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Biomedical subjects

C Sitthi-Amorn

Publications and source records attributed to C Sitthi-Amorn.

16 recordsLinked to original sources
PubMed2006

Health Research Profile to assess the capacity of low and middle income countries for equity-oriented research.

BACKGROUND: The Commission on Health Research for Development concluded that "for the most vulnerable people, the benefits of research offer a potential for change that has gone largely untapped." This project was designed to assess low and middle income country capacity and commitment for equity-oriented research. METHODS: A multi-disciplinary team with coordinators from each of four regions (Asia, Latin America, Africa and Central and Eastern Europe) developed a questionnaire through consensus meetings using a mini-Delphi technique. Indicators were selected based on their quality, validity, comprehensiveness, feasibility and relevance to equity. Indicators represented five categories that form the Health Research Profile (HRP): 1) Research priorities; 2) Resources (amount spent on research); 3) Production of knowledge (capacity); 4) Packaging of knowledge and 5) Evidence of research impact on policy and equity. We surveyed three countries from each region. RESULTS: Most countries reported explicit national health research priorities. Of these, half included specific research priorities to address inequities in health. Data on financing were lacking for most countries due to inadequate centralized collection of this information. The five main components of HRP showed a gradient where countries scoring lower on the Human Development Index (HDI) had a lower capacity to conduct research to meet local health research needs. Packaging such as peer-reviewed journals and policy forums were reported by two thirds of the countries. Seven out of 12 countries demonstrated impact of health research on policies and reported engagement of stakeholders in this process. CONCLUSION: Only one out of 12 countries indicated there was research on all fronts of the equity debate. Knowledge sharing and management is needed to strengthen within-country capacity for research and implementation to reduce inequities in health. We recommend that all countries (and external agencies) should invest more in building a certain minimum level of national capacity for equity-oriented research.

Africa↗
PubMed2001

Cardiopulmonary resuscitation performed in patients with terminal illness in Chiang Mai University Hospital, Thailand.

BACKGROUND: The original target of cardiopulmonary resuscitation (CPR) was victims of acute cardiopulmonary arrest. However, the use of CPR has expanded to a wide variety of patients including those with terminal illness for whom CPR is futile. The objective of this study was to identify the incidence of CPR performed, the severity of illness and the outcome of CPR attempted in terminal illness in a teaching hospital. METHODS: Cardiopulmonary resuscitation attempted in terminal illness was retrospectively assessed from the medical records of hospital deaths with any one of eight life-threatening diagnoses during a 3.5-year period. RESULTS: Of 532 hospital deaths from terminal illness, 411 records (77.3%) were reviewed and abstracted. Most of the 411 patients had a low pre-CPR functional status. Generally, CPR was performed in 270 (65.7%) cases; 114 of those given CPR (42.2%) initially survived, but all died shortly after the manoeuvre. The high death rate following CPR may reflect both terminal illnesses and the severity of pre-event functional capacity of patients. CONCLUSION: The criteria for CPR in this group of patients need to be re-assessed and use of a Cerebral Performance Categories (CPC) score may be helpful.

Advance Directives↗
PubMed1999

Serum cyrptococcal antigen: diagnostic value in the diagnosis of AIDS-related cryptococcal meningitis.

RATIONALE: The incidences of HIV-AIDS patients with opportunistic infections of the central nervous system are increasing. Of these, cryptococcal meningitis is the most important and serious. A simple method for the diagnosis of cryptococcal meningitis is needed despite its variable clinical features and the lack of a capacity in most health facilities in Thailand to exclude it from other diseases especially mass lesions in the brain. OBJECTIVE: To identify the capability and cut off point of serum cryptococcal antigen for diagnosis and screening of cryptococcal meningitis in HIV-AIDS patients. METHODS: One hundred consecutive cases of HIV-AIDS patients suspected of having central nervous system infections were prospectively recruited for the study. The serum of all patients were examined for cryptococcal antigen by latex agglutination test, the Pastorex Cryptococcus manufactured by Sanofi Diagnostic Pasteur, France. If a test was positive, the serum dilution was carried out using 10-fold serial dilution. Every patient went through pre-defined standard investigations to derive at a definite diagnosis. The gold standard for diagnosis of cryptococcal meningitis was the presence of encapsulated yeast forms in the cerebrospinal fluid or a positive culture for cryptococcal neoformans from the cerebrospinal fluid. RESULTS: Of 100 patients enrolled in this study, 58 patients had cryptococcal meningitis and serum cryptococcal antigen was detectable in 60 patients. If the cut-off point for a positive test was when the serum cryptococcal antigen titer was more than zero, then, the sensitivity of the test was 91.4 per cent, the specificity was 83.3 per cent, likelihood ratio if test positive (LR+) was 5.47, likelihood ratio if test negative (LR-) was 0.1, false positive was 16.7 per cent, false negative was 8.6 per cent. CONCLUSION: We conclude that serum cryptococcal antigen is a simple and rapid screening method for diagnosis of cryptococcal meningitis.

