location: , 'Thailand year: 2023 source: HSRI

title: The Development of Innovative Treatment Using Polymeric Targetable Drug Delivery System for Thai Medicinal Herb Ingredients to Stem Cells with the Pharmacokinetics and Pharmacodynamics Principle

abstract: The aim of this research was to characterize and evaluate the innovative effects of the Thai herbal extract, Andrographolide (AG), on the human suprapatellar fat pad (SPFP) in the osteoarthritis (OA) patients and also develop and optimize the formulation of AG using Poly Lactic-co-Glycolic Acid (PLGA) nanocarriers and gelatin-based hydrogel. Suprapatellar fat pad adipose-derived stem cells (SPFP-ASCs) were isolated by enzymatic digestion, cultured and analyzed by light microscopy to observe morphology and growtAh. The cells treated with AG or without AG were characterized in vitro by immunophenotype, gene expression, and ability to differentiate into multilineage potential to be further differentiated into the osteogenic, adipogenic and chondrogenic cells under the appropriate inductions. The medium SPFP-MSCs cells showed uniform morphology and good proliferation. They expressed CD29, CD73, and CD105 but were negative for CD34 and CD45. Multilineage potential became positive for Alizarin Red S, Oil Red O, Toluidine Blue, and Alcian Blue staining while the effect of AG revealed that AG had no cytotoxic effects when the concentration was less than 12.5 μg/mL. Interestingly, AG had significantly enhanced osteogenesis and chondrogenesis as evidenced by a the significantly intensified stain for Alizarin Red S, Toluidine Blue and Alcian Blue. Moreover, AG can upregulate the expression of genes related to osteogenic and chondrogenic differentiation, including Runt-related transcription factor 2 (Runx2), Osteopontin (OPN), SRYBox Transcription Factor 9 (Sox9), and Aggrecan. In contrast, AG suppressed adipogenic differentiation as evidenced by significantly diminished Oil Red O staining and the expression levels for adipogenic-specific genes for Peroxisome Proliferator-Activated Receptor gamma 2 (PPAR-γ2) and Lipoprotein lipase (LPL). For these therapeutic properties, AG was successfully prepared the nanoparticles by the single emulsion solvent evaporation method and incorporated with gelatin-based hydrogel. The results of in vitro release patterns showed that the AG significantly delayed the AG release more than 1 month when combined with gelatinbased hydrogel and successfully displayed a long term sustained release almost 2 months for implantation and over 2 months for injection providing a novel strategy for the local management of osteoarthritis disease. Therefore, AG has great potential as the therapeutic agent derived from natural sources for regenerative medicine. Furthermore, this research aims to develop a pharmacokinetic model of an intra-articular drug delivery system for predicting drug concentrations targeted to mesenchyme stem cells. Using ADMET PredictorTM program, the physical and chemical properties of AG were predicted from the chemical structure. Then we develop and test a model of the formulation when injected into the knee joint. By using GastroPlus® 9.8.2 program and using the formulation as 0.1, 1, 5, and 10 mg solution, the amount of AG was predicted at the synovial fluid, plasma, cartilage, intimal, subintimal and lymph node. The amount of AG in different layers is the dosage of the AG that can be completely dissolved since the drug is injected into the knee joint as a clear liquid formulation. And from the prediction, it was found that there was no precipitation. The elimination of AG in rats, normal humans, and humans with rheumatoid arthritis is a first-order reaction. The elimination of AG in rats is the slowest when comparing with that in normal humans and humans with rheumatoid arthritis. In normal humans, AG can be eliminated better than in humans with rheumatoid arthritis so elimination time of AG in normal humans is shorter than humans with rheumatoid arthritis. Moreover, it was predicted that approximate 30% of the AG in the synovial fluid is in free form and the AG was not able to enter the lymph node. Since this study has not yet developed a model of AG as a delivery system that may also be able to enter the lymph node. In addition, for delivery system, AG can be specifically targeted to the MSCs located at the knee joint. Unlike conventional AG small molecule drugs, the pharmacokinetics of AG delivery system can be simulated using the theory of Target-mediated drug disposition (TMDD) model. We have successfully developed this model using Berkeley Madonna program as well in this study.


location: , 'Thailand year: 1999 source: HSRI

title: Health policy evaluation for the elderly persons

abstract: Health Policy Evaluation for the Elderly persons	Problems of health policy for elderly population in Thailand were the uncertainty of how well the policy has met the elderly’s health needs and covered such a group. Additionally, life quality resulted from the policy implementation and supportive system to the policy were less evaluated than the quantity of policy coverage. The elderly policy evaluation in this study was to review formal document relevant to the policy, to interview and observe key stakeholders including a number of policy makers, health administrators at provincial and district level and key health officials at community level. These key informants were sampled by multi-stage sampling technique. 	The current policy for the elderly aims at encouraging 70% or more elderly to have proper self-care behaviors, having 50% or more aged people receive comprehensive care from public health facilities and expanding free health care for all elderly. The policy comprised health care plan, health promotion plan, health behavior development plan and health insurance plan. The study found problems of putting the policy into practice for example lack of actual supportive system e.g. budgeting system and health official incentive system, lack of proper information based planning system. The policy evaluation was more likely to evaluate in terms of coverage than quality of policy implementation. Health promotion was much emphasized at the operational level while health services needs were largely unmet.


location: , 'Thailand year: 2022 source: HSRI

title: Drug resistant tuberculosis rate in Thai children and Pharmacokinetic study and safety of levofloxacin in pediatric tuberculosis treatment

abstract: Three major institutes in Thailand, including King Chulalongkorn Memorial Hospital, Queen Sirikit National Institute of Child Health, and Faculty of Medicine, Chiang Mai University, worked in collaboration to establish the management plan for drug-resistant tuberculosis in children mainly consists of two paralleled projects, including the prevalence of drug-resistant tuberculosis in Thai children and the study of pharmacokinetics and safety of levofloxacin in pediatric tuberculosis treatment. The prevalence study of drug-resistant tuberculosis in Thai children had screened 186 children during 2019 and 2021, of which 104 children were diagnosed with tuberculosis, including 11 children with any forms of drug-resistant tuberculosis; 7 (7%) children were resistant to isoniazid, 2 (2%) were rifampicin, and 1 (1%) was multi-drug-resistant. In comparison with the medical records data from Siriraj hospital (the year 2009 to 2011) and Queen Sirikit National Institute of Child Health (the year 2001 to 2010), the prevalence tended to decrease over time. As a result, the prevalence of tuberculosis in children was similar to that in adults in 2017-2018. Thus, the characteristics of tuberculosis in children may represent those in adults. Moreover, the majority of drug resistant tuberculosis in children is isoniazid resistant tuberculosis which may reflect the similar prevalence of isoniazid-resistant tuberculosis in adults. The current World Health Organization’s recommendation and the Thai National tuberculosis management guidelines have implemented the treatment regimen of rifampicin, pyrazinamide, ethambutol, and levofloxacin for 6 months for isoniazid resistant tuberculosis has been shown to reduce the mortality and recurrent rates. However, the current application of molecular diagnosis as Xpert MTB/RIF could not detect isoniazid-resistant tuberculosis. Therefore, the culture for tuberculosis within two months after the treatment is still mandatory to consider the appropriate treatment regimen for the specific patient. However, the use of line probe assay 1st line drug or Xpert MTB/XDR is able to detect levofloxacin-resistant tuberculosis, thus helping establish the treatment regimen in the meantime. Additionally, for the pharmacokinetics and safety study of Levofloxacin in children with tuberculosis, a total of 10 children were equally divided into two groups which the first group received levofloxacin dosed 15-20 mg/kg/day which is a WHO recommendation dose in 2020 and 20-30 mg/kg/day in the second group. As a result, the serum levofloxacin level was lower than the therapeutic level in the first group and reached the therapeutic level in the second one, with no significant adverse event. Therefore, our study recommended increasing the levofloxacin dose to 20-30 mg/kg/day as the standard treatment of drug-resistant tuberculosis in children in order to enhance the therapeutic efficacy and minimize the risk of levofloxacin-resistant tuberculosis in the future.


location: , 'Thailand year: 2007 source: HSRI

title: Treatment of Type II- Diabetic Patients at Manorom District Health Centers in Fiscal Year 2007

abstract: This study was conducted in Chainat Province, comparing the results of treatment
of type II-diabetic patients treated at two health centers with those treated at a community
hospital. The study group of 39 patients voluntarily agreed to attend the District
Health Center for at least six months of treatment; they were cases receiving oral medications
and were not at risk of serious complications. Results of treatment were based upon
blood pressure, body mass index, waist circumference, and blood chemistry parameters,
i.e., fasting plasma glucose (FPG), HbA1c, total cholesterol, triglyceride, HDL and LDL.
Data were analyzed statistically using percentage, mean and standard deviation in order
to assess the value of the treatment. The non-parametric (chi-square) test was used for
showing the differences of treatment results between the hospital and health centers. Successful
of treatment was demonstrated by the following: FPG (46.3%), HbA1c (23.1%),
blood pressure (20.5%), total cholesterol (41.0%), triglyceride (43.6 %), HDL (53.8%), LDL
(17.9%), BMI (33.3%) and waist circumference (23.1%) for the patients treated at the two
health centers compared with those obtained at the community hospital. Only the results
of blood pressure testing were of statistically and significantly different.


location: , 'Thailand year: 2018 source: HSRI

title: Molecular Alteration Profile and Metabolomic Biomarker Discovery of Lung Cancer in Thai Population

