After the enactment of the Narcotics Law, Seventh version, B.E. 2562 on 17th February 2019, there was an implementation of the amnesty programme by the Ministry of Public Health (MoPH) between 27th February and 21th May 2019, mandating persons who had previously been using cannabis products for medical purposes to notify the Food and Drug Administration (FDA) of their possession and/or use of it. The Ministry of Public Health started opening piloted medical cannabis clinics in 12 hospitals in August 2019 and Thai traditional medicine cannabis clinics in 13 hospitals nationwide on 2nd September 2019. At the time of writing this report (June 2020), there were 255 hospitals around the country that had opened a medical cannabis clinic, including those conducting research on cannabis oil extracts, and 24 Thai traditional medicine clinics. Despite these official services, there were still many medical cannabis users who did not register for amnesty or could not legally access medical cannabis via the public health system. Furthermore, there are several medical professionals who have different levels of knowledge, opinions, and experiences concerning medical cannabis. The quality of medical cannabis products available also varies considerably. A study on the current situation of medical cannabis users, suppliers, and other stakeholders is thus needed in order to understand their needs and quantify the magnitude of problems, including the number of medical cannabis users in Thailand. This study is a sub-project under the research programme to develop policy recommendations for medical cannabis in Thailand. It specifically aimed to examine patterns and purposes of the use among medical cannabis users and their perception and opinion towards the benefits and harms of cannabis and related policies. We also estimated the size of the current medical cannabis-using population in Thailand at the time of the study between the end of 2019 to early 2020. Methods This study has two parts, a qualitative study using in-depth interviews and non-participatory observations, and a quantitative cross-sectional survey. Purposive sampling was used to recruit 36 key informants, including medical professionals working in medical cannabis clinics of the Ministry of Public Health, folk or alternative medicine doctors, underground traders, not-for-profit provider groups (for example priests, folk healers, civil society advocacy groups), and home or clandestine growers or producers. A respondent-driven sample of 485 medical cannabis users was obtained, 125 from the northern region and 120 each from the central, northeastern, and southern regions. Data collection was conducted between late September 2019 and the end of February 2020. Results Of all 485 medical cannabis users, 55.7% (95% confidence interval (CI): 49.4, 62.0) were males. The highest proportion of users was seen in the late adult age group (45-65 years). About one-third had attained a tertiary education or higher. The main occupation types were business owner (16.5%, 95% CI: 11.5, 21.5) and government officer (14.2%, 95% CI: 9.3, 19.1). The average duration of current cannabis use for medical purposes was 10.5 months (range 7 – 828 days). The three most common illnesses that the respondents used cannabis for treatment were cancers (including cancers of the breast, prostate gland, lymph nodes, liver, lung, intestine, ovary, ureter, and bladder) or non-malignant tumors (23.3%, 95% CI: 16.1, 30.4); neuro-psychiatric symptoms or disorders, including stress, depression, anxiety, bipolar affective disorders, insomnia, stroke, epilepsy, multiple sclerosis, dementia, and Parkinson’s disease (22.8%, 95% CI: 17.5, 28.0) and musculoskeletal pains, spasms, rigidity or weakness (21.6%, 95% CI: 16.7, 26.6). Other diseases or symptoms that the respondents reported using cannabis for treatment were various, for example diabetes mellitus, hypercholesterolemia, hypertension, gout, asthma, chronic lung disease, anemia, liver cirrhosis, HIV-AIDS, herpes zoster, herpes simplex, psoriasis, vitreous degeneration, cataract, and low appetite. Based on the condition groups classified by the MoPH, similar percentages of the respondents reported using cannabis for the treatment of conditions in Groups A (strong evidence of benefit from cannabis, 21.5%), B (some evidence of benefit, 20.6%) and C (insufficient evidence of benefit, 21.7%). However, the highest percentage was seen in the “other” group, which was composed of other conditions that had not been classified as an indication for medical cannabis treatment by the MoPH (36.3%). Most respondents (84.7%, 95% CI: 78.9, 90.5) used an oral form of crude oil extract (unidentified tetrahydrocannabinol or cannabidiol content) while 9.2% (95% CI: 4.1, 14.2) used raw plant ingredients (flowers, leaves, or whole plants with roots and stems) and 5% (95% CI: 2.2, 7.8) used topical skin products, for example: massage oil, cream, spray, and soap. The majority used it 6-7 days per week or many times a day every day (68.8%, 95% CI: 61.4, 76.2). Most (72.6%, 95% CI: 64.9, 80.2) reported using the same amount of the product continuously since the beginning of their use for medical purposes and most (79.1%, 95% CI: 69.3, 89.0) felt that their conditions got better after use. The main source of medical cannabis products was illegal suppliers (74.0%, 95% CI: 63.7, 84.3), which included underground traders (54.5%, 95% CI: 40.8, 68.3), not-for-profit provider groups such as priests, folk healers, and civil society advocacy groups (5.2%, 95% CI: 0.5, 10.9), friends and relatives (12.2%, 95% CI: 6.2, 18.3) and home or clandestine growers or producers (2.9%, 95% CI: 0.6, 5.3). Among the legal sources (26%), the most common suppliers were modern (0.4%, 95% CI: -0.1, 1) and Thai traditional medicine doctors in medical cannabis clinics of MoPH hospitals (7.2%, 95% CI: -3.2, 17.7), medical doctors who provided care in their private clinics (12.8%, 95% CI: -0.3, 25.8), and folk doctors who were licensed for folk medical cannabis treatment (4.6%, 95% CI: 0, 9.2). Almost all respondents in the south and all in the central region reported obtaining medical cannabis from illegal sources, of which most were underground traders who were contacted via the internet or social media (of all sources: 77.8%, 95% CI: 33.5, 122.2 in the central region and 80.4%, 95% CI: 70.6, 90.2 in the southern region). Most participants (94-96%) agreed or strongly agreed with the policies regarding permission to use, sell, or home grow cannabis for medical purposes. However, 60-65% agreed or strongly agreed with the policies regarding sales and home-growing cannabis for recreational purposes. Moreover, most preferred the legal control of cannabis to be at the same level as alcohol 75.0%, 95% CI: 69.1, 81) or tobacco (75.8%, 95% CI: 69.9, 81.7), whereas 21.6% (95% CI: 15.9, 27.2) expressed the view that cannabis should remain as a substance of abuse under the narcotics control law, which should be controlled at the same level as other hard drugs such as methamphetamine and heroin. Using the number of people who were successfully granted amnesty, and received treatment from medical cannabis clinics operated by the MoPH at the same time of data collection as benchmarks, the number of medical cannabis users in Thailand in 2019-2020 was estimated to be 560,031 (95% CI: 438,774 - 677,637) and 606,153 (95% CI: 415,095 - 814,210), respectively, with an estimated prevalence of 10.93 and 11.83 per 1000 population. Our qualitative study revealed that most used cannabis based on their personal beliefs for conditions not recommended by the MoPH. Most believed that cannabis could treat any disease and did not cause any adverse effects. Most obtained medical cannabis products from illegal suppliers as they had accessed these sources before legal sources became available and they also trusted their suppliers. Furthermore, it was difficult to access the legal sources as their illnesses were not indicated as conditions for cannabis use by the MoPH. Most users agreed with the policy of legalizing cannabis for medical purposes but not for recreational purposes. Users and suppliers were mostly anonymous and contacted each other via social media. Some respondents mentioned that medical cannabis products that were sold using raw materials which are contaminated with a wide variety of toxic substances, for example insecticides or fertilizers and there have been several illegal cannabis plantations or clandestine home-growing sites. Most producers or suppliers of medical cannabis are businessmen or politicians with high influences in the areas. Additionally, the cannabis products which are sold underground are for commercial purposes rather than philanthropic or pure medical purposes. However, the starting point of medical cannabis services was often because the providers had used it for treating their own illnesses and found it worked well. In conclusion, our study reflects the experiences of medical cannabis users during the first year after the major regulatory transition in Thailand. Most users obtained cannabis from illicit suppliers and used it for various indications that were not supported by scientific evidence but appeared positive towards the results of use. Given that many people have already been using illicit medical cannabis products for a variety of conditions, there is an urgent need to facilitate access to legal and high-quality supplies, revise prescription indications with updated scientific evidence to ease physicians reluctance to prescribe medical cannabis, and provide effective mechanisms for public communication. These findings and recommendations highlight ongoing policy challenges for Thailand.


The main objective of this study was to assess the health and economic impact of medical cannabis policy appropriate to the Thai context. It consists of three studies which are literature reviews to assess the positive and negative impacts of cannabis use in other countries, assessment of the medical cannabis demand and cost-benefit analysis of medical cannabis use. A review of international experiences of using medical and recreational cannabis can be concluded that elements of the cannabis legalization policy in each country affect accessibility to cannabis. The flexibility must be balanced between access to cannabis for therapeutic use among legally eligible patients, which is the benefit from the law; and the use in patients other than the permitted disease group, including leakage of drugs into recreational use which could have an impact on population health and public health where the cost of these impacts would affect the cost-benefit of medical policies. The medical cannabis demand was estimated using the burden of disease data or the number of patients in the disease groups that likely benefited from modern medical treatments using cannabis, including cancer patients with chemotherapy treatment, treatment of pediatric epilepsy, treatment of multiple sclerosis, and the treatment of neuropathic pain syndrome, as well as a group of promising therapeutic uses, such as, Parkinson’s disease, HIV patients, and those who seeking palliative treatment in the future. Estimated from 2013-2018 using mortality data to predict those seeking palliative care at the end of their life to 2030 shows that in 2018 the total number of a patient admitted from cancer was 212,256 cases, 10,128 from difficult and drug-resistant epilepsy in children under 14 years old, 281 from multiple sclerosis, 20,245 from neuropathy, 14,472 from Parkinson’s disease, 7,030 from HIV, and 53,924 cases from those needing palliative treatment. The result of the study to predict palliative care shows a trend of increasing demand for palliative care in the population group of 65 years and over, reflecting the growing demand for medical cannabis as the aging population grows. The cost-benefit analysis of medical cannabis policy, using decision tree and the Markov model with a societal perspective, by assigning 1 quality-adjusted life year (QALY) equal to GDP per capita, found that the use of cannabis according to medical indications was worthwhile for only one disease group, namely the treatment of chemotherapy-induced nausea and vomiting of cancer patients over a period of 5 years with a net result of 130 million baht. In summary, the benefits of medical cannabis use, including its use according to medical indications, use in diseases with no medical indication and for recreational use, indicate no economic value; by causing a negative impact on economics. This is due to the higher price of medical cannabis oil comparing to the standard regimens. While the use of cannabis in patients with no medical indications has a high cost of treating complications, as some patients will substitute cannabis for modern medicine. When patients stop using modern drugs, while the effects of cannabis are still lacking strong evidence, patient’s disease are more likely to occur as well as complications. There are also those who use cannabis for other unauthorized cases, such as for recreational use; which in this case will have negative impacts on both the cannabis users and other people in the society However, the implementation of the medical cannabis policy is also operating in the area of traditional Thai medicine, which has not been included in this study, as well as, the situation of using from illegal sources that the price may be higher than the standard price. Also, this study does not include community income if farmers are allowed to grow and sell cannabis, as well as export them. Therefore, in order to comprehensively assess the impact of the policy, the study should be expanded to cover the implementation of the policy in all sectors for further use in decision-making.


