location: , 'Thailand year: 2022 source: HSRI

title: Long-term kinetics of antibody against SARS-CoV-2 in the recovery patients with COVID-19

abstract: Thailand is another country affected by the coronavirus disease 2019 (COVID-19) pandemic, which has affected the public health system and its economy. Therefore, it is important to develop cognition in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as quickly as possible. Therefore, this research aims to study the kinetics of immune response patterns after SARS-CoV-2 infection both mild and severe symptoms. The information on a kinetic immune response from SARS-CoV-2 infection can help to predict prolonged immunity. Understanding antibody responses after natural SARS-CoV-2 infection can guide the COVID-19 vaccine boosting schedule in this population. The objective of this study to assess the dynamics of SARS-CoV-2 antibodies, including anti-nucleocapsid protein (N), immunoglobulin (Ig)G, anti-spike protein 1 (S1) IgG, anti-receptor-binding domain (RBD) total Ig, anti-S1 IgA, and neutralizing antibody against wild-type SARS-CoV-2 in a cohort of patients who were previously infected with SARS-CoV-2. The research method starts with RT-PCR screening to confirm the results of SARS-CoV-2 infection and performs blood collection for immunogenicity testing at 3, 6, 9, and 12 months after the date of infection or confirm the results of infection to monitor immune levels by anti-nucleocapsid protein (N), immunoglobulin (Ig)G, anti-spike protein 1 (S1) IgG, anti-receptor-binding domain (RBD) total Ig, anti-S1 IgA, and neutralizing antibody ต่อ SARS-CoV-2 against wild type. The population studied and followed during the periods was as follows: 531 volunteers in the project were divided into 420 SARS-CoV-2 infected with mild symptoms and 111 SARS-CoV-2 infected with severe symptoms, divided into 269 males, and 262 females The average age is 38. The total specimens enrolled in this study are 968 samples, divided throughout sample collection. The following: 376 samples of 3-month periods after infection, 241 samples 6-month periods after infection, 207 samples 9-month periods after infection, and 144 samples 12-month periods after infection. The results showed that seropositivity rates began to decrease during the period 6 months after infection and started to decline continuously after symptom onset 6–12 months. The seropositivity rate was significantly lower at 6, 9, and 12 months than at 3 months (p-value < 0.05), especially in SARS-CoV-2 infected with pneumonia symptoms was showed higher seropositivity rate than in SARS-CoV-2 infected with non-pneumonia/asymptomatic group at 6 months (p-value < 0.05), 9 months (p-value = 0.04), and 12 months (p-value = 0.04). At 6, 9, and 12 months after infection, the anti-N IgG levels were significantly reduced. The seropositivity rates of anti-N IgG reduced by less than 50% 6 months after infection, while seropositivity rates of anti-RBD total Ig, anti-S IgG, and anti-S IgA still had more than 80% seropositivity rate. The immunogenicity levels among SARS-CoV-2 infected with severe symptoms were significantly higher than SARS-CoV-2 infected with mild/asymptomatic. At 12 months, the seropositivity rate among SARS-CoV-2 infected with mild/asymptomatic individuals in each method of examination found seropositivity rates as follows: anti-N IgG 21.5%, anti-RBD total Ig 87.0%, anti-S IgG 59.3%, and anti-S IgA 74.1%. The seropositivity rate in the SARS-CoV-2 infected with severe symptoms was found as follows: anti-N IgG 41.7%, anti-RBD total Ig 97.2%, anti-S IgG 91.7%, and anti-S IgA 86.1%. In some cases, the immunogenicity can be found prolonged for more than 12 months. Moreover, we found no significant difference between immunogenicity response and sex. In Elder (>60 years), the immunogenicity response showed significantly lower than in adults (≤ 60 years). These data on the natural history of SARS-CoV-2 antibodies will be useful for comparing and planning the future COVID-19 vaccination. Normally, SARS-CoV-2 antibodies in infected patients can be prolonged for more than 6 months and these patients may not be necessary to receive the COVID-19 vaccine within 6 months after clearance.


location: , 'Thailand year: 2004 source: HSRI

title: The evaluation service system and following up the HIV patient therapy result

abstract: This study aims to 1) to review the policy and process of implementation for provision of antiretroviral therapy, 2) to assess quality and adequacy of hospital services for ARV provision. 3) to assess the effects on health and behavior of people with HIV/AIDS receiving ARV and 4) to study costs and cost-effectiveness for provision of ARV therapy comparing between provincial and district hospitals. The study conducts the documents relevant to national HIV policy was analyzed, and in-depth interview was performed with people responsible for ATC project. The 12 provinces stratified by region were randomly selected: Ayutthaya, Lopburi, Prajinburi, Prajuabkeyrekhun, Surin, Udonthani, Aumnartchareon, Sukothai, Nan, Chiang Mai, Krabi and Songkla. In each province, a provincial hospital was purposively selected and two district hospitals were randomly selected. The total numbers was 36 hospitals. The hospital visits was performed by the research team to assess quality of services for ARV. Practice guidelines, record form, and documents relevant to ATC project were reviewed. Focus group discussions and individual interviews were conducted with hospital personnel including doctors, nurses, counselor and laboratory technician, who provide care for people with HIV/AIDS. The hospital records of people enrolled in the ATC project during the fiscal year 2003 were reviewed. Survivals, incidence of opportunistic infections, clinical failure, changes of CD4 cell count at six months after treatment initiated, were analyzed. People with HIV/AIDS who currently receives ARV treatment were interviewed for their perceptions on health status, adherence, social and behavior impacts of ARV medication. The costs and cost-effectiveness study was conducted in three hospitals in Chiang Mai province. The overall cost of ARV provision was a combination of provider cost at ARV clinic, laboratory cost, ARV drug cost and patients cost. The overall costs/person/year and cost-effectiveness were analyzed. Results found that at present, after seven months of expansion of existing ATC project to reach the target of 50,000 in the year 2004, an average enrollment of new cases was 5 percent per month. The 33,381 people with HIV/AIDS were enrolled and this was about 66.7 percent of the project target. However, a number of people were with some reason dropout from the project and 29,549 people remained in the project during this period of time  The cost of ARV drugs was approximately 60-80 percent of overall costs of ARV services. The fundamental ARV formula in the ATC project was GPO-Vir which was cheapest compared to the others.


location: , 'Thailand year: 2023 source: HSRI

title: Review of the 2019 Verbal Autopsy Records Among those Died from Tuberculosis

abstract: Cause of death statistical information is important for health planning. The information enables policy planners to understand the medical nature of fatal health problems of the country. Priority can be set based on the information, which can also be baseline for evaluation of various health programs. However, in Thailand, the standard of death registry is still poor. My deaths took place outside the hospital and registered by non-medical personnel. The information is therefore not accurate enough for planning. In 2019, in order to solve this problem, a research team from the International Health Policy Program (IHPP) did a survey on causes of deaths using so-called ‘verbal autopsy’ method. After the data were analyzed, IHPP invited relevant experts to review the report. Tuberculosis (TB) was reported to be the 10th cause of death in male and 17th cause of death in female population. These figures indicated that TB is still a very important health problem. However, the above findings are in contrast with reports from the National TB registry, which show that TB notification rate is rapidly and steadily declining. To solve this problem of inconsistency, our research team carried out the current study with the following objectives: 1. The primary objective is to review the records of the verbal autopsy of the so-called TB deaths in order to check the accuracy of the reports 2. The subsidiary objectives include to assess clinical cause of these deaths Our research team were kindly supported by the IHPP team who provided the verbal autopsy data Our team consist of the following experts: (1) Senior Medical Epidemiologist who conceptualized and designed the study. (2) Senior Infectious Disease Expert (3) National Senior Expert on Tuberculosis (4) Statistician Experts No (2) and No (3) initially independently reviewed the data, write their comments and finally scored how much they agreed with the verbal autopsy reports. The score could be one of these 5 levels 1 Not agree 2 Somewhat disagree 3 Indecisive 4 Somewhat agree
5 Agree Out of 198 records provided by IHPP, the 63 duplicated records were removed, leaving 135 unique records. Frequency of the 1, 2, 3, 4 and 5 scores given by the National TB expert were 10, 12, 94, 11 and 8 Frequency of the 1, 2, 3, 4 and 5 scores given by the Infectious Disease expert were 14, 7, 21, 21 and 72. Weighted kappa statistic = 0.226, indicating fair agreement between the two experts. There were 3 types of weighting scheme were applied. The unweighted, linear weighted and quadratic weighted kappa statistic were 0.86, 0.141 and 0.226 respectively, which can be concluded as relatively low. In conclusion, the revision of history of cause died from TB in the verbal autopsy result got inconsistent rate of likelihood from two independent experts. The findings suggest the need to improve such data in the future.


