plueme/wizJson huggingface dataset:
Drug expenditure is a lion share of health expenditure and grows rapidly in the Civil Servant
Medical Benefit Scheme (CS). This research analyzed electronic databases of drugs in 5 selected
therapeutic classes, including (1) antihypertensive drugs (angiotensin-converting enzyme inhibitors –
ACEIs and angiotensin-2 receptor blockers -ARBs); (2) antilipidemics (statins and other new
products); (3) antiplatelets; (4) antiulcerants (proton pump inhibitors –PPIs and histamine-2 receptor
antagonists -H2As); and (5) non-steroidal anti-inflammatory drugs (NSAIDs, both conventional and
coxibs) that were prescribed during 2003 – 2007 from 6 provincial hospitals. The analysis focused on
a 60-month, interrupted time-series of 2 expenditure components, including propensity of use and
intensity of use, before and after the direct disbursement policy of the CS and the 30-Baht
abolishment in the Universal Healthcare Coverage Scheme (UC). The drug expenditure of each
therapeutic class was forecasted for the years 2008 and 2009 and potential cost-saving for the CS as a
result of 3 cost-containment strategies, including (1) substitution policy; (2) reference pricing; and (3)
UC-like prospective payment system (PPS) was estimated.
The study found that the drugs deemed as the cost-containment target, including ARBs,
single-source statins, clopidogrel, single-source PPIs, and coxibs had a major impact on the drug
expenditure of CS and its growth. The PPS could reduce the CS drug expenditure by approximately
40% (for PPIs-H2As and coxibs-NSAIDs) and 100% (for antilipidemics), which was comparable to
the reference pricing strategy. Potential cost-saving from the substitution policy depended on
substitutability in the real world setting, for example, the 20% substitutability would reduce the CS
expenditure by 8% (for PPIs-H2As and coxibs-NSAIDs) and 20% (for antilipidemics); whereas the
saving of 30-80% was expected, given substitutability of 80%.
The research on “Good models on the elderly care by family and community in rural areas in Thailand” aims to study formats and duplicate the models for the long term care for older persons in the family and services management for the older persons in the community from the models selected as having good service management. A case study were 8 elderly with dependency level 3 and 4 who resided in the sampling areas, namely, Mae Prik Sub-District Administrative Organization, Mae Sua District, Chiang Rai Province, Kao Suan Kwang Sub-District Administrative Organization, Kao Suan Kwang District, Khon Kaen Province, Banpaew Sub-District Administrative Organization, Banpaew District, Samutsakhon Province, and Pakpoon Sub-District Administrative Organization, Muang District, Nakhonsithammarat Province. The data analysis included the content analysis, or analyzing answers gathered from conversations and the thematic analysis. The study results were summarized as follows.
Of all samples, there were 6 females and 2 males. The minimum and maximum ages were 66 and 90 years, respectively, with the mean of 82.87 years. The religion of 7 elderly was Buddhism and another one was Islam. With regard to marriage status, 7 elderly were widow and another one was marriage. All elderly had chronic illness and were not able to rely on or slightly relied on themselves. Main caregivers were children. Methods and techniques of good careing covers 9 indicators, namely, personal hygiene care, medicine management, movement assistance, pressure ulcers care, proper food, feeding, excretion, emotional stability and spirit. Proper management for elderly of communities included 7 indicators, namely, formal and informal care system, strong team, beneficial social capital, solving by creating community recognition, complete elderly database and service evaluation system.
The recommendations from the study are that, at the policy level, the efficiency of the health and social service system at home should be enhanced and the care management system should be established. At the operational level, local services should be developed by creating qualified long-term care teams, and increasing supporting service for families and care tool alternatives. At the family level, the recommendation are seeking knowledge on elderly care and enhancing family members to participate in elderly care. The action research on integrated and proper community care should be conducted and proper indicators should be set.
