plueme/wizJson huggingface dataset:
We conducted a test negative case control study to assess the Vaccine Effectiveness (VE) of various vaccine regimens for preventing COVID-19 infection and its severity during the period when Omicron was the dominant causative virus in Thailand. All 8,600 individuals, aged ≥5 years, at risk for COVID-19 (Patient Under Investigation, PUI) who presented for nasopharyngeal real time polymerase chain reaction (RT-PCR) testing were prospectively enrolled at Thammasat University hospital during January to June 2022. There were 3,546 cases who were infected. For preventing omicron variant associated infections, the VE increased along with the increase in the number of vaccine dose and the four dose regimen (2 boosters) had the highest but only moderate VE. For preventing severity, the three and four dose regimens (1 and 2 boosters) had comparable high VE and their effectiveness was more durable than the two dose regimens. Significant protective factors to prevent infection were vaccine doses, female and healthcare personnel. Significant risk of infection included elderly, at least one chronic morbidity and household infection. Significant risk of severe COVID-19 was incomplete two dose vaccination, at least one chronic morbidity and elderly. Longcovid condition was prevalent after 6 months of COVID-19. It consisted of multi system symptoms. Weakness and neurological symptoms were the most common manifestations. Risk factors of longcovid condition were female, cough symptom at acute infection and severe COVID-19. Based on the study findings, current mass vaccination programs should focus on reducing COVID-19 severity and mandate at least one booster dose after primary series vaccines. The heterologous boosters with viral vector and mRNA vaccines were highly effective and can be used in individuals who had previously received the primary series of inactivated viral vaccine.
Background: Digital health governance was identified as an essential foundation for establishing e-health in Thailand by the Ministry of Public Health (MOPH) and World Health Organization (WHO) Thailand since 2010. Despite many health information systems and digital health developments, there is still no consensus amongst stakeholders on national digital health governance mechanism. Objective: This study aimed to identify appropriate digital health governance mechanism for Thailand health systems. Methodology: There were two parts to the study. First, we reviewed literature including digital health governance and health systems from international reports and various digital health governance documents from Malaysia, the Philippines, Australia, England, the USA, and Canada. Second, a qualitative study design was used involving a semi-structured in-depth interview method. Eleven health information technology scholars, executives, and startup entrepreneurs were interviewed face to face or online. Result: The review on digital health governance in the six countries showed the influences of political systems, culture, and health systems leading to diverse implementation models. In-depth interviews employed the governance models of the Broadband Commission 1) the health ministry mechanism, 2) a government-wide digital agency mechanism, and 3) a dedicated digital health agency mechanism. Majority of key informants agreed with the dedicated digital health agency mechanism. More than two-thirds made pertinent suggestions: 1) leaders should be decisive in their decision-making with continuity of leadership, 2) strong collaborations to reduce working in silos, and 3) proper health information standards. Conclusion: In the context of Thailand, the MOPH alone cannot govern digital health. However, the MOPH can lead governance mechanism through collaborating with other ministries and stakeholders. Good collaborative governance is the key to an effective digital health governance system, with decisive leaders and continuity of leadership. The preferred model is the dedicated digital health agency mechanism and health information standards are crucial.
This study retrospectively investigated the effectiveness of the vaccine in real-life situations. The objective focused on the reduction in deaths of elderly people infected with COVID-19 who received the complete 3-dose COVID-19 vaccine compared to those who did not. Data were collected from the electronic database of the Samut Prakan Provincial Health Office, linked to the Ministry of Public Health’s database on vaccination. Data were collected retrospectively from January 1, 2022 to March 31, 2022. Result: The study found that there were 5,891 COVID-19 elderly individuals resulting in 56 deaths. Of those 2,236 patients who received the complete 3-dose vaccine faced 5 deaths, while 3,655 who did not face 51 deaths; odds ratio of 0.16 (95% CI = 0.06-0.40) or an 84% reduction in mortality (p < 0.001). Conclusion: Elderly individuals who received the complete 3-dose vaccine had a reduced risk of mortality if contracted COVID-19 in real-life situations. Therefore, the results should be disseminated to encourage complete 3-dose COVID-19 vaccine in elderly individuals.
This study aimed to assess the situation of premature mortality due to four noncommunicable diseases (cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases) between 2000-2018 in the Thai population aged 30 to 70 years, and the feasibility of achieving the Sustainable Development Goals (SDGs) of reducing premature death by one-third by 2030. We estimated premature mortality using civil registration and vital statistics (CRVS) from the Bureau of Registration Administration with cause of death coded by the Strategy and Policy Division. Verbal autopsy data were applied to improve accuracy of causes of death from the vital registry. We predicted the premature mortality up to 2030 using Bayesian model averaging (BMA). The findings showed that given the current historical trend, achievement of the SDG target of 9.9% by 2030 was unlikely, as we predicted it to be 12.0% (95%CI, 10.6-3.6). However, this goal is more likely to be achievable in women than men. Among the four NCDs, respiratory diseases are most likely to reach the target.
