plueme/wizJson huggingface dataset:
Since 2002, Thailand has achieved Universal Health Coverage (UHC) under the three main
public health insurance schemes. UHC enabled Thai population to access essential healthcare services
regardless of income. Patient would not be worried about negative financial impacts from medical
bills to their household however the unmet health need can be found. Therefore, there is a study
on unmet health need conducted in order to monitor UHC on another aspect and to demonstrate
whether or not Thailand has patients who cannot access health service when needed, if yes, how
many; who are they and why? The objective of this study is to analyze prevalence of unmet health
need, to describe profile of patients with unmet health need and to identify factors and reasons for
unmet health need. Descriptive statistics and logit model were applied for analysis of Health and
Welfare Survey (HWS) in 2015 with 55,920 sampled households representing Thai populations.
Prevalence of unmet health need for outpatient, inpatient and dental service were 1.50 percent,
0.14 percent and 0.99 percent of all population, respectively. Main factors of being unmet health
need were age, especially elderly; uninsured people; and the poorest household economic group.
In addition, people living in Bangkok had more unmet health need for outpatient services than other
regions. The main reasons of unmet health need were inadequate time of patient for seeking care,
too long queue at health facilities, and too far to travel to health facilities.
Ministry of Public Health, National Health Security Office and other relevant agencies should
collectively work together for a policy and strategy to reduce unmet health need of Thai population,
especially for elderly. Primary health care service delivery system should be strengthened to cover
all urban areas in particular in Bangkok. “Close to client health services” should be developed for
improving access to health services.
This study used health and welfare survey 2015, national household survey, to explore pattern
of dental service utilization including use of health insurance, and expenditure among Thai population
in order to improve national policies related to dental services. The results showed that (1) 8.1
percent of Thai population received dental services in the past 12 months. More than 80% of dental
services were dental treatment. Thus, dental health policies should focus more on dental prevention
and promotion. (2) Main reasons of unmet need were no time to get the services and long waiting
time. So, the dental health service providers should be expanded. (3) Different access to dental services
associated with different health insurance schemes. The dental services should be harmonized
among health insurance schemes in particular payment methods, and benefit package and points of
service. Also, criteria, quality control, scope of services and payment mechanism should be considered.
Advancement of Universal Health Coverage in Thailand since 2002 increased access to both
outpatient (OP) and inpatient (IP) services. This study aimed to analyze the utilizations of government
health insurance schemes and also the factors affecting access to outpatient and inpatient services in
2015. Based on the 2015 Health and Welfare Survey data, descriptive and logit model was performed
to analyze individual utilization of outpatient and inpatient and the factors determining the heath care
utilization.
Results demonstrated that universal health coverage scheme covered the majority of Thai
population. However, the general characteristic, employment and economic status of beneficiaries
differed across different schemes. The illness rate for ambulatory care was 3.1 episodes per capita per
year. Over-the-counter medicines had the biggest share around 27.2 percent, while the hospitalization
was 0.06 admission per capita per year. Most of them were admitted at community hospital and
general hospital (39.6 percent and 38.7 percent respectively), while the hospitalization in private
hospital was only 11.3 percent. In addition, there are some other factors that affected the utilization
of both outpatient and inpatient services such as household characteristic, chronic diseases and the
variation of benefit package of each scheme.
Many people chose to buy drug (around one-third of total treatments). It is important to
establish safety measures through awareness on rational use of drugs and develop a mechanism to
ensure drug quality. Policy maker should strengthen primary care services such as family care team,
home health care and long-term care to reduce the utilization gap in vulnerable groups especially the
poor and elderly and reduce financial burden from medical treatment of patient with chronic disease.
Moreover, government should expand the coverage to uninsured group to increase access to health
care services without financial burden to reduce the gap among health insurance groups.
This study aimed to determine the adequate physical activity level of Thai adults, and disaggregated
by subgroups of participants. The study re-analyzed data of 108,416 Thai adults aged 18 and
above from the 2015 National Health and Welfare Survey conducted by National Statistical Office. Descriptive
and analytical statistics were defined in the analysis. The results showed that 42.4% of Thai
adults aged 18 and above met physical activity level according to the recommendation by the World
Health Organization and 33.8% had high level of physical inactivity. Most males, farmers and laborers,
and those who had no underlying diseases, reached recommended physical activity level and had
low-rate of high level of physical inactivity. On the other hand, most elderly, unemployed, and those
who had underlying diseases, did not reach recommended physical activity level and had high-rate of
high level of physical inactivity. Our findings will benefit to the national policy development to reduce
sedentary behaviors and increase physical activity especially in work and transportation domains, with
the focus on the subpopulations that did not reach the recommended physical activity level and had
high level of physical inactivity.
