Chronic obstructive pulmonary disease (COPD) is one of the top five diseases treated
at Sungmen Hospital. This cross-sectional descriptive study was carried out to review
the management practice of COPD patients in Sungmen Hospital. The subjects studied
were 167 patients who attended the COPD Clinic from August to October 2007. The
majority of patients (77.8%) were male, with the mean age being 68.2 years. Ninety-four
percent of them had a history of smoking and 26.7 percent were still active smokers.
Diagnosis of COPD was made in 84.7 percent of the cases by history-taking, combined
with physical examination and pulmonary function test. The mean values of FVC, FEV1
and %FEV1 were 68.6, 55.5 and 58.4 percent, respectively. The patients were categorized
based on the severity of the disease; 71.2 percent of the patients suffered moderate to
severe disease. The study disclosed that COPD patients with mild to moderately severe
morbidity had received excessive medications, according to the COPD clinical practice
guidelines. Sustained-release theophylline was prescribed at a high rate in every stage of
severity of the patients. More needed long-acting beta-2 agonist inhalers and long-term
oxygen therapy, but these therapies were not available due to the patients’ economic constraints.
The therapeutic management of COPD patients, by establishing a COPD clinic
in a community hospital, using existing hospital resources, would offer better efficiency
in the diagnosis and treatment of COPD patients.


This retrospective descriptive study was designed to determine the clinical outcomes
of mini-laparotomy exploration (MLE), with simple closure of a perforated ulcer in patients
treated at Chaibadan Hospital. Of the 70 ulcer patients, 62 (M:F 8:1; aged 51.2 ± 15.6
years and 12.8% over 60) underwent the MLE procedure in the period between October 1,
2001 and September 30, 2007. The ulcer types were type I (prepyloric part of stomach and
first part of duodenum) 78.4 percent, and type I (antrum) 14.5 percent. The average operative
time was 32.8 ± 12.7 minutes. Operative complications were encountered in 30
percent of the patients, i.e., 12 patients with an infected wound, and four patients had
postoperative fever; however, there was no death. Postoperative medication included
anti-H. pylori and proton pump in all patients. The benefits of the surgical procedure
studied were small abdominal wound and scar with less pain, decreased severe complications
with early ambulation and no mortality.


The objective of this quasi-experimental research was to apply the Thai diabetes
risk score for evaluating diabetes prevention outcome in order to conduct a cost-effectiveness
analysis of diabetes primary prevention for prediabetes. The study population
included 1,182 cases of prediabetes selected by verbal screening criteria and impaired
fasting glucose level (100 - 125 mg/dl); they were divided into two study groups for
comparison. The experimental group consisted of 400 prediabetes cases who agreed to
participate in a prediabetic day camp; the control group comprised 410 prediabetes cases
receiving ordinary health-care services. The instruments used for collecting the data were
questionnaires, Thai diabetes risk score, customer and provider cost data recording profiles,
practice guidelines for a diabetes prevention program in a day camp. Data were
analyzed statistically, using frequency, percentage, mean, standard deviation, and ratio;
they were comparatively analyzed by t-test and paired t-test at the 0.05 level of statistical
significance.
The results of this study were as follows: (1) prediabetic day camp activities effected
a reduction in the cumulative incidence of developing diabetes by a factor of 7.49 times in
the experimental group (relative risk = 7.49) compaired with the control group; it also
statistically significantly decreased the average diabetes risk score and the probability
level of the sample in the day camp compared with those in the control group. Furthermore,
the risk factors for diabetes reduced from lifestyle modification caused a statistical
decrease that was significant (p < 0.05) on both average BMI and BP level, except for
waist circumference; (2) the effectiveness of diabetes primary prevention for prediabetes
justified by summation of the individual differences in diabetes risk probability before
and after intervention was 0.0198; otherwise the cumulative incidence of lower diabetes
risk score for prediabetes in the experimental group revealed a score of 0.2375; (3) the
economic cost of diabetes primary prevention for prediabetes in the prediabetic day camp
was 357,100 Baht, with the opportunity cost being 20.31 percent compared with the total
cost; (4) the cost-effectiveness ratio of diabetes primary prevention for prediabetes in the
day camp was 18,035,353 Baht per effective diabetes risk probability prevented and/or
1,503,578.9 Baht per effective cumulative incidence prevented.
It was recommended that (1) the research findings should provide important information
for policy decisions to apply the Thai diabetes risk score for evaluating diabetes
prevention outcome; (2) comparative cost-effectiveness analysis of diabetes primary prevention
for prediabetes should also be studied by other health-care teams on a long-term
basis.


Diabetes is an important risk factor for the development of coronary heart disease
(CHD). Recent studies have found that the rise in the mortality rate of diabetes mellitus type 2 patients was due to coronary heart disease. This study was conducted in June
through September 2007, with the intention to evaluate CHD risk in diabetes patients
attending Sangkhom Hospital, Nongkhai Province. Data were collected by interview, blood
sampling and retrieval from medical records. The participants were 309 patients with
type 2 diabetes, aged 33 to 75 years (mean 55 ± 22 years), and without cardiovascular
diseases. The 10-year probability was estimated by using the INTERHEART Study modified
from NCEP ATP III (National Educational Program and Adult Treatment Panel III).
Student t-test and chi-square test were used to determine the differences between men
and women patients regarding risk factors, and to predict the probability of CHD. Most
patients (92.2%) smoked; 46.9 percent were hypertensive or were taking antihypertensives;
37.2 percent had total blood cholesterol (CHOL) higher than 200 mg/dl and a high density
lipoprotein cholesterol (HDL-C) level of less than 40 mg/dl. Evaluation by the heart
risk score (based on a model using basic risk factors, i.e., age, smoking, CHOL, HDL-C,
systolic blood pressure), 6.8 percent of the patients (25.3% men and 1.6% women; p <
0.001) had a predicted 10-year probability of more than 20 percent at very high risk (I)
and 21.4 percent of the patients (58.2% men and 11.2% women; p < 0.001) had a predicted
10-year probability of 10-20 percent at high risk (II); whereas 71.8 percent of the patients
(16.4% men and 87.2% women; p < 0.001) had a predicted 10-year probability of less than
10 percent at moderate risk (III). The predicted 10-year probability of 10-20 percent and
over 20 percent of the diabetic men was significantly higher than that of diabetic women,
whereas the predicted 10-year probability of less than 10 percent of the diabetic women
was significantly higher than that of diabetic men. The prevalence of risk factors related
to high risk of CHD was different in diabetes patients. Thus, estimates of probability of
CHD are necessary for all persons with diabetes, indicating the risk factors to be corrected
in order to prevent mortality and morbidity. Despite differences in individual risk
factors and predicted probability between men and women, the estimated risk for CHD
should be calculated for all persons with diabetes mellitus.


This research was aimed at analyzing the relationships between relating factors and
their characteristics in relation to high blood pressure in Banlaem district, Phetchaburi
Province. The sample population comprised 1,521 randomly selected people who were
interviewed by using a questionnaire during the period between August 2007 and January
2008. The data were analyzed by Pearson chi-square.
The result of the study revealed that 7.10 percent of patients were living in the area
under the responsibility of Tapoonoak Primary Care Unit. The majority of them also had health behavior related to hypertension at the middle level (69.36%), had a model of selfcare
at the middle level, understood and had knowledge concerning hypertension at the
middle level (65.22%). The factors that related to hypertension included geographical
area of residence (p<0.000), age (p<0.001), education (p=0.040), income (p=0.000), marital
status (p=0.002), having specific illness (p<0.001), having experience in screening for hypertension
(p=0.028), body mass index (p=0.000), exercise behavior (p<0.001), and selfcare
behaviors (p=0.001). Therefore, holistic care is necessary for the population in order
to decrease risk factors as well as to adapt health behavior. The service should cover the
family and community, including the local administrative organization, to get them to
participate in solving the problems. Moreover, multidisciplinary health personnel would
necessary be allocated to primary care units in an appropriate manner.


Low birth weight newborns are more vulnerable to higher mortality and morbidity
rates than normal weight infants. Research to determine the maternal risk factors would
be valuable in planning a way to solve the problem. This retrospective study was aimed
at finding out those risk factors in women of more than 28 weeks pregnancy from the
delivery records during the period from September 1, 2005 to October 31, 2007. There
were 3,622 deliveries, of which 174 delivery incidents of low birth weight infants were
taken as the study group and 177 deliveries of normal birth weight infants as the control
group by systematic randomized sampling. The prevalence of low birth weight in this
study was 4.8 percent. Results from the univariate analysis showed that a maternal age
of less than 18 years, a gestational age of less than 37 weeks, attending ANC less than four
times, and maternal height less than 145 centimeters were risk factors. Multiple logistic
regression analysis revealed the risk factors to be maternal age being less than 18 years
old, gestational age less than 37 weeks, twin pregnancies, ANC less than four times, premature
membrane rupture, and pregnancy-induced hypertension.


This study was aimed at investigating an outbreak of acute diarrhea during the
period February 20 to March 23, 2006 in Tapanhin district, Phichit Province. It is a descriptive
epidemiological study that was undertaken to identify the problems and the interventions needed to control the disease, using an interview with individual case surveillance,
as designed by the Bureau of Epidemiology, and specimen collection. The study
population comprised 554 cases, including all cases who visited health-care facilities and
those in communities in Tapanhin district. An additional study was based on an observation
of the environmental factors and the disease-control measures. Quantitative data
analysis was presented in percentage, ratio, minimum and maximum, using a computer.
These data analyses were based on triangulation in order to make links, between the
factors and effective implementation.
The study found 554 cases in total (526.67 per 100,000 population). The epidemic
began in the municipal area and spread rapidly to surrounding sub-districts. The highest
prevalence was among children 1-4 years old (3,485 cases per 100,000) and 5-9 years (1,413
cases per 100,000), respectively. Leading symptoms included watery stool (85.35%), and
stomach ache (58.81%). Non-pathogenic bacteria were detected in 94.52% of the cases
based on rectal swab culture, whereas rota virus was detected in 3 of 9 stool cultures. A
centralized operation unit was set up in order to conduct active case surveillance and
control the disease. The interventions were conducted through both sanitation (cleaning
animal slaughter units, markets, and public restrooms) and education of street food-vendors.
As a result, the epidemic was brought under control within four weeks.
The achievement of diarrhea prevention and control requires rapid disease investigation
and community intervention from the district health system. To determine the
root cause of an epidemic, objective data, based on active case surveillance and comprehensive
laboratory examination are helpful.


