Pufferfish belong to two families of marine and estuarine fish: Tetraodontidae and Diodontidae. The term
Tetraodontidae refers to the four large teeth fused into the upper and lower plates of the fish’s mouth, which are
used for crushing the shells of crustaceans and mollusks; the Diodontidae, as denoted by the name, possess only
two cutting teeth.
Poisoning by consumption of the members of puffer fish families is one of the most violent intoxications
caused by marine species. The ovary, liver, intestine and skin of pufferfish can contain levels of tetrodotoxin
sufficient to produce rapid and violent death. Treatment of the victims consists of supportive care and intestinal
decontamination with gastric lavage and activated charcoal concurrently with diuretic drugs. On the other
hand, the flesh of many pufferfish is not usually dangerously toxic and may be beneficial, producing a feeling of
well-being for the consumer. A pharmaceutical product derived from tetrodotoxin called Tectin is a potent pain
reliever and helper in opiate addicts going through withdrawal, when administered in very small quantities.
Both events conform to the mechanism exercised by hormesis, i.e., the effect of small doses of a toxic substance
that at higher doses has an adverse effect. A less powerful biotoxin of the puffers, named saxitoxin, the cause of
paralytic shellfish poisoning (PSP), can also be found in these fish. It should be noted that puffer toxins seem
not to be synthesized by the fish itself, but can be traced to the food chain through the ingestion of toxin-bearing
organisms, such as starfish, gastropods, crustaceans, flatworms, and ribbonworms.
Nevertheless, the meat of some pufferfish species is considered a delicacy in both Japan (as fugu) and
South Korea (as boh-guh). The good news for staunch pufferfish eaters is that non-toxic pufferfish have been
produced in netcages or land culture; even the formerly toxic liver is now available as a Japanese traditional
dish “fugu-kimo” (puffer liver).


The refilling of prescriptions for patients with chronic diseases under Thailand’s Universal
Coverage Scheme (UCS) by a private community pharmacy was developed as the model for a
health-care network linking the pharmacy and primary care units under the UCS. The objective of
this study was to compare the outcomes of the pharmacy providing health-care services for stablechronic patients, including those with diabetes mellitus, hypertension and dyslipidemia, between
those of the community pharmacy and primary care units. The quasi experimental study and
qualitative study were conducted during the period from December 1, 2005 to November 30, 2006.
Data collection was performed using pluralist methodology, including patient clinical data, questionnaire,
observation and telephone interview. The percentile, mean, standard deviation were
calculated. Levene’s test for equality of variances, paired t-test, and independent t-test were used
for comparing the clinical data. The patients were divided into a treatment group (n=27) and a
control group (n=69). The treatment group repeatedly refilled their prescriptions at the pharmacy
whereas the control group obtained normal services at the Phra Samuth Jadee Hospital, the main
contractor. After six months, clinical outcomes were compared between both groups. The results
revealed that the fasting blood sugar level, systolic blood pressure and diastolic blood pressure
between the treatment and the control group were not significantly different (p-values = 0.875,
0.770 and 0.706, respectively). The results of a telephone interview with the treatment group indicated
that the overall satisfaction with the services was 63.5 percent. Interestingly, the satisfaction
in the fast and convenient services among the patients who refilled their medications at the pharmacy
was 100 percent. These results indicated that the refill prescription service by the pharmacy
is as effective as that by the hospital. This study confirms the distinct and important roles played by
community pharmacists in delivering pharmaceutical care to chronic patients. In addition, the
pharmacy could be a health-care provider serving as a subcontractor in the health-care network
under the Universal Coverage Scheme in Thailand. This could improve and develop the quality of
the overall health-care services. This health-care service model provides more access to care and
increases the treatment quality of patients.


A study was carried out to evaluate the impact of local wisdom on safety, occupational health, and
the working environment among metal handicraft workers in Bangkok Metropolis. The objectives were
to survey the variety of the population and their problems; to analyze the data and construct a model; and
to evaluate the safety, occupational health and working circumstances. The sample group for this study
comprised 48 people in five communities. The data-collection instruments were questionnaires and interview
questions. The study methodology compared the risk assessment of a production process without
using the model, and the risk assessment (TISI.18001) of the process, using the constructed model.
The data were analyzed by job safety analysis (JSA).
The findings were as follows:
Baan Bu Community making brown bowls. The process of melting and hammering metal posed a high
occupational risk (82.7 percent); this was reduced to 50.6 percent by using the model and the level of
danger was acceptable.
Baan Bart Community producing food bowls for monks (batr phra). The blowing process to make bowls
showed a high occupational risk of 93.59 percent; this was reduced to 48.14 percent by using the model
and the level of danger was moderate.
Baan Nern Community producing “khong wong” (a musical instrument). The process of polishing and
cutting metal in making a khong wong poses a high danger risk (85.18 percent); this was reduced to 46.9
percent by using the model and this level of danger was low.
Baan Tee Tong Community producing gold leaf. The process of melting and hammering gold leaf poses
a high danger risk (86.42 percent); this was reduced to 64.19 percent by using the model and the level of
danger was acceptable.
Baan Chang Tong Community producing gold ornaments The process of melting gold for making ornaments
poses a high danger risk (67.9 percent); this was reduced to 37.03 percent by using the model and
the level of danger was acceptable.


Children under five years old normally grow and develop rapidly; during that process they are at
risk of failing to reach the vital goal. Therefore, health promotion and disease prevention comprise potential
means for taking care of such children. This study was aimed at studying a profile of the health promotion
and disease prevention (HP-DP) services for them, regarding the utilization of the Universal Health
Coverage System, and the attendants’ behavior. Descriptive design with in-depth interview was employed
for data collection in the period from April 2003 to March 2004. The materials and the subjects
studied included documents, 1,000 selected children and their parents who attended HP-DP clinics, 12
health-care providers, and experts. Questionnaires and interview guidelines were used for collecting
information. The findings revealed the following:
1. All university hospitals, regional and community hospitals, as well as community primary care
units were providing HP-DP services in those settings both before and after the implementation of the
Universal Health Coverage policy, apparently without establishing institutional policies and practice guidelines,
manpower allocation, staff development or resource planning. Services were also extended to the
community despite the limitations of personnel and time constraints. The majority of health-care providers
did not understand much about the newly introduced benefit package for children under five years
old. In addition, limitations remained on practices in the assessment of childhood development, in
developmental stimulation or promotion, the arrangement of the developmental promotion corner and
counselling on child-rearing. Thalassemia screening for children whose parents showed traits or were
diseased, and thyroid hormone testing for children with indications were seldom practiced.
2. The old and new benefit packages of health promotion and disease prevention in children under
five years old did not differ much. Although the known services in the United Kingdom and the United
States were included, the practices of recording family history, genetic history, vision and hearing tests,
mother-child interaction, parental advice regarding food, oral care, accident prevention, and child development
promotion and empowering parents in child care were covered.
3. General information on children and their parents’ behavior on attending the HP-DP service noted
that the mothers were mostly the persons who brought their children to the well baby clinic. Most of
them were workers, housewives and civil servants. They preferred the hospital’s HP-DP service as it
was the place where their child was delivered and was in the vicinity of their residence. However, the
services included mainly weight and height measurements, and vaccination. Seldom included were child
development assessment and advice on child-rearing and child development promotion. Satisfaction
with the health service was 53.3 percent of the samples before and after the introduction of the Universal
Health Coverage policy, denoting no difference. Satisfaction with the services related to height measurement,
vaccination, developmental promotion, health assessment and advice on child care did not differ
significantly statistically (p <0.001).


Overcrowding in hospitals’ out-patient sectors is a chronic problem of public hospitals in Thailand.
Patient visitors have to wait for a long time no matter how serious their illnesses. A reasonable step in
solving this problem is to understand the nature of the attendants, i.e., who they are and why they come.
It is known that over half of the visitors live in the local district; they come with every type of problem;
most of the problems could be taken care of by practical nurses and general practitioners. The reasons for
attending the hospital include ineffective treatment at primary care units, and inconvenience because
there are not enough primary care units to cover the areas, and their quality is not well accepted. Therefore,
an important approach to solving hospital overcrowding is strengthening the function of primary
care units and forming them into a hospital network. Further, management is needed to find out which
outpatient sections are crowded and when, so that supplemental services could be organized accordingly.
Among the top five outpatients are those with diabetes mellitus and hypertension; these are chronic lifetime
patients. Thus, the service system for this group should be organized specifically and efficiently by
linking the provision of care with primary care units and/or private dispensaries to relieve the patient
pressure on big hospitals. Ultimately, owing to the complexity and variability of the problem, ad hoc
teams should be established specifically to be responsible for managing and monitoring the system effectively


The research manager is an essential component of the research system. This article describes the
academic capacity of the research manager, which should at least comprise 1. neutrality, 2. program
evaluation skills, 3. knowledge of research methodology, 4. ability to systematically review existing
knowledge, 5. research mapping skills, and 6. ability to conduct research on research management.


Decentralization has fully materialized in the Philippines over a period spanning
almost two decades. In Thailand, decentralization was initiated as early as 1932, but
materialized only in 2007. However, decentralization process in the health sector has been
delayed in the devolution of health service facilities from the central to local government
levels.
Lessons learned from the Philippines, which has fully implemented decentralization
for 17 years, will be very valuable lessons for learning about the positive and negative impacts
arising from decentralization in order to provide policy options for Thailand so that it
can avoid negative impacts and follow successful policy measures in support of the decentralization
process of health services to the local government level.


