location: , 'Thailand year: 2007 source: HSRI

title: Factors Affecting Blood Sugar and Lipid Levels in Non-insulin Dependent Diabetic Patients Attending Tesabarn Nakorn Chiangmai Hospital, Chiang Mai Province

abstract: Background This study of 118 non-insulin-dependent diabetes mellitus patients
attending the out-patient department of Tesabarn Nakorn Chiangmai Hospital in the period
from January 2001 to June 2005 was conducted in order to study factors that affect
the change in blood sugar and blood lipid levels of those practicing self-dietary control
and self-care behavior.
Methods To evaluate the effects of dietary self-control, and self-care behavior on
blood sugar and blood lipid levels, a descriptive and retrospective study using an interview
form and a blood sugar record form was undertaken.
Results Of the total 118 patients aged 33-86 years, comprising 33 males (27.97%) and 85 females (72.03%), 66 of them (55.93%) had blood sugar levels below 120 mg/dl; 36
(30.51 %) had blood sugar levels of 121-140 mg/dl; and 16 (13.56%) had blood sugar
levels above 140 mg/dl. Sixty-nine patients (58.47%) had total cholesterol levels above
200 mg/dl; 58 patients (49.15%) had triglyceride levels above 150 mg/dl; 60 patients
(50.85%) had low-density lipid levels (LDL-C) above 130 mg/dl; and 46 patients (38.98%)
had high-density lipid (HDL-C) levels below 40 mg/dl.
Normal body mass index (BMI), good dietary control and good self-care behavior
tended to decrease blood sugar levels better than others, but the result was not statistically
significant.
Conclusions Multi-medical personnel should work together in the management of
diabetic patients in order to enable good control of blood sugar levels.


location: , 'Thailand year: 2020 source: HSRI

title: Molecular Alterations Profile and Metabolomic Biomarkers Discovery of Lung Cancer in Thai Population (3rd Year)

abstract: Currently, lung cancer treatment has been developing in several approaches such as; conservative chemotherapy or novel targeted therapies which increase the overall response rate, survival rate with good quality of life for the patients. Thus, this research project’s goal is to explore the molecular alterations in Thai lung cancer patients which could be different from the other ethnicities. The result of this research will lead to targeted drug development in Thailand for Thai lung cancer patients. The final result of molecular alterations in 159 Thai lung cancer patients (178 tissue samples) from this research project by NGS method from both FFPE and fresh frozen tumor tissue (initial analyzed only the common mutations in lung cancer) showed EGFR mutation 54.7%, BRAF mutation 10.1%, KRAS mutation 28.3%, and MET exon14 splice site 8.8%. We also found 37 patients (23%) whom had more than one gene mutation. These results were very interesting and different from the other countries’ results, especially BRAF and MET exon14 splice site mutation which occurring only < 4% incidence in other populations. BRAF and MET inhibitors are in the clinical development. Furthermore, we confirmed the tumor heterogeneity of lung cancer from our study in 14 patients. One out of 3 patients had different gene profile in different organ at the same time. The other 2 patients had same gene profile even in different organ. Eight out of 11 patients had the different gene profile when they developed disease progression in different organ. These results are very interesting and very useful for exploration of resistant mechanism in lung cancer and developing targeted therapy drug for lung cancer patients. In addition, our research team also found 3.7% of EML4-ALK translocation and 1.3% of CD74-ROS1 translocation which currently we already have the targeted drugs for these two types of fusion genes. PDL1 expression is one of our interesting predictive and prognostic biomarker. We demonstrated that high PDL1 expression (≥ 1%) significantly correlated to higher stage of lung cancer disease (stage 3 and 4) which also had the worse prognosis compared to the early stage lung cancer. EGFR-positive lung cancer patient with high PDL1 expression (≥ 1%) also had significantly poor responded to EGFR-TKI and shorter survival compared to those with low PDL1 expression (< 1%) [16.3 vs. 25.0 months HR = 3.0 (1.17-7.73), P = 0.023]. These findings are very useful for the further drug resistant research together with targeted and immunotherapy drug development in the future. Even though we explore the diagnostic technique and the approach for lung cancer treatment as mentioned above, but the cancer prevention is also very important for the oncology world right now. The previous literatures reported the role of Metformin (anti-diabetic drug), Aspirin (anti-platelet drug), and Statins (lipid lowering agents) in decreasing cancer incidence rate, but the results were not homogenous and most of studies were small population-based studies only. These 3 groups of drugs involve in the metabolism of human body, thus cancer metabolism is the important and interesting field which could lead to cancer prevention in the future. This research project also focuses in cancer metabolism and cancer prevention by studying the largest and longest follow-up of population-based study in Thailand (EGAT database: Electricity Generating Authority of Thailand). Our final results showed ASA, Statins, and Metformin did not significantly decrease the cancer incidence rate. Alcohol drinking and increased aging significantly increased risk of gastrointestinal cancer. Hepatitis virus B carrier also significantly increased risk of liver cancer. However, this report had several of limitation due to nature of retrospective study, but it is very interesting and fascinating to explore more in term of cancer prevention with these group of drugs in prospective study. In this study, we also explored about serum metabolomics profile in 38 early stage lung cancer patients whom underwent surgery. We will report the final result in 75 patients next year. We found the significant changing in amino acid, biogenic amines, sphingolipids, and glycophospholipids in patients’ serum before and after surgery. It is very interesting that tryptophan was significantly increased while glutamate was significantly decreased after surgery. Kynurenine, a biogenic amine which use tryptophan as the initial compound, was also significantly increased after surgery. These finding are very useful to develop immunotherapy and predictive biomarker for immunotherapy. It is also useful to further explore in cancer prevention. In conclusion, the study of molecular alterations in Thai lung cancer patients is very important for targeted drug development in order to drive the innovative lung cancer treatment. However, the other important issue and concern is cancer prevention. Nowadays cancer is the most leading cause of death in Thailand and cancer also causes a lot of burdens in Thailand and Global public health. We believe that cancer metabolism is one of the key factors for cancer prevention in the future which could probably help to prevent and decrease the cancer incidence rate and solve the cancer burden in Thailand.


location: , 'Thailand year: 2020 source: HSRI

title: Reviewing and Developing Revision Proposal on the Benefit Package of the Health Insurance Card Scheme for Migrants

abstract: The Ministry of Public Health issued the Health Insurance Card Scheme (HICS) for migrants who
were not covered by any health insurance schemes; however, the benefit package under the HICS has
not been significantly revised for the last 10 years. This study aimed to review and develop a proposal
to revise the benefit package of the HICS for migrants. The study was conducted by reviewing documents,
including clinical practice guidelines and cost-effectiveness studies of health interventions of the first 20
important health problems among migrants in Thailand, 10 communicable and 10 non-communicable
diseases. The benefit packages of the HICS and the universal health scheme were also compared. A
focus group discussion was arranged with 13 representatives from relevant agencies and healthcare
providers, and in-depth interviews were conducted with 33 key informants comprising decision-makers/
government officers, healthcare providers, non-governmental organizations and 15 migrants. The study
showed that the HICS covered diagnosis and treatment of almost all (90%) of the prioritized health
problems. About 80% of the non-listed or unclear health services in the current benefit package were
related to health promotion and disease prevention activities. Those unclear benefits led to disparities
in services availability and user charge for access to service. The analysis of qualitative data suggested
that health interventions that should be included in the benefit package and provided in all hospitals
consisted of the maternal and child health diary (in translated version), the screening and treatment for
common mental disorders, and breast self-examination advice.


location: , 'Thailand year: 2018 source: HSRI

title: Effect of intermittent very-low-calorie diet on glycemic control and cardiovascular risk factors in obese patients with type 2 diabetes mellitus

abstract: Aim/ Hypothesis: Caloric restriction in patients with type 2 diabetes mellitus and obesity can induce diabetes remission but the beneficial effects often disappear after discontinuation of caloric restriction.  Intermittent caloric restriction may be beneficial in the long term.  This study aims to examine the effects of intermittent caloric restriction by means of very-low calorie diet (2 and 4 days/week) on diabetes remission, glucose homeostasis, metabolic and anthropometric changes, quality of life, as well as beta cell function and insulin resistance.  Method: Forty-two patients with type 2 diabetes and obesity (mean age 40.6 years, BMI 36.9 kg/m2) were enrolled. Participants were randomly assigned into 3 groups (control [n=12], intermittent VLCD 2 days/week [n=14] and intermittent VLCD 4 days/week [n=14]) for 20 weeks.  They received blood tests, anthropometric measurement and answered the quality of life questionnaire at weeks 0, 2, 10 and 20.  Results: At 20 weeks, diabetes remission was found only in the intermittent VLCD 2 days/week and the 4 days/week groups (4 each).  Anti-diabetic medications were successfully withdrawn in 7, 9 and 12 subjects, representing 58%, 63% and 86%, in the control, the intermittent VLCD 2 days/week and the intermittent VLCD 4 days/week groups, respectively.  In both the intermittent VLCD 2 days/week and the intermittent VLCD 4 days/week groups, there were significant decreases in FPG, 2 hr glucose after a 75 gm OGTT, and HbA1C.  In addition, triglyceride level, body weight, BMI, body fat percentage, fat mass, fat free mass and muscle mass were significantly decreased.  Improvement in glycemic control was associated with a reduction in a decrease in insulin resistance. Quality of life was also significantly increased in borth VLCD groups.  No serious adverse events were observed.  Moreover, in the intermittent VLCD 4 days/week group, there were significant decreases in SBP, DLP, AST and ALT.  Conclusion: Intermittent dietary caloric restriction (2 days/week and 4 days/week) for 20 weeks was highly effective in rapidly achieving glycemic control without serious adverse ecvents.  Improvements in the intermittent VLCD 4 days/week were more pronounced than those in the intermittent VLCD 2 days/week.


