The main purpose of the research project, “Improving Capacities for Access to Medicines (ATM) in
Thailand” is to analyze national mechanisms and local-level situation for ATM and to propose policy
recommendations for an improved ATM with regard to the following issues: (1) use of the compulsory
licensing (CL) measure for innovative drugs; (2) national mechanisms for improved ATM; (3) access to drugs in
National Lists of Essential Medicines (NLEM), Sub-list Ngor; and (4) monitoring of purchasing prices and
reimbursed prices of medicines under sustainable financing.
Based on literature review of the ATM context, the main issue for Thailand is about getting access to
innovative medicines, of which various factors on intellectual property and international trade play important
roles. This resulted in unaffordable prices for most developing countries due to market exclusivity of the
patented, branded originator products, coupled with the delayed competition of generic drug industry.
Lessons learnt from international community that could be applied to Thailand include (1) counteracting the
evergreening patents by India using Sections 3(D) and 3(E) and by Australia using information on minimal
therapeutic values of the evergreening patented medicines; (2) regional pooled procurement by Pan-
American Health Organization (PAHO) for drugs used for non-communicable diseases (NCDs) additional to
antiretrovirals, drugs used for tuberculosis and malaria; (3) country’s integrated policies toward strengthening
domestic drug industries in Brazil and Argentina; (4) strong networks of civil societies that were synergetic with
public sectors in incorporating social value judgement additional to technical support in making policy
decision.
Success in the use of CL by the Thai government in 2006 shed light on the following critical success
factors, including (1) collaboration with civil societies and academia to counteract the reaction from original
drug industry, (2) availability of the clear and easily accessible patent databases, and (3) secured sources of
generic drug supply plus available information on production process and finished product quality. Other
alternatives including price negotiation and use of TRIPS flexibilities should be considered as well.
For management of ATM at the national level, the Thai government by Ministry of Public Health
(MOPH) has focused on drugs covered by National Lists of Essential Medicines (NLEM), which have been
established since the first National Drug Policy (in 1981). In early versions, the NLEM covered mostly basic
essential drugs. At present, several drugs were included and ranged from sublist Gor for the basic essential
drugs to sublist Jor(2) for the very expensive drugs.
An innovative policy for improved ATM in the Universal Health Coverage (UC) scheme has been
implemented through National Health Security Office (NHSO)’s Drug Fund. Drugs that have been managed by
the NHSO included those in the NLEM sublist Jor(2), chemotherapy or hormones for outpatients, drugs for thalassemia and hemophilia, clopidogrel, orphan drugs, methadone, drugs of opportunistic infections in
patients with HIV/AIDS, inhaled corticosteroids and long-acting bronchodilators, antituberculosis,
immunosuppressants, morphine, psychiatric drugs (risperidone and sertraline until 2013). Use conditions for
certain drugs might not be in accordance with those Indicated by the NLEM due to different committees.
However, this issue has now been being resolved. Apart from medicines, NHSO managed vaccines under the
Expanded Program for Immunization (EPI) and those under campaigns such as influenza virus vaccine and
Japanese encephalitis vaccine.
In implementing the national policies at the health care service level, because the three major
insurance schemes used different payment methods and mechanisms, pharmacists and hospital personnel
had to shoulder administrative burdens, such as separation of drugs and patients according to eligibility
criteria. Changes in the policies and practices from MOPH, NHSO and Government Pharmaceutical
Organization (GPO) required timely adaptive measures at the health care level and caused job stress to
implementers. Thus, a recommendation would be to reconcile fragmented administrative methods that
factor in limitation of the concerned parties.
For drugs in the NLEM sublist Ngor, of which several are for non-communicable, chronic diseases
such as diabetes (pioglitazone, repaglinide, insulin aspart, insulin glargine), epilepsy (sodium valproate,
lamotrigine, levetiracetam) and high-cost, broad-spectrum, injectable antibiotics for the hospital-discharged
patients, there existed the issues for the UC patients living in the district or sub-district levels. Therefore,
financing mechanisms of health insurance schemes should be available at the provincial or regional levels
(estimated budget for 240 million Baht). To reduce budget constraint, these drugs should be negotiated for
the lower prices using the national mechanism similarly to those in sublist Jor(2). In addition, capacities of
health professionals on proper use of these medicines should be built in order that patients could be
referred back to district hospitals where the medicines could be easily accessed.
For health financing to be sustainable, monitoring of purchasing prices and reimbursement prices is a
crucial mechanism. The quarterly provider price index during 2010-2013 had a decreasing trend for an overall
and for almost all therapeutic classes (166 items in 11 classes). This would make room for fiscal space to
support the ATM in hospitals. Controlling drug prices are the major role played by various committees,
whereby the focal point is MOPH (for the purchasing prices) and Civil Servant Medical Benefit Scheme
(CSMBS) (for the reimbursement prices). Medium prices for lipid modifying drugs announced publicly in 2014
which relied on methods other than mode or median is a stepping stone for controlling the purchasing prices;
whereby lessons learnt from Taiwan’s National Health Insurance on market survey-based price adjustment
shed light on technical feasibility for controlling the reimbursement prices despite limited administrative
feasibility in Thailand. Finally, delay in implementation of the CSMBS’ new reimbursement rates and controversy on cost structure as a required condition for drug registration in the new Drug Act are the latest
unsettled issues.


Background : Quality of infection control in primary care center is very important for community health. The study aimed to develop the primary health center networks of infection control in Chiang Mai province.
Methods : An intervention study was conducted. Two hundred and sixty nine primary health centers were included the study. The interventions were a quality infection control network in Chiang Mai, group discussion for knowledge sharing and infection control guideline manual for primary health centers. Quantitative and qualitative data were collected and analyzed in order to describe impact of the intervention and factors associated successful of the network.
Result : The primary health center networks of infection control in Chiang Mai province were developed. During 17th Apr – 15th Dec 2014, The intervention was implemented to 150 of 269 primary care centers (55.78%). The intervention strengthened the network and improved infection control knowledge of study population.
Conclusion : Infection control nurses networking for knowledge sharing associated/in nosocomial infection control Chiang Mai province was developed by a quality infection control network in Chiang Mai. The effectiveness of the intervention and factors associated successful of the network are studying.


ST segment elevation myocardial infarction (STEMI) is a major cause of death. Recent evidences showed that primary percutaneous coronary intervention (PPCI) can reduce mortality rate. However, in a situation where PPCI is unavailable, facilitated percutaneous coronary intervention (FPCI) using fibrinolytic drug before patient referral could be an important life-saving solution. Since FPCI may increase the risk of major bleeding and it incurred more expenditure, the information on cost-effectiveness of FPCI is useful for policy makers.
A Markov model was used to compare the lifetime cost and quality-adjusted life years (QALYs) accrued to patients receiving FPCI before referral or PPCI at referral center from societal and health system perspective. All analyses were performed using Microsoft Excel. Input data were retrieved from literatures and electronic databases.
We found that FPCI program at community hospital is a dominant alternative given its lower cost and higher effectiveness than PPCI at referral center. This means it is a cost-effective policy option.
Therefore, community hospitals with the capacity to provide FPCI service for STEMI patients should be supported to offer such service for better access to the patients with higher overall quality of life and lower costs to the systems. We suggest that policy makers in the Ministry of Public Health and the hospital administrators should consider these findings and provide support to make FPCI available in community hospitals with existing capacity. Capacity strengthening particularly in terms of manpower, and budget should be provided especially in the areas where there is still shortage of supply.


With a promising import-substituting alternative of electromyography (EMG) needle electrodes used in spasticity treatment, this research aimed to investigate polymer types and polymer coating technologies that were suitable for coating on the needle shaft of the common hypodermic needles. Previous study of the EMG needle electrodes with accessible data of related coating products and Thailand’s commercially available raw materials data revealed a potential technique of implementing the dip-spinning process of aqueous fluoropolymer dispersion coating onto the surface of 316 stainless steel needle shaft. As a result of the former research on topic “a study of polymer coating on needle for medical application” financially supported by National Research Council of Thailand, the newly designed dip-spin coating equipment was used to coat FEP and PTFE on the needle shafts of the common hypodermic needles. Various characterizations and testing of the polymer-coated surfaces were conducted. Depended on predetermined coating parameters, thicknesses of FEP and PTFE could be coated on the needle shafts in the range of 5-10 μm. Both FEP- and PTFE- coated needles showed good adhesion with no polymer film detachment after insertion the needles into a piece of pork shoulder. In addition, the results of penetrating the FEP- and PTFE- coated needles to the injection vial stoppers showed low friction forces and good adhesion. Film adhesion qualities were in agreement with measuring adhesion by using tape test on the FEP- and PTFE- coated flat surfaces of 316 stainless steel plates that showed no detachment. As results of penetrating the FEP- and PTFE- coated needles to the injection vial stoppers, their drag forces were compared with the commercially available EMG needles. Drag forces of the FEP- and PTFE- coated needles were, respectively, 1880-1900 mN and 2650-3000 mN while the commercially available EMG needles from companies A and B were, respectively, 1450-1520 mN and 1400-1900 mN. However, the coats from company A were detached from the needle shafts during penetrating the injection vial stoppers with possible cause of poor adhesion of the coat on the needle shaft. Biological evaluation testing was complied with Thailand’s TIS-1398 sterile hypodermic needles for single use and TIS-2395 Biological evaluation of medical devices. Seven sets of the biological evaluation testing included cytotoxicity testing, irritation testing, sensitization testing, pyrogen testing, haemocompatiblity testing, systematic toxicity testing, and intracutaneous testing.


