Tuberculosis (TB) is a global health problem. It not only causes disease burden measured by combining the years of life lost due to premature death and years of life lost due to time lived in state of less than full health, but also results in economic burden. In 2015, the World Health Organization classified Thailand as one of 14 countries on all three “high burden country” (HBC) lists: tuberculosis (TB), multidrug-resistant tuberculosis (MDR-TB), and TB/HIV. Based on recent estimates made by the WHO, Thailand had 119,000 new TB patients in 2016, equivalent to an incidence rate of 172 per 100,000 population. This rate is more than 50 times higher than those in developed countries and is the cause of death for up to 12,500 people per year (1). Artificial intelligence (AI) algorithms can be trained to recognize tuberculosis-related abnormalities on chest radiographs. This study aims to develop deep learning model to classify tuberculosis related chest radiographs using data from the national tuberculosis program. Method: We collected chest radiographs from the active TB screening project of the national tuberculosis program. Then, expert chest radiologists reviewed and classified images into one of six categories according to the standard recommendation for reporting chest radiograph for TB screening from the royal college of radiology of Thailand. Next, we developed deep learning model from this dataset. Conclusion: In the first part, we collected and classified 80,086 chest radiographs according to the study protocol. In the second part, we successfully developed deep learning model to classify TB related or non-TB related chest radiographs with AUC of 0.94.


Non-communicable diseases (NCDs) are major health problems in the working-age population. As the workplace health promotion (WHP) plays a crucial role in reaching this group, the measures for the WHP need to be implemented. This project aims to review literature and gain stakeholders’ perspectives in order to synthesize policy recommendations. The mixed methods had been used, including literature review and stakeholder interviews using the Delphi technique. The literature review was carried out in 5 different topics: 1) policies and legislation, 2) behavioral economics and social science theories, 3) Information system and applications supporting lifestyle modification (LSM), 4) personal data protection laws, and 5) comparison of WHP packages (the results of studies in topic 2, 3, 4, and 5 will be published elsewhere). Fifteen stakeholders including representatives from units in the Ministry of Labour, employers, and employees were interviewed twice. The policies and legislation which provide opportunities for WHP were categorized into 4 groups: 1) health insurance scheme, especially Social Security Scheme (SSS), 2) welfare and quality of life, 3) control, diagnosis, and compensation for work-related illnesses or injuries, and 4) control of risk factors of NCDs in the workplace. Stakeholders had agreed upon most of the proposed recommendations to amend the legislation regarding group 1, 2, and 3, except in reducing working hours. These proposed amendments can be implemented immediately through the Ministry’s efforts. The proposed amendments to the legislation to provide the opportunities for the WHP are: 1) To include the LSM consultation in the health benefit package There is a proposal to clearly incorporate the LSM consultation to adjust health behaviors in the National Health Security Act B.E. 2545 (2002). 2) To include the SSS reimbursement in the first aid room service The National Social Security Act B.E. 2558 (2015) Section 24 indicates that the insured shall have the right to receive compensation when they experience dangers or illnesses as well as receiving health support and preventive care. In addition, the document attached to the Act indicates that hospitals shall collect health information to analyze the health problems of the insured in order to create health and preventive care plans for the insured, and inform the insured, Social Security Office, and the employers to be aware of the health problems in the establishments. 3) To provide health-promoting environment in the workplace The Ministerial Regulation B.E. 2548 (2005)regarding the welfare arrangement in the workplace indicates that the establishments must provide the environment which promotes health and wellness such as installing signs to encourage the use of stairs instead of elevators, building outdoor and indoor walkways, having more healthy dishes in cafeteria alongside with providing knowledge about nutrition for employees. 4) To expand the role of healthcare personnel in the first aid room to be able to provide LSM consultation The Labour Protection Act B.E. 2541 (1998) broadens chances to upgrade the role of healthcare personnel in the first aid room, allowing them to take part in providing healthcare consultation to adjust health behaviors. 5) To expand the role of the safety committee to include WHP According to the Safety, Occupational Health, and Environment at Work Act B.E. 2554 (2011), the role of the safety committee should be expanded to include the health promotion of employees, based on the concept of integrated health protection and health promotion for workers’ health which is globally recognized for the better outcome than separate operations. 6) To include illnesses caused by long working hours in occupational diseases and diseases covered by SSS Adding illnesses caused by long working hours into the list of work-related or occupational diseases will emphasize the importance of health problems and facilitate disease diagnosis which can lead to preventive and controlling measures in the future.


The research purpose was to explore the lessons learned of COVID-19 patients journey in providing health care Services in health region 9. Data were collected using mixed methods, starting with a qualitative methodology and supplemented by a quantitative methodology. The sample groups in qualitative research were health care providers and health service recipients selected using purposive sampling: director of the Bureau of Communicable Disease Control, director of the 9th Public Health Region, hospital director, deputy director of Medical Affairs, head of Nursing Mission Group, group head director of Tambon Health Promoting Hospital by choosing two persons per group, a total of 12 persons: plus selecting six persons from each group of doctors, nurses, health workers, EMS, EMT, and health service volunteers from the top two areas of each province in the 9th Public Health Region with the high covid infection: and twenty health service recipients who experienced receiving health care services and recovering from Covid-19. The instrument used was an interview from the sample group in quantitative research who were the health care providers at both administrator and operational levels and health service recipients by purposive sampling, 384 persons per group. Data were analyzed using descriptive statistics, frequency, percentage, mean, and standard deviation, content analysis, and COVID -19 patients journey in providing health care Services in health region 9. The results of the study were as follows: 1) The perception of information from the public health unit for use in family and community disease prevention found the main issues as follows; (1.1) Promotion strategies, the perception of information from public health agencies for preventing diseases in families and communities consisted of the use of digital technology, direct communication with the public, forward authoritative documentation from governments, community leaders and health volunteers knock on the door, and Covid-19 Information Center (1.2) Build awareness of information for sustainable disease prevention, create an understanding not to panic but to be aware, promote knowledge, competence, self-care, creating awareness of information correctly, and creating responsibility for a new norm of life; 2) Access to the first point of receiving health services for patients with Covid-19 infection, operates services in a proactive and reactive form through an integrated network of government, local and private sectors, transferring patients to hometown, proactive in the area, receive health care services at the first pick-up point of the nearest hospital, and receive health services through the call center; 3) Assessment and detection of pathogens of patients with Covid-19 infection, two main types of assessment were carried out for pathogens: Antigen Test Kit (ATK) and RT-PCR, ATK test for initial screening, Confirmation of COVID-19 infection with RT-PCR at provincial hospitals or districts that have only RT-PCR machines, the journey of receiving the Covid-19 testing service is the respiratory clinic, visiting the area to check in the community and referral for infection detection at network hospitals; 4) Receiving care from medical and public health personnel for patients with Covid-19 infection in compliance with the guidelines of the Medical Department; The first wave were hospitalized, and the second wave were divided according to the severity of the disease; 5) Planning for patient discharge to go home follow by providing care information, coordination, referral, preparation of patients and their relatives, and community preparation 6) Ongoing care at home for patients with Covid-19 infection visit in the area public health volunteers follow up to visit areas of responsibility. Local authorities are responsible for the service. Factors contributing to the health services received for patients with Covid-19 infection from the perspective of service providers found that the social media usage like line, facebook, website, were at the highest level (mean = 4.34; SD = .683). Followed by initial screening with Antigen Test Kit or ATK (mean = 4.28; SD = .718), and RT-PCR verified for high-risk groups (mean = 4.25; SD = .722). Obstacle factors of receiving health services for patients with Covid-19 infection from the perspective of service providers reveal that the multi-step process of transmitting information was at the highest level (mean = 3.65; SD = .830). Receiving unfiltered data from social media (mean = 3.65; SD = .931) and receiving rumors from neighbors (mean = 3.56; SD = .918), respectively. Factors contributing to the reception of health services for patients with Covid-19 infection from the service recipients’ perspective like Line, Facebook, and websites were at the highest level (mean = 4.27; SD = .763). Followed by having the patient take a fever test, high blood pressure, and oxygen send information about symptoms during treatment to the staff as scheduled (mean = 4.23; SD = .762). Initial screening with Antigen Test Kit (ATK) (mean = 4.22; SD = .791). RT-PCR assays for high-risk groups (mean = 4.22; SD = .783) and compliance with the Covid-19 treatment guidelines of the Department of Medical Services (mean = 4.22; SD = .798). Obstacle factors receiving health services for patients with Covid-19 infection in the view of the service recipient overall revealed that the multi-step process of information transmission was at the highest level (mean = 3.73; SD = .907). A limited number of personnel to provide health services at the first point of admission (mean = 3.66; SD = .986). The process to access health services is a multi-step process (mean = 3.63; SD = .944). Getting unfiltered information from social media (mean = 3.63; SD = 1.042) and having limited skills in using technology to access and receive news (mean = 3.63; SD = .990), respectively. The results recommended that (1) health services during the Covid-19 epidemic situation should use digital technology to assist in service dimensions of promotion, prevention, treatment, and rehabilitation: (2) There should be an integrated government network with the private and local operation; and (3) Supporting the use of ATK initial screening kits and enhancing health literacy, and creating responsibility for a new norm of life and sustainable lifestyle for the people.


