location: , 'Thailand year: 2021 source: HSRI

title: A Synthesis of Research for Evaluating Health and Economic Impact of Medical Marijuana Use in Thailand

abstract: The main objective of this study was to assess the health and economic impact of medical cannabis policy appropriate to the Thai context. It consists of three studies which are literature reviews to assess the positive and negative impacts of cannabis use in other countries, assessment of the medical cannabis demand and cost-benefit analysis of medical cannabis use. A review of international experiences of using medical and recreational cannabis can be concluded that elements of the cannabis legalization policy in each country affect accessibility to cannabis. The flexibility must be balanced between access to cannabis for therapeutic use among legally eligible patients, which is the benefit from the law; and the use in patients other than the permitted disease group, including leakage of drugs into recreational use which could have an impact on population health and public health where the cost of these impacts would affect the cost-benefit of medical policies. The medical cannabis demand was estimated using the burden of disease data or the number of patients in the disease groups that likely benefited from modern medical treatments using cannabis, including cancer patients with chemotherapy treatment, treatment of pediatric epilepsy, treatment of multiple sclerosis, and the treatment of neuropathic pain syndrome, as well as a group of promising therapeutic uses, such as, Parkinson’s disease, HIV patients, and those who seeking palliative treatment in the future. Estimated from 2013-2018 using mortality data to predict those seeking palliative care at the end of their life to 2030 shows that in 2018 the total number of a patient admitted from cancer was 212,256 cases, 10,128 from difficult and drug-resistant epilepsy in children under 14 years old, 281 from multiple sclerosis, 20,245 from neuropathy, 14,472 from Parkinson’s disease, 7,030 from HIV, and 53,924 cases from those needing palliative treatment. The result of the study to predict palliative care shows a trend of increasing demand for palliative care in the population group of 65 years and over, reflecting the growing demand for medical cannabis as the aging population grows. The cost-benefit analysis of medical cannabis policy, using decision tree and the Markov model with a societal perspective, by assigning 1 quality-adjusted life year (QALY) equal to GDP per capita, found that the use of cannabis according to medical indications was worthwhile for only one disease group, namely the treatment of chemotherapy-induced nausea and vomiting of cancer patients over a period of 5 years with a net result of 130 million baht. In summary, the benefits of medical cannabis use, including its use according to medical indications, use in diseases with no medical indication and for recreational use, indicate no economic value; by causing a negative impact on economics. This is due to the higher price of medical cannabis oil comparing to the standard regimens. While the use of cannabis in patients with no medical indications has a high cost of treating complications, as some patients will substitute cannabis for modern medicine. When patients stop using modern drugs, while the effects of cannabis are still lacking strong evidence, patient’s disease are more likely to occur as well as complications. There are also those who use cannabis for other unauthorized cases, such as for recreational use; which in this case will have negative impacts on both the cannabis users and other people in the society However, the implementation of the medical cannabis policy is also operating in the area of traditional Thai medicine, which has not been included in this study, as well as, the situation of using from illegal sources that the price may be higher than the standard price. Also, this study does not include community income if farmers are allowed to grow and sell cannabis, as well as export them. Therefore, in order to comprehensively assess the impact of the policy, the study should be expanded to cover the implementation of the policy in all sectors for further use in decision-making.


location: , 'Thailand year: 2004 source: HSRI

title: Development of a package development promotion activities for children from birth to 5 years old in the primary care level

abstract: This research on development of developmental promotion activities package for children from birth to five years old at the primary care level was aimed to analyze the policy, concepts and the current situation on developmental promotion activities for children from birth to five years old in the child daycare centers, kindergartens, well babies clinics and the primary care units; to study the developmental screening and assessment tools, and propose a package for promoting child development at the primary care level.  Data were collected from document review, the interview with the 63 administrators, teachers and the child care providers in kindergarten or in the child daycare centers and nurses in well baby clinics or in the primary care units from the Northern, Southern, Eastern and Northeastern regions of Thailand. Data from the meeting with eight experts in child developmental field.          The results is the following :Most nurses, kindergarten teachers and child care providers knew and shared the same an understanding of child developmental activities promotion. Some of health care centers or kindergarten had the written policy concerning  child development. In health care centers or kindergarten where there was no written policy. In well baby clinic, the emphasis was on vaccination, weight & height measurement and providing advice. In some places simple child developmental assessment and stimulation were conducted by involving parental participation. At well baby clinics, the maternal and child health guidebook was commonly used to assess development progress. The role of the nurse at primary level of promoting development of children from birth to five years old, comprises of the following activities:-Maintenance of a child’s developmental history record. -Screening and assessment children at scheduled times suitable for their age.-Organizing child developmental promotion activities and the corner for  child developmental promotion.-Giving advice/ consultation to parents on anticipated development and guidelines for developmental promotion.-Referring the child for proper diagnosis and help.           6. A package of developmental promotion activities was designed for the following persons:  For child care providers, For Kindergarten Teachers, Nurses at the primary care level


location: , 'Thailand year: 2022 source: HSRI

title: Long Term of Antibody Response to Hepatitis B after Immunization with Hepatitis B Vaccine at Birth, Combine DTPa-HiB-HB-IPV or DTPw-HiB-HB+OPV at 2, 4, 6 and 18 Months in Aged 4 and 5 Year Old. Antibody Response to Hepatitis B after Immunization with Monovalent Hepatitis B Vaccine at Birth, and DTPw-HiB-HB+OPV at 2, 4, 6 Months as Part of National Program Immunization

abstract: The universal hepatitis B vaccination for Thai newborns was integrated into the EPI in 1992. After that HB vaccine schedule had to be changed for facility to provide the vaccination. In the future, WHO will be not provide a weakened poliovirus given by mouth to infants and changed to be an inactivated poliovirus given by injection as combine vaccine likes pentavalent (wP) or hexavalent (aP) vaccine which result in the infant will be received five doses of HB vaccination in age at birth, 2, 4, 6 and 18 months. Therefore, this study is the long term to determine anti-HBs titers in the new born whom were received combine wP or aP vaccine.This study is determine anti-HBs titer in the new borns in age at birth, 7, 18, 19, 24, 36, 48, 60 and 72 months. And the results show that aP vaccine group had the anti-HBs titer and GMT level higher than wP vaccine group. However, the vaccination in age 18 months (5th dose) was influent to stimulate anti-HBs titers more than 4th dose for the both of combine vaccine. Then the long-term study show that the ant-HBs titer was initiate decreasing at age 2 year old and rapidly dropping at age 3 year old but the GMT level was remain in the same log scale in age between 3 - 6 year old. Children aged 6 year old had the level of anti-HBs (anti-HBs ≥ 10 mIU/ml) 94.2 and 62 of aP and wP vaccine group, respectively. Thus, the 5th dose for the both of combine vaccine was influent to stimulate the long term protective HB infection likes the long term study of the antibodies persistence more than 20 years after infant received monovalenct hepatitis B vaccination. Moreover, the study of antibody response to hepatitis B after immunization with monovalent hepatitis B vaccine at birth, and DTPw-HiB-HB+OPV at 2, 4, 6 months as part of national program immunization was imitating in June, 2019. After 1 and 6 moth of the 4th dose stimulation found that anti-HBs and GMT level was highly increasing levels and similar with the results of aP vaccine group at age 7 and 18 month. Therefore, the combine vaccine in EPI program might be highly effective long term against HBV infection.


location: , 'Thailand year: 2019 source: HSRI

title: Role of Fungal quorum sensing molecule, Farnesol, on Immunopathogenesis and Virulence factors against Pseudallescheria/ Scedosporium complex (PSC) [Second year]

abstract: Scedosporiosis in Thailand is mostly caused by Scedosporium boydii, which is known to be resisted to anti-fungal drugs resulting in death from infection. Most of the organs that shown disease pathology are cerebral edema and pulmonary disorders. Currently, there are many substances that can enhance the performance of antifungal drugs. It was found that substances that have been studied and developed for use in the treatment of many types of fungal infections are substances in the group of fungal Quorum sensing molecules. In laboratory studies, the Farnesol group at 100 µM can inhibit Scedosporium boydii infection without any toxicity effect to target cells. When confirmed the results of experiments in neutropenia-induced mice with Cyclophosphamide, it was found that the pathogenesis of the brain can be reduced clearly. The results of studies in mice that were inserted in the Catheter coated with Farnesol (F +) compared with those that were not coated with Farnesol (F-) shown that the amount of Scedosporium boydii at the hollow tube of the Catheter was lesser in F + group than F- group by Scanning Electron Microscopy. Moreover, the treated catheter was further cultured, which shown the lesser amount of infection or the formation of colony in F+ group than F- group (p <0.05). When comparing pathological examination between groups that were inserted Catheter, it was found that the F-group had symptoms of disseminated Scedosporiosis clearer than the F + group. It was found that the rats from F- group exhibited brain edema with severe damaged of alveolar septum and pulmonary edema. Based on the above study, both laboratory studies and animal studies as well as the underlying medical prototype product, the Catheter revealed that quorum sensing molecules, Farnesol, played an important role in inhibiting the growth of Scedosporium boydii. This preliminary study will help to develop a research in depth into the development of effective medical product. Moreover, study of other types of Scedosporium spp. should be further extended as well as the larger sample size of animal experiments. The interaction between Farnesol and the existing antifungal drugs including the study of pharmacokinetics in both in vitro and in vivo models need to be further elucidated.


