Health Services Provided at the Primary Care Network of the Faculty of Medicine, Thammasat University.

Background: Health care network of Faculty of Medicine, Thammasat University is one of Contracting Unit for Primary Care (CUP) under Thai Universal Coverage (UC) scheme. It comprises four primary care units (PCUs): Khukhot Subdistrict Health Promoting Hospital (KSHPH), Lamsamkaeo Municipality Health Center (LMHC), Khukhot Municipality Health Center (KMHC), and Thammasat Health Center (THC, also acted as CUP).A primary objective of this research was to study health service indicators of these four health centers. Material and Method: A retrospective study was performed. Data between January 1, 2014 and December 31, 2014 were collected. Following indicators for health service quality were collected and analyzed: 1) numbers of patients visiting PCU/number of patients visiting CUP (OP visit), 2) charge on drugs and medical supplies for outpatient services, 3) newborn and children under five mortality, 4) maternal mortality, 5) low birth weight 6) nutrition status of children under five, 7) diabetes mellitus (DM) patients with Hemoglobin A1C, low density lipoprotein, urine microalbumin tests, diabetic retinopathy screening, and feet examination, 8) hypertension (HT) patients with lipid profile, urine protein and fasting blood sugar tests, 9) controlled DM patients, and 10) controlled HT patients. Results: OP visit of KSHPH, LMHC, and KMHC were 0.22, 0.19, and 0.05, respectively. Charge on drugs and medical supplies for services of KSHPH, LMHC, KMHC, and THC were 102.39, 91.47, 162.04, and 463.85 baht/visit, respectively. There was no newborn, children-under-five and maternal deaths. Percentages of low birth weight of KSHPH, LMHC, KMHC, and THC were 14.3, 14.3, 0, and 9.1%, respectively. Percentage of children under aged five with underweight of KSHPH, LMHC, KMHC, and THC were 12.6, 12.0, 5.6, and 9.1%, respectively. Percentages of children under aged five with overweight of KSHPH, LMHC, KMHC, and THC were 3.7, 22.2, 1.9, and 12.8%, respectively. Percentages of DM patients with HbA1c test of KSHPH, LMHC, KMHC, and THC were 95.4, 87.6, 74.3, and 90.8%, respectively. Percentages of DM patients with LDL tests of KSHPH, LMHC, KMHC, and THC were 98.5, 90.0, 75.7, and 81.5%, respectively. Percentages of DM patients with urine micro albumin tests of KSHPH, LMHC, KMHC, and THC were 6.9, 3.3, 10.0, and 10.2%, respectively. Percentages of DM patients with DR screening of KSHPH, LMHC, KMHC, and THC were 0, 18.7, 0, and 22.6%, respectively. Percentages of DM patients with feet examination of KSHPH, LMHC, KMHC, and THC were 0, 18.7, 0, and 22.7%, respectively. Percentages of HT patients with lipid profile tests of KSHPH, LMHC, KMHC, and THC were 90.8, 73.2, 60.2, and 92.2%, respectively. Percentages of HT patients with urine protein tests of KSHPH, LMHC, KMHC, and THC were 7.3, 17.3, 0.4, and 7.8%, respectively. Percentages of HT patients with FBS screening of KSHPH, LMHC, KMHC, and THC were 92.2, 84.3, 61.0, and 78.1%, respectively. Percentages of controlled DM patients of KSHPH, LMHC, KMHC, and THC were 54.8, 57.9, 54.8, and 61.4%, respectively. Percentages of controlled HT patients of KSHPH, LMHC, KMHC, and THC were 75.7, 19.3, 35.7, and 66.3%, respectively. Conclusion: Several health service indicators need to be improved including: low OP visit, low birth weight, high underweight and overweight among children under aged five, low coverage of urine micro albumin, DR screening, and feet examination among DM patients, low coverage of urine protein among HT patients, and high percentage of uncontrolled DM and HT patients.

Occupational safety and health management among five ASEAN countries: Thailand, Indonesia, Malaysia, Philippines, and Singapore.

