Journal of Disease and Health Risk DPC.3

Medical surveillance and return-to-work assessment for workers exposed to ionizing radiation: A case study

Suraphat Siwawut — 2026-08-12

A 44-year-old male employee of Indonesian nationality, working as a Radiologic Testing Technician at a petrochemical plant, was informed by the laboratory that his cumulative radiation exposure had reached 89,935 microsieverts in one month, which exceeded the legal limit. He then met with an occupational physician for health surveillance and a return-to-work assessment. From the history taking, physical examination, and laboratory tests, it was found that the nature of the work had appropriate radiation safety measures, and the potential for exposure to ionizing radiation was low. The root cause of the problem was due to an unintentional operational error. The employee did not exhibit any symptoms or abnormal laboratory results and was cleared to return to work in his original position. After a literature review, such cases were rarely found. Therefore, the authors report this case study to serve as a guideline for investigating the cause, conducting health surveillance for occupational exposure to ionizing radiation that exceeds legal limits, and implementing the application of a return-to-work assessment protocol.

Investigation Report on Disease from Oxygen Deficiency at the Clear Water Reservoir of the Village Water Supply System, Moo 4, Nongklap Subdistrict, Nongbua District, Nakhon Sawan Province

Naphasanan Khankaew — 2026-08-12

On April 23, 2025, the Situational Awareness Team of the Office of Disease Prevention and Control 3 was notified of an incident involving five casualties (one fatality and four injuries) inside a clear water storage tank of a village water supply system in Moo 4, Nong Klap Subdistrict, Nakhon Sawan Province. The disease investigation team deployed to the area on April 25, 2025. The objectives were to confirm the diagnosis, determine the causes of injuries and fatalities associated with working in a confined space, and identify appropriate measures for planning the prevention of confined space-related injuries and fatalities. The study methodology employed a descriptive cross-sectional epidemiological approach. This involved reviewing medical records from Nong Bua Hospital in Nakhon Sawan Province, interviewing relevant individuals, collecting data on the injured and deceased, surveying the environment, and measuring toxic gas levels under normal conditions compared to simulated conditions involving the agitation of sludge at the bottom of the tank. The results showed a total of five victims: one fatality (a 26-year-old male) and four injuries. The cause of death was asphyxiation (lack of oxygen). The incident site was a 4-meter-deep concrete clear water storage tank with an accumulation of sludge reaching 1 meter high. Gas monitoring under normal conditions showed values within standard limits. However, during the simulation involving the agitation of the sludge at the bottom of the tank, hydrogen sulfide (H₂S) levels reached as high as 41.6 ppm (standard limit: 20 ppm), and ammonia (NH₃) levels surged to 440 ppm. This exceeded the Immediately Dangerous to Life or Health concentration (IDLH: 300 ppm) according to NIOSH standards. In conclusion, the loss of consciousness and fatality were caused by the inhalation of high-concentration toxic gases released from organic sediments during operations. The primary root cause was working in a confined space without ventilation and adequate safety systems.

Comparative Effectiveness of Telemedicine and Conventional Care for Diabetic patients

Lalita Ueawiriyanukun — 2026-08-12

The rising incidence of type 2 diabetes has necessitated the development of digital health interventions as a key mechanism for enhancing healthcare accessibility. This quasi-experimental study aimed to compare the effectiveness of telemedicine-based care versus conventional care among 62 patients with type 2 diabetes in the primary care network of Phetchabun Hospital. Participants were divided into an experimental group and a control group (n = 31 per group) and followed for 24 weeks. Data were analyzed using Repeated Measures ANOVA and ANCOVA. The results demonstrated that both groups achieved statistically significant reductions in HbA1c and capillary blood glucose (DTX) from baseline (p < 0.001 and p = 0.001, respectively). The telemedicine group showed a mean HbA1c reduction of 0.56%. However, no significant differences were observed between the two groups regarding HbA1c and DTX levels at week 24 (p = 0.210 and p = 0.558). In conclusion, telemedicine is a non-inferior alternative to traditional care, effectively reducing travel barriers and closing gaps in primary care settings. Future studies should focus on cost-effectiveness and extended follow-up to evaluate long-term behavioral sustainability.

