plueme/wizJson huggingface dataset:
This research aimed to 1) evaluate the situation of primary care provision in Northeast of Thailand 2) lessons learned for the role model of primary care, strengths, key success factors, problems, and obstacles for the area-based service 3) home care by the three doctors’ team and 4) to make a policy recommendation. A questionnaire and guideline for in dept-interview and brainstorming were used as a research tool. The subjects consisted of 468 primary care team members selected by a simple random sampling method. Most consisted of nursing professional and public health technical officer working in the health region 7, 8, 9 and 10. It was found that the attitude of respondents was at a good level. The most of unit passed in quality outcomes framework (QOF) with 80.7%. Half of total lacked doctor and less than half lacked health personnel. Most of them received a lesser budget than the expense from the Contracting Unit for Primary Care. With a full score of 3, the overall mean of service was 2.61 (SD 0.84). The lowest was 2.29 consisting of consultation and communication channels (SD 0.57), and service system (SD 0.39). The lowest scores consisted of service delivery 1.73 (SD 0.51), health workforce 1.92 (SD 0.68), and health information system 2.39 (SD 0.52). The registered teams showed the statistically significant completion in service more than those with the non-registers (p-value 0.018, Adjusted Odds Ratio 5.16 with 95% confident interval 1.33 to 20.12). The service of primary care unit among urban, semi-urban and rural model were not different. The urban, and semi-urban showed superior in ability of team, a holistic care and advice by family doctors. The community participation, supported by public health volunteers and network of rural model were closer and stronger than of the urban and semi-urban. Key factors for the patients regarding to primary care unit were in a good location, quick service, easy to access and the familiarity of. Most of patient accepted the three doctors. The urban team with more experienced showed completely in the service and activities better than in the rural. The policy and the registration help to link primary care team and support for the patient care. The problems were lack of the family doctors and health personnel. Instrument was broken, and the data results inputting was overload. The Human Papilloma Virus (HPV) screening and Antenatal care (ANC) were not covered. It was concluded that primary care in urban, semi-urban, areas was found to be outstanding in home health care by the family doctors consisting of multidisciplinary teams. The continuing service delivery to patients’ home was duly covered. The small primary care in rural areas proved significantly with a pass in the QOF more than the medium size. Lacking the family doctor and health team, it was supported by the network in the rural areas. Training and knowledge were required to update within the health professionals. The management of health information by technology and reference systems should be improved for the patients’ benefit more than the staff workload. The telemedicine needed to be an innovative for all areas.
Thailand is entering an aging society completely. Osteoporosis is another disease that may become more frequent as it is more common among the elderly around the world. Osteoporosis increases the risk of bone fractures and, when fractures occur, is a contributing factor in increased mortality for the elderly. If fractures can be predicted for older adults with osteoporosis and solutions to prevent fractures can be found before they occur to the elderly, these will help to reduce the danger, loss of property, wasted time, and death of the elderly. The medical images obtained either as a direct diagnosis of fractures or in the diagnosis of other diseases can be further enhanced by combining with computer modeling techniques for biomechanically analysis based on finite element method, which are used in the diagnosis, treatment, and may include prognosis of various medical conditions widely, to analyze and predict fractures for elderly people with osteoporosis. However, this analysis technique is used mainly in research laboratory. This is due to a lot of resources required. If a sufficiently large number of analytical results can be obtained and used as a sample set input for the machine learning system to learn, then the current operating procedures may be reduced. It may result in faster diagnosis or prediction with adequate accuracy compared to traditional techniques. Therefore, the objective of this study was to predict fractures in the elderly due to various activities and conducting a study on the feasibility of collecting the biomechanical analysis results to be used as a sample input for future machine learning systems to use in learning with the aim of replacing the current procedure for performing part of the finite element analysis. From the study, it could be confirmed that the condition of osteoporosis greatly affected the force transmissibility. The external load was mainly experienced by the bone tissue which has a high bone mineral density, but this type of bone tissue is less common in patients suffering from osteoporosis. Therefore, occurring of osteoporosis affect bone strength directly. Moreover, the study was likely to find a relationship between the bone mineral density values obtained from medical imaging and stress values obtained from finite element analysis under various stress conditions. This may be the possibility of using machine learning to replace engineering analysis using the finite element method leading to the ability to reduce the process of finite elements in order to get a faster but still accurate diagnosis or prediction result.
