Association of cause-specific hospital admissions with high and low temperatures in Thailand: a nationwide time series study.

Background: Non-optimum temperatures are associated with a considerable mortality burden. However, evidence of temperature with all-cause and cause-specific hospital admissions in tropical countries like Thailand is still limited. Methods: Daily all-cause and cause-specific hospital admissions for outpatient and inpatient visits were collected from 77 provinces in Thailand from January 2013 to August 2019. A two-stage time-series approach was applied to assess the association between non-optimum temperatures and hospital admission. We first fitted the province-specific temperature-morbidity association and then obtained the national association in the second stage using a random-effects meta-analysis regression. The attributable fraction (AF) of hospital admissions with 95% empirical confidence interval (eCI) was calculated. Findings: A total of 878,513,460 all-cause outpatient admissions and 32,616,600 all-cause inpatient admissions were included in this study. We observed a J-shaped relationship with the risk of hospital admissions increasing for both cold and hot temperatures. The overall AFs of all-cause hospital admissions due to non-optimum temperatures were 7.57% (95% eCI: 6.47%, 8.39%) for outpatient visits and 6.17% (95% eCI: 4.88%, 7.20%) for inpatient visits. Hot temperatures were responsible for most of the AFs of hospital admissions, with 6.71% (95% eCI: 5.80%, 7.41%) for outpatient visits and 4.50% (95% eCI: 3.62%, 5.19%) for inpatient visits. The burden of hospital admissions was greater in females and in children and adolescents (0-19 years). The fractions of hospital admissions attributable to non-optimum temperatures exhibited variation among disease categories and geographical areas. Interpretation: The results indicate that low and high temperature has a significant impact on hospital admissions, especially among the females, and children and adolescents (0-19 years). The current investigation could provide evidence for policymakers to develop adaptation strategies and mitigate the adverse effects of climate change on public health in Thailand and other tropical countries. Funding: National Research Council of Thailand (NRCT): E-Asia Joint Research Program: Climate change impact on natural and human systems (N33A650979).

Risk Assessment of Heavy Metals in Sediment Samples from the Mae Chaem River, Chiang Mai, Thailand.

Heavy metals are significant environmental pollutants that are recognized as posing a potential health hazard to human beings. We investigated the concentrations of the heavy metals As, Cd, Cr, Cu, Ni, Pb, and Zn in surface sediments collected from the Mae Chaem River in Chiang Mai, Thailand, during the dry season in 2021. The mean concentrations of heavy metals in sediments were, in decreasing order, Zn > Cr > As > Pb > Ni > Cu > Cd. The mean values of As, Cd, Cr, and Cu were determined to be 32.5 ± 18.3, 0.33 ± 0.07, 45.8 ± 11.9, and 21.9 ± 7.42 mg Kg-1, respectively. These levels are higher than their standard levels in Thailand, namely 10.0, 0.16, 45.5, and 21.5 mg Kg-1, respectively. Principal component analysis (PCA) revealed that the primary origins of heavy metal contamination are predominantly attributed to residential settlements and agricultural areas. The hazard quotient (HQ) was used to estimate the non-carcinogenic risk of exposure to heavy-metal-bound surface sediments for both children and adults. The results showed that the HQ values for both groups were less than 1.0 (HQ < 1.0), indicating no risk. Moreover, assessment of the long-term risk for ingestion of toxic metals indicated no risk (<10-6) based on the lifetime cancer risk (LCR). However, the LCR values of As and Cr were 5.3 × 10-6 and 2.5 × 10-6, respectively, demonstrating the most elevated LCR among the hazardous metals in terms of children's exposure. Therefore, it is possible that children living in agricultural areas and participating in activities around the study area may be exposed to elevated concentrations of As and Cr.

Respiratory infections among junior high school students in upper northern Thailand: The role of building dampness and mould, biomass burning and outdoor relative air humidity (RH).