The purpose of this study was to assess the addiction rehabilitation model (adopting
the matrix-intensive outpatient program - IOP) in the primary care units of Bangphli
Contracting Unit of Primary Care (CUP). The capacity of the primary care unit’s health care workers has been developed to implement this model. This action research was
completed by Bangphli Hospital. The program follows the matrix-intensive outpatient
program, which features cognitive - behavioral therapy. The Bangphli Hospital therapist
team oversees and advises all the other primary care units involved in this program. The
therapist team monitors every session of the program. Their results are evaluated by using
the standard criteria from the Thanyarak Institute. These criteria require the involvement
of at least 60 percent of those who attended and completed the program, and 60
percent of those who attended being non-relapsing, and who returned to work or school.
The results of the study revealed that implementing and pursuing this addiction rehabilitation
program has been an effective solution for the drug addiction problem. The primary
care units monitored were found to have exceeded these criteria by having 88.89
percent of the patients completing the matrix program and 100 percent of those did not
relapse but returned to work or school. These patients returned to their communities and
were welcomed by their families.


Non-insulin dependent diabetes mellitus (NIDDM) is a major health problem. One
significant factor that affects the success in its control and treatment involves the individual
self-care behavior in patients’ life style.
The purpose of this study was to assess the effectiveness of group participation in
self-help on self-care in patients with non-insulin dependent diabetes mellitus by comparing
them with patients receiving routine advice. The subjects included 88 non-insulin
dependent diabetes patients who attended the outpatient department of Prachathipat
Hospital in the period from December 2006 through May 2007. The samples were simply
randomized into experimental and control groups comprising 44 patients each. The experimental
groups assigned to the self-help group was further divided into four subgroups
of 8 -11 patients to join three activity sessions, spending 40 minutes in each of
them once a month. The control group received routine advice. Data were then collected
through interviews using questionnaires before and after the experiment. The statistical
analyses provided mean, standard deviation, and information from paired t-test and ttest.
The findings showed that, after completing the study project, the self-care behavior
mean score of patients who participated in the self-help group was statistically higher
than it was before starting the experiment and higher than the results in the control group.
The gained mean score on self-care behavior after the experiment between the self-help
group participating and the routine teaching group differed statistically.
The explanation given was that participation in the self-help group provided the
patients with sharing and learning experiences. The researcher suggested that the efficiency
of self-care behavior could also be modified for practice in the prevention of complications
from other chronic diseases.


Formerly, the programs for the elimination of iodine deficiency disorder in Thailand
had used the total goiter rate in school children as an indicator for evaluating the
program. That indicator showed improvement, from 19.3 percent in 1989 to 1.31 percent
in 2003. However, for protection against brain damage from iodine deficiency, importance
must be given to the transfer of thyroid hormones across the placenta even during
early gestation. Thus, the ultimate focus must be women who are going to be pregnant,
pregnant women and neonates. The criteria recommended by WHO/UNICEF/ICCIDD
are salt iodization, proportion of households consuming effectively iodized salt > 90 percent,
median urinary iodine in school age children > 10 μg/dl, thyroid size in school age
children, proportion with enlarged thyroid by ultrasound or palpation < 5 percent and
neonatal TSH, proportion with levels > 5 mU/l whole blood < 3 percent.
The present study took for examination thyroid size and collected blood and urine
specimens for TSH, thyroid function test, urinary iodine in many age groups both from
the hospital and the community in 1998 and 2003. The results showed that the goiter rate
in school age children by ultrasound decreased from 5.1 percent in 1998 to 0.5 percent in
2003, but this proportion was not similar to those identified according to thyroid size by
palpation i.e., 16.1 percent in 1998 and 21.4 percent in 2003. Median urinary iodine in
2003 in the subjects in age groups 0-1 year, 1-3 years, 4-6 years, 6-12 years, pregnant women
and elderly persons were 12.44, 15.49, 15.44, 15.31,11.30, 5.52 μg/dl, respectively. The levels
seemed to decline when compared with the 2003 findings of 19.62, 19.06, 15.83, 46.92,
7.17 μg/dl respectively. Neonatal TSH (serum based) >11.25 μlU/ml in 2003 were 26
percent, which showed that our area was a moderate iodine deficiency disorder area.
This might be caused by unsatisfied coverage with iodized salt at 45 percent.
In this study, most outcome indicators achieved the criteria, but the impact indicator
was unsatisfied in neonatal TSH. Accordingly, a process indicator such as coverage of
salt iodization showed the failure to achieve the criteria. Therefore, Dansai Crown Prince
Hospital would analyze the data in each community and show those data to people in the
community in order to solve this problem. We recommend that every district follow the
multidimensional evaluation of iodine deficiency disorder continuously as process, outcome
and impact indicators.


The objective of this work was to assess the results of tuberculosis patients treated at Sanam Chaikhet District, Chachoengsao Province by comparing the result of treatment between the Group 1 regimen, i.e., with the assistance of family members or public health volunteers in 141 patients and the Group 2 regimen, with treatment assisted by sub-dis trict personnnel, together with family members or volunteers for 38 patients. The data obtained from the patients’ registration (RorBor. 1K04) and treatment cards were analyzed for the number of patients, means, percentage, and the chi-square test. Of the 179 patients, 66.5 percent were male and 33.5 percent female, aged 10 to 88 years, with the average being 53.3 years. About 91.1 percent were cases of lung TB, of which 73.2 percent were registered as new cases, and 88.3 percent had no history of allergy. The majority (76 percent) of patients received treatment for category I, for which only 35.2 percent of the patients completed the treatment. Successful treatment, as cured patients and completed treatment, was obtained in 64 percent of patients. The results of treatment with the adapted regimen were 81.6 percent cured, 18.0 percent unsuccessful, while those treated with the old regimen showed success in 60 percent of patients and 39.7 percent were unsuccessfully treated. The difference between the two regimens was statistically significant at the level of 0.05.


Cataract is a significant cause of blindness in the global population. The objective of
this descriptive study was to study visual function (VF) and the quality of life (QOL) in 32
cataract patients treated by phacoemulsification at Bangnamprieo Hospital from January
to April 2007. Information was obtained before and one month after the intervention.
The patients were 12 men and 20 women, aged 50-82 years, with 62 years being the average.
Half of them had no occupation; average family income was 57,769 baht per year.
They suffered low vision for 23 months on average. The VF and QOL scores after one
month of treatment were higher than before, and the VF scores positively correlated to
the QOL scores (r =.567, p <.01). In conclusion, the present study shows higher visual
function and better quality of life scores after the intervention by phacoemulsification
together with the standard of care. The authors recommend this particular measure for
tackling cataract disease in community hospitals without full-time ophthalmologists, in
order to increase the health of the Thai population and improve the quality of life of the
people.


Objective: To study diabetes mellitus epidemiology in Phanomphrai district and
to assess diabetes risk factors in the Phanomphrai sub-district (tambon).
Methodology: Descriptively reviewed the Phanomphrai population and diabetes
registration and services for epidemiologic data in fiscal year 2006, and carried out a
community survey to assess diabetes risk factors through interviews using questionnaires
and specimen collection among those aged 20 years and older in Phanomphrai tambon in
the period July - September 2005.
Results: The Phanomphrai population was 100,870, with 38,069 (37.7%) aged 40 or
older; 2,648 diabetic patients were registered, with a prevalence rate of 2.6 percent. There
were 10 (0.4%) with type 1 diabetes, 2,630 (99.3%) with type 2 diabetes, and 8 (0.3%) with
gestational diabetes. New cases of type 2 diabetes totaled 299, 300 and 192 cases during
2004, 2005 and 2006, respectively, making the incidence rate 0.29 percent, 0.30 percent and
0.20 percent, respectively. After complication screening, there were 8.4 percent renal, 2.0
percent neurological, 1.7 percent arterial and 1.2 percent ophthalmologic complications
with 0.5 percent experiencing amputation and 0.9 percent multiple complications. After
the community survey of a total of 1,540 subjects, 474 (30.8%) were classified as cases of
disease, 605 (39.3%) as being at risk and 461 (29.9%) as normal. Risks by body mass index
(BMI ≥25) were 46.9 percent, 31.8 percent and 22.1 percent in the disease, risk and normal
groups, respectively. Risks by abdominal circumference were 41.3 percent, 28.3 percent
and 17.8 percent in the disease, risk and normal groups, respectively. High blood pressure was found in 84.6 percent and 97.4 percent in the disease and risk groups, respectively. Abnormal fasting blood glucose levels were 44.7 percent and 9.0 percent in the
disease and risk groups respectively. Abnormal triglyceride levels (≥250 mg%) were found
in 27.6 percent, 14.2 percent and 12.0 percent of the disease, risk and normal groups,
respectively. High density lipoprotein levels (≤40 mg/dl) were 47.2 percent, 49.2 percent
and 45.5 percent in the disease, risk and normal groups, respectively.
Conclusions: Epidemiologic study helps increase understanding of the diabetes
situation and disease burden, and indicates that diabetes has imposed huge public health
and economic burdens. Measures of high priority must be emphasized in relation to the
quality of care, information systems and the interventions made to prevent or delay diabetes in high-risk groups, and to study the risk factors for diabetes and metabolic syndromes for the development of efficacious preventive measures.


