location: , 'Thailand year: 2017 source: HSRI

title: The application of (1->3)-β-D-glucan: a surrogate biomarker for therapeutic monitoring in pythiosis patients

abstract: Pythium insidosum is the causative agent of the life threatening pythiosis. The main clinical manifestations are often found in artery (vascular type) and cornea (ocular or corneal type). Among the vascular type, thalassemia is the common underlying disease. The investigation of specific P. insidiosum antibody in serum is practical tool and provides high accuracy for diagnosis. Using the high technology, computer tomography angiogram to indicate the occlusion point in artery is another protocol that physicians often requested. However, with the high cost and availability only in tertiary care hospital are the limitation. Presently, the combination treatment, surgery, antifungal agents, and immunotherapy, has been applied since standard treatment has been established yet. Regarding the immunotherapy, 2 mg/ml protein antigen extracted from P. insidiosum (PIA) to stimulate host immune response, via subcutaneous route has been performed. The protocol is one prime dose, after diagnosis, and 6 boosters in one year period. To follow up and monitor the patients’ illnesses, the physicians investigate by observing and asking the patient directly about the lesion without any biological markers. In addition, no reliable markers regarding the patients’s previous symptom for the next visit was shown. Thus, it is dispensable to find the biological evidence base. To examine the specific antibody is to study the host immune response to the specific pathogen. Regarding the pathogen side, the presence of (13)-β-D-glucan (BG) is found in the cell wall of P. insidiosum and PIA, similar to certain kind of fungi. Therefore BG level monitoring is another attractive marker.  We hypothesized that after the combination treatment, the level of both specific antibody against P. insidiosum and the BG would change and possible to apply as the monitoring surrogate markers for pythiosis. Materials and Methods The levels of BG and cytokines: IFN-γ, IL-17 in the sera prior PIA immunotherapy (PIAI) at each time point through out the 1 year regimen from vascular and corneal pythiosis patients (n=20 of each) were examined. The control sera were collected from healthy with thalassemia (n=20) and without thalassemia (n=20) for vascular pythiosis and corneal pythiosis investigation, in order. All results including the patients’ data from survivor and death groups for vascular type; visible and invisible from ocular type will be analyzed.  Results All patients who survived more than 1 year after PIA immunotherapy showed the significant declining trend of serum BG (p-value<0.05) whereas the ones who died before 1 year demonstrated the high level of BG with non-significant changing (p-value<0.05) despites both group presented the non-significant difference of >423.4 picogram/ml prior PIA injection. In contrast to the cytokine level: IFN-γ and IL-17, all patients who survived more than 1 year after PIA immunotherapy showed the significant increased trend of cytokines (p-value<0.05) whereas the ones who died before 1 year demonstrated the decreased trend  of cytokines’ level.  Discussion The pattern of BG and cytokines: IFN-γ and IL-17 are ones of the biological markers (quantitative scale) which can be applied for the disease monitoring and prognosis. However, these biological markers have some limitation in term of their specificity. The pattern of their levels can be presented by several factors such as fungal or bacterial infection which compose of BG. Thus, the development of P. insidiosum specific biological marker for testing in parallel need to be investigated in the future.


location: , 'Thailand year: 2003 source: HSRI

title: Effectiveness and appropriateness of the LEPTO-SCORE for decreasing severity of suspected leptpspirosis cases refered to Khon Kaen Hospital : a randomized-controlled field trial in a northeastern province of Thailand

abstract: Effectiveness and appropriateness of the LEPTO-SCORE for decreasing severity of suspected leptospirosis cases referred to Khon Kaen Hospital: A randomized-controlled field trial in a northeastern province of Thailand	The objective was to evaluate the effectiveness and appropriateness of LEPTO-SCORE for decreasing severity of suspected leptospirosis cases referred to treat at Khon Kaen Hospital. A stratified randomized-controlled field trial was conducted at 4 district hospitals in Khon Kaen province. The suspected leptospirosis patients admitted from July 2000 to February 2001 were included for study. The patients in intervention group who had LEPTO-SCORE of at least 8 on admission or of at least 10 at 12 hour apart was assigned to refer to Khon Kaen Hospital. The severity of referred patients were assessed by using Modified APACHE II score at Khon Kaen Hospital (score of < 10 was accounted to be an appropriate refer). In all, six hundred and eight patients were recruited, 241(39.6%) in intervention group and 367 (60.4%) in control group. Most patients were male (67.9%) with the mean age of 38 years and 86.7 percent were farmers. Twenty-nine patients were referred. The Modified APACHE II score of patients in intervention group (7.5 ( 3.6) was lower than that of control group (10 ( 5.3) without statistical difference (difference = 2.5, 95%CI: -1.9 to 6.4, p = 0.28). There was no significant difference of rate of appropriated refer between both groups (57% in intervention group, 50% in control group, p = 0.73). We concluded that the LEPTO-SCORE trended to be useful for decreasing severity of suspected leptospirosis cases referred to treat in tertiary care center and for development of proper referral system.


location: , 'Thailand year: 2007 source: HSRI

title: Percutaneous Release of Trigger Finger with Applied Dental Equipment in Samchuk Hospital, Suphan Buri Province

abstract: This is a retrospective descriptive research study, the objective of which was to evaluate the results of trigger finger treatment by percutaneous approach using applied dental equipment. The study population included 29 patients with trigger finger (females
with a mean age of 52 years) on whom 35 digits were treated by percutaneous operation
at Samchuk Hospital, Suphan Buri Province. The statistical analysis gave frequency, percentage, mean, median and range. The results of the study revealed that the mean operation time was 14 minutes; only
12 patients (34.3%) kept their appointment for seven days of postoperative follow-up.
The mean home visit period for every patient was 13 months.  On the seven-day followups, every patient could move her fingers normally and only two patients sensed pain.
On home visits 34 of the 35 fingers (90.14%) moved normally; four patients had a sensory
loss but without pain or scars.  The majority of patients (74.28%) could move their fingers
normally within 10 days of the operation.  The mean sastisfaction score was 9.69 out of 10.
All patients were willing to recommend other trigger finger patients to come for treatment at Samchuk Hospital. The author concluded that the treatment by percutaneous
technique with applied dental equipment is effective in releasing trigger fingers without
additional medical treatment; this technique involved fewer complications, no scar formation, a short recovery period, no recurrent symptoms, and produced good patient compliance and faith.


location: , 'Thailand year: 2000 source: HSRI

title: The systhesis of knowledge on informal workers

abstract: The Synthesis of Knowledge on  Informal Workers	The purpose of this study is to synthesize the body of knowledge of informal workers, funded by the Health Systems Research Institute, Thailand.  The study aims to better understand the circumstance of informal workers and the impact on their health.  Moreover, the study will be a guideline for policy recommendations and legal suggestions that are necessary for informal workers.  Previous studies included in this review are of published and unpublished documents.  	This study concluded that  there is not clear on definition and statistics of informal workers.  Informal sector provides many benefits to country both at macro and micro levels.  However, informal workers still face with a lot of problems such as unclear status, unsecured work conditions, inappropriate work environment, lack of enhancing their skill, low income, no social and legal protection, lack of responsible organization.  In addition, important health problems are risk and dangerous work, health problems related to work conditions, rush work, and long period of work, lack of adequate health information, lack of social insurance.  In terms of law, informal workers do not include in the relationship between employer and employee system.  Therefore, they could not get any benefit of social insurance.  They are applied with commercial legal system that has a weakness point since partners of agreement can agree, by themselves.  This study proposed policy recommendations and identifies areas that require further research.  These recommendations are offered to enhance, develop and protect the quality of life for informal workers, as well as a guideline for their welfare.  They may lead to improve the health care system and enhance appropriated health insurance for informal workers and their families.


location: , 'Thailand year: 2023 source: HSRI

title: Mapping, Monitoring, and Assessing Impacts from Air Pollution from Coal-fired Power Plant on Community Health and Quality of Life in Nan Province

abstract: This research developed tools and data systems to collect field data and evidence for monitoring health and vocational impacts from transboundary air pollution from a coalfired power plant in Lao on laypeople in 8 villages in Huai Kon subdistrict and Khun Nan subdistrict, Chaloem Phra Kiat district, Nan province. This research applied the principle of community citizen science (CCS), starting from formulating research questions to address the community’s concerns and negative direct experience potentially caused by transboundary air pollution. Next, these concerns and experience were used to design relevant environmental indicators for field monitoring to verify the association between community’s concerns and transboundary air pollution. Next, air pollution dispersion and deposition models were used to create risk maps illustrating health risk from PM2.5 and PM10, agricultural land degradation risk from acid deposition from SO2 and NO2 , and child’s IQ development risk from consumption of Hg-elevated fish, all of which are caused by major transboundary air pollutants from a coal-fired power plant. These risk maps helped us identify risky areas and receptors as well as environmental indicators to prove the effects from these pollutants. Low-cost air pollution sensors, soil acidity, Hg in fish and human hair were assessed. We found that every village except Ban Dan village started to get impacts from acid deposition already as confirmed by acidic soil pH in every village from pH 4.20 to 5.09 much lower than natural, non-acidic soil with pH of 5.5. Also, Huai-kon, Nam-ree, Kewchan, and Sop-Puen villages were likely affected from transboundary Hg already because Hg in fish was relatively high (0.16 mg/kg) even though this is still lower than the acceptable level (0.3 mg/kg), but Hg in hair of women in the area with elevated Hg in fish was abnormally high in comparison to normal Thai people. We roughly estimated the health and vocational cost from transboundary Hg and acid deposition to be around 975 million THB in 30 years. This serious problem should be properly managed using CCS to establish a database which reflects actual current and future impacts from transboundary air pollution. Moreover, the owner of the coal-fired power plant should join force with this CCS effort to design prevention, mitigation, and compensation measures. A risk management fund of 1,000 million THB should be established together with a clear protocol to use this fund for community in the fairest and the most community-engaging manner.