location: , 'Thailand year: 2000 source: HSRI

title: Societal organization and development on Tambol Civil Society : case study in Tambon Muang Jung, Nan Province

abstract: Societal organization and development on tambol civil society : case study in Tombol Muang Jung, Nan province 	This is a qualitative study intended to examine the origins, development, role and potential of various government and non-government groups in Tambon Muang Jung, Ging Amphoe Pupieng that carry out work in the manner of civil societies. In-depth interviews were carried out with leaders, core individuals and  members of 22 out of 48 groups and organizations in Tambon Muang Jung through the use of questionnaires that were later analyzed, synthesized and summarised. 	The study found that Tambon Muang Jung originated from two villages that subsequently expanded to the present number of ten. Groups and organizations arose naturally and through establishment by the government. There are now 48 groups in 14 categories, many of  which are members of the Hug Muang Nan Network. Many of the leaders, core individuals and members of the groups and organizations have been elected to the Tambol Administration Organization (TAO). 	In the past it had suffered from the effects of encroachment and destruction of the forest for subsistence farming and then through promotion of the cultivation of cash crops and the increased immigration into the tambon. This has led to degradation of the forests, the soil, the aquatic ecosystem and aquatic life. Encroachment into the forest has increased along with an opening up to the wave of development from the outside. This has changed the quality of the community in the tambon and the balance between people and tha nature until many problems have arisen. 	The aforementioned problems have given rise to a large number of smart, honest, dedicated and committed leaders, and many groups and organizations that have spread to every  village in the tambol. The groups have also networked with non-government organization outside the Tambon. They have been able to solve their problems and those of the their communities and bring about a recovery from the conditions brough about by agricultural practices and debt and to survive the crisis. There have arisen for example 6 community forests covering an area of more than 17,500 rai, 7 fish conservation zones, which have led to a dramatic increase in the numbers and species of fish in the rivers, 2 sustainable agriculture groups, 6 community savings organizations, 5 youth groups, 2 "mueang fai" community water supply management groups, 10 housewife groups, 2 cremation fund groups, 3 occupational groups, 10 public health volunteer groups and 10 elderly groups, which together have been able to solve the problems, such as those of drug abuse, effectively.


location: , 'Thailand year: 2019 source: HSRI

title: Peritoneal Dialysis Satisfaction and Kidney Transplantation Attitude among Patients under the Peritoneal Dialysis First Policy

abstract: The Thai Peritoneal Dialysis First Policy (PD First Policy) has improved
survival of end-stage renal disease patients since 2008. However, evidence on patients’ attitudes toward
the policy and the accessibility to kidney transplantation (KT) has been lacking. This study aims to assess
PD care satisfaction and KT attitude among continuous ambulatory peritoneal dialysis patients under the
Thai PD First Policy. Methodology: A telephone questionnaire survey asking demographic data, general
opinion on PD First Policy, PD treatment satisfaction, and KT knowledge and attitude was conducted in
April 2018 among 114 randomly selected PD patients from PD centers in Chanthaburi. Results: The mean
age of PD patients was 54.21 years, and their duration of peritoneal dialysis was 3.42 years on average.
Majority of them were satisfied (79.8%) and very satisfied (4.4%) whereas only 2.6% expressed their
dissatisfaction. One hundred and six patients (93.0%) agreed with PD First Policy, of which 65.1% stated
that this policy had saved their expenses. Of the total 114 patients, only 24.6% had KT knowledge but
73.7% would like to undergo KT. The main motivation for KT was the increased chance of returning to
work and contribute to family (88.7%). Conclusions: The Thai PD First Policy has been well received.
The perceived need for KT was high. A good strategic plan to improve knowledge on and access to KT
is required.


location: , 'Thailand year: 2021 source: HSRI

title: Physical Activity in Thai Children and Youth Aged 0-22 Years: A Systematic Review

abstract: Background and rationale: Having sufficient physical activity (PA), as recommended by the World
Health Organization, is necessary for developing motor skills and physical fitness of children and youth
and reducing risks of non-communicable diseases when entering adulthood. Over the past years, there
has been a large amount of research and development of PA knowledge in Thailand, but the research
gaps and clear directions for future research have not been analyzed and identified. Objective: To
investigate research topics conducted in the past and identify research gaps in PA among Thai children
and youth aged 0-22 years and provide future research suggestions. Methodology: This study applied a
systematic review by searching research articles from Thai and international databases. The review
included studies on PA in Thai healthy children and youth aged 0-22 years written in Thai or English and
published during 2009-2019. The quality of the studies was assessed using a standard checklist. Descriptive
statistics and content analysis were used for data analysis. Result: A total of 79 studies were qualified
and included in the review. The least age groups represented in the review were children aged 0-5
years (1.3%). There was a low number of studies in the areas concerning the association between PA and
cognitive functioning, physical environment, and sociological-cultural factors. Areas that had not been
investigated were the associations between PA and mental health, socio-economic status, and technology
for promoting PA. Recommendation: Researchers should consider conducting studies that have
been identified as gaps of the research in this field to provide comprehensive information for the development
of policies and programs to encourage Thai children and youth to have sufficient PA and adopt
PA as part of their lifestyle.


location: , 'Thailand year: 2008 source: HSRI

title: Introduction and Development of an Addiction Rehabilitation Program in Bangphli Hospital, Samut Prakan Province

abstract: The purpose of this study was to assess the addiction rehabilitation model (adopting
the matrix-intensive outpatient program - IOP) in the primary care units of Bangphli
Contracting Unit of Primary Care (CUP). The capacity of the primary care unit’s health care workers has been developed to implement this model. This action research was
completed by Bangphli Hospital. The program follows the matrix-intensive outpatient
program, which features cognitive - behavioral therapy. The Bangphli Hospital therapist
team oversees and advises all the other primary care units involved in this program. The
therapist team monitors every session of the program. Their results are evaluated by using
the standard criteria from the Thanyarak Institute. These criteria require the involvement
of at least 60 percent of those who attended and completed the program, and 60
percent of those who attended being non-relapsing, and who returned to work or school.
The results of the study revealed that implementing and pursuing this addiction rehabilitation
program has been an effective solution for the drug addiction problem. The primary
care units monitored were found to have exceeded these criteria by having 88.89
percent of the patients completing the matrix program and 100 percent of those did not
relapse but returned to work or school. These patients returned to their communities and
were welcomed by their families.


location: , 'Thailand year: 2007 source: HSRI

title: A Running Campaign : Summary of Health Promotion at Waritchaphum Hospital

abstract: This was a one-group quasi-experimental study carried out at Waritchaphum Hospital
in 2006, with the objective of determining the health benefits of a running campaign.
The study population comprised personnel who were working at Waritchaphum Hospital
in 2006. Descriptive statistics were used to summarize demographic characteristics
and the level of cooperation. The difference in the results before and after the campaign
on body mass index, blood levels of sugar, cholesterol, and triglyceride was analyzed by
paired t-test.
Of the 122 persons analyzed, 67 percent were women and the average age of the
sample was 35 years; of the total, only 76 percent participated in the campaign. Over 58
percent of the persons had good physical ability. From the analytical results, the mean
blood cholesterol and triglyceride levels obtained before and after the campaign were
statistically significantly different (p-value < 0.05), whereas the means of fasting blood
sugar and body mass index were not statistically different.
As exercise is known to be necessary for health, this study of the running campaign
was conducted in the hope that, if the persons studied could change their behavior so
that they took exercise regularly for better health, they could become leaders in promoting
exercise in the community.


location: , 'Thailand year: 2018 source: HSRI

title: Economic burden and prognosis of preschool children with acute wheezing

abstract: Wheezing is an important health problem in Thailand. This study aimed to estimating costs of hospitalization of preschool children with acute wheezing under societal, provider and patient’s perspectives were also studied. The study recruited 240 children, aged 6 months to 5 years, who were admitted with acute wheezing at Thammasat hospital, King Chulalongkorn Memorial hospital, Bhumiphol hospital and Saraburi hospital. Data were collected from the hospital financial database and interviewing caregivers for the expenses. Cost-to-charge ratio method was employed for valuation of direct medical costs. Informal care cost was determined by human capital approach. It is found that societal, provider and patient costs per admission were 20,269±20,537, 18,126±16,898 และ 3,020±6,632 THB, respectively. The costs during hospitalization were the maximal proportion of 94.59 percents with the direct medical costs นด 88.83 percents. The main cost component in all perspective was hoteling cost during admission. The costs in medical school hospitals were higher than other type hospitals. The prognosis of these wheezing children was studied to determine the clinical outcomes including emergency visits and hospitalization due to recurrent wheeze during the follow-up period of 24 months. Patients’ characteristics and non-invasive biomarkers including serum specific IgE to common allergens, serum 25-hydroxy-vitamin D, and urinary leukotriene E4 reflecting airway inflammation were collected at entry to determine the association with the clinical outcomes. According to the results, the participants were boys (62.7 %) and having history of recurrent wheezing at entry (59.1%). According to laboratory results, atopy was found in 75.9 percent. Vitamin D insufficiency was found in 24.8 percent. The one-year incidences of emergency visits with recurrent wheezing during the first and second years of follow-up were 67.5 percent (95% confidence interval: 60.4% to 74.2%) and 12.2 percent (95% confidence interval: 7.8% to 17.9%) respectively. The one-year incidence of hospitalization with acute wheezing during the first and second years of follow-up were 32.3 percent (95% confidence interval: 25.4% to 39.9%) and 3.9 percent (95% confidence interval: 1.6% - 7.8%) respectively. Passive smoking from household (p=0.045) and atopy (p=0.038) were significant factors associated with emergency visits of recurrent wheezing.