This cross-sectional study was conducted to determine the lead levels in the blood
of people living within 1 kilometer of a lead smelter.  The subjects included were 134
residents aged 20 years and older, randomly selected, one each from the households.
Among them, 103 (77%) were female, 12.7 per cent had occupational exposure to lead,
83.6 per cent spent their time at home seven days a week, 57.5 percent had a primary
education, 54.5 percent lived within 500 meters of the smelter, and 71.6 per cent drank
water from sealed containers.  The average blood lead level was 12.7 micrograms/deciliter.  Factors which were statistically and significantly associated with blood lead levels
were education level, distance from the smelter and source of drinking water.  The results
of this study could be used to locate the hazardous zone surrounding the smelter, to
select safer sources of drinking water and to educate residents at risk in order to prevent
future health hazards


An outbreak of influenza A (H1N1) in Li district, Lamphun Province in November
2007 led to investigation and control of the event and an epidemiologic study to determine the characteristics of the outbreak, to define the cause and factors associated with
the outbreak, and to implement effective prevention and control measures. Methods included
descriptive epidemiology, environmental survey and laboratory study. A total of
80 cases were identified in this outbreak; 58.8 percent were students and 35 percent were
children aged 5-9 years. The causative virus, influenza A (H1N1), was identified by PCR
technique in 61 out of 77 cases (79.2%). The highest incidence rate of 38.31 per 1,000
population was evident in Village 5 of Srivichai subdistrict. The propagated source epidemic
probably started after introduction of influenza virus A by a student who contracted
it from the local market and then spread it at his school. The health team implemented
comprehensive control measures, including health education on disease etiology
and prevention for local residents both in the school and the community, screening and
isolation of new cases, giving prompt treatment, providing masks and promoting hand
washing among school children and teachers, temporary closure of schools to cut the
transmission chain, and active surveillance and early treatment in the community. A
field hospital was set-up in a temple to accommodate and provide treatment to overloaded
cases from Li Hospital. As a result of all intervention measures implemented by
public health agencies, community leaders and villagers, the outbreak was curtailed
quickly, with no further outbreak in nearby areas.


This quasi-experimental research study was aimed at assessing the effect of the positive
self-talk training program on anxiety in patients with generalized anxiety disorder.
All subjects were outpatients of the Takfa Hospital, Nakhon Sawan Province, seen during
the period October through December 2007. The study was one of a group of pre-post
tests conducted on 15 subjects obtained from random sampling. Research instruments
comprised (1) a demographic data form, (2) the translated version of State-trait Anxiety
Inventory of Spielberger, and (3) the Positive Self-talk Training Program based on the
concept of Nelson-Jones. Data were analyzed using descriptive statistics and paired ttest.
The findings were that the state-anxiety score of the patients decreased significantly
after they joined the Positive Self-talk Training Program (p < 0.05). The finding suggests
that the methodology could be taken as a guideline for ameliorating anxiety in patients
with generalized anxiety disorder.


This cross-sectional study was conducted with the objective of determining the hospital
staff’s health behavior, health conditions and differentials in health behavior conforming
to the six-habits policy of the Ministry of Public Health. Data were collected by
questionnaires administered among 120 hospital staff in September 2007.
The results indicated that almost all of the hospital’s staff were in good health, without
remarkable underlying disease and had no work-related injury or illness. The problems
that disturbed them, making them worried or nervous, were their job and debt, but
they were able to manage somehow. Minor problems were indigestion and constipation.
Overall health behavior, including food consumption, environmental sanitation,
wealth, temptation, and temperament, was at a moderate level. By contrast, their exercise
behavior was at a low level. The differences in age, working hours and educational levels
were not related to health behavior; however, gender, marital status, job position, work
experience, job description and health conditions were related to their health behavior.


The objectives of this study were to: (1) examine the quality of life of HIV-infected
persons and patients; (2) identify the factors related to their quality of life, and (3) map
out the problems and seek ways to improve their quality of life.
A questionnaire was employed as the research instrument to obtain information
from 180 HIV-infected persons and patients who had been members of the Ruam Nam Jai
Rim Nam Lao Group in Mae Lao district, Chiang Rai Province, for at least three mouths.
Frequency, percentage, t-test and F-test were used for data analysis. About 50.6 percent of
the subjects were females, aged below 35 years (43.9%) and married. The majority (68.9%)
had finished elementary school. The majority (60%) were engaged in general employment
or in agriculture (33.9%), among others. The average monthly income was below
1,000 baht (42.80%). Most of them had been members of the Ruam Nam Jai Rim Nam Lao
Group for four years or more. The reason for joining the group was to access the facilities
to look after their own health and to get anti-AIDS medicines. They participated in the
group activities 1-4 times. They learned that they were HIV-infected at least six years
previously. They experienced a mild ill-feeling approximately once a month. The period
of treatment with anti-HIV medicines was one and a half years to three years. To a great
extent, they looked after their own health ( x = 0.74 out of 1).
Overall, the quality of life of the HIV-infected persons and patients was moderate
(x = 3.59 out of 5). When the individual dimensions were considered separately, it was
found that the quality of family life and that of community life were high ( x = 4.07 and
3.84, respectively). Their health and economic security were found to be moderate ( x =
3.43 and 3.03, respectively).
The factors relating significantly to their quality of life at the 0.05 level were gender,
marital status, income, length of time knowing about their HIV infection, and the nature
of their illness, respectively. In contrast, education, number of years of taking anti-HIV
medication and self-care were all found to have no relationship to their quality of life.
From the findings of the study, the researchers were able to compile some suggestions
for improving the situation of the HIV-infected persons and patients in the communities;
the details of the study are described in the text.


The objective of this study was to explore the performance of the diabetic patients’
care system that referred patients to the primary care unit (PCU) in the Kantang network
health service one year ago. It was to compare the output of care between, before and
after patients were referred for diabetic care from Kantang Hospital to the PCU. A self-administered questionnaire, using the PRECEDE PROCEED Model, was used
among 14 PCU personnel and 97 patients between October 1 and 31, 2007. The study
found that most of the participants were in the age group 41-55 years (40.2%), females
reprecented the majority of them at 79.4 percent, couples at 81.4 percent, the level of education
at the primary school level at 76.3 percent, agricultural occupation at 32.0 percent,
duration of disease 1-5 years at 83.5 percent. The participants with no related disease
comprised 51.5 percent of the total; those with hypertension, 32.0 percent, normal body
mass index (BMI), 55.7 percent and higher level at 41.2 percent. The levels of blood sugar
both before and after referral were not different. Loss to follow-up after referral decreased
significantly (p-value < 0.05). The level of knowledge about diabetes was found to be at
high at 76.63 percent. With regard to the level of behavior for diabetic control, the highest
behavior was drug use at 92.58 percent; the least behavior that patients performed was
exercise activity at 52.80 percent. The association between knowledge and behavior with
regard to eating, drug use and general health care was moderate, but with stress management,
low there seemed to be no effect on exercise activity behavior. Concerning the
service that patients got at the PCU after referral, almost all items were high at more than
90 percent, except participation in group practice activity, which was moderate at 14.4
percent. The level of the patients’ satisfaction toward the service was found to be moderate
to high, at 86.94 percent.
The overall findings indicated that the output of care both at the DM clinic in the
hospital and the PCU was not different; thus, this system can continue to perform but
there should be concern about the problems and attendance.


Handwashing is an important method for the prevention of nosocomial infection,
especially in light of the fact that all health personnel, i.e., doctors, nurses, and others,
have contact with patientsû blood, excreta and secretions. The objectives of this cross-sectional study were to determine the rate of handwashing
practiced, the accuracy of handwashing and average times spent in handwashing among
health-care personnel in Khuankalong Hospital. The study was carried out in the period
from April 1 to 30, 2006. Participant observation with a check-list form was used for data
collection on 43 subjects, comprising physicians, nurses, dental health workers and laboratory
technicians, using purposive sampling. Descriptive statistics were used for data
analysis.
The results of the study disclosed that, from 118 observations, the handwashing and
accuracy rates of health-care personnel were 88.98 percent and 17.14 percent, respectively.
The handwashing rates among physicians, nurses, technical nurses, dental health workers
and laboratory technicians were 43.75 percent, 100 percent, 100 percent, 100 percent
and 50 percent, respectively. It was evident that the health-care personnel of Khuankalong
Hospital had a very high rate of inaccuracy in handwashing (82.86%) while their
handwashing rate was only 88.98 percent. Thus, it is mandatory that all health-care personnel
in this hospital should be encouraged to attend the intensive training course focusing
on handwashing in order to reduce the occurrence of nosocomial infection.


This study was aimed at evaluating the clinical practice guidelines for the management
of dengue hemorrhagic fever by evaluating the knowledge of doctors, nurses and
subdistrict health officers in Nonthai district and by evaluating the care map of dengue hemorrhagic fever patients in Nonthai Hospital. The results showed that the knowledge
accuracy rates of doctors, nurses and subdistrict health officers concerning dengue hemorrhagic
fever were 87.5, 81.0 and 78.7 percent, respectively. Incorrect knowledge concerned
the proper time to order a tourniquet test, the proper type and volume of intravenous
fluid to administer to patients in the febrile stage, the proper volume of intravenous
fluid to administer to patients in shock.
Conformity to the clinical practice guidelines for dengues hemorrhagic fever was
89.6 percent and the non-conformity with the guidelines was as follows: the order of
tourniquet test, 73.9 percent correct; the order of intravenous fluid in the febrile stage, 67
percent correct. The frequency of recording the vital signs in the shock stage was 68.2
percent correct; that of intake/output in the shock stage, 60.2 percent and urine specific
gravity, 3.4 percent correct.
The treatment outcomes of dengue hemorrhagic fever were 94.3 percent recovery,
5.7 percent referral, 4.5 percent complication, and zero deaths. The research found that
the main problems in the management of dengue hemorrhagic fever were incorrect knowledge
and non-conformity with the clinical practice guidelines by the Patient Care Team.
The research findings will be used as baseline data for improving the clinical practice
guidelines and the teaching programme in Nonthai district and Nakhon Ratchasima Province.


