Journal of Health Systems Research https://he04.tci-thaijo.org/index.php/j_hsr <p><strong>Journal of Health Systems Research</strong></p> <p><strong>E-ISSN: 2672-9415</strong></p> <p><strong>Publication Frequency</strong> 4 issues a year, quarterly, January-March, April-June, July-September, and October-December</p> <p><strong>Aim &amp; Scope</strong> <span class="fontstyle0">The </span><span class="fontstyle2">Journal of Health Systems Research is the publication forum to inform discussions on health systems research findings that cover health delivery system, health workforce, medicine-vaccine and technology, information, financing and governance; leading to policy and innovation developments for higher capability of community and society of lower- and middle-income countries.</span><strong><br /></strong></p> Health Systems Research Institute en-US Journal of Health Systems Research 2672-9415 <p>Journal of Health Systems Research is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) license, unless otherwise stated.</p> Reviewers Acknowledgement for 2024 https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3032 <p>เรียน ผู้ทรงคุณวุฒิที่ได้พิจารณาบทความให้วารสารวิจัยระบบสาธารณสุขในปี พ.ศ. 2567</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ในรอบปี พ.ศ. 2567 (ม.ค.-ธ.ค. 2567) มีผู้ยื่นบทความขอเผยแพร่ในวารสารวิจัยระบบสาธารณสุขจำนวน 49 เรื่อง (ปี 2566 จำนวน 62 เรื่อง ปี 2565 จำนวน 102 เรื่อง ปี 2564 จำนวน 96 เรื่อง) ผ่านการกลั่นกรองขั้นต้นและส่งให้ผู้ทรงคุณวุฒิพิจารณาจำนวน 37 เรื่อง (ปี 2566 จำนวน 42 เรื่อง ปี 2565 จำนวน 76 เรื่อง ปี 2564 จำนวน 67 เรื่อง) แต่ละเรื่องได้รับการพิจารณาจากผู้ทรงคุณวุฒิอย่างน้อย 2 ท่าน</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; ในกระบวนการพิจารณาดังกล่าว มีจำนวนวันเฉลี่ยในช่วงการทำงานต่างๆของรอบปีนี้ ดังนี้</p> <ul> <li class="show">จำนวนวันเฉลี่ยในการปฏิเสธเผยแพร่บทความในขั้นแรก เท่ากับ 9 วัน (ปี 2566 จำนวน 12 วัน ปี 2565 จำนวน 10 วัน, ปี 2564 จำนวน 10 วัน, ปี 2563 จำนวน 8 วัน)</li> <li class="show">จำนวนวันเฉลี่ยในการปฏิเสธเผยแพร่บทความหลัง review เท่ากับ 131 วัน (ปี 2566 จำนวน 181 วัน ปี 2565 จำนวน 170 วัน ปี 2564 จำนวน 136 วัน, ปี 2563 จำนวน 60 วัน)</li> <li class="show">จำนวนวันเฉลี่ยที่บทความอยู่ในระบบจนถึงวันเผยแพร่ ลดลงเป็น 220 วัน (ปี 2566 จำนวน 357 วัน ปี 2565 จำนวน 372 วัน ปี 2564 จำนวน 267 วัน, ปี 2563 จำนวน 162 วัน)</li> </ul> <p>ในการดังกล่าวข้างต้น กองบรรณาธิการวารสารวิจัยระบบสาธารณสุขขอขอบคุณผู้ทรงคุณวุฒิที่ได้ช่วยพิจารณาทบทวนบทความ ดังมีรายนามต่อไปนี้</p> <p>นพ. ก้องเกียรติ เกษเพ็ชร์</p> <p>พญ. กิตติมา บ่างพัฒนาศิริ</p> <p>ศ.นพ. เกื้อเกียรติ ประดิษฐ์พรศิลป์</p> <p>รศ.ดร. ขนิษฐา นันทบุตร</p> <p>นพ. คำนวณ อึ้งชูศักดิ์</p> <p>อ.ดร.นพ. จักรกฤษณ์ เอื้อสุนทรวัฒนา</p> <p>รศ.นพ. ชลธิป พงศ์สกุล</p> <p>นพ. ชูชัย ศรชำนิ</p> <p>รศ.นพ. โชคชัย หมั่นแสวงทรัพย์</p> <p>ผศ.ดร. ณภัควรรต บัวทอง</p> <p>ผศ.ดร.ภญ. ณัฏฐิญา ค้าผล</p> <p>พญ. ดวงดาว ศรียากูล</p> <p>รศ.ดร. เดชา ทำดี</p> <p>ศ.ดร.พญ. ทิพวรรณ เลียบสื่อตระกูล</p> <p>รศ.นพ. ธีระ วรธนารัตน์</p> <p>ศ.ดร. นงเยาว์ เกษตร์ภิบาล</p> <p>ผศ.ดร. นงลักษณ์ พะไกยะ</p> <p>รศ.ดร. นิทรา กิจธีระวุฒิวงษ์</p> <p>รศ.ดร.ภญ. นิลวรรณ อยู่ภักดี</p> <p>ผศ.ดร. นิษฐา หรุ่นเกษม</p> <p>รศ.ดร.ภญ. นุศราพร เกษสมบูรณ์</p> <p>อ.ดร.นพ. บุญชัย กิจสนาโยธิน</p> <p>ศ.นพ. ประชา นันท์นฤมิต</p> <p>อ.ดร.นพ. ประสิทธิ์ เผ่าทองคำ</p> <p>รศ. ดร. ปานใจ ธารทัศนวงศ์</p> <p>ศ.ดร.นพ. พรพรต ลิ้มประเสริฐ</p> <p>ศ.เกียรติคุณ ดร. พันธุ์ทิพย์ รามสูต</p> <p>รศ.ดร. เพ็ญประภา ศิวิโรจน์</p> <p>ศ.เกียรติคุณ นพ. ไพบูลย์ สุริยะวงศ์ไพศาล</p> <p>ศ.ดร. มรรยาท รุจิวิชชญ์</p> <p>รศ.ภญ. ระพีพรรณ ฉลองสุข</p> <p>รศ.ดร. รัชนี สรรเสริญ</p> <p>รศ.ดร. รัมภา บุญสินสุข</p> <p>ผศ.ดร. ลักขณา เติมศิริกุลชัย</p> <p>ผศ.ดร.ทพ. วรรณธนะ สัตตบรรณศุข</p> <p>อ.ดร.นพ. วรสิทธิ์ ศรศรีวิชัย</p> <p>รศ.