PUBLISHED RESEARCHES IN THE YEAR 2010

VOLUME 4 No.1 Title: An application of Decision Tree Algorithms with Diagnosis of the Diseases of the Respiratory System Researchers: Ditapol , Mantuam Lily Ingsrisawang Corresponding author, e-mail: m_ditapol@hotmail.com Department of Statistics, Faculty of Science, Kasetsart University Abstract: The Knowledge Discovery in Database (KDD) has been extensively used through data mining, a statistics and computer sciences, to organize the crucial useful data into knowledge base form for further research purpose. The data classification is a techniques applied by the KDD to various fields and medical research. The primary purpose of this study was aimed to applications and compare the performance of the 3 decision-tree algorithms, including ID3, C4.5, and CART, which have currently become famous in sorting data. The results would be expected to support the screening process and to be used as guidelines for primary diagnosis. The medical record of 7,327 out-patients at the Pranakorn Sri Ayutthaya Hospital during 2004-2006 was examined. The results have demonstrated that algorithm C4.5 which percentage split method was used to divide the data into 70:30 was 99.41% accurate in respect of no selection of variables. The Kappa was 0.9881. Sensitivity was 99.31% while specificity 99.50%. Positive predictive value (PPV) was 99.40% while negative predictive value (NPV) was 99.41, ROC area was 99.70%, regarded as the most effective classifier. On the other hand, it found that algorithm ID3 which percentage split method was used to divide the data into 70:30 was 95.85% accurate in case of selection for variables. The Kappa was 0.8821. Sensitivity was 91.55% while specificity was 97.22%. Positive predictive value (PPV) was 90.25% while negative predictive value (NPV) was 97.52%, ROC area was 97.60%. The results indicated that there was no significant difference in classifying patients data in both cases (Selection of variables, no selection of variables). However, in case of the selection of variables, lesser variables were used, resulting in time and cost saving. The algorithm ID3 produced higher performance in classifying patients data in respect of the selection of variables. Keywords: Data Classification, Decision Tree, Diseases of the Respiratory System, Diagnosis (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: Researchers:

Decision making on patient compensation related to adverse events Pattapong Kessomboon*, Nusaraporn Kessomboon**, Supasit Pannarunothai***, Amorn Premgamone* * Faculty of Medicine, Khon Kaen University, **Faculty of Pharmaceutical Sciences, Khon Kaen University, ***Faculty of Medicine, Naresuan University Adverse events occurred in health service settings lead to more lawsuits than ever before. The new patient compensation Bill is expected to resolve patient-provider conflicts. It will be designed to cover all groups of Thai people with acceptable claim process and amount of compensations.

Abstract

Objective: To study decision making processes on compensation for injured patients under the Article 41 of the National Health Security Act 2002. Method: This was a descriptive study. The reasons used by committees in making decisions on whether to pay or not pay the victims conducted under the article 41 were analyzed and compared with the compensation criteria set out by the National Health Security Office. Altogether, 1,276 claims during 2003 - 2008 were recruited for the study. Results: Among 1,276 claims, compensations were paid out for 1,049 cases (82.2%) and 227 cases (17.8%) were not paid. The main reason for paying compensation was that it was an unavoidable situation (76.5%). However, the reason above was not in accordance with the criteria for compensation. There were only 27.1 % of claims that were in accordance with the criteria saying that the injuries were related to medical errors or mistakes or substandard care. The main reason for not paying compensation was that the adverse events were the results of disease processes (61.6%). This was in accordance with the criteria. Conclusion: Inconsistency and unclear decision making on patient compensations were found. Two cases with the same kind of injury might be paid or not paid. This might motivate patients to bring the case to court. Key words: criteria for decision making, adverse event, medical service, patient compensation (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: Good Governance Index for Health Systems Research Management Unit:Case of Health System Research Institute Researchers: Decharut Sukkumnoed1, Rungthip Sukkumnoed2 1 Lecturer, Faculty of Economics, Kasetsart University 2 Researcher, Healthy Public Policy Foundation

Abstract The project of developing good governance index is a part of developing the research management system in Health Systems Research Institute (HSRI) and its research alliances. Objectives of this project are 1) to define the framework of monitoring and evaluating the project administration in accordance with good governance practices 2) to develop good governance index 3) to study the appropriateness of the developed index and barriers for index perceived 4) to set a guideline to gather essential data for project performance evaluation which is based on good governance principle of research management team in health system. The process of this project begins with 1) reviewing theories, concepts, and research reports related to good governance practices and its index both domestically and internationally 2) interviewing experts from related disciplines, and research managements 3) developing and testing questionnaire and then analyzing data 4) using the drafted good governance index to conduct internal pilot test with HSRI 5) reviewing index and modifying it to be more suitably. The result of this study has indicated that two crucial conceptual frameworks of index development has emerged and they are comprised of 1) conforming to six good governance practices including Rule of Law, Transparency, Worthiness, Participation, Quality, Accountability and 2) applying six good governance practices to five steps of the research management process. The outcome of evaluating Health Systems Research Institute (HSRI)s good governance practices has been depicted that overall in the organizational level HSRI has high good governance practices. When considered in the perspective of five research management process, the process of gathering and allocating resources gains the highest level of engaging good governance practices and is followed by the process of planning the research management as a second. Other research

management processes are evaluated that their involvement in good governance practices are in the middle level. Keywords : Good Governance, Health Systems Research Unit. (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: Health Decentralization in 5 countries Researchers: Jiraboon Tosanguan*, Siriwan Pitayarangsarit*, Hathaichanok Sumalee* *International Health Policy Program (IHPP)

