plueme/wizJson huggingface dataset:
This research and development aims to study current situations and associated factors of health
management and needs for model development in health management among the Thai-Melayu elderly
living in the South of Thailand. The participation action research (PAR) was conducted using qualitative
and quantitative research. The sample of 149 participants recruited into the study were 33 elderly people
being diagnosed with hypertension, 33 care givers of those elderly, and those who involved in the care
for those elderly including 2 health public officers taking care of the patients with hypertension, 3 health
public offices working for the Sub-district Administration Organization (SAO), 3 political members of SAO,
20 religious leaders, 10 village leaders, and 45 village health volunteers. The interviews and focus groups
were used for collecting. The content analysis was used to analyze the qualitative data.
Finding revealed that the needs and community participation in health management in Thai-
Melayu elderly with hypertension included; 1) religious leaders providing health education for the elderly
people, 2) visiting home by the religious leaders to encourage the elderly patients, 3) health education
for the community to reduce sweet, salty, and fatty foods 4) providing the place for exercise, 5) setting-up
the home visit system by village health volunteers , and 6) having a village leader to carry-on the
activities for elderly in the community.
Based on the qualitative data, the researchers developed the guideline to promote health
management among the elderly having hypertension and found that post intervention, the average score
of health management, at higher level, (X = 4.30 S.D = 1.08) was higher than that of pre-intervention
(X = 3.87 S.D = 1.21), at the same higher level. However, it also discovered that the lowest average scores
were found in the following dimensions: reducing high fat diet, and deep-fried foods or stir-fried meals
X= 2.4 S.D= 1.29, X= 3.26 S.D = 1.46, respectively.
The results showed that after receiving health management the systolic blood pressure (SBP) and
diastolic blood pressure (DBP) were also significant lower than pre-receiving the health management at
the level of P< 0.001 and P< 0.05 respectively but there was no significant difference in body weight,
waistline, and body mass index (BMI).
The devolution of health centers to Local Government Units (LGUs) in Thailand has been one of the many tools that the Ministry of Public Health (MOPH) used in its healthcare decentralization policy. Fifty-one out of 9,787 health centers have been devolved since 2007. This study aimed to (1) understand devolution process; (2) evaluate outcomes of the devolution; (3) analyze strengths, weaknesses, enabling factors, and threats of the devolution of health centers in Thailand and (4) make policy recommendations on the provision of primary health care that fits with the Thai context. The study employed qualitative and quantitative approaches consisting of literature review, data analyses of four selected quality indicators and self-administered questionnaires by health personnel at devolved health centers, in-depth interviews and focus-group discussions in four representative provinces.
The study showed that the rates of screening for diabetes mellitus, hypertension, and cervical cancer in devolved health centers were lower than those in non-devolved health centers (p-value = 0.0400, 0.0438, and 0.0000 respectively). The analysis found no statistically significant result for the rate of early access to antenatal care (p-value = 0.1974).
The findings from 41 questionnaires suggested that budgets, medical supplies and equipments, and facilities in devolved health centers were sufficient although some health centers still lacked adequate health personnel. Some devolved health centers could extend the range of their medical services. 75.61 percent of the respondents reported that quality of care and responsiveness were improved after the devolution. The short chain of command between LGUs and devolved health centers could contribute to less bureaucratic management but might also involve local politics. Although the relationship between devolved health centers and Public Health Organizations remained close after the devolution, only 19 devolved health centers reported to have routine audit by Public Health Organizations. Seven respondents indicated they would prefer to move back to MOPH. Lastly, it was reported that the devolution process lacked the participation from people and frontline health personnel.
Successful healthcare decentralization requires clearer devolution policy and supportive laws and regulations from the government. The MOPH should maintain its roles of supervision and regulation in all devolved health centers and collectively address any arising challenges with the LGUs. The devolution of health centers should maintain within the LGUs with sufficient capacities and people participation must be strongly promoted.
