Hsri Journal 2 3

.-.
Contents
335
Somchai Bovornkitti
Jaruayporn Srisasalux
337
EDITORIALS
The World Changes, So Does Disease
342
Ethics and Research in Humans
345
350
360

372
388
Somchai Bovornkitti
Jaruayporn Srisasalux
EDITORS NOTE
SPECIAL ARTICLE
The Etiology of Human Aggression
Lertsiri Bovornkitti
ORIGINAL ARTICLES
The Role of Key Stakeholders in the Introduction
of the Government Use of Patents for Essential
Medicines in Thailand
Sripen Tantivess
Nusaraporn Kessomboon
Chotiros Laongbua
Health Research System for Sustainable Health

Reform in Thailand
Pongpisut Jongudomsuk
Measuring Catastrophic Health Expenditures

Using the Poverty Approach
Viroj NaRanong
Anchana NaRanong
Attakrit Leckcivilize
Capacity-building for Health Policy and System

Research in Thailand
Jomkwan Yothasamut
Adun Mohara
Yot Teerawattananon
Sripen Tantivess
Ladda Damrikarnlerd
Suwannee Laoopugsin

.-.
Contents
401

Barbara Starfield
409
:

419

427

437

443
450
Assessment of Primary Care in Thailand from the

Providers Perspectives
Krit Pongpirul
Supattra Srivanichakorn
Barbara Starfield
Exercise Behavior among Type-2 Diabetic Patients

in Bangkok: The Bangkholaem Urban Community
Study
Somnuke Gulsatitporn
Darawan Sritanyarat
Valla Tantayotai
Sirinate Krittiyawong
Yupa Praingamnetr
Winai Dahlan
Thep Himathongkam
Health Research Expenditures of the Health Systems Research Institute

Kittinan Anakamanee
Factors Influencing the Retention of Medical

Graduates of Khon Kaen University in a Northeastern Community Hospital
Phisal Maireang
Anongsri Ngoson
Apida Runvat
Bussayasri Sribussayakul
Health Checks for the People under Health Insurance Project Amphur Tan Sum, Ubonratchathani
Province
Prachak Thong-ngam
Reviewing the Literature on Governance in Health

System
Manvipa Indradat
Ardyuth Natithanakul
Competency Assessment of Personnel of Chiang

Mai Provincial Health Office
Rathavuth Sukme
.-.
Contents
460
Sombat Boonyaprapa
Paitoon Wanapongse
Atttapon Cheepsattayakorn
Sriduda Saeung
Boontham Sola
Somchai Bovornkitti
464
477
482
485
MISCELLANEOUS
Knowledge Management and Routine to Research
Jaruayporn Sirsasalux
Mutiple Logistic Regression with Odds Ratio

Aroon Chirawatkul
The Pros and Cons of Ozone

Sranya Hengphraphorm
487
Article Format
489
The Prototype of Arabic Numerals
Somchai Bovornkitti
Somchai Bovornkitti
REVIEW
Lifestyle Modification in a Group at High Risk for
Diabetes
Wiroj Jiamjarasrungsi
Vitoon Lohsuntorn
Residential Radon Exposure and Lung Cancer: A

Survey in Chiang Mai Province
490
APPENDIX
English-Thai Medical Dictionary: The Letter C
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The Publisher and Editors cannot be held responsible for errors or any consequences arising
from the use of information contained in this journal; the views and opinions expressed do
not necessarily reflect those of the Publisher and Editors, neither does the publication of
advertisements constitute any endorsement by the Publisher and Editors of the products
advertised.
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Abstract
The Etiology of Human Aggression

Lertsiri Bovornkitti*
*Faculty of Fine Arts, Srinakarintharawirot University, Bangkok 10110
This paper is an edited, transcribed version of the 16th chapter of Edith Kramers book
entitled Art as Therapy, published by Athenaeum Press, Gateshead, Tyne and Wear, Great Britain; 2000, p. 218-222. The author investigates the consequences of the absence of any instinctively anchored inhibitions against killing ones own kind in our species. Art seems indeed
able to help tame irresponsible human destructiveness, as it gives form and creates symbols
that can endure. However, art cannot substitute for religion nor create beliefs that would possess the power to control aggression. Art and art therpy can do no more than help individuals
to resist the seductive appeal of commercialism, to make them responsive to the majesty of the
natural world, and therefore more ready to defend it.
Key words: etiology, human aggression, art, art therapy
348
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Abstract
The Role of Key Stakeholders in the Introduction of the Government Use of Patents for Essential
Medicines in Thailand
Sripen Tantivess*, Nusaraporn Kessomboon, Chotiros Laongbua
*Bureau of International Health Policy Development, Policy and Strategy Office, Ministry of Public Health,
Nonthaburi, Faculty of Pharmacy, Khon Kaen University, Khon Kaen Province, National Cancer Institute, Bangkok,
Thailand
In late 2006 and early 2007, the Thai government announced its intention to introduce the use by the
government of patents for three pharmaceutical products: two antiretrovirals (ARVs) and an anti-thrombotic drug. This action, which was aimed at improving access to essential medicines in the public sector,
complied with the flexibilities of the Agreement on Trade-related Aspects of Intellectual Property Rights
(TRIPS). By employing qualitative approaches, this study assesses the involvement of key stakeholders in
the policy process.
* ,
350
This analysis suggests that the idea of enforcing TRIPS flexibilities for expanded access to essential
medicines in Thailand was adopted as a public policy when the new government took office after a change
in the political system in September 2006. This policy obtained significant support from non-governmental organizations in the health sector, patient groups and academics, both inside and outside the country.
However, the action by Thailand was strongly opposed by patent-holding companies, the multinational
medical industry and their national governments. The contributions from civil society were managed in
several forms, such as technical and information support and demonstrations to advocate the policy. Meanwhile, powerful nations introduced trade retaliation and put political pressure on the Thai side. Global
concern about the unaffordable costs of patented medicines that hampered access to essential health care
in the South was beneficial to the enforcement of the government use provision. The potential diffusion of
this policy from Thailand to other developing countries triggered serious opposition from stakeholders
who lost their benefits.
Key words: government use of patents, access to essential medicines, stakeholders, policy
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Introducing
government use of patents on essential medicines in
Thailand, 2006-2007

Foundation Open Society Institute (Grant Number 20021722). ,
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365:1198-200.
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pharma giant. Want govt to decide if drug withdrawal legal.
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.-.
Health Research System for Sustainable

Health Reform in Thailand
Pongpisut Jongudomsuk*
Abstract
During the past two decades health research has contributed substantially to health system development in Thailand. Health system has been increased its system complexity and thus increases demand for
health research for further development. This paper is aimed to explore the current health research system
in Thailand and its capacity to cope with the increasing demand. Literature review and in-depth interview of key informants were used for data collection. In addition, a series of brain-storming meetings and
a synthesis workshop were organized to help analysis and to draw recommendations for future development.
It was found that the national health research system was facing many problems including lack of
leadership, limited health research resources both research budget and health researchers with inefficient
use. Strengths of the system which could be a foundation for future development included an establishment of autonomous research funding agencies which created a productive working environment for
health researchers to work effectively and a new working model called triangle that moves the mountain which involved stakeholders and civic groups in the research management process which could
promote research utilization and health system change based on knowledge. In addition, capacity building has been shifted from a conventional formal training model to on the job training under mentorship of
senior health researchers.
It is recommended that capacity building of health researchers is urgently needed and this has to be
done on the job-training basis. Mobilization of additional research budget is needed not only for supporting more research studies required for on-going health system reforms but also for capacity building. A
possible solution for mobilizing addition research budget is through making research more responsive to
demand of other public organizations. Using earmarked budget, 1 percent of total health budget, by enactment of the National Health Research Bill could be a long term solution and needs a strong political
support. Research management system needs to be strengthened through competent research managers.
Increasing management capacity of these research managers needs a special training programme and
research management tools. Finally, strengthening leadership of national health research system needs a
structural reform. However, a temporary solution is to use an existing health research funding agency to
perform this leading function with an acceptance of other health research funding agencies.
Key words: health research system, research management
*Health Systems Research Institute, Ministry of Public Health, Thailand.
360
*
*
.

.
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.
,
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.
.
.

,
.
.
.

.
:
1. Introduction
funding agencies. However, overall development of

national health research system lags behind what is
needed to tackle with rapid increase of system complexity.
This paper aimed to assess the health research
system in Thailand in various dimensions in order to
recommend policy to improve the performance of
national health research systems. This paper covers
analyses of leadership and governance, resources for
research systems and utilization of health research
for policy decision and integrate them into practices.
Methods covers literature reviews and in-depth interview of key informants, including 3 senior researchers and 24 research managers. In addition, a series
of brain-storming meetings and a synthesis workshop
had been organized in May 2008 to draw recommendation for the future development of health research
espite impressive success in health system de

velopment in Thailand, its health system is still
facing several challenges and, having gone through
several reform periods,(1) needs continuous reform.
Recent reforms of health system in Thailand included
establishment of universal healthcare coverage system,(2) enactment of National Health Act 2007(3) and
Control of Alcohol Beverage Act 2008,(4), to name a
few. These have been supported by substantial health
researches. Knowledge generation through research
has been identified as a crucial component to improve health system for a long time but an important
landmark of health research system development occurred in 1992 when the Thailand Research Fund (TRF)
and the Health Systems Research Institute (HSRI) were
established as effective research management and
.-.
before getting approval from the Bureau of Budget

(BOB).
The current 7th National Research Policy and
Strategies (2008-2010) has 5 research strategies and
health research is part of the 2nd strategy which focuses on developing and strengthening national potential and capability for social development. The priority research areas under this national health research
policy include health promotion, emerging diseases,
efficient health service delivery system, rehabilitative
care, consumer protection, traditional, and herbal
medicines.(5)
In 1992, Thailand Research Fund (TRF), Health
Systems Research Institute (HSRI) and National Science and Technology Development Agency (NSTDA)
were established as autonomous research funding
agencies through legislations. These three research
funding agencies have different focuses and management approaches, summarized in Table 1.
system. This paper is prepared as one of five country

case studies for the preparatory meeting in Bangkok
in June 2008, prior to the Bamako Summit end of
2008.
2. Present situation of health research

system
2.1 Leadership and governance

2.1.1 Institutional arrangements
Since 1959, the National Research Council
of Thailand (NRCT) has been established through an
Act as a national policy body for development of overall
research system in Thailand. NRCT also provides funding support directly to researchers for research proposals relevant to national research policy. NRCT develops a five-year National Research Policy and Strategies and uses it as a tool to direct public investment
in research. Research budget requested by all government offices, except autonomous research funding agencies, needs to be considered by the NRCT
Table 1 Main characteristics of TRF, HSRI and NSTDA