Abstract Decentralisation is one of the tools for the development of health system which can have many benefits such as the improvement in technical and allocative efficiency, the improvement of the responsiveness of the health system in meeting the needs of the people. According to Rondinelli , decentralization has been categorized into deconcentration, devolution, delegation and privatization. In Thailand, there has been an increasing emphasis on community participation and decentralization following the Constitution of B.E. 2540 and the Decentralisation Act of B.E. 2542 which has led to the development of the Decentralization Plan of B.E. 2544 and the Devolution Plan to LAO in B.E. 2545. These plans dictated that the provisions of public services were to be devolved to Local Administrative Organisation which include the transfer of infrastructure and the authority to provide health and health promotion services. This study will examine these issues by reviewing international experience of Mexico, Sweden and New Zealand in the decentralization of health promotion services will also be discussed. From the review, after the reform, decentralization has led to many benefits to the provision of health services and to the health system as a whole. In Portugal (deconcentration), it was found that the health status of the population improved significantly after the improvement in access to care. Furthermore, the local authority has become more autonomous and more flexible in order to be more responsive and efficient. Also, in Italy and the UK, the internal market and the purchaser-provider split have been introduced in order to improve efficiency, quality and service satisfaction. However, problems related to decentralization were also found. For example, the occurrence of political conflicts from the reform, inequity which emerged in many forms, the problems relating to responsiveness in the deconcentration system, and the problems with unfavorable condition and contract in the internal market system. The Ottawa Charter has been adopted in many countries as a model for their policies on health promotion which it has emphasized on community participation. In Mexico, they have developed a method of evaluating their progress of the implementation of health promotion policy, and then they have developed a national policy on health promotion, called Health Promotion Operation Model (MOPS) which are both based on the Charter and consists of 7 components which are the management of personal determinants, health capacity building, community participation, Development of healthy environment, social marketing in health, and evidence in health promotion. In Sweden, which is considered to be a welfare state, developed their National Public Health Policy in 2003 with 1 main aim which was to provide societal conditions for good health on equal terms for the entire population. It also had 11 objectives which only consider about the determinants of health. Interestingly, Pettersson has summarized the evolution of Swedish local authority in dealing with health promotion into The Health Promotion Staircase for Building Local Capacity which could be beneficial in the development of LAOs in Thailand. In New Zealand the Local Government Act of 2002 was passed which it clearly defined the roles and responsibilities of the central and local government according to the risk-specialisation model. Furthermore, to enhance the role of the community, a Long-Term

Council Community Plan (LTCCP) must be developed with the expected Community Outcome in order to improve community living condition and address their health concerns. Key word: health decentralization (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: The review of Health Promotion Decentralization in 3 countries Researchers: Jiraboon Tosanguan*, Siriwan Pitayarangsarit*, Hathaichanok Sumalee* *International Health Policy Program (IHPP)

Abstract The Ottawa Charter has been adopted in many countries as a model for their policies on health promotion which it has emphasized on community participation. In Mexico, they have developed a method of evaluating their progress of the implementation of health promotion policy, and then they have developed a national policy on health promotion, called Health Promotion Operation Model (MOPS) which are both based on the Charter and consists of 7 components which are the management of personal determinants, health capacity building, community participation, Development of healthy environment, social marketing in health, and evidence in health promotion. In Sweden, which is considered to be a welfare state, developed their National Public Health Policy in 2003 with 1 main aim which was to provide societal conditions for good health on equal terms for the entire population. It also had 11 objectives which only consider about the determinants of health. Interestingly, Pettersson has summarized the evolution of Swedish local authority in dealing with health promotion into The Health Promotion Staircase for Building Local Capacity which could be beneficial in the development of LAOs in Thailand. In New Zealand the Local Government Act of 2002 was passed which it clearly defined the roles and responsibilities of the central and local government according to the risk-specialisation model. Furthermore, to enhance the role of the community, a Long-Term Council Community Plan (LTCCP) must be developed with the expected Community Outcome in order to improve community living condition and address their health concerns. Key word Health Promotion Decentralization (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: Experts opinion on role, function and activity as primary care provider of accredited pharmacy under the National Health Security Scheme Researchers: Wiwat Arkaravichien* Tarinee Arkaravichien** Chanchai Jarupach* Khanitha Jermkuntood* Parkwipa Charoenthum* * Faculty of Pharmaceutical Sciences, Khon Kaen University ** Faculty of Medicine, Khon Kaen University

Abstract Although community pharmacy normally provides health service to community, it has never been officially recognized as a primary care unit under any health security scheme. After the National Health Security Scheme has been implemented in Thailand, there were efforts to test accredited pharmacies as network with the scheme. In order to put a community pharmacy into the network, it is essential to clarify the role and function of community pharmacy as a primary care provider under the network. Therefore, this study aimed to project the role, function and activity of community pharmacy from the viewpoint of community pharmacy experts, both from private sector and government sector.