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 which the investigators will co-operate with ECDD (Excellence Center of Drug Discovery). This center was established in July 2016 by the co-operation and commitment between Faculty of Science, Mahidol University and Faculty of Medicine Ramathibodi Hospital, Mahidol University. 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. We also initiate the discussion with ECDD to further investigate for the chemical that could inhibit these 2 genes for our populations. 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.
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 drug 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: 2007 source: HSRI

title: An Outbreak of Measles in Umphang District, Tak Province, 2004 – 2005

abstract: This report describes an investigation of a measles outbreak in Umphang District,
Tak Province, in the period 2004-2005 and emphasizes the importance of coverage of
measles immunization in children. Medical records of measles cases diagnosed between
January 2004 and April 2005 in the district were reviewed. Data on measles immunization
in children 9 months of age or older and measles-mumps-rubella immunization in
school children were retrieved from Umphang Community Hospital and 4 out of the 7
health centers to determine the coverage. Over the outbreak period, among the 187 measles
cases, about 85 percent were Thai and 15 percent were cases among citizens of Myanmar.
One case died from pneumonia, producing a fatality rate of 0.5 percent. Of the 187 cases,
89.8 percent were children 0 - 14 years old and 10.2 percent were 15 years of age or older.
Measles cases were reported from all subdistricts in Umphang District. Sporadic cases
were reported from January to April 2003 and the cases increased thereafter. Clinical manifestations
included fever (100%), rash (100%), cough (80.2%), and rhinorrhea (67.9%).
Measles complications in these cases were pneumonia (17.6%), diarrhea (10.7%), and otitis
(5.9%). About 61.6 percent of the Thai cases had not received measles immunization
and the remainder could not be determined. Of the 106 measles cases examined for
measles-specific IgM by ELISA, 80.2 percent were positive. The coverage of measles immunization
in both > 9-month and school children was low in some areas of the district.
The outbreak tapered off after providing preventive and control measures. The authors
suggest that full coverage of measles immunization among the target children is essential.
For remote areas in the district where people face difficulty in traveling and limited
outreach of health services, the provision of an immunization program in dry season may
be useful.


location: , 'Thailand year: 2023 source: HSRI

title: Office of Permanent Secretary for Public Health’s Structure in the New Context

abstract: From the Ministerial Regulations on Government Divisions in the Office of the Permanent Secretary Ministry of Public Health 2017 stipulates that the Office of the Permanent Secretary Has a mission regarding strategic development and transforming the Ministry's policies into government action plans, as well as allocating resources and administering the ministry's general affairs. In order to achieve the goals and achieve the missions of the Ministry which covers management transfer the policy drive to personnel both in the central and provincial areas. By the Office of the Permanent Secretary, there are driving agencies divided into 16 centrals administration agencies, 2 provincial administration agencies, and 17 internal agencies. However, from changes in the context of the economy, society, environment, and various policy issues affecting the structure of the Permanent Office at present. Some of which may be similar to the roles of existing divisions of government or there may be unclear while some parts have changed according to policy causing the work of some agencies to be established within some parts may be inconsistent with what is being done at present In this regard, the results of the analysis of the roles and structure of internal agencies under the Permanent Office led to the proposed structure, which was divided into 4 central administration agencies directly under the Ministry of Public Health, 15 central administration agencies, 1 central administration agencies located in the region, 2 provincial administration agencies, and 5 internal agencies. It is proposed to divide into 1 independent agency and dissolve 1 agency. In addition, it is proposed to analyze the context and roles of agencies under the structure of the Permanent Secretary on a regular basis, such as every 5 years in order to be consistent with changing contexts, including requiring that the establishment be assessed internally every year.


location: , 'Thailand year: 2016 source: HSRI

title: In vitro sensitivity and resistance mechanism of artemisinin derivatives  and their combined antimalarial drugs in Plasmodium falciparum

abstract: This study aimed to determine in vitro sensitivities of artemisinin derivatives and their partner drugs in artemisinin derivative based combination therapy (ACT) and genetic characterization of resistant genes in 95 Plasmodium falciparum isolates collected from Thai-Myanmar and Thai-Cambodia borders. Almost all isolates were sensitive to artesunate และ dihydroartemisinin. Approximately seventy seven percent of the samples had a mutation on an artemisinin-resistant gene, Kelch13 propeller which C580Y mutation was predominant. All parasites isolated from Thai-Cambodia border contained 184F allele with 1 copy number of pfmdr1 gene. In contrast, the parasites collected from Thai-Myanmar border had the pfmdr1 184F allele at 47.2% and contained a few copy number of the pfmdr1 gene with the average of 2.5 copies. Most isolates were resistant to mefloquine which might lead to treatment failure of artesunate-mefloquine in Thailand. Consequently, The Ministry of Public Health has changed the first-line treatment for falciparum malaria to dihyroartemisinin-piperaquine. The present study shows that the parasites containing the pfmdr1 86Y allele exhibited reduced piperaquine sensitivity. Prior to nationwide implication of dihydroartemisinin-piperaquine usage in Thailand, efficacy testing should be conducted. In addition, regular monitoring should be properly performed especially in Thai-Malaysia border where most parasites contained the pfmdr1 86Y allele. Artesunate-pyronaridine is a new effective ACT. The parasites’ pyronaridine IC50 in this study were 3-220 times lower than the IC50 of a recrudescent parasite previously reported in Thailand. In addition, there was no significant difference of pyronaridine IC50 among the parasites with different haplotypes. Thus, artesunate-pyronaridine may be a suitable ACT of choice in the area containing parasites with varied resistant haplotypes especially the pfmdr1 haplotypes. In vitro sensitivities and genotypic characterization of the resistant genes of P. falciparum should be continuously monitored in order to detect the emergence of antimalarial resistance. Rationale drug use can be guided using this information.


location: , 'Thailand year: 2005 source: HSRI

title: Expectation, Health Seeking Behavior, and Impacts of Universal Health Coverage : People's Views

abstract: Title	Expectation, health seeking behavior, and impacts of universal health coverage : people’s viewsAuthor	Onchana Na RanongFund source	Health Systems Research InstituteYear Print	2005	This paper examines the impact of the 30 Baht Health Care Scheme – a part of the Universal Health Coverage Program – on Thai people. The study is mainly qualitative, employing both focus group and in –depth interviews in order to obtain views from people in the ten provinces throughout all regions of Thailand (including the Bangkok Metropolitan Area). The study sites include both urban and rural communities. 	The study finds that health seeking behaviors are determined, often concurrently, by one or more of the following factors : income, health care coverage, transportation costs, health status/ sysmptoms, age group, and the information patients have. Although the 30 Baht Scheme reduces some people’s health care expenditure, other opt out of the service because of the lengthy queues and non-confidence in the quality of care, especially high or medium income families. Moreover, unequal treatment on patients with different schemes, especially moral hazards on the provider side, are also often mentioned in the focus groups.	While the highest priority of the poor is to acquire low-cost or free health care services, respondents from other income groups place more emphasis on the adequacy of hospitals and personnel-especially doctors, or good treatment from health care personnel. However, most subject would like to have the scheme in place in order to help the poor, and to guard against their own catastrophic illnesses. In general, the 30 Baht Scheme-like other preceding schemes in the past three decades, has enhanced health security for many Thai people. Respondents from various regions noticed improvement in the services, especially that of the front ends of the hospitals. However, the quality of health care still remains an issue that clouds the scheme.


location: , 'Thailand year: 2014 source: HSRI

title: Assessing Food Advertising on Children’s Television Program: Policy Recommendation for Regulation

abstract: We aim to examine the food advertising in children’s television programs based on Notification of
the Public Relations Department Announcement on “Criteria and duration of time for advertising on
radio and television that may have an impact on children”, dated 18 January 2008, and to propose policy recommendation in regulating food advertising in children’s television programs in Thailand. The study
on advertising during children’s programs in free TV on 18th September- 8th October 2010 was conducted
to identify the duration, frequency, technique and strategy used for advertising, and type of products
advertised based on the previously mentioned Notification.
25 (64%) of 39 of children’s programs advertised more than 10 minutes per hour. Of the 39 children’s
programs, 15 (38%) had half of their advertising time that could have an effect on children. Technique and
strategy used for advertising did not follow the criteria in the Notification. Eight products no warning to
consumers to children announced by the Food and Drug Administration regulation. 82 percent of children’s
television programs had indirect advertorial.
Advertising in children’s television still did not follow the Notification of the Public Relations
Department Announcement. The duration and frequency that were in violation of the Notification
decreased from the year before. The Office of the National Broadcasting and Telecommunications
Commission (NBCT) should establish new regulations to protect children and enforce compliance from
the media.


