The diabetes risk score is a simple tool for predicting the probability that individuals will develop
diabetes mellitus in the future. This paper introduces the Thai diabetes risk score calculated from data
obtained from a previous study of cardiovascular disease in a cohort of employees of the Electricity
Generating Authority of Thailand. The scores were derived from coefficients in the logistic regression
model. Variables which significantly predicted the diabetes incidence included age, sex, body mass index,
waist circumference, blood pressure and family history. The predictive performance of the tool was
75 percent. This simple tool could be used to identify those who are at high risk of diabetes and encourage
them to follow healthy lifestyles.


This study was aimed at assessing the governance and management of purchasing universal health
care services of Thailand’s National Health Security Office (NHSO). The research methodology used was
the quality method; it involved reviewing the literature and related documents, a briefing from the staff of
the NHSO and in-depth interviewing of the representatives of providers and purchasers in each selected
province in four regions of Thailand. The data obtained were analyzed by using content analysis technique
and the result was presented descriptively. The results of the study showed that governance existed
at both the central and provincial levels. At the central level, governance was provided by four important
organizations including the NHSO Board, the NHSO, the Service Standard and Quality Control Board
(SQCB), and the Ministry of Public Health. At the provincial level, governance passed through three
important organizations comprising the Provincial Public Health Office (PPHO), the provincial branch of
the NHSO, and the public and private health-care providers. The regional branch of NHSO and local
government had little to do with governance. Governance was informal in the provinces. The problems
of governance were due to the confusion between the purchasing and providing functions of the PPHO.
The purchasing power of the NHSO provided a great effect on the governance of the provincial health
insurance. There are four important summarizing recommendations for improving service purchasing
governance, including separating the SQCB into an autonomous body, making the division the cutting
between the purchasing and providing roles, delegating more authority to branch offices of the NHSO,
and opening more opportunities to civil society and local organizations for participating in governing the
purchasing functions under the Universal Coverage Scheme.


Diabetes mellitus and its associated complications are major health and economic burdens worldwide,
in Asia and the Pacific and in Thailand. This burden is expected to continue to rise. The aim of this
study was to determine the prevalence of diabetes and impaired fasting glucose (IFG), their association
with cardiovascular risk factors, and evaluate the management of blood glucose, blood pressure and cholesterol
in diabetes by geographical region of Thailand. We used a database of the National Health Examination
Survey 2004, a stratified multistage sampling design representing 37,138 individuals aged ≥ 15
years; the data were collected using questionnaires, physical examination and laboratory examination
The prevalence of diabetes mellitus and IFG weighted to the national 2004 population was 6.6 percent
(5.9% in men and 7.2% in women) and 12.6 percent (14.8% in men and 10.5% in women), respectively.
Diabetes was more prevalent in urban areas. In two-thirds of those diabetics who had not been previously
diagnosed, the prevalence of associated risk factors was high among diabetics as well as those with IFG.
Two-thirds of the diabetics with concomitant high blood pressure were not aware that they had high
blood pressure. Eighty percent of the diabetics with concomitant high cholesterol were not aware that
they had high cholesterol. The risk factors for diabetes and IFG were male sex, high blood pressure, high
cholesterol, central obesity and overweight. Most risk factors could be modified by lifestyle interventions.
Improvements in prevention, diagnosis and treatment of diabetes and associated risk factors are
required in order to decrease the expected burden.


Basic bio-medical research is an essential component in public health for dealing with increased and
complex threats from emerging, re-emerging and existing prevalent diseases in the modern world. The
existence of a critical mass of scientists, personnel, facilities and technology, working concurrently with
efficient public health and clinical facilities, capable of producing high-quality scientific information
related to diseases or problems, is a critical component for any nation, in particular for developing countries facing health threats. The article gives a close-up view of the experiences of a network of bio-medical
research within academic institutions collaborating with clinical facilities within the Ministry of Public
Health. The purpose of collaboration was the production of essential scientific information that could
translate into useful clinical and epidemiological applications. The article reveals the tacit potentials, in
personnel and facility, embedded within the Ministry that, if properly managed and supported, could be
utilized in order to enhance this essential collaborative activity


This retrospective descriptive study was conducted on 370 patients to assess the
efficiency of extracorporeal shock wave lithotripsy (ESWL) in removing their renal or
ureteral calculi in Thabo Crown Prince Hospital in the period from March 2006 to March
2007. There were no severe complications and, at the three-month follow-up, KUB radiography
revealed stone-free pictures in an average of 66.21 percent patients who underwent
the procedure. Thus, it is concluded that ESWL is a good alternative intervention
for the removal of renal and ureteral calculi, especially those smaller than 20 mm.


The purpose of this research was to study the levels of job satisfaction of Pakkhad
Hospital staff, Nongkhai Province, with the policy on universal coverage of health insurance.
The population comprised 80 staff who had been working at least one year. The
data were collected by questionnaires. Descriptive statistics (percentage, mean, standard
deviation) were used in data analysis. The result showed that the job satisfaction of the
staff, with regard to the universal coverage of health insurance policy, was at a moderate
level. Job satisfaction with regard to responsibility in work, satisfaction with policy and
admi-nistration, compensation and fringe benefits, working freedom in health services,
interpersonal relations, position advancement and working conditions was at a moderate
level.
Based on this research, it is suggested that the compensation and fringe benefits of
staff should be improved and health personnel should be supported in continuing their
studies so as to improve their academic status. For this, they could be better equipped and
become a greater help as human resources of the department for the development of the
organization.


Serious complications of the eyes often occur in diabetic patients. This research was
aimed at studying diabetes retinopathy (DR) in type 2 diabetes patients who were registered
with the diabetic clinic of Thaluang Hospital, Lop Buri Province, using pictures
from a fundus camera. All pictures from this camera were interpreted by an ophthalmologist.
In addition, if some cases could not be diagnosed by the pictures taken, these
cases were examined by the ophthalmologist directly. Out of 763 type 2 diabetic patients
(86.31% of all the diabetic patients), 87 patients (11.40%) had to be examined by the ophthalmologist.
The results of this examination revealed that there were 121 cases of non-proliferative
diabetic retinopathy (15.89%); seven cases of proliferative diabetic retinophathy (0.92%); 15 cases of glaucoma (1.97%); 44 cases of presenile cataract (5.77%); and 156 cases
of senile cataract (20.45%).
The results of this study showed that DR could be found in the early years of diagnosis
as type 2 diabetic patients. The percentage of DR increased in relation to the number
of years after the patients were diagnosed as diabetic. Screening DR by examining pictures
from a fundus camera is appropriate for community hospitals and hospitals that
have no ophthalmologist because it could be performed in these hospitals and sent to the
ophthalmologist for diagnosing later. Therefore, using pictures from the fundus camera
to search for DR in diabetic patients would decrease a large number of patients who
should be examined directly by ophthalmologists.


The purpose of this research, which is a descriptive study, was to study the relationship between effective factors to decrease the blood sugar level of the diabetes mellitus
patients who are clients of the Diabetes Clinic, and actual decreases in blood sugar levels.
The samples were 176 non-insulin-dependent type diabetes mellitus patients who were
clients of the Diabetes Clinic, Saraphi Hospital, Chiang Mai, during the period from October 2006 to December 2006, using purposive sampling according to required characteristics. The data collection method was a combination of interviews and studies of medical
records. Descriptive statistics were used for data analysis, and chi-square for hypothesis
testing.
The research results were as follows: about half (48.9%) of the samples had decreased
blood sugar levels and most samples (53.4%) had self-care at a good level. Moreover, it
was found that age, weight, and period of being diabetic were not related to decreased
blood sugar levels, but the self-care of the patients was related to a decreased blood sugar
level, statistically significant at the .05 level.
This research result is useful for the officers concerned, as guidance for enlightening
other diabetes mellitus patients formally by focusing on the self-care of diabetic patients
in order to obtain more effective services.


This was an exploratory and retrospective study, the objective of which was to study
the medical treatment provided to aliens availing themselves of remedial services, medical privileges, and the expenses paid for such services at Klaeng Hospital in Rayong
Province.  The data were collected using the HIM Pro. program, which extracted data
from the medical records of this group of patients and their families who sought medical
treatment in the previous year (from October 1, 2006 to September 30, 2007). The total
6,165 cases comprised 5,792 out-patients and 373 in- patients. The analysis used percentages and means. The results of the study found that the majority of the non-Thai laborers and their families were Cambodian, aged 21-25 years, with mean age being 26.5 years
old.  With regard to the medical privilege, they paid the fee concerned by themselves, the
cost of which exceeded the privilages obtained.  The majority of alien laborers were using
the services for medical check-ups for employment purposes, health promotion, antenatal care (ANC), immunization, family planning, etc. The major diseases or illness found
were injury, and gastro-intestinal tract and respiratory tract problems, 13.37, 7.10, 5.94
percent, respectively. The infected diseases found in the out-patient section were diarrhea, tuberculosis, syphilis, HIV, and food poisoning in 1.19, 0.22, 0.19, 0.10, 0.07 percent
of the cases, respectively.  Admitted patients had diarrhea, dengue hemorrhagic fever,
HIV, appendicitis and viral hepatitis in 2.86, 1.07, 1.07, 0.54, 0.27 of the cases, respectively.
As for the expenses for the medical treatment of the alien laborers that did not have such
privileges, the study found that 54.49 percent of the patients were able to pay the fees.
The out- patients had a greater capacity to pay the fees than the patients admitted to the
hospital.