Delphi method was used by sending questionnaires to experts for two times. There were 17 experts completed the two times questionnaires. Levels of agreement were calculated as median, mode and inter-quartile range. The results showed that the experts agreed that it was possible to have community pharmacy to play role in treatment and play role in health promotion and disease prevention in a community. The medians of agreement levels were between 4 5 from 5 Likerts scale and the inter-quartile ranges were narrow. In treatment role, a community pharmacy would have functions and activities in drug dispensing for common illnesses, refilling prescriptions for chronic diseases, and providing counseling to patients. In health promotion and disease prevention role, a community pharmacy would have functions and activities in screening for risk of chronic diseases, referring a high risk patient to physicians, promoting and making concern of appropriate drug usages, providing advices regarding nutrition and exercises, campaigning for smoking cessation and reducing alcohol consumption, and co-ordinating with local authority to promote community health. Key words: accredited pharmacy, community pharmacy, primary care provider, role and function of community pharmacy (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

Title: The Effects of Direct Billing System on Prescribing Patterns in Civil Servant Medical Benefit Scheme Researchers: Piyameth Dilokthornsakul1, Nathorn Chaiyakunapruk1,2,3, Piyarat Nimpitakpong1 1 Center of Pharmaceutical Outcome Research, Faculty of Pharmaceutical Sciences, Naresuan University 2 School of Pharmacy, University of Wisconsin-Madison, USA 3 School of Population Health, University of Queensland, Australia

Abstract: Introduction: In 2006, the reimbursement system for the Civil Servant Medical benefit Scheme(CSMBS) in Thailand was changed to direct billing system. It was unknown how this new system affected drug expenditures and the number of drug supply given to beneficiaries. This study aims to assess the effects of direct billing system on prescribing patterns in terms of the number of months of coverage per prescription and over possession. Method: This study was undertaken with retrospective cohort approach. We used the data recorded in database of a university hospital in northern part of Thailand. We undertook the data on all patients with CSMBS who came to out-patients department between Oct 1, 2005 and Mar 31, 2007. Mean cost of medication, the number of months of coverage per prescription and medication possession ratio (MPR) of five highest costs of oral medication were calculated in one year before and after the system was changed. Results: Out of 43,897 patients seeking outpatient care at the hospital, 15,632 (36%) were under CSMBS. Eighty-eight percent (13,785/15,632) received medications during visit. The total cost of medication increased from 2 million to 4 million bahts in one year. Glucosamine, atorvastatin, rosiglitazone, clopidogrel and diacerein were highest used in terms of cost. The average number of months of coverage based on these medications increased from 1.29 to 1.48 months per prescription. Percentage of prescribing more than 3 months, was slightly increased from 1.82 to 2.43. Three out of five MPRs were higher after system was changed (Relative risk ranged on 1.192.32). Conclusion: The direct billing system may affect prescribing patterns as indicated by trend of the increased number of months of coverage per prescription and higher medication possession ratio. Further evidence remains needed. Policy makers need to consider all

relevant and important consequences associated with the new system prior to policy decision making. Key words: direct billing system, civil servant medical benefit scheme, prescribing patterns, over-possession (Published in Journal of Health Systems Research Vol.4 No.1 Jan.-Mar.2010)

VOLUME 4 No.2 Title: Database of Health Technology Assessment: Development and Implications Researchers: Nattiya Kapol*, Surasit Lochid-amnuay*, Rapeepan Chalongsuk*, Pagamas Maitreemit*, Yaowalak Amrumpai*, Namfon Sribundit* *Faculty of Pharmaceutical Sciences, Silpakorn University Abstract Health technology assessment is an important tool for policy decision makers to allocate health resources efficiently. Though, the accessibility and knowledge in health technology assessment are barriers for research utilization. The health technology assessment database has developed in Thailand to retrieve related research and disseminate to targeted users. The development was divided into 3 phases 1) developed database structure by focus group method from decision makers, health practitioners, and academic/ researchers, 2) searched and recorded research in the database, and 3) dissemination and evaluation of the database use. The database was available online at www.db.hitap.net starting in January 2008. The results revealed that the database included 471 full economic evaluation studies, 155 randomized controlled trial studies, and 106 quality of life studies. The evaluation of the database use in January 2009 showed that most users are most satisfied with upto-date articles, the usefulness of the database, and the database service that meet the expectations. However, the variety of research articles should be determined to meet the users needs in the future. Key words: Database, Health Technology Assessment, Economic Evaluation (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010) Title: Research Questions for Tobacco Control: Document Analysis and Experts opinions Researchers: Siriwan Pitayarangsarit *,**, Suwatthana Praikean*, Prapapun Iamanun*, Sarinya Laohapanpong*, Haris Taveeputtana* and Siripen Arunpraphan* *Tobacco Control Research and Knowledge Management Center (TRC) ** International Health Policy Program (IHPP), Ministry of Public Health, Thailand Abstract Policy linked research is identified by the countrys problems and concerns. The purpose of this study is to evaluate the missing knowledge in tobacco control in Thailand and to examine the significant research questions needed for tobacco control policy. Two methods: Framework of Analysis and Documentary Research were employed to evaluate the scope of needed research, the method of comparison to the WHO Framework Convention on Tobacco Control (FCTC), by selecting equivalent topics related to Thai society. The next step was collecting the previous research evidence such as research report and meeting papers. Those collected documents were evaluated to identify gap of knowledge using a focus group discussion in order to bring forward specific research questions. Seven main areas for tobacco control were identified as relevancy to current tobacco control situation in Thailand and needed to advance more evidence: (1) The surveillance system of tobacco consumption and tobacco industry (2) Tobacco control tax measures and trade agreements, (3) The

alternative model of services for smoking cessation (4) Control for various tobacco products (5) Communication for behavior and social changes (6) Situation of roll your own cigarettes (7) Evaluation of the effectiveness of the tobacco control measures. This analysis suggested that research prioritization for tobaccos control research could use the WHO Framework Convention on Tobacco Control (FCTC) as a framework of analysis. The selected components could be adjusted for country specific that should guide effectively investing in specific tobacco research to solve the countrys specific problems. Keywords: Research questions, Tobacco control, Framework of analysis (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