location: , 'Thailand year: 2007 source: HSRI

title: Experience in Using Antiretroviral Therapy in Cross-border Areas along the Mekong River

abstract: Chiang Saen Hospital has provided antiretroviral therapy (ART) to people infected
with HIV, especially the Burmese and Laotians residing in Thailand or in their own countries.  The guidelines of the country program were applied.  The cohort study design
measured ART adherence, survival rate, clinical outcomes, result of the prevention approach and psychological support as outcome indicators.  Data were collected and analyzed using FUCHIA software.  The Kaplan-Meier method was conducted for survival
analysis.  The results revealed that 73 non-Thai PLHA (people living with HIV/AIDS)
who received ART from July 2004 to June 2007 (19 Laotians, 16 of whom resided in their
own country; 51 Burmese, 20 of whom resided in their own country, and three minority
people residing in Chiang Saen.  Mean ART adherence was more than 98.2 per cent.  Mean
survival time in months was 41 (95% CI 39.0-43.2).  Survival at 36 weeks was 96 percent.
Three cases died after ART, two from AIDS and one from the adverse effects of ART.   No
case had been lost to follow-up or stopped treatment.  Thirty per cent of the patients
needed to change individual drugs due to adverse effects.  The health of those on treatment improved.  Access to ART increased the uptake of service in the prevention approach.  Eleven cases received vocational loans and one case received an education fund.
It is one model of how the disadvantaged can access ART in cross-border areas and how
Thailand can support its neighbors.  However, the effectiveness and the sustainability of
the program still need to be considered


location: , 'Thailand year: 2015 source: HSRI

title: Gaps and Opportunities of Policy Implementation in Thailand to Comply with WHO’s Set of Recommendations on the Marketing of Foods and Non-Alcoholic Beverages to Children

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


location: , 'Thailand year: 2009 source: HSRI

title: Cost-effectiveness Analysis and Budget Impact of Laparoscopic Surgery in health insurance system in Thailand

abstract: Laparoscopic surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions for treatment and diagnosis.  As compared to larger incisions needed in traditional surgical procedures, the patients with laparoscopic surgery had smaller incisions and less blood loss which leads to better quality of life.  However, laparoscopic surgery is more expensive.  Currently, the reimbursement method and rate are different among health insurance schemes.  Therefore, this study aims to evaluate the utilization of laparoscopic surgery  between  patients under Civil Servant Medical Benefit scheme (CSMBS) and those under Universal Coverage scheme (UC) as well as the cost-effectiveness and budget impact of laparoscopic surgery in health insurance system in Thailand.
The data of inpatients undergoing laparoscopic surgery obtained from the Central office for Healthcare Information (CHI) from 1 January 2005 to 31 December 2007 based on procedure code (ICD-9-CM) and principal diagnosis code of laparoscopic (ICD-10) were used to determine the access to laparoscopic surgery between the patients under CSMBS and those under UC. It was found that diseases of gallbladder and cholecystitis, diseases of gynaecology and acute appendicitis were the most dieases performing laparoscopic surgery. Patients’ health insurance is the facor associated with the access to laparoscopic surgery the most. The patients under  CSMBS had significantly higher access to laparoscopic surgery compared to those under UC because the reimbursement method and rate are different among these two insurance systems. Moreover, large hospitals were more likely than small hospitals to perform the laparoscopic procedure since surgeons with expertise in laparoscopic surgery and and expensive equipments are usually in large hospitals.
           The cost-effectiveness analysis of laparoscopic surgery was obtained from the study in 2005 i.e., the cost-utility of laparoscopic surgery versus conventional open cholecystectomy. It was found that the incremental cost per QALY was 144,692 Baht under government perspective and 86,464 Baht under a societal perspective. Laparoscopic surgery would be considered as a cost-effective strategy regarding to a threshold of one to three times of gross domestic product per capita recommended by the subcommittee of the development of benefit package and service system, the National Health Security Office (NHSO).

	Based on the results, it was concluded that although laparoscopic surgery in cholecystectomy would be cost-effective, the patients under UC still could not appropriately access to laparoscopic surgery when compared to patients under CSMBS for the reason that the NHSO does not provide higher reimbursement rate in case of laparoscopic surgery compared to traditional surgery procedures. This reimbursement system of NHSO does not support hospitals to perform laparoscopic surgery which had higher cost but same reimbursement rate compared to traditional surgery.  In order to increase the access to laparoscopic surgery, the NHSO should provide the interventions such as an increase in reimbursement rate of laparoscopic surgery compared to open surgery to hospitals by assigning the higher relative weight score or allowing patients under any Thai health insurance schemes pay the co-payment when receiving laparoscopic surgery.  In addition, the Ministry of Public Health should provide financial support for the training on laparoscopic surgery to increase the number of surgeons in this field.


location: , 'Thailand year: 2018 source: HSRI

title: Thai Public Health System and Workforce Planning for Thai Traditional Medicine in the Year 2026

abstract: This mixed methods research study of workforce situation for Thai traditional medicine (TTM) in state-run health-care facilities, the production of TTM workforce in educational institutions, and TTM workforce planning for future workforce development involved a survey, focus group discussions, and workforce demand forecast using the heath demand method. All activities were involved with the multi-disciplinary and the service providers working groups from November 2015–October 2016. The results revealed that across the country there were 11,279 TTM personnel, including 2,692 TTM and applied TTM practitioners, and 8,597 TTM assistants in 2016. TTM workforce demand forecast for three levels of health services, based on the workload, showed that in 2026 there will be demand for 13,275–16,534 TTM practitioners and 14,714–18,509 TTM assistants. That will result in the service provider to population ratios of 1 : 4,015–5,000 for TTM practitioners and 1 : 3,586–4,511 for TTM assistants. Regarding the workforce production capacity at all 27 TTM educational institutions, (until 2016) 11,034 students had been admitted to the program, of whom 4,502 were studying in 2016, and 6,532 had been graduated cumulatively. According to the production plan, beginning in 2017 there will be 1,080 new TTM graduates each year, making a cumulative total of 19,080 graduates in 2026. In conclusion, currently there are shortages of 10,583–13,842 TTM practitioners and 6,127–9,922 TTM assistants. In the next 10 years, the ratio of TTM practitioner to population will be 1 : 4,454 and that for TTM assistants will be 1 : 3,996. As for workforce production in 27 institutions, there will be cumulatively 19,080 TTM graduates by 2026, resulting in a surplus of 2,546–5,805, compared with demand


location: , 'Thailand year: 2016 source: HSRI

title: The Locomotor Skills in Prosthetic Use and Quality of Life of Lower Limb Amputation Persons in Lamphun Province

abstract: This research aims 1) to know the difference in locomotor skills classified by causes and levels of
amputation in persons with lower limb amputation, 2) to know the difference in quality of life classified
by causes and levels of amputation. The research population was people with lower limb amputation
who are older than 18 years living in Lamphun. The samples were selected by stratified random sampling from 82 people by using questionnaire developed by Locomotor Capabilities Index-5 and the World Health
Organization’s WHOQOL-Bref-Thai quality of life version. Validity was examined by experts and a reliability
test was obtained from 30 cases excluded from the study samples. Data were analyzed by frequency,
percentage, mean, and t-test.
Results of this research showed that 1) overall locomotor skills classified by amputation causes were
different at the significant level (0.05) but there was no difference in overall locomotor skills classified by
amputation levels; 2) overall quality of life scores classified by amputation causes and levels were not
different but physical domains classified by amputation causes were different at the significant level (0.05).
Research results indicated the differences in locomotor skills and physical domains were by causes rather
than levels of amputation. Thus, rehabilitation teams should design interventions carefully for different
groups of amputation causes, to encourage amputees to have better locomotor skills in prosthetic use and
to have better quality of life.