location: , 'Thailand year: 2022 source: HSRI

title: Rehabilitation Services Framework by the Disabled and their Family in Disability Services Centers for Intellectual Disability, Autism, and Learning Disability

abstract: This study aimed to investigate rehabilitation services framework by the disabled and family for people with intellectual disabilities, autism and learning disabilities, and to study the feasibility of developing other necessary services for policy recommendations. Data were collected using the process of lessons learnt and the focus group discussions with service providers, people with disabilities and their families in 8 disability service centers. Then, analyzing data based on the framework, considering the care process of people with disabilities throughout their lives from birth to death and needs of people with disabilities for each age range. The ultimate outcomes were that people with disabilities could live to their full potential. The results showed that the disability services centers for intellectual disabilities and autism had similar service characteristics including family peer counseling, independent living skills and social skills training, respite care, job skills training and job coach, life stop service and family support. Obviously, there were unclearly services providing in the center of disability services for individuals with learning disability. However, lessons learned from experts, parents of people with learning disabilities and related organizations indicated that emphasis should be placed on learning skills both in school and out of school together with school buddy for teacher and family in order to increase learning skills and potentiality based on individuals’ condition. This services framework would lead to the establishment of standards for service provision in the disability services centers in the future, together with the adjustments in accordance with the guidelines for the development of service systems for the disabled in the disability services centers. It covered the issue of amending the rules and regulations related to the establishment of service centers, setting service standards, service provider development, financial support, and information system.


location: , 'Thailand year: 2018 source: HSRI

title: Priority Setting of Health Conditions and Non-communicable Diseases among Migrants in Thailand

abstract: In 2004, the Ministry of Public Health (MoPH) introduced the nationwide Health Insurance Card Scheme (HICS) for migrants who were not covered by the Social Security Scheme (SSS). Before being insured and granted work permits, these migrants must pass the health screening procedures first. However, the health screening and benefits package of the HICS have not been changed much throughout the last 10 years. The present study was conducted with an aim to revise the health screening guideline and benefit package in accordance with current disease situation by prioritization study on health conditions among migrants in Thailand. The health conditions and non-communicable diseases were reviewed. The document sources were received from the burden of disease study, and the health screening report of the One Stop Service. Another related source was the reimbursement database of HICS for migrants on the frequency, mean, and total reimbursement of high-cost care. By using modified Delphi consensus process, the research team presented the result of documentary reviews and database analysis to stakeholder meeting before prioritization process. The top 10 health conditions and non-communicable diseases in the final round consisted of pregnancy, diabetes, neonatal abnormalities, high blood pressure, substance abuse and alcoholism, work injury, head injury, mental disorders, breast cancer and cervical cancer respectively.


location: , 'Thailand year: 2014 source: HSRI

title: Family Participation in Supporting Drug Use for Thai Elderly with Chronic Diseases

abstract: The Objectives of this study were to investigate family participation in
supporting drug use for Thai elderly with chronic diseases and to create a
handbook for families who are assisting in treatment of Thai elderly with chronic
diseases.
Key informants are elderly's family, where the elder has at least one
chronic disease, in lower northern areas. The key informants are composed of
two main groups; the elderly with a chronic disease and their family members.
Purposive sampling and in-depth interview with interview guide were used for the
study. Data collection and content analysis were conducted from early in
October, 2013 until late in June, 2014. Data saturation was achieved with 50
cases. The results from this part were employed to make a handbook for families
who are assisting in treatment of Thai elderly with chronic diseases. The
handbook was reviewed by three specialists. After editing, the handbook was
evaluated by those families. Frequency, mean and standard deviation were
employed for analysis in this part.
The results showed that there were nine types of family participation
in supporting drug use. Those were 1) taking the elderly to see their physicians,
2) travelling to get medicine for the elderly, 3) tracking physician's appointments,
4) assisting with correct drug use, 5) assisting with appropriate diet, 6) maintaining
correct medication schedule, 7) preparing drugs for each meal, 8) monitoring
symptoms of drug use, and 9) building both self-esteem and esteem in others.
Several obstacles to good support were identified. They are
employment outside the family, misunderstandings between family members
and the elderly about the capabilities/self-support of the elderly, lack of
knowledge about chronic diseases and drug use in the elderly and weak family
relationships. In terms of handbook evaluation, the families had a good level of
satisfaction in every item evaluated.


location: , 'Thailand year: 2016 source: HSRI

title: The study of immunity to Diphtheria from Corynebacterium diphtheriae, Pertussis from Bordetella pertussis and Tetanus from Clostridium tetani

abstract: Purpose To investigate the immunity of Diptheria from Corynebacterium diphtheriae, pertussis from Bordetella pertussis and tetanus from Clostidium tetani in Thais Subject and method Firstly, commercial kit for the detection of antibodies to diphtheria, tetanus and pertussis using indirect ELISA (EUROIMMUN, Germany) were pre-evaluated. Secondly, the seroprevalence of antibodies to diphtheria toxin IgG (anti-DT), tetanus toxin IgG (anti-TT) pertussis toxin IgG (anti-PT) were performed in 965 sera from blood volunteers in 2014, aged between <20 and >60 years, who attending at regional blood center from the North (240 sera from Chiangmai, Pitsanulok, Lampang and Nakon Sawan provinces), the Central (243 sera from Lopburi, Ratchaburi, Chonburi and Bangkok provinces), the Northeastern (240 sera from Khonkaen, Nongkhai, Nakhon Phanom and Ubon Ratchatani provinces) and the South parts (242 sera from Krabi, Songkha, Pattani and Prachuap Khiri Kan provinces). Result Overall the seroprevalence at the protective level (>0.1 IU/ml) of anti-DT was 62.9% [GMT (geometric mean titer) 0.19 IU/ml, 95%CI 0.13-0.25)] and anti-TT was 87.8% (GMT 1.16, 95%CI 0.73-1.59). Anti-DT level from provinces in the South was higher than other parts (p<0.05, Chi square and Kruskal Wallis). Anti-DT level in Bangkok was the lowest prevalence (43.3%) and low anti-DT level might be seen at all age groups in some area such as Nakornsawan, Lopburi and Ubonrachatanee provinces. Regarding to pertussis, no information of the protective level of anti-PT was documented. In this study, the prevalence of anti-PT was 52% based on the presence of antibody in subjects bearing at 5 IU/ml (criteria for vaccine trial) and was only 12.9% based on antibody at 40 IU/ml (criteria for diagnosis based on kit) with GMT of anti-PT 10.16 (95%CI 6.93-13.39). This will be implied that Thai population might be risk of pertussis due to low prevalence of anti-PT antibody. No significant difference of gender was found in these 3 specific antibodies. Conclusion The information from this study might be the useful for the consideration to stimulate the immunity by vaccination at high risk group of waning antibodies. In Thailand, booster vaccination against diphtheria, tetatnus and including pertussis should be considered in Thai adult.


location: , 'Thailand year: 2023 source: HSRI

title: Feasibility and Acceptability of Health Maintenance Organizations for Medical Care Service under the Social Security System: Policy Research

abstract: Health maintenance organization (HMO) is one of interesting models for responding to Social Security Office’s (SSO) medical service developments. Therefore, feasibility and acceptability of stakeholders were needed to be studied for further planning decisions. Methodology: This policy research study was to assess the feasibility and acceptability of three proposed HMO models with the SSO transforming into supervisory and monitoring roles. Model one was the HMO through a large private hospital network; model two, HMO through the public health insurance or regional health system; and model three; HMO through a private insurance company. Four key informants groups were selected by using purposive sampling including 1) policy executives serving as HMOs, 2) service providers, 3) service users, and 4) executives or experts with relevant roles. Qualitative data were collected, and content analysis was performed. Results: HMO model two was the most feasible model regarding service area coverage, economies of scale, experiences of management and credibility, etc. However, there were other challenges such as regional health system capacity. Stakeholders concerned that insurer’s overhead cost would take away the desirable benefits of service users, especially in private HMOs that might have a for-profit culture. Some opinions suggested on more precise improvements of the current system instead of establishing HMOs. In addition, they disagreed on the sub-district health promoting hospital acting as gatekeeper at primary care level, as this would deprive user’s rights and create barrier of access to health services. Conclusion and discussion: Although the proposed HMO model two was considered the most possible, skeptics were on limited competitions within the HMOs. HMOs might not reduce the health expenditures because of overhead cost and long-term investment in primary care system. Further study should consider possible competitive HMO models or other HMOs in Thailand such as medical schools network.


