Hsri Journal 1 2

1 2 .. - ..
2550
Journal of Health Systems Research

Vol. 1 No. 2 Jul.-Sep. 2007
/Content
97
98
116
132
145
.. 2547
Elderly Health Problem 2547
4 :
3
Vegetables and Fruit Consumption Patterns among
Thai Population across Four Regions and
the Metropolitan Thailand National Health
Examination Survey III
: 4
HIV-clinic Services at Community Hospitals :

Case Studies of 4 Provinces in the Upper-North of
Thailand
Health System during Crisis in Restive Southern Provinces

of Thailand
156
( 1)
National Multicenter Clinic Research System :
Experience Clinical Research Collaboration
Network - CRCN (Part I)
1

1 2 .. - .. 2550
/Content
168
Diabetes in Thailand : Lessons Learned from

Policies of Developed Nations
180
System and Mechanism : Access to Second

Opinion and Public Health Information
190
Challanging Steps in Regional Health System

Research Management : Review of Health System
Research Management in the North
193

Northeastern Migrant Labor : Situation
and Health Issues
1 2 .. - .. 2550
97
1 2 .. - .. 2550
.. 2547
*
**

3, ,
, ,
,

(60 ) 19,372

3 .. 2547

51.6, 25.4 14.8
56.8, 81.5 41.2
12.4, 10.3
26.4
80

* (SPICE project)
**
98
Abstract
Elderly Health Problems 2004

Yawarat Porapakkham*, Junya Plattara-Achachai**
*Setting Priorities using Information on Cost-Effectiveness-SPICE Project, Ministry of
Public Health, **Faculty of Medicine, Thammasat University
Key words:
National Health
Examination Survey III, Thai elderly, health status,
chronic diseases, risk
behaviors, treatment
and control
As part of the National Health Examination Survey III, the objectives of

this study were to determine the health problems of Thai elderly in 4 dimensions; self-reported health status, prevalence of behavioral risks, biological risks
and examine an awareness, treatment and control of the leading chronic
diseases.
The samples of 19,372 respondents aged 60 years and over were drawn
from those included in the multi-staged sample national survey during JanuaryAugust 2004. Methods of data collection were interview, physical examination
and laboratory findings. Descriptive analysis was used to estimate the size of the
conditions and prevalence at the national level, base on standard criteria for diagnosis of chronic diseases and levels of their effective control.
With regard to behavioral risks, prevalence of cigarette smokers decreased
with ages, the rate among males was nine times over that of females. Alcohol
drinking decreased in a small proportion. Insufficient physical activities as well
as fruit and vegetables intakes based on standard criteria were observed at high
rates (80-90percent), increased with advanced ages and the oldest females were
the worst. For biological health risks, anemia and underweight appeared to increase with advanced ages and lower proportion of obese elderly respondents
with advanced age was observed. Selected chronic diseases were hypertension,
hypercholesterolemia and Diabetes Mellitus, of which known as high risks associated with major cardiovascular events for example, stroke, ischemic heart, and
long- termed diabetic consequences.Age-adjusted prevalence of hypertension
were at 51.6 percent, diabetes 14.8 percent and high cholesterol 25.4 percent. While
overall proportion of unawareness of those chronic diseases were reported to be
56.8 percent for hypertension, 41.2 for diabetes and 81.5 percent for high cholesterol. The proportions of those treated and control of blood pressure, blood sugar
and blood cholesterol were12.4, 26.4 and 10.3 percent respectively. Women were
found to be more aware of their illnesses, received treatment with effective control than their men counterparts. An ineffective control group was observed
among the oldest - 80 years and over- of both genders.
In conclusion, there were high prevalence of hypertension and diabetes
in the Thai elderly with high percentage of unawareness and inadequate control
of those treated.Screening program for early detection was essential. Treatments
of these diseases to maintain adequate control should be improved.

1.7 5 .. 2513
5.8 9.5 .. 2543
.. 2568 ( 18 ) 14.6 21 (1,2)

99
1 2 .. - .. 2550

(3,4)

( 1)

-
-
-
(IHD)
Prediabetic (IGT)
BMI
100
3
(15-59 ) (60 )
(Three-stage stratified probability sampling)

15 - 15 .. 2547
Stata 9.0 19,372

(hemoglobin hematocrit)
(fasting blood sugar) (total cholesterol) (5)
1.

(WHS 2002-2003)(6) 5 (1)
(5)

1-3
2.

( 1)
(ethanol)
8-13 (7)
(1) (2)
/ -. (3) conversion factor
4-5 12 40
(4) (specific density) = 0.79
= ( / / )
101
1 2 .. - .. 2550
1 ()
0
> 0 < 40
> 40 < 60
0
> 0 < 20
> 20 < 40
x = 0.79 x conversion factor content

2 (1) 1
(2)
() (never - smokers) () (ex - smokers)

(8,9)

(physical activity)(10)

3 (1)

(2)
(3)

(1)
(2) (3)
Metabolic
Equivalent Time (MET) (10) 1 MET = 1 kcal/kg/.
102
(1) (2)
(3) (4)
1 6 - 8
1 1 1 4 1
(250 .) 1/2
1
1/2 (1 = 250 . 1 ) 1 1
1/2
()
12 .
3 / 2 = 2
1/2 = 1 = 3
3.
2 (BMI) (waist
circumference) (11,12)

2
(
2)
2 -
- ()
-
-
-
(Central obesity)
(BMI kg/m2)
< 18.5 kg/m2
* 18.5 < 25 kg/m2
> 25 ) 30 kg/m2
> 30 kg/m2
()
* 90
* 80
103
1 2 .. - .. 2550

0.05
.. 2547
1.

60
24.0 37.3
2 ( 3)
1.
/
2.
/
/
3.

/
4.
60-69
(5,323)
70-79 80+ 60-69 70-79 80+

(3,372)
(690) (9,385) (5,635) (3,574) (709) (9,918)
13.8
18.0
22.2
28.4
36.6
51.3
19.5
25.8
21.6
29.4
32.0
45.3
49.7
62.0
29.5
39.7
19.9
11.3
26.2
15.3
35.6
23.8
24.0
14.3
31.9
20.0
39.8
23.9
49.6
32.1
37.3
23.2
8.8
9.6
10.3
12.5
14.3
18.3
10.0
11.7
14.8
17.1
18.8
20.3
20.6
21.2
17.0
18.8
4.3
7.3
19.5
7.3
6.3
11.0
22.4
10.4
5.9
8.2
13.3
7.6
10.3
11.9
18.7
12.2
104
2.

50.8 36.3 22.0 70-79 80
18.9, 12.6 10.0 ( 4)
1
( 20 40 ) 6069 5.2 ( 4)
42.6 9
5.5 (60-69 ) 80 ( 5)
10 9
70-79 80
5-6
(5)

90 67
80 2
60-69
70-79
80
49.2
43.0
5.2
2.6
63.7
31.2
2.4
2.7
78.0
18.4
1.0
2.6
5,274
81.1
16.0
1.0
1.9
5,568
105
3,346
87.4
10.5
0.7
1.4
3,546
685
90.0
8.8
0.6
0.6
699
1 2 .. - .. 2550
60-69
70-79
7,301
9,394
9,419
9,068
50.8
44.8
8.5
83.8
36.3
40.8
15.1
87.6
80+
22.0
32.5
33.0
89.6
43.7
42.6
12.7
85.1
3,167
9,931
9,953
9,510
60-69
70-79
80+
18.9
5.5
14.5
82.8
12.6
5.8
28.6
87.6
10.0
3.4
51.7
89.4
16.2
5.5
22.2
85.0
14.5, 28.6 51.7 60-69 70-79 80 ( 4)
1
12 (13)

5 400 80-90
60-69 70-79 80
99
3.

(14) 140
90
52.2 50.7
60-69

106
60-69
70-79
47.3
20.2
13.8
24.6
52.2
16.1
12.3
36.1
80+
60-69
70-79
80+
59.4
15.8
10.1
51.8
50.7
18.4
12.7
30.4
48.1
32.8
18.9
33.6
54.2
30.3
15.7
42.3
61.8
27.4
9.2
56.1
52.2
31.1
16.1
37.6
51.6
25.4
14.8
36.4
47.3 59.4 80 48.1 61.8 80

( 6)
240 mg/dl (5.7
mmol/l)
31.1 18.4
60-69 80 27.4 15.8

(15,16) Fasting Blood Sugar
(FBS) 126 mg/dl
12.7 16.1
60-69 13.8 18.9
10.1 80
80 9.2
(Hct)
(Hb) Hct < 39%, Hb < 13 gm% Hct < 36%, Hb < 12
gm% 30.4 37.6
10 60-69 70-79
80
4.

