plueme/wizJson huggingface dataset:
The increasing trend of diabetes mellitus (DM) cases and weak coordination among groups who
take responsibility for taking care of these cases, brought about to the study of holistic care for DM patients
in Chiang Dao Subdistrict Municipality, Chiang Mai Province. Objectives: (1) To explore the problems
related with coordination among stakeholders who involve with health promotion and disease prevention
for DM patients (2) To develop strategic map for the implementation of health promotion and
prevention for DM patients. The study design is qualitative research approached by focus groups among stakeholders as a tool for collecting information. The sample consisted of four groups: subdistrict municipal
authorities, health volunteers, diabetes patients and health workers. Data were collected from 9 June
to 20 November 2014 through focus groups. Data reliability was tested by information contributors and
triangulation. The data were analyzed by using content analysis. Results: 1. Problems were identified in
four categories: (1) Management (2) Man (3) Materials for work (4) Money, 2. Strategic map for the implementation
of health promotion and prevention for DM patient of Chiang Dao Subdistrict Municipality,
Chiang Mai Province, was created comprising: (1) Learning and development perspective, (2) Internal
process perspective, (3) Efficiency perspective, and (4) Performance perspective.
Recommendations from this study are: (1) Development of information system for all groups involved
with DM care system is needed and should be easily accessible, (2) Development of network should
be continously used as a tool for coordinating, and for knowledge and resources sharing, (3) Provision of
knowledge on project planning and management including strategic management to achieve target result
with appropriate method should be in place.
Objectives: Since our previous study showed the 3 years mortality rate in diabetic patients with peripheral arterial disease (PAD) is very high (56.5%). The investigator therefore would like to evaluate the risk factors to determine the high cardiovascular morbidity and mortality in 3 years cohort study. In this first year report, we illustrated the screening PAD in diabetic patients and then showed the cardiovascular morbidity and mortality rate in 6 month period. Also the risk factors for atherosclerosis was scrutinized.
Method: Between May 2014 and August 2014, consecutive eligible outpatients, aged ≥45 years with established DM in 3 hospitals in Northern Thailand, were invited to be involved in this study. History, physical exam and laboratory test were reviewed. Ankle brachial index ≤ 0.9 was considered PAD. Then patients were evaluated the percentage of risk factor control according to American Heart Association (AHA) criteria. ]
Result: 2,247 diabetic patients were recruited for the study. 286 patients out of 2,247 were diagnosed PAD(12.7%). 236 PAD patients(82.5%) did not have any symptom of PAD namely intermittent claudication, rest pain, gangrene or ulcer. According to AHA criteria, the percentage of adequate control in low density lipoprotein, HbA1C and systolic blood pressure in PAD patients was 18.9, 30.1 and 33.2% respectively. In the 6 months follow up study, there were 11 death, 7 non- fatal myocardial infarction and 3 non-fatal stroke. Comparing with the first visit, the systolic blood pressure and waist circumference was worsening.
Conclusion: The prevalence of PAD in diabetic patients was 12.7%. Most PAD in diabetic patients was asymptomatic. Therefore the ABI screening in all diabetic patients must be performed to early detection and proper management. The atherosclerotic risk factor control was poorly controlled in this group. The number of cardiovascular event was too small to analyse the risk factors to determine cardiovascular morbidity and mortality. More further data are needed.
Aims/hypothesis: The prognostic information about CKD progression, particularly for GFR categories 1 and 2, is still limited. This cohort was therefore conducted to determine the CKD progression using a competing risk approach. 
Methods: We conducted an ambi-directional cohort study linking community health screening with hospitals and death registry data in a province of Thailand, from 1997-2011. A competing risk model was applied by treating death as a competing risk factor to estimate 2-, 5-, and 10-yearprobability of kidney failure and median time for CKD progression from lower to higher GFR category.
Results: There were 17,074 non-diabetic and 15,032 diabetic CKD subjects. Diabetic subjects progressed more rapidly through GFR categories with the median times for CKD progression from GFR categories G1 to G2, G2 to G3a, G3a to G3b, G3b to G4, and G4 to G5 of 4.4, 6.1, 4.9, 6.3, and 9.0 years, respectively. Non-diabetic subjects took longer to progress with the corresponding median time of 9.4, 14.0, 11.0, 13.8, and >14.3 years. After adjusting for confounders, diabetic subjects were 49% (cause-specific hazard ratio (csHR=1.49, 95% CI: 1.37, 1.62) more likely to develop kidney failure than non-diabetic subjects. Albuminuria categories A3 and A2 were respectively 3.40 (95% CI: 3.07, 3.76) and 1.71 (95% CI: 1.53, 1.92) higher risk of kidney failure when compared to A1. For each albumin category, death rate increased as albuminuria increased particularly in diabetic subjects, which was approximately two times higher in A3 compared to A1. 