Objective: To assess the cost-utility and budget impact of transcatheter aortic valve implantation (TAVI) compared with surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis Methods: A hybrid model between decision tree and Markov model was used to compare TAVI and SAVR in 2 groups of patients with severe aortic stenosis, intermediate and high surgical risks. The societal perspective was taken into consideration; therefore, direct medical costs and direct non-medical costs were included. Direct medical costs comprised of costs of surgery, operation and complications (both outpatient and inpatient costs). Direct non-medical costs comprised of costs of transportation, accommodation, food, and caregiver. Those costs were collected either from electronic hospital databases or from patients’ interview of 5 hospitals (Siriraj, Chulalongkorn, Maharaj Nakorn Chiang Mai, Prince of Songkla, and Ramathibodi hospitals). Utility data were also directly collected from patients who visited above 5 hospitals. Probability data were obtained from literature review. Outcomes were measured in terms of life year and quality-adjusted life-year (QALY). All costs and outcomes were discounted with an annual discount rate of 3%. Incremental cost-effectiveness ratio (ICER) was estimated. A variety of sensitivity analyses such as deterministic sensitivity analyses (one-way sensitivity analysis, threshold analysis, scenario analysis), and probabilistic sensitivity analysis were performed. Budget impact analysis was also conducted based on the data from literature review and epidemiological data in Thailand. A scenario of no TAVI used (85%) versus TAVI used (15%) for treating severe aortic stenosis treatment was analyzed in base-case analysis. Sensitivity analyses were also performed by 5% increase in TAVI uptake each year, and the reduction in TAVI cost. Results: The base-case results showed that life-time total cost of TAVI and SAVR were 1,717,132 THB and 893,524 THB, respectively, while the QALYs were 4.88 years for TAVI and 3.98 years for SAVR. This yielded the estimated ICER of 906,937 THB per QALY for patients with intermediate risk. In case of patients with high risk, life-time total cost was 1,551,895 THB for TAVI and 548,438 THB for SAVR, while the QALYs were 3.15 years for TAVI and 2.31 years for SAVR. This yielded the estimated ICER of 1,196,191 THB per QALY. Comparing with the ceiling ratio of 160,000 THB per QALY, TAVI was not a cost-effective treatment for both groups with intermediate and high risks. The chance of TAVI being cost-effective would increase with higher level of the willingness to pay. In addition, TAVI valve was the most influential factor on the estimated ICER. The ICER was declined to 160,000 THB per QALY when the reduction in cost of TAVI valve was about 63.5% with the remaining cost of 390,583 THB and 81.3% with the remaining cost of 199,655 THB for patients with intermediate and high risks, respectively. The base-case results of budget impact analysis showed that the net budget impact (NBI) on average was 136,561,166 THB per year. The NBI would increase to 171,119,480 THB per year and 196,391,442 THB per year with an increase in TAVI uptake of 5% per year and 10% per year, respectively. The extension of TAVI treatment to the population aged 70 years and older increased the NBI to 403,008,823 THB per year for constant TAVI use of 15%. An increase in the TAVI uptake rate of 5% and 10% per year results in the NBI of 504,994,664 THB per year and 579,575,337 THB per year, respectively. The NBI would decline depending on the cost of TAVI valv. With the cost of TAVI valve of 470,069 THB (reduction by 60%), the NBI was decreased to 38,727,267 THB per year, 47,890,464 THB per year, and 54,366,994 THB per year when the TAVI use was 15% constant, or 5% yearly increase, or 10% yearly increase, respectively. Conclusion: The findings of the study indicated that TAVI is not a cost-effective technology at the ceiling ratio of 160,000 THB per QALY. The high cost of TAVI valve is of great important factor. Therefore, it needs several strategic mechanisms such as price negotiation, appropriate patient selection because TAVI is a life saving for severe aortic stenosis patients who are inoperable or have high risk for operation.


The coronavirus disease 2019 (COVID-19) pandemic have an impact on healthcare systems. A Mixed method study was used to explore 1) situation analysis of COVID-19 pandemic in Bangkok and metropolitan region 2) health system management COVID-19, problems and obstacles 3) lessons learned from the management of COVID-19 pandemic and 4) policy synthesis for the tertiary health service systems in COVID-19 pandemic in Bangkok and metropolitan region. Data were collected during from week 14 to week 54 in 2021. Quantitative data were collected from Co-lab and Co-ward. Qualitative data were collected by in-depth interview and focus group discussion. 126 purposive participants were conducted from hospital administrators or hospital representative, assessors, and multidisciplinary team in health care services. Descriptive statistics were used for quantitative data and content analysis were used for qualitative data. The results show that: 1. The situation analysis of COVID-19 pandemic in Bangkok and metropolitan region, the highest infected rate in Bangkok were found in week 32 (14,373 person/week or average number 2,053 person/day). Similarly, in metropolitan region, 183,558 infected persons reported on week 32. The highest infected persons reported on Nonthaburi, Samut Prakan and Samut Sakhon (54,998, 34,499 and 30,373 respectively). The registered hospital bed in Thailand were 154,942 beds, the bed capacity in Bangkok were reported 14.28 % and total bed capacity in Bangkok and metropolitan region addressed 23.01% of registered hospital bed. 2. The health system management COVID-19, problems and obstacles in Bangkok and metropolitan region, 2.1 service delivery: The hospitals adapted healthcare services under the concept of Incident Command System (ICS) in response to public health emergencies. Moreover, they modified some places to support many infected patients, postponed non-covid and non-emergency cases, developed clinical practice guideline, and making change in working methods follow the dynamic of situation. The participants reported service delivery barriers such as no service coverage during high infected rate, limited expertise due to emerging disease, people more afraid of catching COVID-19, non-collaboration between organizations across different sectors, lack of unity, and limited quality services. 2.2 health workforce: The hospitals reduced workload for responding to COVID-19, pooled the workforce, and managing appropriate role. In addition, developed competencies of healthcare providers, ensuring health care professionals safety, and providing reward. The informants reported health workforce barriers for example work overload and lack of health workforce during high infected rate, and fear during the first outbreak of COVID-19 pandemic 2.3 Information: The COVID-19 pandemic required health information systems (HIS) to report healthcare service, and disbursement record from National Health Security Office system. Furthermore, they needed to communicate with people and Covid patients. The participants reported information barriers such as the difficult to use and collapsed central health information system record from Ministry of Public Health, no linkage between health information system, incorrect data, unclear message, Wi-Fi problem. 2.4 Medical products, vaccines & technologies: The hospital adapted medical products, vaccines and technologies system by distribute medical products, accelerating access to vaccines, applied essential medical device, and developing innovations and technologies in health care services. The participants reported barriers to shortage and high price of medical products, medicine, and vaccines due to COVID-19 outbreak, coverage of distribution, and poor-quality. 2.5 Financing: The hospitals used budget of the hospital, special budget, disbursement from NHSO, and donation to fight against Covid-19. The financing barriers addressed unclear disbursement system, and limitation of disbursement. 2.6 leadership and governance: The leaders of team make a good, fast decisions, doing role model of hard work, co-operating, controlling and consulting management team, daring to switch new job, changed mindset, and good governance. However, the participants mentioned about without unity of command as the barriers in Bangkok hospitals. 3. The lessons learned from the management of COVID-19 pandemic in the tertiary health service systems, the key success factors to fight against COVID-19 lies in how to deal with COVID-19, learning and working together, taking advantage of working hard, Thai helping each other, crisis is an opportunity, and academic advising resources in response to COVID-19. 4. Policy synthesis for the tertiary health service systems in COVID-19 pandemic in Bangkok and metropolitan region, given that we now know the importance of revised Incident Command System for Disaster Preparedness with unity of command, developed data information system, and revised stock and allocation system of medical product, should be expected to provide resources to help support health service systems in COVID-19.


This qualitative study employed a phenomenological approach and aimed to understand experiences towards HIV/AIDS medical and nursing service during the COVID-19 pandemic among people living with HIV (PLHIV), and healthcare providers. This study also explored medical and nursing service model of HIV/AIDS follow-up during the COVID-19 pandemic. Narrative interview and group interviews were conducted among 34 participants (14 health providers (nurses, pharmacists, and public health workers), 14 PLHIV, and 6 physicians) from April 2021 to February 2022 in the hospitals of the 5th health service region, Thailand. Interviews were audio-recorded, transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis The finding was showed medical treatment in HIV-AIDS patients before the COVID-19 epidemic period. These are included a medical treatment plan in the hospital and an Out-of-hospital care plans. A medical treatment plan in the hospital is a primarily assessed from the patient's symptoms which are included patient who has an unstable or uncontrol symptoms and require a close supervision for further assessment. In addition, patients who need a follow-up appointments or clinical visits should be assessed for a period of time, such as physical examination, blood tests and other necessity examinations. An Out-of-hospital care plan is a treatment that joint decision between service providers and patient and focused in patient centered care. The finding was showed medical treatment in HIV-AIDS patients in the COVID-19 epidemic period. The result revealed that there were three primary themes, including: (1) new normal in HIV/AIDS medical and nursing service during the COVID-19 pandemic, (2) participative management of HIV/AIDS medical and nursing service during the COVID-19, and (3) factors contributing to succeed of HIV/AIDS medical and nursing service delivery. In theme 1, interview data revealed four subthemes pertaining to new normal of HIV/AIDS medical and nursing service during the COVID-19 pandemic: (1) reducing HIV/AIDS medical and nursing service step, (2) rotation of PLHIV group service, (3) using alternative methods to get medications during the COVID-19 pandemic, and (4) modification of HIV/AIDS medical and nursing service environment. During the COVID-19 pandemic, the participants stated that their quality of life has not changed. Additionally, the COVID-19 prevention measures (i.e., wearing face mask, hand washing, and avoiding crowded places) were extremely practiced. In theme 2, interview data demonstrated two subthemes regarding participative management of HIV/AIDS medical and nursing service during the COVID-19: (1) communication within the organization to reach mutual understanding, and (2) networking. In theme 3, interview data demonstrated three subthemes regarding factors contributing to succeed of HIV/AIDS medical and nursing service delivery: (1) effort of team members to deliver excellent service, (2) administrator’s support, and (3) awareness of self-management among clients. This study provides a backdrop for the implementation of nursing interventions that will be designed to reshape flexible medical and nursing service for Thai PLHIV during the COVID-19 pandemic.


