plueme/wizJson huggingface dataset:
Thailand could achieve the goals of the universal health coverage (UHC). But there are some remaining challenges on inequities in cost protection and quality of services. This study endeavored to report the country’s inequity situation in terms of coverages of population, cost, and services. Using the 2020 Household Socio-Economic Survey, the analysis covered disparities across health insurance schemes, household wealth quintile, sex, age group, region, and urban/rural area. The results show that the highest inequity was among different health insurance schemes of the UHC system. Therefore, it is essential to implement national health reform to solve the disparity issues by integration of the health insurance schemes.
Background and Rationale: Thailand becomes an ageing society. The Thai government officially implemented long-term care (LTC) for dependent older persons in 2016. Sa-ard subdistrict of Namphong, Khon Kaen, has provided an LTC service program by the family care team and the LTC center since August 2017. However, the impacts of this program, particularly social impact, have not been reported. This study aimed to determine social return on investment (SROI) of the LTC program for dependent older persons in this setting. Methodology: A mixed-methods approach was used to collect data on outcomes, program impacts, and costs of the LTC program for dependent older persons (37 people with the Barthel index of activity of daily living (ADL) ≤ 11 points) in the fiscal year 2018. We conducted a questionnaire survey among 74 program beneficiaries (dependent older persons and family caregivers) and focus group interviews among 49 program stakeholders (dependent older persons, family caregivers, family care team members, trained caregivers, and community and local government representatives). Secondary data were gathered from reports, records, and databases of the hospital, the local government, and the LTC center. SROI was calculated and sensitivity analysis was performed. Results: Outcomes of LTC program delivered better conditions (walkability or doing usual activities by themselves) to the dependent older person group, more relaxation/leisure time and saving costs from going to hospitals to family caregivers, happiness in helping other people to the family care teams and trained caregivers, and the healthy community. Of the total 37 dependent older persons, after participating in the LTC program their ADL increased significantly on average 3.9 ± 5.2 points (p < 0.001) and 73% had better outcomes. The older persons valued their better outcomes at a median of 708,432 baht (Q1-Q3 = 699,216 - 2,000,000). For a one-year investment of LTC program of 2,138,704 baht and its benefit of 15,853,919 baht, the SROI ratio of this program was 7.4 with a range of sensitivity analysis values between 1.3 and 20.5. Conclusion: This study indicated that the LTC program for older persons could effectively improve their outcomes and provide values to stakeholders and society. The LTC program provided social return higher than investment. Therefore, the LTC program should be promoted and expanded to other settings.
Background and rationale: The Thai medical cannabis (or medical marijuana: MMJ) system was first established in February of 2019. This study aimed to identify the most essential and urgent policy and research and initial policy recommendations regarding the implementation and impacts of the MMJ policy in Thailand. Methodology: A narrative literature review and other qualitative methods; 18 in-depth interviews with key stakeholders, focus group discussions of nine service providers and patients, and a participant observation in the MMJ clinic at the Ministry of Public Health. Results: Our crucial findings showed that: (a) the Thai MMJ system is complex, consisting of three subsystems: modern medicine, Thai traditional medicine, and folk medicine. These subsystems are not harmonized, and have resulted in poor access to legal MMJ products. (b) MMJ is a new entity in Thailand, and a comprehensive monitoring and evaluation system is needed. (c) the MMJ movement in Thailand has “political economy” attribute, meaning that the policies may be driven by benefits beyond a medical rationale. These findings lead to six research questions. (1) What do the governance structure and plans regarding MMJ policy in Thailand look like? (2) How do we improve the complex MMJ system to best serve patients? (3) How much and how to invest in a knowledge-generation system, and a monitoring and evaluation system regarding the MMJ policy? (4) How do we build MMJ consumers’ health literacy? (5) What are the efficacy levels and cost-effectiveness of the Thai medical cannabis products? And (6) What should be the future MMJ policy in Thailand? Conclusion: The newly established and complicated Thai medical cannabis system is novel for Thai society. This system has potentials to produce both positive and negative consequences, with potentially enormous underlying economic benefits. Therefore, the government and all relevant sectors must collaboratively manage the medical cannabis system in a transparent, creative, and considerate way, to provide the best benefits for patients and the whole of Thai society, in both the short- and long-term.
