plueme/wizJson huggingface dataset:
The objective of this quasi-experimental research was to apply the Thai diabetes
risk score for evaluating diabetes prevention outcome in order to conduct a cost-effectiveness
analysis of diabetes primary prevention for prediabetes. The study population
included 1,182 cases of prediabetes selected by verbal screening criteria and impaired
fasting glucose level (100 - 125 mg/dl); they were divided into two study groups for
comparison. The experimental group consisted of 400 prediabetes cases who agreed to
participate in a prediabetic day camp; the control group comprised 410 prediabetes cases
receiving ordinary health-care services. The instruments used for collecting the data were
questionnaires, Thai diabetes risk score, customer and provider cost data recording profiles,
practice guidelines for a diabetes prevention program in a day camp. Data were
analyzed statistically, using frequency, percentage, mean, standard deviation, and ratio;
they were comparatively analyzed by t-test and paired t-test at the 0.05 level of statistical
significance.
The results of this study were as follows: (1) prediabetic day camp activities effected
a reduction in the cumulative incidence of developing diabetes by a factor of 7.49 times in
the experimental group (relative risk = 7.49) compaired with the control group; it also
statistically significantly decreased the average diabetes risk score and the probability
level of the sample in the day camp compared with those in the control group. Furthermore,
the risk factors for diabetes reduced from lifestyle modification caused a statistical
decrease that was significant (p < 0.05) on both average BMI and BP level, except for
waist circumference; (2) the effectiveness of diabetes primary prevention for prediabetes
justified by summation of the individual differences in diabetes risk probability before
and after intervention was 0.0198; otherwise the cumulative incidence of lower diabetes
risk score for prediabetes in the experimental group revealed a score of 0.2375; (3) the
economic cost of diabetes primary prevention for prediabetes in the prediabetic day camp
was 357,100 Baht, with the opportunity cost being 20.31 percent compared with the total
cost; (4) the cost-effectiveness ratio of diabetes primary prevention for prediabetes in the
day camp was 18,035,353 Baht per effective diabetes risk probability prevented and/or
1,503,578.9 Baht per effective cumulative incidence prevented.
It was recommended that (1) the research findings should provide important information
for policy decisions to apply the Thai diabetes risk score for evaluating diabetes
prevention outcome; (2) comparative cost-effectiveness analysis of diabetes primary prevention
for prediabetes should also be studied by other health-care teams on a long-term
basis.
Diabetes is an important risk factor for the development of coronary heart disease
(CHD). Recent studies have found that the rise in the mortality rate of diabetes mellitus type 2 patients was due to coronary heart disease. This study was conducted in June
through September 2007, with the intention to evaluate CHD risk in diabetes patients
attending Sangkhom Hospital, Nongkhai Province. Data were collected by interview, blood
sampling and retrieval from medical records. The participants were 309 patients with
type 2 diabetes, aged 33 to 75 years (mean 55 ± 22 years), and without cardiovascular
diseases. The 10-year probability was estimated by using the INTERHEART Study modified
from NCEP ATP III (National Educational Program and Adult Treatment Panel III).
Student t-test and chi-square test were used to determine the differences between men
and women patients regarding risk factors, and to predict the probability of CHD. Most
patients (92.2%) smoked; 46.9 percent were hypertensive or were taking antihypertensives;
37.2 percent had total blood cholesterol (CHOL) higher than 200 mg/dl and a high density
lipoprotein cholesterol (HDL-C) level of less than 40 mg/dl. Evaluation by the heart
risk score (based on a model using basic risk factors, i.e., age, smoking, CHOL, HDL-C,
systolic blood pressure), 6.8 percent of the patients (25.3% men and 1.6% women; p <
0.001) had a predicted 10-year probability of more than 20 percent at very high risk (I)
and 21.4 percent of the patients (58.2% men and 11.2% women; p < 0.001) had a predicted
10-year probability of 10-20 percent at high risk (II); whereas 71.8 percent of the patients
(16.4% men and 87.2% women; p < 0.001) had a predicted 10-year probability of less than
10 percent at moderate risk (III). The predicted 10-year probability of 10-20 percent and
over 20 percent of the diabetic men was significantly higher than that of diabetic women,
whereas the predicted 10-year probability of less than 10 percent of the diabetic women
was significantly higher than that of diabetic men. The prevalence of risk factors related
to high risk of CHD was different in diabetes patients. Thus, estimates of probability of
CHD are necessary for all persons with diabetes, indicating the risk factors to be corrected
in order to prevent mortality and morbidity. Despite differences in individual risk
factors and predicted probability between men and women, the estimated risk for CHD
should be calculated for all persons with diabetes mellitus.