Drug-related problems (DRPs) such as overdose drug use, drug used without indication, concurrent drug use with possible drug-drug interaction may cause harm to the patients who receive healthcare service at the hospital. Therefore, DRPs are the national burden. Electronic health record (EHR) was widely adopted and used in many hospitals. However, collecting DRPs was not developed and implemented systematically. In addition, categorization of DRPs was not standardized, this could hamper pooling DRPs regionally and provincially. The objective of this research was to develop EHR, which is a part of hospital information (HI) system, to be able to systematically collect DRPs and to standardize categories of DRPs to be user-friendly and can be used in routine work. The committee for EHR and HI development of community hospitals in Ubon Ratchathani Province was met to identify management problems related to DRPs and to gather opinion towards DRPs system. Thereafter, DRPs program was developed and tested to identify any technical problem which was consequentially fixed to make the program more user-friendly and implemented in HI system. The results showed that DRPs management system was different among community hospitals although these community hospitals used the same HI system. Thus, DRPs report was dissimilar. DRPs program developed from the committee’s consensus was user-friendly and appropriated for the routine work. DRPs categories were also standardized. Pooling and reporting DRPs regionally and provincially was reliable and valid. Thus, it is possible to benchmark and evaluate the quality of medical services.


Performance Assessment of District Health System in Tak Province.The aims of this study were
to assess of the provincial and district committee level,in 9 district of Tak province. ), which will assess
the compliance of the project in the context ,input, process, output and outcome .Using the model CIPP
Model of Stoughton Waffle Beam. (Stufflebeam's CIPP Model ) Data were collected and analyzed by
quantitative method with descriptive statistics.
The results showed that the context of each area with the integration of technical development in
areas already include self-assessment. The district health system Using a model planned community with
quality development, including the development of quality guidelines HA PCA standard and are used for
process-driven application development, network management services, process know-how. The
knowledge from routine to research. The input policy, budget, personnel, equipment showed that.
Commented that there is a consistent level. The process Issue Rating Is the process of implementation
Tracking supervision and evaluation The samples of the opinion that there is consistency in the level of
output of the sample is of the opinion that there is a consistent level of results, the sample is of the opinion
that there is a consistent level. The development of district health network. The collaboration at the district
level were moderate consensus. Providing essential health The samples of the opinion that there is a
consistent level. The sharing and development groups. Commented that there is a consistent level. The
involvement of community groups. Commented that there is a consistent level. And the value of work
Sample Commented that there is a consistent level.


The National Health Security Office, region 8, Udon Thani had surveyed the perception and opinions
of health providers towards an increase of funding to facilitate appendectomy, hernia repair surgery
and tubal resection in community hospitals around the North-Eastern region; Loei, Nong Bua Lam Phu,
Udon Thani, Nong Khai, Bueng Kan, Sakon Nakhon, and Nakhon Phanom during the fiscal year of 2013.
The informants consisted of 280 people. The results demonstrated that 66.1% has never known about this
policy before, 72.9% agreed with this policy, and 40% has acknowledged that their hospitals have had the
policy to increase the operations. 76.4% has wished that this kind of policy would not be terminated. The
study revealed that the relationship between the health provider’s perception and the hospital’s policy to
increase surgeries was significant (p<0.05). Three factors influencing hospital to increase the operation
are: 1) the readiness of the operation team, 2) the availability of surgeons, and 3) the convenience of the
patients. However, the first three factors that make “No more” surgical are: 1) the capability of the team is
not enough, 2 ) no surgeon, and 3 ) the risk of being sued.


The objective of this study is to assess the situation of hospital-based smoking cessation clinics in
Thailand from 2007 to 2012 by conducting literature review and assessment in 10 sites supported by
National Health Security Office (NHSO) in order to identify success factors and good practices for scaling
up. The result shows that there are four models such as hospital-based cessation clinics, Quitline service,
cessation services in pharmacies with full-time pharmacist and by dental clinics in public health centres
under Bangkok Metropolitan Authority. Two systems were developed to achieve universal access to
cessation service such as Quitline 1600, cessation clinics supported by NHSO, including SMART Quit
Clinic. Clinical practice guidelines for treating tobacco dependence by physicians and other health professionals,
for which the contents of the guideline can be adjusted to suit each profession, were also issued. In
the ten smoking cessation sites, the structure and services differ slightly depending on the context and
size of hospital. The 5A’s system (Ask, Advice, Assess, Assist and Arrange) was fully integrated into
routine work in all departments without referring the smoker clients to the smoking cessation clinics.
Usually providing consultations and parallel medication are offered. Plans for rehabilitation and followup
with support from network outside hospitals such as health centres and volunteers are the key performance
indicators
This study recommends: 1) In collaboration with organizations involved or with capacity to be
involved in existing cessation services, make services for smokers a special program under NHSO to
improve central and regional systems. 2) To plan and integrate Thai cessation services into one system, set
up a workgroup with clear organizational policies as the responsible body for all levels from ministerial,
regional, district to provincial level. 3) To develop up-to-date educational media for use by cessation
clinics through which standardized cessation techniques can be taught. Provide channels for continuous
report and public relation including seminar, training and research dissemination where those responsible
for cessation clinics are invited. 4) To have personnel throughout the country trained under the same
system, set up a central office responsible for setting consultation and treatment training standards. 5) To
have service conditions set; for patients with chronic diseases make cessation a condition for receiving
services.


The World Health Organization recommends exclusive breastfeeding for 6 months for the baby’s
health and illnesses protection. Several studies have assessed the effect of breastfeeding on the risk of
atopic dermatitis and asthma. This study aimed to systematically review the relationship between duration
of breastfeeding and atopic dermatitis and asthma. We used relevant key words to search for studies
published during 2001-2013 in PubMed database and Cochrane library. Forty-two studies met the inclusion
criteria. The results found that infants not breastfed were at a greater risk of developing atopic dermatitis
and asthma (Relative risk (RR) or Odds ratio (OR), 1.15-11.53) than infants who were breastfed.
Breastfeeding for less than 3 months increased risk of the diseases (RR, OR =1.25-1.45) than infants who
were breastfed for 3 months or more. Breastfeeding for less than 6 months were associated with increased
risk of diseases (RR, OR= 1.15-2.00) than 6 months or more. Several studies show that breastfeeding is
likely to associate with protection against development of atopic dermatitis and asthma. However, since
the literature has a wide range of quality, further studies including meta-analysis study should be undertaken.


As older persons moving through the stage of dependence and seeking for help, some of them needed
to receive care in long-term care facilities. This transition period can be very emotional and stressful event.
This qualitative study aimed to examine the experiences of Thai elderly (n = 19) focusing in their adaptations
in the transitional period in long-term care facilities. Participants (≥ 60 years old) who moved to the
long-term care facilities for at least 6 months and had partially impaired of IADLs or ADLs, were interviewed
using open-ended questions. Example of the questions included: “How do you make the decisions
of moving?“, “What were your experiences before moving?“, “How do you feel about the new place and
come up with?” Qualitative results were analyzed by content analysis. The analysis was made to find the
similarities and differences between the experiences of participants. The results showed that the elderly
experienced their transitional period differently. Key determinant was the extent to which they were able to
control over the decision to move to long-term care facilities. Participants who preserved their autonomy
learned to adapt and accepted the transitional period better than the participants who lost their control.
Meanwhile the elderly who were forced to move and had family conflicts, tended to have depression. Facing
death and functional decline, some elders gained the concepts of life cycle and became more calm and
motivated to modify their behaviors for maintaining their capability of livings as long as they could.


This review aimed to describe the methods that have been used for workforce projections and to
explore the relevant literatures of pharmacist workforce in Thailand and other countries. Determining a
workforce is an important part of workforce projections. Several methods were used for workforce projection
which included: population ratio method, health need method, health demands method, service targets
method, adjusted service target-based method, budget driven mechanisms, workload measurement
method, work point evaluation method, and needs assessment models. The selection of methods used
depends on the availability/accessibility of data and the proposed application. Forecasting the future is a
difficult task and related situations are always dynamic. Therefore, a continuity of workforce projection
studies is essential to ensure the data accuracy in both micro and macro perspectives in order to illustrate
the problem at national and local levels.


Marketing and advertising of food and beverages with high sugar, fat, and sodium are important
environmental factors which influence on children’s eating behavior and health. In 2010, the World Health Assembly, the World Health Organization (WHO) Member States endorsed a set of recommendations on
the marketing of foods and non-alcoholic beverages to children, aiming to reduce the impact of foods high
in saturated fats, trans fatty acids, free sugars, or salts, and expecting cooperation at policy level. The
structure of this document includes a description of the background and process for the development of
the recommendations, an evidence section and 12 recommendations structured under five sub-headings:
1. rationale; 2. policy development; 3. policy implementation; 4 policy monitoring and evaluation; and 5.
research. This study describes theoretical concepts of the set of recommendations, situations, gaps, and
opportunities of food and beverages marketing and advertising regulations in Thailand which correspond
to these recommendations, and analyses 3 mechanisms: policy development; policy implementation and
policy monitoring and evaluation. The review of regulations to control food and non-alcoholic beverage
marketing and advertising to children in Thailand found that Thailand has laws related to marketing and
advertising, which can be deployed to control the marketing and advertising of foods and non-alcoholic
beverages high in saturated fats, trans fatty acids, free sugars, or salt in children. However, the law enforcement
is not as efficient and productive as it should be and there is also a lack of specific regulation to
control food and non-alcoholic beverage marketing and advertising to children.