location: , 'Thailand year: 2017 source: HSRI

title: Evaluate Motivational Interviewing utilization on health behavior changes in chronic non-communicable disease patients at regional health 2

abstract: This Mixed-method research design aimed to evaluate Motivational Interviewing utilization on health behavior changes in chronic non-communicable disease patients at regional health 2, during May 2016 to April 2017. The explanatory design was performed with consisted of two phases. The first phrase was quantitative data collection by surveying the use of MI techniques to alter health behavior. There were 579 health care units in 5 provinces including Uttaradit, Phitsanulok, Tak, Sukhothai and Phetchabun provinces. Moreover, MI competence was also evaluated in this period. Four hundred and thirty personnel who using MI technique were purposive sampled. The second phrase was qualitative data collection following CIPP model evaluation. Health care unit visiting
was conducted in five provinces; focus group and in-depth interview were performed in 380 staffs. Ten health care units were purposing selected with five units achieved versus not achieved goals. The in-depth interviewees in each unit were 3-5 persons including administrator and personnel responsible for health behavior change and used MI technique. Five research tools were developed by researcher team, that were questionnaires including MI service survey, MI performance evaluation, MI competence evaluation, In-depth interview question and MI using outcome record. Determination the reliability of MI performance evaluation and MI competence evaluation questionnaires by alpha coefficients that were 0.97 and 0.99, respectively. The quantitative data were analyzed by percentage, mean, standard deviation, Chi-square, Pearson Product Moment
Correlation and Multiple regression analysis. Content analysis was also used for qualitative data and verify correctness by reflecting the summary data to personnel to agree on the correctness. The results were as follows. 1. The MI techniques utilization to modify health behavior was collected from 579 health care units. Numbers of diabetes and hypertension patients in their responsibilities were 112,867 and 238,607 respectively. They were 47,316 (41.9%) of diabetes patients and 91,636 (38.4%) of hypertension patients that received behavior change. 73.2% of health care units were using MI technique for behavior change. The average length of MI was 1.18 years. The personnel were trained to improve MI skill with 1,529, but only 686 people used MI technique (44.9%). They were 293 of MI mentor or counselor. Moreover, community volunteers (VHV.) were also trained to develop MI skills (13,363). The amount of overall budget was 1,583,826 baths for MI support in all 5 provinces. 2. The overall MI performance was at low level (Mean 2.30, SD 1.1). The overall MI adherence was considered at moderate level (Mean 2.27, SD 1.3). The overall MI competence was at novice level (Mean 1.71, SD 1.1). The important thing, advanced and expert competence level were indicated 3.8 % and 1.2 %, respectively. MI competence of personnel from different province was different statistically significant at 0.001, however, different types of health care units and staff positions were not significantly different (p>0.05). Personal factors, MI skill training factors and MI using experience factors were significantly correlated with MI competence (p <0.001). The MI performance factor was correlated with MI competence at medium level statistically significant (r=0.654, p <0.001). Interestingly, MI adherence was associated with a high level of MI competence
statistically significance (r=0.767, p <0.001). Factors that could predict the MI competence statistically significant (p <0.001) including, MI Adherence (b=0.493), MI using performance (b=0.346), MI skill training (b=0.187) and duration of work time (b=0.007). Consequently, all factors were cooperatively predict MI competence at 67.0 percents (r2 = 0.67).  3. Consideration an outcome of MI implementation for altering health behavior in chronic non-communicable diseases, 412 (71.2%) and 399 (38.8%) of health care units were using MI in diabetes and hypertension group respectively. 34,101 of diabetes group received MI technique for behavior change, with 13,994 persons (41.0%) were achieving goals. In 2016 period outcome, people at the risk of diabetes were achievement higher than those with diabetes patients. It was found that the percentage of patients with glycemic control were 49.1% and 69.1%, respectively. The percentages of Hb1Ac below 6.5% were 43.0% and 69.6%, respectively. Behaviors changes were also detected at 56.1% and 70.7% respectively. Furthermore, 62,725 persons of hypertensive group received MI technique for behavior change, and 34,665 people (55.3%) achieved the goals. In 2016 period outcome, people at the risk of hypertension achieved goals the same as those with hypertension patients. The percentages of blood pressure control were 63.4% and 67% respectively. Behaviors changes were also indicated at 67.0% and 71.6%, respectively. 4. The results of qualitative data that evaluation using the MI technique based on the CIPP Concept Framework Model. Policy and Indicators, it founded that regional health 2 had announced a policy; however, personnel perception did not cover all areas. The policy was appropriate to be practical. Four types of MI techniques were conducted including: 1) No clear pattern, 2) 7-colors ping pong, 3) Clinical setting and 4) Particular project. Health care units were supported not only administrators but also budget. However, in all areas lack of information systems for MI tracking and evaluation. MI data were recorded through Excel, HosXp and JHCIS formats. Remarkably, factors and barriers to using MI techniques were including lack of budget support, personnel have a lot of workload, lack of MI skills and experience, lack of MI learning and share and service recipients do not cooperate. Therefore, requirement to encourage support are including: 1) Regional health 2 defined as the main MI policy; 2) Construct pattern of using MI
techniques; 3) the development of MI skills; 4) Consultant team; 5) Provide manuals and tools for MI operation. 6) Support staffing, 7) Motivation support and 8) Support operating budget. Notably, the patterns and factors supporting that different between achieve versus not achieve MI goals health care unit, in conclusion, that administrators should be promote including Inner inspiration, MI commitment, Relationship, Self study learning, MI home visit, and MI Dynamic improvement.


location: , 'Thailand year: 2000 source: HSRI

title: Public health management

abstract: Public Health Management ReformThis policy research is an action and goal oriented study. Its main objective is to outline a new framework for public health management reform. In the study, concepts on public sector management were reviewed and public health reforms in selected developed countries, namely, Canada, Austria and Singapore, as well as health reform movements in Thailand were discussed. Within an advocacy approach and a macro perspective, public health management system was treated as a unit of analysis. Under such perspective, its ultimate goal is placed on the human well-being while new roles and direction towards public health management reforms were analyzed through various qualitative techniques, including SWOT Analysis with SWOT Matrix.Based on the available sources of data relevant to the space, timeframe and actors, its findings are presented covering two main themes. Firstly, policy and structural constraints have let to the inefficient management – as witnessed from the centralized management approach and the lack of policy integration and coordination at macro level. Secondly, based on the environmental scanning, strategic issues are determined in shaping public sector roles include, among others, enhancing civil society organizations and health networks, strengthening self-reliant and healthy communities, upholding local wisdom and indigenous knowledge base for health promotion.


location: , 'Thailand year: 2019 source: HSRI

title: Development of biomarker detection tools for screening and diagnosis of prostate cancer

abstract: Prostate cancer (PCa) is one of the most common cancers among men. Presently, a screening test for PCa is based on serum prostate specific antigen (PSA) level. However, PSA level is not a specific biomarker for PCa. Recently, several potential biomarkers of PCa have been discovered. In this study, detection methods for sarcosine and PCA3 in urine have been developed for PCa screening and diagnosis. An enzyme-coupled colorimetric method was proposed for sarcosine assay. This method is a specific reaction based on sarcosine oxidase (SOX) and horseradish peroxidase (HRP). The method was performed in the 96-well microtiter plate and measured spectrophotometrically (OD570). At the optimum conditions, the limit of detection (LOD) and quantification (LOQ) were found to be 0.7 and 1 μM, respectively. A good linearity was revealed with a coefficient of 0.990. The assay showed no significant interference from ascorbic acid, glucose and bilirubin. In addition, it is extremely specific for sarcosine rather than other amino acids. The determination of sarcosine in human urine displayed high accuracy and good reproducibility. This method is promising to differentiate among prostate cancer patients, benign prostatic hyperplasia patients and healthy subjects according to urinary sarcosine level. Simultaneously, a gold nanoparticle-based colorimetric assay was also achieved for PCA3 detection. The assay used the property of thiol group on the 5’-end of the PCR product to simply immobilize onto the surface of gold nanoparticles (AuNPs), which can be able to prevent self-aggregation of AuNPs under high concentration of NaCl solution. Our assay can distinguish the positive from negative results by the naked eye observation of color change or using the ratio of the absorbance at 520 and 640 nm (A520/640). This method was also performed in the 96-well microtiter plate. At the optimum conditions, the optimal ratio (520/640) was > 1.5 in the presence of thiolated PCR product. The sensitivity of assay was approximately 31.25 ng of PCR product. In addition, the assay showed significantly specific for prostate cancer cell lines, which PCA3 is highly expressed, while the other cell types showed no PCR product. Altogether, this study provides the rapid, simple and specific tools to determine urinary sarcosine and PCA3 which could be useful for prostate cancer screening and diagnosis.


