plueme/wizJson huggingface dataset:
Background: Cervical cancer is the third most common cancer in Thai women. Despite the national health benefit coverage of cervical cancer screening, its incidence and mortality rates are still high. The success of the screening policy is restrained due to various barrier factors that minimize the screening rate. Self-screening is one of the promising strategies that could reduce barriers to screening in Thai women. This study aimed to conduct (1) a systematic review of efficacy or effectiveness, cost-effectiveness, and acceptability; (2) cost-utility analysis; (3) budget impact analysis; and (4) feasibility analysis of cervical cancer screening policy by using a self-collected sample kit for HPV DNA test in Thailand. Methods: (1) A systematic search was conducted in 3 medical databases, i.e., Embase, MEDLINE, and PubMed on October 12th, 2022. The studies related to efficacy or effectiveness, cost-effectiveness, and acceptability or feasibility of cervical cancer screening by using a self-collected sample kit for HPV DNA test were included in the systematic review. (2) A cost-utility analysis of 3 options, i.e., (a) additional self-screening, (b) clinician screening only, and (c) no screening policies, was performed using a societal perspective. (3) budget impacts of the additional self-screening policy were calculated from a provider perspective. Lastly, (4) a feasibility study was done by in-depth interviewed medical professionals involved in cervical cancer screening and women who were the target group. Results: (1) Among 1,326 studies, 16 were included in the systematic review. There were 6 studies that reported screening performance of self-collected sample HPV DNA tests. Overall, the accuracy of screening by HPV DNA test using either self-collected or clinician-collected samples was similar, with approximately 74-91% sensitivity and 84-99% specificity when compared to the results of colposcopy at CIN2 or worse. There were 7 economic evaluation studies, all of which reported that self-screening was cost-effective. In addition, 3 feasibility studies found that majority of Thai women preferred self-screening to clinician screening. (2) Our cost-utility analysis revealed that the additional self-screening policy was the best-buy policy when compared among the three option. (3) The average budget impact per year of additional self-screening policy was around 723 million Thai baht. (4) Medical Professionals and the target group mostly accepted self-screening method. However, women who were at-risk or had gynecological symptoms should be examined by a clinician. Conclusions: In context of Thailand, additional self-screening policy for cervical cancer prevention was cost-saving compared to clinician screening only policy. The benefit of additional number of screened women predominated the incremental cost. Policy-makers should consider this evidence in the policy optimization process.
Zika (ZIKV) is emerging and re-emerging arboviral diseases. These viruses are transmitted to humans through the bites of Aedes mosquitoes. Recently, ZIKV infection has been described as an emerging disease in Thailand and many countries, especially in tropical and sub-tropical areas. The specific drugs and vaccines against these infections are unavailable; therefore, effective disease control relies on vector control measures only. To understand the transmission cycle of these viruses, mosquito vectors and human. This study is designed 1) to determine seasonal ZIKV infection rates in mosquitoes for prediction the outbreak of ZIKV infection, and 2) to develop and validate a Zika-RT-LAMP (SYBR). The present studies detected very few positive samples of ZIKV and chikungunya viruses in mosquitoes by hn-RT-PCR, collected from 4 provinces which were proposed. However, we detected the chikungunya virus in mosquito samples collected from the outbreak areas in Bangkok, and we successfully performed whole genome sequencing with these samples. The Zika-RT-LAMP (SYBR) assay showed high sensitivity and specificity. The detection limit of the ZIKV-RT-LAMP assay was 10-6 ffu/ml and detected the Asian lineage of ZIKV RNA without cross-reactivity with other arthropod-borne viruses. In addition, the researchers used dengue fever data as a prototype to test the developed model by applying ontology to enhance the classification efficiency of decision tree algorithms. These findings have provided information regarding pathogen-pathogen interaction in host cell. The data from this study could be used for future development of more effective prevention, control strategies, and predict outbreaks of ZIKV in Thailand.