ดร. วันเพ็ญ แก้วปาน</p> <p>ผศ.ดร. วันวิสาข์ พานิชาภรณ์</p> <p>พญ. วิชนี ธงทอง</p> <p>รศ.ดร.ภก. วิทยา กุลสมบูรณ์</p> <p>ผศ(พิเศษ)ดร.นพ. วินัย ลีสมิทธิ์</p> <p>อ.ดร. วิภาดา วิจักขณาลัญฉ์</p> <p>ผศ.(พิเศษ)นพ. วิโรจน์ วรรณภิระ</p> <p>รศ.พญ. วิไล คุปต์นิรัติศัยกุล</p> <p>ศ.ดร.นพ. วีระศักดิ์ จงสู่วิวัฒน์วงศ์</p> <p>นพ. สมเกียรติ โพธิสัตย์</p> <p>ศ.นพ. สมนึก ดำรงกิจชัยพร</p> <p>รศ.ดร.ทพญ. สุกัญญา เธียรวิวัฒน์</p> <p>รศ.ดร. สุกัลยา อมตฉายา</p> <p>ศ.ดร. สุภา เพ่งพิศ</p> <p>นพ. อนุรักษ์ อมรเพชรสถาพร</p> <p>รศ.ดร.ภญ. อรอนงค์ วลีขจรเลิศ</p> <p>ศ.พญ. อวยพร ปะนะมณฑา</p> <p>ดร. อารี แวดวงธรรม</p> Editorial Board Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 8 9 Commit to Maintain Journal of Health Systems Research at TCI Tier 1 https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3030 <p><span class="fontstyle0">การประชุมกองบรรณาธิการวารสารวิจัยระบบ สาธารณสุข เมื่อวันที่ 14 กุมภาพันธ์ 2568 หลังจากทราบ ผลการประเมินคุณภาพตามระบบ Thailand Citation Index (TCI) รอบ 2568-2572 ว่าอยู่ใน Tier 2 ที่ประชุม กองบรรณาธิการฯ จึงมีมติให้บรรณาธิการแถลงต่อผู้อ่าน และโดยเฉพาะผู้นิพนธ์ที่จะส่งบทความเพื่อลงตีพิมพ์ใน ฉบับต่อๆ ไป เพื่อให้เกิดความมั่นใจได้ว่า ภาวะ Tier 2 จะเป็นภาวะชั่วคราว สถาบันวิจัยระบบสาธารณสุขผู้เป็น เจ้าของวารสารฯ และกองบรรณาธิการจะมุ่งมั่นให้วารสาร วิจัยระบบสาธารณสุขกลับมาสู่ TCI Tier 1 โดยเร็ว</span></p> <p><span class="fontstyle0">TCI ติงว่าวารสารฯ ยังไม่ผ่านเกณฑ์หลัก “วารสาร ต้องมีเว็บไซต์ที่มีข้อมูลครบถ้วน” และเกณฑ์รองอีก 3 เรื่อง ได้แก่ “วารสารมีการเผยแพร่บทความที่มีความ สมบูรณ์” “วารสารต้องมีระบบการจัดการวารสารแบบ ออนไลน์” “วารสารมีข้อมูลของบทความบนเว็บไซต์ตรง กันกับข้อมูลในไฟล์อิเล็กทรอนิกส์ (PDF) ที่เผยแพร่” ส่วน เกณฑ์คุณภาพจากการพิจารณาบทคัดย่อ เนื้อหา ตาราง และภาพ ความต้นคิดและสดใหม่ ได้ระดับเบาบางแต่รับ ได้ (mild but acceptable) กับให้ข้อสังเกตว่าข้อมูลบน เว็บไซต์ในหัวข้อ เป้าหมายและขอบเขตของวารสาร ควรได้ รับการปรับปรุง</span></p> <p><span class="fontstyle0">เพื่อตอบสนองต่อการประเมินของ TCI กองบรรณาธิการจึงเห็นชอบให้ขยายคำอธิบายของ </span><span class="fontstyle2">เป้าหมาย</span><span class="fontstyle2">และขอบเขตของวารสาร </span><span class="fontstyle0">เป็น </span><span class="fontstyle3">“วารสารวิจัยระบบ สาธารณสุขเป็นเวทีตีพิมพ์เผยแพร่องค์ความรู้วิชาการ จากงานวิจัยระบบสุขภาพ ที่ครอบคลุมระบบบริการ กำลังคน ยา วัคซีนและเทคโนโลยี ข้อมูลข่าวสาร การคลัง ระบบอภิบาล เพื่อพัฒนานโยบายและนวัตกรรมที่ยกระดับขีดความสามารถในสังคม ชุมชนและประเทศ กลุ่มรายได้ปานกลางและรายได้ต่ำ”</span></p> <p><span class="fontstyle2">Aims and Scope: </span><span class="fontstyle3">Journal of Health Systems Research is the publication forum to inform discussions on health systems research findings that cover health delivery system, health workforce, medicine-vaccine and technology, information, financing and governance; leading to policy and innovation developments for higher capability of community and society of lower- and middle-income countries.</span></p> <p><span class="fontstyle0">หวังว่าการปรับระบบการจัดการบทความของ วารสารฯ ผ่าน ThaiJO ในรอบประเมิน TCI ครั้งนี้ จะ สำเร็จราบรื่นโดยเร็ว เพื่อให้ชุมชน/สังคมวิชาการวิจัยระบบ สาธารณสุขมีความยั่งยืนต่อไป</span></p> Supasit Pannarunothai Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 1 1 Service-Information-Finance: The Three Pillars of Successful Universal Health Coverage Implementation https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3031 <p><strong>Introduction</strong></p> <p>Achieving universal health coverage (UHC) is a critical global goal that enables all individuals to access quality health services without financial hardship. However, as many countries work toward this ambition, a key realization has emerged: successful UHC implementation requires the harmonious integration of three key pillars—health service delivery, health information systems and health financing. These components form the "<strong><em>Service-Information-Finance (SIF) framework</em></strong>," which emphasizes the critical interdependence of these health system building blocks.