Side Effects of Antihypertensives Induced by Switching to Different Generic Medications: Case Reports.

Generic medication is a product that contains the same active substance and pharmaceutical characteristics as brand-name medications. Generic medications are cost-effective and comparable to brand-name medications in terms of clinical endpoints. However, the use of generic medications instead of brand-name medications is a debatable issue among patients and healthcare providers. Two patients with essential hypertension experienced side effects after switching to different generic antihypertensives (one generic medication to another generic medication). Adverse drug reactions, including, hypersensitivity, side effects, and intolerance, should be identified through present and past medical history and clinical characteristics. The adverse drug reactions in both patients were more likely to be side effects of the medications after switching to different generic antihypertensives produced by different companies (patient 1: enalapril and patient 2: amlodipine). The side effects were possibly caused by the different inactive ingredients or excipients. These two case reports emphasise the importance of monitoring adverse drug reactions throughout the course of treatment and communicating with patients prior to switching to a new generic medication.

Results from the Medical School Physical Activity Report Card (MSPARC) for a Thai Medical School: a mixed methods study.

BACKGROUND: Data systems for surveillance and monitoring are essential to develop understanding of the levels of physical activity (PA) occurring at the population levels. To comprehensively understand PA in medical schools, a suitable surveillance tool might be useful to present and monitor key PA-related metrics. This study investigated PA-related metrics in a Thai medical school and summarised the findings using a newly developed tool-the Medical School Physical Activity Report Card (MSPARC). METHODS: A mixed methods study was carried out at three campuses of a medical school in Southern Thailand. Data analysis included descriptive statistics and qualitative reviews. All 285 medical students from a medical school were the target population. The prevalence of PA (≥ 150 min/week of moderate- to vigorous-intensity PA) and sedentary behaviours (SB) (≥ 8 h/day of sedentary time) among medical students were analysed using data from a self-administered questionnaire. Usage patterns, quality, and accessibility of walkable neighbourhoods; bicycle facilities; and recreational areas were assessed. PA promotion programmes, education, and investment related to PA promotion were reviewed from the school documents. RESULTS: Of 279 participants, 138 (49.5%) met PA recommendation, but 71.7% met criteria for SB. Male students were more active (61.8 vs. 42.4%) and less sedentary (65.7 vs. 75.1%) than female students. Bicycle facilities were rated as having the lowest quality and accessibility among PA-related facilities. Most PA promotion programmes were sports clubs and sport competitions. A total of 25 h of PA education was taught throughout the entire curriculum, which provided minimal PA counselling training. The school invested 2136.14 Baht/student/year (US $64.34) in PA promotion, or 2.4% of the annual tuition. The MSPARC presented the summary of the findings by using simple symbols, infographics, and short texts. CONCLUSIONS: To increase PA and decrease SB among medical students, there is a need to improve the quality and accessibility of the built environment as well as the natural environment, so as to establish health promoting policies. PA counselling training is required to develop the medical students' essential skills and awareness for future practices. Monitoring and subsequent surveillance of PA in medical school are needed.

Patients' perspectives regarding hospital visits in the universal health coverage system of Thailand: a qualitative study.

BACKGROUND: A universal health coverage policy was implemented in Thailand in 2002 and led to an increase in accessibility to, and equity of, healthcare services. The Thai government and academics have focused on the large-scale aspects, including effectiveness and impacts, of universal health coverage over one decade. Here, we aimed to identify patients' perspectives on hospital visits under universal health coverage. METHODS: A qualitative study was carried out in four public hospitals in rural Thailand. We collected data through focus group discussions (FGDs) and in-depth interviews (IDIs). The semi-structured interview guide was designed to elicit perspectives on hospital visits among participants covered by the Universal Coverage Scheme, Social Security Scheme or Civil Servant Medical Benefit Scheme. Data were transcribed and analysed using a thematic approach. RESULTS: Twenty-nine participants (mean age, 56.76 ± 16.65 years) participated in five FGDs and one IDI. The emerging themes and sub-themes were identified. Factors influencing decisions to visit hospitals were free healthcare services, perception of serious illness, the need for special tests, and continuity of care. Long waiting times were barriers to hospital visits. Employees, who could not leave their work during office hours, could not access some services such as health check-ups. From the viewpoint of participants, public hospitals provided quality and equitable healthcare services. Nevertheless, shared decision making for treatment plans was not common. CONCLUSIONS: The factors and barriers to utilisation of healthcare services provide exploratory data to understand the healthcare-seeking behaviours of patients. Perceptions towards free services under universal health coverage are positive, but participation in decision making is rare. Future studies should focus on finding ways to balance the needs and barriers to hospital visits and to introduce the concept of shared decision making to both doctors and patients.

Development of a physical activity monitoring tool for Thai medical schools: a protocol for a mixed methods study.

INTRODUCTION: Physical activity (PA) is important in promoting health, as well as in the treatment and prevention of diseases. However, insufficient PA is still a global health problem and it is also a problem in medical schools. PA training in medical curricula is still sparse or non-existent. There is a need for a comprehensive understanding of the extent of PA in medical schools through several indicators, including people, places and policies. This study includes a survey of the PA prevalence in a medical school and development of a tool, the Medical School Physical Activity Report Card (MSPARC), which will contain concise and understandable infographics and information for exploring, monitoring and reporting information relating to PA prevalence. METHODS AND ANALYSIS: This mixed methods study will run from January to September 2017. We will involve the School of Medicine, Walailak University, Thailand, and its medical students (n=285). Data collection will consist of both primary and secondary data, divided into four parts: general information, people, places and policies. We will investigate the PA metrics about (1) people: the prevalence of PA and sedentary behaviours; (2) place: the quality and accessibility of walkable neighbourhoods, bicycle facilities and recreational areas; and (3) policy: PA promotion programmes for medical students, education metrics and investments related to PA. The MSPARC will be developed using simple symbols, infographics and short texts to evaluate the PA metrics of the medical school. ETHICS AND DISSEMINATION: This study has been approved by the Human Research Ethics Committee of Walailak University (protocol number: WUEC-16-005-01). Findings will be published in peer-reviewed journals and presented at national or international conferences. The MSPARC and full report will be disseminated to relevant stakeholders, policymakers, staff and clients.