Referring patients from community to provincial hospitals results in higher direct non-medical costs
(DNMc), which include the costs of transportation, food, accommodation, and informal caregivers. However, these costs have not yet been quantified.
This study estimates the increase in DNMc for referred ambulatory and hospitalized patients. To
approximate the DNMc of patients at community hospitals, a cross-sectional survey was conducted in
three community hospitals in Suratthani province during 16-26 February 2015. The DNMc of patients
who were referred to the Suratthani provincial hospital, were derived from previous studies which reported
the DNMc of patients at this hospital. Cost adjustment was performed using the consumer price
index, with base year 2015. T-tests were used to compare the differences between parameters, with a
significance level of 0.05.
The results showed that, for each day the patients were hospitalized at a provincial hospital, the
costs of informal caregivers were 632.90 Baht higher than those admitted to community hospitals. For
ambulatory care patients, the total DNMc of those referred to a provincial hospital were 513.40 Baht higher
than those receiving care at community hospitals.
Higher DNMc may prevent patients from accessing needed care when referred from community to
provincial hospitals. One way to mitigate this obstacle is to improve the capacity of community hospitals,
thereby reducing the need to refer patients to provincial hospitals without compromising quality of care.


The emergency medical personnel in Thailand are always challenged by the task difficulty in working
with limited resources and spaces, as well as the high risk of encountering traffic accidents. This study
aims to elaborate situation and analyze the causes and factors of the ambulance crash in Thailand.
This was a retrospective analysis of all fatal ambulance crash on Thailand public roadways in 2014, from the secondary data in three main sources, including the database of Information Technology for
Emergency Medical System (ITEMS), the records of surveillance ambulance accident of EMS from
January to December 2014, and the report of ambulance accident investigation collected from the local
network in 2014, using the Haddon’s matrix approach. The study was conducted from January to March
2015. The results are presented using descriptive statistics
According to the ambulance accident surveillance data, 61 ambulance accidents occurred in 2014,
resulting in 130 injured victims and 19 deaths. The accidents happended more frequently during June to
August (25 times). The accident rate was 0.05 with the mortality rate of 0.02 per 1,000 operations. From the
nine accident investigation reports, factors related to accident and safeness of the ambulance could be
concluded into human factors, vehicle and equipment factors, and road environment factors. Human
factors included lack of ambulance driving training, unfastened seat belts, and high speed driving exceeding
90 km/hr. Unregistered ambulance and missing GPS installation contributed to the lack of vehicle
standard. The disparity in each local road environment such as speed curve, crowded site, and missing
directive signs led to higher risk of accident.
This study found that ambulance accidents was increased, resulting in an increasing of injury and
death in emergency medical personnel. The causes of ambulance accidents and risk from the above three
factors were still prevalent. Therefore, it is necessary for the related organizations to implement new policies
and take actions towards preventing future ambulance accidents.


The increasing trend of diabetes mellitus (DM) cases and weak coordination among groups who
take responsibility for taking care of these cases, brought about to the study of holistic care for DM patients
in Chiang Dao Subdistrict Municipality, Chiang Mai Province. Objectives: (1) To explore the problems
related with coordination among stakeholders who involve with health promotion and disease prevention
for DM patients (2) To develop strategic map for the implementation of health promotion and
prevention for DM patients. The study design is qualitative research approached by focus groups among stakeholders as a tool for collecting information. The sample consisted of four groups: subdistrict municipal
authorities, health volunteers, diabetes patients and health workers. Data were collected from 9 June
to 20 November 2014 through focus groups. Data reliability was tested by information contributors and
triangulation. The data were analyzed by using content analysis. Results: 1. Problems were identified in
four categories: (1) Management (2) Man (3) Materials for work (4) Money, 2. Strategic map for the implementation
of health promotion and prevention for DM patient of Chiang Dao Subdistrict Municipality,
Chiang Mai Province, was created comprising: (1) Learning and development perspective, (2) Internal
process perspective, (3) Efficiency perspective, and (4) Performance perspective.
Recommendations from this study are: (1) Development of information system for all groups involved
with DM care system is needed and should be easily accessible, (2) Development of network should
be continously used as a tool for coordinating, and for knowledge and resources sharing, (3) Provision of
knowledge on project planning and management including strategic management to achieve target result
with appropriate method should be in place.


Measuring combination of blood sugar and glycated hemoglobin (HbA1c) is a way to monitor the diabetes progression. However, HbA1c level in the red blood cell keeps constant during its life cycle (120 days), which is somehow too long to be monitored in severe cases. In addition, in condition effecting red blood cell structure or hemoglobin production (hemolytic anemia, thalassemia, and etc.), HbA1c level can be unreliable. Therefore, monitoring the intermediate indicator outside the red blood cell could improve the way to control diabetes progression and treatment.
	The percentage of GHSA in normal serum is 0.6-3.0% whereas in diabetic patient serum has been found to be 2-5 folds higher than normal level. It has become clear that GHSA can be a marker of intermediate glycation and also a causative agent of the damage of diabetes complications, such as atherosclerosis, coronary artery disease and kidney failure. GHSA testing has been strongly recommended for monitor glycemic control for diabetes mellitus in hemodialysis patient and a test for complications associated with diabetes, which can also serve as a monthly report card for type 1 diabetes in the USA. Several GHSA detection platforms have been developed, which include enzymatic assay, colorimetric assay, high performance liquid chromatography, affinity chromatography and immunoassay. Enzymatic and chromatography based assay have demonstrated higher %GHSA due to nonspecific enzymes and imprecise of the binding site on the resin bead. The lower %GHSA has been observed in the immunoassay using antibody that specifically bind GHSA however using antibody are high cost and easily to be denatured
This research program are focusing on development of aptasensor platform for detection of glycated albumin for diabetes mellitus detection and monitoring. Three platforms, which are graphene oxide-aptamer, electrochemical and nanopore sensors, have been developed.
Considering the graphene oxide-aptamer approach, the fluorescence aptamer was fluorescence labeled and incubated with the graphene oxide (GO) and fluorescence signal was quenched. The fluorescence signal was recovered in the presence of GHSA protein. We tested the approach with three known proteins, which were GHSA, HSA, and streptavidin. HSA structure is similar as GHSA structure but streptavidin structure is totally different from the GHSA structure. These results indicated that GO-aptamer approach is specific method for in vitro GHSA detection. After optimization of the serum dilution, we investigated LOD of the GO-aptamer approach at serum dilution 1:5000. We found the LOD of 50 µg/ml at serum dilution 1:5000 with the linear correlation between 0.05 µg/ml and 3 µg/ml
For the electrochemical sensor development, the aptamer was coated on carbon electrodes and electrochemical signal was detected when the aptamer bind glycated albumin. By using this approach, we could detect glycated albumin in PBS buffer and also in serum with the LOD of 30 µg/ml
For the nanopore analysis, we have set nanopore measurement and prepared all components for the analysis. Next study, all components will be assembled and the sensitivity and specificity of the system will be tested.
These results demonstrated that our GO-aptamer and electrochemical approach could potentially be used for simple and sensitive detection and monitoring of GHSA in human, which is an intermediate protein marker for diabetes mellitus. Next study, we will do field test for both GO-aptamer and electrochemical approach.


Objectives: Since our previous study showed the 3 years mortality rate in diabetic patients with peripheral arterial disease (PAD) is very high (56.5%). The investigator therefore would like to evaluate the risk factors to determine the high cardiovascular morbidity and mortality in 3 years cohort study. In this first year report, we illustrated the screening PAD in diabetic patients and then showed the cardiovascular morbidity and mortality rate in 6 month period. Also the risk factors for atherosclerosis was scrutinized.
Method: Between May 2014 and August 2014, consecutive eligible outpatients, aged ≥45 years with established DM in 3 hospitals in Northern Thailand, were invited to be involved in this study. History, physical exam and laboratory test were reviewed. Ankle brachial index ≤ 0.9 was considered PAD. Then patients were evaluated the percentage of risk factor control according to American Heart Association (AHA) criteria. ]
Result: 2,247 diabetic patients were recruited for the study. 286 patients out of 2,247 were diagnosed PAD(12.7%). 236 PAD patients(82.5%) did not have any symptom of PAD namely intermittent claudication, rest pain, gangrene or ulcer. According to AHA criteria, the percentage of adequate control in low density lipoprotein, HbA1C and systolic blood pressure in PAD patients was 18.9, 30.1 and 33.2% respectively. In the 6 months follow up study, there were 11 death, 7 non- fatal myocardial infarction and 3 non-fatal stroke. Comparing with the first visit, the systolic blood pressure and waist circumference was worsening.
Conclusion: The prevalence of PAD in diabetic patients was 12.7%. Most PAD in diabetic patients was asymptomatic. Therefore the ABI screening in all diabetic patients must be performed to early detection and proper management. The atherosclerotic risk factor control was poorly controlled in this group. The number of cardiovascular event was too small to analyse the risk factors to determine cardiovascular morbidity and mortality. More further data are needed.


Aims/hypothesis: The prognostic information about CKD progression, particularly for GFR categories 1 and 2, is still limited. This cohort was therefore conducted to determine the CKD progression using a competing risk approach.
Methods: We conducted an ambi-directional cohort study linking community health screening with hospitals and death registry data in a province of Thailand, from 1997-2011. A competing risk model was applied by treating death as a competing risk factor to estimate 2-, 5-, and 10-yearprobability of kidney failure and median time for CKD progression from lower to higher GFR category.
Results: There were 17,074 non-diabetic and 15,032 diabetic CKD subjects. Diabetic subjects progressed more rapidly through GFR categories with the median times for CKD progression from GFR categories G1 to G2, G2 to G3a, G3a to G3b, G3b to G4, and G4 to G5 of 4.4, 6.1, 4.9, 6.3, and 9.0 years, respectively. Non-diabetic subjects took longer to progress with the corresponding median time of 9.4, 14.0, 11.0, 13.8, and >14.3 years. After adjusting for confounders, diabetic subjects were 49% (cause-specific hazard ratio (csHR=1.49, 95% CI: 1.37, 1.62) more likely to develop kidney failure than non-diabetic subjects. Albuminuria categories A3 and A2 were respectively 3.40 (95% CI: 3.07, 3.76) and 1.71 (95% CI: 1.53, 1.92) higher risk of kidney failure when compared to A1. For each albumin category, death rate increased as albuminuria increased particularly in diabetic subjects, which was approximately two times higher in A3 compared to A1.
Before 2008 (when the “PD first” project was launched), an access rate to renal replacement therapy for kidney failure patients belonging to the universal coverage scheme, civil servant medical benefit scheme, and social security scheme were 1%, 14%, and 18% respectively. The corresponding access rates rose to 25%, 43%, and 56% after 2008. Subjects with kidney failure who were members of the universal coverage scheme had increased risk of death when compared to the other 2 schemes.
Conclusions: Diabetic subjects progress through GFR and albuminuria categories and reach kidney failure about twice as rapidly as non-diabetic subjects.Although an access rate to renal replacement therapy among 3 health insurance schemes has consistentlyincreased since 2008, members of the universal coverage scheme still had substantially lower access rate when compared to the other 2 schemes. Further study assessing factors contributing to such low access rate and comparing CAPD and hemodialysis should be conducted.


