location: , 'Thailand year: 2015 source: HSRI

title: The Daily Energy Expenditure of 4 Domains of Physical Activity of Thai Adults

abstract: This study aimed to determine the amount of energy in total and by physical activity domains (Activity
at Work, Transportation, Recreational Activities, and Sedentary Behavior) of Thai adults, and disaggregated
by subgroups of participants. The study re-analyzed data of 22,136 Thai adults aged 15 and above from the 2007 National Physical Activity and Obesity Survey conducted by ABAC Poll Centre of
Assumption University. Descriptive statistics were defined in the analysis. The results showed that the
average total daily energy expenditure was 1,239 kcal and the average daily energy expenditure in work
domain was the highest at 523 kcal, followed by sedentary, transportation, and recreational activity domains
at 409, 180, and 126 kcal, respectively. Male participants aged 25-44 living in rural areas including
farmers and laborers, and those who had the lowest education level and income level spent the highest
total daily energy expenditure and energy expenditure in work domain. In contrary, women, elderly,
unemployed people and students spent the lowest energy.


location: , 'Thailand year: 2023 source: HSRI

title: Development of Telepharmacy Practice Guideline in Thailand

abstract: Although the Pharmacy Council has launched the Guidelines for Telepharmacy, it required additional details for implementation. The present study aimed to develop the standard practice for telepharmacy and guidelines for pharmaceutical care and to design data architecture that supported and facilitated the operation of telepharmacy. This developmental research was designed into 2 phases. The first phase combined literature review, focus group discussion, and stakeholder hearing with the aim of developing the basic guidelines for telepharmacy and guidelines for pharmaceutical care. Minimum dataset consisting of patient data, prescription, dispensing, logistics, and guidelines for pharmaceutical care was an output and recommendation of phase I study. The results from the first phase were inputs for stakeholder consultation of the second phase. The output of phase II study was the telepharmacy data architecture compliance to HL7 FHIR (health level 7 fast healthcare interoperability resource) for telepharmacy data sharing consisting of patient personal information, health data, treatment history, and logistic statistics. The recommended data architecture of the phase 2 study was named “Thailand Telepharmacy Profile”. Finally, this present study proposes the Pharmacy Council of Thailand to implement the guidelines and standard data set.


location: , 'Thailand year: 2019 source: HSRI

title: Alcohol Drinking and Provincial Alcohol Problem Index (PAPI) in Thailand: The 2017 Survey

abstract: The objective of this study was to report drinking patterns and alcohol-related health risks using Provincial Alcohol Problem Index (PAPI) of Thai population by region and province. Data from the 2017 Cigarette Smoking and Alcohol Drinking Behavior Survey, a stratified two-stage random sampling to select 120,003 Thai participants aged 15 years and over, were analyzed using descriptive statistics. The prevalence was estimated by weighted proportion and presented at national, regional and provincial levels. A composite PAPI score, ranging from 0-1, was also calculated to represent a relative level of alcohol risk problem in each province. At regional level, the Northern and Northeastern regions had the highest prevalence of adult (35.4% and 32.8%, respectively) and adolescent drinkers (19.0% and 16.8%, respectively), while the Central and Southern regions had the highest proportions of regular to heavy drinkers and drink driving. Provinces with the highest PAPI score were scattered in the Northern and Central regions, including Lampang (0.72 point), Chiang Rai (0.69 point), Phitsanulok (0.65 point), Chantaburi (0.64 point) and Sukhothai (0.63 point). This study showed that alcohol use and related problems remained significant health issues in Thailand with a diversity of specific problems that needed to be prioritized in each local area. Lampang, Chiang Rai, Northern, and Northeastern regions should urgently consider these issues. These hence warrant comprehensive measures targeting both establishment of local community actions and national alcohol policies.


location: , 'Thailand year: 2023 source: HSRI

title: Empirical Evidence of Medication Adherence in Patients with Non-communicable Diseases in Community of Thailand: Using Integrated Review and Delphi Technique

abstract: Introduction: Non-communicable diseases (NCDs) constitute significant contributors to global morbidity and mortality, with Thailand being no exception. Adhering to prescribed medications plays a pivotal role in the treatment and management of these diseases. Nevertheless, more than half of the patients encounter difficulties in adhering to the recommended treatment regimen. This not only affects patients in terms of complications, disability, premature mortality, but also leads to escalated healthcare costs attributed to the care of patients with complications and disabilities. In the Thai healthcare context, there appears to be a dearth of understanding regarding the definition and significance of medication adherence among healthcare providers, alongside policy-level factors linked to this crucial aspect of treatment. Previous studies have primarily concentrated on patient-level determinants. Specific objectives: 1) To synthesize knowledge regarding the definitions, meanings, and policy factors that influence medication adherence of patients with NCDs, based on relevant documents and research studies both domestically and internationally. 2) To analyze the definitions and meanings of medication adherence among patients with NCDs attending community hospitals under the Ministry of Public Health of Thailand. Additionally, to investigate the policy factors affecting medication adherence through expert consensus. Method: This study synthesizes knowledge related to the definitions, meanings, and policy factors influencing medication adherence in patients with NCDs, employing Cooper’s literature synthesis method (2007). This acquired knowledge is subsequently utilized to formulate the initial set of questionnaires, encompassing the definitions and meanings of medication adherence, as well as policy factors. The questionnaires are further assessed for expert consensus using the Delphi technique, gathering opinions from 21 experts, divided into three distinct groups. The first group, consisting of five experts, is responsible for decision-making, involvement, and oversight of medication policies. The second group, comprising twelve experts, focuses on implementing policy responses related to medication and its usage. Finally, there is a group of four academic experts. Data is collected in two rounds to solicit opinions from these expert groups. In the second round, the same questionnaire is employed, enriched with median values, interquartile ranges, and reference points, allowing experts to provide self-assessments and evaluate their responses in comparison to the group's collective input before finalizing or revising their answers. The data analysis encompassed an examination of responses from questionnaire rounds 1 and 2. The median and interquartile range were used to gauge the significance of the identified factors. Experts exhibited consistent responses (median ≥ 3.5, interquartile range ≤ 1.5), though a 12.02% variation indicated divergent views. Consequently, the researcher finalized the questionnaire and summarized the findings. Round 1 data was collected from December 15, B.E. 2565 (2022), to March 18, B.E. 2566 (2023), and round 2 data was collected from April 15, B.E. 2566 (2023), to May 15, B.E. 2566 (2023). Results of the Study: 1) Definition and meaning of medication adherence in patients with NCDs in Thailand, Experts are highly to most highly agree, and have consensus across all six dimensions and 18-item checklist includes items ranging from 3.77 to 4.88 (IR = 0.61-1.38). 2) National drug-related policy: This encompasses both the national drug policy and the main national drug formulary, the Public Procurement and Supplies Administration Act B.E. 2560 (2017), as well as the policies and core regulations concerning the rights and costs of treatment and medication for chronic disease patients. Experts agree these impacts on the management of chronic disease medications in hospitals and the prescription of medications by physicians, ranging from a high to the highest level of impact and consistency across the two dimensions. Additionally, an 8-item checklist with items ranging from 3.78 to 4.63 (IR = 0.94-1.41). 3) The policy of the Near-home Medicine Pick-up Project, which allows patients with chronic illnesses to obtain medications from nearby over-the-counter pharmacies, has an impact on medication adherence. Experts agree that the policy shows a high to the highest level of impact and consistency across the six dimensions of the 16-item list (MD = 3.68-4.12, IR = 0.61-1.26). 4) National Policy on medicines, the National List of Essential Medicines Government Procurement and Supplies Management Act 2017 and universal health coverage policies and regulations related to rights and expenses for treatment and medicines of patients with NCDs, experts do not agree.


location: , 'Thailand year: 2009 source: HSRI

title: Performance Study of Four Hyperlipidemia Screening Methods, 2008

abstract: This cross-sectional descriptive study was aimed at determining the efficiency and cost-effectiveness of four serum lipid screening methods: Method 1 proposed by the Thai Royal Medical Association (TRMA), Method 2 of the National Cholesterol Education Program (NCEP), Method 3 of the British Hyperlipidemia Association (BHA), and Method 4 invented by the first author. Study subjects included 2,000 workers aged 35 years and older who underwent an annual health examination provided at King Chulalongkorn Memorial Hospital during the period July-September 2008. All subjects answered the questionnaires of four screening methods and took blood tests for TC, TG, and HDL. LDL was calculated by Friedewald’s formula. The performance of each screening method was then analyzed, using lipid blood test as the gold standard. Overall sensitivity and specificity of the screening methods were 30 to 99 and 0.5 to 74 percent respectively, with the AUC of 0.506 to 0.671. Method 4 had the highest sensitivity and the lowest specificity at 99.4 percent and 34.3 per cent, respectively. Method 3 and Method 1 had higher AUC of 0.671 and 0.621 respectively. Method 2 had high specificity and low sensitivity (74% and 45.2%). In conclusion, the performance of the four serum lipid screening methods used in Thai adults was modest and therefore the methods need further improvement.


