Art therapy is a form of expressive therapy that uses art materials, such as paints, chalk and markers.
Art therapy combines traditional psychotherapeutic theories and techniques with an understanding
of the psychological aspects of the creative process, especially the affective properties of different art
materials. Its psychotherapeutic modality is based on the disciplines of “art” and “psychology” involving
Sigmund Freud’s psychoanalytic theory, relying on the human person’s symbolic expression as a
means of communication as an alternative to verbal communication.
The term was coined by Margaret Naumburg in 1947 in the United States of America (some have
mentioned that Adrian Hill did so in Britain in 1945). Art therapists have generated definitions of art
therapy split into two categories. The first involves a belief in the inherent healing power of the creative
process of art making, embracing the idea that the process of making art is therapeutic, which is referred
to as “art as therapy” (Edith Kramer’s theory). The second definition of art therapy is based on the idea
that art is a means of symbolic communication, referred to as “art psychotherapy,” emphasizing the products
– drawings, paintings and other art expressions – as helpful in communicating issues, emotions, and
conflicts. The art image becomes significant in achieving insight, resolving conflicts, solving problems,
and formulating new perceptions that in turn lead to positive changes, growth, and healing. In reality,
both approaches are used together in varying degrees.


Occupational Health and Safety Assessment Series (OHSAS) 18001:2007 is an occupational health
and safety management system utilized in the United Kingdom. This article addresses the importance of
health and safety in today’s legal milieu, as well as establishing, implementing and maintaining procedures
for ongoing hazard identification, risk assessment, and determination of necessary controls. It also
explains the managment and control of workplace and occupational risks, and gives some successful
examples.


Research management is a key supporting factor for systems research investment. The main objective
of research management is essential linkage between researchers and research users. This article describes
points of view in health systems research management from the authors’ direct experience in
reviewing and analyzing three issues: the research management concept, the research management process
and the role of the research manager.
Good research management helps in building qualified researchers, formulating interesting research
questions, and obtaining acceptable research results leading to suitable utilization. The key success factor
of research management depends on the linkage capacity of all partnerships within the research system.
The principal roles of health research management may be summed up in four major functions: (1) facilitating
formulation of the research scope by identifying problems and setting priorities; (2) facilitating
research involvement among researchers and stakeholders in the health system for selecting research
proposals; (3) facilitating research monitoring; and (4) facilitating research assessment for knowledge
utilization. Certainly, the key person in this process is the research manager. For this reason, research
managers should be strengthened both in terms of academic capacity and in management skills for qualified
research administration.


Road traffic injuries are a significant problem in developed and developing countries. The trend of
mortality owing to traffic accidents is increasing in Thailand. The objective of this descriptive study is to
describe the trend and characteristics of risky behavior related to road traffic injuries in Thailand during
the period 1998-2007. The study was conducted by using and analyzing data from the national injury
surveillance database within 28 sentinels, these were reported during the period 1998-2007.
The results show that the proportion of road traffic injuries was the highest of all injuries (51.6%).
The percentage of injuries in the age groups between 15 and 24 years was the highest (33.29%). Most of
the injuries occurred among laborers and student groups (35.0% and 20.1%); 75.7 percent of them were
motorcycle injuries and tended to increase. The highest incidence of injury occurred during the evening
between 6 and 8 o’clock (37.7-40.2%). The most severely traumatized parts of the body were the head and
neck (29.3%). The percentage of alcohol use while driving was 36.4 percent and it was highly used in the
age group 20-29 years (40.1%). The high-risk behavior occurred over the New Year holidays and during
the Thai new year (Songkhran festival) during the months of December-January and April. Further, the
drivers and riders had not used seatbelts and helmets while driving and riding . Only 13 percent used
helmets and 18.6 percent used seatbelts. Those injured were referred by a relative or others in 56.2 of the
cases; only 10.4 percent were referred by EMS, although the tendency is increasing.
This study identified the problem of injuries, especially motorcycle injury in younger persons, which
tends to increase every year. The higher fatality rate may relate to risk behavior involving alcohol use, not
wearing a helmet, or using seatbelts and driving at high speed. Traffic accident prevention requires that
drivers be educated and that the laws be enforced in the high-risk group (mainly younger men).


Oroantral fistula (OAF) is a pathological connection between the maxillary sinus and the oral cavity.
The condition mostly follows extraction of postcanine teeth in the maxilla because of the close relationship
between the apex of those teeth and the floor of the maxillary antrum. An accurate history and
physical examination and proper investigation should be performed to rule out possible contributing
factors, e.g. previous sinonasal infection and inflammation, benign or malignant neoplasms or osteomyelitis.
If these are present, appropriate treatment should be performed before closure is attempted.
Although smaller fistulas of less than 5 mm in diameter may close spontaneously, larger fistulas always
require surgical closures. Procedures involving local flaps are usually adequate to close minor-to-moderate-
size defects. The buccal mucoperiosteal advancement flap is the simplest and most effective way of
closing OAF. The palatal rotation flap has also been a popular choice. Wound breakdown and flap necrosis
are the most common complications of OAF repair. Careful preservation of the flap’s blood supply
and tension-free wound closure are the keys to avoiding these complications.


Cryptosporidium parvum is one of the leading causes of opportunistic infections among HIV/AIDS
patients. Due to the small size of its oocysts, detection of this protozoan requires special staining and
laboratory expertise. In this study, we compare the effectiveness of the three leading parasitology laboratories
in Mahidol University, Thailand. Serial concentrations of Cryptosporidium parvum oocysts from 6 to
1,500 oocysts per 10 μl were added to stool samples and distributed to the study laboratories. Conventional
microscopy and special staining, using dimethyl sulfoxide (DMSO) modified acid-fast stain and
modified cold Kinyoun’s acid-fast techniques were applied. The sensitivity of both techniques was similar.
All three laboratories could detect at least as many as 20 oocysts per 10μl with no statistically significant
difference (p= 0.998). Either staining method could be applied at any laboratories serving HIV patients
with opportunistic infections. However, training laboratory technicians to acquire such expertise
and standardize it is necessary. Effective laboratory diagnosis would be very helpful for physicians, leading
to patients’ appropriate management.


The chemical 1, 3-butadiene is used primarily in the production of synthetic rubber and polymers. It
is a carcinogen, although the International Agency for Research on Cancer has not determined the affected
organ(s). This article reviews the production, exposure, exposure assessment, biomarker of exposure
and biomarker of effect of butadiene.


Objectives: This study aims to determine the maximum cost of HIV vaccination at which the vaccine is still cost-effective under the Thai healthcare setting and to identify the possible relative importance of several vaccine characteristics and subsequent impact of risk behavior changes among vaccine recipients. on its value for money.
Methods: A semi-Markov model was developed to estimate the relevant costs and quality-adjusted life year (QALY) over the patients’ lifetime based on the government perspective of providing prime-boost combination HIV vaccines (ALVAC-HIV® and AIDSVAX B/E®) in conjunction with the existing HIV prevention programs compared to existing HIV prevention programs. The analysis focused on the general population aged 18 to 30 years as well as high-risk populations (i.e. female sex workers, injecting drug users, men who have sex with men, and military male conscripts). Threshold analysis was carried out to determine the maximum cost of cost-effective HIV vaccination at a Thai ceiling threshold of 100,000 Thai baht per QALY gained. One-way and probabilistic sensitivity analyses were performed to examine the uncertainty of all input parameters. The study also employed an analysis of expected value of perfect information (EVPI) to determine the relative importance of input parameters and prioritize future HIV vaccines studies.
Results: The highest cost of HIV vaccination given to the general population was identified at 12,000 Thai baht with 70% efficacy, lifetime protection, and unchanged in terms of risk behaviour post-vaccination. The vaccine would be cost-ineffective at any price if it demonstrated relatively low efficacy (30%) and increased risk behaviours by 10% or more of the population. This is especially true among those high risk populations. This study also found that incremental cost-effectiveness ratios were the most sensitive to the change in risk behavior post-vaccination, followed by vaccine efficacy, duration of vaccine protection, and vaccine acceptance rate. The analysis of EVPI indicated the need to quantify several parameters, namely risk behavior changed post-vaccination, vaccine efficacy, and costs of community engagement and vaccine delivery.
Conclusions: The results are useful and important for both researchers conducting future HIV vaccine research, as well as policy decision makers who, in the future, will consider the vaccines adoption in Thailand.


This study used qualitative and quantitative methods to explore the use of alternative medicine in term of meaning, prevalence and predictors of alternative medicine usage. The sample was taken from 8 provinces in 4 regions of Thailand. The qualitative study consisted of 40 cases that were purposely selected, using different measures, to reflect different social backgrounds and use of alternative medicine. The quantitative sample consisted of 1,099 that were randomly withdrawn using different random sampling methods.
This study found that for lay people the meanings of alternative medicine were: Integrated self-care, the decision of choice to care, holistic care, naturalistic care, non-western medicine, the inferior medicine, the preventive medicine and the cultural wisdom medicine. The most popular therapies are exercise, herbs, massage, natural nutrition, lifestyle management.
The predictive factors of alternative use that were found in this study included :  Memberships of health group together with health status and sex. In addition, satisfaction from the effectiveness and safety were also predictors of using alternative medicine. The reason of using alternative medicine in term of ability to self-care and promotion and maintaining of health and balance to health were also found to be the predictors of alternative medicine use.
Following these results, we suggest strategies for developing alternative medicine and integrating it into national health care systems and national insurance programs, to develop mechanism to ensure appropriate, safe and effective use of traditional medicine which include: Increasing access to alternative medicine information and the development of health network in all social levels.