()
( 7)
107
1 2 .. - .. 2550

(BMI >30 kg/m2)
(BMI <18.5 kg/m2)

1

- 20
-
60-69
70-79
9,366
9,366
9,366
9,419
9,419
2.9
21.1
14.1
81.4
35.7
1.7
16.0
22.6
86.4
38.8
1
10.6
31.6
91.5
42.2
2.3
18.5
18.1
85.2
39.8
9,873
9,873
9,873
9,953
9,953
8.6
47.1
12.1
88.9
43.7
5.4
38.2
19.1
91.1
48.1
2.5
27.8
34
94.1
44.2
7.0
42.5
16.1
90.5
48.4
5,377
5,751
37.1
26.3
49.6
28.4
63.3
34.2
44.5
28.1
5,751
5,751
34.5
26.1
51
28.3
66
26.6
44.7
26.9
80+
60-69
70-79
80+
2.3 7.0
(60-69 ) 2.9 8.6
1 2.5 (80 )
( 7)

18.5 42.5

(< 18.5 kg/mm2)
18.1 16.1
(17,18)
7-8
11
90.5
85.2 5 ( 7)
7 2(17)
(18)
108
60-79
(p > 0.05)
1

60 39.8 48.4
2-3 60

5.

3

4
(1) (2) (3)
(4)

140 90
56.8 ( 50)
80
( 2)
5-6
20-23 26-30 70-79
( 28) 10
15 80 ( 2)

(total cholesterol) 240
80-90
10
10 10
109
1 2 .. - .. 2550
100
90
80
70
60
50
40
30
20
10
0

Fasting Blood Sugar (FBS) 126
41
46.9 37.7
6 27
26
60-69
80 57.1 58.7
5.7
20.9, 22.6 23.4 60-69 70-79
80 30.2, 30.4 20.0
60-69
60-69
29.0 ( 2)
110

3 (1)
(2) (3)

7 10

80 35.6 49.6

50.8 36.3 22.0 70-79 80
18.9, 12.6 10.0 5.2
(60-69 ) 42.6 9 (5.5%)
9-10
5-6

90
2 5
400 80-90
(60-69 )
80

111
1 2 .. - .. 2550

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20
20
45 27-28
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16 28 81.5
10 (3) 12.7 16.1
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80

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(22)
(23)
(24)

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112
) (24,26-29)

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1. . .. 2513-2543. :
; 2543.
2. , . ..
2543-2568. : ; 2546.
113
1 2 .. - .. 2550
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, , , , , .
: .
: ; 2545.
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. Healthy Thailand 2548-2550. :
; 2548.
115
1 2 .. - .. 2550
4 :
3
*
*
**
*
:
, ,
,

4
3 2546
2547 39,290 * 15

Wilcoxon rank-sum test Kruskal-Wallis test
0.05 5.97 4.56

1.78
( = 1.14), 1.46 ( = 1.00), 3.24 ( = 2.86)

4 (p < 0.05)

26.9, 35.4 26.6

*
**
116

Abstract
Vegetables and Fruit Consumption Patterns among Thai Population across

Four Regions and the Metropolitan: Thailand National Health Examination Survey III
Warapone Satheannoppakao* Rewadee Chongsuwat* Wichai Aekplakorn**
Mandhana Pradipasen*
*Department of Nutrition, Faculty of Public Health, Mahidol University, **Community
Medicine Center, Faculty of Medicine Mahidol University
Key words:
vegetables, fruit,
consumption patterns, National
Health Examination Survey
The objective was to examine vegetables and fruit consumption patterns

among Thai population across four regions and Bangkok. This study was a part
of the National Health Examination Survey III in Thailand conducting between
2003 and 2004. A total of 39,290 individuals aged * 15 years were interviewed by
using a set of questionnaire including information on sociodemographic and
vegetables and fruit consumption. Employing descriptive statistics, Wilcoxon
rank-sum test and Kruskal-Willis test at 0.05 level of confidence. The findings
demonstrated that overall, an individual had average frequencies of vegetables
and fruit consumptions equal to 5.97 and 4.56 day per week, respectively. Individuals living in the Central and Northeastern regions had the highest number of
days per week for vegetables consumption, while those living in Bangkok had
the highest number of days for fruit consumption. On average, numbers of
servings of vegetables, fruit, and both vegetables and fruit consumed a day were
1.78 (median = 1.14), 1.46 (median = 1.00), 3.24 (median = 2.86), respectively.
People in Bangkok ate more vegetables, fruit, and both vegetables and fruit than
those in other regions. There were significantly differences in median number of
days per week and the amount of servings per day for vegetables and fruit consumed across four regions and the metropolitan (p< 0.05). Proportion of individuals who met the recommendation for vegetables, fruit, and both vegetables
and fruit consumptions were 26.9 percent, 35.4 percent, and 26.6 percent, respectively. In conclusion, frequencies and amount of vegetables and fruit consumptions in Thai people varied by regions of residence. Majority of Thais had an
inadequate daily amount of vegetables and fruit consumption.

(1-10)
(phytochemicals)

2.7
(11)

(11)
3 2529(12) 4 2538(13)
106 1.33 113 1.42 (
80 1 )(14) 85 1.06
77 0.96

117
1 2 .. - .. 2550
3 (cross-sectional survey) 2546 2547

(.) (.)
15 59
60 (Stratified three
stage cluster probability sampling) (1) (2)
(3)

4 4

(validity) (reliability)

( )
(Semi-quantitative food-frequency questionnaire) ()
1 12 /
/ 1
1 1 1
1 1 1
118
6-8 1 1 1
4 1 1 1
(1)
1 1 (2)
1 ( 250 )
.. 2547

KruskalWallis test
4
Wilcoxon rank-sum test 2
Kruskal-Wallis test p < 0.05
() 4

* 5 (15) * 3
* 2
39,290 48.2 51.8

( 1) 39.80 60-69 (
28.0) * 80 ( 3.6)
4
45-59 60-69
2 3 ///
90
119
1 2 .. - .. 2550
1 39,290
()
6,391 (48.2)
6,458 (51.8)
12,849 (100.0)
4,605 (49.5)
4,772 (50.5)
9,377 (100.0)
4,341 (48.9)
4,605 (51.1)
8,946 (100.0)
2,704
3,074
5,778
(48.8) 893 (46.6)

(51.2) 1,447 (53.4)
(100.0) 2,340 (100.0)
()
15-29
30-44
45-59
60-69
70-79
* 80
x
SE
1,255 (9.8)
2,557 (19.9)
2,653 (20.7)
3,739 (29.1)
2,203 (17.1)
442 (3.4)
12,849 (100.0)
40.57
0.253
999 (10.6)
1,895 (20.2)
1,856 (19.8)
2,663 (28.4)
1,592 (17.0)
372 (4.0)
9,377 (100.0)
38.82
0.249
816 (9.1)
1,794 (20.1)
1,799 (20.1)
2,471 (27.6)
1,728 (19.3)
338 (3.8)
8,946 (100.0)
40.96
0.326
680
1,148
1,048
1,566
1,135
201
5,778
(11.8)
(19.9)
(18.1)
(27.1)
(19.6)
(3.5)
(100.0)
39.14
0.517
235 (10.0)
3,985 (10.1)
539 (23.0)
7,933 (20.2)
644 (27.5)
8,000 (20.4)
549 (23.5) 10,988 (28.0)
315 (13.5)
6,973 (17.7)
58 (2.5)
1,411 (3.6)
2,340 (100.0) 39,290 (100.0)
40.19
39.80
0.439
0.150
///
1,496 (11.6)
8,706 (67.8)
2,641 (20.6)
12,843 (100.0)
966 (10.3)
6,500 (69.3)
1,908 (20.4)
9,374 (100.0)
898 (10.0)
6,116 (68.4)
1,928 (21.6)
8,942 (100.0)
664
3,902
1,177
5,743
(11.6)
(67.9)
(20.5)
(100.0)
385 (16.5)
1,555 (66.5)
398 (17.0)
2,338 (100.0)
4,409 (11.2)
26,779 (68.3)
8,052 (20.5)
39,240 (100.0)
12,569 (97.9)
101 (0.8)
173 (1.3)
12,843 (100.0)
9,255 (98.8)
103 (1.1)
5 (0.1)
9,363 (100.0)
8,837 (98.9)
76 (0.8)
25 (0.3)
8,938 (100.0)
5,160
16
562
5,738
(89.9) 2,167 (92.7)