Cardiovascular diseases are classified as non-communicable diseases (NCDs) that are dangerous and have an increasing trend nowadays. This disease is related to lifestyle behavior. It tends to accumulate symptoms gradually and become more severe if it is not treated properly and in time. Abdominal aortic aneurysm (AAA) is a dangerous disease and can cause sudden death if ruptured. This research project has applied an engineering tool called a computational fluid dynamic (CFD) for medical applications. Computed tomography images of patients with abdominal aortic aneurysms were acquired to perform a reconstructed geometry of AAA. There were 12 cases of patients who have AAA with a diameter larger than 3 cm. The blood properties and boundary conditions were assigned in the model. The results of this study found that the aortic aneurysm was highly turbulent in the diastolic phase and there was an increase in turbulence as the aneurysm size increased. This turbulent flow was also found during peak systole as well. Wall shear stress (WSS) in the artery was high at peak systole and during diastole. Furthermore, WSS was higher in the aortic aneurysm sac than in the rest of the aorta. The oscillating shear index (OSI) was higher at the aortic aneurysm sac than other areas. This may lead to a risk of rupture point of blood vessels. However, the results could not be directly compared in the same group of patients because each patient had a different geometries and degree of tortuosity. Therefore, this kind of calculation is individual as a personalized model. In addition, this work has 3D printed models of the abdominal aorta to create a testing mock-up for the aneurysm. However, it was found that the material used in the AAA phantom was not clear and flexible. These problems relate to the flow visualization in the blood vessels and the wall contraction simulation of the blood vessels. More studies are needed to explore suitable materials to mock-up the AAA model for flow testing.
The 14th Southeast Asia Regional Scientific Meeting of the International Epidemiological Association and International Conference on Public Health and Sustainable Development (IEA-SEA 2022) is the major forum for public health and medical epidemiologists to share their experiences and good practices especially in prevention and control several global health threats including COVID-19, HIV, TB. In 2022, the conference is organized by the School of Health Science, Mae Fah Luang University which is ranked the 1st university in Thailand for four (4) consecutive years by Time Higher Education (THE) World University Ranking, and other key partners such as the Southeast Asia Epidemiological Association (SEAIEA), World Health Organization (WHO), International Organization of Migration (IOM), Ministry of Public Health, Thailand (MOPH-Thailand), Health Systems Research Institute (HSRI), The Council of Community Public Health, Thailand, The Council of Public Health Education Institute of Thailand. Many organizations support scientific and excellent speakers to the conference such as the Centers for Disease Control and Prevention (CDC), United Nations Programme on HIV/AIDS (UNAIDS), etc. More than 15 keynote speakers from major health agencies in the world deliver their excellent information to the conference. In addition, more than 400 people participated in the conference with 150 excellent papers selected to present in the conference.