<sup>(1)</sup></p> <p><strong>Three Prongs of UHC</strong></p> <p>The analogy of a "three-legged stool" effectively conveys the importance of these foundational components. Each "leg" is essential to maintain balance and stability:</p> <ol> <li><strong>Service delivery systems</strong>: The cornerstone of health systems, service delivery ensures that quality healthcare reaches all populations equitably. This includes robust healthcare infrastructure, adequately trained workforce, and the availability of essential medical products, vaccines, and technologies.<sup>(2)</sup></li> <li><strong>Information systems</strong>: Informed decision-making and effective management rely on accurate and timely health data. Information systems serve as the backbone for monitoring health outcomes, assessing system performance, and enabling evidence-based policy formulation.<sup>(3,4)</sup></li> <li><strong>Financing systems</strong>: Sustainable health financing underpins UHC by reducing out-of-pocket expenses, pooling resources, and ensuring equity in health access. It enables governments to provide comprehensive healthcare services while protecting citizens from financial risk.<sup>(5)</sup></li> </ol> <p><strong>The Need for Simultaneous Development</strong></p> <p>One of the key lessons learned in UHC implementation is the necessity for these three components to be developed concurrently rather than in isolation.<sup>(2)</sup> In many instances, health system reforms focus on one area at a time, leading to misaligned priorities, inefficiencies, or gaps in service delivery. For example:</p> <ul> <li><strong>Service Delivery Without Data</strong>: Investing heavily in expanding healthcare infrastructure without integrating effective information systems can result in inefficiencies, as decision-makers lack the insights needed to allocate resources optimally or monitor progress.<sup>(2)</sup></li> <li><strong>Data Without Financing</strong>: An information system is only as impactful as the financing mechanisms supporting its use. Without financial backing, innovative data solutions may remain underutilized<sup>(5)</sup></li> <li><strong>Financing Without Service Delivery</strong>: Strong financial mechanisms, the absence of accessible and quality services limits the impact on population health.<sup>(5)</sup></li> </ul> <p>Thus, the SIF framework emphasizes the interconnect of these pillars, which must operate in synergy to achieve long-term UHC success. (Figure 1 as shown in PDF file)</p> <p><strong>Beyond the Core Pillars: </strong>Leadership and Governance, Workforce and Medical products</p> <p>While the three primary components form the foundation of the SIF framework, additional elements such as leadership and governance, healthcare workforce, and medical products play indispensable roles. Leadership ensures vision, coordination, and accountability, while governance establishes the policies and regulatory environments necessary for health systems to thrive. A skilled and adequately distributed healthcare workforce is crucial to translating policy into action, delivering services, and supporting the functionality of information and financing systems. Moreover, the availability of medical products, vaccines, and technologies complements the three core components, ensuring that health systems can respond effectively to emerging health challenges.