TiTle: Development of Local Recipes for the Elderly Researchers: Pasamai Egkantrong*, Orapin Banjong*, Atitada Boonpraderm*, Gene Charoonruk* Institute of Nutrition, Mahidol University Abstract This study aimed to identify and develop nutritious local Thai recipes for healthy elderly, based on their nutrient requirements. Community leaders were identified and were asked to identify community cooks within their communities. A list of 201 local dishes was identified through in-depth interviews performed among 74 local food experts. From the list, 40 dishes that had the potential to improving their overall nutritious quality, for instance adjusting meat and vegetable quantity and substituting coconut cream with cereal cream and/or soy milk were selected. The recipes were adjusted and the dishes were tested for sensory acceptability by the elderly in their communities. Mixed dish recipes provided the highest average energy content (319 Kcal per serving), while Namprik and non-coconut cream curry provided the lowest energy content (89 Kcal per serving). Noodle soup with chicken had the highest content (6 mg). Thai rice noodle in sweet chili sauce (Kanom Jeen Nam Prik), Thai rice noodle in spicy sauce (Kanom Jeen Nam Ya), steamed snake headed fish with Morinda Citrifolia Linn (Noni) Leaves (Hor Mok Pla Chon Bai Yor) , and Namprik had the highest fiber, iron and vitamin A content. Since cereal cream and/or soy milk, which contain appropriate fat content, was used instead of coconut cream in this study, these recipes may help to decrease risk of chronic noncommunicable diseases in elderly. Keywords: Elderly, Local recipe, Participatory Action Research (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Health impacts from open-pit mining project: scope and guideline for investigation of possible impacts Researchers: Chudchawal Juntarawijit*, Yuwayong Juntarawijit, Sivaporn Aungwattana** Nongyao Udomvong**, Jitnatee Kaney***, Nootchayong Yaowapanon***, Monvipa Sirihorachai**** *Faculty of Agriculture, Natural Resources and Environment, Naresuan University, **Faculty of Nursing, Chiang Mai University, *** McCormick Faculty of Nursing, Payap University, **** Chiangmai Provincial Public Health Office Abstract Lignite mining may post several health impacts but at present, there was no guideline to investigate those effects. This study was aimed to set up scope and guideline for investigation of possible health impacts from open-pit mining project, using the participatory approach from public and other stakeholders.. Results from literature review on possible health impacts, and data on the living styles of the affected community were used to identify the possible health impacts. Public and other stakeholders were allowed to join the study and provide suggestions for public scoping. It was found that there were four aspects of possible health impacts: physical, mental, social, and spiritual health. Physical health impacts were: accidents and injuries from mining and transportation; effects from noise; diseases and effects from air pollution; diseases and effects from water pollution; effects from explosion; and labor migration and communicable diseases. Mental health impacts were expected from stress and anxiety. Social health impacts were likely from effects to community life style; effects from community migration and resettlement; and effects from depletion of forest and agriculture land. Spiritual health impacts were likely from effects from aesthetic changes and loss of loyalty to and connection with the locality; and effects from losing their spiritual haven. Key words: Health impact, open-pit mining, HIA, coal mine, coal, Wieng Haeng (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Budget Impact Analysis of Incorporating of Community Pharmacy into Universal Health Coverage in Thailand Researchers: Nusaraporn Kessomboon*, Surasit Lochid-amnuay, Waraporn Poungkantha, Weerasak Putthasri *Faculty of Pharmaceutical Sciences, Khon Kaen University, Faculty of Pharmacy, Silapakorn University, International Health Policy Program Abstract There are some practical models of community pharmacy provision in Thailand that coordinated with the hospitals in providing care for stable diabetes and hypertension. This study aimed to estimate budget impact of incorporating of community pharmacy into Universal Coverage in providing care for stable diabetes and hypertension. Firstly secondary data were reviewed to estimate supply and demand of community pharmacy services. Unit cost analysis of the community pharmacy activities were performed using the activity based costing technique. Finally, the budget impact analysis was estimated under the model of refill medication at the community pharmacy. The timeframe of this study was January to September 2009. The result showed that the budget impact of community pharmacy in providing medication refill for stable diabetes varied between 182 to 1,044 baht per patient or 194,740-1,117,080 baht per hospital. Regarding the budget impact for medication refill in stable hypertension, the average expenditure was 182-1,098 baht per patient or 242,242-1,461,438

