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Objective: Opisthorchis viverrini and cholangiocarcinoma have been recognised by the World Health Organisation as critical public health concerns, particularly in northeastern Thailand, where Opisthorchis viverrini is a significant cause of cholangiocarcinoma. This study examines the factors influencing Opisthorchis viverrini and cholangiocarcinoma prevention within the One Health framework in Kanthararom District, Sisaket Province, Thailand., Methods: A cross-sectional study was conducted among 327 residents aged 20 and above, utilising a structured questionnaire to assess knowledge, attitudes, perceived self-efficacy and prevention behaviours. Data were analysed using descriptive statistics, Pearson's product-moment correlation coefficient and multiple regression analysis to identify relationships and predictors within the dataset., Results: The results showed that 53.52% of participants had moderate knowledge and attitudes towards prevention, while perceived self-efficacy was generally high. Positive correlations were found between income, knowledge, attitudes, self-efficacy and prevention behaviours. Key predictors of Opisthorchis viverrini and cholangiocarcinoma prevention behaviours included attitudes towards human health (β = 0.212), perceived self-efficacy in human health (β = 0.211), attitudes towards animal health (β = 0.205) and knowledge about human health (β = 0.138), accounting for 24.40% of the variance in prevention behaviours. These predictors were statistically significant at 0.05 (F = 25.95; p <0.001)., Conclusion: The findings suggest that enhancing knowledge, attitudes and self-efficacy is crucial to improving Opisthorchis viverrini and cholangiocarcinoma prevention. This study underscores the need for integrated public health strategies incorporating human, animal and environmental health to reduce the prevalence of Opisthorchis viverrini and cholangiocarcinoma in high-risk regions., (© 2024 John Wiley & Sons Ltd.)

Objective: Despite the Ministry of Public Health's initiative to involve local governments in waste management through the establishment of sewage treatment ponds aimed at disrupting the life cycle of Opisthorchis viverrini (OV), the majority of areas still lack adequate sewage treatment facilities. This action research sought to develop an environmental management model (EMM) to prevent OV and cholangiocarcinoma (CCA) in a high-risk region of Thailand., Methods: The study identified two primary target groups: a process development group comprising 20 participants and an evaluation group comprising 32 participants. Research tools involved structured interviews using questionnaires and focus group discussions. Quantitative data were analyzed using descriptive and inferential statistics, with a paired t-test employed for specific comparisons. Qualitative data were examined through content analysis., Results: The findings were categorized into three key aspects: (1) The contextual factors and challenges related to OV and CCA were analyzed using an epidemiologic triangle framework. (2) Model development: The Appreciation-Influence-Control (A-I-C) method facilitated several activities, including knowledge dissemination, raising awareness among local administrators, training environmental surveillance volunteer leaders (ESVL), developing public relations materials, conducting food waste management training, and constructing a sewage treatment system. (3) Model evaluation: Significant improvements (p<0.05) were observed in participants' knowledge, attitudes, behaviors, and health beliefs regarding OV and CCA prevention. The outcome of these efforts led to the creation of a new model, termed the "KALMeFS Model," which comprises K=Knowledge; A=Authority (raising awareness among administrators); L=Leader (establishing ESVLs); Me=Media development; F=Food waste management; and S=Sewage management., Conclusion: The initial steps toward establishing an effective EMM for OV and CCA prevention involved comprehensive planning, knowledge dissemination, standard-setting, and implementation. Monitoring and evaluation are critical to ensuring the long-term success of CCA prevention efforts in Thailand.

Objective: This study aimed to determine the proportion of fruit and vegetable (FV) consumption in regions of Thailand with the highest risk for cholangiocarcinoma (CCA)., Methods: A multi-stage sampling method was employed to recruit participants. One sub-district per district was selected using random sampling. Simple random sampling was used to select individuals based on age range and sex, resulting in a final sample size of 744 participants. Data were collected using a structured questionnaire. FV consumption was assessed through a 24-hour recall interview, recording the types and quantities consumed in three meals. Consumption proportions were calculated by comparing the amounts of each FV consumed. Household consumption units were converted to grams. Descriptive statistics, including number, percentage, mean, and standard deviation, were calculated. The total amount of FV consumed across all meals was compared to the recommended daily intake of ≥400 grams. The prevalence rate of FV consumption was also calculated.  Results: The prevalence rate of FV consumption in Ubon Ratchathani, Thailand, was 11.30 per 100,000 people. The highest frequency of FV consumption was 1-3 days/week, reported by 66.93% of participants. Most respondents (61.43%) exhibited excellent knowledge regarding FV consumption. Similarly, the mean score for attitude regarding the health benefits of FV consumption was 3.10±0.18., Conclusion: This study highlights insufficient FV consumption, associated with the high incidence of CCA, in the studied region. To mitigate the risk of CCA, relevant organizations should implement campaigns to raise awareness about the importance of FV consumption through social media communication and other channels.

