As Thailand enters ageing society, it is increasingly necessary to be economically and socially prepared. The health care system deserves particular attention for the reason that elderly’s health tends to deteriorate overtime. In this regard, in fiscal year 2016, the National Health Security Office (NHSO) allocated 600 million baht for the “Long-term Care System for Dependent Elderly (LTC)” program. The objective of this study was to analyse the effectiveness of long-term care services under the LTC program in Udon Thani province. The study examined a total of 405 elderly who received long-term care services. The participants were divided into two groups: a control group of 261 elderly who received regular services; and an intervention group of 144 elderly who were under the LTC program. The elderly participated in the LTC program received long-term care services according to care plan provided by care manager. The services included vital sign measurement, Barthel activities of daily living (Barthel ADL) care, and physical therapy. After four months of receiving long-term care services, the effectiveness of the LTC was analyzed based on the average Barthel ADL index of both groups of participants. The study found that both regular services and LTC program encouraged the elderly to be more independent in performing activities of daily living. Specifically, the intervention group has significantly higher Barthel ADL index than that of the control group (p<0.05) by approximately 1 point. This difference suggests that the LTC program was likely to be more effective than the regular program. In addition, the LTC program was more cost-saving than regular services. The LTC program costed only 0.72 million baht, saving the intervention group’s costs of care by approximately 5.7 million baht. The results suggested that the government should support the LTC service and encouraged participation from various societal sectors, ranging from family, communal, local, to governmental levels.


This research aimed to analyze the expenditure in patients with diabetes mellitus. This study was a retrospective descriptive study. Data was collected from electronic medical record by HOSxP of Bangbuathong Hospital in Nonthaburi since 1 January 2012 to 31 December 2014. Cost analysis was based on 2 concepts of disease classification. The concept 1 was chronic disease group system and the concept 2 was complication risk assessment system. Descriptive statistics such as frequency, percentage, mean, was performed for baseline characteristics, and analytical statistics such as coefficient of variation (CV) and reduction in variance (RIV) for testing of classification. The results showed that there were 1,066 patients with diabetes mellitus. Most of them were women (71.95%). The average age was 65.42 ± 10.29 years and most were covered by the universal health coverage scheme (86.87%). The average expenditure was 6,442.26 baht per person per year (SD = 3,904.78). Disease classification by both concepts had CV lower than 150% and decrease RIV. The concept of chronic disease group system had clarity in the pattern of payment, pattern of disease and items of medication. The concept of complication risk assessment system had clarity only on the pattern of payment, but not on the pattern of disease or items of medication. Further research and development on outpatient disease classification should focus on the concept of chronic disease group system.


The implementation of decentralization concept under Thai health policy follows the National Health Security Act B.E. 2545 (2002) and Determining Plans and Process of Decentralization to Local Government Organization Act, B.E.2542 (1999). Community health funds (CHF) have been set up by National Health Security Office (NHSO), Ministry of Public Health, and Department of Local Administration, Ministry of Interior at the subdistrict level, emphasizing on participatory process. CHF primarily aims to support health-related activities done by communities and organizations based on community demand and readiness. CHF can be used for health promotion, prevention, rehabilitation, and proactive primary healthcare. This study was a mixed-methods study conducted in the Public Health Region 11 (upper southern Thailand). First, tertiary data from NHSO region 11 was analyzed to provide an overview of the regional situation. Afterwards, interviews were conducted; interviewees included NHSO region 11 personnel and subjects from 10 subdistricts (6 subjects for each subdistricts: 3 CHF committee and 3 non-CHF committee). We were able to complete 57 of 60 planned interviews from the subdistricts. Among 10 subdistricts, 5 were selected from the eastern coast; other 5 were selected from the western coast with mixing between good and bad performance CHF of those subdistricts. Two subjects from a provincial state audit office were also interviewed. Moreover, a population survey was conducted in those 10 subdistricts. The sample size was 350 (35 subjects from each subdistrict). Subjects were residents of each subdistrict aged 18 years and above who did not work with SAO or public health centers/hospitals. Preliminary results were presented to stakeholders including NHSO, SAO, community members, public health officers, and HSRI on 28th June 2018. Discussion during the presentation were recorded, analyzed, and included in the final report.


The study is aimed at implementation evaluation of the three core interventions in health promotion among adult population during 2556-2560 BE which include projects of Health Promoting Hospital, Flat-belly workplace, and DPAC Clinic. Evaluation includes policy implication, supportive measure, implementation, outputs and outcomes as well as key success factors. Situation analysis and literature review Review situation of NCD in Thailand shows that prevalence of overweight including obesity has been obviously increasing during the past two decades and currently reaches 48% among adult population. Thus creates burden on health service delivery and overall socio-economic status of the country, with estimate of annual economic loss of 12,000 THB. Comparative review in different countries emphasized national policies and strategies with key indicators which are mostly focused on promoting physical activities, proper diet, workplace environment and healthy community. Stakeholder engagement and partnership is the key factor, particularly in the workplace where employer and employees are mutually aware of and participate in health promoting activities. At community level, role of local governments as well as community leaders and organizations are undoubtedly crucial.


Thailand has become an aging society. Old age people risk of developing dementia including Alzheimer's disease (AD). Therefore, early diagnosis is crucial in order to prevent the serious health problem. Herein, the rapid simple and low cost detection method have been developed for screening test of Aß1-42 which is essential biomarker of AD. Firstly, the antibodies used were investigated and selected to perform in the assay. The gold nanoparticles (AuNPs) was used as a labelling materials because the results can be seen by naked eye and provide the stability. The dot-blot with direct and sandwich immunoassay were developed for measurement the level of Aß1-42. However, the sandwich immunoassay provides higher sensitivity when compared with the direct assay which was then selected to use in further work. For the assay, the anti-rabbit Aß pAb was immobilized on nitrocellulose membrane. To test, the sample was dropped on the test zone and incubated for 10 min. After that, 2 µL of anti-rabbit Aß mAb conjugate- AuNPs was applied on the test zone and incubated for 10 min following by washing. The results can be visualized in few min. Under optimized conditions, the limit of detection was found to be 5 µg/mL. In order to enhance the signal, the silver enhancer was applied in the system after test. In the present of silver enhancement solution, the darker color in signal becomes more strengthened due to silver precipitation on the AuNPs which providing better sensitivity. The limit of detection was observed at 1 µg/mL. Moreover, the approached assay would be applied to detect of Aß1-42 antigen in real blood sample and the results showed the different between the sample with and with out Aß1-42. However, the further development to increase the sensitivity of detect tool still need more study to apply for the measurement of the plasma Aß in clinical sample.


This study applied a Straussian grounded theory to explore the perspectives of caregivers on how they accomplished their long-term management in the process of caring for stroke survivors. Fifteen samples were recruited from the caregivers who had spent at least four hours per day on caring their patients for six months or more, and lived in Satengnok sub-district or Muang municipality, Muang district, Yala province. Data were gathered by using in-depth audio taped interviews, as well as observations, and field notes that enabled concurrent data validation with methodological triangulation. Following coded analysis of the data, the findings showed that the caregivers dealt with stroke and its negative consequences that influenced their patients, themselves, and their families in three stages that were represented by three categories. The first category related to the issue of dedicating care and cure where anticipating that the patient might make a full recovery/could be able to do some daily living activities was a significant condition that motivated the participants’ caring practices. They firstly assisted the patients who could not take/nearly could not take care of themselves to recover in order to limit undesirable effects that affected them and their families, and coupled this with managing their stress, leading to further developments in their caring. The second category, namely preventing deteriorating condition(s) where being concerned about developing complications was identified as the most powerful influence that reinforced the caregivers’care. They attempted to assist the survivors with fluctuating symptoms to continuously maintain their rehabilitation, in order to maintain some degree of recovery as long as possible. They also tried to cope with stresses and strains from the situations they encountered, including beginning to take care of themselves, to regain their power and effort to keep their care going. The final category, labelled as not seeking any treatments but keeping the survivors away from suffering where intending to provide care until the last minute came out as a challenging condition that encouraged the caregivers to sustain their care for their patients although their cure was hopeless. They attempted to make their patients as comfortable as they were able. Also, the participants tried to keep themselves healthier, and maintain their families without more difficulties. Nevertheless, throughout the care period, the caregivers and their families encountered a number of difficulties that challenged their own strength, endurance, and care intentions that they needed to care for their patients from the beginning of the illness to the end; however, they did not give up caring. This led them to reach the process of modifying care and cure based on the patients’ conditions, which emerged as the core category.The noteworthy findings are that the strength, endurance, and full care intention of caregivers encouraged them to develop more likely effective strategies to cope with their dramatically changed lives following the stroke and that would not return to a pre-stroke situation. This required establishing a balance in their “new lives” and in their families. They sought normality in a new way of living little by little, before making an advance to a certain degree that corresponded to the survivors’ conditions and the negative consequences they and their families encountered. Finally, they could still have normal lives of their own depending on their responsibility to sustain the long-term caregiving and probability of other support. The findings could be applied to guide nursing administrators and nursing practitioners about how to manage the provision of corresponding long-term care for stroke survivors, caregivers, and their families when their needs change over time throughout the stroke trajectory.