location: , 'Thailand year: 2004 source: HSRI

title: Mahidol historical almanac for democracy : Phase II

abstract: After the event in October 14, 1973, the students, co-operated with the administrators of Mahidol University, arranged the seminar on “the Mahidol University Development Project.” The ideal of “personnel production to serve the disadvantaged people in the society” was made for the members of the Mahidol University Students’ Club(MUSC). The Mahidol United Party could win the election and the first Chairman of MUSC was the Medicine Student Weng ToeJirakarn. The students’ The students’ activities, formerly emphasizing on technical affairs, sports, music and voluntary camps, had been given more importance to the social and political activities of which the centre was established in the recreation building. 	In the 1974 academic year, the MUSC arranged the “edcation and development camp” which emphasized on the learning of social problems and the training to live with the villagers. In this year, a group of the Mahidol University students joined two projects which ran by the Government: the democratic dissemination and the aids to farmers. They could learn the problems of the landlords-capitalists’ oppression and exploitation against the farmers. Additionally, they could see the authoritative persons’ distortion, incrimination and serious suppression against the people. These encouraged their political alertness and they could understand the suffering of the grass-root people, untill the actively created theconsciousness of serving the people.	The activites o fthe Mahidol University students which could enthusiastically support the struggle for equity of the people were those of the Nursing Unit for Mass (NUM), Which was developed from the small nursing unit in the 14 th October event, and those of the Labourers’ Band, the string-band for life. Both them were the most popular at that time. They played the important roles and always worked together on various stages. While the songs of the Labourers’ Band encouraged the fighters, the NUM also assisted in treatment for the persons who were threatened, hurt and injured.	As to the students continually joined their activities outside the university, they were blamed as those who misunderstood of themselves, overdid their duties and neglected their classrooms. This caused more conceptual conflict among the students and the instructors administrators, as well as among themselves. Misunderstandings in various matters became more serious conflicts that the Dentistry Faculty students claimed against four of the administrators and instructors to quit, because the administration and the instruction were unsatisfactory. Finally, the students’ protest and strike were called for months.	The “Rightists VS the Leftists” Movement had been brewing since the mid-year of 1974. Going out for activities in rural areas and the gatherings of the students were threatened. The labourers, the farmers and the student leaders were assassinated, including two student leaders- Mr. Preeda Chindanondh of the Labourers’ Band and Mr. Amares Chaisa-aad, Vice-Chaimam, the coordinator for outside activities of the Mahidol University Students’ Club (MUSC) and the Treasurer of the Students’ Centre of Thailand . During the years of 1975-1976, the situation was more serious. As the students with low experience made lower evaluation of the suppressive and authoritative persons in terms of the violence and the tactics, they also could not co-ordinate in the time of crisis. The suppressive blockade event in Thammasat University, in the early morning of October 6, 1976, consequently caused the great loss. The Nursing Unit for Mass, the Labourers’ Band and a part of the Mahidol University students as the safety guard unit held their responsibilities until the last second. In that event, five of them lost their livers.	After the 6th October sanguinary conflict, many students were arrested and put into prison. The Coup d’Etat with the absolute right-wing policy seized power and Mr. Thanin Kraivichien was appointed Prime Minister. The leftists were heavily suppressed. The unsafety condition covered both the society and the universities in general. At that time the students’ movement separated into two parts. One part escaped into forest and took weapons to join the Communist Party of Thailand. While another part was still in city.	Some hundred of the Mahidol University students scattered in the different sites in forest throughout the country. A majority of them acted as the forest military doctors who played the role in the medicine and public health development, in the forest-mountain areas. They produced alcohol, saline solution, anaestheitics, liniments and other medical products, by using the raw material in localities. They opened the medical training school for general doctors and doctor assistants. The medical school with special curriculum on surgery and general medical treatment was also established. The curriculum and the textbooks were written from what they learnt in the city. Those fellows as they called themselves “sa-hai” also learnt the acupuncture treatment from China and integrated such practice with the Thai traditional wisdom on herbs. Approximately in the year 1978, some of the Mahidol University students were sent for further education in medicine, pharmacology and veterinary in China.	In city, though all of the students’ activities were forbidden, the movement was secretly carried to support their “sa-hai” in forest. The reproduction of the answer sheets of the entrance exam questions was sold for funding. They visited their fellows who were arrested in prison without fear of the State’s power. This matter brought perssure force to bear on the Governmen, both from inside and outside the country. Finally, the Coup d’ Etat was made, with more relief policy, by Gen. Kriangsak Chamanan. The Mahidol University students’ activities were revitalized with the emphasis on professional movement. They arranged the Mahidol Celebration’78 and went out to assist the flood victims in the Northeastern area, with the co-operation of 12 institutions. Later on in 1979, they gathered and formed into the Students’ Club of 18 institutions.	Since 1978, the Government allowed for the set up of Students’ Club by the indirect election. The movement for the direct election of the Students’ Club, the appeal for the Students’ Council and that for the Students’ Party were made, and they could gain success in 1980. Afterwards, the Students’ Clubs of 181 institutions made more socio-political movements such as the protests on the anti-bus fee raise, on the anti-electric fee raise and on the Vietnam attacking Cambodia. At the same time, the movement of universal socialism was declined; with addition to the Government’s policy which allowed the students who escaped into forest to return to further their education. Many survivors of the Mahidol University students could consequently return to study once again.	The growth of capitalism technology sent much effect to the overall changes. It could be said that the crisis of faith in the socialism ideal was the main cause against the weakness of the students’ movement. In 1984, the first-year Mahidol University students of all faculties had to move to Salaya, and most of the experienced key persons finished their education. The socio-political students’ activities gradually came to and end. The “recreation building.” The fostering centre for the Mahidol University activists was over. 	It could be said that the struggle for democracy of the students in that period of time has made a greater contribution to Thai society. It could foster the qualified personnel whose creative roles and movements could make progress to the medicine and public health in rural areas throughout the country up to now.


location: , 'Thailand year: 2012 source: HSRI

title: Current concepts on medical error disclosure

abstract: Recently, rate of medical malpractice claim and file a law suit on the medical adverse events are
increasing. The primary etiology of claims and filing were adverse medical events which caused by either
preventable medical error or mishap. No one wants adverse event occurred. In the past ten years after the
Institute of Medicine (IOM) reported the facts of medical errors in “To Err Is Human: Building a Safer
Health System”, health care personals have been deeply concerned with and have tried to improve their
practice for patient safety worldwide. However, there are still many medical errors in recent years and
will inevitably occur in the future. So, health care providers should learn how to manage and disclose
when the medical errors occur. Several studies have proved that disclosure of medical error have taken
more benefits than risks. The main benefits are decreased in filing rate, decreased in payments for adverse
events, and maintenance of doctor and patient relationships with trust. Disclosure of medical error is the
process which closely related to the incident report system. The importance of full open disclosure to the
patient after medical error occurrence will significantly increase in the future for patient’s safety and
should be simultaneously integrated into the mediation system.


location: , 'Thailand year: 2022 source: HSRI

title: A study to develop quarantine recommendations for health care workers who have been exposed to COVID-19 patients

abstract: Background: The rapid increase in COVID-19 cases puts significant stress on the health system. Healthcare workers (HCWs) who are at the frontline responding to the crisis are particularly susceptible to this highly transmissible infection, given their long and close exposure to infected persons. Decision-makers are in need of the information to appropriately determine a quarantine guideline and policy for healthcare workers while maximizing the patient’s safety and ensuring the continuous provision of services to society. Objectives: The primary objective of this study is to develop recommendations for quarantining HCWs who have been exposed to COVID-19. The secondary objectives are 1. to estimate the proportion of HCWs with COVID-19 by nucleic-acid amplification test (NAAT) within the quarantine period and the difference in proportions of HCWs with COVID-19 by NAAT at day 5, 10 and 14 of the quarantine period; 2. to descriptively report the incubation period (from the date of exposure to COVID-19 source case to when the symptom first appear (symptomatic case) or to when the NAAT is positive (asymptomatic case); and 3. to estimate the proportion of asymptomatic COVID-19 among those HCWs with COVID-19. Methods: This is a prospective cohort study to identify the incidence of COVID-19 among health care workers who had been in contact with COVID-19 cases. The inclusion criteria were HCWs aged over 18 years old who have been identified as HCWs in which a patient with laboratory confirmed COVID-19 infection is receiving care or ‘HCWs contact’. Following the initial routine test (Nucleic acid amplification tests, RT-PCR), if the result is PCR negative ‘HCWs contact’ with or without any respiratory symptoms and works in a health care facility were included for this study. The sample size calculation was 375 participants. Data collection included 1) daily self-monitoring symptoms and temperature for 14 days, 2) Nasopharyngeal & oropharyngeal swabs and saliva at day 5, 10 and 14 of the quarantine period and 3) serum at day 0 and 14 of the quarantine period. For confirmation of COVID-19 cases, it was based on detection of unique sequences of virus RNA by Nucleic acid amplification tests such as real-time reverse-transcription polymerase chain reaction (rRT-PCR) from nasopharyngeal & oropharyngeal swab and saliva samples at day 5, 10 and 14. For monitoring purposes, serum immunoglobulin G (IgG) were analyzed by ELISA for antibody against SAR-CoV-2 virus at day 0 and 14 of the quarantine period. Results: From January to July 2021, 153 eligible health care workers met the inclusion criteria and provided consent. Most participants were women (84%), age range between 22 and 63 (mean age, 34 years old) and worked as nurses (52%), assistant nurses (14%), doctor/dentist/pharmacist/laboratory staff (20%) or other supporting HCWs (15%). Most of the participants worked at an emergency room (ER) or intensive care unit (ICU) (41%). Most of the participants reported to have been vaccinated (78%) and only 5% of the HCWs reported to have full PPE when exposed to COVID-19 patients. Three HCWs were tested positive for SARS-CoV-2, giving the positivity rate of 2.08% (95%CI: -0.28% to 4.44%) of the HCW contact which was detected at day 5 for 2 HCWs and at day 10 for 1 HCW. All three HCWs received 2-dose COVID-19 vaccination (Sinovac) at an average of 40 days before the contact. They did not use the complete set of PPE and were only put surgical masks and gloves on while in contact with COVID-19 patients. This study reported the incubation period from the date of exposure to known COVID-19 source to when the PCR positive is positive of 6.33 days. Two out of three (66%) COVID-19 positive cases are symptomatic. The overall positivity rate for SARS-CoV-2 serostatus from the blood sample was 84.15% (95%CI: 76.07% to 92.22%) at day 0-5 and 79.07% (95%CI: 71.96% to 86.18%) at day 14. Most of the positivity rates for SARS-CoV-2 serostatus were correlated with vaccination status. The level of anti-SARS-CoV-2 IgG antibody titer from COVID-19 positive HCWs at day 14 ranged between 20,665 to 40,000 AU/mL. During the 14-day monitoring period, health-related quality of life (measured using the EQ-5D-5L) of HCWs decreased due to depression and anxiety domain. On average, the quality of life of HCWs decreased from the baseline up until day 5 of monitoring and increased as the PCR results became available. The decreased quality of life was significantly associated with increasing age and showing signs of respiratory disease. The increased quality of life was significantly associated with those who used the full set of PPE. Discussion: The study can only be carried out after the reopening policy in Thailand was implemented. From January to July 2021, there was a national campaign to encourage healthcare workers to receive COVID-19 vaccination. Around 78% of the healthcare workers were vaccinated against the COVID-19, and 82.8% of these groups received two doses as scheduled. This study did not recruit enough sample sizes, and only 2% of the HCWs were positive for COVID-19.Therefore, it is unclear whether to reduce the number of days of quarantine or be certain about the factors associated with infection. However, this research highlighted that HCWs in all departments are at risk of being exposed to COVID-19 patients. Closely monitoring high-risk COVID-19 contact cases during the first 5 to 10 days after exposure and periodic testing for infection remains essential for controlling the spread of the disease in healthcare facilities. Nurses and axillary nurses who work in emergency departments and intensive care units are at high risk of COVID-19 exposure. HCWs who work directly with known COVID-19 patients may take full precaution and be equipped with a full set of PPE while those working in other departments may have less awareness or lack of adequate protective equipment. The government should therefore focus on supporting PPE for all HCWs and should develop a working system to minimise the risks of being exposed among coworkers such as shift arrangement. Additional supports for HCWs to tackle mental health issues and compensation in various forms should also be considered. Recommendations: 1. Closely monitoring of healthcare workers who had been in high-risk contact with COVID-19 patients for 5 to 10 days remains necessary even if personnel have been vaccinated. 2. A booster dose of COVID-19 vaccination for healthcare workers is still necessary to control the epidemic. 3. The government should procure and distribute sufficient Personal Protective Equipment (PPE) for all healthcare workers who were on duty whether working directly with COVID-19 patients or not. This is because all personnel are at risk of coming into contact with COVID-19 patients who have no symptoms. 4. The government should have measures to support healthcare workers who perform their duties to ease mental health problems.


