The National Public Health Committee (NPHC) has made a resolution to establish the Provincial Public Health Sub-Committee (PPHSC) according to the Public Health Law B.E. 2535 operating in all 76 provinces since September B.E. 2557. After reviewing the performance of the PPHSC which found some problems and barriers emerged unable to enforce the PPHSC’s resolutions and orders, the NPHC then set out a correct resolution by adjusting the legal role, authority, and composition of the Committee and including changing name from the Provincial Public Health Sub-Committee (PPHSC) to the Provincial Public Health Committee (PPHC) as revised and enacted by the new Public Health Law (Volume 3) B.E. 2560. The Public Health Law Administration Center of Department of Health and the Faculty of Public Health of Khon Kaen University were then to study the influential success factors and approach in moving forward the implementation of the PPHC.

This research was a cross-sectional descriptive study with three objectives set forth by exploring of; 1) success factors that influencing the achievement of the PPHSC according to its legal role and authority, 2) guidance in moving forward the PPHC’s implementation, and 3) desirable roles of the PPHC according to the Public Health Law B.E. 2560. The researchers collected related quantitative and qualitative data sets from the PPHSC, by selecting the provinces with high performance one province of each region totaling 12 provinces; Chiang Rai, Uttaradit, Kampangpetch, Surin, Sakonnakhon, Roiet, Yasothorn, Prachinburi, Samut Songkram, Ang Thong, Phuket, and Satun. Collection data by using the questionnaire for 234 PPHSC members, making in-depth interviews of the PPHSC chairperson, secretary, and assistant secretary totaling 36 persons, organizing PPHSC consultation meetings of each province, analyzing key information from PPHSC meeting minutes and its performance reports during B.E. 2558-2559. The study was done April to December B.E. 2560. The quantitative data were analyzed using descriptive statistics while the qualitative used content analysis.

The study results revealed the key factors influencing the success of the PPHSC’s performance were; 1) a high valuation of the matter by the provincial governor is the most influential factor, 2) the effective implementation made by the PPHSC secretary by driving the environmental health actions using the PPHSC’s resolutions, 3) if the matter brought to the PPHSC’s meeting agenda as conformation to the national and provincial policies as well as that of highly concerned and interested by national and local public, 4) the provincial local administrative office strongly supported and pushed forward the compliance with the PPHSC’s resolutions, 5) cooperation of local administrative organizations, concerned agencies, and communities in compliance with the PPHSC’s resolutions, 6) technical support from Regional Health Centers and Department of Health.

Guidance on driving the mission and implementation of PPHC according to the Public Health Law (Volume 3) B.E. 2560 were; 1) initiation policy advocacy, 2) strongly technical support to the mission and implementation of PPHC from central and regional agencies, and 3) effective due actions and evaluation in compliance with the PPHC’s resolutions. Recommendations to the desirable roles of the PPHC according to the Public Health Law (Volume 3) B.E. 2560, the desirable roles of PPHSC needed every mission and action conforming to the Articles of the Public Health Law (Volume 3) B.E. 2560 however the desirable roles by this study was not fully meeting the assignment roles by the Public Health Law.

The due enforcement of the Public Health Law (Volume 3) B.E. 2560 on 19 December 2560 onward on the PPHC, the Department of Health as the leading agency in support of compliances to the public health law by driving the PPHC as a key mechanism for driving the provincial environmental health actions, the Department of Health should make use of this research results in building capacity of PPHC, implementing guidance, and future follow-up and evaluation for the improvement of PPHC’s performances.


Overexpression of human papillomavirus (HPV) 16 oncogenic protein E6 and hypermethylation of HPV16 L1 gene are of interest as biomarkers for cervical cancer progression. Immunochromatography (IC) and enzyme-linked immunosorbent assay (ELISA) are widely used to detect target biomolecules in human. In this study, we developed IC and ELISA assays to detect viral oncoprotein E6 and L1 gene methylation of HPV16 in cervical cells, respectively. The conjugated gold coated with protein G and mouse monoclonal anti-HPV16E6+HPV18E6 was optimized and can detect as low as 312.5 nanogram of HPV16 E6 purified protein using 0.5 microgram of antibody to E6 coated on strip in phosphate Buffer/0.05% Tween 20/1% BSA, pH 7.4 as running buffer. Positive band can also be detected in protein extraction from cervical cell lines containing HPV16 at least 1x105 cells. Nonspecific band was not detected when other types of HPV positive cell line and HPV negative cell line as well as bacterial cell lysate were used in the assay. The remaining cervical cells samples obtained from routine laboratory were used to evaluate the performance of the developed assay. HPV negative samples or other high-risk HPV types other than HPV16 and 18 showed negative results. HPV16 positive samples showed 40%, 22.22%, 50%, 28.6% and 18.18% positive results by IC in squamous cell carcinoma, CIN3, CIN2, CIN1 and inflammation/ASCUS groups, respectively. HPV16 L1 gene methylation status was first detected using bisulfite treated DNA and pyrosequencing assay was used for quantification of methylation. Hypermethylation was detected in cervical cancer but was low in normal/CIN1 lesions. CpG sites 5600 and 5609 are highly methylated compared to other CpGs. Indirect and sandwich ELISA were developed to detect HPV16 L1 gene methylation status using specific oligonucleotide probe for HPV16, however, it was not successful in developing sandwich ELISA assay. Indirect ELISA showed high background when oligonucleotide probe was present with other reagents in the absent of HPV16 positive DNA. Other system without oligonucleotide probe in the present of all reagents revealed low background. Optimization of blocking reagents, oligonucleotide probe concentration, streptavidin concentration, anti-5-methylcytosine dilution and incubation time were not successfully reduced the background. The ELISA assay was not yet developed successfully, however, troubleshooting will be further performed to reduce the background and can be further tested for specificity and sensitivity and will be applied in clinical samples


Pythium insidosum is the causative agent of the life threatening pythiosis. The main clinical manifestations are often found in artery (vascular type) and cornea (ocular or corneal type). Among the vascular type, thalassemia is the common underlying disease. The investigation of specific P. insidiosum antibody in serum is practical tool and provides high accuracy for diagnosis. Using the high technology, computer tomography angiogram to indicate the occlusion point in artery is another protocol that physicians often requested. However, with the high cost and availability only in tertiary care hospital are the limitation. Presently, the combination treatment, surgery, antifungal agents, and immunotherapy, has been applied since standard treatment has been established yet. Regarding the immunotherapy, 2 mg/ml protein antigen extracted from P. insidiosum (PIA) to stimulate host immune response, via subcutaneous route has been performed. The protocol is one prime dose, after diagnosis, and 6 boosters in one year period. To follow up and monitor the patients’ illnesses, the physicians investigate by observing and asking the patient directly about the lesion without any biological markers. In addition, no reliable markers regarding the patients’s previous symptom for the next visit was shown. Thus, it is dispensable to find the biological evidence base. To examine the specific antibody is to study the host immune response to the specific pathogen. Regarding the pathogen side, the presence of (13)-β-D-glucan (BG) is found in the cell wall of P. insidiosum and PIA, similar to certain kind of fungi. Therefore BG level monitoring is another attractive marker.  We hypothesized that after the combination treatment, the level of both specific antibody against P. insidiosum and the BG would change and possible to apply as the monitoring surrogate markers for pythiosis. Materials and Methods The levels of BG and cytokines: IFN-γ, IL-17 in the sera prior PIA immunotherapy (PIAI) at each time point through out the 1 year regimen from vascular and corneal pythiosis patients (n=20 of each) were examined. The control sera were collected from healthy with thalassemia (n=20) and without thalassemia (n=20) for vascular pythiosis and corneal pythiosis investigation, in order. All results including the patients’ data from survivor and death groups for vascular type; visible and invisible from ocular type will be analyzed.  Results All patients who survived more than 1 year after PIA immunotherapy showed the significant declining trend of serum BG (p-value<0.05) whereas the ones who died before 1 year demonstrated the high level of BG with non-significant changing (p-value<0.05) despites both group presented the non-significant difference of >423.4 picogram/ml prior PIA injection. In contrast to the cytokine level: IFN-γ and IL-17, all patients who survived more than 1 year after PIA immunotherapy showed the significant increased trend of cytokines (p-value<0.05) whereas the ones who died before 1 year demonstrated the decreased trend  of cytokines’ level.  Discussion The pattern of BG and cytokines: IFN-γ and IL-17 are ones of the biological markers (quantitative scale) which can be applied for the disease monitoring and prognosis. However, these biological markers have some limitation in term of their specificity. The pattern of their levels can be presented by several factors such as fungal or bacterial infection which compose of BG. Thus, the development of P. insidiosum specific biological marker for testing in parallel need to be investigated in the future.


