plueme/wizJson huggingface dataset:
Cholangiocarcinoma (CCA) is still a major public health problem in Thailand. The major risk factor for CCA in Thailand is the carcinogenic liver fluke Opisthorchis viverrini (OV) infection. This study aimed to investigate the CCA burden attributable to OV infection using the disability-adjusted-life-year (DALY). A cross-section study was conducted using several secondary data including mortality and incidence of CCA from the National Cancer Institute and the prevalence of OV infection from the Department of Disease Control, Ministry of Public Health. The burden of CCA was estimated at 216,530 DALYs. The bur den in men was 1.5 times higher than in women. The burden of CCA attributable to OV infection was 70,745 DALYs (33% of total CCA) when adjusted for past use of praziquantel and it was 138,221 DALYs (64% of total CCA) when estimated with raw fish eating. This study reflects a considerable reduction of burden if OV infection was prevented, particularly in the northeast of which infection is the highest. Nevertheless, better information and further related research are needed to improve the estimation.
Oral valganciclovir is the alternative option for prophylaxis and treatment of cytomegalovirus (CMV) disease that is widely used in transplantation due to the equivalent safety and efficacy compared with intravenous ganciclovir. So valganciclovir was proposed for the inclusion into the national list of essential drug. The systematic review criteria were the original article of the full economic evaluation for valganciclovir or intravenous ganciclovir in various durations of therapy. Prophylaxis, pre-emptive prevention regimen and wait-and-treat regimen of only one or both of these drugs for all organ transplantation recipients were included to the study. The eligible studies showed 4 studies in the US, 2 studies compared between different duration of therapy of using prophylaxis valganciclovir, 1 study compared prophylaxis with pre-emptive therapy using valganciclovir, and the other compared pre-emptive valganciclovir with no prevention therapy. In European countries, there were 3 studies: compared prophylaxis ganciclovir among durations of therapy, compared prophylaxis with pre-emptive ganciclovir, and compared prophylaxis ganciclovir with prophylaxis valganciclovir. The studies targeted in kidney, lung, liver, pancreas, and hematopoietic stem cell transplantation in hospital, societal, or health system perspective. There were 5 of 7 studies modeled the Markov and decision tree and discounted 3-5% with 5 month to 10 year horizon to estimate costs and outcome, while 2 of 7 studies considered costs and outcome in 1 year after transplantation. The results showed prophylaxis 200 days was more cost-effective than pre-emptive and wait-and-treat regimen because of the superior outcome of longer duration prophylaxis in preventing early DNAemia, CMV disease, opportunistic infection, and graft rejection, but the costs were equally high of drug for prophylaxis, and laboratory monitoring for pre-emptive therapy. To compare the cost effectiveness between ganciclovir and valganciclovir, it could be concluded only the costs of using ganciclovir were high particularly in 1 year after transplantation due to catheter culture test, drug administration, room expenses, and intravenous caused adverse event. However, there was no the long-term costs and outcome presented. The studies from other countries were differently designed of comparator approach upon their routine practice and resource concerns. This systematic review could explore the elementary information for further economic analysis and making decision included valganciclovir into the Thai national list of essential drug.
This study was a cross-sectional survey research that aimed to study the factors related to blood sugar level among diabetes mellitus type 2 patients. The sample consisted of 400 patients who visited outpatient department at hospitals in Satun province during March until May 2017. The instruments for data collection comprised 5 parts: (1) personal information, (2) information on treatment patterns, (3) results of the treatment, (4) knowledge on diabetes, and (5) self-care behaviors of 58 items. Data were analyzed by using binary logistic regression. The results showed that 25.0 per cent of diabetes mellitus type 2 patients were able to control blood sugar levels (HbA1c <7). The occupation and self-care behaviors were significant factors correlated with blood sugar control at the 0.05 level. Diabetes mellitus type 2 patients who did not have occupation were 2.71 times more likely to control blood sugar (HbA1c <7) than those who had occupation (ORadj = 2.71, 95% CI = 1.19-6.17). Likewise, diabetes mellitus type 2 patients who had low level of health care behaviors were 0.54 times less likely to control blood sugar (HbA1c <7) than those who had high level of health care behaviors (ORadj = 0.54, 95% CI = 0.29-0.99). Therefore, public health personnel must emphasize and develop a pattern of caring for type 2 diabetes mellitus patients, especially in those with no occupation and low level of health care behaviors to better control blood sugar level.