location: , 'Thailand year: 2007 source: HSRI

title: Unit Cost and Cost Recovery in Charttrakarn Hospital

abstract: This descriptive study was designed to determine the unit cost and cost recovery in
Charttrakarn Hospital in Phitsanulok Province in fiscal year 2006 from the provider’s
perspective.  The hospital’s operations were classified into three categories: non-revenueproducing center (NRPCC), revenue-producing cost center (RPCC), and patient service cost center (PS).  The total direct cost of each cost center/activity was determined by
combining labor cost, material cost with capital cost.  After that, the  direct costs of NRPCC
and RPCC were allocated to PSCC as indirect costs by using the step-down method.  Then
the full cost of each PS was calculated from direct plus indirect costs. Dividing the final
full cost of each cost center by its output provides the unit cost.
The results show that the total cost of the hospital in the year 2006 was 44,257,662
baht, with the proportion of LC: MC: CC = 53:37:10. The unit cost of the whole out-patient
service was 417 baht per visit, while the unit costs of the out-patient cost center, dental
health cost center and family practice cost center were 348, 603 and 1,205 baht/visit respectively. The unit costs of the in-patient service were 4,287 baht/case,  1,756 baht/day,
and 7,005 baht/relative weight (RW).  The total cost recovery of the hospital was 0.94. The
scheme with maximum cost recovery was CSMBS (1.28); the second highest was that of
VHCS (1.22), followed by the universal coverage scheme at 0.91.
Recommendations:
1. Costs and unit costs among hospitals should be compared carefully.  The details
of cost identification, cost allocation and unit cost determination should be considered,
because they vary among studies.  Besides hospital revenue, the meaning should be clarified and defined with regard to the extent of revenue as well as its components. Furthermore, the value of the money in different periods of time is not the same, so it should not
be compared directly.
2. Governmental budget allocation criteria for the entire country should be assessed
for appropriateness according to the various cost characteristics among hospitals operating in different contexts.
3. Each hospital should set up an effective information system for collecting an essential database on hospital accounting, resources consumption, workload of hospital
service, and other important data. The system should be able to assess the financial situation, hospital costing and hospital performance


location: , 'Thailand year: 2011 source: HSRI

title: Analysis of News Coverage in Removing Glucosamine from the list of reimbursement, a Reflection of Advocacy for the CSMBS reform processes

abstract: Dramatically increasing in the cost of OPD drug reimbursement under the CSMBS resulting in policies
to control and reduce the cost. The cabinet mandated Comptroller General’s Department (CGP) to
manage such policies into practice. A technical taskforce was appointed and assigned to study and propose
policy recommendations. Based on a key study by the technical taskforce, medical benefit and
pharmacoeconomic aspects of Glucosamine HCL (GS) are not well established. Thus, it was recommended
to remove GS from the list of reimbursement. This resulted in the CGP regulation announced on January 1, 2011. Affected patients and other stakeholders fight against the regulation. Conflicts and arguments
were presented in newspapers continuously for 6 months. The analysis of news coverage using 62 news
clippings compared the achievement of policy advocate and the opposition in using media to affect policy.
It clarified that the advocate seemed to be more successful in output from media both in size and PR value
of news but the outcome return to be different. Resulted from sender, message and channel strategies and
variety of alliance, the opposition successfully blocked the regulation. This article suggests on future advocacy
and media strategies for CSMBS reform processes.


location: , 'Thailand year: 2012 source: HSRI

title: Compliance of research projects to the Ethical guideline of research on human

abstract: The study is part of continuous review of the Ethics Committee. The objective of the study is to
follow up the adherence of the research proposals approved by the Ethics Committee of the Institute for
the Developments of Human Research Protections (IHRP). Methods: All the studies approved during the
year 2008-2010 were randomized by stratified random sampling. The sample size is 20 from the total of
197 studies. The relevant documents were revised and the researchers were interviewed. The data were
analysed by percentage. Findings: Majority or almost all of the studies adhered to the approved protocol,
i.e., volunteer recruitment, information provision and consent process, submission for protocol amendments,
documentation in case of protocol deviation, keeping and control of studied drugs, provision of
compensation for the volunteers, keeping of confidentiality, data record and the operating procedure in
case of termination of the study. Conclusion: The studies that strictly adhere to the research protocol are
those drug studies, including both new drugs and bioequivalent studies. The main reason for good adherence
is to maintain the credibility of the data, otherwise it will not be accepted for drug registration. Some
studies that were not fully adhere to the practice guidelines for drug studies were social science studies.
Since there was no appropriate guidelines available. The operational guidelines for social science studies
should be developed.


location: , 'Thailand year: 2003 source: HSRI

title: Survey of health status and drug utilization of people in community

abstract: This study “ Survey of health status and drug utilization of people in Community “ is one of the studies in research series “ Role of drug store in the Universal Coverage (UC) Program” 	Since the government implemented the universal coverage policy and started the UC Program, profession is urged to improve the role of drug store. Drug store, which is a primary health care setting for community, should be able to response to people’s need under the change of national health system. University Pharmacy (UniPham) is the only drug store in Thailand that participated in the UC program as a sub-contractor of Mahasarakham Hospital.	University Pharmacy, an enterprise body of Faculty of Pharmacy and Health Sciences, Mahasarakham University, was established with an objective  to be a community practice setting that supports learning process in Doctor of Pharmacy program.	The complete role of health care setting needs to include both active and passive health services. It has accepted that drug stores preformed passive role in health services for a long time. Health promotion and health prevention are new challenge roles for them.	Mahasarakham Hospital assigned Nakkhawichai community to be a study area for University Pharmacy to implement its active health activities. In order to achieve this new role. Understanding of health status and drug utilization in community is a prerequisite for the University Pharmacy to plan an active public health intervention.


location: , 'Thailand year: 2003 source: HSRI

title: Detecting adverse events in hospitalitzed patient in Thailand : Recommandations from a pilot study

abstract: Adverse events can cause huge damages to both patients and hospitals financially and socially. Countries are seeking ways to resolve the problems. To do so, the first step of any institutional actions should be the development of procedures and tools to efficiently detect and monitor adverse events.ObjectivesTo study the reliability and validity of the methods for screening and detecting 	adverse events used by the Harvard Medical Practice Study when applied in ThailandTo estimate incidence, and distributions of adverse events among hospitalized patients in Thailand MethodsThis was a descriptive study. 400 cases were randomly selected from computerized medical records kept in CD-ROM of the Office of Social SecurityA three - step medical record (chart) review by 4 trained nurses and 3 physicians was employed. The procedures were adapted from the methods used by the Harvard Medical Practice Study.ResultsThe agreement of screening process among the nurses and a physician was low  (Kappa = 0.34, 95% C.I. of Kappa = 0.24  to 0.43,  Sensitivity  =  70.23 %,   Specificity  =  66.27 %, Positive predictive value  =  51.69  %, Negative predictive value  =   81.25 %).The agreement of the 2 physicians in detecting the occurrence of adverse events was also low (Kappa = 0.393, 95% C.I. of Kappa = 0.25 - 0.53). The incidence of adverse events was 9.1 per cent (95 % C.I. = 6.19  ถึง  11.94 ). 71.4 % of adverse events occurred were considered preventableConclusions	The reliability of the procedures to screen and detect adverse events in hospitalized patients applied in the study was low. Therefore, studies to improve the reliability of the procedure are needed.


location: , 'Thailand year: 2011 source: HSRI

title: Screening, Treatment and Rehabilitation for Alcohol Problems: Gaps under the Universal Health Coverage

abstract: Services to provide screening, treatment and rehabilitation of alcohol-related problems are covered
under the Universal Health Coverage Scheme in Thailand. However, massive number of population with
risks and patients are practically ignored, do not get what they should be serviced, from the current health
care system and practices. Unintentionally but significantly, the shortage to provide proper care, escalates
the magnitude and severity of alcohol problems. Technical evidence shows the need, appropriateness,
benefit and practicability of the comprehensive services for alcohol related problems with in Thai health care system. The comprehensive service should cover four interconnected components; 1) alcohol screening
and brief intervention, 2) Detoxification and treatment of physical co-morbidity, 3) Alcohol treatment
and rehabilitation, and 4) Long term after care. Major limitations at macro scale is the lack of policy to
strengthen health care system in addressing alcohol problems, including in raising significance, building
up preparedness and capacity of the systems, providing incentive, and resource management. Critical
constraints at institutional level include awareness and capacity of health workforces, the lack of risk
assessment and management, the unavailability of clear and comprehensive policy. The framework to
strengthen Thai health care system response to alcohol problems should tackle major system gaps in
current systems, and strike balance of and cover all four components in parallel.


location: , 'Thailand year: 2014 source: HSRI

title: Evaluating service quality of primary care units in Prachuap Khiri Khan Province

abstract: The study aims to evaluate and identify factors affecting the quality of services in the primary care
units in Prachuap Khiri Khan. Subjects were specifically selected from 162 health personnel (a head of
each primary care unit and staff) and 405 patients (five per unit) and asked to fill in the questionnaires.
Descriptive statistics was employed to determine service quality; K-mean method of cluster analysis was
used to classify the primary care units; and multinomial logistic regression was used to determine the
relationship between the unit’s characteristics and service quality. The results show that 75.80% of respondents
found the quality of service higher than expected. 27.16%, 45.68% and 27.16% of the primary care
units offered good, medium and poor quality of service, respectively. The factor affecting service quality
was the availability of electricity.