Good governance in the health system generally refers to the exercise of political authority and the
use of institutional resources to manage health problems and affairs. There are eight dimension of governance:
participation, rule of law, transparency, responsiveness, consensus orientation, equity and inclusiveness,
effectiveness and efficiency, and accountability. The enhancement of stewardship functions and
the improvement of management support systems of the government in terms of collective responsibility
for overall performance of the health system are aspects of good governance. In addition, good governance
is the responsibility of other stakeholders outside of the public sector. Therefore, the principles of
good governance will be used by the National Health Organization to enhance accessibility to care, the
quality to care, equity rights, and stakeholder participation.


This is a report of a review of the situation of decentralization in health and to recommendations for
further steps that need to be taken. Documents, news and information from 1999 to 2007 were reviewed.
Key persons from the organization concerned were interviewed. The study revealed that the decentralization
process was operated slowly and that the infrastructure among the local administrative organizations
to support decentralization was not well prepared and well established. The analysis showed that
decentralization still has strengths and advantages because of the higher local administrators’ capability,
the increase in budget and a transfer of some public health personnel to the local level. Moreover, monitoring
and external audits could be easily conducted since the local authorities’ structures and functions
are less complex compared with that of the government structure. On the contrary, there are some weaknesses
in decentralization. These weaknesses include questions of transparency and lack of skill in public
health affairs among the existing staff. Also, the public health division has not yet been structured in most
sub-district administrative organizations. To consider opportunities, a health security system and health
promotion system from the Thai Health Promotion Foundation, as well as a health-care reform system
that could be possibly established, all would increase the opportunities of the public to participate in
health-care initiation at local levels. An internal audit of the system by the community and the general
public was also counted as an opportunity. Nevertheless, there can also be some obstacles. Currently, the
Thai government does not pay much attention to decentralization and does not really focus on decentralization
management. Therefore, it is possible that the “CEO Governor” system could be a system that
hinders and interferes with the local administration system. Moreover, there is a lack of cooperation
among government officers, and currently many public health personnel still have no confidence in decentralization.
A clear conceptual framework is therefore needed. Recommendations are: (1) Decision-making should
be done by the local administrative organizations; (2) the system needs to be efficient and autonomous; (4)
equity in health is needed; (4) good governance, transparency and accountability are very important; (5)
Public participation and responses to community needs should be focused; and (6) the relationship between
local authorities and the government need to be well established. Additionally, it is recommened
that the Ministry of Public Health be changed into a “standardization authority” with the roles and responsibilities
of monitoring, advising, and providing technical support to local administrative organizations.
At the same time, the local administrative organizations should be authorized with clear roles and
responsibilities to provide suitable public health services directly and specifically for the population in
their own areas. In addition, it is necessary to strengthen capacity-building among local administrative
organizations and capability development of public health personnel to support a good public health
system at the community level. Revision of laws and regulations also needs to be focused and carried out
together with the decentralization process among well-prepared local organizations. For monitoring the
outcomes, the ultimate goal of “health-care services with equity, good governance, efficiency, good quality,
and satisfactory standards” should be used as indicators for the evaluation.


Primary care providers have the pivotal role in the care of people with diabetes; therefore, improving
care in this setting is an imperative. This review illustrated issues concerning diabetes management in
primary care including the following: aim and provision of diabetes care; organization of care; and education,
training and skill of the health-care team. The situation of diabetes management in primary care,
both in Thailand and other countries, predictors of high-quality care, and barriers to control of diabetes
were described. Suggested indicators for auditing the quality of diabetes care and the strategies utilized
for improving diabetes management in primary care were also described.


In the contemporary development of the Thai national framework for health system development,
this report has drawn the experience of Brazil, the United States of America, and the United Kingdom for
lessons to be learned for Thailand. The study was conducted using document analysis carried out during
August to December 2007, by searching available information from the Internet. Data sources were from
published literature, the media and the websites of several organizations.
The study found that histories, political changes and reform initiatives have influenced the route of
health system development of different countries in different ways. Brazil, which had been under military
dictatorship for a long time during the period 1964-1985, has established a supporting mechanism for
people’s participation in health reform agenda-setting and health policy formulation. Widened participation
successfully pushed the concept of human rights in health care to be adopted in the 1988 Thai Constitution.
Since then universal access to health care has been established and financed with taxes. Every
new reform direction which has been adopted in the national health conference was incorporated to revisions
of the 1988 Constitution. The USA case presents a model of decentralization in health system development.
The federal government supported states in extending the coverage of health-care access. A
collaborative project involving academics and state governments called “Turning Point Initiative” formulated
a model of the overarching public health framework and formulated the “Model State Public Health
Act” which provides initiative ideas for the states to develop their own laws and development plans with
a collaboration from for all stakeholders in the state. The UK case presents long experience with centralized
management for controlling universal access, achieved since after the World War II. Several reforms
were introduced to tackle with the cost escalation and system irresponsiveness (long queues for elective
surgery, for example). Current issues include a balance of the centralized policy and decentralized management.
Thailand passed the National Health Act in January 2007 with the aim of establishing national health
governance which promotes the role of individuals and civil societies in participating in health policy
development and system monitoring and evaluation. Brazil’s experience in the supporting mechanism
for people’s participation is useful for Thailand for comparison with the Thai national health assembly
and for gaining knowledge for strengthening the role of civil societies in health policy development. The
experience of the USA in collaborative work among academics, state officials, and the private sector would
seem to be fruitful in the promotion of the deliberative policy process of health system development. An
experiment in a different context, such as in Thailand, should be practical. The UK’s experience shows the
transitions from the state’s responsibilities in people’s health to the community’s and individual’s choices
in health care. This reflects the direction of sharing responsibilities in society which Thailand has pursued
in this era of health system reform. This study suggested that, in the Asian context, Thailand could adapt,
but not adopt, some good concepts and procedures in health system development from these three countries
in order to establish a reform mechanism and an overarching health system framework with a particular
characteristic based on the wisdom of Thais.


The purpose of this descriptive study was to explore health promotion processes of Local Administrative
Organizations (LAOs). Data were collected by using mail questionnaires from May to December
2007. The subjects were 950 executives of LAOs obtained by stratification and simple random sampling. Five hundred and thirty-two LAOs responded to the questionnaires (56.0 %). The results showed that the
scores of LAOs’ health promotion processes were at a moderate level (54.5 %). The majority of LAOs did
not have a division of public health in their organization’s structure (62.8 %), had a health promotion
policy (51.7 %) but the specified policy constituted a real policy for only 7.5 percent of them, had health
promotion plans/projects (95.7%), and supported budgets and materials for other institutes for health
promotion processes (89.5%). However, health promotion processes were evaluated and used for improvement
in only 38.9 percent of the LAOs. The majority of LAOs did not receive materials and budgets
from other institutes in 78.0 and 61.7 percent, respectively, but did receive mass media and knowledge in
70.3 and 65.4 percent of them, respectively. The LAOs needed support from the Thai Health Promotion
Foundation, National Health Security Office and Provincial Public Health Offices in 94.0, 91.0, and 89.5
percent, respectively. Major problems in the health promotion processes of LAOs were a lack of public
health personnel, budget and knowledge of health promotion.
The recommendations from this research are to integrate policies at the ministerial level, and to set
the standards of health processes and evaluation in the same direction for all provinces, districts and
subdistrict. The LAOs should establish a division of public health in their structure, enact local legislation
concerning health promotion, support budget and health personnel, and train the leaders of LAOs about
the vision of health promotion. Moreover, public health organizations should promote self-care, give
advice and vigorously act as advisor of the LAOs in terms of health promotion.


The survey research was aimed at determining the retention rate of medical graduates of Khon Kaen
University in Northeastern Part, after their compulsory three-year bonded period. The population under
study were physicians who graduated from Khon Kaen medical school during the period 1979-2000. The
list of alumni was colleted from the Alumni Association and Medical Education section. The list of alumni
and their workplaces was investigated from Provincial Health Offices and the GIS of the Ministry of
Public Health. The incomplete list of alumni and their workplaces was investigated by searching telephone
numbers and asking questions of the alumni deputy. The list of alumni was verified by teachers
who had to visit the alumni at their workplaces. The data were analyzed using percentages. The research
findings were as follows:
1. The medical graduates remaining in the Northeast (70%) was higher than the quota rate (60%) by
10 percent.
2. The distribution of alumni was as follows: in the Northeast 70 percent and in Bangkok 11.65 percent.
Compared with findings in 1992, the distribution in the Northeast decreased by 3 percent whereas in
Bangkok it increased by 1.85 percent.
3. The alumni were stationed in large hospital (51%) more than community hospitals (49%).
4. The alumni in the Northeast worked at community hospitals 26.88 percent, regional hospitals
25.48 percent and private hospital 3.46 percent.
5. The production of the Collaborative Project to increase the production of rural doctors (CPIRD)
was higher than the target by 29.66 percent for 1999 graduates and by 21.63 percent for 2000 graduates.
6. The retention rate in the Northeast (70%) was higher than the target (60%); 19 years out of 22 years
had higher than quota rate. The three highest retention rates were 1998 graduates (92.45%), 1994 graduates
(92.45%), and 1999 graduates (92.45%) respectively. The three lower rates were 1983 graduates (48.78%),
1982 graduates (51.16%), and 1979 graduates (54.55%) respectively.
Medical graduates from Khon Kaen University were retained in the community. The retention rate
was in line with the intention and philosophy of three medical curricula, which emphasize that medical
doctors should improve the public health of the community, have a positive attitude toward serving and
working with others in the health team. The research findings confirmed the objective of the Faculty of
Medicine, Khon Kaen University.