location: , 'Thailand year: 2008 source: HSRI

title: Risk of Coronary Heart Disease in Type 2 Diabetes Patients Attending Sangkhom Hospital, Nongkhai Province

abstract: Diabetes is an important risk factor for the development of coronary heart disease
(CHD). Recent studies have found that the rise in the mortality rate of diabetes mellitus type 2 patients was due to coronary heart disease. This study was conducted in June
through September 2007, with the intention to evaluate CHD risk in diabetes patients
attending Sangkhom Hospital, Nongkhai Province. Data were collected by interview, blood
sampling and retrieval from medical records. The participants were 309 patients with
type 2 diabetes, aged 33 to 75 years (mean 55 ± 22 years), and without cardiovascular
diseases. The 10-year probability was estimated by using the INTERHEART Study modified
from NCEP ATP III (National Educational Program and Adult Treatment Panel III).
Student t-test and chi-square test were used to determine the differences between men
and women patients regarding risk factors, and to predict the probability of CHD. Most
patients (92.2%) smoked; 46.9 percent were hypertensive or were taking antihypertensives;
37.2 percent had total blood cholesterol (CHOL) higher than 200 mg/dl and a high density
lipoprotein cholesterol (HDL-C) level of less than 40 mg/dl. Evaluation by the heart
risk score (based on a model using basic risk factors, i.e., age, smoking, CHOL, HDL-C,
systolic blood pressure), 6.8 percent of the patients (25.3% men and 1.6% women; p <
0.001) had a predicted 10-year probability of more than 20 percent at very high risk (I)
and 21.4 percent of the patients (58.2% men and 11.2% women; p < 0.001) had a predicted
10-year probability of 10-20 percent at high risk (II); whereas 71.8 percent of the patients
(16.4% men and 87.2% women; p < 0.001) had a predicted 10-year probability of less than
10 percent at moderate risk (III). The predicted 10-year probability of 10-20 percent and
over 20 percent of the diabetic men was significantly higher than that of diabetic women,
whereas the predicted 10-year probability of less than 10 percent of the diabetic women
was significantly higher than that of diabetic men. The prevalence of risk factors related
to high risk of CHD was different in diabetes patients. Thus, estimates of probability of
CHD are necessary for all persons with diabetes, indicating the risk factors to be corrected
in order to prevent mortality and morbidity. Despite differences in individual risk
factors and predicted probability between men and women, the estimated risk for CHD
should be calculated for all persons with diabetes mellitus.


location: , 'Thailand year: 2011 source: HSRI

title: Hardship Area : Criteria and Classification

abstract: This study was aimed at developing criteria and guidelines for identification and classification of
hardship areas. This was part of a study on “Reform of Financial Incentives for Public Health Personnel”
submitted to the Ministry of Public Health, Thailand. Criteria to identify hardship areas included transportation,
city-life effect and economic development. It was found that, in classification of hardship areas
using developed criteria, 69.8 percent corresponded with the opinions of the provincial chief medical
officers. A guideline to classify hardship areas using hardship scores and confirmation by using opinions
of the provincial chief medical officers and health inspectors involved some difficulties and limitations
during implementation. There is a need to improve this methodological approach.


location: , 'Thailand year: 2016 source: HSRI

title: Outcomes of an Integrative Thai Child Development Project in a Community Hospital, Phrae Province

abstract: Birth asphyxia and low birth weight were important causes of mental retardation, delayed development,
learning disabilities and cerebral palsy. This retrospective research was aimed to study the outcome
of Thai Child Development Integration Project in Sungmen Hospital. The subjects studied were 51
patients who attended the Well Child Clinic from October 1, 2013 to September 30, 2015. Developmental
Assessment for Intervention Manual [DAIM] was used to evaluate child development. The majority of
patients were low birth weight (86.3%) and were female (64.7%). Most of the low birth weight (72.7%)
were intrauterine growth restriction. The influencing factors of birth asphyxia were from delivery and
abnormal delivery (57.1%). Most mothers had secondary education (37.2%). Primary caregivers were
parents/grandparents (51%). Infants fewer than six months of age were predominant breastfeeding (62.1%).
The majority of patients had normal child development (78.3% - 97.8%). The growth, weight for age,
height for age and weight for height were normal in range. Neurodevelopmental assessment at 1, 4 and 12
months of age were normal. Anemic patients (hematocrit less than 33%) at 6 months of age were 22.6%.
Iron supplement statistically improved anemic condition (P = 0.012). The Thai Child Development Integration
Project could be established in a community hospital by training DAIM skill and be most effective
for birth asphyxia and low birth weight.


location: , 'Thailand year: 2020 source: HSRI

title: How is Case Investigation Performed in Light of Coronavirus Disease 2019 (COVID-19) Pandemic–A Case Study of the First Imported COVID-19 Case from Europe in Thailand

abstract: This study aimed at describing an investigation of a confirmed coronavirus disease 2019 (COVID-19) case in Chonburi, Thailand. He was the first imported case of COVID-19 from Europe to Thailand. The case was an Italian expatriate working in Chonburi. He left for Italy on 14 February 2020 and returned to Thailand on 1 March 2020. At the port of entry, he passed the temperature scan. The following day, he developed upper respiratory symptoms. The providers at a private hospital performed nasopharyngeal swab (NPS) and throat swab (TS). On 3 March 2020, positive results for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection were reported. Subsequently, he was referred to Chonburi Regional Hospital. The investigation team of the Department of Disease Control (DDC), Ministry of Public Health (MoPH), could identify 75 contact persons. Of these 75, 56 were classified as high-risk. Of these 56, 40 were tested for NPS and TS and all were found negative for SARS-CoV-2 infection. The rest 16 contacts could not be reached at the time of investigation but their name list was submitted to the incident commander (IC) and the Immigration Bureau for further tracing. Later, the investigation team found that none of these 16 contacts became positive. Another important discovery from this investigation was that a number of healthcare workers were counted as high-risk contacts due to improper use of personal protective equipment (PPE). The report of this investigation raised the concern for proper PPE application amongst healthcare workers to the Emergency Operating Center (EOC) of the MoPH. Outcomes from this event in combination with other events alike were fed into policy decision making process of the MoPH. The MoPH later launched a message to emphasize the importance of proper PPE application amongst healthcare providers to minimize the number of high-risk healthcare-worker contacts who would be subject to a 14-day quarantine. In addition, the MoPH also underpinned that the self-quarantine measure must be strictly enforced to mitigate the risk of wider disease spreading.


location: , 'Thailand year: 2021 source: HSRI

title: Development of Stroke Clinical Practice Guideline for Physician and Healthcare Team in Healthcare area 7 in Web Applications form

abstract: Background and Rationale: Acute ischemic stroke is a major public health problem in Thailand. Treatment decisions are based on the national clinical practice guideline (CPG). However, the guidelines are in the form of publications or pdf files, generating several barriers to implementation. Adopting clinical decision support (CDS) technology will increase practice effectiveness. This study intends to develop web application-based stroke guideline for physicians and teams in health care area 7. Methodology: Health professional team from health care area 7 convene for a discussion. We determine clinical practice gaps based on Thai CPG, develop a web application, evaluate user satisfaction, and track key performance indicators (KPI) after using the web application. The project has a one-year operating period. Results: This study structures guideline suggestions and converts evidence synthesis into executable knowledge for web applications via a multilayer framework (https://strokenetwork.kku.ac.th). The National Institute of Health Stroke Scale (NIHSS) is used to classify stroke subtypes. It is a clinical decision support (CDS) tool that assists physicians in making treatment decisions. CPG was separated according to the hospital's potential level. A list of hospitals consists of details necessary to assist physicians in planning patient referrals. The satisfaction of the health care teams was assessed. The CPG for health care area 7 in web application is appropriate: 40% strongly suitable, 60% suitable. NIHSS assessment are appropriate: 40% strongly suitable, 53% suitable. Easy to understand and convenient to use: 20% strongly agree, 40% agree. Web application will benefit actual clinical practice: 13% strongly agree, 73% agree. The KPI for stroke patient treatment at Srinagarind hospital demonstrated that specific indicators have potentially improved after the web application's implementation: increase of stroke fast track notification rate, increased rate of receiving intravenous thrombolytics, decreased rate of intracerebral hemorrhage with death post intravenous thrombolytics, shorter duration of receiving intravenous thrombolytics, increase proportion of patient with improved outcome, and decreased time of hospitalization. Conclusion and discussion: We demonstrate how to develop web application for physicians and healthcare teams. The web application guideline was appropriate, simple to understand, and easy to use. There are numerous potentially improved KPI. Web apps should benefit health care teams and have ability to improve in the future.


location: , 'Thailand year: 2002 source: HSRI

title: Health Impact Assessment of Khon Kaen City Municipal Solid Waste Management Policy: a Scoping and Methodology

abstract: The study aims to define the scope and present the guideline of research methodology for health impact assessment of Khon Kaen City Municipal solid waste policy using the literature reviews, field work study, interviewing and getting data from stakeholders’ participation of the group meeting. Results revealed that Khon Kaen City Municipality has a 100 Rai disposal site at Khum Bon Village, Non Ton sub-district, 17 km far from Khon Kaen City in Udonthani province direction. The disposal site has operated since 1968 and was latest improved in 1986. The disposal system was combination designed, consisting of a sanitary landfill, an infectious incinerator, and a composing plant. However, they could dispose solid waste occasionally and the operation was not followed to the design. Thus, these could cause to the environment impacts and human health. Moreover, the land of disposal site is nearly over because of the increasing of solid waste, about 200 tons/day. This site has to be rehabilitated for 5 years extension and it must find out the new disposal area. The stakeholders of solid waste management identified as 1) municipal solid waste workers, personnel group  2) group of communities, people who live near the disposal site  3) private occupation with solid waste group: scrap merchant, scrap collectors at disposal site, scraper using tricycle (Sa-Leng) and 4) the administrative group related to solid waste management and policy. The physical health impact from solid waste was found as gastro enteric disease, respiratory tract disease, infectious disease, skin disease, allergic disease, injury from vehicle accident, sharpen objects which occurred to the person who worked, direct contacted with solid waste. Metal and social health impacts were found as the stress, worrying, low society, dirty, etc. Spiritual health impact was indicated that lacking the responsibility, recognition on solid waste management, feeling of self-reliance. Positive impacts were found that the scrapers, workers could make money from the scrap and they were proud of reducing, recycling, reuse, renew the solid waste.     Scope and methodology for health impact assessment of Khon Kaen City Municipal solid waste management can identify as three categories. The first is health impact assessment of population studies (stakeholders): a) municipal solid waste workers, personnel group,  b) group of communities, people who live near the disposal site  c) private occupation with solid waste group: scrap merchant, scrap collectors at disposal site, scraper using tricycle (Sa-Leng) and d) the administrative group related to solid waste management and policy. Health impacts cover physical, mental, social and spiritual health such as sickness, stress, self responsibility, worrying, recognition, social relationships, morale, citizens participation etc. The second is assessment of environmental quality that impacts also to human health. These consider the air, water, soil qualities at the disposal site and the area around 2 km nearby. At the solid waste discharge point and the transfer station should consider the visual sighting, air quality. And the third is assessment of the linkage of environment and health analysis for decision-making.