location: , 'Thailand year: 2020 source: HSRI

title: Health Systems Challenges by the Intent of Primary Health Care: Synthesis of the Recommendations for Oral Health Care System Development for Thai Population

abstract: Health care system development had been the global basic health need goals of world population
by the year 2000. Signatory countries to the World Health Organization agreed that the primary health
care principles were the key for the development. However, current oral health data of Thai population
show gaps to the expected goal even by 2020. This article is a review of documents related to the
primary health care, aiming to understand the original intentions of this principle together with analyzing
oral health situation of Thai population, then synthesizing challenges in the overall development of oral
health care and proposing recommendations for improving the oral health service system to ensure oral
health fairness. Three challenges are presented; 1) The oral health goals should be clarified with agreement
among stakeholders including individuals who own their oral health, 2) Revising the six building block
components of the health system and managing these driving components towards the goals, and
3) Managing other oral health determinant factors not limited to the utilization of oral health service
delivery. In the end, three recommendations are proposed; 1) The long-term oral health goals review and
revision together with service delivery system goals through periodic monitoring, 2) Integrating these
long-term goals with the current policy practice of the Ministry of Public Health (the service plan, the
regional health, and the district health system driving forces), and 3) Providing oral health personnel with
appropriate competencies for the future oral health system, including planning skill, dental practitioner
skill, and the coordination skill.


location: , 'Thailand year: 1999 source: HSRI

title: Human resources for health in Thailand : technical report

abstract: There has been significant improvement in distribution of human resources for health in Thailand. Historically, a shortage of health personnel in rural areas was severe. Nevertheless, the most needed group in rural areas was the physician. The doctors, dentists and pharmacists in rural areas were mostly under compulsory service program by which they were financially subsidised while studying. Nevertheless, there were high turnover rates of these groups in rural areas. The Bureau of Health Policy and Planning was responsible for determining needs for HRH (human resource for health) for utilisation while the Ministry of University Affairs (MUA) mainly produced HRH especially doctors, dentists and pharmacists. However, the Office of Civil Service Commission (CSC) controlled staffing patterns of all public health facilities. Most reasons of leaving district level given by HRH were job dissatisfaction and their need for further training especially for being specialists. However, health sciences students and their parents were not against the compulsory service program rather favouring government financing for education. The paper proposed number of doctors at the provincial level be less than that of district level which was opposite to the CSC’s requirement and the compulsory service program be remained for doctors, dentists and pharmacists. More equity of HRH distribution among provinces should be implemented and additional budget should be given to district health facilities to employ additional staff. Financial and educational incentives should also be delivered for those working in rural areas.


location: , 'Thailand year: 2003 source: HSRI

title: Medical doctors' behavior and responsiveness to compensation and incentive measures neccessary for health promotion under the health insurance for all

abstract: The objectives of this research are to study: 1) the knowledge, understanding, and health promotion practice of  medical doctors; 2) the health promotion delivery process of public and private hospitals; 3) existing compensation and incentive measures provided medical doctors to enhance positive health promotion behavior; 4) condition for health promotion practice of medical doctors; and 5) guidelines for the development of effective compensation and incentive mechanism enhancing participation of medical doctors in health  promotion. Samples in this study are 15 central, general, community and private hospitals representing the Northern, Northeastern, Southern and Central Regions. Interviews are conducted with 26 hospital administrators and 41 medical doctors, while group discussions are organized for 106 medical personnel and 300 copies of questionnaire are administered to 300 patients.	The study finds that medical doctors have fair knowledge and understanding on health promotion. For instance, they understand that health promotion is a preventive measure, “good health” covers 4 dimensions namely physical, mental, social and spiritual, health promotion is worth as an investment and is very one’s responsibility. Most medical doctors view that the Health for All Policy which emphasizes health  promotion service in congruent with treatment is a good policy but has not yet been materialized.	Health promotion behavior of medical doctors at the time of the study is not much evident. Those who adopt the practice are found to be the ones who have been trained in family medicine or specialized doctors who are personally interested and voluntarily carry out the task, believing that  health  promotion makes people healthy and do not need to come to the hospital for treatment which helps saving the expenses. Health promotion roles of medical doctors are found to include: 1) giving health promotion service to individual patients; 2) giving health promotion information to groups of patients; 3) formulating health promotion policy; and 4) acting as good examples in health promotion for the people.	Health promotion process as practiced by general and specialized medical doctors in different categories of hospital relatively differs. Most central and general hospitals tend to introduce health promotion service in a lesser degree than community hospitals, but more than private hospitals. Generally health promotion process takes place during the treatment rather than before of after the treatment and has not been operated holistically, as physical health is more emphasized than mental, social or spiritual health. Conditions hindering medical doctor’s health promotion behavior are the lack of clarity and integrity of the policy, budget allocation which does not facilitate the process, outnumbered patients, heavy workload, long-time measurement of success, lack of spicalization, less chance for progress and social acceptance.	Compensation and incentive measures for medical doctors and other medical personnel are not visibly existed. Doctors who give health promotion service are mainly inspired by their in-born attitude, by the leaders, teamwork and spiritual support from the patients. Contributing factors as seen by the doctors are for instance appropriate and fair compensation, recognition of their dignity, opportunity for professional progress, balance between number of doctors and the workload, corresponding educational system offered in schools of medicine, upgrading of doctors’ skills and support from the administrators	Recommendation of the study are that health promotion service should be successively continue in accordance with The National Health Insurance Act, B.E. 2545. Schools of medicine’s curricula should have more contents on health promotion and appropriately integrate its body of knowledge therein. The hospitals should be prepared for health promotion  service which includes the policy consideration, plans, activities, structure, resources and public relations. Concept that doctors are the main engineers of health promotion system should be cultivated and consequently incentive measures and appropriate compensation should be established for them along with other health promotion development mechanism.


location: , 'Thailand year: 2022 source: HSRI

title: Situation and Lesson Learned for the Role Model of Primary Care via Sam-Mor Policy in Northeast Thailand

abstract: This research aimed to 1) evaluate the situation of primary care provision in Northeast of Thailand 2) lessons learned for the role model of primary care, strengths, key success factors, problems, and obstacles for the area-based service 3) home care by the three doctors’ team and 4) to make a policy recommendation. A questionnaire and guideline for in dept-interview and brainstorming were used as a research tool. The subjects consisted of 468 primary care team members selected by a simple random sampling method. Most consisted of nursing professional and public health technical officer working in the health region 7, 8, 9 and 10. It was found that the attitude of respondents was at a good level. The most of unit passed in quality outcomes framework (QOF) with 80.7%. Half of total lacked doctor and less than half lacked health personnel. Most of them received a lesser budget than the expense from the Contracting Unit for Primary Care. With a full score of 3, the overall mean of service was 2.61 (SD 0.84). The lowest was 2.29 consisting of consultation and communication channels (SD 0.57), and service system (SD 0.39). The lowest scores consisted of service delivery 1.73 (SD 0.51), health workforce 1.92 (SD 0.68), and health information system 2.39 (SD 0.52). The registered teams showed the statistically significant completion in service more than those with the non-registers (p-value 0.018, Adjusted Odds Ratio 5.16 with 95% confident interval 1.33 to 20.12). The service of primary care unit among urban, semi-urban and rural model were not different. The urban, and semi-urban showed superior in ability of team, a holistic care and advice by family doctors. The community participation, supported by public health volunteers and network of rural model were closer and stronger than of the urban and semi-urban. Key factors for the patients regarding to primary care unit were in a good location, quick service, easy to access and the familiarity of. Most of patient accepted the three doctors. The urban team with more experienced showed completely in the service and activities better than in the rural. The policy and the registration help to link primary care team and support for the patient care. The problems were lack of the family doctors and health personnel. Instrument was broken, and the data results inputting was overload. The Human Papilloma Virus (HPV) screening and Antenatal care (ANC) were not covered. It was concluded that primary care in urban, semi-urban, areas was found to be outstanding in home health care by the family doctors consisting of multidisciplinary teams. The continuing service delivery to patients’ home was duly covered. The small primary care in rural areas proved significantly with a pass in the QOF more than the medium size. Lacking the family doctor and health team, it was supported by the network in the rural areas. Training and knowledge were required to update within the health professionals. The management of health information by technology and reference systems should be improved for the patients’ benefit more than the staff workload. The telemedicine needed to be an innovative for all areas.