location: , 'Thailand year: 2021 source: HSRI

title: A synthetic research study to develop measurement, analysis, review and improvement systems for primary-care performances in Thailand

abstract: This report is part of a research project, funded by Health System Research Institute (HSRI), for developing primary care and end-of-life care performance measuring systems in Thailand, including operational definitions and key components of a patient-centered model of primary care, a framework and a set of key performance indicators (KPIs), guidelines for KPI analyses and identification of opportunities for improvement. The study was conducted during October 2018 to December 2020, using mixed-methods methodology consisting of roundtable events and workshops with key stakeholders, including physicians, nurses and policy makers from the Ministry of Public Health and from the National Health Security Office, twelve rounds of focused-group discussion amongst service users from six participated pilot primary care providers, and a pilot application of the selected KPIs as a part of the value-based payment initiative of the National Health Security Office (NHSO), Region 13 Bangkok. As one of the key study conclusions, primary care is defined a type of health care services that a person, when having queries regarding their health, facing health problems or risks, suffering from illnesses, or in need of continuous follow-up and rehabilitation services refers to as his or her first contact and should pay regular visit to. It also includes any proactive health service which is provided on basis of participation by networks of providers and users. The conceptual framework of primary care performance comprises four groups of performance, which could be subcategorized into 13 key result areas. First, the outcome group comprises three areas, including health outcomes, patient acceptability, and cost. The process group consists of accessibility, effectiveness, continuity, safety, and patient-centeredness. The structural group covers coverage and availability. And, lastly, the other key system performance group includes efficiency, equity and value. The pilot KPIs for primary care include 49 KPIs, which are grouped into eight sets, as follows: (1) processes and outcomes for the healthy group, such as Index of women aged 15-49 who received five antenatal quality care visits, Effectiveness average score of children aged 5 years Immunization completeness by vaccine for each vaccine in the national schedule, Health promotion and disease prevention effectiveness index in adults; (2) processes and outcomes for the risk group, such as Effectiveness average score of health promotion and disease prevention in the elderly; (3) processes and outcomes for the chronic-care group, such as Average point of Diabetes effective care bundle score, Ability to control blood pressure of patients with hypertension, and Inappropriate drugs used index in patient with chronic kidney diseases; (4) processes and outcomes for the dependent groups, such as Average number of days to receive long-term care after screening; (5) processes and outcomes for the end-of-life group, such as Percentage of terminal cancer patients received quality of life assessment at least 10 days in the last 30 days of life; (6) overall primary care services, such as Average primary-care physician service hours per week per 10,000 population (PCPH per 10k pop); (7) patient experience in primary care, such as Patient Acceptability index of primary care services, and Patient-reported accessibility index of primary care services; and (8) Primary care value, which is Primary care value index. The KPI sets were found useful, and mostly feasible to apply in the real setting. However, there were number of problems and obstacles including (1) perception of staffs, (2) consistency between healthcare service systems, service processes and data-recording practices, (3) additional burdens of data collection, (4) many and fragmented databases and needs to link and integrate many databases to get an overview of the personal health care, health service utilization, and KPI results in the given time. In addition, there were needs for simple statistical analyses and presentation of KPI results, guidelines for root-cause analysis and the needs to develop staff competencies on these matters. Nevertheless, the piloted KPI initiative with the NHSO Bangkok-area office demonstrates possibility for implementing KPIs to improve primary care using Value-base healthcare concept. Based on the findings, some key policy recommendations include that the Primary Care System Committee and the Ministry of Public Health should collaborate with other agencies related to primary care development, such as HSRI, NHSO, the Thai Health Promotion Foundation, The Healthcare Accreditation Institute (Public Organization) and primary care providers in (1) using the proposed operational definition, framework, components and perspectives of primary care performance to review and improve policies, related law and regulations, and roadmaps for developing primary care systems to respond to population health needs given changing social contexts, (2) applying the proposed set of KPIs, reviewing and improving details and develop additional KPI as needed, and using at least four selected KPIs for long-term system monitoring—including Average primary-care physician service hours per week per 10,000 population (PCPH per 10k pop), Charlson Comorbidity Index for selected chronic conditions (CCI), Patient Acceptability index of primary care services, and Primary care value index—in order to manage the overall systems, to balance quality of care with resource efficiency, and to reduce disparities between areas, (3) urgently defining health data standards, data file structure and databases, and data-exchange standards to support primary care, (4) developing survey systems and patient experience questionnaires from the proposed prototypes, (5) upgrading management information systems, and (6) improving staff competencies to support data collection, analysis, review and improvement of primary care.


location: , 'Thailand year: 2013 source: HSRI

title: Recommendation of population-based screening guideline for asthma in Thailand

abstract: Although asthma is a disease of high prevalence, incidence and burden of disease in Thailand, no
population-based screening guideline exists for the country. The purpose of this article was to review the
recommendations of population-based screening guideline for asthma in three phases: discussing guidelines
from Thailand and international literature with clinical experts for scoping of the research; conducting
a systematic literature review; and presenting preliminary recommendations to stakeholders. We found
no recommendation for asthma screening via laboratory testing in the general population. Asthma screening
through history-taking and spirometry was cost-effective only in children with uncontrolled asthma, but
not cost-effective in unaffected children, while screening with questionnaire could detect more patients.
In conclusion, screenings were recommended only in children with uncontrolled asthma. Moreover, appropriate
questionnaire for the Thai society should be developed to increase detection.


location: , 'Thailand year: 2008 source: HSRI

title: National Health Statute and Overarching Framework for Health System Development in Brazil, United States of America, United Kingdom: Lessons for Thailand

abstract: In the contemporary development of the Thai national framework for health system development,
this report has drawn the experience of Brazil, the United States of America, and the United Kingdom for
lessons to be learned for Thailand. The study was conducted using document analysis carried out during
August to December 2007, by searching available information from the Internet. Data sources were from
published literature, the media and the websites of several organizations.
The study found that histories, political changes and reform initiatives have influenced the route of
health system development of different countries in different ways. Brazil, which had been under military
dictatorship for a long time during the period 1964-1985, has established a supporting mechanism for
people’s participation in health reform agenda-setting and health policy formulation. Widened participation
successfully pushed the concept of human rights in health care to be adopted in the 1988 Thai Constitution.
Since then universal access to health care has been established and financed with taxes. Every
new reform direction which has been adopted in the national health conference was incorporated to revisions
of the 1988 Constitution. The USA case presents a model of decentralization in health system development.
The federal government supported states in extending the coverage of health-care access. A
collaborative project involving academics and state governments called “Turning Point Initiative” formulated
a model of the overarching public health framework and formulated the “Model State Public Health
Act” which provides initiative ideas for the states to develop their own laws and development plans with
a collaboration from for all stakeholders in the state. The UK case presents long experience with centralized
management for controlling universal access, achieved since after the World War II. Several reforms
were introduced to tackle with the cost escalation and system irresponsiveness (long queues for elective
surgery, for example). Current issues include a balance of the centralized policy and decentralized management.
Thailand passed the National Health Act in January 2007 with the aim of establishing national health
governance which promotes the role of individuals and civil societies in participating in health policy
development and system monitoring and evaluation. Brazil’s experience in the supporting mechanism
for people’s participation is useful for Thailand for comparison with the Thai national health assembly
and for gaining knowledge for strengthening the role of civil societies in health policy development. The
experience of the USA in collaborative work among academics, state officials, and the private sector would
seem to be fruitful in the promotion of the deliberative policy process of health system development. An
experiment in a different context, such as in Thailand, should be practical. The UK’s experience shows the
transitions from the state’s responsibilities in people’s health to the community’s and individual’s choices
in health care. This reflects the direction of sharing responsibilities in society which Thailand has pursued
in this era of health system reform. This study suggested that, in the Asian context, Thailand could adapt,
but not adopt, some good concepts and procedures in health system development from these three countries
in order to establish a reform mechanism and an overarching health system framework with a particular
characteristic based on the wisdom of Thais.


location: , 'Thailand year: 2020 source: HSRI

title: Physical Fitness Testing and Physical Well-being in Thai Elderly

abstract: The objective of this research was to test the physical fitness, evaluate physical well-being, analyze relationships and cluster analysis of physical fitness, and investigate indicators for physical fitness in Thai elderly throughout Thailand. The samples were self-help elderly consisting of males and females, aged 60-69 years old. They were recruited from 5 regional parts of Thailand, 400 participants in each region, including a total of 2,000 participants. The research instruments were two set. Set one was the physical fitness testing for Thai elderly in 6 categories including with body composition, cardiorespiratory endurance, muscular strength and endurance, agility and balance, flexibility, and reaction time and coordination. In addition, there were recordings of electromyograms (EMG). Set two was the physical well-being in elderly including with physical activity, nutrition, rest and sleep, and health problem and non-communicable disease (NCD). The analysis of general data were used with distribution of frequencies, percentages, means and standard deviations, classifying by genders and regions. The classifications of physical fitness groups in Thai elderly were used with cluster analysis and physical fitness indicators. The results demonstrated that the physical fitness groups of the elderly were classified into four groups composed of the 522 participants in very good group (26.14%), the 770 participants in good group (38.56%), the 478 participants in fair group (23.93%) and the 227 participants in risk group (11.37%). The cluster results revealed that the waist circumference could be best used to classify (F = 669.732), followed by the VO2 max from the six-minute walk test, body weight and body mass index (BMI) respectively. The results of indicators were 12 assessment criteria including 30-s block transfer test, reaction time, sit and reach test, TUG time, distances in six-minute walk test, body fat percentage, hip circumference, and waist circumference. In conclusion, the physical fitness test of Thai elderly and assessing the physical well-being of most Thai elderly. This information can be used for health promotion planning for Thai elderly.