location: , 'Thailand year: 2021 source: HSRI

title: The integration of GIS into a health information system for migrant health monitoring: In the Eastern Economic Corridor

abstract: This project “The integration of GIS into a health information system for migrant health monitoring: In the Eastern Economic Corridor” is about utilizing data for health service and health status of migrant workers management. Migrants’ health information is extracted from 43 files of database, Health Data Center (HDC) dashboard, Ministry of Public Health. This new developed system presents data in Dashboard and mapping. Accordingly, the users can access migrant workers’ health information through web browser: http://www.eecmigrants.com. The web application has 3 main categories: statistical database, spatial database, and data table, which divided into 5 subcategories: Patient identification, Diagnosis, treatment, Treatment results, and Medical rights. This database assists users to manage health data quickly and effectively. However, there are problems and limitations in this study described as below:
1. The database system of Ministry of Public Health did not support the programmer to access information automatically via Application Programming Interface (API). Therefore, the programmer had to access data through only channel that the ministry allows, which was difficult to pull selected data out. Apart from that, the data collection at the sub-department level still was lack of unity. It used different systems to gathering data, it also contained out-of-date information.
2. This database system allowed us to retrieve 1,000,000 record at one time. In practice, downloads were specified by date and time. The programmer would not exactly know the amount of data that pulled out. As a results, when having information overload, the programmer had to split the big data into small size. Then, making a data account to keep track on latest download location. This would help acquiring full information.
3. The database system did not support the OFFSET in SQL command which allow users to select the range of data. Nevertheless, the development team analyzed data and found that data had date written in each table. Thus, we selected information by date to do analyze.
4. The database did not connect with other databases which belong to private sector and other public healthcare organisations (e.g., office of the Municipality, pharmacy).
5. Some of migrant workers’ information were incomplete due to illegal immigration. Also, when access healthcare, they used other workers’ information for hiding their undocumented status, causing duplicate data at that. According to the interview with Burmese, Cambodian, Lao migrant workers, most of them had education lower than high school. Additionally, lots of migrant workers entered Thailand legally with health insurance. Some were undocumented immigrants. Their monthly income were about 10,000 baht and monthly average expenses were 6,000 baht. Mostly migrant workers accessed healthcare knowledge from television, mobile phone, friends and their employers. It is obvious that when they got sick, they would go to the nearest hospital. The finding revealed that they were satisfied with Thai healthcare service. Furthermore, migrant workers were interested to know about their right and benefit of health insurance and the access to healthcare service.
The problems that arise from providing service to migrant workers were 1) the burden of medical expenses that patients could not afford to pay 2) healthcare workers even worked harder 3) there were a chance that emerging and re-emerging infectious diseases would be spread and difficult to control 4) a risk of recurrence of vaccine-preventable disease from migrant workers’ children 5) migrant workers took part in rights and medical resource that preserve for citizens 6) delayed payment of insurance did serious impact on hospitals’ financial management, and 7) inefficient use of health care resources.
In spite of the fact that the recommendations from the study can help planning the more effective healthcare for migrants in the Eastern Economic Corridor, there are some points that need to be improved
1. Establishing the same standard for recognized migrant workers’ identification in order to reduce data redundancy.
2. Organizations should share relevant information, as well as, allow the others to access the data regarding the law.
3. Setting data standardization that can be connected to other database properly. Besides, create strong security for protecting the data.
The effective way to sending health information to migrant workers, is using media in their own languages. According to that, they can easily access via television, mobile phone and their employers. Turning to urgent health issues in migrant workers, communicable disease and emerging and re-emerging infectious diseases should be taken care of as top priority.


location: , 'Thailand year: 2020 source: HSRI

title: Stem cell therapy for patients with diabetes with critical limb ischemia phase 1 (Year 1)

abstract: Peripheral arterial disease (PAD) is commonly caused by atherosclerosis. PAD is one of the major health problems in the modern society. Most patients who suffer from diabetes mellitus type II tend to suffer also from a severe PAD complication, i.e., critical limb ischemia (CLI). The main therapeutic approach for CLI is either surgical debridement or endovascular revascularization in order to improve blood flow to the affected body area, like extremity. However, approximately 20-30% of patients with CLI are not able to receive vascular or endovascular procedures and amputation appears to be the only option. This is to say that CLI patients have a relatively high tendency to have their afflicted body parts removed and the mortality rate of this group of patients is also high. With severe obstruction of blood flow, type II diabetic patients often have their limb loss from debridement. To search for the new therapeutic option of PAD/CLI, most of the researchers are focusing on progenitor cells, which were identified as a potential new therapeutic option to induce therapeutic angiogenesis. Recently, cell-based therapy for treating CLI has been introduced. Several studies show that the cell-based therapy for vascular regenerations is safe and effective. Especially, the new culture medium called culture medium which able to enhance quality and quantity mononuclear cell. The recent study reveals the efficacy of QQMNC in angiogenesis and vasculogenesis function already. This study was conducted to further investigate the efficacy and safety in animal model. The QQMNCs were injected to the critical ischemic limb mice model at the site of occlusion intramuscularly, then, the blood perfusion was assessed by using Laser doppler image scan. In this study, the group of nude mice which was injected with QQMNC show a promising angiogenesis and vaslucogenesis significantly while the group of PBMNC injection was not. The PBMNC injection group show gangrene and finally lost their limb. This study show the efficacy and safety in animal model which will pave the way to the next phase of the study about applying this method of QQMNC for treating in critical limb ischemic patient.


location: , 'Thailand year: 2010 source: HSRI

title: Research Questions for Tobacco Control Based on Document Analysis and Expert Opinion

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


location: , 'Thailand year: 2023 source: HSRI

title: Medication Adherence of Patients with Non-communicable Diseases Attending Chronic Disease Clinic in Community Hospital: A Qualitative Study

abstract: Non-communicable diseases such as cardiovascular diseases, cancer, chronic respiratory diseases, and Diabetes Mellitus, contribute significantly to global illness and mortality rates, including in Thailand. Collaborative efforts are crucial for effectively managing these diseases and ensuring patients' adherence to medication. However, over half of the patients struggle with following the prescribed treatment regimen, leading to complications, disability, premature death, and increased healthcare costs. Existing knowledge on medication adherence for chronic non-communicable diseases is primarily derived from foreign social and cultural contexts, which may limit its applicability to Thai patients. Additionally, there is a lack of in-depth studies on medication adherence from the patients' perspective in the Thai community. Therefore, this study aims to explore and understand the meaning and experiences of medication adherence in Thai patients with chronic diseases, as well as the conditioning factors that influence adherence. This research applies qualitative methodology to study at chronic disease and psychiatric clinics at Wang Thong Hospital and Nong Phra Subdistrict Health Promoting Hospital. Data collection involves in-depth interviews, observations, and studying medical records of 24 registered patients. Inclusion criteria include 1) patients with high blood pressure [hypertension: HT], and/or abnormal blood lipid levels [dyslipidemia: DLP], and/or myocardial infarction [MI], and/or chronic heart failure [CHF], and/or stroke, and/or diabetes [DM], and/or chronic obstructive pulmonary disease [COPD], and/or depression. 2) have received treatment for chronic diseases for at least one type of medication from either the Chronic Disease Clinic or the Psychiatry Clinic at Wangthong Hospital or Nong Pra Hospital continuously for a minimum of one year. 3) able to communicate in the Thai language. 4) voluntarily participate in the research study after receiving informed consent. This study interviewed 8 repeat informants, totaling 32 interviews. Data analysis utilizes Colaizzi's method (Colaizzi, 1978 cited in Sanders, 2003) and ensures trustworthiness using Lincoln and Guba's framework (Lincoln & Guba, 1985). The study identified five themes regarding experiences of medication adherence in patients with chronic diseases in the community. The first theme is patients' expectation for better life through treatment and medication adherence. Patients follow doctor's instructions to recover or alleviate symptoms and return to normal life. However, when treatment outcomes, including the effects of drug use, are unsatisfactory or when side effects occur, patients may engage in non-adherent behaviors. This means that the treatment and medical regimen recommended by physicians do not meet their expectations or needs. They may also seek additional treatment methods, such as visiting private and reputable clinics and using supplements. The second to fifth themes involve conditioning factors that affect medication adherence within the Thai context. These themes cover concerns about consistent medication adherence, self-management, family support, and building relationships with healthcare professionals for effective treatment, as well as addressing specific sub-issues.