The purpose of this research is to synthesis policy recommendations for management of the health service system at the tertiary level in North-East of Thailand in order to support the critical epidemic of COVID-19. This research was conducted between September 2021 and February 2022. Four provinces in the public health region 7,8,9 and 10 namely Khon Kaen, Udon Thani, Surin and Ubon Ratchathani were stratified selected. Mix-methods was adopted based upon the Health Care Capacity indicator and six-building blocks together with policies and regulations issued by the Emergency Decree on Public Administration in Emergency Situations and other related measures. The participants were purposively recruited through administrators at a public health region, provinces, hospitals, COVID-19 committees, health professional and responsible for environmental work of Tertiary hospitals within four provinces, and secondary key informants were a group of stakeholders. The research instrument was the health service management assessment form, in-depth interview, focus group, lesson learn form, and relevant document record form. Quantitative data were analyzed by statistical percentage, mean. Qualitative data were analyzed by content analysis. Each interview was digitally recorded, and the data from the interviews were analysed using Nvivo. The findings revealed ten policy recommendations covering ten issues for public sector organizations as follows: 1) A clear policies and utilization are needed; 2) considering a framework for expanding health professionals; 3) developing a large-scale centralized database system and connecting the use of sharing-data network with public health sectors; 4) establishing a public health region as a juristic person for the development and flexible service; 5) providing training programs to continuously upskill personnel's potential; 6) having a committee to consider the risk compensation of health professionals working during COVID-19 with all health sectors covered by a good moral and fairness and equality 7) Providing clear and accurate information and having public relations which covering target groups and easy to access 8) establishing guidelines for vaccine administration management in accordance with the context and having a committee to consider the compensational payment 9) all hospitals should have the resources planning with an effective strategy, and 10) having a clear organized-screening and health service standards in all public health sectors which participate in raising awareness of people's self-management. This will result in the management system for the management of the health service system at tertiary level to support the outbreak of the COVID-19 crisis in the future.


This research aims to understand and uncover experiences, thoughts and practices of the 5 groups of people in dealing with COVID-19 includes (1) executives and policy makers (2) medical and public health officers (3) disease control workers (4) poor and disadvantaged people and (5) civil people and journalists. This study used both qualitative and quantitative research methodology. Conducting in-depth interviews with 148 people and use an online questionnaire to get the data from 555 samples. Information from social media and online documents are also collected. From March to November 2021 is the period of data collecting. This study uses anthropological perspectives to suggest that the COVID-1 9 crisis is syndemics that inseparably related to unequal society, economy, politics and human life. The 5 chapters of this research are: (1) recording important events of the COVID-1 9 outbreak in Thailand, which is divided into 5 periods. (2) a study of the experiences of 5 target groups. (3) lessons in the work of various organizations in the COVID-19 crisis. (4) an analysis of social science knowledge in an pandemic situation. (5) conclusions and policy recommendations. The four key findings are: (1) the Thai state uses medical, economic and governance knowledge that leads to a centralized command system and controls people in the same inflexible regulation. The Thai state does not understand the different changing socio-cultural contexts found in local areas and communities. Government solutions do not meet the needs of the people. Social science knowledge disappears from the Thai state policy-making that reproduces and expands structural violence in which the disadvantaged people are damaged. (2) failed coordination between government agencies, civil organizations and the private sectors can be found in every local communities. Government officials do not plan for effective work and change practices over time. This problem is the source of conflicts. Another important problem is that there are a poor welfare and caring for medical and public health workers. (3) people distrust in the government because of their inefficient work and error decision making. The Thai government fail to give public enough and clear information but give privileges to some people. This problem leads to the people protests and calling for the government resign. (4) there have been several unexpected consequences in government policy. Particularly, the lockdown and the close of various businesses that affects many people who work in the informal sector. Policy recommendations are outlined in the final chapter for government agencies to take account in solving the pandemic in the future.


The considerable care for youths with substance abuse in recovering phase is enhancing resilience, cultivate life immunity in order for relapse prevention. This quasi-experimental study was to examine the effectiveness of Acceptance Commitment Group Therapy on resilience and intention to drug abstinence among youths with amphetamine abuse. One hundred youths from the rehabilitation treatment at Wiwatphonlamuang School, Thai Royal Navy in Chonburi Province, Thailand were recruited and randomly selected to participate in experimental group and control group. Fifty participants in the experimental group participated the Acceptance and Commitment Group Therapy for cultivating resilience and intention to drug abstinence, and both experimental and control group attended the routine psychosocial rehabilitation program. The group therapy was carried on twice a week for 4 weeks. The resilience and Intention to drug abstinence questionnaires were applied for data collection before and after participation, then four weeks follow up. Descriptive statistics and Two-way repeated measurement ANOVA were used for data analysis. The results revealed as follows: 1. The mean scores of resilience in experimental group were higher than control group at post-test and 1-month follow-up were significantly different at .001 2. In experimental group, the mean scores of resiliance at pre-test and 1 month follow up were significantly different at .05 and 3. The mean scores of intention to drug abstienance in experimental group were higher than control group at post-test and 1-month follow-up were significantly different at .05 The results suggest that nurses and health care providers could apply this program to promote resilience and intention to drug abstinence in youth with substance abuse. This therapy will be an alternative treatment for both health personnel and those who work in the drug treatment and rehabilitation facilities. Those personnel can employ the body of knowledge to develop and improve their drug treatment skills.


This research aims to develop the knowledge about problem situations, causes and guidelines for driving social change. at the goal of creating a supportive society do not abandon each other through a series of research on target groups, areas or issues by creating quality academic work can bring the results into action to solve the problems of vulnerable groups and develop an effective health system that responds to all people and to develop the potential of researchers and people working in complex and difficult-to-reach marginalized populations through the development of methodological knowledge A new kind of training focused on real-world operations. and connection Seek cooperation between partners, networks, both from higher education institutions in the country. and abroad Public organizations, government agencies, NGOs Driving social change by developing a management system for the Center of Excellence to be the center of academic work for vulnerable groups and is a center for disseminating various information by creating a public communication space to drive policy and research strategies for vulnerable groups that can be put into action. aiming to create a society that does not leave each other at various levels, both at the policy level and the area The results showed that Reviewing family knowledge for a database Knowledge and understanding of family conditions in the context of Thai society that are facing It is such a study that will lead to seeing the "family" in the dimensions and surrounding context. To support the drive to solve the problem of social vulnerability situation. and understanding technology issues in the future world There will be a connection with human beings in terms of rights. The fairness that will occur is different for many levels of people. While the study of access to health systems among vulnerable populations both children and adults It is a study of both the body of knowledge about the complexity of the problem of social inequality and related dimensions in economic, social and political aspects. It has been found that inaccessibility of public health services is an important factor that must be addressed in the mechanism of both in the system and outside the system The research hence contains summary and policy proposals, 1) Work should be developed in the dimension of knowledge development concerning the complexity of social inequality problems. both in terms of situations Causative factors and contextual conditions in various dimensions and levels, and solutions at both the operational level and the structural or policy level. 2) Developing the potential of workers is important Because it is a solution that leads to the development of people in the mechanism of work both in the system and outside. Ready to drive work that is difficult and complex effectively 3) Should create a prototype area to perform specific problems. Based on the knowledge developed and networking at all levels from policy to community which will lead to driving for change in the future.


This research aims to study families in Thai society from the historic to the modern period and take a look at policies, measures, mechanisms, and methods to strengthen the foundation of families and presents possible means to improve the healthy life of vulnerable families in Thai society through public debates with related parties and experts and revision of relevant documents. The research shows that 1) The vulnerable families, or the target group, are unprepared for the collective lifestyle as a family and other factors unrelated to age as individuals, regardless of their age, could face difficulties in having a family, 2) The target group lacks comprehension on a concept of family and how to conform with such kind of relationships and do not realize own’s duties to bring the family together as a whole, 3) People in charge lacks supportive system, tools, or methods to help them set goals or adapt to work together; each section works separately toward their specific goals without communication or cooperation, 4) The importance of family is neglected causing the family to be excluded from any development plans or national policies, 5) Without coordination, the gap of interpretations on ambiguous policies leads to unorganized work and demotivates unity. This research summarizes and presents the following policy proposals; 1) Family crisis can be solved with logic and vision expansive enough to help recognize family crisis as a systematic crisis caused by multiple factors and dimensions with complexity. It is the reflection on the mainstream development which emphasizes materialization exchanged with family failures, social regression, and moral decline. It is the development that destroys the mind, family, and society as it drives people to go out into fierce competition for materials and money. Resources are spent on “country development” while they should be used to expand the prosperity of children and families., 2) To solve the family crisis, it is essential to see the importance of families as a foundation of future sustainability and security of the society and the country. The health of families fluctuates with each and every government policy, especially economic, academic, social, and labor policies. Therefore, we should recognize the healthy life of families and children as an ultimate goal of the nation.


