Associations between frailty and mild cognitive impairment in older adults: Evidence from rural Chiang Mai Province.

Thailand entered an aged society phase in 2000, with mild cognitive impairment (MCI) and frailty becoming prevalent among the older adult population. However, no studies have yet examined these issues specifically within rural communities. This study aims to explore the relationship between frailty and MCI among older adults in rural Thailand. It was a cross-sectional study conducted between December 2022 and June 2023. A questionnaire was administered by trained village health volunteers. The survey targeted older adults aged 60 years and above, residing in rural Chiang Mai, Thailand, with those having a history of dementia, depression, and brain injury being excluded from participation. Nine hundred eighty-four participants among the older adults were available for analysis. The mean age was 69.8 (SD 7.9) with 62.2% females (n = 612). The median frequency of exercise was three days (0-7). The prevalence of MCI and frailty among rural older adults in the community was 35.6% (n = 350) and 8% (n = 79), respectively. There were four factors associated with an increased risk of MCI, including age (aOR = 1.07, 95% CI 1.04-1.09, p < 0.001), smoking cigarettes (aOR 1.95, 95% CI 1.27-2.98, p = 0.002), feelings of loneliness (aOR 1.43, 95% CI 1.01-2.03, p = 0.043), and the presence of frailty (aOR 1.92, 95% CI 1.10-3.35, p = 0.022). There were two factors associated with a lower risk of MCI: a higher education level (aOR 0.90, 95% CI 0.86-0.94, p <0.001) and engaging in frequent exercise (aOR 0.9, 95% CI 0.86-0.95, p < 0.001). Frailty exhibited an association with an elevated risk of MCI among older adults in rural communities. Enhancing screening through health volunteers and primary healthcare professionals, coupled with bolstering community-driven health promotion initiatives, becomes imperative.

Exploring the adverse effect of fine particulate matter (PM2.5) on wildland firefighters' pulmonary function and DNA damage.

Chiang Mai encounters severe pollution during the wildfire season. Wildland firefighters encounter various hazards while engaged in fire suppression operations, which encompass significant exposure to elevated concentrations of air pollutants resulting from combustion, especially particulate matter. The adverse effects of wildfire smoke on respiratory health are a significant concern. The objective of this study was to examine the potential adverse effects of PM2.5 exposure on the respiratory function and DNA damage of wildland firefighters. This prospective cohort study conducted in Chiang Mai from January to May 2022 planned to evaluate the health status of wildland firefighters during the pre-peak, peak, and post-peak ambient air pollution seasons. The measurement of PM2.5 was done at every forest fire station, as well as utilizing data from the Pollution Control Department. Participants received general health examinations, spirometry evaluations, and blood tests for DNA damage analysis. Pair t-tests and multiple regression models were used to examine the connection between pulmonary function parameters (FVC, FEV1) and PM2.5 concentration, with a significance level of P < 0.05. Thirty-three peak-season and twenty-one post-peak-season participants were enrolled. Four pre-peak-season wildland firefighters had FVC and FEV1 declines of > 15%. Multiple regression analysis showed a negative association between PM2.5 exposure and FVC% predicted (- 2.81%, 95% CI - 5.27 to - 0.34%, P = 0.027) and a marginally significant negative correlation with FVC (- 114.38 ml, 95% CI - 230.36 to 1.59 ml, P = 0.053). The remaining pulmonary measures showed a statistically insignificant decline. There were no significant changes in DNA damage detected. Wildland firefighters suffered a significant decline in pulmonary function associated with PM2.5 exposure. Spirometry is crucial for monitoring and promptly identifying respiratory issues that occur during wildfire seasons. Further research is recommended to explore DNA damage alterations and their potential association with PM2.5.

Seroprevalence of dengue, Japanese encephalitis and Zika among long-term expatriates in Thailand.

