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Background Lower respiratory tract infections (LRTIs) are the most common cause for hospitalization in pediatric patients. Pediatric patients with LRTIs are at an increased risk of morbidity and mortality. The national data analysis of epidemiologic variations facilitates awareness and develops solutions to prevent these conditions in the future. Objective This study aims to evaluate the epidemiology, causative pathogens, morbidity, and mortality of LRTIs in pediatric patients of Thailand from 2015 to 2019. Methods This was a retrospective study among pediatric patients aged between 0 and 18 years old admitted in hospitals due to LRTIs in Thailand from January 2015 to December 2019. The data were extracted from National Health Security Office using the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Thai Modification; ICD‐10‐TM of J09 to J22. Results A total of 1,423,509 children hospitalized due to LRTIs were identified. Most of the patients were of age 1–5 years. Pneumonia was the most common LRTI (876,557 children, 61.58%) in hospitalized children. Respiratory syncytial virus (RSV) is the main etiologic pathogen of bronchiolitis, which presents in approximately 10.86% of all episodes. Influenza viruses were found predominantly in children with pneumonia (15.52%). The mortality rate since 2015–2019 was highest in pneumonia under 1 year old (P

Background : The natural history of valvular regurgitation detected by echocardiography in Sydenham's chorea has been lacking. Methods : Clinical assessment and transthoracic color Doppler echocardiography were independently performed for each patient with an initial attack of Sydenham's chorea and also for each normal control (Khon Kaen University, Thailand; 1991–2001) at the time of their presentations. Serial clinical examinations and echocardiography were done for each patient at 1- and at 5-year follow-up. Results : Of 44 patients, 17 (39%) had carditis (valvulitis) evident by auscultation at the time of the initial attack. Three (11%) of the 27 patients with no clinical evidence of carditis had echocardiographic evidence of acute mitral regurgitation (subclinical valvulitis). All 17 patients with carditis had echocardiographic evidence of acute mitral regurgitation. None of the 88 control children had evidence of pathologically significant valvular regurgitation. Of the 15 patients with carditis regularly followed, the persistence of a mitral regurgitation murmur and of pathologically significant valvular regurgitation by echocardiography were 33% (5/15) and 60% (9/15), respectively, at 1-year follow-up, but the persistence of both was 25% (1/4) at 5-year follow-up. Conclusions : Color Doppler echocardiography is a useful tool in the early diagnosis of rheumatic carditis (valvulitis) and at 1-year follow-up of rheumatic valvular heart disease in the patients with initial Sydenham's chorea but the incremental benefit beyond 5 years after the initial attack might be minimal.

Adolescence is generally a period of good physical health, but future health problems may begin at this age due to exposure to risk factors for diseases.To analyze the health situation of adolescents (age 13-18years) in Thailand in order to derive guidance for the refinement and calibration of the medical curriculum and enhance health service provision to adolescents.National data from Thailand's 3 major health care systems, regarding; the causes of out-patient visits, in-patient admissions and deaths in the fiscal year 2010 were analyzed.The leading causes of out-patient visits were (1) factors influencing health (2) respiratory infections (3) diseases of the digestive system (4) injury and poisoning and (5) external causes of morbidity and mortality. The leading causes of admissions were (1) pregnancy (2) injury and poisoning and (3) arthropod-borne viral fevers. The leading causes of hospital deaths were (1) injury and poisoning (2) neoplasms and (3) other infections.The majority of the causes of morbidity and mortality were related to psychosocial factors and engagement in high risk behaviors.

Unintended pregnancy during adolescence can have profound effects on adolescents, their parents and family, the child and the country's developing population.To analyze the adolescent pregnancy situation in Thailand in order to provide data and suggestions for refining the nation's medical curricula and enhancing health services for adolescents.National data from Thailand's 3 major health care systems, regarding; adolescent pregnancy complications, deliveries, outcomes and deaths in the 2010 fiscal year were analyzed and compared to women 20-34 years of age.There were 80,523 adolescent pregnancies, comprising 25.9% of all pregnancies. The pregnancy rate for 15-19 year-olds was 33.4 per 1,000 and abortion was the outcome in 14.4%, (18.0% of all abortions). The adolescent birth rate was 28.7 in women 15-19 years of age-on average, there were 188.8 adolescent deliveries per day. Adolescents gave birth to 37.2% of all preterm infants: the preterm birth rate was significantly greater than in women in the optimum reproductive age. Most deliveries were spontaneous vertex deliveries with lower complications and mortality rates than for women in the optimum reproductive age.Unintended pregnancy can have profound effects on adolescent parents, their parents and families, the child and the country's developing population. It should, therefore, be considered a major public health problem that warrants immediate intervention at the national level.