baht per hospital. It can be concluded that the community pharmacy be a part of integrated package of care for people with long-term conditions such as stable diabetes and hypertension. However, financial incentive is required to meet additional costs and to connect community pharmacies to the Universal Coverage. Co-payment may be used in this program to prevent inappropriate utilization. Key words: Budget impact, Community Pharmacy, Universal Health Coverage, Co-payment (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Relationship between Information Received and Satisfaction of Health Personnel in Health Security System in 6 Provinces Upper Northeast, Thailand. Researchers: Preeda Taearak*, Wanrapee Samanachangphueg* *National Health Security Office Abstract National Health Security Office (NHSO) region 8 Udon thani surveyed health personnel in 6 provinces included Loei, Nongbualampoo, Nongkhai, Udon Thani, Sakonnakhon and Nakhon Phanom province aimed to evaluate the understanding of the benefits, information and their satisfaction in health security system. The result revealed that pharmacist and dentist knew about the benefits in health security system at 76.9 percent which was less than other health profession. Most personnel received information about health security via television (68.1 percent). For radio, the popularity of song, news and general events was almost the same proportion at 31.5, 30.2 and 26.5 percent respectively. The most popular period was 06.00 to 08.00 am. (37.1 percent). 62.6 percent of health personnel did not read newspaper. Personnels satisfaction in health security was 8.15 out of 10 score and general personnel had highest satisfaction at 8.5 score. The least satisfaction belonged to the pharmacist at 7.37 score. The study found that the satisfaction of the personnel positive related to knowledge in health benefits in health security system and satisfaction in the media from national health security office. Internet is also an interesting route as it is easy and efficient to communicate to target population. Suggestion is that NHSO should perform the specific public relation strategies and work more specific to each group of health personnel. The low level of information that personnel had received should be paid more attention. The formal letter is still the main route to provide information to health personnel. The alternative route of information should be used more especially newsletter to create good attitude to national health security system continuously with the enough quantity, style and content should conform to the taste of the personnel. Key words: health security, information, satisfaction (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Iodine status in sampling population in Chiengmai, Lumphun, Lumpang, and Maehongson during FY2007-2009 Researchers: Sumet Ongwandee*, Hathairat Thongkhew*, Wanruedee Kijjaroenrungroj #, Darawan Sakhulvong, Khulrat Chaibhom * Maehongson Provincial Health Office # Chiengmai Provincial Health Office Lumphun Provincial Health Office Lampang Provincial Health Office Abstract Iodine deficiency had several effects on health, particularly concerning the development of brain in fetus and early childhood. Regarding the past few decades, a situation was mitigated when considering a total goiter rate in children. In a mild degree of deficiency; thus, no obviously physical

effect was seen but impaired mental function. The north and northeastern were the highest risk areas. This descriptive study was aimed to review iodine status of population in Chiengmai, Lumphun, Lumpang, and Maehongson by analyzing secondary data during Fiscal Year 2007-2009 and was framed under the manual Assessment of Iodine Deficiency Disorders and Monitoring Their Elimination of WHO. It was found that a proportion of households using adequately iodized salt was progressively over 90% in every province except Maehongson. Thyroid function assessment by a screening TSH level in newborn, that was over 11.2 mu/L, in Chiengmai, Lumphun, Lumpang, Maehongson was 12.73%, 7.84%, 10.29%, 15.83% respectively and the incidences of thyroid hormone deficiency were 1:2,297, 1:1,665, 1:2,468, 1:3,058 respectively as well. Total goiter rate was below 5% in every province. A level of iodine in urine in pregnancy in Maehongson was 50.89% equally insufficient and in primary school pupils in Lumphun was 52.38% equally more than adequate. In conclusion, four provinces were indicated mild iodine deficiency areas but their situation had gotten better. Iodine deficiency prevention was required more attention of policy makers. Proper IQ development by adequate iodine intake should be designated as one of the national strategies on children capacity building. Right knowledge building on a benefit of proper iodine intake to people should be installed. Social responsibility of salt manufacturers, as well, was required and legal measures were necessary, if otherwise. Key words: Indicator, Iodine, Chiengmai, Lumphun, Lumpang, Maehongson (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

Title: Effects of rocking chair on bowel function in patients with gynecological abdominal surgery Researchers: University Abstract An abdominal operation has effects on gastrointestinal (GI) motor activity. Postoperative care for early recovery of GI motility is recommended. The purpose of this quasi-experimental research was to study the effects of rocking chair on bowel function in patients with gynecological abdominal surgery. The framework of this study based on the effect of mechanical pressure and relaxation technique affected on GI tract. The sample of 60 abdominal hysterectomy patients were drawn by carefully selected criteria from a patient population admitted for abdominal hysterectomy during June to October 2008. The patients were randomly assigned into 2 groups: the experimental group who ambulated by rocking chair exercised and the control group who did not. The collected data consisted of 4 parts: demographic, treatment, bowel function and patient satisfaction. The experimental instruments were rocking chair and stethoscope. The bowel function was measured 16 hours after surgery. The experimental group who were assigned to ambulate by rocking chair exercised for 45 minutes and the control group who did not. Data were collected and analyzed by using mean, standard deviation and independent t-test. We compared the different by 2 - test and independent t-test. The results revealed that numbers of bowel sound and belching were statistically significant difference (p = 0.001and 0.01 respectively).The days of passing flatus and feces were not difference. The 53.3 % of patients had high satisfaction and 90%of patients had no dizziness. We suggest that the postoperative abdominal surgery patients should be ambulated with rocking chair. The outcome of our study theoretically applies to the others surgical patients. Keywords: rocking chair, bowel function, abdominal surgery (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010) Uaiporn Pattrapakdikul * , Orathai Chayapiwat * *Nursing Service Department, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla

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Title: Postpartum care through Thai traditional medicine in Amnat Charoen province Researchers: Somying Pumtong*, Lalita Wirasathien, Worapan Sitthithaworn, Apichat Rungmekarat, Ornlaksana Paeratakul

