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Number 16 on page 343 When the same hypothesis is tested in two different population and the resulting P values are on the opposite sides of 0.05, the results are conflicting is wrong.
We cannot look at the p-value and conclude result from two different population because two results might have the same effect side but the different standard error thus this contributes to different P-value finally. To compare the results, the proper analysis should be considered such as heterogeneity, interaction or modification. -
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I would go with focus group discussion first, however, if the result for discussion were varied or not saturated, I would prepare an in-depth interview for further data collection. For better understanding of their culture and thoughts, I will conduct a direct observation by living with them and follow through their daily activities.
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To compare usefulness of new technology with an old one, we could ask this followings to assess perceived usefulness.
When using new technology compared to an old one
1. it improves user’s job performance
2. it saves user’s time
3. it gives users greater control over work
4. it enhances effectiveness on the job
5. it increases user’s productivity
6. it makes it easier to do jobs
if users have answer yes to these questions, it is implied that users perceive usefulness of new technology in job effectiveness, productivity and time savings aspect compared to an old one. -
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I reviewed this paper “Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry” via this link “https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7184991/”
This study aimed to assess and compare the immediate stress and psychological impact experienced by people with and without psychiatric illnesses during the peak of the COVID-19 epidemic with strict lockdown measures.
– Main exposure variable of interest
Control: The healthy control participants were recruited through convenient sampling
Case: All psychiatric patients must be aged 18 years or above and be previously diagnosed by psychiatrists to suffer from F32 Major Depressive Disorder–single episode, F33 Major depressive disorder–recurrent episodes, F41 other anxiety disorders including generalised anxiety disorder, panic disorder, and F41·8 mixed anxiety and depressive disorder based on the ICD-10 criteria.
– Main outcome variable of interest
the psychological impact of the COVID-19 epidemic measured using the Impact of Event Scale-Revised (IES-R) that measures post-traumatic stress disorder (PTSD) symptoms in survivorship during COVID-19 pandemic.
– Limitations of the study
Selection bias from convenient sampling as psychiatric patients who have more symptoms tends to respond to the questionnaire more.
Information bias as healthy people might not want to answer in a way that makes them looks like stress persons. -
1. Title: Accessibility to health services among migrant workers in the Northeast of Thailand
URL: https://f1000research.com/articles/6-972/v1
2. Main objectives of the study
Examines the factors associated with access to health services among legal migrant workers in the Northeast of Thailand
3. Sampling method used in the study
Randomly selected from a list of migrant re-registered
However, sample size in this study was not well described and variable which was considered on sample size calculation.
4. Limitations of the study
Selection bias as this study select sample population from only registered migrants, thus this study could be generalized to only registered migrant. However migrants worker who have registered usually have better chance of accessing than who have not registered. We could assume that the accessibility in whole migrant population would be worse. -
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Barriers of emergency health care accessibility among the migrant patients in the context of Thai-Myanmar border area and the possibility of information tool that could reduce those gap
Example of 5 variables
1. Treatment fee – continuous variable – median and IQR
2. Education level – categorical variable – proportion
3. Time to reach health care facility – continuous variable – median and IQR
4. Health insurance status – categorical variable – proportion
5. Distance of health facility – continuous variable – median and IQR -
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1. The author contributed to this study because suicide is an important problem in Thailand, the number of suicides has risen during 2011-2014, in the average of 6 suicides per 100,000 population.
2. As mentioned in the introduction path, population density might be the potential risk factor for committing suicide since it can be implied urbanization in each area and people who lived in urban city tend to have less social supports which can worsen the suicidal idea.
3. Statistical modelling can convert the independent variables and dependent variable to be the formula and measurable. After putting those potential risk factors in the independent variables side, the coefficient could tell the reader whether which risk factors have an impact on the suicide rate. Furthermore, the higher positive or negative coefficient can reveal the strength of those associated risk or protective factor respectively.