location: , 'Thailand year: 2017 source: HSRI

title: Effects of Campaigns Using Change Agent Team and Mass Media to Promote Concept of and New Social Norm towards Antibiotic Smart Use

abstract: This quasi-experimental research aimed to determine effects of campaign using change agent team and mass media for promotion of Antibiotic Smart Use (ASU) concept and new social norm towards ASU. A correlation between social norm and ASU behaviors was also examined. The sample was 624 subjects, 348 were assigned to the intervention group, and 276 to the control group. The interintervention group was implemented with a campaign using change agent team and mass media aimed at promotion of ASU concept and new social norm. Paired t-test was used to compare social norm and ASU behaviors between baseline data and after the campaign implementation. An independent t-test was used to compare those between the intervention and control groups. Results at the end of the campaign implementation demonstrated that social norm in the intervention group was significantly higher than the baseline data, but no significant difference in social norm was found between the intervention and control groups. With regard to ASU behaviors, there was significant improvement in ASU behaviors after the campaign implementation in the intervention group. A Significant difference was also found for ASU behaviors between the intervention and control groups after the campaign implementation. In addition, this study demonstrated that changes in social norm towards ASU were significantly correlated with changes in ASU behavior.


location: , 'Thailand year: 2013 source: HSRI

title: Patients’ experience in using private hospitals for elective surgery under the Civil Servant Medical Benefit Scheme

abstract: The Civil Servant Medical Benefit Scheme has extended its’ benefit by allowing beneficiaries to get
elective surgery in accredited private hospitals with some cost sharing since May 2011. Three are 77 avail-able procedures in 32 private hospitals for this matter; however, three main procedures, intraocular lens
replacement for cataract, knee replacement surgery, and cesarean section, accounted for 88 percent of all
procedures. This study aimed to assess patients’ experiences in getting elective surgery from private hospitals
in terms of channels of receiving information and access to private hospital, burden of expenditure,
and their satisfaction. The study employed a telephone interview with patients or care givers, who received
any of the three main procedures, within a week after being discharged from private hospital.
Results reveal that majority of users were those with age60 and above and were parents of civil servants.
Main channels of information about this benefit gotten by the patients included physician who provided
care for them, message from friends or relatives, and public relation of private hospital. Apart from community
screening for cataract, physician who works in both public and private hospitals was key actor
bringing the patient to private hospital. Main reasons for getting care from private hospital include shorter
queue, convenience in transportation, and following their preferred physician. Majority of them were
informed about the payments prior to admission; however, most of them did not know that they could
compare the price with that of other hospitals prior to making decision. It was found that the level of cost
sharing for knee replacement surgery varied greatly, ten times, among private hospitals. This let some of
them reporting incurred financial burden even though it was unclear whether it was catastrophic for
them. However, this made some of them would not recommend the others to use private hospital. Despite
the cost sharing, majority of them had high level of satisfaction in using private hospital and would recommend
the others to use private hospital for elective surgery.


location: , 'Thailand year: 2002 source: HSRI

title: Development of a primary care model : A case study of Na-Mom district, Songkhla

abstract: This action research aiming to develop primary care model in Na-Mom district, Songkhla province consisted of 4 stages: 1) Situation analysis, 2) Design health service model based on community’s needs and resources, and develop action plan, 3) Implement the plan along with reflective cycle to continuously improve the services, and 4) Evaluation and synthesize what being learnt. Settings were all government health care agencies in the district. Informants included health care providers and key persons in the community. Data were collected from documents as well as reports and by in-depth interviews and group discussion. Content analysis with the validation of study conclusion were performed.	The results were following:	1.  Na-Mom is a small district with population of 20068. It is 10 kilometers from Hat Yai where people can easily come and get access to various health care agencies.  Na-Mom people have good health and economic status. The common illnesses were mild and many of them could be prevented. Within the district, the number of health care providers and agencies met the criteria of Ministry of Health. People preferred to come to Na-Mom hospital when they were sick rather than the nearby health center. They wanted good medical care for the sick but were not much interested in health promotion and illness prevention. Despite many networks in agricultural and economic development, only few groups being actively involved in health development.	2.  Researchers, administrative team and health care providers agreed to develop four primary care units (PCU), one unit one Tambon. One was new and the three were the previous health centers. The primary health care model was designed, based on the community’s needs and available resources. The Na-Mom hospital allocated a few nurses and health workers to work regularly at PCU. Health care Networking Committee at    Na-Mom district had responsibility to create changes, monitor and evaluate the development of these 4 PCUs. In addition, the research team and the health care providers worked together and agreed on the principles of  “Near House At Heart PCU”, tools to be used, tasks and activities in health promotion, illness prevention, primary medical care  and rehabilitation, and work schedules at the units as well as in communities.The process to establish effective primary care units in Na-Mom district included:		3.1 Transforming health care policy by the administrative team to health care providers;		3.2 Shared perception of health care situation among administrative team, health care providers and community;		3.3 Experiential learning from the prior success primary care units;		3.4 Shared design of primary care model and guidelines;		3.5 Continuing personnel development such as meeting, conferences, training, study visits as well as sharing experiences;		3.6 Allocating resources; and 		3.7 Monitoring, evaluation and reflecting the progress of PCU development to continuously improve the services and systems.Outcome and learned experiences: The new established PCU was the effective one  which  accomplished the goal and plan. The others three units, the health center based had less achievement. Each unit had its own limitations such as readiness, competencies and attitudes of heads of the units as well as health care providers, work load in documentation and inadequate supports. The nurses demonstrated high competencies in working at PCU particularly in providing primary medical care and family visit.Suggestions for health care networking committee at Na-Mom district are as followed:5.1 Developing an evaluation system, which is accountable in terms of evaluators, tools, methods and impacts on persons being evaluated.5.2 Promoting community participation in health system development.5.3 Strengthening a support system.


location: , 'Thailand year: 2008 source: HSRI

title: The Role of Key Stakeholders in the Introduction of the Government Use of Patents for Essential Medicines in Thailand

abstract: In late 2006 and early 2007, the Thai government announced its intention to introduce the use by the
government of patents for three pharmaceutical products: two antiretrovirals (ARVs) and an anti-thrombotic
drug. This action, which was aimed at improving access to essential medicines in the public sector,
complied with the flexibilities of the Agreement on Trade-related Aspects of Intellectual Property Rights
(TRIPS). By employing qualitative approaches, this study assesses the involvement of key stakeholders in
the policy process. This analysis suggests that the idea of enforcing TRIPS flexibilities for expanded access to essential
medicines in Thailand was adopted as a public policy when the new government took office after a change
in the political system in September 2006. This policy obtained significant support from non-governmental
organizations in the health sector, patient groups and academics, both inside and outside the country.
However, the action by Thailand was strongly opposed by patent-holding companies, the multinational
medical industry and their national governments. The contributions from civil society were managed in
several forms, such as technical and information support and demonstrations to advocate the policy. Meanwhile,
powerful nations introduced trade retaliation and put political pressure on the Thai side. Global
concern about the unaffordable costs of patented medicines that hampered access to essential health care
in the South was beneficial to the enforcement of the government use provision. The potential diffusion of
this policy from Thailand to other developing countries triggered serious opposition from stakeholders
who lost their benefits.


location: , 'Thailand year: 2012 source: HSRI

title: Development of processes in environmental and health surveillance on organization and community participation based in environmental health impact: a case study of Phichit Province

