plueme/wizJson huggingface dataset:
This research was to study and propose functions, roles, and structure of
the Ministry of Public Health in the next decade as a mechanism of the National
Health System. The proposal was done by analysizing related documents and
research papers published in Thailand and other countries. Research methodology
also included individual and focus group interviews among those academicians
and involved partners in health. This study revealed rapid and tremendous
changes of global context re-defining health to cover physical, mental, social
and intellectual dimensions. Moreover a plenty of organizations and mechanism
related to health have emerged. The Ministry of Public Health that has
currently been responsible for health affairs of the country as the key stakeholder
is supposed to emphasize its functions and roles on collaborating and bridging
all the social sectors of the nation; it then systematically and apparently mobilizes
their resources and potential for health development.
Ten functions and roles of the Ministry of Public Health during 2007 -
2012 were proposed. 1) Play major role in formulating national health policy and
strategy. 2) Advocate knowledge generation and management. 3) Determine and
regulate health standard. 4) Build capacity of social sectors and people in health.
5) Enforce health and health-related law. 6) Superintend the control of diseases
and health hazards. 7) Superintend health care financing for people and specific
needy groups. 8) Secure and assure the integrity of health resources. 9) Implement
international health. 10) Mobilize the health-related royal initiation projects.
Therefore organizational structure of the Ministry during 2007 - 2016 would
be basically changed in comply with the aforementioned functions and roles. It
was proposed that all the health service facilities ranging from primary to tertiary
levels within the same services area would be reposed in the same authority
of command. It would also be legislatively adopted to be juristic body as a
state agency other than government agency or state enterprise but under the
supervision of the Ministry of Public Health. The status will also be applicable
to sub-specialty facilities. Meanwhile particular mechanism would be established
at the central level to coordinate those facilities in terms of policy and direction
of services as a whole.
To attain that goal, policy makers, high executives of the Ministry and
involved agencies must share policy commitment for changes. Then the establishment
of “The Bureau of Change Management for the Ministry of Public
Health” as an autonomous body under the supervision of the Ministry would
streamline and accomplish the organizational restructuring. The Bureau is supposed
to propose plan and phases of those undergoing change.
This study is part of the study to develop the monitoring system for primary
care at a macro level. This part shows the evaluation result of diabetic care
system of various contracting units for primary care in purposively sampled 18
CUPs, 4 regions. The components of the evaluation were diabetic care system
and process, clinical results, knowledge, practices and quality of life of diabetic
patients. The methodologies used were internal evaluation by questionnaires
and explore evaluation by observation, interview and documentary review. The
result showed that the quality of the systems among CUPs was much varied.
Most were passive, not proactive on risks and complications management. Primary
care showed fewer roles, only screening and follow up. Most of them were
not well supported by hospitals and CUPs. Health outcomes indicated that 38
percent of the total had good control of plasma glucose (HbA1c < 7 mg%); 10-19
percent high cholesterol, 21-43 percent high HDL, 2-12 percent high triglyceride
particularly among women than men; 31-50 percent micro-albuminurea (>30),
high creatinine 2-30 percent. These were different among areas and diabetes over
5 years had more complications than diabetes less than 5 years. The knowledge,
practice and quality of life of diabetes were varied among CUPs. Most had good
knowledge and practice on medication and general management, but has less
on diet, foot care and care for special events. Diabetes had quality of life on mental
aspect less than other aspects. Those with diabetes less than 5 years had
quality of life score on physical and dependency aspect better than those more
than 5 years, but the scores other aspects were not different. The diabetes in
areas that had better knowledge and practice also had higher score of quality of
life.
This study showed that the evaluation of diabetes care system can be one
tracer to monitor quality of primary care and contracting units of primary care.
The process and some outcome indicators in this study can be used to compare
conditions among areas.
This study is one part of the development of primary care monitoring
system at a macro level in 2005. This part shows the conceptual framework to
develop the indicators and the existing database system of primary care units
based on such development. The diabetic care and mother and child health care
were used to represent the unique characteristic of primary care, advocating
holistic approach, continuity of care, and supporting self-reliance. The study
found that data for quality indicators of diabetic care lacking, varied among units,
and needed to be newly developed. The data for indicators of MCH care have
not been so different among units, but the collection form was varied and segmented
by different units. The incompleteness and inconsistency of data of the
same case was high. The outcome indicators were too insensitive to allow differentiation
of the quality of individual primary care networks. It needs the process
indicators that can be collected through hospital database. Moreover the
database will be more reliable and accurate if the provincial monitoring committee,
instead of the central unit check and analyze the data as a package.
The Universal Coverage policy has incorporated two major reform elements,
financial management reform and strengthening primary care which inevitably
affects health service delivery system in Thailand. This paper was aimed
to review implications of the Universal Coverage policy on service delivery system
in terms of financial implications and service provision. Review of secondary
data was the method adopted to explore the implications and the study was
conducted during 2004 - 2006.