This research aims to develop a concept and basic framework for research regarding a topic of artificial intelligence technology, and health and social equity; and to propose research agendas in response to long-term research on the topic. Data were collected from documents and multi-disciplinary workshops. The documentary data provided a basis for development of a basic conceptual framework regarding artificial intelligence technology, and health and social equity. Subjected to further development based on data from the workshops, the framework was applicable to research agenda analysis. Three workshops were organized comprising a total of 27 experts from the fields of philosophy and ethics in technology, laws, sociology, environment and development, computer science, bio-medical engineering, bio-science, and bio-medical information technology. From the study, a framework was obtained for analyzing issues and research agendas regarding a topic of artificial intelligence technology, and health and social equity. The framework consists of general and management principles. The general principles include respect for human dignity, justice, non-maleficence, and beneficence. The management principles are connected to and serve implementation of the general principles. In addition, the data from the workshops were analyzed through the framework and synthesized to form agendas for long-term research. These agendas are (a) research on factors from human nature and culture influencing equity in digital technology and artificial intelligence; (b) development of citizens' competencies related to digital technology and artificial intelligence; and (c) development of frameworks for policy development and implementation to develop and apply artificial intelligence to promote health equity.


This research aims to probe the health problems and the access to the healthcare system in a sensitive group of citizens in Thailand, as well as to explore and expand the research topics on health and access to the healthcare system in the mentioned group, which could lead to the development of future proposals of policies. This research is composed using mixed methods which are: 1) Citations from documents, articles, and related academic writings, 2) Qualitative research with the information gathered from insightful interviews with taxi drivers in Bangkok and its vicinities, 3) Quantitative research with 300 sets of queries answered by taxi drivers found at several taxi stops, taxi depots, and rest stops in Bangkok and its vicinities, and 4) Public debates with taxi drivers allowing them to voice their opinions and problems for practical development of policies. The research shows that 97.7 percent of the 300 informants are male, and one-third of them aged over 60 years old. They are from 4 major backgrounds: 1) Internal migrants with 80 percent of them migrating from the provinces in the North-East region for many generations, 2) Workers changing jobs, 3) Part-time taxi drivers, and 4) Retired civil servants, which increase in the past years. With their age and the nature of the job that requires them to sit and drive for an average of 10-12 hours per day, most taxi drivers face multiple health problems – with the majority adopting diseases such as hypertension, diabetes, and hyperlipidemia. On the other hand, more than half of them have never had an annual health check and are afflicted with body, knee, or back pain, urinary tract inflammation, and accumulating depression from the traffic, decreasing income, and behaviors of the passengers. For access to healthcare services and other benefits, we found that the majority have the Universal Coverage Scheme (UCS) which is known for its limitation when used outside of the registered domicile. Moreover, the taxi drivers are found to have limited knowledge of healthcare services and lack fundamental benefits such as unemployment funds, insurance, provident funds, or bank credits. With rising competitiveness and disruptions from either taxi applications or the Covid-19 pandemic, they end up having deficits. These lead to bad driving behavior which is followed by customer complaints aggravating the existing systematic problems such as loosening standards, pressuring government policies that demotivate the compliance of their income and expense, particularism, and conflicts of interest. These problems impact the small-time drivers and are the root of the ongoing dissatisfactory services.
The research hence contains summary and policy proposals. In the short-term we should 1) Promote taxi drivers’ access to the healthcare service and provide health screening, 2) Provide public benefits equivalent to the benefits prescribed in Article 33 of Social Security Rights, 3) Establish a central fund and foundation to look over driver registration and benefits with taxi drivers participating as a part of the establishment, and 4) Improve taxi drivers’ skills and knowledge to prepare them for market competition and service disruption. For the long-term proposals, 1) Develop taxi standards, which could be done in various ways whether to set up driver qualifications (having a public driving license, regular car inspection, and an up-to-date certificate, passing performance tests regularly) and enforce legal requirements for the professional certificate and specific driving license as a part of a quality driver screening, 2) Create alternative taxi systems for central government or in Bangkok such as taxis for the senile, disabled people, and other specific groups in addition to the non-developed typical taxi meters with uneducated and old drivers to improve service and income.


This research aims to develop the knowledge about problem situations, causes and guidelines for driving social change. at the goal of creating a supportive society do not abandon each other through a series of research on target groups, areas or issues by creating quality academic work can bring the results into action to solve the problems of vulnerable groups and develop an effective health system that responds to all people and to develop the potential of researchers and people working in complex and difficult-to-reach marginalized populations through the development of methodological knowledge A new kind of training focused on real-world operations. and connection Seek cooperation between partners, networks, both from higher education institutions in the country. and abroad Public organizations, government agencies, NGOs Driving social change by developing a management system for the Center of Excellence to be the center of academic work for vulnerable groups and is a center for disseminating various information by creating a public communication space to drive policy and research strategies for vulnerable groups that can be put into action. aiming to create a society that does not leave each other at various levels, both at the policy level and the area The results showed that Reviewing family knowledge for a database Knowledge and understanding of family conditions in the context of Thai society that are facing It is such a study that will lead to seeing the "family" in the dimensions and surrounding context. To support the drive to solve the problem of social vulnerability situation. and understanding technology issues in the future world There will be a connection with human beings in terms of rights. The fairness that will occur is different for many levels of people. While the study of access to health systems among vulnerable populations both children and adults It is a study of both the body of knowledge about the complexity of the problem of social inequality and related dimensions in economic, social and political aspects. It has been found that inaccessibility of public health services is an important factor that must be addressed in the mechanism of both In the system and outside the system The research hence contains summary and policy proposals, 1) Work should be developed in the dimension of knowledge development concerning the complexity of social inequality problems. both in terms of situations Causative factors and contextual conditions in various dimensions and levels, and solutions at both the operational level and the structural or policy level. 2) Developing the potential of workers is important Because it is a solution that leads to the development of people in the mechanism of work both in the system and outside. Ready to drive work that is difficult and complex effectively 3) Should create a prototype area to perform specific problems. Based on the knowledge developed and networking at all levels from policy to community which will lead to driving for change in the future.


The purposes of this project are 1) to develop the potential and train the knowledge, cognitive skills for working with children and youth, 2) to synthesize the working knowledge of street teachers and vulnerable children, 3) to identify the system constraints, and 4) to push for policy recommendations to address vulnerable children by collecting data on 30 teachers from various organizations throughout the country. Results of this study showed that the problem of vulnerable children, especially tramp children that faces with different problems than most vulnerable children, such as rights to education, rights to medical care, psychiatric problems from domestic violence, sexual harassment issues, and problems of the judicial system, etc. Therefore, the street teachers need to have assistive skills that are consistent with the quality of life of children in all aspects. The development of teachers' potential is to equip with weapons as how to make the work of street teachers to be publicized to others, and will help them when it comes to difficult problems for empowering themselves, as well as in academic dimensions, teachers should understand the complexity of these social conditions and take it for useful, build stability and career path of street teachers amid the hard work of helping vulnerable children. The life of the street teachers was also difficult as same as the children because working with the heart and physical strength requires the support that is like the wind beneath their wings for these teachers. But in facts, the street teachers are in conditions of insecurity at all, including problem of budget issues that are used to fund for working with children, budget for living on their own, and career path of teachers in the future. Therefore, the conclusions and policy recommendations of this project have as follows: 1) how to make mechanisms be recognized and developed into concrete mechanisms for organizations and their respective sectors such as local administration organizations, non-governmental organizations (NGOs), government agencies, and civil society. Moreover, the street teachers and others working like them, should have stable work spaces, having support systems for capacity building and appropriate tools in order to ensure the society will have more efficient and sustainable systems and mechanisms to address the problem of vulnerable children, 2) the development of street teachers is not only the personnel development, but also the need to connect networks to learn from various lessons. Therefore, street teachers shouldn't have to work alone but should be a strong network partners group which will help the work of street teachers are more efficient due to the problem of vulnerable children are associated with many contexts, so it requires cooperation as a support network partner. However, the network partners should take place seriously and continuously, 3) They should focus that initiating the development of street teachers will affect to the recovery, social reintegration and vulnerable children's survival. The group of street teachers is a key that able to reach this group of children the most. Therefore, it is very important to create a process of engagement with local people in order to properly implement preventive and corrective actions, and 4) problem-solving that emphasizes the role of coordinating with the community is another mechanism that street teachers must have a role to play in work integrating among local practitioners then it led to find out the problem-solving that are practical in the area. These are mechanisms of network adaptation in horizontal that will be driven in the prevention and resolution of problems of children and youth in understanding the rapidly changing situation as well as immunization before other problems will arise and able to solve the problem effectively which this will be a guideline to create sustainability in the future.