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1. I do agree with Ameen that the software should provide follow up and reminder module and be handled by other health care officers than the doctor. Moreover, the software should remind patients in addition to physicians and receive a reply from them whether they have had done the test as scheduled.
2. Some of screening program such as colonoscopy, mammogram and PAP smear for cervical cancer screening could be performed under the national health insurance coverage. Although some disease screening program is not under this coverage, some burden diseases have already be covered and this list could be added on further. Additionally, EMR has been used widely throughout Thailand and there are only few companies running this EMR business, thus this software could be scaled up easily if it is effective in disease prevention program. -
1. Although location is one of the epidemiological triads that determine the disease distribution, the researchers might not explain much about the location in the literature as a scarcity of database and unpowerful software in the past. Additionally, the researchers themselves might have less experience and skill in spatial epidemiology, because it is an interdisciplinary science that integrates epidemiological and geographical knowledge together. It needs both arts and science to not only making an attractively meaningful map but to convert the information into measurable information.
2. Since those who live in the same area tend to have similar potential determinant such as culture, economic status, social behaviour and sharing the same infrastructure more than those who live far apart. For example, the Broad Street Cholera outbreak in London, people who live nearby the broad Street Pump had a mortality rate higher than those who lived further because they shared the same water source. -
1. Developing countries like us should start health information with the small scale of the technology and put more effort into workforce development as we can put the workforce work better without paying as high as investing in technology. Mobile software is a promising technology to improve the timeliness of information sharing until the decision-makers realize what they will get from investing technology, as well as the fundamental infrastructures, are developed.
2. The human resource sector should find out why they cannot retain the workforces. However, in my opinion, fundamental causes are an incentive do not meet staff’s need and lacking skill improvement in their job. These causes should be resolved to reduce a high turn over rate instead of managing the capacity. -
1. The study showed that SO2 in the resident had spatial autocorrelation to AECOPD in the clustering pattern as well as in the workplace both were statistically significant. However, the Moran’s I index in the residence subgroup showed more clustering pattern more in the workplace as in the residence. This was only my interpretation.
2. This kind of spatial analysis would also show the effect of air pollution in Thailand, however, it would be better if the source of pollution was identified on the GIS map. Showing abrupt onset disease with pollutant density and the location of pollutant generating sources, this information could make readers imply the relationship more accurate and have better solutions. -
Please visit this link instead MyDashboard.
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Please visit this link My Dashboard.This dashboard could visualise total cases categorised by confirmed, recovered and death cases and the readers are able to select a country and these numbers will be accordingly changed. GIS map shows cases by the location that help the reader to understand disease geological distribution. The line graph shows total cases distributed by time and it is also selectable for the country like in the GIS. This board provides confirmed case by date of the top 5 most affected countries that will give readers an idea of whether how those countries are able to control the disease.
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Please visit my link My Dashboard.
GIS map helps the reader to understand the burden of confirmed cases by reporting country while the scatter chart in Power BI can visualize a number of confirmed case at the same time with recovered and death case by time. The Funnel plot reveals how much the number of cases is by far increasing, whereas a tree plot can group and shows the proportion of cases by country and continent. -
Please visit my dashboard in this link
I would like to show a total number of confirmed cases by country, trends of confirmed, death and recovered cases, Proportion of confirmed case by continent daily and daily confirmed cases count in the top 10 ranks. This could help the reader to understand the most COVID-19 affected countries in both total cases and the most recent situations. It also compared the confirmed proportion by continents in order to show the dynamic of disease transmission over time. To select the duration and focus deeply in each interval, the reader can select at the filter on the top-right corner.
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Please visit my published power BI on this link: https://app.powerbi.com/view?r=eyJrIjoiNGYzMjRiMGUtNmQxMS00ZTM2LTlmN2EtZjJhMDExNzlmZWYxIiwidCI6ImE1NjYxYjU3LTQ3ZDItNDNlNC04MGFhLWYxNzcwMTZhNTJmYiIsImMiOjEwfQ%3D%3D
In fact, the matrix function allows users to calculate variable by dimensions such as summarise, average, or other advance formulas. However, in this assignment, showing the GDP variable that belonged to each capital, we do not need to use the matrix function to summarise the GDP further. That’s why to show the capita GDP in the table is meaningful enough. I visualised capita GDP in a clustered bar chart as it allows the reader to compare the GDP in each capital easily. Allowing reader to select a specific area, this table provided the slicer function of the continent on the same page. Please give some comments if having question or suggestion.