Bile duct cancer (cholangiocarcinoma) is a cancer caused by abnormalities of the lining of the bile duct inside and outside the liver. Thai people die of cholangiocarcinoma and liver cancer in the number of 10,000 - 20,000 cases per year, with more than half of the population being northeastern. The World Health Organization has made liver fluke a major cause of this type of cancer. The knowledge gained from the research from Khon Kaen University has been applied to prevent and search for the first stage of cancer patients in order to accomplish curative treatment. Importantly, about 55 percent of the working-age population is a head of household between the ages of 40-60 years, which is a serious disease and causes loss of economic, social, quality of life of people in the society. Therefore, the Health System Development for Screening, Early Diagnosis and Management of Cholangiocarcinoma in Northeast, Thailand) by the support of the Health Systems Research Institute (HSRI) with the co-funding with Khon Kaen University through the Cholangiocarcinoma Screening and Care Program (CASCAP) and The National Research Council of Thailand via the Grand Challenges Thailand: Fluke Free Thailand is running the project with the aim of establishing a comprehensive program for the long-term control and elimination liver fluke infection and CCA in Thailand in all aspects. There are 11 interrelated projects running under this program in Thailand, which provide a holistic approach covering primary-, secondary-, and tertiary prevention of liver fluke and cholangiocarcinoma. The program has successfully negotiated with the Thai government to launch a 10 years strategic plan for the elimination of the liver fluke and CCA running from 2016-2026. In addition to the Ministry of Public Health, this policy involves several other ministries including the Ministry of Education, the Ministry of Agriculture, the Ministry of the Interior, the Ministry of Communication and the Ministry of Foreign Affairs. The data obtained and fed into the Isan Cohort database are being used for monitoring and evaluating the policy’s progress. In addition, there are 4 innovations have been established in order to solve liver fluke and cholangiocarcinoma problem as followings. 1. The Isan Cohort software (https://cloud.cascap.in.th/) which is an online and real-time database system used for nation-wide at risk population registration, data recording, monitoring, evaluation and reporting to the Thailand Ministry of Health as well as the general public was established. The registration and inclusion of the high-risk population takes place at primary health care hospitals. The at-risk people are then transferred for ultrasound screening to district hospitals and suspected CCA cases are referred for further investigation and treatment to super-tertiary care hospitals. Screening is performed simultaneously with at the risk members of the local population at the primary health care units. Some initial data have been published in the BMC Cancer (Khuntikeo et al. 2015) 2. An ultrasound screening system has been developed (Chamadol et al. EMSO open 2017), composed of ultrasound machines with mini-PACS, which allow the transfer of ultrasound images through the internet into the Isan Cohort database. This system also includes online-based consultation where the images can be reviewed by an expert radiologist for confirmatory diagnosis (Figure 3). In addition to increasing the screening capability, hepatobiliary ultrasonography training courses are offered for radiologists and general practitioners. 3. A new technology to detect the liver fluke antigen in urine has been developed (Worasith et al. 2015). The new method id more sensitive and specific than the
detection of parasitic eggs in feces. Interestingly, the Ov antigen detection kit is now under mass production 4. Network Hospitals for Screening, Surveillance, Diagnosis and Treatment of Liver Fluke Disease and Cholangiocarcinoma Patients. The Ministry of Public Health's service units are involved in about 3,626 health units, including the District Health Promotion Hospital, Community Hospital, General and Center hospital. Network hospitals are designated for the diagnosis and treatment of cholangiocarcinoma and for further management of the suspected CCA cases identified by ultrasound screening. This network comprises all 7 super-tertiary care hospitals in the northeast of Thailand. Moreover, hepatobiliary and pancreatic surgery training courses are provided to increase the number of the specialist surgeons available to perform potentially curative surgery Therefore, the successfully this project is an example of the results of research and development to solve the problem of the country. Importantly, the people could access services related to liver fluke and cholangiocarcinoma in all level including primary, secondary and tertiary level in timely manner with high quality.


This qualitative study aimed to propose options for developing urban health services system in Health Region 3. The study’s scope involved only primary care systems in urban areas of Nakhonsawan and Kamphaengphet provinces. Literature review, case studies, in-depth interviews, and focus group discussions were administered to collect the data, which focused on participants’ perceptions and collaborative decision-making. 260 informants were recruited purposively, including Mueang District Health Boards, senior health executives at regional and provincial levels, senior health managers from public, private and local government sectors, representatives from community, civil society and health system experts. Thematic and content analysis techniques were used for data analysis. This study showed that the Social Medicine Departments of the regional and provincial hospitals were the major organizations which were responsible for primary care services in urban areas. Though public, private and local government sectors also provided these services. Primary care service planning under the Primary Care Cluster policy was done mainly by the organizations under the Ministry of Public Health (MOPH). This study found that despite the improvement of the services quality, the services quality could not cover all areas nor created a sense of ownership for those in other sectors including civil society. The major challenge was the increasing service demand due to the increase in the number of aging population and patients with Non-Communicable Diseases. Also, there were a shortage of health workforces and lack of health promotion skills as well as a problem of not being able to use the budget effectively for health promotion because of incomprehensible understanding between the service units and the Office of the Auditor General and a lack of policy communication focused on the development of urban health services. The result showed that there could be 3 major options for urban health services system development in Health Region 3: 1) Management through single leadership of the MOPH (Current Model), 2) Management by collaboration between sectors through District Health Board (DHB), and 3) Management through transfer of health mission to the local governments. The assessment of the options showed that the current model may not be able to respond to the challenge effectively. The ideal option was management through the transfer of health mission to the local government, mainly because they were close to their people and could well understand their people’s health problem under the context of their areas, and can encouraged people to take responsibility for their health more effectively. However, these limitations were found; the government had yet to clarify the transfer of mission in relation to health services from the MOPH to the local governments, and, the local administration and personnel lacked the capacity to manage health services. This study proposed that a model of collaboration between sectors through DHB was the best option to move forward. This option could encourage all sectors to learn together and to become involved in the development of the primary care system in an urban setting collaboratively. It could encourage all related sectors, including the people, to have a better understanding of the roles and responsibilities of each sector and to lead to better self-management of the people in the future.


Background: Safety in anesthesia can be improved through monitoring and analysis of anesthetic complications. We conducted the present Perioperative and Anesthetic Events in Thailand (PAAd Thai) incident reporting study to determine the current frequency distribution of incidents related to the anesthetic complications, factors contributing to the incidents, and corrective strategies. Objectives: The Perianesthetic Anesthetic Adverse Events in Thailand (PAAd Thai) study aimed to investigate patient, surgical, and anesthetic profiles, and suggestive strategies for prevention of adverse events. Methods: A prospective descriptive study was conducted in 22 hospitals across Thailand. Each hospital was invited to report, on an anonymous basis, any perianesthetic adverse incident during 12 months (between January 1 and December 31, 2015). A standardized incident report form was completed to determine the type of incident, and where, when, how, and why it occurred using closed and open-ended questionnaires. Data regarding main anesthetic techniques were also reported monthly. Descriptive statistics and comparative statistics were used as appropriate. Results: Twenty-two hospitals across Thailand participated in this study. Fourteen of them (63.6%) were non-university (service directed) hospitals while eight of them (36.4%) were university (academic) hospitals. The majority of hospitals were involved in residency training and teaching medical students (77.3%), while half of them (57.1%) were involved in training nurse anesthetists. The ratio of anesthesiologists to an operating room was 0.67:1 and the ratio of nurse anesthetists to an operating room was 2.03:1. During 12 months period, there were 333,219 cases, 2,206 incident reports with 3,028 critical incidents. The incidents commonly occurred in male patients (52.0%), aged <10 y (13.0%) and >70 y (18.2%). The incidence of adverse events included cardiac arrest within 24 h (15.5:10,000), death (13.0:10,000), reintubation (11.1:10,000), esophageal intubation (8.5:10,000), difficult intubation (8.0:10,000), endobronchial intubation (8.5:10000), failed intubation (0.7:10000), pulmonary aspiration (1.3:10000), suspected pulmonary embolism (0.5:10000), total spinal block (0.3:10000), awareness (0.4:10000), coma/cerebrovascular accident/convulsion (1.5:10000), nerve injury (0.6:10000), suspected myocardial infarction/ischemia (1:10000), serve arrhythmia (14:10000), anaphylaxis/anaphylactoid reaction/allergy (2.3:10000), medication error (3.2:10000), equipment malfunction/failure (1.4:10000), anesthesia personnel hazard (0.6:10000), transfusion mismatch (0.2:10000), wrong patient/wrong site/surgery (0.2:10000) and malignant hyperthermia (1:200000). General, cardiothoracic neurological and otorhinolaryngological surgical specialties posed a high risk of incidents. Operating room and recovery room were common locations for incidents.
Conclusion: In the past decade, there were dramatic reductions of perioperative cardiac arrests and pulmonary complications particularly difficult intubations. Common factors related to critical incidents were inexperience, emergency, inadequate preanesthetic evaluation, inappropriate decisions, lack of vigilance, and inexperienced assistants. Suggested corrective strategies are compliance with guidelines, additional training, and improvement of supervision and quality assurance.


This mixed method research aims to conduct 1) the situation analysis of Routine to Research (R2R) research among the 11th and the 12th regional health level and the support from researchers, facilitators, and administrators for research utilization, 2) the process of transformative learning by learning organization components among R2R researchers, and 3) the implementing of R2R research into practice for clients, organizations, and social by using six building block components. Data collection consisted of: 1) R2R research conducting among the 11th and the 12th regional health level between 2551-2559 BE and 2) the focus group of 88 R2R researchers, facilitators, and administrators between December 2559 BE to November 2560 BE. Quantitative data was analyzed by using frequency and percentage. Qualitative data was analyzed by using content analysis. Results revealed that: 1) there were 415 R2R research conducting among the 11th and the 12th regional health level between 2552-2559 BE. The number of R2R research among the 11th and the 12th regional health level was increasing from 2552 BE to 2559 BE but the number of the 12th regional health level R2R research was 3 times more than the number of the 11th regional health level R2R research. However, most of R2R research still lacked of research utilization. The regional health level administrators supported R2R research by issuing R2R research policy, setting R2R research responsibility personnel, appointing R2R research board, supporting the use of technology and social media for knowledge sharing and research publication both at provincial level and regional health level. 2) R2R researchers leaned and transformed themselves by system thinking, mental model, personal mastery, shared vision and team learning. 3) R2R research was utilized the most in health system services by improving health service system such as eliminating unnecessary health service steps, decreasing number of clients, decreasing cost of care, and promoting patient safety.