The objectives of this study were to prove the effect of non-financial incentive, by the definition in Guidelines: Incentives for Health Professionals of Global Health Workforce Alliance (GHWA), to retain the physician in rural area and how to manage this kind of incentive. The study used the retention data of the physicians in 8 provinces hospitals since 2006 to 2015 , from the previous study ”The study of the labour cost of health workforce in MOPH hospital”, to predict the study area that can retain the physician in rural area. The questionnaire was developed to ask all physicians in the study area about the effect of nonfinancial incentive and the intention to work in the same hospital next year. The results showed that all categorized of non-financial incentive have a significant effect to the retention of the physicians at 95%CI. These effects were difference between the first 3 years working physicians and the physicians that have more than 3 years working experience. This study found that the hospitals can promote the non-financial incentive in the hospital working environments, so the Ministry of Public Health should to have the policy to promote these non-financial incentives.
Tuberculosis (TB) is a disease of poverty and stigmatization. Thailand is one of the countries with high burdens of TB, TB/HIV and MDR-TB. Although contact investigation (CI) can reduce TB morbidity and mortality, the coverage is low and a CI operations manual was not yet available. Thus, this project aims to develop tools and collect research evidences for the development of a CI manual to increase implementation of CI by including household (HC) and other contacts (OC). The manual will also guide staff to perform non-stigmatized CI. We implemented the project between January 2017 and August 2018. The outcomes are summarized as follows: 1) Development of a geographic information system (GIS)-based computer program as a tool for CI coverage enhancement. 2) Research activities: the project implemented 4 sub-studies as follows: 2.1 A review of international CI manuals. 2.2 A survey of physicians and nurses’ TB knowledge, perceived stigma, and CI Experiences. 2.3 Knowledge, attitude and experiences related to contact investigation for tuberculosis among former tuberculosis patients and representatives from nurseries, schools, hospital and private business: A qualitative study. 2.4 The outcomes of using invitation card and providing transportation fee in CI. 3) Policy recommendations: 3.1 Contact investigation must be seriously implemented in Thailand, particularly children contacts aged under 5 years old must achieve 100% CI. The CI should cover household and non-household contacts. 3.2 Healthcare providers working for TB patients should pass training courses to obtain CI interview skills and effective communication skills for TB-stigma reduction. 3.3 In occupations like teachers/lecturers, caregivers, and hospital staff, the chest x-ray should be mandatory in health check-up system and performed before the employment and in annual health check-up. The practical guidelines should also be available in case TB occurs in teachers, students, and health staff. 3.4 Information about TB and messages to reduce TB stigma should be disseminated through the internet.
Lymphatic filariasis (LF), commonly known as elephantiasis is caused by Filaria parasite i.e. Wuchereria bancrofti, Brugia malayi, B. timori and transmitted by mosquitoes. There are about 40 million people in tropical and subtropical areas suffer from severe disfigurement and disability caused by the disease. It is estimated that more than million Myanmar migrant workers have settled in Thailand and some of them also carry Wuchereria bancrofti. Moreover, Thailand was certified by WHO for successful elimination of lymphatic filariasis and now is in surveillance phase to prevent reemergeing of the disease. Since microfilariae detection by thick blood smear staining technique need night blood collection. Thus, convenience and effective diagnositic tool is needed for the management of filarial infection both at the level of the individual treatment and disease control in populations in regions endemic for filariasis. In the present study, two recombinant proteins iPGM and SXP were produced. Then prototype two test kits, an enzyme-linkedimmunosorbentassay (ELISA) based test kit (FilariaDIAG test kit) and a chromatographic rapid test kit (FilariaDIAGRAPID), were developed, using iPGM recombinant protein and SXP recombinant protein as antigen. Efficacy of the developed test kits were validated in both laboratory condition and in field. Sensitivity of the rapid test kit using recombinant protein SXP antigen shows 97.9% sensitivity, 98.9% specificity, 95.8% positive predictive value and 99.4% negative predictive value when using microfilaria detection by thick blood smear staining as gold standard. The rapid test kit using recombinant protein iPGM antigen reveals sensitivity, specificity, positive predictive value and negative predictive value of 72.3%, 68.8%, 51.6% and 90.5% respectively. For the ELISA based test kit (FilariaDIAG test kit) showed sensitivity, specificity, positive predictive value and negative predictive value of 98.1%, 98.9%, 96.3% and 99.4% accordingly. For field validation, the prevalence of bancroftian filariasis in 509 Myanmar live in Thai-Myanmar boarder in Masod and Phoppha district, Tak province was 1.2% (6/509) while the prevalence of bancroftian filariasis in 363 Myanmar live in Thai-Myanmar boarder in SopMye district, Mahongsorn province was 1.9% (7/363). For prevalence of brugian filariasis in Thai people live in Tak Bai, Sugnai-Padee and Sugai-kolok Narathiwat province (endemic areas of B. malayi) was 0.57% (3/525). Using the ELISA based test kit (FilariaDIAG), antifilarial IgG4 was detected in 1.2% (6/509) of sera collected from Myanmar live in Thai-Myanmar boarder in Masod and Phoppha district, Tak province and in 1.9% (7/363) of sera collected from Myanmar live in Thai-Myanmar boarder in SopMye district, Mahongsorn province. In conclusion, the 2 prototype test kits are useful as tools for screening and surveillances of lymphatic filariasis in B. malayi-endemic areas as well as in Myanmar workers.