A monitoring system of food and beverage marketing plays a crucial role in tracking progress in the marketing of food industry particularly the marketing of unhealthy food and beverage. The objective of this study was to review the existing monitoring system of food and beverage marketing in Thailand and foreign countries, and to analyze the gaps and opportunities for improving the monitoring system of food and beverage marketing in Thailand. Document review and in-depth interviews with the stakeholders were conducted. Searches were performed through PubMed, Google Scholar, websites of international organizations (such as UNICEF) and relevant organizations in Thailand, selected country databases such as Chile, Republic of Korea, and Australia from 2007 to 2021-timeframe. Purposive sampling was used to identify key informants from government agencies, academia, and civil societies for interviews. Content analysis by using the World Health Organization’s set of recommendations on marketing of foods and non-alcoholic beverages to children was performed on the data from stakeholder interviews and document reviews. Results showed that Thailand, Chile, and the Republic of Korea had government agencies responsible for monitoring the marketing of food and beverage. While the governments of Thailand and Chile cooperated with relevant agencies to monitor the marketing of food and beverage, Australia was active in co-regulation between government and private sectors to monitor food and beverage marketing in collaboration with active civil society sector. Key challenges for Thailand included lack of human resource, outcomes monitoring, and progress report on complaint management. Opportunities for improvement included technology utilization, collaboration and information sharing with relevant agencies and civil society.
Currently, there has been an increasing number of psychiatric patients. From 1 in 5 people in the country to have mental health problems, Thailand has 14.3% or 7 million psychiatric patients at risk of mental health crisis with a chance of inflicting self-harm or violent behaviors towards people and surrounding property. The present research aimed to implement a seamless locally integrated emergency medical service system for emergency mental health crisis patients, monitor, evaluate, and provide policy recommendations. The mixed methods research comprised quantitative and qualitative analysis. The sample group is a multidisciplinary stakeholder in the field of “Emergency Medical Service Systems for Locally Integrated Emergency Mental Health Patients”. The research is conducted in 12 provinces distributed across Health Region 1-12 using a purposive sampling. The tool consisted of a knowledge set, risk evaluation survey, warning sign knowledge assessment form, and questions for the group discussion. The data were analyzed with descriptive statistics and content analysis. The results showed that 1,858 risk groups in 12 pilot sub-districts were mostly male (76.7%), aged 21-50 years (71.4%), with a history of intermittent treatment for psychiatric disorders (43.8%). From these 2,099 relatives/caregivers, most had good understanding on “warning symptoms and requests for help for emergency mental health patients”. As for the self-management community system, most pilot areas had working guidelines before, during, and post treatment, especially on organizing a response team to assess and mitigate before external teams enter the scene. This is connected to the local police unit in conjunction with the initial emergency operations to bring the health service system to the appropriate destination hospital. As an outcome, patients with mental health crises have faster and more access to emergency medical services. In addition, there were no reports of injuries to patients, officer or surrounding people as well as being able to extend the results through the service plan of the Mental Health and Substance Abuse. The impact for the expected effects, those at risk of mental health crisis can access the health system quickly and appropriately, reducing complications and preventable dangers. In addition, it is expected that the community become more self-reliant, increase in health literacy in promoting, preventing, and providing basic assistance for mental health crisis situation, as well as having established integrated guidelines for the health service system including prevention, pre-hospital care, in-hospital care and inter-facility transfer seamlessly.
Currently, there is no epidemiological study of diabetes diagnosed before the age of 30 in Thailand. The aim of this study was to determine type of diabetes and clinical characteristics of Thai diabetic patients diagnosed before age 30 years. Six hundred and forty-six patients were enrolled from 31 network hospitals in Thailand between August 2018 to December 2021. Type 1 diabetes was identified in 63.6% of patients, type 2 diabetes in 19.8%, and other specific types of diabetes in 16.6%. For type 1 diabetes patients, the median age at diagnosis was 11 years and presentation with diabetic ketoacidosis (DKA) was common (45%). The average glycated hemoglobin (HbA1c) at diagnosis was 9.9%. For type 2 diabetes patients, the median age at diagnosis was 18 years and the presentation of DKA was 4.7%. The average HbA1c at diagnosis was 10.9%. In conclusion, type 1 diabetes was more common in diabetes diagnosed before age 30 years and DKA was frequent. The prevalence of type 2 diabetes increased with age and HbA1c increased during adolescence. This study can be used as reference and may lead to applicable public health policies related to diagnosis, treatment, and prevention of diabetes in young people in Thailand as well.