Objective: This case-control study sought to explore the social determinants of health (SDH) associated with cholangiocarcinoma (CCA) risk in high-incidence regions of Thailand., Methods: The research was conducted in two phases. Phase 1 assessed the prevalence, context, and conditions among at-risk populations for CCA in Yasothon, located in Northeast Thailand. This phase utilized a survey-based research design, employing verbal screening methods to categorize individuals into risk groups (at-risk vs. not at-risk). Phase 2 aimed to identify the SDH associated with CCA risk through a case-control study. Of 496 recruited participants, 238 cases of subjects were at risk of CCA, and 258 controls were not at risk of CCA. Data were collected using structured questionnaires. Multiple logistic regression was employed to analyze the factors associated with CCA risk., Results: The study revealed that 48.00% of participants were at risk for CCA, with 32.06% having a history of liver fluke eggs detected in their feces. Despite this, only 45.40% of participants engaged in adequate preventive behaviors. Analysis of SDH among the cases identified significant challenges, including high levels of poverty (49.14%), food security (52.22%), social exclusion (48.82%), inadequate housing (50.22%), and overall SDH burden (53.42%). In contrast, relatively lower levels of health inequality (48.78%) and unfavorable working conditions (51.65%) were observed. Multivariate analysis indicated that overall SDH was a significant risk factor for CCA (AOR=1.63; 95% CI: 1.09-2.46), while perceived disease severity (AOR=0.57; 95% CI: 0.39-0.83) and safe working conditions (AOR=0.61; 95% CI: 0.42-0.90) were protective factors., Conclusion: Improving CCA prevention behaviors should focus on enhancing perceived severity and addressing the relevant SDH.

Background and Objective: Genetic polymorphism studies in families and twins indicated the heritability of depression. However, the association between genes with genetic polymorphism and depression provides various findings and remains unclear. Therefore, we conducted a systematic review and meta-analysis to determine the genes with their polymorphism associated with the symptomatic depression known as major depressive disorder (MDD)., Materials and Methods: PubMed and Scopus were searched for relevant studies published before May 22, 2023 (1968-2023), and 62 were selected for this review. The study's bias risk was investigated using the Newcastle-Ottawa scale. Gene functional enrichment analysis was investigated for molecular function (MF) and biological process (BP) and pathways. A meta-analysis of the studied genes that were replicative in the same single nucleotide polymorphism was conducted using a random-effect model., Results: The 49 genes involved in MDD were studied and engaged in several pathways, such as tryptophan metabolism or dopaminergic and serotonergic synapses. Based on gene overlapping in MF and BP, 13 genes with polymorphisms were identified as related to MDD. Most of them were only studied once. Solute carrier family 6 member 4 (SLC6A4) overlapping between MF and BP and brain-derived neurotrophic factor (BDNF) as unique to BP were replicative studied and used in the meta-analysis. The polymorphism of SLC6A4 SS and LS genotypes increased the occurrence of MDD development but not significantly [odd ratio (OR) = 1.39; 95% confidence interval (CI) = 0.87-2.22; P = 0.16 and OR = 1.13; 95% CI = 0.84-1.53; P = 0.42, respectively]. A similar result was observed for BDNF rs6265 GG (OR = 1.26; 95% CI = 0.78-2.06; P = 0.35) and BDNF rs6265 AA genotypes (OR = 1.12; 95% CI = 0.77-1.64; P = 0.56). These studies indicated low bias and significant heterogeneity., Conclusion: At least 13 studied genes with polymorphisms were involved in MDD development according to MF and BP, but not significantly. These results suggest that MDD development risk factors might require genetic and other factors for interaction and induction., (© 2024. The Author(s).)

Background: Health literacy is crucial in managing health outcomes, including overweight, which is a significant issue among late adolescents. Despite the importance of health literacy in weight management, research focusing on this population remains limited., Objective: This study aimed to investigate the factors influencing health literacy in overweight management among late adolescents in Thailand., Methods: A cross-sectional study was conducted with late adolescents from five higher education institutions in Ubon Ratchathani Province, Thailand. A total of 403 participants were selected through multistage random sampling. Self-report questionnaires, validated for reliability and accuracy, were used to collect data from March to May 2023. Multiple regression analysis was employed, with a significance level set at 0.05., Results: The sample consisted predominantly of females (91.10%) with an average age of 20-21 years (54.30%). The prevalence of overweight/obesity among participants was 25.06%. Four factors were significantly associated with health literacy in overweight management: access to health and weight control resources ( r = 0.368, p <0.001), access to online social learning resources ( r = 0.321, p <0.001), access to books, journals, and websites ( r = 0.340, p <0.001), and management of weight control behaviors ( r = 0.145, p <0.001). These factors together accounted for 20% of the variance in health literacy ( R 2 = 0.200)., Conclusion: The study identified key factors that enhance health literacy in overweight management among late adolescents in Thailand. It is recommended that nurses and other healthcare professionals develop targeted interventions focusing on these factors to effectively manage overweight in this population., Competing Interests: The authors declare no potential conflict of interest in this study., (© The Author(s) 2024.)

Background: Despite the national campaigns in 1997 to control Opisthorchis viverrini (OV), a significant risk factor for cholangiocarcinoma (CCA) was accounted for in the northeast of Thailand, which is also considered the highest-risk area for CCA as per the latest national-wide survey in 2019. Social innovations were employed to address OV and CCA issues in this area, but they have yet to be thoroughly investigated. Investigating social innovations in areas where issues can already be solved is a particular approach for expanding on a broad basis., Objective: This study aimed to search for social innovations used to handle OV and CCA in northeast of Thailand., Methods: Researchers coordinated with the Office of Disease Prevention and Control Region-10 (1 of 12 regional offices under the Department of Disease Control, Ministry of Public Health) to specify the model areas for taking OV and CCA. In addition, researchers cooperated with local coordination units for data collection. The data were coded and classified for content analysis, and triangulation was performed for comparative analysis. Finally, a meeting was conducted to summarize the social innovations discovered in each study site area., Results: Our findings have been presented according to the epidemiologic triad: agent (risk factors), host (individuals/communities), and environment. The researchers and experts addressed and proposed social innovations for dealing with OV and CCA, such as the "3 Health" (Health Behaviours, Health Hygiene, and Environmental Health), in order to achieve a CCA-free society., Conclusions: This is the first study to highlight the significance of social innovations in managing OV and CCA. The findings will be utilized to further create strategies for addressing these public health issues in this and other regions in a sustainable and successful manner.