Mental and psychiatric illnesses are major health problems and the trend is increasing.
Most seekers of health care still lack adequate treatment, and preventive and rehabilitative
coverage. Thus, health personnel working in primary care units (PCUs) are persons
who are able to provide complete services in better caring for their clients.
The purpose of this descriptive study was to assess the standard practice of mental
health and psychiatric services in various PCUs in Phichit Province. The survey samples were colleagues who authorized mental health and psychiatric services at 51 PCUs in
Phichit Province. Data were collected from September to November 2007. The instruments
consisted of questionnaires for the standard practice of mental health and psychiatric
services from the Department of Mental Health, Ministry of Public Health (2005).
The data were analyzed by descriptive statistics and content analysis. The findings of the
study revealed that 66.27 percent of the overall PCU analysis was fairly satisfactory.
Independent PCU analysis found that 17 PCUs (33.3%) were dissatisfied, 14 PCUs (27.5%)
were fairly satisfied, 13 PCUs (25.5%) were satisfied and 7 PCUs (13.7%) were very satisfied.
However, this study found that important limitations to mental health and psychiatric
services that followed standard practices were the patients’ lack of knowledge and
understanding about mental health and psychiatric services, a lack of specialists in mental
health and psychiatric services and continued development of specialists; these shortcomings
must be resolved. Other limitations were an inadequate support system and
insufficiency of mental health reports. This article suggests that the strategy and policy
planning for the mental health and psychiatric services for the primary care unit (PCU) in
Phichit Province need improvement.


Social movement is a way to solve some of the problems of diabetes.  The aim of this
research was to study factors affecting the social movement of diabetic patient groups in
Saraphi district, Chiang Mai Province.  A descriptive cross-sectional survey was done
during the period from October to November 2007.  The study population were 469 diabetic patients in the primary care unit; they had been chosen by the stratified random
sampling method.  The contents of the study were knowledge about social movement,
social network density and frames of social movement.
Findings revealed that the majority had low social network density and inadequate
knowledge about social movement.  About haft of the diabetic patients had progressive
frames of social movement.  The conditions of these factors affected the lack of social
movement. Diabetic patient groups should be developed and supported by adequate
social movement knowledge, resulting in increasing social network density


A randomized controlled trial for determining the incidence of omphalitis and observing cord separation time in two groups of newborn infants used two different methods of umbilical cord care, namely, cleaning with alcohol or with dry cotton wool.  Of 384
full-term newborns, 169 were assigned randomly to receive dry cord care and 188 infants
alcohol cleaning.  Both groups were followed up for examination at one week and one
month after delivery.  There was only one infant in each group showing signs of omphalitis.  Cord separation time in the alcohol group was significantly longer than in the dry
cord care group (8.03 days vs 6.74 days; p-value < 0.05).
It was concluded that dry cord care should be recommended for umbilical cord care
in newborn infants based on the results of the study that it did not increase the incidence
of omphalitis and took a comparatively shorter time to achieve cord separation.


The research objective was to study the effectiveness of antiretroviral (ARV) drugs
and the effective technique in taking care of HIV-infected and AIDS patients. The research
sample comprised 50 HIV-infected and AIDS patients taking ARV drugs. The
scope of the study included their sex, age, occupation, and time period before starting to
take ARV, history of ARV drug usage, CD4 levels before and after treatment, drug side
effects, prevalence of opportunistic infections, causes of changing drug formula, and
mortality rate; all data were analyzed by descriptive statistics. The result of the research
showed no difference among male and female subjects, whose age ranged from 30 to 39
years. Previous occupations were employees and industrial workers. The CD4 response
study disclosed that the group of subjects who had CD4 levels of 0-100 cells/mm3 had changed little from previous levels after the patients had taken drugs until the end of 24
months, with the highest CD4 level average being 68 cells/mm3. The second group had
CD4 levels of 101-200 cells/mm3; the CD4 level average increased until the patients had
taken drugs at the end of 24 months with the average being 173 cells/mm3. The third
group had CD4 levels of >200 cells/mm3; the CD4 level continued to increase when the
patients had taken drugs at the end of 24 months, with the highest average being 447.55
cells/mm3. The study about their weight found that it clearly changed and that about
opportunistic infections found that the most frequent were cryptococcosis (8%) and PCP
(6%). The change in drug formula was because of drug side effects. The study about
adverse drug reaction found that the most frequent were rash (8%) and hepatitis (6%).


The purpose of this research was to study the prototype development of palliative
care services for end-of-life patients through community participation in Selaphum district,
Roi Et Province, between January and September 2008. The aim was to explore and
develop continuity of palliative care from the hospital to the community by using three
steps in a participatory process, i.e. preparation, planning and implementation phases.
Data were collected by using questionnaires and interviews. The results revealed that the
participation processes were used throughout the study by consulting and by group discussion.
The policy was developed; the palliative care unit was established and team was
formed, including hospital staff, health-care workers, volunteers, and patients’ relatives.
A total of 99 patients were enrolled in the study. The most common group, which included 35 patients, comprised those with cancer. The most common services provided
were demonstration and skill training for patients’ relatives to enable them to take care of
the patients at home. There were 18 funeral cere-monies which staff could join. Development
of the services had followed the “4S” principles: start early, stakeholders, sincerity
and suitability. Situation analysis found the strength of the service was sound policy and
good communication between stakeholders, but the weaknesses were budget schemes
which did not support the service set up. Opportunities in the participatory process were
assigned by the Constitution and the Ministry of Public Health’s policy, but there were
also threats about staff confusion concerning decentralization to the local government
level.


This descriptive research was aimed at evaluating emergency medical services in
Sungmen district, Phrae Province. Information was collected from emergency medical
service record sheets in the period January 1 - December 31, 2007. Descriptive and content
analyses of the data were used. The major findings were as follows: the mean of response
times of advance life support (ALS) level was 10.38 minutes, with a standard deviation of
6.39 minutes (more than the national standard), in basic life support (BLS) and first
responder (FR) levels, the means were 6.24 and 6.29 minutes, with the standard deviations
being 2.22 and 2.67 minutes. The means of on scene time of ALS, BLS, FR levels were 5.90, 4.27 and 3.62 minutes, with standard deviations of 3.83, 2.59 and 2.16 minutes. Evaluation
of all treatments on the scene by doctors were: treatment of respiratory system in
ALS level was done properly 100 percent of the time, while in the BLS and FR levels, the
treatments were not done in 50 and 53.84 percent of cases requiring treatment. Stoppage
of bleeding in the ALS level was done properly 100 percent of the time, in the BLS level it
was not done properly in 2.08 percent and not done at all in 16.67 percent of the cases,
while in the FR level it was not done in 33.33 percent of the cases requiring treatment.
Splints and slabs in the ALS level were properly applied 100 percent of the time, while
in the BLS and FR levels, they were not done in 10.71 and 14.28 percent of the cases requiring
treatment respectively. Although most rescuers were trained in emergency practices,
they all needed more skill and knowledge. The training methods should be revised
accordingly.


A study of the outcomes of the Prevention of Mother-to-Child Transmission Project in
Nakhon Ratchasima Province was aimed at assessing the achievements of 29 government
hospitals in the period from October 1, 2002 to September 30, 2007, and determining strategies for improving the effectiveness of the project.
This study follows a descriptive epidemiological study design. Secondary data on pregnant women attending antenatal clinics and giving birth at those hospitals, together with
the outcomes of children born to HIV-infected mothers during fiscal years 2003-2007, were
analyzed by the Epi Info V. 3.3.2. descriptive statistics program.
The percentage of pregnant women who were tested for HIV increased from 97.1 percent in 2003 to 99.7 percent in 2007. The HIV-positive rate among pregnant women peaked
in 2004 at 1.2 percent before declining to 0.8 percent in 2007. Women giving birth had relatively stable HIV infection rates (0.6-0.8%). However, the proportion of pregnant women
with HIV- positive status who received antiviral drugs (AZT) rose from 86 percent to 100
percent in the period from 2003 to 2007. Those who received AZT for at least four weeks
increased from 72.7 percent in 2003 to 91.9 percent in 2007, while the remainder received the
antivirals for fewer than four weeks. Newborn babies receiving AZT also increased from
46.2 percent to 78.4 in 2007.
The surviving babies had been monitored for HIV infection until reaching the age of
18 -24 months and the follow-up rates rose from 73.5 percent in 2003 to 81.6 percent in 2007.
Every baby (100%) was provided with infant formula powdered milk before leaving the
hospital. The rate of loss to follow-up decreased from 35.3 percent to 18.4 percent during the
period 2003-2007. The main reason was change of address (87.5%), followed by guardians
not wanting to know the HIV status of their child (12.5%). Among those infants whose
blood was available for HIV testing, the HIV-positive rate was highest in 2003 at 6.4 percent
(9 cases), then the number of HIV-positive infants decreased to 5 (2.6%), 6 (3.7%), 2 (1.6%),
and 1 case (0.7%), respectively, during the period 2004-2007.
Conclusions: Overall, the Prevention of Mother-to-Child Transmission Project in fiscal years 2003-2007 successfully achieved its objectives and was implemented at all government hospitals in Nakhon Ratchasima Province. The outcomes of the project improved during that period. The percentage of mothers and infants who were tested for HIV and received antiviral drugs increased and resulted in a drop in maternal HIV transmission in the
province. Given the significant decline in the trends of the HIV infection rate among children aged 18-24 months, the project achieved the national target of lowering maternal HIV
transmission below 6 percent.


The purpose of this descriptive research study was to examine the level of satisfaction
of health personnel with the services provided by the Contracting Unit of Primary
Care (CUP) Board, Bankhai Hospital. Those services consist of planning, organizing,
leading and controlling. The study samples were 118 public health personnel working in
the CUP Board. The research instruments were demographic questionnaire and satisfaction
questionnaire with a five rating-scale. Data were analyzed by using percentage, mean,
standard deviation, and F-test.
The results of this study revealed that the public health personnelûs satisfaction was
at the middle level. Their differences in sex, age, work experience, education level, and
place of work were statistically different at the 0.05 level with regard to satisfaction with
the CUP Board’s services.