Wheezing is an important health problem in Thailand. In this multi-center clinical research, clinical characteristics and biomarkers were studied to determine the factors associated with persistent wheezing in the next three year among pediatric patients with acute wheezing under five years of age. However, this first year report will focus on baseline characteristics including biomarker results. Two hundred and forty pediatric patients, aged 6 months to 5 years, with acute wheezing were recruited from the pediatric wards at Thammasat hospital, Bhumiphol hospital, Saraburi hospital and King Chulalongkorn hospital. Patients’characteristics and their family data were collected. Blood samples were collected for detecting ImmunoCAP specific IgE against common food and inhalant allergens. Serum 25-hydroxyvitamin D (25OHD) concentration was measured by ELISA. Spot urine samples were measured for urinary Leukotriene E4 (uLTE4) levels by enzyme immunoassay. Two hundred and nine data collecting forms with the bioassay results were available for analysis in this report. The mean age of the participants was 26 months with boys of 62.5 percent. First wheeze episode was accounted for 40.6 percent. Seventy five percent was atopic with mono-sensitization (29.3 %). The highest prevalence of sensitization was egg (45.6%), following by cow’s milk (45.3%). The high median urine leukotriene E4 (uLTE4) levels of 226 pg/ml and 956 pg/mg creatinine was documented. The prevalence of vitamin D insufficiency, defined by the serum 25OHD levels of less than 30 ng/ml, was detected for 22.3 percent. Estimating costs of wheezing treatment in preschool children under societal, provider and patient’s perspectives were also studied. Cost data of 136 six participants who admitted with asthma and wheezing at Thammasat hospital, Bhumiphol hospital and Saraburi hospital were available for this analysis. Data from hospital financial database and caregivers’ expenses were collected. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care cost was determined by human capital approach. It is found that societal, provider and patient costs per admission were 18,330±69, 17,055±707, 4,968±644 THB, respectively. The main cost component in all perspective was hoteling cost during admission. The economic burden of asthma and wheezing admission of preschool children in Thailand was estimated as 687 million THB per year. To decrease length of stay and admission rate will save costs of asthma and wheezing care in preschool children.


Background: The WHO surgical safety checklist (SSC) has been globally implemented including Thailand to reduce preventable surgical adverse events. However, it has no national data of SSC implementation in Thailand. This study aimed to evaluate the use, the compliance, the satisfaction, the obstacle, and problem solving of SSC implementation.
Methods: A mixed methods, quantitative and qualitative methods, descriptive study was conducted between November 2013 and February 2015 in 61 hospitals in Thailand, 46 government hospitals and 15 private hospitals. A questionnaire eliciting on demographics, the use, the compliance, the effectiveness, the satisfaction, the obstacle, and problem solving of SSC implementation was distributed to surgical personnel for collecting quantitative data. Three focus group discussions with 39 operating room nurses and in-depth interviews with 50 surgical personnel (10 surgeons, 10 anesthesiologists, 10 operating room nurses, 10 nurse anesthetists, and 10 surgical ward nurses) were performed for gathering qualitative information. Data were analyzed using descriptive statistics and content analysis.
Results: A total 2,024 surgical personnel were recruited. The three majorities were operating room nurses (55.04 %), nurse anesthetists (23.42%) and surgeons (12.94%). Of these, 10.09% was hospital administrators. The means of the use and the compliance with the SSC were 86.98 % (+19.09) and 84.44 % (+20.59), respectively. Overall, surgical personnel satisfied with the SSC at a high level (mean=3.79+0.71). The three most satisfactions were the benefit to the patient (mean 4.11+0.69), the benefit to the organization (mean 4.05+0.68), and affected to reduce the adverse event (mean 4.02+0.69). Overall, the obstacle for implementation of SSC was rated as moderate (mean=2.52+0.99). In the sign in period, overall item was rated as weak (mean=2.41). The two major obstacles were rated as moderate including a surgical site mark (mean=2.67) and evaluating the risk of > 500 ml blood loss (7 ml/kg) in children (mean=2.62). In the time out period, overall item was rated as weak (mean=2.50). The two major obstacles were rated as moderate including the surgeon anticipated critical events (mean=2.77) and all team members have introduced themselves by name and roles (mean=2.72). In the sign out period, overall item was rated as weak (mean=2.34). The two major obstacles were rated as moderate including the surgeon, anesthetist and nurses anticipated the key concerns for recovery and management of the patient (mean=2.56) and nurse verbally confirmed the name of the procedure (mean=2.51).
The qualitative data documented that the major obstacles of SSC implementation included no policy, unclear or impractical policy, poor teamwork or individual cooperation (especially at the beginning), unsuccessful communication to surgeon, and inadequate personnel. Further obstacles were some surgical personnel lack of true understanding about the contents of SSC and process of implementation caused uncertainty, incorrectly, or ineffectively implementation. The SSC was completed before or after the surgery which was not “real time” and the processes were “cut short” to get it done quickly. Additional obstacle was patients’ tiredness of being asked and investigated for many times.
The study suggested that the strategies to improve SSC implementation were the policy enforcement and support from national level (Ministry of Public Health, Ministry of Education) and hospital level. The SSC should be added in the training curriculum for surgeon, anesthesiologist, nurse anesthetist, and operating room nurse, and added in the key performance indicators. Other key strategies were mandatory implementation with clear operational guideline, using collaborative approach, using modern media and technology, performing public relations and campaign, training using role play and station-based model, modifying the SSC suitable for hospital’s context, giving reward, imposing some rules seriously, monitoring and feedback, and patient-involvement. Potential promotion factors were enforcement SSC implementation to the residency training center by the Royal College of Surgeons of Thailand, recognizing surgical adverse events, providing information about the benefit of SSC implementation, and building self-awareness of surgical team.
Conclusion: The use and the compliance with WHO SSC in Thailand was high. The satisfaction with WHO SSC was high. The obstacles of SSC implementation were rated as weak to moderate. These included both structures and processes. The policy enforcement and support, collaborative approach, training with practice, imposing some rules, giving reward, monitoring and feedback, acknowledgement the benefit of the SSC, self-awareness of surgical team, and patient-involvement may lead to improve the use and the compliance with WHO SSC in Thailand.


The flu is epidemic disease that has spread rapidly. Although many patients are not show the symptoms but it lead to loss of time and money. Now a day, there are emergences of new virus outbreaks. A lot of patients were infected with the flu in Thailand. They were admitted to the hospital. The government had lost and enormous of money budgeted to maintain and procurement of vaccines from abroad. They caused the vaccine research and development projects urgently to produce a vaccine for local service providers to reduce the cost of importing. Thereby encouraging vaccination against this disease is essential. However, the respiratory organ is the target to infect from the other viruses. So, the nasal spray vaccine is alternative to produce immune system for protect themselves.
According, this research study of the properties and the nasal spray vaccine raw materials and production processes, injection vaccine nasal spray. Study and design products according to the study and development of a nasal spray vaccine. The development of a computer simulation program was applied to design and simulation the head of nasal spray vaccine. The vaccine has the ability to spray vaccine to the desired size and distribution of the aerosol vaccine. To study the performance of the head of nasal spray vaccine by analyzing the size and direction based on the properties of the vaccine given. That would lead to the production of the vaccine is effective. Results and products include molding and the head of nasal spray. Including, technology in manufacturing processes indeed helpful and support to commercial development in the future.
With education and advanced production technology. This research aims to design and develop the injection head of vaccine nasal spray that had the potential of industry standards to produce the injection head of vaccine nasal spray, referring by "Guidance for Industry Bioavailability and Bioequivalence Studies for Nasal Aerosols and Nasal Sprays for Local Action" published by the Food and Drug Administration (USFDA). After there are the best of design, then to design molds for plastic injection nozzles produce a vaccine injection hole size master with 3 sizes of 50, 100 and 150 microns, which can be sprayed aerosol spray out completely. The tests concluded that only 50 micrometers injector prototype can spray with a particle size in the range of desired properties is 20 - 100 micron particles, which will be distributed and fill to the target organ as directly. The vaccination of 50 micrometers, thereby fulfilling the requirements and can be applied to the nasal spray vaccine. While the vaccine prototype 100 and 150 micrometers, although spray particle size than the size of aerosol particles is preferred from 37.05 to 115.2 and 42.24 to 129.2 micrometers respectively with an aerosol vaccine cannot move to the incident on the organ. The goal is the full unit volume required. The problem will solve by increase the volume of vaccine.
However, three vaccinations prototypes also be applied to use benefit in the pharmaceutical, Medical and the other various public industries. Thailand will be success of the prototype and can produce the vaccine ourselves. In addition, Production technology of molding and prototypes that also be used to study the development and improvement of the products that exactly are beneficial to the country anymore.