Background: Due to the dramatic rise in overweight and obesity, adolescent weight management interventions are required. Therefore, this study aimed to study the components and the effect size of weight control programs for adolescents with overweight and obese., Materials and Methods: Following the PRISMA 2020 guidelines, we systematically searched electronic databases (PubMed, Google Scholar, ThaiJo, ThaiLis, and Embase) through December 2021 published in English and Thai, samples aged 15-22 years, and presenting the mean, SD a sample size of both experimental and control groups. However, we excluded articles other than full-text articles. In addition, a risk of bias assessment was performed according to the Cochrane Collaboration's quality assessment tool. Finally, this meta-analysis included six studies that met the criteria. The meta-analysis used a fixed-effects model with a forest plot to compute effect sizes and Cochran's Q and I 2 statistics as measures of heterogeneity., Results: We found six primary studies which included 721 overweight adolescents. The analysis of the effectiveness of weight control programs for overweight adolescents revealed that 360 adolescents with overweight and obese (49.93%) who underwent the weight control programs changed body weight and body mass index values with the effect size of -0.80 (-1.03, -0.56) and I 2 was 56.00%., Conclusions: The results indicate further studies should focus on constructing programs that consider adolescents' changes in technology and lifestyles. Additionally, social and mobile tools should motivate and educate adolescents about body weight control to help them adapt to a healthy lifestyle and maintain weight control over time., Competing Interests: Nothing to declare., (Copyright: © 2024 Iranian Journal of Nursing and Midwifery Research.)

Objective: This study aimed to develop a model for promoting fruit and vegetable consumption  in Thailand's high-risk population for cholangiocarcinoma (CCA)., Methods: Action research was used as a guiding framework for model development. Participants were divided into groups for process development and evaluation. Group discussions and practice notes were utilized as tools for process development. Data were collected through questionnaires. Qualitative data were categorized and analyzed using content analysis. Descriptive and inferential statistics were applied to analyze quantitative data., Results: The model development process, following the PAOR framework (Planning, Action, Observation, Reflection), involved fruit and vegetable consumption promotion.  The model, named the "NONGBO NO-CCA Model" included various components: active involvement of villagers in planning, objective sharing of experiences and brainstorming to identify CCA prevention strategies, establishment of networks to support community healthcare, enhancement of community self-reliance through utilization of local resources, and encouragement of chemical-free and environmentally friendly fruit and vegetable cultivation. Following model development, at-risk individuals demonstrated a statistically significant improvement in knowledge, attitude, and practice (p<0.001)., Conclusion: The findings indicate that at-risk individuals exhibited improvements in knowledge, attitude, and practice. Knowledge gains may be attributed to educational training activities, improved attitudes may result from networking processes, and modifications in practice behaviors may be influenced by community participation. Therefore, active involvement in community development can serve as a guiding principle for effective proactive CCA prevention.

Ojective: This participatory action research aims to develop healthy fruit and vegetable juice products (FVPs) to enhance people's income and quality of life (QOL) in a community with the highest prevalence of cholangiocarcinoma (CCA) in Thailand., Methods: We randomly sampled study areas from 25 homes in a Thai community to solve poverty and improve QOL. Descriptive and inferential statistics were employed for data analysis. Moreover, qualitative data were analyzed by content analysis., Results: The community management system relies on local resources under religious inspiration. Academics also keep developing FVPs from local raw materials planted by organic farming under "Nong Lak Rak Sukapab." The product's nutritional value was measured by In-House and Nutrition Labeling Methods from National Food Institute Laboratory (IEC/ISO17025). According to the Bureau of Nutrition, a 230 ml bottle of each wheatgrass and corn juice contains nutrients beneficial to health and necessary for the body. In addition, the community has participated in production planning, marketing, distribution, and household accounting. As a result, average monthly household income and QOL increased with statistical significance after the project implementation.  Conclusions: These findings demonstrated that improving communities' capacity to be health leaders by producing FVPs to prevent CCA in high-risk areas is critical to early disease prevention and community health care. These issues can also be applied to public policy implications for other regions and diseases in order to emphasize community health care and long-term community development.