According to the 1997 Constitution of the Kingdom of Thailand, all Thai people’s rights are protected.
Particularly, older adults have the right to access health-care services equally as other populations.
Therefore, the Thai Government passed the 2003 Act on Thai Older Persons as law. The purpose of this
study was to describe the satisfaction of older persons with medical and health-care services, according to
the 2003 Act on Thai Older Persons, as those services relate to the Public Health Unit of Pakchong District,
Nakhon Ratchasima Province regarding disease prevention, medical services, and medical treatment. The
study sample consisted of 200 older persons recruited by cluster random sampling and simple random
sampling from a total of 14,135 older adults in Pakchong District, Nakhon Ratchasima Province. A structured interview was used to collect the data, which were analyzed with descriptive statistics and t- test.
The results revealed that the majority of the sample had a high level of satisfaction with overall
services and with services on disease prevention (3.51-4.50, p = 0.05), while they had a moderate level of
satisfaction with medical services and medical treatment (2.51-3.50, p = 0.05). In addition, non-significant
differences in overall satisfaction with medical and health-care services between males and females, occupation
(government officer/non-government officer), and dwelling location (municipal/non-municipal)
were found.
The results of this study are expected to provide useful information for health-care providers in
improving medical/health-care services for older persons, such as annual dental care service, annual
physical examination, elderly club activities, special-track services, and environmental safety. These services
should be established to serve the needs of older persons fairly according to the goal of the 2003 Act
on Thai Older Persons.


This study was carried out with the intention of obtaining and providing knowledge in developing
policy to promote the growth of private hospitals with least negative effect on government health care. By
studying the literature about private hospital segments and the impact of government policy together
with questionnaires sent to most private hospitals in Thailand about their resources and services back to
five years previoustly, the financial resources of the hospitals were analyzed using the data from the Ministry
of Commerce and the Stock Exchange of Thailand. Quantitative data obtained by interviews were
also analyzed. From these processes, we found that the rapid growth of private hospitals during the past
three decades has a strong relationship with the economic status of the country. The Government’s investment
promotion policy has had both negative and positive impacts on the income of hospitals. Largescale
hospitals earn more income than small-scale hospitals. Hospitals in Bangkok earn more income than
hospitals in rural areas. Three factors, namely price, quantity and quality, together with quality assurance
by the Ministry of Public Health, the National Health Security Office and the Social Security Office
synergized the working process to reform the health infrastructure of Thailand.


Community participation is an essential strategy for improving community health in the context of
Namkao Subdistrict, which has strong community organizations was considered suitable as a model for
the development of a participatory community health fund at the subdistrict level.
The study was divided into two periods: the first for formulating a model by collecting data about
the existing social fund and the situation of organizations in the community, and the second for assessing the real operations of the Namkao community health fund and evaluating the administration processes
designed.
The results showed that all three sectors (community sector including groups of community savings
organizations, health-care sector and subdistrict administrative organizations) agreed with establishing
the fund. The contribution from the community sector is the key to community ownership of the fund.
The community health fund board consisted of people from every sector. Approval for budgets of any
projects is considered by its linkage to the Namkao health plan in that it would have a wider perspective
of health than a bio-medical model.
For the second step, the Namkao community health fund was established in 2007; a contribution
was provided by the National Health Security Office, which funded 37.5 baht per capita every year (about
140,287 baht in 2007), while the local government provided 100,000 baht, the community sector 14,000
baht and the health-care sector 100,000 baht. Currently, the community is developing a community healthplan
for allocating budget to health-promoting projects.
The participatory process is the core concept in establishing community health. A community health
fund at the subdistrict level is an important participative strategy that can support real operations. This
innovation promoted the concept of good health, which should not be limited to health organization staff
only but a task shared by everyone.


In order to achieve the standard and effectiveness of care and finally to enhance the quality of life of
people, strategies to improve the quality of services is an important approach for both public and private
health sectors. Mayo Hospital is one of many hospitals that has implemented the TQM/CQI, as recommended
by the Hospital Accreditation (HA) standard for a health promotion Hospital. In addition, Mayo Hospital has applied the criteria for the TQA award in order to evaluate the outcome of implementation.
The purposes of this study were to describe the strategies and outcomes related to the implementation of
quality improvement of services at Mayo Hospital based on the six aspects of the TQA criteria. Both
qualitative and quantitative methods were used in this study. A questionnaire was sent to health personnel
asked about the working atmosphere and organizational environment. In addition, in order to gain
better understanding about the organization’s vision, facilitating and inhibiting factors and lessons learned,
in-dept interviews were held with seven administrative staff and document analysis of a self-assessment
form was conducted. Content analysis was applied for assessing the qualitative data, while quantitative
data were analyzed using percentage, mean, and standard deviation.
The results of this study revealed that, based on six aspects of TQA, leaderships and patient-customer
focused aspects were at the level of improving, while strategic planning and internal process were
at the level of awareness to improving. In addition, the MIS and human resource, development and
administration were at the level of “awareness”.
The strengths of Mayo Hospital were that the administrative team had good understanding about
quality development while the health personnel were involved in determining the directions and goals of
the organization. In addition, patient and customer centered care is their priority of the services. The
coordination among departments was well developed. However, there were areas that needed improvement,
including dissemination of the organizational mission so that it could be transformed into practice,
the information system, the development of practice guidelines or standards of patient-centered care in
all departments, human resources developments, and collaboration and coordination across departments.


Hospital health-care workers are vulnerable to occupational hazards from dangerous workplaces;
however, there has been little concern about this issue in the Thai governmental hospitals. The purpose of
this health service system research was to develop the occupational health system in Rayong Hospital in
two steps: first, reviewing the generally accepted standard guidelines instituted by the National Institute
for Occupational Safety and Health, and the World Health Organization, in tandem with those advocated
by the Thai Bureau of Occupational and Environmental Health, the Hospital Accreditation System and
the Health Promoting Hospital Program; second, implementing those guidelines into the hospital’s strategy. The result was the successful establishment of the occupational health system into policy, network
and knowledge in the hospital.


This study was aimed at assessing the mortality differential according to demographic, socio-economic
and health status among the Thai elderly (aged 60 years and older) during the period 2004 and
2006. The data used were from the National Health Examination Survey III, 2004 (NHES III) and death
registry between 2004 and 2006. Area of residence, geographical area, marital status, education, house-hold income, dependence on daily activities of living and cardiovascular risk factors
were selected as demo-socioeconomic and health status indicators. The standardized
mortality ratio (SMR) was used to measure old-age mortality according to these indicators,
disaggrageted by sex.
It was found that mortality differences existed in almost all demo-socioeconomic
and health status indicators of the Thai elderly, except area of residence. Male and female
elderly people who lived in northeastern and northern Thailand had higher mortality,
while those who lived in the southern part of the country and Bangkok had lower
mortality than those who lived in the central region. Furthermore, the elderly who had
always been married, widowed, divorced or separated had higher mortality than those
who had always been single. The dependent elderly or those with cardiovascular (CV)
risk factors had higher mortality than those who were not dependent or who did not
have CV risk factors. These mortality differences could reflect health inequality among
different groups of the Thai population.


Tuberculous meningitis (TM) is associated with high morbidity and mortality. The early diagnosis
and treatment of tuberculous meningitis saves lives. Diagnosis is based on clinical features, cerebrospinal
fluid changes, and imaging characteristics. The clinical features of TB meningitis sometimes are initially
non-specific, although clinical meningitis with cranial neuropathies, cerebral arteritis, hydrocephalus and
spinal arachnoiditis are well recognized by most physicians. Bacteriological confirmation, such as microscopy
for acid-alcohol-fast bacilli, polymerase chain reaction and culture, is not possible in all cases as
those tests do not have sufficient sensitivity; however, this depends on the volume of CSF examined.
Brain imaging should be performed if the patient deteriorates. The complications of hydrocephalus, infarction,
and tuberculoma are common complications of tuberculous meningitis and a neurosurgical opinion
should be sought in those who are failing medical therapy. Early treatment with four drugs (isoniacid,
rifampicin, pirazinamide and etambutol) prevents death or disability. Adjunctive treatment with corticosteroids
improves survival but probably does not prevent severe disability.


After almost 20 years of effort, the Art Therapy Demonstration Center was established under the
Rajanukul Institute, a 48-year-old mental health hospital and academy of the Department of Mental Health,
Ministry of Public Health. The date was April 3, 2008 and the occasion was presided over by General
Wanchai Ruengtrakul, President of the Rajanukul Foundation, and Dr. Wachira Pengchan, Deputy Director
General of the Department of Mental Health, Ministry of Public Health. The co-chairpersons announced
the official opening of the “Art Therapy Demonstration Center.” The opening event was followed
by the Art Therapy Specialist Seminar on “Art Therapy Roadmap in Thailand”, which was attended
by 120 mental health personnel, some art therapists, professional artists and art educators, among
others.
The seminar comprised two sessions: “Art Therapy in Thailand” and “Art Therapy in the West.” The
first speaker, Dr. Udom Petchsangharn, the former director of the Institute, spoke of the value and status of art therapy in Thailand based on the concept of “adjunct therapy” or “essential adjunct therapy,” and
the role of “art” in human sociology, and its power in the treatment of the mind. The second speaker, Prof.
Punya Vijinthanasarn, an outstanding artist and Dean of the Faculty of Painting, Sculpture and Graphic
Arts of Silpakorn University, spoke on the historical development of fine art in association with innersubconscious
expression by using extensive examples of Western art works. Prof. Saman Supprasri, Dean
of the Faculty of Fine and Applied Arts, Burapha University, gave notes on the role of art education and
aesthetical values in relation to the therapeutic approach. Dr. Lertsiri Bovornkitti concluded the session
by addressing the role of art therapy and its value, and the characteristics and knowledge that art therapists
should formulate, i.e., the two types of art therapy in the West: “Art as Psychotherapy” and “Art as
Therapy,” and then summarized a roadmap for art therapy in Thailand.
He acted as moderator for two invited speakers, Mr. Jordan Potash from the United States and Ms.
Debra Kalmanowitzs from England, who spoke on “Art Therapy in the West.” An example of historical
practices associated with traditional and indigenous art therapy was Navajo sand-painting. They also
provided background knowledge of art therapy in the West based on the two concepts, art as therapy and
art psychotherapy, explicating the three knowledge roots of art therapy, i.e., art, psychology and therapy;
and theoretical notions on “witness/witnessing.” The presentation was followed by a question-and-answer
session related to the practice of art therapy. The presentations of the two international art therapists
provided support for the future development of art therapy in Thailand.
For further improvement of the knowledge of Thai art therapy, the authors suggest that a series of
art therapy workshops be organized by qualified international art therapists and educators for the Thai
art therapy practitioners and those who are interested in this newly developing field.