location: , 'Thailand year: 2019 source: HSRI

title: Frequency and Associated Factors of Hypoglycemic Symptoms and Fear of Hypoglycemia in Elderly Patient with Type 2 Diabetes at Primary Care Unit of Songklanagarind Hospital

abstract: Objective: To determine the frequency of symptomatic hypoglycemia and its associated factors and fear of hypoglycemia in a population of elderly patient with type 2 diabetes at primary care unit of Songklanagarind Hospital. Methodology: This cross-sectional study was conducted from July to October 2018 at primary care unit of Songklanagarind Hospital. The participants aged 60 and older with type 2 diabetes were included. The socio-demographic characteristic questionnaire was interviewed by a researcher or research assistants. Baseline clinical data, included body weight, height, underlying disease, duration of diabetes, complications of diabetes (diabetic retinopathy, diabetic nephropathy, cerebrovascular, peripheral vascular, neurovascular and diabetic foot complication), HbA1c, fasting plasma glucose, type and dose of glucose lowering drugs, were reviewed from the hospital information system (HIS). The participants were asked on their experiences of hypoglycemic symptoms in the previous month. Fear of hypoglycemia was measured by the Thai version of Hypoglycemia Fear Survey (HFS) covering behavior subscale (HFS-B) and worry subscale (HFS-W). The higher scores indicate higher fear of hypoglycemia. Chi-square, Wilcoxon, and Fisher tests were applied to study significant variables. Logistic regression analyses were performed to evaluate the associations between associated factors and hypoglycemic symptoms. Results: Overall, 160 participants were involved (mean age 68.6 ± 6.1 years, 53.8% females, diabetes duration of 10.5 ± 6.4 years, 57.5% diabetic complications, 7.5 ± 1.8% HbA1c), of whom 30% reported hypoglycemic symptoms. The associated factors of hypoglycemic symptoms were diabetic
complications (aOR = 2.75; 95% CI 1.23 - 6.14; p = 0.012), glipizide use (aOR = 5.03; 95% CI 1.99 - 12.71; p < 0.001) and fasting plasma glucose (aOR = 0.97; 95% CI 0.96 - 0.99; p < 0.001). The mean of hypoglycemia fear survey score was 16.9 ± 16. The score on the fear of hypoglycemia (HFS) and
worry subscale (HFS-W) for the patients with more frequent hypoglycemia episodes in the previous month (>2 episodes) was significantly greater than another group (1-2 episodes) (p = 0.006 and 0.002), indicating a greater degree of fear of hypoglycemia in the first group. Conclusion: The occurrence of symptoms of hypoglycemia is one of complications in the elderly with type 2 diabetes and their presence is associated
with complications of diabetes and glipizide use. Frequent symptoms can have a negative impact
on fear of hypoglycemia. Minimizing the risk of hypoglycemia represents a high priority in the diabetes
treatment of the elderly people.


location: , 'Thailand year: 2015 source: HSRI

title: Situation analysis and study on the factors affecting the achievement of problem solving of maternal health care in the 3 southernmost provinces of Thailand

abstract: Maternal and child health (MCH) situation in three southernmost provinces has been in a critical stage. MMR was about three times higher than country’s targets and almost two times in MDGs Plus target, lower than the performance in almost all indicators. Most deaths due to causes that can be prevented in the context of modern obstetrics. There is only a small detail that seems to be absent. Prenatal care to pregnant women with traditional midwives. The way of life, religion and cultural norms determine the practice of pregnant women. But it is not seen as important as surveillance and health complications.   Key factors which affect the success of maternal and child in three southernmost provinces are
1. Manpower  : Turnover rates are frequent, because it is a difficult task, required high skills and experience. More tools and indicators and some indicators are not consistent with the context in three southernmost provinces.
2. Belief : Two believes persists that determines the norms and practices of pregnant women are 1) do not eat more and do not take the medicine  2) seek female personnel’s service for delivery. Including lifestyle, religious values are very high in regard to procreation, and that the death is natural. The attitude that contraception is wrong, against the principles of Islam.
3. Traditional Birth Attendants (TBA) : TBA is the strength of maternal and child health in the southernmost provinces. Pregnant women are faithful and believe in TBA. While Islam still had limited access to medical services.
Suggestion and Policy Brief
1.	Urgent measures : Cooperation with TBA to reduce MMR (Maternal Mortality Rate) in three southernmost provinces. Development competency TBA to learn assessment of high risk pregnancy, refer and delivery of emergency cases safely. Appropriate Incentive measures are important. We should also encourage Muslim husbands to have proper attitude and to help woman during pregnancy and childbirth.
2.	Medium and long term measures : Department of Health and related agencies  should review policy,  strategy and tools that is flexible, affordable and possible. Provides analysis and support capacity in maternal and child health. We should put more obstetricians in the three southernmost t provinces and enhance them and their MCH team to understand the way of truly Muslim.


location: , 'Thailand year: 2022 source: HSRI

title: To Investigate the Genetic Variants Responsible for Cannabis Dependence in Thai Population

abstract: Objective: The objective of this study was to identify gene or genetic variants that would be responsible cannabis dependence in Thai people. Methods: We studied 144 cannabis dependent Thai people and 20 cannabis non-dependent people using whole exome sequencing and bioinformatic analysis. We used an integrated bioinformatic pipeline that combines two techniques: gene collapsing and disease module detection to identify potential genes involved in cannabis dependence. Results: Disease module detection analysis identified a single module of 53 genes with significantly higher rate of potentially damaging variant careers in cannabis dependent group compared to non-dependent group (Percentile Bootstrap’s p-value = 0.0000337, FDR=0.024). Of this module, we found that MYEF2 (Myelin Expression Factor 2; MIM 619395) was associated with cannabis dependence in our Thai cohort (Fisher’s Exact p-value = 0.0013, Odds ratio = 2.43(1.38-4.23), FDR = 0.04). MYEF2 is a single-stranded DNA-binding protein. Its role is to inhibit transcription of MBP (Myelin Basic Protein; MIM 15940) gene. MBP regulates maintenance of myeline structure. Conclusion: We propose for the first time based on our bioinformatic analyses that MYEF2 was associated with cannabis dependence.


