Ambient air pollution as a time-varying covariate in the survival probability of childhood cancer patients in the upper Northern Thailand.

The objective of this study is to determine the possible association between exposure to air pollution and the risk of death from cancer during childhood in upper northern Thailand. Data were collected on children aged 0-15 years old diagnosed with cancer between January 2003 and December 2018 from the Chiang Mai Cancer Registry. Survival rates were determined by using Kaplan-Meier curves. Cox proportional hazard models were used to investigate associations of potential risk factors with the time-varying air pollution level on the risk of death. Of the 540 children with hematologic cancer, 199 died from any cause (overall mortality rate = 5.3 per 100 Person-Years of Follow-Up (PYFU); 95%CI = 4.6-6.0). Those aged less than one year old (adjusted hazard ratio [aHR] = 2.07; 95%CI = 1.25-3.45) or ten years old or more (aHR = 1.41; 95%CI = 1.04-1.91) at the time of diagnosis had a higher risk of death than those aged one to ten years old. Those diagnosed between 2003 and 2013 had an increased risk of death (aHR = 1.65; 95%CI = 1.13-2.42). Of the 499 children with solid tumors, 214 died from any cause (5.9 per 100 PYFU; 95%CI = 5.1-6.7). Only the cancer stage remained in the final model, with the metastatic cancer stage (HR = 2.26; 95%CI = 1.60-3.21) and the regional cancer stage (HR = 1.53; 95%CI = 1.07-2.19) both associated with an increased risk of death. No association was found between air pollution exposure and all-cause mortality for either type of cancer. A larger-scale analytical study might uncover such relationships.

Factors Associated with Suspected Developmental Delay in Thai Children Born with Low Birth Weight or Asphyxia.

OBJECTIVES: The aim of the study was to identify factors associated with a risk of suspected developmental delay (SDD) in high-risk children in Thailand. METHODS: We used data on children enrolled for developmental delay (DD) screening across Thailand collected by the Rajanagarindra Institute of Child Development, Department of Mental Health, Ministry of Public Health, Thailand. Children who were under 5 years of age with a birth weight of fewer than 2500 g and/or birth asphyxia in Thailand with high risk of DD were assessed using the Developmental Assessment for Intervention Manual (DAIM) between August 2013 and November 2019 (N = 14,314). RESULTS: The high-risk children who had a gestational age at birth of < 37 weeks (adjusted odds ratio = 1.54; 95% confidence interval = 1.39-1.70) and/or had a birth weight < 2500 g (1.22; 1.02-1.45), or had mothers who were not government officers (1.46; 1.11-1.93), had a low education level (1.36; 1.19-1.55), had a poor nutritional status (1.34; 1.09-1.65), and/or who were living in a high-altitude area (1.59; 1.32-1.91) were at a higher risk of SDD. CONCLUSIONS FOR PRACTICE: Children with a low birth weight and/or asphyxia during birth had a high risk of DD. SDD monitoring of children by community health workers and/or by developing outreach strategies, especially in underserved regions, should be considered. In addition, developing policies and guidelines, and intervention for high-risk children ought to be conducted to reduce the subsequent problems caused by the late detection of DD.

Risk Factors Associated with Loss to Follow-up Among Transgender Women Receiving HIV Pre-exposure Prophylaxis in Chiang Mai province, Thailand.

Although HIV pre-exposure prophylaxis (PrEP) is free in Thailand, many transgender women discontinue taking it after initiation. We determined the loss to follow-up (LTFU) rate of transgender women who initiated PrEP at the Mplus Foundation, Chiang Mai, Thailand, and identified associated risk factors using Cox proportional hazard models. Of 235 participants who initiated PrEP, 59 (55%) out of 108 remaining participants had reactive syphilis. The LTFU rate at 6 months was 38% (95% confidence interval [CI]: 29-48%). Multivariable analysis indicates that LTFU is independently associated with age ≥ 26 years old (adjusted hazard ratio [aHR] = 2.09; 95% CI: 1.06-4.14) and reactive syphilis (aHR = 1.98; 95% CI:1.01-3.88). Delayed appointment scheduling by the PrEP providers and the syphilis clinic was associated with transgender women having reactive syphilis, and the lockdown policy during the COVID-19 pandemic might have influenced them to discontinue PrEP and their subsequent LTFU.

Impact of Residential Concentration of PM2.5 Analyzed as Time-Varying Covariate on the Survival Rate of Lung Cancer Patients: A 15-Year Hospital-Based Study in Upper Northern Thailand.