location: , 'Thailand year: 2002 source: HSRI

title: Geographic information system

abstract: Geographic Information SystemThe problems of primary health care shortages in Bangkok and its vicinity has been intensified due to the explosion of population, resulting from rural urban migration. The concentration of medical facilities within Bangkok’s CBD further complicates the patients’ traveling problems. Such dilemmas could be solved by careful spatial planning of primary health care service facilities. Patients’ pattern of travelling to health care facilities depends primarily on the decision making process, by which the patient choose his/her primary health care service. This research comprises two phases. The first phase aims to elucidate the factors affecting the patients’ choice towards the type of facilities, to model the spatial pattern of the patients’ travelling behavior from the collected data, and to reach the service catchment areas for each type of primary health care facilities, using Geographic Information System (GIS).   	The second phase of this study attempts to experiment, using GIS and the data obtained from phase I of this study, the modeling of spatial pattern of primary health care, in accordance with the current government’s “equal access to primary health care” program. The model is bound to be utilized as a tool to assign patients to their nearest respective facilities and to build a patient referral network. 	The study is based on Walter Christaller’s Central Place Theory, which attempts to explain the consumer’s purchasing behavior vis-à-vis the spatial pattern of retail facilities. The theory looks at three primary factors—distance of retail facilities from consumer’s home, range of goods (the center’s hierarchy), and the spatial location of facilities. Applying Christaller’s theory to health facility consuming behavior, this research assumes three primary variables affecting the travelling pattern of patients. First, the range of treatment in a particular facility, which comprises two indicators: public/private run hospital, hospital size, and its specialization of treatment. The second factor has been the patients’ attributes, which indicators are sex, income level, occupation, state of being able to be reimbursed, state of being insured, and the acquaintance to the medical personals. The final factor has been the types of sickness, which can be categorized as acute sickness, chronic sickness, and accident.  	This research integrates the primary and secondary data, by which the GIS model is achieved to explain the patients’ travelling pattern.  Structured questionnaires is utilized to obtain the primary data while locational data from the Bangkok Metropolitan Administration is used to identify the spatial location of each health care facility. 	The questionnaire survey based on a random sampling of 4464 patients from private and public hospital, health care centers, and medical clinics, which are drawn form 13 districts in Bangkok. The result is used to represent the patients’ decision making pattern toward the choosing of primary health care. 	Factors such as range of treatment, patients’ attributes, and types of sicknesses are found significantly related to each other, and therefore, determining the pattern of journey to health facilities. Low income patients and civil servants, who cannot afford to pay and who are able to be reimbursed, have the constraints to use only government run facilities, and therefore, must travel longer distance to get there. Higher income patients have the choice to travel shorter distance to private run facilities in their local areas. Age also found significantly related to travelling distance due to the factor of dependency and acquaintance to medical personals.  The younger cohort (0-19 years of age) travels the shortest distance, while the independent group (20-60 years of age) travels a little longer than the first group. Elderly patients travel the longest distance due to the need of specialized care and the acquaintance to medical personals. In terms of sickness types, chronic patients travel the longest distance in viewing that they are in no hurry and are already assigned a medical doctor. Acute patients travel the shortest distance due to urgency, while accident patients must balance between short distance and reliable medical care, and therefore, travel a little longer than the second group.   	From the above finding, the research then models the patients’ travelling pattern by means of GIS buffering, to obtain the catchment areas of public / private hospitals, health care centers, and medical clinics.  The out of reached areas are then identified. Modeling according to the type of sickness and patients personal attributes are also charted to identify the respective groups’ pattern of traveling.  	The second phase of study aims to experiment the modeling of patients assignment to the most proximal health care facilities in accordance to the current government’s “equal access to primary health care” campaign. Using the Bangkok Guide base map and the data obtained from phase I, the study compare the carrying capacity of health care facilities and the spatial organization of population (population density) to sort out the out of service areas and the patient assignment. 	Since the present health care policy predetermine the travelling pattern to health care facilities, ignoring the factor of range of treatment and other factors, a referral network is therefore needed for cases beyond the capability of the local facility enable them to be transferred to a higher order hospital. A referral network is also charted using the existing GIS information gained from the previous phase to optimize the travelling distance to their respective host hospitals. 	In short, this research applies Chistallers’s approach using GIS as a tool of health care facility planning. One can conclude from this experimentation that modeling could be helpful for the prediction of health care sufficiency and the planning of the spatial organization of the facilities in the future.


location: , 'Thailand year: 2022 source: HSRI

title: The Impact of COVID-19 pandemic on Occupational Engagement and Occupational Therapy Services Delivery in New Normal Situation

abstract: This mixed-methods study consists of quantitative research using questionnaires and qualitative research using focus group discussion. The aim of this study was to examine the impact of the COVID-19 on occupational engagement of physical, developmental, learning and psychosocial impairment clients and study of their needs for healthcare services, and adaptation of OT services in public and private hospital. Addition with the impact on practical fieldwork education and guideline for solution. The Occupational Therapists (OTs) (n = 153) were asked to complete the questionnaires while those (n = 45) were invited to once in focus group sessions. Results showed that COVID-19 has caused a negative impact on clients with occupational deprivation owing to uncontrolled situations especially social participation and health management. Three service types provided by the OTs in the pandemic have emerged along with infection control which are onsite, online or telehealth, and hybrid. OTs are developing telethealth services by use information and communication technology or social media through telephone, the LINE application, and VDO calls. Performances evaluation and home-based rehab training activities were provided according to the personal context. Caregiver consultation and education with media resources were innovatively enhanced in various channels. Contributing and barrier factors related to the institute’s policy, supporting infrastructure and readiness to use digital technology-assisted devices was highlighted in both service providers and clients. The impact of COVID-19 on occupational therapy students (OTS) were lack of fieldwork settings and clinical skills due to the decrease in number of clients. To maintain standards of clinical teaching in fieldwork placements, a combination of online case simulation and real client practice was used. The necessary skills for enhancing OTS’s competency in this situation were awareness and practice according to the infection control procedure, resilience skills, good communication, and the creation of innovative skills for telehealth services to be an OTs who response with the needs of client and society in the future.


location: , 'Thailand year: 2008 source: HSRI

title: The Development of indicators of good governance management of the provincial public health office

abstract: The research for “The Development of Indicators of Good Governance Management of the Provincial Public Health Office" was commissioned to The Center for Applied Economics Research, Kasetsart University by The Health Systems Research Institute. The objective of this research are to study a conceptual framework for a theory concerning good governance of the health system management in local areas, to develop good governance indicators regarding the
provincial public health office management which can then be implemented as a tool to evaluate and further develop the organization’s effective governance and also evaluate the level of good governance management of the provincial public health offices in the four pilot provinces: Chiangmai, Krabi, Cholburi, and Nakorn Pathom.
In the process of working on a conceptual framework and a theory concerning good
governance of the units handling health systems in the local areas, the research team has looked at extensive literature on good governance. They also arranged meetings with administrators, academics, and health personnel from the provincial public health offices. The meetings were designed to brainstorm opinions and come up with an understanding for setting up the conceptual framework on good governance of the administrative agencies handling health systems in the local area.
The conclusions for an indicator framework of good governance management are
comprised from the following ten principles: The Principles of Rule of Law (L), Ethics (E), Transparency (T), Participation (P), Accountability (A), Value for Money (V), Human Resources Development (H), Knowledge Management (KM), Management (M), and Information Technology and Communication (IT).
In the development of indicators measuring good governance management of the
provincial public health offices, the research team designed three sets of questionnaires based upon these principles. The first set of questionnaires was evaluated by internal officials within the agencies and consisted of fifty indicators. The second set was evaluated by officials with specific functions and contained eleven indicators. Finally, the third set was evaluated by related agencies and consisted of thirty-seven indicators. A range of scores were numerically assigned from 1 to 5 to evaluate good governance: 1 being the lowest, 2 low, 3 moderate, 4 high, and 5 being very high.
The findings based on the evaluations concerning management of the provincial public health office, as evaluated by the internal officials of the four provincial public health offices, revealed high levels of good governance management. The scores were 3.72, 3.43, 3.54 and 3.70 respectively. There was an especially remarkable score shown in the Principle of Information Technology and Communication. This may be due to the agencies having a data based system
and connecting the databases which helps reduce their workload and gives people the opportunity to share their opinions via the website.
The Principle of Value for Money found that their budget corresponded with the strategic plan that audited and evaluated evaluation results. It was found to improve internal management including financial support from external sources.
As for the Principle of Rule of Law, the regulation was found to be disseminated to
employees and freedom given to service recipients.
The questionnaire results indicate three principles that need to be developed: the
Principle of Management, the Principle of Knowledge Management, and the Principle of Human Resource Development. The Principle of Management could be defined as ‘incomplete’ in terms of people’s assessment. One possible cause was an institution research study that was conducted, but the results of which were not applied to their full potential, and there was no evaluation of administrative leadership. Based on the Principle of Knowledge Management, the culture of learning was shown to be lacking amongst working groups. Results indicated that continuity was deficient in the development of personnel ability. With the Principle of Human Resource Development, it was found that contingency plans
for the rationing of the workforce in some working groups were lacking.
The evaluation results for good governance management of the provincial public health offices by the agencies related to the provincial public health office of Chiangmai, Cholburi, and Nakorn Pathom revealed that good governance management was moderate. The scores were 3.36, 3.32, and 3.26 respectively.
For the Krabi provincial public health office, good governance management was rated as high, with a score of 3.61. For all four provincial public health offices, the Principle of Transparency was found to have the most significant rating. This could be due to opportunities for those concerned to give their opinions and listen to feedback from external parties; including activities to promote people’s participation. The three principles that needed to be developed were: the Principle of Management, the Principle of Human Resource Development, and the Principle of Participation. For the Principle of Management it was found that the provincial public health offices did not make a survey suitable to meet the needs and satisfaction of concerned offices. The evaluation results were not used to improve the work process and be transparent. Based on the Principle of Human Resource Development, the officials were found to have unity only among the working groups; the survey results indicated that individuals performed their work independently rather than as a group. For the Principle of Participation, there was an indication of inadequate consideration for the opinions of outside agencies and the public sectors concerned. The comparative results of the evaluation of the level of good governance management of the provincial public health offices by internal officials and related offices indicated a very significant difference for the Chiangmai and Nakorn Pathom provincial public health offices. As for the evaluation of the offices in Krabi and Cholburi, there were no significant differences. However, the distinguished principles and those needing development based on the evaluation of both the internal offices in the provincial public health offices and those related
offices, followed the same direction.