location: , 'Thailand year: 2023 source: HSRI

title: The Development of Integrated Medication-Adherence Community Model for Non-Communicable Chronic Disease Patients

abstract: Background Non communicable diseases (NCDs) require continued use of medications for life. Medication adherence is an important factor for successful achievement of therapeutic goal. Objectives (1) To synthesize knowledge from projects in the upstream, midstream, and downstream phases of the Medication Adherence Research Network for Rational Drug Use in Thailand. (2) To develop an integrated medication adherence community model for patients (3) To examine the efficacy of a new integrated medication adherence model for improving medication adherence in patients with non communicable chronic disease. Methods: This study is a mixed method research consisting of: (1) a qualitative method to synthesize knowledge from upstream, midstream, and downstream research results of a series of medication adherence projects; (2) data analysis of knowledge shared in exchange meetings with providers, patients, and caregivers to develop the drafted prototype; and (3) the application of a cross-over randomized clinical trial. Study sample size was calculated to include 72 patients who did not adhere to medication use and attended the clinics of non communicable diseases at Wangthong hospital. Group 1 examined the prevalence rate of patients with medication adherence before and after receiving the new service system model in a group of 36 patients. This group of patients attended a current service model for 1 month, then were assigned to a new service model for another 1 month, and Group 2 examined duration of continued effect from the new service model in another group of 37 patients. This group of patients were assigned the new service system model for 1 month, then attended the current service model for another 1 month The Medication Adherence Questionnaire 20 items (MAQ-20) was a tool for evaluating medication adherence and data was collected through patient interviews. The data was analyzed using McNemar Test and Wilcoxon Signed Ranks Test to compare the two related groups and Mann Whitney U Test to compare the differences between the two independent groups, via SPSS version 21. Results Experts reached a consensus on the definition and meanings of medication adherence consistent with the 6 steps of medication self-management according to Bailey et al. (2013). This covers activities along the patient service path in the hospital. Proportion of patients who adhere to medication use was significantly higher after receiving a new service model in overall process of medication use p < 0 0001) and especially in the step of organizing medication p 0 046)), the step of taking medication p < 0 0001). The effect of the new service model continued for at least 1 month after returning to the current service model judging from the proportion of patients with medication adherence remained the same during and after receiving the new service model. p value = 0 063)). Comparison of the effect of these 2 systems for each time period was also performed. During the first month, a statistically significant difference in medication adherence between the new system and the routine system was observed. (p-value < 0.001). The proportion of patients with medication adherence in the new system was higher than that in the routine system. During the second month, a statistically significant difference in medication adherence between the group that switched to the new system and the group that switched to the routine system was also observed. (p-value < 0.002). The proportion of patients with medication adherence in the group that switched to the new system in 2nd month increased compared to that in this group when receiving the routine system in 1st month. In contrast, the proportion of patients with medication adherence in the group that switched to the routine system in 2nd month decreased compared to that in the group when receiving the new system in 1st month. Conclusions The new service model helped to improve medication adherence in patients with non communicable diseases and the new service model had continued effect on medication adherence for at least 1 month. In the future, implementation of this new service model should be tested in other hospital settings.


location: , 'Thailand year: 2018 source: HSRI

title: Dentist and Dental Nurse Projections for Thailand in the Year 2026

abstract: Previous forecasts of dental health work force demand in Thailand mostly used health need method, adopting health need data in professional view linked to demand for dentist only, contradicting the real practice which dentist works together with dental nurse. On the supply side, the loss rates especially for dental nurses were overlooked. The present study used different technique from the past, i.e., health demand technique mixed with service target. Scope of the present study was limited to dental health organizations with major service role. Task shift from dentist to dental nurse was assumed to be completely shifting, with no overlapping of duty. Supply side started with actual number of active personnel, then adding with actual number of students in production line and current loss rate. The result in 2026 showed 15,742-16,764 dentists in demand (dentist to population ratio of 1 : 4,217 and 1 : 3,960 respectively), and 8,669–12,140 dental nurses in demand (dental nurse to population ratio of 1 : 7,657 and 1 : 5,468 respectively), varying on proportion of clinical dental service of each profession. However, balancing the supply of and demand for both dentist and dental nurse by limiting all treatment services to dentist while health prevention and promotion services to dental nurse, the production rate of dentist can stay at the present rate, while retention rate of dental nurse should be paid higher attention.


location: , 'Thailand year: 2013 source: HSRI

title: Mechanisms to prevent the interference with tobacco control of the tobacco industry under Article 5.3 of the WHO Framework Convention on Tobacco Control in Thailand

abstract: Background WHO Framework Convention on Tobacco Control (WHO FCTC) was the first ever
global public health treaty under the auspices of the World Health Organization. The FCTC is the treaty
that emphasizes on the right of public health by providing a framework for tobacco control measures.
Thailand as the Party to the WHO FCTC has obligations to develop and implement national tobacco
control strategies, plans and programs in accordance with this Convention including Article 5.3 focusing
on protecting public health policies from commercial and other vested interests of the tobacco industry.
Objective To analysis and evaluation of the preparedness of Thailand to implement FCTC Article
5.3 and best practices in Canada, Philippines and Kenya.
Method Qualitative methods were employed for the study including: literature review and documentary
analysis and in-depth interview.
Results The findings are Thailand has some progress in implementing WHO FCTC Article 5.3, for
example, the Department of Disease Control, Ministry of Public Health issued the regulation regarding
measures to limit interactions with the tobacco industry. The comparison studies of Canada, Philippine
and Kenya show that all of these countries have the best practices and more progress than Thailand in
some aspects. Thai government and Ministry of Public Health should revise laws, regulations and issue
some measures regarding WHO FCTC article 5.3, for example, the Regulation of Prime Minister’s Office
concerning the article 5.3 and propose new tobacco control law in order to set up the national tobacco
control board.


location: , 'Thailand year: 1999 source: HSRI

title: Control of assessibility to cigarette among young people aged under 18 by health volunteer, teacher, cigarette seller and community leader, Nongkhai Province, 1998

abstract: A survey on antismoking law compliance in Nongkhai municipal area	This  quasi-experimental study  aimed to find a local  preventive-smoking  model  for  the younger  group of  under 18  year-old. The  study  was done in 5 villages at Serm  Sub-district  Ponpisai District, Nongkhai Province, Thailand. Three study-stages  was  organized; (i) surveying  the  locals’ altitude (including  the  group  of  under  18  year-old), as  to  search  critical  smoking  accessibility factor, (ii) establishing a meeting(excluding  the 18  year-old group) as  to  achieve  a  collectively  smoking  prevention  model,  and  lastly(iii)evaluating  such  that  proposed  model.	The survey results showed the critical smoking  accessibility  factor  was “no hazard  understanding”. Only  60.6 %  of  the  younger  understood  health hazard and related smoking  prohibited law. The health volunteers, teachers, cigarette  retailers  sub-district  members, abbots,  polices  and  students  knew  new-enforcement  smoking law and  regulation  by  only  61.5 %, 62.5 %,  78.9 %, 66.7 %, 33.3 %, 61.9 % and  67.2 % respectively.  The  result  also  showed  79.4 % of  the students used  to buy cigarette. Other smoking accessibility factors were “new try”, broken  home,  elder-like smoking, no recreation activity available, no rigorous no-smoking  campaigns  done by local institutions, and lastly, influential from friends. The no-smoking  campaigns  introduced  by  the  study  were  through  education  mediums  as  smoking  causing  health-hazards. These were distributed  via several means. Such those non-smoking campaigns  included “the 18 year-old prohibited” signs adhered  at  the  cigarette  shops,  leaflet,  radio  spots,  local  anti-smoking clubs, playground sport arrangement, healthy student for not smoking competitions, no-smoking  classrooms, smoking-hazards  warning delivered by  abbots, 216 students  swore  for not smoking, monthly cigarette shops’ inspection by polices and  yearly  budget put forward  for no-smoking campaigns  by sub-district  administrative offices.	The achievement by the study campaigns could have the  more  number of students getting to know the non-smoking law increased from 26.6%  to  44.1%. The smoking rate reduced from 31.1% to 20.9%. Persons who gave up  smoking  during  the  campaign  project  were  42.5%, and  buying  cigarette  habits  decreased  from 79.4% to 45.6%. General  public smoking rate from 27.0% could  reduce  to  finally  quit  of  smoking  19.5%.	The  model  applied  by  this  study  was  genuinely  from  grass-root  initiatives,  any achievements was  then  originated  from  community-based  practice.  On-going  activities  following  the  model  applied  remained  next to  be  evaluated.