BACKGROUND: Few studies exist on environmental risk factors for respiratory infections in Thai school children. AIM: To study associations between home and outdoor environment and respiratory infections among school children in Northern Thailand in dry and wet season. METHODS: A repeated questionnaire survey among the children (N = 1159). Data on ambient temperature and relative air humidity (RH) and PM10 and ozone was collected from nearby monitoring stations. We used logistic regression to calculate odds ratios (OR). RESULTS: 14.1% had current respiratory infections (last 7 days), 32.1% had any respiratory infection last 3 months, and 26.1% had any respiratory infection last 12 months with antibiotic treatment. Students with diagnosed allergy (7.7%) and diagnosed asthma (4.7%) had more often respiratory infections (ORs 1.40-5.40; p < 0.05). Current respiratory infections were more common in dry (18.1%) than in wet season (10.4%) (p < 0.001) and was associated with indoor mould (OR 2.16; p = 0.024) and outdoor RH (OR 1.34 per 10% RH; p = 0.004.) in the total material. In wet season, mould (OR 2.32; p = 0.016), window pane condensation (OR 1.79; p = 0.050), water leakage (OR 1.82; p = 0.018), environmental tobacco smoke (ETS) (OR 2.34; p = 0.003) and outdoor RH (OR 2.70 per 10% RH; p = 0.01) were risk factors for current respiratory infections. In dry season, mould (OR 2.64; p = 0.004) and outdoor RH (OR 1.34 per 10% RH; p = 0.046) were associated with current respiratory infections. Irrespectively of season, biomass burning inside or outside the home was a risk factor for respiratory infections (ORs 1.32-2.34; p < 0.05). Living in a wooden house decreased the risk of respiratory infections (OR 0.56: p = 0.006). CONCLUSIONS: Dry season, high outdoor RH, household dampness, indoor mould and ETS can increase childhood respiratory infections. Living in a traditional wooden house can reduce respiratory infections, possibly due to better natural ventilation. Smoke from biomass burning can increase childhood respiratory infections in northern Thailand.

Asthma and rhinitis in wet and dry season among students in upper Northern Thailand: the role of building dampness and household air pollution.

We investigated associations between domestic exposure and respiratory health in students inNorthern Thailand in wet and dry season (1159 participants), calculating odds ratios (OR) with 95% confidence intervals (CI) by multilevel logistic regression. Totally 6.0% had wheeze, 23.0% dyspnoea, 4.0% current asthma, 54.6% rhinitis and 31.5% rhinoconjunctivitis. Girls had less wheeze (OR 0.66; 95% CI 0.43-1.00) and current asthma (OR 0.32; 95% CI 0.19-0.54). Water leakage was associated with wheeze (OR 2.35; 95% CI 1.09-5.06), dyspnea (OR 2.00; 95% CI 1.24-3.23) and rhinoconjunctivitis (OR 1.62; 95% CI 1.11-2.38). Mould was associated with rhinitis (OR 1.89; 95% CI 1.06-3.38). Window pane condensation was associated with wheeze (OR 2.60; 95% CI 1.13-5.98) and rhinoconjunctivitis (OR 1.70; 95% CI 1.08-2.67). Biomass burning was associated with wheeze, dyspnoea, rhinitis and rhinoconjunctivitis. In conclusion, household dampness and pollution from domestic biomass burning can increase asthma symptoms and rhinitis symptoms in students in northern Thailand.

Is biomass burning always a dominant contributor of fine aerosols in upper northern Thailand?