Occupational safety and health is one of important issues for workforce movement among ASEAN countries. The objective was to study laws, main agencies, and law enforcement regarding occupational safety and health in Thailand, Indonesia, Malaysia, Philippines, and Singapore. This documentary research covered laws, main agencies' duties, and occupational safety and health law enforcement in Thailand, Indonesia, Malaysia, Philippines, and Singapore. Thailand has its Occupational Safety, Health, and Work EnvironmentAct 2011. Its main agency was Department of Labor Protection and Welfare. Indonesia had WorkSafety Act (Law No. 1, 1970). Its main agency was Department of Manpower and Transmigration. Malaysia had Occupational Safety and Health Act (OSHA) 1994. Its main agency is the Department of Occupational Safety and Health. The Philippines has its Occupational Safety and Health Standards. Its main agency was Department ofLabor and Employment. Singapore has its Workplace Safety and Health Act 2006. Its main agency is Occupational Safety and Health Division. Occupational safety and health law enforcement among each county covers work environment surveillance, workers' health surveillance, advice about prevention and control of occupational health hazards, training and education of employers and employees, data systems, and research. Further in-depth surveys of occupational safety and health among each ASEAN county are needed to develop frameworks for occupational safety and health management for all ASEAN countries.

Work environment and health promotion needs among personnel in the faculty of medicine, Thammasat university.

BACKGROUND: Work environment and health promotion needs are important factors for quality of life of workers. OBJECTIVE: Study occupational health and safety hazards and control measures as well as health status and health promotion needs among personnel in Faculty of Medicine, Thammasat University. MATERIAL AND METHOD: This was a cross sectional study. Questionnaires were designed to collect demographic data, health status, health promotion needs, occupational health and safety hazards, and job demand/control data. RESULTS: Questionnaires were sent out to 181 personnel and 145 were returned filled-out (80.1%). Among them, 42.8% had physical illness or stress, 68.3% had debt problem, 20% had some problems with coworker or work environment, 65.5% had a high workload, and 64.1% felt they did not get enough work benefits. Job demand and control factors included attention from leaders, fast-pace work, relationship among coworkers, repetitive work, hard work, high stress work, and high workload The occupational safety and health system included training to use new equipment, supervisor training, work skill training, work in sitting position for long period of time, appropriate periodic health exam, appropriate medical service, proper canteen, proper salary raise, and facilities for health promotion. In the occupational health hazards, employees were working in low temperature, bright light, and had a lack of health promotion programs. Requested programs to improve quality of life were Thai traditional massage, workplace improvement, health promotion, one-day travel, and Friday's happy and healthy program. CONCLUSION: Results from the present study can be used to improve workplace environment and health of personnel in the Faculty of Medicine, Thammasat University.

Health risk assessment of workers exposed to metals from an aluminium production plant.

OBJECTIVE: Foundry is an industry involved various kinds of metals and chemicals. Workers who work in foundry industry are at risk of exposure to these metals and chemicals. Objective of this study was to conduct quantitative health risk assessment for workers who exposed to metals from an aluminium production industry. MATERIAL AND METHOD: The U.S. National Academy of Sciences' four steps of health risk assessment were used to conduct quantitative health risk assessment in this study. RESULTS: This study showed that there were 6 types of metals involved in the aluminium foundry in this study. These metals could cause various health effects but not cancers. Workers were mostly exposed to these metals by inhalation. Calculated reference dose (RfD) for inhalation of aluminium used in this assessment was 0.000015 mg/kg/day. Calculated RID for inhalation of manganese used in this assessment was 0.000002 mg/kg/day. Calculated RfD for inhalation of copper used in this assessment was 0.000028 mg/kg/day. Calculated RID for inhalation of zinc used in this assessment was 0.000083 mg/ kg/day. Calculated RID for inhalation of magnesium used in this assessment was 0.949833 mg/kg/day. Calculated RID for inhalation of iron used in this assessment was 10.6219 mg/kg/day. Maximum daily doses (MDDs) for workers who exposed to metals measured in this foundry were 0, 0, 0.000463, 0.0000927, 0.000162 and 0 mg/kg/day for manganese, zinc, aluminium, iron, magnesium and copper, respectively. Finally, risk characterization for workers exposed to metals in this aluminium foundry showed that workers in this foundry had 31 times higher risk of developing diseases from aluminium than persons who were not exposed to aluminium. These workers had the same risk of developing diseases from other metals and chemicals as persons who were not exposed to those metals and chemicals. CONCLUSION: Workers who exposed to aluminium in this aluminium production plant had 31 times risk of developing non-carcinogenic effects from aluminium compared with normal persons. Therefore, appropriate preventive measures should be applied to protect workers.