location: , 'Thailand year: 2014 source: HSRI

title: Transforming Diabetes Self Management Education for living with Diabetes: A Story of How One Private Hospital Plays Bigger-Than-Itself Public Role

abstract: Diabetes management is an essential strategy for better accessible to qualified health care services.
People with diabetes should have learned how they can live with diabetes by adjusting food intake, exercise,
medication regulation, monitoring blood sugar and interpretation. Theptarin Hospital is a role model
of public health that support people with diabetes for lifestyle modification through diabetes selfmanagement
education with varieties of activities of class, camp, and club. With public health concerns,
Theptarin Hospital builds partnership with the National Health Security Office and the Ministry of Public
Health to deliver diabetes case management and foot care education to nurses and physicians across
country. Family doctor should be a doctor who gives holistic care for a patient with diabetes. These
strategies propose that diabetes self-management education and multidisciplinary approach could prevent
complication and better diabetes control. Theptarin Hospital has developed a good practice of transformative
learning for better outcomes of diabetes management in Thailand.


location: , 'Thailand year: 2023 source: HSRI

title: Monitoring and Restriction System on Food and Beverage Marketing in Thailand and Selected Countries: Gap, Weakness, and Opportunity for Development

abstract: A monitoring system of food and beverage marketing plays a crucial role in tracking progress in the marketing of food industry particularly the marketing of unhealthy food and beverage. The objective of this study was to review the existing monitoring system of food and beverage marketing in Thailand and foreign countries, and to analyze the gaps and opportunities for improving the monitoring system of food and beverage marketing in Thailand. Document review and in-depth interviews with the stakeholders were conducted. Searches were performed through PubMed, Google Scholar, websites of international organizations (such as UNICEF) and relevant organizations in Thailand, selected country databases such as Chile, Republic of Korea, and Australia from 2007 to 2021-timeframe. Purposive sampling was used to identify key informants from government agencies, academia, and civil societies for interviews. Content analysis by using the World Health Organization’s set of recommendations on marketing of foods and non-alcoholic beverages to children was performed on the data from stakeholder interviews and document reviews. Results showed that Thailand, Chile, and the Republic of Korea had government agencies responsible for monitoring the marketing of food and beverage. While the governments of Thailand and Chile cooperated with relevant agencies to monitor the marketing of food and beverage, Australia was active in co-regulation between government and private sectors to monitor food and beverage marketing in collaboration with active civil society sector. Key challenges for Thailand included lack of human resource, outcomes monitoring, and progress report on complaint management. Opportunities for improvement included technology utilization, collaboration and information sharing with relevant agencies and civil society.


location: , 'Thailand year: 2023 source: HSRI

title: Field Hospital Administrative System in COVID-19 Situation: A Case Study of Budsarakhum Hospital

abstract: Budsarakhum Hospital was a large field hospital specialized in providing temporary care for COVID-19 patients. The research objectives were to describe the current situation, problems, constraints, and administrative strategies of Budsarakhum Hospital and to develop policy recommendations for field hospital administrative systems. This is qualitative research and documentary review with a purposive sampling on directors of field hospitals from public and private sectors; emergency medical specialists; administrators and health care providers; including patients who were admitted to Budsarakhum Hospital. Data were collected from participants through in-depth interview and analyzed using the content analysis. Results: 1) From literature review and interviews with experts, administrative system of Budsarakhum Hospital was compliant to administrative model of field hospital for COVID-19, in the scope of input, process and output. However, the emergency human resource mobilization and outcome monitoring were unclear. 2) Problems, constraints, including hospital administrative strategies were identified on hospital structure, extra-organizational communications, risk management, infection control, personnel recruitment and stress management, medical record system, handling of medical materials/devices, admission process, clinical care, patient referral system, and outcome monitoring. 3) Policy recommendations on administrative system of field hospital focused on the information for the public, private, and people sectors to prepare themselves to deal with the epidemic particularly field hospital administrative system if facing future crises.


location: , 'Thailand year: 2001 source: HSRI

title: The scoping of health impact assessment of the eastern seaboard development program : a case study of Mab Ta Put Industrial Estates and their vicinities

abstract: The Scoping of Health Impact Assessment of the Eastern Seaboard Development Program:A Case Study of Mab Ta Put Industrial Estates and their VicinitiesMr. Decharut SukkumnoedFaculty of Economics, Kasetsart University						decharut@hsrint.hsri.or.th	The Eastern Seaboard Development Program is the most obvious case showing “the Two Sides of the Coin” from Thai development experiences. On one hand, this development program is the most successful story of industrialization program in this country. On the other hand, it is also the most visible example of terrible environmental and health impacts in Thailand development experiences. The HIA from the Eastern Seaboard Development program aims to gain more experiences and knowledge on health impact assessment, as well as, to find the better ways in protecting and promoting local people’s health.	The WHO’s health and environment cause-effect framework has been applied to this study. According to this model, the industrial development is the driving force causing hazardous chemical uses and pollution in this area. The increasing in chemical uses and pollution becomes the pressure for local environmental quality. The air pollution and related health impacts, chemical accident, illegal hazardous waste dumping and chemical contamination in water resources and food web have been the most serious environmental problems in this area. The three epidemiological studies during 1997 to 2000 show the association between the exposure to air pollution and acute health impacts, especially in respiratory and central nervous systems. 	The state of socio-economic factors and social supports in these local communities has also been degraded. The changes in economic, social, and demographic structure cause local people to live with higher uncertainty, both in economic and social senses. The rate of out-patient per population in mental disorders, in this area, has been significantly increased, from slightly lower than regional and national average in the past to almost three times higher than regional and national average at present. The situation has become more serious after Thailand economic crisis in 1997.	The WHO’s health and environment cause-effect framework can be applied as a hypothetical model for assessing health impacts. To understand the complexity of health impacts, the combination and triangulation of qualitative and quantitative analyses are highly recommended. As a participatory learning process, it is also very important to ensure meaningful public participation within HIA process, specifically, by avoiding technical barriers.


location: , 'Thailand year: 2007 source: HSRI

title: Supplementary Treatment of Chronic Asthma Patients with Subcutaneous Embedding Soluble Chromic Catgut

abstract: In the period from March to June 2007, a trial was carried out in 14 asthmatics in
order to observe the therapeutic effects on dyspneic symptoms produced by embedding
subcutaneously soluble catgut threads. All patients, eight men and six women, aged 35 -
76 years, who had had 3-8 years of asthmatic symptoms, had received treatment with
oral bronchodilators and meter-dose inhalers regularly. The treatment technique used
soluble chromic catgut No. 0 embedded subcutaneously into an area between the midline
of the back and inner border of both scapulae at the level of the T2 and T3 vertebrae twice
one month apart. Based on the Classification Asthma Score, pre and post-treatment asthmatic
scores were compared. It revealed that the treatment had satisfactorily reduced the
asthmatic symptoms in all patients, having improved asthmatic scores in 12 of the 14
patients. The OPD visits and hospitalization were reduced. This therapeutic technique is
recommended for an alternative treatment for asthmatic patients.


location: , 'Thailand year: 2019 source: HSRI

title: Effect of Rational Drug Use Policy on Antibiotic Prophylaxis Use in Normal Vaginal Delivery in Mahasarakham Hospital

abstract: Background & Rationale: Ministry of Public Health introduced “antibiotic use in vaginal delivery of
normal term labor” as an indicator of rational drug use (RDU) service plan with target goal of not more
than 10% use. Mahasarakham Hospital implemented this RDU policy in October 2016 via meetings,
setting a goal and practice guideline together with regular monitoring and evaluation. The objective of
the present study was to examine effects of the RDU policy on antibiotic use, expenditure on antibiotic
and infection rate after implementing the policy among vaginal delivery of normal term labor in
Mahasarakham Hospital. Methodology: A retrospective study was conducted using hospital data of
vaginal delivery of normal term labor during October 2015 to April 2018. Antibiotic use and expenditure
were obtained from the 43-file standard dataset. Infection rate was collected from readmission record
of obstetrics and gynecology department. Patterns of antibiotic use after implementing the policy were
investigated from medical record reviews between October 2017 and April 2018. Mann-Whitney U test
was performed to compare antibiotic use rate and expenditure and infection rate between before (October
2015 – October 2016) and after (November 2016 – April 2018) policy implementation. Segmented
regression of interrupted time-series analysis was applied to examine policy effects. Results: Comparing
before and after policy implementation, the antibiotic use rate and expenditure were declined significantly
(median antibiotic use rate: 100% vs 13.2%, p<0.001 and median expenditure per month: 8,368
baht vs 1,328 baht, p<0.001). The infection rates were not significantly different (median: 0% vs 0%,
p=0.222). From time-series analysis, the policy significantly decreased antibiotic use rate (-82.1%, 95%CI:
-87.3 to -76.9, p<0.001) and decreased monthly-expenditure of antibiotic use (-6,663.2 baht, 95%CI:
-8,396.7 to -4,929.8, p<0.001) but no effects on infection rate by month (0.063%, 95%CI: -0.280 to 0.406,
p=0.709). From chart review of 721 vaginal normal deliveries, 45 women (6.2%) used antibiotics. The
major reason of antibiotic use was the 3rd - 4th degree tear (14 women, 31.11%). Amoxycillin and Cefazolin
were mostly used antibiotics. Conclusion: The findings of this study indicate that implementation of the
RDU policy significantly reduced antibiotic use and expenditure and did not increase infection rate. The
policy could improve rational use of antibiotic prophylaxis in vaginal delivery of normal term labor.