BACKGROUND: Travel to Southeast Asia increases the likelihood of acquiring mosquito-borne Flavivirus infections such as dengue (DENV), Japanese encephalitis (JEV) and Zika viruses (ZIKV). Expatriates are long-term travellers who have a higher risk of mosquito-borne illness at their destination country. The purpose of this study was to evaluate the seroprevalence of DENV, JEV and ZIKV infections and the determinants contributing to seropositivity among expatriates living in Thailand. METHODS: A cross-sectional study was performed from December 2017 to February 2020. Expatriates from non-Flavivirus endemic countries were recruited. 5 mL of blood was collected for DENV 1-4, JEV and ZIKV antibody testing by plaque reduction neutralization test (PRNT50). Individuals with vaccination histories or diagnoses for dengue, Japanese encephalitis, yellow fever and tick-borne encephalitis were excluded. RESULTS: Among 254 participants, most participants (83.1%) were male, the mean age was 65 years and the median duration of stay in Thailand was 6 years. Seroprevalence rate of any Flavivirus, non-specific DENV, DENV1-4, JEV and ZIKV were 34.3, 30.7, 20.5, 18.1, 18.9, 10.6, 4.7 and 2.8%, respectively. The presence of neutralizing antibodies against DENV1-4 positively correlates with the duration of stay in Thailand. DENV seropositivity was associated with living in urban areas (aOR 2.75, 95% CI 1.36-5.57). Expatriates were unlikely to have detectable anti-JEV antibodies regardless of time spent in a JEV-endemic area. No risk factors were identified that were significantly associated with JEV or ZIKV seropositivity. Only 48.4% received pre-travel counselling services, while only 18.9% visited a travel medicine specialist. CONCLUSIONS: A high proportion (34.3%) of long-term expatriates living in Thailand were seropositive for flavivirus, mainly from dengue (30.7%). To minimize risk, travel medicine practitioners should provide adequate pre-travel health risk information on mosquito-borne flavivirus infection and offer advice on mosquito bite prevention strategies. Dengue vaccine might be considered in high-risk travellers such as long-term expatriate.

Unveiling the road to safety: Understanding the factors influencing motorcycle accidents among riders in rural Chiang Mai, Thailand.

Background: Motorcycle accidents pose a significant threat to traffic safety in Thailand, particularly in rural areas where the severity of these accidents often results in prolonged medical treatment and a reduction in the quality of life of the affected individual. Objectives: To investigate the prevalence and the factors associated with motorcycle accidents among motorcycle riders in rural areas in Chiang Mai, Thailand. Method: A cross-sectional study was conducted from December 2022 to March 2023 via an anonymous survey in Chiang Mai, Thailand. A total of 308 participants engaged with the survey. The data about background information, motorcycle details, personal protective equipment, risky behaviors, attitude toward riding, and history of motorcycle accidents in the prior six months were collected and analyzed by binary logistic regression. Results: Of 308 participants, the mean age was 56 years old (SD = 14.2), females were 56.8 % (N = 175), 51 % had co-morbidity, and 40.6 % were active alcohol drinkers. The prevalence of individuals who experienced a motorcycle accident within the previous six months was 57.1 %. Notably, the most unsafe riding behavior was not wearing a helmet while riding, which had a prevalence of more than 80 % in both the accident and non-accident groups. The study found significant associated factors for motorcycle accidents in rural communities, including the history of alcohol consumption (aOR 1.71, 95 % CI: 1.05,2.79), changing lanes without using turn signals (aOR 1.93, 95 % CI: 1.07,3.48) and those who strongly disagree with the notion that listening to music while riding is dangerous (aOR 2.80, 95 % CI: 1.06, 7.43). Conclusion: Over half of motorcycle riders have been in accidents. These findings emphasize the need to enforce drunk-driving and traffic laws. Comprehensive motorcycle rider education and safety training are needed to encourage responsible riding.

Aspirin for primary prevention in patients with high cardiovascular risk: insights from CORE-Thailand registry.