With an increasing number of persons with disabilities, the government should provide them with
decent services that meet their needs. One of the crucial services is the provision of assistive devices. The
problem of accessing to the service in Thailand is caused by the inequity of the benefit package provided
by the public health insurance schemes, which can lead to a number of adverse consequences. This study
used qualitative methodology, including review of literature, reports, and other documents that are related
to assistive devices service of the public health insurance schemes in Thailand and other organizations,
to determine the difference of the schemes’ assistive devices benefits. It was found that the different
definitions of person with disabilities for each scheme led to different benefits. In addition, the number
and type of assistive devices and reimbursement methods were different and created financial burden to
persons with disabilities, especially for the scheme that required advanced payment. Furthermore, the
different assistive devices covered in each scheme could prevent disabled persons with certain disabilities
not access to essential medical devices. The integration of benefits and services for persons with disabilities
of these public health insurance schemes is needed in order to reduce inequity problems among them
and make most efficient resource use.


The study aims to investigate an accessibility of assistive technology for people with disabilities and
the costs of assistive technology during 2009-2012. The secondary data was derived from three main sources:
1) Disability survey data (2012) from National Statistical Office-NSO 2) Registration of National Office for
Empowerment of Persons with Disabilities-NEP, Ministry of Social Development and Human Security,
and 3) Database from the budget of assistive devices to people with disabilities: National Health Security
Office-NHSO, Social Security Office and The Comptroller General’s Department. In addition, the data
was analyzed and presented with descriptive statistics.
According to disability survey data (2012), there were 1.5 million people with disabilities in which
accounted for 2.3 % of the population in Thailand. Moreover, the estimation survey showed that 7 out of
10 people with disabilities were still in needs of assistive devices. According to the analysis of three main
health benefit packages in Thailand (Universal Coverage Scheme-UC, Social Security Scheme-SSS and
Civil Servant Medical Benefit Scheme-CSMBS), they annually subsidized with an increasing support of
assistive devices to people with disabilities. The budget subsidized on CSMBS patients was 4 to 10 times
higher than the budget supported to UC and SSS patients. According to the expenditures of assistive
technology: UC’s expenses increased 7 times, SSS’s expenses rose at the lower rate, and CSMBS’s expenses
slightly reduced. However, only CSMBS reimbursed the high price cochlear implant sets that accounted
for more than half of the total costs of devices. Moreover, it is found that cost from an overuse of
the assistive devices in each main health benefit package was increased every year, especially in 2011 the
cost was 6-10 percent of total cost of devices.
People with disabilities under Thailand’s health benefit packages still have an unequal access to
assistive devices. People with disabilities under CSMBS gained more access to assistive devices than other
insurance schemes. Henceforth, the decision makers of Thailand’s main three health benefit schemes need
to revise the policy to make more equal benefits. Moreover, it is necessary to collaborate with both public
and private sectors to solve an inappropriate use (overuse) of the assistive devices that continues to cause
more costs each year.


Medical rehabilitation aims to strengthen or sustain functions of persons with disabilities. The objective
of this research was to explore the current situations of medical rehabilitation services for persons
with disabilities available in public hospitals, including community, general and regional hospitals in
Thailand. The questionnaires were mailed to 215 hospitals in 20 provinces between January and March
2014. The data were derived from 155 hospitals (72 percent response). Descriptive statistics were used for
data analysis.The results showed that, at community level, physiatrists and rehabilitation nurses were employed
in only 4% of hospitals; 88% of hospitals hired physiotherapists and there was no audiologist, speech
pathologist and orthotic technician. There were physiotherapists working in all general and regional hospitals
whereas physiatrists and rehabilitation nurses were found in only 40% and 25% of general and
regional hospitals.
The assessment of disability and prescribing assistive devices were mainly for persons with physical
and mobility disability. The most common services were physiotherapy (100% in regional and general
hospitals, 91% in community hospitals) while speech and hearing rehabilitation services were provided at
the smallest proportion (2% in regional and general hospitals and no service in community hospitals). The
services of training programs for using assistive devices, user follow-up and device repair were still missing
in some hospitals. Visual and hearing aids were unavailable in community hospitals. Medical device
services for all type of disabilities were provided in regional and general hospitals but some items of
devices still were unavailable in some hospitals.


This study aimed to 1) investigate effects of assistive devices on quality of life (QOL) and functional
outcomes in disabled people, and 2) quantify factors affecting access to devices. From March to May 2014,
an observational study was carried out in mobility impaired individuals of ages 15 to 65 years old, who
need to use assistive devices i.e. wheelchair, handicap tricycle and prosthesis leg in 10 provinces throughout
Thailand. The sample was classified into two groups: 1) access group; and 2) without access group.
Individuals that have the assistive device, use it regularly and are satisfied with their device were classified
into the “access group” while those who did not meet the aforementioned criteria were classified into the “without access group“. World Health Organization Quality of Life (WHOQOL) - BREF was used to
elicit QOL while selected International Classification of Functioning, Disability and Health (ICF) codes
were used to measure functional outcomes. This study included a total of 308 individuals in the “access
group“ and 295 individuals in the “without access group“. Compared to those who without access,
disabled people with access had significantly better QOL in all dimensions except for the environment
dimension. Additionally, the “access group“ showed a significantly higher level of functioning than the
“without access group” in all functions with exception to the education. Factors affecting access to assistive
devices were age, health scheme, registrations for disabled people, occupation, and care from family. In
conclusion, assistive devices enhance both QOL and function in disabled population; hence, increase
access to these technologies is crucial. Furthermore, health scheme and disabled registration are government-
side factors influencing access to assistive devices.


This qualitative research aimed to examine the perspectives of three key informant groups purposively
selected from those who had direct experiences in receiving, providing medical rehabilitation services, and those responsible for development of related policy. The data were collected in May and
June 2014 in three focus group discussions (FGDs) involving 11 representatives of persons with disability
organizations, 13 service providers, and 16 executives and managers from respective policymaking
authorities. Content analysis was introduced in the data analysis.
The results showed that access to medical rehabilitation services including assistive devices among
persons with disability (PWDs) was limited. This was because PWDs did not get the information on
benefits and services provided in the public sector, and that most of them needed one or more accompanying
persons when they travelled to receive services. Other impediments included inadequate service
providers and the disparity, in terms of coverage and quality, of the information for PWDs disseminated
by public agencies. The lack of effective system for assistive devices management was identified as crucial
obstacle. It was agreed among FGD participants that health benefits for PWDs in the three governmentfinanced
schemes were different resulted in unequal access to services and assistive devices. Moreover,
when PWDs were employed by private business and therefore, transferred from the Universal Coverage
Scheme to the Social Security Scheme (SSS), their health benefits would be diminished because the latter
scheme covered fewer benefits than the former. To solve the problems as earlier mentioned, the FGD
participants proposed: (1) the National Committee for Empowerment of Persons with Disabilities to
develop mechanisms to strengthen the integration and collaborations of organizations that ensure quality
of life of PWDs and allow PWD representatives to participate in every level of policy making decisions;
(2) PWDs databases currently managed by different institutes be strengthened and integrated with each
other; (3) increase the numbers of health providers for PWDs in particular areas of the country; and
(4) reduce the disparity in health benefits by collectively develop a single benefit package for use in the
three government schemes.


Patient satisfaction on health service is derived from direct experience and expectation of patients,
which directly relates to therapeutic compliance. Results of patient satisfaction can be used in developing the health service system. This study aimed to evaluate the satisfaction of disabled persons on the
rehabilitation and assistive device services, where they were provided in government hospitals. This study
used a structural questionnaire together with face-to-face interview by trained staff and collected satisfaction
information from disabled persons who used rehabilitative or assistive device services at the regional
or general hospitals and community hospitals in 8 provinces, namely Phrae, Phitsanulok, Maha Sarakham,
Roi Et, Lop Buri, Samut Prakan, Surat Thani and Trang. The study evaluated 7 dimensions (with 1-4
sub-dimensions), namely, interpersonal manner, quality of care, service accessibility, finance, environment,
adequacy of providers and equipment, and outcome of services. The data from 244 disabled
persons found that average score of satisfaction in all dimensions was 3.77 out of 5. Interpersonal manner
and quality of care were the dimensions that got the highest score at 4.14 each, while the finance dimension
was scored the lowest at 3.15. The waiting time was scored as the lowest sub-dimension comparing to
all sub-dimensions. However, there were no dimensions or sub-dimensions that scored lower than
3. Some additional comments and suggestions from disabled persons were provided for improving the
services in terms of distance and comfort of settings, and waiting time. Policymakers and providers should
consider those issues as important issues for the improvement of rehabilitative and assistive device
services. The services that respond to the needs of disabled persons can help their compliance and
continuity in receiving rehabilitation and assistive device services, which will directly improve health
status of disabled persons.


Home and environment modifications are essential to improve quality of life (QoL) of persons with
disabilities (PWDs). Our research aimed to conduct economic evaluation of home and environment modification service to develop the service guideline and address policy recommendations to improve
the services and to suggest how the resources should be mobilized. Sixty houses of PWDs were recruited
based on designated criteria. Capacity building sessions for architects, engineers, local builders, nurses,
physiotherapists and social workers were also conducted. Functions of PWDs before and after modifications
were recorded using the questionnaire based on the International Classification of Functioning,
Disability and Health (ICF). Forty-nine houses were successfully modified. The important findings from
this study were that (1) the home and environment modification service was cost-effective (2) health
personnel and non-health personnel should be involved in the selection process of PWDs who are
suitable to receive the service and (3) PWDs and family members should also be invited to participate in
all construction process. Those with the same impairments may not end up with the same design of the
home and environment modifications because the design depended upon PWDs functions. If the ultimate
goal of services for PWDs is to improve QoL, the home and environment modification is merely one
among other tools to enhance QoL. We recommend that to provide the service, the following procedures
should be considered: stakeholder linkage, resource integration and allocation, decision making based
on functioning data and capacity building. Knowledge management should be conducted to add more
knowledge and understandings.