location: , 'Thailand year: 2009 source: HSRI

title: Global Warming and Infectious Diseases

abstract: Globalization and climate change are important phenomena in a changing world. Among them global
warming has been marked by a series of events that affect natural resources and the health of human
beings. The magnitude of global warming will depend on future emissions of greenhouse gases and climate
sensitivity. To date, global warming and globalization have the potential to influence the emergence
and re-emergence of infectious diseases. The effect of globalization on infectious diseases from vectorborne
to respiratory infection has been well established. The influence of global warming has also been
scientifically recognized; however, there is still no conclusive evidence of the effect of global warming on
the pattern of infectious disease distribution.


location: , 'Thailand year: 2013 source: HSRI

title: Health services provision for patients with chronic kidney disease by sub-district health promotion hospital

abstract: Chronic kidney disease (CKD) is an important public health problem due to high volume of patients
and high cost of treatment. Sub-district health promotion hospitals are involved in screening the high risk
group. The aim of this study was to investigate the services provided to CKD patients by the sub-district
health promotion hospitals to understand the problems and limitation in providing health services.
This survey was conducted from March-April 2012. 135 directors of the hospital in Songkhla were
recruited. The questionnaire consisted of 2 parts: 1) general information of the participating directors and
hospitals, 2) services provided by hospitals. 92 (68.1%) of the directors were female. The median age was
45±11. 13/3% of the directors had never participated in the CKD-care workshop. The number of CKDpatients
was 1±2 per hospital. No CKD patients were found in 47.4% of the hospital. CKD services were
not provided in 57.8% of the hospitals. Searching and screening were not conducted in more than 80% of
the hospitals.


location: , 'Thailand year: 2022 source: HSRI

title: The Lesson Learned on Telehealth Care Model of Home Isolation in Terms of Health Workforce in the Public Health Region 12

abstract: The COVID-19 epidemic situation is affecting the health workforce in the public health is not enough to care for the infected people. This has led to home isolation and volunteer group was formed using a telehealth care model. The objectives of this study were to 1) learned lessons from the telehealth care model of home isolation in terms of health workforce in the public health region 12 2) study the role and operation process of health workforce 3) study the success factors, problems and obstacles in the implementation of the telehealth care model with the home isolation, and 4) to synthesize lessons to form a knowledge in the 12th health zone. Used qualitative research methodology. Data were collected through structured in-depth interviews. And online group discussions with 30 volunteers and 50 patients. Data were analyzed by qualitative content analysis. Data is checked at every step of the analysis. Using a triple check Content Analysis and interpretations creates conclusions. The results of the study revealed that the telehealth care operation model with the home isolation system consists of 1) Building human resources in the form of volunteering to help carry out work in caring for home isolation patients. 2) Understanding common goals by explaining the objectives and goals of work to all volunteers. 3) Organizing training sessions to provide knowledge on various issues related to the care of COVID-19 patients. and 4) Follow up on the activities of volunteers through online meetings. The role and operation process consisted of 3 teams: the central team, the patient follow-up team, the community team, and the corps volunteer team. The key success factors were attitudes, thoughts, beliefs towards volunteer work. Knowledge and process of developing knowledge and competence of the volunteer team the problems and obstacles encountered include accessing the database system. Health workers are not only health officials, but may also come from those who consciously go through the step-by-step construction and development process. Health promotion consultation during the operation of the system.


location: , 'Thailand year: 2003 source: HSRI

title: The development of health impact assessment process for small and medium enterprise promotion policy

abstract: The study of health dimension and the development of small and medium scale industry (SMIs) has 4 objectives. Firstly, it is to review the situations and the trend of SMIs development towards production, employment, and consumption. The second is to review the development plan of policy, laws, promotion and support policy towards SMIs development. The third is to specify the analytical and health impact assessment framework of SMIs development. The last objective is to reveal and get feedback of setting this analytical and health impact assessment framework on SMIs development. Besides, the study aims to specify the framework of SMIs policy development in which it affects people’s health.The study uses the Health Impact Assessment (HIA) approach as the tool in order to specify the scope of factors that affect health. The methodology of the study includes literature review, the interviews with concerned organizations and five case studies; those are foods and product manufacturing industry, sub-contract production, rice mill industry, the industries affected urban environment, and ceramic and pottery industry.According to the monitoring report on Thailand’s SMEs in 2001 by the SMEs Promotion Office, it is found that during the year 1994 to 2000 SMEs had a 40% proportion of its Gross Domestic Product (GDP). The value was approximately 3.6 to 4.9 thousand billion Baht a year. The production sector had a 25% proportion in the SMEs Gross Product.In 1999, there were totally 99,568 SMIs’ manufacturers; 4,057 manufacturers were medium industry and 95,511 manufacturers were small industry. More than 40% of these firms were in the North-East, the next ranks were 18.3% in Bangkok and 13.7% in the North. More than half of all firms was foods and beverages industry. The other main industries were metallic product industry, non-metallic product industry, and machinery and equipment industry. The employment in SMIs was about 1.928 million labours: 57.0% of the total amount in manufacturing sector. In this figure, more than 78.5% was the employment in small industrial firms.The framework of SMIs development policy of Thailand has been stated in all National Social and Economic Master Plan. It is more emphasized in the government of Chatchai Chunhawan and has been pushed into practical work in the government of Taksin Chinnawat. Until 1997, the SMIs development was only a part of the industrial development. The SMIs was expected to support large scale industry in the production and to be input material suppliers. After the economic crisis in 1997 the SMIs development has been supported with many effective economic measurements. Besides, the SMIs development policy aims to (1) initiate the development of supported industries, and connect them to large scale industry development, (2) create employment for a number of labours in non-agriculture sector, (3) create the locals income, and (4) promote SMIs to play an important role in Thailand’s economic growth instead of large scale industries that are affected by the economic crisis.Before the economic crisis the process of SMIs policymaking was not in clear figure. After the crisis, the government’s policy plays its role in the SMIs development clearly. It is operated through the operations of concerned government’s organizations. It is also opened to private sector to become participants of continued policy development. Meanwhile, the laws concerned SMIs development accordance with 4 stakeholders; producer, labour, consumer, and environment; are most related to producer merely. The laws related to labour and consumer are most about the protections, but the laws related to environment are in general enforcement; not specific to the SMIs.From the review of the situations and the trend of SMIs development towards production, employment, and consumption and the review of the development plan of policy, laws, promotion and support policy towards SMIs development, the study hereby proposes 2 aspects of the analytical and health impact assessment framework on the SMIs development policy.In which way does the development policy aim to benefit for health?What are the continuous effects of the development and what are the results?In addition, there are 4 basis principal that should be considered in long term;the equity of accessibility and using policy, the stakeholder of each policy must be concernedthe fairness of resources distribution from using the policy in which it could reduce the unequal social and economic structurethe impacts of using policy towards health rather than the target to the economic growth onlythe policy-makers and people affected by policy should be co-developers of evident based and knowledge


location: , 'Thailand year: 2021 source: HSRI

title: The Development of Community Participating Heat-Health Warning and Heat-related Illness Surveillance Systems