“Design for Life” is a documentary program about the health system in Thai society produced by Health Systems Research Institute (HSRI). This program of 47 episodes in total was broadcast every Friday, 11.30 am to 12.00 pm on Thai PBS.  Some of the audiences requested additional information as well as commented on the content and the production of the program. This research aims at surveying the opinions and popularity of the program so as to improve the production in the next phase.
	This study used 3 methodologies as follows: 1) a telephone survey of the program’s popularity conducted with 400 samples in all regions 2) a questionnaire survey for the audiences’ comments and suggestions conducted with 40 samples, representing 80 percent of the audiences who have given feedback to the program 3) a focus group discussion to check the audiences’ comprehension of the program content conducted with four groups of seven samples.
	The popularity survey indicates that eight percent of the samples know this program. The number of subjects who have known and seen this program is only three percent, mostly females, married with children, holding Bachelor’s Degrees, aged over 50 years, business owners, with 5,000 – 15,000 baht per month income. They have accessed to television and it is convenient to watch the program at home. Most of the audiences know the program by chance and they do not watch the program regularly. Their watching behaviors to one episode are discontinuous. They also switch to other programs back and forth. They also do not know the sponsor of the program.
	The samples think that the program gives more knowledge and creates health awareness, provides health information and leads to health behavior changes. The program is interesting, reliable and relates to the audiences. The documentary format is appropriate but the television station, broadcasting time and the length of the program are inconvenient for broad audiences to watch.
It is not uncommon to encounter medical articles written by Thai authors that fail to cite the readily available, relevant and accomplished works of other Thai investigators. The reasons why they ignore the work of their countrymen may be manifold, but the lack of a local literature review may have an adverse impact on their findings. In a recent article entitled “Occupational Malignant Mesothelioma in Thailand,” published in the March-April 2009 issue of the Journal of Health Science, the researchers, perhaps unwittingly, overlooked a number of Thai publications on mesothelioma and asbestos in this country. While we accept the single reported patient of those investigators as a case of pleural mesothelioma of the malignant variety, reference to it as “occupational” in relation to asbestos exposure has yet to be demonstrated and is therefore unsound.
Global warming is the term used to describe the increase in the average temperature of the earth’s surface, air and oceans. High temperature increases due to global warming can cause injury and may finally lead to the death of plants by many mechanisms. Although plants have natural defense mechanisms for their survival under high temperature stress, some of them are sensitive to high temperature stress and cannot adapt themselves. Current advances in science and technology enable the application of molecular biology techniques helful for studying the effects of high temperature on plants related to their gene expression. The knowledge gained from research can help us to understand sensitive and tolerant plants in respect of high temperatures with control provided by multigene families. Cloning gene(s) responsible for the heat tolerance of plants and the transfer to other plants sensitive to heat stress can increase heat tolerance in transgenic plants. This results from doing basic research. Therefore, it is necessary for scientists to use advanced science and technology to reduce the adverse effects of global warming on plants, especially economic and medicinal plants.
This research was undertaken to evaluate the devolution of health centers and hospital autonomy in Thailand. The assessment team conducted literature and document review and interviews with the Provincial Health Office (PHO), District Health Office (DHO), Provincial Governor’s Office and Department of Local Administration (DLA), the Contracting Unit for Primary Care (CUP) Hospital, Tambon Administrative Organization (TAO) and health center (HC) staff in five devolved health centers and five nondevolved health centers and a hospital-owned primary care unit (PCU) in six provinces. In relation to the three stated objectives of decentralization, the team’s findings concerned changes in flexibility, responsiveness and participation following devolution of health centers to TAOs.
Findings on the devolution of health centers were as follows: (1) increased management flexibility: three of the devolved health centers had positive perceptions of improvement in management flexibility, in the sense that future decision-making is expected to be faster and there should be greater scope for initiative; (2) increased responsiveness to the community and to patients: three devolved health centers could point to a number of ways in which service delivery had improved and new services had been provided in response to the needs and preferences of the community; and (3) increased participation of the community: all five TAO CEOs and Councils were active in obtaining community input on health and health service delivery.