(0.3)
32 (1.4)
(9.8) 138 (5.9)
(100.0) 2,337 (100.0)
37,988 (96.9)
328 (0.8)
903 (2.3)
39,219 (100.0)
1,157 (9.1)
8,819 (69.0)
2,254 (17.6)
546 (4.3)
12,776 (100.0)
563 (6.1)
6,691 (72.1)
1,527 (16.5)
495 (5.3)
9,276 (100.0)
1,369 (15.4)
5,692 (63.8)
1,424 (16.0)
429 (4.8)
8,914 (100.0)
559
3,629
1,136
401
5,725
(9.8)
(63.4)
(19.8)
(7.0)
(100.0)
3,822 (9.8)
26,118 (66.9)
6,945 (17.8)
2,135 (5.5)
39,020 (100.0)
120
174 (7.5)
1,287 (55.3)
604 (25.9)
264 (11.3)
2,329 (100.0)
18,934 (48.2)
20,356 (51.8)
39,290 (100.0)
1 () 39,290
320 (4.3)
3,138 (42.1)
123 (2.8)
1,646 (37.7)
1,586
365
38
582
(21.3)
(4.9)
(0.5)
(7.8)
53 (0.7)
1,374 (18.4)
7,456 (100.0)
650
339
29
808
(14.9)
(7.7)
(0.7)
(18.5)
56 (1.3)
716 (16.4)
4,367 (100.0)
()
204 (4.3)
1,766 (37.1)
990
280
34
656
(20.8)
(5.9)
(0.7)
(13.8)
65 (1.3)
769 (16.1)
4,764 (100.0)
99 (3.0)
1,116 (33.5)
415
241
6
59
(12.4)
(7.2)
(0.2)
(1.8)
37 (3.2)
492 (42.4)
783 (3.7)
8,158 (38.7)
400
91
19
21
4,041
1,316
126
2,126
(34.5)
(7.9)
(1.6)
(1.8)
(19.2)
(6.2)
(0.6)
(10.1)
7 (0.2)
1,390 (41.7)
3,333 (100.0)
9 (0.8)
91 (7.8)
1,160 (100.0)
190 (0.9)
4,340 (20.6)
21,080 (100.0)
< 10,000
6,784 (52.9)
10,000-24,999
4,120 (32.1)
25,000-49,999
940 (7.3)
> 50,000
367 (2.9)
613 (4.8)
12,824 (100.0)
x
13,998.30
SE
911.462
6,864 (73.3) 6,517 (72.9)

1,503 (16.1) 1,410 (15.8)
432 (4.6)
372 (4.2)
170 (1.8)
137 (1.5)
390 (4.2)
504 (5.6)
9,359 (100.0) 8,940 (100.0)
6,614.13
7,360.49
334.397
437.959
2,535 (44.2)
1,347 (23.5)
284 (5.0)
108 (1.9)
1,459 (25.4)
5,733 (100.0)
11,190.82
586.138
615 (26.3)
783 (33.5)
317 (13.6)
205 (8.8)
416 (17.8)
2,336 (100.0)
23,305.03
1,633.606
23,315 (59.5)
9,163 (23.4)
2,345 (6.0)
987 (2.5)
3,382 (8.6)
39,192 (100.0)
10,175.66
400.094
4,651 (49.6)
4,726 (50.4)
9,377 (100.0)
2,743 (47.5)
3,035 (52.5)
5,778 (100.0)
2,340 (100.0)
0 (0.0)
2,340 (100.0)
20,617 (52.5)
18,673 (47.5)
39,290 (100.0)
6,453 (50.2)
6,396 (49.8)
12,849 (100.0)
4,430 (49.5)
4,516 (50.5)
8,946 (100.0)
10,176
23,305 ,

121
1 2 .. - .. 2550
5.971.699 ( 1)

70
( 2)
7
6
5
5.84 5.8
5.77
6.14 6.03 6.11 6.09 5.98 5.97 6.03

6.03
6.06
5.95
4
3
:

4
(p-value < 0.05)
2
1
0
../.
1
80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
3
4
5

122
()
4.562.166
3 40
( 4)
( 3)
6
4.71
4.57 4.71
4.43
4.35 4.71
3.99
4.94 5.04
4.41 5.1
4.12
4
(p < 0.05)
2
1
0
4.79
../.
3
45
40
35
30
25
20
15
10
5
0
4
5

123
1 2 .. - .. 2550
4
(p < 0.05)

2 (Mean) (Standard deviation; SD) (Median)
1.781.298 (Median = 1.14)
(* 3 )
(Mean = 1.891.314; Median = 1.71)

4
(Mean = 2.251.494; Median = 2.00)
4 (p < 0.05)
1.461.245 (Median = 1.00)
(* 2 )
4 1.661.193 (Median = 1.43) 1.191.091 (Median =
0.86) 4

(p < 0.05)

3.242.079 (median = 2.86) * 5
(mean = 3.362.205; median =
2.86) (mean = 2.831.847; median
= 2.29)
(mean = 4.03; SD = 2.442; median = 3.71)
4 (p < 0.05)
, ,
1 4 * 3
( 3) 4

( 41.0)
124
125
a,b,c,d
(Median) (p<0.05)
(Median) (p<0.05)
1,2,3,4,5
(Median) (p<0.05)
: [(A,B,C,D,E), (a,b,c,d), (1,2,3,4,5)] (Median)
(p<0.05)
A,B,C,D,E
5,799 5,731 11,530 4,367 4,350 8,717 4,023 4,108 8,131 2,578 2,807 5,385 2,220 35,983
3.44 3.28
3.36
2.90
2.76
2.83
3.42
3.18
3.30
3.20
3.20
3.20
4.03
3.24
2.246 2.161
2.205 1.853 1.839 1.847 2.178 1.998 2.092 1.727 1.898 1.818 2.442 2.079
A
a
2.861 2.43B 2.14b 2.292 3.00A,C 2.71a,c 2.861,3 3.00A,C,D 2.86a,c,d 3.001,3,4 3.71E,5 2.86
3.00 2.86
n
Mean
SD
Median
5,999 5,900 11,899 4,454 4,456 8,910 4,121 4,203 8,324 2,635 2,888 5,523 2,268 36,924
1.60 1.50
1.55
1.28
1.09
1.19
1.53
1.30
1.41
1.68
1.64
1.66
1.78
1.46
1.338 1.297
1.319 1.113 1.059 1.091 1.282 1.170 1.232 1.154 1.227 1.193 1.360 1.245
A
a
1.001 1.00B 0.86b 0.862 1.00C 1.00c 1.003 1.43D 1.29d 1.434 1.43D,E,5 1.00
1.14 1.00
n
Mean
SD
Median
6,124 6,069 12,193 4,526 4,580 9,106 4,223 4,345 8,568 2,655 2,907 5,562 2,279 37,708
1.85 1.79
1.82
1.63
1.66
1.64
1.90
1.88
1.89
1.51
1.57
1.54
2.25
1.78
1.396 1.354
1.375 1.153 1.207 1.180 1.334 1.294 1.314 1.013 1.179 1.103 1.494 1.298
A
a
1.291 1.00B 1.00b 1.002 1.71C 1.71c 1.713 1.00D 1.00d 1.004 2.00E,5 1.14
1.43 1.29
n
Mean
SD
Median
2 () 39,290

4,662 4,696 9,358 3,775 3,687 7,462 3,202 3,275 6,477 2,269 2,409 4,678 1,433 29,408
(67.1) (71.4) (70.0) (79.5) (75.8) (76.4) (70.3) (71.4) (71.2) (80.5) (76.8) (77.6) (59.0) (73.1)
1,791 1,700 3,491
876 1,039 1,915 1,228 1,241 2,469
474
626 1,100
907 9,882
(32.9) (28.6) (30.0) (20.5) (24.2) (23.6) (29.7) (28.6) (28.8) (19.5) (23.2) (22.4) (41.0) (26.9)
126
* (Being weighted)
(/)
<5
4,499 4,594 9,093 3,748 3,806 7,554 3,151 3,350 6,501 2,080 2,256 4,336 1,492 28,976
(64.8) (70.5) (68.7) (78.5) (79.7) (79.6) (67.9) (72.2) (71.4) (73.5) (72.2) (72.5) (63.5) (73.4)
*5
1,954 1,802 3,756
903
920 1,823 1,279 1,166 2,445
663
779 1,442
848 10,314
(35.2) (29.5) (31.3) (21.5) (20.3) (20.4) (32.1) (27.8) (28.6) (26.5) (27.8) (27.5) (36.5) (26.6)
(/)
<2
3,766 4,033 7,799 3,297 3,606 6,903 2,728 3,141 5,869 1,494 1,787 3,281 1,289 25,141
(54.8) (61.1) (59.0) (69.3) (73.7) (73.0) (58.2) (66.4) (64.8) (52.9) (55.9) (55.1) (57.2) (64.6)
*2
2,687 2,363 5,050 1,354 1,120 2,474 1,702 1,375 3,077 1,249 1,248 2,497 1,051 14,149
(45.2) (38.9) (41.0) (30.7) (26.3) (27.0) (41.8) (33.6) (35.2) (47.1) (44.1) (44.9) (42.8) (35.4)
(/)
<3
()
3 *
1 2 .. - .. 2550
1 3 * 2
( 44.9)