location: , 'Thailand year: 2023 source: HSRI

title: Efficacy and Safety of Andrographis Paniculata Extract for the Treatment of Asymptomatic or Mild-Symptom COVID-19 Patients: A Multi-Centered Double-Blind Randomized Controlled Trial

abstract: The treatment and care process for COVID-19 disease has continually evolved since our knowledge and understanding have been expanded. The main goal of treatment was decreasing the viral replication activities to limit the number of viruses, aiming to reduce the magnitude of clinical symptoms. Multiple techniques, such as vaccines and medication, could achieve this goal. Andrographolide extract was prepared with active ingredients of 180 mg andrographolide for COVID-19 treatment with a regimen of three times a day for five consecutive days. The AG was claimed to be used in-vitro to inhibit SARS-CoV-2 viral replication through the virus life-cycle and also inhibit Spike protein, Angiotensin Converting Enzyme 2 (ACE2), PLpro and 3CLpro. As a result, this study plans to prove AG’s efficacy in COVID-19 treatment in vitro by performing Double-blinded Randomized-Controlled Trial under the robust quality control of quality by Data-Safety Monitoring Board (DSMB), approved by ethical committee from Department of Thai Alternative Medicine, Ministry of Public Health project number 11-2564, RCT registration number was TCTR20211224002 from www.thaiclinicaltrials.org and granted budget by Health System Research Institute (Thailand). This study was conducted in a multicenter health facility throughout the Health Region 4 of Thailand. We enrolled 396 people, of which 201 were assigned to receive standard treatment with a placebo (PB), and the rest received standard therapy with andrographolide (AG) add-on. The general characteristic of samples was males 38%, and the median age of samples was 35 years old, with indifferent vaccine history but significantly different rate of lorazepam taken in the AG group (p=0.038) The efficacy of AG was evaluated with multiple rubrics: 1. The incidence rate of pneumonia was 0.51% with 95%-CI 0.06% to 1.82%; PB was 0.50 % vs. AG 0.52% but no statistical significance. 2. We found an insignificance difference between AG and PB in clinical spectrums: a. Percentage of subjects who self-reported clinical resolved (on Day10 86% vs. 89%, p=0.133) b. Time of detection of low level of blood oxygenation (O2 sat less than 96%) (Kaplan-Meier; Log-rank test = 0.471) 3. We found no difference in terms of the ability to decrease SARS-CoV-2 viral load between PB and AG: a. Viral load decreased from 104 copies/ml baseline to 102 copies/ml on Day 5 and 10 copies/ml on Day 10 in both groups (p=0.624 and p=0.685) b. The percentage of samples that were presented with less than 35 percent of viral load when compared to baseline on Day 5 (PB 85% vs. AG 86%, p=1.000) and Day 10 (PB 91% vs. AG 97%, p=0.175) were found no different. c. The percentage of samples that were presented with no virus found on Day 5 (PB 41% vs. AG 37%, p=0.624) and Day 10 (PB 87% vs. AG 90%, p=0.685) showed insignificant changes after treatment. Moreover, this study aimed to monitor the side effects of AG during the regular COVID-19 routine treatment. We measured some adverse impact on AG treatment: 1. Liver function: a. The AG group showed a significant elevation level of Aspartate transferase (AST) on Day 10 (PB: 19 IU/L vs. AG: 22.5 IU/L, p=<0.001) but not statistically significantly different in case of three times the upper normal limit b. The AG group showed a significant elevation level of Alanine transferase (ALT) on Day 5 (PB: 20 IU/L vs AG 24 IU/L, p=0.041) and Day 10 (PB: 22 IU/L vs AG 27.5 IU/L, p=<0.001). Moreover, we found that enzyme elevation was over three times higher than the upper normal limit significantly (1% vs. 4%, p=0.03) 2. Kidney function by Estimated Glomerular Filtration Rate(eGFR): Due to the accidental finding of significant differences between PB and AG since baseline measurement until day 10; Day 0: 105 cc/min vs. 110 cc/min, p=0.017, Day 5: 110 cc/min vs. 116 cc/min, p=0.002 and Day10: 111 cc/min vs. 117 cc/min, p=0.010. By the way, both groups of samples showed gradual renal function improvement. 3. Potassium levels were found to be insignificant different through the course of treatment: Day 5 (PB: 3.9 mmol/L vs. AG: 3.8 mmol/L, p=0.218 and Day 10 (PB: 3.8 mmol/L vs. AG: 3.8 mmol/L, p=0.895) Based on AG’s adverse event finding versus the fact that no significant drug efficacy was found during the preliminary analysis, the DSMB has decided to discontinue the trial because the risk was higher than the benefit. In conclusion, AG extract was found to have no efficacy on pneumonia prevention, symptom reduction, and decreasing viral replication compared with placebo based on this number of samples but a significant risk of hepatitis. So, we recommend making public communication on these topics: 1. The 180 mg of AG extract daily showed no clinical effectiveness in pneumonia prevention, symptom reduction, and decreasing viral replication activity more than usual based on the limited number of samples. A vaccine was one of the most substantial pieces of evidence to prevent the clinical symptoms and pneumonia prevention. 2. The Department of Thai and Alternative Medicines and the Thai Food and Drug Administration should announce the warning that AG usage can produce significant levels of hepatitis. So, the physician should prescribe this herb with risk concerns, and close monitoring should be recommended. Avoid using this drug with other herbs or medicines metabolized by the liver, such as Warfarin. The following study could be done on three more issues: the Dose-Related effect of AG, contraindication of usage, and other diseases that benefit from AG extracts.


location: , 'Thailand year: 2017 source: HSRI

title: Implementation of One Health Concept in Lowering of Human Streptococcus suis Cases in Chiang Mai

abstract: This study aimed to explore the epidemiological information of Streptococcus suis (S. suis), either in pigs and human. Those information was used to find the appropriate method to reduce the number of S. suis infection in human. The tonsil swab samples from sows and fattening pigs, pork from pig slaughter houses and pork in wet and super markets in Chiang Mai province were collected for S. suis culture. Moreover, demographic data, education attitude and risk factors data from 35 S. suis infection patients were collected. The results indicated that from 43 farm, sow samples from 13 farms were detected S. suis (30.23%). In fattening pigs, S. suis was detected in 57 farms from 111 farms (30.23%). Pork sample from pig slaughter houses and pork in wet and super markets were detected S. suis 26 from 119 (21.85%) and 5 from 50 samples (10.00%), respectively. S. suis type 2 were found in 1 pork sample from pig slaughter houses and 1 pork sample from wet market. The virulence gene, including gdh+,arcA+,mrp+,thrA+ and sly+ were detected from those sample. The data in human showed that S. suis patients were male more than female. All of them had underlying diseases and always drank alcohol. They had the history of raw pork or unsure well cooked pork before showed clinical signs. Nine patients (27.71%) showed deafness and trend to be permanent deafness. This study indicated that even though pigs is the important carrier of S.suis and the agent can transmit to human via slaughter process, the consuming behavior is the key factor that effect S. suis in human.


location: , 'Thailand year: 2022 source: HSRI

title: Characterization of Bacteria and Saliva Proteome Specific to Periodontal Disease in Patients with Rare Genetic Immune Diseases (2021)

abstract: Periodontal infections are common problem in general populations, particularly in patients with inborn errors of immunity (IEI). The disease is chronic and deliberating, resulting in reduced quality of life. Due to limited understanding of oral characteristics of the IEI patients, the aims of this project were to investigate genetic variants, phenotypes, plaque microbiome, and salivary proteome of IEI and periodontitis patients using exome/genome sequencing, metagenomic sequencing, mass spectrometry, and bioinformatics. Seventy participants: 15 IEI, 15 periodontitis, and 45 healthy were recruited. Seventy-five plaque DNA, 75 salivary samples, 75 metagenome data, and 75 proteomics data were obtained. This project showed that the IEI patients had poor oral hygiene and gingival inflammation. Genetic variants in BTK, CD40LG, FERMT3, STAT3, ELANE, TTC37, and NCF1, and chromosome 22q11.2 deletion were identified. The diseases diagnosed such as X-linked agammaglobulinemia, hyper-IgM syndrome, leukocyte adhesion deficiency, and congenital neutropenia. Metagenomics revealed that IEI patients had alterations in oral microbe composition, alpha-diversity, and beta-diversity. Bacterial species that were significantly increased in IEI: T. denticola, S. gordonii, S. oralis, Actinomyces, and V. parvula were pathogenic species also observed in periodontitis patients. Moreover, salivary proteins, particularly those related to bacterial defense, host immunity, and glycolysis, were significantly changed in IEI and periodontitis patients. In summary, this project demonstrates IEI-causing variants, microbiome dysbiosis, and disturbed salivary proteome in IEI and periodontitis patients. The study expands understanding of genotype and phenotype of IEI, leading to identification of biomarkers of periodontal diseases and impaired immunity. We provide genetic counselling and personalized oral care to the patients and families, publish international papers, groom researchers and students, build network, and distribute knowledge in international conferences and organizations. The project produces outputs/outcomes in academics, research, community, and health care that will lead to utilization of research in policy-making in the future.


location: , 'Thailand year: 2017 source: HSRI

title: Socio-demographic Characteristics of Persons at Risk of Falling into a Vicious Cycle of “Low education, Poverty and Illness”: Findings from a National Health and Welfare Survey, 2015

abstract: The ultimate aim of Universal Health Coverage (UHC) is 1) to ensure that all Thai citizens have
access to essential health services when needed without financial barriers, 2) to improve equity in
utilization of health services and 3) to protect households from financial catastrophe and impoverishment
due to medical bills. Thailand has achieved UHC since 2001. However, some are still uninsured
and may face difficulties when they need health services. Objective: This study aims to estimate the
number of Thai population who were at risk of potentially falling into a vicious cycle of “low education,
poverty and illness”, and identify who they are, where they live and whether they suffer from
medical bill? Method: Data from the Health and Welfare Survey 2015 conducted by the National
Statistical Office were utilized. The studied variables included socioeconomic, healthcare utilization
of both inpatient and outpatient services, and the out of pocket payments. Result: There were about
2.4 million Thai populations identified as having lowest economic household status, educated up
to primary school and had no jobs or being economically inactive. Among these vulnerable people,
59,779 had no health insurance. For this subset of population, 86 percent were female, their average
age was 38 years and most of them lived in municipal or urban area, Bangkok or in the central
region. When they were ill, the majority (62 percent) chose self-medication or sought traditional care
or herbal medicines. For hospitalized illness, all (100 percent) admitted to public hospitals, and paid
for medical bills by themselves (i.e., out of pocket) with a higher amount than those insured (Median:
9,999 Baht vs 700 Baht, respectively). Summary: Proactive and passive policies with collaboration
among ministries, especially the Ministry of Public Health, the Ministry of Labour and the National
Health Security Office would mitigate vulnerability of these risk groups and gradually reduce, then
eliminate the vicious cycle.