Background:
The prevalence and incidence of CKD have been increasing in Thailand caused by the
pandemic of non-communicable disease or the inappropriateness of renal replacement therapy
initiation. The optimum or critical renal function for renal replacement therapy initiation has been
an important issue. Late renal replacement therapy may cause morbidity and mortality while too
early renal replacement therapy cause patients’ morbidity and unnecessary health economic
burden. This study aimed to investigate the association of renal function at renal replacement
therapy initiation towards clinical outcome and investigate the comparison of mode of renal
replacement therapy towards patients’ outcome.
Methods:
The evaluation of pre-renal replacement therapy renal function was investigated by cross
sectional study. The results of most accurate pre-renal replacement therapy renal function
assessment was used to enroll patients in multicenter, prospective observational study for
association of renal function, mode of renal replacement therapy and clinical outcome
Results.
113 cases of CKD stage V by CKD-EPI equation who expected for renal replacement therapy
were enrolled for the cross sectional study. The average age was 59.2 ± 17.8 years and
average serum creatinine was 6.59 ± 3.00 mg/dL. By reference 99Tc-DTPA plasma isotope
renal clearance GFR study, the average renal function was 16.6 ± 5.5 mL/min per 1.73 m2.
CKD-EPI Equation for GFR severely underestimated pre-renal replacement therapy renal
function. Cystatin C based GFR showed better performance and Thai GFR Equation showed
best estimation of late CKD patients who may need renal replacement therapy. 386 late CKD patients who enrolled for renal replacement therapy were included in multicenter,
prospective observational study. The average age of patients was 59.8 ± 16.1 years and
average serum creatinine was 10.81 ± 6.73 mg/dL. The prevalence of co-morbidities was high
and more than 85 % of patients reimbursed the renal replacement therapy cost from the
government reimbursement plan. The renal function when the renal replacement therapy
initiation by CKD-EPI was inaccurate and range from CKD stage IV to early stage V and late V.
The findings cause problems to analyze for the association of renal function, mode of dialysis
and clinical outcome. Thus more cases are needed to be enrolled and more follow up are
needed.
Conclusion:
Renal replacement therapy initiation by CKD-EPI was inaccurate and underestimated renal
function. Renal replacement therapy initiation cases enrollment by CKD-EPI was inappropriate
and cause unnecessary renal replacement therapy reimbursement. Thai GFR equation should
be used for renal replacement therapy initiation. By Thai GFR equation, the investigation for
the association of renal function and mode of dialysis towards clinical outcome can be feasible.


Background: Anemia is the most common problems in chronic kidney disease especially dialysis patients. Anemia is also the important risk factors of cardiovascular morbidities and mortality in these patients. Iron deficiency is the most common cause of erythropoietin hypo responsiveness. Intravenous iron supplement had a benefit on improvement of anemia parameters and decreased erythropoietin dose in chronic hemodialysis patients. However, indication and schedule of intravenous iron supplement are different in several clinical practice guidelines. This study was conducted to explore the benefit of Intravenous iron supplement on anemia and erythropoietin dose in chronic hemodialysis patients in Thailand. Methods: The multicenter randomized controlled trial was conducted in 194 chronic hemodialysis patients in 5 dialysis centers. The participants who had serum ferritin 200-400 ng/ml and serum transferrin saturation< 30% were randomized to low ferritin ( serum ferritin 200-400 ng/ml) and high ferritin (serum ferritin 500-700 ng/ml). During run-in period (-8 weeks), intravenous iron 100 mg was given every week for 6 weeks in high ferritin group, and no iron prescription in low ferritin group. During 6 months observation period, intravenous iron prescription was given to keep serum ferritin as study protocol. Anemia parameters, iron dose and dose of erythropoietin were monitored. 61 Results. 96 participants were randomized to keep target serum ferritin 200-400 ng/ml and 98 participants were randomized to keep target serum ferritin 500-700 ng/ml. Baseline characteristics between two groups were not different. During run-in period, the mean hemoglobin was 9.1±1.4 g/dl, mean erythropoietin was 7105.1±2279.1 unit/week in low ferritin group and the mean hemoglobin was 10.0±1.7 g/dl, mean erythropoietin was 6262.5±2467.0 unit/week in high ferritin group ( P<0.05). At baseline, the mean hemoglobin was 8.9±1.3 g/dl, mean erythropoietin was 7331.2±2118.1 unit/week in low ferritin group and the mean hemoglobin was 9.8±1.8g/Dl, mean erythropoietin was 6347.1±2663.1 unit/week in high ferritin group (P<0.05). During 3 month follow up, the mean hemoglobin was 9.0±1.3 g/dl, mean iron dose was 318.8±78.8 mg/3 months, mean erythropoietin was 6946.6±1837.1 unit/week in low ferritin group and the mean hemoglobin was 9.8±1.6 g/dl (P<0.05). mean iron dose was 595.3±216.1mg/3 months (P<0.05), mean erythropoietin was 6587.4±2956.1 unit/week (P=0.55) in high ferritin group. However, the mean different change between two groups did not reach statistical significance at 3 months follow up (Hb 2.8±13.0% vs Hb 1.6±15.1%, P=0.625, erythropoietin dose -1.9±16% vs 8.1±30.4%, p=0.099 ). At the end of treatment, the mean hemoglobin was 9.4±1.4 g/dl in low ferritin and 10.1±1.4 g/dl in high ferritin (P=0.04). Conclusion: Intravenous iron prescription keeping serum ferritin 200-400 ng/ml or 500-700 ng/ml seem to maintain hemoglobin and require erythropoietin dose as the same benefit. However, the mean iron dose 100 mg/month and 200 mg/month should be prescribed to keep target serum ferritin 200-400 ng/ml and 500-700 ng/ml in Thai chronic hemodialysis patients. Therefore, at least 100 mg intravenous iron supplement every month should be used to maintain serum ferritin around 500 ng/ml.


Health promotion and disease prevention for all at all ages relies on the participation of local communities. Nan province has strong and various social groups, organizes and health networks, but many health outcomes are not achieved. Therefore, the aims of this study were toexamine the development of the civil society in health promotion, to study the situation and the condition of the sustainability of health groups / organizations, to determine factors that affect the success and outcome of policy implementation and the participation of the civil society, and to synthesize proposals for the development of community health systems. Implementation research were conducted in three phases: 1) study of situational, group and health networking, 2) operations and 3) assessment, between April 2516 and December 2517. The quantitative data was analyzed using frequency and percentage, and the qualitative data was analyzed using content analysis. The study found that Nan has a good cost of health care, with the involvement of network partners in all of study area. The civil society were formed through three different processes: 1) to start with governmental or private policy from the outside, 2) to start from the organization within the area, 3) to initiate from the community organization itself. Factors of maintaining the strength of the civil society include strong leadership, faithful acceptance, transparency, multi-level networking, informal and formal coordination, having regular meetings, continuously develop the potential, running and managing the welfare fund, set up community or district health measures, and having a review summary evaluation together. The development of the civil society begins with the initiation of people in the community who need development or government policies. The process start with aggregate review of potential, limitations, goals, common development of community health care. Next, they develop a plan to improve the existing learning process. Then they build the learning process to develop the potential for leaders and volunteer. In addition, they raise the strength of the management with repeatedly accumulate knowledge. Finally, they achieve the best practices for community health carethat isled to the strength of the health community. Factors influencing the success and outcome of policy implementation are as follows : building central concept, creating an organizational structure with a clear roles, raising community awareness, Based on the results, we suggest that health promotion and disease prevention should be initiated by the public health volunteers and the elderly. They are a core group that plays an important role in the development of health and disease prevention in all age groups. Furthermore, toward self-reliance and sustainable community, the role of the health workers is to act as the coach of community health and networks by using an empowered communities approach. building strong leader, enhancing community cooperation, empowering and learning with the young people's community worker, working with collaborating networks, using informal communication, learning by using case studies and being put into practice, actively involving diverse volunteers in community, making a variety of communication channels, particularly, Facebook and Line applications, continuously supporting by stakeholders, and making a participatory monitoring and evaluation. Based on the results, we suggest that health promotion and disease prevention should be initiated by the public health volunteers and the elderly. They are a core group that plays an important role in the development of health and disease prevention in all age groups. Furthermore, toward self-reliance and sustainable community, the role of the health workers is to act as the coach of community health and networks by using an empowered communities approach.


Implementation of a policy needs different knowledge from that for formulating or adjusting one. Implementation Research (IR) aims to develop strategies to bring policy into effects and achieve  successful results as stated in policy. This study used scoping review method to gather knowledge regarding theories and concepts of implementation research. Although IR has been conducted for some times, the attempts still are unsystematic, scattered and unstandardized. The report addressed 6 theories and conceptual frameworks from which a research can utilize more than one. IR can be conducted at pre-, during- or post-implementation using quantitative, qualitative or mixed methods. Context plays an important role in implementation. Therefore a successful implementation in one context cannot guarantee another success in others. To implement a policy, an implementer or a policy maker needs to consider a variety of implementation strategies and balance between policy adaptability and policy fidelity. Health care workers should be allowed to be involved in designing implementation strategies to enhance effective policy implementation process. Policy maker should pay more attention to establish standardized and longitudinal study of implementation research to achieve information regarding implementation of a policy as inputs to contribute with a policy process especially a policy formulation or a policy adaptation.