At present, it is apparent that the incidence of obesity keeps increasing. It has also been discovered that there is a strong positive correlation between body mass index and the prevalence of chronic diseases. However, there are still many undiagnosed obesity patients. Therefore, the present research aimed to determine the prevalence of obesity in terms of underdiagnosed cases and chronic diseases in all obese patients from the Prince of Songkla University Hospital information system. This study employed a cross-sectional descriptive approach. We gathered data of all outpatients older than 18 years, excluding pregnancy cases. Data collection was taken from the hospital information system between 1 January 2016 and 31 December 2020. From 327,300 patients, a total of 135,112 patients were included in the study and 35.6% of patients met the Asia Pacific criteria for obesity (BMI ≥ 25 km/m2), but only 15.9% of them were given a diagnosis of obesity using Asia. The prevalence of 3 chronic conditions in obese patients was 21.3% for hypertension, 12.3% for type 2 diabetes mellitus, and 32.4% for dyslipidemia. Moreover, 9.5% of patients met the World Health Organization criteria for obesity (BMI ≥ 30 kg/m2), but only 33.5% of them were given a diagnosis of obesity. The prevalence of 3 chronic conditions in obese patients was 16.3% for hypertension, 18.8% for type 2 diabetes mellitus, and 11.3% for dyslipidemia. This present study showed that despite having a BMI exceeding the threshold for obesity, many people are still not given a diagnosis of obesity. Moreover, the prevalence of hypertension, type 2 diabetes mellitus, and dyslipidemia found among obese patients were lower than research in western countries.
Background: Acute kidney injury can occur from many reasons. As a result, the body cannot excrete wastes from the body. In Thailand, the number of acute kidney injury patients accessing renal replacement therapy show a decreasing trend with two potential assumptions: true reduction in the number of patients; or inaccessible to the treatment. There are no measures from relevant agencies to address this problem, in addition to different service systems even in the same service providers. Moreover, the reimbursement for continuous renal replacement therapy (CRRT) does not reflect the actual cost of the service. Objective: The objective of this study was to survey the hospital resources for providing CRRT in Thailand. Methods: The study used data from a document review and secondary data from a previous study in Thailand including distribution of hospitals, medical personnel training information and characteristics of patients receiving services. A questionnaire survey on CRRT services in 280 public and private hospitals registered to the National Health Security System in the fiscal year 2020 was undertaken. Results: The survey revealed that hospitals were capable of providing CRRT services to more patients if the reimbursement to hospital increased to an average of 25,563 baht per patient. Given the appropriate reimbursement rates for CRRT services, 88% of the hospitals could provide services to more number of patients with acute kidney injury in critical periods, leading to greater access to CRRT.
The purpose of this study was to estimate the cost of outpatient care for older patients with a primary diagnosis of hypertension, heart attack, and stroke at community hospitals in Thailand. This cross-sectional study used cost information in 2014 from four community hospitals. The hospital cost information consisted of service data, hospital statistics, and financial reports. We used the International Classification of Diseases (ICD-10), the 10th revision coding system to identify hypertension, heart attack, and stroke. Traditional cost and the cost to charge ratio methods were used to estimate average cost per visit and cost per person-year. Inflation rate was used to report the average cost in 2021. Overall, the major costs were for labor (53%), followed by material (42%), and capital (6%). The unit cost per visit for older outpatients in 2014 was between 447-688 THB for hypertension (531-817 THB in 2021), 634-1,171 THB for heart attack (753-1,392 THB in 2021), and 611-1,238 THB for stroke (726-1,470 THB in 2021). Our cost analysis used actual cost data, which provided useful information for budgetary planning and management for outpatient care among older adults with a primary diagnosis of hypertension, heart attack, and stroke.
This research aimed to study the cost of health service model for COVID-19 inpatient care that hospitals provided according to the level of inpatient’s condition. The data were from a 5-hospitals case study in Thailand, employing a standardized top-down cost analysis and the micro-costing method based on provider perspective. Three regional and two general hospitals participated by providing hospital data of the fiscal year 2021. There were 7 health service models under study: 1) cohort ward 2) intensive care unit-cohort ward 3) hospitel 4) field hospital 5) field hospital for prisoners 6) home isolation and 7) community isolation. The average cost of treating COVID-19 patients was 31,342 baht per case for the average length of stay (aLOS) of 10.9 days. The cost at the ICU-cohort ward was the highest at 187,257 baht per case, followed by the cost at the cohort ward at 62,033 baht per case and the lowest cost at community isolation at 4,532 baht per case. For COVID-19 patients who experienced more than one service models due to clinical condition change, the average total cost was 91,568 baht per case for aLOS of 11.0 days for those cared in community then moved to hospital; and 149,844 baht per case with aLOS of 12.1 days for those cared in cohort ward then moved to ICU-cohort ward. The results of this study demonstrating different resource uses by service models could be used to evaluate the amount of COVID-19 budgets that health insurance funds made available and paid for service delivery of the hospital compared to the actual cost by service model.