This descriptive research study was aimed at assessing the progress of antivirus
treatment, the difference in CD4 related antivirus treatment formulation before and after
treatment. The sample population comprised cases of HIV/AIDS who were treated at
Wanghin Hospital, Srisaket Province in the period from 2003 to July 31, 2007. The study
used secondary data on 89 cases of HIV/AIDS. Data analysis was carried out by using a
computer program. The mean difference was calculated by chi-square, t-test and paired
t-test. The samples comprised male patients (52.8%), female patients (47.2%); and 56.2 percent of the samples were aged 31-40 years. The CD4 counts in the five-year period
exceeding 200 cells/mm3 were 35.5, 40.0, 60.7, 65.5 and 84.4, respectively. There were two
antivirus treatment formulas, i.e., GPO vir, which was used in 80.9 percent of the cases,
and the formula of D4T, 3TC and Efavirenz in 19.1 percent of them. There was no difference
in the CD4 count between the two drug formulations, but the differences were significant
at the 0.001 level between, after and before treatments. CD4 cells exceeding 200
cells/mm3 were found in 93.8 percent of the female patients and in 75 percent of the male
patients, which was significantly differnt (p< 0.05). Based on the present research, it is
recommended that the patients should receive drugs continuously and follow-up, evaluation,
and patient care should be provided continuously.


The purpose of this cross-sectional survey was to determine the factors influencing
village health volunteers’ performance in the prevention and control of dengue hemorrhagic
fever in Phisalee district, Nakhon Sawan Province. The participants consisted of
303 village health volunteers in that district, who were studied from July 1 to August 31,
2007. A questionnaire was used for collecting information and the data were analyzed by Pearson’s product moment correlation coefficient and stepwise multiple regression. The
findings disclosed significant relationships between the village health volunteers’ performance
and the following factors, i.e., their income, experience with motivational and
supporting factors. These four factors had a 46.7 percent power of prediction. Therefore,
public health offices should pay attention to and continue the development of public
health volunteers. This should be done through motivational training that promotes sustainable
performance and organization loyalty. In addition, the public health offices should
provide sufficient public health resources for the prevention and control of dengue hemorrhagic
fever. Future studies might focus on the effectiveness model of village health
volunteer performance in preventing the occurrence of dengue hemorrhagic fever cases
in villages.


Distal sensory polyneuropathy (DSPN) has commonly been found in HIV patients.
This cross-sectional study was carried out in the period January 1 to December 31, 2007 in
order to determine the prevalence and risk factors of distal sensory polyneuropathy (DSPN)
in 100 outpatients treated for HIV infection at the infectious clinic of Kanthrarawichai Hospital.
The criteria for the diagnosis of DSPN was one of the following neurological signs,
i.e., decreased or absent ankle jerks, decreased or absent vibratory perceptions at the toes, or
decreased pinprick or temperature sensation in the area of stocking distribution. Subjects
were classified at each visit as being asymptomatic DSPN (ADSPN) (signs only) or symptomatic
DSPN (SDSPN), on the notification of numbness, paresthesia or pain.
Of the total, 32 percent of the subjects met the criteria of DSPN, 28 percent were classified
as ADSPN, and 72 percent SDSPN. Height, cigarette smoking, hypoalbuminemia and
taking fluconazole were risk factors, with the P-values being 0.021, 0.045,0.047 and 0.032,
respectively, using univariate analysis. However, multivariate analysis did not show significant
risk factor association between HIV patients and those with DSPN. It was concluded
that there were no significant risks factors for DSPN in HIV-infected patients.


To examine the correlation between capillary whole blood glucose and plasma glucose
determined by a capillary glucose biosensor (Accu-Chek Advantage) and the standard
venous glucose oxidase test, a descriptive cross-sectional study was conducted on
267 diabetic patients who attended the DM Clinic of Srichiangmai Hospital from August
to September 2007. A pair of finger-tip capillary whole blood and venous blood samples were collected from each subject for glucose determination by the capillary glucose biosensor
(Accu-Chek Advantage) and the standard venous glucose oxidase test. Correlation
of the results from both methods was performed by using the correlation coefficient
and linear regression methods.
The mean level of capillary whole blood glucose was 156.08 mg/dl, and of plasma
glucose, 171.73 mg/dl. The mean plasma glucose level was 9.1 percent higher than that of
the capillary whole blood. The correlation coefficient (r) of the two methods was 0.913.
The plasma glucose level may be estimated from the known capillary whole blood glucose
level by the linear regression equation: Y = 0.824X + 14.574.
The glucose levels determined by the capillary glucose biosensor (Accu-Chek Advantage)
correlated well with those obtained by the standard method (Glucose oxidase
test) which represents the actual blood glucose level. Accu-Chek Advantage can be used
for both DM screening and patient follow-up; the actual glucose level, which was determined
by the glucose oxidase technique, can be calculated using the linear regression
equation.


The viral load (VL) test is not widely available in Thailand for HIV follow-up, which
relies mostly on CD4 count and clinical manifestations. Kuchinarai Crown Prince Hospital
(KCPH) has implemented the VL test in collaboration with MSF-Belgium. Coherent
PHA (N=128) for 2-7 years, including VL, CD4 count, clinical symptoms and Karnofsky
score 90-100, were used. The first arm reading involved 88 cases (68.75%) with undetectable
VL (<50 copies/ml), 84 (95.45%) having good CD4 count with no OI symptoms; that
of arm 2 involved 33 cases (25.78%) with VL between 50 and 1,000 copies/ml, with 30
cases (90.91%) having good CD4; that of the last arm involved 7 cases (5.47%) with VL >
1,000 copies/ml, of which 4 cases (57.14%) has good CD4.
Arm 2 received adherence counseling, followed by second and third VL follow-up
(3-month interval) resulting in undetectable VL after the second interval.
Arm 3 (last arm) showed no improvement in 4 cases (57.14%). They were put on
second line ART. At the end of the study, 124 cases (96.88%) out of 128 cases were undetectable
(VL < 50 copies/ml); while 4 cases (3.13%) with VL > 1000 copies/ml became
resistant to the first line ART and were switched to the second line ART.
The study shows that the systematic VL test should be included in HIV treatment to
detect treatment failure (i.e. virologic failure). The VL test is a tool for PHA active involvement
addressing adherence.
Viral load test should comprise a minimum package for HIV treatment in Thailand.
Our study shows that proper follow-up with systematic (client center) VL test reduces
the cost of second line treatment.


A study was conducted to determine the outcome of treatment following the GINA
(Global Initiative for Asthma) guidelines 2006 on asthmatic patients visiting Kanthararom
Hospital, Srisaket Province. The guidelines stressed the reduction of bronchial hyperresponsiveness
and treatment of bronchospasm. A total of 128 asthmatic patients (having
340 visits) during the period January 1 to July 31, 2007 were interviewed and the peak
expiratory flow rate (PEFR) measured by experienced nurses. The patients were then
treated according to the guidelines. Of the total cases, 61.72 percent were female. The
mean age of the first asthmatic attack was 35 years. The admission rate within one year of
the interview was 30.47 percent and the incidence of acute severe symptoms (ER visit)
was 76.57 percent. The drugs used in the patients comprised inhaled corticosteroid (ICS)
35.15 percent, oral corticosteroid 5.45 percent, B2-agonist combined with corticosteroids
inhalant 18.75 percent, and ICS combined with long-acting B2-agonist 12.50 percent. These
patients made visits to the asthma clinic an average of 2.65 times in four weeks. The
results of treatment producing total asthma control were 12.94 percent, good control 30.58
percent, and poor control 56.47 percent. Since a significant number of treated cases remained
in the poorly controlled category, it is reasonable to conclude that the increased
practice of ICS may be effective in reducing ER visits and hospitalization.


Objective : To assess the coverage of the type 2 diabetes screening program among
the high-risk population in the catchment area of Phonphisai Hospital, Nongkhai Province
before and after the implementation of the application of the Ministry of Public
Health’s operative plan for diabetes screening.
Methodology : The target population comprised residents of the catchment area
aged 40 years and older who were covered by health insurance during the period 2003-
2005. Verbal screening of the Ministry’s Bureau of Non-communicable Disease was used
in the diabetes mellitus screening program. Annual data about the number of the target
population, persons screened, and detected diabetes cases relevant to the catchment area
of Phonphisai Hospital were collected for the years 2003 to 2007. The coverage and prevalence
rates of diabetes mellitus were then analyzed and presented.
Results : The coverage rates of diabetes mellitus (DM) screening in 2003-2004 and
in 2005-2007 and the application of the Ministry’s operative plan for DM screening were
49.76 and 78 percent, respectively. The population with the highest coverage rates were
females and those in the 50-59 year age group. The overall DM prevalence rate during
the period 2005-2007 was 2.46 percent. Detailed analyses showed that males had lower
prevalence rates than females, and the 50-59 age group had the highest DM prevalence
rate compared with the other age groups. Compared with the whole Nongkhai Province,
DM was more/less prevalent in the catchment area of Phonphisai Hospital. The DM
prevalence rates for these two areas for 2005 were 419.02 and 286 per 100,000 population,
respectively.
Conclusions : The application of the Ministry’s operative plan for DM screening
resulted in clarification of its policy and importantly that of the Chief Provincial Health
Officer as well as the vision of the administrator as the Director of the District Hospital
applies to his operating staff with regard to the participation and integration of the community
and to increases in the effectiveness of efforts to detect DM cases in the catchment
area of Phonphisai Hospital. Thus, the Ministry’s operative plan for DM screening should
be continued and applied to other areas.


A study was conducted to determine the factors associated with depression and
suicidal risk among 359 residents aged 35 years and older living in Ko Sichang district,
Chonburi Province. The subjects were recruited by random sampling from the household registry. Information was obtained using the questionnaires prepared for the detection of
depression and suicidal risk by the Department of Mental Health of Thailand’s Ministry
of Public Health. Chi-square test and probit regression analysis were used to determine
the factors associated with depression and suicidal risk. Of the 359 persons interviewed,
35.93 percent were male and 64.06 percent female; 34.26 percent of them were aged 40-49
years and 64.35 percent had an educational level of primary school; 59.33 percent had a
monthly income of less than 5,000 baht; and 38.44 percent suffered a chronic disease. The
care-givers who accompanied the study population to the health-care centers for treatment
were mainly their family members (53.20%). Of the persons surveyed, 22.56 percent
suffered depression (depressive score > 6) and 13.37 percent were at risk of suicide
(suicidal score > 2). It was apparent that chronic illness was a significant factor associated
with depression, while higher educational levels and having intimate care from family
members or relatives such as accompanying them for health-care services seemed to reduce
depression. Having a chronic disease was also a significant factor associated with
an increase in suicidal risk. Further prevention or reduction of depression or suicidal risk
among people with a chronic disease is essential. Family members and relatives may help
this population at risk to reduce their depression.