Background: The booster vaccination for Covid-19 prevention has been specifically recommended among high-risk populations such as older people. Previous studies have reported that intradermal (ID) vaccination could be as effective as intramuscular (IM) or subcutaneous (SC) vaccination In addition, ID vaccination causes less systemic adverse effects which are much concerned by older people giving rise to lower vaccination rate in this particular age group. Therefore, this study aims to compare the immunogenicity and adverse effects following ID and IM booster vaccination of mRNA vaccines against COVID-19 in older populations. Methods: This randomized, open-label study was conducted at a single center, Siriraj Hospital, Bangkok, Thailand, which was completed in July 2022. The eligible participants were individuals aged 65 years or older who already had received 2-dose IM primary series of ChAdOx1 vaccine within 12-24 weeks. Participant were randomly assigned to six vaccine groups: ID mRNA-1273 (20 mcg; 0.1 ml, n=35), IM mRNA-1273 (100 mcg; 0.5 ml, n=35), ID BNT162b2 (10 mcg; 0.1 ml, n=35 for each group of 65-79 and ≥ 80 years of age) and IM BNT162b2 (30 mcg; 0.3 ml, n=35 for each group of 65-79 and ≥ 80 years of age). Self-reported adverse events (AEs) were collected for 7 days consecutively following each vaccination using an electronic diary application. The immunogenicity was determined by the level of IgG antibodies against receptor binding domain (RBD) of the SARS-CoV-2 spike protein (S1 subunit). The pseudotype-based neutralization assays (PVNT) were used to measure neutralizing antibodies against SARS-CoV-2 variants. The T-cell response was measured using S-peptide and NMO-peptide stimulation. Results: Of 210 participants, the majority (70.5%) were female, median age was 77.5 years old (Interquartile range (IQR): 71.0-84.0 years old). At 4 weeks after booster vaccination, the geometric mean concentration (GMC) of anti-RBD IgG increased in all groups by overall of 45.11 (95% CI: 38.82, 52.41) folds from baseline. The GMC among participants who received IM mRNA-1273 had gained the highest immunogenic responses and significantly higher than IM BNT162b2 (GMC of IM mRNA-1273: 3,837.12 BAU/mL, GMC of IM BNT162b2: 2,530.58 BAU/mL, p=0.021). ID vaccination had significantly lower GMC than IM of the same vaccine type. Across vaccine groups, the geometric mean titer against Omicron variant BA.1 was the highest among participants who received IM mRNA-1273 boosting (616.8), followed by ID mRNA-1273 (213.9), IM BNT162b2 (144.6), and ID BNT162b2 (82.1). The ID route had significantly more frequent local AEs than IM with the highest rate among ID mRNA-1273 and the lowest in ID BNT162b2 group. Conclusion: The IM mRNA-1273 group gained the highest immunogenic responses as well as experienced less systemic AEs than BNT162b2. Although ID route achieved lower level of antibody than IM route, the immunologic responses were highly enough to create vaccine efficacy and caused less systemic AEs. Therefore, the ID mRNA-1273 could be the alternative type of Covid-19 vaccination for older people.
Rational Drug Use (RDU) has been set to be a strategic policy since the first issue of the National Drug Information. In the fiscal year of 2560 B.E., the Ministry of Public Health defined RDU and antimicrobial resistance management were projects under the National Strategy (2018-2037) regarding public health, and announced that all hospitals were RDU hospitals. RDU hospitals were evaluated with 18 hospital indicators according to the guidelines of service plan development. Some researches reflected limitations and obstacles of the RDU hospital indicators administration; however, this research was undertaken. The objective of this study was to review and develop rational drug use indicators for healthcare facilities. A cross-sectional, convergent mixed methods design was conducted between May 10, 2021 and November 9, 2022. Quantitative research was carried out with an online survey and analyzed with descriptive statistics. Qualitative research included documentary research, semi-structured in-depth interview, field study with group discussion, and modified Delphi technique, and analyzed data with thematic analyses. Also, a public hearing inquiry was held in representatives or experts of hospitals, professional organizations, and policy makers. Research population were all public healthcare facilities in primary, secondary, and tertiary care. Samples were selected from multi-stage sampling in both Bangkok and upcountry. In research summary, all hospital indicators should be kept, although some indicators were suggested to be terminated. The reason was to be the national database of all healthcare facilities until there will be better quality, efficient, and effective indicators. At present, RDU indicators will be divided into three categories. First, the Monitor (M) category included indicators Item no. 2 and 5. The Amendment (A) category were indicators Item no. 3, 4, 8 and 11. The Existence (E) category, lastly, were indicators Item no. 1, 6-7, 9-10, และ 12-18. Further studies will be needed to develop Thailand to be a RDU country. For examples, researches related to 1) spatial environment, 2) non-communicable diseases, 3) drug labelling and information, 4) RDU curriculum, 5) political research, 6) drug use in upcountry, grocery store or community pharmacy, 7) drug use in food chain cycle, and 8) information and exchange system.