Systemic lupus erythematosus (SLE) is a clinically heterogeneous, human systemic autoimmune disease characterized by autoantibody formation. MicroRNAs (miRNA) have emerged as an important new class of modulators of gene expression and have been confirmed to regulate the lymphocyte tolerance and autoimmunity in SLE. In this study, we investigated the exosome of serum miRNA profile in SLE patients with miRNA array (nanosting). TaqMan-based stem-loop real-time polymerase chain reaction was used for validation. We also examined the serum cytokines of IL-29 and then analyzed the association of the upregulated of IL-29  and miRNA-548n. Microarray analysis of miRNA indicated 4 downregulated miRNAs and 2 upreguated miRNAs in SLE patients. Such upregulation of hsa-miRNA-181d 3p, hsa-miRNA-542 and downregulation of hsa-miRNA-548n, hsa-miRNA-16, and hsa-miRNA-122 and has-miRNA-183 was also confirmed by RT-qPCR. We also recognized the upregulation of serum IL-29 in those active SLE patients. The upregulated miRNA-548n contributed to the upregulation of inflammatory IL-29 in active SLE. Our findings demonstrate that miRNA-548n can be a novel biomarker for SLE, and help elucidate pathogenic mechanisms of SLE.
Health Systems Research Institute (HSRI) is committed to develop a guideline for the management and improvement of healthcare system for migrant workers in Thailand, by relying on knowledge and empirical data as a basis for development. The Thailand Development Research Institute (TDRI) has received research grants from HSRI to conduct research on the attitude of Thais towards migrant workers in public health, economic and security aspects of Thailand, with Dr. Yongyuth Chalermwong being the head of this project. This research aims to study and synthesize the government policies and regulations on the attitudes of Thais (and government) toward migrant workers in dimensions of public health, economic and national security. Also, to study a linkage of Thai (and government) attitudes towards management policies related to migrant worker. The study concludes that the Thais attitude towards migrant workers are diverse, both positive and negative, depending on which group of Thais, such as locals, Thai workers, Thai officers, Thai employers, and so on, and their interaction. The policy for managing migrants was established under the concept of maintaining national security which regulates policies for migrants very strictly. In addition, the concept of maintaining the country’s security is influenced by economic and public health dimensions. The feeling of Thais expressed through their actions towards migrant workers varies in different dimensions. In terms of public health, In the economic dimension, on the national security aspect. This study also pointed out the important determinant of attitudes of Thai people towards migrant workers in appropriate forms of communication. To create a contextual understanding of each dimension, it involves the coexistence of Thais and migrants. This issue is important to all parties because it will lead to situational awareness. This will be very useful for policy making. In addition, by creating a platform for Thais and migrant workers to participate together, it will create a major turning point in the perception and understanding of migrants' lives, leading to a change of attitude, and a better view from Thais toward migrant workers.
At present, the Royal Thai Government tends to instigate policies to downsize civil servant posts with a purpose to reduce its budget burden and increase system flexibility and efficiency. These policies affect not only supporting/administrative health staff, but also the health professionals themselves, including doctors, dentists, pharmacists and nurses. The objective of this study is to explore the current situation and types of employment for the Thai health personnel under the Office of Permanent Secretary of the Ministry of Public Health (MOPH). Cross-sectional mixed-method design was used. Data collection techniques comprised document reviews, indepth individual interviews with policy makers and health personnel users, and group interviews with, and self-administrative questionnaire survey on, health personnel. The interview questions focused on advantages, disadvantages, and recommendations for each employment type. The study also included analysis on health personnel retention and budget implication for paying salary to doctors, dentists, pharmacists and nurses in the next 15 years. The results revealed that according to policy makers’ and health personnel users’ perspectives, hiring health personnel as civil servants faced a number of constraints, including rigid bureaucracy and inflexibility in adjusting personnel’s positions to match their expertise. Yet civil servant posts should continue in certain functions, for instance, those dealing with legal issues and authoritative work. From the views of health personnel, civil servant employment is a crucial determinant in making them retain in the public sector because of work security and attractive benefits, especially treatment benefit for themselves and their family members. In the future, there should not be too many employment alternatives. If new civil servant posts are not available, the replaced employement choices should guarantee increased startup salary and additional benefits that are not inferior to the regular benefits for civil servants. Overall, the design of employment benefits should minimize discrepancy and inequity between employment types and between professionals. The MOPH should shift its role from being health care providers to being health policy regulators. Local health facilities should have more flexibility in designing employment benefits that suit their own staff while engaging local administrative authorities since the inception stage of the design. Besides, there should be mechanisms that provide opportunities for younger generations of health care providers to design and choose their employment benefits that fit their need before entering the labor force.