The medical marijuana (MMJ) system has been established for the first time in Thai history since February 19, 2019, according to the Narcotic Control Act 2019 (7th edition) . This study aimed to find essential research questions regarding the implementation and impacts of and design the monitoring and evaluation system for the MMJ policy in Thailand. Research methods employed include a literature review, 22 in- depth interviews with key stakeholders, two focus group interviews covering nine service providers and patients, and a participatory observation in the MMJ clinic at the Ministry of Public Health. Our crucial findings cover: (a) the Thai MMJ system is complex, consisting of the sub-systems: modern medicine, Thai traditional medicine, and local community medicine. These three sub- systems are not harmonized. Patients could not access and benefit from the whole system, resulting in many of these patients having to use illegal marijuana products. ( b) MMJ is a new matter in Thailand and could provide both benefits and drawbacks for the Thai society; hence it is essential and urgent for Thailand to have an MMJ related knowledge generation system and an MMJ policy impact monitoring and evaluation system. (c) MMJ movement in Thailand has attributes like “political economy,” which means the MMJ policies may be driven by benefits rather than medical rationale. The proposed policy recommendations include follows. (1) Establish an advisory committee containing various capability dimensions and socially accepted, and have no conflict of interest. (2) Strengthen the MMJ service system in a way incorporating the advantages of all three MMJ sub-systems. (3) Urgently invest in the policy impact monitoring and evaluation system, including evaluating the supply, service utilization, and short-term and long-term consequences. (4) Promote Thai people’s health literacy regarding MMJ is crucial to prevent them from being victims of false information of the illegal MMJ providers. (5) Study the efficacy and the cost-effectiveness of various MMJ products in Thailand using the Thai culture-relevant, modified scientific method. And (6) study future MMJ policies for Thailand to inform policy decision making guided by scientific evidence.


The current situation of the SARS-CoV-2 virus infection causing COVID-19 is more serious. The development of antiretroviral drugs is urgently important. To stop the spread of the virus, the lungs model is critical to develop of antiretroviral drugs. Due to, SARS-CoV-2 relies on the Angiotensin-converting enzyme 2 (ACE2) target receptor protein, which is more common in lung cells, and caused of pneumonia. Thus, the focus of this research is to develop a lung model to study the mechanism of viral infection and develop the treatment of COVID-19, because of it is difficult to study biopsy samples from infected people. The aim of this research project is to simulate lung tissue structures using a technique as the Air-liquid interface to create conditions like the pulmonary scaffolds with ACE2 receptor protein expression. Development of therapeutic and drug testing guidelines for COVID-19. The experimental results in two-dimensional A549 lung cancer cells that were induced inflammation by lipopolysaccharide (LPS) was found the highest protein concentration of 0.2 micrograms per microliter. The nitric oxide measurement was observed in LPS-stimulated samples for 24 hours. Inflammation was observed with low nitric oxide about 2 µM, while the three-dimensional with LPS and hydrogen peroxide (H2O2) stimulation, the nitric oxide was not detected. As for the expression of ACE2 receptor that analyzed by Western blot method, the result can be found at approximately 97 kilodalton (kDa) size of the ACE2 receptor. Consequently, the lungs cancer cell line A549 in three-dimensional Air-Liquid Interface was expression ACE-2 receptor. However, the experiments also need to be repeated in the analysis of ACE2 and AT1R expression and control as beta-actin with western blot, and further at the gene level through qPCR analysis in a two-dimensional versus three-dimensional model. To determine the difference in receptor expression in inflammatory stimulation. The model will further investigation of the substance and the stimulation concentration was selected with spike protein instead for stimulation. The antioxidant was measured, and nitrate content will detect inflammation by LPS and H2O2. The problems that cannot trigger inflammation. So, the experiment still needs quality testing and test the concentration of the substance again.


There was an outbreak of SARS-CoV-2, a novel coronavirus, in late December 2019, originated in Wuhan, China. The virus causes problems with the respiratory tract. The syndrome is called "COVID-19". The number of infections and mortality has increased in China within a few weeks after the first patient was discovered. The virus quickly spread globally, including in Thailand. Fortunately, Thailand has an excellent public health policy for handling the outbreak. So we could control the first wave of the epidemic by reduced the infection rate to zero for several months. However, the health systems research institute (HSRI) is looking forward to finding the research direction of COVID-19 for the country. Therefore, this project was funded to review the essential knowledge about the COVID-19 and SARS-CoV-2 for HSRI. The review will be used as basic information for making a policy and manipulating COVID-19 granting in the future. The investigators reviewed the general knowledge of the SARS-CoV-2 that was a causative agent of the COVID-19. The report is divided into five chapters, where Chapter 1 addresses the basic biology of the SARS-CoV-2 virus, including taxonomy, virus structure, genome structure, viral proteins, and virus life cycle. Chapter 2 describes the diagnosis of infection by different test kits. The investigators have identified the key points of the different test kits, the limitations of the use of the diagnostic kits and their interpretation. Chapter 3 summarized all five major types of SARS-CoV-2 antiviral agents, which is currently used. The five grooups of antiviral drugs are (i) anti-enzyme activity of RNA Dependent RNA polymerase (RdRp), (ii) protease inhibitor, (iii) anti-fusion between the viral envelope and the host cell membrane, (iv) the antagonistic binding activity between the virus and host cell surface and receptors, and (v) anti-interleukine-6 receptor. Chapter 4 is focused on the immune system responding to SARS-CoV-2 virus infection. Chapter 5 will address the opinions of researchers, who are working on COVID-19 research over time of outbreak. The investigators wish the information of this report would be helpful for HSRI to be used in country policy-making for COVID-19 funding.


