Surveillance of Populations at Risk of Cholangiocarcinoma Development in Rural Communities of Thailand Using the Korat-CCA Verbal Screening Test.

Cholangiocarcinoma (CCA) is a serious problem in Thailand, particularly in the northeastern region. Active surveillance in rural communities with an appropriat low-cost screening tool is required to facilitate early detection. Therefore, this study aimed to investigate the population at risk of CCA in Bua Yai district, Nakhon Ratchasima province, Northeastern Thailand using the Korat-CCA verbal screening test (KCVST) during June to October 2015. Reliability of KCVST demonstrated a Cronbach alpha coefficient=0.75 Stepwise-multiple regression showed that alcohol consumption was important for CCA screened, followed by agriculture and pesticide use, under-cooked cyprinoid fish consumption, praziquantel use, naïve northeastern people, opisthorchiasis, family relatives with CCA, and cholangitis or cholecystitis or gallstones, respectively. Population at risk for CCA was classified to low risk (63.4%), moderate risk (33.7%), and high risk (1.32%) for CCA. When CCA was screened using ultrasonography, 4 of 32 high risk participants had an abnormal biliary tract with dilated bile ducts. This study indicates that KCVST is a potential useful too which decrease the cost of large scale CCA screening.

Nurses and Television as Sources of Information Effecting Behavioral Improvement Regarding Liver Flukes in Nakhon Ratchasima Province, Thailand.

BACKGROUND: Liver fluke infection with Opisthorchis viverrini and its associated cholangiocarcinoma constitute a serious problem in Thailand. Healthy behavior can decrease infection, therefore, the investigation of knowledge, attitude, and practice is need required in high risk areas. OBJECTIVE: This study aimed to investigate the behavior and perceptions regarding liver fluke. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted in Chum Phuang district of Nakhon Ratchasima province, Thailand during July to November 2015. A total 80 participants who had screened with verbal screening test, stool examination, and ultrasonography, were purposive selected and completed a pre-designed questionnaire (Kruder-Richardon-20=0.80, Cronbach's alpha coefficient=0.82 and 0.79). T-test, ANOVA, and Pearson correlation test were used for analyzed data. RESULTS: The results reveal that O. viverrini infection was 1.25%, and 3 patients had a dilated bile ducts. The participants had a high knowledge, attitude, and practice regarding liver fluke. The education, occupation, and income, were statistical significant to attitude regarding liver fluke. Nurses and television were the main sources of information regarding liver fluke, with statistical significance(p-value <0.05). Knowledge was significantly associated with attitude and practice (p-value<0.05). CONCLUSIONS: Participants had good behavior regarding liver fluke. Improvement of knowledge and attitude is influenced to practical change regarding this carcinogenic fluke. In addition, nurse and television are the main information resources for key success in increasing people perception for disease prevention and control in this area.

Distribution of the Population at Risk of Cholangiocarcinoma in Bua Yai District, Nakhon Ratchasima of Thailand Using Google Map.

BACKGROUND: Cholangiocarcinoma (CCA), a major problem of health in Thailand, particularly in Northeastern and Northern regions, is generally incurable and rapidly lethal because of presentation in stage 3 or 4. Early diagnosis of stage 1 and 2 could allow better survival. Therefore, this study aimed to provide a distribution map of populations at risk for CCA in BuaYai district of Nakhon Ratchasima province, Northeast Thailand. MATERIALS AND METHODS: A cross-sectional survey was carried out in 10 sub-districts and 122 villages, during June and November 2015. The populations at risk for CCA were screened using the Korat CCA verbal screening test (KCVST) and then risk areas were displayed by using Google map (GM). RESULTS: A total of 11,435 individuals from a 26,198 population completed the KCVST. The majority had a low score of risk for CCA (1-4 points; 93.3%). High scores with 6, 7 and 8 points accounted for 1.20%, 0.13% and 0.02%. The population at risk was found frequently in sub-district municipalities, followed by sub-district administrative organization and town municipalities, (F=396.220, P-value=0.000). Distribution mapping comprised 11 layers: 1, district; 2, local administrative organization; 3, hospital; 4, KCVST opisthorchiasis; 5, KCVST praziquantel used; 6, KCVST cholelithiasis; 7, KCVST raw fish consumption; 8, KCVST alcohol consumption; 9, KCVST pesticide used; 10, KCVST relative family with CCA; and 11, KCVST naive northeastern people. Geovisual display is now available online. CONCLUSIONS: This study indicated that the population at high risk of CCA in Bua Yai district is low, therefore setting a zero model project is possible. Key success factors for disease prevention and control need further study. GM production is suitable for further CCA surveillance and monitoring of the population with a high risk score in this area.

Re-Examination of Opisthorchis viverrini in Nakhon Ratchasima Province, Northeastern Thailand, Indicates Continued Needs for Health Intervention.