In this chapter Edith Kramer discusses her experience in art therapy at Wiltwyck Boys School in
New York on particular cases of poor and problematic children as it related to their citizen rights and
national origins. These children’s initial drawings showed their own cultural and national beliefs along
with the problem of integrating into the mainstream culture. Later on they somehow succeeded in making
drawings, compromised with the new culture, and their work was copied by other children. These
children enjoyed their leadership position and were proud of their development, indicating by their progress
that they had normal mental and emotional status and were living normal lives thereafter.


This research was conducted to determine the relationship between job satisfaction, organizational
commitments and the intention to quit among Thai pharmacists, and to compare the influence of latent
variables in the model between pharmacists working in government service and private organizations. A
literature review was carried out in order to develop the assumption model. The study population comprised
pharmacists whose names were retrieved from the Pharmacy Council documentary system and
who had worked as a professional pharmacist for either the government service or private organizations.
The questionnaires, Cronbach alpha 0.63 - 0.94, covered individual dimensions, job satisfaction, organizational
commitment and intention to quit. A total of 542 pharmacists completed the questionnaires. Descriptive
statistics were used to analyze the data collected and t-test was used to compare the average
means. The LISREL program (version 8.72) was used for model testing and multi-group analysis. It was
found that the pharmacists who worked for private organizations had a higher level of job satisfaction and organizational commitment. The relationship model consisted of individual factors, job satisfaction,
organizational commitment and intention to quit; organizational commitment showed the highest correlation
with the intention to quit. The model accounted for 45.0 percent of the variance in intention to quit
and there was invariance across groups.


The constitution of the national health system under the National Health Act B.E. 2550 (2007) shall
be deemed as a framework and guideline in making policies, strategies and assessing the performance of
activities in respect of national health. In other words, the health system constitution is the national framework
for the health system, providing for the state of human beings that are perfect in physical, mental,
intellectual and social aspects, all of which are holistic in balance. This study used documentary research
and in-depth interviews; it is aimed at exploring the legal status of the national health system constitution,
how it binds relevant organizations, the linkages with rights and duties in respect of health and the
Constitution of the Kingdom of Thailand and its implementation in practice.The national health system constitution is not a formal law and has no legal sanction, but with the
approval of the Council of Ministers, the health system constitution shall be binding on relevant parties,
including state agencies, civil society, politicians and the government. This does not reflect a weakness in
the Act. This Act uses a “mountain-moving triangle” strategy and health assembly for implementing
some restrictions on interested parties, using a participatory approach.
For the purpose of implementing the fundamental principles in the national health system constitution,
there should be some relationship between this constitution and the provisions in Chapter 3 (Rights
and Liberties of the Thai People) and Chapter 5 (Directive Principles of Fundamental State Policies) of the
Constitution of the Kingdom of Thailand, including section 163 of the Constitution. Therefore, the National
Health Act constitutes the model for health laws. Moreover, the health system constitution should
be mentioned in government policy and the administration of the state affairs plan.


This study is aimed at providing a detailed analysis of the nursing workforce in Thailand and monitoring
the supply and demand of the nurse workforce. The study was conducted in order to identify the
size, age structure, and the increasing trend of the current registered nurse workforce and to assess the balance between the supply and demand for nurses in order to understand whether there is any current
shortfall or surplus. The research population consisted of 100,671 nurses registered in the Thai Nursing
Council database. The findings led to the following conclusions:
1. There were approximately 97,942 nurses in the active age group (under 60 years) registered in
Thailand by December 2005. Of these, around 88,440 or 90.3 percent participated in the nursing workforce.
At the same time, owing to the impact of the increasing demand for health services and the decreasing
supply of nursing professionals, their numbers remain woefully insufficient for meeting the country’s
health needs, with the total shortage being on the order of 31,260 full-time equivalents.
2. Although total nurse numbers have been relatively constant during the period 2000-2001, between
2000 and 2004 there was also a substantial overall decrease in the net additions to the nurse population of
35.29 percent (from 6,086 to 3,938) because of the decreases in the production of nurses and the increases
in the loss rate, from 2.35 percent in 2000 to 4.15 percent in 2005.
3. The workforce is aging; the average age of Thai nurses has increased to 37.8 years and the average
working life declined to 22 years, which is typical of most Western countries.
The nursing shortage occurring in health systems is bringing in its wake a serious crisis in terms of
their duration of adverse impacts on the health and well-being of the population. This situation poses
unprecedented challenges for policy makers and planners to take effective action in developing and sustaining
an appropriately prepared, equitably deployed, well-motivated and well-supported nurse
workforce.


The objective of this study was to describe the migration and the distribution pattern of pharmacists
in Thailand. A self-administered questionnaire survey was employed. Stratifried sampling by timing of
the compulsory pharmacist project of the Ministry of Public Health was used in the survey. The total
sample included 1,500 registered pharmacists in three sub-units: those who graduated with a bachalor’s
degree before, between, and after the compulsory pharmacist project, i.e. those who graduated between
1975 and 1988, 1989 and 2004, 2005 and 2006, respectively. The response rate was 43.27 percent. The
results showed that 59.78 percent of the samples had moved 1.8 times on average. The mobility patterns
from their first to current workplaces were different among the three sub-groups. According to the distribution, the results indicated that the number of pharmacists was increasingly distributed into regional
areas. Most of them had worked for the government sector, especially in government hospitals. It was
concluded that the compulsory pharmacist project may effect imbalances in the distribution of pharmacists in the public and private sectors. This problem could distort the professional development of pharmacists, particularly in the pharmaceutical industry and drugstores. Therefore, it is necessary to consider
the balance in the distribution of pharmacists between the public and private sectors in Thailand.


This research was aimed at exploring the Health Systems Research Institute (HSRI) users’ satisfaction,
the nature of their problems and needs, including their opinions toward HSRI research construction strategies. The samples were divided into four groups of research users: executives, academics, networks, and the
general public. The data were collected by two main methods: mail questionnaires and interviews with
executives.
For the general public group, 25 percent of the 5,401 HSRI library members during the period from
2006 to the middle of the year 2007 were randomly selected; 730 of those sent questionnaires, or 56.8 percent
of the total distribution, responded.  For academics, 75 percent of the 500 people who used to work with
HSRI during the previous five years were randomly selected, and 110 questionnaires, or 31.4 percent, were
received.  Network groups were those who served on committees or as staff of any subsidiary, in total 120
people, and 58 questionnaires, or 48.3 percent, were received.  Finally, the last sample group comprised
executives, who were HSRI board committee members, consultants, and medical doctors of related organizations, a total of 22 respondents.
The findings were as follows:
1) The utmost purpose that the general public, academics, and network groups had in using HSRI
research findings was for conducting research (their own research purposes), while most executives used
them to gain a broad perspective in expanding their view, and to support their policy-and decision-making.
2) Regarding the satisfaction towards HSRI research usage, the general public evaluated “content”, “research quality”, and “communication channel” at a high level of satisfaction; academics evaluated
“research quality” and “communication channel” at a high level of satisfaction, “content” at a high level of
satisfaction and moderate satisfaction for some content issues.   Network groups evaluated “research
quality” at a high level of satisfaction, and most of them evaluated “communication channel” at a high level
of satisfaction, with moderate satisfaction applying to only one issue.  “Content” was evaluated mostly at a
moderate level of satisfaction, with a high level of satisfaction for only some content issues.
All three groups evaluated the  academic performance of the HSRI at a high level of satisfaction.
Most executives evaluated it at a high level of satisfaction, with the remark that the evaluation needed to
include a range or periods of time and various perspectives as well.
3) As for the communication channel in using HSRI research, it was found that, besides the HSRI
library, the general public, academics, and network groups used the Journal of Health Systems Research the
most, and radio broadcasts the least.
4) The research topic that the general public would like HSRI to develop the most is research which
supports the care of chronic and non-chronic patients, while academics and network groups need research
on the evaluation of governmental health policies.  Most executives felt that HSRI should review health
systems as a whole since every system and topic is interconnected, whereas the evaluation of governmental
health policies is a topic that must be conducted regularly.
5) Data, which the general public, academics, and network groups said were available in the HSRI
database, were data about health systems research projects.  Regarding website improvement, the general
public would like to have a “research analysis column” added, while academics and network groups wanted
a “health policy analysis column”.   However, in the opinion of executives, if anything should be added, it
should be research synthesis, combined with health policy analysis.
6) Regarding knowledge management of the HSRI for the benefit of the public and the value of
HSRI academic work, the general public, academics, and network groups agreed that HSRI can manage
knowledge for public benefit at a high level of accomplishment.  On the other hand, most executives were of
the view that HSRI has a strong point in being an organization which stimulates health systems knowledge,
and plays an important role in enabling national health policies to be put into action.


Unit cost analysis has often been used as a tool to determine the efficiency of a health-care facility.
Policy makers employ the unit cost of health services in order to make decisions on resource allocation
and for efficiency improvement. This descriptive study was aimed at calculating the unit cost for each cost
center in Mae Sariang District Hospital by collecting financial and accounting secondary data during
fiscal years (FY) 2003 and 2004. The study then evaluated a change in the unit costs of the health services
in each cost center for the two-year period. This study applied the principle of cost analysis and the manual
of unit cost analysis for district hospitals affiliated with the International Health Policy Program (IHPP).
Costs in the study were defined as accounting costs with a provider’s perspective.
The results showed the following proportion of labor costs, material costs, and capital costs in FY
2003 and 2004: 57.73; 27.59; 14.68 and 61.61; 31.61; 6.78, respectively. Average unit costs of all outpatient
departments were Baht 257.01 and 256.33 respectively. Those of all in-patient departments were 4,579.31
and 4,944.22 Baht per case admission, respectively, and the unit costs per adjusted relative weights were
6,575.79 and 7,177.76 Baht, respectively. Compared with the out-patient departments, the unit cost of
dental services was the highest (679.28 baht per visit) in FY 2003 and the counseling service department
had the highest cost (684.39 baht per visit) in FY 2004. Among in-patient wards, the intensive care unit
(ICU) had the highest cost in both years (14,327.40 and 12,338.29 baht respectively per case admission). A
comparison between both years revealed an increase in the number of ambulatory visits and in-patientdays
in most departments. Compared with unit costs in FY 2003, half of the out-patient service centers
had a higher unit cost, but most of the in-patient departments, except for the male ward, could operate at
a cheaper in-patient-day. The data collection methods and the unit cost calculations as described in the Manual of Unit Cost
Analysis for District Hospitals, which were used in the study, were practical and easy. The proportion of
the labor costs to total costs of Mae Sariang Hospital was similar to that of other district hospitals. The
average unit cost of out-patient services was not very different from that of other 90-bed hospitals, but the
average unit cost per in-patient case was higher. Specialists practicing in the hospital and the provision of
ICU services and preterm baby care may explain the more expensive unit cost for in-patient care. In terms
of cost efficiency, an increasing number of patients and the total expenditure in some service centers actually
resulted in an increase in the unit cost; thus, several service centers surprisingly turned out a cheaper
unit cost for visits as well as unit cost of in-patient-days. The findings may indicate greater efficiency of
resource utilization. However, the quality of health services and relative weight of diagnosis-related groups
should be taken into account.