Since 2015, the World Health Organization has annually reported Thailand as one the 14 countries with high tuberculosis (TB) burden. Sigma against TB and poverty hinder the effort to end TB epidemic. A multisectoral approach and engaging civil society are needed to end TB. However, research to reduce TB stigma and study to engage civil society are lacking. This operational research program composed of 2 projects implemented in Central district, Chiang Rai between 24 June 2019 – 23 December 2020. The program developed and evaluate tools and innovations to reduce stigma against TB and enhance multisectoral collaboration to end TB epidemic. Project 1: Communication for reducing stigma against TB and to enhance participation in End TB 1.1 Developing and evaluating the effectiveness of the videos for reducing stigma against TB and to enhance participation in End TB
Based on the previous TB research and anecdotal evidences, the project developed 3 videos for different target audiences. 1.1.1 The video entitled “End TB Chiang Rai” and “Love overcomes the secret of tuberculosis” were used in the training for ten groups of people. The pre and post-test were used to evaluate TB knowledge and stigma. 1.1.2 The video entitled “Happy Ending with TB” was used as an intervention in a randomized control study with 170 TB patients They were randomly assigned to an intervention and a control group, each with 85 participants. The TB awareness and stigma level before watching the video of the intervention group were not different from the control group. However, in the intervention group, the mean tuberculosis knowledge after watching the video increased from 7.3 to 9.0 (p<0.001). The mean scores for stigma were reduced from 20.6 to 11.5, (p<0.001). The 6 month follow of the individual patient revealed that the median adherence rate of the intervention group was significantly higher than the control group 99.6% (IQR 3.3) and 96.9% (IQR 9.2) (p<0.001). The proportion of patients achieving 100% adherence of the intervention group was significantly higher than the control group (49.3%, 19.7%, p<0.001) 1.2 Curriculum development and conducting training to mitigate stigma against TB and enhance ending TB through multisectoral approach Based on the previous TB research and anecdotal evidences, the curriculum is composed of updated global, Thailand and local TB situation, essential TB knowledge and social aspects of TB. The training methods include lecture, discussion, watching the videos and group works. The training evaluation is based on the pre and post-test for TB knowledge and level of stigma against TB. Project 2: End TB through a multisectoral approach 2.1 Engaging civil society to End TB Ten different groups of people were identified and invited to the first meeting. These included medical doctors from private clinics, pharmacists from drugstores, nurses from TB clinic and admission wards, teachers, student leaders, religion leaders, charity organizations, local government administration, justice and legal sector, business sector. The selection emphasized persons or organizations locating in the area with highest TB notification for 5 consecutive years. Number of persons attended the first meeting ranged between 13 - 32 persons, Coverage of participation to attend the meeting was 19.5% - 90.3%, the lowest participation is medical doctors from clinics and the highest participation is the group of student leaders. The average participation rate is 51.2%. The pre-posttest of the 10 groups show that post-test score for TB knowledge significantly increased (p< 0.001) in every group, except the group of nurse (p=0.605). Level of stigma against TB significantly reduced (p< 0.001) in every group, except the group of private clinic physicians (p=0.08). After the first training, the project created 10 groups of communication networks through the Line application and weekly reported the records of new TB cases. The post training follow up found the End TB activities as follows: drugstores and clinics screen and referred persons with TB symptoms; The provincial education office disseminated End TB information to every school; The Christian group organized TB training for community religion leaders and updated weekly TB report; The provincial probation office organized TB information corner for pardoned inmates visiting the office. 2.2 Development and utilization of a mobile phone application for screening and referring persons with tuberculosis symptoms in drugstores and private clinics A mobile phone application entitled “TB-REFER” was developed and used in drugstores and private clinics. The clients whose symptoms meet the TB referral criteria will be referred to the hospital via the application. The referred persons received compensation for travel when they arrived the hospital. The drugstores and clinics did not receive any incentives. The one-year implementation shows 36 drugstores 20 clinics with medical doctors and 9 clinics with professional nurse totally 65 voluntarily participated in the project. Eighteen drugstores and clinics (27.7%) referred 38 clients but only 24 (63.2%) went to the hospital. Six clients were diagnosed as TB. Five cases were pulmonary TB (one smear-positive and 4 smear-negative sputum) and one extra-pulmonary TB. The 36.8% (14/38) of clients did not visit the hospital because they needed to work, no person to accompany and unable to bare for hospital cost. The clients who did not go to the hospital had higher proportion of coughing with blood (35.7% vs 12.5%) and higher average TB symptom scores than the clients who visit the hospital (4.5 vs 4.1 scores). A self-administered questionnaire with 81.3 response rate (52/65) revealed that 67.3% of drugstores and clinics did not refer clients because no clients reaching the criteria of referral. As for the clinics and the drugstores with referrals, they felt the TB-REFER application is easy to use (mean scores of easiness 9.5 out of 10 scores. The shortest, the longest and the average time spent with clients and the application are 5, 15 and 10 minute respectively. The impact of Covid-19 on the research implementation and TB patients The research project could not organize the World TB day on 24th March which is a highlighted research activity to campaign TB awareness by engaging all groups of civil society in the public for the first time. Moreover, the project could not organize face to face meetings to follow up the progress from the first training. The internet-based meetings were not practical. A rapid assessment with drug stores and private clinics show that Covid-19 reduced more than half of their clients. Persons with fever and cough also significantly reduced. Strict infection control measures were practiced by most clinics and drugstores. A rapid survey with 81 TB patients living with poverty found 70.8% lost their income. Hand washing and wearing mask in the public were regularly practiced by 95% of the patients. Female patients significantly washes hands more than male patients (97%, 78%, p=0.027). Utilization of research findings The TB-REFER mobile application and the referral pattern have been applied to HIV prevention and care program at the Thai-Myanmar border and the sexually transmitted infection (STI) clinic in local setting. Engaging drug stores and private clinic in TB case finding will be expanded to the whole region in 8 northern provinces. Conclusions The videos and the training curriculum for civil societies improved tuberculosis knowledge and reduced stigma against TB in various groups. The video for TB patients enhanced TB awareness, reduced stigma and promoted adherence to treatment. It was possible to engage drug stores and private clinics to screen TB symptoms and used the TB-REFER mobile application to refer patients to the hospital with high yield of TB case detection. However, only 61% of referred patients accessed the hospital. Other social protection measures are needed to enhance vulnerable people to access the hospital service. Policy Recommendations 1. The videos are low cost intervention for reducing stigma and enhance treatment adherence. Every tuberculosis clinic and primary care health center should be informed about these videos. The newly diagnosed tuberculosis patients should watch the video. 2. Provincial Health Office, regional hospitals and community hospitals should engage drug stores and private clinics in screening and referring persons with tuberculosis symptoms for definite diagnosis at the hospital. and 3. The community grant funded by the National Health Security Office should play role to support the vulnerable persons to access TB diagnosis.


The objectives of this study are to develop Thai Human resources for health (HRH) core indicators including the data standardization and related organizations and to propose policy recommendations to establish these indicators. Indicators engage comprehensive health labour market framework; such as education and labour market dynamics. Study’s method includes literature reviews and key informant interview. Multi-stake holders committee under Ministry of Public Health is established to be a policy platform to implement this indicators. The result shows there are 17 HRH core indicators for Thailand categoried into 4 groups, 6 indicators for HRH production, 1 indicator related HRH professional registration, 9 indicators related to health labour market including distribution, retirement and retention and 1 indicator for unit cost on the health workforce production. In term of data completion of each indicator, this study shows that only 7 indicators, namely number of faculties and production capacity, graduation rate, rate of passing licensing examination, number of foreign-trained and foreign-born, accreditation system and continuous professional development system, are completed and ready to report. Data completeness and the linkage system between data source are the main problems to report the rest indicators. Three important measures recommended for policy makers to implement Thai HRH core indicators are 1) Strengthening HRH registry 2) Establishment HRH data platform among related sources and 3) Conducting systematic researches on HRH loss rate and unit cost of production.


From the communicable diseases in Songkhla province committee meeting, there are authorizes and duties are assigned to Prince of Songkhla University, under the responsibility of the faculty of Medicine, to operate a travel tracking program from Malaysia in which the 12ths Objective To create a database system for surveillance and monitoring of COVID-19 infectious diseases and follow to other systems for communicable diseases, as well as developing a database for surveillance and monitoring of Covid-12 from the researcher team have been developed. This research focuses on understanding the systematic overview of both the surveillance and database system of COVID-19 reporting system, it is necessary to use a combined viewpoint to achieve this objective, which divided into two subjections 1.Transcription a lesson on COVID-19 infectious disease management both Thailand and abroad 2.Qulitative data collection and stakeholder analysis to develop a database and surveillance system for COVID-19 infectious disease by specialty in Thai transborder population for Sample population. The sample population that the research team had chosen to collect data for the research and field trip was 12th health sector for the reason is there is the nearest border to Malaysia which has a different context than other health sector and essential to, there must be a system and measures for the Thai transborder population between Thailand and Malaysia. Until the data is analytically saturated. The data is divided into two parts: 1. Data analysis using the content analysis method by collecting the content from the interviewer and classifying them according to various issues according to the set concept 2. The analysis of stakeholders is divided into divisions. It is analyzed based on the stakeholder matrix, the relationship between significance and influence. After the implementation of the system that the research team has recommended and installed, there are five establishments in the 12th health sector area that have the following recommendations. 1. Immigration can be updated and displayed on the dashboard in real-time as well as telemedicine used to track the patient symptoms and such recommendations can also be applied to other people. 2. Hotels and department store (Lee garden plaza) are places that got a lot of people to enter and exit at the same time, so a thermometer camera was needed instead. However, the reason is the thermometer camera is a face recognition recording system, cannot be identified, it should be developed to establish a system for scanning RFID cards and measuring the temperature at the same time to obtain accurate and fast information. 3. The bus station (Songkhla bus station area) suggests developing a method to extract datafrom the handwriting in the photo database. 4. Train station (Hatyai railway station area) Hatyai railway station will adjust to transforming the ticket to be an RFID ticket while waiting for the RFID ticket system, part-time staff will be hired for two months to help the monthly passenger register and print a QR code and stamp be hide the ticket. 5. School (Nataweewittayakom school area) as same as Hotels and department store that have a lot of people enter and exit at the same time so that necessary to use the thermometer camera instead, the reason is the thermometer camera is face recognition recording system, cannot be identified, it should be developed to establish a system for scanning RFID cards and measuring temperature at the same time to obtain accurate and fast information.


The incidence of dementia in elderly population, aged 60 year or older, has been rapidly increasing. Dementia causes significant negative impacts on quality of lives, both in patients and families, constituting a huge socioeconomic burden and drawback in country’s development. Current diagnostic approach based on clinical symptoms and signs may not sufficient. Thus, early detection of amyloid deposition in the brain may play important role in accurate diagnosis, identifying patients at risk, planning for patient management and also leading to development the drug or procedure aimed for therapy or prevention of dementia. Objectives To evaluate the use of [F-18]Florbrtapir PET scan in assessing brain amyloid deposition in Alzheimer’s disease (AD), mild cognitive impairment (MCI) and healthy cognitive elderly (HC) and the correlation between brain amyloid deposition in PET scan and results from neuropsychological test, MRI brain and [F-18]FDG PET scan. We also aimed to evaluate the correlation between [F-18]Florbetapir PET scan results and changes in neuropsychological test, MRI brain and [F-18]FDG PET scan results. Methods 1) Synthesis of [F-18]Florbetapir PET tracer 2) Clinical study in 86 eligible subjects including 21 HCs, 33 MCIs and 32 ADs according to clinical diagnosis. All subjects underwent clinical and neuropsychological assessment including TMSE, CDR-SB, ADAS-COG, brain MRI, [F-18]FDG PET and [F-18]Florbetapir PET scan of the brain within 6-week period. The images were then analyzed using visual and quantitative analyses. Results The in-house synthesized [F-18]Florbetapir PET tracer demonstrated equivalent characteristics to those of reported original compound and passed the standard for drug for injection. There was no report of any adverse symptom after the study. The baseline clinical study in 86 eligible subjects found that results from all imaging techniques were concordant with clinical diagnosis and showed statistically significant correlation with neuropsychological test scores, either by visual assessment or quantitative analyses. The ability to differentiate AD from HC by [F-18] FDG PET was higher than [F-18]Florbetapir PET and MRI, respectively. Results from [F-18]Florbetapir PET were also significantly correlated with both [F-18]FDG PET and MRI, with higher correlation with [F-18]FDG PET>MRI. The results at 2-year follow-up period in 72 subjects (19 HCs, 31 MCIs and 22 ADs) found that baseline [F-18]Florbetapir PET results significantly and moderately correlated with the change in all neuropsychological test scores. But there was insignificant and low correlation between the change in quantitative results of [F-18]Florbetapir PET and the change in neuropsychological test scores. Moreover, the level of Aβ deposition in baseline [F-18]Florbetapir PET had high and significant correlation with the follow-up [F-18]Florbetapir PET in all brain regions and in AD>MCI>HC. Baseline [F-18]Florbetapir PET results also showed significant negative correlation with [F-18]FDG PET at parietal and occipital lobes in AD, although the level of correlation was relatively low. There was very low and insignificant correlation between baseline Aβ deposition and degree of mesial temporal atrophy at floow up. Conclusion The results from all imaging techniques showed concordance with clinical diagnosis and highly correlated with neuropsychological test results, which the highest correlation was detected in [F-18]FDG PET followed by [F-18]Florbetapir PET and MRI, respectively. Results from baseline [F-18]Florbetapir PET was well correlated with [F-18]FDG and MRI, both during baseline and follow-up, and also correlated with the change in neuropsychological test scores. The level of correlation varied among clinical groups and neuroimaging techniques.