Aspirin may be considered for primary prevention in non-elderly patients with high cardiovascular risk. However, contemporary management aimed at aggressive cardiovascular risk factor control may alter benefit-risk ratio of aspirin. Therefore, we aimed to examine the effect of aspirin for primary prevention on the long-term MACEs in a large cohort registry. Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) registry is a prospective, multicenter, observational, longitudinal study of Thai patients with high atherosclerotic risk. Patients with established atherosclerotic cardiovascular diseases were excluded. Among 4259 patients with multiple cardiovascular risk factors, 1945 (45.7%) patients used aspirin. After propensity score matching, there were 3228 patients remained in post-matching analysis. During the median follow-up period of 58.2 months, we demonstrated that aspirin use increased risk of long-term MACEs in pre-matching cohort (unadjusted HR 1.76, 95% CI 1.43-2.17, P < 0.001) and post-matching cohort (HR 1.66 (1.31-2.10), P < 0.001). In addition, patients taking aspirin had a higher risk of bleeding than non-aspirin users in pre-matching cohort (unadjusted HR 2.28, 95% CI 1.09-4.75, P = 0.028). We demonstrated that aspirin was associated with increased risk of long-term MACEs in patients with multiple cardiovascular risk factors. Due to the non-randomized design, our results should be interpreted with caution.

Exposure to pesticides and the risk of hypothyroidism: a systematic review and meta-analysis.

BACKGROUND: Knowledge surrounding the association between exposure to pesticides and hypothyroidism is inconsistent and controversial. METHODS: The aim of present study was, therefore, to review scientific evidence systematically and conduct a meta-analysis into the contribution of exposure to pesticides to hypothyroidism. PubMed, Scopus, Web of Science, and Google Scholar were searched. The findings are presented as OR, HR, PR, IRR, and 95% confidence interval (95%CI). A fixed-effect model using the inverse-variance method and random-effects inverse-variance model with DerSimonian-Laird method were used for estimating the pooled estimates. Cochran Q and I2 tests were used to confirm the heterogeneity of selected studies. RESULTS: Twelve studies were included in the systematic review, and 9 studies in the meta-analysis. Epidemiological evidence suggested that exposure to insecticides including organochlorines, organophosphates, and pyrethroids increased risk of hypothyroidism (adjusted odds ratio (aOR) = 1.23, 95%CI = 1.14, 1.33 for organochlorines, aOR = 1.12, 95%CI = 1.07, 1.17 for organophosphates, aOR = 1.15, 95%CI = 1.03, 1.28 for pyrethroids). Exposure to herbicides also increased risk of hypothyroidism (aOR = 1.06, 95%CI = 1.02, 1.10). However, exposure to fungicides and fumigants was not found to be associated with hypothyroidism. CONCLUSION: To increase current knowledge and confirm evidence to date future research needs to center on large-scale longitudinal epidemiological and biological studies, examination of dose-response relationships, the controlling of relevant confounding variables, using standardized and high sensitivity tools, and investigating the effects of environmental exposure.

Effect of Beta-Blocker on Long-Term Major Cardiovascular Events in High Atherosclerotic Risk Population.

PURPOSE: Beta-blocker is a frequently used medication in cardiovascular diseases. However, long-term benefit of beta-blocker in patients with preserved left ventricular ejection function (LVEF) on major adverse cardiovascular events (MACEs) is uncertain. METHODS: The Cohort Of patients with high Risk for cardiovascular Events (CORE-Thailand) was a prospective study that enrolled Thai patients with high atherosclerotic risk including multiple atherosclerotic risk factors and established atherosclerotic cardiovascular diseases. Baseline demographic data, co-morbidities and medication were recorded. Patients were followed for 5 years. Patients with LVEF<50% were excluded. Primary outcome was the effect of beta-blocker on the occurrence of MACEs including all-cause death, non-fatal myocardial infarction and non-fatal stroke (3P-MACEs). Propensity score matching was used to control confounding factors. RESULTS: There was a total of 8513 patients in the pre-matched cohort, 4418 were taking beta-blocker and 4095 were not. After adjustment of confounders, beta-blocker was an independent predictor of 3P-MACEs (adjusted HR 1.29;95% CI 1.12-1.49;p<0.001). After propensity score matching, 4686 patients remained in the post-matched cohort. Propensity score analysis showed consistent results in which patient taking beta-blocker had higher risk of 3P-MACEs (adjusted HR 1.29;95% CI 1.10-1.53;p=0.002). Subgroup analysis in patients with coronary artery disease (CAD) indicated that taking beta-blocker did not increase the incidence of 3P-MACEs (adjusted HR 0.99;95% CI 0.76-1.29) while those without CAD did (adjusted HR 1.51; 95% CI, 1.22-1.86;p-interaction=0.015). CONCLUSION: In patients with high atherosclerotic cardiovascular risk, taking beta-blockers had a higher risk of 3P-MACEs. Care should be taken when prescribing beta-blockers to patients without a clear indication. TRIAL REGISTRATION: TCTR20130520001 registered in Thai Clinical Trials Registry (TCTR) https://www.thaiclinicaltrials.org/ , date of registration 20 May 2013.