This study was carried out in the period from September 2005 to January 2006 in order to determine
the effect of the frightening pictures printed on cigarette packs on the smoking behavior of 120 Burapha
University students aged 18 to 23 years, using specially designed questionnaires. The average number of
cigarettes smoked per day was 5.2. The results of the study suggested that the warning labels on cigarette
packs had reduced the number of cigarettes by 1-7 cigarettes/day, or 32.5 percent overall. The most
frightening label, which influenced the reduction in smoking, was one showing that cigarettes would
induce lung cancer; the first runner-up in the category was the picture showing that cigarettes lead to bad
breath, followed by one showing that cigarettes cause fatal pulmonary emphysema. The other three labels,
namely smoking enhances aging, smoking is hazardous to the young, and cigarettes are potential
killers, were not effective; therefore, they should be replaced. Smokers avoided seeing the frightening
labels either by removing the cigarettes from the packs and placing them in other containers, using a cover
over the pack, smearing the labels, changing to unlabeled cigarette brands, or purchasing the packs with
less horrifying labels. Accepting the inability to change smokers’ behavior entirely , the researchers opined
that, in addition to frightening the smokers with unhealthy-looking pictures, the implementation of more
effective strategies would be useful, such as making smokers fully realize the hazards of smoking, and
carrying out anti-smoking policies unceasingly.


Village Health Volunteers (VHV) were the hallmark of primary health care during the past three
decades. The volunteer exemplifies the concept of “community participation,” one of the most important
strategies for achieving the goal of “Health for All by the Year 2000”. As the health situation and political
landscape have changed, there was a need to re-conceptualize the roles and functions of the health volunteer
in health development. This study is aimed at assessing the roles and potentials of village health volunteers in the changing contexts of Thailand. Village health volunteers in Thailand, numbering almost
800,000, are an extremely valuable health resource. Although the recruitment of village health volunteers
has occasionally been questioned as being nepotistic or incentive-driven, village health volunteers are
those chosen by their communities for not only being public minded, generous, and willing to help those
in need, but also comparatively knowledgeable and concerned about health matters.
The study found that village health workforces were still very much active and have increasingly
become femininized. More than 35 percent of existing volunteers were recruited not more than five years
ago, while the number of female volunteers rose to almost 70 percent of the total. These volunteers performed
comparatively well on short-term tasks such as taking ad hoc health surveys, collecting periodic
data, or conducting disease prevention campaigns. They did not fare well, however, in the areas of work
that need long-term, continuous dedication, such as caring for chronically ill patients. Existing volunteer
workforces were found to be from a comparatively low educational and economic background. As health
issues have become more complicated, this finding poses the question of how could a volunteer workforce
with higher attributes and economic status more prepared for dedicated work be recruited. The changing
administrative system and decentralization has resulted in the village health volunteer being increasingly
implicated in local and national politics. Changing contexts and concerns call into question the relevance
of conventional model of VHVs. Case studies, however, suggest increasingly innovative roles and forms
of volunteers in health development, ranging from volunteers in hospital settings to disaster relief volunteers.
This strongly indicates that the idea of volunteering has been progressively more accepted and will
play an increasing role in Thai society in the future.


Protective behaviors against alcohol drinking were studied in 346 students in
Kanchanaburi Technical College; the studied group was recruited by stratified random
sampling technique. Information was collected by constructed questionnaires and the
data were analyzed by means of percentage, mean, standard deviation, t-test, one-way
ANOVA and stepwise multiple regression analysis. The findings were as follows: social
support and protective behaviors against alcohol drinking were at a moderate level. Selfesteem
and self-awareness concerning the drinking of alcohol were at a high level. Protective
behaviors against drinking alcohol among students with different educational level,
grade point average and alcohol-drinking behavior in their family were significantly different
at the statistical level of 0.05. Social support and self-awareness about drinking
alcohol could predict the protective behaviors against drinking alcohol among students
in 11.3 percent of the cases, with the statistically significant level being 0.05.


The objective of this study was to assess the situation of in-patient care for chronic renal failure
patients under the Universal Coverage Scheme. The in-patient claim database for fiscal year 2005, compiled
by the Central Office for Health-care Information, was used for the analysis. All admissions with ICD-10 codes compatible with chronic renal failure were included.
There were 45,326 chronic renal failure patients who accounted for 83,734 admissions (1.84 admissions
per patient) in 929 hospitals. The average length of stay was 5.4 days. Fifty-six percent of patients
were female, with the average age being 63.9 years. One-third of the patients had multiple admissions and
95 percent had multiple morbidities. The most common diagnoses were related to hypervolemic problems
or infections. Blood transfusions were the most common treatment procedure . Hemodialysis and
peritoneal dialysis were performed on a number of the admissions even though they were not covered by
the benefit package. Total hospital charges were 917 million baht (median 4,845 baht per admission).
Approximately 82 percent of the patients were discharged with clinical improvement; the fatality rate was
9.84 percent (4,462 deaths). The validity of data was the major limitation regarding diagnostic and procedural
coding, hospital charges, and discharge status. The patient demographic information was quite
valid.


Maternal and child health is a major health concern in the lower reaches of southern
Thailand. This action research was aimed at developing an integrated, participatory model
for solving problems related to maternal and child health in Kapho district, Pattani Province.
The model incorporated several activities, namely promoting community participation
through, for example, participatory community development for solving problems
related to maternal and child health; increasing access to maternal care through, for
example, promoting the delivery of newborns in the hospital by providing incentives for the pregnant women and traditional birth attendants (TBAs); and improving the quality
of maternal care through, for example, developing antenatal care clinic (ANC) and laborroom
services to meet with the safe motherhood project standard, the arrangement of a
place for Muslim ceremonies for the newborn in the hospital, training TBAs about postpartum
care, including ancient Thai massage and hot herbal compression.
The outcomes were assessed by ANC visits at least four times and delivery in the
hospital in comparison to the Department of Health standard of 90 percent of such visits
and deliveries. During the period from 1999 to 2007, the results clearly demonstrated
continuous improvement. In that period, the percentages of pregnant women attending
ANC at least four times were 78.9, 89.0, 93.4, 94, 97.5, 97.5, 98.4, 95.4 and 98.1, respectively.
The percentages of pregnant women delivering in the hospital were 52.1, 54.6, 63.7, 72.4,
81.5, 91.8, 97.1, 97.5 and 97.6, respectively. This study has shown a successful model of
maternal and child health problem-solving using the Plan-Do-Check-Act process,
multidisciplinary integration and community participation.


The purpose of this study was to identify factors affecting the compliance of diabetes
patients and to examine the relationship between the compliance of the patients and
the levels of Hb A1c. The subjects included 274 type 2 diabetes mellitus patients attending the diabetes mellitus outpatient clinic of Somdet Prayannasangworn Hospital in Chiang
Rai Province. Patients were interviewed using a structured questionnaire. Data were analyzed
by both descriptive and inferential statistics, i.e., paired t-test, analysis of variance
(ANOVA) and the Pearson‘s product moment correlation coefficient.
The results of this study were as follows: there were statistically significant differences
in patients‘ compliance behavior regarding the relationship between the selected
relationship between doctor and patients and the patients‘ perception of self-efficacy (pvalue
< 0.01), and the relationship between the selected patients‘ compliance behavior
and the level of Hb A1c (p-value < 0.01).


There is a growing number of elderly people in Thailand nowadays. This study
was aimed at investigating the situation and problems of promoting a network of aging
groups in Sangkha district, Surin Province. The study sample consisted of 39 public health
officials in Sangkha district and committee members of Sangkha’s aging groups by staging
for survey data, planning, doing and assesing the findings on the elderly at three
community levels, i.e., village, subdistrict and district. Activities in the group emphasized
religion, occupation, economy, and health linked to physical exercise and psychological
support. Suggestions were put forward that the elderly could develop their own
group, which would enhance their pride and be the best adaptation in their lives.


