plueme/wizJson huggingface dataset:
Objectives: To study the proportion, patterns, and factors associated with inappropriate antibiotic prescription (IAP) in acute upper respiratory tract infection (ARTI) at the Student Health Center (SHC), Prince of Songkla University (PSU). Methodology: A descriptive retrospective study was conducted by reviewing medical records from the hospital information system (HIS) of Songklanagarind Hospital. Seven hundred and thirty ARTI patients, who met inclusion criteria at the SHC, PSU from 1 January to 30 September 2018 and diagnosed with common cold, acute pharyngitis, and acute tonsillitis under the ICD10 code. Four hundred and thirty-four patients were excluded after medical record review. Descriptive and inferential statistics were employed in the data analysis using the R® 4.0.0. software program. Associations were evaluated via odds ratios with 95% confidence intervals. The level of statistical significance was set at p<0.05 using multivariate analysis. Results: Two hundred and ninety-six participants were enrolled in the study. The proportion of antibiotic use in ARTI was 17.2% (51 of 296). Among antibiotic prescriptions, the proportion of IAP was 80.4 % (41 of 51). The patterns of IAP were as follows: no antibiotics indication 90.2% (37 of 41), wrong duration 26.2% (11 of 41,—a 5 day amoxicillin therapy was the most common 27.2%), and wrong dose 12.2% (5 of 41,—all received amoxicillin in the dose of 2,000 mg/day). The multivariate analysis demonstrated that factors significantly associated with IAP were being a patient with an underlying disease (adjusted OR=4.22, p=<0.001) and a nurse practitioner as prescriber (adjusted OR=10.93, p=<0.001). Conclusion: Antibiotic prescriptions in ARTI at the SHC, PSU did not exceed the 20% rate set in the rational drug use hospital policy for antibiotic prescription criteria. Nevertheless, the proportion of IAP among ARTI patients was high, and the most common pattern was prescribing antibiotics without an indication. Therefore, future research should focus on how to enhance the adherence to antibiotic prescription guidelines to promote appropriate antibiotic prescription, especially among nurse practitioners.
Background and rationale: Having sufficient physical activity (PA), as recommended by the World
Health Organization, is necessary for developing motor skills and physical fitness of children and youth
and reducing risks of non-communicable diseases when entering adulthood. Over the past years, there
has been a large amount of research and development of PA knowledge in Thailand, but the research
gaps and clear directions for future research have not been analyzed and identified. Objective: To
investigate research topics conducted in the past and identify research gaps in PA among Thai children
and youth aged 0-22 years and provide future research suggestions. Methodology: This study applied a
systematic review by searching research articles from Thai and international databases. The review
included studies on PA in Thai healthy children and youth aged 0-22 years written in Thai or English and
published during 2009-2019. The quality of the studies was assessed using a standard checklist. Descriptive
statistics and content analysis were used for data analysis. Result: A total of 79 studies were qualified
and included in the review. The least age groups represented in the review were children aged 0-5
years (1.3%). There was a low number of studies in the areas concerning the association between PA and
cognitive functioning, physical environment, and sociological-cultural factors. Areas that had not been
investigated were the associations between PA and mental health, socio-economic status, and technology
for promoting PA. Recommendation: Researchers should consider conducting studies that have
been identified as gaps of the research in this field to provide comprehensive information for the development
of policies and programs to encourage Thai children and youth to have sufficient PA and adopt
PA as part of their lifestyle.
