Fall among physically active elderly in senior housings, Bangkok, Thailand: situations and perceptions

Natthawadee Maneeprom, Surasak Taneepanichskul, Alessio Panza College of Public Health Sciences, Chulalongkorn University, Bangkok 10330, Thailand Purpose: A mixed-method study aimed to assess situations in which falls occur including prevalence and associated risk factors of falls among physically active elderly who are at risk of experiencing a fall in senior housings, Bangkok, Thailand, and their perceptions regarding falls. Patients and methods: In the first phase, a cross-sectional study was conducted on 64 physically active elderly senior housing residents. Data on sociodemographics, health status, Barthel Index (BI) of activities of daily living, and fall experiences were collected through face-to-face interviews. Data on balance scores were obtained from Time Up and Go (TUG) test and Berg Balance Scale (BBS). In the second phase, a qualitative study was conducted on 41 physically active elderly who had experienced falls. Data regarding perception on falls, fall preventions, and fall management, were gathered through in-depth interviews from November 2017 to December 2017. Results: The prevalence of falls among participants in senior housings was 64.1%. Univariate analysis found that a higher BI was associated with fall (P<0.004). Multivariate analysis using binary logistic regression showed that a higher BI (OR=6.00, 95% CI=1.24–29.10) together with ≥2 environmental hazards (OR=6.33, 95% CI=1.24–32.29) were associated with fall. The result from content analysis indicated that the elderly were aware that they were at risk of fall. In addition, the elderly also perceived that fall could be avoided even though they did not know how to prevent it. Conclusion: The prevalence of fall among physically active elderly in senior housings was relatively high. A higher BI scale and having ≥2 environmental hazards were associated risk factors of falls. Although the elderly perceived that fall could be avoided, they did not know how to prevent it. The intervention that focuses on environmental modification, balancing enchantment, and education on fall prevention is highly required. Keywords: fall, elderly, senior housing, perception, Thailand, fall preventio

Implementing a geographical information system to assess endemic fluoride areas in Lamphun, Thailand

Nonthaphat Theerawasttanasiri,1,2 Surasak Taneepanichskul,1 Wichain Pingchai,3 Yuwaree Nimchareon,4 Sangworn Sriwichai5 1College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand; 2Department of Health, Health Promotion Center Region 1, Chiang Mai, Thailand; 3Mueang Lamphun District Public Health Office, 4Pasang District Public Health Office, 5Ban Thi District Public Health Office, Lamphun, Thailand Introduction: Many studies have shown that fluoride can cross the placenta and that exposure to high fluoride during pregnancy may result in premature birth and/or a low birth weight. Lamphun is one of six provinces in Thailand where natural water fluoride (WF) concentrations >10.0 mg/L were found, and it was also found that >50% of households used water with high fluoride levels. Nevertheless, geographical information system (GIS) and maps of endemic fluoride areas are lacking. We aimed to measure the fluoride level of village water supplies to assess endemic fluoride areas and present GIS with maps in Google Maps.Methods: A cross-sectional survey was conducted from July 2016 to January 2017. Purpose sampling was used to identify villages of districts with WF >10.0 mg/L in the Mueang Lamphun, Pasang, and Ban Thi districts. Water samples were collected with the geolocation measured by Smart System Info. Fluoride was analyzed with an ion-selective electrode instrument using a total ionic strength adjustment buffer. WF >0.70 mg/L was used to identify unsafe drinking water and areas with high endemic fluoride levels. Descriptive statistics were used to describe the findings, and MS Excel was used to create the GIS database. Maps were created in Google Earth and presented in Google Maps.Results: We found that WF concentrations ranged between 0.10–13.60 mg/L. Forty-four percent (n=439) of samples were at unsafe levels (>0.70 mg/L), and. 54% (n=303) of villages and 46% (n=79,807) of households used the unsafe drinking water. Fifty percent (n=26) of subdistricts were classified as being endemic fluoride areas. Five subdistricts were endemic fluoride areas, and in those, there were two subdistricts in which every household used unsafe drinking water.Conclusion: These findings show the distribution of endemic fluoride areas and unsafe drinking water in Lamphun. This is useful for health policy authorities, local governments, and villagers and enables collaboration to resolve these issues. The GIS data are available at https://drive.google.com/open?id=1mi4Pvomf5xHZ1MQjK44pdp2xXFw&usp=sharing. Keywords: endemic fluoride area, water supply, Google Maps, safe drinking water, GI

Organophosphate pesticide exposure and dialkyl phosphate urinary metabolites among chili farmers in Northeastern Thailand