Introduction: Currently, continuous ambulatory peritoneal dialysis (CAPD) has been included in the Universal Health Coverage (UHC) benefit package, whereas automated peritoneal dialysis (APD) which is more expensive has not been included in the benefit package, yet. Economic evaluation of APD in pediatric patients has not been studied before. Objectives: We aimed to assess the cost-utility and budget impact of APD versus CAPD in pediatric ESKD patients using a Markov model as well as to study the social impact of APD and CAPD from the perspectives of patients and caregivers. Methods: Cost-utility and budget impact analyses were applied using the Markov model based on a social perspective. The results were presented as the incremental cost-effectiveness ratio (ICER). Budget impact analysis was evaluated based on a governmental perspective. In addition, the social impact was assessed by qualitative and descriptive researches which collected the data from patients and caregivers for patients receiving APD and CAPD using in-depth interviews. RESULTS: Based on a social perspective, compared to those receiving CAPD, patients receiving APD had an ICER value equal to 3,063,598 baht per QALY gained and APD increased the budget in average by 54 million per year compared to CAPD. Kidney dialysis in pediatric with ESKD had social impacts on both pediatric patients and their caregivers. It is different from ESKD adult patients in that dialysis affects patients themselves. APD was satisfactory and a positive social impact was found among ESKD pediatric patients and their caregivers. Discussion and conclusions: If the societal willingness to pay in Thailand equal to 160,000 baht per QALY gained, APD would not be cost-effective. Compared with CAPD, when considering the social impact on pediatric patients and caregivers. It is clear that APD can help both pediatric patients and their caregivers carry out their daily activities during the day and the inclusion of APD can result in an increase in annual budget of 54 million baht. Therefore, we recommend to include APD into the benefit package for UHC. However, the government should offer social support methods for pediatric patients and their families.
Currently, there are no epidemiological studies in Thailand on type 1 diabetes and diabetes diagnosed before the age of 30 Long-term studies in Thai children and adolescents have been published periodically. less 5 years ago. Recent evidence has shown that the ratio of type 2 diabetes in Thai children has increased as well as type 1 diabetes. The etiology and clinical features of diabetes in children and adolescents are tendency to change according to environmental factors and lifestyles. The study of type 1 diabetes in all ages and diabetes diagnosed as young as 30 years old consists of two sub-projects: Sub-project 1: Basic patient data collection for registering diabetic patients who are admitted to network hospitals nationwide. Basic laboratory data from the patient's blood was analyzed. Epidemiological analysis and measurement of autoantibodies against 3 islets antigens, GAD65, IA2 and ZnT8 in the laboratory to know the incidence of type 1 diabetes. Subproject 2 Study molecular genetics of diabetics diagnosed before the age of 30 years by studying patients with clinical characteristics compatible with NDM and MODY together with negative autoantibodies results. The prevalence of T1D, NDM and MODY diabetes in the Thai population can be used to diagnose and treat diabetics, especially personalized medicine. A total of 4,749 people registered for type 1 diabetes and diabetes diagnosed before the age of 30 in Thailand from 84 network hospitals across Thailand, and 1,337 specimens were obtained from 1,337 diabetic patients diagnosed before the age of 30, with clinical diagnosis of diabetes divided into type 1 diabetes 868 cases (64.9%), type 2 diabetes 314 cases (23.5%), 72 cases of MODY diabetes (5.4%) and 83 cases (6.2%) of unspecified diabetes. In the study of autoantibodies against three types of islets antigens, namely GAD65, IA2 and ZnT8, 868 patients with type 1 diabetes tested positive 529 cases (60.9%). Autoantibodies tests in type 1 diabetes patients showed 449 GAD antibody positives (51.7%). 301 IA2 antibody positive cases (34.7%) 267 cases (30.8%) were positive for ZnT8 antibody. Patients with clinical characteristics compatible with MODY diabetes, where diabetes is transmitted in a distinctive family and no autoantibodies were found in 29 islets antigens. Based sequencing analysis by exome sequencing revealed gene variation associated with previously reported diabetes. Another 20 MODY patients have not found a previously reported pathogenic gene (MODYX). This study, systematic nationwide, is a preclinical and scientific study that directly contributes to Thailand's cognition related to diagnosed diabetes under 3 0 years of age in Thailand. It can be used as an empirical reference and may lead to the formulation of appropriate public health policies related to diagnosis. Treatment and prevention of diabetes in young people in Thailand as well.