<sup>(6)</sup></p> <p><strong>Real-World Applications of the SIF Framework</strong></p> <p>Countries that have embraced the SIF framework demonstrate the benefits of this integrated approach:</p> <p><strong>Taiwan</strong>: Taiwan stands out as another excellent example of UHC success through the efficient integration of all three pillars. Taiwan's National Health Insurance (NHI), implemented in 1995, has developed a health service system that covers over 99.9% of the population, a fee-for-service payment system with cost control measures, and a modern health information system. The use of the NHI IC Card enables patient health information to be linked between healthcare facilities nationwide, reducing treatment redundancy and increasing service efficiency. Additionally, the electronic claims system has significantly reduced administrative costs, allowing more budget to be allocated to improving service quality.<sup>(7)</sup></p> <p><strong>Estonia</strong>: Leveraging advanced digital health infrastructure, Estonia has created a seamless health information system that supports service delivery and financing. Citizens can access health records digitally, ensuring continuity of care, while the government uses data analytics to optimize resource allocation.<sup>(8)</sup></p> <p><strong>Rwanda</strong>: Following a devastating health crisis, Rwanda built an innovative UHC model that combines community-based health insurance, an extensive health workforce, and a robust health information system. This integration has resulted in dramatic improvements in life expectancy and reductions in maternal and child mortality.<sup>(9)</sup></p> <p><strong>Challenges and Opportunities within Thailand Anywhere Primary Care System</strong></p> <p>Implementing the SIF framework within Thailand current anywhere UHC environments is very challenging. The primary care system must be strengthened as the backbone. With limited level of finance,<sup> (10)</sup> the strengths of efficient digital health must be exploited to bridge unaligned communications of specialized health systems with primary care systems as seen in the three-country case studies. Apart from the three prongs of UHC, motivated healthcare workforce and good governance leaderships are essential elements for success.</p> Boonchai Kijsanayothin Supasit Pannarunothai Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 2 7 Prevalence of Congenital Abnormalities in Thailand between 2008 and 2022: A Retrospective Study from a Standard Health Data Center https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3023 <p>Congenital anomalies are still the leading cause of death in children under 5 years of age. A study of the prevalence of congenital anomalies in Thailand was conducted in 2014-2016, since then there is no current data. Therefore, a retrospective study was conducted to examine the current prevalence of congenital anomalies in Thailand. Methods: A retrospective study using the 43-file standard dataset from the Health Data Center, Ministry of Public Health was conducted. Data including ICD10 (International Classification of Disease tenth revision) codes of 18 birth defect groups and child birthdates between 2008 and 2022 were collected and analyzed for the prevalence of each disorder. Results: The prevalence of 18 congenital anomalies was approximately 2 percent. The five most common congenital anomalies were congenital heart defects, limb anomalies, cleft lip/cleft palate, Down syndrome, and urinary tract obstruction, respectively. The prevalence of Down syndrome has been reduced steadily since 2016. The prevalence of congenital hydrocephalus and neural tube defects was found to be approximately 0.03 percent (among the top 10 common congenital anomalies). Conclusion: Congenital abnormality is still an important problem for children at the national level.