Physical activity (PA) is proven to have great benefits to health. Previous studies found that differences
in social determinants of health and environment affect physical activity levels; different policy
interventions are, therefore, required. This study explored the association between physical activity
levels and residential areas in Thailand in different household asset indices. The data were obtained
from the 2015 National Health and Welfare Survey of 113,882 Thai adults aged 15 and above. Descriptive
and analytic statistics were employed in the analysis.
The result showed that urban respondents with higher income tended to have less energy expenditure.
People with the highest income level (Quintile 5) spent the least energy expenditure (1,159 and
1,437 Metabolic Equivalence of Task-minute/week in urban and rural areas, respectively). In contrast, the
poorest (Quintile 1) had the highest energy expenditure (2,182 and 1,921 MET-minute/week in urban and
rural areas, respectively). When analyzed by three PA domains, it was found that rural and poorer
people tended to have higher occupational energy expenditure, whereas urban and richer people had
significant higher recreational energy expenditure. In transportation, urbanites had slightly higher energy
expenditure than rural people.
Our findings will benefit the formulation of the national PA-promotion policies by tailoring physical
and social environments conducive to PA needed for each subgroup according to their socioeconomic
status.


Commercial availability and density of alcohol outlets are the factors influencing availability of alcohol and alcohol consumption. The objective of this study is to explore alcohol outlets situation and compliance with the Alcohol Control Laws in Thailand. Methods: There were 325 alcohol outlets from five provinces across Thailand joining in this study by multi-stage cluster sampling. A questionnaire survey was administered to gather demographic characteristics and type of alcohol outlets and alcohol license. This study found that there were high alcohol outlets densities in five provinces of Thailand. There were alcohol beverages in milk and coffee shops. Grocery store, kiosk selling herbal drink and mix shop had ever gotten alcohol license as alcohol outlet but their licenses were expired. Alcohol outlets business hours violations during morning, afternoon and evening prohibition periods were prevalent. Therefore, government or related agencies should seriously enforce the legislations and develop regulations related to control alcohol outlet density and set criteria of alcohol license for alcohol outlets owners in order to prevent and protect the health of children, youth and people in Thai society.


Youth smoking remains to be a major public health problem of Thailand that partly as a result of a law violation of tobacco retailer in the sale of cigarettes to youth or minors. This research aimed to explore associated and predicting factors of retailer related to tobacco sale to minors in Health Region 2. Independent variables were based on previous systematic review and qualitative research. This study gathered data through questionnaires asking opinions of a sample of 658 tobacco retailers taken through a multi stage sampling in Health Region 2. Data were analyzed by using descriptive statistics, chi-square and multiple logistic regression analysis. The findings revealed 58.7 percent of tobacco sale to minors. The associated and predicting factors of tobacco sale to minors included duration of performing the retailer occupation (ORAdj=2.099), motivation about revenues from tobacco sales. (ORAdj=2.620), defined a youth differed from the law (ORAdj=1.993), conforming to social norms regarding the sale tobacco to minors (ORAdj=2.955), selling individual cigarettes or small packages (ORAdj=11.504), selling tobacco by self-service (ORAdj=3.825), facilitating customers to buy and smoke cigarette (ORAdj=2.392), and not asking buyer age before selling tobacco (ORAdj=1.734). The independent variables have a predictive value of 67.2 percent of the variance (Pseudo R2 = 0.672) in the behavior of selling tobacco to minors. These findings suggested that government agencies involved should strictly enforce the law in particular the ban on selling individual cigarettes or small packages and selling tobacco by self-service, together with enhancing retailer understanding on the content of tobacco control law.


Cannabis is traditional plant that contains psychoactive substances, which have several risks and benefits. By law many countries (including Thailand) probihited the use of cannabis, and included it in the narcotic or addictive substance list. Between 2015 and 2016, there were massive campaigns from both public and private agencies urging an amendment of the Narcotics Act B.E. 2522 (1979) to withdraw cannabis from the narcotic drug list. This report therefore sought to review the current situation regarding the use of cannabis for medical purposes in various aspects, as well as cannabis legalisation from foreign experience (using Netherlands, United States, and Uruguay as case studies). The main data collection technique is literature review on electronic databases, namely, Medline. The findings show that most studies on cannabis were limited to laboratory work. Though there were some clinical trials on humans, the majority of them still had a small number of participants comparing clinical effects of cannabis with placebo. Concerning foreign experiences, the scope of cannabis medicalisation varies substantially; from extracting medical substances in cannabis to treat patients that did not respond to conventional treatments, to using cannabis for recreational activities. Some countries implemented decriminalisation measures. The openness of cannabis policies in many countries had some similar approaches: (1) the revision of cannabis related laws was gradually made over time, and (2) there were several measures implemented in parallel to prevent cannabis use in the way that deviates from original policy intentions. If the Thai government aims to implement policies vis-à-vis the utilisation of cannabis, it is imperative to distinguish medicalisation issue from legalisation issue to avoid misperceptions in the society. The Thai government should assess its capacity in regulating the use of cannabis before introducing cannabis-medicalisation/legalisation policies.


The introduction of new vaccines depends on various criteria, including policies, clinical guidelines and economic considerations. Various stakeholders have differing criteria they view as important in selecting vaccines into a national immunization program. The present study aimed to identify factors impacting the adoption of new vaccines from the perspective of policy makers, healthcare professionals and healthcare administrators. The vaccine attributes identified from a literature review and semi-struc¬tured interviews were categorized into burden of disease, age group, budget impact, fever from vaccine, severity of disease, vaccine effectiveness and cost of vaccine. Main-effects orthogonal design was used to identify 18 profiles. Then a postal survey was conducted among policy makers, healthcare profes-sionals and healthcare administrators. Respondents were asked to choose the most important and the least important choices in each profile. Conditional logistic regression was used to estimate importance weights of attribute levels, and then relative attribute importance was calculated. A total of seventy respondents completed the questionnaires (a 55% response rate), including 11 policy makers, 26 health¬care professionals, and 33 healthcare administrators. The attributes listed by all groups as being the most important for new vaccine adoption were severity of disease (35.9%), fever from vaccine (16.7%) and burden of disease (13.5%), respectively. Policy makers and healthcare professionals listed severity of disease (35.0% and 35.9%), fever from vaccine (22.9% and 17.0%) and burden of disease (14.8% and 15.3%) as the most important, respectively; whereas healthcare administrators listed severity of disease (32.5%), budget impact (15.1%) and fever from vaccine (15.0%) as the most important, respectively. New vaccines with high protection targeting severe disease in young children have a greater chance of being selected by respondents in the present study. The findings reveal the importance of attributes from public healthcare workers and will be useful for policy development of new vaccine adoption.


The Trans-Pacific Partnership Agreement (TPP) is a comprehensive model of regional trade and investment agreement. As a complex and comprehensive new generation of trade agreement, tobacco industry or transnational tobacco companies would employ TPP to interfere with tobacco control policy and law of the State Parties. The State Party may not adopt the Investor-State Dispute Settlement (ISDS) with respect to claims challenging a tobacco control measure; however, such exception provision covers only the investment chapter. In sum, some of TPP’s provisions may have negative impact on tobacco control in Thailand and tobacco industry may not comply with the WHO Framework Convention on Tobacco Control (FCTC) or threaten the government by claiming the litigation or trade disputes in order to undermine tobacco control measures.


Mental health service is an important health service system with increasing resource consumption due to social and economic changes. The objective of this study was to develop Thai Mental Health Casemix Classification (TMHCC) for inpatient payment method. This research and development employed 4 steps to develop TMHCC: 1) standard data identification, 2) data collection and edit, 3) cost calculation 4) classification, calibration and evaluation. Eighteen hospitals with inpatient beds for psychiatric care and 2015 top-down cost accounting data joined the study organized by the Department of Mental Health. Data for TMHCC development included administrative data, clinical data, resource uses and mental problems. The Thai version of the Health of the Nation Outcome Scales (HoNOS) and the Health of the Nation Outcomes Scales for Child and Adolescent mental health (Thai-HoNOSCA) were used for adult and children psychiatric assessment. Prospective data collection was conducted in the second half of fiscal year 2016. The total inpatient data for classification were 15,417 cases. The statistics to explain performance of the TMHCC were coefficient of variation (CV) for homogeneity of cases within each group and the reduction in variance (RIV) for overall performance of the casemix classification. Results: TMHCC classification provided 39 disease groups (34 for adult and 5 for children). The highest number of adult cases was for Schizophrenia, Age <= 50, with cognitive problems, with problems from reactive/aggressive/ agitated behavior (2,088 cases, 17.1% of all cases). About 83.4% of children patients were grouped into Other Child Psychiatric Conditions (2,463 cases). Mental Health Disease, Ongoing type had the highest cost per admission (200,817 Baht) and Mental Health Disease, Same-day type had the lowest cost per admission (590 Baht). The result of CV on cost showed that only one group had CV higher than 100%. Most TMHCCs had high homogeneities within groups. The results also confirmed good overall performance of TMHCC that RIV on cost after the classification was as high as 39.9%. Moreover, RW of TMHCC better predicted cost than RW of the current Thai DRG version 5. In summary, the performance of this casemix is good enough based on homogeneity within groups and high heterogeneity of resource uses between groups. Recommendations: The payment based on TMHCC was an option for payment. However, payers should prepare budget for psychiatric inpatient care benefit package that needed longer stay service in hospital than acute inpatient. Moreover, mental health measurement data should be put into addition¬al routine electronic databases of all hospitals that provided care to psychiatric inpatients.