*Department of Clinical Pharmacy and Social Pharmacy, Faculty of Pharmacy, Srinakharinwirot University Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Srinakharinwirot University Amnat Charoen Provincial Public Health Office Department of Pharmaceutical Technology, Faculty of Pharmacy, Srinakharinwirot University

Abstract The objective of this qualitative research was to investigate and compile the knowledge of Thai traditional medicine for postpartum care in Amnat Charoen, a province in the Northeastern part of Thailand. Data collection was done through individual and group interviews of folk doctors, including herb doctors, midwives, shamans, traditional massage therapists (n=43) and health care professionals from all hospitals (n=7), along with on-site observations. The study was undertaken between May 2009 and April 2010. It was evident that the inherited traditional medicine/folk medicine regarding midwifery and postpartum care has long been practiced in the area of Amnat Charoen up to present. The knowledge and wisdom in this particular area have passed from generation to generation, i.e. from ancestors to younger family members, via story telling, traditional practice, and mentor system. In the past, child labor was typically performed by a traditional midwife. Several postpartum care regimens would then be employed after childbirth, e.g. Yu-Gum or Yu-Fai (body warming using heat/fire), herbal bathing, along with many other religious rites. Various medicinal plants, either of single or multiple formulas, have been used for mothers for the purposes of body cleansing, evacuation of amniotic fluid from the uterus, and stimulation of lactation. In addition, some plants are used as blood tonics or laxatives for nursing mothers. A number of herbs have already been investigated for their chemical constituents and related pharmacologic actions, however, some have not yet been studied thus their activities remained unknown or questionable. It was found that folk medicine/traditional medicine has been integrated harmoniously with modern medicine in the current practice of postpartum care in government hospitals in Amnat Charoen. It was also quite apparent that the government policy on Thai traditional medicine has played a major role in expanding both number and quality of traditional health services available in every level of health care settings. Key words: postpartum care, Thai traditional medicine (Published in Journal of Health Systems Research Vol.4 No.2 Apr.-Jun.2010)

VOLUME 4 No.3 Title: Renal function among gout patients in Nongjik Hospitol, Pattani Province

Researcher: Nealanad Cheyor* *Nongjik Hospital, Pattani Province

Abstract This descriptive research determined the prevalence of renal impairment and drug use in gout patients in Nongjik Hospital , Pattani province. Medical records of the patients from October 2008 to December 2009 were reviewed. The estimated glomerular filtration rate (eGFR) was calculated by the MDRD equation. Frequency, percentage, mean and standard deviation were used to analyse the data. Chi-square test was used to compare between proportions. Multiple logistic regression was used to determine association between prevalence of eGFR < 60 ml/min/1.73 m 2. The majority of patients were male. The average age was 64 years old. Most patients had co-morbid

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diseases. Most of them received allopurinol and colchicine. A significant proportion of patients with chronic kidney disease stage 4 and 5 received colchicine without dose adjustment. About 58.2 % of patients had eGFR < 60 ml/min/1.73 m2 and 81.7 % of such patients suffered hypertension. Age was the only significant factor associated with eGFR < 60 ml/min/1.73 m 2 by multiple logistic regression analysis Screening of renal function among gout patients is important for early detection of renal impairment. The finding was also useful for dose adjustment of drugs prescribed for the patients, which could prevent or slow the end stage renal disease. Keywords : gout, glomerular filtration rate, renal impairment (Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)
Title: DETERMINATION OF HEALTH POLICY AND SYSTEM RESEARCH TOPICS IN THAILAND Researchers: Songyot Pilasant*, Yot Teerawattananon* *Health Intervention and Technology Assessment Program (HITAP) Abstract Health policy and system research (HPSR) is crucial for strengthening health systems. In cases where resources are limited, research topic prioritization is an important process to ensure the effective use of the available resources and to help acquire research topics that are relevant and also address stakeholders' concerns. Foreseeing the benefits of introducing a prioritization process, the Health Systems Research Institute (HSRI) and its affiliates organized the HPSR topic prioritization seminar 2010, aiming at a list of national prioritized research topics with the hope that list will be used to support policy decisions in Thailand. This is a research and development study which employed participatory observation, brainstorming and questionnaire surveys. A total of 247 organizations were identified as stakeholders. Ninety of these participated in the prioritization process. At the beginning of the process, 120 HPSR topics were proposed by 66 organizations. Of these topics, 15 were prioritized. It was found that topics that are related to (1) disease with a high burden and (2) service delivery, are likely to be included in a priority list. In addition, results from a self-administered survey demonstrated that 93% of stakeholders strongly supported the process and expressed their interest to participate in similar events if conducted in the future. Key words: health topics determination, health priorities, health systems management, health policy (Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