This research was aimed at analyzing the relationships between relating factors and
their characteristics in relation to high blood pressure in Banlaem district, Phetchaburi
Province. The sample population comprised 1,521 randomly selected people who were
interviewed by using a questionnaire during the period between August 2007 and January
2008. The data were analyzed by Pearson chi-square.
The result of the study revealed that 7.10 percent of patients were living in the area
under the responsibility of Tapoonoak Primary Care Unit. The majority of them also had health behavior related to hypertension at the middle level (69.36%), had a model of selfcare
at the middle level, understood and had knowledge concerning hypertension at the
middle level (65.22%). The factors that related to hypertension included geographical
area of residence (p<0.000), age (p<0.001), education (p=0.040), income (p=0.000), marital
status (p=0.002), having specific illness (p<0.001), having experience in screening for hypertension
(p=0.028), body mass index (p=0.000), exercise behavior (p<0.001), and selfcare
behaviors (p=0.001). Therefore, holistic care is necessary for the population in order
to decrease risk factors as well as to adapt health behavior. The service should cover the
family and community, including the local administrative organization, to get them to
participate in solving the problems. Moreover, multidisciplinary health personnel would
necessary be allocated to primary care units in an appropriate manner.
Low birth weight newborns are more vulnerable to higher mortality and morbidity
rates than normal weight infants. Research to determine the maternal risk factors would
be valuable in planning a way to solve the problem. This retrospective study was aimed
at finding out those risk factors in women of more than 28 weeks pregnancy from the
delivery records during the period from September 1, 2005 to October 31, 2007. There
were 3,622 deliveries, of which 174 delivery incidents of low birth weight infants were
taken as the study group and 177 deliveries of normal birth weight infants as the control
group by systematic randomized sampling. The prevalence of low birth weight in this
study was 4.8 percent. Results from the univariate analysis showed that a maternal age
of less than 18 years, a gestational age of less than 37 weeks, attending ANC less than four
times, and maternal height less than 145 centimeters were risk factors. Multiple logistic
regression analysis revealed the risk factors to be maternal age being less than 18 years
old, gestational age less than 37 weeks, twin pregnancies, ANC less than four times, premature
membrane rupture, and pregnancy-induced hypertension.
This study was aimed at investigating an outbreak of acute diarrhea during the
period February 20 to March 23, 2006 in Tapanhin district, Phichit Province. It is a descriptive
epidemiological study that was undertaken to identify the problems and the interventions needed to control the disease, using an interview with individual case surveillance,
as designed by the Bureau of Epidemiology, and specimen collection. The study
population comprised 554 cases, including all cases who visited health-care facilities and
those in communities in Tapanhin district. An additional study was based on an observation
of the environmental factors and the disease-control measures. Quantitative data
analysis was presented in percentage, ratio, minimum and maximum, using a computer.
These data analyses were based on triangulation in order to make links, between the
factors and effective implementation.
The study found 554 cases in total (526.67 per 100,000 population). The epidemic
began in the municipal area and spread rapidly to surrounding sub-districts. The highest
prevalence was among children 1-4 years old (3,485 cases per 100,000) and 5-9 years (1,413
cases per 100,000), respectively. Leading symptoms included watery stool (85.35%), and
stomach ache (58.81%). Non-pathogenic bacteria were detected in 94.52% of the cases
based on rectal swab culture, whereas rota virus was detected in 3 of 9 stool cultures. A
centralized operation unit was set up in order to conduct active case surveillance and
control the disease. The interventions were conducted through both sanitation (cleaning
animal slaughter units, markets, and public restrooms) and education of street food-vendors.