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Thank you Chanapong and Ameen for your interesting questions.
For Chanapong’s question, the author did not discuss why there was a high number of collisions around the bus terminal. However, in my point, it is crowded and has a high traffic density around the bus terminal. As well as, population around those areas also higher than the rest.For Ameen’s question, this study would like to find the crash-prone area in the capital city in Tehran and used spatial analysis to answer whether the accidents occur in the cluster or dispersion pattern. If the result suggested clustering pattern, it might indicate that environmental factors i.e.; lighting, junctions or downtown are the risk factors. Because there was an autocorrelation in the neighbour areas. On the other hand, if the result suggested randomness or showed no spatial autocorrelation, we rather find some other factors such as people behaviour or vehicle instead. To indicate this clustering pattern, this study then calculated Moran’s I in spatial analysis.
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Thank you for your presentation. I wonder that relative risk for lung cancer among male was in a different area compare to female? To be precise, Although it is related to the environment, why male in Chiang Mai had a higher risk for lung cancer meanwhile female in Chiang Rai had a higher risk for the same disease?
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I prefer you to choose the first paper which is about lung cancer mortality than the second one. To support my choice, firstly, the first paper has a clear objective, also its methods and results are relevant. On the other hand, the second article has several objectives and showed a more sophisticated series of methods and results. Secondly, the first paper is related to public health and geographical method directly while the second one is also about the genomic and temporal analysis that contribute to its complexity. However, these two papers are beneficial to our class.
Best wishes,
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It is quite difficult to choose these two papers out of another one. The first one is more straightforward and simple. We can learn how to make a situation analysis with a geographical image. However, it is not quite interesting to me because it used plain method. On the other hand, the second one is more complicated. It is a mixture of statistical process control method, time series and GIS. The latter one is far more appealing, however, it has several supplementary materials to scan. You might have to make an overtime presentation.
Best wishes,
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The first paper (GIS-based spatial modeling of COVID-19 incidence rate in the continental United States) is better in terms of quality and importance. This article has a clear objective and we can learn from this article better. It is also related to spatial analytical method which is appropriate for our class.
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I don’t know the exact number of health informatician in Thailand. However, the number of this career might not adequate to develop health technology system in this country. For example, I observed that the programmer develop a feast of software in order to assist the health care workers or patients, however, few of that software could be applied practically. We do not evaluate which software is effective while the others are not. Health informaticians could analyze throughout this problem and disseminate the knowledge so that the developer could make the useful software. The challenge of increasing health informaticians includes several factors. Firstly, I could not clearly see the career path of the health informatician whether there is few or it is not well introduced publicly. Secondly, the incentive for health informaticians is not as much as other professional. Thirdly, the course for health informatics is still limited in Thailand. These three factors are challenges for health information in Thailand.
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I consider sharing the information rather than keeping it alone. The advantage of data sharing is to contribute the update knowledge or situation to others. For example in this COVID-19 outbreak, we could follow the current number of cases start from China through many countries, thus we could assess the risk for our own country. That benefit the pandemic preparedness. On the other hand, the disadvantage of data sharing includes privacy and security. Patients themselves might not intensionally reveal their medical history and the private information might be invaded. For that reason, information technology could not only extend the benefit of data sharing, but also minimize the risk from using it.
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Universal Health Coverage (UHC) is medical insurance supported by Thailand’s state welfare. UHC does not only lessen the out-of-pocket expenditure but also improve preventive health care. However, this welfare burden the health care workers from the outrageous visits.