location: , 'Thailand year: 2016 source: HSRI

title: The Development of the Health Information System for Project and Budget Management in Health Service Area 12

abstract: This participatory action research was undertaken to determine the process used to develop
the Health Information System for Project and Budget Management (HIS4PM) and to evaluate its
effectiveness. The HIS4PM was developed to support work related to the missions of the health
care organizations in the seven provinces in Southern Thailand under the 12th Regional Health
Service Center, also known as Health Service Area 12 (HSA 12). A sample of 84 HIS4PM users, 12
from each of the 7 provinces, was purposively selected into the study. Three representatives from
four different health care organizations in each province, namely the hospitals and the sub-district
health promoting hospitals, the provincial and the district public health centers, were chosen
to participate. The administrators of the hospital/healthcare center, the project planning staff,
and the budget department staff for each organization were specifically recruited. Qualitative
and quantitative data were gathered by using in-depth interviews, documentary studies and analyzing
the current health information system; assessing the HIS4PM development using questionnaire.
Results: The study found that the main concept employed to guide the development of the
HIS4PM web-based application was a relational database based on a Rapid Prototyping Design
Model (RPDM) in order to allow any involved users to be able to access the single entry system
and update their real time data information. There were three main steps used to develop the
HIS4PM including: 1) reviewing the current health information system and assessing what developments
were needed to improve the system; 2) determining the possibility of determining and
assessing risks during the HIS4PM system development process and to plan-out the project to
ensure that all aspects of performing work related to the project planning and budget monitoring
missions could be performed and were addressed; and 3) completing the development process
using the 6-phase rapid prototyping design model. These 6 phases included: 3.1) assessing the
needs and analyzing the content to gather the vital information regarding what needed to be
included in the new software program using the rapid prototype manual along with in-depth interviews; 3.2) setting objectives for the software design and development using the data flow diagram
and object-oriented design techniques; 3.3) constructing a prototype; 3.4) performing a trial run evaluation
of the prototype HIS4PM system for approximately two months (February-March 2015) to evaluate
the program and obtain feedback and suggestions for improving the system, as well as the preliminary
users’ level of satisfaction; 3.5) installation and maintenance of the completed system; and 3.6) evaluation
the new HIS4PM software program using the questionnaires during March-April 2015.
In terms of its effectiveness, the study discovered that the newly developed HIS4PM could help
support the project planning and budget monitoring by the public health organizations in HSA 12. The
HIS4PM was practical and facilitated performing work at all levels ranging from the level of regional
health administrators to the working users at operating units. Moreover, the newly developed HIS4PM
not only helps reduce the duplication of data records and allows all users to update data in real time from
their operational sites, but it is also able to link data from all operating sites together. Therefore, it can be
accessed rapidly, meets the users’ needs, helps facilitate working from different operating sites, and helps
promote an effective, focused work atmosphere.
HIS4PM user satisfaction was assessed using the questionnaires and found that the majority of the
users were highly satisfied with all aspects of the new HIS4PM, including the policy to provide the HIS4PM
program to every public health organization, the policy’s implementation strategy, as well as the applicability,
the completeness and the appropriateness of the HIS4PM program.
Recommendations: 1) When the HIS4PM is considered for use in other regions, it is important to
take into account the drive behind the administrators’ policy management, 2) the HIS4PM national development
process should take into account the interests and needs of the local areas’ main operating unit,
and 3) when the HIS4PM is considered for nationwide use, it still has to be subjected to the operational
standard framework of the information system.


location: , 'Thailand year: 2005 source: HSRI

title: Traffic victim protection act in the contest of universal coverage : What are the reform option

abstract: Traffic Victim Protection Act was implemented since 2535. Though it is a mandatory scheme, instead of public sector, the for profit private insurance companies are the carriers of the scheme. The Scheme compensates healthcare based on fee for services and maximum liability, a lump sum death and disability compensation are also granted. Financial report in 2545 indicated a net premium of 7,003 million Baht collected, with very high administrative cost (41%) and low loss ratio (52%), and inadequate cover all traffic victims. There is a need for a major reform in the context of achieving Universal Healthcare Coverage in Thailand in 2545. 	The objectives of this study are to estimate total resource requirement (for medical care, death and disability compensation) for all traffic accident victims, to estimate how much would the government introduce additional gasoline tax to cover all traffic victims, and provide policy choices for reform. 	Based on secondary sources of information, it was estimated that total resource requirement for all traffic accident victims would be 7,158 million Baht in 2545, of which 63% for inpatient care, 16% for pre-hospital care, 15% for death compensation, 5% for ambulatory care and 1% for disability. 	Household consumption of gasoline from the 2545 household socio-economic survey conducted by National Statistical Office was used to compute total litre of different types of gasoline consumed by household categorized by income deciles. To generate the total 7,158 million Baht to cover all traffic victims, the government has to raise 0.32 Baht to a litre of gasoline, given no price elasticity of demand by all household deciles. Several scenario of raising gasoline tax was proposed. We recommend the least regressive option, 0.26 Baht per litre for all type of gasoline except Octane 95, and collection 0.55 Baht per litre of Octane 95. 	Two goals of reform are identified: to cover all traffic victims (both caused by the insured and non-insured cars) and appropriate Scheme administrative cost. 	Three reform options were proposed based on sources of finance, option one generate revenue from premium contribution by car owners, option two from general tax and option three from dedicated gasoline tax. Analysis indicates that option two and three are neither politically feasibility nor socially acceptable. Three choices of reform under option one were identified: conservative, minor and major reforms. We recommend a major reform. This is to sub-contract the Department of Land Transport to collect premium while the mandatory annual renewal of car license. The large part of premium would be transferred to the National Health Security Office (NHSO) to cover all victims for medical care, death and invalidity compensations. The second preferred choice is minor reform, sub-contracting private insurance companies to collect premium, the large part of premium would be transferred to the NHSO.


location: , 'Thailand year: 2008 source: HSRI

title: An Outbreak of Viral Hepatitis A in Wiangpapao District, Chiang Rai Province, 2005

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


location: , 'Thailand year: 2020 source: HSRI

title: Predictors of Major Adverse Cardiovascular Events in Coronary Artery Patients Undergoing Percutaneous Coronary   intervention (PCI) in Thailand: Thai PCI Registry