The World Health Organization (WHO) has been recommending the directly observed
treatment short course (DOTS) for the management of tuberculosis since 1994.
Vachira Phuket Hospital has strengthened its education of health-care workers (HCW)
and family members to become directly observed treatment (DOT) observers in order to
improve the success rates of the treatment. This study was conducted to evaluate the
treatment outcomes that the HCW DOT or family member DOT provided to patients.
We prospectively collected epidemiologic data on TB patients treated at the TB clinic
in Vachira Hospital from 2004 to 2006. We limited our analysis to pulmonary TB patients
never previously treated for TB. We analyzed the proportion of the patients, stratified by
type of drug administrator. We used chi-square to analyze the association of successful
treatment with the type of DOT, and multivariate analysis for controlling other factors
associated with treatment success. A total of 506 TB patients were included in this analysis,
364 (72%) had treatment success, compared with 142 (28%) of patients experiencing
non-successful treatment, 90 percent received HCW DOT, and 10 percent family/other or
self-administered therapy (SAT). Smear-positive TB was diagnosed in 72 percent of the
cases, and 24 percent were infected with HIV. The type of drug administered had a
significant impact on treatment success (P<0.001). Using multivariate analysis, controlling
for confounding factors, HCW DOT was significantly associated with successful treatment
(OR 2.1, 95% CI 1.1-4.3).
Based on the results of this study, TB patients who received HCW DOT achieved
treatment success rates higher than patients receiving family member DOT.


A long-term follow-up study of mortality and morbidity in normal subjects has not
yet been conducted in Thailand owing to the limited resources available and time constraints.
This was a long-term cohort study (5 years) carried out as part of an existing
research project of Thepa Hospital, namely the Prospective Cohort of Thai Children (PCTC)
in Thepa District. In this study, the parents of these children involved were taken for a
follow-up study in a co-research project in the period 2003-2007. Out of 2,000 parents,
1,325 volunteers (mean age 30.84 years) were interviewed and underwent several medical
examinations in 2003. Although the other 675 parents did not enter the program, they
were also taken for monitoring their status throughout the study period. In addition, 75 health worker couples from the hospital (mean age 36.5 years) were included in the study
as well. The mortality rate in this five-year study was 1.9 cases per 1,000 person-years (20
deaths). The incidence of disease, as observed from closely monitoring the subjects in the
last two and a half years of the study, was 9.7 cases per 1,000 person-years. The causes of
death and of diseases varied from road accidents and violence to infectious and cardiovascular
diseases. The incidence of hypertension and diabetes mellitus was five cases per
1,000 person-years and 1.6 cases per 1,000 person-years, respectively.
This study demonstrated that health personnel in community hospitals could develop
their research skills for conducting long-term studies through a strategy using a
“routine-to-research” philosophy.


An investigation of a food poisoning outbreak in Moo 2 Village of Kambok subdistrict,
Khamcha-ee district, Mukdahan Province was carried out to confirm the diagnosis,
verify the outbreak and to determine the etiology in order to control the outbreak. The
descriptive study was conducted on seven outpatients and two hospitalized patients who
were diagnosed at Khamcha-ee Hospital on 26 February 2008. All nine patients involved
lived in two separated houses; their ages varied from 13 to 83 years, with the median age
being 38 years. The clinical features were abdominal pain (100%), headache (88.88%),
fever (88.88%), and diarrhea (77.78%). The incubation periods varied from 6 to 29 hours. The food suspected of causing the particular illness was koi (raw red-ants eggs), a kind of
native salad. Salmonella serogroup B was identified from the raw ant eggs in question,
and rectal swab cultures of all patients. This outbreak was most likely caused by Salmonella
serogroup B, based on the clinical features, incubation periods and the laboratory
findings. Health education was given to food handlers in Moo 2 village. The investigation
disclosed possible evidence of risk factors of poor sanitation and poor hygiene in the
kitchens and toilets. Active surveillance was maintained in the affected area for one week
without the emergence of new cases.


Mycobacteriosis avium (MV) is a disease rarely diagnosed in community hospitals.
The diagnosis is very difficult to make because it requires specialists and a laboratory
with full facilities for making a diagnosis of the disease. However, such specialized teams
are usually available only in medical schools. Furthermore, the microbiological examination
necessary takes several months before the results can be reported. In the meantime,
patients would inevitably suffer from the disease and the side-effects of the medication
prescribed, i.e., for a case with a provisional diagnosis of pulmonary tuberculosis.
The patient in this report had suffered from a chronic illness for almost seven years
before receiving treatment as a case of pulmonary tuberculosis based on the common
clinical features of tuberculosis coupled with the results of three consecutively positive
direct smear sputa tests. He subsequently suffered from TB drug toxicity adverse reactions,
including hepatotoxicity, renal toxicity, color blindness, nausea, flatulence, diarrhea,
itching, arthralgia, headache and shock. A correct diagnosis was obtained when he
sought an opinion in several hospitals, with a culture of the mycobacteria revealing the
fact.
This article recounts the true story of a doctor and patient written with the intention
to provide lessons for other physicians and health-care workers that mycobacteriosis avium
ought be one of the differential diagnoses for patients with signs and symptoms similar
to tuberculosis.


Hypertension is the most common cause of preventable death in developed countries
and also an important problem in developing countries. The objectives of this study
were to evaluate clinical audits and clinical outcomes of hypertensive treatment compared
with the Thai Hypertension Society guidelines, 2007. The study population included
1,274 patients who were treated in the hypertensive clinic of Thawatchaburi Hospital from October 1, 2006 to September 30, 2007. The results showed that 492 males
(38.62%) and 782 females (61.38%) with a mean age of 64 years 5 months participated in
the study and 83.31 percent of the cases were under the universal health care coverage
system. Only some risk factors associated with hypertension were recorded, ranging
from 2.51 percent to 90.66 percent. Almost all (98.74%) of the patients’ BMI levels were
recorded; 55.57 percent of them had normal BMI. There were several co-morbidities in
the records: 53.14 percent had dyslipidemia and 35.24 percent DM. The prevalence of
nephropathy and left ventricular hypertrophy was 6.59 percent and 3.77 percent, respectively.
One- third of the medical treatments used two categories of hypertensive medicines
and the other third used only one catagory. Diuretics were used in 36.50 percent of
the cases, with 29.75 percent being ACE-inhibitors, 20.15 percent beta blockers and 12.35
percent Ca channel blockers. Follow-up adherence was 76.45 percent; 23.41 percent of
the cases had well-controlled blood pressure whereas only 3.39 percent of those with DM
were well controlled.
In conclusion, a model for the development of hypertensive care should be developed
by all stakeholders, including clinicians, other health-care professionals, patients
and their families in order to improve continuously the quality of care and its outcome.


This was the third cross-sectional survey conducted in Nakhon Ratchasima Province
in 2006 to follow up the surveillance of a cluster of female sex workers whose behaviors
potentially put them at risk of contracting HIV infection, and to verify their knowledge
about HIV. A one-stage cluster sample with equal probability was used to select the
brothels where the women worked. All the female sex workers willing to participate were included in the study. Self-administered questionnaires were used for data collection.
A total of 147 female sex workers participated in the survey; their average age was
30.4 years. Only 34.6 percent of them were capable of answering correctly all of the five
UNGASS knowledge questions. The rate of condom use with clients in the previous
week was 99.2 percent. In the previous month, 46.3 and 36.7 percent of them had sex with
their spouse and none-client partners, respectively. The rates of condom use with spouse
and none-client partners in the previous month were 30.8 and 79.6 percent, respectively.
The drug addiction rate and rate of injecting drug use in the previous year were rare, only
0.7 and 4.1 percent, respectively. In the previous six months, 78.2 percent of the female
sex workers had participated in voluntary HIV counseling and undergone anti-HIV testing.
From the results of this survey, it is obvious that female sex workers in Nakhon
Ratchasima Province still need to improve their knowledge about HIV/AIDS. Their regular
condom use needs to be extended to cover all types of sexual partners.


Many middle-aged women are facing problems with overweight, which is a risk
factor for cardiovascular disease, diabetes mellitus and hypertension. Key determinants
are physiological changes and food consumption and exercise. Controlling overweight
requires appropriate self-care. Self-efficacy would help middle-aged women to have confidence
that they are capable of appropriate practices. This study was aimed at identifying
the relationships between self-efficacy and practices to control the weight of women
aged 40-60 years. Three hundred and thirty-three middle-aged women who attended the
Golden Age Clinic of the Bandung Crown Prince Hospital in Udon Thani Province were
randomly recruited. Data were collected using a questionnaire on self efficacy and overweight
controlling practices for middle-aged women. The questionnaire was modified
from the questionnaire developed by Rawicha Hongrojchanpak, which used Cronbach
alpha coefficient for the self-efficacy part at 0.82.
The results indicated that the middle-aged women had high levels of overall selfefficacy.
The self-efficacy of food consumption and exercise were also at high levels. Most
of the middle-aged women (70.3%) had high to very high self-efficacy in eating fiber-rich
vegetables, walking instead of using vehicles for short distances (62.2%), not drinking
alcohol to relieve stress (60.7%) and drinking water rather than sweet soda (59.5%).
Their overall practices for controlling overweight were at a high level. They usually
and often did not eat fast food (72.1%), walked instead of using vehicles for short distances
(64.6%), avoided eating sweets (64.3%), did not drink alcohol (64.0%), avoided
eating carbohydrates (63.7%) and did exercises during their free time (61.3%).
The self-efficacy of these middle-aged women had a moderate relationship with
overall overweight practices with regard to food consumption behavior and exercise (r=
0.65, r=0.60 and r=0.58 respectively). However, most of the middle-aged women had
problems concerning self-efficacy and overweight controlling practices in avoiding highcalorie
foods, and seldom exercising, which resulted in their inability to control their
weight. It is essential to modify health promotion activities which emphasize self-efficacy
and continuity of appropriate overweight controlling practices among midldle-aged
women.