The study of information system in occupational and environmental health is a project under the development of information system in occupational and environmental health project. The aims of the study were to review knowledge on information system in occupational and environmental health field and study the situation of such system in the country. The steps of the study included literature review, information collection, and seminar for information and experience sharing among experts and relevant organizations
 	The results of the study showed that there are 2 issues concerning the study: the information system for occupational health and the other for environmental health. There are at least 2 important databases for both information systems, including environment database and health database. Environment database consists of data from measurement of hazardous levels in various setting such as working environment, or pollution level in communities. On the other hand, health database consists of exposure data in population from health screening and disease information from hospitals and other health service centers. Apart from the database, the proper information system should include data collection, data analysis and interpretation, and dissemination systems.
	In this study, only occupational health information system under the responsibility of the Ministry of Public Health was selected for analysis. The study found that such information systems are mainly responsible by two agencies such as the Bureau of Health Strategy and Planning and the Bureau of Epidemiology. Both agencies have established and developed their own information system, e.g. data collection, analysis, and interpretation. They focus on not only occupational diseases but also general diseases, depending on their mandates.
	Regarding health service centers, several hospitals and health centers throughout the country have provided occupational health services. The occupational health services include pro-active and passive approach (or service at health service stations). The information collected includes data from walk-through survey, environmental assessment, health screening, and disease diagnosis and treatment. Up to now, several health service centers have developed their own occupational health information system to manage information they collected.
	In conclusion, the development of information system in occupational and environmental health is very important for occupational and environmental health service system. However, the system faces many obstacles and problems, such as no information available, data accuracy, data sharing among relevant organizations, and supportive system for system maintenance. Therefore, responsible agencies have to co-operate to tackle the problems and to improve the information system.


Plague, an infectious disease caused by the bacillus Yersinia pestis, is primarily a disease in rodents
and is carried by fleas. Humans accidentally contract the disease via flea bites or exposure to infected
animals. There are records of several plague pandemics in the past that produced enormous mortality.
Today the incidence of plague has been substantially reduced owing to the effectiveness of antimicrobials,
improved sanitation and effective pest control. Currently, however, the disease seems increasingly to be
re-emerging, especially in Africa. Climate change and the global fluctuation in politics and poor economics
may be related partly to the migration of human populations into plague endemic areas. Also,
plague bacilli can be used for modern-day bioterrorism. Because the tendency of plague epidemics to
occur is increasingly alarming, the World Health Organization has categorized plague as a re-emerging
disease.
This communication may serve as a refresher course on plague so that those in Thai medical circles
may prepare for future outbreaks.


The impact of global warming on everything on Earth has been observed and reported by scientists
from every corner of the world for an extended time. Among those phenomena have been the correlation
of sex ratios at birth to increasing global temperatures. From known biological facts, sex determination
can be genotypic (GSD) or temperature-dependent (TSD). A number of previous studies have suggested
that TSD may be very common in many species of lower vertebrates, especially fish and reptiles, with
increasing temperatures generally affecting the sex ratio of a species (leading to many males and few
females). The most frequent citation is noted in a study directed by two Spanish researchers, Natalie
Ospina-Alvarez and Francese Piferrer, reported under the title “temperature-dependent sex determination
in fish revisited: prevalence, a single sex ratio response pattern, and possible effects in climate change,”
published in the July 30, 2008 edition of the scientific journal Public Library of Science (PLoS ONE). They
show that even small changes of just 1-2°C can significantly alter the sex ratio from 1:1 (males : females) to 3:1 in both freshwater and marine species. It is already known that high temperatures inhibit the synthesis
of estrogens, which are essential for female sex differentiation in fish and reptiles.
In mammals, under circumstances of ordinary temperature, male live births exceed those of females.
In humans, the ratio of male births to total births also favor the same trend. It has been hypothesized that
levels of steroid hormones (testosterone and estrogen) in both parents around the time of conception are
positively associated with the offspring sex ratio (proportion of males at birth) of mammals, including
humans. Some people, particularly women, in suboptimal health produce an excess of sons; thus, gonadal
hormones are responsible for adaptive variation.
While our findings of the comparative analysis on the secondary data obtained from the Thai Meteorological
Department and from the National Statistical Office in the 16-year period 1993-2009 show that
increasing temperatures result in an increased prevalence of newborn females over males. Details of
complex analytic patterns are elaborated in the text.


In 2006, the reimbursement system for the Civil Servant Medical Benefit Scheme(CSMBS) in Thailand
was changed to a direct billing system. It was unknown how this new system affected drug expenditures
and the number of drugs given to beneficiaries. The aim of this study was to assess the effects of the
direct billing system on prescribing patterns in terms of the number of months of coverage per prescription
and over possession. The study was undertaken using a retrospective cohort approach on the data
recorded in the database of a university hospital in the northern part of Thailand. We gathered data on all
patients with CSMBS coverage who came to the out-patients department between Oct 1, 2005 and Mar 31,
2007. Mean cost of medication, the number of months of coverage per prescription and the medication
possession ratio (MPR) of the five highest prices of oral medication were calculated for the one-year period
before and after the system was changed.
Results: Out of 43,897 patients seeking out-patient care at the hospital, 15,632 (36%) were covered
under CSMBS. Eighty-eight percent (13,785/15,632) received medications as a result of their visit. The
total cost of medication increased from 2 million baht to 4 million baht in one year. Glucosamine,
atorvastatin, rosiglitazone, clopidogrel and diacerein were the most frequently used in terms of cost. The
average number of months of coverage based on these medications increased from 1.29 to 1.48 months per
prescription. The percentage who were prescribed medication for more than 3 months, was slightly increased
from 1.82 to 2.43. Three out of five MPRs were higher after the system was changed (relative risk
ranged from 1.19 to 2.32).
Conclusion: The direct billing system may affect prescribing patterns, as indicated by the trend of
the increased number of months of coverage per prescription and the higher medication possession ratio
found in our study. Further evidence is still needed. Policymakers need to consider all relevant and
important consequences associated with the new system prior to decision-making for policy purposes.


The project for developing a good governance index is a part of the developing research management
system of the Health Systems Research Institute (HSRI) and its research alliances. The objectives of
this project are to (a) define the framework for monitoring and evaluating project administration in accordance
with good governance practices; (b) develop good governance index; (c) study the appropriateness
of the developed index and the perceived barriers; (d) set a guideline to gather essential data for
project performance evaluation, which is based on the principle of good governance for the research management team in the health system.
The process of this project began with (a) reviewing theories, concepts, and research reports related
to good governance practices and its index both domestically and internationally; (b) interviewing experts
from related disciplines, and research managements; (c) developing and testing a questionnaire and
then analyzing the data obtained; (d) using the drafted good governance index to conduct an internal
pilot test with Health Systems Research Institute, and (e) reviewing the index and modifying it to make it
more suitable.
The results of this study indicated that two crucial conceptual frameworks of index development
emerged, with the first conforming to the six good governance practices, namely the rule of law, transparency,
worthiness, participation, quality, and accountability, and the second applying those practices to the
five steps of the research management process.
The outcome of evaluating the Health Systems Research Institute’s good governance practices has
been depicted overall at the organizational level, where HSRI has high levels of good governance practices.
When considered the perspective of the five research management processes, the process of gathering
and allocating resources gains the highest level of engaging good governance practices; it is followed
by the process of planning research management. Other research management processes were evaluated
and their utilization of good governance practices was found to be at the middle level.


The objectives of this study involved (a) the application of methods of knowledge discovery from
database using decision tree algorithms for respiratory system diagnosis to classify patients of the Pranakorn
Sri Ayudthaya Hospital into three groups: acute upper respiratory tract infection, acute sinusitis, and
pneumonia, and (b) the comparison of performance of the three decision tree algorithms, i.e., ID3, C4.5,
and CART, for the classification or screening of the patients with the three diseases. The data used in this
study came from the medical records of 7,327 out-patients with respiratory diseases who attended Pranakorn
Sri Ayudthaya Hospital in the period from 2003 to 2006. The variables considered were age, body temperature,
residential area, occupation, and certain symptoms, e.g., rhinorrhea, fever, nasal congestion,
periorbital pain, headache, wheezing and coughing. The study methods were knowledge discovery with
the employment of ID3, C4.5, and CART decision tree algorithms from the hospital’s medical records and
determination of the effectiveness of the three algorithms. The validity of the decision tree algorithms was
studied by dividing the data into two sets: training and testing data sets, which were based on the crossvalidation
and the percentage split methods.
The results of the knowledge discovery method found that, for the patients with acute URI with only
seven selected variables and a ratio 70:30 of the training data set and the testing data set, the C4.5 algorithm
was the most effective, with a classification accuracy of 92.31 per cent. For the classification of the
patients with acute sinusitis with only eight selected variables and ratio 70:30 of the training data set and
the testing data set, the C4.5 algorithm was the most effective, with a classification accuracy of 94.70 per
cent. For the classification of the patients with pneumonia with only seven selected variables and ratio
50:50 of the training data set and the testing data set, the CART algorithm was the most effective, with a
classification accuracy of 94.69 per cent. The results obtained could be used to support the diagnosis of
patients with respiratory diseases.