Effects of metformin and donepezil on the prevention of doxorubicin-induced cardiotoxicity in breast cancer: a randomized controlled trial.

Doxorubicin (DOX) causes deleterious cardiotoxicity. We aimed to investigate the protective roles of metformin and donepezil against DOX-induced cardiotoxicity. In this randomized-controlled trial, 143 female breast cancer patients were enrolled. Metformin (n = 43), donepezil (n = 52), or placebo (n = 48) were prescribed during DOX treatment. The primary endpoint was a proportion of patients with high sensitivity troponin-I (hsTnI) more than the 99th percentile value (> 15.6 ng/L) after DOX treatment. The secondary outcomes were the changes in the hsTnI, N-terminal pro-B-type natriuretic peptide (NT-proBNP), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS) and peripheral blood mononuclear cells analysis for mitochondrial respiration. Baseline characteristics were similar between the groups. The primary endpoint occurred in 58.54% of metformin group, 76.92% in donepezil group, and 69.77% in placebo group (p = 0.215). The level of hsTnI increased after receiving DOX with subsequent decline in LVEF and GLS. Metformin and donepezil did not attenuate hsTnI elevation, LVEF or GLS reduction. There was no significant change in NT-proBNP level. Mitochondrial respiratory dysfunction was observed in the placebo and donepezil groups. However, metformin preserved mitochondrial respiration during DOX therapy. In conclusion, co-treatment with metformin or donepezil did not prevent myocardial injury. Metformin had a favorable mitochondrial outcome and warranted future studies.

Malnutrition, Depression, Poor Sleep Quality, and Difficulty Falling Asleep at Night Are Associated with a Higher Risk of Cognitive Frailty in Older Adults during the COVID-19 Restrictions.

The COVID-19 restrictions, such as social isolation and disruption of daily routines, can have detrimental effects, including increased stress, anxiety, sleep disturbance, and physical and cognitive decline among older adults. This study aimed to examine the association between nutritional status, depression, sleep quality, falling asleep at night, and cognitive frailty (CF) among older Thai adults during the COVID-19 pandemic. This cross-sectional study included 408 older adults with an average age of 70.54 (5.49) years. CF was determined using Fried's frailty phenotype and the Montreal Cognitive Assessment Basic. The Mini Nutritional Assessment-Short Form, Pittsburgh Sleep Quality Index, and geriatric depression assessment were used for assessment. Multiple logistic regression analysis demonstrated that participants who were malnourished (OR 3.786; 95%CI 1.719-8.335), depressed (OR 5.003; 95%CI 2.399-10.434), had poor sleep quality (OR 1.613; 95%CI 1.041-2.500), and engaged in difficulty falling asleep (OR 1.809; 95%CI 1.022-3.203) had a higher risk of CF compared to those who did not exhibit these factors. Therefore, malnutrition, depression, poor sleep quality, and difficulty falling asleep were identified as risk factors for CF among older adults in Thailand linked to the impact of the COVID-19 pandemic. It is crucial to develop interventions to prevent CF resulting from the mentioned variables.

Predisposing factors of non-syndromic cleft lip and cleft palate in the northern Thai population: A 10-year retrospective case-control study.