Budsarakhum Hospital was a large field hospital specialized in providing temporary care for COVID-19 patients. The research objectives were to describe the current situation, problems, constraints, and administrative strategies of Budsarakhum Hospital and to develop policy recommendations for field hospital administrative systems. This is qualitative research and documentary review with a purposive sampling on directors of field hospitals from public and private sectors; emergency medical specialists; administrators and health care providers; including patients who were admitted to Budsarakhum Hospital. Data were collected from participants through in-depth interview and analyzed using the content analysis. Results: 1) From literature review and interviews with experts, administrative system of Budsarakhum Hospital was compliant to administrative model of field hospital for COVID-19, in the scope of input, process and output. However, the emergency human resource mobilization and outcome monitoring were unclear. 2) Problems, constraints, including hospital administrative strategies were identified on hospital structure, extra-organizational communications, risk management, infection control, personnel recruitment and stress management, medical record system, handling of medical materials/devices, admission process, clinical care, patient referral system, and outcome monitoring. 3) Policy recommendations on administrative system of field hospital focused on the information for the public, private, and people sectors to prepare themselves to deal with the epidemic particularly field hospital administrative system if facing future crises.
The COVID-19 outbreak greatly disrupted healthcare systems and made it more difficult for patients to access treatment, ultimately affecting the quality of life of patients and society. This paper highlighted the issues and importance of policy management and examined the financial cost and social benefits of treating allergic rhinitis and allergic asthma caused by house dust mites (HDM) amid an outbreak of COVID-19. A comparative analysis was executed between HDM sublingual immunotherapy (SLIT) as an intervention and subcutaneous immunotherapy (SCIT) as a comparator. It was found that HDM SLIT provided a better return on investment from the perspective of society during the COVID-19 pandemic in 2021 than HDM SCIT. The benefit to cost (B/C) ratio of the HDM SLIT to HDM SCIT was 1.72 and likely to be less than 1.00, respectively, which were statistically different. Policymakers could use these results to establish strategies for treating allergic rhinitis with and without asthma by choosing between HDM SLIT and SCIT, particularly during the pandemic.
This research developed tools and data systems to collect field data and evidence for monitoring health and vocational impacts from transboundary air pollution from a coalfired power plant in Lao on laypeople in 8 villages in Huai Kon subdistrict and Khun Nan subdistrict, Chaloem Phra Kiat district, Nan province. This research applied the principle of community citizen science (CCS), starting from formulating research questions to address the community’s concerns and negative direct experience potentially caused by transboundary air pollution. Next, these concerns and experience were used to design relevant environmental indicators for field monitoring to verify the association between community’s concerns and transboundary air pollution. Next, air pollution dispersion and deposition models were used to create risk maps illustrating health risk from PM2.5 and PM10, agricultural land degradation risk from acid deposition from SO2 and NO2 , and child’s IQ development risk from consumption of Hg-elevated fish, all of which are caused by major transboundary air pollutants from a coal-fired power plant. These risk maps helped us identify risky areas and receptors as well as environmental indicators to prove the effects from these pollutants. Low-cost air pollution sensors, soil acidity, Hg in fish and human hair were assessed. We found that every village except Ban Dan village started to get impacts from acid deposition already as confirmed by acidic soil pH in every village from pH 4.20 to 5.09 much lower than natural, non-acidic soil with pH of 5.5. Also, Huai-kon, Nam-ree, Kewchan, and Sop-Puen villages were likely affected from transboundary Hg already because Hg in fish was relatively high (0.16 mg/kg) even though this is still lower than the acceptable level (0.3 mg/kg), but Hg in hair of women in the area with elevated Hg in fish was abnormally high in comparison to normal Thai people. We roughly estimated the health and vocational cost from transboundary Hg and acid deposition to be around 975 million THB in 30 years. This serious problem should be properly managed using CCS to establish a database which reflects actual current and future impacts from transboundary air pollution. Moreover, the owner of the coal-fired power plant should join force with this CCS effort to design prevention, mitigation, and compensation measures. A risk management fund of 1,000 million THB should be established together with a clear protocol to use this fund for community in the fairest and the most community-engaging manner.