AIDS-Related Opportunistic Infections↗
PubMed1995

Technology assessment. Old, new, and needs-based.

Recent health reports, including the 1993 World Development Report, have emphasized the importance of integrating the needs of the population into technology assessment. This paper reviews previous approaches to technology assessment and identifies the missing link between technology and its impact on the physical, emotional, and social needs of the community, namely needs-based technology assessment. It stresses the key role played by issues of equity and community values in making technology decisions. A number of models for needs-based technology assessment are described.

Community Health Planning↗
PubMed1995

Health transition and needs-based technology planning and implementation.

Investment in health can offer additional benefits to development independent of economic improvement. Many technologies have been useful in improving the health of the people in the past. However, rapid and often unpredictable change has contributed to the inequity, inefficiency, and rising cost of health care. This paper outlines why a needs-based approach to assessing any new technology in the health sector is essential. To respond to changing needs, capacities within the health care system, several of which are described here, must be strengthened. Needs-based technology planning and implementation is affordable and feasible and is crucial in order that both health as a basic human right and good health at low cost can be attained.

Cost-Benefit Analysis↗
PubMed1994

Spontaneous echo contrast on transthoracic echocardiography and left atrial thrombus in rheumatic mitral valve disease patients: a clinicopathologic study.

The association of spontaneous echo contrast and thrombus in the left atrium in patients with mitral valve disease is controversial. This study was undertaken to determine whether there is an independent association between spontaneous echo contrast on transthoracic echocardiography (TTE) and intraoperative evidence of left atrial thrombus and to evaluate the clinical implications of spontaneous echo contrast in patients with symptomatic rheumatic mitral valve disease. A total of 255 patients who underwent surgery for rheumatic mitral valve diseases were preoperatively evaluated by transthoracic two-dimensional and Doppler echocardiography. Spontaneous echo contrast in the left atrium was carefully sought. The left atrium was carefully searched for evidence of thrombus intraoperatively. The association of spontaneous echo contrast and left atrial thrombus was determined by univariate and multivariate analysis. Of the patients studied, 77 (30%) had left atrial thrombus. Left atrial thrombus was found in 47 and 21% of patients with and without spontaneous echo contrast, respectively (p < 0.001). Spontaneous echo contrast and atrial fibrillation were found to be the only two independent predictors of left atrial thrombus (odds ratio = 2.16; 95% confidence interval 1.15-4.04 p < 0.05, and odds ratio = 6.98; 95% confidence interval 3.45-14.16, p < 0.001, respectively). It was concluded that there is an independent association between spontaneous echo contrast on TTE and left atrial thrombus in patients with mitral valve disease requiring surgical correction. These patients are at high risk for left atrial thrombus and should, therefore, be considered for long-term anticoagulation.

Adult↗
PubMed1991

Effect of a selective restriction policy on antibiotic expenditure and use: an institutional model.

Strictly enforced antibiotic formulary restriction in combination with formulation of agreed guidelines for antibiotic use in common infection problems such as septicemia, febrile neutropenia, urinary tract infection, biliary sepsis, liver abscess, peritonitis, nosocomial pneumonia, soft tissue infection and purulent meningitis, generated a combined savings of 307,748.5 bahts or 13.5 per cent cost reduction over a 6 month period, and improved quality of use, appropriate 54.8 vs 67.5 per cent, statistically significance (P less than 0.002). Although this saving was offset in part by increased spending of unrestricted antibiotics, such as Penicillin and Gentamicin, an overall cost saving remained. In the months during the restrictions, no significant changes occurred regarding patients response and mortality. However, after the onset of the controls, it was revealed that antibiotics were more appropriately used afterwards. This study has shown, most importantly, that savings were achieved with no negative effect on good patient care. Moreover, the antibiotic use control was operationally successful, most house-staff and attending physicians, not only antibiotic evaluating team, have accepted the program in a very positive way. Overall, this program successfully achieved its initial goal, cost saving without compromising good medical practice. We are now continuing our program and also trying to modify so that it will be useful to all departments in the hospital.

Anti-Bacterial Agents↗
PubMed1990

The prevalence of obesity, risk factors and associated diseases in Klong Toey slum and Klong Toey government apartment houses.

The epidemiological study in low socioeconomic area of Bangkok, Klong Toey slum residents (n = 976) and apartment house residents (n = 906) of both sexes revealed the prevalence rates of overweight of 25.5% and 30.5%, obesity 10% and 11.1%; hypertension 17.3%; and 14%; diabetes 4.5% and 5.9%; IGT 6.1% and 4.4%; total abnormal GTT 10.6% and 10.3%; hypercholesterolemia 14.1% and 12%; hypertriglyceridemia 24.8% and 22.7%; low HDL-C 3.1% and 1.8%; hyperuricemia 7.7% and 10.4% respectively. The prevalence rates of the related diseases and conditions were increased when BMI was over 25 in both populations except for those with abnormal GTT and hyperuricemia in the slum residents. Concerning risk factors, discriminant analysis disclosed diastolic blood pressure (DBP) and atherogenic index as the first two factors significantly associated with overweight and obesity (BMI greater than 25) in both populations. Restructuring of the health service delivery system and care-taker re-educating together with production of meaningful mass communication media are needed for promotion of health care, prevention of these non-communicable diseases and their sequelae by non-pharmacological approach.