At present, there is a dramatic increase of elderly in Thailand. There is an awareness and there are a number of studies of the significance of the effect of environment on elderly, especially in United State and Europe. However, there is a little knowledge about the design of health care environment for Thai elderly. Moreover, since there is a difference of physical characteristics and psychology between people from United State and Europe, the design recommendation from the studies in these areas seem to not apply to Thai elderly. This is especially there is a little knowledge about the design of environment for Thai elderly in terms of lighting, colour, material and view-out and their effects on visibility and health recovery.
	The main objective of this study is to develop interior environment suitable for the visibility and recovery of Thai elderly. There were two types of hospital to be surveyed,, which are 1) provincial hospital and 2) community hospital. There were two main parts in the study. The first part deals with the effect of interior environment of ward on visibility of Thai elderly. The second part related to the effect of interior environment of ward on recovery of Thai elderly. The results showed the significant effects of factors relating t interior environment of ward. The study also proposed an approach for design guideline of ward suitable for visibility and recovery for Thai elderly in provincial hospital and community hospital.


Background:   Diabetes mellitus and hypertension are major health problem in Thailand. Patients who suffer from these diseases experience undesirable symptoms and complications at target organs that affect levels of quality of life of patients.
Purpose:   This study purposed: 1) to examine quality of life levels of diabetes patients and hypertensive patients with/without complications 2) to explore the method to increase levels of quality of life in diabetes patients and hypertensive patients with/without complications.
Method:   Mixed method design was used in this study for examining quality of life of the patient. Sample of quantitative study include 543 patients with diabetes and/or hypertension and these patient were with/without complications. Study sample was recruited from 17 health care settings in Saraburi province. For qualitative study, sample was 36 patients with diabetes and/or hypertension, including with/without complications. Quantitative data was collected using WHOQOL-BREF-THAI. This questionnaire was tested for validity and reliability. The reliability was 0.82. With respect to qualitative study, data was collected by in-depth interview procedure using the list of 12 questions. Field note and voice-recording were performed during interview with the patient.
Data analysis:  Demographic data was analyzed using frequency, percentage and S.D. Predictive factors of quality of life was analyzed by performing multiple regression procedure. Qualitative data was analyzed and categorized for major theme of perception of quality of life, levels of quality of life, and method to increase quality of life in diabetes mellitus and hypertensive patients.
Results:   Average age of patient was 60.08 years (S.D.= 13.37)  The majority of study sample was female (65.54%, n= 350). The major group of patient was married (66.88%, n= 374 ), and education levels was primary school  (71.64%,  n= 389). The majority of patient was low income, 0-1,000 Baht a month (36.1%, n= 196). Many patients can control diabetes mellitus and hypertension (60.22%, n= 327). The period of diabetes was 3.64 years (S.D.= 7.06), hypertension was  5.47 years (S.D.= 6.89), and both diabetes and hypertension was 2.25 years (S.D.= 8.12) Average score of quality of life of the patient was moderate levels ( = 3.42, S.D.= 1.79). With respect to perspective of the psychological aspect was the lowest score ( = 2.97, S.D.= 1.32) when comparing to all perspectives. The highest score was physical quality of life  ( = 3.61, S.D.= 1.01) With regard to the predictive factor of quality of life, marital status, relationship in family, performing exercise, period of diabetes, period of hypertension, controlled diabetes mellitus and hypertension, and complication of diabetes and hypertension were statistically significant with levels of quality of life    (p≤ .001-.05, r2 = .70). The effect of these predictors on quality of life was .70 (r2 = .70).
For qualitative results: The qualitative data was categorized to be three themes that were         1) the perception of diabetes mellitus and hypertension included diabetes mellitus and hypertension being chronically illness, diabetes mellitus and hypertension being caused by unhealthy behavior, and diabetes mellitus including dry and wet symptoms, 2)  quality of life of diabetes mellitus and hypertension patients included levels of quality of life in diabetes mellitus and hypertension patients being moderate levels, diabetes mellitus and hypertension affecting physical aspect of the patients, diabetes mellitus and hypertension leading the patients to have morbidity, suffering from diabetes mellitus and hypertension having to dependent family member, and caring from health care providers can help the patient to be better 3) methods to improve quality of life included patients with diabetes mellitus and hypertension could have good quality of life by diet control, doing exercise, medication compliant, emotional management, self - management, good caring from health care provider and alternative medicine could help the patient to increase quality of life.


The study of “Self-management, perceived warning signs, risk of complications and management for complication in chronically ill patients (Diabetes mellitus and/or hypertension) in Saraburi province” purposed to examine self-management, influential factors and barriers, and experience to manage themselves of chronically ill patients. Furthermore, the perception of warning signs and risks of complications and management for complication in chronically ill patients (Diabetes mellitus and/or hypertension) in Saraburi province were explored.
Method: Mixed method design in relation to concurrent pattern was used in this study. Study sample was recruited from 18 health care settings in Saraburi province that were sampling by using multi-stage procedure. Quantitative data was collected in 536 chronically ill patients (Diabetes mellitus and/or hypertension) who visited health care settings in Saraburi province.  Qualitative data was collected by conducting person focus group with 165 chronically ill patients (Diabetes mellitus and/or hypertension).
Results: Sample included 536 chronically ill patients. The major group was diabetes mellitus with hypertension patients (n=231, 41.09%), hypertension patients (n= 214, 39.93%), and diabetes patients (n= 91, 16.98%). Average age of sample was 60.4 years (SD= 12.13) Maximum age was 94 years and minimum age was 21 years. Average period of suffering from diabetes mellitus was 5.04 years (SD=6.78), and hypertension was 6.29 years (SD=8.13). The majority of the patient was female (n=360, 66.90%). The major of education was primary school (n=392, 73.13%)  The number of patient who had or had not family members suffering by chronically illness was not difference (51.87% and 48.19% respectively).  The majority of co-morbidity was hyperlipidemia (n=211, 39.37%) The major sample has no complication (n=381, 71.08%)  The majority of complication was neuropathy (n=81, 15.11%)
With regard to health behavior, the majority of study sample was no smoking (n=492, 90.49%), no drinking (n=485, 90.49%), eating high fat diet (n=194, 36.19%), eating spicy food (n=179, 33.40%), having lower than 3 meals a day (n=171, 31.30%), drinking tea, coffee and pop more than two cup a day (n=166, 30.97%) and eating frequently  (n=137, 25.56%). The majority of patient did not doing exercise (n=320, 59.70%). With regard to patient who performing exercise, these patient did standard exercise (n=61, 28.24%). For the type of exercise, the majority was arm swing (n=63, 29.17%) and walking (n=53, 24.51%), running (n=22, 10.19%) and aerobic exercise (n=10, 4.10%).  The majority of sample had ability to care for themselves (n=442, 82.46%). The major group of patient had good social support from family members, friends and health care providers (n=442, 82.46%). The majority of sample had recreation activities and they have religion and family to lead themselves (n=305, 56.90%) and came to visit as appointment (n=521, 97.20%)


ST segment elevation myocardial infarction (STEMI) is a major cause of death. Recent evidences showed that primary percutaneous coronary intervention (PPCI) can reduce mortality rate. However, in a situation where PPCI is unavailable, facilitated percutaneous coronary intervention (FPCI) using fibrinolytic drug before patient referral could be an important life-saving solution. Since FPCI may increase the risk of major bleeding and it incurred more expenditure, the information on cost-effectiveness of FPCI is useful for policy makers.
A Markov model was used to compare the lifetime cost and quality-adjusted life years (QALYs) accrued to patients receiving FPCI before referral or PPCI at referral center from societal and health system perspective. All analyses were performed using Microsoft Excel. Input data were retrieved from literatures and electronic databases.
We found that FPCI program at community hospital is a dominant alternative given its lower cost and higher effectiveness than PPCI at referral center. This means it is a cost-effective policy option.
Therefore, community hospitals with the capacity to provide FPCI service for STEMI patients should be supported to offer such service for better access to the patients with higher overall quality of life and lower costs to the systems. We suggest that policy makers in the Ministry of Public Health and the hospital administrators should consider these findings and provide support to make FPCI available in community hospitals with existing capacity. Capacity strengthening particularly in terms of manpower, and budget should be provided especially in the areas where there is still shortage of supply.


Road accident tends to rise, resulting in enormous loss of lives and assets. According to statistics of deaths from road accident from The World Health Organization found that Thailand mortality rate was 38.1 deaths per 100,000 populations and 3rd in the world ranking. The purpose of this report was to study the situation of trauma care process in Ministry of Public Health hospitals in regional health 3 through mixed methodology research. 382 traumatic patients were randomized from Emergency Department and 59 of administrators and staffs were interviewed and group discussed.
The result found that most traumatic patients were urgent. The average time of care in Emergency Department was 86.4 minutes. Most were highly satisfied to the services. Most traumatic patients entered to hospital privately. Patients who came with ambulance would communicate directly through emergency call of 1669 in trust of the safety system. The problems of Emergency Room management were insufficient of medical personnel especially emergency physicians and inadequate of referral system, budgets, equipments and information system including lacking of coordinated work and integrations with Fast Responder unit of other local government and foundations.
The policy recommendations from this study were Ministry of Public Health and Emergency Medical Institute should long-term plan to support emergency physicians and other medical personnel for hospitals in any level from A,S,M to F in 5-10 years. Including encouragement of local government to participate in developing of emergency system.