5
1 4 ( 26.6)
( 36.5)

5
1.1,
1.2, 1.2
50
40
30
41.3
29.5
26.1 26.9
33.4 35.4
30.9
25.1 26.6
20
10
0
( 4)
( 34.9, 73.2, 48.2 ) (
9.1, 17.1, 15.0, )
15
2 3
10,176 2 3

127
1 2 .. - .. 2550
) 6
7
(/)
<3
*3
90.9
9.1
12,931
65.1
34.9
26,359
(/)
<2
*2
82.9
17.1
25,453
26.8
73.2
13,837
(/)
<5
*5
85.0
15.0
10,492
51.8
48.2
11,398

(weight)

3 .. 2529(12) 4 .. 2538(13)
.. 2529
1.33, 1.06, 2.40 (12) .. 2538 1.42,
0.96 2.38 (13) 5
.. 2546(16) 24
128
0.28, 0.88,
1.16
(semiquantitative food-frequency questionnaire)
1
1.78, 1.46 3.24
4
5.97 4.56

1 ( 70)

4

(vegetables
and fruit availability)

( 27)

Joshipura (1)
(coronary heart disease)
126,399 The Nurses Health Study The
Health Professionals Follow-Up Study 1
4
5 12(2)

129
1 2 .. - .. 2550
(4) (5) (6)

(7,8) (2,7) (7)
70

1. Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rlmm EB, Spelzer FE, et al. The effect of fruit and vegetable intake
on risk for coronary heart disease. Ann Intern Med 2001; 134: 1106-14.
2. Hung HC, Joshipura KJ, Jiang R, Hu FB, Hunter D, Smith-Warner SA, et al. Fruit and vegetable intake and risk of
major chronic disease. J Natl Cancer Inst 2004; 96: 1577-84.
3. Djousse L, Arnett DK, Coon H, Province MA, Moore LL, Ellison RC. Fruit and vegetable consumption and LDL
cholesterol: the National Heart, Lung, and Blood Institute Family Heart study. Am J Clin Nutr 2004; 79: 213-7.
4. Pavia M, Pileggi C, Nobile CGA, Angwlillo IF. Association between fruit and vegetable consumption and oral cancer:
a meta-analysis of observational studies. Am J Clin Nutr 2006; 83: 1126-34.
5. Ahn J, Gammon MD, Santella RM, Gaudet MM, Britton JA, Teitelbaum SL, et al. Associations between breast cancer
risk and catalase genotype, fruit and vegetable consumption, and supplement use. Am J Epidemiol 2005; 162: 943-52.
6. Michels KB, Giovannucci E, Chan AT, Singhania R, Fuchs CS, Willett WC. Fruit and vegetable consumption and
colorectal adenomas in the Nurses Health Study. Cancer Res 2006; 66: 3942-53.
7. Genkinger JM, Platz EA, Hoffman SC, Comstock GW, Helzlsouer KJ. Fruit, vegetable, and antioxidant intake and allcause, cancer, and cardiovascular disease mortality in a community-dwelling population in Washington County, Maryland.
Am J Epidemiol 2004; 160: 1223-33.
8. Hertog MGL, Bueno-de-Mesquita H, Fehily AM, Sweetnam PM, Elwood PC, Kromhout D. Fruit and vegetable
consumption and cancer mortality in the Caerphilly study. Ca Epidemiol Biomark & Prev 1996; 5: 673-7.
9. Christen WG, Liu S, Schaumberg DA, Buring JE. Fruit and vegetable intake and the risk of cataract in women. Am J
Clin Nutr 2005; 81: 1417-22.
10. Tucker KL, Hannan MT, Chen H, Cupples LA, Wilson PW, Kiel DP. Potassium, magnesium, and fruit and vegetable
intakes are associated with greater bone mineral density in elderly men and women. Am J Clin Nutr 1999; 69: 727-36.
11. World Health Organization. The world health report 2002: Reducing risks, promoting healthy life. Geneva: World Health
Organization; 2002.
12. Nutrition division department of Health Ministry of Public Health, School of Public Health Mahidol University. The third
national nutrition survey of Thailand, 1986. Bangkok: The War Veterans Organization of Thailand; 1995.
13. . 4 .. 2538.
: ; 2538.
14. Lock K, Pomerleau I, Causer L, et al. Low fruit and vegetable consumption In: Ezzati M, editors. Comparative
quantification of health risks, global and regional burden of disease attributable to selected major risk factors. Geneva:
WHO; 2004.
130
15. World Health Organization. Fruit and vegetable promotion initiative: a meeting report. WHO Fruit and Vegetable
Initiative Expert Meeting; 25-27 August 2003; Geneva. Swisszerland: World Health Organization; 2003.
16. . 5
.. 2546. : ; 2549.
131
1 2 .. - .. 2550

: 4
*

#
/

4

44 1 ..2547 ..2548
(30 ) 30
(60 ) 9 ( 90 ) 5
/ 106 (
25 - 333 ) 20 ( 45.5)
100 95

35 ( 4 -
80 ) 1
Population Council
132
:
, ,
,
,

Abstract
50
1 13 ( 29.5)
1

/

HIV-clinic Services at Community Hospitals: Case Studies of 4 Provinces in

the Upper-North of Thailand
Suwat Chariyalertsak*, Peninnah Oberdorfer , Jiraporn Suwantherangoon ,
Darawan Thapinta, Philip Guest#
*The Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand,
Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand,
Department of Community Medicine, Faculty of Medicine, Chiang Mai University, Chiang

Mai, Thailand,
Department of Psychiatric Nursing, Faculty of Nursing, Chiang Mai University, Chiang Mai,
Thailand,
#
Population Council, Bangkok, Thailand
Key words :
HIV, AIDS, Anti
Retroviral Therapy
(ART), ARTS clinic,
health personnel
This study was aimed to describe the development of HIV-clinic services

for HIV/AIDS patients in community hospitals and perceived needs of health
manpower resource development responsible for HIV-clinic services under the
National Access to Antiretro-viral Programs for People Living with HIV/AIDSNAPHA. Survey questionnaires were sent to 44 hospitals of 4 provinces in the
Upper-north namely ; Chiang Mai, Chiang Rai, Lampang, and Lamphun which
were the hospitals involved in the reducing drop-outs and increasing adherencerate among the beneficiaries of the project. The questionnaire was answered by a
nurse who was responsible for HIV-clinic service in each hospital between
December 2004 and January 2005. Descriptive statistics and content analysis were
used.
The findings revealed that among all community hospitals participating
in this survey, 30 were 30-bed (small) sized hospitals, 9 were 60-bed (medium),
and 5 were large sized hospitals with 90 beds or more. The mean of total HIVinfected clients was 106 cases per hospital (minimum: 25, maximum: 333). Among
all of the hospitals, 20 (45.5%) took care of more than 100 HIV-infected clients in
each of them. Most hospitals (95%) set up their HIV-clinic services separately
from the outpatient departments. The number of service days varied according
to the hospital size and number of clients. On average, the number of HIV-infected clients receiving ART services was 35 cases per service day (minimum: 4,
maximum: 80); and an additional 50 new cases per hospital were expected to be
recruited for anti-retroviral therapy within the next 1 year. All hospitals had one
or more counseling nurse for ARV services; 13 hospitals (29.5%) reported having
only one counseling nurse. To reduce the workload of health personnel, all hospitals had volunteers, who had HIV/AIDS, helping in providing service in HIVclinics. The main problems, calling for urgent solutions, were reported to be a
lack of health manpower responsible for the HIV-clinic services, an ongoing educational training for health care workers on ARV treatment, sufficient ARV drug
supply in the hospitals, and policy to support the volunteers to work in HIVclinic services with health care providers in hospitals.
133
1 2 .. - .. 2550
Human Immunodeficiency Virus (HIV)