Adult↗
PubMed1989

The prevalence and risk factors of hypertension in Klong Toey slum and Klong Toey government apartment houses.

We have investigated the prevalence and factors associated with hypertension in 976 residents of Klong Toey Slum and 909 residents of government apartment houses, aged 30 and above, selected by probability sampling after systematic household surveys with an average response rate of over 80%. Hypertensives were those who had, on at least three measurements, average diastolic blood pressure equal to or above 95 mmHg and/or systolic blood pressure equal to or above 160 mmHg or had blood pressure below 160/95 mmHg but were currently on antihypertensive medication. The prevalence of total hypertensives were found to be 17.3% and 14.0% for residents of slum and government apartment houses respectively. Men and women had more or less equal mean blood pressure and similar prevalence of hypertension. The mean systolic blood pressure increased with age while the mean diastolic blood pressure, after an initial rise with age in lower age groups, tended to level off from the age group 55-64 years upwards. Only one quarter to one third were aware of their illness and less than 15% were receiving treatment. Significant risk factors include age, duration of smoking, duration of alcohol intake, high body mass index, high Cholesterol, high Triglyceride, high Low Density Lipoprotein Cholesterol (LDLC), low High Density Lipoprotein Cholesterol (HDLC), high Total Cholesterol (TC) to High Density Lipoprotein ratio (TC/HDLC), high LDLC to HDLC ratio and diabetes mellitus. The data suggested that hypertension was an important public health problem in low socioeconomic groups in Bangkok. Some of the risk factors were related to an unhealthy lifestyle which should receive due consideration in planning for appropriate control.

Adult↗
PubMed1987

The diagnostic properties of laboratory tests for rabies.

We have prospectively followed 915 victims bitten by 664 dogs between January 1984 and December 1985 to assess death and severe neurological disability. These dogs were brought either by the owner or bite victims to Ta Pra Diagnostic Centre for detection of rabies. Each patient was followed every three months by mail for at least one year after the bite. In addition, intensive follow-up in the community was undertaken on 235 patients who failed to respond to mail follow-up, all 23 who reported events as well as 523 of the 720 mail-responders. Hospital records were examined for all patients requiring treatment. All patients with non-fatal events were also examined at the university hospital. Blind independent comparison of the three diagnostic tests (Sellers stain, fluorescent antibody test and mouse inoculation test) for the presence or absence of rabies in animal brains were performed to assess the accuracy of local routine diagnostic test methods. In case of disagreement between test methods, the result on mouse inoculation was considered definitive for the presence or absence of rabies. Test results were mailed to all victims. Seven hundred and twenty out of 955 subjects responded to the mail follow-up giving a response rate of 75.4%. Intensive follow-ups were successful in all subjects who responded. Of 235 subjects who did not respond to the mail follow-up, only 195 (83%) were located. The remaining 40 bite victims who did not respond to mail follow-up and could not be located were all bitten by animals who did not have rabies.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1986

Mail follow-up of chronic diseases in northeast Thailand.

The use of mailed questionnaires to follow patients with chronic diseases was investigated in 650 patients from 16 provinces of northeastern Thailand who sought care at the University Hospital. The overall response rate to the first mail follow-up was 73.2%. If all three mail follow-ups were considered, up to 86.6% of all patients responded. The demographic variables appeared to be similar between the respondents and the non-respondents. Cancer and deterioration of disease status had an adverse effect on the response rate. Utilization of peripheral health centres to supplement mail follow-up in these sub-populations was suggested. Almost 78% of 650 patients were followed and interviewed to assess the validity of mailed response. The percentages of respondents and non-respondents who were followed were almost identical. Of the 504 patients followed, 92% were located. The successful location was over 98% for the respondents and only 54% for non-respondents. The agreement of some parameter such as death and survival time after discharge was very high between mail and intensive follow-up data. Less distinctive events had lower agreement rates. Some precautionary notes were voiced and the possibility of extension of mail follow-up in collection of information and supervision of health care was suggested.

Chronic Disease↗
PubMedDate not supplied

Evidence of an extended representation of the visual field in the superior colliculus of the rabbit (Oryctolagus cuniculus).

Electrophysiological mapping using multiple-unit criteria was employed to study the representation of the visual field in the superior colliculus of the rabbit. It was found that the contralateral superior colliculus of the rabbit has an extended representation beyond the representation of the zero vertical meridian or the line of decussation in the geniculostriate system. The amount of extended representation in the contralateral superior colliculus is coextensive with the extent of visual field represented ipsilaterally in areas 17 and 18 of the visual cortex. In agreement with previous findings, the representation of the visual field on the superior colliculus is extremely distorted. Finally, no evidence of an ipsilateral input can be produced.

Animals↗