Findings on hospital autonomy were as follows: (1) the Ban Phaeo Hospital model was found to be well-designed, clear and consistent. Its performance in improving service quality and increasing its revenue had been highly successful; (2) community support for the hospital has been a major success factor but mechanisms for patient and community feedback on priorities and service delivery performance could be strengthened to improve accountability and better align service priorities with the needs and preferences of users; (3) this model should be replicable in other MOPH hospitals, except small community hospitals serving small, dispersed populations.
The objectives of this study are to study a conceptual framework for a theory concerning good governance of health system management in local areas, to create good governance indicators regarding provincial public health office management, which can then be implemented as a tool to evaluate and further develop the organization’s effective governance and also evaluate the level of good governance management of the provincial public health offices in the four pilot provinces: Chiang Mai, Krabi, Cholburi, and Nakhon Pathom. Analysis is done by secondary data, such as annual reports, and related documents, and primary data which were obtained from a questionnaire using three sets: the first set was evaluated by internal officials within the agencies and consisted of 50 indicators, the second set was evaluated by officials with specific functions and contained 11 indicators; and the third set was evaluated by related agencies and consisted of 37 indicators for evaluating good governance management. The evaluation was divided into two parts: the first part was evaluated from the first and the second set of questionnaires by 86 internal officials and the second part was evaluated from the third set of questionnaires by 184 related agency officials. Purposive sampling was used to collect the primary data. Descriptive statistics were used to analyze the data and t-test used to compare the average scores.
The findings based on the evaluations concerning management of the four provincial public health offices, as evaluated by the internal officials, revealed high levels of good governance management. There was an especially remarkable score shown in the Principle of Information Technology and Communication, the Principle of Value for Money, and the Principle of Rule of Law. The evaluation results for good governance management of the provincial public health offices by the agencies related to the provincial public health office of Chiang Mai, Cholburi, and Nakhon Pathom revealed that good governance management was moderate. For the Krabi provincial public health office, good governance management was rated as high. For all four provincial public health offices, the Principle of Transparency was found to have the most significant rating.
In considering the evaluation by the internal officials and related agencies, the results showed that development was still required regarding the Principle of Management, the Principle of Human Resources Development, and the Principle of Participation. Thus, it would be appropriate for each provincial public health office to consider improving its work standards in line with a systematic evaluation of administrators’ work performance. Training programs should be established along with an incentive system for personnel participation and successful official development. Finally, listening to feedback from the outside agencies concerned could help to improve work performance.
Background: Essential drugs in Subclass 4 are high-cost drugs (HCDs). Their use was an important factor in influencing pharmaceutical expenditure. Exploring drug items, extent of their use, and the difference in their use among health insurance schemes would provide in-depth understanding of the efficiency and equity of their use. The objectives of this study were to identify items of HCDs, to assess their impact on pharmaceutical expenditure, and to explore HCD users classified by age and type of health insurance schemes.
Methods: Retrospective data on overall drug expenditure including the top 10 HCDs in Subclass 4 of the Essential Drug List in three fiscal year (2003-2005) were obtained from the Hospital Inventory Database. Drug use data of the to 10 HCDs in 2005 were obtained from the Dispensing Database. The rates of the top 10 HCD use per 1,000 patients were classified by age and health insurance scheme, including the Universal Coverage Scheme (UC), Civil Servants Medical Benefit Scheme (CSMBS), and Social Security Scheme (SSS), and compared.