Title: Legislation and Health Promotion Researchers: Hathaichanok Sumalee*, Siriwan Pitayarangsarit*, Jiraboon Tosanguan* *Office of International Health Policy Program (IHPP) Abstract In Thailand, there has been a number of legislations which concerns health promotion including the National Health Act (B.E.2550), and the Supporting Fund for Health Promotion Act (B.E.2544). Most important of all is the Thai Constitution, B.E. 2550 which guarantees the rights of individuals on this issue as followed: 1) rights to public health and welfare services; 2) rights to access information on certain activities and/or programs which may affect their environment, health and quality of life; and 3) rights to be protected from environmental health hazards. Furthermore, the Constitution also states that health policies must emphasize on health promotion which would lead sustainable healthiness of the population, and local government should be given the responsibility and authority in the management and provision of public services for the local people. Even though, other related laws, which concern the roles of local government in public health service provision, may not have included health promotion as one of the responsibilities of local government, however, the responsibilities of local governments could be extended. Legislation such as the Public Health Act (B.E.2535), and Tambon Council and Tambon Administrative Organization Act (B.E.2537) have given powers to the ministers in charge to allocate extra responsibility to local government as allowed by that law. Especially the latter has given the tambon administrative organization the role to manage

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basic environmental control services which is relevant to the function of health promotion. In the 2 nd Action Plan and Protocol for Decentralization to Local Government, has clearly stated that health promotion responsibility, along with basic health services and disease control are to be the responsibilities of the local government with a certain level of readiness. These will be transferred together with funding, the existing staff and infrastructure (health center). However, as local government needs to undergo assessment and other processes in the devolution of health center, there is a need for specifying the roles of local government in health promotion in order to clarify the issue and to make the roles conform to the health promotion strategy. Key words : Law , Role of Local Administrative Organization , Health Promotion (Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010) Title: Policy Options on Medical Injury Compensation Fund for Thailand Researchers: Siriwan Pitayarangsarit *, Hathaichanok Sumalee* *Office of International Health Policy Program (IHPP) Abstract The implication or unwanted outcome from health services, either it was unavoidable or from negligence, can lead to damages and conflicts between providers and patients. Consequently, this can have an impact on the health service delivery system which the faith and credibility has been deteriorating. The current compensation mechanism which is done through the judicial system cannot enhance the good relationship between the providers and patients, while the no-fault basic compensation, which the affected patients are entitled according to article 41 of the National Health Security Act of B.E. 2545, can alleviate their distress to a degree but the law only cover patients in the Universal Coverage Scheme. This has led to the idea of drafting new laws to extend this protection to all Thai patients. As a result, the authors have summarized the policy options and the pros and cons of each option in order to inform the public, create symmetry of information between different groups of stakeholders, and empower the society to assess the feasibility and long-term impact of the policy options by themselves. This study found that non-judicial no-fault compensation for affected patients is widely accepted and adopted in many countries (such as the Scandinavian and New Zealand) under the principle which emphasize on the responsibility of the party who afflict the damage before proving right or wrong. There are two different sources of fund for no-fault compensation: 1) funds collected from providers; public hospitals, through health funds which are mainly from taxation, and private hospitals which they pay directly; and 2) contribution from people proportionately to their income with a certain level of income ceiling and the government contribute for the low-income or unemployed people. Also the providers may also need to contribute (as in New Zealand). It is the authors opinion that Thailand should adopt the no-fault liability policy which can help reducing the conflicts between patients and providers, and non-judicial mechanism should be developed for provision of full compensation, which if the patient accepted, no further lawsuit can be filed. This would allow the affected patients to be compensated in a timely manner. Regarding the funding source, we propose to use the health funds model which the government contributes for the public hospital and the private hospitals contribute themselves. The estimation for compensation is about 341-679 million baht per year with an average 5-10 Baht per capita. The discussion by the stakeholders on the topic would allow the facts to be revealed to the public who can then participate in the policy-making process more effectively. One should beware that if the quality of health service delivery system is poor and the problems are mostly caused by complications or the system itself, then the amount of compensation paid for these damages will be higher than the compensation for damages caused by the practitioners and hence this would lead to rising cost. Furthermore, the nofault compensation process should also be protective of the providers reputation and try to give encouragement and feedback in order for them to improve their performance. Keywords: Policy Option, Funds, Medical Injury, health service delivery system (Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

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Title: Working and social life of informal workers and their impact on health: A Case Study of the sewing group of Ban Meng sub-district, Nong Ruea district, Khonkaen province Researcher: Suvit Innamma* *Ban Meng sub-district health center, Nong Ruea district, Khonkaen Abstract The purpose of this study was to explore the quality of working life among the workers in Ban Meng sub-district. This include career initiation, finding jobs to work at home,working environment, and coping with health and other problems concerning informal working condition. It was a qualitative research of which the main data were collected from community survey, observation, interview, and in-dept interview. The study revealed the local value toward the sewing vocation which had been transmitted among people in the community from generations. The condition of employment, which was influenced by economic situation, competition in production supply, and external trading, had stong impacts on the vocational security of the workers through exploitation, negotiation, and resistance regarding employment. These impacts included health and social problems resulting from bad working conditions and environment, as well as imoroper health behaviors. It also found that family, community, and working network were the most important parties that participated in the health care of the workers. This study recommened a model of quality of life improvement among the workers in community. This will be accomplished through group creation, strengthening the capacity of local organizations, community, and other agencies in order to gain a skill in management regarding career, health, and social welfare suitable for each situation and necessity. Key words: informal workers, work at home, health and society (Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010) Title: A flower in the storm : , the case study from experience point of a woman who was the violence repetitiously in a family . Researcher: Bussabong Wisetpholchai * *Naklua Health promotion hospital. Abstract The purpose of this study was to explore the reproduction of violence and patterns of resistance. It was a qualitative research of which the main data were collected from in-dept interview, participation observation and document review. For answer the research questions ,what are the context of cultural and power relationships that the reproduction of violence exist in , how are the meaning of experience and suffering of the abused by the result of community . It was found that the process of repetitious violence in the family caused the resistance that went against the social norms,but it was the only way the individual could reacted, under the terms of structural power were pressed. The findings reveal that patterns of resistance that occurred under the terms of the context of violence that went against the social norms , it might be the only way that individual could reacted under such conditions. Keywords : domestic violence ,repetition of violence, resistance (Published in Journal of Health Systems Research Vol.4 No.3 Jul.-Sep.2010)