A need assessment study of occupational health curriculum for Thai medical students.

OBJECTIVE: To assess and develop an appropriate occupational health curriculum for Thai medical students. MATERIAL AND METHOD: An assessment of existing occupational health curriculum in 12 Thai medical schools, questionnaire survey of occupational medicine experts, questionnaire survey of physicians practiced in industries and primary care hospitals in Pathumthani province, and questionnaire survey and public comments of medical education administration, academician, occupational physician, and medical students were performed RESULTS: An appropriate occupational health curriculum for Thai medical students included 1) knowledge of occupational health hazards and their illnesses, occupational health hazard evaluation and control, clinical features and investigation of occupational disease, principles of occupational safety, emergency treatment of occupational injury, and principles of health promotion, education, and behavioral modification; 2) experience of occupational health and safety surveillance and occupational disease differential diagnosis; and 3) competence in occupational disease diagnosis, taking clinical history and examination, advise on provision of first aid facilities, physical hazards recognition and control, work related and environmental related disease differential diagnosis, performing a risk assessment, and risk communication. CONCLUSION: The present study evaluated an occupational health curriculum needed for Thai medical students. Necessary topics for curriculum were developed. However, a future study of learning methods for each topic is needed.

Model development for health promotion and control of agricultural occupational health hazards and accidents in Pathumthani, Thailand.

In Thailand, agriculture is one of the major occupations; however, there is no comprehensive agricultural occupational health promotion and disease prevention model available. Objectives of this study were to empower farmers to study occupational health and safety situation in rice farming and to develop model to promote their health and prevent occupational health hazards among them. This participatory action research was performed in Tambol Klong 7, Klongluang district, Pathumthani, Thailand. The 24 rice farmers from 9 villages were voluntarily recruited as members of research team called farmer-leader research group. This group had a monthly meeting to discuss issues of agricultural occupational health and safety during 3 yr study period. At first stage, farmer-leader research group analyzed occupational health and safety during rice farming process. After we had results from situation analysis, farmer-leader research group decided which problems would be solved first. We developed model to solve those problems during the second stage. Finally, model was implemented to farmers in the study area. During first stage, results of questionnaires showed that there were 3 major occupational health and safety problems among these farmers; symptoms from pesticide exposure (65% of respondents), musculoskeletal problems during various process (16.6%-75.9%), and injuries during various process (1.1%-83.2%). From these results, farmer-leader research group decided to deal with pesticide problem. There was an experiment comparing using biofertilizers and bio pest-control with using chemical fertilizers and pesticides in the rice paddy. Results showed that the biological field produced the same amount of rice as the chemical field but cost less money than the chemical one. Benefits from using biofertilizers and bio pest-control were having higher profit, less exposure to chemicals, and good mental health from higher profit. After this experiment, biofertilizers and bio pest-control were disseminated to rice-farmers and students and teachers in local schools. At the end of study, we found that there were networks of farmers and networks of students-teachers using biological methods. This study showed that participation with farmers could create a real sustainable model to promote farmers' health and prevent them from occupational health hazards.

Cancer risk assessment of toxaphene.

The primary purpose is to do cancer risk assessment of toxaphene by using four steps of risk assessment proposed by the United States National Academy of Sciences/National Research Council (NAS/NRC). Four steps of risk assessment including hazard identification, dose-response relationship, exposure assessment, and risk characterization were used to evaluate cancer risk of toxaphene. Toxaphene was the most heavily used insecticide in many parts of the world before it was banned in 1982. It increased incidence of neoplasms of liver and uterus in mice and increased incidence of neoplasms of endocrine organs, thyroid, pituitary, adrenal, mammary glands, and reproductive systems in rats. From mice's and rats' study, slope factor for toxaphene is 0.8557 (mg/ kg/day)(-1). Lifetime average daily dose (LADD) of toxaphene from ambient air, surface water, soil, and fish were 1.08 x 10(-6), 5.71 x 10(-6), 3.43 x 10(-7), and 7.96 x 10(-5) mg/kg/day, respectively. Cancer risk of toxaphene for average exposure is 7.42 x 10(-5). From this study, toxaphene might have carcinogenic risk among humans.