plueme/wizJson huggingface dataset:
Accumulating data indicate that obstructive sleep apnea is an independent risk for gestational hypertension, preeclampsia, gestational diabetes, and preterm delivery. Preliminary studies demonstrated the benefits of early nasal continuous positive airway pressure (CPAP) treatment in high risk pregnant women to prevent adverse maternal and fetal outcomes. Highrisk pregnant women such as those with obesity, chronic hypertension and prior history of preeclamsia should be evaluated for diagnosis and treatment of sleep-disordered breathing given the potential benefit of early CPAP treatment. The pathophysiological evidence linking preeclampsia and sleep-disordered breathing supported the rationale for CPAP treatment in addition to conventional antenatal care. However, currently there is no standard guideline that systematically screens and treats for sleep-disordered breathing during pregnancy. The situation of sleep-disordered breathing is in the state of “clinical equipoise”, where strong evidence is needed to make any treatment recommendation during pregnancy. It is an urgent need to conduct a randomized controlled trial that can demonstrate the efficacy of CPAP treatment.
Diabetic Retinopathy (DR) and Age-related Macular Degeneration (AMD) can prevent or reduce the severity of the disease if the diseases are found early.  This can lead to a treatment to reduce loss, reduce medical expenses, and increase the quality of life for the elderly.  Diagnosis of DR and AMD must be examined by an ophthalmologist by retinal examination. However, ophthalmologists in Thailand are still inadequate for their needs, especially in remote areas. With such restrictions, patients do not receive proper treatment on time and that can cause vision loss. Therefore, our research team developed DeepEye using deep learning, a technique in artificial intelligence that is very accurate. By developing it to be easy to use in the form of application on smartphone that can connect to any portable fundus cameras, can be screened quickly, and provide very high accuracy equivalent to an ophthalmologist.  Specifically, it can be used to screen DR and classified into three types of retinal images that are normal, DR, and other diseases. If detecting a diabetic retinopathy, DeepEye can also accurately identify the severity of DR into 4 levels, i.e., mild, moderate non-proliferative DR (moderate NPDR), severe (severe non-proliferative DR: severe NPDR), and severe with new blood vessels (proliferative diabetic retinopathy: PDR) which is a very dangerous stage of DR.  Moreover, DeepEye can be used to screen AMD, which can be classified into dry age-related macular degeneration (dry AMD) and wet age-related macular degeneration (wet AMD).
Background: The deep southern border provinces consist of Pattani, Yala, Narathiwat and 4 districts of Songkhla province--Nathawi, Chana Thepha and Sabayoi, which are the diverse areas of life under the framework of beliefs, religions, cultures, and other traditional ethnic groups. Besides, there has been a situation of unrest and violence for more than 15 years, affecting health service systems, quality and accessibility. This research is a descriptive study aimed to explore the feasibility of applying the multicultural health service standards for the three levels of health services in those areas to meet the spiritual needs, religions, cultures and customs of each ethnic group or focus on the culture of the sub-groups, contributing to health equity. Methods: The study consisted of 2 phases between June 2018 - November 2019: phase 1, the draft criteria were developed in 5 steps. First, documentary research was reviewed and synthesized to provide a general understanding of the multicultural health service standards in other countries. Second, the survey was conducted to draw the opinions of people in the area by using questionnaires. Third, the focus group discussion was performed between the recipients and health service providers. Fourth, in-depth interviewing was a loosely structured interview among the service management team such as the hospital director, head of district public health, and the local government organizations. Fifth, the content of the standards was screened and standardized by experts such as provincial public health doctors in Delphi techniques. A total number of 5,555 people were given information in these processes. Phase 2, a feasibility study of using standards was launched in the pilot areas with 3 steps: (1) the standards were approved by policymakers to consider into action, (2) the standards were implemented in pilot hospitals, and (3) an evaluation and monitoring was then proceeded to announce as a policy. Results: The multicultural health service standards were finally drafted and organized into 7 main criteria and 47 sub-criteria. The standards were then implemented in 4 hospitals in study areas and 1 hospital in the other area that has a similar context. The parallel evaluation during the trial period revealed that the customers’ opinions for the service quality were 88.6-99.4%. They knew, needed and satisfied this service that was 34.3%, 99.2%, and 97.1% respectively. While the health care providers know about this service 100% and need it 85.0%. The outcomes also provided 97.9% of the concrete model and 98.6% having good management for customer complaints. Suggestion and conclusion: The feasibility study of the multicultural health service standards utilization in the Southern border provinces has contributed to familiar and acceptance among recipients and health service providers. Therefore, this is an opportunity for the Ministry of public health and local administrative organizations to promoting as a policy to apply in all health services and in communities for better service accessibility in the long run.