This cross-sectional survey was aimed at exploring the health-promotion coverage
of and disease-prevention services for children 0-5 years old in Lop Buri Province. A total
of 173 children were selected by two-stage cluster sampling probability proportional to
size. This study found that the persons most frequenlty acting as checkers of the children’s
progressive development were their mother and father (68.5%); 2.2 percent of the children had abnormal results and all of them were take care of by physicians; of the 71.8
percent that were weighed, 68 percent had normal weight. Almost all (98.3%) had received Bacillus-Guerin (BCG) vaccine, hepatitis B vaccine (97.7%), polio vaccine (95.4%),
diphtheria, tetanus toxoid and pertussis vaccine combined (94.8%), measles vaccine (93.3%)
and Japanese encephalitis vaccine (86.2%). Most of the children did not get dental care
(65.9%) and 42.4 percent had dental carries. More than half (56.7%) of the parents had
read their children’s health record and almost all (96.9%) of them used their books. The
three most useful aspects of the books were for child-feeding, checking the progress of
the children and making appointments for vaccination, respectively.


The purpose of this study was to determine how to control weight among personnel in Health Promotion Center, Region 10, Chiang Mai. It focused on participation between the health promotion clinic team and 20 volunteers 35-55 years of age, who had a body mass index of at least 27 kilograms/square meter, during the period May 2006- May 2007. The study involved variety activities, such as health education and community of practice concerning proper diet and physical activity, nutrition demonstration, physical activity practice, as well as encouraging and motivating the volunteers to take part in activities continuously. The results of this study showed that 18 of the volunteers (90%) were female; only 2 (10%) were male. Body weight was not increased in 15 persons (75%), waist circumference was not increased in 16 persons (80%) and knowledge about health was increased in 15 persons (75%) following the education activity. Follow-up six months after the end of the project revealed that weight was still controllable in 13 persons (65%), persistent behavioral nutrition in 16 persons (80%) and continuous physical activities in 18 persons (90%). This model study should be developed and applied to control weight among the general public for good health.


Medical records serve as a tool for the continuation of patient care, maintaining communication among health team members, providing quality assurance and, at present, using them as a reference for allocation of budgets under the national universal healthcare coverage scheme (UC). This study was aimed at exploring the level of quality of the medical records and developing good-quality procedures for in-patient records through multidisciplinary participation at Muangsruang Hospital. A descriptive study was used, with both qualitative and quantitative methods: in-depth interviews were conducted with doctors, nurses, anesthetic nurses, pharmacists and medical information technicians. Additionally, focus groups were set up with two groups of nurses. Moreover, 50 medical records were randomly sampled and were thoroughly examined. Data were analyzed using several methods, including content analysis, and triangulation techniques. Twentyfour staff members were interviewed and eight nurses joined each focus group. All professional groups realized that medical records are very important. Physicians, nurses and anesthetic nurses had clear guidelines on recording procedures. The recording quality was classified as good in 80.91 percent of the records. The accuracy of the medical records on the diagnoses of physicians and on codifications for diagnoses with procedures were 58 and 56 percent, respectively. The quality of medical records was influenced mainly by a number of factors, including clear policy deployment from executive officers, awareness among stakeholders, appropriate format of the forms, involvement of stakeholders in developing criteria for practical recording, the monitoring and evaluating systems used, the arrangement of a conference related to nursing care records, the availability of technical articles related to pharmaceutical care and nursing care at the ward as references.


The objectives of this mixed-method study were to investigate the implementation
of the persons treated with narcotics with regard to the information management process
in the Policy to Win the War against Narcotic Drugs, from 1 February to 30 April 2004. A
management model was applied and data were collected from the public health personnel
who worked in the information management process, two provincial personnel, two
district personnel, four tambon personnel and the personnel responsible for finding narcotic
takers/addicts, six district personnel, 6 tambon personnel and 70 village leaders
using in-depth interviews. For 47 public health personnel, focus group discussion was
used as well as documents study and data analysis from the registration form (BST.1-5).
Qualitative data were checked and analyzed by triangulation techniques. Quantitative
data were described as percentages.
The urgent activities followed by the policy, especially determeneing the number of
narcotic takers/addicts, could not be rechecked. There were some persons who had quit
taking narcotics and some persons who had never taken any illicit drugs. The registration
and report form for selecting them and the treatment activities that had been used before
was changed to BST.1-5 and reported on the hospital‘s website. The change occurred after
these processes had already been done; thus, the personnel had to register and report
later. Inadequate essential supporting activities; technological skills (computer and
Internet), urgent problem-solving ability affected some elements of personal data loss,
especially in the area where computer and/or high-speed Internet were not available.
Data diviations occurred in all processes so that the data reported by the website could
not be used for monitoring and evaluation. However, the policy was the most important
factor reinforcing the development of information systems useful for multi-sectors.
Implementation of the policy should be in the same direction. Rechecking the understanding
of personnal and adequate essential support must be provided.


This evaluation research was aimed at assessing the effectiveness of the psychiatric
patient care system of Sangkom Hospital in a community of Sangkom district, Udon Thani
province, i.e., whether it could encourage the community participating in providing con-tinuity of care for psychiatric patients, families and communities having knowledge and
a positive attitude and supporting the patients to live within the community, reducing
readmission rates, suicide and referral to higher institutions. A qualitative method was
applied for data collection, including document research, in-depth interviews, small group
meetings and participatory and non-participatory observations. Data were collected between
September 1, 2007 and January 30, 2008.
The study revealed that the psychiatric patient care system in the community was
established with community participation. Changes were noted from the time when there
were no services in the communities, poor drug compliance and no continuity of care, all
of which resulted in readmission, to a time when a community participation psychiatric
patient care system had been established. The development process included increased
community awareness and understanding of the situation and facilitation of all community
sectors to participate in identifying problems and causes of the problems, planning
for appropriate interventions to help psychiatric patients, families and communities in
line with a proactive policy for continuity of care. A community health committee was
established with the financial support of the local administration organization. The committee
organized a training workshop for volunteers to improve their knowledge, attitudes
and skills in caring for and counseling those with special needs. These volunteers
made monthly home visits to support the psychiatric patients and identify new cases.
Capacity-building training for patients and their families was organized. Both patients
and their families were helped and supported in joining community activities. The development
resulted in reducing drug non-compliance; there were no suicides and the number
of patients referred to specialized hospitals was reduced. As a resalt, the volunteers
as well as the community had knowledge and better attitudes towards psychiatric patients.


Teenage pregnancy is considered a high-risk situation that increases the likelihood
of adverse obstetric and perinatal outcomes, such as those associated with low birth weight,
anemia, hypertensive disorder in pregnancy and preterm delivery. The trend in teenage
pregnancy has increased. To effectively solve the problem of teenage pregnancy, currently
a global and nationwide problem (including in Wiangsa district as well), it is necessary
to study the real causes and results before implementing local, specific strategies.
The purposes of this study were to study the epidemiology of teenage pregnancy in
Wiangsa district and to compare the pregnancy outcome of teenage pregnancy with adult
pregnancy in Wiangsa Hospital. The research design for comparing the pregnancy outcome
was a retrospective cross-sectional study; that used for studying the epidemiology
was a descriptive study.
The study and the control groups (teenage and adult mothers respectively) each
consisting of 146 singleton primigravida females aged <20 and 20-29 years, respectively,
who were Wiangsa district citizens and who delivered at Wiangsa hospital between October
1, 2004 and September 30, 2007. The data were extracted from medical records and
analyzed for pregnancy outcomes. Then 43 teenage mothers who were still available in
the province were studied for epidemiology and interviewed in-depth (under informed
consent) to determine the factors causing them to become pregnant.
Results: In the study group 39.04 percent were 13-17 years of age. Antepartum period:
the study group had a significantly higher average gestational age at the first antenatal
care visit, a lower average number of antenatal visits, a lower average weight gain,
a higher rate of those who received inadequate antenatal care (<4 times), those who were
unsure about their last menstrual period, those who developed anemia and premature
membrane rupture. Intrapartum period: the study group had a significantly higher rate
of inadequate pelvis measarements (crudely evaluated by nurses during admission), caesarean
section, especially when indicated by cephalopelvic disproportion. Postpartum
period: the study group had a significantly higher rate of urinary tract infections. There
was no increase in significant complications commonly found in other studies, especially
preterm labor, and low birth weight. Epidemiology: the trend in the teenage pregnancy
rate in Wiangsa district increased, especially in younger teens. Weaker families and
society seem to be the major root causes of this problem.
Conclusions: Teenage pregnancy in Wiangsa district had poor outcomes, especially
antepartum and intrapartum. The trend of this situation is getting worse, mainly because
of weaker family and socialties.


This cross-sectional study was aimed at (1) assessing the knowledge, attitude and
practices of caretakers regarding the development of IQ and EQ of children in day care
centers, (2) identifying problems related to this issue, and (3) proposing suggestions to
improve the development of IQ and EQ of those children in day care centers in Phen
district, Udon Thani Province. Questionnaire interviews were conducted with 80 caretakers,
randomly selected from all 54 day care centers in Phen district from January 15 to February 28, 2008.
The results indicated that these caretakers had low levels of knowledge about childhood
IQ and EQ development, with a mean score of 7.65 (SD= 1.34) out of 15. However,
they had higher levels of attitude and practices concerning childhood IQ and EQ
development, with an average score of 3.79 (SD = 0.33) out of 5 and 3.10 out of 4 (SD =
0.37) respectively. The caretakers identified several obstacles related to childhood IQ and
EQ development, including lack of knowledge of the caretakers, inadequacy of materials,
equipment and budgets, poor building structures and management problems of the centers.
These caretakers suggested various measures to solve the problems: providing training
for caretakers, and supporting more equipment, materials and budgets for the centers.
Participation of the local governments in terms of supporting more budgets and
working cooperatively with parents, communities and hospitals would be a successful
strategy for the development of IQ and EQ of children in day care centers.


