plueme/wizJson huggingface dataset:
Studies from high-income countries observed that health outcomes among individual having access to care still differed based on their socio-economic status (SES). This led to a concern that performance-based payment introduced by National Health Security Office (NHSO) in Thailand would penalize healthcare facilities located in low SES areas where health outcomes would be worse compared to high SES areas, although same standard of care is provided. Patients with high SES would have better health outcomes because they could control themselves better. Those with high SES evidently had higher level of perceived control. Perceived control comprises two important parameters: health locus of control and self-efficacy. This cross-sectional study has been conducted to test whether SES affects health outcomes of Thais who are under the universal health coverage policy. Patients with diabetes (all having access to care) were used as an example. We found no association between SES and treatment outcomes and service-based indicators. CCM-related activities had strong association with health outcomes. SES was, however, associated with perceived control as found in previous studies. Those with high SES tended to have higher perceived control (high self-efficacy and internal locus of control). Perceived control had a tricky relationship with compliance. Those with high self-efficacy had better compliance to diet recommendation, but worse compliance to prescribed medicine. In contrast, those with internal locus of control had worse compliance to diet recommendation, but better compliance to prescribed medicine. The effects were cancelled out; overall, no association was found between perceived control and compliance.
Respiratory allergy, which consists of allergic rhinitis (AR) and allergic asthma (AA), requires high cost of medical treatment. These medications can only temporally relieve the allergic symptoms without any modification of an allergic hypersensitivity status. The only option that can modify the immunologic status is the allergen immunotherapy Three hundred and forty three subjects with chronic rhinitis was screened from 13 centers in Thailand. One hundred and forty six patients had been recruited according to the inclusion criteria, in which 108 subjects was randomly assigned into the intervention group (receiving immunotherapy and standard treatment) and 36 subjects had been assigned to the controlled group (receiving standard treatment with placebo injection). The clinical characteristics between two groups were not statistically significant. After one year, the median composite score in the intervention group decreases 3.8 score comparing to the baseline (p < 0.001). But comparison between the intervention group and control group was not statistically significant. After one year of treatment, 66.7 percent of subjects in the intervention group can reduce their medication use by 50%. Moreover, 23% of subjects in the intervention group were medication-free after 1 year of allergen immunotherapy. Eighty five percent of subject tolerate the 500 allergen unit dosage of vaccine. There were 423 adverse events (AE) out of 4,444 injections, 2.31% of total AEs (77/423 events) were systemic reactions.
Currently, the number of patients with chronic kidney disease is increasing. The main problem in chronic kidney disease patients is the reduction of blood flow to the kidneys, causes the insufficient blood supply to the kidneys. As a result, the accumulation of waste in the body due to the renal function excreted less waste from the body. It leads to a gradual decline in kidney function. In the elderly, it is found that blood flow to the kidneys decreased. The purpose of this study was to compare the effects of renal blood flow and heart rate variability before bed rest, after bed rest, and after the trial in the elderly. The 41 healthy elderly volunteers were divided into three groups: foot massage group (14 persons), foot exercise group (14 persons), and control group (13 persons). All of them were received bed rest for 15 minutes, then got a foot massage or foot exercise or bed rest for 15 minutes. Volunteers were measured for renal blood flow and heart rate variability for 3 times and 24-hours urine analysis was measured before and after the trial. The results found that renal blood flow and 24-hours urine analysis were not significantly different from the pre-treatment and no difference between groups. In massage group found that the standard deviation of the normal-to-normal intervals (SDNN), the square root of the mean squared differences of successive normal R-R intervals (RMSSD), and low frequency (LF) were significantly increased (p<.05). In foot exercise group found that SDNN and RMSSD were significantly increased (p<.05). And the control group found that only RMSSD was significantly increased (p<.05). However, there was no difference between groups comparison. Conclusion, the foot massage, the foot exercises, and bed rest could increase the heart rate variability by increasing the activity of the parasympathetic nervous system. But it does not affect the renal blood flow.