Adverse events that occur in health service settings are resulting in more lawsuits than ever before.
The new patient compensation bill is expected to resolve patient-provider conflicts. It will be designed to
cover all groups of Thai people with acceptable claim process and amounts for compensations. This
communication reports the results of a study on the decision-making processes involved in compensating
injured patients under Article 41 of the National Health Security Act 2002.This was a descriptive study. The reasons used by committees in making decisions on whether to
“pay“ or “not pay“ the agrieved parties under the provisions of Article 41 were analyzed and compared
with the compensation criteria set out by the National Health Security Office. Altogether 1,276 claims
made during the period 2003 - 2008 were included in the study.
It was found that, of 1,276 claims, compensation was “paid out“ for 1,049 cases (82.2%) and 227 cases
(17.8%) were “not paid”. The main reason for paying compensation was that “it was an unavoidable
situation“ (76.5%). However, the reason above was not in accordance with the criteria for compensation.
Only 27.1 percent of the claims were made in accordance with the criteria, stating that the injuries were
related to medical errors or mistakes or substandard care. The main reason for not paying compensation
was that “the adverse events were the results of disease processes“ (61.6%). This was in accordance with
the criteria.
The conclusion was that inconsistency and unclear decision-making on patient compensations existed.
Of two cases with the same kind of injury, one might be paid and the other not. This type of
situation might motivate patients to bring cases to court.


Decentralization is one of the tools for the development of a health system which can produce many
benefits, such as improvements in technical and allocative efficiency, and improvements in the responsiveness
of the health system in meeting the needs of the people. According to Rondinelli(1), decentralization has been categorized into deconcentration, devolution, delegation and privatization. In Thailand, an
increasing emphasis has been put on community participation and decentralization following the Constitution
of B.E. 2540 and the Decentralisation Act of B.E. 2542 which has led to the development of the
Decentralization Plan of B.E. 2544 and the Devolution Plan to Local Administrative Organizations in B.E.
2545. These plans dictated that the provision of public services was to be devolved to LAO, and this
includes the transfer of infrastructure and the authority to provide health and health promotion services.
This study examines these issues by reviewing the international experience of Portugal, Spain, Italy, Mexico,
and the United Kingdom in health system decentralization.
From the review, after the reform, decentralization has led to many benefits in the provision of
health services and in the health system as a whole. In Portugal, it was found that the health status of the
population improved significantly after improvements were effected in access to care. Furthermore, the
local authority has become more autonomous and more flexible in being more responsive and efficient.
Also, in Italy and the United Kingdom, the internal market and the purchaser-provider split have been
introduced in order to improve efficiency, quality and service satisfaction. However, problems related to
decentralization were also found. For example, the occurrence of political conflicts from the reform, inequity
which emerged in many forms, problems relating to responsiveness in the deconcentration system,
and problems with unfavorable conditions and contracts in the internal market system.


Although community pharmacies normally provide health services to communities, they have never
been officially recognized as a primary care unit under any health security scheme. After the National
Health Security Scheme had been implemented in Thailand, efforts were made to test accredited pharmacies as part of a network within the scheme. In order to put a community pharmacy into the network, it is
essential to clarify the role and function of a community pharmacy as a primary care provider within the
network. Therefore, this study was aimed at projecting the role, function and activity of community pharmacies
from the viewpoint of community pharmacy experts, both from the private and government sectors.
The Delphi method was used by sending questionnaires to experts twice. Seventeen experts completed
the questionnaires twice. Levels of agreement were calculated as in the median, mode and
interquartile ranges. The results showed that the experts agreed that it was possible to have community
pharmacies play a role in treatment, health promotion and disease prevention in a community. The medians
of agreement levels were between 4 and 5 out of 5 on the Likert scale and the interquartile ranges were
narrow. With regard to the treatment role, a community pharmacy would have functions and activities in
dispensing drugs for common illnesses, refilling prescriptions for chronic diseases, and providing patients
with counseling. Regarding the health promotion and disease prevention role, a community pharmacy
would have functions and activities in screening for risk of chronic diseases, referring a high-risk
patient to physicians, promoting appropriate drug use, providing advice regarding nutrition and exercise,
campaigning for smoking cessation and reducing alcohol consumption, and coordinating with local
authorities to promote community health.


The Ottawa Charter has been adopted in many countries as a model for their health promotion policies which emphasize community participation. Mexico has developed a method for evaluating its
progress in implementing health promotion policies, and has developed a national policy on health promotion,
called Health Promotion Operation Model (MOPS,) which is based on the Charter and consists of
several components: management of personal determinants, health capacity-building, community participation,
development of a healthy environment, social marketing in health, and evidence in health
promotion. Sweden, a welfare state, developed its National Public Health Policy in 2003 with the main
aim of providing societal conditions for good health on equal terms for the entire population. It has 11
objectives which consider only the determinants of health. Interestingly, Pettersson summarized the evolution
of Swedish local authority in dealing with health promotion into “The Health Promotion Staircase
for Building Local Capacity”, which could be beneficial in the development of LAOs in Thailand. In New
Zealand, the Local Government Act of 2002 was passed which clearly defined the roles and responsibilities
of the central and local governments according to the risk-specialization model. Furthermore, to enhance
the role of the community, a long-term council community plan must be developed in line with the
expected ‘community outcome’ in order to improve community living conditions and address their health
concerns.


This research was intended to discern the adverse mental state of prison inmates based on their
expression of art images. Thirty inmates, 20 males and 10 females aged 24-57 years, were subjected to
psychoanalysis by two psychologists, and interpretation of their drawings by the art investigator.
Results obtained by the psychology group and the art educator were then compared, discussed and
a conclusion reached. It became evident that in the present project the drawings did not demonstrate
revelations as expected in the objective nor were they in accord with the psychologist’s findings; the
outcomes of both groups denoted only the prisoners’ present mental state, reflecting their factual situation
as prisoners. In realizing that the present study included subjects who were prisoners because of
having committed crimes that were not so serious, mental state was similar to that of normal persons.
Therefore, the researchers decided to carry out further research on persons convicted of committing more
serious crimes, which theoretically might be reflected in a more severe innate mental status.


This study aims to explore risk factors and risk behaviours that factory and construction workers are
facing at both individual and community levels as well as to examine existing health promotion interventions.
These information are consequently used for constructing useful recommendations for the development of
existing and new interventions by employing ‘social marketing’ principles; it is not designed for social
marketing interventions evaluation. Research team was assigned to embed in the purposively selected
factory and construction workers communities to collect qualitative data, namely lifestyles, social value, as
well as risk behaviours and risk factors. Afterward a cross-sectional survey was implemented basing on first
set of data obtained from qualitative investigations. Finally the data from both methods were analysed and
presented to the communities’ representatives in focus group discussions. This is to verify and explore crucial
explanations underpinning the findings, moreover it was expected that these findings would be beneficial to
the people in the communities.
It was found that although factory and construction workers had a number of constraints in terms of
purchasing power and time because they received relatively low payments with high workloads, they were
offered with convenience and motivation to access to unhealthy products e.g. alcohol drinks and tobacco.
Therefore in order to develop health promotion interventions that are suitable for these groups, health
promoters need to understand the context and be able to seek for ways to increase burdens to access to
those products.
It can be observed that legal interventions i.e. restriction on alcohol-selling time and restriction on
age of tobacco buyers did not perform efficiently, especially in factory and construction workers; thus,
commonly-known recommendation is that strengthening law enforcement is the key factor for the legal
interventions to be succeeded. On the contrary, this study pointed that the use of social marketing principles
to communicate with the target group regarding the true purposes and relevant facts of the interventions.
Selection of information to be communicated with the target group is also very crucial that health
promoters select information that is suitable for and relevant to knowledge, social values, and attitudes that
influence the target population. For instance, if a provision of new information is not fit well with their
attitudes, this can lead to a denial of adopting the new information. Conversely, if the new information is
compatible with their attitudes, it is likely that the target group will easily understand and adopt the healthy
message for their behaviour changes. Therefore to understand way of thinking, belief, and attitudes of the
studied population is very essential for health promotion communication.It is recommended that social marketing should initially be applied for promoting behaviours that are
easy to change and require low costs for the changes e.g. limiting smoking areas (rather than asking them to
quit smoking) or stop drinking in certain period of time (rather than asking them to suddenly stop drinking).
This is to offer reachable targets to the population and once they can achieve such a goal, they would be
proud of themselves and believe in their abilities, and this will help them to step up to reach more difficult
goals e.g. stop smoking or drinking.
It is widely accepted that effectiveness of social marketing interventions in persuading target
population to adopt health message to change their behaviours depends on internal factors which are the use
of language and level of motivations (e.g. peer or social pressures) in the interventions and the positive and
negative responses of the target group. Moreover external factor, e.g. fear of disease pandemic, or economic
factors also play important roles. As a result, a continual monitoring and evaluation of the intervention for its
improvement can make interventions well-run and able to keep pace with dynamic changes of both internal
and external factors.
In order to apply the principles of social marketing in practices, key points that health promoters
should employed are (1) to conduct formative study of the target population on their behaviours including
their responses to the interventions, (2) to develop, test, and then implement the interventions, and (3) to
monitor and evaluate the implemented interventions. In addition it is recommended that health promoters
should be aware of external factors which are very influential to behaviour changes of target population.
The Thai Health Promotion Foundation, governmental bodies and NGOs have been investing large
amount of funding in social marketing interventions. However, it was found that there are limited numbers of
literatures available on the effectiveness including an estimation of impacts of social marketing interventions.
The authors therefore suggested that further studies on this area should be conducted in systematic manner
as it would enhance an acceptance and use of social marketing principles, which is proved to be able to
tackle public health problems at national level.