UHC profit the country reducing the medical expense because of several reasons. Firstly, the government can regulate the pharmaceutical provider having the essential medicine at a reasonable price. Secondly, hospitals funded by the government claim the insurance in the standard price thus the doctors would investigate only in need, not throughout the body. Thirdly, Hospital accreditation mandates the hospital to give a standard service to all patients. The citizen could trust the public hospitals and do not worry about their service charge, hence they will access to health care earlier when they face the abnormal symptoms. Health care providers then could restore the patients in time and regularly.
On the other hand, UHC is also a two-edged sword. Charge-free service persuades the patients with self-limited illness to the hospital unlimitedly. This situation burdens the health care providers and reduces treatment resources for serious illness patients. Modest capital gain in this UHC country could not attract the researchers to innovate the novel medicine or instrument like in the United States. Hence we could rarely see the new innovation for health care in Thailand.
To conclude, State medical welfare is beneficial for their citizen throughout the country, yet the number of patients with self-limited illness ought to be reduced. Also, the government should raise the incentive for innovation development. -
The internet era has improved the ability of communication and information sharing. People can access knowledge by browsing the internet at home. Products can be advertised without a physical store and it can be sold online. Public health officer can communicate with people with Facebook Live instead of waiting for the television broadcaster. It is apparently beneficial to expand the internet accessibility coverage, however, Net Pracharat might cause the problems as mentioned in the article. A large scale of internet infrastructure needs not only high cost of maintenance but also the system upgrading. Thus the Free wifi hotspot might be neglected if the private communication companies expand the better network to those areas. Since the privacy policy of Net Pracharat is not well informed, I am worried that the browsing data might be traced and monitored by the government officers. To conclude, I agree with the articles that Net Pracharat has to concern about the performance of the WI-FI and privacy policy to make it more valuable.
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EMR implementation in the hospital could be beneficial in several aspects while there are some limitations after digital transformation. After using EMR, health expenditure could be claimed from universal health insurance and the other two major insurances accurately and timely compared to the paper-based system. Registration procedure and space for collecting the registration card is reduced. Error from mismatching both patient identification and the test result are decreased. Moreover, EMR could early alert to inappropriate treatment such as drug allergy or fatal drug interaction prescribing. However, EMR could reduce the interaction between clinician and patients. Data confidentiality, integrity and availability are not well concerned in the current EMR system which makes data loss or open to unauthorized users. To conclude, EMR is useful in several ways yet it is needed to be improved to minimizing the limitations.
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Suggestion on coping with the challenges in health informatics includes:
1. Missing data: we should imply the solution in these three steps involve
1.1 Collection: The necessary information should be set as compulsory in the electronic medical record.
1.2 Consolidation: Algorithm to check required variables should be set up.
1.3 Analysis: Several analysis techniques could be applied such as imputation, mixed-effects regression model, generalized estimating equations, or inference.
2. Selection Bias: The training, monitor and evaluation should be implemented to reduce the difference between health care. Big data analytic technique included propensity score analysis, instrumental variable analysis and Mendelian randomization could address this systematic error.
3. Data analysis and training: Besides training, the health sector should give the job position and proper incentives to recruit the data analyst or data scientist.
4. Interpretation and translational applicability of results: Promoting the big data study includes different techniques and dataset could reassure the result.
5. Privacy and ethical issue: Rule and regulation should be address firmly to all health sector in order to make e-health safe and private. -
The biggest step of health system improvement is the universal health coverage implementation. Despite it seems to focus on fair financial contribution, but to make the sustained system it needs a good governance system to improve effective health facility, skilful technician and efficient resource management. After universal health coverage implementation, Thailand has become a country that has one of the best health care system in the world. However, responsiveness has been a barrier to health system improvement in Thailand. The responsiveness includes both population and health system. Basically, people have the basic right of individuals to be treated with dignity. The system should promote the health provider with the idea of equitable health care as well as improve population health literacy both in the school and society.