Research areas
Support
In-house
of area based
research
Capacity building
TRF
Basic research and research & development focusing on agriculture, industry, services (esp. logistics of agricultural products, tourism and education) and energy areas
Prohibited
A specific PhD grant program & empowerment of

researchers through participatory and experience
exchange process domestically and internationally
HSRI
Health system and health policy research to support health system reform
Based on policy in
different periods
Empowerment of researchers through participatory

and experience exchange
process
NSTDA
Research & development to support science and technology development (bio-medical and clinical research)
Mostly in-house,
>80% of grants
Training and providing

grants to young researchers to work with senior researchers
362
TRF is not allowed, by its law, to conduct research by

its own staff while HSRI used to conduct in-house
research by its own staff at the beginning but later
on transferred this task to their alliances/networks.
NSTDA has its own research facilities to absorb 80
percent of research fund.
Recently, the newly established public autonomous organization such as Thai Health Promotion
Fund (Thai-Health) also plays a vital role in supporting health research. Thai-Health was established in
2001 and is solely funded by earmarked sin tax from
tobacco and alcohol to support health promotion activities and to empower civil society organization.
Thai-Health started to provide significant support to
health policy research, mainly through the management of HSRI, since 2002.
The Ministry of Public Health (MOPH) and the
Ministry of Education (MOE) are two other public
organizations which function as research funding
agencies as well as research institutes. Most of health
researchers work in these two organizations. In addi-
tion to their own research budget which is strongly

directed by the NRCT, they are the main recipients
of all other research funding agencies.
It is unknown how large the private for profit
enterprises support health researches, especially pharmaceutical industries. There are only two non-forprofit organizations, National Health Foundation (NHF)
and Thailand Development Research Institute (TDRI),
which have prominent role in managing and conducting health research. NHF was established in
1991, with initial financial support from an international donor agency. NHF plays a crucial role in coordinating and managing health and biomedical researches, supported by various local research funding agencies, which could support health system development. TDRI was established in 1984 as a policy
research institute to provide technical and policy analysis that supports the formulation of policies with longterm implications for sustaining social and economic
development of the country. TDRI though focused on
economic researches, however, involved in health
Financing health
research
Based on NRCT
Figure 1 Institutional arrangement of the health research system in Thailand
4 .5
4 .0
3 .7
.-.
3.9
3.5
3.5
Percent
3 .5
3 .0
2 .5
2 .0
1 .5
1 .0
0 .5
0.92
0.92
0.26
0.47
1.22
0.55
0.32
0. 13
0 .0
2002
2003
THE (%GDP)
2004
HR1 (%THE)
2005
HR2 (%THE)
Note: HR1 = Health research budget based on the study by Hanvoravongchai, P et al.
(2007).
HR2 = Health research budget based on national health account data studied by
the International Health Policy Programme-IHPP (2007).
The data from HR1 obtained from a survey of main public health research
funding agencies and, therefore, were lower than those from HR2, which tried to cover
all health research budgets from every source.
Figure 2 Total health expenditure and health research expenditure in Thailand: 2002-2005
use of limited funds.(6)
Recently, there was an initiative to reform health
research system by amending the Health Systems
Research Act 1992. According to the draft law, HSRI
would be changed to the National Institutes of Health
(NIH)* and would act as a secretariat office of the
National Health Research Committee (NHRC). NHRC
would set up national health research policy and oversee management of NIH. Initial endowment fund of
Baht 1 billion or approximately US$32.25 million** and
regular budget support of 1 percent of total health
budget or approximately US$4.6 billion would be provided annually to NIH to ensure sufficient health re-
research during the last decade especially in development of universal healthcare coverage policy.
Organizations involved in health research system in Thailand and its relationship can be presented
in Figure 1.
2.1.2 Leadership
Although NRCT is expected to be a policy
body of research system development in Thailand, its
leading role is rather limited. The bureaucracy of NRCT
limits participation of high qualify staffs especially
research managers and, therefore, limiting organizational capacity. In addition, NRCT has little influence
on priority setting and budgeting process of all autonomous health research funding agencies.
Leadership of health research system is worse
than that of research system. Many organizations involve in health research system but there was no
organization to steer and coordinate the whole health
research system. Each organization has its own priority setting and research management approach
without an effective coordination mechanism that
might result in fragmentation and lack of synergistic
* At the moment, there is an organization under the Department of

Medical Science called National Institute of Health (NIH) but its
mandate focuses mainly on laboratory research and providing laboratory services. The proposed new organization would perform as US
National Institutes of Health which comprises 27 institutes and centers
and provides researchers with leadership and financial support.
**
Based on currency exchange rate 1US$ = 31 Baht
Calculation based on health budget in the 2008 fiscal year = 141,833

million Baht
364
HSRI
8%
WHO
3%
NSTDA
11%
Health
system
research
16%
MOPH
31%
Clinical
4%
Others
1%
Public
health
42%
Applied
research
16%
TRF
12%
NRCT
14%
Basic
science
21%
Thai-Health
21%
Source: Hanvoravongchai, P et al. (2007)
Source: Hanvoravongchai, P et al. (2007)
Figure 3 Distribution of research budget by funding agencies
Figure 4 Distribution of research budget by types of health

research
search budget. Unfortunately, this draft law had not

been submitted to the cabinet for resolution because
of the lack of political support.(7)
2.2 Health research resources
2.2.1 Health research budget
It is recommended that developing countries should spend at least 2% of their national health
expenditure in research and research capacity
strengthening.(8) However, during 2002-2005 the average budget spent for health research in Thailand
was only 0.37-0.78 percent of total health expenditure, much less than the benchmark of 2 percent (see
Figure 2). The average total health expenditure during the same period was 3.6 percent of Gross Domes-
tic Product (GDP).

Based on the analysis of research budget during
2002-2006,(6) it was found that about one-third of research budget was managed by the MOPH. Distribution of research budget by funding agencies is shown
in Figure 3. Almost half of research budget was spent
on area of public health. Research budget spent on
clinical research was only 4 percent of total research
budget. Distribution of research budget by types of
health research is show in Figure 4.
NRCT conducted a survey and found that in 2005
budget for health and medical researches, spending
on salary of research personnel, equipment, land and
building were 4.7 percent, 12.9 percent and 0.1 per-
Equipment
12.9%
Land &
building
0.1%
Total
Private not-for-profit
Salaries
4.7%
Public enterprise
Private university
University
Government
0%
Other
current
expenditure
82.3%
Source: NRCT (2007)
Figure 5 Distribution of research budget by type of expenditure in 2005
20 %
PhD
PhD
40 %
Masters
Masters
60 %
Bachelor
Bachelors
80 %
100 %
Below-bachelors
Below-bachelors
Source: NRCT (2007)
Figure 6 Educational background of health researchers in different organizations
.-.
cent respectively.(9) The majority of the budget was

used for current expenditure, including per-diem of
researchers (see Figure 5).
2.2.2 Health researchers
Although budget allocated for health research
in Thailand is quite low as compared to the benchmark of 2 percent of total health expenditure, shortage of competent health researchers is even more
severe. Based on recent survey of NRCT,(9) it was
found that there were 4,687 health researchers nationwide and almost all of them worked in public
sector. There was only 0.92% of health researcher work
in private sector. Among those who worked in public
sector, 69 percent were university staff, 52.9 percent
of health researchers were master-degree graduates.
Health researchers with doctorate and bachelor degree were 26.2 percent and 20.2 percent respectively.
Educational background of health researchers in different organizations is shown in Figure 6. NRCT also
found that most of researchers were part-time researchers. The full-time equivalent (FTE) researchers, in person-year, were only 0.6 of total number of
researchers.
Shortage of health researchers is a result of
many underlying problems and these include;
- Career of health researchers in public sector
is unclear. Although there are some academic positions in MOPH and their career promotion could be
as high as administrative positions, unfortunately,
these positions are not used to promote health researchers. Assigning civil servants to these positions
is not based on their academic competencies and
their technical contribution to the system.
- University and academic institution emphasize on teaching more than doing research. Some
researchers informed that they got complaints from
their bosses and colleagues about their research works
which could negatively affect their teaching responsibility.
- Researcher is not a popular profession, as
compared to physician, dentist, pharmacist, nurse and
etc, and its role has less public recognition. Income
of researchers was irregular, except those who work
in research institute and get regular salary, since it

would be based on the number of contracted research
projects.
2.2.3 Capacity building
Capacity building covers what beyond generally understood of a conventional training of individuals, it encompasses a comprehensive approach of
human resource development, institutional and legal
framework development which provide enabling environment for maximum contributions of researches
in a sustainable way.(10) Concerning institutional capacity development of health researchers in Thailand,
there are some impressive experiences where lessons
can be drawn as one of several models in capacity
building. For example;
- Field Epidemiology Training Programme
(FETP): established in 1980 by Communicable Diseases Control Department of the MOPH, with the
support of the World Health Organization (WHO) and
Center for Disease Control and Prevention (CDC) in
Atlanta. FETP is a two-year training programme in
epidemiology and Bureau of Epidemiology, MOPH is
a training center as well as performing its epidemiological functions. Strength of FETP is based on its
approach using on the job training and regular exchange of practical experience in the field of diseases
surveillance, outbreak investigations and outbreak containments, with minimal lecture only 1 month in 2
years. At the moment, there are 25 batches of trainees with 109 graduates who are actively in many key
positions in health system either at provincial or MOPH
level. Undeniably, FETP alumni are the backbone of
a functioning diseases control systems in Thailand.
- International Health Policy Programme (IHPP)
Thailand: established in 1998 with initial support from
the Senior Research Scholar (SRS) Programme of TRF.
Its sole mandate is to build up and sustain capacity
in health policy and systems research. From 19982007, IHPP supported 17 Masters, 5 certificates and
14 PhD and most of them were academically active
with substantial contribution to health system development where IHPP plays a major role in key policy
decisions in health systems reform in the past de-
366

cade.(11) Key successful characteristics of IHPP include strict recruitment criteria for research apprenticeship of young and talent public health workers for
a few years, conduct policy relevant researches under mentoring of senior researchers, prior to placement for doctoral training, and post-doctoral research
assignment upon return.
- Health Intervention and Technology Assessment Programme (HITAP): a budding agency of IHPP,
established in 2007 with multi-source funding from
HSRI, Thai-Health, National Health Security Office
(NHSO) and MOPH. The prime mandate of HITAP is
to provide empirical evidence on cost-effectiveness
or cost-utility of health interventions to inform policy
decisions whether to adopt new medical and health
technologies. HITAP develops a clear linkage with
policy decision in national health insurance schemes
and National Essential Drug Committee. In addition
to generate evidence, HITAP also aims to invest in
health researchers in this area. Similar to its mother
organization-IHPP, HITAP emphasizes strict recruitment criteria of young researchers and assigns senior
researchers to work with them closely as partners in
conducting relevant policy researches. Within 1 year
of establishment, HITAP could attract more than 20
new researchers both masters and post-doctoral from
the pool in Universities either on a full- or part-time
basis, to work in the programme with an impressive
performance.
2.3 Research management
2.3.1 Priority setting of research agendas
As mentioned earlier, each research funding agency had its own criteria to prioritize research
agendas for funding support, Prioritization criteria
varied, but closely related to each organizational mission and strategy. Using Burden of Disease (BOD) as
a criterion to prioritize research agendas, we found a
serious mis-match, only 10 percent of health research
budget went to high-burden diseases.(6) However, BOD
might not be a good criterion since it will focus only
on disease problems not health problems of the population in a broader sense. HSRI uses a research
mapping(12) to set up priority research agendas but
this approach is not well-accepted by all research