This study aimed to explore process for the selection of global health issues, frameworks for
monitoring and evaluation (M&E) activities, and the management of global health strategies internationally,
and to provide recommendations on future development process of Thailand’s global health
strategy. This study collected data through descriptive literature search and document reviews. Literature
search was conducted from July to August 2017 and was updated in August 2019. Global health
strategies of eight countries were selected as case studies, namely Canada, Japan, Norway, the USA,
Switzerland, England, Australia, and Thailand.
This study found that in most countries, the ministries of foreign affairs were responsible for the
development and the monitoring and evaluation (M&E) of global health strategy. The widely used
principles for the selection of global health issues comprised: (1) the globally threathening health
problems which also threatened own country, and (2) the country’s public health and foreign policies.
Deliberative discussion and consultation with stakeholders were the methods that all eight countries
employed to select global health issues for the development of their global health strategic framework.
There was no evidence of using quantitative methods or weighting methods for selection of global health
issues. The main principles underpinning the M&E activities focused on: (1) incorporating the M&E
activities as an integral part of the global health strategic framework at the beginning of the process;
(2) evaluating both outcomes and impacts (if possible) and (3) appropriately designing the M&E process
that fits with the implementation of the strategic framework.
The Ministry of Public Health issued the Health Insurance Card Scheme (HICS) for migrants who
were not covered by any health insurance schemes; however, the benefit package under the HICS has
not been significantly revised for the last 10 years. This study aimed to review and develop a proposal
to revise the benefit package of the HICS for migrants. The study was conducted by reviewing documents,
including clinical practice guidelines and cost-effectiveness studies of health interventions of the first 20
important health problems among migrants in Thailand, 10 communicable and 10 non-communicable
diseases. The benefit packages of the HICS and the universal health scheme were also compared. A
focus group discussion was arranged with 13 representatives from relevant agencies and healthcare
providers, and in-depth interviews were conducted with 33 key informants comprising decision-makers/
government officers, healthcare providers, non-governmental organizations and 15 migrants. The study
showed that the HICS covered diagnosis and treatment of almost all (90%) of the prioritized health
problems. About 80% of the non-listed or unclear health services in the current benefit package were
related to health promotion and disease prevention activities. Those unclear benefits led to disparities
in services availability and user charge for access to service. The analysis of qualitative data suggested
that health interventions that should be included in the benefit package and provided in all hospitals
consisted of the maternal and child health diary (in translated version), the screening and treatment for
common mental disorders, and breast self-examination advice.
An implementation research on the development of integrated-people centered care started a
pilot reform of service delivery system in 20 primary care clusters (PCCs). Patients with diabetes and/or
hypertension were employed in this pilot test model. An initial assessment was taken after a 4-months
implemention on patient’s experiences on receiving integrated people-centered care comparing between
PCC under the project with other primary and ambulatory care facilities in the same district. A community
survey of 200 samples was conducted from each district. There were totally 4,071 samples, 1,311
samples from hospital DM/HT clinics, 1,721 from PCCs in the project, 823 from other PCCs, and 216
samples from health centers.
Results showed that PCCs in the project had significantly better patient-family care team relationship
compared with other types of health facilities, a greater proportion of patients knew the name of family
physician, family care team, and had more convenient communication channel. However, the target of
receiving care from the same family doctor and team needed further improvement. The PCCs in the
project achieved significantly greater proportions of patients receiving care according to the guideline for
chronic illness care in most of the 5 dimensions (knowing health determinant factor, care plan, goal
setting, health behavior, and care result) compared with other types of facilities. However, the dimension
on health behavior modification got relatively low score compared with other dimensions. It is noticeable
that the other PCCs did not perform any better than hospital DM/HT clinics either in terms of patient-doctor/
family care team relationship or care for chronic illness. Further implementation research is needed
to evaluate implementation outcomes and service outcomes of the model.
This report presents a brief technical methodology on unit cost per disease and cost per diagnosis
related group (DRG) for Thailand. Cost analysis was on provider perspective. Standard costing method
and micro-costing or bottom-up approach were employed. The process started with cost per activity
estimation, patient-level costing, disease costing, and DRG costing. Cost data were voluntarily collected
from 13 hospitals. They were 4 regional hospitals, 1 general hospital, 7 community hospitals, and 1
specialty hospital. All data were for the fiscal year 2018 (October 2017 to September 2018). Results were
presented into two parts, cost methodology prototype and cost per disease and cost per DRG. Cost
analyses consisted of 2 major processes. They were hospital cost and cost center analysis using top-down
costing method, and cost per disease using bottom-up method. Top-down costing included 4 steps
1) cost center identification, 2) direct cost determination, 3) indirect cost determination, and 4) total cost
determination. The bottom-up costing was composed of 1) unit cost per service activity, 2) patient level
costing, and finally, costs of each patient were summed up as cost per disease of outpatient visit and
cost by Thai DRG version 6.2. The study also demonstrated that cost per activity such as an average
bed-day (room and board) cost for common ward was 377 baht, for intensive care unit was 930 baht.