Factors Influencing Helmet-wearing Behavior among Motorcycle Riders at a Vocational College in Phayao Province

Nongkran Sakunaphong — 2026-08-12

This study aimed to examine factors influencing helmet-wearing behavior among vocational students in Phayao Province, Thailand. A quantitative cross-sectional study was conducted among 389 vocational students selected through cluster sampling from certificate and diploma levels. Data were collected using a questionnaire developed based on the Health Belief Model (HBM), validated for content (IOC ≥ 0.5) and reliability (Cronbach’s alpha = 0.86). Data were gathered during March–April 2025. Descriptive statistics (frequency, percentage, mean, and standard deviation) were used to describe general characteristics, Pearson’s correlation to examine relationships among variables, and multiple regression analysis to identify predictors of helmet-wearing behavior. Results revealed that most participants were male (65.0%) and only 40.1% reported always wearing helmets. Significant positive predictors of helmet-wearing behavior included health motivation (β = 0.308, p < 0.001), perceived severity (β = 0.164, p = .039), and cues to action (β = 0.276, p < 0.001), while perceived barriers had a negative influence (β = –0.131, p = 0.011). The regression model explained 47.6% of the variance in helmet-wearing behavior (R² = 0.476). In conclusion, enhancing health motivation, increasing awareness of accident severity, and strengthening external cue such as family support and law enforcement are essential strategies to promote consistent helmet use among adolescents.

Spatial Association of Malaria in Thailand

Pathaweekan Koedsawat — 2026-08-12

Malaria remains a major public health problem in Thailand, with weather and environmental factors being key factors affecting its proliferation. This research aims to study the distribution, spatial association, and factors associated with malaria incidence in Thailand. The study was conducted using a cross-sectional study design applying secondary data from January to December 2021, including 1) data on 3,628 malaria patients, 2) weather data, and 3) spatial and environmental data. The statistics used for data analysis included Moran’s I and panel regression analysis. Malaria in Thailand was found to be spatially distributed in the northern region (Mae Hong Son provinces), the western region (Tak, Kanchanaburi, Ratchaburi, Phetchaburi, and Prachuap Khiri Khan provinces), and the southern region (Ranong and Yala provinces). The occurrence of malaria was found to be spatially dispersed, and no disease concentration was found (Moran’s I = -0.017). The minimum temperature and forest area were significantly associated with malaria incidence at the 0.05 level (coefficient = 0.15 and 9.11, respectively). Accordingly, surveillance should be conducted in each province during the rainy and winter seasons when temperatures are low. Further, malaria prevention guidelines should be developed for those living or working in forested areas, while early warning systems should be developed for communities during the rainy season, and proactive screening should be conducted in malaria-prone areas during June.

Effectiveness of a Self-management Promotion Program combined with Video Media among Type 2 Diabetes Mellitus Patients with Hyperglycemia, Phrae Hospital

Suwannee Sroisong — 2026-08-12

This study employed a quasi-experimental research design aimed at examining the effectiveness of a self-management promotion program combined with video media among patients with type 2 diabetes mellitus. The sample consisted of 56 patients with uncontrolled type 2 diabetes mellitus who were randomly assigned to either an experimental group or a control group. The experimental group (n = 28) received the self-management promotion program combined with video media, whereas the control group (n = 28) received routine nursing care. The research instruments included a diabetes knowledge test, a diabetes self-management behavior assessment form, and a 12-week self-management promotion program incorporating video media. Content validity was established by a panel of experts, yielding a content validity index 0.70 – 1.00. The reliability of the diabetes knowledge test and the self-management behavior assessment form was determined using Cronbach’s alpha coefficient, demonstrating acceptable internal consistency. Data were analyzed using descriptive statistics, Chi-square test, paired t-test, and independent t-test. The findings revealed that, after the intervention, the experimental group demonstrated significantly higher self-management behavior scores (Mean = 37.68 ± 3.97) and significantly lower glycated hemoglobin (HbA1c) levels (Mean = 7.47 ± 1.02) compared with the control group (Mean = 34.21 ± 6.37; Mean = 8.45 ± 1.87, respectively) at the .05 level of significance. However, there was no statistically significant difference in diabetes knowledge scores between the experimental group (Mean = 19.71 ± 2.01) and the control group (Mean = 19.14 ± 2.09) at the .05 level. The results indicate that the self-management promotion program combined with video media was effective in enhancing self-management behaviors and reducing HbA1c levels. This program may be further developed as a care model to improve glycemic control among patients with type 2 diabetes mellitus.