abstract: Coronary artery disease (CAD) is the leading cause of death and disability in Thailand. The incidence of CAD has constantly been increasing. Percutaneous coronary intervention (PCI) is the standard and mainstay of CAD treatment. In Thailand, PCI has been performed for more than 20 years. Because of the benefit of PCI in reducing mortality, morbidity and symptom, it is recommended by many clinical practice guideline as a standard treatment of CAD. Since the Ministry of Health realized the benefit of PCI and support the opening of new catheterization laboratories (cath lab) in all parts of the country, the number of cath lab and the number of PCI cases in Thailand has rapidly increasing for the last ten years. PCI registry is very important, as it provides many useful information (e.g. baseline demographic data of the patients, practice pattern, device and equipment use, outcome of treatment, complications, success rate, emergency CABG rate), as well as information regarding health care system (e.g. prevalence of referral cases, waiting time of the system, appropriateness of PCI, cost of PCI, cost-effectiveness/cost-utility which could be compared to treatment of other diseases (such as cancer, etc.). The information is essential in improving the outcomes of PCI, in preventing complications, in increasing the efficacy and safety of PCI, which may lead to more effective national resource allocation and proper reimbursement. With the reasons given, many countries have conducted their own data collection and PCI registry. The good examples include SCARR registry of Sweden, NCDR of USA and NCVD PCI registry of the National Heart Association of Malaysia. Cardiovascular Intervention Association of Thailand (CIAT) realized the importance of having our own data, therefore initiating the project “Thai PCI Registry” in order to collect the data of patients undergoing PCI in current clinical practice in our country. The project received financial support from Health System Research Institute (HSRI). The project was planned for 4 years with summary of the project as follow: The first year is the preparation year. The plan was to generate CRF, get approval from CREC and local EC/IRB, create definition brochure/operator manual, invite every cath lab all over the countries to participate, set up the online data entry system, set up and maintain database and server, establish national network for cath lab personnel, test the data entry system and arrange for workshop and training of research personnel/cath lab staff from every participated site. The second year would focus mainly on data entry. The plan was to maintain uneventful data registry, improve and evolve the online data entry system, maintenance of database, communicate within the network and perform site audit of all 39 participating hospital all over the countries. The third year is to close the recruitment of new cases, clean and check of the data obtained as well as perform data query. When the data quality is confirmed, the data lockdown of the baseline (in-hospital) data would be conducted. During this year, there will be initial data analysis, some manuscript writing and submission for publication. Furthermore, the follow data at 6 and 12 months will be gather as well as outcome verification and ascertainment. The final year we plan to perform data query of follow up data before the final and complete data lockdown as well as data analysis, manuscript writing and submission for publication. The main activity of this year will also focus on distribute all important results to the public and all stakeholders. This report is the full report of the Phase 1 of Thai PCI registry project (year 1-2) which received financial support from HSRI. The final Phase 2 of the Thai PCI registry project (year 3-4) will be conducted immediately after receiving approval and grant support from HSRI. There were 22,741 patients participating in Thai PCI registry. Approximately 70% were male with the mean age of 64 years. Two third of all patients use Universal Coverage (UC) scheme. Most common presentation was stable CAD (37.6%) and most common procedures were performed electively (61.2%). More than half of all patients were referral cases. In terms of coronary anatomy, most patients were classified as triple vessel disease (32.9%) follow by double vessel disease (28.7%) and single vessel disease (26.4%), respectively. Ten percent of all patients had left main stenosis. The main vascular access was femoral approach (12,568 cases; 54.4%). When we categorized the patients into their presentation of acute coronary syndrome and stable coronary disease, we found that 27.6% was STEMI, 29.8% was Non STEMI, 37.6% was Stable CAD, and others was 5.1%. The In-hospital mortality rate was 6.7%, 2.1%, 0.3%, and 3.3%, respectively. with overall in-hospital mortality was 2.8%. The overall success rate of PCI in this registry was 96% which was very good and comparable to data from other countries. The factors that were independently associated with procedural failure included older age, referral cases, hypertension, history of heart disease, complex lesion, long lesion, and poor TIMI flow. The incidence of procedural complications was approximately 5%. The common complications reported included coronary dissection, side branch occlusion, no reflow, coronary perforation, device dislodge, acute stent thrombosis. The factors that were independently associated with procedural complications included older age, female, health care coverage, hypertension, history of heart disease, cardiogenic shock, requirement of IABP/mechanical support, unsuccessful vascular access, long lesion, thrombotic lesion, complex lesion, bifurcation and abnormal TIMI flow. The common clinical complications included post-PCI MI (1,374 cases, 6.0%), bleeding within 72 hours (1,102 cases, 4.9%), stroke (85 cases, 0.4%) and emergency CABG (0.3%). In term of mortality, the in-hospital mortality rate was 2.8%. The independent factors associated with incidence of clinical complications included older age, female, referral cases, peripheral vascular disease, requirement of dialysis, emergency PCI, ACS, cardiogenic shock, requirement of IABP/mechanical support, left main stenosis, unsuccessful PCI, and procedural complication. In summary, the first phase (year 1-2) of Thai PCI registry was completed with great success. Many goals and objectives were achieved which included 1) establishing national network which can be a platform of nation-wide collaboration of other registry in the future, 2) creating CRF in PCI cases which can be used by any participating sites even after completion of the registry or can also be used by general public by request, 3) Training the new researchers from all area of the country, 4) obtaining crucial data which will lead to improvement of PCI outcomes, prevention of complications and improvement of health care system resulting in better care of patients with cardiovascular diseases in the future.


location: , 'Thailand year: 2001 source: HSRI

title: Health Impact Assessment of Agriculturalists on Contractual Arrangement

abstract: Health Impact Assessment (HIA) of Contract Farming in Thailand : A Scoping Process Objectives: 1) To define the scope of health impact assessment of contract farming policy. 2) To provide a venue for stakeholders’ participation in the health impact assessment Methods: The assessor used varieties of methods to identify the scopes of the health impact assessment. The processes were consisting of two meetings with stakeholders, in-depth interviews with farmers and seed companies’ personnel as well as government officials, direct observation at the farms and literature reviews. The definition of health used in the study was based on bio-psycho-social model. Results: The Thai government has been promoting Contract Farming practice since the 6th National Economic and Social Development Plan in 1987. Farmers will produce agricultural materials for agricultural industry companies and receive payment for the products if they comply with the standards defined in the contracts. Tomato seeds, chili seeds, tobacco leaves, vegetable seeds, chicken raising are examples of the agricultural products that are commonly defined in the contracts. Contract farming policy brings numbers of potential impacts, particularly on one that uses a lot of pesticides, on the health of farmers and villagers. Potential positive impacts are short-term financial benefits, choices of employment during dry season. Potential negative impacts are on physical health especially impacts on neurological illnesses, illnesses of endocrine systems, illnesses of reproductive systems. It has been shown that stakeholders were concerned about health impact of the contract farming practice in terms of physical health, mental health, social health, spiritual health, social impacts and environmental impacts. Literature reviews found that farmers and farm employees were affected by the heavy use of pesticides. Neurological illnesses were the most common problems. Stakeholders have identified scopes for health impact assessment including impacts on physical health, mental health, social health, spiritual health, social impact, economic impact, environmental impact. The stakeholders also proposed that assessment of impacts on illnesses of endocrine system, reproductive system and cancers were needed. Qualitative and quantitative methods of data collections with stakeholders’ involvement have been identified for the assessment. Conclusion It has been shown that early involvement of stakeholders in the scoping processes of health impact assessment is feasible and beneficial to all involved and it is more likely that the results of health impact assessment will be used.


location: , 'Thailand year: 2016 source: HSRI

title: Itemized Dental Service Cost of Thatum Hospital in 2014

abstract: This study aimed to determine the total direct cost and the itemized unit cost of dental services of
Thatum Hospital in 2014 fiscal year. The total direct cost was summed of labor cost which paid from
dental personnel’s remuneration and welfare, material expenditure, and depreciation costs of durable
dental equipment. Costs were allocated by dental service time and amount of dental services. The study
revealed that the ratio of labor cost : material cost : capital cost was 71.79 : 20.03 : 8.19. The first and second
highest unit costs were prosthetics and endodontics. Sealant had lowest unit cost (86.76 baht/tooth). Comparing
to the 2006 fee schedule of the Comptroller General Department (CGD), most dental services operated
at Thatum Hospital had a lower unit cost. In prosthetics, unit costs were higher, except temporary
plate 1-5 teeth was lower than the CGD’s fee.


location: , 'Thailand year: 2020 source: HSRI

title: An Evaluation of Awareness and Preparedness on Infectious and Emerging Diseases at the Cross Border   Areas; Thailand - Myanmar - Cambodia – Lao PDR Project in the Fiscal year 2015-2017

abstract: Background: As the north of Thailand is bordered to Myanmar and Laos, and the east to Laos and Cambodia, the high migration of populations between border areas leading to a high risk of an outbreak of contagious diseases and emerging diseases due to people’s migration. The surveillance system of disease control and prevention at border areas did not entirely cover and reach the standard in five systems as well as lacking information in all five dimensions. In order to improve surveillance system of disease control and prevention at border areas, Thailand International Cooperation Agency (TICA) launched a pilot project in five provinces from 2015 to 2018 to build up awareness and preparedness for better border health. Objectives: To evaluate outcomes of the project and lesson learnt from work systems in the study areas. The results will be used to make a decision for budget support in the second phase and to investigate the factors related to the processes for successful project. Methods: This study was an evaluation research design by using both quantitative and qualitative methods consisting of questionnaire, focus group and group discussion. The study tools were developed to cover the CIPP model. The data were obtained from purposive sampling in five groups of people covering board of directors, public health staff, Thai public health volunteers, non-Thai health volunteers (border countries), stakeholders and immigrant workers in the six parallel border areas. The data were analyzed by using percentage, mean, standard deviation (descriptive study) and by content analysis and triangulation (qualitative study). Results: The quantitative study showed that Tak province had the highest overall knowledge scores at 16.07, followed by Vientiane, Nong Khai, and Chiang Rai, respectively. For the knowledge of health volunteers, the village health volunteers showed the highest knowledge scores (the first rank) while the home health volunteers, border community health workers and lay people after training in the surveillance and disease control and prevention were ranked in the second, third, fourth, respectively. The results by CIPP model revealed that the outcomes from the project were completely processed from context and policy and received a great support from Thai – Laos - Cambodia border areas. For the input factors, all personnel demonstrated an effective working and operation from all border areas, however the lack of budget and equipment was still the weak process in the three border areas. Product part, all borders developed the processes for surveillance system of disease control and prevention at both provincial and district levels based on the context of each area. Conclusion: The outcomes of the operation in three border areas varied upon the context and extent of experiences exchanges among volunteers, health workers and health providers in both provincial and district levels through co-learning and sharing as well as integrating their work with other organizations. Good cooperation between communities at parallel border areas was strong at Nong Khai province; health strategy was prominent in both border areas in Tak province; patient referral systems were established in Chiang Rai and Ubon Ratchathani provinces between two borders; and strategic personnel development was formed at Sa Kaeo province. In order to improve border health care system in a sustainable way, the crucial key components include intensive support and policy from the executive committee at ministry and local areas to effectively guiding the working in a timely manner on the strategy of emerging diseases and surveillance system of disease control and prevention at cross border areas.