location: , 'Thailand year: 2018 source: HSRI

title: Budget Impact and Situation Analysis on the Basic Vaccination Service for Uninsured Migrant Children in Thailand Migrant health

abstract: Migrant health is an important issue that has caught much political attention for years, particularly at the present where migrant birth rate is rapidly increasing. The objectives of this study are to 1) explore the operational system of the provision of essential vaccines for migrant children in Thailand through views of policy makers and health professionals, 2) analyze the extent to which migrant children have accessed to vaccination services in Thailand, and 3) estimate the budget impact in the provision of essential vaccines to all migrant children in Thailand. Parallel mixed methods design was employed. Data collection techniques comprised in-depth interviews for qualitative part and secondary data analysis for quantitative part. Study sites were public hospitals in four migrant-populated provinces. The results showed that although there was no explicit policy to provide basic vaccination for uninsured migrant children in Thailand but practically, health providers at the hospitals catered vaccination services free of charge for all migrant children regardless of their insured status through the leftover vaccines which were initially provided to Thai children. From migrants’ perspectives, buying health insurance is not the most important reason that influenced migrant parents to pay for health insurance for their children. Some migrant children travelled back to their country of origin when they grew up. The vaccination utilization rates amongst migrant children were quite low relative to standard utilization rate. If the government wished to provide basic vaccinations specifically for migrant children, the additional budget impact would be around 6.9-73.9 million Baht. In terms of policy recommendations, the Thai government should consider imposing essential vaccination as basic rights for all children regardless of their insured status, and such a service should be independent from nationality precondition and financial barriers. The government might consider investing more on vaccination at the cost suggested above. However adequate supporting mechanisms for the health facilities should be in place in order to ensure the country’s health system and financing sustainability.


location: , 'Thailand year: 2015 source: HSRI

title: Medical Assistive Devices Benefit under Public Health Insurance Scheme for Disabled People in Thailand

abstract: With an increasing number of persons with disabilities, the government should provide them with
decent services that meet their needs. One of the crucial services is the provision of assistive devices. The
problem of accessing to the service in Thailand is caused by the inequity of the benefit package provided
by the public health insurance schemes, which can lead to a number of adverse consequences. This study
used qualitative methodology, including review of literature, reports, and other documents that are related
to assistive devices service of the public health insurance schemes in Thailand and other organizations,
to determine the difference of the schemes’ assistive devices benefits. It was found that the different
definitions of person with disabilities for each scheme led to different benefits. In addition, the number
and type of assistive devices and reimbursement methods were different and created financial burden to
persons with disabilities, especially for the scheme that required advanced payment. Furthermore, the
different assistive devices covered in each scheme could prevent disabled persons with certain disabilities
not access to essential medical devices. The integration of benefits and services for persons with disabilities
of these public health insurance schemes is needed in order to reduce inequity problems among them
and make most efficient resource use.


location: , 'Thailand year: 2009 source: HSRI

title: Effects of Changing Antihypertensive Drug Administration Time during the Muslim Fasting Period of Ramadan

abstract: This study was conducted to determine the effect of changing antihypertensive drug administration time during the period January 1, 2008 to October 31, 2008 among patients who received treatment at Nongjik Hospital, Pattani Province. The 140 patients studied received antihypertensive drugs once daily. Determination of the blood pressure before and during the Ramadan period were carried out among 70 patients without changing drug administration time, compared with those 70 patients with changing the time concerned. Data were collected from OPD cards, glucose level records of the patients, and monitoring change records during the Ramadan period. The SPSS for Windows software package was used to analyze the data.
The distributions by sex, age, and items of antihypertensive drug use were comparable between both groups. Both groups had significantly lower mean weight and systolic blood pressure during the Ramadan period, compared with figures before Ramadan. There were no statistically significant differences in systolic and diastolic blood pressures between both groups.
It is suggested that before the Ramadan period, good health education about food intake, exercise, administration schedules, and hypotension should be given to Muslim patients with hypertension.


location: , 'Thailand year: 2005 source: HSRI

title: The feasibility of an outpatient casemix classification system based on the health insurance database in Thailand

abstract: The objective of this study was to examine the feasibility of an outpatient casemix classification system based on the health insurance database in Thailand. The Ambulatory Patient Groups (APG) developed by 3M and Adjusted Clinical Group (ACG) by John Hopkins University were used as the reference model. Model for predicting outpatient expenditure in selected chronic disease groups i.e. diabetes mellitus, hypertension and high cost of care i.e. renal failure and thallasaemia. From 39.1 outpatient visits was grouped into 82 medical APGs which is 21.2 million visits. Most common medical APG groups were 3.3 million visits in influenza, upper respiratory infection and ear, nose throat infections (APG 542), 1.5 million visits in dental diseases (APG 541) and 1.4 million visits in hypertension (APG 572). While can be grouped into 80 groups in ACG which is 7.7 million persons. Most common ACG groups were 1.9 million persons in acute minor, age > 5 (ACG 300), 8.7 million persons in chronic medical: stable (ACG 900) and 0.7 million persons in likely to recur without allergy (ACG 500). From APG concept, significant variable (p-value < 0.05) which increasing medical charges per visit in diabetes model were age, male, provincial and general hospital, refer-out, complication and comorbidities as hypertension, cardiovascular diseases (CVD), cerebrovascular diseases and renal diseases. Significant variable which increasing medical charges in hypertension model were age, male, provincial and general hospital and co-morbidities as diabetes, hyperlipidaemia, cerebrovascular diseases, ischaemic heart disease and renal diseases. Significant variable which increasing medical charges renal failure model were provincial and general hospital, APG and cardiovascular diseases as comorbidity. Age was significant variable which increasing medical charges in thallasaemia model. From ACG concept, significant variable (p-value < 0.05) which increasing medical charges in chronic diseases with hypertension were age, male, provincial and general hospital, number of visits, length of duration between visit and MAC 5 AND 15. Significant variable which increasing medical charges in diabetes model were age, provincial and general hospital, number of visits, length of duration between visit. The results indicated that outpatient classification system requiring more information such as significant procedure and ancillary service for the other two main APG groups. These will be further developed for outpatient classification system in Thailand.


location: , 'Thailand year: 2007 source: HSRI

title: Program Outpatient Department Audit, Sisaket Province

abstract: The software program OPDAudit was developed from Microsoft Visual Foxpro. It
was used to audit outpatient data in contracting units of primary care (CUP) of Sisaket
Province, to analyze the outpatient services: health-care services or health promotion services
and finally to made a report for claims to the Sisaket Provincial Health Office. Input
files for this program comprised 12 electronic files, which every CUP sends to the Sisaket
Provincial Health Office monthly.


location: , 'Thailand year: 2008 source: HSRI

title: The Benefit of Group Participation in the Control and Self-care Patients with Non-insulin Dependent Diabetes Mellitus

abstract: Non-insulin dependent diabetes mellitus (NIDDM) is a major health problem. One
significant factor that affects the success in its control and treatment involves the individual
self-care behavior in patients’ life style.
The purpose of this study was to assess the effectiveness of group participation in
self-help on self-care in patients with non-insulin dependent diabetes mellitus by comparing
them with patients receiving routine advice. The subjects included 88 non-insulin
dependent diabetes patients who attended the outpatient department of Prachathipat
Hospital in the period from December 2006 through May 2007. The samples were simply
randomized into experimental and control groups comprising 44 patients each. The experimental
groups assigned to the self-help group was further divided into four subgroups
of 8 -11 patients to join three activity sessions, spending 40 minutes in each of
them once a month. The control group received routine advice. Data were then collected
through interviews using questionnaires before and after the experiment. The statistical
analyses provided mean, standard deviation, and information from paired t-test and ttest.
The findings showed that, after completing the study project, the self-care behavior
mean score of patients who participated in the self-help group was statistically higher
than it was before starting the experiment and higher than the results in the control group.
The gained mean score on self-care behavior after the experiment between the self-help
group participating and the routine teaching group differed statistically.
The explanation given was that participation in the self-help group provided the
patients with sharing and learning experiences. The researcher suggested that the efficiency
of self-care behavior could also be modified for practice in the prevention of complications
from other chronic diseases.