The definition of alcohol from the Excise Tax Act, B.E. 2560 requires that alcoholic beverages not more than 0.5% alcohol by volume are not considered alcoholic. So, the beverages containing not more than 0.5% alcohol by volume are not controlled by labelling, advertising, and other measures under the Alcohol Control Act, B.E. 2551 and other relevant laws. The objective of this study was to review the beverages containing not more than 0.5% alcohol by volume regulations in Thailand and foreign countries. Searches were conducted through government database from websites, MEDLINE (PubMed), and Google for ten years (from 2008-2017). Purposive sampling was used to select 6 countries; the United States, Singapore, Australia, South Africa, Norway and Thailand. All regulations were analyzed using a content analysis approach. The study of labelling found that the US, Singapore, Australia and South Africa laws stated that the beverages containing not more than 0.5% alcohol by volume must be labelled as non-alcoholic products and the beverages containing not more than 0.05% and 0.0% alcohol by volume must be labelled “alcohol-free”. For advertising control, the US, Australia and South Africa laws stated that the non-alcoholic and alcohol-free beverages were not allowed to be advertised as alcoholic product. Besides, the US and South Africa laws indicated that the beverage advertising had to show the content and intensity of alcohol on the label. Additionally, the US has a law to ban deceptive advertising techniques and strongly control brand name and brand advertising.
This qualitative study aimed to propose options to develop urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhon Sawan and Kamphaeng Phet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on 260 participant’s recommendations and collaborative decision-making. The data were analyzed by thematic and content analysis. The Social Medicine Departments of the Regional and Provincial Hospitals were the major organizations responsible for management of primary care services delivery in urban areas. Though public, private, and local government sectors also provided these services. However, under the primary care cluster policy, primary care service planning was done mainly by those under the management of the Ministry of Public Health (MOPH). At present, despite the improvement of curative service quality, it cannot cover all areas nor create a sense of ownership for those in other sectors. The major challenge both at present and in the future is the increasing service demand due to the increase in the number of aging population and patients with non-communicable diseases. Also, there is a problem of not being able to use the budget to effectively promote health and disease prevention because of incomprehensible understanding between the service units and the Office of the Auditor General and the lack of policy communication focused on the development of urban health services. The result showed that there could be three major options for urban health services system development: (1) Management through single leadership of the MOPH (the current model), (2) Management by collaboration between sectors through District Health Board (DHB), and (3) Management through transfer of health mission to the local government. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option proposed by the key informants is management through the transfer of health mission to the local government, mainly because they are close to the people and can understand the context of the area well, and encourage the people to take responsibility for their health effectively. However, limitations were identified as: the unclear government policy to transfer health services mission from the MOPH to the local government; the lack of local administration and personnel capacity to manage health services; and the leadership of local government executives. The present study proposes that a model of collaboration between sectors through DHB is the best option to move forward. This option can encourage all sectors to become involved in the development of the primary care system in an urban setting. It can encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and lead to better self-management of the people in the future.
National Health Security Office (NHSO) has established health promotion and diseases prevention fund (P&P fund) with the primary intention of appropriately managing the P&P budget. However, P&P management approach has been changed over the years. This study reviews relevant literature, using narrative and systematic review approaches, on P&P payment mechanisms published in both domestic and international journals. Furthermore, this paper analyses strengths and weaknesses of each P&P payment mechanism. A total of 12 studies were identified for inclusion in the systematic review. Moreover, other studies gathered by narrative literature review were also included into the analysis. The results showed that P&P payment mechanisms can be categorized into five groups including fee schedule, capitation, pay-for-performance (P4P), global budget, and a blended payment method. The plausible outcomes of each payment mechanisms can be divided into three groups: volume and quality of P&P, supplier-induced demand, and risk selection. Each payment mechanism has its own strengths and weaknesses and is appropriate for different types of P&P services. For Thailand, a blended payment method may be the most appropriate mechanism for all P&P services as it naturally combines the potential benefits of each traditional payment mechanism. However, there should definitely be the consideration of the appropriateness of the list of existing P&P services.