The quality and primary care standard system (PCS) is consisted of eight main topics with a checklist of 40 items. PCS has been used as guidelines to implement and organize service systems and develop the laboratory work of the primary care units to meet quality and service standards. This study aimed at collecting and analyzing data in order to sort the frequency of unmet quality requirements of 7,452 primary care units (80.89%) assessed by network laboratories in fiscal years 2014 – 2016. The highest nonconforming requirement was Item 3 concerning the unavailability/insufficiency of materials, solutions and instruments at primary care units (such as blood glucose test with glucometer, pregnancy test, urine strip test for glucose and protein and hematocrit). The findings of this study revealed areas for improving quality and primary care standards. In addition, involved agencies should use the data to formulate policies and guidelines for improving quality and service standards focusing on the parts that the primary care units were unable to accomplish in order to improve the quality of the laboratory services at the primary care units. This will result in a decrease of service congestion at major hospitals in addition to promoting efficient treatment, prevention and disease control.


Substandard medicines have a great impact on health systems. For example, they can engender drug resistance, adverse effects, drug toxicity, increase mortality and morbidity, etc. As a result, a larger budget is needed for longer healthcare treatment, while health personnel lose confidence in drug qual-ity monitoring and generic drugs. This study employs a descriptive retrospective design. It aims to analyze the database of test results from the Quality Assurance of Medicines Program, which was operated by the Department of Medical Sciences between the fiscal years of 2002 to 2016. The international pharma-copoeia, for example, the United States Pharmacopeia (USP) or British Pharmacopoeia (BP), were used as reference standards. The findings revealed that 428 government hospitals voluntarily sent medicine samples to the Quality Assurance of Medicines Program. The total number of modern medicine samples was 572 items or 16,212 samples. The number of substandard samples decreased from 19.0% in 2002 to 0.8% in 2016. Based on the latest 3-year data, 2.9% of domestic generic drugs failed the standard specifications, whilst 0.9% of imported drugs failed. Dissolution and content of active ingredients were the most common issues found. The corresponding organizations in pharmacovigilance and pharmaceutical manufacturing, for ex¬ample, the Thai Food and Drug Administration (Thai FDA), the Department of Medical Sciences (DMSc), the Government Pharmaceutical Organization (GPO), and the Thai Pharmaceutical Manufacturers Associ¬ation (TPMA) should cooperate to monitor and improve the quality of domestic generic drugs in order to achieve greater confidence in using domestic generic drugs while also making budget savings. This could also strengthen the domestic pharmaceutical industry and enhance national drug security.


Hearing aids can rehabilitate hearing and improve communications abilities of people with hearing loss for efficient daily living. This study aimed to analyze factors associated with hearing aids use by analyzing data obtained from a survey conducted. The survey sample comprised 380 people with hear-ing loss who received hearing aids under the Universal Health Coverage scheme (UHC) from 2005-2015 in five provinces: Phayao, Samut Prakan, Chonburi, Khon Kaen, and Songkhla. The data were collected via interviews based on a questionnaire. Of the 200 people interviewed in the community, it was found that internal factors such as gender, age, occupation, and economic status were not significant factors related to usage. However, users who were satisfied with their hearing aids significantly used their hearing aids more than those who were not satisfied (adjusted OR = 3.99, 95% CI; 1.09-14.67, p-value = 0.037), and users who came for follow-ups significantly used their hearing aids more than those who did not (adjusted OR = 2.60, 95% CI; 1.22-5.53, p-value = 0.013). Thus, the National Health Security Office should provide hearing aids with improved follow up system to ensure appropriate use of hearing aids as well as to prevent discontinuation of use in the future.


In Thailand, people with hearing impairment under the Universal Coverage scheme (UCS) are entitled to having hearing aid free of charge from accredited hospitals. This cross-sectional survey aims to describe the situation regarding hearing aid usage and economic loss from discontinuing usage of hearing aid in people with hearing impairment under the UCS. Data were collected from 364 persons in five provinces (Phayao, Khon Kaen, Chonburi, Samut Prakan, and Songkhla) through face-to-face structured interviews. Descriptive statistics were used for data analyses. The results showed that 54% of the sample experienced improvement in quality of life and 39% were satisfied with hearing aid use. Out of the 164 persons who were interviewed at hospitals, three stopped wearing hearing aid. For the 200 persons who were interviewed in the community, 29% stopped hearing aid use, to whom 50% used for less than one year. The most common reasons for discontinuing usage were high background noises and faulty devices. The economic loss from discontinuing usage up to third year was estimated to be 19.4 million baht. For subjects who were still using the hearing aid, 71% wore the hearing aid daily for 9 hours on average, whereas 44% occasionally wore approximately 3-4 days a week for four hours per day. For persons who used hearing aid with zinc-air battery, around 1-2 batteries were used per month, costing 65-96 baht a month. 43% stated that the cost of batteries was a burden as they were only able to pay approximately 32 baht per battery. Therefore, the National Health Security Office should: 1) set up a follow-up system for hearing aid users; 2) provide training or guideline to hearing aid users, their relatives, and primary care unit officer regarding the service, procedure of treatment, and basic maintenance of hearing aid; 3) set up mobile service for hearing aid maintenance in community; 4) support zinc-air battery in order to match the ability to pay of users and increase distribution channels to sell hearing aid battery; and 5) raise the awareness to hearing aid users and their relatives regarding the government subsidized cost of hearing aid.


This study entitled “Muslim Women’s Social Space and Health Empowerment through Physical Activities amid Unrest Situation in Southernmost Provinces, Thailand” aims i) to investigate information of the Muslim women’s social space and health empowerment through physical activities. ii) to investigate to what extent of capability of Muslim women’s physical activities according to Islamic Jurisprudence and iii) to provide channels of possible physical activities to Muslim women in strengthening physical health. The research findings are as following points: Point 1: The data regarding Muslim women’s social space and health empowerment through physical activities were found that they strengthen their physical health through daily routine activities including taking ablution for prayers, performing daily five time prayers, watering trees in housing areas, shearing grass, fruit picking from their farms and washing clothes using hands. Moreover, they still strengthen their physical health through their careers as self- employed businesses. These activities can be considered to be Muslim women’s social space in health empowerment.  However, there are certain limitations regarding insufficient public places for their physical activities which are permissible according to Islamic principles. On the other hands, they have their own space for informal discussion to release stress and for the sake of entertainment. They also organize various activities among themselves based on their capability particularly, volunteering activities contributing to others in the community. Moreover, external organizations support them in terms of physical therapy and activities to encourage them to live their lives happily. Point 2: The extent of capability of Muslim women’s physical activities according to Islamic Jurisprudence shows that Muslim women are able to do exercise for strengthening their physical health through several activities under the framework of Islamic principles. In other words, the activities involved in should not much extreme, the outfits should be properly dressed under Islamic Jurisprudence. Most importantly, it is not allowed to mix between males and females in the same workout place. So far, there have no specific places for the Muslim women’s physical activities provided in all levels of age and gender.  Point 3:  The channels of Muslim women’s physical activities in health empowerment are proposed as follows: 1. The workout places should be specifically for women publically since there are not only the venues for their health empowerment but they are also the platforms for them specifically widowed women to exchange experiences and ideas among themselves 2. Policy makers who are in charge of building Muslim women’s social space of physical activities in the area of Southernmost provinces of Thailand should support and cooperate all organizations involved for instance, Islamic committee, local government organizations and Halal institute. 3. Training providing knowledge to Muslim women from different government and non- government organizations involved should be held to release and relieve their stress, depression, worry and the symptoms of major depressive disorder (MDD) through organizing physical activities. 4. Encouragement of participation of Mama (Pondok leader’s wife) in organizing both religious and physical activities in their own community.


This research and development aims to study current situations and associated factors of health
management and needs for model development in health management among the Thai-Melayu elderly
living in the South of Thailand. The participation action research (PAR) was conducted using qualitative
and quantitative research. The sample of 149 participants recruited into the study were 33 elderly people
being diagnosed with hypertension, 33 care givers of those elderly, and those who involved in the care
for those elderly including 2 health public officers taking care of the patients with hypertension, 3 health
public offices working for the Sub-district Administration Organization (SAO), 3 political members of SAO,
20 religious leaders, 10 village leaders, and 45 village health volunteers. The interviews and focus groups
were used for collecting. The content analysis was used to analyze the qualitative data.
Finding revealed that the needs and community participation in health management in Thai-
Melayu elderly with hypertension included; 1) religious leaders providing health education for the elderly
people, 2) visiting home by the religious leaders to encourage the elderly patients, 3) health education
for the community to reduce sweet, salty, and fatty foods 4) providing the place for exercise, 5) setting-up
the home visit system by village health volunteers , and 6) having a village leader to carry-on the
activities for elderly in the community.
Based on the qualitative data, the researchers developed the guideline to promote health
management among the elderly having hypertension and found that post intervention, the average score
of health management, at higher level, (X = 4.30 S.D = 1.08) was higher than that of pre-intervention
(X = 3.87 S.D = 1.21), at the same higher level. However, it also discovered that the lowest average scores
were found in the following dimensions: reducing high fat diet, and deep-fried foods or stir-fried meals
X= 2.4 S.D= 1.29, X= 3.26 S.D = 1.46, respectively.
The results showed that after receiving health management the systolic blood pressure (SBP) and
diastolic blood pressure (DBP) were also significant lower than pre-receiving the health management at
the level of P< 0.001 and P< 0.05 respectively but there was no significant difference in body weight,
waistline, and body mass index (BMI).