funding agencies. In summary, there is no consensus
on approach used for priority setting of health research agendas now.
2.3.2 Quality assurance mechanism
Expert review has been used as the main approach for ensuring a quality health research in Thailand but this would focus mainly on technical or scientific aspects of research. There are some similarities of assessment forms although common framework for assessing research quality has not been developed and well accepted by all concerned agencies.
However, quality of research should be more than
its scientific soundness but should also include its
output or impact.(13) It means that the research should
be successfully applied by end-users and lead to a
change in decision. Mechanism and process to ensure effective research policy interfaces were discussed
in section 2.4.
Ethical review is another crucial component of
research quality assurance to ensure standard protection of human subjects in research. Ethical review is quite new in Thailand and most of health
researchers are not familiar with this process. At
present, an ethical committee has been established
in almost every academic institution including MOPH.
However, ethical review processes were conducted
on different standard and was a time-consuming process. Some human experimental researches still could
be conducted without ethical review.(14) These could
discourage researchers to comply with this process.
Recently, HSRI has established the Institute for the
Development of Human Research Protections. This
office is aimed to develop national standard for ethical review and to support all ethical committees across
different agencies to achieve this standard. Legislation on Human Experimentation has already been
drafted but has not been adopted yet.
2.3.3 Networking with national and international partners
Thailand, as many other developing countries,
received substantial external technical supports for
.-.
ers at the late stage of research project seems to fail

to convince the policy makers.(12) The common practice for this approach, used by many research management agencies, is to set up a steering committee,
including all stakeholders and senior researchers, to
oversee the whole process. This could be an approach to integrate research into policy process.
Having relevant research questions is important
to promote the link of research into policy and practice. Research mapping is an effective research management tool to set up relevant research questions in
a comprehensive approach and this changes research
project based on specific research questions to a thematic research plan.(3,12) It is proposed that this thematic research plan is managed in an integrated way.
health development, both from bilateral and multilateral collaborations. These included scholarships for
overseas trainings and created opportunity for
strengthening capacity of Thai health researchers as
well as establishment of long term relationship with
some academic institutions in developed countries.
Some of these academic institutions included Center
for Disease Control and Prevention (CDC) in Atlanta,
USA for strengthening epidemiological system, Institute of Tropical Medicine (ITM) in Antwerp, Belgium
for strengthening public health system especially primary care, and London School of Hygiene and Tropical Medicine (LSHTM) in UK for strengthening health
policy, financing and health economics. There are a
number of ongoing collaborative researches between
Thai health researchers and national and international
institutes.
At the national level, HSRI, TRF and Thai-Health
also support networking of health researchers. This
aims to empowerment them through exchange of experience and to create synergistic effect of their research works. For HSRI, there are more than 20 research networks working under its support. However,
its expected effect of networking could not be fully
achieved because of the less involvement of research
networks.
2.4 Linking research to policy and practice
The Theory on triangle that moves the moun(15)
tain proposed by a senior social leader, Professor
Prawase Wasi, has been used to promote knowledge
based health system development for more than a
decade. This principle emphasizes the integral link
among the three main determinants for successful
policy decisions: knowledge generation, social movement and political domains. This theory has been
applied and proven successful in many recent health
reform movements in Thailand.
Involving stakeholders in the processes of research (propose policy relevant questions, research
objective, and regular informed of the results) since
the beginning is a crucial step to promote the use of
research result. The conventional approach to present
research result with recommendation to policy mak-
3. Challenge and opportunity
3.1 A functional leading organization: A solution for leadership problem

The recent initiative to draft a law to transform HSRI to be a lead agency of health research
system demonstrated concerns of stakeholders to
improve leadership of the system. However, failing to
enact the proposed law because of the lack of political support led to another proposal.
The new proposal still expected HSRI to act as a
lead agency of health research system but on a functional basis.(7) HSRI was expected to coordinate all
health research funding agencies, without authority
and financial power, and to harmonize their works to
fit with the prioritized health research agendas. The
first attempt of HSRI to achieve this expectation was
a process to synthesize research outputs, supported
by various health research funding agencies, to improve well-being of Southern Muslim people under
the civil unrest and conflicts situation. HSRI was a
leading organization to coordinate with NRCT, TRF,
Thai-Health, NHSO, local academic institutes and civic
groups for the synthesis and advocacy processes. This
attempt led to a formation of a small task force, comprising of representatives of all research funding agencies, to coordinate and to oversee all researches in
the Southern of Thailand.
368

Some arguments were raised for the new role of
HSRI. Strength of HSRI since its establishment was
on the health systems research not on the health research. Expanding the role of HSRI to cover all health
researches could undermine its current strength especially when there was no additional resource for
this. HSRI should focus on health systems research
but should extend its partners to cover more than
those getting financial support from HSRI.(16)
At present, there is no new prescriptive solution
for the problems of leadership of health research system. HSRI might be the most suitable organization to
be the leading organization but this could be achieved
only when its structure and financial mechanism have
been reformed in parallel.
3.2 Overcoming health research resources constraints
Health research resources in Thailand, both
health researchers and research budget, are quite limited as compared to international norms. Mobilizing
more health researchers and research budget at the
same may not be feasible and therefore prioritization
is needed.
But this prioritization is looked like the chicken
or the egg problem. Without sufficient research budget, it would be difficult to attract competent health
researchers into the health research system. On the
contrary, it was found that existing research budget
could not be spent effectively and efficiently since
there was no adequate number of competent health
researchers. In addition, training for competent researchers is a time-consuming process.
Mobilizing more health research budget could
be the first priority since budget is needed for the
capacity building of health researchers, which mainly
based on on the job-training, and more budgets could
attract part-time researchers to fully commit to research work. Thai-Health plays an important role in
providing additional financial support to health research during the last 5 years though it is not the
main mission and could be difficult to sustain.
Another source of mobilizing research budget
is from the users of research. At the moment some
public organizations, such as NHSO and Ministry of

Finance, have allocated budget for research to improve their performance and this is a good opportunity to mobilize more research resources as well as to
make research more responsive to the users. Using
earmarked budget, 1 percent of total health budget,
to finance health research as indicated in the drafted
National Health Research Bill could be the best option but this needs strong political support.
3.3 Capacity building through networking of
health researchers with collegial support
It was found that conventional formal training
may not be enough to create a productive critical
mass of health researchers in Thailand. Some outstanding case studies confirm that on the job training with intensive support of senior mentors could be
an effective option. However this needs to be done
with strict recruitment criteria due to a limited number of capable researchers or mentors. Binding health
researcher with administrative procedures of bureaucratic system should be avoided and appropriate organizational and legal framework should be developed to create effective and conducive working environment for health researchers. Establishment of research networks using legal framework of HSRI, and
managing under health research thematic management, could be a possible option and has been proved
to be an effective model.(3) However, this has to be
done together with a system to ensure transparency
and accountability of research management system.
3.4 Role of health researcher or research manager in policy advocacy
As mentioned earlier, involvement of policy makers in the research management process since the
beginning is critical to ensure the use of research
outputs but who should manage this process? It is
also interesting how much this person has to do to
intervene and manipulate the policy process to achieve
expected policy changes. The strengths of health researchers are their technical competency and these
might not be compatible with those required for the
management of the proposed process, though a very
few number of researcher can do this function. In
.-.
expected to devote part of their times to this capacity building process. There is also a need to create a
productive working environment for health researchers which bureaucratic system is proved not be able
to serve this objective. A more flexible management
system under an autonomous public organization can
be used for this purpose but this has to be done with
a mechanism to ensure transparency and accountability.
Secondly, additional research budget is needed
and it could be mobilized from other public organizations who are users of research results by making
health research more responsive to demand of these
organizations. Achieving an earmarked budget of 1
percent of total health budget, by enactment of the
National Health Research Bill could be a long term
solution and needs a strong political support. It is
recommended that part of this research budget should
be spent on capacity building of health researchers
by paying more on personnel cost to allow junior researcher working under mentorship of senior researcher and by paying some long term fellowship for
health researchers in selected priority areas of expertise on the condition that these fellows come back
and fully commit in long term on health research a professional researcher career path.
Thirdly, there is a need to strengthen research
management system to ensure efficient use of research resources as well as to enhance the use of
research results for health system development. This
could be done through a competent research manager. A special training programme and research
management tools need to be developed for this capacity strengthening. Research management tools
include guideline for prioritizing research agenda or
research mapping, research quality framework, monitoring and evaluation of research study and most
importantly skills in knowledge management which
translate research into several channels of communication to e.g. general public, professional councils,
practitioners and policy decision makers.
Finally, there is a need to strengthen leadership
of health research system through a structural reform.
addition, too much involvement of health researchers

in the policy process, with or without pre-determined
solutions, could threaten their independence and impartiality and damage their technical credibility in
the long run(17).
It is expected that a new profession called
research manager should perform this advocacy function in addition to other research management tasks.
At the moment some health research funding agencies in Thailand have a staff position called a research manager but with different expected roles.
There is no specific training programme for this profession and its career development is quite unclear.
There is a need to building up this research management capacity to maximize the use of research results in policy process. However, challenges for research manager are numerous, for example their technical capacity and good understanding of the subject
matter, and credibility in advocating policies as well
as sustaining them in this career.
4. Conclusion and recommendations
Though it seems Thailand is at the forefront of

health systems reforms where health systems and
health policy researches contributed significantly on
evidence based policy decision, health research system in Thailand is still facing resource constraint as
well as leadership and coordinating problem while
there is an increasing demand for research to support on-going health system reform.
Although the system has been operated under
these limitations, research outputs could contribute
to recent health system reforms substantially. The
strengths are a close link between health researchers
and potential users of their researches especially policy
makers and the bridging role of policy entrepreneurs.(18)
In addition, there is a need to involve civic groups in
the process to ensure successful policy change.
More effective health research system could be
achieved through various measures. Firstly, there is
an urgent need for capacity building of health researchers and this has to be done through on the jobtraining basis. Existing senior health researchers are
370
tems Research Institute; 2007.