Background: Dancing is a type of physical activity that has been associated with physical benefits in older adults. Regular dancing can help maintain physical function and improve the quality of life in this population. This review evaluated randomized control trials (RCTs) of the effectiveness of dance programs on the physical function of healthy older adults., Methods: We systematically searched four databases (PubMed, Google Scholar, Embase, and ThaiLis) through December 2021 for primary studies evaluating dance programs in healthy older adults aged 60 years and over. The meta-analysis used a random-effects model to compute the effect sizes using a forest plot and Cochran's Q and I2 statistics as heterogeneity measures., Results: Eight types of dance programs showed significantly improved physical function. Muscle strength was assessed using the five times sit-to-stand test (I2=89%; p=0.003), chair-sit-to-stand-30S test (I2=75%; p=0.006), and 30-s arm curl test (I2=22%; p=0.260). Static balance was evaluated using the Berg-balance scales test (I2=0%; p=0.620) and the one-leg-stand test (I2=32%; p=0.220). Dynamic balance was tested based on the time up-and-go and eight-foot up-and-go tests (I2=51%; p=0.110). Flexibility was assessed based on the back-scratch (I2=56%; p=0.130) and sit-and-reach test (I2=0%; p=0.930)., Conclusion: Dance exercise programs improved muscle strength, balance, and flexibility. Such programs are effective and safe for healthy older adults for use as daily exercise to promote health. Therefore, researchers, healthcare providers, and policymakers should establish properly organized dance interventions to improve physical function in healthy older adults.

Although Opisthorchis viverrini (OV), lifestyle, and diet co-factors have a relatively high prevalence in the Greater Mekong Subregion (GMS) population, cumulative (0-74) incidence rates of cholangiocarcinoma (CCA) do not reach 5% in this region. Other co-factors must influence, but in this study, we only highlighted positive factors for guiding joint planning to address public health problems at the regional level. Therefore, we aimed to study prevalence and factors associated with CCA incidence focusing only on protective factors. A cross-sectional analytic study was carried out from June to October 2017. Participants with informed consent completed the questionnaires. Descriptive statistics were used to analyze general information. Primary variables were classified into high and low levels by mean. Logistic regression was employed to investigate the correlation between interesting variables and the overall risk level of CCA. The overall prevalence of CCA protective factors of the whole region was knowledge (61.39%), health beliefs (42.32%), prevention behavior (31.93%), and community participation (14.53%). When considering the proportions at a high level, they were 49.53%, 53.72%, 35.37%, and 49.67%, respectively. Significant factors associated with CCA prevention were females with secondary or vocational education, a high level of perceived seriousness and benefits, and community participation. These findings are likely to be helpful for both the public and administrators. First, it can be information for people to be aware of CCA risk. Second, policy-driven authorities at the local or regional level should apply the critical issues from this study for joint planning to sustainably solve regional public health problems., Competing Interests: The authors have declared that no competing interests exist.

Introduction/objective: To examine the effects of applying social marketing and Health Belief Model (HBM) in preventing cholangiocarcinoma (CCA) in high-risk areas of Thailand., Methods: About 2 randomized high-risk areas of CCA from multiple-stage sampling were assigned as study areas. The 150 participants were allocated to the experimental group, which received a 12-week health education program that applied social marketing and HBM. The comparison group received the usual services. Data were collected by a questionnaire created by the researchers. We employed descriptive, inferential statistics (paired t -test and independent t -test) for normal distribution, while Analysis of Covariance (ANCOVA) was used for mean scores differing before the experiment., Results: After the experiment, the mean scores of the perceived risk of CCA, perceived severity of CCA, perceived benefits of CCA prevention, perceived barriers to CCA prevention, and correct behaviors of CCA prevention in the experimental group were significantly higher than those before the experiment the .05 level. They were also considerably higher than those of the comparison group at the .05 level., Conclusion: This is the first study to integrate social marketing and HBM for CCA prevention. Therefore, formulating policies or measures to prevent disease through public communication will form a model to avoid CCA and create a channel for distributing useful information to the general public.

Objective: This research aimed to study the effects of the risk communication program through the Cambodian folk song to prevent Opisthorchiasis-linked cholangiocarcinoma (OV-CCA)., Methods: We conducted the quasi-experimental research between August and December 2017 in the Cambodian communities, one-fourth of ethnic minorities residing in multicultural areas of Sisaket Province, Thailand. The samples consisted of 94 equally people divided into experimental group and control group. The experimental group included 47 people at-risk of OV-CCA who received the program for 12 weeks, while the control group received regular services. We collected data by using a questionnaire with a reliability of 0.93. Descriptive and inferential statistics were used for data analysis., Results: The study indicated that the socioeconomic information of both groups was not different. The mean scores of all issues (health beliefs, social support, and prevention behavior in the experimental group were higher than those of the control group with statistical significance. Closer inspection showed that the mean difference of the health beliefs was 55.61 points (95%CI: 52.39-57.42, p<0.001), social support was 9.09 points (95%CI: 8.12-10.05, p<0.001), and prevention behavior was 6.38 points (95%CI: 5.43-7.33, p<0.001)., Conclusion: Through the Cambodian folk song, the risk communication program by applying the health beliefs and social support to prevent OV-CCA is beneficial for behavior modification in areas with similar cultures.

Objective: To study the effectiveness of public health interventions in preventing Opisthorchis viverrini (OV) re-infection in high-prevalence areas of Thailand., Methods: 68 people from Sisaket, the province with the second-highest prevalence in Thailand, who tested positive for OV eggs in faeces and took praziquantel before the start of the study, participated. 34 participants were allocated to the experimental group, which received a 12-week public health intervention based on the self-efficacy theory and group process between July and October 2018. The control group received the usual services. Data were collected using a questionnaire with a reliability of 0.84. Faecal examinations using the formalin-ether concentration technique were conducted before and after the experiment. The re-infection rate was analysed after the experimental 12 weeks and after one year. Descriptive and inferential statistics, including paired t-test and independent t-test, were employed for data analysis., Results: After the experiment, the mean scores of knowledge, perceived self-efficacy, self-efficacy expectation and OV prevention behaviour of the experimental group were significantly higher than before the experiment and also higher than scores of the control group (P < 0.05)., Conclusion: The public health intervention is useful. It educated the experimental group about OV, perceived self-efficacy and self-efficacy expectation in changing behaviour to prevent OV re-infection. As a result, no re-infections were observed after the 12-week intervention nor at the one-year follow-up. Public health benefits will be evident if the results are extended to other high-prevalence areas., (© 2021 John Wiley & Sons Ltd.)