location: , 'Thailand year: 2022 source: HSRI

title: The Proposed Policy to Human Resource for Health Management During the Transitional Period of Transfer Health Promotion Hospital to Provincial Administrative Organization

abstract: The purpose of this mixed methods research was to 1) study human resources management/ problem and obstacle in human resources management during the transitional period of transferal health promotion hospital to the provincial administrative organization 2) explore the competency of health personnel who transfer to the provincial administrative organization and 3) develop policy proposal for human resources management during the transitional period of transferal health promotion hospital to the provincial administrative organization. This research was conducted between May 2 to November 1, 2022. The data were collected from the stakeholder including the policy administrator, the person who was involved in the transfer of missions, the practitioner from the primary care center, the representative from the provincial administrative organization, and the representative from the public sector. The results were as follows: 1. The human resources management during the transitional period of the transfer health promotion hospital to the provincial administrative organization showed that healthcare personnel are willing to practice according to their responsibility and follow the manual guideline for transferring. Healthcare personnel could provide full services. There are enough human resources according to the structure stated in the manual. Healthcare personnel found their career advancement. Most of the healthcare personnel were ready to transfer to the provincial administrative organization including administration, academic and family medicine services as well as perform the services according to their professional position. However, there were some limitations such as coordination, the local health committee not functioning properly, the differences in the payroll, wages, and compensation, lack of confidence in the system of the local sector, and the allocated budget does not meet the agreement 2. The competencies of healthcare personnel in health promotion hospital were at a high level except for medical rehabilitation, management and development of emergency medicine and referral systems, motivational communication, creativity, and quality improvement. 3. Policy proposal for human resources management during the transitional period of transferal health promotion hospital to the provincial administrative organization were as follows: 3.1 Policy proposal on workload 3.1.1 Provincial administrative organization in each province should communicate a better understanding of the transfer of manpower, manpower rate, compensation, and career advancement. 3.1.2 Provincial administrative organization set the job description and job specification then transfer to personnel in all levels of the provincial administrative organization. 3.1.3 Provincial administrative organization and provincial health office must urgently work together to make a memorandum of cooperation for the development of the provincial administrative organization in primary health care services. 3.1.4 During the transitional period provincial health office should control the medical practice of personnel in health promotion hospital under the provincial administrative organization. 3.1.5 Ministry of public health should provide the option for those who do not wish to transfer by positioning, workplace, and job in the same area. 3.1.6 The local health committee should carry out the roles and duties as stated in the manual guideline for transferring in order to benefit the people in the area. 3.2 Policy proposal on manpower rate In long term, the provincial administrative organization should establish a manpower framework and allocate health personnel in all fields following the Primary Health System Act B.E.2562. Develop the personnel database to engage in executive decision-making and practitioner in planning for individual progress development following the manual guideline for transferring. 3.3 Policy proposal on career path progression Provincial administrative organization create guidelines for escalation, career path progression, and establish an understanding with personnel as well as push for promotion according to the established guidelines. 3.4 Policy proposal on competency development 3.4.1 Provincial administrative organization creates a better understanding of the working system of provincial administrative organization and gives the opportunity to personnel involved with the development of the public health system. 3.4.2 Provincial administrative organization should develop management readiness, financial and accounting, internal audit and control related to the regulations with the transfer personnel. 3.4.3 Department of local administration together with Praboromarajchanok Institute and other health education institutes should help to develop healthcare personnel competency including research and services according to primary healthcare services. 3.5 Another policy proposal 3.5.1 Provincial administrative organization establishes the guideline for wage disbursement, compensation and other follow the benefit of transfer personnel which is not lower than the previous amount and consistent with the decentralization of power to local government organizations in B.E. 2542 and the regulations of the Ministry of Interior on the compensation for staff who working in healthcare in health center under provincial administrative organization in B.E.2562. 3.5.2 Publicize to the public related management and services of health promotion hospital under provincial administrative organization. 3.5.3 Provincial administrative organization should develop the health promotion hospital according to its size (small, medium, and large) to be the master of primary healthcare unit in management and providing full services in primary healthcare.


location: , 'Thailand year: 2018 source: HSRI

title: Identifying Important Factors Impacting the Adoption of New Vaccines in Thailand by Using a Best-Worst Scaling

abstract: The introduction of new vaccines depends on various criteria, including policies, clinical guidelines and economic considerations. Various stakeholders have differing criteria they view as important in selecting vaccines into a national immunization program. The present study aimed to identify factors impacting the adoption of new vaccines from the perspective of policy makers, healthcare professionals and healthcare administrators. The vaccine attributes identified from a literature review and semi-struc¬tured interviews were categorized into burden of disease, age group, budget impact, fever from vaccine, severity of disease, vaccine effectiveness and cost of vaccine. Main-effects orthogonal design was used to identify 18 profiles. Then a postal survey was conducted among policy makers, healthcare profes-sionals and healthcare administrators. Respondents were asked to choose the most important and the least important choices in each profile. Conditional logistic regression was used to estimate importance weights of attribute levels, and then relative attribute importance was calculated. A total of seventy respondents completed the questionnaires (a 55% response rate), including 11 policy makers, 26 health¬care professionals, and 33 healthcare administrators. The attributes listed by all groups as being the most important for new vaccine adoption were severity of disease (35.9%), fever from vaccine (16.7%) and burden of disease (13.5%), respectively. Policy makers and healthcare professionals listed severity of disease (35.0% and 35.9%), fever from vaccine (22.9% and 17.0%) and burden of disease (14.8% and 15.3%) as the most important, respectively; whereas healthcare administrators listed severity of disease (32.5%), budget impact (15.1%) and fever from vaccine (15.0%) as the most important, respectively. New vaccines with high protection targeting severe disease in young children have a greater chance of being selected by respondents in the present study. The findings reveal the importance of attributes from public healthcare workers and will be useful for policy development of new vaccine adoption.


location: , 'Thailand year: 2011 source: HSRI

title: Effectiveness of Intensive Behavioral Modification Program for Individual at Risk of Type 2 Diabetes

abstract: In the past decade, Diabetes Mellitus tends to become more and more important problem in Thailand.
Nowadays, research results clearly indicate that behavioral change strategies can decrease complications
and death among Diabetes patients. Several studies in China, Finland and USA have reported that intensive behavioral modification program focusing on exercise and weight loss certainly decreases the
risk of Diabetes in high risk group by 31-58 percent. Previous related researches in Thailand have found
that giving knowledge alone have led to negative outcome of Diabetes patient care. This research aimed to
test the effectiveness of intensive behavioral modification program for individual at risk of type 2 diabetes.
This Quasi-experimental research is to study effectiveness of intensive behavioral modification model
which focuses on diet and exercise for 24 weeks. Participants who are overweighed person (BMI > 25 kg/
m2) were divided into two groups. Forty-one participants attended the intensive model while 61 participants
received standard care. Effectiveness of the groups was compared at the end of the study. From data
analysis made through changes of both physical and biochemical indicators, there was no significant
difference found between two groups but subgroup analysis in overweight group (BMI > 30 kg/m2)
indicate that the experimental group significantly lost more weight than control group (95%CI= -1.976 - -
0.019, p-value = 0.046). This finding shows that the program is more suitable for overweight person. However,
long term study is still needed.


location: , 'Thailand year: 2008 source: HSRI

title: Accuracy of the Test Result from the Blood Glucose Meter at Maesai Hospital, Chiang Rai Province

abstract: This study was aimed at assessing the accuracy of the blood glucose meter currently
in use in comparison with the reference test. A cross-sectional analytical study design
was used. The sample population comprised diabetic patients from the diabetic clinic at
Maesai Hospital, Chiang Rai Province during the month of September 2007. Blood glucose
levels, sex, and age of the samples were collected. The statistical methods used were
descriptive, Pearson’s correlation, Spearman’s rho correlation, Wilcoxon’s signed rank test, paired t-test, and univariate linear regression. The results of the study showed that,
out of 139 patients, 69.6 percent were female, with the average age being 54.3 ± 12.5 years.
It was found that the average blood glucose levels were not statistically significant.
Spearman’s rho coefficient was 0.96 (p<0.001). Since the difference in the results from
both tests was higher when the blood glucose level was higher, subgroup analysis was
conducted by separating the blood glucose level into two groups: less than 300 mg/dL
and 300 mg/dL or over. The results revealed that in the former group, the total number of
samples was 130. The average of the blood glucose levels was not statistically significant.
Spearman’s rho coefficient was 0.95 (p<0.001). The results of the analysis of the latter
group showed that there were 8 patients whose average blood glucose levels were not
statistically significant. Pearson’s correlation coefficient was 0.76 (p=0.03). The univariate
linear regression model in this part was the blood glucose level from the reference test =
15.9+blood glucose level from the blood glucose meter. Moreover, the clinical differences
(±20%) from both subgroups were less than 5 percent.