During the period February - August 2005, an outbreak of viral hepatitis A occurred in Wiangpapao
district, Chiang Rai Province. An investigation was promptly carried out in order to determine the source
of disease transmission and provide preventive and control measures. The medical records and investigation
forms of the persons diagnosed with viral hepatitis A during the outbreak were reviewed. An
environmental survey was conducted in those areas. Proportions and attack rates were used to present
the results of the analysis.
A total of 1,308 cases of hepatitis with two deaths were detected during the outbreak. One case with
diabetes mellitus died from hyperglycemia and the other died of scrub typhus. Children aged 5-14 years
had the highest attack rate (7.5 %). The male-to-female ratio was about 1.6:1. The cases were reported
from all subdistricts in Wiangpao district. Only two cases were reported in February 2005 and a number
of cases were found in April and May 2005. Of the 438 cases examined for IgM anti-hepatitis A virus, 361
(82.4%) were positive. Contaminated ice might have been the source of transmission since a lot of cases
reported that they had consumed ice produced by one factory in the district. Samples of ice from that
factory were found it to be harbouring the causative organisms. Preventive and control measures included
the establishment of a war room for planning and supporting the activities, making improvements
in food hygiene and environmental sanitation through good cooperation with local community leaders/
schools/ owners of food, drinking water, and ice-production factories, fostering health education and a
campaign for disease prevention and control, and carrying out surveillance for cases of infection in the
areas concerned. The outbreak was curtailed after intensive preventive and control measures had been
introduced.
Continuous surveillance of food handlers and water, the conduct of health education campaigns
advocating food safety among the public, and improvements in sanitation are essential activities for preventing
or at least reducing the number of future outbreaks of food- and water-borne diseases.


Although effective treatment of and care for some chronic diseases exist nowadays, the majority of
patients with such diseases still do not receive appropriate treatment. This is due to: (a) the rapidly rising
number of patients in parallel with the increasing age structure of the population, which exceeds the
ability of the existing health-care system; (b) the health-care system falling short in its ability to translate
knowledge into routine medical practice; and (c) the health-care delivery system being designed for acute
patient care; it is poorly organized for providing the full complement of services needed by people with
common chronic conditions. The chronic care model (CCM) was developed in the 1990s, based on the
premise that effective chronic illness care can be delivered by prepared provider teams who engage productively
with an activated, informed patient. The six dimensions of CCM that enhance this productive
interaction include the following: (1) self-management support; (2) delivery system redesign; (3) a clinical
information system; (4) decision support; (5) health-care organization; and (6) community policies and
resources. To date, CCM has been applied for patients with diabetes, cardiovascular disease, chronic
respiratory diseases and asthma, depression and HIV infection. Evaluation results, particularly for diabetes,
show that the implementation of CCM improves the process and immediate outcomes of care. However,
its long-term impact on patients’ longevity is still undetermined.


This study was aimed at surveying the distribution of dental hygienists and their job identification
in a primary care unit (PCU) in 2006. Also, a dental health workforce database of the Division of Dental
Health, Department of Health, was updated for 2006, using a questionnaire survey on the working status of dental nurses dispatched to 450 PCUs in Thailand’s 75 provinces. Almost all (94.9%) responded to the
questionnaire. The analysis revealed that 97 percent of the dental nurses in Thailand in 2006 were working
under the Ministry of Public Health and 95.9 percent of their workplaces were outside Bangkok. These
included 55.7 percent working in community hospitals and 32.5 percent in PCUs. The ratio nationwide of
dental nurses increased from 1:21,331 in 2002 to 1:16,883 in 2006, excluding Bangkok. Among those working
in PCUs, the workload of those involved in oral health care to other types of care was 3:1 in terms of
time sharing. The proportion of jobs in curative care, promotion and prevention, and proactive services
was cited as 3:1:1. With regard to workforce in capacity-building, training is required in (1) oral health
promotion and proactive activities, (2) oral health prevention and disease control, (3) health literacy and
communication, (4) project planning, management and evaluation according to local priorities, and (5)
first-aid treatment.


This study was undertaken to determine qualitative data pertaining to the availability, beliefs, attitudes,
and utilization of poisonous plants and animals in a community using group discussion, followed
by an assessment of the efficiency of conveying the knowledge by civil society. The format was a quasiexperimental
research approach in 11 villages in Khukhan district, Sisaket Province. The experiment was
conducted by means of a stratified random sampling procedure; 120 samples were retrieved. The data
obtained were statistically assessed in respect of frequency, percentage, means plus or minute the standard
deviation, and paired t-test for comparison.
The results showed that, among the 23 kinds of poisonous plants and animals studied, jatropha,
tapioca, toad, Copelandia cyaneseens, Russula emetica, and Phaeogyroporus portentosus were present in
every village in the fields, around temples and residences, etc. This finding, together with the traditional
beliefs and attitudes of the villagers regarding poisonous plants and animals, could possibly lead to a
health risk for the community. After utilizing simple civil society communication, the study group had
shown significantly increased knowledge (p <0.05). The factors affecting the result of the learning process
included language and the villagers’ traditional beliefs and attitudes. Although the statistical increase
was not distinctive, the propagation of knowledge on poisonous plants and animals among the community
through a simple civil society was a learning strategy that was related to some extent to the educational
level in the community with regard to the local villagers in their own community. Furthermore, this
type of learning strategy may also be adapted for utilization in other public health-related work.


This study was aimed at assessing the development of the diabetes mellitus clinic of the Jungharn
Hospital’s Outpatient Department. The hospital’s management personnel together with the clinic practitioners
participated in the study in order to analyze and solve service problems, so that the clinic could be
refitted. Seventy-five diabetes patients were included in the study group obtained by systematic random
sampling technique. The data were collected by interviews, questionnaires, group discussions, and observation
in the period from October 2005 to September 2006. The data were subjected to content analysis,
frequency, percentage, means, and paired t-test
In situation analysis, the first step in this kind of study, it was found that the existing service was not
convenient for diabetic patients because too many steps were required, the time consumed was prolonged,
and health education was not at all applicable to the patient’s problems and what was needed to solve them. The following stages were conducted by the groups of managers and care providers who participated
in the planning, implementation, and evaluation of the service. Nurses were prepared for work in
the diabetes mellitus clinic service, and used OPD cards for following up diabetic patients. When such
patients made contact with the diabetes mellitus clinic, their fasting blood sugar level was assessed; they
were treated by a physician, and received drugs. The last step in the service was a group discussion.
Evaluation of each patient’s satisfaction was assessed in terms of whether they had a say and were given
recognition, which were much higher, and the means of fasting blood sugar decreased after the diabetes
mellitus clinic was developed; this was found to be statistically significant at the p-value < 0.01 by paired
t-test.
The study suggested that, clinic development requires staff participation in all processes, team work,
good patient relationships, and the availability of a service center.


This retrospective study involved 470 pregnant women who first attended the antenatal clinic of
Sanpatong Hospital in Chiang Mai Province in the period from October 2005 to March 2007. The objective
was to determine the prevalence and causes of anemia in pregnant women and to study the association
between thalassemia traits and anemic status. All pregnant subjects received screening for hemoglobin concentration, hematocrit level, mean corpuscular volume (MCV), one-tube osmotic fragility test (OF
test), and serology for hepatitis B virus, syphilis and anti-HIV. In anemia cases, a therapeutic trial with
iron supplementation was performed in order to assess iron status. In cases positive for thalassemia
screening tests were taken of hemoglobin electrophoresis, hemoglobin A2 level and PCR for alpha thalassemia-
1 trait. Thalassemia traits and hemoglobinopathies were detected in 97 cases (20.7%). The prevalence
of anemia was 23.2 percent (109/470). Classified by trimester, the prevalence was 19.3, 24.5 and 43.2
percent in the first, second and third trimesters, respectively. In anemic pregnant women, the proportion
of thalassemia traits was 46.3 percent (50/108) and the proportion of iron deficiency anemia was 40.6
percent (28/69). Among the thalassemia traits group, the proportion of anemic status was 51.5 percent,
and anemic status in β-thalassemia trait was 70 percent; in α-thalassemia-1 trait, 68.7 percent; in α-thalassemia-
1 and HbE trait, in 40 percent; and HbE trait 28.2 percent. The overall thalassemia trait was significantly
associated with anemic status (OR 5.7,95%CI 3.5-9.3 ), p<0.00, and the α-thalassemia-1 trait and the
β-thalassemia trait were also statistically and significantly associated with anemic status. In conclusion,
the prevalence of anemia in pregnant women attending Sanpatong Hospital was 23.2 percent. The main
causes of anemia were thalassemia traits and iron deficiency anemia. The prevalence of thalassemia traits
in pregnant women in the present study was high and the subjects with thalassemia traits, α-thalassemia-
1 trait and β-thalassemia trait were associated with anemic status.


