Effects of the tai chi qigong programme on functional capacity, and lung function in chronic obstructive pulmonary disease patients: A ramdomised controlled trial.

Although the beneficial effect of exercise on the health of Chronic Obstructive Pulmonary Disease (COPD) patients has been widely demonstrated, that of Tai Chi Qigong (TCQ), as an alternative exercise, has been inconclusive. Therefore, this study aimed to evaluate the effects of combined center-and home-based TCQ on functional capacity and lung function in patients with mildly and moderately severe COPD. A total of 50 patients, with a mild and moderate degree of COPD, were recruited and randomly assigned to either the TCQ (n = 25) or control group (n = 25). The TCQ group completed 12-week center-and 12-week home-based training. The control group attended a meeting class once a week for 12 weeks. Outcome measures were assessed at baseline, and the 6th, 12th and 24th week. The primary outcomes were functional capacity (6-min walk test; 6MWT) and lung function. The secondary outcomes were dyspnea score and quality of life. The TCQ group demonstrated significant improvement in functional capacity at week 12 and 24 (p < 0.05) and dyspnea score and quality of life at week 6, 12 and 24 (p < 0.05) when compared to baseline. Functional capacity, forced expiratory volume in 1st second (FEV1), dyspnea score, and quality of life were significantly better in the TCQ group from week 6 to week 24 when compared to the control group (p < 0.05). Combined center-and home-based TCQ training for patients with mildly and moderately severe COPD is effective in improving functional capacity, dyspnea score, and quality of life.

Azithromycin for acute lower respiratory tract infections.

BACKGROUND: Acute lower respiratory tract infections (LRTI) range from acute bronchitis and acute exacerbations of chronic bronchitis to pneumonia. Approximately five million people die from acute respiratory tract infections annually. Among these, pneumonia represents the most frequent cause of mortality, hospitalisation and medical consultation. Azithromycin is a macrolide antibiotic, structurally modified from erythromycin and noted for its activity against some gram-negative organisms associated with respiratory tract infections, particularly Haemophilus influenzae (H. influenzae). OBJECTIVES: To compare the effectiveness of azithromycin to amoxycillin or amoxycillin/clavulanic acid (amoxyclav) in the treatment of LRTI, in terms of clinical failure, incidence of adverse events and microbial eradication. SEARCH METHODS: We searched CENTRAL (2014, Issue 10), MEDLINE (January 1966 to October week 4, 2014) and EMBASE (January 1974 to November 2014). SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs, comparing azithromycin to amoxycillin or amoxycillin/clavulanic acid in participants with clinical evidence of an acute LRTI, such as acute bronchitis, pneumonia and acute exacerbation of chronic bronchitis. DATA COLLECTION AND ANALYSIS: The review authors independently assessed all potential studies identified from the searches for methodological quality. We extracted and analysed relevant data separately. We resolved discrepancies through discussion. We initially pooled all types of acute LRTI in the meta-analyses. We investigated the heterogeneity of results using the forest plot and Chi(2) test. We also used the index of the I(2) statistic to measure inconsistent results among trials. We conducted subgroup and sensitivity analyses. MAIN RESULTS: We included 16 trials involving 2648 participants. We were able to analyse 15 of the trials with 2496 participants. The pooled analysis of all the trials showed that there was no significant difference in the incidence of clinical failure on about days 10 to 14 between the two groups (risk ratio (RR), random-effects 1.09; 95% confidence interval (CI) 0.64 to 1.85). A subgroup analysis in trials with acute bronchitis participants showed significantly lower clinical failure in the azithromycin group compared to amoxycillin or amoxyclav (RR random-effects 0.63; 95% CI 0.45 to 0.88). A sensitivity analysis showed a non-significant reduction in clinical failure in azithromycin-treated participants (RR 0.55; 95% CI 0.25 to 1.21) in three adequately concealed studies, compared to RR 1.32; 95% CI 0.70 to 2.49 in 12 studies with inadequate concealment. Twelve trials reported the incidence of microbial eradication and there was no significant difference between the two groups (RR 0.95; 95% CI 0.87 to 1.03). The reduction of adverse events in the azithromycin group was RR 0.76 (95% CI 0.57 to 1.00). AUTHORS' CONCLUSIONS: There is unclear evidence that azithromycin is superior to amoxycillin or amoxyclav in treating acute LRTI. In patients with acute bronchitis of a suspected bacterial cause, azithromycin tends to be more effective in terms of lower incidence of treatment failure and adverse events than amoxycillin or amoxyclav. However, most studies were of unclear methodological quality and had small sample sizes; future trials of high methodological quality and adequate sizes are needed.

Characteristics and determinants of Thailand's declining birth rate in women age 35 to 59 years old: data from the Fourth National Health Examination Survey.

