Development of a Health Education Modification Program Regarding Liver Flukes and Cholangiocarcinoma in High Risk Areas of Nakhon Ratchasima Province Using Self-Efficacy and Motivation Theory.

A quasi-experimental study was conducted to develop a health education modification program based on self-efficacy and motivation regarding liver flukes and cholangiocarcinoma development in Keang Sanam Nang district, Nakhon Ratchasima province, Thailand. A total of 36 individuals were invited to participate in the program and were screened for population at risk of liver fluke infection and cholangiocarcinoma using SUT-OV-001 and SUT-CCA-001. Development of health education modification program regarding liver fluke and cholangiocarcinoma prevention included 3 steps: (1) preparation, (2) health education program, and (3) follow-up and evaluation. The study was implemented for 10 weeks. Pre-and-post-test knowledge was measured with questionnaires, Kuder-Richardson-20: KR-20 = 0.718,and Cronbach's Alpha Coefficient = 0.724 and 0.716 for perception and outcome expectation questionnaires. Paired and independent t-tests were applied for data analysis. The majority of the participants were female (55.6%), aged between ≤50 and 60 years old (36.1%), married (86.1%), education level of primary school (63.9%), agricultural occupation (80.6%), and income <4,000 Baht (44.4%). The results revealed that after the health education program, the experimental group had a mean score of knowledge, perception, and outcome expectation regarding liver fluke and cholangiocarcinoma prevention significantly higher than before participation and in the control group. In conclusion, this successful health education modification program for liver fluke and cholangiocarcinoma, therefore may useful for further work behavior modification in other epidemic areas.

Lipid Accumulation Product and Index of Central Lipid Distributions for Subclinical Atherosclerosis in Perimenopausal/Menopausal Women.

Background: Lipid accumulation product (LAP) is a novel biomarker of central lipid accumulation related to the risk of diabetes and cardiovascular disease (CVD). Consistent with physiologic observations, an alternative index uses waist circumference (WC) and fasting triglycerides (TG) concentrations to describe lipid over accumulation. Objective: Explore the association of LAP with anthropometric parameters and subclinical atherosclerosis in perimenopausal/menopausal women with no evidence of established CVD. Objective: Explore the association of LAP with anthropometric parameters and subclinical atherosclerosis in perimenopausal/menopausal women with no evidence of established CVD. Material and Method: The study was an observational cross-sectional study and included 130 perimenopausal/menopausal participants. The anthropometric parameters used were height, weight, and WC. Laboratory lipid profile and LAP were calculated. High-resolution B-mode ultrasonography was performed to measure carotid intima media thickness (CIMT) and to search for carotid atherosclerosis. Results: One hundred thirty perimenopausal/menopausal women were studied. About 22.3% had an abnormal CIMT. The percentages of normal weight, generalized obesity, and central obesity among study participants were 30.7%, 14.0%, and 55.3%, respectively. LAP was not correlated with CIMT and atherosclerosis. WC and waist-hip ratio (WHR) were correlated with CIMT but were not correlated with atherosclerosis. The other parameters of LAP and body mass index were not predictive of carotid atherosclerosis. Systolic blood pressure, diastolic blood pressure, fasting blood sugar, TG, and highdensity lipoprotein cholesterol were higher with LAP equal or greater than 34.5 than with LAP lower than 34.5. However, CIMT was not statistically different between the two LAP groups (p = 0.99). Conclusion: Central lipid distribution in perimenopausal/menopausal women using anthropometric phenotype WC and WHR was correlated with higher CIMT values. Both LAP index and anthropometric phenotype were not helpful for identifying subclinical atherosclerosis defined by CIMT measurement equal or greater than 0.9 mm.

Psychometric Properties of Depression Anxiety and Stress in Preclinical Medical Students.

Background: Medical education and learning outcomes might adversely affect students' mental health in all axes depression, anxiety, and stress. Faculty has a concern regarding the mental well-being of the medical students. Objective: Explore the prevalence of depressive anxiety and stress symptoms, ways of coping, and their relationships to variables among preclinical medical students. Material and Method: A cross-sectional, observational study was conducted in preclinical medical students, Suranaree University of Technology in March 2015. Two hundred thirty medical students (First, second, and third year students) were included and then completed the Self-administered questionnaire, The Depression Anxiety Stress Scale-21 (DASS-21) is a quantitatively measured for distress along the three axes of depression, anxiety, and stress. Results: At the beginning of the study, 230 students enrolled in the study (43.2% male). The overall response rate among medical students was 92.61% (213/230). The prevalence of mild to moderate degree in depression, anxiety, and stress level was 9.4%, 22.5%, and 5.6%, respectively while the prevalence of severe to extremely severe degree in depression, anxiety, and stress level was 0.9%, 3.2%, and 0%, respectively. The second-year medical students exhibited the highest percentage of depression, anxiety, and stress but there was no significant difference among depression, anxiety, and stress between academic year in preclinical medical students. No burnout and suicidal ideation were reported by either males or females. Conclusion: This present indicated that medical students have a low level of depression, anxiety, and stress, however, the data is useful for further planning of prevention in psychometric risks.

Analysis of Risk Areas of Opisthorchis viverrini in Rural Communities by Using SUT-OV-001.

Background: Opisthorchis viverrini is still a serious problem in rural areas of Thailand particularly Northeastern and Northern region. Active surveillance is required to determine the update data for further prevention and control planning. Objective: To determine the population at risk and analyze the risk areas for O. viverrini in rural communities of Nakhon Ratchasima province, Thailand. Material and Method: A cross-sectional survey was conducted between October 2015 and March 2016 at Kang Sanam Nang district, Nakhon Ratchasima province, Thailand. The population at risk for O. viverrini was screened by SUT-OV-001 with Cronbach' alpha coefficient, 0.724. O. viverrini infection was examined by using Kato thick smear. The risk areas were analyzed by using geographic information system. Results: Three hundred ninety seven people were recruited for this study. The majorities were female (53.15%), age group 41 to 50 years old (35.01%), educated with primary school (59.45%), agriculture (85.64%), and of income of 2,000 baht (47.36%). The majorities of them were high-risk (49.62%), followed by moderate risk (36.02%), and low-risk (7.3%). Risk areas were classified as very-high-risk areas, found in Beng Samrong (11.44 km(2)), followed by Keang Sanam Nang (5.21 km(2)). High-risk areas were found in Bueng Phalai sub-district (70.16 km(2)), followed by Bueng Samrong (30.45 km(2)), and Non Samran (27.33 km(2)). O. viverrini infection was 3.02%, and distributed in the moderate risk areas (four cases), high-risk areas (three cases), low-risk areas (three cases), and very-high-risk areas (two cases). Conclusion: The present study indicates the population at risk for O. viverrini and risk areas in the rural communities by using SUT-OV-001 and GIS. These tools are useful to display the risk areas for further prevention and control planning and monitor.

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.