As a result, the epidemic was brought under control within four weeks.
The achievement of diarrhea prevention and control requires rapid disease investigation
and community intervention from the district health system. To determine the
root cause of an epidemic, objective data, based on active case surveillance and comprehensive
laboratory examination are helpful.
The purpose of this study was to assess the addiction rehabilitation model (adopting
the matrix-intensive outpatient program - IOP) in the primary care units of Bangphli
Contracting Unit of Primary Care (CUP). The capacity of the primary care unit’s health care workers has been developed to implement this model. This action research was
completed by Bangphli Hospital. The program follows the matrix-intensive outpatient
program, which features cognitive - behavioral therapy. The Bangphli Hospital therapist
team oversees and advises all the other primary care units involved in this program. The
therapist team monitors every session of the program. Their results are evaluated by using
the standard criteria from the Thanyarak Institute. These criteria require the involvement
of at least 60 percent of those who attended and completed the program, and 60
percent of those who attended being non-relapsing, and who returned to work or school.
The results of the study revealed that implementing and pursuing this addiction rehabilitation
program has been an effective solution for the drug addiction problem. The primary
care units monitored were found to have exceeded these criteria by having 88.89
percent of the patients completing the matrix program and 100 percent of those did not
relapse but returned to work or school. These patients returned to their communities and
were welcomed by their families.
Non-insulin dependent diabetes mellitus (NIDDM) is a major health problem. One
significant factor that affects the success in its control and treatment involves the individual
self-care behavior in patients’ life style.
The purpose of this study was to assess the effectiveness of group participation in
self-help on self-care in patients with non-insulin dependent diabetes mellitus by comparing
them with patients receiving routine advice. The subjects included 88 non-insulin
dependent diabetes patients who attended the outpatient department of Prachathipat
Hospital in the period from December 2006 through May 2007. The samples were simply
randomized into experimental and control groups comprising 44 patients each. The experimental
groups assigned to the self-help group was further divided into four subgroups
of 8 -11 patients to join three activity sessions, spending 40 minutes in each of
them once a month. The control group received routine advice. Data were then collected
through interviews using questionnaires before and after the experiment. The statistical
analyses provided mean, standard deviation, and information from paired t-test and ttest.
The findings showed that, after completing the study project, the self-care behavior
mean score of patients who participated in the self-help group was statistically higher
than it was before starting the experiment and higher than the results in the control group.
The gained mean score on self-care behavior after the experiment between the self-help
group participating and the routine teaching group differed statistically.
The explanation given was that participation in the self-help group provided the
patients with sharing and learning experiences. The researcher suggested that the efficiency
of self-care behavior could also be modified for practice in the prevention of complications
from other chronic diseases.
Formerly, the programs for the elimination of iodine deficiency disorder in Thailand
had used the total goiter rate in school children as an indicator for evaluating the
program. That indicator showed improvement, from 19.3 percent in 1989 to 1.31 percent
in 2003. However, for protection against brain damage from iodine deficiency, importance
must be given to the transfer of thyroid hormones across the placenta even during
early gestation. Thus, the ultimate focus must be women who are going to be pregnant,
pregnant women and neonates. The criteria recommended by WHO/UNICEF/ICCIDD
are salt iodization, proportion of households consuming effectively iodized salt > 90 percent,
median urinary iodine in school age children > 10 μg/dl, thyroid size in school age
children, proportion with enlarged thyroid by ultrasound or palpation < 5 percent and
neonatal TSH, proportion with levels > 5 mU/l whole blood < 3 percent.