Objective To study the prediction of pre-eclampsia in advanced age pregnant women by using  of uterine artery Doppler combined with serum sflt-1,PlGF and PAPP-A. Method The prospective collective data study was conducted at antenatal care clinic Thammasat University Hospital. The pregnant women with age above 35 years old with  gestational age between 18-24 weeks were recruited. The clinical risk factors were recorded. Uterine artery Doppler was performed at the same time with measurement of  serum markers. The occurrence of pre-eclampsia and obstetrics outcomes were followed and recorded. All data was analyzed. Results The total enrolled pregnant women were 296. Only 276 pregnant women have  complete  information to analyze.  5.43 percent (15 pregnant women) had pre-eclampsia while 94.57 percent (261 pregnant women) had no pre-eclamptic symptoms. The baseline characteristics of both groups including age, body weight, body mass index, parity and history risk of pre-eclampsia were not statistically significant different. In pre-eclamptic group has higher percentage of  abnormal uterine artery Doppler compared to non pre-eclamptic group (26.67%, 4/15 vs 16.48%, 46/261) but no significant different (p= 0.31). The ratio of sflt-1/PlGF in pre-eclamptic group were higher than non pre-eclamptic group ( 8.60 +4.79 vs 8.09 + 5.24) but no statistically significant different (p= 0.71). MoM( Median of mean )  of PAPP-A in pre-eclamptic group was  less than  non pre-eclamptic group but there is also no statistically significant. The logistic model was generated to predict  the risk ratio of pre-eclampsia. The abnormal uterine artery Doppler has risk ratio (RR) 1.78, while the ratio of sflt-1/PlGF above 14 has RR  2.54. The MoM of PAPP-A less than 0.5 has RR  2.5 , respectively. Combination of these factors has prediction value for prediction 64.62%. Conclusion The combination of these factors could not be used  to predict the occurrence of preelcampsia in advance age pregnant women . However, the  incidence of preeclampsia in our study was lower than expectation , the larger sample size might be needed to verify this benefit.
Objectives: Peripheral arterial disease (PAD) in diabetic patients is associated with high morbidity and mortality. The mortality rate in such patients is 56.5% in 3 years follow up period in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Therefore the incidence and predictive factors to determine the major adverse cardiovascular event (MACE), which composed of non-fatal myocardial infarction, non-fatal stroke, worsening PAD and death is of paramount important. Researchers aimed to explore these outcomes in our population. Method: 500 diabetic patients with being diagnosed as PAD between May 2014 to February 2017, were followed up in 30 months to determine MACE. The potential clinical predictors were entered into a Cox proportional hazard model with backward stepwise regression was performed. Researchers also evaluated the adequacy of treatment by assessing the risk factor control for atherosclerosis. The target of the risk factor control for atherosclerosis has been using the criteria of American Heart Association (AHA) and the Royal College of Physicians of Thailand. Result: During a mean follow-up of 30 months period, 81 MACE events occurred, corresponding to incidence rate 16.20, (95%CI 13.10-19.70). The number of death was 59 patients. The predictive factors, that were significantly associated with MACE, were history of chronic kidney disease (Hazard ratio (HR) 2.09, 95% confidence interval (95% CI) 1.24-3.52), myocardial infarction (HR 1.98, 95% CI 1.06-3.71), the history of gangrene or chronic ulcer or obtaining of revascularization in the legs (CLI) (HR 2.50, 95%CI 1.53-4.08), history of aortic surgery (HR 20.31, 95%CI 4.49-91.82), history of carotid stenting (HR 9.20, 95%CI 1.13-74.71), patients with history of taking warfarin (HR 2.83, 95%CI 1.19-6.72). In terms of risk factor control for atherosclerosis management, patients had reach the target in majority (>50%) only in the control of diastolic blood pressure (71.93%) and stop smoking (92.26%). Conclusion: The incidence of MACE was 16.2%. The predictive factors for high MACE in the 30 months follow up in diabetic patients with PAD was chronic kidney disease, myocardial infarction, history of CLI or history of obtaining revascularisation, history of aortic surgery, history of carotid stenting, patients with history of taking warfarin. This may be used to identify high-risk patients for MACE to assist optimize medical treatment to increase life expectancy and to decrease vascular event. There were still a large gap of improvement for risk factor control in atherosclerosis management.
The policy of Ministry of Public Health states that all hospitals under MOPH should establish Chronic Kidney Disease Clinics (CKD clinics). This study aims to evaluate the implementation of CKD clinics using mixed method research and the CIPP model. Results from 140 hospitals in 12 regional service providers showed that 70.71% of established CKD clinics in line with MOPH policy, while 22.14% already had CKD clinics prior to the MOPH policy statement, and the remaining 7.14% hospitals had not developed CKD clinic citing limitations due to area, personnel or budget. In total, 82.31% established sole purpose CKD clinics providing at least one day per week, but occupied the space used by other clinics. Whereas 17.69% did not separate CKD clinic from other health clinic and ran CKD services in parallel to other clinics. For example, some centers had a ‘CKD corner’ as part of their regular DM/HT clinic. In terms of the hospitals that had implemented CKD clinics, 44.62% of centers used both consultative meetings and two ways communication about policy, goals, future plans of CKD clinics to all health personnel and other stakeholders. Whereas, 27.69% used only two ways communication to realize policy, goals and planning of CKD clinic to among interested parties. The remaining 3.08% hospital used no clear consultative process in developing their clinics. Almost all hospitals reported that the supporting budget for CKD clinic was insufficient. Most hospitals (63.21%) funded the establishment of their CKD clinics from their own operating budgets and some fund support from National Health Security Office (NHSO). In terms of human resource, 58.46% have professional team (full) including physician, nurse, pharmacist physical therapist, and nutritionist or Dietitians. However, we found that 20.77% of hospital did not have funded position for nutritionists and in this cases, the advice about nutrition was provided by nurses. All hospitals with professional nutritionists funded this position of their own accord with temporary employee’s position. In addition, 95.38% of all hospital had implemented and maintained CKD patient databases, but only 42.31% of these contained all recommended clinical measures such as Serum Cr and eGFR, blood pressure, blood sugar, take ACE-I or ARB drug, and urine protein. For the most part, patient data were not utilized to track patient disease progression. Most personnel reported the reason for not using routine CKD patient data to gauge patient disease progression and outcomes was excessive workload. In general, CKD patient data was mainly used to report CKD’s KPI to the Ministry of Public Health.