Effect of High-Intensity Interval Training on Diabetes: A Systematic Review

Wiroj Ruangwarapitch — 2026-08-12

This systematic review aimed to synthesize the available evidence on the effects of High-intensity interval training (HIIT) on glycaemic control, cardiorespiratory fitness, body composition, and lipid profiles in individuals with type 2 diabetes mellitus (T2DM). The outcomes of HIIT were compared with those of non-exercising control groups and, where applicable, with moderate-intensity continuous training (MICT). A comprehensive literature search identified 650 potentially relevant studies, of which 9 high-quality randomized controlled trials (RCTs) met the inclusion criteria and were included in the final synthesis. The findings demonstrated that HIIT significantly reduced glycated hemoglobin (HbA1c) levels and fasting blood glucose compared with non-exercising controls. Moreover, HIIT produced comparable or superior improvements in glycaemic outcomes relative to MICT in several studies. In addition, HIIT was associated with significant improvements in cardiorespiratory fitness, as measured by maximal oxygen uptake (VO₂max), and showed favorable trends in reducing body weight and blood lipid levels. Importantly, no serious adverse events related to HIIT were reported across the included studies. In conclusion, HIIT appears to be an effective and safe exercise modality for individuals with T2DM, particularly for improving long-term glycaemic control and enhancing cardiorespiratory fitness. Given its time-efficient nature, HIIT may represent a practical alternative for patients with limited time and could be incorporated into evidence-based diabetes management strategies.

Development of a Self-Management Model Based on Health Coaching to Delay Chronic Kidney Disease Progression in Patients with Stages 1–3 CKD in Primary Care Settings Uthai Thani Province

Nattaporn To-im — 2026-08-12

This research and development study aimed to develop and evaluate the effectiveness of a self-management model based on the health coaching concept to delay disease progression among patients with chronic kidney disease (CKD) stages 1–3. A mixed-methods approach was employed and conducted in three phases. Phase 1 involved a situational analysis of problems, related factors, and needs among 140 patients with CKD stages 1–3, selected using purposive sampling based on inclusion criteria, including age ≥18 years and a confirmed diagnosis of CKD stages 1–3. Phase 2 focused on the development and synthesis of the self-management model by integrating Self-Management Theory with the health coaching concept. Phase 3 involved the implementation and evaluation of the model using a quasi-experimental pretest–posttest control group design. The sample consisted of 60 patients, divided into an intervention group (n = 30) and a comparison group (n = 30). Stratified random sampling combined with simple randomization was applied to minimize contamination. The intervention was conducted over a 12-week period. Research instruments included health behavior and self-management questionnaires with reliability coefficients (Cronbach’s alpha) ranging from 0.87 to 0.92, as well as clinical data obtained from medical records, including estimated glomerular filtration rate (eGFR), serum creatinine, glycated hemoglobin (HbA1c), and blood pressure. Data were analyzed using descriptive statistics, t-tests (independent and paired), and analysis of covariance (ANCOVA). The results revealed that, after the intervention, the intervention group demonstrated significantly higher self-management and health behavior scores compared to both baseline and the comparison group (p < .001), with an adjusted mean self-management score of 4.01. After controlling for baseline values, the intervention group showed significantly better outcomes than the comparison group. Clinical outcomes also improved significantly in the intervention group, with eGFR increasing from 61.2 ± 18.4 to 63.8 ± 18.1 ml/min/1.73m² (p = 0.003). ANCOVA results further indicated that the intervention group had significantly higher eGFR than the comparison group (F = 6.84, p = 0.011), while no significant changes were observed in the comparison group. In conclusion, the self-management model based on the health coaching concept was effective in enhancing self-management and health behaviors, as well as delaying disease progression among patients with CKD stages 1–3. The model demonstrates strong potential for implementation in primary healthcare and community-based health systems.