The present study took for examination thyroid size and collected blood and urine
specimens for TSH, thyroid function test, urinary iodine in many age groups both from
the hospital and the community in 1998 and 2003. The results showed that the goiter rate
in school age children by ultrasound decreased from 5.1 percent in 1998 to 0.5 percent in
2003, but this proportion was not similar to those identified according to thyroid size by
palpation i.e., 16.1 percent in 1998 and 21.4 percent in 2003. Median urinary iodine in
2003 in the subjects in age groups 0-1 year, 1-3 years, 4-6 years, 6-12 years, pregnant women
and elderly persons were 12.44, 15.49, 15.44, 15.31,11.30, 5.52 μg/dl, respectively. The levels
seemed to decline when compared with the 2003 findings of 19.62, 19.06, 15.83, 46.92,
7.17 μg/dl respectively. Neonatal TSH (serum based) >11.25 μlU/ml in 2003 were 26
percent, which showed that our area was a moderate iodine deficiency disorder area.
This might be caused by unsatisfied coverage with iodized salt at 45 percent.
In this study, most outcome indicators achieved the criteria, but the impact indicator
was unsatisfied in neonatal TSH. Accordingly, a process indicator such as coverage of
salt iodization showed the failure to achieve the criteria. Therefore, Dansai Crown Prince
Hospital would analyze the data in each community and show those data to people in the
community in order to solve this problem. We recommend that every district follow the
multidimensional evaluation of iodine deficiency disorder continuously as process, outcome
and impact indicators.
The objective of this work was to assess the results of tuberculosis patients treated at Sanam Chaikhet District, Chachoengsao Province by comparing the result of treatment between the Group 1 regimen, i.e., with the assistance of family members or public health volunteers in 141 patients and the Group 2 regimen, with treatment assisted by sub-dis trict personnnel, together with family members or volunteers for 38 patients. The data obtained from the patients’ registration (RorBor. 1K04) and treatment cards were analyzed for the number of patients, means, percentage, and the chi-square test. Of the 179 patients, 66.5 percent were male and 33.5 percent female, aged 10 to 88 years, with the average being 53.3 years. About 91.1 percent were cases of lung TB, of which 73.2 percent were registered as new cases, and 88.3 percent had no history of allergy. The majority (76 percent) of patients received treatment for category I, for which only 35.2 percent of the patients completed the treatment. Successful treatment, as cured patients and completed treatment, was obtained in 64 percent of patients. The results of treatment with the adapted regimen were 81.6 percent cured, 18.0 percent unsuccessful, while those treated with the old regimen showed success in 60 percent of patients and 39.7 percent were unsuccessfully treated. The difference between the two regimens was statistically significant at the level of 0.05.
Cataract is a significant cause of blindness in the global population. The objective of
this descriptive study was to study visual function (VF) and the quality of life (QOL) in 32
cataract patients treated by phacoemulsification at Bangnamprieo Hospital from January
to April 2007. Information was obtained before and one month after the intervention.
The patients were 12 men and 20 women, aged 50-82 years, with 62 years being the average.
Half of them had no occupation; average family income was 57,769 baht per year.
They suffered low vision for 23 months on average. The VF and QOL scores after one
month of treatment were higher than before, and the VF scores positively correlated to
the QOL scores (r =.567, p <.01). In conclusion, the present study shows higher visual
function and better quality of life scores after the intervention by phacoemulsification
together with the standard of care. The authors recommend this particular measure for
tackling cataract disease in community hospitals without full-time ophthalmologists, in
order to increase the health of the Thai population and improve the quality of life of the
people.
Objective: To study diabetes mellitus epidemiology in Phanomphrai district and
to assess diabetes risk factors in the Phanomphrai sub-district (tambon).
Methodology: Descriptively reviewed the Phanomphrai population and diabetes
registration and services for epidemiologic data in fiscal year 2006, and carried out a
community survey to assess diabetes risk factors through interviews using questionnaires
and specimen collection among those aged 20 years and older in Phanomphrai tambon in
the period July - September 2005.