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I am going to scope the disaster recovery plan for hospital information system, It should include identify and classify the risks that may lead to disasters, define the resources and process that ensure health service continuity, define the reconstitution mechanism. I would like to adopt the replication to shorten the recovery time objective because it could help save the patient life and lower the workload for personnel. However, as a government hospital, we cannot afford the advanced technology which costly. Thus some of the early records should be kept in a backup server and replicate only the daily data.
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High Availablity technology will make a hospital information system (HIS) work effectively. HIS can reduce the work redundancy, the information can be collected as a digital record at a time of consultation, thus it can be analysed instantly. HIS also help the decision making and prevent the adverse effect from inappropriate prescribing. Without high availability technology, hospital officer would worry about system downtime or information loss. If the threat attacks the system, the risk from prescribing would be increased. Financial information of the patient might be loss and decrease the hospital income. Moreover, staff need to re-entry the patient information into the HIS which put more workload to staff. Thus, High Availablity technology will save both patient and staff.
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My hospital once had the hospital information system broke down due to the server is out of order. At that time the server was backed up every evening, it is mean that information stored after last back up became unavailable. The HIS was shut down for a day and the staff have to re-entry the data. This situation is an example of lacking availability. After that, the IT staff design to have a dual server and make it as a virtual server that can backup data continuously in a real-time manner. Additionally, we improve the stability of power supply for the server.
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The surveillance could monitor not only the new case but also the situation from the past. Thus it would be great if the objective includes more than the new case. Case definition might include clinical symptoms and laboratory as well. You can find the example in the national r506 surveillance system which also included dengue, dengue hemorrhagic fever and dengue shock syndrome. However, this is a good surveillance system.
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This is the worth tool to tackle tuberculosis which is one of the most important communicable diseases in Thailand. The case definition should be clarified more specific as well as using laboratory result. However, the technology that will apply to this surveillance will be helpful in real practice.
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People get panic because plaque is the re-emerging disease in China. People might not familiar with this disease and it is spread by a rodent that makes them more worry because this animal is commonly live nearby human in the households. The government should determine the risk communication authority who will prepare the information to the public. Situation awareness should assess the investigation and assess through the event. As soon as the government have the information, communication should be performed to the public via several media such as TV broadcasting, social media, and radio. The message should start with empathy, identify and explain the public health threat, and explain what is currently known and unknown, explain what public health actions are being taken and why, emphasize a commitment to the situation. The government then evaluate the impact of communication after providing the information.
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I would like to have an early warning system for measles. Although it is a vaccine-preventable disease, measles has high transmissibility and it is become epidemic in several areas over the world including Thailand. The manifestation of measles is quite unique, though physicians might not recognize as it is a vaccine-preventable disease and it occurs sporadically. If we could detect measles outbreak earlier, we would prevent the susceptible host by immunization as soon as possible.
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The pollution could be a potential future public health emergency in Thailand because the pollution is wide spreading all over the country in a different time and it affects health in a both acute and chronic manner. The pollution in Thailand is becoming more severe and prolonged than in the past. Moreover, it is under the public concern. Hence, it is needed more resources and multiple stakeholders to encounter this problem.
In the mitigate section, firstly, information about the source and amount of pollution from each origin is crucial then we can reduce this major pollution cause. Secondly, pollution density information in each area should be accurate and real-time thus local stakeholder could be warned early. Thirdly, information about the capacity of the hospital and public facility to encounter the pollution-related health effect should be assessed in order to enhance the preparedness. -
Health informatics can improve the work of surveillance and response in several ways. Firstly, health informatics will improve planning and system design. Data collection could capture all concerned disease or symptoms by using automated data collection. Secondly, not only improving hospital information but the interoperability also integrates the environmental surveillance system such as the pollution level from Internet of Things devices. Thus public health surveillance is able to rely on the high-value data then analyse and interpret them, Thirdly, we will have powerful information and use it to warn the public and policymaker in order to respond in a timely manner. Lastly, health informatics could disseminate the data in a user-friendly format timely to informed the public and policymaker whether their interventions are effective.
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