In Thailand, directly observed therapy (DOT) has been performed for tuberculosis treatment monitoring for two decades. However, this program lacks an accountability system leading to becoming an unsustainable strategy, especially to continue DOT during the pandemic of COVID-19. The research team developed a video observed therapy (VOT) system using the mobile application called "TH VOT" to monitor medication adherence among tuberculosis patients. The system provided feasibility and safety to both the patients and their observers. The observers can remotely inspect the patient’s taking medication through the videos sent by the patients. The system was implemented in Hat Yai and Mueang Songkhla District, Songkhla province, Southern Thailand, and assessed its usability by the participants in these jurisdictions. All of the users could use the system to perform the VOT sessions, and they rated the system above-average level of the general benchmark of UEQ for its usability. A cluster randomized controlled trial of patients with pulmonary TB and their observers was conducted over a 60-day period to compare the cumulative compliance days, smear conversion rate, and the number of adverse events reported in the VOT system with those in the traditional DOT system. The study recruited 63 patients for the VOT program and 65 patients for the DOT program. Patients in the VOT program had an average of 27.6 cumulative compliance days, while those in DOT had 12.4 on average. The mean difference was 15.2 (95% confidence interval [CI]; 0.6 to 29.7). Observers in the VOT program averaged 21.5 cumulative compliance days, while those in DOT observed 0.3 days on average. The mean difference was 21.2 (95% CI; 10.8 to 31.6). There is no significant difference in the smear conversion rate, and the number of adverse events reported. In conclusion, TH VOT significantly outperformed the traditional DOT in ensuring compliance with TB treatment for both patients and observers. However, the low compliance rates observed in both groups suggest a need for system improvements and regulatory policies to ensure accountability of the observers.
During the COVID-19 pandemic, MTEC researchers developed “HI PETE”, patient isolation chamber for Home & Community Isolation, a device for isolating patients with respiratory tract problems, which 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. Most of negative pressure isolation chambers or tents are currently expensive and have various limitations, like, most designs are heavy and it takes time to install. Therefore, they are not practical due to high costs for maintenance, and lack of quality testing and certification of equipment in safety and performance. The HI PETE consists of 2 main parts; a clear plastic patient isolation room and a negative pressure unit designed to control the air circulation inside the chamber. This HI 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 HI 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 3 sampling institutions: Mongkutwattana hospital (Bangkok), Saint Mary hospital (Nakhon Ratchasima) and Sai-ngam hospital (Kampangpetch). Different types of HI PETE chambers are used both in emergency department to treat COVID-19 patients using spray medicine, and in COVID-19 pre-screening station. Especially in Sai-ngam hospital (Kampangpetch), the HI PETE is applied in obstetrics gynecology department. Based on the user feedbacks, 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 lightweight, quick and easy to install, compatible with existing medical equipment such as respirator, infusion pump. Foldable chamber requires small space to keep and be easy to transport. Pre-inlet filter prevents redundant disease. Chamber gloves ensure safe patient manipulation and additional ports for connection external medical devices 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).
Current literature raises caution against the indiscriminate application of decentralization and advocates careful formulation of decentralization measures to prevent the unintended perverse consequences. In 2021, Thailand has embarked on a large-scale decentralization reform that resulted in the transfer of 33.21 % of subdistrict health promoting hospitals (SHPHs) to 49 provincial administrative organizations (PAOs). SHPHs serve the important function of providing primary care services as stipulated in the 2017 Constitution. In Rayong—a province along the eastern coast of Thailand, 40 SHPHs were transferred from the Ministry of Public Health (MOPH) to Rayong PAO in 2022. This research sought to understand the problems and obstacles facing Rayong PAO after it became responsible for 40 SHPHs and their primary care function. The research also attempted to analyze how Rayong PAO has managed to solve these problems and planned for the future challenges of primary care. The World Health Organization’s (WHO) six building blocks of a health system was used to guide our research. Data were collected by interviews and focus group discussions. A total of 62 key informants participated in this study. This research found that after decentralization, SHPHs experienced severe staffing shortages, particularly the shortages of physicians and dentists. However, these staffing shortages were chronic organizational problems that existed in the Thai health system prior to decentralization. Confusion arose immediately after SHPHs were transferred to Rayong PAO, as the Thai government did not provide adequate financial resources and clear guidelines on medicines and medical supplies, population health data management, and primary care service provision. Despite all these shortcomings, Rayong PAO demonstrated a coping capacity that enabled it to use all the available resources and networks to ensure the proper functioning of SHPHs. The salient elements of Rayong PAO that contributed to its coping capacity included: (1) the comprehensive health promotion strategy, (2) effective solution for staffing shortages, (3) clear plan for SHPH development, (4) experienced and skilled advisory team, (5) efficient area-based health committee, and (6) strong relationship with the family medical doctors in the area.