Religious places are sacred places where people come to perform important religious activities according to their respect and faith. However, this gathering could increase the risk for the transmission of COVID-19 through the respiratory route. In this study, the participatory action research was done in 9 religious places, including Buddhism, Christianity, and Islam, in Mueang and Tha Sala Districts, Nakhon Si Thammarat Province. A total sample of 202 people (from 9 studied places and other extended religious places) was recruited. The results found that religious places changed the form of the prevention of the COVID-19 in different ways during the pandemic. However, measures that all religious places must implement and comply with are the VUCA (Vaccine, Universal Prevention, COVID Free Setting and ATK), DMHTTA (Distancing, Mask Wearing, Hand Washing, Temperature, Testing and Application Thaichana), and environmental health measures. Moreover, when considered in the context of each religion, the developed guideline will include practical recommendations for people in charge of religious places, priests, people, and important religious activities.


Background Thailand was firstly imported SARS-CoV-2 from Travelers from China in January 2020. As COVID-19 has transmitted globally as pandemic to cause more than 500 million cases and 6 million deaths in last 2 years. Emergency disaster measure has been enforced which has impacted to social-economic crisis in most of the countries. Thus, every country redirect effort to modify its disease prevention and control measures to compensate for social and economic downturn. Purposes In the first year of pandemic, surveillance of COVID-19 in Thailand has been constrained by focusing to mobility populations at the screening immigration ports for imported travelers and tested by RT-PCR technic. The surveillance information has been daily reported for public. Thus, the disease control managers at local level would never have sufficient intelligence for planning and adjust intervention measures to facilitate their own community socio-economic resilience. The study aims to modify tests from medical laboratory as biomarkers for monitor rapid genomic variation of SARS-CoV-2; Immunological status of population from both natural infection and variation type of vaccination; as well as effectiveness of each social and public health measures applied to each community. Such intelligence should be strong basis for planning at national as well as local level. Methodology Community from Thungyangdaeng District and Yarang District, Pattani Province has been selected to represent an area-based population which were infected and studied since 2020 as longitudinal cohort study of RT-PCR test and Immunity study for 2 years. The study included the preparatory phase of the 2 community hospitals and teams for collecting information and specimens; conveyance of specimens to central laboratory in Bangkok; modification technic of laboratory procedures to fit with the test requirement; and feedback the analysis to depict the existing epidemic situation of COVID-19 in local area. The immunity status of population will be tested by ELISA. The incidence and prevalence of COVID-19 in community has been estimated from the RT-PCR test and immunological study. Specific T cell Immunity and Cytokines reaction in the populations’ specimens has been study in the Central Lab. Throat gargle from the population has been tested through Mass Spectrometry to identify protein of SARS-CoV-2 in the central lab as well. Literature review have been conducted to study the evolution of COVID-19 Surveillance and Monitoring system employed in international recommendation and emerging technology for evaluate the situation of local disease control management. These novel technology and systems might be applied to be recommendation to improve the country’s and local level’s COVID-19 surveillance and monitoring systems in Thailand. Result ELISA based Immunological test, Antigen Test Kit (ATK), RT-PCR can be main tools for monitor of Incidence of infection, and sustainable immunology in individual community and at the country level. Specific T cell Immunity and Cytokine Th1 test requires further modification in transportation to Laboratory and adjustment of Lab technic. These 2 tests would be benefit to justification of the duration of immunity and prediction of severity of infection as well as durable prevention of individual and community Immunity. However, Mass Spectrometry has not been well supported for application in Thailand. Systematic surveillance of SARS-CoV-2 and its variants in wastewater may be trialed for sequencing analysis as environment surveillance. Conclusion Modification of 4 tests have been recommended to be feasible to be applied to COVID-19 Surveillance and Monitoring in Thailand. Environmental surveillance (SARS-CoV-2 variants in Wastewater) may be experimented in high-risk area. Definition of systematic COVID-19 surveillance and its strategy and wholistic scope of monitoring in all related sectors in area-based and National level should be established


Since COVID-19 situation in Thailand, there is no research study of the immune responses to SARS-CoV-2 among the active COVID-19 patients and their high-risk closed-contacts individuals. The aim of this project was to study the antibody production (humoral immune responses) and the immune response mediated by T cells (cell-mediated immune responses) specific to SARS-CoV-2. The results of this study can be used as the knowledge for vaccine development for COVID-19 and the production of a monoclonal antibody for the treatment of infection in stead of using plasma-derived antibodies from the convalescent patients. Moreover, this project has evaluated the antibody production in the individuals who received the inactivated vaccine and viral vector vaccine. During that period, most of the Thai population have been vaccinated with the inactivated vaccine. The knowledge of immune responses from the inactivated vaccine is in need and should be studied as fast as possible. The results from this study showed that the best suitable technique for evaluating the immune responses among many participants is the determination of total antibody specific to spike protein by using ELISA assay. Although the detection of neutralizing antibody is better for evaluation of the protection against SARS-CoV-2 infection, this technique is expensive and low in the feasibility in lab. As for the evaluation of T-cell mediated immune responses by using ELISpot assay, this test cannot be used to evaluated T-cell responses in the individuals who received the inactivated vaccine. We found that the determination of T-cell responses among individuals who got infected with SARS-CoV-2 and individuals who received the viral vector vaccine should be stimulated with peptide from nucleoprotein and spike for ELISpot assay, respectively which does not need to use the whole protein for evaluating T-cell responses by this technique. This project provides the information of the seroprevalence among the high-risk closed-contacts individuals but not getting infected by evaluating the antibody production. We found that the seroprevalence rate among these participants is zero. Although they were identified as the closed contact, but they may not get the viral transmission, so they do not have any antigen to stimulate the immune responses. For the evaluation of the kinetics of antibody production in the individuals who received 2 doses of the inactivated vaccine, the results showed that the level of total antibody is significantly decreased after receiving the 2nd dose for a month. This could be used in the policy for providing the booster dose to them since, the gradually decrease in the antibody would not be enough to fight against SARS-CoV-2 transmission. When compared the antibody level to the individuals who received viral vector vaccine, it revealed that the viral vector vaccine is able to stimulate the higher level of antibody than the inactivated vaccine. The output obtained from this study is the knowledge of the immune response to SARS-CoV-2 in the active COVID-19 patients, the closed-contact individuals, individuals receiving the inactivated vaccine and individuals receiving the viral vector vaccine. As for the outcome and the impact, we found that the determination of the total antibody to spike is suitable for using as a test for screening the immune responses to SARS-CoV-2 resulting to the planning of the policy for the prevention of viral transmission and the recommendation for the vaccination. This result could be used for making the decision of the policy involving the prevention of SARS-CoV-2 spreading, for examples, the booster dose of the COVID-19 vaccine should be considered for the individuals who received the inactivated vaccine. In addition, the booster vaccination should be the viral vector vaccine rather than the inactivated vaccine since this study showed that the inactivated vaccine cannot induce T-cell responses and stimulate the lower level of antibody production compared to the viral vector vaccine. This would be the benefit for the policy of effective prevention of SARS-CoV-2 spreading in Thailand. Additionally, this data can be used as the information for vaccine development to prevent or control COVID-19. This project will lead to outcomes and impacts as follows: In the policy terms, the results of this study can be used to make decisions about the COVID-19 situation in Thailand in term of the stringency or easing of policy for preventing the spread of COVID-19 in Thailand. Based on the results of the analysis of immune responses mediated by the antibody production (Humoral immune responses) and T-cell responses. (Cell-mediated immune responses), these results can be used for developing the test kit for COVID-19 or developing the vaccines in the future. Additionally, the results of this study can be used to understand the immune responses against the SARS-CoV-2 infection that causes COVID-19.