Background: Extending social insurance to informal employment has become a goal among international and national authorities. For Thailand, the voluntary social security scheme under Article 40 (A40) of the Social Security Act covers only seventeen percent of the total informal workers of 20.4 million. Many studies had identified factors relevant to the enrolment and renewal of voluntary social health insurance scheme. Thailand can learn and use the existing research findings from international perspectives to improve the coverage of voluntary social security scheme continuously and efficiently. Methodology: Searches of electronic databases from Google Scholar, PubMed, ThaiJo and ThaiLis were conducted. Studies that aimed to identify factors associated to the enrolment and renewal of health or social insurance, A40, and the National Saving Fund (NSF), written in English and Thai were included for the analysis. Key results: Ten studies were included in this review. The included studies reported demographic factors, education, occupation, income, knowledge and understanding of the scheme, quality of services, health issues, benefit package adequacy, and socio-cultural factors as significant determinants of the enrolment in a voluntary health insurance scheme, the A40, and the NSF. Conclusion: The present study provides evidence on determinants of the enrolment in a voluntary health or social insurance scheme that applicable to the Article 40 of Thai Social Security Act. Strategies should be developed with consideration of those significant determinants to increase the coverage and sustainability of the scheme.
This study aims to explore the MDR-TB spreading in an outbreak area of Thailand. A crossectional study is carried out to determine bacteria and host genetic factors relate to MDR-TB infection in patients and their contacts, epidemic process, and treatment outcomes. The sample population including MDR-TB patients who were registered at Makarak hospital between 2014 to 2019. A total of 205 MDR-TB isolates were sequenced and a total of 352 MDR-TB contacts from 152 MDR-TB patients were enrolled in this study. A total of 205 MDR-TB isolates were sequenced, 88.8 % of these were MDR-TB cases, while the other 4.4 % and 6.8% were pre-XDR-TB and XDR-TB respectively. The result of whole genome sequencing and SNPs analysis showed 4 lineages(L) of the MDR-TB genotype in this study, including L1, L2, L3, and L4. L2 of Beijing strains (L2-Beijing) was the most common genotype and 77% of the L2-Beijing genotype belonged to the sub-lineage of Asia African3 (AAF3). When we considered the number of SNPs different among AAF3 genotype, found that 34.1 % of those were clonal. And found that, patient with DM is more likely to be in a group of clonal MDR-TB than without DM. Of 352 MDR-TB contacts, 71.3% were household contacts, 64.1% were working for the age group. There were 31.5% of contact had the comorbid disease, included DM, HT, and other disease were 8.8, 16.2, and 10.5% respectively. A latent tuberculosis infection (LTBI) among contacts of clonal and non-clonal MDR-TB were 27.8% and 30.2% respectively. However, there was no statistically significant difference between these 2 groups (p-value = 0.697). To identify host genetic factors associated with MDR-TB infection, GWAS was used to an identified specific genes associated with MDR-TB infection. We considered contact with IGRA positive as a case and contact with IGRA negative was control. The most common significant SNPs and genes were located on chromosome 6 and HLA gene, including HLA-DRA and HLA-DRB1 which had been reported in previous studies. Other significant SNPs were also found to be associated with TB infection, the SLC1A2 gene on chromosome 11. In summary, a high proportion and homogeneous gentic of AAF3 strain among MDR-TB patients may reflect the adaptation of the strain to spread more readily in thai population, and the increasing of this pathogenic strain may impact the tuberculosis control program. Early diagnosis and contact tracing will be essential to inhibit the spread of these strains. Furthermore, it will be important to ensure that future vaccines protect against these strains.