This cross-sectional research focused on studying the prevalence of mental health outcomes and preventive behaviors, and to examine work-related factors associated with mental health outcomes during the COVID-19 pandemic amongst the healthcare workers employed by the Ministry of Public Health Thailand. The data were collected by the online questionnaire from 12 health regions, 417 healthcare workers administered during the first wave (May 1-15, 2020). The Depression Anxiety and Stress Scale – 21 Items (DASS-21) Thai version was used to assess mental health outcomes. The Chi-square test was used to examine association between depression, anxiety and stress-related factors. The results found that 2.4%, 7.2%, and 3.9% of all respondents demonstrated severe to extremely severe depression, anxiety, and stress; while practices of preventive behaviors were as high as 82.0% of wearing masks and 76% of practicing hand-hygiene. The associated factors of mental health outcomes were: (i) working with COVID-19 inpatients; (ii) organizational management to ensure low infection risk; (iii) inadequate of personal protective equipment (PPE); (iv) work with the fear of contracting infection; (v) the non-adherence behavior of patients towards safety protocols. The study recommends that effective management practices towards reducing infection was predominant associating and modifiable factor of mental health outcome. In particular, this should be applied to the healthcare workers coming in direct contact with patients in the “new-emerging phase” or a “repeated wave” of COVID-19 outbreaks.
Physical inactivity is ranked number four leading risk factor of premature deaths from non-communicable diseases. The Global Action Plan on Physical Activity 2018-2030 (GAPPA), adopted in the 71st World Health Assembly in 2018 emphasizes the need for a whole-of-society approach to creating social, cultural, economic, and environments conducive to physical activity. This study assessed the promotion of physical activity in the urban setting of twelve selected municipalities in Thailand against the four GAPPA strategic actions. The findings revealed that all twelve municipalities implemented at least one intervention of the four strategic actions, and achieved 12 out of 20 (60%) GAPPA recommended actions. The city municipalities achieved the highest score, followed by the town and the subdistrict municipalities. The highest achievements were the implementations of strategic action 3: create active people, and strategic action 1: create active societies. This study showed that GAPPA recommendations were relevant and feasible in the Thai context. However, gaps remained in the promotion of strategic action 2: create active environments, and strategic action 4: create active systems. In conclusion, the municipality could be one of the lead agencies for physical activity promotion in an urban setting in collaboration with other public and private stakeholders. GAPPA strategic actions should be translated to be specific tools and indicators for monitoring the progress of policy implementation.
The health benefits of physical activity are linked to active transport. The Thai Walking and Cycling Institute has implemented a project to promote walking and bicycle use in daily life in many provinces since 2017. This study aimed to identify the association between local demographic characteristics (sex, age, body mass index (BMI), education, occupation, and income), and the effects of physical activity from active transport. This was done in three purposive selected sites namely, 1) King Taksin Community, Chachoengsao, 2) Suksabaijai Community, Kalasin, and 3) Ban Thatsobvan Community, Phayao. A cross-sectional study was carried out through a self-administered questionnaire survey. The questionnaire was randomly distributed via community leaders. Multivariate Poisson regression was performed. The average amount of active transport energy expenditure in three communities at 180 metabolic equivalent task-minutes/week contributed to 30% of the World Health Organization’s recommended physical activity levels. Being female, overweight or obese, higher educational attainment, higher income, and office-based employee had a significantly reduced chance of having higher energy from active transport than their counterparts. While being older and living in optimal size community and near the city center had significantly raised chance of having higher energy from active transport. Interventions for active transport promotion should be more attractive and appropriate to all demographics and contexts. In addition, the policy should aim not only at individual lifestyle modification but also at re-shaping the physical environments that facilitate active transport.
Prince Mahidol Award Conference (PMAC) is a well-known international conference organized annually by the Prince Mahidol Award Foundation and the Royal Thai Government with collaboration from multiple partners to share experiences focusing on policy-related public health issues among the global community. Due to COVID-19 pandemic, the PMAC 2021 under the theme “COVID-19: Advancing towards an Equitable and Healthy World” was held virtually with significant changes made to its program and management. The rapporteur system, a main component of the program conference synthesis, was also adjusted to fit with an online platform. This paper aimed to draw lessons learnt from the PMAC 2021 by the viewpoint of the rapporteur team, including lead rapporteur, rapporteur coordinator, and session rapporteur, covering three main points; (i) the structure of rapporteur team, (ii) the process of work, and (iii) the output of the rapporteur system. This paper provides useful ideas to any organization that organizes an international conference requiring accurate and comprehensive conference synthesis.
Effective coverage is a concept of measuring health gain which incorporates health needs, utilization of health services, and the benefits to patients from using them into a single metric. In the past two decades, the World Health Organization and other agencies advocated the use of effective coverage as a way to assess health systems performance and track outcomes of universal health coverage. Two main objectives of this paper were to review literature relevant to definition, methodologies, and international and domestic experience; and to synthesize the recommendations for effective coverage assessment in the Thai context. The literature review found discrepancies of definition and measurement across various studies which caused confusions in communication, comparison and interpretation of the results. The authors proposed that Thailand should apply the definition of ‘the proportion of a population in need of a service that had a positive health outcome from using the service’. This definition communicated clearer meaning and reduced methodological complexities. Selection of proxy interventions should be guided by national health priorities, the possibility of making a positive change in the coverage and health gain, and reliable data sources. Key challenges of measuring effective coverage include defining operational criteria, understanding data requirement and results of low coverage as well as inequity dimensions across sub-population groups. Stakeholder participatory process of effective coverage monitoring should improve policy usefulness.