OBJECTIVE: To describe characteristics and determinants of Thailand's declining birth rate using national representative survey data. MATERIAL AND METHOD: The Fourth National Health Examination Survey was conducted between 2008 and 2009. Four stages of stratified probability samples, proportionate to size, were used to represent the whole Thai population. Information from women aged 35 to 59 years old was included in the analysis. Curve estimation was used to characterize the correlation between the number of children ever born and the age of married and un-married women. Binary logistic regression analysis was used to identify predictors of having fewer than two children among ever married women. RESULTS: Of all 4120 women, the number of children decreased sharply among the oldest women aged 45 to 59 years old, decreased less sharply for women younger than 45 years of age, reached the lowest level at the age of 37 and 38 years old, and then increased minimally among the younger women surveyed. Among those who were ever married (n = 3,761), the independent predictors of having one or no child instead of having two or more children were aged 45 to 49 compared to 50 to 59 years old (OR = 1.66; 95% CI = 1.37-2.00), age 35 to 44 compared to 50 to 59 years old (OR = 1.39; 95% CI = 1.16-1.68), living in households with wealth index level 3 compared to level 1 (OR = 1.28; 95% CI = 1.01-1.63), urban residence (OR = 1.33; 95% CI = 1.14-1.57), attaining secondary school education (OR = 1.35; 95% CI = 1.11-1.64), and having junior college diploma or higher level of education compared to elementary or no education (OR = 1.81; 95% CI = 1.39-2.34). CONCLUSION: Birth rate of Thai women declined steeply in the past then less steeply, and might have begun to rise minimally in recent years. Younger age, living in an urban area, and having higher socioeconomic status were predictors of having fewer than two children.

Acupuncture use among people living with HIV/AIDS in Northern Thailand: motives, barriers, and attitudes.

OBJECTIVE: The present cross-sectional, qualitative study examined attitudes toward and motives for acupuncture use and disuse among people with HIV/AIDS (PHA) in Northern Thailand. MATERIAL AND METHOD: Over a seven-day period, interviews were conducted in Thai by two research assistants and two PHA volunteers on 20 patients. RESULT: The social support, psychological well-being, clinical symptoms, and analgesic avoidance were the primary motives for use among acupuncture users. Among non-acupuncture users, better health status, instrument aversion, lower effectiveness, high perceived risk of deleterious interactions with antiretroviral therapy, inferiority to conventional medicine, and lack of time and knowledge were the main reasons for disuse. Nineteen out of twenty patients expressed positive or neutral attitudes toward acupuncture. Further study is recommended to explore long-term benefits and ramifications of acupuncture as a substitute for pharmacological pain interventions. CONCLUSION: Though acupuncture is not a panacea that is recommended for everyone, health care provide.rs should educate patients about acupuncture's prophylactic benefits, offer services at more convenient times, and be aware of the potential barriers of acupuncture use.

Breastfeeding and its relation to child nutrition in rural Chiang Mai, Thailand.

A cross-sectional study was conducted to evaluate current breastfeeding practices among a population in a remote rural area of Chiang Mai, Thailand. Three hundred and ninety-five women with children aged less than 36 months were studied. Mothers were interviewed and anthropometric status of children was assessed. Seventy per cent of them were from a hill-tribe ethnic group and 30 per cent were Thai. The results showed that breastfeeding was highly prevalent amongst the hill-tribe population especially in uneducated multiparous women. Only 53.6 per cent of children were exclusively breastfed in the first six months of life. Breastfeeding tended to be continued until or beyond the age of one year but complemented with other foods. For children aged up to 6 months, the prevalence of undernutrition, wasting and stunting in the exclusively breastfed group was 0.0 per cent, 1.9 per cent and 7.7 per cent, respectively, compared to 2.1 per cent, 4.3 per cent and 8.5 per cent, respectively in partial/ non-breastfed children (p > 0.05). For children aged between 7-12 months, the undernutrition, wasting, and stunting in the exclusively breastfed group was 23.1 per cent, 15.4 per cent and 7.7 per cent, respectively, compared to 13.4 per cent, 7.3 per cent and 9.8 per cent, respectively in partial/non-breastfed children (p > 0.05). For children older than one year (n = 201), 12 were exclusively breastfed and six of them were undernourished. In the partial/non-breastfed group, 70 of 189 were undernourished (p > 0.05). The results showed that children were more likely to be malnourished as age increases in either exclusively breastfed or partial/non-breastfed group. This may not be a breastfeeding issue but the weaning practices. Appropriate food supplementation and correct weaning practices are essential in order to maintain nutritional status in children beyond six months of age.

Serum and breast-milk vitamin A in women during lactation in rural Chiang Mai, Thailand.

Vitamin A deficiency can occur during lactation and breast-milk vitamin A has been recommended for monitoring the vitamin A status of lactating women and their infants. This study aimed to investigate the vitamin A status of lactating women in relation to race, age, parity, duration of lactation and anthropometric status. A cross-sectional study was conducted among 262 lactating women in rural Chiang Mai, Thailand. Blood and breast-milk samples were collected. Serum retinol, carotene and breast-milk retinol concentrations were analysed by high-performance liquid chromatography. The results show that mean serum retinol and breast-milk retinol in hill tribes were significantly lower than in Thais, 1.91 (0.59) and 0.79 (0.52) compared with 2.10 (0.51) and 1.04 (0.58) mumol/L, respectively. Mean serum retinol and breast-milk retinol were highest during the 1st 3 months of lactation. Maternal age, parity and anthropometric status (BMI) were not associated with serum or breast-milk retinol concentrations. There was a significant relationship between serum and breast-milk retinol values in women who breastfed for 6 months or longer (regression co-efficients 0.30; 95% CI 0.16, 0.43). Breast-milk retinol levels declined significantly from 4 to 12 months after delivery, which could increase the risk of vitamin A deficiency in children who were exclusively breastfed or receiving inappropriate complementary foods during this period. Weaning foods which commence at 6 months and have an adequate vitamin A content should ensure that the vitamin A status of the young child is maintained.