The coronavirus disease 2019 (COVID-19) pandemic is a complex, highly dynamic problem with negative impacts on health and socio-economics aspects, both nationally and internationally. In addition to the direct impacts on the health of COVID-19 patients, the pandemic also affected the provision of healthcare services for patients with many other diseases and conditions. Policymakers in Thailand and around the world are trying to take measures to deal with the outbreak to reduce its consequences with two major groups of disease control policies: by general measures (non-pharmaceutical interventions: NPI) and by using drugs or vaccines (on-pharmaceutical interventions: PI). At the beginning of the pandemic there were no drugs or vaccines to control COVID-19. Many countries around the world therefore focus on an enforcement of non-pharmaceutical interventions, such as a ban on travels in and out of the country, limited people going out of residence for certain periods (curfew), the closure of government buildings and the suspension of social and business activities, physical distancing and personal hygiene campaign. Yet, these non-pharmaceutical interventions measures are of limited effectiveness when applied over the long term, and also have serious economic and social impacts. Due to the severity of COVID-19 that affects the health of the infected persons and the limitation of NPIs, agencies around the world, both public and private, have accelerated research studies to develop anti-COVID-19 vaccines. While many vaccines have been developed and proven to be effective in humans, there are still challenges and difficulties in implementing them at the population level. This is because newly developed vaccines need to be certified and allowed before being used for a larger population. There are also limitations in terms of its long-term safety that have not been comprehensively assessed. Some of the vaccines being developed by new technologies that require specialized storage and transportation that may not be suitable for use in many contexts. Lastly, the number of vaccines produced at an early stage is still insufficient to meet both global and national demands. Therefore, without a well-informed policy decision to manage the COVID-19 vaccine supply chain, the policy makers not even achieve the effectiveness of disease control, may cause unnecessary loss of life, and even create health inequity. Not only the COVID-19 pandemic is a complex problem with high dynamics, policy decisions regarding the anti-COVID-19 vaccines are also very complex with uncertain results. We applied systems thinking process to deal with complexities and uncertainties by reviewing the related vaccine literature and conducting system dynamics modeling of the epidemic situations with vaccinating the anti-COVID-19 in Thailand’s populations. Group model building (GMB) process was used to work with policymakers and stakeholders of the COVID-19 vaccine policies. The Susceptible-Exposed-Infectious-Recovered (SEIR) model customarily used for epidemiological forecasting can be modified to build a structure of system dynamics (SD) models that simulated the scenarios emerging from various COVID-19 vaccine policy decisions. The target populations and the prioritization among the target groups were considered when considering which options can lead to the most effectiveness, and with the least unexpected results. We found that the data needed for developing simulation modeling of the anti-COVID-19 vaccines in Thailand had been very limited. But our literature review and consultations with experts led to sufficient data to construct a system dynamics model. We modeled the epidemiological scenarios during the April 2021 outbreak in Thailand, where the vaccines was somewhat effective in preventing infection but only limited supplies of vaccines available domestically, not enough for all population groups. The findings from our simulation model suggested that, deaths would be lower if the policymakers prioritized vaccines to people living in hyperendemic rather than distributing them across the country. Even though empirical evidence suggests that the vulnerable populations had a greater risk of developing severe symptoms and deaths if infected, allocating the vaccines to both the healthy and vulnerable populations can lead to less number of deaths than vaccinating only the vulnerable. As for the results from a situational model during the January 2022 outbreak with Omicron strain, as Thailand started to secure sufficient doses of vaccines yet the vaccines become less effective in preventing COVID-19 infections. This, the policy option of procuring and allocating a booster dose of COVID-19 vaccine to vulnerable populations becomes critical to reducing the COVID-19 case-fatality rate. Lastly, after the populations fully vaccinated or the immune levels of the previously infected reduced over time (vaccination waning), there is a chance of a new wave of outbreaks domestically. Therefore, policymakers should continue monitoring a set of indicators for effective policy decision-making on vaccination and other disease control policies in the first quarter of 2022, particularly when the vaccination coverage of the booster-dose vaccine was still less than desirable. With the Omicron strain, two doses of vaccination became not sufficient to prevent the symptomatic infections caused by infection. Other policy deployment mechanism to speed up the vaccination coverage, especially in the health-sensitive population groups, would reduce the severity of another wave of severe infections and deaths in 2022. The preliminary results of our research have been presented to policymakers at different levels to support their decision-making process. These included the scientific advisory committees of The Centre for COVID-19 Situation Administration (CCSA) of the Royal Thai Government, The Emergency Operation Center (EOC) of The Ministry of Public Health, The Macroeconomics Department of the Central Bank of Thailand, and The Board of Directors of the Health Systems Research Institute. Yet, using system dynamics modeling as a policy decision support tool (DST) still has limitations. The public policy process to cope with Thailand's public health emergencies tends to focus more on reactive measures than on planning and addressing the structural issues of the health systems that created persisting problems during the COIVD-19 pandemic. Without policies that address the high-leverage point of the systems, many issues related to the management of the COVID-19 vaccine supply chain still persists, including confusing communication of the risks of vaccination versus no vaccination to the public. Therefore, it is crucial to create a learning platform among policymakers and stakeholders to synthesize lessons learned on integrating research in the public policy process, and focusing more on the evidence-informed policy-making process under the country's emergency management systems. It can be challenging for policymakers to use evidence from simulation modeling in the decision-making process amid uncertain information and pressure from the public. But it is vital to work on this complex problem-solving process to prepare for any soon emerging public health emergencies.


Chronic kidney disease is one of a major health problem both nationally and globally due to the tendency of the patient has been increased annually. At an early stage of chronic kidney disease, the patient has no symptom, but the diagnosis is possible by analyze an amount of microalbumin in urine and combine with serum creatinine. However, this process is allowed at the hospital only. To enable an effective and extensive access for a high-risk of chronic kidney disease population, this project focuses on using a urine microalbumin screening test kit for screening the chronic kidney disease at an early stage and including data storage in an online database for easily follow up and proper treatment planning. From the screening of a high-risk of chronic kidney disease population and asymptomatic at Ban Phaeo District in Samut Sakhon province, the 595 volunteers or 25.72% out of the 2,313 volunteers in total was suspected of chronic kidney disease. After 3 months follow-up, 178 patients (out of 260 volunteers) still had renal dysfunction that met the criteria for diagnosis of chronic kidney disease. The estimated prevalence of chronic kidney disease was 17.5%, which is similar to the prevalence in a general population from the Thai-SEEK project. The urine microalbumin screening test kit provides 96% accuracy, 86% sensitivity, and 98% specificity that indicated an efficient, highly accurate, convenient to use, and the results can be read rapidly. It can be used outside the laboratory which enable to reach high-risk populations. Moreover, it also possesses the potential for further commercial use.


Schools are places that are at very high risk of the spread of the COVID-19 virus and are made up of large numbers of people, including students, teachers or caregivers, and parents. Therefore, there is a risk of spreading the virus easily. In light of the COVID-19 pandemic, the subsequent closure of educational institutions has caused more than 1.5 billion students, or more than 90% of all students in the world, to be affected in the learning process. Objectives: to present educational management guidelines in preparation for the new normal that will occur after the COVID-19 crisis. Reasons for the importance of conducting research on a new normal living model of upper elementary school students in the COVID-19 outbreak with school-based management in the upper southern provinces This research model uses mixed methods, both quantitative and qualitative research methods. and qualitative research methods. The project started from June 1, 2021 to May 31, 2022. A participatory action research study was conducted. Participatory Action Research (PAR) together with qualitative data collection. by group chat the operation was divided into 3 phases by using the educational institute area to represent the upper primary schools in the upper southern provinces, totaling 7 provinces, one for each province using the selection criteria from the primary schools under the jurisdiction. According to the context and size of the school, OBEC or the municipality may apply for participation. It is a large school and teaches from kindergarten to upper elementary school in 7 provinces in the upper southern part of Thailand. Based on the above criteria, the 7 participating schools were: Kindergarten in Phang Nga Province and Kindergarten in Ranong Province. Chumphon Kindergarten Krabi Kindergarten, Phuket Kindergarten, Surat Thani Province and the Municipality International School Nakhon Si Thammarat, Thailand Sample calculation and sample selection (Sample size and sample selection) The study population consisted of primary school students in grades 4-6 and teachers in teacher schools in large primary schools in the 7 upper southern provinces; 4,635 grade 4-6 students and 712 teachers. A total of 5,347 people were included in the sample group. with qualitative data collection by group discussion with teachers and related people of students and schools, such as parents, Sub-District Administrative Organization health workers, health promotion hospitals, and parents, a total of 15 people per school. The sample group was calculated using the Kracy & Morgan formula, totaling 1,530/235, using a simple random sampling method, totaling 1,765 students. The objectives were to study the following data in upper primary schools in 7 provinces in the region. Thailand's Upper South 1) to evaluate the situational experience of adjusting to a new normal lifestyle during the COVID-19 outbreak 2) To develop and evaluate a new normal life model for upper elementary school students affected by the COVID-19 outbreak with school-based management, and 3) To pass on a new normal life model for upper elementary school students affected by the COVID-19 outbreak with school-based management. The majority of the students who received this research were female (54.5%), aged 11 years (29.28%), and in grade 6 (36.4%). Overall preparedness for management on the overall COVID-19 outbreak was high (74.0%) across all components, according to the DMHT-RC measure. Overall, 75.5 percent of students' health literacy was found. The average of all 6 components, which were at a relatively high level (60-80 percent), showed that the teachers had average scores in literacy and cognitive health, and the overall picture was at the most correct level (mean 4.97, SD = 0.86). Practices against the COVID-19 outbreak are at a high level (Mean = 93.24, SD = 15.41). In the second phase, the model school development activities were conducted by a participatory workshop for 10 hours, totaling 2 days of operation. Nakhon Si Thammarat volunteered to participate. There were 330 students in grades 4-6, 49 administrators and teachers to develop an epidemic prevention management model. COVID-19 to the new normal by using the school as a base, it was found that there were 3 development patterns, namely the full development model. full and standard. The program provides knowledge using four components: school management, Health Literate School (HLS) development, environmental management, and school safety (EH&S) and Participation and Partnerships The productivities including Handbooks policies model, measures model, and response plans of schools in the form of electronic media, posters, and e-books, it was found that in the second phase, the schools that developed the literacy program had the effectiveness of the program with the mean scores of the two groups that differed significantly higher than the other two formats. COVID-19 prevention behaviors and average knowledge score After the training using the school program, statistically significantly higher than before the program. In the third phase, from the study of factors affecting school readiness for school reopening using Binary logistic regression statistics, it was found that factors affecting school reopening of the primary school is the management of the school environment. by a school with a better managed environment is twice as likely to reopen as schools with poor environmental management (B = 2.047, CI = 1.428-2.934, P-value = .000). Due to the qualitative study results found under the theme requirements, new normal life (New Normal); risk communication. (Communication); Stakeholders and Networks; Disease prevention and control (Caution and Control); Health Literate School; Countermeasures to respond to incidents (Operating); organization management (Organizational practice); and policies, measures (Legislation) which can bring the development program to 3 The model can be applied in the school according to the school context in a variety of ways. and create sustainability by utilizing participatory development in four key elements to mitigate the potential negative impacts of future changes in the communicable disease situation. Survey information system for learning readiness in schools must be improved. Four areas must be addressed: policy implementation, management measures, health literacy development, environmental management and school safety. Spatial information for educational advancement, access to technology and preventative care for security and cleanliness should be used.