Introduction: Tuberculosis (TB) is a communicable disease caused by M. tuberculosis. Contacts of TB cases become clinically active TB or remain in the latent tuberculosis infection (LTBI), which is subsequent progression to tuberculosis disease. Currently, the available tests for LTBI diagnosis include tuberculin skin test (TST) and interferon-gamma release assay (IGRA). In Thailand, IGRA test is costly and has not been included in the benefit package. The results from this study can be used as an evidence informed policy whether IGRA test should be included in the benefit package and can be applied to support the strategies to eradicate TB. Objectives: To evaluate cost-utility analysis, budget impact analysis and feasibility analysis of LTBI diagnosis for contacts of TB patients using societal and government perspectives. Methodology: Cost-utility analysis using a decision tree and Markov model was performed to simulate the costs and utilities, and to estimate the budget impact of contacts with pulmonary TB patients. All parameters were obtained from published studies. Lifetime horizon was applied with both costs and outcomes discounted by 3%, as recommended by the guidelines of economic evaluation in Thailand. One way and probabilistic sensitivity analyses were conducted to examine the uncertainty of input parameters. This study considered three alternative diagnosis strategies as follows: 1) No screening, 2) TST alone to diagnose LTBI, if TST test was positive, treatment would be provided, and 3) IGRA alone to diagnose LTBI, if IGRA test was positive, treatment would be provided. Focus group discussion and literature reviews were applied for feasibility analysis. Results: The incremental cost-effectiveness ratios (ICER) of IGRA alone compared with TST alone was THB 1,220,287 per QALY gained. At the willingness to pay (WTP) THB 160,000 per QALY gained, IGRA would not be cost-effective. If the price of IGRA was decreased to THB 575 per test, the strategy of IGRA would be cost-effective. Five-year budget for TST and IGRA was estimated to be THB 148 million and THB 330 million, respectively. The barriers for IGRA implementation were lack of laboratory infrastructure and limited availability of laboratory personnel.
The purposes of this were to study the health adjusted life expectancy (HALE) of people in health region 3, 2022, and prioritize diseases and health hazards that are important problems in health region 3. The cross-sectional study design was used. A sample of 1,230 Thai people aged 10 and over in the responsible area of health region 3, were randomly selected using a multistage sampling technique. The EQ-5D-5L Thai Version is composed of Mobility Self-care Usual activities Pain/discomfort, and Anxiety/drepression. The Sullivan method was used to analyze the data. For priority diseases and health hazards problems in health region 3, data was collected by the priority setting methods were seven components of the World Health Organization. From the committee of the health region 3. The results revealed that the HALE of people in health region 3, 2022 was 65.16 years. Lower than the Thailand target set by at least 68 years. The self-care dimension had the greatest effect on utility scores. Health status at best scores 48.94% and lowest score 0.08%. The priority diseases and health hazards that are important problems in health region 3, showed that the top three were stroke, ischemic heart disease, and road traffic injuries. Further research should be recommended to determine the model or approach to increasing HALE. as well as developing policies and measures to solve disease and health hazards and allocating sufficient resources to lead to more effective and efficient implementation.
