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As Thailand transitions to a high-middle-income country, noncommunicable chronic diseases such as diabetes are on the rise.

A new study by researchers from Boston University School of Public Health (BUSPH) and Chulalongkorn and Mahidol Universities in Bangkok identifies the strengths and weaknesses of diabetes care in Thailand’s universal health system. Published in the journal PLOS ONE, the study found that the majority of Thai adults with diabetes were never diagnosed, but that most of those who were diagnosed did receive treatment and got the condition under control.

“Our findings highlight both the achievements of universal health care in Thailand and also the opportunities that remain both on a national level and regionally to ensure that people living with diabetes are integrated into care,” says Dr. Andrew Stokes, assistant professor of global health at BUSPH and the study’s corresponding author.

The researchers used data from the 2014 Thai National Health Examination Survey, which included both face-to-face interviews and a physical exam portion that collected blood samples after overnight fasting. Of the 15,663 Thai adults included in the study, 8.8% appeared to have diabetes based on their blood samples and/or reporting being treated for diabetes. Of those who appeared to have diabetes, the researchers found that 67.0% reported ever being screened for diabetes, 34.0% reported being diagnosed, 33.3% had been treated, and 26.0% had their diabetes under control.

“Thai healthcare systems may have put emphasis on expanding coverage both in terms of population coverage and medical care benefit packages, which they did quite well with relatively low cost (and limited resources). Nevertheless, this paper highlights the importance of improving the quality of care, especially primary care and public health promotion and disease prevention,” says study co-author Dr. Piya Hanvoravongchai, lecturer in the Department of Preventive and Social Medicine in the Faculty of Medicine at Chulalongkorn University.

The researchers found that living in areas with more medical staff and health centers, such as the south and central parts of the country and in urban centers, as well as being older, made a patient more likely to be diagnosed and to have their diabetes under control.

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