Background: The mental illness high risk to violence patients need to have a continuum well care. Since these patients have tendency of psychiatric relapse and mental health risks. Therefore, the continuity of care system in mental illness patients project was created to help and care for them. Objective: To compare the cost and effectiveness by using cost-effectiveness analysis between continuity of care system (home health care service every 1 month) in severe mental illness high risk to violence patients at primary care setting versus routine service system in provider perspective. Methods: Data was derived from randomized controlled trial study between 1 January, 2016, to 30 June, 2016. The patients who been diagnosed as F200 to F299 and had at least 1 or more criteria of severe mental illness high risk to violence were recruited to the research. Result: There were 72 patients for continuity of care system and 90 patients for routine service system. Patients in continuity of care system had higher re-hospitalize incident rate (7.04) than patients in routine service system (5.56) with no significant at p .750. The incremental cost for continuity of care system was 30,716 Baht. The risk factor in this patient were a discontinuous medicine, alcohol or substance abuse. Number needed to treat (NNT) of re-hospitalization was 13. There were no statistical difference of mean of global assessment scale , disease burden scale and psychological scale at the 6th.month between continuity of care system and routine service system. Conclusions: This study showed that the continuity of care system can’t reduce re- hospitalization rate in severe mental illness psychiatric patients. The incremental cost for the continuity of care system to re-hospitalization rate was 30,716 Bath.


Prostate cancer (PCa) is one of the most common cancers among men. Presently, a screening test for PCa is based on serum prostate specific antigen (PSA) level. However, PSA level is not a specific biomarker for PCa. Recently, several potential biomarkers of PCa have been discovered. In this study, detection methods for sarcosine and PCA3 in urine have been developed for PCa screening and diagnosis. An enzyme-coupled colorimetric method was proposed for sarcosine assay. This method is a specific reaction based on sarcosine oxidase (SOX) and horseradish peroxidase (HRP). The method was performed in the 96-well microtiter plate and measured spectrophotometrically (OD570). At the optimum conditions, the limit of detection (LOD) and quantification (LOQ) were found to be 0.7 and 1 μM, respectively. A good linearity was revealed with a coefficient of 0.990. The assay showed no significant interference from ascorbic acid, glucose and bilirubin. In addition, it is extremely specific for sarcosine rather than other amino acids. The determination of sarcosine in human urine displayed high accuracy and good reproducibility. This method is promising to differentiate among prostate cancer patients, benign prostatic hyperplasia patients and healthy subjects according to urinary sarcosine level. Simultaneously, a gold nanoparticle-based colorimetric assay was also achieved for PCA3 detection. The assay used the property of thiol group on the 5’-end of the PCR product to simply immobilize onto the surface of gold nanoparticles (AuNPs), which can be able to prevent self-aggregation of AuNPs under high concentration of NaCl solution. Our assay can distinguish the positive from negative results by the naked eye observation of color change or using the ratio of the absorbance at 520 and 640 nm (A520/640). This method was also performed in the 96-well microtiter plate. At the optimum conditions, the optimal ratio (520/640) was > 1.5 in the presence of thiolated PCR product. The sensitivity of assay was approximately 31.25 ng of PCR product. In addition, the assay showed significantly specific for prostate cancer cell lines, which PCA3 is highly expressed, while the other cell types showed no PCR product. Altogether, this study provides the rapid, simple and specific tools to determine urinary sarcosine and PCA3 which could be useful for prostate cancer screening and diagnosis.


Studies from high-income countries observed that health outcomes among individual having access to care still differed based on their socio-economic status (SES). This led to a concern that performance-based payment introduced by National Health Security Office (NHSO) in Thailand would penalize healthcare facilities located in low SES areas where health outcomes would be worse compared to high SES areas, although same standard of care is provided. Patients with high SES would have better health outcomes because they could control themselves better. Those with high SES evidently had higher level of perceived control. Perceived control comprises two important parameters: health locus of control and self-efficacy. This cross-sectional study has been conducted to test whether SES affects health outcomes of Thais who are under the universal health coverage policy. Patients with diabetes (all having access to care) were used as an example. We found no association between SES and treatment outcomes and service-based indicators. CCM-related activities had strong association with health outcomes. SES was, however, associated with perceived control as found in previous studies. Those with high SES tended to have higher perceived control (high self-efficacy and internal locus of control). Perceived control had a tricky relationship with compliance. Those with high self-efficacy had better compliance to diet recommendation, but worse compliance to prescribed medicine. In contrast, those with internal locus of control had worse compliance to diet recommendation, but better compliance to prescribed medicine. The effects were cancelled out; overall, no association was found between perceived control and compliance.


Dengue hemorrhagic fever (DHF) is one of the critical public health problems in Thailand. During the disease progression, DHF patients will enter the critical phase in which hypovolemic shock potentially occurs and might lead to death. The shock in dengue is caused by substantial plasma leakage from blood circulation. Plasma leakage potentially leads to hemoconcentration, insufficiency of blood plasma, and ultimately hypovolemic shock. Thus, current guidelines on management of dengue fever/ dengue hemorrhagic fever recommend monitoring patient’s hematocrit levels by performing invasive blood collections every 2-4 hours during the critical phase. hematocrit levels are then used to adjust intravenous fluid replacement in DHF patients to prevent hypovolemic shock. This project aims to address two main research questions, including 1. the feasibility of using a noninvasive hemoglobin monitoring device (Masimo), already approved for medical used, for monitoring hemoconcentration instead of collecting patient’s blood through conventional methods and 2. development of a non-invasive prototype measuring hemoconcentration with a comparable or higher level of efficiency compared to the commercialized noninvasive device (Masimo). The prototype has been designed to be affordable for public hospitals in Thailand and to potentially replace expensive commercialized devices (Masimo). For the first research question, hemoglobin levels were measured in 154 patients with dengue fever (from 336 patients in this study) using the commercialized devices. Data were analyzed for the relationship between hemoglobin from noninvasive device and hematocrit from blood collection. The analysis revealed that hematocrit levels obtained from venipuncture or fingertip prick and hemoglobin levels from the Masimo device tended to change in the same direction. However, the incidence rate of dengue infection was very low over the course of the data collections. In addition, the majority of dengue patients in this study had dengue fever (DF) that does not have a critical phase seen in DHF. Thus, the overall variation of hematocrit levels observed in patients in this study was small due to the lack of data from the critical stage. Hence, our proposed model for the relationship between hemoglobin and hematocrit was not sufficiently tested with patients during the critical stage. In order to apply our model to routine hematocrit monitoring, an interface extension from Masimo was built to receive signals from the Masimo device, analyze the signals using our proposed mode, and convert them to hematocrit. In addition, we also proposed a new guideline for monitoring patients with dengue infection before, and after, reaching the critical stage using the developed interface and Masimo device. For the second research question, we adopted AFE4490 Integrated Analog circuit and Nellcor ds100a probe for non-invasive hemoconcentration measurement prototype. This prototype used Arduino DUE as a processor. We have designed the real-time algorithm and auto alert system calibration by weight average technique using signals from red and infrared sensors. The data were collected by a computer connecting to the Arduino processor. The prototype was calibrated with FLUKE Index 2 pulse Oximeter simulator. We found that the signals read were accurate. A comparison of data from the prototype and the Masimo device suggests that the correlation between REDDC signals from the prototype and SpHb values from the Masimo is very strong although accuracy of measurement from the prototype is not as high as the Masimo. Initially, the prototype was also used to monitor hemoconcentration of 73 patients with thalassemia (with about 70% of accuracy) after they received blood transfusion. The prototype will be further improved to increase its accuracy in measurement of hemoconcentration through laboratory tests and model adjustment.


Respiratory allergy, which consists of allergic rhinitis (AR) and allergic asthma (AA), requires high cost of medical treatment. These medications can only temporally relieve the allergic symptoms without any modification of an allergic hypersensitivity status. The only option that can modify the immunologic status is the allergen immunotherapy Three hundred and forty three subjects with chronic rhinitis was screened from 13 centers in Thailand. One hundred and forty six patients had been recruited according to the inclusion criteria, in which 108 subjects was randomly assigned into the intervention group (receiving immunotherapy and standard treatment) and 36 subjects had been assigned to the controlled group (receiving standard treatment with placebo injection). The clinical characteristics between two groups were not statistically significant. After one year, the median composite score in the intervention group decreases 3.8 score comparing to the baseline (p < 0.001). But comparison between the intervention group and control group was not statistically significant. After one year of treatment, 66.7 percent of subjects in the intervention group can reduce their medication use by 50%. Moreover, 23% of subjects in the intervention group were medication-free after 1 year of allergen immunotherapy. Eighty five percent of subject tolerate the 500 allergen unit dosage of vaccine. There were 423 adverse events (AE) out of 4,444 injections, 2.31% of total AEs (77/423 events) were systemic reactions.