An average outpatient nursing service cost was 252 baht per visit, inpatient nursing service cost was 1,055
baht per bed-day, ICU nursing service was 4,245 baht per bed-day. Metformin drug was 0.35 baht per
tablet, and HbA1C was 126 baht per test. Average cost of outpatient treatment for diabetes mellitus was
1,676 baht per visit: 1,951 baht per visit for regional hospital, 1,114 baht for big community hospital, and
929 baht for small community hospital. The total cost per admission was 3,847 baht for DRG 15540
newborn admission weight >2499 gm, 18,478 baht for DRG 14010 cesarean delivery. Costs of admission
among hospital levels were still different even for common DRG 06570 infectious gastroenteritis age >
9: 9,601 baht per admission for regional hospital, 7,772 baht for big community hospital, and 8,176 baht
for small community hospital. This paper demonstrated that the expanded standard cost methodology
development on cost per activity estimation at patient level would be useful for studying costs of service
provision of all health insurance systems in Thailand.
The objective of this study was to estimate unit cost of Thasongyang Hospital, Tak province from
provider perspective. Retrospective study was conducted in fiscal year 2018 and cost was obtained during
1 October 2017 and 30 September 2018. The hospital cost and service cost were analyzed using standard
top-down method and cost-per-patient was analyzed using bottom-up method. Cost centers were divided
by department types into two main groups: absorbing cost center and transient cost center. Costs
were distributed from transient cost centers to absorbing cost centers using simultaneous equation
method. The allocation criteria used data from absorbing cost centers together with information from
hospital database, and data were processed by (Hospital Service Cost Estimate: HSCE) computer program.
The study found that in fiscal year 2018, total service cost of Thasongyang Hospital was 159,909,496
baht. The proportion of labor cost, material cost and capital cost was 56.7:32.4:10.9 respectively. An
average outpatient cost per visit was 615 baht. An average outpatient cost per visit of each scheme including
the civil servant medical benefit scheme, social security scheme, universal coverage scheme,
stateless people, non-Thai resident with health insurance, non-Thai resident, road accident victims and
other was 747, 613, 599, 629, 617, 581, 1,175 and 459 baht, respectively. An average inpatient cost per
adjusted relative weight was 13,945 baht. An average inpatient cost per adjusted relative weight of each
scheme including the civil servant medical benefit scheme, social security scheme, universal coverage
scheme, stateless people, non-Thai resident with health insurance, non-Thai resident, road accident
victims and other was 15,330, 12,888, 13,792, 13,263, 14,429, 14,488, 10,840 and 22,967 baht, respectively.
Service cost of Thasongyang Hospital was higher than the service charge and labor cost was the
highest cost. Hospital administrators, therefore, should apply the results from this study for better management.
Further studies should examine cost recovery in each scheme.
Background and Rationale: Previous studies showed that emergency medical dispatcher (EMD)
infrequently made a correct diagnosis. We found no similar study in Thailand. This study aimed to evaluate
the accuracy of out-of-hospital cardiac arrest (OHCA) diagnosis made by EMD. Methodology: This
was a retrospective study. We reviewed emergency response record from Maharaj Nakorn Chiang Mai
Hospital EMS unit and all records with the diagnosis of OHCA made by EMD at Chiang Mai Province EMS
center from 2011 through 2018. Results: In total, 276 medical records were reviewed. The mean age was
55.3+20.5 years, 72.1% were male, 272 patients had cardiac arrest upon arrival of the EMS team, whereas
4 patients had other conditions. Among these 272 patients, 116 patients (42.6%) were diagnosed with
OHCA by EMD; whereas 86 patients (31.6%) were diagnosed with unconsciousness, 22 (8.1%) with traffic
accident, and 48 (17.6%) with other conditions. The EMD made a diagnosis of OHCA in 120 out of 272
patients, with the sensitivity of 42.6%, and positive predictive value 96.7%. Conclusion: EMD’s diagnosis
of OHCA was inaccurate. However, the diagnosis of OHCA made by EMD had high probability.