location: , 'Thailand year: 2020 source: HSRI

title: The Development of Interior Environment of Residential Building for Recovery of Older Persons with Depression

abstract: The main objective of this study is to develop interior environment of residential building suitable for recovery elderly with depression. There are three main steps for this study: 1) an investigation of behavior of using, obstacle and limitation of existing building affecting depression recovery in elderly; 2) a study of characteristics of the interior environment and facility suitable for recovery elderly with depression; 3) a study of post evaluation of depression symptom of elderly after environment modification according to the study results. The study explored in two types of residential building which are a private house and a hospital. This study, also, propose the design guideline of residential building and facilities for elderly with depression. Results of the study shows appropriate interior characteristics of residential building suitable for recovery elderly with dementia. The results in the last section showed that depression symptom is not different, when using in examination room which environment was modified by results of this study. But, the modified examination room could make the subject less anxious, more preferred, and led subject feel better well-being and more interested in the examination room. However,   the results in the last section illustrated that depression symptom of subject is reduced, when living in house that environment was modified by results of this study. The modified house made the subject less stressful, less anxious, more preferred, and led subject feel better well-being and more interested in the house.


location: , 'Thailand year: 2016 source: HSRI

title: Health Research Classification for Thailand: Review of Health Research Classification in 5 Countries

abstract: Appropriate standardized research grouping is important for research management of researchers,
research institutes and funding agencies. Health research funding agencies in Thailand have different
management policies and system regarding allocation of funds. As a result, there exists a gap in the information
on which areas of research are progressive. Grouping research projects properly, in the same standard
with other funding agencies, will not only strengthen the funding strategy of each agency, but also
help avoid the duplication of research funding in one area with less funding in another.
This study aimed to review the health research classifications in high-income countries in order to
have a basis for recommendations to Thai health research. Literature review was conducted to find the
key characteristics of successful research classification systems. Five countries were selected for review of
best research classification. These countries include: Australia, Germany, New Zealand, United Kingdom
and United States.
The study found the following six principles of successful research classification systems: 1) simplicity
2) relevance 3) consistency 4) standard 5) multi-dimensionality and 6) flexibility. From assessing the
research classifications in five countries, we concluded that the Health Research Classification System
(HRCS) of the UK Clinical Research Collaboration. (UKCRC) met all six principles. Therefore, based on
this study, we recommended the adoption of the HRCS classification systems. Furthermore, we recommended
adding the health policy and system research as a new classification in order to aid with policy
development and implementation in Thailand. In conclusion, health research funding agencies should
apply the same classification standards.


location: , 'Thailand year: 2020 source: HSRI

title: Development of Surveillance System for Neural Tube Defects

abstract: Neural tube defects (NTDs) is a congenital syndrome which might result in severe disabilities or deaths. Folic fortification in food including rice has been proposed as a prevention of the syndrome. However, the efficacy of the intervention have to be judged based on the baseline incident of the NTDs cases. Thorough analysis of the incident of NTDs cases is needed. Therefore, we proposed an analysis on the spatio - temporal distribution of the NTDs cases in Thailand using 43 folder database and develop a software needed for NTDs surveillance. Objectives: To assess the spatio - temporal distribution of NTDs cases in Thailand and to develop NTDs surveillance system for Thailand Material and Methods: In this study, the 43 folder database of Thai National Health Security Office was retrieved. The inpatient data were filtered with ICD-10 correlated with the diagnosis of NTDs. The hospital codes were then linked to the patient data to identify the probable district that the NTDs cases lived in. The choropleth maps were generated to describe the distribution of the NTDs cases by districts and year. The clustering of cases was assessed using Moran’s I. Results: The total numbers of NTDs cases from year 2014 - 2018 was 11,296 cases, including 4,531 congenital hydrocephalus cases, 2,655 Spina bifida cases, 2,638 Microcephaly cases, 979 Encephalocele cases, 224 Anencephaly and similar malformations cases, and 269 other congenital malformations of spinal cord cases. The district with the most numbers of NTDs cases was Ratchaburana district of Bangkok. There is no temporal trend observed. The average number of cases per year was 2,259 cases per year. The calculated incidence per 10,000 livebirths was 30.67 cases. The spatial autocorrelation by Moran’ s I does not shown any statistically significant clusters except for Bangkok and neighboring area in year 2014. The prototype of the NTDs surveillance program were developed. Conclusion: The incident of NTDs cases in Thailand is relatively high comparing to the incidents in Asian countries. Therefore, continuous NTDs surveillance might be needed. The folic fortification policy did not show a promising result. Therefore, the policy to improve the rate of antenatal care visits should be a better choice to reduce numbers of the NTDs cases in Thailand.


location: , 'Thailand year: 2021 source: HSRI

title: Developing analysis and evaluation system for MDR-TB epidemic in community by studying MDR-TB genetic factor, host-related infection rate of MDR-TB patients and their contacts, spreading and treatment in outbreak area of Thailand

abstract: This study aims to explore the MDR-TB spreading in an outbreak area of Thailand. A crossectional study is carried out to determine bacteria and host genetic factors relate to MDR-TB infection in patients and their contacts, epidemic process, and treatment outcomes. The sample population including MDR-TB patients who were registered at Makarak hospital between 2014 to 2019. A total of 205 MDR-TB isolates were sequenced and a total of 352 MDR-TB contacts from 152 MDR-TB patients were enrolled in this study. A total of 205 MDR-TB isolates were sequenced, 88.8 % of these were MDR-TB cases, while the other 4.4 % and 6.8% were pre-XDR-TB and XDR-TB respectively. The result of whole genome sequencing and SNPs analysis showed 4 lineages(L) of the MDR-TB genotype in this study, including L1, L2, L3, and L4. L2 of Beijing strains (L2-Beijing) was the most common genotype and 77% of the L2-Beijing genotype belonged to the sub-lineage of Asia African3 (AAF3). When we considered the number of SNPs different among AAF3 genotype, found that 34.1 % of those were clonal. And found that, patient with DM is more likely to be in a group of clonal MDR-TB than without DM. Of 352 MDR-TB contacts, 71.3% were household contacts, 64.1% were working for the age group. There were 31.5% of contact had the comorbid disease, included DM, HT, and other disease were 8.8, 16.2, and 10.5% respectively. A latent tuberculosis infection (LTBI) among contacts of clonal and non-clonal MDR-TB were 27.8% and 30.2% respectively. However, there was no statistically significant difference between these 2 groups (p-value = 0.697). To identify host genetic factors associated with MDR-TB infection, GWAS was used to an identified specific genes associated with MDR-TB infection. We considered contact with IGRA positive as a case and contact with IGRA negative was control. The most common significant SNPs and genes were located on chromosome 6 and HLA gene, including HLA-DRA and HLA-DRB1 which had been reported in previous studies. Other significant SNPs were also found to be associated with TB infection, the SLC1A2 gene on chromosome 11. In summary, a high proportion and homogeneous gentic of AAF3 strain among MDR-TB patients may reflect the adaptation of the strain to spread more readily in thai population, and the increasing of this pathogenic strain may impact the tuberculosis control program. Early diagnosis and contact tracing will be essential to inhibit the spread of these strains. Furthermore, it will be important to ensure that future vaccines protect against these strains.


location: , 'Thailand year: 2008 source: HSRI

title: The Good Practices towards the Pre-Hospital Emergency Medical Services (EMS) System of Communities and Local Government Authorities for the Development of Model and Performance Indicators (Pls)

abstract: To this research, it is to consider the good practices of pre-hospital emergency medical
service (EMS) system. By an in-depth interview with responsible units, story telling and lessons
learnt can contribute the big picture of their EMS practices in 6 areas (provinces); KhonKhan,
Ubonratchathanee, Lumpang, Petchaburi, Phuket and Songkhla. Initially, the research team has to
choose the modeling framework. Malcolm Baldrige National Quality Award (MBNQA) is chosen;
since it represents wisely for what are key elements in the system and how those are integrated for a
holistic view. Subsequently, the practices of the EMS system in 6 areas are captured. Besides, the
summary of good practices classified by elements of MBNQA is considered prior to shorten the
learning curve or speed-up the practices in other areas.
Respectively, MBNQA is applied as a framework for ascertaining the factors contributing the
success and the key obstacles in the practices of each area. However, it is interesting that the
practices of 6 areas, which have the diverse levels of success, tend to have indifferent obstacles.
Even, the most success area in Thailand encounters the problems in ‘Process Management’,
‘Workforce Focus’ and ‘Customer Focus’, which are similar in other areas. Additionally, the survey of
people who either use or never use the EMS in 6 areas results in the same problems, which are
‘insufficient promotion for the service’ and ‘inefficient service processes’. Besides, the research
team pinpoints that by completing the data collection and analysis, the lesson learnt and practices in
all areas are all remarkable. The differences in success rate are insignificant. In other words, the
practices and lessons learnt should not be limited only the success areas. Every area puts their
attempts to improve the EMS system and their diverse practice should be valued as meaningful
knowledge.
Therefore, the results of this research are concluded as two issues. (1) The guideline for
MBNQA application in the EMS system. The modeling framework enables the responsible units to
analyze the service system for a holistic view. Indeed, the analysis can point out the elements of
underemphasized. (2) The story telling from effective practices. This is an attempt to shorten the
learning curve prior to speed-up the practices in any areas. Significantly, the effective practices,
which are not limited only in the success areas, can cheer up any areas to improve their
performances of practices.