Thailand is facing the dilemma of which groups to prioritise for the limited first tranche of vaccinations in 2021. A mathematical modelling analysis was performed to compare the potential short-term impact of allocating the available doses to either the high-risk group (over 65-year-olds) or the high incidence group (aged 20-39). Vaccinating the high incidence group with a vaccine with sufficiently high protection against infection (more than 50%) could provide enough herd effects to delay the expected epidemic peak, resulting in fewer deaths within the 12-month time horizon compared to vaccinating the same number of the high-risk group. After 12 months, if no further vaccination or other interventions were deployed, this strategy would lead to more deaths. With the right vaccine efficacy profile, targeting the high incidence groups could be a viable short-term component of the Thai vaccination strategy. These results and emerging evidence on vaccines and susceptibility suggest prioritisation guidelines should be more nuanced.


Objectives of this study are to (1) estimate fiscal space for universal health coverage (UHC) in Thailand, and (2) investigate the demand-supply gaps in health workers and develop microsimulation models to examine how to improve the allocation of health workers in the same areas. The study on health fiscal space found that the public budget for the Universal Coverage Scheme (UCS), when compared with the national goals of Sustainability, Adequacy, Fairness, and Efficiency (SAFE), tends to be neither sustainable nor adequate in the next ten years. This study also conducted quantitative analysis on three options to integrate the three schemes of UHC, which could reduce public budgets and improving fiscal efficiency. In addition, the political economy analysis indicates that there are possibilities to expand sources of funds such as earmarked VAT and tax reform for universal social welfare. The political movement is necessary to actualize the revenue and budget expansion. The study of area-based network allocation focuses on the hospitals under the Office of Permanent Secretary of the Ministry of Public Health and extends to the public-private partnership analysis. The basic results show that healthcare networking combined the primary hospitals and the first--secondary and middle-secondary hospitals within each district could alleviate workforce shortage. Furthermore, the provincial networking of the secondary and tertiary hospitals with the private hospitals which provide inpatient service could not significantly reduce workload per worker at the national average. However, when considered by province, the public-private partnership could reduce workload per worker by 10% or more in major provinces.


The two main purposes of this research were to develop the health information system using GIS program and evaluated for migrant worker in Bueng Kan province. And the second was to use this database system for related work department. The program was evaluated by 2 group of quality staffs, 6 experts and 20 other relevant officers. The evaluated program was test in 4 areas: functional requirement test, function test, security test and usability test. The statistic uses for analyze the data were mean, standard deviation (SD). The results were as follows: 1. Functional requirement test was good with mean 3.90 and S.D. 0.32 2. Functional test: good with mean 3.89 and S.D. 0.49 3. Security test: good with mean 3.92 and S.D. 0.62 and 4. Usability test: good with mean 3.89 and S.D. 0.29 In Summary, that means this program was quite good enough to use as a main database of migrant worker for most related work department at a 95% confidence level.


A research study entitled “The Result of Capability Development of Language Coordinators' on Foreign Workers' Health Insurance, Chiang Rai Province” aims to provide foreign workers with access to health insurance by developing the capability of language coordinators on foreign workers health insurance and to provide foreign workers with knowledge of foreign labor health insurance. The samples were 120 language coordinators from Muang Chiang Rai District and Mae Sai District and a random survey of knowledge on foreign worker health insurance of 385 people. Survey tools used included general information query, before-after training knowledge quiz, knowledge evaluation form on foreign workers' health insurance, Supervising and tracking form as well as the collection of migrant worker’s health insurance registration statistics. Statistics used for analysis; descriptive statistics were frequency, percentage, mean and standard deviation, the inferential statistics are t-test. The results of the study showed that the capability development of the language coordinators in health insurance for foreign workers in Chiang Rai: starting with the survey of the language coordinators with required qualifications and setting up training sessions according to health insurance guidelines of the Ministry of Public Health. Most of language coordinators were 20-29 years of age, male, primary education qualification, freelance workers with monthly income from 5,000-10,000 baht, and were language coordinators based in Thailand for 5-9 years. Before the training, the language coordinators had a low level of knowledge and after the training they have a high level of knowledge. The test scores before and after the training were significantly different with statistical significance at the level of .05 After the training, the language coordinators' performance was monitored and supervised with result indicating that the most seek-for-advice topics were the benefits of health insurance, rates, required documents for health examination and health insurance, change of medical facility eligibility according to work location, and verification of health insurance eligibility. For the registration of health insurance of migrant workers, it was found that more foreign workers registered for health insurance cards after the development of capability of language coordinators. In assessing the knowledge of foreign workers on health insurance with the support of the trained language coordinators, it was found that foreign workers had a moderate level of knowledge of health insurance. The results of the research can be used to guide the development of language coordinators in other areas of Thailand. As a result, migrant workers have more access to health insurance.


The purpose of this study was to develop a mobile application for standing work safety. The study process was divided into 3 steps including the determination of safe standing measures, the creating applications for standing work safety in the form of mobile application, and the trial programs created. The 180 standing workers participated in this study. Satisfaction and pain sensation in the calf and foot muscles were assessed after the trial run. The application can be installed through App Store in the IOS system and via the Play Store for Android users with the keyword "Safety Standing". The results of the study showed that the sample group was satisfied with the composition, and the usability of most programs is at a high level. After the trial run of the program, the feeling of calf pain was significantly reduced for 3 weeks and the sensation of foot pain was significantly reduced after just 1 week. Therefore, it can be concluded that the safety standing application in the form of a mobile phone application can help reduce pain in the calf and feet. As well as causing satisfaction in use that will result in the safety of the workers' standing.


This research is applied research and aims to improve the training course administration
of Thai Diagnostic Autism Scale (TDAS) in the context of secondary and tertiary health care services and develop prototype models for implementing TDAS tools for useable innovations. The trial was conducted in 13 secondary and tertiary health care services with a sample size of 382 children between the ages of 12 and 48 months with suspected autism, found that 317 cases, representing 82.98 percent, had autism. All multidisciplinary staff, were found to have a very good level of post-training administration skills. Additionally, children at risk of delayed development in Expressive language (EL), Receptive language (RL) and Personal and Social (PS) ,results indicated that a delay in one of these domains had a statistically significant proportion of autism greater than 0.5 at the .01 level. At the secondary and the tertiary level, the multidisciplinary health care service teams prioritize centralized policy, leadership of the hospital director, personnel, and the multidisciplinary team. A major obstacle to providing local autism services is the waiting time for diagnostic services, continuing therapy. As well as the awareness and collaborative participation of parents. This research suggests the Ministry of Public Health that to simplify and shorten the waiting time for diagnose a child with autism, the revision of the care mapping of early childhood care is needed. As a result of the revision, a child can access the treatment process 6-12 months sooner than the present system allows.


This project is a participatory action study. The objective was to develop two related systems, where the Tambon Health Promoting Hospital is the core of implementation comprising of the heat-health warning system and the heat-related illness surveillance system. The development of the heat-health warning system was based on a concept proposed by the World Health Organization, namely: 1) Weather forecasting using data from the Meteorological Department; 2) Setting the threshold temperature based on the method from the study of Phongtape Wiwatanadate (2016) under the project “The Development of Health Warning System and Mechanism for Heat-Related Illnesses” and analyzing the data obtained from the Nakhon Sawan Provincial Health Office for the past 5 years and 3) Issuance of watch/warning messages to related persons including identifying vulnerable groups through participation from the community and all stakeholders in every step. Nonetheless, this project has added a fourth step of activity, namely monitoring, providing advice and first aid to vulnerable groups, carried out by village health volunteers in collaboration with caregivers. Development of both passive and active heat-related illness surveillance systems was also carried out at the target sub-district level. It was adapted from a surveillance model developed by the Centers for Disease Control and Prevention (CDC), which has four steps: 1) data collection, 2) data analysis, processing and interpretation, 3) summarizing the surveillance results and reporting the results of the surveillance to those involved, and 4) corrective action or prevention of problems. The duration of the project was 1 year and 6 months with the pilot area being Klang Daet Sub-district, Mueang District, Nakhon Sawan Province. The outcome of the heat-health warning system between 1 March-to 30 April, 2020 (2 months) showed that the warning level in the "warning" level (level 3) (temperature above 39 degrees Celsius) was the highest for 25 days and there were 28 cases of heat-related illnesses. Most cases were found at Moo 6, a total of 30 cases. The most common disease was heat syncope, totally 39 cases. No cases of heatstroke were found. For the heat-related illness surveillance system between March 1, 2020 and February 28, 2021 (1 year), it revealed that the warning level of "surveillance" (level 1) (temperature below 37 degrees Celsius) was the highest totally 280 days. Most cases were in March 2020, with 42 cases. Most cases were found at Moo 6, a total of 36 cases. The most common disease was heat syncope, with 47 cases. The ratio of female : male was 1.6:1. The top 3 most common age group were 65–69 years old, followed by 50–54 years and 60–64 years old, respectively. The top 3 risk factors were working outdoors or in a hot place, drinking tea or coffee, and having heart disease or high blood pressure, respectively. No patients with heatstroke were found. The overall project evaluation found that the sub-district agencys, such as the Tambon Health Promoting Hospital, together with the village health volunteers, were able to operate both systems by themselves without difficulty, not adding too much workload as it can be integrated with other activities that are routinely performed. Most importantly, there is almost no budget required for the activities, but it can prevent morbidity and mortality from heatstroke. Policy Recommendations Policy recommendations are divided into 3 levels as follows: 1. Provincial level. Nakhon Sawan Provincial Health Office should be the key to expanding the project area. It may begin with a meeting of the heads of district government agencies to establish policies for implementing the heat-health warning and the heat-related illness surveillance systems at least 1 sub-district per district in the first year and making an assessment to expand the project to other sub-districts in the following years. It can get the funding support from the Health System Research Institute. 2. National level. The Ministry of Public Health may issue the policy to implement the heat-health warning and the heat-related illness surveillance systems according to the guidelines presented in this report by piloting one sub-district in each province in the summertime for a period of 3-4 months, and then gradually expanding to cover the entire province. It may use the same policy implementation guidelines at the provincial level aforementioned. 3. Health System Research Institute (HSRI). It may present the results of the study in this project to the meeting of HSRI Board of Directors to propose to the relevant departmental administrators of the Ministry of Public Health, such as the Office of the Permanent Secretary, Department of Disease Control, Department of Health, Department of Medical Services, Department of Health Service Support, etc. in order to have policy-making and driving at the national level.