Quality of life of migrants has gained increased attention in the last decade, especially amongst those with vulnerability, such as migrant children. Despite continuous efforts from the Thai government to expand education services to all children on the Thai soil, some migrant children are still left uneducated. Exemplary barriers to education services are miscommunication of national policies, implementation hardship, and problematic attitudes of parents of migrant children. The establishment of ‘Migrants Learning Centers’ (MLCs) in migrant communities helped increase access to education for children of migrants, however, the academic quality remains questionable and hygienic statusin MLCsis still below standard. All in all, this study aims to analyse current education and school health promotion services provided for migrant children through a case study of Ranong province. The objectives of this study are: 1.to assess and understand the management of education services provided for migrant children, 2.to assess and understand the school health promotion services provided for migrant children, 3.to evaluate migrant children’s academic performances, 4.to evaluatenutritional status and hygienic behaviour of migrant children, and 5 to exploreperspectives of parents of migrant children on the access to education and health promotion services. The researchers applied a parallel mixed method design. Objectives 1, 2 and 5 used in-depth interviews with policy makers, service providers, and parents of migrant children. Objective 2 used observation and school health policy checklist as the main data collection tools. Objective 3 used secondary data on student attrition rate. Questionnaire survey was used in objective 4. The study revealed that migrant children did not face serious hurdle inenteringthe Thai public schools. This observation coincided with the government policy that provided per-headcount financial subsidy to schools according to the number of admitted migrant children in the same amount as Thai children. Parents’ intention was a key determinant influencing school enrolment. Parents with the intention to permanently reside in Thailand tended to choose Thai public schools, whereas parents who sent their children to MLCs were more lineated to return to their home country some time in the future. Even though the Thai public schools opened rooms for free education services to migrant children, MLCs seemed to fit the preference of migrants in several angles, such as the provision of curricula currently used in Myanmar, the use of Burmese language in classes, and more importantly, the offering of opportunities for children to continue their education in Myanmar schools or universities (in some MLCs). These features attracted parents’significantly as evidenced by the fact that the number of migrant children in MLCs was almost three times as large as those in Thai publicschools. Nonetheless, many MLCs were facing operational problems. These included non-standardised curricula, limited staffcapacities, insufficient budget, shortage of school lunch and milk for children, and lack of school health surveillance. Besides, some MLCs were operating in poor hygiene environment. Currently, there wasclear official regulatory agency on MLCs and the academic degrees between the two countries (Thailand and Myanmar) remained unlinked.


Currently, lung cancer treatment has been developing in several approaches such as; conservative chemotherapy or novel targeted therapies which increase the overall response rate, survival rate with good quality of life for the patients. Thus this research project’s goal is to explore the molecular alterations in Thai lung cancer patients which could be different from the other ethnicities. The result of this research will lead to targeted drug development in Thailand for Thai lung cancer patients which the investigators will co-operate with ECDD (Excellence Center of Drug Discovery). This center was established in July 2016 by the co-operation and commitment between Faculty of Science, Mahidol University and Faculty of Medicine Ramathibodi Hospital, Mahidol University. The final result of molecular alterations in 159 Thai lung cancer patients (178 tissue samples) from this research project by NGS method from both FFPE and fresh frozen tumor tissue (initial analyzed only the common mutations in lung cancer) showed EGFR mutation 54.7%, BRAF mutation 10.1%, KRAS mutation 28.3%, and MET exon14 splice site 8.8%. We also found 37 patients (23%) whom had more than one gene mutation. These results were very interesting and different from the other countries’ results, especially BRAF and MET exon14 splice site mutation which occurring only < 4% incidence in other populations. BRAF and MET inhibitors are in the clinical development. We also initiate the discussion with ECDD to further investigate for the chemical that could inhibit these 2 genes for our populations. Furthermore, we confirmed the tumor heterogeneity of lung cancer from our study in 14 patients. One out of 3 patients had different gene profile in different organ at the same time. The other 2 patients had same gene profile even in different organ. Eight out of 11 patients had the different gene profile when they developed disease progression in different organ. These results are very interesting and very useful for exploration of resistant mechanism in lung cancer and developing targeted therapy drug for lung cancer patients.
Even though we explore the diagnostic technique and the approach for lung cancer treatment as mentioned above, but the cancer prevention is also very important for the oncology world right now. The previous literatures reported the role of Metformin (anti-diabetic drug), Aspirin (anti-platelet drug), and Statins (lipid lowering agents) in decreasing cancer incidence rate, but the results were not homogenous and most of studies were small population based studies only. These 3 groups of drug involve in the metabolism of human body, thus cancer metabolism is the important and interesting field which could lead to cancer prevention in the future. This research project also focuses in cancer metabolism and cancer prevention by studying the largest and longest follow-up of population based study in Thailand (EGAT database: Electricity Generating Authority of Thailand). Our final results showed ASA, Statins, and Metformin did not significantly decrease the cancer incidence rate. Alcohol drinking and increased aging significantly increased risk of gastrointestinal cancer. Hepatitis virus B carrier also significantly increased risk of liver cancer. However, this report had several of limitation due to nature of retrospective study, but it is very interesting and fascinating to explore more in term of cancer prevention with these group of drugs in prospective study.
In this study, we also explored about serum metabolomics profile in 38 early stage lung cancer patients whom underwent surgery. We will report the final result in 75 patients next year. We found the significant changing in amino acid, biogenic amines, sphingolipids, and glycophospholipids in patients’ serum before and after surgery. It is very interesting that tryptophan was significantly increased while glutamate was significantly decreased after surgery. Kynurenine, a biogenic amine which use tryptophan as the initial compound, was also significantly increased after surgery. These finding are very useful to develop immunotherapy and predictive biomarker for immunotherapy. It is also useful to further explore in cancer prevention.
In conclusion, the study of molecular alterations in Thai lung cancer patients is very important for targeted drug development in order to drive the innovative lung cancer treatment. However, the other important issue and concern is cancer prevention. Nowadays cancer is the most leading cause of death in Thailand and cancer also causes a lot of burdens in Thailand and Global public health. We believe that cancer metabolism is one of the key factors for cancer prevention in the future which could probably help to prevent and decrease the cancer incidence rate and solve the cancer burden in Thailand.


Oral squamous cell carcinoma (OSCC) is often diagnosed with late stage resulting in poor prognosis. Therefore, early detection and screening methods of OSCC that has the accuracy, precision, rapidity and simplicity are urgently developed for screening of people who exposure with risk factors including smoking, alcohol consumption and betel quid chewing as well as human papillomavirus (HPV) and Epstein-Barr virus (EBV) infection and have precancerous lesion. From our preliminary result, peroxiredoxin 2 (PRDX2) and zinc-alpha-2-glycoprotein (ZAG or AZGP1) were significantly upregulated in salivary OSCC different from cancer-free control using two-dimensional gel electrophoresis (2-D) Gel which was the step of validation test. Therefore, this study aimed to examine the expression of PRDX2 and ZAG proteins in saliva from healthy control, oral inflammation, precancerous and OSCC groups which was the step of confirmation test. In addition, we also investigated the function of PRDX2 and ZAG in OSCC cell line that has not been reported yet. The saliva samples from healthy volunteers, patient with any inflammatory lesions in oral cavity, precancerous lesions with leukoplakia or lichen planus and OSCC were analyzed for the expression of PRDX2 and ZAG proteins using western blot. The function of PRDX2 and ZAG were in vitro studied by transduction to OSCC cell line (ORL-48T) with retrovirus containing pCLXSN-PRDX2 and pCLXSN-ZAG, respectively. These transduced cells were selected by the G418-containing medium and analyzed for cell proliferation, cell-cycle progression, apoptosis and cell migration using MTT, PI staining for flow cytometry, apoptosis kit for flow cytometry and wound healing assay, respectively. The results showed that the relative expression of PRDX2 protein in salivary precancerous and OSCC was significant difference from healthy volunteers and patient with any inflammatory lesions in oral cavity, whereas only the relative expression of ZAG protein in saliva of OSCC significant difference from healthy volunteers and patient with any inflammatory lesions in oral cavity.  The result showed that AUC of PRDX2 in salivary precancerous and OSCC was 0.8661 and 0.9521 whereas AUC of ZAG was 0.8832 and 0.8494 respectively when compared to healthy control. In addition, AUC of PRDX2 in salivary precancerous and OSCC had higher value (0.8512 and 0.8543, respectively) than ZAG (0.7752 and 0.7848, respectively) when compared to the patient with any inflammatory lesions in oral cavity. This result demonstrated that only PRDX2 can be a biomarker for screening of precancerous and OSCC from healthy control and the patient with any inflammatory lesions in oral cavity. The AUC of the combination of PRDX2 and ZAG in precancerous and OSCC was 0.8677 and 0.9009 respectively compared to healthy control and 0.8002 and 0.8570 respectively compared to the patient with any inflammatory lesions in oral cavity. The combination of PRDX2 and ZAG can increase the sensitivity to discriminate the precancerous and OSCC from the patient with any inflammatory lesions in oral cavity. For in vitro study, the proportion of cell proliferation, cell-cycle progression and cell migration in PRDX2-overexpression ORL-48T cells were significantly higher than pCLXSN-transduced ORL-48T cells. Inversely, cell proliferation and migration in ZAG-overexpression ORL-48T cells were not different from pCLXSN-transduced ORL-48T cells.These results demonstrate that PRDX2 functions as a tumor promoter whereas ZAG plays role on induction of late apoptosis in ORL-48T cells. The expression of PRDX2 in saliva can be biomarker to screen of precancerous and OSCC and the combination of PRDX2 and ZAG can increase the sensitivity to discriminate the precancerous and OSCC from the patient with any inflammatory lesions in oral cavity. These proteins will be further used for development of OSCC screening method.