Despite the availability of effective antiretroviral therapy (ART), tuberculosis (TB) remains the leading cause of morbidity and mortality among people living with human immunodeficiency virus (PLWH). The use of effective ART can reduce the risk of developing active TB by 65%. Additional of TB preventive therapy (TPT) to ART is shown to further reduce TB incidence by 30% and mortality rate by 35-50%. Therefore, TPT is one of the important strategies for ending TB. TPT amomg PLWH in Thailand is currently implemented in clinical practice guideline2023. The preferred TPT regimen are 3 HP (weekly isoniazif 900 mg+ rifapentine 900 mg for 12 weeks)) and 1 HP (daily isoniazid 300 mg + rifapentine 450-600 mg for 4 weeks). It is crucial to investigate the drug-drug interaction to find the optimal dose of dolutegravir (DTG), the most preferred ART when it is being used with rifampin for active TB and rifapentine for TPT. This study investigated the effect of rifampin on DTG 50 mg once daily (experimental dose) versus DTG 50 mg twice daily (recommended dose) among active TB/HIV co-infection. The study demonstrated that DTG based regimen is highly effective (90% had HIV RNA < 50 copies/ml at week 48) and the standard dose DTG may be appropriate to be concomitantly use with rifampin. The study also investigated the effect of rifapentine as 1 HP or 3 HP for TPT on DTG 50 mg once daily among PLWH. The study showed that DTG based regimen is highly effective (> 95% had HIV RNA < 50 copies/ml at week 48) and the standard dose DTG may be appropriate to be concomitantly use with rifapentine. Since, fixed dose combination of DTG/tenofovir disoproxil fumarate (TDF) /lamivudine or TLD is widely used in Thailand and other low-middle-income countries (LMICs), thus, the standard dose TLD without additional DTG is more convenient for national HIV program, it is cost saving (no extra DTG dose) and the adherence of patients is not compromised (once daily ART). In those with high risk of isoniazid related hepatotoxicity such as liver disease, alcoholism, older, N-acetyltransferase 2 or NAT2 may be beneficial. The dose of Isoniazid and rifapentine or rifampin can be adjusted. Uridine glucuronosyltransferase 1A1 (UGT1A1) is also important for DTG metabolizer. In this study, rifampin, body weight and poor metabolizer of UGT1A1 are significantly affects the DTG concentration. Poor metabolizer of UGT1A1 increased DTG trough concentration by 22.8%. In summary, this study highlighs that the standad dose TLD can be safety used with both rfampin based anti TB among active TB/HIV co-infection and rifapentine based TPT. This is simple as 1 tab a day, no additioanal DTG is required. It is good for ARV procument, and cost saving. Importantly, it can be used as once a day to improve adherence. This finding is benefit for Thai PLWH and the global PLWH at large.
The devolution of sub- district health promotion hospital to provincial administrative organization effect to the roles of provincial public health office and district public health office. This study aimed to investigate the roles of provincial public health office and district public health office after devolution of sub- district health promotion hospital to provincial administrative organization and synthesize policy suggestions. Mixed methods were used. The Qualitative data were gathered using semi-structured interviews and focus group. The participants, from 8 provinces representative of each region, involved the experts, administrators of Ministry of Public Health, policy makers, chiefs of provincial public health office, district public health executives, district chiefs, and district public health officers. The quantitative data were collected using questionnaire. The data were analyzed with descriptive statistics. Policy suggestions were synthesized from the analysis of qualitative and quantitative data, and connoisseurship. The findings showed that the roles of both offices were the same as before with some new operations in order to solve the problems consequence the devolution: 1) transition phase; the provincial public health office operated as the prior roles and followed Primary Health System Act, 2019, and been the preceptor of district public health office for preparing the readiness and promoting the officers’ competencies of district public health offices to be the academic offices; however. The roles of district public health office should be modified by the ministerial regulations. 2) devolution complete phase; the provincial public health office operated as the prior roles with some modifies roles according to the modified roles of the district public health office. These modified roles involved upgrading the district public health office to be the academic office and enhancing the competency of officers to be the consultants and the evidence-based information providers, being regulators to evaluate the quality of primary care services of all sectors in the area of their district, and improving health consumer protection system.