8. Commission on Health Research for Development. Health research:
essential link to equity in development. Oxford University Press;
1990.
9. Office of the National Research Council of Thailand. National
survey on R&D expenditure and personnel of Thailand. Office of
the National Research Council of Thailand; 2007.
10. United Nation Development Program. Capacity Development. Technical Advisory Paper 2. New York; 1997.
11. Pitayarangsarit S. Tancharoensathien V. Beyond training: Thailands
experience on sustaining capacity in health policy and system
research. International Health Policy Program; 2007.
12. Health Systems Research Institute. Lessons learnt from health
system research management. Health Systems Research Institute;
2004.
13. Commonwealth of Australia. Research quality framework: assessing the quality and impact of research in Australia. Advanced
approaches paper; 2005.
14. Panichkul S. Problems of ethical review process in Thailand.
FERCIT Newsletter Vol. 3. No. 6, 2004. [cited 2008 April 25]
Available from URL: http://www.geocities.com/fercit
15. Wasi P. Triangle that moves the mountain and health systems
reform movement in Thailand. Human Resources for Health Development J 2000;2:106-10.
16. Green A. Converting research on primary care to policy: primary
health care component. Mission report submitted to European
Commission supported Health Care Reform Project. 2007.
17. Phoolcharoen W. In-depth interview in March 2008.
18. Tangcharoensathien V, Wibulpolprasert S, Nitayarampong S. Knowledge-based changes to health systems: the Thai experience in
policy development. Bull WHO 2004;82:750-6.
This reform has to be well-prepared to minimize undesirable consequences. Its recommended that an
existing research funding agency, with a flexible and
efficient management system, should perform this
leading function temporarily during this transition
period.
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.-.
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Abstract
Measuring Catastrophic Health Expenditures Using the Poverty Approach

Viroj NaRanong*, Anchana NaRanong, Attakrit Leckcivilize
*Thailand Development Research Institute (TDRI) School of Public Administration, National Institute for Development Administration (NIDA)
Recent studies on catastrophic health expenditures often use arbitrary and universally cut-off shares
(e.g., 10 percent) of health expenditures on household income (or on total household expenditure) as the
main indicator of catastrophic health expenditure. However, some empirical studies in Thailand which
employed such indicators ended up with counter-intuitive findings, e.g., a substantial percentage of households in the richest quintile were found to be prone to catastrophic health expenditures, and more often
than not, at higher rates than those with lower income.
This paper uses the same set of data to demonstrate that the counterintuitive results resulted from
such faulty indicators. Using sophisticated household-specific poverty lines as a measure of household
*,
372
catastrophic expenditure, the study finds that, unlike households in the two lowest quintiles, it is extremely rare for those with higher-than-median income to have their post-health-expenditure income fall
below the poverty line, a result which is completely opposite to those derived from the former indicator.
However, since the head count of health-related impoverished households is not sentitive for those
households that are already below the poverty line, the study proposes a supplemental indicator, that is,
changes in the normalized poverty gap due to health expenditure, as an indicator that measures the healthexpenditure impact on poverty.
Key words: catastrophic health expenditure, health expenditure related to impoverished households, normalized poverty gap, poverty impact

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. Va Doorslaer E, ODonnell O. Paying out-of-pocket for health
care in Asia: catastrophic and poverty impact. EQUITAP working
paper#2; 2005.
. ODonnell O, Van Doorslaer E. Explaining the incidence of catastrophic expenditures on health care: comparative evidence from
Asia. EQUITAP working paper #5; 2005.
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386
Equity in financing healthcare: impact of universal access to

healthcare in Thailand. EQUITAP working paper # 16; 2005
, , . Catastrophic and poverty impacts of health payments: results from
national household surveys in Thailand. Bull Wrld Hlth Org 2007;85:
600-6.
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, , Nanak Kakwani. Thailands
New Official Poverty Lines. Research Report prepared for The
National Economic and Social Development Board and The United
National Development Programme. Bangkok: Thailand Development Research Institute; 2004.
World Bank. Catastrophic health care payments. Quantitative Techniques for Health Equity Analysis-Technical Note #18.
. World Bank. Poverty impact of health care payments. Quantitative

Techniques for Health Equity Analysis-Technical Note # 19.
. Wagstaff A, Van Doorslaer E. Catastrophe and impoverishment in
paying for health care: with applications to Vietnam 1993-98.
EQUITAP project; 2002.
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Abstract
Capacity-building for Health Policy and Systems Research in Thailand

Jomkwan Yothasamut*, Adun Mohara*, Yot Teerawattananon*, Sripen Tantivess*,,
Ladda Damrikarnlerd, Suwannee Laoopugsin
*Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi
International Health Policy Program (IHPP), Ministry of Public Health, Nonthaburi
Health Systems Research Institute, Ministry of Public Health, Nonthaburi

Capacity-building for health policy and systems research (HPSR) is a vital component in supporting
health system capacity in order to achieve certain health goals. Currently, a number of obstacles prohibit
the use of HPSR in real policy decision-making. These include selective use of evidence to support previously set policy agenda, inadequate funding and support for HPSR, inadequate human resources and
poor research capacity, resulting in low-quality research. It is belived that capacity-building for HPSR
would help break the above-mentioned vicious cycle.
This paper is aimed at informing all stakeholders about the potential approaches to build up HPSR
capacity. It was conducted by (a) reviewing the literature, (b) using a questionnaire survey of existing
research capacity within the Health Systems Research Institute (HSRI) network aimed at identifying capacity gaps and the current practices in building up research capacity, and (c) in-depth interviews with
key persons of leading research institutes, namely, the International Health Policy Program (IHPP), Epidemiology Unit of the Prince of Songkhla University, and the Thai Research Fund, to learn from their
experiences in capacity-building.
Definitions of capacity-building and HPSR, and the potential approaches for building research capacity were given. Results from the survey indicated that there is an urgent need to build up research
capacity at both the individual and research institute levels through formal and informal education, networking, involvement of policy actors and the public in setting up research agendas, conducting research
and disseminating the research results. Lessons learned from the leading research institutes revealed
several key successes, including leadership, long-term and flexible research grants, critical mass,
multidisciplinary teams, and relevant policy research. At the end of the paper, the information gathered
was used to construct recommendations for HPSR capacity-building in health research institutes.
Key words: capacity-building, health policy and system research, Health Systems Research Institute
into a stronger and more resilient fabric. If countries and societies want to develop capacities,
they must do more than expand individual human skills. They also have to create the opportunities and the incentives for people to use and
extend those skills.... (Fukuda-Parr et al. UNDP
2001)
National capacity is not just the sum total of

individual capacities. It is a much richer and more
complex concept that weaves individual strengths
capacity
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. Crisp B, Swerissen H, Duckett S. Four approaches to capacity

building in health: consequences for measurement and accountability. Health Promotion International 2000;15:99-107.
. Hyder AA, Akhter T, Qayyum A. Capacity development for health
research in Pakistan: the effects of doctoral training. Health Policy
and Planning 2003;18:338-43.
. Green A, Bennett S. Sound choices: enhancing capacity for evidence-informed health policy. Geneva: World Health Organization; 2007.
. Gonzalez Block MA, Mills A. Assessing capacity for health policy
and systems research in low and middle income countries. Health
research policy and systems. BioMed Central 200313;1:1.
. , . Beyond training:
Thailand experiences on sustaining capacity in health policy and
systems research. (Submitted to Bull Wld Hlth Org 2008).
. Matachi A. Capacity building framework. Ethiopia: United Nations Economic Commission for Africa; 2006.
. Alliance for Health Policy and System Research. What is health
policy and systems research and why does it matter? Report No.:
Briefing note #1. Geneva; 2007 June.
. . An integrative approach to translating knowledge and building a learning organization in health services
management. Bull Wld Hlth Org 2006; 84:652-7.
. , , ,
. The performance of National Health Research
Systems (NHRS) in Asia Pacific, a self-assessment. Bangkok:
International Health Policy Program and Health Systems Research
Institute; 2008.
400
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Assessment of Primary Care in Thailand from the Providers Perspectives

Krit Pongpirul*,, Supattra Srivanichakorn, Barbara Starfield
*Health Systems Program, Department of International Health, Johns Hopkins University, Baltimore, Maryland, USA.
Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University.
Institute of Community-based Health Care Research and Development, Ministry of Public Health, Nonthaburi Province
Department of Health Policy and Management, Johns Hopkins University, Baltimore, Maryland, USA.
The importance of primary care has increased since the recent health-care reform but no systematic
evaluation has been done. This study was aimed at assessing primary care in Thailand. The primary-care
system questionnaire originally developed by Barbara Starfield was used to assess nine primary-care
domains, namely, resource allocation, adequacy of facilities, first contact and co-payment requirement,
.-.
longitudinality, comprehensiveness, coordination, family-centeredness, community orientation, and professional personnel. Respondents were 77 primary care practitioners from 13 different provincial hospitals. The findings showed a response rate of 53.25 percent. Providers stated that (1) the resource allocation was not appropriately based on intimate needs, although there were some special provisions for
underserved segments of the population, (2) basic equipment and supplies were not adequate in some
regions, (3) consultation with a provider at the primary-care level was required before assessing to seek
other care, whereas the co-payment requirement was low, (4) most patients were seen by the same provider team on every visit, (5) primary-care services are comprehensive although regional variations were
evident, (6) coordination, family-centeredness, and community orientation were satisfactory, and (7) nurses
were key providers at primary-care facilities.
Key words: primary care, providers opinions

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. Starfield B, Shi L. Policy relevant determinants of health: an

international perspective. Health Policy 2002;60:201-18.
.-.
. van Doorslaer E, Masseria C, Koolman X, Group OHER. Inequalities in access to medical care by income in developed countries. Canad Med Assoc J 2006;174:177-83.
. Starfield B. Primary care : balancing health needs, services, and
technology. New York: Oxford Univ Press;1998.
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. Rojpibulstit M, Kanjanakiritamrong, Chongsevivatwong V. Patient
and health system delays in the diagnosis of tuberculosis in Southern Thailand after health care reform. Int J Tuberc Lung Dis
2006;10:422-8.
. Hanucharurnkul S. Nurses in primary care and the nurse practitioner role in Thailand. Contemp Nurse 2007;26:83-93.
. , Garner P, Martineau T.
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Abstract
Exercise Behavior among Type-2 Diabetic Patients in Bangkok: the Bangkholaem Urban Community Study
Somnuke Gulsatitporn*, Darawan Sritanyarat, Valla Tantayotai, Sirinate Krittiyawong, Yupa
Praingamnetr*, Winai Dahlan*, Thep Himathongkam
*Faculty of Allied Health Sciences, Chulalongkorn University, Health Service Center 12, School of
Nursing, Walailak University, Theptarin Hospital
Regular and proper exercise behavior was part of a method to control blood sugar levels in type-2
diabetic patients. This research was aimed at studying the exercise behavior of type-2 diabetic patients
residing in urban communities as well as studying the effect of exercise on their health condition and
diabetic complications. Volunteers in this project included type-2 diabetic patients who had received
medical treatment from BMA Health Service Center 12 from February to June 2006. All the volunteers
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first completed the personal questionnaire form and exercise behavior questionnaire form, and underwent blood testing, anthropometric measurements, and diabetic complications check-up. The study found
that 75 of 203 volunteers (or 36.9%) had regular exercise behavior; while 128 of 203 volunteers (or 63.1%)
refrained from performing regular exercise; however, only 42 of the 75 volunteers in the regular-exercise
group were within the standard criteria for regular exercisers. The regular exercise group had lower
fasting blood sugar and triglyceride levels than those of the non-exercise group, with the statistical significance being (p < 0.05), and tended to have a lower proportion of occurrences of diabetic complications
than those in the non-exercise group. The result of this study indicates that diabetes patients residing in
urban communities had a lower level of regular and proper exercise behavior. To solve this problem, the
body of knowledge on proper exercise and patterns of exercise behavior modification must be taken into
consideration.
Key words: exercise behavior, type-2 diabetic patients, urban community
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. Feuerstein BL, Weinstock RS. Diet and exercise in type 2 diabetes