Objectives To evaluate the use of [F-18]Florbrtapir PET scan in assessing brain amyloid deposition in Alzheimer’s disease, mild cognitive impairment and normal aging and the correlation between brain amyloid deposition in PET scan and results from neuropsychological test, MRI brain and [F-18]FDG PET scan. We also aimed to evaluate the correlation between [F-18]Florbetapir PET scan results and changes in neuropsychological test, MRI brain and [F-18]FDG PET scan results. Conclusion Our results found a significant, high correlation between all imaging techniques using [F-18]Florbetapir and clinical diagnosis and neuropsychological test results, which the highest correlation was detected with [F-18]FDG PET followed by [F-18]Florbetapir PET and MRI, respectively. There were also significant and high correlation amongst imaging techniques. However, correlation between baseline and changes of these imaging results with changes in clinical symptoms as well as neuropsychological performances are still needed to be followed.
Stroke or brain bleeding is a disease occurred when the blood vessels inside of the brain or between skull and brain burst. Common causes are injury due to accident or high blood vessels. This disease requires an immediate diagnose whenever a patient has an abnormal signs such as severe headache, acute fatigue of arms and legs, nausea, vomit, loss of balance, cannot communicate with other people or cannot understand other people, or have an indication that there may be an injury to the brain. The patient when gets hospitalized is usually taken to CT scan to get the slides of the brain images because CT scanning is quick and also less expensive than any other method. The neurosurgeon considers these slides of images to detect any abnormality in the brain and gives appropriate actions. However, as the number of expert neurosurgeons who know how to read the images throughout the country is very low and the majority of them works in Bangkok and vicinity or major provincial hospitals, this makes a big obstacle to effectively save lives of people who live in the rural area. This project aims to develop pilot software that can automatically detect patients who have stroke, for the patient who have a hemorrhage, it automatically makes a 3D model of a brain hemorrhage, compute midline shift, compute a volume of a hemorrhage, and classify patients with emergency condition. This program will be helpful as a supporting tool for doctors especially those who are inexperience to know the condition of stroke of the patients.
Background and Rationale: The flood disaster which affected Bangkok and the central region of Thailand in 2011 presented a critical challenge to the resilience of Thailand’s health system in the face of sudden crisis. Objective: To explore the extent to which the Thai health system was capable of responding to a public health shock, through the lens of health system resilience, with a particular focus on the issues of ‘awareness’ and ‘adaptability’. Methodology: A cross sectional study design was applied. Data were obtained from the representative household survey in 2011. Descriptive statistics and inferential statistics using t-test, Chi-square test and rank-sum test were applied. Results: Overall, the Thai health system is quite ‘resilient’ especially in terms of ‘awareness’, as demonstrated by the good level of satisfaction that people had with the flood warning messages that they received. However, concerning ‘adaptability’, and using public health relief as an indicator, the Thai health system did not appear to perform well. Households in Bangkok had a better level of awareness than those in the central region. Households in the central region reported greater satisfaction in obtaining external public health assistance than the Bangkokian households. Conclusion: The Thai health system is somewhat resilient in coping with public health shocks, but there remains room for further improvement. An expansion of public health collaboration to all relevant sectors including local communities, non-governmental organizations, as well as media and social networks is needed. Furthermore, re-orientating the health registration system to have clearer catchment areas is recommended.
This study aimed to analyze gaps of alcoholic beverage laws and regulations in Cambodia, Lao PDR, Myanmar, and Vietnam (CLMV). Using qualitative approaches with the Global Strategy to Reduce the Harmful Use of Alcohol as a framework, we conducted a document research on laws and regulations implemented before 28 February 2017. The most popular laws and policies of CLMV focus on 1) taxation, 2) blood alcohol concentration limits, 3) restriction on alcohol advertising, and 4) national surveillance. The main policy gaps found in this study included: lack of national leadership and commitment on alcohol policy, lack of control between on-premise and off-premise sales of alcoholic beverages; regulations on alcoholic beverage marketing, sales promotion and product placement; and responsible beverage services training measures. Other key policy gaps included a lack of efficient and effective enforcement, especially control of illegal alcoholic beverages. Promulgation of the overarching national alcohol policy legislation and establishment of national alcohol control committees with participation from several sectors and further cooperation with other stakeholders to tackle illegal alcoholic beverages are recommended.