This study was carried out to assess the satisfaction with the health services provided under the
Universal Health-care Coverage Scheme (UC) at Pranburi Hospital. The study sample included 369 patients,
i.e., 268 females (72.6%) and 101 males (27.4%), whose general population characteristics varied by
sex, age, income and experience with the hospital services in the period from June 2007 to September 2007.
Statistical analysis of data was represented by percentage, means and standard deviation, t-test and F-test.
The study revealed overall satisfaction with the health-care services provided under the Universal Healthcare
Coverage Scheme; these were rated as good (3.61 ± 0.36). Satisfaction with officials (3.69 ± 0.46),
satisfaction with information (3.65 ± 0.49), satisfaction with servicing processes (3.55 ± 0.42) and satisfaction
with places and materials (3.54 ± 0.36) were all good. The patients differing in terms of sex, age and
income showed no difference under the Universal Health-care Coverage Scheme, but their experiences on
health-care services were different (p < 0.05).


The objective of this study was to determine the effects of diabetic drug adjustment during the Ramadan
period among fasting diabetic residents of Tuyong subdistrict, Nongjik district, Pattani Province, who had received
treatment in Nongjik Hospital during the period from October 1, 2006 to October 12, 2007. Diabetic
complications and changes in glucose levels before and during the Ramadan period were detected among 41
patients with diabetic drug adjustment, compared with 38 patients without drug adjustment. Data on their
blood glucose levels were obtained from OPD cards and from monitoring chart records during the Ramadan
period. SPSS for Windows was used to analyze the data.
The distributions of sex, age, co-morbidity and diabetic drug use were comparable between both groups.
Diabetic complications were found only in patients without diabetic drug adjustment. There were three cases
with hyperglycemia and two with hypoglycemia. Before the Ramadan period, both groups had comparable
mean glucose levels. During the Ramadan period, the mean glucose level was significantly lower in the patients
with diabetic drug adjustment than those without drug adjustment. Patients with drug adjustment were significantly
more likely to control their blood glucose levels than the other group.
Diabetic drug adjustment is useful during the Ramadan period. Before the Ramadan period, good health
education about food intake, diabetic complications, and the benefits of drug adjustment should be given to
diabetic Muslim patients.


Stroke is increasingly found without regard to sex and age in the Thai population. Thus, it is mandatory
that the Occupational Therapy (OT) service be directed at either improvement or maintenance with
regard to individual skills of occupational performance. This OT service was systematically developed in
further support of an increasing number of patients. In section I, Occupational Therapy – Mahidol Clinic
System (OT-MCS) was created as an operational service for the OT Mahidol Clinic. This study was
conducted in order to compare the number of patients who attended the OT Mahidol Clinic in the 30-day
study period, before and after attending the OT-MCS. In section II, the patients studied comprised a group characterized as maintained performance (comparison of repeated therapeutic activities via descriptive
statistics) and a group characterized by improved performance (comparison of levels of activity
approach via Wilcoxon Test in the period of 30 days before and after the use of OT-MCS). After the use of
OT-MCS, the number of patients increased although the number of supervised occupational therapists
remained the same. The therapists also differentiated 40 activity items according to the levels of satisfaction
and importance. Moreover, the maintained performance group had moderate and high levels of
satisfaction with the importance of occupational performance. The improved performance group managed
different levels of activity regarding international concepts of occupational therapy. The patients
could express their existing potentials through meaningful activities, proper activity analysis and synthesis,
learning the importance of occupational performance, and gaining satisfaction with the choices of
occupational performance. The practice may be implemented in the patients’ realistic environment.


This research was to study and propose functions, roles, and structure of
the Ministry of Public Health in the next decade as a mechanism of the National
Health System. The proposal was done by analysizing related documents and
research papers published in Thailand and other countries. Research methodology
also included individual and focus group interviews among those academicians
and involved partners in health. This study revealed rapid and tremendous
changes of global context re-defining health to cover physical, mental, social
and intellectual dimensions. Moreover a plenty of organizations and mechanism
related to health have emerged. The Ministry of Public Health that has
currently been responsible for health affairs of the country as the key stakeholder
is supposed to emphasize its functions and roles on collaborating and bridging
all the social sectors of the nation; it then systematically and apparently mobilizes
their resources and potential for health development.
Ten functions and roles of the Ministry of Public Health during 2007 -
2012 were proposed. 1) Play major role in formulating national health policy and
strategy. 2) Advocate knowledge generation and management. 3) Determine and
regulate health standard. 4) Build capacity of social sectors and people in health.
5) Enforce health and health-related law. 6) Superintend the control of diseases
and health hazards. 7) Superintend health care financing for people and specific
needy groups. 8) Secure and assure the integrity of health resources. 9) Implement
international health. 10) Mobilize the health-related royal initiation projects.
Therefore organizational structure of the Ministry during 2007 - 2016 would
be basically changed in comply with the aforementioned functions and roles. It
was proposed that all the health service facilities ranging from primary to tertiary
levels within the same services area would be reposed in the same authority
of command. It would also be legislatively adopted to be juristic body as a
state agency other than government agency or state enterprise but under the
supervision of the Ministry of Public Health. The status will also be applicable
to sub-specialty facilities. Meanwhile particular mechanism would be established
at the central level to coordinate those facilities in terms of policy and direction
of services as a whole.
To attain that goal, policy makers, high executives of the Ministry and
involved agencies must share policy commitment for changes. Then the establishment
of “The Bureau of Change Management for the Ministry of Public
Health” as an autonomous body under the supervision of the Ministry would
streamline and accomplish the organizational restructuring. The Bureau is supposed
to propose plan and phases of those undergoing change.


This study is part of the study to develop the monitoring system for primary
care at a macro level. This part shows the evaluation result of diabetic care
system of various contracting units for primary care in purposively sampled 18
CUPs, 4 regions. The components of the evaluation were diabetic care system
and process, clinical results, knowledge, practices and quality of life of diabetic
patients. The methodologies used were internal evaluation by questionnaires
and explore evaluation by observation, interview and documentary review. The
result showed that the quality of the systems among CUPs was much varied.
Most were passive, not proactive on risks and complications management. Primary
care showed fewer roles, only screening and follow up. Most of them were
not well supported by hospitals and CUPs. Health outcomes indicated that 38
percent of the total had good control of plasma glucose (HbA1c < 7 mg%); 10-19
percent high cholesterol, 21-43 percent high HDL, 2-12 percent high triglyceride
particularly among women than men; 31-50 percent micro-albuminurea (>30),
high creatinine 2-30 percent. These were different among areas and diabetes over
5 years had more complications than diabetes less than 5 years. The knowledge,
practice and quality of life of diabetes were varied among CUPs. Most had good
knowledge and practice on medication and general management, but has less
on diet, foot care and care for special events. Diabetes had quality of life on mental
aspect less than other aspects. Those with diabetes less than 5 years had
quality of life score on physical and dependency aspect better than those more
than 5 years, but the scores other aspects were not different. The diabetes in
areas that had better knowledge and practice also had higher score of quality of
life.
This study showed that the evaluation of diabetes care system can be one
tracer to monitor quality of primary care and contracting units of primary care.
The process and some outcome indicators in this study can be used to compare
conditions among areas.


This study is one part of the development of primary care monitoring
system at a macro level in 2005. This part shows the conceptual framework to
develop the indicators and the existing database system of primary care units
based on such development. The diabetic care and mother and child health care
were used to represent the unique characteristic of primary care, advocating
holistic approach, continuity of care, and supporting self-reliance. The study
found that data for quality indicators of diabetic care lacking, varied among units,
and needed to be newly developed. The data for indicators of MCH care have
not been so different among units, but the collection form was varied and segmented
by different units. The incompleteness and inconsistency of data of the
same case was high. The outcome indicators were too insensitive to allow differentiation
of the quality of individual primary care networks. It needs the process
indicators that can be collected through hospital database. Moreover the
database will be more reliable and accurate if the provincial monitoring committee,
instead of the central unit check and analyze the data as a package.


The Universal Coverage policy has incorporated two major reform elements,
financial management reform and strengthening primary care which inevitably
affects health service delivery system in Thailand. This paper was aimed
to review implications of the Universal Coverage policy on service delivery system
in terms of financial implications and service provision. Review of secondary
data was the method adopted to explore the implications and the study was
conducted during 2004 - 2006.
The result revealed that the Universal Coverage scheme had a great impact
on the service delivery system. Inadequate funding in addition to change
of allocation criteria from supply-based allocation to demand-based allocation,
per capita, had great financial implications on hospitals. Big hospitals, for example,
regional and general hospital, and hospitals with relatively high concentration
of health personnel incurred financial deficit in the first year when salaries
were included in the capitation. However, the problem had been shifted
from regional and general hospitals to community hospitals and those hospitals
in the Northeast when salaries were removed from the capitation in the following
years. Change of criteria of allocation out of inadequate funding was inevitably
shifted the problem from one to another. Providing universal coverage of
health insurance apparently increased demand for care and burden of work.
Strengthening primary care policy drove more service utilization toward community
hospitals and health centers. Mobilizing doctors or professional nurses
to provide care in primary care units and health centers improved overall quality
of care. However, inadequate funding and stagnation of investment budgets
may have negative consequences on quality of care in the long run.