location: , 'Thailand year: 2017 source: HSRI

title: Chondrocyte Cell Sheets for the Treatment of Articular Cartilage Defects

abstract: Cell sheet technology is applied to human articular chondrocytes to construct a tissue-like structure as an alternative treatment for cartilage defect. The effect of a gelatin manipulator, as a cell sheet transfer system, on the quality of the chondrocyte sheets was investigated. The changes of important chondrogenic markers and stress fibers, resulting from the cell sheet manipulation, were also studied. The chondrocyte cell sheets were constructed with patient-derived chondrocytes using a temperature-responsive polymer, and a gelatin manipulator as a transfer carrier. The properties of the cell sheets including sizes, expression levels of collagen type II and I, and the localization of the stress fibers were assessed and compared with those of the cell sheets harvested without the gelatin manipulator. Using the gelatin manipulator, the original size of the chondrocyte cell sheets was retained with abundant stress fibers and a decrease in the expression of collagen type II. Without the gelatin manipulator, although the cell shrinkage occurred, the cell sheet with suppressed stress fiber formation showed significantly high levels of collagen type II. These results supported that the changes of the stress fiber formation in the chondrocyte cell sheets affected the production of the chondrogenic markers. The densely packed tissue-like structure possessed a good chondrogenic activity, indicating its potential use in autologous chondrocyte implantation to treat cartilage defects. One of the challenges in cartilage tissue engineering is the maintenance of the chondrogenic activities during long-term culture. To overcome this problem, we proposed a new culture surface using the fifth generation dendrimer-immobilized surface (G5). Chondrocytes cultured on this surface formed various aggregates, providing desirable three-dimensional structure that closely mimicked the native environment of chondrocytes. As a result, higher chondrogenic markers (collagen type II and aggrecan) with lower de-differentiation marker (collagen type I) were observed in the cells on G5 surfaces as compared to those cultured on traditional polystyrene surfaces. This new surface would be beneficial for chondrocyte cell sheet engineering in our future study.


location: , 'Thailand year: 2021 source: HSRI

title: Extended shedding of viable SARS-CoV2 from COVID-19 patients

abstract: Persistence of viral RNA in respiratory samples of COVID-19 patients and asymptomatically infected individuals is a common and important problem in the outbreak control. The main question is whether the persistence of viral RNA reflects viable virus shedding. And, if there is viable virus shedding, there is an interesting scientific question of how the virus survives in the presence of immune response, which should be developed soon after the infection. Possible explanations include a failure of developing immune response or an immune escape by viral mutations. To answer these questions, this project performed viral isolation in sequential respiratory samples and antibody detection in serum samples of 30 cases with mild-symptom or asymptomatic, who showed viral RNA positive by RT-PCR after 1 week from the diagnosis. Samples in the first week showed a large variation in the viral load levels which significantly declined in most samples from the second week forward together with positive for specific antibody in serum samples. For viral isolation, there were 6 positive samples with high viral load; 4 samples and 2 samples from the first and second week samples, respectively. The two culture positive samples from the second week, one of them had low level of neutralizing antibody in serum at the same time point and these neutralizing antibody level increased in the third and fourth week samples together with a drastic decline in viral load and negative viral culture. The other sample showed high viral load and positive viral culture together with negative neutralizing antibody in the samples from the second and third week. These data indicate that most patients and infected individuals with persistent positive RT-PCR have low level of viral load and this does not indicated shedding of viable virus. However, failure in mounting the immune response in some individuals may result in persistent shedding of viable virus. High viral load and negative neutralizing antibody may be used as markers to identify such individuals.


location: , 'Thailand year: 2023 source: HSRI

title: Model Development for the Improvement of Data Quality on Cause of Death: A Pilot Study on Death Outside Health Facilities in 12 Health Regions

abstract: Cause of death (COD) data is important as it reflects the health problems of a population. The data can be used to assess and monitor the performance of a health system and develop plans for public health work at the national level. Although the country's death reporting system is covered by the civil registration system, it was found that the quality of COD data reported in the civil registry is still poor, especially of natural deaths outside health facilities which depends on information that the deceased’s relative give to the registrar. A Model development for the improvement of data quality on cause of death: A pilot study on deaths outside health facilities in 12 health regions was developed with a primary objective to improve the quality of COD data for deaths outside health facilities according to the policy of the Office of the Permanent Secretary (OPS), Ministry of Public Health (MOPH) with financial support from the Health Systems Research Institute (HSRI). Secondary objectives were 1) to develop a pilot model for COD data quality improvement for deaths outside health facilities, 2) to develop tools and systems for regular review of COD data by community health personnel, and 3) to expand the operational results of improving the quality of COD data for deaths outside health facilities. The study was a research and development study, by developing and piloting a model for improving the quality of COD data for deaths outside health facilities. It consisted of 2 parts: 1) deaths with medical history within 1 year prior to death; medical records (MR) are reviewed by the hospital’s medical coders to ascertain the correct COD in the data collecting program and 2) deaths without medical history during the same period; a community public health officer conducts a verbal autopsy (VA) via an online tool. The VA tool was adapted from the 2016 WHO VA to be short and appropriate for the Thai context for interviews by community public health officer in hospitals and Tambon (sub-district) health promotion hospitals (THPHs). A Provincial Public Health Office (PHO) was responsible for the operations in the province, both monitoring performance and reporting to their Chief Officer. The study was carried out in 12 pilot provinces, one from each of the 12 health regions across the country, namely Chiang Rai, Sukhothai, Nakhon Sawan, Ang Thong, Suphan Buri, Chanthaburi, Maha Sarakham, Udon Thani, Buriram, Ubon Ratchathani, Surat Thani and Songkhla. Death data from the Bureau of Registration Administration (BORA) which was sent to the Strategy and Planning Division, OPS, MOPH was used in conjunction with medical information in the Health Data Center (HDC) database from the Information and Communication Technology Center, OPS, MOPH. The 29,410 deaths between January and May 2022 for natural deaths outside health facilities were allocated to the pilot provinces for review. The study operations included development of tools and systems, training, site preparation, implementation, field visits for reflection, and result summarization, and was carried out between October 2021 and February 2023. Quantitative analysis evaluated the performance according to the pilot model, i.e. percentage of goals achieved. Comparative analysis of COD was performed using COD from death certificates and COD obtained from the pilot study model, i.e. accuracy of COD and decreases in percentage of ill-defined cause. Qualitative analysis using information from meetings with relevant parties, in-depth interviews with executives, and focus group discussions with community health personnel including success factors, problems, obstacles, and solutions, to summarize results and make recommendations. Results Data for natural deaths outside health facilities in the 12 pilot provinces between January and May 2022 included 29,410 deaths. Of these, 28,629 deaths, or 97.3%, were successfully synced and had a medical history within one year before death and/or no medical history but an identified primary care unit. Of the synced cases, 43.8% were deaths outside health facilities with a medical history one year prior to death. There were 781 death cases with no identifiable primary care unit because of a lack of medical history in the HDC database and a lack of details in house registration addresses corresponding to responsible primary care units, such as unspecified municipalities but instead specifying roads or alleys, etc. As of January 3, 2023, data showed that pilot provinces had successful operations for up to 74.1% (21,202) of deaths. A total of 90.3 % of deaths with medical history were reviewed by hospital medical coders, for deaths without a medical history, 61.4% of deaths were followed up with an interview of the deceased’s relatives by a community public health officer. Analysis of COD from death certificates and data from the pilot model implementation found that: 1) In the comparison of COD between death certificates and medical records (MR) reviewed by the hospital medical coders. in 11,318 deaths and 2) In the comparison of COD between death certificates and verbal autopsy conducted by community public health officers. in 9,884 deaths. Factors for success, problems, challenges and solutions. and Policy recommendations.