This is a translated and edited article from chapter III (pp. 55-83) of the book published by Charles C.
Thomas Publisher, Springfield, Illinois, in 1994 entitled Art-centered Education and Therapy for Children with
Disabilities by Frances E. Anderson. Art adaptations for children with disabilities are focused on providing
children with an easy and comfortable way to obtain art experiences and produce creative artworks of
their own. The most important and challenging work for the working team (which comprised teacher,
physical therapist, occupational therapist, medical staff, art therapist, and the disabled child) involves the
method for solving various types of adaptation problems. In general, art adaptations are grouped into
four categories: in the physical space, in the art media and tools, in instructional sequence, and in technological
adaptations. Details on how these art adaptation categories are implemented in children with
mental retardation, learning disabilities, behavioral/emotional disturbances, physical disabilities, hearing
and visual impairments are elaborated in the text.


Lignite mining may result in several health impacts but at present no guideline exists to investigate
those effects. This study was aimed at setting up guidelines for the investigation of possible health impacts
from an open-pit mining project, using the participatory approach involving the public and other
stakeholders. Results from a literature review on possible health impacts and data on the living styles of
the affected community were used to identify the possible health impacts. The public and other stakeholders
were allowed to join the study and provide suggestions for public scoping.It was found that there were four aspects of possible health impacts: physical, mental, social, and
spiritual. Physical health impacts comprised accidents and injuries from mining and transportation; effects
from noise; diseases and effects from air pollution; diseases and effects from water pollution; effects
from blasting; and labor migration and communicable diseases. Mental health impacts were expected
from stress and anxiety. Social health impacts were likely from effects on community lifestyle; effects from
community migration and resettlement; and effects from depletion of forest and agricultural land. Spiritual
health impacts were likely from effects of aesthetic changes and loss of loyalty to and connection with
the locality; and the effects of people losing their spiritual haven.


There are some practical models of community pharmacy provision in Thailand that are coordinated
with hospitals in providing care for cases of stable diabetes and hypertension. This study was aimed
at estimating the impact on budgets of incorporating community pharmacy into the Universal Health
Coverage Scheme in providing care for cases of stable diabetes and hypertension. First, secondary data
were reviewed to estimate the supply and demand of community pharmacy services. Unit cost analysis of
the community pharmacy activities were situation, using the activity-based costing technique. Finally,
the budget impact analysis was estimated under the model of refill medication at the community pharmacy.
The timeframe of this study was January to September 2009. The result showed that the budget
impact of community pharmacy in providing medication refill for stable diabetes varied between 182 and
1,044 baht per patient, or between 194,740 and 1,117,080 baht per hospital. Regarding the budget impact
for medication refill in stable hypertension, the average expenditure ranged from 182 to 1,098 baht per
patient, or 242,242 to 1,461,438 baht per hospital. It may be concluded that the community pharmacy
could be a part of an integrated package of care for people with long-term conditions, such as stable
diabetes and hypertension. However, a financial incentive is required to meet additional costs and to
connect community pharmacies to the Universal Health Coverage Scheme. Co-payments may be used in
this program to prevent inappropriate utilization.


An abdominal operation affects gastrointestinal (GI) motor activity. Post-operative care for early
recovery of GI motility is recommended. The purpose of this quasi-experimental research was to study
the effects on bowel function of using a rocking-chair in patients who had undergone gynecological ab-dominal surgery. The framework of this study is based on the effect of mechanical pressure and relaxation
technique on the GI tract. The sample of 60 abdominal hysterectomy patients was drawn by carefully
selected criteria from a patient population admitted for abdominal hysterectomy during the period from
June to October 2008. The patients were randomly assigned into two groups: the experimental group who
ambulated by rocking-chair exercise and the control group who did not. The data collected consisted of
four parts: demographic, treatment, bowel function and patient satisfaction. The experimental instruments
were rocking-chair and stethoscope. The bowel function was measured 16 hours after surgery. The
experimental group who were assigned to ambulate by rocking-chair exercised for 45 minutes and the
control group who did not. Data were collected and analyzed by using mean, standard deviation and
independent t-test. We compared the difference by χ2 test and independent t-test.
The results revealed that the frequency of bowel sound and belching was statistically significant
with the difference being p = 0.001 and 0.01, respectively. There was no difference in the number of days
marked by flatus and the passing of feces. The majority (53.3%) of patients had high satisfaction and
almost all (90%) of the patients experienced no dizziness.
We suggest that the post-operative abdominal surgery patients should be ambulated with a rockingchair.
The outcome of our study theoretically applies also to the other patients undergoing abdominal
surgery.


The National Health Security Office (NHSO) region 8 in Udonthani Province surveyed health personnel
in six provinces: Loei, Nongbualampoo, Nongkhai, Udonthani, Sakon Nakhon and Nakhon Phanom
for the purpose of evaluating understanding of the benefits, information and people’s satisfaction with the health security system. The results revealed that the majority (76.9%) of pharmacists and dentists
knew about the benefits of the health security system, which was less than that of other health professions.
Most personnel received information about health security via television (68.1%). For radio, the
popularity of songs, news and general events was almost the same proportion (31.5, 30.2 and 26.5%,
respectively). The most popular period was between 6 and 8 a.m. (37.1%); 62.6 percent of health personnel
did not read newspapers. The satisfaction of personnel with health security was 8.15 out of a possible
score of 10 and general personnel had highest satisfaction at 8.5. The least satisfaction was among pharmacists
at 7.37. The study found that the satisfaction of the personnel who were positive related to their
knowledge of health benefits in the health security system and satisfaction with the media provided by
the national health security office. The Internet is also an interesting route as it is easy to use and efficient
in communicating to target populations.
It is suggested that NHSO should perform specific public relations campaigns and work more specifically
with each group of health personnel. Attention should be paid to the low level of information that
personnel had received. Formal letters are still the main route for providing information to health personnel.
Alternative routes of information dissemination should be used, especially newsletters, to create
good attitudes toward the national health security system, taking into consideration aspects such as quantity,
style and content conforming to the taste of the personnel concerned.


This study was aimed at identifying and developing nutritious ingredients in local Thai recipes for
healthy elderly people, based on their nutrient requirements. Community leaders were identified and asked
to point to community cooks within their communities. A list of 201 local dishes was identified through indepth
interviews performed among 74 local food experts. From the list, 40 dishes were selected that had
the potential to improve the overall nutritious quality of food, for instance adjusting meat and vegetable
quantity and substituting coconut cream with cereal cream and/or soy milk. The recipes were adjusted
and tested for sensory acceptability by the elderly in their communities. Mixed-dish recipes provided the
highest average energy content (319 Kcal per serving), while namprik (fish sauce with chillies) and noncoconut
cream curry provided the lowest energy content (89 Kcal per serving). Noodle soup with chicken
had the highest content (6 mg). Thai rice noodles in sweet chilli sauce (kanom jeen nam prik), Thai rice
noodles in spicy sauce (kanom jeen nam ya), steamed snake-head fish with Morinda Citrifolia Linn (Noni)
leaves (hor mok pla chon bai yor), and namprik had the highest fiber, iron and vitamin A content. Since cereal
cream and/or soy milk, which contain appropriate fat content, were used instead of coconut cream in this
study, these recipes may help to decrease the risk of chronic non-communicable diseases in the elderly.


Iodine deficiency has several effects on health, particularly concerning brain development in the
fetus and in early childhood. With regard to the past few decades, the situation was mitigated when considering the total goiter rate in children. A mild deficiency produced no obvious physical effect, but
did impair mental function. In this regard, the northern and northeastern regions comprised the highest
risk areas. This descriptive study was aimed at reviewing the iodine status of populations in Chiang Mai,
Lamphun, Lampang, and Mae Hong Son by analyzing secondary data during Fiscal Years 2007-2009 and
was framed under the WHO manual entitled “Assessment of Iodine Deficiency Disorders and Monitoring
Their Elimination.”
It was found that a proportion of the households using adequately iodized salt was progressively
over 90 percent in every province except Mae Hong Son. Thyroid function was assessed by screening
TSH levels in newborns that were over 11.2 mu/L; in Chiang Mai, Lamphun, Lampang, Mae Hong Son
the levels were 12.73, 7.84, 10.29, and 15.83 percent, respectively, and the incidences of thyroid hormone
deficiency were 1:2,297, 1:1,665, 1:2,468, 1:3,058 respectively. The total goiter rate was below 5 percent in
every province. The level of iodine in urine in pregnancy in Mae Hong Son was equally insufficient at
50.89 percent; in primary school pupils in Lamphun it was 52.38 percent, that is, equally more than adequate.
In conclusion, four provinces indicated mild iodine deficiency areas, but their situation had gotten
better. Iodine deficiency prevention requires more attention from policymakers. Proper development of
intellectual quotients by adequate iodine intake should be designated as one of the national strategies on
childhood capacity-building. Correct knowledge-building on the benefits of proper iodine intake should
be encouraged. Salt producers need to show social responsibility as well; legal measures are necessary, if
they do not do so.