The study of willingness to accept and pay for a COVID-19 vaccine in Thailand aims to 1) explore the prevalence of accepting the COVID-19 vaccine and vaccine booster shots 2) factors associated with accepting the COVID-19 vaccine and vaccine booster shots 3) reasons and willingness to pay for the COVID-19 vaccine and vaccine booster shots and 4) the policy recommendation for the COVID-19 vaccine and vaccine booster shots. This study conducts 3 phases. Phase 1 is to study the prevalence and factors of accepting the COVID-19 vaccine and vaccine booster shots by cross-sectional research of having vaccinated COVID-19 group and having not been vaccinated COVID-19 group, covered four regions in Thailand, by an online survey questionnaire. The total sample is 1,740 used multiple stratified sampling techniques. Data analysis were by a descriptive statistic and multiple logistic regression. Phase 2 is associated with exploring the reasons and willingness to pay for the COVID-19 vaccine and vaccine booster shots. The developed questionnaire is from an online survey. Data analysis is a descriptive statistic. The results from phase 2 are defined policy recommendations. Phase 3 is an expert and stakeholder meeting to propose and discuss policy recommendations. The result showed 86.38% of respondents reported the COVID-19 vaccine acceptance. Respondents had no vaccination accounting for 9.16%, 10.76%, and 53.19% for the first, second, and third doses, respectively. 66.72% of the respondents accepted to have the next dose of the COVID-19 vaccine. Only 8.22% of the respondents refused the COVID-19 vaccine. One-third of the respondents received their desired COVID-19 vaccine. Factors related to the willingness to accept the COVID-19 vaccine and vaccine booster shots were an intention to take the vaccine, vaccine efficacy, attitude towards the COVID-19 vaccine, some doses of the COVID-19 vaccine, age, living area, having Influenza vaccination history, medical personnel, and income. Reasons and willingness to pay for the COVID-19 vaccine and vaccine booster shots were self-efficacy, safety, and proof by WHO. The main reason for refusing the COVID-19 vaccine was negative news on vaccines. Whereas the main reasons for the COVID-19 vaccine acceptance were protecting themselves, the safety of their families, social responsibility, herd immunity, and safety of their co-workers. One-fifth of respondents reported the willingness to pay for a booster shots vaccine between 1-5,000 Thai baht. News objectivity, in a particular vaccine against the severity of illness more than prevention, increased confidence towards the vaccine to higher-educated and higher-income groups, promoted a campaign for a single status group, priority groups for vaccination, combating fake news, and developed efficacy of the COVID-19 vaccine created in Thailand were the policy recommendations for the COVID-19 vaccine and vaccine booster shots in Thailand.
During the COVID-19 pandemic, the patient isolation chamber is crucial as it helps reduce the infection, numbers of medical personnel while transferring patients, and time, as well as protect their safety while taking good care of the COVID-19 patients. The general negative pressure chambers are currently expensive and have various limitations. For example, unable to move intensive care patients with ventilators, inconvenient in some medical procedures e.g., radiation treatment or CT scan, inconvenient and high costs for maintenance, and lack of quality testing and certification of equipment in safety and performance. Therefore, the MTEC research team had developed the PETE (Patient Isolation and Transportation Chamber), a device for transferring patients with respiratory tract problems. The PETE consists of 2 main parts; a clear plastic patient isolator and a negative pressure unit designed to control the air circulation inside the chamber. This PETE innovation is developed in consideration of local manufacture, reduction of shortage necessary medical equipment, and future improvement on the medical devices in accordance with global safety standards. The PETE is designed efficiently and approved after being reviewed along with literature and solution ideas gathered from concerned parties. The outcomes attached with this innovation are an air circulation system, a high-efficiency particulate air filter (HEPA filter), and a UV-C light sterilization system. From a study of current problems and reviews by actual users from 10 sampling institutions, the MTEC research team had digested and concluded for specification of the equipment which its main characteristics or essential features of a product are as follows: Compatible with existing patient transport equipment such as spinal board, stretcher, or scoop, The chamber can be put into the X-ray machine and CT scan, Foldable chamber requires small space to keep and be easy to transport, Pre-inlet filter prevent redundant disease, Chamber gloves ensure safe patient manipulation and additional ports for connection external medical devices and Complies with ISO 14644 standard (Clean room and associated controlled environments), IEC 60601-1 standard (electrical safety testing standard for medical devices) and IEC 60601-1-2 (electromagnetic compatibility)