Results: In the three consecutive years, the six HCDs most highly used were human erythropoietin 4000 u. inj., atorvastatin 10 mg tab., meropenem 1g inj, imipenem/cilastatin 500 mg/vial IV, cefoperazone/salbactam 1g inj and clopidogrel 75 mg tab. The top 10 HCDs used in the hospital consumed 45.6 million, 50.5 million, and 68.8 million baht in 2003, 2004 and 2005 respectively. Expenditures on erythropoetin 4000 u., atorvastatin 10 mg., clopidogrel 75 mg and meropenem inj. 1g increased every year. In 2005, 63.8 percent or 46.8 million baht of the expenditure of the top 10 HCDs was on CSMBS. These items were the drugs used for chronic diseases: erythropoietin, atorvastatin, clopidogrel. and mycophenolate. HCD spending in UC was 32.3 percent or 23.6 million baht, but it was only 1 percent in SSS. In UC, the drug
items mainly used were anti-infectious drugs, including meropenem, imipenem/cilastatin and cefoperazone/salbactam. The rate of use of atorvastatin and clopidogrel per 1,000 patients in the aging group in CSMBS were 20.08 and 6.47 respectively. In UC, they were only 0.05 and 1.45 respectively. The rate of use of meropenem per 1,000 patients in every age group in UC was greater than in CSMBS.
Discussion: The impact of HCD use on pharmaceutical expenditure is quite high since only 10 HCDs account for 18-20 percent of overall pharmaceutical expenditure. There is a difference in HCD use based on the insurance schemes. Further studies should be focused on the evaluation of HCD use, effective measures to control HCD use, and methods to balance equity of HCD access among health insurance
schemes.
This study explored health status, risk factors, and health promotion via occupational health nursing practice concepts, and explored knowledge about noise-induced hearing loss and silicosis, and the practice of using personal protective equipment. This part was a quasi-experiment, with pre- and postparticipatory group process. This study was conducted between March and August 2008. Study subjects
were 47 workers in a granite-processing factory in Muang District, Rayong Province. Data were collected by a walk-through survey form, area air sampling to measure silica dust, sound level meter type I, a health and health behavior interview form, measurement of weight and height, pulmonary function test, audiometer, chest X-ray, questionnaire on knowledge, observation form for health protection behavior, occupational health nursing practice, and participatory group process. Data were analyzed descriptively by number and percentage and inferentially by t-test.
The results revealed major health risks: silica dust above the standard in the gang-saw section (%SiO2 = 7.648) and polishing section (%SiO2 = 6.622); and noise above standard of 90 dB(A) in 4 out of 15 points in the gearing and trimming section (2 points: 97.4 and 102.3 dB(A)) and polishing section (2 points: 91.1 and 99 dB(A)). The results on health status showed that most (78.7%) had abnormal audiograms – reduced high tone hearing (37/47), threshold shift 8.5 percent (4 /47); restrictive lung 6.7 percent (3/47); abnormal chest X-ray requiring surveillance 10.6 percent (5/47), physician observation 2.13 percent (1/47); but none were compatible with silicosis. Regarding health protection behavior, 83.0 percent of workers used ear plugs (39/47), with mean duration being 6.3 hours per day; and nasal masks 55.3 percent (26/47), with mean duration of 6.26 hours per day. Health promotion and counseling were done via participatory group process, demonstration, health education on noise-induced hearing loss, silicosis, and prevention. Before the group process, only 15.38 percent of the workers wore ear plugs correctly (6/39); this increased to 100 percent (39/39) after the group process. Before the group process, workers had knowledge score of 6.52 (SD = 2.12) which increased to 9.81 (SD = 2.60), and the difference was significant (p <0.01).
Silica dust was above standard, but no case of silicosis was detected yet. Audiograms revealed those with abnormality, i.e. 87.23 percent of the total and some areas had noise above the safety threshold. The factory should therefore establish a surveillance program on health and environment and continuing education, especially for new workers. Group process should be deployed to enhance employers’ and employees’ participation.