Mycophenolic acid (MPA) is an immunosuppressant medication used to prevent rejection following organ transplantation and is under investigation for its efficacy against osteosarcoma. We investigated the genetic variability of whole-exome sequencing (WES) data from osteosarcoma patients and healthy volunteers who receive mycophenolate mofetil (MMF), a prodrug of MPA. Using the whole-exome sequencing (WES), we found 95 single nucleotide polymorphisms (SNPs) in osteosarcoma patients and 118 SNPs in healthy volunteers based on the list of genes related to MPA and its metabolite (MPAG) metabolism. For osteosarcoma patients, variants located in the gene UGT1A8, SLCO1B3, IMPDH1, ABCC3, UGT1A6, and UGT1A7 were related to some pharmacokinetic parameters of MPA and MPAG. For healthy volunteers, variants located in the gene SLCO1B3, SLCO1B1, and CYP2C8 were found to be in relation to some pharmacokinetic parameters of MPA and MPAG. In addition, we examined the effects of trimethoprim-sulfamethoxazole (TMP-SMX) on gut microbiota and the pharmacokinetics of MPA and MPAG when co-administered with MMF in healthy volunteers. The results have shown that TMP-SMX could alter the structure of the gut bacterial community. TMP-SMX treatment significantly decreased the relative abundance of genus Bacteroides, a major group of β-glucuronidase-producing bacteria in the gut. Moreover, concomitant administration of TMP-SMX with MMF also significantly reduced the area under the concentration-time curve from time 0 extrapolated to infinite time (AUC0-∞) of MPA. These results imply that TMP-SMX may interfere with the enterohepatic recirculation of MPA by decreasing gut bacterial β-glucuronidase enzymes that are responsible for regenerating MPA from its glucuronide metabolite MPAG, resulting in the reduction of MPA exposure.


This action research aims to develop systems and mechanisms for managing the coronavirus disease 2019 crisis in Ubon Ratchathani Province of district and sub-district departments. A tool used as a guideline for questions in group discussions. Data were analyzed using frequency, a percentage for quantitative data, and content analysis for qualitative data. The results revealed that district and sub-district departments established the cooperation system with guidelines. There are clear guidelines in the disease control manual. Infectious waste was properly management. There is a budget plan for the municipality and the sub-district administrative organization to prepare for disease control in the next year. It planned to use the budget from the Community Health Security Fund to be sufficient for disease control in the sub-district. Kham Krang sub-district created a local health Charter to strengthen the operation, as well as be ready to prepare for the crisis from another infectious disease. The results of this study can be used as a model for budget support from local government organizations, causing the preparation of budgets for disease control by including packaged in the strategic plan and supported by Community Health Security Fund. It can measure the success of the budget administration. They use information and information for learning, assessing, and improving the process of disbursing the fund budget to support the control and prevention of coronavirus disease 2019 continuously and sustainably.


Older people with dependency are those who have limitations in daily activities. It affects physical and mental ability, social participation, and the need for help caring for the family and the community. Descriptive research aims to study the context of integrated care for the dependent older people with community participation by community participation in preparation for the re-epidemic of the coronavirus disease 2019. In addition, develop policy proposals for integrated care for the older people with dependency on community participation in preparation for the re-emergence of the coronavirus disease 2019. They have selected random samples from 6 provinces across the country. According to the inclusion criteria, 440 households of primary caregivers assessed the functioning ability of the older people, primary caregivers, and 440 families involved in older people's care. There were 154 community dependencies. Data were collected from the tools tested for the content quality of the research tools. From 3 qualified health experts, the content accuracy was 0.91, and the confidence value (Reliability) Cronbach's alpha coefficient was 0.69. There were both quantitative and qualitative. The study results were based on the principle of "Trust, Stay at home, Keep distance" and perceptions of COVID-19, impacts, problems, obstacles, and the need for care. Results In terms of quality, there are four preventive principles in mind: "Trust, Self Care, Stay at Home, Keep Distance" and guidelines for preventing COVID-19 at the family level. The gathering data is expected to form the information for planning, operating, and organizing training to provide knowledge and training in caregiving skills. It refers to preparing guidelines for caring for the dependent older people with dependency conditions in the personnel health, social workers, local government organizations, and related agencies.


The pandemic of Coronavirus Disease 2019 (Covid-19) comprises complex health and socio-economic issues. The limited knowledge of this emerging disease has led to uncertainties in solving the problem. Policymakers need comprehensive data to support policy decisions and reduce the constraints of compartmentalized thinking. The literature review suggests that controlling the pandemic depends on developing policy decision processes that effectively deal with public health emergencies at the national policy level. The governance structure of the "Information and Strategy Department" is required to collect data and present it to the "Incidence Commander", who makes the decisions, develops guidelines, and communicates risks to the public. Systems thinking can be applied to the policy process by better understanding the relationships between all connected system components from the perspective of all relevant stakeholders and by testing the effectiveness of policy scenarios by simulation modeling. Thus, the process enables policymakers to make well-informed decisions supported by sound scientific evidence, likely to create optimal disease control with negative impacts and manage the risks that may arise from those decisions. A vital tool to synthesize evidence is the mathematical models that can predict epidemiological scenarios by considering the natural transmission capacity of the 2019 coronavirus. Yet they are still too limited for supporting more comprehensive policy decision-making, as the COVID-19 pandemic comprises complex health and socio-economic issues. The Susceptible-Exposed-Infectious-Recovered (SEIR) model customarily used for epidemiological forecasting can be modified to build a structure of system dynamics (SD) models that include all components of health systems resilience. So the SD model can function as an analytical tool that considers health systems' short-term absorptive, immediate-term adaptative, and long-term transformative capacities. We applied the group model buildings (GMB) process to work more closely with stakeholders to integrate all aspects of problems and solutions. Disease control measures, enhancing healthcare capacity measures, and remedial measures for economic and social consequences were considered in our modeling. Then we can use the simulation model to test policy options and effectively support the policy decision-making process in this public health emergency. Both qualitative and quantitative data were collected from participants in our workshop on health systems design in the COVID-19 era to synthesize a causal loop diagram that demonstrates the relationships of all factors within the health system affecting the control of the COVID-19 pandemic in Thailand. Additional quantitative data were collected continuously between 2020 and 2021 to construct the model for testing policy options and support the policy decision making process in several key policy options, including 1) lifting the intensive disease control measures for remedying socio-economic consequences, including reducing the quarantine duration of inbound international travelers, after the 1st wave of the COVID-19 pandemic in Thailand (the January 2020 outbreak), 2) implementing "lockdown" measures in hyperepidemic areas in the 3rd wave of the COVID-19 pandemic in Thailand (the April 2021 outbreak) at both the national level and in the Greater Bangkok Area, 3) raising the capacity of testing, contact tracing, and isolation and quarantine systems after the enforcement of lockdown measures in July 2021, and 4) enhancing the healthcare capacity to sufficiently care for COVID-19 patients during the April 2021 and the January 2022 outbreaks. The findings from our simulation model show that new waves of outbreaks can reemerge after being well controlled in early 2020. The so-called "lockdown policies," including the closure of government offices and public services and banning cross-provincial and international travel, had been implemented since March 2020. The need for easing intensive disease control measures arises due to the far-reaching socio-economic negative consequences of the government authorizing intensive disease control measures to cope with the first wave of the COVID-19 epidemic in Thailand. Therefore, policymakers should consider adopting integrated policies aimed at disease control and remedying its socio-economic impacts. For instance, subsidizing businesses affected by the lockdown policies to maintain local employment can reduce workers' traveling across territories and lower the risk of spreading the COVID-19 nationwide. Our model also suggested that at both the national level and in the Greater Bangkok Areas during the April 2021 wave, a more severe outbreak than that of January 2020 may happen due to the rapid transmissions capability of Alpha and Delta strains. The number of COVID-19 infections likely exceeded the capacity of the health service systems in some areas, especially in the Greater Bangkok Areas. Yet the effectiveness of disease control can improve if intensive lockdown policies can reduce at least 40% of community transmissions in approximately month of lockdown. Hence, policymakers should ensure that the lockdown policies are effectively enforced intensively enough in the short term. Moreover, the previous policy of isolating all infected people in hospitals should be adjusted by providing additional community isolation services, especially for those with no or minor symptoms, to cope with the limited existing healthcare capacity. The simulation also shows the outcomes of enhancing the performance of testing, contract tracing, and quarantine and isolation systems during the April 2021 outbreak. Proactive screenings in the communities could increase the reported cases in the short run but reduce the number of patients in the long run. Therefore, policymakers should consider implementing a more proactive community screening during the enforcement of lockdown measures in July 2021 to provide more access to testing and take advantage of the opportunity that vulnerable populations still have limited travel during the lockdown. The rapid lateral flow tests, or antigen test kit (ATK), should also be incorporated for screenings, even though it may lead to some false-negative results. As many people still have limited access to real-time polymerase chain reaction (RT-PCR) testing, ATK can help control the disease than using RT-PCR alone for testing. Lastly, the models show the outcomes of optimizing health care systems to provide adequate care for COVID-19 patients during the April 2021 and the January 2022 outbreaks. The number of available hospitals beds may not be sufficient to support the April 2021 outbreak, especially after the outbreak of the Delta strain in June 2021. Hence, it was necessary to build a surge capacity of health care delivery systems, such as creating additional quarantine and isolation services in hotels or the communities. The capacity of healthcare delivery systems for the January 2022 outbreak was likely insufficient to be used as the isolation facilities for an even larger number of people infected with the Omicron strain, which is even more contagious than the Delta. The simulation also shows the most critical policy that could prevent an overrun of healthcare delivery systems is accelerating the vaccination coverage of vulnerable groups to reduce the morbidity and case-fatality mortality rate. The preliminary results of our research have been presented to policymakers at different levels to support their decision-making process. They included the scientific advisory committees of The Centre For COVID-19 Situation Administration (CCSA) of the Royal Thai Government, The Emergency Operation Center (EOC) of The Ministry of Public Health, The Macroeconomics Department of the Central Bank of Thailand, and The Board of Directors of the Health Systems Research Institute. The study findings were also communicated to the public through the researchers' website and the mass media periodically. Nonetheless, using system dynamics modeling as a policy decision support tool (DST) considering health systems resilience still has limitations. The public policy process to cope with Thailand's public health emergencies tends to focus more on reactive measures than on planning and addressing the structural issues of the health systems that created persisting problems during the COIVD-19 pandemic. Without policies that address the high-leverage point of the systems, many problems have persisted more than two years after the pandemic began. Therefore, it is crucial to create a learning platform among policymakers and stakeholders to synthesize lessons learned on integrating research in the public policy process and what governance process can be further improved in public health emergencies. By focusing on the evidence-informed policy-making process under the country's emergency management systems, Thailand's health system can be more fully developed as a "learning health system," an important concepts suggested by the World Health Organization. It can be challenging for policymakers to use evidence from simulation modeling in the decision-making process amid uncertain information and pressure from the public. Nonetheless, it is vital to work on this complex problem-solving process to prepare for any soon emerging health, economic, and social problems.