</p> Chulaluck Kuptanon Apirak Kulsu Shotirose Phurahong Dueanchai Khata Napatsawan Siriwong Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 10 20 Factors Associated with Body Mass Index of Thai Children Aged 6-18 Years https://he04.tci-thaijo.org/index.php/j_hsr/article/view/2773 <p>Body mass index (BMI) is a critical indicator that reflects health and nutritional status and was influenced by many factors. The objective of this study was to examine the factors associated with BMI among Thai children aged 6–18 years. The data were obtained from the research project “Monitoring on Food and Beverage Marketing to Children in Thailand” which employed a stratified two-stage sampling method to select Thai children aged 6–18 years. Data collection was conducted through face-to-face interviews using the Qualtrics Offline Survey application. Ordinal logistic regression was applied to identify significant independent variables associated with overweight and obesity. The independent variables were socio-demographic characteristics of children that consisted of sex, age, education level, region, place of residence, number of children and daily pocket money for snacks and beverages, and BMI and their consumption of high fat, sodium, and sugar (HFSS) foods and beverages (categorized into 8 groups: snacks, beverages, semi-processed foods, desserts and ice-cream, bakeries, chocolate milk and yogurt, main dish, candies and gums). The results found that male, aged 10-18 years, secondary education level, daily pocket money of higher than 50 Thai Baht (THB), and consumption of sweets and ice cream were significantly associated with BMI. These results emphasize the importance of considering these factors in policy formulation and implementation to reduce BMI among Thai children. For instance, school code of controlling sales of unhealthy foods and beverages should be escalated into the law.</p> Nongnuch Jindarattanaporn Salakjit Chuenchom Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 21 32 Estimation of Treatment Cost of Dental Caries, Periodontal Disease and Tooth Loss in Thai People https://he04.tci-thaijo.org/index.php/j_hsr/article/view/2752 <p>The aim of this study was to estimate the cost burden of dental diseases among Thai people using the cost of illness concept. Prevalence of oral illnesses was estimated from the 8<sup>th</sup> National Oral Health Survey in 2017. This study assessed only direct costs for treating dental caries, periodontal diseases, and tooth loss to the entire population. The study’s results showed that 45.0 percent of Thai citizens had dental caries, 74.5 percent had gingivitis, 15.7 percent had periodontitis, and 31.4 percent required dentures. A total of 156,925.1 million baht, or 1% of GDP, would be required if all essential treatments were provided. There were 28.7 million individuals who needed dental caries treatments, 47.6 million gingivitis treatments, 10.0 million periodontitis treatments, and 20.1 million who required removable dentures for dental losses. Dental caries, gingivitis, periodontitis, and tooth loss accounted for 32.9%, 15.3%, 10.9%, and 40.8% of the total costs, respectively. Oral diseases were 36.8, 22.5, 6.5, and 4.4 times more expensive to treatment than diabetes, respiratory conditions, cancer, and cardiovascular disorders, respectively. In summary, the cost of treating these oral diseases was high. Therefore, self-managed technology to prevent dental caries and periodontal diseases to reduce tooth loss and measures to mitigate commercial determinants of oral disease across the population would lower overall treatment costs.