mellitus. Nutrition 1997;13:95-9.
. DeFronzo RA, Bonadonna RC, Ferraunini E. Pathogenesis of
NIDDM: a balance overview. Diabetologia 1992;35:389-97.
. Boule_ NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of
exercise on glycemic control and body mass in type 2 diabetes
mellitus: a meta-analysis of controlled clinical trials. JAMA 2001;
286:1218-27.
. Devlin JT, Ruderman N. Diabetes and exercise; the risk-benefit
profile revisited. In: Ruderman N, Devlin JT, Schneider SH, Krisra
A, Editors. Handbook of exercise in diabetes. Alexandria: American Diabetes Association; 2002.
. Beamer BA. Exercise to prevent and treat diabetes mellitus. The
Physician and Sportsmedicine 2000;28:10.
. Dagogo-Jack S, Santiago JV. Pathophysiology of type 2 diabetes
and modes of action of therapeutic interventions. Arch Intern Med
1997;157:18052-17.
. Devlin JT, Schneider SH. Handbook of exercise in diabetes.
Canada:American Diabetes Association; 2002.
. Dengel DR, Reynolds TH. Diabetes. In: LeMura LM, von Duvillard
SP, editors. Clinical exercise physiology; application and physiological principles. Philadelphia: Lippincott Williams & Wilkins;
2004. p. 319-29.
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. Zhao G, Ford ES, Li. Compliance with physical activity recommendations in US adults with diabetes. Diabetic Med 2007; 25:
221-7.
. Kraus WE, Houmard JA, Duscha BD. Effects of the amount and
intensity of exercise on plasma lipoproteins. N Engl J Med
2002;347:1483-92.
. Williams PT. High-density lipoprotein cholesterol and other risk
factors for coronary heart disease in female runners. N Engl J Med
1996;334:1298-303.

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. , Stolk RP, Neal B. The prevalence and management of diabetes in Thai adult; the international collaborative
study of cardiovascular disease in Asia. Diabetes Care 2003;26:275863.
. Lindstrom J, Tuomilehto J. The diabetes risk score: a practical
tool to predict type 2 diabetes risk. Diabetes Care 2003; 26: 72531.
. Pi-Sunyer FX, Maggio CA. The prevention and treatment of obesity: application to type 2. Diabetes Care 1997;20:744-66.
. Aiello LP, Gardner TW, King GL. Diabetic retinopathy. Diabetes
Care 1998;21:143-56.
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Abstract
Health Research Expenditures of the Health Systems Research Institute

Kittinan Anakamanee*
*Health Systems Research Institute, Ministry of Public Health
The objectives of this study encompassed three elements to study: (1) the financial resources of the
Health Systems Research Institute (HSRI); (2) the budgetary allocation of HSRI; and (3) the relationship
between budget allocation and outcomes of HSRI. Data were collected from existing documents and studies on health research in Thailand and from financial data and activity reports of HSRI. The results showed
that (1) in the period 2002 and 2007, HSRI received 1,445 million Baht for health systems research, and
budgets from other sources dominated the government budget; (2) the major research themes involved
data systems and knowledge generation; and (3) the outcomes of HSRI activities, in terms of social movement and policy linkage, were related to the themes of research that received funds. The author recommends the following: (1) the private sector should play a greater role in supporting the national health
research system; (2) the efficiency of a research funding agency should be measured by the proportion of
administrative costs to the total expenditures, and the real practices of staff of that agency compared with
the agencys existing protocol on funding and terminating a project; and (3) the effectiveness of a research
funding agency should be measured through total outcomes of that agency compared with the targets
mentioned in strategies rather than the figure of unit costs per program/project.
Key words: expenditure, health research
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Health Research Systems Development in South-East Asia Region. [online] 2001. [cited 2008 April 28]; Available from : URL:
http://www.searo.who.int/ meeting/rc/rc54/inf3-rev1.pdf
. Organization for Economic Cooperation and Development (OECD).
Main Science and Technology Indicators 2006/1. 2006.
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Factors Influencing the Retention of Medical Graduates of Khon Kaen University in a Northeast-
.-.
ern Community Hospital#

Phisal Mairieng*, Anongsri Ngoson*, Apida Runvat*, Bussayasri Sribussayakul*
*Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
This research was aimed at investigating the reasons for and the motivation of medical graduates of
Khon Kaen University choosing to work in community hospitals in northeastern Thailand after completing their compulsory three-year bonded period of work. The population comprised 557 physicians who
had graduated during the years 1979-2003. A total of 233 samples were selected by stratified random
sampling and the data were collected by questionnaire. The research findings were as follows:
1. The factors that were significant in the retention of medical graduates who were working in
community hospitals in northeastern Thailand were the usefulness of knowledge of the community, the
preference for rural life and the requirement to work in/near their place of birth, respectively. To compare
the retention factors, the subjects were classified by sex, type of entrance, age range, grade and work
place. It was found that (1) male medical graduates prefer to work in administrative jobs compared with
female medical graduates, and (2) medical graduates who were working in community hospitals prefer to
work in administrative jobs rather than medical graduates working in a regional hospital.
2. The significant factors to support medical graduates who worked in community hospitals were
the extra money, improvement in hospital facilities and physical social welfare improvement, respectively.
3. The order of magnitude of the factors for choosing or changing the location of work was related
to postgraduate education, childrens education and individual factors, such as distance from home, quality of life, etc. In making a comparison of the factors, the graduates could be classified by sex, type of
entrance, age range, grade and workplace as follows : (1) male medical graduates gave a greater priority
to their childrens education than their female peers; (2) medical graduates who had gained entrance by
quota gave greater priority to postgraduate education more than the other group; (3) medical graduates
who ranged in age from 44 to 53 gave greater priority to the management system than those in other age
groups and medical graduates who ranged in age between 34 and 43 years gave greater priority to postgraduate education and their childrens education than any other age group; and (4) medical graduates
who were working in community hospitals gave greater priority to their task than the other group.
Key words: factors influencing the retention of medical graduates, Khon Kaen University, working in community hospitals, retention in the Northeast of Thailand

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Health Checks for the People under Health Insurance Project Amphur Tan Sum, Ubonratchathani
Province
Prachak Tong-ngam*
*Tan Sum Public Health District Office, Ubonratchathani Province
The objectives of the research were to study the health risks and risk-related behaviors of 24,717
people aged 15 years or older who resided in Tan Sum district, Ubonratchathani Province. Information
related to illnesses was collected by asking about their health history, behaviors that made them prone to
health risks, and laboratory check-ups. The work was conducted in the period from October 2006 to September 2007, and the data were analyzed using the Health Check program. The results showed the following: that from the body mass index in 11 percent of the sample were overweight, and 2.29 percent were
obese; waist circumference was above normal in 18.87 percent, and was more prevalent in women than
men; blood pressure in 7.5 percent was in the risky category, among which 4.94 percent suffered high
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blood pressure, and 0.14 percent suffered severe high blood pressure; blood cholesterol levels in persons
aged 40 years and over showed high levels in 0.10 percent among the risk group (3.99 percent); blood
sugar levels were 16.24 percent in the pre-diabetic stage, and 4.15 percent had diabetes, which was most
prevalent in women; the hematocrit was 51.47 percent in the anemia stage; 6.29 percent of stool samples
contained worms, the majority of which were liver flukes; 21.85 percent had calcium deposits on their
teeth, 2.27 percent had caries and 5.49 had both conditions; 0.74 percent had cataracts; among 38.26 percent of women aged 35-60 who came for cervical cancer checks, 0.37 percent had positive results, and 0.02
percent were positive for breast cancer.
With regard to behavior assessment for health risks, it was found that 0.06 percent consumed alcoholic beverages daily, 3.59 percent smoked cigarettes habitually; 3.50 percent had previous accidents; 0.11
percent had extra-marital sex without using condoms; 0.65 percent of both men and women drank energy-boosting beverages; 34.75 percent exercised 3-5 days a week while 3.94 percent exercised more than
5 days per week; with respect to riding motorcycles and driving cars, 1.89 percent of motorcycle riders did
not wear helmets, and 2.41 percent of car drivers did not wear safety belts; women took steroid-mixed
drugs more than men, and women suffered stress more than men; 0.97 percent consumed raw meat frequently.
Key words: health check, health insurance project

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Reviewing the Literature on Governance in Health System
Manvipa Indradat*, Ardyuth Netithanakul*

*College of Social Innovation, Rungsit University, Pathumthani Province
The goal of Thai health system development is to achieve a balanced and sustainable society in which
all Thai citizens have the security needed to live a happy life in a healthy and better condition. The objective
of this study was to perform a literature review to form a foundation and knowledge base on good governance in the Thai health system, analyze and plan for research mapping.
In this study, good governance in the health system was divided into 10 sectors: rule of law, ethics,
transparency, participation, accountability, value for money, human resources development, knowledge organization, management and information technology. These were simultaneously analyzed in macro- and
micro-analysis systems that were influenced by economic, social and political conditions as well as the agency
s role.
The literature review revealed that there were problems in every aspect of health governance. If these
problems were solved more effectively, that would generate better and improved services in the health-care
system. Consequently, it would create a sustainable society in which all Thai citizens would live a happy life
in a healthy condition.
The study found that governance is a function of the health system, that each governance principle
should be developed and adapted, and that governance issues should be identified at all levels. The problems encountered in studying health governance were that the issue needs more research, especially that
undertaken with a qualitative approach and comparison of the international governance functions.
Key words: health governance, stewardship, public participation
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. Dodgson R, Lee K, Drager N. Global health governance: A Conceptual Ceview. Geneva: World Health Organization and London
School of Hygiene and Tropical Medicine; 2002.
. Loughlin K, Berridge V. Global health governance: historical dimensions of global governance. Geneva: World Health Organization and London School of Hygiene and Tropical Medicine; 2002.
p. 4.
. Saltman RB, Ferroussier-David O. The concept of stewardship in
health policy in World Health Organization. Bull Wld Hlth Org
2000; 78(6):732-9.
. Health Network Agency. Health system matrices Report of A
Technical Meeting. Glion, Switzerland 28-29 Sep. 2006.
. USAID. Health governance concepts, experience and programming option, Feb 2008. Available from http://www.healthsystem
2020.org
. Fidler D. Global health governance: Overview of the role of
international law in protecting and promoting global public health.
Geneva: World Health Organization and London School of Hygiene and Tropical Medicine; 2002. p. 273.
. . . Available.
www.manager.co.th/Politics/Viewnews.aspx?NewsID=
9510000012909.htm;
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Competency Assessment of Personnel of Chiang Mai Provincial Health Office