The devolution of health centers to Local Government Units (LGUs) in Thailand has been one of the many tools that the Ministry of Public Health (MOPH) used in its healthcare decentralization policy. Fifty-one out of 9,787 health centers have been devolved since 2007. This study aimed to (1) understand devolution process; (2) evaluate outcomes of the devolution; (3) analyze strengths, weaknesses, enabling factors, and threats of the devolution of health centers in Thailand and (4) make policy recommendations on the provision of primary health care that fits with the Thai context. The study employed qualitative and quantitative approaches consisting of literature review, data analyses of four selected quality indicators and self-administered questionnaires by health personnel at devolved health centers, in-depth interviews and focus-group discussions in four representative provinces.
The study showed that the rates of screening for diabetes mellitus, hypertension, and cervical cancer in devolved health centers were lower than those in non-devolved health centers (p-value = 0.0400, 0.0438, and 0.0000 respectively). The analysis found no statistically significant result for the rate of early access to antenatal care (p-value = 0.1974).
The findings from 41 questionnaires suggested that budgets, medical supplies and equipments, and facilities in devolved health centers were sufficient although some health centers still lacked adequate health personnel. Some devolved health centers could extend the range of their medical services. 75.61 percent of the respondents reported that quality of care and responsiveness were improved after the devolution. The short chain of command between LGUs and devolved health centers could contribute to less bureaucratic management but might also involve local politics. Although the relationship between devolved health centers and Public Health Organizations remained close after the devolution, only 19 devolved health centers reported to have routine audit by Public Health Organizations. Seven respondents indicated they would prefer to move back to MOPH. Lastly, it was reported that the devolution process lacked the participation from people and frontline health personnel.
Successful healthcare decentralization requires clearer devolution policy and supportive laws and regulations from the government. The MOPH should maintain its roles of supervision and regulation in all devolved health centers and collectively address any arising challenges with the LGUs. The devolution of health centers should maintain within the LGUs with sufficient capacities and people participation must be strongly promoted.


Optimal nutrition in both mothers and infants from conception to the first 2 years of
life or the first 1000 days is crucial for growth, health and cognitive development. Thailand
has made considerable progress in maternal and child nutrition, but currently facing the
double burden of malnutrition, i.e., coexistence of both under and over nutrition.
Objectives: This study aimed to improve a tool used in assessing gestational weight gain
(GWG) which is appropriate for pre-pregnancy nutritional status (Body Mass Index, BMI),
develop a new tool for assessing physical activities during pregnancy and lactation, develop
practical recommendations on dietary advice during pregnancy and lactation, develop a
food product using resistant starch for management of overnutrition and finally, to examine
the current nutrition services in maternal and child health program. Key findings: (1) GWG
data of mothers who delivered normal birth weight infants at Siriraj Hospital were obtained
from hospital records. Recommended GWG tables and charts were developed according to
pre-pregnancy BMI, i.e., underweight, normal weight, overweight or obese. (2) A physical
activity questionnaire for pregnancy and lactating women (PAQ-PL) was developed based on
the common physical activities among Thai population. The validity of the PAQ-PL against
the accelerometer was acceptable. This PAQ-PL can be used to monitor GWG and control
post-partum weight retention. (3) Optifood program, which utilized the linear programming
method, was used to create food based dietary recommendations (FBDG) for pregnant and
lactating women. The development was based on dietary consumption data (quantity,
frequency, and food items) of Thai pregnant and lactating women as well as women of
reproductive age. The developed FBDG contained recommended food groups, quantity, and
frequency which aimed to meet the recommended energy, protein, and vitamin and
minerals intake. This FBDG should be tested for acceptability and practicality prior to
implementation. (4) RS milk-based beverage, containing 30 grams of RS, was developed and
tested for acceptability and side-effects. The developed RS beverage was well accepted
among women of reproductive age and the side-effects were rare. The total daily energy intake decreased; however, further study on health impacts is needed. (5) Exclusive breast
feeding (EBF) practice during the first 6 months of age among middle income and working
outside the home mothers was evaluated using the questionnaire, then compared with the
data from the stable isotope technique. Only 31% at 3 months and 61% at 6 months of the
EBF practice data from the questionnaire were consistent with the actual practice. (6) The
current nutrition services in maternal and child health program were based on the policy
and indicators established by the Ministry of Public Health. The services were implemented
through the Regional Health Promotion Center (HPC), which acted as the advisory and
technical support group and monitored policy implementation according to the indicators.
The constraints in the real practices were the lacks of sufficient personnel compared to the
workload and inadequate nutrition knowledge. There was an urgent attention on capacity
building for the health personnel, especially those who work at the local level and
community health volunteers. Recommendation: This study suggests the importance of the
action research that integrates the developed recommendations and tools in the maternal
and child health care services and modify them to be appropriate for the implementation at
all service levels, and suggests the importance of the intensive capacity building on nutrition
aspect for public health personnel.


Objective To study the prediction of pre-eclampsia in advanced age pregnant women by using  of uterine artery Doppler combined with serum sflt-1,PlGF and PAPP-A. Method The prospective collective data study was conducted at antenatal care clinic Thammasat University Hospital. The pregnant women with age above 35 years old with  gestational age between 18-24 weeks were recruited. The clinical risk factors were recorded. Uterine artery Doppler was performed at the same time with measurement of  serum markers. The occurrence of pre-eclampsia and obstetrics outcomes were followed and recorded. All data was analyzed. Results The total enrolled pregnant women were 296. Only 276 pregnant women have  complete  information to analyze.  5.43 percent (15 pregnant women) had pre-eclampsia while 94.57 percent (261 pregnant women) had no pre-eclamptic symptoms. The baseline characteristics of both groups including age, body weight, body mass index, parity and history risk of pre-eclampsia were not statistically significant different. In pre-eclamptic group has higher percentage of  abnormal uterine artery Doppler compared to non pre-eclamptic group (26.67%, 4/15 vs 16.48%, 46/261) but no significant different (p= 0.31). The ratio of sflt-1/PlGF in pre-eclamptic group were higher than non pre-eclamptic group ( 8.60 +4.79 vs 8.09 + 5.24) but no statistically significant different (p= 0.71). MoM( Median of mean )  of PAPP-A in pre-eclamptic group was  less than  non pre-eclamptic group but there is also no statistically significant. The logistic model was generated to predict  the risk ratio of pre-eclampsia. The abnormal uterine artery Doppler has risk ratio (RR) 1.78, while the ratio of sflt-1/PlGF above 14 has RR  2.54. The MoM of PAPP-A less than 0.5 has RR  2.5 , respectively. Combination of these factors has prediction value for prediction 64.62%. Conclusion The combination of these factors could not be used  to predict the occurrence of preelcampsia in advance age pregnant women . However, the  incidence of preeclampsia in our study was lower than expectation , the larger sample size might be needed to verify this benefit.


Objectives: Peripheral arterial disease (PAD) in diabetic patients is associated with high morbidity and mortality. The mortality rate in such patients is 56.5% in 3 years follow up period in Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University. Therefore the incidence and predictive factors to determine the major adverse cardiovascular event (MACE), which composed of non-fatal myocardial infarction, non-fatal stroke, worsening PAD and death is of paramount important. Researchers aimed to explore these outcomes in our population. Method: 500 diabetic patients with being diagnosed as PAD between May 2014 to February 2017, were followed up in 30 months to determine MACE. The potential clinical predictors were entered into a Cox proportional hazard model with backward stepwise regression was performed. Researchers also evaluated the adequacy of treatment by assessing the risk factor control for atherosclerosis. The target of the risk factor control for atherosclerosis has been using the criteria of American Heart Association (AHA) and the Royal College of Physicians of Thailand. Result: During a mean follow-up of 30 months period, 81 MACE events occurred, corresponding to incidence rate 16.20, (95%CI 13.10-19.70). The number of death was 59 patients. The predictive factors, that were significantly associated with MACE, were history of chronic kidney disease (Hazard ratio (HR) 2.09, 95% confidence interval (95% CI) 1.24-3.52), myocardial infarction (HR 1.98, 95% CI 1.06-3.71), the history of gangrene or chronic ulcer or obtaining of revascularization in the legs (CLI) (HR 2.50, 95%CI 1.53-4.08), history of aortic surgery (HR 20.31, 95%CI 4.49-91.82), history of carotid stenting (HR 9.20, 95%CI 1.13-74.71), patients with history of taking warfarin (HR 2.83, 95%CI 1.19-6.72). In terms of risk factor control for atherosclerosis management, patients had reach the target in majority (>50%) only in the control of diastolic blood pressure (71.93%) and stop smoking (92.26%). Conclusion: The incidence of MACE was 16.2%. The predictive factors for high MACE in the 30 months follow up in diabetic patients with PAD was chronic kidney disease, myocardial infarction, history of CLI or history of obtaining revascularisation, history of aortic surgery, history of carotid stenting, patients with history of taking warfarin. This may be used to identify high-risk patients for MACE to assist optimize medical treatment to increase life expectancy and to decrease vascular event. There were still a large gap of improvement for risk factor control in atherosclerosis management.


The policy of Ministry of Public Health states that all hospitals under MOPH should establish Chronic Kidney Disease Clinics (CKD clinics). This study aims to evaluate the implementation of CKD clinics using mixed method research and the CIPP model. Results from 140 hospitals in 12 regional service providers showed that 70.71% of established CKD clinics in line with MOPH policy, while 22.14% already had CKD clinics prior to the MOPH policy statement, and the remaining 7.14% hospitals had not developed CKD clinic citing limitations due to area, personnel or budget. In total, 82.31% established sole purpose CKD clinics providing at least one day per week, but occupied the space used by other clinics. Whereas 17.69% did not separate CKD clinic from other health clinic and ran CKD services in parallel to other clinics. For example, some centers had a ‘CKD corner’ as part of their regular DM/HT clinic. In terms of the hospitals that had implemented CKD clinics, 44.62% of centers used both consultative meetings and two ways communication about policy, goals, future plans of CKD clinics to all health personnel and other stakeholders. Whereas, 27.69% used only two ways communication to realize policy, goals and planning of CKD clinic to among interested parties. The remaining 3.08% hospital used no clear consultative process in developing their clinics. Almost all hospitals reported that the supporting budget for CKD clinic was insufficient. Most hospitals (63.21%) funded the establishment of their CKD clinics from their own operating budgets and some fund support from National Health Security Office (NHSO). In terms of human resource, 58.46% have professional team (full) including physician, nurse, pharmacist physical therapist, and nutritionist or Dietitians. However, we found that 20.77% of hospital did not have funded position for nutritionists and in this cases, the advice about nutrition was provided by nurses. All hospitals with professional nutritionists funded this position of their own accord with temporary employee’s position. In addition, 95.38% of all hospital had implemented and maintained CKD patient databases, but only 42.31% of these contained all recommended clinical measures such as Serum Cr and eGFR, blood pressure, blood sugar, take ACE-I or ARB drug, and urine protein. For the most part, patient data were not utilized to track patient disease progression. Most personnel reported the reason for not using routine CKD patient data to gauge patient disease progression and outcomes was excessive workload. In general, CKD patient data was mainly used to report CKD’s KPI to the Ministry of Public Health.