The most common congenital anomaly is orofacial cleft, which is categorized into two main types: cleft lip with or without cleft palate (CL/P) and cleft palate only (CPO). One of the most accepted etiologies is multifactorial (gene-environment). This study aimed to identify the amendable risk factors of an orofacial cleft in Northern Thailand. A retrospective case-control study in Maharaj Nakorn Chiang Mai Hospital was conducted from 2011 to 2020. One hundred and seventeen cases of CL/P and CPO were included. Forty-nine normal children were enrolled in a time-matched control group. Exploratory survey data on maternal exposures were collected. Multivariate logistic regression was used to estimate the adjusted association between maternal exposures and CL/P, and CPO occurrence. Multivariate analysis identified three predisposing factors that increased the risk of CL/P and CPO. The first factor was caffeine consumption with a total amount of 560 mg/week (adjusted OR: 7.59; 95% CI: 2.48-23.23; p < 0.001). The second factor was any smoker or passive smoking (adjusted OR: 8.47; 95% CI: 1.63-43.92; p = 0.011). The third factor was a low socioeconomic status (income of lower than 270 USD/month; adjusted OR: 4.05; 95% CI: 1.07-15.27; p = 0.039). From the 10-year study in Northern Thailand: caffeine consumption, exposure to cigarette smoke, and low socioeconomic status were identified as associated negative factors for orofacial clefts. We propose that preconceptional counseling for risk reduction should be emphasized in reducing the mother's exposure to these factors. Future investigations in large multicenter populations are suggested.

The Relationship between Handgrip Strength, Timed Up-and-Go, and Mild Cognitive Impairment in Older People during COVID-19 Pandemic Restrictions.

The COVID-19 lockdown restrictions affected physical performance and cognitive function in older people as they were confined to their homes. There is an association between physical and cognitive functions. Mild Cognitive Impairment (MCI) is a condition that risks progressing to dementia. This study aimed to identify the relationship between handgrip strength (HGS), Timed Up-and-Go (TUG), and MCI in older people during the COVID-19 pandemic restrictions. The cross-sectional study recruited 464 eligible participants for an interview and anthropometric measurement. The Montreal Cognitive Assessment-Basic (MoCA-B), HGS, and TUG were measured in addition to demographic and health characteristics. A total of 398 participants (85.8%) were found to have MCI when screened with the MoCA-B. Their mean age was 71.09 ± 5.81 years. Forward multiple regression analysis demonstrated that HGS (ß = 0.032, p < 0.001), education level (ß = 2.801, p < 0.001), TUG (ß = -0.022, p = 0.013), Thai Geriatric Depression Score, TGDS (ß = -0.248, p = 0.011), and age (ß = -1.677, p = 0.019) were associated with MCI. A decrease in HGS and an increased TUG might allow for the early detection of MCI and promote physical training in order to reduce the risk of MCI. Further studies can investigate multidomain indicators for MCI, for example, fine motor skills and pinch strength as components of the motor abilities.

The Survival Outcomes, Prognostic Factors and Adverse Events following Systemic Chemotherapy Treatment in Bone Sarcomas: A Retrospective Observational Study from the Experience of the Cancer Referral Center in Northern Thailand.

This study aimed to assess survival outcomes, prognostic factors, and adverse events following chemotherapy treatment for osteosarcoma and Ewing's sarcoma. This retrospective observational study was conducted to collect the data of the patients with osteosarcoma or Ewing's sarcoma who received chemotherapy treatment between 2008 and 2019. The flexible parametric survival model was performed to explore the adjusted survival probability and the prognostic factors. A total of 102 patients (79 with osteosarcoma and 23 with Ewing's sarcoma) were included. The estimated 5-year disease-free survival (DFS) and 5-year overall survival (OS) probabilities in patients with resectable disease were 60.9% and 63.3% for osteosarcoma, and 54.4% and 88.3% for Ewing's sarcoma, respectively, whereas the 5-year DFS and 5-year OS for those with unresectable/metastatic disease remained below 25%. Two prognostic factors for osteosarcoma included a response to neoadjuvant chemotherapy and female gender. Ewing's sarcoma patients aged 25 years and older were significantly associated with poorer survival outcomes. Of 181 chemotherapy treatment cycles, common self-reported adverse symptoms included tumor pain (n = 32, 17.7%), fever (n = 21, 11.6%), and fatigue (n = 16, 8.8%), while common grade III adverse events included febrile neutropenia (n = 13, 7.3%) and neutropenia (n = 9, 5.1%). There was no chemotherapy-related mortality (grade V) or anaphylaxis events.

