The office of disease prevention and control 9th Nakhon Ratchasima Journal

A study of health conditions of nursing student Boromarajonani College of Nursing Sunpasitthiprasong During 2018-2021 C.E.

Orathai Promkaew — 2024-08-09

This research is a retrospective descriptive study aimed at examining changes in the health status of Bachelor of Nursing students from Boromarajonani College of Nursing Sunpasitthiprasong across two cohorts (the 48^th with 175 students and the 49^th with 196 students). The study analyzed annual health examination results from 2018 to 2021, covering the 2^nd, 3^rd, and 4^th years of study. The health examinations included measurements of body mass index (BMI), vital signs and blood pressure, completed blood count or packed red blood cell volume (HCT), and chest radiographs. Each examination result was evaluated to classify as normal or abnormal. The data were then analyzed using frequency distribution, percentage, and average. The results showed that the majority of the students’ health conditions were within normal levels, with only small portion exhibiting abnormalities. Significant changes in BMI were observed during the 3^rdand 4^th years of study. The percentage and average results were as follows: 1) body mass index (BMI): Both cohorts had dangerously high obese levels, with averages of 4.54% for the48^th generation and 1.02% for the 49^th generation. The total BMI exceeded the criteria, with the 48^th generation having a higher average percentage than the 49^th generation (25.68% vs.17.34%). 2) high blood pressure: Abnormal high blood pressure (level 1) was observed in 0.57% of the 48^th generation and 0.51% of the 49^th generation. 3) Complete blood count (HCT): The packed red blood cell volume was lower than normal in 9.14% of the 48^thgeneration and 11.73% of the 49^th generation. 4) Chest X-ray: Abnormal thoracic bone characteristics were found in 2.29% of the 48^th generation and 1.53% of the 49^th generation. To address health issues, several key recommendations should be considered. Firstly, any abnormal findings from health assessments should be followed up with diagnostic tests and treatment to ensure appropriate care. Secondly, activities should be organized to inform students about periods when health conditions and BMI may change, and to provide strategies for prevention. Finally, encouraging 3^rd and 4^th-year students to participate in outdoor activities is crucial. Promoting physical exercise helps reduce factors contributing to increased BMI and supports overall well-being.

Competencies and Training Needs in Epidemiology: 2023 Public Health Workforce in Health Region 9

Phimruethai Chongkratok — 2024-08-09

The Field Epidemiology Training Center (FETC) plays a crucial role in developing the workforce in the field of epidemiology. The Epidemiology Division of the Department of Disease Control has established standards and guidelines for developing the capacity of the Surveillance Rapid Response Team (SRRT). However, there may still be a lack of understanding regarding individual competencies to reflect the efficiency of their work and the need for epidemiology knowledge development. Therefore, the study was conducted to assess the competencies and development needs in the field of epidemiology. A cross-sectional study design was used, focusing on public health personnel working in the field of epidemiology in Health Region 9. The study included 396 participants, with data collected between March and July 2023. The study found that the majority of respondents were female (64.9%), with a median age of 35 years (ranging from 30 to 45). Approximately 68.9% of participants held the position of public health officer, and 86.6% had completed a bachelor's degree. The proportion of individuals self-assessing their epidemiological competency at a high to the highest level included their ability to establish cooperation with communities in their area of responsibility for disease prevention and control. Additionally, the proportion of those indicating a high to the highest level of need for epidemiological development included competencies related to investigating diseases and formulating assumptions for disease investigations within their area of responsibility. The study also identified a significant statistical relationship between gender, epidemiological training, and competency scores (p<0.05). This suggests that gender and epidemiological training impact the competency levels of public health personnel in Health Region 9. In conclusion, the results of the competency assessment and the identification of development needs will serve as a framework for planning and enhancing the public health workforce in Health Region 9. The goal is to ensure their effectiveness in disease prevention and control at all levels.

The Effectiveness of Clopidogrel and Omeprazole in preventing recurrent of ischemic stroke among ischemic stroke patients at Nangrong Hospital, Narong District, Buriram Province

Jakkrid Banjong — 2024-08-09

Ischemic stroke is a common condition among elderly people that can lead to various health problems and even death. Preventing recurrent ischemic stroke is crucial for physicians to improve patient treatment and reduce mortality. This study aims to evaluate the effectiveness of Clopidogrel and Omeprazole in preventing recurrent ischemic strokes. An analytical retrospective case-control study was conducted on ischemic stroke patients who were given Clopidogrel to prevent recurrence. The study included residents of Nangrong aged 18 and older who were newly treated with Clopidogrel following an ischemic stroke between January 1, 2018, and December 31, 2022, at Nangrong Hospital in Buriram province. The case patients were those who were readmitted within a year following their initial diagnosis of ischemic stroke. Control patients were individuals who had remained stroke-free for at least one year and were matched with case patients in terms of age and gender at a 1:1 ratio. The results showed that among the 1,118 patients who received newly initiated Clopidogrel treatment for ischemic stroke, 139 cases were readmitted for the same condition within one year. We matched these cases with 139 controls and found that 116 patients (83.4%) in the case group and 126 patients (90.6%) in the control group were also treated with Omeprazole. After conducting multivariable analysis, we determined that the concurrent use of Omeprazole and Clopidogrel did not significantly increase the risk of recurrent ischemic stroke. The adjusted odds ratio was0.55 (95% CI = 0.25–1.22). Therefore, we can conclude that the simultaneous administration of Omeprazole and Clopidogrel is not associated with an elevated risk of recurrent ischemic stroke.