Dengue is an important cause of morbidity and mortality in tropical and subtropical regions of the world. In Thailand, there has been no detailed research on mortality in children in terms of duration of admission and associated complications in the cases that died.To assess the burden of dengue in Thailand in 2010 and to analyze the complications in patients aged under 18 years who died.The authors described the mortality and complications of dengue fever and dengue hemorrhagic fever in patients under 18 years old using the information from the Health Situation Analysis of the Thai Population 2010 Project.In 2010, the overall mortality of dengue in all age groups and in patients aged under 18 years were 0.3 and 0.6/ 100,000, respectively. The mortality rate was highest among children aged 6-12 years (0.8/100,000). Among the 8 children with dengue fever that died, the 2 most common complications were fluid electrolyte and acid-base imbalance and disseminated intravascular coagulation (DIC). The common complications among the 91 cases with dengue hemorrhagic fever that died included fluid electrolyte and acid-base imbalance, hepatic failure, respiratory failure, bacterial infection, DIC and renal failure.Early diagnosis, careful management of fluid therapy, awareness of hepatic and renal impairment and early treatment of co-infection should decrease mortality of dengue hemorrhagic fever

Health problems and service utilization patterns among Thai populations have changed significantly over the past three decades. It is imperative to scrutinize the changes so that the health service and human resource development systems can appropriately respond to the changing health needs.To synthesize critical issues for future planning of health service reforms, medical education reforms and health research for Thai society.The authors analyzed data on health service utilization, types of illnesses and hospital deaths among Thais in the fiscal year 2010. Information on the illnesses of in-/out-patients and hospital deaths was extracted from the three main health insurance schemes providing coverage to 96% of the population. The authors then synthesized the key issues for reforming medical education and health services.In summary, Thai patients have better access to health services. The total number of out-patient visits was 326,230,155 times or 5.23 visits per population. The total number of in-patient admissions was 6,880,815 times or 0.11 admissions per population. The most frequent users were between 40-59 years of age. The most common conditions seen at OPD and IPD and the causes of in-hospital mortality varied between age-groups. The key health issues identified were: psychosocial conditions, health behaviour problems, perinatal complications, congenital malformations, teenage pregnancy, injury, infectious diseases, cardiovascular diseases and neoplasms. Medical education reforms need to be designed in terms of both undergraduate and post-graduate education and/or specialty clinical needs. Health service reforms should be designed in terms of patient care systems, roles of multidisciplinary teams and community involvement.The government and other responsible organizations need to actively respond by designing the health service systems and human resource development systems that are relevant, appropriate and integrated. Different levels of care need to work collaboratively in order to achieve the greatest quality and efficiency.

Immune thrombocytopenic purpura (ITP) is not rare disease and it ispotentially fatal, particularly in patients with bleeding events which usually lead to hospitalization. Current data on the impact and disease burden of ITP in Thailand are lacking.To determine admission rate, mortality rate, hospital cost, length of hospital stay, co-morbidities, treatment and major bleeding events in patients with ITP.The authors analyzed the data of inpatients with a diagnosis of ITP according to ICD10 coded D69.3 which were retrieved from a nationwide health financing schemes in fiscal 2010. The data were analyzed by age groups, gender and health financing schemes.The overall admission rate and mortality rate were 7.68 and 0.29 per 100,000 populations, respectively and increased with age. Women were predominant. Average hospital costs and hospital stays were 27,133 Baht and 6.7 days per admission, respectively and slightly higher among men than women. The most common co-morbidity was hypertension. Gastrointestinal hemorrhage was the most common bleeding event which was 21.5 per 1,000 admissions. Patients in the civil servant medical benefit scheme had the highest percentage of high cost treatment accessibility.The admission rate, mortality rate and major bleeding events increased with age and was higher among women than men. Average hospital cost and length of hospital stay are higher in men than women. Common co-morbidities may be related to the treatment of ITP There are the differences in high-cost treatment accessibility between health insurance schemes.

Age-specific causes of death yield important information for planning health services and medical education.To compare the age-specific causes of death between in-hospital deaths and death registration statistics.Information on in-hospital mortality in fiscal 2010 was extracted from the three health insurance schemes. Death registrations (ICD-10 coding) were from the Bureau of Registration Administration, Ministry of Interior Statistics on the age-specific causes of death were analyzed.In-hospital deaths numbered 132,512 (47.5% occurring in tertiary care) vs. 411,331 recorded in vital statistics (68% died outside hospitals). Most (74%) infants died in-hospital so causes were clearly documented vs. death registration. A minority (6.2%) of in-hospital deaths and of death registrations (9.7%) were due to unnatural causes. The majority (79.5%) of unnatural deaths died before arriving at hospital. Ill-defined codes for causes of death were found in 6.1% of in-hospital records and 42.2% of death registrations. After censoring ill-defined codes, the ten leading, age-specific causes of death agreed between the two data sets.Medical personnel should receive training to do proper death certification. Periodic validation of hospital COD certification should also be done. Use of verbal autopsy in the Thai context would help to standardize record-keeping and to reduce ill-defined codes for deaths occurred outside hospital.