This study involved qualitative research aimed at exploring a social movement for changing the
local tradition regarding alcohol consumption in the community. Its goal was to identify the community
capital which facilitated the social movement in order to illustrate the process of social movement and its impacts on the alcohol consumption behaviors in the community. The research setting was Ban Khokyai,
Namphong District, Khon Kaen Province. It was a qualitative research study, the main data for which
were collected from in-depth interviews, participation observation and document review.
Alcohol consumption, which formerly had been considered as a norm in the community, changed
over time in accord with changing community power and capital. Violence among youths who drank and
got out of control evoked a reaction in the community. A civic group was formed in the name of “So-Le.”
Its leader was a respected monk who possessed three dimensions of capital: (1) cultural capital – the belief
and the faith of the people in Buddhist monks, (2) social capital – his good relationships with the village
head and the School principal, and (3) moral capital – his virtue and kindness. However, the success in
controlling alcohol consumption in the temple was just the first step of the movement. It needed further
strong support to struggle against the resistance of a community group.
The investigator suggests that the social movement for solving alcohol-related behaviors, which was
deeply ingrained in the lifestyle and culture of the people, required actors who possess such capital and
the support of the community to empower them as health promoters.


The objective of this qualitative research was to investigate and compile knowledge of Thai traditional
medicine for postpartum care in Amnat Charoen, a province in the northeastern part of Thailand.
Data collection was done through individual and group interviews of folk doctors, including herb doctors,
midwives, shamans, traditional massage therapists (n=43) and healthcare professionals from all hospitals
(n=7), along with on-site observations. The study was undertaken between May 2009 and April 2010.
It was evident that inherited traditional medicine/folk medicine regarding midwifery and postpartum
care has long been practiced in the area of Amnat Charoen up to the present. The knowledge and
wisdom in this particular area have passed from generation to generation, i.e. from ancestors to younger
family members, via story telling, traditional practice, and a mentor system. In the past, labor in childbhirth
was typically assisted by a traditional midwife. Several postpartum care regimens would then be employed
after childbirth, e.g. yu-gum or yu-fai (body warming using heat/fire), herbal bathing, along with
many religious rites. Various medicinal plants, either of single or multiple formulas, have been used for
mothers for the purposes of body cleansing, evacuation of amniotic fluid from the uterus, and stimulation
of lactation. In addition, some plants are used as blood tonics or laxatives for nursing mothers. A number
of herbs have already been investigated for their chemical constituents and related pharmacologic
actions; however, some have not yet been studied, thus their activities remain unknown or questionable.
It was found that folk medicine/traditional medicine has been integrated harmoniously with modern
medicine in the current practice of postpartum care in government hospitals in Amnat Charoen. It was
also quite apparent that the government policy regarding Thai traditional medicine has played a major
role in expanding both the number and quality of traditional health services available at every level of
health care.


Policy-linked research is related to the country’s problems and concerns. The purpose of this study
is to evaluate the missing knowledge in tobacco control in Thailand and to examine the significant research
questions needed for tobacco-control policy. Two methods, namely framework of analysis and documentary research, were employed to evaluate the scope of needed research, the method of comparison
to the WHO Framework Convention on Tobacco Control (FCTC), by selecting equivalent topics related to
Thai society. The next step was collecting previous research evidence, such as research reports and meeting
papers. Those collected documents were evaluated to identify knowledge gaps, using a focus group
discussion in order to bring forward specific research questions.
Seven main areas for tobacco control were identified as relevant to the current tobacco-control situation
in Thailand and that needed to advance more evidence: (1) the surveillance system of tobacco consumption
and tobacco industry, (2) tobacco-control tax measures and trade agreements, (3) an alternative
model of services for smoking cessation, (4) control of various tobacco products, (5) communication for
effecting behavior and social changess, (6) situation concerning “roll-your-own” cigarettes, and (7) evaluation
of the effectiveness of the tobacco-control measures.
This analysis suggested that research prioritization for tobacco-control research could use the WHO
FCTC as a framework of analysis. The selected components could be adjusted for country-specific application
which should guide effective investments in specific tobacco research in order to solve the country’s
problems in this regard.


Health technology assessment is an important tool for policy decision makers to allocate health
resources efficiently. Though accessibility and knowledge in health technology assessment are barriers
for research utilization, a health technology assessment database has been developed in Thailand to retrieve
related research and disseminate it to targeted users. Its development was divided into three phases:
(1) development of database structure based on the focus group method with decision makers, health
practitioners, and academics/researchers, (2) searching and recording research in the database, and (3)
disseminating and evaluatiing database use. The database was available online at www.db.hitap.net
starting in January 2008. The results revealed that the database included 471 full economic evaluation
studies, 155 randomized controlled trial studies, and 106 quality of life studies. Evaluation of database
use in January 2009 showed that the majority of users are most satisfied with the up-to-date articles, the
usefulness of the database, and the database services that meet their expectations. However, the variety of
research articles should be determined in order to meet the users’ needs in the future.


Background and Rationale
There are association between the concentration of air pollutions and morbidities and
mortalities of cardio-pulmonary and vascular diseases from acute and chronic exposure. In Chana
district, Songkla. There are many constructions and many types of business such as the power
plants and the gas separation plants. From the factories’ reports, the concentration of air
continuous monitoring pollutions are below the standard limits but there is no survey to study the
association between the concentration of air pollutions and the symptoms in this population.
Objectives
To study the association between the concentration of air pollutions and the symptoms in
Baan-Kuan-Hua-Chang’s population
Methodology
Time series were performed in 319 subjects (everyone who stays in this region, age more
than 10 years old) in 9 July – 22 August 2009 for 44 days. Exposures are the concentrations of the
air pollutions, there are PM10, NO2, SO2, CO and O3, measuring by the mobile unit and the
concentrations were analyzed with standard methods. Outcomes are 18 symptoms in 5 systems,
there are skin, chest, cardio, neuro, opthamo systems, measuring by self administrative
questionnaires. The other confounders were included in the questionnaires such as smoking,
personal histories. This study also monitored and recorded the meteorological data such as humidity, temperature, wind speed. The Generalized Estimating Equation (GEE) were performed
using R 2.10.1 with Epicalc, NLME packages.
The results
319 subjects were analyzed, 114 male(45.14%). The average of age is 40.45 ± 18.12
years old. There are 10.03% of hypertension in the subjects and 9.4% of allergic disease. 54.55%
of the subjects is rubber tapping. 24.76% of the subjects still smoking (5.99+ 5.39 pack-year) and
54.23 % of the subjects are secondary smoker. There are some associations between the air
pollutions and symptoms after adjusting the meteorological data, personal data. Such as nausea
and vomiting and dizziness is positive association with NO2lag1, cough and rhinorhea is positive
association with O3lag5, eye irritation is positive association with O3lag6, headache is positive
association with O3lag7 , hoarseness is positive association with SO2lag4.
Conclusion
After adjusting the meteorological data, personal data, There are some associations
between the air pollutions and symptoms although the exposure are low concentration in this area.
Caution
This study did not aim to identify which is the source of the pollutions.


Unrest affecting the health system in the area. Therefore, education and development. But the lack of synthesis and adoption benefits. This study was to synthesize findings about the health status. Public health sector management. Public Health and recommendations from research on 103 projects and project 10 project, projects from the year 2547-2551 by the synthesis of quality found that people with little stress to normal Stress management using positive thinking. Talk to your family. Religious principles is dependable. Young families that are affected will have aggressive behavior. For other activities to relieve stress. Widow and loss of mental health and social problems was high. The problems faced by the doctrine But the inability of leadership roles in family. Public Health System-wide emergency medical services and referral. And the remedy is clear, but people are unsure of work The problems  does not cover the public relations people have less access to services. Recommendations from the research project and present the application of research to practice. And in-depth study or research in other samples. Most research is basic research should develop research and evaluation research. To solve the health sector management and public health service public. Should be educated in all groups of health personnel disabled youth to prepare a database builds knowledge.