The result revealed that the Universal Coverage scheme had a great impact
on the service delivery system. Inadequate funding in addition to change
of allocation criteria from supply-based allocation to demand-based allocation,
per capita, had great financial implications on hospitals. Big hospitals, for example,
regional and general hospital, and hospitals with relatively high concentration
of health personnel incurred financial deficit in the first year when salaries
were included in the capitation. However, the problem had been shifted
from regional and general hospitals to community hospitals and those hospitals
in the Northeast when salaries were removed from the capitation in the following
years. Change of criteria of allocation out of inadequate funding was inevitably
shifted the problem from one to another. Providing universal coverage of
health insurance apparently increased demand for care and burden of work.
Strengthening primary care policy drove more service utilization toward community
hospitals and health centers. Mobilizing doctors or professional nurses
to provide care in primary care units and health centers improved overall quality
of care. However, inadequate funding and stagnation of investment budgets
may have negative consequences on quality of care in the long run.
Evaluation of the Project “Development of Gold Card Enrollment
System : A Case Study in Phrae” had three objectives : 1) study actual
activities compared with planned activities, 2) study effectiveness of
the project compared with its target, that was Gold Card enrollment completed
within 15 minutes at hospitals and within 7 days at health centers,
3) evaluate satisfaction of staff and clients towards this new enrollment
system. An evaluation taskforce was established. Data for analysis
came from Gold Card application form, records and reports from
Phrae Provincial Health Office, a group discussion with registrars, and a
questionnaire about satisfaction of clients. Results showed that almost
all activities were accomplished as planned. The staff had learned : planning
by using Project Design Matrix (PDM), system analysis and new
system design, preparation for a new system, starting a new system,
and continuing operation and monitoring a new system. Enrollment
results showed that, at hospitals, 85.4 percent of enrollments could be
completed within 15 minutes; at health centers, 61.8 percent of enrollments
could be completed within 7 days. Nearly 100 percent of staff and
clients were satisfied with this new enrollment system. Problems encountered
were: staff could not access to centralized database due to
instability of the network; health center staff failed to follow the guideline
in forwarding enrollment data to registrars at hospitals within 7 days
because numbers of registration in one week were so small that it seemed
economically invalid to follow the guideline. Lessons learned were applied
to the project “Data Center“ of the National Health Security Office
(NHSO).
The objective of this descriptive study was to determine the relationship between
fasting plasma glucose (FPG) levels, as well as a few other factors, with HbA1c in 100 patients with type 2 diabetes who were receving treatment at Ladlumkaew Hospital. The
data were collected during the period May-July 2007. The variables were sex, age, waist
circumference, body mass index, duration of illness, administration of metformin, and
fasting plasma glucose. The relationship between variables and HbA1c was assessed using
percentage, and odds ratio test.
The results of the study showed that patients who received treatment with metformin
had a mean level of FPG for three months equal to or less than 130 mg/dl related significantly
with an HbA1c level of less than 7 percent. When considering the results, 30 percent
of the patients had a mean level of FPG equal to or less than 130 mg/dl and 15
percent of the patients had FPG levels three times in three months that were equal to or
less than 130 mg/dl; these patients had HbA1c levels above 7 percent at 56.7 and 46.7
percent, respectively. Such findings denoted that the FPG level reflected the short period
of the preceding plasma glucose level; making an evaluation of hyperglycemic control by
FPG level would be misleading in the management of diabetes patients. The HbA1c level
was a better indicator for evaluating the achievement of glycemic control over the preceding
2-3 months. The HbA1c level could predict the complications of diabetes patients.
Therefore, for the goal of glycemic control, the HbA1c test shoud be employed in conjunction
with the FPG test.
The purpose of this study was to determine an appropriate way to prevent bedsores in disabled stroke patients while they are still hospitalized. All stroke patients admitted to the Internal Medicine ward in Sichon District Hospital during the period January 2005 - December 2006 were enrolled into this study. Data collection included demographic data, and information on occurrence and details of the bedsores. We invented a new care protocol and equipment to prevent pressure sores. A comparison of the results of care before and after the use of these interventions in the target group was the outcome measured. During 2005, the incidence of bedsores in stroke patients was 18.37 percent. After the new strategies in caring and monitoring had been introduced, the incidence decreased by 5.36 percent in 2006. The knowledge, attitude and practice of caregivers, which included nursing personnel and patients’ relatives, increased; moreover, they tended to participate more in taking care of their patients. The most common pressure ulcer locations were the coccyx and the sacral area. In hospitalized patients, most pressure ulcers were facility-acquired, so we created new equipment from local products, i.e. pillows made from the inner skin of dried coconut in order to support the at-risk surfaces and decrease the pressure on the skin. New strategies in caring and monitoring bedsores included education, empowerment of caregivers and team work. All patients were followed up, and home visits by the family physician and his/her team were made; no new bedsores were found to have occurred in their homes. This study demonstrated that the best way to treat pressure sores in disabled CVA patients is to prevent those conditions in the first place. Given current evidence, using support surfaces, repositioning the patient, optimizing the nutritional status of the patients, and moisturizing the skin were all strategies that prevented pressure ulcers. Caregivers should be empowered to take care of their patients during the entire period of their entire hospital admission. Family physicians should strive to integrate both holistic care and continuity of care for the patients and their families.
