plueme/wizJson huggingface dataset:
An integration of pharmaceutical management, under limited budget, for sustainability and security of national supply would lead to equity in accessibility. The objectives of this study were 1) to explore the international pharmaceutical management patterns at the national levels 2) to analyze current Thai pharmaceutical management system to find gaps and opportunities to improve 3) to propose policy options for Thai national pharmaceutical management system. The qualitative method was employed to present descriptive and analytical information from primary and secondary data. The population and samples were organizations related to national pharmaceutical management in Thailand and abroad. Data were collected by documentation search, interview in-depth, and focus group discussion. Analysis of qualitative data was performed by the content analysis. The results comprise of 3 parts: 1) international pharmaceutical management patterns at the national levels of Singapore, England, Taiwan, PHARMAC of New Zealand and Thailand. 2) comparative analysis of Thai pharmaceutical management patterns and abroad in 6 dimensions as: Entry points, Horizon scanning, Health technology reassessment, Procurement/Negotiation method, Monitoring and evaluation. 3) propose the appropriate pharmaceutical management system for Thailand. Finally. the policy proposal to deal with stakeholders’ 3 pain points (national medium price, information system, and procurement regulations and laws) was presented.
The objective of this study was to determine the duties and powers of Phitsanulok Provincial Administrative Organization regarding jurisdiction of sub-district health stations. Attention was focused on rules and regulations relevant to the transfer of control over sub-district health stations in the province. Solutions were proposed on how to amend rules and subordinate legislations conducive to efficient transfer of operation of those health stations. Special attention was paid to promoting the healthcare system. The final outcomes were 27 recommendations for national and local policy and measures necessary for public health law reform, especially the operation of universal health coverage scheme. Analyses were carried out on duties and powers of a given provincial administrative organization in dealing with transferring of parts of its missions. Relevant laws, rules and regulations, and subordinate legislations required to achieve any transfer of its mission were also analyzed. Also included were announcements made by the Decentralization Committee, standard operating procedures in managing manpower, budgeting, materiel, and office space. Relevant management systems analyzed included information, drug and medical supplies, patient referral, cooperation and coordination of local and central administrative bodies, and collaboration among primary healthcare units in each province. In short, research findings included a lack of urgent measures to ensure implementation of relevant laws and guidelines provided by the Decentralization Committee. Consequently, problems and issues, and misunderstanding among relevant workers in the field, particularly in the public health sector and provincial administrative organization. Dealing with these issues in a timely manner could potentially lead to reform and improvement of the system by implementing recommendations from this study.
Diagnosis and proper management of latent tuberculosis infection (LTBI) are important components in reducing the number of patients and deaths from tuberculosis (TB). The diagnosis of LTBI using the interferon-gamma release assays (IGRAs) to detect interferon-gamma in bloods sample has advantages over the tuberculin skin test (TST), but the currently used test kits are expensive and require enzyme-linked immunosorbent assay (ELISA), making it complicate and unsuitable for a district or provincial laboratory use. The QIAreach QuantiFERON-TB (QIAREACH-TB) is a novel blood-based test that uses lateral flow immunoassay (LFA) and digital fluorescence signal measurement to detect interferon-gamma. This study aimed to evaluate the QIAREACH-TB for the diagnosis of LTBI using a whole-blood sample compared to the QuantiFERON-TB Gold Plus (QFT-Plus). Blood samples were collected from 154 healthcare workers (HCWs) and tested for LTBI using the QFT-Plus and QIAREACH-TB. The results showed that the overall percentage agreement (OPA; accuracy) between the QIAREACH-TB and QFT-Plus was 93.46% (95% confidence interval [95% CI]: 88.31-96.82), the positive percent agreement (PPA; sensitivity) was 88.46% (95% CI: 69.85-97.55), and the negative percent agreement (NPA; specificity) was 94.49% (95% CI: 88.97-97.76). In conclusion, the QIAREACH-TB has high agreements with the QFT-Plus, but requires fewer laboratory resources and does not require ELISA, thus making it allows for the expansion of efforts to detect individuals with LTBI following the national TB control strategy.