VOLUME 4 No.4 Title: Efficiency of Resource Use in the Health Insurance Scheme Researcher: Jadej Thamthajaree* *National Health Security Office Abstract

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This study examined the efficiency of resource use in the three health insurance schemes Universal Coverage (UC), Social Security Scheme (SSS), and Civil Servant Medical Benefit Scheme (CSMBS) - by analyzing length of stay (LOS) and early readmission rate in Diabetes mellitus (DM) patients, used as the tracer for efficiency use of resource and quality of service respectively. The data came from claims that hospitals servicing all three major health insurance schemes have to send for reimbursement. The aim of the analysis was to compare the effects of insurance schemes and other factors on resource use, LOS as a proxy for resource use and on quality as proxied by the readmission rate within days after discharge. The analysis compares three conditions of DM requiring hospital admission: acute complications, chronic complications, and DM without complication to prove that there were no difference of quality of service in patient condition especially acute complication condition. The study found that CSMBS patients had longer LOS than UC and SSS. This implied the efficient use of resource of SSS and UC compared to CSMBS patients. However, SSS had no difference in early readmission within days after discharge while UC had higher rate of readmission in chronic and without complication condition. Key words : length of stay, readmission, universal health coverage system (Published in Journal of Health Systems Research Vol.4 No.4 Oct.-Dec.2010)

Title: Resolution on Managing Overweight and Obesity in the 11th National Economic & Social Development Plan Researchers: Sirinya Phulkerd*, Thaksaphon Thamarangsi* *Office of International Health Policy Program (IHPP) Abstract Obesity is a global epidemic affecting both the developing and developed worlds alike. Overweight and obesity has also been found to be on the rise amongst Thailands male and female population. Moreover this is considered as a leading health risk factor in Thai population. Tackling overweight and obesity in Thailand has lead to the formation of a Resolution on Managing Overweight and Obesity which has finally been endorsed by the National Health Commission, and was also approved as part of the Thai national agenda by the Cabinet in 2010. Meanwhile, the Office of the National Economic and Social Development Board (NESDB) has been developed the 11 th National Economic and Social Development Plan (NESDP) as a strategic plan for national development in the next five years. The aim of this study is to analyze the consistency between the Resolution and the 11th NESDP. The study results will be useful in formulating the National Action Plan for overweight and obesity as well as in reflecting the drafting and approval process of the 11 th NESDP Comparatively, the key approach for the national development of the 11 th NESDP focuses on individual-level defensive approach such as the promotion of education in the Thai population. Meanwhile, not only does the Resolution focus on a defensive approach, but also an offensive approach, with a wide array of regulatory interventions such as tax, pricing, nutrition and food labeling and food marketing restrictions. The strategies of the 11th NESDP, for example trade liberalization, discourage regulatory interventions in curbing overweight and obesity by which unhealthy foods have an increasing access to the market. Though preventive approaches that affect trade agreement and liberalization are proposed, they will be implemented after market access by these foods. It seems clear from literature that the international trade issues need to be considered in the context of public health including improving diets and health education. The implementation of both defense and offense approaches, for example the promotion of education with food and nutrition labeling intervention may increase the effectiveness of improving healthy behaviors.
Key words Resolution on Managing Overweight and Obesity, the 11th National Economic and Social Development Plan, defensive approach, offensive approach, trade liberalization

(Published in Journal of Health Systems Research Vol.4 No.4 Oct.-Dec.2010)

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Title: Indicators and Health Effect Monitoring of People Living Nearby Mae-Moh Power Plant Researchers: Chudchawal Juntarawijit * Akeau Unahalekhaka ** Yuwayong Juntarawijit ** * Faculty of Agriculture, Natural Resources and Environment, Naresuan University ** Faculty of Nursing, Chiang Mai University Abstract Mae-Moh Power Plant and Mae-Moh Coal Mine may cause environmental and health effects. However, at present, there is no surveillance system to monitor health effects of people living nearby the power plant. This study aimed to identify indicators and health impact study to monitor health status of people living nearby the power plant. Coal mining and power plant process were reviewed, together their related pollutants and possible health impacts of each substances. Study on health effects of people living nearby coal-fired power plant was reviewed. Practical health indicators and research methodology were suggested and reviewed by expert and stakeholder. It was found that MaeMoh Coal Mine and Mae-Moh Power Plant might produce several health hazards including air pollutant, water pollution, noise, accidence and nuisance. Health indicator that should be monitored were: 1) emergency room visits, 2) hospital visit and service requested, 3) mortality monitoring, 4) pulmonary function of school children, 5) lung function of adults with respiratory problems, 6) chronic obstructive pulmonary disease cases, 7) pneumoconiosis among coal worker, and 8) stress and annoy due to environmental problems. Key words: health impact, surveillance system, Mae-Moh, power plant, coal mining (Published in Journal of Health Systems Research Vol.4 No.4 Oct.-Dec.2010)

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