Between 1990 and 2010, many national and international factors converged to both beneficially and antagonistically affect people's health as well as the Thai healthcare system. Among these were: a falling birth rate in Thailand and a gradual decline in poverty-related diseases. Cancer becomes the most common cause of death.To analyze Thailand's childhood neoplasm issues for baseline information for changing medical education, services and research.Information on the illnesses of in-patients, out-patients and casualties was based on hospital withdrawals nationwide from the three health insurance schemes in the fiscal year 2010. The data, which included 96% of the population, were analyzed by age groups and burden of neoplasm disease.The children with neoplasms were treated 127,597 times at outpatient departments (OPD) and 19,159 times at inpatient departments (IPD) at community hospitals (4.3%), provincial hospitals (8.50%), regional or university hospitals (86.1%) and private hospitals (1.1%). Malignant neoplasms of lymphoid hematopoietic and related tissues were the most common in both IPD and OPD settings, which resulted in the highest cost of treatment. Tumors of the central nervous system were associated with the highest cost. The mean length of stay for all patients with neoplasm was 7.85 days.Sufficient budget should be allocated to the more heavily frequented treatment center Specific and better care, national treatment protocols for each type of childhood cancer (including palliative care) should be developed to improve the treatment outcomes and/or the quality of life. Medical schools and health service systems need to be recalibrated to respond proactively to these changes being experienced by the healthcare system.

Unintentional injury has been identified as a public health problem in Thailand as it is the leading cause of death among both children and adolescents.To explore the number of admissions by unintentional injury and cause(s) among Thai children and adolescents in 2010.Data on the number of admissions by unintentional injury in the fiscal year, 2010, were derived from hospitals nationwide as well as the three health insurance schemes. Data on Thai children and adolescents (0-18 years) was collected between October 1, 2009 and September 30, 2010. The coding for underlying cause(s) of unintentional injuries and death were done using the International Classification of Diseases, 10th edition.A total of 118,323 unintentional injuries were reported. The majority of patients were male and falls were the major cause of unintentional injuries (27,139 admissions; 22.94%) followed by motorcycle injuries (20,499 admissions; 17.32%). Accidental drowning and submersion was the major cause of death in the present study, followed by lightning strikes and accidental threats to breathing (i.e., choking and suffocation).The current study revealed that falls were the major cause of unintentional injury and accidental drowning and submersion the major cause of death.

Please cite this paper as: Phungoen et al. (2011) Clinical factors predictive of PCR positive in pandemic H1N1 2009 influenza virus infection. Influenza and Other Respiratory Viruses 5(6), e558–e562. Objective Pandemic H1N1 2009 influenza virus (H1N1) has been spreading globally. Clinical features might be predictive and may be different among countries. Even though the PCR test is a confirmatory test for this viral infection, it is expensive and limited in most Thai health care facilities. We studied predictive factors of PCR positive in H1N1 suspected patients. Methods Consecutive patients who had influenza‐like illness less than seven days and had been tested for H1N1 by the real‐time PCR method between May and July 2009 were enrolled. Clinical data was collected and compared between those who had positive and negative PCR tests. Results There were 6494 patients had flu‐like symptoms. Of those, 166 patients were done PCR test and 75 patients (45·18%) had positive PCR test. There were four predictors for positive PCR test including history of contact with confirmed H1N1 patients, headache, body temperature, and coryza with the adjusted odds ratio (95% confidence interval) of 2·84 (1·09–7·40), 6·25 (1·42–27·49), 1·69 (1·08–2·66), and 0·31 (0·12–0·79), respectively. Conclusions Clinical factors can be both suggestive and protective factors for H1N1 infection. These factors may be helpful in clinical practice to assess the possibility of the H1N1 infection in people who are at risk; particularly in resource‐limited health care facilities.

A clinical trial to assess the immunogenicity and reactogenicity of two doses of varicella vaccine (live attenuated Oka-strain, GlaxoSmithKline Biologicals), when either given 8 or 4 weeks apart in healthy seronegative adolescents and young adults, was conducted in Khon Kaen and Bangkok, Thailand. Contrary to seroconversion rates generally reported for this age group, in our study all subjects were already seropositive after the first vaccine dose. After the first vaccine dose, geometric mean titers (GMTs) for anti-varicella antibodies were 78.4 (median 64) for the adolescent group and 136.5 (median 128) for the young adult group. Six weeks after administration of the second dose, anti-varicella GMTs reached 331.7 (median 256) and 636.9 (median 512) for the adolescent and young adult groups, respectively, with a 4.2-4.7-fold increase from pre-vaccination titers. The difference in GMTs between post-dose I and dose II was statistically significant for each group. The reactogenicity after the first and second doses of vaccination was low: no varicella rash was seen, in either the shorter or longer schedule. GlaxoSmithKline Biologicals varicella vaccine (Varilix) offered a high flexibility, administration possible at either 4 or 8 weeks interval, whilst eliciting good immunogenicity and good tolerability.