The Universal Coverage Scheme (UCS) has operated the Universal Health Coverage Benefits Package Development Project since 2009. The project aims to develop the health benefit package to be covered under UCS with transparent and participatory process involving stakeholders based on evidence. The researchers reviewed the document related to the development of benefit package in 2009-2015 and participated in the meetings of development of benefit package, starting from proposal development, prioritization and selection of health technologies, assessment of health technologies, and results presentation in stakeholder meetings. During 2009-2015, there were 133 health technologies or health topics nominated by the stakeholders. Among the topics nominated, health care package, drug and vaccine, medical devices, screening and treatment topics were nominated at 31%, 25%, 23%, and 21% respectively. Out of the 133 topics, 65 were selected for the health technology assessment, 45 were completed, and 26 were presented to the Sub Committee for the Development of Benefits Package and Service Delivery (SCBP). The SCBP made the decision to include 9 topics in the benefit package, 2 more topics were interpreted as already included in the package, 10 topics were requested for further evidence, and 5 topics excluded. Among the 9 topics selected by the SCBP, the topics that were finally implemented in the UCS were the HLA-B*15:02 screening for carbamazepine-induced severe adverse drug reactions, and the refractive error screening by school teachers in pre-primary and primary schools in Thailand.
Professional fee is one of the emergency medical service disbursement lists that private hospitals can submit for compensation. The recent data showed that the professional fee was the highest item disbursed accounted for approximately THB 88 million. The objective of this study, therefore, was to examine the detailed lists, the amount and disbursement of professional fees made by private hospitals under the Universal Coverage for Emergency Patients (UCEP). The disbursement data from private hospitals providing emergency medical services between 1 April and 27 December 2017 were analyzed by descriptive statistics. The findings illustrated that from the list of UCEP professional fees, there were 512 items made by medical doctors (508 items matched with 4,389 items of the Thai Medical Council’s doctors’ fees handbook, and 4 items outside of the handbook). The items of UCEP disbursement procedures in Chapter 10 Obstetrical procedures covered 34.4% of the TMC doctors’ fees list. The proportion of doctors’ fees disbursement accounted for over a half of 512 items (51.4%), disbursing 30,944 times or 36.2% of total transactions, with approximately THB 47 million or 53.7% of total professional fees. The Item on the next treatment for inpatient (code 59009) incurred the highest transactions at 5,465 (17.7%), while the initial inpatient evaluation and management (code 83786) incurred the highest disbursement of over THB 3.8 million (8% of total fee). Chapter 1 Procedures of the head and maxillo-facial area disbursed over THB 12.3 million or a quarter of the total fee. The top three doctors’ fees were the initial inpatient evaluation and management (13.8%), followed by the coronary artery procedure (11.2%) and the medical examination (10%). Doctors’ fees disbursement of emergency medical services from private hospitals covered just approximately a half of total items. Disbursement agencies should, therefore, explicitly define meaning of individual items related to current services in hospitals. In case of hospitals, they should promote training of personnel to correctly entry disbursement information. Moreover, a specific agency within the National Institute for Emergency Medicine should actively update the list of procedures to cover unavailable items.
Physical activity promotion needs multi-sectoral collaboration. The organizational structure of local authorities is conducive for physical activity promotion administration in the communities. This study aimed to explore local authorities’ physical activity promotion administration in the communities. In depth interviews, direct observations, and document reviews were done in 12 municipalities from 12 Health Regions. The study revealed that all municipalities had common patterns of organizational structure, resources, policies and stakeholders as well as physical activity promotion administration suitable for physical activity promotion to people in all age groups in the communities according to the contexts and levels of municipalities. The study concluded that local authorities was suitable for administrating physical activity promotion to the communities and all physical activity promotion agencies should set high priority on networking with local authorities for physical activity promotion to people.