This survey research study was aimed at to examining the self-health-care behavior
of women in preventing cervical cancer among a target group of women in Tambol Nong Ya Sai, Amphur Nong Ya Sai, Suphan Buri. Applying the Health Belief Model Theory as
a guideline, the research had been performed during June and July 2007 using purposive
sampling on 251 target women aged 35, 40, 45, 50, 55 and 60 in the area under the responsibility
of Nong Ya Sai Hospital. The research workflow consisted of interviewing, data
collection and analyzing processes, using frequency distribution, percentage, means, standard
deviation, chi-square test and Pearson’s correlation coefficient.
The results indicated that 46.6 percent of the target group of women had an intermediate
level of knowledge about cervical cancer, 97.2 percent had an intermediate level
of acknowledging risk opportunities in having cervical cancer, 68.1 percent had an intermediate
level of acknowledging cervical cancer, 72.9 percent had a high level of acknowledging
the benefit of having a Pap smear test, 60.6 percent had a high level of self-care
behavior in preventing cervical cancer, 53.0 percent had a Pap smear test, while 10.7 percent
did not undergo that test. The research also informs that marriage status and knowledge
about cervical cancer have a significant relationship with self-care behavior in preventing
cervical cancer (p value ≤ 0.05).
Recommendation: Public health officials should provide knowledge about cervical
cancer to increase the number of target group women who have undergone a Pap smear
test, which will lead to good health.
Carcinoma of the cervix is the most common cancer in Thai women. Over 40 years,
Pap smears have been used as the standard technique for cervical cancer screening, but
the coverage is quite low among the population and the incidence of advanced stage
cancer is still high. Acetic acid (VIA) testing had been introduced as an alternative method
in order to improve the effectiveness of cervical cancer screening in Thailand. When the
VIA result was positive, the client is referred for further management, but most doctors
do a repeat Pap smear to start rescreening as usual. This study was conducted to evaluate
the effectiveness of VIA and determine how necessary it is to practice in VIA-positive women.
This retrospective descriptive study was conducted in VIA-positive women who
were sent for colposcopic examination between February 17, 2004 and February 16, 2007,
a total of 109 cases. Pap smear and colposcopic cervical biopsy, with or without LEEP
conization, were performed. A Pap smear result of “normal” meant normal; inflammation
was found in 102 cases. “Abnornal” meant SIL or CIN to carcinomas, which was
found in seven cases. The histopathological result was classified as “normal”, meaning
negative and cervicitis, and “abnormal” meaning CIN I to carcinomas, which were found
in 90 and 19 cases respectively. Pap smear sensitivity was 36.84 percent, specificity was
100 percent, positive predictive value was 100 percent, and negative predictive value was
88.24 percent. This study suggested that repeated screening by Pap smear in VIA-positive
women should not be recommended due to its low sensitivity.
This report is aimed at studying the management trend of Rasisalai Clinic and the
general data on the occurrence of new tuberculosis cases in Rasisalai district, Srisaket
Province, for creating a proper TB control planning program. An interview survey was
conducted at the TB clinic; all 134 TB cases had been registered between October 1, 2005 and September 30, 2006. The majority were males (64.2%), had a primary school level of
education (88.1% ), were farmers (71.9%) and were more than 60 years old (40.3%).
These patients were more likely to have been vaccinated with BCG (70.1%) than not
vaccinated (29.9%). The study population also had other health indications as follows:
DM 11.2 percent and HIV infection 1.5 percent. The most important factor was contact
with TB cases in their households (70.1%). Improper protection measures between TB
patients and their relatives could account for the occurrence of new TB cases: no mask
(53.2%), improper sputum collection (36.7%), no isolated bedroom (33.6%) and no isolated
eating area (35.8%). These behaviors were relevant to poor management of the
Rasisalai TB Clinic in terms of screening TB contacts in the households and in terms of
protective education.
We concluded that the effective TB treatment regimen offerred by DOTS to control
TB prevalence was not enough; the incidence of TB cases is still rising. We purpose speeding
up the screening of new cases in different high-risk groups, especially for persons
contacting tuberculosis cases in the same household. Proper protective behavior between
the TB patients and their relatives staying with them is imperative. A good clean environment
is another issue that should be the responsibility of the community at every level.