</p> Rakchanok Noochpoung Sunee Wongkongkathep Sukanya Tianviwat Nipaporn Urwannachotima Siriwan Pitayarangsarit Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 33 48 Personal Factors Related to Hip Bone Density and Osteoporosis Prediction https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3025 <p>Osteoporosis represents a significant health concern among the elderly population globally, including Thailand, particularly among high-risk groups with personal and behavioral factors influencing bone mineral density (BMD). This investigation aimed to examine the associations between personal factors, such as gender, age, body mass index (BMI), and chronic diseases, and hip bone density (BMD), as well as to develop a predictive model for osteoporosis in individuals aged 50 years and older. This cross-sectional descriptive study utilized medical record data from 611 patients who underwent BMD testing (dual-energy X-ray absorptiometry: DXA) between 2021 and 2023. Statistical analyses, including Pearson correlation, chi-square, multiple regression analysis, and multiple logistic regression, were employed to examine associations. Logistic regression was utilized to predict osteoporosis risk. Significant factors associated with osteoporosis were identified, including female gender (OR = 5.605, 95% CI: 3.22–9.75, <em>p </em>&lt; 0.001), advanced age (71–80 years: OR = 7.867, 95% CI: 3.95–15.67, <em>p </em>&lt; 0.001; &gt; 80 years: OR = 8.604, 95% CI: 3.69–20.08, <em>p </em>&lt; 0.001), lower BMI (OR = 4.680, 95% CI: 1.86–11.77, <em>p </em>= 0.001), smoking (OR = 4.202, 95% CI: 1.17–15.13, <em>p </em>= 0.028), alcohol drinking (OR = 3.593, 95% CI: 1.48–8.70, <em>p </em>= 0.005), and chronic kidney disease (CKD) (OR = 7.046, 95% CI: 1.72–28.87, <em>p </em>= 0.007). Multiple logistic regression suggested the optimal model fit for osteoporosis and osteopenia: OST = -2.989 + 1.688 (Gender) + 1.920 (CKD) + 1.515 (Smoking) + 1.331 (Drinking) - 0.192 (BMI). Individuals exhibiting these risk factors demonstrated a 28.9% probability of developing osteoporosis. The prevention of osteoporosis remains a challenge within Thailand’s healthcare system, particularly among the expanding elderly population. This study elucidates the significant associations of personal factors–such as gender, age, BMI, CKD, smoking, and alcohol consumption–with osteoporosis. The developed predictive equation can inform risk screening tools to support clinical decision-making and early prevention strategies. The integration of BMD screening into primary healthcare systems could effectively reduce osteoporosis incidence among high-risk groups.</p> Artist Suebpanich Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 49 65 A Survey on Knowledge and Understanding of Career Advancement among Physical Therapists in Ministry of Public Health’s Hospitals, Thailand https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3026 <p>This survey research aimed to examine knowledge and understanding of position structure and career paths among physical therapists in public hospitals under the Ministry of Public Health, Thailand; to study relationships between personal factors and levels of knowledge and understanding; and to identify barriers to career advancement. Data were collected using an online questionnaire from 534 physical therapists, selected through stratified random sampling by region and hospital size. Results showed moderate levels of knowledge and understanding in both position structure and career paths (mean 3.12 ± 0.78 out of full score 5) and