Currently, the number of patients with chronic kidney disease is increasing. The main problem in chronic kidney disease patients is the reduction of blood flow to the kidneys, causes the insufficient blood supply to the kidneys. As a result, the accumulation of waste in the body due to the renal function excreted less waste from the body. It leads to a gradual decline in kidney function. In the elderly, it is found that blood flow to the kidneys decreased. The purpose of this study was to compare the effects of renal blood flow and heart rate variability before bed rest, after bed rest, and after the trial in the elderly. The 41 healthy elderly volunteers were divided into three groups: foot massage group (14 persons), foot exercise group (14 persons), and control group (13 persons). All of them were received bed rest for 15 minutes, then got a foot massage or foot exercise or bed rest for 15 minutes. Volunteers were measured for renal blood flow and heart rate variability for 3 times and 24-hours urine analysis was measured before and after the trial. The results found that renal blood flow and 24-hours urine analysis were not significantly different from the pre-treatment and no difference between groups. In massage group found that the standard deviation of the normal-to-normal intervals (SDNN), the square root of the mean squared differences of successive normal R-R intervals (RMSSD), and low frequency (LF) were significantly increased (p<.05). In foot exercise group found that SDNN and RMSSD were significantly increased (p<.05). And the control group found that only RMSSD was significantly increased (p<.05). However, there was no difference between groups comparison. Conclusion, the foot massage, the foot exercises, and bed rest could increase the heart rate variability by increasing the activity of the parasympathetic nervous system. But it does not affect the renal blood flow.


Objectives To evaluate the use of [F-18]Florbrtapir PET scan in assessing brain amyloid deposition in Alzheimer’s disease, mild cognitive impairment and normal aging and the correlation between brain amyloid deposition in PET scan and results from neuropsychological test, MRI brain and [F-18]FDG PET scan. We also aimed to evaluate the correlation between [F-18]Florbetapir PET scan results and changes in neuropsychological test, MRI brain and [F-18]FDG PET scan results. Conclusion Our results found a significant, high correlation between all imaging techniques using [F-18]Florbetapir and clinical diagnosis and neuropsychological test results, which the highest correlation was detected with [F-18]FDG PET followed by [F-18]Florbetapir PET and MRI, respectively. There were also significant and high correlation amongst imaging techniques. However, correlation between baseline and changes of these imaging results with changes in clinical symptoms as well as neuropsychological performances are still needed to be followed.


Stroke or brain bleeding is a disease occurred when the blood vessels inside of the brain or between skull and brain burst. Common causes are injury due to accident or high blood vessels. This disease requires an immediate diagnose whenever a patient has an abnormal signs such as severe headache, acute fatigue of arms and legs, nausea, vomit, loss of balance, cannot communicate with other people or cannot understand other people, or have an indication that there may be an injury to the brain. The patient when gets hospitalized is usually taken to CT scan to get the slides of the brain images because CT scanning is quick and also less expensive than any other method. The neurosurgeon considers these slides of images to detect any abnormality in the brain and gives appropriate actions. However, as the number of expert neurosurgeons who know how to read the images throughout the country is very low and the majority of them works in Bangkok and vicinity or major provincial hospitals, this makes a big obstacle to effectively save lives of people who live in the rural area. This project aims to develop pilot software that can automatically detect patients who have stroke, for the patient who have a hemorrhage, it automatically makes a 3D model of a brain hemorrhage, compute midline shift, compute a volume of a hemorrhage, and classify patients with emergency condition. This program will be helpful as a supporting tool for doctors especially those who are inexperience to know the condition of stroke of the patients.


Background and Rationale: The flood disaster which affected Bangkok and the central region of Thailand in 2011 presented a critical challenge to the resilience of Thailand’s health system in the face of sudden crisis. Objective: To explore the extent to which the Thai health system was capable of responding to a public health shock, through the lens of health system resilience, with a particular focus on the issues of ‘awareness’ and ‘adaptability’. Methodology: A cross sectional study design was applied. Data were obtained from the representative household survey in 2011. Descriptive statistics and inferential statistics using t-test, Chi-square test and rank-sum test were applied. Results: Overall, the Thai health system is quite ‘resilient’ especially in terms of ‘awareness’, as demonstrated by the good level of satisfaction that people had with the flood warning messages that they received. However, concerning ‘adaptability’, and using public health relief as an indicator, the Thai health system did not appear to perform well. Households in Bangkok had a better level of awareness than those in the central region. Households in the central region reported greater satisfaction in obtaining external public health assistance than the Bangkokian households. Conclusion: The Thai health system is somewhat resilient in coping with public health shocks, but there remains room for further improvement. An expansion of public health collaboration to all relevant sectors including local communities, non-governmental organizations, as well as media and social networks is needed. Furthermore, re-orientating the health registration system to have clearer catchment areas is recommended.


This study aimed to analyze gaps of alcoholic beverage laws and regulations in Cambodia, Lao PDR, Myanmar, and Vietnam (CLMV). Using qualitative approaches with the Global Strategy to Reduce the Harmful Use of Alcohol as a framework, we conducted a document research on laws and regulations implemented before 28 February 2017. The most popular laws and policies of CLMV focus on 1) taxation, 2) blood alcohol concentration limits, 3) restriction on alcohol advertising, and 4) national surveillance. The main policy gaps found in this study included: lack of national leadership and commitment on alcohol policy, lack of control between on-premise and off-premise sales of alcoholic beverages; regulations on alcoholic beverage marketing, sales promotion and product placement; and responsible beverage services training measures. Other key policy gaps included a lack of efficient and effective enforcement, especially control of illegal alcoholic beverages. Promulgation of the overarching national alcohol policy legislation and establishment of national alcohol control committees with participation from several sectors and further cooperation with other stakeholders to tackle illegal alcoholic beverages are recommended.


The Universal Coverage Scheme (UCS) has operated the Universal Health Coverage Benefits Package Development Project since 2009. The project aims to develop the health benefit package to be covered under UCS with transparent and participatory process involving stakeholders based on evidence. The researchers reviewed the document related to the development of benefit package in 2009-2015 and participated in the meetings of development of benefit package, starting from proposal development, prioritization and selection of health technologies, assessment of health technologies, and results presentation in stakeholder meetings. During 2009-2015, there were 133 health technologies or health topics nominated by the stakeholders. Among the topics nominated, health care package, drug and vaccine, medical devices, screening and treatment topics were nominated at 31%, 25%, 23%, and 21% respectively. Out of the 133 topics, 65 were selected for the health technology assessment, 45 were completed, and 26 were presented to the Sub Committee for the Development of Benefits Package and Service Delivery (SCBP). The SCBP made the decision to include 9 topics in the benefit package, 2 more topics were interpreted as already included in the package, 10 topics were requested for further evidence, and 5 topics excluded. Among the 9 topics selected by the SCBP, the topics that were finally implemented in the UCS were the HLA-B*15:02 screening for carbamazepine-induced severe adverse drug reactions, and the refractive error screening by school teachers in pre-primary and primary schools in Thailand.


Professional fee is one of the emergency medical service disbursement lists that private hospitals can submit for compensation. The recent data showed that the professional fee was the highest item disbursed accounted for approximately THB 88 million. The objective of this study, therefore, was to examine the detailed lists, the amount and disbursement of professional fees made by private hospitals under the Universal Coverage for Emergency Patients (UCEP). The disbursement data from private hospitals providing emergency medical services between 1 April and 27 December 2017 were analyzed by descriptive statistics. The findings illustrated that from the list of UCEP professional fees, there were 512 items made by medical doctors (508 items matched with 4,389 items of the Thai Medical Council’s doctors’ fees handbook, and 4 items outside of the handbook). The items of UCEP disbursement procedures in Chapter 10 Obstetrical procedures covered 34.4% of the TMC doctors’ fees list. The proportion of doctors’ fees disbursement accounted for over a half of 512 items (51.4%), disbursing 30,944 times or 36.2% of total transactions, with approximately THB 47 million or 53.7% of total professional fees. The Item on the next treatment for inpatient (code 59009) incurred the highest transactions at 5,465 (17.7%), while the initial inpatient evaluation and management (code 83786) incurred the highest disbursement of over THB 3.8 million (8% of total fee). Chapter 1 Procedures of the head and maxillo-facial area disbursed over THB 12.3 million or a quarter of the total fee. The top three doctors’ fees were the initial inpatient evaluation and management (13.8%), followed by the coronary artery procedure (11.2%) and the medical examination (10%). Doctors’ fees disbursement of emergency medical services from private hospitals covered just approximately a half of total items. Disbursement agencies should, therefore, explicitly define meaning of individual items related to current services in hospitals. In case of hospitals, they should promote training of personnel to correctly entry disbursement information. Moreover, a specific agency within the National Institute for Emergency Medicine should actively update the list of procedures to cover unavailable items.


Physical activity promotion needs multi-sectoral collaboration. The organizational structure of local authorities is conducive for physical activity promotion administration in the communities. This study aimed to explore local authorities’ physical activity promotion administration in the communities. In depth interviews, direct observations, and document reviews were done in 12 municipalities from 12 Health Regions. The study revealed that all municipalities had common patterns of organizational structure, resources, policies and stakeholders as well as physical activity promotion administration suitable for physical activity promotion to people in all age groups in the communities according to the contexts and levels of municipalities. The study concluded that local authorities was suitable for administrating physical activity promotion to the communities and all physical activity promotion agencies should set high priority on networking with local authorities for physical activity promotion to people.


