Utoomporn Wongsin

Background: Disability poses significant challenges for individuals, families, and societies, leading to diminished quality of life. Hypertension is notably linked to disability among older adults. This study aimed to estimate the prevalence of disability and future healthcare costs among community-dwelling older adults with hypertension in Thailand from 2022 to 2040. Method: Data were obtained from the Health, Aging, and Retirement in Thailand (HART) survey, official government data, and published papers. The regression model was used to estimate the prevalence of disability among older adults. The micro-costing method was used to obtain the actual hospital service costs incurred for hypertensive patients. Then, the service costs of older adults with hypertension and the consumer price index were used to project future healthcare expenses. Results: Thailand’s population of older adults aged 60 years or older is projected to increase from 15.77 million in 2022 to 24.04 million in 2040. Approximately 46% of those had hypertension. The prevalence of disability among community-dwelling older adults with hypertension in Thailand ranged from 22-33%, and the incidence ranged from 11-18% by age group. There are an estimated 1.13 million older adults with hypertension and disability in 2022, and this number is forecasted to increase to 1.91 million by 2040. Disability-related healthcare expenditures among community-dwelling older adults with hypertension in Thailand are estimated to be USD 70.72 million in 2022 and are forecasted to reach USD 152.80 million by 2040. Conclusions: This study sheds light on the anticipated health burden faced by community-dwelling older adults with hypertension and disability, along with the associated healthcare costs in Thailand. These findings provide valuable insights for policymakers in formulating service provision strategies and budgetary planning at the national level.

OBJECTIVE Cardiovascular diseases (CVDs) and/or hypertensions (HTN) are a major contributor to activities of daily living (ADL) disability in ageing populations. Although sex differences in CVDs/HTN incidence and outcomes are well documented, less is known about sex-specific mechanisms underlying functional disability among older adults with CVDs/HTN. METHODS We analysed longitudinal data from four waves (2015–2022) of the HART study using two lagged panels (2015–2017–2020; 2017–2020–2022) to assess whether associations vary across time contexts. Psychosocial exposures (depressive symptoms, physical activity, multimorbidity, and pain) and mobility impairment were examined using ordinal structural equation modelling (SEM) weighted least squares mean- and variance- adjusted (WLSMV), adjusting for baseline covariates. Sex- stratified and panel moderation analyses were performed, with inverse probability weighting in sensitivity analyses. RESULTS A total of 999 and 1,066 participants were included in Panels A and B, respectively. Baseline ADL distributions were similar across panels, with predominantly mild ADL disability. In Panel A, multimorbidity was positively associated with ADL disability, while pain showed an inverse association. In Panel B, mobility impairment was strongly associated with ADL disability. No mediation was observed at the panel level. However, an exploratory indirect association between depressive symptoms and ADL disability through mobility impairment was observed among men in Panel B (β = 0.07, 95% CI: 0.05–0.10), whereas no corresponding association was observed among women. CONCLUSION Longitudinal pathways to ADL disability among older adults with CVDs/HTN varied by sex and longitudinal observation window. An exploratory, panel-specific indirect association between depressive symptoms, mobility impairment, and ADL disability was observed only among men in Panel B. This finding should be interpreted cautiously and requires confirmation in future longitudinal studies with consistent mobility measurements.

This study aimed to identify factors associated with the use of modern contraceptive service among rural married women of reproductive age in Myanmar. A cross-sectional quantitative study was conducted among 648 married women aged 18-49 years (4 townships with the lowest contraceptive prevalence (n=316) and 4 townships with the highest prevalence (n=332). This study found that women in townships with low prevalence of modern contraceptive use were more likely to be illiterate and manual workers or farmers, to have lower education and no regular income, other religions than Buddhism, and higher number of family members and children, compared to those with high prevalence. In addition, they responded negatively to the accessibility, availability, affordability and acceptability of contraceptive services, and lower satisfaction with the services. This study suggests that the Myanmar government should promote contraceptive services more aggressively for women of reproductive age in rural areas that reflect ethnic minority cultures.

OBJECTIVE: Gaining insight into user satisfaction and its impact on the intention to use telemedicine is essential for the continued success of such services.METHODS: A cross-sectional study was carried out through an online survey targeting users of the Vajira@Home telemedicine platform. Data were collected via online survey questions, which was collected and analyzed through descriptive statistics, chi-squared tests, and multivariate binary logistic regression to explore the correlation between satisfaction and the intention to use telemedicine.RESULTS: A total of 389 respondents completed the questionnaire. Most respondents (81.2%) reported being satisfied with telemedicine services, and 72.5% indicated a strong intention to continue using them. Satisfaction emerged as the most influential factor in predicting the intention to use telemedicine (adjusted odds ratios (OR) = 13.28; 95% CI, 6.47–27.26; p < 0.001). Participants with a monthly income between 15,000 and 30,000 Thai Baht also showed a significantly higher intention to use the service (adjusted OR = 3.40; p = 0.048). Other demographic variables were not significant after adjustment.CONCLUSION: Satisfaction is the primary factor influencing the intention to use telemedicine under the Dusit Model. These results highlight the need to prioritize patient-centered care and improve user experiences to support the long-term integration of telemedicine into urban healthcare systems.

This cost analysis study gathered cost information from four community hospitals and two general hospitals in the fiscal year 2014, including service data, hospital statistics, and financial information. The study aimed to analysis and estimate the treatment costs of outpatient mental and behavioral disorders (MBDs) due to psychoactive substance use, provided at community and general hospitals in Thailand. We used ICD-10 codes, F10-F19, to handle the diagnosis codes of MBDs due to psychoactive substances and cost analysis. The unit cost per OPD visit was analyzed according to the cost analysis guidelines of the Ministry of Public Health, Thailand, using two procedures: a traditional method and a cost-to-charge ratio. The great majority of service expenses were labour costs (53%), followed by material costs (42%) and capital costs (6%). The unit cost per OPD visit for substance use disorders (SUD) in 2014 ranged between 172 and 762 THB. It was adjusted by the inflation rate to estimate the cost for 2021. The costs were growth in the range of 204 to 905 THB. The median cost estimate in 2021 from four community hospitals and two general hospitals, each accounting for 396 and 769 THB, respectively. The unit SUD visit costs of OPD from these six hospitals are quite close to the unit costs of the drug treatment centers. The greatest proportion of total service expenses was labor costs. Accordingly, human resources are believed to be a crucial challenge that needs to be considered and planned to deliver successful services. Notably, these hospitals were selected by purposive sampling and might not be representative of each hospital type. More hospitals should, therefore, be recruited in further research to represent the actual cost by hospital type.

The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.