abstract: According to the survey for gold deposits by the Ministry of Industry of Thailand, it has
attracted a private investment for further exploration and development of gold mines. In 1987,
several gold mining sites were opened for investment from the private sector including Chatree
Gold Mine located in Phichit Province. Mining is a large-scale enterprise that can potentially create
a number of negative health impacts. The health effects were concerned after the mine started
the operation, the villagers found they suffered from the increased incidents of illness. Therefore,
conflicts between the community and mining operation over environmental and health impacts
have become increasingly aggressive. The compiled evidence of contamination and filed
numerous complaints with authorities and the water quality was tested and found traces of
cyanide used in gold extraction, and heavy metals such as arsenic, iron, and manganese in the
underground water and tap water. People living near the mine site have suspected to have health
effects since the signs and symptoms of acute and chronic illnesses, especially skin rashes were
commonly found in children, and dust and noise nuisance. This study focused on the processes
undertaken to establish the community participation framework coordinated with environmental
and health agencies that could be implemented locally to the identification, collection and
analysis of environmental hazard, environmental exposure and health data.
The review of environmental and biological monitoring data was performed for computer
mapping and revealed that the key point of a cause of conflict is environmental and health data
have been collected and analyzed separately with little integration between governmental
agencies and community participation. Using the existing environmental data indicates the analysis
and mapping difficulties due to the validity and reliability of monitoring data. Biological monitoring
for the exposure of toxic contaminants has been carried out a few times only when the
complaints and concerns were addressed by the community through the government. The
appropriate health surveillance program was not provided to the community affected by mining.
Thus, the environmental health surveillance program has been established by the community
participating with local and regional government sectors response to environmental, health and
industry for the appropriate environmental health surveillance program and long-term financial
support. The networking of environmental health surveillance could initiate the community to
develop the environmental health surveillance program that could empower the community for
health impact assessment.
The environmental exposure related to health effects is difficult to identify for the
symptoms or diseases, especially chronic diseases due to limitations of biomarker specificity and
the various factors involved in symptom or disease endpoints. The linkage of environmental and
biological monitoring information such as environmental contaminations, exposure data, and
disease reports are needed to support environmental health statuses. In Thailand, very few
integration among responsible organizations was found for environment and health working group.
In this case, the difficulty of data interpretation for health consequences relating to environmental
contaminants resulted from the lack of environmental and health information as well as the data
quality used for database entry.The database of environmental and health is an effective tool and the quality of data is
required for a good surveillance system. Laboratory quality assurance and quality control (QA/QC)
in sampling and analysis are required for the accuracy of the results. The community participation
should be involved in all monitoring processes for conflict resolution. This case study indicated
that the resources of environmental data for the initiation of a database were mainly from EIA
process. The sampling and analysis had been done and sent to laboratory by mining company.
Therefore, it should be reconsidered that the monitoring process has to be reorganized and
community participation is required in all steps for a clear process.
Data on health had been retrieved from the conventional surveillance system used the
same database as other areas. Data collected by the number of morbidity and mortality which
can be obtained by health information flows from the registry of local health care. It
demonstrated that the system is not enough and suitable for the specific area having
environmental hazards. It is suggested that a special medical surveillance program is required for
to identify the environmental hazard exposure and health status, especially the early stage of the
diseases.
The appropriate environmental health surveillance is required with well-defined of the
parameters for both environmental and biological monitoring program. Indicators for the
assessment of environmental quality and contamination must be considered for the specificity
including the validation of the methodology. In this case the monitoring of cyanide for
environmental monitoring and exposure assessment is also considered for the uncertainty.
The networking of environmental health surveillance has been established based on a
concept of community participation. The concern issues of environmental health impacts were
discussed by community. Due to the limitations of budget and resource, the priority setting was
used for the investigation of environmental hazards and exposures. The community was trained
for parameter selections, environmental sampling and preservations. The quality laboratory was
also introduced for the selection of sample analysis to get the quality data. The outcomes of the
surveillance program consist of two sets of mapping, computer database and manual maps, that
are used to link the environmental and exposure data. The key persons were trained to input and
analyze the information from computer database and it shows an effective tool for the
assessment of environmental health status to the community. The manual map is also a
surveillance tool that has an advantage over the computer database in the number of people to
assess the data because of the limitation of computer skill in most population in the community.
The local health organizations and academic intuitions take action in supporting the knowledge,
specific skills and budget. The community could have a potential to be as its own environmental
health surveillance data center. However, the long-term financial funding is needed to be
resolved for the sustainable surveillance.


location: , 'Thailand year: 2008 source: HSRI

title: The Effectiveness of Cognitive Behavior Therapy with Electrostimuli Ear Acupuncture for Hazardous Alcohol Drinkers at Bangprakong Hospital, Chachoengsao Province, 2007

abstract: This retrospective study was conducted to verify the results of treatment of 25 hazardous
alcohol drinkers by a combination method of cognitive behavior therapy with
electrostimuli ear acupuncture at Bangprakong Hospital; there is no known use of the
method being employed previously. The 25 patients were studied by audit questionnaires:
six scores in women and 8 scores in men. Treatment given by electrostimuli ear
acupuncture for one hour and cognitive behavior therapy program for one hour daily on
10 successive days and follow-up four times at one week, two weeks, one and three months,
respectively. The results were analyzed descriptively, showing that 19 of the patients
could stop drinking (76 per cent), although six suffered a relapse (24 per cent). The longest
cessasation was five years.


location: , 'Thailand year: 2009 source: HSRI

title: The Development of Indicators of Good Governance Management of the Provincial Public Health Office

abstract: The objectives of this study are to study a conceptual framework for a theory concerning good governance of health system management in local areas, to create good governance indicators regarding provincial public health office management, which can then be implemented as a tool to evaluate and further develop the organization’s effective governance and also evaluate the level of good governance management of the provincial public health offices in the four pilot provinces: Chiang Mai, Krabi, Cholburi, and Nakhon Pathom. Analysis is done by secondary data, such as annual reports, and related documents, and primary data which were obtained from a questionnaire using three sets: the first set was evaluated by internal officials within the agencies and consisted of 50 indicators, the second set was evaluated by officials with specific functions and contained 11 indicators; and the third set was evaluated by related agencies and consisted of 37 indicators for evaluating good governance management. The evaluation was divided into two parts: the first part was evaluated from the first and the second set of questionnaires by 86 internal officials and the second part was evaluated from the third set of questionnaires by 184 related agency officials. Purposive sampling was used to collect the primary data. Descriptive statistics were used to analyze the data and t-test used to compare the average scores.
The findings based on the evaluations concerning management of the four provincial public health offices, as evaluated by the internal officials, revealed high levels of good governance management. There was an especially remarkable score shown in the Principle of Information Technology and Communication, the Principle of Value for Money, and the Principle of Rule of Law. The evaluation results for good governance management of the provincial public health offices by the agencies related to the provincial public health office of Chiang Mai, Cholburi, and Nakhon Pathom revealed that good governance management was moderate. For the Krabi provincial public health office, good governance management was rated as high. For all four provincial public health offices, the Principle of Transparency was found to have the most significant rating.
In considering the evaluation by the internal officials and related agencies, the results showed that development was still required regarding the Principle of Management, the Principle of Human Resources Development, and the Principle of Participation. Thus, it would be appropriate for each provincial public health office to consider improving its work standards in line with a systematic evaluation of administrators’ work performance. Training programs should be established along with an incentive system for personnel participation and successful official development. Finally, listening to feedback from the outside agencies concerned could help to improve work performance.


location: , 'Thailand year: 2009 source: HSRI

title: The Outcome of Tuberculosis Control in Special High-risk Populations in Northern Thailand: An Observational Study

abstract: Objectives: To evaluate and review the tuberculosis situation in various populations at high risk of
contracting tuberculosis, at various periods of time and general tuberculosis control outcomes in northern
Thailand.
Methods: Data on various high-risk populations were analyzed from the DOTS database and special
project paper-based record systems for various high-risk populations in areas of northern Thailand in
various periods of time.
Results: The 2003 and 2004 reports showed 30 and 60 percent of multidrug-resistant tuberculosis
respectively with cure rates of less than 60 percent of the registered cases. The 2004 report revealed that
tuberculosis was the most common opportunistic infection (38.9%) among the HIV-seropositive/AIDS
cases. Reports of isoniazid therapy for tuberculosis prevention among HIV-seropositive/AIDS populations
showed that 78 percent of them had not developed tuberculosis at the end of the 24th month since
starting therapy. The 2005 report demonstrated that only 3.2 and 37.1 percent of the suspected childhood
tuberculosis cases were diagnosed as tuberculosis and latent infection cases, respectively.
There were no statistically significant correlations between the types of the patient observers and the
cure rates among the general tuberculosis population analyzed from the 2003 report (Pearson correlation
coefficients > 0.01, 2-tailed). There also were no statistically significant changes or improvement in the
treatment outcomes (sputum conversion rates, default rates, death rates, and treatment success rates),
when comparing the 2003 and 2004 reports (p > 0.01).
Conclusions: These findings indicate the DOTS program implementation was not well-developed
for various populations at high risk of tuberculosis in these areas. Recording and reporting systems for
childhood tuberculosis cases in this area still were not well-developed and this contributed to
underreporting of this section of the high-risk population.


location: , 'Thailand year: 1999 source: HSRI

title: Infection control development in Sappasitthiprasong hospital

abstract: Infection control development in Sappasitthiprasong HospitalObjective : 1) To develop an appropiate surveillance and infection control  system for Sappasitthiprasong Hospital 2) To implement the developed surveillance and infection control  system in every inpatient ward 3) To determine the problems and constrained in running the developed system and the method used for solving the problems 4) To determine the sustainability of the system and associated factors.Design : Research and development.Setting : Sappasitthiprasong Hospital, UbonratchathaniMethadology : The activities performed in order to improve the developed surveillance and infection control  system are as follow : 1) The situation analysis of infection control 2) The re-structure the organization and the  line of command of infection control unit. 3) To educate the hospital personnel. 4) Training courses for ICN and ICWN 5) To develop new surveillance data record forms, to establish criteria for diagnosis of hospital acquired infection, guideline for hospital infection control and outbreak investigation. 6) The guidelines for hospital acquired infection surveillance, were created and implemented, in 33 inpatient wards. Periodic monitoring was done. 7) To evaluatie of  surveillance system, effectiveness of infection control and the sustainability  of the whole system.Result : The surveillance system and present report of infection rate in every inpatient ward were set up. The surveillance data were analyzed and audited by the infection control division. During the implementation period the infection problems ,such as the personnels’ confidence, the doctors’ cooperation and duration of culture and sensitivity report, were found. These problems were solved by conference and seminars.  The topic  established criteria  for diagnosis of hospital acquired infection, among infection  control working groups.  All quantitative data such as completeness, accuracy and timeliness, were 99, 98 and 53 % respectively.  The effectiveness of surveillance system was improved. The administrator team’s committee was interested and used surveillance data  for solving the infection control problems.Conclusion To develop an appropriate surveillance and control system , that  will predict trends of hospital acquired infection. Hospital personnel piad attention and used the data to solve the infection problems. Finally, the factors that affected the sustainability of the system were characteristics of the hospital personnels’ : concern , stimulation and participation in surveillance and control systems.