The aims of this case study, conducted at the Wing 23 Drug Rehabilitation Centre, Udon Thani Province, Thailand, were to ascertain, by means of qualitative research, the pathway(s) leading to “Yaba” (Amphetamine) use by drug users and dealers and determine the factors influencing those behaviours. The participating cases (n=70) were female clients at this institution. Structured questionnaires were used for data collection, using an open-ended in-depth interview format with guidelines to ensure content validity. The use of triangulation methodology ensured enhanced validity and reliability, while content (thematic) analysis was used for overall data analysis. The results were as follows:
With respect to the pathway(s) leading to habitual drug use, the study results indicate that the use of Yaba began in participants’ youth, after being introduced to it by friends or boy friends who suggested that they try the drug, thus forming an incipient behavioural pattern of regular use. The influencing factors found to predispose toward such use included a positive attitude deriving from a perception of Yaba’s benefits as a helpful means of acquiring friends and reducing suffering. An important enabling factor was cost, as drug users who have more money can acquire more Yaba and can therefore use it more frequently. Reinforcing factors included the need for acceptance and the influence of significant persons such as friends, boyfriends and family members.
In considering the likely pathway(s) leading to involvement in drug dealing, the study results indicate that such cases had a history of drug-taking, and the increasing need for money to support their habit motivated them to eventually become drug dealers. The results therefore suggest that lack of money was an important contributory factor impelling them towards drug dealing. An influential predisposing factor was a positive attitude engendered by the realization that they could work and earn money by their own efforts, leading to improvement in their economic status, with a concomitant feeling of pride in their ability to do so. The fact that Yaba could be obtained more easily, and that they could sell the drug for 2-4 times more than the original cost, were important enabling factors. A significant reinforcing factor facilitating their decision to become drug dealers was the realization that increased income would lead to greater

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levels of convenience in their life. Family members were also implicated as persons influencing their decision to become drug dealers.
With respect to approaches to solving the narcotic problem, the study indicates that most participants supported maintaining significant interaction between all relevant parties, advocating vigilance with respect to drug-related behaviours. Community members should also participate by providing important information to investigators.  However, some participants suggested that the narcotic problem could not be solved easily because of its large scale and the fact that it was related to personal attitudes, beliefs, behaviours and needs.  Both family and environmental factors within the community were implicated as contributors to the problem. The consensus opinion was that, as an effective approach toward a solution, narcotics production should cease altogether.


A qualitative research, the study was carried out at Ban Maehair Tai Moo 9, Tambon
Panghinfon, Maechaem District, Chiang Mai, a Pakayaw community. The community has managed to
become a drug-free haven without support from outside organizations. The study has two major aims.
On one hand, it means to explore factors contributing to the successful campaign against drug abuse.
On the other, the model shall be developed to consider if its replication can be made to strengthen
other communities as far as efforts to combat drug problems are concerned in light of the social and
cultural aspects.
The study’s conceptual framework depends on the segregative method and the Buddhist
Law of Dependant Origination (Idappaccaya). The method has been used to guide the attempts to
come to terms with conditions in the community of Ban Maehair Tai to delve deeper into the
structures and how each element works relatively to each other. Five groups are the focus of the
study including community leaders from election (four in each group), natural leaders (four in each
group), village members including either the husband or wife, or any family member who fills out the
survey form, fraternity group (six persons) and individuals from outside working in the community of
Maehair Tai (a couple of them).
Two methods were used in the study including (1) the literary review related to Ban Maehair
Tai based on materials provided by relevant agencies, and (2) field survey. The researcher spent
three months to live in the community, conducted the community bioregional mapping, and carried out
basic household surveys, individual interview and focus group interview. Both non-participatory and
participatory observation methods have been used as well as formal/informal interview and note
taking.
It was found from the study that four major factors have contributed to the successful combat
against drugs in the community of Ban Maehair Tai, Moo 9, Tambon Panghinfon, Maechaem District,
Chiang Mai including the following (in order of significance);
1. Religious factor: Religious leaders, the local diocese, and the Church of Christ in
Thailand (CCT) have played significant roles in garnering faith of the villagers in God making them
adhere to good deeds as well as steering away from illicit drugs. 2. Social factors: This constitutes basically family network and kinships. The structure helps
to nurture the ground for morality and virtuous deeds and to training people on vocational skills as
well as to set example for the young generation to follow.
3. Political factors: The Village Committee, religious leaders and self-sufficiency savings
group have been the major impetus for mobilizing various activities in the village. Their roles can be
described in two major ways. Administratively, the Village Committee helps to oversee orderliness
and peace in the community through the enforcement of regulations and division of zones for the
involvement of local villagers. The Village Committee, religious leaders and the diocese and the selfsufficiency
savings group help collectively with the village governance.
4. Educational factors: The Ban Maehair Tai School, Maefahluang Mountain People
Learning Center and Ban Maehair Tai Village Health Post are instrumental in educating local students
and pregnant women about drug abuse and general health. They help to ensure that local students
stay away from illicit drug use.
The religious, social, political and educational actors have workers together in harmony to
make it possible for Ban Maehair Tai, Ban Sedosa and Ban Bloday to become drug-free communities
without support from outside organizations.


This is a translated and edited version of chapter VI (pp. 132-158) of the book by Frances E. Anderson,
entitled Art-centered Education and Therapy for Children with Disabilities, published in 1944 by Charles C.
Thomas Publisher, Springfield, Illinois. Introduced in this chapter are art-based creative activities called
language arts, which include visual vocabulary activities (reading aloud), writing activities, puppet plays,
and poetry. In practice, it is of the same fashion in expressing mentality as symbolic expressions in
drawings in individuals that would not or could not reveal themselves in verbal communication.
Of note, the art-based creative activities presented in this paper will be just the beginning – a jum
ping- off place – for the creative teacher. Teaching children with special needs is a constant challenge. These
children need more practice than other children in learning skills and concepts. There is no reason to make
practice a dull, boring drill when there are so many alternative ways to learn. For some reason, educators
seem to believe that the brightest, most competent learners should be afforded the most creative teaching.
On the contrary, if every child with special needs were taught with the same energy and creativity as a
gifted child we might see far more enthusiastic, energetic progress in them. There is no excuse for boring
any learner of any age with dull, uninspired teaching. Special children need special teaching far more than
any others because they have so much farther to go. “Art-based academic learning can make the journey a
joyful experience.”... F.E. Anderson.


Health policy and systems research (HPSR) is crucial for strengthening health systems. In cases
where resources are limited, research topic prioritization is an important process to ensure the effective
use of available resources and to help identify research topics that are relevant and also address stakeholders’
concerns. In foreseeing the benefits of introducing a prioritization process, the Health Systems
Research Institute (HSRI) and its affiliates organized the HPSR topic prioritization seminar 2010, which
was aimed at preparing a list of national prioritized research topics, in the hope that the list will be used to
support policy decisions in Thailand.
This is a research and development study which employed participatory observation, brainstorming,
and questionnaire surveys. A total of 247 organizations were identified as stakeholders, 90 of
which participated in the prioritization process. At the beginning of the process, 120 HPSR topics were
proposed by 66 organizations. Of these topics, 15 were prioritized. It was found that topics that are related
to (a) disease with a high burden and (b) service delivery are likely to be included in a priority list. In
addition, results from a self-administered survey demonstrated that 93 per cent of the stakeholders strongly
supported the process and expressed their interest in participating in similar events if conducted in the
future.


The purpose of this study was to explore the quality of working life among workers in Ban Meng
subdistrict. This included career initiation, finding jobs to work at home, the working environment, and
coping with health and other problems concerning informal working conditions. The main data of this
qualitative research were collected from a community survey, observation, interviews, and in-depth interviews.The study revealed the local value placed on the sewing vocation, which had been transmitted to
people in the community from previous generations. The condition of employment, which was influenced
by their economic situation, competition in production supply, and external trading, had strong
impacts on the vocational security of the workers in the context of exploitation, negotiation, and resistance
regarding employment. These impacts included health and social problems resulting from bad working
conditions and environment, as well as improper health behaviors. The study also found that the
family, the community, and working network were the most important parties that participated in the
health care of the workers.
This study recommends a model of quality-of-life improvement among the workers in the community.
This will be accomplished through group creation, strengthening the capacity of local organizations,
community, and other agencies in order to gain skills in management regarding career, health, and social
welfare suitable for each situation and necessity.


This descriptive research was conducted to determine the prevalence of renal impairment and drug
use in gout patients treated at Nongjik Hospital, Pattani Province. The methodologies included a review
of the medical records of 122 patients in the period from October 2008 to December 2009; estimated glomerular
filtration rate (eGFR) was calculated by the MDRD equation. Data analysis provided the frequency,
percentage, mean and standard deviation. Chi-square test was applied to compare between proportions
and multiple logistic regression was used to determine associations between the prevalence of eGFR < 60
ml/min/1.73 m2.
The majority of patients were male, with their average age being 64 years. Most patients had comorbid
diseases. Medications used were concurrent allopurinol and colchicine. A significant proportion
of patients had chronic kidney disease stage 4 and 5 which was treated with colchicine without dose
adjustment. Of the total, 58.2 per cent of the patients exhibited eGFR <60 ml/min/1.73 m2 and 81.7 per
cent of them showed hypertension. Age was the only significant factor associated with eGFR < 60 ml/
min/1.73 m2 as revealed by multiple logistic regression analysis.
Based on the experience obtained in this study, renal function testing for gout patients is important
for early detection of renal impairment; the finding would also be useful for dose adjustment of the drugs
prescribed, based on which end stage renal disease may be prevented or slowed down.