Thailand is one of the 14 listed countries encountering TB, TB/HIV and MDR-TB burden. Poor adherence could cause longer treatment, drug resistance, relapse and death in TB patients. With limited-resources, the coverage of Directly Observed Treatment, Short Course (DOTS) is low. Most of TB patients are under self-medication or family-member DOT, which a forgetfulness to take medicine or an improperly early medicine discontinuation caused by side effects or etiological misunderstanding may exist. Most of adherence measurements performed at a next follow-up, not at real-time, is considered as an end point.  Hence, TB/HIV Research Foundation has developed a CARE-call system, an ICT-based medication adherence monitoring system having an electronic pill box (CARE-box) to further function by alarming patients to take medicine, notifying a health care worker (HCW) to follow up a non-adherence patients and providing two-way communication for the patients seeking for advice from the HCW. In order to evaluate the system’s effectiveness, 300 TB patients were randomly recruited into intervention or control group. Preliminary result obtained from treatment-outcome available participants showed that statistically higher adherence rate was observed in the intervention group while treatment success rate is at 88.2%, higher than the 85% NTP target and lost to follow-up cases were found only in the control group. The CARE-call system was proved to achieve its two-way communication function under around four-time lower per capita cost compared to that of the DOT supported by the global fund. Qualitative study remarked the benefits of CARE-call system through the CARE-box including alarming system, daily pack, two-way communication by meeting the satisfactions of the all the participants invited to attend focus group discussion. From the result, it is believed that the CARE-call system could improve the TB patient’s medication adherence and provide two-way communication at low cost, which is more suitable for a high TB burden country like Thailand to achieve the NTP targets for treatment success and loss to follow-up rates. However, the stability of CARE-call should be improved and provide more useful functions to facilitate the TB treatment and care.
The main objective of this project was to develop a cost effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. An android-based screening application was developed. The screening protocol involved asking the child to pick pictures corresponding to the set of predefined words heard at different sound levels offered in a specifically designed sequence. For screening purposes, the developed screening system was 100% sensitive (95% CI = 83.18% to 100%) for children with speech reception threshold (SRT) or pure tone average threshold > 25 dBHL, with a specificity 0f 79.44% (95% CI = 70.83% to 86.01%). The time taken for screening of each child was less than 2 minutes on average, compared to 12 minutes required in normal procedure.  Also, to explore other options that could suit a variety of resource settings, the secondary objective was to implement and evaluate standard pure tone audiometric measurement and tele-audiometry functions on the tablet-based system.  It was found that, with additional hardware to increase the dynamic range, function-wise both could successfully be realized. However, due to calibration difficulties especially for the bone-conduction audiometry, accuracies were found to be less than those measured with standard audiometric equipment. Still, the results were encouraging enough to warrant further research and development on this.
Border health care is a complex situation, and is becoming even more so due to the differences of socio-cultural, political-economy, and geographical context. Notably, Thailand is the heart of Southeast Asia and bordered by Myanmar, Cambodia, Laos, and Malaysia. The movement of people has been thus far featured across the border seeking the health care in Thailand which is referred to as, ‘border health’. Each year, the number of people from neighboring countries across border to receive health care in Thailand has been increasing. This study aims to explore border health care situation in 3 provinces – Ubon Ratchatani
(Thai-Lao border); Sakew (Thai-Cambodia border); Tak (Thai-Myanmar border) using qualitative research methods – in-depth interview, participant observation, and focus group discussion. The participants are divided into three groups: policy makers, health professions and NGOs, and patients who crossing borders seeking health care in Thailand. This study shows that social determinants – geography, politics, health service, belief, culture, networking and social supports. Moreover, due to the politics of neighboring countries, the Thai health services in border areas must adopt different approaches of health surveillance system. The public-private partnership between the government and NGOs enhances the effectiveness of border heath care system.