abstract: This project is a participatory action study. The objective was to develop two related systems, where the Tambon Health Promoting Hospital is the core of implementation comprising of the heat-health warning system and the heat-related illness surveillance system. The development of the heat-health warning system was based on a concept proposed by the World Health Organization, namely: 1) Weather forecasting using data from the Meteorological Department; 2) Setting the threshold temperature based on the method from the study of Phongtape Wiwatanadate (2016) under the project “The Development of Health Warning System and Mechanism for Heat-Related Illnesses” and analyzing the data obtained from the Nakhon Sawan Provincial Health Office for the past 5 years and 3) Issuance of watch/warning messages to related persons including identifying vulnerable groups through participation from the community and all stakeholders in every step. Nonetheless, this project has added a fourth step of activity, namely monitoring, providing advice and first aid to vulnerable groups, carried out by village health volunteers in collaboration with caregivers. Development of both passive and active heat-related illness surveillance systems was also carried out at the target sub-district level. It was adapted from a surveillance model developed by the Centers for Disease Control and Prevention (CDC), which has four steps: 1) data collection, 2) data analysis, processing and interpretation, 3) summarizing the surveillance results and reporting the results of the surveillance to those involved, and 4) corrective action or prevention of problems. The duration of the project was 1 year and 6 months with the pilot area being Klang Daet Sub-district, Mueang District, Nakhon Sawan Province. The outcome of the heat-health warning system between 1 March-to 30 April, 2020 (2 months) showed that the warning level in the "warning" level (level 3) (temperature above 39 degrees Celsius) was the highest for 25 days and there were 28 cases of heat-related illnesses. Most cases were found at Moo 6, a total of 30 cases. The most common disease was heat syncope, totally 39 cases. No cases of heatstroke were found. For the heat-related illness surveillance system between March 1, 2020 and February 28, 2021 (1 year), it revealed that the warning level of "surveillance" (level 1) (temperature below 37 degrees Celsius) was the highest totally 280 days. Most cases were in March 2020, with 42 cases. Most cases were found at Moo 6, a total of 36 cases. The most common disease was heat syncope, with 47 cases. The ratio of female : male was 1.6:1. The top 3 most common age group were 65–69 years old, followed by 50–54 years and 60–64 years old, respectively. The top 3 risk factors were working outdoors or in a hot place, drinking tea or coffee, and having heart disease or high blood pressure, respectively. No patients with heatstroke were found. The overall project evaluation found that the sub-district agencys, such as the Tambon Health Promoting Hospital, together with the village health volunteers, were able to operate both systems by themselves without difficulty, not adding too much workload as it can be integrated with other activities that are routinely performed. Most importantly, there is almost no budget required for the activities, but it can prevent morbidity and mortality from heatstroke. Policy Recommendations Policy recommendations are divided into 3 levels as follows: 1. Provincial level. Nakhon Sawan Provincial Health Office should be the key to expanding the project area. It may begin with a meeting of the heads of district government agencies to establish policies for implementing the heat-health warning and the heat-related illness surveillance systems at least 1 sub-district per district in the first year and making an assessment to expand the project to other sub-districts in the following years. It can get the funding support from the Health System Research Institute. 2. National level. The Ministry of Public Health may issue the policy to implement the heat-health warning and the heat-related illness surveillance systems according to the guidelines presented in this report by piloting one sub-district in each province in the summertime for a period of 3-4 months, and then gradually expanding to cover the entire province. It may use the same policy implementation guidelines at the provincial level aforementioned. 3. Health System Research Institute (HSRI). It may present the results of the study in this project to the meeting of HSRI Board of Directors to propose to the relevant departmental administrators of the Ministry of Public Health, such as the Office of the Permanent Secretary, Department of Disease Control, Department of Health, Department of Medical Services, Department of Health Service Support, etc. in order to have policy-making and driving at the national level.


location: , 'Thailand year: 2009 source: HSRI

title: Studying and Monitoring the Development of the Transfer System of Public Health Centers to Local Government Organizations

abstract: This study utilized qualitative study papers and reports on the process of decentralizing health care. The study employed a quantitative method, using questionnaires on 8,199 villagers. It was aimed at understanding the process of the transfer system of public health centers (PHCs) to a local government organizations (LGOs). Specifically, the study focused on the process of setting up the transfer mechanism, monitoring the product and output, analyzing and summarizing the lessons learned, as well as providing policy recommendations relating to the mechanism and structure for transferring the PHCs to the LGOs. The research was conducted from September 2007 to October 2008.
Research results confirmed that the PHCs under study followed the mechanism and process of the transfer system to the LGOs. However, some difficulties pertinent to time constraints and communication problems at all levels were encountered. With respect to the product, we have discovered that there were four types of transfer system: (1) the complete transfer of PHCs and personnel; (2) the complete transfer of PHCs and some personnel; (3) the transfer of some PHCs with all the personnel of those PHCs; and (4) the transfer of some PHCs with some personnel. The majority of the PHCs employed the second type. Different types impacted the management of work, budget, personnel and materials differently. Relating to the  output, we have learned that the ideas and paradigms of public health decentralization to local areas were significant and made the transfer system efficient by generating people’s participation and coordinating consistently with the public health network. In terms of policy and development strategy implemented at the local level, we have discovered that they emphasized the idea of  ervice to all, stimulated proactive work, and improved policy, strategy and planning for public health and environmental activities parallel to the development of the infrastructure. Also, we discovered some problems relating to the management of work, budget, personnel, property,  aterial, medicine and medical supplies following the imprecise rules and regulations issued by the Ministry of Public Health and the Ministry of Interior. Factors contributing to the success of the transfer included cooperation, leadership ability, having organizational vision and management ability in the LGOs.
Recommendations for transferring the PHCs to the LGOs are as follows. At the policy level, the national decentralization committee should have a clear integrated policy and establish a national coordinating body to be responsible for informing the public of the value, ideas and benefits of public health decentralization. At the provincial and district levels, it is necessary to have a proper academic supporting mechanism based on the participation of all parties concerned for monitoring and supporting the transfer of the PHCs to the LGOs smoothly and to communicate efficiently with all parties concerned during and after the transfer. At the community level, we suggest that the LGOs and the PHCs should abide by the principle of people’s participation, starting from local public organizations to local civil societies in decision-making for the transfer of the PHCs to the LGOs and in supporting community health development planning.


location: , 'Thailand year: 2008 source: HSRI

title: Tuberculosis situation in four community hospitals in Nakorn Ratchasima province, 2005-2007

abstract: The aims of this research were to examine the situation and epidemiology of tuberculosis
in four district hospitals in Nakhon Ratchasima Province in fiscal years 2005-2007.
All tuberculosis patients registered between October 2004 and September 2007 were selected
for the study.
The research instruments consisted of OPD card, treatment card, tuberculosis record,
and sputum examination record. The data were analyzed by using descriptive statistics.
The results showed that prevalence rates were 74.3, 112.1, 81.1 per 100,000 population
respectively in 2005-2007. Incidence rates were 64.9, 100.7, 69.0 per 100,000 and mortality
rates were 8.1, 14.0,3.5 per 100,000 respectively during that period. The success rate
was 73.5 percent and cure rate was 53.5 percent. The percentages of HIV infection in
tuberculosis cases were 4.7, 5.8 and 11.0, increasing by year, with a high mortality rate of
44.2 percent.
A high success rate was found in the occupation of civil servants (100%), students
(100%) and prisoners (91.9%). Tuberculosis cases with diabetes mellitus were also found
to have a high success rate (100%). Directly observed therapy (DOT) by health personnel
produced a relative risk of 1.33 significance compared with no direct observation. However,
DOT, with observation by cousins, showed no significant difference compared with
that produced by no direct observation.


location: , 'Thailand year: 2016 source: HSRI

title: Time-to-Treatment of Stroke Patients: Experience from Ubon Ratchathani Province, Thailand.

abstract: Treating ischemic stroke patients with recombinant tissue plasminogen activator (rtPA) no more
than 3 hours or 180 minutes after the stroke can increase the chance of recovery or improved condition. If, however, treatment is delayed, the potential outcome may be permanent disability or death. This descriptive
study was conducted with the objective of assessing time elapsed before treatment in ischemic stroke
patients and analyzing the factors influencing the amount of time elapsed before ischemic stroke patients
receive hospital treatment. The sample group was composed of 300 ischemic stroke patients treated at
Sanphasitthiprasong Hospital in the province of Ubon Ratchathani, Thailand. Data were collected from
November 2014 to February 2015. The following three sets of instruments were employed: 1) Demographic
Data Questionnaire; 2) Ischemic Stroke Evaluation Form and 3) Time to Treatment Evaluation Form. Data
were analyzed by descriptive statistics and the correlations by using Spearman’s correlation coefficient.
According to the research findings, 229 of the 300 ischemic stroke patients (76.3%) had pre-hospital
times of more than 180 minutes. The median pre-hospital time from the occurrence of stroke to hospital
arrival was equal to 302.5 min. The amount of time elapsed from arrival in the emergency room at
Sapphasitthiprasong Hospital until receipt of treatment (in-hospital time) was equal to 107.5 min. Therefore,
the median time from the initial presenting symptoms until treatment was equal to 590 min. Furthermore,
the pre-hospital time, the distance from the site of the incident to the hospital and the in-hospital
time from arrival until receiving laboratory test results were found to be positively correlated with the
pre-hospital time from the initial presenting symptoms until receipt of treatment (rs = 0.661, 0.185, 0.235,
p < 0.01). The severity of symptoms evaluated with National Institute of Health Stroke Scale (NIHSS)
scores was found to be negatively correlated with pre-hospital time (rs = - 0.129, p < 0.05).
In summary, most ischemic stroke patients within the boundaries of Ubon Ratchathani receive delayed
treatment in which the pre-hospital time has the highest correlation with receipt of treatment and
instructing patients, people at risk for ischemic stroke and their relatives. Moreover, the development of
an emergency medical service provision system and a hospital referral system that minimizes procedures
and time in transferring ischemic stroke patients is vital to helping ischemic stroke patients receive timely
treatment.