Results: The Phanomphrai population was 100,870, with 38,069 (37.7%) aged 40 or
older; 2,648 diabetic patients were registered, with a prevalence rate of 2.6 percent. There
were 10 (0.4%) with type 1 diabetes, 2,630 (99.3%) with type 2 diabetes, and 8 (0.3%) with
gestational diabetes. New cases of type 2 diabetes totaled 299, 300 and 192 cases during
2004, 2005 and 2006, respectively, making the incidence rate 0.29 percent, 0.30 percent and
0.20 percent, respectively. After complication screening, there were 8.4 percent renal, 2.0
percent neurological, 1.7 percent arterial and 1.2 percent ophthalmologic complications
with 0.5 percent experiencing amputation and 0.9 percent multiple complications. After
the community survey of a total of 1,540 subjects, 474 (30.8%) were classified as cases of
disease, 605 (39.3%) as being at risk and 461 (29.9%) as normal. Risks by body mass index
(BMI ≥25) were 46.9 percent, 31.8 percent and 22.1 percent in the disease, risk and normal
groups, respectively. Risks by abdominal circumference were 41.3 percent, 28.3 percent
and 17.8 percent in the disease, risk and normal groups, respectively. High blood pressure was found in 84.6 percent and 97.4 percent in the disease and risk groups, respectively. Abnormal fasting blood glucose levels were 44.7 percent and 9.0 percent in the
disease and risk groups respectively. Abnormal triglyceride levels (≥250 mg%) were found
in 27.6 percent, 14.2 percent and 12.0 percent of the disease, risk and normal groups,
respectively. High density lipoprotein levels (≤40 mg/dl) were 47.2 percent, 49.2 percent
and 45.5 percent in the disease, risk and normal groups, respectively.
Conclusions: Epidemiologic study helps increase understanding of the diabetes
situation and disease burden, and indicates that diabetes has imposed huge public health
and economic burdens. Measures of high priority must be emphasized in relation to the
quality of care, information systems and the interventions made to prevent or delay diabetes in high-risk groups, and to study the risk factors for diabetes and metabolic syndromes for the development of efficacious preventive measures.
This cross-sectional study was conducted to determine the lead levels in the blood
of people living within 1 kilometer of a lead smelter.  The subjects included were 134
residents aged 20 years and older, randomly selected, one each from the households.
Among them, 103 (77%) were female, 12.7 per cent had occupational exposure to lead,
83.6 per cent spent their time at home seven days a week, 57.5 percent had a primary
education, 54.5 percent lived within 500 meters of the smelter, and 71.6 per cent drank
water from sealed containers.  The average blood lead level was 12.7 micrograms/deciliter.  Factors which were statistically and significantly associated with blood lead levels
were education level, distance from the smelter and source of drinking water.  The results
of this study could be used to locate the hazardous zone surrounding the smelter, to
select safer sources of drinking water and to educate residents at risk in order to prevent
future health hazards
An outbreak of influenza A (H1N1) in Li district, Lamphun Province in November
2007 led to investigation and control of the event and an epidemiologic study to determine the characteristics of the outbreak, to define the cause and factors associated with
the outbreak, and to implement effective prevention and control measures. Methods included
descriptive epidemiology, environmental survey and laboratory study. A total of
80 cases were identified in this outbreak; 58.8 percent were students and 35 percent were
children aged 5-9 years. The causative virus, influenza A (H1N1), was identified by PCR
technique in 61 out of 77 cases (79.2%). The highest incidence rate of 38.31 per 1,000
population was evident in Village 5 of Srivichai subdistrict. The propagated source epidemic
probably started after introduction of influenza virus A by a student who contracted
it from the local market and then spread it at his school. The health team implemented
comprehensive control measures, including health education on disease etiology
and prevention for local residents both in the school and the community, screening and
isolation of new cases, giving prompt treatment, providing masks and promoting hand
washing among school children and teachers, temporary closure of schools to cut the
transmission chain, and active surveillance and early treatment in the community. A
field hospital was set-up in a temple to accommodate and provide treatment to overloaded
cases from Li Hospital. As a result of all intervention measures implemented by
public health agencies, community leaders and villagers, the outbreak was curtailed
quickly, with no further outbreak in nearby areas.