location: , 'Thailand year: 2018 source: HSRI

title: Development of an operations manual and tools for enhancing the coverage of tuberculosis contact investigations and reducing their social burden and stigma

abstract: Tuberculosis (TB) is a disease of poverty and stigmatization. Thailand is one of the countries with high burdens of TB, TB/HIV and MDR-TB. Although contact investigation (CI) can reduce TB morbidity and mortality, the coverage is low and a CI operations manual was not yet available. Thus, this project aims to develop tools and collect research evidences for the development of a CI manual to increase implementation of CI by including household (HC) and other contacts (OC). The manual will also guide staff to perform non-stigmatized CI. We implemented the project between January 2017 and August 2018. The outcomes are summarized as follows: 1) Development of a geographic information system (GIS)-based computer program as a tool for CI coverage enhancement. 2) Research activities: the project implemented 4 sub-studies as follows: 2.1 A review of international CI manuals. 2.2 A survey of physicians and nurses’ TB knowledge, perceived stigma, and CI Experiences. 2.3 Knowledge, attitude and experiences related to contact investigation for tuberculosis among former tuberculosis patients and representatives from nurseries, schools, hospital and private business: A qualitative study. 2.4 The outcomes of using invitation card and providing transportation fee in CI. 3) Policy recommendations: 3.1 Contact investigation must be seriously implemented in Thailand, particularly children contacts aged under 5 years old must achieve 100% CI. The CI should cover household and non-household contacts. 3.2 Healthcare providers working for TB patients should pass training courses to obtain CI interview skills and effective communication skills for TB-stigma reduction. 3.3 In occupations like teachers/lecturers, caregivers, and hospital staff, the chest x-ray should be mandatory in health check-up system and performed before the employment and in annual health check-up. The practical guidelines should also be available in case TB occurs in teachers, students, and health staff. 3.4 Information about TB and messages to reduce TB stigma should be disseminated through the internet.


location: , 'Thailand year: 2017 source: HSRI

title: Factors Affecting Job Satisfaction of Health Professionals in Pakdiechumphol District, Chaiyaphum Province

abstract: Moving out from the area of health workforce affects staff shortages. Job satisfaction is the key factor
in the decision to remain or move. Satisfaction analysis will lead to a plan to tackle in the future. This
research aimed to identify the factors that were associated with job satisfaction and satisfaction level. The
instrument was a questionnaire of motivation, morale and satisfaction in their work. All health personnel
included health professional, supporting staff and employees. A questionnaire was filled out by hand.
Data collection was completed in June 2013 with response rate of 52.4%. The research found that most health personnel were satisfied with the work at a moderate level (31.4% satisfied at quartile 2). Quantile
regression showed that working relationships with colleagues and administrators had significant effect
on satisfaction of personnel who were satisfied at a moderate level (coeff. = 3.00; 95% CI: 0.33, 5.67). Life
balance had significant effect on those who had a high level of satisfaction (coeff. = 3.00; 95% CI: 1.60,
4.40), while advancement opportunities significantly influenced satisfaction at all levels. The researcher
proposed that the support of health worker should take into account the different levels of customer
satisfaction through organizational development, behaviors and shared value formation, including proper
appointment and special compensation.


location: , 'Thailand year: 2015 source: HSRI

title: Development Model of the Type 2 Diabetes Mellitus Prevention in High Risk Group

abstract: The research and development study aimed to develop a model of lifestyle intervention to prevent type 2 diabetes mellitus (DM) in high risk group.
Methods:	The study was divided into two phases, phase one developed a lifestyle program and phase two evaluated the effectiveness of the model using quasi-experimental study. According to phase two, the participants were selected from high risk group of DM in the local community, Kudjub district, Udonthani province, north-eastern part of Thailand. The lifestyle program was applied from the diabetes prevention program (DPP). Researcher team and public health nurses in District Health Promoting Hospitals (DHPH) performed seven meetings to deliver education and empowerment consisted of healthy diet, physical activity, stress management and social behaviors. The participants in intervention group were encouraged to match as a “buddy” for coaching each other throughout 16 weeks of the program. The outcomes were body mass index (BMI), waist circumference (WC), fasting blood sugar (FBS), health behaviors, and satisfaction of the program.
Results:    Totally, 30 persons in intervention and 30 in control group participated. Most of them were women (73.3%), and the mean age was 51.2 years. The mean of BMI was 28.4 kg/m2, FBS was 95.3 mg/dl, and waist WC was 93.8 centimeters. After 16 weeks, adjusted mean difference (MD) of FBS (90.1 mg/dl in intervention vs 95.3 mg/dl in control group) and BMI (25.7 vs 29.1 kg/m2) were not significant. WC was significantly decreased in intervention group compared to control group (MD –5.9 cm; 95%CI = –9.4 to –2.4; p=0.001) Health behavior score (MD 3.6 score; 95%CI = 0.3 to 6.9; p=0.035) and knowledge (MD 2.0 score; 95% CI=0.6 to 3.4; p=0.006) were significantly increased in intervention compared to control group. Overall, 96.7% of the intervention group was satisfied and very satisfied with the program.
Conclusion: 	Lifestyle intervention program demonstrated significant improvement in WC, health behaviors and knowledge. The program could lead to prevent type 2 DM in the local community.


location: , 'Thailand year: 2015 source: HSRI

title: Risk factors for morbidity after liver resection

abstract: Postoperative liver failure is a life-threatening complication after hepatic resection. Because of recent advances in liver surgery technique and a better patient selection, morbidity after hepatic resection has steadily decreased, but its incidence still ranges from 1.2% to 32%. The factors of postoperative liver failure, morbidity and early mortality in major hepatic resection in the modern era should be reevaluated.
STUDY DESIGN:Demographics, extent of resection, liver fuction, ICGR15, liver volumetry, operative and transfusion data, complications, and hospital stay were analyzed for patients undergoing major hepatic resection(no less than bisegmentectomies) from January2013 to September 2013 at RajavithiHospital. Factors associated with morbidity and mortality and trends in preoperative and perioperative variables over the period of study were analyzed.
RESULTS:Of 50 patients who underwent major hepatic resections, 6 patients (14.63%) developed postoperative liver failure after hepatectomy, 18 patients (36%) had morbidity and 2 patients (4%) died within 30 days postoperatively. Amount of segmentectomy was the significant risk factor for postoperative liver failure and 30-day mortality after major hepatectomy. ICGR15, blood transfusion operative time and more than 3 segmentectomies were the significant risk factors for morbidity. The only significant risk factor for morbidity by multivariated analysis were operative time.
CONCLUSIONS:Careful patient selection based on ICGR concurrent with decreasing blood transfusion and decreasing operative time in major hepatectomy cases could help prevent the occurrence of postoperative liver failure, morbidity and 30 day mortality.


location: , 'Thailand year: 2002 source: HSRI

title: The effectiveness of holistic health care in diabetes mellitus at Kutchum hospital, Yasothon

abstract: The prospective study was conducted at Kutchum Hospital during April 2000 to January 2001.The objective was to determine the effectiveness of holistic health care that provided to type 2 Diabetes mellitus ( type 2 DM ) by health care team. The health care team were consist of a pharmacist, a nurse, a dietition , a doctor, a patient and other related. person who take care the patient. The effectiveness were determine by comparing of patient compliance,chronic complication and individual problems before and after interventions. The subjects were intervenced after visited a doctor.Patient counseling was the most important instrument of interventions. There were fifteen out-patients without chronic complication were included,11 females and 4 males.Average age was 40 – 50 years old. They were diagnosted as diabetes around 1 – 5 years ago and nine cases had diabetes relatives. Most of them were farmers and also had health cards. The compliance to prescribed medication, usage of appropriate diets and self-care behaviour were increased from 2 to 8 cases, 3 to 13 cases and 9 to 15 cases, respectively. In addition, we found no report of their complication and trend of their individual problems had been decreased after forcing interventions. The result indicated that holistic health care in diabetic mellitus by health team should be applied to make the patients taking care their health according to their basic conditioning factors and health care demand.


location: , 'Thailand year: 2023 source: HSRI

title: Reflection on COVID-19 Remedial Measures Based on Group-Targeting Principle: A Case Study of Slum and Rural Communities, Ubon Ratchathani Province

abstract: This article reflects on issues in COVID-19 remedial measures based on group-targeting principle. The article drew on document research combined with fieldwork research. Document research explored online sources of government COVID-19 remedial measures, including online research papers and articles discussing the socio-economic impacts of COVID-19 from national and international institutions and experts. Fieldwork research was a qualitative research study conducted in two communities: an urban slum community and a rural community in Ubon Ratchathani province. Data collection involved in-depth structured interviews with purposively selected 22 samples, as well as non-participatory observations over short period in both communities. The findings indicated that in the context of the pandemic, the major population suffered significantly and required urgent remedial measures. However, the targeting remedial measures did exclude affected individuals at the outset. During the implementation phase, the online registration screening had resulted in the exclusion of more affected individuals. While the recovery measures faced challenges in achieving success due to limited financial compensations compared to impacts, the delays in delivering economic and social recovery programs, and the inadequate social welfare designs. The present study recommended that the remedial measures should be applied on a universality principle, which needed no registration nor screening that expedited the remedial process, and avoided mis-exclusion of the affected individuals. By implementing the remedial measures prioritizing universal social welfare principle, a more allocative efficiency of remedial measures in future pandemic is foreseeable.