Health service provision in urban area is a key challenge in Thailand as there is only tertiary care
hospital and a network of health center provides curative and health prevention services. As a result,
primary care services seem to be neglected. Recently, there are interventions to upgrade health health promotion services in Mueang districts of Nakhon Ratchasima and Burirum provinces. Capitation
budget for out-patient care is now transferred to CUP instead of provincial hospital. This study aims
to explore process in setting up those autonomous CUPs as well as key success factors and remaining
challenges in these provinces to be lessons learned for other provinces.
We reviewed documents and interviewed key informants who involved in setting up autonomous
CUPs or were working in those CUPs. Results showed that main purposes of autonomous CUPs were
to reduce crowdedness of provincial hospitals and to improve quality and access of health services
at health centers. One major change after the implementation was the increased numbers of staff
especially those of medical doctors and supporting staff. Key success factors are consistent with
policy direction at provincial and district levels as well as availability of retired medical doctors who
were key human resources. The remaining challenges were to increase active role of District Health
Coordinating Committee, integrate district health system principle and appoint responsible persons to
coordinate health service system within the district.
A cross-sectional survey research aimed to compare the humanitarian behaviors between patients’
and providers’perspectives. The samples were out- and in-patients and staff of Queen Savang Vadhana
Memorial Hospital, The Thai Red Cross Society. The sample sizes were estimated by Krejcie & Morgan
table. Data were collected by the generated questionnaire with Likerts’ scale from 1 to 5 scores. Its
indexes of item objective congruence were 1.7-2.0 from range 0-2 scores, and its reliability was 0.95
by Cronbach’s alpha. One-way analysis of variance and independent t-test were used to compare the
humanitarian behavior scores among the three groups, and between the two groups including patients and provider. A p value less than 0.01 was defined as significant difference.
Five hundred out-patients, 630 in-patients, and 1250 staffs answered the questionnaires. The
average age of in-patients was the highest, followed by of staffs, and of out-patients (mean (SD) =
41.4 (16.1), 36.9 (10.3), 33.9 (9.6) year old (p<0.001), respectively). The humanitarian services behavior
scores among the three groups were significant different, and the scores from lowest to highest were
in-patients, out-patients, and staffs (mean (SD) = 80.8 (14.4), 82.0 (10.4), 85.3 (10.9) from 100 scores
(p<0.001), respectively).
The suggestions for quality improvement of the out-patient service were to emphasize on the
humanitarian services behaviors of the general service staffs; such as, explaining the choices of treatments,
participating in decision making, being presence and encouraging when the patients faced
suffering, providing opportunity for patients’ compliance to their religious activities.
The proportion of elderly in Thailand is 16% of population. At hospital discharge, most of elderly
patients still need helps for their daily living activities. This study aims to explore situation of hospitalization
and having carers during the recovery period at home among elderly people. Study samples
were elderly people (age ≥60 years). Data analyses were based on Health and Welfare Survey 2015
conducted by National Statistical Office (NSO). Sample weight was applied using appropriate statistics
to represent total population. The results showed that total number of hospitalized elders in the year
before was 706,183 persons (7% of all elderly people) higher than other age groups (children 3.5%,
and adult 4.5%). Overall, average length of hospital stay was 5.98 days and average number of days
needed care during recovery period at home was 13.06 days. Of all hospitalized elders, patients under
Universal Coverage (UC) scheme were the largest group, whereby those under Civil Servant Medical
Benefit (CS) scheme accounted for 17.2%. Majority of elderly patients under UC scheme were in very
poor quintile. While majority of elderly patients under CS scheme were in very rich quintile. Average
numbers of days needed care during recovery period among elderly patients in poor and very poor
quintiles were higher than those in other quintiles across all schemes. Approximately 17.7% of elderly
patients did not have caregiver during their recovery period at home and most of them were in very
poor quintile and with small household size (1-2 living persons). Although, 76% of elderly patients
were taken care by someone in their family, most of these patients were in very poor quintiles and
had small household size. The government should realize the importance of continuity of care after
hospitalization in order to provide a better living for elderly patients and their families.