In Thailand, legislation which concerns health promotion ranges from the National Health Act
(B.E.2550), and the Supporting Fund for Health Promotion Act (B.E.2544) to the most important of all, the
Thai Constitution, B.E. 2550. The constitution guarantees the rights of individuals on this issue as follows:
(a) the right to public health and welfare services; (b) the right to access information on certain activities
and/or programs which may affect their environment, health and quality of life; and (c) the right to be
protected from environmental health hazards. Furthermore, the Constitution also states that health policies
must emphasize health promotion, which would lead to sustainable health of the population, and
that local government should be given the responsibility and authority in the management and provision
of public services for the local people. Even though other related laws which concern the roles of local
government in public health service provision may not have included health promotion as one of the
responsibilities of local government, the responsibilities of local governments could be extended. Legislation
such as the Public Health Act (B.E.2535) and the Tambon Council and Tambon Administrative Organization
Act (B.E.2537) has given power to the ministers in charge to allocate extra responsibility to local
government as allowed by those laws. The latter especially has given the tambon administrative organization
the role of managing basic environmental control services. This is relevant to the function of health
promotion. The Second Action Plan and Protocol for Decentralization to Local Government clearly states
that health promotion responsibility, along with basic health services and disease control, are to be the
responsibilities of the local government, with a certain level of “readiness.” These will be transferred
together with funding, the existing staff and infrastructure (health centers). However, as local government
needs to undergo assessment and other processes in the devolution of health centers, there is a need
for specifying the roles of local government in health promotion in order to clarify the issue and to make
the roles conform to Thailand’s health promotion strategy.


The purpose of this qualitative research study was to explore the incidence of repeated violence and
patterns of resistance. The main data were collected from in-depth interviews, participatory observation
and a document review. The research questions were: (a) what is the context of the cultural and power
relationships in which the repeated violence exists, and (b) how is the meaning of the experience and the
suffering of the abused the fault of the community?
It was found that the process of repetitious violence in the family caused resistance to social norms,
but it was the only way that the individual could have reacted in view of the power structure.
The findings reveal the patterns of resistance that occurred under the terms of the context of violence
that went against the social norms; it might be the only way that the individual could have reacted under
such conditions.


Unwanted outcomes of health services, either unavoidable occurrences or due to negligence, can
lead to damages and conflicts between health-care providers and patients. Consequently, this can have an
impact on the health service delivery system, in which the faith and credibility of the people has been
deteriorating. The current compensation mechanism implemented through the judicial system cannot
enhance good relationships between the providers and patients. The “no-fault” basic compensation system,
under which the affected patients are entitled to damages, according to article 41 of the National
Health Security Act of B.E. 2545, can alleviate their distress to a degree but the law covers only patients in
the Universal Coverage Scheme. This has led to the idea of drafting new laws to extend this protection to
all Thai patients. As a result, the authors have summarized the policy options and the pros and cons of
each option in order to inform the public, create symmetry of information between different groups of
stakeholders, and empower the society to assess by themselves the feasibility and long-term impact of the
policy options. This study found that non-judicial no-fault compensation for affected patients is widely
accepted and adopted in several countries (such as the Scandinavian countries and New Zealand) under
the principle which emphasizes the responsibility of the party who afflicts the damage before proving
who is right or wrong. There are two different sources of funds for no-fault compensation: (a) funds
collected from providers, public hospitals through health funds which are mainly from taxation, and
private hospitals which pay directly; and (b) contributions from people proportionate to their income
(with a certain income ceiling) and (c) from the government for low-income or unemployed people. Also,
the providers may need to contribute (as in New Zealand). It is the authors’ opinion that Thailand should
adopt a no-fault liability policy which could help in reducing conflicts between patients and providers. A
non-judicial mechanism should be developed for provision of full compensation, which if the patient
accepts, would mean that no further lawsuit could be filed. This would allow the affected patients to be
compensated in a timely manner. Regarding the funding source, we propose the use of the health funds
model through which the government contributes to public hospitals while private hospitals contribute
themselves. The estimation for compensation is about 341-679 million baht per year, with the average
being 5-10 baht per capita. Discussion by stakeholders on this topic would allow the facts to be revealed
to the public who could then participate more effectively in the policy-making process. One should be
aware that if the quality of the health service delivery system is poor and the problems are caused mostly
by complications or the system itself, then the amount of compensation paid for these damages would be
higher than the compensation for damages caused by the practitioners; hence, this would lead to rising
costs. Furthermore, the no-fault compensation process should also be protective of the providers’ reputation
and try to give encouragement and feedback in order for them to improve their performance.


Since 1999, the Ministry of Public Health (MOPH) has transferred 28 health centers to 28 local governments (LGs). There were both success and failure. Most of LGs accepted that they lack capability in both health care management and financing. It was essential that MOPH find out other alternatives for decentralization as the law assigned. This was the rationale why needed a study. The research had four important objectives including 1) finding out the alternatives for managing health care units of the MOPH after decentralization. 2) analyzing the appropriate roles of the MOPH linking with the LGs for health promotion and disease prevention in local areas. 3) analyzing the roles of the MOPH’s different organizations after decentralization and 4) analyzing the appropriate overall system governance after decentralization in order to achieve better health care. The research methods consisted of reviewing the national and international experiences on health care decentralization, and brainstorming of the representatives from MOPH, NHSO, LGs, NGOs, experts and community. The obtained data was analyzed with content analysis technique. Then the results of analysis was synthesized and presented descriptively, complementing with relevant tables and figures.
	The result of the study pointed out six important issues comprising, first, health care decentralization in the Thai context was a means rather than an end. The definition was far more meaningful than just the transfer of health care units to LGs, concentrating on population’s beneficiaries.  Second, area health, under the responsibility of the area health board supporting by the MOPH, was the most appropriate option for decentralization since the health care system was united ,not fragmented, especially the referral system. There was economy of scale. The area health was very flexible allowing all stakeholders to join in both service administration and delivery. Good governance was feasibly developed. It could solve the problem of conflict of interest at both policy and operational levels. However, there was a lack of legal statute to support. The area health required expertise recruited as a board member which was very scarce in local area.  Third, the appropriate roles of the MOPH connecting with LGs for health promotion and disease prevention should focus on quality of life improvement, the specific target group services, endemic disease control, and social services provision which were the social determinant of health. The MOPH needed to take responsibility for the pandemic disease control and advanced epidemiological technique development. Fourth, roles of the MOPH changed much after decentralization. The MOPH had important roles in policy setting, law regulation and collaboration with international agencies. The units of the MOPH played an important role for putting the declared policy into practice via health care planning, monitoring and evaluation, resource allocation, technical support and coordination with other organizations.  Fifth, the overall system governance needed a combination of formal bureaucratic system, market mechanism to improve efficiency, and partnership in health working for good governance. And, finally, it should be bewared that there were some effects of decentralization concerning health personnel’s tenure and motivation, and the incapability of some LGs. The study recommended that the meaningful definition of health care decentralization should be publicly advocated. The area health should be more deeply studied and proposed as a national policy. The national board of health care decentralization was essential that it needed to be taken into consideration for the sake of continuous decentralization planning and development. The relevant regulations and laws needed to be revised and mandated in order that the decentralization could be implemented flexibly, especially the establishment of area health and the designing of the new roles of MOPH and its organizations. Finally, it was recommended that the area health need urgently studied in terms of the relations of the structure, authority and service delivery to be clearly figured out.


This research had three major objectives that were: 1)to explore HSRI research users’ satisfaction both from the research contents and from accessibility to the research information, 2)to explore the problems and needs of the users and 3)to study the opinions on HSRI operation from the relevant parties who took part in formulating the policy of HSRI. The sample consisted of two groups; one from the executives or the parties relevant to policy formulation and the other from the researchers and academics who used the HSRI research. The data were gathered by mailing the questionnaires to the researchers and academics and interviewing the executives. The researchers and academics were randomly selected from 6,621 members of HSRI digital library during the years between 2007 to the mid 2008. The response rate was 48.4 percent calculating from 727 returned questionnaires. There were 9 executives who were interviewed.
The results were as follows:
1. The most important purposes of HSRI research usage were to develop themselves by increasing their research knowledge and to conduct their own research respectively. The least important purpose was to use the research for running their business.
2. For the satisfaction with HSRI research usage, the researchers and academics were most satisfied with publishing full text research papers in .pdf files and the contributions of research to develop health system respectively. The least score was the satisfaction with the research coverage of all areas of health system but the score was still at the high level of satisfaction.
  For the satisfaction with academic work of HSRI, the satisfaction of the researchers and academics was at the high level. However, the executives rated their satisfaction at moderate level by giving reasons that the role of HSRI had been diminishing and its research contributions leading to health policy adaption were less than its former research work.
3. Regarding HSRI research usage communication channels, the researchers and academics used research via Journal of Health System Research most. The least usage of communication level was radio broadcasting.
4. New threats such as natural disasters and terrorism were the most needed research topics that the researchers and academics required HSRI to develop more. The second highest needed topic was mechanisms and tools for solving health problems occurring from environment.
5. The research on health system was the most needed information that the researchers and academics required HSRI to gather and store in HSRI database. For the improvement of website, the most needed contents were research analysis column and health policy analysis column respectively.