Rathavuth Sukme*
*Inspector Generals Office, Ministry of Public Health
This research encompassed two objectives: (1) to assess the competencies of the personnel of the
Chiang Mai Provincial Health Office and compare these acquired competencies with expected competencies of the organization; and (2) to compare results of competency assessment by self-assessment with the
results of assessment by peers, by heads of sections and by the Competency Assessment Committee. The
target group comprised personnel of the Chiang Mai Provincial Health Office. Respondents were recruited
by the accidental sampling method during the days that the Committee collected data (between October
1, 2006 and March 31, 2007). The research tool was the competency assessment form adapted from the
competency assessment guideline of the Public Sector Development Commission, which comprised eight
dimensions. Data were collected from 147 respondents (94.2 % of the total staff). Results showed that:
(1) in the deputy director group, the underdeveloped dimension was mentoring for personnel development; (2) in the assistant director group, heads of clusters and heads of sections/technical experts, the
underdeveloped dimensions were ethical issues, holistic thinking and proactive management; (3) in the
technical operator group, the underdeveloped dimension was proactive management; and (4) from the
overall competency scores, the self-assessment produced similar scores to those assess by the Committee.
These findings will be useful for formulating individual development plans.
Key words: competency assessment, provincial health personnel
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Residential Radon Exposure and Lung Cancer: A Survey in Chiang Mai Province
Sombat Boonyaprapa*, Paitoon Wanapongse, Atttapon Cheepsattayakorn, Sriduda Saeung, Banthom
Sola, Somchai Bovornkitti#
*Department of Radioisotopes, Faculty of Medicine, Chiang Mai University, Chiang Mai Province, Thailand Institute of Nuclear Technology, Bangkok, Tenth Office of Disease Prevention and Control, Chiang Mai Province,
Chiang Mai Provincial Health Office, # Academy of Science, the Royal Institute, Bangkok
This survey was conducted in four districts in Chiang Mai Province as part of a multidisplinary
research study by academic staff of three universities, namely Chiang Mai, Songkhla and Khon Kaen
university, in collaboration with researchers from the Thailand Institute of Nuclear Technology and the
Royal Institute, with the aim of verifying the association between residential radon exposure and lung
cancer risk. The study was carried out by measuring radon gas levels in the homes of proven cancer
patients and in other homes as controls for the purpose of comparison. As the findings in both categories
of residences showed that the radon levels did not exceed the safety threshold (148 Bq/m3), it was concluded that radon gas exposure in such a situation of low levels would likely not be a significant cause of
lung cancer, but rather attributed to the heavy smoking habit of the northern citizens.
Key words: radon gas, lung cancer
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. Saccomanno GS, Yale C, Dixon W, uerback O, Huth GC. An

epidemiological analysis of the relationship between exposure to
Rn progeny, smoking and bronchogenic carcinoma in the U-mining population of the Colorado plateau 1960-1980. Health Physics
1986;50:605-18.
. Samet J. Radon and lung cancer. J Natl Cancer Inst 1989;81:74557.
. Martz DE, Falco RJ, Langne GH Jr. Time-averaged exposures to
220Rn and 222Rn progeny in Colorado homes. Health Physics
1990;58:705-13.
. Qualitative evaluation of the radon and lung cancer association in
a case control study of Chinese tin miners. Cancer Res 1990;50:17480.
. Samet JM. Diseases of uranium miners and other underground
miners exposed to radon. In: Rom WN, editor. Environmental and
occupational medicine. Boston: Little, Brown & Co.; 1992. p.
1085-91.
. Moolgavkar SH, Luebeck EG, Krewski D, Zielinski JM. Radon,
cigarette smoke, and lung cancer: a re-analysis of the Colorado
plateau uranium miners data. Epidemiology 1993;4:204-17.
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Thailand. Intern Med J Thai 2001;17:241-2.
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Lifestyle Modification in a Group at High Risk for Diabetes

Wiroj Jiamjarasrungsi*, Vitool Lohsoonthorn*
*Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok
Accumulating evidence from randomized controlled trials have shown that diabetes mellitus can be
prevented or delayed in high-risk individuals by an intensive lifestyle modification program. However, to
be meaningful for clinical practice in the real world, the results need to be both widely generalizable and
the methods practical and affordable enough to implement in a wide variety of health-care settings. This
review described some aspects of the intensive lifestyle modification program in groups at high risk for
diabetes. Topics included epidemiologic evidence about the relationship between lifestyle factors and
diabetes risk, clinical outcomes and cost-effectiveness of the intensive lifestyle modification program, and
predicting factors for its success. Some details of the three example programs, including the Chinese Da
Qing IGT and Diabetes Study, the Finnish Diabetes Prevention Study (DPS), the US Diabetes Prevention
Program (DPP) and Look AHEAD Study, were described. The information provided could be utilized in
the development of practical lifestyle interventions for diabetes prevention in Thailand.
Key words: intensive lifestyle modification program, diabetes high-risk group
464

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.
. Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care 2002;25:2165-71.
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chronic diseases. Report of the joint WHO/FAO expert consultation. WHO Technical Report Series, No. 916 (TRS 916). Geneva:
World Health Organization (WHO) 2002.
. Neel JV. Diabetes mellitus: a thrifty genotype rendered detrimental by progress? Am J Hum Genet 1962;14:353-62.
. Schulze MB, Hu FB. Primary prevention of diabetes: what can be
done and how much can be prevented? Annu Rev Public Health
2005;26:445-67.
. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television
watching and other sedentary behaviors in relation to risk of
.
.
obesity and type 2 diabetes mellitus in women. JAMA.

2003;289:1785-91.
Pan XR, Li GW, Hu YH, Wang JX, Yang WY, An ZX, et al.
Effects of diet and exercise in preventing NIDDM in people with
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Ilanne-Parikka P, et al. Prevention of type 2 diabetes mellitus by
changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343-50.
Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin
JM, Walker EA, et al. Reduction in the incidence of type 2
diabetes with lifestyle intervention or metformin. N Engl J Med
2002;346:393-403.
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Lau J. Long-term non-pharmacologic weight loss interventions for
adults with type 2 diabetes. Cochrane Database Syst Rev.
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factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 200618;:CD001561.
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2007;99(4A):68B-79B.
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diabetes. Ann Intern Med. 2005;143:251-64.
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for Disease Control and Prevention(CDC), U.S. Department of
Health and Human Services [cited 2004 Aug 31]. Available from:
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De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova
R, Dallongeville J, et al. European guidelines on cardiovascular
disease prevention in clinical practice. Third Joint Task Force of
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2003;10(Suppl 1):S1-S78.
Glazier RH, Bajcar J, Kennie NR, Willson K. A systematic review
of interventions to improve diabetes care in socially disadvantaged
populations. Diabetes Care. 2006;29:1675-88.
.-.
. Eriksson J, Lindstrom J, Valle T, Aunola S, Hamalainen H, IlanneParikka P, et al. Prevention of Type II diabetes in subjects with
impaired glucose tolerance: the Diabetes Prevention Study (DPS)
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1999;42:793-801.
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476
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(match casecontrol study) ,
(conditional logistic regression).

(dichotomy).
.
(adjusted OR).
. Kleinbaum DG, Klein M. Logistic regression. A self-learning

text,. New York : Springer; 2002.
. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic research principles and quantitative methods,. New York : Van
Nostrand Reinhold; 1982.
484
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. McMichael AJ, Campbell-Lendrum DH, Corval_n CF, Ebi KL,
Githeko A, Scheraga JD, Woodward A. Climate change and human health - risks and responses. Geneva: World Health Organization (WHO); 2003. 322 pages.
. http://en.wikipedia.org/wiki/Ozone_therapy#cite_note-33
. http://epa.gov/groundlevelozone/pdfs/2008_03_design_values_
2004_2006.pdf
. Salls CM. The ozone fallacy in garage ventilation. J Industr Hyg
1927; 9:12.
. Shaughnessy RJ, Levetin E, Blocker J, Sublette KL. Effectiveness
of portable indoor air cleaners: sensory testing results. Indoor air.
J Internat Soc Indoor Air Quality and Climate 1994;4:179-88.
. Esswein EJ, Boeniger MF. Effects of an ozone-generating airpurifying device on reducing concentrations of formaldehyde in
air. Applied Occup Environ Hyg 1994;9:139-46.
. Zhang J, Lioy PJ. Ozone in residential air: concentrations, I/O
ratios, indoor chemistry, and exposures. Indoor air. J Internat Soc
Indoor Air Quality and Climate 1994; 4:95-102.
. Weschler CJ, Shields HC, Naik DV. The factors influencing indoor ozone levels at a commercial building in southern California:
more that a year of continuous observations. Tropospheric ozone.
Pittsburgh. Air and Waste Management Association; 1996.

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.-.
()
choreal - . . choreic
choreic . choreal
choreiform .
choreoacanthocytosis
.
, ,
. neuroacanthocytosis
choreoathetoid .
choreoathetosis .
()
(athetotic movement);

. mobile spasm
familial paroxysmal c. . MountReback syndrome
paroxysmal c. . familial paroxysmal c., Mount-Reback syndrome
paroxysmal kinesigenic c.
.
-
choreoid . choreiform
chori(o)-
chorial . chorionic
chorioadenoma .
c. destruens
.
. invasive
mole, malignant mole
chorioallantoic .
chorioallantois .

chorioamnionitis
.
chorioangiofibroma
.
chorioangioma
.
chorioblastoma . . choriocarcinoma
chorioblastosis .
choriocapillaris .
. lamina choroidocapillaris
choriocarcinoma . .
chorioblastoma, chorioepithelioma,
chorionic carcinoma or epithelioma,
syncytioma malignum
choriocele .
chorioepithelioma . choriocarcinoma
c. malignum . choriocarcinoma
choriogenesis .
choriogonadotropin
.
c. alfa
. recombinant technology

chorioid .

. choreoidea, chorioidea, choroid

chorioid(o)- . choroid(o)chorioidea . chorioid, choroidea,
choroid
chorioma . .
. . . choriocarcinoma
choriomammotropin
.
choriomeningitis
.
lymphocytic c. .
-

;

chorion .

c. frondosum . .
*. . , . . . , . . , . . ,
. . , . , . . , . . , . . .
, . , . . , . . . , . . ,
. . , . , . . . , . , . .
, . , .
490
shaggy c., villous c.

c. laeve . . smooth
c.
primitive c. .

primordial villi
primodial c. . primitive c.
shaggy c. . c. frondosum
smooth c. . c. laeve
villous c. . c. frondosum
chorionepithelioma . choriocarcinoma
chorionic - .
chorioplacental - .
chorioptic . chorioptes
chorioretinal - .
chorioretinitis .
. retinochoroiditis
c. sclopetaria
.

toxoplasmic c.
.