This Research and Development research focused on developing the model of Participation Health Public Policy for the Elderly Care Fund in the community at Northeastern of Thailand (E – San) by community participation process. Data were collected by using both qualitative and quantitative methods including survey, observation, in-depth interview, focus group discussion, and documentation reviews. The participants consisted of 11,109 elders, 660 elderly caregivers, 15 elderly care managers, 264 involved people, and 28 observation participants. Data were collected from October 2016 to November 2017 and were analyzed by using content analysis, percentage distribution, 95%CI, and McNemar Test. The study found that: 1) the situation of long-term dependency care needs of in the elders had a prevalence of dependence in the elders 14.14% (95% CI 13.5 - 14.8), with dementia 15.20%. (95% CI 14.6 - 15.9). Only 43% of dependent elders had accessed to long-term care benefits which was followed the long-term care fund policy in the pilot area. The major obstacles were the problem of inadequate provision of personnel to local government organizations and the burden of care manager. 2) The process of driving long-term care policy into public policy to create public participation in elderly care consisted of 3 components: community involvement, creating knowledge for public policy of long term care, and integrating with the policy-making agency in the area that could lead to the public policy to practice in the area. 3) The community participation increased in every componence. This enabled the long-term care fund to be implemented and encouraged the elders with dependency be accessed to long-term care services increased significantly (p-value <.001). The quality of life of caregivers was also improved significantly (p-value <.001). However, it was found the level of disability was no statistically significant difference in the elderly who received care services under long-term care fund before and after the study. Long-term dependence is a problem and long-term care needs in the elders. Health Public Policy of the long-term care for the elderly is a social movement for the cooperation of network partners, especially local governments and primary health care, to drive important government policies, that can lead to practice in the area. This will lead to the development of long-term care for the elders in the community to support the elderly society in the future.
Purpose: To study pattern of tremor symptoms in Parkinson’s disease patient for differential diagnosis from other symptoms, including related movement disorder and study measure parameters of tremor and create the system to collect the data with wireless internet. Method: This study particularize 2 periods 1) To develop assisted device for detect tremor symptoms, including tremor assessment device with tremor analysis software and spiral drawing 2) To enroll population who have tremor symptom 100 sample and manufacture 40 device give to 20 hospital for test this device. Results: This study during in period 1, to design and develop tremor device for diagnostic and monitoring patients with Parkinson's disease. This device include hardware that can detect accelerometer 3 axial and gyroscope 3 axial and tremor analysis software that show angular rate, angular rms, peak rate, peak frequency and other parameters and can save the data by notebook or android technology. Tremor device was designed modern form, small sensor board as a wristwatch and can take pulse rate. This device can set time to test. In part of the signal made stably and reduce to send error signal. Conclusion: In the part of develop tremor device in episode1 and 2 focus on practical use of medical device, that save the data from user and have to design with regard to available use in daily, safety , smart and technology is more modern.
Cell sheet technology is applied to human articular chondrocytes to construct a tissue-like structure as an alternative treatment for cartilage defect. The effect of a gelatin manipulator, as a cell sheet transfer system, on the quality of the chondrocyte sheets was investigated. The changes of important chondrogenic markers and stress fibers, resulting from the cell sheet manipulation, were also studied. The chondrocyte cell sheets were constructed with patient-derived chondrocytes using a temperature-responsive polymer, and a gelatin manipulator as a transfer carrier. The properties of the cell sheets including sizes, expression levels of collagen type II and I, and the localization of the stress fibers were assessed and compared with those of the cell sheets harvested without the gelatin manipulator. Using the gelatin manipulator, the original size of the chondrocyte cell sheets was retained with abundant stress fibers and a decrease in the expression of collagen type II. Without the gelatin manipulator, although the cell shrinkage occurred, the cell sheet with suppressed stress fiber formation showed significantly high levels of collagen type II. These results supported that the changes of the stress fiber formation in the chondrocyte cell sheets affected the production of the chondrogenic markers. The densely packed tissue-like structure possessed a good chondrogenic activity, indicating its potential use in autologous chondrocyte implantation to treat cartilage defects. One of the challenges in cartilage tissue engineering is the maintenance of the chondrogenic activities during long-term culture. To overcome this problem, we proposed a new culture surface using the fifth generation dendrimer-immobilized surface (G5). Chondrocytes cultured on this surface formed various aggregates, providing desirable three-dimensional structure that closely mimicked the native environment of chondrocytes. As a result, higher chondrogenic markers (collagen type II and aggrecan) with lower de-differentiation marker (collagen type I) were observed in the cells on G5 surfaces as compared to those cultured on traditional polystyrene surfaces. This new surface would be beneficial for chondrocyte cell sheet engineering in our future study.