Seroprotection Against COVID-19 Among Urban Migrant Workers: Evidence to Inform Health Screening Policy

Watcharanan Chakchuai — 2026-08-12

While the COVID-19 pandemic is no longer classified as a public health emergency, it is crucial to maintain preventive measures to control its transmission, particularly among vulnerable population like migrant workers. The level of immunity against COVID-19 is a valuable tool for surveillance because it is still detectable for an extended period, while the current diagnostic methods such as Real-time PCR and Antigen test kits (ATK), are primarily sensitive to the initial infection phase. This study aimed to evaluate the immunity levels (IgG) against SARS-CoV-2 and analyze health policies related to renewal of work permits for these migrant workers. The research was a cross-sectional design, with the participants of 975 migrant workers in Bangkok, Pathum Thani, Samut Prakan, Nakhon Nayok, and Prachinburi. Data was collected from September 16, 2022, to December 31, 2022. The laboratory method to test COVID-19 immunity levels utilizes Electrochemiluminescence immunoassay (ECLIA). The study finding indicated that out of the migrant workers, 878 participants (90.1%) show positive immunity test results, while 97 participants (9.9%) showed negative results. Among those who positive immunity, the proportions from Vietnam, Laos, Myanmar, and Cambodia were 100% (4/4), 94.3% (50/53), 89.8% (733/816), and 89.1% (90/101) respectively. Notably, 64.3% (265 participants) showed immunity levels of 200 BAU/ml and above and reported a vaccination history of over 4 months. Additionally, 105 participants showed immunity levels ranging between 18-199 BAU/ml, having either a history of vaccination or prior infection. Conversely, there were 30 participants who tested negative for immunity, having no history of COVID-19 illness. Participants with immunity levels of 200 BAU/ml and above, along with a vaccination history of more than 4 months, were significantly associated with protection against COVID-19 infection (p-value <0.001). Thus, it is recommended that migrant workers who have been vaccinated for more than 4 months or lack immunity should consider receiving the COVID-19 vaccine to ensure comprehensive protection against the disease.

Development and Evaluation of an Online Proficiency Testing System for Malaria Microscopy Diagnosis using Digital Blood Film Photography Innovation

Patcharida Boondej — 2026-08-12

This research aimed to develop and evaluate an online proficiency testing system for microscopic malaria diagnosis, utilizing digital photography innovations of actual blood films, and to assess the agreement between the online and conventional assessment methods. The sample consisted of 94 laboratory personnel assessed by the conventional method and 134 participants assessed by the online method. Nine standardized blood film cases, validated by WHO-certified level 1 and level 2 experts and confirmed by Real-time PCR, were used as test materials. Data were analyzed using one-way ANOVA, paired t-test, and Bland-Altman plot. The results showed that the conventional method yielded mean percentages of 84.75, 97.40, and 70.39 for parasite identification, parasite detection, and parasite counting, while the online method showed 81.96, 97.14, and 78.78, respectively. Paired t-test analysis revealed p-values of 0.53, 0.78, and 0.06 for the three competencies, respectively, indicating no statistically significant differences (p>0.05). Bland-Altman analysis demonstrated that parasite detection exhibited the highest agreement with a bias of 0.26 and limits of agreement ranging from -5.15 to 5.66. User satisfaction averaged 90 percent. The study concludes that the online proficiency testing system, utilizing digital blood film photography, is an effective alternative to the conventional method. It is an appropriate tool for assessing laboratory network personnel with increased coverage, which can enhance the quality assurance system for microscopic malaria diagnosis to support Thailand's malaria elimination goals.