Objective: To determine the model of nurse led diabetic clinic network, the effects of model on vascular risk factors in primary care units of health department, Bangkok metropolitan.
Study design: Prospective descriptive study, and action research
Materials and methods: Fours primary care units 251 diabetes were recruited, and the model was developed on the 2 stages as following: stage1 preparation, in this stage, we review the diabetic burden,  nursing role and service pattern for diabetes patients these primary care units, before model set up. and in stage2,  we developed The Nurse led diabetes program to help nurse manager in providing standardized care for diabetes as recommended in national guideline, and nurse educator development by educational motivation from multidiscipline conference, and clinical set up with periodic auditation and brain storm to re-evaluate, re-modeling the model.
Results:
•	The risk burdens as in obesity, truncal obesity were high initially 78%, 62%  in subsequently, and the patients having target LDL cholesterol, blood pressure, fasting sugar, HbA1c were 36%, 38%, 31%, 34%  in subsequently, However These un-optimized risk factors had trended to lower after the model implementation.
•	For the model had improved the nursing attitude as nurse manager, confident , quality service and standardized diabetes care, and the patients had improved coping skill in behavior modification, and most importantly the good relationship between the community and clinic which could motivated patients adherence and confidence in nurses.
•	The Nurse led diabetes program could help nurse manager in risk factor development, sugar control, complication detection and improved standardized protocol as in national guideline recommendation.
Conclusion: The nurse led diabetic clinic network could provide more standardized care by The Nurse led diabetes program, multidiscipline approach, and community relationship.


Mae-Moh Power Plant and Mae-Moh Lignite Mine may cause adverse environmental and health
effects. However, currently, there is no surveillance system to monitor the effects on the health of people
living near the power plant. This study is aimed at identifying indicators and studying the health impacts
in order to monitor the health status of people living near the power plant. The mining and power plant
processes were reviewed, together with their related pollutants and the possible health impacts of each
substance. A study on the health effects of people living near the power plant was reviewed. Practical
health indicators and a research methodology were suggested and reviewed by an expert and stakeholder.
It was found that these Mae-Moh facilities might produce several health hazards, including air pollutants,
water pollution, noise, accidents and other nuisances. The health indicators that should be monitored are:
(1) emergency room visits, (2) hospital visits and the services requested, (3) mortality monitoring, (4)
pulmonary function of school children, (5) lung function of adults with respiratory problems, (6) chronic
obstructive pulmonary disease cases, (7) pneumoconiosis among mine worker, and (8) stress and annoyance
due to the environmental problems.


Obesity is a global epidemic affecting both the developed and developing worlds alike. Overweight
and obesity has also been found to be on the rise among Thailand’s male and female population. More-over, they are considered as a leading health risk factor in the Thai population. Tackling overweight and
obesity in Thailand has lead to the formation of the Resolution on Managing Overweight and Obesity,
which has finally been endorsed by the National Health Commission, and was also approved by the
Cabinet in 2010 as part of the Thai national agenda. Meanwhile, the Office of the National Economic and
Social Development Board (NESDB) developed the 11th National Economic and Social Development Plan
as a strategy for national development over the next five years. The aim of this study is to analyze the
consistency between the Resolution and the 11th Five-Year Plan. The results of the study will be useful in
formulating the National Action Plan for overweight and obesity, as well as in reflecting the drafting and
approval process of the 11th Plan.
Comparatively, the key approach for the development of the 11th Plan focuses on an individual-level
defensive approach, such as the promotion of education among the Thai population. The Resolution
focuses not only on a defensive approach, but also on an offensive approach, with a wide array of regulatory
interventions, such as tax, pricing, nutrition and food labeling, and food marketing restrictions. The
strategies of the 11th Plan, for example, trade liberalization, discourage regulatory interventions for curbing
overweight and obesity. Unhealthy foods have increasing access to the market. Although preventive
approaches that would affect trade agreements and trade liberalization are proposed, they would be implemented
after these foods access markets. It seems clear from the literature that the international trade
issues need to be considered in the context of public health, including improving diets and health education.
The implementation of both defensive and offensive approaches, for example, the promotion of
education through food and nutrition labeling interventions, may increase the effectiveness of efforts to
improve healthy behaviors among the population.


This study examined the efficiency of resource use in Thailand’s three health insurance schemes:
Universal Coverage (UC), Social Security Scheme (SSS), and Civil Servant Medical Benefit Scheme (CSMBS).
It analyzes the length of stay (LOS) in hospital and early readmission rate in diabetes mellitus (DM) patients,
using as a tracer for efficiency the use of resources and the quality of services, respectively. The
data came from the claims that hospitals servicing all three major health insurance schemes have to send
for reimbursement. The aim of the analysis was to compare the effects of the insurance schemes and other
factors on resource use, LOS as a proxy for resource use, and on quality as proxied by the readmission rate
within 30 days after discharge. The analysis compares three conditions of DM requiring hospital admission:
acute complications, chronic complications, and DM without complication, to prove that there were
no differences in the quality of service in patients’ condition, especially the acute complication condition.
The study found that CSMBS patients had longer LOS than UC and SSS patients. This implied the
efficient use of resources by patients of SSS and UC compared with those covered by CSMBS. However,
SSS patients showed no difference in early readmission within 30 days after discharge, while UC patients
had a higher rate of readmission in chronic DM and without the complication condition.


This cross-sectional descriptive study was aimed at determining the prevalence rate and related
factors of musculoskeletal disorders in sugarcane workers of Baan Meng subdistrict, Nong Rua District,
Khon Kaen Province. The data were collected in the period from April to May 2009 by interviews; they
were modified using Worksheet “A” and Worksheet “B” MSI risk factor identification of the Workers’
Compensation Board of British Columbia, Nordic Musculoskeletal Questionnaire, and the musculoskeletal
disorders questionnaire devised by Somkiat Siriratanaphruek MD, PhD. All 219 sugarcane workers in
Baan Meng subdistrict were randomly selected. The prevalence rate of musculoskeletal disorders in the
sugarcane workers over the previous 12 months was 72.6 percent. Factors significantly related to musculoskeletal
disorders were maintenance work, extending arms away from the body for at least two hours
per day and working with repetitive movement for at least two hours per day. The authors recommend
that these practical surveillance guidelines be developed and provided to the governmental agencies concerned
in order to prevent such musculoskeletal disorders in sugarcane workers.


Purpose        : The  study  was to  identify  the  general  characteristics of  herbal  healers in  the         north-eastern of Thailand and the many types of herbal which were use by herbal healers who  treat patients and observed a sign of diseases or symptoms of diseases.
 Methods       : The study was designed to be a descriptive survey. The sample consists of 43 herbal healers with more than 10 years experience from 13 provinces in the north-eastern of Thailand. In depth an interview were used to collecting data and was substantiated through observations.
 Results         : It was found that the herbal healers incomes based on  treating diseases with herbs. The healers were allocated into one of four categories : amateur, semi-professional, professional, and expert. Herbal healers were able to treat 33types of disease or symptoms using one or more of 99 active formulas.   Herbal healers apply two concepts for the treatment of diseases to :
                              1.To stimulate or suppress human physiological response mechanisms such as vomiting, laxative, cathartic concretions in sweat, diuretic and pustules, This concept was based on the belief that these responses were to eliminate toxins and to drive out toxins,  or to absorb toxins form out of the body. The many conditions that were treated by methods. To apply this concept, for example, dog bite (by both a rabid and non-rabid dog).
                             2.To treat the symptoms and to cure illness and disease. Under this concept the herbal healer had no expectations concerning the physiological response to the herbal medicine. The same as the concept one, the patients had those signs and system that they would treat it as complication.  There were many symptoms and diseases that the herbal healers treating to use this concept, for example, herbal medicine code Pharm.001 was used to treat CA liver, AIDS,  etc.
Conclusion      : The formulas of herbal medicine were found in this study can not be used to represent all the herbal remedies which were found in the north-eastern of Thailand. However, the concept was used in the treatment of disease by professional and expert herbal healers. It is consistent through out the region


This study was conducted to investigate the ideal characteristics of husbands from the perspective of married women before and after marriage. Participants were 228 first-time married Thai women, aged
25-40 years, residing in Bangkok. All paticipants married Thai husbands and were issued legal marriage
licenses. They were categorized into three groups: (1) women married < 3 years (n = 00); (2) women
married for 3 to 5 years (n=54), and (3) women married more than 5 years (n=00). The survey employed
a questionaire for gathering information regarding the ideal characteristics of husbands.
Findings:
1. Among the top five ideal characteristics of husbands that the married women in all three groups
emphasized before and after marriage were (1) honesty/fidelity; (2) love, care, and understanding; and
(3) attention and care of family members.
2. After marriage, the ideal characteristics of husbands that were significantly less important before
marriage were as follows:
- Women married less than 3 years showed less concern about (1) looks; (2) figure; (3) physical
appearance; (4) manners, and (5) singles status;
- Women married 3 - 5 years showed less concern about (1) looks; (2) figure; (3) physical appearance;
(4) attractiveness; and (5) single status;
- Women married more than 5 years showed less concern about (1) looks; and (2) figure.
3. After marriage, the ideal characteristics of husbands that were significantly more important than
before marriage were as follows:
- Women married less than 3 years showed more concern about (1) looks and industriousness
toward work; and (2) occupation;
- Women married 3 - 5 years showed more concern about (1) Attention to and care of family
members;
- Women married more than 5 years did not show more concern about any characteristic.
4. After marriage, the ideal characteristcs of husbands that had not changed from before marriage in
all groups of married women were listed in descending order: (1) love, care, and understanding; (2) honesty/
fidelity; (3) general personality; (4) emotional stability; (5) relationship with husband’s family; (6)
self-responsibility; (7) morality; (8) relationship with wife’s family; (9) intelligence; (10) financial status;
(11) education; (12) age; (13) social status; (14) sexual activity; (15) leisure activity; and (16) virginity