This study aimed to develop the physical activity questionnaire for pregnant and lactating women (PAQ-PL) and to assess its reliability and validity. The PAQ-PL was developed based on the modification of the previous physical activity questionnaires for pregnant women from Thailand and other countries. The developed PAQ-PL was initially tested to determine the feasibility and acceptability for health care service by interviewing pregnant and lactating women as well as health care service providers. The reliability was assessed by administering the PAQ-PL twice within a 7-day interval (N=212) and the validity was assessed based on the correlation between the PAQ-PL and the accelerometer (N=86) in pregnant and lactating women who visited the Health Promotion Hospital, Health Promotion Center Region 5, Ratchaburi Province. The developed PAQ-PL was in the table format and consisted of 21 items of physical activities (PA) that were appropriate for Thai pregnant and lactating women context. It had good reliability on the time spent (minutes/day) for total PA, moderate-to-vigorous PA (≥3.0 metabolic equivalents, METs), and sedentary- to-light PA (<3.0 METs) [intraclass correlation coefficient, ICC = 0.79, 0.84, and 0.77, respectively (p-value <0.05)]. Its validity was acceptable when used for assessing the time spent on vigorous-to-moderate PA [Spearman’s correlation, rs = 0.21–0.37 (p-value <0.05)]. In summary, the developed PAQ-PL had moderate to good reliability and acceptable validity, especially when considering the assessment of moderate-to-vigorous PA. Hence, it may be feasible to use the PAQ-PL to assess the PA of pregnant and lactating women in the public health service system.
People with disabilities face several challenges, especially children who are often discriminated against and have limited access to social services. Despite the significant impact on a child’s development, family life, and its economic implications, research on childhood disability is inadequate. This study aimed to study the situation of children with disabilities up to the age of 14 years by type of disability and explored factors associated with disability. The study involved analyzing the National Statistical Office’s 2015 Household Socio-Economic Survey. There were 22,499 children aged 0 – 14 years in the sample of 15,538 households. Applying sampling weights, the country-wide estimates were derived. The study found that 93,129 children aged 0 to 14 years (0.87%) suffered from some kind of physical and intellectual disabilities, and most of them were congenital disabilities (0.80%). High prevalence of child disability was found in the following groups: males (0.93%), the 11-14 year old age group (1.12%), household heads with vocational diploma (1.20%) and unemployed household heads (1.16%). Among children with disabilities, more than one-third did not attend school. In addition, almost all children with both physical and intellectual disabilities could not take care of themselves or go out independently (81.6% and 94.5%). After multivariate adjustment, it was found that the children aged 7 – 14 years had a 1.39-time higher prevalence of disability compared to children aged 0 – 6 years (Adj.OR=1.39; 95%CI= 1.05-1.84). On the other hand, the prevalence of children with disabilities was lower in households where the heads were employed by the government and by private companies (51% and 41%, respectively) than those with unemployed household heads. The prevalence of child disability was concluded to be high among school age children (5 – 14 years) and in households with unemployed household heads. School aged children lacked educational opportunities especially those with congenital disabilities. The present study suggests that the government should pay more attention on special education of people with disabilities, and children with disabilities should have education or vocational training appropriate to their condition. Special education policies for children with disabilities have to be evaluated for improving the effectiveness. Moreover, authorities should promote private or public organizations to employ the head of family having children with disabilities.
In 2016, Ministry of Public Health’s service plan included antibiotic use in traumatic wound patients as an indicator of rational drug use. The target of this indicator was set at <40% based on a study in one large university hospital. Little is known on antibiotic use particularly in other hospital levels and regions. The objective of this study is to describe types of wounds and patterns of antibiotic use in traumatic wound patients. A prospective study was conducted in emergency unit, Mahasarakham Hospital during 1 March to 30 April 2018. The study measured types of wounds, wound classification according to antibiotic use guideline (antibiotic use is recommended for only class 2 and 3), prevalence of antibiotic use, type and duration of antibiotic use, and proportion of appropriate antibiotic use according to the guideline. Of total 267 patients, most of them were male (51.7%), had no co-morbidity (75.3%) and average age of 34+21 years. Median time from injury to hospital was 1 hour (IQR: 0.3, 3). The most common location of wound was at leg (32.2%) and wound type was animal bite (55.1%). Wound contamination was 74.5%. Prevalence of antibiotic use was 65.5%, when stratified by wound classification the prevalence was 11.1% in class 1, 72.2% in class 2 and 87% in class 3. The most common antibiotic use was Amoxycillin (62.9%). Average duration of antibiotic use was 5+1 days. According to the guideline, the rate of appropriate antibiotic use was 86.5% and appropriate duration of antibiotic use was 65.9%. In conclusion, use of antibiotics in traumatic wounds in Mahasarakham Hospital mostly adhered to the guideline but was higher than the target. Ministry of Public Health should reconsider the target of this indicator and promote further study in various hospitals and regional settings for appropriately reflecting quality of care.