Before 2008 (when the “PD first” project was launched), an access rate to renal replacement therapy for kidney failure patients belonging to the universal coverage scheme, civil servant medical benefit scheme, and social security scheme were 1%, 14%, and 18% respectively. The corresponding access rates rose to 25%, 43%, and 56% after 2008. Subjects with kidney failure who were members of the universal coverage scheme had increased risk of death when compared to the other 2 schemes.
Conclusions: Diabetic subjects progress through GFR and albuminuria categories and reach kidney failure about twice as rapidly as non-diabetic subjects.Although an access rate to renal replacement therapy among 3 health insurance schemes has consistentlyincreased since 2008, members of the universal coverage scheme still had substantially lower access rate when compared to the other 2 schemes. Further study assessing factors contributing to such low access rate and comparing CAPD and hemodialysis should be conducted.
Wheezing is an important health problem in Thailand. In this multi-center clinical research, clinical characteristics and biomarkers were studied to determine the factors associated with persistent wheezing in the next three year among pediatric patients with acute wheezing under five years of age. However, this first year report will focus on baseline characteristics including biomarker results. Two hundred and forty pediatric patients, aged 6 months to 5 years, with acute wheezing were recruited from the pediatric wards at Thammasat hospital, Bhumiphol hospital, Saraburi hospital and King Chulalongkorn hospital. Patients’characteristics and their family data were collected. Blood samples were collected for detecting ImmunoCAP specific IgE against common food and inhalant allergens. Serum 25-hydroxyvitamin D (25OHD) concentration was measured by ELISA. Spot urine samples were measured for urinary Leukotriene E4 (uLTE4) levels by enzyme immunoassay. Two hundred and nine data collecting forms with the bioassay results were available for analysis in this report. The mean age of the participants was 26 months with boys of 62.5 percent. First wheeze episode was accounted for 40.6 percent. Seventy five percent was atopic with mono-sensitization (29.3 %). The highest prevalence of sensitization was egg (45.6%), following by cow’s milk (45.3%). The high median urine leukotriene E4 (uLTE4) levels of 226 pg/ml and 956 pg/mg creatinine was documented. The prevalence of vitamin D insufficiency, defined by the serum 25OHD levels of less than 30 ng/ml, was detected for 22.3 percent. Estimating costs of wheezing treatment in preschool children under societal, provider and patient’s perspectives were also studied. Cost data of 136 six participants who admitted with asthma and wheezing at Thammasat hospital, Bhumiphol hospital and Saraburi hospital were available for this analysis. Data from hospital financial database and caregivers’ expenses were collected. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care cost was determined by human capital approach. It is found that societal, provider and patient costs per admission were 18,330±69, 17,055±707, 4,968±644 THB, respectively. The main cost component in all perspective was hoteling cost during admission. The economic burden of asthma and wheezing admission of preschool children in Thailand was estimated as 687 million THB per year. To decrease length of stay and admission rate will save costs of asthma and wheezing care in preschool children.
With an increasing number of persons with disabilities, the government should provide them with
decent services that meet their needs. One of the crucial services is the provision of assistive devices. The
problem of accessing to the service in Thailand is caused by the inequity of the benefit package provided
by the public health insurance schemes, which can lead to a number of adverse consequences. This study
used qualitative methodology, including review of literature, reports, and other documents that are related
to assistive devices service of the public health insurance schemes in Thailand and other organizations,
to determine the difference of the schemes’ assistive devices benefits. It was found that the different
definitions of person with disabilities for each scheme led to different benefits. In addition, the number
and type of assistive devices and reimbursement methods were different and created financial burden to
persons with disabilities, especially for the scheme that required advanced payment. Furthermore, the
different assistive devices covered in each scheme could prevent disabled persons with certain disabilities
not access to essential medical devices. The integration of benefits and services for persons with disabilities
of these public health insurance schemes is needed in order to reduce inequity problems among them
and make most efficient resource use.
The study aims to investigate an accessibility of assistive technology for people with disabilities and
the costs of assistive technology during 2009-2012. The secondary data was derived from three main sources:
1) Disability survey data (2012) from National Statistical Office-NSO 2) Registration of National Office for
Empowerment of Persons with Disabilities-NEP, Ministry of Social Development and Human Security,
and 3) Database from the budget of assistive devices to people with disabilities: National Health Security
Office-NHSO, Social Security Office and The Comptroller General’s Department. In addition, the data
was analyzed and presented with descriptive statistics.