/ .. 2524 - 2545
42 3 (1)
.. 2527 30
.. 2548 362,768 86,923 (2)
/

/
.. 2545
3 2548(3)
/
3 .. 2543 2545
GPO-Vir 2547
/
(National Access
to Antiretroviral Programs for People Living with HIV/AIDS - NAPHA)
50,000 2547
900
80
/
60,547 .. 2548
2,0003,000 (4)
3-4

/

/ 4
134
(cross sectional study)

.. 2547 .. 2548 4
44

*

2

/

1

44 1
1.
44 15 13
*

10
Horizons Program, The Population Council
135
1 2 .. - .. 2550
(%)
30
60
90 - 150
9
7
10
4
30 (68.2)
3
4
1
1
9 (20.5)
3
2
5 (11.4)
15
13
11
5
44
11 5 (30 )
68.2 (60 ) 20.5 (90 ) 11.4 ( 1)
2.
(93.2 %) /

2

150 1
2 /

3.
41

2

1
2 ( 2)
136
30
60
90 - 150
(n = 28*)
(n = 9)
(n = 4)
3 1 .
1
6
2
3
5
4
9
3
8
2
2
-
1
1
6
1
-
1
1
1
1
5
10
3
14
2
3
3
1
* 2
106 (25 - 333 )

20 (45.5%) 100
250
100 84
32 - 36
/ 1
106 39
3
3 /
/
30
60
90
SD
SD
SD
SD
( - )
( - )
( - )
( - )
83.9 40.2
(25 - 206)
36.5 16.3
(10 - 80)
39.0 22.7
(10 - 100)
SD = Standard deviation
137
100.6 43.2
(46 - 165)
34.4 12.9
(15 - 50)
63.5 40.1
(15 - 120)
250.0 95.6
(95 - 333)
32.2 17.6
(11 - 50)
106.0 56.4
(50 - 200)
106.2 71.0
35.6 15.5
51.3 37.7
1 2 .. - .. 2550
4.

80
1-2 1
73.3 1-2 76.6
1-3
55.5
1-2 1-2
4

/
44

/
60
22.2 26.7 1
2-3 46.7 44.5
20.0
6 16.6 ( 4)

83.7
1 9.3 2
138
(%)
30
60
90
8 (26.7)
19 (63.3)
3 (10.0)
4 (44.5)
3 (33.3)
2 (22.2)
1 (20.0)
3 (60.0)
1 (20.0)
7 (23.3)
18 (60.0)
5 (16.7)
4 (44.5)
3 (33.3)
2 (22.2)
1 (20.0)
4 (80.0)
-
8
14
3
5
2 (22.2)
4 (44.5)
3 (33.3)
-
3 (60.0)
1 (20.0)
1 (20.0)
-
1
2
1
2-3
1
2-3
4-5
6-10
(26.7)
(46.7)
(10.0)
(16.6)
5. /
//

24.6 17.5 5.4
/
3
6.
(Global Fund)

5.7 6.7 9.6
7.

/ 80
139
1 2 .. - .. 2550

19 (43%) 27 (61%)
8.

-
-

-
/
1)
2)
3) //

4)

5)

3-4

/

(5-6)

/ 3-4
140

.. 2548
NAPHA 73,507 10
( 6 ) 10,377 (14%)
.. 2545
3-4 3-4 (7)

(8)

90
1 5-10
141
1 2 .. - .. 2550

/

/(9)

/ 1
1 4 /
3

(10)
80

/

(11)
/
142

/ 1

/

4
44
143
1 2 .. - .. 2550
1. Global situation of the HIV/AIDS epidemic, end 2004. Wkly Epidemiol Rec 2004; 79(50):441-9.
2. . :
. : ; 2548.
3. World Health Organization. The WHO strategy : treating 3 million by 2005 : making it happen. France: 2003.
p. 9-11.
4. . . 2548; 6:214-6.
5. Chequer P, Hearst N, Hudes E, Castilho E, Rutherford G, Loures L, et al. Determinants of survival in adult
Brazilian AIDS patients, 1982-1989. AIDS 1992; 6:483-7.
6. , , , , ,
. CD4 200 cell/mm3
. 2548; 31:184-92.
7. ARV NAPHA 2548. [online] 2007 [cited 2007
Mar 24]. Available from URL: http://www3.easywebtime.com/demo010/chart1.htm
8. , , , .
50,000
. 2548; 17:129-46.
9. Kitahata MM, Koepsell TD, Deyo RA, Maxwell CL, Dodge WT, Wagner EH. Physicians experience with the
acquired immunodeficiency syndrome as a factor in patients survival. N Engl J Med 1996; 334:701-6.
10. , , , .
(PCU)
6 . 6 2548; 2(1): 82-97.
11. , .
. 2004;
13: 632-41.
144
1 2 .. - .. 2550
:
,
,

\
2547 2550

2547 2549 5,460
1,730 2,513
22 (.) 31

.

* ,
145
Abstract
1 2 .. - .. 2550
Health System during Crisis in Restive Southern Provinces of Thailand

Pongthep Sutheravut*, Amorn Rodklai, Suwat Wiriyapongsukit, Supat
Hasuwannakit
*South-Health Systems Research Institute, South Branch of National Health Security
Office, Thepha Hospital, Songkhla Province, Chana Hospital, Songkhla Province
Key words:
crisis, health system, southern provinces
The violence in the Southern provinces in Thailand took a toll on physical, psycho-social and spiritual health. Data collection began from March 2004
to March 2007 using questionnaires, face to face interview including group seminars and brainstorming sessions. It was found that the frequency of chaotic events
occured 5,460 times during January 2003 to August 2006. About 1,730 have been
killed and 2,513 injured. These victims included 22 health workers and 31 health
volunteers.
In the prime of the violence, every single hospital has prepared itself to be
ready to cope with those crises. Health workers, for example, suddenly changed
their behaviors substantially such as adjusting their work schedules, not
wearing uniform, taking more precautions, decreasing or avoiding their proactive roles in field works, particularly health promotion and health prevention.
These were remarkable changes in health care roles which would have long term
serious effects on the communitiy health. In addition, security in hospitals has
been tightened while stocks of food became critically necessary. Some local health
offices rearranged their teams by having village health volunteers working closely
with their health officers. These actions could boost their morale and ensure
their safety. Community faith in them and being natives inspired health workers
to remain in their posts.
It was interesting that the number of cases of out-patient and in-patient
departments had not changed much but the number of patients visiting local
health offices clearly decreased. Nevertheless, the number of patients in labor
departments increased and the chronic disease cases increased as well. Besides,
the number of cases with psychosis or having mental problems sharply increased.
Eventhough, the turn over and replacement of health workers became even but
the lack of medical specialists in some areas remained. Number of registered
nurses would become the major concern in the near future if the violence is not
restrained.
The crisis dictates requirements on short-term measures to focus on security, life protection, creating the supporting systems about counseling, referring,
transferring and maintaining the systems. In the long run, measures include
peace restoration, then, create health participatory system of people in communities, self-care system and enhance effectiveness of health system. It should be
concerned about the opportunity to build Muslim medical curriculum and
agenda. Having a specific team work to monitor the situation closely, connecting and communicating with the government and developing the participatory
management of data system and solving the problem may gradually decrease
the violence. In addition, research and development on the consequences of the
health system of the restive southern provinces are required in order to cope
with the drastic change.
146

2547- 2550
(Intellectual Deep South Watch)
(.)

(
) 1 4 27
2 - 2547
3
12-15 1 12
- 2547

.. 2547
147
1 2 .. - .. 2550
1. : (1)

32 .. 2547 .. 2549
5,460 2,074 1,656 1,412
318
32
1,730 2,513
4,243 1
350
316
300
200
211
198
150
100
50
0
134
87
41
91
180
92
56
90
129
77
134
114
165
145 157
173
171
131
125
100
99
116
152
131
146
124
131
91
38
. 47
. 47
. 47
. 47
. 47
. 47
. 47
. 47
. 47
. 47
. 47
. 47
. 48
. 48
. 48
. 48
. 48
. 48
. 48
. 48
. 48
. 48
. 48
. 48
. 49
. 49
. 49
. 49
. 49
. 49
. 49
. 49
250
1 2547 2549

(2) 5,381
1
(3) 2549
22 31 ( 2)
148
1 (
)
..
2545
2546
2547
2548
2549
2550
6
35
869
1,087
1,114
69
3,180
13
36
435
893
689
25
2,091
1
0
44
23
42
0
110
20
71
1,348
2,003
1,845
94
5,381
: 20 2550
2
:

5 .
5
4
4
2
15
4
1
2
0
7
3
1
4
0
8
9
3
11
0
23
: 2549
2. (4)

8.00-16.00 .
149
1 2 .. - .. 2550

(service mind) exit nurse

.
3.

