plueme/wizJson huggingface dataset:
Background:
The prevalence and incidence of CKD have been increasing in Thailand caused by the
pandemic of non-communicable disease or the inappropriateness of renal replacement therapy
initiation. The optimum or critical renal function for renal replacement therapy initiation has been
an important issue. Late renal replacement therapy may cause morbidity and mortality while too
early renal replacement therapy cause patients’ morbidity and unnecessary health economic
burden. This study aimed to investigate the association of renal function at renal replacement
therapy initiation towards clinical outcome and investigate the comparison of mode of renal
replacement therapy towards patients’ outcome.
Methods:
The evaluation of pre-renal replacement therapy renal function was investigated by cross
sectional study. The results of most accurate pre-renal replacement therapy renal function
assessment was used to enroll patients in multicenter, prospective observational study for
association of renal function, mode of renal replacement therapy and clinical outcome
Results.
113 cases of CKD stage V by CKD-EPI equation who expected for renal replacement therapy
were enrolled for the cross sectional study. The average age was 59.2 ± 17.8 years and
average serum creatinine was 6.59 ± 3.00 mg/dL. By reference 99Tc-DTPA plasma isotope
renal clearance GFR study, the average renal function was 16.6 ± 5.5 mL/min per 1.73 m2.
CKD-EPI Equation for GFR severely underestimated pre-renal replacement therapy renal
function. Cystatin C based GFR showed better performance and Thai GFR Equation showed
best estimation of late CKD patients who may need renal replacement therapy. 386 late CKD patients who enrolled for renal replacement therapy were included in multicenter,
prospective observational study. The average age of patients was 59.8 ± 16.1 years and
average serum creatinine was 10.81 ± 6.73 mg/dL. The prevalence of co-morbidities was high
and more than 85 % of patients reimbursed the renal replacement therapy cost from the
government reimbursement plan. The renal function when the renal replacement therapy
initiation by CKD-EPI was inaccurate and range from CKD stage IV to early stage V and late V.
The findings cause problems to analyze for the association of renal function, mode of dialysis
and clinical outcome. Thus more cases are needed to be enrolled and more follow up are
needed.
Conclusion:
Renal replacement therapy initiation by CKD-EPI was inaccurate and underestimated renal
function. Renal replacement therapy initiation cases enrollment by CKD-EPI was inappropriate
and cause unnecessary renal replacement therapy reimbursement. Thai GFR equation should
be used for renal replacement therapy initiation. By Thai GFR equation, the investigation for
the association of renal function and mode of dialysis towards clinical outcome can be feasible.
Implementation of a policy needs different knowledge from that for formulating or adjusting one. Implementation Research (IR) aims to develop strategies to bring policy into effects and achieve  successful results as stated in policy. This study used scoping review method to gather knowledge regarding theories and concepts of implementation research. Although IR has been conducted for some times, the attempts still are unsystematic, scattered and unstandardized. The report addressed 6 theories and conceptual frameworks from which a research can utilize more than one. IR can be conducted at pre-, during- or post-implementation using quantitative, qualitative or mixed methods. Context plays an important role in implementation. Therefore a successful implementation in one context cannot guarantee another success in others. To implement a policy, an implementer or a policy maker needs to consider a variety of implementation strategies and balance between policy adaptability and policy fidelity. Health care workers should be allowed to be involved in designing implementation strategies to enhance effective policy implementation process. Policy maker should pay more attention to establish standardized and longitudinal study of implementation research to achieve information regarding implementation of a policy as inputs to contribute with a policy process especially a policy formulation or a policy adaptation.
Physical activity (PA) is proven to have great benefits to health. Previous studies found that differences
in social determinants of health and environment affect physical activity levels; different policy
interventions are, therefore, required. This study explored the association between physical activity
levels and residential areas in Thailand in different household asset indices. The data were obtained
from the 2015 National Health and Welfare Survey of 113,882 Thai adults aged 15 and above. Descriptive
and analytic statistics were employed in the analysis.
The result showed that urban respondents with higher income tended to have less energy expenditure.
People with the highest income level (Quintile 5) spent the least energy expenditure (1,159 and
1,437 Metabolic Equivalence of Task-minute/week in urban and rural areas, respectively). In contrast, the
poorest (Quintile 1) had the highest energy expenditure (2,182 and 1,921 MET-minute/week in urban and
rural areas, respectively). When analyzed by three PA domains, it was found that rural and poorer
people tended to have higher occupational energy expenditure, whereas urban and richer people had
significant higher recreational energy expenditure. In transportation, urbanites had slightly higher energy
expenditure than rural people.
Our findings will benefit the formulation of the national PA-promotion policies by tailoring physical
and social environments conducive to PA needed for each subgroup according to their socioeconomic
status.