Opisthorchiasis and cholangiocarcinoma (CCA) are major public health problems in Northeast Thailand, especially in Ubon Ratchathani, which are the alluvial plains. Those with poor food habits are mostly at risk of having diseases. This study was a participatory action research (PAR) aimed to define the models/plans for CCA prevention. The samples consisted of 40 community representatives. The data were collected by the PAR method. Qualitative data were analyzed by content analysis. The samples coordinately analyzed and prioritized the problems and presented information to the community. The plans consisted of (1) cultivating the right values and behaviors of eating food safe from CCA in children, (2) supervising the shops not to sell foods that are the main risk factors for CCA, (3) supporting the community leaders to act as good role models to the people, (4) assigning every housewife to cook clean and safe food from CCA, and (5) encouraging the villagers to have knowledge and awareness, which can protect them from CCA. After the community designed these plans, responsible persons were assigned to implement them. Two years later, researchers evaluated the outcome. The average scores on knowledge and attitude toward CCA were significantly higher than before implementation. For the impact of projects, prevalence of opisthorchiasis in 2016 was significantly lower than that in 2014. CCA prevention by community participation employed a combination of quantitative and qualitative studies. This study has been successful and sustainable since the community has human resources, budget, and appropriate management of the project.

Background: Chronic inflammation and repeated infection with Opisthorchis viverrini (O. viverrini) induces intrahepatic cholangiocarcinoma (ICC). Inflammatory cytokines such as interleukin (IL) and tumor necrosis factor (TNF) are substances in the immune system that promote inflammation and causes disease to progress. Genes that help express proinflammatory cytokines can affect an individual's susceptibility to disease, especially in cancer-related chronic inflammation. This study aimed to investigate risk factors for ICC with a focus on opisthorchiasis and polymorphisms of proinflammatory cytokines (IL-1β and TNF-α)., Methods: This study was a nested case-control study within a cohort study. 219 subjects who developed a primary ICC were identified and matched with two non-cancer controls from the same cohort based on sex and age at recruitment (±3 years). An O. viverrini-IgG antibody was assessed using enzyme linked immunosorbent assay. IL-1β and TNF-α polymorphisms were analyzed using a polymerase chain reaction with high resolution melting analysis. Associations between variables and ICC were assessed using conditional logistic regression., Results: Subjects with a high infection intensity had higher risk of ICC than those who had a low level (OR = 2.1; 95% CI: 1.2-3.9). Subjects with all genotypes of TNF-α (GG, GA, AA) and high infection intensity were significantly related to an increased risk of ICC (p < 0.05)., Conclusions: Polymorphisms of IL-1β and TNF-α are not a risk of ICC, but an individual with O. viverrini infection has an effect on all genotypes of the TNF-α gene that might promote ICC. Primary prevention of ICC in high-risk areas is based on efforts to reduce O. viverrini infection.

In northeast Thailand, cholangiocarcinoma (CCA) is a major cause of mortality. Patients with CCA have a poor prognosis and short-term survival. The purpose of this study was to investigate the association between health-related quality of life (HRQOL) and survival time, and to explore whether change in HRQOL score is related to survival among CCA patients. The study was performed between February 2011 and January 2012, and included 171 patients with newly diagnosed CCA from 5 tertiary hospitals in four provinces of northeast Thailand. The HRQOL was measured at baseline, 1 month, and 2 months after diagnosis by the FACT-Hep questionnaire (Thai version 4). The outcome was survival time from diagnosis. Cox's proportional hazard model was used to evaluate the association between HRQOL and survival time. A higher overall score on HRQOL was associated with a significantly better survival (HR per 5 units increase in HRQOL was 0.92, 95% CI: 0.88-0.96). Two of the separate domains contributing to the overall HRQOL-functional well-being and hepatobiliary cancer subscale-were found to have independent effects on survival, even after adjustment for potential confounding variables, and the other domains of HRQOL. CCA patient whose HRQOL scores had improved (≥9 units) at the 1st month of follow up had a reduced probability of dying from the disease (HR: 0.56, 0.32-0.95) after adjustment for the same confounding factors. A positive association between HRQOL at diagnosis and survival time was found. An improvement in HRQOL score in the first months after diagnosis further increases survival., Competing Interests: The authors have declared that no competing interests exist.