The objective of this quasi-experimental study was to determine the effects of counseling
on self-care behavior among diabetic patients in Nongpok Community Hospital,
Roi Et Province. The subjects included 30 diabetic out-patients with a fasting plasma
glucose level > 140 mg/dl who were selected by purposive sampling from those attending
the diabetic clinic and agreed to participate in the study. They received counseling on
self-care issues in respect of food modification, treatment and drug use, foot care, emotional
control, prevention of complications, and proper exercise. Data on self-care behavior,
fasting plasma glucose, and body mass index were obtained from the participants
before and three months after the program ended. Percentage and mean were used for
descriptive analysis; Pearson’s correlation, chi-square test or paired t-test were used to
determine the association between data before and after the program.
The results showed the mean scores of self-care behavior following the counseling
program were significantly higher than those obtained on commencing the program, and
the levels of fasting plasma glucose were significantly reduced after the counseling program.
The body mass index of the patients, however, remained unchanged. Counseling
on self-care behavior may be advocated for use in diabetic patients.


This research was aimed at studying the knowledge and implementation of the “six
categories” policy for the establishment of health. The tool used was the modified interview
questionnaires of the Health Education Division, Health Service Support Department
(Reliability = 0.70). Descriptive and inferential statistics were used.
The samples were 56.1 percent female; average age was 44.5 years, 41.1 percent finished
primary education, 65.1 percent were married, 28.5 percent were farmers, 69.7 percent
had no fixed income, 79.3 percent had congenital disease, 69.3 percent, when they
got a health problem, went to a public health center or hospital having knowledge of the
“six categories” policy on food aspects at the highest level and on environmental health
at the least high level, mostly cooking for themselves, exercising normally by walking
and jogging, relaxing by watching films/listening to music/walking around, and on the
environmental health aspect by cleaning house and disposing of rubbish by burning,
using seat belts less often or a safety helmet while driving. The majority did not smoke/
or drink alcohol, and their education level was related to their environmental health
knowledge, while fixed income was related to their knowledge of preventive measures
(p <.05).
The results indicated that building systemic knowledge among the public should be
focused on those practices which will lead to correct health behavior.


The study employed a descriptive approach, aimed at confirming the medical diagnosis
of hand, foot and mouth disease (HFMD) and attempted to identify infected people,
disease transmission and appropriate measures for disease prevention and control in a
child development center in Sainoi District, Nonthaburi Province. Patients’ data were
collected from investigation reports, OPD card, and laboratory reports. This center served a total of 159 children and 20 personnel, including nursery shcool teachers, assistant teachers, house-maids and cooks (and/or their parents). They were interviewed and examined for the disease during the period July 16 - August 1, 2007. Surveillance data on
HFMD from 506 reports for Nonthaburi Province from 2002 to 2007 were also reviewed.
An environmental survey was conducted in the center to determine the possible mode of
transmission. During the period July 13 to 27, 2007, three cases (1.9 %) out of the 159 children who visited the center were found to have HFMD. In the first case, the onset of clinical symptoms occurred on July 13, 2007; in the 2nd and 3rd cases symptoms were observed on July 16, 2007. All three cases were 3 years old. One case was a boy and the others were girls. No case died in this outbreak. The stool specimens obtained from two cases were negative for enterovirus 71, the organism causing severe HFMD. The possible common-source transmission of this disease might be from contact with the contaminated toys, common equipment or places used by children, and droplet spread. Prevention and control measures included massive health education, early detection of suspected HFMD cases, reduction in the transmission from humans to humans by closing the center concerned, and setting up disease prevention and control regimes in the patients’ houses, the center, and the community. No subsequent cases were detected after implementing the control measures.


Among people developing diarrhea, some take oral rehydration salt solution, but
most did not know the proper amounts to drink. After drinking some amounts of a salt
solution without recovering, they came to the hospital. Formerly, during the hospital
visits, they never received information what amounts of the salt solution they should
take. This study revealed that, with the practice of demonstration for the 2,704 diarrhea
cases seen in the period from June 2005 to May 2006, only five patients (0.18%) needed
intravenous fluid and only 254 patients were hospitalized, while in previous years (June
2004 - May 2005)the in-patients numbered 559 (Jun 2004-May 2005), dropping to 254 admitted
cases in the following year (Jun 2005-May 2006); this saved a lot of expense for the
hospital. It is necessary for the health-care provider to demonstrate how much of oral
rehydration salt solution is needed when one has diarrhea.


The objective of this study was to create an appropriate care guideline for diabetic
patients with hypoglycemia at Phayuhakiri Hospital. The methodology included a literature
review, knowledge sharing with other community hospitals and diabetes mellitus
specialists, after which a care guideline for diabetes with hypoglycemia was developed.
All diabetic patients hospitalized for hypoglycemia during the period October 2005 - September
2006 were enrolled in this study. Mortality, readmission rates of recurrent hypoglycemia,
knowledge, self-caring behaviors and support from relatives before and after
the intervention were compared. The findings showed that these new practices reduced
the hazardous consequences of hypoglycemia, such as death or recurrent hypoglycemia;
patients and relatives developed better knowledge in preventing hypoglycemia
and had more appropriate responses to hypoglycemia symptoms. This care guideline
has been implemented in Phayuhakiri Hospital since fiscal year 2007. The pitfalls found
in this guideline will be adjusted in order to obtain more efficient care.


Phenytoin is an anticonvulsant commonly prescribed for prophylaxis and the treatment
of patients with generalized or partial seizures. Therapeutic drug monitoring of
phenytoin is mandatory owing to its narrow therapeutic range, long duration to achieve
steady-state plasma drug concentration, wide range of pharmacokinetic parameters and
non-linear pharmacokinetics. This descriptive study was carried out to determine the
patients’ compliance in taking phenytoin at the Promkiri Hospital epileptic out-patient
clinic during the period March to July 2007. The subjects were 75 patients aged 18-60
years; the male to female ratio was 1.58:1, with their average body weight being 46.07 kg,
and all had normal liver and renal functions. The dose of phenytoin used varied from 100
to 500 mg/day; the median dose was 300 mg/day. Drug non-compliance was verified in
15 patients (20 per cent of the subjects ) from pill counting, missing drug-taking days, and
checking serum phenytoin concentrations. The result of this study would lead to urgent
planning implemented for future patients’ therapy in order to improve the success rate in
the administration of phenytoin.


This retrospective study was conducted to verify the results of treatment of 25 hazardous
alcohol drinkers by a combination method of cognitive behavior therapy with
electrostimuli ear acupuncture at Bangprakong Hospital; there is no known use of the
method being employed previously. The 25 patients were studied by audit questionnaires:
six scores in women and 8 scores in men. Treatment given by electrostimuli ear
acupuncture for one hour and cognitive behavior therapy program for one hour daily on
10 successive days and follow-up four times at one week, two weeks, one and three months,
respectively. The results were analyzed descriptively, showing that 19 of the patients
could stop drinking (76 per cent), although six suffered a relapse (24 per cent). The longest
cessasation was five years.


Background and Rationale: The health service system, as one part of the means for
preserving health, is focused on health insurance to assure the good quality, efficiency,
and equity of health services. The main concept behind developing and improving health
services, using the Hospital Network Quality Audit, is the participation and willingness
of people to develop the quality of health services continuously. Therefore, participation
plays a major role in the success of the Hospital Network Quality Audit.
Methodology: This was a descriptive research study using cross-sectional analysis.
The questionnaires were distributed between the 3rd and 10th of October 2007. The
data were entered into the program to analyze them for frequency, percentage, means,
standard deviation, and range. Pearson’s product-moment correlation coefficient was used
to evaluate the relationships between the independent variables and the participation in
the Hospital Network Quality Audit.
Setting: Two hundred and fifty-six health professionals for the Hospital Network
Quality Audit in the hospital network, Chonburi Province.
Results: The majority of health professionals had a medium level of knowledge of
the factors in the Hospital Network Quality Audit. Knowledge factors were significantly
related to the level of participation in the Hospital Network Quality Audit. The majority
of the health professionals had a medium level of motivator factors and there were significantly
related to the participation in the Audit. When considering each subscale, the
results showed that the subscales of advancement, achievement, recognition, work itself
and responsibility were significantly related to the participation in the Hospital Network
Quality Audit; the majority of the health professionals involved had a low level of hygiene
factors and these factors were significantly related to their participation in the Audit.
When considering each subscale, the subscales of policy and administration, work
conditions, interpersonal relations with supervisor, subordinates, peers, salary and job
security were significantly related to participation in the Audit, and the majority of the
health professionals had a medium level of participation in it.
From the results of this study, suggestions were made on measures ranging from
personal development by self-learning, training and seminars for quality improvement.
Moreover, the hospital committee should assess the needs of all staff in order to improve
the social welfare benefits and financial remuneration in addition to the government support.


Although awareness exists that over-crowding in the Outpatient Department has
been a similar to that in government hospitals, previous studies of the problem had been
carried out on the situation in provincial and university hospitals. The present researcher
conducted this study to determine the factors relating to the problem of overcrowded
outpatient services in a community hospital where he works; he used the experience thus
obtained for developing the service quality of the hospital. A survey was taken by questionnaires on stakeholders (June 2007), regarding service
quality; the study was carried out in the period July-October 2007. The survey resulted
in most staff agreeing with the need to refer chronic cases to the primary care unit,
but disagreeing with the posting of a doctor service in the primary care unit on weekends;
the patients were not happy with the self-care functions if there was health worker
visit. After the service has been initiated, it could be expected that patient waiting time
would decrease from 192 minutes to 110 minutes.
The researcher made suggestions for reducing the overcrowding problem by integrating
health taskforce distribution by equity versus efficiency and incentive policy for
community hospitals and primary care units in order to improve the service quality and
the referral system.


