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To quantify the admission mortality, pathogens,factors related to mortality, length of hospital stay, and healthcare costs in adult hospitalized pneumonia in ThailandThe data on hospitalized pneumonia for the 2010 fiscal year extracted from the three main health insurance coverage schemes in Thailand (the Social Security System (SSS), the Medical Welfare System (MWS), and the Civil Servant Medical Benefit System (CSMBS)) were analyzedAdult hospitalized pneumonia admissions numbered 136,696, with mortality rate 9.63%. The mortality increased with increasing age, 15.49% for age80 years. Influenza virus was the major etiology for 19 to 25 years old (49.30%) with low mortality (1-2%). S. pneumoniae and typical pathogens were found in every age group. The mortality rate for S. pneumoniae increased with age, viz. 0%, 1.96%, 5.56%, 7.02%, 6.98%, and 24.24% for 19 to 25, 26 to 40, 41 to 60, 61 to 70, 71 to 80, and 81+ years old. The mortality rate from C. pneumonia was about 10% and high among the younger age group. Gram-negative bacilli and Staphylococcus caused high mortality (about 20 to 35%), especially in the older age group. The major risk factors for increasing mortality were: elderly (OR 3.46, 95% CI 3.27-3.77), alcoholic liver disease (OR 3.26, 95% CI 2.85-3.72), cirrhosis (OR 3.45, 95% CI 2.93-4.08), heart disease (OR 2.47, 95% CI 2.38-2.56), ischemic heart disease (OR 2.21, 95% CI 2.07-2.36), renal failure (OR 5.26, 95% CI 5.07-5.49), and cerebrovascular disease (OR 3.62, 95% CI 3.43-3.82). The median length of hospital stay was four days (IQR, 3-7 days) and the median cost of treatment per admission was US$ 256.63 (IQR, US$ 147.81-531.21). Complications such as acute respiratory failure, acute respiratory distress syndrome (ARDS), septicemia, shock, and acute renal failure made hospital stays two to three days longer and costs three to seven times higher than no complications.The mortality from pneumonia among the elderly was high, especially for those over 80 and with multiple medical co-morbidities.

The rate of cardiovascular disease marked by coronary artery disease (CAD) is increasing in low-middle income countries including Thailand. The burden of CAD will have a significant impact on the healthcare system and the national budget.To identify the CAD-related hospitalization rate over one year; to determine in-hospital mortality in various subgroups of patients with CAD and to examine the hospitalization costs of patients with CAD.The data were extracted from in-patient discharge forms from the three main health insurance schemes in Thailand for the fiscal year 2010 (October 1, 2009 to September 30, 2010. The data included the three major health insurance schemes which provided coverage for about 62 million people (96% of the population). Data regarding coronary artery disease using the ICD-10 (I20-angina, I21-acute myocardial infarction (AMI) and I25-chronic ischemic heart disease) were extracted and analyzed for number of admissions, mortality rate, length of hospital stay and hospital charges.In 2010, the total admissions of patients with coronary artery disease were 22,507. The most common presentation of CAD was angina pectoris (10,822 admissions)followed by AMI (6,391 admissions) and chronic ischemic heart disease (5,294 admissions). The respective in-hospital mortality rates in patients admitted with AMI, chronic ischemic heart disease and angina pectoris were 11.3%, 2.9% and 0.7%.Thailand is entering a period of epidemiologic transition marked by an increase of cardiovascular disease and hospital expenses dominated by cardiovascular disease. Information on the burden of CAD--indicates a need to improve health care system.

To date, only small, selected groups of elderly hospitalized with mental and behavioral disorders (EHMBD) have been studied. Since no national epidemiological studies have been published, the recent advent of universal healthcare in Thailand makes doing such a study timely for improving the medical curricula and service provision.To analyze the epidemiology of the EHMBD in the year 2010 of Thailand.The data analyzed were gathered from Medical Expense Reimbursement forms submitted for the fiscal year 2010. The particular focus of this research was on elderly inpatient aged 60 years and over with ICD-10 (for 2010) diagnosis: F00-F99 Mental and Behavioral Disorders. The authors extracted and analyzed the number of in-patient department (IPD) admissions, psychiatric diagnoses, length of hospital stays, hospital charges and mortality rate. Data were analyzed using SPSS 17 for Windows.In 2010, EHMBD accounted for 11,418 admissions which was 1.56 admission per 1000 elderly people or 13.9% of overall admission (19 years and over). Of the 11,418 admission, 44 died (0.39%). The mean in-patient charges/admission in Thai Baht (SD) for the EHMBD with any F00-F99 diagnosis was 12,896 (51,659). The average range of stay was 8.3 +/- 22.2 days. The leading diagnosed clusters of behavioral and mental disorders were organic mental disorders (F00-F09: 23.8%), neurotic, stress-related and somatoform disorders (F40-F48: 21.1%); and mental and behavioral disorders due to use of alcohol (F10: 20.3%). Alcohol use disorders among the elderly resulted in four times more men being hospitalized than women. Regarding the F30-F39 cluster mood (affective) disorders, the prevalence of depressive episodes increased with age and bipolar affective disorder decreased with age.The prevalence of hospitalization among the elderly with mental and behavioral disorders was about one-eighth that of all admission of adult from 19 years old. Death was an uncommon result. The most common psychiatric diagnoses were organic mental disorders, neurotic, stress-related and somatoform disorders and mental and behavioral disorders due to use of alcohol.