location: , 'Thailand year: 2007 source: HSRI

title: Development of Contracting Primary Care Unit for Baan Hong District, Lamphun Province

abstract: The aim of this development research study was to develop the patterns of the primary
care service in Sritia and Laoyaw tambons of Baan Hong District in Lamphun Province,
where they conjoin with Chiang Mai Province. The study was undertaken in the
period 2003 - 2006. The study was conducted in a number of phases: first, correcting the data, then planning, followed by processing, and finally evaluating the outcome. In the
first period of this study, the population of the Sunpulauy Primary Care Unit (PCU) required
extraordinary health-care service out that posed a budgetary problem under the
Universal Coverage system in the Banhong PCU. Subsequently a meeting was held to
study and correct the statistical data, the health-care services received, the number of
patients with chronic illness, the ways to establish health-care services, the ability to recruit
new patients, evaluate the competency of the health-care team, and prepare to develop
the pattern of health-care services. In second phase, arrangements were made for
family nurses to work in the PCU full time and be associated with the community based
health-care services. In the third phase the Laoyaw PCU was developed to become the
center for community medical-care services with the provision of a doctor for providing
medical care and evaluating the outcome of processing.
In the fourth phase, the people in Sritia and Laoyaw tambons enjoyed a greater
range of health-care services. Patients in the Laoyaw PCU increased from 11.94 percent
of the population in 2004 to 24.60 percent in 2006, because family nurses were working in
this PCU and developed it into a community medical-care center. The Laoyaw PCU decreased
the UC budget following the DRGs of the Sunpulauy PCU. The population receiving
health-care services increased from 20.69 percent in 2004 to 36.13 percent in 2006.
The screening of patients with hypertension increased 3.32 more than three fold, and that
of patients with diabetes mellitus increased more than 5.6 times from 2003. The number
of patients with respiratory diseases decreased; increased screening was carried out for
diseases associated with community problems, that is, myalgia of the muscle and skeleton
systems. The community medical hub was connected to the primary health-care
service system in this area. The study found that it is possible to develop persons in the
community and public health volunteers following the system policy that stresses improving
health using the Banhong UC budget.


location: , 'Thailand year: 2004 source: HSRI

title: The study of civil society and its impact : Banphaew district, Samutsakorn province

abstract: This research examines the idea of civil society in Thai community. The important themes are running through the rise and the existing of social groups as the institutionalization of the concept of civil society. This study aims to display the communicative actions of Thai village’s civil society, how this approach becomes institutional organizations, and also, how this approach has any impact in our community. The community groups in this study have emerged at the beginning of community. They are differently occurred and taken to various forms; depend on the environmental conditions, social contexts and life world in their localities. The social actions of civil society might be different, for example in the form of various communicative actions; the place for addressing problematic situations in community; the social institutions or organizations that share taking action and responsibility in public activities with the state sector.	There are three actors of civil society in public sphere of Banphaew District. Firstly, the civil society in the sphere of state-market sector, these fundamental groups are found mostly in all villages of Thailand. They are formed by the state policy to enlarge the growth of market sector, and they are subordinated the budget and the means of production by the state sector. The social relationship in these groups is formally organized, such as the village fund, the cooperatives, and the women groups. The leader members mostly have closely relationship with the officials and also have former social capital to influence collective actions legitimately. The social relations in this group based upon kinship networks, neighborhood relation and reciprocity in patron and client relationship. This group is a kind of the state sector in sharing of public sphere in the name of civil society, influence more opportunity in state-resources distribution.Secondly, the civil society in the sphere of social sector that refers to meditating sphere between the state (as the range of activities organized and legitimated by formalized coercive powers); and the market (as the range of profit-oriented activities). Its important role is basically the free place for exchange and discussion about cultural interests and social health. This kind of civil society is different and has variations in each locality. For example, it is the public place of community groups as known as “Sapa Cafe”. Sometimes these communications are institutionalized and organized in the form of voluntary organizations that work for the better public life, such as education, the quality of public life, public health etc.The community groups or “Sapa-Cafe” mostly occur in the form of small shops in the village. The important social role of these shops is the flow of various informations, such as the product prices, their agriculture knowledge, the movement update of the village fund or the community cooperatives, and also activities in everyday life. These communicative actions sometimes lead to the social movements of community or the decision making of social policy, rely on their problematic social situations. Another kind of the social sector is in the form of the formal structured institutions, social organizations, social clubs, foundations etc. Their members need to take action in voluntary activities, being free of formal coercion and the distribution of profits. Their activities in civic engagement are the participation in decision making and sharing responsibility with the state sector; addressing the problems and needs of community; and the negotiation with the state.	Thirdly, the civil society in the sphere of private sector is the group of people that have the same interests. It functions individual utility more than collective utility. Sometimes these groups are in the organized groups to take more opportunity in the redistribution of resources, especially the supporting budget from the state sector. 	The concept of civil society approaches into the village community. It brings changes in many aspects, especially the adjustment of all sectors in public sphere. The state sector is required to reduce its size and de-centralized its authority to the social sector. But it becomes a part of civil society by create and support the budget for organizations in the village. In the meanwhile, even if the social sector is more significant, it’s dispersedly in the various forms. The new social meanings of civil society or gathering into group are new opportunity in the redistribution of public resources, and also the new performing in negotiation with the state. These conduct to the change of public or civic consciousness, more or less.


location: , 'Thailand year: 2020 source: HSRI

title: Accuracy of Dispatcher in Out-of-Hospital Cardiac Arrest Diagnosis

abstract: Background and Rationale: Previous studies showed that emergency medical dispatcher (EMD)
infrequently made a correct diagnosis. We found no similar study in Thailand. This study aimed to evaluate
the accuracy of out-of-hospital cardiac arrest (OHCA) diagnosis made by EMD. Methodology: This
was a retrospective study. We reviewed emergency response record from Maharaj Nakorn Chiang Mai
Hospital EMS unit and all records with the diagnosis of OHCA made by EMD at Chiang Mai Province EMS
center from 2011 through 2018. Results: In total, 276 medical records were reviewed. The mean age was
55.3+20.5 years, 72.1% were male, 272 patients had cardiac arrest upon arrival of the EMS team, whereas
4 patients had other conditions. Among these 272 patients, 116 patients (42.6%) were diagnosed with
OHCA by EMD; whereas 86 patients (31.6%) were diagnosed with unconsciousness, 22 (8.1%) with traffic
accident, and 48 (17.6%) with other conditions. The EMD made a diagnosis of OHCA in 120 out of 272
patients, with the sensitivity of 42.6%, and positive predictive value 96.7%. Conclusion: EMD’s diagnosis
of OHCA was inaccurate. However, the diagnosis of OHCA made by EMD had high probability.


location: , 'Thailand year: 2002 source: HSRI

title: Review and analyze the standard setting processes both in Thailand and overseaes

abstract: The objectives of this study are to review and analyze the standard setting processes both in Thailand and overseas, in order to propose recommendations regarding the appropriate and practical process for Thailand. The methodology included literature reviews both in relevant documents and Internet searching, in-depth interviews with the concerned officials responsible for standard setting in various organizations, and a workshop to brainstorm the involved experts. The results showed that many countries and organizations have the similar process, i.e., they use health risk assessment as a pivotal tool including scientific evidences to set the standards. Most of the standards are intended to be the guidelines for local authorities to modify in order to fit the public’s needs and to be enforceable. In Thailand, it was found that there are a variety of standard-setting agencies authorized under the different acts resulting in an inharmony of standard setting process, amendments, and monitoring. It is suggested that a national independent organization be set up to lay criteria and guidelines of standard setting, standard review and amendment, and people participation process and to select the standards that should be necessarily set in the Thai context in terms of studies in order to obtain an appropriate standard of Thailand. In addition, the decentralization of decision-making process of standard setting to the local areas should be considered in the future, including that the people participation in standard setting process should be imposed in the National Health Act.


location: , 'Thailand year: 2011 source: HSRI

title: Expanding Health Care Coverage for People with Citizenship Problems (Stateless Minority): A Step Forward for Health Insurance in Thailand

abstract: Thailand achieved universal health insurance coverage for the entire Thai population in 2002. However,
the health insurance system does not cover all people who live in the country because the National
Health Security Act 2002 indicates only “Thai citizenship” for eligibility under the scheme. This has made
it impossible for people with citizenship problems to get basic health care. It also caused financial problems
for health care providers that have to provide essential care for the people and disease control in
many areas.
For five years (four health ministers), there were many attempts to push forward the provision of
basic health care for people with citizenship problems. This policy was complicated, and concerned with national security. The lack of understanding of the institution concerned and the society at large are the
main obstructions. In 2010, the National Health Security Office (NHSO) employed the Moving Mountains
Triangle Theory which comprises three strategies: (1) knowledge generation; (2) social movement;
and (3) political engagement to push forward the policy. On March 23, 2010, the Cabinet approved this
policy and assigned the Ministry of Public Health (MoPH) to operate the scheme instead of NHSO.
Although the policy has been approved, some important issues need to be considered. For instance,
how well can MoPH manage when supporting systems are lacking? The budgets may not be enough
because the capitation budget was calculated by sharing risks with a population of 47 million under the
universal coverage (UC) scheme. The benefit packages also may not equal those under the UC scheme.
Thus, these aspects are challenging issues for everyone who works on this project.


location: , 'Thailand year: 2009 source: HSRI

title: Analyzing and Forecasting Drug Expenditure for Outpatients in Provincial Hospitals under Civil Servant Medical Benefit Scheme and Universal Health Coverage Scheme

abstract: Drug expenditure is a lion share of health expenditure and grows rapidly in the Civil Servant
Medical Benefit Scheme (CS). This research analyzed electronic databases of drugs in 5 selected
therapeutic classes, including (1) antihypertensive drugs (angiotensin-converting enzyme inhibitors –
ACEIs and angiotensin-2 receptor blockers -ARBs); (2) antilipidemics (statins and other new
products); (3) antiplatelets; (4) antiulcerants (proton pump inhibitors –PPIs and histamine-2 receptor
antagonists -H2As); and (5) non-steroidal anti-inflammatory drugs (NSAIDs, both conventional and
coxibs) that were prescribed during 2003 – 2007 from 6 provincial hospitals. The analysis focused on
a 60-month, interrupted time-series of 2 expenditure components, including propensity of use and
intensity of use, before and after the direct disbursement policy of the CS and the 30-Baht
abolishment in the Universal Healthcare Coverage Scheme (UC). The drug expenditure of each
therapeutic class was forecasted for the years 2008 and 2009 and potential cost-saving for the CS as a
result of 3 cost-containment strategies, including (1) substitution policy; (2) reference pricing; and (3)
UC-like prospective payment system (PPS) was estimated.
The study found that the drugs deemed as the cost-containment target, including ARBs,
single-source statins, clopidogrel, single-source PPIs, and coxibs had a major impact on the drug
expenditure of CS and its growth. The PPS could reduce the CS drug expenditure by approximately
40% (for PPIs-H2As and coxibs-NSAIDs) and 100% (for antilipidemics), which was comparable to
the reference pricing strategy. Potential cost-saving from the substitution policy depended on
substitutability in the real world setting, for example, the 20% substitutability would reduce the CS
expenditure by 8% (for PPIs-H2As and coxibs-NSAIDs) and 20% (for antilipidemics); whereas the
saving of 30-80% was expected, given substitutability of 80%.