This evaluation research was aimed at assessing the results of service system development of the Labor Unit of Srithat Hospital, Udon Thani, and its problems and providing a basis for making recommendations for the further development of the Labor Unit.
The qualitative data were obtained from relevant document reviews, in-depth interviews,
participatory and non-participatory observations, from October 1, 2007 to February 29, 2008. It was revealed that the Labor Unit had improved its service system in both process
and outcome as follows: (1) Capacity-building. The administrators assigned multidisciplinary staff members to the Labor Unit.  A staff member visited Kumpawapee Hospital, the model hospital, to gain insight into the Labor Unit’s service system development.
The Unit organized training for staff to improve the quality of care for pre-labor, labor,
post partum, newborn, discharge plan and special equipment applications; (2) Facility
improvement. There was also structural development in that the pre-labor attending room
was separated from the Inpatient and Emergency Units. Essential equipment was procured and allocated to the unit; (3) Process improvement. Three service practice guidelines were developed by the multidisciplinary team to ensure good quality of care for
both normal and high-risk labor. The three practice guidelines were (a) care map for intra-partum and immediate post-partum care: low risk, (b) pregnancy-induced hypertension (PIH) care practices guidelines and (c) birth-before-admission practices guidelines.
A post-partum and newborn care handbook was also developed and distributed to mothers
before they were discharged from the unit in order to educate them on how to look after
themselves and their children. The results of improving the system were satisfactory.  Client
satisfaction with the services of the Labor Unit increased from 75.2 percent to 88.4 percent. There was no infant and maternal death. Maternal complications also decreased.
Problems encountered in developing the Labor Unit service system were unfamiliarity
with the practice guidelines of staff for both normal and high-risk labor. Reporting on the
care given to patients was still incomplete.  Recommendations for further development
included training on applications of the service practice guidelines, simplifying the practice guidelines, monitoring the reporting and establishment of continuous and systematic evaluation of the performance of the Labor Unit.


This action research was aimed at assessing the health behavior of members of the
health club, Wang Sammoh district, Udon Thani Province. One hundred and ninety-eight
members were purposively selected to answer a questionnaire and to be physically examined
during the period from September 2006 to October 2007. This study employed
both qualitative methods, including focus group discussion, and quantitative methods in
collecting and analyzing data using descriptive statistics: average, percentage and chisquare.
The results of small group meetings found that 86 percent of the members of the
club had diabetes mellitus and/or hypertension; 90 percent of them wanted to know the
causes of leg-pain and back-pain. A method for self-care in a communal way for solving
health problems would be to buy medical supplies from drug stores in conjunction with
promoting the use of herbs.
General data analysis revealed that 79.3 percent of the subjects were women (average
age was 36 years old), 30.81 percent had chronic illnesses or personal diseases;
average body weight before entering to the club was 55.9 kilograms and after was 56.4
kilograms.
The researcher and his team used the results of this research for devising a plan in
such a way as to create two projects: (1) one for adapting and changing heath behavior in
exercise and health checks for monks, civil servants, beneficiaries (insurees) of the social
security assurance scheme; and (2) the other, related to abdominal fat, by using tactics
concerning how to eat food properly; how to exer cise appropriately depending on age
and health status. These projects would be monitored and evaluated every three months
and it could be expected that the people of Wang Sammoh would have awareness about
developing their own health behavior in order to attain better physical, mental and social
health status.


The objective of the study was to evaluate the effectiveness of the remodeling of
health behavior programme. Participants included 118 civil servants of Prayuen district,
Khon Kaen Province. The programme consisted of lectures and behavioral remodeling
activities lasting two days and one night. Data collection was performed before and six
months after programme implementation. Six areas of health behavior according to the
Ministry of Public Health policy were measured by conducting interviews. Measurement
of blood pressure, body mass index, and blood sugar level were also performed. It revealed
that, at six months after programme implementation, the participants consumed less sugar, took more fish and decreased the amount of food consumed at dinner time,
at significantly different levels than before they began participating in the programme
(p-value = 0.03, 0.02 and 0.01, respectively). They also spent more time in performing
routine physical exercises, taking care of the sanitary environment and recycling garbage
(p-value = 0.01, 0.03 and 0.01, respectively). Significant improvement in physical examination
results were shown in terms of blood pressure (p-value = 0.02) and pulse rate
(p-value = 0.03). However, no significant differences were found in the following variables:
taking raw meat, participating in a health club, controlling emotions, eradicating
disease carriers, treating waste water, practicing protective measures against diseases,
practicing harmful behaviors that would lead to ruin and changes in body mass index.
More studies are needed to understand these unhealthy behaviors and to find appropriate
resolution.


Combination antiretroviral therapy has proved to effect lower morbidity and mortality
rates among HIV/AIDS patients. However, the effectiveness of continuing patient care is also important. Therefore, evaluation of treatment to improve the management
system is needed. This study was aimed at evaluating the effectiveness of triple therapy
with antiretroviral drugs by comparing CD4 cell counts, opportunistic infection rates during
treatment, side effect and adherence to treatment.
The patients’ data were retrospectively obtained from patient records. The patients
were those who came for treatment at Somdetpraboromrachineenart Hospital, Nathawee
district, Songkhla Province from January 2003 and April 2008. None of the patients received
treatment previously. CD4 cell count, body weight before and after treatment
were compared and analyzed by Wilcoxon signed-rank test.
There were 46 patients who met the criteria for treatment, but complete data were
available from 42 patients, 23 were male and 19 were female, 17 had AIDS, and there were
16 symptomatic and 9 asymptomatic HIV-infected patients. The results of treatment revealed
that CD4 counts after six months in all groups were significantly increased compared
with those before treatment. Side effects occurred in 10 patients, 8 with rash, 1 with
lipoatrophy and 1 with increased SGPT level. None of the patients developed opportunistic
infection after six months of treatment until now. Almost all (39 patients) showed
good adherence to treatment.
The study concluded that triple therapy with GPO-VIR in a middle-sized community
hospital gave good results. An effective management system that helps patients to
adhere to treatment and continuing evaluation is an important factor.


The aims of this research were to examine the situation and epidemiology of tuberculosis
in four district hospitals in Nakhon Ratchasima Province in fiscal years 2005-2007.
All tuberculosis patients registered between October 2004 and September 2007 were selected
for the study.
The research instruments consisted of OPD card, treatment card, tuberculosis record,
and sputum examination record. The data were analyzed by using descriptive statistics.
The results showed that prevalence rates were 74.3, 112.1, 81.1 per 100,000 population
respectively in 2005-2007. Incidence rates were 64.9, 100.7, 69.0 per 100,000 and mortality
rates were 8.1, 14.0,3.5 per 100,000 respectively during that period. The success rate
was 73.5 percent and cure rate was 53.5 percent. The percentages of HIV infection in
tuberculosis cases were 4.7, 5.8 and 11.0, increasing by year, with a high mortality rate of
44.2 percent.
A high success rate was found in the occupation of civil servants (100%), students
(100%) and prisoners (91.9%). Tuberculosis cases with diabetes mellitus were also found
to have a high success rate (100%). Directly observed therapy (DOT) by health personnel
produced a relative risk of 1.33 significance compared with no direct observation. However,
DOT, with observation by cousins, showed no significant difference compared with
that produced by no direct observation.


Workers in small industries in rural areas work under unhealthy and poor environmental
conditions because of the limitation of local health services. In addition, unsafe
equipment and chemicals are commonly used in the manufacturing process. This study
explored the working processes in wooden furniture factories in Loei Province after the
workers had received information about the health and safety of workers, and about the health and environmental risks in surrounding communities affected by these small industries.
This study employed both qualitative methods, including participation observation,
in-depth interviews, group discussions and questionnaire interviews, as well as
quantitative methods, such as secondary data analysis from existing documents. The
results of the study showed that the manufacturing processes of these kinds of factories
might be directly harmful to the health and safety of the workers. Poor working conditions,
for example, dust, smoke and noise pollution, might not only affect the health and
safety of these workers but also afftect the health of their family members and communities.
Community hospitals and tambon administrations should be major stakeholders in
managing theses occupational health problems by launching a “healthy public” policy
and providing all sectors with guidance, including that on the manufacturers, workers,
and health centers or primary care units. Moreover, management at the national policy
level should be implemented by providing a simplified version of the diagnosing process
of diseases related to occupational health, strengthening occupational health surveillance
in local settings and initiating prospective cohort studies to identify specific determinants
of local occupational diseases.


The purposes of this study were to determine the results of the screening of Papanicolaou
smears (Pap smears) for cervical cancer in HIV-infected women in Prachantakam
district, Prachinburi Province. The subjects enrolled in this study were 34 HIV-infected
women who were among the people living with HIV/AIDS.
PAP smears were done in 34 HIV-infected women; one (2.94%) of them was found
to be abnormal, and one (2.94%) revealed cervical cancer. Compared with the results of
PAP smear that had been done on 7,756 women in Prachinburi Province, 0.31 percent
were found to be abnormal, and 0.04 percent had cervical cancer.
Therefore, standard routine screening for cervical cancer using PAP smears for HIVinfected
women should be necessary under the health insurance policy.