Dengue disease is an important problem in global public health. Annually, 390 people are infected with dengue virus. The majority of infections results in asymptomatic cases. For symptomatic cases, patients will develop either mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF). DF is a self-limiting disease meaning the patients will recover within 4-7 days without any significant intervention. However, DHF patients will eventually develop plasma leakage which may progress into potentially fatal hypovolemic shock known as dengue shock syndrome (DSS) without prompt and adequate fluid management. Dengue disease is caused by dengue virus which belongs to the genus Flavivirus. There are four serotypes of the virus including dengue virus 1, 2, 3 and 4. The virus is transmitted by Aedes mosquitoes. There is no antiviral drug against dengue virus and the only available vaccine has limited efficacy and elevates the risk of hospitalization from dengue disease in seronegative vaccines. Dengue infection is usually confirmed by assaying patient’s blood obtained by invasive procedures, such as venipuncture or fingertip pricking. Qualified personnel are required to effectively and safely collect and process blood specimen. In addition, the blood specimen processing is usually costly in terms of budget and personnel. However, previous studies reported the presence of dengue virus, NS1 protein, and anti-dengue virus antibodies in non-invasively obtained clinical specimens such as saliva and urine. Recently, oral fluid was interestingly used for detecting anti-virus antibodies and virus genomes for HIV, hepatitis viruses (HAV, HBV, HCV). We believe oral fluid specimen could be an alternative for study dengue virus. Oral fluid is non-invasively obtained so the specimen collection and processing are inexpensive and simple. Minimally trained personnel should be able to collect, handle and process oral fluid specimen safely and effectively. In addition, oral fluid could be obtained from people in the household or workplace of the index case to capture asymptomatic dengue cases. Therefore, we tested whether oral fluid specimen could be used to detect virus genome, NS1 protein and anti-dengue IgM/IgG. We also compared the accuracy for assaying oral fluid specimen to that of blood specimen. Consequently, we evaluated whether oral fluid could be an alternative to blood specimen. We found that although viral genome and NS1 antigen were rarely detected in oral fluid, anti-dengue IgM and IgG were dramatically detected for 3 day of illness and still completely detected until 1 -2 months after illness. Efficiency of anti-dengue IgM and IgG detection in oral fluid specimens was not statistically different with plasma specimens after analyzed by Fisher’s exact test. Thus, oral fluid could be a suitable specimen for screening of asymptomatic infection in dengue season or screening of immune response after vaccination.
Introduction: Transgender people are well recognized in Thai society nowadays and need specific care. There are challenges in the transgender medical health system in Thailand. Aims: This study aims to assess the current situations of a transgender health care service from providers' and patients’ perspectives and to evaluate the effect of a gender-affirming hormone therapy on health in general, mental health and sexual transmitted diseases in order to provide recommendations to improve the transgender medical health system in Thailand. Methods: The study is divided into 4 sub-studies. The sub-studies 1, 2, and 3 assessed the effects and complications from hormone therapy on general health, HIV and sexually transmitted diseases (STI), and mental health among Thai transgender people. The sub-studies 4 assessed the current situation of the health care system through panel discussions. Results: The hormone therapy effectively induces body changes in all transgender people. Complications in transgender men include elevated systolic and diastolic blood pressure, elevated uric acid levels without gouty attack, elevated hematocrit levels, and a decline in the glomerular filtration rates. There is no effect on liver function and blood sugar. In transgender women, decreased blood pressure was found without adverse effects on liver function, blood sugar, uric acid, and lipid profiles. There is no HIV or STI in this study. However, there is a low rate of protection in sexual activity among transgender men, and hepatitis B immunity is low among transgender people. Regarding mental health, there is a trend of higher depression and anxiety scores but improved gender dysphoria, attention deficit, and internet gaming disorder scale. The assessment of the current Thai transgender health systems demonstrated several barriers and challenges from providers' and patients’ perspectives. The main issues include unsupported laws involving the fundamental right, discrimination, access to medical care, health care insurance regarding gender-affirming treatment, funding for developing transgender clinics, education for medical providers, mental health care, health data gathering, lack of support for the transgender community and transgender law. Summary: Transgender people have specific physical and mental changes with gender affirming hormone treatment. Most are consistent with international data, apart from the minimal decrease in depressive and anxiety scores, which should be monitored closely. The medical professional should recognize the changes along the treatment process. Several barriers in transgender care are present from providers' and patients’ perspectives. Therefore, a strategy supporting the development of transgender clinics should be designed to ensure that transgender people receive high-quality care without discrimination.
This research and development project on Massive Open Online Course (MOOC) for teachers and carers of children under 3 is to create a set of online courses for teachers and caregivers of children under 3. This set of online courses is designed to raise awareness about the importance of nurturing infants and young children, aged between 0-3 years, a critical period that requires fostering and instilling a stable and appropriate foundation for life. The project aims to 1) upskill and reskill teachers and caregivers of early childhood development institutions accepting children under the age of 3 by creating MOOC courses, 2) evaluate the effectiveness of the created courses in the development of teachers and caregivers of early childhood development institutions, and 3) assess the efficiency of MOOC in teaching and training. The main target groups used in this study were teachers and caregivers of early childhood development institutions and students in the field of early childhood education. Evaluation of course effectiveness was conducted in three key areas: learning, reaction, and attitude. The assessment of the efficiency of MOOC was achieved by analyzing learners’ video clip traffic, because video clips are the most important medium of MOOC courses. The results showed that assessment of the learning and reaction effectiveness of the MOOC courses yielded markedly positive results. As for the attitude, there was no difference between before and after learning the courses. In the evaluation of the efficiency of the MOOC system, it was found that creating learning content in the form of video clips should be made into a short clip. Each clip should not exceed 5 minutes. This set of courses can be revised and expanded to develop into a non-degree program, as they are licensed under Creative Commons CC: BY-NC-SA.