This participatory action research (PAR) aimed to 1) develop a participatory public policy for the prevention of coronavirus disease 2019 (COVID-19) in Muang District, Trang Province, and 2) monitor and evaluate the implementation of public policy. The target groups for collecting data were divided into 2 groups: qualitative data, consisting of 1) a group of scholars or people working in a government agency, 2) a group of executives of a local government organization, and 3) a group of 94 people or civil society groups, and quantitative data consisting of 384 people in the targeted areas. The research was divided into 3 phases, namely 1) the study of the situation of the problem, 2) the policy development and the policy trial, and 3) the public policy assessment together with the development of public policy driving processes for health. In this phase, there were 5 steps as follows: 1) Formation of policy issues, 2) Public policy formation, 3) Public policy decision making, 4) Implementation of public policy, and 5) Monitoring and public policy evaluation. The research was conducted between April 2021 – May 2022. The research instruments consisted of a group discussion guideline, in-depth interviews, questionnaires, observations, and learning exchange forums (lesson learned). The results showed that the first step was the formation of policy issues caused by the problem of disease outbreaks in the community with preventive actions control of outbreaks under a committee based on the incident command system and the Public Health Emergency Operation Center (PHEOC) together with community participation. The proposal from a group of scholars included an accelerated measure that covers the active case finding, treating infected people, vaccination, campaigning for people to follow universal prevention measures, as well as healing infected people’s minds. The local government organizations support public relations information, equipment, and utilities that were necessary for home and community quarantine. Measures done by the people's groups or civil society, were to create a safe area from COVID-1 9 (COVID Free Setting), focusing on important places, including restaurants, schools, hospitals, factories, hotels, and markets. Once the public policy has been formulated, then policy decisions have been made. The policy has been implemented in the communities. There was the monitoring and evaluation of the policy implementation. It was found that people have followed the measures at a high level (M=2.62, SD=0.28). They were satisfied with the public policy at a high level (M=8.30, SD=1.69), and their participation was at a high level (M=8.45, SD=1.57). The findings suggest that the development of participatory public policy in the prevention of coronavirus disease 2019 (COVID-19) in Muang District, Trang Province arose under the participation of government personnel, the private sector, and the people in communities. They have driven the public policy concretely.


Fungal pathogens in humans have now been increasingly reported worldwide. In addition, the most common pathogenic fungi that are resistant to standard antifungal agents, particularly azole group, are Candida albicans, Aspergillus fumigatus, and Scedosporium spp., causing the need to develop various antifungal drugs and pharmaceutical products to co-treat such infections. Several active antifungal compounds are obtained from medicinal plants and fungal metabolites known as fungal quorum-sensing molecules, which have been shown to inhibit the growth of another fungal species. One of the fungal quorum-sensing molecules is tryptophol. This study aimed to develop a topical product as tryptophol-containing emulgel for inhibiting the growth of Candida albicans, Aspergillus fumigatus, and Scedosporium species complex as Scedosporium apiospermum, which is the most reported cases of infections and deaths. The preliminary results showed the minimum inhibitory concentration (MIC) of tryptophol against three fungal species were 0.5, 1, and 2.5 mM, respectively, while the minimum fungicidal concentration (MFC) was 3, 6, and 6 mM, respectively. Tryptophol at the concentration of 6mM, which was the maximum inhibitory effect of the three fungal concentrations, was not found to induce toxicity in the fibroblast (HFF-1) cells and had no effect on the life cycle of the Caenorhabditis elegans worms. The results from the laboratory have led to the development of a prototype topical product as tryptophol-containing emulgel at a concentration of 6 mM. When examining the cosmeceutical properties, it was found that the properties were good according to the cosmeceutical standards. It is also stable in both accelerated testing and at room temperature. Tryptophol-containing emulgel was used to reduce the size of eumycetoma from S. apiospermum infection in rats with a significant reduction in the eumycetoma size after at least 14 days of treatment. Moreover, the prototype product had no stimulant effect in rats when tested histologically (40/40 animals), consistent with the results obtained in human volunteers, with no cream-induced irritation using closed patch test for 96 hours in 30/30 volunteers. The results showed that tryptophol-containing emulgel at a concentration of 6 mM was able to reduce the number of pathogenic fungi in humans Candida albicans and Aspergillus fumigatus (in vitro study), as well as to reduce eumycetoma size caused by S. apiospermum infections. Moreover, tryptophol-containing emulgel did not cause irritation in rats and in human volunteers. These laboratory results can be used as the basis knowledge for further application in clinical studies for the acquisition of co-treatments to treat mycoses or other skin pathogens.


One-hundred-five patients diagnosed with drug-induced severe cutaneous adverse reactions (SCARs) were recruited for this study. The results demonstrated that Steven-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptom (DRESS) were caused by similar culprit drug groups, which were different from acute generalized exanthematous pustulosis (AGEP). SJS/TEN phenotype, advanced age, high neutrophil/lymphocyte ratio (NLR) and systemic infections independently increased the risk of in-hospital mortality. The application of NLR to predict mortality in SCARs should be reconfirmed in a large-scale study. The combined measurement of drug-induced IFN-gamma (IFN-γ), granzyme B and IL-22 releasing cells could confirm the causative drugs in 77.8% of SCAR subjects, while α-GalCer supplementation significantly increased the frequencies of drug-induced IFN-γ releasing cells. The appropriate in vitro test panel yields optimal diagnostic values, and cost-effectiveness should be determined. Although SJS/TEN and DRESS are caused by similar drug groups, clinical manifestations and long-term prognosis are clearly different. Our study suggested that keratinocyte death observed in SJS/TEN was partly due to drug-specific exosomes released from peripheral blood mononuclear cells upon stimulation with the culprit drugs in SJS/TEN, but not in DRESS. Five exosomal microsomal RNAs (miRNA-486-5p, miRNA-183-5p, miRNA-96-5p, miRNA-132-3p and miRNA4488) were confirmed statistically different between SJS/TEN and DRESS by microRNA sequencing. The regulatory roles of these exosomal miRNAs on keratinocyte death in SJS/TEN and might be used as the therapeutic roles of exosome inhibitors to prevent SJS/TEN progression warrant further study. The different fates of regulatory T cells (Treg) were observed between SJS/TEN and DRESS patients. While Treg functions in DRESS were stimulated during the acute drug allergic phase, the regulatory/suppressive functions of Tregs in DRESS were subsequently diminished compared to SJS/TEN when followed up during the recovery phase. According to the comparative analyses of Treg mRNA profiles during the acute drug allergic phase, genes regulating T cell differentiation and genes regulating interleukin-10 production were found downregulated in DRESS patients who developed autoimmune consequences compared to healthy individuals and might be used as prognostic factors for long-term complications in DRESS subjects.