location: , 'Thailand year: 1999 source: HSRI

title: A case study of services of welfare centers in communities

abstract: An Evaluation on Social Services for Aging People in Communities: A Case Study of Services of  Welfare Centers in Communities	This study aims to study social services in communities; especially, which aging people reached; quality of life of aging people; and their troubles and life satisfaction.  This study also aims to study the welfare centers in communities’ operations and the relationship of communities’ strength and the welfare centers’ effectiveness. 	There were 2 types of data, primary and secondary.  Primary data were both in qualitative and quantitative forms, collected by interviewing 380 aging people, 101 heads of welfare centers, other people such as, teachers, health officers, monks, imams, merchants and other peasants including juveniles from 19 amphurs, 9 provinces of every part of Thailand.  Secondary data were documentary data; such as, handbooks, reports, official memorandum and national policies.	The results of the study are as follow:	1. Social services in communities: privilege cards service, institutional service, social group service, and service or assistance from community leaders.	- Social services which aging people could reach and were satisfied most were all kinds of health services; such as, hospitals, health centers, including the convenience in using health cards.	- Services or assistance from community leaders were fair, mostly moderately good in quantity; such as, giving foods, cloths, money or things.  Other services which could help people – in - troubles to have better life quality were low.  	- Service from social groups in communities which most aging people preferred was ‘cremation service’, a community fund which people in community raises every time one member in the village dies, both in the form of legal and illegal ones.  However, aging people preferred illegal cremation fund services to legal ones.	2. An evaluation on welfare centers in communities.	Welfare centers in communities, which their objectives were to help people from troubles, were moderately successful in doing their careers because of the insufficiency of knowledge in welfare services.	3. The study on community strength related to aging people’s life quality and life satisfaction.	Aging people in highly strengthened communities have been supported in money, foods and things, messages and visits from family members, friends, neighbors and other people more than those lived in less strengthened ones.		From the findings shown above, it leads to the following suggestions:	1. In the policy level.	- It is not necessary to implement one national policy in every part of the country.	- The national policies should be really suitable to the situation and needs of people.	2. In the operational level.	- The concepts and trends of forming welfare centers in communities should be readjusted.  Members of the centers must have, at least, basic knowledge on social welfare and social work in order to be able to help people – in  - troubles as much as possible.	- Local government officers in charge of welfare services, if they really know what and how to do welfare careers, they could be the greatest assistants in communities.


location: , 'Thailand year: 2015 source: HSRI

title: The Association between Duration of Breastfeeding and Atopic Dermatitis and Asthma in Children

abstract: The World Health Organization recommends exclusive breastfeeding for 6 months for the baby’s
health and illnesses protection. Several studies have assessed the effect of breastfeeding on the risk of
atopic dermatitis and asthma. This study aimed to systematically review the relationship between duration
of breastfeeding and atopic dermatitis and asthma. We used relevant key words to search for studies
published during 2001-2013 in PubMed database and Cochrane library. Forty-two studies met the inclusion
criteria. The results found that infants not breastfed were at a greater risk of developing atopic dermatitis
and asthma (Relative risk (RR) or Odds ratio (OR), 1.15-11.53) than infants who were breastfed.
Breastfeeding for less than 3 months increased risk of the diseases (RR, OR =1.25-1.45) than infants who
were breastfed for 3 months or more. Breastfeeding for less than 6 months were associated with increased
risk of diseases (RR, OR= 1.15-2.00) than 6 months or more. Several studies show that breastfeeding is
likely to associate with protection against development of atopic dermatitis and asthma. However, since
the literature has a wide range of quality, further studies including meta-analysis study should be undertaken.


location: , 'Thailand year: 2021 source: HSRI

title: An early health technology assessment of COVID-19 vaccines: data for vaccine selection and targeting to maximise public health impact in Thailand

abstract: Thailand is facing the dilemma of which groups to prioritise for the limited first tranche of vaccinations in 2021. A mathematical modelling analysis was performed to compare the potential short-term impact of allocating the available doses to either the high-risk group (over 65-year-olds) or the high incidence group (aged 20-39). Vaccinating the high incidence group with a vaccine with sufficiently high protection against infection (more than 50%) could provide enough herd effects to delay the expected epidemic peak, resulting in fewer deaths within the 12-month time horizon compared to vaccinating the same number of the high-risk group. After 12 months, if no further vaccination or other interventions were deployed, this strategy would lead to more deaths. With the right vaccine efficacy profile, targeting the high incidence groups could be a viable short-term component of the Thai vaccination strategy. These results and emerging evidence on vaccines and susceptibility suggest prioritisation guidelines should be more nuanced.


location: , 'Thailand year: 2003 source: HSRI

title: A Synthesis of the Role and Structure of Primary Care Service System: in the Context of Health Professional and Health Services

abstract: A Synthesis of the Role and Structure of Primary Care Service System: in the Context of Health Professional and Health Services	A Primary Care Service System (PCSS) is believed to be the system that can enhance people’s health.  However due to the unclear policy and concepts of PCSS and the policy announcement on univeral health care coverage, each health care setting creates its own management.  This synthesis was made in order to find out the role and structure of PCSS and roles of health professional personnel including physicians, nurses, pharmacists and dentists in the transition period.  The data were synthesized from 8 case studies.  The findings were as follows :	PCSS is defined as the fundamental care service aiming to provide health promotion, disease prevention, therapeutics and rehabilitation services to individual, family and community through the holistic approach and continuation.  Home health service is also included.  It is the health service place which is near, is easy to access, has needed services and the service is provided by professional persons who work as a team and coordinate with a community organization.  There is a network of service and an effective referral system.  PCSS is aimed to empower people to be health self-reliant and promote family and community participation in health building.PCU structures	1.	Establishment of a PCU as on an extended OPD.  It is located in the hospital building or hospital area or in an urban area. It has permanent staff or hospital staff taking turns to work in the PCU.	2.	Establishing the PCU in a hospital or in an urban area to be a PCU model.  Permanent staff are hired to work in the PCU.	3.	Adjusting or extending the activities of social medicine or home visit teams to be multidisciplinary teams and visit both discharged patients, chronically ill patients and general people at home.	4.	Development of a potential health center, public health center or community health center to become a PCU by changing personnel’s way of thinking and working,   emphasizing health promotion and disease prevention , providing systematic home visit and assigning health personnel from contracted units of primary care service (CUP) to work  temporarily or permanently  at PCU.	5.	A drug store serves as a PCU by providing knowledge on drug use and health promotion.	The main persons who work in PCUs are nurses and public health personnel.  Some PCSS, physicians or pharmacists may work every day or a few days per week and dentist may come occasionally. In some PCUs there are dental health worker and sanitation worker in the team.  Each profession has roles as follows:	Physicians : perform physical examination, make diagnosis, give treatment, teach and advice, do home visit and administer the PCU.	Nurses : perform child health examinations, give vaccinations, do ANC care, teach and advise, do physical examinations and primary medical care, make home visits, do data surveys and family folders, do surveillance, build community collaboration, and administer PCUs (when there is no physician).	Pharmacists: provide pharmaceutical care at PCUs and home, do drug administration, give prescribed drugs, provide suggestions or counseling on drug use.	Dentists: do dental treatment including pulling teeth, filing, polishing the enamel surface, giving pain control medicine; provide oral health promotion and prevention including dental advice, advise use of fluoride in those who risk tooth decay and provide advice for oral care.Conditions for the success of PCU include:	1.	Understanding and experience of administrators and personnel in doing similar projects.	2.	Participation of administrators and personnel in policy identification and guidelines development.	3.	Building difference and creating value to the service.	4.	Paradigm shift and change of working style among personnel.	5.	Provision of essential knowledge and skill for personnel.	6.	Building understanding and clarity in role and responsibility of each personnel building morale.	7.	Good attitude toward teamwork and respect for others.	8.	Adequate manpower and appropriate workload.	9.	Having professional people as required.	10.	Understanding  primary case concepts and commitment of administrators.	11.	Strong support from community organization.	12.	Provision of appropriate budget by the government.	13.	Building more knowledge on primary care through continuous research.


location: , 'Thailand year: 2008 source: HSRI

title: Self-care participation of diabetes patients, Sophisai hospital, Nongkhai province

abstract: The purpose of this research was to study the level of self-care participation of diabetes
patients according to the opinions of those patients in Sophisai District, Nongkhai Province,
and to study the factors of the correlation and self-care participation. The sample included
400 diabetes patients who had been registered by Sophisai Hospital and cured. A
survey questionnaire was administered to the participants. The study utilized the SPSS program,
with statistics on percentage, mean and standard deviation, including the chi-square
for correlation with normal scale and interval scale factors and utilized the Cramer ’s V coefficient
for ratio scale. The results of the study showed that the self-care participation of diabetes
patients according to their opinion was at the medium level. The analysis of sectors
found that the most common self-care participation of diabetes patients was diet; the next
were exercise and self-care participation in daily life. The least common form of participation
was foot care.
The correlation between the factors related to personal characteristics, economics and
social aspects and self-care participation found that: there was no correlation for sex in the
self-care participation of diabetes patients as a whole nor was there any correlation with
participation in every side when considering sectors.
There was no correlation in age for the self-care participation of diabetes patients, nor
was there any correlation with the participation when considering sectors.
There was correlation in education for self-care participation as a whole; when considering
sectors, but there was correlation with participation, namely diet, exercise and selfcare
in daily life.
There was no correlation in income for self-care participation of diabetes patients as a
whole, nor was there any correlation with participation in considering sectors.
There was correlation in occupation for the self-care participation of diabetes patients,
when considering the sectors; the correlation with was in diet.
There was correlation in the factors of receiving information about self-care participation
as a whole, and there was correlation with participation in every aspect when considering
sectors.
The study would be applied in planning for good-quality services, supporting the
diabetes patients for self-care participation, emphasizing communication. Providing knowledge,
giving health information through the targets, building leaders who acknowledge
and are able to be the primary person in self-care participation and able to transfer information
to the members or the diabetes patient group.