Cervical cancer is a major public health problem in Thailand, being ranked second only to breast cancer. Thai women have been reported to have a low rate of cervical cancer screening (27.7% of the 80% goal of WHO). We therefore aimed to apply the social marketing theory and health belief model in promoting cervical cancer screening in Kanthararom District, Sisaket Province. A total of 92 from 974 targeted women aged 3060 years were randomly divided into two groups. The experimental group underwent application of social marketing theory and a health belief model program promoting cervical cancer screening while the control group received normal services. Two research tools were used: (1) application of social marketing theory and health belief model program and (2) questionnaire used to evaluate perceptions of cervical cancer. Descriptive and inferential statistics including paired sample ttest and independent ttest were used to analyze the data. After the program had been used, the mean score of perception of cervical cancer of experimental group was at a higher level (x=4.09; S.D. =0.30), than in the control group (x=3.82; S.D. =0.20) with statistical significance (p<0.001). This research demonstrated an appropriate communication process in behavioral modification to prevent cervical cancer. It can be recommended that this program featuring social marketing and the health belief model be used to promote cervical cancer screening in targeted women and it can be promoted as a guideline for other health services, especially in health promotion and disease prevention.

Wetland geographical areas have a higher incidence of Opisthorchis viverrini-associated cholangiocarcinoma (CCA), confirmed by data from geographic information systems, than other areas. Behavioral data also indicate that people in these areas traditionally eat uncooked freshwater fish dishes, a vehicle for O. viverrini infection. The best approach to reducing CCA incidence is decreasing risk factors together with behavior alteration. Evaluation of CCA risk and its related factors are first needed for planning the prevention and control programs in the future. We therefore aimed to evaluate the CCA risk and explore its related factors among people in wetland communities of Ubon Ratchathani, Thailand. A cross-sectional study was conducted between July and August 2014. In total 906 participants, with informed consent, completed questionnaires. Overall risk of CCA was determined by multiplying odds ratios (ORs) of the risk factors for CCA from literature reviews. A mean score of 5.95 was applied as the cut-off point. Assessment of factors related to overall risk of CCA was accomplished using conditional logistic regression. Of all participants, 60.15% had a high level of the overall risk of CCA. Factors related to the overall risk of CCA were gender (<0.001), marital status (<0.001), perceived susceptibility (p=0.043) and prevention behavior for CCA (<0.001). In conclusion, most participants in this community had a high level of overall risk of CCA. Therefore, integrated prevention and control programs continue to be urgently required.

A high prevalence of Opisthorchis viverrini infection is usually found in wetland geographical areas of Thailand where people have traditional behavior of eating uncooked freshwater fish dishes which results in cholangiocarcinoma (CCA) development. There were several approaches for reducing opisthorchiasis-linked CCA, but the prevalence remains high. To develop community participation as a suitable model for CCA prevention is, firstly, to know what factors are related. We therefore aimed to investigate factors associated with the community participation in CCA prevention among rural residents in wetland areas of Ubon Ratchathani, Thailand. This was a cross-sectional analytic study. All participants were 30-69 years of age, and only one member per house was invited to participate. A total of 906 participants were interviewed and asked to complete questionnaires. Independent variables were socio-demographic parameters, knowledge, health belief and behavior to prevent CCA. The dependent variable was community participation for CCA prevention. Descriptive statistics were computed as number, percentage, mean and standard deviation. Associations were assessed using logistic regression analysis with a P-value <0.05 considered statistically significant. Of all the participants, more than 60% had regularly participated in activities to prevent CCA following health officials advice. Age and health behavior to prevent CCA were factors associated with community participation for CCA (p<0.001). Both factors will be taken into consideration for community participation approaches for CCA prevention through participatory action research (PAR) in future studies.

Objective: Cholangiocarcinoma (CCA) is the most common malignancy in a Northeast Thai population. Smoking and alcohol drinking are associated with the production of free radical intermediates, which can cause several types of DNA lesions. Reduced repair of these DNA lesions would constitute an important risk factor for cancer development. We therefore examined whether polymorphisms in DNA base-excision repair (BER) genes, XRCC1 G399A and OGG1 C326G, were associated with CCA risk and whether they modified the effect of smoking and alcohol drinking in the Thai population., Design: A nested case-control study within the cohort study was conducted: 219 participants with primary CCA were each matched with two non-cancer controls from the same cohort on sex, age at recruitment and the presence/absence of Opisthorchis viverrini eggs in stools. Smoking and alcohol consumption were assessed on recruitment. Polymorphisms in BER genes were analysed using a PCR with high-resolution melting analysis. The associations were assessed using conditional logistic regression., Results: Our results suggest that, in the Thai population, polymorphisms in XRCC1 and OGG1 genes, particularly in combination, are associated with increased susceptibility to CCA, and that their role as modifiers of the effect of smoking and alcohol consumption influences the risk of CCA., Conclusions: Better ways of reducing habitual smoking and alcohol consumption, targeted towards subgroups which are genetically susceptible, are recommended. CCA is a multifactorial disease, and a comprehensive approach is needed for its effective prevention. This approach would also have the additional advantage of reducing the onset of other cancers., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Colorectal cancer (CRC) is one of the most common cancers worldwide. This study aimed to investigate the interaction between the presence of a polymorphism of the XRCC1 gene and known risk factors for colorectal cancer in Thailand., Materials and Methods: A hospital-based case-control study was conducted in Thailand. The participants were 230 histologically confirmed new cases and 230 controls matched by sex and age and recruited from the same hospital. Information about demographic characteristics, life style, and dietary habits was collected using structured interviews, and blood samples were taken which were used for the detection of a homozygous and heterozygous polymorphisms of XRCC1. Associations were assessed using multiple conditional logistic regression., Results: In the univariate analysis, factors found to be significantly associated with an increased risk for CRC were the presence of the XRCC1 AA homozygote (OR= 4.95; 95% CI: 1.99-12.3), a first degree family history of cancer (OR= 1.74; 95% CI: 1.18-2.58), and a high frequency of pork consumption (OR= 1.49; 95% CI: 1.00-2.21). Intakes of fish fruit and vegetables appeared to be protective factors, but the associations were not statistically significant. In the multivariate analysis only the XRCC1 AA homozygote polymorphism and a family history of cancer emerged as risk factors (OR= 4.96; 95% CI: 1.90- 12.95 and OR=1.80; 95% CI: 1.18-2.72, respectively)., Conclusions: While the XRCC1 AA homozygote and a family history of cancer were found to be associated with an increased risk of CRC, none of the dietary intake variables were clearly identified as risk or protective factors. There is a need for further research to determine the reasons for this.