Fall is a preventable condition associated with disability and mortality in elders. The overall data regarding admission rates and its impact in Thai elderly are lacking.To identify admission, mortality rates of older persons with fall, its causes and consequences.Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups in older patients with fall.There were 311,132 falls of all admissions; accounting for admission and mortality rates of 423.4 and 11.1/100,000 older persons. The number rose with age. Slipping, tripping were the major causes. The average length of stay (LOS) of fallers with and without fractures was 8.1 and 6.4 days. The average hospital costs in these same groups were 25,728 and 19,419.3 Baht.The increasing age is related to an increased admission and mortality rates of fall. Slipping, tripping was the frequent causes. Greater LOS and hospital charges were found in fallers with fractures. Allied-healthcare workers should routinely implement a fall assessment and educate modifiable factors to elders to prevent future fall.

Thailand has reached an ageing society on account of demographic transitions. Hospitalized elders are susceptible to having detrimental consequences in many aspects. Understanding the situation regarding elders being hospitalized would help allied-healthcare workers to focus and take necessary action on particular issues.To demonstrate the admission rate of elders, common causes of hospitalization and their mortality rates.Information on illness of inpatients and casualties came from hospitals nationwide and from hospitals withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups and burdensome diseases.Elders posed the highest rate of all hospitalization (24.3/100 older persons) and the proportion increased with age. The top three common causes for hospitalization were diseases of respiratory tract (13%), circulatory (12%) and digestive system (11%). Mortality rates were highest in elders with pneumonia (129.7/100,000 persons).Older hospitalization was the highest for all hospitalization ages. Common causes for hospitalization are partly the consequences of modifiable factors. Thus, healthcare providers require extensive effort to enhance education and training to allied-healthcare workers regarding preventive and early diagnosis strategies to those with frequent illnesses.

Delirium is a frequent complication associated with hospitalization of older adults leading to serious complications but it is potentially preventable. The overall data regarding admission rates and its impact in Thai geriatrics are limited.To identify admission, mortality rates of older persons with delirium and its consequences.Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the three health insurance schemes in fiscal 2010. The data included 96% of the population. The data were analyzed by age groups in delirious patients.Delirium occurred in 11,410 of all admissions; contributing admission and mortality rates of 155.4 and 6.4/100,000 older persons. These figures increased with age. The average length of stay in persons with and without delirium were 22.3 and 5.4 days and the average hospital charges were 53,174 and 18,230.8 Baht, respectively.The admission rate of patients with delirium was lower than prior reports; underdetection and underreport should be considered. Admission and mortality rates rose with age. There was an increase in length of stay and hospital charges.

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.

Colorectal cancer incidence rate is high and expected to increase in Thailand. But it is a preventable and curable disease if found in the early stage of development. The overall data regarding admission rates and healthcare cost in Thai patients are lacking.To identify admission rates and healthcare cost of colorectal cancer.Information on illness of inpatients and casualties came from hospitals nationwide and from hospital withdrawals from the 3 health insurance schemes in fiscal 2010. The data included 96% of the population and were analyzed by age groups, hospital level and insurance schemes in patients with colorectal cancer.Colorectal cancer occurred in 45,692 of all admissions, contributing to admission rates of 98.5 per 100,000 persons. These figures increased with age. The highest admission was found in the central region including Bangkok (43%) followed by the northeast region (23%). The average hospital charges per admission in three insurance schemes groups: government welfare, social welfare and universal coverage were 64,241, 49,490 and 28,588 Baht, respectivelyAdmission rates showed that colorectal cancer increased with age. The highest rate was observed in sixty years and older The hospital charges were extensive, especially in those on the government welfare scheme. Thus, screening programs, cost-effective analysis of treatment modalities and treatment protocol for the elderly should be examined.

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.

Non-typhoidal salmonellosis is a major cause of food-borne illness in Thailand. Specific serotyping of Salmonellae, linked with certain foods, can be used to identify outbreaks, transmission, and for surveillance. We aimed to identify the chain of non-typhoidal Salmonella transmission from food to humans in five slums, two open markets, four supermarkets and an abattoir in the municipality of Khon Kaen. During three months representing the cool-dry, hot-dry, and rainy seasons of 2002, culture samples were collected from water, food, pork, and chicken. Stool cultures of food venders, and others in the same area, were performed. Serological typing was done by the WHO National Salmonella and Shigella Center in Thailand. Of the food, drinking water, and stool samples from food handlers and healthy persons, 18, 7, 11, and 5%, respectively, were positive for Salmonella. Nearly all (96-98%) of the fresh pork and chicken, both from the open markets and supermarkets, were positive for Salmonella. The major Salmonella serovars were S. Anatum, S. Rissen, S. Virchow, S. Enteritidis and S. Panama, similar throughout the food chain and to the other reports that year. To reduce the incidence of human salmonellosis, several preventative measures must be taken where animals are produced, slaughtered and processed, and at home and in eateries. Vulnerable groups, such as infants, the elderly and the immuno-compromised, should be made aware of their increased susceptibility to food-borne disease.