Background: Increasing trend of Traditional and Complementary Medicine use has been documented worldwide. In many developing countries, the majority of the population continues to use Traditional Medicine to meet its primary health care needs. In Thailand, the Thai Traditional Medicine service is a priviledge for all Thai according to our constitutional as well as Universal Health Care Coverage program. However, none of the study has been conducted to survey for Thai Traditional and Complementray Medicine (TT&CM) services together. This study therefore aims to survey the data base of TT&CM services as well as to study the factors influenecing outpatient department utilization of TT&CM services of Ministry of Public Health hospitals.
Method: The data base of TT&CM services were collected from October 2013 to March 2014. The structured collection sheet was distributed and collected through the 76 representatives of Thai Traditional services at the Health Provincial Office. The factors influenecing the outpatient department utilization of TT&CM services were analysed with Pearson’s Correlation, Independent t-test and multiple linear regressions.
Results: There were 266 from 456 hospitals have been reported their information. The response rate was 58.33. Only 231 hospitals (86.84%) could be analysed. One hundred percent reported that they have provided Thai Traditional Medicine services with 186 hospitals (80.52%) provide only Thai Traditional Medicine services while 45 hospitals (19.48) provide TT&CM services. The ratio of outpatient department utilization of TT&CM services among Ministry of Public Health hospitals was 16.69. Factors influencing outpatient department utilization of TT&CM services were the number of staffs (p-value<0.001), clinical competency for inpatient services (p-value=0.002), the number of staff receiving wage at least 15,000 Baht per month (p-value=0.017), being a study/ visiting site for education (p-value=0.011), continuing year of services (p-value=0.004) and herbal consumption value (p-value <0.001).
Discussion and Conclusion: Results of this study reveal that the numbers of Minsitry of Public Health hospitals providing TT&CM services are increase. To support TT&CM services, human resource planning along with reliable wage, clinical skill for Thai Traditional doctor especially inpatient services and networking with university are prioritized factors.


Maternal and child health (MCH) situation in three southernmost provinces has been in a critical stage. MMR was about three times higher than country’s targets and almost two times in MDGs Plus target, lower than the performance in almost all indicators. Most deaths due to causes that can be prevented in the context of modern obstetrics. There is only a small detail that seems to be absent. Prenatal care to pregnant women with traditional midwives. The way of life, religion and cultural norms determine the practice of pregnant women. But it is not seen as important as surveillance and health complications.   Key factors which affect the success of maternal and child in three southernmost provinces are
1. Manpower  : Turnover rates are frequent, because it is a difficult task, required high skills and experience. More tools and indicators and some indicators are not consistent with the context in three southernmost provinces.
2. Belief : Two believes persists that determines the norms and practices of pregnant women are 1) do not eat more and do not take the medicine  2) seek female personnel’s service for delivery. Including lifestyle, religious values are very high in regard to procreation, and that the death is natural. The attitude that contraception is wrong, against the principles of Islam.
3. Traditional Birth Attendants (TBA) : TBA is the strength of maternal and child health in the southernmost provinces. Pregnant women are faithful and believe in TBA. While Islam still had limited access to medical services.
Suggestion and Policy Brief
1.	Urgent measures : Cooperation with TBA to reduce MMR (Maternal Mortality Rate) in three southernmost provinces. Development competency TBA to learn assessment of high risk pregnancy, refer and delivery of emergency cases safely. Appropriate Incentive measures are important. We should also encourage Muslim husbands to have proper attitude and to help woman during pregnancy and childbirth.
2.	Medium and long term measures : Department of Health and related agencies  should review policy,  strategy and tools that is flexible, affordable and possible. Provides analysis and support capacity in maternal and child health. We should put more obstetricians in the three southernmost t provinces and enhance them and their MCH team to understand the way of truly Muslim.


Treating ischemic stroke patients with rt PA no more than 3 hours or 180 minutes after the stroke can increase the chance of recovery or improved condition.  If, however, treatment is delayed, the potential outcome may be permanent disability or death.  This descriptive study was conducted with the objective of assessing time elapsed before treatment in ischemic stroke patients and analyzing the factors influencing the amount of time elapsed before ischemic stroke patients receive hospital treatment.  The sample group was composed of 300 ischemic stroke patients treated at Sanphasitthiprasong Hospital in the province of Ubonratchathani, Thailand.  Data were collected from November 2014 to February 2015.  The following three sets of instruments were employed:  1) Demographic Data Questionnaire; 2) Ischemic Stroke Evaluation Form and 3) Time to Treatment Evaluation Form.  Data were analyzed by descriptive statistics and by finding the correlations by using Spearman's correlation coefficient.
According to the research findings, 229 of the 300 ischemic stroke patients (76.3%) had pre-hospital times of more than 180 minutes.  The mean pre-hospital time from the occurrence of stroke to hospital arrival was equal to 1,117.7 minutes (SD=1,556.4).  The amount of time elapsed from arrival in the emergency room at Sapphasitthiprasong Hospital until receipt of treatment (in-hospital time) was equal to 134.0 minutes (SD = 93.4).  Therefore, the mean time from the initial presenting symptoms until treatment was equal to 1,218.7 minutes (SD = 1,602.0).  Furthermore, the pre-hospital time, the distance from the site of the incident to the hospital and the in-hospital time from arrival until laboratory test results were received were found to be positively correlated with the pre-hospital time from the initial presenting symptoms until receipt of treatment (rs= .661, .185, .235, p<.01).  The severity of symptoms evaluated with NIHSS scores was found to be negatively correlated with pre-hospital time (rs= -.129, p<.05).
In summary, most ischemic stroke patients within the boundaries of Ubonratchathani receive delayed treatment in which the pre-hospital time has the highest correlation with receipt of treatment and instructing patients, people at risk for ischemic stroke and their relatives.  Moreover, the development of an emergency medical service provision system and a hospital referral system that minimizes procedures and time in transferring ischemic stroke patients is vital to helping ischemic stroke patients receive timely treatment.


The incidence of childhood obesity in Thailand has become increasingly high and its effects are likely to worsen in the future.  To control and prevent obesity effectively by behavioral changes, various levels of control and factors are needed.  This two-group pretest-posttest non-equivalent control quasi-experiment aimed to compare health behavior and the lost weight among overweight secondary school students before and after the experiment.  The subjects of the study were male and female students whose weight was over the standard weight studying in secondary schools in Hat Yai District of Songkhla Province.  There were 51 students in each group of the control and the experimental groups.  The behavioral change tools consisted of administrative policy, physical environmental development, peer influence, health service systems, parents program, food sellers program, and health behavioral change program for overweight children.  The experiment was from July 2014 to February 2015.  The general data were analyzed with frequency and percentage, health behavior and weights before and after the experiment were compared using Wilcoxon Signed Ranks Test and Mann-Whitney U Test.  Analysis was performed with qualitative data on school administrative policy, physical environmental development, health service system, and food sellers in the school.
	The study found that after the experiment, the experimental group had a higher level of health behavior in food consumption than the control group at a statistically significant level of p<.05, the level of health behavior in exercise for the experimental group was also higher than that for the control group at the level of p=.05.  The effects of the programs on weight loss revealed that the average of ordinal scale for the experiment group decreased with a statistic significance of (p< 0.05) while that for the control group increased with a statistic significance of (p< 0.05).
The results of the study indicate that the health behavioral change program improved health behavior among the overweight secondary school students, and decreased their weights.


The research and development study aimed to develop a model of lifestyle intervention to prevent type 2 diabetes mellitus (DM) in high risk group.
Methods:	The lifestyle program was applied from the diabetes prevention program (DPP). Researcher team and public health nurses in District Health Promoting Hospitals (DHPH) performed seven meetings to deliver education and empowerment consisted of healthy diet, physical activity, stress management and social behaviors. The participants in intervention group were encouraged to match as a “buddy” for coaching each other throughout 16 weeks of the program. Quasi-experimental study was used to evaluate the effectiveness of the model. Participants were selected from high risk group of DM in the local community, Kudjub district, Udonthani province, Thailand. The outcomes were body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), health behaviors, and satisfaction of the program.
Results:	Totally, 6o participants (30 persons in intervention and 30 in control group) participated. After 16 weeks, adjusted mean difference of FBS (90.1 mg/dl in intervention vs 95.3 mg/dl in control group) and BMI (25.7 vs 29.1 kg/m2) were not significant between two groups. WC was significantly decreased in intervention group compared to control group (mean difference –5.9 cm; 95%CI = –9.4 to –2.4; p=0.001). Health behavior (mean difference 3.6 score; 95%CI = 0.3, 6.9; p=0.035) and knowledge (mean difference 2.0 score; 95%CI = 0.6, 3.4; p=0.006) were significantly increased in intervention compared to control group. Overall, 96.7% of the intervention group was satisfied and very satisfied with the program.
Conclusion: 	Lifestyle intervention program demonstrated significant improvement in WC and health behaviors. The program could lead to prevent type 2 DM in the local community.


The purpose of this study was to examine changes in body mass index among elderly in royal denture bestowed project. The study design was a retrospective cohort study. Data collection was carried out in 436 subjects, from 6 months to 2 years after denture services. Multiple linear regression was used to analyses the relationship between denture use and body mass index adjusted for gender, age, income level and baseline body mass index.
	The results showed that the denture use significantly increased body mass index of elderly in royal denture bestowed project (P < 0.05)


The methodology of this research was a Mixed method ,combination of survey research and In-depth interview. The Objective to study medical rehabilitation services situation ,  to study factors relating to access of medical rehabilitation service amongst  people with mobility impairment and to utilize information for policy planning in the aspect of development of the service system. A sample of people with mobility impairment were drawn using multi-stage sampling from 10 provinces in 4 regions of Thailand. The samples used in the research were 400. The questionnaire was used to collect the data from June to September 2013.The response rate was 97.25%. The data were analyzed using percentage, mean, standard deviation, t – test, F test, chi-square test, and Forward stepwise logistic regression analysis. The study results situation of 26 items of rehabilitation services, service sectors can provide only some items. The most accessibility of service consist of evaluation, medication and advice & councelling. While the less accessibility consist of vocational rehabilitation, skill & knowledge training for care giver and social skill training for  people with mobility impairment. Correlation factors according to rehabilitation accessibility consist of gender, medical right, type of impairment, onset of disability, travelling to the health service and public facilities. These factors can be used as a predictor of rehabilitation accessibility at 14.5 percentage.