academic work production (mean 2.83 ± 0.84). Correlation analysis revealed significant but very low relationships between work experience and understanding of position qualifications and career paths (rs = -0.0991, <em>p </em>&lt; 0.05), and between current position and understanding of academic writing (rs = 0.0867, <em>p </em>&lt; 0.05). Major barriers identified included organizational structure and management systems, workload and time management, and knowledge and skills in academic work production. These findings can serve as foundational data for developing robust support systems, adjusting workload balance, and enhancing academic skills to promote sustainable career advancement in physical therapy profession.</p> Watcharin Tayati Santipap Pueng-am Monticha Muang-ngoen Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 66 76 Evaluation of the PM2.5 Surveillance System in Nakhon Phanom Province, Thailand: A Pilot Case Study https://he04.tci-thaijo.org/index.php/j_hsr/article/view/3029 <p>Thailand is facing air pollution problems from particulate matter of diameter less than 2.5 micron or PM<sub>2.5</sub> exceeding standard levels every year. Particularly Nakhon Phanom province of Health Region 8 has been significantly affected. This study aimed to evaluate the PM<sub>2.5</sub> surveillance system in Nakhon Phanom both qualitatively and quantitatively to develop policies and operational guidelines and to serve as a case study for Health Region 8. This research employed a mixed-method approach by conducting in-depth interviews with 11 public health officials and stakeholders and reviewing 508 medical records of patients suspected of PM<sub>2.5</sub>-related diseases at Nakhon Phanom Hospital between October 1, 2020 and March 31, 2023. The qualitative analysis revealed a high level of acceptance of the surveillance system, primarily due to growing public concern regarding the health impacts of air pollution. The system was found to be relatively simple and flexible in implementation. The quantitative results showed that out of 485 medical records, 442 matched the reporting definitions according to the ICD-10 (International Classification of Disease 10<sup>th</sup> revision) criteria, and 355 matched the disease definitions. The system demonstrated high coverage (90.7%), indicating that a substantial proportion of potential cases were included in the surveillance data. However, the positive predictive value was moderate (72.9%), suggesting that while the system is generally accurate, there is room for improvement in differentiating between diseases directly attributable to PM<sub>2.5</sub> exposure and other factors. Additionally, no clear correlation was found between PM<sub>2.5</sub> levels and the number of reported patients. The absence of clear diagnostic criteria for diseases related to PM<sub>2.5</sub> exposure adversely impacts data accuracy and consistency. In conclusion, the PM<sub>2.5</sub> surveillance system in Nakhon Phanom province was functioning satisfactorily, with high coverage and reasonable data accuracy. However, the study highlights the need to improve the diagnostic criteria for PM<sub>2.5</sub>-related diseases and the development of learning machine artificial intelligence for coding Z58.1. Furthermore, refinements to the surveillance system would better support the development of evidence-based policies aimed at mitigating the health impacts of air pollution.</p> Kaewalee Soontornmon Sumanee Wacharasint Patsaraporn Nasa Sansuk Charoenkun Suthat Chottanapund Copyright (c) 2025 Journal of Health Systems Research https://creativecommons.org/licenses/by-nc-nd/4.0 2025-03-31 2025-03-31 19 1 77 93