Evaluation of Operations according to the 5-year Strategic Plan Office of Disease Prevention and Control 9th Nakhon Ratchasima during the Fiscal Year 2020–2021

Pagamas Sukharee — 2024-08-09

The objectives of this research were to evaluate the process of the Office of Disease Prevention and Control 9^th (ODPC9) Nakhon Ratchasima 5^th year strategic plan for Fiscal Year 2020–2021 and to conduct a needs assessment for disease and health hazard surveillance, prevention, and control in health region 9. The Deming Cycle was used for the evaluation. Data were collected through in-depth interviews, questionnaires, and data recording forms from 32 health personnel of the ODPC9 and 221 personnel in Provincial Public Health Office, District Health Office, and Public Hospitals in health region 9 between July 2022 and January 2023. Frequency, percentage, mean, standard deviation, and content analysis were used for data analysis. The results indicated that 1) Key performance indicators of the goals were unclear. The strategic implementation comprised ODPC9 projects, with most activities focusing on the first strategy. The majority of implementations had a mean score () and a standard deviation (S.D.) of 3.89±0.86, and the opportunity to achieve goals had a mean score () and S.D. of 3.92±0.82, indicating a high level. Monitoring, evaluation, and implementation of strategic plan reviews were unclear. 2) The need for operational support was at the highest level of operational steps. It is suggested that monitoring and summative evaluation of the strategic plan for success should be conducted clearly.

Performance of Government Service Assessment According to Enhancement Measures for Efficiency of Government Service in Ministry of Public Health and Affiliated Agencies

Phatchadaporn Kunkeaw — 2024-08-09

This research employed a mixed-methods study, applying Stufflebeam’s CIPP Model as the assessment guidance. The objectives were to evaluate government service performance in accordance with enhancement measures for efficiency and to examine factors contributing to success, obstacles, and recommendations for improvement within the Ministry of Public Health and its affiliated agencies. The sample group for the quantitative research consisted of 108 personnel responsible for implementing and evaluating government service performance under the specified measures. The sample group for the qualitative research consisted of 18 members of committees overseeing the assessment process. Data was collected between June and August 2023 through questionnaires and interviews. Quantitative data were analyzed using descriptive statistics, while qualitative data were analyzed using content analysis. The results revealed the perception of government service assessment performance, based on the enhancement measures for efficiency within the Ministry of Public Health and its affiliated agencies, as assessed by the CIPP model. Context and output evaluations received the highest scores (= 4.43, 4.40; S.D. = 0.55, 0.53, respectively), followed by input and process evaluations which also garnered high scores ( =4.05, 4.18; S.D. = 0.59, 0.55, respectively). To achieve success, executives must recognize the importance of assessing government services as part of the efficiency enhancement measures implemented by the Ministry of Public Health and its affiliated agencies. The organization or public sector should provide adequate resources, including human resources, budget allocations, and information and communication technology systems. Additionally, personnel should possess the necessary knowledge, understanding, and capability to engage in all processes from inception to completion. However, several challenges exist. Executives and staff lack awareness of the significance of assessing government services within the efficiency enhancement framework. Moreover, there are insufficient personnel dedicated to this task, which leads to workload issues. This shortage results in decreased morale, motivation, and productivity. Additionally, shortcomings in the efficiency of information and communication technology systems, as well as in monitoring and evaluation processes, contribute to suboptimal outcomes. These findings suggest the need for executives and relevant personnel to raise awareness, prioritize, and support government service assessment activities that align with efficiency enhancement measures. This involves addressing various aspects, including policy, budgeting, human resources, information and communication technology systems, knowledge dissemination, empowerment, and motivation. Furthermore, it is important to ensure that appropriate monitoring, tracking, and evaluation mechanisms are in place to facilitate continuous improvement.