Cholangiocarcinoma (CCA) is a major health problem and cause of death among people in Northeastern Thailand. In this prospective study 171 patients newly diagnosed with CCA by physicians in 5 tertiary hospitals in four provinces of northeastern of Thailand between February and July 2011 were followed up to January 2012. The outcome was survival time from diagnosis to death. A total of 758.4 person-months of follow-up were available. The mortality rate was 16.9 per 100 person-months (95%CI: 14.1-20.1). The median survival time among CCA patients was 4.3 months (95%CI: 3.3-5.1). Cox's proportional hazard model was used to study the independent effects of factors affecting survival time among patients. Statistically significant factors included advanced stage at diagnosis (HR: 2.5, 95%CI: 1.7-3.8), presentation with jaundice (HR: 1.7, 95%CI: 1.1-2.4) or ascites (HR: 2.8, 95%CI: 1.8-4.4), and positive serum carcinoembryonic antigen (HR: 2.3, 95%CI: 1.2-4.3). Patients who had received standard treatment had a better prognosis that those who did not (HR: 0.5, 95%CI: 0.3-0.7).

Background: Cholangiocarcinoma (CCA) is the most common cancer in Northeast Thailand. It is also a crucial health problem for Thai people. Various risk factors for CCA have been identified in the upper part of Northeast Thailand, but no similar studies of risk factors have been conducted in the lower parts of the region. This study aimed to investigate factors associated with CCA in the resident population., Materials and Methods: A hospital-based case-control study was conducted during 2009-2012 with the recruitment of 123 CCA cases and 123 non-CCA patient controls, matched for sex, age and residential area. Information was collected by interview with a structured questionnaire. Blood samples were collected for assays of anti-OV antibodies. Associations between various personal factors, dietary habits, family history, the presence of anti-OV antibodies and CCA were analyzed using multiple conditional logistic regression., Results: Patients who consumed raw meat (beef, pork) and alcoholic beverages ≥3 times per week had a higher risk of CCA than non-consumers (ORadj=4.33; 95%CI=1.14-16.35 and ORadj=2.13; 95%CI=1.00-4.55, respectively). Patients who had a family history of cancer had a higher risk than those who did not (ORadj=4.34; 95%CI=1.80-10.43). Also, patients who had anti-OV antibodies (AU>23.337) had a higher risk than those whose anti-OV antibodies were below the cut-off (AU≤23.34) (ORadj=3.09; 95%CI=1.04-9.16)., Conclusions: As is the case in the upper part of Northeast Thailand, OV infection is a crucial risk factor for CCA in people who live in lower part of the region. Similarly, a family history of cancer and the consumption of alcohol are risk factors for CCA.

Background and Aim: Polymorphisms in methylenetetrahydrofolate reductase (MTHFR) are known to be associated with predisposition for certain cancers. This study aimed to evaluate the effects of lifestyle factors, family history and genetic polymorphisms in MTHFR C677T and A1298C on rectal cancer risk and possible interactions with lifestyle factors in Northeast Thailand., Methods: A hospital-based case-control study was conducted during 2002-2006 with recruitment of 112 rectal cancer cases and 242 non-rectal cancer patient controls. Information was collected using a structured-questionnaire. Blood samples were obtained for assay of MTHFR C677T and A1298C genotypes by polymerase chain reaction with restriction fragment length polymorphism (PCR-RFLP) techniques. Associations between lifestyle factors, family history and genetic polymorphisms v.s. rectal cancer risk were assessed using logistic regression analysis., Results: Subjects with frequent and occasional constipation had a higher risk (OR adj.=14.64; 95%CI=4.28-50.04 and OR adj.=2.15; 95%CI=1.14-4.06), along with those who reported ever having hemorrhoids (OR adj.=2.82; 95%CI=1.36-5.84) or a family history of cancer (OR adj.=1.90; 95%CI=1.06-3.39). Consumption of a high level of pork was also associated with risk (OR adj.=1.82; 95%CI=1.05-3.15). Interactions were not observed between MTHFR and other risk factors., Conclusions: This study suggested that the risk factors for rectal cancer in the Thai population are bowel habits, having had hemorrhoids, a family history of cancer and pork consumption.