Acinetobacter baumannii (A. baumannii) is a gram-negative bacterium that is the leading cause of nosocomial infections. This organism usually develops antimicrobial resistance, resulting in multi-drugs resistant A. baumannii. Adult and pediatric patients, including neonates with A. baumannii infections have a high mortality rate. The spread of A. baumannii in hospitals occurs through contact transmission, which could be direct contact with the hands of healthcare professionals, or indirect contact through contacts with the bacteria in various environments in the ward. This study aims to study the pattern of A. baumannii transmission in the Pediatric and Neonatal Intensive Care Unit of Thung Song Hospital, Maharaj Nakhon Si Thammarat Hospital and Tha Sala Hospital. Specimens were collected in 1) each patient's touch points, consisting of a bed or a cabinet of A. baumannii infected patients, an adjacent bed or cabinet, healthcare providers' hands and clothing. 2) Common touch points in the ward consisted of treatment record files, work desks in the ward, doorknobs, computers, telephones, sinks and bathtubs. The specimens were collected from October 2021 – September 2022. During the 12-month period, there were 27 patients with confirmed cultures of A. baumannii, of which 15 were from the infant intensive care unit of Thung Song Hospital, 5 patients from the pediatric intensive care unit of Maharaj Hospital and 7 patients from the pediatric intensive care unit of Maharaj Hospital. The results from both hospitals showed that the most contaminated areas of A. baumannii were each patient's bed (29.63%) and adjacent beds (29.63%). The other contaminated areas in the ward were healthcare providers' clothing (22.22%), infusion set (14.81%), monitor (11.11%) and healthcare providers' hands (11.11%). Regarding common touch points, the bathtub area (25.93%) was the most contaminated, followed by the patient's file (18.52%) and the desk in the ward (18.52%).
Hip fracture in older people is one of the major public health issues worldwide including Thailand. Appropriate care for older people with hip fracture includes fast track surgery and perioperative multidisciplinary team care. This study aimed to monitor pilot hospitals involved in ‘Fast Track Surgery for Hip Fracture Program’ to explore patients’ outcomes and factors associated with the clinical outcomes. We discovered that the operation rate for hip fracture in older people in Thailand remains suboptimal. The rate of non-operative surgery remains high around 40 %. Hospitals in pilot project had higher rate of patients received ‘fast track surgery’ compared to hospitals nationwide. Moreover, pilot hospitals had made significant changes to the policy and process of care for this group of patients. However, some recommended processes could not be arranged. With respect to patients’ outcomes, the mortality rates tend to be reducing in pilot hospitals but did not reach statistically significant. This could stem from the finding that several recommended quality indicators could not be arranged. Multivariate linear regression models were carried out to determine factors at hospital level affecting mortality. Having internists involved in postoperative care significantly associated with lower one-year mortality. Having rehabilitation specialists involved in postoperative care is also associated with lower three-month mortality. Covid-19 pandemic did not have negative impact to operation rate and mortality for hip fracture patients in Thailand.
COVID-19 pandemics effected health systems in term of increasing of workload caused by the number of infectious, also the effected on routine health services especially continuity of healthcare deliveries for the patients with chronic conditions. The Ministry of public health and the National health security office established the new-normal healthcare policy which emphasized on outside hospital care deliveries by strengthening primary care services together with the partnership including private rehabilitation clinics, nursing clinics and drug stores. This project applied the evaluation development concept by applying mixed-method research design to evaluate the implementation of the policy and synthesized the policy recommendations based on the findings. We performed the literature review, together with analysis of secondary quantitative data and qualitative data collecting from multi-stakeholders. We found that health burden of non-communicable diseases and conditions are high and increasing over the time especially on hypertension, diabetes, and related complications such as stroke. The services utilizations of this group of patients were disrupted by lock-down policy during COVID-19 pandemics. There were existing of new-normal care deliveries during 2020-2022 especially there were the high number of telemedicine which performed by public health facilities. However, the services provided by private rehabilitation clinics and private nursing clinics were still limited in term of number of clinics, number of patients, and also in the term of geographical distributions of services. According to our findings, we strongly emphasized that primary care should be the core of new-normal health services for the patients with chronic conditions. To delivery high effective coverage care, the area manager position and role should be established and should be paid by NHSO at primary care level. Individual care plan should be done by care team and should be monitored and evaluated by area manager. Effective information systems should be designed and implemented and should be able to connect every stakeholder in primary care network. Also, the information systems must allow the patients to confirm their received care by private partners. The authorities should arrange the platform that allow all partners working together effectively and analyzing the routine data for better policy designing and decisioning.