3 (4)

(refer case)

150
/
70.0
60.0
60.0
55.0
50.0
25.0

18.00 .

(5)

2549

( 3)

3.42 2545 3.26 2547

151
1 2 .. - .. 2550
72
23
51
786
5
2
1
5
2
1
2
30
63
20
48
751
80
16
42
737
13
8
5
5
59
11
36
737
101
41
67
243
16
2
3
2
1
84
41
63
239
: 1) 2
1/2549
2)
2.1
2.2 2
4.

(crisis management)
152

(recruitment) (GIS)

-

-
- /

-
(on the job training)
-
153
1 2 .. - .. 2550
5.
Head & Brain & Body

Crisis Forum

1. . 32 . :
; 2549.
2. . . :
; 2550.
154
3. . :
. 30 2549
. : ; 2549.
4. , , . 3
. : ; 2548.
5. . :
2 2/2550 11 2550;
. : ; 2550.
6. . 3 . :
; 2549.
155
1 2 .. - .. 2550
:

( 1)
*
*
*
*
*
;
,
,

,
,
,
* (Clinical Research Collaboration Networks: CRCN)
156
Abstract
National Multicenter Clinical Research System : Experience from Clinical

Research Collaboration Network - CRCN (Part I)
Piyatat Tasanavivat*, Ram Rangsin*, Suthee Ratanamongkolkul*, Aroon
Chirawatkul*, Lily Ingsrisawang*
*Clinical Research Collaboration Network (CRCN)
Key words:
multi-center study,
clinical research,
collaborative research, outcome research, research
management, research network
Thailand has been facing a crucial situation of insufficient support on research work especially those for health care services or clinics. This results in the
high expenditure of the nation on curing and nursing with significant incremental rate year on year. In order to maximize the effectiveness of health care with
less spending and improve the capability of clinical research leading to the self
reliance on the national medical system, Clinical Research Collaboration Network (CRCN) or the research network of the Consortium of Thai Medical Schools
and Health System Research Institute - HSRI, was established. With the objective to facilitate the multicenter clinical research projects, the network has been
promoting the joint venture in research investment and encouraging healthy relationship among investigators by having pre-agreements on governance, data
ownership and authorship issues, and the scope of responsibility and authority
of each member of the team.
The research topics are primarily driven by clinical experts main interest
which is based on direct working experiences. In order to lessen the collaborative burden and difficulties, CRCN encourages investigators to conduct a simple
design study, for example, Disease Registry, and focuses substantially on the
data quality assurance and team building. As a result, the team spirit of the team
members is also enriched and strengthened, in addition to the improvement of
data quality control.
Moreover, the collaborative research management capacities are also enhanced as more research management team is built; data management unit is
constantly improved in data management and statistical analysis skills, working
through on-going projects. Networking of data management and statistical analysis was established, a memorandum of understanding was signed with the University of North Carolina. Subsequently, data management experts have regular
communication with Thai counterparts and visited the sites of the CRCN projects
annually to help in the areas of local data management and capacity development on statistics. This also led to quality assurance of multicenter clinical research conducted locally.
The CRCN experiences, will serve as the convincing examples and foundation for the more sophisticated new or extended multicenter clinical research
projects, especially the clinical trials on new local medical products and searching for new clinical investigative tools to improve health under the local Thai
context in the future.

200,000 3
2546 6.5 5
2 30,000 (1)

157
1 2 .. - .. 2550

(WHO-GCP ICH-GCP)(2)

(National Clinical Research Enterprise, NCRE)(3)
National Institute of Health (4), UK Clinical
Research Collaboration (CRC)(5)

(6)

International
Health Research Awards 2543
(Collaborative Research Coordination Network)

(Clinical Research Collaboration Network: CRCN)

(Clini-
158
cal Research Network) 14

30 212 57

CRCN
1.
1.1

(7)

0.57 10.20

(8)
(.)
(.)
(9%) (9%) (10%) (7%)(7)
1.2

1.2.1

1.2.2

1.2.3
4
159
1 2 .. - .. 2550

(clinical trial)

1.2.4

1.3

1.3.1

Population Health Research Institution, McMaster University, Hamilton, Canada
2
1.3.2

University
of North Carolina 2549
1.3.3 Thailand Center of Excellence in Life Sciences
(TCELS) postdoctoral fellow (.. 2550)
1.3.4 (TCELS)

contract research organization (business unit)
1.3.5
(Forum for Ethical Review Committees in
160
Thailand, FERCIT) TCELS

Joint Research Ethics Committee (JREC)
2549
1.3.6
1.4

1.4.1

1.4.2

1.4.3
1.4.4

2.

( 1)
3.
2
(monitor) (audit)

161
1 2 .. - .. 2550
clinical trial

3-4

ICH-GCP

(monitoring)
CRCN

(clinical indicator)
3
162
1 ()

Data Management and Biostatistics Network (DMBN)

DMBN

-

guide line ICH/GCP

Clinical Research

-

(criti-
cal mass) DMBN
e-Journal
-

DMBN
(Prof.
Shrikant Bangdiwala)

University of North Carolina
CRCN
163
1 2 .. - .. 2550
3.1
3.1.1

Good Clinical Practice (GCP)
3.1.2
(sponsor)

Standard Operating Procedure (SOP) GCP

3.1.3 CRCN

(blinding)

GCP
3.1.4 CRCN

3.1.5
CRCN
3.1.6

CRCN

164

CRCN
3.2 (audit)
3.2.1

GCP
3.2.2
CRCN

3.2.3 CRCN

CRCN
3.3
CRCN

CRCN
CRCN CRCN

165
1 2 .. - .. 2550
1. . 28 2549 5
2549 2549 [ 4 . 2549]; : URL: http/www.fda.moph.go.th/news/
news2849.html
2. World Health Organization. Guidelines for Good Clinical Practice for Trials on Pharmaceutical Products: WHO technical
report series, No. 850. Geneva: WHO; 1995.
3. Crowley W. Clinical research in the United States at a crossroads: proposal for a novel public prevate partnership to
166
4.
5.
6.
7.
8.
9.
establish a naitonal clinical research enterprise. JAMA 2004; 291:1120-6.

NIH. About NIH. 2006 [cited 2006 Nov 4]; Available from:URL: http://www.pih.gov/about
UK Clinical Research Collaboration. Research workforce. 2005 [cited 2006 Nov 4]; Available from: URL: http://
www.ukcrc.org/aboutus/introduction.aspx
, .
; 7-8 2548;
; ; 2548.
CORED. Health research expenditures: essential information for rational decision-making. 2006 [cited 2006 Dec 4];
Available from: URL:http://www.cohred.org/cohred/content/785.pdf
Pongpanich S, Sithi-amorn C, Harr HR, Likitkeerirat T. Resource flows for health research and development-Thailand
agenda for health research and development. Bangkok: The College of Public Health/Chulalongkorn University; 2000.
CORED. Health research expenditures: essential information for rational decision-making. 2006 [cited 2006 Dec 4];
Available from: URL:http://www.cohred.org/cohred/content/785.pdf
167
1 2 .. - .. 2550
:
, ,

,
,
,
,

41
26 3 2550
3.5 - 8.4
(micro vascular complications)
50
(retinopathy) 10-29
(proteinuria) 10-36 (neuropathy) 9
(macro vascular complications)
2

58

43.9
42.8 30.7
8.1 4.4
2
(myocardial infarction) (ischemic heart disease)

2

* ,
168
Abstract
Vol. 1 No. 2 Jul. - Sep. 2007
Diabetes in Thailand: Lessons Learned from Policies of Developed Nations