Opisthorchis viverrini infection is associated with cholangiocarcinoma particularly in the cases of chronic or re-infection. This presents a serious health problem in northeastern and northern Thailand. A community base approach is required for surveillance. Therefore, in a pilot project, re-examination of O. viverrini infection was conducted in the 3 districts of Nakhon Ratchasima province, Thailand, during June and October 2015. A total of 355 participants from a 194,152 population, was selected through multi-stage sampling. O. viverrini infection was determined using modified Kato Katz thick smear technique. Participants were 229 males and 126 females, and aged ≥30 years old. Prevalence of O. viverrini infection was 2.25% (8/355 participants). O. viverrini infection was slightly higher in females (3.17%), and age group between 41-50 years (4.49%). Mueang Yang district had a highest of O. viverrini infection rate (2.82%), and followed by Bua Yai (2.48%), and Chum Phuang (1.84%), respectively. O. viverrini infection rate was increased from year 2012 to 2015 particularly in Bua Yai and Mueang Yang. These re-examinion results indicate that opisthorchiasis is still problem in community of Nakhon Ratchasima province, therefore, the provincial-wide scale is need required. Furthermore health education is need intervened in the infected group, and screening of cholangiocarcinoma is urgently concerned.

Helicobacter Species are Possible Risk Factors of Cholangiocarcinoma.

Several infectious agents are considered to be causes of cancer in human, mainly hepatitis B and C viruses, high-risk human pailloma viruses, Helicobacter pylori, Clonorchis sinensis, and Opisthorchis viverrini. Here we described the evident research and the association between Helicobacter spp. and biliary tract cancer particularly cholangiocarcinoma (CCA). Global epidemiological studies have suggested that Helicobacter spp. are possible risk factors for biliary tract diseases. Molecular studies support a linkage of Helicobacter spp. with CCA development. H. pylori, H. bilis, and H. hepaticus, are found in CCA, but the most common species are H. pylori and H. bilis. The type of CCA are associated with Helicobacter spp. include extrahepatic CCA, and common bile duct cancer. Up to the present, however, the results from different regions, materials and methods, sub-sites of cancer, and controls have not been consistent, thus introducing heterogeneity. Therefore, a comparison between co-Helicobacter spp.-CCA in the countries with low and high incident of CCA is required to settle the question. Furthermore, clarifying variation in the role of Helicobacter species in this CCA, including pathogenesis of CCA through enhanced biliary cell inflammation and proliferation, is necessary.

Caffeine Consumption Behaviors of the Working-Age Population in Rural Communities in Northeastern Thailand.

Background: Caffeine use is on the rise among working-age population in Thailand. Little is known about caffeine consumption and potential risk practices of the population group in a rural setting in northeastern Thailand. Objective: Examine caffeine-consumption behaviors (CCB) and contributing factors catering to potential risk practices of CCB pattern among the working-age population. Material and Method: This cross-sectional analytical research study used multi-stage random sampling included 1,321 out of 3,332 working-age participants in rural communities in northeastern Thailand. Data collection used a caffeine consumption survey interview guide and a seven-day-caffeine consumption diary. Data analysis used descriptive and inferential statistics, frequency, percentage, mean, standard deviation, binary logistic regression, odds ratio, and 95% confidence interval (95% CI). Results: The results showed that 39.6% of the working-age population in the rural communities consumed caffeine. Their age ranged from 15 to 59 years with a mean ± SD of 40.2±8.3 years. The woman comprised 49.4% of the group. They consumed caffeine on an average ± SD of 302.5±176.9 mg/day. Sixty-seven point four percent of them were everyday caffeine users. Their caffeine sources were from coffee, energy drinks, chocolate milk, cocoa drinks, carbonated soft drinks, and tea drinks. Their potential "at risk" practices of CCB included excessive consumption of caffeine greater than 300 mg/day (44.7%), frequent consumption of caffeine (67.4%), modification of caffeine consumption method by mixing it with other substances (44.4%), and consumption of caffeine while having illness (29.1%). Income, status in a household, and occupation were factors contributing to "at risk" practices of CCB of this population group (p<0.01-0.05). Conclusion: Rural working-age residents in northeastern Thailand were potentially vulnerable for adverse effects from their "at risk" practices of CCB. Modification solutions for suitable caffeine consumption behavior should be targeted to higher income individuals and household members of certain occupations.

Primary Care Intervention to Prevent and Control Cholangiocarcinoma: Lesson from Nakhon Ratchasima, Thailand.

Background: Cholangiocarcinoma (CCA) is a bile duct cancer. It includes intra-and extra-hepatic bile duct. It is most commonly found in Thailand particularly in the northeast and north region. Those regions have been reported as the highest of incident of the world. Objective: Primary car interven in the risk areas of CCA among population in Nakhon Ratchasima province,Thailand. Material and Method: A community-based study was conducted among three districts of Nakhon Ratchasima province, Thailand including Bua Yai, Chum Phuang, and Mueang Yang district between July and December 2015. Mix method was used in this study that included cross-sectional survey, action research, and application of Geographic Information System. The study was composed of five steps, develop Korat CCA network, CCA screening by using Korat CCA verbal screening test, detection of liver fluke and CCA in the population at risk by using Kato Katz thick smear technique and ultrasonography, health behavior modification, and development of Geographic Information System for CCA database. Results: Three hundred fifty five participants were tested for liver fluke infection and the infection rate was found to be 2.25%. Eight cases from 88 participants at risk had a dilated bile duct. Populations at risk in each district were selected for health modification briefing that used the social engagement model. Seven community rules were agreed, cooked fish consumption, stop under-cooked fish, hygienic defecation, CCA campaign, food safety club, annual health check, an ongoing monitoring by village health volunteer and local public health officer. Conclusion: Infection in Nakhon Ratchasima is high. A community briefing and rules were agreed. A geovisual display of the population at risk for CCA is now available.