location: , 'Thailand year: 2023 source: HSRI

title: A Whole Exome Study of Sudden Unexplained Nocturnal Death Syndrome in Young-Adult Thai Population

abstract: Genetic testing for identifying genetic factors underlying diseases or their correlations with disease development is widely used in medical research. It can be employed to search for elusive disease-causing genes or genes contributing to complex diseases, leading to treatment and prevention strategies. The concept has been applied to investigate the causes of sudden unexplained nocturnal death within the young population, particularly in Thais. Studying the exome of deceased individuals is valuable for identifying potential gene factors that may be related to or responsible for their demise. Previous studies have focused on single gene, such as those associated with channelopathies related to sudden cardiac death. These genes were found to be interconnected and systematically organized. However, due to the unique nature of sudden unexplained nocturnal death, the causative factors might differ from the previously studied groups. This forms the basis of the current research. In this study, blood samples were collected from a sample group of 98 deceased individuals and 2 deceased relatives. Comprehensive genetic analysis was performed on whole exomes study. The results were then compared against medical databases and classified according to bodily systems, such as the cardiovascular system, nervous system/brain, and metabolism. The study presents genes identified within Thai population, categorized based on various factors that could potentially contribute to their demise. Additionally, novel genes were discovered, both within the nervous system and brain, as well as the cardiovascular system, which could be significant contributors to fatalities.


location: , 'Thailand year: 2012 source: HSRI

title: The national health promotion and disease prevention policies targeting children age 0-5 years  among the Middle Eastern Countries

abstract: The review of international experiences focusing on national policies on child health promotion
and disease prevention of the Middle East region was part of the development of health promotion and
disease prevention policies for children aged 0-5 years in Thailand. This article aims to draw lessons about
the selection, implementation, tools and management of policies that are relevant to identified health
problems in Thailand.
The Middle East region consists of many countries and even though they have fuel resources and are
relatively wealthy from oil exports, the poor education and instability of the government in some of these
countries worsen their quality of life. The World Health Organization (WHO) and other international
organizations conduct the majority of health promotion and education activities. In this review article, the
author found that the nutritional policies which point to mineral and vitamin supplements are interesting
because the distribution of these supplements in at-risk groups free of charge was effective. Another project
that is noteworthy was the flour fortification project because it fit well with the population’s high consumption
of wheat products and did not change their daily lives. The disease prevention policy through
newborn screening programs was well-developed. If appropriate screening tests that are applicable and
cost-effective in Thailand’s population are chosen, we might benefit from early detection and prevention
of additional diseases affecting child health in the future.


location: , 'Thailand year: 2007 source: HSRI

title: Comparison between Breast Massage Alone and Breast Massage Combined with a Warm Compress in Increasing Milk Production in Post-partum Mothers

abstract: This non-randomized controlled study was carried out in order to compare the efficiency
of simple breast massage with breast massage combined with warm compress
regarding milk production in 1,150 non-complicated postpartum women in five district
hospitals of Sakhon Nakhon Province. The subjects were assigned to two groups. The
first group of 567 pregnant women went into labor during the period 1 October 2005 - 31
March 2006. The second group comprised 583 pregnant women who went into labor
during the period 1 April 2006 - 30 September 2006. The first group had only simple
breast massage after vaginal delivery. The second group had breast massage with a warm
compress after vaginal delivery. The proportion of pregnant women producing milk within
six hours, and within 48 hours post partum was measured. The proportion of pregnant
women in whom the production of milk started within six hours post partum: 1st group
and 2nd group, was 61.9/97.1 percent respectively; those producing milk within 48 hours
post partum: 1st group and 2nd group was 75/98.8 percent respectively. The differences
were statistically significant (p < 0.001) in both groups. The conclusion of this study is
that breast massage with a warm compress is a better method than breast massage alone
in promoting milk production within six hours post partum and effectual milk production
within 48 hours post partum.


location: , 'Thailand year: 2011 source: HSRI

title: Antibiotics Prescribing for Acute Diarrhea at Pua Crown Prince Hospital, Nan Province

abstract: Antibiotic prescribing for acute diarrhea was common among prescribers although most for acute
diarrhea conditions were not caused by bacterial infection. The purpose of this study was to investigate
antibiotics prescribing for acute diarrhea in the outpatient department in Pua Crown Prince Hospital,
Nan province. Medical record of the targeted patients during 1 January to 31 December 2009 were evaluated
regarding antibiotic prescribing. Criteria for antibiotic prescribing for acute diarrhea included having
fever (38o C or above) and mucous or bloody stool or stool exam with red blood cell and/or white
blood cell. Result showed that of a total of 613 patients with acute diarrhea, 406 patients (66.23%) were
prescribed antibiotics. For patient who received antibiotics, 90.40% were identified as irrational antibiotics
prescribing. This data showed that clinical practice guideline was important data to make good decision
to start antibiotics in patient with acute diarrhea.


location: , 'Thailand year: 2000 source: HSRI

title: Health system reform visioned by social development leaders

abstract: This study objective was to synthesise a number of vision, philosophy, and view regarding health reform system in Thailand in order to put these inputs into public debate. A number of social development leaders which were 3 politicians, 5 academics, 4 community leaders, 2 businessmen and 1 representative from mass communication group, were interviewed from August 1999 to February 2000. Prior to the interview, the VDO program was shown to the interviewee and the questions were previously structured. 	The study found that problems and changes in health system were complicated. The most problematic cause was ill- or un-informed people about health leading to risk living behaviour and poor health. Health system itself particularly lack of health insurance and care quality also jeopardised people’s health. In views of most interviewees, desirable health system should be composed of good cooperation in multi-groups, emphasis on health prevention and promotion, proper structure to support the system, effective political system, response to principles of equity and society’s needs Health system reform needs vision at various levels from top (policy) to individuals. Health reform should be considered as a national goal by having clear policy, strengthening public involvement, creating health insurance, administrative decentralisation, appropriate standard of care, people centred service management, support and supervision by the government, ethical providers and people’s awareness of health


location: , 'Thailand year: 2011 source: HSRI

title: Working Process and Supporting Factors and Barriers for the Development of Public Health Programs under the Sub-district Administration Organization in Nakhon Si Thammarat Province

abstract: The objectives of this mixed method study were: (1) to study situation of public health operation of
sub district administration organizations in Nakhon Si Thammarat ; (2) to study role, working process
and outputs of the sub district administration organizations related to development of public health activities; and (3) to identify conditional factors that influenced or hindered implementation of projects for
health development under the sub district administration organizations.
The population of the first phase study was 81 sub district administration organizations in Nakhon
Si Thammarat Province. The data analysis was performed using descriptive statistic. In the second phase
Thakuen sub district administration organization was selected as a case study among sub district administration
organizations and followed by the analysis using content analysis method.
The result of the first phase study showed that most sub district administration organizations were
in medium size. Most of the public health officers were untitled personnel of the manager offices (43.2%),
followed by community health development workers (35.8%). In terms of health projects, the most common
type was those for prevention and control of dengue fever (92.6%). The most successful projects were
those concerning surveillance and solving of problems of malnutrition, supporting to health centers for
their curative care services and supplying of essential drugs to community centers for primary health
care. All successful health projects (100%) were found to have promoting factors as cooperation of the
various organizations in the community such as community health volunteers and health clubs (80.25%).
The main obstacles were lack of knowledgeable, human resources and funding.
The results of the second phase of the study showed that the beginning point of public health development
by the sub district administration organizations was when they enrolled in local community health
fund. The working process was jointly carried out by sub-district administration organizations, local health
centers, community health volunteers, and health clubs. The main factors for successful health development
were team leadership, team working, strong community health volunteers and general public involvement.
Enabling factors are public-mind consciousness and open-mindedness of the public health
staff. The problems and obstacles were lack of experience in community health fund and the indifference
in health by some groups of the people.