location: , 'Thailand year: 2007 source: HSRI

title: Evaluation of Public Health Service Innovation: Subdistrict Hospital Created by Triangular Cooperation

abstract: This is an evaluation of public health service innovation, with a focus on subdistrict
hospital creation.  The major aims of this work were strengthening the community with
regard to the building of and participation in sustainable health care.  The method considered three phases. The first phase was to create a participation center for fostering
community trust and belief. Triangular cooperation consists of a government organization, subdistrict administration and a community plebiscite in the pilot innovation intiated in three subdistrict hospitals.  In the second phase that followed, 31 subdistrict hospitals
were distributed in 22 subdistrict areas.  The third phase utilized useful community trust
and belief for the creation of various novel projects.  The overall creation extended five
years and involved underlying community triangular participation.  The subdistrict hospitals had permanent registered nurses, telemedicine consulting and medication storage
development. The consequences of subdistrict hospital creation improved the people’s
health service access. While the number of walk-in clients seeking subdistrict hospital
services expanded year on year, a three-fold reduction was observed among those
seeking medical services in Lomsak Hospital.  Important was the two-fold improvement
in chronic illness screening.  In conclusion, the results of this evaluation suggest that a
key important success indicator of subdistrict hospital creation is the strength of community participation, consequently improving community development and sustainability.


location: , 'Thailand year: 2010 source: HSRI

title: The Comprehensive Knowledge Management in Diabetes/Hypertension Case

abstract: The comprehensive knowledge management in Diabetes/Hypertension
case project is organized to integrate the two existing networks- Toward Clinical
Excellence Network-DM (TCEN-DM) and Diabetes Knowledge Management Network.
The main objective of this project is to combine the comprehensive knowledge
management in Diabetes/Hypertension case in Thai content with the specific objectives
of the followings (1) To collect and synthesize the experience, knowledge and
innovation about diabetes/hypertension prevention and health promotion in or to
develop the clinical excellence system (2) To establish the benchmark measurement in
diabetes/hypertension management and (3) To share the knowledge in comprehensive
diabetes/hypertension knowledge management among network for best practice. The
assumption of this project is that the knowledge can be extracted from the best practice
and staff. So, the knowledge management in this project is to transfer the knowledge
from the person to the others and continuous management to create, share and adapt the
knowledge.
The leader from TCEN and Diabetes KM network from 4 regions of the
Thailand was selected to be the core responsible person (Node). They were trained for
the knowledge management, TCEN indicator and outcome mapping for building the
network, planning and operating the project. The Node was then transferred the
knowledge into their area and provided the knowledge management forum “Synergy
between tacit and explicit knowledge for diabetes and hypertension patient” during Aug
03-04, 2009. Based on the output competency from 11 events of knowledge
management market in each region, the working committee had a conclusion of 9
factors and classified into 5 levels that were used to evaluate and improve the potential
of diabetes/hypertension care team in Thailand context.
For TCEN indicator, it was increased from 17 to 20 indicators to accord
with indicator of the National Health Security Office which was revised to an
appropriate template of each the indicator.
Other than the above activity, this project has published 2 books:-
“Diabetes story: learning through practicing volume 2” and “Diabetes TCEN: Pointing,
Setting the target and Developing”. The synergy tacit and explicit knowledge story was
produced in CD and made the weblog: http://gotoknow.org/blog/dmcop to distribute the
data, story and another summary from this project.
Through a year of the project implementation by using the knowledge
management tool, most of activities were conducted under the positive, friendly,
respective atmosphere with appreciation of all participants of this project. This made the
leader and the members of the network a good relationship and collaboration. It is
confident that the network can be operated in a sustainable way.


location: , 'Thailand year: 2020 source: HSRI

title: Model development of primary care services for non-communicable disease patients using an innovative network of homecare providers

abstract: Background At present, there are an increase in the proportion of Thai elderly people who are patients with non-communicable diseases (NCDs) including diabetes and hypertension. The patients need holistic care within medical care and non-medical care in order to improve their quality of life. An investigator conducted the model development of primary care services for non-communicable disease patients using an innovative network of homecare providers. The study aimed to determine the quality of life outcome of NCDs patients who received WinCare, and to improve a non-formal health sector for NCDs patients. Methods A non-randomized trial was conducted in 2019-2020. NCDs patients were enrolled to the present study. The participants were divided into 2 groups including (1) Control group and (2) Intervention group (received non-medical care from WinCare). Baseline characteristics comprised of demographic data, blood pressure (BP), body mass index (BMI), and quality of life out come were obtained from face-to-face interview. The intervention group had been received WinCare for 6 months. The quality of life outcome, BMI, and BP were access at month 1, 3 and 6. Results A total of 99 NCDs patients were enrolled in the present study. There were 53 NCDs patients in the intervention group. After 6 months, compared to the quality of life (QOL) outcome of NCDS patients in the control group, the QOL outcome of those in the intervention group was relatively high. Conclusion WinCare are the volunteers who well trained and have a potential for provided non-medical care in the community. An innovative network of homecare providers will enhance the public health system to support the activities of NCDs patients at their home.


location: , 'Thailand year: 2020 source: HSRI

title: Incidence of tuberculosis in difference of CD4 cell count among HIV infected patients receiving antiretroviral treatment and innovative of self-assessment tuberculin skin test for latent TB screening in resource limited settings

abstract: Background: Tuberculosis preventive therapy (TPT) among HIV-infected patients are not well established in Thailand and may be due to multifactorial reasons. One of the most crucial reasons is because most physicians are convinced that antiretroviral therapy (ART) alone can decrease the incidence rate of active tuberculosis (TB) to the incidence rate of the general population. However, the incidence of TB data among Thai HIV-infected patients on ART is also scant. This information is very important because HIV-infected patients can have latent tuberculosis infection (LTBI) which can later progress to active TB. Therefore, TPT is crucial among HIV-infected patients to prevent active TB. Method: We conducted a cross-sectional, multi-center study in HIV-infected patients from 14 hospitals throughout Thailand between 2009 and 2018. This study compared the incidence of active TB among HIV-infected patients with different CD4 cell count after ART has been initiated. Results: A total of 9,179 HIV-infected patients were enrolled; 442 (4.8%) were diagnosed with active TB after ART was initiated and 8,738 had HIV mono-infection. According to the multivariate analysis, the significant risk factors associated with active TB post ART initiation were the male sex, CD4 less than 350, body weight less than 50 kg and have a prior history of active TB. When ART was initiated at low CD4 cell count, the incidence of active TB was high (Table) compared to the general population (about 150-200 per 100,000 persons-year). Furthermore, when ART was started when the CD4 count was more than 500, the incidence rate of active TB was 2-3 times higher than the general population (394 per 100,000 persons-year). The incidence of TB for the first 2-5 years after ART was initiated decreased to 7,251, 4,083, 2,661 and 1,957 per 100,000 persons-year, respectively. However, these numbers were much higher than the general population in Thailand even when these patients were on ART for many years. Conclusions: The incidence of TB among HIV-infected patients with various CD4 cell count and on ART were high. The incidence of active TB was 2.5 times higher than the general population even when ART was initiated when CD4 was more than 500. For this reason, HIV-infected patients who have had TB infection should benefit from TPT which can decrease the incidence and mortality rate of TB.


location: , 'Thailand year: 2013 source: HSRI

title: Social Welfare and Provision of Informal Care: A Case Study Using Economic Valuation to Determine Monetary Compensation in Thailand

abstract: This study evaluates informal care for disabled stroke survivors in Thailand. It applies the proxy
good method to determine monetary value of the care. Market prices of labor similar to informal care
activities were used in the cost calculation. Data were collected by means of interviews conducted during
2006. The sample consisted of 101 disabled persons who had suffered a stroke at least six months prior to
the interview, and had a functional status score of less than 95 as measured by the Barthel Index. Average
monthly time spent on informal care was 94.6 hours. Time spent for household activities of daily living
(HDL), health care activities (HCA), activities of daily living (ADL) and instrumental activities of daily
living (IADL) was 29, 24, 38 and 3 hours/month, respectively. The average monthly monetary value of
informal care was US$136 (at 2010 prices). Variations of the market price of labor caused changes in the
cost of approximately 50% (both increase and decrease). Severity of disability and urban area had significant
effects on the cost. The informal care value was less than that found using the opportunity cost
method of calculation. It was much more than the current welfare payment for disabled people (500 Thai
baht, or approximately US$16 per month). The findings should be considered as inputs for revision of
welfare payment for people with disabilities, particularly those who are also elderly.


location: , 'Thailand year: 2017 source: HSRI

title: Development of rapid screening tests for neurodegenerative diseases for self-reliance and sustainable development

abstract: Alzheimer’s disease (AD) is a primary common neurodegenerative disorder worldwide and increases prevalence in elder ages of life span. The critical detection of early diagnosis is the mostly important to support treatments to defense this incapacitating disease. Amyloidbeta proteins have various significant physiological or pathophysiological effects on AD progression. It was affirmed that amyloid-beta protein levels are detected for preclinical diagnosis and prognosis as a reliable biomarker for neurodegeneration. The available methods for detection of amyloid-beta proteins are time consuming and complicated operations. Herein, a gold nanoparticle-labelled dot blot immunoassays was had been developed for detection of beta amyloid 1-42 oligomers providing high potential early diagnosis for AD. The optimization of direct dot blot immunoassay assay was investigated and the interpretation of the colorimetric results can be visualized by naked eyes.