This project “The integration of GIS into a health information system for migrant health monitoring: In the Eastern Economic Corridor” is about utilizing data for health service and health status of migrant workers management. Migrants’ health information is extracted from 43 files of database, Health Data Center (HDC) dashboard, Ministry of Public Health. This new developed system presents data in Dashboard and mapping. Accordingly, the users can access migrant workers’ health information through web browser: http://www.eecmigrants.com. The web application has 3 main categories: statistical database, spatial database, and data table, which divided into 5 subcategories: Patient identification, Diagnosis, treatment, Treatment results, and Medical rights. This database assists users to manage health data quickly and effectively. However, there are problems and limitations in this study described as below:
1. The database system of Ministry of Public Health did not support the programmer to access information automatically via Application Programming Interface (API). Therefore, the programmer had to access data through only channel that the ministry allows, which was difficult to pull selected data out. Apart from that, the data collection at the sub-department level still was lack of unity. It used different systems to gathering data, it also contained out-of-date information.
2. This database system allowed us to retrieve 1,000,000 record at one time. In practice, downloads were specified by date and time. The programmer would not exactly know the amount of data that pulled out. As a results, when having information overload, the programmer had to split the big data into small size. Then, making a data account to keep track on latest download location. This would help acquiring full information.
3. The database system did not support the OFFSET in SQL command which allow users to select the range of data. Nevertheless, the development team analyzed data and found that data had date written in each table. Thus, we selected information by date to do analyze.
4. The database did not connect with other databases which belong to private sector and other public healthcare organisations (e.g., office of the Municipality, pharmacy).
5. Some of migrant workers’ information were incomplete due to illegal immigration. Also, when access healthcare, they used other workers’ information for hiding their undocumented status, causing duplicate data at that. According to the interview with Burmese, Cambodian, Lao migrant workers, most of them had education lower than high school. Additionally, lots of migrant workers entered Thailand legally with health insurance. Some were undocumented immigrants. Their monthly income were about 10,000 baht and monthly average expenses were 6,000 baht. Mostly migrant workers accessed healthcare knowledge from television, mobile phone, friends and their employers. It is obvious that when they got sick, they would go to the nearest hospital. The finding revealed that they were satisfied with Thai healthcare service. Furthermore, migrant workers were interested to know about their right and benefit of health insurance and the access to healthcare service.
The problems that arise from providing service to migrant workers were 1) the burden of medical expenses that patients could not afford to pay 2) healthcare workers even worked harder 3) there were a chance that emerging and re-emerging infectious diseases would be spread and difficult to control 4) a risk of recurrence of vaccine-preventable disease from migrant workers’ children 5) migrant workers took part in rights and medical resource that preserve for citizens 6) delayed payment of insurance did serious impact on hospitals’ financial management, and 7) inefficient use of health care resources.
In spite of the fact that the recommendations from the study can help planning the more effective healthcare for migrants in the Eastern Economic Corridor, there are some points that need to be improved
1. Establishing the same standard for recognized migrant workers’ identification in order to reduce data redundancy.
2. Organizations should share relevant information, as well as, allow the others to access the data regarding the law.
3. Setting data standardization that can be connected to other database properly. Besides, create strong security for protecting the data.
The effective way to sending health information to migrant workers, is using media in their own languages. According to that, they can easily access via television, mobile phone and their employers. Turning to urgent health issues in migrant workers, communicable disease and emerging and re-emerging infectious diseases should be taken care of as top priority.


Tuberculosis is still a major public health problem in Thailand due to the increased incidence in drug-resistant and multidrug-resistant infections. From the study on multidrug-resistant tuberculosis in Thailand by using whole genome sequence analysis technique, Associate Professor Dr. Angkana Chaisprasert has discovered that there is a clonal outbreak strain in the Kanchanaburi Province (which is now referred to as the "MKR superspreader"). The MKR superspreader belongs to the Beijing family sequence type (ST) 10 genotype and is appeared to have a special ability to spread the infection when compared to that of other strains in Thailand. In this research, our team therefore aimed to identify the mycobacterial and host factors that contribute to the special ability of the MKR superspreader to transmit the infection better than other strains in Thailand. Since one of the main factors affecting the ability of Mtb to spread well from one patient to another depends on its ability to grow at a high rate in the host macrophages such that the host cells will die by necrosis, at which the bacteria will be released outside the cells. When the patient coughs or sneezes, the infectious aerosols will then transmit the Mtb to the other person. The higher the number of bacteria in the infectious aerosols, therefore, will increase the chance of infection to others. In this study, we hypothesized that the MKR superspreader has the special ability to transmit better than other strains because it has the ability to inhibit the defense mechanism of host cells resulting in high growth rate and causes the host cells to undergo necrosis. In year 1, we already confirmed that the MKR superspreader grew at a high rate in host macrophages and caused host cells to undergo necrosis when compared to the other strain. By conducting RNA-sequencing analysis, we also identifed host and mycobacterial genes that may contribute to the higher ability of the MKR superspreader to grow inside host macrophages and cause host cells to undergo necrosis. In year 2, we validated the expression of these genes by qRT-PCR as well as studied their function using the Crispr-dCas9 interference system (specifically developed for mycobacteria) and siRNA knockdown (for host cells) coupled with the phenotypic analysis. The results obtained led to the identification of new drug targets that can be further developed to be used to inhibit the infection by this strain in the future.


Primary care is a crucial quality health care system in achieving health for all people. This study
aimed to evaluate the provisioning and supporting systems, and also compare the provisioning and
supporting systems to the district areas of primary care services for diabetic and hypertensive patients
in Khon Kaen province covering the pilot and non-pilot primary care clusters (PCCs), the non-communicable
disease (NCD) clinics of hospitals, and the health-promoting hospitals of Mueang, Nam Phong and
Ubolratana districts. A cross-sectional study was conducted with 170 health personnel via purposive
sampling. Data were collected by self-administered questionnaire with 0.84 Cronbach’s alpha coefficient.
Data were analyzed using descriptive statistics in terms of percentage, mean and standard deviation, and
inferential statistics in terms of ANOVA and least-significant difference. The findings showed that mean
score of the provisioning and supporting system of the primary care service of NCD clinics of the hospitals
was higher than the PCCs and health-promoting hospitals at both province and district levels. The mean
scores of the NCD clinics were higher than the others in all dimensions of the provisioning system, including
the relationship between clients and family medicine or family doctor, shared care plan for the
individual patient, health information system, and self-management supports of the patients. However,
the mean score of continuity of care and coordination provided by the pilot PCCs was higher than the
NCD clinic of the hospitals. In terms of the supporting process associated with the family care team and
multi-disciplinary team, and the understanding of primary care service principles, the mean score of the
NCD clinics was higher than the PCCs and health-promoting hospitals. However, regarding the aspect of
trust in time allocation of the team in providing care to patients, the mean score of the non-pilot PCCs
was the highest, while the another aspect of continuity of health care service development served by
the pilot and non-pilot PCCs and the NCD clinic had the same level of mean scores. When considering
the dimension of the provisioning system of all three districts, in particular, the pilot PCCs of Nam Phong
and Ubolratana districts had a higher mean score than the pilot PCCs of Mueang district. The pilot PCC
of Nam Phong district had the highest mean score in two aspects: relationship between clients and
family medicine or family doctor, and self-management supports of the patients. The pilot PCC of Ubol-ratana district had the highest mean score in two aspects: shared care plan for the individual patient,
and continuity of care and coordination. In addition, the remaining aspect linked to the health information
system provided by the pilot PCCs of Nam Phong and Ubolratana districts had the same mean.
There were significant differences in all aspects in all three districts, except the relationships between
clients and family medicine team (no significant difference in all districts). The present evaluation of the
primary care models was an early assessment set by the central national project that needed longer
time after implementation to learn more lessons for further improvement. Moreover, the present study
was biased on the opinions of health care providers and did not include the opinions of clients and
clinical outcomes of the service provision.