This cross-sectional descriptive study was aimed at determining the efficiency and cost-effectiveness of four serum lipid screening methods: Method 1 proposed by the Thai Royal Medical Association (TRMA), Method 2 of the National Cholesterol Education Program (NCEP), Method 3 of the British Hyperlipidemia Association (BHA), and Method 4 invented by the first author. Study subjects included 2,000 workers aged 35 years and older who underwent an annual health examination provided at King Chulalongkorn Memorial Hospital during the period July-September 2008. All subjects answered the questionnaires of four screening methods and took blood tests for TC, TG, and HDL. LDL was calculated by Friedewald’s formula. The performance of each screening method was then analyzed, using lipid blood test as the gold standard. Overall sensitivity and specificity of the screening methods were 30 to 99 and 0.5 to 74 percent respectively, with the AUC of 0.506 to 0.671. Method 4 had the highest sensitivity and the lowest specificity at 99.4 percent and 34.3 per cent, respectively. Method 3 and Method 1 had higher AUC of 0.671 and 0.621 respectively. Method 2 had high specificity and low sensitivity (74% and 45.2%). In conclusion, the performance of the four serum lipid screening methods used in Thai adults was modest and therefore the methods need further improvement.
Objectives: This study was a literature review assessing the clinical efficacy of statins available in Thailand (i.e., atorvastatin, fluvastatin, pravastatin, rosuvastatin and simvastatin) for use in reducing acute coronary syndrome (ACS) and stroke events. 
Methods: A systematic review and a meta-analysis of randomized controlled trials (RCTs) of statins were studied. The clinical trials on an electronic Medline database were searched. Efficacy studies of statin monotherapy were compared with placebo or other statins on the occurrence of fatal and non-fatal ACS and stroke. Odds ratios (OR) and 95 percent confidence interval (CI) were used to determine the summary efficacy of statins. Indirect comparison of the random effect meta-analysis, using the Bayesian approach and WinBUGS14 software program, were applied.
Result: Twenty-nine RCTs in 26 studies enabled comparing statins with a placebo; one study compared statins with no treatment, another compared statins with usual care, and yet another compared atorvastatin with pravastatin. For ACS events, the relative risk reduction (RRR) of simvastatin was 42 percent (OR=0.58, 95%CI=0.51-0.65), the RRR of atorvastatin was 41 percent (OR=0.59, 95%CI=0.51-0.70) and the RRR of pravastatin was 26 percent (OR=0.74, 95%CI=0.66-0.83). For stroke events, the RRR of simvastatin was 26 percent (OR=0.74, 95%CI=0.66-0.83), the RRR of atorvastatin was 19 percent (OR=0.81, 95%CI=0.72-0.93) and the RRR of pravastatin was 14 percent (OR=0.86, 95%CI=0.75-0.97). However, fluvastatin did not significantly reduce ACS (OR=0.37, 95%CI=0.11-1.05) and stroke events (OR=0.85,
95%CI=0.46-1.55). No efficacy study of rosuvastatin on decreasing ACS and stroke events is yet available. Conclusion: The available evidence indicate that simvastatin, atorvastatin and pravastatin significantly reduced ACS and stroke events.
This study was aimed at exploring satisfaction with health education about health promotion among 324 patients attending the outpatient department, King Chulalongkorn Memorial Hospital in the period from January to April 2006. The majority of them (63.6%) were women, whose education levels were lower than diploma in 50.3 percent; 6.0 percent had qualifications higher than bachelor’s degree. Their occupations were housewives and laborers in 33.9 and 26.8 percent, respectively. The reasons for the visit were annual check-up in 67.5 percent and follow-up appointment in 17.3 percent. The reasons for choice in attending this hospital were knowledge of its good service and the expertise of physicians and nurses (82.1%) and of its up-to-date medical equipment (48.4%). The study disclosed that television was the most influential medium (77.8%) and newspapers (48.5%).
Regarding satisfaction with the health education given, patients were most impressively satisfied with the health educators’ suggestions (79.4%), simple terms used in communication (73%) and patients’ self study of the documents and leaflets provided (30%). Another indication of satisfaction was that most patients were willing to recommend acquaintances to visit this hospital (93.8%). There were no associations of satisfaction for health education as such between health promotion and personal factors (sex, age, educational level, and occupation).