According to disability survey data (2012), there were 1.5 million people with disabilities in which
accounted for 2.3 % of the population in Thailand. Moreover, the estimation survey showed that 7 out of
10 people with disabilities were still in needs of assistive devices. According to the analysis of three main
health benefit packages in Thailand (Universal Coverage Scheme-UC, Social Security Scheme-SSS and
Civil Servant Medical Benefit Scheme-CSMBS), they annually subsidized with an increasing support of
assistive devices to people with disabilities. The budget subsidized on CSMBS patients was 4 to 10 times
higher than the budget supported to UC and SSS patients. According to the expenditures of assistive
technology: UC’s expenses increased 7 times, SSS’s expenses rose at the lower rate, and CSMBS’s expenses
slightly reduced. However, only CSMBS reimbursed the high price cochlear implant sets that accounted
for more than half of the total costs of devices. Moreover, it is found that cost from an overuse of
the assistive devices in each main health benefit package was increased every year, especially in 2011 the
cost was 6-10 percent of total cost of devices.
People with disabilities under Thailand’s health benefit packages still have an unequal access to
assistive devices. People with disabilities under CSMBS gained more access to assistive devices than other
insurance schemes. Henceforth, the decision makers of Thailand’s main three health benefit schemes need
to revise the policy to make more equal benefits. Moreover, it is necessary to collaborate with both public
and private sectors to solve an inappropriate use (overuse) of the assistive devices that continues to cause
more costs each year.
Medical rehabilitation aims to strengthen or sustain functions of persons with disabilities. The objective
of this research was to explore the current situations of medical rehabilitation services for persons
with disabilities available in public hospitals, including community, general and regional hospitals in
Thailand. The questionnaires were mailed to 215 hospitals in 20 provinces between January and March
2014. The data were derived from 155 hospitals (72 percent response). Descriptive statistics were used for
data analysis.The results showed that, at community level, physiatrists and rehabilitation nurses were employed
in only 4% of hospitals; 88% of hospitals hired physiotherapists and there was no audiologist, speech
pathologist and orthotic technician. There were physiotherapists working in all general and regional hospitals
whereas physiatrists and rehabilitation nurses were found in only 40% and 25% of general and
regional hospitals.
The assessment of disability and prescribing assistive devices were mainly for persons with physical
and mobility disability. The most common services were physiotherapy (100% in regional and general
hospitals, 91% in community hospitals) while speech and hearing rehabilitation services were provided at
the smallest proportion (2% in regional and general hospitals and no service in community hospitals). The
services of training programs for using assistive devices, user follow-up and device repair were still missing
in some hospitals. Visual and hearing aids were unavailable in community hospitals. Medical device
services for all type of disabilities were provided in regional and general hospitals but some items of
devices still were unavailable in some hospitals.
This study aimed to 1) investigate effects of assistive devices on quality of life (QOL) and functional
outcomes in disabled people, and 2) quantify factors affecting access to devices. From March to May 2014,
an observational study was carried out in mobility impaired individuals of ages 15 to 65 years old, who
need to use assistive devices i.e. wheelchair, handicap tricycle and prosthesis leg in 10 provinces throughout
Thailand. The sample was classified into two groups: 1) access group; and 2) without access group.
Individuals that have the assistive device, use it regularly and are satisfied with their device were classified
into the “access group” while those who did not meet the aforementioned criteria were classified into the “without access group“. World Health Organization Quality of Life (WHOQOL) - BREF was used to
elicit QOL while selected International Classification of Functioning, Disability and Health (ICF) codes
were used to measure functional outcomes. This study included a total of 308 individuals in the “access
group“ and 295 individuals in the “without access group“. Compared to those who without access,
disabled people with access had significantly better QOL in all dimensions except for the environment
dimension. Additionally, the “access group“ showed a significantly higher level of functioning than the
“without access group” in all functions with exception to the education. Factors affecting access to assistive
devices were age, health scheme, registrations for disabled people, occupation, and care from family. In
conclusion, assistive devices enhance both QOL and function in disabled population; hence, increase
access to these technologies is crucial. Furthermore, health scheme and disabled registration are government-
side factors influencing access to assistive devices.
This qualitative research aimed to examine the perspectives of three key informant groups purposively
selected from those who had direct experiences in receiving, providing medical rehabilitation services, and those responsible for development of related policy. The data were collected in May and
June 2014 in three focus group discussions (FGDs) involving 11 representatives of persons with disability
organizations, 13 service providers, and 16 executives and managers from respective policymaking
authorities. Content analysis was introduced in the data analysis.