This research and development aimed: 1) to examine health literacy and health management situation
of older people with diabetic and hypertension; 2) to develop health literacy and health management
program for older people with diabetic and hypertension; 3) to assess the effectiveness of
health literacy and health management program for older people with diabetic and hypertension; and
4) to develop policy recommendations on health literacy and health management of older people with
diabetic and hypertension. The samples were 140 early older people for quantitative study, and 18
healthcare providers such as family medicine doctors, nurses in primary care cluster (PCC), province and
district public health offices. The 140 early older people were divided into 70 for experimental group
and 70 for control group to assess effectiveness of the program. Data on health literacy, health management, A1c, and blood pressure were analyzed by using descriptive statistic. Paired t-test was used to compare between pre and post intervention. Independent t-test was used to compare mean between
experimental and control group. Results: 1) The overall health literacy of the older people with diabetes
and hypertension at the PCC was found to be insufficient at 52.7% (n = 78) and sufficient at 44.3%
(n = 62), respectively. The health management scores were at moderate level (x ̅ = 2.15). The highest
score was the ‘continuing care’ (x ̅ = 2.53), followed by a moderate level of ‘stress management’ (x ̅ =
2.22), ‘drug use pattern’ (x ̅ = 2.13) and ‘food consumption behavior’ (x ̅ = 2.12). The ‘exercise’ had the
lowest mean score (x ̅ = 2.01). Regarding the effectiveness of health literacy program, the average A1c
in the experimental group was lower than the control group (p < 0.01). The average systolic blood pressure (SBP) of the experimental group was lower than the control group (p < 0.001). Likewise, the health management scores of the experimental group were higher than the control group (p < 0.001), as well as the health literacy score (p < 0.001). The PCC should consider applying this program in order to help older people and family to better control A1c and blood pressure to reduce the risk of complications.


This study was a retrospective descriptive study. The objectives were to determine the costs and formulate the cost function due to HIV and AIDS treatment from a provider perspective for the fiscal year 2018 at Phra Thong Kham Chaloem Phrakiat Hospital, Nakhon Ratchasima province. Descriptive statistics were used to summarize demographic characteristics and costs. Stepwise multiple regression was employed to construct the cost function. Ninety-six patients with complete cost data were analyzed. Male and female was equal. More than sixty-nine percent aged higher than 40 years old (mean age 42 years). The total treatment cost was 1,652,314 baht, or an annual average of 17,212 baht per person. Based on the fitted regression model, the significant explanatory variables included drug resistance, the number of out-patient visits, age, and adherence to treatment. The model could explain fifty-seven percent of the cost (Sig. F<0.001). In conclusion, the present study provided a description of costs of HIV and AIDS treatment. It also explored factors affecting institutional costs. These data can assist financial and efficiency management.


The present study aimed to 1) illustrate the situations of intermediate care according to the Ministry
of Public Health’s policy. Seventeen healthcare facilities providing acceptable intermediate care to
patients with stroke, traumatic brain injury (TBI), and spinal cord injury (SCI) were multi-stage sampled
from the Ministry of Public Health provider sampling frame of 897 hospitals. Questionnaire with item-objective
congruence index (IOC) of 0.6–1.00 was the tool used for data collection during September 2019
to March 2020. Electronic data related to inpatient intermediate care were alternative study data source.
The data were analyzed with descriptive (frequency, percentage, mean, standard deviation) and inferential
statistics (median test, paired t-test, t-test, Pearson correlation). The findings showed that the selected
hospitals were divided based on service data into 3 groups: 1) intensive intermediate care services,
2) moderate intermediate care services, and 3) moderate intermediate care services with limited evidence
from questionnaire and individual inpatient data. The majority of patients were stroke. Group 1 community
hospitals had longer length of stay (LOS) than other groups in all 3 conditions; stroke 9.2 days, TBI
13.6 days and SCI 26.8 days. The average medical expense per visit for out-patients with SCI in the provincial
hospitals from group 1 was the highest; 30,458 baht. The average medical expense per visit for
in-patients with SCI in the hospitals from group 1 was the highest; 57,254 baht. The patients with SCI
from community hospitals in group 1 had the highest re-admission rate of 38.1 per cent. The Barthel
index (BI) at discharge was higher than on admission date for stroke (paired t- test(3,423) = 30.82, p < 0.01),
TBI (paired t-test(88) = 3.64, p < 0.01), and SCI (paired t-test(104) = 3.05, p < 0.01). The stroke patients in
group 1 hospitals showed better patient functional improvement by higher improvement in Barthel index
(IBI) than in group 2 hospitals (4.0 vs 1.8, independent t-test 3,381 = 12.51, p < 0.01). The medical expense
had positive correlation with LOS of 3 conditions (CSI r = 0.98, p < 0.01; TBI r = 0.53, p < 0.01 and stroke
r = 0.17, p < 0.01). The IBI of stroke had negative correlation with LOS (r = -0.044, p < 0.05) and with age
(r = -0.035, p < 0.05). In conclusion, the intermediate care with intensive rehabilitation to enhance
clinical effectiveness should be continuously supported.


The study aimed to project the health workforce requirements to provide long term care for the
dependent older people in Thailand. The descriptive study comprised 2 steps, primary and secondary
data collection and forecasting for health workforce requirements for the long term care services. Survey
conducted at 66 public and private long term care institutions and 130 care managers (CMs) looking
after home health care services. Self-administered questionnaires comprised questions in relation to
service provision, health workforce, quantity of services and time used were applied. The health need
method was used to project the health workforce requirements for home health care services and the
population ratio method was then employed to project the health workforce requirements for institutional
care. Health workforces included in the projection were: CM, nurses, doctors, physiotherapists,
social workers, nurse assistants and care givers (CGs). The results showed that when service utilization at
institutional care increased at 10-20% each year, the requirements for CM, nurses, physiotherapists,
doctors, social workers, nurse assistants and CG in 2030 would be 37,235-37,636; 29,520-30,499; 4,858-
5,260; 3,555-4,000; 338-740; 1,613-3,529; and 126,542 -134,312 respectively. Comparing to health workforce
supply of the whole country, it is likely that there would be a critical shortage of nurse and CM.


Objectives: To study the proportion, patterns, and factors associated with inappropriate antibiotic prescription (IAP) in acute upper respiratory tract infection (ARTI) at the Student Health Center (SHC), Prince of Songkla University (PSU). Methodology: A descriptive retrospective study was conducted by reviewing medical records from the hospital information system (HIS) of Songklanagarind Hospital. Seven hundred and thirty ARTI patients, who met inclusion criteria at the SHC, PSU from 1 January to 30 September 2018 and diagnosed with common cold, acute pharyngitis, and acute tonsillitis under the ICD10 code. Four hundred and thirty-four patients were excluded after medical record review. Descriptive and inferential statistics were employed in the data analysis using the R® 4.0.0. software program. Associations were evaluated via odds ratios with 95% confidence intervals. The level of statistical significance was set at p<0.05 using multivariate analysis. Results: Two hundred and ninety-six participants were enrolled in the study. The proportion of antibiotic use in ARTI was 17.2% (51 of 296). Among antibiotic prescriptions, the proportion of IAP was 80.4 % (41 of 51). The patterns of IAP were as follows: no antibiotics indication 90.2% (37 of 41), wrong duration 26.2% (11 of 41,—a 5 day amoxicillin therapy was the most common 27.2%), and wrong dose 12.2% (5 of 41,—all received amoxicillin in the dose of 2,000 mg/day). The multivariate analysis demonstrated that factors significantly associated with IAP were being a patient with an underlying disease (adjusted OR=4.22, p=<0.001) and a nurse practitioner as prescriber (adjusted OR=10.93, p=<0.001). Conclusion: Antibiotic prescriptions in ARTI at the SHC, PSU did not exceed the 20% rate set in the rational drug use hospital policy for antibiotic prescription criteria. Nevertheless, the proportion of IAP among ARTI patients was high, and the most common pattern was prescribing antibiotics without an indication. Therefore, future research should focus on how to enhance the adherence to antibiotic prescription guidelines to promote appropriate antibiotic prescription, especially among nurse practitioners.


Background and rationale: Having sufficient physical activity (PA), as recommended by the World
Health Organization, is necessary for developing motor skills and physical fitness of children and youth
and reducing risks of non-communicable diseases when entering adulthood. Over the past years, there
has been a large amount of research and development of PA knowledge in Thailand, but the research
gaps and clear directions for future research have not been analyzed and identified. Objective: To
investigate research topics conducted in the past and identify research gaps in PA among Thai children
and youth aged 0-22 years and provide future research suggestions. Methodology: This study applied a
systematic review by searching research articles from Thai and international databases. The review
included studies on PA in Thai healthy children and youth aged 0-22 years written in Thai or English and
published during 2009-2019. The quality of the studies was assessed using a standard checklist. Descriptive
statistics and content analysis were used for data analysis. Result: A total of 79 studies were qualified
and included in the review. The least age groups represented in the review were children aged 0-5
years (1.3%). There was a low number of studies in the areas concerning the association between PA and
cognitive functioning, physical environment, and sociological-cultural factors. Areas that had not been
investigated were the associations between PA and mental health, socio-economic status, and technology
for promoting PA. Recommendation: Researchers should consider conducting studies that have
been identified as gaps of the research in this field to provide comprehensive information for the development
of policies and programs to encourage Thai children and youth to have sufficient PA and adopt
PA as part of their lifestyle.


Background: Extending social insurance to informal employment has become a goal among international and national authorities. For Thailand, the voluntary social security scheme under Article 40 (A40) of the Social Security Act covers only seventeen percent of the total informal workers of 20.4 million. Many studies had identified factors relevant to the enrolment and renewal of voluntary social health insurance scheme. Thailand can learn and use the existing research findings from international perspectives to improve the coverage of voluntary social security scheme continuously and efficiently. Methodology: Searches of electronic databases from Google Scholar, PubMed, ThaiJo and ThaiLis were conducted. Studies that aimed to identify factors associated to the enrolment and renewal of health or social insurance, A40, and the National Saving Fund (NSF), written in English and Thai were included for the analysis. Key results: Ten studies were included in this review. The included studies reported demographic factors, education, occupation, income, knowledge and understanding of the scheme, quality of services, health issues, benefit package adequacy, and socio-cultural factors as significant determinants of the enrolment in a voluntary health insurance scheme, the A40, and the NSF. Conclusion: The present study provides evidence on determinants of the enrolment in a voluntary health or social insurance scheme that applicable to the Article 40 of Thai Social Security Act. Strategies should be developed with consideration of those significant determinants to increase the coverage and sustainability of the scheme.