The Urgent Need for Cardiopulmonary Fitness Evaluation among Wildland Firefighters in Thailand.

Wildland firefighting is a high-risk occupation. The level of cardiopulmonary fitness can indicate whether wildland firefighters are ready to perform their job duties. This study's objective was to determine wildland firefighters' cardiopulmonary fitness using practical methods. This cross-sectional descriptive study aimed to enroll all 610 active wildland firefighters in Chiang Mai. The participants' cardiopulmonary fitness was assessed using an EKG, a chest X-ray, a spirometry test, a global physical activity questionnaire, and the Thai score-based cardiovascular risk assessment. The NFPA 1582 was used to determine "fitness" and "job restriction". Fisher's exact and Wilcoxon rank-sum tests were used to compare cardiopulmonary parameters. With a response rate of 10.16%, only eight wildland firefighters met the cardiopulmonary fitness requirements. Eighty-seven percent of participants were in the job-restriction group. An aerobic threshold of eight METs, an abnormal EKG, an intermediate CV risk, and an abnormal CXR were the causes of restriction. The job-restriction group had a higher 10-year CV risk and higher systolic blood pressure, although these differences were not statistically significant. The wildland firefighters were unfit for their task requirements and were more at risk of cardiovascular health compared to the estimated risk of the general Thai population. To improve the health and safety of wildland firefighters, pre-placement exams and health surveillance are urgently needed.

Changes in agricultural context and mental health of farmers in different regions of Thailand during the fifth wave of the COVID-19 pandemic.

BACKGROUND: Thailand's agricultural sector is crucial to the country's development and economy. The COVID-19 pandemic caused negative effects on the agricultural context and the mental health of Thai farmers. This study aimed to compare changes in the agricultural context and mental health among farmers in different regions of Thailand during the fifth wave of the COVID-19 pandemic. We also investigated the determinants associated with the mental health of farmers. METHODS: This cross-sectional study was carried out from December 2021 to January 2022 in Thailand, with 1,676 Thai farmers interviewed. RESULTS: The results found that the Central region found to be the highest impact of increased agrochemical costs (91.0%) and decreased crop yields (92.0%), while the highest in the North and the North-East was found in decreased crop product prices (84.0 and 66.4%). In the context of economic status, the greatest impact in the Central region was found to be in increased household expense (96.3%), while the highest impact in the North, the North-East, and the South was found in decreased household income (91.5, 80.0, and 69.8%, respectively). Regarding mental health, the Central region was found to be the highest prevalence of extremely high stress and severe depression symptoms (18.3 and 23.4%), whereas the South region was found to be the highest prevalence of severe anxiety symptoms (7.4%). Interestingly, the multivariate analysis also found that the agricultural factors associated with mental health were decreased working days, changes in agrochemical type and crop cultivation, decreased crop rotation, increased difficulty in accessing agrochemicals and markets, decreased crop yields, and increased household debt. CONCLUSION: The findings of this study are useful for government and relevant organizations to plan and implement supportive measures and improve mental health services to mitigate both short and long-term impacts of the COVID-19 pandemic suit on the regions. Specific measures and facilities should be tailored toward the target regions.

Comparison of Effects of Storage at Different Temperatures in a Refrigerator, Upright Freezer on Top of Refrigerator, and Deep Freezer on the Immunoglobulin A Concentration and Lysozyme Activity of Human Milk.