The purpose of this research was to study the level of self-care participation of diabetes
patients according to the opinions of those patients in Sophisai District, Nongkhai Province,
and to study the factors of the correlation and self-care participation. The sample included
400 diabetes patients who had been registered by Sophisai Hospital and cured. A
survey questionnaire was administered to the participants. The study utilized the SPSS program,
with statistics on percentage, mean and standard deviation, including the chi-square
for correlation with normal scale and interval scale factors and utilized the Cramer ’s V coefficient
for ratio scale. The results of the study showed that the self-care participation of diabetes
patients according to their opinion was at the medium level. The analysis of sectors
found that the most common self-care participation of diabetes patients was diet; the next
were exercise and self-care participation in daily life. The least common form of participation
was foot care.
The correlation between the factors related to personal characteristics, economics and
social aspects and self-care participation found that: there was no correlation for sex in the
self-care participation of diabetes patients as a whole nor was there any correlation with
participation in every side when considering sectors.
There was no correlation in age for the self-care participation of diabetes patients, nor
was there any correlation with the participation when considering sectors.
There was correlation in education for self-care participation as a whole; when considering
sectors, but there was correlation with participation, namely diet, exercise and selfcare
in daily life.
There was no correlation in income for self-care participation of diabetes patients as a
whole, nor was there any correlation with participation in considering sectors.
There was correlation in occupation for the self-care participation of diabetes patients,
when considering the sectors; the correlation with was in diet.
There was correlation in the factors of receiving information about self-care participation
as a whole, and there was correlation with participation in every aspect when considering
sectors.
The study would be applied in planning for good-quality services, supporting the
diabetes patients for self-care participation, emphasizing communication. Providing knowledge,
giving health information through the targets, building leaders who acknowledge
and are able to be the primary person in self-care participation and able to transfer information
to the members or the diabetes patient group.


Banphaeo hospital is going to be the first autonomous hospital in Thailand: non-profit and government subsidiary hospital. This paper aims to show the background, methodology and philosophy of the hospital subsidiary budgeting for the year 2000 ehich their rational is based on the Banphaeo hospital's mission. It's mission is to provide universal coverage of basic health service package in Banohaeo district. The basic health service package consists of health promotion, prevention, primary health care, rehabilitation, and curative service for the health cardholder.
Thus, the Banphaeo hospital subsidiary budgeting is based on capitation. It will pay to the tertiary care hospital for referred patients and to subcontractors for gatekeeper services too. The new budgeting method will change the service concept by aiming at holistic care not the quantity of curative care.
However, this budget should be only for the operating cost, not including with capital cost, which should be proposed by each item project.
The subsidiary budgeting use the data from morbidity rate and admission rate from Health and Welfare survey of National Statistics Office and average operating cost from several costing studies. Per capita budget is consisted of curative expenses and health promotion expenses. For the curative expense, this study uses outpatient department care (OP) cost (morbidity rate X OP cost per visit) plus Inpatient department care (IP) cost (admission rate X IP cost per case). For the health promotion expenses, this study estimate 20% of per-capita subsidiary budget.
From the calculation above, Banphaeo which is located in the rural of central Thailand will receive per-capita subsidiary health budget about 562 baht per year and per capita subsidiary health promotion about 149 baht per year, all together 712 baht per year. Yet, changing from a public hospital to an autonomous hospital will increase salary up to 150% thus the curative cost will rise to 633 baht. Ultimately, summing up with 149 baht of health promotion, the per capita budget will be 782 baht per year.
The researchers analyze the financial feasibility and found the operating expense is about 100.4 millions. Banphaeo population is 91,000, less Civil Servants Medical Benefit Scheme and health insurance 10% the hospital will receive 64 millions per year (91,000*0.9*782) from government and 39 millions from other revenue. Finally, the researchers do believe that it is possible for Banphaeo hospital to provide the universal health care coverage to the Banphaeo population. Moreover, this study can apply this method of budgeting to the whole kingdom.


The objectives of this descriptive study of a food-borne botulism outbreak caused
by the consumption of minced barking-deer meat in Phusang district, Phayao Province
were: (1) to confirm the diagnosis of botulism and the outbreak of the disease; (2) to
study the characteristics of the disease’s epidemiology, the outbreak and the distribution
of the disease; (3) to find the cause of the outbreak, source and vector of transmission of
the disease, and (4) to measure the disease control interventions. Descriptive and analytical
epidemiological studies used retrospective cohort studies to prove the hypo- thesis
of relative risk (RR) factors.
The result of this study found that 69 persons (26.53%) of the 260 persons who ate
the barking-deer were hospitalized in Chiangkham Hospital (between 24 June and 5 July
2006). The majority were males (62.31%), aged 30 - 60 years (34.62%). The main symptoms
of infection were abdominal distension, stomach ache, nausea, diarrhea, dry mouth,
difficulty breathing, and vomiting, respectively. An analytical epidemiological study
found that the food that caused the illness was raw minced barking-deer meat (RR = 2.04,
95% CI = [1.11 - 3.75] and showed that the persons who ate the raw meat were two times more to get the disease. As for other barking-deer body parts, it was found that the bile
(RR = 1.66,95 % CI = [1.13 - 2.43]) and entrails (RR = 1.66, 95% CI = [1.10-2.05] were the
main risk factors. The laboratory results confirmed that seven of the patients who got
botulism survived.
It was suggested to the public health institute and the officials related to the Bureau
of Epidemiology that they should take care of the people by emphasizing the importance
of hygiene and not eating raw meat, especially entrails, and that they should change their
consumption behaviors.
It was also suggested that the next research (1) study the consumption behaviors
related to eating raw meat and find methods for reducing illness, and (2) study ways to
communicate information on safe consumption behavior.


The economic crisis, that occurred nearly two year ago, has affected on campaigning all sectors to cut back their spendings and buying local made products in order to reduce national currency reserve. Drugs or pharma ceutical products are considered as manufactured goods that are relied on imported raw materials that represented 35-50%of the local manufactured pharmaceutical product cost. For import finished products, it represents 80-100% of the cost. With this import dependency, there is no doubt that the impact of economic crisis on pharmaceutical business would be unavoidable.
This study was aimed at describing and analyzing the situation and problems of drug management system and utilization in the Ministry of Public Health hospitals, recommending measures for drug management reform.


Thailand’s 1996 National Essential Drug List (NEDL) was based on the World Health Organization (WHO) minimal drug list concept. However, after Cabinet Resolution in February 1998, copayment for drugs outside the NEDL was enforced to Civil Servant Medical Benefit Scheme (CSMBS) beneficiaries. Pressures from CSMBS copayment triggered the 1996 NEDL revision resulted in a new version of “maximum drug list” 1999 NEDL. Promulgated on January 29, 1999, the current 1999 NEDL consisted of 933 items classified as sub-list A., B., C., D. and E whereby DUE must be introduced for the use of sub-list D.
The objectives of this study were 1) to compare the hospital drug list and cost of drug consumption in fiscal year 1999 broken down by sub-lists of 1996 NEDL compared to 1999 NEDL, 2) to analyze the pharmaceutical and therapeutic committee (PTC) decisions on their hospital drug list revision in 1993, 3) to assess the impact of 1999 NEDL on different types of patients, namely CSMBS, Low income patients, Voluntary Health Card Holders and Social Security Scheme (SSS) beneficiaries. The researchers used two approaches: document research and structured telephone interview.
Thirty-four hospitals (39% of proposed samples) agreed to provide electronic database of the fiscal year 1999 drug list and consumption value. Ninety five from 108 hospitals agreed to provide telephone interviews. Despite the fact of maximum list of 1999 NEDL, Department of Medical Service hospitals (DMS) and non-Ministry of Public Health (non-MOPH) public hospitals dispensed quite high proportion of  non-ED drugs. Reclassification of previously 1996 non-ED into sub-lists A., B., C., D. and E. of 1999 NEDL account for 9.9%, 24.2%, 32.4%, 42.5% and 42.2% of total drug consumption in district, provincial, regional, DMS and non-MOPH public hospitals respectively. Cost of drug consumption due to reclassification of 1996 non-ED to 1999 DEDL account for 881.67 million Baht in 34 hospitals, this implies that if there were no 1999 NEDL, there will be savings of 881.67 million Baht to insurance schemes assuming that all ED are reimbursable. Sub-list D. drug consumption in 34 hospitals was 602 million Baht in the fiscal year 1999, 24.2% of total drug consumption in these hospitals. Telephone interview reveals to the reasons for adding some more non-EDs into 1999 NEDL by PTC in 15 hospitals are patients have to take and cheap cost. All these drugs were drugs that used to be considered by 1999 NEDL developing subcommittee. There are some extent discriminating dispensing policy, biased towards CSMBS and against Low Income Scheme beneficiaries, Social Insurance and Voluntary Health Card lied in-between, during the 1999 hospital drug list revisions.


Art therapy has long been practiced in many countries, especially in the West, as an alternative
means for treating mentally traumatized persons. It is not yet implemented routinely in Thailand. The
present investigators took the opportunity of a catastrophic event that occurred in Uttaradit Province in
May 2006, which caused vast destruction of most of the citizens’ houses and farmland and caused great
mental trauma among the residents. Study samples comprised eight school children aged 7-14 years (five
boys and three girls) whose property and relatives’ lives were lost. For the present study, the psychiatrist
member of the author team selected those patients with symptoms that were not so severe that they
would require conventional psychiatric therapy. There were followed up weekly for 12 weeks to observe
the progress of their illness.
The artists also attended the weekly sessions and provided the children with the supplies necessary
for doing art work and urged them to draw anything they wanted to on the paper provided every week.
Their weekly products were photographed for subsequent interpretation of their mental progress. At the
end of the research session, their mental progress was judged by comparing the results of the psychiatrist’s
opinion about the interpretation of the drawings. It was concluded that the art therapy practice in
this group of children yielded considerable success as evidenced in seven of the eight subjects (87.5%).
The investigators suggest that art therapy is effective for managing chidren suffering from mental trauma
caused by disasters.