The results showed that access to medical rehabilitation services including assistive devices among
persons with disability (PWDs) was limited. This was because PWDs did not get the information on
benefits and services provided in the public sector, and that most of them needed one or more accompanying
persons when they travelled to receive services. Other impediments included inadequate service
providers and the disparity, in terms of coverage and quality, of the information for PWDs disseminated
by public agencies. The lack of effective system for assistive devices management was identified as crucial
obstacle. It was agreed among FGD participants that health benefits for PWDs in the three governmentfinanced
schemes were different resulted in unequal access to services and assistive devices. Moreover,
when PWDs were employed by private business and therefore, transferred from the Universal Coverage
Scheme to the Social Security Scheme (SSS), their health benefits would be diminished because the latter
scheme covered fewer benefits than the former. To solve the problems as earlier mentioned, the FGD
participants proposed: (1) the National Committee for Empowerment of Persons with Disabilities to
develop mechanisms to strengthen the integration and collaborations of organizations that ensure quality
of life of PWDs and allow PWD representatives to participate in every level of policy making decisions;
(2) PWDs databases currently managed by different institutes be strengthened and integrated with each
other; (3) increase the numbers of health providers for PWDs in particular areas of the country; and
(4) reduce the disparity in health benefits by collectively develop a single benefit package for use in the
three government schemes.
Patient satisfaction on health service is derived from direct experience and expectation of patients,
which directly relates to therapeutic compliance. Results of patient satisfaction can be used in developing the health service system. This study aimed to evaluate the satisfaction of disabled persons on the
rehabilitation and assistive device services, where they were provided in government hospitals. This study
used a structural questionnaire together with face-to-face interview by trained staff and collected satisfaction
information from disabled persons who used rehabilitative or assistive device services at the regional
or general hospitals and community hospitals in 8 provinces, namely Phrae, Phitsanulok, Maha Sarakham,
Roi Et, Lop Buri, Samut Prakan, Surat Thani and Trang. The study evaluated 7 dimensions (with 1-4
sub-dimensions), namely, interpersonal manner, quality of care, service accessibility, finance, environment,
adequacy of providers and equipment, and outcome of services. The data from 244 disabled
persons found that average score of satisfaction in all dimensions was 3.77 out of 5. Interpersonal manner
and quality of care were the dimensions that got the highest score at 4.14 each, while the finance dimension
was scored the lowest at 3.15. The waiting time was scored as the lowest sub-dimension comparing to
all sub-dimensions. However, there were no dimensions or sub-dimensions that scored lower than
3. Some additional comments and suggestions from disabled persons were provided for improving the
services in terms of distance and comfort of settings, and waiting time. Policymakers and providers should
consider those issues as important issues for the improvement of rehabilitative and assistive device
services. The services that respond to the needs of disabled persons can help their compliance and
continuity in receiving rehabilitation and assistive device services, which will directly improve health
status of disabled persons.
Home and environment modifications are essential to improve quality of life (QoL) of persons with
disabilities (PWDs). Our research aimed to conduct economic evaluation of home and environment modification service to develop the service guideline and address policy recommendations to improve
the services and to suggest how the resources should be mobilized. Sixty houses of PWDs were recruited
based on designated criteria. Capacity building sessions for architects, engineers, local builders, nurses,
physiotherapists and social workers were also conducted. Functions of PWDs before and after modifications
were recorded using the questionnaire based on the International Classification of Functioning,
Disability and Health (ICF). Forty-nine houses were successfully modified. The important findings from
this study were that (1) the home and environment modification service was cost-effective (2) health
personnel and non-health personnel should be involved in the selection process of PWDs who are
suitable to receive the service and (3) PWDs and family members should also be invited to participate in
all construction process. Those with the same impairments may not end up with the same design of the
home and environment modifications because the design depended upon PWDs functions. If the ultimate
goal of services for PWDs is to improve QoL, the home and environment modification is merely one
among other tools to enhance QoL. We recommend that to provide the service, the following procedures
should be considered: stakeholder linkage, resource integration and allocation, decision making based
on functioning data and capacity building. Knowledge management should be conducted to add more
knowledge and understandings.
At present, there is a dramatic increase of elderly in Thailand. There is an awareness and there are a number of studies of the significance of the effect of environment on elderly, especially in United State and Europe. However, there is a little knowledge about the design of health care environment for Thai elderly. Moreover, since there is a difference of physical characteristics and psychology between people from United State and Europe, the design recommendation from the studies in these areas seem to not apply to Thai elderly. This is especially there is a little knowledge about the design of environment for Thai elderly in terms of lighting, colour, material and view-out and their effects on visibility and health recovery.
	The main objective of this study is to develop interior environment suitable for the visibility and recovery of Thai elderly. There were two types of hospital to be surveyed,, which are 1) provincial hospital and 2) community hospital. There were two main parts in the study. The first part deals with the effect of interior environment of ward on visibility of Thai elderly. The second part related to the effect of interior environment of ward on recovery of Thai elderly. The results showed the significant effects of factors relating t interior environment of ward. The study also proposed an approach for design guideline of ward suitable for visibility and recovery for Thai elderly in provincial hospital and community hospital.