.
ocular toxoplasmosis, toxoplasmic retinochoroiditis
chorioretinopathy .
choristoblastoma .
.
choristoma
choristoma . aberrant rest,
choristoblastoma, heterotopia, heterotopic tissue
choroid . . chorioid,
chorioidea, choroidea
choroidal - .

choroidea . choroid
choroidectomy
.
choroideremia .

. progressive tapetochoroidal dystrophy
choroiditis .
uveal tract
acute diffuse serous c.
. ()

() -
-
anterior c. .
areolar c. .

. Frsters c.
or disease
areolar central c. . areolar c.
central c. .
diffuse c. .
disseminated c.
.
Doynes familial honeycombed c.
.

. Doynes familial colloid degeneration, Doynes honeycombed degeneration
exudative c. .

focal c. .
Frsters c. .
. areolar c., areolar central c.
c. guttata senilis
.

. Tays c.
juxtapapillary c.
.
macular c. .
metastatic c. .

,
senile macular exudative c.
.
. disciform macular degeneration
c. serosa .
. glaucoma
suppurative c.
.
Tays c. . . c.
guttata senilis, Tays disease
choroidocyclitis .
choroidoiritis
.
choroidopathy . choroiditis
choroidoretinitis . chorioretinitis
Chotzens syndrome .

. acrocephalosyndactyly type III, Saethre-Chotzen syndrome
Christensen-Krabbe disease
- . . Alpers disease
Christians disease (syndrome) (
) .

()
. Hand-Schuller-Christian
disease, chronic idiopathic xanthomatosis
Christian-Weber disease .

. relapsing febrile nodular
nonsuppurative panniculitis
Christmas disease (factor) ()
.
. hemophilia B
Christ-Siemens-Touraine syndrome
-- . .
anhidrotic ectodermal dysplasia
chrom(o)-
chromaffin .
. chromaphil, pheochrome
chromaffinity
.
chromaffinoma
. pheochromocytoma
medullary c. . pheochromocytoma
chromaffinopathy .
chromaphil . chromaffin
chromargentaffin .

chromat(o)-
chromate . .
. -
.
chromatic . - .
. - .
chromatid .

chromatin .
;
sex c. .
Barr body
chromatinic - .
chromatin-negative - .
chromatin-positive - .
chromatism .
chromatize
.
chromatocinesis
. .
chromatokinesis
chromatogenous -, - .
chromatogram ,
.-.
chromatograph , .
chromatographic - .
chromatography .

adsorption c. .
-
affinity c. .
column c. .
gas c. (GC) .
( =
gas-solid = gasliquid)
gas-liquid c. (GLC) gas c.
gas-solid c. (GSC) gas c.
gel-filtration c.
.
.
gel-permeation c., molecular exclusion
c., molecular sieve c.
gel-permeation c. . gel-filtration
c., molecular exclusion c., molecular
sieve c.
high-performance liquid c.
.
. high-pressure liquid c. (HPLC)
high-pressure liquid c. (HPLC)
. . highperformance liquid c.
ion exchange c.
.
ion exchange resin;
aqueous buffer solution
degree of ionization
492
liquid-liquid c.
- .

partition coefficients
. partition c.
molecular exclusion c. . molecular
sieve c., gel-filtration c.
molecular sieve c. . molecular exclusion c., gel-filtration c.
paper c. .

partition c. . liquid-liquid c.
thin-layer c. (TLC)
.

chromatoid - .
chromatokinesis . .
chromatocinesis
chromatology .
chromatolysis .
Nissl (chromaphil) bodies ,
,
(axon reaction)
chromatometer . . chromatoptometer, chromometer, chromoptometer
chromatopectic - . . chromopectic
chromatopexis .
chromatophagus .
chromatophil .
chromatophile . . chromatophil
. - .
chromatophilia .
chromatophilic - . . chromatophilous
chromatophilous . chromatophilic
chromatophore .

chromatophorotropic -
.
chromatoplasm
.
chromatopsia .
chromatoptometer . chromatometer
chromatoptometry
.
chromatoscope .
chromatoscopy . .
. .

gastric c.

.
chromatoskiameter .
chromatotaxis
.
chromatotropism
.
chromaturia .
-chrome
chromesthesia - . photism
chromhidrosis . .
chromidrosis
chromic acid .

chromic - .
c. chloride .

c. phosphate P32
.

chromicize
.
chromidrosis . chromhidrosis
chromium (Cr) .

.
.;
;

;

;

Chromobacterium .

chromoblast .
chromoblastomycosis
.
Phialophora verrucosa, Fonsecaea
pedrosoi, F. compactum, Cladosporium
carrionii /
chromocholoscopy
.
chromoclastogenic -
.
chromocystoscopy
.

.
cystochromoscopy
chromocystoscopy
.

chromocyte .
chromodacryorrhea
.
chromodiagnosis . ()
()
chromocholoscopy ()
chromogen . ()
()
chromogenesis .
chromogenic - .
. chromoparic
chromolipoid .

. lipochrome
chromometer . . chromatometer, colorimeter
chromomycosis . chromoblastomycosis
chromone . coumarin
chromoparic - .
. chromogenic
chromopectic - . .
chromopexic chromopexy
chromopexic . chromopectic
chromopexy .
chromophage . pigmentophage
chromophil ,
. . chromophile

chromophile .
. . chromophil
. - . . chromophilic,
chromophilous
chromophilic . chromophile
, chromophilous
chromophilous . chromophile
, chromophilic
chromophobe
.
chromophobia .
chromophore .
. color radical
chromophoric . - .
. - .
chromophorous . chromophoric
chromophose .
chromophototherapy . chromotherapy
chromoplasm . chromatin
chromoplast .
. chromoplastid
chromoplastid . chromoplast
chromoprotein .
chromopsia . chromatopsia
chromoptometer . chromatoptometer
chromoretinography
.
chromorhinorrhea .
chromoscope . chromatoscope
chromoscopy . chromatoscopy
chromosomal - .
chromosome . ()

;

XX XY
()

chromospermism .
chromotherapy
. . beam therapy
chromotoxic - .
chromotrichia .
chromotrichial - .
chromotropic -, - .
chron(o)-
chronic .
chronicity .
chronobiologic, chronobiological .
chronobiologist .
chronobiology .
chronognosis
.
chronograph
.
chronometry .
chronophobia .
.-.

. prison neurosis
chronophotograph
.
chronoscope .

chronotaraxis .

chronotherapy .

chronotropic - .
chronotropism .

chrotoplast .
chrys(o)-
chrysalis .
Chrysanthemum .
Compositae
;
chrysene .

chrysiasis .

. auriasis
chrysoderma .

. aurochromoderma
Chrysomyia .
Calliphoridae
;

(cutaneous myiasis)
Chrysops .
Tabanidae
494
C. cecutiens . .
C. dimidiata . .

Loa loa
mango fly, mangrove fly
C. discalis . .

deer fly
C. silacea . .
Loa loa
Chrysosporium .
Fungi Imperfecti
Hyphomycetes
dermatophytosis
chrysotherapy .
. aurotherapy
chrysotile .

,

Chrysozona .
Tabanidae

, ,
, anaplasmosis,
. Haematopota
Churg-Strauss syndrome
- .

. allergic granulomatosis, allergic granulomatous angiitis, Churg-Strauss vasculitis
Chvosteks sign .

. ChvostekWeiss sign, Schultzes sign, SchultzeChvostek sign
Chvostek-Weiss sign . Chvosteks
sign
chylangioma .
chylaqueous -
.
chyle . ()

( )
()

chylectasia .
chylemia .
chylifacient - .
. chylopoietic
chylifaction .
. chylopoiesis
chylifactive . chylifacient, chylopoietic
chyliferous . -
. . chylopoietic; . -
.
chylification . chylopoiesis
chyliform . .
chyloid
chylocele .
.
elephantiasis scroti
chylocyst . cisterna chili
chyloderma
. . elephantiasis
chyloid . chyliform
chylology .
chylomediastinum
.
chylomicrograph .
(
)
chylomicron .

chylomicronemia
. . hyperchylomicronemia
chylopericarditis
.
chylopericardium
.
chyloperitoneum
. . chyliform ascites
chylophoric . chyliferous

chylopleura
. . chylothorax
chylopneumothorax
.
chylopoiesis .
. chylifaction, chylification
chylopoietic - .
. chylifacient, chylifactive
chylorrhea . ()

; ()
chylosis .

chylothorax
.
congenital c.
.
;
traumatic c.
.

chylous - .
chyluria
.

. chylous urine
chylus . chyle
chymase .

chyme .
.
chymus
chymification .
chymopapain .

(
)
chymorrhea .
chymous - .
chymus . chyme
Ciaccios glands . glandulae
lacrimales accessoriae
Ciaccios method .
. Ciaccios stain
cibisotome . cystitome
cicatrectomy .
cicatrices cicatrix
cicatricial - .
cicatricotomy .
cicatrix .
filtering c. .
hypertrophic c. .
vicious c. .

cicatrizant .
cicatrization . .
scarring
cicatrize .
ciclopiroxolamine .

Cicuta .
Umbelliferae

cicutoxin .
Cicuta
-cide ,
cidofovir .
ciguatera .
ciguatoxin .

pretoxin
(Gambierdiscus toxicus)
cilastatin sodium .

cili(o)- ,
cilia . .
. .

ciliariscope .
ciliarotomy .
ciliary . - .
. - .
ciliate . -, - .
. .
Ciliophora . ciliophoran
ciliated - .
ciliectomy . .
. .
ciliogenesis , .
Ciliophora .

ciliophoran .
.-.
. ciliate
cilioretinal - .
cilioscleral -
.
ciliospinal - .
ciliotomy .
cilium cilia
cillo . . cillosis
cillosis . cillo
cilostazol .

( )

cimbia .
cimetidine .
()
cimex .
-

Cimex
lectularius, C. hemipterus
Cimex .
Cimicidae
cimicid .
Cimicidae
Cimicidae .
Heteroptera ;
Cimex,
Haematosiphon, Leptocimex,
Oeciacus
Cimicifuga .
Ranunculaceae
C. racemosa (L.) Nutt . black snakeroot cohosh
cimicosis .
cinching .
cinchona . () Cin-
496
chona ()
Cinchona

. calisaya
bark, cinchona bark, Jesuits bark, Peruvian bark, quinquina
Cinchona .
Rubiaceae
cinchonine .

cinchoninic acid .
-
cinchonism .

cinclisis .

cinconidine .

cine-
kinecineangiocardiography
.
cineangiograph
.
cineangiography
.
cinedensigraphy
.
cinefluorography
. cineradiography, cinematography
cinematics . kinematics
cinematization . kineplasty
cinematography . cineradiography,
cinefluorography, cinematoradiography
cinematoradiography . cineradiography
cinemicrography
.
cineol . eucalyptol
cinepazetmaleate .

cinephlebography
.
cineplastics . cineplasty, kinematics,

kineplasty
cineplasty . kineplasty
cineradiofluorography . cineradiography
cineradiography . cinefluorography,
cinematography, cinematoradiography
cinerea .
cinereal -
.
cineritous -, - .
cinesalgia .
cinesi- kinesicinet(o)- kinet(o)cineurography
.
cingula cingulum
cingulate - .
cingule . . cingulum
, girdle
cingulectomy
.
cingulotomy
.
cingulum . () . cingule,
girdle ()
cingulate
hippocampal gyri ()

. basal ridge,
linguocervical ridge, linguogingival
ridge
cingulumotomy . cingulotomy
cinnamaldehyde .

cinnamene . styrene
cinnamol . styrene
Cinnamomum .