This study aimed to develop the physical activity questionnaire for pregnant and lactating women (PAQ-PL) and to assess its reliability and validity. The PAQ-PL was developed based on the modification of the previous physical activity questionnaires for pregnant women from Thailand and other countries. The developed PAQ-PL was initially tested to determine the feasibility and acceptability for health care service by interviewing pregnant and lactating women as well as health care service providers. The reliability was assessed by administering the PAQ-PL twice within a 7-day interval (N=212) and the validity was assessed based on the correlation between the PAQ-PL and the accelerometer (N=86) in pregnant and lactating women who visited the Health Promotion Hospital, Health Promotion Center Region 5, Ratchaburi Province. The developed PAQ-PL was in the table format and consisted of 21 items of physical activities (PA) that were appropriate for Thai pregnant and lactating women context. It had good reliability on the time spent (minutes/day) for total PA, moderate-to-vigorous PA (≥3.0 metabolic equivalents, METs), and sedentary- to-light PA (<3.0 METs) [intraclass correlation coefficient, ICC = 0.79, 0.84, and 0.77, respectively (p-value <0.05)]. Its validity was acceptable when used for assessing the time spent on vigorous-to-moderate PA [Spearman’s correlation, rs = 0.21–0.37 (p-value <0.05)]. In summary, the developed PAQ-PL had moderate to good reliability and acceptable validity, especially when considering the assessment of moderate-to-vigorous PA. Hence, it may be feasible to use the PAQ-PL to assess the PA of pregnant and lactating women in the public health service system.


People with disabilities face several challenges, especially children who are often discriminated against and have limited access to social services. Despite the significant impact on a child’s development, family life, and its economic implications, research on childhood disability is inadequate. This study aimed to study the situation of children with disabilities up to the age of 14 years by type of disability and explored factors associated with disability. The study involved analyzing the National Statistical Office’s 2015 Household Socio-Economic Survey. There were 22,499 children aged 0 – 14 years in the sample of 15,538 households. Applying sampling weights, the country-wide estimates were derived. The study found that 93,129 children aged 0 to 14 years (0.87%) suffered from some kind of physical and intellectual disabilities, and most of them were congenital disabilities (0.80%). High prevalence of child disability was found in the following groups: males (0.93%), the 11-14 year old age group (1.12%), household heads with vocational diploma (1.20%) and unemployed household heads (1.16%). Among children with disabilities, more than one-third did not attend school. In addition, almost all children with both physical and intellectual disabilities could not take care of themselves or go out independently (81.6% and 94.5%). After multivariate adjustment, it was found that the children aged 7 – 14 years had a 1.39-time higher prevalence of disability compared to children aged 0 – 6 years (Adj.OR=1.39; 95%CI= 1.05-1.84). On the other hand, the prevalence of children with disabilities was lower in households where the heads were employed by the government and by private companies (51% and 41%, respectively) than those with unemployed household heads. The prevalence of child disability was concluded to be high among school age children (5 – 14 years) and in households with unemployed household heads. School aged children lacked educational opportunities especially those with congenital disabilities. The present study suggests that the government should pay more attention on special education of people with disabilities, and children with disabilities should have education or vocational training appropriate to their condition. Special education policies for children with disabilities have to be evaluated for improving the effectiveness. Moreover, authorities should promote private or public organizations to employ the head of family having children with disabilities.


In 2016, Ministry of Public Health’s service plan included antibiotic use in traumatic wound patients as an indicator of rational drug use. The target of this indicator was set at <40% based on a study in one large university hospital. Little is known on antibiotic use particularly in other hospital levels and regions. The objective of this study is to describe types of wounds and patterns of antibiotic use in traumatic wound patients. A prospective study was conducted in emergency unit, Mahasarakham Hospital during 1 March to 30 April 2018. The study measured types of wounds, wound classification according to antibiotic use guideline (antibiotic use is recommended for only class 2 and 3), prevalence of antibiotic use, type and duration of antibiotic use, and proportion of appropriate antibiotic use according to the guideline. Of total 267 patients, most of them were male (51.7%), had no co-morbidity (75.3%) and average age of 34+21 years. Median time from injury to hospital was 1 hour (IQR: 0.3, 3). The most common location of wound was at leg (32.2%) and wound type was animal bite (55.1%). Wound contamination was 74.5%. Prevalence of antibiotic use was 65.5%, when stratified by wound classification the prevalence was 11.1% in class 1, 72.2% in class 2 and 87% in class 3. The most common antibiotic use was Amoxycillin (62.9%). Average duration of antibiotic use was 5+1 days. According to the guideline, the rate of appropriate antibiotic use was 86.5% and appropriate duration of antibiotic use was 65.9%. In conclusion, use of antibiotics in traumatic wounds in Mahasarakham Hospital mostly adhered to the guideline but was higher than the target. Ministry of Public Health should reconsider the target of this indicator and promote further study in various hospitals and regional settings for appropriately reflecting quality of care.


Project: A cohort of CKD patients with high risk for cardiovascular events or renal disease progression multicenter study (CORE-CKD Thailand) Phase 2: Outcomes and Cost-Effectiveness Extension Study Introduction: Chronic kidney disease (CKD) has effects on quality of life, high cost of care, increases the risk of cardiovascular disease, renal disease progression and other complications. Both traditional factors including hypertension and non-traditional factors including arterial stiffness, salt and water retention, genetic factors and other biological molecules contribute to the cardiac complications and renal decline. Methods: CORE-CKD (Thailand) Phase 2 is multicenter, hospital-based, non-interventional prospective cohort which follow patients with CKD stage 1-4 enrolled in Phase 1. CORE-CKD phase 2 study comprises of 3 objectives: Evaluate risks for 1) cardiovascular disease and 2) renal decline over 3-5 years and 3) Economic impact of CKD by evaluating direct and indirect cost and cot-effectiveness of various treatment. This study will also collect data from elderly patients, patients with on hemodialysis or peritoneal dialysis for comparisons with CKD stage 1-4; Aim 3 Collect DNA, blood and urine into biobank for studies in biomarker studies. Results: 1,409 patients have been enrolled from 21 centers covering all regions of Thailand. Over 1000 samples have been stored in biobank. This report will focus on cross-sectional analysis of the baseline data 1) Control of blood pressure in Thai CKD subjects in comparison to International cohort. Among Thai CKD patients, the proportion above target BP were: <130/80 mmHg 73.1%, and <140/90 mmHg 45.5%. Just over 50% were on angiotensin receptor blockers or ACE inhibitors. 2) Relationship of arterial stiffness measured by cardio-ankle vascular index (CAVI) and abnormal cardiac contraction by echocardiography in the development heart failure in CKD. Both mean CAVI and Ventricular-arterial Coupling (VA coupling) was significantly higher in CKD patients with heart failure compared with patient without heart failure. 3) Researchers currently evaluating relationship of psychosocial impact, risks of CVD, relationship of CAVI and pelvic vascular calcification, CKD staging using creatinine or cystatin C, 24 hr. urine sodium intake, prevalence of anemia and other complications, development of metabolomics for identification of renal disease progression and economic impact in CKD patients. Conclusions: CKD patients have high prevalence of many risk factors. Arterial stiffness and abnormal cardiac contraction is associated with heart failure in CKD. The treatment of hypertension in still inadequate. This knowledge will be useful to make strategies to achieve control of various risk factors. This is the first year of a three year project. In the next 2 years data analyses on other parameters will be more complete and more information would be available on risks for CVD, kidney disease progression and economic burden of CKD in Thailand.


Background: In our previous clinical study showed that probiotic Lactobacillus paracasei SD1 was safe, and the strain could reduce salivary cariogenic mutans streptococci resulting in reduce caries progression in volunteers by receiving everyday milk powder containing probiotic L. paracasei SD1. Aims: This continued study aimed to examine the efficacy of caries prevention by receiving probiotic milk powder every day, 3 days/week compared to normal milk (without probiotic). Methods: The study designed as randomized double blind controlled trial taking 1 year of monitoring. After consented, all participants have been randomized into 3 groups including: probiotic group who received probiotic milk every day, mixed group who received probiotic milk 3 days a week and control group who received milk without probiotic every day, 3 grams for 6 months. All participants were monitor at baseline (T0), 6 (T6) and 12 (T12) months for caries status, salivary immune, human neutrophil peptides (HNP) 1-3 by ELISA kit, and bacterial levels (total lactobacilli, L. paracasei/L. casei and S. mutans) by real time PCR. Results: It showed that probiotic L. paracasei SD1 could prevent caries progression and promote regression among children who received probiotic milk either every day or 3 days/week compared to control group. This is the results from the findings of reducing of cariogenic S. mutans and stimulating of salivary immune HNP 1-3 among children who received probiotic milk either every day or 3 days/week compared to control group. In conclusions: Results of study indicated that the consumption of probiotic milk either every day or 3 days/week could prevent dental caries. However, it noticed that salivary immune HNP 1-3 level was significant higher in children who received probiotic milk every day than in children who received probiotic milk 3 days/week, which may effect on caries prevention in long term. This study provides information that may be useful for administration of giving probiotic L. paracasei SD1 to prevent caries in young children.