For disease control such as COVID-19, limiting the spread of epidemics is an important activity. Parts of activities are the roles of primary care or health centers in the area including contact tracing and active care finding. The objective of this study is to develop the methodology to assess the workload of health personnel at primary care in the normal situation and in the COVID-19 pandemics situation in order to identify human resource capacity and gap at primary care level for defending COVID-19 at different levels of epidemics. This study assessed the workload for 6 types of health services by analyzing the related databases and estimating average time of service using previous study and discussion with 9 health centers in 3 provinces. Subtraction of total working hours for 4 types of health personnel including doctor, nurse, public health technical officer, public health officer by service workload (6 types of services) and workload for community services and others (2 hours per person per day in average) was done. The remaining working hours were used for estimating capacity of COVID-19 control activities, in this case, the highest number of contact tracing and active case finding that can be performed in one day at health center level, district level and provincial level for the whole country (except Bangkok). The result of the study showed that in case of using 50% of remaining working hours after subtraction by the existing workload (6 services workload and community workload), there are about 85% of provinces that can perform 2,000 – 8,000 cases per day of contact tracing or active case finding. At district level, there are about 75% of districts that can perform 200 – 800 cases per day. At health center level, there are about 75% of health centers that can perform 20 – 80 cases per day. These figures are based on service data between January and June 2020 which was the first round of COVID-19 epidemics. The result reflects that health centers have different capacity (flexible working hours) for defending epidemics. District level seems to be more flexible and manageable to mobilize human resources within district for not severe epidemics situation and provinces can cover higher volume of active case finding per day. Therefore, the surge capacity plan should be developed at district and provincial level for mobilizing human resources within area in the situation of epidemics.
Development of a health literacy model to enhance self-management behaviors and health outcomes among older adults with coexisting type 2 diabetes mellitus and hypertension in primary care cluster Saraburi province was a research and development. The main purposes of this study were to develop health literacy model of older adults with coexisting type 2 diabetes mellitus and hypertension and to determine the effects of this model. A sample of 150 older adults with coexisting type 2 diabetes mellitus and hypertension visiting in primary care cluster Saraburi province was randomly entered into the experimental and control group, 75 participants for each group. The experimental group participated in the health literacy developmental activities for a period of 12 weeks, whereas the control group obtained regular care. The instruments employed in this research included 1) the health literacy developmental model and supporting documents and 2) the self-management behavior questionnaire. The percentage, mean, standard deviation, t-test, and content analysis were used to analyzed the data. The results showed that: 1. The health literacy developmental model to promote self-management behavior and health outcomes among older adults with coexisting type 2 diabetes mellitus and hypertension consisted of 5 stages as followed: 1) confidence to change, 2) access and understand our disease, 3) communicate and make decisions for health, 4) set the direction for self-change, and 5) continuously perform towards good health outcomes. 2. The effects of the health literacy developmental model to promote self-management behavior and health outcomes were found: 2.1 Post-test mean score of self-management behavior of the experimental group was significantly higher than the control group (p < 0.001). Post-test mean of HbA1c and systolic blood pressure of the experimental group were significantly lower than the control group (p <0.01 and p <0.001, respectively), whereas mean of diastolic blood pressure of the experimental groups were lower than the control group, but there was no statistical significance. 2.2 Post-test mean score of self-management behavior of the experimental group was significantly higher than pre-test (p <0.001), whereas mean HbA1c, systolic blood pressure, and diastolic blood pressure of post-test was significantly lower than pre-test (p <0.001). The results of this study can be employed to develop health literacy to promote self-management behaviors and control HbA1c, and blood pressure among older adults with coexisting type 2 diabetes mellitus and hypertension.
Operational system for excellence in medical bioinformatics for lower southern Thailand in health region 12 is a fundamental implementation of genomic medicine in South of Thailand co-operated by the Faculty of Medicine, Prince of Songkhla University and Health Systems Research Institute, Ministry of Public Health. To integrate genomic medicine into the healthcare system in the Heath Region 12, infrastructures including clinical data management, biological sample processing and storage and certified molecular laboratory were considered to be organized in Translational Medicine Research Center (TMRC), Songklanagarind Hospital. Not only infrastructure standardization, but the project has also consent volunteers for clinical data and biological sample retrieval under the approval of the Human Ethical Committee, Faculty of Medicine, Prince of Songkla University. To achieve goal of the study, we included 175 participants covering 3 major genetic associated diseases (hereditary cancer, rare diseases and infectious diseases). Moreover, clinical data and specimens were collected under standard operation procedure of Genomic Thailand Consortium and consecutively shipped to Department of Medical Science, Ministry of Public Health. For the leftover specimens, whole exome sequencing was performed to intensively discover pathogenic variants related to respective participants and their families. Ultimately, annotated exome sequences were comprehensively integrated to establish aggregated exome database which provides useful clinical implication of each variant and regional specific minor allele frequency as a public database. In conclusion, our project has laid infrastructures for genomic medicine and linked them to the clinical environment in the South of Thailand.