location: , 'Thailand year: 2002 source: HSRI

title: Methodological development for health impact assessment : A case study from TRIPs agreement in drug Patent

abstract: Rationale: Drugs are essential for patients. International trade agreements might affect accessibility to essential drugs for many patients.   Some would finally die because they do not have enough money to buy expensive drugs. One of the major international trade agreements is  the “Trade Related Intellectual Properties or TRIPs” . Intellectual properties include “patent” and “copy right”.  A patent is granted to inventors for any branches of industrial inventions. A copy right is granted to the owners of writings, musical composure, art works, movies and trade marks.  Protected intellectual property rights encourage innovations and innovators are fairly rewarded. It is believed that intellectual property right protection will be economically and socially beneficial to the world in the long run. Intellectual property right related to health policy is “drug patent”. There are two subgroups for drug patent i.e. one is related to “product patent” , another is related to “production process patent”. In Thailand, Patent Act has been enacted since 1979. Under this act, the protection of  “product patent” right for drugs is excluded but “process patent”.  The rationale for the exclusion is based on human health and livelihood. Unreasonably expensive drugs are the major concerns. The country’s drug industry might also be affected if the right is granted. 	 During 1984-1999, the US government put pressure on the Thai government to amend the “Patent Act” and “Copy Right Act”. The US government required that “product patent” must be included otherwise Thailand will be punished by abolishing the “GSP” granted to Thailand. The “GSP” is granted to allow some developing countries to be able to export commodities to The US with low tariff rates. It was estimated Thailand will lose $US 165 millions or  4,125 million Baht (in 1983). Other measures will simultaneously be implemented if Thailand refuse to amend the Act.  Finally, Thailand has amended the Act in 1992.	Major amendments are as follows:  	1. Extend the protection to other items including food product, beverage, drugs and drug ingredients, agricultural machinery. Extend protection period from 15 years to 20 years effective from the date of submission for patent. Compulsory licensing must be done according to the Uruguay round on trade agreements.  For instance, compulsory licensing can be used only if the owner of the patent unrightfully performed by unreasonably not producing or not selling the products.  If compulsory licensing is implemented, the owner of the patent can make an appeal to the court.Clauses related to drug patent as well as other regulations related to pricing and anti-dumping must be amended according to the Uruguay round on trade agreement.   Later in 1999, more amendments were done. The committee on “Drug Patent” was abolished.  A system of petty patent was implemented. The study aims at studying the scopes of the health impacts arising from the amendments of the Patent Acts.Study Methods: Literature reviews, In-depth interviews with government officials who have duties on the related issues, group discussions with stakeholders to outline the scopes of the impacts of the amendments to be assessed in the future.  Results of the study:	The scopes of the impacts on Thailand drug systems because of  TRIPs were found in these three areas:  1.    Rising costs of drugs and inaccessibility  to drugs especially those with AIDS Hindering the development of home drug industry	CASE STUDY: Anti-retroviral drugs for AIDSDrug manufacturers purchase license from various research institutions. They then manufacture drugs to be sell in the markets around the world under their own brand names.  For example, Bristol Meyer Squipp bought license to produce an anti-retroviral drug called “Didanosine” (ddI) from the National Institute of Health who has discovered the drug. The company has modified the ingredients of the drug by adding antacid components in order to make it acid tolerable and not being destroyed in stomach. The company submitted for new drug patent in Thailand. and		Moreover, the company was also submitting for new drug patent for the combined formula, for example,    “Indinavir” combined with “Efavirenz”  or  “AZT” combined with “3TC”. 	The company was granted protection even though it has not discovered any new drugs at all. This enables the company to extend its right for longer period of time and hinder local drug companies to produce the drugs. The progress of new drug development in Thailand is slow, although there is claims that the “Patent Act” will encourage innovations.  Since 1996 – 2000, most of the new drug patent in Thailand were granted to foreign drug companies.   	     	3.  No real technology transfer  Multinational drug companies always claim that granting drug patent is beneficial to the countries in terms of technology transfer. Because the formula of new drugs were provided therefore countries can further develop new drugs.   The former director of the Research and Development Institute of the Government Pharmaceutical Organization once said it is unlikely that Thailand will benefit from the drug patent in terms of technology transfer. Three reasons for her argument were 1) there are insufficient information in the submitted document 2) the drug companies deliberately keep essential information secret and 3) the inventions were so complicated.   In addition, the capabilities and infrastructures of Thai institutions are lacking in order to be able to check whether the submissions were really new inventions.   Conclusions and suggestions: The health impacts due to TRIPs are inevitable if applied.  Serious public health problems still remain endemic in Thailand, for example, AIDS, Tuberculosis, Malaria etc.. Drugs are essential for the patients with these diseases. Trade agreements need to be revised and reconsidered with concerns of health values, benefits and well being of all Thais.


location: , 'Thailand year: 2022 source: HSRI

title: Economic Evaluation and Budget Impact Analysis of Transcatheter Aortic Valve Implantation in Patients with Severe Aortic Stenosis

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


location: , 'Thailand year: 2022 source: HSRI

title: Benefit Package of Universal Coverage Scheme for Hereditary Angioedema (HAE) Caused by C1 Esterase Inhibitor Deficiency (C1-INH)

abstract: Background: Hereditary angioedema (HAE) is a rare and life-threatening genetic disease. This disease can lead to recurrent attacks of severe swelling occurring in areas such as the face, gastrointestinal tract, and larynx. These attacks can result in hospitalization or death. Thus, effective medications are necessary for treating the acute attacks. However, Thailand did not specify medication for treatment and prophylaxis. Therefore, effective strategies for universal health coverage for the management of HAE patients remain a challenge in Thailand. This review aims to determine the extent of research in the published literature that examine benefit package and strategies for universal health coverage for the management of HAE patients in Thailand. Method: On 5th January 2022, Embase, Scopus, OpenGrey, PubMed, Science direct, Clinicaltrials.gov, and Cochrane were searched for literature published from inception. Studies evaluating the efficacy and safety of medication for treating acute attacks in HAE patients were included. Additionally, this study performed a survey of data from the drug company, experts in the field, and stakeholders. Our survey asked about the situation, cost, and health service systems for screening, diagnosis, treatment, and referring HAE patients in Thailand. Result: Of 4,834 articles identified, 28 studies were included. Twenty-four studies are original articles, one study was a systematic review and network meta-analysis, and three studies were cost-effectiveness analyses. From current trials, first-line therapy such as Plasma-derived C1 inhibitor, Recombinant C1 inhibitor Conestat alfa, Icatibant, and Ecallantide showed benefits over placebo.However, the study related to the full economic evaluation of first-line therapy in Thailand has not been provided. Conclusion: HAE may affect the budget of Thailand if patients do not receive appropriate treatment. Thus, screening, diagnosis, and effective medication for treating acute attacks are essential measures to decrease the overall HAE-related healthcare cost. However, full economic evaluation studies of first-line therapy in Thailand are needed.


location: , 'Thailand year: 2021 source: HSRI

title: Development of molecular diagnostic assays for personalized lung cancer treatment in Thai patients

abstract: Cancers are still the major cause of death in Thai population. Personalized treatment that targets specific genes or proteins is efficacious in cancer patients. Various molecular analyses of patients' tumors are used to determine whether they contain somatic mutations that could be used as reliable predictive biomarkers for tailoring therapy. Patients with primary lung adenocarcinomarcinoma harboring activating EGFR gene mutations respond well to targeted treatment by EGFR Tyrosine Kinase Inhibitors (EGFR-TKIs). Approximately 50 percent of Thai lung Adenocarcinomarcinoma patients have these mutated variants of EGFR gene in their tumors. Some patients who do not have EGFR mutation harbor mutations of other genes, such as ALK fusions and BRAF mutations that may benefit from treatment with other targeted therapy. However clinical samples yield nucleic acids in limited quantity and often of low quality. Sensitive molecular assays are therefore crucial to detect these somatic mutations. We engage in the development of new polymerase chain reaction (PCR)-based assays for determination of predictive molecular biomarkers for targeted medications. We have developed assays that efficiently detect clinically important mutant alleles, including mutations in EGFR, BRAF and ALK genes, presented in ultrashort nucleic acid sequences. These simple, highly sensitive and cost-effective mutation detection assays will be useful tools to enhance precision medicine in oncology.


location: , 'Thailand year: 2001 source: HSRI

title: Coverage and acceptance in spray and impregnated mosquito nets for malaria control, Krabi 1999

abstract: Coverage and acceptance  in  spray and impregnated  mosquito   nets for  malaria  control,  Krabi 1999	The objectives of this study were to measure the coverage and the acceptance of Krabi people in spray and using impregnated mosquito  nets for malaria control, 1999. This study design were cross-sectional survey to collect quantitative data and focus group discussion  for qualitative data. The result showed that the coverage of spraying was 92.8% of target household ,however the quality of total spraying covering the household area was 58.6%. Bed room and interior were not accepted to be sprayed ,since the owner could not gather things in time and were afraid of being dangerous for human being , animals and things. People accepted the spraying for they knew more about malaria and feared to be sick. As the result they would like their houses to sprayed every 6 months. Because of the polite and reliant manner of the spray workers, people were not afraid of loosing things during their working. However, only 68.3% of reporting and marker were correct. Additionally, the spray workers did not introduce themselves ,make an appointment, and tell about usefulness to the householder before spraying. Further, the people accepted that chemical used for spraying smelled bad but not being dangerous and dirty. To spray was better than bed  nets as perceived by children and older since it could protect them from  mosquitos in the wider area and while staying out side the bed nets. Also spraying chemical decreased the number of mosquitos and other insects. Generally, 85.9% of household was given one impregnated nets and  90.8 % of them used the impregnated nets. At the same time the bed nets were usually utilized every night for 89.3 %.The acceptance was found that they were pleased to receive impregnated mosquito nets and needed it more. However, health workers did not suggest them  how to wash nets and  impregnated  nets again. They had good perception for malaria and felt fear this disease also. They thought that impregnated mosquito nets were better than normal bed nets as 78.1 % Chemical for impregnated nets had odor after it was  not dried and it was not dangerous. In addition , some people liked impregnated mosquito nets more than spray  because it could protect mosquito bite every night, tough spray could protect it in a short time.