This study aimed to investigate the effects of storing expressed human milk (HM) at different domestic storage temperatures on the secretory immunoglobulin A (SIgA) concentration and lysozyme activity. Forty mothers of full-term infants aged one to six months provided milk samples. The fresh samples were examined within 24 h of expression, and the other samples were stored in a refrigerator for four days or in two types of freezers for six months. The SIgA concentrations and lysozyme activity in the milk samples were studied using enzyme-linked immunosorbent assay (ELISA) kits and fluorometric lysozyme activity assay kits, respectively. The pairwise comparisons of the SIgA concentration and lysozyme activity were carried out using one-way analysis of variance with Dunnett T3 or Kruskal-Wallis tests with Bonferroni correction, depending on the data distribution. The mean temperatures of the refrigerator, upright freezer on top of the refrigerator, and deep freezer (chest freezer) were 2.0, -16.7, and -22.3 °C, respectively. Our study results highlight that the SIgA concentration and lysozyme activity of HM stored in the refrigerator for four days and in freezers for six months were significantly lower than those of fresh HM (p < 0.001). During the first six months of storage in both types of freezers, the SIgA levels were stable, whereas the lysozyme activity significantly decreased (p < 0.001). HM stored in the deep freezer had a higher SIgA concentration and lysozyme activity than HM stored in the upright freezer on top of the refrigerator. Our data support the superiority of fresh human milk over stored HM. If HM is to be stored, then storage in a deep freezer is potentially a more effective method for the preservation of SIgA concentrations and lysozyme activity than storage by refrigeration for four days or in an upright freezer on top of a refrigerator for six months.

Respiratory Symptoms and Skin Sick Building Syndrome among Office Workers at University Hospital, Chiang Mai, Thailand: Associations with Indoor Air Quality, AIRMED Project.

Sick building syndrome (SBS) is the term used to describe the medical condition in which people in a building suffer from symptoms of illnesses for no apparent reason. SBS was found to be associated with indoor air quality (IAQ) but there are a variety of determinants (buildings, in particular). Identifying and controlling factors related to SBS is crucial for improving worker health and efficiency. A cross-sectional study was conducted to investigate (1) the prevalence of respiratory symptoms and skin SBS and (2) their associations with IAQ among office workers in administrative offices in an academic medical institute. A self-reporting questionnaire assessing the worker's characteristics, working conditions, and perception of working environments was used. The building assessment was via a walk-through survey and IAQ measurement. Of 290 office workers, 261 (90%) in 25 offices of 11 buildings took part in the survey. The highest prevalence of SBS was nasal symptoms (25.3%). We found that to reduce the risk of SBS, optimal air temperature levels in air-conditioned offices should be lower than 23 °C, with relative humidity between 60% and 70%. Lowering indoor CO2 levels below 700 ppm may be indicative of adequate ventilation to prevent SBS by reducing worker discomfort and indoor contaminants (e.g., formaldehyde).

Effects of Home-Based Nine-Square Step Exercises for Fall Prevention in Thai Community-Dwelling Older Adults during a COVID-19 Lockdown: A Pilot Randomized Controlled Study.

The deterioration of muscle strength in aging has been associated with fall risks. During the COVID-19 pandemic, older adults were restricted from doing outdoor activities. This study aimed to investigate the effect of Nine-Square Step Exercises (NSSE) on improving physical performance and balance in older adults at risk of falling. We conducted an open-labelled, assessor-blinded, randomized controlled trial in 46 (aged 65-84 years) community-dwelling older adults. They were randomly assigned to an NSSE group (n = 24) instructed to perform the program for at least 45 days over 8 weeks or a control group (n = 22). The outcomes were measured by the Timed Up and Go Test (TUG), the Berg Balance Scale (BBS), the Five-Times-Sit-to-Stand test (FTSS), and hand grip strength during the baseline, 4th and 8th weeks in both groups. A mixed-effect linear regression model analysis was performed to estimate the independent effect of NSSE by the intention-to-treat over the 8-week period. The NSSE group showed significant weekly changes in BBS (ß 0.57, 95% CI: 0.30, 0.84), TUG (ß -0.44, 95% CI: -0.74, -0.14), and FTSS (ß -0.52, 95% CI: -0.78, -0.25), demonstrating beneficial improvements in lower extremity and balance, whereas the control group did not demonstrate significant changes over time in any parameter.

Focus on High School: Factors Associated with Creating Harmony between the Educational Transition and Adolescents' Well-Being.