Thailand is one of the 14 listed countries encountering TB, TB/HIV and MDR-TB burden. Poor adherence could cause longer treatment, drug resistance, relapse and death in TB patients. With limited-resources, the coverage of Directly Observed Treatment, Short Course (DOTS) is low. Most of TB patients are under self-medication or family-member DOT, which a forgetfulness to take medicine or an improperly early medicine discontinuation caused by side effects or etiological misunderstanding may exist. Most of adherence measurements performed at a next follow-up, not at real-time, is considered as an end point.  Hence, TB/HIV Research Foundation has developed a CARE-call system, an ICT-based medication adherence monitoring system having an electronic pill box (CARE-box) to further function by alarming patients to take medicine, notifying a health care worker (HCW) to follow up a non-adherence patients and providing two-way communication for the patients seeking for advice from the HCW. In order to evaluate the system’s effectiveness, 300 TB patients were randomly recruited into intervention or control group. Preliminary result obtained from treatment-outcome available participants showed that statistically higher adherence rate was observed in the intervention group while treatment success rate is at 88.2%, higher than the 85% NTP target and lost to follow-up cases were found only in the control group. The CARE-call system was proved to achieve its two-way communication function under around four-time lower per capita cost compared to that of the DOT supported by the global fund. Qualitative study remarked the benefits of CARE-call system through the CARE-box including alarming system, daily pack, two-way communication by meeting the satisfactions of the all the participants invited to attend focus group discussion. From the result, it is believed that the CARE-call system could improve the TB patient’s medication adherence and provide two-way communication at low cost, which is more suitable for a high TB burden country like Thailand to achieve the NTP targets for treatment success and loss to follow-up rates. However, the stability of CARE-call should be improved and provide more useful functions to facilitate the TB treatment and care.


The main objective of this project was to develop a cost effective, tablet-based hearing screening system that can perform a rapid minimal speech recognition level test. An android-based screening application was developed. The screening protocol involved asking the child to pick pictures corresponding to the set of predefined words heard at different sound levels offered in a specifically designed sequence. For screening purposes, the developed screening system was 100% sensitive (95% CI = 83.18% to 100%) for children with speech reception threshold (SRT) or pure tone average threshold > 25 dBHL, with a specificity 0f 79.44% (95% CI = 70.83% to 86.01%). The time taken for screening of each child was less than 2 minutes on average, compared to 12 minutes required in normal procedure.  Also, to explore other options that could suit a variety of resource settings, the secondary objective was to implement and evaluate standard pure tone audiometric measurement and tele-audiometry functions on the tablet-based system.  It was found that, with additional hardware to increase the dynamic range, function-wise both could successfully be realized. However, due to calibration difficulties especially for the bone-conduction audiometry, accuracies were found to be less than those measured with standard audiometric equipment. Still, the results were encouraging enough to warrant further research and development on this.


Border health care is a complex situation, and is becoming even more so due to the differences of socio-cultural, political-economy, and geographical context. Notably, Thailand is the heart of Southeast Asia and bordered by Myanmar, Cambodia, Laos, and Malaysia. The movement of people has been thus far featured across the border seeking the health care in Thailand which is referred to as, ‘border health’. Each year, the number of people from neighboring countries across border to receive health care in Thailand has been increasing. This study aims to explore border health care situation in 3 provinces – Ubon Ratchatani
(Thai-Lao border); Sakew (Thai-Cambodia border); Tak (Thai-Myanmar border) using qualitative research methods – in-depth interview, participant observation, and focus group discussion. The participants are divided into three groups: policy makers, health professions and NGOs, and patients who crossing borders seeking health care in Thailand. This study shows that social determinants – geography, politics, health service, belief, culture, networking and social supports. Moreover, due to the politics of neighboring countries, the Thai health services in border areas must adopt different approaches of health surveillance system. The public-private partnership between the government and NGOs enhances the effectiveness of border heath care system.


This Research and Development research focused on developing the model of Participation Health Public Policy for the Elderly Care Fund in the community at Northeastern of Thailand (E – San) by community participation process. Data were collected by using both qualitative and quantitative methods including survey, observation, in-depth interview, focus group discussion, and documentation reviews. The participants consisted of 11,109 elders, 660 elderly caregivers, 15 elderly care managers, 264 involved people, and 28 observation participants. Data were collected from October 2016 to November 2017 and were analyzed by using content analysis, percentage distribution, 95%CI, and McNemar Test. The study found that: 1) the situation of long-term dependency care needs of in the elders had a prevalence of dependence in the elders 14.14% (95% CI 13.5 - 14.8), with dementia 15.20%. (95% CI 14.6 - 15.9). Only 43% of dependent elders had accessed to long-term care benefits which was followed the long-term care fund policy in the pilot area. The major obstacles were the problem of inadequate provision of personnel to local government organizations and the burden of care manager. 2) The process of driving long-term care policy into public policy to create public participation in elderly care consisted of 3 components: community involvement, creating knowledge for public policy of long term care, and integrating with the policy-making agency in the area that could lead to the public policy to practice in the area. 3) The community participation increased in every componence. This enabled the long-term care fund to be implemented and encouraged the elders with dependency be accessed to long-term care services increased significantly (p-value <.001). The quality of life of caregivers was also improved significantly (p-value <.001). However, it was found the level of disability was no statistically significant difference in the elderly who received care services under long-term care fund before and after the study. Long-term dependence is a problem and long-term care needs in the elders. Health Public Policy of the long-term care for the elderly is a social movement for the cooperation of network partners, especially local governments and primary health care, to drive important government policies, that can lead to practice in the area. This will lead to the development of long-term care for the elders in the community to support the elderly society in the future.


Purpose: To study pattern of tremor symptoms in Parkinson’s disease patient for differential diagnosis from other symptoms, including related movement disorder and study measure parameters of tremor and create the system to collect the data with wireless internet. Method: This study particularize 2 periods 1) To develop assisted device for detect tremor symptoms, including tremor assessment device with tremor analysis software and spiral drawing 2) To enroll population who have tremor symptom 100 sample and manufacture 40 device give to 20 hospital for test this device. Results: This study during in period 1, to design and develop tremor device for diagnostic and monitoring patients with Parkinson's disease. This device include hardware that can detect accelerometer 3 axial and gyroscope 3 axial and tremor analysis software that show angular rate, angular rms, peak rate, peak frequency and other parameters and can save the data by notebook or android technology. Tremor device was designed modern form, small sensor board as a wristwatch and can take pulse rate. This device can set time to test. In part of the signal made stably and reduce to send error signal. Conclusion: In the part of develop tremor device in episode1 and 2 focus on practical use of medical device, that save the data from user and have to design with regard to available use in daily, safety , smart and technology is more modern.


Cell sheet technology is applied to human articular chondrocytes to construct a tissue-like structure as an alternative treatment for cartilage defect. The effect of a gelatin manipulator, as a cell sheet transfer system, on the quality of the chondrocyte sheets was investigated. The changes of important chondrogenic markers and stress fibers, resulting from the cell sheet manipulation, were also studied. The chondrocyte cell sheets were constructed with patient-derived chondrocytes using a temperature-responsive polymer, and a gelatin manipulator as a transfer carrier. The properties of the cell sheets including sizes, expression levels of collagen type II and I, and the localization of the stress fibers were assessed and compared with those of the cell sheets harvested without the gelatin manipulator. Using the gelatin manipulator, the original size of the chondrocyte cell sheets was retained with abundant stress fibers and a decrease in the expression of collagen type II. Without the gelatin manipulator, although the cell shrinkage occurred, the cell sheet with suppressed stress fiber formation showed significantly high levels of collagen type II. These results supported that the changes of the stress fiber formation in the chondrocyte cell sheets affected the production of the chondrogenic markers. The densely packed tissue-like structure possessed a good chondrogenic activity, indicating its potential use in autologous chondrocyte implantation to treat cartilage defects. One of the challenges in cartilage tissue engineering is the maintenance of the chondrogenic activities during long-term culture. To overcome this problem, we proposed a new culture surface using the fifth generation dendrimer-immobilized surface (G5). Chondrocytes cultured on this surface formed various aggregates, providing desirable three-dimensional structure that closely mimicked the native environment of chondrocytes. As a result, higher chondrogenic markers (collagen type II and aggrecan) with lower de-differentiation marker (collagen type I) were observed in the cells on G5 surfaces as compared to those cultured on traditional polystyrene surfaces. This new surface would be beneficial for chondrocyte cell sheet engineering in our future study.