Background This study aimed to synthesize policy recommendations for future planning in family physician training and effective primary care cluster policy implementation with regards to actual needs and responsive to the situation Methods Situation review and value chain analysis were done in 8 primary care clusters in Central, Eastern, Southern, and Bangkok Metropolitan areas in 2018. A national survey in all 13 health services areas was deployed during the second and the third trimesters of 2018 in order to assess major stakeholders’ perceptions and opinions; including administrators, academics, and family physicians, on national primary care cluster policy implementation as well as the performance and roles of family physician in their settings. The data from primary and secondary sources were analyzed and policy recommendations were synthesized accordingly. Results 213 subjects were participated in the study. 50.7% was female, and median age was 38 years (range 24-84 years). Regarding performance and roles, all groups of the stakeholders indicated that expectable performances of family physicians had not been achieved yet in accordance with 6 performance dimensions of Royal College of Family Physician of Thailand. For primary care cluster policy implementation, there were significant hurdles from frequent changes in policy contents, unclear messages, incongruencies with community situation, rigid specifications, lack of positive retention strategies on healthcare personnel, misunderstanding and acceptance problems among healthcare professionals as well as community, imbalance between demand and supply, lack of policy advocacy at local areas, and problems in family physician training system including trainers, trainees, and related resources. Policy recommendations 1) The Ministry of Public Health should allow those in local areas to propose their own operation plans as well as appropriate and feasible performance indicators. 2) The Ministry of Public Health should modify their policy contents by allowing any physicians to perform as family physician without the necessity to train in family medicine program. 3) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should develop self-directed learning system for the physicians and other health professionals to gain knowledge and experience in family medicine. 4) The Ministry of Public Health in collaboration with the Royal College of Family Medicine of Thailand and other related Royal Colleges should discontinue their diverse approaches in family medicine training, and preserve only a standard training program. Moreover, they should develop specialty training programs that are in needs for the society such as longterm care, elderly care, etc. 5) The Ministry of Public Health should develop networking system in the local areas that can effectively link specialists with family physicians by using “Shared care and responsibility”.


This study aimed to develop learning of the elderly’s community waste management, enhance efficiency of community waste management, recommend the guideline to develop learning and increase efficiency of community waste management through the participation of the elderly in the rural central plains of Thailand and create cooperation mechanism of relevant agencies to drive waste management towards accommodation of appropriate learning and increased efficiency of community waste management. It was a mixed research including quantitative and qualitative research, as well as Participatory Action Research (PAR). The data was collected from 291 sample of 19 local administrative organizations in the rural central plains by systematic sampling. The random system was used to acquire policies, activities, projects, potential of community waste management, and participation of the elderly. Afterwards, selection was conducted for the community with potential to develop participation in waste management in parallel with care for the elderly in six provinces in six communities to organize focus group discussions; foster understanding of waste management; tend to various needs to create occupation of waste management with the elderly, with no fewer than 30 people per community; community leaders and relevant personnel of local administrative organizations. Creative activities of community waste management and products made from community waste were set up in addition, enhanc learning network with other communities through participatory action research, lessons learned, and performance assessment of the development of learning and increased efficiency in community waste management; promote occupation by making products out of community waste; prepare the handbook on the elderly’s community waste processing towards value-added creation for dissemination to other communities and network were undertaken. Test information prepared from two rural communities in two provinces, were conducted by doing activities of community waste management and making products from community waste, and by referring to the knowledge from the prepared handbook. Then 90 days later, the research team followed up on the sustainable assessment of community waste management and production of products from community waste to create cooperation mechanism of relevant agencies to drive waste management towards accommodation of appropriate learning and increased efficiency of community waste management. The study findings revealed that for the work on community waste management and care for the elderly of the sample of the local administrative organizations, there were enough personnel at the operating level; personnel had knowledge and ability to perform their work; sufficient equipment, tool, and locations; sufficient budget for operation; for the development of learning and promotion of the elderly’s participation in waste management, the annual operating plan and the plan on the development of learning and promotion of the elderly’s participation in waste community management were formulated where the elderly participated in the planning of community waste management. According to the workshops organized during the field trips, when the elderly learned about waste management from the trainings, they acquired knowledge and understanding of waste separation and recognized waste problems affecting the current environment. The elderly could implement the knowledge and disseminate knowledge and experience of waste separation to their children, grandchildren, and neighbors. The elderly were also interested in the occupation through production and sale of products from waste. They could apply the knowledge of waste recycling system to design and develop products or transform waste into new products to deal with community waste. Consequently, they had hobbies, income, pride in themselves, and attractive communities.


At present, the management of drugs and medical supplies in the emergency is not very efficient. In addition, Thailand very much relies on the importation of drugs and medical supplies in the normal circumstance. This research study aims to review and analyse the management situation of drugs and medical supplies and to propose the recommendations to reform the management of drugs and medical supplies for Thailand in emergency and at normal situation. This study was designed as a qualitative study. The data was collected using qualitative approaches including the literature review, focus group discussion with stakeholders, in-depth interview with experts and Delphi Technique. The study revealed that to reform the system towards the goal of drugs and medical supplies security in the emergency, the national master plan is needed. There is also a need to assign Division of Public Health Emergency Management (DPHEM), Office of the Permanent Secretary, Ministry of Public Health to be the focal body with the aim to integrate and cooperate with all other related agencies. The Information and Communication Technology Center should be assigned as the main responsible organization in the reform of the IT system. In addition, the study also indicated that the national list of drugs and medical supplies to be reserved, the quantity to reserve should be determined using the scenario planning technique. Moreover, a new law specific to the management of drugs and medical supplies in the emergency should be developed to enhance the efficiency of the management system. Regarding the self-reliant capability, the study indicated that the reform should first start with fast re-structuring of the existing organizations which are responsible for the improvement of drugs and medical supplies industry and reviewing of their roles and responsibilities to put special focus on drugs and medical supplies. The approaches to reform should be performed throughout the entire supply chain. Furthermore, it is really essential to change the budgeting system and unite the working mechanisms among related authorities. Reduction of selling privilege of the Government Pharmaceutical Organization and other organizations which have similar privilege, aiming to create equity and enable real market competition, is one of the main findings from this study. The government should also support the budget to drugs and medical supplies industry to facilitate more efforts and investment in research and development and production, To conclude, the government should place as much emphasis as possible on this reform. Extensive effort should be carried out to facilitate the system reform. The focal authority should be strengthened on every aspect thus the actual integration could be established and the security of drugs and medical supplies of Thailand could be expected.


Heart failure (HF) is a major health problem globally. Multidisciplinary team care increases standard medication treatment, decreases risk of hospitalization with heart failure and all-causes mortality, also improve quality of life in patient with heart failure. However, with the increasing of number of patients and lacking the clinical practice guidelines in the HF clinic, are affecting the problems of data management, redundancy of documentation. These are obstacles for data management in patient care, quality assurance and initiating of academic work. This is a participatory action research among staffs inside the HF clinics and outside the HF clinic, also patients or care givers. The objectives of this study including the development of multidisciplinary care model and the clinical practice guidelines for HF patients in the clinic, the development of data management system and other tools, and the comparisons of outcomes between before-after receiving care from the HF clinic The results from problem survey found that problem related to data management was the most important including data collection, documentation and report, redundancy of data documentation and communication within the clinic. The patient’s data-base system was developed, as well as the clinical practice guidelines and other tools for supporting patients’ care. A total of 100 patients, 58.00 percent were male, the mean age of 6 1 . 9 2 + 1 5 . 7 5 years old. Patients received treatment in the HF clinic for at least 6 months. The mean of ejection fraction (EF) was 30.80 + 8.48 %. The common cause of cardiomyopathy (CMP) was ischemic CMP (70.00%). The evaluation of all process outcomes found improved significantly including patient’s knowledge for self-care score, the mean guideline adherence indicator (GAI) increased from 64.35 + 38.25 % to 88.50 + 21.76 (p=0.009), the New York heart association functional class was improved, and also the 6-minute walk test. All drug related problems (DRPs) found were 134 problems. The common DRPs were dosage too low (47.00%), non-compliance (37.00%), and adverse drug reactions (21.00%). The DRPs were solved mostly by physicians adjusted the medication combined with pharmacist provided counseling to patients (61.94%). The majority of DRPs were solved completely (70.00%) with 29.00 percent were pending for following-up. The outcomes after development of patient’s care model resulted in the numbers of hospitalization with heart failure decreased significantly (33.0 and 8.0%, p<0.001) and saved the total of hospitalization cost 8,839.72 baht per patient, the quality of life score increased significantly, and the mean patient satisfaction score was in the level of good-best after received the developed patient’s care system.