Chaisri Supornsilpchai*, Nitaya Chanruang Mahabhol, Orapin Mookdadilok
*Department of Diseases Control, Ministry of Public Health, Health Technical office,
Office of the Permanent Secretary, Health System Research Institute
Key words:
chronic diseases,
diabetes, prevention and control
framework, screening, change of life
style, complications, national
policy
The prevalence and burden of chronic diseases, particularly diabetes, are

rapidly increasing in Thailand and worldwide. Yet in a national survey, it was
reported that 41 percent of those diagnosed with the diabetes were unaware of
the condition and only 26 percent had their blood glucose controlled effectively.
The national health care cost for the 3 million cases is estimated to amount to
350-840 billion baht in 2007. Several studies have been reported that microvascular complications existed prior to the diagnosis of diabetes and later resulted in
retinopathy (10-29%), proteinuria (10-36%) and neuropathy (9%). Furthermore,
risk of macrovascular complications and their death rates of those with prediabetes were equal to those with diabetes and twice of those without. Studies
showed that among those with high risk, the chance of developing to diabetes
can be reduced by changing to of healthy life style - nutrition, physical activity,
and weight reduction - which cut down the incidence of diabetes by 58 percent.
It was reported that risk factors among Thais that might be related to diabetes were high blood pressure, over weight, high blood cholesterol, inadequate
fruit and vegetables intakes, limited physical activity and malnutrition.
In Thailand, among those with diabetes, the prevalence of diabetic complications were nephropathy 43.9%, cataract 42.8%, retinopathy 30.7%, ischemic
heart disease 8.1% and stroke 4.4%. In Finland, the major causes of death among
over half of cases with diabetes type 1 and 2, were myocardial infarction and
ischemic heart disease.
Review of national diabetes prevention and control programs of the United
State of America, Canada, England, Finland and Australia shows that programs
on prevention of diabetes type 2 by changing of life style were commonly endorsed. Advocacy on early diagnoses by screening service for high risk group
and underserved population were clearly spelled out. However, the program in
Finland used a screening questionnaire focusing on risk factors to identify those
with high risk rather than depending alone on laboratory test. Similarities were
reported on the efforts of the 5 developed nations to provide high quality service, continuing care and forming networks at all levels reaching communities
in particular. Many of them underlined the essential of adequate information for
general population in order to increase awareness and commitment in changing
life style. Likewise diabetic patients need this continuing health information pertinent to their participation in treatment and self-care. The national health plans
always underline strategies to strengthen infrastructure and capability of the
health services and health manpower development.
(1)

169
1 2 .. - .. 2550
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80 +
0.6
0.8
0.7
1.1
0.6
1.8
3.1
3.1
4.8
4.1
4.3
4.2
2
0.1
0.3
1.1
1.5
1.2
2.4
5
5.8
7.8
4.4
6.8
5.5
2.8
4.4
NA
NA
1.6
5.2
5.1
11.4
12.6
13.8
18.9
12.3
10.1
6.4
15.7
9.2
7.3
: 1(3) .. 2534 - 2535 : 140 .% (

15 )
2(4) .. 2539 - 2540 : 126 .% (
13 - 59 )
3(2) .. 2546 - 2547 : 126 .%
( 15 )

3 .. 2546 - 2547
6.4 7.3 50-69 13.8
18.9 (2) ( 1)(2-4)
41 26 (2)
30-50 (5)

1 2539 7,702
- 18,724 (6) 3 2550
170
Vol. 1 No. 2 Jul. - Sep. 2007
50 3.5 - 8.4
1.4 - 2.1
.. 2547
2.7 Disabilities-Adjusted Life Years (DALYs) 100,000 1.8
DALYs 100,000

( 2)(7)
(micro vascular complications) 50
(retinopathy) 10-29
(proteinuria) 10-36 (neuropathy) 9(5)
(macrovascular complications)

2

(8,9)
(life style intervention) 7
150 5
2 .. 2542 2547 ( DALYS 100,000 )
1
2
3
4
5
6
7
8
9
10
2542
2547
9.6
5.1
2.7
1.3
2.5
1.6
1.6
1.7
1.2
1.0
6.4
5.8
3.3
3.3
2.8
1.9
1.8
1.8
1.4
1.4
2547(7)
2547
171
2542
2547
2.8
3.7
2.7
1.5
1.1
1.1
1.2
1.2
0.9
1.0
3.1
2.9
2.7
1.9
1.4
1.2
1.2
1.2
1.2
1.1
1 2 .. - .. 2550
58 metformin
31(10)

(11)
.. 2547
7 15
(7) ( 1)

- BMI 27.5 ( 3.4 ) (
2.9 ) ( 1.9 ) 50 ( 1.8 ) ( 1.7
) ( 1.5 )(9)
(2)

31.4 2(12)
()
()
()
0.5
0.3
0.3
0.2
0.9
0.9
1.3
1.7
2.2
3.8
4.6
5.8
5.6
8.1
.. 2547(7)
1 .. 2547
172
9.5
Vol. 1 No. 2 Jul. - Sep. 2007
: 11 .. 2546
2 (13) (n = 9,419)
27.0 18.7
10.5 14.2 (12)

43.9 42.8 30.7
8.1 4.4 (13) ( 2)
3 .. 2531-2545 (n = 1,502)(14)
318
200
86
69
58
51
45
40
29
18
35
22
9
8
6
6
5
4
3
1
173
1 2 .. - .. 2550
4 .. 2531-2545 (n = 83,489)(14)
20,785
11,416
7,197
2,710
2,670
2,093
1,867
1,692
1,453
1,376
42
23
14
5
5
4
4
3
3
3
(myocardial infarction) (ischemic

heart disease)(14) ( 3, 4)

(Centers for Disease Control and Prevention (CDC)

(National Diabetes Prevention and Control Program - NDPCP)
(15)
1 .. 2520
2 .. 2524

3 .. 2536
174
Vol. 1 No. 2 Jul. - Sep. 2007

2 HbA1c 9.2 7.7
3
4

-
-
-
6 (16)
1.

2.

3.
4.

5.
6.
(Diabetes National Service Framework)

. 2013(17) (. 2556)
1.
2.
3.
175
1 2 .. - .. 2550
4.

5.

6.
7.

8.
9.
10.
11.
12.
.

.

.
(Development Programme for the

Prevention and Care Diabetes in Finland 2000-2010-DEHKO)
(18)
(Population Strategy)

(High-Risk Strategy)

176
Vol. 1 No. 2 Jul. - Sep. 2007
(Type 2 Diabetes Risk Assessment Form) (National

Public Health Institute)

12

5 (National Service Improvement Framework for

Diabetes)(19)
1. /

2.
3.

4.

5.

(Scottish Diabetes Framework)(20)

177
1 2 .. - .. 2550
1.

2.

3.

4.

5.

6.
7. .. 2546

(Bangkok Charter)(20)
..
1. Chronic Disease Epidemiology, 2nd ed. USA: American Public Health Association; 1998.
2. , , .
3 .. 2546-2547 . : ; 2550.
178
Vol. 1 No. 2 Jul. - Sep. 2007
3. , . 1
.. 2534 - 2535. : ; 2539.
4. , . 2
.. 2539 - 2540. : ; 2541.
5. Lawrence J, Robinson A. Screening for diabetes in general practice. Prev Cardiol 2003; 6: 78-84.
6. .
. : ; 2541.
7. . 2547. :
; 2550.
8. , . : 2.
2550; 23(5): 1-9.
9. Aekplakorn W, Bunnag P, Woodward M, Sritara P, Cheepudomwit S, Yamwong S, et al. A risk score for predicting
incident diabetes in the Thai Population. Diabetes Care 2006; 29(8): 1872-7.
10. Knowler WC, Barrett - Connor E, Fowler SE, Hammon RF, Lachin JM, Walker EM, et al. (Diabetes Prevention Program
Research Group). Reduction in the incidence of type 2 diabetes with life style intervention or metformin. N Engl J Med
2002; 346: 393-403.
11. Goyder E, Irwig L. Screening for diabetes: what are we really doing? BMJ 1998; 317: 1644-6.
12. Chetthakul T, Deerochanawong C, Suwanwalaikorn S, Kosachunhanun N, Ngarmukos C, Rawdaree P, et al. Thailand
diabetes registry project: prevalence of diabetic retinopathy and associated factors in type 2 diabetes mellitus. J Med
Assoc Thai 2006; 89 (Suppl 1): S27-36.
13. Rawdaree P, Ngarmukos C, Deerochanawong C, Suwanwalaikorn S, Chetthakul T, Krittiyawong S, et al. Thailand
diabetes registry (TDR) project: clinical status and long term vascular complications in diabetic patients. J Med Assoc
Thai 2006; 89 (Suppl 1): S1-9.
14. Marja N, Klas W. Prevalence and variation in quality of care. Diabetes in Finland. [online] 2007. [cited 2007 July 7];
available from: URL: http://www.diabetes.fi/ tiedoston_katsominen.php?dok_id=534
15. Murphy D, Chapel T, Clark C. Moving diabetes care from science to practice: the evolution of the National Diabetes
Prevention and Control Program. Ann In Med 2004; 140(11): 978-84.
16. Stewart P, Douglas Consulting. Building a national diabetes strategy: a strategic framework. Volume 2. [online] 2007.
[cited 2007 May 25]; available from: URL: http://www.phac-aspc.gc.ca
17. Robert S. Improving diabetes services - the NSF two years on. [online] 2007. [cited 2007 July 7]; available from: URL:
http://www.dh.gov.uk/prod_consum_dh/groups/ dh_digitalassets/@dh/@en/documents/digitalasset/dh_4106720.pdf
18. Etu - Seppl L, Ilame - Parikha P, Haapa E, Martlila J, Korkee S, Sampo T. Programme for the prevention of type 2
diabetes in Finland 2003 - 2010. [online] 2007. [cited 2007 July 7]; available from : URL : http://www.diabetes.fi/
tiedoston_katsominen.php/?dok_id=179
19. Australian Health Ministers Conference. National Service Improvement Framework for Diabetes. [online] 2007. [cited
2007 July 7]; available from: URL: www.health.gov.au/chronicdiseasestrategy
20. The Bangkok Charter for Health Promotion in a Globalized World 2005. [online] 2007. [cited 2007 July 7]; available
from: URL: http://www.who.int/healthpromotion/ conferences/6gchp/bangkok_charter/en/print.html
179
1 2 .. - .. 2550
*
*
:
,
, ,
,
Abstract
System and Mechanism : Access to Second Opinion and Public Health