Performance Assessment of District Health System in Tak Province.The aims of this study were to assess of the provincial and district committee level,in 9 district of Tak province. ), which will assess the compliance of the project in the context ,input, process, output and outcome .Using the model CIPP Model of Stoughton Waffle Beam. (Stufflebeam's CIPP Model ) Data were collected and analyzed by quantitative method with descriptive statistics.
	The results showed that the context of each area with the integration of technical development in areas already include self-assessment. The district health system Using a model planned community with quality development, including the development of quality guidelines HA PCA standard and are used for process-driven application development, network management services, process know-how. The knowledge from  routine  to research. The input policy, budget, personnel, equipment showed that. Commented that there is a consistent level. The process Issue Rating Is the process of implementation Tracking supervision and evaluation The samples of the opinion that there is consistency in the level of output of the sample is of the opinion that there is a consistent level of results, the sample is of the opinion that there is a consistent level. The development of district health network. The collaboration at the district level were moderate consensus. Providing essential care The samples of the opinion that there is a consistent level. The sharing and development groups. Commented that there is a consistent level. The involvement of community groups. Commented that there is a consistent level. And the value of work Sample Commented that there is a consistent level.


The purpose of the project was to (1) conduct a baseline survey of health behavior
in type 2 diabetic patients with low risk of cardiovascular disease (CVD) (less than 10%) and
those with high risk of CVD (20% and more), according to the 10 year risk of cardiovascular
events prediction chart developed by the World Health Organization (South-East Asia: SEAR
B) and (2) explore factors associated with health behavior in type 2 diabetic patients with
risk of cardiovascular disease. The PRECEDE-PROCEED Model was used as a framework to
guide the survey development for data collection. The methods of data collection consisted
of 2 phases as follows;
The 1st Phase: The development of the survey instruments. In this phase, the data
was collected from a hospital in Samutsakorn province. At the beginning phase, focus group
was conducted in 10 type 2 diabetic patients to develop the questions, and then sent to
experts to examine how well the questions corresponded to components of The PRECEDEPROCEED
Model. The questionnaire was pilot-tested in 30 type 2 diabetic patients and
refined. To further test and refine the survey, 228 type 2 diabetic patients completed the
final version of the questionnaire. The items of the questionnaire were analyzed by using
factor analysis to determine if there were unnecessary items and identify sets of measures
reflecting different dimensions of the questionnaire. After removing or adding some items,
this process resulted in a final 60-item questionnaire for associated factors and 38-item
questionnaire for health behavior.
The 2nd Phase: The survey administration of factors related to health behavior. In this
phase, 566 type 2 diabetic patients with risk of CVD, who received treatment from a hospital
in Ayutthaya province from May to October 2014, were recruited and asked to complete the
questionnaire. These participants included 169 high risk of CVD group (20% and more) and
397 low risk of CVD group (less than 10%). The result showed that there was no significant
difference in health behavior between diabetic patients with low and high risk group. No
difference among groups in food consumption, risk behavior, and physical activity, whereas
treatment plan adherence was greater in the diabetic patients with low risk group compared
to those in the high risk group. Self-efficacy, perceived barriers, and social support were
accounted for approximately 19% of total variance in predicting health behavior. Recommendation of the study was that health service should be designed to initially
increase patients’ perception in their efficacy and reduce perception in obstacle to perform
health behavior in order to motivate their awareness in the possibility to get the
cardiovascular disease and then affect their readiness to manage their own health.
Engagement of patients’ social support should be concerned when conducting the lifestyle
modification program including family members and friends. Knowledge and health
promotion skill improvement program for health volunteer should be established due to
the findings that information availability from them was the least compared to those from
another resource.


Background: End stage renal disease (ESRD) cause the high morbidity, mortality, and cost in health
care system. The prevention of chronic kidney disease/ESRD is the early recognition and
appropriate treatment of the etiology disease. Glomerulonephritis (GN) is the third most common
cause of ESRD in Thailand comparable to the Western country. The development of qualified
registry and GN network may improve the health care service and accurate epidemiological data
that support the further studies in both clinical and translational research.
Objective: To develop web-based On-line Thai Glomerular Disease Registry for studying the
epidemiology and clinical outcomes of glomerular diseases in Thailand. To develop Thai
Glomerular Disease Collaborative Network (TGDCN) through the country for creating the GN
database and supporting together in taking care of the patients. To perform the clinical
recommendation in GN management.
Methods: TGDCN originally consists of 9 tertiary care centers. We developed the Web-based
Online registry to collect the data from all native kidney biopsy-proven GN patients with aged >
18 years after approval by the ethical committee of each site. We recorded the demographic data
including gender, age, education, native habitat and the laboratory tests including serum
creatinine, albumin, cholesterol, urinalysis, proteinuria, serology tests and the pathological
findings. The clinical outcomes including remission, flare, doubling of serum creatinine, renal
survival, and patient survival were investigated.
Results: We recruited 666 patients performed kidney biopsy during Jul 1, 2014 to Jun 30, 2015.
The female to male ratio was 2.16:1. The mean age, creatinine, albumin, and cholesterol were 42
(18-82) years, 1.4 (0.4-13) mg/dL, 2.9+0.8 g/dL, and 296+118 mg/dL in respectively. The median
proteinuria was 3.2 g/day and ranged 0-22 g/day. The patients presented with 34% of nephrotic
syndrome, 22% of nephritis, 21.7% of nephrotic nephritis, 52% of renal impairment (creatinine >
1.2 mg/dL), and 54.4% of new or aggravated hypertension. The renal pathological findings showed 38% of lupus nephritis (LN), 17.6% of IgA nephropathy (IgAN), 9% of focal segmental
glomerulosclerosis (FSGS), and 8.9% of membranous nephropathy (MN). The mean age of LN,
IgAN, FSGS, and MN were 34, 38, 46, and 50 years. The average creatinine at biopsy of LN, IgAN,
FSGS, and MN were 1.9, 2.4, 2.4, and 1.1 mg/dL. Due to the time limited, the clinical outcomes
were not described at this time.
Conclusion: Our study described the first three common renal pathological findings including LN,
IgAN, and FSGS They were in the working age and presented with the initial renal impairment at
kidney biopsy. This might be the severity of the disease or the delay in performing biopsy due to
limitation of facility in kidney biopsy procedure and referring system. In addition to the data from
Thailand Renal Replacement Therapy (TRT), LN, IgAN, and FSGS were the most common GN
causing the ESRD in our country. Early diagnosis and proper management should be improve the
clinical outcomes among these patients.


The aims of the study of “People With Disabled, Phitsanulok Taxi on Demand Systems” focus on four main components which are; 1) to survey the transportation demand of people with disability and the ability to provide service by the entrepreneur/taxi drivers; 2) to review the regulations and/or the standards of transportation service for disabled people that are represented both in Thailand and in other countries around the world; 3) to analyze and to find the appropriate way to support and assist the taxi service system for people with disability; 4) to design and to experiment the taxi service information system for people with disability.

The study found that

1. Transportation is essential for people with disability. It does not only provide a need purposely for disabled people but also it does reframe the society’s perspective toward disability.

2. Taxi service in Phitsanulok can be able to serve the people with disability in six aspects, which consist of; 1) the indistinguishable feeling of disabled people from ordianary ones when using the taxi service; 2) the assistance for getting into and out from the vehicle; 3) the assistance of taxi driver for lifting the passenger’s belongings; 4) the ability of taxi driver to communicate with the passenger when providing the service; 5) the hospitality and service mind to serve people with disbility; and 6) the ability to assist in case of emergency.

3. The designed information system is called “TODIS: Taxi on Demand Information System”. It purposely aims to represent a user friendly interface and comprehensive information regarding transportation service for disability, which can be viewed in the following links: http://www.wearehappy.sci.nu.ac.th/plk/taxi4dp/ and http://www.wearehappy.sci.nu.ac.th/plk/taxi4dp/taxiservice.html

4. The foundation of taxi service system for people with disability in Phitsanulok is an important key point to consider and it is needed to perform in order to improve the system to be a suitable and functional service in the future. According to the results of the study, it is suggested that; 1) the taxi drivers have to customize their vehicles to suit the disabled person; 2) it is necessary to build the knowledge and attitude of the taxi drivers toward the disabilties; 3) the taxi service is needed to call via the call center service; 4) local administrative organization plays an important role in terms of transportation service for disability due to it has responsibility to improve the wellbeing and quality of life of the disabled people who live in the area of responsibility; and 5) it is necessary to determine the reasonable extra transportation fee for people with disability.


It has been well-recognized that quality control (QC) samples are essential for routine testing results, particularly HIV serology testing conducted by a rapid test. This study was to establish Dried Tube Specimens (DTS) for implementing as QC samples at laboratory networks of RMSC 1/1 Chaing Rai and RMSC 3 Nakhonsawan. DTS were delivered to 48 community hospital laboratories and were tested 1 time a week for 4 months. It was found that 1302 of 1350 (96.44%) tests and 48 of 1350 (3.55%) tests were reported positive and negative, respectively. Our study suggested that it is possible to use DTS as QC samples for HIV rapid testing. HIV misclassification might possibly be due to testing procedure, reading test results or competency of technicians. Owing to its ease of preparation and storage, DTS are alternative tools for community hospital laboratories to use as quality control materials as a requirement for routine testing in compliance with medical laboratory standards.