This study was aimed at assessing the accuracy of the blood glucose meter currently
in use in comparison with the reference test. A cross-sectional analytical study design
was used. The sample population comprised diabetic patients from the diabetic clinic at
Maesai Hospital, Chiang Rai Province during the month of September 2007. Blood glucose
levels, sex, and age of the samples were collected. The statistical methods used were
descriptive, Pearson’s correlation, Spearman’s rho correlation, Wilcoxon’s signed rank test, paired t-test, and univariate linear regression. The results of the study showed that,
out of 139 patients, 69.6 percent were female, with the average age being 54.3 ± 12.5 years.
It was found that the average blood glucose levels were not statistically significant.
Spearman’s rho coefficient was 0.96 (p<0.001). Since the difference in the results from
both tests was higher when the blood glucose level was higher, subgroup analysis was
conducted by separating the blood glucose level into two groups: less than 300 mg/dL
and 300 mg/dL or over. The results revealed that in the former group, the total number of
samples was 130. The average of the blood glucose levels was not statistically significant.
Spearman’s rho coefficient was 0.95 (p<0.001). The results of the analysis of the latter
group showed that there were 8 patients whose average blood glucose levels were not
statistically significant. Pearson’s correlation coefficient was 0.76 (p=0.03). The univariate
linear regression model in this part was the blood glucose level from the reference test =
15.9+blood glucose level from the blood glucose meter. Moreover, the clinical differences
(±20%) from both subgroups were less than 5 percent.


The objectives of this cross-sectional study were to analyze the correlation between
Personal Qualities and the Pregnancy’s Perception Factors, such as the pregnancy nutrition
graph and pregnancy pathway, as they related to self-care during pregnancy and antenatal care for newborns’ birth weight. The subjects were 371 pregnant women who
visited community hospitals in Sisaket when going into labor. The data were collected
using self-administered questionnaires and these were analyzed using t-test, chi-square
and Pearson’s correlation coefficient.
The results revealed that both the educational level and age were significantly correlated
to the newborn’s birth weight (p=0.034 and 0.002). Gravidity was significantly
correlated to quality of antenatal care (p=0.049). The quality of antenatal care of second to
fourth gravidity was 1.57 times significantly higher than the first and fifth gravidity. Perception
on the pregnancy pathway was significantly correlated to the utilization of the
pregnancy nutrition graph and pregnancy pathway (r=0.403, p-value=0.000 and r=0.407,
p=0.000). Perceptions on the pregnancy pathway were significantly correlated to the utilization
of the pregnancy nutrition graph and the pregnancy pathway (r=0.416, pvalue=
0.000 and r=0.487, p=0.000).


Asthma is a chronic inflammatory disease of the airways; occasional cases may succumb
from severe attacks. Bang-Pa-In Hospital established an asthma clinic in 2006; it is
operated by a multidisciplinary team which provides treatment according to international
standard guidelines. This study was undertaken to evaluate the efficacy of the Hospital’s
asthma clinic by comparing the results of the care before and after attending the clinic in
82 selected patients (24.4% male, 75.6% female) in the period from June 1, 2006 to December
31, 2007. The results showed that the hospitalization rate of asthma cases was reduced from
24.4 to 2.4 percent, the rate of patients receiving nebulizers in the emergency room was
reduced from 75.6 to 14.6 percent, the use of short-acting beta2-agonist was reduced from
81.7 to 23.2 percent, the rate of correct practice during asthma attack was 73.2 percent, the
use of inhaled corticosteroid (ICs) increased from 19.5 to 100 percent, the rate of correct
use of inhalers increased from 28.9 to 87.8 percent, and the control of the disease increased
from 11 to 24.4 percent. The means of in-patient admission, visiting the emergency room,
use of short-acting beta2-agonist, and peak expiratory flow of the experimental group
was significantly different at the 0.05 level.
This overall result implies that the quality of life of the asthmatic subjects became
better and that asthma can be controlled by providing, in addition to the use of appropriate
drugs (ICs), appropriate education about the disease and an understanding of how
asthma treatments work. Finally, the reduction in in-patient admissions, emergency department
visits and school or work days missed was achieved.


This descriptive study was designed to determine the unit cost and cost recovery in
Charttrakarn Hospital in Phitsanulok Province in fiscal year 2006 from the provider’s
perspective.  The hospital’s operations were classified into three categories: non-revenueproducing center (NRPCC), revenue-producing cost center (RPCC), and patient service cost center (PS).  The total direct cost of each cost center/activity was determined by
combining labor cost, material cost with capital cost.  After that, the  direct costs of NRPCC
and RPCC were allocated to PSCC as indirect costs by using the step-down method.  Then
the full cost of each PS was calculated from direct plus indirect costs. Dividing the final
full cost of each cost center by its output provides the unit cost.
The results show that the total cost of the hospital in the year 2006 was 44,257,662
baht, with the proportion of LC: MC: CC = 53:37:10. The unit cost of the whole out-patient
service was 417 baht per visit, while the unit costs of the out-patient cost center, dental
health cost center and family practice cost center were 348, 603 and 1,205 baht/visit respectively. The unit costs of the in-patient service were 4,287 baht/case,  1,756 baht/day,
and 7,005 baht/relative weight (RW).  The total cost recovery of the hospital was 0.94. The
scheme with maximum cost recovery was CSMBS (1.28); the second highest was that of
VHCS (1.22), followed by the universal coverage scheme at 0.91.
Recommendations:
1. Costs and unit costs among hospitals should be compared carefully.  The details
of cost identification, cost allocation and unit cost determination should be considered,
because they vary among studies.  Besides hospital revenue, the meaning should be clarified and defined with regard to the extent of revenue as well as its components. Furthermore, the value of the money in different periods of time is not the same, so it should not
be compared directly.
2. Governmental budget allocation criteria for the entire country should be assessed
for appropriateness according to the various cost characteristics among hospitals operating in different contexts.
3. Each hospital should set up an effective information system for collecting an essential database on hospital accounting, resources consumption, workload of hospital
service, and other important data. The system should be able to assess the financial situation, hospital costing and hospital performance


This is a retrospective descriptive research study, the objective of which was to evaluate the results of trigger finger treatment by percutaneous approach using applied dental equipment. The study population included 29 patients with trigger finger (females
with a mean age of 52 years) on whom 35 digits were treated by percutaneous operation
at Samchuk Hospital, Suphan Buri Province. The statistical analysis gave frequency, percentage, mean, median and range. The results of the study revealed that the mean operation time was 14 minutes; only
12 patients (34.3%) kept their appointment for seven days of postoperative follow-up.
The mean home visit period for every patient was 13 months.  On the seven-day followups, every patient could move her fingers normally and only two patients sensed pain.
On home visits 34 of the 35 fingers (90.14%) moved normally; four patients had a sensory
loss but without pain or scars.  The majority of patients (74.28%) could move their fingers
normally within 10 days of the operation.  The mean sastisfaction score was 9.69 out of 10.
All patients were willing to recommend other trigger finger patients to come for treatment at Samchuk Hospital. The author concluded that the treatment by percutaneous
technique with applied dental equipment is effective in releasing trigger fingers without
additional medical treatment; this technique involved fewer complications, no scar formation, a short recovery period, no recurrent symptoms, and produced good patient compliance and faith.


The objective of this study was to observe the behavior of hypertensive patients along
with the factors affecting their self-care practice. The qualitative study was conducted during
the period July - December 2006 and involved 29 diagnosed hypertensive patients, the persons
who took care of them, the leaders of the health-care team in the community, and the healthcare staff of the local hypertensive clinic. Information was collected by personal interview,
group discussion, and observation.  Data were analyzed and checked by using the content
analysis and triangulation techniques, respectively.
The results were as follows: most of the hypertensive patients pursued inappropriate
self-care behaviors, including food consumption behavior, cooking in familiar ways, consuming food together in companion groups, with the choice of the food being provided at the
discretion of the cooks. Among the factors affecting them were insufficient physical exercise
owing to fatigue or no extra time due to their overwhelming responsibility of providing family care.   A minority group could not perform the physical activities due to senile frailness.
Most patients suffered stress from varying causes including debt.  With regard to the factors
affecting tension, the most serious was the liability they faced.  In the group discussion, the
patients and persons who took care of the patients criticized the health-care providers with
regard to patient behaviors on food consumption and regular exercise.


Asthma is a chronic disease for which a good number of patients need lifelong treatment.  It is hoped that an easy asthma clinic, established according to the standard guidelines for asthma control, would provide effective treatment of asthma.  The objective of
this study was to assess the outcomes of Banphai Hospital’s easy asthma clinic from its
founding in January 2004 to December 2006. Information obtained on the 331 patients
(males 51.4%, females 48.6%) was that the in-patient admission rate decreased from 442
to 79, the numbers visiting the emergency room decreased from 560 to 241, and the total
control group increased from 5.88 per cent to 8.94 per cent. These findings provide evidence that the Easy Asthma Clinic has produced a reduction in the admission rate and
number of emergency room visits and increased the efficacy of asthma treatment. Therefore, the Banphai Hospital Easy Asthma Clinic model may be considered for implementation in all community hospitals in Thailand.