Air pollutants, especially particulate matter (PM) ≤ 2.5 µm (PM2.5) and PM ≤ 10 µm (PM10), are a major concern in upper northern Thailand. Data from a retrospective cohort comprising 9820 lung cancer patients diagnosed from 2003 to 2018 were obtained from the Chiang Mai Cancer Registry, and used to evaluate mortality and survival rates. Cox proportional hazard models were used to identify the association between the risk of death and risk factors including gender, age, cancer stage, smoking history, alcohol-use history, calendar year of enrollment, and time-updated PM2.5, PM10, NO2 and O3 concentrations. The mortality rate was 68.2 per 100 persons per year of follow-up. In a multivariate analysis, gender, age, cancer stage, calendar year of enrollment, and time-varying residential concentration of PM2.5 were independently associated with the risk of death. The lower the annually averaged PM2.5 and PM10 concentrations, the higher the survival probability of the patient. As PM2.5 and PM10 were factors associated with a higher risk of death, lung cancer patients who are inhabitant in the area should reduce their exposure to high concentrations of PM2.5 and PM10 to increase survival rates.

Associated factors for depressive disorder in patients with end-stage renal disease treated with continuous ambulatory peritoneal dialysis.

BACKGROUND: The aim of this study was to primarily determine factors associated with the depressive disorders in continuous ambulatory peritoneal dialysis (CAPD). METHODS: CAPD patients were recruited from the chronic kidney disease and CAPD Clinic of University Hospital. The stable CAPD patients for at least 3 months were included in the study. Sociodemographic data, renal conditions, and depressive disorder were evaluated. In addition to determining prevalence rate of depressive disorders, identification of factors associated with depressive disorders in CAPD patients were analyzed by using the multivariable logistic regression analysis with backward elimination procedure. RESULTS: The eligible participants were 108 patients. The study found that 11% of CAPD patients were diagnosed with depressive disorders including, minor depressive, dysthymic, and major depressive disorders. Additionally, the depressive disorders were associated with the duration between the diagnosis date of the end-stage renal disease (ESRD) and the initial treatment date (P=0.043). Accordingly, the ESRD patients diagnosed in <12 months had 3.57-fold higher risk of depressive disorders than the patients diagnosed after a long time. CONCLUSION: The rate of prevalence for depressive disorder is high in the CAPD patients. Additionally, the results of this study have shown the relationship between depressive disorder and time for diagnosis of ESRD. Specifically, the risk of depressive disorder increases when patients have a shorter duration between the dates of ESRD diagnosis and initial treatment. In addition to closed monitoring for those patients, the psychiatrists should be consulted for evaluation and treatment of depressive disorders for the suspected high risk patients.

Spatial and Temporal Analyses of Cervical Cancer Patients in Upper Northern Thailand

Background: Cervical cancer is a major public health problem worldwide. There have been several studies indicating that risk is associated with geographic location and that the incidence of cervical cancer has changed over time. In Thailand, incidence rates have also been found to be different in each region. Methods: Participants were women living or having lived in upper Northern Thailand and subjected to cervical screening at Maharaj Nakorn Chiang Mai Hospital between January 2010 and December 2014. Generalized additive models with Loess smooth curve fitting were applied to estimate the risk of cervical cancer. For the spatial analysis, Google Maps were employed to find the geographical locations of the participants' addresses. The Quantum Geographic Information System was used to make a map of cervical cancer risk. Two univariate smooths: x equal to the residency duration was used in the temporal analysis of residency duration, and x equal to the calendar year that participants moved to upper Northern Thailand or birth year for participants already living there, were used in the temporal analysis of the earliest year. The spatial-temporal analysis was conducted in the same way as the spatial analysis except that the data were split into overlapping calendar years. Results: In the spatial analysis, the risk of cervical cancer was shown to be highest in the Eastern sector of upper Northern Thailand (p-value <0.001). In the temporal analysis of residency duration, the risk was shown to be steadily increasing (p-value =0.008), and in the temporal analysis of the earliest year, the risk was observed to be steadily decreasing (p-value=0.016). In the spatial-temporal analysis, the risk was stably higher in Chiang Rai and Nan provinces compared to Chiang Mai province. According to the display movement over time, the odds of developing cervical cancer declined in all provinces. Conclusions: The risk of cervical cancer has decreased over time but, in some areas, there is a higher risk than in the major province of Chiang Mai. Therefore, we should promote cervical cancer screening coverage in all areas, especially where access is difficult and/or to women of lower socioeconomic status.