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Air quality health indices (AQHIs) translate multipollutant exposure into graded public-health messages, but their performance as morbidity classifiers or nonlinear lag-informed indicators remains uncertain in tropical megacities. We evaluated the Bangkok AQHI using city-wide outpatient morbidity data from 2021 to 2024. We conducted a retrospective city-wide time series analysis of outpatient department (OPD) data from 23 hospitals across 26 residential postcodes in Bangkok, Thailand, from 2021 to 2024. Fixed AQHI coefficients from the original model were applied without recalibration. The outcomes included broad operational, clinically selected restricted, disease specific, and sensitivity groups. Receiver operating characteristic analyses were used to assess the discrimination of high-morbidity days according to the outcome-specific 90th percentile. Negative binomial models estimated global log-linear associations per interquartile range increase in AQHI. Distributed lag nonlinear models (DLNMs) evaluate nonlinear same-day and cumulative associations over lags 0–7, contrasting AQHI 7 with the citywide median. Sensitivity analyses included post-COVID-19 restriction, PM2.5 comparator analyses, alternative exposure aggregation, postcode fixed effects, spline sensitivity, stratified ROC analyses, and leave-one-year-out validation. Across the 1,461 study days, ROC analyses revealed limited discrimination for all broad and restricted outcomes. The fixed-direction AUCs ranged from 0.353 to 0.539 for the AQHI and from 0.421 to 0.562 for the PM2.5. Negative binomial models revealed no consistent global log-linear associations between the AQHI and morbidity. DLNMs identified small same-day associations at AQHI 7, most coherently for clinically selected respiratory morbidity (RR 1.023, 95
Hemodiafiltration (HDF) is increasingly used because of its enhanced theoretical clearance of diverse uremic toxins, particularly middle molecules and inflammatory cytokines, relative to conventional hemodialysis (HD), yet evidence on its biochemical benefits remains conflicting. Therefore, this meta-analysis was performed to evaluate the effects of HDF versus HD on uremic toxins, inflammation, anemia, and nutritional parameters. A systematic literature search was conducted using PubMed, Scopus, and the Cochrane Central Register of Controlled Trials to identify relevant studies. Only randomized controlled trials (RCTs) were included. Random-effects meta-analyses were performed to evaluate changes in the prespecified outcomes. Twenty-four RCTs involving 6072 dialysis patients were included. Compared with conventional HD, HDF was associated with significant reductions in serum phosphorus (weighted mean difference [WMD] −0.28 mg/dL; 95% CI −0.44 to −0.12) and β2-microglobulin (WMD −4.84 mg/dL; 95% CI −6.13 to −3.54). HDF also significantly reduced serum urea and C-reactive protein (CRP) levels, along with weekly erythropoietin requirements. Serum albumin levels were slightly but significantly lower in the HDF group than in the conventional HD group (WMD –0.06 g/dL; 95% CI −0.10 to −0.01); however, the clinical significance of such a difference remains uncertain. Higher convective volumes were identified as a key determinant of greater reductions in β2-microglobulin and CRP. Compared with conventional HD, HDF demonstrated superior reductions in several surrogate endpoints, including serum phosphorus, urea, β2-microglobulin, CRP, and weekly erythropoietin requirements. Reduced need for phosphate binders and anemia management may lower treatment-related costs.
Background: Exercise is often recommended for patients receiving dialysis, but uncertainty remains regarding its benefit on musculoskeletal and nutritional outcomes. Methods: We conducted a systematic review and random-effects meta-analysis of randomized controlled trials (RCTs) comparing structured exercise (aerobic, resistance, or combined) with usual care, sham, or placebo in patients receiving dialysis. Searches of PubMed, Scopus, and Embase were performed in May 2025 without language or date limits. Primary outcomes included muscle mass, muscle strength (handgrip strength [HGS]), and physical performance (6-minute walk test [6MWT], sit-to-stand test [STS], short physical performance battery [SPPB], and timed up and go test [TUG]). Secondary outcomes were nutritional indicators (serum albumin, body mass index [BMI], and cholesterol), and health-related quality of life (36-item short form health survey [SF-36] score). Results: Thirty-one RCTs including 2535 patients were analyzed. Exercise significantly improved muscle strength and physical performance (HGS + 2.21 kg; 6MWT + 48.2 m; 60sSTS + 4.96 repetitions), exceeding minimal clinically important differences. Gains were consistent across SPPB, TUG, STS-5, and STS-10. However, no significant effects were observed on muscle mass or nutritional markers (serum albumin, BMI, and cholesterol). Quality of life improved in physical domains but not consistently in the SF-36 mental component score. No publication bias was detected except for the SF-36 domain. Conclusion: Exercise training in patients receiving dialysis significantly improves strength, functional capacity, and physical quality of life but does not increase muscle mass or alter nutritional markers. These findings reinforce structured exercise as an evidence-based adjunct to dialysis care and highlight the need for complementary nutritional and anti-inflammatory strategies to more effectively target sarcopenia.
BackgroundDengue and chikungunya, both transmitted by Aedes mosquitoes, continue to pose significant public health concerns in Thailand, particularly during the rainy season. Despite ongoing vector control efforts, the incidence of infection remains high, with an increasing trend observed in chikungunya. This underscores the need for additional control measures, including vaccination, to reduce disease burden and morbidity. This study aims to assess the seroprevalence of dengue and chikungunya infections among children aged 10-15 years in Bangkok and to evaluate the knowledge, attitudes, and practices (KAP) related to mosquito-borne disease prevention.MethodologyA cross-sectional descriptive study was conducted across 12 schools in Bangkok. Children aged 10-15 years were included. Seroprevalence was determined using rapid diagnostic tests (Abbott DENGUE IgG/IgM and Citest Chikungunya IgG/IgM) based on the immunochromatography technique, using fingertip blood samples. Parents completed KAP questionnaires, including factors influencing vaccination decisions.Principal findingsFrom June to August 2024, 937 participants were enrolled, with a mean (SD) age of 11 (1.6) years; 67% were aged 10-12 years, and 33% were aged 13-15 years. The seroprevalence of dengue was 28.1% (95% CI 25.2-31.0), while that of chikungunya was 6.3% (95% CI 4.7-7.9). KAP assessments revealed a high level of awareness regarding symptoms and transmission; however, notable deficiencies in preventive behaviors were identified. Only 14.8% of respondents reported consistent use of mosquito repellent, and 17.5% routinely inspected and removed mosquito larvae from their homes.ConclusionThe substantial seroprevalence of dengue and the emerging trend of chikungunya among children in Bangkok highlights the urgent need to enhance community education and strengthen vector control interventions. Expanding dengue vaccination coverage and raising awareness about chikungunya prevention, including consideration for future vaccine implementation, are essential to mitigating future outbreaks and reducing the disease burden.Trial registrationThai Clinical Trials under the number TCTR20240404002 (https://www.thaiclinicaltrials.org/show/TCTR20240404002).