Dengue virus infection is a global threat for which no specific treatment has not been established. Previous reports suggested chrysin and flavanone derivatives were potential flaviviral inhibitors. Here, we reported two halogenated chrysins, abbreviated FV13 and FV14, were highly potent against DENV1-4 and ZIKV infectivities with the FV13 EC50 values of 2.30 ± 1.04, 1.47 ± 0.86, 2.32 ± 1.46, 1.78 ± 0.72 and 1.65 ± 0.86 μM; and FV14 EC50 values of 2.30 ± 0.92, 2.19 ± 0.31, 1.02 ± 0.31, 1.29 ± 0.60 and 1.39 ± 0.11 μM, respectively. The CC50s to LLC/MK2 of FV13 and FV14 were 44.28 ± 2.90 μM, 42.51 ± 2.53 μM, respectively. Mechanism of drug action studies suggested multiple targets but maximal efficiency was achieved with early post infection treatment. Computational study suggested the target at viral envelope and further optimized the pharmacophore to the stronger binding affinity. Pharmacophore models were generated using trajectories obtained by molecular dynamics (MD) simulations of the dengue envelope E protein complexed with the active inhibitor, flavanone (FN5Y). Subsequently, compounds presented in various drug databases were screened using the LigandScout 4.2 program, molecular docking, followed by extensive MD simulations. The highest-ranked compound from this procedure was then synthesized and tested on its inhibitory efficiency by experimental assays. Moreover, we synthesized two halogenated flavanones, dibromopinocembrin and dibromopinostrobin, and tested against dengue serotype 2 at the EC50s of 2.06 ± 0.75 and 5.86 ± 0.51 μM with at the CC50s of 67.21 ± 0.97 and >100 μM, respectively. Flavanones are more aqueous soluble than flavones therefore they are more suitable for further in vivo experiments. Computational studies suggested the potential target be likely the NS5 methyltransferase. Since flavones and flavanones inhibited viral translation and replication potentially with multiple targets. A flavone was chosen for alkyne addition to the B-ring, resulting in an alkyne-tagged apigenin. The alkyne serves as a chemical tag for the alkyne-azide cycloaddition reaction for subcellular visualization. The compound located at the perinuclear region at 1 and 6 h after infection corresponded to a previous report that apigenin-fixed bead pulled down a ribosomal protein S9. Interestingly, the compound signal started shifting to vesicle-like structures at 6 h and accumulated 24 and 48 h after infection. Moreover, the drug treatment in dengue-infected cells showed that the compound restricted the viral protein inside the vesicles, especially at 48 h, where the dengue envelope proteins spread throughout the cells. The alkyne-tagged apigenin showed stronger efficacies than the originals at the EC50 of 2.36 ± 0.22, and 10.55 ± 3.37 μM, respectively. The cytotoxicities were similar at the CC50 of 70.34 ± 11.79, and 82.82 ± 11.68 μM, respectively. Therefore, the newly synthesized, alkyne-tagged flavone did not interfere with the anti-dengue efficacies and was found in cytoplasmic vesicles inside the cells targeting a previously reported ribosomal protein S9 protein. Molecular docking predicted two RPS9-binding sites of both apigenins with similar affinities. The interaction should attenuate dengue productivity by interfering with viral translation and suppressing the viral proteins from trafficking to the cell surface.


This research was a cross-sectional analytic study of both quantitative and qualitative methods. The objectives of the study were 1) to describe the level of Pre-Diabetes Mellitus among Myanmar migrant workers in Suratthani Province 2) to describe the level of Pre-Hypertension among Myanmar migrant workers in Suratthani Province 3) to evaluate the factors associated with Pre-Diabetes Mellitus among Myanmar migrant workers in Suratthani Province 4) to evaluate the factors associated with Pre-Hypertension among Myanmar migrant workers in Suratthani Province and 5) how to solve the problem through policy development support of those having Pre-Diabetes and Pre-Hypertension situation. Five hundred and eight samples of Myanmar migrant workers in Suratthani Province. In the first phase study (Quantitative study) data was collected data by interviews questionnaires; questionnaire structures were constructed based on literature reviews and were used for data collection. Cronbach’s alpha coefficient of stress, attitude, and practice were 0.78, 0.87, and 0.82, and the Kuder-Richardson coefficient of knowledge was 0.77. Multi-stage random sampling was used for sampling selection and data analysis was perfumed using Multiple logistic regression. The second phase (Qualitative study) collected data by focus group discussions and multi-disciplinary meetings. The results revealed that those workers who had a normal blood glucose level of 81.30% (95% CI: 77.66-84.46), had a blood glucose value at risk of 12.60% (95% CI: 9.97-15.78), and had a blood glucose level in the group requires of the clinical confirmation of a diagnosis by a physician of 6.10% (95% CI: 4.32-8.55). Those workers had blood pressure values in the normal group of 31.70% (95% CI: 27.78-35.88) and had blood pressure values at the risk group of 43.70% (95% CI: 39.43-48.06), had blood pressure values had to submit a doctor's diagnosis of 22.24% (95% CI: 18.83-26.07) and had to see a doctor within the same day 2.36% (95% CI: 1.34-15.78). Factors associated with Pre-Diabetes Mellitus consisted of graduating below junior high school students (Adj.OR=2.12; 95% CI: 1.09-4.10; p-value=0.026) married (Adj.OR=1.96; 95% CI: 1.04-3.70; p-value=0.037), unsupported media or materials in Myanmar language (Adj.OR=1.78; 95% CI: 1.11-2.85; p-value=0.016), and the problem of housing environment was moderate/high (Adj.OR=1.71; 95% CI: 1.05-2.77; p-value= 0.028). Factors associated with Pre-Hypertension including age >30 years (Adj.OR=2.77; 95% CI: 1.77-4.33; p-value<0.001), BMI on the overweight /obese scale. (Adj.OR=2.30; 95% CI: 1.50-3.53; p-value<0.001), average family payment per month ≥5,000 baht (Adj.OR=2.28; 95% CI: 1.17-4.44; p-value=0.015), not received health information (Adj.OR=2.28; 95% CI: 1.44-3.61; p-value<0.001), male (Adj.OR=1.97; 95% CI: 1.27-3.07; p-value=0.002), had duration stay in Thailand ≥48 months (Adj.OR=1.69; 95% CI: 1.06-2.71; p-value=0.027), and had work our per day ≤8 hours (Adj.OR=1.60; 95% CI: 1.03-2.49; p-value=0.036), respectively.
In conclusion, the results of this study were found that almost a fifth of Myanmar migrant workers are at risk of Pre-Diabetes and two-thirds are at high blood pressure risk. Factors associated with Pre-diabetes Mellitus and Pre-Hypertension include personal and socioeconomic characteristics, Environment factors, and the health service system. These factors are thought to have a profound effect on Pre-diabetes Mellitus and Pre-Hypertension. The recommendations policies; 1) The development system of spatial management in the public health system should be developed for the special area to operate area-based public health for Myanmar migrant workers. 2) Integrating all health network partners in Suratthani Province and establishing a Provincial Health Promotion Committee for migrant workers is a very useful process for integrating resources for the development of the labor health care system.


This study aims to explore the MDR-TB spreading in an outbreak area of Thailand. A crossectional study is carried out to determine bacteria and host genetic factors relate to MDR-TB infection in patients and their contacts, epidemic process, and treatment outcomes. The sample population including MDR-TB patients who were registered at Makarak hospital between 2014 to 2019. A total of 205 MDR-TB isolates were sequenced and a total of 352 MDR-TB contacts from 152 MDR-TB patients were enrolled in this study. A total of 205 MDR-TB isolates were sequenced, 88.8 % of these were MDR-TB cases, while the other 4.4 % and 6.8% were pre-XDR-TB and XDR-TB respectively. The result of whole genome sequencing and SNPs analysis showed 4 lineages(L) of the MDR-TB genotype in this study, including L1, L2, L3, and L4. L2 of Beijing strains (L2-Beijing) was the most common genotype and 77% of the L2-Beijing genotype belonged to the sub-lineage of Asia African3 (AAF3). When we considered the number of SNPs different among AAF3 genotype, found that 34.1 % of those were clonal. And found that, patient with DM is more likely to be in a group of clonal MDR-TB than without DM. Of 352 MDR-TB contacts, 71.3% were household contacts, 64.1% were working for the age group. There were 31.5% of contact had the comorbid disease, included DM, HT, and other disease were 8.8, 16.2, and 10.5% respectively. A latent tuberculosis infection (LTBI) among contacts of clonal and non-clonal MDR-TB were 27.8% and 30.2% respectively. However, there was no statistically significant difference between these 2 groups (p-value = 0.697). To identify host genetic factors associated with MDR-TB infection, GWAS was used to an identified specific genes associated with MDR-TB infection. We considered contact with IGRA positive as a case and contact with IGRA negative was control. The most common significant SNPs and genes were located on chromosome 6 and HLA gene, including HLA-DRA and HLA-DRB1 which had been reported in previous studies. Other significant SNPs were also found to be associated with TB infection, the SLC1A2 gene on chromosome 11. In summary, a high proportion and homogeneous gentic of AAF3 strain among MDR-TB patients may reflect the adaptation of the strain to spread more readily in thai population, and the increasing of this pathogenic strain may impact the tuberculosis control program. Early diagnosis and contact tracing will be essential to inhibit the spread of these strains. Furthermore, it will be important to ensure that future vaccines protect against these strains.