Intestinal parasitic infections (IPIs) are still important to the health of Thai rural residents. IPIs are the cause of many chronic diseases with, for example, opisthorchiasis resulting in progression to cholangiocarcinoma (CCA). This cross-sectional study in a prospective cohort study aimed to examine the prevalence and co- infection of intestinal parasites among Northeastern Thai rural residents, recruited into the Khon Kaen Cohort Study (KKCS), and who were residing in areas of high-risk for developing CCA. On recruitment, subjects had completed questionnaires and provided fecal samples for IPI testing using the formalin ethyl acetate concentration technique. Data on selected general characteristics and the results of the fecal tests were analysed. IPI test results were available for 18,900 of cohort subjects, and 38.50% were found to be positive for one or more types of intestinal parasite. The prevalence of Opisthorchis viverrini (O. viverrini) infection was the highest (45.7%), followed by intestinal flukes (31.9%), intestinal nematodes (17.7%), intestinal protozoa (3.02%), and intestinal cestodes (1.69%). The pattern of different infections was similar in all age groups. According to a mapping analysis, a higher CCA burden was correlated with a higher prevalence of O. viverrini and intestinal flukes and a greater intensity of O. viverrini. Both prevention and control programs against liver fluke and other intestinal parasites are needed and should be delivered simultaneously. We can anticipate that the design of future control and prevention programmes will accommodate a more community-orientated and participatory approach.

Opisthorchis viverrini (OV) infection is the major risk factor for cholangiocarcinoma (CCA). Methylenetetrahydrofolate reductase (MTHFR) is an important enzyme in folate metabolism. Change in MTHFR activity may influence both DNA methylation and synthesis, crucial steps in carcinogenesis. This study aimed to investigate the association between MTHFR polymorphisms and OV infection with CCA risk in a high-incidence area of Thailand. A nested case-control study within cohort study was carried out: 219 subjects with primary CCA were matched with two non-cancer controls from the same cohort on sex, age at recruitment and presence/ absence of OV eggs in stool. At the time of recruitment information on consumption of foodstuffs potentially contaminated by OV was obtained by questionnaire. MTHFR polymorphisms were analyzed using PCR with high resolution melting analysis. Associations between variables and the risk of CCA were assessed using conditional logistic regression. Risk of CCA was related to consumption of a dish of raw freshwater fish (Koi- Pla) with clear dose-response effects, and there were joint effects on CCA risk between MTHFR polymorphisms and consumption of dishes containing raw- and/or semi-raw freshwater fish. This study provides evidence to support a relationship of increased susceptibility to CCA in individuals with MTHFR variants, especially for those individuals who have OV infection or consume semi-raw freshwater fish (acting either as a source of OV or of pre-formed nitrosamine). Folate may play an important role in OV-related cholangiocarcinogenesis by upsetting the balance between DNA methylation and synthesis in the folate pathway.

Background: Polymorphisms in methylenetetrahydrofolate reductase (MTHFR), such as MTHFR C677T and A1298C, are associated with several cancers. This study aimed to evaluate the effects of MTHFR polymorphisms on colon cancer risk and possible interactions with environmental factors in a population from northeastern Thailand., Methods: This hospital-based case-control study was conducted during 2002-2006; 130 colon cancer cases and 130 age- and sex-matched controls were enrolled. Information was collected and blood samples were obtained for assay of MTHFR C677T and A1298C polymorphisms by polymerase chain reaction with restriction fragment length polymorphism techniques. Associations between variables of interest and colon cancer were assessed using conditional logistic regression., Results: Increased risk of colon cancer was associated with alcohol consumption and bowel habits. Alcohol drinkers who consumed < or = 0.50 or >0.50 units of alcohol per day had elevated risks (OR(adj) = 3.5; 95% CI: 1.19-10.25 and OR(adj) = 1.71; 95% CI: 0.74-3.96, respectively). The risk was also higher in subjects with frequent constipation (11.69; 2.18-62.79) and occasional constipation (3.43; 1.72-6.82). An interaction was observed between the MTHFR C677T polymorphism and freshwater fish consumption on colon cancer risk (P value for interaction = 0.031). Interactions were observed between the MTHFR A1298C polymorphism and bowel habits, family history of cancer, alcohol consumption, and beef consumption on colon cancer risk (P-value for interaction = 0.0005, 0.007, 0.067, 0.003, respectively)., Conclusions: In a Thai population, colon cancer risk was associated with alcohol and beef consumption, bowel habits, and family history of cancer. Interactions between MTHFR polymorphisms and environmental factors were also observed.

Liver fluke infection of Opisthorchis viverrini (O. viverrini) is closely associated with several hepatobiliary diseases including cholangiocarcinoma (CCA), but no reports have described these diseases in chronic and long-standing experimental opisthorchiasis in hamsters more than 10 months of age. A longer period of infection could induce different pathological lesions. To prove the hypothesis, we therefore sequentially investigated histological changes of the hepatobiliary system in 4 groups of hamsters: O. viverrini infection (OV group) for up to 20 months; O. viverrini infection combined with short-term DMN (OV+DMN group) until 7 months; long-term treatment with DMN (DMN group) to 7 months; and normal controls for up to 20 months. Pathological changes in hamsters of the OV group gradually increased. Induction of CCA in this study was apparent with all three protocols. Importantly, this is the first report of CCA-induction in hamsters solely with long-term opisthorchiasis for up to 20 months. Although the histopathology of CCA in the OV group showed some differences in appearance from the OV+DMN and DMN groups, overall, O. viverrini itself can really induce CCA. In addition, this study confirms the previous studies both in vitro and in vivo on of effects of parasites and their metabolic products inducing cell proliferation, resulting in cholangiocarcinogenesis.