location: , 'Thailand year: 2023 source: HSRI

title: 13 Years - Learning and Development of Stroke Fast Track in Thailand

abstract: The National Health Security Office (NHSO) has encouraged the free treatment of patients with acute ischemic stroke with thrombolytic treatment starting in 2008 only at university hospitals in Greater Bangkok. Subsequently, the aforementioned treatment services have been expanded to all areas in Thailand. The challenge of such treatment is that the time from the patient’s neurological symptoms until receiving thrombolytic treatment must be within 270 minutes as soon as possible. A shortage of neurologists in the provinces challenged the development of stroke service network. Using the principles of NETWORK (N: national standard, E: engagement, T: teamwork, W: wisdom, O: organization, R: reach target, K: knowledge management) and STANDARD (S: seamless, T: timeliness, A: awareness, N: network, D: drug available, A: ability, R: referral system, D: district health system) enabled nationwide service expansion in 2011. The current rate for acute ischemic stroke patients with thrombolytic treatment was approximately 8%.


location: , 'Thailand year: 2004 source: HSRI

title: The dissemination on and the campaign for public policy in Chiang Mai city

abstract: The Project on the Dissemination on and the Campaign for Public Policy in Chiang Mai City is an action research project conducted by the Urban Development Institute Foundation (UDIF) supported by the Health System Research Institute (HSRI). Its objectives are: to disseminate information about public policy to the residents of Chiang Mai; to stimulate Chiang Mai residents to call for public policy that can solve their problems; and to propose their public policy to the candidates who run for the first elected mayor of Chiang Mai to be elected in February.  The study period of this project was from May 2003 to February 2004. This project was divided into 4 phrases.  The First phrase (May-September 2003) was to prepare for the campaigning process, to coordinate with the lecturers from other organizations joined as the campaign network.  They were from the Department of Architectural Technology, The Rajmongkol Technical Institute, Chiang Mai Campus; The Department of Geography, Faculty of Social Sciences, Chiang Mai University; and the Faculty of Nursing, Payup University. The first questionnaire was conducted to get baseline information to be used as one of the indications for the success of the project, to be evaluated at the end of the project.  We wanted to know whether the residents of Chiang Mai have clear understanding about public policy – what it is and who can form public policy of the city.  About 56 % of those who answered had correct understanding about public policy.  Moreover, people proposed several problems should be addressed as the city’s public policies to solve them.	During this phrase, a workshop was organized by volunteers who were students at high school and college levels.  The name of the workshop was “Yiea Ja Dai Jiang Mai tueng ja dee” meaning “How to make Chiang Mai (Jiang Mai) better?” The German “Objective Oriented Planning Process” (ZOPP) was used as brainstorming process.  Participants from various occupations, including academics, housewives, community leaders, non-government organization workers, private sector, media, people’s organization, elderly, etc., were invited.  Many socio-economic and physical problems were addressed at this workshop.  Our campaign process included the poster and essay contests on public policy and the direct election of mayor.  We hoped that information would be passed on from students to parents to raise their awareness. The Second Phrase (November – December 2003) we organized “The 3rd Oo-fuu Ruang Muang Chiang Mai: Oo Gun Bolaew Bohai Gup Nayobai Satarana” meaning public forum to repeatedly discuss about public policy.  This forum was to  collect information about the quality of directly elected mayor in Chiang Mai residents’ mind and the problems that people thought should be solved immediately.  Small group meetings and the campaigning with organized groups and individuals were done on the citywide basis. The Third Phrase (January-Early February 2004) was the time to launch  intense campaign for the first direct election of mayor of Chiang Mai.  Posters, leaflets, radio spots, banners, and handout were produced and disseminated to the public to announce the election day.  Voters were encouraged to exercise their votes and to consider the candidates’ healthy public policies as factors to vote for.  Radio time was bought to turn on the spot. The project hired some radio programs to turn on our radio announcements produced to invite people to vote on 1st February for the first direct election of mayor.  We also pointed out that the voters should consider public policies that each candidate offered whether they are healthy policies or not.  The second questionnaire was conducted during this period.  After the campaign on public policy and direct election of mayor was lunched several months ago, people have had better understanding about both issues and how they were related.  About 75% of the answer sets returned knew the date of the Direct Election of Mayor and had correct understanding about public policy.  About 49% of the answers said they would go to vote and the same percentage had no intention to vote.	Before the election, a public forum on “Direct Election of Mayor – Which Direction is Chiang Mai going?” was organized.  The aims of organizing this forum were to analyze urban problems and their impacts and the strengths and weaknesses of the existing mayor system.   	Formally before the election the “Ruam Duay Chuay Gun” (Let’s Help) radio program planned to invite all candidates to broadcast their public policies so that more general public knew their thoughts.  However, the Election Watch Committee banned this special program.  They were afraid that if the candidates presented their ideas which sounded like they promised to do something, it might be illegal. 	The 4th period (February – March, 2004) post election period.  This study was evaluated, analyzed and lessons were drawn for other cities.  Public policies that would solve critical problems were continuously presented to policy makers so as to implement them.  Final report was finished and submitted to funding agency.  	Extra activities were the co-organization of public forum on “Chiang Mai Muang Ngam and the High Rise Building” (Beautiful Chiang Mai and the Impact of High Rise Building).  The resolution of the meeting was to protest the construction project of the new Municipal Office.  Based on the health impact assessment, conducted last year, revealed that negative impacts high rise buildings caused on social, mental and spiritual impacts to Chiang Mai society.  In addition, we published the special issue of Chiang Mai Journal on the Cable Car Project to Doi Luang Chiang Dao to call for the ban of the project.     	After the election, our project joined the research projects of the Social Research Institute, Chiang Mai University namely the Study of People’s Participation in the Solving of Air Pollution Problem in Chiang Mai Urban Area and the Sustainable Cities Project in meeting with the governor of Chiang Mai.  The purpose of the meeting was to present information of the critical air pollution in Chiang Mai urban area and its health impact and call for strong action from the management.  	This project also organized a meeting on “Public Policy Which way is Chiang Mai heading to” to brainstorm about new public policy in Chiang Mai and the reaction of people’s organizations to these policies.	It is important to notice that statistics showed the decline of number of population and the number of voters due to more out-migration of the middle income families to the suburban area.  In general, Chiang Mai people are submissive and have no courage to argue with others or present their ideas to policy makers. Popular phrase has been “Let the other decide”.   	Those who have good quality but do not have much money dare not run for the election.  Every sector of the society agreed that those who run for any position MUST be using a lot of money.  This is due to the patron-client or superior-subordinate relationship.  Politicians are expected to support the poor voters all the time.  Because the voters were not satisfied with the quality of the new candidates, they did not vote for anyone regardless of the strong campaign calling for voters to exercise their rights to vote.  		The interview and the questionnaires showed that more people had correct understanding about public policy.  They knew that public policy was the policy that could give great impact to the whole society and was widely accepted by the public.  The Central government, local government units and people could all propose public policy.  More people had correct understanding after the campaign of the project than before the campaign was launched.      	Because we could not have exactly the same group of the citizens who answered both sets of questionnaire, the results would not be the only indicators to measure the success of this project.  Particularly when asked about the first directly elected mayor because of the different methods used in each questionnaire.  No matter what method was used, Boonlert Booranupakorn always came first on the list.  Other names on the list changed completely from the first to the second questionnaire.  It is interesting to notice that politician at national and provincial levels appeared on the list when we used open-end method, for example, Dr. Taksin Shinnawatr, Dr. Purachai Piamsomboon, Pakorn Boonranupakorn.  A majority of the answers did not put any name but stated the qualification of the mayor people desired to have.  These answers reflected that most people could not think of a person that they have always thought of or wished to have run for the local election or manage the city.	Five major problems, from both questionnaires and in-depth-interview, that people think should be solved are problems about youth, garbage, drugs and air quality.  It is noticeable that none of the policies announced by all candidates touch upon the youth and drugs problems which were both social aspects.  Most of them were concerned about physical aspects especially the traffic congestion.  Moreover, not very much economic aspect was pointed out.	The following are several reasons why the number of votes reduced from the last election.  First, none of the candidates had an outstanding qualification that touched the heart of the middle class or could attract the voters to vote for.  Even though there was a box that people could check if they did not desire to vote for anyone, most voters still thought it was a waste their Sunday pleasure for local politics.   They thought none of the candidates could improve the city or made a drastic change.  Second, many middle class migrated to the suburban area.  This trend reflected on the reduced number of registered population in the city.  Many of them might have social mind and were interested in politics, but they had no right to vote or run for the mayor of Chiang Mai.	Third, most people thought city management which were in their terms had already paid their ways to the position next term.  This included the regular study tours to other provinces for the community leaders, the all-year free gifts, the free drinking water for the funeral ceremony, etc.  People had tendency to think that their votes could not make a difference, therefore, why would they have to waste their time for the election.  Fourth, besides the Mayor Boonlert Booranupkorn, other candidates were unknown to the public.  This was because other candidates did not perform very much of the public activities.  Some only ran for the election and after they lost, they disappeared and then came back to the lime light again before the next election.  As a result, people never knew their management ability or the willingness to work for the public.	From interviewing the residents and many groups in the city, most people had no interest in the city problems - they only cared for their earn of living.  In addition, Chiang Mai local residents have had the mind set that Seksan Prasertkul called “Contractor mind”, meaning people would not fight for anything for themselves but waited for others to do for them.  In general people would be active only when the problems gave negative impacts directly to them.  Moreover, many people thought politics was a serious matter and had nothing to do to their lives that they did not want to pay attention to or get involved with.  No many people understand the connection of politics, management and public policy.  Some were interested in politics but dared not to criticize it.  They were afraid that their criticism might cause them some trouble.  Those small entrepreneurs along the streets were not very cooperative, partly because they were busy with their business, partly because they would be cheated by strangers.              	From the questionnaires, the most powerful media was the leaflets produced by the project, radio spot, information form others, newspaper, volunteers and the meetings. 	Even though the number of votes decreased from the previous election, it was because of the afore-mentioned reasons.  The number of votes should not be used as the only indicators of the success of this project.  There were more people who had correct understanding about the direct election of mayor, public policy and the importance of it.  The evidence showed by the increase of stakeholders joined in our meetings and activities.  Additionally, more media, academics and citizens have mentioned about public policy repeatedly.  Citizens have had more courage to push for the positive change of the city.     	“Nayobai Satarana” or public policy is a new, unfamiliar word that needs translation.  It is difficult for ordinary people to have clear understanding about the word.  Therefore, it is advisable to find a more simple word to substitute this word.  Simple Thai that is not rooted from Pali or Sansakrit is recommended because every group in the society should be able to understand the word without translation so that people will know that it is related to their well being and they should be concerned and call for healthy public policy. 	One of the problems we faced when conducting this project was the quality of those who applied to be our staffs and volunteers.  Most of them had no knowledge about local government, the old and new election system.  New generation has never paid attention to public policy or urban problems, therefore, they have had limited knowledge on the topic they would have to campaign for.  Therefore, it took time to train the staffs and volunteers.  Apart from the knowledge, the young generation has had no determination to work hard.  They want to get high pay but offer low performance.  Moreover, many of the volunteers were students and when the university opened, they had limited time to work on the projects regardless of the training they got.  Some students never join any student activities and had no experience to work with the community many people lack.  This could be the result of family upbringing, educational system, including the trend of the Thai society.  The young generation now has no patient because they always get something instant and quick.  Many of those who worked for the project had no patient, not torelent or common sense which were one of the major problems of the campaigning process. 	The residents had no sense of strong citizenship, particularly many of those who newly migrated to the city.  The new comers have no sense of belonging to the city.  Very few have good understanding about the city.  Traffic congestion and environmental degradation are something people expected.  They think every city must face all these problems.  They never heard that there are some well managed cities where healthy public policies have been proposed by all sectors of the society.   	There are three comments related to the role and performance of the Health System Research Institute that affects the performance of the project.  First, there were too many changes of responsible persons.  It was confusing who we should contact or seek advice from.  Second, the delay of transferring funding made it difficult to work in each phrase.  UDIF had to allocate some budget to keep the project continued.  Third, in practice there was no other two supporting teams as formerly planned.  Until the end of the projects the other two teams have not signed the contract.  As a result, there was no other team that would comment and give suggestion for the improvement of the campaigning process. 	Lessons for campaigning in other cities are: First, the project leader must spend full time for the project to be able to work continuously and efficiently. Second, the project must have a strong team work.  Third, the success of the campaign depends on the qualification of the candidates who run for the mayor.  Unless there is a charismatic and committed candidate, the silent majority will not go to vote or push healthy public policy through him.