Importance: Superficial surgical site infection (SSI) is common in appendectomy for complicated appendicitis. Delayed primary wound closure (DPC) is preferentially used over primary closure (PC) but its efficacy is still controversial. Objective: To compare superficial SSI rates between DPC and PC for complicated appendicitis. Design, setting, participants: A multicenter, randomized controlled trial of complicated appendicitis, involving 607 adult patients from 6 hospitals in Thailand between November 2012 to February 2016. This included cases of gangrenous appendicitis, as well as rupture. Intervention: Patients were randomized to PC (i.e., immediately wound closure after operation) or DPC (i.e., wound closure at postoperative days 3 to 5). Main outcome and measure: Superficial SSI, as defined by the Center for Disease Control criteria. Secondary outcomes included postoperative pain, length of stay, recovery time, quality of life and cost of treatment. Results: Among 303 and 304 patients in the PC and DPC groups, 5 and 4 patients were lost follow up respectively, leaving 300 and 298 patients for intention-to-treat (ITT) analysis. The superficial SSI rate was lower in the PC than DPC group (i.e., 7.3% (95% CI: 4.4, 10.3) versus 10% (6.6, 13.3)) with a risk difference (RD) of -2.7% (-7.1%, 1.9%). Protocol violations occurred in 15 patients (i.e., 9 in PC and 6 in DPC groups).  RDs for per-protocol and as-treated approaches were respectively -1.9% (-6.5%, 2.6%) and -1.1% (-5.6%, 3.4%). In addition, a counterfactual approach using instrumental-variable analysis yielded a RD of -3.6% (-8.3%, 1.1%).  Postoperative pain, length of stay, recovery times, and quality of life were not significantly different between groups with corresponding RDs of 0.3 (-2.5, 3.0), -0.1 (-0.5, 0.3), -0.2 (-0.8, 0.4), and 0.02 (-0.01, 0.04). However, costs for DPC were 2083 (1410, 2756) Baht higher than PC (~$60 USD or 56 euros). Conclusion and Relevance: Superficial SSI rates were slightly lower for PC than DPC groups, although this did not reach statistical significance. Costs were modestly but statistically significantly lower for the PC group. Trial Registration: clinicaltrial.org Identifier:  NCT01659983
Nan province is an index area of leptospirosis study model in Thailand where provided the evidence linkage between human and rodents but lack of a data in domestic animals such as cattle, pigs and dogs. This study aimed to detect and isolate the pathogenic Leptospira spp. from domestic animals by serological assay, Microscopic Agglutination Test (MAT), molecular assay, rrs nested polymerase chain reaction (PCR), and culture. Identification Leptospira species by near-full length 16S rRNA sequencing, determination Leptospira genetic relationship and clonality by constructed phylogenetic tree and MLST and PFGE from a total of 525 sample of bloods and urine from animal in Nan province during 2013 to 2015. Overall, the seroprevalence to leptospiral detection by MAT was 8.09% (95% confident interval (CI) 4.38-11.74). The major leptospiral serogroup was Shermani and the minor serogroup were Sejroe and Tarassovi, respectively. By rrs nested PCR, 7.42% (95% confident interval (CI) 5.18-9.66) of samples were positive to pathogenic Leptospira spp.. DNA sequencing and phylogenetic analysis found the positive samples were clustered in a branch of L. interrogans, L. weilii and unidentified Leptospira spp.. We could successfully isolate four leptospires from dogs and identification Leptospira species by near-full length 16S rRNA sequencing revealed L. interrogans (n=2) and L. weilii (n=2). In molecular epidemiological study by MLST, we found novel sequence type (STs) of Leptospira; ST26 and ST33 for L. interrogans and ST94 for L. weilii. ST26 and ST33 was a singleton without clonality to Leptospira species in database. ST94, however, was a putative founder of ST193 and ST183 isolated from human leptospirosis in China and Laos. Our study provides an important epidemiological information of animal leptospirosis in an endemic area that may be continually useful for disease control and prevention strategies.
This study aimed to explore the epidemiological information of Streptococcus suis (S. suis), either in pigs and human. Those information was used to find the appropriate method to reduce the number of S. suis infection in human. The tonsil swab samples from sows and fattening pigs, pork from pig slaughter houses and pork in wet and super markets in Chiang Mai province were collected for S. suis culture. Moreover, demographic data, education attitude and risk factors data from 35 S. suis infection patients were collected. The results indicated that from 43 farm, sow samples from 13 farms were detected S. suis (30.23%). In fattening pigs, S. suis was detected in 57 farms from 111 farms (30.23%). Pork sample from pig slaughter houses and pork in wet and super markets were detected S. suis 26 from 119 (21.85%) and 5 from 50 samples (10.00%), respectively. S. suis type 2 were found in 1 pork sample from pig slaughter houses and 1 pork sample from wet market. The virulence gene, including gdh+,arcA+,mrp+,thrA+ and sly+ were detected from those sample. The data in human showed that S. suis patients were male more than female. All of them had underlying diseases and always drank alcohol. They had the history of raw pork or unsure well cooked pork before showed clinical signs. Nine patients (27.71%) showed deafness and trend to be permanent deafness. This study indicated that even though pigs is the important carrier of S.suis and the agent can transmit to human via slaughter process, the consuming behavior is the key factor that effect S. suis in human.
