Se Asian J Trop Med
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Se Asian J Trop Med · May 2005
Assessment of capacity for cardiovascular disease control and prevention in Thailand: a qualitative study.
The present study explored community members' knowledge and perceptions about cardiovascular disease (CVD), risk factors and prevention, and identified the current capacity of primary care providers to manage and control CVD at the provincial level. A qualitative study, including in-depth interviews and focus group discussions, was conducted in Suphan Buri Province, Thailand. Participants included community members, CVD patients and healthcare providers in health centers and hospitals. ⋯ In conclusion, capacity building for strengthening CVD prevention and control at the primary care level should be implemented. The existing training and education systems have to be revised with an orientation towards health promotion and disease prevention. Publicity of CVD burden and preventive measures, and local programs, should be implemented with community participation.
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Se Asian J Trop Med · May 2005
Randomized Controlled TrialLife-saving rectal artesunate for complicated malaria in children.
We report the effectiveness of two regimens of rectal artesunate formulation in treating 13 Thai children with cerebral/complicated falciparum malaria. The drug was given at an initial dose of 40 mg/kg bodyweight, in 3 or 4 divided doses in the first 24 hours, followed by 10 mg/kg bodyweight once daily for three consecutive days. Mefloquine, at a dose of 15 mg/kg bodyweight was given orally at 72 hours after the initial dose of artesunate, followed by 10 mg/kg bodyweight 6 hours later. ⋯ No recrudescence was observed in any of the patients during the 28-day follow-up period. Plasma concentrations of artesunate and dihydroartemisinin (active plasma metabolite of artesunate) measured in two patients who received the high initial dose regimen (20 mg/ kg bodyweight) suggested rapid absorption and adequate plasma concentrations of both compounds following the administration of artesunate via the rectal route. Further studies for the optimized regimen of rectal artesunate in the treatment of cerebral/complicated childhood falciparum malaria in areas of multidrug resistance are warranted.
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Se Asian J Trop Med · May 2005
An economic evaluation of universal infant vaccination strategies against hepatitis B in Thailand: an analytic decision approach to cost-effectiveness.
To evaluate the cost-effectiveness of four infant vaccination strategies aimed at protecting the Thai population against hepatitis B virus (HBV) infection, vaccination and giving hepatitis B immunoglobulin (HBIg) to high-risk infants were compared with universal vaccination of infants and no vaccination. An analytic decision model was used to estimate the clinical and economic consequences of HBV for a hypothetical cohort of newborns for each of the immunization strategies. The model focused on the numbers and the costs of cases prevented. ⋯ There is no socially acceptable threshold value for cost per case prevented to guide decisions on funding health care interventions. Strategy 3 should certainly be continued. Nevertheless, based on these results, Strategy 2 may be considered, despite the incremental cost being about 2 times that of Strategy 3, as it might represent a worthwhile investment of public funds.
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Se Asian J Trop Med · Mar 2005
ReviewRisk of respiratory infections in health care workers: lessons on infection control emerge from the SARS outbreak.
Close proximity of persons together with handling of human secretions (eg respiratory secretions) make health care workers (HCW) particularly vulnerable to transmission of droplet-transmitted respiratory infections. This was tragically highlighted during the international outbreak of severe acute respiratory syndrome (SARS) in 2003 with attack rates of more than 50% in HCW. The purpose of this article is to review common airborne and droplet-transmitted bacterial and viral respiratory tract infections with regard to their impact on health care workers. ⋯ Integrated syndromic and virological surveillance systems set up during the SARS epidemic will also further our understanding of other respiratory infections in the hospital setting. Even if pursuing early diagnosis for unspecific respiratory illnesses is expensive, identification of the causative organism may reduce unnecessary isolation, contact tracing and anxiety, in particular during an outbreak situation. We have a duty to protect our health care workers.
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Se Asian J Trop Med · Mar 2005
Comparative StudyDecentralization and recentralization: effects on the health systems in Lao PDR.
In Lao PDR, lack of skilled manpower and financial resources in the central government, plus the policy urging local authorities to be self-sufficient and self-reliant caused the central government to decentralize all sectors to the provincial level in 1987. After 1987, the provinces took over all responsibilities such as planning, financing and provision of health services, only informing the Ministry of Health (MOH) about their activities. Because of economic differences between the 18 provinces, health services became unequal between the richer and poorer provinces. ⋯ A cost-recovery system was introduced to obtain additional funds, and conditions in the provinces gradually improved. The unique situation of decentralization followed by recentralization provides an excellent opportunity for study. We reviewed documents relating to these periods and interviewed officials at all levels who were concerned with the process.