location: , 'Thailand year: 2017 source: HSRI

title: Relationship between Health Literacy and Quality of the Elderly’s Life at the Central Part of the North-East Thailand

abstract: When getting old, health usually becomes decelerating. Generally, it is believed that health literacy
could replenish the elderly to good quality of life; hence the research tried to prove this belief. This study
is a descriptive research comprising two objectives. Firstly, it aimed to investigate the level of the elderly’s
health literacy according to the ABCDE behavioral campaign by the Ministry of Public Health (A: Alcohol
abandon, B: Baccy, no tobacco smoking, C: Coping with emotion, D: Diet consumption, and E: Exercise).
Secondly, the research examined the relationship between health literacy and the quality of life of the
elderly in the Central Region of the Northeast. The research was done with 600 elderly living in Roi-et,
Khon Kaen, Mahasarakham and Kalasin. The data were collected by interviewing conducted during January
to March, 2015 and were analyzed by frequency, percentage, mean, standard deviation and Pearson’s
correlation coefficient. The results revealed that the overall level of the elderly health literacy according to
the campaign was low but the quality of life of the elderly was high. The relationship between health
literacy and quality of life of the elderly was positive (r=0.305, p<0.01). From the findings, the researcher
suggested that there should urgently be wider assessment of the elderly health literacy at both individual
and community levels in order to know the real health status of the elderly. The result of the wider assessment
will be useful for creating qualified strategic plan appropriate to the situation of the elderly increase
in the future. The strategic plan in the future should focus on urgent needs in developing the elderly’s
skills such as; information access, communication, and media literacy.


location: , 'Thailand year: 2021 source: HSRI

title: Situation analysis on health service utilization, health insurance status, and unmet need among foreigners who came to have a family in the northeastern region of Thailand: A case study in Nong Bua Lam Phu, Udon Thani and Khon Kaen Provinces

abstract: Currently, there is a rapid increase in the international migration around the world. This may be due to various reasons, such as political situation in their home countries (refugees or asylum seekers), job or business opportunity, works, studies, or to start and/or to live with families. In 2017, it was found that approximately one fourth (25.7%) of international migrants resided in overseas more than 3 months with the purpose of working or starting families, so-called “Expatriates (Expats)”, accounted for 0.9 of the world population (7.6 billion). In Thailand, according to the data of Foreign Workers Administration Office, Department of Employment, Ministry of Labour (as of October 2019), there were foreigners who obtained a working permit in the country totally 3,028,000 people. Most of them were migrant workers from Cambodia, Lao PDR, Myanmar, and Vietnam (CLMV), which were 2,748,189 people. When considering only skilled workers (excluding CLMV workers), there were 166,896 people (6.07%). More than half (92,860 people; 55.64%) of these skilled workers lived in Bangkok, while the rest were scattering in other regions (74,030 people; 44.36%). Of those who lived in other regions, 7.19% (5,330 people) lived in the north-eastern region. However, this figure was the record of foreigners with a work permit only. There would have been many foreigners that come in and out as a tourist and temporarily stay in the country by marrying Thai women or living with Thai partners, whom Thai people called “Keui Farang” -- which literally means “Caucasian son-in-law” – with the term “Farang” referring to Caucasians. Although there are increasing trends of international migration globally as well as substantial numbers of Expats in Thailand, there are limited studies to investigate health and well-being or health related issues among these people. There may be some studies about neighboring migrant workers; however, the studies about Expats, particularly those come from Europe or America who have families in Thailand are very scarce. This study aimed to explore the situation of Expats’ health, especially health service utilization, health insurance, and unmet need. This information is very important and useful for health systems design in responsive to health need of this group of people in Thailand. Methods This study employed a mixed method design, focusing on Expats who came to have families and live in the northeast of Thailand only or son-in-law foreigners (not only westerners as there might have been male Expats from other places e.g., Middle-eastern, Asian, or Asia-pacific countries). The purposively selected study areas comprised three provinces: Nong Bua Lam Phu, Udon Thani, and Khon Kaen. Quantitative data were an analysis of 43 files (Health service data of public hospitals that are annually submitted to the Health Data Center of the Ministry of Public Health (MOPH)). Also, the health survey among son-in-law foreigners by using the survey questionnaire (68 questions) adapted from the Health Welfare Survey questionnaires of the National Statistics, which consisted of 83 respondents. Qualitative data included the reviews of literature conducted in Thailand and elsewhere, and the in-depth interviews and focus group interviews purposively conducted among 42 participants. interviewees comprising 6 MOPH policy makers, 4 representatives from other ministries that deal with foreigner-related work (Ministry of Justice, Ministry of Foreign Affairs, Ministry of Social Development and Human Security, and Immigration Bureau of the Royal Thai Police Headquarters), 1 NGO staff, 3 academics, 1 Deputy Director of a Provincial Health Office, 1 Director of a District Health Office, 11 public health officers, 4 registered nurses, 2 staff from the international affairs unit of a private hospital, and 9 expatriates comprising 6 different nationalities (2 French, 2 English, 1 Swedish, 1 American, 1 Australian, 1 Swiss and 1 Canadian).


location: , 'Thailand year: 2004 source: HSRI

title: The pesticide sale promotion in local area

abstract: The pesticide sale promotion in local area According to the National Health Assembly held in 2003, pesticide advertising and sale promotion control were raised, among participants, as significant policy implications to relief pesticide problem in Thailand. These concerns emerged when it was found that pesticide advertising and sale promotion with various techniques have influenced the attitude, belief and practice on the pesticide use among farmers. In addition, the monitoring and control mechanism related to these two issues by public agencies at local scale was weak in terms of vague regulation and shortage of capital, qualified staff and essential information. Under this situation, the study on the pesticide sale promotion in the local area became an urgent task. This study would provide evidence based information which strengthened the movement of National Health Assembly in monitoring and urging local government to take better action in controlling the pesticide advertising and sale promotion control in their responsible areas. This study was conducted, during June until September 2004, in four provinces Nan, Kampaengphet, Suphanburi and Khonkaen, with aims to investigate the pattern and techniques of pesticide advertising and sale promotion in the sample sites as well as mechanisms in controlling and monitoring these two issues. The policy implications were the expected outcomes. Various techniques in the quality research were applied during the step of data collection such as documentary and field survey, observation, focus group, group interview and in-depth interview of key informants (pesticide vendors, farmers, communal leader and relevant public officials). Based on both primary and secondary data, the knowledge found in 4 provinces was synthesized and then presented through the seminar held for receiving the feedback and comments from experts and relevant organizations. With regard to the results, it was found that the farmers in all four provinces intensively used the pesticide for their agricultural practices. The agro-chemical shops were prevailing at all local administrative units (province, district, sub-district and village). The key actors in distributing the pesticide to the local farmers comprised of sale men, pesticide vendors, agro-chemical shop, agricultural cooperative, traders and retail shop. The popular techniques to increase the sale volume among pesticide producers, trading agencies, salesmen and vendors were price cut, road show, demonstration, premium, sweepstake, contest, commission, price rewards, tour reward in Thailand and international countries, bonus, party and seminar, score collection reward, credit, sale in packages and training. The model of sale promotion at local areas was a mix model. Although, the techniques to promote the pesticide use were variety, they were differentiated by the positions of pesticide supplier and the purchasing patterns. For example, salesmen and retail shop mainly focused on the direct sale while, contract farming could be observed as one of techniques by agricultural cooperative. In addition, the sale representatives and key vendors were recognized as the target groups of pesticide production companies. These companies would support their sale representatives by running sale promotion campaigns with specific farmers. However, the sale representatives in the local areas had to conduct sale promotion campaigns in parallel but they mostly dealt with small vendors and local farmers. Another interesting finding was that advertising through mass media was a key channel to serve the sale promotion campaigns. In conclusion, the model to promote the pesticide use in local areas were 1) Sale representative based promotion 2) Customer based promotion 3) Sale force based promotion The factors leading to the uncontrolled pesticide advertising and sale promotion in local areas consisted of 1) lack of stringent implementation and enforcement by relevant public agencies in controlling the pesticide advertising and sale promotion 2) high preference, among most of farmers, to get free rewards, cheap pesticide and quick returns from agricultural practices but low education about the danger of the pesticides 3) many trading names (grouping in the same general name) leading to the confusion among the farmers 4) high concern on economic profit rather than others observed among pesticide trading agencies 5) pro-pesticide policy or regulation of agricultural cooperative in forms of loan for pesticide 6) high competition for the market share among the production companies


location: , 'Thailand year: 2015 source: HSRI

title: Medical Rehabilitation Services for Person with Disabilities: The Perspectives of Clients,_x000D_
Providers and Policymakers

abstract: This qualitative research aimed to examine the perspectives of three key informant groups purposively
selected from those who had direct experiences in receiving, providing medical rehabilitation services, and those responsible for development of related policy. The data were collected in May and
June 2014 in three focus group discussions (FGDs) involving 11 representatives of persons with disability
organizations, 13 service providers, and 16 executives and managers from respective policymaking
authorities. Content analysis was introduced in the data analysis.
The results showed that access to medical rehabilitation services including assistive devices among
persons with disability (PWDs) was limited. This was because PWDs did not get the information on
benefits and services provided in the public sector, and that most of them needed one or more accompanying
persons when they travelled to receive services. Other impediments included inadequate service
providers and the disparity, in terms of coverage and quality, of the information for PWDs disseminated
by public agencies. The lack of effective system for assistive devices management was identified as crucial
obstacle. It was agreed among FGD participants that health benefits for PWDs in the three governmentfinanced
schemes were different resulted in unequal access to services and assistive devices. Moreover,
when PWDs were employed by private business and therefore, transferred from the Universal Coverage
Scheme to the Social Security Scheme (SSS), their health benefits would be diminished because the latter
scheme covered fewer benefits than the former. To solve the problems as earlier mentioned, the FGD
participants proposed: (1) the National Committee for Empowerment of Persons with Disabilities to
develop mechanisms to strengthen the integration and collaborations of organizations that ensure quality
of life of PWDs and allow PWD representatives to participate in every level of policy making decisions;
(2) PWDs databases currently managed by different institutes be strengthened and integrated with each
other; (3) increase the numbers of health providers for PWDs in particular areas of the country; and
(4) reduce the disparity in health benefits by collectively develop a single benefit package for use in the
three government schemes.