Burkholderia pseudomallei are a causative agent of melioidosis and ceftazidime is the drug of choice for treatment. However, the motility rate is high in endemic areas. This study aimed to investigate an incident of the blaPenA and blaOXA mutation and tendency of β-lactam antibiotics in B. pseudomallei from patients admitted to hospitals in lower North-East Thailand. A total of 1,340 isolates of patients with B. pseudomallei admitted to Sappasitthiprasong Hospital, Sisaket Hospital, and Amnatcharoen Hospital between January 2013 and February 2015 were determined for antimicrobial susceptibility by standard disk diffusion and minimum inhibitory concentration (MIC). The conventional polymerase chain reaction (PCR) was used for the detection of blaPenA and blaOXA in β-lactamase genes with the specific primers. Almost all of the clinical isolates of B. pseudomallei were susceptible to ceftazidime, piperacillin, cotrimoxazole, cipofloxacin, and imipenem by the standard disk diffusion test. Cefatzidime MIC was ≤1-≥32 μg/ml and imipenem MIC was ≤0.5-≥8 μg/ml. MIC50 and MIC90 of ceftazidime were 2 μg/ml and 4 μg/ml respectively, and MIC50 and MIC90 of imipenem were ≤0.5 μg/ml and 1 μg/ml respectively. The conventional PCR followed by gel electrophoresis revealed that only Class D beta-lactamase gene or oxa was detected in all DNA samples isolated from B. pseudomallei. DNA sequencing followed by amino acid analysis and comparison by the bioinformatic approach found that all translated amino acid sequences showed 100% identity to those reported in the National Center for Biotechnology Information (NCBI) database. This result demonstrated that there were no any mutations in oxa gene in B. pseudomallei. PenA gene was not detected in all DNA samples. However, the penA gene with the length of 300-500 bp was detected from the beginning of this study. It is suggested that this amplified product be sent for sequencing to confirm that it is penA.
Health Region 7th has developed strategies to build up and enhance capacity for medical services in orthopedic at the M1 level hospital. This study was aimed to assess cost utility of arthroscopic knee surgery in patients who had anterior cruciate ligament injury with or without meniscus injury at M1 hospital level as compared to the operation performed at only the provincial hospital level. The present study was based on decision tree analysis with the time horizon of 1 year using a societal perspective. The primary data collection was performed to obtain the following key variables: waiting time, complication rate, return to sport outcome (up to 1 year), direct medical cost, direct nonmedical cost, indirect cost, and utility (EuroQoL-EQ-5D-5L). The study sites included Sirindhorn Hospital (M1 level) and Khon Kaen Hospital (provincial hospital). The training cost and cost of instruments were 99,328 Baht. At Sirindhorn and Khon kaen hospitals, proportions of patients undergone surgery within 2 months were 93% and 25%, and the averages of waiting time were 1.03 ± 0.67 and 4.3 ± 3.0 months, respectively. The complication rates were similar of 7%. All patients with or without complications could return to sport within 1 year. Utilities at baseline, after surgery, 3, 6, 12 months thereafter were 0.66±0.15, 0.77±0.22, 0.92±0.07, 0.93±0.06 respectively. Under the timeframe of 1 year, direct medical cost, direct non-medical cost, and indirect cost for one case were 19,215, 7,488, and 1,479 Baht at Sirindhorn Hospital and 19,413, 7,888, and 1,538 Baht at Khon Kaen Hospital. For one case, total costs were 31,493 and 28,839 Baht, and quality-adjusted life years were 0.91 and 0.85, respectively. An incremental cost effectiveness ratio was 41,058 Baht/Quality adjusted life year. In conclusion, arthroscopic knee surgery for anterior cruciate ligament injury at M1 hospital level could reduce waiting time and was cost effective as compared to the operation performed at the provincial hospital level. The complication rates were similar and relatively low. All patients with and without complications in both hospitals could return to sport within 1 year. The policy recommendation proposes that provision of orthopedic services at the M1 hospital level should be promoted for the procedures that complication rates were similar and relatively low in both levels, complications do not lead to the final clinical outcomes, post-treatment utility outcome would increase by 0.24 (EQ5D 5L), and waiting time should not be greater than 2 months. The procedure as such would be cost-effectiveness if the initial program cost is about 662 Baht per one case.
Chronic kidney disease (CKD) is one of the major public health problem in Thailand. The Nephrology Society of Thailand was granted the community-based cross-sectional survey study using stratified-cluster sampling method to represent population from all region of Thailand called Thai SEEK (Screening and Early Evaluation of Kidney Disease) study during 2007 to 2008. The overall prevalence of CKD from Thai SEEK was 17.5% which increased awareness of CKD burden and lead to deliver strategic planning for CKD prevention and management programs. However, study about the natural history of CKD progression, particularly among Asian and Thai population which might useful for the estimation of health cost and strategies prioritization for slow CKD progression stills limited. Moreover, we still lack of information of the incident of CKD using a standardized method for GFR estimation in representative Thai adult populations. So the research committee of The Nephrology Society of Thailand was conducted this follow-up study from Thai SEEK population.