Tuberculosis remains the leading killer of people living with HIV (PLHIV) and HIV greatly increases the risk of reactivation tuberculosis (100 fold). Although tuberculosis prophylaxis therapy (TPT) could prevent TB reactivation in 60-90% but current regimen (INH 9 months:9H) is limited by poor implementation and low completion rate due to long duration, fear of INH resistance and dormant TB could not be killed by INH. We evaluated the safety and efficacy of a novel shorter TPT in Thailand, a high TB/HIV burden country. Methods: PLHIV on ART > 2 weeks and free of active TB are randomized to Arm A: 1 HP (isoniazid 300 mg plus rifapentine 450-600 mg once daily for 4 weeks) or Arm B: 3HP (isoniazid 700-900 mg plus rifapentine 750-900 mg once weekly for 12 weeks) from 14 hospitals in Thailand. The participants will be followed up for 3 years. The primary end point was the first diagnosis of TB or death from TB or unknown cause. This study is ongoing, plan to enroll 2500 PLHIV. However, it is affected by COVID 19 pandemic and also impurified of rifapentine. By the way, the impurified of the study drug has been approved from the US FDA that it has a few impurification so it causes a few effects to the develop cancer. This analysis is focused on 1st year with 644 PLHIV enrolled. Results: A total of 644 patients (86% male) were enrolled, 322 each were assigned to Arm A or Arm B. Median age was 30 (IQR 25-39) years, median baseline CD4 cells counts were 300 (201-415) cells/mm3, and 24% of them had baseline CD4< 200 cells/mm3. All received FDC of tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC)/efavirenz (EFV) for a median 1.3 months. The median duration of follow-up was 1 year at the study entry. There were no active TB or death reported. Adverse event occurred 6.1% (Arm A = 6.5% and Arm B = 5.6%) as following hepatitis (elevated ALT) (Arm A=3.1% and Arm B 4%). Majority of hepatitis were asymptomatic cases, it was found during schedule blood testing. Rash occurred 0.8% (Arm A=1.2% and Arm B 0.3%). 1 case (Arm A) had numbness of feet. Serious side effect occurred among 10 cases (Arm A=0.9% and Arm B 2.1%. Totally 2 cases developed hypersensitivity reaction (rash and hepatitis), both of them were in Arm B. The percentage of treatment completion was 93.2% and 91.6% in Arm A and Arm B, respectively. At 48 weeks after starting TB drugs, 96% and 95.7% of Arm A and Arm B had HIV RNA <50 copies/ml, respectively. Conclusion: In the treatment of latent tuberculosis infection, both Arm A and Arm B resulted in better adherence, low percentage of discontinued treatments and highly efficacy to prevent active TB. No active TB or death were reported during 1 year.
The research project on the preparedness and responses of the health services system to the COVID-19 crisis in Thailand: Hospital operation and economic and social impacts within the boundary of the health services system consisted of 6 main parts using mixed research methods, pursuing the following key objectives: (1) To study overall research areas and topics for health services system to prepare and respond to the COVID-19 situation focusing on hospital systems, and economic and social impacts within the boundary of the system by reviewing key literature and expert panel suggestions, and by piloting data collection based on the framework. (2) To study key characteristics of hospital wards and innovation in hospital services for COVID-19, and to synthesize recommendations for hospital accreditation processes by making case studies on selected hospitals, and sharing discussions in focus groups. (3) To study challenges, problems, obstacles, preparedness, adaptation and new normal in key service offerings by hospitals in response to the COVID-19 situations, and synthesize new normal that may persist after the crisis by surveying hospitals and surveyors of the hospital accreditation programs in Thailand, organizing online focus groups and case study of the Bangkok area. (4) To estimate cost and opportunity costs of a hospital in responding to the COVID-19 situation involving all kinds of activities in a hospital by working with a case-study hospital. (5) To study and monitor operations of universal health coverage schemes in Thailand in responding to the COVID-1 9 situations, including reimbursement in the fiscal year B.E.2563 by reviewing documents and analysis of the reimbursement databases of the universal coverage scheme (UCS) and (6) To study governmental mechanisms in responding to the COVID-19 situation in Thailand, including key features in different phases of the situation, policies and measures to prevent and control the pandemic situation, related factors, and consequences by examining overall situations and making case studies of selected key events.