Rare diseases affect more than 350 million people worldwide. Of those, more than 80 percent are of genetic origins. The diseases are severe, frequently cause congenital deformities, and rapidly deteriorated. Diagnosis of rare diseases is complicated and could take up to 8 years. Long-lasting diagnostic procedures mean wasting time and opportunity of medical personals to treat other patients, several laboratory tests, repeated hospital admission, and unnecessary treatment. These deteriorate the physical, psychological, and economic conditions of the patients and their families. To date, a vast number of patients with rare diseases lack an opportunity to access precise or correct diagnosis and treatment. Previous studies have demonstrated that more than 52 million children worldwide are died before the age of 5 years due to rare diseases. These show that urgent implementation must be employed to tackle undiagnosed rare diseases. With the Next Generation Sequencing (NGS) technology including whole exome sequencing (WES) and whole genome sequencing (WGS), up to 50 percent of rare diseases have been successfully diagnosed in the last 10 years. NGS has improved disease prevention, prenatal diagnosis, prognosis, and pharmacogenomics. Although WES/ WGS which are the short-read technologies (< 150bp nucleotides) have increased diagnostic yield of rare diseases, the yield is limited at 50 percent of cases. One founding reason is that short-read WGS is unable to diagnose certain molecular pathologies including structural mutation, inversion, and repeats. Our research team therefore has utilized a recent sequencing technology “long-read sequencing”, which can sequence more than 20,000 nucleotides in length, to do whole genome sequencing for 60 individuals comprising patients and their parents. We successfully performed the high-molecular weight DNA extraction, checked the DNA quality, optimized sequencing condition, analysed the genome information and sent the genome data to NSTDA for the establishment of long-read genome database. We have found that long-read sequencing could identify the diversity of genomics including single nucleotide variation (SNV), in/del (insertion/deletion), structural variation (SV), and copy number variation (CNV) which were unable to be identified by short-read sequencing. During the process which required short-read exome/genome sequencing and subsequently long-read sequencing, we could published 22 articles in international academic peer-review journals. The database will be beneficial to genomic research and medical service in the era of genomics medicine. The long-read WGS has a great potential to be the new standard in the era of precision medicine when personalized therapy can benefit the patient, family, society, and economy.
Three major institutes in Thailand, including King Chulalongkorn Memorial Hospital, Queen Sirikit National Institute of Child Health, and Faculty of Medicine, Chiang Mai University, worked in collaboration to establish the management plan for drug-resistant tuberculosis in children mainly consists of two paralleled projects, including the prevalence of drug-resistant tuberculosis in Thai children and the study of pharmacokinetics and safety of levofloxacin in pediatric tuberculosis treatment. The prevalence study of drug-resistant tuberculosis in Thai children had screened 186 children during 2019 and 2021, of which 104 children were diagnosed with tuberculosis, including 11 children with any forms of drug-resistant tuberculosis; 7 (7%) children were resistant to isoniazid, 2 (2%) were rifampicin, and 1 (1%) was multi-drug-resistant. In comparison with the medical records data from Siriraj hospital (the year 2009 to 2011) and Queen Sirikit National Institute of Child Health (the year 2001 to 2010), the prevalence tended to decrease over time. As a result, the prevalence of tuberculosis in children was similar to that in adults in 2017-2018. Thus, the characteristics of tuberculosis in children may represent those in adults. Moreover, the majority of drug resistant tuberculosis in children is isoniazid resistant tuberculosis which may reflect the similar prevalence of isoniazid-resistant tuberculosis in adults. The current World Health Organization’s recommendation and the Thai National tuberculosis management guidelines have implemented the treatment regimen of rifampicin, pyrazinamide, ethambutol, and levofloxacin for 6 months for isoniazid resistant tuberculosis has been shown to reduce the mortality and recurrent rates. However, the current application of molecular diagnosis as Xpert MTB/RIF could not detect isoniazid-resistant tuberculosis. Therefore, the culture for tuberculosis within two months after the treatment is still mandatory to consider the appropriate treatment regimen for the specific patient. However, the use of line probe assay 1st line drug or Xpert MTB/XDR is able to detect levofloxacin-resistant tuberculosis, thus helping establish the treatment regimen in the meantime. Additionally, for the pharmacokinetics and safety study of Levofloxacin in children with tuberculosis, a total of 10 children were equally divided into two groups which the first group received levofloxacin dosed 15-20 mg/kg/day which is a WHO recommendation dose in 2020 and 20-30 mg/kg/day in the second group. As a result, the serum levofloxacin level was lower than the therapeutic level in the first group and reached the therapeutic level in the second one, with no significant adverse event. Therefore, our study recommended increasing the levofloxacin dose to 20-30 mg/kg/day as the standard treatment of drug-resistant tuberculosis in children in order to enhance the therapeutic efficacy and minimize the risk of levofloxacin-resistant tuberculosis in the future.