Objective: The purposes of the study in Panomsarakham District, Chachoengsao
Province, were as follows: 1) to survey the quantity of fluoride in drinking water sources;
2) to determine the prevalence and severity of dental fluorosis in district elementary
schools, and its relationship to the presence of fluoride; and 3) to encourage community
participation in solving the dental fluorosis problem.
Method: 1. Collection of 426 water samples from 87 villages; these were sent for
fluoride detection by ion-specific selection method (electrode); 2. a cross-sectional study
was conducted on 2,281 elementary students in grades 1-6 resident in Panomsarakham
district, for the presence of fluorosis and caries;  and 3. resorting to community participation with local authorities.
Result: Highly fluoridated drinking water was found in 13 of 81 villages, and the
levels were especially high in Bansong, Nongyao, Kaohinsorn and Tatan villages.  The
dental fluorosis prevalence rate was 35.9 percent among students from highly fluoridated
villages, and only 12.7 percent among those from villages where the level of fluoridation
is low.  The severity of dental fluorosis depends on the concentration of fluoride in drinking water, with statistical significance being p=0.000.  The mean DMFT was 1.46 in a
highly fluoridated village while it was 1.42 in a village where fluoridation was low.  It
was noticed that the highly fluoridated area still had higher rates of dental caries compared with the area with a low level of fluoridation, which is contrary to the findings of
other reports; this aspect requires further study in the future.
Conclusions: High levels of fluoridation in drinking water were found and its presence directly related to the prevalence and severity of dental fluorosis.  Therefore, the
problem should be solved by stakeholders [government, communities and politicians],
i.e., the communities concerned should take responsibility for a campaign to change  the
source of drinking water; politicians should provide a budget for intervention and the
government should support surveillance and the provising of data.


This research study was conducted on 204 non-insulin dependent diabetes patients
to assess their behavior and the relationship between supporting factors, by making
practical use of the theory of the PRECEDE Model of Lawrence Green, which involves
studying cross-sectional data collected by survey, using structural interviews.  The study population (n = 204) was obtained by simple random sampling from the non-insulin
dependent diabetes patients attending the diabetes clinic in the period June 1-30, 2006.
Descriptive data were submitted for Pearson’s coefficient and multiple regression analyses.  The results were that the behavior in controlling the blood glucose level among
non-insulin dependent diabetes patients was at a moderate level.  Knowledge of diabetes
(p<0.01), perceived susceptibility to diabetes (p<0.01), perceived severity of diabetes
(p<0.01), benefits and cost of following the advice and suggestions of health officers
(p<0.01), the skill of a diabetic (p<0.01), and promotion by spouse, parents, relatives, siblings, neighbors, co-workers, doctors, nurses and public health officers (p<0.01) are positively and statistically significant related to the behavior of blood glucose level control.
The results of the stepwise multiple regression analysis revealed that the factors affecting
the behavior of blood glucose level control in non-insulin dependent diabetes patients
can be promoted by their spouses, parents, relatives, siblings, neighbors, co-workers,
doctors, nurses and public health officers (p<0.001) and the benefits and cost of following
the advice and suggestions of public health officers (p<0.01).  The two variances were in
line with the prediction at 12.90% (R
2
=0.129).  Information obtained from the present
study suggests that the use of certain health strategies, such as meetings, trainings, movies, slides, videos, and showing actual data, would enable the patients to gain more knowledge about the complication of diabetes which might occur in them.   Such strategies
could also give knowledge to their family members (spouses, siblings, as well as public
heath volunteers of the village, and community leaders), and lead to the establishment of
a diabetes club in their village.  Such steps would encourage the patients to take control of
their blood glucose levels so that thay become normal or near normal.


Dapsone hypersensitivity syndrome (DHS) is a condition rarely reported in Thailand.  Recently, during the period from January 1 to August 8, 2007, a 40-year-old male
patient, among the five cases on multidrug therapy (containing dapsone) for treatment of
leprosy, developed DHS (fever, maculopapular rash, hepatitis, lymphadenopathy and
pneumonitis) eight weeks from the start of the treatment.  Prompt drug withdrawal, administration of corticosteroid and supportive treatment led to his rapid are recovery; he
was discharged on the 11th day of hospitalization.  The patient is likely to have represented the second reported case of its kind in Thailand.  The author is publicizing this
case as a  warning to physicians who chance the use of dapsone; they must be aware that
the severe and potentially fatal side-effects of such a hypersensitivity syndrome is not so
rare


Chiang Saen Hospital has provided antiretroviral therapy (ART) to people infected
with HIV, especially the Burmese and Laotians residing in Thailand or in their own countries.  The guidelines of the country program were applied.  The cohort study design
measured ART adherence, survival rate, clinical outcomes, result of the prevention approach and psychological support as outcome indicators.  Data were collected and analyzed using FUCHIA software.  The Kaplan-Meier method was conducted for survival
analysis.  The results revealed that 73 non-Thai PLHA (people living with HIV/AIDS)
who received ART from July 2004 to June 2007 (19 Laotians, 16 of whom resided in their
own country; 51 Burmese, 20 of whom resided in their own country, and three minority
people residing in Chiang Saen.  Mean ART adherence was more than 98.2 per cent.  Mean
survival time in months was 41 (95% CI 39.0-43.2).  Survival at 36 weeks was 96 percent.
Three cases died after ART, two from AIDS and one from the adverse effects of ART.   No
case had been lost to follow-up or stopped treatment.  Thirty per cent of the patients
needed to change individual drugs due to adverse effects.  The health of those on treatment improved.  Access to ART increased the uptake of service in the prevention approach.  Eleven cases received vocational loans and one case received an education fund.
It is one model of how the disadvantaged can access ART in cross-border areas and how
Thailand can support its neighbors.  However, the effectiveness and the sustainability of
the program still need to be considered


This is an evaluation of public health service innovation, with a focus on subdistrict
hospital creation.  The major aims of this work were strengthening the community with
regard to the building of and participation in sustainable health care.  The method considered three phases. The first phase was to create a participation center for fostering
community trust and belief. Triangular cooperation consists of a government organization, subdistrict administration and a community plebiscite in the pilot innovation intiated in three subdistrict hospitals.  In the second phase that followed, 31 subdistrict hospitals
were distributed in 22 subdistrict areas.  The third phase utilized useful community trust
and belief for the creation of various novel projects.  The overall creation extended five
years and involved underlying community triangular participation.  The subdistrict hospitals had permanent registered nurses, telemedicine consulting and medication storage
development. The consequences of subdistrict hospital creation improved the people’s
health service access. While the number of walk-in clients seeking subdistrict hospital
services expanded year on year, a three-fold reduction was observed among those
seeking medical services in Lomsak Hospital.  Important was the two-fold improvement
in chronic illness screening.  In conclusion, the results of this evaluation suggest that a
key important success indicator of subdistrict hospital creation is the strength of community participation, consequently improving community development and sustainability.


Background & rationale Poor adherence to medication is a common problem in
handling patients with chronic disease.  Induction of patient adherence to a long-term
regimen requires impressive information about the regimen being given and the importance for the patient of following strictly the treatment, together with the full support of
their families.
Objectives To evaluate the adherence to medication and clinical outcomes in hypertensive patients with or without diabetes mellitus.
Methodology A retrospective study of hypertensive patients was conducted by reviewing outpatient medical records from June 2006 to June 2007 at Nangrong Hospital.
Two groups of subjects included men and women aged over 18 years old: the group of
primary hypertensive patients had blood pressure above 140/90mmHg and the group of
hypertensive patients with diabetes mellitus had blood pressure above 130/80 mmHg.
Patients with other causes of hypertension, or blood pressure over 200/120 mmHg, or
who had serious complicating illnesses, such as terminal stage of cancer, chronic renal
failure, chronic liver disease, congestive heart failure, stroke, and uncontrolled angina,
were not included.
Results Among the total of 54 patients, the hypertensive patient group (n=30)
had higher blood pressure than the group with hypertension and diabetes (n=24).  The
average ages of patients in the hypertensive group and the group with hypertension and
diabetes group were 60.56±8.97 years and 57.75±7.87 years, respectively.  The risk factors,
i.e., cigarette smoking and alcohol consumption, showed no difference in the two groups.
The study disclosed that the major factors for poor adherence were the complexity of
treatment (66.66%, 83.33%) and a poor provider-patient relationship (66.66%, 75%); the
major factors for improving adherence were emphasized value of the regimen (93.33%,
95.83%) and family support (93.33%, 96.66%).  Impediments to successful adherence to
medication in individual cases, namely taking drugs at the wrong time (36.66%, 37.50%)
and taking extra doses to make up for missed doses (20.00%, 20.83%), showed no difference in the two groups.
Conclusions Poor adherence to a medication regimen is common, contributing to
substantial worsening of disease, death, and increased health-care costs.  Improving adherence requires emphasizing to the patients the value of the regimen, making the regimen simple, medication-taking behavior and family support.


This research studied the factors related to the sick leave behavior of personnel in
Pranburi Hospital, Prachuap Kiri Khan Province to determine the reasons for sick leave
behavior as it related to disease/symptoms, age, sex, income, position, section/institute,
and type of career.  The study population numbered 174.  Retrospective research was
used to compile data on sick leave based on requests for leave of absence over the period
from October 1, 2004 to September 30, 2006.  Analysis of the data was by statistics, percentages, averages, standard deviation, and Chi-square.  Most of the personnel took sick
leave an averae of 2.54 times over the two-year period; a frequent reason for taking sick
leave was  respiratory system disease (35.4%).   The number of days of sick leave ranged
from 0.5 to 2 days/time (84.1%), but there was no significance according to age, sex,
income, position, section/institute, or type of career.


The objective of this qualitative study was to study the adaptation to illness of tuberculosis patients and develop recommendations for family and social support of the
patients. Purposive sampling was carried out by in-depth interviews of registered AFBpositive pulmonary tuberculosis patients who were treated in Chaingyuen Hospital and
lived in Chaingyuen district.  It also included in-depth interviews of the families, neighbors, and health volunteers, as well as the local governor, and health officer. Focus group
discussion was conducted among three groups of neighbors, families and cousins of tuberculosis patients; there were four cases of non-participatory observers in the patients’
families. The results of this study show that, in the first two months of treatment, the
patients required physical and psychological adaptation because of worring disease progression and drug side effects, which made them reduce their activities.  They also needed
support from others, which lowered their self esteem.  After the first two months the
patients felt better owing to their improving health, and the normal activity which gave
them confidence in the treatment and boosted their self esteem.  Although most of the
patients could adapt to the role-functioning aspects, they still helped themselves and
sought the support of others appropriately.  One-third of the patients sought alternative
treatment, especially with Thai herbs, without addressing financial problems.  For social
support most patients were given good care and love by their families and the community with regard to finance, work, using utensils and providing information on the disease, all of which helped the patients.   The patients were satisfied with the treatment
service received from  the national health insurance system despite the lower number of
homevisits allowed under related guidelines. The health officer therefore followed up by
telephone instead of making homevisits, which showed that local government authorities can play a role in homevisits.  Based on this study, we recommend that the authorities
involved should consider develping community networks and creating a referral system
for patient support, providing knowledge about tuberculosis to the community through
appropriate channels, for example, community radio, and developing a home visit system to meet establihed standards, and make continuous evaluation.