Commercial availability and density of alcohol outlets are the factors influencing availability of alcohol and alcohol consumption. The objective of this study is to explore alcohol outlets situation and compliance with the Alcohol Control Laws in Thailand. Methods: There were 325 alcohol outlets from five provinces across Thailand joining in this study by multi-stage cluster sampling. A questionnaire survey was administered to gather demographic characteristics and type of alcohol outlets and alcohol license. This study found that there were high alcohol outlets densities in five provinces of Thailand. There were alcohol beverages in milk and coffee shops. Grocery store, kiosk selling herbal drink and mix shop had ever gotten alcohol license as alcohol outlet but their licenses were expired. Alcohol outlets business hours violations during morning, afternoon and evening prohibition periods were prevalent. Therefore, government or related agencies should seriously enforce the legislations and develop regulations related to control alcohol outlet density and set criteria of alcohol license for alcohol outlets owners in order to prevent and protect the health of children, youth and people in Thai society.
Youth smoking remains to be a major public health problem of Thailand that partly as a result of a law violation of tobacco retailer in the sale of cigarettes to youth or minors. This research aimed to explore associated and predicting factors of retailer related to tobacco sale to minors in Health Region 2. Independent variables were based on previous systematic review and qualitative research. This study gathered data through questionnaires asking opinions of a sample of 658 tobacco retailers taken through a multi stage sampling in Health Region 2. Data were analyzed by using descriptive statistics, chi-square and multiple logistic regression analysis. The findings revealed 58.7 percent of tobacco sale to minors. The associated and predicting factors of tobacco sale to minors included duration of performing the retailer occupation (ORAdj=2.099), motivation about revenues from tobacco sales. (ORAdj=2.620), defined a youth differed from the law (ORAdj=1.993), conforming to social norms regarding the sale tobacco to minors (ORAdj=2.955), selling individual cigarettes or small packages (ORAdj=11.504), selling tobacco by self-service (ORAdj=3.825), facilitating customers to buy and smoke cigarette (ORAdj=2.392), and not asking buyer age before selling tobacco (ORAdj=1.734). The independent variables have a predictive value of 67.2 percent of the variance (Pseudo R2 = 0.672) in the behavior of selling tobacco to minors. These findings suggested that government agencies involved should strictly enforce the law in particular the ban on selling individual cigarettes or small packages and selling tobacco by self-service, together with enhancing retailer understanding on the content of tobacco control law.
Cannabis is traditional plant that contains psychoactive substances, which have several risks and benefits. By law many countries (including Thailand) probihited the use of cannabis, and included it in the narcotic or addictive substance list. Between 2015 and 2016, there were massive campaigns from both public and private agencies urging an amendment of the Narcotics Act B.E. 2522 (1979) to withdraw cannabis from the narcotic drug list. This report therefore sought to review the current situation regarding the use of cannabis for medical purposes in various aspects, as well as cannabis legalisation from foreign experience (using Netherlands, United States, and Uruguay as case studies). The main data collection technique is literature review on electronic databases, namely, Medline. The findings show that most studies on cannabis were limited to laboratory work. Though there were some clinical trials on humans, the majority of them still had a small number of participants comparing clinical effects of cannabis with placebo. Concerning foreign experiences, the scope of cannabis medicalisation varies substantially; from extracting medical substances in cannabis to treat patients that did not respond to conventional treatments, to using cannabis for recreational activities. Some countries implemented decriminalisation measures. The openness of cannabis policies in many countries had some similar approaches: (1) the revision of cannabis related laws was gradually made over time, and (2) there were several measures implemented in parallel to prevent cannabis use in the way that deviates from original policy intentions. If the Thai government aims to implement policies vis-à-vis the utilisation of cannabis, it is imperative to distinguish medicalisation issue from legalisation issue to avoid misperceptions in the society. The Thai government should assess its capacity in regulating the use of cannabis before introducing cannabis-medicalisation/legalisation policies.