Insulin treatment is one of the standard regimens for controlling blood glucose in
patients with diabetes mellitus (DM). The use of the “Insulin Pen” device for injecting
insulin, instead of the traditional vial/syringe for injection, provides additional convenience and accuracy and it reduces pain during injection. This descriptive observational
study was aimed at studying the behavior of 124 DM patients using insulin pens. Questionnaires were used to assess the following items: knowledge, history of using the insulin pen, attitude and practice in using the pen.
Data were analyzed by independent sample t-test and one-way ANOVA (F-test).
The majority (70.17%) of the samples were women, the average age of the samples was
57.0 ± 5.0 years; 87.90 percent of the patients were primary school graduates; 74.19 percent were experienced in using the pen for 6-8 months; 78.20 percent had used the traditional syringe insulin injection twice daily before switching to the insulin pen; 41.19 percent self-administed the insulin injection; 92.74 percent were instructed about the insulin
pen, using the method described by health-care staff. The average knowledge score was
8.25 ± 2.17 out of a possible 10; the average attitude score was 3.14 ± 1.55 out of a possible
4 and the average practice score was 2.62 ± 0.54 out of a possible 3. When comparing the
differences in sex, age, knowledge, history of using the insulin pen, attitude and practice
in using the pen, we found that differences in educational background affected the knowledge of patients about using the insulin pen. The ones who were experienced in using
the insulin pen were more likely to use it correctly than those who were inexperienced (p
< 0.05).
This report describes data on the referral by Khuandon Hospital in Satun Province
of patients experiencing unsuccessful labor in fiscal years 2005-2007. The objectives of
the study were to compile knowledge for planning in order to improve patient care and
referrals. The methodology of the study was to review the 122 cases of unsuccessful
delivery in the labor division of Khuandon Hospital, focusing on the rate of unsuccessful
labor, the characteristics of the patients experiencing unsuccessful labor and the patterns
of delivery after they were referred to a general hospital in the province. The findings
were as follows: the unsuccessful labor rate was 15.74 percent among the total study population
of 775 pregnant women. The patterns of delivery at Satun Hospital, to which the women had been referred, resulted in normal labor including breech-assisted cases
(41.80%), caesarean section (40.98%) (or 6.45% of the total of 775 pregnant women, which
was similar to the data of the Office of Health Service Development, Ministry of Public
Health (5.46 - 7.04%). The majority of patients experiencing unsuccessful labor were
primigravidae. The causes of referrals ranged respectively from pregnancy-induced hypertension
(PIH), cephalopelvic disproportion (CPD), prolonged stage, and fetal distress,
to premature labor and breech presentation. With regard to the patterns of delivery after
the referrals at the Satun General Hospital, PIH, fetal distress and premature labor cases
were successfully delivered in 66.67, 45.46 and 54.54 percent of the cases, respectively, but
the majority of CPD, prolonged stage and breech presentation necessitated caesarean section
(50.00, 45.46 and 90.91% respectively). The following recommendations were made
: the medical and nurse committees, obstetricians and pediatricians should join together
to develop guidelines for the care and referral of patients in labor and the hospitals should
link the data about the results of the care and health status of the mother and child after
referral.
This was a cross-sectional analytic study conducted to compare intraocular pressure
(IOP) measurements by non-contact tonometer (NCT) and a standard Goldmann
applanation tonometer (GAT) in glaucoma and non-glaucoma patients. One hundred and
forty-eight outpatients attending Thamuang Hospital in the period December 2007 - January
2008 were categorized into two groups: the glaucoma group comprised 48 patients
(48 right eyes, 47 left eyes) and the non-glaucoma group comprised 100 patients (99 right
eyes, 100 left eyes). None of the patients had a history of ocular surgery or corneal disease.
Their IOP were measured by two independent parallel observers using non-contact
tonometer Canon TX-F and Goldmann applanation tonometer.
The results of the study disclosed that the intraocular pressures measured by the
non-contact tonometer were significantly different from those measured by the Goldmann
applanation tonometer (paired t-test statistical analysis p < 0.05) in both glaucoma and non-glaucoma groups. Mean IOP in the glaucoma group, measured by NCT, was lower
than GAT (4.63 ±3.14 mmHg right eye, 4.33±3.50 mmHg left eye); also, the mean IOP in
the non-glaucoma group, measured by NCT, was lower than GAT (1.95±2.89 mmHg right
eye, 2.40±2.62 mmHg left eye). The pressure difference increased in cases with a higher
IOP, thus reflecting the reliability of NCT measurement only in measurement of the cases
with normal intraocular pressure range. Therefore, repeat intraocular pressure measurement
should be performed to conform with the standard Goldmann applanation tonometer,
if necessary.