Background. Chlorpyrifos and profenofos are organophosphate pesticides (OPPs), we studied exposure and urinary metabolites in an agricultural area in the northeastern of Thailand during the chili-growing season (March - April) in 2012. Objective. This study was designed to assess pesticide exposure concentration through dermal and inhalation pathways and to find and depict a relationship between urinary metabolites and means of exposure. Materials and methods. To estimate the pesticides exposure concentration, dermal wipes (hand, face, and feet), dermal patches and air samples were collected from 38 chili farmers. The morning void of pre and post application urine samples was an indicator of biological monitoring in the study which derived from 39 chili farmers. Results. Chlorpyrifos and profenofos residues were detected on dermal patches, face wipes, and hand wipe samples, while no significant residues were found on the feet. Using a personal air sampling technique, all air samples detected pesticide residues. However, significant correlation between dermal pesticide exposure concentration and inhalation was not found (p>0.05). For urinary metabolite levels, there was a relationship between the first pre application morning void and post application morning void (p<0.05); similar to the association between the first pre application morning void and the second post application morning void (p<0.05). The main relationship between pesticide exposure and urinary metabolite was found to have been relevant to dermal exposure (r= 0.405; p<0.05). Conclusions. The results of this study could suggested that public health education training programs, including the use of appropriate personal protective equipment (PPE), should be offered for the chili growing farmers in order to improve their ability to properly use pesticides.Wprowadzenie. Chlorpiryfos i profenofos należą do pestycydów fosforoorganicznych (OPPs) stosowanych w rolnictwie, dlatego narażenie na te związki badano w północnowschodniej Tajlandii w okresie uprawy chili (marzec – kwiecień) w 2012 roku. Cel. Celem badania była ocena narażenia na pestycydy przez skórę i drogi oddechowe oraz zbadanie zależności pomiędzy stężeniami metabolitów w moczu a drogą narażenia. Materiał i metoda. Do oceny wielkości narażenia wykorzystano wymazy z rąk, twarzy i stóp i naskórne plastry absorpcyjne oraz próbki powietrza pobierane za pomocą indywidualnych próbników u 39 rolników uprawiających chili. Wyniki. Pozostałości chlorpiryfosu i profenofosu stwierdzano na plastrach absorpcyjnych, wymazach z twarzy i rąk, podczas gdy w wymazach ze stóp nie stwierdzano znaczących ilości tych pestycydów. We wszystkich próbkach powietrza stwierdzono obecność pestycydów. Jednakże, nie wykazano znaczącej korelacji pomiędzy wielkością narażenia przez skórę i drogi oddechowe (p>0.05). W przypadku poziomów metabolitów w moczu, wykazano zależność pomiędzy poziomami metabolitów w moczu przed i po pierwszym zabiegu wykonywanym rano (p<0.05). Zależność pomiędzy narażeniem na pestycydy a stwierdzanymi metabolitami w moczu wynikała z narażenia przez skórę (r= 0.405; p<0.05). Wnioski. Wyniki niniejszych badań mogą sugerować potrzebę wprowadzenia programów edukacyjnych z zakresu zdrowia publicznego, uwzględniających stosowanie przez hodowców chili odpowiedniego sprzętu ochrony osobistej, w celu poprawy możliwości właściwego stosowania pestycydów

Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08.

BACKGROUND: There has been concern about rising rates of caesarean section worldwide. This Article reports the third phase of the WHO global survey, which aimed to estimate the rate of different methods of delivery and to examine the relation between method of delivery and maternal and perinatal outcomes in selected facilities in Africa and Latin America in 2004-05, and in Asia in 2007-08. METHODS: Nine countries participated in the Asia global survey: Cambodia, China, India, Japan, Nepal, Philippines, Sri Lanka, Thailand, and Vietnam. In each country, the capital city and two other regions or provinces were randomly selected. We studied all women admitted for delivery during 3 months in institutions with 6000 or fewer expected deliveries per year and during 2 months in those with more than 6000 deliveries. We gathered data for institutions to obtain a detailed description of the health facility and its resources for obstetric care. We obtained data from women's medical records to summarise obstetric and perinatal events. FINDINGS: We obtained data for 109 101 of 112 152 deliveries reported in 122 recruited facilities (97% coverage), and analysed 107 950 deliveries. The overall rate of caesarean section was 27.3% (n=29 428) and of operative vaginal delivery was 3.2% (n=3465). Risk of maternal mortality and morbidity index (at least one of: maternal mortality, admission to intensive care unit [ICU], blood transfusion, hysterectomy, or internal iliac artery ligation) was increased for operative vaginal delivery (adjusted odds ratio 2.1, 95% CI 1.7-2.6) and all types of caesarean section (antepartum without indication 2.7, 1.4-5.5; antepartum with indication 10.6, 9.3-12.0; intrapartum without indication 14.2, 9.8-20.7; intrapartum with indication 14.5, 13.2-16.0). For breech presentation, caesarean section, either antepartum (0.2, 0.1-0.3) or intrapartum (0.3, 0.2-0.4), was associated with improved perinatal outcomes, but also with increased risk of stay in neonatal ICU (2.0, 1.1-3.6; and 2.1, 1.2-3.7, respectively). INTERPRETATION: To improve maternal and perinatal outcomes, caesarean section should be done only when there is a medical indication. FUNDING: US Agency for International Development (USAID); UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), WHO, Switzerland; Ministry of Health, Labour and Welfare of Japan; Ministry of Public Health, China; and Indian Council of Medical Research