Evaluation of the Project “Development of Gold Card Enrollment
System : A Case Study in Phrae” had three objectives : 1) study actual
activities compared with planned activities, 2) study effectiveness of
the project compared with its target, that was Gold Card enrollment completed
within 15 minutes at hospitals and within 7 days at health centers,
3) evaluate satisfaction of staff and clients towards this new enrollment
system. An evaluation taskforce was established. Data for analysis
came from Gold Card application form, records and reports from
Phrae Provincial Health Office, a group discussion with registrars, and a
questionnaire about satisfaction of clients. Results showed that almost
all activities were accomplished as planned. The staff had learned : planning
by using Project Design Matrix (PDM), system analysis and new
system design, preparation for a new system, starting a new system,
and continuing operation and monitoring a new system. Enrollment
results showed that, at hospitals, 85.4 percent of enrollments could be
completed within 15 minutes; at health centers, 61.8 percent of enrollments
could be completed within 7 days. Nearly 100 percent of staff and
clients were satisfied with this new enrollment system. Problems encountered
were: staff could not access to centralized database due to
instability of the network; health center staff failed to follow the guideline
in forwarding enrollment data to registrars at hospitals within 7 days
because numbers of registration in one week were so small that it seemed
economically invalid to follow the guideline. Lessons learned were applied
to the project “Data Center“ of the National Health Security Office
(NHSO).


The objective of this descriptive study was to determine the relationship between
fasting plasma glucose (FPG) levels, as well as a few other factors, with HbA1c in 100 patients with type 2 diabetes who were receving treatment at Ladlumkaew Hospital. The
data were collected during the period May-July 2007. The variables were sex, age, waist
circumference, body mass index, duration of illness, administration of metformin, and
fasting plasma glucose. The relationship between variables and HbA1c was assessed using
percentage, and odds ratio test.
The results of the study showed that patients who received treatment with metformin
had a mean level of FPG for three months equal to or less than 130 mg/dl related significantly
with an HbA1c level of less than 7 percent. When considering the results, 30 percent
of the patients had a mean level of FPG equal to or less than 130 mg/dl and 15
percent of the patients had FPG levels three times in three months that were equal to or
less than 130 mg/dl; these patients had HbA1c levels above 7 percent at 56.7 and 46.7
percent, respectively. Such findings denoted that the FPG level reflected the short period
of the preceding plasma glucose level; making an evaluation of hyperglycemic control by
FPG level would be misleading in the management of diabetes patients. The HbA1c level
was a better indicator for evaluating the achievement of glycemic control over the preceding
2-3 months. The HbA1c level could predict the complications of diabetes patients.
Therefore, for the goal of glycemic control, the HbA1c test shoud be employed in conjunction
with the FPG test.


The purpose of this study was to determine an appropriate way to prevent bedsores in disabled stroke patients while they are still hospitalized. All stroke patients admitted to the Internal Medicine ward in Sichon District Hospital during the period January 2005 - December 2006 were enrolled into this study. Data collection included demographic data, and information on occurrence and details of the bedsores. We invented a new care protocol and equipment to prevent pressure sores. A comparison of the results of care before and after the use of these interventions in the target group was the outcome measured. During 2005, the incidence of bedsores in stroke patients was 18.37 percent. After the new strategies in caring and monitoring had been introduced, the incidence decreased by 5.36 percent in 2006. The knowledge, attitude and practice of caregivers, which included nursing personnel and patients’ relatives, increased; moreover, they tended to participate more in taking care of their patients. The most common pressure ulcer locations were the coccyx and the sacral area. In hospitalized patients, most pressure ulcers were facility-acquired, so we created new equipment from local products, i.e. pillows made from the inner skin of dried coconut in order to support the at-risk surfaces and decrease the pressure on the skin. New strategies in caring and monitoring bedsores included education, empowerment of caregivers and team work. All patients were followed up, and home visits by the family physician and his/her team were made; no new bedsores were found to have occurred in their homes. This study demonstrated that the best way to treat pressure sores in disabled CVA patients is to prevent those conditions in the first place. Given current evidence, using support surfaces, repositioning the patient, optimizing the nutritional status of the patients, and moisturizing the skin were all strategies that prevented pressure ulcers. Caregivers should be empowered to take care of their patients during the entire period of their entire hospital admission. Family physicians should strive to integrate both holistic care and continuity of care for the patients and their families.


This survey research study was aimed at to examining the self-health-care behavior
of women in preventing cervical cancer among a target group of women in Tambol Nong Ya Sai, Amphur Nong Ya Sai, Suphan Buri. Applying the Health Belief Model Theory as
a guideline, the research had been performed during June and July 2007 using purposive
sampling on 251 target women aged 35, 40, 45, 50, 55 and 60 in the area under the responsibility
of Nong Ya Sai Hospital. The research workflow consisted of interviewing, data
collection and analyzing processes, using frequency distribution, percentage, means, standard
deviation, chi-square test and Pearson’s correlation coefficient.
The results indicated that 46.6 percent of the target group of women had an intermediate
level of knowledge about cervical cancer, 97.2 percent had an intermediate level
of acknowledging risk opportunities in having cervical cancer, 68.1 percent had an intermediate
level of acknowledging cervical cancer, 72.9 percent had a high level of acknowledging
the benefit of having a Pap smear test, 60.6 percent had a high level of self-care
behavior in preventing cervical cancer, 53.0 percent had a Pap smear test, while 10.7 percent
did not undergo that test. The research also informs that marriage status and knowledge
about cervical cancer have a significant relationship with self-care behavior in preventing
cervical cancer (p value ≤ 0.05).
Recommendation: Public health officials should provide knowledge about cervical
cancer to increase the number of target group women who have undergone a Pap smear
test, which will lead to good health.


Carcinoma of the cervix is the most common cancer in Thai women. Over 40 years,
Pap smears have been used as the standard technique for cervical cancer screening, but
the coverage is quite low among the population and the incidence of advanced stage
cancer is still high. Acetic acid (VIA) testing had been introduced as an alternative method
in order to improve the effectiveness of cervical cancer screening in Thailand. When the
VIA result was positive, the client is referred for further management, but most doctors
do a repeat Pap smear to start rescreening as usual. This study was conducted to evaluate
the effectiveness of VIA and determine how necessary it is to practice in VIA-positive women.
This retrospective descriptive study was conducted in VIA-positive women who
were sent for colposcopic examination between February 17, 2004 and February 16, 2007,
a total of 109 cases. Pap smear and colposcopic cervical biopsy, with or without LEEP
conization, were performed. A Pap smear result of “normal” meant normal; inflammation
was found in 102 cases. “Abnornal” meant SIL or CIN to carcinomas, which was
found in seven cases. The histopathological result was classified as “normal”, meaning
negative and cervicitis, and “abnormal” meaning CIN I to carcinomas, which were found
in 90 and 19 cases respectively. Pap smear sensitivity was 36.84 percent, specificity was
100 percent, positive predictive value was 100 percent, and negative predictive value was
88.24 percent. This study suggested that repeated screening by Pap smear in VIA-positive
women should not be recommended due to its low sensitivity.


This report is aimed at studying the management trend of Rasisalai Clinic and the
general data on the occurrence of new tuberculosis cases in Rasisalai district, Srisaket
Province, for creating a proper TB control planning program. An interview survey was
conducted at the TB clinic; all 134 TB cases had been registered between October 1, 2005 and September 30, 2006. The majority were males (64.2%), had a primary school level of
education (88.1% ), were farmers (71.9%) and were more than 60 years old (40.3%).
These patients were more likely to have been vaccinated with BCG (70.1%) than not
vaccinated (29.9%). The study population also had other health indications as follows:
DM 11.2 percent and HIV infection 1.5 percent. The most important factor was contact
with TB cases in their households (70.1%). Improper protection measures between TB
patients and their relatives could account for the occurrence of new TB cases: no mask
(53.2%), improper sputum collection (36.7%), no isolated bedroom (33.6%) and no isolated
eating area (35.8%). These behaviors were relevant to poor management of the
Rasisalai TB Clinic in terms of screening TB contacts in the households and in terms of
protective education.
We concluded that the effective TB treatment regimen offerred by DOTS to control
TB prevalence was not enough; the incidence of TB cases is still rising. We purpose speeding
up the screening of new cases in different high-risk groups, especially for persons
contacting tuberculosis cases in the same household. Proper protective behavior between
the TB patients and their relatives staying with them is imperative. A good clean environment
is another issue that should be the responsibility of the community at every level.


Insulin treatment is one of the standard regimens for controlling blood glucose in
patients with diabetes mellitus (DM). The use of the “Insulin Pen” device for injecting
insulin, instead of the traditional vial/syringe for injection, provides additional convenience and accuracy and it reduces pain during injection. This descriptive observational
study was aimed at studying the behavior of 124 DM patients using insulin pens. Questionnaires were used to assess the following items: knowledge, history of using the insulin pen, attitude and practice in using the pen.
Data were analyzed by independent sample t-test and one-way ANOVA (F-test).
The majority (70.17%) of the samples were women, the average age of the samples was
57.0 ± 5.0 years; 87.90 percent of the patients were primary school graduates; 74.19 percent were experienced in using the pen for 6-8 months; 78.20 percent had used the traditional syringe insulin injection twice daily before switching to the insulin pen; 41.19 percent self-administed the insulin injection; 92.74 percent were instructed about the insulin
pen, using the method described by health-care staff. The average knowledge score was
8.25 ± 2.17 out of a possible 10; the average attitude score was 3.14 ± 1.55 out of a possible
4 and the average practice score was 2.62 ± 0.54 out of a possible 3. When comparing the
differences in sex, age, knowledge, history of using the insulin pen, attitude and practice
in using the pen, we found that differences in educational background affected the knowledge of patients about using the insulin pen. The ones who were experienced in using
the insulin pen were more likely to use it correctly than those who were inexperienced (p
< 0.05).