The introduction of new vaccines depends on various criteria, including policies, clinical guidelines and economic considerations. Various stakeholders have differing criteria they view as important in selecting vaccines into a national immunization program. The present study aimed to identify factors impacting the adoption of new vaccines from the perspective of policy makers, healthcare professionals and healthcare administrators. The vaccine attributes identified from a literature review and semi-struc¬tured interviews were categorized into burden of disease, age group, budget impact, fever from vaccine, severity of disease, vaccine effectiveness and cost of vaccine. Main-effects orthogonal design was used to identify 18 profiles. Then a postal survey was conducted among policy makers, healthcare profes-sionals and healthcare administrators. Respondents were asked to choose the most important and the least important choices in each profile. Conditional logistic regression was used to estimate importance weights of attribute levels, and then relative attribute importance was calculated. A total of seventy respondents completed the questionnaires (a 55% response rate), including 11 policy makers, 26 health¬care professionals, and 33 healthcare administrators. The attributes listed by all groups as being the most important for new vaccine adoption were severity of disease (35.9%), fever from vaccine (16.7%) and burden of disease (13.5%), respectively. Policy makers and healthcare professionals listed severity of disease (35.0% and 35.9%), fever from vaccine (22.9% and 17.0%) and burden of disease (14.8% and 15.3%) as the most important, respectively; whereas healthcare administrators listed severity of disease (32.5%), budget impact (15.1%) and fever from vaccine (15.0%) as the most important, respectively. New vaccines with high protection targeting severe disease in young children have a greater chance of being selected by respondents in the present study. The findings reveal the importance of attributes from public healthcare workers and will be useful for policy development of new vaccine adoption.
The Trans-Pacific Partnership Agreement (TPP) is a comprehensive model of regional trade and investment agreement. As a complex and comprehensive new generation of trade agreement, tobacco industry or transnational tobacco companies would employ TPP to interfere with tobacco control policy and law of the State Parties. The State Party may not adopt the Investor-State Dispute Settlement (ISDS) with respect to claims challenging a tobacco control measure; however, such exception provision covers only the investment chapter. In sum, some of TPP’s provisions may have negative impact on tobacco control in Thailand and tobacco industry may not comply with the WHO Framework Convention on Tobacco Control (FCTC) or threaten the government by claiming the litigation or trade disputes in order to undermine tobacco control measures.
Mental health service is an important health service system with increasing resource consumption due to social and economic changes. The objective of this study was to develop Thai Mental Health Casemix Classification (TMHCC) for inpatient payment method. This research and development employed 4 steps to develop TMHCC: 1) standard data identification, 2) data collection and edit, 3) cost calculation 4) classification, calibration and evaluation. Eighteen hospitals with inpatient beds for psychiatric care and 2015 top-down cost accounting data joined the study organized by the Department of Mental Health. Data for TMHCC development included administrative data, clinical data, resource uses and mental problems. The Thai version of the Health of the Nation Outcome Scales (HoNOS) and the Health of the Nation Outcomes Scales for Child and Adolescent mental health (Thai-HoNOSCA) were used for adult and children psychiatric assessment. Prospective data collection was conducted in the second half of fiscal year 2016. The total inpatient data for classification were 15,417 cases. The statistics to explain performance of the TMHCC were coefficient of variation (CV) for homogeneity of cases within each group and the reduction in variance (RIV) for overall performance of the casemix classification. Results: TMHCC classification provided 39 disease groups (34 for adult and 5 for children). The highest number of adult cases was for Schizophrenia, Age <= 50, with cognitive problems, with problems from reactive/aggressive/ agitated behavior (2,088 cases, 17.1% of all cases). About 83.4% of children patients were grouped into Other Child Psychiatric Conditions (2,463 cases). Mental Health Disease, Ongoing type had the highest cost per admission (200,817 Baht) and Mental Health Disease, Same-day type had the lowest cost per admission (590 Baht). The result of CV on cost showed that only one group had CV higher than 100%. Most TMHCCs had high homogeneities within groups. The results also confirmed good overall performance of TMHCC that RIV on cost after the classification was as high as 39.9%. Moreover, RW of TMHCC better predicted cost than RW of the current Thai DRG version 5. In summary, the performance of this casemix is good enough based on homogeneity within groups and high heterogeneity of resource uses between groups. Recommendations: The payment based on TMHCC was an option for payment. However, payers should prepare budget for psychiatric inpatient care benefit package that needed longer stay service in hospital than acute inpatient. Moreover, mental health measurement data should be put into addition¬al routine electronic databases of all hospitals that provided care to psychiatric inpatients.
The quality and primary care standard system (PCS) is consisted of eight main topics with a checklist of 40 items. PCS has been used as guidelines to implement and organize service systems and develop the laboratory work of the primary care units to meet quality and service standards. This study aimed at collecting and analyzing data in order to sort the frequency of unmet quality requirements of 7,452 primary care units (80.89%) assessed by network laboratories in fiscal years 2014 – 2016. The highest nonconforming requirement was Item 3 concerning the unavailability/insufficiency of materials, solutions and instruments at primary care units (such as blood glucose test with glucometer, pregnancy test, urine strip test for glucose and protein and hematocrit). The findings of this study revealed areas for improving quality and primary care standards. In addition, involved agencies should use the data to formulate policies and guidelines for improving quality and service standards focusing on the parts that the primary care units were unable to accomplish in order to improve the quality of the laboratory services at the primary care units. This will result in a decrease of service congestion at major hospitals in addition to promoting efficient treatment, prevention and disease control.