From the study of "The process of caring mental health for the patient’s terminal stage following the Islamic way: Thai patients Muslims in the three southern border provinces ". This study is qualitative research. It consists of information from documents by studying from the Quran and the Sunnah. As well as the opinions of accepted Muslim scholars. The information obtained in many languages such as Arabic, Malay, English and Thai. In this study using structured in-depth interviews, participant observation and group discussions. The participants of this study were selected based on the purposive random sampling, the researcher uses their personal judgment to select the sample. The participant’s total number of 39 persons, namely 1) 30 caregivers from 3 provinces 2) 6 Muslim scholars from 3 provinces 3) 3 public health personnel from 3 provinces. The objective of this study to study 1) Knowledge about general health care methods in accordance with Islamic way 2) Islamic mental health care model of terminal stage patients of three Thai Muslims in Southern Thailand 3) compare the knowledge of Islamic path with the real practice of mental health care according to the Islamic way of the terminal stage patient of Thai Muslims in the three southern border provinces and 4) produce a manual for the care and treatment of mental health according to the Muslim way of the patient in terminal stage. From the study, it was found that 1) illness is a condition and pain that occurs with the desire of Allah that was destined to come from various causes whether it is perceived or not perceived all diseases and revival are all destined for Allah. As for the sickness, he will normally give through various causes or factors. Reasonable There are two ways to treat the disease: 1) mentally: healing by reading the verses of the Maruur and reading the Quran, blowing and stroking all over the body. 2) Objects: healing by prevention and control accordance with the nature that Allah has set through the healing process on the basis of the specific cause and regulation that the servant can recognize and study from the academic medicine. The drugs listed in the Qur'an and Al-Hadith are 1) honey, 2) Samsum water 3) Habatus, Sao Dao (black cumin) and 4) date palm. Or other breeds. Islam has forbidden Muslims to treat them with things like pigs, dogs, spirits, and other things that are dirty and etc. Except in conditions that are necessary and have no choice. And do not treat with any type of magic or amulets tied to the neck, wrist, or waist because this is considered a big sin. 2) The caregiver should be giving encouraged with religious principles and remembers Allah every morning and evening by reading al-Fatihahah and 3 Kul including surah alikhlas-annas and alfalaq and recite the Dua and blown down on both palms, then rubbed on the patient's body especially in areas with pain (3 times). Give more often to the patients to read and listen to the Quran or Azkar nabavi from a tape or phone. And persistently saying Tasbiht, tahmid, takbir, and apologizing, etc. All good work, the caretaker will begin by reading the name of Allah and recite the dua by using the right hand regularly except for washing the genitals or washing the penis using the left hand. After completion should thank Allah regularly. And the caretakers should focus on the patient to say Cha-had throughout that "La Ila ha illallah". 3) the actual practice of the caregiver is a) Consolation and encouragement with the principles of Islam. B) Reading the Quran and dua, blowing, and stroking patients. c) Sleeping care and closing food containers and d) off the lamp and closing the window and door before bed and the part that is practised from time to time is the writing the dua put near the patient for often recite. The patient should perform regularly: a) saying "La Ilha Ilallah" b) Reading surah al-fatihah and 3 kul. c) Reading the name of Allah in every action. D) Recite the dua before going to bed and waking up and being patient for every trail. The things that the patient has to do for some time are a) Reading and listening to the Quran or Azkar Nabawi from tapes or phones. B) Saying zikrullah and istigfar in the moment Dawn c) Prayer and fasting in Ramadan. d) Donations and dressing that covers up. E) Sufficient eating and ablution before going to bed and sleeping on the right side of the body and saying, takbir and tahmid before sleeping. E) Recite dua when see sneezing. Handshaking with the visitors and thanking and f) salawatunnabi to praise the messengers (r). 4) The caretakers should try to take care of the patients according to the style of the messengers (r) by doing the following: a) Helping patients to take salat for patients throughout especially for patients with bedridden. B) Consolation by religious principles. C) Recite zikrullah regularly and suggest the patients recite dua according to the chapter on various topics. And helping patient to make tayammum instead of taking a bath for the patients who cannot be watered. D) Read the Qur'an and blow on the palm and stroking around the patient's body. And every time to eat food, medicine and water, speak the name of Allah and use the right hand regularly. F) Flick the patient's mattress, turn off the lights and close the door of the house and window completely. And close the food container when going to bed all the time.


Background: Based on national and international guidelines (Kidney Disease Outcomes Quality Initiative-K DOQI) in patients with end staged renal disease, arteriovenous access (AVA) creation without history of central venous catheter (CVC) insertion is the recommended approach, but in Thailand, most hemodialysis patients had experiences of CVC insertion beforehand. Underestimation of consequences of such approach in our patients and medical personnel, might be a cause. Therefore, we aimed to develop the protocol that can improve the outcomes. Methods: Expressed Protocol in Northern Thailand (EPNT) was formulated. EPNT was composed of: 1) patients who did not have any experience of CVC insertion before AVA creation, 2) patients almost used vein for AVA creation, 3) AVA was under good surveillance after operation. This study plan followed up in 24 months, but this report compared and illustrated the outcome between EPNT and non-EPNT patients in the first 15 months. The outcome included the rate of maturation, AVA complications, central vein stenosis, sepsis, major adverse cardiovascular event (MACE), and the score of Quality of life by SF-36. Results: There were 100 EPNT patients and 101 non EPNT patients. EPNT group had lower cumulative rate of AVA infection (EPNT: 0% vs non EPNT 2.52%, p = 0.087), than those in non EPNT. Also 11.9% in non EPNT patients had history of CVC sepsis. EPNT group had lower rates of central vein stenosis (EPNT: 1.23% vs non EPNT 5.11%, p = 0.146), than those in non EPNT group. However, these trends did not reach a statistically significance. The rates of maturation, AVA complications, and MACE were not different between two groups. The score in the general mental health in EPNT group was significantly better than those in non EPNT group. Conclusion: EPNT patients had a trend toward lower rates of sepsis and central vein stenosis, and better general mental health scores than those non EPNT patients. However, this 15-month result does not make any solid conclusions to determine the difference between EPNT and Non-EPNT. Further results will shed more light on this field.


Objectives: 1). To compare the economic and social impact of mental illness between those who receive early and delayed treatment, between those with early and late onset of disease, and between those with short and long durations of illness. 2) To examine the effectiveness of home visits made by community health workers in improving patients’ outcomes (by conducting a before-and-after home visit evaluation among those who receive visits). Methods: The mixed method study design was employed. First a cross-sectional community survey was conducted by sampling: 1) psychotic patients aged 18 or above residing in the catchment areas of Thammasat University Hospital and its primary care unit (PCU), namely the areas administered by Kukot and Lamsamkaew Municipalities, who had had histories of receiving psychiatric treatment at the hospital and its PCU, 2) individuals living in the areas who had been screened positive for psychiatric conditions in the earlier community survey (year 1) and 3) psychiatric individuals who were so called “hard to reach” and recruited by using a technique called chain referral method (i.e. by asking community residents to introduce patients they had seen or known in the area). Face-to-face interviews were conducted by trained interviewers with the World Mental Health - Composite International Diagnostic Interview version 3.0 (WMH-CIDI 3.0)-Thai version, eliciting sociodemographic information, education, employment, finances, DSM-IV diagnoses (including psychosis, depressive disorders and alcohol use disorders), chronic physical conditions, history of service use, health care coverage and family burden. The second study design employed was before-and-after treatment without control group. The intervention was home visit delivered by community health workers to those who had had histories of medication non-adherence or losses to follow up, and were therefore at increased risk of relapse and rehospitalization. Results: The sample comprised a total of 623 participants (respondent rate 89.1%). The majority of the sample were recruited using the chain referral method. The proportion of those with a lifetime history of psychotic symptoms was 88.9%, depressive disorders 81.4% and alcohol use disorders 19.6%. Multivariable analyses revealed that early onset of illness was significantly associated with increased risk for low educational attainment, unemployment, reduced annual earnings and metabolic syndrome. History of delayed treatment was significantly associated with increased risk for low educational attainment. Long duration of illness was significantly associated with unemployment and reduced annual earnings, whereas relatively short duration of illness was significantly associated with greater risk of metabolic syndrome. In terms of family burden, the majority of carers reported substantial or great burden related to illness such as keeping (him/her) company, giving emotional support, and helping with medication. More than half reported time spent on caregiving at 8-9 hours/week. The majority of carers also reported substantial or much embarrassment due to having a mentally ill relative. More than a third reported financial burden caused by caregiving. The majority of respondents had had received psychiatric treatment (86.4%), most of whom were in regular follow-up (57.1%), followed by those who had lost to follow-up for less than a year (20.5%) and for a year or more (14.2%). Of those who had never sought treatment (N=301), 38.2% were able to get treatment after the interview assessment. A total of 61 respondents received home visits. After a period of visits, the majority of these respondents showed improvements in almost all areas under evaluation, except employment, quality of caregiver and home environment. Conclusions: A substantial number of psychiatric patients in the community has dropped out from treatment, or never even received treatment. These patients would never have had access to regular and adequate treatment if psychiatric care was only facility-based without community involvement. Proving early treatment without delay, especially to those with early onset of disease, and continuous care, by effective interventions such as home visits, is essential. This will help reduce the long term serious impact of illness such as school dropout, unemployment, family burden, chronic physical diseases. Development and evaluation of innovative early identification and continuous care methods in the community, with the help of modern technology, is essential in reducing the accessibility and treatment gap experienced by mentally ill patients.


This study aimed to synthesize the primary care service provided by a Public Health Center (PHC) of Health Department under the Bangkok Metropolitan Administration. Objectives of this study were to explore the ratio of the people who received and did not receive the service from the PHC, to propose the PHC Family Medicine Service Model based on the Ministry of Public Health Reform Policy which relevant to the BMA context in terms of professional competencies, Information technology system, financial regulations which reflects the principles of transparency, and good governance. Moreover, the proposed service model should also take into account the possible public health networks in the area such as a drug store and the private hospital or private health service center. Mixed method research method design was applied in 4 pilot public health centers included PHC 29, PHC 30, PHC 60 and PHC 66. Data collection at each center included 7 in-depth interviews with public health staff, 4 face to face interviews with 100 patients and 30 family members who attended services from the center, 50 family members who did not seek services from the center, 30 people who worked in the one kilometer radius of the PHC and attended service from the PHC. Significance findings revealed that people who attended the PHC service due to the close distance and easy to travel to the PHC. In addition, they also perceived that the PHC provided health promotion service, immunization, emergency care for a minor injury. However when comparing with people who live in the area, data revealed that percentage of people who seek these same services in the hospital are still higher than those who come to PHC. The four PHCs included in this study are the pilot PHC. Despite the same principles and policy, each center has offered in three different service models due to the different socioeconomic and cultural context. As the result, this study proposed a “service model” which provides services based on the information from the Central Information System which also connects with a private hospital and a drugstore in the catchment area. Moreover, the service model must create the network with all organizations and mobilize them to promote health of their people via intervention such as nutrition, exercise, etc. in concordance with the world health organization strategy on “Health in all Policies” and connects with the Quality of Life District Committee mechanism. To facilitate this service model, the supporting system has to be established in at least three mechanisms: an information management system, capacity building system for PHC staff, and a transparent financing system with good governance mechanism. Recommendation can be drawn as follows: Factor influencing health seeking behavior of the Bangkok people included distance and convenience to travel, perception of the types and quality of service. Therefore, public relation activities through social media and word of mouth to promote services provided in each PHC should be done; PHC Professional skills especially in technical skill such as documenting and evaluating the service, service process improvement, and digital information technology development and management need to be enhanced. Moreover the financial call center unit for PHC administrative staff should be set up.