Information
Garn Suwansakornkul, Anupong Wilepananont
International Health Policy Program-IHPP
Key words :
second opinion, system, mechanism,
health information,
access
Second opinion is one of the efficient medical procedures to enhance

quality and reliability of health care system, particularly from the patients point
of view. To be applied in Thailand, this will provide evidence of Thai patients
rights enhancement as well as consumer empowerment, in terms of allowing
consumers to receive better quality of health care services. The objective of this
study is to review the literatures related to second opinions and peoples access
to public health information, with the aim to find out preliminary information
required for a proper development of second opinion system in Thailand.
180
Vol. 1 No. 2 Jul-Sep. 2007

(second opinion)

1.

1970

(1)

Second Surgical Opinion Program
(SSOP) mandatory SSOP
Mandatory SSOP

clinical guideline objective evidence

- (prove or disprove)
-
(best option)
181
1 2 .. - .. 2550
-
- (claim)
- (efficiency)

- (American Medical Association)
Gray B. (trust)

(2)
2. (3)
(1) (uncertain diagnosis)

(2) (life-threatening)

(3) (controversial) (experimental) (risky)

(4) (treatment not working)
(5) (risky tests or procedures being recommended)

(6) (another approach)
(7) (doctors competency)
(gynecology) (orthopedic surgery) (orthodontics)

(gastroenterology)
Richard and Annette Bloch(4) 4

(1) (geometric growth)

182
(5)
(2)
(3)
(4)

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(clinical trial)
3.
(1) - (cost benefit) McCarthy EG (6)
$1.00 mandatory SSOP $2.63
McSherry CK (7) -
mandatory SSOP 1.34
(2) (therapeutic advice) 71
(diagnosis)
10
Mustafa MK (8)
(3) caesarean delivery 7 intrapartum caesarean
delivery 13 maternal/perinatal morbidity mortality 149,276
36 (9)
Newhouse JP Lindsey P(10)
utilization cost benefit

(error percentage)

183
1 2 .. - .. 2550
4.
(1)

(11)
(2)

(11)
(3) on-line consultation e-consultation
on-line consultant

(11)
(4)
-

-

(physical examination) (medical record)
(12)
184
5.

cyberspace

(13)
(
18 ) 97 2001 1998 54 (14) Fox
S.(15) 8 10 79
66 51
( 1) 5
1 3 7
1
( : )
2002
2004
, , *
*
*
*
*
,
*
(Medicare or Medicaid)
63
47
44
36
34
25
28
21
21
18
17
13
10
9
8
6
66
51
51
42
40
31
30
28
23
23
18
16
11
11
8
7
: Pew Internet & American Life Project, December 2002 Survey (N = 1,220); November 2004 Survey (N = 537). Margin
of error for comparing the two samples is 4.6%.
*
185
1 2 .. - .. 2550
(video conference)

(on-line diagnosis)

(integrated)
6.

/ 2
186
-
-
-
-
-
-
-
-
-
-
- Patients Bill of Rights

- State legistation
- Second Opinion Bill
- WHO/EURO, The Rights
of Patients
- American Medical Association
-
-
-
-
- Royal College of GP
- British Medical Association
-
-
-
-
-
- Singapore Medical Council
-
- .

(voluntary)
(mandatory)

187
1 2 .. - .. 2550
Internet

Call
Center

4

2
(Drive)
(Implement & Control)
(Support)
Call Center
188
(.)
(.) (.)

1. Wagner TH, Wagner LS. Who gets second opinions?. Health Affair 1999; 18 (5):137-45.
2. Gray BH. Trust and trustworthy care in the managed care era. Health Affairs 1997; 16:34-49.
3. Rosenthal MS. When to get a second opinion?. The Gynecological Sourcebook. [serial online] 1999 [cited 2005 Sep 1].
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4. Bloch R, Bloch A. Multidisciplinary second opinion fundamentals. [serial online] 2005 [cited 2005 Sep 5]. Available from
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2005 Oct 12]. Available from: URL : http://cancer.unm.edu/content.aspx?section=cancerinformation&id=23017
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8. Mustafa MK, Bijl M, Gans ROB. What is the value of patient-sought second opinions?. European J Intern Med 2002; 13:
445-7.
9. Althabe F, Belizan JM, Villar J, Alexander S, Bergel E, Romos S. Mandatory second opinion to reduce rates of
unnecessary caesarean sections in Latin America : a cluster randomized controlled trial. Lancet 2004; 363: 1934-40.
10. Newhouse JP, Lindsey P. Do second opinion programs improve outcomes?. Journal of Health Economics 1988; 7: 28588.
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189
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(Research Mapping)

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2. . [ 3 .. 50]; : URL:
http://www.kmi.or.th/autopage/show_all.php.?h=26
192
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193
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Abstract
Northeastern Migrant Labor: Situation and Health Issues
Key words:
labour, health, strategy, research mapping
Outstanding labour migration has been reported in the northern region

of Thailand leading to changes in physical and social aspects. Subsequently effects on health status at individual, household and eventually community level
shall be witnessed. This article was aimed at presenting situation, recommended
research issues and strategies in order to develop preventive measures and reassurance of adequate health services accordingly.
Presently, labour is classified as formal and informal. Whereas, the latter
is not yet entitled to legal protection and benefits of the social security scheme.
These discriminations exist among some industrial labors undergoing unfairly a
series of probation periods. As such, the phenomena calls for research related to
situation and pattern of employment; classificaiton of labor and required health
care/insurance; their health behaviors and proper health promotion measures.
Safety regulations and guidelines in working place, particularly in small,
and medium enterprises have often been neglected and the premises can avoid
monitoring of the public sector. It may critically call for strong participation of
community and local health facility. Research effort should, then, be made on;
development on tripartite monitoring and surveillance on safety work place,
labor protection system by community, and labor in home industries, guideline
for labor protection from occupational health risk, guideline on rehabilitation of
vulnerable labor with participation of family and community, an of health status
and safety of labor in service sector.
Haphazard movements of labor on provincial, regional and national
levels do not accommodate registration, provision and coverage of health care
and insurance with respect to their health needs. Further development of health
care system, hence, should focus on accessibility.
Health and safety regulation information should also be disseminated.
The research issues should cover on an effective model for disseminating health
and safety regulation information at community level, life skill for adapting in
cross cultural environment, community and health facilities roles and functions
on surveillance on health, and self-care empowerment of labor.
Based on information synthesis and brain storm of experts and stakeholders, research strategies and issues were formulated as follows: strategic I promotion health of labor at community and strategic II self-care empowerment of migrant labor. The research issues of strategic I include situation of labor health,
classification of labor based on health care system, effect and impact of Free Trade
Act (FTA) and new production pattern on health, monitoring and surveillance
on safety work place and labor health problem, labor protection at community
industries, health protection and rehabilitation of labor with high risk, and perception on labors right at community.
Dusadee Ayuwat*, Pattara Sanchaisuriya**

*Faculty of Humanities and Social Sciences, **Faculty of Public Health, Khon Kaen
University
194

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2. Krongkew M, Chamratrithrong A, Woramontri A. Study of low income household in the Northern region of
Thailand. Nakhon Pathom: Institute for Population and Social Research, Mahidol University; 1983 Report
No.74.
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