location: , 'Thailand year: 2008 source: HSRI

title: Papanicolaou smear screening for cervical cancer in HIV-infected women

abstract: The purposes of this study were to determine the results of the screening of Papanicolaou
smears (Pap smears) for cervical cancer in HIV-infected women in Prachantakam
district, Prachinburi Province. The subjects enrolled in this study were 34 HIV-infected
women who were among the people living with HIV/AIDS.
PAP smears were done in 34 HIV-infected women; one (2.94%) of them was found
to be abnormal, and one (2.94%) revealed cervical cancer. Compared with the results of
PAP smear that had been done on 7,756 women in Prachinburi Province, 0.31 percent
were found to be abnormal, and 0.04 percent had cervical cancer.
Therefore, standard routine screening for cervical cancer using PAP smears for HIVinfected
women should be necessary under the health insurance policy.


location: , 'Thailand year: 2007 source: HSRI

title: Warning Pictures on Cigarette Packs and Smoking Behavior

abstract: This study was carried out in the period from September 2005 to January 2006 in order to determine
the effect of the frightening pictures printed on cigarette packs on the smoking behavior of 120 Burapha
University students aged 18 to 23 years, using specially designed questionnaires. The average number of
cigarettes smoked per day was 5.2. The results of the study suggested that the warning labels on cigarette
packs had reduced the number of cigarettes by 1-7 cigarettes/day, or 32.5 percent overall. The most
frightening label, which influenced the reduction in smoking, was one showing that cigarettes would
induce lung cancer; the first runner-up in the category was the picture showing that cigarettes lead to bad
breath, followed by one showing that cigarettes cause fatal pulmonary emphysema. The other three labels,
namely smoking enhances aging, smoking is hazardous to the young, and cigarettes are potential
killers, were not effective; therefore, they should be replaced. Smokers avoided seeing the frightening
labels either by removing the cigarettes from the packs and placing them in other containers, using a cover
over the pack, smearing the labels, changing to unlabeled cigarette brands, or purchasing the packs with
less horrifying labels. Accepting the inability to change smokers’ behavior entirely , the researchers opined
that, in addition to frightening the smokers with unhealthy-looking pictures, the implementation of more
effective strategies would be useful, such as making smokers fully realize the hazards of smoking, and
carrying out anti-smoking policies unceasingly.


location: , 'Thailand year: 2003 source: HSRI

title: The evaluation on radiation therapy service system comparing with  need and access to care of cancer patients in Thailand, Fiscal year 2002

abstract: Radiation therapy, an essential treatment for cancer, has been concerned over the recent years due to its enormous investment in both high technology medical devices and various specialists.  Anecdotal observation found inappropriate distribution of radiation therapy resources across the country which led to inefficient use of health care resources and possibly under-standard treatment in some radiation therapy units (RTUs).  A lack of evidence-based planning on health care services is supposed to be the major cause.  Thus, this study aims to demonstrate the current situation of radiation therapy comparing with expressed health needs and access to radiation therapy services of cancer patients.  This will bring about the policy recommendations on how to invest and distribute health care resources according to health needs.  The goal of this study is to improve efficiency of health resource utilization and equitable access to health services by using radiation therapy as the case study. Both quantitative and qualitative methods were employed in this research.  A census of 25 RTUs and 72 radiation therapists were conducted.  Cancer patients and some radiation therapists were interviewed by using semi-structured questionnaires.  Moreover, document and content analysis were also used.The results reveal that lacking of human resources, both radiation therapists and medical physicists, are more serious problems of the MOPH radiation therapy services than the shortage of radiation therapy devices.  The finding illustrates that no radiation therapy unit of MOPH passes the minimal standard amount of radiation therapists, whilst only 20% of them passes the minimal standard amount of medical physicists.  Moreover, access to radiation therapy services are inequitable among cancer patients.  Cancer patients in remote provinces tend to have poorer access to health care than those in RTUs neighboring provinces.  Factors influencing not access to radiation therapy services are physical barriers, and financial barriers in terms of medical care costs and transportation expenditure.  For socio-economic status, most cancer patients are the elderly and poor without doing any jobs.  Quality improvement on radiation therapy services as well as adequate vital human resources (radiation therapists and medical physicists) are urgent issues which the MOPH has to solve.  In the long run, the national plan of radiation therapy system which determines the amount, proportion and distribution of principle, advanced, and excellent radiation therapy centers have to be made.  For improving access to care, the improvement of health insurance coverage and the provisions of financial support for transportation are  better policy than investment in the new radiation therapy units.


location: , 'Thailand year: 2015 source: HSRI

title: People With Disabled, Phitsanulok Taxi on Demand Systems

abstract: The aims of the study of “People With Disabled, Phitsanulok Taxi on Demand Systems” focus on four main components which are; 1) to survey the transportation demand of people with disability and the ability to provide service by the entrepreneur/taxi drivers; 2) to review the regulations and/or the standards of transportation service for disabled people that are represented both in Thailand and in other countries around the world; 3) to analyze and to find the appropriate way to support and assist the taxi service system for people with disability; 4) to design and to experiment the taxi service information system for people with disability.

The study found that

1. Transportation is essential for people with disability. It does not only provide a need purposely for disabled people but also it does reframe the society’s perspective toward disability.

2. Taxi service in Phitsanulok can be able to serve the people with disability in six aspects, which consist of; 1) the indistinguishable feeling of disabled people from ordianary ones when using the taxi service; 2) the assistance for getting into and out from the vehicle; 3) the assistance of taxi driver for lifting the passenger’s belongings; 4) the ability of taxi driver to communicate with the passenger when providing the service; 5) the hospitality and service mind to serve people with disbility; and 6) the ability to assist in case of emergency.

3. The designed information system is called “TODIS: Taxi on Demand Information System”. It purposely aims to represent a user friendly interface and comprehensive information regarding transportation service for disability, which can be viewed in the following links: http://www.wearehappy.sci.nu.ac.th/plk/taxi4dp/ and http://www.wearehappy.sci.nu.ac.th/plk/taxi4dp/taxiservice.html

4. The foundation of taxi service system for people with disability in Phitsanulok is an important key point to consider and it is needed to perform in order to improve the system to be a suitable and functional service in the future. According to the results of the study, it is suggested that; 1) the taxi drivers have to customize their vehicles to suit the disabled person; 2) it is necessary to build the knowledge and attitude of the taxi drivers toward the disabilties; 3) the taxi service is needed to call via the call center service; 4) local administrative organization plays an important role in terms of transportation service for disability due to it has responsibility to improve the wellbeing and quality of life of the disabled people who live in the area of responsibility; and 5) it is necessary to determine the reasonable extra transportation fee for people with disability.


location: , 'Thailand year: 2008 source: HSRI

title: Relationship between Neuropathy and Foot Ulcer in Diabetes Mellitus Type 2 Patients

abstract: The increasing incidence of diabetes mellitus (DM) every year has resulted in multiple
complications of DM. Diabetic neuropathy is one of the most important complications;
it causes diabetic foot and leads to amputation of the legs. In a rural hospital, the
relationship between neuropathy and foot ulcer provides important information for the
development of a preventive foot-care program in a DM clinic. A retrospective study
was performed from medical records and diabetic foot evaluations from October 2005 to
September 2006; a total of 1,029 diabetic patients from Wichianburi Hospital, 247 from the Putaey primary care unit and 308 from the Kokeprong primary care unit, were studied.
Of the total, 31.51 percent were males and 68.49 percent females; 404 patients (24.72%)
had neuropathy, 60 patients (14.85%) in this group had foot ulcer, and 47 of them (3.82%)
had foot ulcer without neuropathy. The risk of foot ulcer in neuropathic patients was
almost eight-fold (7.92 times) greater than that of non-neuropathic patients. Seventynine
patients with foot ulcer had hyperglycemia; the mean blood glucose levels ranged
between 125 and 179 mg/dl, and blood glucose levels of more than 125 mg/dl were 4.39-
fold greater than the normal glucose level. Foot ulcer in diabetic patients was related to
neuropathy and blood glucose levels; thus well-controlled blood glucose and good foot
care in diabetic neuropathic patients is important in preventing foot ulcer.