Lauraceae C. camphora
; C. loureirii, C.
cassia C. zeylanicum
cinnamon . ()
Cinnamomum; ()
C. loureirii
cinnarizine .

cinology . kinesiology
cinometer . kinesimeter
cinoplasm . kenetoplasm
cinoxacin .

cinoxate .
Cionella .
Cionellidae
Dicrocoelium dendriticum
Cionellidae .
Cionella
ciprofibrate .

ciprofloxacin .

, ,
circadian - .
(circadian rhythm)
circannual - .

circellus . . circlet
circinate . - .
. - .
circle , , .
circlet . circellus
circling .

circuit .
short c. . () ()
circular -, - .
circulation . .
. .
circulatory . - .
. - .
. - . sanguiferous
circulus , .
circum- ,
circumanal . . perianal
circumarticular .
circumaxillary .
circumbulbar .
circumcallosal (
) .
circumcise
.
circumcision .
.
. .
. .
female c.
female c. . circumcision

pharaonic c. .
.
. .
sunna c. .
circumcorneal .
circumcrescent
.
circumduction
.
circumference .
.;
articular c. .
. circumferentia
articularis
midarm c., mid upper arm c.
.
circumferentia . circumference
circumferential - .
circumflex .
circumflexus . .
. . circumflex
circumgemmal .
circuminsular
(
) .
circumintestinal .
circumlental .
circumnuclear .
circumocular .
circumoral . . perioral
circumorbital .
circumrenal .
circumscribed - .
circumscriptus . circumscribed
circumstantiality .

(obsessive-compulsive disorder)
circumvallate .
circumvascular
.
circumventricular
.
circumvolute .
cirrhogenous -
.
cirrhonosus .
cirrhosis .
; cirrhosis
.-.
Lannec
acholangic biliary c.
.

acute juvenile c.
.

. chronic active
hepatitis
alcoholic c. .

atrophic c. .
biliary c. .

;

biliary c. of children
.

. infantile liver
primary biliary c.
.

;

;

,

,

secondary biliary c.
.

calculus c. .
498
cardiac c. .
Charcots c. . primary biliary c.

congestive c. .

Cruveilhier-Baumgarten c.
- .

;

. CruveilhierBaumgartens syndrome
decompensated c.
.
fatty c. .

Lannecs c. .

c. of liver .
;

. chronic interstitial hepatitis
macronodular c. .

;

. multilobular c.,
periportal c., postnecrotic c., toxic c.
malarial c. .

metabolic c.
.

multilobular c. . macronodular c.
periportal c. . macronodular c.
pigment c., pigmentary c.
.
;
pipestem c.
.

portal c. . Lannecs c.
posthepatitic c.
.
postnecrotic c. . macronodular c.
stasis c. . Budd-Chiari syndrome,
cardiac c., veno-occlusive disease
syphilitic c. .

Todds c. . primary biliary c.
toxic c. . macronodular c.
unilobular c. . primary biliary c.
vascular c. .

cirrhotic .
cirri cirrus
cirrus .

,

cirs(o)-
cirsenchysis .
(sclerotherapy)
cirsocele . varicocele
cirsoid . varicoid
cirsomphalos . caput medusae
cirsophthalmia
.
cisapride .

,
;

cisatracurium besylate
.
cisplatin .

;
Cissampelos .
Menispermaceae; C. capensis
; C.
pareira L.

cistern, cisterna .
cisterna chyli
cisternae cisterna
cisternal - .
cisternographic -
.
cisternography .
cistron .

citalopram hydrobromide
. selective serotonin reuptake inhibitor (SSRI)
citelli syndrome .
citrate .
citrate (Si)-synthase - .
citrate cleavage enzyme

. . ATP citrate lyase
citreoviridin .
Penicillium citreoviride
citric acid . ()
(citrus fruits)
()
citrinin . Aspergillus ochraceus, Penicillium citrinum

;
Citrobacter .

Enterobacteriaceae

Citromyces . Penicillium
citrulline .
citrullinemia . ()
()
citrullinuria . ()
()
Citrus . Rutaceae

citta, cittosis .

Civatte bodies
.
. colloid bodies
Civininis ligament, process (spine)

ligamentum pterygospinale processus pterygospinosus
cladiosis .
cladosporiosis .

Cladosporium .
Fungi Imperfecti
Hyphomycetes Dematiaceae
acropetal conidia
Cladothrix .
Actinomyces, Bacterionema, Nocardia, Sphaerotilus,
Streptomyces
cladribine . 2chlorodeoxyadenosine

clairvoyance .
clamp , , . ()
()
()
clamping .

clanging .

clap .
clapotage, clapotement
.
claquement , ,
.
c. douverture (
) . . opening snap
clarificant .
clarification .
clarify .
clarithromycin .

.-.
Helicobacter pylori
clasmatocyte .
clasmatosis .
clasp . .
. .
class . .
. .

classic . , (first
class), (first rank),
classification .
-clast ,
clastic . - .
. - .
clastogenic - .
clastothrix . trichorrhexis nodosa

clathrate . .
. .
. - .
clathrin . ,

claudicant . - . .
claudicatory
. - .
. -
.
claudication . . lameness, limping
intermittent c. .

500

. angina cruris, Charcots
syndrome
jaw c. .
neurogenic c.
.

venous c. .
claudicatory . claudicant

claustra claustrum
claustral - .
claustrophobia .

claustrum .
()

. c. of insula
clausura . . atresia
clava . tuberculum gracile
clavacin . patulin
claval clava .
clavate . () . claval ()
Claviceps .
Clavicipitaceae
; C. purpurea
ergotism
Clavicipitaceae .
Clavicipitales
clavicle .

.
clavicula, collar bone
clavicotomy .
clavicula . clavicle
clavicular - .
claviculus .
claviformin . patulin
clavipectoral -
.
clavulanate potassium
.

clavus .

. corn
claw .
. unguiculus
cats c. . Uncaria
tomentosa

devils c. . Harpagophytum
procumbens

( )
clawfoot . . gampsodactyly
clawhand .

. main en
griffe
clay .
China c. . kaolin
clear , .
clearance . ()
; ()

()
clearer .
cleavage
.
complete c., holoblastic c.

. . total c.
incomplete c.
. . meroblastic c., partial
c.
latitudinal c.
.
meroblastic c., partial c. . incomplete c.
total c. . complete c., holoblastic
c.
cleft . ()
()

cleid(o)-
cleidagra
.
cleidal - .
cleidarthritis
.
cleidocostal - .
cleidocranial - .
cleidomastoid -
.
cleidotomy .
cleisagra . cleidagra
clemastine .
(
)
c. fumarate .
(
)
Clematis .
Ranunculaceae ranunculin

clemizole .

clenching . .

bruxism
. (.) .
click .
midsystolic c.
.

mitral c. . . mitral opening snap

clicking .
clid(o)- . cleid(o)climacteric .
()
()

climacterium . climacteric
c. praecox
.
climatology .

climatotherapeutics .

. climatotherapy
climatotherapy . climatotherapeutics
climax .
(crisis), (orgasm)
climograph .
clinarthrosis .
clindamycin .

clinic . . /
. .
;
. .
. .

clinical . - .
. -, - .
clinician , .
clinicogenetic -
.
clinicopathologic - .

clinocephalism
.
. clinocephaly
clinocephaly . clinocephalism
clinodactylism . .
clinodactyly
clinodactyly . clinodactylism
clinography
.

clinoid -, - .
clinostatic - .
clinostatism .
clinotherapy ,
.
clip .

cliseometer
.
clition
.
Clitocybe .
Agaricaceae
clitoral - .
clitorectomy . . clitoridectomy
clitoridauxe . .
.-.
clitorimegaly
clitoridean . clitoral
clitoridectomy . clitorectomy
clitoriditis . . clitoritis
clitoridotomy .
clitorimegaly . clitoridauxe, clitorism
, clitoromegaly,
macroclitoris
clitoris .
;
clitorism . . .
clitorimegaly
.
.
clitoritis . clitoriditis
clitoromegaly . clitorimegaly
clitoroplasty .
clitorotomy . .
clitoridotomy
clival - .
clivography
.
clivus .
cloaca () .

()

()
cloacal - .
cloacitis .
cloacogenic -
.
clobazam .

clobetasol propionate
.

clobetasone butyrate
.
502

clock .
biological c. .

clocortolone pivalate
.
clodronate disodium
.

clodronic acid .
clofazimine .
clofibrate .

clomiphene citrate .

clomipramine hydrochloride
.

, , bulimia nervosa

clonal - .
clonality
.
clonazepam .

Lennox-Gastaut,

()

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.-.

Ethics and Research in Humans

Health Research System for Sustainable Health

Measuring Catastrophic Health Expenditures

Capacity-building for Health Policy and System

Assessment of Primary Care in Thailand from the

Exercise Behavior among Type-2 Diabetic Patients

Health Research Expenditures of the Health Systems Research Institute

Factors Influencing the Retention of Medical

Reviewing the Literature on Governance in Health

Competency Assessment of Personnel of Chiang

Mutiple Logistic Regression with Odds Ratio

The Pros and Cons of Ozone

The Prototype of Arabic Numerals

Residential Radon Exposure and Lung Cancer: A

The Royal Institutes Medical Dictionary Committee

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

shellfish poisoning amnesic shellfish poisoning.

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

The Etiology of Human Aggression Art as

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

The Etiology of Human Aggression

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

(Agreement on Trade-related Aspects of Intellectual

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

. Messerlin TA. Trade, drugs, and health-care services. Lancet 2005;

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

December 2006. Geneva: UNAIDS.

Health Research System for Sustainable

*Health Systems Research Institute, Ministry of Public Health, Thailand.

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

funding agencies. However, overall development of

espite impressive success in health system de

before getting approval from the Bureau of Budget

system. This paper is prepared as one of five country

2. Present situation of health research

2.1 Leadership and governance

Table 1 Main characteristics of TRF, HSRI and NSTDA

A specific PhD grant program & empowerment of

Empowerment of researchers through participatory

Training and providing

Journal of Health Systems Research

Vol. 2 No. 3 Jul.-Sep. 2008

TRF is not allowed, by its law, to conduct research by

tion to their own research budget which is strongly

Figure 1 Institutional arrangement of the health research system in Thailand

* At the moment, there is an organization under the Department of

Calculation based on health budget in the 2008 fiscal year = 141,833

Journal of Health Systems Research