Background: In addition to the economic evaluation and budget impact information of dialysis in patients with end-stage renal disease (ESRD) obtained from sub-project 1, social impact and problems related to dialysis would be very useful information which can be applied as evidences for policy decision making. Objective: To study the social impact and problems related to dialysis in patients with ESRD using (1) continuous ambulatory peritoneal dialysis (CAPD) (2) CAPD using icodextrin one cycle per day of icodextrin plus glucose (CAPD+ICO) and (3) automated peritoneal dialysis (APD) methods as well as in all stakeholders providing care for ESRD patients. Methods: This study applied a mixed method which quantitative data of all patients participating in sub-project 1 were collected using a self-administrative questionnaire and qualitative data were obtained using in-depth interviews and focus group discussion among patients/relatives, healthcare personnel in service units related to dialysis services for ESRD patients. Results: According to the results of surveys using questionnaires, it was found that ESRD patients were relatively well equipped with reagent storage sites. In addition, CAPD patients undergoing peritoneal dialysis had more limitations in their daily lives than those receiving APD, however, there was no statistically significant difference. CAPD+ICO dialysis patients were reported to be statistically significantly more complicated than APD and CAPD dialysis. This may be due to a shorter pre-dialysis period for patients undergoing CAPD+ICO dialysis (51.9 months) than those undergoing CAPD (65.3 months). Most ESRD patients receiving APD reported that the absence of fluid during the day resulted in feeling better and more independent to the greatest degree. For patients undergoing CAPD+ICO, icodextrin was found to improve hyperhydration and decrease fatigue. Conclusions: APD is appropriate for pediatric patients, working adults, people who cannot perform dialysis during the day and old people who are unable to do dialysis on their own, but will have a caregiver to do it. However, if APD is included in the benefit package, the expansion of services with APD will require more healthcare personnel, especially peritoneal dialysis nurses and training. The system should be developed in conjunction with the service provider to provide an efficient service system for providing services to the patient.
This research aimed to study the policy proposal for monitoring and evaluation of the Sub-district Health Promoting Hospital (SDHP) where have been transferred to Mahasarakham Provincial Administrative Organization (MPAO). The mixed methods research was conducted in 2 phases. Phase 1 was a survey in 500 samples and phase 2 was action research. The target samples were the stakeholders from 175 settings of Health Center in Honor of His Majesty the King’s 60th Birthday Nawamintrachini (HCN) and the SDHP. Data was collected by questionnaires, focus group discussion and commenting record. The results reveled factor affected the health service following the six building blocks of health system framework. The factors related the health services significantly were married status (p-value<0.001), work position (p-value=0.019), committee (p-value=0.023), and information sources (p-value=0.024). The factors affected the monitoring and evaluation of the HCN and the SDHP who transferred to the MPAO statistically significant were transferring (p-value=0.027), personal transferred status (p-value=0.006), gender (p-value=0.014), married status (p-value<0.001), education (p-value=0.0043), work position (p-value<0.001), work type (p-value<0.001), and training experiences (p-value=0.001). The comparing between a transferred group and a non-transferred group found the statistically significant difference (p-value<0.001) in the improved health, the responsiveness and the improved efficiency. The policy proposals will be implemented in 4 domains. First, the improved health domain should involve all stakeholders participate in the evaluation. The format depends on each district and should have a sharing forum. The first phase should evaluate the people impacts rather than outputs, according to the changes of health service system. Second, the responsiveness domain should select the indicators which can be performed under the situation of transferring to the MPAO. Third, the social and financial risk protection domain should monitor and evaluate the health impacts covering manpower, materials and network coordination. The facilities should be flexible for good health services. Lastly, the improved efficiency domain should increase the human resources for the effective coordination and performance. The assessors for the monitoring and evaluation should be the delegates of the health networks of the Ministry of Public Health, Provincial Administrative Organization, and stakeholders. The manual should be development for assessing guideline and improving performance.