location: , 'Thailand year: 2001 source: HSRI

title: Health insurance problems and needs of agricultural informal sector workers

abstract: Those working in the agricultural informal sector were at disadvantage in getting access to the public service. They lacked assets and were at health risk owing to their occupations. This study was aimed at finding out their problems, needs, readiness and cooperation concerning the health insurance system in order to determine some ways to deal with their health insurance. The samples of the study were those who were engaged in farming, plantation, fruit-growing, animal-raising, and fishing. The studied areas were Chiangmai, Khonkaen, Suphanburi and Trang. The data were collected by interviewing household heads in individual occupations and holding focus group discussion with community leaders and government officers in the study area. It was found that working characteristics depended on their earning assets and land and the environment. Occupation inputs were investment funds, labor and agricultural materials. The uncontrollable external factors, such as prices of produces and fishery sources were main conditions. Those working in the agricultural informal were different from general agriculturists in that they had to follow the regulations set by others, i.e., public organizations and officers, employers or product purchasers and other influential people, such as capitalists, and local leaders. Because they had to rent land, encroached forest reserves, lacked public utilities, lived in remote areas, could not get access to current news and modern technology. They entered the occupations in either of the two ways : 1) succeeding their ancestors, and 2) seeking a new occupation because of the failure in the old occupation or in the old workplace. Moreover, it was found that most of the household members completed elementary school. They received news or information at a low level. There were not many working hours each day and the productivity was low. They lacked motivation as a result of drops in prices of goods, lack of funds, and inadequate agricultural land. Their yearly incomes ganged from 20,000 to 30,000 per household. More than half of the sample's expenses exceeded the income and they were in debt. Working problems were that they did not form a group, lack of continuing activities. It was difficult for them to solve their own problems and to do so required high expenses. They did not prevent themselves from health problems; on the contrary, they sought treatment after they were ill. They had risky behavior because they drank, stroked, and took pain killing or stain-releasing medicines. Some also encountered health problems resulting from their occupations such as fishery. Some used chemical substances to a great extent in cultivation and some suffered from pollution in the environment. To deal with these problems. It was necessary to organize a system, to identify of classify health insurance people into groups, to set criteria for evaluation, to define the scope, and to update the data every 6 months. Responsible agencies should be established and power should be decentralized to local government. Cooperation among agencies should be sought. The health system should be built, taking into consideration the area, function and participation (AFP). Emphasis should be put on providing health insurance with a charge of 300-500 baht yearly or seasonally. Also, health prevention measures should be of primary concern. Those responsible for collection the fees should be the municipality and the tambon administrative organization. The follow-up and evaluation of the health insurance project should be carried out continuously.


location: , 'Thailand year: 2020 source: HSRI

title: Revision of National Health Assembly Resolution: Thailand ban asbestos measure

abstract: Every form of asbestos is carcinogenic. Workers and general population exposed to asbestos can suffer negative health effects. Although, the third National Health Assembly’s Resolution (2010) proposed asbestos ban measures and the cabinet on April 12, 2011 approved the resolution, asbestos is still in use in Thailand. Some government agencies have not followed the resolution arguing too few asbestos- related cases to reach cost-benefit of the asbestos ban. Recent data reveal the increased numbers of asbestos-related patients and new measures to reduce the risk of developing asbestos-related diseases. Therefore, it is necessary to revise the National Health Assembly Resolution at the twelfth National Health Assembly: Thailand’s asbestos ban measures.


location: , 'Thailand year: 2010 source: HSRI

title: Effects on Bowel Function of Using a Rockingchair after Abdominal Surgery in Gynecological Patients

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


location: , 'Thailand year: 2023 source: HSRI

title: Lessons Learned from the Tertiary Health Service Systems during Critical COVID-19 Pandemic in the Northeast of Thailand

abstract: The objective of this mixed-method research was to study the lessons learned from organizing health service systems at the tertiary level in the northeastern region of Thailand during the critical pandemic of COVID-19. The study focused on the health care capacity and utilization and the six building blocks frameworks, examining the tertiary hospitals in Khon Kaen, Udon Thani, Surin, and Ubon Ratchathani in the northeastern region of Thailand. The data sources included health region administrators, provincial and hospital managers, COVID-19 committees, medical personnel, environmental workers, and stakeholders from the community. The research was conducted from September 2021 to February 2022, using health-care capacity and utilization assessment tools including in-depth interviews, focus group discussions, and lesson learned extraction. Quantitative data were analyzed using percentages and averages, and qualitative data by content analysis. The research findings plus lessons learned were as follows. 1) The emergency operation center committee’s province played a crucial leadership role. 2) Managers and practitioners collaborated, participated, managed, and took responsibility together. 3) Intersectoral networks supported cooperation and resource sharing. 4) Information and communication technology was used for decision-making by managers. 5) The screening principles for COVID-19 of rapid knowing, detecting, isolating, quarantining, and treating were followed. 6) Preparedness of personnel capacity framework. 7) Competency development of personnel through mentorship, peer support, and networking. 8) Employed SMART principle in management and administration. 9) Enforced seamless referral of patients. 10) Provided knowledge and understanding to practitioners and service recipients. These lessons learned could be effectively applied to tertiary hospitals in future contexts.


location: , 'Thailand year: 2022 source: HSRI

title: Model Development Using Healthier Choice Nutrition Symbol for Promoting Health of Noodle Consumers in Mueang Lampang District

abstract: The aims of this research and development were to 1) develop a model and 2) study the effectiveness of using the healthier choice nutrition symbol in noodle shops, Mueang Lampang district, Lampang province. The research process consisted of 4 steps: 1) analyze, assess needs by in-depth interview with relevant parties (R1). 2) Design and develop of a model by adjusting the noodle soup recipe using low sodium seasonings to replace the original seasonings (D1). 3) The experimental model consisted of guidelines for adjusting soup recipes, how to cook soup, measurement of sodium salt content in the soup, placement of healthier choice nutrition symbol seasonings in the shop (R2), then assessing knowledge, attitudes, and behaviors on healthier choice nutrition symbol and sodium salt content in noodle soup in the experiment group, assessing satisfaction on new noodle soup recipe with 16 purposively selected experiment samples. Data were collected by using a questionnaire and an in-depth interview. 4) The evaluations on knowledge, attitude, behavior, sodium content in soup and post-satisfaction were undertaken to improve the final optimal soup recipe (D2) using content analysis from group discussions. The results found that: step 1, noodle shop owners realized the need to reduce the use of sodium salt in soup. Step 2, developed new soup recipe using soy sauce containing potassium chloride to replace the original sodium salt. Cooking manual was developed as guidelines explaining new recipes, how to cook soup, measuring the amount of sodium salt and placement of extra seasonings in a noodle shop. Step 3, after serving new soup recipe, the noodle shop owners gained better knowledge, attitude and behavior, with reduced sodium consumption. They were satisfied at the highest level. Step 4: The evaluations revealed that the amount of sodium salt use decreased from the daily measurement. However, the present study was just a pilot scale with small sample size. The model should be extended to a larger population for more reliable results.


location: , 'Thailand year: 2015 source: HSRI

title: The Administration of the Collaborative Project to Increase Production of Rural Doctor (CPIRD), and the One Doctor One District (ODOD)

abstract: This study aimed to explore administrative and management system of the Collaborative Project to
Increase Production of Rural Doctor (CPIRD), and the One Doctor One District (ODOD) programs by
using qualitative study methods: document reviews, in-depth interviews and group interviews of 56
stakeholders. The stakeholders consisted of the Office of Permanent Secretary, the Office of Collaborative
Project to Increase Production of Rural Doctor, medical faculties, medical education centres in affiliated
hospitals, and provincial health offices (PHOs). Content analysis was employed for data analysis.
The results showed that the Office of Collaborative Project to Increase Production of Rural Doctor
plays important roles for overall management including proposal endorsement to the cabinet, quotas and
the criteria for admissions determination, budget and procurement procedures, and student database
establishment. Medical schools are responsible for the selection of medical students and teaching medical
students in preclinical years while medical education centres have been taking care of students in clinical
years. All three units are highly coordinated and consistent. While the PHOs play vital role on monitoring
the contract and the work of the medical graduates under the project. The budget and personnel
administration are managed under the Ministry of Public Health regulations and universities.
This study recommended the Ministry of Public Health establishes long term status of the CPIRD
and ODOD program. In addition, it requires the improvement of management for overlapping location of
student recruitment by establishing the network among the program and medical schools according in
individual geographical areas. Moreover, promoting roles of PHOs in tackling with rural physician
shortage is recommended.


location: , 'Thailand year: 2012 source: HSRI

title: Employment benefit packages to attract health workforce in public health facilities

abstract: As the health needs increased, health workforce requirements have been increased too. However,
the policy to downsize the civil servant positions implemented has made the Ministry of Public Health
failed to attract and retain health workforce into public health facilities. This study therefore aimed to assess the factors affecting the health workforce’s decision making in choosing public health facilities as
their job of choices. A Discrete Choice Experiment (DCE) tool was used and that each health workforce
was asked 16 questions to choose between 2 jobs which have different attributes. The data were analyzed
by conditional logistic regression.
The findings showed that both financial and non-financial incentives played important roles in health
workforce decision making to choose their job of choices. Benefit packages that were significantly associated
to their choices of non-civil servant positions were: salary increase at 20%-40%, career advancement,
opportunity for continuing education, bonus provision, pension fund and a longer employment contract.
The results indicated that the government needs to develop the appropriate employment packages that
could attract health workforce in public sectors. The attractive benefit packages comprise: higher salary,
career advancement, opportunity for continuing education, bonus provision, pension fund and longer
employment contract. These packages could be attractive for health workforce to choose to be hired as
non-civil servants.


location: , 'Thailand year: 2022 source: HSRI

title: Life, Health and Health Service Accessibility of Urban Vulnerable Population: A Study of Aging Immigrant Workers in Bangkok

abstract: 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.