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Pneumonia is a significant global public health problem, and climatic factors play a crucial role in disease epidemic dynamics. However, there are limited studies on this relationship in tropical monsoon coastal climate regions. This study aimed to analyze the impact of climatic factors on pneumonia pattern in Satun Province, a southern coastal province of Thailand, using Bayesian Structural Time Series (BSTS) modeling. This ecological study utilized monthly time series data spanning 10 years (January 2015 – December 2024). Pneumonia case data (ICD-10: J12-J18) were collected from the National Disease Surveillance System, and monthly climatic data were obtained from Satun Province meteorological stations. The BSTS model was employed to decompose long-term trend components, seasonal patterns, and the simultaneous effects of multiple climatic variables, using spike-and-slab priors technique for Bayesian variable selection. The median number of pneumonia cases was 63.0 cases per month (IQR: 34.0-102.0). BSTS model analysis revealed that relative humidity was the most influential climatic predictor of pneumonia cases, demonstrating a 2-month lag effect (Posterior Inclusion Probability [PIP] = 0.284). A one standard deviation increase in relative humidity was associated with approximately 6.4% increase in cases. Other climatic variables such as temperature, precipitation, and wind speed were not identified as robust predictors in the final model. Additionally, distinct seasonal epidemic patterns were observed, with case peaking during October-November. Relative humidity is a factor associated with pneumonia epidemics in Satun Province, challenging traditional concepts that typically emphasize temperature as the primary factor in temperate regions. The discovery of this 2-month lag relationship is significant for developing public health early warning systems, enabling effective preparation of resources and proactive preventive measure planning.

Background Dengue fever represents a significant and escalating public health challenge in tropical megacities such as Bangkok, Thailand. This study aims to examine the associations between temperature, humidity, rainfall, and wind speed with dengue incidence across multiple lag periods and to explore spatial heterogeneity in these climate-dengue relationships across Bangkok’s urban zones. Methodology Analysis of 105,890 confirmed dengue cases reported in Bangkok between 2015 and 2024, stratified across six urban zones. Distributed Lag Non-Linear Models (DLNM) were employed to quantify the effects of four key meteorological variables: temperature, humidity, rainfall, and wind speed. Results Significant non-linear relationships and heterogeneity in climate-driven dengue risk were found across both space and time. Spatially, the effects were most pronounced for humidity and wind speed. For instance, over a 0–2 months lag, higher humidity was associated with a substantial increase in risk in North Krung Thon (RR=1.477, 95% CI: 1.290–1.690) but a significant protective effect in South and Middle Bangkok. Similarly, wind speed was associated with a significant risk increase in South Bangkok (RR=1.405, 95% CI: 1.293–1.526) but a protective effect in East Bangkok (RR=0.749, 95% CI: 0.710–0.789). Elevated minimum temperature also exhibited a spatially varied impact, peaking in Middle Bangkok (RR=1.350, 95% CI: 1.288–1.414). The analysis confirmed distinct patterns over time, with climate impacts manifesting as immediate risks in some zones and as pronounced delayed risks (8–12 months) in others. Conclusion The associations between climatic variables and dengue incidence in Bangkok are highly complex, non-linear, and characterized by significant spatial and temporal heterogeneity. The varied timing of climate impacts, from immediate to delayed, suggests that public health responses must be adapted to the unique temporal risk structures of each urban zone, providing a framework for more precise interventions in complex urban environments.

Kratom ( Mitragyna speciosa ) has transitioned from a traditional Southeast Asian remedy to a substance of global interest. The existing evidence on its safety is contradictory, with case reports from Western countries suggesting organ toxicity, while community-based studies in traditional settings show minimal adverse effects. This study aimed to evaluate the physiological impact of long-term, traditional kratom use in an endemic region of Southern Thailand. A cross-sectional study was conducted among 285 traditional kratom users and 296 non-user controls from the same community. Key hematological and clinical-chemistry parameters, including liver and kidney function markers, were compared. Analyses were stratified by sex and kratom use characteristics (duration and quantity) to assess subgroup-specific effects. Analysis of Covariance (ANCOVA) was used to adjust for potential confounding variables, including age, sex, BMI, smoking, and alcohol consumption. After adjusting for confounders, no clinically significant differences were observed in hepatic or hematological parameters, with mean values for both groups remaining within normal clinical reference ranges. However, kratom use was significantly associated with lower serum creatinine ( p  < 0.001) and higher eGFR ( p  = 0.002), a finding likely attributable to the lower BMI in the user group. Stratified analyses by duration and quantity revealed no clear dose–response relationship regarding organ toxicity, although higher consumption was associated with altered renal markers. These findings suggest that within a traditional-use setting, chronic kratom consumption was not associated with clinically significant hepatic or hematological toxicity. The observed association with renal markers is explained by differences in body composition rather than a direct pharmacological effect. These findings underscore the critical importance of controlling for lifestyle and demographic confounders in evaluating the health impacts of kratom.

