/- 5.9%. All were within normal range except that 2 children (6%) had mild LV dilatation. The mean LMPI was 0.35 +/- 0.08. However, 11 children (33%) had abnormal LMPI (>0.4). The severity of obese children did not correlate with the global LV dysfunction. CONCLUSION: The left ventricular dimensions and systolic function in children with obesity were essentially normal. LMPI which indicates LV global function was found to be abnormal in 33% of children with obesity and may be used to do early detection of LV global dysfunction.

Cardiac dimensions and function in children with obesity.

BACKGROUND: Obesity can cause alterations in cardiac dimensions and function, and cardiac dysfunction during childhood may affect the quality of life in adulthood. This study was done to evaluate left ventricular dimensions, systolic function, and the left ventricular myocardial performance index in children with obesity. MEHTODS AND RESULTS: Thirty-three obese children whose mean age was 9.8 +/- 2.4 years, weight was 61.3 +/- 20.8 kg, body mass index was 29.5 +/- 5.8 kg/m(2), and percentage of actual weight to ideal body weight for height (% IBW) was 170 +/- 25%, underwent echocardiography for the assessment of left ventricular dimensions, and systolic and global functions. There were 2, 14, and 17 children with mild (< 140% IBW), moderate (141-160% IBW), and severe obesity (> 160% IBW), respectively. The mean ratio of left ventricular end-diastolic dimension to predicted left ventricular end-diastolic dimension expressed in percentage was 98.3 +/- 7.8%, the left ventricular shortening fraction was 37.5 +/- 4.9%, and the left ventricular ejection fraction was 67.5 +/- 5.9%. All were within the normal range, with the exception of two children (6%) who had mild left ventricular dilatation. The mean left ventricular myocardial performance index was 0.35 +/- 0.08. However, 11 children (33%) had an abnormal index (< 0.4). The severity of obesity did not correlate with the global left ventricular dysfunction. CONCLUSION: The left ventricular dimensions and systolic function in children with obesity were essentially normal. The left ventricular myocardial performance index, which is an indicator for left ventricular global function, was found to be abnormal in 33% of the children, and may be used for the early detection of left ventricular global dysfunction.

Youth risk behavior survey: Bangkok, Thailand.

PURPOSE: To identify the prevalence of risk behaviors and related risk factors in adolescents in Bangkok, Thailand. METHODS: Youth risk behavior survey questionnaires were collected from 2311 adolescents in 8 schools, 13 communities and 2 Juvenile Home Institutions from January to February 2001. Their mean age was 15.5 +/- 1.8 years, and 59% were female. Risk factors of interest were gender, parental marital status, socioeconomic status, family relationship, parental drug addiction, peer group, loneliness, self-esteem, and school performance. Multiple logistic regression was used to identify significant risk factors associated with each risk behavior. RESULTS: The risk behaviors leading to traffic accidents were rarely or never having worn a seat belt (30.6%) or helmet while bicycling (66.9%) and while motorcycling (50.1%), riding with drivers who had consumed alcohol (18.8%), and driving after consuming alcohol (12.1%). The studied group carried weapons (8.5%) and has been involved in a violent event (31.5%). Among 13.9% who were assaulted, 6.7% needed hospitalization; rape was reported by 2.4%. Depression was reported by 19.9%, with 12% having suicidal tendencies and 8% attempting suicide. The lifetime use vs. heavy use prevalence of substance abuse, respectively, was: 15.4% and 3.5% for smoking, 37.3% and 1.7% for alcohol, 37.8% and 4.6% for amphetamine use, and 37.9% and 0.1% for other drugs. Among the 10% who have had sexual intercourse, 1% were homosexual, 7.1% have never used a condom, and 2.1% resulted in pregnancy. Being male was a risk factor for every untoward behavior except depression. Other risk factors included poor self-esteem, poor school performance, and early school leaving. Factors relating to the family included a low socioeconomic status, poor relationships, broken families, and parental substance abuse. Socioenvironmental factors included being in a gang and loneliness. Some risk behaviors started at younger than 8 years old. Schools and media were given as the sources of information regarding sex, human immunodeficiency virus infection, and substance abuse. CONCLUSIONS: The prevalence of six major-risk behaviors in adolescents in Bangkok was significantly high. Several risk factors were identified, the knowledge from which may help to form preventive measures in this population.

Risk factors of high lead level in Bangkok children.

UNLABELLED: Lead poisoning is the most important pollution in children which affects the developing brain and IQ. Previous studies of blood lead levels in Thai children were all higher than 10 microg/dl. OBJECTIVE: To identify risk factors and impacts associated with high lead levels (>10 microg/dl) in Bangkok children MATERIAL AND METHOD: The longitudinal study (n = 84) followed blood lead levels of a birth cohort, 6, 12, 18, 24 and 72 months of age from 1993 to 1999. Multiple cross-sectional studies (1992-1996) comprising children under 15 years of age attending the outpatient clinic, Ramathibodi Hospital (n = 511), kindergartens (n = 60), 6 primary school students (n = 564) and secondary school students (n = 377) in Bangkok, were recruited. Blood lead levels were assessed by atomic absorption spectrometry. Questionnaires to identify risk factors were completed by parents of under 2-year-old children and primary school students. IQ was assessed in the longitudinal group at 2 years of age and in primary students. RESULTS: The mean blood lead levels (microg/dl) were 5.57 +/- 2.31 at birth, 5.03 +/- 2.21 at 6 years of age in a cohort study, 6.74 +/- 2.02 in kindergartens, 9.26 +/- 3.68 in primary students and 9.03 +/- 3.65 in secondary school students. The proportion of high blood lead increased with age from 1 per cent at birth to 35 per cent in secondary school students. In the kindergartens and secondary school, males had higher lead levels than females. In the primary school study, the significant risk factors (Odd Ratio-OR) of high lead level were; living in Bangkok (6.18), male (1.67), maternal labour workers (1.79), family income lower than 3,000 baht/month (2.24), a crowded family with more than 9 members (2.22), household members whose present occupation was related to printing (4.55) or lead smelting previously (4.85). Children in the high lead group had lower weight (p = 0.0000) and height (p = 0.0000) and were slow learners determined by their teachers (p = 0.0332). CONCLUSION: The blood lead levels in Bangkok children were not high and have tended to decrease following the reduction of air lead levels because of unleaded gasoline usage. A periodic surveillance survey is still necessary to monitor blood lead level in Bangkok children especially among those with risk factors.