Alzheimer’s disease (AD) is a primary common neurodegenerative disorder worldwide and increases prevalence in elder ages of life span. The critical detection of early diagnosis is the mostly important to support treatments to defense this incapacitating disease. Amyloidbeta proteins have various significant physiological or pathophysiological effects on AD progression. It was affirmed that amyloid-beta protein levels are detected for preclinical diagnosis and prognosis as a reliable biomarker for neurodegeneration. The available methods for detection of amyloid-beta proteins are time consuming and complicated operations. Herein, a gold nanoparticle-labelled dot blot immunoassays was had been developed for detection of beta amyloid 1-42 oligomers providing high potential early diagnosis for AD. The optimization of direct dot blot immunoassay assay was investigated and the interpretation of the colorimetric results can be visualized by naked eyes.


This descriptive mixed method study aimed to 1) investigate workload and factors associated with productivity of health personnel in District Health promotion Hospitals 2) describe relationship between workload and existing staffs and 3) formulate policy recommendations for health workforce planning and development. Stratified random sampling was applied to select samples for quantitative data collection. 48 District Health promotion Hospitals (DHPH) of 5 sizes (S,M,L,Extra and special size) were selected from 12 provinces in 12 health regions of Ministry of Public Health. All 336 health personnel in 48 selected DHPH were requested to record their daily time spent and productivity in electronic forms for 3 months. Purposive sampling was applied to select 8 outstanding DHPHs from 4 geographic regions across country. Focus Group Discussions were conducted, all health personnel who working in selected settings were participated. Descriptive statistic and content analysis were applied for data analysis. The main findings from this study indicated that 1) Health personnel in DHPH spent their working hours for curative activity 60%-70% more than health promotion and prevention activities which were their major responsibility 2) Comparing with staffing standard and current workload, there was shortage of health personnel in DHPH. In average each staff provided 1.2 FTE to complete their jobs. They also complaint about not balancing between their effort and reward, they did not get overtime payment and career advancement. 3) Health personnel had to share 30% of their working hours for administrative and clerical jobs which led to decrease time to provide health services. These jobs consisted of performance reporting associated with MOPH mandatory indicators, financial and accounting report, supply and inventory document and input data into management information system for various public agencies etc. These finding suggested that, MOPH should improve staffing standard and allocation, improve morale and optimize resources utilization. Moreover, development of administrative competency for directors of DHPH and re-orientation of mandatory reporting system need to be concerned as well.


The objectives of Research Project in Development of Rational Drug Use (RDU) Hospital include: (1) to support the hospitals which join the RDU Hospital Project to achieve its goal by having a plan for concrete and effective actions based on the key advice P-L-E-A-S-E, (2) to strengthen the network of hospitals within the same geographical area, and (3) to support central tools in the implementation process of the hospital and network. The participatory action research (PAR) has been used to emphasize participation and action of local personnel and administrative team in 6 networks in the northern, northeastern-upper and lower, southern, central-eastern areas and the University Hospital Network (UHosNet). The suitable approaches are analyzed through the
self-assessment of the hospital, network, and the performance indicators at the end of the project. Good practice and advice will be shared with the collaborators, stakeholders and hospitals continuing the RDU Hospital Development along with the central supporting tools. The key findings of the projects conducted within the two-year period (10/2015 to 9/2017) can be summarized as follows: (1) In cooperation with the hospitals and networks, several good actions were recognized in each aspect of the key advice P-L-E-A-S-E, which enable us to collect, recommend and distribute the report as a KM book; (2) Results of the performance indicators revealed improvement of the RDU Hospital processes and outputs in most hospitals, even if the targets are not reached in some metrics, thus imply the project success; (3) The key success factors are identified as the support of the executive team, multidisciplinary joint collaboration and the clear national policy. These also include the importance of networking of which results
showed that more members of well-established network submitted the key performance results at the end of the project; and (4) Collaboration at multiple levels were established to develop a single and unique patient information drug leaflet in the country, that will be linked to Mobile Application ‘RDU รู้เรื่องยา’ to improve the nation's health literacy in medication for Thai people. Major impacts of the research project are (1) its utilization as the development for the 15th Ministry of Public Health Service Plan started in the budget year 2017, (2) its acceptance as one of the tools being used for the healthcare accreditation process (the subjects of pharmaceutical and therapeutic committee and medication safety), (3) its support for the RDU Core Curriculum for healthcare undergraduates, and (4) its involvement to promote the adoption of 2016 Ethical Criteria for Medicinal Drug Promotion Thailand.


The research aims to explore and describe the Urbanites’ Accessibility, Understanding, Evaluation and Application of Health Information for their Self Care in Emerging Infectious Disease International Spreading. Mixed method was used in collecting data including in-depth interview of doctors, public health facilitators, village health volunteers (Or Sor Mor) and local press in the 4 provinces where immigration checkpoints are--Chiangrai, Nong Khai, Ubon Ratchathani and Songkhla—and administration of questionnaire for survey research on sample group living either Amphoe Mueang (a capital district of a province) or an Amphoe (districts) where immigration checkpoint or international airports is located. Those areas belong to the 7 provinces namely Bangkok, Chiangrai, Tak, Songkhla, Nong Khai, Ubon Ratchathani and Phuket.  The overall data was collected from 1,400 samples in total. The finding indicated that Thai Ministry of Public Health has a well-developed system and strong policy and control measures on the management of infectious diseases spread internationally as well as beneficial cooperation between Thailand and other countries. Measures on disease surveillance, control and prevention together with risk communication plan have been installed and are actively used.  The finding revealed the people become more aware when infectious diseases start to spread closer into the country and their hometown. The level of awareness fluctuates in accordance with the severity level of diseases. Usually, people’s awareness level rises high during the first period of news announcement about infectious diseases and gradually lowers as media ceases to report about diseases. On the other hand, when there is news report on the severity of infectious diseases, lack of treatment and mortality number of the infected combined with insufficient amount of information, the awareness level soars up and turns into panic. This can be alleviated by news informing people of government’s countering measures and procedures in screening, preventing and controlling contagious diseases. The health information about emerging infectious diseases spreading internationally are both news reports by the press and media created by Public Health facilities. Information sent are consisted of both arousing information of the severity of diseases warning them to change their behaviors and plain information of diseases aiming for understanding and procedures to follow for their safety. It is found that people access information about emerging infectious diseases spreading internationally through various media; mass media, personal media such as village health volunteers, neighbors, specialization media, local press and online media. The survey result shows that the overall frequency of people media exposure is medium. The most frequent media used is television. Radio, newspaper, friends, public health facilitators, village health volunteers, Facebook, LINE, news website, health care website, vinyl banners, pamphlets and broadcast towers have medium usage frequency. The accessibility level to the information of infectious diseases internationally spreading is medium. However, the number of channels accessed by the people and frequency of follow ups are low. The eagerness and content engagement are at medium level. Overall, the level of understanding is high. The most understanding of well-informed topic for the sample group are the chance of getting infected, the lack of treatment and the importance of following news trailed by following instructions. The survey result indicated that level of value and correctness of information evaluation is medium. Looking closely, sample group indicated that they mostly evaluate on the benefits of information in ensuring personal safety, however, they set up basic assumptions and check the validity of information, so these two topics are at medium level.  Application of information is found to be at high level. Sample group usually use the information learnt to protect themselves from infectious diseases, practice sanitary behaviors, self-observe for sickness and find further news and information. The result of a test on the hypothetic relationship reveals that the frequency of information access is positively correlate to understanding of content. Also, the mean of access to information varies positively correlate to evaluation of value and correctness of information. Both pairs have significant relationships shown statistically at .05 In addition, the information accessibility, understanding and evaluation of value and correctness of information all have significant positive relationship with application of information shown statistically at .05 It is found from comparative hypothesis testing that information accessibility, understanding, evaluation and application vary significantly between age groups and levels of education at .05 based on statistic.


The objectives of Research Project in Development of Rational Drug Use (RDU) Hospital include: (1) to support the hospitals which join the RDU Hospital Project to achieve its goal by having a plan for concrete and effective actions based on the key advice P-L-E-A-S-E, (2) to strengthen the network of hospitals within the same geographical area, and (3) to support central tools in the implementation process of the hospital and network. The participatory action research (PAR) has been used to emphasize participation and action of local personnel and administrative team in 6 networks in the northern, northeastern-upper and lower, southern, central-eastern areas and the University Hospital Network (UHosNet). The suitable approaches are analyzed through the
 self-assessment of the hospital, network, and the performance indicators at the end of the project. Good practice and advice will be shared with the collaborators, stakeholders and hospitals continuing the RDU Hospital Development along with the central supporting tools. The key findings of the projects conducted within the two-year period (10/2015 to 9/2017) can be summarized as follows: (1) In cooperation with the hospitals and networks, several good actions were recognized in each aspect of the key advice P-L-E-A-S-E, which enable us to collect, recommend and distribute the report as a KM book; (2) Results of the performance indicators revealed improvement of the RDU Hospital processes and outputs in most hospitals, even if the targets are not reached in some metrics, thus imply the project success; (3) The key success factors are identified as the support of the executive team, multidisciplinary joint collaboration and the clear national policy. These also include the importance of networking of which results
 showed that more members of well-established network submitted the key performance results at the end of the project; and (4) Collaboration at multiple levels were established to develop a single and unique patient information drug leaflet in the country, that will be linked to Mobile Application ‘RDU รู้เรื่องยา’ to improve the nation's health literacy in medication for Thai people. Major impacts of the research project are (1) its utilization as the development for the 15th Ministry of Public Health Service Plan started in the budget year 2017, (2) its acceptance as one of the tools being used for the healthcare accreditation process (the subjects of pharmaceutical and therapeutic committee and medication safety), (3) its support for the RDU Core Curriculum for healthcare undergraduates, and (4) its involvement to promote the adoption of 2016 Ethical Criteria for Medicinal Drug Promotion Thailand.