location: , 'Thailand year: 2008 source: HSRI

title: Study of General Data on Tuberculosis Cases and Management Trends in a TB Clinic in Rasisalai District, Srisaket Province

abstract: This report is aimed at studying the management trend of Rasisalai Clinic and the
general data on the occurrence of new tuberculosis cases in Rasisalai district, Srisaket
Province, for creating a proper TB control planning program. An interview survey was
conducted at the TB clinic; all 134 TB cases had been registered between October 1, 2005 and September 30, 2006. The majority were males (64.2%), had a primary school level of
education (88.1% ), were farmers (71.9%) and were more than 60 years old (40.3%).
These patients were more likely to have been vaccinated with BCG (70.1%) than not
vaccinated (29.9%). The study population also had other health indications as follows:
DM 11.2 percent and HIV infection 1.5 percent. The most important factor was contact
with TB cases in their households (70.1%). Improper protection measures between TB
patients and their relatives could account for the occurrence of new TB cases: no mask
(53.2%), improper sputum collection (36.7%), no isolated bedroom (33.6%) and no isolated
eating area (35.8%). These behaviors were relevant to poor management of the
Rasisalai TB Clinic in terms of screening TB contacts in the households and in terms of
protective education.
We concluded that the effective TB treatment regimen offerred by DOTS to control
TB prevalence was not enough; the incidence of TB cases is still rising. We purpose speeding
up the screening of new cases in different high-risk groups, especially for persons
contacting tuberculosis cases in the same household. Proper protective behavior between
the TB patients and their relatives staying with them is imperative. A good clean environment
is another issue that should be the responsibility of the community at every level.


location: , 'Thailand year: 2019 source: HSRI

title: Lessons Learnt from Developing the 2018 - 2030 National Physical Activity Plan in Thailand

abstract: Thailand National Physical Activity Plan 2018 - 2030, the first national strategy addressing insufficient
physical activity of Thai people, was developed through a cross-sectoral cooperation processes in 2015,
led by the Department of Health, Ministry of Public Health. The development process took three years
before being approved by the Cabinet in August 2018. This article reviewed policy process since agenda
setting and policy formulation to policy adoption as well as policy content and context.
Key policy lessons were drawn from the development of the national plan. First was the identification
of principles, strategic objectives and implementing mechanisms of existing international policies
ensuring a comprehensive and effective national policy framework. Secondly, the engagement of all
relevant stakeholders in the policy process increased the ownership and the feasibility of policy adoption
despite a longer process. Lastly, capacity of central government agency and policy and strategic skills of
staffs were crucial throughout all policy processes. There should be more investment in human resource
management and development.


location: , 'Thailand year: 2003 source: HSRI

title: A study for health impact assessment : A case study of city transport development of Chiangmai Phase I : Public scoping

abstract: There is growing evidence that present pattern city and transport development, in which private motorized vehicles plays a dominant role, have important health effects through, for example, accidents, emissions of air pollutants and noise and reduced opportunities for physical exercise. However, a methodology for Health Impact Assessment is presently in a beginning stage. The objective of this study is  (I) to review situations of Chiangmai City and its transport development, development policies, citizen expectations, current efforts, environments, social and health situations, and (2) to determine scope and guidelines for the evaluation of health issues or impacts  identified.	The Chiangmai’s policy “ Public Transport is not considered as a public service. PT is provided by individual operator under market mechanism “ is chosen for the study. In addition there are two relating practices involved in the area --- no restriction on private vehicle use and road construction – based policy. Through public participation during the scoping process Chiangmai civic society identifies issues or factors to be considered covering all four dimensions of health. Impact evaluation should include accessibility to activities, accidents, air quality and noise disturbance, supporting health transport modes, feeling unsafe, traffic related diseases, social network and social interactions, social severance, and  people behaviors in traffic. Tools and indicators for the impact assessment  varies, depending on the impact considered, including scientific measurements, group discussion, questionnaires,     in-depth interview, case studies, and their combinations.


location: , 'Thailand year: 2016 source: HSRI

title: The Proposals for Reforming Laws to Limit Tobacco Access of the Thai Youth

abstract: The use of legal process to protect and prevent the Thai youth from easily accessing to tobacco is one
of the important missions at the national level. In the past, some facts indicate failure. This article aims to
review the weakness and to present proposals for reform the laws for restriction of access to tobacco
among youth in Thailand. Using the literature review of research and article related to both domestic and
foreign that published or produced since 1990 to 2015 in databases, Cochrane Tobacco Addiction Group,
PubMed, Thailist and google.This study found that Thailand needed to reform limiting youth access to tobacco laws on two
issues. First) the content of the law is not up to date with the new marketing strategy of the tobacco
companies and sale behavior of tobacco retailer, and second) the law enforcement is ineffective. Two
reforms related to tobacco laws are proposed. First, amendments of 2 Acts: 1.1) The Tobacco Production
Control Act B.E. 2535: (1) changing the definition of the term “advertisement” and issuing additional laws
on prohibiting all types of indirect advertisement of tobacco, (2) prohibiting sales of individual cigarette
or in small packages, (3) demanding plain packaging practice of tobacco product, and (4) identifying
provincial authority to control tobacco at provincial level. 1.2) The Tobacco Act B.E. 2509: to limit the
number and location of the tobacco retailers in the community and near schools. Second, strengthen law
enforcement: 2.1) developing the database of tobacco retailers, 2.2) developing the measures that enforce
law more effectively, and 2.3) developing the community participation in solving the problem of easy
access to tobacco among the youth.


location: , 'Thailand year: 2008 source: HSRI

title: The Effectiveness of Health-care Services at Na Klang Hospital Primary Care Network, Nongbua Lamphu Province, Under the Universal Health Care Program

abstract: The purpose of this study was to determine the effectiveness of healthcare services of
doctors and nurses in the Primary Care Network of Na Klang Hospital, Nongbua Lamphu Province,
under the Universal Health Care Program (UC). The study was conducted as a quasi-experimental
research in the period August›December 2004. The experimental group consisted of 48 networked doctors and nurses working at the Na Klang Primary Care Unit (Na Klang PCU) and the control group consisted of 47 networked doctors and nurses working at the Sri Boon Reung Primary Care
Unit (Sri Boon Reung PCU). Subjects in the experimental group received training using a problem based approach in order to improve their service effectiveness; there was no intervention for the control group. A questionnaire was used to gather general information, information on the health
promotion service, medical treatments, disease prevention, and rehabilitation. Data were gathered twice: pre and post experimental period and were analyzed using percentage, arithmetic mean,
standard deviation, and paired sample t-test. The results showed that, after the experimental period,
the Primary Care Unit networked doctors and nurses in the experimental group had higher
effectiveness in providing healthcare services, which was higher than that of the control group at a
statistically significant level. It was concluded that the advantage of this study includes the
application of the research results as a guideline in improving healthcare services, health promotion
service, medical treatments, disease prevention, and rehabilitation of the Na Klang Hospital
Network in order to make the services more effective.


location: , 'Thailand year: 2001 source: HSRI

title: Development of Juvenile delinquents care System in the Observation and Protection Center of Ubonrajchathanee : primary situational analysis

abstract: Development of Juvenile delinquents Care System in the Observation
and Protection Center of Ubonratchathani : Primary Situational Analysis.
The research for development of Juvenile delinquents System in the
Observation, Center of Ubontatchathani (OPCU) was carried out by PAR technique
(Participatory Action Research). The purposes were : to study on the problem
conditions, the development of Juvenile delinquents care system, and to improve
mental health task by integrating it into the system of child care in the OPCU.
The research samples were carried out by the purposive selection
technique. There administrators and sixty-five personnel were selected. Ninety
Juvenile delinquents in the OPCU were selected by the simple random technique.
The instruments consisted of : a quideline for interview, a quideline for group
conversation, questions in the workshop conference of which being used for
researcher training and tried out in order to have the same clear concepts before
implementation. Then the content analysis was used for the data analysis.
The problem conditions analysis in the target area, it was found that
the problem of Juvenile delinquents care system of the OPCU could be divided
into five categories. Those were : organization structure, policy and implementation,
personnel, Juvenile delinquents , and environment.
From the problems, it induced to planning for problem solving. The
researchers did present the findings to the Ministry of Justice. And a seminar
was fostered to hold for administrators in order to emphasize the operative policy
direction of the OPCU synchronizingly, an operation plan with responsible
personnel was established. There was also a plan presentation in cooperation with
other organizations participating in the development of Juvenile delinquents care
system. The principal research team was a cooperation and supports of
Prasrimahabhodi Hospital. This project was carried in cooperation with both
governmental and private sectors during 2001. There various activities and subprojects inducing to the development of Juvenile delinquents care system which
covered thoroughly physical, mental, and social conditions. It could be also a
good opportunity to develop the mental health task by integrating it into the
system of Juvenile delinquents care of the OPCU and extend the project to related
organizations for various target areas in every corner of Thailand.