Substandard medicines have a great impact on health systems. For example, they can engender drug resistance, adverse effects, drug toxicity, increase mortality and morbidity, etc. As a result, a larger budget is needed for longer healthcare treatment, while health personnel lose confidence in drug qual-ity monitoring and generic drugs. This study employs a descriptive retrospective design. It aims to analyze the database of test results from the Quality Assurance of Medicines Program, which was operated by the Department of Medical Sciences between the fiscal years of 2002 to 2016. The international pharma-copoeia, for example, the United States Pharmacopeia (USP) or British Pharmacopoeia (BP), were used as reference standards. The findings revealed that 428 government hospitals voluntarily sent medicine samples to the Quality Assurance of Medicines Program. The total number of modern medicine samples was 572 items or 16,212 samples. The number of substandard samples decreased from 19.0% in 2002 to 0.8% in 2016. Based on the latest 3-year data, 2.9% of domestic generic drugs failed the standard specifications, whilst 0.9% of imported drugs failed. Dissolution and content of active ingredients were the most common issues found. The corresponding organizations in pharmacovigilance and pharmaceutical manufacturing, for ex¬ample, the Thai Food and Drug Administration (Thai FDA), the Department of Medical Sciences (DMSc), the Government Pharmaceutical Organization (GPO), and the Thai Pharmaceutical Manufacturers Associ¬ation (TPMA) should cooperate to monitor and improve the quality of domestic generic drugs in order to achieve greater confidence in using domestic generic drugs while also making budget savings. This could also strengthen the domestic pharmaceutical industry and enhance national drug security.
Hearing aids can rehabilitate hearing and improve communications abilities of people with hearing loss for efficient daily living. This study aimed to analyze factors associated with hearing aids use by analyzing data obtained from a survey conducted. The survey sample comprised 380 people with hear-ing loss who received hearing aids under the Universal Health Coverage scheme (UHC) from 2005-2015 in five provinces: Phayao, Samut Prakan, Chonburi, Khon Kaen, and Songkhla. The data were collected via interviews based on a questionnaire. Of the 200 people interviewed in the community, it was found that internal factors such as gender, age, occupation, and economic status were not significant factors related to usage. However, users who were satisfied with their hearing aids significantly used their hearing aids more than those who were not satisfied (adjusted OR = 3.99, 95% CI; 1.09-14.67, p-value = 0.037), and users who came for follow-ups significantly used their hearing aids more than those who did not (adjusted OR = 2.60, 95% CI; 1.22-5.53, p-value = 0.013). Thus, the National Health Security Office should provide hearing aids with improved follow up system to ensure appropriate use of hearing aids as well as to prevent discontinuation of use in the future.
In Thailand, people with hearing impairment under the Universal Coverage scheme (UCS) are entitled to having hearing aid free of charge from accredited hospitals. This cross-sectional survey aims to describe the situation regarding hearing aid usage and economic loss from discontinuing usage of hearing aid in people with hearing impairment under the UCS. Data were collected from 364 persons in five provinces (Phayao, Khon Kaen, Chonburi, Samut Prakan, and Songkhla) through face-to-face structured interviews. Descriptive statistics were used for data analyses. The results showed that 54% of the sample experienced improvement in quality of life and 39% were satisfied with hearing aid use. Out of the 164 persons who were interviewed at hospitals, three stopped wearing hearing aid. For the 200 persons who were interviewed in the community, 29% stopped hearing aid use, to whom 50% used for less than one year. The most common reasons for discontinuing usage were high background noises and faulty devices. The economic loss from discontinuing usage up to third year was estimated to be 19.4 million baht. For subjects who were still using the hearing aid, 71% wore the hearing aid daily for 9 hours on average, whereas 44% occasionally wore approximately 3-4 days a week for four hours per day. For persons who used hearing aid with zinc-air battery, around 1-2 batteries were used per month, costing 65-96 baht a month. 43% stated that the cost of batteries was a burden as they were only able to pay approximately 32 baht per battery. Therefore, the National Health Security Office should: 1) set up a follow-up system for hearing aid users; 2) provide training or guideline to hearing aid users, their relatives, and primary care unit officer regarding the service, procedure of treatment, and basic maintenance of hearing aid; 3) set up mobile service for hearing aid maintenance in community; 4) support zinc-air battery in order to match the ability to pay of users and increase distribution channels to sell hearing aid battery; and 5) raise the awareness to hearing aid users and their relatives regarding the government subsidized cost of hearing aid.