The transition from online to on-site education was difficult due to a lack of standardized school guidance for school reopening. Even though schools have reopened, uncertainty about the COVID-19 situation and the capacity of the school to maintain safe school operations to mitigate risks may increase hesitancy among students and parents to participate in on-site studying. Rapid-response surveys of students and parents can provide information to stakeholders on how learning and well-being can best be supported during the educational transition in each context. The aim of this study was to explore the hesitancy of high-school students and the factors that influenced their hesitancy to return to school on site. An online cross-sectional survey was distributed to high-school students in an urban district of Chiang Mai, Thailand, during the fourth wave of the pandemic from 17 November to 13 December 2021. A multivariable logistic regression was performed to explore factors related to the students' hesitancy to attend on-site education. With a response rate of 10.2% of the targeted study population, the 1266 participants revealed that 15.9% of them had very-high- and extremely high-level hesitancy to study on site, which was associated with less negative moods while studying online (aOR, 1.69; p, 0.016) and a greater fear of infection after returning to school (aOR, 2.95; p, 0.001). Increased readiness to return to school on site (aOR, 0.28; p, 0.001) and discussing COVID-19 prevention with family or friends (aOR, 0.71; p, 0.016) were also associated with a lower hesitancy of students. Only 5.6% of the students reported being hesitant to receive the COVID-19 vaccination. However, no significant associations were found between schooling hesitancy and their willingness to get vaccinated, nor the frequency of students' outside activities. High-school students who experience negative moods during online studying should be monitored and receive additional support if the reopening is postponed. More opportunities to discuss COVID-19 prevention with family or friends, as well as a higher level of readiness, may increase the willingness to return to school on site. Local authorities and schools need to strengthen communication and coordination mechanisms to reduce parents' and students' schooling hesitancy by providing explicit information about the COVID-19 situation and risk-mitigation measures, along with normalizing messages about fear and anxiety.

Effect of N95 Respirator on Oxygen and Carbon Dioxide Physiologic Response: A Systematic Review and Meta-Analysis.

During the COVID-19 pandemic, N95 respirators were commonly used in many situations. Respiratory problems from prolonged use of respirators were discussed in many studies, which show varied results. From the inconclusive results, the current systematic review and meta-analysis discerned the effects of the N95 respirator by assessing the oxygen and carbon dioxide changes in both high- and low-to-moderate-intensity physical activities in a healthy population. Thirteen studies were identified for inclusion in the study. In high-intensity physical activities, our meta-analysis showed borderline lower oxygen saturation and higher carbon dioxide partial pressure, but oxygen saturation did not change in low-to-moderate physical activity. The use of N95 respirators could statistically affect the physiologic changes of carbon dioxide and oxygen in high-intensity physical activity among healthy participants, but this may not be clinically significant. Some users who have certain health conditions, such as respiratory problems, should be informed of the clinical symptoms related to hypercarbia and hypoxia for the early detection of adverse effects of N95 respirators.

Diagnostic Values of Red Flags and a Clinical Prediction Score for Emergent Intracranial Lesions in Non-Traumatic Pediatric Headaches.

INTRODUCTION: Diagnosis of emergent intracranial lesions that require emergency treatment either medically or surgically in non-traumatic pediatric headaches is important. Red-flag signs and symptoms are commonly used as justification for neuroimaging; however, evidence on its diagnostic values is limited. The study aims to identify diagnostic values of red-flags and develop a clinical prediction score to help improve the diagnostic yield of neuroimaging. METHODS: A retrospective review of 109 pediatric patients from 2006 to 2020 who presented with a non-traumatic headache was conducted. A clinical prediction score from red flags was developed using multivariate logistic regression. Discriminatory ability was examined using the area under the receiver operating characteristic curve. RESULTS: A total of 51 patients were diagnosed with emergent intracranial lesions. Four potential clinical red flag predictors were identified: (1) acute onset (less than 3 months), (2) altered conscious state, (3) focal motor abnormality, and (4) and ocular/pupillary abnormality or squint. A clinical prediction score was developed with good discriminatory properties (0.84). CONCLUSIONS: Clinical predictor scores from these four red flags may play an important role in maximizing neuroimaging and proper management for pediatric patients with non-traumatic headaches. Future validation studies are needed and could guide referrals and optimize the use of neuroimaging for these patients.