This report describes data on the referral by Khuandon Hospital in Satun Province
of patients experiencing unsuccessful labor in fiscal years 2005-2007. The objectives of
the study were to compile knowledge for planning in order to improve patient care and
referrals. The methodology of the study was to review the 122 cases of unsuccessful
delivery in the labor division of Khuandon Hospital, focusing on the rate of unsuccessful
labor, the characteristics of the patients experiencing unsuccessful labor and the patterns
of delivery after they were referred to a general hospital in the province. The findings
were as follows: the unsuccessful labor rate was 15.74 percent among the total study population
of 775 pregnant women. The patterns of delivery at Satun Hospital, to which the women had been referred, resulted in normal labor including breech-assisted cases
(41.80%), caesarean section (40.98%) (or 6.45% of the total of 775 pregnant women, which
was similar to the data of the Office of Health Service Development, Ministry of Public
Health (5.46 - 7.04%). The majority of patients experiencing unsuccessful labor were
primigravidae. The causes of referrals ranged respectively from pregnancy-induced hypertension
(PIH), cephalopelvic disproportion (CPD), prolonged stage, and fetal distress,
to premature labor and breech presentation. With regard to the patterns of delivery after
the referrals at the Satun General Hospital, PIH, fetal distress and premature labor cases
were successfully delivered in 66.67, 45.46 and 54.54 percent of the cases, respectively, but
the majority of CPD, prolonged stage and breech presentation necessitated caesarean section
(50.00, 45.46 and 90.91% respectively). The following recommendations were made
: the medical and nurse committees, obstetricians and pediatricians should join together
to develop guidelines for the care and referral of patients in labor and the hospitals should
link the data about the results of the care and health status of the mother and child after
referral.


This was a cross-sectional analytic study conducted to compare intraocular pressure
(IOP) measurements by non-contact tonometer (NCT) and a standard Goldmann
applanation tonometer (GAT) in glaucoma and non-glaucoma patients. One hundred and
forty-eight outpatients attending Thamuang Hospital in the period December 2007 - January
2008 were categorized into two groups: the glaucoma group comprised 48 patients
(48 right eyes, 47 left eyes) and the non-glaucoma group comprised 100 patients (99 right
eyes, 100 left eyes). None of the patients had a history of ocular surgery or corneal disease.
Their IOP were measured by two independent parallel observers using non-contact
tonometer Canon TX-F and Goldmann applanation tonometer.
The results of the study disclosed that the intraocular pressures measured by the
non-contact tonometer were significantly different from those measured by the Goldmann
applanation tonometer (paired t-test statistical analysis p < 0.05) in both glaucoma and non-glaucoma groups. Mean IOP in the glaucoma group, measured by NCT, was lower
than GAT (4.63 ±3.14 mmHg right eye, 4.33±3.50 mmHg left eye); also, the mean IOP in
the non-glaucoma group, measured by NCT, was lower than GAT (1.95±2.89 mmHg right
eye, 2.40±2.62 mmHg left eye). The pressure difference increased in cases with a higher
IOP, thus reflecting the reliability of NCT measurement only in measurement of the cases
with normal intraocular pressure range. Therefore, repeat intraocular pressure measurement
should be performed to conform with the standard Goldmann applanation tonometer,
if necessary.


This study was aimed at identifying the general characteristics and different factors
related to the commission of suicide, and the factors affecting the accomplishment of
suicide between residents of Khanuworalaksaburi and Khlongkhlung districts in 2007.
Secondary information on the patients was obtained from the report 506 DS in 2007. The
data were analyzed by descriptive statistics, t-test and logistic regression.
The study included 110 patients, 12 were successful in committing suicide, equal to
10.6 percent of the total. The death rate of Khlongkhlung’s victims was four-fold greater
than Khanuworalasaburi’s. Nearly all of the suidcides committed were Thai agriculturists,
in the working-age group and married. The prevalence in females was four times
higher than in males. For most of the subjects, it was their first attempt; of those who
survived, they were reluctant to repeat the suicide attempt. Most of the victims had two
or more precipitating factors: the most common was depression, physically chronic
diseases and having sufferred abuse; these were enabling factors but not significant.
Most of the victims received service provision two or more times. The comparative study
indicated that there was significance in the different modes of committing suicide, especially
with regard to the use of insecticide, and physically chronic illness, particularly
rheumatic diseases, as well as tobacco addiction. The types of services provision included
making suggestions to their relatives, handout distribution, medication for depressive
disorder, other supportive services such as referral for repeated suicide attempts. The
risk factors and service provision were both significant factors in decreasing the success
rate of those intending to commit suicide. Having suffered abuse was an important factor
in raising the success rate. The authors suggest that the provision of good-quality and
appropriate services would effectively decrease the success of attempts to commit suicide,
while the screening for the precipitating factors and a change in abusive behavior
would reduce the number of attempts.


This descriptive research was carried out to study psychosocial adjustment during
the perimenopausal period of women. The subjects were 89 married women in the
perimenopausal period who visited the outpatient department of Phoprathapchang Hospital,
Phichit Province, in 2007. The study used a questionnaire consisting of two parts:
personal data record and psychosocial adjustment in the perimenopausal period.
The results showed that 53.93 percent of perimenopausal women reported overall
psychosocial adjustment at a good level and 46.07 percent at a poor level. In considering
each aspect, the aspects of the vocational environment, domestic environment, social environment
and psychological distress were at good levels, i.e., 59.55, 51.69, 62.92 and 55.06
percent, respectively, while the aspects of health-care orientation, sexual relationship and
extended family relationship were at a poor level of 51.69 percent.
The results of this study could be utilized as basic information in planning care,
counseling and for enhancing psychosocial adjustment for the well-being of the perimenopausal
women.


This is a report of the results of a prospective series of manual sutureless extracapsular
cataract extraction on 161 eyes, performed at Taphanhin Crown Prince Hospital,
Phichit Province, in the period May 2006 - November 2007. The patients, aged 42 to 82
years (mean 68.9 years), had a preoperative visual acuity of less than 3/60 in 47.8 percent
of the cases (76 eyes). Of the 159 patients who returned for follow up, the visual acuity at
one month postoperatively was improved in 153 eyes (96.2 %), i.e., VA 6/18 or better in
42.1 percent, and 6/24 - 6/60 in 57.2 percent. When measured by pinhole, visual acuity
was 6/18 or better in 78.6 percent of the eyes. There was no major sight-threatening
complication; only minor surgical complications were encountered in 10 eyes (6.3%). In
conclusion, this intervention is cost-effective, appropriate and provides accessibility for
underserved cataract-blind patients in community hospitals. It also empowers health
personnel and should be implemented in other community hospitals or eye camps in
order to eliminate the backlog of such patients and improve the quality of life of the Thai
elderly in rural areas.


The objective of this retrospective study was to determine the incidence of teenage
pregnancy and to compare pregnancy outcomes between teenagers and adults who delivered
in Chaibadan Hospital, Lop Buri Province. The study group included singleton
primigravida women aged 13-19 years who gave birth between October 1, 2003 and September
30, 2006. The comparison group consisted of singleton primigravidae, aged 20-29
years, who gave birth at the same hospital in that period. The study revealed that the
incidence of teenage pregnancy was 20.77 percent; teenagers had a higher proportion of
inadequate antenatal care (i.e., no ANC or ANC<4 times) compared with adult pregnant
women. Preterm delivery was higher in the study group than in the control group. There
was no statistically significant difference in obstetric complications, birth weight, stillbirth
and Apgar score between the two groups.


This survey-based research was aimed at determining the factors associated with
low back pain, satisfaction levels, needs and suggestions regarding the service of the Bang
Pla Ma Hospital, Suphanburi Province. The sample comprised 347 patients undergoing
low back pain treatment more than once during the period October 1 to November 30,
2007. Data were collected by a structured questionnaire, analyzed and reported as frequency,
percentage and mean. Of the total number of patients, 64.3 percent were female (average 48 years and
married); 37.2 percent were graduated from primary school; 35.2 percent had a bachelor’s
degree. A good number of them were government officers (41.5%) and had moderate
salary (63.9%); those earning more than 20,000 Baht/month comprised 29.1 percent of the
total. Most the patients (56.8%) held the right of reimboursement and 34 percent had
rights under the health assurance scheme. Most of the low back pain occurred not only
when the patients lifted heavy objects using two hands while bending (49.9%), but also
when they had improper postures. They were mostly non-consumers of alcohol (81.8%)
and non-smokers (87.3%), and regularly exercised (65.1%). Patients had received health
education relating to low back pain, in particular using local heat massage (80.7%); however,
most had moderate knowledge about keeping healthy (61.4%). Patients were mostly
satisfied with Thai massage; the next highest level of satisfaction was among those taking
a prescription pill. Having treatments 1-3 times alleviated the symptoms of most patients.
Alternative medical therapies should be advised for patients with low back pain.


anphotpisai Hospital, Nakhon Sawan Province
The effects of health promotion development among diabetics, using self-efficacy
and social support, on fasting blood sugar and HbA1c in type-2 diabetes patients were
studied in four primary care units (PCUs) in Banphotpisai district, Nakhon Sawan Province, in the period from April to July 2006. The study sample comprised 126 patients who
attended the medical outpatient department and diabetic clinic of four PCUs; they had
fasting blood sugar levels higher than 180 mg/dl. The data were collected by means of
demographic questionnaires and diabetic care questionnaires, including measurement of
FBS and HbA1c. The data were analyzed using percentage, standard deviation, and paired
sample t-test. The average score for self-efficacy of pre-test was 101.28 and of post-test
113.70. The average score for social support of pre-test was 85.94 and of post-test 94.33.
The average FBS of pre-test was 142.42 mg/dl and of post-test 126.43 mg/dl. The average
HbA1c of pre-test was 5.34 mg/dl and of post-test 5 mg/dl.