From the Ministerial Regulations on Government Divisions in the Office of the Permanent Secretary Ministry of Public Health 2017 stipulates that the Office of the Permanent Secretary Has a mission regarding strategic development and transforming the Ministry's policies into government action plans, as well as allocating resources and administering the ministry's general affairs. In order to achieve the goals and achieve the missions of the Ministry which covers management transfer the policy drive to personnel both in the central and provincial areas. By the Office of the Permanent Secretary, there are driving agencies divided into 16 centrals administration agencies, 2 provincial administration agencies, and 17 internal agencies. However, from changes in the context of the economy, society, environment, and various policy issues affecting the structure of the Permanent Office at present. Some of which may be similar to the roles of existing divisions of government or there may be unclear while some parts have changed according to policy causing the work of some agencies to be established within some parts may be inconsistent with what is being done at present In this regard, the results of the analysis of the roles and structure of internal agencies under the Permanent Office led to the proposed structure, which was divided into 4 central administration agencies directly under the Ministry of Public Health, 15 central administration agencies, 1 central administration agencies located in the region, 2 provincial administration agencies, and 5 internal agencies. It is proposed to divide into 1 independent agency and dissolve 1 agency. In addition, it is proposed to analyze the context and roles of agencies under the structure of the Permanent Secretary on a regular basis, such as every 5 years in order to be consistent with changing contexts, including requiring that the establishment be assessed internally every year.
Common illness is the most symptoms sickness in people. Since they are less severe and less complicated, people could do initial selfcare to recover from these symptoms. Receiving services at drug stores is therefore an option for people. This is the first study to estimate the cost savings of common illnesses that cover 16 symptoms as announced by the National Health Security Office (NHSO) in conjunction with the Pharmacy Council in the new Common Illness pharmacy project at drug stores to cost of Thailand's health system. This study gathered retrospective secondary data from several studies those reported the number of visits for treatment 16 symptoms common illnesses, direct medical costs direct nonmedical costs, and indirect costs. The cost of illness of treatment for 16 symptoms common illnesses at a pharmacy compared with outpatient treatment at a hospital from 3 perspectives: government perspective, patient perspective and social perspective were estimated. This study assumed that patient is responsible for cost of drug and health care services. The average number of hospital visits of treatment for 16 symptoms common illnesses was 2,356 visits per month. The first most 3 symptom groups that patients received services were sore throat, fever, and abdominal pain. The average number of hospital visits were 529, 442 and 394 visits. The estimation of the cost savings of treatment for 16 symptoms common illnesses at drug stores to cost of Thailand's health system from 3 perspectives including government, patient, and societal at tertiary care hospital were 446 – 683, 665 – 901, and 742 – 927 Baht per visit, respectively. When calculating from the amount of service received in a year, it was found that the average cost saving per year were 16.49 – 25.23, 24.56 – 33.30, and 27.39 – 34.26 million Baht, respectively. At secondary care hospital, cost saving per visit were 212 – 448, 430 - 667, and 507 - 692 Baht, respectively. Cost saving per year were 7.81 – 16.56, 15.88 – 24.63, and 18.72 – 25.58 million Baht, respectively. In conclusion, every 1 Baht reimbursed for treatment 16 symptoms common illnesses at drug stores will save additional costs in Thailand's health system if people choose to receive treatment services for 16 symptoms common illnesses at drug stores instead of receiving outpatient services from tertiary care hospitals saving ranged from 1.41 – 8.58 Baht and secondary hospitals savings ranged from 0.67-5.63 Baht. This savings comes from the fact that people do not have to take time off work to wait for receiving health care services at the hospital. It can be concluded that the treatment for 16 symptoms common illnesses at drug stores can clearly save costs.
Genetic testing for identifying genetic factors underlying diseases or their correlations with disease development is widely used in medical research. It can be employed to search for elusive disease-causing genes or genes contributing to complex diseases, leading to treatment and prevention strategies. The concept has been applied to investigate the causes of sudden unexplained nocturnal death within the young population, particularly in Thais. Studying the exome of deceased individuals is valuable for identifying potential gene factors that may be related to or responsible for their demise. Previous studies have focused on single gene, such as those associated with channelopathies related to sudden cardiac death. These genes were found to be interconnected and systematically organized. However, due to the unique nature of sudden unexplained nocturnal death, the causative factors might differ from the previously studied groups. This forms the basis of the current research. In this study, blood samples were collected from a sample group of 98 deceased individuals and 2 deceased relatives. Comprehensive genetic analysis was performed on whole exomes study. The results were then compared against medical databases and classified according to bodily systems, such as the cardiovascular system, nervous system/brain, and metabolism. The study presents genes identified within Thai population, categorized based on various factors that could potentially contribute to their demise. Additionally, novel genes were discovered, both within the nervous system and brain, as well as the cardiovascular system, which could be significant contributors to fatalities.