Chronic cadmium exposure is linked to bone loss, but its effect on the short-term progression of bone mineral density (BMD) in previously exposed populations is not well understood. This study aimed to investigate the association between baseline urinary cadmium (U-Cd) levels and the subsequent three-year change in BMD in a chronically exposed cohort in northwestern Thailand. We conducted a three-year longitudinal study of 393 residents (40 men, 353 women) aged 35 and older. Baseline (2019) U-Cd was the primary exposure, and BMD at the calcaneus was measured in 2019 and 2022. Dual-energy X-ray absorptiometry was used for BMD measurements and atomic absorption spectrometry for U-Cd analysis. The mean U-Cd levels in males (7.18 ± 1.35 μg/g creatinine) were significantly higher (p < 0.001) than in females (3.68 ± 2.13 μg/g creatinine). This study found a statistically significant decrease in BMD in the group with the lowest U-Cd levels (<2.0 μg/g creatinine, p = 0.001) and in the overall sample (from 0.392 ± 0.079 μg/g creatinine in 2019 to 0.384 ± 0.094 μg/g creatinine in 2022, p = 0.004). However, no statistically significant changes were observed in groups with U-Cd levels above 2.0 μg/g creatinine. Osteoporosis prevalence remained stable in both males and females. The Linear Mixed-Effects Model analysis revealed significant associations between BMD and several factors: increasing age, female sex, diabetes status and BMI. Age and female sex were negatively associated with BMD, while BMI showed a positive relationship. U-Cd levels were not significantly associated with BMD changes over the three-year period (coefficient = −0.002, p = 0.073), though a slight downward trend in BMD was observed across all cadmium exposure levels. This study underscores the complexity of cadmium’s effects on bone health and emphasizes the need for longer-term follow-up studies to better understand the potential cumulative impact of cadmium exposure on BMD.

The increasing prevalence of e-cigarette use among adolescents and young adults has raised concerns about its potential association with cognitive and behavioral functions. While nicotine exposure is known to affect brain development, its associations with Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms, emotional intelligence (EQ), and dementia risk remain unclear. This study primarily examined the association between e-cigarette use and cognitive impairment assessed by the Montreal Cognitive Assessment (MoCA). Secondary analyses explored associations with ADHD symptom tendencies and emotional intelligence. A cross-sectional analytical study was conducted in Lat Krabang District, Bangkok, Thailand, with 232 participants aged 18–25 years, equally divided into e-cigarette users (n = 116) and non-smokers (n = 116). Data were collected using the Adult ADHD Self-Report Scale (ASRS-v1.1, 18 items), the Emotional Quotient Test, and the Montreal Cognitive Assessment (MoCA). Statistical analyses compared cognitive function, EQ levels, and dementia risk between the two groups. No significant differences were found in ADHD symptom tendencies and EQ levels between e-cigarette users and non-smokers. However, e-cigarette users exhibited a significantly higher proportion of dementia risk compared to non-smokers. Notably, individuals with no intention to quit within one month had a sixfold increased dementia risk, while those without plans to quit within six months had a fourfold increased risk. No other personal factors significantly influenced dementia risk. While e-cigarette use was not significantly associated with ADHD symptom tendencies or EQ levels, it was associated with a higher likelihood of dementia risk. These findings suggest potential neurocognitive concerns related to e-cigarette use; however, causal inferences cannot be made due to the cross-sectional design. Further longitudinal studies are warranted to clarify these relationships.

The purposes of this study were to determine the prevalence of osteoporosis after 15 years of reduced cadmium exposure and to determine the association between urinary cadmium (U-Cd) and osteoporosis. The study was conducted with 937 participants (109 males, 828 females) living in a cadmium-contaminated area in northwestern Thailand. All participants were required to respond to a questionnaire. Bone mineral density (BMD) was investigated by measurements taken at the calcaneus by dual-energy X-ray absorptiometry. U-Cd, which reflects the amount of cadmium contained in the body, was measured by atomic absorption spectrophotometry (AAS). The geometric mean of U-Cd was significantly higher in males than in females ( p < 0.001). The mean level of BMD for females was found to be statistically significantly lower than that for males ( p < 0.001). Increasing U-Cd levels were correlated with decreasing levels of BMD. The association between U-Cd and osteoporosis appeared to exist only at concentrations of U-Cd ≥ 10 μg/g creatinine (OR = 2.7, 95% CI = 1.2–5.9). It can be concluded that despite discontinued or reduced cadmium exposure for more than 10 years, the effect of cadmium toxicity on bone, which is stronger in women, continues, as cadmium, once absorbed, will accumulate in the human body for a long time due to its extremely long half-life.