location: , 'Thailand year: 2006 source: HSRI

title: The condition of public sphere in Bangkok

abstract: The condition of public sphere in Bangkok is one of research in the project of “Civil society and Public Sphere in Thai Society”. Indeed, the public sphere is an artifact of modernity’s social dynamics. This is why its ‘Structural transformations’ can be studies from a variety of socio-cultural perspective. Moreover, the notion of the public sphere keeps an essential resemblance to the notion of the political pluralisation of the public sphere in spaces of particular cultural life-forms. To study the kinds of public sphere in Thai society, especially about condition of construct the public spheres in Bangkok, there are four case studies in the research. to study the contesting of mechanisms of solving of landless policy by the center of Bangkok’s community development for poor people. to study of the role of NGOs for the emancipation of women public sphere of sex worker by the center for women empowerment.to study the independence of the rise of the public sphere upon the sexual differentiation by Krungthep rainbow group. to study of the roots of democratic politics in the private and public sphere of the middle class by Mass center of direct sale.In these four cases studies, the research find that the condition of constructions of the ‘public sphere’ in Bangkok are not only compatible with, but rather require an understanding of different mode of associations of human existence. By the same token, having a sphere of public sphere in which each case both loses itself and creates itself is depending on a condition of many cultural-historical phenomena.


location: , 'Thailand year: 2017 source: HSRI

title: Muslin Women’s Social Space and Health Empowerment through Physical Activities amid Unrest Situation in Southernmost Provinces (Phase I)

abstract: This study entitled “Muslim Women’s Social Space and Health Empowerment through Physical Activities amid Unrest Situation in Southernmost Provinces, Thailand” aims i) to investigate information of the Muslim women’s social space and health empowerment through physical activities. ii) to investigate to what extent of capability of Muslim women’s physical activities according to Islamic Jurisprudence and iii) to provide channels of possible physical activities to Muslim women in strengthening physical health. The research findings are as following points: Point 1: The data regarding Muslim women’s social space and health empowerment through physical activities were found that they strengthen their physical health through daily routine activities including taking ablution for prayers, performing daily five time prayers, watering trees in housing areas, shearing grass, fruit picking from their farms and washing clothes using hands. Moreover, they still strengthen their physical health through their careers as self- employed businesses. These activities can be considered to be Muslim women’s social space in health empowerment.  However, there are certain limitations regarding insufficient public places for their physical activities which are permissible according to Islamic principles. On the other hands, they have their own space for informal discussion to release stress and for the sake of entertainment. They also organize various activities among themselves based on their capability particularly, volunteering activities contributing to others in the community. Moreover, external organizations support them in terms of physical therapy and activities to encourage them to live their lives happily. Point 2: The extent of capability of Muslim women’s physical activities according to Islamic Jurisprudence shows that Muslim women are able to do exercise for strengthening their physical health through several activities under the framework of Islamic principles. In other words, the activities involved in should not much extreme, the outfits should be properly dressed under Islamic Jurisprudence. Most importantly, it is not allowed to mix between males and females in the same workout place. So far, there have no specific places for the Muslim women’s physical activities provided in all levels of age and gender.  Point 3:  The channels of Muslim women’s physical activities in health empowerment are proposed as follows: 1. The workout places should be specifically for women publically since there are not only the venues for their health empowerment but they are also the platforms for them specifically widowed women to exchange experiences and ideas among themselves 2. Policy makers who are in charge of building Muslim women’s social space of physical activities in the area of Southernmost provinces of Thailand should support and cooperate all organizations involved for instance, Islamic committee, local government organizations and Halal institute. 3. Training providing knowledge to Muslim women from different government and non- government organizations involved should be held to release and relieve their stress, depression, worry and the symptoms of major depressive disorder (MDD) through organizing physical activities. 4. Encouragement of participation of Mama (Pondok leader’s wife) in organizing both religious and physical activities in their own community.


location: , 'Thailand year: 2021 source: HSRI

title: Pharmacokinetics and Pharmacodynamics of Ivermectin in Pediatric Dengue Patients (PKIDEN)

abstract: Dengue disease is an important problem in global public health. Annually, 390 people are infected with dengue virus. The majority of infections results in asymptomatic cases. For symptomatic cases, patients will develop either mild dengue fever (DF) or severe dengue hemorrhagic fever (DHF). DF is a self-limiting disease meaning the patients will recover within 4-7 days without any significant intervention. However, DHF patients will eventually develop plasma leakage which may progress into potentially fatal hypovolemic shock known as dengue shock syndrome (DSS) without prompt and adequate fluid management. Dengue disease is caused by dengue virus which belongs to the genus Flavivirus. There are four serotypes of the virus including dengue virus 1, 2, 3 and 4. The virus is transmitted by Aedes mosquitoes. There is no antiviral drug against dengue virus and the only available vaccine has limited efficacy and elevates the risk of hospitalization from dengue disease in seronegative vaccines. We previously conducted a phase 2/3 trial by repurposing ivermectin to treat adult dengue patients. We found that ivermectin was safe, and the drug could significantly speed dengue virus non-structural protein NS1 clearance. In addition, the drug showed a potential efficacy in reducing the severity of the disease. In this study, we primarily evaluated the safety and pharmacology of ivermectin in pediatric dengue patients (age younger than 15 years and weighing more than 15 kilograms). Since ivermectin ingestibility, absorption, metabolism and excretion in pediatric patients were expected to be dissimilar from adult patients, this study was essential for determining the appropriate dose of ivermectin before conducting a trial for evaluating clinical efficacy. Two doses of ivermectin were studied: 400 μg/kg per day for three days and 600 μg/kg per day for three days. The patients in each dosage group were also stratified by weights into two groups including those weighing over 30 kg and those weighing between 15 to 30 kg. Our analyses showed that both doses of ivermectin were safe for treating pediatric dengue patients. However, no dose dependent relationship in efficacy against viral load or NS1 levels were found between the two administered doses. Advanced pharmacological analysis is required to confirm this finding. If the finding is confirmed, the more appropriate dose for phase 3 clinical trials in pediatric patients will be 400 μg/kg per day for three days.