Persistence of viral RNA in respiratory samples of COVID-19 patients and asymptomatically infected individuals is a common and important problem in the outbreak control. The main question is whether the persistence of viral RNA reflects viable virus shedding. And, if there is viable virus shedding, there is an interesting scientific question of how the virus survives in the presence of immune response, which should be developed soon after the infection. Possible explanations include a failure of developing immune response or an immune escape by viral mutations. To answer these questions, this project performed viral isolation in sequential respiratory samples and antibody detection in serum samples of 30 cases with mild-symptom or asymptomatic, who showed viral RNA positive by RT-PCR after 1 week from the diagnosis. Samples in the first week showed a large variation in the viral load levels which significantly declined in most samples from the second week forward together with positive for specific antibody in serum samples. For viral isolation, there were 6 positive samples with high viral load; 4 samples and 2 samples from the first and second week samples, respectively. The two culture positive samples from the second week, one of them had low level of neutralizing antibody in serum at the same time point and these neutralizing antibody level increased in the third and fourth week samples together with a drastic decline in viral load and negative viral culture. The other sample showed high viral load and positive viral culture together with negative neutralizing antibody in the samples from the second and third week. These data indicate that most patients and infected individuals with persistent positive RT-PCR have low level of viral load and this does not indicated shedding of viable virus. However, failure in mounting the immune response in some individuals may result in persistent shedding of viable virus. High viral load and negative neutralizing antibody may be used as markers to identify such individuals.
The objectives of this research were to develop a model, and to study the effectiveness of a good health promotion integrated with Buddhist ways model for prevention and control of non-communicable diseases. It was designed as two group pretest-posttest design. The samples were 99 patients with uncontrolled diabetes and or hypertension, divided into two groups: 50-person group; the study group who were managed by the model, and 49-person group: the control group managed by routine care. Data were collected using mixed method, both quantitative and qualitative approach. The research tools were: 1) the good health promotion program integrated with Buddhist ways was named in Thai as 3 Sor, 3 Orr, 1 Nor from which comprised: pray, meditation, Buddhist dialogue, nutrition, exercise, emotion, biological clockwise daily activities with Buddhist integration. 2) health assessment form 3) self-report manual 4) the knowledge test 5) the happiness test 6) the satisfaction questionnaire 7) group discussion and in-depth interview guidelines. The KR 20 of the data collecting tools no. 4 was 0.8. The Cronbach's alpha coefficients of the data collecting tools no. 5, 6 were 0.85, 0.84 respectively. The quantitative data were analyzed using descriptive statistics, paired t-test and independent t-test. The qualitative data were analyzed using content analysis. The results of the model development found 3 components: 1) the good health promotion program integrated with Buddhist ways 2) self-reporting towards the program and 3) monitoring, supporting, and empowering by the health team. The findings on the effectiveness of the model found that 1) After try-out the model, the study group had lower average in health status namely weight, waist circumference, BMI, blood pressure and blood sugar levels were significantly decreased. 2) Before try-out the model, the study group had average in health status not different with those of the control group while after try-out the model, the average of health status in study group were significantly lower than those of the control group. 3) After try-out the model, the study group had significantly higher average in the knowledge scores and higher average in happiness score towards the activities of the program. And they were satisfied with the activities of the program at a high level.