Although high-level carotid bifurcation (HCB) could lead to notable surgical difficulty, the definitive reference point for HCB is unclear. HCB is typically characterized as carotid bifurcation (CB) located higher than the level of the third cervical vertebra (C), however, a major obstacle regarding carotid artery surgical exposure is angle of the mandible (AM). The objective of this study was to investigate CB level, define HCB in relation to AM and vertebral levels, and measure the vertical distance from HCB to ipsilateral AM. Moreover, the percentage of surgically challenged CBs, misclassified as low CBs (LCB) based on vertebral level, was investigated. Patients who underwent neck computed tomography angiography were retrospectively studied. HCBs were classified into two categories: CBs above the C3 and either at or above the ipsilateral AM. Of 172 CBs (86 patients; 57 men, 29 women), CB was mostly found at C3 (44.19%), whereas AM was commonly located at C2 (51.16%). Based on vertebral level and AM, HCBs were detected in 10.47% and 20.35% of CBs, respectively. The association of HCBs determined by either C3 or AM between both sides in each individual was nonsignificant (p>0.05), but HCBs determined by C3 level were predominant in women (OR = 3.58, 95%CI = 1.31–9.80). Considering both C3 and AM, there was 8.72% of HCBs. The remaining 91.28% was classified as LCBs, including 11.63% of CBs located at both C3 and AM which were actually classified as HCBs if determined by AM. In cases of CBs above AM level, the mean vertical distance was as high as 6.56 ±2.41mm.

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.

The tropical climate of Thailand encourages very high mosquito densities in certain areas and is ideal for dengue transmission, especially in the southern region where the province Nakhon Si Thammarat is located. It has the longest dengue fever transmission duration that is affected by some important climate predictors, such as rainfall, number of rainy days, temperature and humidity. We aimed to explore the relationship between weather variables and dengue and to analyse transmission hotspots and coldspots at the district-level. Poisson probability distribution of the generalized linear model (GLM) was used to examine the association between the monthly weather variable data and the reported number of dengue cases from January 2002 to December 2018 and geographic information system (GIS) for dengue hotspot analysis. Results showed a significant association between the environmental variables and dengue incidence when comparing the seasons. Temperature, sea-level pressure and wind speed had the highest coefficients, i.e. β=0.17, β= –0.12 and β= –0.11 (P<0.001), respectively. The risk of dengue incidence occurring during the rainy season was almost twice as high as that during monsoon. Statistically significant spatial clusters of dengue cases were observed all through the province in different years. Nabon was identified as a hotspot, while Pak Phanang was a coldspot for dengue fever incidence, explained by the fact that the former is a rubber-plantation hub, while the agricultural plains of the latter lend themselves to the practice of pisciculture combined with rice farming. This information is imminently important for planning apt sustainable control measures for dengue epidemics.

This study was performed to investigate the dose-response relationship between average daily cadmium dose (ADCD) from rice and the occurrence of urinary cadmium (U-Cd) in individuals eating that rice. This was a retrospective cohort designed to compare populations from two areas with different levels of cadmium contamination. Five-hundred and sixty-seven participants aged 18 years or older were interviewed to estimate their rice intake, and were assessed for U-Cd. The sources of consumed rice were sampled for cadmium measurement, from which the ADCD was estimated. Binary logistic regression was used to examine the association between ADCD and U-Cd (cut-off point at 2 µg/g creatinine), and a correlation between them was established. The lowest estimate was ADCD = 0.5 µg/kg bw/day [odds ratio (OR) = 1.71; with a 95% confidence interval (CI) 1.02–2.87]. For comparison, the relationship in the contaminated area is expressed by ADCD = 0.7 µg/kg bw/day, OR = 1.84; [95 % CI, 1.06–3.19], while no relationship was found in the non-contaminated area, meaning that the highest level at which this relationship does not exist is ADCD = 0.6 µg/kg bw/day [95% CI, 0.99–2.95]. Rice, as a main staple food, is the most likely source of dietary cadmium. Abstaining from or limiting rice consumption, therefore, will increase the likelihood of maintaining U-Cd within the normal range. As the recommended maximum ADCD is not to exceed 0.6 µg/kg bw/day, the consumption of rice grown in cadmium-contaminated areas should not be more than 246.8 g/day. However, the exclusion of many edible plants grown in the contaminated area from the analysis might result in an estimated ADCD that does not reflect the true level of cadmium exposure among local people.