Biomass burning (BB) is an important contributor to the air pollution in Southeast Asia (SEA), but the emission sources remain great uncertainty. In this study, PM2.5 samples were collected from an urban (Chiang Mai University, CMU) and a rural (Nong Tao village, NT) site in Chiang Mai, Thailand from February to April (high BB season, HBB) and from June to September (low BB season, LBB) in 2018. Source apportionment of carbonaceous aerosols was carried out by Latin Hypercube Sampling (LHS) method incorporating the radiocarbon (14C) and organic markers (e.g., dehydrated sugars, aromatic acids, etc.). Thereby, carbonaceous aerosols were divided into the fossil-derived elemental carbon (ECf), BB-derived EC (ECbb), fossil-derived primary and secondary organic carbon (POCf, SOCf), BB-derived OC (OCbb) and the remaining OC (OCnf, other). The fractions of ECbb generally prevailed over ECf throughout the year. OCbb was the dominant contributor to total carbon with a clear seasonal trend (65.5 ± 5.8 % at CMU and 79.9 ± 7.6 % at NT in HBB, and 39.1 ± 7.9 % and 42.8 ± 4.6 % in LBB). The distribution of POCf showed a spatial difference with a higher contribution at CMU, while SOCf displayed a temporal variation with a greater fraction in LBB. OCnf, other was originated from biogenic secondary aerosols, cooking emissions and bioaerosols as resolved by the principal component analysis with multiple liner regression model. The OCnf, other contributed within a narrow range of 6.6 %-14.4 %, despite 34.9 ± 7.9 % at NT in LBB. Our results highlight the dominance of BB-derived fractions in carbonaceous aerosols in HBB, and call the attention to the higher production of SOC in LBB.

Fractional exhaled nitric oxide (FeNO) in students in Northern Thailand: associations with respiratory symptoms, diagnosed allergy and the home environment.

OBJECTIVE: There are few studies on fractional exhaled nitric oxide (FeNO) among children in subtropical areas. We studied associations between FeNO and respiratory symptoms, reported diagnosed allergies and indoor and outdoor environmental factors in first grade junior high school students (N = 270) in upper northern Thailand. METHODS: Data on demographics, health and home environment were collected by a questionnaire distributed in dry season (February-March 2018). FeNO was measured when the research team visited the school. Daily outdoor pollution data (PM10 and ozone) were collected from the nearest monitoring station 3 days (lag 3) and 7 days (lag 7) before the FeNO measurements. Two-level (student, school) linear mixed models were used to analyze associations, adjusting for gender and family education level. RESULTS: In total, 29.6% had elevated FeNO level (>20 ppb) and 7.8% reported any allergy diagnosed by a doctor. Male gender (p = 0.02), diagnosed allergy (p = 0.001), especially to cat (p = 0.001) and house dust mite (HDM) allergies (p = 0.001) were associated with FeNO. Eye symptoms (p = 0.01), rhinitis symptoms (p = 0.03) and dyspnea (p = 0.05) in the last 3 days were associated with FeNO. Household indoor mold (p = 0.03), gas cooking (p = 0.03) and PM10 (lag 3 and lag 7) were negatively (protective) associated with FeNO. CONCLUSIONS: Diagnosed allergy, especially to cat and HDM, can be associated with increased FeNO. Indoor mold and gas cooking can be associated with lower FeNO. Ocular, nasal and dyspnea symptoms reported by students in dry season in northern Thailand can be associated with FeNO, a biomarker of Th2 driven airway inflammation.

Associations between indoor environment in residential buildings in wet and dry seasons and health of students in upper northern Thailand.

We performed a repeated questionnaire study on home environment and health (six medical symptoms) in 1159 junior high school students (age 12.8 ± 0.7 years) in upper northern Thailand in wet and dry seasons. Data on outdoor temperature, relative humidity (RH), and air pollution were collected from nearest monitoring station. Odds ratios (OR) were calculated by multi-level logistic regression. Most common symptoms were rhinitis (62.5%), headache (49.8%), throat (42.8%), and ocular symptoms (42.5%). Ocular symptoms were more common at lower RH and rhinitis more common in dry season. Water leakage (28.2%), indoor mold (7.1%), mold odor (4.1%), and windowpane condensation (13.6%) were associated with all six symptoms (ORs: 1.3-3.5). Other risk factors included cat keeping, environmental tobacco smoke (ETS), other odor than mold odor, gas cooking, and cooking with biomass fire. Biomass burning inside and outside the home for other reasons than cooking was associated with all six symptoms (ORs: 1.5-2.6). Associations between home environment exposure and rhinitis were stronger in wet season. In conclusion, dampness-related exposure, windowpane condensation, cat keeping, ETS, gas cooking, and biomass burning can impair adolescent health in upper northern Thailand. In subtropical areas, environmental health effects should be investigated in wet and dry seasons.