Objectives: To evaluate people’s understanding on prehospital triage for the level of severity of
emergency illness in terms of interrater agreement compared with the Thai criteria-based dispatch, and
to assess the factors associated with people’s understanding. Study design: A cross-sectional survey of
Chiang Mai people’s perception on responses and management by call takers and dispatchers at the
call center of the emergency medical service. Methods: The survey asked people’s perceived priorities
by randomly selecting 4 out of 24 pre-set emergency scenarios of the Thai criteria-based dispatch triage
cases. The questionnaire also asked respondent’s characteristics, such as, education, previous experience
on emergency medical care, and related perceptional factors. Apart from descriptive statistics, Cohen’s
kappa coefficient to compare the agreement and logistic regression to explore associated factors with
agreement were analyzed. Results: A total of 102 participants responded to the survey, 62.7% were
female, median age was 25 years old (IQR = 21-37). Most of them were bachelor’s degree holders, a
38.2% agreement between people’s perceived priority and the Thai criteria-based dispatch was found
(k = 0.175, p < 0.005), with 42.9% under triage and 18.9% over triage. The percentage of agreement was
higher for non-urgency (49.5%), and semi urgency (40.8%), but lower for urgency (33.0%) and emergency
scenarios (29.0%). No factors associated with the agreement of people’s perceived priority and the prehospital
triage were found. Conclusions: People’s perceived priority did not match with the actual triage
category, and no people’s characteristics associated with prehospital triage agreement were established.
Physical activity (PA) for the active aging becomes essential policy for health among the global
countries, as well as Thailand. Thus, the database of PA policy is essential to accurately identify direction
of formulating master plan to promote physical activity for active aging. The aims of this study were to:
1) systematic review the physical activity policy for active aging, and 2) recommend physical activity
policy to promote active aging. A systematic review was conducted on PA research articles through 12
bibliographic international electronic databases and Thai articles were identified through 5 reference lists
published during 2008-2018. Experts and researchers screened the selected papers independently.
The result showed that out of 3,239 screened articles, a total of 315 studies were included in the
review. Most studies (35.2%) were for the built environment (BE), 34.3% for the PA intervention, 20.0%
for the active transportation (AT), and 10.5% the accessibility towards PA resources. According to the
systematic review, recommendations were as follows. 1) The government and business organizations as
well as older adults’ club and school should develop 6 PA intervention programs, namely, home-based,
community-based, group-based, sedentary-based, noncommunicable disease-based, and smart phone
application-based PA programs engaging in at least 150 minutes per week of moderate to vigorous PA.
2) The Ministry of Transportation should arrange AT to support independent mobility for active aging
under the safe and flexible circumstances relevant to their needs. 3) The government and business
sectors should develop built-environment policy to promote PA for older adults’ better lifestyle in all
levels of social status with safety. 4) The Ministry of Digital Economy and Society, the Ministry of Social
Development and Human Security as well as academic institutions should provide an opportunity and
capability to older adults to access PA knowledge and information via smartphone and applications.
Moreover, due to the lack of study regarding the impact of the 4 PA policies, further studies should focus
more on the impact of PA policy, particularly on AT system and BE, as well as health outcome in active
aging. The evidence from this study should be a basis for reformulation of future national elderly policy
directions.
This research aims to evaluate the compliance level of Health Measure and its constraints to prevent and control COVID-19 pandemic of several population groups in Thailand; general urban people, urban poor, rural people and people in Southern border. This research uses questionnaire survey via google form and telephone with 7,569 samples and then repeats two more times with different but continuous surveys. The Behavioral Insights concept is applied. Results find that each population group can comply with Health Measure in public area indifferently, but each one has different capacity to comply in house due to physical constraint such as limited space, which is from limited wealth and income before. Moreover, repeated survey finds that low-income people have to face with higher risk because of insufficient income to survive for their family. So fiscal measure for the poor such as subsidy is necessary and important to capacity to comply Health Measure and then to prevent and control COVID-19 pandemic.
Background At present, there are an increase in the proportion of Thai elderly people who are patients with non-communicable diseases (NCDs) including diabetes and hypertension. The patients need holistic care within medical care and non-medical care in order to improve their quality of life. An investigator conducted the model development of primary care services for non-communicable disease patients using an innovative network of homecare providers. The study aimed to determine the quality of life outcome of NCDs patients who received WinCare, and to improve a non-formal health sector for NCDs patients. Methods A non-randomized trial was conducted in 2019-2020. NCDs patients were enrolled to the present study. The participants were divided into 2 groups including (1) Control group and (2) Intervention group (received non-medical care from WinCare). Baseline characteristics comprised of demographic data, blood pressure (BP), body mass index (BMI), and quality of life out come were obtained from face-to-face interview. The intervention group had been received WinCare for 6 months. The quality of life outcome, BMI, and BP were access at month 1, 3 and 6. Results A total of 99 NCDs patients were enrolled in the present study. There were 53 NCDs patients in the intervention group. After 6 months, compared to the quality of life (QOL) outcome of NCDS patients in the control group, the QOL outcome of those in the intervention group was relatively high. Conclusion WinCare are the volunteers who well trained and have a potential for provided non-medical care in the community. An innovative network of homecare providers will enhance the public health system to support the activities of NCDs patients at their home.