location: , 'Thailand year: 1999 source: HSRI

title: People participation concerning health issue in constitution writing : a case study in Khon Kean province

abstract: People participation concerning health issue in constitution writing:A case study in Khon Kean Province	Common people in Thailand in the past had never been involved in writing the Constitution.In 1997,it was the first time in the Thai history that people werw encouraged to participate the process of writing the latest constitution. The study of people participation in constitutional writing was therefore implemented using action researth approach. The study aimed at documanting the process of people involvement in expressing their opinion in the process of drafting the constitution as well as the public hearing of the constitution. In addition the project also conducted number of group discussion in order to stimulate public interest and collect people’s option and needs in various aspects including the health and medical care. The project started the implementation by organizing a working committee who became educated about the constitutional writing process. The committee menber helped organize 13 discussion group, which involved 146 people from various occuppation including disable people. Opinion from group discussion were collected, synthesized and extended to the constitutional group which involed 232 people, some were in the same discussion group before. To gater wider rang of public opintion project thin launched 7,000 concise questionnaires to people  Of 18 year or more throughtout province and got more than 70 percent reponses.	The research results indicated that people in Khon Kaen province had show their interest and were willing to share their opinion on the constitutional writing. However, threr were no existing socail mechanism to facilitate people involvement in public event within such a short time span since the public hearing hed to be done within two months. Under time constraint, most core groups in the province therefore organized one day seminar in order to get more number of participants but this method could not facilitate people interaction and indepth information gathering. On the other hand, group discuss could fill the gap of big seminar menthod, it was time consuming and required number of volunteers to facilitate the group discussion and budget management. The use of concise questionnaires was found to be effective method to gather public consensus.


location: , 'Thailand year: 2019 source: HSRI

title: Types of Wounds and Patterns of Antibiotic Use in Trauma Patients in Mahasarakham Hospital

abstract: In 2016, Ministry of Public Health’s service plan included antibiotic use in traumatic wound patients as an indicator of rational drug use. The target of this indicator was set at <40% based on a study in one large university hospital. Little is known on antibiotic use particularly in other hospital levels and regions. The objective of this study is to describe types of wounds and patterns of antibiotic use in traumatic wound patients. A prospective study was conducted in emergency unit, Mahasarakham Hospital during 1 March to 30 April 2018. The study measured types of wounds, wound classification according to antibiotic use guideline (antibiotic use is recommended for only class 2 and 3), prevalence of antibiotic use, type and duration of antibiotic use, and proportion of appropriate antibiotic use according to the guideline. Of total 267 patients, most of them were male (51.7%), had no co-morbidity (75.3%) and average age of 34+21 years. Median time from injury to hospital was 1 hour (IQR: 0.3, 3). The most common location of wound was at leg (32.2%) and wound type was animal bite (55.1%). Wound contamination was 74.5%. Prevalence of antibiotic use was 65.5%, when stratified by wound classification the prevalence was 11.1% in class 1, 72.2% in class 2 and 87% in class 3. The most common antibiotic use was Amoxycillin (62.9%). Average duration of antibiotic use was 5+1 days. According to the guideline, the rate of appropriate antibiotic use was 86.5% and appropriate duration of antibiotic use was 65.9%. In conclusion, use of antibiotics in traumatic wounds in Mahasarakham Hospital mostly adhered to the guideline but was higher than the target. Ministry of Public Health should reconsider the target of this indicator and promote further study in various hospitals and regional settings for appropriately reflecting quality of care.


location: , 'Thailand year: 2010 source: HSRI

title: Developing Local Recipes for the Elderly

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


location: , 'Thailand year: 2004 source: HSRI

title: Hegemonic Sexuality and State Policy on AIDS

abstract: The spread of AIDS epidemic in Thai society through some forms of sexual contact led to the policy that has been focusing on changing sexual behavior of people. Certain forms of behavior, such as teen and commercial sex, have been classified as highly risky. The policy relies on the measures to convince or force people to contain their sexual conduct in monogamous marriage. Although such measures succeeded in raising public awareness about AIDS, sex outside marriage has continued and new high-risk groups emerged. People in Thai society seem to resist the attempt of the state to discipline their sexual behavior. Based firmly on dominant system of belief about sexuality, policy on AIDS reflects and perpetuates sexual and gender inequality which has been accounting for social vulnerability to contact the HIV virus of various groups of people. The policy has been a mechanism to control sexual practices of the people. The policy process on AIDS issue has also been a site of contestation of many groups with different sexual beliefs.  Policy on AIDS has been affected, as well as a part of, sexual politics that people negotiate and resist the dominant version of sexuality in Thai society.


location: , 'Thailand year: 2008 source: HSRI

title: Evaluation of Health Systems Research Institute User's Satisfaction

abstract: This research was aimed at exploring the Health Systems Research Institute (HSRI) users’ satisfaction,
the nature of their problems and needs, including their opinions toward HSRI research construction strategies. The samples were divided into four groups of research users: executives, academics, networks, and the
general public. The data were collected by two main methods: mail questionnaires and interviews with
executives.
For the general public group, 25 percent of the 5,401 HSRI library members during the period from
2006 to the middle of the year 2007 were randomly selected; 730 of those sent questionnaires, or 56.8 percent
of the total distribution, responded.  For academics, 75 percent of the 500 people who used to work with
HSRI during the previous five years were randomly selected, and 110 questionnaires, or 31.4 percent, were
received.  Network groups were those who served on committees or as staff of any subsidiary, in total 120
people, and 58 questionnaires, or 48.3 percent, were received.  Finally, the last sample group comprised
executives, who were HSRI board committee members, consultants, and medical doctors of related organizations, a total of 22 respondents.
The findings were as follows:
1) The utmost purpose that the general public, academics, and network groups had in using HSRI
research findings was for conducting research (their own research purposes), while most executives used
them to gain a broad perspective in expanding their view, and to support their policy-and decision-making.
2) Regarding the satisfaction towards HSRI research usage, the general public evaluated “content”, “research quality”, and “communication channel” at a high level of satisfaction; academics evaluated
“research quality” and “communication channel” at a high level of satisfaction, “content” at a high level of
satisfaction and moderate satisfaction for some content issues.   Network groups evaluated “research
quality” at a high level of satisfaction, and most of them evaluated “communication channel” at a high level
of satisfaction, with moderate satisfaction applying to only one issue.  “Content” was evaluated mostly at a
moderate level of satisfaction, with a high level of satisfaction for only some content issues.
All three groups evaluated the  academic performance of the HSRI at a high level of satisfaction.
Most executives evaluated it at a high level of satisfaction, with the remark that the evaluation needed to
include a range or periods of time and various perspectives as well.
3) As for the communication channel in using HSRI research, it was found that, besides the HSRI
library, the general public, academics, and network groups used the Journal of Health Systems Research the
most, and radio broadcasts the least.
4) The research topic that the general public would like HSRI to develop the most is research which
supports the care of chronic and non-chronic patients, while academics and network groups need research
on the evaluation of governmental health policies.  Most executives felt that HSRI should review health
systems as a whole since every system and topic is interconnected, whereas the evaluation of governmental
health policies is a topic that must be conducted regularly.
5) Data, which the general public, academics, and network groups said were available in the HSRI
database, were data about health systems research projects.  Regarding website improvement, the general
public would like to have a “research analysis column” added, while academics and network groups wanted
a “health policy analysis column”.   However, in the opinion of executives, if anything should be added, it
should be research synthesis, combined with health policy analysis.
6) Regarding knowledge management of the HSRI for the benefit of the public and the value of
HSRI academic work, the general public, academics, and network groups agreed that HSRI can manage
knowledge for public benefit at a high level of accomplishment.  On the other hand, most executives were of
the view that HSRI has a strong point in being an organization which stimulates health systems knowledge,
and plays an important role in enabling national health policies to be put into action.


location: , 'Thailand year: 2018 source: HSRI

title: The Civil Society Development of Nan Province for Health Promotion and Disease Prevention

abstract: Health promotion and disease prevention for all at all ages relies on the participation of local communities. Nan province has strong and various social groups, organizes and health networks, but many health outcomes are not achieved. Therefore, the aims of this study were toexamine the development of the civil society in health promotion, to study the situation and the condition of the sustainability of health groups / organizations, to determine factors that affect the success and outcome of policy implementation and the participation of the civil society, and to synthesize proposals for the development of community health systems. Implementation research were conducted in three phases: 1) study of situational, group and health networking, 2) operations and 3) assessment, between April 2516 and December 2517. The quantitative data was analyzed using frequency and percentage, and the qualitative data was analyzed using content analysis. The study found that Nan has a good cost of health care, with the involvement of network partners in all of study area. The civil society were formed through three different processes: 1) to start with governmental or private policy from the outside, 2) to start from the organization within the area, 3) to initiate from the community organization itself. Factors of maintaining the strength of the civil society include strong leadership, faithful acceptance, transparency, multi-level networking, informal and formal coordination, having regular meetings, continuously develop the potential, running and managing the welfare fund, set up community or district health measures, and having a review summary evaluation together. The development of the civil society begins with the initiation of people in the community who need development or government policies. The process start with aggregate review of potential, limitations, goals, common development of community health care. Next, they develop a plan to improve the existing learning process. Then they build the learning process to develop the potential for leaders and volunteer. In addition, they raise the strength of the management with repeatedly accumulate knowledge. Finally, they achieve the best practices for community health carethat isled to the strength of the health community. Factors influencing the success and outcome of policy implementation are as follows : building central concept, creating an organizational structure with a clear roles, raising community awareness, Based on the results, we suggest that health promotion and disease prevention should be initiated by the public health volunteers and the elderly. They are a core group that plays an important role in the development of health and disease prevention in all age groups. Furthermore, toward self-reliance and sustainable community, the role of the health workers is to act as the coach of community health and networks by using an empowered communities approach. building strong leader, enhancing community cooperation, empowering and learning with the young people's community worker, working with collaborating networks, using informal communication, learning by using case studies and being put into practice, actively involving diverse volunteers in community, making a variety of communication channels, particularly, Facebook and Line applications, continuously supporting by stakeholders, and making a participatory monitoring and evaluation. Based on the results, we suggest that health promotion and disease prevention should be initiated by the public health volunteers and the elderly. They are a core group that plays an important role in the development of health and disease prevention in all age groups. Furthermore, toward self-reliance and sustainable community, the role of the health workers is to act as the coach of community health and networks by using an empowered communities approach.