Tuberculosis (TB), an infectious disease remains a major public health concern in Thailand. This research, we focused on design and discovery of potent anti-tuberculosis agents to overcome fluoroquinolone drug resistant using molecular modeling, computer aided molecular design approaches combined with biological assay evaluations. In order to design and develop structure of DNA gyrase inhibitors targeting at ATPase domain of DNA gyrase subunit B including 4-aminoquinoline, 4-(piperazin-1-yl)quinolone, 2-(1H-benzo[d]imidazol-2-yl)-2-cyanovinyl, Nitro-thaizole and benzo[d]isothiazole derivatives, molecular docking calculations, quantitative structure–activity relationship (QSAR), molecular dynamics (MD) simulations and FMO calculations were performed. The crucial interactions in ATPase domain and structural requirement of inhibitors revealed the key information for ration design highly potent DNA gyrase inhibitors.  Virtual screening and biological assay were applied to discovery of novel and highly potent DNA gyrase inhibitors. 17 compounds showed the inhibitory activity based on ATPase assay closed to reference compound, Novobiocin. For antimicrobial assay, two active compounds, G24 and G26 were obtained the 12.5 µg/ml. DNA supercoiling assay of active compounds in wild-type and N538D mutant type of DNA gyrase were investigated. The obtained results showed that the inhibitory activity of two compounds (G18 and G24) were higher potent than the reference drug, ciprofloxacin. There active compounds (G18, G22 and G24) showed the DNA supercoiling inhibition higher than the reference drug. Pharmacokinetic properties of active compounds were predicted using ADMET predictions. The obtained results revealed that new active compounds were suitable for structural modification to improve the biological activity. MD simulations and X-ray crystallography were used to investigate the binding mode and binding interactions of active compounds in ATPase domain. The obtained results provided the crucial interactions for developing novel and highly potent compounds for fluoroquinolone drug resistant tuberculosis.


Tuberculosis (TB) remains a public health problem in Thailand and causes socio-economic consequences. Studying of epidemiology and biology of Mycobacterium tuberculosis, a causative agent of TB, development of rapid diagnosis of drug-resistant TB, and effective treatment are urgently required for effective prevention and control of TB. Genotyping of M. tuberculosis strain based on specific genomic markers has been widely used for epidemiological study. Particularly, single nucleotide polymorphisms (SNPs) are current genomic markers appropriate for epidemiological and evolutional study and also for prediction of drug resistance. From the first-year study, we could develop the whole genome sequence analysis pipeline for prediction of resistance to first-line anti-TB drugs (isoniazid, rifampicin, streptomycin and ethambutol) and for rapid genotyping. Comparison with results obtained from standard drug susceptibility testing, the analysis pipeline had sensitivity and specificity of 94.6% and 98.5% for isoniazid, of 92.4% and 99.6% for rifampicin, of 85.3% and 98.9% for streptomycin, and of 66.7% and 97.9% for ethambutol, respectively.  For genotyping the pipeline showed 100% concordant results with the standard LSP. In addition, SNPs databases for drug resistance and genotyping were created from this study. In the second year of the study, the automatic genome analysis pipeline for prediction of drug resistance and for genotyping was developed and validated with a test sample set of 50 M. tuberculosis strains comprising of 41 isoniazid-, 43 rifampicin-, 23 streptomycin-, 27 ethambutol-, 12 amikacin-, 13 kanamycin-, 25 fluoroquinolone-, 11 ethionamide- and 15 PAS-resistant strains. Results were compared with those obtained from the standard drug susceptibility testing and revealed the sensitivity and specificity from 82.6 to 92.6% and from 87.0 to 100%, respectively, for prediction of first-line anti-TB drugs. The sensitivity was lower for prediction of second-line drugs; sensitivity and specificity ranged from 66.7 to 80.0% and from 92.0 to 100%, respectively. The automatic genome analysis pipeline also showed 100% concordant results with the standard LSP for genotyping.


The present study was invention of an instrument for balance assessment and feedback in second year. The purpose of this research was to test the efficiency of the instrument by testing reliability. Forty-two participations, aged range 40-93 years, were recruited into this study. Participants were divided into two groups, including aging group (n=22) and people with stroke group (n=20). The finding showed that reliability of force measurement was very high for both plates (ICC (3,1) = 0.945 for plate 1 and 0.978 for plate 2, p<0.000) in aging group, while reliability of force measurement in people with stroke group was between high and very high (ICC (3,1) = 0.872 for plate 1 and 0.968 for plate 2, p<0.000). Reliability of center of pressure was between middle and high in both groups. In conclusion, the instrument was able to measure force efficiently. However, this instrument should be developed in order to increase effectiveness of measuring center of pressure.


The present study was aimed to develop a method to detect cancer cells in venous blood of cancer patients, either for screening for following-up. Heparinized venous whole blood of about 10 milliliters from the subjects were processed for red blood cell lysis and white blood cell depletion. The cells remained were cryo-fixed and stained using commercially available reagents claimed to give a good morphology of the fixed cells that could be stored for many months. Blood samples were collected from 25 colon cancer patients and 12 subjects who were negative for colon cancer screened by colonoscopy. Early in the study, blood samples from 2 breast cancer patients, 5 hepatocellular carcinoma patients, 1 cholangiocarcinoma patient, 1 lung cancer patient and 1 osteosarcoma patient were also collected. Antibodies against vimentin, cytokeratin, CD45, CDX2, CD31 and CD34 were used. Due to a technical problem on red blood cell lysis and staining temperature, a few weeks were spent to solve it and later cells could be fixed and stained at low temperature. Other optimizations included low temperature handling steps and concentrations of antibodies. The immuno-stained cells appeared mostly to be white blood cells of good morphology. A pathologist had investigated the stained samples and found that there were only 2 cases out of 25 colon cancer patients that seemed to have some abnormal/cancer cells. These were larger and their neclei were also bigger than the nearby white blood cells. They were especially positive for CK 20 and CDX2, the latter being reported to be specific for adenocarcinoma. However, the size of many abnormally stained cells found in many cases was similar to white blood cells, it may be concluded that in this present study abnormal cells could be found in blood samples of colon cancer patients but perhaps with a very low sensitivity. Also owing to quite a high cost of reagents for cell isolation and low temperature processing, this method at the moment could not be used as a routine colon cancer screening.


Thailand has enacted the Excise Tax Act B.E. 2560 and relevant regulations since 2017. As a result, the structure and tax rates of sugar-sweetened beverages (SSBs) have been adjusted with an intention to reduce sugar intake from SSBs. The majority of SSBs containing sugar more than 6 grams/100 ml. have been taxed with different rates according to the sugar contents. However, dairy products have been exempted. The objective of this study was to monitor SSBs’ prices and sugar content, compared between pre and post SSBs tax adjustment. This study used a comparative analysis of prices of and sugar content in SSBs from two surveys (March 2015 and March 2018) and used Mann-Whitney U test to test differences between pre and post SSBs tax adjustment. The results indicated that overall of SSBs’ prices were increased after the tax adjustment (+11.1% by median), both domestic beverages (+12.7% by median) and imported beverages (+18.1% by median). Sugar contents in domestic SSBs were declined (-9.6%), while in imported SSBs increased. In addition, high sugar content in dairy products was not decreased. Conclusion, the study shows that the SSBs tax adjustment may provide a positive change in terms of prices and sugar content as intended, except for imported SSBs and dairy products. Therefore, the excise tax should cover all SSBs and there should be complementary measures to reduce SSBs consumption.


This study aimed to assess outcome of alcohol-free funeral policy, firstly launched in Lampang in 2008, by comparing between three areas of campaign implementation (completed, ongoing, and no campaign). Methodology: A mixed methods study was carried out in 2012. A face-to-face interview of 1,445 villagers with a structured questionnaire was conducted to evaluate perceptions, attitudes and supports of the respondents toward the policy as well as exposure to the alcohol-free funeral. Twelve funeral hosts were elicited about their funeral details and perspectives on outcomes of the policy by a semi-structured questionnaire. Results: People who lived in the completed implementation areas ever attended fewer funerals with alcohol (26.7%) when compared to people who lived in the ongoing areas (37.4%) or in the areas without campaign (40.9%). The proportion of alcohol drinking experience among who had attended the alcohol-serving funeral in the completed implementation areas was quite low as 26% (6.8/26.7) when compared to 37% and 41% of those in the ongoing areas and the areas without campaign, respectively. The funeral hosts in the completed implementation area elaborated that the areas with no alcohol offering at the funeral complied with the community agreement, and hence, helping them to save money. While some of the funeral hosts in the ongoing and without campaign areas still offered the local white spirit for the participants, and hence, had the expenses and some drunk-driven quarrel and violence in the funerals. At the funeral without offering alcohol, there were fewer attendances because people in the community believed that offering alcohol at the funeral was a tradition. This study recommends that the community agreements and social agreements are needed to support the hosts conducting the alcohol-free funeral.