location: , 'Thailand year: 2007 source: HSRI

title: Hearing Loss Caused by Noise Hazards among Sawmill Workers in a Factory in Nakhon Si Thammarat Province

abstract: This descriptive study was conducted in a lumber mill in Nakhon Si Thammarat
Province to identify noise hazards and hearing impairment among workers in places where
working condition are noisy.  Noise was found to be greater than 90 decibels (A) over
seven areas (63.64%) in the workplace.  Among the 46 workers who worked in noisy areas
without ear protection, hearing losses of 500, 1,000 and 2,000 Hz at 25 decibels (A) were
found in 26 workers (56.62%), at 26-40 decibels (A) in 19 (41.31%), and at 41-55 decibels
(A) in 1 (2.17%).
The investigator suggests that the Hearing Protection Program be introduced and a
work manual be provided for the factories concerned in order to ensure the workers’
safety


location: , 'Thailand year: 2020 source: HSRI

title: The Development of Multi-sectoral Approaches to End TB in Municipality and Central District

abstract: Since 2015, the World Health Organization has annually reported Thailand as one the 14 countries with high tuberculosis (TB) burden. Sigma against TB and poverty hinder the effort to end TB epidemic. A multisectoral approach and engaging civil society are needed to end TB. However, research to reduce TB stigma and study to engage civil society are lacking. This operational research program composed of 2 projects implemented in Central district, Chiang Rai between 24 June 2019 – 23 December 2020. The program developed and evaluate tools and innovations to reduce stigma against TB and enhance multisectoral collaboration to end TB epidemic. Project 1: Communication for reducing stigma against TB and to enhance participation in End TB 1.1 Developing and evaluating the effectiveness of the videos for reducing stigma against TB and to enhance participation in End TB
Based on the previous TB research and anecdotal evidences, the project developed 3 videos for different target audiences. 1.1.1 The video entitled “End TB Chiang Rai” and “Love overcomes the secret of tuberculosis” were used in the training for ten groups of people. The pre and post-test were used to evaluate TB knowledge and stigma. 1.1.2 The video entitled “Happy Ending with TB” was used as an intervention in a randomized control study with 170 TB patients They were randomly assigned to an intervention and a control group, each with 85 participants. The TB awareness and stigma level before watching the video of the intervention group were not different from the control group. However, in the intervention group, the mean tuberculosis knowledge after watching the video increased from 7.3 to 9.0 (p<0.001). The mean scores for stigma were reduced from 20.6 to 11.5, (p<0.001). The 6 month follow of the individual patient revealed that the median adherence rate of the intervention group was significantly higher than the control group 99.6% (IQR 3.3) and 96.9% (IQR 9.2) (p<0.001). The proportion of patients achieving 100% adherence of the intervention group was significantly higher than the control group (49.3%, 19.7%, p<0.001) 1.2 Curriculum development and conducting training to mitigate stigma against TB and enhance ending TB through multisectoral approach Based on the previous TB research and anecdotal evidences, the curriculum is composed of updated global, Thailand and local TB situation, essential TB knowledge and social aspects of TB. The training methods include lecture, discussion, watching the videos and group works. The training evaluation is based on the pre and post-test for TB knowledge and level of stigma against TB. Project 2: End TB through a multisectoral approach 2.1 Engaging civil society to End TB Ten different groups of people were identified and invited to the first meeting. These included medical doctors from private clinics, pharmacists from drugstores, nurses from TB clinic and admission wards, teachers, student leaders, religion leaders, charity organizations, local government administration, justice and legal sector, business sector. The selection emphasized persons or organizations locating in the area with highest TB notification for 5 consecutive years. Number of persons attended the first meeting ranged between 13 - 32 persons, Coverage of participation to attend the meeting was 19.5% - 90.3%, the lowest participation is medical doctors from clinics and the highest participation is the group of student leaders. The average participation rate is 51.2%. The pre-posttest of the 10 groups show that post-test score for TB knowledge significantly increased (p< 0.001) in every group, except the group of nurse (p=0.605). Level of stigma against TB significantly reduced (p< 0.001) in every group, except the group of private clinic physicians (p=0.08). After the first training, the project created 10 groups of communication networks through the Line application and weekly reported the records of new TB cases. The post training follow up found the End TB activities as follows: drugstores and clinics screen and referred persons with TB symptoms; The provincial education office disseminated End TB information to every school; The Christian group organized TB training for community religion leaders and updated weekly TB report; The provincial probation office organized TB information corner for pardoned inmates visiting the office. 2.2 Development and utilization of a mobile phone application for screening and referring persons with tuberculosis symptoms in drugstores and private clinics A mobile phone application entitled “TB-REFER” was developed and used in drugstores and private clinics. The clients whose symptoms meet the TB referral criteria will be referred to the hospital via the application. The referred persons received compensation for travel when they arrived the hospital. The drugstores and clinics did not receive any incentives. The one-year implementation shows 36 drugstores 20 clinics with medical doctors and 9 clinics with professional nurse totally 65 voluntarily participated in the project. Eighteen drugstores and clinics (27.7%) referred 38 clients but only 24 (63.2%) went to the hospital. Six clients were diagnosed as TB. Five cases were pulmonary TB (one smear-positive and 4 smear-negative sputum) and one extra-pulmonary TB. The 36.8% (14/38) of clients did not visit the hospital because they needed to work, no person to accompany and unable to bare for hospital cost. The clients who did not go to the hospital had higher proportion of coughing with blood (35.7% vs 12.5%) and higher average TB symptom scores than the clients who visit the hospital (4.5 vs 4.1 scores). A self-administered questionnaire with 81.3 response rate (52/65) revealed that 67.3% of drugstores and clinics did not refer clients because no clients reaching the criteria of referral. As for the clinics and the drugstores with referrals, they felt the TB-REFER application is easy to use (mean scores of easiness 9.5 out of 10 scores. The shortest, the longest and the average time spent with clients and the application are 5, 15 and 10 minute respectively. The impact of Covid-19 on the research implementation and TB patients The research project could not organize the World TB day on 24th March which is a highlighted research activity to campaign TB awareness by engaging all groups of civil society in the public for the first time. Moreover, the project could not organize face to face meetings to follow up the progress from the first training. The internet-based meetings were not practical. A rapid assessment with drug stores and private clinics show that Covid-19 reduced more than half of their clients. Persons with fever and cough also significantly reduced. Strict infection control measures were practiced by most clinics and drugstores. A rapid survey with 81 TB patients living with poverty found 70.8% lost their income. Hand washing and wearing mask in the public were regularly practiced by 95% of the patients. Female patients significantly washes hands more than male patients (97%, 78%, p=0.027). Utilization of research findings The TB-REFER mobile application and the referral pattern have been applied to HIV prevention and care program at the Thai-Myanmar border and the sexually transmitted infection (STI) clinic in local setting. Engaging drug stores and private clinic in TB case finding will be expanded to the whole region in 8 northern provinces. Conclusions The videos and the training curriculum for civil societies improved tuberculosis knowledge and reduced stigma against TB in various groups. The video for TB patients enhanced TB awareness, reduced stigma and promoted adherence to treatment. It was possible to engage drug stores and private clinics to screen TB symptoms and used the TB-REFER mobile application to refer patients to the hospital with high yield of TB case detection. However, only 61% of referred patients accessed the hospital. Other social protection measures are needed to enhance vulnerable people to access the hospital service. Policy Recommendations 1. The videos are low cost intervention for reducing stigma and enhance treatment adherence. Every tuberculosis clinic and primary care health center should be informed about these videos. The newly diagnosed tuberculosis patients should watch the video. 2. Provincial Health Office, regional hospitals and community hospitals should engage drug stores and private clinics in screening and referring persons with tuberculosis symptoms for definite diagnosis at the hospital. and 3. The community grant funded by the National Health Security Office should play role to support the vulnerable persons to access TB diagnosis.


location: , 'Thailand year: 2015 source: HSRI

title: The Expert System to Advise Nutrition and Physical Therapy for Chronic Disease Elderly Patient on Mobile Device

abstract: This research proposes using technique data mining modeling support an expert
system to advise nutrition and physical therapy for chronic disease elderly patient on
mobile device. The development of model with weka3.6.9 program, by using the algorithm
classification of patients with simple k-means and the apriori for generating association rules.
The distance measurement of data with percentage split66% from each of disease 250
samples. Then create rules in the group of 10 on minimum confidence level 0.9. That are
rules used for nutrition and physical therapy each of disease 80 rules for the use of
embedded code on the application to run through the user interface on mobile devices.
For example, patients with diabetes were K= 4 : 5 dimension and K= 4 : 4 dim, hypertension
K=4 : 5 dimension and K= 4 : 4, hepatitisB K=4 : 5 and K= 4 : 4, osteoarthritis K= 4 : 5 and K=
4 : 4, paralysis K= 4 : 5 and K= 4 : 4 and parkinson K= 4 : 5 and K= 4 : 4 for the physical and
nutrition therapy respectively.