The increasing incidence of diabetes mellitus (DM) every year has resulted in multiple
complications of DM. Diabetic neuropathy is one of the most important complications;
it causes diabetic foot and leads to amputation of the legs. In a rural hospital, the
relationship between neuropathy and foot ulcer provides important information for the
development of a preventive foot-care program in a DM clinic. A retrospective study
was performed from medical records and diabetic foot evaluations from October 2005 to
September 2006; a total of 1,029 diabetic patients from Wichianburi Hospital, 247 from the Putaey primary care unit and 308 from the Kokeprong primary care unit, were studied.
Of the total, 31.51 percent were males and 68.49 percent females; 404 patients (24.72%)
had neuropathy, 60 patients (14.85%) in this group had foot ulcer, and 47 of them (3.82%)
had foot ulcer without neuropathy. The risk of foot ulcer in neuropathic patients was
almost eight-fold (7.92 times) greater than that of non-neuropathic patients. Seventynine
patients with foot ulcer had hyperglycemia; the mean blood glucose levels ranged
between 125 and 179 mg/dl, and blood glucose levels of more than 125 mg/dl were 4.39-
fold greater than the normal glucose level. Foot ulcer in diabetic patients was related to
neuropathy and blood glucose levels; thus well-controlled blood glucose and good foot
care in diabetic neuropathic patients is important in preventing foot ulcer.


To develop a stroke-care model for the outpatient department, Thoen Hospital in
Lampang Province, 32 patients were studied in the period February -July 2007 (six months)
by a multidisciplinary team. The method of study was a three-dimensional framework.
The first dimension was to strengthen the health-care team, focusing on control of comorbid
conditions and risk factors. It was found that, in the DM-patient group of 13
cases, the results of risk control as the compliance levels of blood pressure, plasma fasting
glucose, TG and LDL were about 23.08, 30.77, 69.23 and 23.08 percent, respectively. In
the group of 14 cases without DM but having other risk factors, we found that the levels
of blood pressure, TG and LDL were under control at 64.29, 57.14 and 14.29 percent, respectively.
By monitoring for new risk factors, we could detect such factors in 24 cases
(75%), for whom we controlled both their previous and new risk factors purposely in
order to reduce stroke recurrence. The second dimension was to encourage self-care
behavior in the patients and their caregivers; we could empower 30 cases (93.75%) to
achieve successful rehabilitation. For evaluating the quality of life, we used the Barthel
Index of Activity of Daily Living; we found that the score had statistically significantly
increased (p = 0.005). The stroke patients could pass their post-test in the topics of nutrition,
domestic vegetables and traditional Thai medicine; the increase was significant (p =
0.005). The last dimension was for providing competency for the partnership of the community
health-network. The local government and a volunteer-group participated in
home health-care activities for stroke patients in the villages. For improving the quality
of life for the stroke patients, many community plans have been implemented, such as
the screening activities among the population at risk for stroke prevention and fostering
health promotion in the Thai style. In conclusion, there is a limitation on stroke care in
the outpatient department of the community hospital, but with such a model, using the
concept of a multidisciplinary team, the effectiveness of integrated health care for stroke
patients could definitely be improved.


Neonatal jaundice is a common and, in most cases, benign problem in neonates. The
treatment of neonatal jaundice is indicated in pathologic jaundice and the goal of therapy
is to prevent the concentration of unconjugated bilirubin in the blood from reaching levels
at which neurotoxicity may occur. For more than three decades, phototherapy has been the standard of care for the initial treatment of neonatal jaundice. A retrospective
study about the result of treatment for neonatal jaundice compared between phototherapy
with and without blue light lamps was done in Thabo Crown Prince Hospital from October
1, 2004 to September 30, 2007. The purpose of this study was to identify which type of
lamp used in phototherapy was more effective in decreasing the blood bilirubin level.
This study showed that the highest blood bilirubin level during treatment with phototherapy
without blue light lamps was significantly higher and also the length of stays for
treatment was significantly longer than in the group that used phototherapy with blue
light lamps. Although many factors affect the efficacy of phototherapy in decreasing the
blood bilirubin level, one of the important factors is the type of lamps used. This study
suggests that, for the treatment of neonatal jaundice to be effective, phototherapy with
blue light lamps is recommended.


A clinic for HIV-infected patients was set up at the Sawangdandin Crown Prince
Hospital, Sakon Nakhon Province in October 2002. This study was conducted during the
period from October 2002 through September 2007 to collect clinical as well as administrative data from the outpatient and inpatient medical records of all HIV patients who
attended the Clinic during the period October 2002 to September 2007. Descriptive data,
i.e., frequency, percentage, means and standard deviation, median, minimum and maximum
values, derived from the use of the Mann-Whitney U test and Kruskal Wallis test
were obtained.
The results showed that the HIV-infected patients were 54.4 percent male and 45.6
percent female, their average age 35.5 years, education status 72.3 percent primary school,
agriculture 73 percent, and heterosexual infection risk 93 percent. There were significant
differences in the median amounts of CD4 when they started taking anti-HIV drugs (p
value= 0.035). There was no statistically significant difference in the median duration
from contracting HIV infection to the treatment period (p = 0.113). The most common
drug regimen used was Nevirapine, Lamivudine and Stavudine during the periods 2002-
2004 and 2005-2007 (75.8%), and the response rate was 81.7 percent. There was no statistically
significant difference in median duration of response to anti-HIV drugs depending
on the amount of CD4 (p= 0.088). Side effects of anti-HIV drugs included skin rashes,
neuritis and cheek lipoatrophy. The most common of the opportunistic infections was
pulmonary tuberculosis. The initial time to receive drugs was quite delayed when a CD4
level of lower than 100 cells/ml was used as an indicator. When acute symptoms subsided,
the majority of patients moved to new working areas and received drugs via relatives.
The result was inconsistent taking of drugs and drug resistance usually developed
thereafter. In such a context, the author has suggested that HIV patients should be given
information about opportunistic infection and CD4 levels. Regular care and medications
for the patients would be effective if high-quality networks are set up. Finally, it is
importanct to pursue the cooperation of organizations offering work and proper income
for the patients after their condition has been improved by treatment with anti-HIV drugs.


This was a retrospective study on intentional self-harm among patients at
Khoksamrong Hospital in the years 2004-2006. The patients were those who intentionally
attempted suicide but survived, and who were brought to Khoksamrong Hospital
for treatment. Data were collected using a standard form for depression and a self-harm
surveillance system (report 506.DS) and a form to collect data from death certificates
( M.B.1.). Women comprised the majority of the cases (64.17%), married persons (58.33%)
and laborers (49.17%). Most of them (96.67%) had attempted suicide for the first time.
Common precipitating causes (48.33%) were “personal conflicts with a close person and
love affair problems.” A common self-harm method was “ingesting a sedative” (21.67%).
Of eight cases who died among the 120 suicidal patients hospitalized, the youngest was
25 years old and the oldest 70 years old. The most common stimulating event among the
cases of mortality were “personal conflicts with a close person and love affair problems.”
The most common method of committing suicide was “drinking chemical agents.” Of the
29 cases dead on arrival at the hospital, 17 were males and 12 were females, and 31.03
percent were aged 30-39 years. The most common methods were hanging (58.62%), following
by drinking chemical agents (31.03%). It is apparent that men used more aggressive
methods than women.


Hand, foot and mouth disease is a communicable disease caused by a virus that
infects mostly preschool children. In 2006, there were 3,961 cases and seven deaths in
Thailand; Nakhon Ratchasima Province had 85 cases and 3 deaths. Enterovirus 71 was
the causative pathogen. This descriptive study conducted at Chumphuang District,
Nakhon Ratchasima Province during the period from 2002 to September 30, 2007, used
individual disease investigation forms, outpatient and inpatient records and the midyear
population data of the Ministry of Interior. There were 47 cases, no deaths, 31 males
and 16 females among them; the sex ratio was 1.9:1. Most of them were found during
June to October. Forty were treated as outpatients and only seven were admitted to the
hospital. Fever, and palm and sole rash were the common symptoms; most patients were
from Chumphuang Tambon, and no case was detected at Nontoom Tambon; only one
patient was found in each village. Stool and paired serum samples were derived from
93.62 percent of the patients and Enterovirus 71 was isolated from two stool specimens in
2006 and 2007. According to the disease surveillance system, primary health-care staff
should be trained to screen and refer the suspects to hospitals, viral isolation should be
supported and promoted among the health-care services. The disease-control measures
should emphasize community health education and the isolation of patients from other
children either in school or in child-care centers.


Thailand and Myanmar are both among the 22 countries with a high burden of
tubercuosis (TB) cases identified globally. Population migration in Mae Hong Son Province
may have a great impact on the national TB-control program. Mae Hong Son’s Muang
district is close to Myanmar. Citizens of both countries travel back and forth across the
border for business or for temporary or permanent settlement. This phenomenon causes
problems in controlling tuberculosis in Thailand.
In the period 2001-2007, a total of 829 tuberculosis patients were registered at the TB
clinic of Srisangwan Hospital. They were taken for study and 795 newly registered cases
(Thai 49.6%, non-Thais 51.4%) were reviewed, reflecting a very high incidence of new
tuberculosis cases in this region. Detailed data were reported in the text.


Cardiovascular diseases are among the three most important causes of death worldwide, including in Thailand and in Chai Nat Province. This one-group prepost test design of quasi-experimental research was conducted in order to study the effectiveness of the cardiovascular risk reduction model of Nongkhoon Primary Care Unit, Amphur Watsing, Chai Nat Province. The study sample included 129 residents aged 35 to 60 years, living in the vicinity under the responsibility of the Nongkhoon Primary Care Unit; they were selected by simple random sampling. Data were collected using questionnaires, i.e., the pre-test data were collected in the month of March 2006 and post-data in September 2006. The statistical analyses were descriptive, such as percentage, arithmetic mean and standard deviation, and analytic statistics by paired t-test and multiple regression. The results revealed that pre- and post-data disclosed that all samples had normal blood pressure and body mass index. Men had a low health risk, while women had a high health risk. Pre-test data denoted a low level of self-care practice for prevention of cardiovascular risks and post-test data had a medium level. All parameters, i.e., blood pressure, body mass index, health risks and the practice of self-care for reducing cardiovascular risks both pre- and post-data, yielded significant correlations at a p-value of