location: , 'Thailand year: 2001 source: HSRI

title: Analysis of health impact assessment system from large investment projects and public policy

abstract: Analysis of Health Impact Assessment System from Large Investment Projects and Public PolicyDecharut SukkumnoedSince, health is redefined in Thailand as a complete state of well – being, which is well balanced of a body of intertwined elements of the physical, mental, social and spiritual dimension. Therefore, health is dynamically linked to all factors related to the way of living. Any environmental changes in terms of physical, economic and social conditions occurred in form of development process have a potential impact on the people’s health. Health Impact Assessment (HIA) is the combination of procedures, methods, and tools, which enable a judgement to be made on the positive and negative effects of policies, programs, projects, or other development actions. The overall objective of HIA is to maintain and improve the health of entire community/population by reducing health hazards as well as providing determinants for better health.  HIA has been promoted by WHO since the 1980s, before developed and implemented in many developed countries during the 1990s. In general, HIA systems apply the common concept and steps of impact assessment, with the specific focus on human health, which are not adequately covered by existing EIA and SIA systems. Like other impact assessment process, the main steps of HIA process include screening, scoping, analyzing, review, mitigation, decision-making, and monitoring and evaluation.Since, according to Thailand’s experience, the people’s health has been seriously threatened by a series of developmental policy and projects themselves. The study found that HIA should become an essential mechanism to prevent and recover negative health impacts as well as to promote positive health impacts derived from development policies and activities in this country.HIA process and system, which will be developed in Thailand, should be (a) effective enough in health protection and promotion, (b) equally participated by all stakeholders, (c) relevant to contexts and conditions within the operational organizations and Thai society, and (d) emphasizing on participatory learning process and capacity strengthening within Thai society.During an initial stage, HIA system in Thailand should based their ground on being participatory learning process, aiming to provide better information and influence for better decision-making according to health aspects, rather than being approval mechanism. This positioning will provide more times and opportunities to build up information, knowledge, understanding, and recognition within society, which is very important for trust building within HIA system.  Therefore, in drafting National Health Act, it should be mentioned clearly that the government should support the development of HIA system by establishing an independent organization under the supervision of the supreme organization of Thailand’s health system. It is also very important to search for more details on appropriated HIA models, especially in analytical and institutional frameworks, as well as, to look for strategic partners in order to develop HIA system in Thailand.


location: , 'Thailand year: 2023 source: HSRI

title: The Development of Appropriate People Public Private Partnership for Managing on Primary Health Care

abstract: This study aimed to study attitude of health workforce toward primary health care management to examine, synthesize, and develop appropriate model of people public private partnership (PPPP) for managing primary health care. Quantitative and qualitative methods were used in this study. Data collection was conducted in two study areas namely Kuchinarai district, Kalasin province and Dansai district, Loei province. Samples in this study included 61 participants for quantitative and 44 participants for qualitative data collection. They were from community, private and government sectors. Nonetheless, they were identified as executives, implementing staff and common people. The result revealed that samples had relatively high positive attitude toward partnership among people, public, and private sectors. The samples thought that contributing factors of partnership model for primary health care management included 1) national policy, 2) strong health leadership, 3) homogeneous and closerelationship community, and 4) natural and man-made environment capitals and social capital. While hindering factors that the samples figured out were 1) the red-tape system, and 2) lack of resources (human, money, material and knowledge). Processes of developing PPPP for primary health care management included 1) developing relationship among partners, 2) building trust and safety zone of working together, 3) having continuing knowledge communication, 4) empowering each other, 5) strengthening and expanding network, and 6) working together under the rules, regulations and committees. The samples believed that this partnership model could contribute to four dominant outcomes including 1) health outcome (not only access to services in the community), 2) economic outcome, 3) environmental outcome, and 4) learning and knowledge outcome. To materialize the model in other areas, the following two broad recommendations are proposed: 1) integration of the partnership model in the district health system (DHS) that could benefit primary health care in terms of human resource, budget and other resources efficiently; 2) all related stakeholders and their staff should acquire knowledge, skills and positive attitude toward partnership model among three sectors for primary health care management.


location: , 'Thailand year: 2008 source: HSRI

title: Evaluation of emergency medical services at the scene by rescue teams, Sungmen district, Phrae province

abstract: This descriptive research was aimed at evaluating emergency medical services in
Sungmen district, Phrae Province. Information was collected from emergency medical
service record sheets in the period January 1 - December 31, 2007. Descriptive and content
analyses of the data were used. The major findings were as follows: the mean of response
times of advance life support (ALS) level was 10.38 minutes, with a standard deviation of
6.39 minutes (more than the national standard), in basic life support (BLS) and first
responder (FR) levels, the means were 6.24 and 6.29 minutes, with the standard deviations
being 2.22 and 2.67 minutes. The means of on scene time of ALS, BLS, FR levels were 5.90, 4.27 and 3.62 minutes, with standard deviations of 3.83, 2.59 and 2.16 minutes. Evaluation
of all treatments on the scene by doctors were: treatment of respiratory system in
ALS level was done properly 100 percent of the time, while in the BLS and FR levels, the
treatments were not done in 50 and 53.84 percent of cases requiring treatment. Stoppage
of bleeding in the ALS level was done properly 100 percent of the time, in the BLS level it
was not done properly in 2.08 percent and not done at all in 16.67 percent of the cases,
while in the FR level it was not done in 33.33 percent of the cases requiring treatment.
Splints and slabs in the ALS level were properly applied 100 percent of the time, while
in the BLS and FR levels, they were not done in 10.71 and 14.28 percent of the cases requiring
treatment respectively. Although most rescuers were trained in emergency practices,
they all needed more skill and knowledge. The training methods should be revised
accordingly.


location: , 'Thailand year: 1999 source: HSRI

title: Social and cultural dimension of community drug use : development of knowledge based on theory and research

abstract: Self-medication with modern pharmaceuticals in rural Thailand: Theoretical concepts and empirical findingsThe study aims to:1) make a critical review of theoretical concepts and studies concerning self-medication practices; 2) investigate self-medication behaviors of the rural Thais and’ 3) discuss research and policy implications regarding the promotion of rational drug use by consumers. The study uses two main methods: documentary review and the analysis of empirical materials. The existing data sets collected during a research project conducted by the author- The Implications of Community Health Workers Distributing Drugs- A Case Study of Thailand-.were relied upon in the second method. The study comprises six chapters. Chapter One and Chapter Two provide backgrounds of the study and the accounts of the methodology and data used respectively. Theoretical concepts and studies concerning drug use behaviors are reviewed and discussed in Chapter Three. Highlighted are the theoretical perspectives such as modern pharmaceuticals as cultural artifacts, health commodification, cultural reinterpretation, and role of the informal commercial drug sector on self-treatment. Empirical data are presented in Chapter Four and Chapter Five. Chapter Four describes the quantitative figures and general patterns of how and what drugs are used by the rural villagers to solve their ill-health problems. Beliefs and perception associated with drug choosing and evaluating (i.e., brand, provenance, form, physical attributes etc) are also described. Chapter five moves on to the qualitative accounts of how people’s self-medication practices are shaped. Case studies are presented to demonstrate how the community’s socio-cultural and economic contexts (i.e., the availability of drugs and drug sources, the marketing practice of local drug firms, life-hardships of the rural dwellers that underlie work-related ill-health and, subsequently, determine demand for drugs) condition people’s self-treatment. In Chapter Six, the author concludes and argues that self-medication is, in fact, a cultural phenomenon. Its pattern is shaped by a complex web of causes embedding in both local and structural levels. Any attempt to elevate people’s drug use problems will hardly achieve unless such a complexity is realized and brought into consideration.


location: , 'Thailand year: 2000 source: HSRI

title: Health care reform in Germany

abstract: Germany was the first country to institute nationwide insurance-based social and health programs. Three powerful ideas or principles underlie the development of German health insurance and medical care policy, Solidarity, Subsidiarity, and Corporatist organization.   The main roles of government (State and Federal governments) are providing legal framework and regulation while providing of services and insurance are delegated to self-governance agencies, sickness funds, various associations (Association of Sickness Funds, Association of Panel doctor, etc), and health care carriers.The German reform aimed to achieve overall social benefits. Enactment of laws achieved universal access to health care and delegation of public roles to various self-governance bodies enable accountability and transparency of the system. The later reforms intended to control increase of medical care cost to be not exceeding level of income growth and more emphasized on controlling provider and hospital behavior. By conclusion, success of the German health system reform is according to values and principles of the society while economic, political context and increase of health care expenditure determine the need for reform.