Model development of Occupational Health and Environmental Medicine Services Ban Song Sub-District Health Promoting Hospital Chaloem Phra Kiat District Nakhon Ratchasima Province, 2022

Supapon Saensri — 2024-08-09

Implementing occupational and environmental health services according to the standards is crucial for providing a framework for both proactive and reactive occupational and environmental health operations. This research aimed to develop a model for operating occupational and environmental health services at a sub-district health promotion hospital (HPPH). The study selected a representative sample area, the HPPH in Ban Song District, Chaloem Phra Kiat, Nakhon Ratchasima. Participants included six HPPH staff and four personnel from network organizations. Data were collected from January to May 2022 using the Participatory Action and Operations Research (PAOR) process. This involved interviews, tests, and evaluations based on occupational health service standards. Quantitative data were analyzed using percentages, while qualitative data were subjected to content analysis. The results revealed a developed operational model consisting of three components: 1) policy and team involvement (adjusting mindset), 2) workforce capacity building (knowledge enhancement), and 3) compilation of work results, data summarization, and evaluation based on standard criteria (process refinement). Post-development, HPPH staff demonstrated a high level of knowledge in occupational health operations at 86%, and the evaluation results achieved excellent standards. Based on these study outcomes, the operational model can be adapted for use in other HPPHs. For successful implementation, HPPHs should receive support from provincial-level organizations, undergo continuous academic supervision and performance assessments, prioritize staff improvement through training, and maintain ongoing information sharing and model expansion.

Development of value-based health service packages and Value-Based Payment methods for Health Promotion and Preventing diabetes among risk people of diabetes, Health Region 9

Wijitra Phaungko — 2024-08-09

This research aims to develop a model of health service for health promotion and disease prevention in people at risk of diabetes, linked to value-based payment, and to compare behavior modification in at-risk groups. This participatory action research (PAR) utilizes the PAOR process, which includes planning (P), Action (A), Observation (O), and reflection (R). The study is conducted in 4 purposively selected community hospitals: Hospitals A, B, C and D. A sample of 1,586 people from the diabetes risk group was selected using a purposive sampling method along with 16 purposive samples assigned responsibility for implementing measures to reduce the risk of chronic non-communicable diseases. The study period was from October 2022 to November 2023. Data were analyzed using descriptive statistics, Paired t-tests for analytical statistic, and content analysis for qualitative data. The results of this study include a model for organizing health service packages and a Value-Based Payment method for promoting health and preventing diabetes in people at risk, with the participation of network agencies responsible for implementing diabetes risk reduction measures. These efforts are aimed at driving the policy and operational measures under the NCD Board at the district and provincial levels. There was clear communication and understanding of guidelines, with participation in planning, decision-making, and evaluating results after implementing this model. It was found that the mean BMI and blood sugar levels significantly decreased after the intervention (p<0.001). From the results of this study, it can be concluded that the effectiveness of the behavior modification program for diabetes, combined with Value-Based Payment for health promotion and diabetes prevention, depends on its application in the context of health service units and participation in community-level networks.

Investigation of the First Case of Monkeypox in Chaiyaphum Province, from August 21 to September 11, 2023

Sabaitong Hanbungkla — 2024-08-09

On August 21, 2023, the Province Public Health Office, Chaiyaphum received notification of a confirmed case of monkeypox (mpox) from Pattaya, Chonburi Province. The individual in question had a history of sexual contact with an unknown man. An investigation was conducted to confirm the diagnosis, describe the epidemiological characteristics of the case, identify risk factors, determine the transmission source, examine infection among the case's contacts, and recommend appropriate preventive and control measures. The descriptive study involved reviewing the patient’s medical records from the hospital and case reports, interviewing the patient, close family contacts, physicians, and health personnel involved in the patient’s care. Samples were collected from the patient to detect the mpox virus using real-time PCR and to identify viral strain through genome sequencing. An environmental study was also conducted, and the mpox surveillance system in Thepsathit district was assessed. The results identified one confirmed case of mpox in a 33-year-old Thai male with HIV infection, who identifies as gay (LGBTQ). He had traveled by bus from Pattaya, Chonburi province, and experienced symptoms such as fever, muscle pain, pain and swelling in the inguinal lymph nodes, and developed rashes and papules that first appeared on perineum on August 14, 2023, and before spreading across his body. Samples from the lesion roof of a pustule on the penis tested positive for the mpox virus in two laboratories, with the viral strain identified as West Africa cade IIa. All four high-risk, six low-risk and twelve no-risk contacts of this case tested negative for mpox infection. Although he was an imported case, there was no evidence of transmission to others or futher spread in Chaiyaphum province. The mpox surveillance system in Thepsathit district was improved. The identified risk factor for mpox virus infection was direct contact through sexual activity with infectious skin or other lesions, such as those in the mouth or on the genitals. The individual had changed sexual partners through a dating application for the gay community. Therefore, we recommended that hospitals include emerging infectious diseases in their surveillance system to timely update the situation. This can be achieved by designed a surveillance report for suspected cases of mpox for patian care wards, clinics, and pharmacies, and by adding risk communication channels in sexually transmitted disease clinics and LGBTQ groups.