This descriptive study was conducted in a lumber mill in Nakhon Si Thammarat
Province to identify noise hazards and hearing impairment among workers in places where
working condition are noisy.  Noise was found to be greater than 90 decibels (A) over
seven areas (63.64%) in the workplace.  Among the 46 workers who worked in noisy areas
without ear protection, hearing losses of 500, 1,000 and 2,000 Hz at 25 decibels (A) were
found in 26 workers (56.62%), at 26-40 decibels (A) in 19 (41.31%), and at 41-55 decibels
(A) in 1 (2.17%).
The investigator suggests that the Hearing Protection Program be introduced and a
work manual be provided for the factories concerned in order to ensure the workers’
safety


The practice of the Bangmunnak-Dongcharoen Health Network in carrying out the
policy of preventive control of diabetes mellitus had been by screening patients and high
risk groups using capillary blood glucose levels greater than 110 mg/dl.  Such persons would
be sent to the hospital for conventional diagnosis.  However, this process created considerable inconvenience as a result of overcrowding with attendees; satisfaction dropped and
attendees missed the opportunity to obtain important knowledge about nutrition and exercise.  The author thus created a model for the screening of diabetics and persons at risk and
for providing knowledge by a multidisciplinary team at the health center.  The model could
be used for evaluating the satisfaction of the attendees, comparing mean scores on their
knowledge about nutrition and exercise before and after education and demonstration, and
evaluating the satisfaction of the health officials with such a model.
The study was carried out at seven health centers in Bangmunnak district, Phichit
Province.  The target population included persons 40 years old and older who had a fasting
plasma glucose level higher than 110 mg/dl.  The sample group was tested for knowledge
about nutrition and exercise (pre-test).  Then education and a demonstration was given by a
doctor, nutritionist and physiotherapist. Post-testing was done, and the satisfaction of the
sample group and health officials was evaluated. The results of the study showed that 77
persons were included in this study: 29 cases were diagnosed as diabetics, and 48 cases were
in the impaired fasting glucose group. Most of the cases studied were in the age group 41-50
years and 51-60 years.  The ratio of females to males was 3.8:1.  Average body weight was
63.56 kg, average height was 154.98 cm; the average was 28.74 kg/m2
and 37 cases (48.05%)
had a BMI of 25 kg/m2
.  The sample group was satisfied with the education and demonstration.  Overall satisfaction was 100 percent and most of the studied group was satisfied with
every step.  The cost of travel was reduced by 7.5 times compared with travel to the hospital.
The mean score of the pre-test for knowledge about nutrition was 7.74/10.  After education,
the mean score increased to 8.94.  The mean score of the pre-test for knowledge about exercise was 7.34/10.  After education, it increased to 8.44.  A significant difference (tested by
paired t-test) in knowledge about nutrition and exercise of the sample group before and
after the education program (p < 0.05) was observed.  The result regarding the satisfaction of
the health officials showed that all the health officials were satisfied with the model (100%).
The results of the study showed that screening, coupled with education about nutrition and
exercise by a multidisciplinary team, can make the attendees more comfortable, economically safe, satisfied with less crowding and able to achieve significantly higher scores on
knowledge about nutrition and exercise.  The officials concerned were satisfied about the
education and demonstration aspects.


The purpose of this study was to explore the trends of dengue hemorrhagic fever on
the disease’s occurrence and its association with ambient temperature, rainfall and relative humidity. Information was collected retrospectively from secondary data related to the occurrence of dengue hemorrhagic fever and meteorological data, reported from January 1, 1996 to December 31, 2006.  Data were presented in frequency, and an association
was analyzed with cross-sectional time-series regression.  The results revealed that the
rate of dengue hemorrhagic fever varied from 120.62 to 277.6 per 100,000 population between epidemic years.  There was a tendency for the population to be affected by the
disease every two to five years.  Ambient temperature, rainfall and relative humidity
were positively associated with the occurrence of the disease (p<0.001, p<0.001 and
p<0.001, respectively).
Based on the results of this study, the author would like to suggest that the Ministry
of Public Health should continuously increase the people’s awareness of the occurrence
of dengue hemorrhagic fever.  The provincial health office should coordinate with the
provincial meteorological center, requesting meteorological data related to dengue hemorrhagic fever for preparation of early warning systems for the prevention and control
program.


A 41- year-old woman was bitten on the left foot by a Russell’s Pit-viper.   Four vials
of antivenin were administered promptly on the first day; however, the antivenin did not
prevent multiple organ bleeding from developing the following day.  The patient had
hematemesis, bleeding per vagina and oliguria the next day from acute renal failure.
Owing to high levels of blood urea, creatinine and anuria, interventions including blood
transfusion, antimicrobials, diuretic and 15 sessions of hemodialysis were given.  All her
conditions improved gradually; the patient was discharged from the hospital after being
hospitalized for 45 days.  This case is a good example showing that prompt antivenin
administration along with other therapeutic modalities, especially adequate hydration, is
effective in dealing with acute renal failure caused by this type of snakebite


Diabetes is a lifelong chronic illness. Effective diabetes treatment has to adjust patients’ behaviors by integrating the care techniques of the health team and service science.
This study is aimed at developing an integrated care model for diabetes patients and developing diabetes patients’ potential. The study population  consisted of 204 diabetes patients
of all kinds, selected by using the purposive sampling technique, in the two tambon service
area of the primary care unit of Borabue Hospital.  The study was a research and development model. Before developing it, data were collected for assessing problem conditions as
a supplement to planning. Development was divided into two rounds of six months each.
Round 1 assessed the period before development, and then the model was improved so
that it would be appropriate for operating in the next round. Round 2 assessed operations
based on the developed and improved model from Round 1, compared the operational
outcomes with Round 1, and further developed the model for more appropriateness. Then
the study results were concluded. The instruments used for collecting data were: 1) patient
records, 2) a patient data-recording form comprising personal data, body mass index, complications (diseases), and values of sugar in the blood, HbA1c,  3) an interview form on
knowledge, attitude, and self-behavior to control diabetes, and a questionnaire on patient
stress using the GHQ-28 questionnaire; and 4) a guideline for an in-depth interview. Data
were comparatively analyzed using paired t-test, independent t-test, 95% confidence interval, and content analysis. For development outcomes in Round 1, the following were found.
The developed integrated care model for diabetic patients covered the dimension of service
provision at the hospital and at family/community levels, the dimension of the interdisciplinary team of service provision practitioners at the hospital and at the family/community levels, and the dimension of the services provided using the science of modern medicine and the science of alternative medicine in these five aspects: physical, mental and emotional, intellectual, social, and environmental. The assessment outcomes after development
in Round 1 were as follows.  The diabetic patients had statistically significant higher knowledge of diabetes, attitudes toward diabetes, and diabetes control behaviors (p < 0.05); the
mean of stress decreased statistically and significantly (p = 0.002); sugar in the blood of
both the female and male diabetic patients  statistically and significantly decreased (p <
0.05); and the HbA1c mean after development in Round 1 was 7.84 per cent (SD=1.49).
From in-depth interviews with patients in a group with well-controllable diabetes and in a
group with not-well-controlled diabetes, it was found that their beliefs were different with
regard to correct healing and self-adjustment so that they would still have joy despite their
diabetic ailment.  Development in the next round had to create confidence in healing and
self-care of the patients.   The interdisciplinary team, in providing services at the clinic and
at the family/community levels, had to foster correct behaviors according to the normal
way of life, together with increasing the potential for caring for diabetic patients by the
interdisciplinary team.


Bronchial asthma is a chronic debilitating illness highly prevalent in Thailand.
Danchang Hospital established an asthma clinic on July 10, 2006; it is operated by a patient care team who provide treatment according to international standard guidelines.
This research study was aimed at evaluating the efficacy of the Danchang Hospital asthma
clinic’s efficacy by comparing the results of caring before and after treatment on 85 selected clinic attendees during the period from July 10 to December 31, 2006.
The results showed that the rate of patients receiving medication by nebulizer in the
emergency room was reduced from 59 percent to 11.7 percent and hospitalization was
reduced from 27.3 percent to 2.35 percent; the severity of disease was reduced by 68.2
percent; the rate of correct use of inhalers was 38 percent; decreased use of short-acting
beta 2-agonists was reduced by 82 per cent, and the rate of patients who were able to
perfrom their daily routine activities was 87.3 per cent, which means that their quality of
life was better, and the necessity of emergency room visits and hospitalization was much
reduced.


The purpose of this study was to identify factors influencing the control of blood
pressure levels encompassing four aspects, i.e. personal, pre-disposing, enabling and reinforcing factors.  A sample of study subjects included 381 hypertensive patients living in
Tha Chang district and seeking health care at Tha Chang Hospital, Thon Samo Subdistrict Health Center, Wihan Khao Subdistrict Health Center, and Phikun Thong Subdistrict
Health Center for Commemoration of Her Majesty the Queen’s 60th Birthday Anniversary.  Data were collected by using a questionnaire and analyzed by using percentage
values and the binary logistic regression method for testing the statistical significance of
the factors influencing blood pressure control. The study revealed that the factors influencing blood pressure control among hypertensive patients in Tha Chang district include, in order of high-to-low levels of significance, enough income (OR=2.345), perception of health worthiness (OR=0.478), co-morbidity with hypertension and other diseases (OR=0.414), and supportive care from relatives or someone else with a close relationship (OR=0.316).  Other factors that were found
to be unassociated with blood pressure control are sex, age, educational attainment, knowledge about the illness, perception about being ill, perception about continuous care, attitude toward hypertension, accessibility to health-care facility, satisfaction with healthcare facility, satisfaction with the effects of medication, assistance from health personnel,
and doctor-patient relationships.