location: , 'Thailand year: 2006 source: HSRI

title: Policy recommendation on geographical of physician's distribution under universal coverage health insurance

abstract: Geographical imbalance of physician is a globally chronic problem of health service, particularly in countries which has overall physician’s shortage. The geographical imbalance negatively affects the efficiency and equity of health system in both areas, high and low health workforce’s density. In Thailand, physician’s distribution problem plays a major role in indicating the success or failure of health insurance schemes.In 2005, Thailand has approximately 25,600 physicians who have active service status. With this figure, the overall physician shortage is around 4,500, compared with the demand forecast, which was conducted before universal coverage health insurance implementation. However, there are at least 3 main factors, currently triggering the rising of demand for physician in our country, including 1) universal coverage health insurance scheme, 2) Thailand as an Asian Medical Hub policy and 3) universal coverage for anti-retroviral treatment for HIV infected population. The additive burdens from these 3 policies are equivalent to 1,222 full time physicians’ performance.  The physician’s distribution discrepancy does not substantially change from the trend in last few decades, although Thailand has 3 significant increases in physician production in the same period. Furthermore, the mushrooming of private sector, as a result of economic recovery, severely aggravates the discrepancy, in term of internal brain drain.Incentive system is the popular tool to alleviate the discrepancy. It affects physicians, by both attraction and maintenance physician in the shortage areas. Unfortunately, the existing incentive pattern does not strike a balance among many types of incentive. Non-financial benefit is always less prioritized.  In addition, increasing of public physicians’ incomes alone is prone to have an adverse impact, in term of spurring the national health expenditure.In the macro view, Thai physicians receive less income while suffer from more workload burden, when compared with other countries in the same region. Internally, there is significant difference of total incomes between public and private physicians. A sampling phone survey shows 37,000 and 50,000 Baht in monthly incomes in resigned general practitioner and specialist physician, respectively.Implemented measures to mitigate the geographical imbalance display the irrelevance of strategies and roles of stakeholders. Therefore, it’s necessary to improve the existing policy and strategies to effectively solve with this problem, with sustainability. 	The policy recommendations, drawn from this study, are including 4 parts of policy, as followed;Supply policy: the physician supply can be improved by 1) increasing in number of physician, which are including new production and activation of service inactive group and 2) improvement of productivity by arranging the optimum skill mix and specialty mix, including establishing of flexible employment i.e. public-private mix.Distribution and utilization measures: Revisions of existing procedures are urgently need including educational contracting, physician allocation method, long term development system and migration.   Incentive measures: the physician’s incentive system should reflect the shortage situation and performance, as well as focusing on effective non-incomes incentives.Other measures: these are including 1) preparation of physician to shortage context, 2) applying of health workforce demand identification concept to both public and private investment and 3) utilization of physician as public asset, such as financial mechanism to support the optimum physician’s distribution.


location: , 'Thailand year: 2022 source: HSRI

title: Claim Behaviors among Insured Persons under Social Security Act’s Article 40 with Occupations in Transportation: An Analysis of Social Security Office’s Administrative Data between 2018–2020

abstract: The present study’s objective was to investigate the claim behaviors of the insured persons
under Social Security Act’s Article 40 who had transportation related occupations. This would provide
lessons for other platform workers being prevalent during COVID-19 pandemic who chose to register
under Social Security Act’s Article 40. The Social Security Office’s administrative database between
2018–2020 provided a total of 417,135 insured persons for analysis. Descriptive statistics of number,
percentage, mean, and standard deviation were presented to reflect insured persons’ claim frequencies,
benefits and averaged days from registration dates to first claim dates by benefits. The analysis showed
that 4.1 percent of insured persons submitted claims. The average duration from the registration dates
to the first claim dates exceeded a year. The most benefit claims came from the sickness benefit. The
highest rate of denied claims came from the disability benefit. Developing effective communication
strategies for platform workers should consider potential claimants and their needs as found by this
study.


location: , 'Thailand year: 2018 source: HSRI

title: Human Resources for Health Projections for Primary Health Care Services in Thailand 2026

abstract: The study aimed to forecast human resources for health (HRH) requirements for primary health care services in the next 10 year (2026). The HRH requirements covered both public and private sectors for 3 types of services, (1) curative and Thai traditional medical services; (2) health promotion, disease protection and health risk factor interventions; and (3) rehabilitation services for elderly care. HRH included in this study were: doctors, dental health personnel, pharmacists, nurses, public health personnel, physical therapists, Thai traditional medical personnel, and medical technologists. The combination of health need method and health demand method were used for HRH forecast. The results showed that when the primary health service system maintains the status quo, in 2026, the primary health care system required 9,826-12,009 doctors; 26,249–32,082 nurses; 16,797–20,530 public health personnel; 6,043–7,385 physical therapists; 5,880–7,186 Thai traditional medical personnel; 9,187–11,229 Thai traditional medical assistants; 4,757–5,814 dental health personnel; 1,997–2,441 pharmacists; and 578–706 medical technologists. However, when 25% service utilizations are shifted from secondary health care services to primary health care services and elderly care services in communities are increased in the future scenario, the system requires 23,523-28,751 doctors; 32,523-39,753 nurses; 6,695-8,182 pharmacists; 18,568-22,694 public health personnel; and 811-991 medical technologists.


location: , 'Thailand year: 2020 source: HSRI

title: Situation of Employing Retired Nurses in Hospitals under the Permanent Secretary Office of Ministry of Public Health

abstract: The cross-sectional survey research was conducted to study the situation of employment of retired nurses in hospitals under the Permanent Secretary Office of the Ministry of Public Health. The data on employment of retired nurses were surveyed from regional hospitals, general hospitals and community hospitals during fiscal year 2019-2020. The results show that there were 31 of 116 regional and general hospitals (26.7%) that employed retired nurses in 2019. In the fiscal year 2020, there were 28 hospitals (24.1%) that employed 162 retired nurses. For community hospitals, 20 of 780 hospitals (2.6%) employed 32 retired nurses in 2019 and reduced to 18 hospitals employing 20 retired nurses in 2020. Hospitals in the central and the eastern regions had the highest employments of retired nurses. There were 2 types of job characteristics (nursing work and non-nursing work such as health information management and health record). The pattern of employment was either full-time or part-time. Many payment arrangements were reported, such as daily payment (at a rate of 600-800 baht a day), monthly payment, and performance compensation. However, all payments were based on the regulations of the Ministry of Public Health. As for community hospitals, 20 hospitals employed 32 retired nurses (2.6%) in 2019, and reduced to only 18 hospitals employing 20 nurses (2.3 %) in 2020. During the fiscal year 2019-2020, hospitals in the central and the eastern regions (Health Region 4, 5 and 6) reported the highest employment rate than other regions. Regarding the 2 types of employment: 1) the nursing work employment was reported at the outpatient department, inpatient wards, special clinics and antenatal care clinics, accident and emergency department, central dispensing unit, breast feeding clinic, orthopedic department, primary and community care unit, and diabetes clinic. 2) The non-nursing work employment was reported in other departments such as in the medical records audit, the outreach health check unit, the patient complaint services, the health insurance center, and the public relations. The monthly payment was approximately 13,000-20,000 baht a month. The time-based payments varied as 100 baht an hour for working in the central supply unit, 80 baht an hour for other units, 450-600 baht a day for the patient complaint services, and the public relations, respectively. The results revealed the situation of employment of retired nurses, the characteristics and the patterns of employment. These results should be useful for policy development on human resource planning. Moreover, employment of retired nurses at different levels of health sectors should be further researched.


location: , 'Thailand year: 2007 source: HSRI

title: Health Status of Factory Workers in Chakkrarat District, Nakhon Ratchasima Province

abstract: This research was aimed at studying the health status and risk behavior of workers
in factories in Chakkarat district, Nakhon Ratchasima Province in the period March-May
2007. The methodology involved data a collection form; secondary data, questionnaire
and risk-screening data. The results showed that there were 8 factories with 2,274
workers; data were collected on 2,227 of them, or 97.9 percent of the total. These factories
produce clothing, underwear and shoes. Most of the workers were women (74 percent),
aged between 25 and 29 years; most were married and had a primary level education.
Seamstress accounted for 68.5 percent of the total. Those who sat working totaled 77.3
percent. The top-five out-patient cases were respiratory tract infection, dyspepsia, myalgia,
headache and oral disease, in that order. With regard to accidents in workplace, it
was found that the most were needle accidents. Annual health examination data found
that only two patients had lung problems; eyes problems accounted for 21.6 percent of
the total. The patients with presbyopia problems comprised 8.0 percent of the total, but
there were no hearing problems. The result of risk screening found that 20.8 percent of
the workers’ parents had diabetes and high blood pressure; 6.8 percent of their brothers
and sisters has these health conditions, while only 1.8 percent of the workers themselves
did so, and additional new cases accounted for 0.9 percent, a total of 2.7 percent. The
workers who had diabetes and hypertension were following doctors’ supervision. As for
the behavior of workers, 10.6 percent smoked, 21.8 percent drank alcohol; 12.4 percent of
the workers usually exercised. With regard to eating behavior, it was found that most of
the workers consumed sweet, more salty and fatty food. As for driving/riding behavior,
it was found that most workers wore helmets and safety belts (75.6%). Unsafe sexual
behavior was practiced by some workers. The shape of body (waist/hip) exceeded the
standard for 26.54 percent of the subjects. The body mass index (BMI) exceeded the standard
in 43.7 percent of the workers. Health care for all the workers should be the responsibility
of the related organization; health promotion activities including solving problems,
should be carried out by each factory with appropriate conditions.