For disease control such as COVID-19, limiting the spread of epidemics is an important activity. Parts of activities are the roles of primary care or health centers in the area including contact tracing and active care finding. The objective of this study is to develop the methodology to assess the workload of health personnel at primary care in the normal situation and in the COVID-19 pandemics situation in order to identify human resource capacity and gap at primary care level for defending COVID-19 at different levels of epidemics. This study assessed the workload for 6 types of health services by analyzing the related databases and estimating average time of service using previous study and discussion with 9 health centers in 3 provinces. Subtraction of total working hours for 4 types of health personnel including doctor, nurse, public health technical officer, public health officer by service workload (6 types of services) and workload for community services and others (2 hours per person per day in average) was done. The remaining working hours were used for estimating capacity of COVID-19 control activities, in this case, the highest number of contact tracing and active case finding that can be performed in one day at health center level, district level and provincial level for the whole country (except Bangkok). The result of the study showed that in case of using 50% of remaining working hours after subtraction by the existing workload (6 services workload and community workload), there are about 85% of provinces that can perform 2,000 – 8,000 cases per day of contact tracing or active case finding. At district level, there are about 75% of districts that can perform 200 – 800 cases per day. At health center level, there are about 75% of health centers that can perform 20 – 80 cases per day. These figures are based on service data between January and June 2020 which was the first round of COVID-19 epidemics. The result reflects that health centers have different capacity (flexible working hours) for defending epidemics. District level seems to be more flexible and manageable to mobilize human resources within district for not severe epidemics situation and provinces can cover higher volume of active case finding per day. Therefore, the surge capacity plan should be developed at district and provincial level for mobilizing human resources within area in the situation of epidemics.


Development of a health literacy model to enhance self-management behaviors and health outcomes among older adults with coexisting type 2 diabetes mellitus and hypertension in primary care cluster Saraburi province was a research and development. The main purposes of this study were to develop health literacy model of older adults with coexisting type 2 diabetes mellitus and hypertension and to determine the effects of this model. A sample of 150 older adults with coexisting type 2 diabetes mellitus and hypertension visiting in primary care cluster Saraburi province was randomly entered into the experimental and control group, 75 participants for each group. The experimental group participated in the health literacy developmental activities for a period of 12 weeks, whereas the control group obtained regular care. The instruments employed in this research included 1) the health literacy developmental model and supporting documents and 2) the self-management behavior questionnaire. The percentage, mean, standard deviation, t-test, and content analysis were used to analyzed the data. The results showed that: 1. The health literacy developmental model to promote self-management behavior and health outcomes among older adults with coexisting type 2 diabetes mellitus and hypertension consisted of 5 stages as followed: 1) confidence to change, 2) access and understand our disease, 3) communicate and make decisions for health, 4) set the direction for self-change, and 5) continuously perform towards good health outcomes. 2. The effects of the health literacy developmental model to promote self-management behavior and health outcomes were found: 2.1 Post-test mean score of self-management behavior of the experimental group was significantly higher than the control group (p < 0.001). Post-test mean of HbA1c and systolic blood pressure of the experimental group were significantly lower than the control group (p <0.01 and p <0.001, respectively), whereas mean of diastolic blood pressure of the experimental groups were lower than the control group, but there was no statistical significance. 2.2 Post-test mean score of self-management behavior of the experimental group was significantly higher than pre-test (p <0.001), whereas mean HbA1c, systolic blood pressure, and diastolic blood pressure of post-test was significantly lower than pre-test (p <0.001). The results of this study can be employed to develop health literacy to promote self-management behaviors and control HbA1c, and blood pressure among older adults with coexisting type 2 diabetes mellitus and hypertension.


The aim of this study was to study the health effects among workers from BTEX exposure in gas stations. Data were collected from study group of 100 employees who were working in the fuel dispenser area and the control group of 100 workers who were operating outside the fuel dispenser area. The data collection was conducted thro μg h the interview, determined BTEX compounds in the working atmosphere by using a passive badge sampler, and BTEX compounds from urine as well as the blood test serving a biochemical analysis. The findings of the study had shown that, from 200 informants, the majority of study subjects was female with 68.5%, the average age (SD) was 27.78 (5.95) years-old with body mass index exceeded 32%, smoking 21% and alcohol consumption 17%. The physical and mental health condition during the past year was good 85.0% and 74.0%. Percentage of hours worked per week, mostly workers had 1-2 years 28% whereas the percentage of the working hour for more than 8 hours per day was 36%, and worked 6 days per week was 55%. From the interview, 73% of the workers had abnormal symptoms of neurological system, 52.5% had respiratory tract. Personal exposure to ambient concentrations of benzene, toluene, ethylbenzene and xylene (BTEX) assessed by passive-diffusive samplers in a subgroup of 200 workers were expressed as non-detected for all samplers. Urinary concentrations of biomarkers in the whole group were 431.232 (233.69) g/ g creatinine [59.71-1482.46 g/ g creatinine] for t, t-MA, 0.011 (0.001). mg/ l[0.011-0.013 mg/ l for toluene in urine, 0.341(0.125) g/ g creatinine [0.061-0.772 g/ g creatinine] for hippuric acid, 0.062 (0.015) g/ g creatinine [0.03-0.11 g/ g creatinine] for mandelic acid, 0.414 (0.104) g/ g creatinine [0.20-0.88 g/ g creatinine] for methyl hippuric acid. The means ± SD of hemoglobin between exposed group and non-exposed group, hemoglobin (13.08 ± 1.67 g/ dL vs 13.29 ± 1.53 g/ dL), hematocrit (39.75 ± 5.41% vs , 39.95 ± 4.39%), red blood cell count (5.13 ± 0.77 mil/ μl vs 5.33 ± 0.62 mil/ μl), mean corpuscular volume (MCV) (78.82 ± 10.54 fl vs 78.38 ± 10.53 fl), mean corpuscular hemoglobin (MCH) (26.85 ± 3.72 pg vs 27.69 ± 3.11 pg), mean corpuscular hemoglobin concentration (MCHC) (33.34 ± 1.52 pg vs 33.53 ± 1.05 g/ dl), plt (283.91 ± 67.54 x103 cell/ ul vs 285.94 ± 62.80 x103 cell/ ul), white blood cell (8.65 ± 2.46 x103/ ul vs 8.14 ± 1.82 x103/ ul), aspartate aminotransferase (AST) (29.63 ± 29.87 u/ l vs 36.30 ± 10.67 u/ l), alanine Aminotransferase (ALT) (33.88 ± 48.91 u/ l vs 36.15 ± 19.75 u/ l), blood urea nitrogen (17.72 ± 2.52 mg/ dl vs 12.72 ± 3.21 mg/ dl), creatinine (0.77 ± 0.17 mg/ dl vs 0.68 ± 0.14 mg/ dl), HbA1C(5.72 ± 1.06 vs 5.45 ± 0.94), acetylcholinesterase (7.38 ± 1.73 u/ ml vs 7.85 ± 1.49 u/ ml), cardiac troponin(0.49 ± 0.03 ng/ ml vs 0.51 ± 0.08 ng/ ml). Multivariate logistic regression showed that female [P = 0.001, OR = 2.946 (95% CI 1.586,5.471)] were associated with MCH as well as female [P = 0.043, OR = 2.683 (95% CI 1.032,6.979)] were associated with MCHC. Fueling up to 11 or more vans per day [P = 0.019, OR = 3.952 (95% CI 1.252,12.479)] were associated with WBC. Additionally, no wearing a mask [P = 0.021, OR = 4.797 (95% CI 1.264, 18.211)] were associated with BUN. The number of working hours per day was more than 8 hours. [P = 0.032, OR = 3.122 (95% CI 1.101, 8.851)] were associated with SGPT. Operation at the dispenser P = 0.044, OR = 2.618 (95% CI 1.028-6.667)] were associated with acetylcholinesterase enzyme  Multivariate logistic regression showed that overtime over 6 hours per week [P = 0.067, OR = 2.212 (95% CI 945,5.177)] and no wearing closed shoes [P = 0.033, OR = 2.027 (95% CI 1.057-3.887)] were associated with development of neurological symptoms as well as the duration of sleep per day was less than 8 hours [P = 0.008, OR = 2.932 (95% CI 11.1197,7.18)], overtime over 6 hours per week[P = 0.019, OR = 2.932 (95% CI 1.197, 7.18)] were associated with development of mental and emotional disorders symptoms. As a result of these factors can potentially increase risk of developing the neurological system as well as mental and emotional disorders related illness which results from the exposure to BTEX. Therefore, one should find ways to continuously monitor health and working environment surveillance.


Operational system for excellence in medical bioinformatics for lower southern Thailand in health region 12 is a fundamental implementation of genomic medicine in South of Thailand co-operated by the Faculty of Medicine, Prince of Songkhla University and Health Systems Research Institute, Ministry of Public Health. To integrate genomic medicine into the healthcare system in the Heath Region 12, infrastructures including clinical data management, biological sample processing and storage and certified molecular laboratory were considered to be organized in Translational Medicine Research Center (TMRC), Songklanagarind Hospital. Not only infrastructure standardization, but the project has also consent volunteers for clinical data and biological sample retrieval under the approval of the Human Ethical Committee, Faculty of Medicine, Prince of Songkla University. To achieve goal of the study, we included 175 participants covering 3 major genetic associated diseases (hereditary cancer, rare diseases and infectious diseases). Moreover, clinical data and specimens were collected under standard operation procedure of Genomic Thailand Consortium and consecutively shipped to Department of Medical Science, Ministry of Public Health. For the leftover specimens, whole exome sequencing was performed to intensively discover pathogenic variants related to respective participants and their families. Ultimately, annotated exome sequences were comprehensively integrated to establish aggregated exome database which provides useful clinical implication of each variant and regional specific minor allele frequency as a public database. In conclusion, our project has laid infrastructures for genomic medicine and linked them to the clinical environment in the South of Thailand.